Saturday, 25 February 2012


With an ambulance service comes expectations. Expectations from the public, from its employees and the expectations it has from it's staff. Following a difference of opinion with my employers I found myself asking three open questions. 

  1. What do the public expect when they call an ambulance?
  2. What do ambulance staff expect when they arrive at work?
  3. What does an ambulance service expect from their employees?

They are open because I can only assume what peoples answers would be. They might disagree. I'd very much like to gather an opinion on all three. This blog is in no means a criticism of the company for which I work. Far from it. It's questioning the system and pressures in which they are forced to operate. Unfortunately, opinions and agendas between managers and road staff will always differ. If they didn't, what would we moan about!

This was the actual side cupboard on the day in
question. A solitary, empty Entonox cyclinder!
My shift was due to begin at 07:00. As always, I arrived at 06:30 to sign drugs out etc and VDI the vehicle. On this particular day, there were 4 crews starting and there were 4 ambulances in the garage. Perfect! We grabbed our stuff and went to sign out drugs. There were no technician drugs left but we had everything else we needed so headed over to the truck. We swung the back door open to be greeted by a lack of trolley bed. Not only that, a lack of carry chair. There was no Lifepack, no defibrillator, no response bags at all. No Entonox, no maternity pack, no dressing pack, no burns kit and no infection control pack. No collars, no head blocks, no rescue board and no scoop! No straps, no splints, no manual handling kit, no suction unit and no helmets! No main oxygen cylinders, no bins, no blankets and no traction splint! Do you see a theme here? We had nothing! It was a shell. We explained our situation to the DSO and were told to hunt around station for missing kit. There was none. A new system is in place whereby all the vehicle were kitted elsewhere and then delivered where needed. Clearly, it's working wonders! We were told to head to the other station and re-stock there. Before we left we were told that we had to make ourselves available for a job as we could 'render aid'. Apparently, the policy states all we need is a BVM and we can attend calls. Obviously I tried to argue and say how could we possibly do our job to the best of our abilities with no kit. Unfortunately I don't have pips on my shoulder! So be it! Off we went!

Sure enough, not 30 seconds from station and we got a job. We explained we had no kit AGAIN but were told we were the nearest vehicle so we had to go. We arrived at the address and wandered in with nothing. The guy had chest pain. We gave him aspirin but that was it. Then we waited. And waited. Ordinarily we would do his blood pressure. We didn't have a cuff. If his blood pressure was OK, we'd have given him GTN to reduce the pre-load on his heart. If we had a Lifepack, we'd do 12-Lead ECG. We didn't have one. Normally, we would check his oxygen saturation, temperature and blood sugar. Maybe even monitor his carbon dioxide levels. He would be constantly monitored. Instead we sat there with our BVM taking a history. After half an hour a second crew arrived and took over. It was embarrassing. Really embarrassing. We were used to stop the clock, that is all. I can see no other reason we were sent. Who's fault is it though? The DSO for not showing us Off The Road (OTR)? How can he, the policy says we only need a BVM, we had one. The dispatcher for sending us? How can they not? We were the nearest resource for someone with a life threatening condition. The Operation Control Manager? They have an 8 minute target to meet, miss it and get a financial penalty. It's the system (the poxy government), but that brings us back to expectations. When Joe public picks up the phone and calls 999 he / she expects the following:
An ambulance, manned by a well trained, uniformed, courteous crew, capable of dealing with any situation and with the necessary kit to do so.
I think it is as simple as that. That should be what is sent to a job. Anything short of that is a failure. That is what the service should be judged on. That is what there should be financial penalties for not adhering to. 

Regarding our vehicle, we made it to our destination. We then spent the next hour re-stocking the vehicle from scratch. An hour that could have been spent hitting that precious target. That's the problem, short term fixes for long term problems. That vehicle was delivered because it ticked a box for the people delivering it. No thought to what the consequences would be because they had ticked their box. Quick fix. We couldn't go straight to fix the problem because we could stop the clock on one job. No thought to the consequences of wasting two ambulance crews on one call. Quick fix. We couldn't take one of the fully kitted vehicles because of station politics. No thought to the childish nature of what was happening because their crews had vehicles sorted for the rest of the day. Quick fix. That brings us back to expectations. When an ambulance crew arrive at work they expect the following:
A clean ambulance, fully stocked, fully kitted and mechanically working to enable them to go and do their job to the best of their ability.
That shouldn't be a rarity. That should be a matter of course. Sadly it isn't. Because of a lack of kit many staff bring in their own kit, even their own bag. Myself included. It makes things easier at the start of a shift, you know you have all the diagnostics you need, you know you have a fully stocked response bag. If you have a shell to work on at the very least you can do some tests and find out what is going on with your patient. Unfortunately, there is now a policy that under no circumstances are staff aloud to use their own diagnostics kit or bag. This is because all the kit we need is provided!! Clearly!! This brings us back to expectations. When an ambulance crew arrives at work the employer expects the following:
To be punctual, well dressed, work within their scope of practise and provide the clinical excellence one expects from a world class ambulance service.
A wry smile crept across my face as I wrote that! We can't do what we are expected to do, without having what we expect to have, which prevents us from providing what the public expect from us! I expect that confused you, but read it twice an I expect you'll understand.


  1. That's appalling but sadly true :S must have been so embarrassing going to a pt with no kit! I'd say "unbelievable" but I believe every word...

    When I did some obs shifts with SCAS there was an age old debate of sign on/make vehicle available or VDI first. Crews object to coming in early to VDI but if they don't make vehicle available for first 10 mins of shift while they're doing VDI (so they don't have to attend a call with no kit) they get complained at by control and station management.

    Tricky. I blame the government.

  2. Trying not to rant...

    I expect to be treated like a professional by patients (and relatives/bystanders), by other HCPs, and by management.

    I expect the same degree of courtesy from handover staff as I give them. More than happy to help out making/shifting trolleys if the department's busy, but at least acknowledge our existence while we queue to handover and listen to the handover.

    I expect a degree of trust from management, where it's assumed that you're not always trying to pull a fast one and that there's some recognition that we're human before we get slapped with disciplinaries for minor things.

    I expect vehicles, equipment and drugs to be available, and enough time to make sure they're present and working.

    I expect vehicles to be cleaned.

    I expect patients calling with minor ailments to at least have attempted self-treatment/GP access/speaking to NHS Direct. And for them to cover their mouths and noses when they cough and sneeze.

    I expect to be able to get a cup of tea a couple of times during a shift, and maybe visit the loo.


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