Unprecedented staffing crisis forcing bosses to consider radical action, admits health chief
The ambulance staffing crisis could become so bad that paramedics will be unable to attend patients in cardiac arrest.
Dr Nigel Ruddell, the medical director of the Northern Ireland Ambulance Service (NIAS), said that with five Covid-19 cases detected every minute on Thursday, health bosses were being forced to consider radical action.
The 7,215 cases on Thursday was a 53% rise on the previous day’s total of 4,701. That is 300 new infections an hour on average, or five a minute.
UK daily Covid cases also reached another record high of 189,846.
Dr Ruddell said NIAS is dealing with severe staff shortages.
He said that the current average response time for cardiac arrest cases was between 13 and 14 minutes — almost twice the eight-minute target.
Dr Ruddell said it was “not uncommon” for stroke and heart attack patients to wait up to an hour for an ambulance.
As a result, some of these patients are being advised to make their own way to an accident and emergency department.
Dr Ruddell also warned the NIAS was triggering a special protocol designed to free up paramedics from lengthy handovers at hospital emergency departments “several times a day”.
According to official figures, 91% of the 256 people waiting in an accident and emergency department to be admitted to a ward on Thursday had been there for more than 12 hours.
Staff shortages in hospital wards and the community have resulted in spiralling waiting times in emergency departments, which in turn means paramedics having to endure long waits to hand over patients to other staff.
When the NIAS does not have any crews to attend high-priority calls, dispatchers can contact accident and emergency resuscitation units directly and ask them to urgently admit a patient from an ambulance.
Dr Ruddell said: “It’s something we’re having to do on a regular basis now, which wouldn’t have happened before.”
Apologising for the delays, he added staff shortages were the worst he had ever seen, resulting in the most difficult working conditions staff have ever experienced.
The NIAS is currently liaising with the PSNI and Fire and Rescue Service to bolster staff numbers and help improve average emergency response times.
An email sent to NIAS staff on Friday from the organisation’s silver command asked for “understanding and cooperation” as it introduces measures designed to address the crisis.
“It is proving very difficult to get rest breaks and to get you finished on time,” the message admitted.
“We recognise how frustrating this is for you, your families and for your patients, and it remains a cause of considerable concern for us.”
Among the proposed measures is a reduction in outpatient services to free up ambulance care attendants who transport patients to and from appointments and home from hospital.
Patient care services (PCS) staff would then be re-diverted to support paramedics and emergency medical technicians.
Bosses have also proposed “splitting PCS crews and accident and emergency crews to expand our capacity”.
Dr Ruddell said the measures, which could also include sending less qualified staff to medical emergencies such as cardiac arrests, may be required if staff absences continue to rise in the coming days.
“It’s something we would have to consider if it’s a choice between sending no one to a patient or sending someone who can begin treatment,” he added.
“It’s not where we would want to go. We’re always trying to maintain high clinical standards. We’re trying to ensure people get some response instead of no response at all.
“The pressure has been building significantly and will continue to build over the next couple of weeks.
“We’re busy every Christmas, but we’ve never seen anything like this before. None of us has seen staff shortages like this before.
“The combination of staff shortages and delays in handing over patients at the hospitals is seriously impacting on our response times.
“We have 1,400 staff in total and 220 are unavailable because they either have or they have been exposed to Covid, while about 150 staff are off through general sickness.
“This all means we’re not meeting our response targets, even for the most urgent of calls, and — we’re very upfront about this — it means there is a risk to patients.
“As a result, we’re taking the difficult decision to advise patients on a case-by-case basis to make their own way to hospital where it is safe for them to do so.
“If a patient has a stroke, it’s better for them to get to hospital themselves and begin treatment within 20 minutes than wait an hour for an ambulance.”