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Found 67 results
  1. 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
  2. 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
  3. 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
  4. 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
  5. 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!).
  6. 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
  7. 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
  8. 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
  9. 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
  10. 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
  11. 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?
  12. Event
    A Q Community webinar on Human Factors in paramedic practice. Register
  13. Content Article
  14. Content Article
    I don’t ‘do’ mental health. Growing up, my family always had a stiff upper lip, told me to "take a breath and get on with it". It was seen very much as a weakness. If I was ever feeling upset about something that had happened at work, they would always retort back with a story far more gruesome and awful than mine. My family are all healthcare professionals. Dinner table talk usually turned to horror stories of car crashes, attempted murders, limbs falling off, wounds and cardiac arrests. Very interesting and often led to great discussions, but didn’t explore how we felt about being involved in the worst days of other peoples' lives. My family spoke of these incidents as if they were viewing through glass, an invisible wall. They distanced themselves. This is how they dealt with the horror of healthcare. From their behaviour and how they dealt with ‘work’, I followed suit. It seemed to work. Something bad would happen – a traumatic cardiac arrest at the roadside, a stabbing of a young man, a four car pile up with three dead at the scene, a murdered child – I would then go back to my family home on days off, have dinner and we would swap stories. We would all try and out do each other, a bit like a game of gruesome top trumps. But I could not brush off what I had seen. I saw the trauma that was inflicted on survivors, the pain people had been through, the raw emotions from other during the worst day of their lives, the conditions people lived in. I was seeing this daily, not once a month or once a year, daily. It was bound to take its toll. All was going well, or so I thought. Until my life got in the way. I have two boys: 13 and 11 years old. Starting out in the world. I have been able to keep them safe; I keep them away from these horrors I see. I have protected them from the society we live in. The knife crime, the drugs, the violence, but as they grow up they have become more independent. They want to go out alone, they mix with other groups of kids I don’t know. No longer can I call the parents of a child I deem ‘suitable’ for a play date. I am relying on my children to make the right choices. I felt out of control. Whereas at work, I am in control. I may not have control about which job I go to, but I have control on how I manage the patient, I have drugs to ease pain and can give immediate treatment. I feel as if I am in a ‘bubble of professionalism’. What happens at work, stays at work (or my parent's dinner table). But here in the real world, there is no bubble. I tried bringing my feelings about the loss of control and fear around bringing up boys in 2020 at the dinner table. "That’s life," announced my dad. "We got through it and you're OK," said mum. And that was that. My feelings were deemed as mundane, not good enough to discuss. Before I knew it, the conversation had moved on to a patient who needed helicoptering off a rugby field with a broken leg. I wasn’t sleeping. I couldn’t concentrate. I had this weird pain in my chest. All I could think of was the safety of my boys. I replayed scenarios of them getting run over, getting into a fight and getting stabbed, being involved in a car crash. I wouldn’t go on unnecessary journeys in case we crashed and they died. I was just about coping with work. I did not have the capacity to take stress from any other angle. So, when I needed to step up to the plate at home, bringing up kids, it was all too much. Getting help I made an appointment with a GP. I’m never ill, so don’t see a regular one. Any GP would do. I wanted some help, but wasn’t sure what help was available. I felt embarrassed about going. I didn’t tell anyone. Once I was in there, I just burst into tears. I’ve seen GPs behind closed doors, people do it all the time. I bet they get sick of it. I was now one ‘of those’ people. She heard my symptoms; she heard the causes. With that she wrote a prescription for Sertraline (a drug for anxiety) and an offer to sign me off sick for 2 weeks and I was out the door with a follow up in 3 weeks. Looks like I am labelled now, and it took less than 10 minutes. Were pills the answer? Surely there are other therapies I could try? I don’t want time off. It won't make it better. After opening up to a colleague at work, it seems myself and my family are suffering with moral injury. The term ‘moral injury’ has been used to describe the psychological effects of ‘bearing witness to the aftermath of violence and human carnage’ (Litz et al., 2009[1]). Carnage sounds like a normal shift to me. The symptoms of moral injury are strongly linked to feelings of guilt and shame and can manifest as social isolation and emotional numbing. This was my mechanism for coping with the stress at work. Numbing the emotions, not allowing my emotions to show themselves in fear that I would not be able to do my job. I’m no good to anyone being a blubbering wreck am I, everyone else is OK, so I must hold it together. Binned the pills I was told about ‘talking therapies’ that my employer can refer me to – for free. I went to my line manager. We spoke at length about how I felt, and she referred me to the talking therapy provided by my Trust. While I waited for the appointment date, I opened up to friends. Found out I am not alone. Seems we are all struggling in different ways. Being able to speak freely with a trained counsellor has really helped. I have strategies to help me with anxiety and stress, I have started the NHS couch to 5K and have started to feel so much better. I have not taken the pills offered by the GP. I’m sure some people need them; I feel I don’t need them at the moment. We know that we need to have more and better conversations about our mental wellbeing, and it is worth thinking about what kinds of conversations might be useful; certainly a game of top trauma trumps isn’t a good idea while eating sausage and mash. It is true what the literature suggests, that paramedics are suffering from increasing rates of post-traumatic stress disorder (PTSD) (Regehr et al., 2002[2]), but it is also true that not all those who are psychologically affected by their work, even in lasting ways, will reach the threshold for a diagnosis of PTSD. Some people will become ill as a result of their work, and some will become distressed; moral injury offers a different way of thinking about the psychological harms that may result from the practice of prehospital and emergency medicine (Murray, 2019[3]). This may give paramedics and other ambulance staff the opportunity to think about the impacts of their work in ways which do not threaten their ability to do it. Ensuring there are opportunities to sit down and talk through their jobs in the course of a working day, or night, could be the best place to start (Murray, 2019[3]). References 1. Litz BT, Stain N, Delaney E et al. Moral injury and moral repair in war veterans: a preliminary model and intervention strategy. Clin Psychol Rev 2009;29(8):695–706. 2. Regehr C, Goldberg G, Hughes J. Exposure to human tragedy, empathy and trauma in ambulance paramedics. Am J Orthopsychiatr 2002;72(4):505–13 3. Murray E . Moral injury and paramedic practice. Journal of Paramedic Practice 2019;1(10).
  15. Content Article
    About the author Jo Mildenhall is a Doctoral Research Student at Manchester Metropolitan University; and Paramedic Team Leader, South Central Ambulance Service NHS Trust, Newbury Ambulance Station.
  16. Content Article
    The PRSB have collaborated with the Royal College of Physicians Health Informatics Unit on this project. Clinical leadership was provided by clinicians from the Royal College of Emergency Medicine and the College of Paramedics (CoP). The standard has been developed with the support of professionals and patients. This resource includes: The standard Information model Information model (as Excel spreadsheet) Documentation Ambulance handover standard final report v1.0 Implementation guidance v1.0 Clinical Safety Case Report v0.3 - Currently being approved through the NHS Digital Clinical Safety Group Hazard log v0.7