Putting A Halt On A Plan

This is interesting,

The Scottish Ambulance Service has been given a month to bring forward plans to end the single-staffing of its emergency ambulances.

“I have made it clear to the Scottish Ambulance Service that it must take action to eliminate rostered single-manning,” Ms Sturgeon told MSPs, making it clear the use of rapid response vehicles, designed to be manned by a single-paramedic, was also being looked at.



In London there is an increasing move to have solo responder RRVs going to calls (it helps with the eight minute target), in fact the move is to reduce the number of double manned ambulances and instead have many more solo cars.

In London a lot of the RRVs are manned staffed by ambulance technicians rather than paramedics, and ambulance techs don't have the same drugs available as paramedics.

When I was working on the RRV if I arrived at someone who was having a seizure there I couldn't give the drugs that a paramedic would use to stop the fit.

This plan, the 'front end' model, where a RRV is first sent to a job to decide if a double-crewed ambulance should be sent is due to be rolled out in London in the near future. This story would mean that at least one person in government is unhappy with this plan. Along with a lot of on-the-floor ambulance staff.

So I wonder if the Health secretary will be looking at other ambulance trusts?

22 thoughts on “Putting A Halt On A Plan”

  1. That is something I would be afraid of.After all, underfunding, understaffing, unrealistic and useless targets lead to inefficient services.

    Then comes the magic solution: Outsourcing and Project Financing.

    EMT and para being recruited with “services company” contracts, and not NHS. Possibly from abroad and with fixed term contracts.

    Some fat cats very happy….

    Andrea (MD formely EMT) Happily not in the UK, although I'd love to live again in London

  2. AH? out sourcing ! : start with Emergency number and follow the telemarketers and big business and use off shore labour. They can then use google,and guide an unmanned drone to evaluate the the problem using the latest IR- spy guides, where required, supply the drip needle until the necessary backup can appear on scene.latest upgrade to 1984.

  3. Unfortunately for London's ambulances Nicola Sturgeon is the Health Secretary for Scotland; not the UK.She's SNP – not New Labour – and Health Secretary in the Scottish Government and they've been having fun doing things differently up here in Scotland.

    Sorry, but at least if this works the UK Gov't as a whole might nick the idea and claim it as their own.

  4. I think Nicola Sturgeons' point is being made after the recent incident where a young guy got stabbed but as it was classed as a 'violent incident' the lone FRU who attended was told by Ambulance Control NOT to get out of the vehicle till the cops got there and she had to literally sit in the car and watch the guy bleed out, when she felt she could have helped, until help arrived – or face a disciplinary hearing if she disobeyed.A Hellish conundrum and the bosses need their collective arses kicked.

  5. The fun is going to come with A19 and B19.To explain, everyone knows about the 8 minute response. “Something” has to be on scene to a life threatening call in 8 minutes. Hence the trend towards more RRVs.

    However the government is now asking for A19 and B19 to be reported. A conveying resource (that's ambulance in English) must be on scene within 19 minutes for all life threatening (Cat-A) and potentially life threatening (Cat-B) calls.

    So with the increase in hitting the “8” minutes, we'll see a sharp decline in hitting the “19” as we have more crews on RRVs and less on ambulances. The governemnt will ask the trusts why, and the trusts will want more funding for more vehicles to deal with the increase in calls.

    I have a feeling the government will find it easier to change the targets than provide more money.

  6. I think the article had more emphasis on ambulances in rural areas not being single manned which makes sense as if you need to convey, your back up could be hours away which isn't cool if you're the solo on scene.At least in the cities backup is (geographically) not far away and so it's down to control to make a sensible decision to keep running and not divert them.I agree, so many times it seems as once there is somebody there to stop the clock in sub 8mins then its a victory, but for the poor bugger left with the patient on their own for any length of time it's really not fun.Have to disagree slightly with you Tom about techs on cars. With the exception of your example on fitting, techs are still very a useful resource. What can a para actually do single manned at a cardiac arrest?; you could argue about lines in and drug adminisatration but at the end of the day the most effective treatment is CPR and defibbing which can be done by a tech, not playing around with cannulas

  7. “Something” has to be on scene to a life threatening call in 8 minutes. Hence the trend towards more RRVs. …and community responders.

    I'm more cynical than you I'm afraid – I foresee the targets staying the same but outside firms being brought in to 'save' failing trusts (as is being proposed for hospitals) – this then becomes the thin end of the wedge of privatisation.

    There are plenty of private firms doing patient transport in blue light ambulances, it's only a matter of time until they start handling A&E work.

  8. When I was on the car in densely populated East London it wasn't unusual for me to wait 45 minutes or more for an ambulance – and from talking with FRU drivers it seems that it hasn't got any better.I remember spending 45 minutes in the street in the middle of the day with a stabbing as people tutted and walked past.

    I agree with you about CPR, but there are other occasions where a paramedic is more useful.

    E.g.

    Needle chest decompression.

    Penicillin for someone with meningitis.

    (in non-London trusts) Thrombolytics for heart attacks.

    Fluids for severe blood loss (which reminds me of a job where I was *seriously* considering going outside my protocols and hanging a line up on someone with an awful rectal bleed)

    Those are just off the top of my head, and until recently Naloxone for opioid overdoses.

  9. If dispatch had a bit more common sense/flexibility they would be able to see situations which they could send a single responder tech or para to. Yes, it comes down to what information they receive from the caller & call taker but when they rely on an inflexible algorithm (and a sepo one at that) they are stuck. And as its all about times now they will send the nearest available resource.Not being funny mate but why haven't you gone for your para yet? The incident you mentioned above must have been frustrating as you had the skills from your previous life as an a&e nurse but powerless to use them without backlash from management.

    I am but a 'mere' tech and going through the processes to become a para as i get frustrated in situations where i know i could do more good such as the examples you cited either as a FRV or 2x crew ambo

  10. Why not para?1) I'm looking to get out of the job.

    2) I love my crewmate and my station – I'd have to change both if I became a para.

    3) I've done enough learning in my life, the thought of sitting in a classroom again for something medical fills me with boredom.

    4) All that extra hassle for an extra 1 an hour or so? no thanks.

    5) I have enough hate in my life without bringing in the HPC.

    6) Becoming a relief again – no thanks!

    7) Doing para the old fashioned way, only for the only route of progression being a degree.

    So yeah, I'm a stick in the mud but likewise I can't remember the last time my para crewmate needed to reach into her bag.

  11. Yes Nicola Sturgeon has a point and being in the SAS I am pleased to see it being addressed!With regard the story reported in the Daily Record please can I direct you to my own blog Ambulance Nut – Learning the Ropes and the 'Press Release' post. It shows the blatent miss representation by the paper and the services response, including releasing the transcript of the incident.

    This is a huge problem………….. people outside the service who do not know how it works at a ground level have only the media's take on such situations and this ultimatley ends up in this kind of mis-information.

  12. Thank you for bringing this article to my attention Tom, I really should keep up but have been on hol for a bit so out of station.I am pleased the current situation of 'single manned rostered' shifts is being looked at. In my area the reason this is happening is due to selective overtime. This has lead to the union advising people not to do any overtime so the management will re-implement the old system of O/T to cover core shifts. At the moment there are core shifts (days and nights and RRU's) Not being manned, this will ultimately have a detrimental effect on targets and patient care as there will not be enough vehicles to cover demand.

    The article mentions that ambulances are manned with a paramedic unless the situation is 'exceptional'. In my experience the exception is when there IS a paramedic on the crew. I have the next 2 weeks working with a Technician (I am still a trainee) There are times when the 2 crews on my station and the RRU are all Techs. They are pushing many through the Pramedic training but there are simply not enough people going through to achieve this.

    Lastly, one of you commenters and the article mention the Highlands and that the crews need to be 'fully' manned with qualified persons. A person I trained with works in the highlands and since she started has been encouraged to work with an auxillary………… as a probationary technician of less than 9 months this scares her (as it does me). The auxillary is trained to drive in blue light conditions and CPR. Other then that they are a 2nd pair of hands but the ultimate responsibilty for the patient and scene is the Probationary Technician…………… certainly not something the press would report on favourably I think.

  13. “Then comes the magic solution: Outsourcing and Project Financing. EMT and para being recruited with “services company” contracts, and not NHS.”But it's worked so well on the tubes and in prisons, with water companies, and the railways, what could possibly go wro- ???

    Oh.

    Bugger!

  14. We have these 'probationary technicians' although they have a slightly different name, and I have to say, I can't remember the last time I was crewed with someone fully qualified. I'm a Paramedic, but I miss the feeling of having another brain to fall back on as I am nearing the end of my 5th 12 hour shift. They are useful in some cicumstances, but I personally feel that this is a cheap cop out that has been tried and tested and has failed miserably. It's not fair on them, us, and the patients.As for the RRVs…the same model has been implemented in our service and there are positives and negatives. I agree with the comment about Techs on cars. I think one of the most important drugs our Techs used to be able to give is Diazepam, and it's been taken off them. They too can sit with a fitter for 45 minutes because there are no double crewed vehicles to back up. That's if control remember to send one. There have been far too many times recently when they have 'forgotten'. Inexcusable.

    With the comment about the dispatchers sending the relevant resource, eg a Paramedic, to certain jobs…..the information is rarely correct that they (and therefore we) get through! How many 'unknown problems' have been a drug overdose or cardiac arrest?

    I think the switch to Paramedic is a tough one, especially like Tom was saying…hardly any financial difference yet a lot more responsibility. However, the frustration is a lot less when you know you can give the drug/intervention. There is a tendancy to mess around on scene a lot more, I agree, but as long as this is kept in mind, it's generally not a bad role (except for the politics).

    I love the job, but I hate that I have been forced into a) doing shift patterns I don't want to (and having my annual leave chosen for me) and b) that I can't work with qualified members of staff anymore.

    But to be honest, I can't think of anything else I would want to do. So why am I so tired and miserable?! I think, like LAS, we will eventually go back to just Techs and Paras. I can't wait. I don't mind the RRV too much, although feel a little unsafe in some circumstances (a recent job to a wrist injury was 5 very very drunk men being completely loutish and sexually inappropriate and explicit. I did NOT feel comfortable).

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