Hong Kong’s ambulance services are busier than ever, but abuse of the facility can prove costly to people in genuine need
- Fire Services Department Ambulance stands to receive 744,600 calls this year, up 22 per cent from a decade ago
- Statistics show 2 per cent of calls are for non-emergency cases, but paramedics say the real number is much higher
Veteran paramedic Li Wai-keung recalls the time his crew was called out to a bus terminus at Deep Water Bay. “There were four teenagers and one of them said he had an upset stomach, so after assessing his condition, we put him in the ambulance to take him to hospital,” says the former principal ambulance man.
“But before I could even get into the vehicle, his three friends climbed in.”
According to protocol, only one family member or friend is allowed to accompany a patient in an ambulance.
“When I told them only one of them could be in the vehicle with their friend, they got annoyed, but two of them got out. Then, just minutes after we drove off, we heard a second emergency call over the radio from the same location in Deep Water Bay,” Li says.
“The teenagers must have been calling the two emergency ambulances for free rides into town to save time queuing for a bus.”
After arriving at the hospital with Li and his ambulance crew, the teenager declared he was fine without being seen by a doctor, and left unassisted.
This is not the only bizarre case rescue crews in Hong Kong have encountered. According to staff members, some Hongkongers think that incidents ranging from things as minor as breaking a fingernail to missing a bowel movement merit the attention of the city’s emergency services.
“These cases might sound unusual, but they’re not as uncommon as you’d think,” says Lee Wai-hau, chairman of the Hong Kong Fire Services Department Ambulancemen’s Union.
Local demand for urgent service has continued to increase over the past decade, with the department seeing a steady rise in the number of emergency ambulance call-outs. Last year, it received 734,310 such calls, up 22 per cent from a decade ago.
In 2018, the department expects to receive 744,600 calls – or an average of 2,040 per day.
But official statistics show that not all of those who are calling need emergency help. Last year, the department analysed 10,000 randomly selected cases and found that about 2 per cent of cases had no obvious need of emergency ambulance services. However, there are no penalties for abuse.
“As service providers, we empathise that people sometimes have misunderstandings – and we can’t penalise them for that,” says superintendent Suki Ng Yuen-yan from the department’s Community Emergency Preparedness Division.
Hong Kong has significantly less emergency ambulance misuse than Singapore or Japan. In 2017, nearly half of all callers in Japan were said to have only minor illnesses or injuries, whereas in Singapore, non-emergency calls accounted for around 6 per cent of all emergency medical service calls. The situation here even seems to be improving: in 2009, one call in 10 was non-urgent.
But frontline emergency ambulance workers the Post spoke to say that the numbers are in reality much higher.
Li, 56, who retired two years ago, claims at least half the patients he saw did not actually need emergency service.
“I believe more than half of the calls we received every day were from people who, if they had second thoughts, would have realised they didn’t need emergency assistance after all,” he says.
“Our services might be free, fast and personalised, but when people take advantage of it, this can seriously affect those in need.”
Meanwhile, Lee from the union says he is concerned that public misconceptions of what constitutes a medical emergency might affect people who actually require urgent help.
The 40-year-old joined the department more than two decades ago and is currently serving as a senior ambulance man.
Given the complexity and wide range of traumas or medical conditions, the department has no specific guidelines on what should or should not be considered an emergency. However, it does list several examples on its website, including the loss of consciousness, stroke, heart disease, and asthma.
“Some of the obvious signs are convulsions, shortness of breath, chest pain, fractures, severe bleeding, anaphylaxis, and choking, or if there’s been a major traffic accident,” says Ng.
“Of course, if a person is really in doubt and worried that the patient’s situation may deteriorate rapidly before reaching medical help, they should seek help from paramedics.”
A misunderstood service
The city has 276 ambulances on standby in the day, and 145 at night, with eight additional short day shifts on weekdays. Paramedics work 12-hour shifts, encountering about 10 patients a day on average.
Each ambulance is manned by three staff members who provide treatment and care to patients before they get to the accident and emergency (A&E) department at the designated hospital.
“We bring to the scene many of the critical treatments which were previously only provided at A&E departments hospital to our patients,” superintendent Ng says.
“Sometimes a patient or their family might not understand why the ambulance crew spend more time at the scene instead of driving straight to the hospital. But it’s only because we’re doing what we believe is beneficial for the patient by checking their medical history, assessing their condition and treating them on the spot.”
Senior ambulance man Lee says it is important for the public to recognise that ambulances are more than just a form of emergency transport.
“Occasionally, I would get callers who wouldn’t let us into their homes to assess their conditions. The moment we got to their residences, they would just head out the door, straight for the wheelchair we’ve prepared for them – with their belongings – and tell us they’re ready to go,” he says.
Ng says the public should also be aware that patients who arrive at the A&E department by ambulance are not given priority over patients.
“Unless the patient is in a critical condition and has to be sent to the resuscitation room upon arrival, all ambulance patients are triaged like everyone else,” she explains.
Former principal ambulance man Li says that, because of this common misunderstanding, he has encountered a number of disgruntled patients.
“I suspect some patients dial for emergency medical assistance because they think it’ll give them priority over everyone else at the A&E,” he suggests.
“When I joined the force 35 years ago, people wouldn’t really call an ambulance because they thought it would be bad karma,” says Li.
“But they gradually became more aware of the services available to them, and it was sometime in the late 1980s when we really started getting calls from people who weren’t necessarily in emergency situations.”
The department says these non-urgent calls could cost lives.
“Whenever an ambulance responds to a call-out, it becomes unavailable to the next caller. That means an ambulance from further away might have to be summoned,” Ng says.
“In a critical situation, it might be the difference between life and death. Using emergency ambulance services properly means more ambulances will be readily available for people who really need our help.”
Li recalls attending to someone in Cheung Chau who habitually requested emergency ambulance services, each time saying she was feeling unwell.
“That day, she was waiting for us downstairs, as usual. A couple of minutes after we got there, we received another call to assist a man who had just hanged himself,” he says.
Cheung Chau having only one ambulance, Li and his crew had to take the woman to hospital first before they could attend to the next patient. By then, 30 minutes had passed.
“The woman lived only five minutes from the hospital. I couldn’t help but tell her, ‘You heard the radio, someone hanged himself, but here we are serving you,” Li recalls reprimanding the woman.
“Obviously, by the time we got there, he was dead. We mightn’t have been able to save him, but we could have at least tried.”
Li admits he was out of line for scolding the woman, but he also noted that it was the last time he and his colleagues were called out by her.
It’s Anyone’s call
Manpower in the department has grown steadily to 2,840 active staff, up 17 per cent from a decade ago.
“The fact we’ve been consistently meeting our goal of reaching 92.5 per cent of our destinations within the target response time of 12 minutes is a good indication that we have enough manpower,” Ng says.
Overall, the department is satisfied with growing awareness of the city’s emergency services, but Li insists nuisance users who abuse call-outs should be weeded out.
“It can take more than 12 minutes when you have to travel to another district to cover for unavailable ambulances there,” he says. “I loved my job, but, sometimes I couldn’t help but feel disappointed in people who were so oblivious to the potential consequences of their actions.”
Ng says the department campaigns to promote the proper use of emergency ambulance services in schools and road shows have drawn a positive response from the public.
A few weeks ago, the Fire Services Department introduced Anyone, a mascot that went viral online sparking thousands of mixed reactions from internet users. Anyone dished out safety tips and advice in a quirky way, including how to put out fires or give emergency first aid, the department told the Post it plans to incorporate elements of Anyone into future campaigns promoting the responsible use of emergency ambulance services.
“We hope that, with more education and communication, we’ll be able to address these misunderstandings,” Ng says.