Tuesday, November 07, 2006

Ambulance crisis

A recent comment by Altissima said...

Rob, I would be interested to hear your response to the article that appeared in Sunday's Age:
Ambulance crisis as 'killer' shifts take toll.
MELBOURNE is losing some of its most highly trained and experienced ambulance paramedics because of what they say is a dangerously heavy workload, an inflexible "killer" roster and a dispatch system that sends them to inappropriate "nonsense" cases...

Full article can be found here: http://tinyurl.com/y7czbv

Firstly thanks Altissima for bringing that to my attention. I missed the article when it was run. Look for what my response is worth, I'd have to say that the article is a fairly accurate reflection of the feeling of paramedics on the road at the moment, whether they are MICA paramedics or not. Everyone is working really hard right now and many are suffering both personally and or professionally because of it.

The current workload appears to be increased - why? Many think its because of the recently introduced Nurse On Call service which seems to be flooding us with jobs, the majority of which turn out to not need an ambulance. Whether this is also due to the Nurse On Call staff being hesitant to tell people to see their own doctor in the morning. I was told that when the same kind of service was introduced in the UK there was an initial increase in calls but then it reduced the overall call rate - Please someone over there let me know if that is the case, or have we been fed a big serving of PR. Other reasons? There are many, the dispatch grid, the rostering, the public perception of what constitutes an emergency. These are problems being experienced by ambulance services worldwide.

As far as the MICA officers leaving, yes there have been a considerable number of them leave, and this represents an enormous loss of skills and experience for the service and the general public. While many of the standard Paramedic units have alternate rosters, with or without nightshifts that they can arrange to spend time on if they get exhausted, the MICA crews only have the 10/14 roster. And when our grid system has them running around, chasing their tails and going to crazy jobs, its no wonder that many have thrown in the towel. All of us, MICA or not are expected to remain motivated and perform at our highest standards at all times. This is a hard thing to do when you are completely trashed.

The dispatch grid is directly repsonsive to the data that is fed into it - that's what it was designed for. However if you ask the relative of the person who has a nasty cough and a chest cold; is the patient breathing normally? the answer will inevitably come back that no they aren't. Do they have chest pain? Again the answer is likely to be Yes. They are in pain when they cough. This automatically gets a lights and sirens response because its now coded as Chest pain with abnormal breathing. If the Clinician who is on duty happens to have a look at it and catch it before it goes out, the case may get downgraded. But otherwise 2 cars are now barrelling through the streets trying to get there inside the allocated time frame.

As far as nonsense dispatches, I have personally been sent twice in the last month to people who can't sleep, to other people who have an outpatient appointment at the hospital in the morning and thought they'd save the taxi fare, people who left the waiting room at the hospital and went home to call an ambulance, thinking they'd get seen quicker if they come in by ambulance. Ask any paramedic and they'll tell you a long list of unbelievable things people have called an ambulance for. Solve that issue and you'd go a long way to relieving the workload.

5 comments:

Anonymous said...

Hi I am a para from the uk. We have a system here called NHS Direct which is similar to your nurses on call. It seems that your pr machine has been less than truthful about reducing calls as we have seen a rapid rise in calls especially at night.Most of the calls we receive from them dont require any medical attention at all ie helping people to the toilet. we have renamed the system as NHS RE-Direct. This puts more pressure on our already stretched 999 system

Carmelo said...

Yup exactly what Moose999 said. NHS re-direct. They are also really scared to tell people definitve medical advice over the phone. Also the holding times to actually speak to someone is ridiculous.

Anonymous said...

The 10/14 roster is one of those things I've never understood, especially the 14 hour bit. Why on Earth do MAS and RAV make night shift, which is the harder of the two mentally and physically (and sometimes the busier), longer than day shift? You'd think common sense would dictate an even split, or even a reversal to 14/10 if management were feeling a tad over-enthusiastic.

At least staff are likely to get some sleep over the 14 hours at a lot of the quieter RAV branches. I can understand the appeal. And my general observation has been of a steady career-progression from moderate to busy suburban branch, to MICA, to RAV after about five years. Frankly I think MICA skills and knowledge a probably more useful in the middle of nowhere a lot of the time, but that doesn't necessarily help either MAS or the individual officers and their families.

One of the ideas that I've been toying with on night shift at The Most Wretched Hive of Scum and Villainy is referring patients on to the Nurse-On-Call program myself. ("Look here's a phone. Since I've got no idea whether your scorching case of herpes justifies a visit to A&E at 03:30 in the morning (although I'm somewhat doubtful), why don't you try asking them and see what they say?").Why not try referring some of your... less than acute patients back to the telephone system and making it wrk for you? ;)

Anonymous said...

As a Scottish paramedic, I just found your blog today,and it could be Edinburgh that you are writing about. As I'm looking to move to OZ it's somewhat dispointing to hear that I wont be leaving all the bull behind. but strangely comforting that I'll probably know some of the people that I'd see. Different accent, name and nationality but I'll know them all.

Also, NHS24 here in scotland is pants. Workload has increased dramatically. Also the staff ther deliberatly mis diagnose/report cases to get an emergency ambulance. dont know why but were always turning up to people who say " I didn't want an ambulance there's nothing wrong with me, I just wanted ...something minor or advice"

anyway, like the blog. keep it up :-)

rob said...

Moose999 and Carmelo - thanks for dousing that faint flicker of hope I had that things with our "Nurse on Call" were going to get better :) It sounds like we shouldn't expect it to improve in the near future.

I like Usuakari's suggestion to bounce it "right back atcha". Might be worth a go, I'll heve to get the number from my next patient. Although I took one look at the last phone I picked up at a patient's house and thought - that filthy thing is not coming within a foot of my ear! Ewww..Please tell me that's porridge on the receiver...

Badman, its always strangely comforting to know that stupidity is the same all over the world. I have a relative doing some work in the UK who wrote back and said that he was nervous before his first day of work, but then found that "the morons are just the same" over there. Theres no place like home? Ha! BTW Which bit of Aus are you thinking of heading to?