It was on the news, it must be right, right?

I’m writing this week’s blog about a recent news article in our area.  It featured some community first responders (CFRs) speaking out to a news team.  They were expressing various concerns among which were that CFRs were spending a long time on scene waiting for the ambulance staff to arrive and another concern that CFRs were being asked by the ambulance service to ‘discharge’ patients without the need for an ambulance to attend.

The tone of the article was quite negative.  It implied that the ambulance service were being quite negligent and trying to do things ‘on the cheap’.  The general public may have their confidence knocked in the ambulance service.  Some of our excellent (and very competent) volunteer CFRs and ECFRs feel de-motivated by the article.

As always, these are my own opinions and do not necessarily represent my employing ambulance service, my union or any of my colleagues.  It is all just my own humble opinion.  I also only speak about my own area, other areas may and probably do have different procedures and guidelines.

Community First Responders are volunteers who undertake training in their own time and at their own expense.  They are then provided with a uniform, pager and some equipment.  In their spare time they log on duty with the emergency operational control centre (EOC).  Then when certain categories of jobs come in details are passed to the CFR by pager and they set off (in their own car, no emergency lights or sirens) to the address to assess and provide initial first aid until the ambulance or response car arrive and then lend a hand to the paramedic or technician.  Some CFRs have undertaken extra training to become Enhanced CFRs (eCFRs).  ECFRs are trained to the same level as Emergency Medical Technician level 1 (EMT1).  ECFRs respond in the same way as CFRs and use their extended skills to assess the patient and provide certain treatment while waiting for the ambulance or response car.  I’ve already blogged about them here.

Getting back to the article:

CFRs (and eCFRs) waiting on scene for long periods with no ambulance response.

It’s true that people are waiting long times for an ambulance response.  At the time of writing it is winter and the well known ‘winter pressures’ are putting a seasonal strain on all aspects of healthcare.  Phenomenal demand for services means that a high volume of 999 calls are coming in.  Added to this, hospitals are pretty full with very few spare beds.  This means that patients in the Emergency Departments (EDs) are waiting for beds on wards with no beds available so they have to wait on trolleys (gurneys) in the ED.  This in turn means that the EDs become full so ambulances have to wait longer to hand over our patients meaning that ambulances are tied up at EDs and not out responding to emergencies.

I know it’s difficult for the CFR/eCFRs on scene for ages but I know that the members of the public are relieved and grateful to have you there, every one generally understands the current political climate and know that you (and us) on the ‘front line’ of emergency care are not to blame.

Discharging patients.

This is an emotive point.  The word ‘discharge’ in this context means to provide a safe, appropriate plan for a patient without the need to attend the ED.  This can mean a visit to or from a doctor (General Practitioner (GP)), either the patient’s own GP or the Out of Hours GP service (OOHGP).  It may also mean a visit from a nurse, or it may mean that after assessing a patient reassuring them that they don’t need to do anything now, just wait for natural healing to occur and see their own GP in a few days if needed. The minimum level of education needed to discharge a patient is nurse, paramedic or EMT2 (the cover-all term for medical staff is clinician).   Some cases the clinician can discharge with no further referral, some cases the clinician has to consult a doctor (usually one of the OOHGPs) by phone to affect the discharge.  The emphasis with any discharge is always safety.  Advice is always given about what to look out for which may show that the patient is deteriorating and what to do in that case after the clinician has left the patient.  This is called ‘escalation advice’.

The point of the article seems to be that CFRs are being expected to discharge without the patient seeing a trained clinician.

Discharges have already for many years been safely made by phone without a clinician actually visiting the patient.

If a patient rings the OOHGP or their own GP for a consultation the patient will speak to a call taker or receptionist who will take basic details.  The patient will then speak to a clinician who will ask detailed questions about the symptoms experienced by the patient and their detailed medical history.  From this, sometimes the patient is then safely discharged with a safe, appropriate care plan without seeing the clinician.

When someone rings 999 for an ambulance the call taker asks lots of computer generated questions.  Based on the answer to these the job is categorised in terms of seriousness.  Certain of the lower category jobs are then passed on to a group of clinicians in the EOC who ring the caller back.  In the same way as the clinician at the GP service they will assess over the phone and may be able to safely discharge the patient without an ambulance or any clinician visiting the patient.

The CFR or eCFR would never be expected (or allowed) to make a discharge decision alone.  The CFRs have access by phone to clinicians in EOC who with the benefit of the clinical observations measured by the CFR (pulse rate, respiration rate, blood pressure, blood sugar level) in addition to the signs and symptoms experienced can safely make a discharge decision if appropriate before the ambulance or response car arrives.

I guess my messages from all this are:

  • Although far from ideal response times are currently being experienced, if a discharge decision is made it is by a fully educated and trained clinician to national guidelines. Safety of the patient is always foremost in a discharge decision and escalation advice is always given.
  • CFRs and eCFRs should be proud to serve their communities and I know from talking with many of my patients that they are admired for their unselfish contribution to the local community.

Are we valued?

This is a question that is coming up a lot now in hospital corridors where ambulance staff gather and meet.  It used to be the mess rooms where we met and got things off our chests but we spend very little time on station now so hospital corridors are the new mess rooms.

A particularly disgusting clip of MPs cheering as a motion to end the public sector pay cap of 1% was voted against is currently circulating on social media.  Cheering??!!  I can accept that as part of the democratic process some decisions in parliament will not go the way I would like.  I would have been angry about the defeat of the motion if it had been carried out in a mature, professional way as a logical economical decision.  But to cheer?? That smacks of contempt for everyone in the public sector.

The hypocrisy is overwhelming; some of these politicians were the loudest voices to praise the ‘invaluable work’ of the emergency services and hospitals in the aftermath of the recent terrorist incidents in London and Manchester and the horrific flat fire in London.  The same MPs no doubt cheered equally loudly as they accepted their 11% rise last year.

It’s no surprise that public sector workers feel undervalued.  Should we though?

In the aftermath of the recent events many of the public expressed their appreciation of the work we do; food deliveries to the stations in our group from a local supermarket, offers of cups of coffee and cakes, free chips, cards and messages posted through the station door.  I know that these grateful people also appreciate the other emergency services and public sector workers also.  On a day to day basis working with the public working to uphold the nhs values I feel generally valued.  Most of the people we get to appreciate and are grateful to us.  There are obviously the exceptions, the drunks and drug fueled street warriors and certain people who are very aware of their ‘rights’ (don’t seem to be as aware of their responsibilities however) and are not satisfied that they are being adequately met.  This has always been the case though and I can’t see it changing.

I am happy to say that in my area, support for staff affected by the terror incident is ongoing.  Frankly I have never seen support offered at this level before and I sincerely hope it continues and helps.

Are we valued by our managers?  Controversial question I know.  I can only speak from my own experience and say a definitive yes and no.  I personally have decided that paramedic is the level I want to stay at.  I’ve never had the desire for bars or pips.  A brief flirtation with the idea of getting into training was thankfully beaten out of me several years ago and I came to my senses.  I have very little contact with any managers other than the team leaders immediately above me.  I do feel valued by them most of the time.  I’m lucky though, I enjoy good health.  I have seen colleagues falling on hard times with periods of sickness not treated so well.  The current sickness policy or perhaps the way it’s implemented can seem punitive and at times harsh.  Again this starts to trigger my hypocrisy alarm.  The Emergency services are pushing various initiatives aimed at maintaining and supporting the good mental health of staff and yet the thought of the disciplinary policy triggered by spells of absence from work are hardly the way to sooth anxiety or help lift the depressed out of a low mood so they can resume the challenges of emergency work.

Personally I feel I’m more than just a paramedic.  I’m a dad, a son, a brother, a partner, a neighbour.  In all these roles I definitely feel valued.  Even when my kids were teenagers I still felt valued as their dad.

To sum up:

A feeling of value is best when not dependant on external factors such as money.  Frustrating to hear I know but bear with me here.  If money were a measure of value then among the most valued professions in the country would be premier league footballers, financial brokers and politicians. Really?  From chatting with patients over the years maybe footballers are valued (with our younger football fans) but financial brokers?  Not many patients class them as valuable, most see them as the cause of the austerity requirements.  Politicians?  Maybe the 650 MPs and their families value them but would but I’ve never met anyone else who does.

Everyone in the public sector should hold their heads high and value their self.  Politicians come and go but the emergency services will always be here responding thanks to the high value of our staff.