Private Parts

"79 year old female, abdo pain"

For a change from the norm, I wasn't working on an ambulance. Tonight I was on the FRU (Fast Response Unit) car on my lonesome. A typical 12 hour car shift generally consists of sitting on standby waiting for the higher priority of calls to come through. You generally stay in your area so that you can be on scene quickly for the patients (and to stop the clock before the 7 minute 59 second deadline). Unlike the ambulance you are not sent to anything and everything which is a pleasant change but you do often have to wait some time, often with a sick patient, for an ambulance to arrive. When the ambulance arrives you hand over and leave your patient in their more than capable hands. If there is no paramedic on the ambulance and you either have concerns about the patient or need to administer drugs etc  then you may travel with the crew but more often than not it's a simple handover and off you go.

I arrived within about 3 minutes of the call coming in, grabbed all my kit (so much heavier on your own) and trundled up to the front door. Once inside I was taken to the patient who was sat on the toilet. She was obviously in pain so offered her some Entonox which worked well. The basic aim for the FRU is to a) stabilise the patient and get us much information, history and observations as possible before the crew arrives. I checked her over and most of her observations were OK. Her heart rate was raised a little and her temperature was a little high but other than that it was just a pain problem. I suspected from the way she was describing it, it was an inflamed stomach ulcer or something similar and she had a history and medication list to match that. I couldn't give morphine as she had a known sensitivity to it so it was a case of waiting for a crew to take her in. Simples!

Then, the crew arrived. Not a crew from my NHS Ambulance trust but a private ambulance service. The two middle ages guys were rude to the relatives who were trying to tell them what was happening on their way up the stairs. 

"We'll find out what going from the car driver if it's OK."

What a douche bag! Sure, clinically, you'll find out what is happening from the FRU but there is no harm is at least pretending to be interested in what the family have to say. Also, 'car driver'?! Seriously?! Two middle aged guys stood in the door to the bathroom, the one who appeared to be attending had his arms in his pockets and was chewing gum in a hugely grotesque way. I started my handover with full history, observations and differential diagnosis and it was clear he wasn't listening to a word I was saying. In fact, half way through, he turned to his crew mate to say 'reckon she can walk'. I ended my handover with, 'so if one of you could grab a chair that would be great'.

"I reckon she'll be alright on her feet"

"Well I'd like her to go in chair, so could you get a chair please."

He didn't bother hiding his displeasure and rolled his eyes. They BOTH went to go and get the chair, clearly to have a bitch about me. I've been on scene for 25 minutes, if they had listened to my handover they would have heard me describe her pain and would have heard me say that the Entonox is helping but is making her dizzy. They would have also heard me mention her usual mobility is slow and she uses a frame. A lifetime of tax and national insurance and being unwell entitles a 79 year old to god dam chair in my opinion. These numpties would just have to suck it up. 

After helping carry her down the stairs because one of them 'had a bad back' we got her onto the ambulance. The driver got in the front and the attendant sat behind the head of the patient. I find this impersonal and rude but that didn't surprise me from these two. 

"Are you going to monitor her and give her some more Entonox?"

"We don't have any and what are supposed to monitor?"

"Her pulse, oxygen saturation, her blood pressure etc."

"But you've said they were OK"

"But it could change!"

Again he rolled his eyes and reached for a blood pressure cuff. I'd had enough, I didn't want to spend any more time with them but I also didn't want to leave this lovely elderly lady in their 'care'. I decided to travel with them, bring my Entonox and monitor the patient myself much to the annoyance of Tweedle Dum and Tweedle Dee. Eventually, we go to hospital, I handed over to the nurse and managed to grab another FRU to take me back to my car. Before I left I told the private crew what I thought of their lacking professionalism and told them in no uncertain terms I'd be lodging a complaint. They didn't seem to care one iota. 

This job is not an isolated case unfortunately. If you speak to any FRU who has come across one of the ever increasing amount of private ambulance services you will hear similar tales. At busy periods, my service is becoming more and more reliant on them rather than using the money to staff their own ambulances. There is little or no quality control and you also have a situation where vast numbers of staff who have been sacked for a wide number of reasons from drink driving, drug offences, misconduct, patient complaints and having sex in ambulance service vehicles are now working for the service again through the private companies who's only motivation is money. 

This is having an effect on patient care and it is only getting worse. The training these private ambulance services provide to their staff is minimal at best, they are generally staffed with much less qualified members of staff because it is cheaper that way. They also are picking from a much smaller talent pool because generally, and there are exemptions, the people looking for work in the private sector are not qualified or not allowed to work for NHS trusts. i.e.: criminal records and those previously struck off by the HCPC. As the role of Emergency Medical Technician, Emergency Care Assistant etc are not protected or registered titles, anyone can do them. I met one crew who between them had had 6 days of training before stepping foot on the ambulance. It's a liability. They are a bunch of cowboys and chancers. 

In my opinion these companies need to be irradiated. Where money is the primary focus, patient care will suffer. That's a fact. Sure, it may be cheaper for the government to gradually privatise the ambulance services but at what cost. I certainly wouldn't want these imbeciles to go to a member of my family. Would you want them to come to yours? It seems that the budget cuts are being used to undermine the ambulance services for the ulterior motive of future privatisation. If you cut our staff and cut our budgets we cannot work as efficiently with the ever increasing call volume. Then, to blame us and say private ambulances are the way forward because we are not providing the level of cover required is absurd. Put the money to where it is needed. Well trained staff on well equipped ambulances. What do I know, I'm just a bum on a seat, I probably can't see the big picture. 

By the way, that 'Big Picture' the Tories tell you all about is this...... A picture of our elected MPs and our unelected Lords sitting round a big table, raising a glass to the stroke of genius that led them to all own shares in private medical companies and then sell of the NHS to the highest bidder, thus making them all richer than they were. Great picture from down here.

Please Please Please

"Signature Needed NOW"

The purpose of this post is simple! I want you and everyone you know, to sign this e-petition as soon as possible. I want the link to it emailed and re-tweeted as much as possible. The e-petition was set up by the Oliver King foundation and was set up after his death at the age of 12. He died from Sudden Arrhythmic Death Syndrome (SADS).

Their aim is to try and raise awareness about the medical condition SADS which commonly affects people aged between 12 and 35 years of age.

By doing this through their fundraising events and major PR drives, their aim is to boost the awareness about SADS enabling them to take the first steps towards preventative steps being made freely available.

They are currently based in Liverpool, UK and are striving to ensure that schools primarily get the equipment they need to help any young people who are affected by this condition. This is namely defibrillators. They need your help to get the government to listen, as until now the only response they have had has been to refuse to help and pass the buck to the ambulance service. 

"From February 2007, responsibility for continuing the legacy of the National Defibrillator Programme was devolved to ambulance trusts. Most of the ambulance trusts across the UK have community resuscitation departments or similar, which work to place defibrillators in the community, and in areas of need."

What they mean is they won't pay for it! What they also don't tell you, is that the ambulance service places defibrillators in places only where the owners pay for them. We do provide HeartStart training in basic life support and defibrillation free of charge to anyone that wants it but this training is provided by willing staff, unpaid, and in their own time. I myself am a trainer. It is something I believe passionately about and it was of such a surprise to me that defibrillators were not in schools by legal requirement. 

The cardiac arrest survival rate in London is around 32%. That figure is much higher than the rest of the country but it also much lower than other cities in the world. Seattle has the highest survival rate in the world at 55%. The reasons for the huge gulf is simple. Basic Life Support is taught as part of the national curriculum from the age of 6. Everyone knows how to use a defibrillator and there is one on every street, in every school and in every public building. That is the survival rate that is possible but that is what the government are unwilling to do. £650 for a defibrillator is more than a 12 year olds life is worth apparently. They even refused to meet The Oliver King Foundation, yet weeks later 16 defibrillators were installing in Westminster and government buildings! If it's good enough for them, it's good enough for you and your children!

Please please please have your say. We have the chance to make a real difference so lets put our weight behind it. 

SIGN THE PETITION NOW!

For more information on the Oliver King foundation please visit  http://www.theoliverkingfoundation.co.uk/ or see them on twitter at @TheOKFoundation.

Fire Brigade: Hands off our service

In the news today were a number of articles regarding the London Fire Brigades audacious bid to take over control of the London Ambulance Service. Their main argument this time is the value of property that the LAS owns and how merging ambulance stations with fire stations would save the £50 million. As the spending of public sector money is at the forefront of the news and political debate it is of no surprise that their proposal has turned all the heads the LFB intended. With apparent backing from the London Assembly and various areas of the Tory government it is perhaps a sign that the latest effort of the LFB to gain control of the LAS may this time be more fruitful. But let's not be fooled. The 'shared station facilities' and 'joint working' are just political jargon for 'land grab' and 'LFB takeover' and if it wasn't for £80 million valuation of LAS property there wouldn't be a peep about it. I'm watching keenly to see who this many effect other services around the country too.

This isn't the first time the LFB have tried to get their hands on the LAS. In recent years they have made moves to try responding to Cat A calls stating their response times are much better so could be on scene quicker. Admittedly, the amount of time LFB spend sitting on station playing pool, basketball, table tennis and hero makes it easier to respond quickly. They don't deal with anything like the call rate the LAS deals with, in fact they only receive 15% of the calls that we do in a 12 month period. Compared to the 1.5 million calls that come through our control room the LFB receive less than 230,000, they mobilise on only 60% of those (138,385) and of those calls only 21% (29,215) were fires. Of the calls the LAS received in 2010/11 1.1 million were activated on an of these 347,675 were deemed immediately life threatening. Until the LFB can show they would cope under such high demand with a much smaller budget maybe they should concentrate on their own budget and their cost to the tax payer.

The power struggle they are seeking smacks of desperation. Desperation to justify their existence and the extensive budget the receive. Maybe it's a convuluted way of staving off the threat of privatisation. Who knows?! Each year they receive roughly £437 million from the government compared to £288 million that the LAS receive. Taken into account call volume it seems a vastly generous and unnecessary figure. Why do they need so much? With less staff and less work load why is there such disparity in the budgets? Maybe they should look at ways to cut their costs rather than ways to cut ours. They cost the London tax payer £60 a head for the service they provide compared to the £30 it cost per head for the ambulance service. In the reports today about how much they could save the tax payer, nothing is mentioned about their recent financial indiscretions. No mention of the £500 million of wasted tax payer money last year with wasted unused vehicles, ill conceived new control rooms and coffee machines! For the full report see http://www.bbc.co.uk/news/uk-14974552. Brian Coleman, chairman of the LFB admitted to a government committee that they had spent £25,000 on a coffee machine at one of their London centres. How frugal of them!

Another point which should be made is that throughout all their latest takeover efforts, there hasn't been a mention of patient care. Just money. At the end of the day, the ambulance service is there to provide care to the people that needed. The LAS is the largest 'free at point of contact' ambulance service in the world. Like every NHS and organisation it has its faults but on the whole an excellent service is provided to our patients. Yes, savings need to be made and yes, there is always room for improvement but those savings and the improvement needed does not come in the form of the Fire Brigade. The arrogance from 'Pet Rescue' that they could swoop in and save Londoners millions is not only unrealistic but would be a huge risk to our patients. Whats next? Will they want to take control of the police, coast guard and RNLI? They could be an all singing all dancing ultimate emergency service with a huge budget to boot! The could be called the 'London Fire Fighting, Crime Stopping, Life Saving Service'. Maybe then and only then would they be happy. 

What I hope is that the LAS continues to rebuff any attempt by the LFB to gain control. The Cheif Exec Peter Bradley has always been outspoken on the issue and today released the following comments:

“While we are happy to discuss opportunities for greater collaboration between emergency services, we believe it is vital that the London Ambulance Service remains part of the NHS."

“We are an integral part of the health service in the capital, delivering world class care to Londoners, day in day out. Our track record shows we are managing increasing numbers of calls while improving our response to the most seriously ill and injured patients."

“The suggestion that savings of £500m could be made by merging stations is completely unrealistic. We respond to around 1.1m incidents a year with a budget of just £288m - providing excellent value for money."

“Our award winning emergency control room is the busiest in the world. We take nearly 1.5m calls a year – more than all 46 English fires services put together. And it costs Londoners just £30 a head for our service compared to £60 per head for the fire service."

“We do want to work more closely with our emergency partners. Where it is operationally practical, we will look at sharing facilities and at joint purchasing arrangements. We are in the process of organising a meeting at a senior level with the Metropolitan Police Service and the London Fire Brigade to improve collaboration between services.

“However, our job is to deliver clinical care to Londoners and, as the London Assembly review concludes, we can do this most effectively if we remain integrated within the health service.”

Well said! The LAS doesn't need help, it has made significant cuts in it's budget quicker than expected and way over and above that of the fire brigade, and the sooner they leave the LAS alone and get their own house in order the sooner they may start to chip away at their exorbitant overspending.