Dublin Fire Brigade losing ambulances to HSE

ratracer · 27-03-2014 2:33pm

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.

So that'll never be considered then...

Torpedo · 27-03-2014 2:49pm

ratracer wrote: »

So that'll never be considered then...

If I was a betting man I'd say it’s the most likely outcome, DFB maintain their ambulance fleet of 11 under NAS ambulance control room and Swords ambulance is withdrawn. HSE will argue they've 2 ambulances out there now so excess capacity. I know there’s no excess capacity but HSE won’t want to pay and either will DCC.

If NAS are stuck for an ambulance they send a fire truck/ cfr/ rrv etc and first clock stops when they arrive on scene.

HSE aren't going to increase their funding so what happens internally in DFB is another story ie whether they go the FDNY route and have separate EMS and FIRE section, this would obviously impact current para status of fire crews. I’m sure DCC would prefer it to save money in training etc.

repsol · 28-03-2014 10:20pm

Most DFB members in favor of keeping the ambulance fall into 2 groups, officers who don't staff the ambulance and in many cases are unqualified medically and those who do a lot of overtime which is always on the ambulance (no ambulance= no overtime)

A few points which those not in the DFB may be unaware of

:there is no proper policy in place for allowing staff to get meals/breaks or finish on time which leads to ambulance crews hiding, not answering radio calls or diverting to stations for crew changeover instead of going directly to the case. When the crew get back to the station they are still expected to crew a fire engine so they have no rest period, just a change of duty.There is no GPS on vehicles and staff themselves have to make themselves available for the next call

:ambulances are rarely cleaned properly as the crews cannot routinely take the vehicle off the road to empty it of equipment and clean. They are usually mopped out which only really cleans the floor.

:ambulances are crewed often by personnel on overtime who are sometimes from the opposite side of the city and don't know the area they are working

:a number of individuals in DFB have failed their paramedic exams, some more than once, and yet are still employed and still crew ambulances. Some have refused to resit exams and have escaped sanction.

:there is no control over the number of hours worked by crews. It is not uncommon for personnel to do a Saturday night followed by Sunday night on overtime (a 16 hour night followed by a 15 hour night with an 8 hour break between) on top of the persons own working week. You wouldn't be allowed to drive a truck for this amount of hours

:many staff feel that they are not adequately trained . There is a huge gulf in skills between staff employed under 10 years and those who are more senior. The younger members are more skilled because less time has passed since they trained and also because they are better trained anyway. Some of the senior staff were for example trained to give injections into pieces of fruit.

:Advanced paramedics who to be fair are very skilled are not rostered the ambulance ahead of less qualified personnel or can be rostered to drive the vehicle leaving a less qualified (or exam failure) person to care for the patient when the vehicle is moving.

miju · 29-03-2014 6:44pm

You mean the sun doesnt shine out of DFBs arse and it has its problems too ??? :P:P:P:P:P:P

oscar2 · 29-03-2014 9:13pm

To quote Non Believer: "Interesting, no one ever asks about Fire Service or AGS response time standards (non existent)"

Check out Performance Indicators for Fire Authorities on Department Environment site. Some Brigades are ISO compliant.

NonBeliever14 · 30-03-2014 10:28am

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.

Old diesel · 30-03-2014 1:01pm

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.

I think the reasonable question - is - are the 8 min for first response and 19 minutes for Ambulance response - good targets.

In other words - would meeting those targets make improvement to patient outcomes.

If the answer is yes - then the important issue surely - is how do we put in place the resources needed to meet the targets.

Yes clearly theres no hope of meeting the targets with current resource levels.

BUT

you could achieve superior performances if you invested in the Ambulance service and put the require resources in place.

For example Initiatives like the East Cork and West Cork rapid response would make a huge difference I think nationwide.

I do think that while brilliant - the East Cork and West Cork Rapid response model should move to a situation where the HSE provides funding as part of an expanded Ambulance/Pre hospital care budget

oscar2 · 30-03-2014 3:37pm

Baseline study of Fire Service performance indicators here

http://www.environ.ie/en/Community/NationalDirectorateforFireandEmergencyManagement/PublicationsDocuments/FileDownLoad,26936,en.pdf

I don't necessarily agree that the indicator chosen mean much as it measures first attendance regardless of whether such an attendance is adequate. Personally I would use when a "Stop" or Available at Incident" message to measure when a situation has been contained or finalised.

Really I was answering your blanket assertions about the Fire Service not having standards or targets to meet.

Finally Fire Crews operate as close knit familiar teams. Crews generally work together under same Officers for years and this builds up team spirit and rapport. When this is coupled with membership of a Brigade that has existed for over a hundred years then Institutional loyalty,pride and unwillingless to let down team members is developed.

Many Firefighters live in the areas they serve in and this further motivates them.

This I fear is what some call historical baggage but should not be dismissed lightly.

I can post literally tons of data but I feel this would lose sight of the issues.

NonBeliever14 · 31-03-2014 3:53am

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?

crackcrack30 · 31-03-2014 12:08pm

My belief is that DFB will have to furnish some form or targets and reports to HIQA and that will be one of the possible outcomes of the review, In that case they will face the same scrutiny that the HSE and this has to be welcomed....
Rather than the 8 or 19 minutes targets or whatever international variant of targets is desired or required being used as a stick to beat the HSE mgt or the staff with they should be used to benchmark where we should be and a measurement of adequate resources and geographical Ambulance cover.

Concentration , effort, resources, personnel, vehicles/ equipment, the necessary focus and funds should then be directed towards righting the short-comings regardless of service HSE or Dfb with the support and backing of all concerned......NAS may need more frontline vehicles/ambulances or relief factor.....DFB may need more funding or less control... I don't know.

The Patient Transport Service was a step change for the Ambulance service ........But It should be only one of several areas tackled and reviewed on a yearly basis. Centralized Control or dynamic deployment are being rallied as silver bullets only time will tell (or has it been told)..... taking from peter to pay paul was Is like musical chairs IMO.

Speaking from experience (which is outside of Dublin) the response from the fire service is exceptional and usually unbeatable, but their call volume is low negating delays due to being on other calls.

All areas should be on the table...

Control, AMPDS, Targets, moral, finiance, regional borders, sick rate, cars, relief factor, performance mgt & Mgt performance, dual service response, solo response, A&E delays , Designated meal breaks, on call...... ect ect ect..

oscar2 · 31-03-2014 6:43pm

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?

At the moment Each Fire Service has minimum PDA's (pre-determined attendances ) depending on incident type.For example An RTC on motorway will dictate a higher level of response then one on a standard national roadway.

The Keeping Communities Safe Document has draft national PDA's which unfortunately will downgrade some responses and eliminate response to some incident types.

Response times are already monitored in performance indicators and stations are expected to book mobile under a certain time limit. Generally within 5 minutes for retained and 1 minute for wholetime.

http://irishfireservices.ie/technical-documents/cat_view/53-fire/61-miscellaneous-fire-related-document

sedgley · 31-03-2014 8:08pm

Having applied to both DFB and NAS before but failing on medical grounds also i'm involved with the vols and I am fairly well informed on the current issues.

I have to say from what has been going on in the media in recent weeks I am in utter disbelief at the amount of flak the HSE NAS have been getting from the media, politicians and also from Dublin Fire Brigade. It seems the usual spin doctors have successfully managed to destroy public confidence in the NAS with a barrage of attacks from RTE primetime, various media outlets, public representatives and IFESA. A lot of the figures being spouted out are just plain lies! The extrapolated figure of DFB calls was found to be 27% not 40% but the papers are still using the 40% figure!

While pointing out certain examples of the services' failures and the misuse of officer cars which I agree is a joke, the media are completely overlooking its many successes. They claim their grievances are with management but the frontline staff are the ones who the public deal with everyday. I can't help but sympathise with the paramedics on the ground who I can imagine are already demoralised as a result of severe cuts to their pay and conditions in recent times. I admire both organisations for the work they do but it would seem that the DFB are taking part in this smear campaign and using it as a cheap shot in a bid to keep their Dublin ambulances. It is also a bizarre coincidence that these so called concerned politicians who ordinarily wouldn't know the difference between the two ambulance services have become overnight experts on the subject now that the elections are just around the corner. The DFB are rallying in the cause of "save our ambulances", as somebody mentioned earlier and as a result it comes across as a "look after ourselves" campaign devoid of any concern about what is best for the public. Both DFB, the media and the political voices have also failed to recognise the presence of the NAS ambulances in Dublin. I am disappointed in the DFB for using the primetime program to basically say "we're better than them" even though the program was about the service in rural countryside areas miles from hospitals. I also noticed on primetime that one scenario in tallaght the DFB had no ambulance but were not held to account??? Whatever bit of respect I had for the Irish media, is well and truly lost. Shame on them for turning the public against their ambulance service by only highlighting the shortcomings and not the good work being done by them everyday.

crackcrack30 · 31-03-2014 9:00pm

Highlighting bad points are fine in the media when correct and deserved , highlighting good points are fine when warranted, personally I find the voyeuristic angela griffin stuff ect. ect.. a bit over done at the moment.

As per DFB minding their own , well there will always be self interest so cant blame them there to a point...

We always look over seas for best practice to do with X and best practice to do with Y, but what works for one system or country may not work for ours & what works now may not work in 5 years time... what I would like is for us to lead the way for once, find out what works over a proven period implement it and call it our best practice...

At the moment ,and it is becoming ever so noticeable, the NAS is being run as a business first and a service provider second and this stance is a big barrier for ever implementing a fully patient focused emergency service.

The NAS should look at Cork, Limerick and Galway (our other Cities) and if they can get it right in those regarding HIQA targets & guidelines over a period of a few years then and only then would I have confidence in them taking over Dublin as the sole Ambulance service provider.

miju · 31-03-2014 9:05pm

crackcrack30 wrote: »

The NAS should look at Cork, Limerick and Galway (our other Cities) and if they can get it right in those regarding HIQA targets & guidelines over a period of a few years then and only then would I have confidence in them taking over Dublin as the sole Ambulance service provider.

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

Old diesel · 31-03-2014 9:32pm

miju wrote: »

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

Its an interesting question - ive always though myself - that the advantage DFB have over NAS - is that having fire fighters as trained Paramedics - means the fire engines can be used as a first response - so you could get really good response times.

However - imo - the NAS - could achieve similar performance to DFB - if it was properly resourced.

So the advantage imo - to DFB - is having extra resources - rather then the model of operation

NonBeliever14 · 01-04-2014 6:59am

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.

NonBeliever14 · 01-04-2014 11:16am

It seems SIPTU/IMPACT are happy to support a review of NAS with no stakeholder representation but have a different standard for their DFB subscribers. What is the non verbal message from this action?

Clear conflict of interest by both unions

http://www.impact.ie/14/03/31/Public-demo-to-defend-Dublin-City-Fire-Brigade.htm

All NAS members of any grade should resign from both unions immediately on a point of principle and join UNITE whom have a track record of representing NAS members and no affiliation to DFB

crackcrack30 · 01-04-2014 11:46am

NonBeliever14 wrote: »

CrackCrack30,

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

My point is ....this is/should not a DFB v NAS debate, We should have our own back garden in order before be start looking into that of DFB.

We should do this by proving that we can efficiently and effectively operate the ambulance service to the acceptance of all concerned- the public, the hospital groups and HIQA in our other cities before we take on Dublin.

I know for a fact that the number of frontline ambulances in one of our major regional cities has not been increased since the 1970's.

Old diesel · 01-04-2014 12:13pm

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.

My apologies

What I meant was - that in terms of achieving fast response times - the extra paramedics SHOULD give DFB an advantage - in that it SHOULD give them a better chance of achieving fast response times - due purely to having extra hands.

That only speeds up (in theory) the initial response - it doesn't address the Ambulance shortage at all - and in fact you could raise the question of whether the extra people should be responding in an Ambulance to a 999 call rather then a fire engine

That doesn't mean that the DFB model is better however - if your going to have extra resources - I think the West and East Cork Rapid response model is a much better way of doing that then having 6 Paramedics on a fire engine.

Mind you - if other Ambulance service in Midlands, Mid west etc - are achieving better response times then DFB - then its not looking so clever for DFB in that case.

BTW - in an ideal world id rather have a situation where - Ambulance and Fire are two separate organisations - and the Ambulance service concentrates on the Ambulance side - and Fire concentrates on Fire and rescue.

There is however merit in considering the idea of having firefighters trained as responders - but you could argue a strong case for having doctors trained up as East and West Cork rapid response demonstrates.

Have absolutely no connection whatsoever with ECRR or WCRR btw - I just like what they are looking to do

NonBeliever14 · 01-04-2014 12:44pm

CrackCrack30

who says our back garden is not in order or do you believe the media spin about a crisis?

NAS is fraying at the edges, not the middle. Primary reason for the fraying is primarily down to the fact that the service has historically never been resourced properly but always got away with it because of overtime. The former health boards would "wear" the over spend which was small in their overall context and systems of accountability and financial governance (very varied)

While resources, training, coordination, technology and work practices have all improved, the PSA and Haddington Road removed most of the overtime, effectively undercutting service gains, to some extent. The service has a long way to go but it has made consistent gains, albeit with a lot of pain and parochial/localised union backlash.

On the other hand, the NOISE about the fraying at the edges is down to disgruntled staff running (airing grievances, loss of overtime, grudges with management and their unions) to the media, identifying patients whom have not received a timely response whom are then cultivated by the media.

the number of ambulances is not a measure of performance, response times KPI are currently the only actual measurement.

Everyone talks about response times..............question?

If we as a nation accept that the current 19 minute target for a transporting vehicle should apply to 85% of ECHO/DELTA calls (as per HIQA Standards), why do we not appear to accept (according to the media headlines) that 15% of those calls will not be responded to in 19 minutes??????? There is no second tier target! What if all of the cases reported in the media fell into the 15%? While clearly unpatable for the families affected, when is this country going to have an honest debate about what we can afford, what we are prepared to spend and what do we expect in turn from a national ambulance service. Setting unrealistic targets and not providing the resourcing and then crying murder in the media every time there is a delay is not the solution. Quite the reverse, it is just a distraction from political accountability.

When the media state there was a delay in response to an emergency call for say a broken ankle at a football match (classified as a CHARLIE call), why do we not accept (according to the media headlines) that response times Standards do not apply to such calls? which means there is no delay because there is no Standard

This is the double standards, half truths, blatant lies, "motivated" whistleblowers, ill informed journalists, opportunistic private operators, pretend trade unions and contemplative local or by election candidates now jumping on the NAS in Crisis bandwagon.

Be careful what we wish for, we are not positively positioned for outsourcing .........

crackcrack30 · 01-04-2014 1:20pm

NonBeliever14 wrote: »

CrackCrack30

who says our back garden is not in order or do you believe the media spin about a crisis?

NAS is fraying at the edges, not the middle. Primary reason for the fraying is primarily down to the fact that the service has historically never been resourced properly but always got away with it because of overtime. The former health boards would "wear" the over spend which was small in their overall context and systems of accountability and financial governance (very varied)

While resources, training, coordination, technology and work practices have all improved, the PSA and Haddington Road removed most of the overtime, effectively undercutting service gains, to some extent. The service has a long way to go but it has made consistent gains, albeit with a lot of pain and parochial/localised union backlash.

On the other hand, the NOISE about the fraying at the edges is down to disgruntled staff running (airing grievances, loss of overtime, grudges with management and their unions) to the media, identifying patients whom have not received a timely response whom are then cultivated by the media.

the number of ambulances is not a measure of performance, response times KPI are currently the only actual measurement.

Everyone talks about response times..............question?

If we as a nation accept that the current 19 minute target for a transporting vehicle should apply to 85% of ECHO/DELTA calls (as per HIQA Standards), why do we not appear to accept (according to the media headlines) that 15% of those calls will not be responded to in 19 minutes??????? There is no second tier target! What if all of the cases reported in the media fell into the 15%? While clearly unpatable for the families affected, when is this country going to have an honest debate about what we can afford, what we are prepared to spend and what do we expect in turn from a national ambulance service. Setting unrealistic targets and not providing the resourcing and then crying murder in the media every time there is a delay is not the solution. Quite the reverse, it is just a distraction from political accountability.

When the media state there was a delay in response to an emergency call for say a broken ankle at a football match (classified as a CHARLIE call), why do we not accept (according to the media headlines) that response times Standards do not apply to such calls? which means there is no delay because there is no Standard

This is the double standards, half truths, blatant lies, "motivated" whistleblowers, ill informed journalists, opportunistic private operators, pretend trade unions and contemplative local or by election candidates now jumping on the NAS in Crisis bandwagon.

Be careful what we wish for, we are not positively positioned for outsourcing .........

Looks like every one else is wrong and everything is just rosy in the garden. If Carlesberg had an ambulance service it would be run by the HSE....

The trouble and flaws in the NAS back garden did not start on the introduction of Haddington Road, that's a very blinkered way of looking at the vast bulk of the issues raised....

I repeat..... Until the NAS can prove that they can effectively run and achieve all targets in the other city's to the liking of - the public the hospitals & HIQA it would be premature to tackle a project the size of Dublin....... ....IMO

Why open Battles on all fronts?????

NonBeliever14 · 01-04-2014 1:26pm

I repeat the question then, how do you know they dont meet the Standards in the cities?

crackcrack30 · 01-04-2014 1:38pm

NonBeliever14 wrote: »

CrackCrack30,

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

*****

This is the question you asked..... my answer is that , We should be tackling this with proof that we excel at prehospital care in city/urban enviornments. With the support and backing of all parties concerned prior to looking at a city of over 1 million people.

We cannot say that at the moment...

Millenium Falcon · 01-04-2014 4:39pm

sedgley wrote: »

Having applied to both DFB and NAS before but failing on medical grounds also i'm involved with the vols and I am fairly well informed on the current issues.

I have to say from what has been going on in the media in recent weeks I am in utter disbelief at the amount of flak the HSE NAS have been getting from the media, politicians and also from Dublin Fire Brigade. It seems the usual spin doctors have successfully managed to destroy public confidence in the NAS with a barrage of attacks from RTE primetime, various media outlets, public representatives and IFESA. A lot of the figures being spouted out are just plain lies! The extrapolated figure of DFB calls was found to be 27% not 40% but the papers are still using the 40% figure!

While pointing out certain examples of the services' failures and the misuse of officer cars which I agree is a joke, the media are completely overlooking its many successes. They claim their grievances are with management but the frontline staff are the ones who the public deal with everyday. I can't help but sympathise with the paramedics on the ground who I can imagine are already demoralised as a result of severe cuts to their pay and conditions in recent times. I admire both organisations for the work they do but it would seem that the DFB are taking part in this smear campaign and using it as a cheap shot in a bid to keep their Dublin ambulances. It is also a bizarre coincidence that these so called concerned politicians who ordinarily wouldn't know the difference between the two ambulance services have become overnight experts on the subject now that the elections are just around the corner. The DFB are rallying in the cause of "save our ambulances", as somebody mentioned earlier and as a result it comes across as a "look after ourselves" campaign devoid of any concern about what is best for the public. Both DFB, the media and the political voices have also failed to recognise the presence of the NAS ambulances in Dublin. I am disappointed in the DFB for using the primetime program to basically say "we're better than them" even though the program was about the service in rural countryside areas miles from hospitals. I also noticed on primetime that one scenario in tallaght the DFB had no ambulance but were not held to account??? Whatever bit of respect I had for the Irish media, is well and truly lost. Shame on them for turning the public against their ambulance service by only highlighting the shortcomings and not the good work being done by them everyday.

The HSE contract the DFB to provide 11 ambulances and haven't changed that since the 80's. If there is someone to blame for no ambulance being available during that case in Tallaght it is the HSE.
Unless you think that ambulances can be bi-located?

sedgley · 01-04-2014 5:12pm

Millenium Falcon wrote: »

The HSE contract the DFB to provide 11 ambulances and haven't changed that since the 80's. If there is someone to blame for no ambulance being available during that case in Tallaght it is the HSE.
Unless you think that ambulances can be bi-located?

Surely then this is an argument against the DFB providing an ambulance service? The attitude of "It's the HSE's fault, let them sort it out" has surely influenced their decision to say "ok, not your problem anymore lads"???

sedgley · 01-04-2014 5:13pm

I heard recently on another forum that the HSE have purchased a number of properties in Dublin to serve as ambulance stations. Can anyone from the NAS confirm this?

Tango Alpha 51 · 01-04-2014 6:57pm

NonBeliever14 wrote: »

I repeat the question then, how do you know they dont meet the Standards in the cities?

You appear to have some grievance re other trade unions etc. Can you clarify for me what is a "pretend" trade union as you put it.

Millenium Falcon · 01-04-2014 9:15pm

sedgley wrote: »

Having applied to both DFB and NAS before but failing on medical grounds also i'm involved with the vols and I am fairly well informed on the current issues.

I have to say from what has been going on in the media in recent weeks I am in utter disbelief at the amount of flak the HSE NAS have been getting from the media, politicians and also from Dublin Fire Brigade. It seems the usual spin doctors have successfully managed to destroy public confidence in the NAS with a barrage of attacks from RTE primetime, various media outlets, public representatives and IFESA. A lot of the figures being spouted out are just plain lies! The extrapolated figure of DFB calls was found to be 27% not 40% but the papers are still using the 40% figure!

While pointing out certain examples of the services' failures and the misuse of officer cars which I agree is a joke, the media are completely overlooking its many successes. They claim their grievances are with management but the frontline staff are the ones who the public deal with everyday. I can't help but sympathise with the paramedics on the ground who I can imagine are already demoralised as a result of severe cuts to their pay and conditions in recent times. I admire both organisations for the work they do but it would seem that the DFB are taking part in this smear campaign and using it as a cheap shot in a bid to keep their Dublin ambulances. It is also a bizarre coincidence that these so called concerned politicians who ordinarily wouldn't know the difference between the two ambulance services have become overnight experts on the subject now that the elections are just around the corner. The DFB are rallying in the cause of "save our ambulances", as somebody mentioned earlier and as a result it comes across as a "look after ourselves" campaign devoid of any concern about what is best for the public. Both DFB, the media and the political voices have also failed to recognise the presence of the NAS ambulances in Dublin. I am disappointed in the DFB for using the primetime program to basically say "we're better than them" even though the program was about the service in rural countryside areas miles from hospitals. I also noticed on primetime that one scenario in tallaght the DFB had no ambulance but were not held to account??? Whatever bit of respect I had for the Irish media, is well and truly lost. Shame on them for turning the public against their ambulance service by only highlighting the shortcomings and not the good work being done by them everyday.

Can you show me where you got the figure of 27%? The figures submitted by the NAS SIPTU committee to the public accounts committee suggested that DFB account for aprox 35% of all EMERGENCY 999 ambulance calls. Perhaps you could furnish me with a link?

I would suggest that we are doing our best not to turn this in to a NAS paramedic vs DFB Firefighter Paramedic thing. We are highlighting the inadequacy of the NAS/HSE management system and the fact that the NAS is struggling provide an adequate service outside of Dublin. There will always be a few eegits on facebook who make it personal but thats on both sides.

sedgley wrote: »

Surely then this is an argument against the DFB providing an ambulance service? The attitude of "It's the HSE's fault, let them sort it out" has surely influenced their decision to say "ok, not your problem anymore lads"???

It certainly isn't an argument against the DFB providing ambulances. It highlights the fact that the HSE are not providing enough resources to provide a safe service.
I wonder if anyone can answer what service will be in place if the DFB were removed from medical calls? How many paramedic ambulances will the HSE assign to the Dublin area? How many ICVs? How many Rapid response/officer cars? Will the provision match/exceed/be nowhere near the cover that we now provide in Dublin utilising the fire/EMS model?
Also many speak of the "cost" associated with turning out a fire engine to a medical call. Can someone quantify that cost because the fire crews in Dublin are full time. They are already in the station waiting to turn out and don't get paid any differently if it is quiet or busy. Other than the cost of Diesel, wear and tear and insurance what is the cost?

If the HSE take over in the morning will it be the same, better or worse for the people of Dublin?

NonBeliever14 · 01-04-2014 11:59pm

Tango Alpha,

LCR 20726 is effectively a death sentence for IFESA and by association NASRA. One led by a retired Fireman consumed with self projection through the media, and now it appears to be possibly imposed on some section of the electorate. The other led by a well known disgruntled "Paramedic". His registration history would not engender confidence is his clinical credibility.

The only thing either are good at is building relationships with journalists and using those connections to promulgate half truths and blatant lies. The latest "Kidd Factor" statistics around "DFB do 40% of ALL ambulance calls for 7% of the NAS budget" is a perfect example of how a gullible media, public and regrettably workforce can be sucked into believing such rubbish just because this clown says it. Remarkably, the media never ask these "experts" to validate their claims before publication. Having worked with many fine people in DFB over the years, neither he or the NASRA one are thankfully representative of the average NAS or DFB professional.

My gripe is not with the concept of unions or alternative ones. I am dismayed by the deliberate acts or omissions of these organisations (whom are often just representing a minority of 1 or more) for the furtherance of their own agendas at the expense of NAS reputation and by association the professional reputation of the workforce and the confidence of the public

Millenium Falcon · 02-04-2014 12:29am

NonBeliever14 wrote: »

Tango Alpha,

LCR 20726 is effectively a death sentence for IFESA and by association NASRA. One led by a retired Fireman consumed with self projection through the media, and now it appears to be possibly imposed on some section of the electorate. The other led by a well known disgruntled "Paramedic". His registration history would not engender confidence is his clinical credibility.

The only thing either are good at is building relationships with journalists and using those connections to promulgate half truths and blatant lies. The latest "Kidd Factor" statistics around "DFB do 40% of ALL ambulance calls for 7% of the NAS budget" is a perfect example of how a gullible media, public and regrettably workforce can be sucked into believing such rubbish just because this clown says it. Remarkably, the media never ask these "experts" to validate their claims before publication. Having worked with many fine people in DFB over the years, neither he or the NASRA one are thankfully representative of the average NAS or DFB professional.

My gripe is not with the concept of unions or alternative ones. I am dismayed by the deliberate acts or omissions of these organisations (whom are often just representing a minority of 1 or more) for the furtherance of their own agendas at the expense of NAS reputation and by association the professional reputation of the workforce and the confidence of the public

LCR 20726 is a perfect example of what a closed shop the Irish industrial relations landscape actually is. I agree with your point about a certain individual simply because I believe him to be a divisive character and not one suitable to front an organisation.

I would ask you now to validate you claims as you have mentioned in numerous posts that the DFB are not doing 40% of the calls for 7% of the budget. You seem like you know a good bit more than the ordinary paramedic so I assume you are in a management position within the NAS. I understand you do not wish to identify yourself so it might be difficult to give all details but the DFB do respond to over 70,000 (in fact I think we went over 80,000 last year ambulance cases a year (each one individually tagged with no duplications for extra vehicles etc) on a budget of €9.2 million (plus the extra DCC put in for Swords).
According to the joint DFB/NAS SIPTU submission to the PAC there were 280,572 calls of which 230,433 were EMERGENCY 999 calls last year (2013).
That works out that DFB did approx 35% of the EMERGENCY calls for under 7% of the Budget.
I understand that the urban/rural set up is different and there are factors to be added in but in any mans language that is a pretty decent return.

I again ask you to provide your evidence that the comments made are way off the mark and not just about 5%.

You have also implied about disgruntled NAS staff being to "blame" for the furore. I have yet to meet many gruntled NAS staff when it comes to the current situation. Again this makes you appear to be in a managerial role than on the coalface.

You do have an excellent grasp of the KPI's and figures although I note that you are being somewhat biased and selective in the ones you use (although who isn't on here:rolleyes:).

For example you posted the following

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.

Was DFB at 55%? Was the DFB figure counted seperately from the NAS figure or was all of Dublin counted as one? Was this figure the first response time or the transport vehicle response time. If it was the latter then this again shows how the DFB require more ambulances to cover for the lack of investment in decades. Will the removal of DFB ambulances mean a like for like replacement or will there be a heap of ICVs thrown in and response cars and bikes (which have really burst on the scene the last few days for some reason). How will this increase the transport vehicle response times?
Also since DFB are contracted to provide 11 ambulances what should be happening is that we should not queue a single case when we are maxed out. Instead they should be sent to queue in your system which might bring a bit more realism to the stats in the region.

NonBeliever14 · 02-04-2014 2:22am

MF,

Rightly or wrongly, the reality is IFESA are going no where fast. My opinion (just mine) is that both DFB and NAS would probably see some value in engaging with both. However, both have leadership liabilities and given their origin was in an anti PSA platform, which they subsequently accepted...........It's like voting for Labour and ending up with a FG government!

The current use of the Kidd statement by the media, other unions and Save DFB campaign is disingenuous, misleading, a lie and belittling to the average NAS staff member. A review PQs this week and how TDs has just copied and pasted the same line adds to the offence in my mind. There is no other way to say it.

In relation to stats, my view is that any expression of statistics regarding DFB workload is entirely misleading, regardless of the percentage. Not deliberately so by most (but absolutely so by a few) because the offerer knows the listener does not understand the difference in casemix costs, etc. Most staff, the public, media and politicians have no idea how to cost an ambulance service. Against this backdrop, it is too simplistic a statement, too biased and consequently promulgated widely to support various propaganda messages. As I have previously stated, it is not just direct costs, it is the overhead costs, Control infrastructure, fleet management, education, building, etc. These are carried in the Fire Service budget while NAS carry it in their ambulance budget. Too simplistic a comparison.

Everyone in NAS knows what areas the media spin originates in and most know who's actually doing it. Most will even know whom the journos are.

The Irish Times figure quoted the 19 minute standard, not the 8 minute (first response) standard. The public, media, most politicians and some staff don't know the difference.

The proposal regarding Dublin, I think, is possibly misunderstood. I think the HSE are considering withdrawing the current 9.2m plus the fleet allocation monies and investing in NAS. This does not mean they are taking over or withdrawing DFB. DCC is a statutory agency and as provided for (loosely) in Section 25 of the Fire Service Act, could choose to continue from their own funds.

If NAS expand their existing services (everyone seems to forget they already exist there) in Dublin, then I suspect heavy emphasis on ICV (2 stretcher) to release all existing emergency ambulances along with some new emergency ambulances and new Paramedics to improve the 19 minute performance (transporting vehicle). I would then anticipate additional RRVs to focus on 8 minute performance as cities are not as suitable as rural areas are for CFR schemes. The obvious question is would DFB continue to first respond to support the 8 minute performance as do some other Fire Services in Ireland and in line with Government Policy (Cardiovascular Strategy) (I know KCS contradicts this!)

My final, final comment is that one issue is NEVER considered and ALWAYS overlooked in this debate........NAS has at least 20 emergency ambulances from outside Dublin in Dublin everyday doing transfers. These assets are currently invisible for the most part. Once the National Control Centre is commissioned, TETRA is live nationally and TERRAFIX is fully operable, this is a game changers on an epic scale. Emergency Ambulance availability during the day could double overnight.

Tango Alpha 51 · 02-04-2014 1:15pm

NonBeliever14 wrote: »

Tango Alpha,

LCR 20726 is effectively a death sentence for IFESA and by association NASRA. One led by a retired Fireman consumed with self projection through the media, and now it appears to be possibly imposed on some section of the electorate. The other led by a well known disgruntled "Paramedic". His registration history would not engender confidence is his clinical credibility.

The only thing either are good at is building relationships with journalists and using those connections to promulgate half truths and blatant lies. The latest "Kidd Factor" statistics around "DFB do 40% of ALL ambulance calls for 7% of the NAS budget" is a perfect example of how a gullible media, public and regrettably workforce can be sucked into believing such rubbish just because this clown says it. Remarkably, the media never ask these "experts" to validate their claims before publication. Having worked with many fine people in DFB over the years, neither he or the NASRA one are thankfully representative of the average NAS or DFB professional.

My gripe is not with the concept of unions or alternative ones. I am dismayed by the deliberate acts or omissions of these organisations (whom are often just representing a minority of 1 or more) for the furtherance of their own agendas at the expense of NAS reputation and by association the professional reputation of the workforce and the confidence of the public

Thanks for the clarification. I think every PS worker has a right to be in a union of their own choosing & not one forced on them by certain people. Siptu did nothing for the service in my opinion & Nasra hasn't got any teeth to deal with management.

NonBeliever14 · 03-04-2014 11:08pm

Well said Tony O'Brien.

http://www.98fm.com/reader/523.685/4019/0/

Refreshing to see the Director General of the HSE get behind NAS and publicly correct the half truths and blatant lies being promulgated around the Save Dublin Ambulance Service campaign

Millenium Falcon · 03-04-2014 11:22pm

NonBeliever14 wrote: »

Well said Tony O'Brien.

http://www.98fm.com/reader/523.685/4019/0/

Refreshing to see the Director General of the HSE get behind NAS and publicly correct the half truths and blatant lies being promulgated around the Save Dublin Ambulance Service campaign

So there are 28 HSE ambulances available for calls in Dublin? Where are they? Are they manned?
How many emergency calls do the 28 HSE ambulances do in a year? I assume it is over 140,000 since the 11 DFB do over 70,000?
Or maybe they have to leave Dublin to cover surrounding counties?
Seriously now do you actually stand over the 28 HSE ambulances comment?
He is being fed lines by NAS management that bear no reflection of what is actually happening on the ground. Oh it's great to see all the response cars actually responding now BTW

NonBeliever14 · 04-04-2014 9:43am

MF if you think the DG of a 13+ billion euro organisation with almost 100,000 staff delivering health and social services to the Irish State is going to allow himself to be put into a position where he quotes figures he can't stand over, you're very naive. In fairness, we're not talking about the head of IFESA are we.

The DG is more than capable of standing over his own public statements. He will be more that aware that he will be quizzed in Oireachtas Committees which are televised and made available to the public. To date, he has not shy'd away from being transparent.

Millenium Falcon · 04-04-2014 10:31am

NonBeliever14 wrote: »

MF if you think the DG of a 13+ billion euro organisation with almost 100,000 staff delivering health and social services to the Irish State is going to allow himself to be put into a position where he quotes figures he can't stand over, you're very naive. In fairness, we're not talking about the head of IFESA are we.

The DG is more than capable of standing over his own public statements. He will be more that aware that he will be quizzed in Oireachtas Committees which are televised and made available to the public. To date, he has not shy'd away from being transparent.

So there ARE 28 manned HSE ambulances in Dublin? I mean actual ambulances not motorbikes or response cars or jeeps or minibuses or officer taxis? And I mean manned? At peak times?
Because if there isn't then it might suggest the Head of the HSE (or those who have given him the lines to read) are attempting to bamboozle the health conmittee with fancy statistics. I suppose on this day and age that is no longer called lying but let's just say it's an untruth. The most recent report(wriiten by the HSE) from 2010 suggests this.
Or there is the alternative that the HSE have 28 manned ambulances in Dublin and yet do less than half the calls that the DFB do with 11 ambulances. Even if you take into account spins out to the country to cover the lack of ambulances nationally(which raises another problem) and patient transfers that seems like a very poor return.

I'm not sure which is more damaging really. Maybe you can clarify.

As for being naive about heads of large organisations. Have you been watching the news for the last decade?

NonBeliever14 · 04-04-2014 12:28pm

MF, you're question to the DG is unlikely to secure an answer through www.boards.ie However, I suspect his office would happily respond to your request if you made it directly.

Millenium Falcon · 04-04-2014 1:27pm

NonBeliever14 wrote: »

MF, you're question to the DG is unlikely to secure an answer through www.boards.ie However, I suspect his office would happily respond to your request if you made it directly.

I imagine I would get a stock answer but I am sure the members of the oireachtas health committee might want ...erm... Clarification

ivabiggon · 05-04-2014 11:29am

http://au.news.yahoo.com/video/watch/22382549/anger-over-ambulance-claims/

world wide coverage!!! love his uniform tho, wonder how it rates in terms of been up there with the best!!

CB19Kevo · 09-04-2014 4:45pm

The way i see this is there needs to be massive investment in both DFB and the NAS.
The DFB Model i believe works however they require more ambulances and should be dispatched by/Have direct contact with NAS while also coming within HIQA.
The reasons i believe the DFB model should stay are:
-It improves response times,As there is no way NAS could provide enough resources as DFB without massive cost.
-The experience,Training and working knowledge is already in place.
-It justifies the level of fire cover and crewing which would be vital in the event of a major incident.

While it is clear that the service provided by DFB should be improved i fail to see where the benefit for Dublin would be if NAS took over the service.

The NAS nationally is imo very poor as has been highlighted recently but more importantly has been known to me and many others for years.
This is in no way a reflection of the staff in either service. They are all working under extreme pressure in underfunded services. Response times need to improve and even with new NAS vehicles and staff i believe there has to be considerable consideration to mobilise fire services to life threat incidents even in areas retained brigades operate.

Old diesel · 09-04-2014 5:10pm

CB19Kevo wrote: »

The way i see this is there needs to be massive investment in both DFB and the NAS.
The DFB Model i believe works however they require more ambulances and should be dispatched by/Have direct contact with NAS while also coming within HIQA.
The reasons i believe the DFB model should stay are:
-It improves response times,As there is no way NAS could provide enough resources as DFB without massive cost.
-The experience,Training and working knowledge is already in place.
-It justifies the level of fire cover and crewing which would be vital in the event of a major incident.

While it is clear that the service provided by DFB should be improved i fail to see where the benefit for Dublin would be if NAS took over the service.

The NAS nationally is imo very poor as has been highlighted recently but more importantly has been known to me and many others for years.
This is in no way a reflection of the staff in either service. They are all working under extreme pressure in underfunded services. Response times need to improve and even with new NAS vehicles and staff i believe there has to be considerable consideration to mobilise fire services to life threat incidents even in areas retained brigades operate.

Fair enough on Dublin - but nationally - theres the option of improving the NAS a lot more.

Start funding it and resourcing it properly - so if you need 30 Ambulances in an area - that's what will be provided - fully crewed

Think theres a culture within health service - of trying to make do tbh

While theres great merit in having fire personnel responding to calls as first responders - I think we should also consider the idea of evolving the West and East Cork Rapid response model - where you have a doctor responding to 999 calls - fully trained and kitted out.

I think we should evolve it to the point - where NAS/the state provides funding so that the doctors are PAID to respond to the 999 calls.

Having the doctors as additional resources seems to work really well in Cork - especially when they bring even more skills to the job then even an Advanced Paramedic would have.

Could the likes of GPs and/or local nurses in areas - be trained in 999 response too???.

Youd need extra resources still - but isn't it another option in terms of getting extra resources on the road???.

So for example - say you have 10 nurses in an area working - so say you had 13 instead - and 1/2/3 of them would be on call to go to 999 calls as first responders.

The question then araises - what level do you train them too - Paramedic???

Nothing againsed the firefighter/paramedic model - it works well in Dublin - but not sure how well it would work in a retained model.

Its asking a lot of retained fire personnel I think.

Change of mindset is whats needed - resource the Ambulance service properly with NAS Paramedics and Advanced Paramedics.

Look at back up resources - you've got firefighters who as you say could be trained up.

You could consider training a certain number of nurses for 999 response - perhaps you could organise the staffing so a nurse might do 4 days a week on "normal" nursing work - and one day a week on 999 response??? - put in extra nursing resources to allow that???.

Also look at integrating a 999 responder model into the primary care centre - id boils my urine to think of the idea - that I might be waiting 40 mins for an Ambulance if they are all out on calls - yet - there might be staff in the Primary care centre - who aren't dealing with life treatning situations - 10 mins down the road - but no way of mobilising them :mad::mad::mad:

And of course we have the East Cork and West Cork rapid response model - id love to see that evolved so that the doctors are paid by the state to respond to these 999 calls rather the voluntary.

That's where funding the service properly and resourcing it properly comes in.

Sorry for the long post - thinking aloud here

NonBeliever14 · 21-02-2015 5:11am

The publication of the Dublin Review must be getting close now. It looks like at least one journalist is collecting some information for a story to be ready to go when it gets leaked:

http://

health.gov.ie/wp-content/uploads/2015/02/FOI-2014-73.pdf

Anyone any views on what it is likely to recommend?

snoone · 02-03-2015 10:42pm

Dublin City Manager announced tonight at monthly council meeting that the HSE are taking over the running of the ambulance service ?

NonBeliever14 · 02-03-2015 10:49pm

I presume the media report refers to "taking over ambulance calls", I.e. Control arrangements, not running the actual ambulances. I suspect this is a knee jerk reaction to both the HIQA report and the recent debacle over a 999 call being held (allegedly). This was always an inevitability once NAS NEOC established but I suspect it may be actioned until NAS NEOC is running the rest of the country. Wexford and Tullamore yet to transition. Dublin would be the next logical step once those moves are complete and stabilised.

snoone · 02-03-2015 11:28pm

Will DFB ff's allow HSE 'control' them?

palmtrees · 03-03-2015 12:10am

snoone wrote: »

Will DFB ff's allow HSE 'control' them?

I'd imagine the DFB ambulance crews be left sitting in the station if they didn't.

What's the big issue here? They're not taking over the ambulance service, they're just getting dispatched by somebody wearing a different uniform...I really don't see the issue?

greenmat · 03-03-2015 12:25am

palmtrees wrote: »

I'd imagine the DFB ambulance crews be left sitting in the station if they didn't.

What's the big issue here? They're not taking over the ambulance service, they're just getting dispatched by somebody wearing a different uniform...I really don't see the issue?

You'll find out soon enough when you ring for an Ambulance in Dublin and find out it's coming from Wexford.

palmtrees · 03-03-2015 12:35am

greenmat wrote: »

You'll find out soon enough when you ring for an Ambulance in Dublin and find out it's coming from Wexford.

I'm a bit confused by the apparent scaremongering there, can you please clarify:

Are you saying that they will deliberately send an ambulance that is not the nearest to me if I call 999?

Or are you saying that if the closest available ambulance (either DFB or HSE) will be sent to me if I call 999?

easygoing1982 · 03-03-2015 12:57am

Does this mean DFB will go on to the HSE radio system(tetra) or will the HSE go on to the DFB radio.

sjb25 · 03-03-2015 9:13am

greenmat wrote: »

You'll find out soon enough when you ring for an Ambulance in Dublin and find out it's coming from Wexford.

Sumting like that will only happen If all resources in dublin both DFB and NAS are tied up on calls the other closer counties meth Kildare Wicklow would respond stop scaremongering

One control for all ambulance resources makes sense instead of ringing and ambulance getting one control if they have Notting they have to ring the other ti ask them do they when this starts you call an ambulance ambulance control will dispatch nearest available be they DFB or NAS straight away

Dublin Fire Brigade losing ambulances to HSE

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