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Following is a question by the Hon Lee Cheuk-yan and a written reply by the Secretary for Security, Mr Ambrose S K Lee, in the Legislative Council today (February 22):
Question:
It has been reported that the Fire Services Department (FSD) is conducting a study on the possibility of Auxiliary Medical Service (AMS) taking over part of the urgent ambulance transfer service. In this connection, will the Government inform this Council:
(a) of the details of the study, including the scope of services involved, the mode to be adopted for consultation with the staff concerned and the public, and the expected completion date of the study;
(b) given that AMS comprises volunteers, how it will ensure a stable and sufficient supply of manpower within AMS to provide the above service, as well as adequate professional training for AMS officers to cope with situations in which the condition of the patients worsens during the transfers; and
(c) of the estimated annual savings to be achieved by FSD and the projected additional annual expenditure to be incurred by AMS after the above transfer of service?
Reply:
Madam President,
The demand for Emergency Ambulance Service (EAS) has been on the rise in recent years. As such, at its meeting on June 7, 2005, we informed the Panel on Security that we had been looking into three areas for possible ways to better meet the demand for EAS:
(i) continue to consider allocating additional staffing resources for the ambulance stream.
(ii) work on the demand side, for example, by encouraging appropriate use of EAS with a view to ensuring that EAS is more targeted at persons in genuine need of such service.
(iii) review the modes of service delivery to ensure ambulance resources are put to better use.
Regarding (i), the Fire Services Department (FSD) was given approval to recruit a total of 92 ambulance staff by open recruitment in 2004/05 and 2005/06. More recently, FSD was given approval for open recruitment of 97 ambulance staff in 2006/2007. Regarding (iii), we are studying the question, as asked by the Honourable Member, on whether the mode of service delivery of "Priority Two" calls could be adjusted. Our detailed reply to the question is as follows:
(a) FSD currently provides two types of ambulance service for the Hospital Authority (HA), namely "Priority One" calls and "Priority Two" calls. The former involves transfers of patients with extreme urgency from a hospital or medical institution to an acute hospital for emergency treatment or examination without delay. FSD treats these "Priority One" calls as EAS calls. According to its performance pledge, such calls should be responded to within 12 minutes.
As regards "Priority Two" calls, they are termed as "Urgent Calls" by FSD. According to the definition of HA, these calls are less urgent as compared with "Priority One" calls. Ambulance staff are required to transfer patients from a hospital or medical institution to another for medical treatment or examination. There is no performance pledge, but FSD's internal target is to respond to such calls within an hour. In 2005, FSD handled a total of 34,175 "Priority Two" calls.
We understand that for some cases of "Priority Two" calls, the patients may not need to be handled by professionally trained personnel like the ambulance staff of FSD. Therefore, the Security Bureau (SB), FSD, HA and the Auxiliary Medical Service (AMS) are carrying out preliminary discussion about whether some of the "Priority Two" calls can be triaged and handled by other organisations based on the assessment of medical personnel. This could enable FSD's ambulance staff to focus on EAS calls that need their expertise, and hence improve the service for those who are in genuine need of EAS.
The above proposal for adjusting the mode of service delivery of "Priority Two" calls is still at the initial stage of study. The primary focus of our study is to ensure that any adjustments to the mode of service delivery will not affect patients' access to appropriate medical service. We also need to examine whether it is feasible operationally. We are still discussing these questions with the departments concerned (including HA) and will consult FSD's ambulance staff before deciding on whether and when the existing mode of service delivery of "Priority Two" calls will be adjusted. If we eventually decide to adjust the existing mode of service delivery, we will consult the Legislative Council on a more concrete proposal.
(b) AMS has also been involved in the discussion on the feasibility of adjusting the mode of service delivery of "Priority Two" calls because it is one of the SB's auxiliary services departments, and has been providing non-emergency ambulance transfer services to HA, the Department of Health and private hospitals. In 2005, AMS handled 16,443 such transfers.
AMS has some 400 members who are qualified as doctors or nurses, and more than 3,400 frontline members. All frontline members have completed AMS' "Disaster Medical Assistant Course", which covers basic ambulance-aid training. In addition, they have to keep themselves up to the required standard by passing an annual proficiency test. They are often deployed to provide first-aid services and man ambulances at venues of public activities, take part in inter-departmental disaster drills, and arranged to be attached to FSD's ambulance depots and hospitals, to ensure that they have adequate training to handle unexpected events and emergencies. AMS also runs an advanced course on ambulance aid for its members. The course is designed and taught by doctors and professional nurses. It covers common illnesses such as cardio-pulmonary illnesses, senile diseases and mental illnesses, as well as how to handle intravenous infusion, catheters, nasogastric tubes, stomas, wound drainage, etc.
(c) The proposal for adjusting the mode of service delivery of "Priority Two" calls is still being studied. The preliminary idea is that medical personnel of HA will make decision on every "Priority Two" calls based on clinical observation. In other words, if they consider that a case needs to be handled by FSD's professional ambulance personnel, it will still be handled by FSD's ambulancemen.
As SB, FSD, HA and AMS still have to study the details of the triage arrangements, a concrete estimate on the resources involved is not available at this stage. But we need to emphasise that, even if we eventually implement the adjustment, we believe FSD, based on the assessment of medical personnel, will still have to handle part of the "Priority Two" calls. And given the continued increase in EAS calls, we still have to continue to consider the staffing situation of EAS, and study the feasibility of other demand management measures and service delivery adjustments.
Ends/Wednesday, February 22, 2006
Issued at HKT 15:28
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