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367 points DustinEchoes | 17 comments | | HN request time: 0s | source | bottom
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pugio ◴[] No.45910134[source]
I can speak to this. I recently joined a community first responder association (I've always wanted to know what to do in case of a medical emergency) and was shocked to hear the members' horror stories of how long it can take an ambulance to arrive. Like the author, I grew up with the narrative "in trouble, call the ambulance, they'll scream through the streets to get to you in moments".

That might still be true where I grew up, in the US, but that's certainly not a guarantee in Melbourne, where I now live. On joining the local volunteer organization, I went from thinking "oh this will be a useful bonus for the community" to "wow, we can literally be essential". Since our org is composed of people living within the community, average response time to ANY call is <5 minutes (lower for cardiac arrest, when people really move). Sometimes one of us is right next door.

We can't do everything an ambulance paramedic can, but we can give aspirin, GTN, oxygen, CPR, and defibrillation. We can also usually navigate/bypass the usual triage system to get the ambulance priority upgraded to Code 1 (highest priority, lights + sirens, etc.) If for some reason the ambulance is far away (it backs up all the time), we can go in the patient's car with them to the hospital, with our gear, in case of further issues in transit.

I tell everyone now to always call us first (since our dispatcher will also call the ambulance) but while I feel more confident in how I'd handle an emergency, I feel less safe overall, with the system's faults and failings more exposed, and the illusion of security stripped away.

My condolences to the author.

In terms of updating - consider whether The System is really working. If not, what can you do yourself (or within your larger network) to better prepare...

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1. gobins ◴[] No.45910193[source]
Wow melbourne is getting that bad! Does your org have a name?
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2. softgrow ◴[] No.45910343[source]
Sounds like Hatzolah Melbourne, https://hatzolah.org.au since 1994

Since 1998, in Melbourne for anything that might need a defibrillator a fire engine is sent at the same time as the ambulance (EMR Emergency Medical Response Program). https://www.mja.com.au/journal/2002/177/6/cardiac-arrests-tr... Medical Journal of Australia article. There is also GoodSAM https://www.ambulance.vic.gov.au/goodsam/ for individual helpers

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3. scorpioxy ◴[] No.45910505[source]
Oh yes. Quite bad and I don't know if things are getting slightly better than "bad" or the media is tired of reporting about it.

Up until a year or so ago, an appointment at a GP would take weeks of waiting. Specialist appointments were 1+ years waiting time. This is somewhat better now with the establishment of critical-care clinics operating after hours. This is from personal experience.

The emergency rooms often had waiting time of 12+ hours(or more). I know someone who has been waiting on a procedure at the public hospital for 6+ years. Another has a child waiting for an appointment with an estimated wait time of 3+ years. All non-urgent but a wait list in the years is no longer a wait list to me, it's a system that is not fit for purpose.

Initially all of this was attributed to the pandemic and the harsh lockdowns in Victoria. But a few years out, it seems difficult to still do that. When asked, our government just re-states that they've invested in this and that and then deflect. Recently, due to the horrible state finances, the healthcare system was being downsized with services cut and the bloodshed continues. This is without talking about the systemic issues and incompetence I've seen.

The funny thing is that outsiders think that public health care means free. It's really not. We pay for it on top of our income tax(1-2% on top, more if you're above a certain threshold) and it is not cheap. It wouldn't be so bad if it was working like you'd expect but paying for a non-functional system is....I don't know what to say.

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4. tharkun__ ◴[] No.45910608[source]
What about helicopters? Does Melbourne not have/use theirs in those cases or is the system just overwhelmed?

Asking because (different country) when we had a person present with stroke symptoms and called 911, they sent both an ambulance and the helicopter. The heli came first but it had to land a ways off on a field and they had to walk over and basically arrived around the same time as the ambulance. A couple minutes earlier basically. No fire engine dispatched but that made sense too as it's volunteer based and while they would've been much closer, getting them to the station would've taken longer than the helicopter.

Driving time for the ambulance if it came from the same place as the helipad would've been about 15 min for the ambulance. Fire engine driving time from volunteer department: 2 min but no dedicated paramedic services, just volunteer firefighters. Heli time in air probably about 2 minutes given the "as the crow flies" distance I just checked, add whatever time is needed to get them in the air and such.

Now I can't really trust these numbers fully of course but according to "a quick AI analysis" :P Melbourne with millions of population has 0.08 helicopters and 8-10 ambulances per 100k population while the aforementioned location is at about 0.3 helicopters per 100k and 6-12 ambulances. Can it be true? It also says New York City has no emergency helicopters at all? Los Angeles has 0.18 per 100k? I know my current location definitely also has none at all. For millions of people.

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5. tecoholic ◴[] No.45910677[source]
Wow. I didn’t know that things are this way. I am a recent immigrant living close to the city and always seem to be able to see a GP on the same day. Is that because I have private insurance and I pay out of pocket anyways? If I were a citizen, I wouldn’t be able to go to those places (at least for “free healthcare”), and will have the same wait times? Or is it geography dependent with rural Victoria having issues and Melbourne city being well covered?
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6. d0ublespeak ◴[] No.45910692[source]
This isn’t an inherent flaw of public health care. A lot of the health care problems in this country (Australia) stem from a continued disinvestment in the public system after a decade (prior to the current government) of conservative mismanagement. Most state funding here comes from the federal governments standard sales tax. They intentionally gimped our public system to fund a private system that isn’t financially viable. Reversing that is going to take time. The problem exists it’s just important to attribute it to the correct sources. Medicare (our public insurer) is an incredible privilege that we should protect and hold our leaders accountable for managing.
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7. 0_____0 ◴[] No.45910712[source]
I pay ~500 US/mo for health insurance. Just for me, no dependents. Not an exotic low-deductible health insurance plan. 2% on top of income tax sounds like a dream.
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8. d0ublespeak ◴[] No.45910743{3}[source]
With seeing a doctor we have two main systems that you can use and each will have a different waiting time. Bulk-billing and the fully public option has longer waiting times because there aren’t enough clinics/specialists or doctors, The reasons for this are complex but they stem from an unwillingness from prior governments to raise the amount the government pays for each service to adequately to support this system meaning less doctors and practices being willing to support it.

You’ve then got practices/specialists etc… that charge copays and they tend to have less waiting times because less people are willing to pay copays. A lot of these practices will also do outright private billing which is what you’re experiencing.

9. d0ublespeak ◴[] No.45910756{3}[source]
It can be less/more than 2 percent too dependent on income. But yes we are extremely blessed in this country with a healthcare system that isn’t perfect but is extremely affordable.
10. scorpioxy ◴[] No.45910894{3}[source]
It depends on the location and it depends on what services you're after. If you have private healthcare insurance, you get to skip the wait times at hospitals and get a choice of public or private hospitals. For clinics, it's a different story and can get quite detailed. The private insurance can help you with the payment there but not wait times.

For some regional and rural locations, the wait times can be better or can be worse than metro depending on the service.

By the way, I also pay out of pocket on top of the medicare rebate so my experience is not with bulk billing clinics. When you get access to medicare, you'd probably still need to pay out of pocket on top of the rebate as bulk billing clinics have all but disappeared. Recent government incentives aim to bring them back but with cost of living increases I doubt that'll work.

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11. softgrow ◴[] No.45910925{3}[source]
I don't think my taxes/insurance costs/donations to charity are high enough. London (donation funded) has a helicopter service that attends 6 serious trauma cases a day. Denmark, Germany and others has a Helicopter Emergency Medical Service which delivers a senior doctor and paramedic. It probably doesn't scale well.

Basic issues like overhead powerlines make life difficult for helicopters. They are used in rural Australia as an alternative to road, but only due to time saving. In a city, well you get a road ambulance/paramedic/medical team.

The (Melbourne) Victorian Ambulance Cardiac Arrest Registry claims third best in the world in out of hospital cardiac arrest.

12. pugio ◴[] No.45910988[source]
Yes it's Hatzolah. It's a volunteer Jewish organization - run (and paid for) by the local Jewish community, but we respond to anyone who calls us, regardless of background or ethnicity.

(There are Hatzolah organizations all over the world, where there are Jewish communities.)

13. scorpioxy ◴[] No.45910990{3}[source]
I don't understand where you got that I am saying public health care systems are flawed. Both systems have pros and cons. And I have seen the "going to take time" phrase for quite a long time now and so don't think it holds any value anymore.

In terms of affordability which you also referenced in a separate comment, I disagree. Compared to some prices I've seen in the US, it is cheaper. Compared to other countries I've experienced, it is more expensive. Comparing private and public systems is not straight forward and I don't think this adds any value to the discussion.

In terms of attributing failure to correct sources, Victoria hasn't had a "they"(who you're claiming gimped our public system) for many years now but I am not interested in a discussion about politics.

14. sqrt_1 ◴[] No.45910992{3}[source]
I think it is mostly just a problem with Victoria - and they are are hardly conservative. Hospitals and ambulance service is a state issue and other states fair much better.
15. scorpioxy ◴[] No.45911056{3}[source]
It's actually anywhere between 1%-5% depending on your income but I didn't want to get too detailed in my comment. And you'd still have the absurdly long wait times. And the out of pocket expenses. Again, not a problem if you can actually make use of what you're paying for.

I do have to state though that the US healthcare system, minus the fact that most healthcare research/advancements happens there, is crazy.

16. strken ◴[] No.45911432{3}[source]
I was under the impression that air ambulances in Victoria are mostly for rural areas - either responding to incidents in the middle of nowhere, or flying patients to Melbourne for urgent specialist care. Most of them aren't even based in Melbourne, they're out in regional centres like Bendigo and Warrnambool[0].

A helicopter seems like it would be pretty useless for landing in an urban area. I can't imagine winching is risk-free or would save much time, and you can probably put many more ambulances on the ground for the cost of a single air ambulance.

[0] https://www.ambulance.vic.gov.au/air-ambulance-victoria

17. koolba ◴[] No.45911437{4}[source]
> The private insurance can help you with the payment there but not wait times.

That must be a great deal for the insurance company. If it takes multiple years to get an appointment, they must pay out significantly less claims as well.