By Sue-Ann Wayow
THE refusal of severely ill Covid- 19 patients to go with an ambulance to the hospital continues to pose a major problem.
And it contributes significantly to a delayed response time for other patients who require ambulance services.
Principal Medical Officer of Health Dr Maryam Abdool-Richards and other members of the health team have repeatedly said during the Ministry of Health’s Covid-19 updates that medics have to sometimes beg patients to seek treatment at the hospitals and ambulances have to visit homes several times before a patient agreed to go to the hospital.
Last Saturday, Dr Abdool-Richards again spoke about the delay when asked about the issue raised by AZPNews.com at the ministry’s virtual media conference.
She also described in detail, several other reasons for the ambulance delays.
Dr Abdool-Richards said, “I would like to make one major point. When a person contacts the ambulance service or their relative, the ambulance service now has to find or locate that person and do an assessment. There is a call that is made, there is an assessment, then the ambulance goes to the home. There is another assessment that is done, a medical team reviews this patient via telemedicine.
“We noticed a significant number of refusals. And we understand that persons may be hesitant to seek care. We understand there is a reliance on other forms of care but when you contact the ambulance and you request a service, it causes the decrease in the turnaround time and it means that one ambulance is basically off the grid so someone else who needs an ambulance will have it delayed. We understand your concerns and your fears but you will be denying someone else in need of care.”
Ambulance workers told AZPNews.com that they have been cursed and driven away by some patients who were upset that their relatives called the ambulance service. Some relatives have also retaliated verbally when the paramedics informed relatives that they cannot remove patients from their homes against their will.
“Only the police can forcibly remove someone without their consent,” one paramedic said.
What the law says
According to the Emergency Ambulance Services and Emergency Medical Personnel Regulations, a licensed provider may only accept the consent for treatment of a patient from the patient himself, where he is over the age of eighteen years; the parent of a patient in respect of his minor child or adult child of unsound mind; the guardian or a custodian of a person who is disabled or is of unsound mind, a married person under the age of eighteen; in the absence of a parent, a grandparent for his minor grandchild or for his adult grandchild of unsound mind; a married person for a spouse of unsound mind; and a person over the age of eighteen years for his parent of unsound mind.
GMRTT and RHA doing inter-facility transfers
Dr Abdool-Richards explained that the Global Medical Response of Trinidad and Tobago (GMRTT) and the regional health authorities’ ambulances have been doing inter-facilities transfer of patients since the onset of the Covid-19 pandemic.
The GRMTT ambulance service remains the sole ambulance service to conduct home to hospital patient transfer in Trinidad and is contracted by the Ministry of Health. In Tobago, there are no GRMTT ambulances and a fleet of 10 operates under the jurisdiction of the Tobago Regional Health Authority (TRHA). AZPNews.com was informed on Monday by the TRHA’s Interim chief executive officer Angell Second that two of those were in need of repairs and eight were functional.
Last November, Minister of Health Terrence Deyalsingh stated that there were 48 GRMTT ambulances adding that there were discussions to have more onboard and there was a total of 50 being used by the RHAs.
Dr Abdool-Richards said, “If we have to move a patient from the Accident and Emergency to the step-down facility or to the hospitals, GMRTT or an RHA ambulance may transport that patient based on availability. That is the first step that we took to collaborate or to increase the ambulance service capacity.”
She continued, “We do have metrics that we measure that we look at. We do look at operational issues. The GMRTT service has a real-time monitoring and computerised system that is shared with us at the Ministry of Health and the RHAs. Every four hours, we are able to look at a spreadsheet that comes to us automatically identifying delays at the different hospitals. We do have a metric of 60 minutes.
“Secondly, we have a clear communication between the ambulance services and we have regular meetings. If there is a change that is required or change in the procedures, we do make the amendments subject to the relevant approval.”
Trolleys and wheelchairs
AZPNews.com was informed by medical personnel that another reason for the ambulance delays was the waiting time at hospitals to transfer patients to medical facilities from the ambulance due to a lack of trolleys and that there was also insufficient wheelchairs.
The issue of trolleys was an operational issue that arises out of the RHA, Dr Abdool-Richards said adding that in December through the United National Operation service, the Minist
“We noticed that this one particular centre had this challenge with trolleys and the trolleys were donated to that centre and we have noticed less delays from Christmas Eve to present,” she said.
She also took note of the wheelchair challenge and said the ministry will follow-up with the RHAs regarding that issue.
Dr Abdool-Richards added, “We also monitor usage. We did notice the rolling average due to increase demand , more people are ill and more people require ambulance care that would lead to a delay in care. Since the onset of this wave on October 19, we have increased the capacity of the service by increasing the number of ambulances per shift and also the number of advanced life support ambulances.”
The life-support system are ambulances were equipped to transport Covid-19 patients who require Intensive Care Unit (ICU) and High Dependency Unit(HDU) care, she explained.
Don’t focus on lack but on getting vaccinated
Minister of Health, Terrence Delaysingh once again emphasised Covid-19 vaccination as a means of easing the burden on the healthcare system and workers.
He said if more members of the population were vaccinated against the deadly virus then the country would not have a system overload and that the solution was not in more resources but in more persons becoming vaccinated.
At present, the vaccination rate stands at 48.9% of those who are fully vaccinated.
Epidemiologist Dr Avery Hinds had previously explained that persons who began the vaccination process but did not complete it, would have the efficacy wane over time and was one of the reasons why he recommended persons already fully vaccinated receive their booster shots.
