Figures released in 2002 by the Ministry of Health revealed that around 50 people die a year because of inadequate staff and equipment on ambulances in Cyprus.
Cyprus still does not have an accessible, efficient and effective ambulance service. This is despite promises made by the Health Ministry to adhere to the 1994 World Health Organisation’s recommendations which 14 years ago criticised the complete lack of skilled ambulance drivers and urged the government to introduce professionally trained paramedics on board ambulances by 1995.
In 1996 a study by a British paramedic consultant concluded that two years on from that report none of the WHO recommendations had been implemented.
In August 2002 the then Health Minister Frixos Savvides pledged that trained paramedics would be on board ambulances within the year. It didn’t happen.
In October 2005 the government pledged that a paramedic school was being planned along with the updating of all public hospital ambulances. This scheme is now promised to be up and running by 2010.
The Cyprus Resuscitation council in 2005 confirmed road traffic accidents resulting in death was around 120 annually. Cardiac arrest was listed as being the leading cause of death in Cyprus accounting for 56 per cent of all cases. Better paramedic care would reduce those deaths.
What is a paramedic?
A professionally trained paramedic deals with medical emergencies, as well as complex non-emergency hospital admissions, discharges and transfers.
They work as a rapid response unit, usually with support from an ambulance technician or emergency care assistant.
Paramedics face emergencies ranging from minor injuries to dealing with serious casualties in a major road accident.
They will respond to an emergency and must be able to undertake all of the following.
1. Be able to swiftly assess a patient’s condition
2. Decide on the appropriate course of action based on clinical need.
3.Be able to make quick decisions about moving a patient
4. Use advanced life support techniques, such as electric shocks (defibrillation) to resuscitate patients.
5. Carry out certain surgical procedures such as incubation (inserting a breathing tube into the throat)
6. Use advanced airway devices to keep the airway open
7. Use intravenous fluid therapy and drug therapy.
8. Administer medicines and give injections
9. Dress wounds and apply splints.
In the UK there are two ways to train to become a registered paramedic – the higher education route and the traditional work-based route.
The first requires trainees to have entry qualifications which will usually include between one and three A levels including a life science or natural science.
The traditional work-based route is to join an ambulance service as an ambulance care assistant. After gaining promotion and experience as ambulance technician candidates then apply through open competition for a place on a paramedic training course.
All UK paramedics are registered with the Health Professionals Council after completing 600 hours of intensive training. This training is divided into three sections and examinations on all three courses have to be passed.
The other route is a two year diploma or three year university course.
The level of training required to be a paramedic reflects the changing role of the ambulance service to integrate the qualifications and skills of the paramedics into the community.
Currently ambulances act as taxis, ferrying patients to and from hospitals and clinics with patients in the company of a nurse who is not allowed to administer any medication or perform any invasive techniques.
Cyprus ambulance drivers are without any medical training, nor are they ‘blue light’ and Emergency Response trained, a legal requirement in Europe before anyone can drive an emergency vehicle.
The latter course consists of three weeks theory and intensive driving training, learning how to control, under and over steer and understanding all types of skids that could happen when travelling at high speeds. Critically for the patient, the course teaches a standard of driving which does not inflict additional pain or discomfort.
So what do people in Cyprus do if they or their family members require immediate emergency aid?
Naively, many foreign residents will call for an ambulance and then expect that the vehicle will have all the essential life-saving equipment plus the on-board expertise to keep them alive until they get to the hospital or clinic.
For most, that is still a dream. You will be exceedingly fortunate if the ambulance gets to you within 40 minutes over the accepted response time, and when it turns up at your doorstep it will invariably be manned by either a freelance driver who is paid by the hour and holds zero medical or even first aid qualifications.
This is in direct contrast to the high standard of medical treatment found within our hospitals and some private clinics. It’s as if risking the death or further injury to a patient whilst en route to proper medical aid has become both a calculated and accepted risk by the medical profession.
One lady in Peyia, who telephoned for an ambulance for a friend suffering from acute chest pains, was greeted by a driver who told her when they were ‘loading’ her friend into the ambulance that “this job wasn’t so much different from his job back in Bulgaria”. He had been a lorry driver delivering fresh fruit and vegetables.
Recruitment of foreigners spectacularly unqualified to offer any link in the chain of survival for emergency patients are now being recruited by private clinics.
I spoke to one man in his late sixties who told me a major clinic had asked if he would take on the role of freelance ambulance driver to cover staffing shortages on certain shifts.
“I asked the clinic if they would give me any special training as I’d never done anything like this before although I can drive almost any vehicle and have a clean licence. The owner of the clinic told me to just load up the patient and get back to clinic as fast as possible. I didn’t end up taking the job because I felt so unqualified dealing with such a responsibility,” he said. “To be honest the whole thing shocked me as I thought naively that there must be some training at least in basic first aid and how you go about lifting a seriously injured patient.”
So when tourist Roger Kennedy suffered spinal injuries after a fall, and friends here on holiday telephoned me to ask where they could get emergency help, I immediately contacted the Paphos-based private ambulance service Houston Medical run by John Thompson.
I explained that this man had suffered a painful back injury and within 12 minutes two qualified paramedics and an ambulance technician were on the scene. They carefully moved Roger onto a ‘scoop’ board having first fitted him with a neck brace. In the ambulance they took all his vital signs, patiently reassured him and, with the driver aware of the extent of the injury, smoothly delivered him to the clinic.
The neurosurgeon who attended Roger later told him he had been extremely lucky not to have suffered paralysis and complimented the emergency treatment he had received from the qualified paramedics on board the Houston Medical ambulance.
John Thompson is a qualified paramedic and teacher of first aid. He is also a qualified health and safety officer.
For the last five years he has been trying to get the government to accept and back his professionally run service which currently employs six qualified blue light drivers, six UK-trained paramedics and four nurses.
John makes no profit from the service. Three words explain his motives: ‘To save lives’.
“That’s what it’s all about. I want to make a difference. As a professional paramedic and teacher, I fully recognise the acute problems faced here in an emergency situation,” he said. “It’s ironic, if not downright wasteful that we have sitting here in Paphos two state-of-the-art ambulances both licensed and fully operational with top flight staffing, yet we cannot get the all essential backing needed from the government.”
The government argument for not doing this, John said, was because the government service will have paramedics of their own soon. “To be honest that’s a bit pie in the sky when you consider it takes years to train a professional paramedic,” he said. “Where are they going to recruit and train these potential recruits? There’s no medical school in Cyprus and to my knowledge no trainers with the qualifications to train them.”
Houston Medical offer emergency ambulance cover to residents and visitors in the Paphos district. They charge a very reasonable fee, with the money going to keep the service running. Residents under a scheme currently in operation can now also pay for six month or an annual cover. This allows those with chronic health problems the peace of mind to call on the service at any time day or night. In addition they offer EU-approved first aid classes for employees and for those house bound and in wheelchairs. There is the offer of a safe transfer system from home to any destination on the island. They also work with insurance companies wishing to transfer sick patients safely to the airport for treatment back in their own country.
Houston Medical offers a unique service to the public. Its very uniqueness is in effect wrong as this level of professional ambulance cover should by rights be available to every one on the island. It’s now a case of waiting and seeing if the many promises made by the government are kept… this time.
n Houston Medical
Tel: 26 811 771 Mob: 99 538 158
email [email protected]
www.houstonmedicalltd.com
