Us and Them

The Control Manager finally gets his hands on that bloody ECP.

Anyone who works for an ambulance service will know that there is very much an “us and them” attitude between Control and road crews. On a bad day, crews think Control are a bunch of idiots who haven’t got a clue what they’re doing and they, in turn, consider us a load of lazy, arrogant sh*ts who’ll do whatever we can to get out of doing a ‘job’. Of course we’re really all part of the same team, with the aim of making sure that when Aunt Nelly dials 999 she gets a qualified paramedic or EMT turning up in a reasonable time. Sadly, the other day was another case of communication breakdown.

Throughout the shift I attended a ‘severe difficulty in breathing’ which turned out to be a panic attack. A patient “fitting” who actually just felt unwell in the supermarket so the staff had dialed 999 (according to the caller no one mentioned fitting). There was a young person with “chest pain”. Well that was true enough, they did have chest pain, but only because they’d been coughing a lot; a bit like the person with ‘difficulty in breathing’ who had a cold; fair enough, if your nose is bunged up it’s likely you’ll have trouble in breathing.

There’s also that little annoying habit the dispatchers have of not passing on helpful information. Like when I and a crew turned up at an address:
“Ah, you found our red house alright then?”
“Actually no, not really, we’ve been traipsing up and down the street for 5 minutes.”
“Well I told that nice lady on the phone that we’re the only red house in the road.”
She’s wasn’t wrong there; it stood out a mile. Shame no one in Control actually thought to pass on that useful bit of information to either me or the crew.

By the end of the shift I was getting a little bit peeved by all these apparent mis-diagnosed jobs.
Doesn’t anybody up there (in Control) ask the caller what’s actually wrong with patient?

So, on my way back to station the bat phone rang (again).
“Red call, allergic reaction. Would you be OK to advise?”
“No, I’d like to have a vehicle running just in case it’s anaphylaxis
“Hold on, I’ll check with call taker to see what’s going on.”
After a pause. “It’s OK the patient just has a rash.”
Now that sounds like a nice easy call, just dish out some Piriton – job done. “Are we treating this as an ECP visit then, or a ‘C’ cat call?”
“No, it’s been coded as a ‘B’ so go on blue lights please.”
“Strikes me they don’t know what’s going on.”
I pitched up at the address to find a man semi-conscious on the floor; face all swollen; covered in a rash; vomiting and crying out that he couldn’t see, “My vision’s gone all blurred.”
Anaphylaxis all right. I called up for an immediate ambulance whilst I readied some adrenaline. By the time the crew arrived he’d had 1 mg of 1 in 1000 adrenaline I.M (intra-muscular) and he was looking (and feeling) decidedly better.

After we’d got him settled on the bus I asked the gentleman who dialed 999 what he’d told the caller taker. “That he had an all over body rash with blisters. That he couldn’t see, that he was vomiting and that his face had blown up like a balloon.”

Right – so that’s just a rash then!

This is just the sort of experience that drives a wedge between us and them.

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10 Responses to Us and Them

  1. Millietant says:

    Relations between us and control are usually good, although i work non-emergency and don’t have to deal with the stress of mis-diagnosis like yourself so that’s probably why!
    My gripes are usually minor, like we’ve just loaded up the vehicle with 5 patients and are about to leave when they blow through requesting that you dump your patients onto another vehicle because they want you to go to a children’s hospital to pick up a stretcher patient on an out of town job. (Not out of town since we’ve all merged!) You smile nervously at the patients who all heard the message and having made your apologies rearrange the vehicle into stretcher mode, run across to the EPS trucks, get directions from their sat-navs (aquire) a fast tag because somebody’s already (aquired) yours. Arrive at the other hospital, get to the ward to find an EPS truck has just taken them. It’s not stressful, its just time wasting. But at least now i know the way to Nantwich.

  2. Kingmagic says:

    Our service uses AMPDS which I think should be binned as it is total B*ll*!ks. Since having it our Red Call Cat A,s have more than quadrupled and crews are getting mightly pi*!ed off arriving at jobs which are nothing like the screen says!!
    What ever happened to the days when “puzzle palace” (control) could use discretion?
    My biggest bugbear with them at the moment is that we are still being used as a taxi service for hospitals i.e. transfers, routines, discharges etc. So that when we are loaded up and a job comes in all they do is send a car or a PTS crew as all that matters is hitting the times.
    What is the point of being a trained paramedic with additional skills like thrombolysis, paeds trained, gynae trained etc etc etc….?

  3. ecparamedic says:

    Don’t get me started………………………….

    The biggest problem I have with Control is a lack of consistancy, some back you up for ‘A’ cat calls, some don’t. Some answer the phone, some don’t. The one thing they all do is sound mortally offended when I do finally get through, aren’t we supposed to be able to talk to them?

    SD

  4. badman says:

    the basic problem is AMPDS. it’s bolloc**. leading questions – what we told during teck training? No leading questuions. Obviously thought up by a complete moron, who now works for NHS24/direct.

    Of course the other issue is that the staff of NHS24 ARE c***s while those on control are procbaly C***s.

    No system is perfect.

  5. Millietant says:

    In reference to Kingmagic’s post i would like to say that i believe the PTS is being chipped away at. The latest example in our area is the new on line system which narrows down even further those who qualify for a white taxi with the “green starsky and hutch go faster stripes down the side” (I would go faster but i fear if we hit an ant the vehicle would fall apart)
    I think this is a mistake as missed appointments cost the NHS millions and will eventually lead to further illhealth in the patients. But i believe in the not too distant future there won’t be a PTS, or they will be run by a private company.
    At the hospital i usually frequent, there are 1400 beds and there is only 1 discharge bus. Do the maths. I have worked on it. It is exhausting. Discharges are passed to the PTS on a begging basis.
    Lastly I don’t want to put emergency patients at risk because they’ve been sent the wrong crew and i don’t want an emergency crew tied up with patients i could be taking

  6. Kevin Byrne says:

    Re Kingmagic’s post – the Cat As. My service is having more than a little difficulty in meeting its Cat A commitment; interestingly, though, examination of the data shows that in 2006/7 we seem to be fielding significantly fewer Cat As than we did in 2005/6. Far be it from me to suggest that moving the goalposts is a good way of dealing with the problem.

  7. ecparamedic says:

    Must admit the number of inaccurate reds does seem to have increased with AMPDS, I often end up with one of my assessment visits being coded red when I have specifically requested a green response.

    SD 😉

  8. magwitch says:

    Thanks all for your comments. I’m doing a little research at the moment trying to find out where the 8 minute target actually came from. Have drawn a blank so far. Interestingly I did come across a review of AMPDS in identifying patients with an MI. The authors conclude:

    AMPDS with DH call prioritisation is not a tool designed for clinical diagnosis, and its extension into this field does not enable accurate identification of patients with ACS.

    No wonder it can’t identify real life threatening calls.

  9. ecparamedic says:

    I’ve had a dig around for the same info, there are numerous DoH documents that refer to ‘clinical evidence’ without actually referencing it formally.

    There is a presentation here http://www.resus.org.uk/pages/IDaP_DF.pdf that does have a reference to some work done by LAS that got published.

    SD
    😉

  10. Miranda says:

    Whilst not wanting to alienate anyone here on this ‘control bashing’ post I feel I have to defend. Sometimes callers lie. Its a sad fact. They tell us one thing and explain to the crews another thing when they get there. When the officer in charge asks them if they passed on important information when they rang it in, not wanting to appear stupid, they say ‘Of course I did’. I know when I have had important information to pass over, after the event I play it through in my head and wish I had said this or that. In their case they get another opportunity to pass on everything they forgot to say earlier. Sometime we get calls passed to us from Amb or Police and they haven’t got the relevant information we require, the same when we pass jobs through to them, its not us being lazy or stupid, but not having the right knowledge of what is required, we do what we think is best. Its not always right though!

    We have a lovely system in Fire Control called ‘relief duties’. When we have on ongoing incident crews can only be there for 3.5 hours so we have to organise crews to relieve them. Nobody wants to be on that list at 0300hrs so we tend to find that most crews are nice to us. Behind our backs is a different story I am sure, but what I don’t hear I don’t care about!

    I like to think it is a lack of understanding on both sides, not really understanding each others role. When we have crews to visit us they are usually very surprised at how much we do. They have a better understanding of why we don’t always answer them on the radio immediately, they listen to callers and can’t quite work out how we managed to turn the call around to get the information within about 30 seconds and mobilised someone. Big team, different roles, more understanding required!!

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