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Patients in cardiac or respiratory distress to visit the closest hospital

Ambulances responding to patients suffering from cardiac arrest or serious respiratory distress will go directly to the nearest hospitals in future, in accordance with recommendations from the Office of the Ombudsman.

The public watchdog released its recommendations on Thursday in response to complaints about a system under which "procedures" superseded emergent circumstances concerning the health of patients. The old rules defined 20 so-called "catchment" areas for local hospitals. Patients within those areas were required to be taken to the local catchment hospital. The system raised obvious concerns when it became evident that the catchment hospital might not be the closest emergency facility, putting patients at greater risk.

One example showed that an emergency trip protracted by 10 minutes because the responding ambulance was directed to take an emergency patient to a catchment hospital instead of to the nearest one.

The Ombudsman looked into 22 complaints over the past three years received by the Fire Services Department (FSD), which operates the city's ambulances. "We found examples on Hong Kong Island, in Kowloon as well as in the New Territories, which showed that the local area hospital was not the nearest hospital," the office said.

"There are concerns that the current fixed rule for ambulance men to take patients, even in critical condition, to area hospitals may lead to serious consequences because of delays caused by extended travel times."

The division of catchment areas was based on the scale, equipment and intake capacity of hospitals and were the main factors in determining where patients should be taken, according to the Hospital Authority (HA).

"Travel distance and travel time, or the local traffic conditions are neither the only nor the most important factors for consideration," the FSD said.

The only exception was for large scale accidents which would involve diversion to multiple hospitals, patients suffering from severe trauma who would be taken to hospitals with appropriate equipment or traffic diversions and road congestion.

The Ombudsman also called on the FSD to provide further frontline training for first responders to allow them to assess the severity of a patient's condition.

The FSD contends that if ambulance men were allowed to make their own judgment, it could give rise to complaints when human error becomes a factor.

The department said the current medical skills of frontline ambulance men would not ensure patients in critical condition would be quickly and accurately diagnosed.

The Ombudsman suggested the department err on the side of caution.

The FSD "could simply adopt the minimal risk approach and take the patient to the nearest hospital. Surely, that would do more good than harm," the office said.

The watchdog also noted only 4 percent of ambulance patients were found to be in a critical condition upon arrival, according to HA statistics, and that the rule revamp would not have a major impact on workloads and intake capacities.

The watchdog blasted the current regime for potentially causing several minutes' delay which could lead to "significant impacts on patients in critical condition".

As a compromise, the FSD and HA agreed to send patients in cardiac or respiratory distress to the closest hospital, while maintaining catchment area procedures for less serious patients.

The authority and department have agreed in principle to the recommendations and will conduct research, procedural changes and training ahead of implementation.

tim@chinadailyhk.com

(HK Edition 01/11/2013 page1)