Saturday 6 April 2013

Tweedle Dumb and Tweedle Dee

"73 year old male, low blood pressure"

In a change from the norm, I was sat blissfully relaxing on standby on the Fast Response Unit (FRU). It may have been a clapped out Vauxhall Zafira with a billion miles on the clock, help together with micropore tape, but it had a radio and the was a Michael Buble CD doing its thing! Oh, and I had a massive vanilla latte from Costa! Bliss! I couldn't moan too much when after two hours I was sent a job. It was a low priority call which the FRUs don't normally attend but it was accompanied with a ringing radio!

"Whiskey Delta Four Zero go ahead."

"This CAD you're running on, the is a private crew on scene requesting your opinion on a patient with very low blood pressure. They are not happy moving the patient until a paramedic gives them them OK."

"Rog, thank you."

Great! Another private! Based on recent experiences I should have been more than cynical but fair enough, they have recognised an ill patient and have asked for help. No complaints there, at least they have the patients interest at heart.

I pulled up on scene, grabbed my bag and headed into the care home. I was taken by manager to the room where the patient was. As I walked down the corridor I heard a voice I recognised followed by the most heinous of laughs. The kind of laugh that is totally inappropriate in front of a patient. In the room was Tweedle Dum and Tweedle Dee, one with hands in pockets, chewing gum like Sir Alex Ferguson and the other sitting in the patients arm chair, leg on knee, on his phone. Standing next to the cot bed was the patients daughter and a carer. I was given the most vague of handovers, culminating in being told his blood pressure was 65/23.

For those in the know, a BP that low is very serious. Very serious indeed. It would also be accompanied with other symptoms. There were none. With a BP that low you wouldn't expect to be able to feel a pulse. There was a VERY strong pulse. Attached to his arm was one of those blood pressure machines you can get in the chemist. 

"Is this what you used to take his blood pressure?"


"Is it yours?"

"Nah, it's theirs."

"So have you taken a manual blood pressure as well?"


Are they for real?! I promptly did a manual blood pressure which was perfectly normal, 142/85 to be precise. I checked him over and he was fine. His reason for going to hospital was at a GP request for scan he was due to have. There was nothing acutely wrong  with him.

"Right guys, do you want to grab your chair, we'll get him downstairs now."

"*chew chew* We'll just use one of their wheelchairs. *chew chew*"

Due to the patients disability I didn't think a normal wheelchair was ideal, as it wouldn't have any straps. Needless to say, my fears were ignored. Rather than get the chair himself, he sent the home manager to go and get it. Whilst waiting they continues to make stupid, childish, crass jokes. I was so embarrassed. These idiots are representing the NHS. When someone calls 999 they have an expectation of what an ambulance crew will be like. These two were a total embarrassment to the profession. 

After a few minutes, the chair arrived. 

"Right, shall we top and tail him." (one under the shoulders, one under the legs, and lift)

"We're not lifting him, *chew chew* our insurance won't cover it. *chew chew* Use a hoist."

The carer disappeared and returned with a hoist. She started putting the lifting sling on the patient and asked for assistance. I began to help from my side of the bed. The carer asked Tweedle Dum to help on the opposite side. 

"*chew chew* Sorry, we're not allowed to help with hoisting, *chew chew* we are not trained in it *chew chew."

So, I walked around the bed, helped get him in the hoist and between me and the carer, lifted him into the wheel chair. Tweedle Dee had vanished and I wasn't going to ask Tweedle Dum to bother pushing the chair so with my bag on my back, downstairs we went. 

In the lobby was Tweedle Dee with the bed. Wow! Pro-active, wonders will never cease. 

"Right, can we lift him across to the bed."

"*chew chew* Nah, we'll use the hoist again *chew chew*."

I'm guessing the "we" was meant to be ironic.

"Seriously, put the chewing gum in the bin or I will call and ask for another crew to convey, this is ridiculous."

With that, I handed the patient to the carer, stomped off to the lift, went back upstairs, grabbed the hoist and went back down. They looked pretty sheepish but he wasn't chewing gum. Me and the carer hoisted him onto the bed and I strapped him in.

Out of earshot of the patient I turned to Tweedle Dee, "Can you push the bed?"

"Yeah, no need to be sarcastic."

The patient was loaded on board and taken off to hospital. If there had been anything wrong with the patient I would have travelled with them. However, as he was well and the hospital was half a mile away I just followed behind in my car. 

To say I had words with the crew at hospital would be a massive understatement. I told them exactly what I thought about them and their behaviour and took their names and call sign. Tweedle Dum wouldn't give me his name and just kept repeating his call sign at me. 

Since when are we not allowed to lift patients? What if there was no hoist, like in most places? I'm all for protecting my back, but really?! Insurance won't cover lifting a patient? Do we just leave them on the floor now? 'Sorry, not allowed to pick you up, you're on ya own luv'! Let us not forget, we are told by the government that tendering for contracts will lead to better competition and better patient care. The NHS certainly has its faults, that's no secret and it also employs some bad eggs but this is now getting dangerous. 

THIS is the NHS. THIS is the future. YOUR life in THEIR hands. NO regulation. NO standards.

I'm sure I will told I'm taring all private ambulance services and their employees with the same brush unfairly and those who do, or know good people that work for them, I apologise. I have no doubt there are good people working in every company and this isn't about them. There is a reason people are sacked from ambulance services. These private companies give them a job in full knowledge of their past. As the old adage goes, you can't polish a turd. Sticking a new uniform on an unprofessional moron will not change a thing. 

A complaint was made. Outcome, unknown.

This is my opinion. This blog was based on 1 crew and my experiences. Not all Private Ambulance services are bad, not all crews are bad but I can only write on what I experience. I'm not interested in any comments left about the QCC regulating etc. It isn't done properly and there are some real cowboy outfits out there. It is of little surprise that my service has announced it is trying to move away from using them. Now why would they do that if they were so cost effective and so reliable? *tumbleweed*


  1. Whilst the general attitude of the crew is unacceptable, using a hoist in this situation seems perfectly sensible to me. Top and tail shouldn't be happening unless absolutely necessary. A hoist is both safer for the patient and for everyone's backs. The patient wasn't time critical, so safe moving and handling techniques should be employed.

    1. I didn't complain about the principle of using a hoist. I wasn't aware there was one when I arrived. I objected to their refusal to help with the hoist ie: helping roll the patient to get the strap in place. Also, due to their refusal to get their chair we were left with a patient in the lobby of a care home with relatives of other patients and staff around. I don't think it is appropriate to be hoisting a patient in such a public place as it is very undignified. Insurance won't cover lifting a patient?! As I said, what if there was no hoist?!

  2. When profit is the sole driving force, this is the end result. So very sad really.

  3. This story does not reflect all private firms and private crews, in some of the private firms there are medics more skilled and highly qualified than the nhs can ever dream of having, also as an ex front line nhs medic I know for sure that there are nhs crews out there that are just as incompetent, uncaring towards the patients and so bitter at the service and patients it makes them dangerous and yet they still are allowed to attend emergency calls, how many people have nhs crews like this allowed to die due to a lack of care or out of date clinical knowledge?? We all know crews on nhs stations we wouldn't let near our pets let alone our family members!! I'm sorry to hear about a private crew with such an attitude problem but "having words" or putting out a blog that comes over as institutionalized propaganda does not help, instead talk to the management of the particular private firm involved as the nhs offer us no feedback whatsoever about our frontline crews and if we found this out about one of our crews they would be suspended from front line duties immediately!!!! As for regulation the cqc regulates us and has the power to close private stations down, who regulates the nhs???? Have any of the trusts that have been found to be responsible for the deaths of hundreds of people even been fined let alone shut down?? The answere is no and we all know the nhs is far from perfect including the ambulance service. Lastly your statement about chewing gum makes you sound like a school teacher from the 1950's, people chew gum, get over it. Jus the thoughts from a medic from a private firm that's been supporting the nhs and keeping its ambulance service from falling apart since 1996, I truly hope our paths cross and we can have a proper and respectful discussion about this.

  4. Sounds like a very basic " driver and his mate " , and nothing else .

  5. I must admit I have wrote this comment a number of times then pressed something and I lose it all. Then I cry myself to sleep and start again.

    There are so many different private and voluntary organisations out and about providing support to the NHS be it 999, PTS or both. But the standard of training is completely different.

    I work privately, I'm an emergency crew (hides). The comments what you have put scare me and concern me, but somewhat don't supprise me.

    You have all these companies and some are very good at training. Wouldn't like to blow my companies trumpet but we get 6 weeks clinical training then 3 weeks driver training and then we are mentored for a minimum of 6 weeks. Then we get the countless CPD sessions.

    But then you get some private companies will do a weeks worth of training then next minute they are responding 999 calls on the unsuspecting public.

    Surely it would be good to have a national standard for roles in the ambulance service be it NHS, Private or Voluntary and there is a standard training course as well. So it won't be pot luck if a private crew turns up on what they are trained in.

    I know it's said IHCD Tech is outdated but maybe something like that this should be brought back and it should be a minimum standard before someone can work for a private company on behalf of the nhs.

  6. Surely anyone who is working on the frontline with patients has to do basic moving and handling. I have to do the basic load bearing one but not the patient moving one as my patients are able to move themselves, I am only allowed to "assist" them. I am however more than happy to assist someone with a hoist. As long as you follow instructions from the person leading there is no problem and 2 people doing it makes it far nicer for the poor patient. I regularly assisted my friend in moving her mother who had multi infarct dementia. Not putting myself and my already poorly back in any danger. I have also assisted ambulance staff when they need an extra pair of hands. Not in major load bearing as that would be stupid for me to do. But it is basic politeness and common sense that if you are there and you are mobile yourself you would help out. Well done for reporting them.

  7. I know a few guys that work for private firms and sja that if I called 999 and they knocked on my door I would happily let them in but there is on firm that regularly does quite a bit of ambulance service support who I would never ever let near me especally after they came onto my ward to do a patient transfer and 1) couldn't use the trolley they brought with them 2) couldn't get said trolley into the back of their own ambulance 3) the guy attending turned around and asked me what should he do if the patient becomes poorly in the 3 hours they would be travelling because he normally does event work not patient transfer

  8. Don't get me started..again! The hoist thing does my head in. When my Mum fell from her chair in a nursing home, the staff called an ambulance and wouldn't let me move her until crew arrived, then wouldn't let them move her without said hoist. In a tiny room it was crazy and one of the crew picked her up as tho she was a child and lifted her to stretcher.
    I was waiting for you to say Billy Bass kicked off with a chewing gum related song then!
    Keep them coming Ella!!

  9. I work on a PTS ambulance for an NHS Ambulance service and the stories i have been told by patients that have been taken to and from appointments by private crews is scary.
    One of the worst i have heard is a regular patient of ours who was taken to a hospital on a stretcher, the crew that showed up did not have a patslide which we carry as standard, they pulled the patient across with the side rails of the bed still up! When on board both members of staff stayed in the front of the vehicle with their music very loud so they had no idea how their patient was doing in the back, they drove fast and reckless as the patient described, being thrown around from side to side, and sliding down the stretcher with their harsh braking. Shockingly this was also a 2 hour trip to a specialist hospital that only uses private crews as they are the cheapest option.
    This whole ordeal left the patient afraid and not wanting to go home as they were waiting.
    This patient made a complaint at the clinic and another crew was sent, which apparently was not much better, again worked for the same company. A written complaint was made later but who knows what will ever come of that.
    I have heard many stories of bad treatment from private crews and i have no time for them at all.

  10. Glad you made a complaint. Totally unacceptable. I may be Red Cross rather than SJA but all of our ambo's have to be 2 IHCD crew members and to be IHCD you have to have done 3 levels of manual handling. I can't imagine SJA being all that different. There actions are just pure laziness.

    Will you find out the outcome? I truly hope they're dealt with suitably.

  11. I work for a large private ambulance service, with out naming the company they been going for a very very long time. We are told we can't operate the hoists but nothing stops us helping with the straps under supervision of the staff. I personally don't use automatic for the first bp, done manually.

    If I had a crew mate like that ill be apologizing and having a strong word with that crew mate.

  12. I've only been working as an "EMT" for 6 weeks at a PAS and unfortunately this really doesn't shock me.

    When I say EMT I dont mean the skill level that NHS staff will associate with an EMT, we are very under qualified ECAs with FPOS intermediate training.

    All of us joined up with the promise of "full training" however this training was nowhere near enough what is needed to be on the front line however ever is more than some PAS that send staff out with FPOS basic training.

    So first day... I find that I have a grossly under equipped truck, that was filthy and I was paired with an ACA who had been sacked as an EMT from another PAS because he had abandoned a PT who "pisses him off".

    We had been promised to be Paired with an experienced EMT for the first few but that didn't happen so we were packed off on the road with no idea how to book ok, no idea how to complete forms and no idea how to hand over at A&E.

    I can see why they wouldn't lift as Manual Handling says we shouldn't engage in Australian lifts, top & tail lifts etc.

    I did mention to you on Twitter about seeing a (not ours)crew refuse to help in escalation because it wasn't in their Job Description. In my view they were just being lazy

    From the above, I think I have supported your concerns.

    However this isn't all PAS crews.

    The first thing I did when I passed my FPOS was get a library card, I spend ever day I could in the big central library reading up ever book I could because I didn't feel ready enough. I spent all my birthday money on books too which I keep with me at all times too.

    Prior to starting I visited A&E at 3 hospital to ask about procedures and see where everything was. I also visited the security guards at all 3 to enquire about parking and night time entry procedures.

    I also arranged to meet up with the friend-of-a-friends who is a Para to talk me through the PCRs.

    When on scene I do what I need to do... If the RRV is there first, I do what im told by the Para/ECP as they are a LOT more experienced and qualified than I am... And I dont argue.

    I have only called in a Para for 2 reasons. After 2 or more sets of double checked obs I see a significant deterioration in condition that i dont understand and because PT was in cardiac arrest.

    I know not all of my colleagues take the job as seriously as I, but that's the seems to be the norm for PAS and it gets people like me a bad name.

  13. I have not had any experiences with the NHS, living across the pond so things are probably a bit different from what I've read but still! Those two are honestly nothing more than a disgrace to people such as yourself who work hard at your job knowing full well the risks and taking them anyway. An insurance risk?!?! I've drug a 300 some pound(not including the scuba gear weight) unconscious man out of the ocean in a scuba diving emergency rescue by myself and I sure as hell wasn't covered by insurance when I strained my back and neck muscles but did that stop me? NO! Did the fact that the only thing insurance covers in a rescue diver situation is O2 tanks stop me? Once again NO! When my grandmother fell right in front of me in the kitchen, breaking her hip, if the ambulance crew that arrived had acted in such an appalling manner I would have raised hell over it. That kind of behavior is utterly unacceptable, it's no wonder that the hard workers like you get such bad reviews in newspapers, because it's their unprofessionalism that gets everyone else judged unfairly. Those kind of people should not be allowed to work in this kind of field, it only is a disgrace to you. I may only be a EFR with a whole litany of various certifications (O2, basic and advanced first aid, ERF course, lifeguard, search and rescue diver.....goes on for awhile) but not only am I honor bound to do everything I can even though most things are uninsured, I am legally obligated to do everything I can. While this situation was obviously not an urgent one, that kind of inaction in a serious one could cost people their lives. URG these kind of stories really irk me, because they just disgrace those that actually do their job with not only professionalism but with honor and respect as well.

    P.S. You have a minor grammer error, in the last paragraph you have written "I'm sure I will told....." I think there might be a "be" missing but I might be wrong. (Don't want to sound rude or anything my dyslexia just happened to trip over that and I thought you may wish to edit that)

    Any who I'll end my little rant now, it was actually rather soothing to get that out lol. If that doesn't make any sense your welcome to just delete the comment.

  14. I work for a large private ambulance service that is more prolific down south than up north where I am based. Many of my colleagues would prefer to work for the NHS where we would get better training, pensions and rates of pay however it's very hard to get into in our area. When I started almost 3 years ago we were on minimum wage and had only 2 weeks training (inc. first aid and intermediate FPOS) before doing PTS work and hospital transfers 48 hours a week.

    Like all workplaces we have some better staff than others. It's good that when you see inadequate care and behaviour that you address it. I personally would have given my crew mate a dressing down for chewing gum when dealing with patient and for not offering any assistance to the care staff as I agree that was poor and unacceptable.

    Also it's important not to forget that when you get involved with a patient transfer that a private crew require assistance with, you will be dealing with a crew that is unable/untrained in what to do in this circumstance. Private crews that are competent and able obviously won't require your assistance! Don't forget that you only ever get to see the "bad side" of PAS when you're working.

    As you have rightly pointed out many of the titles used by private crews aren't protected so training will be different from place to place. I agree with you that it's not ideal. ECA is a National Vocational Qualification however and is a Level 2 diploma so I suspect will be at a set level. I'm currently progressing toward this standard in my own time via an apprenticeship route. It does have aspects on responding to RTCs and assisting a Paramedic on scene so in theory a private ECA should be the same skill level and have had the same training as a NHS ECA as the training is nationally recognised.

    I enjoy your blog very much and agree with much of what you say but please don't forget that not everyone in the PAS side is there because they have been sacked from the NHS. I have a non-related degree in a field that is no longer hiring in my area as do a few other of my colleges. I love my current job and do it to the best of my ability and I am actively trying to improve that ability.

    Best wishes,
    Plastic Ambulance Man

  15. In the beginning, the driving coach worked the pedals while I steered until I got to a confident level. From there I took over, learning to use the clutch and brakes.


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