How many Lives to balance the books ?

St John Ambulance Service

It always struck me as odd that in New Zealand the most vital of emergency service is not run by the government but an NGO (non governmental organisation). In this case a not for profit charitable organisation, which in regular intervals approaches us with their begging bowl. I do not know of any civilised country where such a crucial part of the health and disaster service is run by a private charity.
Of course as always in these cases there is a long history behind it going back according to their web-site to the crusades. In New Zealand St John started in 1885. In light of recent reports about a Steep rise in reported ambulance mistakes one has to ask if the charitable model as least for the ambulance part of St John’s operation is still adequate for the twenty-first century.

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The recent revelations seem to point to underfunding as the main problem. The service is under-resourced and under-staffed. This leads to more and more mistakes being made by exhausted and stressed medics, which have lead in some cases to serious harm or even death of patients.
Of course we hear the usual obfuscation about the steep rise in reported incidents being just the result new reporting procedures. And as always the government tries to wash it’s hands of the responsibility to provide adequate funding as it is not running the service.

Fortunately I live to tell about my own experience. I wonder how it was recorded by St John. Here is a slightly abridged version of what I wrote almost seven years ago.

31 July 2010 was my lucky day

I might not have been so lucky as it was a Saturday. However I live to tell the tale.

The pain in the middle of my chest started slowly at around 12:30 pm. As I had a heart attack before I knew the routine. First the Nitrolingual Pumpsray under the tongue. After 5 minutes the repeat brought no relieve. The pain became more crushing. I had to make the decision to ring 111. The ambulance dispatcher was reassuring. “Have you got Aspirin? Can you get to it? What is the strength? Chew three but don’t drink water. The ambulance is on the way.”

The ambulance arrived about 15 minutes later. The paramedics started their work: ECG, blood pressure, Oxygen, shunt into the arm and more Nitrolingual spray.

One piece of advice to all tough guys out there. You will be asked to rate your pain on a scale from 1 to 10, ten being the worst. Being men we will probably never know a ten but it doesn’t pay to downplay your pain. If you are in agony don’t understate and go for the 8 or 9.

The ride in the ambulance seemed painfully slow as I was increasingly struggling with more crushing chest pain. Then we hit some traffic backlog on the Northern Motorway and instead of asking for permission to turn the flashing lights and siren on as the patient was getting worse we went off the motorway to go through the suburbs to reach North Shore Hospital. This alone would have caused a 10 to 15 minute delay.

And here comes the next problem. As a resident of the Waitemata Health Board area north of Auckland you are inevitably taken to North Shore Hospital even if on the weekends they are not fully open for business. We finally got there and into the A&E room. I was  now struggling  with excruciating pain. The medical staff did all they could to stabilize me with anti-clotting medication and more and more morphine. “Can I have another signature ?” Obviously needed to give the restricted drug. The medical staff got to the end of their capabilities and decided to have me shipped to the catheter lab at Auckland Hospital.

My wife by now as scared as I was desperately tried to cheer me up by pointing out to me how beautiful the cardiologist was accompanying me in the ambulance. She was beautiful alright. However her qualification and the fact that two nurses got with her (and me) into the back of the ambulance and that this time the lights were flashing and the sirens were going was more comforting to me. At least my situation was now taken very seriously.

At the Auckland Hospital the Cardiac Care Unit (CCU) was ready for me. The catheter lab had been fired up. “Where is the radiologist ? We need a radiologist.” He appeared a minute later. The surgeon managed to get the catheter into my coronary arteries. It didn’t seem to be easy. You eagerly listen to the communication between the team. He managed to open up the blocked artery and put a stent inside a previous stent, which had been blocked. At around 5pm it was all over. I knew and told everybody, the medial staff, my family and visitors, that I was a very lucky man. About half the heart attack victims don’t even make it into hospital alive.

I am thankful to our public health system, which really looked after me in my hour of need. However some questions remain.

Why can an ambulance crew not turn the flashing lights and siren on when the patient in the back is clearly struggling and deteriorating ? This seems to be a management and/or communication problem the patient really doesn’t need. During a heart attack they speak of the “golden hour” i.e. every minute counts.

Looking back

I just recently had another look at my heart. My cardiologist pointed to an extended white area on the ultrasound image telling me that this was the scar from my last heart attack. I am wondering if the scar would be smaller if I had reached the hospital 15 minutes earlier.

I am convinced that proper funding by the government will improve the survival chances of many patients and the ambulance service is just one small example.

Our government is so smug about balancing the books and even posting a budget surplus. However they achieve this by underfunding even the most vital services like health. Think of the rosters of junior doctors, underfunded and understaffed midwifes run of their feet, life saving medications. Think of other life saving services like suicide prevention, women’s refuge and related services. Think of safe and healthy housing, social services to protect vulnerable children. And the list goes on.

And the government is still spinning us a neo-liberal lie like “trickle down” like “the tide will lift all boats big and small” and most of all “there is no alternative“. This time the lie we hear from government and even the Auckland mayor Phil Goff is the promise to do “more for less“.

The government should be asking themselves :

How many lives are we prepared to sacrifice to balance the books ?

by  Dr. Hans B. Grueber

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