Are we waiting for someone important to die?

Byline: Gwyn Pritchard

ON JULY 14, 1970, California Governor Ronald Reagan said he had no hesitation in passing the Wedsworth Townsend Act giving birth to Paramedics. In his opinion, no suffering human being should have to wait a long time and everyone was entitled to a much better standard of care from the closest available ambulance.

After pressure from Fire Service Unions, Governor Reagan was ready to reject this very same bill, so what made him change his mind? He was at home when his father suffered a severe episode of chest pain. Governor Reagan called for an ambulance believing it was a serious heart attack. Due to jurisdiction problems, distance with the driver going to pick up an attendant first, there was a delay of about an hour. When the ambulance got there his father was dead. They did not attempt to resuscitate as there was no cardiac equipment and, if there were, the driver and attendant wouldn't know how to use it.

Within a year, twenty US States were on board with paramedics. In a very short space in time, paramedics were everywhere. In the UK and Ireland, medical experts and cardiologists were also seeing a need for better cardiac care on ambulances with trial projects in Belfast and Brighton.

Interestingly at the same time, a hit American TV services called 'Emergency' with Johnny and Roy as Los Angeles County Paramedics became regular weekly viewing in the US.

Ambulance woes are not unique to Cyprus. Reaction to change has always been the same everywhere.

First, ambulance service directors must want change to happen. Some ambulance management executives seem comfortable and frightened of changes. They see a lack of support in the change process and prefer to stay as they are.

However, prominent physicians and University Medical Schools are recognising Emergency Services as a medical speciality for doctors. Politicians on the other hand, and some senior managers, have a narrow view of the ambulance service.

Second, financial implications of change blow the budget. In state annual health budgets, departments down the food chain like ambulance services have problems surviving let alone improving. Changing to a paramedic system needs capital injection but many assume it is cost prohibitive: using this as an excuse not to progress is a weak argument.

The academic and clinical training period for a paramedic is longer than one to become a police officer or fire fighter, yet in Cyprus there is very little public awareness of what they do.

Forty years ago, unless on contract, private services were not allowed to respond to 112 emergency incidents even if they were just a few metres away. It seems no one thought about the poor patients.

Cyprus has no paramedics except one private service in Paphos. Highly trained and well equipped, this service is not sent to 112 emergencies as it is considered 'private', even if the incident is just round the corner.

Today, paramedics and technicians are the accepted standard of care in all of the US, Canada, South Africa, Australia, the UK, Europe and many more countries. It is proven to be the best practice using internationally approved European Resuscitation Council protocols, American Heart Association cardiac protocols and international trauma protocols.

Paramedic ambulances use the best patient care equipment to comply with these standards. It's not perfect but it is continually improving. Why not Cyprus?

Paramedics can start treatments to unblock arteries in heart attacks, they can resuscitate and they are specially trained in trauma life support, adult and child life support and all kinds of cardiac emergencies. Additionally they are trained to take care of respiratory problems, allergy problems, pregnancy and delivery, burns and much more -- all this is on the way to hospital.

Sadly, in some countries there is a fixation on ambulance response times and very little on assessment and proper pre-hospital patient care. Sometimes response times are seen for the benefit of those in urban areas and people living in rural areas do so at their own risk.

Today in Karachi, Pakistan parts of India, Africa, South America the main ambulance service is a basic van with no equipment. Sometimes, if they are short-staffed, the patient will just lie in the back and the driver will be off to the hospital leaving the patient alone in the back. There is no pre-hospital care, no assessment, no care plan or treatment.

The European Community has expectations that real paramedics attend emergencies with the right equipment at the right time. People calling 112 expect to be told what to do by the Emergency Medical Operator while the ambulance is on its way. They expect to be treated according to standards with best medical practice and sue if they don't.

There is nothing more terrifying than a true emergency. A child having severe difficulty breathing or fitting, a loved family member in severe distress or an injury needing help is all very frightening. Most of us will never make an emergency call for an ambulance and we believe it will never happen to us. A minute's waiting seems to last forever and people feel totally helpless.

In Cyprus we need technician and paramedic education, training and certification, improvements in dispatching protocols, in equipment, in regulation and audit. There is a need to look at response times and medical treatment protocols.

There is a need to create a new career path for Cypriots wanting to be professional emergency medical personnel, all under the watchful eye of a forward thinking, physician led, State Emergency Medical Board.

It may be daunting but it's a very achievable goal in Cyprus. It's already been done all over the world. It takes a willingness to change on all levels, a driving force and acknowledgment that a system can do better by providing timely, professional pre hospital care.

Changes need funding but usually the stalling is in the politics not in the financing. Let's hope the Ministry of Health keeps its promise for a better Paramedic Ambulance Service for Cyprus and its many visitors. The Minister of Health is on the right track; lets get this done and let's not wait for someone important to die to make it happen.

n Gwyn Pritchard is an International Emergency and Medical Services Consultant living permanently in the Paphos area since 2008. He is currently working with EMS systems in Kuwait, Qatar, Dubai and Lithuania on improving ambulance systems. [e-mail]

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Copyright Cyprus Mail 2009

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