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.


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.]