Wednesday, 15 December 2010


Voluntary Aid Societies (VAS). Some of you reading this may well be part of them, Red Cross, St. John Ambulance, St. Andrews Ambulance. I am. Which one is not important. Indeed it was getting involved with the VAS during my first degree that got me into EMS in the first place. However, being part of one of these organisations is often frowned upon by many in EMS. It’s almost a stigma and many think less of you because of it.

Now I do understand some of the reasons why. I see the good, the bad and the downright worrying within my organisation. While this can also be said of EMS (I’m sure we can all identify one or more individuals we would NOT want turning up to us or our families!) the appears to be a higher concentration in VAS possibly because the need to make up numbers and only having those who volunteer to do it with. So you sometimes take what you can get and have less room to be picky. Not a good excuse but a reason none the less. I have also been informed by some friends in London that during the ambulance strike back in 1989 St. John Ambulance volunteers worked and this was seen as them working against the strike so there is still some animosity from that.

However, I have found that, along with the bad and the ugly there is indeed some good in what these organisations do. Some support that ambulance services in times of need providing ambulances and crews to cover some of the lower grade 999 calls freeing up frontline NHS services to attend the higher priority calls. Some NHS trusts favour one VAS over the other, some don’t work with any. They also provide first aid provision at thousands of events every week. Volunteers. Not being paid. Surely that has to be commended? I personally don’t do much front line direct care (I do that at work) instead choosing to give my time in other ways within the organisation utilising some of my other non-clinical skills. But I also get something back from all this. I get courses which improve my skills from leadership to recognised planning, major incident and training qualifications which I can add to my CPD and aid my career progression.

But, what I wanted to know is this: Do VAS have a place within EMS? And if so what? Should we be actively working with them to raise their standards? Should they be confined to providing first aid at fetes? Should they be providing support to ambulance services? Do they have the skills to be answering 999 calls?

Well, I look forward to seeing what people think.


Thursday, 25 November 2010

Lies, more lies and statistics

I have a growing irritation in this job. That irritation is statistics. Many of you reading this will think this is going to be about the great God ORCON (time targets that ambulance trusts get measured by) but it goes much deeper than that....

For those of you who are not aware, ambulance trusts in the UK are primarily measured by how quickly they get to jobs - ORCON targets. For urban areas this is 8 minutes from the time the 999 call is routed to our call centre for Cat A jobs (highest priority) and 19 minutes for Cat B jobs (not as life threatening as Cat A but still sometimes not well patients). Cat C (Low priority but also sometimes unwell) used to be 4 hours but now they have different measures. The category of the call is determined by AMPDS. I will not be discussing the "wonders" of this system here but feel free to look it up on Wikipedia or something. Or ask anyone in EMS about it. I'm sure they'll give you an idea about its "Brilliance".

So, these targets exist. Get there in that time and *woop woop* jobs a success. Outside, and it's a fail. Get to a sick patient in 7 minutes and give poor quality care and the patient dies, that's a success. Get to the same sick patient in 9 minutes and perform excellent, high quality care and save a life, well that's a fail. It is that black and white. Needless to say this bugs me quite a bit but I have got to a stage where I am more concerned with the care that I give than whether I got there quick enough. Don't get me wrong, I don't hang around - I get there as quick as I can - even if the details on the call lead me to believe that the Cat A job is actually a Cat C job just the person knows how to answer the questions so they get a quick response (not that any member of the public would do this!). I am paid to get there quickly, so I will get there as quickly AS IS SAFE TO DO SO.

"As is safe to do so". This is the important bit. Now I am currently doing a stint on an RRU / FRU (Rapid / Fast Response Unit). These are cars that are designed to get to the sickest patients (Cat A) very quickly to initiate life saving treatment (the cynical amongst us may well say that they are there just to meet these Cat A targets). So currently my job is mostly about getting there quickly. And I do. Very quickly. BUT I will only go as quick as is safe. Rule No. 1 - If you don't get there because you crash, you are no help to anyone. I refuse to drive any quicker than I do because a) I am not going to be responsible for an accident that may kill / injure other people b) I don't like pain c) I like my driving licence. I am responsible for the vehicle and it's actions. EMS people are NOT exempt from dangerous driving.

So - in my mind, I get to jobs as quickly as is possible. There may be some that can get there slightly quicker, but I'd say I do a fairly good job of using as much diesel as I can. However, my "Statistics" don't show this. The target for Ambulance Trusts to meet is 75% of all Cat A's in less than 8 minutes. I am above this target but not by much. My trust expects cars to be 80-85%. I am not in this bracket. I am in the middle of all the car people in my area, with some lower and some higher. Some are in this 80-85% bracket. And so to management, 80-85% is achievable so why am I not doing this well??

My biggest problem with all this is the way these statistics are calculated. All they do is pull from the computer systems the number of times I got there WITHIN 8 MINUTES OF THE CALL STARTING and the number of times I don't. There is NO consideration given to any delays I book - for instance, delays because of traffic (you try moving anywhere in a built up area during a) school leaving time b) rush hours), delays for distance (I know I am quick but I don't not have warp engines) or my favourite, delays due to activation (If I don't get given a job until 6 minutes into the call this does not leave me with a great amount of time to get anywhere!). These statistics are raw data. We are judged by these statistics yet management can't be bothered to get them right.

Just to rub salt on the wound, when this is pointed out to management types their response is "Well everyone else has the same problems so it should average out over time with everyone getting the same number of delays etc so if one person can get 80-85% then everyone should be able to". Eh? Hello! Do you understand statistics and probability? Now I am no statistician however I do understand a few basic principles. I believe (and if anyone out there does know statistics better than me please correct me) that there is as much chance of one person getting all "impossible" jobs, that is jobs that no matter what speed you were doing you'd never make the target, and another getting all "possible" jobs, as there is of getting an even mix. In the same way that each time you flip a coin you have an equal chance of getting a heads and a tails. It has no bearing on your previous flip.

In my mind, my personal performance targets are 97%+. That is, all jobs that I have not booked a delay for distance / activation / traffic - i.e. all jobs I deem it possible to get there quickly, I have made it 97% of the time. There will always be some exceptions but I still believe that I get to (virtually) every job in the fastest time I can THAT IS SAFE. Any faster would be unsafe and thus unacceptable. If I am sent a job with 2 minutes to spare and is 5 miles away, it's rush hour and the main roads are blocked, well that is not a PERSONAL failure if I do not make it. A service failure perhaps for not having enough vehicles in the right areas or not giving me the job quick enough, but not a personal one. To be honest, if I were to make that job in time I'd be asking questions about how the bloody hell I did this without driving dangerously! Just because there are not enough vehicles in the right areas, just because the jobs don't get sent to us quickly enough, or a patient changes their story 5 minutes into a call changing it from a green to a red, none of this should be held against the individual in the car.

However it is. It is on my head. Now, my main concern is with patient care. I will get to a patient as quickly as I can and give them the best care I can give. That is my target. However I am judged by these other, inaccurate targets. I have pressure put on me to "do better". Thankfully I'm old enough and cynical enough to smile and nod and keep doing what I'm doing. However younger people who I see going on the car, those with less driving experience, less life experience, and more fear of management, I see them pushing them selves to drive faster. And I am worried that one day I'll be sent to an FRU with a dead colleague in it because they had recently been told off for not getting to calls quick enough and were pushing it too hard.

Clearly this is just one set of statistics. There are many more: Mobilisation times, Compliance on filling in PRF's, Patients taken to appropriate facilities rather than nearest A+E, all sorts. But it is these inaccurate times that get under my skin from time to time. Is it just me that feels this way? Am I the only one that believes that all these statistics detract from what we are there to do - provide good quality care?

Friday, 29 October 2010

Keeping up to date

As a Paramedic, I am responsible for ensuring I keep myself up to date with all the latests guidelines, practices and to make sure I keep my skills up and prove that I can still do those things that I was taught many moons ago. This is part of my profession and part of being a professional, taking responsibility for ones "upkeep".

However, this is not easy. Yes, you can read journals. Yes, you can keep reflective accounts of jobs you do etc to help learn what you have done and how you could improve it. But, and I don't know if I am alone in this (which is one of the reasons I blog - to see if I am alone or if others are in the same boat and how they deal with it!), I do find that my trust is not hugely supportive of on going training and development. I also feel there are limited courses out there in commercial world specifically designed for the Paramedic market, and many of these courses are not cheap either!

Now, don't get me wrong, but I think trusts (well my trust at least) are trying. Rota's now have (or are getting) training days built into them. There does seem to be more of a push towards yearly reviews for staff and individual training plans. They are trying to get more training staff available more of the time to more staff, which is all good. However, as soon as the pressure levels increase and the trust is over worked *poof* away goes the training. Certainly, in the trust I am in, we seem to be "under pressure" more and more these days, and I guess it is the same for many with the wanting us to do more for less. But is this really an excuse? While I am not going to go into the intubation debate here (I'll save that for another post!) even though it is recognised that Paramedics don't get as much exposure to this skill as is desirable, there is little that trusts seem to be doing to address this. One trust I know of has even stopped training intubation to all it's new Paramedics - so instead of trying to find a solution to the training they have just removed it which, given we are in the 21st century and wanting to move the profession forward (well I know I do and I am sure I am not alone!) this only seems to be a step backwards.

As for external course, yes you have things like PHTLS and ALS but really these are Doctor courses and while they are relevant for Paramedics in the whole, they have not been designed FOR the paramedic. If I am honest, I'd love to see some courses with us in mind being developed between the College of Paramedics and HPC. In my little brain I can see a huge market here - perhaps a course that you could do where you can have simulation manikins and practice intubating (to reduce the aparent skill fade and thus stave off the skill removal), prove compitence in managing cardiac arrests or truama or any number of scenarios, perhaps some theory and even an exam. Perhaps even make this a mandatory course which you need to do every 2 years and produce the certificate when re-registering with the HPC. Some people reading this (assuming anyone does) may think I am crazy, and in part this may be true. But surely, something like this, designed for paramedics, making sure we keep skills up to date, proving that we still know stuff can only help to improve the profession. It would ensure we keep ourselves up to date. It would ensure we do still remember things and are regularly tested on them, not only proving to ourselves that and our peers that we can remember it but proving to the public that paramedics are not just a group who have done training once but are constantly being re-tested to protect them. Yes, I know this in part is what CPD (Continual Professional Development) is about, along with folders, but wouldn't it be good to have specific courses targeted at paramedics with this in mind?

Ah well. Until such time as these sort of courses appear I shall keep doing whatever training I can get out of my trust, probably some additional courses on top (if my bank balance will allow!) and perhaps a conference or two. Will definately keep reading blogs and listening to the Ambulance Matters podcast - - (strongly recommend this to people!) as this seems to be quite a good way of reflecting...

Oh, and if anyone has any great learning resources, any tips or tricks, or any courses they'd recommend, I'd be really interested to hear. I want to become a good paramedic and I know I am right at the beginning of this journey. Like I have said before, anyone who thinks "I'm now registered. I've got there" is in for a shock as there is always more to learn. And if anyone fancies setting up some Paramedic Training Courses designed by paramedics, for paramedics, let me know!

Friday, 8 October 2010

Who wants trauma?

What is it with Trauma? You've probably heard similar comments as I have...

"Went to this wicked job last night"
"Oh, what happened"
"Well it was this proper trauma job...."

I have heard people talk, even rave about trauma jobs, "proper jobs", jobs where people are significantly injured and it takes a lot of effort to save them. So many people, and often new people particularly, seem to be transfixed on these jobs, some I'd say even look forward to them.

And, to a point, I understand their "attraction" - the fact you have to use your skills, think on your feet, actually use all that training you once did, cannulation, the needle chest decompression (sticking a needle in the chest to relieve a potentially fatal pressure build up), giving fluids, working alongside HEMS. It's a proper job. The sort we all trained for.

But, is this right? We are a profession that exists to care, to help the sick and injured. So how can we WANT a trauma job when that requires someone to be seriously injured? In fact, any "proper" job where someone is unwell enough for them to require full blown paramedic interventions, drugs etc surely is a bad thing? After all, we want people to be well do we not? Surely a day with no patients would mean a day where everyone is well and not injured??

It seems to be a contradiction - liking the trauma jobs (or other such hard working jobs) yet wanting to make people better. A bit of a moral nightmare. And this got me thinking....

I can't speak for everyone, but I don't want people to be injured or sick just so I can use a skill I haven't done in a while. Some of the least used skills are ones that I don't want to use (they mostly involve very unwell kids / babies - which is why I don't want to use them!). However, I think we all can agree that a day with no illness / injury is not something we are likely to see. And so, I'd rather be somewhere where I can help those who most need it.

It's still morally shaky. Still not sure how I feel about trauma. I wouldn't say I "enjoy" a trauma job, again there is a sick and injured human being at the centre of all of it - someone's son/daughter, brother/sister - but as a job, whatever the outcome I find it brings the best out of people. There is definite teamwork, there's a yearning to do the best, do it well and do it quickly. We all pull together and fight together for the same outcome, and it is this shared experience, this teamwork that I think I enjoy.

So, judge me if you will, but I do like a proper job, trauma or otherwise, but not because I like guts and gore or really sick people, but that as a job it's one that brings the best out in people and you really work as a team. But I'd still rather I was never needed.

Saturday, 25 September 2010

It's not easy being green.

So, there you are. Fresh out of training school / university / whatever route you have entered the mad world of EMS. You are all keen. Full of knowledge and enthusiasm and wanting to put that into good use. You know what you should be doing. You want to get out there and do it. Do the best for your patients no matter what.

Then you meet them. Those who "remember the days when". Those who want to just take every patient to hospital. Those who think machines are evil. Those who think that there is no point asking too many questions as they never listen at hospital. Those who never take anything into a job because "it'll just be rubbish anyway".

And here comes the dilemma. You have to work with these people. You are a very small fish in their very large pond. How far do you go to get along? What will you sacrifice so as not to become "that bloody uni student"??

Will you sit idly by while they do things you know to no longer be best practice?

When you attend, will you still take in all the bags because YOU want to make sure you are not caught out?

Will you try and leave people at home when it is the best option for you or will you be pressured into taking them to hospital "to cover your arse"?

When you are driving, will you "turn those lights and sirens off, its a load of bull and we don't need them on"?

Will you continue to listen to the chest or will your stethoscope become another bit of kit gathering dust in your bag?

When a patient would benefit from a drug that while not essential right now you can give, but it will involve cannulating, will you spend the time to make the patient feel that bit better slightly quicker or "just take them to hospital. They'll do that there"

Will you keep your keenness or be sucked into the cynical, anti-management, anti-work world of the old school?

Now, don't get me wrong, I think the old school have huge amounts of experience to teach us newbie’s. They have coped and done the job with less equipment, facilities and drugs for years. Their hunches about patients are quite often spot on. They know how to deal with PEOPLE, something that can sometimes be lacking with newbie’s. But it's about extracting the good from the bad and learning from it.

A wiser person than I once said "You can learn something from everyone you work with, either something you want to incorporate into your way of working, or something you don't. Treat every shift as a learning opportunity".

I'd like to think that throughout my training I have tried to do this but I know that there have been times when, working with certain individuals, I may not have done as much as I'd like because I didn't want grief. Now, I'm a little more confident (not that much tho!) and take what I want into jobs, deal with patients the way I want to and try not to slip into bad habits. Yet a recent incident has made me realise that I have a long way to go still. I'm still very new in the grand scheme of things and could be working with these people for years to come. And a 12h shift is a long time to work with someone who really dislikes you.

Thankfully, with words of encouragement from numerous people I am happier with what I am doing. While I have noted the comments made about me, I haven't really changed my practice. I'm just more aware of it.

If EMS is to change, to improve, to move forward, we have to make sure that we do not let those who would anchor us in the "I'm just an ambulance man with a van" era succeed in bringing us down. While we must respect their views, learn what we can from them, we need to be mindful that EMS is developing and we can help that development. We are the future.

Best not tell them that tho, seems to p*** them off!


Saturday, 11 September 2010

Me and my blog

Well, here goes nothing. Me. Blogging. Bizarre. I suppose it would be best to start by saying who I am and why I have started to blog.

Who am I? Well for now at least, this shall be, in part, a mystery. Anonymity provides a certain level of protection, not only for myself but also for those patients who I may end up blogging about. Anonymity also provides a level of freedom to open up without any fear of reprisals from management, colleagues, friends or anyone. Needless to say, all details of patients, colleagues and anyone else involved will be anatomised to protect confidentiality. So, to an extent, the blog will be works of fiction based loosely on fact.

However, to understand why I am blogging some sort of background into who I am may provide a frame of reference as to where I am coming from. I am a registered Paramedic working within a large NHS Ambulance trust. I have been with them for a while but only been a Paramedic for a little over a year. Before joining the trust I also had experience working in an A+E department for a number of years, something I am very thankful of to this day.

However, even with my background of working in the health care field of a good few years, I still feel very new. VERY new. I have been a Paramedic for a year but still feel like I am just out of my box, shiny and new and sent out to deal with anything and everything. A bit daunting to say the least.

And it is this feeling of newness that has prompted me to start this blog. I don't know if anyone will read it. I don't know if anyone will care about my ramblings. But it is a way for me to mull over those feelings inside me, to put down all thoughts thoughts that are rattling around my brain and to try and make sense of it all. Even if one other person reads any of my blog and thinks "thank God I am not the only one who feels totally out of their depth" then it will be worth it.

I don't expect this blog to be a "hit" like many others I read. I am not looking for stardom or to be thought of as a "hero" - If I were then I'd be in the wrong job to start with. But I do hope that writing things down, getting them on paper (well, on screen) will give me a better chance to reflect on what I do, and to try and become a better medic for it.

And so, with this brief intro into to who and why, I begin blogging. See ya around!