Pressure on ambulance crews

kub

A friend of mine recently had to call 999 for an ambulance for her child who was completely out of it. Luckily for her a neighbour was a medical professional and was at hand to assist her.
Her husband was with me at the time she rang, I immediately drove him home to attend to his child. I knew at that stage that an ambulance had been called. I noted the time that he had received the call from his wife, she rang 999 before she rang him.
It took 40 minutes for the ambulance to arrive, I have to say the lads looked knackered but in fairness did their jobs in an excellent way as usual.
Thankfully now the child is on the mend. Some thing called a febroyed convulsion (sorry about the spelling)
Now we are not talking about rural Ireland here. This is in the suburbs of Cork city, it turns out that the ambulance that arrived was from Midleton. Thats 20 miles from Cork.
Another incident which I heard of was Cork City Fire Dept being called out by ambulance control to tend to a man suffering from a heart attack a few years back, as they did not have a crew available. Also bear in mind, this was in a fire engine, the HSE operate the ambulances down this neck of the woods.
So my query is, just how bad is it out there for you ambulance crews?

CB19Kevo

You could often be waiting over an hour for a ambo here.
Its a complete and utter joke, Almost pre historic service capability.
No fault to any EMT'S, Paramedics or controller's but damn someone made a complete bags of the current setup.
Its a case of plan for the best case and hope for it as well, Thats why you have towns with one 24hr ambulance that could often need 2.

Why cant the fire service be mobilised to every call that an ambo will take 30 mins or more to reach
Would this not take some pressure off and at least be some form of help to casulty's.

Tango Alpha 51

Simply down to budgets. Do you honestly think that any CFO is going to pay for ye to be mobilised to medical calls. Demographics play a big part in our problems too. Loads of fire stations covering an area whereas we have only a handful of stations covering an area.

Also whilst the idea of fire service personnel being first responders is noble, it ultimately doesn't solve the issue as you will still need an ambulance to transport & delays will still be inevitable.

The only solution really is more ambulances & crews which in reality is not going to happen anytime soon.

Paulzx

Did ye not hear?

An upgraded ambulance sevice is upon us in order to sort out all the downgraded hospitals.

No need to worry anymore. Utopia is here.You'll never have to wait more than 5 mins again

Well thats what the Dept of Health and the HSE is telling us.


And in other news.........The recession is officially over

999nobody

HSE logic, there are many more ambulance calls per year than fire calls but... there are many more fire appliances/stations than ambulances.

stevie06

999nobody wrote: »

HSE logic, there are many more ambulance calls per year than fire calls but... there are many more fire appliances/stations than ambulances.

A fair point, but the majority of those Fire Stations are manned by retained staff, so the costs for those stations are a lot cheaper than having an ambulance which has full time staff on it in each town.

crackcrack30

kub wrote: »

So my query is, just how bad is it out there for you ambulance crews?

Guestimate - City of Cork and surrounds population >100,000 people with maybe 3 ambulances on a 12hr shift with capability of treating/transporting one patient at a time.
Lets say each ambulance treated & Transported 8-10 patients per day (allowing for break if possible) thats approx 27 transports per day per cork/city <or>100,000 population. (Open for correction on numbers)

So ya expect to wait at no fault of the crews involved...........cc30

kub

crackcrack30 wrote: »

Guestimate - City of Cork and surrounds population >100,000 people with maybe 3 ambulances on a 12hr shift with capability of treating/transporting one patient at a time.
Lets say each ambulance treated & Transported 8-10 patients per day (allowing for break if possible) thats approx 27 transports per day per cork/city <or>100,000 population. (Open for correction on numbers)

So ya expect to wait at no fault of the crews involved...........cc30

Sorry if I gave the impression it was the crews fault, far from it. I could see the state of both lads when they arrived on the scene.
Also with this crew in Cork city covering for a city crew, who was covering for these guys at their base in Midleton? Again I am not all blaming crews, they have my upmost respect, having saved my own life once upon a time.
Am i correct in thinking that there was one of these famous european directives introduced a few years ago regarding transporting and treating only 1 patient per vehicle?
If this was the case then surely and logically a responsible authorithy would surely lay on extra vehicles and EMTs?
Was this done, or they did do something more important like employing more admin staff?

Delancey

While it would be great to have more ambulances and crews everywhere I agree it probably is an unrealistic aspiration in the current climate.

Perhaps the pressure would ease if HSE / Ambulance Service management took a tougher line on so-called emergency calls that are in fact as urgent as a runny nose ?
I have direct experience of ridiculous 999 calls complaining of toothache ( I kid you not ) that nonetheless get an ambulance response.

I know there is the AMPDS dispatch system that in theory allocates calls based on urgency but to my knowledge the HSE has failed to implement the Omega or no dispatch code.
There is of course the conspiracy theory that says all these bullsh1t calls get taken because Ambulance management use them to ' puff up ' their statistics and thus bolster their demands for more funding

Rather tham slamming politicians I think these are issues that the HSE and Ambulance Service management should be sorting out first.

kub

Delancey wrote: »

While it would be great to have more ambulances and crews everywhere I agree it probably is an unrealistic aspiration in the current climate.

Perhaps the pressure would ease if HSE / Ambulance Service managemnt took a tougher line on so-called emergency calls that are in fact as urgent as a runny nose ?
I have direct experience of ridiculous 999 calls complaining of toothache ( I kid you not ) that nonetheless get an ambulance response.

I know there is the AMPDS dispatch system that in theory allocates calls based on urgency but to my knowledge the HSE has failed to implement the Omega or no dispatch code.
There is of course the conspiracy theory that says all these bullsh1t calls get taken because Ambulance management use them to ' puff up ' their statistics and thus bolster their demands for more funding

Rather tham slamming politicians I think these are issues that the HSE and Ambulance Service management should be sorting out first.

And there I was thinking that people only dial 999 in an emergency, Toothache???? have people any sense?
Of course then if they did prioritise calls, it would mean that some one somewhere is responsible. This is not really a HSE policy is it?

Tango Alpha 51

Delancey wrote: »

I know there is the AMPDS dispatch system that in theory allocates calls based on urgency but to my knowledge the HSE has failed to implement the Omega or no dispatch code.
There is of course the conspiracy theory that says all these bullsh1t calls get taken because Ambulance management use them to ' puff up ' their statistics and thus bolster their demands for more funding

.

Omega dispatch codes are used by NAS control room staff. These would be at the lowest level for priority but as has been pointed out before, the resources to deal with these calls are still not in place so therefore it falls on the ambulance service to respond to them.

In an ideal world, you would have different specialities ie drug counsellor's, therapists etc available to deal with these without the need for an ambulance to respond but we don't live in a utopia.

As for the conspiracy theorists, that could be applied to all sorts really. The ambulance service is busy enough with out having to resort to artifically inflating their figures for funding purposes. Unfortunately when the times were good, the necessary investment wasn't put into the service ie fleet, staff, equipment, buildings & now when times are bad & cutbacks are everywhere, we're not going to get any now.

It is hard on the public to fathom, but you do have to draw the line somewhere as to how many ambulances you can physically put out there.

Delancey

buzzman wrote: »

It is hard on the public to fathom, but you do have to draw the line somewhere as to how many ambulances you can physically put out there.

Agree 100% with you on that point but something is wrong when any cretin can phone 999 with a toothache and get an ambulance response.
I was badly hurt in a fall years ago , I remember the DFB crew telling me that I was their 6th call that day but the first call that justified an ambulance , the other 5 calls were in their words '' glorified taxi runs ''.

In my opinion lives are endangered by HSE / Ambulance Service management not tackling this problem.

Actual Paramedic

Delancey wrote: »

While it would be great to have more ambulances and crews everywhere I agree it probably is an unrealistic aspiration in the current climate.

Perhaps the pressure would ease if HSE / Ambulance Service management took a tougher line on so-called emergency calls that are in fact as urgent as a runny nose ?
I have direct experience of ridiculous 999 calls complaining of toothache ( I kid you not ) that nonetheless get an ambulance response.

I know there is the AMPDS dispatch system that in theory allocates calls based on urgency but to my knowledge the HSE has failed to implement the Omega or no dispatch code.
There is of course the conspiracy theory that says all these bullsh1t calls get taken because Ambulance management use them to ' puff up ' their statistics and thus bolster their demands for more funding

Rather tham slamming politicians I think these are issues that the HSE and Ambulance Service management should be sorting out first.

You seem set against the HSE ambulance service? Why?

The NAS have not implemented the no dispatch policy, either has the DFB but don't see you slating them. Also PHECC is the governing body and am not sure they will agree with straight off using Omega no dispatch.

Some areas of the NAS don't proQa calls from GP's whilst others do. The proposed 2 control centres; year away; should be a help in eradicating this issue.

Delancey

Actual Paramedic wrote: »

You seem set against the HSE ambulance service? Why?

The NAS have not implemented the no dispatch policy, either has the DFB but don't see you slating them. Also PHECC is the governing body and am not sure they will agree with straight off using Omega no dispatch.

Some areas of the NAS don't proQa calls from GP's whilst others do. The proposed 2 control centres; year away; should be a help in eradicating this issue.

Sorry if I appear set against the NAS , any comments I've made about them apply equally to DFB.

I am annoyed that in these difficult times of hospitals being downgraded we will see increasing use of Ambulances to transport patients to other hospitals with the nescessary facilities , these changes will see increased pressure on Ambulances yet no effort seems to be made to reduce/eliminate the significant number of non-emergency calls that get an emergency response.

My comments are directed at management of the services and certainly not the crews on the ground.
Somebody , be it HSE , NAS , PHECC needs to take ownership of this rather than seek a decision by someone else.

CB19Kevo

buzzman wrote: »

Simply down to budgets. Do you honestly think that any CFO is going to pay for ye to be mobilised to medical calls. Demographics play a big part in our problems too. Loads of fire stations covering an area whereas we have only a handful of stations covering an area.

Also whilst the idea of fire service personnel being first responders is noble, it ultimately doesn't solve the issue as you will still need an ambulance to transport & delays will still be inevitable.

The only solution really is more ambulances & crews which in reality is not going to happen anytime soon.

Ime not a member of any Fire services but that aside, The County council should not have to pay for these mobilisations, Just set in place a link between hse and camc.
As for the demographics - Fire stations need to be within a certain response range, And with recent closures of some stations this has been made difficult / Along with reduced retained crews.
Investment is needed in the fire service aswell to at least maintain current services. The national ambulance service needs to bring down response times outside of the major urban areas, And its clear for this to happen that investment in new vehicles and staff has to take place.

If the reality is that new crews and equipment will not be made avalible i stick to my earlier point that fire service & Community responders are the best solution 2nd to ambulance assistance in my opinion.

flazio

IMHO every emergency vehicle, be it a squad car, fire tender or Rapid response vehicle should be equipped with a defib and the crew of said vehicle trained to use it. Last night's traffic blues demonstrated just how committed AGS are to playing their part in saving someone's lives. Likewise if I came across a medical emergency where I know the fire station is closer then the ambulance station, I wouldn't hesitate to at least call the fire dispatch and ask if they had a defib they could get down quickly. Time is of the essence.

crackcrack30

IF a squad or fire tender were dispached to every "collapse"/ "query arrest"/ or "pt unresponsive" there would be alot of services chasing their tales with no idea or training of how to treat/stabilise the the patient with their probable non arrest needs ..............crime rates would (in the mean time) soar and buildings would burn.

If the Gardai who are very often undermaned and also under pressure were told that the ambulance service would be helping out with operating check-points or drugs raids when they are busy there would be eyebrows raised...

Investment is needed in the Ambulance service taking into account call numbers - census - demographics with amalgamation of ambulance and fire services set as a near term goal, A paramedic placed or trained on every fire rig / fire ambulances following tenders to RTC's ect ect..........cc30

psmate

crackcrack30 wrote: »

IF a squad or fire tender were dispached to every "collapse"/ "query arrest"/ or "pt unresponsive" there would be alot of services chasing their tales with no idea or training of how to treat/stabilise the the patient with their probable non arrest needs ..............crime rates would (in the mean time) soar and buildings would burn.

If the Gardai who are very often undermaned and also under pressure were told that the ambulance service would be helping out with operating check-points or drugs raids when they are busy there would be eyebrows raised...

Investment is needed in the Ambulance service taking into account call numbers - census - demographics with amalgamation of ambulance and fire services set as a near term goal, A paramedic placed or trained on every fire rig / fire ambulances following tenders to RTC's ect ect..........cc30

Hi...for anyone that might be reading this that is new, all members of Dublin Fire Brigade are Paramedics, so if you call for an ambulance in Dublin and a fire engine shows up the crew on the fire engine are equally as qaulified and experienced as the ambulance crews.
Has happened that we show up and you get the "I rang for an ambulance, there's no fire".

kub

psmate wrote: »

Hi...for anyone that might be reading this that is new, all members of Dublin Fire Brigade are Paramedics, so if you call for an ambulance in Dublin and a fire engine shows up the crew on the fire engine are equally as qaulified and experienced as the ambulance crews.
Has happened that we show up and you get the "I rang for an ambulance, there's no fire".

Yes correct, a bit of a waste though especially with only one casualty. By all means from a first aid / treatment point of view though. Usually an ambulance crew consists of 2, a fire appliance 6.
So if the red truck does turn out you have 4 trained paramedics with nothing to do and a fire engine not fit for purpose.
Might be better off sending out 2 guys in one of those fire officers marked cars. Either way, should it be necessary for a hospital transfer, an ambulance will still be necessary.

999nobody

psmate wrote: »

Hi...for anyone that might be reading this that is new, all members of Dublin Fire Brigade are Paramedics, so if you call for an ambulance in Dublin and a fire engine shows up the crew on the fire engine are equally as qaulified and experienced as the ambulance crews.
Has happened that we show up and you get the "I rang for an ambulance, there's no fire".

Where do the AP's count in your scenario? Are they on an engine?

psmate

kub wrote: »

Yes correct, a bit of a waste though especially with only one casualty. By all means from a first aid / treatment point of view though. Usually an ambulance crew consists of 2, a fire appliance 6.
So if the red truck does turn out you have 4 trained paramedics with nothing to do and a fire engine not fit for purpose.
Might be better off sending out 2 guys in one of those fire officers marked cars. Either way, should it be necessary for a hospital transfer, an ambulance will still be necessary.

hi Kub...the control room would only have an engine respond for certain types of cases and not the minor cases. In Dublin the crews consist of either 4/5 and an officer, the engines would be sent to all calls of an unresponsive pt, along with an ambulance. For example if it turns out that there is a cardiac/respiratory arrest then the more people there the better, also in these cases when an engine shows up first treatment is not delayed and we can obtain advanced airways as well as drug admin for a narcotic induced repiratory arrest.
Also for RTC's that the engine attends, means everybody knows what to do in relation to pt care as well as take a roof off the car.
The engines are never used for a patient transfer, a kind of an advanced treatment while wating for an ambulance or working along side the ambulance crews to speed up patient packaging and removal.
From what I have seen there is always plenty to do at major traumas and medical cases, IMO the more trained personal that are on scene the quicker the treatment and removal to hospital for a pt, the only person that benefits from this is the patient!