Overly cautious response to 111 calls led to 'multiple patients suffering from preventable harm' - St John medical director

Have St John staff been too cautious in responding to 111 calls after a violent incident? A senior St John leader thinks so, and says patients may have been harmed as a result. Photograph / Supplied

First responders including ambulance crews have been praised at the highest levels for the way they responded to the Christchurch mosque attacks. But an internal memo shows there is serious concern from one St John Ambulance leader about how quickly they have been treating patients after violent incidents.

Patients may have died or been seriously injured because ambulance workers unnecessarily delayed entering a property, a St John Ambulance executive has said.

St John medical director Tony Smith said in an internal newsletter that there had been several recent cases in which ambulance crews had delayed their entry to a scene for safety reasons - only for a review to later find they were not at risk.

"In all of these incidents the patient suffered from potentially preventable harm," he said.

The strongly-worded opinion piece, obtained by the Herald, said St John workers would not accept the delays if the patient was one of their family members.

It has angered some ambulance workers, who felt that they were being pressured to take more risks. It came at a unfortunate time following the Christchurch mosque attacks, when first responders were sensitive about the potential dangers they faced at emergency callouts.

Smith's article for staff was published just before Easter and focused on "safe forward points" - a safe location near an incident where emergency service workers meet until it is deemed safe to enter.

Safe forward points are used for cases involving firearms or knives or when an attacker is still at the scene. Dispatchers or ambulance crew can decide whether one is necessary.

"I'm very concerned that our current use of safe forward points is resulting in multiple patients suffering from preventable harm," Smith said.

"I am not saying we should expose our personnel to unnecessary risks, but I am concerned that we have not got the balance of risks quite right at the moment."

He gave three recent examples. In one, an ambulance crew asked to be sent to a safe forward point after receiving a call about a person threatening to commit suicide. This led to a "significant delay" before they entered the scene and when they eventually went in the patient was dead.

"Upon reviewing the call there was nothing indicating the crew were at risk, other than that the patient was suicidal and indeed he was asking for our help," Smith said.

In another case, a shop assistant had been stabbed by several people during a robbery and a member of the public who called 111 said the attackers had fled in a car. The crew were sent to a safe forward point, delaying their entry, and when they arrived the patient had uncontrolled bleeding and was being helped by members of the public.

"Upon reviewing the call there was nothing indicating the crew were at risk, other than that a person had been stabbed," Smith said.

He warned that a coroner or licensing body was unlikely to agree that the use of a safe forward point was appropriate in the three cases he cited.

"Nor do I think that we would think it appropriate if the patient was a family member of ours," he added.

First Union national ambulance co-ordinator Sarah Stone said some St John staff were very upset by the email.

She said staff felt they were best-placed to make decisions about their safety, and they were feeling pressured to be less cautious.

While the union backed the review, it had been raised in an inappropriate way. Smith's article - which included included explicit details about how patients had attempted suicide - was unfair on the workers involved in the callouts, she said.

"The implication that if the staff hadn't waited … the outcomes might have been different - that's insensitive to say the least."

Ambulance crews experienced high levels of abuse and violence, Stone said. And they could not always take the public's word that a scene was safe. Nor could they assume a scene had no risks after a person had taken their life.

At a recent callout in Hamilton, St John held back after a person had poisoned themselves. Stone said they were later justified in their decision because the poison was so harmful they would also have been at risk if they rushed in.

Emergency services made some changes to the way they responded to serious incidents in 2010 following a high-profile incident two years earlier in which liquor store owner Navtej Singh was shot in a robbery and later died.

Shopkeeper Gurinder Singh, left, Daljit Singh and widow Harjinder Singh speaking at a press conference in 2010 following the death of liquor store owner Navtej Singh.

In that case, police did not arrive for 31 minutes after the 111 call and ambulance services were not sent in for another six minutes. At the time, police rejected findings from its independent watchdog that there was a systemic failure in the way it responded to callouts.

Smith was now proposing a sector-wide review on the issue of safe forward points, and said a working group would be formed by the end of the year.

In a statement, he said his article was intended to generate discussion and signal the plan to form a working group.

"St John provides a learning culture for our people and continually improves the service we deliver by sharing and reflecting on challenging incidents" he said.

"It is important we review our systems and processes, embedding any learnings as we go."

He added: "St John is committed to working to ensure the fastest, most clinically appropriate response to a seriously ill or injured patient. The safety of patients and ambulance officers must always be a key component in any response."