Do you really need an ambulance?

The humble apology from NSW Ambulance and the Health Minister, following the death of an 18-month boy from Tregear who slipped into cardiac arrest while waiting for an ambulance on September 9, was welcome. And although an overloaded system may not have contributed to this particular tragedy, demand remains the greatest problem affecting ambulance response times.

While people are quick to blame ambulance services when things go wrong, one of the biggest factors slowing down the system is the enormous number of inappropriate emergency calls placed by the public. And it is doubtful one will ever hear an apology from a patient who has phoned 000 for a mild case of food poisoning, man-flu or a broken fingernail.

During the recent bushfires in NSW, emergency calls for ambulances were the lowest they had been for a long time. Response times improved because more ambulances were available for critical emergencies. It is a phenomenon seen during previous major incidents, as people assume that ambulances must be too busy to attend less serious health complaints. As a result, people make their own way to hospital. Or they see their local doctor or wait at home and discover their symptoms miraculously resolve. This proves, to some extent, a difference between ”needing” an ambulance because there’s no other way, and ”wanting” one because the service is there.

Most people are unaware that even without natural disasters or major incidents ambulance services are under enormous pressure daily. And the majority of emergency calls are not for emergencies at all. If only callers had the same attitude to calling ambulances during normal weekdays as they do when they know there’s a disaster happening, demand would go down, response times improve and more lives would be saved.

Interestingly, ambulance services face less system abuse in rural areas. Why? Because, beyond the bush culture of stoicism, comes an awareness of the valuable resource that is the only ambulance in town. The community values and respects this and reserves using ambulances for only the most serious of illnesses and injuries.

In metropolitan environments people assume unlimited resources. But there is no such thing. Over the past 30 years there has not been a substantial increase in emergency ambulances in proportion to the population. Of course, there have been changes in service delivery, such as the establishment of a separate patient transport wing that frees up paramedic ambulances. But these measures are often only as effective as the public allows them to be.

There are many contributors to the problem of inappropriate emergency calls. General practitioners are not doing as many house visits as they once did, and many are unwilling to respond after hours. The public also know that ambulances are packed with high-tech diagnostic tools and medication that GPs don’t have. One assumption many people make is that they will be seen to quicker if they arrive at hospital by ambulance. This is not the way it works. All patients are coded by the same triage system. If your condition is considered low acuity, you are likely to end up in the waiting room where time to see a doctor may well exceed that of suburban medical centres.

NSW Ambulance does a remarkable job considering the demands placed on its limited resources. Occasionally a tragedy occurs which hopefully leads to an improvement in the system. In these moments it is easy to lay all responsibility on the ambulance service. But we, the public, are also responsible. Perhaps we should take another look at what we would call an ambulance for. We all have a role to play in improving the function of our emergency services and saving lives.

Published on 26/11/13 in the Sydney Morning Herald

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