Dublin Fire Brigade losing ambulances to HSE

discus · 18-03-2014 10:13am #1

So, the HSE gives 9 million euro annually to DFB, to run the ambulances in dublin. The DFB respond to 40% of all calls nationally. Yet the other 60% of ambulance calls are funded by the remainder of the ambulance budget which is 125 million euro.

Why the disproportion?

It will be a terrible decision to make. I expect losing ambos from dublin means our firemen will no longer be dual trained.

NonBeliever14 · 18-03-2014 12:24pm

1st point: Lets look at some numbers. In 2013, NAS responded to 860,000+ calls. Even if you believe the 75,000+ DFB claim? (and remember, they report actual verified numbers to the HSE so they will know the actual amount) this does not equate to "40%". Remeber, just because you hear a bark, doesn't mean it came from a dog.

2nd point: every health system uses "casemix" to determine accurate workload and expected resource consumption. In simple terms, the cost of "a call" responded to from Dolphin's Barn DFB Station for a Chest Pain (let's say it is a STEMI) is a fraction of the cost of "a call" responded to from Castletownbere NAS Station for a Chest Pain (let's say it is a STEMI). One "call" will result in disposition of the patient in possibly 20 minutes with limited labour and non labour costs while the other exact same "call" could take 2 hours to result in patient disposition and may involve the use of a helicopter (comparing apples with oranges)

3rd point: Fire Based EMS is predominantly a US model and one that is almost exclusively "city" based. NAS does not have the luxury of a dozen Stations in a small city scape environment. Instead, NAS is expected to deliver the same level of response from Mizen Head to Malin Head. Comparing these two organisations is at best farcical. The top three ambulance services in the world are "not" integrated with Fire but with the health system.

4th point: EMS is an out of date term from the US. Today, the worlds most progressive and innovative ambulance services treat about 40-50% of their workload without lights and sirens and without going to hospital. The future of Pre Hospital Emergency Care lies in diversification into "Out of Hospital" care. A subtle but important difference which can only be achieved if the ambulance service is integrated with Primary, Social, Children and Family and Mental health Services. Fire Services have an important role to play in "first response" to life threatening calls but in reality, these are a small proportion of any modern or future ambulance services workload. Lot's of international experience on this point.

5th point: Paramedic CPC (when it arrives from PHECC) will become a huge financial millstone for every registrant and any approved service provider. It will improve patient safety and the quality of care provided. It is unsustainable to suggest that DFB should continue to spend money upskilling 800 Paramedics to have just over 100 provide an emergency ambulance service. If we are all so confident that Paramedics on Fire Engines are "necessary", let's do a transparent audit of everyone's practice to see how many interventions (at Paramedic level) they did that someone else did not also claim credit for. Again, Fire Services have an important role to play in "first response" to life threatening emergencies but not just in Dublin.

Last point: wanting to continue to do something because you have done it a particular way for 150 years is not a valid reason to avoid change. Again, if we are confident the system as is works, why do we still have duplicate responses, why did the C&AG recommend elimination of duplicate control arrangements. Why not have a review by appropriate experts whom can confirm that Dublin needs 800+ Firefighters to do approx 15000 fire calls (about 4000 are hoax or alarm calls) and that doing the emergency ambulance work is not a form of subvention to shoulder the cost of having a standing army of Fire fighters (I know nothing about Fire Services)

Not for a moment taking away from the best intentions of anyone trying to deliver services but don't be blinkered by the usual commentators and journalists whom are so hungry for print copy they will print anything regardless of the validity of all of the content.

Beano · 18-03-2014 2:51pm

Perhaps someone here could educate me a little. Lets assume that the ambulance services are taken away from DFB and given to NAS.

Where would the NAS ambulances be based?
Do NAS have the same number and spread of locations that the DFB has?
What effect will this have on response times?
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?
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?
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.
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.

kub · 18-03-2014 4:31pm

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.

Where would the NAS ambulances be based?
Do NAS have the same number and spread of locations that the DFB has?
What effect will this have on response times?
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?
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?
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.
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.

I trust you are aware that HSE operate the Ambulance service in Cork as well? Which while being smaller than Dublin is still an urban area, now I don't know but I have not heard of any paramedics down there suffering from exhaustion.
As a matter of fact if I recall correctly Cork city fire department used to do the ambulance service in Cork and stopped back in the 70's.

Beano · 18-03-2014 4:35pm

kub wrote: »

I trust you are aware that HSE operate the Ambulance service in Cork as well? Which while being smaller than Dublin is still an urban area, now I don't know but I have not heard of any paramedics down there suffering from exhaustion.
As a matter of fact if I recall correctly Cork city fire department used to do the ambulance service in Cork and stopped back in the 70's.

thank you for answering one of the questions i posed.

kub · 18-03-2014 4:42pm

Beano wrote: »

thank you for answering one of the questions i posed.

Well that about completes my knowledge on the subject.

Just wondering is this official and does it mean or dare I say it, that it may be a sign that the powers that be might be setting up a National Fire Service?

mhaise · 18-03-2014 4:54pm

HSE are not perceived to have a stellar record in many areas of healthcare, seems to be more about the about the bottom line. Like in any war there are "acceptable casualties" rates.
Recently in CountyMayo when Mulranny based Dr Jerry Crowley requested an ambulance for a patient he was informed that the two ambulances based in the county were out of the county attending an accident. In such circumstances what about the "golden hour" there?
If it was a heart attack or stroke victim it's the services of an undertaker he'd require as rigour mortis would have long set in before an ambulance was dispatched to him/her

Beano · 18-03-2014 5:00pm

kub wrote: »

Well that about completes my knowledge on the subject.

Just wondering is this official and does it mean or dare I say it, that it may be a sign that the powers that be might be setting up a National Fire Service?

would that involve bringing the rest of the country up to the standard of Dublin or reducing Dublin to the same standard as the rest of the country?

Mycroft H · 18-03-2014 8:02pm

kub wrote: »

Well that about completes my knowledge on the subject.

Just wondering is this official and does it mean or dare I say it, that it may be a sign that the powers that be might be setting up a National Fire Service?

I highly doubt there will ever be a national fire service. It's too much of a headache to set up and not really needed at all.

kub · 18-03-2014 9:42pm

Mycroft H wrote: »

I highly doubt there will ever be a national fire service. It's too much of a headache to set up and not really needed at all.

Sorry but i thought it would be a good idea, let people who know all about the Fire Service run it instead of local authorities. Let the organisation have its own budget and resources.

I remember a few years back there was a house fire in County Kerry fairly close to the border with Cork. The Kerry crew called for assistance and an appliance was dispatched to the scene from a Co Cork station.

Unfortunately when they got there they could not refill with water as their couplings were a different size to the Kerry ones. Again the effect of different local authorities which i hope has been ironed out since then.

discus · 18-03-2014 11:06pm

That was an enlightening response from nonbeliever. Anyone from DFB have an opinion?

petergfiffin · 19-03-2014 8:58am

Aside from the financial part of this, how is all of this going to be resourced? I would have thought the number of ambulance staff working in the HSE is based on the HSE's current workload (and then some), if they now take on the DFB workload too where are the extra staff coming from? Are they now going to go and hire new staff (extra cost)? If so then how much experience is going to be lost?

The HSE claim it "has inadequate control over the almost €10 million it contributes to the cost of running the ambulance service. Given the above deficits [Dublin’s ambulances]...should now be provided by the HSE."
http://www.irishtimes.com/news/politics/tds-criticised-hse-plan-to-take-over-dublin-ambulance-duty-1.1730102 yet this is the same organisation who in 2012 gave €41.3m to Rehab & €16.2m to the CRC (http://www.thejournal.ie/hse-grants-funding-crc-rehab-group-1276738-Jan2014/) with - it would appear - absolutely no control over how that money was spent.

Even if the number of actual ambulances may be retained at the same level (which I wouldn't trust the HSE to do) you will still lose out because - as I've witnessed myself - the DFB will very often send a fire engine or other appliance to a non-critical call if the ambulance is on another call or otherwise not available not forgetting most most if not all DFB staff are also trained paramedics.

GoProGaming · 19-03-2014 10:32am

the nas have an *almost full paramedic panel and emergency medical dispatcher panel ready and waiting to be trained. so in theory they could easily fill the gaps.

*a few have been drawn from each already and are shortly beginning training.

supermedic · 19-03-2014 10:37am

nonbeliver, excellent post.

Far too many people believing the fire based ems thing being pushed by Mr. Kidd et al. The "protect what we have at all cost" is a natural reaction by the lads in the DFB.

Relatively easy to appear to be running a good service when you have a small area of coverage compared to the rest of the state, you have a minimum manning level which is hard to justify on the level of fire / rescue work being carried out, you have access to hospitals within a very short travel time, you appear to have no issue with covering shifts on overtime.

DCC published a list of all calls for 2011, even if it was accurate, it still shows a call volume of 16 calls per 24 hour period per ambulance, very busy but not impossible given the short journey to call and return to hospital distances.

Is it now possible to continue to train / refresh ? 800 people to run a service that only needs about 120 to achieve the same result.

The only reason the DFB can send the kitchen sink and the pipe band to everything is that they are there , being paid and doing very little else. Does that make it right. There will be a handful of incidents each day where additional manpower in handy to have, by nothing that needs 8 paramedics all pushing each other out of the way to touch a patient.

Nonbeliever is right when CPC arrives next year and everyone has to show what they have being doing, that will be interesting. All NAS do patient care all the time nothing else, admittedly some areas have small calls volumes, but how many interventions will a sub officer/paramedic in DFB make any year?

Many thousands of the DFB are omega and alpha calls yet are all responded to as code 1 both to the call and 2 the hospital. In 25 years I have never seen a DFB ambulance arrive to an ED with no lights. Clinical risk ?? Legal risk ??

The NAS have serious issues at present related to a diminishing budget, a 10 % increase in calls last year and a lot of ongoing change. If the DoH got serious and funded the NAS properly, all the negative stuff in the press would stop and the service could be top notch.

Beano · 19-03-2014 10:39am

GoProGaming wrote: »

the nas have an *almost full paramedic panel and emergency medical dispatcher panel ready and waiting to be trained. so in theory they could easily fill the gaps.

*a few have been drawn from each already and are shortly beginning training.

so you suggest you withdraw all of the trained and experienced DFB personnel from ambulance work and replace them with NAS staff that haven't been trained yet? I cant see any problems with that at all.

I cant see any benefits to the people of Dublin with this change. And i cant see how the HSE think they can do it cheaper and maintain the same standards. The HSE are not known for their financial prudence. This all seems like a land-grab on the part of the HSE.

Beano · 19-03-2014 10:47am

You seem to have a lot of experience in this area supermedic. care to answer some of the questions i asked earlier?

NonBeliever14 · 19-03-2014 10:53am

Beano, I'll give it a go:

Where would the NAS ambulances be based?

They don't have to be "based" anywhere. You only have to look at the UK's best performing services to see "HUB and SPOKE" is how they deliver services. One Station for Dublin would be sufficient with resources then deployed tactically and dynamically using leading edge systems such as Optima or Signals for Noise to provide evidence based deployment (and performance)

Do NAS have the same number and spread of locations that the DFB has?

As above. Ireland's system of Ambulance Stations is outdated by comparison with the best performing services

What effect will this have on response times?

With the right technology, training and work practices, drastically improved. A significant enabler to do this in Dublin is the Intermediate Care Service which will free up existing Emergency Ambulances for tactical deployment to emergency calls.

Presumably NAS would have to purchase new ambulances to cover the dublin region, yes? NAS have in excess of 300 emergency ambulances with a 13% spare capacity built in for planned and preventative maintenance. Putting an extra 12 vehicles is easily achieveable while additional vehicles are built.

Or are DFB expected to hand over their ambulances to NAS?

NAS provide the capital money to purchase the ambulances already (FOI request will confirm)

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?

Obviously, NAS would need to spend some of the 9.2m on additional ICS, Paramedic and Control staff. My guess is about 6m. They would still save money and bring all ambulance services under the legislative scrutiny of HIQA which does not have powers of inspection or regulation over Fire Services. ICS and Control staff are paid less than Firefighters. ICS staff can first response to ECHO/DELTA and be the sole response to low acuity calls

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.

Why should it be different in Dublin? Every where else in Ireland, UK, NZ, Australia, most of Canada and parts of the US, you work on ambulance full time.

Will DFB personnel no longer be dual-trained? After all they wont be doing ambulance work so why spend the money.

Why would you? Unless you can evidence base that they are currently practicing as Paramedics when not on ambulances currently. It would make economical and patient safety sense to train all Fire Fighters as EFRs (not just in Dublin). EFRs are acceptable by HIQA as a first response to ECHO/DELTA

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?

I would be interested to see a critical appraisal of ALL available literature on the subject that evidence bases that statement. If only all people in Ireland lived in a "city", would we be able to provide a great service. As previously stated, NAS does not have the luxury of providing services in a small city scape environment. The HSE, through NAS, does has statutory for providing services to the entire country (including all of Dublin), hence why they financially subvent DCC. You can confirm this by reviewing the relevant legislation.

Hopefully helpful with your questions

Beano · 19-03-2014 11:54am

NonBeliever14 wrote: »

Beano, I'll give it a go:

Where would the NAS ambulances be based?

They don't have to be "based" anywhere. You only have to look at the UK's best performing services to see "HUB and SPOKE" is how they deliver services. One Station for Dublin would be sufficient with resources then deployed tactically and dynamically using leading edge systems such as Optima or Signals for Noise to provide evidence based deployment (and performance)

Do NAS have the same number and spread of locations that the DFB has?

As above. Ireland's system of Ambulance Stations is outdated by comparison with the best performing services

What effect will this have on response times?

With the right technology, training and work practices, drastically improved. A significant enabler to do this in Dublin is the Intermediate Care Service which will free up existing Emergency Ambulances for tactical deployment to emergency calls.

What do mean by tactically deployed? I currently live less than a minute from a fire station. I can see it from my house. Surely the response times from my perspective will get worse? How can traveling from a greater distance improve response times?

NonBeliever14 wrote: »

Presumably NAS would have to purchase new ambulances to cover the dublin region, yes? NAS have in excess of 300 emergency ambulances with a 13% spare capacity built in for planned and preventative maintenance. Putting an extra 12 vehicles is easily achieveable while additional vehicles are built.

Or are DFB expected to hand over their ambulances to NAS?

NAS provide the capital money to purchase the ambulances already (FOI request will confirm)

So no saving at all in capital terms then?

NonBeliever14 wrote: »

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?

Obviously, NAS would need to spend some of the 9.2m on additional ICS, Paramedic and Control staff. My guess is about 6m. They would still save money and bring all ambulance services under the legislative scrutiny of HIQA which does not have powers of inspection or regulation over Fire Services. ICS and Control staff are paid less than Firefighters. ICS staff can first response to ECHO/DELTA and be the sole response to low acuity calls

I'm sure when your guess meets reality it will be a lot closer to 9 than it is to 6. I cant see any savings here at all.

NonBeliever14 wrote: »

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.

Why should it be different in Dublin? Every where else in Ireland, UK, NZ, Australia, most of Canada and parts of the US, you work on ambulance full time.

NonBeliever14 wrote: »

Will DFB personnel no longer be dual-trained? After all they wont be doing ambulance work so why spend the money.

Why would you? Unless you can evidence base that they are currently practicing as Paramedics when not on ambulances currently. It would make economical and patient safety sense to train all Fire Fighters as EFRs (not just in Dublin). EFRs are acceptable by HIQA as a first response to ECHO/DELTA

I have no idea what ECHO/DELTA means.

how could it make more patient safety sense to train firefighters as EFRs rather than paramedics? Surely you want people working on patients to be as qualified as possible? The economic argument doesn't seem to stand up either.

NonBeliever14 wrote: »

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?

I would be interested to see a critical appraisal of ALL available literature on the subject that evidence bases that statement.

i based that statement on this article

http://www.independent.ie/entertainment/tv-radio/firefighters-make-our-capital-one-of-safest-places-to-have-heart-attack-26844171.html

Surely you can see that the faster you can get a qualified person to a patient having a heart attack the better the survival rates will be.

NonBeliever14 wrote: »

If only all people in Ireland lived in a "city", would we be able to provide a great service. As previously stated, NAS does not have the luxury of providing services in a small city scape environment. The HSE, through NAS, does has statutory for providing services to the entire country (including all of Dublin), hence why they financially subvent DCC. You can confirm this by reviewing the relevant legislation.

What luxury do you refer to? The cost of NAS providing the service versus DFB providing the service seems to me to be pretty comparable. And the fact is that Dublin is a city so it makes sense to tailor the service appropriately. The system that works outside dublin will not necessarily work in Dublin. If the system outside dublin can be said to work at all.

NonBeliever14 wrote: »

Hopefully helpful with your questions

Helpful yes, but ultimately not convincing.

Beano · 19-03-2014 12:51pm

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.

NonBeliever14 · 19-03-2014 12:57pm

Hi Beano, I'm not trying to convince you.......

If you don't know what tactical deployment is or what ECHO/DELTA calls are or are using a quote from the Irish Independent to substantiate a statement about cardiac arrest survival rates, well..........you can make up your own mind about what you know about how an ambulance service is delivered.

Your theory about "seeing the fire station from your house" would be great if the rest of the population could do the same. You know the answer to that one too. Hopefully you don't move.

In relation to cost of service delivery, my first post refers to the principle of case mix.

Public sector pay rates are a matter of public record and a guess of 6m is accurate (FOI request will get you pay rates)

Paramedic CPC is dependent of currency of practice at the Paramedic level. That means interventions that cannot be done by a lower scope of practice. If you can't support CPC for all Paramedics then all Paramedics can not deliver safe patient care (there is a significant body of literature on currency of practice across a range of healthcare professions)

In relation to tailoring services to cities and beyond, you may want to read the National Standards for Safer Better Healthcare.......

miju · 19-03-2014 12:59pm

You say

Beano wrote: »

I have no idea what ECHO/DELTA means.

and somehow feel qualified to also say

Beano wrote: »

I'm sure when your guess meets reality it will be a lot closer to 9 than it is to 6. I cant see any savings here at all.

:rolleyes::rolleyes::rolleyes::rolleyes::rolleyes::rolleyes::rolleyes::rolleyes:

Beano · 19-03-2014 1:00pm

NonBeliever14 wrote: »

Hi Beano, I'm not trying to convince you.......

If you don't know what tactical deployment is or what ECHO/DELTA calls are or are using a quote from the Irish Independent to substantiate a statement about cardiac arrest survival rates, well..........you can make up your own mind about what you know about how an ambulance service is delivered.

Your theory about "seeing the fire station from your house" would be great if the rest of the population could do the same. You know the answer to that one too. Hopefully you don't move.

In relation to cost of service delivery, my first post refers to the principle of case mix.

Public sector pay rates are a matter of public record and a guess of 6m is accurate (FOI request will get you pay rates)

Paramedic CPC is dependent of currency of practice at the Paramedic level. That means interventions that cannot be done by a lower scope of practice. If you can't support CPC for all Paramedics then all Paramedics can not deliver safe patient care (there is a significant body of literature on currency of practice across a range of healthcare professions)

In relation to tailoring services to cities and beyond, you may want to read the National Standards for Safer Better Healthcare.......

So I'll just go back to being one of the uneducated masses and let people who know better make these decisions then? I presume you are one of the people who think they know what is best? Your only interest in this is what is best for the people of dublin?

Beano · 19-03-2014 1:03pm

miju wrote: »

You say

and somehow feel qualified to also say

:rolleyes::rolleyes::rolleyes::rolleyes::rolleyes::rolleyes::rolleyes::rolleyes:

well first off the 6 million is a guess by the poster. And even if it was an official figure from the HSE i still doubt they could come even close to reaching that figure in reality. Cos we all know that the HSE are fantastic for keeping within budget.

and spare me the rolleyes. it only makes you look like an idiot.

miju · 19-03-2014 1:04pm

Beano wrote: »

So I'll just go back to being one of the uneducated masses and let people who know better make these decisions then?

To put it quite bluntly yes your not an expert in this field obviously from your posts and by the time you would be qualified to not be one of the "uneducated masses" it will be 5-10 years down the line.

It's like me going into a construction site and telling the foreman, brickies and sparks how to build a house even though I've never been near a building site.

Beano · 19-03-2014 1:05pm

miju wrote: »

To put it quite bluntly yes your not an expert in this field obviously from your posts and by the time you would be qualified to not be one of the "uneducated masses" it will be 5-10 years down the line.

It's like me going into a construction site and telling the foreman, brickies and sparks how to build a house even though I've never been near a building site.

and what qualifications do you bring to the party?

miju · 19-03-2014 1:06pm

Beano wrote: »

well first off the 6 million is a guess by the poster. And even if it was an official figure from the HSE i still doubt they could come even close to reaching that figure in reality. Cos we all know that the HSE are fantastic for keeping within budget.

and spare me the rolleyes. it only makes you look like an idiot.

But what do you know about HSE procurement practices or the fact of how much their procurement and service level changes have saved in 2013??

I know the answer of course because I'm involved in that field, you on the other hand dont but still feel compelled to a: question others figures b: call people idiots :rolleyes::rolleyes::rolleyes::rolleyes::rolleyes::rolleyes::rolleyes::rolleyes:

Beano wrote: »

and what qualifications do you bring to the party?

Don't normally do this but I've over 20 years in emergency medicine, emergency governance, emergency planning, policy design / creation at a national level for a major voluntary ambulance service, budget and category spends of over €150m in public procurement and development of a CAD system.

Please do continue

Beano · 19-03-2014 1:09pm

miju wrote: »

But what do you know about HSE procurement practices or the fact of how much their procurement and service level changes have saved in 2013??

I know the answer of course because I'm involved in that field, you on the other hand dont but still feel compelled to a: question others figures b: call people idiots :rolleyes::rolleyes::rolleyes::rolleyes::rolleyes::rolleyes::rolleyes::rolleyes:

again with the rolleyes. calm down dear.

Beano · 19-03-2014 1:10pm

miju wrote: »

But what do you know about HSE procurement practices or the fact of how much their procurement and service level changes have saved in 2013??

I know the answer of course because I'm involved in that field, you on the other hand dont but still feel compelled to a: question others figures b: call people idiots :rolleyes::rolleyes::rolleyes::rolleyes::rolleyes::rolleyes::rolleyes::rolleyes:

Don't normally do this but I've over 20 years in emergency medicine, emergency governance, emergency planning, policy design / creation at a national level for a major voluntary ambulance service, budget and category spends of over €150m in public procurement and development of a CAD system.

Please do continue

and in all those years of experience projects have not gone over budget?

miju · 19-03-2014 1:12pm

Beano wrote: »

and in all those years of experience projects have not gone over budget?

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?

NonBeliever14 · 19-03-2014 1:14pm

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

Old diesel · 19-03-2014 1:18pm

Maybe rather then say DFB vs NAS - isn't it better to think - what we want is a very good/top class Ambulance service.

So how do we achieve that - that's what needs to be focused on I think.

Two vital things that matter imo - firstly having the resources and systems in place to have good response times - but equally important is having very good, very well trained personal delivering very good treatment and care in the pre hospital environment to patients.

So how do we achieve that - is surely the key question imo.

Beano · 19-03-2014 1:18pm

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?

Beano · 19-03-2014 1:19pm

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.

Beano · 19-03-2014 1:23pm

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?

miju · 19-03-2014 1:29pm

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.

Beano · 19-03-2014 1:44pm

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.

Bang Bang · 19-03-2014 4:51pm

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.

Old diesel · 19-03-2014 5:20pm

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.

Old diesel · 19-03-2014 5:23pm

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.

flazio · 19-03-2014 11:28pm

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.
Where would the NAS ambulances be based?

Do NAS have the same number and spread of locations that the DFB has?

What effect will this have on response times?

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?

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?

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.

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.

In ambulance bases or hospitals,
In other cities no, is it adequate, in all honesty I'd say no, there have been poor response times of late.
Can't be told until new system is implemented.
If the DFB fleet are in good nick then NAS will likely purchase them
Well since the NAS concentrate on one job rather then two, they can employ less
Works everywhere else in the country.
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

sjb25 · 20-03-2014 12:19pm

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

truebluesac · 20-03-2014 12:54pm

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 .

Old diesel · 20-03-2014 1:07pm

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.

truebluesac · 20-03-2014 1:27pm

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 ???

miju · 20-03-2014 1:58pm

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?

Bang Bang · 20-03-2014 2:01pm

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.

miju · 20-03-2014 2:05pm

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

Bang Bang · 20-03-2014 2:15pm

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?

miju · 20-03-2014 2:18pm

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.

Paulzx · 20-03-2014 2:45pm

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.

Beano · 20-03-2014 3:00pm

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

Dublin Fire Brigade losing ambulances to HSE

Comments