CHAPTER 4 Fire Services Department Emergency ambulance service Audit Commission Hong Kong 23 October 2008 This audit review was carried out under a set of guidelines tabled in the Provisional Legislative Council by the Chairman of the Public Accounts Committee on 11 February 1998. The guidelines were agreed between the Public Accounts Committee and the Director of Audit and accepted by the Government of the Hong Kong Special Administrative Region. Report No. 51 of the Director of Audit contains 12 Chapters which are available on our website at http://www.aud.gov.hk. Audit Commission 26th floor, Immigration Tower 7 Gloucester Road Wan Chai Hong Kong Tel : (852) 2829 4210 Fax : (852) 2824 2087 E-mail : [email protected] EMERGENCY AMBULANCE SERVICE Contents Paragraph PART 1: INTRODUCTION 1.1 Background 1.2 – 1.3 Ambulance calls 1.4 – 1.6 Audit review of the provision of the ambulance service in 1997 1.7 Latest developments 1.8 – 1.9 Maintenance and replacement of ambulances 1.10 Mobilisation of ambulances 1.11 Audit review 1.12 – 1.13 General response from the Administration 1.14 – 1.16 Acknowledgement 1.17 PART 2: USE OF THE EMERGENCY AMBULANCE SERVICE 2.1 Demand for the emergency ambulance service 2.2 Audit observations and recommendations 2.3 – 2.7 Response from the Administration 2.8 – 2.10 Public education on the proper use 2.11 of the emergency ambulance service Audit observations and recommendations 2.12 – 2.15 Response from the Administration 2.16 — i — Paragraph PART 3: PERFORMANCE MEASUREMENT 3.1 Performance measurement for the emergency ambulance service 3.2 Audit observations and recommendations 3.3 – 3.12 Response from the Administration 3.13 PART 4: USE OF AMBULANCE RESOURCES 4.1 Resources for the ambulance service 4.2 – 4.4 Availability of ambulances for the emergency ambulance service 4.5 – 4.6 Audit observations and recommendations 4.7 – 4.10 Response from the Administration 4.11 – 4.12 Monitoring the urgent care ambulance service 4.13 – 4.14 Audit observations and recommendations 4.15 – 4.21 Response from the Administration 4.22 – 4.23 Resources for the paramedic ambulance service 4.24 Audit observations and recommendations 4.25 – 4.30 Response from the Administration 4.31 Deployment of resources for community education programme 4.32 Audit observations and recommendations 4.33 – 4.35 Response from the Administration 4.36 PART 5: MAINTENANCE OF AMBULANCES 5.1 Maintenance services provided by the EMSD 5.2 – 5.3 Availability and reliability of the ambulance fleet 5.4 – 5.5 Audit observations and recommendations 5.6 – 5.19 Response from the Administration 5.20 – 5.21 — ii — Paragraph PART 6: PROCUREMENT OF REPLACEMENT 6.1 AND ADDITIONAL AMBULANCES Procurement of replacement ambulances 6.2 Audit observations and recommendations 6.3 – 6.11 Response from the Administration 6.12 – 6.13 Procurement of additional ambulances 6.14 – 6.15 Audit observations and recommendations 6.16 – 6.21 Response from the Administration 6.22 – 6.23 — ii i — Page Appendices A : Organisation chart of the Ambulance Command (June 2008) 51 B : Conveyance of patients by ambulances to the Hospital Authority’s 52 Accident and Emergency Departments (2004 to 2007) C : Performance target and indicators (2006 to 2008) 53 D : Achievement of the performance target of the emergency 54 ambulance service (April 2007 to June 2008) E : Baseline daily ambulance availability 55 (January 2007 to June 2008) F : Urgent calls with more than 30-minute waiting time at hospitals 56 (January 2007 to May 2008) G : Training in the cardiac pulmonary resuscitation and public access 57 defibrillator (30 June 2008) H : Procedures of identifying ambulances to be replaced under the 58 Resource Allocation Exercise I : Lead time for the replacement of ambulances (2005-06 to 2007-08) 59 J : FSD bids for additional ambulances for projected increase in 60 ambulance calls (2005 to 2007) K : FSD bids under the Non-works Capital Expenditure Resource 61 Allocation Exercise (2004 to 2007) L : Acronyms and abbreviations 62 — iv — PART 1: INTRODUCTION 1.1 This PART describes the background to the audit and outlines the audit objectives and scope. Background 1.2 The Fire Services Department (FSD) is responsible for fire-fighting and rescue on land and sea, and the provision of the emergency ambulance service for the sick and the injured under the Fire Services Ordinance (Cap. 95). The FSD is organised into seven Commands (i.e. the Headquarters Command, the Hong Kong Command, the Kowloon Command, the New Territories Command, the Fire Safety Command, the Licensing and Certification Command, and the Ambulance Command). The Ambulance Command is responsible for the provision of the emergency ambulance service, comprising pre-hospital care, and conveyance of patients and casualties to hospitals. Under the Ambulance Command, there are two operational regions (i.e. the Hong Kong and Kowloon Region, and the New Territories Region). The organisation chart of the Ambulance Command is shown at Appendix A. 1.3 As at 30 June 2008, the Ambulance Command had 36 ambulance depots, 27 outstations (fire stations used as ambulance outstations and standby locations) and 2 ambulance posts (standby locations at the immigration control points) strategically located in the territory to provide the emergency ambulance service. The Ambulance Command had an establishment of 131 ambulance officers and 2,298 ambulancemen, and a fleet of 252 ambulances, 4 mobile casualty treatment centres (Note 1) and 34 ambulance motorcycles (Note 2). In 2008-09, the estimated expenditure for the provision of the emergency ambulance service is $948 million. Ambulance calls 1.4 Ambulance calls are classified into emergency, urgent and non-emergency calls. In principle, the FSD is responsible for providing the ambulance service in response to emergency and urgent calls. Emergency calls are classified into: Note 1: The four vehicles, fitted with communication and medical equipment, are used as treatment centres in incidents involving a large number of casualties. Note 2: These motorcycles are used to provide advanced pre-hospital paramedic care for casualties and patients before the arrival of ambulances. — 1 — Introduction (a) calls from the public, requesting conveyance of patients and casualties from scene of incidents to hospitals for emergency treatment; and (b) calls from hospitals or medical institutions, requesting transfer of patients with extreme urgency from a hospital or medical institution to another for emergency treatment. 1.5 Apart from emergency calls, there are also urgent calls and non-emergency calls. The FSD is also responsible for handling urgent calls from hospitals of the Hospital Authority (HA). Urgent calls are calls for transfer of patients with some degree of urgency from a hospital or medical institution to another for urgent treatment. In April 2003, the FSD, in consultation with the HA, introduced an urgent care fleet. Each ambulance of the fleet is manned by a 2-man crew instead of a 3-man crew to release resources for the emergency ambulance service. As at 30 June 2008, there were 12 ambulances under the urgent care fleet. In 2007, the FSD handled 573,657 emergency calls and 36,916 urgent calls. 1.6 Non-emergency calls are calls for transporting patients of non-emergency nature from a medical institution to other places. The non-emergency ambulance service is provided by the HA, the Auxiliary Medical Service and the St. John Ambulance Brigade (Note 3). Audit review of the provision of the ambulance service in 1997 1.7 In 1997, the Audit Commission (Audit) conducted a review of “The provision of ambulance service”. The results of the review of the emergency ambulance service were included in Part I of Chapter 6 of the Director of Audit’s Report No. 29 (October 1997). Audit found that there was room for improvement (such as the performance measurement for the emergency ambulance service and the provision of the paramedic ambulance service) and made a number of recommendations. The Administration generally agreed with the audit recommendations and took action to implement them. Note 3: The HA has a fleet of 127 ambulances for providing the ambulance service for the mobility-handicapped patients. The Auxiliary Medical Service has a fleet of 6 ambulances providing the ambulance service for patients of the Department of Health, the Social Welfare Department and private hospitals. The St. John Ambulance Brigade has a fleet of 10 ambulances providing the ambulance service for the public. — 2 — Introduction Latest developments Revised performance measurement 1.8 Since November 1998, the FSD has set a performance target of answering 92.5% of the emergency calls within a target response time of 12 minutes. In late 1999, the FSD reviewed the performance target and concluded that the target response time of 12 minutes was reasonable and achievable. In 2007, the FSD answered 92.8% of the emergency calls within the target response time. Paramedic ambulance service 1.9 Since February 2005, the FSD has committed to providing the paramedic ambulance service to improve the survival rate of critical patients and casualties for all the emergency calls. All FSD ambulances are equipped with paramedic equipment (such as automated external defibrillators — AEDs) to facilitate the ambulance crew to render advanced pre-hospital paramedical care to patients. Ambulance staff are trained to be Emergency Medical Assistants II (EMA IIs — Note 4) to provide the paramedic ambulance service. Maintenance and replacement of ambulances 1.10 The maintenance service of the FSD ambulance fleet is provided by the Electrical and Mechanical Services Department (EMSD) under a 10-year Service Level Agreement (SLA) from 2006-07 to 2015-16. In 2007-08, the SLA maintenance charge of the ambulance fleet was $19.2 million. Ambulances are considered as large vans and the Government Logistics Department (GLD)’s endorsement is required for procuring them. Note 4: Advanced countries, such as Canada, have the following three skills levels of the ambulance staff for providing the paramedic ambulance service: (a) EMA Is provide patient care at the basic level. Their training includes the use of defibrillator and basic life support; (b) EMA IIs provide a more comprehensive patient examination and advanced pre-hospital treatment. Their training includes intravenous infusion, defibrillation and use of selected drugs; and (c) EMA IIIs provide advanced patient care. Their training includes knowledge and technique of intubation and in-depth cardiac management. The FSD’s target skills level of ambulancemen is only the EMA II level. — 3 — Introduction Mobilisation of ambulances 1.11 The Fire Services Communication Centre (FSCC) of the FSD is responsible for mobilising all ambulance resources. It acts as an emergency co-ordinator for other government departments and public utilities in major incidents. Upon receipt of an emergency call, the FSD’s Third Generation Mobilising System (TGMS — a sophisticated telecommunication and computer integrated mobilising system) will assign the ambulance that can reach the scene of incident within the shortest time to respond to the call. The FSD has to maintain a high level of availability of ambulances and ambulance crew for the provision of the emergency ambulance service. Audit review 1.12 Audit has recently conducted a review to examine the economy, efficiency and effectiveness in the provision of the emergency ambulance service by the FSD in response to emergency calls. The review has focused on the following areas: (a) use of the emergency ambulance service (PART 2); (b) performance measurement (PART 3); (c) use of ambulance resources (PART 4); (d) maintenance of ambulances (PART 5); and (e) procurement of replacement and additional ambulances (PART 6). 1.13 In carrying out the audit review, Audit examined the records and interviewed the staff of the FSD. Audit has found that there are areas where improvements can be made. Audit has made a number of recommendations to address the issues. General response from the Administration 1.14 The Director of Fire Services generally agrees with all the audit recommendations and will take follow-up actions in a proactive manner. — 4 —