St John failing to meet response time targets: 90yo waits three hours after cat attack

A 90-year-old woman lost consciousness at least three times during a three-hour wait for an ambulance after her cat bit her leg leaving her kitchen “awash with blood”.

And the daughter of a 92-year-old with a severe stomach pain which left her shaking and vomiting was told to drive her mother to hospital.

Both patients used the St John medical alarms they pay for and were disappointed by the level of care they received.

They are not the only ones facing long waits for help.

Only two of the eight St John ambulance response time targets were met in the year from July 1, 2019 to June 20 ,2020.

St John has 50 per cent and 95 per cent targets for rural and urban areas for both suspected cardiac or respiratory arrest and for instances where a person’s condition appears life-threatening.

When it came to cardiac or respiratory response times in rural areas, the charity exceeded its target of getting to 50 per cent of cases in 10 minutes by 2 per cent and was bang on its target of getting to 95 per cent of cases in 25 minutes.

In urban areas, where target times are lower, ambulances only got to 44.5 per cent of cardiac or respiratory cases within the allotted six minutes and 91.9 per cent within 12 minutes.

When it came to life-threatening callouts, none of the targets were met.

In urban areas 44 per cent of calls were responded to within eight minutes and 93.1 per cent in 20 minutes.

Rurally, ambulances got there within 12 minutes 47 per cent of the time and were within 30 minutes in 90.4 per cent of cases.

St John said new clinical procedures and guidelines had increased the time it took to treat a patient meaning ambulances were tied up for longer while traffic on the roads also affected response times.

St John deputy clinical director Dr Craig Ellis said St John was currently seeking Government funding for 200 extra ambulance staff and in last year’s Budget they were given additional funding to recruit 100 ambulance officers to help relieve the pressure in high demand areas.

He said the organisation was half way through recruiting staff to work in communities that provide the most challenge to response targets such as South Auckland.

“The public can be reassured that we will respond to those patients in life-threatening or serious condition quickly, but in some circumstances people who are not in a serious condition may experience a delay in ambulance response.”

Three hour wait with blood "spurting" from leg

Wilhelmina Pondman, 90, was among the 21,653 patients who had to wait more than an hour for an ambulance in the last six months.

Her injury was not classified as life-threatening by St John operators but she feared for her life as she struggled to remain conscious.

She activated her St John medical alarm about 9.15am on March 28 after her 16-year old Burmese cat got a fright and bit her on the shin causing blood to “spurt” from the wound.

The Tuakau resident managed to make her way to the kitchen and reach the alarm and her phone off the table so she could alert St John and call her neighbour for help while she waited.

“The whole floor of the kitchen was awash with blood,” she said. “I saw that and of course it frightens you. I thought, ‘Oh my God, am I bleeding to death?’. It’s very, very frightening.”

Pondman’s neighbour helped move her to the garage, wrapped her leg in a towel and sat her on her walker with her leg up on a stool while they waited.

Pondman’s two daughters, who had been alerted by St John when their mother activated her alarm, also arrived before the ambulance and one ended up on the phone with St John staff trying to talk her through how to care for her.

During the three-hour wait, Pondman said she lost consciousness at least three times and remembers her daughters telling her not to go to sleep and to stay with them.

“It was really a trauma, it was really very bad,” she said.

She said they were told an ambulance was on its way but was then diverted to a more urgent job so another ambulance had to be sent in its place.

However, when St John did finally arrive the staff were great, Pondman said. The crew used tape to close the wound and put a dressing on it.

Pondman, who has been a member of St John for 26 years and began paying for the medical alarm after she had a stroke three years ago, said it was the length of the wait which caused her to speak out.

“I am horrified at what happened. I could have bled to death. What is the use of this alarm if there is no immediate response,” she said.

“What good is that if I press that button and they don’t come? Am I any better off with that alarm or not?”

St John said a call handler who spoke to Pondman assessed her injury as being non-life threatening and all available ambulances were tending to patients who needed an immediate response.

Because of the delay a St John telephone clinician called to perform an advanced phone triage and make sure the bleeding was under control.

The ambulance crew who tended to Pondman said they treated a “minor injury”.

Daughter told to drive mother who thought she was 'going to die' to hospital

Whang─ürei resident Nellie Joosten, 92, has had a St John medical alarm since 2012 and used it for the first time at 3.54pm on January 30 this year when she began to feel “enormous pain in my stomach and back like I have never experienced before”.

The contact centre then asked her some questions and told her a nurse or paramedic would call within 10-30 minutes. If anything was to change she was to call back.

Joosten said the pain was so bad she was shaking uncontrollably and as it became worse she began to vomit.

“I have never in my life been in so much pain or so sick before. I thought I was going to die.”

Daughter Marie Martinovich, who was with her at the time, then called back and was asked more questions before again being told someone would call back.

At 4.23pm an emergency nurse called and asked more questions including whether Joosten could walk.

When Martinovich said she could if she was holding on to something the nurse told her to drive her mother to hospital herself because ambulances were for “life-threatening” cases. The nurse said they would send help if she could not get Joosten into the car.

When Martinovich did get her to hospital she was admitted straight away where tests were done showing she had a bad kidney infection and kidney stones.

She was operated on first thing the next morning and finally discharged after six nights in hospital.

“The surgeon was concerned and stated he nearly lost me on the table – is this life-threatening enough?,” Joosten asked.

Joosten said she paid the fee for her medical alarm without hesitation because she was assured that if she ever needed emergency assistance it was simply a push of a button and help would be on the way.

“Something needs to be done as this is unsatisfactory for not only myself, but others also – especially those who rely on the alarm as I did.”

In response to a formal complaint made to St John and also sent to local MPs and the Health and Disability Commission, St John said based on the information provided to the emergency medical dispatcher it was agreed she needed further clinical assessment.

“St John has emergency nurses and paramedics trained in specialist telephone assessment of patients, and their role is to carry out detailed clinical assessments over the phone, give advice and arrange the best help for the patient,” ambulance communication centre clinical effectiveness manager Lilah Barnett said in the response.

“This may result in ambulance response, referral to local accident and emergency or self-care advice. On this occasion the emergency nurse completed an assessment recommending you be transported privately to hospital for further assessment.”

Barnett said their review of the case had “identified areas of learning for the emergency nurse to ensure that all emergency symptoms are ruled out and to ensure that a clear explanation relating to transport is provided”.

“As a result, the emergency nurse has had one-to-one coaching with their line manger to
ensure that the appropriate care is always demonstrated and applied.”

However, based on the information provided it was safe for Joosten to be transported privately, she said.

“I sincerely apologise for the distress this matter has caused you and your family,” Barnett said.

How a St John medical alarm works

St John’s website explains one of the major benefits of an alarm is that the cost of ambulance transfers is covered. It also explains call handlers assign one of five priorities to all medical alarm activations.

Purple is for immediately life-threatening situations like a cardiac arrest, red is for potentially life-threatening and time-critical cases. Both situations will see an ambulance sent immediately using its lights and sirens.

Orange cases are urgent and potentially serious but not life-threatening so an ambulance will be sent immediately but may travel at normal road speed.

Green is neither serious nor life-threatening so an ambulance would be dispatched as soon as possible but may take some time to arrive depending on workload.

Grey incidents include aches, pains and vomiting and are deemed to require “further clinical assessment”. That means a registered nurse or paramedic will call back to ask further questions and determine if an ambulance is needed or if you should make your own way to a GP or accident an emergency centre.

Priorities

St John deputy clinical director Dr Craig Ellis told the Weekend Herald the organisation always aimed to respond as soon as possible but life-threatening calls had to be given the highest priority.

Ellis said there had been a marked increase in demand for ambulances with callouts increasing an average of 3 per cent a year for the last five years.

“We’re advocating for the operating costs of the ambulance service we provide to be close to fully funded,” St John’s annual report read.

“Right now, we can only respond with the resources we have, but we want to continue to improve access to health services for the New Zealanders we serve.

“For example, we always prioritise those with life-threatening conditions, but this means those with less acute presentations but who are still in pain are increasingly waiting longer for assistance.”

St John response time targets – the best and worst regions

The regional breakdown of St John’s success hitting response time targets showed mixed results with about half the regions exceeding the 50 per cent target.

Broken down by region, the central west area was the worst performer in the urban 50 per cent target when it came to getting to cardiac or respiratory cases within six minutes at only 36.4 per cent. Best was Southland/Otago at 58.5 per cent.

In life-threatening cases ambulances in Auckland’s urban area only made it to callouts within the eight-minute window 37.1 per cent of the time. Again the best performing areas was Southland/Otago on 57.4 per cent.

When it came to rural performance, Auckland was the worst performer for both cardiac and respiratory callouts (36.8 per cent within 10 minutes) and life-threatening incidents (29 per cent within 12 minutes). Southland/Otago was again best across both categories with 65 per cent and 57 per cent respectively.

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