Thursday, 20 September 2012

Why the Public Should Care About the Institutionalised Abuse of Their Ambulance Workers

Regional Ambulance Trusts in England

In conference rooms and administrative buildings around the country, statisticians and logistics experts pore over figures, maps and budgets in an effort to squeeze maximum efficiency from available ambulance resources. Like every business in the UK, the era of austerity has meant even the emergency services are required to tighten their belts.

The problem of how to cope with rising ambulance calls in the face of budgetary reductions seems an impossible task.  According to Hayden Newton, East of England Ambulance Service chief executive, closer analysis of population distribution, social behaviours and trends in call history are "paving the way for the rota review and revisions which, using sophisticated modelling technology, tell us where and when vehicles are needed and what type." Assuming this miraculous technology is capable of what Mr. Newton says, this will lead to "ambulances not being cut overall, but matched to where the demand lies.”

Aside from the flippant thought that - if the "sophisticated modelling" is so accurate as to know where the emergencies will be before they happen, why don't they use it to stop the accidents in the first place - there seems to be a touch of messianic delusion at work here. With the government-stated requirement of East of England Ambulance Service to reduce expenditure by £50m over five years, Hayden Newton is essentially proposing to perform the ambulance equivalent of feeding the five-thousand with a few loaves and a couple of fish.

As far as we know, the EEAST chief exec does not have access to divine powers, so with £50m-worth of resources disappearing from his coffers, where does he think the ability to continue delivering pre-hospital healthcare worthy of a first-world nation is going to come from? Fortunately, like every ambulance service figurehead in the country, Hayden Newton believes he has access to a miraculous fountain of endless resources.

The front-line workforce.


Superhuman?

These carefully selected individuals are capable of superhuman feats of endurance. They do not require rest or nourishment, they can perform efficiently without sleep and can reabsorb their own excreta so access to toilet facilities is not required. They have cat-like reactions, heightened diagnostic powers and physical strength which only improves with fatigue and they can sustain emotional and psychological extremes far beyond normal humans. They are practically indestructible.

This is of course total rubbish. The real ambulance workforce is made up of normal folk. Every one of them is fallible - they are prone to hunger, exhaustion and injury, all things with which they are already far too familiar. Many of them carry persistent injuries due to their arduous work and the constant physical stress exposes them to all manner of infection whilst their immunity is lowered due to fatigue. Work-related absence due to illness and injury is rife but many soldier on despite their ailments.

Unfortunately, the basis for all ambulance planning assumes that every paramedic, technician and care worker has limitless stamina. This misguided assumption is compounded by the emergency services' exclusion from normal working time rules under Employment Law. Of course this is entirely understandable given the nature of ambulance work and few road staff would contest the need to attend genuine emergencies immediately, irrespective of policy. However, this has led to a culture where the ambulance employer is under no obligation to provide any rest to its operational staff for many hours often equal to a full working day. When they are finally stood down, it is for a brief thirty minute window in the entire 12-hour shift, often in an environment ill-suited for meaningful rest. Again, this would not be a problem if the work-rate was endurable. But it is not.

The ambulance service is under siege, even before the proposed cuts. Almost without exception, road crews will arrive at work at the start of a 12-hour shift and they will be sent straight out on an emergency call. They will be sent from emergency to emergency relentlessly. They will be driving, assessing, carrying and treating for the entire time, demanding every ounce of their physical and mental fortitude. Why is this a problem? Because fatigue leads to errors and errors in the ambulance service can lead to misdiagnosis, mistreatment and all the problems that come with it.

The average ambulance worker?
Before anyone dismisses these concerns as “just a hard day's work” in the “tough times for everyone”, consider this; would anyone want to be treated by an exhausted ambulance crew who are drained from having already been on the go for the entire length of a normal working day? Some might say this was what was signed up for. Wrong - no one signs up to work in a system that advocates the abuse of employees. It puts crews and patients at risk, it crushes morale and it reduces efficiency. What use are “efficiency measures” with a crippled and inefficient workforce?

Yet crews will muddle through. They would rely heavily on their training and experience and in many cases, everyone gets away with it. But make no mistake, they are likely to be judgement impaired. Disrupted sleep and eating patterns combined with physical and mental exhaustion are known to cause impaired memory, loss of cognitive function and physical weakness. There is a reason there are signs throughout the country's road networks which state “tiredness kills”.

Sleep When You're Dead

From personal experience, I know that there are times when I reflect on attendances past which might have gone differently. After relentless nights of dealing with challenging calls with little respite, I can recollect the struggle of those last jobs of the shift. Desperate for sleep, I would pray they would not be life-threatening. But sometimes they were. To this day I wonder if some outcomes would have been better had I been more well rested.

In 2006, a book was published giving account of the experiences of a UK Ambulance Technician writing under the pseudonym of Tom Reynolds. Amusingly, it was called Blood, Sweat & Tea. There was a time when the occasional shift would allow for the crew to return to their station, have a cup of tea and get some rest to remain fresh for the next attendance. On quieter shifts there would be time to improve medical knowledge and clinical skills to provide a better service.

British leadership strategy c.1914
Tom Reynold's book was only six years ago, but times have changed. Now, with a strategy similar to First World War tactics of going “over the top” and charging the enemy guns, ambulance crews across the country are brutally thrown at an endless tide of calls. If they break, they will be replaced. The “Blood, Sweat & Tea” pun doesn't work any more - there's no time for tea. However, the tears will certainly be there to replace it. Pray they aren't yours because somebody made the wrong call.

Maybe Mr. Newton's modelling technology will let him know in advance where to send the tissues.

[Edit: Further to the emotive comments below, I went to EEAST Ambulance HQ to investigate further.]

182 comments:

  1. This article is absolutely spot on. Front-line ambulance crews are demoralized like never before. No-one in any profession can be expected to work to their total capacity every day yet this is exactly what is being asked of ambulance paramedics and technicians. The workload is relentless and stories often appear in the press how a member of the public has suffered because an exhausted crew has elected to go undisturbed on the only half hour break allowed in a 12 hour shift. Information that could only be obtained from the management. Many workers are over 50 so changing profession is hardly an option open to them and are expected to keep going at this pace ' til they reach the age of 68. I ask you......would you be happy, should you be unlucky enough to suffer a heart attack, to be carried down the stairs by a worn out 68 year old ?.......me neither but that's the way we're heading. It won't be long now before the 'shock horror' headlines will be relating to stories of ambulance staff dropping dead when attending the public. It's only a matter of time. !!!

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    1. unfortunately the same thing happens over seas as well
      boken down medic from Toronto Canada!!!

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    2. they have just done some new rotas, not family friendly or emergency worker friendly 8 10 12 hour shifts, body clock wont know whats hit us and only garaunteeing 20 mins break in twe
      lve hours, unfriendley hours, 11am till 23 hrs,5pm till 3am so will be waking family members up and what about single parents whose going to look after their children till 3 or 4 oclock in the morning well let them who did the rotas spend a month doing them idiots

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    3. they have just done some new rotas, not family friendly or emergency worker friendly 8 10 12 hour shifts, body clock wont know whats hit us and only garaunteeing 20 mins break in twe
      lve hours, unfriendley hours, 11am till 23 hrs,5pm till 3am so will be waking family members up and what about single parents whose going to look after their children till 3 or 4 oclock in the morning well let them who did the rotas spend a month doing them idiots

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    4. i to work for an ambulance service and we have noticed how many calls we get that dont require our attendance but due to how the calls are answered it triggers a responce.i belive if people had to pay for an ambulance it would stop people calling just because they want a free lift to hospital or they think it will reduce their waiting time.i also think they should not enforce overtime if u have 20mins of a shift left but you are being sent 30 mins away this is not fair .

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    5. This is so true. I transferred from one Service to another and was expected to settle in enough to work with agency staff after 3 shifts of third manning in a area where I was unfamiliar with local arrangments and procedures. As the driver that night I was held responsible when the attending, more senior paramedic made a bad call and the hospital complained. Without even speaking to the agency parmedic I was under investgation and sacked. The end of my 10 year career for one incident where I could have done more. No harm came to the patient in this either. This happened after I had worked 2 weeks leading up to the incident of an average of 60 hours per week..... and no, it was not overtime! They were short staffed and me being new and a "relief" copped all the left over, odd shifts. I have literally been left on the scrap heap and have had to give up the profession to earn money doing anything at all just to survive. Thats all I got for the hard work, commitment and time that I gave to the public who continue to abuse the system. Never again!

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    6. I've just woke for my third 12--->14 hours shift and am shattered / physically drained before I even start.... The above is so so true. God Help Us all.

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    7. My husband took several years to die and I had to call an ambulance many times. Every single time we had an amazing service, kind, competent and efficient. I'm appalled to hear that the service is so demoralised. I hope to offer some encouragement by saying a huge THANK YOU to all you heroes out there.

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    8. Here is an example in the USA. Recently I responded on a non-emergency transfer to take a patient to a medical procedure. The weighed 550 lbs. With the weight of the specialized stretcher, the totally weight is over 700 lbs. Well, four people can handle this with difficulty, but not if - and I apologize if this offends people - one or more of them is a small woman who can't lift (or a small guy or a guy who because of conditioning can't lift). But to be asked to lift far more than your weight. Well the problem is, any of us with experience know that this is a six-person call including our operations supervisors. But the "Business Development" office said, only two crews and want to cut it back to one crew because, "we're going to get the bariatric ambulance with the winch repaired and then you'll only need one crew. But the stretcher is non-electric ("we aren't going to spend the money for anything like that because we can send enough people" except they don't). Well if you can imagine trying to lower this person to the ground so they can be winched into the truck - over 350 lbs per person - or lowering them out of the house over the sill (they won't build a ramp and our company won't build one for liability reasons) or what do we do with her at the doctors office where she needs to be moved to a bed... and that's just on the non-emergency side. This essay is spot on and it's worse than he tells.

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    9. whilst I fully hearted agree, this is so true of the accident and emergency staff too !! ambulance crews and a/e staff are the forgotten....they do think us super human, and that is why there is sickness, stress and depression amongst our once loyal crews....we do the job to help people, patients and our colleagues we do not do it to help the service.....

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    10. Very well said!

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  2. BRAVO! spot on...

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  3. Thanks for writing this. Shame the people who need to read this, won't.

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  4. Concern Senior Citizen North Norfolk21 September 2012 at 19:22

    I've just followed your link to East Midlands Ambulance Service consultation process. I assume all areas are under the same pressure, but these people seem to be talking about hubs, community ambulance posts with toilets and break facilities AND extra staffed ambulances to cater for future increases in demand. From a layman's view point that all sounds much more user friendly for everybody. Or have I missed the point and somewhere in there, it's sugar coated cuts? But if it really is win, win all round, can somebody tell East Anglia about it?

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    1. I'm a paramedic who has been with EMAs over 10 years and the EMAS proposals are indeed sugar coated rubbish. There are no extra staffed ambulances, in fact DMAs are being cut by up to 50% overnight in rural areas. Of course more FRVs will be put out but no crews available to transport them. Even before the cuts. THe hubs and spokes are pooling resources in urban areas and leaving the outlying rural communities uncovered. Yes reposnse times will improve (in urban areas) but at the expense of patients in rural communities. The ambulance service nationwide is in a critical condition and EMAS is no better and in some cases worse off than other services. THe article above and many others on the blogspot is true for almost every ambulance trust in the country. All you need to do is substitue the names where applicable!!!!

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    2. It's all about stopping the clock,nothing else matters,nothing.
      Get there in 7 minutes and the patient dies= success.
      Get there in 9 minutes and the patient lives= failure
      These computer 'models' that predict jobs,I'd like to re programme them so it can predict the lottery numbers so I can jack the job in.
      If a clock stopper(officially called an RRV),attends a patient with a good response time,treats the patient but then has to wait for a real ambulance over an hour,that won't be in the statistics,it's just the clock stopping that matters.
      So,in general,resouces get pulled towards the more populated urban areas where common sense says more calls will be made,but at the expense of rural areas.To pacify the public they use community first responders,a well meaning group of local first aiders,these can also stop the clock,but little else,then wait for god knows how long for a trained crew on a real ambulance.
      Is the services fault for just pandering to the governments constant targets?
      Or the governments fault for not understanding the real world emergencies. ( I estimate only 5% of jobs are truly life threatening).

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    3. As a paramedic for EMAS I can definately tell you that the hub and spoke model will not work, It will not reduce response times even in the urban areas as once we get to our hub we will be sent immediately to community stand by points (CAPS). These strangely enough are in areas where there are already ambulance stations, on the way to these CAPS we will be available for any 999 call that comes in if we are the nearest vehicle so invariably we wont even make it there! During the consultation period we have just been through management made a big point of stations being empty most of the time, this is true but so will the CAPS! Another problem I foresee is the one of the distance most staff would have to travel. At present if there is heavy snowfall staff are asked to make it to their nearest station to crew up with whoever can make it in and as most staff work from a station that is near to their home this has always worked very well, staff have actually walked miles in the snow to get to work! If we move to the proposed hubs a lot of staff, me included will not be able to get to work, subsequently there will be a very limited service, if any at all. This also means staff would be unable to get home after a long 12hr shift.
      Our Chief has been on TV twice that I know of during the consultation and both times I believe he has misled the public, firstly he said the proposals were not financially motivated and were purely to reduce response times. This is total rubbish, the only way to improve response times is to have more double crewed ambulances on the road and to filter out the unnecessary calls that take up the majority of our time and resources. The second time he said the proposals were what the staff wanted. I can assure you this is a total fabrication as I have yet to meet a front line member of staff who agrees with these misguided changes. And I for one was never asked my opinion before the proposals were announced.

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    4. I have heard the EMAS chief exec speak on a number of occasions. He is clearly not fit for purpose! He doesn't even know the correct name of the rural area I live in which is often badly affected by snow. He also seems to think it is perfectly feasible for ambulances to travel to our area from a hub approximately 1hr away when the roads are good and impassable when the snow hits!

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    5. Things were getting bad when l left thirteen years ago, then we had predicted areas to wait in, nowhere near facilities for loo's or a hot drink. Mainly areas where the rate of calls were highest, and also the most common for unnecessary visits. Management had no idea where they were coming from, and one xmas after working hard unsociable hours, we were left a mars bar as compensation, a gift from management. The guy who had worked at our unit for thirty years had a party thrown by his friends, from management nothing was done at all. He said at one point, in the past the crews and staff were solid and you could count on, but the vehicles were rubbish. As he left he said the whole thing had turned round. The vehicles were good, and the rest were rubbish. He was so so right. l left the service and my health improved, also my temperament. Yes, l missed my friends there, as we relied on each other in every situation, but I did not miss the stress, difficult times, and aches and pains. When will the governments that be realise you have to look after the people so a good job can be done. To add to all this, l had nursed before, so I went back to nursing. On retirement, l took early retirement, then discovered l had to lose a third of my pension, as despite working for the health service, (and no self loading cots etc then) being a paramedic was not nursing......So did not count as part of my time. l still left gladly, being taken advantage of even to the end.

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  5. Nice to know at least someone gives a monkies - well written - thanks x

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  6. Working in A&E I have many friends who are on the ambulances and see what they go through regularly, as for those on the cars... very brave people as they then wait for back up, and wait, and wait....

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  7. This is for Concern Senior Citizen North Norfolk and what all of the managerial words actually mean

    hubs - you sit in your car or ambulance at the side of the road
    community ambulance posts with toilets and break facilities - is normally a petrol station or a gym where you can use the toilet (only sometimes dependent on who is working there!!)
    extra staffed ambulances to cater for future increases in demand - are non-paramedic ambulances so you will not be getting what I class as top treatment!!

    Does it still seem user friendly to you??

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    1. Concerned Senior Citizen North Norfolk22 September 2012 at 19:24

      Many thanks to Anonymous for your reply to my query. I thought it sounded too good to be true. I asked more in hope than expectation!

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  8. This comment has been removed by a blog administrator.

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    1. No need for that sort of language. Detracts from the real point and makes people think you are an ill educated thug! The article is, indeed, superb - please don't reduce yourself to such a level.

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    2. Original comment: "superb article sir. unfortunately nobody gives a fuck....i have put tons of datixs in and guess what??? fuck all done."

      [Last sentence deleted - Colourful language is okay, personal attacks aren't. Let's keep it civil and professional please.]

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  9. In 20 years of front-line service, I have never read an article which so comprehensively sums up what is wrong with the way we work today.

    Unfortunately, as has been commented the people who need to read this and take note ie senior managers and board members will not, as they are no doubt too busy debating the merits of their next lease car to give a toss about the workers who continue to strive to deliver a service.

    The future isn't orange, it's bleak especially with FT status to look forward to....

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  10. As Parents of a Paramedic, all of the above are so accurate but we would like to add the following:

    It is common for Staff to experience abuse from "Patients", especially on the weekend collection of Drunks.

    They can also suffer from various injuries, whilst lifting Obese patients.

    Our Paramedic has often worked in excess of 12 hours, without meal breaks.

    For those who don't know, on the 17th Sept the service had a stack of 80 Red calls, which obviously could not be met.
    On the open airways a call to the Police requested their assistance to use Panda Cars to transport patients to A&E.

    Our Paramedic has frequently been on North Walsham Standby.
    The reality being they are rarely at N Walsham, or return there, until shift ends.

    They may be anywhere in Norfolk, Suffolk, Cambs or even further afield.

    In essence N Walsham is left without cover as other ambulances rarely fill the vacant slot.

    The use of "sophisticated" models to predict arisings is a complete nonsense.

    Mum and Dad

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    1. Another parent in North Norfolk24 September 2012 at 16:15

      I'm so pleased another parent is sounding the drum for their paramedic son or daughter.

      It's really unbelievable what goes on and they can't say a thing themselves! Can anyone beat the "open airway" call that resulted in a crew based in Wisbeck, Cambs being the first on scene at an incident in Hoveton, North Norfolk?

      I don't think the public realise just how "not fit for purpose" the ambulance service is. For some years, the only thing that has held it together is the dedication of the front line staff inspite of the apparently uncaring management - but perhaps their hands are tied behind their backs too!

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    2. Agreed. The management rely on our malleability. Unfortunately this is changing and people have had enough. You said it right. It is not fit for purpose. We cannot say anything. No one listens. No one cares and if we stick our heads above the parapets it gets shot off.

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    3. This is happening in Toronto, Canada too. Identical nonsense! Here, the EMS management's strategy also involves down-staffing some areas to up-staff others. Not taking into consideration the higher level of seriousness when those lower call volume areas do call! Penalizing people who typically take better care of themselves, until, inevitably something very sudden and serious happens. And they admit that there will still be typically 12-14 hour hour shifts without any breaks for the Paramedics themselves... Everyone loses. Apparently hiring more Paramedics is not something they are willing to do.

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    4. The same is happening in BC. We put in 100 hours a week and get paid an average of $8 an hour. I knew this when I signed up, what I didn't expect was that my employer and union would be in a constant battle trying to figure out what was good for them and hang the paramedic out to dry. Just once I would like the powers that be follow a paramedic for a week. Just one week.

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  11. Oh my god, some one who finally has the balls to sum up a paramedics job, pity the people who need to read it won't !! And even if they do, they won't care as its not them out on the frontline, they will still be sitting in big offices and having lunch on time, able to go to the toilet in clean toilets and not be a sitting target for drunks or drug uses

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  12. Finally an article that just wants to report it as it is. very well put indeed.Dear old trumpton seem to have cracked it though.Some thing along the lines of charging for non-emergency calls? No moronic drunken collapse,assault,fall or accident would appear cool or amusing if that individual had a bill at the end of their so called "big night out". I can still remember champing at the bit to go out and help someone,I'd like to get that back!

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    1. Ken Jones retired.24 September 2012 at 20:46

      I remember in about 1963 calling an ambulance because a lad fell off his motor cycle outside my house in East London. He suffered cuts and bruises so no real damage. Later I recieved a bill from the London Ambulance Brigade for the sum of £1-5s-0p for their service. My car insurance paid it without affecting my no claims bonus!

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    2. Seriously that's your helpful input? What does that have to do with the pressures on Ambulance staff? You think the crew that picked up the injured rider sent you the bill? Direct your complaint at the service's management, if any of them are still alive (49 years ago...!!!) and knock on wood that you're still up and kicking and able to waste people's time with your whining.

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    3. I think you missed Ken's point. I understood it as being in support of the previous comment about charging for ambulances, which proves that there was a time when folk were charged for ambulance call-outs in certain circumstances. Interesting to note.

      There's no need to misdirect your frustration at meaningful input provided by the older generation.

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    4. Ken, I think the bill would have been sent by the hospital for treatment received following a road traffic crash, as they are allowed to under road traffic act. They would have received the money not the ambulance service. Regards.

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    5. Ken. As the comment above stated, the bill was from the hospital which, for whatever reason, gets to bill for ambulance transport in RTA incidents. I was involved in a minor accident a number of years ago, self treated and presented at my GP for follow up. I still received a bill even though no ambulance was called. I assume 'ambulance' means something different to the hospital bean counters. But alas, no. The Ambulance service and crews don't see the money.

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  13. An excellent article, well written and articulate and yes the people who need to read this won't......but that is not just managers.....the general public need to sit up and take note when they decide ti ring with their sore throat thay have had for 4 weeks or their constipation or their 6 day old ankle injury.....emergency service seems to have a different meaning to different people

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  14. Interesting article, thing is, we clearly need reviews of rotas and more efficient ways of working. I am just in from working a 10 hour shift on an car. Saw two patients and spent 8.5 hours sat in the car on standby. this is neither healthy, or efficient use of resources. Elsewhere other services crews are being run in to the ground. If using modern software to predict service needs, prevents this from happening at either extreme its got to be worth trying. What we cant do, is nothing.

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  15. Bravo, a completely true article. Being an A&E sister in the East of England, with many paramedic/ tech friends, I feel that the same attitude of managers goes from the ambulance straight into the hospital. I genuinely fear for our patients now and god help us in the future. What the hell are the staff going to go through when we call 999 in 20-30 years time for ourselves?

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  16. If an ambulance did not havwe to queue for 30 minutes plus at A&E because of cuts there then maybe there would be enough to go round

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    1. Unfortunately this is not the answer and we will still be short of ambulances even without queueing. Too many people call 999 for an ongoing problem, drunkeness, minor injuries (4 cars in the drive and no one can take the minor sprain to the minor injury unit, we are used as people have not registered with a GP and because people are too lazy to look after and treat themselves 70% of the time. The powers that be do not see this, they just see staff as hamsteres on a treadmill, who can go without breaks, toilets and dignity and respect just so they can get their big salaries, nice offices etc. People need to be educated and told NO when they call 999 for a simple problem or being drunk. Then there would be enough ambulances to go round.

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    2. Exactly. About 90% of what we go to does not require health care let alone an ambulance. My crewmate and I worked it out. In four weeks we had five jobs that required an ambulance. One of those was a general call out for an arrest where they had no units to attend. We were on break yet chose to go. We did not have another rest for the shift

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  17. I was told by a paramedic the other week that they are regularly having to wait two hours for an ambulance to join them!!!!!

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  18. I forgot to say. I have total respect for ambulance staff/paramedics. Too little pay and too much &&&& to put up with.

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  19. Very well said, the breaking point is just over the horizon. North of the border we don't have protected rest periods anymore either. 12 hr shift means 12 on the road now. And NHS24 only adding to the workload, not reducing it

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  20. Absolutely spot on!! And while we're at it perhaps someone should look at the pay of the 3 PAs Mr Newton employs!! Don't see them doing 12 hour shifts+ getting home late, working in all weathers, getting chucked up on,bled on and spat on!! I am remaining anonymous as most are as if you are caught speaking the truth the job you love (for the most part) will be snatched beneath your feet and replaced by a private/volunteer/ECA/ who aspire to becoming a paramedic - and so the cycle begins again!!!!

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  21. As an Australian Paramedic in NSW we are experiencing exactly the same foolishness. I am also required to do on call between my day shifts and between my day and night shift. As an example I did my 12 hour shift with no break. Got home at 1930 to be called out again at 2130 home at 2328 out again at 0150 home at 0323 then back to work to start at 0700 for my next 12 hour breakless shift and oncall again. This doesn't even count as a bad run.

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  22. I'm a Paramedic in the US, in the Atlanta metro area of the state of Georgia. We too suffer from long shifts, many of the county and private services here have gone to 24 hour shifts. These companies have gone to the 24/48 shifts to improve their budgets. But in fact they are killing those of us on the front lines. I am so terrified that I'm going to screw up at 3am, on the 20th call, that I will kill someone, lose my license and my job. Not to mention how if u do screw up due to exhaustion, the service you work for will not be there to back you when the family of the person you gave the wrong treatment to, sues you for everything you have. Most of these places have no chance of moving up, so we too have older adults manning the ambulances. The only chance of advancement is going back to school to het your RN or PA license. I'm too old to quit my job and go back to school. Don't get me wrong, I absoluter love my job and wouldn't trade it for the world. However, it would be great if those of us on the frontlines weren't forgotten so easily by the services we provide the foundation for. We are part of the wall that separates the community from the dark. Great article!!

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    1. Well said. I, too, work for a service in Georgia. I do 24 hr shifts and we are often ask to work more. I struggle to get through a 24 hr shift due to high call volume and constant posting. No chance for moving up. Once your a paramedic, thats it. Your responsible for everything that happens. Including when you and your partner are so exhausted in the middle of the night for no sleep you have to determine who is going to take the risk to drive. Wish i knew the answer to all this. Perhaps stopping the regulars and ones who just need a taxi from being to call in the first place? I wish.

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  23. The ambulance service is broken. The staff are tired, demoralised and miserable. Pay is low and getting worse soon. In some areas of our service, once the cuts go through will be almost minimum wage.
    No chance of advancement as they only employ young inexperienced people as paramedics who have a meaningless degree based on what pen pushers think our job is and taught by people who have never done the job.
    Being sent to every call because the service isn't allowed to have the balls to say no ( we went to someone who had been stung by a bee 2days before and were worried it was slightly swollen).
    Ambulances with over 300k on the clock that aren't fit for purpose.
    More and more emails telling us how bad we all are for not hitting stats.
    Constant overruns. This month alone I have had 8 hours of them. With the new shift system we get three weekends off every 12. Holiday requests refused or ignored, my family are sick of not seeing me and are choosing to have days on their own.

    But. Should we whinge, then they just wave capability at us.
    There is no greater feeling than being at a job we are needed for. But. So many jobs are for absolute crap this is few and far between.

    Who do we complain to? Who would listen? When they killed our pensions we didn't even get a few lines in the papers. Our unions are a complete waste of time. Our managers wouldn't tell us anything if they were forced to by law and treat us like meat in a seat.


    I give it a maximum of five years and our service will be a privately led one. I feel it is what the government want. I genuinely do. They will wave the American service at us and say this is how it should be. A service that pays its staff less than ours and is constantly looking for profits.

    I will not stay in this job for much longer. It is killing me. It is killing my friends and my crewmate and while the government ruins any chance of growth in this country by cutting everything, we will always be forgotten as a service.

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    Replies
    1. SCAS - South Central Ambulance Service
      SECAMB - South East Coast Ambulance Service

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    2. I would like to state that not all of us educated by a degree were taught by people that don't do the job every tutor I had was or had been a registered paramedic or health care professional and new what the job entailed. Admittedly there are some that are very young with little or no life experience so the job is harder for them I myself don't ever say I know more than an individual that has done the job for 20 years I trust there help and support but they also need to be open the the graduate and the teaming that they have had to. I can't see the service getting any better more education to the users needs to go ahead and stopping NHS redirect from redirecting calls that are obviously not an emergency " I have been told of a young girl who had absorb pain had treated with pain killers but wasn't getting better partner called NHS direct was told to go to a&e asked if she had chest pain said no partner would take to a&e himself NHS direct called 999 told call taker that patient had chest pain which when the crew questioned said patient the story unfolded that it wasn't true GO are also increasing the demand on the service and need to be educated about the service.

      Delete
  24. You forgot to mention that this rare breed also does not want for pay, and gratefully accepts the peanuts offered.

    ReplyDelete
  25. You are not alone.... It's the same in Australia:
    Click on my link to visit the Australian Fair-Go Blog for paramedics.

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  26. Similar problems in Portland, Oregon. Sounds like we are all fighting the same battles...

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  27. 17 years ago I started in the ambulance service. 11 years ago I went onto 12 hour permanent night shifts - we did 3 or 4 calls a night.
    By the time I moved to pastures new 6 years later we did 12 - 14 cals in the same 12 hours, with no extra resources. I was exhausted and to this day I still cram my food in as quickly as possible when ever I eat - always expecting the phone to ring!
    Hayden Newtyon was bringing the same modeling technology in to that service all those years ago - It just meant crews got to hang around on street corners rather than getting back to their stations for a rest.
    When I was young people didn't need to learn first aid - you just patched your family or friends up and got on with it. Now they go to A&E or even call an ambulance - For a paper cut!! (I have had it in both settings!)
    People need to get a life and stop expecting others to wipe thier butts and let us help people who really need our care.
    The government need to stop chanting "Orcon" and let crews focus on treating patients.
    I have some respect for the likes of Hayden Newtons as they have to balance the books despite all the pressures from all side - They are (usualy) trying their best to make ends meet but at the end of the day it is the crews who are at the bottom of the food chain.
    Want to make things better - allow both control and crews the right to refuse - or let them treat and discharge/refer minor things.
    Many services don't so the paper cut gets taken to A&E rather than told to go and buy a plaster - that would stop people calling in the first place and ease the pressure on our guys.

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  28. great article. all who have made comments are of same opinion, how would you like someone who has just worked 7x12 hour shifts, coming for a member of your family. I work in one of the busiest stations in scotland, work load is up, sickness is up, but rather than cover for this the management drop the shifts to save money, this only puts more strain on those few on shift, because the call volume does not decrease when we are crews down. only time we will see change is when the media start reporting people dieing in the street waiting for a ambulance crew which has been cut for financial recovery plan to work.
    we have more managers than ever, it staff, management pa staff, all sort of managers doing the same job, how many does it take to hold a clinical review? all have service cars that get replaced every 3 years but an ambulance has to last 7-10 years. maybe we need someone to look at services as a whole and not in small parts the money is there just not used correctly.

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  29. In Australia, this article rings true as well. It's as if all of our governments got together and decided that we are an expendable workforce all around the world, only worthy of ridiculous pay rates and able to leap tall buildings in a single bound!

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  30. i see that wherever we go, there is a dipshit manager who has no idea what an actual ambulance shift is like and is making all kinds of decisions to make the shift even worse than it already is.

    thank you for a fine article.

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  31. London is no different to all the places mentioned. Last weekend we were 70 ambulances down from a fleet of 200 or so supposed to be available. I can't recall the last time I actually had a rest break on shift. I don't believe our managers are entirely to blame. It starts in government and then the shit rolls down hill. Unfortunately we are at the bottom and are barely keeping our heads above the mire. Our CEO left recently to move to pastures new and a number of our senior managers have also decided to desert the sinking ship. As yet we've had no applicants for the top job. Could senior managers even see that it may now be a poisoned chalice. Who would want to be in charge when the walls finally come tumbling down.

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    1. The LAS for me was a sinking ship, listing from side to side, with too many captains. Governed by targets from central government, taking patients into hospitals at bursting point, who themselves are governed by ridiculous targets and "cost improvement programmes" (cuts). The nhs as we know it is unsustainable. Start charging people for ambulances and the call rate will drop. Start charging for hospital treatment and admittances will drop. Those needing ambulances will be exempt and those needing treatment will be exempt. Time wasters will pay.

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  32. Some of us have had our lives ruined doing the job we love,(loved). Thing's have changed so much since my career began 34 yr's ago, not all for the better..Staff are not cared for as they should be..I have lost several colleague's over the year's due to the job..Management are concerned about response time's ect than our welfare..This has GOT to change.... NEAS.

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  33. According to so called management at EEAS, demand falls after 2 am. So how come requests for vehicles are broadcast frequently after this time ? Last night (25/10) there were up to five ambulances at the A&E Norfolk and Norwich Hospital at 5 am. At one stage prior to this there were 12 vehicles waiting, with some crews waiting up to three hours to hand over their patients. This used to be the exception, it is now the norm. God help us if there is a severe winter.

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  34. Thanks and well done on a well written article which sums things up really well.
    The general public also need to be aware that not only will there be less of us to attend calls at a time when activity is up by 5.5% but the crews will be less qualified. With the advent of an ECA driver now being proposed to work with a paramedic - no longer will ambulances be staffed with 2 highly trained individuals.
    However, these ECA staff who are often going to be downgraded current staff will be tempted to work way outside their job description. Where they don't the paramedics who normally share the workload with their technician colleague will now have Ro do the work of 2 people and this will lead to a massive decrease in good clinical care - it has to?
    As a paramedic - it scares me to death to think that I will be going some of the jobs I m currently doing now with an ECA instead of an experienced qualified Technician.
    I do hope sharing this conversation as widely as possible means someone listens that can make a difference?

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  35. Parent of para in N.Norfolk26 September 2012 at 14:59

    I understand why everybody is commenting Anonymously but just in case some people out there that can make a difference and are actually reading this blog, would'nt it help just to mention the area you work in under the name heading? The more area's that walk the walk, the louder the voice crying out for a fair deal for the staff in the ambulance shake up!

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  36. Well said.......happens north of the border exactly the same. Mr Newton was up here a long time ago spouting the same stiff

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  37. I find all of this rather depressing. having recently retired from a very senior position in a public service I wondered at first if it wasn't the usual "we all complain about management" syndrome so prevalent in many walks of life. I was directed to this discussion by a couple of paramedics, dedicated to their work but obviously driven to distraction by poor organisation, lack of professional development, ridiculous shifts, stupid people misusing what should be one of our star services. The media paints the picture of these workers as if they are angels and always emphasise the spectacular, the big emergency etc, we need a real reality check on this service before it implodes - it can't operate only on good will or keeping your head down. Everyone should forward this discussion to their MP - I'm going to.

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    Replies
    1. Fred, I'm a Paramedic with Emas...... our Exec left recently, would you like to take his place because for the first time in the last few years that is the most realistic thing I have heard a senior manager say.

      As for the original article, it is so well said and as the comments state it is obviously the way we all feel about the service throughout the Country. I love my job and would like to carry on doing it until I retire..... but I don't want to retire at 68.

      Delete
  38. When will ambulance staff wake up and smell the coffee ?. They should hold a ballot to decide which union best represents their interests.. either Unison, Unite, GMB or Apap. Whichever one comes out on top is the union that we ALL should join to a man/woman. Until this happens we will be continuously shafted by management with little more than a whimper of protest. A union by the very meaning of the word means we stand together. While we are spread over 4 or more different unions we stand divided and management are laughing at us. Look at the fire service. One union. Maybe their more militant days are in the past but they are enjoying a holiday camp existance where I work while we are being run into the ground. My message is ...stop throwing £17 or whatever you're paying down the toilet each month and get organised. Then and only then will there be any light at the end of the tunnel.

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  39. This so called "sophisticated modelling" is in fact chaos theory. There's a reason it's called chaos theory; because it's CHAOTIC!! Ask the weather forecasters why they won't accurately predict more than 24 hours in advance, you can't, plain and simple (and they use the same software). We are being LIED to by these idiots who are probably charging the Government huge sums of money to buy their modelling software. Never forget the words of President Dwight Eisenhower " There are lies, there are DAMN lies and then there are Statistics! ".....although this could have been President Trueman :-)

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  40. As a medic, I can truely atest to the comments being made, my response is that it's the medics that are making the services run. It is dedication and commitment of all frontline medics that make defunked EMS systems around the world keep running, which also might be the cause as to why nothing seems to be done to help us!

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  41. Yorkshire Ambulance service is just the same! Well said! Dilution of skilled staff and exhausted crews are not good enough for patient care and the treatment of our loved ones!

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    Replies
    1. YAS treat their staff like dirt and it is obvious that senior management don't care at all as long as they can still pick up their salaries & sit in their nice warm offices. I note the comments about misuse of the Ambulance service as well but like everywhere else NHS111 is chronically understaffed patients speak to a non medically trained call handler who has to rely on a computer system to ask questions about their condition certain answers trigger a 999 response automatically and some of the "frequent flyers" know exactly what answers to give in order to get an ambulance. Also when patients do need to speak to a medically trained member of staff there are simply not enough of them so the patient gets put in a queue or promised a callback which can take hours so no wonder the patient sometimes panics & calls 999 instead.

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  42. Sounds like every where in the world treats there paramedics the same. Over worked and under paid. Our division in southern California is a private ambulance company and they think they can get away with whatever they want. Thank you for writing this article. Unfortunatly I don't see a change... Ever! May God bless us and attempt to keep us safe. I have heard of more deaths and accidents in the last yr than in the last 5yrs I've been in the field.

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  43. Thank you, thank you Mat,
    Your article was very well written and spot on.
    This 'Trust' has collapsed - the directors are some of the few who have not recognised this fact.
    Elderly patients are being left on the floor literally for hours risking pressure sores, DVT's, PE's and death from unrecognised illness and injury.

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  44. Thanks Matt great article from a EEAS employee you have hit the nail on the head We are no longer an ambulance service, we are a help/advice line and beaten with sticks and never given any carrotts.

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  45. We can go on and on about how unpleasant it is to work in the ambulance nowadays and it is. I,ve done 11 years with EEAS and i hate it though i used to love it. The main question i would like to know is why did we get to this point and who,s fault is it. If you look at the NHS information centre you can find all the ambulance call statistics from 1999. I worked out that from 1999 to 2005 the rate of increase in emergency calls was about 7% a year.SO ( are you concentrating?) if in 2005 one had assummed a growth rate of 7% a year and projected forward to 2012 you would have come up with a figure of 834,000 calls a year in 2012. The published true figure is 863,000 emergency calls a year! In conclusion there is no reason why all these top people on obscene amounts of money could not have forseen this, using quite simple maths. What in fact happened was an economic boom when money poured in to the ambulance service and they spent like imelda marcos, on shiny new ambulances, ECG machines, HART teams( for dealing with earthquakes, terrorism,nuclear incidents in east anglia)cycle paramedics etc completely ignoring the fact that the main workload of the ambulance service today is complete and utter time wasters. Care homes that call us for the most trivial problems(it,s policy don,t you know?),persistant callers who call each day every day for years,police to "check people over" (and hopefully take them off their hands),drunks on a weekend who get so pissed they collapse and then we get called to take them away, old people that fall, people with bad backs,headaches,stomach aches, children that fall at home on to carpeted floors from a height of 5cm and we have to bring an electron microscope to observe the supposed injury, footballers writhing in agony after a tackle and left in the middle of a muddy field until an ambo arrives( "we thought it best not to move him"). The list goes on and on. I would estimate the daily calls not needing an ambulance to be about 70-80% and my colleagues confirm this. Whilst these monsters were being created by our society our management did absolutely nothing to stop these abuses. They did not give a fuck and let us get on with coping while they had high level meetings about strategic planning and care pathways etc. And this ambulance service today is the end result of these years of apathy and incompetence. Today they are running around like headless chickens trying to reorganise rota,s,cut wages, increase our workload etc and nothings working. They ought to read a very good book, it,s called "the emperors new clothes", but i think it would go over their heads. One last thing, if you look at the annual reports on the ambo website you,ll find, buried deep in the goobledy gook, a list of the renumeration( wonga) and pensions for our directors, chief executive etc. At least some people are doing ok from this mess. Trebles all round!!!!

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  46. Let's face it, the Ambulance Service is Fucked. Along with this once great country of ours ( I love my country and my job, but not what it has become). Would the last person to leave please turn off the light. Goodnight and God Bless all frontline ambulance people.

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  47. What I don't understand is if patients are waiting hours for ambulances and rapid response paramedics are waiting hours for backup ambulances then how are ambulance services such as East of England Ambulance Service supposedly achieving their response time targets of reaching 75% of life threatening calls within 8 minutes and 19 minutes for "a fully crewed and equipped ambulance capable of transporting the patient"?

    With a bit of investigation I found the answers.

    It appears that they can 'downgrade' a staggering number of category A calls if the patient is more than 8 minutes away by either entering incorrect data or by using 'Enhanced Clinical Triage' to devise all the 'clinical' reasons under the sun to downgrade the call. Unfortunately as the Enhanced Clinical Triage is being targeted at the life threatening calls more than 8 minutes away this results in the critical patient being doubly disadvantaged as once downgraded their response may be diverted or delayed whereas the non critical patient who is less than 8 minutes away is likely to be attended to. They are also downgrading road traffic collisions.

    Secondly it appears that EEAS has been classing its rapid response vehicles as "a fully crewed and equipped ambulance capable of transporting the patient" therefore the car is 'achieving' the 8 minute and 19 minute backup response. Of course again the patient (and response paramedic) is doubly disadvantaged as the ambulance is delayed and not activated until the response paramedic has arrived - assessed the patient - and requested backup. This also results in the patient and paramedic waiting possibly for hours for a double crewed ambulance (sometimes exposed to the elements) as the 8 and 19 minute response targets have both been 'achieved' there is no further penalty for a long wait and again the backup ambulance can be delayed or diverted. Its win win for response times and lose lose for patient care.

    I never understood how reducing the number of double crewed ambulances and replacing them with cars was going to help the patient and reduce the long delays, well there is the answer it wont it is merely about response times and cost saving to achieve 'foundation' status.

    If they really are performing like this their 'real' response times must be horrendous. If this is the culture in the East of England Ambulance Service management it looks similar to what was going on in Staffordshire hospitals before the enquiry into the increased deaths and "appalling" care, in fact this may be worse. Who is their regulator?

    Anyone want to spill the beans?
    Enquiry anyone?
    Is Norman Lamb on the case?






    ReplyDelete
    Replies
    1. It is also common practise for crerws to be redirected to another call then reassigned and only the second mobilisation time recorded, the ex- CEO of Staffordshire was caught, his tricks have been copied by others as is the practise of responding to uncoded calls which get coded when the vehicle gets within quarter of a mile depending on the timing not the nature of the call... Red 2 toothache... Green 2 NOF....
      It's impossible to expose this to the media as only the individual crew and the controller (who is amending the codes and times) so if the story gets out the crew are for the sack.... Presuming the government give a dam...

      Delete
  48. Retired North Norfolk para parent3 October 2012 at 12:24

    I can answer one of those questions. In the hope that somebody high up the chain was actually reading what the masses are experiencing, I personally emailed Norman Lamb and asked him to read this very informative blog. I addressed it to his constituancy office and had a reply dated 19.09.12 that they would be back in touch within 10 days - if not please send a reminder. I've just re-checked my emails and to date still haven't had a reply. I think I'll have to ring his office to remind him!

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    1. Retired North Norfolk para parent9 October 2012 at 14:01

      As promised, I’m reporting back that Norman Lamb has replied to me: a bit late but worth the wait. I have seen evidence that he has been made aware of all your grievances by visiting crews and keeping up to date with relevant social media sites etc. In August he demanded exacting answers from the Ambulance Trust and is working towards rectifying the problems.

      As I’ve grown older, I have realised the euphoria of cutting off the figurehead doesn’t last. The rot underneath is still there. It does, however, give everybody the chance of a fresh start. Please make it a good one.

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  49. It's now 2 weeks since I made the comment regarding the need for ambulance staff to join the same union instead of being divided over 4 or more. My post has triggered an absolute zero response which can only be interperated that ambulance people don't feel it is a necessity. Shakespeare wrote "You blocks, you stones, you worse than senseless things". He wasn't talking about ambulance workers but he might as well have been. Just keep moaning then. You must love it...............obviously your preferred option to actually DOING anything. Sit back........perhaps Mat Westhorpe will do it all for you.

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    Replies
    1. Willie, you are right, the ambulance workforce needs to unite and make a stand. I'm very grateful for your support, it's encouraging to know I'm hitting the right notes.

      The problem with many ambulance personnel is they often don't have the time or the energy for the fight whilst on shift and when they get home they just want to forget about the whole mess. I can understand this, I was the same. The only reason I have the time and the energy is because I'm no longer doing the job.

      I have been hearing rumblings from within service and there has been some evidence that people are starting to speak out. I hope my appeal for staff to register their concerns with the CQC generated some activity, but I certainly don't expect anyone to publicly report they have done so, here or anywhere else.

      Attention from the public and the media is certainly gaining pace. Whilst I cannot be certain of the UNISON stance at the moment, it is my hope that there is some activity on a co-ordinated front. I would imagine these things would take place behind closed doors and may take a little time to organise.

      Perhaps I'm being naively optimistic, but with the recent resignation of EEAST's chief executive and rising criticism of the government's current NHS policy, I believe there is reason to hope that positive change is a possibility.

      I'll keep pushing. I think others are too.

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    2. I am aware of a large exodus in the Scottish Ambulance Service from the "main" unions to GMB/ASU. This happened last year in amongst all the change in rest period situation (removing the undisturbable rest period and changing to do disturbable). That seems to be a start. Nothing has changed yet, although there is some information-gathering going on regarding rest periods. Not sure what's going to happen with that information yet though - it's no use if it remains on station walls...

      Delete
    3. Willie you are correct, in My 25 years as a Paramedic in WMAS, the Unions a once strong and may I say fair organisation have divided opinions and Yes they are not strong anymore due to their make-up, You are correct we need ONE union, and not the half dozen that we have. My argument at present is that Unison have accepted the loss of our 25% unsocial allowances, This remarkable turn round was not even mentioned to the Unison Ambulance side until it was imposed upon all Ambulance staff this September 2013 after the Unison leaders in London decide to give away our A4C agreements. And prior to this we were balloted to see if we would accept it or not, however it seemed that the head leaders of Unison had already accepted it, Egg on face ballot me thinks. It’s refreshing to see Unite and GMB did NOT accept but as most of our union members are Unison we have no chance of fighting for our A4C agreements anymore. I for one have left Unison and have gone to Unite as I need a Union that will listen to ALL its members and not like Unisons approach who deal with so many of the NHS staff that the ambulance workers, being such a small minority to them, do not have a say or even have the opportunity to be informed of their own plight.
      I like so many other people here hate the way the job has become over the years , caring in the community DOES NOT EXIST. Figures, Stats and politicians with no idea about the job run the organisations and will be its demise for the future. There is no point me going on about the way it is because all the comments are so similar to what I would write that I would just be going over old ground, however if you had have asked me 10 years ago “Would you recommend being a Paramedic to your son”? I would have said yes without any doubt , however thank god he isn’t and I would not advise any one to work in this profession if they had other opportunities. He leads a healthy life and has a young family he sees every day and every weekend he does something with them, something I know that I have missed out on and still do. My being a Paramedic for so many years has had a very negative result on my social life, Mental health and physical health I have Osteoarthritis in both knees and in left hand, Recently under further investigation also now starting in my hips. I do 12 hour shifts days/nights and often run over to 13/14 hours with no break, I find it hard to walk after 10 hours due to pain and know that if I spoke out about my plight to much I would be sacked due to physical competence issues even though it’s the job that has exacerbated my injuries. I know I am not alone with so many other Paramedics carrying long term injuries and we are supposed to do this till were 68 ??

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  50. Poor treatment of paramedics by management is rife world wide. Have you ever considered a world wide strike? That would get everyones attention...

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  51. Nine years ago I left a small county ambulance trust (now part of SWAST) because I was so downheartened by attitudes within the service and the NHS. Attitudes that left me depressed and with a rapidly shrinking self confidence for the job. Did I get any backing or help? Don't make me laugh!! I was with the service for nigh on 19yrs, but for the last 6 or 7 yrs it was unbearable. Where once I looked forward to my shifts, it got that each working day was an unpleasant chore. It was when we changed to 12hr shifts that the rot seemed to set in - the workload seemed to double virtually overnight. Or was it just that at the same time management and govt changed too? Unrealistic times set for attendance were a killer and lack of breaks even worse. My condolences go to all of you who still struggle on making the most of a bad thing. And when the next paramedic dies an early death (I had an ex-colleague who died in his sleep at a relatively early age), why does nobody sue for corporate manslaughter blaming abuse through neglect and overwork? That would make the buggers sit up and think!!

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  52. I have decided enough is enough and am retiring from the Ambulance Service after 30 years and so I have seen the once proud Service dragged down to become the whipping boy for all and sundry, constantly criticised but no one asking the relevant questions. I wrote to the government some 5 years or more ago and asked them to bring in a law to enable the Ambulance Service the right to charge for inappropriate calls, the reply that I had back was that the law was already there. I passed this through to senior management to be told we could not enforce it - what a load of rubbish.
    In the area where I currently work we also work 12 hour shifts and frequently go deep into the shift without a break due to inappropriate tasking from doctors etc. using the computer aided despatch, if they can get the patient to say headache, chest pain or abdominal pain or the current classic "generally ill", irrespective if they have had the problem for days, coughing up green phlegm or have been seen at the local casualty a number of times, always taken by ambulance ("because it is their right as a taxpayer", seen by their own G.P and given medication but still they call.
    The Service will also denude a complete area of Double Manned Ambulances to bolster another locality, when challenged they stated they could manage with Rapid Response Vehicles, is this 1st class patient care or just post code patient care?
    Regarding response times, in this area management use First Responders, members of the public who have had some First Aid / First Person on Scene training and respond to emergency calls from home or as in some area's, book on and sit in a car somewhere awaiting a call. The other response is from St John Ambulance Service who have been given contracts to support the Service both on Emergency and Urgent calls, is this the Service this once great country deserves, I will leave you to make up your own mind, but for me the Service reflects the country, Fractured

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  53. l have taken early retirement after 32 years of service as a Paramedic .... l got fed up with the management of southwestern ambulance circus ruling by shear bullying, fiddling times and codes for years to meet time targets,to look good to the Health minister and of course be top of this months league table.
    my last role was a clinical supervisor Control and my brief before l left was to recall patients and re triage any red call that we would not make and to downgrade where ever possible. post code lottery it is not myth = fact if you live in a rural area you are sacrificed for the stats...
    It did sadden me to leave a once great service, but i now work part time in the private ambulance sector picking up all the work that NHS ambulances don't deal with any more, and its a happy place, better pay and much nicer people. l am again respected, treated properly and allowed to give the patient care as required not dictated by codes/times.
    To many of my old colleagues have been brow beaten to love the "TRUST" and lets put the Foundation trust empire first,sucking up to managers 2nd and the poor old patient is last , (unless a relative)...

    l hope for everyone's sake, patients and operational staff that things improve.. best wishes from someone who was fortunate to be there in the good days... rergards Buzz

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  54. I apologise for the Emas staff member here, who is spouting the GMB and UNISON version of events, and who is clearly unable to read the actual consultation documents.

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    1. How rude to apologise for what someone else has written! I am not a paramedic or a member of ambulance staff. I am a local resident in the EMAS area who is also a carer of elderly parents. I and other members of my family have had need of the ambulance service in recent years. The EMAS service is already failing to meet targets in High Peak on a regular basis. I have read the so called consultation documents and they were complete rubbish, asking leading questions and ignoring a number of very important issues. The basic facts are that there will be an increase in meeting targets in Urban areas under the current proposals, however the majority opinion in this area is that one model does not fit all and that the proposals will be detrimental to those in rural areas. In future please don't denigrate other people's opinions, just state your own.

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  55. At least someone has said it how it is now all we need is someone to do something about it.

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  56. Just got a link to this through the Scottish Ambulance Service Staff Forum.

    Brilliant and spot on. Well done that man.

    We work in a remote rural setting and, as such, are reasonably protected from these stresses. However, we have other, similar but less obvious ones.

    Since we mainly cover 24hr shift periods, half of which are called "On Call" and therefore circumvent the Working Time Directive laws, we can end up in situations where we have been up since start of day, which on School days is 0630hrs for me, and have lived a normal life, like everyone else, i.e. be awake, eat, do a bit of housework (Work from home) eat, and just generally be alive for the normal waking hours of the day. Then, someone needs our help at 2200hrs.

    An average call out which requires patient transport to Hospital takes us six hours. So now we are comitted to being awake until approximately 0400hrs. However, it is usually later than that.
    While we are in the City we become, by the Governments rules, a "resource" for the Ambulance Control room and will be tasked to any emergency that comes in if we are the closest "resource"
    This can keep us in town for several hours.
    As much as possible is done to avoid this, nevertheless the system allows for it and it is, presently, unavoidable.

    So, lets say I am tasked to a couple of emergencies in the City of around an hour each. I will now arrive home at 0600hrs and have been awake for close to 24 hours.
    In my opinion, and in the opinions of most of my colleagues (Sadly not all) this is unacceptable.

    The final chapter to this is that we are expected to take the initiative and "book off" duty ourselves, leaving the community without an Ambulance. If we don't then we will be sent straight back out on another job and no one in authority will care, unless, that is, we have an accident and the Police find out that we have not had the required amount of rest. At this point we get charged with dangerous driving (provided we survived the accident) and will loose our licence and therfore our job.

    Please note that I have been accused of abusing the, very limited, Fatigue Policy by booking off duty inappropriately in the past. No doubt the same will happen in the future as I fully intend to protect myself and my patients as much as possible with the limited tools I have available to do so.

    Thank you very much for this post. It deserves much wider publication.

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  57. There are so many of the comments that I would only be repeating, this seems to be endemic throughout the UK and in the wider world. There are so many issues that it will be a mammoth task to address them all. I do not advocate introducing a charge as this will invariably cause many genuine patients to delay or even not call due to fear of not being able to pay- something that many of our elderly patients have a real fear of.It will not bother our workshy, unemployed, illegals, or asylum seekers- they already get everything funded by the tax payer. We need a greater form of education for the masses to explain the very nature of the word EMERGENCY. It's no good slating the very dedicated paramedics and
    technicians- they do an outstanding job under increasing pressure. The ambulance service needs to have the backing of thelaw andbe able to legally refuse to attend some situations. There should be joined up support from health, social care, police, and families- we all have regular callers who just want company because they are lonely as well as those who truly abuse the service by asking paramedics to change light bulbs or walk their dog. The attitudes of both public and service bosses needs to change. Staff moral is at rock bottom but most staff keep going, even when they are tired, hungry, cold,etc. Because deep down they all remember why they wanted to do this job in the first place.

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  58. john belstead retd ED doc24 January 2013 at 20:43

    'Sophisiticated computer modelling' is one of those phrases that makes me want to throw up. In 1965 'Father' Ellis (the first Casualty consultant in the country - at Leeds General Infirmary) was told that he wouldn't have any problems with queues if he organised his workload properly! He was sufficient of a gentleman not to punch the politician in question. Sadly such ignorant ideas and attitudes still prevail

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  59. Para What a wonderful blog and so many truths orcon waste of time!over 50 yrs old doesnt meet the world of modern health care and amount of traffic larger geographical area ,staff not getting breaks common in every ambulance station now not just the tradional busy ones.Lots of cheating on figures by useless spineless managers like ring ring "hello ambulance service how can we help you?" "I have 999 transfer from ccu to specialist unit 50miles away" control-"no worries do you have defib in dept?" ccu-" off course twats its a coronary care unit !!!" control" ok no worries we will send an ambo after they have their break " worrying yes but because they have defib in dept crew are marked on scene !!! and may not be there for a while but good old god orcon is met to hell with the pt !!!!!

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  60. I am not in the Ambulance Service, but a friend of mine was taken by ambulance to Hillingdon Hospital, and there were six ambulances in front of him all waiting to hand the patient over to the staff in A&E, so it took over an hour and a half to be admitted, all of that time the ambulance crew had to sty with him. Unavailable ambulance while he was waiting, most probably meant someone else could not get help, many A&E departments are being closed in the LAS area, means longer journeys and now with less crews available, what next?
    Do we just call the undertaker in stead?
    The government cannot keep cutting available money and expect a wonderful service, the MP's are demanding a rise, why? they get all the perks they want, instead donate some of their salary to the hard working ambulance crews and vehicles.
    Martin Ames.

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  61. Unfortunately, I must also post anonymously for fear of losing my job for speaking about what goes on. I work for the Scottish Ambulance Service. The problems are the same here.

    Having seen a member of staff die and another one have a serious medical event while still employed in my area, my concerns increase more about the job I choose to do (I love my job, just not the politics that makes it such a health hazard). Staff are falling ill or having injuries, living on painkillers just to get through shifts or thinking about retiring as early as 50 because they can't handle the 12 hour nights and increase in workload.

    Education on limited resources is needed for the public (ambulances are not hiding on every street corner, waiting for their call, although the newspapers fuel this though by telling them we are lazy and prefer “tea-breaks” instead of helping dying patients), for doctors (why should a patient wait 3, 4, 5+ hours at home when they have their own means of transport to get to where their treatment can be started?) and for NHS 24 (buck-passing instead of asking prominent questions is not acceptable).

    Buck-passing is rife. We are as guilty of this as any other part of the health service). Buck-passing patients to hospital because it's easier and less risky. Buck-passing to doctors because we have few protocols for leaving patients at home on our own. We are increasingly attending more calls falling outwith our training, more suitable for a GP. Organising other care at home frequently takes longer than taking someone to hospital. Hospital cannot cope with demand. Nurses in A&E and medical receiving units look stressed out regularly. There’s a lot of venting/bitching - between crews, control and hospital staff. Venting purely caused by frustration at the whole machine. Cynics might say that management like to keep us infighting so we don't have the time/energy to stand together and fight against them.

    Now some staff are also expected to fully clean their ambulances (removing a double-crewed ambulance from the pool for 2+ hours) and also having to clean stations to frankly ridiculous standards on the odd occasion we get back there, due to a lack of funding to follow new infection control policy.

    And, the promised new staff, employed to fill the gaps of roster changes for disturbable breaks? They're being put through the new university course in droves. And coming out with nothing. They end up being trained fully by people stupid enough to have agreed to be "mentors" for no reward. Trying to ensure you don't make mistakes yourself when you're tired and hungry is one thing. Looking out for another who has been let down by their training is just impossible.


    I’ve had to book off shift to get a decent feed as the snacks I can carry in the ambulance (heaven forbid anyone finds out I carry food there) have failed to sustain me for the 10 hours I’ve worked non-stop, because my hands wouldn't stop shaking and I could barely spell my own name, never mind make decisions on a patient's life. Who would want me in that state? Why do we work to that point? We care about patients and are aware that the service has no provisions in place for losing an ambulance and I'm always afraid that the next call will be the one that time could make the difference. But if I make a mistake, I'll lose my registration and probably my job.

    I, for one, am desperate to make a change, not just for me and my likely prolonged working years ahead of me, but for the members of staff I see completely broken by the whole thing and the fact that patients deserve better. But I am a bit bewildered as to how to make a difference officially. Blogs like this are great to see (very well written Mat thank you) in the hope that some of the ambulance-haters might actually see the truth instead of what ends up in the press, and also showing all of us that the problems are rife around the world, not just the UK. But unfortunately, they’re not being noticed by managers.

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    1. Whilst I, and many others I'm sure, echo your sentiments, I feel the battle has already been lost. There is very much a 'put up or get out' attitude from managers, or senior people within the organisations across the U.K.

      The bullying and intimidatory tactics employed by ambulance services in order to reach targets has clearly worked; a classic divide-and-rule outcome.

      Many have left, more are leaving, and recruitment seems to have plateaued for many years. As for training: what training? A private service looms for all. What's so wrong with that you ask? Maybe nothing, but I suspect otherwise.

      A de-skilled, de-motivated, unhappy, tired, undertrained - but ultimately caring staff who want nothing nore than to just do their job - arriving at some undetermined point in the future so they can help you? I think I'll start walking to hospital now then.

      I for one fear for the future of emergency care in the streets.

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    2. I'm sorry, i may have misinterpreted your reply... Do you feel that education for paramedics is not necessary? We moan about people belittling the service, yet when we endeavour to educate the future of the work force it would seem that they are taught 'nothing'.

      Whilst I fundamentally agree with the majority of what you have written and what every other poster has commented on, I am surprised that there has been no mention of how trusts have aimed to reduce their liability by placing this primarily on the head of each individual. As a medic, much like yourself, I do feel incredibly vulnerable at times but I do not think that it is the fault of our fellow employees (graduate or not): this thinly veiled dig at New comers is neither helpful or productive.

      The one common theme running through all of the posts I have read is the need for change: how do you imagine change is possible when there is a massive hostility and cynical out look when ever anything alternative is implemented?

      We all know the agenda: all hallowed FT status, meeting response times, 'streamlining' services. Blah blah blah.

      We all like a moan and a whinge but do we actually do anything as individuals to make anything different? The water fairy had it right. Whilst we stand around and scratch our collective nut sacks out front of cas, harping on about how shit it is and how we are getting violated (sans lube), things will just keep teetering on the edge of the abyss.

      Educational isn't to be critisised, neither is experience; a healthy mix of both is ideal but this takes time. It also means a broader out look is required when selecting candidates for promotion rather than the 'jobs for the boys/nepotic' culture that will continue to inhibit the progression and development of our services and most public service across the country.

      The bottom line is: protect yourself and your mate whilst providing the best care that you can. Not fret over how little your mate knows and think that you're infallible. They will also have their concern about you.

      Anyhow, I just got my eta clear so I'm outta her. Thanks

      Delete
  62. Don't forget Photosensitive Epilepsy

    Most ambulances have so many lights the bounce back rate is horrendous (at night) never mind when it's snowing.

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  63. I also work for the Scottish Ambulance Service, and I am also an active Union Steward. There are a few home-truths that need to be told here.

    Our management are becoming increasingly autocratic, have no regard for staff governance and have become blindly target led and not patient led. They are aided in this by having a Government appointed HR director who appears to be more career led than ambulance led, who is helping senior managers to by-pass reason and common sense and impose new ways of working which are to the detriment of everything, apart from falsifying government targets. This we union reps all know. So why is nothing being done?

    Actually it is being done. There will shortly be a meeting with the Scottish Govt to voice our concerns. At a local level, reps are being harassed, shackled by management using "exigencies of the service" to restrict attendance at critical meetings, fabricate or enhance evidence to use against those stewards who stand up to them etc etc. But we still do our best to curb the excesses of the clueless incompetents in charge. They have just avoided an idustrial tribunal which would have blown the lid off the sas to the highest level by paying off the steward who was taking it.

    There are 2 things in Scotland that have caused problems with getting management stopped, a sister union and the staff themselves. The sister union has misled staff with hollow promises and fighting talk and they have been helped by preferential treatment by management! Why would they do that? Divide and rule is the simple answer. All the sister union has done is undermine the efforts of the rest of us and they have yet to achieve any of their promises, from getting lawyers to ban on-call to sorting out the rest period issues. The impact that this has had cannot be underestimated, and has severely watered down any staff side opposition.

    The staff themselves are not united, apart from the union split they cannot agree on anything, and refuse to help themselves. They moan and complain to each other, blame everyone else, refuse to listen to the difficulties that are forced on us by employment law, but when we ask for something put in writing, or raise a grievance they run a mile. Then they undermine their stewards by agreeing to do the very things that we are objecting to on their behalf. Managers are very clever at manipulating the rank and file, with threats and intimidation - if you object we will make you work 8 hr shifts/report you to the HCPC/ impose a new shift pattern etc etc.

    I am not blaming staff; they are either young, keen and very naive or de-motivated, unhappy, tired etc as many have mentioned above. As if things aren't bad enough right now, there is the prospect of 67 year old road crews, underfed, under rested and petrified to do anything in case they make a mistake turning up at patients doors - or more likely on the scrapheap as they have been kicked out under the capability policy.

    The service lies and misleads the govt, the govt enforces targets that are impossible to meet, and staff are so busy trying to cover their arses that there is little energy left to fight. Bullying and harassment is institutionalized, the press are fed misinformation to blame the staff - Tomintoul is a good example - and the training system is on the verge of collapse. Us road crews hate control who in turn hate us, policies are ignored, staff governance doesn't exist and yet somehow we still manage to attend patients and do a good job despite everything.

    But don't worry, this is called "treating people well" by our corporate visionarys!



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  64. Isn't the ambulance service defined as an essential service not an emergency service? If this is the case how can they get away with not feeding us and giving us correct rest periods?

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  65. Too true! I remember when I first started we would get back to station several times a shift, on Sunday night's maybe even have a good few hours!
    By the time I was sacked for my sickness (having just discovered I had served hypothyroidism), you'd never see station, be lucky if you got a break and it was relentless.
    My heart goes out to all the crews still struggling with a service which is being held together with tech tape!

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    1. WTH????? I am a US Medic. I worked 100hrs out of 120 every week for 16 year. Lost my marriage, home, & pension due to the anger & frustration I retained from the stress of making enough money to barely survive...but, my Sister, I am done whinge-ing to learn of your sacking due to illness. WHAT? These bum-nuggets think you ASKED to be hypothyrodic? Uhhhhh. 1)lack of rest; 2) lack of nutrition; 3) stress; 4) stress; 5) possible hereditary influence; 6) did I mention STRESS?
      In the US unions became more harmful than naught. One gets pilloried for refusing to take Mrs. 6-Weeks-Ingrown-Toenail-at-0200hrs, 'cos, y'know, that toe pain might be indicative of an impending we-can-bill-the-crowns-off-their-molars job.' Privatisation is just as bad for us Medics as Civil service is. There is no winning for trying. Pray for everyone left in the Service. PRAY LIKE HELL for our patients. Forgive us for allowing ourselves to be abused, Dear Lord, & if You have it in You, strike all these inept/selfish/clueless policy makers with an intractable case of the hiccups & 'NUA'(no units available).
      I quit. Come visit me in my palm hut in a 3rd world tropical nation & I'll teach you to fish with expired intravenous catheters.
      May you heal from this, Sister. & win the lotto.

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  66. Management don't care if we burn out. We now lose pay if we take any time off, not forgetting the draconian "absence" policy that had seen several dedicated staff lose their jobs.
    One major reason they don't care is that there are queues of ready qualified students that can be thrown straight in to fill gaps at no cost. Cheaper than experienced staff and no cost to the trust for their training.
    As long as they can get there in 8 mins their lack of patient experience is of little interest.

    Never in my life have I had such a great job, ruined by such a terrible employer...

    Yorkshire

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  67. Whilst the lack of respect and human dignity is utterly appalling and should be fought against at ALL costs, I do think that the Government could make instant improvements by simply charging time-wasters that use the ambulance service as little more than a taxi ride to A&E.
    It is well publicised, the number of 999 calls that are made that really are not any where near like life threatening conditions along with the extremely high volumes of incidents as a result of extreme intoxication.
    If the public had to pay for the service in a situation that only requires a GP or where the patient could make their own way quite safely to A&E or if the injury was acquired as a direct result of complete drunkenness, then I am quite certain that it would not be very long before these amazing people would be able to do the job that they are trained to do and actually save lives, with the added bonus of fewer call outs which would make way for time to eat, drink and use the toilet.
    I would be interested to see the statistics of how many 999 calls are actually in real need of the ambulance service and how many are complete and utter time/money wasters.
    It's not enough to give the service a fair working day but it would be a start.

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  68. I was a paramedic for 13 years and witnessed a steep increase in demand coupled with a rapid decrease in resources - it was a recipe for disaster. 13 years of the 'you knew what you signed up for' lack of emotional compassion from management, and colleagues, while dealing with death, dying, emotional relatives and the kind of trauma that very few ever get to witness all took its toll. Did management care? No chance! The shit rolled so heavily down from managers who got their perky jobs from having the right kind of friends, or sleeping with the right kind of people, and were so insecure in their own abilities they took it out on their subordinates - right down the line. Never mind all the abuse from patients and under-resourcing, add on top the daily stress of being bullied by station management, line management and colleagues, as nobody seemed to like an over-achiever (even in the health professions!), and you end up with a very broken paramedic indeed. I was forced to resign on health grounds from a career I loved so much I very nearly died of a broken heart afterwards - and I mean that in a very literal sense.

    The whole system is broken and has been for years and the health care professionals always ignored by media (unless they are accountable for some mistreatment or other), the ones who bear the brunt of the idiotic 'public' and their onslaught of pointless 999 calls (including one to 'fluff up a pillow') and the ones who are most in need of both physical and emotional support from their employers - the paramedics/technicians - are the ones who receive the least of all.

    My heart still aches today for a career I loved, cared deeply about and still miss dreadfully - but in one key sense I am glad that I got out when I did. The physical pressure you are all under today (on top of everything else I mentioned) is absolutely insane. Nobody is superhuman and nobody should be expected to be.

    Today I am on more medication than I remember any of my patients being on - numerous health issues caused by nothing other than 'stress' - not from the job itself, but from the way I was treated by my employers and colleagues while doing that job, and doing it well.

    All currently serving front line staff have my up-most respect but do yourselves a huge favour and get out before the job destroys you.

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  69. An absolutely brilliant blog, well written but most definately the truth. The public really don't realise what we're up against. The vocation I came into 27 years ago has completely changed. Myself and many of my colleagues are under the same threats and pressures, many will leave, which will further add pressure.
    Well done, lets hope someone with some clout in the media gets to read this and brings it to the attention of those we serve to the very best of our abilities, despite the enormous pressures we are under.

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  70. Sadly all the above is true and it has driven me from a job I have loved for many years. Luckily I was fortunate to have the qualifications and skills to move to an alternative career, but sadly many of my colleagues were career paramedics and as such had no other strings to their bow. They are trapped in a job which they still dearly want to love, but which is literally killing them. The one thing this article doesn't raise is the additional pressures from the HCPC etc whereby clinicians are scrutinised and interrogated at every turn, by their control staff, their managers and the HCPC. The emotional toll of such work is vastly underestimated and the culture of relentless "reflective practice" means that staff are forced to repeatedly relive experiences which they would often rather forget. In my immediate circle of myself, family, friends and colleagues there has been a terrifying level of diagnosis of PTSD and other stress disorders, directly attributable to work. The ramifications of this require no explanation. Such situtations are only compounded by all the things mentioned above, such as extreme fatigue, blood sugar dips etc, but consider also the impact that the lack of down time has - these are the periods when we talk through jobs we have attended - both to vent and de-stress and also as a clinical learning tool - shared experience is a very valuable thing. Without time to speak to trusted colleagues on a station we are boiling a pressure cooker with a safety valve that has been welded shut - humans can only carry so much emotional baggage before they crack - and whether this results in resignation, breakdown or suicide (I have sadly known all of the above), this is surely both dangerous and unacceptable. All the more so when you realise that these individuals cannot go to their own management for support for fear of ridicule, bullying and of course the "C" word - the capability policy.
    You will never meet such a dedicated group of people who genuinely put themselves through this on a daily basis purely in the interest of helping others and achieving the best outcomes for their patients. The fact that they are no longer allowed to do this is the thing which is killing the ambulance service at present.

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  71. Well Monday is the funeral of my wonderful Paramedic husband who committed suicide whilst suffering from PTSD.

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    1. So sorry for your loss from BC Canada.

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    2. so sorry for loosing your loved one. , but how many will it take to suffer in silence before it stops... many, many more I'm sure.

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  72. Thinking of you on mon N. He was a genuinely wonderful human being and a superb Paramedic. I greatly enjoyed the jobs I attended with him. It's a huge loss and and he is sorely missed by all.

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  73. We'll done Matt! Without a shadow of doubt you hit the nail squarely on the head! I left the Ambulance Service just as it was going for trust status as I could see that all they cared about was an arse on a seat at the start of the shift. As a union rep, I found it difficult to get to meetings management organised as they always seemed to be on days I was on shift and 'there was no cover' and this was in the early 90's. I now work for a private company providing support services to a number of NHS services and know that they system is failing on a spectacular scale. We, as clinicians, working in London are told that once we turn up at a call, the patient HAS to be taken to hospital, no exceptions, we can contact the CSD desk but 99% of the time the answer is 'take them in' - probably because that's what the guy's and girl's on the desk have been told to say. In other services we have an hour's drive before we book on so we end up working a 15 hour shift minimum. I love my job, it's the best job in the world, but the public have to know that ringing 999 for a headache or gingivitis is unacceptable! As for degree paramedics..... I'm sorry but they should have a minimum age before they can undertake this degree, with all due respect, a 21yr old graduate has no life experience and 90% have no idea on how to converse with the patients they see, bring back 'on the job' training, bring back technician training, how can you expect to provide best practice when one crew member drives for 12-15 hours while their partner attends for the same amount? Nepotism was rife in the 90's and seems the same nowadays, although I'm sure these days being 'too tall' or 'not making the tea enough' is no longer a managerial excuse for preventing staff to progress to become a paramedic. I'd love to have an MP third man on my truck for a 105hr week and see what bollocks they would come up with!
    A tech with 26yrs on the road.

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  74. and when neas calles the community first reponders 3 times in one week saying we are at code red - the service cant cope all cfr log on for duty to help says a lot. maybe as a start they should thin out the management and make the managers left actually work for their wagers. the ce and his croneys give up their company cars. and finaly the government and every one else realise the health service is not a business and connot be run as one and thoes in power grow some balles and really work towards sorting it and not lining their pockets and thoes of their ass kissing friends.

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  75. If you think the job is that bad and genuinely taking that kind of toll on your health then it sounds like you need a change in career.
    As a practising Paramedic myself, I often see substandard care being delivered by clinicians with this kind of attitude - the "management don't care about me" ethos affecting clinical judgement.
    Paramedics are paid very well for what they do - if you really feel it's that bad, the job centre beckons - there's plenty of people that would love to do your job...

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    1. Paramedics are not well paid. A corporal in the forces gets paid 32K a year and not all of them go to the front line a lot just sit in the UK and polish their backsides.a paramedic only gets that wage because of enhancements. Some of the substandard work you go on about is caused by the stresses at work. Yes some people do have the attitude of the management don't care so why should I but I don't know of a single clinician who doesn't give it their all when carrying for a patient yes it may be rushed yes it may be blunt but it is always the treatment that is required

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    2. New to the grind, are you?

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    3. I take it from that , that you have spent very little time in the job, have no family and probably still live at home , so the money would seem good, and the life style is the only one you know, I feel for you as you will look back in years to come and eat those words?

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    4. Unfortunately those people at the Job Centre you mention (such a cliche, by the way) have not trained for at least 2 years and experienced the frequently unpaid overtime, anti-social shifts, abuse from members of the public, or intimidation by managers who are supposed to protect them. I am not a Paramedic but a close relative of mine is. He recently injured his back when a patient assaulted him, an A&E nurse & a doctor. He is currently being harassed (I use the word advisedly) by his manager because he needed to take time off sick as a direct result of this injury (not his opinion, but that of 2 different physiotherapists). He is extremely committed to his job and for his manager to imply that he has taken unnecessary sick leave is both cynical and insulting. I suggest you read the rest of these posts carefully-this is not whingeing but a genuine attempt by dedicated Paramedics to raise awareness of a situation which needs to be urgently addressed by NHS 'strategisers' who seem to be completely detached from the reality of what is actually happening.

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  76. Presumably you're new.

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    1. Practising paramedic, lol! Wait till you do it for real, and for 20 years, and cringe when you look back at what you said. One of these newer graduates reported a crew because they found an empty crisp packet in the cab when taking over a vehicle!!!!! Worse was that 2 managers acted upon it!!!!

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    2. New and STUPID! No doubt you'll go far in the service with an attitude like that! Best your colleagues start wearing stab vests when on shift with you...

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  77. 12hrs I wish...24hrs in a 911 system in the 3rd largest city in the US with a shortage of medics. The Administration including the medical director could care less. What do you do when nobody has your back. I love what I do but...

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  78. And people wonder why Paramedics are leaving the job in droves.

    Abused by the patients who treat an ambulance as a glorified taxi.
    Abused by PD who need psychiatric patients transported by ambulance for observation.
    Abused by nursing homes who transfer out low grade fevers at 3am.
    Abused by hospital staff wondering why it took so long to get a car for a transfer.
    Abused by senior management for not clearing the hospital to go take the next BS 911 call.

    And yet people wonder why a lot of medics look at other career opportunities. EMS is quickly becoming something you do in your 20s and not a career.

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  79. In Israel we have a great EMS servises but the ambulance workers is in worst condition than in England

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  80. And when they question neglect of a patient from a nursing home, they get dismissed!!

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  81. My dear husband was a front line paramedic team leader for 25 years. He left the service after being awarded two medals for long service and bravery.

    Why did he leave...because he developed PTSD after the demands of an underpaid, un-appreciated job for a service that at the time, offered one counselling session per year and did nothing to help him when he became ill. He has never been the same again, my advice to any parent with kids thinking of entering the service, do all you can to put them off. Its not worth it...to all of those moaning that if we all did that, we wouldn't have any emergency service...hard luck... a lot of you don't appreciate them anyway...they suffer abuse on a daily basis and the pay is disgusting.

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  82. I couldn't agree more with all of the above! As an added insult management spout about putting the patients first, BULL! The only thing management care about is statistics - How long it took to attend an incident. If a person dials 999 and states (when asked) that there is a defibrilater at the location, the ambulance service will declare that a resource is on scene only seconds after receiving the call and therefore reflect well on the service. They then claim that we attend 85% (for example) of all calls in under 8 minutes. The fact is, the ambulance took 30 minutes because the nearest available one was 20 miles away. The patient had a head injury after a fall so a defibrilater being at the location is irrelevant anyway as it would never have been needed! Yet management proudly use these statistics to spout about how great the service is!!! This is just 1 from a million examples of how the ambulance service is nothing but a money spinning joke!

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  83. Just done a 12 hour shift as described in this article. Relentless. Overworked. Unappreciated. Ignored. Unsustainable. Dangerous. Unacceptable.
    These words are seemingly unrelated to practices of ambulance services in the eyes of their management.
    Patient condition/improvement are indicators that should be of primary importance. Instead it is time to on scene-regardless whether the resource is appropriate for the case in question.
    Disillusioned and stressed staff are working beyond their capacity each and every shift, facing cuts to pay and conditions, in an attempt to carry out the job which they believe they signed up to do.
    Meanwhile the executives and non executives award themselves absurd and undeserved financial rewards.
    I potentially have 30 years service until retirement. The way things are presently I honestly believe the only way to retire will be enforced through ill health.
    Red base out.

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  84. Just done a 12 hour shift as described in this article. Relentless. Overworked. Unappreciated. Ignored. Unsustainable. Dangerous. Unacceptable.
    These words are seemingly unrelated to practices of ambulance services in the eyes of their management.
    Patient condition/improvement are indicators that should be of primary importance. Instead it is time to on scene-regardless whether the resource is appropriate for the case in question.
    Disillusioned and stressed staff are working beyond their capacity each and every shift, facing cuts to pay and conditions, in an attempt to carry out the job which they believe they signed up to do.
    Meanwhile the executives and non executives award themselves absurd and undeserved financial rewards.
    I potentially have 30 years service until retirement. The way things are presently I honestly believe the only way to retire will be enforced through ill health.
    Red base out.

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  85. As a California medic, I commend the writer of this piece on the accuracy of these observations.

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  86. My son aged 25 has just started his degree course to become a paramedic. He has wanted this for years. I was so pleased for him until I read this blog and all the comments which concur with what is happening. Now I am filled with dread!

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  87. My son aged 25 has just started his degree course to become a paramedic. He has wanted this for years. I was so pleased for him until I read this blog and all the comments which concur with what is happening. Now I am filled with dread!

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  88. Different part of the world; same scenario; I guess it is just our lot to be relied upon and dependable... When you are strong for others so long and so often, on whom then do YOU rely on for strength - we only have so much.....

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  89. Well written, but 12 hours is not exactly a marathon. If you are still signing up for overtime shifts, and otherwise burning the candle at both ends with recreation, moonlight jobs, or other duties that interfere with your rest and exercise and nutrition during your off-duty hours, then you have no one else to blame for fatigue or errors on the job.

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  90. Identical situation here in Ireland. OT is next to gone. Breaks not being given. New entrants being paid less than Lidl checkout staff. Sick not being covered. Ambulances being dropped left right and centre. Using RRVs when a crew member goes sick, in place of an ambulance. Bullying and harassment is flourishing. Up to 5 years wait for new staff to be rostered to a station. Wrong AMPDS codes being given out. Tetra radios sitting in storage the past 5 years, still on analogue system. Closest ambulance not being sent in the Dublin area as the fire service has 12 ambulances that they give the calls to first, despite the fact a Health Service ambulance may be much closer. It's a dysfunctional tragedy at the moment. Changes being promised for years now. We're all sick and tired of it.

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  91. Willie you are correct, in My 25 years as a Paramedic in WMAS, the Unions a once strong and may I say fair organisation have divided opinions and Yes they are not strong anymore due to their make-up, You are correct we need ONE union, and not the half dozen that we have. My argument at present is that Unison have accepted the loss of our 25% unsocial allowances, This remarkable turn round was not even mentioned to the Unison Ambulance side until it was imposed upon all Ambulance staff this September 2013 after the Unison leaders in London decide to give away our A4C agreements. And prior to this we were balloted to see if we would accept it or not, however it seemed that the head leaders of Unison had already accepted it, Egg on face ballot me thinks. It’s refreshing to see Unite and GMB did NOT accept but as most of our union members are Unison we have no chance of fighting for our A4C agreements anymore. I for one have left Unison and have gone to Unite as I need a Union that will listen to ALL its members and not like Unisons approach who deal with so many of the NHS staff that the ambulance workers, being such a small minority to them, do not have a say or even have the opportunity to be informed of their own plight.
    I like so many other people here hate the way the job has become over the years , caring in the community DOES NOT EXIST. Figures, Stats and politicians with no idea about the job run the organisations and will be its demise for the future. There is no point me going on about the way it is because all the comments are so similar to what I would write that I would just be going over old ground, however if you had have asked me 10 years ago “Would you recommend being a Paramedic to your son”? I would have said yes without any doubt , however thank god he isn’t and I would not advise any one to work in this profession if they had other opportunities. He leads a healthy life and has a young family he sees every day and every weekend he does something with them, something I know that I have missed out on and still do. My being a Paramedic for so many years has had a very negative result on my social life, Mental health and physical health I have Osteoarthritis in both knees and in left hand, Recently under further investigation also now starting in my hips. I do 12 hour shifts days/nights and often run over to 13/14 hours with no break, I find it hard to walk after 10 hours due to pain and know that if I spoke out about my plight to much I would be sacked due to physical competence issues even though it’s the job that has exacerbated my injuries. I know I am not alone with so many other Paramedics carrying long term injuries and we are supposed to do this till were 68 ??

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  92. This applies to the USA too. Crews work 24 hour shifts. I've been a paramedic for 16 years (average lifespan is 10 years). While the suits are trying to find ways of cutting spending, it will 100% of the time include increasing call volume/ work load on the crews. For many years I was in a moving ambulance 26 hours out of a 24 hour shift. I would easily work 18 hours straight without food and no sleep. Driving home from work I fell asleep at the wheel of my car many times (I should NOT be alive right now). Countless times I reported to dispatch that we were low on fuel or had run out of oxygen, but it didn't matter.. they'd respond with "But you have to take this next call.." It would have been less frustrating if there wasn't at least 2 people certified to work on an ambulance sitting at the headquarters (who had office jobs now)who could run 1 call long enough to let us refuel and refill our oxygen. The emotional stress the EMS crew faces if their vehicle breaks down. I was yelled at by dispatchers AND management because a serpentine belt broke on the ambulance while we were on our way to our 10th call of the shift. My favorite thing though, was when I would get a 10 minute break to eat a few bites of food while typing up an EMS report, the boss decided I needed to do some chores instead.. The sad part is, many EMS services will embrace this to give the impression that they truly care meanwhile crossing their fingers behind their back. The longer a paramedic works, the less stable his job is because he costs too much money. Overall, cost is worth more than experience and patient care. Quantity is worth more than Quality.. and I think this is where the system lies in fault...

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  93. I am Chair of the independent Patients'Forum for the London Ambulance Service and we have consistently raised many of the issues above with the LAS and with the LAS commissioners. The response that often comes back is that front line staff prefer to work long hours and have long breaks between shift blocks. We have consistently opposed this approach, arguing that 12 hours shifts over several days potentially harm patient care and harm front line staff.
    But why are so many respondents to the blog anonymous? We have legislation and policy on 'whistleblowing' and a 'duty of candour'yet so many paramedics are scared to speak out. I think the fear of speaking out contributes to the problems and keeps paramedics under the thumb. Surely its about time that all staff met their professional duty and obligation to speak out when things are wrong. The public will support you but they can't if you hide behind anonymity. Malcolm Alexander

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    1. Dear Malcolm, the reason that people are anonymous is because they value their jobs! Anyone who whistleblows will lose their job one way or another, the trust will see to that!

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    2. I guess it highlights the lack of confidence and level of mistrust toward their employer's.

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  94. Surely one of the elements in this is the public's seeming inability to deal with household First Aid and minor injuries and emergencies without calling 999, whether for Fire, Ambulance or Police. We have become a nation of incompetent wimps. We wouldn't survive the Blitz nowadays.

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  95. Nothing new. In the 1980's medics made barely over minimum wage, had no union, worked 24 hour shifts, and could not go home if our relief didn't show up and forced to work up to 48 hours in a row. Things are better now than they ever have been. This is a whiny article from the new generation.

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    1. With respect, having spoken to and worked with many clinicians from that era, "working" was a very different concept then. I agree that being on station, sitting down and resting for extended periods of time with the occasional shout is perhaps sustainable for longer periods of time.

      The modern pre-hospital emergency environment involves a relentless barrage of calls that stretch the workforce thin, something unheard of in the 1980s.

      I suspect your clearly antagonistic comment was just designed to provoke a response. Any credibility you may have had was lost with "This is a whiny article from the new generation."

      But thanks for reading.

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    2. Yeah right "sitting down and resting for extended periods of time with the occasional shout". Not sure what planet you are from but if you consider running an average of 15 ALS in a 24 shift and doing move-ups on top of that, "sitting down" you are delusional. And I spent over 2 decades in EMS before leaving in the 2000's so I'm well aware of what conditions are like now. So quite your false assumptions and your crybabying. You guys have it so easy compared to back in the day. You have absolutely no clue.

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    3. As far as stretching the workforce thin. Back in the 1980's before there was a union to protect you, all the small mom-and-pop ambulance companies, which is what 90% of US EMS systems were ran by, were run like sweatshops. Paid like crap and treated like expendable crap. They put up the minimum number of ambulances to get the most out of their employees to save money. What, you think this a new concept? When were you born? When I was in high school lol?

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    4. I appreciate that there were difficulties back then - hence the strike - but that's no reason to be dismissive of the difficulties facing the service today. If you believe things are going well then I suspect you're in a minority.

      For future reference, if you can't refrain from personal attacks in your comments, any subsequent messages will be deleted.

      Delete
    5. Not a helpful post really. Why we should share in a 'race to the bottom' is beyond my level of thinking; thankfully.

      Delete
  96. Why are you whining about 12+ hour shifts? I have to do this on a regular basis just to make a living. I don't get an overtime rate, just the basic rate 24hrs a day, and I am expected to work at short notice, pretty much every weekend, nights, days (or both). A zero hour contract means I have to work when it is offered, and all work may be withdrawn if I refuse to go, count yourselves lucky to have contracted employment! You guys do a difficult job very well, but please be aware that there are those of us that go unreciognised, and have to work longer for much less than you earn! I have worked a 36 hour shift with only a half hour break. I have worked a 109 hour week, and worked for over 1,000 hours in a two month period. Thankyou for your efforts and contribution to society, but there is always someone worse off than you are ;)

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    1. I do appreciate that some are worse off than us, very much so. I worked in a private firm before i joined the service which was pretty horrendous. However, in that job I did not have to make decisions for the life or death of other people, I did not have to treat seriously ill kids with their parents watching as their life ebbed away, did not have to cope with distressed kids whose mother had just passed away, or drive at high speed through busy streets with the idiot drivers doing bizarre things in front of me. For my current employment I need to be firing on all cylinders 100% of the time, which is difficult when exhausted, hypoglycaemic and harassed by my bosses. I want to work 12 hour shifts but a wee break to rest and eat occassionally is surely not too much to ask given the work I do? And, by the way, your working hours are illegal, unsustainable and dangerous.

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    2. Are you suggesting that because you're having to endure intolerable working conditions that so should everyone else? Surely your experience should serve as a dire warning of how things could end up? This is NOT whining-it's an attempt to prevent an already dangerous situation get even worse.

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  97. I read this and I'm amazed how much this sounds like Hamilton Ontario! This could have been written by one of my coworkers. We feel the pain that you feel... small comfort, but, we know why we do the work we do. We don't need banners raised in our honor. A half hour meal break would certainly fit the bill though!
    Keep fighting for your rights, don't let management get you down, and stand together. It has worked for us. Have your work force complete a worker satisfaction survey and present the results to your city/regional government, and local/country-wide newspapers. Make sure the survey is professionally done by a recognized company that is respected for their neutral stand. Perhaps use a survey company that your city has used on previous occasions. Our union did this very action I've just described and it resulted in our previous manager being shown the door.
    You can affect change in your work conditions, but it's up to you to do it.
    In solidarity.

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  98. Totally accurate. Government would not last one shift through! I am not an ambulance person, I am a nurse and see the effects on my friends on a daily basis. My ex husband is a paramedic, I used to go on shift with him for experience back in the day before all the red tape. We often had "down time" to drink tea and rest and discuss cases. Gone are those days. Now it is relentless and worse it is often ferrying people around who call irresponsibly. I admire my Paramedical colleagues. I could not do your job. You have my full support.

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  99. To Malcolm Alexander, thanks for your contribution. I wish that more people would be strong and feel able to speak out openly. Despite legal protection, whistleblowing policies etc, there are ways in which management will get you for speaking the truth. You get charged with bringing the service into disrepute, have evidence fabricated against you or minor things enhanced, etc etc. Organisations with in-built cultures of bullying and incompetence are very clever at manipulating statistics and keeping lids on. It often takes a catastrophe to get people to take notice outside the organisation, and expose malpractice and usually only through an an independent inquiry. I am sorry, but that is the reality.....I know because it happened to me!

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  100. To those detractors who refer to what things were like in the past, you have no idea! In those day pt care was usually a chair and a blanket, workload was a fraction of what it is now, 90% of the work was genuine, you got a cuppa between jobs almost always, and the professional standards were based on politeness not complex clinical issues. No-one wore gloves, infection control consisted of clean blankets for every patient and there was no driver training. Management was more open and honest, you got a bollocking if you needed it and then it was forgotten whereas now it is devious and underhand. For example, we have managers placing out of date opa's in response bags (after they have been checked!) to see if they get noticed or getting weak minded wanna-be bosses to collect "evidence" against the troublemakers. Those of us who remember what it was like in those days and that are still working today, albeit in the twilight of our careers can see that there is no comparison. Please go and contribute in a forum that deserves your ill-informed rhetoric and leave us to moan in peace, it is how we cope!

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  101. If anyone has managed to read this far down it may also be good to note that almost every comment made has been done so anonimously. This is due to fear of reprocussions from non road working management. The situation above will never change. We are considered easily replaceable. And are being replaced by nieve and very young paramedics who are made to feel grateful to sign even worse contracts than ours. I hope I am wrong. I love my job. Please let me do it.

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  102. This has made for sad and shocking reading. Your work is valued and your working conditions not widely known, understood or appreciated. At the suggestion of one contributor, I will indeed be drawing this to the attention of my MP. And anyone else who'll listen. Know that your work is valued. For those of you that are suffering ill health due to your working conditions, I sincerely hope that you will treat yourselves with the same care, sensitivity and good sense you administer to your patients and put yourself and your wellbeing ahead of the job. No job, however noble, is worth sacrificing yourself, family and relationships and your own future wellbeing for, especially as no gratitude, support or compassion is likely to be forthcoming from those in a position to ensure adequate care and support can be provided if you need it.

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  103. Where to start? When I joined the ambulance service 13 years ago a paramedic's pay was roughly 19k a year with no unsocial hours allowance with flat rate overtime. I now have a basic wage of just over 30k a year with a 25% unsocial hours allowance and my overtime is paid at time and a half. In realistic terms I am getting paid more than double what I expected to be paid when I first started.
    I started out working 8 hour shifts on a 5 week rota pattern averaging 37.5 hours a week which I found didn't give me much of a home life as I was always at work. I have now chosen to work 12 hour shifts, still averaging 37.5 hours per week as I find it gives me more time at home with my kids. In realistic terms I cannot find another job that pays me so well and gives me as much flexibility to spend time with my family. Trust me, I have looked.
    It seems that I work for a service that is marginally better at looking after it's staff in the fact that we do get a break on a 12 hour shift (currently 45 minutes) and if this break is taken late in the shift we are given a late break payment. We are also offered the chance to be undisturbed or to make ourselves available and if we are disturbed, are once again given a payment for being disturbed followed by being stood down for the remainder of the break. We also have lone worker policy which gives me the right to carry out a risk assessment prior to arriving at the job and choose to wait at a safe distance if I deem there is a risk to myself. In my numerous years working on an RRV I have experienced pressure a few times to attend, but nothing has ever been resulted in management bullying or further action.
    Having said all this, I do believe the Ambulance service is in a state of meltdown at the moment and agree with a large amount of the comments raised in the blog. I am consistently being forced to spend extended periods of time waiting for a double manned ambulance to back me up on jobs to convey patients to hospital or in some cases to get them off the floor. I am also tasked to various jobs that really should not be 999 calls. As someone mentioned earlier GPs, the police and nursing/care homes seem to make up a large proportion of these. If these professional groups can't seem to grasp the idea of an emergency what chance do the general public have.
    The service I work for is quite proactive in screening calls and does operate a system to carry out telephone triage on certain calls to avoid an ambulance response, unfortunately it also uses a telephone triage system which is not particularly robust. How many people remember having it drilled in during training NOT to ask leading questions?
    Whilst I do not agree with the way the service is managed or the fact that patient care is far from a priority, the management do seem to be in an unenviable position. Call volumes are rising, budgets are shrinking in real terms and they have to be seen to be delivering a "cost effective" service against government set targets. These targets are completely false, frequently manipulated by management to their own benefit and hopelessly outdated for todays service. Unfortunately if the chief executives decided to ignore these figures for the benefit of the patients then they would have their funding cut, reducing the ability to provide such a service. The sword of Damocles seems to be a better option.
    Until there is a marked shift in the culture of our government, fellow professionals and society, we are doomed to carry on the downward spiral. It could be worse though, we could be on 22k with no benefits.

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  104. Only just found this article, but what a great read! I agree though that a lot of ambulance time is wasted by GPs and nursing homes who basically need a taxi, but don't bother to ask their patients if they have family who might be able to transport them - they just order an ambulance. So while the ambulance (often staffed by a paramedic and technician) drives for miles on a taxi run to deliver a patient to hospital, the genuine emergency calls build up in the system and there aren't any ambulances available to respond to them: all too busy being free taxis. If GPs and others who should know better abuse the ambulance services in this way then we can't expect the public to know any better.

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  105. About time the powers that be realised they are slowly killing crews,,not that they care !!!!!!!

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  106. I note the comments about misuse of the Ambulance service as well but like everywhere else NHS111 is chronically understaffed patients speak to a non medically trained call handler who has to rely on a computer system to ask questions about their condition certain answers trigger a 999 response automatically and some of the "frequent flyers" know exactly what answers to give in order to get an ambulance. Also when patients do need to speak to a medically trained member of staff there are simply not enough of them so the patient gets put in a queue or promised a callback which can take hours so no wonder the patient sometimes panics & calls 999 instead.

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  107. Disgruntled beyond belief10 August 2014 at 15:30

    In view of the recent revelations that ambulances are left queueing at a and e departments because hospitals simply cannot cope I would much like to hear your comments on this Matt. Front-line staff ambulance staff have had to endure years of management bullying tactics as senior managers toady to their government counterparts. Tactics which have seen good,honest talented paramedics leave the job they used to love and many more considering their futures. I find the whole thing an absolute disgrace that this has been allowed to happen. It just disgusts me.

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  108. Please please please can everyone fight for us and make things right. Of everyone reading this and being shocked by our treatment, somebody must know someone, or have a friend who knows someone, who has the connections to do something about this and make it right. We have been downtrodden for too long. The more people that read this, and the other broken paramedic articles, the more likely it is that something positive happens. People do care about us. Keep pushing for change, keep sharing and encourage everyone you know to do everything in their power. I have genuine concern that we are dangerously close to that final meltdown and we don't want to live in a country with no Paramedics. I believe we can do it if we keep going. Prove me right!

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  109. This comment has been removed by the author.

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  110. Assuming this miraculous technology is capable of what Mr. Newton says, this will lead to "ambulances not being cut overall, but matched to where the demand lies.
    in home care boston

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  111. There is often talk about privatization. Dont let this happen. It will be worse believe me. We should hold on to our morales and protect the nhs. Lets not allow this government grind us down in believing lies which they sold to royal mail, trains etc. Tell your patients to complain and back them. I am sick of people waiting 4 plus hours after a call and our managers just shrug it off. Get them working out these problems not draining you with there pety monetary issues.

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  112. I was considering a career change (to paramedic), but from what you've got to put up with is ridiculous.

    Q1 for NHS direct - are you immobile/going to die if you don't get to a hospital immediately? No, then it's not an emergency get a cab.

    You also need sensible hours/shifts, breaks 12+ hours non-stop is frankly dangerous.

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  114. Thanks for setting up this Blog, I am a graduate Paramedic who suffered Disability Discrimination at the hands of South West Ambulance FT. I successfully represented myself and sued the trust, and have used the money to support Student Paramedics including disabled students. Thanks for all the info on here i would like to reference some of these comments in court in the next round of litigation against the trust, best wishes, Gary.

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