Response time targets not being hit by emergency services

By David O’Farrell and Amy Connaughton

The average response time for National Ambulance Services is under 19 minutes, according to figures released under the Freedom of Information Act.

The calls are split into two separate categories, echo and delta. Echo calls are in response to patients suffering from a life-threatening emergency such as uncontrolled bleeding or finding it difficult to breath. Delta calls are calls from patients suffering from other non-life-threatening emergencies such as a pulled muscle or a minor cut.

The response times are split into the four quarters of the year and can be seen in the graph below .

The best response time on echo calls was recorded in quarter two, from April to June, where North Leinster had an 85.7% on time response. The outliers were the Western Area with 75.3% and the South with 74.3% response times. Meanwhile, the best response time on delta calls was recorded in quarter three, from July to September, where North Leinster once again came out on top at 64%, while the Southern area at 56.1% and the Western area at 61.6% performed the worst.

On the other hand, the worst response time to echo calls occurred in the first quarter of the year, from January to March, where North Leinster performed best with an 82.4% on time response.

The Western area at 58% was the outlier. The poorest response times to delta calls also happened in the first quarter with the Western Area and Southern Area performing poorly with a 53.8% on time response, while North Leinster performed best yet again with a 57.8% on time response.

The average response time to life threatening calls in Dublin is 12 minutes and 41 seconds. spoke to Clare O’Byrne, Media and Stakeholder Relations Manager for the Health Information and Quality Authority (HIQA), regarding the response times: “HIQA has conducted two comprehensive reviews of pre-hospital emergency care over the past number of years, one in 2014 and another follow-up review in 2017.

“As part of these reviews, a number of recommendations were made to improve services, including measures to improve efficiency within the service to improve response times.”

She went on to talk about how response times could be improved: “It should be noted that response times are not the only measure of service quality and safety, and HIQA also recommended that the service act to better define and measure other parameters to assure itself around the quality of care provided.

“Furthermore, parallel to this work by HIQA, the HSE commissioned a review of capacity needs, which identified deficits in ambulance resourcing levels. HIQA is aware that some, but not all, necessary resources have been provided to the ambulance service to address these deficits”.

It was interesting to compare ambulance response times in Ireland to those abroad. For example, Reuters found out that in America, responders arrived on the scene of emergencies 7.9 minutes after the call was placed on average. In England, the National Health Service set out new timeframes for emergency services to arrive on the scene after a call is placed; their calls are split into four categories.

Category one calls are life-threatening calls; services expect to be on the scene in seven minutes on average and respond to 90% of category one calls within 15 minutes. Category two calls are emergency calls that require immediate assistance and/or transportation. They are expected to respond to these calls in 18 minutes on average and 90% of category two calls within 40 minutes.

Category three calls are described as urgent calls and are usually when people need pain relief. They are expected to respond to 90% of these calls within two hours. Finally, there are category four calls which are non-urgent situations but require assessment and potentially transportation. They are expected to respond to 90% of those within three hours.

Amanda Kenny, Press Officer for the Health Service Executive (HSE) also noted that ambulance response times, while helpful for performance measurement, do not provide a comprehensive picture of modern ambulance service performance if solely relied upon. 

“It’s not uncommon to wait over an hour with a patient when we could be back out answering calls”

She said: “Response time performance is being globally reviewed in terms of whether it is the only appropriate measure of patient care. While rapid deployment and timely arrival are accepted, patient outcome indicators are being viewed as a more appropriate measure of patient care and experience.”

Regarding improving response times, she said: “The National Ambulance Service has recently established a clinical hub to implement the Hear and Treat alternative care pathway for low acuity calls that don’t require the dispatch of an emergency ambulance.”

A Dublin paramedic, who wishes to remain anonymous, has said that to improve response times there should be less time spent waiting in emergency departments to hand over the care of a patient. He said: “Lack of capacity and staffing in emergency departments results in ambulance crews waiting to handover a patient. This means that it’s not uncommon to wait over an hour with a patient when we could be back out answering calls.”

This paramedic also suggested that there should be less time spent on non-emergency calls and with patients that can be cared for at home: “A greater number of GP’s are required, particularly in rural areas, who could commence care of a patient at home where appropriate. This would avoid further hospital overcrowding and ambulance callouts. 

“This also requires a greater number of community nurses to continue the prescribed care plan and assess progress. There is a community paramedic programme in motion that is aimed at filling this void.”

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