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Uthority Ambulance Service The Local Authority ambulance service. Item Type Report Authors Department of Finance. Operations Research Centre. Citation Department of Finance. Operations Research Centre. 1971. The Local Authority ambulance service.earch Centre.1971. Dublin: Department of Finance. Operations Research Centre. Publisher Department of Finance. Operations Research Centre. Download date 05/10/2021 10:51:38 Link to Item http://hdl.handle.net/10147/559269 Find this and similar works at - http://www.lenus.ie/hse THE LOCAL ~UTHORITY AMBULANCE SERVICE )Z .' • ••.• '\i . iJo . ~: ... .< Departmen t of Fi1U1nce OR Section May 1971 THE LOCAL AUTHORITY AMBULANCE SERVICE ., '. Department o{ Finance , , . OR Section May 1971 '\ ... - - , Contents Page I. Introduction I II. Summ ary and Main Recommendations 3 III. Tasks, perforrne~ by the Ambulance Service 4 IV. Statement of the Problem 6 V. Level of Service 9 VI. Method of Anproech 10 VII. Ch aracteristics of the Western Heal th Board Area 11 VIII. The Wadel 15 IX. Experiments 18 X. Interpretation of Results 23 XI. Sensitivity Analysis 28 XII. Control and Communication 29 XIII. Organisation and Staffing 34 XIV. Cost 38 :.xV. Transportation of Ambulant Patients 41 XVI. Further Ccnsiderations 43 XVII. Implementation 45 XVIII. Conclusion 46 Acknowledgements 47 Reference.s A:)pendices "'. ) .~ ". , ,, . ""-. - .." ~-- - ~-.~--.~ - .-----....-- ....... ~............. -~----~-- - I - A THE FITZGERALD -REPORT In November 1967, the Minister for Health appointed a Consultative Council to examine the general hospital service. Th e Counc il • s repo rV) known as "Th e Fi tzGerald Report", published in June 1968, recommended that facil Hies for acute care should be concentrated into a small number Qf· Regional and General Hospitals. The report noted that "the concentration of acute care hospital services into a small number of centres increases the importance of the ambulance service and makes it essential that it be brought to the highest level of efficiency." Accordingly, it recommended that the Minister establish an Ambulance Board to advise on the various medical and technical aspects of organising and operating an ambulance service. B HEALTH ACT, 1970 In parallel with the Consultative Council's study the Minister for Health in- , vestigated the administrative structure of the health service. The Heal th , .,:" Act, 1970, Was drawn up, under which eight Health Boards were established to . ~~, 1 replace the existing 27 Local Health Authorities. Each Board was given responsibility for an area encompassing two or more counties. These Boards took over effective a~inistration of the health service on 1 April 1971. , C AMBULANCE CONSULTATIVE COUNCIL "­ " In line with the recommendations of the Fitz~erald Report the Minister set up . a Consul tative Council on the Ambulance Service\in May 1969. This Council ....... - 2 - decided to undertake a detail ed study of the service with a view to making recommendations on any necessary reorganisation. In August 1969, the Council asked the Operational Research Section of the Department of Finance to assist them with the study. D TERMS OF REFERENCE FollQwing discussions with members of the Ambulance Consul tative Council and a preliminary evaluation of the contribution OR might be able to make to the study, it was agreed that a detailed investigation into the service in the area to be administered by the Western Health Board, that is, .Counties Galway, Mayo and Roscommon, should be carried out. I SpecificallY,the Council sought recommendations on the ambulance service re- quired to service the area to be administered by the Western Health Board. Two points in particular were stressed and were to be given special emphasis in the study. These were: 1 The main concern of the Minister for Heal th, and of the Council, was ·that any inadequacies in the performance of the ambulance service in dealing with emergency calls should be removed. 2 The Minister was anxious that public confidence in the capabilities of the ambulance service should remo~~ misgivings about the distance factor in relation to the concentration of acute hospi~al, services. In addition, the Council made it clear that any recommendations on the reorgan- "', isation of the ambulance service shouJd be based on the proposed reorganisation " '. of the three counties into one unit. under the Western Health Board. .' \ . \, - Other aspects of the service relating to vehicle 5pe~1fication and equipment would be studied by a special s~b-committee of the Council. These aspects 'of the service were not considered by the OR Section. _---". _ a . .- "" " - 3 - II SUMMARY AND MAIN RE~DATIONS A comprehensive analysis of the demand for ambulance service in Counties Galway, Mayo and Roscommon was made. The ' deployment of the ambulance fleet was studied and the ability of the existing system to meet the demand was measured. Using computer simulation techniques proposals for improving the service involving alternative numbers and deployments of ambulances were evaluated. A scheme which would ensure that 98% of all emergency cases would be reached by an ambulance within 30 minutes of the call being received was developed in detail. The ability of this scheme to cater for different demand patterns was anal ysed. Final I y the general management of the service was examined and recommendations made on organisation, staffing and control. The main recommendations are: 1 Ambulances should be distributed more uniformly throughout the area~ 2 Tne normal staffing of an ambulance should be altered from the present driver/ attendant and nurse to two driver/attendants. 3 A sufficient number of driver/attendants should be available to ensure that each ambulance is full~, staffed during its duty period. 4 All ambulances in the area should be under one operational control. , A preliminary analysis seems to indicate that a fleet of minibuses should be provided to transport ambul,ant patients;·" ~u. t further examination of this aspect of the problem is necessary. , .; '\ .. \ , · .' , 1.... .. ____• ••. - 4 - III l&§KS PERFOru~ED BY THE AMBULANCE SERVICE A PRIMARY TASK The primary task of an ambulance is to transport non-ambulant patients to hospital. These non-ambulant patients may be: 1 Emergency Ca~ Emergency cases include both medical and accident patients. A medical emergency would normally be so designated by a doctor. A person~l injury accident is, ipso facto, ,an emergency. 2 Non-emergency Stretcher Cases This category includes all patients who cannot or should not be transported by ordinary transport but who are not emergency cases. B SECONDARY TASKS Our investigations revealed that in addition to these primary tasks ambulances were also used for: I The transportation of non-urgent ambulant patients to and from hospitals and cl inics. 2 The transportation of groups of retarded children to and from special schools. ' \ .. 3 Miscellaneous work, such as the tran~portation of medical supplies, equipment and hospital personnel. '. - 5 - C ALTERNATIVE TASKS Or.iginally an ambulance was a mobile hospital and this aspect of the service is not obsolete. The equipment recommended for stretcher ambulance~~)and the trained nurse or attendant who travels with all non-ambulant Cases, can provide sophisticated aid at the scene of an emergency and during transportation to hospi tal. The "Heart" ambulances \\hich qpel'ate in Dublin and Belfast are a practical demonstration of this aspect of the service. The Consultative Council emphasised that the provision of an efficient emergency service was, in their opinion, the primary role of the ambulance service. In addition, it was important to provide an adequate l~v~l of se~/ice for non- emergency stretGher cases. It was primaril y to these two aspects of the service that the OR Section directed its attention. ". " ., " , , , . ,.. \ - 6 - IV SY AYEMENI OF IHE P ROBLEl:!1 A BAERGENCY CASES The ambulance service becomes involved in an emergency case when a request for an ambulance is received: involvement cea,ses when the patient is del ivered to hospital. Vfuen an emergency occurs a series of successive events takes place as fnJlowss 1 ~bulance is contacted Occasionally difficulty may be experienced in trying to contact the ambulance. This aspect of the problem would require a detailed study in itself and we shall refer to it later in Section XII .• 2 The ambulance leaves its base and travels to the scene of the emergency The time taken for the ambulance to reach the scene of the emergency depends on: (a) Where the ambulance happens to be relative to the scene of the emergency when the call is received, (b) Whether or not the ,ambulance is free to travel i,nmeqiatel y to the scene 'of the emergency, (c) The vehicle used. The vehicle specifications were examined separately as mentioned in Section I. , Assuming that all ambulances are equi?tped with radio, as 'is the case at present, factors ( a) and (b) are governed.'''essentiall y by: , ( i) The number of ambulances available .to ':"se~vice a given area, " ( i i) The way in which these ambulances are d,epl6yed throughou t the area • . --.. -" - 7 - The staffing of an -ambulance is an important factor ~ere. Generally an ambulance is staffed by a driver and a nurse. On a number of occasions we found that bystanders or neighbours had to come to the assistance of a driver to load a stretcher case into an ambulance. 4 ~~bulance transpotts the patient tO~~2i The time to transport a patient to hospital depends on: (a) The distance the patient is from the hospital. (b) The condition of the patient. Some Cases, for example spinal injuries, may require slow smooth transportation~ (c) The vehicle used. 5 The 2atient is admitted into the hospital In general, little delay is experienced here. The ability to radio ahead to alert the hospital to be ready to receive an emergency admission is often a big advant;;tge. B NON-EMERGENCY STRETCHER CASES When a request for an ambulance for a non-emergency stretc~er case is received a similar series of events take place.
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