An Introduction

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.

Stayed tuned.

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8 Responses to An Introduction

  1. Tom Reynolds says:

    An excellent first two posts – please do keep it up. I want to keep being reminded why I never went for ECP…

  2. Hugh says:

    Just been pointed at your website by Mark over at NeeNaw…. Great first couple of posts – really looking forward to reading more….

    And what, out of interest, does N.F.I. stand for? For the moment, I’m going to assume “No Fucking Idea”, but please do correct me on that…..

  3. Magwitch says:

    Hugh – spot on 🙂
    See the note at the end of Disclaimer and Other Stuff

  4. Hugh says:

    Ahhh – had skimmed that page, but not properly read it 😉

  5. Nice blog. I look forward to reading it. Keep it up, as the actress…….

  6. resqellie says:

    I’m so glad you’ve started this! I rode in and ECP car last summer for a couple shifts, I think it’s a great idea that we could really use it here in the states. Can’t wait to hear more!

  7. geepeemum says:

    This looks really interesting – and I love your 1st few posts… Even as a GP who, only FOR ONCE, might occasionally be helpful 😉 I’m enjoying it!! It’s good to know what’s out there…

  8. Welcome

    I thought that was about the best introductory post I have ever read. And I agree with just about every word. You say “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.” and that says it all.

    We still have this nonesense in the UK that anyone can pick up a phone and summon a doctor/paramedic/whatever to their bedside for any condition however trivial.

    I did 12 years on call before I co-founded a co-operative to ease the burden. That 12 years nearly broke me. I went into medicine as a GP genuinely thinking that people would only call at 2.00 on the morning with serious illness. And I never had any problem going to see the old lady in heart failure, the asthamtic…or whatever. But mostly it was unmitigated nonesense. As has been said many times, people put more thought into ordering a take away pizza than they do into calling out a doctor. I used to dread pub closing time, give him time to walk home, see his child has been vomiting whilst he was in the pub and he is on the phone “I want the fucking doctor out”

    I could not cope.

    The government had no concept of the amount of work that was involved. So they said they would take over the OOH work for doctors who would be prepared to accept a £7000 a year paycut. They did not think there would be many takers. 98% of the profession walked. That leaves the government with a real headache. They now have to pay doctors a competitive economic rate to do OOH. And they cannot afford it.

    So now they are looking for cheaper methods.

    It is different but equally ridiculous to use paramedics. You guys should be at train crashes/on the M25/RTAs and that sort of thing. That is where your skills are.

    I talk to paramedics I know. I cannot believe the crap that they are called to. I still cannot believe the things that people think it appropriate to dial 999 for.

    Instead of being at RTAs, you are going to be used to go round to see little Johnny with a temperature. That is a complete waste of your skills but also, with respect, not fair on you because you do not have the diagnostic skills to exclude, for example, meningitis. It is not easy.

    When I am in my plane crash, and if I am lucky enough to survive, I don’t want to be sitting in the wreckage, exsanguinating, because the paramedics are tied up with an “emergency” in growing toenail. I want you at the accident, please.

    There is no other country in the world where you can summon medics of one sort or another to your house in this fashion. It is a ludicrous, stupid waste of money.

    I agree with you when you say:

    Get the real nurses back into A/E and lots of them. Get more casualty officers. Force people to come in. Get the paramedics out to major RTAs/blood/artery/spurt/Hitchcock scenarios.

    This works in the USA. I worked in Chicago. Everyone got into the ER there. Just like ER (which of course in based on Cook County in Chicago)

    Make it quite clear to patients that it is THEIR responsiblity to get to the A/E department or the doctor-on-call centre. Anyone who cannot get there due age, infirmity or genuine illness does need to see a doctor. It is not right that paramedics should go to see them. They need either a driver to take them into the doctor, or the doctor to go out. They are few and far between. A doctor needs to triage them and make the decision about whether to send someone out. And all the nonesense of “we can’t come in because my husband is in the pub” needs to be stopped.

    As you say, people must take responsibility for their own health needs.

    Phew! I feel better for that

    Welcome again

    John

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