Scottish Ambulance Service
AC 01 Ambulance Control Centre Standard Operating Procedure
Rest Break Deployment
To ensure appropriate and effective rest break deployment of Accident &Emergency crews, Specialist Operations Response Teams, Urgent Tier and Air Wing resources. The Ambulance Control Centres will be responsible for the consistent application of this Standard Operating Procedure (SOP) and the effective monitoring and reporting of any incidents which have resulted in crews being interrupted whilst on a rest break.
The Scottish Ambulance Service values the considerable work and effort of all staff. The Service acknowledges that on occasion a delayed or interrupted rest break is unavoidable, but reasonable measures should be in place to reduce such instances while maintaining a clinically safe response to patients.
The Service gives an absolute commitment to provide rest breaks to all staff to whom this agreement applies. The SOP will apply to all A&E operational vehicle crew staff within the Scottish Ambulance Service but will have no wider application to any other staff or workers employed by NHS Scotland, Scottish Health Boards, Special Health Boards or anyone covered by the NHS Terms and Conditions.
It is important that clinical decision making in the ACC is underpinned by sound clinical judgment in the dispatching of ambulances to emergency calls and the decision to ask a crew to respond from a rest break. It is vital that patient safety and crew safety and welfare are balanced in the decision making process. This element of the decision is best made by a combination of human judgment and software assistance. To assist in this process, the following procedure should be followed:
To ensure an appropriate response is maintained to the most time critical patients and major incidents, all staff as listed above will be required to remain available throughout their shift for the following:
Ambulance Control Centres will make every effort to allocate rest breaks at the earliest opportunity when rest break windows open. Crews will be required to comply with allocation of the rest breaks.
When a crew who have not been rested enters the mid point of their rest break window (in accordance with their shift code and window) they will be returned to station for their rest period.
When returning to station for a rest Break and beyond the mid point of their window crews will remain available for MPDS coded ILTs, Amber calls and Major Incidents.
On commencement of an allocated rest break, resources may only be deployed under the following criteria:
MPDS Coded ILT (Purple/Red) calls.
A PRU or alternative resource is not available within a 25 minute response time.
Should there be no PRU or alternative resource available then the call will be passed to the Clinical Service Desk (CSD) and triaged by a Clinical Advisor who will contact the patient within 5 minutes of the call coming into the queue. These calls will then be prioritised appropriately in light of the available clinical information.
Following the clinical advisors assessment it is then deemed to be a time critical call and there is no resource available within 25 minutes the crew will be deployed.
d) If it has not been possible for a Clinical Advisor to review the call within 5 minutes,
the crew will then be deployed.
The following operational considerations should be applied by Ambulance Control Centre’s (A.C.C’s):
Staff will normally return to their home base to take a rest break. However, in exceptional circumstances Ambulance Control centres may on occasion require crews to take their rest break at an alternative suitable location.
These locations must comply with the standards outlined in the social TDP agreements and are agreed in partnership.
Where crews have been disturbed, Ambulance Control Centres have a responsibility to allocate the remainder of the rest period as soon as reasonably practicable and avoid any further disturb if possible.
Crews returning from a lie-in will be allocated a rest break in line with the agreed rest break windows. Those returning from fatigue or compensatory rest will be allocated a rest break commensurate with the entitlement of the remainder of the shift and allocated in line with current arrangements.
Guiding Principles to Assist ACC Dispatchers in applying Rest Break SOP.
All rest breaks have equal priority whether it is the 1st or 2nd. They are all agreed through partnership and identified through the C3 system.
If a crew are split due to skill mix, the dispatcher must advise the crew to call and speak to the supervisor/Duty Manager. The supervisor/Duty Manager should then come to an agreement with the crew on what shift code they will be using to book on (system accepts only 1 code) and the rest break window best suited to both parties.
Any queries/problems with operational colleagues regarding rest breaks should be automatically passed to the performance supervisor to deal with.
Rest Break Windows
The agreed Rest Break windows and permitted length of rest breaks across the country are outlined in Table 1.
Shift Length No of Window Period Period
Breaks Entitlement Lengths
08 Hour 1 3rd& 5th Hour 30 30
10 Hour 1 3rd& 5th Hour 38 38
10 Hour 2 3rd& 5th Hour 38 20
7th &9th Hour 18
12 Hour 1 4th &6 hour or 45 45
5th &7th hour
12 Hour 2 3rd & 5 Hour 45 30 + 15 7th & 9th Hour or 25 + 20