Ambulances to take up to 20 minutes for less urgent cases as SCDF prioritises resources

SINGAPORE — People who call "995" for lower priority medical cases such as minor burns or low blood sugar will have to wait up to 20 minutes for an ambulance to arrive from July 31.

The "slightly longer" response time for such calls would allow more flexibility to prioritise resources for emergencies such as cardiac arrests and respiratory issues, which require more immediate medical attention, said the Singapore Civil Defence Force (SCDF).

It currently aims to dispatch an ambulance to an incident location within 11 minutes for 80 per cent of the calls.

The demand for emergency medical services (EMS) has increased significantly over the years, SCDF said as it announced several initiatives on Thursday (July 4) at its annual workplan seminar.

Last year, it responded to 246,832 EMS calls.

This is equivalent to about 670 calls daily, which is 30 per cent higher than that in 2019 before the pandemic.

"The number of EMS calls is expected to continue to trend upwards, in part due to Singapore’s ageing population," SCDF added.

During a speech at the workplan seminar, Minister of State for Home Affairs Muhammad Faishal Ibrahim said it was "not easy" for SCDF paramedics and emergency medical technicians to cope with such high call volumes.

"Already, they work long and strenuous shifts in hot and humid conditions, sometimes responding to up to 12 calls during each shift. No call is easy," said Assoc Prof Faishal.

He added that the crew has to maintain a high level of focus from one call to the next as "lives are at stake".

In response to CNA’s queries, SCDF said the annual increase in such calls is projected to be about 3 to 5 per cent over the next few years. 

Currently, SCDF receives about 12 non-emergency calls a day, and this number is also expected to increase in the coming years, it noted. 

Each of these cases takes about 75 minutes on average to complete. This includes the time it takes for an ambulance to be activated, make its way to the incident location, provide on-site treatment to the patient, and convey him or her to the hospital, SCDF explained. 

It added that it will implement safeguards to ensure that patient safety is not compromised due to the longer wait time.

For example, in less severe cases, should SCDF receive a second call informing that the patient’s condition has deteriorated, it will re-triage the medical call and send an emergency ambulance to attend to the patient more quickly.

The lowest priority calls — those considered under priority four — make up a "small minority" of the current "995" calls, said Professor Marcus Ong, of the Singapore General Hospital's emergency medicine department. 

Medical calls are triaged across four priority levels: Urgent and life-threatening cases fall under priority one and non-emergencies under priority four, the senior consultant and clinical scientist said during an interview with the media on Thursday.

Conditions such as wrist or ankle fractures may come under the remaining priority levels.

Prof Ong, who is part of the medical advisory committee to SCDF, added that if a patient is suffering from an emergent condition, he or she will usually not be triaged as priority four. 

"So it is indeed very rare that we would have a priority four case that actually turns out to be a severe or serious emergency, and has a bad outcome."

The professor also explained that there is no "magic number" for the response time; the 20-minute wait is an operational estimate based on the current resources and what SCDF "feels (it’ll) be able to deliver".

"But by and large… within 20 minutes, we don't expect priority two, priority three cases to change very much in terms of the condition," he added, reiterating that the patients can call again should their situation worsen during this period.

Since March 2023, the SCDF operations centre has also been using the emergency video system to provide visual assistance for higher-priority cases.

SCDF added that it is looking at integrating video- and artificial intelligence-assisted triaging for all medical calls. 

It is also working with related agencies to develop alternative care service pathways such as telemedicine services and GP clinics that the public can visit instead of hospital emergency departments. 

Meanwhile, a six-month trial is also in the pipeline for a mobile pod at Jurong Lake Gardens in the fourth quarter of this year. 

Known as a dynamic deployment pod, it will allow SCDF to react quickly to surges in EMS calls at different areas across the country, it said. 

It also allows for quick deployment in newly built areas before a permanent base is established. 

"The reduced time required to secure approval for the use of outdoor spaces means that DDPs (dynamic deployment pods) can be operationalised faster compared to building new infrastructure or securing infrastructure in existing premises," said SCDF. 

SCDF has also introduced the paramedicine expert track to increase manpower for emergency medical services, said Assoc Prof Faishal.

For now, 10 to 15 paramedics will be appointed as senior specialists — functioning as the "pillar" for SCDF to build knowledge in this field.

They will also be given additional opportunities to attend conferences and workshops to hone their knowledge and skills, conduct adjunct lectures to teach others as well as mentor younger officers.

"In recognition of their expertise, and additional contributions to SCDF, the senior specialists would be granted a skills allowance," Assoc Prof Faishal said. 

TRAFFIC SIGNAL PRIORITY FOR AMBULANCES

SCDF also launched a new traffic priority system for emergency ambulances that are within the "final mile" when conveying a patient to a hospital. 

Ambulance drivers may at times need to run a red light under strict circumstances when handling life-threatening cases, SCDF said.

Having the traffic priority system in place at junctions near hospitals will thus reduce this need, it added.

The system, which is co-developed by the SCDF, Land Transport Authority (LTA) and Home Team Science and Technology Agency, uses an in-vehicle device to "activate priority passage" for ambulances at traffic junctions near hospitals.

Designated traffic junctions near hospitals will be installed with roadside equipment - used to send and receive messages from nearby vehicles - that is linked to the traffic light controller.

When an ambulance is within 200m of these junctions, its on-board device will be activated. The equipment will then trigger the traffic lights in favour of the ambulance.

When the traffic priority system is activated, the affected traffic light junctions will still proceed as usual with the normal sequence of lights, but with shorter duration between the phases.

The transition of the traffic light "would not be overly sudden", keeping in mind the safety of other road users, SCDF added. It also stressed that the priority system will only be used when conveying life-threatening cases.

Trials were conducted at traffic junctions near Ng Teng Fong General Hospital and Khoo Teck Puat Hospital, which indicated time savings of "about 30 to 100 seconds per conveyance".

The traffic priority system will be progressively implemented in three phases starting from Jul 15 and is scheduled to be fully operational by 2026. 

This will involve all SCDF emergency ambulances and 47 traffic junctions serving all nine public hospitals.

The first phase will involve ambulances operating from Jurong Fire Station and Bukit Batok Fire Station. Roadside equipment has been installed near Ng Teng Fong General Hospital, which lies within the response boundary of the two fire stations. 

In the second phase, on-board devices will be installed for all other SCDF ambulances. The traffic priority system coverage will also be extended to three more hospitals — Khoo Teck Puat Hospital, Changi General Hospital and National University Hospital. This will scheduled for completion by the second quarter of 2025.

The final phase will see the coverage extending to the remaining public hospitals by the fourth quarter of next year.

Implementing the traffic priority system is an important step towards further enhancing the ambulance crew’s response time in reaching hospitals, said director of SCDF’s emergency medical services department Senior Assistant Commissioner Yong Meng Wah.

"Together with the hurry call system, the traffic priority system will save valuable time in critical situations where every second counts and can make a difference between life and death," he added.

The hurry call system is used at fire stations, where the activation and response of emergency vehicles are given priority. 

Road users also play a crucial role in reducing response time, said Mr Alvin Chia, senior group director for traffic and road operations at LTA.

"Motorists are reminded to give way to ambulances and other emergency vehicles to allow them to reach their destination quickly."

NEW MYRESPONDER APP

A new myResponder app was also introduced on Thursday. 

First launched in 2015, the app allowed registered community first responders to respond to suspected cardiac arrest incidents before SCDF arrived. The app was later enhanced in 2018 to enable first responders to respond to nearby minor fires.

As of May, more than 40,000 cases — both cardiac arrest and minor fires — were created on myResponder, SCDF said.

With the new app, all registered community first responders can select how they will be responding to an incident - either by foot, bicycle, or motor vehicle.

Based on the chosen mode, the first responder will receive alerts to incidents with an increased radius of up to 800m by bicycle or 1.5km by vehicle.

Community first responders will also be able to view each other's locations on the incident map, giving them the confidence that there is additional support, said SCDF. 

Other features include a new chat function that community first responders can use to communicate with one another, including locating AEDs or fire extinguishers. 

Responders can also chat with the SCDF operations centre for guidance. This will be ready by the fourth quarter of this year. 

A video call function that is expected to be ready next year will also be integrated with the myResponder app to complement the existing photo and video functions. 

Using the real-time video call function will help SCDF make a better assessment of an ongoing emergency so that the appropriate emergency resources can be promptly dispatched, SCDF said. 

With the new app, the previous version will cease operation by the end of August.

SCDF added that existing community first responders have since been notified through the app to download and install the new version from mobile app stores, the Apple App Store or Google Play Store. CNA