Singapore EMS

Emergency Medical Services in Singapore -- View from an ambulance medical orderly

I had an ambulance call in the early afternoon today. A warm, sunny Sunday, the 19th of July. Hearing the address of our destination, my paramedic immediately groaned. "Oh it's him. He's a 'regular.'"

In the Singapore EMS vernacular, a 'regular' is somebody who abuses (our kind nature and) ambulance services. Normally, people who call 995 -- the emergency number -- for non-emergency cases, as determined by the paramedic, are fined a misuse fee of $274. They also would have to pay the hospital A&E admission fee which is around $100. However, even if you are unable to pay your outstanding medical bills, neither hospitals nor ambulances can refuse you. Hence the 'regular' problem.

Don't get me wrong, some 'regulars' are simply really ill people. Their cases tend to be emergencies: fainting, shortness of breath, giddiness, irregular heart rhythms, strokes, etc. Some of these 'regulars' are vagrants, or simply put, homeless. They may have families, but their families don't want them around, so they end up on the streets. They need hospitals and ambulances, but can't afford them. Luckily, the Singapore government can, and it's willing to do so. (Social safety net ftw!)

But there are other types of 'regulars'. They work in groups, taking turns to call 995 and make calls convincing enough to bring us over. Call texts such as "man is lying on the pavement, I'm not sure if he's unconscious or not, might be dead" are common. But from the location and the fact that the caller called from a public telephone (and doesn't pick up our return call), we can often surmise what we're getting ourselves into.  These people even time their calls so that they can end up in the hospital in time for (free) meal time. If they're lucky, they'll get to spend the night in clean sheets and air-con. If not, they're on the streets for a night or two... until they call us again. Often times, we'll pick up on of these guys, and they'll still have a hospital admission tag on them, or even ECG electrodes from some previous ambulance crew.

But back to today's call. The security guard of the condo called it in. Dude's lying on the floor outside the lift lobby, drunk. He's moaning "hospital, hospital". We manage to lift him into a chair and he starts crying when my paramedic (let's call him Para A) tells him that we're not taking him to the hospital because Para B, who worked the day before, told Para A they he had already conveyed the man earlier. "I need a drink," he says. He has a bottle of spirits next to him, and despite our protestations, he takes a swig and then starts crying again. 

So everyone at my station already knows his story -- it's been told that many times. He's well-educated, a degree holder from overseas, and yet... here we are, and here he is. We take him to his family's unit -- which Para A knows without needing to ask the guy, and the father comes to the door when we knock. The father doesn't want the son (who's 50 years old) in the house because "he gets violent when he's drunk... I'm old... I can't look after him."

Queue long debate/argument between great-grandfather-aged father and ambulance crew about responsibilities as a parent and public service abuse. Lectures go back and forth about our duties as public servants (from the father) and duties as a father (from us). We're simply not taking him to a public hospital simply so that he can sober up, get discharged, get drunk, and get re-conveyed and re-admitted to the same hospital. My paramedic calls Control to ask for police back-up.

Two hours later and three police patrol cars (six officers) later, and the father-aged son is inside the flat snoring on a mat on the floor.

Around 8pm, another ambulance from my station was sent to their flat. 

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How does one square this circle? What should be done with people who simply don't want to work with the system? The system is built to accommodate them -- productive workers pick up the slack of their less productive counter-parts -- but should it? People suffer in the process, from police to us ambulance crews to everybody at the hospital. We lose faith in the system, become disaffected. Oh and taxpayer money, that gets defenestrated. 

But he's been to alcoholic rehab programs. He said he lost his wife. If he doesn't believe in the system, can he be blamed for trying to live outside of it? Who said one has to get a job and be a "productive citizen"? It's all a human construct, so maybe he just constructed something else... to our detriment.