Who Wants The Sack?

Recent news means I get to comment on this again…

Sorry.

In the dumbing down of the NHS, other healthcare professionals are to take over the job of doctors – these people normally have the word 'practitioner' tagged onto the end of their job title. There are Emergency Nurse Practitioners (who look at minor injuries in the A&E) and there are Medical Nurse Practitioners (who do most of the scut-work that House Officers used to do).

Now we have Emergency Care Practitioners who are Paramedics with some extra qualifications who are tasked to go out to out 'minor' calls and dissuade the people from going to hospital.

Research has shown that half of the people who call an ambulance don't need hospital treatment and that only 10% of our calls are 'life threatening'. ECPs are sent out to these 'non-emergency' calls in a desire to stop patients from going to hospital and to cover the lack of GPs providing out of hours cover.

I've talked about this previously, here and here.

But what has me thinking about this again is two recent news stories. In the first a Paramedic has been suspended by the Health Professions Council (on which I shall probably write later) because a young woman died.

The second is that the BMJ report that Paramedic treatment at home is 'viable' (I don't have a BMJ subscription so I can't read the original report).

It is obviously awful that a young woman died, but I honestly can't see that the Paramedic did anything worthy of being suspended. You can read the HPC report here. The patient, who had been having headaches for weeks previously and had been checked out twice and nothing had been found. Then when the patient became worse an ambulance was called and she was taken to hospital. She died five days later.

The Paramedic gets the blame.

I don't think that the treatment that he gave the patient was awful, certainly not worth suspending him in preparation for possibly sacking him. I've heard that he's previously been a damn fine 'medic.

This isn't the point of this post.

The point is that two other people saw the patient, that a hospital saw the patient – yet it is the ambulance Paramedic who is getting disciplined.

This is the tightrope that I walk every day. If I make even the slightest mistake (as in this case, not recording the patient's 'pain score'), then I can easily lose my job. I think that the reason why we are the ones to catch the hatchet is because we are reasonably cheap to train. It would also seem that ambulance trusts want to do anything to avoid bad publicity – so they suspend or sack crews in order to show that 'something has been done'.

So on one hand the government wants us to do more with some extra training (but not the 8+ years that GPs have), yet if something goes wrong we'll lose our jobs.

This government is going to have a rude shock when they realise that there aren't going to be a lot of ambulance staff willing to train up to be an ECP.

There is a simple rule that we tend to follow in order to keep our jobs.

'Take them to hospital'.

By taking the patient to hospital we are avoiding the responsibility if they later die. It is incredibly sad that we need to 'cover our backs' in this fashion, but it's the only way we keep our jobs.

Who is going to want to take that responsibility for another £2,000 a year? I know I wouldn't, and I have my nursing experience to back me up.

We do what we do incredibly well – we deal with drunks, trauma, chronic and acute medical problems. We deal with these by stabilising them and taking them to hospital. We do this very well. A bit of extra training will not turn us into Doctors, and we are fully aware of this fact. We are also mostly sensible people, and the feedback that we have got from the first set of ECPs won't have us running to join up.


Birmingham was lovely, highlights were seeing Paul Cornell (a writer I greatly admire) speak and watching Alan Davis, Staz Johnson and Mark Buckingham work their astounding artistic magic on flipcharts.

Now I start on a run of four nights. I may be grumpy. Actually, no, I will be grumpy.

16 thoughts on “Who Wants The Sack?”

  1. 1) Was the paramedic in question actually an ECP?2) I think most clinical staff in the NHS with even a modicom of sense realise that if you have a patient who has a sudden worsening of headache, vomiting etc., then a proper assessment of pupils, blood pressure etc. is mandatory. This amounted to more than not filling in a pain score!

    3) “By taking the patient to hospital we are avoiding the responsibility if they later die.”I think we've established from this piece that that is simply not the case! Reading into it a little more, it appears that this clearly unwell patient was asked to walk down some stairs, and went unconscious whilst on the stairs; almost certainly leading to a fall, and possible further injury; and was then transported in an inappropriate manner to the ambulance. If this is the case, it's entirely possible that the patient's condition deteriorated as a result of this paramedic's actions, in which case he IS negligent, no matter what went on when she got to hospital.

  2. 1) I have no idea. That wasn't the point though as I'm just pointing out how easy it is to get into trouble in the job.2) The assessment of the pupils was (according to sources) done using the bedroom light. GCS drops before pupil response alters in almost all cases. That the HPC mentions that the pain score wasn't recorded seems a little like clutching at straws – if a BP wasn't recorded then surely that would be noted? (Admittedly the HPC report is kind of sketchy, more detail would be welcomed).

    3) Walking them… Without being there it's difficult to say, I try to walk as many patients as I can because it is safer for me and them. In this case if the patient's GCS was 15/15 then why not walk? How many people with headache and vomiting do we go to, and how many do we carry? Without being able to see the future would it have been reasonable to expect the patient to collapse?

    Without being there, or without seeing the full evidence of the case we are just speculating. My point still stands – that the two previous 'check-ups' and the treatment at the hospital aren't mentioned as being investigated. It's all down to one man (and perhaps this is why, one man is easier to discipline than an entire GP surgery or other place where she went for a 'check-up').

  3. So we are paying the HPC to publicly hang us out to dry???Why was this case not dealt with at local service level?

    It seems to me that the HPC are acting as “judge, jury & executioner” in cases that should be heard in a confidential manner until the profiency or professionalism of the “accused” is deemed to be at fault!

    Theres a big difference in what the HPC thinks we should be doing and what goes on in reality in the big bad world out there.

  4. It is very hard to comment on individual jobs, even harder when you are not the person who is in attendance. With the exception of those people in the house at that time, no one is qualified to comment on the best way to transport the patient from house to ambulance. Just like Tom, I too tend to walk as many patients as possible. If the legs are still working and are able to keep the body upright, then why put three people at risk by chairing them. I am also with Tom on why it should be just one single person who gets the blame. While it is a very sad story, and my heart goes out to the family involved, there is an obvious catologue of errors going on in this story. Has the patients previous notes been taken into consideration? Has anyone looked into the treatment that she recieved when she attended surgery/hospital?Unfortunately Tom is also right on the other point that is made, we are cheaper to train….. it is easy to replace someone like us, a great deal of GPs look down their noses at us, they see us as a taxi. (a prime example is of the post about the lady having a seizure)

    As for completing the correct obs, I had an interesting job the other night, called to a dementia patient who was deteriorating, now I won't go into too much detail, but we decided that rather than drag this poor patient out into the cold and down to A&E on a Friday night at 2am, we would contact an out of hours gp to do a home visit. They did so and arranged for the patient to go into hospital, I know this as it just so happened that I was the crew that attended him later on in the morning to get him in. He bypassed A&E and things were a lot better for him in that respect. My point however was the note that we were given as the letter to the medics. All his obs were strangely enough exactly the same as when I had done them 3 hours earlier. Now why did the GP who attended him not do any of his own obs? What if something had changed? And to make matters worse, he even copied down my initial obs rather than my post treatment obs, which showed he had a low blood sugar (which I had taken action on at the time and administered dextrose tablets and got his levels up to what they should have been) tut tut.

    Now if I had done that, I do believe I would be in a rather lot of trouble now, however it doesn't really matter as I can be replaced a lot easier than a doctor can't I?

  5. Have heard a lot recently about HPC being overzealous in their approach to investigations, some justifiable others not. Apparently the current chairman is on a bit of a crusade…Even in the event of a disciplinary procedure being satisfactorily dealt with at local level, the HPC can step in at any point thereafter and suspend or revoke registrations without the need of ever consulting the Ambulance Service in question.

  6. That poor paramedic – sounds like a witchhunt to me. That and a distressed partner wanting someone to pay. I can't see how a paramedic could have saved her. As for trial by the Manchester Evening News – shudders! Isn't it normal to ask about illegal drugs. I even get asked in routine rheumatology appointmenst often twice and I certainly was when admitted to A&E. I've always assumed it's routine but maybe I look like a junkie.

  7. Is this HPC the equivalent of the Police Complaints Commission – in name only? What happened to the innocent till proven guilty democratic slant.The MD kicks the director.

    The director kicks the site director.

    The site director kicks the site manager.

    The site manager kicks the supervisor.

    The supervisor kicks the staff.

    The staff kick the apprentice.

    The apprentice kicks the dustbin.

    And no-one knows what they have supposed to have done to deserve it.

  8. I once had an informal complaint lodged against me because a patient died from an anesthesia complication five days after we brought him to the hospital. The operation that he was being put under for was elective and not related to the reason that we transported him.Apparently I and my partner were supposed to know that the anesthesiologist that would be working the day the patient died didn't know what he was doing. Or something.

    I also know of cases where EDs tried to blame ET tube dislodgement on the paramedics even though the hospital documented that the tube was properly placed when the patient arrived.

    Apparently, we're easy targets.

  9. I know a (very) little about what happened that night.24601, have you ever carried someone down stairs on a carry chair? If you have you will know it's not easy, comfortable for the patient or in terms of H&S safe for your back. It then becomes even more difficult if you have to try to manouver past a large obstruction on the stairs that the householder (or other people in the house) wont move out of the way. If your patient is unconcious then you may want to break your employers H&S regs and move said obstruction but since your patient is 'with it' and reasonably mobile you make the decision to 'walk' them downstairs.

    A lot of the reason this paramedic has been damned by the HPC is to do with the fact he didnt attend in his defence. Had he attended at his own cost, with an overnight stay at his own cost, with a lawyer who he might have got from the union if he was lucky. He would have travelled 200 miles to face a panel who also stayed in a hotel, who's expences he pays his registration fee for. All to be told he should have looked in a womans eyes, taken her blood pressure and risked his back carrying her downstairs and end up getting her to hospital 15 to 20 minutes after he did. He would then have got disciplined and suspended for not hot-footing her to hospital.

    It's no wonder sickness is so high (40% to 50% here), shifts are uncovered and no one wants to be an ECP or Paramedic anymore.

  10. We need more people who realise that having the word “Practitioner” in their job title doesn't make them a doctor.To use a slightly ropey analogy:

    Being an Ambient Products Replenishment Practitioner still means you're essentially a shelfstacker. It doesn't automatically make you the Supermarket Manager – that would take longer training and a degree of expertise in the whole range of goods that your supermarket sells – not just the Ambient products…

    The real irony is that nurse practitioners aren't really any cheaper than house officers!

    And while practitioners take on more & more jobs that us juniors used to do, we lose out on crucial experience!

  11. The more I do this job (im an officer in the service) the more i feel all i do day in day out is cover not only my bottom but the bottoms of the crews who perhaps are just emplying their own initiative, it seems that if the patient / relative arnt out to get you the HPC seems to be, Until things change the “taking healthcare to the patient” approach wont be taken rather “take the bugger in as they wont sack for for taking them” swill still prevail. If we are left to use our initiative ie walk them, leave them, dont bow all the way in or out then they complain and we cop it. Ive seen and dealt with so many trivial complaints that have escalated beyond reason it nakes you scared of your own shadow sometimes and to be honest if i get sacked for trying to do the job “right” who will pay my mortgae or feed the kids

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