” “

The computer terminal in the cab of the ambulance rang.

The description of the job was blank. The address we were supposed to go to was blank. The ORCON start time wasn't blank.

The terminal continued to ring, it wanted us to press our 'on the way to the job' button.

But where were we supposed to go?

Twenty seconds later a postcode arrived on the screen. Still no proper address, still no patient complaint.

Another twenty seconds later and we had a full address, there was still nothing in the 'patient complaining of' section. We didn't know if it was one of the addresses in our area that was flagged as 'dangerous'.

Finally, a minute and a half later, the job description arrived – a young man with abdominal pain.

Then a few moments later we were cancelled as Control sent the call to our Clinical Telephone Advice desk, to see if they could determine if an ambulance really was required.

Finally I let the handbrake up and started to drive.


'Call Connect' was the new way of measuring ORCON (our eight minute response), brought in to standardise the way that ambulance trusts reported their response time. Until call connect came in, some trust started the clock when they had the address and complaint, some started in when the phone rang and some seemingly started it once the ambulance arrived on the scene…

Obviously this was unfair – so a new national standard was brought in to start the clock from the moment the patient phoned the ambulance service – as soon as BT connected the call the stopwatch starts.

What this means is that, via caller line identification, the service knows the rough area that the call is coming from and an ambulance is automatically assigned – even if we don't know the full address.

No longer do we start the clock with an address and a complaint – so we could be sent into 'man walking around shooting people indiscriminately' without back up and without warning. All to make a (pointless) government target.

It doesn't just mean that we are placing ambulance crews in more danger (because, being generally cynical swines, we'll sit by the side of the road until we get some relevant information). If you go racing off to a call that you get cancelled on a few moments later you are putting the general public at risk.

On more than one occasion I've been sent on, and cancelled, five times in the space of a minute – you end up dizzy while continuously doing three point turns in the middle of the road only to be cancelled and sent in the direction you were originally travelling in.

Crew safety is no longer a priority it would seem (if it ever was), instead it's just more chasing of the clock.

I wish someone up in our management would have the bollocks to take the government to task over the utterly pointless and now dangerous ORCON target.

But it was my boss, and governmental advisor, that thought up the new way of recording the time, so I don't think it'll be him.


I'm bunkering down at the moment, I need to have the sequel to 'Blood, Sweat and Tea' in to my publishers this Friday – I really should make a start on it…

27 thoughts on “” “”

  1. Tom mate, brilliant blog been reading it over the past few months and thought id join up and say hello!Its been a very useful bit of kit as im currently planning on changing jobs, i work fot the rozzers hear in hampshire and life on the frontline is starting to take its toll, what with the endless amounts of paperwk and little time spent on the street doing the job i joined up to do. I had a thought on the ambulance service a while back but being ingnorant didnt really know what you guys get up to on a daily basis (the only time i see you is on a saturday night dealing with the scroates in the ciy centre). Anyway after reading this and riding along with a few ambo crews dwn this end ive decided to apply to LAS as a student paramedic. Anyway mate a big thankyou for helping me decide, your blog has been brilliant as it has outlined the highs and lows of life on the NHS frontline (oh and i also read your book, very addictive, TOP JOB!)

    Thanks again mate.

    Keano.

  2. We get a phone call from Control if we're in station and it is frequently “We have an emergency in Jacketsville, don't know what it is yet”More frequently I have had to start calling control en route to ask what it is we are heading at break neck speed towards. On one occasion the call came back “Patient feeling suicidal, has been violent in the past, police informed”

    My curt reply was “Well the police need to be on scene before we go anywhere near this, oh and in future you might want to update us on what we're going to………….. tends to help in avoiding us becoming the patient!”

    Some supervisors in control have even taken to ringing us and questioning why we didn't meet the 8 minute target?!! Crew and patient care have become secondary to these crap government targets.

  3. logic clearly has no place in government! this is one of the few statements that remain appropriate no matter what party is in the majority. re: the book part2, good thing you work well under pressure, eh?

  4. I do find that targets and “good ideas for working practice” come from people who work mon to fri in an office and never go out of their nice comfort zone.im sure if we out on the frontline started making stupid suggestions to them it would stop sharpish! on another note Yay another book coming out, i cant wait. the last one i couldnt put down for 3 days

  5. re; the new book, will it be available on ebook format? I have got a reader after your comments on it (and research) so what a more fitting tribute than to read your book on it? Thanks.

  6. Spot on, TR!it is bloody dangerous!

    we say it over and over again in our neck of the woods.

    Am pretty sure it's echoed throughout the UK.

    Better safe than sorry eh? shame such old-fashioned terms aren't adhered to a little more!

    Good luck with part2 :0) and looking forward to it.

  7. I know what you mean TR.we can get two messages to initiate a call on the screen “General area of incoming 999 call” because im telepathic knowing where the next 999 call is. we usually sit on station and wait for an address but we have to book en route.

    or we have got ” General area of __________” this usually states a town to this we have to book en route and start running towards the town stated unless were in that town they we stay put.

  8. No one ever wants to be the bearer of bad news up the chain of command -ie telling someone something isn't working- in case it reflects badly on them. Therefore all senior management ever hear is “YES, WE CAN!!!” from middle management -who then get a big star on their chart because of their 'positive attitude'. And nothing ever improves.I worked for the civil service, but I'm sure it's the same everywhere.

    The older I get the more relevant the tale of the Emperor's New Clothes seems -anyone pointing out the truth is accused of negativity and a 'bad attitude'. šŸ™

  9. So would the police or trumpton allow their control to work in such a way?Someone dials 999 and asks for the police…a police officer gets told on his/her radio to proceed with all haste…to nowhere yet!

    Someone dialss 999 and asks for trumpton…a fire engine is activated and told to go mobile…just wait on the forecourt with blues & twos going until we find out where to!

    Police then get an address (same in trumptons case) and are sent to said location still waiting for nature of incident to be confirmed!

    Both police & trumpton get stood down as control finally get reason for callers call…'What time is the next train to London?'

    Sounds daft??? It happens in the ambulance service, day in day out. Call connect is the worst thing to happen to the service in years!!! If its so good then why dont the police and trumpton use it? Answer, they have a bit of common sense!

    I've said it before…someone is going to die through being sent to an iffy job or crashing their vehicle on yet another pointless turn out. Before call connect we were getting hammered for jobs. Now we are getting malleted. I know we can only do one job at a time but management still get onto us if we dont turn round at A/E quick enough or miss the ORCON target.

  10. With all the layoffs can we but hope that management will be booted and let those that do the work do it properly, in all walks of life… l guess not they give workers the shove instead šŸ™

  11. It's no better from a dispatcher's point of view. I try to let my crews return to station as often as possible, but in return they need to mobilise quick enough to stop statistics saying they should be out all day. When it goes to plan I can call the station and advise of a job in x area, by then the address is in and I can send that down, by the time they press mobile I have the rest of the details I can send down, and hopefully call on the radio with full details. However ….. when it gets busy (about two minues after sitting down) there is less and less time for passing full details. Although that said the whole blue lights into a knife weilding killer* line is a little far fetched, but the problems of stop start blue lights in traffic is very real. I've lost count of how many crews blue light it round a corner so they can stand down out of view of all the motorists they've just passed.No wonder crews sarcastically question everything we ask them to do, we must look like muppets to them. (yes, you are the closest :p and yes I do know where you are).

    * as a side note, we're not allowed to contact the Police to DSH and other “might be” dangerous situations now, due to patient's rights, and threats of fines to Dispatchers for breaching data protection laws. We have to wait for crews to make a dynamic risk assessment as to if Police intervention is actually needed.

  12. you know..id love getting one of those government officals who give us these damned protocols/laws what ever you call them…and have them ride with us for a week, i bet you he will either be car sick or become mentally ill from the sheer fear of driving around a semi-city…love the people who have the balls to play chicken with us

  13. * as a side note, we're not allowed to contact the Police to DSH and other “might be” dangerous situations now, due to patient's rights, and threats of fines to Dispatchers for breaching data protection laws. We have to wait for crews to make a dynamic risk assessment as to if Police intervention is actually needed.What about the employers legal responsibility to ensure an employees health & safety at work? This onus should be pushed back onto the powers that be. It's not good enough for someone to say go & assess this job or that job, cos if it is a whirling dervish mad axe man armed with a tommy gun & samurai fountain pen, you ain't likely to finish your assessment to report it back to control.

    It might go something like this,

    ” Hallo control this 1234 here, I have just assessed the situation & yes it is dangerous & I form that opinion because the patient has just shot me with a cross bow !”

  14. Hmmm….In London they do – I suspect that it may be some idiot's misreading of legislation that has led to that policy…

    While the walking into a knife wielding maniac doesn't happen every night, it's *nearly* happened to me (I sat outside until the update arrived) and it's definitely happened to a friend of mine. Both within a fairly short space of time.

  15. Like the first one it will be released under a CC licence – which means that it should work on any e-reader.Getting it into different formats so that it looks lovely is a *bit* trickier, and I'll be seeing if I can get some volunteers to have a swing at it when we release it.

    All of which should be free.

    (And I hope that not many Americans paid huge amounts of cash for the original on the Kindle when the full text is available on http://www.archive.org)

    There may also be something in audio…

  16. Just curious to know whether, if ORCON timing has been started, the “call to our Clinical Telephone Advice desk” cancel/ssuspends it; or does the clock still tick?

  17. Two points here:Firstly, the fun we all have chasing mobile phone masts: calls from mobile phones initially flag up with a location “in the vicinity” of the phone mast. Two minutes down the road we find we're actually heading to the wrong side of town. Just one of the many perverse outcomes of “improving” the service.

    Secondly. regarding your comment concerning Peter Bradley being one of the main instigators of this “f**k-up”. I have been in conversation with someone else very closely involved with the Bradley report. I am assured (and I have no reason to doubt my source) that the government had already decided that “a target” was to be the main corner stone of the report even before Bradley started his review. If true, then his failing is that he didn't have the balls to walk away from the review but acquiesced to Nu-Labour's target driven culture. (I wonder when we can expect to see him rewarded with a lucrative QUANGO appointment or another honour for “Services to the Health Sector)

  18. The other person that was advocating 8 mins was Dr Carney of East Anglia Fame who was also heading up the ATLS,noting in his training sessions to us all (thats when is back was not too bad and he was not having the figures adjusted to reach the target times) that the brain starts to loss all the oxygen so it was imperative to get on scene in 8 minsBut we have known that for donkeys years so why all the fuss now

  19. IMHO if road crews where allowed to do some shifts in control and control staff some shifts on the road it would help each of them understand some of the problems the other faces. I know that it does happen on an occasional basis and that many control staff are ex road staff and vice versa but l think it should be part of basic training.On the subject of not being told if there is a history of violence from a particular patient or address, that policy does not apply to the police and l cannot see how it can to us. What position does that place RRV staff in? It would be like sending the fire brigade to a burning building but not telling them that it was full of oxyacetaline cylinders because it might affect how they approach it…too bloody right it does.

  20. Must admit i find that a tad wired.To be fair to our control and its not “las” they have police, hems etc, whoever running to the job as soon as they have as much information about the job a possible.

    If we get an assault the police are automatically called and are usually feet in front of us or behind, its good in a sense.

    Ive called for police to scene when im still 2.5 miles from scene as i know the town im going into has lots of little streets and if it kicks off im really up a creek without a big paddle.

  21. wow, i really enjoy the new direction Tom!! I am so glad we do not do that in my department!! oh man, i am happy we dont. Our time starts from time the dispatcher tones us out…thats when our 8 min. begins.

  22. It's not just the ambulance service that has targets, most of the NHS and emergency services are now governed by targets that are supposed to improve things. Things need to change on a much bigger scale than just ORCON, but how?Can't wait for the sequel by the way, blood, sweat and tea was absolutely brilliant.

  23. Similar thing happened to me. sent to, and stood down on 3 jobs, 5 times in as many minutes all at different compas points durring insanely heavy traffic.All initialy coming through as “General Area Of” before getting the address, having to turn round in heavy traffic, blast back in the opposite direction to where we came from, no doubt annoying the public more than usal by making them slow down and may be even stop for an Ambulance twice.

    Finaly left to run on a new job at a GP's surgery.

    Got there to flnd a man about to breathing his last in a packed waiting room!

    When we arrived at A&E and were clearing up, realised the last job was an Urgent!

    In all the confusion of stand downs, activations, U turns, 3 point turns, we missed the job coding, but in a way it was a good thing we did otherwise this poor guy would have been dead.

    But hey, we were mobile within 40 seconds, and got to an hour Urgent in 5 minutes!

    So some one, some where is happy!

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