Tonight (With No Paramedics)

I've just seen Tonight With Trevor McDonald.


The programme does give the impression that if you get a Paramedic then you are guaranteed to survive, while if you get an EMT then you just have a 'stretcher monkey' and. will. DIE.

It also confuses 'Heart attack' and 'Cardiac arrest' and I believe that there is research that you are more likely to survive a cardiac arrest if you are attended to by a double technician crew.

You have read my blog, you know the truth.

The problem is this – it's down to the money that the government gives us (or rather doesn't). If we had enough money then we would have paramedics all over the place, an ambulance on every street corner. Hell, give us enough money and we'll see about getting a doctor on every ambulance. There is a limit to how much money you can throw at an ambulance service.


We don't have enough money to provide the service that the government wants. It wants us to reach calls in under 8 minutes, so we split ambulance crews to put them on cars. We can't afford to train people up to Paramedic (because where are the wages going to come from?). We can't spare the people off the road to train them up, we need them manning ambulances now. Because of our chasing of (pointless) government targets the people who would train paramedics are being used to man FRUs and ambulances.

A friend of mine has been given the go ahead to train up to paramedic. His course starts in April next year.

Ah damn it – you've heard it all before, pointless targets, not enough money, raised expectations; just search this site for whenever I mention the word 'Government' to read my views about it.

The real problem is that there isn't enough ambulances and ambulance staff and those that we do have are run ragged dealing with crap calls.

The LAS has released a Press statement.

There are a number of issues that we would like to clarify following the broadcast of last night’s Tonight with Trevor McDonald ‘Paramedic Lottery’ programme.

Director of Operations, Martin Flaherty, said:

“Reference was made to London having a smaller percentage of paramedics among frontline staff than any other ambulance service.

“Firstly, our ratio is actually higher than the 34 per cent quoted in the programme when account is taken of our training staff and other managers with paramedic skills who also respond to emergency calls. Equally importantly, the figure itself is quite misleading, as we know that in the last six weeks we have had a paramedic working on an average of 60 per cent of our ambulances and 50 per cent of our fast response cars.

“We also believe that the programme downplayed the role of our emergency medical technicians and did not fully explain the extent of their training and skills, which enable them to provide life-saving treatment in the majority of medical and traumatic emergencies.

“As far as the tragic case of Kayleigh Macilwraith-Christie is concerned, we carried out a full investigation into our response to her and shared our findings with her family. We have always recognised that she could have benefited from treatment by a paramedic, although there is no way of knowing if this could have helped save her life.

“An ambulance with a paramedic on board was originally dispatched to the call, but the crew came across a serious road traffic collision and stopped to assist. A second ambulance was subsequently sent to attend Kayleigh, but this did not have a paramedic on it.

“We have since reviewed our response protocols for patients reported to be suffering a prolonged epileptic seizure or series of seizures, and have put in place procedures to ensure that control room staff will always look to send a paramedic to the relatively small number of calls we receive to these patients every year.

“We are also continuing to discuss with various bodies the possibility of emergency medical technicians being able to administer anti-convulsant drugs in the future.

“Every year our service responds to more than 300,000 emergency calls which are categorised as being potentially life-threatening, and the increased survival rates of patients who suffer cardiac arrests – doubled in the last eight years – is testament to the skills of all our frontline staff.

“We will continue to strive to improve the care we provide to all our patients, aiming to ensure that they get the most appropriate response for their needs.”


Background information:

* For the future – and in partnership with our staff’s union representatives – we are looking to review the make-up of our workforce, and this will include a significant increase in the number of paramedics.

We currently employ more than 1,000 paramedics, and by March next year this figure will increase to about 1,200. By 2012/13 we envisage we will employ in the region of 1,900 paramedics.

With their enhanced paramedic skills, more of our staff will be able to diagnose and treat patients with a wider range of conditions and, instead of taking them to hospital, will ensure they get more appropriate care for their needs – either at home, through a referral to their GP or social services, or at minor injuries units or NHS Walk-in centres.

* Trainee emergency medical technicians undertake a 16-week training course. This includes a one week induction, followed by a three-week advanced driving module, then 12-weeks’ intensive training and education in the following areas:

o airway management and resuscitation including the use of airway adjuncts

o treating wounds and bleeding

o treating infectious diseases

o respiratory and circulatory systems including cardiac care, asthma, chest injuries and drowning

o musculoskeletal trauma such as broken bones

o maternity and neo-natal resuscitation

o paediatric care

o nervous systems and nervous disorders such as epilepsy

o poisoning

o diabetes

o digestive problems

o dealing with casualties at major incidents

o care of the elderly

o care of mental health patients

They then go on to undertake a minimum of five weeks' operational training, working as part of a crew attending emergency calls. Throughout this period they are accompanied by an experienced member of staff who supervises them and monitors their progress.

Emergency medical technicians are legally able to administer a wide range of drugs to treat conditions such as asthma, diabetes, severe allergic reaction, drug (opiate) overdose, certain cardiac conditions and are able to give basic analgesic and oxygen gases.

They are also trained in 12-lead ECG acquisition and interpretation, enabling them to make key decisions about the care and treatment of cardiac patients.

31 thoughts on “Tonight (With No Paramedics)”

  1. So. Lets summarise: Too much work and not enough people to do it, a pay cut this year with possibly more pay cuts to follow, a government demanding more and more and giving us less and less to do it with and now television programmes telling the country we are crap at our jobs. I don't know about you but I'm starting to feel a bit unappreciated

  2. “Every year our service responds to more than 300,000 emergency calls which are categorised as being potentially life-threatening”It is a great pity that LAS didn't also include a stat along the lines of “Every year our service also responds in person to more than x,000,000 calls which should have been seen by a local doctor – if at all – but which stopped our staff doing their proper job of treating *emergencies*”.

  3. Firstly, our ratio is actually higher than the 34 per cent quoted in the programme when account is taken of our training staff and other managers with paramedic skills who also respond to emergency calls. Equally importantly, the figure itself is quite misleading, as we know that in the last six weeks we have had a paramedic working on an average of 60 per cent of our ambulances and 50 per cent of our fast response cars.” So in other words to try and get these appaling figures up LAS include the trainers and managers who by virtue must do less shifts as frontline ambulance crews???

    For the last six weeks – whooooppeeee do! Funnily enough I thought a year consisted of 52 weeks – what did LAS do – find the best six weeks they could…

    Can't really dig at the crews – It's the bloody management that need to wake up and smell the coffee….

  4. Having watched the programme I am embarrassed and ashamed to be a good, hard working EMT. I now feel as though all I am good for is to colour in a colouring book with big thick crayola crayons and to put on a Band Aid plaster.The misleading representation of an EMT is a disgrace. I had Police officers questioning my role last night!

    I'm too frustrated and annoyed to be able to express myself specifically, so I'll leave it there at the moment.

    I know there are Paramedics who'd rather myself and other EMT's attend to them and their families than some of the “fully qualified Paramedics” we've got loose in our Trust.

  5. Really liked your post and of course you are right.Might be a bit of an off topic now, but can anyone explain to me the role of an (ambulance) “officer”?


  6. I haven't seen it, and it sounds like it's a good thing that I haven't.About this 8 minute thing anyway – do they think that without a target to reach you wouldn't try to get to emergencies as quickly as you can? Sorry that may be slightly off topic but it's a thought that popped into my head while I was reading your post.

  7. i fell ill a work a couple of weeks ago with chest pains and the care and treament i had was secound to none they were 2 emt i was just gald to see them as it was i was suffing from stress felt a silly hvae seen the crew 2 times since they treated me we should not knoct any one who does such a good job my name is rachel and i live in somerset

  8. I felt sorry for the EMT's mentioned in the programme. Good people, who no doubt knew what drugs the paitent needed, put in the postion of basically having both hands tied behind their backs.It's the same story throughout the public sector- not enough money, not enough staff with ridiculous targets. How can a service that is basically charged with saving lives be deemed to have failed if they arrive in the allotted time to a dead “customer” and yet if they arrive within 10. and the “customer” lives be considered a failure.

    I accept that most calls are not life threatening (did i read somewhere that 10% of calls are?) so most calls probably are good outcomes brought about by skilled EMT's.

    I suppose the answer is more money, and tackle the problem that there appears to be with abuse of the service. I must admit i did not realise how many people do abuse the service untill i read Tom's book.

  9. It doesn't get any better does it? Didn't see the programme but get the gist. Propaganda if you ask me, trying to justify crazy new policy.

  10. Delete EMTInsert Paramedic Class 1, Class 2

    that will instantly solve the problem

    these numpties reporting this are the same numpties that will call an ambulance out for chipped nails and want removing, at high speed no less, to the nearest nail intensive repair centre

  11. When I was watching this programme I was wondering what you would have to say about it. Living in Northern Ireland (one of the three places in the UK where, according to the programme, FRUs are always piloted by a paramedic), should I feel lucky?? I doubt it. The money will have to come from somewhere and that somewhere definately won't be straight from the government's pockets. Until I read Tom's book I had thought that there would always be at least one Paramedic on each vehicle, but now I see what a valuable (and undervalued at that) job EMTs do. Keep up the good work!!!!

  12. I must agree, EMT's were poorly represented. Many many many people in this country owe their lives to people like you.

  13. But no-one – least of all the “journalists” will either read all that or report on it. Like someone else suggested is the real problem not the targets and government intervention but the overutilisation of an emergency service by those who have no real medical emergency. When are the people who need help and don't get it going to start pointing their fingers at the drunks and neerdowells who plague the likes of Tom and my brother (A&E Cons) with stuff they or their GP should look after ???

  14. So basically (depending on your trust and AFC) we are just band four stretcher monkey van drivers, and if we come to help you we will probably kill you. So when you dial 999 make sure you ask for a paramedic and not one of us numpties who couldn't help you as we are not trained (I believe it was Sir Trevor who stated that we were not trained) tooDoes loads for morale doesn't it – but I must say it was nice of the families of these unfortunate individual cases that were brought to our attention in the programme, for taking the time to state that the EMTs did all they could and could not be blamed for anything happening to their loved ones. If only the programme makers could have invited someone who was pro ambulance on to the programme we may have had our honour defended.

  15. What are peoples opinions on the comments made by the APAP representative?We have been discusssing it at work, & people aren't too impressed with the stance they took.

  16. Well in New Zealand, “Ambulance Officer” is the term for any clinical worker on an ambulance – just like “Police Officer” is any sworn person working for the police.Confusingly, “Ambulance Officer” is also a St John Ambulance qualification level.

    As far as the media goes (if they're good enough not to call us “Ambulance Drivers”) we are “Ambulance Officers” or “Paramedics”

    Over here we don't have the “EMT” acronym. Not sure if Ambulance Officer exists in the US or UK.

  17. Herts Ambo Bloke I couldnt have put it better.I emailed our Chief Exec & urged him to put out a press release to reassure members of the public that the EMT's in our Trust are fully trained and to stress that care will not be second class if delivered by a Technician.

    I read yesterday (Wednesday) in our local paper the Exec saying “10% of calls are life threatening and the other 90% are non life threatening which EMT's are adequately trained to deal with”. So we get kicked in the bits by out Exec too!! He implies to the public that Tech's are unable to deal with life threatening calls but can deal with the other 90% shiyte.

    The programme has placed untold pressures on all Techs in the country and made attending work a difficult place to be.

    It's offensive and insulting crap.

  18. “Every year our service responds to more than 300,000 emergency calls which are categorised as being potentially life-threatening”I presume this is the category that they are assigned when the call is put through? (The unconscious, not breathing stubbed toe…) It would be very interesting to see the percentage of these that turned out to be non-life threatening – does the LAS keep those sort of statistics?

  19. I have osteoporosis so I've had a couple of (necessary) ambulance trips. The first time an ambulance was called for me (two breaks in the humeral head) I had an ambulance with two EMTs. They were fantastic – caring, supportive and concerned.On the other occasion (probable broken femur) a paramedic was first on scene (because there was no EMT available and they had to meet the 8 minute target!) He had to call for an ambulance to transport me to A&E. The paramedic was brilliant, but really couldn't do anything during the 20 minute wait other than offer pain relief. Again the EMTs on the ambulance were great – friendly, caring and great guys. They also offered pain relief.

    (Incidentally the call was classed as catgeory A because I had several abrasions and there was bleeding and I was “breathing abnormally” cus it hurt! Although I explained to the call-taker the reason for the bleeding and puffing he said he couldn't downgrade the call!)

    My husband and I watched the programme and thought it very biased. On both occasions EMTs were the appropriate people to attend the incidents I was involved in, but I had to take up 20 minutes of a paramedic's time because he was the only one who could make the 8 minute target. That is not efficient or proper use of the paramedic's time.

    If the 8 minute target was abolished paramedics would be free to attend more serious incidents because they wouldn't be sent to people who could wait.

  20. Holy crap.Lets hope that's not what he thinks but is instead a failure of the reporting, or of your press office.

  21. Exactly.And our FRUs are being sent to lower priority calls now in the hopes that they will cancel the ambulance.

    With no extra training mind.

    Again because of government targets and the lack of proper ambulances.

  22. During my email to him I quoted what your Director of Ops had said (which was genius as it looked as though I'd done some research!) and I effectively told him that compared to what perfect sense your Dir of Ops had said, he had stated utter plop, which was equally as ridiculous as the programme.I ended my rant by telling him it sucked our Chief Exec wasn't fully briefed on the capabilities and skill base of his front line staff.

    Fearing I would be asked to have tea and sticky buns with the Chief the moment I pressed the send button, I received a reply about 3hrs later and to be fair I don't think that's what he truly believed – he should just should sack his Communications dude (Band 8b!)

    Out of interest has anyone felt they have been received differently from service users, members of te public or other healthcare professionals since the programme?

  23. Amulance Officers is a generic title for members of managment within the ambulance service who are “opperationally active”. Clearly the role will be different within different services however when used in relation to the LAS it will typically refer to either training officers, who spend their time running training courses for both existing and new members of staff, and station officers, who are tasked with the day to day running of a complex (give or take 100 staff) and scene managment, attending large or significant incidents and overseeing the care to all patients and the safety of all staff. Any of these officers who hold a paramedic qualification will need to spend time with patients to ensure their skills are up to date and that they maintain their registration.Hope that helps

  24. Sorry but I'm sick and tired of this attitude. Over the last year I did about 300 hours clinical work, all over the year not just the last 6 weeks, I am available to prvoide a paramedic assistance to any of my crews almost every hour that I am at work, why the hell shouldn't my contribution be recognised. The number of paramedics a service has is the number of staff that are qulaified paramedics regardless of what other work they have to do. We don't discount staff who are sick so I see no reason to discount staff just because they don't do 37.5 hours a week on the road.If you read Reynolds piece you'll see that the shortage of paramedics is down to government funding not LAS managment policy, we all are responsible for the government and so I'll hapily share the blame with you on that one.

    In the mean time I'd rather have a good EMT attend me if I got ill than a bad paramedic.

  25. I don't have a problem with the logical reasoning that if you send medics with more experience/training/expertise out to a casualty, that patient's chances of recovery are – on average – better than if they had been attended by staff with less experience/training/expertise. I'm quite sure that if it was practical to dispatch a big equipment-packed helicopter manned by a crack team of doctors, surgeons, anaesthasists, neurologists, paediatricians, gynaecologists, etc etc, to every single 999 call, then “survival rates” would go up. But this is the real world and this is a debate about the best use of available money.The point I think people sometimes fail to acknowledge is this. Let us fantasise for a moment that the budget for Ambulance crews' training/wages could be increased by 50% or so. This would allow every ambulance worker to be a paramedic. (And this is essentially the solution it seems a lot of people would like ideally.) But this would not be the best use of such a budget increase in terms of “saving lives”. Given this extra money, it would still be better to get some extra ambulances and more EMTs to man them.

    The fact is: 100 ambulances manned by highly trained, higly competent medics would save fewer lives than 150 ambulances manned by medics who are “only” quite well trained and moderately competent. No matter how much extra money can be pumped into the ambulance service – within realistic limits – the most efficient use of that money (in terms of numbers of lives saved) will not be to increase training/quality of existing staff/ambulances but to get additional staff/ambulances at the current level of training/quality.

  26. This makes me so cross. I am a nurse, and know full well the benefits of EMTs. Didn't watch the programme (probably as well) because I know how bad a job they do of presenting a reasoned argument. Maybe the government could start a 2 tier system like they have in many countried (e.g. Holland) where if you dial 999 (well 211) for an ambulance rather than the non-emergency number (0845 equivalent) and its not an emergency (maternataxi, etc) then you are charged for it. Prevents the system being abused and works well because those who can wait do and those who can't are seen very quickly, and means that the calls can be appropriately prioritised without a failue of targets. BTW the call takers can upgrade the 0845 ones to a 999 if they feel its appropriate without charge to the patient

  27. Hi ive been trying to get into the ambulance service for six months both east anglia and london but there are no vacancies. I am a community first responder the ambulance service wouldnt make their eight minutes if it wasnt for us. It doesnt matter how quailified you are if cpr is carried out as soon as possible. Some of the government ministers should go out with the crews for a day. In essex when ive been on a ambulance for a day we can get held up for 20minutes just waiting for a nurse to take the patient from us as they have no staff either. Where i live the council turn the street lights of at midnight , we got called to a chest pain which is 2 minutes from my house it took 3 minutes to find the number in the dark and the ambulance crew drove past the end of the road twice as we cant see in the dark. !!!!

  28. Fair representation of Technicians during that programme? I think not, what a load of bollocks. I am a paramedic and it is usually the technicians that keep my feet firmly on the ground, and that is the way I like it. In fact I would rather work along side my fellow technicians than some of the paramedics that I know!

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