Intuitively, it makes sense that ambulance response times matter. If you have been stabbed and are bleeding heavily, then clearly there is a window of opportunity for emergency services to get to you, stabilise your condition and bring you promptly to a hospital emergency department.
In the case of a road crash involving a life-threatening injury, again a prompt response within a specified time is a “must” if you are to survive. Doctors speak about a “golden hour” following major trauma – in effect the time medical staff have to maximise your chances of pulling through.
The relationship between response time and patient outcome is well documented, although most of the research relates to survival following cardiac arrest.
A 2011 study in the
British Medical Journal
found that just 2.6 per cent of patients with a cardiac arrest survived to hospital discharge. However, if paramedics had arrived on scene as the patient arrested, survival rates jumped to 14 per cent.
Researchers concluded the most important predictive factors for survival were response time, whether someone had witnessed the patient having the cardiac arrest and the type of heart rhythm disturbance they had when the paramedics arrived.
Tellingly, the study estimated that a person’s chances of survival improved by some 24 per cent for every one-minute reduction in response time. But the real gain was for people who collapsed, an ambulance was called and the crew arrived before the person progressed to cardiac arrest. Their chance of survival increased seven- fold. This suggests a more nuanced approach to ambulance response times is needed.
A Canadian study found a steep decline in survival rates in the first five minutes after a person suffered a cardiac arrest. Specifically the odds of survival decreased by 23 per cent for each additional minute’s delay in giving defibrillation (electric-shock therapy) to the patient.
In a 2010 report, the Health Information and Quality Authority, while acknowledging the role of response time indicators in driving improvements in the system, warned against their isolated use. It has recommended the focus should be on identifying clinical outcome indicators and using these to assess the performance of ambulance services here.
Whatever the parameter, a key aim must be for uniformity across the system. Because of geographic and demographic considerations, targets and outcomes have to be different in rural and urban areas. However, each must have reasonable, scientifically determined quality targets. The current wide regional variation in response times is not acceptable.
The HSE uses a system that affords top priority to a person in respiratory or cardiac arrest (echo call) and to those who report any other life-threatening condition (delta). It has a target that 70 per cent of echo and delta calls must have a first responder on the scene in eight minutes and a fully equipped ambulance must arrive within 19 minutes. These targets are not currently being met.
People in rural Ireland are most exposed by the failings in our ambulance system.
Response times in the west and northwest are especially poor. Figures for January 2012 show just 28.6 per cent of echo calls had an ambulance on the scene within the target time in both regions.
It means a high percentage of victims with a life -threatening condition simply never had a chance.