LEGISLATIVE COUNCIL BRIEF
PERFORMANCE INDICATOR
FOR THE EMERGENCY AMBULANCE SERVICE
INTRODUCTION
At the meeting of the Executive Council on 22 September 1998, the Council ADVISED and the Chief Executive ORDERED that the emergency ambulance service (EAS) of Fire Services Department (FSD) should adopt a 12-minute response time as its performance target to replace the current target of one of a ten-minute travel time effective from 1 November 1998.
BACKGROUND AND ARGUMENT
Consultancy Studies on Ambulance Services
2 In 1986, a consultancy study was conducted on the provision of ambulance services in Hong Kong. The consultancy study recommended, inter alia, a ten-minute target travel time should be achieved for 95% of emergency calls. This recommendation was endorsed by the previous Executive Council in 1987 and has since been used as the basis for the development of the EAS.
3 FSD commissioned another consultancy study in 1995 to update the findings of the 1986 study and explore further improvements to to advise on how to further improve the EAS. The study recommended, inter alia, that the ten-minute travel time target should be retained as the performance target until it could be achieved consistently, and that we should move towards replacement of travel time by response time for performance measurement of the EAS.
Measurement of the Performance of the Emergency Ambulance Service
4 Response time is defined as the interval between the time of call and the arrival of an ambulance or ambulance aid motorcycle (AAMC) at the street level of the scene. It is the sum of two consecutive components i.e. the activation time and the travel time. Activation time is the duration between the receipt of a call and the time when the dispatch procedure is completed. Travel time refers only to the time taken by an ambulance or AAMC to travel to the street level of the scene. Since travel time does not take account of the activation time taken by the EAS, it is generally accepted that response time should present a more realistic performance indicator of the EAS.
Travel Time Performance
5 The current pledged performance target for the EAS is responding to 92.5% of calls within a ten-minute travel time. Actual performance against the growth of emergency calls in the last three years is as follows -
| Year | No. of emergency calls | Percentage % increase | Percentage of calls reached within 10-minute travel time
|
|---|
| 1995 | 317,749 | - | 89.5%
|
| 1996 | 347,607 | 9.39% | 89.7%
|
| 1997 | 367,064 | 5.60% | 89.64%
|
| 1998 (up to August) | 264,534 | 7.33* | 89.37%**
|
(measured by trunked radio)
Note * Compared with corresponding period in 1997.
** The lower performance level was attributable to -
- the substantial increase in EAS calls during the period; and
- some technical difficulties encountered during the initial trial operation of the trunked radio system.
6 We have been implementing the recommendations of the 1995 consultancy study to improve the performance of the EAS. A list of the improvement measures taken is at
Annex A. Additional resources have been secured to improve the EAS over two phases in 1997/98 and 1998/99. The next batch of additional manpower will finish training and render active service by October 1998, whilst the last batch will render service in April 1999. As recommended by the consultant, efforts are being made to build additional ambulance depots to improve the coverage of the EAS in the Territory. In addition, the FSD has initiated other improvement measures to enhance further the quality and efficiency of the EAS. The measures are set out at
Annex B.
7 The anticipated performance of the EAS under a 12-minute response time target is expected to be around 92% in the fourth quarter of 1998. We expect to see further improvement in the performance by some 0.5% when the last batch of additional manpower become fully functional by the second quarter of 1999.
The Proposal
8 FSD conducted a trial scheme using its newly commissioned trunked radio system during September 1997 to March 1998 to measure the response time performance of its EAS. Before the commissioning of this new radio system, FSD was unable to measure response time performance automatically because of the inadequacies of the old radio systems. The main advantage of using the trunked radio system is the protection against both radio interference and communication black spots encountered in the past. As the technical feasibility of reliable data capture is resolved, FSD now proposes to switch andto use response time as the performance indicator of the EAS to provide a better measurement of its performance.
9 The EAS requires on average two minutes for the activation process. To take account of the existing performance target of a travel time of ten minutes, therefore, we propose a response time of 12 minutes, i.e. two minutes for activation and ten minutes for travelling. FSD proposes to maintain its pledge of responding to 92.5% of emergency calls within the new performance indicator.
10 Our proposed 12-minute response time performance target compares favourably with overseas standards. For example, Iin New South Wales, the performance target of the EAS is a response time of to respond to 95% of calls within 15 minutes for urban areas and 19 minutes for rural areas. The activation time for the EAS is three minutes for the United Kingdom and New South Wales, whilst that for Taiwan is six minutes. We have also noted that in many countries, such as Japan and Singapore, there are no performance pledges for the EAS.
11 The actual performance of the EAS, expressed in terms of response time, for the period from October 1997 to AugustJuly 1998 is appended at Annex C. The effect of the improvement measures including those described in Annex AA is reflected by the improvement significant rise in performance level from 88.416% in for the first six months in 1998 June to over 91% in July and 91.29% in July and 92.58% in August 1998 under the proposed response time target. The opening of the Accident and Emergency Department in the North District Hospital in August 1998 and the relatively dry good weather and favourable traffic conditions thisin summer year have also contributed to the better performance.
12 With 82 and 108 additional ambulance staff joining the service in October 1998 and April 1999 respectively, we expect the EAS to be able to meet the proposed performance pledge of responding to 92.5% of calls within the 12-minute response time by the second quarter of 1999. When the proposed performance target can be achieved consistently, we will review the performance target by seeking to achieve 95% of emergency calls within the 12-minute response time or reduce the duration of the target response time.
FINANCIAL AND STAFFING IMPLICATIONS
13 The proposal to switch to a 12-minute response time as the performance target of the EAS would not incur additional resource requirements.
PUBLIC CONSULTATION
14 The 1995 consultancy study recommended that we should consider moving towards the replacement of travel time by response time when the performance target for travel time could be achieved consistently. Although the EAS has not been able to meet the pledged target of ten-minute travel time target for less than 90% of calls only, as against the pledged target of 92.5% of emergency calls, the Public Accounts Committee had, at a hearing in December 1997 to consider the Director of Audit's Report No. 29, urged the Administration to adopt response time as the performance measurement as soon as possible. This was echoed by the Legislative Council Panel on Security. We were committed to a trial scheme to test the feasibility of adopting the new performance measurement and report the findings to the Legislative Council (Legislative Council in the second half of 1998.
15 Our proposal to switch to a 12-minute response time performance target has the support of the Ambulance Services Steering Group which comprises representatives from the Security Bureau, Health and Welfare Bureau, FSD, Department of Health and Hospital Authority.
PUBLICITY
16 A press release is issued today. Wof the recommendation in paragraph 2 above, we will include the new response time target in the Policy Address booklet of the Security Bureau to be issued in October 1998. Weare planning to will brief the Ambulance Officers' Association, the Ambulancemen's Union and the Legislative Council Panel on Security in October before we adopt make the new performance target on 1 November 1998.the middle of the month A spokesman will be available for answering media enquiries.
OTHERS
17. For enquiries, please contact Mr Edward TO, Assistant Secretary for Security on 2810 3948.
Security Bureau
5 October 1998
LEGISLATIVE COUNCIL BRIEF
PERFORMANCE INDICATOR
FOR THE EMERGENCY AMBULANCE SERVICE : ANNEXES
Annex A -Recommendations of the Consultancy Study in 1995 implemented by the FSD
Annex B -Additional Measures taken by the FSD to Improve the Quality and Efficiency of the EAS
Annex C -Response Time Performance (%)
Annex A
Recommendations of the Consultancy Study in 1995 implemented by the FSD
- To extend emergency cover to fire stations at strategic locations.
Ambulances have been redeployed as recommended.
- To redeploy ambulances from well-provisioned stations to those where manning is inadequate.
Resources have been redeployed as far as practicable according to the consultant symbol 146 \f "Times New Roman" \s 14 s recommendation.
- To transfer non-emergency ambulance service to another agency.
All non-emergency cases have been transferred to the Hospital Authority and the Auxiliary Medical Service.
- To include the turn-outs of AAMCs in the calculation of emergency ambulance performance.
Contribution of the AAMCs in achieving target performance has been included and the FSD will continue to maximise utilisation of the AAMCs in emergency response.
- To streamline the operational procedures on ambulance deployment to achieve a more efficient mobilisation.
Recommended measures which include more flexible use of available crews on mobile and at hospital, more rational and effective move-ups, etc have been adopted.
Annex B
Additional Measures taken by the FSD to Improve the Quality and Efficiency of the EAS
- We have upgraded the ability of ambulance crews to deal with cardiac conditions by equipping all ambulances with automatic external defibrillators in early 1998. The FSD has also commissioned the second Mobile Casualty Treatment Centre to improve the ability to deal with incidents involving multiple casualties. The Department is planning to procure a third Mobile Casualty Treatment Centre to further improve the service.
- The communication amongst ambulances crews and the FSCC has been significantly enhanced with the commissioning of the new trunked radio system in late 1997. All ambulances will also be equipped with hand held radio sets to supplement the existing radio telephones.
- As part of the development programme of paramedic ambulance service, the FSD engaged a medical doctor as the department symbol 146 \f "Times New Roman" \s 14 s medical director in April 1997 to provide advice and assistance in the paramedic training programme, including the establishment of a quality assurance programme for the paramedic service.
- Refresher/continuation training programmes are organised for the FSD staff to enhance their professional skills and knowledge. Overseas training programmes are also arranged annually for officers to keep abreast of the latest ambulance techniques and technology.
- Commencing 1997, the FSD has started a programme to replace old ambulances with newly designed ones to provide better patient comfort and operational efficiency.
- The provision of medical equipment on board of ambulances is under constant review. Apart from the various improvements in ambulance equipment, burn dressings specifically designed for front line ambulance use have been employed to render the most expeditious and suitable stabilising treatment to patients suffering from burns and scalds. A new oxygen resuscitation system is also being procured to replace the existing oxygen ventilators of ambulances to keep up with the latest development in emergency service.
Annex C
Response Time Performance (%)
|
Month/ Year
|
No. of Emergency Calls
|
Response Time
|
|
(6 min.)
360 Sec.
|
(8 min.)
480 Sec.
|
(10 min.)
600 Sec.
|
(11 min.)
660 Sec.
|
(12 min.)
720 Sec.
|
(12.5 min.)
750 Sec.
|
(13 min.)
780 Sec.
|
(14 min.)
840 Sec.
|
(15 min.)
900 Sec.
|
(16 min.)
960 Sec.
|
Average Response Time (Sec.)
|
|
Oct 97
|
29773
|
29.83%
|
57.23%
|
78.07%
|
84.80%
|
89.28%
|
91.05%
|
92.43%
|
94.39%
|
95.79%
|
96.83%
|
479
|
|
Nov 97
|
29781
|
29.97%
|
56.68%
|
77.58%
|
84.55%
|
89.16%
|
90.82%
|
92.12%
|
94.22%
|
95.76%
|
96.84%
|
480
|
|
Dec 97
|
32788
|
28.81%
|
55.79%
|
76.85%
|
83.36%
|
88.30%
|
89.97%
|
91.47%
|
93.57%
|
95.20%
|
96.38%
|
487
|
|
Jan 98
|
32447
|
29.54%
|
56.62%
|
77.77%
|
84.87%
|
89.16%
|
90.81%
|
92.08%
|
94.07%
|
95.56%
|
96.65%
|
481
|
|
Feb 98
|
30963
|
28.57%
|
55.42%
|
76.42%
|
83.45%
|
88.18%
|
89.97%
|
91.35%
|
93.52%
|
95.13%
|
96.31%
|
489
|
|
Mar 98
|
34481
|
27.55%
|
54.07%
|
75.25%
|
82.63%
|
87.55%
|
89.23%
|
90.77%
|
93.17%
|
94.88%
|
96.20%
|
495
|
|
Apr 98
|
31294
|
28.47%
|
55.63%
|
77.07%
|
84.09%
|
88.68%
|
90.28%
|
91.70%
|
93.77%
|
95.32%
|
96.35%
|
489
|
|
May 98
|
33051
|
28.97%
|
56.18%
|
77.65%
|
84.94%
|
89.41%
|
91.07%
|
92.35%
|
94.35%
|
95.84%
|
96.90%
|
483
|
|
June 98
|
33406
|
28.24%
|
55.87%
|
76.87%
|
83.90%
|
88.41%
|
90.07%
|
91.61%
|
93.74%
|
95.30%
|
96.47%
|
487
|
|
July 98
|
35193
|
30.78%
|
59.62%
|
81.29%
|
87.46%
|
91.29%
|
92.58%
|
93.68%
|
95.46%
|
96.64%
|
97.46%
|
467
|
|
Aug 98
|
33290
|
31.36%
|
60.09%
|
82.00%
|
88.38%
|
92.58%
|
93.76%
|
94.70%
|
96.20%
|
97.25%
|
97.95%
|
460
|
