St John too busy for dying woman

ArcticKat

ArcticKat

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No ambulance was sent to the aid of a shot and dying Otaki Beach woman this month because staff were busy on other calls.

The 23-year-old mother was allegedly shot by her partner on May 8. Firefighters and police gave her first aid but firefighters became so concerned with the St John response they called off-duty paramedics to the scene themselves, the Dominion Post reported.

Read The Article
 
Brown is no fan of St John but will defend them in this case.

The town concerned is half way along State Highway 1 between two major metro areas (Wellington and Palmerston North) with a small population, like a couple thousand small. They have one crew, Levin (about 20 minutes north) have two, including an Intensive Care Paramedic. Paraparaumu to the south (about 20 minutes) also has one crew as it is a small population centre.

All four were out at jobs, the Levin crews (probably three officers) were at a cardiac arrest and the Otaki crew were transporting somebody to hospital, which is an hour way one way. Brown does not where the Paraparaumu crew were transporting but it is up to an hour each way as well for them.

Any road response from Palmerston North is going to take nearly an hour even at increased speed, being a rural area they do not have Oscar/Tango available (Jeep based rapid response) and the only resources available are station-based crews, who again, were all busy.

Fire Service does provide emergency first response for the Ambulance Service when appropriate and they are trained in advanced first aid. In this case they were probably totally outside of their educational or experience level but knowing what the local volunteer Firefighters are like, they would have given 400%.

This is not a case of "somebody has exceeded their regulated driving hours and we did not call them" as has happened in the past but it sounds like nobody was actually free. Like any jurisdiction we have a finite amount of Ambulance resources and if they are busy, what do you do?

Being a small community it sounds like the Fire Service did call back the off duty crew who took about half an hour to locate, so they were obviously not in the town otherwise it would only take a few minutes. We do not respond off duty crews (i.e. who are off roster) because that is what we have on-duty crews for.

Brown agrees with St John (this is a rarity make some sort of note of the date and time) that in this case, the best resource (the only resource) was a HEMS Intensive Care Paramedic from Palmerston North. They are a seconded, road based crew so took a few minutes to get to the helicopter, although the helicopter and ambulance station are on the hospital grounds that is not to say they were not returning from a job and had to get into their HEMS jumpsuit.

So despite Brown not actually liking a lot of what St John does, Brown agrees that in this case the response was appropriate.
 
My only question is why two ambulances were tied up with a code... on a patient with a DNR order...
 
emt.dan said:
My only question is why two ambulances were tied up with a code... on a patient with a DNR order...
Click to expand...

Because it was not apparent at time of dispatch that she had a DNR, we always try to get three staff to a cardiac arrest and Levin 2 was probably one up (solo Officer without volunteer) as it was a day shift.
 
Too bad you folks didn't have a few half trained poorly educated American style medics floating around to pick up the slack, but I'm sure the woman would have preferred to wait for someone with 6 years of advance medical training under their belt anyway. :P
 
bigbaldguy said:
Too bad you folks didn't have a few half trained poorly educated American style medics floating around to pick up the slack, but I'm sure the woman would have preferred to wait for someone with 6 years of advance medical training under their belt anyway. :P
Click to expand...

The amount of education our Ambulance Officers receive has nothing to do with how many are available at any one time in a given geographical area.

We are resourced with a finite amount of crews appropriate for the given workload of the area. The area in question is predominately rural with a small population centre (only a few thousand people) so has one ambulance crew on duty at any one time. The larger population centre to the north (Levin) has two, however both were busy at a cardiac arrest.

It is simple deductive reasoning that the most appropriate resource was in the largest population centre (PN) which was unfortunately, the most distant and therefore, going to take the longest to arrive.
 
I think what bigbaldguy is saying...

is that in a "saturation" plan (lots of less-trained vollies in rural areas, as opposed to the "smaller numbers of better trained and qualified responders" plan) someone could have come, although in this case with a GSW I doubt (without much info on the pt condition, here I go again) that a lesser responder could have done much but boogie her to a hospital.

Between reading the article and Brown's expansion, sounds like it was one of those things you have happen rarely, and folks involved tried their darndest to make it work nonetheless.
 
There are four ambulance stations on the 150km stretch of highway concerned, five ambulances in total to coincide with the population centres, three of which are very small (several thousand people) one one of which is slightly larger (maybe ~15,000 people) so it has two ambulances including an Intensive Care Paramedic.

All vehicles were busy, the off duty crews would have had no vehicle to respond in, and the volunteer Ambulance Officers are watch/roaster based and not "on call" so are they supposed to drive to this job, with no medical equipment beyond the AED and Thomas Pack the Fire Service has and do what exactly?

We do not know where she was shot or what she died of. On the surface it looks poor form but it is a simple equation that is experienced by dozens of jurisdictions, you have a finite number of resources for a given planned workload and exceptions from time to time will occur, this being one of them.

Lets not get all silly and say "oh the half hour it took the ambos to come meant she died!"
 
30 minutes could make the difference, but maybe not in this case anyway.

We can get into the "Paramedic on every corner" syndrome if we start mincing minutes too finely.

Face it, when you don't live in an urban setting, you face potentially longer response times (although in some underserved US cities' neighborhoods that is questionable). Distances are longer, roads scarcer, and resources are thinner because there are both less profit and fewer voters.

I do not see any realistic failure in this system from what the article had to say.
 
Exactly, there was no failure. It is simply that a job came in when the Otaki crew were transporting, Paraparaumu and Levin were also busy.

It is something that Brown knows has happened before, you are talking about small population centres along a major state highway with very long transport times and it does not justify having extra vehicles on all the time.

It just so happens in this case, it was a shooting and not somebody with the sniffles.
 
Here is another article about it.

http://www.stuff.co.nz/national/5017216/Help-for-dying-woman-not-good


The area talked about here has had on going problems with lack of ambulance officers for years.
I would put it down to a certain amount of the issues between St John paid staff and management attitudes, along with the funding issues.

These areas in years gone by had a large group of volunteers, but as time has gone by, they have left the service and not been replaced or become paid staff.

People that have fulltime jobs and look at volunteering for St John, have to take so much time off their paid jobs to fulfil the training needed now, that it is just not worth it.
Also alot of employers will not let their staff take that amount of work off. Something the service should think about, in their goal for excellence.

Enjoynz
 
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Nah I just felt like winding Brown up.

Hey brown I'm thinking about going back to Sydney should I fly Quantas? :P
 
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MrBrown said:
There are four ambulance stations on the 150km stretch of highway concerned, five ambulances in total to coincide with the population centres, three of which are very small (several thousand people) one one of which is slightly larger (maybe ~15,000 people) so it has two ambulances including an Intensive Care Paramedic.
Click to expand...

Interesting I would think that the likely hood of there being a situation with the need for more then two ambulances at a single given time in a fifteen thousand population would occur frequently. no?
 
MrBrown said:
There are four ambulance stations on the 150km stretch of highway concerned, five ambulances in total to coincide with the population centres, three of which are very small (several thousand people) one one of which is slightly larger (maybe ~15,000 people) so it has two ambulances including an Intensive Care Paramedic.
Click to expand...

That is interesting, how much time do those ambulances spend on task? I have three ambulances to serve a population of about 4000 to do about 500 calls per year. We do quite a few transfers to a tertiary centre though and that can have an ambulance tied up for 7 - 12 hours on one call.
 
samiam said:
Interesting I would think that the likely hood of there being a situation with the need for more then two ambulances at a single given time in a fifteen thousand population would occur frequently. no?
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I think Mr Brown is a bit light on the population of these areas.

Stats last taken for this area (Otaki and Levin, with 3 ambulance stations, Mr Brown forgot Foxton) was 29.868 in 2006 at the last census,
which would be higher than that now, 5 years down the track.

The area of Paraparaumu (with one ambulance station, which is not run by St John) had 46.197 at the 2006 census.
This area has grown steadily over the years, as the greater Wellington (Capital city) population moves further out into urban areas.

There has not been enough ambulances or crews to manage these areas well enough for years...funding and manpower are the main issues.
Should we have a major incident within this area, (i.e. earthquake) I'd hate to think what would happen.

I'm sure there are areas within the USA and Canada that have the same issues??
 
What would have changed, or been different if fire brigade (department) personnel had more training, or a vehicle to transport this patient in?
 
There are area's all around the world that has issues like this. It isn't just the management that doesn't schedule enough crews, but also a world that does not pay enough for people to want to stay in EMS.
If services got paid $800-1000 for each transport the companies could and would schedule more crews because they would be able to hire more people and keep them.

My old service lost people to Fast Food chains, because they paid more.
 
HotelCo said:
Welcome to Detroit.
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Agreed. Last time I was talking to one of the medics there were 18 units out to cover a 140 sq mile area 713,777 people and half the calls were owww my toe hurts take me to the hospital.
 
I remember hearing at some con-ed lecture that in certain large city/cities in the US (Philadelphia?) PD normally transports stabbing/shooting victims in their cars rather than waiting for fire/EMS, and they actually have very good survival rates. Can anyone give more info on that?
 
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