ambulance service disfunctional

ivabiggon

http://www.independent.ie/national-news/urgent-call-to-tackle-ambulance-shortage-2492705.html

gbee

It is a bit of a joke alright. The problem as I see it is too much decompartmentalisation.

The ordinary 'Ambulance' has in fact been removed from the service and replaced with an EMT specialist unit carrying specialist EMT personnel.

To cover say one car accident and one casualty will take 3 Ambulances as each has its own speciality ~ a bit akin to too many chiefs ....

On another side EMT personnel are only marginally below MASH/Surgical doctors and yet they need to be supported by doctors who arrive in other units.

We actually need the reintroduction of the ambulance alongside the EMT vehicle corps, collecting patients to bring to hospital is in fact the sole purpose of the 'ambulance' ~ all you need for that really is a driver's licence ~ there are plenty of vehicles and sufficient staff in most cases, but, just as getting into hospital now has to be an emergency, every patient transport has to be an emergency too, tying up specialist equipment and highly trained and skilled personnel.

gbee

gbee wrote: »

The ordinary 'Ambulance' has in fact been removed from the service and replaced with an EMT specialist unit carrying specialist EMT personnel.

To cover say one car accident and one casualty will take 3 Ambulances as each has its own speciality ~ a bit akin to too many chiefs ....

Oh please explain this one. Sounds like it's going to be a good work of fiction.

Paulzx

gbee wrote: »

It is a bit of a joke alright. The problem as I see it is too much decompartmentalisation.

The ordinary 'Ambulance' has in fact been removed from the service and replaced with an EMT specialist unit carrying specialist EMT personnel.

To cover say one car accident and one casualty will take 3 Ambulances as each has its own speciality ~ a bit akin to too many chiefs ....

On another side EMT personnel are only marginally below MASH/Surgical doctors and yet they need to be supported by doctors who arrive in other units.

We actually need the reintroduction of the ambulance alongside the EMT vehicle corps, collecting patients to bring to hospital is in fact the sole purpose of the 'ambulance' ~ all you need for that really is a driver's licence ~ there are plenty of vehicles and sufficient staff in most cases, but, just as getting into hospital now has to be an emergency, every patient transport has to be an emergency too, tying up specialist equipment and highly trained and skilled personnel.

Could you please post that in English. That appears to be a language known as Gibberish.

I have absolutely no idea what you are trying to say

civdef

gbee wrote: »

We actually need the reintroduction of the ambulance alongside the EMT vehicle corps, collecting patients to bring to hospital is in fact the sole purpose of the 'ambulance' ~ all you need for that really is a driver's licence ~ there are plenty of vehicles and sufficient staff in most cases, but, just as getting into hospital now has to be an emergency, every patient transport has to be an emergency too, tying up specialist equipment and highly trained and skilled personnel.

I have just the vehicle in mind:



Scoop and run, all the way.

gbee

Sorry lads if you don't understand how the service works, I'm not going to elaborate on it past the fact that the Ambulance Service was elevated to EMT status in three specialist fields based on equipment issued and trained personnel to use such equipment.

This is why one sees multiple ambulances respond to incidents. There are for instance no ambulance drivers anymore ~ they are all emergency medical technicians, highly trained and highly skilled and just the people you want in a car collision ~ ie, you don't need them to ferry you to hospital for tests or routine check-ups.

Paulzx

gbee wrote: »

Sorry lads if you don't understand how the service works, I'm not going to elaborate on it past the fact that the Ambulance Service was elevated to EMT status in three specialist fields based on equipment issued and trained personnel to use such equipment.

This is why one sees multiple ambulances respond to incidents. There are for instance no ambulance drivers anymore ~ they are all emergency medical technicians, highly trained and highly skilled and just the people you want in a car collision ~ ie, you don't need them to ferry you to hospital for tests or routine check-ups.

Mate, this makes even less sense than the first post

Are you talking about another country than Ireland?

ivabiggon

http://breakingnews.ie/ireland/fire-services-want-to-take-control-of-ambulance-service-488843.html?sms_ss=facebook&at_xt=4d307c39a4895b2f,0

5500

I've heard of cases being que'd and delayed ect but recently one of my friends fathers had a cva. I was close by so went to him while waiting on an ambulance, it took nearly an hour and twenty minutes for one to arrive to Clondalkin, in the end it was 114 from townsend street and the lad's were saying that there was something like 20 odd cases que'd at the time and they were the only free resource available.

I dont think people are aware in the slightest of the delays that there are, this was even on a "normal" day ie no snow/ice mass casualty incident in the city. It would make you wonder how we would cope if there was terrorist or other large incident when resources seem to be so stretched on a daily basis.

Q for the lad's in service, what ideally do you think would sort the issue out? Is an amalgamation of the services needed in Dublin or does both services need more ambulances and personell?

Elessar

ivabiggon wrote: »

http://breakingnews.ie/ireland/fire-services-want-to-take-control-of-ambulance-service-488843.html?sms_ss=facebook&at_xt=4d307c39a4895b2f,0

I can't see this happening, what would the HSE or ERAS have to say about this?

Isn't it the HSE that wants to setup a new control room for all dublin ambulances under its own personnel?

ivabiggon

eireal wrote: »

I've heard of cases being que'd and delayed ect but recently one of my friends fathers had a cva. I was close by so went to him while waiting on an ambulance, it took nearly an hour and twenty minutes for one to arrive to Clondalkin, in the end it was 114 from townsend street and the lad's were saying that there was something like 20 odd cases que'd at the time and they were the only free resource available.

I dont think people are aware in the slightest of the delays that there are, this was even on a "normal" day ie no snow/ice mass casualty incident in the city. It would make you wonder how we would cope if there was terrorist or other large incident when resources seem to be so stretched on a daily basis.

Q for the lad's in service, what ideally do you think would sort the issue out? Is an amalgamation of the services needed in Dublin or does both services need more ambulances and personell?

i my opinion what would sort it out is that dublin be ring fenced have no hse ambulance bases within this fence and any fire station within dublin including dun laoire to have 2 ambulances, coupled with the 6 existing district within the fire brigade having a AP/ light rescue response unit, and for the financing of all this to come direct from gov.not through the HSE also all the non urgent transfers be done by out sourcing.

plus a facility for more specialized area, mobile HD units manned by dublin fire/ems personnel. initially more personnel would have to be taken on but preference would go to existing hse personnel to enter under the same pay and pension conditions as the fire service personnel.

this way the people get the cover of a sole fire/rescue ems based system all in the same uniform and on the same radio/control system where an organisation can have 100 plus trained paramedics on scene with 20 mins.
so no matter who arrives at your door weather it be a fire truck or an ambulance the training in those vehicles are all the same. there for the need to supply official lunch breaks and down time for crews can be supplemented from their colleges within their station without taking the ambulance off the road, the way it done currently in the DFB

i know i might rub some people up the wrong way and that is not my intention but it would be a very efficient system.

coolmoose

gbee wrote: »

The ordinary 'Ambulance' has in fact been removed from the service and replaced with an EMT specialist unit carrying specialist EMT personnel.

No it hasn't.

gbee wrote: »

To cover say one car accident and one casualty will take 3 Ambulances as each has its own speciality ~ a bit akin to too many chiefs ....

Nope, wrong again. One ambulance per patient, maybe ALS backup from an AP on another ambulance, or a 2nd vehicle for a cardiac arrest to provide an additional Paramedic for patient care.

gbee wrote: »

On another side EMT personnel are only marginally below MASH/Surgical doctors

No we're not.

gbee wrote: »

We actually need the reintroduction of the ambulance alongside the EMT vehicle corps, collecting patients to bring to hospital is in fact the sole purpose of the 'ambulance' ~ all you need for that really is a driver's licence ~ there are plenty of vehicles and sufficient staff in most cases, but, just as getting into hospital now has to be an emergency, every patient transport has to be an emergency too, tying up specialist equipment and highly trained and skilled personnel.

These "ambulances" do exist, now known as Patient Transport Vehicles. Not every patient encounter is an emergency. There is no such thing as the EMT vehicle corps (whatever that is).

Stop now. You seem to have no idea, and I mean NO idea what you are talking about. Please.

coolmoose

This thread is about to go down the HSE v DFB route again, and I really hope it doesn't...

ivabiggon

no..no...no! it can't and just to say it's only my opinion, and any of that won't be supported by in in this forum.

but i would be interested to hear of a more efficient and functional fire/rescue ems system that would work for the interest of you and me as a member of the public waiting that long 5-10 mins one would wait if your wife, son mother is lying there on the floor in trouble and waiting for someone, somewhere to appear when they make that 999 call.
my point is resources are already there in dublin, what is the best way to use it, for everyone.

Tango Alpha 51

Ivab,
Why does it have to be a fire/rescue based ems system. Why can't the NAS look after the ambulances & the F&R look after what they do best. I'm not going to go down the route of being condescending either buddy cos your well aware that no where else in Ireland do the F&R provide ambulance cover of any kind. I know where your coming from when people state that with an appliance in Dublin you have 6 extra trained para's alongside the ambulance crew but surely this isn't a productive use of trained personnel either. I don't really have any idea how the problem in Dublin will be rectified but I would hope like CM that this thread doesnt descend into us v's ye thread.

supermedic

Buzzman,

I agree with your comments, everyone of these treads turns into a HSE V DFB match at some stage. I don't work in Dublin now, but I am HSE and fiercely proud and protective of the people that I have worked with for 20 years, in my various roles. To even suggest that the HSE is perfect would be crazy, but also to suggest that the only way to run the ambulance services in Dublin is to give it to the DFB is equally crazy.

There are numerous ways it could be done. In the high performing ambulance services in the UK, without any fire service interaction at all, large cities and huge geographical rural areas can achieve 8 minutes responses for 75% of their Echo and Delta calls, with proven positive clinical outcomes.

It's all about funding, give either service the proper capital, estate, manpower, management and leadership and the results will be excellent, try to run either the way they are being run now and we are going nowhere.

The topic of the DFB cardiac arrest save rates keeps coming up, can some one please provide a link to this research, as I would be very interested in having a look. I

Elessar

Nothing wrong with a good debate on the subject, I've often wondered why threads like these end up closed. This is a discussion forum after all. I would appeal to the mods to allow threads like these and simply infract anyone who strays off topic, instead of locking the thread and stifling debate.

The ambulance service in Dublin is indeed disfunctional. The current system doesn't work. As I understand it and correct me if I'm wrong, moves are being made to unify the control center into one operated by a single service (HSE). The IFESA now want the fire service to do it, the HSE want themselves to do it.

I don't know what's going to happen, because neither side wants the other do take over dublin ambulance control. Let's be honest, the DFB wont want the HSE controlling their ambulances and the HSE wont want the DFB to do it either. It will be a tough challenge, but maybe someone else has some ideas.

I agree with Buzzman that a fire/ems system for Dublin isn't the only option. How about doing it like the UK, handing the ambulance service to the NAS and letting the DFB concentrate on fire/rescue. Ivabiggon's ideas can be implemented into that system too.

However I think all of these ideas are merely pipe dreams, considering the realities of the situation, not to mention the strength of unions in this county.

ivabiggon

it's about making use of the nearest available resource with the appropriate skill. that can't be done with 2 separate control centres and radio systems run by 2 separate organisations.

the way i see it if a 999 call comes into one call centre the location of that incident geographically should have a range of vehicles surrounding it on a map no matter where it is in dublin. at the moment no one service has the monopoly on the knowledge of those available resources.
so would it not be to patient advantage to have that system where one 999 operator has at their finger tips the exact availability/location of a rescue unit, and i refer to this term broadly to include fire appliance, emerg tender, ambulance, rapid resps vehicle etc.
lets face it, no one service either hse or dfb can handle a really busy period without the other, so if its left to the fire brigade with its limited ambulances it would mean that fire cover would be compromised in a particular area, alternatively if left to the hse they don't have the ready available resources to cope either 24/7 and they wouldn't know the closest available appliance if their was one in the location of an incident.

also is a mass casualty incident the fire brigade are the only service that can land multiple amounts of parmedics on scene which can stay on scene, were as an ambulance service land only the amount of paramedic on scene that are available in their respective vehicles on that day and then when they do start treating a patient they have to leave with that patient so they are no longer available on scene until they return.
i just think that this over all umbrella of an emergency service would be better for people, and it doesn't have to be called a fire service or ambulance service it could be reinvented into another name...for example dublin emergency service or something similar.

plus from a existing logistical resource point of view it would cut down on doubling up on bases, fire and ambulance, uniforms, training centres, equipment purchase vehicle purchase and delivery. at the moment all these are duplicated
& then their is pay and pension and union strength.. also it would provide for a strong leverage when it comes to battling individual hospitals when it come to delaying ambulances for their own advantages,and i think we all know who they are?
i have spoken to a lot of HSE lads and are good friend with some that would like to come under the pay and pension scheme of the fire service
lets face it we would be quite a strong organisation.

paraletic

gbee wrote: »

Sorry lads if you don't understand how the service works, I'm not going to elaborate on it past the fact that the Ambulance Service was elevated to EMT status in three specialist fields based on equipment issued and trained personnel to use such equipment.

This is why one sees multiple ambulances respond to incidents. There are for instance no ambulance drivers anymore ~ they are all emergency medical technicians, highly trained and highly skilled and just the people you want in a car collision ~ ie, you don't need them to ferry you to hospital for tests or routine check-ups.

I can only asume you don't work in the ambulance service (in ireland anyway), coz you have the wrong information on some of the things you mention in your posts. if you need any info check out the phecc website.

Shield

They end up closed because people end up behaving like children and start sniping at each other rather than engage with each other and exchange viewpoints in a respectful and mature manner.

As long as this thread can run a course without resorting to the above, I'm all for an exchange of opinions too.

Elessar wrote: »

Nothing wrong with a good debate on the subject, I've often wondered why threads like these end up closed. This is a discussion forum after all. I would appeal to the mods to allow threads like these and simply infract anyone who strays off topic, instead of locking the thread and stifling debate.

maglite

gbee wrote: »

Sorry lads if you don't understand how the service works, I'm not going to elaborate on it past the fact that the Ambulance Service was elevated to EMT status in three specialist fields based on equipment issued and trained personnel to use such equipment.

This is why one sees multiple ambulances respond to incidents. There are for instance no ambulance drivers anymore ~ they are all emergency medical technicians, highly trained and highly skilled and just the people you want in a car collision ~ ie, you don't need them to ferry you to hospital for tests or routine check-ups.

Sir,


Am am sorry to be the one to have to inform you but your post appears to have been written by an idiot, May I sugest you look at changing your password.

EMT Paramedic
three specialist fields- lol wut?
they are all emergency medical technicians paramedics


EMTs are those of us playing along part time in our spare time. The hilarity of your posts have been epic.


Anyway back to the OP, where could one read this report. It seems strange the HSE did't get a copy

drill

ivabiggon wrote: »

it's about making use of the nearest available resource with the appropriate skill. that can't be done with 2 separate control centres and radio systems run by 2 separate organisations.

the way i see it if a 999 call comes into one call centre the location of that incident geographically should have a range of vehicles surrounding it on a map no matter where it is in dublin. at the moment no one service has the monopoly on the knowledge of those available resources.
so would it not be to patient advantage to have that system where one 999 operator has at their finger tips the exact availability/location of a rescue unit, and i refer to this term broadly to include fire appliance, emerg tender, ambulance, rapid resps vehicle

Ivabiggon, That is exactly what the NAS are trying to do with one central point for taking calls and dispatching ambulances in dublin, one cad system 1 radio system 1 avl system. With the new ambulance control in tallaght, taking calls for 90% of the country also with a mirror control in ballyshannon taking and dispatching for the west of the country and acting as an over flow for dublin control. Is the dublin "issue" now finally being addressed along with streamlining the country ?


Not sure as to appliance / rescue units/ tenders being dispatched haven't heard

Shield

What did I say about sniping?

First and only on-thread warning: Keep it civil.

Back on topic please.

maglite wrote: »

your post appears to have been written by an idiot

ivabiggon

drill wrote: »

Ivabiggon, That is exactly what the NAS are trying to do with one central point for taking calls and dispatching ambulances in dublin, one cad system 1 radio system 1 avl system. With the new ambulance control in tallaght, taking calls for 90% of the country also with a mirror control in ballyshannon taking and dispatching for the west of the country and acting as an over flow for dublin control. Is the dublin "issue" now finally being addressed along with streamlining the country ?


Not sure as to appliance / rescue units/ tenders being dispatched haven't heard

ye in a sense that is on the right track, but that is only for the ambulance service.
what i suggested earlier and maybe i wasn't all that clear is one umbrella agency to do it for all the resource needed, fire ambulance,rescue. all under the one roof, and that is already in place in dublin under the fire brigade existing operations, just that they don't have the facility to dispatch hse ambulances.
also you mentioned the new control been constructed, sure that facility is already there at the moment in townsend st, all they have to do is move the desks closer, they are already in the same room less than 15 feet away from each other. what a complete waste of money setting up a new one.
it's money the HSE could use to reallocate to other areas.

oh and i think having major cities mixed in with the rest of the country in regards to call taking is a bad idea, dublin for starters is far too busy without having to deal with calls outside the the area.

ivabiggon

GBee, just to clarify something, after reading your OP I got a bit confused, so i'm going to post up my broad experiences with the development of my current qualification and i think this will resemble alot of people here in their careers.

when i join the fire brigade 20 yrs ago i did an EMT coarse the qualification was EMT-B and it was done through Boston university/DFB.

PHECC wasn't up and running then, before that we had just.... "ambulance men".
now over the years after Phecc was born we progressed in CPD's which was good,and then we were all labeled with the term paramedic.

so all the old "ambulance men" dotted around the country should have progressed up through this same CPD ladder.
Speaking from the fire brigade point of view we didn't have different stages of ambulances for different calls, it was all the one type of ambulance and training.

From a personal point of view i don't think we should have been given the handle "paramedic" as we aren't full paramedics (skill levels) on apar with the equivalent in the states or britain or any where else in the world for that matter, our job description title should have stayed at a "technician" level until such time that all the skills that a paramedic can do in britain was achieved, then be alocated the term paramedic.

but we had to try reinvent the wheel here and form an "advanced paramedic" tital, so now if you decide to go for a job abroad you can't say your a paramedic as other countrys precieve this as a person who can set up I.V's administer cardiac drugs, intubate etc etc.
so personally i'm in a bit of limbo when it comes to trying to put my qualification on a cv. thats if i ever wanted to work abroad for a while.
so in an interview i would have to discribe myself as sort of a bit more advanced technician, with my current level of training, but not quite a fully pledged paramedic in the eyes of other countrys, but yet i have a little card & certificate that says i'm a parmedic...so where does that leave me and others like me...

but look.... i'm seriously going off track here, and i don't want PSNI to have to close this down for not keeping on the subject.
maybe this subject would be better posted under a new topic.
it's just a small insight into the way things are done on the ambulances here.

Shield

Great post there ivabiggon. That's how it's done people.

Tango Alpha 51

Ivab,
Agree with psni, a well written post outlining what we do here. The only part i disagree with in your post is when you state that we had to reinvent the wheel with the terms Para & Advanced Para. For example, New Zealand & Austrailia both use these terms to describe all their ambulance staff

As for the whole Dublin situation, i think it's never going to be resolved to most people's satisfaction. If the DCC loose control over their vehicles, i would imagine that most DFB will be pissed off about this, likewise if DCC/DFB gain control over NAS vehicles, that would equally be annoying for NAS staff.

ivabiggon

buzzman wrote: »

Ivab,
Agree with psni, a well written post outlining what we do here. The only part i disagree with in your post is when you state that we had to reinvent the wheel with the terms Para & Advanced Para. For example, New Zealand & Austrailia both use these terms to describe all their ambulance staff

As for the whole Dublin situation, i think it's never going to be resolved to most people's satisfaction. If the DCC loose control over their vehicles, i would imagine that most DFB will be pissed off about this, likewise if DCC/DFB gain control over NAS vehicles, that would equally be annoying for NAS staff.

tell ye the truth, my knowledge of different ambulance services are only limited to the british and american model. i wasn't aware the new zealand and oz model was similar. would that mean my qualification is more recognized down there?
because if i went to another country my fire fighting certs, they would probably worth nothing with the exception of my swift water tech. instructor qualification.

is it the exact same, same limited drug admin and limited pain management etc.

refereing to the comment about one organisations nose out of joint about the other taking over is right, and i think the solution would be like i suggested at the outset was to form an new "dublin emergency service" funded direct from gov. and it could be a roll model for the rest of the major cities, it could be run under this emergency management agency we've been seeing in the media recently dealing with the snow and floods, this way it would encompass the vol. organisations and their equipment and training. i would say the DCC would only happy to give it all away as a frie service/ ambulance cost them a fortune and that goes for any county council, its a thorn in all their sides, hence the reason why we have more fire chiefs ( i think 34 of them) than any other country in europe and hence the reason why we have a limit turnout for emergencies in rural area....its all down to money.

paraletic

buzzman wrote: »

Ivab,
, New Zealand & Austrailia both use these terms to describe all their ambulance staff

As for the whole Dublin situation, i think it's never going to be resolved to most people's satisfaction. If the DCC loose control over their vehicles, i would imagine that most DFB will be pissed off about this, likewise if DCC/DFB gain control over NAS vehicles, that would equally be annoying for NAS staff.

first: OZ and New zealand ambulance service have actively recruited in ireland, i asume because of similarities,(also canada i believe) in USA i think our paramedic level is roughly EMT-I (Intermediate).

By international level irish prehospital care is probably amongst the highest in the world (although some european contries have doctor led ambulances).

in our unique 'Dublin' situation, (which is quite disfunctional) i think the problem does not come from 2 ambulance service providers. i think the problem is two dispatch providers.
ie: if a fire call comes in for dubln, the dfb control should be used.
if medical/ambo call come for dublin, the hse contol should be used, they could then send either hse or dfb ambo to the scene, whichever is closest.

ivabiggon

paraletic wrote: »

first: OZ and New zealand ambulance service have actively recruited in ireland, i asume because of similarities,(also canada i believe) in USA i think our paramedic level is roughly EMT-I (Intermediate).

By international level irish prehospital care is probably amongst the highest in the world (although some european contries have doctor led ambulances).

in our unique 'Dublin' situation, (which is quite disfunctional) i think the problem does not come from 2 ambulance service providers. i think the problem is two dispatch providers.
ie: if a fire call comes in for dubln, the dfb control should be used.
if medical/ambo call come for dublin, the hse contol should be used, they could then send either hse or dfb ambo to the scene, whichever is closest.

but that is exactly what is happening at the moment except the shoe is on the other foot.
ok..sinario.. what if ambulance resources are streched and the ambulance dispatch can only send an ambulance from tallaght to an urgent call in swords when there is a fire tender or rescue unit sitting available in the station or better still mobile and available within the immediate location of the call. how is the ambulance dispatch suppose to know that the fire truck with 5 paramedic and equipment on board is in that local? that would not a good use of available resources for patient benifit, this is a typical scenario that is happening on a daily basis, and i know that from experience.

drill

Ivab,

yes the fire tender issue needs to be addressed 5 paras avaible for amb calls etc. But have to say it’s a huge step forward at last maybe we mite get nearest ambo to a call. ( and then work on resources - tenders/rrv etc)

One dispatch is the key, as said above there will be noses out of joint however it’s done. dfb or nas or joint etc, will never please everyone no matter how they do it.

At least there is a start with tallaght, from what ive heard it there will be 45 call taker / dispatch desks in main control room with a 12 desk major incident room, 20 desk pts room, and 120 new jobs!