The Gisborne Herald

Paramedic cut is a fight this region can’t really afford to lose
by Iain Gillies
Friday, 11 May, 2007

It is disturbing to learn that our emergency services could be compromised by the loss of a permanent advanced paramedic in Gisborne, while ambulance stations at Ruatoria and Te Puia will be managed from Tauranga.

And this at a time when St John Ambulance here has been two paramedics down since the end of last year.

Sometimes it is necessary for governments to come to the rescue and spend money they were saving for something else.

It all boils down to priorities. And in the build-up to Budget week everyone and every organisation, every arm of government services can come up with a "priority".

But health must always be right up there at the top of the list. And the Government is already pouring multi-millions of dollars into health services every year.

Even so, providing isolated areas such as the Gisborne-East Coast with the paramedic services we feel are necessary won’t start a new bout of inflation or empty the Government’s coffers.

New Zealanders, through the state, spend big on health. They rightly feel entitled to at least a satisfactory standard of health service in return.

But, whatever the causes, many no longer feel confident that services will be available to them when they need them.

They worry whether they are receiving a fair return for their outlay. They suspect unreasonable waste. And it hurts when they see an organisation as valuable as St John having to ration its resources.

National Distribution Union branch organiser Neil Chapman says there is "serious concern" about the staff shortage and further planned restructuring.

"We have argued for many years to get advanced paramedic positions in this area and we don’t want to see a dilution of that in any way. Gisborne has gone from having three advanced paramedics to two, and that is our concern."

Our view? The only area of health services that needs cutting is the bureaucracy. And there will be a lot of appreciation if steps are taken to ensure emergency services are kept at full strength.

St John sets record straight
by Staff Reporters
Friday, 11 May, 2007

The Gisborne Herald would like to correct inaccuracies in a report in Wednesday’s paper on St John ambulance resource levels in Gisborne, and to apologise to St John and spokesman Brent Nielsen.

We accept that information provided to us by St John Midland regional operations manager Brent Nielsen was provided in good faith and is correct — that is, that Gisborne’s rate of single-crewing in ambulances is in line with the national average.

We regret repeating unchallenged an allegation from National Distribution Union spokesman Neil Chapman that a significantly higher percentage of ambulance callouts in Gisborne are attended by a single crew member.

St John’s position on single-crewing — stated publicly on several occasions — is that all emergency ambulance calls should be responded to by a vehicle with two ambulance officers, and that to achieve this St John needs increased resources, including increased full-time paid staff and volunteers.

"Where St John responds to an emergency with an ambulance with a single crew member, it is not a matter of choice — it is a matter of available resources," says St John external communications manager Ali Tocker.

"St John believes it is appropriate in these situations to respond with a single-crewed vehicle rather than responding with no vehicle at all or waiting for one to come from a greater distance."

• St John also wants to correct a statement in last night’s paper by Mayor Meng Foon, reported from the Waerenga-o-kuri long-term community plan meeting.

Mr Foon said St John planned to "downgrade" staffing by having ambulances staffed by "just the driver" instead of by a paramedic and driver.

"We want to reassure the public that all staff crewing St John ambulances have medical skills," Ali Tocker said.

A senior St John ambulance officer has been accused of giving deliberately misleading information about single- crewing of ambulances, which is said to be putting lives at risk.

National Distribution Union branch manager Neil Chapman says up to 70 percent of ambulance callouts in Gisborne are attended by a single crew member.

This is in response to claims made by Midland regional operations manager Brent Neilsen that Gisborne’s rate of single-crewing in ambulances matches that of the national average, at less than 20 percent.

"That is an absolute urban myth," Mr Chapman says.

"Those results are skewed due to the high volume of double-crewing in large centres like the Auckland metro area. In regional areas like Gisborne, it is much more than that."

In Gisborne, most callouts occurring during business hours are double-crewed, but night-time callouts are predominantly single-crewed, Mr Chapman says.

"This is definitely a concern that needs to be addressed," he says.

The situation is about to get worse, with permanent staffing levels dropping from 10 staff to nine before the end of the month, Mr Chapman says.

St John Gisborne area manager Shane Clapperton says he is not at all happy with single-crewing in any situation.

"We never want vehicles leaving single-crewed for a job, due to staff safety and patient care.

St John chief operations officer Kevin Tate acknowledges regional variations to the national statistic and says single-crewing always occurs due to a shortage of available staff.

"On the occasions that we single-crew, we have only one ambulance officer available in that area at that time. There can be several reasons for this and it is never a matter of choice," Mr Tate says.

"We rely on a combination of paid staff and volunteers to crew our ambulances within available funding.

"The most common reason for single-crewing is that, in a number of locations, we rely on a volunteer to be the second crew member.

Mr Clapperton says it is an ongoing process to recruit volunteer ambulance staff to fill shifts on the Gisborne roster.

"However, voluntary staff are exactly that — voluntary — and it is always difficult to recruit and retain a full complement of voluntary staff."

A new report from the New Zealand Ambulance Association says many patients have suffered as a result of single-crewing, and ambulance officers are also far more vulnerable in dangerous situations, Green Health spokeswoman Sue Kedgley says.

"Many aspects of an ambulance officer’s job cannot be handled alone, from performing CPR to lifting an immobile patient on
to a stretcher and into the ambulance, and it is putting
people’s lives at risk to send single-crewed ambulances to emergencies.

"Officers are turning up to car crashes and heart attack victims on their own, and staff are being forced to choose between tending a patient or driving.

"Ambulance officers tell of repeatedly stopping
en route to hospital, losing valuable time in the process, to monitor patients and administer treatments," Ms Kedgley says.

However Mr Tate says in circumstances where single-crewed responses do occur, most take place without incident, with the patient treated or stabilised by the ambulance officer before being transported to hospital.

"The St John position is clear — all emergency ambulance calls should be responded to by a vehicle with two ambulance officers," he says.

"Full-time ambulance officers are allocated throughout the country, based on available funding, an assessment of comparative workloads and local factors."

Emergency services in this region could be further compromised by the loss of a permanent advanced paramedic in Gisborne, while ambulance stations at Ruatoria and Te Puia will be managed from Tauranga.

St John Ambulance has been short of two paramedics in Gisborne since the end of last year, when an advanced paramedic and a paramedic relocated elsewhere.

The staff shortage and further planned restructuring for this region is a serious concern, says National Distribution Union branch organiser Neil Chapman.

"We have argued for many years to get advanced paramedic positions into this area and we don’t want to see a dilution of that in any way.

"Gisborne has gone from having three advanced paramedics to two, and that is our concern. It puts a huge amount of pressure on the remaining two advanced paramedics."

Advanced paramedics are able to administer medicines and carry out life support procedures that other staff are not qualified to do. They are also called on to attend emergencies that require the attendance of the Lion Foundation Rescue Helicopter, and often attend other incidents to support other paramedics.

"We are absolutely concerned that the number of paramedics able to carry out this role has been limited," Mr Chapman said.

"Gisborne is some way away from other centres — staff who are out there on their own with a seriously ill patient need to know with confidence the advanced paramedic is available to support them.

"There are times when ambulance staff know a patient will have a better chance of recovery with access to an advanced paramedic."

Proposed restructuring by St John Ambulance in the midland region means that Gisborne’s area manager position will be disestablished and replaced by a duty-based team manager.

Effectively, the Gisborne station loses a staff member, leaving it with just two advanced paramedics on staff.

The car-based area manager position has meant an extra vehicle with a full supply of medical equipment has been on the road at busy times, as well as providing a quick response by an advanced paramedic at trauma situations.

While it has been proposed the car will still be available for use in Gisborne without a car-based manager, it is likely to remain on-station, meaning delays in responding to emergency situations.

While the Gisborne station will still be managed by the team manager, this position will now be ambulance-based, with the manager working shifts as part of the station roster.

This means reduced availability to support other staff or attend as back-up to major incidents, Mr Chapman believes.

St John Gisborne area manager Shane Clapperton was unable to comment on the situation.

The proposed restructuring will be implemented by the end of May.

The decision to have Ruatoria and Te Puia managed from Tauranga rather than Gisborne meant local relationships and knowledge would be lost, Mr Chapman said.

"I am astounded these changes are happening and not one iota of consultation has taken place.

"They’ve just gone ahead and made decisions that have a big impact on our communities.

"The ambulance service is a public service, publicly-funded and therefore should consult the public.

"It has got to the stage where we at the union are considering going to the Government and asking the health select committee to carry out an investigation into the ambulance service provided by St John in this country."

• St John Midland regional ambulance service manager Brent Nielsen said the changes were being made as a result of months of consultation and extensive input from staff and management.

"The changes are part of a wider change programme designed to improve our management framework and help us better deliver services to the community.

"The changes are not about cutting costs, but about providing a better service for patients and customers.

"In fact, there will be more staff overall after the changes."

The Herald understands that while this might be true in other regions, Gisborne’s staffing level will drop from 10 to nine.

The ambulance service in Gisborne is also staffed with 15 volunteers and is always looking to recruit more.

"The service relies on a combination of volunteer and paid staff.

"Volunteers form an essential part of St John in New Zealand," Mr Neilsen said.

Gisborne staffing change seems ‘crazy’ after Wairoa’s experience
by Staff Reporters
Wednesday, 9 May, 2007

While the proposed Gisborne staff cuts are news to some people, to others it is a case of déjà vu, after Wairoa spent months last year and earlier this year battling similar staff cuts.

Just last month, the town won its long-fought battle to re-instate a fourth full-time ambulance officer after going without since 2000.

After fighting a staffing battle in her town, Wairoa paramedic Adrienne Andresen said proposed changes to Gisborne staffing was going to be a big problem for the whole East Coast region.

"It seems absolutely crazy. Gisborne definitely needs that third advanced paramedic — not just
to cover Gisborne, but also for the rescue helicopter and as back-up across the whole region.

"Having Ruatoria and Te Puia under Tauranga’s control is a crazy idea too. All their patients come down to Gisborne — they have absolutely no connection to Tauranga."

"From my experience in the battle we fought here, we did not win because of what we put forward, but from putting the battle to the community. It was only then St John management sat up and took notice," she said.

While rostered overtime had covered the shifts for six years, St John management proposed changing to a three-person roster with a part-time patient transfer officer staffing the second ambulance on weekdays.

St John’s initial assessment of Wairoa’s workload and demand had indicated two emergency ambulances were not required 24 hours a day.

That thinking was turned on its head on April 3 after the community and National Distribution Union rallied together, telling St John executives loud and clear they wanted nothing less than the return of a fourth full-time paramedic officer.

"We have looked at the circumstances again. Wairoa is quite a unique case with rural isolation features," St John Midland Region chief executive officer Eddie Jackson said at the time.