The Ambulance Service (Free phone 196) within the Casualty and
Emergency Department of St. Luke's Hospital is operated by the Health Department and is located at St. Luke's
Hospital, Malta's only public General Hospital for the moment.
The fleet of Ambulances consists of several VW Ambulances and 6 new Fiat Ducato Ambulances. These new Ducato ambulances which have been recently added to the fleet, each containing state-of-the-art equipment for medical care inside the ambulance.
It is now a speciality in its own right and all persons involved in the running of such a service are highly trained. This includes the ambulance personnel, radiographers, nurses and doctors. At a casualty department one must not forget the reception, portering, and cleaning staff whose support, although not so obvious, is essential. With so many people involved, the care of any emergency will have to be a "team event", with all those involved working together to offer the best possible care to a patient.
Besides the long established family practitioner, who today is often very well equipped, Malta is very lucky to have an extremely well structured national health service. Health centres are strategically located around the Island, so that no one is more than a few minutes away from medical care. These health centres are staffed round the clock with nurses and more than three times the number of doctors staffing the casualty department at St. Luke's Hospital. They not only attend to patients arriving at the clinics but also carry out home visits to those who are house bound. The service is free and available to everyone. The health centres have been equipped with many diagnostic facilities like ECG and X-ray machines, and also specialist services.
With the easy availability of such extensive medical care in the community, it stands to reason
that the family doctor or the health centres should be the first port of call of most patients
when an "emergency" arises. The patient is assessed by the doctor and treated. If necessary, he
is then referred to the Casualty Department at St. Luke's for further treatment and/or
investigations.
Unfortunately this is not always the case. For various reasons, often best known to the patients themselves, many people present themselves at the Casualty Department as soon as they percieve an ailment. This is not the right thing to do. Such patients cite innumerable excuses as to why they use the casualty department in the first instance. These include living close to the hospital, being at SLH to visit friends or relatives who are in-patients, unaware of the facilities offered at HCs, distrust of HC services, belief that the cause for a long-standing complaint that has not been found by several GPs and specialists will be found in the casualty department...the list is endless. It is obvious that the public must be better educated and informed. But this brings us back to the question of what is an EMERGENCY?
Any incident that is life threatening is an obvious emergency and there is usually no difficulty with these cases. There is a wide spectrum of such cases - from heart attacks to car accidents.
However, with many cases it is not so easy and it is here that the vast experience of the Casualty staff is to be appreciated. Every case attending the casualty department at SLH is first registered and then seen to by a triage nurse.
TRIAGE is an internationally recognised procedure, dating back to Napoleonic times, concerned with sorting out cases in order of urgency. That is prioritising them so that the cases most in need are attended to first. Triage is an ongoing process whereby repeated assessments of patients ensures that the changing condition of a patient is recognised and the patient will get treated appropriately. This ensures that at no time is the waiting period going to affect the management or ultimate out-come of the patient's condition.
The essential role of triage cannot be over-emphasised. In an emergency department, one cannot expect to be treated on a "first come first served basis", but only according to the urgency of the need of care.
Once a patient has been assessed by the triage nurse, he or she is managed accordingly. There are three groups of patients. The first are seen to virtually immediately while a second group may have to wait for treatment. A third group are those that are told that their complaints do not necessitate the use of the Emergency Department, e.g. sprained ankles, cuts and grazes, rash, sore throat or any long standing complaint. These can be easily managed by their general practitioner or at the Health Centres. These last ones, are of course, non-urgent cases but no patient is ever refused treatment at the department. However it is obvious that, should they wish to wait, they will be attended to when all other more urgent cases have been seen.
And this is what some patients find unacceptable. More often than not, the valued advice of the
triage nurse is ignored. A patient will insist:
Meanwhile, the more urgent cases are being treated out of sight in the treatment area. A small number of cases deserve a mention at this stage. Some cases require immediate resuscitation. These cases (such as unconscious or collapsed patients, or cases of drowning or major road traffic accidents) usually bypass reception and are rushed into specially equipped resuscitation rooms for immediate treatment. These are deservedly very demanding on staff and time.
Of course no one case is the same as another and every patient needs adequate time for
treatment. One case may need a few minutes of medical and nursing time while another may take up
to an hour with various specialists having to be involved. The manpower resources of the
Casualty department are not inexhaustible. There are a set number of nurses and doctors
manning the Emergency Department 24 hours a day, every day of the year. They have to deal with
all the patients who turn up at the Department. These staff work in an extremely stressful
environment having to make difficult decisions quickly and correctly. They are faced with
patients who are often severely injured or mutilated, tragic accidents and awful diseases, day
in day out. However they are often taken for granted by the patients seeking treatment and
sometimes even verbally or physically abused.
So why do they do it? The answer is simple: DEDICATION! Many of the staff have been in the department by choice for several years. Their wealth of experience is invaluable and should be better appreciated. Many of the doctors, at great personal and financial sacrifice, have undergone post-graduate training to enable them to offer better patient care from which every patient benefits. The doctors and nurses continue to undergo in-house training and education regularly as the speciality of Accident & Emergency is so dynamic and all are keen to keep up to date with knowledge and skills. This continuing education occurs both during working hours as well as on days off!
One must mention the ambulance service. The Health Department offers a 24-hours emergency
ambulance service, which can be reached by phoning 196. These calls are received at the
Casualty Department by experienced nursing staff who will decide on the staffing and
equipment needed for the various calls. A call out for a patient wqith a suspected heart attack
will require different things from a patient who has fallen off scaffolding. This is where
the co-operation of the public is required and asked for when an ambulance call is received.
Correct details regarding the condition of the patient are very important and not a waste of
time.
Unknown to many, both staff and equipment come from the casualty department so that when an ambulance goes out with a nurse on board, that nurse depletes the nursing complement on duty in the Casualty Department. It is not unusual to have four or five ambulances out at the same time. Judicious use of the ambulance service is essential. It is there solely for the transport to or from casualty of patients who are unfit to travel by other means. As in all things free of charge, the service is abused and misused. Again, this is not an inexhaustible resource and a futile ambulance trip may mean that a more urgent case may be endangered by having to wait for an ambulance to be available.
One must not forget the possible occurance of a major incident at any time, with a large number of casualties at the same time making it very difficult for the service to cope. One example was the explosion at the drydocks in February, 1995. These, thankfully rare, incidents cause great stress and stretch resources to the limit, both in the sense of manpower as well as equipment. Casualty staff are trained and committed to deal with these events.
For an efficient emergency service it is important to let the people, trained in emergency work, do just that: MANAGE EMERGENCIES. Greater public awareness is needed for better use of the Casualty Department. In the end, it is this same public who will benefit from the service in an unexpected "emergency".
So next time you think of using the Casualty Department, please stop and think: "Do I really have an emergency? Can my GP or well staffed Health Centre deal with this problem first? Am I abusing of the Doctor's or nurse's time and stealing it from more deserving cases?"
And in the unfortunate event that you DO HAVE to attend the Casualty Department, you will find CARING and COMMITTED STAFF to take care of you, but please BE a "patient" PATIENT.
From the 19th July 1997, the life
saving service which started in 1996 at Ghadira Bay, Ghajn Tuffieha Bay and
Birzebbugia will be operational during the summer weekends. This service is
sponsored by the Ministry for Home Affairs (Department of Civil
Protection) and will last till the the last week of September. 
This service is being organised by the Civil Protection Department in conjunction with the Malta Red Cross Society, the St. John Ambulance and St. John Rescue Corps.
This service will give prompt assistance in case of emergencies, until the proper services arrive on the scene of accidents. Dinghies for Coastal life saving will also be available to the rescuers. Moreover, the Maritime Unit within the Department of Civil Protection will be located at Xemxija Bay for any emergencies which may occur at sea.
It is hoped that these life saving operations will be better co-ordinated for the benefit of the citizen.
Fil-jiem shan tas-sajf, id-Dipartiment tas-Sahha Pubblika jappella
lill-pubbliku biex jevita temperaturi gholja. Id-Dipartiment jissugerixxi
dawn il-mizuri :
1. Evita x-xemx diretta bejn l-10 ta' filghodu u l-4 ta' wara
nofs in-nhar. Sports u attivita' fizika fit-tul u fis-shana tista'
tgholli t-temperatura tal-gisem b'mod perikoluz u twassal ghal
heat stroke.
2. Meta espost ghax-xemx uza kapell jew umbrella tad-dell.
3. Thallix tfal jew pets f'karozza maghluqa, lanqas ghal
perjodu qasir. Shana zejda jkollha effetti aktar qawwija fl-anzjani,
tfal u nies li jbatu b'certu mard kroniku.
4. Uza fan u ivventila tajjeb il-kmamar biex tbaxxi t-temperatura
fid-dar.
5. Ixrob hafna ilma; mal- 1.5 sa 2 litri kuljum, sakemm ma jkollokx
problemi medici. Ilma b'tahlita ta' melh u zokkor apposta (oral
rehydration salts) jghin jirkupra l-gharaq mitluf.
6. Ilbes hwejjeg hfief, komdi u li ma jkunux issikati mieghek.
7. Sintomi tal-effetti hziena tas-shana jinkludu telqa, nixfa
fil-halq, ugigh ta' ras u dardir. Jekk xi hadd ihossu hazin minhabba
s-shana, ressqu f'post fid-dell sakemm jistejqer. It-temperatura
tista' tnizzilha permezz ta' fan u billi xxarrab il-gilda
b'bicciet imxarrba. Jekk il-persuna tkun tiflah ghandha tinghata
tixrob. Ghandu jigi kkonsultat tabib mill-aktar fis.
Is-sajf huwa zmien ta' mistrieh u hafna Maltin u anki barranin jerhulha lejn il-bajjiet taghna ghal mistrieh taghhom. Huwa wkoll iz-zmien meta ghandna noqghodu ferm attenti biex jigu evitati incidenti kemm fuq il-bahar kif ukoll fix-xtut taghna, bhalma huma kazi ta' "bends", kazi ta' gharqa, kollizjonijiet fuq il-bahar, u incidenti simili li jkunu jenhtiegu interventi ta' malajr kemm mis-servizzi medici kif ukoll tas-servizz tal-ordni pubbliku.
Ghall-konvenjenza tal-pubbliku, qeghdin inxandru n-numri tat-telefon ta' xi servizzi ta' emergenza li huma ghas-servizz tal-pubbliku matul il-gurnata kollha:
| Pulizija - 191 | Ambulanza - 196 |
| Tifi tan-Nar - 199 | Rescue Team - 683443 |
| AFM Patrol Boats - 238797 | Helicopter Rescue - 809279 |
| St. Luke's Hospital - 234101 | Mosta Polyclinic - 433256 |
| Paola Polyclinic - 691314 | Mosta Police - 433800 |
| Paola Police - 237542 | Valletta Police - 225496 |
Il-pubbliku huwa mitlub biex jikkopera billi ma jabbuzax minn dawn is-servizzi essenzjali u meta juzahom jaghti dettalji ezatti u precizi lil operators sabiex l-ghajnuna mehtiega tasal malajr u bla dewmien.
Dawn huma s-servizzi b'risq ic-cittadin u ghalhekk ghandhom jintuzaw bil-ghaqal.
One fine day, you may find yourself face to face with an emergency in which you are either the victim or a witness. What are you to do in such circumstances? Remain a passive spectator or try to be of help to any victims who may urgently need your assistance, even by making a little phone call to the EMERGENCY SERVICES? Do you know the Emergency Numbers?
Do you know what to do when you come face to face with an emergency situation at your office, during your recreation or at home? What will you do when you witness a car crash, when your kitchen catches fire, or when your child chokes on some food?
The sites which appear hereunder, link to some professional information which may be of help to you to for such an eventuality. Go through them and try to gain some benefit from other people's know-how. If you are really interested click on any one of these wonderful and beneficial sites: You may one day need their advice!
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last modified: Sept. 1998