Collaboration & Specialisation

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I recently attended the Blue Light Collaboration Conference in London representing the College of Paramedics. I was initially a little sceptical, as I don’t have much to do directly with collaboration between services apart from direct contact with them as an on road paramedic, but then I thought this may be a good opportunity to meet new people, see different perspectives and get some other thoughts.

And it delivered. There were many delegates from various UK Fire & Rescue Services, plus a few paramedic, police and government representatives. Due to this, the main `topic was the collaboration between paramedic and fire services – co responding, emergency response, joint response…different names for basically the same thing: Fire & Rescue Services with their decreasing workload assisting Paramedic Services with their increasing workload.

There are a couple of different models how this works, but the most advanced and integrated (or overlapping?) model comes from Lincolnshire, in the East Midlands of England. There, East Midlands Ambulance Service (EMAS) and Lincolnshire Fire & Rescue Services (LFRS) have been working together in an official capacity since 1998, and their current setup is a natural progression of pure first responder type scheme: In a UK first, Fire & Rescue are actually manning three ambulances.

In my opinion, the pros outweigh the cons: The Fire & Rescue Service have capacity to spare. Their workload has gone down significantly over the past decades, but the public still deserve a good level of fire protection. In between fire and rescue calls, there is only so much training one can do – why not utilise their time for medical transport? Ideally, fire cover should not suffer from this model, but have a thought and compare: the risk of morbidity and mortality of medical origin (mainly cardiac) outweighs the morbidity and mortality of a fiery origin by quite a high factor. Both Paramedic and Fire & Rescue Services have one single task when broken down to the bare essentials: to serve & protect the public. Why not collaborate in order to maximise our efforts and outcomes?

This direction also got me thinking one step further: What if Ambulance Services (you may have noticed I have been avoiding that term) focus on their core strength of providing healthcare to the public, and “outsource” the transport side of operations to other services or suppliers?

A true Paramedic Service would take requests for help from the public, and point them in the right direction. If they can be helped at the point of their initial query and be referred on to more appropriate services (e.g. home care, GP, pharmacy), that works in favour of the public (accessing the appropriate care as timely as possible), and in favour of the service (only sending paramedic resources to the patient when appropriate). If a Paramedic is required at the scene of an incident, they can decide if transport is necessary. All this is already happening in some services around the world, but lets take it one step further: The Paramedic on scene then needs transport capacity, as they respond in mobile rapid response units (fancy speak for cars or minivans). Enter Fire & Rescue Service: they provide the transport capabilities, with basic life support dual trained fire fighters. Should the patient be stable and only need transport, they they can be transported. Should they need ongoing paramedic intervention and/or monitoring, the paramedic can hop in the back of the fire ambulance, and paramedic care can be given en route until handover at hospital.

Currently, there are only three Fire & Rescue (F&R) Ambulances in Lincolnshire supporting the Ambulance Service in a transport capacity. But if F&R took charge of the entire transport side of things, Ambulance Services could turn in to dedicated Paramedic Services, and focus on delivering high quality paramedic care to the community, without the overhead and distraction of not only fleet maintenance but number of other areas. F&R Service would be able to use their resources more effectively, and not have to close fire stations, thus keeping up fire cover for the public.

The above lines are only a thought experiment taking the Lincolnshire model one step further, but it is an option to be considered. The people behind the pilot programme in Lincolnshire are due to publish some numbers based on their facts and figures over the past month (the preliminary data, I’ve been told, is promising). It will have to be properly evaluated and adapted to local needs, but  I believe this could be quite an exciting game changer. I will be watching these developments carefully and with a lot of interest.

366 days

366 days – a short film about a young paramedic in Austria.

These 12 minutes really brought back some memories, feeling and thoughts not only from when I started, but also where I am now. A very touching insight in to life as a Paramedic.

366 Days from Die Trickfilmer on Vimeo.

OPQRST

 

…or  Overload, Procrastination, Quiet Reflection, Structure, Time to shine!

I’ve got a lot going on at the moment, keeping myself busy in and outside of work. Too busy, it felt at times, and too uncoordinated. Overload, and with it, Procrastination (of the bad kind)

Time to simplify. Out with the unnecessary, focus on the big picture. Not always easy in the age of information overload and the ever luring presence of social media to get your procrastination fix, but it can be done.

Reflective cap on, time for some introspection, reflection, rearranging, reprioritising. What do I want to do, what can I do, where do I want to go, how do I get there, who do I want to be?

But first, get the basics sorted, daily life. Bringing in some structure:

 

IMG_1034Soon, blogging should be back on the list.

Interested in the outcome? Watch this space.

 

Epilogue

Thirty people, spread over four countries and two continents, and with a variety of backgrounds, meet in a wooden hut in the alps for 48 hours. The only thing they have in common, apart from the german language, is an interest – a passion – for paramedicine. Why do people travel hundreds of kilometres on their days off, organise shift swaps, and take annual leave ‘just’ to be with colleagues and to talk shop? Why would mostly underpaid paramedics spend their hard earned money to be in company of others in the same profession?

Dedication and Desire. Dedication to the Profession, and the Desire to improve. Make things better. Improve systems. Improve working conditions. Optimise procedures. Exchange ideas and experiences. Discuss thoughts. Improve outcomes. Save lives. Working and focussing on our raison d’être, our motivation and purpose of existence: the patient, and the community.

It is easy to get stuck in the negative spiral with burnt out, cynical and overly sarcastic colleagues. But nobody ever said it would be easy sailing in this job; that is true from a clinical perspective, but also from an operational point of view. Think back to the time when you were but a newby in the job.. Think of what motivated you to get in to this great and noble profession. What gave you your drive? What were the deciding factors? What grabbed you, and made you go “YES! I want to be a Paramedic!” ?

Make sure to hold your head high, and be a proud professional. We all have our ups and downs, and if you ever find yourself doubting – get out of the rut and surround yourself with some like minded individuals to lift your spirits. Add some clean alpine air to the mix and you’re sorted.

It was a great time meeting with the group, and I, for one, will return home just that little bit more refreshed with just that little bit more motivation to do what I love doing: being a paramedic.

I am refuelled. The flame is still burning strong.

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SwissScapes

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OxyBear is saturated.

 

_MG_1209StethoLion hears you breathing.

 

_MG_0940Emergency!

 

_MG_1183 …whilst it’s cousin naps, solemnly waiting for an emergency of it’s own…

 

IMG_8204…wishing it had a bed of it’s own, an actual ambulance bed…

 

Thanks to Martin Greca for the photos. They are Creative Commons licence, but please get in touch with me via the Contact! page if you want to use them.

Bern Baby Bern

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Up next on the second day of the meet up was a guided tour of the Paramedic Service in the Swiss City of Bern, curiously named the “Sanitätspolizei”, literally “medical police”. I guess that gives a whole new meaning to the term “Cardiac Arrest”…

In reality though, the terminology can be explained historically – over a century ago, it was realised that a dedicated corps was needed to help people with medical problems in the community (well, get them to hospital). This group was recruited from the police force, and the police moniker stuck, although they have nothing to do with the police at all.

044When the service was being set up early last century, a specialised water rescue group was also needed. So the Sanitätspolizei got lumped with that too, and has proudly kept it to this day and age. Every ambulance is fitted to tow one of the many boats that can be found at their HQ.

 

The 6 day rota that staff work seemed interesting; day shifts on day 1 & 2, moving on to a night shift from the evening of day 3, finishing on the morning of day 4, and having day 5 & 6 off.

Far more interesting (read: different, strange) was the way vehicles are staffed. To understand this, I will list the “clinical points” that are given to staff of varying clinical grades:

  1. Student Paramedic, year 2
  2. Student Paramedic, year 3
  3. Qualified Paramedic
  4. Experienced Qualified Paramedic
  5. Experienced Qualified Paramedic with ICU/Anaesthesiology nursing qualifications, OR Junior Emergency Doctor
  6. Experienced Emergency Doctor

There are a pool of staff floating around the station (the only station in Bern) at any given time. Staff are not assigned to a specific vehicle during shift, or have a certain partner. When an emergency call comes in, the calltaker/dispatcher (same person) triages the call. Depending on the nature of the call, a varying amount of “clinical points” are needed to appropriately staff the vehicle. A patient transfer job (all done by these guys and girls) can be handled by a single qualified person, only three points are needed (there will always be a fully qualified Paramedic on every vehicle). If a call is deemed low to medium priority and needs (minimum of) six clinical points, it could be two qualified paramedics, or an experienced qualified paramedic with a year three student. Cardiac arrest calls have the highest point count at 9, and one of the staff have to have at least 4 points to their name. For calls like this, they try to put three staff on a vehicle.

To get the resource running, the dispatcher broadcasts the names of the staff that they want to respond, they go down to the garage, get a “job fax” (a printout stating the nature of the call). Staff then grab a vehicle, tell control what vehicle they are on, the call details are sent to that vehicle (including sat nav), and away they go. After a call is finished, the vehicle is returned to base, the crew restock and clean it, as it unlikely that they will use it themselves in that configuration again.

Confused much? So were we.

IMG_8208Emergency! Jackets and boots are not allowed past the garage, so staff leaver them here, ready for their next call

A few numbers before I leave you with a selection of vehicle pictures:

The Sanitätspolizei Bern

  • have 150 staff
    • 15 of those are office based. They are all qualified paramedics, and can respond to calls if need be (non-clinical work such as accountancy and HR are dealt with by the city of Bern, and are located elsewhere, separate from the service).
  • receive 186 000 calls for help annually (510 calls a day)
  • dispatch 39 000 calls annually
  • do both primary (75%) and secondary (25%) calls.
    • On average, once a week the water rescue team are dispatched. Approximately half of the staff are water rescue trained, both above the water (boats) and below (rescue divers).
    • 2% of secondary calls are made up of transporting corpses to the mortuary. These transports are done with neutral coloured vans with undercover lights and sirens if needed – an example given where expedited removal is needed is to clear the high speed rail lines after people have been hit by a train.
  • have a company policy that staff must use the sliding pole to reach the garage when called out. It is seen as too dangerous to use the stairs. This caused amusement amongst some of us, as in Germany many services have banned the use of sliding poles as it is seen as safer to use the stairs.

And now, finally, the moment you’ve been waiting for. Colorful cars!

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The group around a Mercedes Sprinter 315, coachwork by the German company Ambulanzmobile, type “Delfis”. This is the main type of emergency ambulance in use in Bern.

 

036Mainly used for nonemergency calls is the smaller VW T5, coachwork again from Ambulanzmobile, type “Hornis”. Can be used for emergencies as well, has all the same kit, just less room.

 

049The so called “Hochlang” (literally: talllong, because it is tall and long) built on a Mercedes E Class chassis is a dying breed – as they age, they will not be replaced by newer versions. They are primarily used for long distance transfers – colleagues who have used them love the smooth ride, but this comes at the expense of far less room compared to other types of vehicles.

 

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An officers/supervisor car, Mercedes ML.

 

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And they even have a Lambo in the garage!

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Thanks for additional pictures by © Nils Düster and (cc) Martin Greca. To get in touch with them, please contact me via the Contact! page

Mountains and Madness

A few months back I was made aware of rettungsfachpersonal.de – a high quality German speaking forum for paramedics and those interested in topics about and around paramedicine. Their user meeting was coming up in May, and I might be interested in coming down to Switzerland for a few days. Well….why not?

The meet up was spread over three days. The first day was more of a get to know each other day between paramedics and some emergency physicians from all over Germany, Switzerland, one from Papua New Guinea and yours truly from London. The interesting thing when meeting people in real life after knowing them only from a forum, is the need to establish a link between their online user name and their real name (and their face). Having been quite new to the forum I just had to get to know everybody, end of story. Nothing better than a good old fashioned barbecue then!

IMG_8196Yes, those are actually tofu sausages in the bottom right hand corner, sourced from ethically slaughtered tofu animals.

Set in a scout style wooden hut in the swiss alps (you’d have to be about 1.50m (4’11”) to walk around comfortably in the bedrooms), it was back to the basics: five minute drive to the next tiny village, luckily we had running water and electricity. But no comforts of a luxury hotel – wash up yourself, make your own room (i.e. bring your own sleeping bag for the 8 person sleeping room with bunk beds). I didn’t mind it, nothing wrong with making do with the bare necessities…we’re often enough used to it at work after all! Even the (very) near by (restless) cows with their bells around their necks all too soon became a background noise that I could easily zone out from.

The afternoon, the evening and the night progressed. Food was heaped on to the flames, drinks (kept cold in a trough) were distributed generously (but not too generously). Stories, systems, scenarios and studies were exchanged. Ideas and concepts were conceived, discussed, formed, changed and adapted.

After surviving a night bunched together with various snoring colleagues of various snoring intensities and various snoring intervals (with varying snoring rhythms and notes, including but not limited to: staccato, legato, samba, jive, E flat minor and G sharp), the late morning breakfast was just what was needed to wake us up for the afternoon, our visit of the Paramedic Service in the Swiss City of Bern, the Sanitätspolizei Bern…