Florian Breitenbach

Rettungsdienst und mehr

Collaboration & Specialisation



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.

The Paramedic’s ABC

The Paramedic’s ABC has launched, a website promoting discussion and knowledge amongst Paramedics and interprofessional colleagues.

And we want YOU!

Join us at The PAD. Our very first discussion topic will be on Cardiac Arrest, on Sunday 1900hrs GMT (London) on twitter with the #ParamedicABC hashtag.

Check it out now:

Emergency Services Show 2012, part II

Whilst gear is cool, it’s the networking that adds the heart and soul to these events. Meeting a bunch of enthusiastic and like-minded people in a country far far (or not so far, depending on your definition) away from home was invigorating and exciting. I’d been in touch with a couple of people virtually but had never actually met them in person before – what a better event to change this?

The first day I met up with Matthew Harris who runs HarrisCPD – a great site (not only for UK Paramedics) to keep on top of the fast evolving field of paramedicine. We explored the halls together for the day, chatted about a few different ideas and thoughts about the current paramedic environment in the UK, and Matthew even managed to sneak me in to his live podcasting of the event! Listen to it here. It was great to have someone to wander around and chat with, gave the whole day a much more relaxed and friendly atmosphere.

Unfortunately Matthew could only come for the one day, but not to worry, there were still plenty of people and stands to visit, for example the College of Paramedics (read their review of the show here). I was also very excited to finally meet TJ (aka @meditude) in person, who then promptly ran away (maybe I should have combed my hair differently? Did I brush my teeth properly?). Alas, no, he was just off to give a lecture on Mental Health from a paramedics perspective, which brings us nicely to the Continuing Professional Development seminars:

Both the College of Paramedics and PhysioControl offered some very interesting (and well attended) CPD events both days. I attended the following (with some key points of interest)

  • Mental Health for Paramedic Professionals: Not much training is provided to deal with patient suffering with mental health issues. Yet it is estimated that 10-20% of all calls in the UK have a component of mental health. A novel idea was proposed by TJ, the presenter: Specialist Mental Health Paramedics. We already have Paramedic Practitioners, Critical Care Paramedics – why not specialise in Mental Health? Some rudimentary calculations and thoughts from yours truly: Critical Care Paramedics are sent to really sick patients, but the call volume equates to approximately 2-3% of all calls. Given that mental health takes up a much larger chunk of call volume – surely one could argue a decent case for the introduction of such specialists? I think a trial is needed.
  • Management of Minor Injuries: Presented by a long time Paramedic Practitioner (PP), an overview was given how PP’s have positively influenced healthcare in the UK. An interesting point made was to leave the patient with enough information if they are not conveyed to hospital – enter the Patient Information Leaflets (these are from the South West Ambulance Service). Great idea!
  • Emergency Childbirth: A situation I’ve been in a couple of times, and a situation I dread again, again and again. I just don’t like it…but that doesn’t help, I need to keep refreshing my mind just in case I come in to such a situation again. Initially the course was cancelled as the midwife couldn’t make it – but then luckily last minute a Paramedic turned up and volunteered to fill in, as she had been a midwife in her previous career. Thank you!
  • Dr Richar Lyon talked about Improving outcome from OHCA: The TOPCAT 2 project – the video is from Resuscitation 2012 on Vimeo. Watch the video, it’s very interesting what one can achieve by analysing the data, getting a structure and education framework in place to then achieve some really good improved results.
  • Mark Whitbread, Consultant Paramedic with the London Ambulance Service (LAS), talked about 12 lead ECGs. Not my strongpoint, but the way he explained it de-mystified the whole approach nearly instantaneously. Impressive. Mark is also the man behind implementing true STEMI care within the LAS, a short video can be seen here.

Emergency Services Show 2012

I will be at the Emergency Services Show 2012, held this week Wednesday and Thursday (21st and 22nd of November). Looking forward to meeting new people, catching up on the latest technological developments and getting some CPD from the College of Paramedics.

There will be a couple of us meeting up on Wednesday at 1215hrs outside the College of Paramedics stand (Hall 3, stand E71, floorplan here). I’ll be live-tweeting together with a bunch of fellow tweeters – be sure to follow the #ESS2012 hashtag.

Hope to see you there!


Yes, Ormskirk. A little town in the North West of England, 14 miles north of Liverpool. Bus driver, pub owner, town locals…all asking me the same question: “What are you doing here?!” It seems visitors, be it from London or from Mars, are a rarity. Ormskirk is not a place that prides itself on tourism.

Doesn’t matter to me, I didn’t get to see much of the place anyway. I was here for the Continuing Professional Paramedic Development – a one day conference put on by the UK College of Paramedics.

The day started off with Dr John Freese, Chief Medical Director of New York City Emergency Medical Services. A rather good speaker with an interesting background (John started as a basic EMT in the rural US, worked his way up to Paramedic, then turned to medicine). His talk was based around trauma care in the US, its history and direction of the future. Some interesting points I picked up:

  • Skill decay is a big problem amongst NYC paramedics. Intubation success rate is approximately 30%, many paramedics don’t even get a chance of intubating, and their average training is far less than that of an average UK paramedic.
  • For severe trauma patients, definitive care is needed. Where this care is provided best (i.e. what is the most suitable hospital), NYC EMS has developed a simple reductive flow chart based on patient presentations, events and mechanism in order to determine if a patient should be taken to a trauma centre, and if so, what level. An important note was emphasised: the clinicians decision. The chart could not indicate any need for higher care, but the paramedic must still be allowed to take a patient to the highest care facility if judged so by their clinical experience.
  • Then the big one: “Spineboards: they need to go”. NYC EMS has realised that far too many patients are immobilised for no good reason. Research is proving that immobilisation is possibly doing more harm than good. Currently, new guidelines are being written in order to drastically lower numbers of spineboard usage in NYC. Personally, I applaud this. A big step in the right direction.
This talk was particularly interesting for me, as I had just visited New York last year (if you’ve been reading this blog recently, I am just putting up the stories now). Very nice having seen NYC EMS, then hearing all about it from the Chief MD.
Up next was Professor Kevin Mackway-Jones, Medical Director of the North West Ambulance Trust (NWAS). The presentation was similar to the previous, but this time from the NWAS perspective – a much more diverse landscape with urban, regional and rural settings (something you wouldn’t find in NYC!).
  • To provide a similar level of care that urban area enjoy everywhere in the NWAS catchment area, another 14 full time helicopters and anaesthetist would need to be employed. Far too expensive and ridiculous, he explored the alternatives: Full time HEMS, vs on call residential doctors, vs volunteer doctors (e.g. BASICS), vs full time specialised (critical care) paramedics. The last option won – cost effective, good exposure means good quality, experienced, available and a good skill set.
  • Kevin agreed with John about spineboards, and repeated the overuse of the device, stating that many UK services are re-evaluating their use. Additionally, he stated he is not convinced by pelvic splints; there is not enough evidence to support them.
Next speaker was Professor Andy Newton, Chair of the College of Paramedics and Clinical Director of South East Coast Ambulance Service. After some information update from the College itself, Andy got us in the right mood with a clip from the Simpsons: Homer as an Ambulance Driver (could unfortunately only find it online in Italian). Some points Andy talked about:
  • The history of Paramedicine, especially with regards to the “founder” of out of hospital care, Dominique Jean Larrey.
  • The specialisation of the workforce. The police have a very specialised workforce: General duties, traffic, homicide, fraud…certain cops target certain crime. Paramedicine should (and is) heading int he same direction: Paramedic Practitioners for minor issues that can bypass the A&E department, Critical Care Paramedics for very serious cases.
  • Apparently providing Ambulance Services in the United Kingdom costs 2 billion Pounds annually (surprising actually, since London’s Metropolitan Police alone have an annual budget of 3.5 billion Pounds. Compared to the 282 million Pound London Ambulance annual budget).
  • Then a great point: “Paramedics as a disruptive technology“. Adapted from the business world, the point was made how Paramedicine is influencing healthcare, changing the way care is delivered (e.g. via Paramedic Practitioners), together with potential ways Paramedicine may influence the provision of healthcare in the future.
  • Another video, this time from a cardiac arrest in London from the early 1980’s. Horrible grey uniforms, ghastly hairstyle, but the intubation was spot on (unfortunately nobody cared about chest compressions…). Nothing how an arrest is run in 2012, thirty years later.
After lunch, there were two more presentations; Sudden Arrhythmic Death, and Obstetric emergencies.

In other words: Quite a good event. Interesting speakers, decent venue, and a good attendance. Can’t ask for much more! For those who would like an online summary, I did tweet most of the event under the #ParaUKCPD hashtag on twitter (should be visible on my timeline, dated 19th October).

Couldn’t make it? I will be visiting the Emergency Services Show in Coventry on the 21st and 22nd of November, tweeting and blogging again. Hope to see you there!

CPD time!

Here I am, in the middle of London city,

Writing prose and trying to be witty

Yet slowly going nuts I swear,

With far, far too much time to spare!


Now registered with the HPC,

I realise I must do some CPD!

So off the the North West I go,

To listen up and enjoy the show!

Yes, it CPD time, Ladies and Gentlemen! After having signed up with the College of Paramedics, I thought I may as well jump right in, and have booked myself in to “Managing challenging incidents in the pre hospital environment”. Looks to be a great event. Have a look at the poster, and hoping to see you there!