Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Death Rate in London to Increase

There is an excellent article describing the probable unintended consequences of a new, but not well thought out policy affecting the LAS (London Ambulance Service). It starts with the possible original idea for the article.

When I heard the news that the London Ambulance Service was going to reduce it’s frontline staff by 560 people my first thought was that this would meet the true definition of ‘decimate’, to remove one in ten men.[1]

But the LAS policy is to cut one out of every six, not one out of every ten. Apparently, LAS requires even more severe punishment than mutinous troops.

Call volume increases every year and next year there will be this tiny get together in London that will not cause any problems for EMS. The 2012 Olympics. The build up to the 2008 Olympics in China was a part of the financial bubble that drove crude oil to almost $150/barrel, but that increase in business would not be expected to produce a greater increase in call volume. No. The LAS can cut staff by 16% and do just fine.

They haven’t had to fudge their numbers to avoid fines for responses that are slower than permitted by their rules mandates.

This will change. In the future, when you call for an ambulance, a big yellow van will not be sent. Instead the little yellow car will arrive and see if you really are sick enough to need a proper ambulance to take you to hospital.

But where will the increased need for people to drive the little yellow cars come from? Well, they will be taken off of the big yellow vans to be put on a little yellow car. This will reduce the number of ‘proper’ ambulances on the road even further.[1]

The likely problems with this approach are explained very well in the article.

Decreased physical safety.

Decreased job satisfaction.

Decreased job security.

Increased liability for medics.

Increased risk for patients.

What could be better?

So, you will have staff working outside their scope of experience, worried for their jobs, being sent to decide if you really do need an ambulance – anyone who has been in the job for any length of time will decide that everyone will need to go to hospital in order to protect their own career as well as the life of the patient.

So you will need the same number of ambulances.[1]

Maybe, but this may actually require more ambulances.

There are even some suggestions for form letters expressing condolences for the predictable increase in deaths in London.

Oopsie.

How long before we imitate this in the US?

Footnotes:

[1] Death Rate in London to Increase
Brian Kellett (dot) net
Article

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