Ambulances need extra resources

AMBULANCE chiefs are today waiting to hear if they will get extra manpower to reach emergencies faster after it took 17 minutes to get to a dying man.

Bosses at the regionally-run service answered The Evening Star's ten questions over exactly why it took 17 minutes for a rapid response vehicle and an ambulance 29 minutes to reach heart attack victim Alfred Clark.

Their dilemma is they are paid by the health authorities to reach only 75 per cent of potentially life-threatening emergencies in eight minutes - and only have a set number of crews to use at any time.

A police officer was the first to reach Mr Clark and pulled him out of his car on Felixstowe seafront to give him CPR until a paramedic arrived to take over.

East of England Ambulance Trust says it cannot reach patients within eight minutes for 25 per cent of emergency calls - about 5,000 a year in Suffolk - because it does not have the resources to do so.

At the time the accident in Sea Road on September 28 the emergency crews were all on 999 calls - including dealing with someone choking, a heart attack, an overdose, an allergic reaction and a fall where the person suffered a head injury.

Control room staff have the power to divert a crew from their task but say all were so serious this could not be done.

Unfortunately, the port ambulance was not available and volunteer first responders could not be called out because Mr Clark, of Clacton on Sea, was involved in a road accident after suffering heart failure and the responders are not trained to deal with crashes.

Now the service is hoping to get extra funding from those who commission its services, including NHS Suffolk, the county's primary care trust.

A study has been prepared by an independent consultant to identify where extra resource is required and the costs and business case will shortly be presented to the commissioners for approval.

A spokesman for NHS Suffolk said: “Contracts and funding for the ambulance service are agreed by the consortium which represents all the primary care trusts in the East of England.

“At a meeting in September, the consortium agreed to pay the ambulance trust additional funding for two months to enable it to continue its work towards meeting its yearly average. The consortium is undertaking a financial review to make sure the costs submitted by the ambulance trust will achieve the 75pc within eight minutes target this year.

“NHS Suffolk is working actively with the consortium and ambulance trust to maximise the service for the people of Suffolk.”

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Leader:

GETTING ambulances to emergencies as fast as possible should be the highest priority for health bosses.

Seventeen minutes for a paramedic to arrive and 29 for an ambulance is not good enough.

Extra resources are needed and the primary care trusts have a duty to us all to ensure there are enough vehicles and crews available for when that 999 call is made.

No-one knows when they may face a situation where they need to call on the help of these crews who work so amazingly hard and to the highest standards - and no-one should ever have to be told they have to wait for an ambulance.

It is good news that steps are being taken to deal with the matter and help the ambulance service reach its targets and provide the very best service it can.

Today we call on the primary care trusts - including NHS Suffolk - to make the funds available now for extra crews and vehicles and support the ambulance trust in every way they can for all our sakes.

QUESTIONS AND ANSWERS

Q We understand from Rob Lawrence, chief operating officer for Suffolk, that there were 12 ambulances operating on Sunday September 28 and when the 999 call came from Felixstowe at 9.44am, 11 of them were already on emergency calls and the nearest resource, a rapid response vehicle, was sent to Felixstowe. It arrived at 10.01am. An ambulance arrived at 10.13am. Please can you give us exact details of where the other 11 emergency vehicles were at the time of the Felixstowe call - and what incidents/injuries they were dealing with?

A Both the rapid response vehicle and ambulance came from Ipswich ambulance station and hospital respectively.

The details of the other calls are as follows: choking, Manningtree (RRV and ambulance); unconscious, Aldeburgh; convulsions/fitting, Ipswich; cardiac arrest, Woodbridge; unconscious, Needham Market; overdose, Ipswich; chest pain, Hintlesham; fall/head injury, Ipswich; chest pain, Ipswich; allergic reaction, Walsham-le-Willows;

It was impossible to divert any ambulances or response vehicles from these calls.

Q Do control room staff have the ability to redirect an ambulance crew if a situation is more serious than the one they are currently dealing with and they are closer?

A Yes, they can redirect vehicles if they are closer, not already totally committed to the patient they have been sent to and the priority is higher. In this case, however, there were no closer or freer vehicles.

Q In the Felixstowe incident, where was the car driver Alfred Clark being treated? Was he being given CPR by the police officer in his car or had the officer moved him out of the vehicle and placed him on the pavement?

A We understand the patient had been removed from the vehicle to allow for effective cardio pulmonary resuscitation to be administered. Our arriving paramedic praised the police officers for their intervention and high standard of CPR.

Q What actions did the RRV paramedic take when she arrived? Where did she treat the patient?

A The arriving paramedic is one of the most experienced in east Suffolk and regularly instructs on training courses. Her interventions were all of advanced life support, utilising defibrillation, paramedic drugs, intubation and cannulation. Through the course of her treatment, the patient returned to a state of spontaneous circulation and we passed him to A&E staff with a pulse.

Q The Ambulance Service say Alfred Clark was resuscitated on route to hospital by the ambulance crew to give him the best possible chance of survival. Had the crew arrived within eight minutes, or at least much sooner than the 29 minutes which was achieved, would not the patient have been resuscitated sooner in better conditions (inside a fully-equipped ambulance) and possibly lived?

A The rapid response vehicle and its experienced paramedic, and her suite of treatments and drugs, arrived 16 minutes and 46 seconds after the call was connected to our control room. It is impossible to say with any certainty whether the patient would have survived. However, as the coroner has stated, the thrombosis in the patient's heart meant it was “very unlikely” he would survive the heart attack.

Q Why were first responders from Felixstowe not alerted?

A With the call reported as a road traffic collision, community first responders were not alerted as they are neither trained in trauma nor road accident scene safety. With the exception of defibrillation, the attending police officers were able to begin basic life support to a high standard and initiate the chain of survival.

Q Did you know that the Port of Felixstowe vehicle was not available for work outside the port that morning?

A Not until we made the call, no. Had we known it would not have altered any of the subsequent events.

Q What time did you call Port of Felixstowe crew and what was the response?

A As soon as the call was taken. They said they only had sufficient cover for the port. It is important to remember that the port is not obliged to provide us with cover and we are very grateful for any help they can give us.

Q Should large population centres like Felixstowe not have an ambulance in the town 24 hours a day to be sure of reaching incidents in the fastest response time?

A There is already a 24-hour vehicle stationed at Felixstowe. If we limited that vehicle to responding only to Felixstowe calls there would be times of the day where the crew would sit for a considerable period of time waiting for the next call - while crews in other areas of east Suffolk would be worked hard. We operate a system status plan that uses historical data to predict the most likely location of the next call. For example, Ipswich town centre at 2am on a Saturday morning is busier than it is at 7am. At the time of Mr Clark's call the number of incidents almost matched the number of calls and our nearest response was dispatched immediately.

Q When will a decision be made on whether the finance can be made available for Felixstowe to have its own rapid response vehicle?

A Our commissioners, which includes NHS Suffolk, are responsible for both our funding and monitoring our performance. We are commissioned to achieve 75 per cent of potentially life-threatening calls within eight minutes - and not 100pc - and therefore must deploy our finite number of ambulance vehicles as optimally as possible to achieve this 75pc, hence the system plan based on historical demand. With the current call connect initiative, a study has been prepared by an independent consultant to identify where extra resource is required. The costing paper and business case will shortly be presented to our commissioners for approval. Once that process is complete we will know what additional resources we can deploy.