Changes, And Not For The Best… (Or – Reynolds May Lose His Job Again)

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.

71 thoughts on “Changes, And Not For The Best… (Or – Reynolds May Lose His Job Again)”

  1. “then I'll forget about applying to work for the ambulance service. I'll train as a nurse instead.”NOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO, do not train as a nurse, our service, standards, number of trained people on each shift and pay are all getting as buggered about as poor old tom's job. NHS careers are dying on their feet, there are now practically no interesting specialist roles to move into once you are firmly bored of working a week of 12 hour night shifts EVERY month. And as for pay don't even get me started, having been done over by agenda for change quite badly, i am a nurse with over 6 years of ITU experience and am struggling to get a mortgage in an area of nottingham where you arn't regularly raped and killed.

    Tom, my heart goes out to you, its the dumbing down of your service and is very disrespectful to you and your collegues who work bloody hard and already get paid less than i do. Its madness, its the equivalent of community support offficers, or HCA's level3 in nursing, or Doctors assistant's. Bloody chaos.

    having just spent 1000 on an HGV course to join the ambulance service, i am now stood here going…………………………… maybe not…..

    i think that this will have a very bad effect on your recruitment and retention

  2. is this a government proposal? if yes then I can include it in my latest college assingnment.Also what does this mean for people like me – who are planning to go to uni to get a degree to become a paramedic?

  3. I agree this sounds like a terrible idea for all the reasons you've listed, and I hope they think twice about it.Do you know if EMTs and paramedics are still required to be able to drive the vehicle, and if so, whether they will be put through the same rigorous testing that they are at the moment? I ask because, as you know, I would like to go out on the road one day, but I have serious doubts that I will ever be a good enough driver. So, from a personal point of view, I stand to benefit from this. Doesn't mean I support it, of course, but if it's going to happen…

  4. There is another avenue of protest – how about writing to your local MP? After all, they can't kick up a fuss if no one complains…other people have set up a uniform letter for people to print off and sign. This might help increase awareness of the issue, and might be effective in conjunction with a petition or on its own.Is there any hope that someone will scotch this stupid idea at this point, or are we at national role out stage?

  5. I read something about this on another blog – NOT, I hasten to add, in a newspaper or heard it on the news or anything like that. I'm not in favour at all and I'm not even a professional – I am a member of St John Ambulance with a bit more than First Aid at Work and it is really helpful to have someone with you that you can bat ideas off in a tight spot, or just, as you say, to take over from you when you've had the stroppy customer for half an hour. It's going back to the old days, when ambulance drivers were just that – lifters and loaders.

  6. Wow, they sneaked that one through didn't they? I've not seen or heard anything in the media about this change and given what you've said I'm not bloody suprised they've kept it to themselves. The government really is driving the NHS into the ground, something needs to be done because what they are doing to paramedics, doctors and nurses just isn't right.

  7. Wonderful.I also read in Metro this morning how many 999 call centre staff are taking more and more abusive calls, and not just from patients, but also from doctors and nurses.

    It seems to be getting so bad that many are thinking of quitting.

    Maybe I'm being alarmist, but is our emergency system falling apart?

  8. Jesus.They can't even say “we'll only send the ECAs to the drunks and sniffles and stubbed toes, and send EMT/EMT or Paramedic/EMT teams to serious things” because if there's one thing this blog proves, it's that a lot of calls aren't as advertised.

  9. oh sweet baby jesusi've seen some of these wanna be techs/paramedics but just don't have the mental capacity or personality to be one, who shouldn't be let loose with a wet paper bag, never mind being allowed to drive under exemptions.

    wait to see ambulance v other road user RTC's rise

  10. Can you start a petition or something? If enough people feel as strongly about the issue as you do, maybe the government will listen…

  11. Amazing and disgraceful in equal measure; I'm lost for words Tom, I really am.The suggestion to start a petition might be valid: the exposure you and your blog could get for this issue could perhaps result in an awareness and opportunity to challenge it. Maybe worth a try?

  12. Tom, you're really good at this writing lark… is there anyone in “power” you may be able to “discuss” this with… all these points you have raised above are mine and many others concerns, but I for one am not eloquent enough to write them as well as you do!The future doesn't look bright :'(

  13. Helen Goodman, MP for Bishop Auckland, raised the issue of ECA training and capabilities in Parliament last July:“A third issue that staff have raised with me is the medical qualifications of the emergency care assistants who drive the ambulance, which will be less than those of existing ambulance staff. That does not seem to be very safe, especially for complex problems or where more than one person has been injured, say in a car accident. Surely that marks a worsening of the service and patient care.”

    Junior health minister Rosie Winterton wrapped her in warm flannel:

    “An emergency care assistant will be trained to the equivalent level of first aid responders and will also be qualified to drive an ambulance under blue light conditions. That was something that was changed during the pre-consultation period to ensure that an ambulance with a two-person crew would be available at all call-outs. I hope that that addresses my hon. Friends point.”

    No, it doesn't. This is going backwards, not forwards. I've already delayed a decision about working in this area because of the govt's continual arsing about with the service's structure. If this goes through in my region (Southwest, who have done limited trials in Cornwall with ECAs), then I'll forget about applying to work for the ambulance service. I'll train as a nurse instead.

  14. For EMT, read Police Constable.For ECA, read Police Community Support Officer.Welcome to our world – you are about to be modernised by the Labour Government. Modernisation means cost-cutting and service reduction under the guise of improved service.My opinion – resist this change. While the ECAs might be very good, they are no substitute for a properly trained paramedic.

  15. It's a stupid, stupid idea and I'm dreading working with an ***; 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…service.Sounds like a familiar statement across the NHS… even across the public sector generally.

    ECAs, HCAs, Nurse practitioners, PCSOs, teaching assistants…

  16. I've just arrived back from a national workforce meeting.. We spent last night in the pub bitching and moaning about so many of the new roles, but I doubt any of us even knew about this role. We know about ECP's (Emergency care Practitioners), but this is a new one on me.About to send some emails and see what I can find out.

  17. Doesn't make very nice reading at all, and am now very worried, 1. for the safety and wellbeing of the existing crews, 2. for the general public, when more than one clinically trained personnel is needed 3. for myself as I have just been shortlisted for a job with the ambulance service, I'm now starting to wonder exactly what sort of job I'm going to end up doing! Especially as I want to be more involved and do more than just drive a vehicle, I want to be able to get stuck in and do everthing I can and not just hang around while someone works with the patient… being hands on working directly with patients was the whole point in applying!

  18. Hey tom, regarding your post today. There was a advert in the metro just over a month ago for somthing called A & E support, candidates go on a 8 week training course – instead of 16 for a trainee emt 2. After the 8 weeks training are up , A & E support workers will be trained to drive on blue lights and assess patients, not sure what else yet. then we will be let loose on the public answering catagory B and C calls. This may or may not be the same as ECA's. If it is I see it as a foot in the door – in two years I will be able to go for the technician post, and I will do my best not to kill any one in the mean time.The hierarchy are talking about putting A & E support workers with paramedics over the next two years.

    By the way this is the first time I have ever been on your site. Great book mate

  19. Hello all,I suspect that I'm not going to at all popular by saying what I'm about to say, but I just wanted to give this another perspective.

    I have exactly the same background as Tom, ED nursing and then the Ambulance Service. However, I didn't join the LAS but went to the Netherlands. We know know no different here than a driver and a healthcare professional that it responsible for the patient. I do have days when I'd like to be driving, but can't. I also get fed up of listening to the same stories in the back of the moter. But, you know what? It's my job as attendant.

    Some of the points Tom made are valid, but there are usually solutions. As far as clinical competence is concerned, if Tom does his job as well as he writes (something about his prose suggests he does) then I'm sure he has nothing to worry about. I bet he never double signed every single drug dose in the ED whilst working there (with the exception of opiates). If a job is particularly sticky then there's always the option of a single truck, isn't there?

    This will be a big change for the LAS, and nobody likes change. However I find it difficult to believe that this will be to the detriment of direct patient care. I don't have the idea that we give substandard care here in the Netherlands compared to an average NHS ambulance trust.

    Just my 2(euro)cents worth,

    The Welsh Medic.

  20. So just how does this square with last month's govt initiative to get ambulance crews doing more skilled tasks?Crazy, crazy world…

  21. I agree with you Tom, I work in a rural area with long distances to hospital, which means that the ECA 'driver' is going to be spending a long time at the wheel – how safe is that? And I will be spending all my time in the back, which on a busy shift will be hard going.Also how will ECAs progress? – they won't be having the same experience that trainee techs do at the moment where they start off going in the back with 'safe' patients and gradually build up experience. It will make it a long leap between ECA and paramedic.

    We all know this is a money saving exercise, techs are currently at the top of band 4 (in most places) for A4C, and my trust is advertising for ECAs somewhere in band 3. I guess they are trying to claw back the payrise that occured when A4C was introduced.

  22. I reckon most people think that's how you work anyway, and that 'EMT' is a jumped up PC term for 'ambulance driver' (e.g. the 'I got a double EMT crew and something terrible happened' stories). That's your first hurdle – convincing people that the status quo is two clinically trained people.Scientist.

  23. Oh dear? As an Adv Tech (equivalent i think to your EMT) does this mean we are to be forced into chosing between paramedic or driver?? Personally I don't want to do my paramedic training until i have a few years under my belt as a competent tech…if this comes in then to keep the pennies coming in we will have to do the paramedic training or 'drop down' the scale to driver!! That of course is IF we have a choice and are not just given the push!

  24. This is no good is it, all in the name of saving money again, in my area, these crews work on the urgent tier service, picking up GP referrals, etc. Not doing emergency calls unless in dire need which would very occasionally happen.I am not doubting the skills of ACA's as some of them are good, some are previous ambulance technicians taken a step down or retired early, but I shudder to think what would happen should this be allowed to happen, I certainly wouldnt like to be stuck in the back or driving for a whole 12 hour shift.

  25. To be honest, I don't know if it's a bad government idea or not.Paramedic entry via university will probably soon be the only way that you'll get in to the 'medical' side of ambulance work.

  26. Agreed!Rosie Winterton's reply does nothing except to restate the question!

    Helen said: [paraphrasing] “ECAs are poorly qualified”

    Rosie said: [paraphrasing] “Indeed. Equivalent to First Aid Responders.”

    Helen said: “That does not seem to be very safe, especially for complex problems or where more than one person has been injured, say in a car accident.”

    Rosie said: *whistle* *whistle* *ignore it* *whistle* *whistle*

    Helen said: “Surely that marks a worsening of the service and patient care.”

    Rosie said: [paraphrasing] “Oh, is that the time? Time for lunch folks.”




  27. We haven't had any mention of this in our service (as yet) but I am pretty sure it will be on the cards soon. This is going to be a disaster that will only show its ugly head when someone dies, and believe me they will. The general public in my opinion don't understand what the ambulance service does, they also don't understand what goes into training for our job. I work as a double EMT crew, and yes we joke with each other that we are just band 4 stretcher bearers and van drivers, but this is scary, that someone somewhere has actually thought that it is a good idea!I am sure this is just going over old ground that you, Tom, have already covered, but I have been in so many situations that have required the skills of an EMT and Para or at the very least two EMT's. You depend on your crew mate a lot more than you realise. When you give drugs you are checking with your crew mate that everything that you are doing is to the correct protocol, yeah its not brain surgery, but if you get something wrong then it is your clinical skills that are called into question, are we now going to be saying ” well I would like to give you this drug, but the person I am working with is not clinically trained, and therefore I cannot double check what I am doing, therefore I won't be giving this drug at all, in fact I am going to get this person who has been driving for the last 8 hours pretty much non stop to take us to the nearest A&E (30 miles away – yes devils advocate here) in the hope that if we do get there safely, you will hopefully still be alive”

    As it has been shown jobs are rarely what they seem, I have heard of two cardiac arrests in the last week or so, that on arrival haven't been. Now if the person calling the ambulance can't work out when someone is dead or not, then how the hell will dispatch be able to work out what to send to any other job? (I am not having a go at anyone in particular here, yes I know people panic when they call 999 but its getting the point across I think) So why give them the option to send an inferior crew to a scene where potentially you are going to require more than one clinically trained member of staff – its just too crazy for words.

    Yes I know that this won't happen in every single senario, but it is wrong to happen in just one, I usually have a few comments to add when I read this blog, nothing much, but this is a very serious issue which is going to cost lives in the long run and something that I feel strongly about, I chatted with a few EMTs from LAS yesterday at A&E, we don't see them much out our way, but its always good to have a chat when we do and find out whats going on, they were flabbergasted when I mentioned this to them and it has been a big discussion topic, not one person has thought it is remotely a good idea.

    EMTs and Paras train for a long time to get this job right, it is a hard slog and all this is doing is taking away any kind of morale that may have been in the service, we don't just turn up on the monday and get the keys to a shiny ambo and get told there you go your in the ambulance service now, but this is something that they will be doing in the future?!? There are too few ambulances on the road as it is, so when you arrive at that naughty job, the pt is going to have to wait x mins for a second crew to arrive just to be able to receive the same level of treatment that they are getting within that “8” minute response that they get now.

    Appalling, its not going to work, it shouldn't be allowed to work and I hope to god that it doesn't get implemented in our service, as it will lead to even more qualified staff leaving for the sunnier shores of Australia etc in a bid to be able to actually do our job properly. It can only be detrimental to the service and the medical care that the public want deserve

  28. I don't know, if I understood the whole thing correctly then the road tax one made the govt think really hard about how to send 1.7 million emails explaining (sort of) why they were going to ignore the petition as best they could.

  29. I work on Great Western Ambulance's High Dependency Unit in Bristol… we are all Blues trained, and are FPOS Intermediate trained. We deal with a lot of the GP urgent work, Hosp Transfers, and first respond to 999s with A&E backup.We've just been told that we are now becoming ECAs. So we've gone from being a near frontline crew (sometimes wait a while for backup) to becoming drivers. The main problem for us is that we HAVE medical training (not to EMT standard but we have some!) and now we're going to be expected to do sweet f*** all at a job despite being ABLE to and wanting to. The Ambulance Service is being royally screwed by management and the government at the moment, and I hate to say it, but it's gonna be a huge accident by an ECA driving for 12hrs on their 8th blues run of the day or an EMT or Para missing something because they've dealt with every idiot that day and have just switched off (it's human nature) for anyone to do anything about this rubbish.

  30. Oh dear, what a terrible predicament. Under this new regime all it would take was for one of the staff, driver or medic to fall sick and then the community would be without one whole ambulance. Who comes up with these ridiculous ideas. Me being cynical though I would imagine that the driver would still be dispatched as he could A) render aid with his/her limited skills (and stress them out when the public expects them to act when they aren't trained but more importantly B)run on blues to satisfy the cry of the great god ORCON! I sincerely hope this idea falls flat on its face before someone is hurt or people get dissatisfied with there jobs and leave.

  31. This explains what might be happening in our service where PTS have lost their long-standing contracts with the local hospitals.Existing PTS staff are being offered the chance to retrain as ECA`s as their only alternative to being TUPEed over to whichever “mickey mouse” company picks up their previous contracts, in order to extract a healthy profit margin from moving sick and unwell patients to & from hospital.

    These experienced and under valued members of the same service, who wear the same ambo uniform as EMT`s and Para`s are being forced into an ECA role in order to continue working in the same organisation that they joined, often many years ago.

    I agree totally with you Tom, in that these changes are taking our careers in a downward direction, with less knowledge and experience available to take important decisions about patient treatment and care pathways.

    It can only result in more human errors and otherwise avoidable mistakes, when tired and demotivated ambo staff try to make critical decisions which will put patient`s health at risk.

    How many more sensationalist newspaper headlines will it take, before public outrage makes our policy makers rethink this crass and dangerously stupid decision.

    My greatest aid in making it though a 12 hour w/e night shift is my crew-mate. Don`t let the service take away the only real support that we have to deal with the horrors that this job makes us deal with sometimes, shift after shift.

    Like you, I love my job, but Please, give me the tools and training and crew-mate to enable me to give the best patient care to those few people I go to that Really it.

  32. If you have full time “drivers” would they be as restricted as an HGV driver, i dont belive they are allowed to drive for 12 hours and they are not trying to battle through traffic with lights and sirens going trying to save a life !!

  33. And at least that petition got featured in the press, quite heavily – better than doing nothing, surely? This is appalling news, I don't have to be a medical expert to see why it's all wrong, wrong, wrong.

  34. I believe that a driver can only be behind the wheel of an hgv/bus for 9hrs a day (10 for 2 days a week) and that rest periods must be 45 mins…can someone tell me why i'm spending 1000 of my own money for a c1+d1 license when the ambulance service doesn't seem to fall within these rules?

  35. Everybody KNOWS that taking apart jobs that are built on (and survive on) the “partner system” will make them more efficient and cost-effective! Of course! (please note the dripping sarcasm).Morons. We're surrounded by morons.I'm sorry, Reynolds my boy. Seriously. There are times when even two pairs of experienced, well-trained, in-sync, well-rested hands STILL can't get everything under control on the scene of an accident. How in HELL do they expect only one to be effective with, essentially, a trained driver-monkey and a box of mixed nuts?Come on now. Then, of course, they'll blame the service for not being efficient and for lives being lost.Morons.Sorry, mate.

  36. I know this sounds petty, but could the ECA's not end up falling foul of the EU driving hours time directives? If all they do is in essence drive then in a 12 hour shift, they could well end up driving more than the hours allowed, and of course they would have to take breaks from driving that are “non work”. So would crews then have to be taken off the road whilst this rest period is observed?Sounds like another cost cutting exercise labelled “agenda for change”. I can see that the EMT will be shattered from all of the time working on patients and the ECA unable to drive as he has used up his driving hours. Having just read an article in the paper yesterday about the number of Junior Drs that have made mistakes because of tiredness this worries me. Call me old fashioned, but Id only call an ambulance in a life threatening emergency (or something that I believe to be anyway) OR if moving a casualty should be left to the professionals. In such circumstances Id like the 2 highly trained professionals that I would currently get. Perhaps the Government might like to put their energies into dealing with those who abuse this precious service, thus freeing up the staff to use their skills to help those who actually need them!

    Just a quick question for someone who would know better than me, is there a difference between an EMT and a Paramedic? Or is it just a different name for the same job?

  37. Just a quick question for someone who would know better than me, is there a difference between an EMT and a Paramedic? Or is it just a different name for the same job?A Paramedic is an EMT with extra skills. You cannot become a Paramedic without being an EMT and gaining 2 years experience in frontline duties. A Paramedic can give a larger range of drugs and can do so by the Intra Venous or Intra Osseous (directly into bone marrow) route – an EMT can only give Intra Muscular injections. A Paramedic also has a greater range of “invasive interventions”….Intubation (the passing of a tube directly into the trachea), needle cricothyroidotomy (surgical airway), needle thoracocentesis (decompression of pneumothoracies). A Paramedic can also give “clot busting” thrombolytic drugs as well as Controlled drugs (Morphine) etc.

  38. I hate to burst your bubble, but as of 2008, there will be no more new EMT courses as the IHCD course is to be discontinued. The only way in then will be through a university running the paramedic science degree. I'm afraid it's typical of LAS spin.

  39. Natalie,It means you'll leave uni as a sparkling new paramedic with very limited on the road experience (no disrespect), and placed with a person who can only drive, who won't be able to offer suggestions/advice when you want it.

  40. So if you cut your crews by half, what happens to the other half? Are they going to double the number of ambulances on the road?

  41. I was just thinking that surely there would then be more ambulances to send out if each had one paramedic, so surely they could send a couple if the situation warranted it?

  42. Yep….it's nuts. I'm just about finished my paramedic training, after working as an EMT for nearly 5 years. In those 5 years, I have learnt to rely on the comfort of a crew mate. Even when you are making your own decisions, there is still a back up whenever you need it, from someone with equal training, if not always equal experience. Two heads are truly so much better than one.So…..when I do get on the road as a paramedic, not only will it be with more huge skills, but I will be all alone in this very scary time, as all paramedics will be on cars, to first respond. Don't get me wrong, they train you very well….it's months and months of hard work and learning, but you used to still get to go back to work with those familiar friendly people you have come to rely on so much, who offer some comfort in what can be a bloody awful job sometimes. In a bad job, you automatically turn to your crew mate who went through it with you.

    First responding. This can be so dangerous (being that we never actually get the true story……collapse can often be in the middle of a drug den, with people who don't like you even though you are only there to help), and although I enjoy the occasional shift as a lone worker just as much as the next person, the last thing I want, and need, is for it to be a permanent thing. Not only do you have to completely trust your own instinct, and let's face it, you can't be right all of the time, but how frustrated and limited do you feel when turning up to a job when someone is massively sick, and needs immediate attention, but you couldn't carry every single one of your 15 bags into the address, and there is no crew mate to help by grabbing you that essential bit of kit. Then the relatives start kicking off cos you can't quite do what's necessary and take them immediately to hospital, cos the next available crew is nowhere near, or more to the point, don't actually have a bloody ambulance to go on, as there is barely enough as it is now. So you are trying to handle the sick person on death's door, and the angry relatives who, quite rightly, just want the best care for their loved one.

    I personally am crapping myself! Even more than I was when I knew I would have a fully trained crew mate. Something I have always wanted to do since joining is actually turning out to be a bit of a nightmare.

  43. Interesting that… and I attended selection for [Avon] HDU service a couple of years ago. I agree with what most people have said here… this is incredibly dangerous and is going to lead to deaths all over the place. This is like the theory that by closing the Royal Surrey in Guildford they'll reduce A&E admissions, so everything will have to go to St Peter's Chertsey. Erm… sorry?Speaking as someone who has the clinical skills and the driving ability… I often get stuck with someone who has the clinical skills, but cannot drive, or someone who cannot do either! (Our outfit isn't too hot on these issues). And I know from first-hand experience it's a bloody nightmare when you can't swap over. It really is NOT safe, it's not good for the pt and it's not good for you. It gives me excess stress; I hate to think what it'll do to 1000-odd LAS staff.

  44. You can set-up online petitions at the following site;

    This is being used by the motorcycling comunity and other organised group especially. I think some have been featured in the last couple of months in the news. Possibly something a person in a position of influence (IE Tom) could kick off and raise with the media?

  45. Your C1 covers you on the weight of the vehicle, not much more than that, as for the driving rules, they seem to make it all up as you go along anyway so you just use your own initiative as to when you shouldn't be driving anymore (or like most people, 6hrs as attendant, 6hrs as driver)

  46. Wow, just insane. I can see if you live in God's country with a pop'n density of just 5 people per sq. mile and the nearest ED that can even begin to take a trauma case is 200 mi. away, you field whoever you can get– but in any case, the number of calls is going to be so small that there will be no need for a set of crews standing 24/7 anyway. But a huge city like London with a lot of violent crime in it, too? It's not just impractical it's also dangerous for the crew and the people they go to help.Having only run a few times on calls, I already see that three pairs of hands are far better on an ambulance for any call of any severity than only two. Here where I live, I'd say there have to be at least ten ambulance companies operating in an area that has a pop'n of one million so that at any time, 8-10 ambulances are out there doing something, and it's usually not a false alarm, each ambulance having at least two EMTs on board, usually one being a paramedic. I would say that for a modern urban civilization, this is the least a city needs, and I am not even counting the many calls that fire depts. (who often have a lot of trained first responders and basic EMTs on staff as firefighters) handle in the area as well.

    I don't know what they are thinking back there in the home office, but it really would be tragic for everyone if what you are describing happens.

  47. Re: what the chap said up there about the Netherlands system where there's a driver and an HCP as standard…If I'm not mistaken, don't they in the Netherlands have a lower training level than over here? (I say that because I am aware of a fella who came to UK from Netherlands and couldn't use his training straight to A+E instead had to retrain)

  48. Well how much work does an actual 'driving' paramedic really do? Ask yourself that! Even as the 'attending' officer, how much of the theory you were taught at university do you actually use in your day to day work? Very important life-saving theory and knowledge no doubt however, why have two fully trained paramedics working together when most of the shift is dealing with stings, falls, drunks and more often – social issues. If a critical situation does arise then the paramedic takes charge (1 in every 10 blue light calls are actually critical depending on demographics). It saves resources and makes sense to stratify the personell in an ambulance service. Most rescue helicopters have 1 critical care paramedic, should the pilot get paramedic qualifications also – that would be irrational. Many of the points made by the author of this article are valid, however I can see that these issues can easily be overcome with some thought. Don't just do things becasue 'thats the way it's always been done', be brave and expand your horizons, try something new in hope that it can benefit others.

  49. mmmm, I know where your coming from, and again just like everyone else you have made a valid point, but its not because its always been like that, its because it is needed. The “driver” isn't there to just drive, they are there to assist, not just a paramedic, but as an EMT as well. And their assistance is a lot more than just getting gear, they can get information from relatives or care staff when the “non critical” patient that you are dealing with is unable to communicate with you (ie dementia etc) they are able to prepare the drugs that you require, and more than anything else they are an extra pair or hands, ears and an extra brain that you can pick at any given time. They are equally if not more qualified than you and they have experiences that you may not have come across. An example is I had not dealt with many people in heart failure, it was really good to have someone that had done when I came across my first one, who could read the signs immediately and help me out, a “driver” with some limited medical training isn't going to be able to do that. Granted we don't go out to people in heart failure every day of the week, but on that “naughty” job, and you are just a little unsure about the course of action, who can you ask? oh no-one thats right… he or she is only there to drive and a few other things, so is it right to then make that family and their very ill loved one wait for a second crew to arrive? I don't think many members of the public would be too happy do you?

  50. Another point, and yes I know I have waffled on about this far too much already, but its hard work dealing with patients all of the time, its true that not all jobs are “working jobs” as such, but we don't know what we are going to, the simple elderly female/male fallen is not always a straightforward fall, it can be brought on by a number of things. Would anyone really want their sick loved one treated by someone who is coming to the end of their shift having dealt with many patients all day/night long, who is tired (yes we are human and we do get tired especially when you might have only had 20 minutes back on your home station to relax) and might just miss something…. indeed they might not, but if they did then there would be uproar. So why not have a double qualified crew, who have had 6 hours away from patients each, who can depend on each other to get things right the first time round. It might cost a bit more money, but why try to fix something that isn't broken, it works as it is, so why take away a service that the public depend on, as thats what is going to happen.By the way Tom, excellent post, I hope for your guys sake that this doesn't creep in.

  51. I doubt it – NHS Ambulance Trusts are doing this to save money, so they're not going to be able to afford to buy extra vehicles!In my county, the policy is to send two vehicles to Cardiac Arrests, etc, so does that mean they'll start sending 4?!



  52. Hi i am a first responder in essex and have worked with an ambulance crew on a 12 hour shift and you need two quailified people to man an ambulance, i work with the crews several nights a week and see what has to be done ,you cannot expect one person to be giving orders on what has to be done. I also want to become a technician and i cant get in the ambulance service as they are not recruiting !!

  53. Hi i am a first responder in essex and have worked with an ambulance crew on a 12 hour shift and you need two quailified people to man an ambulance, i work with the crews several nights a week and see what has to be done ,you cannot expect one person to be giving orders on what has to be done. I also want to become a technician and i cant get in the ambulance service as they are not recruiting !!

  54. I work in the South West, and we already have a few of these and are getting a whole load more soon.Shame they don't help with getting the patient from their bed/toilet/armchair to the ambulance! That's still down to the crew to figure out!

  55. Just because a job isn't seen as critical it doesnt mean that it takes less mind power and skill. I have been to plenty of non-critical jobs where it has made a real difference to have a 2nd trained head there. You are right that workin practices need to change, but all who work in NHS ambulance trusts are acutely aware of the same issues:1) It will be done in the quickest, cheapest fashion possible.

    2) Any shortcomings in the training or the system will be swept under the carpet with the “its in hand” rationale.

    3) It will be introduced without any training or preparedness for the Paras and Techs.

    4) Faults at a Trust level will always be placed upon the road staff, jeopardising their futures and/or registration.

    5) No feedback or consultation will be taken on board from the staff involved. As long as the boxes are ticked and the managers keep their posts no-one cares about the road staff…if the NHS was private company the managers would have been sacked long ago.

    Ambulance staff know things are going to change, they are ready to accept change as long as it is introduced in an appropriate manner, with proper consultation.

    Great post Tom, just wish more people would read it, the government and DOH have a great ay of woolying it all up for joe public.

  56. It all depends on who you are working with…i would be more than happy (if the patient and your skill level are appropriate) to allow you to attend…this may not be allowed but how as Paramedics do we support lesser qualified staff? Patient exposure brings with it a wealth of experince training school does not give. Whoever you work with will not undervalue you. Just as if you back me up now I won't take over if its appropriate for you to deal with. You don't have any real medical training, not to undervalue FPOS (which is a good course for CFRS etc), your competency portfolios lie bare because of “misunderstandings”, you do not hear of CFRs referring to FPOS intermediate as medical training so be careful, know the limits. The new procedures introduced may make your life boring not responding to every emergency under the sun, but it is for your own protection. Enough staff have complained that you on HDU are used and abused, it has stopped and not before time. So please don't assume that your colleagues will expect you to do or know sweet FA, we want you to have the safety net too. If you are worth your salt you will wait and be patient, work with and trust your mate. That's what this job is mostly about…teamwork. Yes we are being screwed from above all the way to the top but we need to stick together. Its not an ideal world but we have to stick together and protect each other as much as we can becuase of the sheer plain unfortunate fact…no-one else will

  57. Might be nice to get an ECA point of view on here, not that I am one, but I do know a few.Jeez, you lot are a bit behind eh? West Mids have had ECAs for quite some months now – that is, the ORIGINAL West Mids, not the all new huge regional West Mids, but you can bet you'll get them sooner rather than later.So, is it as doom and gloom as is reported. Well, Yes and No.I like driving. I am a quailified EMT and blue light ticketed. That can't be taken away from me without good reason. Therefore, in theory at least, I can still drive even when crewed with an ECA. Sometimes I do, sometimes I don't.How much do they know? 'Advanced First Aid' are the bywords round here. In practice, they can do that plus a bit more under my supervision – ie: BMs, in theory, administration of Glucagon, etc.Bizarrely, I am missing my Technician Clinical Skills Update for 2006/2007. This means that my CPR protocols are out of date and that ALL of our ECAs have higher CPR protocols than me. Neat eh? No, I don't think so either.I know some staff who still job-about even working with an ECA – I've tried that, it's utterly, utterly knackering.I know crews who work day-about – not essentially possible with an ECA – but it means there are already crews driving for 12 hour shifts.Actually, I feel sorry for ECAs. Some of them have been treated appaulingly by other groups of front line road staff, called names – truck monkey appears to be favourite – ignored, acted towards like they don't exist (if you get my point), etc.They have done their training, such as it is and been released onto the road with precisely zero backup – no ongoing assessment of there skills, such as they are, no support of their driving abilities or lack thereof, no fall back in times of mistakes.I know of one in particular who most staff won't even allow to drive – having been so driven by that ECA, I can see why – dangerous is not even close to the word, but still, that ECA has no support to tell where the mistakes are being made save for an irate EMT or Para in fear of their life. Perhaps not the best of councelling, under the circumstances.Ours do, however, do stuff. Fetch and carry – especially useful are the ex-PTS who at least know how to manage a patient – and pretty much do whatever is directed of them. My first ever shift with a shiny new ECA started with a breach presentation delivery – leg out and a mad dash for labour ward. To be honest, I couldn't fault him at all and there was nothing more a Para or another EMT in his place could've achieved better than what he or I did.You have to take some consideration of what they in turn have been told. There is a standing written and publicised piece in our in-service bulletin that it is fully expected that all ECAs will have the opportunity to progress to Paramedic level. Additionally, some have been told that they will be able to progress to EMT level with 'only' 2 or 3 weeks on A&P…plus obviously there will be a need for 12 months In-Service support and assessment….I'm not so sure some of them believe this will happen or will be required…some rude awakenings then, if it does.What does this tell you? It tells me, that if you want in, maybe the easiest way is via ECA and hope for progression. Essentially, A4C provides for this too.As has been stated already, IHCD – essentially a body of BTeC – will cease to exist from September 2008. Curiously, I wonder what this means for existing EMTs as their qualification base will then cease to exist?Something that WILL NOT HAPPEN is that ECAs will be sent solo to any job – at least, not for now 😉 Again publicised in house, they simply do not have the required patient assessment skills – regardless of their individual background and previous experience* – to make this even a possibility. A-cat's, fair enough, B-cat's & C-cat's? How many of those have you attended where they've turned out to be way more serious than C-categorisation allows for.*Just to clarify this point, we have an A&E staff nurse working as an EMT. Her EMT skills are much lower than those of her other job – which she also still does – but whilst operating as an EMT, she is restricted to the skill sets and procedures that govern that role….those and JRCALC of course.I can' think of anything else to write on ECAs at the moment, but ask me some questions and I'll do my best to alleviate or exacerbate your worries. It's only fair.

  58. Hi, I'm overseas and am planning/hoping to return to London to work for LAS. Having been shortlisted for EMT and now waiting for further info following the '2007 budget' I was getting quite excited about it all and thought I'd swot up by buying THE book (fab Tom!) – now I've found this blog and specifically this post and am having serious second thoughts about coming 'home'.All the replies from EMT/paramedics, however much they love their job, seem to be terribly downhearted and with a very low morale. You're not selling the job guys ! (but then maybe, in light of the ECA news they won't be recruiting anymore EMTs).

    France may have to put up with me after all !!

  59. Hey what a great idea! I'd love to just sit in the cab and watch while my crewmate deals with the people complaining of 'neck pain' on scene at a small bump RTC or inflated ego's at a pub brawl. I'd never miss a ball on TMS during the summer so long as the cab radio is working. I'd always check the oil and washer fluid at the start of the shift for him though!Now these people who think of these ideas just have such a good understanding of what goes on in our job no wonder they are paid so much. Genius.

  60. I am in the same position as you. I finished the recruitment process in october and was expecting to hear soon afterwards, but then I found out they were waiting for the new budget to see whether they could run any EMT courses. Like you I was excited at first, but now i just wonder if anything will ever happen and I am in two minds as to whether i should just wait patiently or go and do something else with my life. I wouldnt mind so much but i spent 750 to gain the C1 category on my license.

  61. I heard rumours about this a while back along with the rumours that there will be no techie courses. Everyone will need to do the uni-based para course. So ECA's are gonna be common place in the ambulance service? It is going to endanger lives and not do a damn thing to the teget meeting agenda the government seem to have. I assume ambulance services across the country do not like sending “single staffed vehicles to jobs”. With just one medically trained person on a vehicle, are they not, in fact doing that?

  62. thts put me off joinind the las treating ALL day. both r fun but u need a contrast of both of thm! also picking up drunks on friday nights has put me off

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