Quote:
Originally Posted by Derek
Isn't this pretty much what's done in the States?
Not sure about this. It could work but I can't see where the benefits or cost savings would come from without affecting patient care.
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IIRC it's what happens with some counties/cities in the states, and apparently depending on the policies of the fires services involved it either works fairly well (when the fire service realises that emt/ambulance response is at least as important as fire response), or it results in terrible service where the fire service treats it as a chore that they do purely because it increases the departmental income.
Just because the two services are both "emergency" services, doesn't mean that the mindset/training/experience from one will work well with the other.
Personally from what I've read/heard from various people that work in the ambulance service, in the ambulances and the control rooms the best things the government could do would be.
Remove the "automatic" grading of calls by a computer* - someone with a "painful cough" should not be automatically rated as a grade A call (heart attack...), whilst an OAP with a possible broken hip gets rated as a Grade B or C call as it's not life threatening (just extremely painful and likely to lead to complications).
Remove the single arbitrary desired response time, it's got no basis in medical fact or practice. A heart attack needs a response ideally measured in <5 minutes, whist a minor burn/sprain/cut can wait potentially for a lot longer without it affecting the clinical outcome adversely.
Stop the practice of financially penalising services that don't meet those limits.
That encourages the use of single manned response vehicles (the clock stops the moment anyone arrives on scene, even if a two man crew is needed, so a follow up transport/full ambulance can be given a much lower priority).
Putting them into a downwards spiral of performance as they can't afford to replace kit or maintain ambulances properly.
Apparently according to some ambulance workers whose comments I trust, some services are effectively calling any vehicle that is roadworthy and has a crew as a fully functioning ambulance - even if it's missing essential, basic equipment (things like treatments for diabetics, splints, drugs/equipment for heart attacks, pan relief, oxygen).
IIRC one of the best improvements in the treatment of heart attack victims came about not because of any government target, but because the London Ambulance service and several of the London specialist hospitals came up with a scheme where heart attacks of a certain type bypass the nearest A&E where possible, and instead head straight to an on call surgical unit (at one of the specialist hospitals) for treatment.
I've also heard that some services are reducing traingin for new staff because they can't afford the refreshers required to retain certification in some skills (so rather than having staff with rusty skills in some procedures that aren't used on a daily basis, but are needed badly at times, they are dropping it completely).
*The computer system was apparently designed for American use, and it's primary claim to fame is pretty much that no one has ever been sued because of it (it'll play it safe with any input that has certain keyword, even if it's blatantly obvious that the problem isn't life threatening).
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