I've reached that point in my blogging career where if an ambulance story is in the media I'm phoned up to provide comment.

So this BBC article about solo responders and the concerns about using them so extensively has already had me woken up by one newspaper.

I don't mind - after all it's something I've been shouting about on this blog for ages. Please remember though that I'm just a worker on the road, if you want real information you should talk to the LAS Press office 020 7921 5113 (and who are a bunch of top folks by the way).

Still it is nice to have something that I'm concerned about in the news. For more on this subject you may want to check out the following links.

A simple description of ORCON (The government target we are desperate to meet)

Why I think that splitting crewed ambulances to man solo responders is a bad idea for patient safety.

Where I describe the plan to increase solo responders and decrease double crewed ambulances. (I'm a lot less enamoured of the idea now than when I wrote this).

One concern for staff and patient safety that often isn't thought of.

Where I moan about some of the hoops we have to jump through to get our targets - but the comments section has more information.

My solution to the 'target' question that will actually benefit patient care.

To summarise things as I see them (and remember - these are my views alone, not those of my employer).

The government wants to measure the performance of ambulance trusts. The main way of doing this is to see how many of our 'high priority' calls we get to in under eight minutes. There are often more calls than there are ambulances, so solo responders effectively double your workforce with respect to reaching this target. Once a responder reaches a patient, the clock stops.

Solo responders can't safely transport patients. They also are unhappy to leave people at home because they are scared they will die. Solo responders therefore can spend a lot of time at scene waiting for a double crewed ambulance to arrive.

Sick people need to be in hospital - it is better to get there in nine minutes and be able to transport them than to get there in seven and have to wait half an hour for a proper 'truck'. The government does not agree.

The eight minute target is from research over 20 years old - and it only deals with cardiac arrest patients, not with 'high priority' calls. The department of health has no copies of the ORCON paper on record -although there is one in the British library. Modern research says that eight minutes is too long to get to a cardiac arrest.

Although our ORCON response percentage in London is roughly the same as has been every year, our cardiac arrest survival rate has more than tripled. Doesn't this show that other initiatives (which aren't tallied up by the government) are far more important?

Getting to patients quickly is never a bad idea, but in concentrating resources on solo responders at the expense of double-crewed ambulances I firmly believe negatively impacts patient care. Sick people need to be in hospital.

In London we are about to start running community responder posts - first-aiders from the public sent to calls. This is so deeply wrong that I can't get my head around it. Again I suspect that this is to help us meet these targets. It's not like we are in the wilds of Scotland where it physically takes you an hour to get from one place to another.

This is just the beginning of the discussion - the plan is to have all but the most serious calls (like confirmed cardiac arrest) attended to by just a solo responder, a double-crewed ambulance won't be sent - once the solo is on the scene they will make the decision as to the patient needing an ambulance to transport them, or if they need a GP, or can make their own way to hospital.

The simple solution is that we need more ambulances and more ambulance crews - but the government won't reach into their pocket and give us what we need, so instead the ambulance trusts have to make these difficult decisions.

It's not the ambulance trusts fault that we are heading down the solo responder route - it's purely the government's focus on this out-of-date target and lack of motivation to give us the funding we need to continue giving Londoners the care that they expect.

Oh and people call us for utter rubbish like veruccas - which is why we are under so much strain at the moment.

I'm hoping that this will run and run and might cause some form of change - unfortunately I suspect that this story will soon be ignored because of some celebrity drug 'sensation' or we find someone else who has faked their own death.

Remember I was telling you about the new function on our display terminals in the vehicles, the one that counst how long you have been at hospital? This is a picture that my crewmate took while I was away playing on the FRU the other day. It shows that she was waiting to hand over their patient for two hours.
It's been crazy the last few days - we leave the station at the start of our shift to attend to a patient who has been waiting for us to start work. Then we spend the rest of the day out, running from patient to patient. While doing my paperwork at hospital or on the way to a patient all I've heard is our dispatchers doing 'general broadcasts' to see if there are any ambulances available to attend to the 'many emergency calls across the sector'.
It's not even your usual winter pressures - I'm yet to see much of the traditional winter illnesses. It's not like there is a sudden increase in 'flu' cases, there hasn't been an outbreak of Norovirus. It's been the usual run of people with chest pains, old people collapsed, drunks, abdominal pains - all the usual stuff, just much more of it.
I was speaking to a hospital site manager the other day, she agreed that there isn't any apparent reason for the increase in people coming to hospital. It's the normal stuff, just more of it.
So we have been waiting at the hospitals, which have been filling up with patients - this means that patients have been waiting for ambulances.
Which was why an lovely old fella was waiting for an ambulance for an hour on the floor of a shop with a broken hip.
Then he had to wait for two hours on an ambulance trolley in order to be handed over to the hospital.
I can't see a solution to this - there will always be periods where more people need emergency healthcare. While I think that we should have more ambulances - this isn't a solution to these short term increases in demand.
Hopefully it'll be better in a few days.

I was spoken to by a reporter from 'The People' newspaper in order to get my comments on the winter pressures. I explained that, as an organisation, we have a pretty good process in place to deal with the demand. As pressure increases we do various things to increase the number of ambulances on the road. Overtime also becomes available - which is nice for us poorly paid people.
The strange thing is that the day after the People article (by Tom Carlin) is published, an very similar article is front page news in the Daily Express. This article is by Mark Reynolds, and contains the same quotes (and a fair bit of the same sentences). Except that they misattribute comments from a nurse as comments from me.

Isn't this plagarism? Or just the 'echo chamber' that blogs are often accused of being.

Have a look and decide for yourself -
Original article in The People.
Second article in the Daily Express. (The comments to that article are both scary and hilarious)

Finally - I managed to persuade my brother to buy himself a Macbook Pro (better than my Macbook, the swine! The next person to say that teachers are paid rubbish will get a severe talking to from me). It was a right struggle to get him to open his wallet - but he's now really rather glad that he did. It especially made an impact as to how easy it was to set the Mac up with his home network as opposed to the swearing I was doing trying to get his Vista machine to work.

Does anyone have any 'killer apps' that they would like to suggest? He's impressed with the ease of Handbrake and iSquint to get video ready for his iPhone. I've already got him admitting that Quicksilver is 'greased loveliness' and he has Delicious library installed but I'd love to hear what other people are using.

Lets talk about something nice for a change.

The LAS, not only doing well against nasty infectious diseases in the backs of ambulances, are also doing pretty well in the fight against people dying from cardiac arrest.

The latest figures for the cardiac arrest survival rate are out and we are doing really rather quite well.

In 2001-2002 of the people having a cardiac arrest, only 5% survived to be discharged from hospital.

in 2005-2006 it was 10.9%

Last year the survival chance is up to 15.8% - more than a three-fold increase from 2001-2002.

We must be doing something right. I would suspect that it's partly down to the change in the resuscitation guidelines. We've moved from the old (and very easy) five chest compressions at a time, to a much more knackering, but also much more effective 30 chest compressions at a time. Also our people who answer the 999 calls are moving towards giving people who call ambulances for cardiac arrests better instructions how to start CPR - we are currently in the middle of a research project based around improving these instructions.

The LAS has also been working in putting public access defibrillators in place in addition to training staff, such as rail and tube workers, in their use.

This is funded, not by the government, but by lottery money...

It's good to see us doing something right, just because it is right - even though the government doesn't 'mark us' on it.

There is only one slight downside to this - and it's because of the simplistic way in which the press reports things. The cardiac arrest survival rate is calculated using the Utstein* method. This means (very simplistically) that it is only the people who realistically have a chance of surviving that are counted. Poor old Doris whose heart stopped two days ago doesn't get counted. This is unfortunate in that this reporting still gives some family members a heightened expectation of their relative surviving - in which case it is up to the crew's people-skills to explain what has occurred.

*The cardiac arrest survival figure is calculated using the Utstein method, which takes into account the number of patients discharged alive from hospital who had resuscitation attempted following a cardiac arrest of presumed cardiac aetiology, and who also had their arrest witnessed by a bystander and an initial cardiac rhythm of ventricular fibrillation or ventricular tachycardia (From the LAS release).