Frontline: Paramedic

Different targets and better joint working between health and social care agencies would improve the ambulance service, says this week’s Frontliner


By Civil Service World

22 Feb 2012

“I’m a paramedic in the South of England. I respond to any 999 calls within the county, which means I can cover vast distances during my 12-hour shift. My record is 280 miles in one night!

Some shifts are busier than others. You can sometimes end up sat for hours in a lay-by waiting to be called out, but it doesn’t happen that often. I’ve been working nights just lately, which has been interesting: over the course of the weekend I had to deal with two people who had died in their sleep, three cardiac arrests and a really nasty motorbike accident, plus the usual array of old ladies who’ve fallen over, drunks and drug addicts. Sometimes we face a lot of aggression, and it can feel like we’ve just walked into World World III. It’s a physically and emotionally demanding job, which takes it out of you. It helps that we have a really good team – everyone looks after each other.

One of the most frustrating things about the job is the targets we have to meet. For example, I have eight minutes to arrive at a Category A call – the most serious type of incident – or it’s considered a ‘fail’. So I could get there in seven minutes but not save the life, and this would be recorded as a ‘success’, meaning the NHS Trust I work for receives a cash bonus. Or I could get there in nine minutes and save the life, but it would be recorded as a ‘fail’ and no bonus would be given. It doesn’t make sense. The system needs to change so that responses are judged on a range of factors, such as whether the correct procedures were followed and treatments administered, and what the patient outcome was, as well as the time it takes for an ambulance to reach the scene.

There are also targets for the amount of time we have to get a patient into a hospital bed. It can be difficult to meet these, particularly during the winter months when hospitals are near or at capacity. There have been many occasions when I’ve had to wait in a corridor with a patient on a stretcher. If the patient is in pain or has incontinence or vomiting, their dignity goes out of the window and puts us both in an unpleasant situation.
It would be easy to improve this – but no-one wants to pay for it. We need more crews, more beds, and better on-going care; far too many people are discharged early from hospital, and they often end up being admitted again.

Meanwhile, the government should run a public education campaign to explain when it’s appropriate to call an ambulance. People don’t take responsibility for themselves these days: we get calls from people who’ve sprained their wrist and could easily get themselves to hospital. Recently, we had a call from a lady who was so fat she couldn’t get out of bed quick enough to get to the toilet and had wet herself. But one of the worst cases was being called to change someone’s light bulb.

Better joint working between agencies would also help. For example, mental health cases can be difficult to deal with, particularly out of office hours. Generally there isn’t any resource available for people having breakdowns at 2am on a weekend, which is when it’s most likely to happen. Ideally there would be a mental health emergency room; but we have to take them to A&E, which is possibly the least appropriate place we could take them.
We’re really lucky in our trust, in that we have what are known as emergency care practitioners. They go to people’s homes to deal with less severe cases which don’t require a hospital visit. That saves a lot of admissions.

Another really great facility is the clinical support desk. Not everywhere in the country has one of these – but they should, as they’re worth their weight in gold. It’s manned by experienced nurses who talk to Category C callers – the least serious cases – and offer advice or direct them to a different service. Paramedics can also call and ask for advice on which pathway might be most appropriate for their patient. They’re brilliant and I love them.

The government could do a lot more to ensure better working patterns. Continually having to work 12-hour shifts isn’t good for our health. Combined with the stress, the physical and emotional demands, and the fact we’re now expected to work until we’re 68, it doesn’t look good for us. Thanks to changes introduced by Thatcher, the ambulance service isn’t considered to be an ‘emergency service’ like the police and fire brigade. So while they can retire at 55, we can’t. But I don’t see how we’re expected to be able to do the job when we’re older. The other day I had to run up 15 flights of stairs because the lift had broken. I then had to carry the critically-ill patient down the stairs – and he wasn’t light, believe me. I simply wouldn’t be able to do that in my sixties. This new retirement age will put ambulance staff at the risk of injury and other health issues. This, ultimately, will end up costing the NHS more – no matter how many targets are put in place.”

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