KEY POINTS:
Most people at some time will have seen an ambulance at close quarters, if not as patients then as family members or witnesses to an emergency call. They have probably been impressed by the speed, skill and dedication of the paramedics and the efficiency of their organisation.
They may be surprised, therefore, at the report of an inquiry by a select committee of Parliament that suggests the service is faulty.
Any study of a worthy industry at any time will find room for improvement, particularly when it can involve matters of life and death as many health services do. The urge to spare no expense on healthcare makes public health spending particularly hard to contain and it is vitally important that all suggested improvements are evaluated against other health needs.
The most costly suggestion from the MPs' ambulance inquiry may be that vehicles attending emergencies should always carry two crew. The committee was told that in some areas as many as 70 per cent of call-outs are answered by an ambulance officer arriving solo, sometimes with another arriving as soon as possible.
On the face if it, this sounds highly unsatisfactory, yet strangely the inquiry, requested by the ambulance officers' union, cites no cases where single-crewing has lost a life that could have been saved. It is likely that people in those areas readily pitch in and do what an ambulance driver instructs. Often, too, other emergency services will be on the scene and able to lend a hand.
Double-crewing is obviously desirable, triple even better, but to make it mandatory could make the service less efficient in places where volunteers have to be on call.
The tenor of the inquiry's recommendations suggests that it was prompted by nothing more serious than a regulatory itch. The Ambulance Association was concerned that the service varied from place to place, that it was "voluntary and contractual rather than regulated". There was no legislation specifying what must be delivered, or setting national standards.
No, there is not, and the service may be better for that. The committee backs the union's desire for a national training programme and qualifications, statutory registration and more certain public funding of course. It even likes the British experiment with a corps of medical professionals, designated "emergency care practitioners", standing ready to treat people in homes, workplaces or at the scene of an accident rather than rush them to hospital.
This "model" is said be proving successful from the practitioners' point of view, allowing them "to make autonomous decisions within the scope of their practice". It is not known what emergency patients think about it. People do not call an ambulance lightly. When they do, they expect to meet a competent paramedic whose job is to stabilise them and deliver them to a hospital as quickly as possible.
They might not welcome anew breed of mobile practitioner intent on justifying their greater training, qualifications and registration to the maximum, before they accept a need to head for a hospital. Perverse consequences are always likely when regulators meddle in a system that has developed in its own way.
New Zealand's ambulance services, started by the Order of St John, have expanded as independent and sometimes competing services to the public health system. Independence and competition are anathema to the bureaucratic mind, but officials and parliamentary busy-bodies can surely find more pressing problems to solve, and more urgent uses for health's precious public funds. Ambulances are working. Let them be.
