Case of emergency

At 8.32am, just seconds after their morning briefing at the Wong Tai Sin ambulance depot, a three-man team jumps into a vehicle to start a 12-hour shift. Fortunately, their first call of the day is a relatively easy home-to-hospital transfer, not some stomach-churning car accident or suicide.

9.08am The ambulance - driven by Ah-man, and manned by team leader Ming and ambulance officer Kelvin, arrives at Queen Elizabeth Hospital. Ming hurries through his routine - queueing to register the admission, briefing nurses on the patient's condition, and recording arrival and departure times. Ming bumps into workmates from other teams, but there is rarely time to talk. Ah-man and Kelvin, meanwhile, rush to change bed sheets and sterilise equipment. The three have to finish everything, including a toilet break if needed, within 15 minutes.

10.05am Minutes after arriving back at the depot, they are called out to a Choi Hung Road market stall to pick up a man injured when a refrigerator fell on him.

11.00am They answer their third call of the day - transferring an elderly woman from a clinic to hospital. They already look stressed.

'There is no time for us to rest mentally or physically, to get ready for the next call,' says Kelvin, whose name, along with the rest of the team, has been changed on request.

Last month, fed up with their working conditions and heavy workload, Kelvin and Ah-man were among 500 off-duty ambulance workers who protested outside the Fire Services Department's (FSD) headquarters in Tsim Sha Tsui, and at the Legislative Council building, to demand an increase in manpower and a split from the FSD.

Workers say an increase in manpower is urgently needed, with the number of calls on the rise due to the city's ageing population, an increase in chronic disease cases, and a rise in the overall population. Official figures show emergency calls increased 19 per cent between 1999 and last year, while manpower increased from 2,119 to 2,192, a rise of 3 per cent.

Director of Fire Services Anthony Lam Chun-man told the South China Morning Post budget constraints made it difficult to increase manpower. But he added that increasing manpower was not the solution to the problem. 'Hong Kong's number of ambulance calls is one of the highest in the world. We should manage the demand rather than increase ambulance resources. Remember, one ambulance call costs the government over $1,400.'

Last month in Legco, the department tabled its controversial proposal to charge ambulance users, and grade the urgency of each call. It quickly came under fire from legislators, who said the moves would put lives at risk.

Unionist Lee Cheuk-yan, and ambulance workers, are worried the fee proposal will discourage people with real needs to call an ambulance, and may result in avoidable deaths.

While Mr Lam says the fee proposal is a long-term goal, he admits he has been lobbying legislators about the proposal to grade the urgency of calls. He says that once Legco approves it, the department will consult the public before implementing the plan.

Mr Lam says the proposal puts the arrival time for emergency calls at just under nine minutes (8.59); non-emergency calls would take between 20 and 50 minutes.

Mr Lee says ambulance workers are worried that members of the public will not be able to adequately assess an emergency situation and relay it on the phone, resulting in mistakes in qualifying the gravity of each case, delays and possible deaths.

The manpower shortage has already caused delays. Almost 20 per cent of calls are not responded to within the 12 minutes pledged by the department.

'There are times when, in the whole of Hong Kong, we have not got a single ambulance available,' an anonymous source from ambulance management told the Post. 'What happens if an accident happens?'

It is not known how many people have been affected, but even the department admits Hong Kong has one of the world's lowest survival rates for pre-hospital cardiac arrest. Only 1.25 people survive out of 100, compared with 6.4 in London; nine in Edmonton, Canada; and 11 in Austin, Texas.

Wat Ki-on, chairman for the Ambulance Men's Union, admits cases of negligence have occurred. 'The problem is alarming,' he says. 'People are so tired and under pressure and cannot concentrate, but our job requires critical decision-making. Some often inject people incorrectly, while others may skip risky procedures.'

The lack of resources, he says, is due to unfair treatment by the FSD towards the ambulance services, which came under its management and funding umbrella in the early 1950s. Figures show $2.2 billion is pumped annually into fire teams, while the ambulance services receive $800 million, despite the rising number of callouts.

Mr Lam denies he is being unfair and says the accusation is 'unfounded'. Despite there being few large fires in recent years, new firemen need to be hired continuously to prepare for potential big blazes and conduct fire-prevention work, he says.

A few years ago, Crow Maunsell Management Consultants, appointed by the government to review Hong Kong's ambulance services, strongly recommended the government increase manpower.

'More ambulance shifts and more ambulancemen are urgently required to cope with immediate needs. These must be secured as early as possible,' its 2001 report says.

The consultant urged the FSD to provide a further 39 ambulances and bring the total to 251 by 2003.

But the recommendation fell on deaf ears, and the FSD added just one vehicle for a total of 213.

Every day, ambulance workers see gruesome sights, from suicides to horrific accident scenes, and they are constantly on the move.

A 2004 mental health magazine's survey of 1,189 ambulance workers showed 37 per cent suffered from depression, with 20 per cent of cases classified as severe depression.

Veteran ambulanceman and union executive Tse Kwan-choi, 43, says he knows the cause of the problem.

'The pressure and workload are very big,' he says. 'From the start of work to the end, we have no time to relax. The calls come one after the other.'

Kelvin admits that with the immense pressure he can't concentrate at work. Like his colleagues, he can't spare 10 minutes for meals. Many times, he has no lunch at all.

12.15pm The ambulance team returns to Queen Elizabeth Hospital, this time with an elderly woman suffering from a slow heartbeat. Before Ming finishes the registration, the team is called out to Chuk Yuen. 'The computer showed the wrong information about us,' Ming says. 'The operators totally lost the information about this order and think we're available.'

A while ago, the global positioning system, installed last month, showed the team in Tsim Sha Tsui when they were in To Kwa Wan. Incidents like this often result in delays, Ming says.

12.50pm The men park their ambulance and hurry to the canteen for lunch. But 10 minutes later they get a call - to a police station to transfer an injured suspect to hospital.

2.00pm While the police take the handcuffed suspect to the toilet, Ming is busy with his registration routine. He has been doing this job for more than 20 years, and has watched the rise in demand from the FSD and the public. 'We are always shouted at for being late,' Ming says in the hospital emergency room. '[Patients] don't know it's because of our workload. We can't argue with them or they will complain about us.'

After another callout - a woman suffering heatstroke - they return to the station.

4.30pm Ming rushes into an office to file records, but is called out 20 minutes later. They transport a mentally ill patient to Kwai Chung Hospital.

7.00pm Back at the depot. A tired Ming, Ah-man and Kelvin are waiting in the office for calls with some other ambulancemen.

8.00pm Half an hour before they are due to finish work, they get called out to a Tze Ching Estate unit to take an elderly woman with a chronic disease to hospital.

9.00pm Back at the station.

The day ends at 9.30pm when they, along with dozens of workmates, head home - weary in mind and body.

Ah-man, who has been an ambulance worker for five years and takes home $15,000 a month, says even his sleep is disturbed. 'Sometimes before I sleep I think about the cases, and at times wake up in the middle of the night,' he says.

'I love this job, and the fact that I can help save lives, but I'm upset with the department.'

Many members of the public think it is not their problem but unionist Mr Wat says they are wrong. 'People are not aware that with their lives not being safeguarded, they are actually the victims.'

Additional reporting by Michael Wei