Dr. David Byer is the Head of Department of the Emergency Ambulance Service (EAS); however, his role there extends far beyond the mere operation of ambulances.

He ensures that when a team of first responders is on the scene of an emergency, these paramedical professionals are providing premium care and intermediary interventions to allow patients to have the best possible outcome when they reach the Accident and Emergency Department (AED).

A veteran emergency care physician, Dr. Byer has been with the EAS since 2006 and has shepherded its transition to a more strategic response operation, and this includes providing staff with important medical training.
“We concentrate a lot more on medical management, both at the scene and enroute. We ensure that ambulances are outfitted to provide that care and that the staff are trained and skilled to perform these services.”

Byer admits that there is a strong connection between the EAS and the Accident and Emergency (AED) Department noting that the EAS is “essentially the outreach of the AED,” and functions as “part of the emergency care team for the QEH.” He strongly believes that the EAS plays a critical role in contributing to good patient outcomes for those who utilize the service. He however cautions those with the misguided belief that they will receive faster medical attention at the AED if transported there by ambulance, as he considers this to be an abuse of the service offered. Byer expounds on this by sharing that the AED utilizes a triage or sorting system to prioritize care for patients based on the severity of the their medical condition, and that the mode of transportation has absolutely no bearing on how quickly a patient may be seen on arrival at the AED.

Size and function

With approximately 15,000 emergency calls annually, managing the department can often be challenging. At the same time, the head of department shares that the EAS is functioning “reasonably well” despite the current circumstances caused by the COVID-19 pandemic.

“At this time, we are able to put five to six ambulance crews on the road at a time.” However, Dr. Byer discloses that ultimately, the EAS would prefer to have “eight units or more on the road” because the more crews available for dispatch directly increases the likelihood that the department will be able to respond quickly when someone does call for help.

Although resources are limited, Dr. Byer explains that the ambulances that are available are used strategically, and that the equipping of these ambulances with GPS technology has greatly assisted the EAS with the management of these resources. He illustrates this by describing a scenario in which the ambulance crew is travelling to a non-urgent case in the north of the island, and an emergent case such as a gunshot wound or heart attack arises in St. James. He shares that in this instance the ambulance is tracked using the GPS technology, and is then rerouted to the emergency if it has not already arrived at the scene for the less urgent medical complaint.

Noting that “every minute in an emergency situation is valuable… if someone is there, they should be able to do things like CPR (Cardio-pulmonary Resuscitation) and some form of first aid” Byer states that the EAS has been able to “create community programmes to improve the community response.” He adds that the EAS team has also been enhancing the medical response skills of other agencies such as the Barbados Red Cross, the Department of Emergency Management, District Emergency Organisations, and the Barbados Fire Service through the training of some of their personnel.

COVID Impact

The EAS has not escaped the clutches of the COVID-19 pandemic, but the department has adjusted its processes and procedures for personnel. Byer recalls that at the onset of the pandemic “part of the training even at a basic level is how to deal with infectious diseases in terms of personal protection… we examined things like the mode of transmission, and what would be the risk level for our staff.” He also notes that part of the training also included simulations and “working with other professionals in the QEH on the safe transfer and management of COVID patients.” As he spoke about some of the COVID-19 risks to which the staff is exposed, Dr. Byer reinforces that continuous training and the following of protocols continues to keep employees relatively safe as they transport seriously ill patients including those on ventilators to the isolation centres.

Restrictions

Dr. Byer says that the EAS operates by the mantra “anyone can have COVID”; and explains that as many presentations of the virus are asymptomatic; his department has adopted a culture of sanitising and disinfecting ambulances and medical equipment after each patient transfer. Although patients and anyone accompanying them are also asked to wear a mask to minimise potential exposure to the virus, this added precaution ensures the safety of staff, future patients and their loved ones.

Another way in which the service offered by the EAS has been impacted is the reduction of the number of individuals who can accompany a patient in the ambulance. “Before we were rather liberal with allowing as many as two people to accompany patients,” Byer says, but now only one person is allowed to ride along in the ambulance.

Despite all these precautions, Byer relays that an EAS member still became infected which resulted in the other members on that individual’s team being placed into quarantine. Recollecting this incident, Byer notes that “We are well aware that this may happen again, and we have put contingencies in place in the event this befalls us, we would still be able to provide this key service to Barbados.”

Criticism

Despite the value of the service provided by the EAS, the department still faces its fair share of criticism, with the main one being its response times to emergencies. Speaking to this Byer indicates that the calls received are prioritized based on urgency, and that at times when there is an influx of emergency calls the wait time for responses to less urgent calls is often extended. He explains “We would respond first to someone who is having chest pains or someone who has suffered some sort of major form of violence or injury, ahead of someone who may have an infected leg.”

Cause of Delays

Byer also took the time to share that the pandemic has increased the number of things the team has to do before it can be dispatched and after returning from a call. He notes that EAS calls that involve respiratory conditions are treated with heightened caution, meaning that teams are required to wear their personal protective equipment (PPE) which can take approximately 10 minutes to put on.

“In this environment, processes are a little more protracted. The ambulance has to be carefully cleaned, and their PPE has to be removed and sanitised. The entire ambulance must be cleaned using whatever modalities are required to make it ready again for a call.”

Dr. Byer concludes by informing us that although the current turnaround times are extended, these delays are necessary to create a safe environment for the next person who requires the use of an ambulance.