Friday 8 March 2013

Cue The Madness

"55 year old female, breathing problems"

Community First Responders (CFR), rightly or wrongly are becoming a big part of pre-hospital care up and down the country. I could argue about the ethics of them for days on end. On the one hand, it's great that these people are giving up their own time to help their local community. That should be commended and overlooked. I am not being critical of ANY of the responders themselves, it is more that fact that they are needed and how they are used. The fact that all ambulance services are relying on un-trained volunteers to get to patients first and stop the clock speaks volumes about the shortcoming in budgets and man power. I know that in some areas, especially rural, the CFR scheme is invaluable. In others, like the city, it seems to be more or a PR and clock stopping exercise. Training standards across the country vary but in my area a 3 day St Johns Ambulance course is all they get. Then, they are given a radio, a response bag and mileage form and off they go. This isn't their fault, it is the system. They have little support and really are thrown in at the deep end. 

After 6 months full time training, multiple assessments, months of placements and untold evening hours studying I didn't feel remotely ready to go out as a crew of two and meet patients. THAT was daunting! To do that after 3 days first is simply terrifying! The most important skill we learn as paramedics / EMTs / ECAs etc is talking to people. Making people calm, using tact, employing diplomacy and telling it straight when appropriate. This cannot be taught in a classroom. You learn it from experience and experience only. It cannot be taught on a 3 day course!

We arrived on scene to be greeted in the middle of the road by not one, but two members of the patients family waving their arms and jumping up and down. Clearly, today we would be acting in a calming role! Our patient was lying in bed, coughing and spluttering. To be fair it sounded like a horrible cough but not one that required all the pomp and circumstance that was surrounding her. We checked her over, listened to her breathing, did our usual battery of tests and came to the conclusion that she had pneumonia. Unfortunately, pneumonia is one of those big medical words that very few people have an understanding of and as such, strikes fear into many. Like many conditions, pneumonia can be serious in the very young, the very elderly and people with complex medical needs. She was none of the above so was going to be just fine! convincing her and her family of that was another matter....

As I was explaining what was going to happen and how pneumonia was just a simple chest infection in walked the CFR! Clearly control had forgotten to cancel them! It would normally just be a case of swapping call signs and they would leave but today this young guy decided to stay. Our patient was getting her stuff ready while I told the CFR what had been going on. Everything seemed quite calm, the patient was no longer panicking and her family had stopped hovering and fussing. Bliss! Cue the CFR.....

"My dad had pneumonia." he blurted out.

"Oh, how hold was he?" said the patient inquisitively.

"He was only 53."

"Was he OK, did he recover well?"

"No, he died."

Cue the madness.......

The room became hysterical and I mean seriously hysterical! They were all mourning over her inevitable death like Victorians. They were not far off picking out their black outfits! I tried and tried to resolve the situation but in vain. The CFR backtracked and said that he had had other medical problems too but what had been done, could not be undone. We went out to the ambulance, patient and relative's arms waving like the Harlem Shake and off we went to hospital. The CFR left the scene of the crime with his tail between his legs. Can you imagine the face I had on?!


  1. Only his tail between his legs???? Lol Wait for the CFR abuse now!

  2. O come on! Hardly his Fault! Some CFR training is even shorter than 3 days you know. They also get not a lot of patient contact.

  3. Oh dear! No words to describe the CFR stupidity

  4. I have only just stumbled across your Blog, its brilliant! This is great, cos I hate it went I have a situation fully in control then some fool comes and cocks it all up!!

  5. A perfect highlight of the tact and people skills learned with experience... Oops He'll know next time ;) lol
    We have some excellent CFR's in service and they do an outstanding job, but the ones that are great have been doing it a few years so have the common sense approach.
    good blog as ever.

  6. I'm not a lover of the CFR schemes either, jumped up clock stoppers that ambo management put on a higher pedastal than their own staff....anyway case above says it all...we learn very quickly when to shut up in similar situations and if you're FNG (F-ing new guy) it's speak when spoken too....if you're unqualified you shouldn't even be talking....

  7. I use to be a CFR in my local village, we did a weekend of training at a local ambulance service station with one of their paramedics. The first time I got called out was daunting, had to remember to keep calm as trying not to speed as we not allowed, while running through what to do in my head. Get there and it all goes and blank mind, so apart from the normal questions I didnt say much else didnt want to say some thing wrong. Now I work for ST John Ambulance and so much better and ready for most calls and types of people.

  8. Arriving at a "Cat A" call to an infant with respiratory distress I was met by a CFR and the patients mother. "It's ok" says mum "The paramedic is already here" "yeah" says the responder "you're alright I've diagnosed it"
    I'm sure my face was a bit like yours!

  9. I would have more respect for the CFR ****scheme**** if it didn't stop the clock. The CFRs themselves, well it appears they're either brilliant or awful (luckily in my area more are brilliant than awful). That said, any lay person who's willing to volunteer for the mental trauma of conducting CPR at a moments notice can only be commended.

  10. So as a CFR.... I am unqualified... well no... actually..... I am a Nurse Practitioner in A&E with 15 years of experience, been a St. John (not john's as he is dead.......) member for 25 years.... we are just assuming that we are all unqualified... no thats not the situation. There are poor professionals in all walks of life, doctors, nurses, paramedics and cfr's - not to mention the paramedic last week who left one of our regular attenders at home in acute heart failure, because they'd been in the day before so cat c'd them... basically what i am saying is dont assume that as a CFR were all rubbish - theres good and bad everywhere....

    1. Did I say anywhere that ALL CFR are unqualified? No I didn't. I say I wasn't critisising ANY of them. You have totally missed the point of the entire post and got defensive about the wealth of experience you have.

    2. Your quote "un-trained volunteers to get to patients first and stop the clock"

      Not all CFRs are all trained.....

      I too am a CFR during the evening and weekends when I am home / on base / and not on deployment (rare these days)

      My day job is a Combat Medic, I am a class 1 with ALS, PHECC, PHTLS to name a few with 24yrs experience with 4 tours of Iraq and 3 in Afghanistan plus various op tours over my 24yrs. My trauma experience I am sure far out weighs that most civilian trained paramedics but on scene i by crews that don't know me get treated like a pleb that is just an untrained clock stopper some crews dont even ask for a handover that push you out the way and start the assessment again.

      My point is not to show my wealth of experience its just to say there are good and bad at all grades, CFR clinical and no-clinical, ECAs, EMT, Paras and yes there also bad CMTs I assure you.

      We are all working for the same goal to save lives and to make the NHS the best it can be and remain the service that is the envy of many countries.

      Rant over.

    3. And what I said was correct. They are all untrained volunteers. Minimal training is provided to an CFR. Average is 3 days. That doesn't mean CFRs don't have vast medical experience outside of that. I didn't say the role was useless, I said its not being used effectively. I also said it is invaluable in certain areas. The point of the post was how certain things can't be taught with any training. It wasn't meant as a pissing contest to see who has the most experience at what. I get it. You are more experienced than everyone.

    4. Someone can have all the training and experience they like, but unless they're an MFR (Medical First Responder) then they can only use the skills/equipment taught to them on the CFR course - this of course negates some of their extended training...

  11. Just another CFR9 March 2013 at 12:16

    Excellent article, I think you've summed it up perfectly Ella - potentially invaluable in a rural situation, being used inappropriately in cities. CFR's can still be useful in a city, anywhere an ambulance can't get there in a few minutes in fact, but once they are being given radios and used on shifts going from call to call rather than called out from home then they've become unpaid barely-trained pseudo-ambulances, whose main contribution is massage the statistics and disguise a lack of professional resources. None of that explains the lack of common sense exhibited by your CFR - your boot between his legs and a stroppy email to whoever is responsible for him would be appropriate.

  12. I am a CFR and I can relate to the story. There are some CFR out there who scare me and I question why they are doing it. However, there are some Paramedics and Technicians that could do with a change in attitude towards patients and CFRS. Working in another public service, if I spoke to our "clients" or staff like some Paramedics and Technicians do I would soon be out of a job. I guess the point I'm making is that in all walks of life you get good people and bad.
    In Scotland our basic training is 2 days followed by another 2 days training. This is then followed up by monthly refresher training. We don't attend the same types of calls in Scotland that some CFR do in England. However what we do attend is daunting enough, especially when a lot of the time all we can administer is a bit of tlc and reassurance.

  13. I would say tact cannot always be taught in any amount of time, the amount of 'professionals' I have met who seriously lack it is scary, haha! Would like to say I've recently found your blog and have sat and read all of them within about a week! Fascinating stuff :) I'm applying to be a CFR but like to think my bedside manner would be much better than that! Thanks for the great reads X

  14. I'm a CFR and I love this blog.

    I don't think it's fair of macca to describe us as jumped up clock stoppers tho.... I know my protocol and skillset and I don't go beyond that. Or want to.

    Just like the trained clinicians, you get good ones and bad ones. I wish there wasn't a need for us and we had an ambulance on every corner, but I we don't and if anything, it'll get worse.

    In my rural town of 15000 people, you rarely get an actual ambulance in the area. Nearest ones tend to be a minimum of 10mins away.... So if I can get there and at least put an aed on, there's some small hope....

    Without a cfr in that scenario you might as well send a hearse instead.

  15. I'm a CFR, and also wish that we didn't "stop the clock", or maybe that there's 2 clocks- resource with AED on scene, then clinically qualified resource on scene.

    Opening your mouth and sticking your foot in it shouldn't happen, but does occasionally, and, as you say, is less likely with experience.

    My CFR course, and the pre-course reading I've done, may have taught me the practical bits, but it's the 30 years St John Ambulance membership that gives me the experience!

    If I arrive after the crew, I'd usually stick my head in, ask if they want me to stay, then leave if not. More likely to stay if it's a single person in an RRV and/or a sick patient, but it's usually down to the crew, not me - although I do sometime get an "if you want to".

    If I'm first on scene, I'll offer to stay when backup arrives- the reply depends on the individual crew/RRV person, the condition of the patient, and sometimes the time we're likely to be waiting for backup if it's a single person.

    We have a good relationship with the crews, and even with the least CFR-friendly people it's now civil, not downright rude as it was at one time, so the patient sees a professional approach from all of us.

  16. As an ECA and a CFR I get to see both sides of this situation. Some of my fellow CFRs are EMTs, ECAs, Nurses, HCAs etc so have some idea what to do in most situations, and if they dont are savvy enough to blag it.

    However there is a Village group and a town group of CFRs off to the west of me who I have dealt with as an ECA and in training as a CFR that I pray to god (if there is one)never ever attend to my family or myself.

    The village group is full of gossiping OAPs who have (apparently) had, or know someone who has had what the patient has... Only worse.

    And the Town group is full of jumped up 20 somethings who live at home with parents and try to argue with the very experienced RRV paramedic that what is being done is wrong according to the first aid book.

    Both groups are known to turn up to jobs even after being stood down to 'HELP'.

    CFR competencies and ability does depend on where you are and who is on duty. Some are good (ME)

  17. Some CFRs may have prior qualifications and experience but I think what Ella actually meant, and some people missed, is that the required training is just 3 days. Therefore there are people swanning about with less training than my first aid at work course and some of them are the ones who have the god complex.

    Those of you who are highly skilled trained clinicians who are contributing some of your precious spare hours for the greater good, good on you, hats off to you. Nobody is getting at YOU.

    As Stewart has illustrated, there are those who go into it for the wrong reasons, good way to get a front row seat on the action and be a stickybeak, and probably divulge gory details over tea and biscuits down the bridge club later.

  18. What a great blog and blog post! My OH is a CFR. Did it because waiting times for ambulance can be up to an hour - even for a bad asthma attack (me in winter!). He's been to some awful events, but deals with it all in his usual calm, caring manner. He has ongoing training but I DO believe that CFRs are used far too much BECAUSE of Ambulance cut backs. In rural areas there would be greater incidences of deaths without the CFR. As I say, great blog!

  19. I love our CFRs... but I also work in rural Australia, where it takes us an hour or so to reach patients.
    Each station is responsible for the CFRs in their area, so although they all have the same base training, some stations really put a lot of work into them to make them really valuable members of the team.
    In the city though? Why would you need them in the city?!? Ridiculous.

  20. I agree with Ella CFR's do a fantastic job particularly in the rural area where I work as a paramedic. I do however think that the CFR in her blog and a small number of the other CFR's out there would benefit from a further 3 days course entitled "how to use some blooming common sense!".


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