Wednesday, 7 November 2012

999 responce times and pointless statistics.



Am always surprised by the fascination the media and politicians have with arbitrary statistics, see Tom Bodden in today's Daily Post.  Take the response times for welsh ambulances and a target that 65% arrive within 8 minutes. Why 8 minutes..why not 10...why 65% - do they actually mean anything? - other than putting pressure on already hard working paramedics. For this statistic measures nothing really, it doesn't show us the 'outcomes'- the quality of care received during the golden hour, and neither can you really use it compare regions.

I've a feeling this statistic was made up by some civil servant living in a large city such as Cardiff. Whereas things are different in rural areas such as Anglesey, and our poor roads, many narrow and winding. It's also a statistic better suited to the olden days, when you had ambulance drivers, whose main job was to chuck you as quick as possible int' back of ambulance and rush you off to hospital, so Doctor could make you all better.

These days we have dedicated and hard working paramedics, whose priority on arriving is to asses the patient and stablise his or hers condition, and if things are really really bad there is always the Wales Air Ambulance to call in, to whisk them away to the nearest Accident and Emergency.

I suppose the clock stops when they reach the location, again easy in a big city, but what about in rural villages and post codes that cover large areas, and houses with no names, and then there's the weather especially over winter, far better that the ambulance arrives in one piece, than not at all.

After all life is about risk, and if you decide to live in a rural area far far away from the madding crowd, well you have to accept things like ambulances may take a bit longer to arrive, and if you judge that risk too high...maybe better you move back to the town or city then.  

2 comments:

The Red Flag said...

Not long back I gave first aid to an old lady who had tripped and smashed her face and jaw in Bangor. Blood and teeth all over the place, semi-conscious, right mess. Lying in the middle of the road in the middle of the day so all the traffic also ground to a halt.

A passer-by phoned an ambulance. A police car arrived. They radio'd for an ambulance to be told one had been dispatched. A passing nurse intervened - phoned in, to be told one was ion the way. Paramedic arrives after about 10 minutes - gets on radio says he needs an ambulance - again told one was on the way. By this time I was directing traffic being as a paramedic and a nurse were there.

Was over 20 minutes before an ambulance finally arrived. Less than a mile from the A&E.

Gwyn Pritchard said...

The 8 minute response originates from a Seattle Study where they found an 8 minute response time would improve patient outcomes in cardiac arrest cases. Since then it has become a blanket 'political' response which is outdated and destroying ambulance services worldwide, not just Wales. USA Emergency Medical Services cannot achieve this and have filed papers with the Government.

The reality is that UK studies by the Medical Research Centre, University of Sheffield have recently concluded that a 4 minute response is needed to make an impact on cardiac arrest.

There should be a response criteria for actual life threatening cases (which by the way is less than 5% of all ambulance calls).

All these response times are useless and unachievable. Ambulances should not be responding to a clock but to actual patient conditions.

How can any government, morally or ethically make a ruling that ambulances ar OK if they respond to Category A calls within 8 minutes 65% of the time. That means 35 patients out of the 100 will not receive a national standard of ambulance care and that's fine with the NHS!

Another myth is the "Golden Hour" which is complete BS. There is no medical study that supports this. It was a promotion scam designed by the operators of new USA Trauma Centres in order to get people into these centres quickly. It worked and there was hope their revenue would increase. But the majority of people who needed Trauma Centres (Gunshots and Auto trauma) did not have the insurance needed to cover the expenses so Trauma Centres started closing down. The founder of Trauma Center Dr. Adams Crawley came up with the slogan and there is no medical justification for it, only common sense. But it caught on......didn't it?

Now the whole emergency service is being driven by 8 minute response times that is baseless and it will take a lot of guts, strong management and a willingness to change and make it happen.

Anglesey would be a great place to do a trial project with a newly designed response strategy.

Gwyn Pritchard
gwynlpritchard@gmail.com
Holyhead