This strikes me as a horrid idea. This is relying on the dispatcher and/or the patient to correctly diagnose the situation ["correctly" never happens]. Where I work in the states, we respond to everything Emergent simply because you never know precisely what's going on at the other end of the phone. We do also have First Responders that also will respond to a call, but they do not by any means replace us.

I imagine this completely throws the "Golden Hour" idea out the window.

I agree with you PunchingJudy, the whole point is that ambulances are being called for the wrong reasons, and that callers are able to either manipulate the situation so that a Cat A is demanded or the despatcher is unable to take the risk not to send an ambulance.

It only needs to go wrong once to be headline news. Tom et al are doing this job to help people, certainly not for the money (!) and yet in the press they will be vilified for a judgement call that goes wrong. So frustrating.

But there is also the risk of emergency response to factor in.

As lights and siren response is not without a fair deal of risk, I'd be very reluctant to respond to everything at above-normal road speed.

Plus there is the assertion (at least here in NZ) that Priority 1 driving (what we call lights and siren) is overrated, and doesn't reduce the response time by a great deal in a lot of cases.

So I think the situation isn't as clear cut as P1=legally/morally safer. But I certainly agree about the press. I think the definition of a reporter is someone who talks alot about something they know nothing about!

Not sure but I think we already have a system similar to that in Suffolk. When my elderly Mother had a fall we were unable to move her but a nice chap in a Land Cruiser arrived after we dialled 999 and got her back her feet with a nifty little move and she needed no further treatment apart from tea and an icepack.

On there other hand when I sprung a leak half an hour after dialysis (in a Tesco's car park, the staff dialled 999 to my enduring embarrassment) I had the full monty - full size ambulance, blues & twos, got there in about 4 minutes.

It's because of my incident that I think there should be some kind of intermediate level non emergency service to render first aid but I fully accept that there is the danger of making the wrong choice. Maybe a different non-emergency number would be a good idea - 444 for instance - there are some reasonably competent lay people (don't scoff at that idea please) out there who can decide whether they just need patching up or are need of hospital treatment. If they dial the non-emergency number in the first place wouldn't that relieve the dispatcher of the burden of making the wrong decision?

with the non emergency number, some caller with get it wrong and blame the ambo service. we are becoming to much like the usa for the blame and sue thing.

as for the ' intermediate level non emergency service to render first aid' idea, may end up being covered SJA bods.

This is what NHS 24 was for here in scotland. An intermediate number for people with common sence. Unfortunatly this system is open to the same abuse, usually by the NHS 24 staff, who send emergency responces to people who only want a dressing on a bed sore changed! Dont laugh, this happened.

The long term fix you suggest doesn't take into account first generation immigrants, drunks or tourists.

How about "A Clockwork Orange" style ambo-wastage aversion therapy, with metal clasps to hold back eyelids, and a looping feature of you guys growling and striking aggressive poses with cups of tea, whilst old B*witched tracks play loudly in accompaniment? No-one would want to call you out then. You could use some social engineering to get maximum exposure - like the Anna Kournikova virus, ie: "Angelina Jolie and Brad Pitt sex tapes", and for the kiddies "Santa's house - REVEALED!!". For those without email I'd recommend abduction.

Sorry, woke up on the wrong side of the bed this morning.

Will the cars be able to transport patients or not?

Surely if the decision whether to send ambulance or car depends on the answers the caller gives to the AMPDS questions, you'll still end up with people that learn to cheat the system in order to get a "proper" ambulance?

Just make sure you weren't the last person to see them. For anything that is more than "I've stubbed my toe" but less than "I'm still unconscious with blood spurting out of me", refer it to another professional.

Have a list of duty chemists and say "this is the out-of-hours pharmacy tonight, go there and he will ask you a few questions and dispense what you need" (paracetamol, probably)

Have a phone with a loudspeaker and call the NHS Direct* nurses or an over-the-phone out-of-hours GP service. Describe the situation (and call it a "cough" rather than "severe chest pain" like the patient would) and get *them* to dispense appropriate advice. Leave a card with the NHS-Direct phone number and patient-number on it. If necessary leave a card explaining in idiot's terms how to make an emergency appointment with their GP in the morning.

Call psychiatric services and leave a message on their answering machine. Then it's their problem, and if they don't respond to the message on time, their fault.

You know the system, I'm sure you can turn it to best advantage.

(*I do realise that they are better known as NHS Re-direct, but maybe they'd react differently with an EMT on the other end of the phone?)

Sorry, Batsgirl, but NHS Misdirect (as some of us call it) are generally a waste of time, no matter who calls them. We frequently get calls from punters who state "NHS Direct told me to call an ambulance". What NHSD actually told the person was "You/he/she needs to go hospital" but the punters interpret this as call an ambo. What NHSD need to specify is " You dont need an ambo - use the car, public transport, walk....... I once had to send an amb to an address in SW10 which was LITERALLY round the corner from Chelsea and Westminster hospital, for a three year old with a minor hand injury. The family rang NHSD for advice, who told them to take the child to the hospital, but when the parents said " But it's raining outside", they NHSD said they sould call an ambo...... I give up!!

Why not go the whole hog and just get motorbikes instead since you can't do much with a car anyway.

This is a much better idea! And bikes can be outfitted to contain anything a non-transport vehicle might need.

Careful, or before you know it the bigwigs will think a pair of rollerblades and some wet weather gear is all an EMT really needs...

As always, the bean counter's approach. In my own (rural) setting, people tend to summon an ambulance only when one is really needed, so pretty well all of our patients go to hospital. Despite this, we are still made to crew a couple of RRUs - by management's admission, just as CatA Target Busters.

Our dispatchers tend to ignore the RRUs; if a double-crewed ambulance is available (which it usually is, even if it's 15 miles away (rural setting)), it gets sent, and that's the job done. If a recent rant about CatA responses is fresh in the despatcher's mind, though, he/she may send an RRU to race the responding ambulance to the scene, thereby committing 3 people to a job that only needs 2.

What concerns me about your description of the FRU's role in London is the fact that a large number of ambulances has been sacrificed to provide you with cars. I can understand the attraction of single-crewed assessment of patients to the bean-counting mind; however, I wear a green suit, and I know that I would still be sending everybody in. ("Crew and patient safety." The word "crew" comes first, and I take "safety" to include keeping my job.) So, I suspect, will the LAS staff - and now you have 100 fewer ambulances with which to do it.

As you say, it could work, and I sincerely hope that it does. However, I think it more likely that it won't. You can't escape the fact that nobody ever was disciplined for taking a patient to hospital.

I spent 7 months on an IRV(thats what we call them round our way), they were introduced as a cat A beater, they seemed to work quite well, we had two teams of chaps, who took pride in what they were doing, we were sent out as an initial response and asked for backup if needed, an Ambulance was only sent if it was a cat A call as well i.e. chest pains. After seven months i was knackered, found a new friend who still speaks to now, strangely only at night when its quiet ive never seen him only heard him!!! The thing is if someone calls for an Ambulance then they generally want an Ambulance, the amount of times i turned up at jobs and the relatives got quite abusive 'cos they wanted an Ambulance, no amount of explaining the"new" system was going to change their minds.
It'll all go full circle again in the end, we'll have vehicles with two trolleys on before much longer, like the good old days, before trusts were invented.......................geeze i sound old!!!

The concept of the RRU/RRV/RFU was in essence initially sound....getting a trained professional to potentially seroius patients with a view to starting life saving treatment. Back up crew would be dispatched once one had "greened up" after doing the transfer/admission/outpatient after treatment discharge/inappropriate job.
When I first started on the RRV we were given extra training and equipment...we were also all paramedics.
Control soon cottoned on that we could just be used for cover while crews were given even more transfers/admissions/outpatient stuff etc etc.
Waiting for a back up crew when you are in a resus situation can be difficult to say the least.
Then with an even greater emphasis on pleasing the Great God "Orcon", we were used as racing cars to beat the clock regardless...a situation made much much much worse with the preposterous AMPDS system. (AMPDS should be sued under the trade description act!!!)
This then brought the introduction of anyone being allowed to man the RRVs....station cleaner and cat included....with the supporting training being diluted...and the inclusion of staff on return to work programmes (as the cars were seen as easy...some people did indeed swing the lead and skived but then this is down to having no system of quality control.)
As ambo people we all know to cover our arses with the paperwork....but how far do we take our responsibility for the patient. Just because we are called to them does not mean we are responsible for them for the rest of their life. As was mentioned in a previous reply we should refer onto other agencies if appropriate.
I, like most of my colleagues, treat for the worst and err on the side of caution. Education of the public should be more high profile rather than just at local level (if this is carried out at all anywhere?).

Kingmagic,
I couldn't agree with you more.
The watering down of the service we provide just to keep the figures/times/beurocrats happy....... Not at all in the best interests of the general public (Or for that matter us, the service providers)
SD

Indeed Snowdrop, really think he's hit the nail on the head there!

Won't be long before only 1 Para/Tech on an ambulance and a 3rd tier person (called HDTS...yes High Dependancy Transport Service but not in the true meaning of HDU!) per ambulance. Put all your Paras on cars, send along a Tech/HDU crewed ambulance and 9 times out of ten, the Paramedic will be available again in approx. 20 mins. A couple of Paras and a couple of ECPs in a sector, apparent appropriate use of resources. A "truly flexible service" apparently!

This needs to be looked at now. The NHS has been watering down the ability of the ambulance services to effectively respond to the public. Okay so some of the calls aren't appropriate, but that's life isn't it? The invention of Super-Trusts, taking away locally based control rooms etc. You would have thought that the lessons may well have been learnt from the London Bombings, that when there is a major incident what help are cars going to be when there are hundreds of injured patients requiring stretcher transfer. They seem twitchy enough to give us dossimeters, excape hoods, atropine in rip away cases in the cabs of vehicles. Do they know something we don't? Perhaps the idea is that hospital admission won't be appropriate for patients after the next attrocity (if you catch my drift).

The nails seem to be hammered into the lids of the coffins of Fire and Recue co-responding with the High Court ruling that it's in breach (I believe it was talking about) the contracts in Notts Fire and Rescue to make them co-responfd, with the comment being about a Health Service on the cheap...where has everyone been whilst they have been giving a defib to every man and his dog and asking them to attend any red call. Don't get me wrong, if my Dad collapses and arrests i don't mind who is there to press THE button, as long as it's pressed. But they are sending them to every red call...falls from height etc. (ok so i'm missing the obvious that the patient may arrest but how many do!?) We all talk about stealth tax...why don't we talk about stealth health cuts?

Stations are being sold, the cheapest inappropriate equipment is being purchased, cheap vehicles that aren't as effective are being considered, shifts being left uncovered because there is no money to pay overtime. It's sheer madness. In our amalgamated trust, the equivalent of nearly the whole budget of the smallest old trust has to be cut...and they say they can do that without damaging the service we provide...who are they trying to kid? The only people to be out of a job and not on a current salary (although recieving a substantial hand shake) are the ex-board of directors...all of the multitude of middle managers have been put in posts with protected pay...where is this leading to? A reduction in the number of bags of filter paper and coffee in the HQ building? Need I go on... But we are told that there is a record investment in the NHS...I haven't seen any yet!

Oh well I'm not so red in the face now and not quite so frustrated...it's good to know I'm not the only one.

One word of warning though. I'm still new to the Paramedic game, being in the service for 5 years (a Para for 2), BUT, I have never seen moral so low as I have now, and the service only works through the commitment and good will of the staff...which is rapidly being lost...what then?!

Signing out...if not off!

forgot to say... I reckon the Welsh Assembly have got it just right, calling an enquiry to investigate the poor performance and state of the Welsh Amb Service, will be interesting to see what they come up with.

Any one seen Mrs Pritchard on TV...perhaps we should nominate Tom for PM!!

Phil (I think I love you.... LOL.....)
In response to this, your first paragraph.....
Won't be long before only 1 Para/Tech on an ambulance and a 3rd tier person (called HDTS...yes High Dependancy Transport Service but not in the true meaning of HDU!) per ambulance. Put all your Paras on cars, send along a Tech/HDU crewed ambulance and 9 times out of ten, the Paramedic will be available again in approx. 20 mins. A couple of Paras and a couple of ECPs in a sector, apparent appropriate use of resources. A "truly flexible service" apparently! "
Just to scare the living bejeezus out of you all.... We are already doing this!!!! (I have to say though not through choice!!!)
Bloody worrying or what????

An even better fix would be, in a Utopian ideal, to make the job less target driven and also to get rid of this attitude that EOC staff can't use their common sense in what really needs an ambulance. Of course there is a danger in this, and ideally, more education in how to actually ask for an ambulance, right from basic first aid to CPR (if some people don't class this as basic, which I do.) My one and only time in possibly needing anambulance for myself was a little episode of palpitations, I was still breathing, no chest pain so I paid for a taxi to take me to the hospital.

As your long term fix mentions, we do need to educate the public. Maybe we should all start now, and damn the government, it's (in my opinion) partly their fault that the mess exists. It has been discussed many a time on here and other (un)official sites. We still have a bastion in free health treatment but we should not take the mickey, because one day the public will wake up and suddenly be charged for an ambulance if hey don't need one. Mmmmmmm.............................. Now there's a thought..... lol

Absolutely, infact i think one day, not too far off, we'll wake up and there won't be an NHS. I think the NHS logistics was the latest branch to go private. The privatisation of and "Stealth health cuts" as Goodgrief put it, in the health service is extremely disturbing, particularly under a Labour government. That old adage that what America does today we do tomorrow appears to be coming true and i shudder at the thought of their model of health care.

From the bureaucracy I see living in the capital of New Zealand, I'd take a private company over a government department any day!

Sounds even worse over there than it is here.

Ambulance service over here is almost entirely private; Wellington Free Ambulance and St John Ambulance cover most of the country.

The funding comes mostly from the same place (Ministry of Health contracts) but I am glad it's not a swarm of public servants trying to run the show.

I might be wrong but isn't that how they do it down in Royal Berkshire already?
I am quite sure they send single respond units without calling an ambulance as well and then they decide if they need one or not..
Does anyone know?

For a number of years we have had an unofficial "treat & refer" policy. But this was down to the individual on the RRV and how confident they were about calling for an ambulance back up or standing the crew down.
It needs to be in writing as we all know if something happens to a patient who has been mis-diagnosed then its P45 time.
So in my area, as in most others with RRV/RFU/FRV cars, different people will work in different ways. Personally I think that single response is a good thing but not at the expense of crews. And we need to really start charging on a sliding scale for the really mad as a banana calls!

haha! it doesn't occur to just increase the numbers (full stop)

Sending out a car with one person in it to make life-or-death decisions will never work. It's obvious to the meanest intelligence (i.e. mine) that all the one person will ever do if there's the slightest shade of doubt is push the decision over to someone else. Then even more people and vehicles will have orbited around the patient than they do now. Meanwhile, there are fewer ambulances because some dingdong decided they wouldn't be needed.

Who thinks of this claptrap?

I'm not sure general education has to take a generation. Besides public service announcements at peak ad-watching times, I wonder if some of the hit TV shows wouldn't be willing to help if outreach people in the ambulance service spoke to them. East Enders, and ER and all the rest of them do "SEND AN AMBULANCE NO-O-WWW!" because it makes for a gripping story, but surely if they could get it through their thick noggins that they could save lives by incorporating something more useful, they'd be willing to do it. It wouldn't have to be any less gripping, any more than it is in real life.

I also think Maverick is onto something with his or her suggestion about having an intermediate service to call. Misdiagnosis then is not newsworthy or sue-worthy, and the responder can still call an ambulance if need be. It should work better than NHS Misdirect because they wouldn't be in a position to misdirect; they'd just be sending out a car rather than the full ambulance.

By the way, to the person above who said education wouldn't reach all the tourists and drunks. That doesn't matter. You're trying to reduce the amount of nonsense. It can never be eliminated.

RE: the above.

Am I alone in thinking that - now that they have settled in, and within the overall healthcare system - NHS24 is doing not too bad a job? Hereabouts, they seem to be managing quite well, and we can see that by far the majority of their calls are being handled by the out-of-hours GP service - either as walk-ins, by despatching out-of-hours transport, or by getting a doctor to attend. Certainly, we do get sent to calls which don't merit an emergency response; on the other hand we get sent to very few which don't merit an ambulance - particularly if you put yourself in the place of the NHS24 practitioner, and imagine what he/she envisaged - as opposed to what you can actually see when you arrive.

A cautionary, true, tale of 2330hrs in the days before NHS24. (It illustrates my point, even though what we found was worse than imagined, not better.) The caller said "My husband has fallen off the settee and I can't get him off the floor." What do you visualise? An elderly gent lying on the carpet, and his frail wife struggling to help him up? Of course you do; we've all been there lots of times. What did we find as we bounced confidently through the front door? A 45 y.o. male in cardiac arrest with his wife and daughter weeping over him. Thank God the call had come as a 999. We were too late to help, but at least we had been swift, so the response looked right.

I have heard plenty of "you couldn't make it up" tales about NHS24, and I've cursed them myself more than once, but the system always seems to fail safe - for which I am profoundly grateful. I have yet to hear personally of a case where NHS24 has failed to send an ambulance to somebody who needed it.

I like everyone else poured scorn upon NHS Direct when in the early days the very mention of "chest" got a 999 response...callers mentioned stubbing toe on "chest of drawers"=999, its very cold outside and my "chest gets tight" = 999 etc.
We don,t get to hear how many calls are fielded away from the ambulance service only the ones where we are sent to be on the safe side. It is getting better...my only complaint about NHS Direct is that I feel it has also created a demand where there was,nt such a big demand before.
The reply earlier about "increasing the numbers full stop.." (more ambulances/crews) wont happen as the books need to be balanced somehow but as I said more RRVs should not be at the expense of fewer crews.
Everyone should work towards helping the patient/casualty in a team effort not to chase targets or times.

I had that from NHS Direct last year... I was fairly newly disabled, and had tightness in my chest and shortness of breath. Website said "call NHS Direct" so I did, thinking maybe they would, I dunno, tell me some stretches to do or something. Next thing I knew there was a 999 operator on the line who was telling me to stay as calm as possible, secure any pets in the bathroom, and could I send someone outside to wave? I was on my own? Well could I prop open the front door?

Within minutes, two ambulance people were lugging heavy bags of equipment up the stairs to my flat and me saying "I'm really sorry..."

To batsgirl. See the above. Don't apologise. That's what we're paid to do.

I really like the idea of sending one person out in a car, given the amount of difficult situations/attacks people in this kind of job have to endure. fucking brilliant really, that'll cut budgets by a) killing/maiming/scaring people out of the profession and b) putting people off signing up to start with.

This is probably irrelevant but touched a nerve: When on a holiday in Austria, one of our group had an MI, a car and bike were sent by the emergency services, (despite being 15 I had to act as interpreter as tour guide felt it more important to keep other punters 'happy'). The patient didn't fully collapse until after their arrival - calmmy,sweaty and blue but still breathing and with an erratic pulse. The bike paramedic said that with a full ambulance he just might have stood a chance, but they couldn't get through traffic with them (lots of Vienna still medieval + narrow) - one did eventually turn up, 20 mins after the poor sod died. Nothing you lot don't already know, but unless the car can carry the same kit as the ambulance, what's the point?

Personally, my quick fix would be bottled common sense! It would certainly reduce the number of inappropriate requests for an ambulance.

I recently spent sometime in Paeds A&E (not as a patient!) and I was really concerned at the lack of common sense displayed by parents and at what people felt was acceptable use of the LAS (and the emergency department in general come to think of it).

In reply to J,s comment the RRV/RRU/RFU etc cars in the UK carry the same equipment as found in an ambulance apart from the stretcher and a carry chair. All cars carry monitor/defibs. Our European collegues work differently in that some only carry enough kit to provide Basic Life Support, whilst in Switzerland an ambulance would pick a doctor up from a clinic or hospital. (Although this does bring its own problems in that emergencies outside a hospital environment are a different kettle of fish).
In reply to cat119,s comment our RRV,s are not sent to potentially violent situations, heroin o/ds, pubs, assaults or domestics.
At anytime an RRV can turn a job down if they feel that its "iffy". With no comebacks. This has happened and the RRV has been backed up by management.
My only complaint about the current RRV situation in my patch is that when I first started on the cars it was voluntary. Now it is compulsory if in your station rota there is a car shift. Not everyone is confident about working alone.

Quite agree...often the cars have better kit than the ambulances!

Then again, those worried/neurotic parents - and believe me most of them probably don't wake up thinking "how can I undermine healthcare in my country today?" - are taxpayers, the people chipping in to "the system" as a whole.

This government spunks its money - OUR money - on useless wars and IT-related disasters, then we're supposed to feel bad if we make a mistake.

I'm against anyone wasting the time of the emergency services (duh) but I'm also against a system that ringfences billions for pointless wars and IT systems that destroy lives (re the CSA suicides, the upcoming ID card disaster) while cutting back on ESSENTIAL services because us naughty taxpayers - their employers - screw up sometimes.

You get a drunk guy with "chest pains" wasting as much taxpayer's money and causing as many innocent people to die as this government's policies and I'll reconsider, until then, I say the issue is to put out more ambulances, not blame the people paying for them through the nose.

I have to say smoochie...i think we might have a winner.

A regular patient of ours was calling perhaps 7 or 8 times a day...he was an alcoholic who always complained of chest pains. When you got there his cider was out of reach or he couldn't find the TV remote! We did a report form and we worked out that on the basis of the number of calls recieved, the activation of an RRV and an ambulance...it had cost the taxpayer over £500 000 that's just one person!

Unfortunately for this patient he was taken very ill and fortunately survived, thank god the crew took notice of him and took him in, eventhough he argued with them all the way to hospital. He has moved back to his flat now but is under an ASBO, it's only taken 18 months or so!

Make that man a govt. minister LOL! Still, doesn't really compare to the CSA or the cost of the war in Iraq, or the millions spent on IT that just doesn't work...

Good to hear he's been ASBO'd up, anyway, and hope that he gets a grip on reality at some point.

That one guy on his own - half a million pounds. Not a lot you reckon, it "doesn't compare".

The many many many people like him - many many many times half a million pounds plus many many many ambulances that should have been going to real emergencies being tied up dealing with irresponsible twats.

The thousands and thousands of time-wasting callers throughout the UK, that aren't as prolific as this guy but still do their bit and waste emergency resources several times a year when what they should do is make a 48hr appointment with their GP - all of those multiplied by the cost of sending out an ambulance and you know what? We've well surpassed the cost of the IT systems and are at the very least fast approaching the cost of the war in Iraq, and we've probably got a good few deaths in there as well due to *real emergencies* having no ambulances available.

Wow, I can see the headline now - "UK Government wastes £572.64 less per annum than alcoholics with ASBOs and irresponsbile twats." That's the re-election campaign slogan sorted then!

Seriously, we're talking about billions in Iraq, and more than a "good few deaths" - last I heard, it was somewhere between 200,000 - 650,000. Google "depleted uranium" and you'll see those deaths won't end when the last of the troops pulls out, either.

Just to be clear since it's slipped off the radar, I'm not PRO drunks and idiots wasting ambulance time, just anti a govt who wastes money, kills innocent civilians in their hundreds of thousands, then blames the people (us) who gave the money to them as taxes for cutbacks in essential services.

It's a tad worrying when we're having to compare the leaders of our country to "irresponsible twats" and alkies, and reckoning they're playing on comparable levels of waste and damage to innocent people, surely?!

Peace.

ECP=CHEAP DOCTOR
BIG AMBULANCE= TAXI + MOBILE HOSPILTAL FOR THE"SICK"+LIFTING=BACK PAIN (emt2+3)
FIRST RESPONDERS=CAT A =PANIC ATTACK
GREEN BASE= NOT SURE???
NEW FIRST RESPONDERS=CHEAP ECP=GOING VERY WRONG=P45
TEAM LEADER=PEN PUSHER+OVER PAID=SMILES
DSO=REPLYING TO EMAILS=SLEEP
UNI DEGREE PARAMEDIC= CHILDEREN =WHY?
PARAMEDIC=COULD HELP IF WANTED TO OPEN BAG
EMT3= F***ED OVER BY AGENDA FOR CHANGE
EMT4=NEW FIRST RESPONDERS