Menu

flobach.com

Contemplating life.

Minimum skill levels on emergency ambulances

If you phone for emergency medical assistance, you would think and hope that there is some sort of minimum set who will actually respond to your call for help.

Call in Germany, and you will be guaranteed that the arriving ambulance is staffed with at least one Rettungsassistent (see paragraph 25 of the Durchführungsverordnung HRDG vom 3. Januar 2011, this is for the state of Hesse).

Call in England, and…well…you might get a Paramedic, or a Technician, or both, or an Emergency Care Support Worker, all three, a mix…it’s up to the individual service. All I could find was the Health and Social Act (Regulation 22), which merely states:

In order to safeguard the health, safety and welfare of service users, the registered person must take appropriate steps to ensure that, at all times, there are sufficient numbers of suitably qualified, skilled and experienced persons employed for the purposes of carrying on the regulated activity.

 

To me, that reads a little like “if you can get by, then you’ll be alright”.

It’s high time for some research to be done in to this (I’ve just started), to ensure that skill levels when staffing frontline ambulances are evidence based, that they are cost effective, that they can deliver the care when and where they are needed. In other words: When a patients needs help, they get the help they need.

Thought I’d share a poster I recently created for uni about the possibility of merging Fire/Rescue Services with Paramedic Services in England. Acknowledgements and thanks to TJ for helping me craft the idea.

Constructive criticism welcome.

The Urge to Merge

Overtime

Work Life Balance. Source

#Paramedics: How much overtime/additional shifts do you do monthly, and why? For the money, for the fun, nothing better to do? #flobachpoll

 

The other day I was having a chat with a colleague about overtime shifts. We agreed that overtime is an easy way to earn some money on the side when saving up for something, and it’s something we generally enjoy doing. They added that because their partner works Monday to Friday 9-5, boredom can kick in easily, so rather than stay at home one may as well do an additional shift.
The discussion moved on to burnout, and how overtime may contribute to this. I thought I’d put this out to the greater twitter community via the above tweet, and got some interesting answers back. The general gist was that people do overtime for all three reasons, with an (somewhat unsurprising) emphasis on being underpaid and overworked in this profession.
Here are some of the highlights:

 

Work/life balance has been reported to be an important, if not the top priority amongst Gen Y employees – but we’d all like a little more money than we currently have. Is our race to own more burning us out – are we living over our means? Are paramedics underpaid, or is everybody else overpaid? Would the profession benefit from increased pay and/or other measures to reinstate a better work/life balance?

As always, I’d welcome your thoughts in the comments or on twitter.

A Decade – part five

Needless to say, I got accepted.

Untitled

Once the lazy, uninterested kid at school, this was different. I dived in to the study. I would be in the library until they kicked me out for closing times. I would relisten to whole podcast lectures, write them out, just to understand and learn the material. I would organise group learning sessions, because I best learn in a group (pure selfish tactic really, but it’s a great social and educational tool too!). I dedicated most of my life that year to my first year of study. And it paid off, achieving highest marks, but more importantly, I knew that I had found something what I want to do, my vocation, my calling.

What followed from there on…well, I don’t really need to write it all down again – because that is when I started this blog.

More than five years have passed since I started as a Student Paramedic, and it is coming up to two years since I graduated as a Paramedic. Nearly a year ago now I gained my UK Paramedic Registration after making the decision to move to London, England. And ten years since I first set foot in an ambulance, which set off a series of events, more than I had ever anticipated.

A big “Thank You!” to everyone who has been, is, and will be on my journey!

Untitled

A Decade – part four

I returned from my visit with the rekindled desire to join the ambulance service. The camaraderie amongst the staff had impressed me, and together with my memories of  time spent on shift made me rush to the phone and enquire about recruitment. Nine months. Nine whole months! At least that woudl give me time to prepare and think it through. But there was nothing to think through, I wanted to become a Paramedic in Australia.

Work was becoming boring, and I had been offered a place at university in Western Australia, so I moved again. Studying computer science was a backup plan, to be continued until I either graduated, or got accepted in to the ambulance service. The more I studied computer science, the more I loathed it. Maths was just not working out, and programming jsut didn’t make sense. It was boring me to tears. I tried to put the long hours in, but my brain would just not cope with the input and could not make any sense to it. By that stage, applications had opened up for the position of Student Paramedic. So instead of studying for my current (failing) degree, I skipped some lectures and instead attended some free “how to ace an interview” courses. I slowly progressed through the application process, preparing meticulously for every stage (I researched nearly every possible interview question there has been in the universe, and laboured over the best answer, wrote them down, and practiced speaking my answers by recording myself on my webcam).

There was only one way of not having to take that stupid maths unit again next semester, and that was to be accepted as a Student Paramedic.

 

A Decade – part three

Seventeen years was enough. I wanted to experience living in Australia as an adult, not just visiting it. So I packed my bags and moved.

A massive leaving party, and a short holiday later, I arrived in Sydney with two suitcases, two guitars, and a bike. May as well do it properly and start from scratch!

Ambulance Service? A thing of the past. As much as I enjoyed it, being a paramedic is not a job for life, working in IT gives you more career opportunities, pays better, and is far more mobile. To be filed under “past experiences and enjoyments”.

I enjoyed the change in scenery. But I also remember spotting my first ambulance even on the taxi ride from the airport to the friends house I was staying at for the first few weeks. I just like the design, I thought. Just to look.

Work was good. I was getting paid, was getting experience, I had some pretty good colleagues (including the woman that used to sit opposite me who now sleeps next to me). It was on a holiday over to the west side of the country to visit my mum that I was able to organise an observer shift with the ambulance service – I was curious how the Australian system worked, and wanted to compare it to the German system I had experienced over the past three years.

I got dropped off at the ambulance station. The day crew weren’t back yet, and the night crew (I was going to follow them through half the night) hadn’t come in yet, so I waited for a few minutes until my aunt’s colleague’s flatmate (yes, you red correctly) turned up, who I had organised a shift with. In his final year as a paramedic student, he was happy to take me out and who me the Aussie way.

IMG_3169.JPG
A brief tour or the van, checking the drugs and equipment, I didn’t have much time to sit down until the first job came in. I can’t remember what it was, but what I do remember is that feeling of sitting in an ambulance again. This one was considerably smaller, made woo woo noise instead of neenaw, and had the addition of red and white flashing lights over the european blue I was used to – but each ambulance I have sat in makes a similar noise; the rattle of equipment in the draws, the crackling of the radio, the strain of the engine when the accelerator is mashed to the floor. In addition, all the other feedback was right too, the vehicle been thrown around corners at high speeds, the clinical white interior, the lights bouncing of the surroundings at night time. It all fit perfectly, a feeling and experience that I hadn’t had in a while. Quite nice, and good to know that it doesn’t differ much from Germany. Still hope that the university get back to me to tell me if I’ve been accepted for my bachelor in computer science, I’d like to progress my career in IT.

We drop our patient off at the hospital, and that is where I notice the biggest difference: it is all one service in the city. You see, in Frankfurt, the Fire Brigade had central oversight and control over EMS, and manned some ambulances. Additionally, the Samaritans, the Red Cross, St Johns and the Maltese Cross all ran ambulances in the city, under governance of the Fire Brigade. Five organisations, five employers – and people from different organisations didn’t mingle, it seems. But here, here in Australia, everybody knew their colleagues, they all wore the same uniform! I was introduced as the guy from Germany who wanted an insight in to the Aussie system, I was made very welcome by everyone else. The shift progressed, and I was able to have a good chat with the crew. Once again, we cleared from hospital, and were told that there were reports of a car crash coming in – one ambulance had already been dispatched, but in case backup was needed, we should head in that general direction. And sure enough, a few minutes later we were called to proceed under priority conditions to the scene.

And what a scene it was: The police had blocked the road, the fire brigade were cutting the roof off one car, whilst the ambulance crew on scene had split and were dealing with what was to become our patient, and another one who was in (what I now know as) traumatic cardiac arrest. Both young, having fun, but one of them had a bit too much of a lead foot for their guardian angel to keep up – even the paramedics weren’t going to change that. I was told to stay close to the ambulance, and was happy to do so – I was happy to take a back step on this chaotic scene, try and make sense of it all, get a general overview. A manager turned up, one that I had met earlier at hospital, who reminded me that if I didn’t want to see what was happening, I could sit in the back of the ambulance and shut the door; he made sure I was OK with the whole situation. I was.

After transporting the patient to hospital (I assisted, upon their request, by keeping the attendant up to date on the patients vital signs…OK I may have gone slightly overboard with the constantly changing heart rate until I was gently told to shut up 🙂 Iwas dropped off at a taxi rank. The crew took off for the rest of their shift, and I returned back to my mums place, deep in contemplation of my newly gained experiences of the life of a Paramedic in Australia…

 

A Decade – Teil Zwei

The next two weeks consisted of a lot of waiting around, reading the newspaper, reading magazines, looking through the ambulance bits, with the occasional call in between. I think we must have done approximately six or seven emergency calls in ten days.

I had become considerably calmer once I realised that I could handle the situations I was taken in to – I was only an observer, and not responsible for much except keeping my mouth shut when appropriate. Jobs I remember was taking an old lady a quarter of a mile down the road for a doctors appointment, a kid with anaphylaxis, an MI and a drunk teen at a foam party at the local disco.

I had tasted my first blood, and relished the flavour. But the waiting drove me crazy.

Later that year, one day after work, I had planned to meet a friend. I had finished earlier than he had, and so had some additional time up my sleeve – and instead of catching the train to out meeting point I did what I still do today when I’m in no rush: walk. Frees your mind, gives you opportunity to think, feel, appreciate, absorb…and walk past organisations that are involved in the cities ambulance service. With time to spare, I thought I’d pop my head in and ask what I would have to do to get on one of their trucks. The answer was simple: sign up, there’s a basic 40 hour course over four weekends starting in two weeks, after that you will be able to third man an ambulance and assist during event first aid work.

The course was interesting. To be honest, I can’t remember much, but there were a lot of concepts discussed. Confusing at the time, but somehow I managed to pass, and proudly received my first certificate relating to medical care. To stay in the organisations good books, it would be good to do a few event first aid services. I did more than a few, was good experience and I met some interesting people…

The tender beginnings in Frankfurt, Germany
…but my real aim was the big white truck with bright red stripes and flashing blue lights…

Photo Source: bos-fahrzeuge.info

For three years I volunteered for first aid and ambulance shifts, slowly getting to know a thing or three about the work, and meeting some interesting people – both colleagues and patients. I really enjoyed my time there, and managed to never be called to a cardiac arrest. In retrospect, I may have even placed a little bit too much emphasis on my volunteering in comparison to my IT training, finishing vocational school for the day, riding my bike to the ambulance station, doing a night shift (rarely doing more than one call after 1am), having a shower on station and riding back to school the next morning. One day, I was five minutes late for school because of a late job – a drunk driver had ploughed in to another car, killing one person and seriously injuring three others (the driver remained unhurt). I can still vividly remember parts of the call – the Mercedes in the middle of the field, the other car absolutely smashed on the Autobahn, one dead body covered by a sheet in the middle lane, the fire brigade on scene, the early morning response prior to rush hour, our patient being on blood thinners, the handover at hospital, knowing that the patient is seriously injured, but not having much idea about the science and the medicine behind it, but knowing that if she survived, she would have two other family members who were also fighting for their lives, and another one who had already lost the battle. All because of one drunk driver in a Mercedes station wagon, with a scratched door and muddy tires in the middle of a field.

The only reason I got away with being five minutes late that day was because the teacher was nearly an hour late. She came in to the room, apologised and briefly explained that there was a horrific accident on the Autobahn that had delayed her.

I didn’t feel like saying anything.

A Decade – Teil Eins

Ten years. Looking back it is still pretty fresh in my mind, yet so long ago at the same time. Ten years ago I got a first proper insight in to the world of being a paramedic.

It began rather…well, decide for yourself. I had completed my mandatory 10 months of Zivildienst (civilian service instead of going to the Bundeswehr, the German Army – at the time Germany still had conscription) as a patient transport driver, and had six weeks or so to kill before starting my Ausbildung (vocational training) in IT. I had been pretty much a wheelchair and stretcher taxi driver, driving disabled kids to and from school, disabled adults to and from work, taking the less mobile to outpatient appointments and hospital discharges. The driveway where we parked our vans to access the hospital was a shared one with the driveway to the local Emergency Department…and with Emergency Departments come ambulances. I’d long had an (some would say unhealthy) interest in vehicles with flashing blue lights, but this was the first time I could actually look inside one for a decent amount of time. Interesting stuff! I’d see the staff milling about, mainly smiling, chatting. One image I will never forget is of a female paramedic sitting on the rear bumper of her ambulance, head in hands, with that powerful yet empty expression on her face – sad, uncomfortable, numb. I wanted to sit down beside her, ask her how she was feeling, what had happened…but one doesn’t do that as a shy 21 year old. I wanted to know what she had just been through, what had caused her so much grief, I wanted to offer any help – but most of all I wanted to do what she did, wear what she did (a paramedic uniform, not women’s clothing).

This desire was not a subtle one (come to think of it, that is one part of my life I’ve never held back. I once used up an entire 36 shot film within fifteen minutes trying to take pictures of emergency vehicles from a helicopter over NYC at the tender age of 7).  The head of the station I worked out of, which was also an ambulance station, offered me a two week work experience, shadowing paramedics on an ambulance after I had finished my Zivildienst. Hell Yeah!

First day. Poor sleep. Excited as a pig in mud, I get my whites (uniform consisting of white polo shirt, white tactical pants, white boots, hi-vis red jacket), and get shown briefly around the station. Every now and again the radio would crackle to life, and the crew would speak some codewords who they were, where they were going to, with the sirens blaring in the background – it all seemed really exciting! (Even today, hearing someone talk through the radio with the sirens going in the background adds a certain drama to the whole transmission). The crew was lounging around, reading, doing stuff on the computer, eating, whatever. I sat down, waiting for the first call.

And waited.

And waited.

And waited.

After five hours, I got excited, a call! No, it was for the other crew. So I kept waiting.

And waited.

And waited.

And whinged that nothing was happening. One of the crew told me that they will definitely be called out in the afternoon, rush hour means work. But I was sick of waiting! But had no choice, so waited a bit longer.

*DING DING DING*

Finally! A job! I am hyperaware and hyperawake, yet have no idea whats going on. I rush downstairs following the other two, and hop in the back of the van:

Photo Source: bos-fahrzeuge.info

The engine roars in to life, I’m strapped in the back of the box, and have no idea whats going on, where we’re heading, what will happen, what to do. I hear the crew talking on the radio. The attendant turns around, and informs me (shouting over the sirens) that there has been a motorcycle crash.

I still remember vividly that fear of panic and fear rising up through my body, up through my neck, in to my head. What the hell have I let myself in to? What in my right mind was I thinking when I signed up? What will I encounter at the crash sight? What do I do? Where do I look?

There was no way around it – I was scared. Really scared. If it was possible, I would have run away back to my car and driven myself home.

The response took ages. Windy roads, lots of accelerating hard, wild corners, sirens blaring, cars not giving way. I was completely lost. Finally, we arrive; all I can see is a small crowd of bystanders whilst I peered through the cubbyhole from the back of the ambulance. My colleague opens the door, I step out. Bright light shines upon me, in a kind of sun-dazed fashion I nervously hop out of the vehicle, and look around: a few people, a motorbike on its side with a few scratches. No mangled metal. No blood. No bones. No screams. The crew are tied up trying to find out what is happening. A bystander grabs me and points me towards something, asking me questions I have no idea what to answer to. I am an untrained observer, but am wearing the same clothes as that of the crew. They realise, and come to my rescue, one deals with the bystander, the other one tells me that the motorcyclist couldn’t bother waiting for us, so he hopped in another bystanders car who drove him to hospital.

Apparently he waved at us as he passed us going the other way.

to be continued…

An Insomniac’s Guide to…Professionalism

Yesterday, I went to the theatre.

Today, I did some study.

The connection? I read an article about “Becoming professional in the 21st century|. It is written that:

“Health care professionals of the 21st century cannot afford to be technically competent only; they need to be competent in social and communicative aspects of practice”.

This was said in a context of mainly communicating with the patient, but I would take it one step further: it is important for the profession; I would go as far as saying vital for an emerging profession (such as paramedicine) that members of the profession communicate and promote themselves as professionals to the public. Making a good impression (through proper treatment) on each individual patient is important, but equally important is to reach out to our “potential” clients. The public must know we take pride in our profession, study hard, work hard, can deal with a variety of situations and are becoming an integral part of healthcare, rather than just a transport adjunct to the hospital.

So, Yesterday? Yesterday, I went to the theatre to see a (possibly the worlds first) play based on a paramedic blog – namely InsomniacMedic himself. I can really recommend going if you are anywhere near London in the next few days. There are still tickets available…just go. After the play there was a Q&A session, so I asked the cast what knowledge they had of “our world” prior to having a role in this play, and then how playing a role had changed their perceptions. The answers were interesting: Most hadn’t had any contact with the ambulance service at all before and regarded the big yellow vans as part of the city landscape. One actor that had been a patient fairly recently stated that after a few panicked minutes, the attending crew managed to calm her down, make her comfortable and take her in to hospital for further treatment; she was impressed with the ‘ambulance drivers’ (followed by a palpable wince amongst the paramedics in the audience).

Only after they had been accepted for the role in the play did they start doing their research, and realise the world we work in. The lead actor said he started turning around, watching after ambulances passing him on the street. If he saw the paramedics attending the job near him, he would observe their actions from a distance (what he stated as “feeling weird, a little voyeuristic, kind of wrong but highly interesting”). Playing the roles of the different paramedics, the cast could immerse themselves in to the lives of paramedics, both professionally and personally; only then (and with the great help of the blog authors former student who was in charge of clinical oversight of the play) did they realise what our world is made up of.

I found this rather interesting, and it highlighted a point that many of us like to forget: the great majority of the public don’t know or sometimes even care about us – until they need us. If we want to improve our standing within the population, we need to have a stronger presence within the mind of the population. And that must come from each and every one of us, reaching out not only to those that are in need of our assistance, but to those who may need our assistance in the future. Everyone.

Hello, my name is

Hello, my name is anonymous

 

It is early in the morning, the break of dawn. A small army of heavily armed specialist police officers congregate behind a wall, around the corner of a house where a wanted suspect with a violent history is suspected. Police intelligence states he may very likely be armed. Last tactical plans are run through again, all members take their positions: Snipers are in place on the rooftop, a group of officers provide firearm cover behind trees in the front yard. The crashing of the battering ram against the front door pierces the silence, breaking it down on second impact.

The armed officers storm the building, guns drawn, making their presence very clear:

ARMED POLICE CARS! WE ARE ARMED POLICE CARS! SHOW YOURSELF! HANDS ABOVE YOUR HEAD!

Unfortunately, the suspect sustained a fatal gun shot wound from the police after laughing so hard he could not comply with the above shouted instructions.

– ~ –

Similar scenario, but instead of a violent criminal, inside the house is someone with a medical emergency who requested the attendance of health care professionals. Instead of a battering ram, a gloved finger gently pushes the doorbell…*ding dong*. Nothing can be heard from inside.

Ambulance! Hello!? Can you hear us? Ambulance! Hello!

No laughter this time.

So why is it acceptable that us paramedics are identified by our primary mode of transport? You may know I follow the International Paramedic naming convention, I even wrote more about it last year.

Now, having been in the UK and getting to know the system more, some difficulties arise. Not only is it very common for people within our profession to refer to themselves as “ambulance person” doing “ambulance work” – local legalities leave them little else to say it seems. The title “Paramedic” is protected in the UK – if you are not HCPC registered, yet still call yourself a paramedic, you are breaking the law. Plain and simple, great for the public, great for the profession (our Australian colleagues look over here with envious eyes), but it leaves us lingering with the question: “What do we call those who work alongside paramedics, but aren’t paramedics?”

There is only one level of Paramedic registration. A Paramedic here has a multitude of advanced skills and to become one nowadays, it is mandatory to have a degree in Paramedical Science. UK Ambulance services aren’t going to solely employ paramedics, they are teamed up with either (Emergency Medical) Technicians (a dying breed of BLS trained colleagues) or colleagues with very basic medical training (approx. one month),  and a driving licence that are called either Emergency Care Support Workers (ECSWs, Emergency Care Assistants (ECAs), Accident and Emergency Support or something in between. Their (unregulated) job is not officially recognised as that of a clinicians.

From personal experience, the vast majority of them a great people and a real asset to work with, generally eager to learn more with the prospect of becoming a paramedic in the future – but their meagre (official) training keeps them locked in a low rank that we cannot call a paramedic.

So – what to do?