DEFIBRILLATOR EMERGENCIES
DEFIBRILLATOR EMERGENCY TELEPHONE NUMBER
WHAT YOU NEED TO DO IN THE EVENT OF A SUSPECTED HEART ATTACK
IMMEDIATELY PHONE :
English speaking 97 836222 Greek speaking 99 313184
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IF YOU HAVE NOT ALREADY GOT ONE, COLLECT A COPY OF THE PISSOURI HEALTH LEAFLET FROM THE VILLAGE OFFICE, MARKOS INTERNET CAFE, PAPANTONIOU and other outlets around Pissouri.
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You cannot be advised strongly enough to call the Village Defib Team ONLY if you have a genuine defibrillator emergency.
And even then call the State ambulance first on 112 or 25 801100 to safeguard yourself. (This is because the Defibrillator Team emergency phone holders do not always answer the emergency phone).
For all other medical emergencies call the State ambulance. If you call the Defib Team you are likely, in a stressful situation, to be persuaded to use a private ambulance at considerable cost.
You can, of course, call a private ambulance yourself, if you wish to protect your privacy and medical details. Have the telephone number of a reputable firm readily available if this is what you want. Once you call the Defib Team your personal and medical details are available to the Pissouri Residents’ Association.
If you call the Defib Team under its current management your finances, your personal and medical confidentiality and even – possibly, your life could be at risk.
The Defib Team may be voluntary, but it is also chaotic and there are major problems with the way it is functioning. For example, senior members of the Team have on occasions disagreed with treatment being given by the less well-trained "first responder" but are ignored. One member of the Team with a known alcohol problem has turned up at a (day time) incident with slurred speech and smelling strongly of alcohol.
The Village Office are aware of the problems, but have effectively handed over management of the Defib Team to the expatriate Pissouri Residents’ Association. Further, it is actively assisting the PRA committee’s membership recruitment drive and private ambulance plans by allowing them to use the Defib Team as a means of networking and recruiting members to both the Association and their private ambulance scheme through the PRA members in the Defib Team. Despite protestations to the contrary from both parties there is no way of preventing this.
This is in spite of the Mukhtar making it clear that the proposed divisive PRA private ambulance service will be detrimental to the health services available to the entire community. This has in no way dissuaded the PRA from going ahead with their plans. And, in spite of what they say, this private ambulance scheme will effectively be mainly for English members of the community, because their private ambulance service is not Greek-speaking. So far almost every call-out to an English patient has resulted in a private ambulance being called. Only the State ambulance has been used for Cypriots.
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THE PRA PRIVATE AMBULANCE SCHEME AND THE DEFIBRILLATOR TEAM
The author of the following note, whose name we have withheld to ensure patient confidentiality, is a trained but non-practising health professional. She was present at two Defibrillator Team call-outs as a friend and neighbour and was so disturbed by what she saw that she reported the matter to the Mukhtar. She has written the paper below outlining her worries:
There appears to be a serious conflict of interest between the PRA Houston private ambulance service (as currently operating in Pissouri through the Pissouri Residents’ Association) and the State-affiliated Village Defibrillator Team.
I was called to help a neighbour who was in trouble. The Defibrillator Team was called out and the State ambulance was called by them at the same time. In these cases, correctly, the State ambulance would automatically take patients to Limassol.
In this particular case, the Defib Team arrived at the neighbour’s house ten minutes after the callout and a Team member then asked the family where they would like to go; the State ambulance was already en-route. The ‘choice’ of where patients would wish to go should not be an option offered by anyone - once the State ambulance has already been called. This event implied that the Defib Team could call a private ambulance if the family wished to go anywhere other than Limassol General, and the State ambulance would have to be stood down. This procedure must be incorrect and, moreover, wastes valuable State resources. In this event, the patient went to the Limassol General Hospital with the State ambulance.
In the second Defibrillator call out I witnessed, the family concerned called the Defibrillator Team Incident Controller on his personal mobile and they asked him to call Houston as they had an emergency. A member of the Defibrillator Team later turned up to see if they could assist the family further. No State ambulance was called in this instance as Houston's was already on its way. There was subsequently an acrimonious disagreement about who should pay for the Houston ambulance. The PRA requested payment from the patient, although the family concerned were PRA members and assumed they were already covered for a Houston callout under the PRA Houston scheme. The family refused to pay for Houston on the grounds that the PRA circular to members (December 2010) stated that payment would not be sought if it was an ‘emergency’ situation.
Having State affiliated Defibrillator Team members intertwined with private Houston business clearly leads to inevitable confusion on both sides.
I was particularly displeased that, as I was asked as a neighbour to help the family out (and not being the patient or part of the family concerned) I was later contacted by a member of the PRA Committee – several times – and asked to put pressure on the family to recover the Houston payment. Subsequently the PRA Committee visited the family themselves and there was another altercation about recovering the Houston payment.
Medical Confidentiality: Regardless of whether the Defibrillator Team or Houston is being used, I regard patient and medical confidentiality as paramount. A senior member of the Defibrillator Team, and also a member of the PRA Committee, discussed the call out with one of the patient’s neighbours then in the UK. This was confirmed by a text to the patient saying how sorry they were to hear about their admission to hospital.
What else concerns me is this: what constitutes an ‘emergency’ for the PRA Houston Ambulance scheme and who decides that? There is considerable confusion about the relationship between Houston and the Defibrillator Team – one is private, the other State funded. There is a role for both – people have a legitimate choice: pay or use the State services. But boundaries must be clearly defined and options spelt out, otherwise valuable medical resources will be squandered.
I have subsequently spoken to some other members of the PRA Committee about this apparent lack of patient confidentiality. Their collective answer was that this was to be expected in a village community and that one of the members of the Defibrillator Team is notoriously indiscreet. More worryingly, Houston subscribers cannot be reassured of their medical confidentiality if the recently circulated ‘Proposal for the Pissouri Residents' Association Paramedic Ambulance Scheme’ cites that “Confidentiality ...... cannot be guaranteed”.
September 2011
298
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PROPOSED PRIVATE AMBULANCE FOR PISSOURI
Note from Joscelyne Humphrey
First of all I would like to start by openly thanking Daintre and Tony Hart for all their hard work over the years. Reading their interesting newsletter about life in Pissouri has been one of the highlights of my week. They have enabled me to feel part of village life in a way that must be almost unique in Cyprus. Their pictures of Cypriot weddings, festivals, flowers, scenery, birds and insects have been a constant reminder of why I enjoy living in this beautiful country.
Beyond this, Daintre and Tony have relayed important facts about community issues. They have attended local meetings at the village coffee shop, found out what is going on and relayed this information back to ‘Contact’ readers. This has only been possible through Daintre’s working knowledge of Greek.
I could go on listing the reasons why I miss ‘Contact’ but I need to tackle the thorny issue of why Daintre and Tony felt the need to give up circulating their excellent newsletter. Following a recent government initiative, local Cypriot communities have been encouraged to set up teams to use strategically placed defibrillators. Thankfully, this has been done in Pissouri and is being administered through Petros at the village office. The crux of the matter is that Daintre and Tony took exception to the behaviour of certain members of the First Response / Defibrillator Team who have been using their position to expand PRA membership by exaggerating the dangers of travelling to hospital in a Cypriot ambulance. This has been having a destabilizing effect on the Team.
I have recently resigned from the PRA Committee over the issue of their proposed Ambulance Scheme for all medical emergencies. I joined the PRA Committee so that we could be of service to the whole community and not just PRA members. I was of the opinion that, if a private Ambulance Scheme was introduced, it should (like the Defibrillation Scheme) be open to everyone without requiring them to join the PRA first. I was a lone voice on the PRA Committee and I bowed out gracefully.
It was not until ‘Contact’ stopped being produced that I was drawn into the situation of the Defibrillation Team. Having talked to some of its key players and also liaised with the village office, I have now completely changed my mind about the validity of operating a private Ambulance Scheme for all types of medical emergency.
The facts I have uncovered are as follows:
1. The Defibrillator Team is not synonymous with a First Response Team which aims to cover all types of medical emergency:
(a) Members of the Defibrillator Team felt they were there to operate the defibrillators. Their remit was to turn up as quickly as possible, operate the defibrillator, and try to keep the patient alive until the ambulance arrived. As a council run scheme, protocol and lines of responsibility required the immediate calling of the state ambulance. Although a patient could request a private Ambulance by this time a state ambulance would already be on its way. Experienced members of the Defibrillation Team felt it went against normal best practice to cancel the state ambulance.
(b) The members of the Defibrillator Team I spoke to did not feel medically competent to answer all First Response medical needs and did not want to be drawn into an extended medical coverage.
(c) The physical telephone and telephone number used by the Defibrillator Team belong to the council and Petros felt a distinct line should be drawn between their commitment to operate a defibrillator scheme for suspected heart attack patients and other medical emergencies.
2. Operating a private Ambulance Scheme for all types of medical emergency would add confusion as to which telephone number people should call for which type of emergency. After all, some would require the use of the defibrillator and others would not; some would be classified as an emergency covered by Houston and others would not. Concern was expressed about the medical competency of those taking such vital initial decisions, as well as about the robustness of a separate First Response Team.
3. Most imperatively, plans are underway to convert the old village school into a medical centre. Central Government funding for this project depends upon the amount of anticipated medical use the village council can demonstrate to the authorities. Various records are kept and one of the key ones is the number of times an ambulance is called to Pissouri. As (hopefully) the number of ambulances called each year is not enormous, any siphoning off of these figures into a private scheme would have a negative impact on Pissouri’s claim to public funding (and perhaps ultimately its ability to have its own state ambulance).
As I have already stated, I was originally in favour of having a private Ambulance Scheme for all medical emergencies but, upon further investigation, I now realize such a scheme could have unintentional negative consequences not only for the smooth running of the Defibrillator Team but also for the long term medical ambitions of the local community.
Daintre and Tony have expressed honest concerns about how the Defibrillator Team was being organized and how competing objectives were leading to conflict. I am sure these issues will be satisfactorily resolved. In the meantime, I hope every one of us who enjoyed reading ‘Contact’ will let Daintre and Tony know how much we appreciate the contribution they have made to Pissouri and how much we would like them to resume their communications with us.
Jocelyne Humphrey
30th August, 2011
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