Crying Wolf

22 July, 2007

Crying “wolf” once too often

Regular readers will know that I am not a big fan of the AMPDS system our Control now uses to ‘aid’ dispatchers. I’ve blogged before how so many calls seem to be categorised as ‘life-threatening’ only for us to find that the unconscious patient is the one who opens the door (see earlier blogs; here, here and here). In fact AMPDS appears so over cautious in its triaging protocols that the merest hint of a cold, a cough, or cut to the head will get you an 8 minute ‘A’ cat response.

Welsh Ambulance Service chief executive Alan Murray made the point in his Ambulance Today interview that…

If we expect EMS crews to respond immediately to 999 calls they have a right to know we won’t abuse that responsiveness.” (see here)

I think many of my colleagues would agree that our responsiveness is being abused. In fact so may calls now come over as Cat ‘A’ – life threatening that staff just roll their eyes and go “yeah, whatever”. Complacency has set in. Control have cried ‘wolf’ once too often.

Now I’ve not been up to Control for a while mainly because the control manager and I loathe each other (see here). Anecdotal reports suggest that part of the problem might be that caller takers ask leading questions.

Consider; you have a cold with a bunged up nose and a cough.
Can you breath? – of course!
What’s you chief complaint? – I’ve got a cold.
Are you having difficulty breathing? – yeah my nose is bunged up!
Does your chest hurt? – Well it does when I cough.
Ah! so you’ve got chest pain with difficulty breathing! According to AMPDS, you’re an ‘A’ cat – life threatening call. An RRV and fully crewed 5 tonne ambulance are, even as we speak, hurtling their way through the rush-hour traffic on blue-lights and sirens to get to you.

What a load of bollox!


Two’s Company

21 July, 2007

Another set of hands is always welcome.

When you’ve spent your whole (ambulance) career working for the same Trust you rather take it as ‘given’ that how ‘we’ do things is how they’re done elsewhere; of course that’s rubbish.

John Robertson @ I Like Curry, works as an EMT in the West Midlands. His recent post The Long Drive In opens with..

When a call comes in for a cardiac arrest, control do their best to send two ambulances, or at least one ambulance and a responder if we’re a bit stretched. Extra pairs of hands are very useful!

Damn right they’re useful. The more the merrier. Then I remembered that Tom Reynolds had mentioned much the same about London. In his post Thanks to a Bystander he writes…

It was about then that another ambulance and an Emergency Care Practitioner arrived.

Excellent, another three pairs of hands. And Nee Naw confirms the LAS practice in A Sad Suspended

This flagged the call as a Red 1, and already two ambulances and an FRU were on their way.

Now in my service you get one, repeat one, ambulance for a cardiac arrest, suspended, call it what you will. If you’re (very) lucky, they might actually send an RRV as well, but only if the ambulance won’t make it within the 8 minutes. And on occasion its not unknown to just send the RRV on its own. Believe me, trying to handle a cardiac arrest on your own, with attendant hysterical relatives, plus trying to get someone in Control to answer the f**king radio so that you can ‘scream‘ for back-up is a barrel-of-laughs.

The only time two vehicles will ever turn up is if the first is a double EMT crew and they specifically request paramedic back-up. Routinely sending two vehicles is NEVER an option.

I have no idea how my Trust’s survival-from-cardiac-arrest figures compare to other services, that kind of thing is a closely guarded secret from us plebs on the front-line. I’m sure they’re shite. I’ve only ever got two patients ‘back’ and neither of them made it out of hospital.

Oh, and by the way, I’ve only ever had to attend two (working) paediatric cardiac arrests. They’re extremely distressing and its impossible to do any advanced life support on a kiddie in the back of a moving motor without assistance; and on both occasions I was refused a second vehicle!

Thanks Control, I just hope its not your kid next time!

Bravo Murray

20 July, 2007

Alan Murray: at last, an ambulance chief with balls.

June’s edition of Ambulance Today has a 2 page interview with Alan Murray, the man charged with dragging Welsh Ambulance Service out of the mire. Amongst all the usual back-slapping over how wonderful the staff are and what a difficult challenge they all face there was one poignant question and, for once, an answer that didn’t reiterate all the usual shit, propaganda from the commissariat.

Q: “Should the Ambulance Service’s performance be evaluated solely on response times or are there other indicators which give a clearer picture of overall service-delivery?

A: “Response times are just a proxy for clinical effectiveness. We categorise too many of our 999 calls as potentially life-threatening and we need to focus much more attention on this area. I have an ethical objection to sending a five-ton vehicle at high speed through heavy traffic when we know the patient doesn’t need it. A clinically effective response to life-threatening emergencies is still a priority but we must find new and better ways of serving the rest of the 999 population. I would expect new measures to be more focused on good clinical outcomes and appropriate delivery of care and advice to people who don’t need an emergency ambulance. This is important to the patient but its also part of the Trust’s duty to its staff. If we expect EMS crews to respond immediately to 999 calls they have a right to know we won’t abuse that responsiveness.

Bravo Mr Murray! How refreshing to hear a Chief Ambulance officer speaking out and stating what road crews have been banging on about for ages. Pity that none of his peers have got the balls to put their heads above the parapet.

More Meal Break Madness

2 February, 2007

They’re at it again in Yorkshire.

Here we go again. More meal break madness and once again it’s the (Yorkshire Ambulance Service) in the spotlight.

The headlines, of course, are emotive and hysterical.

999 crew sacked in meal break rowBBC

Two ambulance paramedics in North Yorkshire have been sacked because they did not respond to a 999 call while on a meal break, the BBC has learned.

Appeal bid by paramedics sacked for not answering emergency callThe Northern Echo

The row over ambulance service meal breaks re-erupted last night after it emerged that two paramedics were sacked because they did not respond to a 999 call. The Yorkshire Ambulance Service (YAS) said yesterday that the paramedics were not on a meal break at the time, but this was refuted by the GMB union.

I confess that I know nothing more about this case than what has been reported, however, I can’t believe that two long serving ambulance staff suddenly take it into their heads to refuse to response to an emergency. The whole fiasco does not appear to be as clear cut as the BBC report would have us believe. According to the GMB rep “They said they could not respond because one of the men felt sick.

My guess is this was a minor situation that got completely out of hand due to the overzealousness of some jumped-up local manager. He probably never bothered with a proper investigation but sacked the staff on the spot. Let’s not forget this is the service with the cowboy management, run by Simon Worthington, that issued termination notices to 400 staff 5 days before Christmas (see here) and then rescinded them 3 weeks later (see here).

Says everything you need to know about management competency in Yorkshire.

Bye, Bye EMT

30 January, 2007

The Return of the Ambulance Driver

So, that’s it then, the end of an era.

Full details are still awaited but it seems that EMTs will be no more.

My service is running it’s last EMT course. It’s also running it’s last paramedic courses for EMTs to convert to paramedics. In future, entry to paramedic level will be by university degree only.

From June 2007 the service will be recruiting a new grade of ‘lumpers and humpers‘ to be known as the Paramedic Assistant. They’ll just drive the ambulance and fetch and carry for the para; no patient care. We’ll be back to the good ol’ days when we had an ambulance driver and an attendant in the back.

It’s amazing how we just keep going round and round and round and round……

Motivational Management – Yorkshire Style

12 January, 2007

Um…, er…, sorry…you’re not fired after all.

So, having f**ked up everyone’s Christmas, Simon Worthington and chums at Yorkshire Ambulance Service have had a change of heart.

Union officials have said there is no immediate threat of redundancies at the Yorkshire Ambulance Service.

Having had all the festive cheer well and truly knocked out of them 5 days before Christmas,

The workers will now receive a second letter over the next few days, telling them to ignore the contents of the first.

Excellent. So that makes it OK then does it?

Hope you have a Happy New Year too Mr Worthington.

More on Meal Breaks

11 January, 2007

Have another cup of tea.

Meal breaks for ambulance crews are still hitting the news, and the blogsphere:

I posted about the meal break fiasco the other day. Tom Reynolds has, as always, posted an excellent article about the whole mess in London, while NeeNaw gives us his view of this nightmare from a dispatcher’s point of view in Tea Breaks Again. The popular press have been up in arms about the situation, led by last week’s edition of the Sunday Express.

Despite all the articles about this contentious issue I was, however, puzzled by one thing – Why didn’t this story get everyone steamed up last year?

Ambulance delay to death crash Pc

Pc Joe Carroll, 46, died from head injuries on 13 April when his patrol car left the A69 in Northumberland. An ambulance from nearby Hexham was not dispatched because the crew were on a meal break. A crew was sent from Prudhoe – 13 miles away.