1 July - A&E closures - EMS impact

resus

I started this thread to discuss very specifically, the impact on the ambulance service. Read below links for background (I have included a variety of links for breadth of reporting). Like it or not, Emergency Department opening hours are going to be curtailed in 4 weeks from today.

- There are simply not enough doctors to run the services
- There has to date been plenty warnings in the news and even on TV
- Where are the official governmental responses?
- What departments exactly are closing and when?
- What arrangements are in place for patient transfer to alternative sites?

So I pose the question. What will be the EMS impact?

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http://www.emergencymedicine.ie/images/stories/iaem/press/2010/iaem_pr_deploring_the_precipitous_reconfiguration_of_emergency_services_120510.pdf

http://www.imn.ie/index.php/current-issue/editorial-comment/3348-emergency-departments-still-a-national-crisis-

http://www.irishtimes.com/newspaper/letters/2010/0517/1224270548571.html

http://archives.tcm.ie/businesspost/2010/04/11/story48519.asp

paraletic

i don't want people thinking i am either for or against the issue.

unfortunatly resus, it all seems to be rumour at this point, nobody is giving any answers at an official level. but it looks like a+e closures are going to be coiming soon. the great motorway network will give a boost to the argument for closures, as well as the upskilling of paramedics and the role out of advanced paramedics.

i don't know exactly how closing a+e depts will affect us really.

if a few extra ambulances were put in around the regions, and a few response cars with advanced paramedics on them, we (as a country could save millions). although crews around the country would have longer travelling times, we all know that a huge % of the work we do is NOT time critical. - not that patient outcome seem to matter to some of the decision makers!

however, as a person with a family, i would like to think that my nearby a+e is safe and that if my family get ill, i can visit them near my home and not 45 mins or more away in a 'regional' hospital.

plus, there are stats regarding mortality/morbitity and its correlation with proximity to hospitals, cant find them on line now, but basically people with serious illnesses (like heart attacks) seek emergency medical aid quicker if they are living close to hospitals, this increases possitive patient outcomes.

this article is interesing reading: http://adc.bmj.com/content/89/3/232.abstract
but on the other side this article is quite shocking: http://emj.bmj.com/content/24/9/665.abstract

the government have been investing in the ambulance service in recent years, unfortunatly they have still underfunded us and the regional hospitals which are expected to take the additional patients that a+e closures would bring.

the question really might boil down to: will the government put profit before people.
again: i am not for or against the issue. but i am also interested to see what other ambulance staff might think.

resus

I worry about our county ambulance crews at night, particularly those who are still on-call. I suspect many smaller units will simply close doors overnight or become GP access only Medical Assessment Units. So someone drunk, post fall, will have to be taken to the regional as opposed to the closest DGH, leaving swathes of countryside uncovered.

Muas Tenek

I'm not too familiar with the rest of the country but I remember in the early 1990's that a decision was made in Dublin to have 1 northside and 1 southside hospital "on call" between 9pm and 9am. The other Dublin hospitals would go "off call" for 12 hours so they could "catch up", This caused major problems for the DFB and EHB ambulance services at the time (but who cared about them (I tried to find a relevant smiley but failed)). My point is that this country is in dire need of a kick up the ar** in terms of front line emergency care and we as frontline providers know it.

resus

Muas Tenek wrote: »

This caused major problems for the DFB and EHB ambulance services at the time

You've probably got some good insight then to what may be coming, please expand on what those problems where?

Chiparus

No one is quite sure as the powers that be have relaxed some of the requirements to staff the A+Es . I think all A+Es will be open come july 1st ( they may be short but locums will fill the gaps)
The real problem may be in Anaesthetics - I hear that some hospitals are very short of staff.

Tango Alpha 51

Resus,
Let me give you an insight from the old MWHB area point of view. Ennis General Hosptial closes at 8pm every night. There is two ambulances on at night in ennis along with a rrv, one ambulance in kilrush, one ambulance in ennistymon & one ambulance in scarriff. That's 5 ambulances for the whole of clare. It has been known at this stage (nearly 1yr into the closure of ennis at nightime) for all these ambulances to make their way into the Regional Hospital in Limerick most nights. This in turn leaves Co. Clare without any cover unless one of the 3 ambulances in Limerick City goes out to provide cover.
Now consider Nenagh closes at 8pm every night as well. You have 1 ambulance on in Nenagh, Roscrea & Thurles plus an rrv. It's also being know for two or more ambulances from Tipp Nth to come into Limerick again having one of the Limerick City crews to provide cover in that area.

All this whilst the calls in Limerick City & County have to be covered. Also the Emergency Department in Limerick Regional has not been upgraded to reflect the increase in the number of patients being bought in from the outlying area's & you see the nightmare from the logistical point of view for the ambulance service. There has been no increase in crews/vehicles since these closures were originally implemented despite what HSE management & the Consultant's who are pushing this agenda for change publicly state.

resus

Chiparus wrote: »

No one is quite sure as the powers that be have relaxed some of the requirements to staff the A+Es . I think all A+Es will be open come july 1st ( they may be short but locums will fill the gaps)
The real problem may be in Anaesthetics - I hear that some hospitals are very short of staff.

Agree, no one is quite sure. However, they relaxed the requirements with 1 month to go !! Many good NCHDs have already got jobs in Australia, Canada, etc .etc. etc . Why would they want to give those up to stay and help out?

There is no longer an endless pot of locums. The Irish Medical Council tranced on that a good year back with the introduction of the 3 types of registration. Only those on the General or Specialist Division can do locums, which cancels out ALL the trainees !

All A&Es will not be open come July 1st. I know of 3 for definite that have rotas drawn up, stopping public access after 8pm. Just like in Clare.

Anaesthetics are indeed cluster f..ked, but that does not directly impact on EMS. Rather it impacts on elective surgery and waiting time misery and drives the private sector.

The county Clare/Limerick experience looks to be coming a lot closer to Cork, Dublin, Waterford, Galway, etc.

kelle

Is there anywhere I can get a list of these hospitals, Resus?

resus

kelle wrote: »

Is there anywhere I can get a list of these hospitals, Resus?

not officially - and THAT is the problem

resus

Does anyone know what is happening to the PTS vehicles that where promised ?

Hooch

resus wrote: »

Does anyone know what is happening to the PTS vehicles that where promised ?

They are parked in Dublin.....last time I saw them they were in the docklands area.....but thats was months ago.

Elessar

They are parked in Mercedes on the Long Mile Road, at least, they were a month ago.

Is the proposed split of PTS and frontline work actually happening?

If so, that will help make a positive impact on the number of A+E ambulances available around the country.

Tango Alpha 51

We got two of them in the last month. Totally & utterly crap !!!!!. Single stretcher & two seats (not including the attendant's seat). At least with the old pts vehicles we had you could take two stretcher cases along with 8 sitters. Now the capacity has been reduced. Just so they can be driven on a B licence.

I keep saying it lads. We got no additional vehicles to augment the closure of the ED's in Clare & Tipp Nth bar two ford focus response cars. The additional staff we were promised got swallowed up by vacancies in the exisiting stations in these area's therefore there is no extra ambulances/crews on especially at night to cover these areas hence my earlier post on the subject !!.

Elessar

buzzman wrote: »

We got two of them in the last month. Totally & utterly crap !!!!!. Single stretcher & two seats (not including the attendant's seat). At least with the old pts vehicles we had you could take two stretcher cases along with 8 sitters. Now the capacity has been reduced. Just so they can be driven on a B licence.

I keep saying it lads. We got no additional vehicles to augment the closure of the ED's in Clare & Tipp Nth bar two ford focus response cars. The additional staff we were promised got swallowed up by vacancies in the exisiting stations in these area's therefore there is no extra ambulances/crews on especially at night to cover these areas hence my earlier post on the subject !!.

Who are they using to crew the new vehicles?

I have heard the term "intermediate care operatives" bandied about recently, in relation to the PTS. Do you know anything about that?

Tango Alpha 51

That ICO term has been bandied about for nearly two years. I don't know what quals these people have but their wearing a navy uniform to distingush them from ourselves. The only thing that bothers me about these vehicles besides what I've mentioned already is that their equipped with blue lights & sirens. I don't really see the need for these especially with the sole function of these vehicles/staff is to carry out clinic runs & discharges ??.

resus

buzzman wrote: »

equipped with blue lights & sirens

Surge Capacity is never a bad thing... Although it is pretty obvious what they might be drafted in to do

Tango Alpha 51

Surge capacity ?? You've lost me on that one. But in relation to your second point, you seemed to get what i'm on about. The only advantage I can see is if there is a major incident/accident & these pts buses are needed to get there quickly then I can see the need for the b&t's but that would be the only time I could see these being sanctioned.

resus

buzzman wrote: »

Surge capacity ?? You've lost me on that one. But in relation to your second point, you seemed to get what i'm on about. The only advantage I can see is if there is a major incident/accident & these pts buses are needed to get there quickly then I can see the need for the b&t's but that would be the only time I could see these being sanctioned.

You answered your own question

Surge Capacity being what we lack, hence A&E closures overnight or whenever are going to be "challenging"

Tango Alpha 51

Never heard the term before but thanks for clarifying it for me

Muas Tenek

resus wrote: »

You've probably got some good insight then to what may be coming, please expand on what those problems where?

Will do via PM as in open forum I may lose anonimity

resus

irishtimes.com - Last Updated: Monday, June 14, 2010, 16:14
Hospitals face service curtailments
EITHNE DONNELLAN, Health Correspondent

Hospital services may have to be significantly curtailed from the beginning of next month due to shortages of junior doctors which could result in up to 600 front line medical posts nationwide remaining vacant, it was claimed today.

The Irish Hospital Consultants Association (IHCA) said the most critical shortages of these doctors, who are "the backbone" of many smaller and medium sized hospitals, were in the specialties of emergency medicine, anaesthesia, paediatrics and obstetrics.

Dr Paul Oslizlok, president of the IHCA, said about 4 per cent of junior doctor posts were vacant last year and this number is expected to double when junior doctors, who change jobs every six months, rotate jobs again on July 1st.

"Everybody knows that these qualified doctors who are training to be specialists carry out a very large part of the work of any hospital. With demand for services increasing, such a radical reduction in a vital area of hospital staffing will have immediate and far reaching effects ... some accident and emergency and obstetrical services may have to close," he said.

"Warning bells have been ringing, particularly in small to medium sized hospitals, as the sudden drop in the number of doctors is predicted to force closure or curtailment of some acute hospital services. The response of the HSE to this well flagged crisis has been disorganised and ineffective," he added.

He said there were a number of reasons for the junior doctor shortage but one significant factor is the fact that around 1,200 of the junior doctors posts in Irish hospitals are no longer being recognised for training purposes by the HSE, making them unattractive to potential applicants.

Dr Oslizlok also expressed concern at the fact that the junior doctors who occupy these non-training posts will also have to go on the general division of the Medical Council's medical register, rather than the training division. This will mean they will be allowed to work unsupervised, which could pose risks to patient safety.

"These doctors, who did not manage to secure training places, will now be allowed to practice independently. They will be free to practice medicine without having their competence formally certified. We are left therefore with the extraordinary position that the more successful doctors will remain under supervision while those who did not succeed in getting a training post will be free to practice independently," he said.

The IHCA has met HSE chief executive Prof Brendan Drumm to outline its concerns and is due to meet Minister for Health Mary Harney on Wednesday.

The HSE has already said it is aware of the shortages and is trying to recruit sufficient numbers of doctors from abroad to fill as many vacancies as possible. However it has acknowledged the staffing shortages may result in services being curtailed.

The Irish Times reported last month that plans have been drawn up by the HSE in the north east to close two wards at Louth County Hospital in Dundalk and 20 beds at Our Lady of Lourdes Hospital in Drogheda to deal with the forecasted critical shortage of junior doctors at both hospitals on July 1st.

The Irish Association of Emergency Medicine also warned in April that the shortage of junior doctors could result in some hospital emergency departments having to close or limit their opening hours. It said while the situation was most acute at Naas General Hospital; Portiuncula Hospital, Ballinasloe; Mayo General Hospital, Castlebar; Kerry General Hospital, Tralee; and Letterkenny General Hospital, almost every emergency department in the country has been unable to recruit its full complement of medical staff.

kelle

resus wrote: »

not officially - and THAT is the problem

Just found out my local hospital (where I also work) is not affected - thank goodness!

resus

Just heard, Nenagh and Ennis A&Es are to close all together from Thursday as there have not been enough doctors recruited around the region. The registrars are being redeployed quite literally to keep Limerick open...

Who's next?

Chiparus

Interesting as they were saying that the smaller hospitals would have to close if they could not recruit staff.

But the bigger hospitals cannot recruit staff the smaller hospitals are able to, but they still will close.

resus

Can't close the ""centre of excellence"" !!

Well aware of folk who don't want to work in these bigger hospitals, in favour of the more personalised and holistic care, nicer environments, community etc etc etc of the smaller hospitals. Guess they'll just be dictated to.

resus

I particularly enjoy the last section. It is plain and simple Lies to say the ambulance service has been enhanced. Well certainly not enough to cope SAFELY

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The Irish Times - Monday, June 28, 2010
Dundalk hospital's A&E unit closes today


EITHNE DONNELLAN Health Correspondent

AROUND-THE-clock emergency services at Louth County Hospital in Dundalk will end today.

The HSE announced yesterday that the emergency department would close overnight tonight and would be replaced by a minor injuries unit from 9am tomorrow.

Patients in the area who are injured in road crashes or falls, who have chest pain, abdominal pain, back injuries or pregnancy-related conditions, will have to travel to the emergency department at Our Lady of Lourdes Hospital in Drogheda for treatment.

The reconfiguration of these services was planned for a number of years but have been accelerated due to difficulties in recruiting sufficient junior doctors to work at both Louth hospitals.

“The HSE has been engaged in a comprehensive international recruitment campaign over the last number of months . . . however at the current time it has not been possible to fill all vacant posts in Louth,” the HSE said. “As such, these new arrangements are being put in place to ensure that patient safety and services are maintained.”

While Louth-Meath is understood to be the area worst affected by the shortage of junior doctors, it is not the only region affected.

Earlier this month there were nearly 300 junior doctor posts vacant at hospitals across the State and the Irish Hospital Consultants Association has predicted that number could double on July 1st when junior doctors changed jobs.

The HSE has refused to say what services at other hospitals will be affected. It would only say yesterday that contingency plans are being prepared in every region to cope with the expected shortfall. While details of the contingency plan for Louth-Meath, which were published in The Irish Times last month, said the establishment of the minor injuries unit in Dundalk “must be supported by an extensive public communications programme to reduce the occurrences of seriously ill or injured patients inappropriately presenting to Louth County Hospital”, the HSE’s decision gives one day’s notice to the public.

The minor injuries unit will be open from 9am and 8pm seven days a week. It will treat adults and children aged 14 years and over who present with non-emergency conditions.

Ambulance services have been enhanced to bring patients who would otherwise go to Dundalk to Drogheda or Cavan hospitals.