News The Commissar Won’t Want To Hear

There is always room for improvement comrades!

“Comrades, from April next year your party expects an increase in potato production per hectare. Co-operatives failing to meet the new quotas will be permanently re-assigned to the mines of Siberia”.

++++++++++

Well, my hunting around the internet, in a serious search for the origins of the 8 minute response time “holy grail” has borne fruit and turned up a hitherto unknown testament (at least to my knowledge). No doubt Commissar Hewitt, in collusion with MI5, has already sought to have the authors permanently gagged under threat of a fatwa.

It seems the initial positing of an ‘8 minutes response to life threatening calls’ (read; out-of-hospital cardiac arrests) all came about in 1996 in a government sponsored paper by the ORCON study group, under the direction of R Chapman, entitled: “Review of Ambulance Performance Standards; Final report of steering group. NHS Executive 1996.

I wrote to the DoH in an attempt to get hold of a copy. A Mr Davie kindly responded.

“Currently we have no publicly-available copies of documents dating back from that time; any publication from that date would now be out of print. In sourcing copies, either print or electronic, I suggest that you contact the British Library.”

So, this catechism, that dictates the whole strategy of ambulance services up and down the land, is no longer available but is languishing in an archive somewhere slowly gathering dust. It’s findings; the current ORCON standards that are now ‘set in stone’ have gone unchallenged for nearly a decade.

Until now that is…..

I stumbled across this little gem; The Costs and Benefits of Changing Ambulance Service Response Time Performance Standards, Medical Care Research Unit, School of Health and Related Research at the University of Sheffield. May 2006Download a PDF copy. This is another tome from the black arts of academia.

But first, a little recent history:

As mentioned, the ORCON standards are ‘set in stone’ and have been since that government report of 1996. It’s main commandment was that 75% of all Category A (life threatening calls) must be reached within 8 minutes. Of course the interpretation of 8 minutes was open to question. What exactly did ‘within’ mean; less than 8 minutes i.e. 7 mins 59 secs? or up to 8 mins 59 secs i.e. 9 minutes? And when did you start the clock running?; when the EMD in control picked up the phone?; when Control dispatched an ambulance?; when the ambulance left the yard? And when did the clock stop?; when the para/emt actually reached the patient?; when they pulled up outside the house?; when they got to the street? All these variables allowed managers to cook the books, manipulate the times sorry, interpret the results in different ways.

Of course none of this has anything to do with patient care or clincial outcomes, it’s just become another way for the current oligarchy and their obsession with targets to ‘tick the right boxes’ allowing Comrade Hewitt to declare that the NHS is “having its best year ever.”

Last year the Department of Health published (another) document: Taking Healthcare to the Patient; Transforming NHS Ambulance Services. In it, the mantra of the 8 minute response time was reaffirmed only now:

“..for the purpose of measuring 999 Category A and Category B response times, the clock should start when the call is connected to the ambulance control room. This will more closely match the patient’s experience and can be consistently understood and applied by services. This change should be introduced from April 2007.”

This, ‘supposedly’ is great news for patients – the ambulance should reach them more quickly; and great news for ambulance services as we’re all starting the clock at the same time. In reality it means that crews will have less time to actually get to the call, response times for Cat ‘A’ calls will plummet and there’ll be the usual knee-jerk-we’ve-not-given-this-any-thought response from management.

As I blogged earlier, LAS are re-stucturing their whole fleet in order to meet these new, and more stringent targets; ‘Now you see us; soon you won’t‘. This was based on an article in the London Evening Standard. In it Mr Ian Todd, LAS assistant director of operations towed the party line and stated,

“the changes would mean significant improvements for patients such as heart attack victims, whose chances of survival drop by 10 per cent for every minute’s delay in getting treatment.”

Sounds grand doesn’t it? Where’s the evidence to back such a claim?

Tom Reynolds has also posted about it in What is an Ambulance?

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So now let’s have a look at the conclusions of this new paper from the University of Sheffield;

Overall, rapid response in terms of an 8 minute target makes no discernible difference to survival to discharge. Nevertheless, we also know there are benefits – for the survival of a small number of out-of-hospital cardiac arrests, and in the short term in reducing levels of anxiety, pain and distress.

For all patients together there was no reliable evidence of an improvement in outcome with faster response, and we estimate that the odds of dying were only 1.4% less with responses ≤ 8 minutes compared to responses over 8 minutes.

Further developments in Ambulance service performance should be focused on better targeting and better clinical care rather than further response time improvements.

In addition, the ambulance services that the group reviewed were all using AMPDS, except one which used CBD. What did they think of computer assisted prioritisation?

The identification of life-threatening incidents was poor with over 40% of patients not needing admission to hospital.

So the Party has decreed that the yield per hectare of potatoes must increase, yet it’ll make no overall difference to the production quotas. Just more Labour lunacy in an effort to convince the great-unwashed that “things are improving”.

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44 Responses to News The Commissar Won’t Want To Hear

  1. kevinmillhill says:

    Good luck with the research. You may well be on a hiding to nothing, though. Wikipedia says that the standard was derived through UK consultancy in 1974; however, the entry is a stub – ie, “Would someone who actually knows something about this subject please edit and improve it?” The fact that it’s a stub probably says it all!

    One of our officers (in the days when we had such things) – now regrettably long dead -was quite expert on the subject. The figure was, apparently, derived empirically. Several time values were tried against what little data was available re survival (in the 70s, we didn’t even have PRFs, just running sheets). I suppose that 8mins/50% just seemed achievable; it might even have appeared to offer useful survival rates for cardiac arrest, though I doubt whether, in 1974, there was much data really to support such a conclusion. Probably another report from the Ministry of Inspired Guesswork, then. The story about 8mins being the time to vote during Division in Parliament seems apocryphal. Since the 70s, the 8mins criterion has remained static, while the 50% goalpost is now in the next playing field.

    A recent number-crunching job done here in Scotland (where we fill in a form for Heartstart every time we have to perform CPR) can be accessed at: http//www.bmj.com/cgi/content/abstract/322/7299/1385. In this, the authors suggest that the survival rate to discharge of arrestees can be “almost doubled” by dropping the criterion from 8mins to 5. (Sounds good, but all they really mean is raising survival just from 6% to 11%; probably OK , though, if you are one of the additional 5%!)

    The scary bit, though, is that – whilst we take the 8 minutes to mean “from the responder’s picking up the phone”, every one of the researchers thinks that it means “from the EMDC’s picking up the phone”!! Their view of data and conclusions is totally different from ours; hardly a good starting point! Other ORCON standards allow 1min for EMDC processing, and 2mins for despatch, so our 8mins is – from the researchers’ point of view – actually just 5mins on the road! Thus, to achieve an 11% survival rate for arrestees, we would have 2mins from chair to scene. Was it Bowie who sang “Rocket Man”?

    Locally, we believe that all callers should either book their 999s a fortnight in advance, or that they should load the patient into a car, drive to the nearest ambulance station which has lights on and vehicles outside, and dial 999 from the yard

  2. Angela says:

    I’m a little ignorant, but “the clock should start when the call is connected to the ambulance control room” – so, as soon as the call comes through and the person starts to explain the reason for the call, if I’m understanding correctly.

    So if you get someone on the end of the line who speaks poor English or just gives poor information and takes a while to get to the point (sounds a little like me really) it’s cutting into the target time and isn’t a true reflection of the service (target meeting rarely is).

    One would hope that if Mr Brown is having a cardiac arrest his wife wouldn’t beat about the bush too much, I also know it shouldn’t be about meeeting targets, it’s just an observation about the wisdom in the clock starting time. I suppose a couner arguement could be that an experienced call taker would be able to direct the call for the relevent information, but some things are behyond control.

    Just (one of) my random thoughts reading that.

  3. ecparamedic says:

    My understanding is that when the BT operator in the 999 call centre picks up the phone is the point the clock starts running.

    When talking about response times versus survivability reference is often made to the experience of the EMS services in Seattle where widespread public access defibrillation and a response time of around three minutes has made a huge improvment in recovery to tax paying status, though that becomes a little blurred over here where we are being taxed quite literally to and beyond death.

    Unfortunately Angela, using targets like the 8 minute response time allows the government to apply a quantitative yardstick to what should actually be a qualitative study. The ambulance services have responded to the ludicrous goal setting by using any means at their disposal to stop the clock and who can blame them? Failure results in reduced budgets and P45s.

    SD
    😉

  4. Alex says:

    I’m a University student, and have access to a university library, who could get hold of this document. My library does not hold a copy itself, but could request one (I’ll check if I can tomorow). The BL do have a copy in their lending collection. The system number is 009804327.

  5. Dory says:

    Hence the introduction of Community First Responders – lay volunteers with a defibrillator, some O2 and basic first aid knowledge, attending local incidents from home – to ‘stop the clock’. Or to cheat ORCON?

    Box ticked.

  6. Alex says:

    In fact, the Bodlean, national library of Wales, Trinity College Dublin and the Southampton health services library also have a copy.

  7. Sue says:

    You could write to DH and ask for all information they have on file about the 8 minute response time. If you ask under the Freedom of Information Act they will have to dig it out and give it to you, unless they can wriggle out of it under one of the Act’s many exemptions!

  8. Dewi Morgan says:

    I feel that it should clearly not be a linear scale, and that any such assumption is farcical. the only way you could get that is by taking two data points, and drawing a line between them. “well, we got to a undred people in 17 minutes and 90% of them were dead, and we got to another 100 in 9 minutes and 10% of them was dead, so that’s gotta be a 10% fatality increase per minute.”

    I always thought the 8min thing was strokes, not heart attacks.

  9. Steve Gibbs says:

    Dewi, the “8 min thing” as you describe it – or Orcon – applies to all category A calls – which can range from a drunk in the street to cardiac arrest.

    ECPPara – As far as I know, the clock will start from the moment the call is connected to the ambulance control room/call-taker.

    My own opinion, is that ORCON means nothing as far as patient care is concerned. How can it when to arrive in 4 mins and find the patient deceased is deemed as a success, but to arrive at 10 mins and save the patient is deemed as a failure??

  10. ecparamedic says:

    Steve,

    So many different versions of the truth flying around at the moment, it’s difficult to work out which is which.

    Like I said in my first post the service provided should be graded by it’s quality, but as that is difficult to set standards for and measure, we have to make do with quantity. We used to often get calls from Control suggesting that we may have had problems booking on scene and that perhaps we were there a minute or so earlier…….

    SD
    😉

  11. David says:

    As somebody who’s actually working these figures out, the Clock Starts when the Operator at BT (or Cable & Wireless) dials the number for the correct Ambulance Control Room AND it starts to ring. A bit like on your mobile phone when somebody rings you.

    Most services are integrating this with EISEC so we do a reverse telephone directory lookup on the number.

    It ill make the ORCON stats more comparable, until that is new ways to “massage” the figures are found – oh and believe me it’s already started!

    Incidentally, you can only officially stop the clock when a vehicle capable of transporting the patient arrives. Yes, a car will suffice even though you could hardly bundle your heart attack victim who’s chopped his leg off with a chain saw into the passenger seat of a car. But then it’s the thought that counts. Whether or not a Community First Responder counts or not varies according to the service.

    Never mind the (clinical) quality feel the speed!

  12. kevinmillhill says:

    I really can assure you that the ORCON figures go back a lot further than 1996, and that the date in the Wikipedia entry is probably right. The IHCD “Green Book” we were taught by when I did my basic course in 1991 contained them, and ,at that time, they were so well known within the Service (and in the adjacent ones just over the border) that they clearly been around for a while.

    Re ecparamedic’s comment above – about 11 years ago I was invited, as the token green suit, to a number of high powered meetings fronted by a “new broom” operations director. He had come from a different world, and (inter alia) wanted seriously to debate the use of performance yardsticks other than time targets. Obediently, we joined in, and had soon drawn up a suitable list – which pleased him no end; however, by lunch time, we had also convinced him that the government (pre- devolution) could only understand time targets, and the press was only interested in our failures “Dying Man Waits 75 Minutes for Ambulance” and it only saw those in terms of times.

    It was a nice lunch, though!

  13. ecparamedic says:

    David, I was under the impression that the ‘stop the clock’ standard was ‘someone trained and equipped with a defibrillator’, if this has changed to a vehicle capable of transporting that would explain some long boring shifts recently.

    Kevin, Hit the nail on the head, any changes would have to come from HMG and that isn’t likely to happen is it?

    SD
    😉

  14. I agree. Nice post. Keep em coming!

    -Abecks
    http://www.abecks.net

  15. Kingmagic says:

    As we are all aware who are in the job, the Cat A response time is met when the first person on scene is either a crew/RRV/doctor/nurse/first responder/first aider/man whos got a first aid book/woman who watches Casualty-Holby City/Saint Bernhard dog which belongs to the cousin of the nephew who once met someone who bought a box of plasters from a chemist.
    I am all for improving the patients/casulties outcome but as you say we are just measured by timings not on quality patient care.
    On the telly this morning on local news there was a high profile report on the 3000 “life threatening calls” which missed the 8 minute target. Great…the public are going to love us. But why oh why oh why arnt the inappropriate calls filtered out of those 3000 before being released to the press?
    That would probaly show that we missed maybe less than 100 genuine life threatening calls. (Which might not have been missed if we were not tied up with jobs given a high priority due to the awful AMPDS system).

  16. katie says:

    WorldCat (database of world libraries) reveals that the British Library does indeed have a copy, as does West Berkshire District Council. Bizarre, but true. I’m not clear if this is actually Berkshire library service or a holding in the offices of the Council.

    Anyone with a genuine reason can join the British Library; it’s not hard to get a reader’s ticket if you have a recommendation.

  17. ecparamedic says:

    Lol ‘3000 calls missed’

    Given that we take 400-600 calls a day, 3000 sort of pales into insignificance doesn’t it? Don’t supposed they’d report that though would they?

    SD
    😉

  18. Mary says:

    Call me crazy, but if I’m having a heart attack, I don’t care if they arrive in eight minutes from when my call is connected or eight minutes from when an ambulance is dispatched or what, I just want them to get to me as fast as f***ing possible and I daresay that’s what the ambulance crew want to do as well.

    I very much doubt that there is a single ambulance crew member in any service in any part of the country, who (for instance) would look at my address on their satnav and think “sod it, that’s only two minutes away, I’ll make a sandwich first,” or turn up outside my door within three minutes and then go “sweet! I’ve still got time for a quick cigarette before going in!”

    Serious emergency – drive like it’s an emergency – get there ASAP and help, no matter what some bit of paper says. Am I wrong?

  19. Kingmagic says:

    In reply to ecparamedic, that 3000 was the ones that were missed. We hit ?how many thousands? Our average daily call taking is around the same as yours. (So there! LOL). We need more time to question the caller to get a better idea of what is going on.
    I remember a classic that I overheard whilst observing in control….caller has dialled 999 and said that the chef in the kitchens had had a cardiac arrest.
    Nearest crew mobilised along with RRV to give backup with the resus that would be required.
    Caller is told not to worry and that the ambulance is on its way, meanwhile we need to get some further information ie age of patient etc. Caller replies….”hang on I,ll ask him he,s just coming to the phone now !!!!!!!!”
    The chef had chest pains and had not collapsed but suffered with angina.

    In reply to Mary… we do care that we get to you and give you the best treatment possible regardless of the government targets set on us.
    But we are being forced to get to you sometimes in a dangerous manner by driving to “beat the clock”. And it is this time scale that governs us. The great god ORCON! As an emergency service we have the best response times going given that we have a very high call rate. Yes the fire brigade have good response times but their call rate is exceptionally low. And yes the police have a significantly high call rate but they do not have to respond like us in under 8 minutes etc.

    At the end of the day i would like to see more emphasis on quality patient care which is what matters the most. “Beating the clock” only puts us in danger for the sake of hitting the targets which takes the flak off management.

  20. ecparamedic says:

    Mary, That just about sums it up. The fact that you survive the heart attack is (to the statisticians) irrelevant.

    Kevin, I knew what you were getting at mate, I suspect that the 3000 missed would represent something in the region of (wild stab in the dark) …….. 25% of your A cats.

    SD
    😉

  21. Jooles says:

    I may not know fancy words and government legislation but I agree with Kingmagic, “more emphasis on quality patient care”. As a paramedic, all I want to do is arrive at a job safely and administer care to the best of my ability and training, give reassurance and transport to hospital if appropriate. That’s it. That’s definitive care. Is that so wrong? Does it matter if I am 30 seconds outside of the great ORCON (on knees – we are not worthy) if the care I give is professional and appropriate to the patient needs? I don’t want to arrive severely traumatised by the drive my colleague has made to try to reach a Cat A in 8 mins. And let me tell you there are those who will try even though they know there isn’t a cat in hells chance of getting there in that time. The problem is what alternative is there for the government to assess our effectiveness? And, how can they take ambulances off the road and replace them with RRV’s, which is what they are doing. I don’t want to be sat with a guy who’s fallen from scaffolding sustaining multi-system trauma and have to wait 40 minutes for a crew to turn up because I’ve stopped the clock, and the vehicle which turns up is diverted to a Cat A and cleared at hospital then comes out to me! (he’s made a good recovery so far). But of course I’m preaching to the converted. Rant over.

  22. kevinmillhill says:

    Dear Mary,

    You also are, very eloquently, preaching to the converted. Targets may be set, and goalposts moved (by governments, I hasten to add, not by ambulance services), but down at the coalface, we continue to do the same thing year in and year out. – get to you as quickly as we can, consistent with safety. Despite increased staffing and technological advance, my own service is reputedly responding 10% more slowly than we did 10 years ago. That strikes me as about correct; there is much, much more traffic about, and roundabouts, traffic lights, pedestrian crossings, speed bumps, and chicanes have been breeding like rabbits. Frankly, I’m surprised that it’s only 10%!

    You can do things to get the wheels turning sooner, but, meeting your “at the door” time is down to pure geography. In my part of the country, there are stations (mine is one of them) which don’t have a hope in hell of achieving the 75% target, and others where they knock it into the long grass. Why? Because at the “good “stations most calls come within spitting distance of the front door, whereas I cover (from a central, principal town) a 1500square mile area of scattered villages and farms.

    My service employs consultants who use focus groups; our National (actually, our only) Press Officer told me that public esteem for our ambulance services is second only to that for our armed forces, and miles ahead of the pack. So, down on the front line, we must be doing something right. The “complaint upheld”level is infinitesimal, so we seem to be giving the public the service they expect.

    Therefore, ORCON is just bean counting, but, drawing on Jooles’ point above, I think that it is dangerous bean counting. With their budgets fixed, it gives our bosses little option but to come up with “clever” strategies which meet targets but which also sacrifice good practice and patient care in the process. The answer , however, is simple – become a bean counter too. See matters from the government’s standpoint, and give the politicians what they want – Cat A compliance everywhere. Just hit the “At Scene” button at 7.75mins regardless of where you are. The green suits will then continue to give the (apparently adequate) service to patients that we always have, and our bosses will no longer have to tie themselves in knots over a meaningless bit of bureaucracy.

    You know it makes sense!

  23. Dan says:

    There are several libraries that have it available in the Reference section – most are listed in various quotes above.

    It is available from Southampton University Library on a 3 week loan.

    Southampton – Health Services Library ; 3 week loan – pamphlet WX 215

    It does not appear to have a ISBN number – but the British Library reference is GPC/09548. You can ask them to photocopy parts of it and send it to you, but they limit it to a maximum of 10% of the book (for copyright reasons)

    http://catalogue.bl.uk/F/?func=file&file_name=login-bl-list

  24. hoaihung says:

    – The Best Album Instrumental Collection
    http://hoatau.wordpress.com

  25. magwitch says:

    Thank you to everyone for posting.

    I need to do more research but….

    kevinmillhill is quite correct. The origin of the targets was back in the 70s. Researchers looked at mortality from cardiac arrests. At that time it was understood that mortality occurred within 4 minutes without any intervention. So they considered mortality rates when someone started CPR or defibrillated the patient. Times where bandied about over how long it took to make the call and pass details etc. (somewhere I had a paper that set all this out). Eventually it was decided that 8 minute response vs improved mortality rate was a practical proposition, but was not a government target.

    It was only in 1996 that the ORCON committee set this out “in stone” Even then, as I understand it, the 8 minutes was for cardiac arrests only but has slowly evolved to include all life threatening calls. The trouble is Control rooms err on the side of caution and with the “help” of computer software “life threatening” becomes all sorts of rubbish.

    On top of this, now that nu-Labour have got a stick to beat ambulance services with they’re not going to let go.

    I’m off back to the university where I did my ECP course next week. I’m hoping they’ll have a copy of the ORCON document otherwise my local library say they may be able to get a copy (might take months to obtain). I’d like to post more on this and keep the debate going. I’m hoping to meet with my MP at his monthly surgery in Dec to see if he can help. He’s been known to carry a bit of clout around the House of Commons in his time so we’ll see.

    So there we are; I’m back on my soap box again!

  26. kevinmillhill says:

    Dear Magwitch,

    You’ve joggled the aging grey matter!! In the days when Pontius was a pilot, ORCON was a kind of self-set standard we tried to achieve; it was self imposed, on the basis that, in order to gauge performance, you have to measure SOMETHING. After basic training, we hardly ever heard the “O” word, and it was only scientists/engineers (such as I) who had strayed into the cult of ambulance-ing as a late second career who took an interest.

    Then, lo, in the late 90s, a new monkey to ride on our backs was born; ORCON became fascinating, and everyone who has come along since believes that the status quo was always so. We live in an industry in which a skyscraper of erudition has been erected on a foundation of utter ignorance.

    On a similar topic, did you know that “Turn of your mobiles in the hospital – they may interfere with vital equipment” is a scam, born in the late 80s in the US as a device to make patients and visitors buy into the revenue-raising “hospital phone (with phonecard) by every bed” wheeze? Regrettably, it’s true. Think about it – if an ITU/CCU/HDU patient has to be shunted to Legover Ward through lack of bedspace, and has to have telemetering, what is the worst that your phone will do? That’s right, trip the telemetering – at which point the relevant machine at the ITU/CCU/HDU Nursing Station starts screaming, using the same alarm signal as it does for a cardiac arrest – and the nurse wanders across, re-sets it, and checks that the patient is OK.

    “Myth Busters” (Discovery) showed that even that wasn’t true; mobile phones DO NOT trip telemetered equipment. They don’t set petrol stations on fire either.

    Now, back to ORCON…….

  27. Bondy says:

    The word ORCON sends shivers down my spine, how I detest that word.

    The new government measuring of trusts DOES include patient care as part of the marking system, but ORCON plays a huge part.

    As a dispatcher I do not run my crews into the ground chasing ORCON, I prefer to keep my crews happy and they in turn, keep me happy.

    In my eyes ORCON is something that you either make, or you dont, there is no point living by the ORCON standard, because as you all know, there are certain calls that you are not going to get to in 8 mins.

    Also its not just the distance of the calls anymore, there has been a huge rise in the number of CAT A calls, due to people knowing how to play the system, a lot of roadstaff who have never even stepped foot inside a control will moan and ask “how can a drunk be a CAT A?” what they dont understand is that the software we HAVE to use does not deal in drunks, you HAVE to put what the caller says, so if the caller is asked “is the patient conscious?” 9 out of 10 times they will say no, so you already have a CAT A call before you have even found out was is wrong with the patient properly.

    Now the goalposts have been shifted once again, the ORCON will go down rapid, and all trusts will be in the spotlight again.

  28. kevinmillhill says:

    Dear Bondy,

    Now the bizarre thing is that – within my outfit – whilst there was a moderate rise in CatA s during the couple of years following our instigation of AMPDS – in the last year in particular, they have dropped dramatically (and ORCON data has, contemporaneously, become unavailable for scrutiny by green-suited peasants such as I!)

    Far be it from me to suggest that management has the goal posts mounted on roller skates, but more power to them if they have!! ORCON is meaningless, bean-counters’ nonsense (see above). It is something for managers to fret about about, but which, in reality, has little to do with how the rank and file (EMDs, EMTs/EMPs etc) perform at the coalface. Just do the job in front of you.

    Older soldiers – such as I – know perfectly well how the call-taking algorithms go, because they are based on the (to us anyway) “familiar” EMTI cards used by Controllers until recently. We do not diagnose – we treat signs/symptoms. The EMDC algorithms work on that assumption. If your road crews have a problem with that, then suggest that they go back to school, acquire the necessary “A” Levels/Higher, and apply for a place as a medical student.

    Then they can be rugged individualists.

  29. Kingmagic says:

    Although a lot of people would disagree, I think it would be a good idea if everyone on the road spent a shift in control (not all at once though).
    I still believe AMPDS is crap.
    I also believe, love them or hate them, “puzzle palace” control do a thankless job and take a lot of unneccessary flak.
    I,ve observed in control and I know that I could,nt do it….I,d lose it by the second or third call shouting obscenities at the caller noting down addresses to go round later and put their windows in!
    What we need is reasoned debate on ORCON in the public domain and get back to providing quality patient care.

  30. Bondy says:

    I totally agree that AMPDS is crap, I loathe the system and cant stand using it, but thats what you get for running an American made system.

    The new version of AMPDS version 11.4 that will soon be intrigrated to every control room is going to cause evenmore controversy, it is designed to deal with situations that Paramedics and Technicians are not trained in, such as breech births.

    The aim is to get Paramedics and Techs to ring control and ask for advice on how to deliver a breech, ive listened to a recording of a EMD delivering a breech with a Paramedic and it went very very well.

    But, I have pitched this new version to some of my crews and they are not happy, the main crux of them is having to ask a non medicaly trained person advice on how to do their job, I dont like the added responsibility.

    But we have no choice once again.

  31. Smiler says:

    ORCAN appears to go out the window when the patient is already in a hospital, in this case specifically A&E. I had a patient who needed a VERY urgent transfer to the Obs/Gynae hospital for theatre. Having dialled 999 and requested an ambulance, yes the patient was bleeding (excessiveley), yes they had difficulting breathing and, yes they were definately not very stable, was assured that an ambulance was on its way. 15 mins later still no nice men/women in green with a large van. Rang control was told that as we were an A&E and therefore the patient was considered to be in safe hands we did not need a Cat A status! Didn’t seem to matter the patient was bleeding out for surgery we couldn’t perform! Even the consultant couldn’t shift this stance. However, we had some very nice paramedics waiting to offload who did some fast rearranging (AKA ditched their patient – who incidentally hadn’t needed an ambulance) and hoofed our patient up to the appropriate hospital. Incidentally, telling control after the fact. The distance they had to the other hospital 1/4 of a mile, time gone 15mins, crews queuing 4. Now why couldn’t control have suggested that option, therefore correctly identifying the call as Cat A, meeting the 8 mins and saving a 21 year old girls’ life with a lot less distress and aggravation for all concerned!!???

  32. Tim Worstall says:

    Britblog Roundup #92

    We seem to be getting closer to that century mark with our little roundups of your nominations of what you think the rest of us should see.You can add to next week’s set by simply emailing the URL to britblog

  33. Bondy says:

    Smiler,

    A major A+E is deemed to have sufficent resources to cope with pretty much anything thrown at them (according to our bosses), that is why a hospital will not get a CAT A response, also you have to bear in mind that under AMPDS interhospital transfers go under card 33 and will NOT allow a CAT A coding, and even if it did allow a CAT A coding the hospital would be used as a resource to get the CAT A and you would still be waiting the same amount of time for an Ambulance. Yes it is cruelly unfair, we dont write the rules, just abide by them.

    As for the concerns of control not using a resource already at hospital, have you ever tried contacting a crew at a hospital?? its next to impossible sometimes, when you do manage to contact one, they then have ago at you for “checking up” on them, and then demand a mealbreak, restbreak or downtime to clean up.

    In my experience a crew will not volunteer to do a hospital transfer unless it suits their needs, or is something close to them, and also a crew that ditches their patient and picks up another, then proceeds to carry said patient without informing control first, is liable to be disciplined.

    I undestand and sympathise with hospitals wanting patients urgently transported, if I had my way they would be treated the same as joe blogs having his MI in the street, but rules and resources do not allow for said circumstance to happen.

  34. kevinmillhill says:

    You are, I think, highlighting the “Ooooh, we didn’t think of THAT one” aspect of setting up any new system. I’m getting long in the tooth at this kind of stuff now, but people who are GOOD at inventing and instigating new systems do not regard their projects as perfect at the first stab, and leave lots of room for tinkering.

    Inter Hospital Transfers – in Edinburgh, there is a specialist neurosurgical unit. We regularly transfer patients there on emergency runs taking about 100mins. We carry an anaesthetist and team (as well as the patient). The team is in contact with the theatre throughout the journey, and, on our arrival, we wheel the patient straight in to the theatre ante-room, and the op starts within minutes.

    The despatching hospital ITU does not know PRECISELY when the patient is going to be ready; what they DO want, though, is an allocated ambulance parked outside the door and ready to go as soon as the patient is stabilised . It is handy if the crew is lurking in ITU as well, to give a hand, and to be briefed on what is going on.

    You wouldn’t think that it was difficult, would you? Well, it is, and the only reason I can see for it is that this kind of thing got left in the cold when AMPDS was first devised, and nobody wants to bring it indoors now.

  35. Bondy says:

    AMPDS is not a new system, it has been in use in the UK for several years, and as all systems get messed about with, AMPDS is no different.

    Hospitals that want transfers are as you highlighted terrible at actually having the patient ready, I have had crews sat at hospital for 45m waiting to take a patient that has to go immediatly or they will die, this is after you have asked “is the patient definatly ready to go straight away?” and the reply is always “yes” and the truth is ALWAYS not a chance the patient is ready.

  36. […] However, and isn’t there always a little ‘but’ with these things. Ambulance staff can only help you if we actually get sent and a big white or yellow van with the blue lights arrives. Yes we’re back to that old chestnut of the 8 minute response time. When I have my heart attack and dial 999 I want a paramedic and a big ‘all singing and dancing’ ambulance. I don’t want a first responder. I don’t want a double EMT crew with no para back up and I don’t want just an RRV with no amblance in sight. I want the works and I want to be taken to the hospital ASAP. […]

  37. Andy says:

    Wouldn’t you be able to gain access to any NHS papers via a Freedom of Information Act request? I don’t think they cost anything, and are pretty simple to do.

    Ive not had the opportunity to read all the comments, so apologies if someone has suggested this already.

  38. Bondy says:

    Diagnosis? N.F.I

    I only assume the NFI means NO FURTHUR INFORMATION, what is wrong with responders and FRU’s? one of these entitys might safe your life.

    The days of all singing all dancing ambulances has passed, much to your and my detriment.

    I was told I had a safe job, I was told today that our control room will no longer be active in 6 months time.

    The mergers have killed my job, killed my spirit and killed our county, but who cares???

    exactly, no one cares as long as the yes men say yes and the big white taxi’s turn up, no one gives a shit.

    I had to go home today and tell my wife and 2 young children that daddies safe job is no longer safe, because a prick in a suit reckons we can run on 2 control rooms to run 3 very diffrent counties, not only that, but the prick in the suit told us we dont know how to do our job properly, yet he comes from THE WORST performing ambulance service in the country, figure that fucker out, because I sure cant.

    He shags his own county up, then comes over to ours and says we are not doing our job properly and shags our service up.

    At this time I deteste the NHS, I deteste the Ambulance service and I hope he dies from Ebola every day for the next 100 years.

    Not only that, I also run a responder group, and I had to go to a meeting after work and say how much I love working for the Ambulance service and how much I love responding to meet their aims.

    I have NEVER been so disillusioned in my life, I have no faith in anything anymore, and I hope they all rot in hell.

  39. kingmagic says:

    At some time during a career in the NHS you will become disillusioned. It might be a passing moment or an everday event.
    But please try to keep your faith, your faith in yourself and your colleagues who do their best against the odds.
    The ambulance service is the best job in the world (and at times the worst). I know its difficult but try and sort the job to suit you and your patients not for the benefit of suits.
    Can you apply for another post in the service? Are you ex-road staff? What about going on the road?
    I really and truely hope that you get to continue your career in the service somehow.

  40. NHS Librarian says:

    Hi folks,

    I can suggest a simple and close to home source for the “Review of ambulance performance standards: final report of steering group”!

    Simply contact your helpful local NHS Librarian. Ambulance staff while find they are welcome at most hospital library services they visit. you can use the search function at http://www.library.nhs.uk/mylibrary/default.aspx to check for a library near you.

    There are three copies available in London alone.

    While I am here – all NHS staff have access to stacks of lovely information resources via http://www.library.nhs.uk

    Cheers

    An NHS Librarian!

  41. Janette Turner says:

    Dear magwitch

    I’ll happily send you a copy of the 1996 report. I am also practised in the black arts of academia (being the author of the Sheffield report you have quoted) . Our findings are actually supporting your views on the usefulness (or lack of it ) of time based performance standards. But we conducted an independant evaluation. We can make recommendations – which we have done with the move to quality based standards as the main one – but it doesn’t mean anyone will listen. Don’t shoot the messenger! For clarity we studied 2 services with CBD, 1 with AMPDS and 1 that started with CBD then moved to AMPDS half way through. And you’re right – they can’t accurately identify cat A calls.

  42. Jack says:

    Jack…

    That is very interesting….

  43. Любопытно написано. А это все на основе Вашего личного опыта?Позвольте полюбопытствовать 🙂

  44. Fermin says:

    I do believe all the concepts you have presented for your post.
    They’re really convincing and will definitely work.
    Still, the posts are too quick for beginners.

    May just you please extend them a bit from next time?
    Thanks for the post.

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