Call to cut emergency response time

James Jones

"Ambulance workers must respond to life-threatening emergencies such as heart attacks within eight minutes, a new report said today.
For the first time in Ireland, paramedics will have to publicly report the time it takes them to reach patients with potentially fatal conditions.
The Health Information and Quality Authority (Hiqa), the health service watchdog, said setting benchmarks can help improve response times".

Read full article HERE.

Will this require the release of ambulances from certain hospitals?

touge_drift

read this earlier today, seems there looking to follow the uk model.

would this possibly mean more rrv's?? or more staff and more ambulances?

Bang Bang

James Jones wrote: »

"Ambulance workers must respond to life-threatening emergencies such as heart attacks within eight minutes, a new report said today.
For the first time in Ireland, paramedics will have to publicly report the time it takes them to reach patients with potentially fatal conditions.
The Health Information and Quality Authority (Hiqa), the health service watchdog, said setting benchmarks can help improve response times".

Read full article HERE.

Will this require the release of ambulances from certain hospitals?

Can you explain the last line, do you mean releasing ambulances that are tied up at Emergency Departments?

The response times submitted to HIQA have proven to be inaccurate where the time frame for the response of an ambulance is concerned.
The eight minute response in based on the ambulance responding from it's station or 'standby' point to the scene within it's catchment area.

I'll give you a rough example of how the response times are way over what's expected, getting away from the fact that certain parts of the country cover huge areas.

Let's use Dublin for example;
An ambulance is responded from Loughlinstown station to Lucan which is way out of it's area. The response time is way over the recommended guideline.
That ambulances goes clear sometime later in Connolly Hospital in Blanchardstown. It receives an emergency call back into it's 'area' just as it leaves Connolly Hospital, again the response time is way over the guidlines.

The % stats shown in recent reports does not stipulate from where the ambulance responded from, or to for that matter.

The vast majority of calls in the city given to a 'clear and available' ambulance within it's area are answered within the recommended guidelines.

HIQA's intentions are good but they have to be fed the correct stats which include the location of an ambulance when it received a call and the area where the call is.

The new control room scheduled for later this year may put HIQA in a better position to attain more accurate information on ambulance response times and distances.

ch252

The Bradley report by the UK ambulance service is a good read on this topic and I'm sure the HSE have looked very closely at it. The report suggested that all cat A (AS1) calls should be responded to within 8 minutes and they have taken the relative measures to ensure this over there by introducing more RRVs where a paramedic rushes out in a car and if necessary calls for an ambulance, or both are dispatched straight away depending on the nature of the emergency.

Also they paramedic practitioners and emergency care practitioners can by-pass the ED, bringing somebody straight to orthopedics or by treating at home example, this results in less patients going through the ED. Here is a quote from the report to back up this and give a good example of how it works:

"Case study: new ways of working improves patient care
In September 2002, South Yorkshire Ambulance Service NHS Trust (SYAS) launched a Paramedic Practitioner Scheme in Sheffield for people over 65 with the aim to see and treat people at home and to avoid A&E attendance. Paramedics were given additional assessment, treatment and referral skills to deal with a range of minor injuries and falls cases. The scheme was part of a randomised control trial and the full results are due imminently. Key results show high patient satisfaction with over 50% of people seen remaining at home. Building on this success, SYAS, with partner organisations, developed an Emergency Care Practitioner (ECP) scheme last year recruiting healthcare professionals to deal with a wider range of minor injuries and illnesses. The 24 ECPs support out of hours work, unscheduled primary care through the day and support the 999 system."

goldie fish

touge_drift wrote: »

read this earlier today, seems there looking to follow the uk model.

would this possibly mean more rrv's?? or more staff and more ambulances?

There seems to be a need for this. More Motorbike paramedics perhaps? First responder on scene in 8 minutes, Patient carrying vehicle in 18 in certain cases.

ger664

Given the economic times and cuts coming down the line, We will do well to maintain current levels of service let alone improve them.

James Jones

Bang Bang wrote: »

Can you explain the last line, do you mean releasing ambulances that are tied up at Emergency Departments?

.

How can the ambulance service in Dublin be expected reach such tight deadlines when over 50% of the fleet are regularly tied up at hospitals unnecessarily?

Bang Bang

James Jones wrote: »

How can the ambulance service in Dublin be expected reach such tight deadlines when over 50% of the fleet are regularly tied up at hospitals unnecessarily?

I agree with you fully, I just wasn't sure if your last line meant that.
But like I said in my previous post, when a call is given to a 'clear and available' ambulance that is in it's 'area' and responding within it's 'area' then the guidelines are usually met.
I am only referring to Dublin here because other County's cover huge areas.
But 'rush hour' in Dublin is another story, where traffic is gridlocked and it's near impossible to get through some streets.
All this info plus info in my previous post is not taken into consideration when publishing stats on response times.
One of the many reasons why the UK ORCON system continually failed into given correct stats on responses.

I might add that Kilcoole in County Wicklow comes under the Dublin catchment area so not even an ambulance responding from it's station in Loughlinstown could meet the recommended time frame.
This is reflected countrywide.
So the whole eight minute response thing is/was doomed from the start with regard to 100% of life threatening calls being answered within the eight minute guideline.
The relevant information on distances, catchment areas etc is not taken into considering when publishing the response stats.
It's very misleading to the public and in my opinion some members of the public may see us as failures because they were waiting way beyond the 'recommended' eight minutes for an ambulance.

ivabiggon

Bang Bang wrote: »

I agree with you fully, I just wasn't sure if your last line meant that.
But like I said in my previous post, when a call is given to a 'clear and available' ambulance that is in it's 'area' and responding within it's 'area' then the guidelines are usually met.
I am only referring to Dublin here because other County's cover huge areas.
But 'rush hour' in Dublin is another story, where traffic is gridlocked and it's near impossible to get through some streets.
All this info plus info in my previous post is not taken into consideration when publishing stats on response times.
One of the many reasons why the UK ORCON system continually failed into given correct stats on responses.

I might add that Kilcoole in County Wicklow comes under the Dublin catchment area so not even an ambulance responding from it's station in Loughlinstown could meet the recommended time frame.
This is reflected countrywide.
So the whole eight minute response thing is/was doomed from the start with regard to 100% of life threatening calls being answered within the eight minute guideline.
The relevant information on distances, catchment areas etc is not taken into considering when publishing the response stats.
It's very misleading to the public and in my opinion some members of the public may see us as failures because they were waiting way beyond the 'recommended' eight minutes for an ambulance.

i have posted some views on another tread and their is no reason why this type of solution couldn't be adopted across the country for the good of the public. at the moment their is great cooperation existing around the country between retain fire service and local ambulance controls, it's a pity politics and money get in the way.

http://www.boards.ie/vbulletin/showpost.php?p=70081391&postcount=18

999nobody

Doesn't the 8 minute response time only really apply to large urban areas? Given the roads and distances in rural Ireland it would be difficult. Assuming an ambulance could maintain 60mph this would allow it to travel 8 miles in 8 minutes, this doesn't even take into account the time taken to leave the station, traffic, road conditions etc.
Or will we post ambulances every 8 miles?

ivabiggon

i was listening to some sort of Representative from PHECC yesterday on today fm explaining that it's not necessary to get an ambulance on scene but first responders could make up the time similar to the british services.
he was referring to CPR and early defib. also he referred to paramedic practitioners that are used in britain that may attend and treat on scene and leave the patient without transporting to a hospital.

http://media.todayfm.com/podcasts/popup

Bang Bang

ivabiggon wrote: »

i have posted some views on another tread and their is no reason why this type of solution couldn't be adopted across the country for the good of the public. at the moment their is great cooperation existing around the country between retain fire service and local ambulance controls, it's a pity politics and money get in the way.

http://www.boards.ie/vbulletin/showpost.php?p=70081391&postcount=18

The eight minute response time is to get a 'qualified' resource to the scene, not neccesarily an ambulance. This is set to tie in with planned national community first responder programme, similar to what they have in Wicklow, but on a larger scale to include larger towns and cities.
It will also tie in with the spreadout of AP RRV's across the country.
There is no reason, in my opinion, why the retained services should not be included in the first responder programme, as they have the qualification and it would mean that a full turnout is not required. This way an SUV or car type vehicle from the retained station could be used by one or two responders, leaving the fire appliance free.
Cost and who would monitor/control this is another story because the responsibilty of alerting the first responders will be with one of the new national control centers. The cost would rest with the local council as they would be paying for the turnout, again the politics of this may get in the way.

Bang Bang

ivabiggon wrote: »

i was listening to some sort of Representative from PHECC yesterday on today fm explaining that it's not necessary to get an ambulance on scene but first responders could make up the time similar to the british services.
he was referring to CPR and early defib. also he referred to paramedic practitioners that are used in britain that may attend and treat on scene and leave the patient without transporting to a hospital.

I looked at the Paramedic Practitioner roll and it carries a huge responsibilty, but it's not impossible. It works really well with simple problems like the sore finger call or the two month long abdo pain call etc. But there's no denying that it keeps the ambulances free for ambulance calls.

ivabiggon

Bang Bang wrote: »

The eight minute response time is to get a 'qualified' resource to the scene, not neccesarily an ambulance. This is set to tie in with planned national community first responder programme, similar to what they have in Wicklow, but on a larger scale to include larger towns and cities.
It will also tie in with the spreadout of AP RRV's across the country.
There is no reason, in my opinion, why the retained services should not be included in the first responder programme, as they have the qualification and it would mean that a full turnout is not required. This way an SUV or car type vehicle from the retained station could be used by one or two responders, leaving the fire appliance free.
Cost and who would monitor/control this is another story because the responsibilty of alerting the first responders will be with one of the new national control centers. The cost would rest with the local council as they would be paying for the turnout, again the politics of this may get in the way.

hence the reason all emergency services should be taken out of the hands of local authorities and the health services and have an country wide emergency service then there would be nobody other than the dept in charge of the emergency service picking up the tab.

ivabiggon

Bang Bang wrote: »

I looked at the Paramedic Practitioner roll and it carries a huge responsibilty, but it's not impossible. It works really well with simple problems like the sore finger call or the two month long abdo pain call etc. But there's no denying that it keeps the ambulances free for ambulance calls.

yeah but is it just bridging the gap of an ever failing health service.

maglite

Bang Bang wrote: »

The eight minute response time is to get a 'qualified' resource to the scene, not neccesarily an ambulance.

Irish Times wrote:

Hiqa said it initially wanted to see trained paramedics on the scene of life-threatening cases, including cardiac or respiratory arrest, within the eight minute deadline in at least three quarters of all call-outs

Massive difference between wanting a CFR and Paramedic...

MagicSean

If they want to increase response times they should introduce legislation that requires motorists to yield to them and move out of their way.

high heels

Im living in London at the mo and where I live there is a few old people about.. So get to see them in action..

By the looks at things a car is sent first to see what the situation is. Then a ambulance is sent and Ive seen if they need more care the helicopter is sent ( twice in 9 months Ive been here), they landed in the local park and the police gave a lift to the location all on scene in less than 20 minutes.

Coming from the west of Ireland Id say it could take a hour and a half to get to Achill from Castlebar, I know there is the local volunteer stuff but can they attend a bad car crash? Thats a 3 hour round trip. Helicopters I think are needed in Ireland ASAP Subsidize is by having them at dangerous sports like motorsport & horse racing..