How EMMA Handles Emergency and Red Flag Calls

Purpose of Document

Emergency handling is the single most clinically critical aspect of EMMA's operation. Support staff must be able to explain it accurately to practices, ICBs, and clinicians, respond confidently to media-driven concerns about AI and patient safety, and identify when a clinical safety incident may have occurred. This article provides the complete internal reference.

Background: Red Flag and Sentinel

Red Flag

Red Flag is EMMA's emergency pathway intelligence. It is the most important component of the system and the one that receives the most rigorous clinical oversight and testing.

As of V12 (May 2026), Red Flag has been refined across every language EMMA supports. This work was conducted with QuantumLoop AI's Chief Safety Officer and with direct clinical oversight from Sir David Sloman, former Chief Operating Officer of the NHS and Special Advisor to QuantumLoop AI. No other AI reception platform in UK primary care operates with this depth of clinical oversight.

Red Flag detects emergency symptoms using the full conversation context, not just the most recent message. This means that if a patient mentions a concerning symptom earlier in the conversation and confirms it again later, EMMA correctly identifies it as an emergency presentation across the full call.

This full-context detection was specifically introduced in February 2026, replacing the previous approach which was largely based on the current message only. Before that change, some callers confirming emergency symptoms in follow-up answers were not consistently receiving 999 or 111 guidance.

Sentinel

Sentinel runs continuously in the background throughout every call. It monitors for safety events at any point, not just at the start or during a designated triage step. If a caller mentions a concerning symptom at any point during the conversation, including mid-way through an admin request, Sentinel will identify it and EMMA will respond appropriately.

When EMMA encounters something she cannot confidently process, Sentinel ensures she routes to a clinically safe pathway rather than guessing. This is the foundational safety layer that governs EMMA's behaviour across every call.

How EMMA Responds to Emergency Calls: The Full Flow

Standard emergency presentation

When EMMA detects emergency or red flag symptoms, she does not continue the call as normal. She immediately advises the patient to:

• Call 999 if the situation is a life-threatening emergency
• Call 111 for urgent medical advice if it is serious but not immediately life-threatening

EMMA then gives the patient the option to continue with a form submission or transfer to the surgery, allowing the patient to choose the next step based on their situation.

Patient insists on speaking to surgery staff despite emergency guidance

If a patient insists on being transferred to the surgery after receiving emergency guidance, EMMA transfers the call directly to reception. The patient's safety always takes priority and EMMA never blocks access to a human.

Emergency at capacity

Medical capacity limits do not apply to emergency calls. If the surgery's medical cap has been reached, EMMA still handles emergency presentations in full. Capacity limits only affect non-urgent medical requests. Emergency calls always bypass the capacity check entirely and are transferred to reception regardless of whether the cap has been reached.

Emergency detected mid-call

Sentinel monitors throughout the entire call. If a patient starts the call with an admin request and then mentions emergency symptoms part-way through, EMMA responds to the emergency immediately. The call does not need to have started as a medical call for emergency handling to activate.

Specific High-Risk Scenarios

Chest pain and stroke symptoms

These trigger immediate 999 guidance. EMMA advises the patient to call 999 immediately and does not continue the standard call flow. The patient is given the option to be transferred to the surgery if they wish.

Severe breathing difficulty

Treated as a 999 emergency. Immediate guidance given.

Severe bleeding

Treated as a 999 emergency. Immediate guidance given.

Unwell baby under 12 months

If a parent or carer mentions that a baby under 12 months is unwell, EMMA transfers the call immediately to reception. This is a hard bypass regardless of transfer sensitivity level and is not affected by any configuration setting.

Suicidal ideation and self-harm

This is handled differently from standard red flag calls. When EMMA detects language indicating suicidal ideation or self-harm, she transfers the call directly to the surgery. She does not route the caller through the standard red flag advice flow of advising 999 or 111. The reasoning is that these callers need immediate human contact and direct connection to someone who knows them is the safest response.

This transfer is a hard bypass. It cannot be changed by transfer sensitivity settings.

Mental health crisis

Mental health crisis calls are handled through the standard emergency pathway. EMMA provides 999 or 111 guidance as appropriate and offers transfer to reception. EMMA does not attempt to manage or assess the severity of a mental health crisis beyond signposting to the appropriate services.

Death registration

When a caller mentions keywords such as "passed away" or "registering a death," EMMA immediately transfers the call to reception. This is treated as a sensitive vulnerability scenario and bypasses all sensitivity settings.

Red Flag Detection Improvements Timeline

Support staff must be aware of the improvement history when responding to practices who report that emergency detection was missed on a specific date.

Rectal Bleeding: Important Clarification

Before April 2026, rectal bleeding was incorrectly triggering an emergency response in SOPHIA. This was a false positive. Rectal bleeding is not classified as an emergency symptom requiring immediate 999 or 111 guidance in standard NHS triage guidelines.

As of April 2026, rectal bleeding is correctly routed through standard triage in SOPHIA, in line with clinical guidance.

If a practice raises a complaint about rectal bleeding being treated as an emergency before April 2026, this is a known false positive that has been corrected.

What EMMA Does NOT Do in Emergency Situations

Support staff must be clear on the following when responding to clinical safety questions:

• EMMA does not provide clinical advice or attempt to assess the severity of symptoms
• EMMA does not attempt to diagnose any condition
• EMMA does not delay emergency signposting while completing other parts of the call
• EMMA does not prevent a patient from being transferred to reception if they request it after emergency guidance
• EMMA does not limit emergency handling based on transfer sensitivity settings or medical capacity

How This Supports NHS Compliance

EMMA's emergency handling is designed to comply with:

• DCB0129: Clinical Safety Case Report and Hazard Log. Emergency detection is one of the primary clinical safety considerations covered in the Hazard Log.
• DCB0160: The practice is required to carry out a local clinical risk assessment after deploying EMMA. Emergency call handling is one of the areas the practice should review.
• MHRA Class I Medical Device registration: EMMA is registered as a Class I medical device. Emergency handling is part of the clinical safety framework governing this registration.

When ICBs or clinical directors ask how EMMA handles emergency calls, this article and the NHSE Assurance document together provide the complete answer.

Responding to the Common Objection: "What if EMMA misses an emergency?"

This is the most frequently raised clinical concern about AI reception systems. Support staff must respond with accuracy and confidence.

The answer is:

EMMA uses Red Flag, a continuously running emergency detection system that assesses the full conversation context throughout every call. As of V12, this has been refined across every language EMMA supports with direct NHS clinical oversight. Sentinel monitors every call in the background as a second safety layer. If EMMA encounters something she cannot confidently process, she routes to a safe pathway rather than guessing.

EMMA also advises every patient at the start of every call that if they have an urgent medical need, they can call 999 or 111 directly. This is stated before EMMA begins collecting patient information.

No system is perfect. However, EMMA's emergency detection has been significantly improved across multiple releases and is now the most clinically scrutinised AI reception system in NHS primary care.

Step-by-Step Triage Process

When a practice reports a potential emergency handling failure:

1. Pull the call recording immediately.
2. Listen to the full call. Identify exactly what the patient said and at what point in the conversation.
3. Identify whether the emergency language was used clearly or in an ambiguous or indirect way.
4. Check the date of the call against the improvement timeline above.
5. If the emergency language was clear and EMMA did not respond with 999 or 111 guidance, this is a clinical safety concern requiring immediate escalation.
6. If the language was ambiguous or indirect and EMMA did not detect it, assess whether the V12 Red Flag update would have addressed it. If so, note this as context.
7. Document findings and escalate as appropriate.

What to Tell the Practice

Example wording when a practice asks how EMMA handles emergencies:

"EMMA uses a system called Red Flag which monitors every call continuously for emergency symptoms. As of our V12 release, this has been refined across every language EMMA supports with direct clinical oversight from Sir David Sloman, former Chief Operating Officer of the NHS. If EMMA detects an emergency, she immediately advises the patient to call 999 or 111 and offers to transfer them to the surgery. Emergency calls always bypass any capacity limits and transfer sensitivity settings."

Example wording when a practice raises a concern about a specific missed emergency:

"We are treating this with the highest priority. We are pulling the call recording now to review exactly what happened. We will come back to you with our findings as soon as the review is complete and will escalate this to our clinical safety lead immediately."

Common Mistakes

• Treating an emergency handling complaint as a standard support ticket without immediately pulling the call recording
• Not knowing that suicidal ideation and self-harm are handled differently from standard red flag calls
• Telling a practice that capacity limits affect emergency calls. They do not.
• Not being aware of the rectal bleeding false positive correction in April 2026
• Not knowing that transfer sensitivity settings do not apply to emergency scenarios
• Failing to escalate a confirmed emergency handling failure to the clinical safety lead immediately

Escalation Guidance

Escalate to the clinical safety lead immediately if:

• A call recording confirms EMMA did not provide 999 or 111 guidance when a patient clearly described emergency symptoms
• A patient may have been harmed as a result of not receiving emergency signposting
• A practice or patient raises a formal clinical safety complaint related to emergency handling

Escalate to engineering immediately if:

• Emergency handling failures are occurring after V12 Red Flag has been deployed
• Suicidal ideation or self-harm calls are not being transferred directly to reception

When escalating, always include:

• Surgery name and ODS code
• Call ID and timestamp
• Exact language the patient used during the call as heard on the recording
• Date of the call relative to the improvement timeline
• Whether any clinical harm has occurred or is suspected
• Whether the practice has raised a formal complaint

Last Reviewed: May 2026 Owner: Support and Customer Success