In Sync

"36 year old female, going blue"

There has been a lot of talk recently about private ambulance services being integrated into the NHS. I have been rather vocal about my dislike for them, some of my reasons rational, some irrational. In general, my reasons are nothing to do with the individual staff or the service they work for. Nor is it really anything to do with the awful crews I have dealt with. It's to do with the 'big picture'. That picture of the systematic dismantling of the NHS. That is what I'm passionate about and personally I think any private service, be it ambulance or anything else, has no place in the NHS. Where the driving force is money, patient care, staff quality and staff training will suffer.

I was recently asked what my issue with their training was, and I was told in some cases they are better trained than we are. That is by the by. I disagree but am not in a position to comment as I don't know the content of the training the staff receive. There are so many different ambulance services that range from no training to excellent training. The point is, we don't know and therefor the trust and understanding will always be missing, rightly or wrongly. Maybe this will explain why......

I was working on an FRU with my student, We were sat on standby watching the world go by when we were sent a job a fair way away. On the car, you don't get the benefit of reading the updates you get as you are driving and as such, I thought I'd been driving to a DIB (Difficulty in Breathing). You can imagine my surprise when the radio started ringing and the following words filled the cab:

"Just to advise, this is now a cardiac arrest, there is another FRU on way who should be there the same time as you. CPR is in progress."

Well that got the adrenaline pumping! Within 2 minutes we were on scene, just in time to see the first FRU head through the door. I grabbed some spare oxygen and a few other bits and headed inside. The FRU had a student with her too so the were 4 of to be getting on with. The patient was indeed blue and as we were told in cardiac arrest. I'd never met the paramedic on the car, nor had I met her student. She took control of the airway whilst I started attaching pads etc. The students was on CPR duty. A minute late the crew arrived, again, I'd never met them or their student and they hadn't met the other FRU or her student. In effect, we now had a group of 7 people who didn't know each other but who had to

work together in a life or death situation! I really is that simple!

The NHS Logo is one that is respected and trusted.

The paramedic on the crew got IV access and took charge of drugs. The FRU on the airway looked up at me and asked if I could run things and write stuff down. The EMT from the ambulance was given the task of the runner, he would be getting the bed should we need, getting and removing kit and generally being useful. I was writing times down and vocalising everything that had been done and was yet to be done. As a resus goes, this is as smooth as it gets. We followed drug protocols, tried to reverse the causes of the arrest and after 19 minutes we got ROSC (Return of Spontaneous Circulation) ie: Her heart was now beating again!

We stabilised her before moving and by the time we were ready to go every i had been dotted and every t had been crossed. She continued to improve all the way to hospital. On mass we entered the waiting crash team who took over the patients care and she had a great chance of returning to 'tax paying status'. That is of course, the only statistic the government cares about!

The reason this job ran seamlessly was because of team work. We were able to delegate roles to each other knowing exactly what the others could do. We know that an EMT of any level in our trust is trained to the same standard as paramedic, the only difference being paramedics cannulate and give the drugs. Most can do the same airways as paramedics and they'll all have a minimum of 7 years experience as an EMT. We know by the epaulettes of the students what stage in their training they are in. We also know that they have had exactly the same training in advanced life support and are trained in all our local protocols and paramedic assist. Regardless of what staff from our trust arrives you know exactly what you are getting and can simply get on with it. You do things without being told, you pass things without being asked and seamlessly work with strangers because the uniform says you can.

This is where there trust is lost with private ambulance services. Their staff may well be trained to a high standard but equally they may not be. Some EMT's in private ambulance services have only been on a 3 day course. Some ECA's may be 18 years old with only a first aid course. We simply don't know and during a cardiac arrest you don't want to be learning the hard way that the crew sent to assist you has never even done CPR before. Ask yourself this, if your relative is in cardiac arrest, who would you rather see walk through the door? I know what I would want.

This isn't an attack on the private ambulance services or the people that work for them, it is simply highlighting the issues that we as road staff are having. If they have to be used then it should be kept to patient transport and assistance services, not front line 999 work. There simply just isn't enough quality control and parity in training to make it a safe, viable option and nor is it in the best interest of the people who use the service. Until such a time that all roles are registered professionals, they cannot be integrated successfully with the NHS. There are too many people calling them selves EMTs, ECAs and  trainee medics when all they have done is a three day course.

In MY opinion.

Tweedle Dumb and Tweedle Dee

"73 year old male, low blood pressure"

In a change from the norm, I was sat blissfully relaxing on standby on the Fast Response Unit (FRU). It may have been a clapped out Vauxhall Zafira with a billion miles on the clock, help together with micropore tape, but it had a radio and the was a Michael Buble CD doing its thing! Oh, and I had a massive vanilla latte from Costa! Bliss! I couldn't moan too much when after two hours I was sent a job. It was a low priority call which the FRUs don't normally attend but it was accompanied with a ringing radio!

"Whiskey Delta Four Zero go ahead."

"This CAD you're running on, the is a private crew on scene requesting your opinion on a patient with very low blood pressure. They are not happy moving the patient until a paramedic gives them them OK."

"Rog, thank you."

Great! Another private! Based on recent experiences I should have been more than cynical but fair enough, they have recognised an ill patient and have asked for help. No complaints there, at least they have the patients interest at heart.

I pulled up on scene, grabbed my bag and headed into the care home. I was taken by manager to the room where the patient was. As I walked down the corridor I heard a voice I recognised followed by the most heinous of laughs. The kind of laugh that is totally inappropriate in front of a patient. In the room was Tweedle Dum and Tweedle Dee, one with hands in pockets, chewing gum like Sir Alex Ferguson and the other sitting in the patients arm chair, leg on knee, on his phone. Standing next to the cot bed was the patients daughter and a carer. I was given the most vague of handovers, culminating in being told his blood pressure was 65/23.

For those in the know, a BP that low is very serious. Very serious indeed. It would also be accompanied with other symptoms. There were none. With a BP that low you wouldn't expect to be able to feel a pulse. There was a VERY strong pulse. Attached to his arm was one of those blood pressure machines you can get in the chemist. 

"Is this what you used to take his blood pressure?"

"Yeah"

"Is it yours?"

"Nah, it's theirs."

"So have you taken a manual blood pressure as well?"

"Nah."

Are they for real?! I promptly did a manual blood pressure which was perfectly normal, 142/85 to be precise. I checked him over and he was fine. His reason for going to hospital was at a GP request for scan he was due to have. There was nothing acutely wrong  with him.

"Right guys, do you want to grab your chair, we'll get him downstairs now."

"*chew chew* We'll just use one of their wheelchairs. *chew chew*"

Due to the patients disability I didn't think a normal wheelchair was ideal, as it wouldn't have any straps. Needless to say, my fears were ignored. Rather than get the chair himself, he sent the home manager to go and get it. Whilst waiting they continues to make stupid, childish, crass jokes. I was so embarrassed. These idiots are representing the NHS. When someone calls 999 they have an expectation of what an ambulance crew will be like. These two were a total embarrassment to the profession. 

After a few minutes, the chair arrived. 

"Right, shall we top and tail him." (one under the shoulders, one under the legs, and lift)

"We're not lifting him, *chew chew* our insurance won't cover it. *chew chew* Use a hoist."

The carer disappeared and returned with a hoist. She started putting the lifting sling on the patient and asked for assistance. I began to help from my side of the bed. The carer asked Tweedle Dum to help on the opposite side. 

"*chew chew* Sorry, we're not allowed to help with hoisting, *chew chew* we are not trained in it *chew chew."

So, I walked around the bed, helped get him in the hoist and between me and the carer, lifted him into the wheel chair. Tweedle Dee had vanished and I wasn't going to ask Tweedle Dum to bother pushing the chair so with my bag on my back, downstairs we went. 

In the lobby was Tweedle Dee with the bed. Wow! Pro-active, wonders will never cease. 

"Right, can we lift him across to the bed."

"*chew chew* Nah, we'll use the hoist again *chew chew*."

I'm guessing the "we" was meant to be ironic.

"Seriously, put the chewing gum in the bin or I will call and ask for another crew to convey, this is ridiculous."

With that, I handed the patient to the carer, stomped off to the lift, went back upstairs, grabbed the hoist and went back down. They looked pretty sheepish but he wasn't chewing gum. Me and the carer hoisted him onto the bed and I strapped him in.

Out of earshot of the patient I turned to Tweedle Dee, "Can you push the bed?"

"Yeah, no need to be sarcastic."

The patient was loaded on board and taken off to hospital. If there had been anything wrong with the patient I would have travelled with them. However, as he was well and the hospital was half a mile away I just followed behind in my car. 

To say I had words with the crew at hospital would be a massive understatement. I told them exactly what I thought about them and their behaviour and took their names and call sign. Tweedle Dum wouldn't give me his name and just kept repeating his call sign at me. 

Since when are we not allowed to lift patients? What if there was no hoist, like in most places? I'm all for protecting my back, but really?! Insurance won't cover lifting a patient? Do we just leave them on the floor now? 'Sorry, not allowed to pick you up, you're on ya own luv'! Let us not forget, we are told by the government that tendering for contracts will lead to better competition and better patient care. The NHS certainly has its faults, that's no secret and it also employs some bad eggs but this is now getting dangerous. 

THIS is the NHS. THIS is the future. YOUR life in THEIR hands. NO regulation. NO standards.

I'm sure I will told I'm taring all private ambulance services and their employees with the same brush unfairly and those who do, or know good people that work for them, I apologise. I have no doubt there are good people working in every company and this isn't about them. There is a reason people are sacked from ambulance services. These private companies give them a job in full knowledge of their past. As the old adage goes, you can't polish a turd. Sticking a new uniform on an unprofessional moron will not change a thing. 

A complaint was made. Outcome, unknown.


This is my opinion. This blog was based on 1 crew and my experiences. Not all Private Ambulance services are bad, not all crews are bad but I can only write on what I experience. I'm not interested in any comments left about the QCC regulating etc. It isn't done properly and there are some real cowboy outfits out there. It is of little surprise that my service has announced it is trying to move away from using them. Now why would they do that if they were so cost effective and so reliable? *tumbleweed*

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.