Sunday, 12 May 2013

In Sync

"36 year old female, going blue"

There has been a lot of talk recently about private ambulance services being integrated into the NHS. I have been rather vocal about my dislike for them, some of my reasons rational, some irrational. In general, my reasons are nothing to do with the individual staff or the service they work for. Nor is it really anything to do with the awful crews I have dealt with. It's to do with the 'big picture'. That picture of the systematic dismantling of the NHS. That is what I'm passionate about and personally I think any private service, be it ambulance or anything else, has no place in the NHS. Where the driving force is money, patient care, staff quality and staff training will suffer.

I was recently asked what my issue with their training was, and I was told in some cases they are better trained than we are. That is by the by. I disagree but am not in a position to comment as I don't know the content of the training the staff receive. There are so many different ambulance services that range from no training to excellent training. The point is, we don't know and therefor the trust and understanding will always be missing, rightly or wrongly. Maybe this will explain why......

I was working on an FRU with my student, We were sat on standby watching the world go by when we were sent a job a fair way away. On the car, you don't get the benefit of reading the updates you get as you are driving and as such, I thought I'd been driving to a DIB (Difficulty in Breathing). You can imagine my surprise when the radio started ringing and the following words filled the cab:

"Just to advise, this is now a cardiac arrest, there is another FRU on way who should be there the same time as you. CPR is in progress."

Well that got the adrenaline pumping! Within 2 minutes we were on scene, just in time to see the first FRU head through the door. I grabbed some spare oxygen and a few other bits and headed inside. The FRU had a student with her too so the were 4 of to be getting on with. The patient was indeed blue and as we were told in cardiac arrest. I'd never met the paramedic on the car, nor had I met her student. She took control of the airway whilst I started attaching pads etc. The students was on CPR duty. A minute late the crew arrived, again, I'd never met them or their student and they hadn't met the other FRU or her student. In effect, we now had a group of 7 people who didn't know each other but who had to
work together in a life or death situation! I really is that simple!

The NHS Logo is one that is respected and trusted.
The paramedic on the crew got IV access and took charge of drugs. The FRU on the airway looked up at me and asked if I could run things and write stuff down. The EMT from the ambulance was given the task of the runner, he would be getting the bed should we need, getting and removing kit and generally being useful. I was writing times down and vocalising everything that had been done and was yet to be done. As a resus goes, this is as smooth as it gets. We followed drug protocols, tried to reverse the causes of the arrest and after 19 minutes we got ROSC (Return of Spontaneous Circulation) ie: Her heart was now beating again!

We stabilised her before moving and by the time we were ready to go every i had been dotted and every t had been crossed. She continued to improve all the way to hospital. On mass we entered the waiting crash team who took over the patients care and she had a great chance of returning to 'tax paying status'. That is of course, the only statistic the government cares about!

The reason this job ran seamlessly was because of team work. We were able to delegate roles to each other knowing exactly what the others could do. We know that an EMT of any level in our trust is trained to the same standard as paramedic, the only difference being paramedics cannulate and give the drugs. Most can do the same airways as paramedics and they'll all have a minimum of 7 years experience as an EMT. We know by the epaulettes of the students what stage in their training they are in. We also know that they have had exactly the same training in advanced life support and are trained in all our local protocols and paramedic assist. Regardless of what staff from our trust arrives you know exactly what you are getting and can simply get on with it. You do things without being told, you pass things without being asked and seamlessly work with strangers because the uniform says you can.

This is where there trust is lost with private ambulance services. Their staff may well be trained to a high standard but equally they may not be. Some EMT's in private ambulance services have only been on a 3 day course. Some ECA's may be 18 years old with only a first aid course. We simply don't know and during a cardiac arrest you don't want to be learning the hard way that the crew sent to assist you has never even done CPR before. Ask yourself this, if your relative is in cardiac arrest, who would you rather see walk through the door? I know what I would want.

This isn't an attack on the private ambulance services or the people that work for them, it is simply highlighting the issues that we as road staff are having. If they have to be used then it should be kept to patient transport and assistance services, not front line 999 work. There simply just isn't enough quality control and parity in training to make it a safe, viable option and nor is it in the best interest of the people who use the service. Until such a time that all roles are registered professionals, they cannot be integrated successfully with the NHS. There are too many people calling them selves EMTs, ECAs and  trainee medics when all they have done is a three day course.

In MY opinion.

32 comments:

  1. max d'frost12 May 2013 at 07:37

    Agree 100% with this.

    ReplyDelete
  2. I did a 4 day first aid course a few years ago, does that mean I can call myself a paramedic? jk.

    I know previously people have posted to say they are highly qualified but most of this seems to have come from previous jobs, not training given or experience asked for with their job.

    Never had experience with a private ambulance crew, always had the real deal or St John's.

    Did once get a transport ambulance ordered by a GP for a guy who was clearly turning hypoxic, even I, a lowly HCA could see that. Crew arrived an hour later and immediately radioed through for an emergency vehicle with O2 on board.

    ReplyDelete
    Replies
    1. Are St John's not considered private also?

      Delete
    2. Haha! I think the para bit was a joke! ;-)

      Delete
    3. I consider SJA a private company in relation to 999 work.

      Delete
    4. Just a question, maybe it's stupid...but would you consider SJA to be more okay to work with if they are necessary to relieve pressure on the service, though they might not be as trained, but the organisation aren't motivated to take over the LAS considering they are volunteers?

      Delete
  3. I'm one of those dodgy private crews that work with the LAS, and I completely agree with you.

    The standard of care the patients recieve is highly variable, and you're right, it isn't easy for staff to work out who can do what in high pressure situations. Even within one of the myriad of organisations working with the LAS, you can get everything from an ECA-alike with twenty years experience who I'd trust with my grandma through to the five-day-tech who I wouldn't trust to operate a tail-lift, so you can't even rely on the uniform as an indicator of quality.

    Personally, I'd really, truly love to see my role become redundant.

    So why do I keep on doing so? Well, I need the money ;) I do the work as bank staff when I have time in between the demands of my real job as an NHS proto-clinician of a different variety (so I feel slightly vindicated). There is unfortunately a very real need for this type of stop-gap work until the NHS can fix the underlying problems leading to the ambulance shortfall, and I'd rather that I could be there to help patients rather than nobody. The fact it's yet more clinical exposure and a few pounds in the bank is an added bonus (but there are a lot easier ways to earn money).

    So I'll keep doing it while I have time, and I'll keep trying to mitigate any risks to patients by holding myself - and staff I work with - to the same high standards expected of my day job, by introducing myself to NHS staff I work alongside. Because if its me or no-one, I know which most patients would choose.

    ReplyDelete
    Replies
    1. THANK YOU! Look, I get it, I really do. Money talks, we all have bills to pay and families to support. In previous posts my thoughts may have got lost a bit in the rage but I don't have an issue with people earning a living and cerntainly not against the hard working crews. I just don't think we can be integrated together due to the lack of parity. I work for 2 private companies, 1 that does event work and 1 that provides staff on bank work to work for the NHS trusts. In 1 event with this company I had to convey a patient to the local hospital and once there assisted in a resus of another patients. The crews were dismissive and mostly ignored us but they didn't know what we could do so they did their thing!

      Thanks for the comment. Really appreciate that you get what I mean and agree. Be safe, hope you carry on doing the work you enjoy and getting the money you need!

      Delete
  4. I think we need to ask whether the shortfall in NHS ambulances is actually an addressable problem. If it is, as in there is some magic way of suddenly educating the public as to when to use ambulances appropriately, fixing out of hours GP services, and doubling the number of fully trained front line staff, then one could view the private crews as a necessary evil in the short term. However, I get the feeling talking to managers that they're going to be here for the long run, especially with the creeping privatisation of the NHS as a whole.

    In that case, you're right in that we need some form of minimum standards and registration for staff (and for NHS ECAs?). I'm lucky in that my organisation is a national one, with a long history of working with NHS trusts, so most staff know at least vaguely what the skillset written on my chest entails. I'm also on a professional register with the day job, so staff can always look me up when I claim to have skills beyond that. But I get confused with the number of different job titles, and variation within a single ambiguous title such as EMT or ECA, when working with private firms either on the road or in hospital.

    I don't think we can escape the fact that we are going to have to integrate NHS and private crews, at least in the medium term. We need to start pushing therefore for national minimum standards and registration for recognised job titles, and ensuring that NHS trusts employ private crews where necessary based on their clinical skills and interoperability with NHS resources, rather than going for the lowest bidder.

    ReplyDelete
    Replies
    1. It is addressable! Whether the incentive is there for them to action it I dont know! Lots of pockets to be lined!

      I totally agree about variable job titles. ECA, EMT, A & E support, ECSW. They need 3 title. Para, student para and ECA / EMT! All with the same training. Anything else should be only a first aider.

      Delete
  5. max d'frost12 May 2013 at 11:47

    not wanting to hijack this thread and In reply to 'anonymous', please, serious? A 4 day first aid course absolutely does not mean you can call yourself a paramedic. I'm not having a go but it really irritates me when the media (and therefore the public) use 'paramedic' as a generic term for ambulance staff. For the record, since around 2005, qualified paramedics have had to complete a degree course at university which includes many exams, high pressure scenarios and hospital placements. To gain the protected title of paramedic, we also have to register with the health and care professions council where our every action is scrutinised and we have to account for everything we do at work ( and out of work). I would say this makes us highly qualified. Unfortunately, many don't know this and think the job is just putting on a bandage and behaving like those baffoons in carry on nurse.
    I know this is somewhat off tangent but I wanted to just make this point.

    ReplyDelete
    Replies
    1. I think it was joke, but....

      Totally agree with your point. Paramedic is banded around to everyone on a yellow vehicle. 'Ooh, gotta go, the paramedics have just arrived' said to a double ECA crew!

      Delete
  6. max d'frost12 May 2013 at 11:50

    @ anonymous. Just noticed the jk tag.......appologies for the rant.

    ReplyDelete
  7. The Saddest Part is the best private crews are never on 999 work as they are put where the profit is highest. SATS Ambulance's carry one experienced ICU nurse and one tech per vehicle, but as aero repatriation and NICU pays the highest they stick to them instead of 999 work.

    To many jobs these days are going to private and they simply don't have the equipment levels or the skill to deal with the job. that being said LAS are having a hell of a time as well. I recently got called to a job with LAS and as we were preparing to move a gentleman I had initiated TCP (trans cutaneous pacing) on, we found that the frontliner had no scoop aboard as it had been left at A&E on the previous job and they weren't given enough time to go back and get another.

    The government should really just allow the NHS ambulance services to expand rather than letting privates drive the cost down and ruin what is probably the best service in the world.

    ReplyDelete
  8. Hi Ella,

    I'm a paramedic student at uni, I have my first year OSCEs next week and instead of practicing/revising I'm sat here reading your blog. I can't stop!....If I fail it's definitely your fault :)

    Really enjoy reading your posts, it's obvious that you're a very competent, caring paramedic. I hope I'll be able to practice to a similar standard in a year's time x

    - BC

    ReplyDelete
    Replies
    1. Thank you! Really appreciate that. x

      Delete
  9. Private ambulance companies have their place, Is that place in a front line 999 role? Maybe.
    One point you brought up was about the terms of ECA and EMT. I fully agree 100% that these 'titles' are thrown around too much. I myself am currently studying as an ECA outside of an Ambulance trust, but with my local college. It is a full years course and at the end holds the Edexcel BTEC L2 in Emergency Care. But would I call myself an ECA at the end of the year? Yes, but I wouldn't feel confident enough to use those skills on the road in a 999 job without time on an ambulance as a student.

    'EMT'is a term that I've seen used far too much, people training for 3-5 days and then calling themselves an EMT. I personally believe unless you complete the IHCD course and rock up 750 clinical hours you shouldn't call yourself an EMT. But that will never happen!

    PAS have their uses i think, as a back up for current trusts in times where they may need extra crews, they're short staffed or something major happens and they need extra vehicles. But they should not be used as a replacement, they should be used primarily in non-emergency roles that then allows Trust crews to deal with the incidents that they need specialist help at. Some PAS may have HCPC registered paramedics and IHCD qualified EMTs, but not all of them will do. Maybe there should be some sort of control of PAS to ensure that they only employ people with such qualifications onto 999 duties?

    If this makes sense to anyone else, Then I've succeeded.

    ReplyDelete
    Replies
    1. Made perfect sense. Really good points made! Thank you!

      Delete
  10. Not to mention that the mp's probably all have shares in these privately run companies so its not in their interest to fix the broken bits of the nhs, police, army and fire service. . . Sorry am i being cynical?

    ReplyDelete
    Replies
    1. Dont even get me started on that!

      Delete
  11. Hi
    I work for a few private companies as a tech, after working for a trust. Here are a few points, first of all, there are some "undertrained" ECAs I've worked with that are great and I've worked with some trust paras that are totally incompetent, so in my opinion the issues with training is not limited to duration, but competency.
    Secondly, to the trust staff who have problems with privates- you are guaranteed work and a salary, you are guaranteed a pension, you are guaranteed sick pay, you have the possibility of the trust paying for extra courses, you have general respect from other trust colleagues.
    As a private, I am not guaranteed work on a weekly basis, I have no pension I have no sick pay, I have to pay for any extra training and cpd, and I give respect to ALL trust and privat staff, usually get it back from other privates, and rarely have respect returned from trust staff. As I write this I'm sitting in a crew room with a trust crew that are blanking us, because we're private. I'm doing what I love as a private because there are no jobs with the trust. Try to understand the struggles we as privates face, and look at yourself, and maybe change your attitude, it looks like privates will be here for a while do get used to it!

    ReplyDelete
    Replies
    1. Thanks for the comment. You make some really good points and I agree with you. I really do. Met a really good private crew last night and chatted about their work patter, or lack off! I know there are crap Paras and great ECAs. My point is, that as ECA and EMT are not protected titles, anyone can use them on minimal training. Because of this, with the best will in the world, a private tech or private ECA won't be trusted to that of a trust one. In any particular trust, you know what training your EMTs and ECAs have had, with a private you just don't know.

      I wil always give credit where it is due and similarly, criticise when needed. There is absolutely no excuse for you being blanked in the crew room. Or on a job. What im saying is that the trust and unspoken understanding isnt there because of a lack of parity in training. We are all on the same team and I will always treat all crews with respect and courtesy. Its a real shame the idiots sitting opposite you are not showing you that respect.

      Delete
  12. Does this not mean that the problem lies with commissioning - that when the Trust commissions a private service, they should be specifying exactly what level of service they require, including training, grades of staffing etc?

    ReplyDelete
  13. Hiya Ella

    I am a student and Plymouth University where i am just about to finish my foundation degree in rescue and emergency management and am then off to either Greenwich or Canterbury Christchurch to study Paramedic Science.

    My email address is matt.rodwell@live.co.uk (all lowercase) i would really love to speak to you via email privately about some of the things i have encountered on my course such as the HART team, the Fire Service, effect of the cutbacks and the some of the things you talk about above regarding EMT and ECAs, and hear your thoughts especially about the HART teams.

    I understand completely that you must get requests like this alot and that you are incredibly busy so if it is not appropriate please do not worry and thank you for your time!

    Matt

    Ps i have read your blog a lot over the last two years and it is a very good read with what i believe to be very topical points even if i am only a student!!! Ll

    ReplyDelete
  14. I am a NHS employed ECA with 3.5 years on the road experience. The majority of road staff in my area know me and know my level of competence (evidenced by the number of times I've heard them say "oh, thank f*** it's you" as we arrive to back up the FRV). And yet...last night, working as a double ECA crew on the way to a job, we were asked by the person on scene, via Control, whether we were qualified to administer entonox. (For the record, yes, since day1 of training school). Unfortunately these questions need to be asked as even within the job role I have it seems that every course has been taught differently and while all ECAs are equal, some are more equal than others. It is only natural, therefore, that there is suspicion amongst Trust staff when they are backed up by private crews with Technician epaulettes that may signify anything between 3days and 30years if experience. In stressful Life/Death situations I completely understand why any para would want to be absolutely certain of the capabilities of the people around them.
    Having said that, blanking private crews when on station is pathetically childish behaviour (and there are still some stations in our trust area where the old school staff blank us too).
    In short, love you blog Ellie... now if you could just fix those grammar problems... ;0) x

    ReplyDelete
    Replies
    1. And if I could just fix my predictive text problems... apologies ELLA.

      Delete
  15. Im sorry but some of this I disagree with. I work for a private ambulance service and myself and my other colleagues have had proper training with IHCD qualifications. So In sense we have done the training to help the trust out with the amount of work load they have been receiving lately. And 50% of our staff are either ex trust or are currently still in the trust.

    ReplyDelete
  16. Here above lies part of the problem with training that even the NHS are responsible for. Why are "double ECA" crews being used when the purpose of an ECA is to Assist a Para / IHCD Tech and were never intended to work alone

    ReplyDelete
  17. I agree there are a number of Private services who operated below parr! I work for several private services and have seen the good and bad in most! I am Ex East of England Ambulance Service! I have had many a discussion with the HCPC with regards to either registering IHCD Technicians or better still we currently have 3 levels of Paramedic Critical Care Paramedics, ECP's and Paramedics now if they adopted the banding system that LAS apply to their techs i.e. 1-4 then you could for arguments sake make Critical Care Paras a level 4, ECP's Level 3, Paramedics as they are now a level 2 and IHCD Technicians a level 1 Paramedic! Then anyone saying they are a qualified Tech will will know they are a 5 day Tech FPosI level! It would also mean that all IHCD Techs would be fully accountable for their actions whereas at the moment if they mess up they just change employer! Just a thought!

    ReplyDelete

I love comments! All bloggers do! If you have something to say, agree or disagree I would love to hear it! I will reply to all! (or try my very best!) If however, you're a troll, save your breath!

Due to an increase in spam I moderate comments but ALL genuine comments will be posted. See above exclusions!