Poor response times "killing patients"

[melclin]

Recently there have been a run of stories making the news about poor response times having negative effects on patients lately.

I know from having spoken to some of the people at the branches involved that there are mistakes in the news articles, so just be aware that all the details are not necessarily accurate.

To my knowledge this high profile case got the recent wave kicked off:

http://www.perthnow....c-1225811325666

followed by this:

http://www.heraldsun...x-1225811523632

and this and probably others:

http://www.heraldsun...x-1225811906644

To a certain extent I think you have to accept that if you live in the sticks, you just aren't going to get an ambulance when you click you fingers. Still, from what I've heard there are some pretty significant resourcing difficulties all over the service but especially in the rural sector.

Edited December 22, 2009 by melclin

[paramedicmike]

I think you'll find this article describing no link between patient outcome and response times interesting.

-be safe

[fireflymedic]

I think you'll find this article describing no link between patient outcome and response times interesting.

-be safe

I recently read that as well and was suprised myself with the outcome. I do believe there are handful of cases where it does make a significant difference (ie CVA, etc) if within the "window", but it presents a unique perspective. Especially when they emphasized that the ALS intervention is increasing survival, but lowering "successful" outcomes (patient is left with major defecits). Will be interesting to see how this may change things in the future and how it is changing things already with the larger emphasis on compressions, not breathing and putting less emphasis on intubation in ACLS. Interesting indeed.

[fireflymedic]

Damn! Triple post. How'd that happen?

Guess you wanted to beat it into their heads eh?

[Chief1C]

Gnomes

[melclin]

To be clear, I wasn't saying that poor response times are killing people. I was commenting that the old horse has been brought out for a little more flogging. Every now and then something like this happens and gets on the news and everyone crows 'response times', 'response time', "Wont someone please think of the CHILDREN', then someone orders an inquiry and some politician in a suit and a carefully chosen hard hat or reflective vest on a work site somewhere announces a new response time target which gets forced upon the service, ignoring more pressing issues.

[Chief1C]

To be clear, I wasn't saying that poor response times are killing people.

Poor response times "killing patients"

[JPINFV]

I think the issue with response time research is scale. Let's look at the differences in times gleaned from the studies discussed in the side column posted by Paramedicmike. The most easily comparable numbers was in the "unlikely survivor" (US) discussion with the "fast" response time being 3.5 minutes +/- 1.2 vs 5.9 +/- 4.3. First, it's worth mentioning that the US group is under the 5 minute mark that's discussed so much (I honestly don't know if it's from several studies or just one). This said, even still it's worth mentioning that the difference between the US group and the death group was an entire 2.4 minutes.

Now, sure, there are a handful of of conditions that are truly 'seconds count' time sensitive (cardiac arrest and respiratory arrest are the archetype examples). However, it's a fairly safe bet that most other conditions, including serious conditions like MIs, are not a 'seconds count' emergency. 2 minutes, in reality, isn't that much time. However, I will say that there comes a point where response times matter and it's most likely not what's being researched. Saying 'well, there wasn't a difference in outcomes between the 5 minute and 8 minute response time groups, therefore response times are meaningless' isn't very helpful and is probably giving the data too much credit. 5 minutes vs 8 minutes probably won't make a difference, but how about 5 minutes and 15? 5 minutes and 30? 10 minutes and 45? Sure, the vast number of emergency responses aren't going to fall into the 45 minute mark, however you still see a 23 minute first response and 38 minute transport unit response times. Trying to apply a study comparing a short response time (6 minutes) vs shorter (4 minutes) to a long time (23 minute or 38 minute) response time is not a valid application of the research data.

[stcommodore]

I think regardless of setting you have to set a bench mark. In the urban setting where system abuse is so rampant they are the root cause of most of the systems dysfunction. Our responce times in the urban setting would be to standard if people didn't call for "testicle pain and ear pain", "pediatric flu symptoms", "headache x3 days" these are all calls I frequently have.

[JPINFV]

To be fair, testicular pain can be a true emergency, and if the patient doesn't have anyone to drive them to the hospital that minute, then an ambulance ride is definitely appropriate. Exactly how good of a driver are you going to be when your junk feels like it's in a vice?