Just to remind you all – this is my own personal view, not that of the LAS or any other authority. I have no official capacity to evaluate government policy or to pass judgement on it beyond that of a ‘civilian’. I’m a taxi driver in a truck.
Half of ambulance trips to hospital may be unnecessary as patients could be treated at the scene, a report says.
The NHS Confederation said the myth the ambulance service was a “patient transport” system must be challenged.
The report said crews were becoming more skilled and in the future nearly two thirds of patients would be treated at the scene in England.
Some 77% of 5.5m emergency calls each year end up with patients being taken to hospital.
But the NHS Confederation said this would change in coming years.
It warned the number of emergency calls had more than doubled in the last decade and it was essential patients accept more will be done out of hospital if the service was to cope.
And it said ambulances were increasingly being staffed by emergency care practitioners, who have a wider range of skills than paramedics.
They can prescribe more drugs, take blood tests and refer patients to GPs to reduce the number of emergency admissions
This leads on from Peter Bradley’s report to the government on the future of the ambulance service. Mr Bradley is also the chief executive of the London Ambulance Service. In the report it is stated that only 10% of 999 emergency calls require the trauma/stabilisation skills that we EMTs and Paramedics have. The other 90% of calls do not have life threatening illnesses or injuries, but have ‘urgent primary (or social) care need’.
That word ‘Primary’, what it means is the sort of thing that General Practitioners are trained in. Doctors who have to do a couple of years at university, then another five years or so working in teaching jobs at hospitals. Remember that training period, It’s important.
Compare that with the training that you need to do in order to be an EMT. You spend 20 weeks in training school learning anatomy, treatments and diseases as well as how to drive, how to safely move a patient and how to deliver babies. A year of post-training experience and you become a fully trained EMT-3. It’s short but intensive – and at no point does it compare to the training of a doctor, instead it turns us into people who know our job and do it pretty well.
The report goes on to mention that only around 40% of patients are admitted to hospital, while ‘at least 50% … could be cared for at the scene or in the community’.
With revised education and training of ambulance clinicians, the number of patients taken to A&E departments by ambulance can and should be significantly reduced. Ambulance clinicians need to be competent, trained and empowered to do this and supported in making decisions for themselves – rather than feeling that they have to get a second opinion. Appropriate education, guidelines, pathways and clinical support need to be in place locally to enable and support this decision making process.
So it is suggested that we can provide ‘primary’ (GP, lots of training) care to people by using ambulance people (taxi drivers with 17 weeks medical training). Dr Crippen has a better breakdown of what this really means. Now we do have some good skills, for example we are excellent at diagnosing STEMI (heart attacks) and transporting them safely to an angioplasty centre rather than a normal A&E. But at no point does the ECP additional training does not turn these people into doctors.
So, how much extra training do you have to do in order to be an ECP? In London at least you have to do eight modules of around five days study each. You also have to do some hours of supervised practice (around 80 hours for certain modules).
Since the government removed the compulsion for GPs to provide out of hours medical cover the ambulance services have had to cope with the fallout – the patients don’t go away, they just go somewhere else. If the doctor won’t come out then the patient will call out an ambulance and go to hospital. The ambulance services/hospitals are getting overloaded, so the 40% of patients who would not need hospital admittance need to be redirected elsewhere.
So do you offer more money to GPs to return to out of hours cover, or do you go the much cheaper route of training up ambulance staff?
The government reduces the pay of doctors who don’t provide out of hours cover by £6,000. ECPs are not paid an extra £6,000 more than basic ambulance workers.
Money in the bank.
The ECPs that I’ve spoken to often feel that they are told to ‘get on with it’, but if something goes wrong they will be the first ones sacked – so, thankfully recognising the limits of their training, they also take most people to hospital. No-one likes to take risks in the medical game. Instead of an ambulance, they have become a people carrier for minor injuries. Truly a ‘taxi service’.
I’m also told that a lot of the patients that they go to, while happy to see an ECP, also want to go to hospital, ‘just to be on the safe side’. So once again the ECP is used as a taxi service.
I’d trust all the ECPs I know personally to deal with my family, they are all good people who know the limits of their training. But how many ECPs will start thinking that they are a doctor? With over-confidence comes mistakes.
The plan for the ambulance service boils down to this – Keep the number of ambulances the same, but increase the number of ECPs as they will reduce hospital admissions.
All the while call rates are increasing. And in this litigation happy society we seem to be turning into, it doesn’t do us any favours to start leaving people at home. It’s why I take everyone to hospital – I’m not a doctor, so who am I to decide who needs proper medical treatment.
As Dr Crippen puts it, “…consider this. If Elizabeth or Phillip, Charles or Camilla, Harry or Wills, or even Tony or Cherie have an acute medical problem, do you think they will see an ECP?”