Elsewhere

Today's blogpost is elsewhere.

Little does the crew know that the woman has just told the call-taker that she has a knife and is going to kill the paramedic about to come through her door.

—–

The Guardian asked me yesterday to write about violence on ambulance staff, this was a strange coincidence as that was the exact subject I was going to write about today.

Here is another example of how Call connect is a danger to ambulance crews that wouldn't fit into the article.

It's nine a.m. in the morning, we have been sent to a young male with a 'head injury' in a residential property. WE have no details of how this occurred so I ask Control if they know anything.

They have to ring the patient up again to ask him. He's been assaulted and the assailant is still with him. The caller promises that the person who inflicted the injury is not going to be a danger to us.

What makes this dangerous is that Control had to ring the patient back, they didn't note that the injury was caused by an assault when the call first came in.

All in an effort to get us to the scene to stop that all important ORCON clock.

It would not surprise me if some time this year an ambulance person is killed because of there not being enough information gathered before they arrive on scene. I'll also predict that the trust involved will use the phrase 'Lessons have been learned'.

29 thoughts on “Elsewhere”

  1. Any call taker who did not ask how an injury occurred is simply not doing their job. I can think of no 911 or in your case 999? centre is not required to ask method of injury as protocol.As for you not having protable radios, I am flabbergasted!

  2. When I worked as a Johnnie, we were always told DHSS – Diagnosis means History, Symptoms and Signs.So if we were expected to think like that, and our usual “emergency” involved running out of coffee at the first aid post, who's training your call centre peeps?

  3. Heh! What's worrying is the fact that it's not all that rare an attitude, whereas those of us who like to have moderately consistent outlooks on life simply couldn't utter that kind of thought.Not because we'd find it abhorrent, but because if we had that great a sense of entitlement, we'd suffocate, as the only consistent behaviour with that poster's attitude is to refuse to fill your own lungs with oxygen when, quite frankly, the government should be doing it for you.

  4. Very powerfully and clearly put Tom.As police officers we have had our complaints about Tetra/Airwave in the past – but no matter what its faults at least we actually have personal radios. I simply can't imagine being without mine.

    It is a *scandal* that you still don't have them.

    As for the targets, how many times do you have to say it before they will listen?

    (BTW, impressed that you managed to write the piece so quickly and so well in such short a time…. I was following Twitter!)

    Rory

  5. It's available all over. I have seen it in bookstores near where I live, and I don't live anywhere as densely populated as London!At the very least they could get it in for you anyway, the ISBN is 1-905548-23-0

  6. Sadly the new tetra/Airwaves radios will NOT solve your problems. My service has had them for over a year now and we're still walking into difficult and violent situations.Control's excuse(s):

    – We're too busy to update you

    – We didn't know (i.e. we're not allowed to ask the caller if they've still got the knife/gun/plank of wood)

    Remember is as long as we get there in 8 minutes its a success – doesn't matter if the crew get injured. Get there in 9, and still get your head kicked in, an you'll be hauled into the office to 'explain' why you missed the target and why you're off work injured.

  7. Tom, I cant help but think you are blaming control in your last post, if the call taker was not told it was a assault then they werent told. We cant guess. Further to that i think youll find that EOC put VERY little effort into “stopping the all important ORCON clock”

  8. Well obviously I don't know how things work up there.But don't you think that it is kind of useful for the calltaker to find out how the injury occurred? “He's not breathing” could mean a cardiac arrest, or someone overcome with toxic fumes that we are about to drive into.

    I know that we normally have this sort of information – so I don't know why it wasn't available on that call. Nor why it needed someone to ring back to find out.

  9. Wow. We carry hand-held radioes, and I can not see how we can do our job without. And, of course it has the alarmbutton that would call the police in an instant. Frankly, I am surprised you manage without. You guys are braver than me, let me tell you… Our control can (and do) ask the caller any questions they like, so it's easier to get info. We don't use stabvests either, we wait for the police. But then we don't have the 8 min target, we simply wait it out. Good for us, bad for the patient.

  10. Wow. We carry hand-held radioes, and I can not see how we can do our job without. And, of course it has the alarmbutton that would call the police in an instant. Frankly, I am surprised you manage without. You guys are braver than me, let me tell you… Our control can (and do) ask the caller any questions they like, so it's easier to get info. We don't use stabvests either, we wait for the police. But then we don't have the 8 min target, we simply wait it out. Good for us, bad for the patient.

  11. Good, because we don't have it yet in Montreal. I could order it from the Web, but it'll be more charming to buy it in London.Thank you Mr Biscuits! 🙂

  12. Tom, my apologies, the room is a highly stressful place at the min, I had just finished writing a letter to LAS news before I read your post so was already in a bad frame of mind.So to clarify, yes the call taker should have asked how the injurys occured and dont let anyone BS you with the whole “we have to stick to the script” speech, yes we do but you can ask how things happened. The room is overflowing with new staff at the minute, so by no fault of there own they have little support, they cant ask the person next to them as they will most likely be as new. Sector staff dont ring down to ask the call takers questions for the same reason, it is often quicker to phone the caller back your self, and if you do phone the supervisors desk, you usually get some attitude and someone mumbling “give them a chance”….many times i have felt like screaming down the phone that we dont really get second chances in the A&E world.

    I know that no member of staff would knowingly send you into a difficult situation, I certainly wouldnt, and yes I know your area is particularly bad, I worked your sector. With the way things are going it is very difficult, as a radio op or allocator, to keep up, FREDA sends calls before you have chance to blink, literally one second there then gone, this may be the reason that you were sent BEFORE enquiries were made, this isnt a excuse on the sector staffs part but it is definately a additional factor to consider.

  13. That first comment is just amazing.Still, I guess at least it reassures you that the article wasn't just read by us lot.

  14. EMD123, No worries – I'm guessing that this is what happened. I know that things up in Control aren't what they should be.(I have my sources…)

    And as for f**king FREDA…. Well that's a post to itself (and one I'd like to collaborate with an EOC type for).

  15. well im happy to help if you want it, im sure my email comes up on this post so get in touch, you can repay me on a obs day 🙂

  16. Up here north of the border, we're supposed to be getting Airwave……unfortunately they seem to have over looked the fact that its not compatable with our current CBT, so they will work completely seperately……..hmmmm……I'm not long out of training, for 10 weeks they drum into you the Patient Management Plan and inparticular the part about Dynamic Risk assessment and crew/patient safety……..this ultimately puts the responsibility on the crew. Unless there is obviously someone else at fault for you walking into a danagerous situation………….I get the feeling it will always come back to you, even if you are the one sporting a black eye.

  17. It's a sad fact that emergency staff get violently attacked when all we do is try to help. I myself have been attacked in an A&E department but at least there is security and normally police around to help. I hope the radios come soon and that something comes into play to help keep the paramedics safe. It's about time the people upstairs took note of how much you guys risk for us.

  18. The answer is simple. Just put a BA logo on the side of the vehicle and get some Wet Wipes, a few teabags and one of those chemical toilet thingies. Once the patient/malingerer/violent person thinks they're getting on a 'plane they'll be in a good mood. Unless of course they think they're going to Terminal 5, in which case they'll beat you to within an inch of your life.

  19. As Tom states we are getting sod all in information from control just so that we can get to the job quicker. Why are control room staff not asking the right questions?Someone will unfortunately die or get seriously injured…and you can bet that management will try and blame it on the crew themselves!

    Example of recent call (within past two days)…called to a male with serious hand injury, badly bleeding, no other info apart from the address. Crew gets to the scene and finds that the reason for the hand injury is an on going knife fight!

    Why the f**k are control not asking simple questions like how did it happen?

    Control has its faults but since call connect came in we are getting sent Cat A Red call to everything!

  20. This completely sucks, I know. In Los Angeles of all places – the private EMT's have no such information either. We also do not have handheld radios, so once out of the rig, we are at the mercy of cell phone coverage or the rare payphone.Add to that that the average dispatcher has the common sense of a gnat (it's okay – I are one too), and even if we did call for immediate assistance, the possibiity of them knowing which department to call is almost nil.

    The companies don't want to spend the $$ to keep such a data base, the individual dispatchers decided what information to give or not to give depending on their mood and whether or not they like the crew in question, and now with the HIPPA privacy laws in question – we'll never get that kind of help out there.

    I find that calling the police out to those address calls is the only way to get the back-up, but again, if you're not under fire you'll have to wait a good 30 to 40 minutes.

  21. As a person who works within an Ambulance Control room I have to point out a couple of things:The wonders of Call Connect are loathed by us just as much as they are by you. We now have to send crews out to simply an address and a “pre-alert”, no details of what's happened or who the patient is or if there are any risks there or not. Supposedly, information is supposed to come through very quickly but bearing in mind crews are expected to get to scene within 8 minutes it's becoming increasingly common for crews to arrive on scene before any info has come through. In our Trust, crews are encouraged to run to the area on blues and if they've received no more information, to stop round the corner and call up for more info. So far, this is pretty hit and miss.

    Unfortunately, the call handlers these days are not allowed to use things like common sense to assess a call. They have a script and, in our trust at least, are audited on their calls every day. If they are found to deviate from the script in even the smallest way they are reprimanded so if there isn't a question in the script that says “How did you sustain your head injury?” then they simply can't ask it! Crazy, I know, and if I had a penny for each and every job I rang back myself to find out what the hell is going on other than someone is “sick” I would not need to work for the service anymore…

  22. madmalteser, Im a dispatcher with the LAS, call takers can ask how a injury occured and they wont be penalised, and if they are its minimal, what is a QA report worth?!! Not an awful lot. unless you do it on EVERY call you should be fine, i cant believe that someone whouldnt question a caller further if they just said they had head injs, for a starters you need to be able to go to a appropriate ProQA card, i know there is traumatic injs, but a head injury can be one of many cards, fall, rta, assault, entrapment, ped v's train, im sure you get the idea. People need to know the limits, no you cant swear to a caller but PLEASE you can ask some appropriate questions, and if you dont/wont/dont dare then maybe these staff should be in a different job. alsong as all the normal questions are answered go for it. What would you rather, you get 98% on your QA or a crew gets attacked because you were to afraid to deviate from the script.

  23. “…because if we had that great a sense of entitlement, we'd suffocate, as the only consistent behaviour with that poster's attitude is to refuse to fill your own lungs with oxygen when, quite frankly, the government should be doing it for you.”Quote of the week, hands down no contest!

    Very true, I read things like that and it just reminds me how utterly full of total nutjobs, and deeply angry people, the internet can be.

    Bit like a big bucket of greasy, rabid frogs (if frogs get rabies that is).

  24. Apologies for the poor writing Tom's too good to imitate…My name's Gill I've just woken up in bed to the sounds of shouting downstairs, Dave, my husband is not in bed with me and I'm suddenly feeling very scared. I get up and slowly creep down the stairs, I hear a scream and I know its Dave, I start running down the stairs. At the bottom someone I don't know pushes past me and runs out of the front door. I'm panicked now and my heart is pounding. I find Dave on the floor of the kitchen, he's moaning and as I hug him I feel dampness on his chest. I turn on the light and there's blood over his chest, its dripping onto the floor. I grap the phone, they ask me where I live, I can't remember, they tell me! I say Dave's dieing, they tell me to put our dog in another room. We don't have a dog I start shouting I just want help, yes we're the only ones here. I wait, time passes, Dave's moans grow less frequent. I ring back, they say the Ambulance is near by, but they're waiting for the Police. I say again it's just me and Dave but they don't come. Dave is feeling cold now when I touch him, he's stopped groaning, I think he's gone. They find me, still holding him tightly, covered in a blanket of red and sobbing hysterically.

    Months pass, I've complained to the ambulance service and to my MP and to the local papers, I fill my days writing to people but I only get the same answer “The safety of our staff is paramount, but we have learnt lessons from this sad event…

    I don't dissagree with the policy of safety first, I'll always advise crews to seek a RVP and wait for the police, but they don't have an 8 minute requirement so it's worth pointing out that there are two sides to every call, that sometimes even 8 minutes call-connect is too late, and that people do die waiting for help to reach them and just because they don't wear green and we don't know them, doesn't mean they aren't loved and missed.

    I hope I never see an ambulance crew killed or seriously injured, and I hope we don't lose sight of the people who can be saved and aren't.

    The world of prehospital care isn't black and white and sometimes there are no answers just very poor compramises

  25. I understand where you are coming from on this Tom – I am a call taker and I still consider crew safety the most important factor for any call. I think the rules vary for each service as to how you deal with calls. Most call takers will ask how the patient obtained the injuries for Proqa.Also some services say you can ask the question about where the attacker is straight away others follow Proqa exactly and ask it half way through the call.

    But call connect has pro's and con's – patients should get an ambulance quicker but the crew safety is sometimes compromised

  26. Another add if I may concerning the 'staging' or 'waiting for police' as brought up by Gill. Again with the perspective of Los Angeles.The private ambulance companies out here are held under a very tight thumb by the likes of L.A.County Fire. Further still, if a particular company has a 911 contract with a city, the EMT's must also by abide the further restraining points of that contract.

    In one particular city, the private EMT's were always 'staged' at various locations, ensuring that even without lights and sirens, the crew could reach any address in 6 to 8 minutes. This meant that in most cases, they were beating the fire department medics to any call dispatched. The FD didn't like this and made it very clear that any ambulance responding to a call – even if made 'official' by the FD dispatcher – had to WAIT AROUND THE CORNER until the first fire vehicles made it to the scene.

    That's right; the ambulance crew could be sitting around the corner from a medical emergency – and had to wait – sometimes 3, 4 or 5 minutes for the medics to arrive.

    I realize our system over here is different, but you get the gist.

    So as it was ineveitable, a crew was called to an address for an unresponsive child. Having already been through more sh*t storms with the FD than they cared to recount, they pulled up two houses away to wait. In no time, a police care sped up to the house, the officer got out, ran into the house and immediately re-appeared carrying a small child in his arms. He threw the child onto the front seat of his cruiser and sped of to the nearest ER. He could be seen trying to do chest compressions as he was driving.

    The result was another major sh*t storm between the FD and police regarding who has control of a medical aid call. A training video was produced and the story made all the front pages of the local papers. Unfortunately no one ever heard about the FD's rule that private EMT's were not allowed to arrive before fire.

    This is still the normal operating standard amongst cities that utilize private ambulance companies for medical transport of 911 patients. This isn't about safety, this is about the fragile egos of the fire slugs being bruised by the more efficient privates.

  27. I also work in LAS control and I have to disagree quite strongly with some of the stuff being posted about control.Firstly, when you are calltaking it's amazing what information you are not given – I had a woman phone up saying her husband was diabetic and unconscious. Did all the questions and got my determinent when the lady happened to mention that her husbands BM was like 5 or something. When I asked if that was unusually low, she replied no. She then added – he just fell down the stairs and now he won't wake up.

    At least in the LAS you aren't sent out on an address alone – other services are even going as far as sending crews whilst the call is still in the queue to the operator (if the address is CLI) in an attempt to meet the godly ORCON. We at least give you a diagnosis!

    Someone else said that if they don't have enough info as they arrive at the call (such as no diagnosis) then they park up and ask for more. There is nothing stopping any crew member doing that. Control can't be expected to babysit everyone.

    We are fully aware that some calltakers are not using any common sense but don't blame “control” as a whole. We are working our arses off for you to get extra info. And considering half the time we don't have any dispatchers, the radio op is doing all the ringbacks alongside talking to you on the radio, putting in blue calls and arranging GP's whilst having their head kicked in by management to put people on standby, get people on break and half the time we are simply the messenger.

    We are doing our best under immense pressure from management and we do our best to give you as much information as we possibly can, as soon as we can possibly get it to you. Remember, if you are a crew then you are dealing with one call – we are dealing with an entire sectors worth.

    If in doubt, or there is ?cause and you're dubious – call us up. Let us try and get more info before going in. We have to sit there and look at our sectors percentages of orcon made and missed for the whole 12 hours and to be honest I couldn't give 2 hoots about maing ORCON if it means a crew is safe. Everything is documented on the log so they can easily see if a person is waiting for police or more information from control.

    Rant over!

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