Not all are waiting to admit patients
During a recent visit to Burnaby General Hospital it was noted that there were between five and eight ambulances parked at and adjacent to the Emergency Department. Some were there for what appeared to be lengthy periods of time. In light of recent reports of significant delays in ambulance responses to emergency calls, the Asian Journal inquired of Fraser Health if ambulances were being delayed at ERs while their crews waited to hand off patients to the hospitals.
Tasleem Juma, a spokesperson with Fraser Health, addressed those concerns and the protocols around ambulance/hospital interaction.
“On that day there were five ambulances which arrived in very close order, however, none experienced off load delays,” said Juma. “They were turned around within thirty minutes. None of the crews surpassed that target.”
She went on to explain that “there is a recognition by health authorities and province emergency health services that patients coming in via the ambulance service need to be handed off as quickly as possible, in order to get the paramedics back onto the street.”
A formal hand-off to the hospital is necessary with each patient arriving by ambulance, and until that is achieved, the paramedics must stay with the patient.
Currently, Juma said there is a regional working group that consists of the Province, the Health Authorities, and Emergency Health Services to look at how the service can be done better. She said there are currently a number of practices in place at different hospitals, rather than one common procedure to facilitate the handing off of patients.
“With the different hospitals (Regional and Community) across this system, each one looks at what works best for them, considering the emergency patient volume, the type of patients they’re getting, and how that works with the practices they’ve developed at their particular site,” said Juma. “At Burnaby, there is a dedicated nurse who works in the area where the ambulances off-load their patients, whereas at Royal Columbian, they have the ability to double up on Ambulance Crews (to supervise incoming patients), so if two ambulances come in with patients who are stable, one crew can supervise both patients releasing the other crew back into service.
Surrey Memorial does something similar to Burnaby with a Nurse working with the incoming ambulances.” She didn’t have details of procedures at all the hospitals in the authority but volunteered to provide those if requested.
She said that generally speaking there will be a nurse or paramedic at the ER dedicated to facilitating the off-loading of patients arriving by ambulance.
Looks can be deceiving
When large numbers of ambulances are observed at any given hospital, Juma said, it isn’t necessarily what it appears. She relayed a situation at Royal Columbian recently where there were ten ambulances on site at the same time.
“But it wasn’t an ER jam and it wasn’t a situation where Paramedics were tied up waiting to hand off patients,” she said. “Ambulances are also used to transport higher risk patients, such as cardiac patients to hospitals with specialty services such as a Cath Lab (catheterization laboratory).”
A cath lab is an examination room in a hospital or clinic with diagnostic imaging equipment used to visualize the arteries of the heart and the chambers of the heart. Not all hospitals have all these or other specialty facilities, so patients who need medical supervision, must be transported by ambulance to receive the test or treatment. The ambulance then waits until the services are performed and returns the patient back to the original hospital.
Adding to the picture of an ambulance jam is that crews may take their breaks at the hospital cafeteria before going back into service. She said that of the ten ambulances in the instance cited, two were from emergency calls, patient transport accounted for four and four were on break.
“They need to take their break somewhere and the hospital is a convenient central location for that,” she said.
Asked if anyone was monitoring the turn-around times, Juma said their target is to have the crews turned around in thirty minutes.
“We do track performance at the various emergency departments,” she said. “If we see those times creeping up, we investigate why and what can be done to reduce those times again. Obviously circumstances do occur where large numbers of casualties arrive at the same time, but that is the extraordinary situation.”
The Asian Journal will continue to follow the issues around Emergency Health Services.