No Break

I've had a crappy day and I get home to find a couple of people have sent this story to me. (And thanks to all those people, I would have missed it otherwise).

A paramedic has been criticised for not cutting short a break to help a woman who had suffered a heart attack.

Catherine Cowie, 50, died two days after collapsing in Fraserburgh.

An ambulance technician was on the scene within four minutes, but a paramedic did not attend with him because he was on a lunch break.

Some cardiac drugs can only be administered by a paramedic. The Scottish Ambulance Service said staff could not be disturbed during breaks.

However, it said staff could choose whether or not to attend calls during break periods.

Well.

Can someone please explain how 'staff could not be disturbed during breaks.' and 'staff could choose whether or not to attend calls during break periods.' can both be in effect?

In London it's quite simple if you get a break* then the first part of it is sacrosanct, with a 45 minute break that's the first half an hour. Then the last third of the break is interruptible. If a high priority call comes in during this time then Control can choose to end your break early. Unless Control chose to do this, the crew having the break have no idea that a call is waiting for them.

There is a lot of other weird stuff in this story that just doesn't sound correct – but then, few people understand the bizarre workings of an ambulance trust, and that includes some of the staff**

And of course I'd like to see the person who wrote this article work without a break for twelve hours while dealing with some of the awful things we have to do. And that means no cups of tea and no hot meals, or if you are lucky then you can get a dodgy takeaway while dodging Control. And having to use the toilets at hospital that patients with infectious diarrhoea have been using. And doing that every day of your working life.

If this story were really as written then I suspect that the Paramedic involved would be thrown to the wolves for 'denying a member of the public an ambulance'.

What next? 'My relative died because Paramedic was off duty'?

Remember people – if you are picked up by an ambulance and die two days afterwards while in hospital then it's all the fault of the ambulance service…

I'm sadly getting used to this attitude that ambulance staff aren't actually human.


*And really, I'm not convinced that the LAS aren't breaking the law by not enforcing break periods, instead paying us an extra £10 if we don't get a break.

**…And all the managers…

39 thoughts on “No Break”

  1. Having read the article, what strikes me most is the arse covering going on. The only treatment the paramedic could have given which a technician could not was to thrombolise her. In our area, this drug is only given under very specific circumstances (a check list has to be completed) and there are no Coronary Care Unit beds available. If there are CCU beds then, then patient is phone patched, blue lighted in and thrombolised there, whether there is a paramedic present or not.No doubt the paramedic involved is gratified by the way this has not been explained, and delighted by the support that they have recieved from thieir employer….NOT!

    Blame the reporter by all means but quite frankly you can't expect much more from a pig than a grunt. The trust however should know better but they have put the paramedic in question in the position of sacrificial lamb. This is a great job but some times…bloody hell!

  2. OK, I may not be in the business (I work at an aquarium), but firstly if the woman's death was directly related to there not being a paramedic on scene why did she die two days later? Secondly, I would look at the management chain above the poor paramedic (who probably knows who they are and are feeling terrible despite if not being their fault) and ask why there wasn't another paramedic who was available?This is an awful situation and it's just a shame that nowadays people always have to blame someone when bad things happen.

  3. The policy at one of the services that I worked at was that they'd give you a lunch period. You couldn't be disturbed to do transfers or minor responses. But they could call you out of break for major responses (like cardiac arrests).I imagine their policy could be similar. Where instead they can get notified about a major response and can choose to end their break or not. Sounds like the EMT thought it'd be a good idea to respond since the person was dying, but the medic wanted to stay on break.

  4. This division is slightly further north than me but the Scottish ambulance service breaks in my division work as such………… We get 30 minutes between the 3rd and 5th hours of a 12 shift and then a 15 minute break between the 7th and 9th hours.We can not be disturbed at any point during these periods. If a call comes in we know nothing about it because control can not tell us. There is an option of opting out of taking these 'protected' breaks and you can be sent out if you have chosen this option………….. for an extra 250 a year……………………. I'll have my breaks thanks!

    If a call came in that was obviously serious and genuine, I don't know any tech/paramedic who would refuse to go if control asked them………… if they do this they get the time back later……….. but the fact is with these stories that we don't know they are waiting.

    Also the only drug a paramedic can give for an MI that is different to a technician is Morphine for pain. The patient would still have got Aspirin and GTN from the Technician, they would also have been given oxygen and entonox for pain relief.

    The patient was alive when they got to hospital and given the required care by the technician. They did their job and a Paramedic would have made bog all difference!!

    But of course these facts don't make for a sensational story

  5. Do they not use thrombolytics up there? In which case, how far away was the hospital?And, yep, looks like the breaks are handled a bit like down here except we don't have the 'opt out' option.

  6. TomThe breaks are quite different I think

    Up here we can NEVER be interrupted during our break UNLESS we decide to take the additional annual payment. This payment is made in our April salary and covers the period of 1st april to 31st march each year. Those who took it this year had to inform the service that they wanted it by the end of February this year.

    So, if a call came in during that paramedic's meal break, he/she would be unaware that the call existed. He/she would not be refusing this call, but had infact refused to attend all/any calls during his/her break time up to thirteen months earlier (depending on the time of year that the call takes place).

    Scottish Paramedics do use thromoblytics, but only for MI's with evident ST elevation in at least two/three leads (not too sure as I am a techie).

    Hope this helps

  7. Y'know, I'd've thought not allowing you your breaks was illegal too. Where I work (admittedly not in the Ambulance Service, and not in the UK – am in the Irish Health Service) we *have* to take our lunch break. We have to clock in an out for it. And we're not allowed work it through in order to say, finish earlier, or take a half-hour off another day. If there's an emergency and we work it through, well tough (though our lab chief might fiddle something to let us get the time back, but it's not supposed to happen)EU Working Time Directive states something along the lines of obligatory half hour break for working 6 hours, and another 15 min if you work 8+ hours, something like that. I think LAS are extracting the urine, personally. Especially for a piddling 10!

    But then, half the time the UK seems to like to pretend it's not in the EU at all, and that EU laws don't apply 😉

  8. The headline writer needs another stint at journalism school. I can sympathize with wanting to drum up readers. But why not say “Ambulances understaffed! Woman dies!”It would have fit the immediate facts at least as well, indicated the actual point that needs to be made, and drummed up readers. Honestly.

  9. In South Central when we book on for lunch we can choose to be availble or unavailable. Needless to say, almost everyone books on as unavailble. Our 30 minute lunch breaks are supposed to be in a four hour window two hours either side of the mid point of our 12 hour shift. Maybe this was the case in Scotland, the paramedic had booked on as unavailible. Anyway, Ambulance staff don't need breaks…you never see them take lunch breaks on casuality

  10. The best bit is the quote from Scottish Labour's health spokeswoman:“Ambulance crews are being asked to do their jobs under increasing pressure. Demand for ambulance services went up by 12% last year, but there was no corresponding increase in the budget.

    “Ministers need to provide the resources to ensure that ambulances are properly crewed. It is not good enough for a vehicle to get to an emergency quickly if it doesn't contain a paramedic.”

    Which appears to go against their own policies for the rest of the UK, and also since Labour is in power and presumably therefore setting the budgets nationally, is this the first case of a politician actually criticising their own party?!?!??

  11. i have a secretarial job in the legal professional. I couldn't imagine being chained to my desk for 12 hours with no tea or food breaks, having my computer throw up over me, swear at me, abuse me and having to sit there all day with my legs crossed.If I make a mistake, the worse that can happen is that I could cause a client financial loss. If Im feeling a bit tired then i can pop out of the office to the shop for a much needed chocolate fix. I can take my lunchbreaks without fear of being summoned. I can drink as many cups of tea/coffee/water as my bladder will allow and I can visit the toilet as and when required.

    The point im trying to make is that having all these options available means I function much better in my job thus compulsory breaks for paramedics should be compulsory. i am a regular reader of this blog but have rarely posted. I find it crazy that the pay is what it is given the responsibility and the job these people are doing and the difference doing the job you do makes.. Im not sure what Tom feels about this but surely shorter shifts (Say 6 hours) would perhaps be an option? whilst this would mean you would perhaps be in work more days than you had off, you wouldnt be doing horrible 12 hour shifts with no breaks. I guess though that there isnt enough staff for this to be a viable option?

  12. Good grief. Here we go again. A patient died so it has to be somebody's fault.So, according to the story a solo tech pitches up on scene in 4 minutes. Excellent! 'A' cat response achieved. Box ticked.

    So what happened to the para back-up? Never mind about the para sitting back on station who probably knew nothing about the call (remember stand-down breaks are your own time: i.e. you're not technically employed by the service so you don't even have to be on station). Why didn't control send a full para crew? solo para? ecp? para manager? Remember this is an A cat chest pain: morphine and thrombolysis are a distinct possibility.

    Interestingly the report doesn't respond to the fact that the back up vehicle was a double tech crew. What happened to 1 para on every vehicle?

    And… who told the family that there was a para sitting around refusing to respond? Was this just an assumption by the family/reporter? As Tom says in the post there are just too many loose ends to this story, but of course it makes great headlines and stokes the ire of the chattering classes who see all public servants as parasites on society.

    P.S. funny that the politico says there has been no increase in funding for the ambulance services when Nu-Labor have been pumping in millions to meet the 8 minutes response target.

    Silly me; that's just for expensive useless I.T. systems, extra control staff and more response cars not more ambulances.

  13. I'm a bit miffed that the BBC published this article. When I saw the headline the first thing that came to mind was “The Sun”.

  14. In my experience, almost without exception, Press = scum-sucking, sensationalist slime. I stopped reading (and certainly stopped buying) newspapers several years ago when I worked as a controlled for the police, and quickly found out that the papers did not accurately report incidents with which I was involved and therefore knew the truth about. If they got those so wildly wrong, there was no way I was going to believe anything else they published.Unfortunately so many people believe 100% of what they skim-read.

    Two or three times a day I arrive at jobs (I'm a paramedic) to hear comments like “Bloody hell, that was quick”. My reply usually includes something like “these are the ones you'll never read about in the papers”. I think I'm winning the public over, one at a time… (“,)

  15. Damn. Clicked “post” instead of “preview”, and I can't edit it.For “controlled” please read “controller”!

    *stropstropstropstrop*

  16. dung beetle 'ere”I read the newspaper avidly. It is my one form of continuous fiction.”Author: Aneurin BevanTo me journalists remind me of all the carrion and other eaters of junk food, especially those luverly Hyenas Jackals and vultures that love to shred lifeThey see everything through specs issued by their leadersevery read MUST be read with a good dose of Epsom salts.

  17. well.. maybe the “technician” told them – perhaps they asked why there was only one crewperson in the vehicle? I bet they must have been very thankful that the patient got to hospital alive!! and then their faces suddenly turned black when she died..

  18. There may or may not of been a technical explanation given by the trust, but even if there was, it would have been left out, as it didn't fit the bias of the piece.

  19. Someone has a heart attack and dies. Well I never. Didn't see that coming.Too many people think a heart attack is a simple thing that you recover from, usually between plot lines on Casualty. If your number is up then that's you finished, even if the ambulance carried technicians, paramedics, doctors, a field hospital and a stasis field. What about lifestyle factors or family history? Did they contribute?No journalist would ever bother writing about the paramedic that didn't get a break because they had to pick up their fifth drunk of the evening. Does anyone remember when the BBC had some idea about journalistic standards?

  20. In too many cases the NHS can no longer cope with demand – to my mind this is a direct consequence of consumerism.Look at patterns of ambulance call outs – in London they have DOUBLED in a decade………..why ?

    http://emj.bmj.com/cgi/content/abstract/22/1/56

    The national pattern also demonstrates year on year increases in demand – have the number of 'true' emergencies increased by a similar ratio………….of course not.

    http://news.bbc.co.uk/1/health/6418241.stm

    Meanwhile, over the last 5 years A&E attendances have mushroomed by a staggering 33% [now hitting 19 million presentations each year] – the situation was already dire back in 2000 when we had reports every winter of elderly patients stranded in busy A&E departments for days on end.

    [see summary of Wanless report “Our Future Health Secured”, p7 – or type 'Casualty Watch 2000' into google].

    Given this unprecedented surge in demand, fueled by increased expectation and sense of entitlement, I do not see how we [the bloody workers] can avoid one or two catastrophes along the way ?

    And who will end up being disciplined – the 'suits' who are far away from the coal face, protected by a growing library of protocols & guidelines, or the staff who actually deliver the service, and have the temerity to expect a bite to eat during a 12 hour shift ?

    These days I don't know who I find most irritating: the managers, or the growing army of punters who call an ambulance because they've smoked dope, had a few drinks and now 'feel weird' [or any other number of feeble health problems] – it's a tough call ?

  21. I understand how the family felt as I am sure that if I was critically ill I would want a Paramedic their attending me ASAP. I would however prefer to have one operating at the peak of his abilities and that is not going to be the case if paramedics are overworked and not even able to take the limited breaks they are supposed to be allowed.If the system is so overstreatched that a Paramedic taking a break can be a life or death matter then I think that says a lot more about the inadequate number of Paramedics than anything else.

  22. I think part of the problem is that the general understanding of 'the man in the street' as it were is that when you call an ambulance it will be crewed by paramedics…The fact you can get EMTs confuses people, especially as 'Technician' doesn't adequately convey the amount of training involved (most people would think of a technician as someone who comes out to repair their washing machine or whatever) – so when they hear that there wasn't a paramedic there, instead 'just' a technician, they immediately assume that's the cause of any problems…

  23. Tom,Yes paramedic's can ues thrombolytics up here, I didn't think of that and stand corrected!

    I have read a wee bit more about this and is it written in report as a cardiac arrest situation. In which case the paramedic could have been of great use, but I still maintain that even if the technician got the patient to hospital and they survived a further 2 days then they did their job.

    I have also read something else quite disturbing about this in that the Paramedic knew the nature of the call and house was only 300 metres from the station. The story goes that the paramedic threw the keys at the technician stating “You go”. If this is the case than that is completely unacceptable and a different story all together

  24. I suspect the nub of this issue is whether or not a paramedic MIGHT have been able to provide pre-hospital thrombolysis, whereas the EMT would not have been authorised to do so ?Aberdeen Royal Infirmary is approximately 40 miles away from Fraserburgh, a very long way to transport a critically ill patient.

    The media report claims the patient collapsed, so it is unclear if an anti-platelet, like aspirin, could have been given irrespective of whoever was at scene ?

    It may surprise some people but the NHS has been cited as the best service in the world when it comes to managing heart attacks.

    http://www.bmj.com/cgi/content/full/333/7557/11-b?rss

    Despite these advances approximately 1 in 3 still die from a heart attack within 24 hours, increasing to 50% after one month.

    There are around 120,000 fatalities each year [after MI].

    http://www.bbc.co.uk/health/conditions/heartattack.shtml

    I must admit I can't help but feel a weary sense of deja vu whenever I hear that a health spokesperson [in this case Cathy Jamieson] calling for an 'investigation'.

    If in doubt why not let the 'suits' waste time and money [on gathering pointless factoids] so they can then issue fresh instructions to front line staff – of course, these new instructions will be almost identical to the concerns we have been trying to tell THEM about for ages………arrrghhhhh !!!!!

  25. Total disgust. So like someone said before if a pt. I take care of dies 2 days later at the hospital its my butt on the line? I wont comment on the whole break thing because I dont really understand that to much……we dont get breaks, if the gods of trauma/ETOH/whiners/medicine allow us. But any who, it sucks how we are blamed for everything that goes wrong..everything. On the flipside we rarely get thanks are recognition for when things go right. Was this writer there when that paramedic saved a childs life?? where was that BBC page?

  26. As an EMT in the states, I'm somewhat unfamiliar with the policies and protocols of UK ambulances services. But I'm curious, couldn't the ambulance technicians go enroute to the hospital and call for an paramedic intercept enroute? Do ambulance technicians have ASA or NTG protocols? If I read correctly, the nearest hospital was 40 miles away. There isn't another unit within 40 miles in the direction of the hospital?? Also, not exactly sure.. but what about a medevac helicopter?Second of all, I am rather confused at the message of the media by publishing this article. What is the purpose and how was it discovered that the nearest paramedic was on break? Shouldn't the next available unit be dispatched? As an EMT who doesn't officially get a break throughout the day, we grab food/coffee/cigarettes/lap dance whenever/where-ever we have the opportunity. I would also look into the dispatch information of this call.. Why didn't this paramedic on break get up from his lunch and respond? Perhaps dispatch did not give enough adequate information to “move” him from his cup of mediocre coffee or question how much the crews actually tried to get a hold of him. Like previously stated, there are a lot of unanswered questions here.

  27. Ya this break thing si very foreign to me….we run 12 or 24 hr shifts where sleep is not garunteed. Heck I remember running 24hrs at this one place…..id walk into the station check out my truck, turn in my morning paperwork and leave my bed roll next to my bed because I knew I'd never get to see it. Sure enough…24 hrs later we would return to the station for the first time since we left it and it was time to go home. Either way…..where do I sign up for the LAS?? lol. Forget what the BBC has to say, they have no idea how hard we work and what we have to deal with. We break our backs, destroy our nerves, and watch our personal lives fall apart just so some 9-5er can critisize us when things get shitty……

  28. Yes, you can call for paramedic assist in the UK, although I don't know the culture of the Scottish Ambulance Service.In London we have Aspirin and Nitro for technicians, as well as diagnosing STEMI by 12 lead and conveying direct to angioplasty labs.

    I agree that there just isn't enough information to correctly analyse this story, it just seems to be about bashing the Paramedic.

  29. We run 12 hour shifts and don't get any breaks because it's 'too busy' (in other words there aren't enough ambulances to deal with the population).I've heard this talk of 24 hour shifts, do you really go job to job for 24 hours? We'd fit 24 jobs in those 24 hours and it would kill us, are you lot really that crazy over the pond?

    Remind me not to emigrate…

  30. haha ya, thats what it can average…me personally? oh no, i did my 24 hr straight in private services doing critical med/trauma transfers (65% nothing wrong with them, 35% white nuckling the steering wheel telling my partner “I swear were close” and when I was doing my clinicals…but ya it averages 24 and depending on refusals 26 calls in 24 hrs….how do we do it, I have no clue.

  31. I'd just like to add a quick word in praise of the poor underappreciated technician in this case. If he/she got this patient to a hospital 40 miles away and still alive, that's a bloody good job well done! Ms. Jamieson's statement that 'it is not good enough for a vehicle to get to an emergency quickly if it does not contain a paramedic' is a slap across the face for all the hard working, well trained techs out there. Just what super powers does she think paramedics have, exactly? If the patient reached hospital alive, it's unlikely that a para would have made any difference to this outcome, sad though it is.

  32. I think the most likely scenario was that the Paramedic was on an undisturbable break and had no idea about the job. The others would have either not been on a break or on a disturbable break. Don't go down the route of accusing an ambulanceman of refusing to end his break for a red call, it's insulting to say the least.

  33. Right, all ambulancemen are full of honor and always act in the best interest of the patient.If he didn't even have the choice to respond, then the techs were out of line to tell the patient and family that there was a medic at the station but he was on break and wasn't coming. They can't expect the patient and family to understand “undisturbable” breaks. How else would the family even know and be able to make a complaint that the medic didn't come because he was on break? Perhaps they might guess there are medics posted at that station, but they can't be sure that the medic is not just out on another call.

    I'm not saying that most people would stay on break rather than respond to a priority call. Almost all ambulancemen would stop what they are doing to help someone. I've paid for plenty of food that I end up not getting to eat. Still, I'm offended that you would require me to side with the medic. Almost all is not all.

  34. If the paramedic was undisturbable then why wouldn't you side with him? He would have been totally unaware of the situation. Is it that you have a problem with undisturbable meal breaks? As for what the techs may or may not have said, your guess is as good as mine.

  35. I haven't read through all the comments so this may have already been covered here. But I am a Paramedic in the U.S. I have never had scheduled lunches or breaks as a medic or an EMT (basic life support tech). You eat when you can. If you are busy, you might not eat. Same thing applies for going to the bathroom. The idea of scheduled lunches or breaks is a completely foreign concept. Our law states that we must be in service 24/7 unless the vehicle, equipment or personnel are somehow broken.

  36. I get so angry with this kind of reporting and this kind of attitude. It goes hand in hand with “I used the Toilet this morning and the Council have not been round to flush it yet..” Being part of the Ambulance Service is a calling, not a job. Who in their right minds would work those hours in those conditions for that pay (no offence Tom or any of you who work in the service of the ungrateful public).

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