Ambulance Service Targets
Discussion
Last week
The Welsh Ambulance Service has hit its target of reaching 65% of life-threatening incidents in eight minutes.
http://www.bbc.co.uk/news/uk-wales-politics-251210...
Today
South West Ambulance Service missed its emergency call-out response targets in October, a report has revealed.The service achieved the eight-minute response time for 71.68% of the most urgent calls, compared with a target of 75%, a report to the board stated.
http://www.bbc.co.uk/news/uk-england-25280719
"An additional challenge for the south west region is that it is predominantly rural, with many isolated communities
Why 65% in 8 minutes in one area, 75% in 8 minutes in another?
Are those reasonable targets for a 999 service or would you expect 100% within 5 minutes?
The Welsh Ambulance Service has hit its target of reaching 65% of life-threatening incidents in eight minutes.
http://www.bbc.co.uk/news/uk-wales-politics-251210...
Today
South West Ambulance Service missed its emergency call-out response targets in October, a report has revealed.The service achieved the eight-minute response time for 71.68% of the most urgent calls, compared with a target of 75%, a report to the board stated.
http://www.bbc.co.uk/news/uk-england-25280719
"An additional challenge for the south west region is that it is predominantly rural, with many isolated communities
Why 65% in 8 minutes in one area, 75% in 8 minutes in another?
Are those reasonable targets for a 999 service or would you expect 100% within 5 minutes?
I'd prefer targets set by clinical need not politics. I remember reading a blog by an ambulance paramedic where the clock stopped when an ambulance medic got there so a motorbike paramedic getting there stops the clock. Another consideration is how easy it is for the service to achieve the target given the equipment, roads and size of the area to cover.
Engineer1 said:
I'd prefer targets set by clinical need not politics. I remember reading a blog by an ambulance paramedic where the clock stopped when an ambulance medic got there so a motorbike paramedic getting there stops the clock. Another consideration is how easy it is for the service to achieve the target given the equipment, roads and size of the area to cover.
Probably oen of the reasons they have a laod of these car drivers going aorund alone as well.The Welsh NHS is managed by the WAG, they refused to spend the Money Roger Thayne said would be needed to bring response standards up the English levels ( never mind roger-era Staffs figures ).
The geography of rural wales does not help ( steep sided valleys )
The obsession with the arbitrary ORCON standards is from the crowd pleasing targets era of british politics i.e. 1997 -2010
The geography of rural wales does not help ( steep sided valleys )
The obsession with the arbitrary ORCON standards is from the crowd pleasing targets era of british politics i.e. 1997 -2010
In rural counties you just can't have a 5 minute limit, there aren't enough vehicles for that kind of coverage - you'd need double or triple the funding for staff and cars/ambulances, and you'd end up in some places with 1 ambulance for ever widely-spaced community of 10 people or so.
BlackVanDyke said:
In rural counties you just can't have a 5 minute limit, there aren't enough vehicles for that kind of coverage - you'd need double or triple the funding for staff and cars/ambulances, and you'd end up in some places with 1 ambulance for ever widely-spaced community of 10 people or so.
it depends on how you construct the service and what the expectations of the service are; you could a achieve a response of some kind for perhaps 99% of population within 5 -8 minutes but it wouldn;t necessarily be a DMA/FLA ( dual manned ambulance / frontline ambulance )
outside of suburbia that response would almost certainly NOT be an ambulance
in busy central urban areas ( as seen in London , heathrow T4/5, Birmingham, Leeds , York and various other places at various times ) it would be a Ambulance service employee on a bike ( whether pedal or motorbike)
and in the sticks it would be either an ambulance service single responder ( in a car / 4*4 or on a motorbike), a RDS (retained duty system) Firefighter 'co-responder' or a volunteer 'community' responder
if the service is constructed and/or deployed in such a way that transport is the norm and the expectation this will tie DMAs up a lot of the time - althouigh NOT transporting can be just as time consuming and requires Health Professional Responders ( Paramedics, Nurses ( and either / both with additional education, training and options as 'emergency care practitioners' , Nurses with Indepdent prescriber status or Doctors).
for none Health Professional crews to not transport it has to be a limited subset of presentations ( i.e. very very minor injuries that clearly just need 'first aid' , certain types of diabetic emergencies in people with DM type 1 or single fits in certain epileptic patients who can be left with a responsible friend, colleague or relative ...
while it;s appealing to suggest that 'panic attacks' etc could routinely not transported you need to have the skills and knowledge to exclude / risk assess against more sinister causes and assess patient's self management of conditions such as Asthma.
Mojooo said:
Would they send a bike to osmewhere where it is obvious the person needs tkaing to hospital?
If so would they send the bike first with an ambulance followign automatically or woudl the biker have to get there first and then authorise an ambulance to come?
'obvious someone needs to go to hospital' is extremely hard to determine over the phone , one of the criticisms of the AMPDS dispatch system was the way in which it over triages ( for safety) and thee way in which questiosn are taught to be asked by call takers ... If so would they send the bike first with an ambulance followign automatically or woudl the biker have to get there first and then authorise an ambulance to come?
One of the early questions in AMPDS is ' is the patient breathing normally ' - it is meant to detect agonal breathing ( a late sign pre- cardiac arrest), a partially blocked airway in the unconscious patient , extremely slow breathing ( with the obvious implications this has for gettign enough oxygen ), really bad wheeze or stridor in respiratory conditions or someone who is in severe clinicla shock and is stil lcompensatign by breathing and pulse being elevated ...
The problem is the way the question gets asked by some call takers - blindly following what the lay managers who run the call centre say and becasue neither they or their managers have any clinical experience - means that coughs, colds, sniffles and hysterical / histrionic episodes get triaged as 'cat A' life threatening emergencies .
the 'front loaded model' of ambulance operations sends an initial response to all emergency calls of whatever resource is closest - regardless of type of resource and it;s not a DMA the clinician on scene requests / cancels the additional resource depneding on what the call was originally classified as.
there is also the aspect of even if someone 'obviously needs to go to hospital' do they need to be transported immediately by a Paramedic or Technician crewed DMA? or could they be treated at scene and make their own way / wait a short period for a middle tier or PTS vehicle ...
Historically the system presumed that calls coming via 999 would be immediately transported by an A+E ambulance crewed by an 'emergency crew' and that calls coming from GPs and Midwives ( and latterly other health professionals including Nurses and Physios in community roles) would wait and be transported by an available resource in a set time frame ... this has resulted in some of the most sick patients waiting and in the past 15 or so years since the concept of 'middle tier' became trendy being cared for by less well trained personnel ...
As an example of this - under the traditional model of post 1974 Uk ambulance operatiosn if you fell over in the street and sustained a wound and a perhaps a broken wrist you'd get an emergency ambulance in 14 / 19 minutes ... but if you were an old dear with multiple health problems who was going into heart failure or had piucked up pneumonia and you or your relative/ carer called the GP - you would get a middle tier ambulance in up to 4 hours - hopefully the GP would come out and visit but thay don;t allways ... In the past doing 'Ambulance Support' with St John Ambulance on behalf of the NHS service i've attended '4 hour urgents' and when i've arrived on scene either had to request a Paramedic crew or made the decision to 'scoop and run' to A+E Resus with a pre-alert rather than pootle to the booked ward. EQually when working in Acute Assessment Areas (NOT the Emergency Dept) i've had patients brought by (NHS employee) middle tier crews who had required the equivalent of A+E resus treatment ( med reg, junior doctor, 2 Nursing staff) to stabilise them - to the point of not being able to care for other AAU patients becasue of the resources required to stop the '4 hour urgent' patient from croaking ...
Mojooo said:
Would they send a bike to osmewhere where it is obvious the person needs tkaing to hospital?
If so would they send the bike first with an ambulance followign automatically or woudl the biker have to get there first and then authorise an ambulance to come?
Yes, they'd send a bike to any call requiring an ambulance apart from certain calls like MH patients and fights in progress as it's deemed too dangerous.If so would they send the bike first with an ambulance followign automatically or woudl the biker have to get there first and then authorise an ambulance to come?
For some calls you automatically get an ambulance dispatched at the same time but more often than not you need to request one if you want one. The main problem is that you can't really believe everything that people tell you when they call 999. People have a habit of making things sound worse than they are as they either aren't sure or know how to play the system and say the magic words to get a quicker response. In London the Cycle Response have about a 50% rate of success with discharging patients on scene without the need for an ambulance to convey them to hospital, it's about the highest in the service.
As others have already said, the 8 minute targets are a waste of time, they are based on data from the mid 70's and haven't been changed much since then despite the ambulance service and everything else around it changing drastically since then.
I know that the cuts that the services have faced seem like an obvious cause of the reduced ability to hit targets but I know that my service have always struggled to hit the target each year, this year will be just the same. I'm sure there's plenty of massaging of the figures going on but obviously we can't say that for sure.
There are many problems affecting the ambulance services.
- Cuts. Every service is having to cut millions off the budgets.
- Demand. This is at record levels and continuing to rise with the failure of 111 to relieve any sort of pressure.
- Inappropriate use. Ask any frontline staff and at least 2-3 jobs a shift will be a load of rubbish. A recent example of a 'Red 2' call I attended. A young adult with vomiting on and off for 1 month who hadn't bothered to register with a GP. instead they called 999.
- A&E departments. See above, they are rammed. Day or night it doesn't matter, they are full.
- Hospital wards. These have been cut due to budgets so less beds and less staff. This means when they fill up, the patient in A&E who needs a bed can't be moved leading to a delay. This I turn means ambulance arrive to a full department and have to wait on the corridor with their patients.
- Response times. These are then affected because crews are tied up at hospital unable to clear.
- Crews working out of area. It is not unusual to travel for 40 mins + to reach an emergency, so stretched are resources.
There are other issues. They are trying to implement a new system for meal breaks which will mean a 20 minute break in a 12 hour shift. I don't even think that legal!
In 7 years I have never known the situation we are in now. It is critical and starting to effect staff and patients alike. I could give more graphic example but confidentiality means I can't be too specific.
- Cuts. Every service is having to cut millions off the budgets.
- Demand. This is at record levels and continuing to rise with the failure of 111 to relieve any sort of pressure.
- Inappropriate use. Ask any frontline staff and at least 2-3 jobs a shift will be a load of rubbish. A recent example of a 'Red 2' call I attended. A young adult with vomiting on and off for 1 month who hadn't bothered to register with a GP. instead they called 999.
- A&E departments. See above, they are rammed. Day or night it doesn't matter, they are full.
- Hospital wards. These have been cut due to budgets so less beds and less staff. This means when they fill up, the patient in A&E who needs a bed can't be moved leading to a delay. This I turn means ambulance arrive to a full department and have to wait on the corridor with their patients.
- Response times. These are then affected because crews are tied up at hospital unable to clear.
- Crews working out of area. It is not unusual to travel for 40 mins + to reach an emergency, so stretched are resources.
There are other issues. They are trying to implement a new system for meal breaks which will mean a 20 minute break in a 12 hour shift. I don't even think that legal!
In 7 years I have never known the situation we are in now. It is critical and starting to effect staff and patients alike. I could give more graphic example but confidentiality means I can't be too specific.
carreauchompeur said:
The cuts to the ambulance trusts gave been savage and effects on the front line devastating.
Expect these response times to rise dramatically. If they are not, then there's figure fiddling going on.
There is defo fiddling going on. Our vehicles auto at scene you. This means if your near the location (not sure of exact distance) say 200m you stop the clock. Reality is it can be 1-2 mins at least before you make patient contact. God know how many more targets are hit using this fiddle.Expect these response times to rise dramatically. If they are not, then there's figure fiddling going on.
BadRotorFinger said:
Never ceases to amaze me how they get away with "auto at scene" to stop the clock, you would think the CQC would have words to say about that.
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