The target ambulance response time to a 000 call in New South Wales is eight minutes. The tragic death of Phil Hughes on a sports ground in central Sydney has thrown the spotlight on ambulance delays. It took twenty-three minutes for the ambulance responding to that first 000 call to reach the SCG.
Response time is critical - and in many cases it is literally a matter of life or death. The Ambulance paramedics are highly trained medical people able to recognise the emergency and apply the appropriate treatment to stabilize the patient. In cases of strokes or heart attacks, blood thinning medication can prevent the ongoing damage escalating, resulting in permanent injury or death. In most cases, time is the critical factor in saving lives.
Every time the spotlight shines on ambulance delay times, it reveals a weakness that seems ever present in our health system. The ambulance may not be directed to the nearest hospital emergency department. The despatchers will try and send it to the hospital with the least time delay in actually accepting that patient - but at least the patient is under treatment and condition details are being exchanged between the treating paramedic and the despatcher.
The real problem comes when the ambulance actually arrives at a hospital emergency department. This is where blockage flow occurs. If the hospital emergency staff of doctors and nurses are fully engaged treating emergency patients, the ambulance crews are required to wait and care for their patients until they can be handed over - and in the worst cases this can be a matter of hours !
It is not unusual for half the city ambulance fleet to be stuck in trolley block, waiting to offload their cares at an emergency department and despatchers calling in ambulances from outside suburbs - and even nearby country towns - to try and ease the resulting time delay. In such cases, it is inevitable that response times suffer.
In many cases, this leads to tragedy. A call to treat a man suffering chest pains took thirty minutes for the ambulance to arrive - by which time the patient had died. Relatives and loved ones are left to wonder. Had emergency response medication been applied sooner the outcome might have been very different.
The health services people are well aware of the trolley block problem and emergency rooms are being enlarged and provided with added staff, but demand will always remain a matter of sheer luck.Without warning, big numbers of people may present at an emergency room and swamp whatever facilities are available, and at other times the flow may reduce to a mere trickle. It is the job of the despatchers to try and manage that balance.
All too often, one of these peaks has all the available hospital emergency departments running on overdrive - and thats when the ambulance fleet is crippled by having to stand by and treat the patients that can not be handed to hospital care. The answer to this problem seems obvious.
We need emergency crews of trained medical people - probably off duty or even retired paramedics - who can be called in at short notice to relieve and take care of those patients waiting acceptance at the door of hospital emergency departments. In that way, the ambulance vehicles and their crews are again available to respond to emergencies - and deliver that critical first response in an acceptable time frame.
The ideal solution would be expanded emergency rooms that could handle the biggest load, but that is not practical from either a cost or a manning point of view. What is required is a stop gap measure to relieve a peak problem - and extending the pool of paramedics to handle the load would be the most cost effective and immediate way of solving the problem.
It would require additional trolleys and medication supplies to enable relieving paramedics to function smoothly - and there would be a cost factor, but this would seem the only way we could quickly overcome what is becoming a totally unacceptable situation.
Something for the health department to ponder !
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