St John too busy for dying woman

[samiam]

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?

In general:

http://www.myfoxdetroit.com/dpp/news/sound_off/fox-2-focus_detroit-ems-response-time

More specifically to your question:

http://www.clickondetroit.com/news/27493777/detail.html

 

[mycrofft]

Rural or isolated urban disasters are special cases

When a real disaster strikes, chances are the indigent response force is out of service.n Help comes in from neighboring areas, and any organic response in the disaster area has to be happenstance and community training based. Trick is to have mutual aid planned and provided for, means for them to get in, and somone to call for them...oh, and hope they aren't out of service too.

Los Angeles, Calif has been closing emergency rooms due to their being crummy. Then your ambulances have no place to go anyway.

This is a good relative case for studying the "saturation" versus "quality" theories of EMS deployment.

 

[MrBrown]

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.

While Brown does not like St John by any stretch of the imagination is there a workload to justify an increase in resourcing?

What is needed? One more full time crew? A day only crew on black watch? Oscar? Perhaps a PTS vehicle during the day?

How many jobs are you getting down there? If transporting to Palmerston North is an hour away that's a problem you cannot really get around.

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.

Well that is unfortunate but the Primary Care volunteer is no longer acceptable clinically and it should have happened a long time ago.

Brown knows for a fact that the NDAP is run online and has 14 two-day weekend blocks. There are exceptions, but if over 800 people have done it since its inception in 2005 so its not impossible.

Weekly training to do the CCE modules is most often held at night or on weekends when most volunteers are not working. Again Brown says most because some are, which is why Clinical Education offer more than one opportunity to do each module.

The bottom line is that the Diploma and CCE are now the minimum requirements as they should be, the Degree will very soon be required for paid staff, as it should be.

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.

The average out of chute time is an hour per job. If you transport from this area it is going to be two hours give or take round trip.

What would have changed, or been different if fire brigade (department) personnel had more training, or a vehicle to transport this patient in?

No.

 

[DrParasite]

Exactly, there was no failure.

I throw the BS flag on this one. the system did fail, just like it fails in urban cities all over, by not having enough EMS units to cover the call volume. the patient needed an ambulance, nor a FD first responder.

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.

I am sure the family of the deceased will take great solace in that.

 

[MrBrown]

I throw the BS flag on this one. the system did fail, just like it fails in urban cities all over, by not having enough EMS units to cover the call volume. the patient needed an ambulance, nor a FD first responder.

We are talking about a low workload rural area that is an hour one way by road from hospital. They have one duty crew to cover the expected workload with two vehicles to the north (one of which is an ICP) and one to the south that cover their expected volumes.

Two ambulances were transporting patients, the local ambulance has a one hour transport time each way and both are required to transport away ie moving further from where this incident happened.

The other two vehicles were at a cardiac arrest. Brown would imagine once they decided not to resuscitate the patient the second ambulance got what we call R99 or told that a P1 job awaits. Even if the Ambulance Officer said OK I will respond, he is going to have to drive twenty to thirty minutes south in order to reach the patient. It's going to be quicker to get the Intensive Care crew from PN in the helicopter and have them go as they were probably already in the air by that time.

What you have here is the simple problem that an exception occurred to the norm, it happened that Levin was busy with the cardiac arrest and Otaki and Paraparaumu were transporting, again up to an hour each way so there was no free resource in the area. It is a rural area with a low workload, so what, is there supposed to be a magic ambulance that appears out of nowhere with a crew to crew it?

It happens that this time the job was a shooting and not somebody with the flu. It is unfortunate but in reality isolated incidents do not mean it justifies having another vehicle in one of the population centres all the time.

We are not talking of an area where you can move another resource in to provide cover, because there is no other bloody resource to move, anything that comes from Palmerston North is going to take an 45 minutes to an hour to get down there at normal road speed.

I am sure the family of the deceased will take great solace in that.

So what, now instantly it is the Ambulance Service's fault she died?

 

[BEorP]

I am sure the family of the deceased will take great solace in that.

Just because a patient died and there was a delay to an ambulance arriving does not mean the delay of the ambulance caused the death.

Brown, maybe I missed this somewhere else in the thread, but is there any kind of deployment strategy that involves pulling in other ambulances for coverage under the unique circumstances when all four area ambulance are out on calls? Or is there anyone close enough who could be pulled in for this.

This really seems like a case of bad luck and limited resources. And I don't mean for there to be negative connotations when I say "limited resources" - that is the reality of everything in healthcare. We're trying to make the most of the limited resources we have to use.

Even if this lady could have been saved had there been another ambulance in the region, would the cost of having an extra ambulance on duty indefinitely justify this maybe 1 in 100 year occurrence of all ambulances being occupied at once when a saveable patient waits be worth it? Almost surely not.

This isn't a time for emotions. Yes, it's sad she died, but it is like triage. Sure it is sad, but that doesn't change the reality of limited resources.

 

[MrBrown]

Brown, maybe I missed this somewhere else in the thread, but is there any kind of deployment strategy that involves pulling in other ambulances for coverage under the unique circumstances when all four area ambulance are out on calls? Or is there anyone close enough who could be pulled in for this.

Yes we have such a plan in place called "fluid deployment" where resources are moved to other stations to cover for mandated breaks or if all ambulances are busy. In Metro Auckland and other large population centres it is easy as we have Oscar/Tango (rapid responders), motorcycles and a larger number of stretcher based ambulances to cover the expected, and historically actual, workload.

The area in question is not really one in which such a methodology can be deployed. The main feature of the area is State Highway 1 which runs from north to south and is sparsely populated except for number of small population centres.

Get out Google Maps and look at how far from Palmerston North Paraparaumu is and you get an idea of what is being covered. Foxton, Otaki and Paraparaumu have one ambulance and Levin has two. They were all busy.

In reality it took a half hour for the helicopter to reach the patient, in that amount of time it is reasonable that given the distance to travel and resources available that it was going to be the quickest way to get there.

This really seems like a case of bad luck and limited resources. And I don't mean for there to be negative connotations when I say "limited resources" - that is the reality of everything in healthcare. We're trying to make the most of the limited resources we have to use.

True but everybody has finite resources; the bank, the fast food place you sit at for thirty minutes in drive thru, it is not exclusive to healthcare.

Even if this lady could have been saved had there been another ambulance in the region, would the cost of having an extra ambulance on duty indefinitely justify this maybe 1 in 100 year occurrence of all ambulances being occupied at once when a saveable patient waits be worth it? Almost surely not.

Exactly, this was an unusual circumstance in which the available resources were busy, and unusual again that it just happened to be a critical patient.

 

[medicsb]

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?

The Philadelphia Police Department has a policy/directive, which is supported by the local trauma centers, to throw the victim in the back of the car and haul *** to the hospital. A study from Temple University Hospital of penetrating trauma victims who required emergency department thoracotomy found that the PD transported patients had double the survival over ambulance transport. A study from the university of Pennsylvania was more broad and (I think) found no difference in outcomes. Considering the number of PD cars over ambulances and their speed of response and transport, from time of the shooting to arrival at trauma center could easily be under 10 minutes. In Philly or any other city, that isn't happening with an ambulance except in exceptional circumstances.