I’ve written about Victoria’s ambulance crisis before; sadly, and spectacularly, things are getting worse. Today’s Age reports that seven Victorians have died in the last three days from cardiac arrest, with delays of between 12 and 27 minutes before paramedics arrived on scene.
The response of the Napthine government to these deaths, like those of over fifty Victorians before them, has not been to take responsibility, to take action, or even to express concern – it’s been to blame the “hard-line, left-wing” Ambulance Employee’s Association, who represents 98.5% of Victorian paramedics. If I were a paramedic, I’d be hard-line, too – because, as was the case in our EBA, they see what’s happening on the ground, and they know what the results of wavering will be. Unions are their members, and they go in the direction the members vote for.
Blaming paramedics, and the union that represents them, is one thing. Tragically, it appears the families of those who died are being blamed, too:
Ambulance Victoria General Manager of Regional Services Tony Walker said the facts of each death were yet to be established, but a preliminary review suggested that several people were “clearly deceased” with no resuscitation started before triple-0 was called.
As anyone whose heart has stopped is ‘clearly deceased’ (as opposed to being beyond resuscitation), the first part of Mr Walker’s statement is meaningless; the second part implies that someone should have commenced resuscitation before calling triple-0. Let’s have a look at that.
When someone’s heart stops, the blood in their system is oxyenated – for the next few minutes their heart and brain are in no danger of long-term damage from anoxia (or oxygen depletion). As a first responder you have a little time – to move the patient into a position where they (and you) are out of danger, where you can safely access them (eg out of a chair and on to the floor), to call for help and unlock the front door.
I started my nursing career twenty-five years ago next month. I stopped counting resuscitations when I hit 200. Every year, as part of my mandatory requirements at work, I have education and assessment on basic adult cardiopulmonary resuscitation. After avoiding danger and checking for a response, when faced with an emergency you cannot resolve unaided, the first thing you do is call for help.
In a hospital that’s easy – there are emergency buzzers and qualified staff close by. In your home, at work, on the street? Not so much. And if you’re alone, if you don’t have a mobile phone on you or a land line close to hand, you have to leave the patient to find one – with adrenaline coursing through your system, making it harder to think, prioritise, and identify objects.
Mr Walker says Ambulance Victoria has an almost 50% success rate with shockable arrests (where the heart stops but still has electrical activity). That’s true, but it’s a success rate based on the previous response time. The longer the delay before a shock is delivered, the lower the likelihood of a response.
Even with defibrillation, CPR isn’t always effective – unlike TV, in real life we’re only successful around half the time, and that’s in hospitals, with fully-trained staff, equipment and drugs. The community rate is far lower. No doubt some of the over fifty people who’ve been victims of Victoria’s ambulance crisis would have been unable to be revived even if they’d arrested in a tertiary level hospital.
But that’s precisely why we need rapid response times – because every minute counts. Because having equipment that allows the circulating blood to carry more oxygen reduces the risk of brain and heart muscle damage. Because defibrillation can reverse a fatal heart rhythm, before there’s so much damage that there’s no electrical activity to shock. Because adrenaline makes the heart more receptive to restarting, and thus makes CPR more likely to succeed. Because the sooner the patient is attended by qualified experts the better their chances of survival.
Victoria’s category 1 response target used to be 8 minutes, in line with the international standard. And our paramedics had the best track record in Australia for survival of heart attack patients.
When response times started to lengthen, this government almost doubled Victoria’s target to 15 minutes. Delays because of unaddressed ramping – an issue flagged in both the nurses and midwives EBA and the still unresolved paramedics EBA – mean that target is still being surpassed. We don’t have statistics on just what the average response time for a category 1 call is, because Ambulance Victoria has stopped releasing them. All we have is reports from the paramedics whose hands are tied by a government unwilling to take responsibility, or action.
Emergency services don’t discriminate -it matters not a whit how much power or money you have, their response depends on proximity and availability. Any single one of us could need the expertise of the best-trained paramedics in the country, today. This really is an issue that affects every one of us.
I’m rarely a vengeful person, and I don’t wish ill-will on a third party, but I would dearly like Dr Napthine and/or Dr Davis (a vet and a chiropractor, respectively) to be faced with the situation hundreds of Victorians face every year – the sudden arrest of someone they care about, without support, waiting for an ambulance that (even if it arrives in the first five minutes) feels like it’s never going to come. Followed by a lifetime wondering – if I’d done something different, if the paramedics had been quicker, would the outcome have changed?
Over fifty Victorian families are asking themselves that. And our government, whose job is to safeguard the best interests of their electorates, is doing nothing.