How can my ambulance service triage patients better? | Hacker News Reader

How can my ambulance service triage patients better?

3 pointsnordita4 comments

I work as a Paramedic for a large regional ambulance service in the UK. Too many of the calls we attend to with blue lights are not emergencies. This is a problem because it puts genuine emergencies at risk due to long waits and degrades staff morale. The long waits are a national crisis. Yesterday I attended to someone on the floor for 5+hrs before we picked her up.

There are many factors to this but I would like to identify the issue of defensive medicine. Defensive medicine refers to the practice of recommending a diagnostic test or medical treatment that is not necessarily the best option for the patient, but mainly serves to protect the clinicians.

I believe this is happening with out national medical advice line '111'. It is a common held belief amongst my colleagues that '111' is too risk adverse.

It's a long shot asking HN but can one implement a smarter triage system? One that filters out the junk so ambulances are kept for real emergencies.

Implementing a smarter triage system is probably feasible, but it's mosr likely not going to be magicked up from random internet strangers replying to an Ask HN post.

You might look at things happening in Rwanda, such as drone delivery of blood to cut wastage and save time, and other parts of Africa for inspiration on how to begin to solve this.

I vaguely recall seeing an article about a different project in Africa solving the medical record keeping issue in the face of very spotty internet service with medical staff visiting villages and the like.

I think the only solution is to have the triage process rely less on people strictly following conservative decision trees or clinical algorithms, and more on experienced clinicians who are prepared to use their judgement and assume some individual risk.

(e.g., GPs have told me that GP-led telephone triage can in some cases be cheaper than nurse-led triage for Out of Hours calls, because the GPs can use their greater experience to be less conservative)

Unfortunately this requires having enough such clinicians available...

How about charging £500 per visit?

But not everyone can afford that... so give everyone £500, which they can use for an ambulance, or anything else they feel they need.

A market is often the best way to allocate resources, and any non-market approach will have weird incentives as you describe.

So preventable deaths for low-income people increase dramatically as they spend their £500 on fuel, rent or booze instead of surviving the heart attack they didn't know they were going to have, and then put off calling the ambulance because they're unable to provide payment details.

On the plus side, rich people get rapid, efficient ambulance service whenever they dislocate a finger or feel a bit nauseous. I'm not sure that was the solution to the triage problem the OP was looking for though.

When you have objective metrics like survivability to assess performance against which trump individuals' personal tastes, a market is almost always laughably inadequate.

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