Blame Us

I've been doing a fair amount of transfers between hospitals of late. Which is why this article on the BBC news site struck me a particularly timely.

Unnecessary risks are being taken when transferring seriously ill people from hospital to hospital, doctors say.

But British Medical Association doctors said medics often had to rely on batteries to power vital equipment – and these were prone to failing.

Most ambulances do not have sockets for standard three-pin plugs. Instead, they have cigarette lighter-style sockets, which means hospital equipment such as ventilators, blood pressure monitoring and intravenous drug equipment cannot be plugged into the vehicle's power supply.

Doctors transferring patients are therefore required to connect the equipment to batteries. Newer ambulances are being brought in which do have three-pin plug sockets but, because many of the older vehicles will be on the roads for another five years, doctors believe action is need now.

Dr Dharmarajah, who works as an anaesthetist in London and as such is often involved in patient transfers, said a “simple solution” would be for ambulances to start using adaptors that would take the three-pin plug. The devices, known as inverters, can be bought for less than £100. But only a handful of NHS trusts are using them.

A Department of Health spokeswoman said: “It is for ambulance trusts locally to ensure they have the right equipment for the job. “Ambulance fleets are constantly being updated and new ambulances are able to support additional equipment.”

First I'd take slight offence to the suggestion that we cannot power equipment such as 'ventilators, blood pressure monitoring and intravenous drug equipment', ventilators are powered by the oxygen cylinder and we have our own blood pressure measurement machines.

What traditionally fails is the intravenous drug equipment – or as we call them, syringe pumps.

When you need to give a medication through a vein over a period of time the best way to do this is via a syringe driver – this machine essentially pushes the plunger of a syringe over a set period of time. Where we most often see these is when you are giving anaesthetic drugs to an intubated patient.

For as long as I've been ambulancing (yes, it's a word, I just made it up) I've been telling staff that if the patient is connected to one of these machines, then we need to take a spare as the internal battery will probably run out before we leave the gates of the hospital.

I was looking at the product sheet for the sort of equipment that we most often come across – the battery life on these is around three hours. Or rather it should be.

This is why this story annoys me, the hospitals, who should be looking after their equipment and servicing them and replacing the battery when it can no longer hold a charge, are blaming the ambulances for not spending the money to cover up the fact that this servicing isn't being done.

Like a laptop battery, these drivers need to have their batteries looked after or replaced. The hospitals aren't doing this because they are plugged into the wall at all times. Consequently the battery holds less and less of a charge, and so once you remove it from the mains supply it no longer has the advertised three hour battery life. More like a fifteen minute battery life.

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The 'simple solution' of ambulance trusts having inverters for ambulances, is not that simple at all because it would have to come from our bank balance. We'd be paying for the failure of hospitals to maintain their own equipment.

You must remember that ambulance trusts are not connected to hospital trusts, and the way we are both funded means that, should I replace a syringe I've used with a fresh one from the A&E department, I am actually 'stealing'.

Remember also that the hospital trusts were very quick to drop the London ambulance service from their patient transport services as soon as private companies offered lower costs. Of course, those private companies can't transport critically ill patients, so the hospitals have to use us.

I laughed when I read that it costs 'less than £100' for the equipment to be able to plug in a mains three-pin plug. I'm riding around on ambulances with incomplete equipment, with cupboard doors held together with medical tape and with electrical systems that often have trouble powering all the normal things that ambulances need.

There is nothing stopping the hospital from investing 'just' £100 in an inverter for their transfer pack in order to power the equipment that they should be maintaining.

Heck, if I were that concerned an anaesthetist I'd buy my own – certainly I'm personally using equipment that I have bought myself on my ambulance, and I'm paid a fair bit less than a doctor.

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Oh, and those 'newer ambulances'? Don't ask my boss about them, as the company that we were contracting to provide them has gone bust, leaving us without vehicles and also taking a fair chunk of our money with them.

I wonder if the people responsible for selecting that company have been disciplined?

Does this sound a bit whingy? It's only because the ambulance service is easy to blame for everything. It's a shame we didn't have a representative of the ambulance service in that story say 'If correctly maintained by the hospital trust the equipment that is used on transfers has a battery life of three hours. There should be no need for an ambulance service to have to cover for this shortfall in essential equipment maintenance.'

14 thoughts on “Blame Us”

  1. Interesting post. I was a senior manager at Graseby Medical before it became part of the SI group. At that time products were either 100% non-rechargeable battery driven or 100% mains operated, so the problems you describe did not arise.Presumably rechargeable battery backup has been added as a safety/convenience feature. The problem was, and always will be, getting overworked nursing staff to remember to do regular maintenance tasks – such as cycling the battery packs.

    Note to my successors at SMI: consider a software change that forces the pumps to switch to battery for 1 hour so that re-charging keeps the battery fresh. It's only software!

  2. Having done many transfers myself, with ventilated, sedated patients, the most useful piece of kit was a customised transfer trolley designed and bought by the ITU. Large internal battery, and a power supply that was compatible with the standard ambulance one. Ventilator, monitor, syringe drivers and emergency equipment all there in one place. Apparently cost about 20,000 to put together but worth every penny.

  3. Ive used inverters for quite a while to power all sorts of things – – – The 100 ones WONT do to power medical equipment! Try 500 and up. Also you need to make sure the wiring on the truck is up to the job….. Oh yeah thats not strong enough so more modification required.Yet again they get someone who doesnt know elbow from posterior to comment and YET again you guys get flack for SMT failings.

    Well done for sticking with it!

  4. This is one thing that's always puzzled me – exactly what good does the Trust structure do? It reminds me of an ancient Dilbert cartoon about “Battling Business Units”, where departments had to fight over the same money to the detriment of the customer.I can understand having “cost centres” or some such to keep the bean-counters happy, but why do we seem to have a situation where NHS money is being squabbled over and spent on duplicate layers of admin rather than on something useful – more equipment, better drugs, higher salaries?

  5. “Ambulancing” is a perfectly cromulent word.I verb nouns at every opprotunity.

    Just as drugs have 'use before/discard after'

    dates, so should the rechargable batteries.

    Does the IV pump device have a battery

    compartmentor does it have to be

    dissassembled to replace the battery?

  6. In the statement where it says UV Modular Limited (UVM) has been placed into Administration, it also mentions the prent company wants to exit from the low profit divisions. So it looks like they have allowed UVM to fail rather than it failing through lack of funds.batteries. My local hospital has machines permanently on charge all over the place with signs saying they must never be unplugged unless thay are to be used. As any electrician will know, this with ruin a battery in a very short time. Wouldn't it be better to have it connected to a device that will only start the charge when it has detected the battery power is below a certain level. In the long run it's cheaper than endless batteries.

  7. Where I used to work machines need to always be plugged in when in use because otherwise they beep and scream at you. Sliding Scales and PCA's being the worst offenders. Taking a patient to the bathroom in the middle of the night means that all of your patients are awake.Though when not in use the machines are unplugged and switched off. I have no idea what it even means to cycle a battery (showing my complete lack of technical knowledge) but I do know that medical physics have to check over the machines once a year.

  8. That 'once a year' must be when the batteries are replaced.I thought NiMH batteries were more tolerant of neglect

    than the older NiCds.

    We are promised 'SuperBatteries' that won't mind

    continous charging or numerous 100% – 75% – 100% cycles.

  9. Sorry to pick holes, but:Ventilators. Yes the Pneupac's might be pneumatic powered, but lots of others, like the Oxylogs which alot of hospitals have, are battery powered. I've had one of these go down on an ITU transfer because the battery was borked, and it's not safe or acceptable. Yes you can get O2 into someone with a waters circuit, but they use shedloads of oxygen*, and if the patient's lung compliance is high (which in ITU tends to be the rule) you cant gauge accurately what pressures you're ventilating at. Plus one of the people in the back has now got their hands full.

    Second nitpick is the syringe driver comment. You didn't mention that some of those syringe drivers contain vasopressors and ionotropes, both of which cannot be (easily or safely) given as an infusion by hand because if you go too slowly the patient dies and too fast and they have a brain haemmorrhage.

    Apart from that I agree entirely. It's because of crappy hospital equipment that they have no desire to spend money on upgrading or properly servicing.

    *Ambulances might have shedloads of O2 available but when you get to destination hospital its a matter of waters circuit + o2 cylinder + lift = standing on St Pauls in a thunderstorm fellating Richard Dawkins. It can only end in tragedy.

  10. Might I refer you to MPT1362 here? Granted, that refers to installing radio equipment, but it will give you an idea of the faffing about required to fit a high-power inverter to the already-stressed electrics of an ambulance.Those fag lighter plug things really are crap, though. Can't you get the DIN-style ones that they have on newer European cars?

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