Emergency case

PUBLISHED : Thursday, 16 July, 2009, 12:00am
UPDATED : Thursday, 16 July, 2009, 12:00am

Finally, the government is serious about introducing a new, three-tier ambulance dispatch system and has launched a four-month-long consultation after years of dithering. Officials know it will save lives, so why it took so long for a relatively simple initiative to get to the top of the policy queue is part of the mind-boggling mystery of Hong Kong's bureaucracy.

The current system provides a target response time of 12 minutes, and aims for a 92.5 per cent success rate on a next-in-queue basis. However, the system is based on a 'first-come, first served' basis that ignores those requiring priority. In the case of a stroke or heart attack, for example, getting medical help within the first 10 minutes dramatically increases the chance of survival or recovery, but the current system does not take this urgency into account. Thus, the system is a 'dumb' one that cannot recognise serious cases.

There is an alternative: 'smart' systems, such as those employed in about 20 jurisdictions around the world. This requires the person who receives the emergency call to ask a set series of simply framed questions, the answers to which enable the operator to categorise the degree of urgency. The questions are designed by medical professionals and the whole protocol is internationally recognised to enable a trained person to determine whether it is a top-priority case. If there is any doubt, an urgent dispatch call-out is implemented, to be on the safe side.

For instance, Toronto's response-time target for life-threatening emergencies is nine minutes in 90 per cent of cases. In London, the standard for the most critical emergency calls is 8 minutes in 75 per cent of cases. For non-acute calls, Toronto sets a target of 21 minutes for 90 per cent of these cases. London has not set a target for serious or life-threatening cases.

Here in Hong Kong, some legislators have expressed doubts about whether the protocol works or not. Evidence elsewhere is quite conclusive - it does work; it saves lives.

Under Hong Kong's proposed medical priority dispatch system, all emergency ambulance calls would be divided into three response modes: nine minutes for life-threatening cases, 12 minutes for urgent ones and 20 minutes for less-serious cases.

This seems reasonable. After the dispatch of an ambulance, the operator will stay on the line to provide first-aid advice to try to improve the patient's condition before the arrival of the ambulance crew. No doubt, many callers will find this comforting.

The recent cases of ambulances breaking down point to a separate problem. The mechanical problems have nothing to do with whether the dispatch protocol works or not. For a very rich city like Hong Kong, there is no reason not to invest adequately to ensure ambulances are in good working order.

According to the Fire Services Department - which operates our ambulances - the government has 70 new ambulances due to join the fleet from this month, lowering the average age of the fleet, while 147 new ambulances will be commissioned before the end of next year. By the start of 2012, Hong Kong will probably have one of the world's newest fleets, with an average age of less than two years.

Hong Kong will also need the manpower to operate this top-notch service. The Fire Services Department is hiring more staff to manage the new scheme. No doubt, the current system has been stretched by our rising population and a general hiring freeze within government during the Asian financial crisis when every department had to cut expenditure.

The new three-tier dispatch system will probably not be operational for another two to three years, meaning we will only have a better system by about 2012. Given that it can save lives, the government and legislators who approve the funding ought to give the highest priority to the roll out of this improved system. Hong Kong has already wasted a decade on this matter.

Christine Loh Kung-wai is chief executive of the think-tank Civic Exchange