Caught Out

Maverick ambulance service managers risked patients' lives in an over-zealous drive to achieve the quickest 999 response times in England, the government's health watchdog disclosed yesterday.

The Healthcare Commission said Staffordshire ambulance NHS trust used poorly trained volunteers to act as “community first responders” to get to emergencies ahead of paramedics. They were authorised to drive at speed, using blue lights and sirens, without the necessary advanced driving training.

The trust supplied ambulance staff and volunteers with controlled drugs that they were not legally allowed to possess, including the sedatives diazepam and midazolam. It also failed to keep proper records of medicines, which regularly went missing from ambulance stations. Patients were sometimes given larger packs of controlled drugs than they needed and told to dispose of the excess themselves.

It's not the London ambulance service, but it just goes to show what lengths trusts will go to in order to hit these targets. A strange first sentence though, “Maverick”. Will the police be looking into whoever illegally supplied the Controlled Drugs?

It said Thayne, a former army officer, was described by senior staff at the trust as “a benevolent dictator”.

From what I hear, that's not what the ambulance crews on the road called him…

The commission blamed regional and local NHS managers for not asking searching questions. “This complacency was brought about by the trust's ability to exceed the Department of Health's targets,” it said.

In other words, “They were hitting their targets, so we didn't look too closely at how they were doing it”.

I think that community first responders are a good idea, out in the country every little town can't have an ambulance sitting waiting for someone to become ill. However, they shouldn't be whizzing around on blue lights, not without training. And with blue-light training you may as well train them to ambulance technician standards – but, oh, that would cost money.

(Although as far as I know the legislation about driving an emergency vehicle is a bit wishy-washy – any experts reading this, please do chip in).

The commission report has this to say,

Some of the problems may have arisen because the trust perpetuated the belief that the role of a CFR was broadly equivalent to that of an ambulance technician. Although the trust, when compared with other ambulance trusts, provided more training for CFRs, this was not comparable to the training given to ambulance technicians.

From the Healthcare commission themselves,

The Commission points out that the trust was a good performer in terms of response times for emergency calls. It was considered to be innovative in its introduction of new equipment and services and had good relationships with patients and the public.

But, the investigation found that these achievements were undermined by a culture and approach that did not prioritise safety and that put patients at risk.

So once more, evidence that the ORCON target puts patients lives at risk,

18 thoughts on “Caught Out”

  1. I'm not a CFR, but I can definitely see the sense in having beacons to clear the way – much in the same way that doctors do. Correct me if I'm wrong, but doctors are not given any exemption from road rules when using green lights but use them to clear a path ahead of them.Would (does) this not lead to more confusion, though, when other road users see the green lights and believe that the driver is exempt from certain road rules, as drivers under blue lights are, and treat them as though they were?

  2. It will never be seen as ORCON's fault though will it – it will be looked upon as cutting corners and perhaps and bit of poor management decision making….Out of curiosity, did the paramedics and the rest of the trained StaffsAS, not think to question the responsiblity being given to the CFRs? Surely with all the training that they get, they should know that CFRs shouldn't be handling CDs? Or is it a case of they didn't feel they could speak out against the big bad bosses?

    Just a thought – no judgements made, just something that passionate about – the ability to speak out when something isn't right…but without being reprimanded.

  3. Legislation on emergency vehicle driving is actually changing – [legal bit coming up] the Road Safety Act 2006 will, when it comes into force, not allow people to drive above the statutory speed limit when legally justified on blue lights unless they've done a course 'meeting requirements as prescribed by the Secretary of State'. Or something.In other words, there will be a requirement for a course (grandfather rights will apply if you've already done a course that meets the same standards) when everything's been sorted for the “high speed driving” bit.

    AFAIK though, the law on blue lights being used on a vehicle being used for “ambulance purposes” and the right to claim other exemptions won't change.

    Thankfully, most trusts explicitly state that CFRs can't use blue lights (with a handful of exemptions ie. a former police driving trainer is one I know of). Which makes sense to avoid the thrill seekers signing up…

  4. I would like to add some perspective from the point of view of a CFR.Firstly, I was aware of the situation in Staffordshire quite some time ago and most CFR's that I know are dismayed at what the CFR's in Staffs are allowed to do in the capacity as a CFR.This is what I do know as fact:CFR's in Staffs undergo a 13 week course, which is in effect a Technician Course. They are required to complete the same assesments to the same required pass rate.Staff's CFR's are the only CFR's in the UK allowed to drive on blue lights, however, they have no exemptions which means they have to drive within the speed limit and can not go through red lights and so on. After the recent report I doubt they will be allowed to continue to drive with blue lights and quite rightly so.Staff's CFR's are dispatched to jobs that CFR's from other areas would not normally be sent to such as RTC's. We all know that a RTC can be a very dangourous scene and there is no way I woud volunteer myself to attend one as a CFR.Many of the locations in Staffs where there are active CFR units are remote rural areas. However, due to the low populations of the areas concerned, the CFR's do not get called out very often. It is the opinion of many very qualified people I have spoken to that the reason why the problems have occurred is not due to the lack of training (in fact the staffs CFR's undergo far more training than counterpart CFR's in other trusts including mine) but is due to skill fade and lack of experience as the CFR's in question simply do not get out in the field often enough.The CFR unit I belong to is not in a rural area but in a densely populated area with several ambulance stations close by, yet, we have been called out more times this year alone than some of the Staffs units got called out for the whole of last year. So I do not subscribe to the idea that CFRs should be limited to remote rural locations only.I am sure that in terms of Staffs there are many things that need fixing but the one thing I would introduce as a matter of urgency would be to ensure that all CFR's in the rural areas of Staff's go third manning often to ensure they use their skills regularly.With regards to blue lights. I do not agree that CFR's should use blue lights. Perhaps there is some merit in extending the use of green lights so that not only doctors can use them but other medical personal such as community nurse practitioners, Midwifes & CFR's but of course only if it is deemed necessary and only with the correct and proper training.As I have said before, I believe that there is a place for CFR's, not just in rural areas but built up ones too. There is the argument that instead of relying on volunteers, trusts should invest adequately in order to employ more front line personnel and have more resources on the road, but the bottom line is that no matter how many there are, if they are all tied up then what else can be done?The idea of a CFR is that they are already in the community and therefore (in many cases) can be at the side of a patient administering life saving treatment before more qualified help arrives. There can be no arguing with the fact that this has been proven to improve survival rates, which surely can only be a good thing?

  5. “And with blue-light training you may as well train them to ambulance technician standards – but, oh, that would cost money.(Although as far as I know the legislation about driving an emergency vehicle is a bit wishy-washy – any experts reading this, please do chip in).”

    You can drive on blues and twos if you've legally got them fitted to a vehicle – in this case one that is “used for ambulance purposes”. What you can't do without taking and passing an appropriate course is the magic triumvirate of emergency service driving: ignore traffic lights, exceed the speed limit and pass to the right of keep left signs. It could still be useful to use blues and twos to clear the way without having to make use of the magic RTA exemptions.

    The driver training could easily come out free if it was tackled the right way. All around the country experienced police driving trainers/examiners give their free time to train people in ROSPA and AIM advanced driving schemes. I'm sure these same people would be equally happy to train up (and probably also examine) some CFRs on the same basis if someone sorted out the certification paperwork

  6. HI my wife reads your blog all the time and she asked me to comment on the Maverick Driver First responders. I am a Police Officer and I think I can give best advice on the law concerning this. Before recently ambulance, fire and the police could use their emergency equipment and were allowed exemption under the Road Traffic Act 1988, if they were using their equipment for an appropriate excuse. However, there has been a change within the law very recently. I think it is called the 'Road Regulations Act 2006' in which it basically says you are not allowed to use your emergency equipment for exemption from prosecution from speeding, going through red lights etc to ascertain smooth, safe progress through traffic UNLESS you have attended an 'Appropriate Fast Road Response Course'. In the Police we have the 'Stage One Response Course'. (This was also the part of the law with which the Government outlawed speed camera detectors etc). This means Police Officers, Fireman, Ambulance Drivers unless they have done the course will be acting illegally if they use that emergency equipment in a response. It sounds like from you Blog these First Line Responders are Acting illegally and these drivers and the Trust should be prosecuted. With the change of the law it is not just another hurdle to overcome or unnecessary bureaucracy, it also allows a Police Officer who has been called in on a Rest Day from their Senior Police Officer to allow them to respond quickly in their own car to work and give them exemption from prosecution; if they have passed the 'Stage One Response Course'. It should allow someone in the Police Force for example to drive and ambulance for a charity or another organisation that has emergency equipment provided, for example St Johns or the TA. However, I have not heard anyone doing that yet!! Matt

  7. Surely Mr. Thayne and his senior managers must have their actions investigated either by the local constabulary or the Health and Safety Executive.

  8. Oh boy – guess who is the ambulance trust for my area !!Oppppssss – but I give them this they do a bl**dy good job of keeping me alive !!

    I've only had the pleasure of ONE of the volunteer responders around 3 yrs back when I collapsed after recent tummy surgery with a massive abscess and she turned out to be a nurse from my GPs surgery who was trained as a community first responder !!

  9. As a CFR myself I would not want to drive my own car with Blue lights etc.Although as I am in a rural area with many houses haveing Names syuck at the top of a drive it would be helpful to have something that people could see to identify me coming from a shoth distance to enable them to identify where i am needed.

    I would not want to put MY own car under the stress of speeding Etc on a cold engine doing damage and using light forcing my insurance even higher.

    I feel we offer an excelent service to the public and I hope this article does not make the public worry when we arrive in our cars.

    From my experiance I only manage to arrive on scene within the 10 mins around 75% of the time Due to various factors Traffic being a key one during rush hour, at other times finding the location in a country lane can take this long on its own once i get to the lane. if it very close to my location I know alot of the house names but as soon as i respond to villages next to me its a lottery to find unless someone is outside the property.

    During peek times for the loacl trust i can be on scene for a while on my own the record being 40 mins although this is rare..

    i would only be too hapy to have some training in advanced driving.

    It sound like the Staf trust were using the lights in the same way as the Coatguard as they are ment to switch off al blues at traffic lights. This does get some strange looks as you arrrive at the traffi lights blues going, swith them off wait fo green then switch the bnlues back on again!

    But they do have a response time of 45 mins NOT 10

    Interested to read others comments on this.

  10. Hi SteveT,Apologies to all of Toms Ambo readers, but how many non-Ambo readers are aware that the ORCON standards you refer to mean that if we take 7 mins and 59 seconds to reach a cardiac arrest but declare the patient deceased this is a success. Whilst an 8 min and 1 second response to an arrest with the patient walking out of hospital some days later is deemed a failure.

    When will someone in high office within the NHS scrap this stupid standard that gets under the skin of every ambo I have soken to

  11. I too am a CFR, and would love some kind of lights to get me through traffic. Frankly, I don't give a bugger what colour they are, provided that they let the person in front know that (a) I'm not a boy racer, but that I'd really like to do 40mph in a 40mph limit – and not the 28mph that they see as quite fast enough, and (b) I do have a real purpose in driving along this road.I reckon that lights would save me 30% or more of my response time on the average job – and that's without breaking any speed limit. (I'm not too keen on breaking speed limits as it would increase my insurance costs manifold – and the Trust wouldn't pick up the bill.)

    As far as drugs are concerned, I'd just like to be able to use such “exotics” as glucogel. If the essentially untrained bloke working next to a diabetic can give glucogel, then why can't I – given the correct training?

  12. EMAS have started replacing technicians with ECAs. They are taking on no more technicians.Obviously they hope that the paramedic/technician will train the ECA on the job, getting “sort of” technicians on the cheap.

  13. My random thoughts as a CFR with a patch that covers a small town in Buckinghamshire and some surronding villages I would say that having some form of beacon on my car would be a benefit in clearing traffic, though I agree with other CFR posters that I would not want to be exempt from normal traffic rules, just use it to clear a path.I also would love to carry on with further training to EMT standerd, as I feel that we could offer a valubale support to the crews in the same way as the Specails do to the Police service.

    In my town the local ambulance station closed 8 years ago and we are fortunate that crews normally get here with in 10-15 minutes though on Friday/Saturday nights it can be longer, Once I performed CPR with another CFR for nearly 40 minutes before a crew or FRU was available to support and the paitent survived.

    I must also say that our crews are amazing and real give us CFRs a lot of support and feedback.

  14. A year on from posting this comment and knowing more now than I did then, I think no use of any lights, red, orange, green or blue should be used by CFR's.I have met CFR's that are a disgrace and simply cant be trusted to use a tea light let alone a blue light. The problem is that, unfortunately, the very nature of this voluntary work attracts the Walter Mitty's and its impossible to detect these sad characters until its too late.

    The training, certainly for the trust I am a CFR for, is not adequate and I am becoming increasingly cynical about the way CFR's are regarded by the management of the trust.

    Don't get me wrong, there are a great deal of CFR's out there who do it for all the right reasons and are a credit to their communities and Ambulance Trusts but, as is often the case, the minority spoil it for the majority. Of course this line of work is to serious to have such people out in the field without adequate training and suitability assessments. CRB checks are not enough in my view.

    The whole national CFR model needs to be revisited and a strict code of conduct needs to be adhered to which includes regular top up training and reassessment. Only such action will give the CFR principle any kind of credibility.

    In fact I feel so strongly about this that I intend to write to the governing body responsible for this.

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