THE CHANGING FACE OF
GEOFF WATERHOUSE, PROGRAM DIRECTOR FOR HEALTH INFRASTRUCTURE AT NSW AMBULANCES, SHARES
SOME INSIGHTS INTO CURRENT AND FUTURE TRENDS IN EMERGENCY MEDICAL COMMUNICATIONS.
In the past, the role of paramedics was primarily to
transport people to hospital, with limited time or
technology to do much more. However, demand for
hospital resource continues to increase:
• Hospitals are stretched because more people go to
hospitals now, rather than to their doctor, at least in
part because they can’t afford to do otherwise.
• More options for public communications mean that
instead of a traditional emergency telephone call,
people ring up anywhere for anything on their cell
phone if they need help.
Most services remain committed to taking the patient
to the hospital. But a new emergency medical model
is evolving, which takes the hospital to the patient.
Consequently, emergency medical organizations must
now build up technology and capability in their fleets,
so that paramedics can do more for patients. And that
creates a more complex environment in which the
paramedics will work.
WHAT WILL THE NEW MODEL MEAN
In a perfect world, there would be specialist doctors
or general practitioners in every ambulance, but this is
clearly not feasible. The current paramedics will need
to ramp their skills in terms of the types of medical
conditions that they will deal with. After triage, the goal
is to give a patient the appropriate care as quickly as
possible, to stabilize their condition, and increase their
recovery and survival chances. Going to a hospital to
treat an acute condition is just one treatment option.
For example, let’s consider heart attack patients, whose
survival chances are increased by intermediate care.
To do this, you need highly trained paramedics, who can
communicate in real time with hospital specialists. And
you need technology that means the clinician in the back
of an ambulance can connect to the cardiologist when
he’s reviewing the script from the patient life pack, or to
a triage doctor who can describe the treatment that will
keep that particular patient alive. This is just one way that
communication will influence the patient outcome and
widen the treatment window. There are many examples
that will potentially make the window wider.
Left untreated beyond the first six minutes, a stroke
victim typically loses two million neurons and seven miles
of nerve tissue every 60 seconds. These patients need
to get to the intermediate treatment point to give them
more time. If you can widen that window so they don’t
lose so much, follow up care is shorter and cheaper.
How could we do that on the ambulance journey? We
could give the hospital the forecast of medical condition
information and time of arrival, to prepare them for what
NSW AMBULANCE AT A GLANCE
• Responsible for seven million people across
600,000 square kilometres.
• Work in both largely unpopulated hinterland
and the city of Sydney, Australia.
• Receives a triple zero (emergency) call every
28 seconds – more than 3,000 every day.
• Operates a fleet of 850 Mercedes sprinter
ambulances, plus 400 single line first
responders who are either intensive care
paramedics or operational managers.