On a cold, damp, winter night in the small settlement of Kaitangata, South Otago, Dormer was seriously ill. A diabetic, she had chronic heart and lung disorders. She had chest pains and difficulty breathing and her temperature and oxygen level had actually sunk low. At the door of her home she needed to disconnect her home-oxygen machine making the trip to the ambulance on the street and no portable oxygen bottle was supplied. As the 81kg Dormer was strapped into a chair with small wheels, she stated to her child: “Sherrill, I’m going to die.” Sherrill Clayton-Reed, and the ambulance officer struggled to move the chair across the lawn and it tipped over. The officer righted it and the pair aimed to manhandle Dormer into the ambulance, but she collapsed, unconscious, taking the officer to the ground with her. The officer yanked on his patient’s pyjama pants but they ripped. Dormer was strapped back into the chair and raised into the ambulance, placed on a stretcher and given oxygen. The officer thought about seeking additional assistance on this, his second call of the night to Dormer’s house, but chose it was more crucial to get her to medical facility; he evaluated that if the local fire brigade turned out, it would delay him by a minimum of eight minutes. He evaluated Dormer and sped to the hospital/medical centre around 13km away in Balclutha, with Clayton-Reed in the back. Dormer passed away in the ambulance. That remained in June 2013. Today, 53-year-old Clayton-Reed, a grandmother, is still getting sorrow therapy and suffering frightening flashbacks. She thinks concerns over her mother’s care have not been effectively responded to, in spite of investigations by the St John ambulance service and Deputy Health and Impairment Commissioner (HDC) Theo Baker. She can’t fathom why her mom had not been taken to healthcare facility after her first ambulance call-out of the night, around 2am, when the ambulance officer was accompanied by a volunteer. Baker’s report indicate a miscommunication between the Balclutha center doctor, who did not decline admission but did so in a way that was translated as a rejection by the ambulance officer. The tragic events have shone a light on the single-crewing of ambulances, a practice St John states is hazardous and ought to be eliminated, but is sadly inescapable sometimes since of a shortage of funding and staff. St John’s single-crewing rate overall has decreased from 14 per-cent of emergency situation responses in 2008-09, to around 10 per-cent in 2014-15. However, it is more common in rural areas. In Dormer’s case single-crewing may have been preventable, although this is contested. The ambulance officer, whose name the Herald has decided not to release, gave up on attempting to awaken his volunteer associate from bed for the 4.04 am second call-out, an omission which assisted earn a rebuke from Baker, who found his failings breached the code of patients’ rights. The officer told the Weekend Herald he was not permitted to talk to media. First Union national ambulance co-ordinator Neil Chapman thinks the HDC investigation is treating the officer unfairly. “They are blaming him for not dragging the volunteer out of bed. You could not go and break down the door. There was nobody to send out.” Baker says that following the 2nd call-out, the officer drove around 950m from the Balclutha station to pick up the volunteer from his home. He knocked on the back door repeatedly, but finding no response, he went to Kaitangata alone. The volunteer woke to check the call on his pager, but it showed the same details as the earlier task, an error no-one had the ability to describe but considered “highly irregular” in St John’s examination. Believing a defective pager system, he went back to rest. The paid officer claims he called the ambulance communication centre and said he was responding single-crewed, but Baker says there is no record of this on the centre’s audio files. Clayton-Reed is irritated by the officer’s failure to discover an assistant, saying he ought to have called the Kaitangata Volunteer Fire Brigade. “There’s a man lives three homes up the road. As quickly as that alarm goes off, they would have had to boil down the hill past Mum’s house. They would have known it was medical and stopped.” How might double-crewing might have helped? “They could have got her out to the ambulance a lot quicker.” She thinks that if the very first ambulance call out had got her to medical facility or if the 2nd had 2 team, her mom would have made it through. “We thought she had a chest infection. All she desired was antibiotics. I should have put her in the car and taken her myself. I’m experiencing it all the time and I have major sense of guilt for her loss … I’m [speaking out] just trying to conserve other individuals from heartbreak.” St John will not discuss Baker’s report with the Weekend Herald because it does not call any of the celebrations. In the names-included version of the report, gotten by the newspaper, Baker says St John told her investigation that there was at the time a “basic understanding” among personnel that if single-crewing may be unsafe, “back-up ought to be requested”. “St John noted that [the officer] knew resources readily available, such as the New Zealand Fire Service, but he might not offer a satisfactory rationale for not requiring that assistance.” … [the officer] told HDC that when there is no volunteer, ambulance officers are exposed to an issue because St John back-up is 28km away, and a volunteer station with volunteers most likely asleep at 4am ‘is truly no option either’.” His union representative told the examination that ambulance officers never call the Fire Service, which is a call made by the ambulance interaction centre. In this case, “comms never ever came back and requested for back up. Nor did the officer ask … We acknowledge interaction in between officers and comms could be improved …” Even if the officer had asked the communication centre to summon the fire brigade, it would have taken eight minutes for firefighters to show up, by which time the ambulance was on its way to the health center. “The best outcome of [firefighter participation] would have been a driver offered,” the union official stated. “We note fire officers can just drive an ambulance at typical roadway speed.” The failings found in Dormer’s case have resulted in some weather changes by St John. The Balclutha station, when separated from oversight, was made more visible to St John local management. And the internal investigation stated volunteers must be “actively urged” to work their shifts from their station. But the union is not satisfied. Chapman states Baker missed out on the essential issue: “to enhance pre-hospital services we need to update to fully-crewed ambulances in backwoods”. St John president Peter Bradley openly acknowledges single-crewing of emergency ambulances can be high-risk for clients and personnel and he desires the practice halted. He calculates this would need an additional 350 paid officers, at an expense of $21 million a year. “We are committed to stopping single-crewing in emergency situation ambulances by 2018 and we are currently waiting for the outcome of a financing evaluation prior to commenting further.” Last year when speaking of the “many thousands” of single-crew reactions to emergency situation occurrences and his commitment to end this, he stated: “We are looking for assistance from the Federal government to assist with this.” Partner Health Minister Peter Dunne did not answer Herald concerns on the acceptability of single crewing, stating “the Government is aware” of the problem, officials are speaking to St John about ways to address it, and a financing review is being led by Murray Horn. Dunne’s workplace noted the Government had moneyed extra paramedics in 2009 to assist minimize single-crewing. Horn, a previous Treasury chief and former lender, wouldn’t comment on whether his draft report, which is with the Accident Compensation Corporation and the Ministry of Health – the main funders of ambulance services – may end single-crewing. “I don’t wish to state anything that’s going to bias their evaluation of the [draft report]” The ministry – which anticipates the testimonial’s result will be made public by mid-year – and ACC offer around 70 per cent of St John and Wellington Free Ambulance’s funding. The rest originates from district health boards, sponsorship, donations, community fundraising, profits from business activities and, for St John, from patient part-charges for medical emergency ambulance trips. Single-crewing was a vital problem in the 2008 ambulance services query by MPs on Parliament’s health committee, which reported that in some locations 70 per cent of emergency situation responses were single-crewed. They recommended double-crewing within 4 years in city areas but were reluctant to have a two-crew demand troubled rural areas for fear that this might lead to solo trained officers being avoided from going to emergencies. St John’s single-crew response rate for emergency occurrences has improved to around 10 percent general and 21 percent in backwoods. In many cases the solo-crew car is followed by one with a full complement. During 2014/15, St John included 158 frontline staff, which the organisation says allowed it to lower the number of incidents gone to by a single-crewed ambulance by 10,000. The organisation acknowledges that continued single-crewing might be costing lives. An audit last year discovered that at 15 per cent, the survival rate of St John’s cardiac arrest clients at medical facility discharge was 5 portion points worse than for the Wellington Free Ambulance service. Running in Wellington and Wairarapa, the Wellington Free service totally teams its emergency ambulance responses. “Our provisional heart information highly recommends survival is decreased if the first showing up ambulance is single-crewed,” St John’s medical director, Dr Tony Smith, told the Herald when the report was released. “That’s no surprise as there are a number of things that need to be done in the first minutes, consisting of CPR.” How come Wellington Free can fully crew all its emergency ambulance responses? “It’s a combination of things,” says chief executive Diana Crossan. “Our geographical area is much smaller with less rural pockets than St John’s, making double crewing a bit less of a difficulty for us. We’ve made double crewing a concern for our service because we know it’s the best thing for the client, and for our crew. We can only do it by constantly weighing up the pros and cons about where to invest our funding – for example we have actually recently put our dedication to double crewing ahead of moving to electronic patient reporting. Volunteers are a core part of our operation – we’re extremely lucky to have medically-trained volunteers who go out on the roadway with a qualified paramedic.” Nowadays if you collapse from a cardiovascular disease you have actually got a likelihood a firemen will do the CPR, under a sharing contract in between the Fire Service and St John. In 2014/15, firemens participated in more than 9000 medical emergency situation call-outs nationally under contracts with ambulance services, in some cases arriving initially. The Fire Service’s 2000 paid and 8000 volunteer firefighters at more than 400 stations – St John’s ambulance workers number around 1600 on pay and 2900 volunteers – can be called as “co-responders” to patients suffering a heart or respiratory arrest. Too, 56 Fire Service brigades mainly in rural and remote areas are trained as “First Responders”. “They can, for instance, offer adrenalin for allergy under the guidance of the St John clinical desk,” states Auckland-Northland Area Fire Leader Paul Turner. “All around the world fire rates [in buildings] are going down. We still have to have the Fire Service there to do that work, but it means we have that capacity to do our medical work.” “The main advantage [of heart and breathing co-response, most of the medical call-outs] is 4 firemens doing CPR, air passage and defibrillator. They rotate individuals doing CPR, which enhances performance, frees the paramedics to do their drug treatment. That’s had a good increase in survival rates.” A complication is that individuals seeking medical assistance can be amazed to see a fire truck, which has led the Fire Service to begin rebranding all frontline automobiles with the addition of door badges that say: “Emergency medical reaction”. But this is not a problem that would have bothered Clayton-Reed. She says that if a firemen had signed up with the solo ambulance officer at her mom’s house: “One of them might have had some sense.” June 28 2013 1.58 am: Balclutha Ambulance sent to Marlene Dormer’s Kaitangata home 2.15 am: Ambulance shows up, Dormer is evaluated but not taken to healthcare facility 4.04 am: Ambulance dispatched a 2nd time 4.23 am: Ambulance arrives with solo officer 4.59 am: Ambulance leaves home 5.08 am: Arrives at Balclutha medical centre, Dormer dead on arrivalJune 28, 2013 – NZ Herald
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