Good News

Patients suffering an out of hospital cardiac arrest in London now have more chance than ever before of being resuscitated by staff, according the latest Service figures.

The report, published by the Clinical Audit & Research Unit (CARU), also shows the Utstein* survival rate is up to 15.2 per cent from 12 per cent the previous year.

So, if you have a cardiac arrest in London (for certain values of cardiac arrest), you have a 15.2% chance of survival. Which is great but won't result in us getting any more funding. Well done everyone involved, and well done to the new CPR protocols – I've personally noticed a difference with the 30:2 compressions.

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Bad News

For the first time in its history the Service has responded to one million incidents in a single calendar year.

The Service has already attended over three per cent more incidents than in the whole of last year (968,952), with the busy New Year's Eve period still to come.

Chief Executive Peter Bradley said: “To attend one million incidents in a single year is an amazing milestone and one that no other ambulance service has ever reached.

“Every member of staff can be proud of the contribution they have made towards helping us to reach more patients more quickly than ever before.

“Demand on our Service has risen steadily over the years , and this is something experienced by ambulance services nationwide. We continue to work to find innovative ways of offering more appropriate care pathways for our patients. The ability to offer some of our callers telephone advice or to transfer them to NHS Direct is allowing us to save thousands of traditional ambulance responses each year.”

The millionth incident was to a patient suffering chest pain in Tower Hamlets. A Poplar ambulance crew and a HART single responder attended. The patient was taken to hospital.

This is what I meant when I previously mentioned that our chief executive sounded proud that we go to more than a million calls. Is that something we should be proud of, or rather something that we should be worried by? And these are the calls that ambulances are sent on, not the ones where telephone advice refuses an ambulance.

Someone please explain to me how this is a good thing, especially if we aren't increasing the number of ambulances and staff on the road?

As an aside, half of my workload is 'chest pain in Tower Hamlets', I'm willing to bet that it was a cough or bellyache, or maybe a bit of 'flu'.

I've not died – my plan was to blog at least every second day, but that has gone for a burton as my internet connection is up and down more times than a *insert metaphor*. I'm trying to get it fixed, but of course that means some time after the bloody waste of time that is Christmas.

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I must admit that I saw this on the BBC, and thought it sounded somewhat familiar.

The government has been urged to review its targets for ambulances responding to 999 calls, following claims that patient care is being affected.

The NHS Confederation, which acts for ambulance trusts, said that targets can produce “unintended consequences” and “may not be benefitting patients.”

Ahem .

However Mr Edwards added: “Any narrow target which focuses on one measure does have the potential for producing unintended consequences and maybe not benefitting patients.

“A solution might be to move to a measure in which we measure the outcome of what's done rather than just the process, so what was the outcome for the patient? Did they receive the emergency care that they should have done?

“And if we could move to a situation which was better at measuring that, then we might avoid some of the unintended consequences of these very tight timescale based targets.”

He was backed by academic Janette Turner, from the Sheffield University's Medical Care Research Unit.

Cough.

She told the BBC: “The only proven clinical value of an eight-minute response is for patients with cardiac arrest, where a really fast response really can make the difference between whether they survive or whether they die, but for the other patients there's no proven relationship between how quickly the ambulance gets there and whether they survive.

“The problem that creates for ambulance services is if they get there in seven minutes and the patient dies, they have succeeded because they have met a target and if they get there in nine minutes and the patient lives, they have failed because they haven't reached the target.”

How's 2004 for warning people about this?

The question that I need to ask now is, seeing as I've been saying this for as long as I've been blogging, I must be an expert on this situation – so can I have a nice paying non-shiftwork job at the DoH?
No, of course not – what do I know about ambulance work anyway? Better to have a someone who has been a teacher and solicitor as the 'expert' on ambulance work?

£5.4 million pounds. For artwork to showcase 'British Culture'.

With £5.4 million pounds spent on the ambulance service I might not be left looking for a spare ambulance on my late starts.

We might have enough blankets for the coming winter.

I might have a fully kitted ambulance.

Looking wider – we might be able to look after our returning soldiers without needing charity.

We might be able to get some people out of poverty – thus saving lives.

Instead we'll have,

'LED panels on the roofs of bus stops aim to provide Londoners with a new way to display their creativity, express what is special about their London and to talk to one another.'

Oh well.

Demonstrations are expected as one of the world's largest arms fairs opens in London's Docklands later.

The biennial Defence Systems and Equipment International is due to take place amid tight security.

Activists from a separate group, Disarm DSEI, will hold another protest and warn they will target the banks and firms which invest in the industry. The group also says it will not co-operate with police ahead of its demonstration.

Yep.

My patch.

Loads of people, some of them perhaps reasonably annoyed.

Quite a few police, some bodyguards.

If the police do some kettling there could be a fair few collapses/illnesses/injuries.*

So you would think that we in the LAS would have some sort of plan, something that those of us working in the area would be privy to.

I've not seen a single memo, bulletin, policy or plan concerning this.

However in the latest bulletin I have learnt that the 'Equality and Diversity' department is changing it's name to 'Equality and Inclusion' (something to do with the future).

Oh well, it'll be interesting seeing how the next few days play out.

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I'm not saying that there isn't a plan, just that I'm completely unaware of it – and the officer I spoke to yesterday was also unaware of any plan.

*Stationary kettling is, in my opinion, a bloody stupid idea and probably against the law.

A round up of recent media stories about ambulances and the talk of the ambulance loading bay at the hospital the other night.

Dozens of patients were removed from hospital wards after two ambulances caught fire and exploded.

I'm glad there were only minor injuries.

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Bottle thrown at ambulance on emergency call

“We were on blue lights on the way to a call and we heard an explosion. The next thing we were covered in glass – it was everywhere”

Ambulance bicycles stolen in the City

The London Ambulance Service is appealing for the return of two cycle response pushbikes after they were stolen from outside the home of a patient in Finsbury. The custom-built Specialized Rockhopper mountain bikes were taken yesterday evening (Wednesday) from Joseph Trotter Close, EC1, after staff had been called to attend a man who was unwell.

Which sort of sums up how some 'members of the community' treat ambulance services.

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Woman Dies In Pub After Paramedic 'Delay'

Then there is this, which is very sad – but I know that there are certain pubs in my area that I hate going into because, well, people get killed in them. Once more it's a case of 'blame the person who wants to survive their shift'. And once more, as usual, the blame is being put on 'health and safety' – at which point I'd like to tell those commenters that if they would like to live without health and safety legislation I'll be seeing them later in the back of my ambulance.

This sort of story is happening more and more – I really should just do one blog-post that I can refer to when another similar story happens.

Incidentally, can someone explain the laws of grammar that have newspapers 'quoting' their own stories? I always read it as indicating sarcasm.

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The current gossip outside the A&E department the other night was how there is a local estate where someone seems to have taken a shine to shooting at ambulance crews with an air pistol. Apparently the official advice is that if you get a call there the crew should wear their stab vest and safety helmet.

This is the sort of 'welcome' that we are dealing with.

What has happened here is tragically sad and my sympathies go out to the family.

A GRANDAD lay dying of a heart attack in his home — while a paramedic stood outside for 16 minutes filling in risk-assessment forms.

And last night Roy Adams’s heartbroken daughter Sarah claimed he would still be alive if there had not been a delay.

She added: “It’s awful. The medic could have saved my dad but instead he stood outside for 16 minutes. All that crucial time was wasted.”

I'm yet to see a 'Health and Safety' form that we fill in on the road – yet more 'Sun' exaggeration. But then they do seem to have a real hatred of people actually being safe at work.

When I was working solo, you made your 'health and safety' assessment in your head – if it felt safe to enter on your own then you would enter, if there was something about the call that made you nervous, then you would wait for backup. From the story in the newspaper, it would seem that the solo thought it was unsafe to enter – but after waiting sixteen minutes for a police escort to arrive, decided to enter on their own.

Probably what happened was that the solo wasn't happy to enter on their own for whatever reason, waited for the police and after they didn't turn up for a while entered the household at their own risk.

From the Times Online article about the same job.

The ambulance service spokesman described the risk assessment as a “mental checklist” which included considering the safety of the scene, types of risk and whether extra help or equipment was required.

“We have a duty of care to treat patients but we also have to look after our staff,” he said. “In this case the medic conducted the assessment, had safety concerns and decided to call for back-up.”

Well done that 'spokesman' for getting the real situation across to at least one paper (even if it is the toilet paper 'The Times')

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But it's not just about the poor reporting – what really sticks in my throat is the comments by the Great British Public who take the rubbish that is printed in the Sun as gospel. When every story becomes a trial by media it's interesting how quickly people are to judge something based on 380 words that they have read in a tabloid paper.

this idiot should be given life in prison

This medic should be struck off straight away, no questions …

Typical Britain today,what a b****y disgrace, everything is Health and Safety, Hitlerite jobsworths …

These people want us to risk our lives to save them when they make comments like that? What next? Moaning because I have two perfectly good kidneys and I should give one of them up for transplant so that someone else can live? Offering to be stabbed in place of someone else because we 'save lives' and are 'paid for it'?

How many of these commentors, after seeing the damage a knife can cause, would volunteer to walk into a place where there is a real fear of losing your life. They are very brave sitting behind their keyboards, but I bet they couldn't walk a mile in our boots.

And calling us 'Hitlerite' – well, I hope that whoever made that comment makes that viewpoint known to any ambulance crew that comes to help you in the future…

I do despair sometimes.

And should the Solo be vindicated, how many column inches would the Sun spend on that?

'Swine flu', which for those following me on Twitter, seems to be one of the things I'm encountering more and more often these days. Let me explain some of the ways in which it is impacting my working life of late.

• While the government leaflet says that masks offer no protection from the 'flu, our latest flowchart for dealing with it mentions not only masks, but also aprons and gloves. We have gone from having a pair of masks and a pair of aprons in our infection control kit to having as many masks as you want. To be fair we did have to steal resource masks from the hospitals that we went to at the start of this outbreak, but supply problems seem to have been sorted out.
• Our call rate has gone from the normal 4,200-4,500 calls per day to around 5,200-5,700 in the last few days. This is an increase of around 26% Rather obviously this is having us run ragged. I have no idea if our sickness rate has increased (with staff being off with the Death Plague). What this has done is raise our DEFCOM level to 4. Which I don't think makes a huge difference to those of us on the road.
• Hospitals are refusing to see Swine 'flu patients unless they are incredibly unwell. I was nearly turned away from the hospital when taking in a woman with vaginal bleeding and dizziness because she had possible Swine 'flu. Do GPs do vaginal examinations and diagnosis? Or would this woman have been sent in by the GP anyway (given some of the… 'quality' GPs we have in my area it wouldn't surprise me if she were just sent up to the hospital without an examination). There is huge paranoia about letting anyone with a high temperature and the sniffles within hospital grounds. My question is, will hospitals be turning patients away in the Winter when the more dangerous 'flus are epidemic?
• We are seeing plenty of people who call us for Swine 'flu symptoms, as well as those who just mention 'chest pain' to our calltakers – thus guaranteeing an ambulance response. Quite a lot of people think that Swine 'flu is a death sentence even though this particular strain of 'flu seems to be a lot less dangerous than the normal seasonal 'flus.
• We have the normal increasing number of people collapsing from the heat – often their first thought is that they are dying of Swine 'flu.
• We are being told to leave people at home to look after themselves (heh, people actually looking after themselves, whatever fantasy scenario will our people think of next); this makes us ambulance staff somewhat nervous – after all there is the perception (if not the fact) that leaving people at home will only have us losing our jobs when someone dies.
• An example of one of our 'clients' – she called four ambulances over four days as her child has Swine 'flu, which isn't 'getting any better', despite being told that it can take over a week to feel better. Needless to say the child involved is fine if a bit generally unwell – certainly nothing that requires hospital treatment. Multiply this by the number of people across London and you can see one more reason why the number of calls is raised.

So, lots of panic, lots of fear, lots of misinformation along with the normal misuse of the ambulance service has resulted in many more calls for us, which then results in delays for people actually needing treatment. For example the police were with an assault patient for an hour waiting for an ambulance to arrive.

Unfortunately there isn't much that we can do, we can't suddenly make the public realise that they may be capable of looking after themselves without us holding their hands – and we can't magic up new ambulance staff from nowhere.

Except maybe get all the officers (that were road trained) up in Waterloo Control to man resource up trucks and get out on the road – I'm sure that for a few weeks we can do without the assistant staff officer to the staff officer for the diversity department* (or similar) and that they might be more use on the road at the moment.

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*I have no idea if this is a genuine position, although it sounds about right – I couldn't tell you how many levels of management there are between me and my boss, nor all the 'performance improvement' staff that float around up there in Waterloo.