OMAC night ambulance service.

Swirly Whirly

See here for article.

THE ORDER OF Malta ambulance corps has started providing midnight cover on the Main Street of Maynooth, county Kildare.

At the request of local councillor Frank O’Rourke, the service is running as a pilot project on Saturday nights. Last weekend, seven members of the corps – including two qualified nurses – provided care to six people.

Two were attended to because of head injuries and another couple were seen to because of an “overindulgence” on alcohol, officer in charge David Wallace told TheJournal.ie.

Two people were subsequently transferred to hospital at the request of HSE Ambulance Control.

The medical crew and volunteers are on hand from 10pm to 3am on the busy street, popular with students attending NUI Maynooth and young adults from the surrounding North Kildare area. They aim to provide a first responder service for those who become acutely unwell or injured while on a night out.
The ambulance crew will take people in, assess them, treat if required and discharge. If something more sinister is detected, the patient can be stabilised and transferred to hospital by a HSE ambulance.

The service was set up after the recent tragic death of a young man who sustained a serious head injury and subsequently stopped breathing on Maynooth Main Street. His family contacted Cllr O’Rourke in the hopes of preventing any similar events in the future.

At the time of the young man’s collapse, a volunteer member of the Nass Order of Malta unit was nearby and performed CPR. Unfortunately, he was not able to save his life but the family believe it is “sad that more qualified personnel were not on hand” to help.

The unit has liaised with the Gardaí and the HSE ahead of setting out last week. Wallace explained that seven volunteers are deployed to provide “safety in numbers”.

“These things are unpredictable,” said Wallace. “We are qualified to give advanced level of first aid and there is a qualified nurse to supervise the whole operation.”

This is the first scheme of its type in Ireland, although similar services do exist in the UK such as SOS Bus.

Although it is run on a volunteer basis, there are overheads to cover and Wallace is hoping that a number of local businesses will step up to support it.
Cllr O’Rourke has approached companies and publicans for support but for the moment he is covering some of the costs himself through a voluntary contribution.

He told TheJournal.ie that he wanted to get the project off the ground – something he has done just four weeks after he was first approached by the bereaved family.

Only 14 months into his first term, he said he treats any issues brought to him by the public with the same level of urgency.

He said the primary care facility that the Order of Malta supplies on a Saturday night is not a result of a culture of drinking or violence but is a necessity in a busy, populated area. “People are out enjoying themselves. Sometimes, it can happen that they overindulge or over do it. In that case, back up is needed,” he said. “Anywhere where there is a large population and people are out having a good time, there may be an incident through nobody’s fault. It makes sense to have medics on hand as quickly as possible.”

He sees the project as a temporary primary care facility that could also assist in the bigger picture.

“It is magnificent that people can be assessed, treated and discharged right there. That may keep them out of GP offices and Emergency Departments. This project could prove very worthwhile and tick a lot of boxes.”

So what do people think of this? I'm a EMT in one of the Dublin units and there has been ideas like this floated in the past, but its never gained traction beyond that partly due to the "need" wasn't seen to be there. How do people feel of this practice? Risky? Or rather something that is needed to relieve the pressure on the statutory services?


Curious to some of the reactions of some HSE people here.

ambo112

So what do people think of this? I'm a EMT in one of the Dublin units and there has been ideas like this floated in the past, but its never gained traction beyond that partly due to the "need" wasn't seen to be there. How do people feel of this practice? Risky? Or rather something that is needed to relieve the pressure on the statutory services?


Curious to some of the reactions of some HSE people here.[/Quote]

Dangerous, no one under advanced paramedic can treat and discharge. Nurses cannot do that.

I have great respect for the OMAC and all other voluntary services, they are highly skilled and professional but PHECC have not authorised them to treat and discharge.

Personnel safety is a major concern, assault, needle stick and verbal abuse.

A minor injury like a cut finger may not seem like much but if not examined by a doctor or tetanus administered, it may become more sinister.

Commendable but I feel the tragic incident should be used to highlight gaps in the NAS deployment and resources in that area, the government needs to accept that if the ambulance service is to develop then the budget must be increased, especially if they are to close A&E's on the back of it.

maglite

ambo112 wrote: »

Dangerous, no one under advanced paramedic can treat and discharge. Nurses cannot do that.

Say what now, The Vols do treat and discharge as a matter of course. We couldn't being everyone we see to hospital.


As for the scheme, I'd think Maynooth does't have the critical mass required for a scheme like this. They would be far better of running basic courses in First Aid, CPR, how to call for help etc.

ambo112

Say what now, The Vols do treat and discharge as a matter of course. We couldn't being everyone we see to hospital.


As for the scheme, I'd think Maynooth does't have the critical mass required for a scheme like this. They would be far better of running basic courses in First Aid, CPR, how to call for help etc.

I know that they do but they are not authorised by PHECC to do so, any lawsuit would be won.

That aside, I would be concerned about their safety more than anything else.

I agree completely with the training!!!

Again, more pressure should be put on NAS, I am a NAS paramedic in the North East and I am frustrated with the pure lack of resources because of budget constraints, the North have more staff, vehicles etc then the entire South????? Begs belief!!

Mycroft H

ambo112 wrote: »

I know that they do but they are not authorised by PHECC to do so, any lawsuit would be won.

That aside, I would be concerned about their safety more than anything else.

I agree completely with the training!!!

Again, more pressure should be put on NAS, I am a NAS paramedic in the North East and I am frustrated with the pure lack of resources because of budget constraints, the North have more staff, vehicles etc then the entire South????? Begs belief!!

So as a paramedic, you get a call to someone with a very minor issue, you still have to refer to an AP/MP and above?

The voluntaries have been treating and discharging for a long long time at events. There not going to bring someone to A+E for a cut hand. I would imagine that the powers that be in the ambulance corps would have had to give the go ahead for this sorta operation insurance wise and legal wise cos if thats true they are leaving themselves open to a lot of abuse.

ambo112

So as a paramedic, you get a call to someone with a very minor issue, you still have to refer to an AP/MP and above?

The voluntaries have been treating and discharging for a long long time at events. There not going to bring someone to A+E for a cut hand. I would imagine that the powers that be in the ambulance corps would have had to give the go ahead for this sorta operation insurance wise and legal wise cos if thats true they are leaving themselves open to a lot of abuse.

We cannot discharge any individual, that's why we end up bringing time wasters to A&E constantly. Most people know themselves and will decline transport to A&E after basic treatment.

I was in the vols for years and know the practice, that is all well and good at field days or minor public events, oxygen has Doctors on site to do it, but dealing with the public on a weekend night is not an area suitable for the vols, it's not a question of training, it's a question of experience and danger, let the professionals do it but this should be used to highlight the need for more NAS resources.

Again, commendable but very rash reaction and quiet dangerous, all round.

Just my two cents, you don't have to agree with it or accept it but that would be my view from a fellow practitioner to another.

kub

Is this politics in action, I mean is there a bigger picture here? Lets just consider this, we have The Garda Reserve.....minimal cost to the taxpayer, now we have free medical treatment without even a medical card, agin minimal cost to the taxpayer.
So what cheap ideas have they got for the Fire Service?

While I do admire the OMAC for providing this service, I think they may be leaving themselves open to abuse both by the patients and by the powers that be.

Swirly Whirly

kub wrote: »

Is this politics in action, I mean is there a bigger picture here? Lets just consider this, we have The Garda Reserve.....minimal cost to the taxpayer, now we have free medical treatment without even a medical card, agin minimal cost to the taxpayer.
So what cheap ideas have they got for the Fire Service?

While I do admire the OMAC for providing this service, I think they may be leaving themselves open to abuse both by the patients and by the powers that be.

Yea, I'm inclined to agree here. I've been sorta undecided on the idea since I read the article.

During bigger events like where these types of causalities can occur there is always advanced level care available; this being the Advanced Paramedic and the Medical Physician. These are present at Oxygen, The O2, Electric Picnic, Horse racing ect. A couple of Nurses and a few EMTs and couple of responders (I'm speaking as an EMT here myself ) does not constitute advanced level care.

Hence while they may be capable of discharging casualties in specific circumstances technically they really can not under current PHECC guidelines. Hence there leaving themselves wide open regarding insurance and legal issues. While the NAS might be okay with it as it eases the pressure there, I wonder what PHECC think of it.

While there intentions are ultimately admirable, it really highlights the huge holes in the NAS. More money is needed to be pumped into the Ambulance service which is ment to deal with these issues.

supermedic

People, I think you are confusing some basic principles here. Someone who presents to a voluntary service and asks for some first aid, to clean and dress a minor laceration or to deal with a bee sting, can and should be treated and let go on their way if they wish. It is not "treat and discharge" in the way PHECC would see it. It is simply basic first aid, and the vols have being doing it well for decades.
The HSE/NAS responding to a 999 call for assistance and finding a "patient" who requests to go to hospital must, at present, transport that patient unless they have a very, very good reason not to.

At some stage in the future the NAS will implement proper Treat and Discharge cpgs. These will only reinforce the reality of current care. If I, as an AP, manage a simple uncomplicated hypo, the patients recovers perfectly well with no "unusual" issues, then that patient can legally and rightly decline to go to hospital, and i would be quite happy with that outcome.

Where the NAS needs to get to is a process like the UK, where firstly the control will refuse ambulances to Omega calls and many Alphas and will authorise certain clinical grades to deal with certain calls and refer to more appropriate pathways, ie GP, out of hours care, X ray dept, minor injury unit. etc. etc.

If you are in the ambulance service, you will know that many calls for help are made with good intention, but turn out to be the most minor of problems, many times they are best dealt with with a trip to the GP the next day. Often the caller simply needs the reassurance of a healthcare professional that the pain in their big toe that have had for a month need not mean a trip to the ED at 03.30 hrs on a Saturday morning. If we get to a situation where we do not have to transport this "Low Acuity" stuff, the whole system will improve.

scholar007

Swirly Whirly wrote: »

See here for article.




So what do people think of this? I'm a EMT in one of the Dublin units and there has been ideas like this floated in the past, but its never gained traction beyond that partly due to the "need" wasn't seen to be there. How do people feel of this practice? Risky? Or rather something that is needed to relieve the pressure on the statutory services?


Curious to some of the reactions of some HSE people here.

Who is paying them to provide this service?

sgthighway

Was I the only person who thought this was an April Fools gag?

Swirly Whirly

scholar007 wrote: »

Who is paying them to provide this service?

Apparently the local Councillor is bankrolling them but there looking for funding from local businesses.

April fools gag? While I admire their enthusiasm, I'm not entirely sure if its the right approach to the matter.

SerialComplaint

THere was a reality show on C4 showing some SJAB folk doing the same in some town in the UK.

EMTFlynn

Yes, that programme on Ch4 was a joke!

999nobody

Swirly Whirly wrote: »

Apparently the local Councillor is bankrolling them but there looking for funding from local businesses.

Isn't it a voluntary service provided by a volunteer organisation?

cocoshovel

999nobody wrote: »

Isn't it a voluntary service provided by a volunteer organisation?

They still charge by the hour to do the work. Although no members or people of the unit get paid the money, but someone has to pay for supplies/equipment, vehicle funds and probably some subscription has to be paid to the main office in Dublin.

Mycroft H

cocoshovel wrote: »

They still charge by the hour to do the work. Although no members or people of the unit get paid the money, but someone has to pay for supplies/equipment, vehicle funds and probably some subscription has to be paid to the main office in Dublin.

In this case, who would they charge? Kildare CoCo? I'd imagine there doing this off their own bat.

Topper7

Im surprised by some peoples reactions to this news. I just read another thread that there seems to be a lot of complaining that there isnt enough ambulances & crew to deal with patients. I even hear of stories from DFB where tendor and ambo are dispatched as its seen as more people to help out the better (I know DFB are all paramedics). While I agree that we need more HSE ambos & crews, the chances of getting them at the moment are slim to none. So why not accept the help when its being offered especially at peak times. Control asked OMAC to transport so maybe that means that the HSE lads where too busy?

I know some say that its too dangerous but the same people also provide cover at various concerts/events where it can be a lot more dangerous for the crews. (I know ALS is available to at major events but it can take a while for them to arrive on scene, similair to maynnoth???) At the end of the day it comes down to safety of the crew and care/comfort of the paient. If its felt by the powers that be that these lads are reasonably safe (wouldnt have got permission if not ie gardai, OMAC HQ, HSE AC) then surely the care of a patients is next on the agenda? & surely any step that aids in the care of a patient is a step in the right direction???

TylerIE

cocoshovel wrote: »

They still charge by the hour to do the work. Although no members or people of the unit get paid the money, but someone has to pay for supplies/equipment, vehicle funds and probably some subscription has to be paid to the main office in Dublin.

It depends on the voluntary organisation and the area - in my home county you have one Vol that charges nothing, but volunteers must be fed.

Another charges an exhorbitant fee higher than one private would for the provision of an ambulance, but free/donations for cover only,

and another does something along the lines of an hourly fee.

rgnmb

[/Quote]Dangerous, no one under advanced paramedic can treat and discharge. Nurses cannot do that.

I have great respect for the OMAC and all other voluntary services, they are highly skilled and professional but PHECC have not authorised them to treat and discharge.

Personnel safety is a major concern, assault, needle stick and verbal abuse.

A minor injury like a cut finger may not seem like much but if not examined by a doctor or tetanus administered, it may become more sinister.

Commendable but I feel the tragic incident should be used to highlight gaps in the NAS deployment and resources in that area, the government needs to accept that if the ambulance service is to develop then the budget must be increased, especially if they are to close A&E's on the back of it.[/QUOTE]

Just to clarify a few matters...

Advanced Paramedics cannot currently treat and discharge.

PHECC does not regulate doctors or nurses, nor decide what they can or cannot do in the pre-hospital or hospital environment.

PHECC does not authorise voluntary organisations to do specific things. It authorises pre-hospital care practitioners (EMT P and AP) working on behalf of a CPG approved organisation to operate under a specific edition of the CPGs. EMT, P and AP cannot treat and discharge under their CPGs, so they cannot treat and discharge on behalf of any CPG approved organisations - so in reference to Maynooth - treat and discharge doesnt seem to be its intended use, first response is the aim of the game.

Nurses and Doctors are regulated by other bodies. They operate within their scope of practice and are are not limited by CPGs - so in reference to Maynooth, nurses deliver care within their scope. The scope is specific to that nurse, so to say "nurses cannot do X" is a nonsense. Scope of practice is another concept that seems to have flown over the heads of some pre-hospital care practitioners.

The lack of understanding of the professions own regulatory system, and that of other healthcare professionals is a sad reflection. A degree of ignorance exists about how PHECC operates and how the CPGs are applied. And then people wonder why they are treated like van drivers...

vidar

Has anyone heard of how this has gone?

Swirly Whirly

Word is that its discontinued as far as I know. As to why, I've no idea.

Given that they were looking for funding, its reasonable to speculate that they didn't have the money.