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Found 71 results
  1. News Article
    Paramedics are being told to take a police escort to more than 1,200 addresses for fear of attack, The Times has revealed. The College of Paramedics said the figure was outrageous and called on courts to implement tougher sentences for assaults on paramedics. Ambulance services have marked hundreds of addresses after violence towards crew. Notes on addresses include “patient keeps axe under pillow — serrated knife hidden round the house and is known to be a risk”, “shoots/throws acid”, and “patient is anti-ambulance”. Read full story (paywalled) Source: The Times, 4 June 2023
  2. Event
    This virtual workshop will provide paramedics with background theory and hands-on practice in incident analysis using Root Cause Analysis (RCA) and in proactive risk assessment using Failure Mode and Effects Analysis (FMEA). Register
  3. Event
    This virtual workshop will provide paramedics with background theory and hands-on practice in incident analysis using Root Cause Analysis (RCA) and in proactive risk assessment using Failure Mode and Effects Analysis (FMEA). Register
  4. News Article
    The London Ambulance Service (LAS) failing on diversity and must implement specific targets for improvements, its leadership has been warned. According to LAS data, just 20% of the workforce is from a Black, Asian or from a minority ethnic background despite almost half of the capital’s population (46.2%) being made up of non-white communities. Of that 20%, 40.9% are in the lowest paid roles, compared to 15.9% who are in the highest wage bands, according to the LAS’ Integrated Performance report. The LAS is in the process of developing a new strategy to help attract more diverse staff, which will be published early next year. Research shows that ethnic minority groups suffer disproportionately higher levels of inadequate ambulance care due to a combination of issues such as a lack of cultural awareness among professionals, language and communication difficulties and a limited understanding of how the healthcare system operates for some minority groups. Read full story Source: The Independent, 21 February 2023
  5. News Article
    Emergency patients are being left open to abuse when they are at their most vulnerable because of a lack of vetting of ambulance workers, watchdog officials have warned. One watchdog official warned that abusers would even seek out work as a paramedic because it provided an “attractive environment” for exploitation. Figures show that dozens of ambulance workers have faced action over sexual assault in the past two years, while paramedics account for one in three cases of tribunal action against care professionals. But one survivors’ group warned the figures were just the “tip of the iceberg”. Paramedics who have been struck off in the past two years include one who performed a sex act in front of a patient, while another was handed a suspended prison sentence for possessing thousands of images of child pornography. Helen Vine, special adviser to the Care Quality Commission, told a recent webinar: “There is a small proportion of the population who are seeking to abuse our patients and the ambulance can be an attractive environment for that type of individual. One of the reasons for this is the ambulance sector is predominantly lone working … and ambulance services offer privileged often unsupervised access to patients who can be very vulnerable". She said the lack of checks meant offenders were able to move between providers, adding: “They test the waters and their behaviours ... if they are challenged, they will move on, however, if they are not challenged then they can hide in plain sight, and they are wearing a trusted uniform and given responsible access to that patient group. Read full story Source: The Independent, 12 February 2023
  6. News Article
    Some ambulance trusts are not sending paramedics to up to around a quarter of their most serious calls, according to figures obtained by HSJ. HSJ submitted data requests to all 10 English ambulance trusts after the Care Quality Commission raised concerns about the proportion of category one calls not being attended by a paramedic at South Central Ambulance Service Foundation Trust. The regulator said in a report published in August last year that between November 2021 and April 2022 around 9% of the trust’s category one calls were not attended by a paramedic. Inspectors said this meant some patients “did not receive care or treatment that met their needs because there were not appropriately qualified staff making the decisions and providing treatment.” But data obtained via freedom of information requests reveals other ambulance trusts had far lower proportions of category one calls attended by paramedics than the South Central service last year. Read full story Source: HSJ, 2 February 2023
  7. News Article
    Ambulance crews say they are treating a growing number of patients who are falling ill because they are unable to afford to heat their homes. The soaring cost of gas and electricity has forced many people to switch off their heating in the winter months. Scottish Ambulance Service crews say they are seeing people who are unwell because their homes are so cold or they cannot afford to eat properly. Charities have warned many people are dealing with a "toxic cocktail" of increasing energy bills, growing inflation and higher interest rates this winter. Glasgow ambulance workers Tanya Hoffman and Will Green say that most weeks they see patients who are facing the stark choice between eating and heating. They have been in homes which feel ice cold, where the patients are clearly struggling to cope. "It is sad to see people are living like that," said Tanya. "There's been quite a few patients I have been out to who can't afford to buy food. They have to choose one or other, heating or food. "So they'll sit quietly at home and it's usually a relative or a friend who will phone for them as they don't want to bother anybody. "They're sitting there [and] you can't get a temperature off them because they're so cold. "So you take them into hospital because they are not managing. You know if you leave that person at home they are probably going to die through the fact they are so cold." Read full story Source: BBC News, 24 January 2023
  8. Content Article
    It was 21:15. We were due to finish shift at 22:00 and station was a 45 minute drive away. A night crew were offering to take over from us as they had just offloaded their patient to the emergency department (ED). We didn't want to hand her over to another crew. She had waited 44 hours for an ambulance and we were currently her 3rd crew in a 16 hour wait outside ED. We thanked them kindly for their offer but said we would stick it out. This lady and her daughter had been through enough, there was no need for more disruption. Besides, we had been told we were definitely the next in. We were. It just took a little time. Everyone was doing their best, but if there's no beds, there's no beds. This was my situation on Monday evening. I ended up finishing my shift at 23:30, an hour and a half late. In reality, that's not too bad. The evening before I had finished 3 hours late, making my shift 15 hours long. Add that to a 40-minute commute each way to station and you can see why I don't have time to fit much else in on work days. My poor dog is beginning to think he lives with my neighbour. He actually goes to their gate first when I do manage to take him out for a walk. I'm an emergency medical technician (EMT). I work in a fairly rural part ofthe UK. Working here is different to working in a city. We have long travel times to hospital and some properties we go to have very difficult access. On a 'normal' shift, things can be challenging. Currently the term challenging doesn't really cut it. When I finally left the hospital on my shift on Sunday, I had just handed my patient over to her 4th ambulance crew of the day. All day I had been listening to shouts coming across the radio for crew availability for red calls (the most serious) but we were all stuck. Stuck in what has become known as the ED ambulance car park. We have become a series of triage rooms where doctors and nurses come out to us to assess patients, to take their blood, to give us forms to take the patients to x-ray or CT to then bring them back onto the ambulance. We have become good at making patients cups of tea, seeking out sandwiches and biscuits, trying to come up with ingenious ways of making patients comfortable on hard, narrow stretchers. We are doing long-term care, not emergency medicine. I'm not trained for this. Trying to use bed pans when patients need to go to the toilet but are unable to mobilise, checking for pressure sores, regularly taking observations and monitoring any deterioration and ensuring this is passed on to the staff inside. We need to keep patients, and sometimes family members, calm, entertained, comfortable. It's draining. And all the while there are other people in need of an ambulance and we can't go to them. It's the same inside the hospital. Nurses are at the end of their tether. They're on their feet all day, not getting breaks, trying to manage too many patients, trying to find beds on wards to move patients out of the ED. Then the nurses in wards are trying to find safe ways to discharge patients that no longer need hospital care but are not able to go home and be independent. It's no wonder staff look drained and exhausted. It's no wonder we are all snapping at each other. The system is broken. I am relatively new to the service and hope to start my three years of paramedic training next year. I love my job but it's impossible not to get frustrated and demoralised right now. We are not doing what we are trained to do and are unable to provide the service that we are supposed to provide. It's oftentimes heart-breaking. So what is the solution? I am asked this question by so many people - patients, patients' relatives, my friends and family. I don't know. There isn't an easy answer. The ambulance service is short staffed - people are leaving the job because they just can't take this situation anymore and we are struggling to recruit people, especially in rural areas. Hospitals are short staffed for the same reason. Nurses are leaving in droves and recruitment is low. Of course, making the job more attractive by increasing wages would help, and making training more affordable - university degrees aren't cheap and trying to work alongside a full-time nursing or paramedic degree is tough! Perhaps providing grants for people to gain their C1 driving licence - this is a requirement for anyone wanting to join the ambulance service and is a massive outlay for people which I'm sure puts a lot of people off applying in the first place. Then there's the issues within the hospital. There are no beds. Why is this? Well, up to 50% of patients on wards do not actually need to be in hospital from a clinical point of view. Unfortunately though, they are also not able to go home without some sort of care package in place. This is where the problem lies. Social care. There isn't any. Again, this is down to massive staff shortages. How do we make social care an attractive job prospect for people? It's long unsociable hours (like nursing and ambulance shifts), it's difficult, it's poorly paid, it involves dealing with patients' personal care, something many are put off by. I'm not sure what the answer is here either, but something needs to happen to make this an attractive career option. Reference [1] Emergency medical technician, healthcareers.nhs.uk, (accessed 20/12/2022) https://www.healthcareers.nhs.uk/explore-roles/ambulance-service-team/roles-ambulance-service/emergency-medical-technician Are you a patient or staff with a story from the frontline to tell? Do you have insights to share to that will help raise awareness of wider patient safety issues? You can get in touch with us at content@PSLhub.org. If you'd like to comment below this blog, you'll need to sign up here first (for free!).
  9. News Article
    Paramedics describe a health service in crisis with a lack of investment and increasing demand, of lengthy waits to transfer patients to hospitals and of a social care system facing collapse. So what does a typical ambulance shift look like? The area covered by the East of England Ambulance Service's nearly 400 front-line ambulances is vast. In 2020-21, the service received nearly 1.2 million 999 calls. Ed Wisken has been a paramedic for 13 years. An advanced paramedic specialising in urgent care, Mr Wisken says: "It is really sad to see patients who have had to wait such a long time for an ambulance - but this is just the culmination of years of underfunding and of reduced resources peaking now where demand outstrips supply." "It is upsetting to see it," he says. "It is not nice to see people who have been waiting hours and hours for an ambulance - but we have really hit crisis point now." He says the morale of fellow paramedics and other healthcare workers is currently very low. "The key is you just have to do just one job at a time and just take the patients that you see and do the best for them," he says. "If you worry about the bigger picture too much you will get frustrated and angry - but that's not going to be beneficial for yourself or your patients." Read full story Source: BBC News, 21 November 2022
  10. News Article
    Directors of a major hospital have ordered their accident and emergency staff to continue receiving ambulance patients into their department “in all instances”, following angry exchanges with paramedics. Hospital staff and ambulance crews have clashed at the new Royal Liverpool Hospital since its opening last month, after ambulance crews were prevented from bringing patients inside accident and emergency department when it was deemed to be full to capacity. The problems were escalated to hospital directors and North West Ambulance Service Trust earlier this month, resulting in new instructions being issued to the emergency department. In a letter to managers in A&E and the other divisions, seen by HSJ, the three most senior directors at the Royal Liverpool, wrote: “As you are aware we are currently experiencing long delays in accepting handover of patients from ambulance crews. “This phenomenon is not unique to us at the Royal Liverpool, nor is it particularly new, but our recent challenges have undoubtedly been exacerbated due to teams still familiarising themselves with working in a new environment and the patient flow challenges we have been experiencing on site. “However, what has changed has been the extent to which we have managed these pressures by continuing to hold patients in the back of ambulances, which we collectively agree is an unacceptable situation. Whilst providing corridor care is not what any of us would aspire to, we have to recognise and respond to the risk of patients awaiting response in the community. “We have therefore today met with NWAS colleagues and agreed that, with immediate effect, we will, in all instances, continue to receive crews from NWAS into the hospital building.” Read full story (paywalled) Source: HSJ, 16 November 2022
  11. News Article
    An audit conducted by an acute trust has found more than half the patients taken to one of its hospitals by ambulance were deemed “inappropriate for conveyance”. The assessment at Scarborough Hospital in Yorkshire, obtained by HSJ through a freedom of information request, examined a random sample of 100 patients, of which around 50 arrived by ambulance. Of those arriving by ambulance, half were deemed not to have required an ambulance conveyance. The Missed Opportunities Audit, which the trust said was “routine” and looked at a range of areas where the emergency department could streamline operations, said: “Fifty-two per cent of conveyance[s] by ambulances were deemed as inappropriate". “The reviewer did not have access to the policies of Yorkshire Ambulance Service, which may account for the low number of appropriate conveyances. However, based on clinical judgment for cases presenting by ambulance the arrivals should have presented either to a community service (33%) or via their own transportation methods (38%), as their documented clinical condition and social circumstances allowed for this.” Read full story (paywalled) Source: HSJ, 9 November 2022
  12. News Article
    Angry exchanges between paramedics and A&E staff in Liverpool have broken out after new measures were deployed to hold and treat patients in the back of ambulances. Sources said there have been “Mexican standoff” situations at Aintree Hospital in recent days, after hospital staff insisted patients who had been brought inside should be returned to ambulance vehicles. Staff at North West Ambulance Service told HSJ they were informed of a new protocol last week, which said patients should be kept in the back of ambulances if the corridor of the emergency department is full with patients. There have been repeated orders from NHS England and the Care Quality Commission over the past year for hospitals to ensure patients can be offloaded by ambulance crews, even if they fear they do not have adequate staffing or beds to accept them. One senior source at NWAS said: “To see a new protocol like this is absolutely unprecedented. I very much doubt the execs had approved it. “We’ve had Mexican standoff situations over the weekend with crews who have brought patients into ED being told to take them back out to their vehicles, but they’ve refused to do this as it means they cannot cohort. “We completely accept that taking extra patients means the ED and hospital staff have to deal with additional and unacceptable risk, but holding ambulances is not the solution because the risks to patients out in the community are even greater. Despite repeated instructions from NHS England and the CQC this still doesn’t seem to be understood.” Read full story (paywalled) Source: HSJ, 17 October 2022
  13. News Article
    Hannah Rusby reassures her patient he’s in good hands. He is in his eighties, skeletal, confused and struggling to answer basic questions. His breathing is rapid. After a few minutes of probing questions and basic tests, Rusby knows this is serious — after months of decline while living alone, the man is critically ill and needs to go to hospital urgently. With more than 500,000 people waiting for social care assessments across England, emergency calls such as this are increasingly common. “We are becoming a middleman for all the other services,” said Rusby, who qualified as a paramedic seven years ago and works for the London Ambulance Service (LAS). She said the job increasingly involves responding to people who fall through society’s cracks. Daniel Elkeles, 49, chief executive of the LAS, agrees: “There are lots of patients who, if something else were available, we wouldn’t need to take them to hospital. As the population has got older and frailer, it’s unsurprising that an increasing number of the calls are not traditional emergencies.” He believes paramedics can be the link between GPs, community nursing and social care. From next week, the LAS will pilot having three cars covering six boroughs in southwest London. Each will have a paramedic and a community nurse and will respond to 999 calls from elderly people who have fallen at home. They’re going to see every frail elderly person who has fallen [and] hasn’t broken a bone, and our aim is to keep all of those patients at home. The community nurse will assess the house to make sure it’s safe then refer the patient to their GP and an urgent community response team,” said Elkeles. The service hopes this will mean as many as 1,000 fewer people going to A&E a year. Read full story (paywalled) Source: Sunday Times, 2 September 2022
  14. Content Article
    Key points Beginning to understand the complexity of physical health concerns in people with mental ill-health conditions will help move practice towards a more holistic approach Embracing health promotion can have a positive impact on patients' physical and mental health Looking at ourselves and how we practise can only be of benefit to those we come in contact with CPD reflection questions for paramedics Have you ever witnessed diagnostic overshadowing, and how did it affect the patient? Do the challenges of dealing with mental health patients obscure your own consideration of the physical health aspects when caring for patients with mental illness? Do you consider health promotion with patients, and does this change with those experiencing mental health problems? How can you make changes to your own practice to address the issues raised in this article?
  15. News Article
    Healthcare systems across Australia are buckling in the wake of COVID waves and the flu season. Pictures of ambulances piling up outside hospitals have become commonplace in the media. Known as “ramping”, it’s the canary in the coalmine of a health system. As a major symptom of a health system under stress, state governments across Australia are investing unprecedented amounts into ambulance services, emergency departments (EDs) and hospitals. South Australia has committed to an increased recruitment of 350 new paramedics. Likewise, New South Wales has committed to 1,850 extra paramedics. Victoria, meanwhile, has committed an additional A$162 million for system-wide solutions to counter paramedic wait times, on top of the A$12 billion already committed to the wider health system. This could begin to alleviate the system pressures that lead to ambulance ramping. But what happens when the paramedics return yet again to ED with another patient? Will they simply end up ramped again? We also need to consider better care in the community – and paramedics could play a role in this too. Read full story Source: The Conversation, 21 July 2022
  16. News Article
    Ambulance services are under intense pressure, with record numbers of callouts and the most urgent, category-one, calls last month. BBC Two's Newsnight programme spent from 08:00 to 20:00 on Monday at six hospitals with the longest delays handing patients over from paramedics to accident and emergency staff. This should take 15 minutes or less - but crews often wait many hours and sometimes whole 12-hour shifts, with ambulances queuing outside unable to respond to other emergency calls. At Royal Cornwall, 25 ambulances were queuing by the afternoon, three for at least 10-and-a-half hours, at Derriford, in Plymouth, 20 were queuing up to 11 hours in an overflow car park and the longest wait at Heartlands was more than five hours. "We're right on the fringe of collapse right now," a paramedic who has worked in emergency care for more than a decade said. "People are phoning and being told that they're not going to get an ambulance for six or nine hours. And that's happening routinely - that is happening pretty much every shift." "It would be wrong to say that there are times when I haven't shed a tear... for the people we haven't been able to help because it's been too late," the paramedic said. "They may have died anyway but there are definitely cases that I've been to where we should have been to them sooner and less harm would have come to them." Read full story Source: BBC News, 15 July 2022
  17. News Article
    There are plans for a major overhaul of how people are rescued from car wrecks amid growing evidence that current methods where people wait to be cut free may be harmful. Last year there were 127,967 casualties and 1,560 deaths in England caused by motor vehicle collisions. During the same period, more than 7,000 patients needed to helped out of the vehicle through a process known as extrication, where rescue crews use “Jaws of Life” and other tools to pry apart the wreckage, and then carefully lift people out. “Since at least the 1980s, firefighters have been trained with movement minimisation as the absolute paradigm,” said Dr Tim Nutbeam, an NHS emergency medicine consultant, and medical lead for the Devon air ambulance. “They’ve been told that one millimetre of movement could turn someone into a wheelchair user, so will often disassemble the car around the patient, to avoid movement of the neck.” Yet, doing so takes time – 30 minutes on average – and if that person has another serious injury, such as a head, chest, or abdominal injury, every minute counts. Nutbeam began researching the issue and discovered that trapped patients were almost twice as likely to die as those who were rapidly freed from the wreckage. Further, that the prevalence of spinal injuries among such patients was, in fact, extremely low – just 0.7% – and in around half of these cases, they had other serious injuries needing urgent medical attention. “Our absolute focus on movement minimisation works for maybe 0.3% of patients, but it extends the entrapment time for 99.7% of them,” Nutbeam said. “Potentially hundreds of people in this country have died as a result of extended entrapment times, and if you multiply that worldwide, it’s many, many people.” Read full story Source: The Guardian, 6 July 2022
  18. News Article
    Paramedics have begun looking after patients inside an A&E unit, in an initiative by the health service to stop ambulances queueing outside hospitals and ease the strain on overstretched casualty staff. The scheme has led to patients being handed over much more quickly at a hospital that was one of the worst in England for sick people being stuck, sometimes for many hours, in the back of an ambulance. Queen’s hospital in Romford, in east London, has set up an ambulance receiving centre (ARC) near its main casualty unit in which two London Ambulance Service paramedics are on duty round the clock to help look after patients who would otherwise be trapped outside or in a corridor, waiting to be seen. Patients who end up in the new six-cubicle unit behind the A&E nurses’ station have a better experience while they wait and are more comfortable – and safer – because they can have their relatives with them, eat and drink and use the toilet more easily. Almost 2,000 patients have passed through the ARC since it opened last November, saving nearly 13,000 hours of ambulance crews’ time and enabling them to respond to emergency calls more quickly. However, some A&E doctors regard the scheme as merely “a sticking plaster”, given that queues of ambulances have become common outside many hospitals and that casualty units are treating the lowest percentage of patients within four hours on record. Read full story Source: The Guardian, 3 July 2022
  19. News Article
    Student paramedics are missing out on learning how to save lives because they are wasting hours in ambulances outside A&E instead of attending calls, it has been revealed. The College of Paramedics and ambulance directors say the hold-ups mean trainees are missing vital on-the-job experience, leading to fears over the safety of patients. Will Boughton, of the College of Paramedics Trustee for Professional Standards, said handover delays had become a problem for trainees’ development and exposure to real-life experience, meaning training had become “unpredictable”. If steps weren’t taken to increase training opportunities and address wider quality concerns in education, “it is very possible that patient safety may be at risk due to missed experience during practice education”, he warned. “A student could complete a regular shift and see lots of patients, getting lots of things in their portfolio signed off, or they could be the unlucky ambulance that joins the back of a queue and is then at hospital X for however many hours waiting to release that patient, so and it varies from county to county and service to service,” he said. Read full story Source: The Independent, 22 June 2022
  20. News Article
    The number of calls for an ambulance in England have almost doubled since 2010, with warnings of record pressures on the NHS that are seeing A&E patients stuck in corridors and many paramedics quitting the job. Ambulance calls have risen by 10 times more than the number of ambulance workers, according to a new analysis of NHS data carried out by the GMB union. An increase in people seeking emergency treatment, GPs unable to cope with demand and cuts to preventive care are all being blamed for the figures. While the figures represent all calls for an ambulance, some of which go unanswered and do not lead to a vehicle being sent, they reveal the increasing pressures that have led to claims that patient safety is being put at risk by ambulance waiting times. There has been a significant increase in the number of the most serious safety incidents logged by paramedics in England over the past year. Paul, a paramedic and GMB deputy branch secretary, said he had recently seen a crew waiting almost 10 hours between arriving at hospital and transferring a patient to hospital care. “They arrived at the hospital at 20.31,” he said. “They then cleared from the hospital at 05.48 in the morning. The impact of the lack of resources is affecting the ambulance service. “We are also seeing people become aggressive to the ambulance crew, because they’ve waited hours upon hours in an ambulance." Read full story Source: The Guardian, 12 June 2022
  21. News Article
    Paramedic Moira Shaw is eyeing the frantic activity at the front doors of Edinburgh's emergency department. She is waiting for the go-ahead to hand over her patients to medics and answer the next 999 call. It can be a long wait. Last week, 1 in 10 ambulances across Scotland took more than 80 minutes to drop patients at an emergency department. BBC Scotland joined Moira and colleague Blair Paul at the Royal Infirmary of Edinburgh where they were among seven ambulances waiting to drop off patients. "At the moment we can be an hour waiting, we sit in the ambulance and we wait until there is a space to go in," explains Moira, who has been with the service for nearly a decade. "This is pretty much an everyday occurrence now. "It's that domino effect, so if patients are waiting to move to other areas, A&E gets clogged up and they can't take any more patients in because they are waiting to move people on." Moira said she has noticed they are attending more calls where people have not been able to get through to their GP so phone 999 instead. Another theme picked up by Moira and her colleague Blair is helping younger sicker patients who need urgent hospital treatment. "I've seen actually quite a lot of people maybe in their 40 or 50s who have got now stage four cancer and they've just not been able to get access to any treatments or anything just due to the pressures on the NHS at the moment," explained Blair. Read full story Source: BBC News, 11 May 2022
  22. News Article
    "Absolutely soul destroying" is how one paramedic describes his job. He is not alone. Over the past few months, BBC Wales has been contacted by employees from the Welsh Ambulance Service who paint a dire picture of a service under immense pressure. Ambulance waiting times have climbed and climbed throughout the pandemic. The impact that has on patients is well known - but what about those on the other side? Mark, who did not want to disclose his real name or show his face for fear that he would lose his job, described the stress of his shifts with a radio strapped to his chest, hearing "red calls waiting, red calls waiting". "That is the potential of somebody's life waiting in the balance - and you can't get there. It's absolutely soul-destroying. We wouldn't treat animals this way, why are we treating humans?", he said. Mark said the job has always come with pressure and anxiety. But over the course of the pandemic that has intensified and he has "never known as many people looking for other jobs as they are at the moment". The stress has become so bad that he is now on antidepressants. Read full story Source: BBC News, 25 March 2022
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