Monday, April 30, 2007

Back on an Ambulance & Trevor McDonald

Well what a month it's been.

Fred's been programmed now to send us to Amber (Category B) calls. To be honest, quite a few of the Amber calls are more genuine than many of the Red calls that we go to, but I've found it to be a real pain in the arse.
The reason is that when Fred sends you an Amber call, if an ambulance has also been assigned, then the FRU desk is cancelling the car. Not a problem, and sensible because it then means the car is again available for the Cat A calls.
The trouble comes when the next amber call comes in - Fred sends it down to you, and a few seconds later, down comes the cancellation because an ambulance has been assigned. As a result, we've gone back to how it was in January, with us running backwards and forwards on blue lights on call after call, but not actually getting to any patients.
Last night for example, I was sent on 15 calls. 12 of them were cancelled. This is why I'm pleased that last night was my last shift on the car. I return to working on an ambulance as of Wednesday.

As I've mentioned before, morale is somewhat low in the ambulance service at the moment, and it wasn't helped by the Trevor McDonald programme a couple of weeks ago. If you didn't see it, the programme basically stated that if you wanted any chance of surviving if you need an ambulance, then you need a paramedic to attend, and not an EMT, virtually implying that EMTs are not fully trained. The bit that really angered me, was when the journalist asked the health minister who he'd want to come if he had to dial 999 - a paramedic, or an EMT, and suggested that if an EMT arrived, then you would receive substandard care.

In all fairness, the programme did make some very good points regarding getting paramedics to patients who are fitting or choking etc, and laid the blame at the door of management and government. It did say that these problems weren't the fault of the staff on the road, but it really made a meal out of the things that EMTs can't do. No mention was made of the life saving skills that we do have - 12-lead ECG interpretation, the ability to bypass A&E altogether in cases of heart attack being confirmed by ECG and instead taking them directly to a cardiac unit for an emergency procedure, giving nebulisers for asthma and patients with chronic airway diseases such as emphysema, giving adrenaline injections for anaphylaxis and life-threatening asthma attacks, glucagon injections for diabetics with low blood sugar. Technicians can now give the antidote for overdoses, and we will soon be able to give a drug to stop people fitting.

The programme also said that response cars should all be staffed by a paramedic, and featured a cardiac arrest where a technician had arrived, but to the horror of the patient's daughter, who's a nurse, was unable to cannulate (put a needle in a vein to administer drugs) or intubate (put a tube down the throat to secure the airway). Just to make a point, even if a paramedic arrives first at a cardiac arrest, he/she would only carry out basic CPR until an ambulance crew arrived to help, because while he/she was intubating and cannulating, no CPR would be being done.

I went to work the next day with some trepidation, expecting to get all kinds of verbal from patients and/or their friends and relatives because I'm "only" a technician. I knew other techs felt the same way, especially when one who never normally lets anything get to him admitted the programme made him "feel like shit, and no use to anybody".
I think I must've been really lucky, because up until the other night, I'd not had one negative comment about being just a technician.
The one comment I did get the other night was indirect, but it was made perfectly clear exactly what was being got at. I'd called in at a shop to buy a sandwich. I was waiting in the queue to pay, and a chap turned, saw me and kindly said I could go first because I had a more important job to do. The girl that was with him looked pointedly at my EMT epaulets and said, "Hmmph. I doubt it!"
I didn't say anything - I couldn't be bothered. Besides, the looks she got from other people in the queue said it all for me.

I still love my job.


Blogger Jason said...

hi Steve, Im glad to hear you still love your job - I (and Im sure nearly everyone) appreciate what you and your colleagues do, it's just that we never say anything so you just hear from the w@nkers like the woman you mention.

Good luck and all the best,


9:42 pm  
Anonymous Damian said...

I didn't see the show, but I'm surprised that most people recognise the distinction. It seems far more likely that people will just see a medically trained person in a uniform and do what they're told.

It sounds like the intubation quesiton overshadowed a whole lot of other issues without mentioning that intubation without backup equipment is very risky indeed.

You might like my brother's blog - He's an Emergency specialist, and had first-hand experience of the importance of EMT/paramedica versus doctors when someone came off their motorcycle in front of him. He's used to patients arriving on a gurney and, in the heat of the moment, was unsure of what to do with the patient - whether to pull him out from under the car or not, etc.

It turns out that his indicesion was irrelevant to the outcome - the guy was too damaged to be saved, and was dead before the ambulance arrived. But it shows it's not the level of qualification that counts, but the appropriateness of the qualification for the task at hand.

1:45 pm  
Anonymous Paul said...

Hi, Steve,

I'm a Belgian EMT and I've been reading your blog for about a year now.

I've visited London Ambulance last summer. I must say that I was really impressed by the skills you guys have. I've visited ambulance services around Europe, and I think that LAS is one of the finest servies I've ever seen.


6:34 pm  
Anonymous Kim said...

All gone silent round here Steve!

9:30 pm  
Blogger Paul said...

That is brutal to hear the media slammed ems like that.

I'm a Canadian EMT and curious about the scope of practice and how you find the UK system.

You said you can do 12 lead interpretation, curious do you mean you guys are trained to interpret the full 12? since here its just the 3.

The drug list you can do seems pretty similar to our scope except we are unable to do narcan or the valium/ativan

Though we can do iv's / nitro / asa if needed.

Do you guys have any plan for doing intermediate airways such as combitubes or lma's?

Mainly curious since used to live in london and thinking of moving back when done my paramedic training. And was wondering how you found LAS to work for, since from reading your blog and marks seems that the no fee system and management there can make it a bit of a headache.

In london next weekend, what is the protocol for doing ride alongs or for checking out the ambulance station / units? Since love to see how you guys operate over there, as well any chance i can try to blag another services flash is good.

Take care


1:20 am  
Anonymous Anonymous said...

As an ambo in Australia, I can sympathise with your "Fred" predicament. We have been using software for years which calculates closest car distances as the crow flies. Especially working in a semi-rural area, this system fails to realise that we cannot climb directly over a mountain range, drive over tall gum trees, or cross lakes, hence having to drive past another ambulance station to arrive at a call. It also fails to realise that roads are indeed winding, and not all in straight lines. A specific example is an area which we show up as 7km away when at the station, however the only bridge to cross the river in our way makes it a 60km round trip. There is another ambulance station 20km away which is never activated unless we suggest it. As always however, the local knowledge factor is lost on the control room....yay for computers!

5:15 am  

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