At the moment when you call for an ambulance you tend to get a big yellow van with two people in it. One or both of these people will be an emergency medical technican, the other will be a paramedic or another EMT. Both would have done the training that lets you safely render aid, diagnose heart attacks, perform resuscitation and do all the other things that I have written about here for more than four years.
All this is about to change, and it seems that it is something that isn't being talked about. It is a shameful change in order to save money and meet government targets.
Soon, when you call an ambulance, you will get a 'driver' and a medic. the driver will have been taught to drive an ambulance and to do chest compressions. They won't be able to give drugs, they won't be able to diagnose – their role will be to drive and to lift and carry. This new role is an 'Emergency Care Assistant' or ECA.
The number of properly trained staff on an ambulance will be cut in half.
I can see more than a few problems with this, not just related to plummeting staff morale as we feel less and less valued.
- It is going to have a big impact on patient safety. Us ambulance people aren't perfect all the time – there is always the chance for one of us to have a clinical error; with two fully trained staff there is a good chance that the other will notice if you are about to make a mistake. An ECA won't have the skills to provide this safety net.
- The EMT/Paramedic will have to 'attend' all the time. At the moment most crews take it in turns driving and attending. Especially with 12 hour shifts constantly being forced to sit in the back will lead to a lot of people going sick with stress. There will be no break from patient 'facetime', and given the quality of some of our customers I for one may end up wanting to throw the umpteen drunk out the back of the ambulance. I predict rocketing sickness due to stress.
- Likewise, the ECA will be expected to drive all the time, which may cause some concern, especially if it's on blue lights all the time. Currently if you feel a bit tired or your eyes are sore, or you just aren't in the mood for talking to people then you can switch jobs for a bit. With an ECA this soul saving trick won't be available.
- We get 'tricky' jobs sometimes, where you need the combined brain power of two medically trained staff – and an ECA, no matter how good their intentions are just won't have the medical knowledge needed.
- Our Agenda for Change banding is based around two EMTs or higher working together, EMTs will find themselves in a supervision role and I doubt we'll be getting any more money for it.
- Actually, will our Agenda for Change banding go down as EMTs won't have the responsibility of driving – less skill use would equate to less money.
- Are our newly qualified EMTs going to be made to work with ECAs one year out from training school? It takes more than one year to come to grips with this job, and it helps if you are working with someone who has at least the same level of education as yourself. Imagine being a year out of training school and being forced to work with someone who has no clinical knowledge.
- Related to the above point, it's a bit tricky to learn new stuff from someone who is less qualified than yourself.
- (This may seem a bit harsh but…) To work for the ambulance service you need a certain amount of intelligence, you have to pass the exams in the training course and then prove yourself throughout your first year on the job. ECAs may turn out to be people who aren't bright enough to pass as EMTs, and they'll be helping to look after your granny.
- When another major incident happens, half the people present aren't going to have any training in what to do. You can currently split the crews depending on the situation, so you may find yourself taking a patient to hospital with someone you didn't start the shift with. With ECAs that option has been lost. Also at any major incident you will have half as many medically trained staff as you do at the moment.
- It'll result in less EMTs being employed and is not going to do wonders for our job security.
The implementation of this hasn't helped matters much either. ECAs have been 'snuck in', the unions have been quiet and the first that many of us knew about these plans was when the first ones started turning up on station. It also would seem that our local management don't understand exactly how this new role is going to work; there has been a vague sort of notice going around and it seems that they are getting some sort of 'on the job' training at the moment, but no-one is sure.
With the whole dumbing down of healthcare under this government, this hasn't come as a huge surprise, what has come as a surprise is that no-one is protesting it. It's a stupid, stupid idea and I'm dreading working with an ECA; it's nothing against the people who will be doing the job, but they won't have the training to provide the care that has traditionally been part of the ambulance service.
It's the sort of thing that will have me leaving this job that I love so much.