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Dublin Fire Brigade losing ambulances to HSE

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    #32
    Beano
    Closed Accounts Posts: 3,357 ✭✭✭Beano


    NonBeliever14 wrote: »
    Beano, happy to engage in respectful and informed debate. I regret to advise you lost me when you qouted the Irish Mirror.

    So all those stories are complete rubbish then?


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    #33
    Beano
    Closed Accounts Posts: 3,357 ✭✭✭Beano


    NonBeliever14 wrote: »
    Beano, happy to engage in respectful and informed debate. I regret to advise you lost me when you qouted the Irish Mirror.

    and when have i not been respectful? I'm the one getting rolleyes thrown at me.


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    #34
    Beano
    Closed Accounts Posts: 3,357 ✭✭✭Beano


    miju wrote: »
    Plenty of times projects have over run by 1-2 million but plenty of times it's also come in under 1-2 million of estimate also, what is your point?

    because the figure quoted was 6 million (which is a guess by a poster btw not an official figure) and the current cost of providing the service is 9M. I'm sure you can see that it wouldn't take much of an overage for any savings to be marginal. and that is not even looking at whether the replacement service would be at the same level as the existing service. Why change unless there are definite financial incentives?


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    #35
    miju
    Banned (with Prison Access) Posts: 8,486 ✭✭✭miju


    Beano wrote: »
    because the figure quoted was 6 million (which is a guess by a poster btw not an official figure) and the current cost of providing the service is 9M. I'm sure you can see that it wouldn't take much of an overage for any savings to be marginal. and that is not even looking at whether the replacement service would be at the same level as the existing service. Why change unless there are definite financial incentives?

    The COST of providing the services isn't €9m that is what is paid to DFB for PROVIDING the service and I can see plenty of savings to be made fairly quickly actually and quite easily could come up with a list of about €2 mill in savings without trying too hard. Alot of duplication of work occurs which when removed by itself saved significant cash.

    This has been on the cards seriously between the HSE and DFB for the last 2-3 years anyways. But this discussion shouldnt be about cost savings, it should be about ensuring a quality service is delivered and improved patient outcomes.


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    #36
    Beano
    Closed Accounts Posts: 3,357 ✭✭✭Beano


    miju wrote: »
    The COST of providing the services isn't €9m that is what is paid to DFB for PROVIDING the service and I can see plenty of savings to be made fairly quickly actually and quite easily could come up with a list of about €2 mill in savings without trying too hard. Alot of duplication of work occurs which when removed by itself saved significant cash.

    This has been on the cards seriously between the HSE and DFB for the last 2-3 years anyways. But this discussion shouldnt be about cost savings, it should be about ensuring a quality service is delivered and improved patient outcomes.

    I agree it shouldn't be about cost savings. I only posted about cost in response to somebody else. Given the small amounts involved (relatively speaking) they shouldnt even enter into the discussion.

    If we restrict ourselves to just the quality of service then what is specifically wrong with how DFB provide the ambulance service in Dublin? Is it perceived to be of poor quality? I don't believe so but perhaps the experts here can correct me. Are the HSE perceived to provide a high quality service? I imagine that the public response to that would be a resounding no. Again i am open to correction.


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    #37
    Bang Bang
    Registered Users Posts: 774 ✭✭✭Bang Bang


    Beano wrote: »
    Are these the people you want running the ambulance service in Dublin?

    http://www.irishmirror.ie/news/irish-news/health-news/hse-ambulance-crisis-shambulance-service-2982701

    http://www.irishmirror.ie/news/irish-news/health-news/state-emergency-irelands-ambulance-crisis-1953528

    http://www.irishexaminer.com/ireland/hse-responds-to-criticism-over-ambulance-delay-250097.html

    http://www.independent.ie/irish-news/ambulance-service-running-on-empty-and-needs-staff-dail-committee-told-30041883.html

    It seems to me that the NAS has trouble servicing its current area. I cant see how it take on Dublin as well and provide an equivalent or better service. Because that is the only way a change can be justified. Either it can provide an equivalent service at a significant saving or it can provide a significantly better service for the same money. I am not confident it can do either.

    DFB are far from innocent when it comes to delays in response and the logging of calls without requesting an ambulance from the NAS.
    There are numerous documented incidents in recent years, do a search here and you will find some of the incidents. But how the HSE are being constantly attacked by the media is another question, perhaps it is because outside of Dublin the DFB are not heard of so would not make the news in the other 25 counties of the republic.

    In recent weeks a pedestrian was struck by a vehicle in O'Connell Street Dublin. Some thirty two minutes after the call was received by DFB control a request was made to the NAS for an ambulance to respond to this incident, an ambulance was immediately dispatched and arrived on scene some nine minutes later. A timeframe of over forty minutes waiting for an ambulance all due to a delay in response by the DFB. This practice by Dublin Fire Brigade is not uncommon.

    I am adding this post to let those not in the know that the DFB model is far from perfect, it has many flaws and the logging of calls without requesting assistance from the NAS is a dangerous common practice resulting in almost daily delays of ambulances reaching patients.


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    #38
    Old diesel
    Registered Users Posts: 5,788 ✭✭✭Old diesel


    The reality is that neither service is perfect.

    Members of the public like myself - if we need an Ambulance - we aren't overly bothered about whats the best type of service.

    What we need is

    1) fast response

    2) highly trained staff delivering the necessary treatment and care to a high standard.

    3) access to the treatment we need - pre hospital and at hospital as quickly as possible

    Once that's happening - im not overly fussed whose names on the door - DFB, HSE or Lifeline (sorry for the curveball)

    So whats the best way to deliver a good ambulance service - that delivers the response times needed - along with the best of patient care/treatment etc.

    I have to say though - that there has been great strides made in terms of the skills ambulance crews have - and the things they can do - in the last 9/10 years.

    Its the management of the service etc - that's where we need better performance in terms of how the service is resourced and the systems in place.


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    #39
    Old diesel
    Registered Users Posts: 5,788 ✭✭✭Old diesel


    BTW - id rather NOT see privatisation of the ambulance service inspite of mentioning Lifeline in my last post.

    But really - what I want is the best possible Ambulance service - and if that's been achieved - its not hugely important who delivers it.

    Problem with privatisation though is the potential for wages to be dropped - and tbh - the wage figures ive seen for Ambulance crews don't look all that brilliant as it is - so the idea of them going down through privatisation - is certainly not something that floats my boat AT ALL.


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    #40
    flazio
    Registered Users Posts: 12,902 ✭✭✭✭flazio


    Beano wrote: »
    Perhaps someone here could educate me a little. Lets assume that the ambulance services are taken away from DFB and given to NAS.
    1. Where would the NAS ambulances be based?
    2. Do NAS have the same number and spread of locations that the DFB has?
    3. What effect will this have on response times?
    4. Presumably NAS would have to purchase new ambulances to cover the dublin region, yes? Or are DFB expected to hand over their ambulances to NAS?
    5. NAS would have to hire new staff to cover dublin. Do they think they can do it with less personnel than DFB currently use? If not then what is the financial incentive for the change?
    6. After the change you would have ambulance personnel working full time on emergency care. Have they estimated the effects on fatigue and morale of doing emergency care full time in an environment as busy as Dublin? DFB personnel only work the ambulance every couple of shifts.
    7. Will DFB personnel no longer be dual-trained? After all they wont be doing ambulance work so why spend the money. What effect would this have on survival rates for heart attacks in the city which i believe is currently one of the best in the world?
    Any education gratefully received.

    Speculation on my part.
    1. In ambulance bases or hospitals,
    2. In other cities no, is it adequate, in all honesty I'd say no, there have been poor response times of late.
    3. Can't be told until new system is implemented.
    4. If the DFB fleet are in good nick then NAS will likely purchase them
    5. Well since the NAS concentrate on one job rather then two, they can employ less
    6. Works everywhere else in the country.
    7. This could actually result in better firefighters. Without the burden of a very complicated Paramedic course, a person with a better appitude towards firefighting now stands a chance of becoming the firefighter they always dreamt to be, likewise, any Dubliner who maybe couldn't get laser eye treatment or wuldn't pass a firefighting fitness test but has a great head for body diagnosis can practice pre hospital care within Dublin


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    #41
    sjb25
    Registered Users Posts: 3,377 ✭✭✭sjb25


    In my opinion what we may see is if the NAS do take over is HSE will advertise for qualified phecc paramedics like they have done before to fill operational demand. So guys in DFB who want to be paramedics can apply and join NAS. They also have a full panel of student paramedics to go into training so they could fill staffing quickly enough. NAS will buy any ambulances in good nick DFB have and buy few new ones or bit of redeployment of vehicles. All my opinion obviously whatever happins i do hope all this does not turn into a NAS vs DFB crew mudsling that's not what it should be this is a management decision and has Notting to do with the great quality of care by both NAS and DFB paramedics


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    #42
    truebluesac
    Registered Users Posts: 406 ✭✭truebluesac


    A very negative thread towards the DFB here ,

    I see this as a turf war rather than a case of providing a better service ,

    I have worked with both DFB and NAS. . Both have great guys ,

    I believe that the NAS and its management are making a hughly underestimation of the service they can provide in dublin , the same service that DFB provide to the residents of dublin would take NAS twice the amount of ambulances if not more to complete the same volume of work which would be a monatary increase when it all comes out in the wash .

    The 2011 DFB cases of 76000 all emergancy calls that 12 ambulances did versus the 860000 total calls the NAS carried out which includes emergancy and transferres by how many ambulances ? Thats 40% of emergancy calls

    Attacks as to firemen not being buzy with only going to fire alarms or fake calls is disgracefull , im sure there are plenty of country ambulances that wouldnt be all tha buzy week on week , im sure the guys in the buzy stations find that comment laughable , also calling for a review of fire stations is inadiquate , the fire service of dublin is a risk based approach , fire trucks proportionatly possitioned in high risk areas ,

    When it comes to a cardiac arrest the more hands on scene as quick as possible the better for the outcome of the patient as proved with the report of dublin being the 2nd safest city in the world to have an out of hospital cardiac arrest ,

    The cities that have been used as examples equate to populations the same size as tallaght , and its not uncommon for ambulances 2 or 3 counties over to be dispatched to cases ,

    The NAS have their problems as do DFB , the current economic climate doesnt help and either does the recuritment embargo both sides have had since the onset of the recission , both services need to change the way they do things

    The big loosers in this would be the people of dublin should the NAS push DFB out .


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    #43
    Old diesel
    Registered Users Posts: 5,788 ✭✭✭Old diesel


    truebluesac wrote: »
    A very negative thread towards the DFB here ,

    I see this as a turf war rather than a case of providing a better service ,

    I have worked with both DFB and NAS. . Both have great guys ,

    I believe that the NAS and its management are making a hughly underestimation of the service they can provide in dublin , the same service that DFB provide to the residents of dublin would take NAS twice the amount of ambulances if not more to complete the same volume of work which would be a monatary increase when it all comes out in the wash .

    The 2011 DFB cases of 76000 all emergancy calls that 12 ambulances did versus the 860000 total calls the NAS carried out which includes emergancy and transferres by how many ambulances ? Thats 40% of emergancy calls

    Attacks as to firemen not being buzy with only going to fire alarms or fake calls is disgracefull , im sure there are plenty of country ambulances that wouldnt be all tha buzy week on week , im sure the guys in the buzy stations find that comment laughable , also calling for a review of fire stations is inadiquate , the fire service of dublin is a risk based approach , fire trucks proportionatly possitioned in high risk areas ,

    When it comes to a cardiac arrest the more hands on scene as quick as possible the better for the outcome of the patient as proved with the report of dublin being the 2nd safest city in the world to have an out of hospital cardiac arrest ,

    The cities that have been used as examples equate to populations the same size as tallaght , and its not uncommon for ambulances 2 or 3 counties over to be dispatched to cases ,

    The NAS have their problems as do DFB , the current economic climate doesnt help and either does the recuritment embargo both sides have had since the onset of the recission , both services need to change the way they do things

    The big loosers in this would be the people of dublin should the NAS push DFB out .

    As I said in an earlier post - I really am not bothered about whose name is on the Ambulance door - if the Ambulance service been delivered is good with good response times, excellent patient care and treatment and Fast access to both Pre hospital and at hospital care and treatment.

    Genuine question though - if Dublin Fire brigade does all its calls in the course of the year with 12 Ambulances - why would the NAS need 24 Ambulances for the same workload.

    Is it a case of 12 not actually been enough - or what other reason am I missing.


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    #44
    truebluesac
    Registered Users Posts: 406 ✭✭truebluesac


    The way each service works is differant , and NAS members would and do agree

    DFB ambulances dont take breaks they are covered by other personell in the station ,

    DFB dont have stand down times

    Within the DFB the ambulance does go all night throughout the night mostly from case to case , without proper breaks the NAS members would burn out with the volume of calls that dublin has night after night . this is why the rotation on and off the ambulance works for DFB .

    Does the city need more ambulances , well Dr king head honcho of PHECC reckons the whole country needs more ambulances as stated with his meeting with the oireachtas recently , he also stated that the service at times is pushed to breaking point , this to me is the whole service devoid of DFB VS NAS and is a national issue ,

    Maybe there should be an education program roled out nationally re the use and misuse of the 999 system by the public , similar ti previous ones in the UK ???


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    #45
    miju
    Banned (with Prison Access) Posts: 8,486 ✭✭✭miju


    Of those 76,000 calls how many were duplicated responses in other words a tender comes with an ambulance following later?

    there is obvious benefit to tender full of P's at a serious RTC or OHCA but the other silly calls?


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    #46
    Bang Bang
    Registered Users Posts: 774 ✭✭✭Bang Bang


    truebluesac wrote: »
    The way each service works is differant , and NAS members would and do agree

    DFB ambulances dont take breaks they are covered by other personell in the station ,

    DFB dont have stand down times

    Within the DFB the ambulance does go all night throughout the night mostly from case to case , without proper breaks the NAS members would burn out with the volume of calls that dublin has night after night . this is why the rotation on and off the ambulance works for DFB .

    I think you're becoming a tad disillusioned. NAS staff don't get dedicated breaks, they continue on through their shift. If a call comes in when they are attempting to eat they leave the food and do the call, unlike the DFB who have the luxury of sending someone else on the call.

    The NAS crews don't have stand down times either.

    NAS crews in the busier stations also work through the night going from call to call.

    Many NAS stations do not have the luxury of beds unlike every DFB station. The roll out of bed removal to the remaining NAS stations has begun.

    DFB ambulance crews do have quiet times just like the rest of us.

    I don't see NAS crews burning out, even the crews in the busier stations that work through the night so you really are just typing up your own anecdotes.

    If you honestly believe in your own words quoted above then you are definitely disillusioned.


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    #47
    miju
    Banned (with Prison Access) Posts: 8,486 ✭✭✭miju


    Just to add ive specifically seen the ambo in Coolmine station sitting there with no calls routinely for periods of 15 mins to 2 hours.

    I have also seen it go from call to call and drive in to the back only to drive back out 10 seconds later


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    #48
    Bang Bang
    Registered Users Posts: 774 ✭✭✭Bang Bang


    miju wrote: »
    Of those 76,000 calls how many were duplicated responses in other words a tender comes with an ambulance following later?

    Many thousands of calls have multiple incident numbers, i.e.; ambulance and two tenders respond the call gets three incident numbers, unlike the NAS where all vehicles on one call get the same incident number.
    I will try dig out the report showing the inaccurate call numbers relating to the DFB.

    Would any DFB personnel care to comment on the reports that DFB control staff were instructed to send double their normal response to every call over the Christmas period in order to bump up the figures some more?


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    #49
    miju
    Banned (with Prison Access) Posts: 8,486 ✭✭✭miju


    Bang Bang wrote: »
    Many thousands of calls have multiple incident numbers, i.e.; ambulance and two tenders respond the call gets three incident numbers, unlike the NAS where all vehicles on one call get the same incident number.

    I know this which is why I was posing the question for the poster who posted the 76,000 call figure over 40% of total calls.

    That NAS system is also down to how their CAD operates which has each vehicle as an asset and each call is simply one call, if a second vehicle is required at that call then the asset is just allocated quickly to the call. NAS CAD is badly outdated but it's functionality is brilliant

    At times I think the DFB guys think there is not much to be doing but going by the attached call stats they deal with 41% of the total fire calls nationwide.


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    #50
    Paulzx
    Registered Users Posts: 1,968 ✭✭✭Paulzx


    Bang Bang wrote: »
    Many thousands of calls have multiple incident numbers, i.e.; ambulance and two tenders respond the call gets three incident numbers, ?

    Wherever you got that information you are completely wrong. Every incident gets assigned an incident number.

    Ambulance case incident numbers begin with DA. Fire calls begin with DF. If a fire appliance is sent on an ambulance case to assist an ambulance it operates under the exact same DA incident number as the ambulance. There is verifiable proof of this (unlike your comment) insofar as the fire report filled out by the fire officer after the incident will have the DA ambulance incident number on it. All fire appliances and ambualnces that attend this incident will have the same incident number. There are not multiple incident numbers for the same call.

    An example of this is the recent Oxigen fire that went on for over a week. The dozens of different crews and appliances that attended over the course of the week would have done so and been mobilised to the same DF incident number.


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    #51
    Beano
    Closed Accounts Posts: 3,357 ✭✭✭Beano


    miju wrote: »
    I know this which is why I was posing the question for the poster who posted the 76,000 call figure over 40% of total calls.

    That NAS system is also down to how their CAD operates which has each vehicle as an asset and each call is simply one call, if a second vehicle is required at that call then the asset is just allocated quickly to the call. NAS CAD is badly outdated but it's functionality is brilliant

    At times I think the DFB guys think there is not much to be doing but going by the attached call stats they deal with 41% of the total fire calls nationwide.

    those stats only include fire calls. RTA's, cardiac arrests and the like are not included. See the section on call stats here http://irishfireservices.ie/dublin-fire-brigade/control-centre


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    #52
    Bang Bang
    Registered Users Posts: 774 ✭✭✭Bang Bang


    Paulzx wrote: »
    Wherever you got that information you are completely wrong. Every incident gets assigned an incident number.

    Ambulance case incident numbers begin with DA. Fire calls begin with DF. If a fire appliance is sent on an ambulance case to assist an ambulance it operates under the exact same DA incident number as the ambulance. There is verifiable proof of this (unlike your comment) insofar as the fire report filled out by the fire officer after the incident will have the DA ambulance incident number on it. All fire appliances and ambualnces that attend this incident will have the same incident number. There are not multiple incident numbers for the same call.

    An example of this is the recent Oxigen fire that went on for over a week. The dozens of different crews and appliances that attended over the course of the week would have done so and been mobilised to the same DF incident number.

    Thank you for informing us of the newer DFB system. As you are familiar with the system I would imagine you are also familiar with one of the reports carried out in recent years, was it the Devine report? I will do my best to get a copy as there has been a number of reports relating to the DFB system, perhaps it's available online.
    The report I speak of is the one that shows where the additional incident numbers were generated as per my example call.

    One would still wonder why DFB control staff were instructed to double 'their normal' responses coming up to the years end 2013, just as the story of the latest report was beginning to be leaked...


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    #53
    Paulzx
    Registered Users Posts: 1,968 ✭✭✭Paulzx


    Bang Bang wrote: »

    One would still wonder why DFB control staff were instructed to double 'their normal' responses coming up to the years end 2013, just as the story of the latest report was beginning to be leaked...

    Where are you getting this stuff from?:)

    You'll be seeing reds under the beds next.

    How can you "double" a response? Send 2 ambos to every collapse? What are you taking?:D


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    #54
    miju
    Banned (with Prison Access) Posts: 8,486 ✭✭✭miju


    Beano wrote: »
    those stats only include fire calls.

    I know that which was why I bolded the part that said "total fire calls nationwide"
    Paulzx wrote: »
    How can you "double" a response? Send 2 ambos to every collapse? What are you taking?:D

    He's referring to the common DFB practice of someone rings 999 asks for ambulance for a "hurty knee" DFB have no ambulances available so send a fire tender instead = 1 call DFB ambulance when available then turns up = 2 calls.

    This has been practiced by DFB EMDs in the past whether current or not I can't say for certain either way.


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    #55
    Paulzx
    Registered Users Posts: 1,968 ✭✭✭Paulzx


    miju wrote: »
    I know that which was why I bolded the part that said "total fire calls nationwide"



    He's referring to the common DFB practice of someone rings 999 asks for ambulance for a "hurty knee" DFB have no ambulances available so send a fire tender instead = 1 call DFB ambulance when available then turns up = 2 calls.

    This has been practiced by DFB EMDs in the past whether current or not I can't say for certain either way.

    At the risk of boring everyone i'll repeat myself. Ambo plus fire tender equals same call same incident number.

    ...........and a fire tender won't be sent to babysit a call that comes in as a "hurty knee". A CVA or an MI or equivalent...yes

    Other stuff will just be queued after an attempt to pass it to the HSE


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    #56
    miju
    Banned (with Prison Access) Posts: 8,486 ✭✭✭miju


    Paulzx wrote: »
    ...........and a fire tender won't be sent to babysit a call that comes in as a "hurty knee". A CVA or an MI or equivalent...yes

    Oh please are you seriously going to deny this that tenders dont go to Charlie, Bravo, Alpha and Omega calls????

    I've seen it with my own eyes, in fact not only have I seen it in real life , it was shown on RTE Firefighters series with the guy explaining the reason for the tender.

    I might be a bit out of practice so can you explain given the information the caller in the video below provided to the EMC who will of course be using EMD cards ( https://www.prioritydispatch.net/emd_cardset_info ) that it gets determined as a CVA, MI which is an Echo call (so posters like Beano can understand - no offence).

    So it's obviously not an Echo call , in fact it's not even a Delta call but you do insist (trying to not bore others in the process) that tenders will only go to Echo calls like CVA / MI's

    Start at 6mins 25s


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    #57
    Bang Bang
    Registered Users Posts: 774 ✭✭✭Bang Bang


    Paulzx wrote: »
    Where are you getting this stuff from?:)

    You'll be seeing reds under the beds next.

    How can you "double" a response? Send 2 ambos to every collapse? What are you taking?:D

    Oh it didn't take you long:roll eyes:

    It was your control management that issued the instruction, I happened to be there on other business and the instruction became a source of entertainment and some bewilderment between not just the NAS staff but some DFB controllers also.

    I'm not completely familiar with your responding system, just that the number you send on some calls is overkill. The instruction of doubling responses maybe meant four appliances to a normal two appliance fire, or two appliances to a normal one appliance call, or maybe a fire appliance with one collapse, oh you already do that! Perhaps it meant two appliances and an ambulances to one collapse I don't know, again it was your management.

    So as you appeared unsure of how to double a response I've just given you a couple of examples ;)


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    #58
    Paulzx
    Registered Users Posts: 1,968 ✭✭✭Paulzx


    Ah sure look lads...................ye seem to know it all. Nothing i say is going to make any difference.

    A "hurty knee" is the same as someone thrown from a horse?

    We "double" the amount of fire engines sent to everything even though there are strict PDA's in place?



    Best of luck with the new ambulance service next year. I hope it works out for the staff and the people of Dublin.


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    #59
    Beano
    Closed Accounts Posts: 3,357 ✭✭✭Beano


    Paulzx wrote: »
    Ah sure look lads...................ye seem to know it all. Nothing i say is going to make any difference.

    A "hurty knee" is the same as someone thrown from a horse?

    We "double" the amount of fire engines sent to everything even though there are strict PDA's in place?



    Best of luck with the new ambulance service next year. I hope it works out for the staff and the people of Dublin.

    Its a prospect that fills me with nothing but dread. But sure it wouldn't affect some of the people on this thread. They have no need for ambulances. They can ride to the hospital on their high horse.


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    #60
    Bang Bang
    Registered Users Posts: 774 ✭✭✭Bang Bang


    Don't go lads, you have been a good source of entertainment. The likes of statements saying that a NAS crew would burn out if they were to do the same number of calls as a DFB crew, are you made of some sort of super human material:D:D:D

    That Dublin's cardiac arrest success is down to the DFB, you do realise that the NAS also operate in Dublin city and county? and we don't 'burn out'!!

    Being filled with dread at the prospect of the NAS responding to calls in Dublin, as stated we do actually work Dublin also. But being filled with dread and strict PDA's, is it normal for the DFB to respond a fire tender to a cardiac arrest but leave their advanced paramedic at the station because he is on kitchen duties? I can tell you I have seen this first hand and find it very worrying.
    So if that's an example of your strict PDA's then it's no surprise another report has been called for.


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    #61
    Beano
    Closed Accounts Posts: 3,357 ✭✭✭Beano


    i hope to god i dont get an awful smug b*astard like you bang bang if i ever need an ambulance.


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