I stumbled across a worrying article in Metro (a free newspaper, given out at train and tube stations). Not only was it worrying because of the events described — the tragic death of a teenage girl from epilepsy, which may have been prevented if a paramedic ambulance had been able to reach the scene earlier — but because of the portrayal of ambulance control staff and Emergency Medical Technicians.
Before I go on I should state that I was not in any way involved in this incident and have no insider knowledge of it. The following is based entirely on reading the article and my experience of similar situations at work.
The phrases that worried me were:
A controller then downgraded her case to a lesser emergency, further delaying the response.
This is impossible. There is no facility on our computers to downgrade a call once it has been taken. Even if it were possible, it would not be allowed (in cases where we get a second call about a patient, where the patient’s condition has improved, the second call will be discarded and an ambulance will be sent on the first, higher priority ticket). Finally, even if it were not impossible and were allowed, it would still be incorrect, because continuous epileptic fitting is a Cat A emergency.
An ambulance was then dispatched but it was forced to stop at an accident scene and so never reached Kayleigh.
How is this a “999 blunder”? Running calls are an unfortunate coincidence and a fact of life - not anyone’s fault.
Despite her mother Jean Murphy pleading for a qualified paramedic, the control room sent a series of ‘technicians’ instead…
When that vehicle finally arrived, not one of the three staff on board was qualified to provide anything other than oxygen.
First of all, an explanation of the difference between paramedics and technicians. Non-medical people tend to think of all ambulance crew members as paramedics, probably because it’s a more familiar and shorter term than “Emergency Medical Technician”. In actual fact, only one third of road staff are paramedics. A paramedic is simply an Emergency Medical Technician who has taken on some extra training, which allows him/her to administer drugs intravenously, intubate patients (put a breathing tube in their lungs), perform cricothyrotomies (putting a breathing tube into someone’s windpipe and other basic surgical procedures. A few paramedics qualify via a university course, but most will apply to go on to a paramedic course after years of experience on the road as an EMT. It’s not easy to get a place on a paramedic course; there is a long application form, exams and interviews before you are even accepted. For this reason, there will always be more technicians than paramedics, and while the service try to put one paramedic into every crew, it isn’t always possible.
The assertion that EMTs are not qualified and cannot provide anything other than oxygen is incorrect. They are not merely ambulance drivers as the article implies. As well as oxygen, they are trained in providing pain relief, CPR, airway management, defibrillation, taking vital signs including reading ECGs and immobilisation. They can administer aspirin and GTN to patients who have had heart attacks, glucose to diabetics, salbutamol to asthmatics, and epinephrine to people having allergic reactions. But no, they can’t give diazepam to someone who is fitting.
Most calls - I would estimate 95% - can be dealt with by EMTs without the need for a paramedic’s extra skills. When a call comes in that seems like it is going to require a paramedic crew (examples - suspendeds, BBAs (Born Before Arrival), continuous fitting, severe trauma) we try to send a paramedic crew. If a technician-only crew is closer, we send them too and ask them to “report on arrival” to confirm the paramedic crew is definitely required. Sometimes crews arrive on scene and radio us to let us know they will be needing a paramedic. Sometimes there will not be a paramedic crew available at all (which is what I imagine happened in this case) and the crew has to make the decision whether to wait for one or rush the patient into hospital. The article makes it sound like the patient’s mother was “pleading” for a paramedic and the control room/FRU technician were telling her that she didn’t need one. I’d be very surprised if this were the case - I think it’s most likely that there just wasn’t a paramedic crew available. (Don’t get me started wondering where all the paramedics were. Probably dealing with “unconscious” patients who really only had a broken toe.)
The patient’s family are campaigning for a paramedic to be on every ambulance, and I can see their point — it may well have prevented the death of this patient — but I also have misgivings. To train more paramedics would cost money, which would have to come from somewhere — perhaps cutting the number of vehicles or other staff. Relaxing entry to the paramedic course might mean some staff become paramedics before they have had sufficient experience as an EMT. If it is against the rules to send an ambulance without a paramedic, there are likely to be less vehicles over all, which means longer waits for patients, most of whom don’t need a paramedic anyway. Personally, I would prefer to see a change in the way we dispatch calls - perhaps a change to AMPDS so that certain calls are flagged as “must send paramedic”, and making sure paramedic crews are not dispatched to calls that obviously won’t need one if there is a technician crew available.
On the whole, I thought the article was very damaging towards people’s faith in the LAS and their perception of a technician’s competence. They seemed to lose sight of the fact that it wasn’t the ambulance service that killed this patient, it was epilepsy. Hopefully in future methods will be in place that help the service to save such patients, but we should not shoulder all the blame when someone dies.
My sympathies to the patient’s family and friends.
November 8th, 2006 at 12:58 pm
I think it’s a lot to do with the way the public perceive it as well. If the woman was the only one giving info to that journalist, probably that’s how it seemed to her. I’ve had experiences with call takers who have not been particularly helpful (not recording half the things we say, etc) and getting a technician crew where we really needed a paramedic crew (to an unplanned homebirth in unsuitable circumstances etc). If I didn’t know the way the system worked (and I frequently have to explain how it DOES work to my colleagues) then I would just assume that I wasn’t being listened to and that things were happening wrongly. That said,most of the time I love LAS and have no problems with them (I know it’s not their fault when they turn up an hour after we phone them with a cat A call because there are no neenaws in South London…)
November 8th, 2006 at 1:00 pm
Thats the problem with our press - things are not reported properly, so people have no real idea of how things happen/are done. People are mis-informed.
I’m new to reading these blogs. I thought they where a complete waste of time. However, now I have several blogs I read daily. They are starting to give me a better picture of how things work out there. At lot of blogs seem to be a waste of time, but some provide a facinating insite into modern life and our politics.
Thanks for giving me an idea about how ambulances are dispatched.
November 8th, 2006 at 1:49 pm
This story has been going around the Islington local papers for a few weeks now - with exactly the same details, so it’s probably not been thoroughly researched by the Metro journalist, more “reproduced”.
The “one paramedic on every amublance” campaign has been raising a petition in Holloway recently and they are definitely of the opinion that a Technician has no skills whatsoever - I know because I asked the person thrusting the petition at me.
November 8th, 2006 at 1:58 pm
Well said Mark - I often see reports in the press about ambulance jobs that you know can’t have happened the way it is being reported. The trouble the ambulance service have is that while the relatives can give their story, the service is bound by patient confidentiality, so usually can’t comment on what is being claimed.
I am a recently qualified Paramedic - I was a tech for five years before that. Very few people outside the service know what an Ambulance Technician is - most of the time they think you fix the ambulances!
November 8th, 2006 at 2:02 pm
I think they should actually get rid of the term EMT altogether and have different grades of paramedics - that’s the term the public understands. I think they’ve already done that abroad somewhere - was it Canada?
November 8th, 2006 at 2:08 pm
I’m guessing a Paramedics salary is more than an EMTs, so if a Paramedic is sent to every “emergency call” it will cost the tax payer a lot of money to pick up drunks and attend broken toes.
Along with your suggestion of “must send Paramedic” flag, if Paramedics drive the FR cars, which can obviously get there quicker, and EMTs follow in an ambulance, then couldn’t the Paramedic leave the scene as soon as it is established that he/she is not needed? Thus freeing them for further calls?
Also this obviously comes back to the fact that people need to be educated as to what is an emergency and what isn’t, so that valuable time isn’t wasted.
November 8th, 2006 at 3:20 pm
What system do you use?
We use AMPDS and it is total b*ll*cks. It has sent our Cat A Red Calls through the roof. Our previous system was CBD which was a lot better.
We have too many crews going to so called Cat A,s when sometimes the real emergency has slipped through as a Cat B or even C. (Which is not always the fault of the call taker.)
Very good blog BTW.
November 8th, 2006 at 3:37 pm
The press really annoy me with this sort of thing; taking what a lay person says happened as gospel generally trying to sensationalise everything!
A lot of people don’t understand the roles of the ambulance crew - a friend told me the other day that they
November 8th, 2006 at 3:38 pm
oops hit publish by accident..
…..that they thought the person in the drivers seat did nothing more than just driving! T.
November 8th, 2006 at 3:39 pm
We use AMPDS too, and I totally agree. I haven’t used CBD, so have nothing to compare it to, but can still see the problems you just mentioned. Apparently AMPDS is “safer” than CBD because there is less room for human error - well, personally I’d prefer the odd human error to hundreds of machine errors. Of course, if AMPDS kills someone, then it’s the AMPDS makers that get sued, and not the ambulance service…
November 8th, 2006 at 5:39 pm
Why is it that when there’s a push to improve or reform something, the last people to be asked for input are the ones actually doing the jobs? Some bureaucrat will now come up with the “Perfect Ambulance”: it will have two doctors on board (in case one has a heart attack, you need backup) a full operating theater, and nursing staff. It will be the size of a house. It will (on paper) still manage to arrive within ORCON time limits because it will be like the ambulance that Tom Reynolds posted once: flaming jet engines at the back.
As to why newspapers publish tripe, as someone who does a good bit of writing, I think I know. There’s no story (as in, No Story) in saying, “Today there was a sad death of a teenager from epilepsy. We all need to think about how procedures could be improved to avoid such tragedies in the future.” It makes a much more entertaining read to have a victim, a weeping mother, and a villain in the form of a cold careless bureaucracy. It’s one more small (or not so small) example of how news and entertainment don’t mix!
November 8th, 2006 at 7:05 pm
How thoroughly stupid and uninformed.. I used to have a reasonable amount of respect for Metro (we get the west mids version here) but really, that sort of publishing is irresponsible. All it’s achieved is to scare people. I suppose someone has to be blamed.. where there’s blame, there’s a claim. Sad.
A paramedic on every crew? Fine, bump up the taxes of the people signing that petition, see how they like it then. Someone’s got to pay for it.
Assessment day on the First Aid course tomorrow.. I’m more petrified than the 20 others on the course, presumably because this is important to me (I’ve paid for this myself, the rest are all there because their employers have sent them). Wish me luck people.
November 8th, 2006 at 8:36 pm
Bunslinger, is this where we all say “Break a leg”?
November 8th, 2006 at 8:41 pm
What you are seeing is the grieving process in action, the part where the bereaved will lash out at anyone they think may have been to blame.
Add into that the feelings of guilt for not being able to cope by themselves (plenty of parents do).
Unfortunately instead of being able to progress through the process their feelings are being ‘fed’ as it were by the furore whipped up by the parasites of the press.
SD
November 8th, 2006 at 8:57 pm
Same old crap from the press…
I actually thought EMT was quite snappy.
Over here, we are “Ambulance Officers,” six syllables just for your job description!
November 8th, 2006 at 10:06 pm
yes, in Canada they’re all Paramedics, just different grades.
the journo’s i’m sure usually do have all the details, but they’re job, first and foremost is to sell newspapers or in this case advertising space by making the story as juicy as possible, and thus encouraging people to read it.
i recently saw an article about a family that i was directly involved in and was privy to all the discussions and organization that went on to sort the mess out that they were 50% responsible for creating, this was reported both in the press and TV, and huge chunks of the story were conveniently missed out - this of course would have shown that the situation was exacerbated by the choices made by this family, that backfired on them. the other 50% of the cause was due to a massive unpredicted demand on services. as i always say, if you pay 22% taxes, don’t expect a 30p in the £ service. healthcare is damn expensive , hence the mess the NHS is in
*sits down, breathes in, hold, exhales and relax*
November 8th, 2006 at 11:16 pm
Try sending your article to the ‘metro’, you never know they may even publish it!
November 8th, 2006 at 11:37 pm
You could rename all your officers to paramedic, but that’s just going to confuse the public. All they’ll see is paramedic written on the uniforms, and wonder why they need another “paramedic” to do things that they’re not qualified to do…
November 9th, 2006 at 12:08 am
As always a very well written and logical piece. Have you sent it to the metro? They may publish it.
November 9th, 2006 at 12:33 am
*rolls eyes* Even us johnnies can give O2.
I wounder what she would of said if a SJA truck turned up???
November 9th, 2006 at 8:09 am
don’t forget who owns the Metro…
I agree - you should send this to them, or maybe pass the article on to the LAS press office? The public having faith in the system is (as you know) vital…
November 9th, 2006 at 10:50 am
The family have set up a website detailing their side of the story - from what they are saying on here the LAS has already had an investigation and admitted fault.
http://kayleighmc.co.uk/
It’s all getting horribly muddled - poor family. And poor LAS - if anyone can sympathise with the hiding to nothing feeling I can!
November 9th, 2006 at 10:58 am
Mark,
As always your blog highlights many issues. Sadly we need to recall that journalists are just lay people with no expertise of the ambulance service, so it’s no wonder they just trot out whatever they’re told as if it was ‘fact’.
The 1 para on each vehicle approach was all the rage 10-12 years ago, Then we went through the ‘everyone will be a para’ phase. In the end its all come down to money and resources. With increase demand more EMTs get employed faster than it’s possible to train them as paras.
When I started in the 90s, EMTs could administer rectal diazepam; now, under current guidelines, diazepam has to be locked away in the morphine cupboard as a class A drug and EMTs aren’t even allowed access. That’s progress for you.
We use AMPDS and its absolute crap; the codings are rubbish and the descriptions are complete and utter gibberish. Bring back CBD!
Finally not all of Canada is paramedic based. That sh*t hole known as Vancouver still has EMTs. Most are part-time and have training which is barely above that of a first responder. Changing a name doesn’t improve the service.
Rant over - off to bed after a really, really, really, really boring night shift.
November 9th, 2006 at 12:33 pm
KJX - thanks for that informative (and very moving) link. I can see from the Islington Gazette articles where the Metro got their information on and most of it seems to be a case of Chinese Whispers. I wonder if they even spoke to the patient’s family?
I felt guilty about not signing the petition, but I honestly believe the way forward is to better utilise the paramedics we have, not to bring in more paramedics. (Also, I would like to point out a mistake in the gazette articles: it’s not true that we have no way of telling which vehicle has a paramedic - we ring/radio and ask, and a new system flagging the paramedics on the computer is being introduced. At the moment only the FRU desk use it).
Also, I’m not saying that the LAS did nothing wrong and are not to blame at all — whether they did or not is a matter for the investigation — but irrespective of that, the Metro article gave a very misleading impression of control staff and EMTs and contained self factual inaccuracies.
November 9th, 2006 at 12:59 pm
The article worries you only because you have an interest - i.e. because you work within the industry, and because the story has been misreported. Take comfort. Almost everything in the press is either misreported or selectively reported; the remainder is made up. An even-handed account does not sell nearly so many papers as a drama does; and outsiders read the tale just as a handy way of passing the time. They’re not involved, so they don’t actually care about what really happened - or whether it happened at all. In common with the rest of us, they savour a ripping yarn, and today’s banner headlines are tomorrow’s chip wrappers. What was the lead story in YOUR local newspaper a fortnight ago? See what I mean?
I am an AT (this being Scotland) with no wish to be a paramedic; I’m aging and idle. There are far more ATs about than APs, and rural stations staffed for 1 vehicle have no opportunity to shuffle crews; 2 x AT crewing is thus a fact of life. I’ve been doing the job a long time, and - though some tasks are easier when I’m with my usual paramedic partner - the fact remains that I have yet to hear of anyone’s losing a patient simply because there wasn’t a paramedic handy. (I appreciate that Technicians are trained to differing levels by different ambulance services; I refer just to my own experience.)
It looks as though the crew caught in the crossfire above were handed the tail end of a deteriorating situation. If the patient died, then, presumably, she arrested; if the LAS is being blamed, then she must have arrested whilst in the Service’s care. Cardiac arrest is a situation we all handle - often; defibrillation, allied to vigorous, expert CPR would have kept a patient (who, I am assuming, was young and otherwise fairly healthy) alive as far as the Resusc Room. What really happened? I don’t know, but, if everyone did the right thing (and why would they not?) then the outcome is not the fault of the LAS - regardless of what the press may prefer. The parents have to grieve, and if lashing out blindly helps them, who would deny them it ? Their actions may be inappropriate, but they do no real harm.
Anyway - said the aging cynic - we all know perfectly well that Patient Outcome is of no interest to the NHS Department of Bean Counting; so long as the Response Times were within ORCON limits, then this job was a success.
November 9th, 2006 at 5:29 pm
I have just noted, and read, KJX’s link; it does not materially alter what I said above. We don’t know what state Kayleigh was in when the responding crew arrived, but I am confident that - seeing a healthy 15-year-old in dire straits - they would have scooped and run, carrying out CPR and defibrillation as necessary.
Mr McTigue hits the nail on the head; paramedics are not the issue here - responses are. This looks like a response disaster caused - not by a “catalogue of errors” (as the Islington Gazette has it) - but by an accumulation of minor delays and misfortunes. We work our way through stuff like this day in and day out - impossible addresses, misdirections, misunderstandings, corrupted information, traffic problems, equipment failures, unfamiliarity with the area, etc. My own service’s urban responses are about 10% worse than they were 10 years ago simply because of traffic density and traffic calming measures. Nevertheless, we cope; we have to, because people and systems are all fallible.
I am so sorry for Kayleigh’s family, and for everyone involved in this incident; however, I don’t think that there are any “lessons to be learned”. We just have to continue coping with what goes wrong, and trying to do our best. We also have to recognise, though, that sometimes the odds are so stacked against us, that even our best isn’t enough.
November 9th, 2006 at 6:05 pm
The Metro doesn’t really have proper journalists in the same way that other papers have. It only really exists by taking news from news agencies such as Reuters and publishing them in an easy to read format. This is one of the reasons how it’s free.
November 9th, 2006 at 10:34 pm
I’m a solicitor and many of the cases I’ve been involved in have made the headlines - and not a single article has been accurate. That’s made me much more sceptical about what I read in the papers.
November 10th, 2006 at 1:15 pm
kevinmillhill, you’re totally right. I was reading the Metro again on my way to work yesterday, and couldn’t help wondering what was wrong with all the other articles in it, even the football reports. It’s only when they report something that you have insider knowledge of that you realise how inaccurate newspapers are.
November 10th, 2006 at 4:13 pm
looking on the families campaigning website, it pobably would have made very little difference if I para crew were sent or a tech crew sent. They openly say that they were waiting 30 mins for a motor and were then in hospital 40 mins after calling 999. So a 10 minute interaction with the ambulance crew then, sounds pretty much like a scoop and run to me, chances are the crew (tech, para, basics dr, superman or whoever) would still be on A (airway) by the time they arrived at the hospital and a medical team in resus (usually consisting of lots of pairs of hands as opposed to just one) ccould take over.
Thats not to say that waiting 30 mins for a motor is ok, but that has nothing to do with who was crewing the dam thing!!
November 10th, 2006 at 10:00 pm
Mart’s comments (above) made me go back to the link. The family’s website has changed since yesterday, and it now contains rather more info. The crew clearly scooped and ran; however, the fact that they were initially stationary for 5-6 mins suggests sustained resuscitation efforts; and, I now see that the A&E staff worked - unsuccessfully - for another 30 mins. Kayleigh was young and (reading between the lines of the website), healthy and fit; if such a person was handed (with a pulse) to A&E she would undoubtedly have survived. I can therefore only deduce that, on arrival at the hospital, she was pulseless.
It is inconceivable that Kayleigh became pulseless AFTER being put in the ambulance; we simply don’t let that happen to healthy 15-year-olds. The crew must therefore have been faced only with one of the following:
a. Kayleigh was in VF, pulseless, apnoeic - in which case CPR and defibrillation would probably have done the trick.
b. Kayleigh was in asystole, pulseless, apnoeic. ie dead.
Had anyone carried out vigorous and effective CPR (in fact, just mouth-to-mouth with occasional chest compressions to empty the lungs) BEFORE the arrival of the ambulance, Kayleigh would have been viable. Let’s not shilly shally - she would have had a pulse, and would have walked out of A&E within hours.
The ambulance response was undoubtedly less than it should have been, but, why did Kayleigh die? Certainly NOT because there wasn’t a paramedic to hand. I’ll leave the rest to you.
I feel quite strongly about this, because I’ve been there (but, fortunately, I didn’t buy the T-shirt). The patient was a 6-year old, long diagnosed as asthmatic; when we arrived, he had ceased breathing, he was deeply unconscious, and navy blue; his chest was hyper-inflated, and he had no detectable pulse. A GP who had also responded (it was a few years ago!) had been infected by the family’s panic and had completely lost the plot. (No criticism, I wasn’t all that clear myself what we were going to do about it; I’d never seen it before; few have.) However, my partner (bless his little socks) said “I think that what we need here is a wee bit of Basic Life Support, let’s get him on the floor.” (I can still hear the capitalised initials). “So we do” I thought.
Literally two minutes of chest compressions and ventilation (mouth-to-mouth, actually, with me spraying salbutamol - which doesn’t taste nice - from my mouth into the boy’s lungs) and he was sitting up and talking.
By the time we reached the hospital, the parents had convinced themselves that the incident hadn’t really been all that serious (!!!). I asked them why - knowing their child’s condition - they hadn’t thought about learning CPR, or at least thinking about what to do if things ever went badly wrong. They told me that they hadn’t thought they needed to(!!!).
Ask your asthmatic friends who are dependent on home nebulisers what provision they have made for power cuts!!
November 10th, 2006 at 11:14 pm
The website is making me a bit confused. Kayleigh’s mum says it took fifteen minutes for the FRU to arrive but one of the other accounts says it took four minutes. She seems to have been led to believe there is no back up system in place, but there is - just not a computerised one. She also does not seem to be aware that EMTs do a have a wide range of skills. Why has no one explained this to her? None of the reports tell us at what point Kayleigh suspended, or why she wasn’t coming out of the fit by herself. Without knowing that, it’s hard to tell whether the lack of paramedic or the delay to hospital caused her death - or whether it would have happened anyway. In any case, just because a paramedic would have saved Kayleigh it does not mean that we need a paramedic on every ambulance. 60% of calls do not need an emergency ambulance, let alone a paramedic.
The whole “catalogue of errors” seems to boil down to two things:
1) The perennial problem of Too Many Calls, Not Enough Ambulances.
2) The fact that paramedics are not “kept back” for calls that need them and are dispatched to less serious calls if they are nearer.
What we need is more ambulances, less inappropriate calls and a better system for allocating paramedic crews to those who need them. I wish that was what the family’s petition was asking for.
November 11th, 2006 at 11:51 pm
well im of avarage high education , level headed and unlike some d***s in government paid job .. HONEST. I was at the 15yr olds house when she had a fit. Her mum called 999 as usual and what followed was what i would call , A BAD HORROR MOVIE. Yes the media carried OUR STORY as factual as it happned.. word for word and we also showed them the LAS inquiry report given to the mum, who said this week in BBC LONDON , felt her chances were taken away . I pay for a service that FAILS as it did in 1992 and 1994 and 2006. We have spent monew on PROJECTS ie. WAR .. and you try to put a price on LIFE? whats your life worth ? mines not at any. http://WWW.KAYLEIGHMC.CO.UK . take a look and see what others say …..
November 11th, 2006 at 11:58 pm
I’m so glad to her from an eyewitness, Martin Nilan. Please tell me, during the time you were waiting for an ambulance to arrive to help Kayleigh, what help did you and other bystanders give her?
November 12th, 2006 at 12:13 am
we put kayleigh in recovery position, removed everything around her whilst her mum rang 999. TWICE……
November 12th, 2006 at 12:57 am
Can kevinmillhill please tell me , are you a paramedic ? only asking cos i have spoken to other paramedics and they tell me that this is NOT an isolated event. In fact ive got the OFFICIAL LAS complaint report here and THEY said their system went down and the second ambulance were NOT aware of the details when they came to the patient. Also , they had no idea of what ambulance had a paramedic on board,, but they said they have JUST put this system in place.. The emt who arrived first could not get hold of ambulance and had to ring hospital , [ no log of his call from LAS and its in his report] and ring again to find out where ambulance was, only to be told :cancelled for higher prioretry call. we were code RED.?
November 12th, 2006 at 10:52 am
Well what to say about this?
Firstly I would like to offer my condolences to the poor family of this young lady - a truly tragic event!
Secondly, there are in reality only a handfull of people who know all of the details of this case, and whilst I may be accused of sitting on the fence, there are two sides to every story, unfortunatly for LAS it is difficult to give their side due to patient confidentiality.
I am an EMT not far from LAS and know from my own expreiance that in this situation every person involved with the case at the time I am sure would have done everything they possibly could for this patient, the EMT’s, the call takers and the mobilisers!
A paramedic on every vehicle - Unfortunatly not a reality in todays funding of the NHS.
November 12th, 2006 at 12:33 pm
Martin, thanks for taking the time to reply. Do you mind if I ask you a couple of questions? I’ve found the press reports a bit confusing and I’d like to get it straight in my head what happened. The first thing is, when did Kayleigh stop breathing? The second thing is, was she still fitting when her mother called 999? (Because if she was, she would have been a “red 2″ and the only way the ambulance would be cancelled for higher priority is if there were someone else not breathing nearby.) Thirdly, when the technician in the car arrived and phoned control, did he specifically ask for a paramedic crew (”hotel crew” is the phrase he would have used)? Did the service give you a reason why technicians were sent instead - were they the only crew available, or did someone decide a paramedic wasn’t needed?
We do have a back up system in place. We constantly maintain a “box” which has a slot for every ambulance and a paper ticket saying which call the ambulance is on. If the systems go down, we turn straight to this. We can contact every ambulance by radio or phone to ask if they have a paramedic on board. It’s obvious something went terribly wrong in Kayleigh’s case and it is the job of the investigating team to find out what happened and make sure it never happens again. It’s not a case of putting a price on life - I think putting a paramedic on every ambulance will cost lives by reducing the number of staff over all. A technician can deal with the vast majority of calls including Red calls like heart attacks, severe asthma attacks and unconscious diabetics.
If you want, the control room can arrange for you or any other member of the family to come in and see how things work. A while ago a man whose wife died in a motorway traffic accident after a 20 minute wait for an ambulance came in and he said he found it immensely beneficial to see what would have been going on and how the control staff were working hard to get the ambulance there. Please remember that while one death is too many, the ambulance service save hundreds of lives every day. Look at stories like this and this. One failure does not make the entire service a failure, and I don’t think people should lose faith in the ambulance service. I have every faith that they will learn from Kayleigh’s death, and will make sure it never happens again.
November 12th, 2006 at 2:37 pm
Dear Martin,
Thank you for your reply; for my credentials and experience, please see my two comments (above) of 9th November, and one of 10th November. Half an hour may be a long wait in London, but in rural and small-town Scotland, it is not exceptional; during that wait, “at risk” patients (unstable diabetics, acute asthmatics, badly-controlled epileptics, for instance) depend entirely on bystanders. (Please see the story of the asthmatic little boy in my 10th Nov comment to illustrate my meaning; that partcular CatA response took us just under 40mins; for the distance and locations involved, the time was excellent.)
If a man collapses in a bar, and goes into cardiac arrest, no ambulance service on earth can react quickly enough to save him; there are just three minutes for someone to do something. If you are the victim, you have to pray that somebody in the pub knows how to do CPR and that he/she will continue doing it vigorously enough and long enough for you still to be viable when we arrive.
Within our area are several patients who suffer from epilepsy, and who are at risk of status epilepticus. They all have diazepam in a form suitable for rectal administration. Their families, and (in many cases) their friends know where they keep it and how to administer it. I note that there is no mention of this medication in the tragic case of Kayleigh.
I believe that it would be beneficial for members of the family to take up Mark’s offer (above), and to see just how hard the people and the system work to deal with the continuing deluge of calls. It would also help correct some of the misconceptions to which you seem to have been led. My own Despatch Centre (at Paisley) controls for the whole of SW Scotland; I was invited to come and see it from their point of view recently, and I certainly found it a helpful eye-opener.
Once again, my sympathies to Kayleigh’s family, and everyone else caught up in this tragic incident.
November 14th, 2006 at 12:13 am
hey folks,
having read as much of this as i can i have to agree with some of the points made. kev i used to SAS at edinburgh control. it is true not every ambulance can have a paramedic but in alot of cases when there was for example a double technician crew and a double paramedic crew these would hae been split. it only makes sense but it is not always possible for this to happen especially if there is only 1 paramedic.
paramedics have a hard job no doubt about it, so do technicians, control staff and the mechanics who face a daily fight to keep vechiles on the road. it’s not an easy job and i belive ein most cases the staff in each and every ambulance service pull on our uniforms not because we like the pay (which is crap lets be honest) but because we honestly want to help.
there is also another problem which quite a few people here are aware of. staff shortages.
there is a lack of money being put into the NHS and things like A4C (agenda for change for the uninitiated) has not helped.
having a paramedic on every ambulance whilst a nice idea and what we would hope for in a perfect world is just not a feasable reality as people have said. it would mean taking technicians off the road to train them, the costs in that alone which means that their shifts might not have cover, plus paramedic training depending on where it is can take 3 months. thats a long time in itself.
technicians have a great amount of skill training and also alot of on the job experience. they do a hard job and i have to say from my nights observing with a techician crew an amazing one. never underestimate them.
perhaps this could be explained to the general public who only seem to learn anything positive about the service or how it works through good old casualty.
i agree that even if the system went down from my experience in 2 service controls now that when a system fails automatically we move straight to paper until the system is up. in my entire time with the SAS the only time a system failed was on a thursday and the switch went without problem. cover was not affected nor dispatch of any calls. i can only imagine a serviice like LAS would be prepared and that their staff are always prepared for this and their contingencies are always prepared to move on. a good example is http://notsonewbieatcac.blogspot.com/2006/10/computer-says-no.html
http://notsonewbieatcac.blogspot.com/2006/10/major-incident-x-2.html
if we were to try and put a paramedic on every ambulance I THINK IT WOULD BE MORE PROBLEMS.
ALSO WHAT HAPPENS IN A FEW YEARS WHEN THERE ARE LESS PEOPLE APPLYING DUE TO THE driving liscense. C1 and D1. people like myself who got their license without this face the fact that we have to pay for this ourselves if we want to become technicians. thats £1200. not good. wheres the solution give us more money? more training? who knows.
perhaps losing nhs24 or nhs direct would be good.
November 14th, 2006 at 4:08 pm
Dear Pete,
Mixing and matching crews works in cities where you have the staff; in the countryside, it doesn’t, because you haven’t. Technician crews are a fact of life, and (as I said above) in donkeys’ years in the job, I’ve yet to hear of a patient dying simply because there wasn’t a paramedic about. If you follow the story above, and read the timeline on the family’s website (follow the link from KJX’s posting above), you’ll see that paramedic attendance is not really the issue here either.
Mixing and matching really falls apart when you have on-call stations; I could be mixed and matched by swapping me with a paramedic from another station (assuming that the shift times coincided - which they usually don’t). However, that would mean that - when the shift finished and the on-call hours started, and in order to maintain Tech/Para crews on both stations’ vehicles - I would have to go to his house and, presumably, sleep with his wife.
Could be worth thinking about………
PS Re the driving licence thing. It isn’t a problem. People are so keen to join that they simply get the licence themselves and turn up clutching it. It’s the same as applying for a job with a haulage firm. You don’t get through the door without the appropriate licence.
November 17th, 2006 at 9:08 pm
would any of you could come along to downing street and join our demonstration on friday24 nov 2006 between 12noon and 2pm. you can contact me via e-mail or michell greves. ta
November 26th, 2006 at 12:09 pm
London Ambulance Service investigation into the death of an epileptic patient
Following the death of epileptic patient Kayleigh Macilwraith-Christie, the London Ambulance Service has conducted a thorough investigation into the emergency response it provided.
Assistant Director of Operations (East London) Richard Webber said: “We are very sorry about the untimely death of Kayleigh Macilwraith-Christie.
“We have conducted an investigation into the care we provided to her and have recently met with her family to share the findings of our investigation and to reassure them that we are taking this matter very seriously.
“We are committed to learning lessons from this tragic case to improve the treatment we provide to our patients. We are making changes in our control room so that we will be able to easily identify which of our vehicles have paramedics on so we can target them efficiently. We are also in discussions with the Medicines & Healthcare Products Regulatory Agency (MHRA) to change the laws around the use of diazepam so that in the future this could be provided by emergency medical technicians.”
December 3rd, 2006 at 5:02 pm
http://www.youtube.com/watch?v=6vWfW5W9dYs
March 13th, 2008 at 9:05 pm
Bizarrely there’s a link to your blog from the website for the petition… I’ve hated the stuff the Metro usually prints, but there was quite a bit in that article I probably would have believed were it not for your explanation.