From Warren Ellis – ‘ So how dead does this place get on a Sunday night?’

Well today (looks at his watch) yesterday was pretty much dead person day.

Two corpses, two nearly dead, and one about to die.

All in one shift.

I think my favourite was an elderly gentleman in a nursing home, who had real trouble with his breathing.  I asked the nurses there to sit him forward, so I could listen to his chest with my stethescope, and they replied, “How?”, and, “I don’t understand”.

I think I got a bit ‘shouty’ with them after that.

I’ll gloss over the way they opened the door for me, but then let me find the patient all on my own…

Posting will possibly be a bit light over the next few days, as Jeannie is coming over to stay from Seattle, so most of my time will be spent showing her around London.  I’m looking forward to it.

Then there will be drinks, feel free to turn up and say hello to a genuine American.

October the 1st, 2004.

We are now one year on from the implementation of Agenda for Change (AfC), and us EMTs still don't know what our new pay and conditions are going to be. The planning for AfC was started a year before this. So AfC has been with us for two years.

I think one of my commenters put it best when someone asked about AfC.

The pay rise announcement for paramedics, whilst being a significant rise, is not the great deal that it's been made out to be, with very little option for improving your pay based on skills and knowledge.

The rise for Technicians which is what you would be to start with if you joined the ambulance service, is still to be decided. The offer from management has been thrown out by the unions as it was utter rubbish, and it's now been referred to a national committee. If the rumours are true, and it seems that's the way it will be, techs will be placed in Band 4 of Agenda for Change, so while our gross annual salary will rise to just over £25k, our basic salary will effectively drop from £21,900 to around £19k, with the rest being made up from enhancements - unsocial hours payments, London allowance etc. We'll get time and a half for overtime, but that'll be based on the £19k basic. Plus band 4 doesn't recognise us doing ECGs, giving drugs and supervising trainees.

To put it into perspective - there are hospital cleaners that are going to be placed in band 4. Enough said?

Sorry to rant on but this A4C stuff, but it really annoys the Hell out of me!


For me, it's not about the money - it's about recognising us for the jobs we do and the skills that we have. We essentially work on our own, have to solve time-critical problems and give drugs that are normally only prescribed by doctors. We are at risk of being beaten up, we have to calm situations down, and maybe even be the first on scene at terrorist bombings.

Yet it seems that we are not recognised for this, instead our basic pay will drop, and the only way that we will make up the shortfall will be the new idea (for the ambulance service at least) that working rotating shifts should earn you a bit more money. The drop in basic pay will imply that our day to day work is not worthy of financial recognition.

Of course, this is all supposition, as no-one seems to know anything.

Morale at the moment is, to put it bluntly, crap, and it wouldn't surprise me if there were some form of 'action' in the near future. (Nothing that would affect patient care though).

It isn't helped by the misinformation in the media that is claiming that we will be earning a 30% pay rise, as this is purely for our (top trained) Emergency Care Paramedics, who are taking on the role of out-of-hours GPs. ECPs are in band 7, EMTs are likely to be put in band 4. So I won't be seeing a 30% increase...

At least we haven't got a job description that tells us to expect to be beaten up by patients and their relatives.

The media has reported a fair bit about MRSA in ambulances of late, one of my commenters has asked how the London Ambulance Service deals with patients who are MRSA positive.

(Note: I'm also writing this to avoid losing my job by posting about a family who have called an ambulance more than seven times in the past week for the same illness).

Primarily the problem is that we just don't know who are MRSA positive, MRSA is prevalent in the community, and I would suggest that most nursing homes have plenty of colonised residents. I remember working in hospital, having to swab everyone coming in from a 'high risk' environment, which basically meant anyone from a nursing home, or another hospital.

It takes time to swab and grow a culture (three days if I remember correctly), and each test costs a not inconsiderable amount of money.

If a patient is MRSA positive, then our infection control booklet tells us that we should use our 'personal protective equipment' (our uniforms) plus what are known as 'universal precautions' - essentially latex gloves.

To clean an ambulance after transporting an MRSA positive patient we use 'System 1' and 'System 2 or 3'.

System 1 - Detergent. System

2 - Chlorine spray System

3 - Alcohol.

So anything the patient has come in contact with is wiped with detergent, and then we either spray it with chlorine solution, or wipe down with alcohol wipes.

The other problem that we have is that we are so chronically overworked, that we often only have a little time to clean the ambulances. If you are having a heart attack, then you won't be impressed if all the ambulances on duty are off the road waiting to dry.

When the LAS do something, we often do it right. Our boss realised that the ambulances aren't as clean as they should be, and that road staff didn't have time to 'deep clean' ambulances every shift. The solution was to contract an outside firm who now cleans and stocks our ambulances for us and from what I have seen, they do a pretty good job.

So every night a gang of underpaid workers clean as many ambulances as possible. This 'make-ready' crew are paid a frankly pitiful £6 an hour, working from 1am to 6am they can clean around 16 ambulances a night using industrial cleaning materials. Every month they are quality controlled by random swabbing. So far they have only had good results.

So I personally think that the LAS is doing something positive and effective against the spread of MRSA

MRSA will never be eradicated, unless we force everyone at gunpoint to use alcohol gel after every physical contact (and this includes 'civilians') and enforce daily antibacterial showers for the entire population of, well, the entire world. But we can do our best to prevent the spread of MRSA (and other, nastier diseases).

It's that special time of the year again, when death-dealers descend on Newham to enjoy the 'Defence Systems and Equipment International exhibition'.

It's an arms fair.

In Newham of all places.

I'm always worried that the local gangs are going to storm the fair and loot it of some 'interesting' souvenirs. Then for the next couple of months I find myself dodging cruise missiles and landmines rather than the usual broken bottles, knives and dog turds...

Both the mayor of Newham, and the mayor of London want the exhibition to stop coming here - but it still comes, bringing with it massive disruption for the people of Newham.

So there will be lots of demonstrations (some have already taken place, such as a street party), but as the exhibition starts tomorrow we are expecting things to start warming up a bit. I haven't seen any soap-dodgers protesters yet, but I'm guessing that tomorrow will see the banner wielding population of Newham increase a thousand-fold. At the moment it seems that a lot of their tactics involve blocking various roads that control entry to the exhibition.

So far I have seen a veritable army of police arriving, shields at the ready (4,000 police taken from other duties to cover the event). Obviously this leaves the rest of London a bit short on policing. I've seen convoys of riot police making their way to the area, and this morning there appeared to be random vehicle checks.

On our part, the LAS have manned an extra ambulance or two for the duration of the exhibition. Sitting in the sun watching people shouting seems like an easy way of getting some overtime. We are also doing other things, but it's probably not a good idea to tell the world and his wife about it. I just hope that the exhibition organisers are paying for our services, after all, it's not like they are short of money.

It might be interesting to print out a spotters card of dictators, warlords and despots just to see how many you can catch turning up in unmarked limousines

I must admit I'm torn. I like the police, they are always helpful, they do a job that is remarkably difficult and when I've needed help they've always turned up and been very useful.

But...

I really sympathise with the protesters, and if I wasn't working, then I'd probably be there amongst them waving a banner and trying not to get stood on by a police horse.

So I'll sit on the fence and say that they are both going to be a huge pain in the backside because they are both going to block roads, probably injure each other and will cause traffic jams when I'm planning on going home.

The philosophy of Reynolds - 'balance through the dislike of everyone'.

A charity is calling for the Scottish Ambulance Service (SAS) to be prosecuted after a damning report from safety inspectors.

I'm off to bed - early start in the morning *gaah*, so no comment. Anyone from the SAS fancy commenting?

Can I have one of these please boss?

It is designed to plug into an oxygen cylinder and will automatically perform effective CPR (they tested it on pigs, which I can't really support - I like pigs, and I have friends who love pigs.)

I mean, not only will it mean that I can be lazy and not actually have to jump up and down on someone's chest, but if I'm the sole responder I can then concentrate on breathing for the patient.

Also it is more effective than manual CPR, and unlike me it doesn't get tired.

Only £6,000 - we can't let Staffordshire ambulance service beats us now, can we?

Note - photograph from the Daily Mail website, copyright does not belong to me.

I’ve not posted anything about hurricane Katrina, mainly because I have to say that hasn’t already been said by better people than me.

Instead, here is some haunting writing by two Paramedics caught up in the middle of it.

“Unfortunately, our sinking feeling (along with the sinking City) was correct. Just as dusk set in, a Gretna Sheriff showed up, jumped out of his patrol vehicle, aimed his gun at our faces, screaming, "Get off the fucking freeway". A helicopter arrived and used the wind from its blades to blow away our flimsy structures. As we retreated, the sheriff loaded up his truck with our food and water.”

“In the pandemonium of having our camp raided and destroyed, we scattered once again. Reduced to a small group of 8 people, in the dark, we sought refuge in an abandoned school bus, under the freeway on Cilo Street. We were hiding from possible criminal elements but equally and definitely, we were hiding from the police and sheriffs with their martial law, curfew and shoot-to-kill policies.”

This is a post that has been a long time coming, if only because I can't really think of a way to make it in the slightest bit interesting.

Agenda For Change.

The short (and therefore hopefully less boring) version is this.

The government want to standardise pay for the whole of the NHS, so they are splitting different wages into 'bands', from band 1 the lowest, to band 9, the highest. Within each pay band is a range of potential wages, so, for eaxample, pay band 4 starts at £16,004 and then increases in 6 increments to £19,284.

Band 5 starts at £18,698 and then increases in 8 increments to £24,198.

Are you with me so far?

To decide what banding each profession in the health service starts at a group is convened, and they "job match". So if for example you "Supervise fellow workers", or "At risk of potentially serious physical abuse", then you score some points and can be put into a higher band.

This is the problem that we in the ambulance service have - because of the things we are expected to do in our daily work, the government would have to pay us a lot of money.

So it has taken two years for them to try and work out how much to pay us.

They still haven't decided.

But today (actually I as was writing this) they published their findings.

Paramedics will be paid in band 5 (to be reviewed in 12 months).

They still haven't decided on EMTs (which is yours truly).

The bulletin that we have just recieved states that 'experienced' EMTs will be paid in Band 5, while less experienced ones will be paid less.

This is, frankly, a load of bollocks.

The reasoning behind the different increments within the band is that this is to represent increasing experience. The banding is supposed to represent what our job is.

EMTs all do the same work, so why I should I find myself working with someone who does all the same things that I do, has the same skills and has exactly the same job description, and yet gets paid a differing amount.

(But we won't know for sure for another two weeks...)

I can see a few things happening.

First, the Unions have all signed up for this, and so the general feeling from the crews on the road is that we have been sold down the river, this means that morale, which is poor at best, is going to plummet.

Secondly, I imagine that our ORCON percentage (our main benchmark of performance) is going to also take a nosedive.

Thirdly, it's going to cause friction between EMTs, paramedics and Team Leaders (who are on Band 6 despite hardly touching a patient). Especially when you consider that Paramedics are going to be paid their new, higher rate much earlier than any change in EMT wages. Add in the time that it will take for them to decide which EMTs are better than other EMTs and there will be a huge disparity in pay for quite some time.

My next post (assuming a Major Incident doesn't happen beforehand) will be about how the LAS could have lessened this problem.

Just to remind everyone (because at the moment I am incredibly angry, and this may explain any typos) is that the thoughts and views expressed here are mine alone - they do not reflect on my employer, or anyone else in the service.