THIS IS AN AUTO-TRANSLATED VERSION OF THE ARTICLE PUBLISHED IN NORWEGIAN.

Loss of inter-municipal emergency services and negative consequences for the simple patient

Unfortunately, there appears to be a - which we believe to be a frightening tendency - to remove local emergency services outside the district in favor of centralizing emergency services, preferably in connection with a hospital.

This tendency will probably result in temporary savings for the municipality, but what will the socio-economic consequence be?

Unfortunately, we could not find studies that researched the difference in mortality (or permanent mortality) in patients in an area where resources in the primary healthcare service (such as ambulances) were removed.

We therefore have to content ourselves with some factual information which we will go into in more detail. Since our background is primarily pre-hospital, and since the first aider will most often have his first meeting with the ambulance service, we will shed light on the problem from the ambulance's side:

The coverage at ambulance stations as well as the number of cars and staffing (day car / 24-hour car) is based on a calculation. It is based on NOU-1998 (yes, it is 15 years old) which states that 90% of the population in cities/towns must be reached within 8 minutes, and 90% of the population in areas surrounded by pigs within 25 minutes.

Already the old figures from the investigation showed that EN municipality did not meet the requirements in response time, i.e. ambulance to patient ( Steen-Hansen & Folkestad, Legeforeningen, 2001 ).

Figures from Statistics Norway show at the time of writing a population of 380,973 citizens in Hedmark and Oppland. This population is looked after by 52 ambulances in operation at Sykehuset Innlandet HF. Of the 57,066 registered assignments in 2013, 13,656 were emergency assignments (blue light) and 27,797 urgent assignments. Source SSB .

It must be taken into account that these ambulances are also used for transfers from emergency room to hospital, nursing home to hospital (and back) as well as other transport tasks. This means that the car is not always available for this population.

The number of assignments has risen sharply in recent years for reasons that we will not go into in detail here. This means that to a much lesser extent than before, paramedics sit at the station waiting for assignments, but are often on the move throughout much of the shift.

A disappearance of the local emergency room (which is part of the primary health care service) will greatly increase the burden on the simple ambulance: the ambulance will now be much longer busy transporting the patient to the emergency room, which is now suddenly several municipalities away. If the patient is not to be admitted to the hospital, the transport back will be additional: Remember that in most cases the patient must be assessed by a doctor, which we will return to.

Discontinuation of the emergency room will not lead to an increase in the number of ambulances in the district!

At the same time, just as many people become ill and injured, and a local resource to deal with these disappears.

This means that emergency assignments cannot be processed as quickly. The nearest available resource is now, on average, further away from the patient or busy with other assignments (remember no increase in the number of ambulances).

The response time is thus increased considerably.

Based on national and international studies in cardiac arrest, the patient's chance of survival decreases by 10% per minute without proper CPR and/or early defibrillation. (SOURCE)

Some may object that in many cases an ambulance will not arrive within the first 10 minutes anyway. And that is correct, but if there is a lack of more resources in the area, this time will surely be increased.

Other examples: Heart attack 6 hours, stroke 2 hours to permanent damage.

There are, however, other agencies that take on health tasks as a secondary task: Eg. fire brigade equipped with defibrillators. The firefighters do an excellent job of keeping up to date and are available for such missions. Nevertheless, this is not a core task of the fire service, and many BVs are on standby duty.

At the same time, BV cannot decide whether we can treat the patient further for reversible causes (for professionals think "4H, 4T") or transport the patient during ongoing CPR. Air ambulance, which would naturally be required as an available resource, is a resource that will therefore be burdened to an even greater extent.

The danger of private individuals "playing ambulance" and driving bad patients themselves will increase. Who should expect an upbeat person to sit at home with their loved ones and wait for an ambulance far too far away while time ticks away but surely gone: This leads to increased risk in traffic (high stress level in the driver and "daring driving") and that a deterioration of the patient's situation presents additional challenges (think deterioration in the patient who requires immediate measures in a road ditch, in an unknown place).

Our recommendation is always that relatives stay at home with the patient (unless it has been agreed with AMK) and wait for the ambulance.

However, it will be difficult to disagree with this recommendation when it comes to serious injuries and illnesses, such as e.g. internal bleeding (child who fell off a bicycle) or major allergic reactions (anaphylactic shock requiring adrenaline), which require prompt attention by a qualified healthcare professional (who may be over 1/2 hour away).

The concept of triage also comes into play here : Triage is a prioritization of the order in which patients are treated. We have to triage when we have fewer available resources than patients. Triage is usually reserved for large incidents where we have a logistical problem getting enough healthcare personnel to the scene of the accident. However, triage can also take place at AMK and will ultimately lead to certain patients having to be de-prioritised.

Ultimately, we say : We must not spread unfounded anxiety! AMK makes use of a set of regulations (medical index) which aims to prevent patients from "falling through the cracks". As an initial guide, the index is invaluable. However, it falls short when it comes to further assessment of conditions that require supervision by a doctor. And that applies to the vast majority of patients who end up at the emergency room: These will now be transported to a greater extent by ambulance to the "next" emergency room, where they will then be examined. As the ambulance is further away, the transport time will increase. These transports are not critical, so the driving time takes as long as a normal car trip. Nor can the ambulance drive an emergency call (idle) back to its own station in the district. If you are unlucky then the car will be at the other end of the municipality, or not available at all.

Politicians surely have their well-considered reasons for deciding that an emergency room should be closed for good. It is not our task at Rohrmüller Medical to question this, but we are concerned that people should survive, as well as manage on their own until qualified help arrives. If people are to survive longer, knowledge must be increased beyond the current requirements for first aid training.

Many first aid courses are based on the assumption that we have access to an ambulance at all times. If you look at the chain of measures in the Norwegian First Aid Council's recommendations (Gyldendal academic, First Aid Handbook), it turns out that most first aid algorithms end in " call 113, wait for an ambulance ". And how could it be different? - A first aider is not a healthcare professional, and naturally has limited medical knowledge and equipment available.

Therefore, learn qualified first aid. We offer courses that go far beyond "normal" first aid courses. We are not satisfied with having satisfied a minimum requirement or given you only an entertaining experience with a powerpoint presentation and a course certificate (however, our courses are fun and you GET a course certificate)!