So… What is it that makes an ambulance?
What sort of equipment do you think needs to be on a vehicle for it to be classed as an 'ambulance'.
You'd probably think that it would need a stretcher, a carry chair and some sort of medical equipment. Perhaps something to take blood sugars, blood pressures and tracings of your heart.
Maybe it would need something to deal with broken limbs, a board to strap you to if the crew thought that you had a broken neck and maybe even some drugs to treat conditions such as asthma, heart problems and allergic reactions.
You might also expect bandages.
You would, of course, be wrong.
We have had the official memo from one of our Assistant Director of Operations.
To be a working ambulance you need…
1) A vehicle which passes the legal requirement of basic roadworthiness – decent tyres, has a windscreen, has working lights and is taxed.
2) A Bag-valve-mask and a defibrillator.
3) That is all.
That is all you need to have a working ambulance – or rather an ambulance that will stop that all 'important' (and utterly bloody pointless) ORCON target.
This level of equipment means that you can perform pretty basic life-support – no drugs, no clever airway management.
If you have asthma, you will be wheezing like a wheezy thing with not a thing I can give you.
If you are having a heart attack I won't be giving you the aspirin that vastly increases your survival rate.
If you have a broken leg, I'll have no way to splint it. And I may not even have a stretcher to put you on anyway.
But I will have 'stopped the ORCON clock', and so the job will be a 'success'.
And this is happening – a friend of mine was sent out on an ambulance with this level of equipment. He was concerned by this and wrote a letter to our medical director who replied that this is a good policy.
Over 50% of the time I'm sent out on a vehicle without a blood sugar kit, and without other equipment like Scissors or a Paediatric Advanced Life Support Kit.
The London Ambulance Service calls itself a 'world class service' – but I think it's a bit rich to refer to yourself as this when ambulances are being sent out with this level of kit.
But who am I to complain that I don't have the right amount of kit? After all, the people who make these decisions are paid a heck of a lot more than me, so they must be smarter.
It is, as regular readers will no doubt have guessed, all because of the frankly dangerous ORCON target – dangerous because our ceaseless chasing of this clinically worthless target means that patient care is suffering.
The government has decreed that a number of targets will be dropped – the four hour A&E wait, the Police Pledge, Literacy (well… they haven't specifically said that literacy must be cut, but if you are cutting the education budget by 25% then that is the sort of thing you are going to get).
Sadly, no, tragically, it would seem that the ORCON target will remain. And so resources that could be spent on, oh I don't know, fully equipped ambulances, are instead being spent on beating that damn clock.
However I think that there are those in management who probably like this – after all they can understand how to chase this target as opposed to being capable of setting a standard of excellent patient care.