A meeting was held on the 22nd February 2017 at the Ambulance Authorities’ office in EWMSC among representatives of TTRNA, the RHA’s and the Ministry of Health. 

 

Present were:
Mr. Idi Stuart President TTRNA
Mr.Corey Dillon Secretary TTRNA

Representing the Ministry of Health were:

Mr.Asif Ali Health Sector Advisor
Dr. Rasheed Adams Chairman of the Ambulance Authority
NB. Legal Advisor to the Minister of Health Ms. Barbie Roopchand was invited but unable to attend. Representing of the RHA’s were:
Mr. Wayne Homer General Manager Operations SWRHA,
Mr. Joe Donald Assistant Fleet Coordinator ERHA,
Ms.Reshma Harrinath General Manager Operations NWRHA
Ms.Keisha Butcher Legal Consultant NCRHA.

The meeting commenced at 9:45am with all persons present. It was clear during the meeting that there is no document governing the use of vehicles as ambulances in the RHA’s. The Emergency Ambulance Services and Emergency Medical Personnel Act governs the work of Global Medical Response (GMR) and private ambulance service providers not the RHA’s ambulance/interfacility transport service. There were many issues pertinent to the Act that was deficient but because we recognized that this act does not apply to the RHA ambulance service we shifted our focus to RHA ambulance/transport specific issues. The main points discussed are outlined below:-
• The insurance coverage varies among RHA’s with SWRHA, in particular having no insurance coverage for staff only patients.
• Some of ERHA ambulances have coverage for up to 5 persons and others for up to 7
• We were informed that there are 3 types of insurance coverage when you are travelling on an ambulance. These are

o The vehicle insurance which is fully comprehensive
o NIS and Worksmen Compensation.
o And Medical Indemnity Insurance.

The first 2 are present in the RHA ambulances but the third is only present in GMR ambulances. The cost of Medical Indemnity Insurance is astronomical (which at a minimum must be 2 Million).
• The RHA ambulances should be called non emergency ambulances because they were not designed to transport emergencies.
• The Ambulance Authority though being part of the above named act and assented since 2009 has not been fully operational and as such has not been able to achieve its full mandate.
• They also are not properly authorized to use lights and siren as regular ambulances it was traditionally that way before and it was just left that way.
• We were informed that if Workmen Compensation is inadequate a common law claim can be made by the injured party.
• In making the application for compensation should you be injured, it is the responsibility of HR to guide you as to the proper forms to be used.
• If members of staff are having problems as it relates to transport eg reckless driving you are advised to write to the Transport Coordinator and cc your supervisor.
• Police escort is a courtesy and not mandatory for Ambulances transporting persons who may be sought by criminals.
• The ERHA has a communication radio whereby they receive information from GMR before a client is brought in and through this service they can guide GMR where to go with a casualty. No other RHA has this.
• With the exception of ERHA all RHA’s in Trinidad have a standard ambulance transport vehicle. There are no grades such as basic and advance which are required depending on the nature of the person requiring transport. Also no ambulances are equipped to transport a mentally disturbed client.
• There is no protocol or policies governing what this interfaciltiy transport/ambulance service should or should not do or transport.
In light of all the above named deficiencies in the service the following were agreed upon by those present
1. The development, implementation and monitoring of the ambulances to ensure it has the requisite equipment on board, that the same is in good working condition and it is the responsibility of the transport department to ensure same (checklist before and after use). This should be fully functioning in all RHA’s by the 11th of March 2017.
2. The development of a policy to control how the service operates eg, Who can authorize lights and siren (code), who determines what category of staff and how many staff are to accompany a patient. These things are outlined in the refer and transfer protocol but we were informed that this does not apply to the RHA interfacility transport service.
3. Risk insurance coverage for all staff and patients who use the RHA ambulance service. NWRHA and NCRHA are already actively pursuing a provider. ERHA says that they already provide same but there was no word from the representative of SWRHA as to when they will begin their search for risk insurance coverage for staff and patients.
4. The communication radio that GMR has with ERHA will be sourced and made available in all RHA’s and the necessary protocol instituted for its use.
5. TTRNA was given the assurance that we will be included in the formation and implementation of these new policies which need to be created to monitor this service. We were asked to write to the respective CEO’s on this collaborative approach to fixing this service.
6. All RHA’s in Trinidad will require new ambulances because ambulances in their current fleet do not cater to persons who require mechanical ventilation, neonates in an incubator etc. We were given the assurance that ambulances that are able to meet the needs of all clients/patient's will be procured soon. We were not given a time frame when these new ambulances will be procured.
TTRNA left with the contact information for all those present and will be following up on promises made to the Association and by extension our members.

Report Submitted By:
Mr Corey Dillon
Secretary (TTRNA)