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Dublin Fire Brigade losing ambulances to HSE
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Wherever you got that information you are completely wrong. Every incident gets assigned an incident number.
Ambulance case incident numbers begin with DA. Fire calls begin with DF. If a fire appliance is sent on an ambulance case to assist an ambulance it operates under the exact same DA incident number as the ambulance. There is verifiable proof of this (unlike your comment) insofar as the fire report filled out by the fire officer after the incident will have the DA ambulance incident number on it. All fire appliances and ambualnces that attend this incident will have the same incident number. There are not multiple incident numbers for the same call.
An example of this is the recent Oxigen fire that went on for over a week. The dozens of different crews and appliances that attended over the course of the week would have done so and been mobilised to the same DF incident number.
Thank you for informing us of the newer DFB system. As you are familiar with the system I would imagine you are also familiar with one of the reports carried out in recent years, was it the Devine report? I will do my best to get a copy as there has been a number of reports relating to the DFB system, perhaps it's available online.
The report I speak of is the one that shows where the additional incident numbers were generated as per my example call.
One would still wonder why DFB control staff were instructed to double 'their normal' responses coming up to the years end 2013, just as the story of the latest report was beginning to be leaked...0 -
One would still wonder why DFB control staff were instructed to double 'their normal' responses coming up to the years end 2013, just as the story of the latest report was beginning to be leaked...
Where are you getting this stuff from?:)
You'll be seeing reds under the beds next.
How can you "double" a response? Send 2 ambos to every collapse? What are you taking?:D0 -
those stats only include fire calls.
I know that which was why I bolded the part that said "total fire calls nationwide"How can you "double" a response? Send 2 ambos to every collapse? What are you taking?:D
He's referring to the common DFB practice of someone rings 999 asks for ambulance for a "hurty knee" DFB have no ambulances available so send a fire tender instead = 1 call DFB ambulance when available then turns up = 2 calls.
This has been practiced by DFB EMDs in the past whether current or not I can't say for certain either way.0 -
I know that which was why I bolded the part that said "total fire calls nationwide"
He's referring to the common DFB practice of someone rings 999 asks for ambulance for a "hurty knee" DFB have no ambulances available so send a fire tender instead = 1 call DFB ambulance when available then turns up = 2 calls.
This has been practiced by DFB EMDs in the past whether current or not I can't say for certain either way.
At the risk of boring everyone i'll repeat myself. Ambo plus fire tender equals same call same incident number.
...........and a fire tender won't be sent to babysit a call that comes in as a "hurty knee". A CVA or an MI or equivalent...yes
Other stuff will just be queued after an attempt to pass it to the HSE0 -
...........and a fire tender won't be sent to babysit a call that comes in as a "hurty knee". A CVA or an MI or equivalent...yes
Oh please are you seriously going to deny this that tenders dont go to Charlie, Bravo, Alpha and Omega calls????
I've seen it with my own eyes, in fact not only have I seen it in real life , it was shown on RTE Firefighters series with the guy explaining the reason for the tender.
I might be a bit out of practice so can you explain given the information the caller in the video below provided to the EMC who will of course be using EMD cards ( https://www.prioritydispatch.net/emd_cardset_info ) that it gets determined as a CVA, MI which is an Echo call (so posters like Beano can understand - no offence).
So it's obviously not an Echo call , in fact it's not even a Delta call but you do insist (trying to not bore others in the process) that tenders will only go to Echo calls like CVA / MI's
Start at 6mins 25s
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Where are you getting this stuff from?:)
You'll be seeing reds under the beds next.
How can you "double" a response? Send 2 ambos to every collapse? What are you taking?
Oh it didn't take you long:roll eyes:
It was your control management that issued the instruction, I happened to be there on other business and the instruction became a source of entertainment and some bewilderment between not just the NAS staff but some DFB controllers also.
I'm not completely familiar with your responding system, just that the number you send on some calls is overkill. The instruction of doubling responses maybe meant four appliances to a normal two appliance fire, or two appliances to a normal one appliance call, or maybe a fire appliance with one collapse, oh you already do that! Perhaps it meant two appliances and an ambulances to one collapse I don't know, again it was your management.
So as you appeared unsure of how to double a response I've just given you a couple of examples0 -
Ah sure look lads...................ye seem to know it all. Nothing i say is going to make any difference.
A "hurty knee" is the same as someone thrown from a horse?
We "double" the amount of fire engines sent to everything even though there are strict PDA's in place?
Best of luck with the new ambulance service next year. I hope it works out for the staff and the people of Dublin.0 -
Ah sure look lads...................ye seem to know it all. Nothing i say is going to make any difference.
A "hurty knee" is the same as someone thrown from a horse?
We "double" the amount of fire engines sent to everything even though there are strict PDA's in place?
Best of luck with the new ambulance service next year. I hope it works out for the staff and the people of Dublin.
Its a prospect that fills me with nothing but dread. But sure it wouldn't affect some of the people on this thread. They have no need for ambulances. They can ride to the hospital on their high horse.0 -
Don't go lads, you have been a good source of entertainment. The likes of statements saying that a NAS crew would burn out if they were to do the same number of calls as a DFB crew, are you made of some sort of super human material:D:D:D
That Dublin's cardiac arrest success is down to the DFB, you do realise that the NAS also operate in Dublin city and county? and we don't 'burn out'!!
Being filled with dread at the prospect of the NAS responding to calls in Dublin, as stated we do actually work Dublin also. But being filled with dread and strict PDA's, is it normal for the DFB to respond a fire tender to a cardiac arrest but leave their advanced paramedic at the station because he is on kitchen duties? I can tell you I have seen this first hand and find it very worrying.
So if that's an example of your strict PDA's then it's no surprise another report has been called for.0 -
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i hope to god i dont get an awful smug b*astard like you bang bang if i ever need an ambulance.0
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Don't go lads, you have been a good source of entertainment. The likes of statements saying that a NAS crew would burn out if they were to do the same number of calls as a DFB crew, are you made of some sort of super human material:D:D:D
That Dublin's cardiac arrest success is down to the DFB, you do realise that the NAS also operate in Dublin city and county? and we don't 'burn out'!!
Being filled with dread at the prospect of the NAS responding to calls in Dublin, as stated we do actually work Dublin also. But being filled with dread and strict PDA's, is it normal for the DFB to respond a fire tender to a cardiac arrest but leave their advanced paramedic at the station because he is on kitchen duties? I can tell you I have seen this first hand and find it very worrying.
So if that's an example of your strict PDA's then it's no surprise another report has been called for.
I think the poster been "filled with dread" is because he or she doesn't trust the HSE to do a job which the poster feels DFB do very well.
In terms of the Cardiac arrest situation - I had heard that before about Dublin doing very well.
I put it down to the higher availability of staff - due to been able to send a tender to the call.
In short extra resources - I personally feel that all the Dublin cardiac arrest successes show - is the difference it makes if you have a lot of resources on the ground.
So all that success shows - is - having extra resources is a good thing - that is different in my book to saying we should have fire based EMS.
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Old diesel wrote: »I think the poster been "filled with dread" is because he or she doesn't trust the HSE to do a job which the poster feels DFB do very well.
+1
There are numerous problems in the HSE that need fixing or improving and numerous areas that need to have their costs brought under control. Tinkering with a €10m (-ish) cost (which means savings of much less than that) on a service that, to the public, seems to be working just fine seems like a waste of time and runs the risk of dis-improving the service.
If the report says the benefits to the service are worth it, fire ahead. Of course whether the HSE can deliver on that waits to be seen.0 -
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No.. but in your case i'll make an exception.
Thank you but I really thought we were all grown up and out of the school playground, but there you go.
But if 'god forbid' you do require an ambulance and I happen to be on the call let me assure you that you will get the level of treatment you require, in a calm, controlled professional manner, without insult or name calling.0 -
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Don't go lads, you have been a good source of entertainment. The likes of statements saying that a NAS crew would burn out if they were to do the same number of calls as a DFB crew, are you made of some sort of super human material:D:D:D
That Dublin's cardiac arrest success is down to the DFB, you do realise that the NAS also operate in Dublin city and county? and we don't 'burn out'!!
Being filled with dread at the prospect of the NAS responding to calls in Dublin, as stated we do actually work Dublin also. But being filled with dread and strict PDA's, is it normal for the DFB to respond a fire tender to a cardiac arrest but leave their advanced paramedic at the station because he is on kitchen duties? I can tell you I have seen this first hand and find it very worrying.
So if that's an example of your strict PDA's then it's no surprise another report has been called for.
yeah, real grown up0 -
if 10 tenders and 10 ambulances went to the same incident it still gets the one incident number0
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its good bang bang that you have the time to listen to whats going on with the dfb, should you not be answering the phone call that comes form the fire control for an ambulace0
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just like the cardiac arrest you took 40mins to respond too in Dunlaoire good work HSE0
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Lot of DFB v NAS arguments here that are ridiculous. I work for NAS and know and have met many DFB who are great paramedics and we always get on well together at a call. I have to admit I have seen call holding by DFB dispatch first hand and this shouldn't happen. I have also had many duplicate calls where a second ambo is sent to the same call because of two seperate controls, and one didn't know the other already had a vehicle dispatched, again a waste of resources. Best thing I believe that can happen is NAS take over national ambo dispatch in the new tallaght control, DFB keep their ambos, DFB ambos get tetra radios and the nearest available ambulance gets the call no matter what organisation. There has been a lot of down talk about Nas paramedics not being as capable but every paramedic is Phecc registered and does the same training and exams so no matter whether you get a NAS or DFB ambo for your emergency , you are getting a highly trained medical professional. I can also confirm Nas staff do not get any stand down time after calls, nor are we guaranteed lunch breaks. I have personally done 12 hour shifts where I haven't gotten back to base and had to grab a sambo while getting diesel. I was talking to a DFB paramedic the other day who stated he had gone his whole shift without a proper lunch either. The fact is both organisations do a great job with the funding each management provides and will continue to do the same0
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I work in a provincial city (NAS) and after 4 nights I've had enough patience, interest, concentration and energy are just shot....
If I were DFB I would fight tooth and nail hold onto some of my ambos regardless of costs for (of course) fires but also RTC's. I see this as a big disadvantage and drain on NAS ambos in the busier regions, dual services at one scene ect....crazy...0 -
Lot of DFB v NAS arguments here that are ridiculous. I work for NAS and know and have met many DFB who are great paramedics and we always get on well together at a call. I have to admit I have seen call holding by DFB dispatch first hand and this shouldn't happen. I have also had many duplicate calls where a second ambo is sent to the same call because of two seperate controls, and one didn't know the other already had a vehicle dispatched, again a waste of resources. Best thing I believe that can happen is NAS take over national ambo dispatch in the new tallaght control, DFB keep their ambos, DFB ambos get tetra radios and the nearest available ambulance gets the call no matter what organisation. There has been a lot of down talk about Nas paramedics not being as capable but every paramedic is Phecc registered and does the same training and exams so no matter whether you get a NAS or DFB ambo for your emergency , you are getting a highly trained medical professional. I can also confirm Nas staff do not get any stand down time after calls, nor are we guaranteed lunch breaks. I have personally done 12 hour shifts where I haven't gotten back to base and had to grab a sambo while getting diesel. I was talking to a DFB paramedic the other day who stated he had gone his whole shift without a proper lunch either. The fact is both organisations do a great job with the funding each management provides and will continue to do the same
Now your talking
And this is what its all about
http://www.independent.ie/regionals/corkman/news/celebration-of-life-as-con-thanks-his-rescue-team-29519263.html
I put that link in another tread - but thought it could do with another outing on this one.
Goes to show though - its not the name on the Ambulance that makes the difference - its the people delivering the service.0 -
Ah sure look lads...................ye seem to know it all. Nothing i say is going to make any difference.
A "hurty knee" is the same as someone thrown from a horse
I simply pointed out your wrong in your statement that tenders only go to CVAs and MIs its now changed to falling off a horse (which he didn't).
You still didn't answer my questions0 -
councillors objecting to the HSE plan
http://www.irishtimes.com/news/politics/council-rejects-hse-ambulance-plan-for-dublin-1.1732750#.UywKpZu5rfE.twitter
Interesting aspect is that some chap from DFB - is quoted as saying they can't meet Hiqa targets due "to factors outside our control"
Reinforces the concept that the biggest impact on Ambulance service delivery is resources and funding allocated to it.
Seems DFB aren't getting as much funding as they need - according to the councillors.
At least that's my reading of it.0 -
The DFB control room and call takers use the pro Q A system to prioritise all calls , they can only input the information being told over the phone .When the information is inputed a priority dispatch classification is generated and im sur the NAS system is similar for emergancy calls ,
For all E calls some D calls and all call that may need extra help ie spinal precautions log roll , bariatric patients etc etc the truck also travels
As for an AP being left behind to do station duties for a cardiac arrest you are sadly mistaken and as an outsider dont know how our system works an fabricating lies or recanting tales of old when few APs where in operation , all AP'are marked on their truck etc at start of shift and a tag is put beside whichever truck they are on , in the case of an arrest this truck is mobilised instead of the normal truck unless already attending an incident ,
also remember DFB dont get any extra funding for their AP's or the additional responces of firetrucks with additional resources , country brigades charge NAS for medical assistance calls whereas DFB DONT0 -
at last someone is talking sence0
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truebluesac wrote: »The DFB control room and call takers use the pro Q A system to prioritise all calls , they can only input the information being told over the phone .When the information is inputed a priority dispatch classification is generated and im sur the NAS system is similar for emergancy calls ,
For all E calls some D calls and all call that may need extra help ie spinal precautions log roll , bariatric patients etc etc the truck also travels
As for an AP being left behind to do station duties for a cardiac arrest you are sadly mistaken and as an outsider dont know how our system works an fabricating lies or recanting tales of old when few APs where in operation , all AP'are marked on their truck etc at start of shift and a tag is put beside whichever truck they are on , in the case of an arrest this truck is mobilised instead of the normal truck unless already attending an incident ,
also remember DFB dont get any extra funding for their AP's or the additional responces of firetrucks with additional resources , country brigades charge NAS for medical assistance calls whereas DFB DONT
I can read from this that you are a member of the DFB.
Accusing me of fabricating lies is just putting you in the same bracket as your colleague who began name calling and insulting, sad really because I had enjoyed your posts to date, initially you came across as someone who could hold a good debate, but there you go.
As for the incident involving kitchen duties, it was your colleagues who made the remark and there were more words in the conversation regarding the kitchen duties but they were just put down to the black humor that we often develop, so I may leave it there, but I hope they enjoyed their "AP chicken"!!
Getting away from the bashing and more in line with the thread title, I would like to offer some advice to a certain number of DFB personnel. If you wish to have the support of the NAS then maybe include the NAS in your campaign to save 'YOUR' ambulance service, you are not the sole Dublin ambulance service. Those members shouting this appear in a minority but also appear to be shouting very loud. Dublin City and County ambulance service is provided by and funded by the National Ambulance Service with an agreement in place for the Dublin Fire Brigade to provide 11 ambulances in support.
For those reading this thread who don't know, the National Ambulance Service have ambulance stations in Swords, James's Street, Tallaght and Loughlinstown, each operating between one and up to five ambulances per shift. There is a rostered AP RRV working out of Loughlinstown. There is a paramedic motorcycle response unit based in Cherry Orchard, there are a number of Intermediate Care Vehicles also based in Cherry Orchard who are available as back up and response to AS1 and AS2 calls, all these stations are in Dublin.
Dunshaughlin and Maynooth ambulance stations have quick access to West Dublin.
The big problem is the way the calls come through the BT exchange, some calls go to the DFB and some go to the NAS. This system has never worked and it is well over the time that something was done to sort it. There should be only one receiving command and control for all ambulances, regardless of what uniform they wear.
Remember the current report is just that, a report, recommendations are sure to come out of it, but the report will not be finalised and published until the end of May, it is then we will see the recommendations.
Worse fool you (general term) if you believe what the daily newspapers are printing before you see or hear anything official from the reporting committee.
Running to the media and calling for the report to be stopped only raises suspicions of what one may be masking or be fearful of.0 -
I can read from this that you are a member of the DFB.
Accusing me of fabricating lies is just putting you in the same bracket as your colleague who began name calling and insulting, sad really because I had enjoyed your posts to date, initially you came across as someone who could hold a good debate, but there you go.
As for the incident involving kitchen duties, it was your colleagues who made the remark and there were more words in the conversation regarding the kitchen duties but they were just put down to the black humor that we often develop, so I may leave it there, but I hope they enjoyed their "AP chicken"!!
Getting away from the bashing and more in line with the thread title, I would like to offer some advice to a certain number of DFB personnel. If you wish to have the support of the NAS then maybe include the NAS in your campaign to save 'YOUR' ambulance service, you are not the sole Dublin ambulance service. Those members shouting this appear in a minority but also appear to be shouting very loud. Dublin City and County ambulance service is provided by and funded by the National Ambulance Service with an agreement in place for the Dublin Fire Brigade to provide 11 ambulances in support.
For those reading this thread who don't know, the National Ambulance Service have ambulance stations in Swords, James's Street, Tallaght and Loughlinstown, each operating between one and up to five ambulances per shift. There is a rostered AP RRV working out of Loughlinstown. There is a paramedic motorcycle response unit based in Cherry Orchard, there are a number of Intermediate Care Vehicles also based in Cherry Orchard who are available as back up and response to AS1 and AS2 calls, all these stations are in Dublin.
Dunshaughlin and Maynooth ambulance stations have quick access to West Dublin.
The big problem is the way the calls come through the BT exchange, some calls go to the DFB and some go to the NAS. This system has never worked and it is well over the time that something was done to sort it. There should be only one receiving command and control for all ambulances, regardless of what uniform they wear.
Remember the current report is just that, a report, recommendations are sure to come out of it, but the report will not be finalised and published until the end of May, it is then we will see the recommendations.
Worse fool you (general term) if you believe what the daily newspapers are printing before you see or hear anything official from the reporting committee.
Running to the media and calling for the report to be stopped only raises suspicions of what one may be masking or be fearful of.
Genuine question - when you say 1 to 5 ambulances at the 4 locations you mention - is that 1 to 5 Ambulances in total between the 4 locations.
Or is it 1 to 5 ambulance PER location - meaning 4 to 20 Ambulances in total for NAS in Dublin - not sure.
I think it is good to know - that there is an existing NAS presence in Dublin - as I youd have a better chance of building the NAS service when theres already a presence in Dublin - rather then starting from scratch.0 -
Old diesel wrote: »Genuine question - when you say 1 to 5 ambulances at the 4 locations you mention - is that 1 to 5 Ambulances in total between the 4 locations.
Or is it 1 to 5 ambulance PER location - meaning 4 to 20 Ambulances in total for NAS in Dublin - not sure.
I think it is good to know - that there is an existing NAS presence in Dublin - as I youd have a better chance of building the NAS service when theres already a presence in Dublin - rather then starting from scratch.
Some stations are one ambulance and the larger stations have up to five ambulances for that station all on duty at the same time.
There has been a NAS existence in Dublin for many decades, including a command and control room.0 -
Some stations are one ambulance and the larger stations have up to five ambulances for that station all on duty at the same time.
There has been a NAS existence in Dublin for many decades, including a command and control room.
Nice one thanks.
At the end of the day - whats needed is the best possible Ambulance service.
That will only be achieved by people working together.
One thing I will say though - is that I wouldn't be a fan of the DFB type idea of the fire fighter also been a Paramedic been adopted OUTSIDE Dublin - simply for the reason that I think it devalues the Paramedic role as a very valuable role in its OWN RIGHT.
I mean fair play to the fire fighters for also been Paramedics and it works well in Dublin.
But I feel that id rather someone didn't get the idea of spreading that idea around the country - I feel it should be unnecessary - and feel that the Ambulance role ON ITS OWN is plenty for anybody to be getting on with.
To me it would be like expecting the accountant to also do reception - or expecting the receptionist to be an accountant :mad:
Also if Cork Co Councils approach to attempting to fix the road near my house is reflective of their approach - I certainly don't want them running the local Ambulance service :rolleyes:
The clowns have filled in the same potholes at least 3 times in the last year rather then fixing the problem properly :mad:
I get that Dublin City Council obviously know what they are doing running DFB and the ambulance service - but not every council is that good0 -
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I am currently a member of DFB but am ex NAS (health board)
Both system have faults and both staffs work well to make a broken system work , i also will point out that both staffs work well together , also when the AP students are on the AP car in dublin they only have good things to say RE how they are treated , respected and involved in incidents but leave with a differant understanding of DFB ,
I find your comment of "leaving the conversation there and a immidiate comment of "AP CHICKEN " in contrdiction of your statement and belittles your stand point
What i will say is that ALL front line workers should stand together and not accept changes from out of touch managment trying to line their pockets or portfolios , its was only a year or 2 ago where we stood shoulder to shoulder as the 24/7 alliance
The problem is with management and their asperiations and not on the ground , i am not making this a us and them thing rather an us and your management thingI can read from this that you are a member of the DFB.
Accusing me of fabricating lies is just putting you in the same bracket as your colleague who began name calling and insulting, sad really because I had enjoyed your posts to date, initially you came across as someone who could hold a good debate, but there you go.
As for the incident involving kitchen duties, it was your colleagues who made the remark and there were more words in the conversation regarding the kitchen duties but they were just put down to the black humor that we often develop, so I may leave it there, but I hope they enjoyed their "AP chicken"!!
Getting away from the bashing and more in line with the thread title, I would like to offer some advice to a certain number of DFB personnel. If you wish to have the support of the NAS then maybe include the NAS in your campaign to save 'YOUR' ambulance service, you are not the sole Dublin ambulance service. Those members shouting this appear in a minority but also appear to be shouting very loud. Dublin City and County ambulance service is provided by and funded by the National Ambulance Service with an agreement in place for the Dublin Fire Brigade to provide 11 ambulances in support.
For those reading this thread who don't know, the National Ambulance Service have ambulance stations in Swords, James's Street, Tallaght and Loughlinstown, each operating between one and up to five ambulances per shift. There is a rostered AP RRV working out of Loughlinstown. There is a paramedic motorcycle response unit based in Cherry Orchard, there are a number of Intermediate Care Vehicles also based in Cherry Orchard who are available as back up and response to AS1 and AS2 calls, all these stations are in Dublin.
Dunshaughlin and Maynooth ambulance stations have quick access to West Dublin.
The big problem is the way the calls come through the BT exchange, some calls go to the DFB and some go to the NAS. This system has never worked and it is well over the time that something was done to sort it. There should be only one receiving command and control for all ambulances, regardless of what uniform they wear.
Remember the current report is just that, a report, recommendations are sure to come out of it, but the report will not be finalised and published until the end of May, it is then we will see the recommendations.
Worse fool you (general term) if you believe what the daily newspapers are printing before you see or hear anything official from the reporting committee.
Running to the media and calling for the report to be stopped only raises suspicions of what one may be masking or be fearful of.0 -
I can read from this that you are a member of the DFB.
Accusing me of fabricating lies is just putting you in the same bracket as your colleague who began name calling and insulting, sad really because I had enjoyed your posts to date, initially you came across as someone who could hold a good debate, but there you go.
...
If by colleague you are referring to me you are very much mistaken. I am not a member of DFB. i thought that was very clear. I'm just a concerned civilian.0 -
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truebluesac wrote: »What i will say is that ALL front line workers should stand together and not accept changes from out of touch managment trying to line their pockets or portfolios , its was only a year or 2 ago where we stood shoulder to shoulder as the 24/7 alliance
The problem is with management and their asperiations and not on the ground , i am not making this a us and them thing rather an us and your management thing
I agree with you, we should stand together but I will reemphasise that the whole DFB 'IS' the Dublin Ambulance Service has to be dropped in order to drum up support from those within the 24/7 emergency services, for as long as certain members of the brigade continue with this banner then any support there is from the NAS will drift away, otherwise you won't see the like of the 24/7 alliance support that WE all just might need come the end of May when the report is published.
I will also state that in my opinion, whoever is deemed to be the appropriate control and command, on the basis that both services retain their positions as emergency ambulance providers for Dublin, then that control and command should control both services. The current long standing split control is detrimental to patient care and needs to be changed to a single control and command structure.0 -
Thought just occurred to me - when I saw a "save DFB Ambulance" type tweet on twitter this evening.
I think the provision of Ambulance services in Dublin for the future is relatively safe - whoever is doing the providing.
Its hard to imagine anyone doing anything that would downgrade the Dublin Ambulance services - simply because - of the fact that its Dublin.
The political opposition would be far too great - and the HSE chaps that came up with the idea - would quickly find the heat.
So safest option imo for HSE management is to either keep DFB on board - or come up with an alternative system - that's at least as good as DFBs.
I expect what will happen - is that HSE sets a date for DFB to hand over their Ambulance service/stop running it - that will get postponed nearer the date, - and get postponed again.
The advantage Dublin has - is that its a very high priority for Govt etc - wheras - if this was small towns around the country - it would be far easier for HSE to take away ambulances and downgrade services.
Id actually be more worried about ambulance services in areas near Dublin - like Kildare - as there is - imo - a risk that HSE may take Ambulances from other parts of the country to fill service gaps in Dublin should they take over DFBs Ambulance role.
Far too risky to downgrade Dublins Ambulance service imo - from a Govt viewpoint0 -
There are some interesting comments on this thread. Some are unbelievably misinformed. Despite the obvious fact that a range of syndicating journalists have decided to accelerate HSE bashing (and by association, NAS bashing) in recent weeks, none have attempted to inject any balance or indeed challenge any so called "truths" on which much of the conjecture is based. A simple example, IFESA chairperson states 40% of all ambulance calls are in Dublin. A blatant lie, whether you use one or more categories of ambulance calls. All journalists, as well as the usual commentators (IFESA and the usual Private Ambulance operators), continue to ignore or avoid some basic facts which are extractable through an FOI request (you don't have to believe what you need here):
more than two thirds of the population live outside of Dublin (check the Census)
In December 2013, only the NAS in the MW, former East (Dublin, Kildare and Wicklow) and the Midlands achieved the 19 minute response time for DELTA/ECHO calls. This target have never been achieved in the areas of Dublin not primarily serviced by NAS
The Private Ambulance company whom is now tweeting support for DFB, sued the State in the EU Court because DFB did not compete in a procurement process. The same commentator, whom criticises NAS on an almost daily basis, sued the HSE when they tried to initially introduce the Intermediate Care Service claiming it would harm their business. PHECC are subject to FOI so it would be interesting to get copies of all correspondence they have received from the same source.
IFESA regularly call for a National Fire Service because of fragmentation and inconsistency amongst Fire Authorities. Apparently it's OK to not have a single National Ambulance Service and to have a fragmented service in Dublin
In addition to the Response KPIs published by HIQA, there is an additional "qualitative" KPI which all services collect. It relates to the percentage of ECHO/DELTA calls that are responded to by an Advanced Paramedic. DFB's own figures in 2013 put the figure at less than 5% while the NAS figure is 68%. Apparently, the quality of NAS services outside of Dublin are inferior. Is it true that Advanced Paramedics in DFB are promoted to Sub Officer and therefore stop crewing emergency ambulances?????
HIQA legislation does not provide it with powers to regulate or inspect any Fire Service. Given the public confidence in HiQA inspections, are the public happy to not have access to regulatory reassurance. The review announced by the Minister for Health, to be conducted by HIQA, will not encompass DFB, unless they volunteer themselves to it.
NAS is so dysfunctional that it is able to coordinate and deliver aeromedical services using both it's own and IRCG assets. NAS has successfully provided national access to Primary PCI therapy for MI patients whom previously were excluded because they lived on the West Coast or Border Areas.
Everyday, NAS (as does DFB) respond to patients with successful outcomes. The difference is that NAS does not have it's "customer base" captivated in a small geographical area where it has a large Fire Service workforce to use as "back up" for meal breaks, lifts, etc. because they have few fires to respond to. Rather, NAS has to deliver services to the other two thirds of the population spread out between Mizen Head to Malin Head as well as still managing to deliver a range of emergency as well as all urgent and routine services in Dublin.
NAS responds to approx. 350,000 emergency/urgent calls every year. If you search the papers, we hear about a dozen well publicised news paper headlines. For some strange reason, we don't here about the the 99.9% calls where everything went right. An example is a headline from the North East recently in a tabloid which claimed a "25 minute delay". What the journalist failed to realise or indeed accurately report was that it was a six minute delay as the first 19 minutes was the target. The second hypocrisy promoted by journalists is the omission of the fact that response time KPIs do not apply to all 999 calls, in fact it is approx 41% of 999 calls that are encompassed. In any human endeavour, including healthcare, people fail to perform or make mistakes. Whilst these mistakes can cost lives, the reality is that the World Health Alliance on Patient Safety, the peak body of same, accepts that a percentage of patients will not get the very best all of the time. That is the reality of what happens when services are delivered by human beings. The Irish response is a media witch hunt. As DFB services are delivered by humans equally doing their best, they too make mistakes.
So, why do we only hear about NAS in the media, and very little about DFB? While everything I have referred to above can be evidence based through research or FOI, I will digress on this point and offer an opinion. In my view, there is the simple reason that DFB is a small ambulance operation in a small densely populated area where most people are non affected and the media outside Dublin not interested (unless it is syndicated journalism) and the capital offers the media a greater choice of scandal. Secondly, DFB has not experienced much organisational reform to unsettle a workforce. When you couple this with a very professional ethos, built on collegiality, loyalty and pride in service, you get little "noise".
conversely, NAS faces huge geographic and demographic challenges but is benchmarked against the same metrics. Secondly, NAS staff and the public has experienced significant organisational reform and loss of income (in the case of staff). NAS does not have the loyalty, pride and collegial culture of DFB. A failure of leadership is generally the root cause. In my mind, the common denominator is the correlation between the location of the media reports, the journalists involved, the extent of loss of earnings in those areas and the degree of service reforms/parochial response. Essentially, following NAS staff running to journalists to air their grievances, these same individuals have now been "cultivated" as informants by these same journalists whom realise the ease with which HSE related stories can be extracted and probably not challenged with the actual truth. The small minority of truly disgruntled think they are getting at their management, however, what they are really doing is allowing themselves to be used to undermine the professionalism of their colleagues and erode public confidence in a national service that has so much potential given the right leadership, political support and workforce buy in.
Instead, we are due to be subjected to another prime time "expose" where in probably 20 minutes, we will be convinced lives at at risk. We will then have the subsequent IFESA, journalistic and Private Ambulance operator analysis in the usual media outlets followed by the usual outpouring of parliamentary questions from "concerned" politicians. And meanwhile, they won't have scratched the truth just further undermined the morale of a professional workforce and worried the public.
Well if we have a crisis, ask the man whom had a cardiac arrest on a golf course in Ballyshannon, was successfully resuscitated, flown to Galway, had a PCI and went home to his family what he thinks of "an ambulance service in crisis". Trouble is, he is only one of about 800,000 patients whom have a good experience of NAS every year.
The purpose of this long post is not to bash any group including DFB, but to point out that when it comes to complex services like an ambulance service, what you read, hear and watch in the media is rarely the truth.0 -
NonBeliever14 wrote: »There are some interesting comments on this thread. Some are unbelievably misinformed. Despite the obvious fact that a range of syndicating journalists have decided to accelerate HSE bashing (and by association, NAS bashing) in recent weeks, none have attempted to inject any balance or indeed challenge any so called "truths" on which much of the conjecture is based. A simple example, IFESA chairperson states 40% of all ambulance calls are in Dublin. A blatant lie, whether you use one or more categories of ambulance calls. All journalists, as well as the usual commentators (IFESA and the usual Private Ambulance operators), continue to ignore or avoid some basic facts which are extractable through an FOI request (you don't have to believe what you need here):
more than two thirds of the population live outside of Dublin (check the Census)
In December 2013, only the NAS in the MW, former East (Dublin, Kildare and Wicklow) and the Midlands achieved the 19 minute response time for DELTA/ECHO calls. This target have never been achieved in the areas of Dublin not primarily serviced by NAS
The Private Ambulance company whom is now tweeting support for DFB, sued the State in the EU Court because DFB did not compete in a procurement process. The same commentator, whom criticises NAS on an almost daily basis, sued the HSE when they tried to initially introduce the Intermediate Care Service claiming it would harm their business. PHECC are subject to FOI so it would be interesting to get copies of all correspondence they have received from the same source.
IFESA regularly call for a National Fire Service because of fragmentation and inconsistency amongst Fire Authorities. Apparently it's OK to not have a single National Ambulance Service and to have a fragmented service in Dublin
In addition to the Response KPIs published by HIQA, there is an additional "qualitative" KPI which all services collect. It relates to the percentage of ECHO/DELTA calls that are responded to by an Advanced Paramedic. DFB's own figures in 2013 put the figure at less than 5% while the NAS figure is 68%. Apparently, the quality of NAS services outside of Dublin are inferior. Is it true that Advanced Paramedics in DFB are promoted to Sub Officer and therefore stop crewing emergency ambulances?????
HIQA legislation does not provide it with powers to regulate or inspect any Fire Service. Given the public confidence in HiQA inspections, are the public happy to not have access to regulatory reassurance. The review announced by the Minister for Health, to be conducted by HIQA, will not encompass DFB, unless they volunteer themselves to it.
NAS is so dysfunctional that it is able to coordinate and deliver aeromedical services using both it's own and IRCG assets. NAS has successfully provided national access to Primary PCI therapy for MI patients whom previously were excluded because they lived on the West Coast or Border Areas.
Everyday, NAS (as does DFB) respond to patients with successful outcomes. The difference is that NAS does not have it's "customer base" captivated in a small geographical area where it has a large Fire Service workforce to use as "back up" for meal breaks, lifts, etc. because they have few fires to respond to. Rather, NAS has to deliver services to the other two thirds of the population spread out between Mizen Head to Malin Head as well as still managing to deliver a range of emergency as well as all urgent and routine services in Dublin.
NAS responds to approx. 350,000 emergency/urgent calls every year. If you search the papers, we hear about a dozen well publicised news paper headlines. For some strange reason, we don't here about the the 99.9% calls where everything went right. An example is a headline from the North East recently in a tabloid which claimed a "25 minute delay". What the journalist failed to realise or indeed accurately report was that it was a six minute delay as the first 19 minutes was the target. The second hypocrisy promoted by journalists is the omission of the fact that response time KPIs do not apply to all 999 calls, in fact it is approx 41% of 999 calls that are encompassed. In any human endeavour, including healthcare, people fail to perform or make mistakes. Whilst these mistakes can cost lives, the reality is that the World Health Alliance on Patient Safety, the peak body of same, accepts that a percentage of patients will not get the very best all of the time. That is the reality of what happens when services are delivered by human beings. The Irish response is a media witch hunt. As DFB services are delivered by humans equally doing their best, they too make mistakes.
So, why do we only hear about NAS in the media, and very little about DFB? While everything I have referred to above can be evidence based through research or FOI, I will digress on this point and offer an opinion. In my view, there is the simple reason that DFB is a small ambulance operation in a small densely populated area where most people are non affected and the media outside Dublin not interested (unless it is syndicated journalism) and the capital offers the media a greater choice of scandal. Secondly, DFB has not experienced much organisational reform to unsettle a workforce. When you couple this with a very professional ethos, built on collegiality, loyalty and pride in service, you get little "noise".
conversely, NAS faces huge geographic and demographic challenges but is benchmarked against the same metrics. Secondly, NAS staff and the public has experienced significant organisational reform and loss of income (in the case of staff). NAS does not have the loyalty, pride and collegial culture of DFB. A failure of leadership is generally the root cause. In my mind, the common denominator is the correlation between the location of the media reports, the journalists involved, the extent of loss of earnings in those areas and the degree of service reforms/parochial response. Essentially, following NAS staff running to journalists to air their grievances, these same individuals have now been "cultivated" as informants by these same journalists whom realise the ease with which HSE related stories can be extracted and probably not challenged with the actual truth. The small minority of truly disgruntled think they are getting at their management, however, what they are really doing is allowing themselves to be used to undermine the professionalism of their colleagues and erode public confidence in a national service that has so much potential given the right leadership, political support and workforce buy in.
Instead, we are due to be subjected to another prime time "expose" where in probably 20 minutes, we will be convinced lives at at risk. We will then have the subsequent IFESA, journalistic and Private Ambulance operator analysis in the usual media outlets followed by the usual outpouring of parliamentary questions from "concerned" politicians. And meanwhile, they won't have scratched the truth just further undermined the morale of a professional workforce and worried the public.
Well if we have a crisis, ask the man whom had a cardiac arrest on a golf course in Ballyshannon, was successfully resuscitated, flown to Galway, had a PCI and went home to his family what he thinks of "an ambulance service in crisis". Trouble is, he is only one of about 800,000 patients whom have a good experience of NAS every year.
The purpose of this long post is not to bash any group including DFB, but to point out that when it comes to complex services like an ambulance service, what you read, hear and watch in the media is rarely the truth.
Nice one - great to hear a different perspective
Your right - we don't get to hear about the times when things don't go right.
My theory on that - is that people just expect an Ambulance service to work (I don't mean that in a bad way)
So if the Advanced Paramedic turns up in his/her RRV quickly - the ambulance then rocks up quickly afterwards - and the Advanced Paramedic and Paramedics do Trojan work - and save the patients life - and patient goes on to make a full recovery - there isn't going to be big fanfare from many people about it - why???.
Because I think people expect to see Ambulance crews arrive quickly when they make a 999 call - and they expect the crews to do everything possible.
They expect that as normal service - the reality is that if a crew comes out to a call swiftly - delivers fantastic care and treatment - and as a result of that treatment a patients life is saved - and patient makes a full recovery - that is a fantastic achievement.
It would of course add greatly to the discussion on Ambulance services etc - if Journalists, Media, RTE etc - would look at the times when things do go right.
There is one very good reason why I think we need to look at the times when things go right.
its this - if you get a situation where everything goes well - response time is good, and great teamwork, great treatment and care from top class staff - saves a life, promotes recovery, and a full recovery for the patient is achieved - that's a great learning tool for making the Ambulance service better.
Because you can say - okay - this job went really well - so why did that happen.
It sounds bizzare - but if we look at why things go well - then we can look at how we can achieve that level of performance as often as possible.
Somehow I doubt Prime time will be delivering much balance tonight though :rolleyes:0 -
Brilliant post 'NonBeliever14', top post of this thread without a doubt.0
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Brilliant post 'NonBeliever14', top post of this thread without a doubt.
Without a doubt
If Non Beliver14 was on the prime time programme tonight giving his or her input - I think I can safely say - that it would improve the programme marvellously.
But alas - I fear we won't be seeing contributions of that quality on Prime time - even though it would help a balanced debate.0 -
Old diesel wrote: »Without a doubt
If Non Beliver14 was on the prime time programme tonight giving his or her input - I think I can safely say - that it would improve the programme marvellously.
But alas - I fear we won't be seeing contributions of that quality on Prime time - even though it would help a balanced debate.
Well we have another day to convince NonBeliever14 to take part in the programme as it has been postponed until tomorrow night due to the resignation of the Garda Commissioner.
It's great to see the actual figures of how many advanced paramedics responded to the calls that the systems states they should. 5% DFB compliance as opposed to 68% compliance with the NAS. It's not a fire based EMS that saves lives alone, it is an Advanced Life Support (ALS) populated service that saves lives.
Of the approximate 48 advanced paramedics that graduate each year, 40 of those are NAS advanced paramedics whilst the remaining figures of approximately 8 account for DFB and Defence Forces collectively.0 -
Facebook is telling me that the PrimeTime Special is delayed due to the big news of the day; the AGS commissioner resigning.0
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Another excellent post Nonbeliver14, Well done0
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NonBeliever14 wrote: »1st point: Lets look at some numbers. In 2013, NAS responded to 860,000+ calls. Even if you believe the 75,000+ DFB claim? (and remember, they report actual verified numbers to the HSE so they will know the actual amount) this does not equate to "40%". Remeber, just because you hear a bark, doesn't mean it came from a dog.
Emergency Call: 230,433
• Urgent Call: 50,139
• Echo Call: 2,916
• Delta Call: 85,670
DFB only respond to emergency calls so 75000 would work out at about 33% of Emergency calls nationally. (I actually believe DFB responded to over 80,000 which is closer to 35% but we won't split hairs). It is still a substantial percentage of the national emergency call volume. Woof.2nd point: every health system uses "casemix" to determine accurate workload and expected resource consumption. In simple terms, the cost of "a call" responded to from Dolphin's Barn DFB Station for a Chest Pain (let's say it is a STEMI) is a fraction of the cost of "a call" responded to from Castletownbere NAS Station for a Chest Pain (let's say it is a STEMI). One "call" will result in disposition of the patient in possibly 20 minutes with limited labour and non labour costs while the other exact same "call" could take 2 hours to result in patient disposition and may involve the use of a helicopter (comparing apples with oranges)
The only real difference between cost in two ambulances however is the diesel and the hourly pay of the crew. There would not be a huge amount of extra meds or equipment used.3rd point: Fire Based EMS is predominantly a US model and one that is almost exclusively "city" based. NAS does not have the luxury of a dozen Stations in a small city scape environment. Instead, NAS is expected to deliver the same level of response from Mizen Head to Malin Head. Comparing these two organisations is at best farcical. The top three ambulance services in the world are "not" integrated with Fire but with the health system.4th point: EMS is an out of date term from the US. Today, the worlds most progressive and innovative ambulance services treat about 40-50% of their workload without lights and sirens and without going to hospital. The future of Pre Hospital Emergency Care lies in diversification into "Out of Hospital" care. A subtle but important difference which can only be achieved if the ambulance service is integrated with Primary, Social, Children and Family and Mental health Services. Fire Services have an important role to play in "first response" to life threatening calls but in reality, these are a small proportion of any modern or future ambulance services workload. Lot's of international experience on this point.5th point: Paramedic CPC (when it arrives from PHECC) will become a huge financial millstone for every registrant and any approved service provider. It will improve patient safety and the quality of care provided. It is unsustainable to suggest that DFB should continue to spend money upskilling 800 Paramedics to have just over 100 provide an emergency ambulance service. If we are all so confident that Paramedics on Fire Engines are "necessary", let's do a transparent audit of everyone's practice to see how many interventions (at Paramedic level) they did that someone else did not also claim credit for. Again, Fire Services have an important role to play in "first response" to life threatening emergencies but not just in Dublin.Last point: wanting to continue to do something because you have done it a particular way for 150 years is not a valid reason to avoid change. Again, if we are confident the system as is works, why do we still have duplicate responses, why did the C&AG recommend elimination of duplicate control arrangements. Why not have a review by appropriate experts whom can confirm that Dublin needs 800+ Firefighters to do approx 15000 fire calls (about 4000 are hoax or alarm calls) and that doing the emergency ambulance work is not a form of subvention to shoulder the cost of having a standing army of Fire fighters (I know nothing about Fire Services)Not for a moment taking away from the best intentions of anyone trying to deliver services but don't be blinkered by the usual commentators and journalists whom are so hungry for print copy they will print anything regardless of the validity of all of the content.0 -
NonBeliever14 wrote: »There are some interesting comments on this thread. Some are unbelievably misinformed. Despite the obvious fact that a range of syndicating journalists have decided to accelerate HSE bashing (and by association, NAS bashing) in recent weeks, none have attempted to inject any balance or indeed challenge any so called "truths" on which much of the conjecture is based. A simple example, IFESA chairperson states 40% of all ambulance calls are in Dublin. A blatant lie, whether you use one or more categories of ambulance calls. All journalists, as well as the usual commentators (IFESA and the usual Private Ambulance operators), continue to ignore or avoid some basic facts which are extractable through an FOI request (you don't have to believe what you need here):more than two thirds of the population live outside of Dublin (check the Census)In December 2013, only the NAS in the MW, former East (Dublin, Kildare and Wicklow) and the Midlands achieved the 19 minute response time for DELTA/ECHO calls. This target have never been achieved in the areas of Dublin not primarily serviced by NASThe Private Ambulance company whom is now tweeting support for DFB, sued the State in the EU Court because DFB did not compete in a procurement process. The same commentator, whom criticises NAS on an almost daily basis, sued the HSE when they tried to initially introduce the Intermediate Care Service claiming it would harm their business. PHECC are subject to FOI so it would be interesting to get copies of all correspondence they have received from the same source.IFESA regularly call for a National Fire Service because of fragmentation and inconsistency amongst Fire Authorities. Apparently it's OK to not have a single National Ambulance Service and to have a fragmented service in DublinIn addition to the Response KPIs published by HIQA, there is an additional "qualitative" KPI which all services collect. It relates to the percentage of ECHO/DELTA calls that are responded to by an Advanced Paramedic. DFB's own figures in 2013 put the figure at less than 5% while the NAS figure is 68%. Apparently, the quality of NAS services outside of Dublin are inferior. Is it true that Advanced Paramedics in DFB are promoted to Sub Officer and therefore stop crewing emergency ambulances?????
Second point. The figures don't count when an AP responds whilst on a fire engine. That is being changed. Finally DFB APs apply for promotion just like everyone else and if they get it then they no longer man ambulances but still respond to Echo and Deltas on the motors.HIQA legislation does not provide it with powers to regulate or inspect any Fire Service. Given the public confidence in HiQA inspections, are the public happy to not have access to regulatory reassurance. The review announced by the Minister for Health, to be conducted by HIQA, will not encompass DFB, unless they volunteer themselves to it.NAS is so dysfunctional that it is able to coordinate and deliver aeromedical services using both it's own and IRCG assets. NAS has successfully provided national access to Primary PCI therapy for MI patients whom previously were excluded because they lived on the West Coast or Border Areas.Everyday, NAS (as does DFB) respond to patients with successful outcomes. The difference is that NAS does not have it's "customer base" captivated in a small geographical area where it has a large Fire Service workforce to use as "back up" for meal breaks, lifts, etc. because they have few fires to respond to. Rather, NAS has to deliver services to the other two thirds of the population spread out between Mizen Head to Malin Head as well as still managing to deliver a range of emergency as well as all urgent and routine services in Dublin.
You guys are stretched thin across the country so why are your management trying to take on another 80,000 calls? Maybe get those resources out to where they are needed?NAS responds to approx. 350,000 emergency/urgent calls every year.If you search the papers, we hear about a dozen well publicised news paper headlines. For some strange reason, we don't here about the the 99.9% calls where everything went right. An example is a headline from the North East recently in a tabloid which claimed a "25 minute delay". What the journalist failed to realise or indeed accurately report was that it was a six minute delay as the first 19 minutes was the target. The second hypocrisy promoted by journalists is the omission of the fact that response time KPIs do not apply to all 999 calls, in fact it is approx 41% of 999 calls that are encompassed. In any human endeavour, including healthcare, people fail to perform or make mistakes. Whilst these mistakes can cost lives, the reality is that the World Health Alliance on Patient Safety, the peak body of same, accepts that a percentage of patients will not get the very best all of the time. That is the reality of what happens when services are delivered by human beings. The Irish response is a media witch hunt. As DFB services are delivered by humans equally doing their best, they too make mistakes.So, why do we only hear about NAS in the media, and very little about DFB? While everything I have referred to above can be evidence based through research or FOI, I will digress on this point and offer an opinion. In my view, there is the simple reason that DFB is a small ambulance operation in a small densely populated area where most people are non affected and the media outside Dublin not interested (unless it is syndicated journalism) and the capital offers the media a greater choice of scandal. Secondly, DFB has not experienced much organisational reform to unsettle a workforce. When you couple this with a very professional ethos, built on collegiality, loyalty and pride in service, you get little "noise".conversely, NAS faces huge geographic and demographic challenges but is benchmarked against the same metrics.Secondly, NAS staff and the public has experienced significant organisational reform and loss of income (in the case of staff). NAS does not have the loyalty, pride and collegial culture of DFB. A failure of leadership is generally the root cause. In my mind, the common denominator is the correlation between the location of the media reports, the journalists involved, the extent of loss of earnings in those areas and the degree of service reforms/parochial response. Essentially, following NAS staff running to journalists to air their grievances, these same individuals have now been "cultivated" as informants by these same journalists whom realise the ease with which HSE related stories can be extracted and probably not challenged with the actual truth. The small minority of truly disgruntled think they are getting at their management, however, what they are really doing is allowing themselves to be used to undermine the professionalism of their colleagues and erode public confidence in a national service that has so much potential given the right leadership, political support and workforce buy in.Instead, we are due to be subjected to another prime time "expose" where in probably 20 minutes, we will be convinced lives at at risk. We will then have the subsequent IFESA, journalistic and Private Ambulance operator analysis in the usual media outlets followed by the usual outpouring of parliamentary questions from "concerned" politicians. And meanwhile, they won't have scratched the truth just further undermined the morale of a professional workforce and worried the public.Well if we have a crisis, ask the man whom had a cardiac arrest on a golf course in Ballyshannon, was successfully resuscitated, flown to Galway, had a PCI and went home to his family what he thinks of "an ambulance service in crisis". Trouble is, he is only one of about 800,000 patients whom have a good experience of NAS every year.The purpose of this long post is not to bash any group including DFB, but to point out that when it comes to complex services like an ambulance service, what you read, hear and watch in the media is rarely the truth.
Couldn't agree more. But this applies to both 'sides' of the argument. The HSE spin about 'cost savings'and the anecdotes about DFB mallets and APs not being dispatched is equally galling from my point of view.
Stay safe0 -
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Apologies up front for another long one
The media frenzy and blatant lies continue today with even two TDs quoting what can now be called the "Kidd Factor" stats. One of them even got confused and blamed the HSE for an incident involving DFB. Dep Lyons statement of "DFB is the best service in the State" is a very tall and very disingenuous statement. He went onto quote the IFESA propaganda of "7% of the NAS budget for 40% of ALL ambulance calls". Eventually, the quoter forgets the liar and fiction promulgated becomes reliable fact.
The IFESA facebook page, along with twitter and facebook accounts of the Private Ambulance Operator are now increasingly dedicated to NAS bashing, scaremongering and insults.
Excellent post Millennium Falcon, respectful debate is excellent
First post:
Statistics - as previously said, anything I quote is available through FOI. I prefer not to rely on anyone's submissions.
Casemix - Millennium Falcon, with respect, you have not articulated any understanding of casemix costing. Labour and fuel are only two elements of costing the price of the call. The lower the call volume, the higher the unit hour rate.
City based services - Firstly, lets get an accurate definition of Fire Based EMS. Is it the DFB model or the NYCEMS model or the LAFD model. Secondly, Fire Based Services are predominant in cities in the US where the tax rates are different depending on where you live. People outside of the "municipalities" pay less taxes and have less services. In some cases volunteer squads. In Ireland, we pay the same rate of tax and are therefore, at least theoretically entitled to equality of access. Several government reports as well as the C&AG have expressed a view. The statutory provider of healthcare in Ireland (HSE) has articulated a policy. The consensus is a single National Ambulance Service. This raises the philosophical question of why should Dublin be different? Should we allow every city to develop stand alone Ambulance Services with the inherent isolated controls, boundaries and inefficiencies, each with each own management structure. This certainly flies in the face of the IFESA propaganda.
Treat and Refer cannot be done by anyone. Please name any service that is not integrated into a healthcare system that is doing it successfully with large volume results. The "****" happens in about 10% of all 999 calls (yes anecdote), unless we all believe all 999 calls are "emergencies". As previously eluded to, really successful and innovative services have reinvented themselves into an "Out of Hospital" service complementing "Pre Hospital Emergency Care". This is absolute necessity given the need to respond to an ageing population and the current GDP % of most jurisdictions being spent on health. Blue lights are not our future. ED avoidance is and this can only be truly and systematically achieved through full integration with primary care. Because people are people, you need to have all the elements sitting within one governance model. A number of jurisdictions have realised this and are moving their ambulance services from an "Emergency Services" to Health portfolio.
CPC - very fair point. However, you don't "have" to have 800 Paramedics in a Fire Service to provide 104 providing 11 (HSE only pay for 11) ambulances 24/7. Conversely, you do have to have 11 to provide a 24/7 service in a low volume Station like Castletownbere thus justifying the expenditure on training. The additional cost is included in casemix thus increasing the overhead of providing every unit hour of service delivery.
Fire Service numbers - As I said, I don't know anything about delivering Fire Services. I do know you don't need 800 Paramedics in Dublin. The Fire Service call outs are a matter of public record and are presumably an excellent reflection of good Fire Prevention by DFB (and other Fire Services) over the years.
Second post:
Performance - I disagree, remember, all ambulances go to the same hospitals and experience the same delays.
IFESA - I am aware of what they are calling for...........my point is the double standards being applied by someone now running for public office. The question of integrity will arise if elected.
AP Deployment - A sample:
DFB provided the following information to the NAS for December 2012 (79 ECHO (1.52% of total 999 call volume) and 2829 DELTA (44.47% of total 999 call volume)). DFB reported that 1 call was responded to by a solo AP (on a Fire Truck???) and 54 calls were responded to by a crew with an AP. The % was 2% of calls that were advised by AMPDS as requiring an AP.
In the same period, NAS reported 297 ECHO (1.52% of total 999 call volume) and 7715 DELTA (39.59% of total 999 call volume). NAS reported that 403 calls were responded to by a solo AP and 2808 calls were responded to by a crew with an AP. The % was 49% of calls that were advised by AMPDS as requiring an AP. In 2012, NAS reached agreement on AP Deployment which saw that figure jump to 68% following implementation.
The figures speak for themselves. Why train APs if your funder, commissioner or service purchaser did not ask or fund you to???? Does every AP secure promotion as a Sub Officer? How many are not Sub Officers?
HIQA - yes, legislation could address this, however, at the time of the report leaked, DFB were not encompassed (and still are not) within their remit. The HSE could not allow a situation to continue where HIQA were holding it accountable for the actions (or indeed inactions) of an organisation it was funding but had no control over. Do an FOI request on all of the attempts made by the HSE to secure a written agreement. Also worth asking for the names of all attendees at the meetings to see if both sides put forward consistent teams or played games with membership.
Takeover - I am not sure NAS management are trying to take over anything. I think they are required to demonstrate good governance and control of public monies that they are accountable for. Context is very important on this point. What happened to the previous Dublin Review commissioned in 2006 but not released until 2009 because of 3 years wrangling by unions. The bottom line is that NAS is frustrated with the game of obfuscation that has been played for many years. A game played on with the protection of the Drumcondra Mafia. The game has changed and NAS and HSE are now the big players in the room. Frankly, having worked with DFB colleagues, I would be quite happy for a dedicated cohort of DFB staff whom want to focus on ambulance work to do so with a single national control centre delivering best results for patients. I would also insist on every paramedic wearing the same uniform, using the same equipment and driving identical vehicles with a single national livery. No room for egos just the projection of a single identity that promotes professionalism and instills public confidence. No room for historical egos or baggage. DFB, and every other Fire Service, should continue to First Respond to appropriate calls. After all, that was Government Policy signed of by Minister Harney in the Cardiovascular Strategy in 2006.
Statistics - I have said my piece on the numbers. In relation to being stretched, of course we are. The country is broke and because of the inability at political level to prioritise various public monies, we do the best with what we have. If you can only afford a hospital or a library, it does not take a genius to articulate which one you close. Billy Kelliher today was a perfect example, so focussed on getting a crack at the Minister for Health, he forgot to say, by the way, Cork should also have DFB type service.
Media - the only reason the media storm started was when NAS staff lost overtime in the roster review. It started in the NE and then spread like a virus through NASRA (whom seem to have dissappeared and have no view so far, on the current debate in Dublin). The journalists then realised what a golden goose they had. Couple of phone calls to/from a disgruntled Paramedic and then a half arsed FOI request with questions probably provided by the Paramedic. Today's story about RRVs costing 100k is a perfect example. Do you think the journalist stopped to FOI the cost of any registration available on Cartell. FOI only works when you know what to ask (rant over!)
Scale - DFB charge the HSE for 104-105 staff doing 70,000 plus calls with 11 ambulances. This is a "small ambulance operation" by both Irish and International standards. No offence to my colleagues at any level in DFB but the numbers speak for themselves.
Culture - I admire the DFB culture, except on those few occasions when they roll out the past DFB/EHB dispute (very few now to be fair) or use history as a reason not to change the future. As a taxpayer, the waste of money using a Firefighter as a cook is also galling. But that's a matter for DCC management to address if it still exists. On the other hand, NAS culture lacks the same level of pride and professionalism. That's not a slant on practice but rather on attitude. It is not unusual in NAS to encounter a Supervisor or Officer whom is more negative, disloyal and outspoken than some of the worst. This cancer pervades the organisation and feeds on the contempt felt by many about pay cuts and cutbacks. DFB seem to have the sense for the most part, to air their issues "in lodge" rather than through the media. That said, these individuals are an absolute minority and regrettably the vast majority whom are professional in everything they do seldom have a voice or are provided with effective leadership.
Resources - NAS is stretched because no one would believe it didn't have the UK level of resources to deliver on UK response time KPIs. We have poor leadership (because we don't do leadership development and succession planning) but I do not believe we have mismanagement. I believe we are doing the best we can with what we have, but are now unfairly villified as an organisation because the public, the media and the politicians do not understand our service or our response time indicators. Interesting, no one ever asks about Fire Service or AGS response time standards (non existent). Our woes are worsened by the small minority of the workforce and NASRA whom take a one dimensional view on life and use every opportunity to ventilate personal grudges with management. Unfortunately, their lack of professionalism blinds them from seeing the harm they are doing to the professional reputation of our workforce and the public's trust and confidence in the services we deliver 99.9% of the time.
Anyway, we will all await the outcome of the various deliberations0 -
Very interesting reading from someone who has no clue of how either service operates. Could anyone tell me what echo and delta calls are or where I could look it up? Thanks.0
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Very interesting reading from someone who has no clue of how either service operates. Could anyone tell me what echo and delta calls are or where I could look it up? Thanks.
The controls rooms in both services operate AMPDS systems. This system generates a dispatch code (depending on the answers given by the caller). Alpha & Omega are non blue light even though it might have come in on the 999. Bravo, Charlie, Delta & Echo are hot responses ie blue lights & sirens. Echo calls are the most serious ie cardiac arrests0 -
Very interesting reading from someone who has no clue of how either service operates. Could anyone tell me what echo and delta calls are or where I could look it up? Thanks.
page 43 and onwards of this link explains it quite concisely
http://www.phecit.ie/Images/PHECC/Clinical%20Practice%20Guidelines/PHECC_Field_Guide_2011.pdf0 -
A centralised control room with access to all resources around Dublin with everything from DFB/ HSE AP’s to Community First Response programs on the one dispatch system seems to make sense for the patient.0
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