"36 year old female, going blue"
There has been a lot of talk recently about private ambulance services being integrated into the NHS. I have been rather vocal about my dislike for them, some of my reasons rational, some irrational. In general, my reasons are nothing to do with the individual staff or the service they work for. Nor is it really anything to do with the awful crews I have dealt with. It's to do with the 'big picture'. That picture of the systematic dismantling of the NHS. That is what I'm passionate about and personally I think any private service, be it ambulance or anything else, has no place in the NHS. Where the driving force is money, patient care, staff quality and staff training will suffer.
I was recently asked what my issue with their training was, and I was told in some cases they are better trained than we are. That is by the by. I disagree but am not in a position to comment as I don't know the content of the training the staff receive. There are so many different ambulance services that range from no training to excellent training. The point is, we don't know and therefor the trust and understanding will always be missing, rightly or wrongly. Maybe this will explain why......
I was working on an FRU with my student, We were sat on standby watching the world go by when we were sent a job a fair way away. On the car, you don't get the benefit of reading the updates you get as you are driving and as such, I thought I'd been driving to a DIB (Difficulty in Breathing). You can imagine my surprise when the radio started ringing and the following words filled the cab:
"Just to advise, this is now a cardiac arrest, there is another FRU on way who should be there the same time as you. CPR is in progress."
Well that got the adrenaline pumping! Within 2 minutes we were on scene, just in time to see the first FRU head through the door. I grabbed some spare oxygen and a few other bits and headed inside. The FRU had a student with her too so the were 4 of to be getting on with. The patient was indeed blue and as we were told in cardiac arrest. I'd never met the paramedic on the car, nor had I met her student. She took control of the airway whilst I started attaching pads etc. The students was on CPR duty. A minute late the crew arrived, again, I'd never met them or their student and they hadn't met the other FRU or her student. In effect, we now had a group of 7 people who didn't know each other but who had to
work together in a life or death situation! I really is that simple!
The NHS Logo is one that is respected and trusted.
The paramedic on the crew got IV access and took charge of drugs. The FRU on the airway looked up at me and asked if I could run things and write stuff down. The EMT from the ambulance was given the task of the runner, he would be getting the bed should we need, getting and removing kit and generally being useful. I was writing times down and vocalising everything that had been done and was yet to be done. As a resus goes, this is as smooth as it gets. We followed drug protocols, tried to reverse the causes of the arrest and after 19 minutes we got ROSC (Return of Spontaneous Circulation) ie: Her heart was now beating again!
We stabilised her before moving and by the time we were ready to go every i had been dotted and every t had been crossed. She continued to improve all the way to hospital. On mass we entered the waiting crash team who took over the patients care and she had a great chance of returning to 'tax paying status'. That is of course, the only statistic the government cares about!
The reason this job ran seamlessly was because of team work. We were able to delegate roles to each other knowing exactly what the others could do. We know that an EMT of any level in our trust is trained to the same standard as paramedic, the only difference being paramedics cannulate and give the drugs. Most can do the same airways as paramedics and they'll all have a minimum of 7 years experience as an EMT. We know by the epaulettes of the students what stage in their training they are in. We also know that they have had exactly the same training in advanced life support and are trained in all our local protocols and paramedic assist. Regardless of what staff from our trust arrives you know exactly what you are getting and can simply get on with it. You do things without being told, you pass things without being asked and seamlessly work with strangers because the uniform says you can.
This is where there trust is lost with private ambulance services. Their staff may well be trained to a high standard but equally they may not be. Some EMT's in private ambulance services have only been on a 3 day course. Some ECA's may be 18 years old with only a first aid course. We simply don't know and during a cardiac arrest you don't want to be learning the hard way that the crew sent to assist you has never even done CPR before. Ask yourself this, if your relative is in cardiac arrest, who would you rather see walk through the door? I know what I would want.
This isn't an attack on the private ambulance services or the people that work for them, it is simply highlighting the issues that we as road staff are having. If they have to be used then it should be kept to patient transport and assistance services, not front line 999 work. There simply just isn't enough quality control and parity in training to make it a safe, viable option and nor is it in the best interest of the people who use the service. Until such a time that all roles are registered professionals, they cannot be integrated successfully with the NHS. There are too many people calling them selves EMTs, ECAs and trainee medics when all they have done is a three day course.
In MY opinion.