Wednesday 28 December 2011

Just for the Record

"Response cars causing ambulance delays...Not so sure"

Recently, Channel 4 aired a report entitled Fast Response cars 'causing ambulance delays'. I watched for 9 minutes in amazement as ambulance services were crucified, conditions of effected patients were grossly exaggerated and even paramedics pointed the finger at their own colleagues for causing patients to die. Admittedly over recent years there has been an increase in different types of first responder. There are cars, motorbikes and even cycle response units, all with their own benefits. The motorbikes can weave through traffic, cycles can get through airports, stations and shopping centres and cars are generally faster than ambulances and don't tend to be stock piled at a hospital. All the above add to getting SOMEONE to the patient quickly or as we like to say, in 7 minutes and 59 seconds. That is all that matters. The report harps on about the 8 minute government target being based on sound clinical evidence but as far as i'm concerned it's just like the 'golden hour'. A nice round number to aim for. If a patient is going to die within 4 minutes of calling, they are going to die in 4 minutes. If a patient can survive for 8 minutes then they will. Why not 7 minutes, why not 6? Because it doesn't matter. 8 minutes is the time that was picked so 8 minutes it is.

The report starts with a typical emotional tug. An ill kiddie. We all love a sob story and let's not forget, it's all about the kids. I'm not disputing this child was unwell, i'm sure he was, but to make their point about ambulance delays it's been laid on heavy. Notice that there were no comments from any of the staff involved in that job. Only the mum's word that her child was 'dying'. If the kid was indeed so perilously close to death they wouldn't have waited for 50 minutes, that is for sure. The clinician on scene would have made it perfectly clear to control that the child would die without an ambulance. If it was going to be that long and it was a life or death situation, get the mum, get the kid and drive in your car. As the report said, he'd done all he could and was just watching. It was great opportunity for the journalist to hammer his point home without any clinical evidence whatsoever. 

He goes on to say, with an air of shock, that there is no guarantee that the first responder will even be a paramedic. This is true. There isn't. Quite frankly, you get what your given. There aren't enough paramedics to have on every ambulance and every car. When calls are categorised and a condition flags up as something that may need a paramedic skill ie; a seizure / cardiac arrest, then a paramedic will be dispatched. The paramedic who berated the use of technicians and spoke about them in such low regard clearly has an extremely high opinion of himself. EMT's were basically made out to be glorified first aiders with 2 months training. What he seemed to forget was that every paramedic was a technician in some way, shape or form and it isn't 2 months training. To work on a fast response car as an EMT you need 2 years experience. That includes the 6 month initial training. I'm sure there are bad technicians out there but there are also bad paramedics. If a member of my family was ill i'd much rather have a good technician with 10 years experience than a bad, newly qualified paramedic with no experience. When they neglected to tell you that a Paramedic can qualify from university now who only a few practical placements and minimal patient contact. That means they can be a first responder with only 6 weeks of working on an ambulance under their belt. Feel reassured that your responder is a young paramedic....? Hmmm. What also surprised me was that Jo Webber, Director of the Ambulance Services Network appeared to have no idea that technicians worked cars. So what if they do? If someone is that ill, surely some intervention is better than none. Is a technician on a car arriving before a paramedic on an ambulance any different to a paramedic on a car arriving after 2 technicians on an ambulance? 

Ok, in an ideal world, every first responder would be a paramedic, every ambulance would have a paramedic and a technician on board and every call would be answered within 8 minutes but this isn't an ideal world, far from it. It's a world dictated by money and to get money, targets must be met. Best practice comes at a cost, so the government has a choice. They pay for best practice or pay for targets. They chose the latter.  As briefly eluded to in the programme, ambulances are financially punished for not meeting the 8 minute target. A policy typical of government with no real grasp of what the emergency servies are like. Although, as is often the case high ranking politicians will do a ride-out with an ambulance, with a handpicked crew, given hand picked jobs. It would be interesting if they came anywhere other than headquarters to work with a crew or responder not hand picked by the politically motivated senior management. In an area of health care where cost cutting is dangerous, taking away the little money they have for staff development / training / recruiting is the real reason cars are being used. The only way of protecting the financial budget is to meet the targets as dictated to by policy makers. They take no note of the ever increasing call volume and the ever decreasing staffing. It's no wonder that there are 60,000 missed targets each year. I'm amazed the number is so small. Bear in mind in London alone (I use London as thats the stats the media report) there are over a million calls each year. That 60,000 would only be 6% of the calls in London yet it's a national figure. It was made to sound like a real issue, an issue that is costing lives and an issue the ambulance services are to blame for. In reality it's just a consequence of chasing targets rather than patient care.

The other financial benefit to cars is the obvious material one. It is less than half the price to fully equip and staff a car than it is an ambulance. Sure, scrap all cars, have more ambulances, but in reality, channel 4 would only be doing a documentary about a patient who had no medical response for 50 minutes while she watched her child die. There is no winning. It'll always be a battle. Ambulances have to go to hospital. Once at hospital ambulances have to wait until there is room for a patient, as I discussed at length in 'Hospital Corridors'. If waiting times at hospitals continue to rise, what good would it be to have less cars? Surely having a paramedic or an EMT on scene with a patient within 8 minutes, regardless of ambulance waiting time is a good thing. At the end of the day, if someone desperately needs an ambulance they will get one. That's what triage is for. Prioritising. On a rare occasion, through unforeseen circumstance, someone will have to wait a long time and someone may even die. That's life. It shouldn't be, but it is. Don't sit there and chastise ambulance services and their staff for trying the best they can, with the little money and fewer resources they have. How about do an article praising what they are doing and take the issues to the policy makers, as they are the only ones who can do anything about it?

As for the spineless individual who is ashamed to be a paramedic... shame on you. I'm ashamed to call you a colleague. If the reporter had any sense he would have consulted more than just one paramedic with an inaccurate jilted opinion of the profession for which he works. If he had done,  he may have found a different story. He may have found a story about the frustrations all paramedics, EMT's and ambulance services face, over the contant battle between balancing patient care with available resources and the little money available to them. That wasn't his agenda though. It's always easier to point the finger of blame then help find a solution.


  1. I'm going to have to agree & disagree. FRVs, Community First Responders and the whole gamut of resources that can be used to beat ORCON can and do save lives especially if used correctly. Then you get the other shit. The lone paramedic who is left with a patient with LVF for an hour that despite begging for back up before the patient arrests. The single techie on scene at an arrest with a GP who doesn't get back up for 40 minutes. Why? Because they are no longer triaged as priority calls if there are medical personnel present. ORCON has been made so who cares? FRV/PRU/RRUs aren't killing people but the system definitely is and in my experience it is only getting worse.

  2. I have only been involved with Ambulances and Paramedics as a user, and as a Care Home Manager and First Aider at my Rugby club I've had to use them quite a bit and I have never, never had a bad experience, the service from the crews has always been excellent.
    "News" services like this one are just trying to sell a story, they are not worried about accuracy or balance, just the headlines, yours is a very good balanced response, its a shame reporters can't be as objective.
    Please keep up the good work and ignore the vocal minority that are not happy unless they are whinging about someone else not doing a job they're not prepared to do themselves

  3. Im reading this as a re-tweet.
    Almost a year before this post- I had to call 999 for my mum. I was her carer and despite background antibiotics, she had pneumonia. Needed blue's in, and straight to resus.
    What I got, to start with was an FRV. 2 maned. Im not sure if they were paramedics or techs, but what I do know is they were lovely. Professional and apologetic when it took 1 1/2 hrs to get a wagon. My mum was semi- consious, my sister was in a state, and I had run from my house in my slippers. The first responders laughed and joked with us. I made them coffee- life blood- and they complemented the fact that my sister and I gave a damn.
    Sadly mum died 3 days later. But it was not the fault of those 2 first responders. It was her time.
    I cant remember the 2 gents names, and no longer live within their patch, but they are exactly the people I would want on hand if every I had an emergency!!
    Keep up the good work ladies and gents!

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