Ambulance's tied up

5500

I just came across this link from last week

By Allison Bray


Wednesday September 30 2009

A NUMBER of people in Dublin who rang for an ambulance to be taken to hospital yesterday for treatment ended up being ferried in the front seat of a fire engine.

The fire brigade engine was used because almost the entire fleet of fire brigade emergency ambulances in Dublin was held up at an A&E ward in the Mater Hospital throughout the day.

The ambulances and their crews were kept at A&E after delivering patients but a backlog in the emergency department meant that patients had to remain on the ambulance stretchers in the hospital.

Beaumont Hospital, which will take up the overflow from the Mater Hospital if requested to do so, was also extremely busy yesterday with 31 patients on A&E trolleys as of 5pm, according to a spokesman.

- Allison Bray

Irish Independent

Source - http://www.independent.ie/health/latest-news/patients-carried-in-fire-engine--due-to-backlog-1899768.html

Are the indo fairly close on this one or miles off the mark?How many ambulances were actually tied up/left covering the city?

Do large volumes of que'd call's happen on a daily basis?Also what are the implications of taking someone to hospital in an engine,ie are they insured to carry patients or who makes the call to do it?

alentejo

I suspect that patients are not allowed to be carried in a fire engine.
DFB would dispatch fire engines to certain kinds of medical cases if there is a delay in dispatching a ambulance. This happens on a regular basis.

Paulzx

Queued ambulance cases are a regular occurance.

Fire engine crews babysitting patients until ambulances become available are a regular occurance.

Patients being transported to hospital in Fire engines is not a common situation

triple-M

so what happens if there is a severe injury broken back and there is no ambulance available does the injured person still have to get in a fire brigade or do they have to wait?

timmywex

triple-M wrote: »

so what happens if there is a severe injury broken back and there is no ambulance available does the injured person still have to get in a fire brigade or do they have to wait?

They wait! Obviously though they would be priooritiesed because that is such a serious injury, there would be the other option of calling the hse, depending on resources!

sgthighway

If Ambulances had the same model ot two trolleys you would imagine there would be spares for some cases. e.g. Joe Blogs with a knee or ankle injury can be left in A&E on the ambulance trolley and the crew take a spare trolley. It would work in some cases.

maglite

I think you would have a problem with a nurse or who ever assuming responsibility for someone on an ambulance trolly.

And if they have a knee or ankle injury that has been triased and not treated go to the waiting room.

Paulzx

timmywex wrote: »

They wait! Obviously though they would be priooritiesed because that is such a serious injury, there would be the other option of calling the hse, depending on resources!

Hse would already have been called before a case is queued irrespective of the seriousness of the case. If they have no ambulance available the case is then queued. A life or death case will obviously have an ambo redirected from another case.

ivabiggon

but i have seen cases before been brought by fire truck and have been present on 3 occasions either driving or in the back fo the truck on these occasions, some times even a priority case can't get an ambulance quick enough because theirs none.
but getting back to the delay in the hospital 2 northside hospitals are renowned for it and i think it's only to further their own conditions, ambo crew regularly delayed for up to 4 hours or more and have even brought people to xray and back without off loading them to the hospital staff

Delancey

Disturbing story alright , but I would love to drill down into the numbers and see just how many of the patients waiting were real emergencies ?

A number of years ago I was badly in jured in an accident , DFB ambulance attended the scene and took me away ( great guys ) but I remember them telling me that I was the 6th call they had done that day but was the first that really needed an ambulance , the other 5 calls had been '' glorified taxi calls ''.
Having worked in 999 I can tell you that people reporting toothache are getting ambulances ( that is no exaggeration ) . Perhaps with recession on us a tougher line may be taken with bullshlt calls ?

BizPost

Is there a certain point they call in army/ Vol ambulance, surely has to be better option than putting someone in a fire engine?

Hooch

BizPost wrote: »

Is there a certain point they call in army/ Vol ambulance, surely has to be better option than putting someone in a fire engine?

Only in major emergencys. PHECC require a minimum of Paramedic on AS1 (emergency) ambulances. Vols dont have this and army only have very few in the curragh.

5500

Paulzx wrote: »

Hse would already have been called before a case is queued irrespective of the seriousness of the case. If they have no ambulance available the case is then queued. A life or death case will obviously have an ambo redirected from another case.

I dont want to open a can of worms with this but how many hse ambulance's are there covering dublin?In que'd case scenario's would other ambulances doing pts work normally be redeployed to clear the backlog?

Hooch

eireal wrote: »

I dont want to open a can of worms with this but how many hse ambulance's are there covering dublin?In que'd case scenario's would other ambulances doing pts work normally be redeployed to clear the backlog?

Dublin is covered by DFB and HSE ambulances. Might be wrong but I think its 11 at anyone time???

5500

Yep its 11 dfb (12 if swords is still running) ambulances,if the majority of these were tied up at a hospital like the article reported im wondering how many hse's ambulances would have been left covering the city or if they also would have been tied up with pts ect

stop

nice guy always wrote: »

Only in major emergencys. PHECC require a minimum of Paramedic on AS1 (emergency) ambulances. Vols dont have this and army only have very few in the curragh.

I've seen a PDF ambo pick someone up (was flagged down by peeps thinking it was DFB ambo) while it was dropping off lab samples in belfield (I think) and they had no problems about picking up & dropping the patient down to Vincent's. I assume those PDF staff would fall into the catagory you mentioned above?

maglite

I would again assume that taking over form a paramedic on a truck would not qualify as AS1. Given that technically a vol could meet up with one of these cases and transport. But the muster time would be significant so much so i would assume another DFB/HSE would be freed.

I also gather this is political by the hosp and not an issue of not enough ambulances. So aother 10 RC/OMAC/CD's would do little.

Smokey Bear

I heard that there was 8 DFB ambulance tied up in the Mater rest at other A+E 's Dept,HSE ambo's were tied up as well.2 or 3 HSE ambo's came down from Dundalk to respond to cases with 1 DFB left doing cases on southside.
All you have to do is Google the topic and you will see how long it has ben going on for.Article below is from 2003.
http://www.accessmylibrary.com/coms2/summary_0286-23895078_ITM

Smokey Bear

timmywex

sgthighway wrote: »

If Ambulances had the same model ot two trolleys you would imagine there would be spares for some cases. e.g. Joe Blogs with a knee or ankle injury can be left in A&E on the ambulance trolley and the crew take a spare trolley. It would work in some cases.

I would think they medics were having to wait to do a han dover of the patient aswell though, thatd be where another problem lies....

BizPost

How long would it take to mobilise a PDF/ Vol ambulance an hour? Not the ideal solution but if you're only one ambulance covering the southside of Dublin and you get 2 trauma cases that need to get to A&E asap you'd take any ambulance you have.

Elessar

Sometimes private companies are asked to do do cases. Sometimes even they are not available.

Problem with vols is it would take too long to mobilise as they're not driving around during the day. Aswell PHECC want Paramedics crewing, which there simply aren't enough of. But I suppose anything is better than nothing. There's at least one vol that has more ambulances in dublin than both the statutory services combined.

I could see a case for using vols/pdf on busy nights of the year like Halloween, but I doubt the powers that be would ever let that happen.

BizPost

Are privates asked in Dublin to do cases?

Yea well the paramedic part could be answered by having a fire brigade paramedic be the medic on the ambulance.

Who would make that call? The HSE ambulance control officer or DFB? Implications could go either way, media frenzy over volunteers being called in away from their jobs to help the ambulance service or the government seeing it as band aid to solve the problem. Either way the patient suffers from a delay in transport.

Hooch

stop wrote: »

I've seen a PDF ambo pick someone up (was flagged down by peeps thinking it was DFB ambo) while it was dropping off lab samples in belfield (I think) and they had no problems about picking up & dropping the patient down to Vincent's. I assume those PDF staff would fall into the catagory you mentioned above?

PDF have Paramedics manning a CEN ambulance in the curragh (24/7 I believe) so they would be covered under PHECC guidelines to do anything.

Elessar

BizPost wrote: »

Yea well the paramedic part could be answered by having a fire brigade paramedic be the medic on the ambulance.

But taking a paramedic (or two, as is required) away from an appliance will leave the appliance tied up until they are out of hospital. Aswell, what would the vols gain from that? All that would be needed in that case is a driver. What incentive is there really if they can't use their own crews?

It's a shame that people have to wait for an ambulance in this day and age, but until such time that more money is made available to run more vehicles, or alternatively, manage A&E wards more efficiently, it wont change. Of course any ambulance is better than no ambulance, so I would like to see the vols or pdf involved in times of high demand. Once there is a practitioner on board, I can't see how having someone wait sometimes an hour or more in dublin for a statutory is in any way a better option.

Hooch

Elessar wrote: »

But taking a paramedic (or two, as is required) away from an appliance will leave the appliance tied up until they are out of hospital. Aswell, what would the vols gain from that? All that would be needed in that case is a driver. What incentive is there really if they can't use their own crews?

It's a shame that people have to wait for an ambulance in this day and age, but until such time that more money is made available to run more vehicles, it wont change. Of course any ambulance is better than no ambulance, so I would like to see the vols or pdf involved in times of high demand. Once there is a practitioner on board, I can't see how having someone wait sometimes an hour or more in dublin for a statutory is in any way a better option.

Well said, +1

civildefence

DFB often dispatch an accompanying fire appliance where additional manpower is required such as carrying a patient on a transfer sheet, suspected spinal patients, bariatric patients etc.

civildefence

Elessar wrote: »

Of course any ambulance is better than no ambulance, so I would like to see the vols or pdf involved in times of high demand. Once there is a practitioner on board, I can't see how having someone wait sometimes an hour or more in dublin for a statutory is in any way a better option.

More likely to be given to the privates first i'd say.

Hooch

civildefence wrote: »

More likely to be given to the privates first i'd say.

Only because they have Parammedics on the books and can supply them. Once Paramedic trainingdoor opens to anyone things will get better......but thats another rant for another thread!

MN_Medic

During busy periods wouldn't it be a good idea to call in the private companies to ease the pressure by letting them respond to AS2 type calls or even AS1's when the HSE & DFB are tied up elsewhere. After all, there does by around 20 private ambulances in the city at any one time with paramedics on board. I know some people don't want to see the private companies doing this but it certainly would reduce response times and free up the statutory services more.

Paulzx

MN_Medic wrote: »

During busy periods wouldn't it be a good idea to call in the private companies to ease the pressure by letting them respond to AS2 type calls or even AS1's when the HSE & DFB are tied up elsewhere. After all, there does by around 20 private ambulances in the city at any one time with paramedics on board. I know some people don't want to see the private companies doing this but it certainly would reduce response times and free up the statutory services more.

How about providing the statuatory bodies with sufficient manning and resources in order to provide the best possible service to the public?
God, i must be a genius for coming up this simple answer!!!

trad

Can anyone put a figure on the HSE's ambulances based in the Dublin Area. I pass Loughlinstown regularly and there appears to be always ambulances available.

maglite

I would assuem there would be spare vans but no crew?

Same in Cork, There is a plethara of spare and some bordering vintage in there

MN_Medic

Paulzx wrote: »

How about providing the statuatory bodies with sufficient manning and resources in order to provide the best possible service to the public?
God, i must be a genius for coming up this simple answer!!!

That certainly is the answer for the long term, Your not the first genius for thinking of that. . However right now in the short term, there is not enough staff and resources.

Elessar

Of course more money is the better option! Better management of the A&Es! More stautory ambulances on the road! But until such time as that happens what should be done? Anything that will help the situation. Remember that privates don't really jump at the chance to do AS1/AS2 work, they already have their own clients and schedules and can't just drop them whenever they're needed. They too are busy.

leadinglady

sure we are all discussing the time that the DFB and HSE have their full compliment of ambulances on the road, what about the time when the DFB ambulance have broken down and have to change over and worse still which has happened only last weekend in rathfarnham that the fire brigade ran out of spear ambulances and had to take one of them of the road for the night and run one ambulance down for the whole night all because the senior officer in charge on that night refuse to get a mechanic in to fix it because of the ban on bringing in mechanics after hours in order to save money, and this also happened some months ago too with the swords ambulance, ye don't hear about that in the papers...
and the HSE are paying for this????

sgt.bilko

Elessar wrote: »

But taking a paramedic (or two, as is required) away from an appliance will leave the appliance tied up until they are out of hospital. Aswell, what would the vols gain from that? All that would be needed in that case is a driver. What incentive is there really if they can't use their own crews?

It's a shame that people have to wait for an ambulance in this day and age, but until such time that more money is made available to run more vehicles, or alternatively, manage A&E wards more efficiently, it wont change. Of course any ambulance is better than no ambulance, so I would like to see the vols or pdf involved in times of high demand. Once there is a practitioner on board, I can't see how having someone wait sometimes an hour or more in dublin for a statutory is in any way a better option.

Voluntary organisations could be utilised by using a HSE/DFB Paramedic on board alongside the voluntary crew. This would also benefit the voluntary crew

Smokey Bear

Leadinglady your correct there but the HSE do not pay for all the reserves ambo only for 1 open to correction.
Sure the HSE are not paying for what they are meant to be paying DFB for at the moment and would be in no position to complain.They dont fund 134 (swords ambo)so DFB had on the road what is ment to be there as DFB are running 134 out of there own pockets and get NO MONEY from HSE for this service.Think there was 4 reserve ambo on Sunday night and it was only from 00:30hrs for apx 12hrs.HSE eastern region run ratio of 55 on the road with 4 spare so all in all DFB ratio a hell of a lot better 12 on the road with 4 spare.There should have been 3 new ambulance last year but for a legal challenge to tender process the deliver dates have been delayed over a year.Will be 3 new ones by end of year with a further 3 in first half next year.So the break downs should reduce with introduction of new spec ambo.

If the A+E delays were sorted problems solved to a certain extent.I am fed up with the politics going on in certain A+E depts.Last week stood there looking at empty trolley for 2 hours while they decided what to do with it and then you have the cases that after 3 hours waiting on trolley they say they can sit in wheel chair aaaaggggghhhhh all because there are now 5 ambulance waiting.

As for the privates doing 999 work not to far off if the Beacon service takes off.

http://www.sbpost.ie/news/ireland/beacon-to-launch-ambulance-service-44607.html

http://www.herald.ie/national-news/city-news/private-ambulance--will-widen-health-gap-1899290.html

As for the number of HSE ambo in DUB region
HSE Eastern Region Ambulance Staff – July 2009
Category
Numbers
Ambulance Staff
183
Patient Transport Staff
15
National Ambulance College
12
Administration, etc. backup
11.5
Management/Supervisor
14
Vacancies
6.5
Total
242
40.7
The HSE Eastern Region provides the service with 55 ambulances including four spare vehicles. In addition, a motorcycle unit provides rapid response to emergency calls. The service also provides a dedicated national neonatal and mobile intensive care retrieval service. As well as responding to emergency calls the HSE service also provides inter-hospital transfers of patients and responses to urgent calls from doctors. Figure 146 details the deployment of the ambulances in the HSE Eastern Region.
Figure 146 HSE Eastern Region Ambulances – July 2009 Region Dublin City and County

James’s Street
7 max on duty
7 spare
14 total

Tallaght
1 max on duty
1 spare
2 total

Swords
2 max on duty
1 spare
3 total

Loughlinstown
4 max on duty
3 spare
7 total

Other Eastern Region
Wicklow
3 max on duty
3 spare
6 total

Arklow
1 max on duty
1 spare
2 total

Baltinglass
1 max on duty
1 spare
2 total

Maynooth
1 max on duty
1 spare
2 total

Naas
4 max on duty
4 spare
8 total

Athy
2 max on duty
2 spare
4 total

National Services
Loughlinstownb
2 max on duty
— spare
2 total
James’s Streetc
3 max on duty
—spare
3 total
Total
31 max on duty
24 spare
55 total

Notes:
a The additional spare ambulances are required to allow duty commencement if existing crews have not returned to base when a shift is due to start. Routine servicing and breakdown is also accommodated within this complement by moving ambulances from one location to another when necessary.
b Two incident response ambulances are based in Loughlinstown.
c Two neonatal and one mobile intensive care ambulances are based in James’s Street.

Have a read of Comptroller and Auditor General Annual Report 2008page 411 chapter 40 in regards to provision of Dublin ambo service,
http://www.audgen.irlgov.ie/documents/annualreports/2008/Annual_Report_2008_Eng.pdf



Smokey Bear

Nice_Guy_Eddie

Is there any sense in using those D-Doc guys who who seem to be knocking about some of the time? If they were available to attend some calls it could take some of the pressure off I imagine.

I'm just thinking out loud and I don't know their set up to be honest. Have just seen the cars about a few times.

Tango Alpha 51

Nice_Guy_Eddie wrote: »

Is there any sense in using those D-Doc guys who who seem to be knocking about some of the time? If they were available to attend some calls it could take some of the pressure off I imagine.

I'm just thinking out loud and I don't know their set up to be honest. Have just seen the cars about a few times.

D/Doc, along with the rest of them ie Shannon Doc, Care Doc, South Doc etc only increase the number of ambulance callouts hence they wouldn't take the pressure off.

Tango Alpha 51

Paulzx wrote: »

How about providing the statuatory bodies with sufficient manning and resources in order to provide the best possible service to the public?
God, i must be a genius for coming up this simple answer!!!

+1

Paulzx

buzzman wrote: »

D/Doc, along with the rest of them ie Shannon Doc, Care Doc, South Doc etc only increase the number of ambulance callouts hence they wouldn't take the pressure off.

Agreed. Whether they like me saying this or not GP's are part of the problem here