Am I a taxi driver with bandages whose job is to get to a location in eight minutes, or am I a well trained, well equipped professional with the ability and knowledge to provide effective medical care in emergency situations?
At the moment I feel like a taxi driver.
Today I am going to tell to you about in service training, and where I see the LAS as failing – tomorrow I'll give my ideas for how we can improve this situation.
Across the NHS workers receive in-service training where they learn new skills, refresh old skills, get updated on new equipment and policies and even get assessed on how well they currently perform those skills.
In the LAS that just doesn't happen.
I went looking for my 'continuing professional development' folder so that I could tell you the last time I had some training. I can't find it, I suspect that it is buried somewhere up in my loft, which gives you an idea of when I last used it.
I have a clinical guidelines book – it's dated 2006.
I honestly can't remember the last bit of training I had – I think that it was some years ago and was about how to escape from an attacker.
Actually that isn't true – the last training session I had was on how to use the new radios, I had this training a few weeks after the radios had been 'rolled out', lasted an hour and we were constantly interrupted by Control asking when our ambulance would be available to go back on the road. This was the third time I'd tried to get trained, the first time I tried to get trained it was cancelled ten minutes into the session, the second time it was cancelled before I arrived at station.
My last CPR training was when the number of compressions per breath was changed to 30:2 (whenever that was)- this was given to me in a ten minute presentation from a team leader.
The last time we were given a new drug to play with I had a single sheet of A4 paper which I was to sign and return to say that I had understood the information on it.
Policies change and unless I see the one bulletin on station directing me to the incredibly poorly-designed internal website (that I seldom have a chance to check because we are so busy) I'll never hear about it.
The problem is that a well trained staff doesn't help the service hit it's governmental ORCON target. Remember that the ORCON target means that reaching someone who is dead beyond any hope of resuscitation in under eight minutes is a success, while reaching a patient in eight minutes and one second yet saving their life is a failure.
When our REAP level goes too high, due to a high volume of calls, or the service not meeting our ORCON target, training is one of the first things to be cancelled. Sadly 'too high' is the normal REAP level these days.
Training is not given the priority that I think it needs – the service wants ambulance crews to leave patients at home (it saves us money and time – meaning that we can get back on the road to continue hitting that ORCON target). But how can crews be confident about leaving patients at home when our post-qualification training is so woefully inadequate?
Since leaving nursing can you guess how many times I have been taught to wash my hands? Handwashing is incredibly important in infection control and you need to be taught how to do this properly, even assessed using a gel that glows under ultraviolet light. There is a specific, effective way to wash your hands that is taught in hospitals in order to make sure it is effective.
I have, since joining the ambulance service, never been taught how to wash my hands.
We have new vehicles being rolled out across the service, there are some big changes as to how the equipment on them is to be used. The training session for these new vehicles takes two hours. I've attempted to get trained on these vehicles on four occasions – on all four occasions the training has been cancelled.
The reason for this training to be cancelled? Someone in Control has decreed that you can't be trained during the rest-break window of your shift.
If we don't get a rest break then we get paid £10. If we are being trained for two hours of that window then the chances of us having a rest break are reduced and the service will have to pay us £10
So, we don't get trained because of the expense of £10.
When I started in the ambulance service we were hit over the head with sixteen weeks of intensive classroom training that turned plumbers, housewives, carpenters and office workers into ambulance people. It wasn't much fun but it seemed effective – we were taught by ambulance people who'd become training officers.
I'd like to tell you how the training has changed, I think it's now more central and people are trained over the period of (I think) three years to be paramedics. Carpenter to paramedic in three years is… quite fast. You could do it in the 'old days' but by then you'd have had around three years 'on the road' learning the basics of your craft, not around a year.
My knowledge of the current training is informed only by the students who are coming out of the training school – and it's not good. Courses are rewritten as they are being taught, days back in the classroom to consolidate knowledge gained on the road are cancelled (most likely due to trying to reach the ORCON target), students are coming out of training to do practical placements with some rather strange ideas of how we work on the road.
We sometimes get students being put on a placement with us – my crewmate is a paramedic and she is supposed to educate the student in how to practically do our work. She is supposed to have a PPED course under her belt, a course that teaches her how to teach student paramedics. She doesn't. She's asked to be put on this course for a number of years (longer than I've been working with her) and she keeps getting no answer.
How is this being fair, or maintaining the quality of training, for the student paramedic?
I've personally noticed that my skills have decreased since joining the ambulance service. My knowledge of drugs has started dripping out my ears, my understanding of medical conditions is decreasing and the physical skills of medical care are atrophying.
The reason is that, for 80% of our jobs there is no need for an ambulance, nor for hospital treatment. We arrive, I chat with the patient and then tell them to take a seat in the ambulance. By rote I check their blood pressure and pulse and then we take them to hospital. With such an influx of uncomplicated cases (drunks, colds, runny noses, babies with a high temperature) it is obvious that there is going to be a loss of skills.
Unfortunately, with no training or regular assessment, this skill decay goes unchallenged.
I try to keep my skills up, but with no support from work it's incredibly difficult – so I find myself turning to American EMS sites and podcasts to try and maintain some sort of education.
One of the ways that you build a motivated work force is through training – something that isn't happening. We get up, turn up to work and do our best to work 'safe'. In this case 'safe' means working so that we don't get any complaints or lose our jobs.
There is no enthusiasm to learn more about our job, about medical conditions or how to do things more effectively.
Hardly anyone reads research on pre-hospital care. After a twelve hour shift I'm seldom in the mood to hit the books myself. The service doesn't provide any encouragement for us to learn on our own, we don't have any libraries, the internal website doesn't have any links with e-learning or educational sites (not that I think any UK based ones exist for ambulance workers) and we don't have any protected time where we can feedback with our peers.
So, in summary – I think that in the pursuit of pointless targets we do not get the training that we deserve. We do not get the training that the public would expect us to have. Training courses are incredibly rare and are cancelled more often than they are run. What post-qualification training we do get is on an ad hoc basis and doesn't take account of modern training techniques.
Current training of trainees also seems inadequate and it seems that all that is wanted is 'bums on seat' (although this is only my impression that I've had from the students I've spoken to).
There is no counter for skills decay, nor any assessment of the skills that we do occasionally use in order to make sure that we are providing best practice.
In essence I feel like a taxi driver with bandages – not someone educated to provide pre-hospital care beyond the very basics.