Welcome to this, my first posting on the Diagnosis? NFI blog. Hopefully you’ll find these musings (and the occasional rant) informative and light hearted.
So, what’s it all about then? I write on the NET under the pseudonym of Magwitch. I’ve been on the frontline of prehospital care (such a great phase – used to be called first aid but that’s what Johnners do now) as a paramedic for over a decade. I work for one of the ambulance services in the Home Counties. I’m now, what is known as, an Emergency Care Practitioner. The original name was to be Practitioners in Emergency Care – PECs, but for some reason the role got re-branded before it had even started. ECPs, as we are known, are a new innovation for front line ambulance services. The concept is to cut down on the number of patients that get carted off to the local A&E department by either treating them in their own homes or referring them to a more appropriate primary care pathway.
Why are they always pathways? Who thinks up these things? Governmentspeak still bemuses me.
In addition, in areas where GPs have opted out of offering an out of hours service, then ECPs are used for OOH home visits. Usually the ones where the out of hours doctor, who triaged the call, has raised his/her eyes to heaven and withheld a sigh of exasperation. LOB jobs – load of bollox.
In many ways, so it seems to me, we are the government’s answer to a question that they haven’t yet formulated.
Patricia H – “Hey, wouldn’t it be a great idea if we could improve Accident and Emergency services by treating people in their own homes? We could employ hundreds of Practitioners (Dr Crippen will have an MI at the thought), at great expense, to visit people at home rather than get them to go to hospital”
Civil servant lackey -“Wow, great idea!! Lets waste even more NHS money on ill conceived projects” (I'm sure Wat Tyler must have a view on this)
No one, it seems, has considered other possibilities; like employing a few more nurses at A&E, running district nursing services 24 hours a day, setting up some minor injuries units, or even getting people to take responsibility for their own health. Why get people to go to a centre of clinical excellence when you can get a bunch of half-wits to visit them in their own homes for a fraction of the cost.
Picture it, if you will. Saturday night, mid winter, it’s cold and raining.
“Damn, I’ve cut my finger. Can’t be arsed to get in the car and pop down to A&E where I’ll have to sit around for 4 hours until a nurse sorts out the wound. I know, I’ll dial 999 and get an ECP to come round while I stay here in the warm, have a few more beers, and watch the footie highlights on TV.”
So naturally the government believes it’s far more cost effective to have ECPs running around, who can see about 1 patient an hour, rather than get patients to go to A&E or a nurse-lead clinic where a nurse could see about 10 patients an hour. No, according to the Department of Health, ECPs are the future of the NHS.
Anyway, I’m now one of these new fangled lot. At which point it’s time for a short rant.
As an ECP there are some things that I’m not and one, which really gets my goat, is being labeled a ‘super’ paramedic. Thanks to uninformed reporting in the likes of the Daily Telegraph and The Mirror the title is starting to stick. Even organisations that should know better, for example Paramedic UK and Sussex Ambulance Service are using the term.
So let’s be clear, I am not a ‘super’ paramedic. I am a ‘standard’ paramedic who has received a little extra training to do a few more mundane skills like wound closure and catheterisation, and who can ‘dish out’ some additional medications like paracetamol (acetaminophen in the States) and gaviscon; stuff you can buy over the counter at any chemist for goodness sake! Ok, so I've also carry a few POMs (prescription only medications) as well, but that's not the point.
The other thing I am not, is – I am not a Doctor.
Don’t have any aspirations to be one, don’t pretend to be one, don’t want to be called one.
Doctors do five years or so of medical training plus however long it takes for their specialty. I did a sixteen week course on top of my paramedic training. One module of which I renamed “how to be a doctor in 2 weeks” – you get the point.
Some of my colleagues however, do, sadly, believe their own press. Although they completed the same course as me they can walk on water, conjure up bread and wine and, on a good day, raise up the dead. Guess I must have missed those lectures. You can easily spot them, they’ve got green uniforms with a big S (for stupid) on the front of their shirt, and wear their underpants outside their uniform trousers. Worst of all, they seem to have forgotten just about every EMT and paramedic skill they were taught. So, all chest pains are gastric reflux, all strokes are single faints. Quite frankly, some of the things they get up to, and I’ve backed up quite a few of them in my time, scare the living daylights out of me. On the other hand, there are some who are absolutely brilliant, and I’ve got loads of time and admiration for them.
I can hear the chorus of “so why did you become one then?” To be honest I wanted the additional training but didn’t really give a thought to the type of work I’d be doing. There had been a lot of turbulence in my life at the time and the training seemed a positive move forward. In truth, I learnt loads and much of it, I suspect, will become part of the paramedic curriculum in the future. Other parts like “how to be a doctor in two weeks” were, quite frankly, not a lot of help. Luckily, I still get to do a lot of ‘real’ emergency work as well as ECP calls but, given a choice, I’d rather be back on the bus (ambulance to the uninitiated) any day, it’s just that there are no paramedic vacancies in my patch anymore, so I’m stuffed. Besides which I get paid a sh*t load of money for doing less work. Dr Crippen take note – it’s more than £30,000 plus pension!
That said, I still have a great time. Illness and injury know no social barriers and I can’t think of any other occupation that allows someone to enter the homes of the rich, the famous, the poor and the downtrodden all in the same day. I confess I’m a ‘nosey bugger’ and it’s a real eye opener to see how people live.
Looking ahead on this blog, I hope to provide an insight into some of the weird and wonderful calls I get to do, both in my paramedic role and as and ECP. Hopefully it will be an stand up alongside some of my favourite blogs; NHS doctor, Nee Naw, Random Reality and Newbie EOC.