I noticed today that a government report has flagged up the stacking of ambulances at A&E as a problem. It has finally been admitted that this is a systemic failure. So I'm writing this as a note to my entry about eight minute deadlines and the use of cars instead of ambulances.
Stacking happens for two reasons. Firstly, in busy periods the A&E department cannot process the patients fast enough. There is not much that can be done about that since there is a finite number of people that hard pressed A&E staff can see and treat at one time, especially if the cases involve complex mechanical and medical trauma.
Secondly, the A&E is assessed on its ability to process patients within 4 hours of being booked in. So in busy periods, the obvious answer is not to book them in until they are more or less ready to see and treat them. Until the patient is booked in to the A&E, they are the responsibility of the ambulance staff. This adds to continuity of care but while the ambulance crew is waiting for A&E to accept the patient (i.e. when they pretty much know that they can meet their 4 hour target) the ambulance is not available to respond to other emergency calls.
There may be some argument that cars (discussed in my previous entry) allow crewed ambulances to be diverted to more serious incidents because the car drivers can not only hold the fort at real jobs but also filter out the rubbish ones that don't require A&E attendance. However, this isn't always the case. A car medic dealing with a serious incident is unlikely to get urgently required backup in time if there happens to be another category A job around the corner because their 8 minute deadline has been met and the dispatchers are under pressure not to miss the other deadline. Remember, once a medic is on scene, the clock has stopped and nobody seems to care what the outcome is. In other words, the use of targets can be detrimental to patient care, even to survival. It is a source of huge frustration for crews attending time wasters when they know a colleague is fighting to save a critically ill patient. It happens alot.
If we consider all these factors we can see that resources are really not available to respond to time critical emergencies in an effective manner. The replacement of 40% of ambulances with cars which cannot transport patients and the holding up of those remaining 60% at A&E for long periods means that transport to definitive care is bound to be delayed for other patients. The cost would be measured in lives, if anyone was measuring...
