"79 year old female, abdo pain"
For a change from the norm, I wasn't working on an ambulance. Tonight I was on the FRU (Fast Response Unit) car on my lonesome. A typical 12 hour car shift generally consists of sitting on standby waiting for the higher priority of calls to come through. You generally stay in your area so that you can be on scene quickly for the patients (and to stop the clock before the 7 minute 59 second deadline). Unlike the ambulance you are not sent to anything and everything which is a pleasant change but you do often have to wait some time, often with a sick patient, for an ambulance to arrive. When the ambulance arrives you hand over and leave your patient in their more than capable hands. If there is no paramedic on the ambulance and you either have concerns about the patient or need to administer drugs etc then you may travel with the crew but more often than not it's a simple handover and off you go.
I arrived within about 3 minutes of the call coming in, grabbed all my kit (so much heavier on your own) and trundled up to the front door. Once inside I was taken to the patient who was sat on the toilet. She was obviously in pain so offered her some Entonox which worked well. The basic aim for the FRU is to a) stabilise the patient and get us much information, history and observations as possible before the crew arrives. I checked her over and most of her observations were OK. Her heart rate was raised a little and her temperature was a little high but other than that it was just a pain problem. I suspected from the way she was describing it, it was an inflamed stomach ulcer or something similar and she had a history and medication list to match that. I couldn't give morphine as she had a known sensitivity to it so it was a case of waiting for a crew to take her in. Simples!
Then, the crew arrived. Not a crew from my NHS Ambulance trust but a private ambulance service. The two middle ages guys were rude to the relatives who were trying to tell them what was happening on their way up the stairs.
"We'll find out what going from the car driver if it's OK."
What a douche bag! Sure, clinically, you'll find out what is happening from the FRU but there is no harm is at least pretending to be interested in what the family have to say. Also, 'car driver'?! Seriously?! Two middle aged guys stood in the door to the bathroom, the one who appeared to be attending had his arms in his pockets and was chewing gum in a hugely grotesque way. I started my handover with full history, observations and differential diagnosis and it was clear he wasn't listening to a word I was saying. In fact, half way through, he turned to his crew mate to say 'reckon she can walk'. I ended my handover with, 'so if one of you could grab a chair that would be great'.
"I reckon she'll be alright on her feet"
"Well I'd like her to go in chair, so could you get a chair please."
He didn't bother hiding his displeasure and rolled his eyes. They BOTH went to go and get the chair, clearly to have a bitch about me. I've been on scene for 25 minutes, if they had listened to my handover they would have heard me describe her pain and would have heard me say that the Entonox is helping but is making her dizzy. They would have also heard me mention her usual mobility is slow and she uses a frame. A lifetime of tax and national insurance and being unwell entitles a 79 year old to god dam chair in my opinion. These numpties would just have to suck it up.
After helping carry her down the stairs because one of them 'had a bad back' we got her onto the ambulance. The driver got in the front and the attendant sat behind the head of the patient. I find this impersonal and rude but that didn't surprise me from these two.
"Are you going to monitor her and give her some more Entonox?"
"We don't have any and what are supposed to monitor?"
"Her pulse, oxygen saturation, her blood pressure etc."
"But you've said they were OK"
"But it could change!"
Again he rolled his eyes and reached for a blood pressure cuff. I'd had enough, I didn't want to spend any more time with them but I also didn't want to leave this lovely elderly lady in their 'care'. I decided to travel with them, bring my Entonox and monitor the patient myself much to the annoyance of Tweedle Dum and Tweedle Dee. Eventually, we go to hospital, I handed over to the nurse and managed to grab another FRU to take me back to my car. Before I left I told the private crew what I thought of their lacking professionalism and told them in no uncertain terms I'd be lodging a complaint. They didn't seem to care one iota.
This job is not an isolated case unfortunately. If you speak to any FRU who has come across one of the ever increasing amount of private ambulance services you will hear similar tales. At busy periods, my service is becoming more and more reliant on them rather than using the money to staff their own ambulances. There is little or no quality control and you also have a situation where vast numbers of staff who have been sacked for a wide number of reasons from drink driving, drug offences, misconduct, patient complaints and having sex in ambulance service vehicles are now working for the service again through the private companies who's only motivation is money.
This is having an effect on patient care and it is only getting worse. The training these private ambulance services provide to their staff is minimal at best, they are generally staffed with much less qualified members of staff because it is cheaper that way. They also are picking from a much smaller talent pool because generally, and there are exemptions, the people looking for work in the private sector are not qualified or not allowed to work for NHS trusts. i.e.: criminal records and those previously struck off by the HCPC. As the role of Emergency Medical Technician, Emergency Care Assistant etc are not protected or registered titles, anyone can do them. I met one crew who between them had had 6 days of training before stepping foot on the ambulance. It's a liability. They are a bunch of cowboys and chancers.
In my opinion these companies need to be irradiated. Where money is the primary focus, patient care will suffer. That's a fact. Sure, it may be cheaper for the government to gradually privatise the ambulance services but at what cost. I certainly wouldn't want these imbeciles to go to a member of my family. Would you want them to come to yours? It seems that the budget cuts are being used to undermine the ambulance services for the ulterior motive of future privatisation. If you cut our staff and cut our budgets we cannot work as efficiently with the ever increasing call volume. Then, to blame us and say private ambulances are the way forward because we are not providing the level of cover required is absurd. Put the money to where it is needed. Well trained staff on well equipped ambulances. What do I know, I'm just a bum on a seat, I probably can't see the big picture.
By the way, that 'Big Picture' the Tories tell you all about is this...... A picture of our elected MPs and our unelected Lords sitting round a big table, raising a glass to the stroke of genius that led them to all own shares in private medical companies and then sell of the NHS to the highest bidder, thus making them all richer than they were. Great picture from down here.