Dublin Ambulance Shortage

dredre · 10-01-2009 9:39am #1

At 16.00h yesterday DFB control had 22 calls queued for ambulance work and 4 ambulances free to do the work due to 8 being held up at hospital. While the HSE have a fair number of ambulances on at that time also, it's fair to say that they too had their own workload and delays at hospital. I don't think the public realise how thinly emergency cover is spread in this country. It is not going to take a major incident to expose this.

Karoma · 10-01-2009 9:45am

Source?

tallaght01 · 10-01-2009 10:19am

It's pretty frustrating to see ambulances stuck in carparks waiting to unload patients, too. I've seen this in a few countries.

The other day here in Oz and adult rolled into the kids emergency department by mistake (as the do about once a week). He was pretty ill, so I stabilised him in our resus room. Then I rang ambo control to get someone to take him to adults emergency. The lady told me they were all waiting to unload their current patient in the adult emergency dept, so they had no one for me there and then.

I had to pile this guy into the back of one of those patient transport vehicles, with our mobile resus kit and the driver floored it around to the proper A+E.

When I arrived there, there were about 4 highly trained paramedic crews just standing int he reception area with people on trolleys, waiting to hand them over.

In Ireland, where the guys are really stretched to the limit, I often wonder if there's a way of streamlining things. I don't know the answer, as I'm not on the ground with the crews that often. The main potential for using our crews well lies in public education. In my experience, about 70% of what comes in by ambulance doesn't need to. Don't know of that's the same for adult cases, but parents call ambulances for their kids for all kinds of crazy reasons.

Number one is "when his temperature hit 39degrees I knew i had to call an ambulance straight away" !!!!:eek:

Celticfire · 10-01-2009 2:11pm

tallaght01 wrote: »

In Ireland, where the guys are really stretched to the limit, I often wonder if there's a way of streamlining things. I don't know the answer, as I'm not on the ground with the crews that often. The main potential for using our crews well lies in public education. In my experience, about 70% of what comes in by ambulance doesn't need to. Don't know of that's the same for adult cases, but parents call ambulances for their kids for all kinds of crazy reasons.

I'd say 70% and a few more don't need to come in by ambulance. It's a free ride that people mistakenly believe will pop them up to the front of the queue.

10-01-2009 2:46pm

One of the mates in DFB was saying on NYE they had the same problem,cases qued for a couple of hours and they had to keep sending motors out untill ambulances were available.

In comparison to other large irish cities how does dublin's cover fair?

Smokey Bear · 10-01-2009 3:44pm

This issue has been highlighted for a number of years now in the media.Nothing has been done by HSE or Goverment.
DFB put an extra ambulance into service in swords in 2007 the cost came out of there budget.
Even with the combined number of ambulances from HSE and DFB there is still not enough ambulances out there for Dublin area.There was an incident in December where ambulances had to respond from Co.Kildare to an incident in Tallaght this in turn led to a reduction in ambulance cover in Kildare.
Delays in A+E are a daily occurance for ambulance crews.
A lot of people who ring for an emergency ambulance do not need one some treat it like a taxi service other do not know that they can walk into A+E themselves ,I belive the public in general need to be reminded or educated as to what an emergency ambulance service is there for and when to call it.

Came across this letter on the inter net from HSE in relation to this topic from 2006 they appear to be strecthing the truth about the actual coverage of ambulances and a few of there facts are wrong what hope do we have if they dont even know what the actual coverage is!!!
http://213.94.192.205/en/FOIandPQs/PQs/November2006/November282006/FiletoUpload,4533,en.pdf

Links to some of the articles that appeared in the media over the last few years.

http://www.herald.ie/national-news/city-news/emergency-services-are-overstretched-1598041.html Hearld 10/01/09

http://www.independent.ie/national-news/ae-causes-new-shortage-of-ambulances-1564540.html indo 05/12/08

http://breakingnews.iol.ie/news/?c=ireland&jp=cweymhgbcwgb
02/07/06

http://www.rte.ie/news/2005/1011/ambulance.html 11/10/05

http://breakingnews.iol.ie/news/?c=ireland&jp=cwcwkfqlmhcw INDO 04/06/06

http://breakingnews.iol.ie/news/?c=ireland&jp=cwojaumhojoj
21/03/06

http://www.independent.ie/national-news/allout-war-ignites-over-ambulance-provision-131004.htmlIOL 20/09/05

Smokey Bear

tallaght01 · 10-01-2009 6:21pm

Celticfire wrote: »

It's a free ride that people mistakenly believe will pop them up to the front of the queue.

So so so true.

There's a little bit of me that gets a kick out of watching the not-particularly-unwell roll in the door on an ambulance stretcher, expecting to go straight through....the look on their faces when the triage nurse points them to the waiting room can be priceless :P

Tango Alpha 51 · 10-01-2009 6:59pm

eireal wrote: »

One of the mates in DFB was saying on NYE they had the same problem,cases qued for a couple of hours and they had to keep sending motors out untill ambulances were available.

In comparison to other large irish cities how does dublin's cover fair?

Coverage in other large irish cities is also brutal.

In Limerick there is 3 ambulances on days / 2 on nights (that's if you have full crews in). Not only do we cover the city but most of the county. Outer limits of our area would be Mitchelstown side of Angelsboro, up past Whitegate in East Clare & Ballyhea which is the Cork side of Charleville. We to get delayed in the Emergency Departments which is quite fustrating. Most of these outer markers are 1hr travelling times just to get there. You can see the picture I'm trying to paint here. The general public do really need to be educated as to what an Emergency Ambulance Service is there for.

Random · 10-01-2009 7:01pm

One of the mates in DFB was saying on NYE they had the same problem,cases qued for a couple of hours and they had to keep sending motors out untill ambulances were available.

By Motors you mean fire engines? Or do you mean those cars they have now?

Smokey Bear · 10-01-2009 7:38pm

Motors is the term used for Fire engines
The 2 DFB Estate cars you see in Dublin are for the Advanced Paramedics has it written on the back of them, rummour has it they are to be axed due budget restraints.
Talking about New years eve one PT waited so long for an ambulance they got a horse and cart to James A+E the picture I saw looked good out side A+E with ambulance parked beside it. I belive they were charged €100 for the trip!!

Smokey Bear

Elessar · 10-01-2009 7:57pm

It is my understanding that during mass casualty incidents the voluntary ambulance organisations are/can be called in to provide ambulance cover for the areas where statutory ambulances have been pulled from.

Could this not be applied to situations like the above? Or known heavy days like NYE/Holloween etc.

Don't mean to offend people (this subject can provoke angry reactions), just putting it out there. I know I would prefer a voluntary ambo (or private for that matter) rather than waiting an hour or two for a statutory if I needed one.

sdanseo · 10-01-2009 9:20pm

Elessar wrote: »

It is my understanding that during mass casualty incidents the voluntary ambulance organisations are/can be called in to provide ambulance cover for the areas where statutory ambulances have been pulled from.

Could this not be applied to situations like the above? Or known heavy days like NYE/Holloween etc.

Don't mean to offend people (this subject can provoke angry reactions), just putting it out there. I know I would prefer a voluntary ambo (or private for that matter) rather than waiting an hour or two for a statutory if I needed one.

That shouldn't need to happen though. The state should be buying enough ambulances. Preferably ones that don't spontaneously combust, too.

Smokey Bear · 10-01-2009 11:05pm

For major incident ambulances do appear from the HSE These ambulances are on Patient transport or transfers from one Hosp to another etc. they are released from tasked duty to respond to major incident take for example the incident in Dunlaoire
http://ie.youtube.com/watch?v=3VXE1ayvXp4&feature=related

Also for airport stand by or emergencys you tend to get a few HSE ambulances appearing to cover incident.
It would take a while to mobilse vols, it would be done in the worst case incident.

Smokey Bear

maglite · 10-01-2009 11:14pm

The vols cant be relied upon to have the level of equipment needed for 112 dispatch. Nor the training, knowlage etc. some of the vol ambulance arround are in a dire state. They would't be suitible for anything more than taxi runs. Unless a paramedic would be able to crew with his own equipment.

I could actually see their bring a case for solo docs and AP's going arround seeing someone and giving them the number of a taxi to get to hosp. do triage at scene and giving them an appointment for the AnE or outpts.

Paulzx · 10-01-2009 11:50pm

Queued cases are almost a daily occurence at this stage. It has become the norm. The simple fact of the matter is that there are not enough ambulances available to cover the existing workload. There are only two solutions to this problem

1. Provide more ambulances.

2. Cut down on the workload either by educating people not to ring an ambo for non emergencies or refusing to dispatch ambos to obvious bull**** non emergency calls.

1. Not going to happen. DFB provides the service under contract from the HSE. We are contracted to provide 11 ambos 24 hrs a day 365 days of the year. When Swords fire station went fulltime last year DFB with Dublin city council provided a twelfth ambo to work out of Swords fire station. No funding is provided by the HSE for this ambo. The dept of Health and the HSE refuse to accept there is a problem and will not provide money for an increased service. This seems to apply outside of Dublin also.

2. I've no idea how to educate people not to ring for an ambo. Someone that rings an ambo for a toothache or a sore toe is incapable of being educated as far as i'm concerned and obviously has the brainpower of a turd. As it stands our controllers are unable to refuse a request for an ambo when a 999 call is made so a response is always made.

Whats the solution? God knows. All i know is that we spend every day and night tearing round the city going from one call to the next. We have 3 year old ambos with over 200,000 miles on them and they never leave Dublin. They are just constantly on short journeys and don't stop.

In the current climate i don't think there will be much change

timmywex · 11-01-2009 12:49am

That hse letter is shocking, the numbers quoted in it are crazy!

TheNog · 11-01-2009 6:00am

I heard of one rta that happened in south meath and when an ambulance was called it came from drogheda. Thing is this ambulance was stationed in cavan!!!

AlekSmart · 11-01-2009 12:17pm

There`s a kind of comon thread running through many of the "Services" now.

It`s difficult to have a pint without being beside some economic minded type who sees great merit in "Cuttin the Public Service" etc etc ad nauseum...

Mind you this sentiment is encouraged by most of what passes for Financial Journalists and broadcasters in the country.

Now,of course,these folks never appear to pause for thought to reflect upon what IS the "Public Service" and what does it do for me (a là the Romans).

It appears therefore that in most peoples minds a society which has NO Ambulance Service,NO Fire Brigade,NO Police,NO Refuse Collection,NO Public Transport and NO Health Service will somehow or other suddenly bring our economic crisis to an end.

The cessation of these services and the dismissal of their staff will most certainly end a great financial burden on one arm of the State,whilst imposing a far greater one as the State then attempts to deal with Anarchy at it`s gates.

Yet those of us who work at the public service Front Line are only too well aware of where the B I G money is going and continues to go.

The Brendan Drumm`s,Kathleen Doyle`s and associated hangers on of the Civil Service world live in a uniquely protected and isolated compound with their peace only occassionally disturbed by the need to cast a message or two to their respective Minister in order to brief him/her about things which they SHOULD have known anyway.

Ireland has been uniquely shafted by a very small group of senior level executive types.
These people have shared a restricted educational gene pool and succeeded by attaching themselves to the hull of the nearest and most opportune political vessel.

Thus,whenever I have attended or watched the Great Set-Piece Political announcements about Health,Transport,Finance or whatever I tend to ignore those well-known faces sitting at the table and instead scan the faces of those semi-invisible earnest looking young folks standing behind the Political shoulder.

It`s quite amazing how over the years one sees those youthful faces age,the waistlines expand (consequent upon salary expansion) yet they remain firmly in place..standing out of the limelight as yet another Political Tool drawls through yet another pile of manifesto dirge...

Yet,in times such as now,it`s most certainly not the Prof Drumms or Kathleen Doyles whose positions are at risk....no sir...it`s easier to get rid of the footsoldier,the hewer of wood and drawer of water..the expendable.

The current situation within the Republic of Ireland is as serious as it gets.

Some observers are concerned at just what will happen when (not If) the Social Welfare system runs out of funds to maintain its customers at PRESENT levels...thats when the Public Order situation may well assume centre stage.

Are we prepared I wonder..???

11-01-2009 12:53pm

How many ambulances would hse generally have for pts duties during the day/night?

Under que'd cases/busy workloads ect are they being diverted from pts?

Also in other counties with less ambulance cover will a motor be made up to a case if there's no ambulance available or is that predominantly only in dublin?

Tango Alpha 51 · 11-01-2009 1:48pm

eireal wrote: »

How many ambulances would hse generally have for pts duties during the day/night?

Under que'd cases/busy workloads ect are they being diverted from pts?

Also in other counties with less ambulance cover will a motor be made up to a case if there's no ambulance available or is that predominantly only in dublin?

If your talking about HSE ambulances for outside Dublin, we don't seperate 999 from PTS we do both along with the Dr's/Urgent calls.

As Paulzx will tell you DFB is the only F&R service which supply motors when ambulances are not available. No where else in the country does this take place. I've pointed this out in other threads, it all comes down to budget. The local authority fire chief is not going to blow his/her budget by tasking thier staff/vehicles to respond to ambulance calls.

I know the original poster started this thread with the title Dublin Ambulance Shortage but the situation really does apply to the country as a whole

Tango Alpha 51 · 11-01-2009 1:53pm

Elessar wrote: »

It is my understanding that during mass casualty incidents the voluntary ambulance organisations are/can be called in to provide ambulance cover for the areas where statutory ambulances have been pulled from.

Could this not be applied to situations like the above? Or known heavy days like NYE/Holloween etc.

Don't mean to offend people (this subject can provoke angry reactions), just putting it out there. I know I would prefer a voluntary ambo (or private for that matter) rather than waiting an hour or two for a statutory if I needed one.

1) Vols ambos providing ambulance cover in the event of a major incident is not quite correct. They would be primarily tasked with taking pt's from the hospital to nursing homes etc to create bed space for whatever pt's we bring in aka PTS.

2) The level of training in the vols differs from org to org & indeed from unit to unit within the respective orgs. Until such time as the PHECC rectifies the matter & the training becomes standardised across the orgs, then i can't see how it would work

Tango Alpha 51 · 11-01-2009 2:03pm

timmywex wrote: »

That hse letter is shocking, the numbers quoted in it are crazy!

What letter???

timmywex · 11-01-2009 4:09pm

Smokey Bear wrote: »

Came across this letter on the inter net from HSE in relation to this topic from 2006 they appear to be strecthing the truth about the actual coverage of ambulances and a few of there facts are wrong what hope do we have if they dont even know what the actual coverage is!!!
http://213.94.192.205/en/FOIandPQs/PQs/November2006/November282006/FiletoUpload,4533,en.pdf

Smokey Bear

buzzman wrote: »

What letter???

The one linked in the quote box above

Paulzx · 11-01-2009 10:46pm

That letter is a disingenuis, corporate management, bull**** answer. There may well be 32 HSE ambos sitting in them stations. There is not however 32 crews on duty at the same time to actually man 32 999 ambos.

Stating the figure of 700 DFB paramedics is also bull**** as they are also obviously not all on duty at the same time.

To correctly answer the question about services available he should state the amount of ambos actually on the road available for calls not whats sitting locked up in stations or giving numbers of employees trained.

All the HSE ambo crews in Dublin would be delighted if they had 32 A and E ambos available 24 hrs a day. As a member of DFB i would also love to see this level of manning provided by the HSE.

Elessar · 11-01-2009 11:44pm

buzzman wrote: »

2) The level of training in the vols differs from org to org & indeed from unit to unit within the respective orgs. Until such time as the PHECC rectifies the matter & the training becomes standardised across the orgs, then i can't see how it would work

I agree absolutely. It is well known that PHECC want a minimum level of EMT on any ambulance in Ireland for any incident which requires transport of a patient in one. This is already happening and I know of at least one organisation which has begun training of it's personnel to NQEMT-EMT level. The rest I'm sure, will follow suit.

Ideally this would never be needed but given that extra ambulances, in current economic conditions, are not likely on any level that is really needed, why not use the services of other organisations on days where high volume calls are likely - just for the more minor of incidents, inc. PTS duties. Or providing the transport at times when only fire appliances are available to an incident.

Primarily it's about patient care - in other words, until the HSE gets its act together, Mrs. Jones should not have to wait hours lying on the floor after she broke her ankle and cant get up on Halloween night.

There are many well kept, equipped vol ambulances available throughout the country with practitioner level crews to man them, and there is no reason not to (at times) use that manpower until the Government actions a plan to give the country the level of emergency cover it needs.

The same case could be made in relation to the private companies but considering the union issues and the fact that they must be paid, I think the above would be less difficult. Again, this is simply an idea which should not be needed but the reality of the situation is far from ideal.

Paulzx · 11-01-2009 11:59pm

Elessar wrote: »

on days where high volume calls are likely - .

Contrary to popular belief this is not just Halloween and New Years Eve. Calls are being queued regulary throughout the week. No day or time of day is exempt from high call volumes. Fire engines are sitting babysitting cases on normal Tuesday afternoons due to no ambulances being available.

Tango Alpha 51 · 12-01-2009 5:29pm

Elessar wrote: »

I agree absolutely. It is well known that PHECC want a minimum level of EMT on any ambulance in Ireland for any incident which requires transport of a patient in one. This is already happening and I know of at least one organisation which has begun training of it's personnel to NQEMT-EMT level. The rest I'm sure, will follow suit.

Ideally this would never be needed but given that extra ambulances, in current economic conditions, are not likely on any level that is really needed, why not use the services of other organisations on days where high volume calls are likely - just for the more minor of incidents, inc. PTS duties. Or providing the transport at times when only fire appliances are available to an incident.

Primarily it's about patient care - in other words, until the HSE gets its act together, Mrs. Jones should not have to wait hours lying on the floor after she broke her ankle and cant get up on Halloween night.

There are many well kept, equipped vol ambulances available throughout the country with practitioner level crews to man them, and there is no reason not to (at times) use that manpower until the Government actions a plan to give the country the level of emergency cover it needs.

The same case could be made in relation to the private companies but considering the union issues and the fact that they must be paid, I think the above would be less difficult. Again, this is simply an idea which should not be needed but the reality of the situation is far from ideal.

As Paulzx has stated it's not just on Halloween or New Years Eve that the queuing of ambulances takes place. It happens all over the country on a daily basis. The idea of using the vols for a pts role etc has some merit but I would point out that how many vols can commit vehicles/volunteers on a daily basis. The HSE NAS management even on a local level would need commitments from the above & if they couldn't deliver, it would ultimately fall back on us.

dredre · 12-01-2009 7:29pm

I agree with almost all of the above. I know it is a regular occurrence, I just thought those figures were particularly bad ones. Source was the horse's mouth but I'm sure a freedom of information request would confirm them.

Regarding ambulances being held at Emergency Departments, if the patient didn't really require an ambulance, they will usually be directed to the waiting room so although the ambulance journey is unnecessary, at least the ambulance isn't held at the ED.

I agree that there should be more medical prioritisation of calls and certain callers should be told that they are not getting an ambulance. Of course they will probably just ring back and say they have chest pain! Perhaps a system like in parts of Australia would work - where you are charged a fee for the ambulance (I think it's $80 or so) alternatively you can pay a smaller yearly charge which exempts you from the fee. I know it doesn't seem right, but it might work?

On second thoughts no it wouldn't!!

The nub of the problem here is exit block in EDs. That is, admitted patients, who require a bed on a hospital ward but spend 2, 3 or 4 days in the ED waiting for one to become available. Frequently all ED cubicles and trollies are occupied with admitted patients, slowing down drastically the assessment of new ED patients.

Eru · 12-01-2009 7:31pm

Paulzx wrote: »

Contrary to popular belief this is not just Halloween and New Years Eve. Calls are being queued regulary throughout the week. No day or time of day is exempt from high call volumes. Fire engines are sitting babysitting cases on normal Tuesday afternoons due to no ambulances being available.

I can vouch for this. Had plenty of calls where I have been babysitting someone waiting for an ambulance or had a firetruck respond because theres no ambulance available. Its a joke and its going to get worse.

Paul, just how much of your calls are pointless ones? Prime example from my experience would be plain and simple drunks who arent sick but cant walk or talk and prisoners using "Im sick" as a get out of jail card. Both of which has increased because the government and Garda management are terrified of having someone sick and/or drunk in a cell.

This is also one area where the fines for S4 public order will really kick in.

Paulzx · 12-01-2009 11:10pm

Karlitosway1978 wrote: »

Paul, just how much of your calls are pointless ones? Prime example from my experience would be plain and simple drunks who arent sick but cant walk or talk and prisoners using "Im sick" as a get out of jail card. Both of which has increased because the government and Garda management are terrified of having someone sick and/or drunk in a cell.

Its hard to figure out what category calls fall into and how many are pointless. I can only do it by trying to figure out in my head the type of calls we go to.

Life or Death

e.g cardiac arrests, resp arrests, shootings, serious stabbings, od's, hangings, cot deaths, bad rta's etc.

Probably only 10% or less would fall into this category.

Definetly requires ambo but not quite as serious as previous

e.g M.I's, CVA's, Serious Seizures, Serious diabetic cases, Bad fractures etc.

Probably about 25% . Some of these would be life or death

Needs medical attention but doesn't require ambulance

e.g cuts that need stitches, sprains, unexplained long term mediacal probs, abdo pains etc.

Big percentage of cases fall into this category.

Minor illness medical att not really required

e.g Toothache, sore toe, vomiting, headache, piles ( believe me i've had all of these:rolleyes:)

Big percentage again

Cranks, Regular Customers, Loonies

e,g homeless, drunks, can't sleep, telly won't work can you fix it, etc.

Obviously there are loads of other calls apart from these but i'm just trying to give an idea.

Karlitos,

The drunks in the garda stns are a nuisance. Some of the Garda sgts can be idiots. You walk in the door and the first thing thats said to you is " this man needs to go to hospital". When you ask whats wrong your told he's drunk. When i inform the SGT he's not sick and shouldn't be in a hospital raising hell the oul sarge nearly collapses that someones answering him back.

I understand the reservations about keeping people in custody but its pure passing the buck. Yes, if someone is unconscious they require attention but i've taken walking, talking drunks out of Garda stations

Eru · 13-01-2009 12:19am

Paulzx wrote: »

I understand the reservations about keeping people in custody but its pure passing the buck. Yes, if someone is unconscious they require attention but i've taken walking, talking drunks out of Garda stations

Agree completely. The problem is and will be, lack of proper facilities for these people and ways to discourage them from wasting all our time.

Also, when your the Gaoler in charge of said drunk its like having a ticking bomb under your ass.

TheNog · 13-01-2009 1:32am

Paulzx wrote: »

Karlitos,

The drunks in the garda stns are a nuisance. Some of the Garda sgts can be idiots. You walk in the door and the first thing thats said to you is " this man needs to go to hospital". When you ask whats wrong your told he's drunk. When i inform the SGT he's not sick and shouldn't be in a hospital raising hell the oul sarge nearly collapses that someones answering him back.

I understand the reservations about keeping people in custody but its pure passing the buck. Yes, if someone is unconscious they require attention but i've taken walking, talking drunks out of Garda stations

I saw this happen once in my station, not on my unit thank christ cos it was embarrasing to say the least. Skipper had the goaler call for an ambulance just cos the drunken eejit in the cell couldnt be roused but it was clear the said drunk was snoring his head off.

Tbh when I get a really drunk person into the station I will not hold them. They will be charged and released. I make every effort to contact a relation or friend before release but if unsuccessful let them out onto the street again.

Karlitosway1978 wrote: »

Agree completely. The problem is and will be, lack of proper facilities for these people and ways to discourage them from wasting all our time.

Also, when your the Gaoler in charge of said drunk its like having a ticking bomb under your ass.

They are a ticking time bomb and a bomb I will not hold.

Before we even had our own little corner of boards.ie I realised from talking with EMTs about how stretched ye are but it wasnt well known within my station. I think from posters we have learned alot from each other and so hopefully spread a little of what we have learned around within our jobs.

Tango Alpha 51 · 13-01-2009 11:15am

Paulzx wrote: »

Its hard to figure out what category calls fall into and how many are pointless. I can only do it by trying to figure out in my head the type of calls we go to.

Life or Death

e.g cardiac arrests, resp arrests, shootings, serious stabbings, od's, hangings, cot deaths, bad rta's etc.

Probably only 10% or less would fall into this category.

Definetly requires ambo but not quite as serious as previous

e.g M.I's, CVA's, Serious Seizures, Serious diabetic cases, Bad fractures etc.

Probably about 25% . Some of these would be life or death

Needs medical attention but doesn't require ambulance

e.g cuts that need stitches, sprains, unexplained long term mediacal probs, abdo pains etc.

Big percentage of cases fall into this category.

Minor illness medical att not really required

e.g Toothache, sore toe, vomiting, headache, piles ( believe me i've had all of these:rolleyes:)

Big percentage again

Cranks, Regular Customers, Loonies

e,g homeless, drunks, can't sleep, telly won't work can you fix it, etc.

Obviously there are loads of other calls apart from these but i'm just trying to give an idea.

Karlitos,

The drunks in the garda stns are a nuisance. Some of the Garda sgts can be idiots. You walk in the door and the first thing thats said to you is " this man needs to go to hospital". When you ask whats wrong your told he's drunk. When i inform the SGT he's not sick and shouldn't be in a hospital raising hell the oul sarge nearly collapses that someones answering him back.

I understand the reservations about keeping people in custody but its pure passing the buck. Yes, if someone is unconscious they require attention but i've taken walking, talking drunks out of Garda stations

+ 1 !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

ps don't forget the Dubdoc, CareDoc, SouthDoc, ShannonDoc calls which also add additional pressure to us. How many times have we got dispatched to call from one of the above who have informed us that they are not attending the call but can diagnose "major" illnessess over the phone & when we arrive out there often after driving on lights & sirens we find out that the pt has had abdo pain (as an example) for the last 4 weeks. Hardly an acute condition.

Drunks in Garda cells can also be a problem from the point of view of tying up limited ambulance resources & hospital beds but I can see the point of view from the Garda in this matter as well though. After all, ye're not medically trained so if something went wrong with your "client" then all hell would break loose.

Paulzx · 13-01-2009 11:44am

Ahh!!!. The wonderfull GP diagnosis by phone. Its an amazing talent and should actually be used by the HSE instead of wasting more money on MRI scanners:rolleyes:.
The amount of times we arrive at a house and are told they rang the Gp. He just tells them to ring an ambo and most of the time its minor. A lot of gp's (not all ) are just not interested in the hassle of house calls. People are being told night and day not to attend A and E but to go to their Gp first. Someone seems to forgot to tell some of the Gp's this.

The other one that pisses me off is going to a call at a Gp's surgery when the Gp has rung an ambo. You go into the waiting room and ask the receptionist to be shown into the Gp's room. She then tells you there's no need as the patient is sitting on their own in the waiting room clutching a doctors letter. No handover from the doctor etc. If the person was fit enough to be plonked back in the waiting room by the Gp, without any medical supervision, surely they don't require a 999 ambo on lights and sirens.

As you can see a some of the problems within the system are caused by the medical proffessions themselves

TheNog · 13-01-2009 11:50am

buzzman wrote: »

+ 1 !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

ps don't forget the Dubdoc, CareDoc, SouthDoc, ShannonDoc calls which also add additional pressure to us. How many times have we got dispatched to call from one of the above who have informed us that they are not attending the call but can diagnose "major" illnessess over the phone & when we arrive out there often after driving on lights & sirens we find out that the pt has had abdo pain (as an example) for the last 4 weeks. Hardly an acute condition.

Paulzx wrote: »

Ahh!!!. The wonderfull GP diagnosis by phone. Its an amazing talent and should actually be used by the HSE instead of wasting more money on MRI scanners:rolleyes:.
The amount of times we arrive at a house and are told they rang the Gp. He just tells them to ring an ambo and most of the time its minor. A lot of gp's (not all ) are just not interested in the hassle of house calls. People are being told night and day not to attend A and E but to go to their Gp first. Someone seems to forgot to tell some of the Gp's this.

The other one that pisses me off is going to a call at a Gp's surgery when the Gp has rung an ambo. You go into the waiting room and ask the receptionist to be shown into the Gp's room. She then tells you there's no need as the patient is sitting on their own in the waiting room clutching a doctors letter. No handover from the doctor etc. If the person was fit enough to be plonked back in the waiting room by the Gp, without any medical supervision, surely they don't require a 999 ambo on lights and sirens.

As you can see a some of the problems within the system are caused by the medical proffessions themselves

Do ye never give the doc a telling off?

or are ye not allowed to?

If I was in that position I would find it very hard not to.

ScubaDave · 13-01-2009 12:58pm

TheNog wrote: »

Tbh when I get a really drunk person into the station I will not hold them. They will be charged and released. I make every effort to contact a relation or friend before release but if unsuccessful let them out onto the street again.

They are a ticking time bomb and a bomb I will not hold.

So, what if your ticking time bomb takes a nice walk out in front of a nearby motor.....

Im not condoning calling an ambulance (unless they are obviously in need of medical assistance), but really drunk people can not just be horsed out if relatives cant be found!

Bang Bang · 13-01-2009 1:38pm

Paulzx wrote: »

Ahh!!!. The wonderfull GP diagnosis by phone. Its an amazing talent and should actually be used by the HSE instead of wasting more money on MRI scanners:rolleyes:.
The amount of times we arrive at a house and are told they rang the Gp. He just tells them to ring an ambo and most of the time its minor. A lot of gp's (not all ) are just not interested in the hassle of house calls. People are being told night and day not to attend A and E but to go to their Gp first. Someone seems to forgot to tell some of the Gp's this.

The other one that pisses me off is going to a call at a Gp's surgery when the Gp has rung an ambo. You go into the waiting room and ask the receptionist to be shown into the Gp's room. She then tells you there's no need as the patient is sitting on their own in the waiting room clutching a doctors letter. No handover from the doctor etc. If the person was fit enough to be plonked back in the waiting room by the Gp, without any medical supervision, surely they don't require a 999 ambo on lights and sirens.

As you can see a some of the problems within the system are caused by the medical proffessions themselves

You've explained perfectly what many of our calls are about.
I always insist on speaking to the GP and getting a handover and I've no problem letting him know that he's wasting our time, if indeed he is.
Many of these GP's are the very callers who complain that they waited X amount of minutes for you to arrive, yet the call is the typical four week old abdo pain and the patient has a relative with them with transport

I believe we should educate the GP's first regarding wasting ambulance resourses, then educate the public.

Regarding the use of voluntary organisations. I seen it once when many of us dealt with the Kentstown bus crash. Both HSE and DFB responded from Dublin leaving the city short of vehicles. But the HSE only used the voluntary ambulances to convey immobile patients home from hospital, leaving the remaining HSE ambulance available for emergency and urgent calls along with the remaining DFB vehicles.

timmywex · 13-01-2009 10:32pm

If called out to one of these calls where the "injured" person can easily get a taxi or make their own way to hospital, can ye refuse to transport the patient and give the doctor a telling off?

met-man · 14-01-2009 4:03am

I had the joy of spending 9 hours in a&e today, the majority of which was spent waiting for an ambulance to transport my sectioned attempt suicide to a specialist unit.

The staff had initially, post treatment for an overdose, suggested that we transport a violent suicidal patient to a secure assessment unit 40 minutes away in the back of our police car, this failing to factor in the patients history back injury and chronic pain condition. Needless to say we politely declined and settled down for the long wait for ambo. Glorious.

TheNog · 14-01-2009 10:00am

ScubaDave wrote: »

So, what if your ticking time bomb takes a nice walk out in front of a nearby motor.....

Im not condoning calling an ambulance (unless they are obviously in need of medical assistance), but really drunk people can not just be horsed out if relatives cant be found!

Oh yes they can and I have and will continue to put these people out of my care. I dont have a crystal ball so cannot see if that person will walk out in front of a car but I'm certainly not going to babysit a person who drank themselves into a stupor. Thats there fault, not mine.

If the said person was being violent or aggressive I will of course hold them but not when they are simply drunk.

Paulzx · 14-01-2009 11:03am

The whole issue of personal responsabiliy seems to have gone out the window. If you get pissed out of your brains and inadvertently walk out in front of a car the blame is with yourself not the Gard who met you on the street and told you to go home ( children being an exception ).

I'm not saying that unconscious people should be left lying drunk in the street but you can't blame others for a situation you got yourself into.

Timmywex

We don't refuse to transport people if they insist on going to hospital

met-man · 14-01-2009 11:14am

The issue we have here is that if you happen across a drunk and incapable person we have a duty of care towards that person, not to mention the fact that they are committing the offence of 'being drunk in a public place' and being 'drunk and incapable'.

The reality is that custody sergeants do not want drunks in the bin, if they can avoid it, so often we are left to sort out other means to discharge our duty i.e organising public transport, a lift home, calling an ambulance etc. Ambo here are pretty good and know the score with this and will usually scoop them up for us and drop them at A&E (a place of safety) and everyone's a winner.

Example of how it can go wrong here? A chap I know encountered a very intoxicated female who gobbed off at him, he opted to play it nice, called an ambo, she promptly got into the ambo, urinated in the back of it then told them to get lost and declined medical aid. The chap I know didn't nick her but set her on her merry way. 2 hours later she got knocked down and killed, not far from where he had stop-checked her. He was subsequently investigated by DPS (Professional Standards) and a large investigation was carried out into his actions. I think the thrust of the DPS argument was that he had a power to arrest the female, but didn't use it, i.e neglect of duty and a girl was killed who might not have been.

TheNog · 14-01-2009 11:20am

Paulzx wrote: »

The whole issue of personal responsabiliy seems to have gone out the window. If you get pissed out of your brains and inadvertently walk out in front of a car the blame is with yourself not the Gard who met you on the street and told you to go home ( children being an exception ).

+1 to that

Paulzx wrote: »

I'm not saying that unconscious people should be left lying drunk in the street but you can't blame others for a situation you got yourself into.

Here in lies the problem. I have found people sprawled out on the street or footpath and I dont know if that person is just drunk beyond belief or if they are the victim of a hit and run. In all my cases the person was just drunk and I've been able to rouse them or passers-by have told me they just fell so there is no need for an ambulance.

But if I found that person on a quiet street and they could not be roused then I feel an ambulance is needed just to be sure.

Paulzx · 14-01-2009 2:54pm

met-man wrote: »

Ambo here are pretty good and know the score with this and will usually scoop them up for us and drop them at A&E (a place of safety) and everyone's a winner.

I completly disagree with your "everyones a winner" comment. Do you think the A and E staff are winners? Are the genuinley sick patients in A and E winners? Is the elderly lady in the corner who needs to be in the A and E a winner whilst she listens to some drunk muppet roaring and shouting.

You have said being drunk in a public place is an offence. It is not a medical condition. That means the correct place for that person is a cell if they have broken the law.

You speak of your duty of care. What about the duty of care for oneself? I drink along with plenty of other people but i never require an ambo or a squad car to bring me home. People need to cop on and act like adults

Paulzx · 14-01-2009 2:56pm

TheNog wrote: »

+1 to that

But if I found that person on a quiet street and they could not be roused then I feel an ambulance is needed just to be sure.

Absolutely the correct action

metman · 14-01-2009 3:11pm

Paulzx wrote: »

I completly disagree with your "everyones a winner" comment. Do you think the A and E staff are winners? Are the genuinley sick patients in A and E winners? Is the elderly lady in the corner who needs to be in the A and E a winner whilst she listens to some drunk muppet roaring and shouting.

You have said being drunk in a public place is an offence. It is not a medical condition. That means the correct place for that person is a cell if they have broken the law.

You speak of your duty of care. What about the duty of care for oneself? I drink along with plenty of other people but i never require an ambo or a squad car to bring me home. People need to cop on and act like adults

In an ideal world, people would take personal responsibility for their own actions, we would also have enough cell space to house every drunk, or every person who broke the law. In an ideal world we would have a system that isn't so afraid of litigation that instead of drunks being put in cells, they're picked up and dropped off at their home address or hospital. As you are more than fully aware, we're not living in such a plentiful eutopia. Instead we get by with the system thats in place.

As regards A&E and drunks being dropped off. My duty is discharged as is that of the ambulance crew by removing a vulnerable person to a place of safety. Whether their vulnerability is self-induced isn't really up for debate at the roadside. A&E make their assessment of the patient and more often than not, slot them into one of the drunk tanks, or discharge them. Them's the breaks.

Is the little old dear thats in A&E at 4am on a sunday morning a winner in these circumstances? No, of course not. That wasn't what I was referring to. Perhaps I should have said that the various duties are discharged and the powers that be are satisfied.

As for people copping on and behaving like adults, I won't be holding my breath.

Paulzx · 14-01-2009 3:28pm

Metman and met-man. I'm confused

Or am i just simple?

metman · 14-01-2009 3:38pm

LOL I had a

moment.....which has now been sorted. Hence the username change, and change-back.

TheNog · 14-01-2009 4:13pm

metman wrote: »

As regards A&E and drunks being dropped off. My duty is discharged as is that of the ambulance crew by removing a vulnerable person to a place of safety. Whether their vulnerability is self-induced isn't really up for debate at the roadside. A&E make their assessment of the patient and more often than not, slot them into one of the drunk tanks, or discharge them. Them's the breaks.

AFAIK hospitals here dont have drunk tanks nor should there be any imo. Drunk tanks are just like cells in a station.

If we did that here in Ireland what ye do, it would be considered "passing the buck".

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metman · 14-01-2009 4:20pm

Yep the buck is firmly passed here. Personally I don't see the problem in locking drunks up, if you get yourself into that state then tough luck. However the headsheds think different. The policy here stems from a fear of deaths in custody, and litigation, so police pass the buck to the heath service.

Like Paulzx, I'm fond of a pint or 15, but don't get myself into a state that I'm likely to wake up in a cell or a&e.

The term 'lions led by donkeys' is readily applicable to the British Police 'service'.

Paulzx · 14-01-2009 7:43pm

metman wrote: »

LOL I had a moment.....which has now been sorted. Hence the username change, and change-back.

Ahhhh!!!!. Its all become clear now.

Unfortunately the drunk tank in A and E here is the waiting room. Its not unusual to see drunks asleep on the floor in the waiting room. They used to have low stretchers here to lie the drunks on so they couldn't fall over but were made get rid of them

Dublin Ambulance Shortage

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