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The staff of the Queen Elizabeth Hospital (QEH) Emergency Ambulance Service (EAS) responds to thousands of calls for medical assistance each year, with each call carrying a high probability of exposure to a health hazard or potential danger. This is the nature of the work of these unsung heroes who operate without fanfare, and oftentimes, little recognition. Despite this, the EAS continues to be the critical link between the Accident and Emergency Department (AED) of the QEH and the members of the public who require urgent medical attention and transport.
From a once archaic “scoop and run” service, today’s EAS has evolved into a sophisticated and modern emergency response unit and is home to several highly trained paramedics. The Department’s response procedures also mirror those available in any developed country.
As the main medical emergency response agency on the island, the EAS often joins forces with both the Barbados Fire Service and the Barbados Police Service, when a call for help is made. These 60 extraordinary men and women work around the clock, including public holidays and in adverse weather conditions to respond to an estimated 15,000 calls annually. Calls range anywhere from 40 to 50 daily, as compared to the 1,500 calls received annually by the Barbados Fire Service which boasts more than twice the staff complement of the EAS.
Mr. Wendy Cadogan, the department’s Senior Ambulance Officer, leads its operations, while his senior, Dr. David Byer, provides the medical management protocols and guidance for the team.
Range of emergencies
The emergency calls the EAS responds to are on a spectrum, the direst of which include cases of heart failure, stroke, gunshot wounds, stabbings, serious vehicular accidents, suspected COVID-19 patients, and even emergency childbirths.
Mr. Cadogan, a paramedic who advanced through the ranks to Assistant Ambulance Officer, and then to the managerial position of Senior Ambulance Officer, explains that under the department’s three-shift 24-hour operation, the EAS aims to partner an Emergency Medical Technician (EMT) with the more advanced Paramedic. He elaborates that this allows the department to provide optimum service delivery during emergencies as although EMTs do provide basic care, paramedics are trained to undertake more complex procedures such as cardiac care and intravenous (IV) treatments.
“The ideal situation would be an equal number of paramedics to EMTs, but due to developments such as promotions, retirements … the service is supported by 15 paramedics and 45 EMTs.” However, Mr. Cadogan emphasises that “those 45 EMTs are experienced persons, who are trained and registered with the Barbados Paramedical Council,” which is responsible for the registration of paramedical professionals such as medical laboratory technologists, physiotherapists, clinical psychologists and medical emergency dispatchers.
An integral part of the service offered by the EAS begins with the call for assistance to the emergency number, 511. The information provided on this first interaction can have tremendous influence on the response one receives.
These calls for help are not answered by your average telephone operators, but by expert and experienced Medical Emergency Dispatchers who process and prioritise these calls based on the level of medical urgency.
Cadogan discloses that the EAS follows an international protocol set by the International Academies of Emergency Dispatch (IAED), whose representatives visited Barbados and trained local dispatchers.
“They are trained to assess the medical situation, and they also liaise with the Fire Service, police or other departments that need to be involved to address the particular emergency.” Mr. Cadogan illustrates this training by explaining that in the event the EAS is called to respond to a shooting, the dispatcher ensures that the police are notified and are in place to secure the scene, thus providing EAS personnel with a safe environment in which to work.
To emphasise the critical role of the Emergency Medical Dispatchers, Cadogan shares that dispatchers also alert the AED, providing the staff there with all the necessary information to prepare them to respond to incoming emergencies such as suspected stroke victims as any delay could mean the difference between life and death. “For stroke patients, we have to get them to the hospital, and get their X-rays, and everything has to happen within four hours.” Adding that ischaemic strokes account for 85 percent and haemorrhagic strokes for 15 percent of the strokes the EAS responds to, Cadogan asserts that if there is a bleed in the brain, then timely treatment is critical to ensure the patient’s survival.
Mr. Cadogan explains that dispatchers are trained to ask multiple questions, not to cause unnecessary delays, but to ensure the patient receives the response that is best suited to their medical needs. Cadogan provides the example “In a traffic accident, it’s important to know what type of vehicle is involved and if anyone is pinned. Then we know whether we need to contact the Barbados Fire Service to use extraction equipment.”
On most days the EAS team finds their work extremely rewarding, but there are times when they fall victim to pranks and even fake emergency calls. Admitting that ultimately, the EAS does not receive an abundance of prank calls, Cadogan does acknowledge that the organization receives a number of calls from those who believe that they will be seen more expeditiously if they are transported to the AED by ambulance. He elaborates that these individuals often intentionally provide incorrect or misleading information, which he attributes to a lack of public education on the EAS’ role and responsibilities.
Nevertheless, Cadogan notes that one of the main obstacles the EAS faces is the refusal of other motorists to pull over and stop when they hear the sirens or see the emergency flashing lights. “We don’t want drivers to slow down, we want them to pull over and stop. When drivers just slow down it is difficult for our drivers to anticipate the motorist’s next move.”
Fundamentally, in addition to saving countless lives, Cadogan, and his team just want to ensure that both staff and patients make it to the AED safely.