Monday, 13 April 2015

30-Year Veteran Paramedic with Unblemished Record Finally Broken by Institutionalised Abuse


In this past week, many major news outlets have covered a story about a London Ambulance Service paramedic who refused to attend a 999 call on the grounds that he and his crewmate were dangerously tired after 11 hours overnight without a break.

Across the mainstream media, the tone of the headlines used invariably focused on the public perspective.

On 7 April 2015, The Guardian reported 'Paramedic refused to help sick woman as crew were tired, tribunal told'. As subsequent news outlets picked up on the story, the Evening Standard went with a more outrage-inducing 'London paramedic "refused to answer 999 call because he was about to finish shift"'. The Mirror chose 'Paramedic suspended after refusing to attend 999 call because he was '"tired"' and the Metro opted for 'Paramedic suspended for refusing to pick up patient because he hadn’t had a break on 11-hour shift'. ITV weighed in with 'Paramedic who refused to help sick woman because crew were 'too tired' is suspended' and even the Belfast Telegraph got involved with 'Paramedic suspended for 12 months over 999 call snub'.

It has most likely been covered elsewhere too, but I think the theme - and the bias - is clear.

The facts which were cherry-picked from the publicly available Health and Care Professions Council (HCPC) hearing documentation are mostly consistent throughout the coverage. Due to his actions on 29th May 2013, Edmund Daly, a paramedic and team leader of 30 years service, was found to have 'seriously undermine[d] public confidence in the profession' by refusing to attend a call to a 43-year-old woman who was 'feeling faint, dizzy and vomiting'.

The HCPC panel chairman, Julian Weinberg, is quoted as saying, 'As a paramedic and as a team leader, he failed to make service users his main concern. (Daly) has also not demonstrated any remorse for his actions and such misconduct seriously undermines public confidence in the profession. However, the panel has taken into account that this was an isolated incident in the registrant's 30-year unblemished history of service as a paramedic and that it occurred after an 11-hour shift without a rest break.'

According to the London Ambulance Service, Edmund Daly's contract had already been terminated following an internal investigation of the matter and the HCPC notes state that he was no longer working as a paramedic. The final outcome of the HCPC hearing was a 12-month Suspension Order. A Striking Off order was considered but thought disproportionate given Daly's 'otherwise unblemished 30-year career'.

Treating the Symptom, Not the Cause

I know I am not alone in thinking that the broader concern has been entirely missed here, hence the provocative choice of headline for this article.

Although we are not privy to the underlying history of this particular case or Edmund Daly's general working practises, it is safe to assume from repeated reference to his 'unblemished record' that he had conducted himself in an appropriately professional manner for the past 30 years. So what drove this veteran to engage in the kind of brinkmanship which was likely to have a poor outcome for him?

I think it's important to recognise that Daly’s actions gave his employers, control room staff and the HCPC little choice but to act in the manner they did, but a man of Edmund Daly's experience would have known this. Yet still he drew his line in the sand and said 'no more'. Whether it was a calculated decision or just the poor judgement of an exhausted mind is a matter of speculation.

Like many current ambulance crews, I empathise with Mr Daly, having many times in the past been exhausted and emotional myself after yet another gruelling, endless shift. I know from first-hand experience how hard it is to think clearly through that haze of fatigue. I am still haunted by attendances gone awry due to fatigue-induced oversights and mistakes, near misses and lapses in professionalism both on the road and when dealing with patients or co-workers. The system forgets paramedics are still only human and it has no regard for the kind of pressure under which the current, brutally under-resourced emergency clinicians are expected to perform flawlessly.

Not one of the previously mentioned articles nor the HCPC panel addressed the implications of the fact that '[a]s a result of the Registrant’s refusal to attend the call, there was a delay of approximately 90 minutes before another crew was able to attend the service user.'

Surely this highlights a much bigger cause for concern than the actions of one clinician. Why such a dearth of ambulances? Was there really not a single other vehicle available for 90 minutes? Or perhaps the call wasn't deemed to be that much of a priority after all. In either case, resources were clearly stretched too thin to provide adequate cover given that the sudden unavailability of a single ambulance caused such an apparent failure. The existing system has no overlap, no redundancy, no buffer. The few ambulance crews available are endlessly bounced from attendance to attendance until they can take no more.

Compounding this is the cultural disregard for crew welfare best exemplified by ITV’s quote, purportedly from the controller called as a witness in Edmund Daly's final hearing, which shows that providing any respite for exhausted staff is given little value,

The crews all know getting off on time is a bonus. If it happens it happens, and if an emergency call comes in it's a late shift. It is not a guaranteed nine to five job.

While it is accepted by all staff that responding to emergencies is the absolute priority, the comment is a bitter pill to swallow coming from a staff member whose role should also include protecting road crews. Considering that this is in the context of a crew who have already worked continuously overnight for longer than most people’s entire working days, the statement is a damning indictment of the emergency service culture and the prevailing attitude to road staff if ever there was one.

However, it’s not the fault of control room staff either. They too are under enormous pressure to perform in the ‘room of doom’. They cannot afford to see staff on the road as anything more than a vital mobile resource. If only dispatchers were provided adequate resources to distribute the calls in a manner that didn't dangerously overwork the few responding crews to hand, there would be far less acrimony and far more efficiency.

Bleeding Out?

But if the problem does not lie with operational staff, then where? Was anyone else’s competence called into question for the circumstances which drove an exasperated paramedic to willingly commit career suicide? Of course not, it's just business as usual. Targets to meet, et cetera, et cetera. Little wonder that sickness, recruitment and staff retention is such a huge problem for ambulance trusts. Edmund Daly, like every other emergency clinician, was expected to make up for the shortcomings of a collapsing, inadequate system being throttled by underfunding and misuse.

How many more staff need to physically or psychologically crumble before the problem is addressed? It is clearly a nationwide problem, with the Manchester Evening News reporting ‘Paramedics in Greater Manchester at breaking point due to stress, says union’. The article details the findings of a staff survey revealing ‘[m]ore than 90pc of the 153 staff surveyed reported suffering with stress with huge numbers of staff reportedly leaving the North West Ambulance Service.This summary of UNISON's national survey indicates the true scale of the problem.

Evidently, if more effort is not made to protect ambulance staff by providing them with tolerable working conditions, they can’t be expected to maintain the level of excellence demanded of them or even stay in their jobs.

There is some hope, at least. Parts of the establishment are aware of the problem and there is evidence that efforts are being made to address it. East of England Ambulance Service recently published a document focused on improving working conditions which identifies the need to tackle the problem. In it, the joint working group of EEAS managers and UNISON members identified key stressors impacting staff performance.

The group recognised that the existing policy around late finishes was not working. As new frontline staff continue to be recruited it will help ease the pressure on staff and reduce late finishes. There was joint agreement that implementing supportive changes over the issues identified will help retention, reduce sickness levels and make EEAST a more supportive, sustainable organisation.’ ~EEAS Trust update: improving working conditions

This is clearly a positive step and EEAS should be commended for attempting to stem the flow. But, as has long been the case, it will likely remain a well-intentioned dream until more deep-seated cultural changes - both within ambulance services nationwide and more broadly in government and the general public - take place.

Meanwhile, if the case of Edmund Daly is anything to go by, existing and future staff will continue to be wrung out, abused and discarded as organisational failings and public demand continue to brutally sacrifice the health and careers of those willing to prop it up until they can't - or won't - any more.

Edmund Daly, like every clinician and operative working to provide emergency care to the public, deserves better.


Addendum: In response to Edmund Daly's case, an iPetition has been set up.


Image credit: Daniel Sundahl, DansunPhotos.com via EMSworld


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88 comments:

  1. The powers that be allocate to little resources to solve a task then blame the resources for the task not being done. Yeah, seen that before.

    I would also like to point out the piss poor journalism of the. Every news outlet running with the same talking points is a clear indicative of being spoon fed, not checking facts and not doing due diligence.

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  2. Had this man helped another patient and made a mistake because he was exhausted, who would have been blamed?
    Cutbacks and savings reduced the number of available ambulances to (below) the minimum required.

    "Finishing your shift on time is a bonus?" This makes me assume the overtime isn't even paid out...

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    1. Where I come from there is no 'over-time' pay for EMS workers. We are all volunteers... it is what it is... if your lucky enough to get off when your shift ends great...if not...you hope that the call your on doesn't last very long!

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  3. Well written mate, you put the so called professional journalists to shame !!

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  4. Put it another way. Why does a 43 year old woman who is feeling feint, dizzy and vomiting really need an ambulance? You can throw all the "worst case scenarios" in the World at me, but I suspect she was not on death's door by the time another crew was sent to her 90 minutes later. There is something very wrong here, and in my mind, the one thing that isn't wrong is Ed Daly saying "enough is enough".

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  5. The service claim it is a privilege to finish on time (I am a serving paramedic)

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  6. It's about time someone regulated the regulators. there is no way the HCPC should be allowed to get away with decision making like this. There are laws in place to protect workers and patients equally. This guy identified his problem and acted on it. What if he had attended and a catastrophic error was made?

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  7. I knew this man and I can tell you that you couldn't have met a quieter, more professional paramedic and team leader. He should have booked off sick on the radio. His mistake was giving them the rope with which to hang him.
    And getting home on time is a bonus? Ridiculous comment and completely against the basic human rights of anyone needing to rest after a long shift. This is why clinical mistakes are made. The dizzy lady would not have died but someone else may have because there is no regards for paramedics and every regard for service users, whether they are actually in need of emergency care or not.
    No balance at all.

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    1. Your mate has been hung out to dry because he was honest!
      As for the controller sorry dispatcher making pathetic comments which made my blood boil.
      Hope it all works out for Ed!

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  8. I had the pleasure of working with Ed for many years, he is one of the kindest caring and compassionate human beings I have ever met. I do wonder what had would have happened if he had gone back on the road and fallen asleep at the wheel, or made a clinical error. Compassion has to be projected onto employees in the manner that it is expected of them.

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  9. Next time you get a late job and feel tired crash on purpose, then take everyone concerned to court for not protecting you from harm . you'll also have time off sick.

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  10. Thats only a tongue in cheek comment above. Please don't do it.

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    1. There are times after a 12 hour shift and a late finish that I am sure we have all been tempted.

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  11. Garth Green alegedly falls asleep at the wheel of an ambulance - crashes - patient dies - fault lies with Green. Ed Daly avoids such risk - refuses to risk patients - fault lies with Daly ? So guilty either way. This is a just and sound judgement is it ?

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    1. Links to coverage of the Garth Green case, for reference:

      http://www.grimsbytelegraph.co.uk/Grimsby-ambulance-driver-fallen-asleep-wheel/story-20618688-detail/story.html

      http://www.grimsbytelegraph.co.uk/Ambulance-driver-Garth-Green-guilty-causing/story-20805354-detail/story.html

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  12. I also currently work as a Paramedic and am constantly being told that i must risk assess every situation before acting, it seems that was exactly what he did. We have a duty of care to ourselves as well as our patients and should not be penalised for considering our own safety as well as others.

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    1. Very well written article.
      I may be looking at this too simply but was Mr Daly not just acting within his legal obligations under the Health and Safety at Work Act? I.e. 'Take reasonable care of your own health and Safety' & 'to take reasonable care not to put other people - fellow employees and members of the public - at risk by what you do or don't do in the course of your work'. Not to mention the HCPC's standards: "you must protect service users if you believe any situation puts them in danger. This includes the conduct, performance or health of a colleague".
      I think the HCPC have got this wrong. Any ambulance employer is of course going to sack people who do this as it would set a bad example of people actually applying all the rules out there and interfering it's core business. But anyone who actually does draw the line like this is not doing it for a laugh, but for a very serious reason - it's dangerous to do the job we do under extreme fatigue.
      Unfortunately it's not a matter of 'if', but 'when' a colleague of ours actually causes death due to fatigue. Inflexible and apparently unsympathetic attitudes shown such as this will only expedite that occurring.

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    2. This situation arose because ambulance services have an "Emergency Exemption" from UK Driving Hour Regulations. I am a paramedic and have worked at a major incident for more than seven hours without a break, no problem, as that is what the exemption is for, not to force staff to work more than 12 hours without a break! Motorway signs state "Tiredness kills" and no other professional driver would be allowed to work these hours! Ambulance services bully staff into working these hours under threat of disciplinary action, The London Ambulance Service and the HPC have upheld these bullying and possibly illegal tactics, shame on you!

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    3. Hear hear!

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  13. I'm surprised to see no mention of driver hours. I'm not really keen on a fully laden ambulance being driven by a sleep deprived individual.

    I'll bet if he had headed out and they'd had a crash he would have been prosecuted for dangerous driving.

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  14. We're there to be broken, once broken we're replaced by a shiny, newly qualified paramedic. No one cares, the public don't care as long as people keep turning up in their hours of need, the organisations don't care as long as targets are being hit, the media don't care because the headlines are better when focusing on our mistakes and not the cancer that's eating away at our profession, and even our own colleagues are becoming numb to the inevitable change in personnel as one by one we burn out and fade away. The only people that care are us as individuals, and its to our detriment, as we will keep on working despite the problems, the stress, the lousy pay deals and attacks on our conditions, the growing abuse of the service and assaults on the staff, we just keep turning up and booking on, till one day we find that we too are broken. The real bitch of it is, I love my job :-(

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    1. well said..plus the newbies will never say NO

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    2. "plus the newbies will never say NO"

      Especially not after seeing stories like this.

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    3. (from a newbie) we cant say no though :/ we love the job just as much; and we have much shorter ropes needed to hang ourselves!
      I see more experienced techs being passed over as we have a contract stating we'll become a paramedic in 2.5 years. It isn't right.
      not to mention the govt can say "paramedic in every vehicle" no matter how inexperienced we are. any of us worth our salt listen to the vastly more experienced techs already out there.

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    4. I loved my job and loved my colleagues. We have been a family support network to one another over the years. Cried together after jobs and stay in touch out of work. The new regime chipped away at that, tired the staff in control and on the road. Isolating one another in the quest for response times.
      Eddy sounds like a good bloke. Shame we can't petition the HCPC to overturn their decision.

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  15. Well written, balanced, factual and a good representation of what goes on out on the road and has done for far too many years.

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  16. They were willing to hang him out high and dry. Does this warrant dismissal. I think not. Suspension yes. 30 years, 30 flipping years.

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  17. I am a dispatcher. ... booooo. ... I do my best to equally space out breaks during a shift, ie first break 4 hrs in to 12 hrs shift, next 4 hrs after that then local job for a finish. BUT there have been occasions where I have not allocated a crew due to finish and sent next nearest, within reasonable distances, and been given warnings for it. It is not always the dispatchers fault. The protocol and practices need an overhaul

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    1. Most despatchers I work with try and work with the crews, and I know the hard time some are given by the managers when they try to take the pressure of crews. If we had a quiet night (rare these days), some control managers would get the despatchers to play 'musical chairs' with crews on standby, shuffling them around every 15 minutes. The trust I work for stopped roadstaff/control room 'get togethers' as it encouraged harmony rather than the friction they wanted. The controller who made the 'finishing on time is a bonus' statement is most probably a control stooge sent as a deliberate wind-up merchant to create more tension and stamp their authority on an already demoralised workforce.

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    2. I wonder if a rule requiring control managers to stay on duty until all crews assigned to calls during the manager's contracted hours have returned to base might have an impact on things. It would enable continuity, would be a show of faith to crews and might encourage a tendency to assign calls as reasonably as possible.

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  18. Management put out newsbytes saying they are addressing the problem, but we all know they are paying lip service to the problem; just as they are cooking the books in terms of response times. The best advice I can give after 27 years is..... do the job, finish late and go off sick.

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  19. London underground staff went on strike because a driver was dismissed for being over the legal alcohol limit......twice! What do the unions do about ambulance staff being treated in this way...nothing, they are happy to take our subscriptions and let us be treated in the way we are.

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  20. Well written article. It a problem that is endemic to ambulance services world wide. I feel for him and his family. Fatigue is a serious problem and needs to be addressed.

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  21. Any other workers happy to work 11 hours with no break in their job?? I don't think so!! Time to change practices AND educate public about the use of EMERGENCY AMBULANCES. They ain't a taxi service.

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  22. I see clear failure of the EMS management structure in this case. An otherwise exemplary career paramedic is asking for a break - asking his brothers and sisters, we are a family remember, for some God damn help . I think he deserved a bit more respect.

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    1. For knowing his limits? I think he deserves the Medal of Valor!!! I agree 100% with you!!

      30 years in, and they destroy him. I can't help but wonder if they were looking for a way to keep from paying out the pension that he EARNED!!!

      Here in the States, many places work 24 hours on, 48 off. After working that shift for 2 years, I vowed and declared - NO MORE!! Too many times we would have run a solid 12 to 15 hours, with no break. I'm here to tell you that with that kind of call volume, after 10-12 hours, most Paramedics could be considered the equal to being legally drunk. They had strict rules about the hours in which we were allowed to "sleep". Definitely NOT during a slower period of the day, and usually only at nights, between 12am, and 5am. We were also docked for those hours, unless we proved we were on a call, or on standby. I got tired of knowing that I was putting both myself and my partner, along with any patient we might have after a certain amount of time, at risk for harm, if not death.

      Oh! I forgot to mention.... We were allowed to pick up shifts as overtime. Some would work up to 6 dasy STRAIGHT! Not bad when it's a 12 hour shift, or if you're allowed a little down time. Otherwise, it is absolutely DEADLY!!

      Somebody needs to wake up here, and it isn't me!!

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  23. i work in new zealand now us to work for the london ambulnce service...we have to have a break after 6hrs and if not then we get a stand down for 30min...for once new zealand is ahead of the game....good on you for standing by what you think...

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  24. The issue that clearly overlooked by the news papers is how the crew were able to go 11 hours without a break. There should have been policies in place to prevent that. It's getting out of hand the sheer lack of care for the crews on the road. Some services are even making crews sign wavers if they want to work overtime so that any fatigue related mistakes cannot be blamed on the service. It's no wonder people are leaving at a record rate

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  25. It is likely the only reason London Ambulance Service disciplined Ed Daly was because it had missed another Red Call target.

    It is unlikely that a 43 year old 'feeling faint, dizzy and vomiting' in pregnancy is suffering from an immediate life threatening condition that would justify the risks involved of sending a fatigued crew who have not had a break 11 hours into a busy night shift. As if to prove the point LAS were so concerned that they couldn't be bothered to get an ambulance to the patient for another 90 minutes - although they, (and the HCPC) appear to be blaming Mr Daly for the further 90 minute delay - instead of the chronic shortage of qualified staff which caused Mr Daly's busy shift, missed breaks and likely Post Traumatic Stress Disorder.

    What should have happened was that the ambulance service should have respected Mr Daly's safety concerns and PTSD symptoms and stood the crew down. Instead they have treated him as if he only challenged them because 'he didn't want to be late off'. Instead of standing him down and referring him for counselling they have disciplined and sacked him, then the HCPC has finally stuck the boot in because "such misconduct seriously undermines public confidence in the profession" or in other words 'blame him for the lack of resources, knackering shifts, missed breaks, late finishes and being abused and treated like a robotic slave because otherwise it looks bad to the public.'

    Shouldn't they be more concerned at the daily risk to the public caused by shortage of ambulance resources and lack of any basic health and safety precautions for ambulance staff. (Even convicted prisoners are guaranteed 3 square meal-breaks a day).

    No doubt the controllers, senior managers and HCPC jury involved would applaud the conviction for cowardice and shooting dead of shell shocked soldiers during world war I. After all wasn't that just to 'send a message'?

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    1. Awesome! Thank you!

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    2. Yes of course we would you ignorant git. Keyboard warriors like you need the shooting.

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  26. Isn't it in the hcpc guidelines to ensure you are fit for work? Surely doing what he did highlighted that, at the point in time, he was no longer fit for duty on the basis of excess tiredness and he did the responsible thing. He should have been commended for protecting patient safety in a timely manner rather than having his otherwise unblemished career written off by who clearly have no realistic understanding of what we go through.

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  27. I have used the ambulance service for heart attack on one occasion and for broken bones on two other occasions. The officers have always been fantastic. Once when I apologised for not being much help, was a bit panicky when my husband had possible spinal injury (only 7 broken bones). I was told "you were OK, I wish every one was like you, we have been abused all day" (by people they had been called to) I was stunned. you guys are great, it is a pity that your employers fall down somewhere, and oh, I have seen nurses treat you like a taxi driver, that must be hard too. just know that plenty of peopleare very greatful to you

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  28. I and my family have known Eddy for many years and members of my family have worked along side Eddy too. He is the best example of a dedicated, kind, calm, professional paramedic you could wish to be treated by. He was never a slacker, always so willing to help, so compassionate when we needed him once, and such a lovely man. To treat him this way is so awful, so shameful. The LAS should be so proud of his 30 years dedicated service. Instead they just burned him up and spat him out. Shame on them.

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  29. We can complain till the cows come home but I cannot see anything changing in our profession until we stand up for ourselves. We need to lobby the unions to go on strike and do so without providing life and limb cover. Unfortunately I don't think there is another way of being heard....
    I urge my colleagues to take action. We do not want to be having this discussion again in another 5 years.

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    1. I agree it's time wee took a stand, if we all stood together the powers that be would have no choice but to listen! The brought in the army to cover the fire brigade when on strike, good luck to them if they think this would cover the volume of work we carry out daily!

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  30. I would have said this man made a professional judgement when risk assessing this job and deeming himself unsafe to attend, rightly so if he felt he would be a danger to patient/public/himself! Unfortunately everyone only reports the "bad" of the service and very rarely the good hard work carried out daily. There is a definite need for an overhaul of the ambulance service policies and a need to educate the public on appropriate use of it before more good people are pushed to breaking point!

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  31. So sad, this is an injustice and passing of blame this man did the right thing after 11 hrs he needed a break and did not feel fit to answer another call. The fact that the patient had to wait 90mins for another ambulance shows where the real problem lies....lack of resourses!

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  32. I have worked for the the ambulance for a short period of time and I never realised how bad things are. The only thing that keeps me going is the love of the job. The hours are long, the workload is endless and a 12 hour shift often turns into over 13 hours. We are given the run around by management and by the public often being sent to things under blue lights inappropriately, but if we don't do what is expected we find ourselves in trouble. I will do my best for the patients until I can cope no more, often putting the patients before myself. We as ambulance crews are not after sympathy, we are asking people to get off or backs and support us as we are the Cannon fodder in the government point scoring system. Trying to earn a living and to make a difference.

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  33. I can comment on Eddie Daly's professionalism, he is quite simply one of the best. I knew him and worked with him on and off for 10 years and not only was his career unblemished he saved many lives and constantly put his patients before himself, and gave his life to the service. It is shameful how he has been treated, just for looking out for his and his crewmate's own health. The LAS and HCP will hang anyone out to dry rather than tackle the root of the problem. Not enough staff being sent out to too many non emergencies.

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  34. Im an RMT member on London Underground, and the truth is, we only get what we want because we fight for it. Wages for drivers have gone up from £26,000 in 2002 to £49,000 in 2014 only because they fight for them. It's harder for you, there is massive moral pressure on you - but that's how they get you. You're costing lives if you go on strike.

    But, the only way this disgusting treatment of dedicated ambulance crews will stop is if they are *scared of you*. They invented the "them and us" - we didn't. We're just trying to do our best here, and if that includes going on strike to protect your own lives, then that's what it has to be.

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  35. He brought the HCPC into disrepute and seriously undermined public confidence in the service...? Good! The public should rightly be alerted to the current situation and loudly question the failing service provision. It is also high time the HCPC stood up for their members who are clearly being abused by a cowering silent management. High time we took Paramedics out of senior management, put them back on the road and employ people who actually know how to run a customer focused business profitably, we might save a few hundred million into the bargain. Sadly there are too many fat salaries and MBEs at stake.

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  36. In my view, after reading the HCPC hearing, they got it wrong. Though he didn't attend or send representation (to be honest, I wouldn't if I'd lost my job and the hearing took 2 years to materialise), they seem to be sending conflicting messages - that we need to report issues (and that includes staff welfare, such as overtiredness) when they occur, but that if you do state you're overtired and not going to be safe to provide patient care then enjoy your suspension. Secondly, they mention that becoming unavailable led to a 90 minute delay for the patient - this is irrelevant to the case.

    If it did lead to a 90 minute delay either the call was not a particularly high priority, or there were issues beyond that which an individual vehicle not going OOS would be able to fix - the fact that there was this delay indicates that staffing was not at a level able to cope with demand, which is going to mean that the staff rostered to work that day were going to be working at a high level, for 12 hours straight, combined with the fact that this was most likely not his first shift in a row (he may have been off late the day before, for example) this is going to make him much more likely to be tired and there is a very real possibility of mistakes being made were he required to treat a patient.

    Most people work 7-8 hour days with a break in the middle, we regularly work 12+ hour shifts on a rotating pattern that is going to lead to people being tired, it's the nature of the job. If someone reports that they are unsafe to continue working, we should not be threatening them with being fired and suspended from a career that they have spent 30 years developing (and, by all accounts, losing a good, patient focussed clinician), we should be supporting them and trying to identify a root cause for this issue. Ultimately staffing issues and excess demand created this problem, not one paramedic who was overtired and had just completed a long shift without a break who said enough.

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  37. An NWAS ops manager recently told me that they actually encourage getting rid of experienced para/tech staff so than replace them with fresh youngsters straight out of uni...because "they're cheaper...they come in at the bottom of the pay band. We then rag them silly and they burn out/ transfer trusts/ emigrate within a couple of years before they rise up the pay bands. Then we get another fresh one from uni." Sums it all up really. We're just good old fashioned cannon fodder.

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    1. This is true. They are excitable and keen and not worldly and lack the experience the old-timers had. It will come. Burn out and leave.

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  38. Should the HCPC not be "struck off" now. Because this awful bullying of a paramedic has undermined public confidence in the professional body not the profession as far as I am concerned.

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    1. Just for the record, the HCPC is the profession's regulator, not the professional's body. And, yes they definately got it wrong.

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  39. The job we do is mentally tiring and then the heirarchy think it is ok to send us out driving on blue lights after 11 hours without a break. Would like to see how keen they are to do that if they were brought up on corporate manslaughter charges when a clinician kills someone because of fatigue!!

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  40. Ambulance Controller14 April 2015 at 20:08

    I work in a UK ambulance control room. On one shift I decided not to send a crew who were seven minutes away from the end of their twelve hour shift to a 25-year-old woman with abdominal pain. I was pulled into the office and given a written warning for this, as well as the whole lecture about "what if this patient died and you ended up in coroner's court?" I asked what would happen if she died because the crew in the thirteenth hour of their shift made a mistake, or if they crashed on way to the call after falling asleep at the wheel and all of them died? It made no difference, I was left with no doubt that if I continued to make decisions like this I would end up losing my job.

    No ambulance crew expects a "guaranteed nine to five job" but is it really unreasonable for them to expect a twelve hour shift to only last twelve hours, unless there are serious extenuating circumstances such as a major incident or an uncovered cardiac arrest. I think a change of the rules is needed to make sure that shifts generally end on time. Otherwise it will only be a matter of time before we hit the headlines again because of the mistakes made by an exhausted crew.

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    1. You are right. I had to work a 48 to 72 hour shift and I was yelled at if I ever said I was to tired. I know I made mistakes, just glad I never truly harmed someone.

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  41. If he had attended the call and had a road accident on the way or made a mistake the papers and HCPC would say he should have said 'no' when he realised he was unfit to keep working!

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  42. OK folks, dunno if this will make any difference at all but the HCPC are currently running a "consultation on revised Standards of conduct, performance and ethics".

    http://www.hpc-uk.org/aboutus/consultations/index.asp?id=188

    It's our chance to influence how the regulatory body works regarding above topic. Consultation closes on 26TH JUNE 2015.

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    1. Section 6 and 7 of the following consultation on draft standards document is what you need to comment on in the survey regarding the matter under discussion here.

      http://www.hpc-uk.org/assets/documents/10004B5410004B4EDraftstandardsofconduct,performanceandethics.pdf

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  43. I am not involved as a paramedic, but my daughter is!! They say that the NHS is underfunded and that the staff in A&E cannot cope and ambulance crews are missing 8 min targets
    I am a simple soul but I believe that we could help towards the 8 billion shortfall needed in the next 5 years.
    Figures produced by South East Counties Ambulance Service indicate that they were called to almost 1/4 million drunks in the year. The minimum cost of an ambulance call out is £300. That equates to a total cost for just 1 region of 75million pounds in the year. There are 10 regions in England. Simple maths the total for the country for the year 10x75million equals £750million. Then there is the cost in terms of time money and motivation of the A & E staff. Just the ambulance costs over 5 years = £3billion 750thousand.
    All for wasted hooligans. may I suggest that a levy of a mere £100 per drunk is levied. Not much for the aggravation caused but would add over 11/2 billion pounds to NHS income over the next 5 years. At least it would help!

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    1. We have thought this amongst staff in the ambulance service for years. It is demoralising work to deal with. Instead of fining the individuals, the health service decided to provide places such as buses to sober up whilst observed - much like a mobile ward. Why are my taxes spent on alleviating someone else's inability to control themselves?

      If you end up drunk enough to need the services of care in a medical facility for the night you should be billed for it - £170 starters. That'll cut the pay packet and reduce the amount they can neck on a night out. Man up government and start making people responsible for their actions!

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

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    1. Vacuous and trolling comment removed.

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  45. 11 hours, no break. I do it every day. Nut up or fuck right off

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    1. Thanks for your intelligent input to the article, idiot.

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    2. And you are responsible for critical clinical decision making champ? Or are you flipping burgers at maccas? I spent 24 years, 11 months as a paramedic, forced to work when tired, expected to accept overtime or cop some 'freeway therapy' by being moved to a station at the opposite end of the city from my home.

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    3. 11 hours with no break, your wrist must be sore by now!

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  46. It is very disheartening when leadership and/or coworkers of a health care organization and profession in which we perform fails to recognize the very signs/symptoms exhibited by an emergency worker (physical/verbal). Also fails to offer any type of support or assistance if necessary to an employee.

    In essence, not really much difference between the lack of performance of he company versus the paramedic. We are all Ed sooner or later.

    God Bless!

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  47. As a fellow NHS professional I can fully sympathise with this paramedic. The demands on a crumbling service go right to the top. If targets don't get met someone higher up has to answer to someone else even higher up. What they have failed to do is recognise that a failing service has implications for the people working in it, not just those at the receiving end of the service.
    NHS staff are an easy target because the public are fed rhetoric and nonsense by the media. It's a sham! they are promised a service which is non-deliverable in a consistent manner.
    I take great pride in my job but I am constantly frustrated by the attitude of the general public who believe what the media tell them. It's not their fault though...perhaps if the journalists would like to work a month of shifts with a paramedic, not just one afternoon,.....then they would see the realities.

    Good luck Ed. I hope this doesn't end here.

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  48. I define anybody to deliver a baby resuscitate a heroine addict babysit a inebriate 18 year old in a city centre explain to the family there's nothing more we can do for their loved one stand in a corridor of an A,E dept for 2 hours waiting to handover a patient who at 0400hrs decides to call a emergency ambulance for a headache they had for 4 days without seeing there GP clean up the vomit on the floor of the ambulance feeling hungry nauseous and all in a 12 hour shift yes a 12 hour shift and you've got another 48 hr shift to go ,and all for a 1% pay rise.Oh ETA clear outstanding emergencies

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  49. Does this forum ever disclose who the anon people are? I have something to say but scared as the bully tactics have worked. Eddie is a diamond, I have something to say.

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    1. I'm the only operator of this blog and am also a registered paramedic (PA25332). I treat the anonymity of people who share their thoughts here or privately as I would patient confidentiality. I absolutely guarantee that I would not disclose identities if I were aware of them. As far as I am aware, if you select the anonymous comment option this blog does not keep any identifiable data.

      My email is m[underscore]westhorpe[at]hotmail[dot]com.

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  50. The press really don't help. I remember the headlines in The Telegraph a couple of years ago when an elderly male, straightforward pick up off the floor waited 2 hours for an ambulance in my area. Headlines screamed 'Battle of Britain war hero waits over 2 hours for ambulance'. Letters page full up of irate people telling us how his generation gave their lives for us to be free.

    Easy for them to point the finger but would the War Hero want us to rush to him when he's not injured and just can't get up whilst there's a paed red call outstanding? Or an arrest. It's all too simplistic these days. Paramedic refuses call, Paramedic not fit, sack him.

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    1. The problem we have is that since the prioritisation of calls it has somehow become 'acceptable' to leave elderly fallers and other 'low priority' patients for hours before they receive a response.

      When you finally get to these 'low priority' patients some of them are in a far worse condition than the 'high priority' 'Red' calls that invariably 'trump' them.

      It is a basic human right and necessity to have access to food, water, shelter and toilet facilities, yet is it now acceptable to leave patients on the floor for hours to get pressure sores, deteriorate and defecate themselves? If we treated an animal the same way it is likely the RSPCA would push for prosecution.

      It is absolutely ridiculous that since prioritisation and concentration on the red calls no system, resources or safety net was set up to ensure a response time limit to low priority calls. Because the response time for the low priority calls is by 'local agreement' and not reported nationally it has resulted in less resources. We now see even calls to children knocked down by a car given a low priority because they were 'conscious and breathing'!

      http://www.chroniclelive.co.uk/news/north-east-news/berwick-ambulance-takes-48-minutes-8942103

      How can you run an 'emergency' service when all your resources are constantly in use, who is going to attend the next emergency? Also how is giving control an extra 2 minutes to triage the red calls before the clock starts going to help? You will still have to respond to the call but but, hey presto, you have 'improved' (or fiddled) the response time by two minutes without even lifting a finger.

      While on the subject of 'fiddling figures', did anyone notice that a few years ago the 'control prioritisation group' (mainly ambulance Chief Execs) altered the response time standards to include a car achieving the 'A19 transport' (as well as the 8 minute response) time for Red calls, even if it does not transport the patient! From memory,the standard used to say 'a fully crewed ambulance capable of transporting the patient must arrive on scene within 19minutes of the call' it now says 'a vehicle capable of transporting the patient'. Again, instant improvement in response time, with no improvement for the patient, in fact to the detriment of the patient because the response time has now been 'achieved' with the car but they will now have to wait longer for a 'real ambulance.

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  51. Mr Daly highlights a problem across the ambulance services and has refused to attend as he felt 'unfit' to do so. Attending whilst unfit puts him at risk of making a mistake. I know how this feels. You feel sick, you are exhausted, you have already been at work 12 hours or more (you have to arrive before the shift start to prep/collect drugs/check vehicle/restock . . .and this is unpaid. Staff do this to reduce their personal stress at going out to incidents such as a man stopped breathing as I have had to do with no kit. It causes incredible pressure).
    We were rarely supported but this has changed lately with better managers at staff / higher management interface. Ambulance work is an almost thankless job.
    You work in tedious situations that do not need an emergency response thanks to 111. You see horrific scenes and are often in the eye of the storm in someone's shocking bereavement.You have to tell people their loved ones are dead, do maths, plan, be calm and think while people surround you screaming. Was "vomiting and feeling dizzy" in that category of urgency?
    The public have no-one to call except 999 as they often are not aware as to the appropriate pathways to access healthcare. An out-of-hours Dr would likely have been able to take the call that Mr Daly was sent to.
    Please please please . . the next government . . don't be mislead into thinking privatisation can sneakily follow repeated bad press of the ambulance services and the ED workloads. Educate the public. Streamline the access and make it transparent for all. Provide longer GP opening hours. Incentivise training to become a doctor. The Doctors are leaving in droves too. The workload increases and gets pushed onto the ambulance service then into ED.

    Mr Daly had a record of 30 years unblemished service. What has he seen and done and who has he saved upon the way? How much trauma and stress has he been subjected to in all those years?
    What category call was the incident he was tasked to, was there a detrimental effect to the patient's well being at the delay in the next vehicle attending? As stated in the article, either it was not a high priority or there was no-one to send.
    Imagine that before ringing 999 for the lesser ailments. You are depriving someone of an ambulance.
    Very good article, well written.

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  52. I represent ambulance staff at Employment Tribunals and paramedics at the HCPC. The common thread is that management do not care one jot about their staff, and the HCPC are not fit for purpose. I do what I can with reasonable success. I am absolutely convinced that whoever represented this paramedic at the HCPC didn't know his arse from his elbow, and more likely than not was represented by someone from his union or instructed by his union. This paramedic has the right of appeal to the Court of Appeal, and I am confident that he will be restored to the register. London Ambulance should, but won't hang their head in shame. All that has happened is that London is short of one more paramedic, and they have so few they are enticing Australians over - who will last a year before going back home, if that. LAS management are up there with the worst of the worst.

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    1. Was Mr Daly represented at all? Was he even a member of a union?

      I do not know Mr Daly and it looks from the support of his colleagues that I am the worst for it, I certainly believe that LAS lost more than Mr Daly when they took the action they did.

      I can also understand that if indeed he was suffering from Post Traumatic Stress Disorder (almost certain after 30 years service with this lot) he was unlikely to be in a fit state to attend the HCPC hearing (he didn't attend) let alone be capable of defending himself, or have the will to launch an appeal without a great deal of moral and professional support.

      Hopefully Mr Daly will have received further moral support via this blog, I hope that he will appeal but would urge caution in pushing him, maybe with his permission an intermediary may keep us all informed if he wishes to continue.

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  53. william richard baxter17 April 2015 at 20:49

    London Ambulance Service senior management shame on you all.

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  54. As well as LAS and other UK ambulance Trusts blaming and disciplining staff when they miss a Red Call target, when the real cause is their own management failure to supply sufficient resources. What is now regularly occurring is that managers are then using the professional body (HCPC) as a public whipping post.

    There have been other recent inappropriate cases referred to the HCPC when Trusts have been annoyed when a red call target was missed, such as the paramedic who did not book on duty and mobile fast enough because the vehicle was not equipped. These cases are more about Trust failures and paramedics not following Trust Policy rather than any breach of HCPC regulations. It can be incredibly stressful rushing to check and equip a vehicle at the start of a shift in case you attend a call immediately and find you require equipment not present and again is this not the fault of management for not having sufficient resources to cover the change over / booking on period and also for not managing a make ready system to ensure the vehicle is equipped and ready prior to the crew starting their shift?

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  55. The HCPC is there to protect the public from us, so why is it we have to pay this Body? if the public need protecting surely they should pay or Service Trust's should pay, they don't seem to protect us in any way or form. Another Quango.

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