Para­medic won’t be enough

Dr Rob Kieboom has worked at sev­eral emer­gency de­part­ments and for five years at the Kenepuru A&M cen­tre. Be­low he out­lines his con­cerns about the plan to re­place the clinic’s overnight ser­vice with a rov­ing para­medic.

Kapi-Mana News - - OPINION -

Peo­ple who get sick overnight in the Porirua basin will be worse off un­der a pro

posal to close the Kenepuru Hospi­tal Ac­ci­dent and Med­i­cal (A&M) cen­tre overnight.

De­spite a Cap­i­tal & Coast health slo­gan to de­liver health­care ‘‘bet­ter, sooner and in the right place’’, this pro­posal is be­ing driven by a de­sire to cut costs, in­clud­ing the amount lo­cal health care providers, in­clud

ing GPs, con­trib­ute to pro- vid­ing an overnight ser­vice for pa­tients.

This is not an at­tempt to im­prove overnight med­i­cal care for the largest group of low so­cioe­co­nomic pa­tients in the Welling­ton area.

A sin­gle ve­hi­cle rov­ing para­medic ser­vice has been pro­posed to re­place the A&M’s overnight ser­vice.

This plan is to use ‘‘ ex­cess ca­pac­ity’’ in the Kapiti ur­gent overnight care model to re­quire its sin­gle para­medic to cover all GPlevel calls overnight from a pop­u­la­tion of 100,000 stretch­ing, from Kapiti through Porirua.

Pa­tients would no longer have di­rect ac­cess to a doc­tor via the A&M be­tween 10pm and 8am. In­stead they will phone a triage ser­vice that will try to as­sess the de­gree of ill­ness and de­ter­mine if and when they need to be seen.

The rov­ing para­medic will then be dis­patched (if avail­able) to see the pa­tient at their home.

Peo­ple could be wait­ing in line for hours to be seen be­cause the para­medic has three or four pa­tients al­ready on his/her list.

This is far from ideal and there are nu­mer­ous med­i­cal and moral is­sues of con­cern.

Am­bu­lance and para­medic staff are ded­i­cated and skilled pro­fes­sion­als but this pro­posal will sim­ply be un­able to de­liver a safe and timely ser­vice.

Most res­i­dents be­tween Plim­mer­ton and Tawa can ac­cess Kenepuru Hospi­tal A&M cen­tre in five to 10 min­utes’ drive.

Two ex­pe­ri­enced A&M nurses and a doc­tor are avail­able overnight for im­me­di­ate care if needed.

The pur­pose-built cen­tre is warm, safe, well equipped and well-staffed.

Be­tween May and Septem­ber this year an av­er­age of 18 pa­tients have gone there be­tween 10pm and 8am.

More than 90 per cent of these pa­tients were treated and sent home, with only about 9 per cent hav­ing to be re­ferred to Welling­ton Hospi­tal for fur­ther treat­ment or ad­mis­sion.

Pa­tients cov­ered by the rov­ing para­medic ser­vice may wait in line at home for po­ten­tially sev­eral hours to be seen. This is lu­di­crous, not to men­tion po­ten­tially dan­ger­ous.

A sig­nif­i­cant num­ber of pa­tients who present acutely to the A&M cen­tre overnight are Pa­cific Is­land in­fants and toddlers with fevers and res­pi­ra­tory dis­tress.

Quick and ex­pe­ri­enced as­sess­ment is needed to rule out such con­di­tions as menin­gi­tis and to treat po­ten­tially fatal res­pi­ra­tory con­di­tions such as bron­chi­oli­tis and asthma.

In­fants and young chil­dren can de­te­ri­o­rate ex­tremely quickly and de­lay of treat­ment of a few min­utes can some­times make the dif­fer­ence be­tween life and death.

Other con­di­tions need­ing ur­gent as­sess­ment in­clude chest pain and ab­dom­i­nal emer­gen­cies – such pa­tients can cur­rently be seen straight away at the A&M cen­tre.

It is med­i­cally dan­ger­ous to ex­pect these pa­tients to wait at home for a health pro­fes­sional po­ten­tially hours away.

The group propos­ing to close the A&M claim a ma­jor ben­e­fit would be fewer hospi­tal at­ten­dances and ad­mis­sions.

How­ever, a re­cent anal­y­sis of the Kapiti Ur­gent Care para­medic ser­vice by Otago Univer­sity re­vealed an as­ton­ish­ing 40 per cent of pa­tients were taken to Welling­ton Hospi­tal for fur­ther treat­ment. And these are not the acutely ill pa­tients that dial 111 for am­bu­lance ser­vice but ‘‘sec­ond tier’’ ill­nesses as­sessed over the phone as be­ing man­age­able in the pa­tient’s home.

Less than 10 per cent of pa­tients seen at Kenepuru A&M overnight are sent to the Welling­ton Hospi­tal emer­gency depart­ment, com­pared to 40 per cent by the Kapiti Ur­gent Care para­medic ser­vice. Forty per cent of Kapiti para­medic pa­tients thus re­quired a dual re­sponse from the para­medic and then the am­bu­lance ser­vice. This is a huge waste of re­sources not to men­tion the ex­pense.

Also of note is the para­medic ser­vice hardly ever sees sick young chil­dren, the most dif­fi­cult pa­tients to as­sess and treat. Add in the large num­bers of acutely ill in­fants and toddlers over win­ter as seen overnight by the A&M cen­tre and the para­medic re­fer­ral rate to hospi­tal over win­ter will prob­a­bly be over 50 per cent. The am­bu­lance will be un­able to cope with this de­mand and emer­gency depart­ment and hospi­tal ad­mis­sions will sky­rocket.

While the Kapiti overnight para­medic ser­vice is a great ben­e­fit for that dis­trict – which doesn’t have a pur­pose built A&M cen­tre on its doorstep – it is not a suit­able re­place­ment for the Kenepuru clinic

Many chil­dren take an hour or more of ob­ser­va­tion and treat­ment be­fore they can be sent home – and there can be three or four ar­rivals in the space of an hour in the mid­dle of the night to the A&M.

A lone para­medic sim­ply could not cover and treat these chil­dren in a safe and timely man­ner. Lack­ing the time and re­sources to prop­erly as­sess and treat these pa­tients, the para­medic will have to get the child taken to Welling­ton Hospi­tal ED by am­bu­lance, ty­ing up an­other valu­able over­worked re­source.

A par­ent in­vari­ably goes with the child and it may take a cou­ple of hours or more to be seen de­pend­ing on the sever­ity of the ill­ness.

Once treated trans­port is needed to get home – of­ten in­volv­ing the other par­ent driv­ing into

Welling­ton with the rest of the fam­ily, adding more cost, stress and in­con­ve­nience.

A med­i­cal is­sue that could have been dealt with in just over an hour could now take five or six hours through the night. Care­givers who have at­tended hospi­tal overnight may be too tired to work the next day, a cost to a low so­cio-eco­nomic group that has not been fac­tored into this pro­posal.

Lat­est talk is the group propos­ing the clo­sure may be back­track­ing on the pro­posal for a sin­gle para­medic re­place­ment. Hope­fully they’ve re­alised four or five rov­ing paramedics in sep­a­rate ve­hi­cles would be needed to pro­vide a rea­son­able al­ter­na­tive to Keneperu A&M overnight.

The Cap­i­tal & Coast health web­site pro­claims the im­por­tance af­ter hours of sick chil­dren un­der six get­ting ‘‘the right care, at the right time and in the right place’’. It ad­vises the Porirua pub­lic to go to A&M.

Why then, is it try­ing to limit af­ter-hours care to this pop­u­la­tion?

A lead­ing ad­vo­cate of the clo­sure pro­posal, Porirua GP Dr Larry Jor­dan is also on the web­site ad­vis­ing peo­ple to take their sick chil­dren to A&M overnight.

Look­ing to the fu­ture one can­not help but think that overnight clo­sure may well be the first step to 24-hour clo­sure of the Kenepuru A&M cen­tre.

Su­pe­rior op­tion: The Kenepuru Hospi­tal ac­ci­dent and med­i­cal clinic should not have its af­ter-hours ser­vice re­placed by house-call­ing paramedics, says ac­ci­dent and med­i­cal doc­tor Rob Kieboom.

Dr Rob Kieboom

Newspapers in English

Newspapers from New Zealand

© PressReader. All rights reserved.