Dublin Fire Brigade losing ambulances to HSE

Old diesel wrote: »

Without a doubt

If Non Beliver14 was on the prime time programme tonight giving his or her input - I think I can safely say - that it would improve the programme marvellously.

But alas - I fear we won't be seeing contributions of that quality on Prime time - even though it would help a balanced debate.

NonBeliever14 wrote: »

There are some interesting comments on this thread. Some are unbelievably misinformed. Despite the obvious fact that a range of syndicating journalists have decided to accelerate HSE bashing (and by association, NAS bashing) in recent weeks, none have attempted to inject any balance or indeed challenge any so called "truths" on which much of the conjecture is based. A simple example, IFESA chairperson states 40% of all ambulance calls are in Dublin. A blatant lie, whether you use one or more categories of ambulance calls. All journalists, as well as the usual commentators (IFESA and the usual Private Ambulance operators), continue to ignore or avoid some basic facts which are extractable through an FOI request (you don't have to believe what you need here):

more than two thirds of the population live outside of Dublin (check the Census)

In December 2013, only the NAS in the MW, former East (Dublin, Kildare and Wicklow) and the Midlands achieved the 19 minute response time for DELTA/ECHO calls. This target have never been achieved in the areas of Dublin not primarily serviced by NAS

The Private Ambulance company whom is now tweeting support for DFB, sued the State in the EU Court because DFB did not compete in a procurement process. The same commentator, whom criticises NAS on an almost daily basis, sued the HSE when they tried to initially introduce the Intermediate Care Service claiming it would harm their business. PHECC are subject to FOI so it would be interesting to get copies of all correspondence they have received from the same source.

IFESA regularly call for a National Fire Service because of fragmentation and inconsistency amongst Fire Authorities. Apparently it's OK to not have a single National Ambulance Service and to have a fragmented service in Dublin

In addition to the Response KPIs published by HIQA, there is an additional "qualitative" KPI which all services collect. It relates to the percentage of ECHO/DELTA calls that are responded to by an Advanced Paramedic. DFB's own figures in 2013 put the figure at less than 5% while the NAS figure is 68%. Apparently, the quality of NAS services outside of Dublin are inferior. Is it true that Advanced Paramedics in DFB are promoted to Sub Officer and therefore stop crewing emergency ambulances?????

HIQA legislation does not provide it with powers to regulate or inspect any Fire Service. Given the public confidence in HiQA inspections, are the public happy to not have access to regulatory reassurance. The review announced by the Minister for Health, to be conducted by HIQA, will not encompass DFB, unless they volunteer themselves to it.

NAS is so dysfunctional that it is able to coordinate and deliver aeromedical services using both it's own and IRCG assets. NAS has successfully provided national access to Primary PCI therapy for MI patients whom previously were excluded because they lived on the West Coast or Border Areas.

Everyday, NAS (as does DFB) respond to patients with successful outcomes. The difference is that NAS does not have it's "customer base" captivated in a small geographical area where it has a large Fire Service workforce to use as "back up" for meal breaks, lifts, etc. because they have few fires to respond to. Rather, NAS has to deliver services to the other two thirds of the population spread out between Mizen Head to Malin Head as well as still managing to deliver a range of emergency as well as all urgent and routine services in Dublin.

NAS responds to approx. 350,000 emergency/urgent calls every year.

If you search the papers, we hear about a dozen well publicised news paper headlines. For some strange reason, we don't here about the the 99.9% calls where everything went right. An example is a headline from the North East recently in a tabloid which claimed a "25 minute delay". What the journalist failed to realise or indeed accurately report was that it was a six minute delay as the first 19 minutes was the target. The second hypocrisy promoted by journalists is the omission of the fact that response time KPIs do not apply to all 999 calls, in fact it is approx 41% of 999 calls that are encompassed. In any human endeavour, including healthcare, people fail to perform or make mistakes. Whilst these mistakes can cost lives, the reality is that the World Health Alliance on Patient Safety, the peak body of same, accepts that a percentage of patients will not get the very best all of the time. That is the reality of what happens when services are delivered by human beings. The Irish response is a media witch hunt. As DFB services are delivered by humans equally doing their best, they too make mistakes.

So, why do we only hear about NAS in the media, and very little about DFB? While everything I have referred to above can be evidence based through research or FOI, I will digress on this point and offer an opinion. In my view, there is the simple reason that DFB is a small ambulance operation in a small densely populated area where most people are non affected and the media outside Dublin not interested (unless it is syndicated journalism) and the capital offers the media a greater choice of scandal. Secondly, DFB has not experienced much organisational reform to unsettle a workforce. When you couple this with a very professional ethos, built on collegiality, loyalty and pride in service, you get little "noise".

conversely, NAS faces huge geographic and demographic challenges but is benchmarked against the same metrics.

Secondly, NAS staff and the public has experienced significant organisational reform and loss of income (in the case of staff). NAS does not have the loyalty, pride and collegial culture of DFB. A failure of leadership is generally the root cause. In my mind, the common denominator is the correlation between the location of the media reports, the journalists involved, the extent of loss of earnings in those areas and the degree of service reforms/parochial response. Essentially, following NAS staff running to journalists to air their grievances, these same individuals have now been "cultivated" as informants by these same journalists whom realise the ease with which HSE related stories can be extracted and probably not challenged with the actual truth. The small minority of truly disgruntled think they are getting at their management, however, what they are really doing is allowing themselves to be used to undermine the professionalism of their colleagues and erode public confidence in a national service that has so much potential given the right leadership, political support and workforce buy in.

Instead, we are due to be subjected to another prime time "expose" where in probably 20 minutes, we will be convinced lives at at risk. We will then have the subsequent IFESA, journalistic and Private Ambulance operator analysis in the usual media outlets followed by the usual outpouring of parliamentary questions from "concerned" politicians. And meanwhile, they won't have scratched the truth just further undermined the morale of a professional workforce and worried the public.

Well if we have a crisis, ask the man whom had a cardiac arrest on a golf course in Ballyshannon, was successfully resuscitated, flown to Galway, had a PCI and went home to his family what he thinks of "an ambulance service in crisis". Trouble is, he is only one of about 800,000 patients whom have a good experience of NAS every year.

The purpose of this long post is not to bash any group including DFB, but to point out that when it comes to complex services like an ambulance service, what you read, hear and watch in the media is rarely the truth.

Torpedo wrote: »

A centralised control room with access to all resources around Dublin with everything from DFB/ HSE AP’s to Community First Response programs on the one dispatch system seems to make sense for the patient.

NonBeliever14 wrote: »

Oscar2, publishing what your performance is is one thing, even if the data is at least 12 months old. But can you tell us or provide a link to the actual standard that is supposed to be achieved. As I'm sure you know, a KPI, is not a KPI unless it is benchmarked against a published standard supported by a metadata set with detailed denominator and numerator.

When does the Fire Service "start" and "stop"?

ISO is an administrative system of compliance and has no relevance to how quickly you get to the scene.

NAS is the only emergency service with published performance standards with a full suite of metadata with defined numerator and denominators.

I hope I am wrong for the publics sake. In due course, every emergency service will be subject to and measured against unrealistic KPIs that they have no hope of meeting. If you have a link to performance standards for any other emergency service in Ireland, please post.

NonBeliever14 wrote: »

Oscar2 I appreciate and acknowledge the cultural issues. My question was can you point us in the direction of the Standards? i.e. where is it published that a Fire Service must provide a specific response to a specific category of incident in a specific timeframe in X% of those specific incident types?

miju wrote: »

Have to ask, what specifically do the DFB do better than the HSE?

NonBeliever14 wrote: »

CrackCrack30,

how do you know that NAS do not have a better response in Cork, Limerick, etc. than Dublin????????

Old Diesel,

the Irish Times recently published Response Times KPI performance for December 2013. The best performance in the State was by NAS in the former East, Midlands and MW. DFB was 55%, closer to the bottom half of the country.

The question MIJU asked was what do DFB do better? NAS don't run Fire Engines so I am not clear on the relevance of your version of better. Those who do run them, for the most part, wont deploy them because of cost.

The HIQA first response standard indicates the appropriate resource for an ECHO is a CFR (minimum) and for a DELTA call is an EFR (minimum). This is already in place in many parts of the country, however, until NAS has a National CAD system, they have no way of capturing the timestamps. Again, a point lost of the media and usual expert analysts

What actual benefits are there from sending 6 Paramedics to 999 calls as First Responders given approx. 45% of all DFB calls are neither ECHO/DELTA.

Medicine is predicated on health economics whereby every intervention must be warranted, justifiable and affordable. Sending 6 Paramedics to 999 calls because, frankly, they have nothing else to do does not meet this criteria. Before you tell me about Cardiac Arrest, these account for approx. 1.5% of workload and you only need two practitioners to adequately manage the scene with assistance from 2 responders. This is consistent with the PHECC EMS Dispatch Standard, i.e. 3-4 Practitioners/Responders, not 6 Paramedics (Practitioners) as a minimum response. As I have previously stated, how many of these paramedics would meet CPC standards when introduced by PHECC without a significant, disproportionate and unaffordable burden on the taxpayer.