Escalation red flags

These are the "stop what you're doing and get a clinician involved" moments. You are not expected to triage — you are expected to recognise a red flag and pull the cord quickly.

Clinical red flags — in the waiting room or at the desk

Call the radiologist on duty immediately, and call 000 if the patient is deteriorating:

• Acute chest pain or sudden shortness of breath
• Collapse or loss of consciousness
• Severe bleeding
• Severe headache with neck stiffness
• Signs of stroke: face droop, arm weakness, slurred speech (FAST)
• Signs of anaphylaxis — especially within 30 minutes of contrast (hives, swelling, wheeze, throat tightness)
• Seizure

Clinical deterioration after a scan

Any of these after a scan, particularly post-contrast or post-procedure, go straight to the radiologist:

• New severe pain
• Persistent vomiting
• Confusion or disorientation
• Shortness of breath, rash, or facial swelling

Non-clinical but urgent

• A parent can't locate their child
• Visible injury we didn't cause and the patient is distressed
• A threat of harm to self or others
• Police arriving to collect or question a patient
• Media at reception asking about a patient or incident

In all of these, stay calm, be brief, get the office manager and/or clinical lead involved before you say anything on the record.

Booking red flags — on the phone

If a caller describes a symptom that sounds immediately dangerous, don't book them a routine slot:

• Chest pain, shortness of breath → ED now
• FAST-positive stroke signs → ED now, call 000 if it's happening while they're on the line
• Severe headache with neck stiffness, sudden vision loss → ED now
• Signs of sepsis (fever + confusion + shaking) → ED now

"It sounds like something that shouldn't wait for an imaging appointment. Please call your GP today or go to the emergency department — they can organise urgent imaging from there."

Escalation routes

• Radiologist on-call: Jules — 0404 721 750
• Site clinical lead and office manager: see Who to escalate to for the per-site table
• Emergency: 000 (triple zero) — always available, never needs approval

ED now vs GP today vs we can see them

You are not the triage nurse, but knowing the rough distinction helps you direct the caller to the right place without delay:

• ED now — chest pain, stroke signs, anaphylaxis, heavy bleeding, collapse, suspected sepsis. Minutes matter.
• GP today — concerning but not immediately dangerous symptoms that need a clinician's judgement before imaging (e.g. persistent abdominal pain without red flags, new neurological symptoms that aren't acute).
• We can see them — routine imaging on a valid referral, with no red-flag symptoms present today.

If you're unsure which bucket a caller falls into, default upward — send them to their GP or ED rather than booking a slot two weeks out.