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So we called 995 and the ambulance came.

And I think that's one of the most immediate responses, right? Because we are very familiar with 995. But there is actually another option. It's called Nurse First. So that's what we're going to talk about. There's a new helpline called Nurse First so that if you have a non-emergency case and you call up 995, they may divert you to this number who can then address your concerns and point you in the right direction.

direction to get medical help. Yeah, so we are here to learn more about Nurse First. It's actually a six-month trial nationwide. And here with us today, we have Colonel Dr David Fluke, Chief Medical Officer, Singapore Civil Defence Force. Nice to meet everyone.

We also have Dr Jade Kwa, Senior Consultant at Emergency Medicine Department in Woodlands Health and also Clinical Lead for the Nurse First Helpline. Hi guys, thanks for having me here today. Okay, welcome guys. So let's give some people some idea of just...

how crazy the number of calls are, you know, because we were surprised. So SCDF responded to 245,000 calls last year. It's a big number. Yeah, yeah, yeah. A lot, a lot. Which amounts to about 672 calls in a day. Wow. That's a whole lot. David, can you share with us, I mean...

Are all these calls emergency? What's the percentage of them? What are some of the most bizarre calls that you get? Well, I don't think it's so much that they're bizarre. The first thing is to highlight is that there's been a very big difference from just 10 years ago. I mean, 10 years ago, we were seeing about 450 calls per day. And suddenly now it's ramped up to about 670, 680 calls per day.

Of that, of course, there are a lot that definitely require emergency care, but there's a certain percentage and this is about 5 to 10 calls per day which are non-emergency and actually would not benefit from being evacuated to hospitals through the EMS system by SCDF. So you're saying, again, out of

672 calls a day. Roughly 5 to 10 are just non-emergency calls. That's right. What are they calling about? Give us an example. Well, I mean, one example that I've personally faced as an emergency physician at NUH was an elderly lady who called 995 who really needed help because she had ran out of her prescription. Oh.

There was nothing actually wrong with her in terms of her physical health, but she just didn't know where to get the help she needed. So freaking out basically, like just maybe, "Oh no, what should I do next?" Exactly. So what happened was because this program wasn't in place at that time, she was referred and came over to the emergency department and we filled up her prescription. She ended up sitting in the A&E for two, three hours before she's being seen because it's a non-emergency case.

All in all, she didn't really get the appropriate help that she required. Okay. And now that's what we're hoping to address some of these situations where truthfully, she needed some help, but probably just not from the 995 number, right? Okay. So Jade, can you tell us a bit about Nurse First? You know, the idea behind it,

It's supposed to help alleviate some of that burden on the emergency call system, right? And it's been around since 2022, but it was just focused in the northern part of Singapore. So now it's going to be nationwide. So Nurse First is a medical triage helpline. So triage is a concept of sorting out. We help the caller to understand how severe the condition might be and therefore where they should seek help. So this could range from going to the emergency department,

It could range from going to the urgent care center, going to a GP, or simply staying home and doing some self-care. So this is really important work. It needs to be done quickly enough so that the caller can get the right help that they need. But it needs to be safe enough so that the caller knows where to go. So this concept of a medical triage helpline is something that other countries do as well. So this already exists in the UK, in Japan, in Denmark.

And we're very proud to do this now in Singapore. But maybe help us understand how it actually works. So when they call 995, they say, I've got this situation. And then the person...

taking that 995 call will then do the first level of triage, so to speak, as an evaluation, right? Right. So if you were to call the nurse first helpline itself, which is 6262 6262, then our trained nurses would assess what the situation is and through a series of questions, guide you on where to go. Can you give us some examples? Like what kind of questions? So let's take a typical example of chest pain.

So if a caller calls up and says, I have chest pain, then our nurses are trained to ask them a series of questions based on validated protocols and which have professional medical oversight. And they'll ask them some questions to determine that this is not a life-threatening condition. If it were a life-threatening condition, we would say, you should call 995 so that an ambulance can take you to the emergency department.

and then down the line, right? So, other questions that would help them to decide whether they should go to an urgent care centre or whether they can go to a GP or stay home. So, this is the same process whether they come in for chest pain or whether they call and say, "I've got back pain, I've got tummy pain, I've got fever."

And so that's when people call 626-662. Is it a nurse on the other side of the line? That's right. So this is a trained nurse just trained in emergency and telephone triage. And it's very, very safe. And what we're actually piloting this time around, what we're announcing, is our collaboration with 995. So if you were to call 995...

and the 995 dispatcher discovers that this is not a life-threatening emergency, then they would transfer the call to us at Nurse First. So I'm curious to know what has the public reaction been for this pilot, right? They call 995, perhaps expecting ambulance, you know, right at their doorstep, but then didn't happen. You sort of redirected them to Nurse First. What sort of, have you got any, you know, sort of negative feedback or really like irate patients? The EMS system,

provides a certain level of certainty and Singaporeans do expect that. So there is some change management required, but the assurance that we give is this is really safe. We have our own triage systems internally with the Ops Centre. There's also further triage by Nurse First and it's really about making sure that you receive the care that you need that's matched according to your needs.

We expect that it will take some time for Singaporeans to accept this idea of the nurse first. But in general, we do have positive cases and feedback. And for things like, one case I recall is one of a small amount of burns. Because when you burn something, of course, your first reaction if you don't know what to do is to panic and then call 995. But honestly, most burns are very small when you touch like a hot handle or hot pan.

And that was something that Nurse First can provide the reassurance, the advice on the treatment and subsequent care plan. So you're talking about that burn is, like in your press release, you mentioned burns which are like 15%. I mean, to the average person, what is 15%? Yeah, I'm like, how many percent is this? Yeah. And do you have video calls to see like, oh, okay, this is actually a 20% burn or like what sort of?

So this is all very protocolized. The actual protocol is to describe to the person on the other end of the line what is the size in terms of coin size and palm size. And they will just estimate something that they would understand and communicate. And from there, we do the back-end medical processing. That's right. So we want to simply be able to understand what the situation is like through the questions that are on the protocol. And just to answer your question, your palm is 1%. Oh!

Oh, you mean if my whole palm is burned, that's 1%. That's right. Oh, wow. So 15% is like... I would freak out though. My whole arm, maybe, right? Yes. Wow. So just to highlight, if you did feel like something bad is happening and you did feel like you were freaking out, no one's saying that you shouldn't be calling 995. So if you know that you're calling on behalf of your grandpa and your grandpa looks like he's having a heart attack, we're saying it's appropriate.

to call 995. But if you weren't sure, let's say you sprained your ankle and you weren't sure, is this a fracture? Is this a sprain? Should I just put some rubbing ointment on it? Then if you call the Nurses Helpline, our nurses would guide you on where to go. Okay.

If you had called 995, then the 995 call centre would say, okay, this sounds like this is not a life-threatening emergency. We're going to now transfer the call to Nurse First and nurses can take it from there. Why? Because the 995 call centre is so busy and they are highly trained professionals to be able to handle life-threatening situations. But they'll still ask you a few questions to evaluate your situation. Absolutely. Mr Tan, you can actually call Nurse First helpline. They can help you with this.

Well, in this particular situation, what would happen is they would transfer the call to us. I'm going to transfer you to nurse first. That's right. So it makes it easier process for the caller. So nurse first, you had one single operator before this nationwide trial? Two nurses that are manning the line at any point in time, manning the lines. From 8 to 11, is that right? That's right, from 8 to 11. Every day, including weekends, public holidays. I'm sorry, but is that enough? It sounds a bit...

Like, just two? Well, at the moment, it's enough. But we're monitoring the situation carefully. So should we have to upscale the whole operation, we're ready to do that. How does this compare to 1-777? We've heard about that non-emergency number, which you were also supposed to call in a non-emergency situation. Is it the same thing or is it different?

Well, I think in comparison, this is a nurse, a clinician on the other end of the line. They can provide advice not just on the right sighting but also on first aid. Can advise appropriate management on site on what they should do and slightly different from 1-777. That being said, 1-777 is going to be one of our alternate care pathways that can be routed through Nurse First if it's deemed that it's appropriate for that patient. It's more for conveyance, let's put it that way. Whereas,

Nurse First is a medical triage helpline. So we'll be able to help you to decide where to go, how to get there. And if you can stay home, what sort of first aid you should do. What we really want to do is to raise medical literacy in Singapore, right? We want people to be able to figure out what's going on with their bodies, to understand, you know, what kind of medication to take, how to do first aid at home.

for things like burns, but that's super important. We want to make sure that the paramedics who are trained to handle life-threatening situations and the emergency physicians who are trained to handle life-threatening situations are able to do their work efficiently without them seeing maybe the kinds of cases that we better suit for a GP, for instance. But here's one other question. So we have to come back to the operating hours of nurse first.

it ends at 11pm at night. What is the peak hour for emergency calls? Is there like 5 to 7 or like morning time when families are rushing their kids to school? I mean in general when people are up they're busy they're travelling that's when we have a lot of emergency situations occur. So peak hour in the morning? Peak hour is like 7 to 9 and then 5 to 7. That's right. So we tend to see peaks then. We usually have reduced load when it's after dark.

Yes. And we cater manpower for that as well. Okay. So now we're saying after office hours, so called after 11pm, if there's no nurse first hotline to call, what happens then? So the default, of course, 995 is available for everyone 24x7. We have no public holidays off.

Okay, okay, okay. So there'll still be a dress code. Same for us as well, actually. Us in the media as well. No public holidays. Anyone can call you anytime. Yeah, no, I switch off my phone. I remember I read somewhere this guy, he drank three cans of beer and I think he couldn't urinate and then he called up 995, for instance. So Moju, what sort of unusual calls do you get? Or the most recent one you can recall?

I think we... Don't be shy. More critically, to every single patient, their challenge, their medical problem is of course of utmost importance to them. We need to see things from a systems perspective, which means we need to tier our response accordingly. So yes, everyone who feels that their situation is an emergency can call 995, and we need some flexibility which Nurse First provides for us to tier that response accordingly. I'm not saying the example you shouldn't call 995. In fact, if...

Really? I couldn't pass urine. I'd be very worried. I would definitely call 995. But that's because the guy mumbled already. That's why his brain wasn't telling the thing what to do. So give us more examples, right? Like 995 and then versus nurse first. Like headache, toothache. Yeah, actually help us define what is considered an emergency and when is it not considered an emergency. I know it's very hard, but give us some ideas. So,

So, I'll give you an example. So, there was a case where someone was eating crab and then bit down and then subsequently had tooth pain. It's happened to my mom actually, yeah. She lost her tooth. This happens pretty frequently to

to that individual, it's a severe pain and it's extremely uncomfortable. And for sure, it seems like an emergency. But from a medical perspective, from a systems perspective, this would be more appropriate place by giving first aid advice through nurse first and then rerouting to an appropriate dental physician or dental surgeon accordingly. Is the term non-life-threatening an indicator? As in like,

yes, it hurts, but I know I will live to see another day, you know? Yes, I think that's a good term to describe a category of cases, but it's difficult to convey that over the phone to the caller, which is why the nurses are trained to ask certain questions. First of all, to make sure that this isn't a life-threatening emergency. So for your example of someone who calls him with a headache, if this was the person's like the worst headache of their lives, if this was associated with

fever and a scary rash, you know, then we're thinking about big emergencies, then that caller would be led to call 9-9-5 or go to the emergency room. But if it turns out that this was an infrequent headache, this was a typical headache for this patient, usually resolves with some medication, and down the line, it's sort of discovered that this is not something that requires a 9-9-5 ambulance to bring them to an emergency department, then they might say,

Do you know what? Maybe you can wait till morning and go to the GP. I also want to ask you because sometime back I learnt about urgent care centres. You mentioned that briefly but I think a lot of people are not aware that there's an option to visit an urgent care centre which provides almost the same facilities as A&E

for so-called non-life-threatening. So you break your leg, you have a bit into a chilli crab and it's stabbing you, you can go to an urgent care centre for those, right? So why has that also sort of not really taken off? I mean, and is that something that we are still addressing? Should people still be looking at that as an option as well?

If one were to call up nurse first, then our nurses would be trained to guide you towards either going to the urgent care center or GP or staying home. So this is because different centers like the emergency department, the urgent care center, GP, obviously your own home, you're differently equipped, you know, and so you're scoped out to deal with different kinds of conditions. So,

I mean, back to the whole ageing population, right? I would imagine the workload would also increase, right? With the calls. Do you think there are certain other areas that also need to shift? I don't know, like polyclinics, I don't know, opening a bit later or more or like, you know, certain areas that perhaps would be looked into?

Yeah, well, nationally, there's many, many different initiatives that are looking at this piece, which we call as alternate care pathways. Nurse First is one part of that solution. We're working together with a lot of the polyclinics, with a lot of the different ageing centres and things like that to see what we can do to help to bridge different gaps for different populations. And like you rightly pointed out, the ageing population is one of concern.

So we do need to, we're working on that piece and how to better site care for them, particularly in the community because community care of the elderly is well known to have better outcomes than actually care in the hospital. So this is a piece that we hope to explore in the upcoming few years. Yeah.

There's just so many things that we want to educate the public on because we feel like there's so many things that Singaporeans can do to help themselves, to help as caregivers, but maybe they just don't know how to do that. I'm just also curious to know which are some of the countries whose EMS services are excellent and that we can copy bits of it that would be ideal for Singapore's population and all that.

Well, we do actually engage with a lot of other countries to learn lessons from them. But in particular, this Nurse First type solution is one that's been rolled out, I think, in UK, Denmark, Japan, Finland, quite a number of countries with very mature EMS systems. And we are trying to adopt best practices from all these countries. And we are further exploring other parts of other solutions from other countries as well.

So in a nutshell, life-threatening emergency, call 995. But do know that there is a nurse-first option for non-emergency cases, which is 62626262. Right. So those are the two numbers we now need to know. Yeah. If you feel it's an emergency, call 995. If not, call 62626262. You got it.

You know how many 62s there are Just keep dialing 62 Until the line Is picked up by someone You know Alright guys This has been an episode Of Deep Dive Thanks so much for joining us We hope you've Learned something And you now know Who to call In light of that situation Let's give a shout out To our team We have Tiffany Ang Junaini Johari Joanne Chan Sayewin Allison Jenna And also video by Hanida Amin Thank you so much Bye for now