Editorial Friday January 4, 2013

The wall is coming

The plight of under-manned volunteer fire brigades in the Far North has been well documented, but that seems to be one small part of a much bigger picture.

Emergency services in general are clearly becoming stretched, to the point where St John operations manager Michael Brooke was moved to comment, three months ago, that "there's a brick wall coming," although that was true of the health sector in general.

Increasing difficulties in attracting people prepared to give significant amounts of time to their communities without reward might well be hastening the impact with that wall, but there would seem to be at least two other factors at play. One would be the admirable commitment shown by St John and the Fire Service to provide an extraordinarily comprehensive level of service from one end of the country to the other, quite remarkable given the extent to which both organisations rely on volunteers.

The other would be the readiness of some people to call for help when dealing with the 'emergency' should be within their own resources.

Neither St John nor the Fire Service are ever likely to dissuade anyone from dialling 111; the Fire Service has long promoted the view that it is better for a crew to respond to a false alarm than to delay calling for help and so allow a small fire to become a big one.

St John probably follows a similar philosophy, although sweeping changes made in September in a bid to stem an annual financial shortfall of $15 million included the decision that ambulances would no longer be dispatched in response to 'minor' calls.

According to one source 'minor' includes abdominal pain, allergies, animal bites, assaults, back pain, falls, headaches, exposure to cold, lacerations and 'feeling sick.' Complaints of that nature would be referred to a GP, or some other health care provider, or a St John officer would be dispatched in a car, as opposed to a double-crewed ambulance.

Whether or not that will be enough to make a dent in a $15 million shortfall isn't clear, but it is hardly surprising that an organisation of this size and nature, which functions as a charity, is feeling the pinch.

Even if there is no shortage of volunteers, maintaining a national ambulance service must be an expensive exercise, and the only obvious option would be to begin withdrawing from smaller communities altogether.

To some extent that would simply shift the problem from one organisation to another, however, given that ambulances spend a good deal of time on the road transferring patients from one hospital to another. One assumes that that service is paid for by the relevant DHB (or rest home), but they would not be expected to relish the prospect of moving patients around with vehicles of their own.

And whether it is a shortage of volunteers, or a purely financial problem, it is becoming evident the Fire Service is already picking up an increasingly significant share of the load traditionally carried by St John.

The Kaitaia Fire Brigade is clearly far from unique in routinely dispatching crews to assist St John personnel, generally with lifting patients - last week crews were even sent to Kaitaia Hospital, after the siren was activated, to lift a patient there twice in about 12 hours.

Hopefully that was an aberration but the trend has been developing for some time.

It was reported last week that in the three years to 2007, the number of medical calls responded to by firefighters more than doubled to 4600. Since then the figure has risen to more than 6000, nine per cent of the firefighters' workload.

And in 2007, Fire Service chair Dame Margaret Bazley said the true figure might have been much higher, given that calls to help ambulance crews lift patients did not go through the 111 system.

Part of the problem, in Kaitaia if not elsewhere, could be that people are inclined to summons the fire brigade when they should more properly be asking for an ambulance. One source claimed last week that that was happening in rural areas because people knew, or suspected, perhaps, that the local fire brigade would arrive more quickly than an ambulance.

Whether that is true is open to debate, but as in many things, perception is the key. And in Kaitaia at least the fire brigade is called out for much more than fires and accidents.

Indeed some of us seem to have lost the ability to take care of the smallest emergency, for want of a better word, preferring to call on others to take over. In the Far North that means calling volunteers away from their work and/or families to deal with situations callers would once have dealt with themselves.

There will be many situations where it is wise to call on the experts as a precaution, although the list of 'minor' St John calls referred to above supports the view that some are far to quick to hit 111.

It is not difficult to imagine that lights and sirens would rarely be warranted in cases of allergic (as opposed to anaphylactic) reactions, all but the most serious assaults, back pain, headaches, exposure to cold or nausea. Indeed one would imagine that medical attention, if needed, would be accessed more quickly if the patient was delivered to the local hospital by car as opposed to waiting for an ambulance or a fire appliance.

Then there are the pressures generated by an aging population and the attendant increase in chronic illnesses.

Ambulance calls are rising about 4.5 per cent per annum; the last year set a record of 337,000, while, according to Mr Brooke, response times slowed, particularly in urban areas. He warned that that trend would continue unless the cash shortage was addressed (by the Ministry of Health and ACC).

The most accurate measure regarding how ill-equipped some people are these days to dealing with anything remotely approaching a crisis is perhaps provided by the police.

Far from spending their nights, in particular, fighting crime and arresting criminals, they are more likely to be intervening in domestic spats - many are no more than that - and providing the kind of discipline that was once left to parents.

The willingness by some people to summons the constabulary when children won't do as they are told, or a drinking mate doesn't know when to go home, is mind boggling, and represents a genuine abuse of taxpayer funding.

Of late, the police have adopted a proactive approach designed to reduce crime and empower victims. Makes sense if that's the outcome, but there's an awful lot of work to do before some people will be in a position to take control of their own lives and show a bit of initiative when needs must. How far we have come from the generation that didn't like to call for help in any form because they didn't want to be a nuisance.

In the meantime, emergency services will continue to come under pressure, perhaps to the point where they won't be there when they are really needed, but how that might be addressed is problematic. Even a small charge for the services of a fire or St John crew would probably be counter-productive, and those who should pay probably wouldn't.

Perhaps we'll become a little more self-reliant when we have no choice. And that day might not be far away.