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FAIL

by Reynolds on Mon 21 Dec 2009 12:46 AM GMT | Permanent Link | Cosmos

He's ninety years old, ex-army.

He's slipped on the ice coming out of his house, we are sent to the call as 'Fallen over, leg is at a funny angle'.

We get there, he's broken his leg all right. He's lovely, the family are lovely.

He has waited one and a half hours for an ambulance.

I am furious. He has been laying on the ice for that long without an ambulance. I've just come from the hospital - the police have been bringing in patients with possibly broken ankles because there are not enough ambulances.

-----

Apparently it doesn't matter, as the 'public perception' of the service is high.

That doesn't mean we provide a good service - it just means that our PR department is good at making us look good.

-----

It's not a hard problem to solve, I can see what it is and I'm on the bottom rung of the ladder.

We do not have enough ambulances to meet demand

It's that simple.

We don't need 'initiatives' where a driver and an ECP go around to a house to see if the call really needs an ambulance.

We don't need 'smarter ways of working' - because it won't work, the reasons are many and varied - but it won't work.

What we need are more ambulances and more road staff.

You don't have to be a genius to work that out.

-----

Year on year the increase of our calls is around 12%.

Our Boss, Peter Bradley seems proud that we will soon be dealing with one million calls in a calendar year.

He's crazy.

The number of calls increase but the number of ambulances, the number of hospital beds don't.

"But there are 400 students being trained at the moment", our PR department will say, "It will all be fine".

Ask how many leave the course, ask how many finish the course and then leave because they are already disillusioned with the job, ask how many regular road staff are leaving the service, retiring, getting the sack, or changing careers?

Is it really a 'huge influx' of staff once you take all that into account?

-----

Even if we have the staff we don't have the vehicles.

The other day my colleagues at my station were waiting five hours for an ambulance. This is not unusual.

We've ordered more, but it takes too long - we spent too long without getting new ambulances.

There aren't enough ambulances on the road.

-----

The population of London is increasing, a large amount of this increase comes from immigration, or the expanding of immigrant populations.

Immigrant populations tend to be both poor and under-educated.

Can you tell what the two big causes of poor health are?

Poverty and a lack of education.

We aren't doing too well at getting these populations out of poverty, so it's no wonder that the number of people wanting an ambulance is increasing.

-----

We aren't going to get people not calling ambulances.

People want ambulances to take them to hospital for free, and no matter how much we tell people otherwise they will continue to call us when they should be using other modes of transport, or not going to hospital at all.

(Today a nurse made an announcement at one of our A&Es that the waiting time was four hours; more than a few people moaned that it was too long and went home - how much of an 'emergency' was their reason for being there in the first place?)

-----

It's simple - More Calls Need More Ambulances.

It's not rocket science.

-----

"Unusual weather conditions" the PR department will say, "Lessons will be learned" they will say when someone dies waiting for an ambulance.

Here is a lesson that seems to have escaped those way above my pay scale - In winter, demand for ambulances goes up. We should then provide more ambulances.

Not blokes on pushbikes, not community responders, not FRUs to stop the clock in order to keep the government happy.

More ambulances to take people to hospital.

-----

If I screw up, I could lose my job.

If I say the wrong thing I could lose my job.

If I'm sick too much I could lose my job.

Apparently if I can't produce enough ambulances, if I can't ensure that they are equipped properly, if I can't promise to get an ambulance to an elderly person with a broken leg in the ice within a reasonable time - well, my job is safe.

I'll probably even get a promotion.

-----

What is important? It's not the 'public perception' that management and the government go on about, it's not about meeting a pointless target.

It's about not leaving a ninety year old man freezing on ice for an hour and a half.

Simple.

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Re: FAIL

by Vic on Mon 21 Dec 2009 08:14 AM GMT | Profile | Permanent Link

What you also need is fewer drunks, fewer cut fingers, fewer tummy aches and a change of attitude from those who call an ambulance over some ailment that can be cured by a couple of Anadin.

Re: Re: FAIL

by Reynolds on Mon 21 Dec 2009 10:59 AM GMT | Profile | Permanent Link

Agreed - but it's not going to happen. Entitlement syndrome is an epidemic for which there is no cure - or at least no cure that wouldn't kill the patient.

Re: Re: Re: FAIL

by Adrian on Tue 22 Dec 2009 06:26 PM GMT | Profile | Permanent Link

Is there a drug that could be given to drunks at A&E that would give them the mother of all hangovers? Literally make them feel like death warmed up? That could reduce the number of drunks. I suppose you then have the problem with discriminating with people who have had their drinks spiked...

Re: Re: Re: Re: FAIL

by Stonehead on Wed 23 Dec 2009 05:33 PM GMT | Profile | Permanent Link

Is there a drug that can be given to bureaucrats and politicians to make their brains work? Or failing that, one that makes them vomit every time they lie?

Re: Re: Re: Re: FAIL

by Caz on Wed 23 Dec 2009 07:18 PM GMT | Profile | Permanent Link

Wouldn't work. People who binge drink like that already have problems making the link of current behaviour to consequences at some nebulous time in the future. What's needed is something that makes blood alcohol above a certain level immediately and severely nauseating.

Or just stop wasting money on business/media consultants and spend it getting and keeping more ambulances on the street.

Reminds me I must pop by our nearest station with some treats for Xmas tomorrow. I'll probably make it something in pocket packs this year so they can be grabbed and taken out on the road as I doubt there'll be much lounging in the tea room with the weather we've had.

Re: Re: Re: Re: Re: FAIL

by Guest Blogger on Sat 26 Dec 2009 04:31 AM GMT | Profile | Permanent Link

Didn't/doesn't Naltrexone do this?

Re: FAIL

by The Saint on Mon 21 Dec 2009 08:15 AM GMT | Profile | Permanent Link

Well said. At 17:00 yesterday (a Sunday for heaven's sake) the cad number hit 4000 for the day (ie since 00:01). Elderly people were doing involuntary "dancing on ice" all over the place. The ambulance manning on Sundays is usually bad compared to the rest of the week but yesterday was appalling. Managers could have been out and about manning ambulances, but that would have been far too easy.

Re: FAIL

by piebald on Mon 21 Dec 2009 09:20 AM GMT | Profile | Permanent Link

I work as a consumer advisor in mental health (that is someone who has been a "consumer" - patient in plain english - who is employed to advise management from the "consumer" point of view). Managment needs to be advised to tick a box - they don't need to actually act on that advice. There is the same sort of pull towards rhetoric over reality in our service. I just try to do what I can, initiate projects that are actually useful and might win a prize which is what some of the staff are motivated by. You do an incredibly useful job, and you are helping by doing that job. there seems to be little we near the bottom of the food chain can do about the absurdities of the system - however I'd say that whatever that is that can be done you are doing - both by doing your job and by writing this blog. Well done and thanks and please don't get disheartened you do a lot of good.

Re: FAIL

by JunkMonkey on Mon 21 Dec 2009 01:06 PM GMT | Profile | Permanent Link

I have been getting text alerts as a voluntary ambulance service member of pleas to help out the local NHS services as they're stacking calls so much. Unfortunatley I haven't done the blue light driving training yet so I can't go and help but it really does show how over-pushed the ambulance services around the country are.

Re: FAIL

by piebald on Mon 21 Dec 2009 02:43 PM GMT | Profile | Permanent Link

I have thought about this some more and wonder if the underlying problem is not necessarily that you need more ambulances to do the real job (helping people who have a medical emergency and getting them to hospital) but that you need a more effective (i.e human and not pre-determined script based) triage system - so you spend your time doing your real job. This is a point you have made loads of times and I think is behind your inablity to help patients like this man in a reasonable timeframe. My take is that we have become so risk adverse as a society that we are actually taking much larger long term risks because we are unable to face up to the short term ones.

Re: FAIL

by Chuck on Mon 21 Dec 2009 02:59 PM GMT | Profile | Permanent Link

Just disgraceful, the people at the top are now so disconnected from reality I'm sure they actually think they're doing a good job.

Even when they know their not, they don't care unless until it's in the papers, then there's an inquiry, a token 'firing', which is 9 times out of 10, just a transfer that looks just enough like a firing to sate the papers until they find the next story.

Not to mention how is snow in winter "unusual weather conditions" FFS? If it was 45c outside with people dropping from heatstroke everywhere, that's an unusual weather condition for December. It being cold isn't.

Idiots.

Re: FAIL

by keith05kate on Mon 21 Dec 2009 05:12 PM GMT | Profile | Permanent Link

i know where you are coming from i work in manchester under the new and improved name NWAS at best yesterday we hit a measly 38% of targets WHO CARES what bothered me most was the fact i was turning up to Open Tib and Fib Fractures that had been waiting more than an hour lay in the snow (70 year old) which had been coded at best amber when people who had a slight sniffle SOB got a red and then the family would say they would follow in the car HOW ABOUT TAKE THEM IN THE CAR when will management see that the population figures they have are from about 15 years ago and are in no way current what would also be nice is to see managment ON THE ROAD

Re: FAIL

by Redcat2 on Mon 21 Dec 2009 08:57 PM GMT | Profile | Permanent Link

At least you still care enough to get mad. It might be bad for your blood pressure but the scary bit is when you can't be bothered banging your head against the wall any more...

Re: Re: FAIL

by oneunder on Mon 21 Dec 2009 09:33 PM GMT | Profile | Permanent Link

The sad thing is that the people who pay our wages (the tax payers) have no idea what we do. They assume, and fill out the questionnaires on the assumption, that we are an accident and emergency service. Instead we are all clock stoppers and statistical target reacher's. Who, rarely use some medical skills and can always be replaced with a newer cheaper version if we make too much fuss.

Re: FAIL

by Jo on Mon 21 Dec 2009 11:52 PM GMT | Profile | Permanent Link

Brilliant post, Tom.
I worked Sunday on an RRV and it was ridiculous - well, more ridiculous than the usual ridiculous.
One patient I attended was waiting 3 hours for an ambulance. ....for a query sub-arachnoid !!! He was classed as a Cat C
Meanwhile, a 22 year old with a headache and shivering got....yes, you guessed it Cat A.
Will the madness ever end?
Not as long as we worship the false idol of ambualnce targets/

Re: FAIL

by BRCJGood on Tue 22 Dec 2009 12:13 AM GMT | Profile | Permanent Link

Yeah, we are seeing this down in Cambridge, I'm a Red Cross First Aider (lowly, I know) but our ambulance crew was requested by the Ambulance Service 3 times, and that was only yesterday! It ended up with them ordering in all BRC Ambulance Officers out. It ended up with single crews in an ambulances, not just FRUs, rediculous!

Hopefully this weather will clear up, making the roads better for all of us (especially you guys out in the ambulances!)

Try and have a good Christmas!

Re: FAIL

by Wedgie on Tue 22 Dec 2009 09:15 AM GMT | Profile | Permanent Link

Alas its the same story all around the world. The public come last in this competition for ever decreasing government funding. Health spends billions of pounds [dollars] and people still lay in agony for hours. The gods of ProQa should be ashamed of themselves.

Re: FAIL

by Eric on Tue 22 Dec 2009 11:51 AM GMT | Profile | Permanent Link

Obviously yesterday was a nightmare on the roads. But yesterday I saw 2 teamleaders out of the office in FRUs. Can't help wondering if this was seasonal overtime/bonus driven, or has management chased them onto the road to hit more targets. Don't see them out too often at other times. If more of the office staff got out into ambulance we would give a better service. But that goes back to your original point about not enough ambulances.
We got an "excellent" rating for finances, and only "fair" for service performance. Penny pinching I think. How about spending some more money on vehicles so that we get downgraded to a "good" rating on finance, then with the extra ambulances we can increase to a "good" rating on service?

Re: FAIL

by cove medic on Tue 22 Dec 2009 05:37 PM GMT | Profile | Permanent Link

Just got home after starting an RRV shift yesterday a 6am. finished at 23:30. had to stay at station as couldn't get home and on shift again today. The reasons for staying on so long? At one point it took my control 1 and a half hours to mobilise a resource to a cardiac arrest with bystander CPR in progress! 75, 999 calls stacking. 15 of them Cat A. every one stayed on as late as was safe. If only the pubic new! I'm in a county next to London.

Re: Re: FAIL

by Tec on Tue 22 Dec 2009 07:58 PM GMT | Profile | Permanent Link

I do feel a little bit guilty about wandering in and out of this forum like the spectre at the feast, making smart-arsed comments.

But the truth is, I am so proud and pleased that I don't have to deal with this shit anymore. Leaving the Anything Service was the best thing I have done in many years.

Seriously guys, get out if you can. There are a few kind souls on here who express gratitude for what you do. But this is just preaching to the converted. The vast majority of the Great Unwashed don't give a toss and the abuse will just get worse.

For the sake of your health and sanity find another job. I did and I am a new man (a better one).

Re: FAIL

by Vetnurse on Wed 23 Dec 2009 10:03 PM GMT | Profile | Permanent Link

I am sorry that you all have such a s**t time with your management can l just say thanks from my folks and l as we have had to call an ambulance fairly regular for my 92 year old dad over the last 2 years.

We had to call an ambulance out for my Dad on friday they were there within 20mins and simply brilliant.

I was going to take a tin of foxes biccis and a couple of tins of quality street to the local ambulance station as a thanks for all their help over the last couple of years with my Dad.
Instead l dropped the foxes (hadn't bought the chocs at that point) on the ambulance seat and told them had a good breakfast. Took the 2 tins in on Monday 1 for night shift 1 for day shift.

Also following a comment Tom made ages ago l dropped off a letter at the same time to the senior station officer, commending the crew who dealt with my dad (and mum) for their professionalism and kindness . They had a hell of a job moving him with his spinal pain and his spinal deformity and couldn't have been better.

Merry Christmas and a good new year to all ambulance crews. And may management be struck with collective intelligence and make your lives easier. Well one can live in hope :-))

Re: FAIL

by flexo24 on Wed 23 Dec 2009 11:52 PM GMT | Profile | Permanent Link

Agreed, I work in SCAS control. We were on REAP Level 5 today (!!!), declared a 'Major Incident' and by 2pm we were night on 2,000 calls (with the average 24hr period being 1,000)

It's awful. Call after call was people asking where the ambulance was. 500 outstanding jobs with only 100 ambulances. Poor old lady had a fall at 2pm, no one saw here until 6pmish!

Anyhoo, Happy Christmas to all NHS Staff :D

Re: FAIL

by DSO on Thu 24 Dec 2009 10:31 AM GMT | Profile | Permanent Link

I'm not sure why I got so angry reading your post.

It could be the way you champion a "brute force and ignorance" approach to problem solving that you yourself know is not based in any form of reality.

I love the idea of 12% more staff year on year, not forgetting 12% more vehicles and equipment, oh and 12% more support functions for those staff; makes a great sound bite! But where are all those patients going? Not to 12% more hospitals with 12% more staff and 12% more beds thats for sure!

Your solution does nothing to manage the growing call volume. It fails to take account of a reduction in funding that will only worsen under a Conservative government.

You can bemoan these funding issues but the truth is that you, your readers and the vast majority of the electorate are not prepared to pay for the Health Service you suggest. Thats a reality!

So maybe I was upset at your throw-away comments about an alternative solution! Could be that I thought you'd look into what happened a little before writing it off so completely. But you haven't, 35% reduction in conveyance to hospital is a significant improvement, but then you don't know that because you haven't looked at the data!

But in the end I think what upset me the most is that you're better than you that post! Emotion is a great driver and passion makes for good reading but in the past you've always underpinned it with an ability to recognise the "other side" of an arguement and an understanding of the complexity of the situations you write about.

I don't know whether you're too heavily influenced by the "Compare the Meerkats" simples philiphosy but this offering was a dissapointment.

That said, Happy Christmas and here's wishing 2010 brings you what you want from life

DSO

Re: Re: FAIL

by Reynolds on Thu 24 Dec 2009 12:40 PM GMT | Profile | Permanent Link

Hold tight to that 35% while old people are laying on the floor with broken hips for an hour and a half.

I'll mention that 35% number to my next call that is supposed to be seen in 18 minutes - yet is held for *four hours*.

I'm sure it'll bring comfort to the woman having a miscarriage waiting for an hour.

No - I don't see the numbers, or look at the spreadsheets - because I'm on the road and I know the realities just fine.

Keep thinking of it as CAD number increase, and ambulances are being left unmanned for FRUs - FRUs that are *untrained* to decide if someone needs to go to hospital or not.

It's rumoured that the ECP programme is in tatters - instead we'll have paramedics with one or two modules being told to do that same job.

'Green motors' going to #NOF because they are low priority, that don't have Morphine, that can't manage blood loss. Meanwhile I'm sent to the 24 year old with a runny nose.

I can reduce the number of calls as well - Just refuse to send to anything that isn't a 'chest pain'. But is that the service you want?

Where is our excess capacity? We *know* that there are spikes in demand, yet seem unwilling to plan for it.

Lets face it - we can't even work out if enforced overtime is allowed or agreed to.

To answer your question - I *would* pay more tax, if I were convinced that it would go to the NHS and not into a pointless war or bailing out private businesses.

Numbers are fine - but I'm in this job to *help people*, while I wasn't at the meetings I'd suggest that trying to get high non-conveyence is primarily about Orcon targets and budget rather than patient care.

If it's all so wonderful, why are there constant GBs for calls being held (and not just at this time of year)? Why are 90 year olds laying on the floor for an hour and a half? Why are FRUs stuck on scene with sick patients for two hours?

Non-conveyance will only go so far - and without a commitment to staff training, quality control and staff support, it will only last until too many die after being left at home.

Or are you saying that no matter the increase in population and call volume we will be able to provide a consistently good service without more staff and ambulances?

I look forward to the Olympics when we have to start relying on the private ambulance firms that have sprouted up everywhere to do our job for us.

And, yes. I *am* emotional. I'm emotional because I looked at a ninety year old man being failed by his country, by the NHS he has paid tax on for all his life.

When you look into someone's eyes and have to apologise for taking so long to get to him laying in the ice - that 35% means bugger all.

-----

And thanks for the good wishes - I hope that everything goes well for you as well.

Re: Re: Re: FAIL

by oneunder on Sun 27 Dec 2009 02:01 PM GMT | Profile | Permanent Link

The problem that lead to this type of situation are multiple and varied. There is no quick fix but the call rate had to rocket with the difficulties in seeing a GP.

Jobs like this should get us all angry and it's a good thing that Tom cares enough to get angry. Most of us are too shell shocked to care anymore. We spend so much time with people who need nothing more than paracetamol.

At some point we need to go back to the public and ask "What do you want the Ambulance service to do?"
I bet a very low percentage would say that we should be going to a cold, let alone treating it as a cat 'A'.

There is a great line about statistics, 'There are lies, damned lies and statistics.' The numbers come up in relation to the questions asked but are the right questions being asked?

What should an Ambulance service be doing?
Why is the drunk in the street a Cat 'A' (response less than 8 mins)when the 90 year old with a fractured leg only a cat 'C'? (response when we have a spare ambulance not going to a drunk in the street.)

Re: FAIL

by joan on Thu 24 Dec 2009 11:45 AM GMT | Profile | Permanent Link

TO tom and all your crew
Wishing you a happy xmas and new year
all the best
joan and family xxx

Re: FAIL

by Vic on Fri 25 Dec 2009 12:17 AM GMT | Profile | Permanent Link

The most ridiculous part is the way the social do-gooders believe the way to handle drunken behaviour is to organise events such as bike rides to awareness or highlight the problem. These binge drinkers are fully aware already, they just ignore it. Making them pay for their treatment is not a complete solution, but one many would like to see implemented.

Re: FAIL

by johnthedog on Sun 27 Dec 2009 02:38 AM GMT | Profile | Permanent Link

Bottom line is that our whole system is based on trust. We trust that the general public understand the difference between acute and chronic; those who have an immediate proplem that needs immediate attention and those who have a problem which can wait until Monday morning when they can visit their GP. Assuming that there is no greater increase in acute illness, the year on year increase in our workload therefore comes from an unwillingness to wait until patients can see a GP or are prepared to make their own way to A&E. We live in a 24 hour socieity. We want attention and we want it now.
What we do about that is the question

Re: FAIL

by MT Waster on Mon 28 Dec 2009 01:34 PM GMT | Profile | Permanent Link

Heads and brick walls come to mind, Tom.
Wishing a slightly belated Happy Christmas.
I'm working NYE so that should be interesting.
What's making you angry happens across all ambulance trusts in the UK - sadly.
The wishes that we have more staff and vehicles go hand in hand with knowing we need more beds in hospitals. One of the biggest bed helps would be more beds in community hospitals not less... and not less community hospitals. as has become the case in recent years.
Anyway - happy christmas to all who read on here. In and out of the job. May 2010 bring some semblance of logic rather than greed.

Re: FAIL

by Vic on Tue 29 Dec 2009 03:57 PM GMT | Profile | Permanent Link

The police also get calls for the most ridiculous of reasons too.

Woman calls police because her cat is too playful

Re: Re: FAIL

by Reynolds on Wed 30 Dec 2009 12:15 PM GMT | Profile | Permanent Link

LAS would send on that - it'd be an amber as well 'Psychiatric problem'.

Re: FAIL

by Lucy Jones on Tue 29 Dec 2009 11:30 PM GMT | Profile | Permanent Link

I'm sorry you had such a horrible experience - it must have felt humiliating to be part of the broken system, and I bet he was a stoic who thanked you for turning up at all.

I think that there are probably two classes of people in your area (or the country in general): 1. those who think "I feel a bit crappy, and it's not like they've got anything better to do" and 2. those who think "I'm not dying just yet, and there must be people far worse off than me". Inevitably 1. has a sniffle and 2. has a heart attack.

I have a retired fire-fighter friend - when I saw a small fire I rang him to ask him if I should ring 999. His response: "Is it a fire? Is it supposed to be there? Then ring 999." Unfortunately medical emergencies are far less clear-cut to the layman.

Would a TV or newspaper ad campaign help, do you think? Examples of sensible and stupid "emergency" calls? Every time stupid "cat is too playful" calls are publicised, surely it makes people think even just a little bit?

Re: Re: FAIL

by oo-ti-ni on Wed 30 Dec 2009 12:48 AM GMT | Profile | Permanent Link

I think the only solution that would have any kind of impact would be to just say no to the more obviously non-life-threatenng calls. To send Ambulances to anything and everything whenever people want them is an unrealistic aim for any organisation. Couple with that a computerised triage system that is ineffective, and the problem is only compounded. Unfortunately, the numerous measures introduced by the "powers that be" have done nothing; at least nothing worth reporting, to decrease the number of emergency calls.
Their solution is to make existing staff work four-times as hard and actually try to meet the demand.
To refer back to an earlier post about leaving - I salute you.
If the pressure and underhand tactics that are currently being employed do not desist, I too shall be off.

Happy New Year To All!!

Welcome to Random Acts Of Reality, a Blog based in London, England, written by an E.M.T working for the London Ambulance Service. Also, number one search result for "Womble porn". All names have be changed to protect the guilty. This Blog was previously known as "Why I Hate Humanity" but the antipsychotic medication seems to have kicked in.
All opinions on this website are mine alone, and may not reflect those of the L.A.S or other ambulance crews
Find out more about me here.