All Media Enquiries to LAS Press Office (But IF You Want Some Priming, Here Are My Thoughts)

I've reached that point in my blogging career where if an ambulance story is in the media I'm phoned up to provide comment.

So this BBC article about solo responders and the concerns about using them so extensively has already had me woken up by one newspaper.

I don't mind – after all it's something I've been shouting about on this blog for ages. Please remember though that I'm just a worker on the road, if you want real information you should talk to the LAS Press office 020 7921 5113 (and who are a bunch of top folks by the way).

Still it is nice to have something that I'm concerned about in the news. For more on this subject you may want to check out the following links.

A simple description of ORCON (The government target we are desperate to meet)

Why I think that splitting crewed ambulances to man solo responders is a bad idea for patient safety.

Where I describe the plan to increase solo responders and decrease double crewed ambulances. (I'm a lot less enamoured of the idea now than when I wrote this).

One concern for staff and patient safety that often isn't thought of.

Where I moan about some of the hoops we have to jump through to get our targets – but the comments section has more information.

My solution to the 'target' question that will actually benefit patient care.

To summarise things as I see them (and remember – these are my views alone, not those of my employer).

The government wants to measure the performance of ambulance trusts. The main way of doing this is to see how many of our 'high priority' calls we get to in under eight minutes. There are often more calls than there are ambulances, so solo responders effectively double your workforce with respect to reaching this target. Once a responder reaches a patient, the clock stops.

Solo responders can't safely transport patients. They also are unhappy to leave people at home because they are scared they will die. Solo responders therefore can spend a lot of time at scene waiting for a double crewed ambulance to arrive.

Sick people need to be in hospital – it is better to get there in nine minutes and be able to transport them than to get there in seven and have to wait half an hour for a proper 'truck'. The government does not agree.

The eight minute target is from research over 20 years old – and it only deals with cardiac arrest patients, not with 'high priority' calls. The department of health has no copies of the ORCON paper on record -although there is one in the British library. Modern research says that eight minutes is too long to get to a cardiac arrest.

Although our ORCON response percentage in London is roughly the same as has been every year, our cardiac arrest survival rate has more than tripled. Doesn't this show that other initiatives (which aren't tallied up by the government) are far more important?

Getting to patients quickly is never a bad idea, but in concentrating resources on solo responders at the expense of double-crewed ambulances I firmly believe negatively impacts patient care. Sick people need to be in hospital.

In London we are about to start running community responder posts – first-aiders from the public sent to calls. This is so deeply wrong that I can't get my head around it. Again I suspect that this is to help us meet these targets. It's not like we are in the wilds of Scotland where it physically takes you an hour to get from one place to another.

This is just the beginning of the discussion – the plan is to have all but the most serious calls (like confirmed cardiac arrest) attended to by just a solo responder, a double-crewed ambulance won't be sent – once the solo is on the scene they will make the decision as to the patient needing an ambulance to transport them, or if they need a GP, or can make their own way to hospital.

The simple solution is that we need more ambulances and more ambulance crews – but the government won't reach into their pocket and give us what we need, so instead the ambulance trusts have to make these difficult decisions.

It's not the ambulance trusts fault that we are heading down the solo responder route – it's purely the government's focus on this out-of-date target and lack of motivation to give us the funding we need to continue giving Londoners the care that they expect.

Oh and people call us for utter rubbish like veruccas – which is why we are under so much strain at the moment.

I'm hoping that this will run and run and might cause some form of change – unfortunately I suspect that this story will soon be ignored because of some celebrity drug 'sensation' or we find someone else who has faked their own death.

24 thoughts on “All Media Enquiries to LAS Press Office (But IF You Want Some Priming, Here Are My Thoughts)”

  1. I agree completely on the 'single man ambulance' idea not being that great, although yes, it does have certain specific improvements in short-sighted results (specifically the number of vehicles on the road being higher, and therefore having reduced response time).As you say though, this results in time-on-scene being higher, and you end up with 3 people at a call (solo plus full crew ambo) instead of just 2 if the person needs to be transported. This is of course counter-productive.

    Being in the service industry, it would be obvious that what is needed is to reduce the number of calls that you respond to. The only way to do this is at the call logging point, and having effective scripting of your operators, and therefore being able to weed out whether a casualty is needing an ambulance or not. Unfortunately, due to the 'sue me' culture, the NHS is reticent to allow this, as they might be sued (yes… because the amount of doctors that get sued every year and being 'highly trained' is not an issue…). Again short sighted.

    I agree that having an alternative to shipping a big old ambulance to every call is a good idea, however, you then need the backup available to provide the transport required for that patient. Otherwise you'll just snare up more resources. Rather than having 'FRU' teams, shouldn't they rather have 'Light Injury Responders' who go to the verruca's, small cuts, etc. that can be dealt with directly at the casualty's home, or similar.

    Then with your Paramedics (in a high-speed response vehicle of course), they can get themselves nice and quick over to your priority-collapse calls (And with the police in London having AEDs, along with the AEDs in railway stations) and get your ORCON numbers within requirements.

    Of course… getting the government to listen… well… Christmas is coming I suppose….

  2. Community responders in a lot of ruaral areas do a great job. They are not a replecement for a full ambulance crew of course, but can provide reassurance and patient support unitl a crew arrives.Also most are not only First aid trained, but have important life support skils (as well as a load of other skills).

    In most cases it is the pateint that benefits here, as it does not matter to them if it says 'st. john ambulance' or NHS on the person that is coming to their aid.

  3. “once the solo is on the scene they will make the decision as to the patient needing an ambulance to transport them, or if they need a GP, or can make their own way to hospital.”I assume they will still send an ambulance if the person calling in identifies the patient has something like a broken leg? I know its generally not life threatening, but a solo responder turning up to this isn't going to be much help apart from gving pain relief while they wait for an ambulance!

  4. Well, when I broke my leg at home, nearly 4 years ago, a paramedic came round first to check it really was broken. Admittedly the proper ambulance seemed to arrive within about 5 minutes of him.

  5. I've just had a thought. How are sole responders in cars and on motorbikes going to legally meet the eight-minute target?If I remember my law correctly, VERA defines an ambulance as a vehicle which is constructed or adapted for no purpose other than the carriage of sick, injured or disabled people to and from welfare centres or places where medical or dental treatment is given.

    The Lighting Regulations define an ambulance as being a vehicle (other than an invalid carriage) which is constructed or adapted for the purposes of conveying sick, injured or disabled persons and which is used for such purposes.

    And Road Traffic Regulations only permit drivers to exceed the speed limit where the observance of the Speed Limit would hinder the use for the purpose the vehicle was being used.

    Now unless those laws have changed in the past two or three years, then an FRU car or bike would not be an ambulance and therefore should not be using blues nor speeding.

    That being the case, an ambulance would be the quicker vehicle to legally reach most scenes within the time limit.

    I know the Government said it was going to review the various laws after a paramedic was charged with speeding in 2003 (Ferguson, I think) while doing an organ transfer. Has it actually done anything?

    Or can we expect some police forces to ignore the law and allow FRUs to speed, while others enforce it and charge paramedics, jeopardising their careers?

  6. I had to ring 999 to call myself an ambulance earlier this year, and I was very relieved when two people arrived. As it turned out, one person would have been enough. But the ambulance service couldn't possibly have known that until they arrived, and every minute could have counted.The future is sounding unacceptably risky.

  7. The things that I have heard that ambulances will be automatically sent on will be…Cardiac arrest.

    RTA.

    Potentially violent situations.

    That's all I've heard so far – it may be different when it actually comes in.

  8. That's a good point. I would suspect that even if it were against the law all police would leave us alone (as we could be rushing to one of their colleagues).I mean, we can still be done for dangerous driving.

    I suspect that FRUs and MRUs are also exempt, but as you say – maybe not…

  9. DG – one person couldn't have transported you, so one person wouldn't have been enough.(I know this only because you told me about this event, and if I were on the FRU and transported you I would have been shot by my bosses if they found out…)

  10. Community responders as in Dad's army – “Don't panic!” What wonderfully ridiculous idea will they have next? It's sad, bloody sad.You've got the right answer, more ambulances, properly manned. No care assistants/drivers. No pathetic numerical targets.

    Some sort of system for fining abusers of the ambulance service and it's staff.

    Given the number of drunks/drug addicts you treat, I think you shouldn't be sent out on your own except if it's to an arrest where you might be able to start treatment sooner.

    We sure need a change of government.

  11. Is it a general across the board thing that FRUs are not allowed to transport patients then or is being shot by your boss particular to DG's case?

  12. I finally managed to find the text of the Road Safety Act 2006, which has expanded the exemptions from observing the speed limits. However, it does not appear to have changed the definition of an ambulance.The Secretary of State can now prescribe, by regulations, other purposes (in addition to those relating to fire and rescue authority purposes or for or in connection with the exercise of any function of a relevant authority as defined in section 6 of the Fire (Scotland) Act 2005, for ambulance purposes or for police or Serious Organised Crime Agency purposes) for which vehicles may be exempt from speed limits.

    The new section provides that the exemption from speed limits does not apply unless the vehicle is being driven by a person who has satisfactorily completed a course of training in the driving of vehicles at high speed provided in accordance with regulations under the new section, or is driving the vehicle as part of such a course.

    FRUs and MRUs may now be prescribed vehicles, but I can't find any regulations to that effect. It wouldn't surprise me if they hadn't got around to it.

    And don't rely on the police not prosecuting. In the case I was thinking of, the driver was charged by Lincolnshire police but not by Cambridgeshire. The case was eventually dropped by the CPS.

  13. I had heard a snidey rumour (via a friend who works with ambulance crews) that jobs on the solo rapid response vehicles were much-coveted among certain folk in the service. This was understood to be because solo work was far more likely esp. on the dayshift? – to include some time parked up with a cup of tea, a butty and the paper…. as the controllers would automatically direct two-man crews to anything involving lifting/transporting people or “real emergency sounding”.Anecdotally, near where I live (urban/suburban, big city, N England) there is a nice quiet verge with a river view overlooking a golf course… it is quite a common occurrence to see a solo responder unit parked up there in the afternoon.

    The same cynical friend says getting put on “light duty” with no lifting – e.g. following back strain – is often viewed as a good way to “expedite” a coveted move from a two-man crew to a solo vehicle.

    Sorry if that sounds cynical. Not doubting that most crew are decent hard-working folk, but if I've learnt anything from two decades in the public sector it's that there are always a number of “experienced finaglers of the system” to be found there. I also would imagine these types get up everyone else's noses, as in my experience they make more work for all the non-finaglers.

    Of course, if the solo vehicles are now going to be first direct to all calls the job of driving them may get less popular!

  14. Unfortunately, being a solo responder isn't the cushy number some think. For one thing, you have to carry all the equipment in yourself, that's the response bag, the oxygen bag, sometimes also the entonox bag, the Lifepak 12, and any other equipment the call sounds as though it might need.With a two man crew you can split the load – when it's just one of you, it wouldn't be the first time I've been loaded down with gear and arrived puffing and panting – and I consider myself reasonably fit.

    And solos are being sent to everything now, including some assist only calls.

  15. I found this web site completely by mistake, but am glad I did so. Its fascinating to get your prospective on life as a ambulance crew on an almost live basis. I would like to congratulate you on a superb blog and cant wait to read your book. It on order from Amazon as I type.Also, I have read your comments concerning single responders and splitting up crews with great interest.

    I am a Community Responder (CR), and your remarks about how you find the very concept of CRs wrong has not been taken to heart and I know and respect the fact that you have far greater experience than me with such matters and are far more qualified to pass comment than I am.

    However, recently it seems, especially in the area which I live and am active as a CR, there seems to be an ever increasing amount of instances where Ambulances are simply not available and are all busy on jobs. I attended a RED call the other day where it took 20 mins for a single responder to get on scene and a further 15 mins for a double crew to arrive. I dont think that the fact I arrived on scene within 3 minutes made any difference in this particular case, however, in the event of a resuscitation being necessary I am certain that the patient would have not have stood a chance if I was not available. This is not criticism of the single responder, crew or the Ambulance Trust involved. The simple matter of the fact is that no matter how many ambulances, double crew or otherwise, there are, if they are all attending to emergencies then what else can be done?

    I know that your remarks are not meant as a dig at CRs, however; I believe there is a necessity for them in our communities, especially now that recourses are so stretched for whatever reason. Providing appropriate training and regular assessment is given to CRs to ensure their skills are being applied safely and that they are used properly by dispatchers, then I cant see what is so deeply wrong in their application. Although our particular CR team has not yet successfully resuscitated a patient, (although I believe it is only a matter of time before we do) there are plenty of instances where CRs in the UK have. Furthermore, when ambulances crews are stretched to and sometimes beyond the limits, CRs at least give reassurance to very worried, scared and genuinely needy patients waiting for, in some cases, a long time for an ambulance.

  16. It's my fault for not being clear.I think that rural Community responders are a good idea if they are used properly. If the nearest ambulance is 40+ minutes way no matter what, then CFRs can provide a good immediate response.

    What I can't get behind is the thought that we need CFRs in London, where an ambulance should be only a few minutes away. To me it's a way of getting ORCON on the cheap.

    But I'll blog about this a bit more in the future.

    Apologies, I'm not 'anti' CFRs at all, just CFRs in London.

  17. Like I said, I did not take your comments personally. However, even in London, if all the ambulances are tied up on existing jobs then surely a CFR could provide vital BLS until a crew is freed up to attend.I am totally in agreement with you that there is a shortage of resources but even with an acceptable force, there are unforeseeable peaks. It can't do any harm to have CFR who can help in very busy times. However, I would not want to see CFR's used to help achieve targets or used as a means to save money. They should only be used as a means to save lives when they are able to, due to their location in the community, to get on scene before the crew arrive.

    Your future comments about CFRs will be very welcome.

  18. “Community responders as in Dad's army – “Don't panic!” What wonderfully ridiculous idea”vivdora; your comments are a little unfair.

    I am a voluntary Community First Responder, (Not St Johns). I undertook intensive (5 days) training by my respective Ambulance Trust and have attended over 20 RED calls in my local community. In many cases it took a single responder or crew over 10 mins to arrive. During this time I was able to provide o2 and monitor the patient just in case there condition worsened until a crew arrived. Had the patient stopped breathing or gone into VF, I am equipped with o2, BVM and AED.

    I believe that CFR's have a vital role in our communities.

  19. On another note, a CFR on our team said he was dispatched to a RED call last week and arrived on scene at the same time as the Single Responder. The Single Responder, a paramedic, asked the CFR to stay with him just in case it was a Resus where the CFR could assist him. So here is another instance where we can be useful and not just help our trust meet its ORCON target.

  20. I am a CR in a 'rural' community (as rural as you can get in the south east) and the gestimated general respond time of an ambulance is at least 15minutes and often much, much longer, where we generally get there within 5minutes. A team of 10 people, many with other relevant skills and experiences maintain more or less 24 hour cover for our village and many surrounding villages. In the last year we have responded to around 90 calls and the vast majority was 'genuine'.I know your comment was not criticising our work, but I was wondering if anyone does have any thoughts on a subject that has worried some of us.

    If CRs make the ORCON statistics look good, are we shooting ourselves in the foot, and causing the powers that decide on how much funding and/or where resources get distributed, to direct these elsewhere?

  21. Tom, Your comment about the need for CFR's in London (I am a rural CFR by the way) ignores the fact that the concept of CFR's was originally started in downtown Seattle USA where, I am told, the scheme dramatically reduced deaths from heart attacks. From experience the fact that anyone has turned up with skill and authority gives a great deal of comfort and relief to patients and loved-ones alike.I got the book from my RGN wife (who refuses to do CFR, I wonder why!)at Christmas – great read, thanks.

  22. My understanding is that, consistent with other ways that this government work out to spend all the extra tax that they instinctively rob us of, if a trust proves that they can manage within their budget they get given more funds, whereas if they can't come up with the goods within their existing budget they get less! This should polarise the funding into the hands of trusts that can make best use of it; we will see.

  23. Hi there, I know this thread is quite old and I dont know if youll still be reviewing comments on it but I also wanted to say something with regards to CFRs. Ive been a CFR for three months now in the South East in an area sandwiched between three ambulance stations (i.e. not rural at all). In that time Ive attended a number of calls and have spent as much time as I can third manning as such I now know most of the crew I meet on jobs and have a great relationship with all of them.I have a huge amount of respect for full time crews, the skills you have, the hours you put in and the working conditions you deal with daily. After a local crew saved my fathers life I decided to commit some time to helping out where I could and the CFR scheme seemed a mutually beneficial arrangement. As well as providing BLS in instances where crews are otherwise engaged I have also found that just being an extra pair of hands is extremely well received. A crew coming to the end of a tiring 12 hour shift are just as appreciative of some physical assistance with heavy equipment as they are if they arrive to a calm scene where I have collected the bulk of the PAF information in preparation of their arrival.

    At the weekend I spent almost two hours waiting for a crew to arrive to an elderly woman who had fallen. The delay was caused by the huge workload and it was satisfying for me to know that as I was on scene resources could be distributed to higher level emergencies. When the solo finally arrived he was able to just copy down my obs and complete a non conveyance form and get on his way again in the space of a few minutes. This surely must help spread the thin resources more efficiently.

    I appreciate that CFR schemes have to be well managed and that there will be instances where things dont go as smoothly as they could but overall I think it can only be a good thing and in the long run will benefit patients across the board. The scheme Im attached to provide 24 hour cover, have attended over 400 calls in the last year and have raised close to 10,000 to ensure we are fully self funded. I hope that your views on the scheme may change after youve met some CFRs and realise that were basically just good honest people who genuinely want to help you in any way we can.

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