An article in the press on 4 December 2014 highlighted the ongoing serious issue of problems with ambulance crews not reaching critically ill people in London within their target response times.
The target for response times is 8 minutes and the article shows that the data from the London Ambulance Service (LAS) reveals that response times in 7 London Boroughs in September 2014 to Category ‘A’ calls was within the targeted 8 minutes in less than 50% of cases. The article highlights that response rates to the most serious “life threatening” calls within “Category A” dropped from 81% in March 2014 to 64% in October, with July being the worst month at 61%. London is not the only ambulance Trust which has failed to reach its target, either.
There would appear to be a number of problems that may be accounting for these figures, including increasing pressure on the ambulance service, staff shortages and ambulance crews having to keep patients in the back of ambulances because A&E departments are full. The LAS treated 10,187 seriously ill and injured patients in the week commencing 24 November 2014, which was a 10% increase on last year and 4.5% greater than the LAS expected.
In one example, a cyclist that was hit by a car was left in the road for 90 minutes before an ambulance crew arrived.
The categories of ambulance responses are as follows:
Red 1: Respiratory/cardiac arrest: Response within 8 minutes, with preferably 2 paramedics attending
Red 2: All other life-threatening emergencies: Response within 8 minutes
Green 1: Blue lights and sirens: Response within 20 minutes
Green 2: Blue lights and sirens: Response within 30 minutes
Green 3: Telephone assessment within 20 minutes and response within 1 hour, without blue lights and sirens
Green 3: Telephone assessment within 60 minutes and response within 1 hour, without blue lights and sirens
The 2 Red category responses are national requirements, whereas the Green categories are recommendations. However, it is, of course, the Red categories that are of primary importance.
The NHS England statistics make interesting reading, too.
There are 11 ambulance Trusts across the country. The average proportion of Red 2 calls responded to within 8 minutes across the country for October 2014 was 69.8%. Most of the Trusts were between 70 and 75%, but London Ambulance Service was 57.5%. East of England Trust was only marginally better, at 62.6%.
Paradoxically, the percentage of patients surviving a cardiac arrest would appear to be on the increase, although there are many potential explanations for this, including the increased availability of defibrillators and bystanders trained both to use them and to administer effective cardiopulmonary resuscitation.
None of the above is really news: the slow ambulance response country-wide is now a perennial problem being identified in the NHS’s statistics and reported in the media, and there seems to be little, if any, sign of lasting improvement; if anything, the figures can be expected to worsen over the winter period.
It remains the case that timely emergency attendance by ambulance crews and paramedics to life-threatening situations is critical to ensuring the optimum outcome for patients, whichever part of the country they may live in. The failure by an ambulance crew to attend within the expected response time may, therefore, result in the possibility of a clinical negligence claim if harm has resulted from the delay.