Saturday, 6 February 2010


I know I don't usually use this forum for complaining, especially about the system that I work for. Something about not biting the hand that feeds me. However, at the moment, even I'm getting despondent - not a normal reaction for me at all, and not one that I'm enjoying.

Part of the problem, at least as I perceive it, is as follows:

There are two main focus groups at work.

One is the outlook of the number-crunchers, the ambulance big-wigs, the ivory tower-dwellers, and even the Government office residents.

The other, is that of the troops on the ground, the real front line. Slowly but surely, the latter group is falling victim to the whims of the former.

Not so slowly, but definitely surely, those troops are being put at greater and more frequent risk by the number crunchers, all in the name of targets. And the troops are not happy.

We are being brow-beaten into working faster, not smarter.

Responding to the never ending stream of calls as if each was a dire, life-threatening emergency, just so you don't get sued.

Activating on calls with all haste, just so you can say that we did.

Spending as little time on scene as possible, not treating, just transporting.

Turning around at hospital without delay, not for patient benefit, but to stop a countdown.

Taking breaks at the times when we don't really need them, just to fill a quota.

So, ivory tower-dwellers, come back to the real world for a minute. Let me tell you that if you're managing to depress one of your normally overly positive people, you must be doing something wrong. We're here because whilst we're at work, we want one thing, and one thing only. We want the best for our patients.

Government bods: you're expecting us to reach more calls in the state-prescribed magic eight minutes, whilst not giving us the resources to do so. Calls such as flu, panic attacks, coughs and colds, sprained ankles and chronically sore backs all become life-threatening, eight-minute demanding calls. For no reason other than the system said so. And the system is all-knowing, infallible. Law-suit proof. And often very wrong.

Big-wigs - it's all well and good sending the call down to the MDT with the barest of bare essentials, just so you can beat the clock. Not even giving an address, just a general direction to head towards. No details of the call. No warnings about the location, if there are any, until many a time when it's too late. Too many times recently, I've walked into a call on my own, only to find out that the crew, who are a few minutes behind, have been told to wait away from the address for the police, as there are threats of violence or other menaces awaiting. Sometimes quick can be too quick. And too dangerous.

Oh, and then you throw this sort of stuff at us, just to make it more difficult.

If all is going well, and I'm not being threatened by someone drunk, aggressive, or violent, but actually attending a patient who is genuinely unwell, I'm now being told to hurry up there too. Well, you know what, it takes whatever time it takes. Unstable patients are not easily stabilised in the back of a moving vehicle bouncing over every speed bump and pot hole on the way to the local hospital. Stable patients sometimes take time too. We need to spend time making sure that they remain stable. That they have the support they need, that they are well cared for, that they know where to turn if they need to. And I'll take however long is required to make sure that I have done what is best for them, not what is necessarily best for the paperwork.

For those who we do transport to hospital, we can't always just dump them and run back out for the next call. Sometimes the hospital is busy. Sometimes the paperwork that you are so concerned about takes time to complete. Sometimes the ambulance needs cleaning from top to bottom, not just the cursory wiping of obvious surfaces. Sometimes, especially on the busiest days, we just need a cup of coffee and a bar of chocolate.

It's also on those busiest days, the ones when we most need the break, that we are the least likely to have one. So we may stop at the hospital to grab a bite to eat too. Sometimes, especially on the FRU, where I don't often transport patients, I might not see a toilet for hours on end. I challenge you, number crunchers, to complete a 12-hour day, or night for that matter, with no break for food or the chance of a hot drink, and being at the mercy of a computer screen as to when you're allowed a convenience stop.

All we ask, is to be allowed to do our job. To be provided with the resources to help us do it. To use our training, to extend our training, and to put that training to good use. To have the positive support from above, rather than the overbearing threat of a whip. A happy workforce will lead to better results, whether those results are on paper, in the field or even in the overall reputation. We'll transform back from a bunch of glorified taxi drivers into a professional unit of Emergency Medicine Providers. And instead of being resentful, we'll be glad to do it too.

And then I can go back to being positive about the job I love.


medic999 said...

I was on a course the other day when the group was asked:
"Do you feel under pressure by the targets and time pressures that are put on you"
My answer?
Absolutely not...
I started to explain my reasons here, but it got too long. I feel a blog post coming on!

Michael Morse said...

Don't let up, keep bringing these issues to the fore, once you lose it, as we have in Providence, it's near impossible to get back. I put my neck on the line every day by refusing to rush;for my sake as well as my patients.

One big thing-stay positive! The only thing we can control is our reaction to whatever is thrown our way.

RD said...

An easy solution for management to guarantee the 8 minute rule is to place more ambulance on the road, but that would cost more money..

Anonymous said...

HEAR HEAR, now who do we actually have to hold hostage to get the message across?