Paramedics and Epileptics - update
You might remember my recent post about a misleading article in Metro about the death of Kayleigh Christie. Kayleigh died as a result of a prolonged epileptic fit; she may have been saved if she had been taken to hospital quicker (she had to wait 30 mins for an ambulance, though an FRU was on scene within five minutes) or if she had been sent a paramedic crew rather than EMTs, as EMTs cannot give diazepam. There were a lot of comments on my post, and I thought you would be interested to know that a long statement is now available on the LAS intranet (though I can’t find it anywhere on a public site, which is rather odd). The report clears up some of the confusion arising from the various articles in the press. It states that the nearest FRU (response car), who was an EMT, was dispatched and, on arrival, reported that Kayleigh was in status epilepticus and that a paramedic crew was needed. One was dispatched straight away, but on the way to Kayleigh’s house, it came across a serious road traffic accident and had to stop and help. The next ambulance to become available was sent to Kayleigh, but this was an EMT crew. Kayleigh’s case was never “downgraded to a lesser emergency” as reported in Metro, nor was the ambulance cancelled for a higher priority call — it was “cancelled” because it had come across the road traffic accident. It is not clear whether the Control staff tried to find a paramedic crew, or simply sent the nearest. (I suspect that if things were busy enough to warrant a 30 minute wait, the EMT crew were the *only* crew available, but I don’t know this for a fact). Kayleigh stopped breathing after she reached hospital. There is no comment as to whether the delay and lack of paramedics caused her death.
Since the statement appeared, there have been changes in the control room. A memo has gone round stating that ALL calls to epileptic fits should be sent a paramedic crew. Every paramedic crew is now flagged on the computer with an “H” (don’t ask me why it isn’t a P!) so Control staff can easily identify which crews are paramedics and allocate calls more appropriately. The LAS also want the rules changed so that EMTs can administer diazepam.
I hope these changes will prevent another tragedy like this happening.
on November 29th, 2006 at 4:49 pm
One very interesting thing (to me) in this case is the diversion of the original ambulance to the auto accident it came upon. In the US, the rules are the exact opposite–crews must go to their original call no matter what they come across.
I recall seeing an episode of the venerable “Resuce 911″ where an ambulance on the way to a call was hit and flipped over. Another crew on the way to yet another call drove past their bleeding colleagues, but could only radio in the accident.
In a hypothetical situation where UK rules were like the US rules, what might have happened if the ambulance crew in this case had passed up the auto accident and gone on to Kayleigh? Would the papers be writing about one or more deaths from a car wreck because of the ambulance that passed by?
on November 29th, 2006 at 5:08 pm
Here the crew can decide what to do. If the crew decide the call they have come across is lower priority (for instance, if the person in the car accident just had a broken arm) they radio it in and continue to the original call. If the new incident is more serious, then they radio for another ambulance to go to the original call.
In this case, both calls seemed equally serious, so I guess the crew just decided to stay put.
Would the papers be writing about one or more deaths from a car wreck because of the ambulance that passed by?
I’m sure they would, and you can just imagine the headlines. “I cradled my dying son whilst the ambulance drove past!” etc.
on November 29th, 2006 at 5:32 pm
Mark,
The administration of diazepam is a nonsense. When I started we only had rectal diazepam which EMTs could administer; no prizes for guessing who got the pleasure - in order of preference: newbie, EMT and paramedic (if I must). Now for some bizarre reason that I don’t understand, diazepam rectal or tablet, and diazemuls all have to be stored as if they are a Class A drugs - i.e. they get locked in the morphine tray. EMTs are NOT supposed to have access to the morphine; which means no access to diazepam either. It’s going to require quite a few changes to rules and drug classification for EMTs to administer diazepam. The other option (which my service has tried) is not to allow solo EMTs on the RRVs; paras and ECPs only. Of course that means that a lot of the time the RRV goes unmanned; so response times go down; so management changes the rules again and so we go round and round and round and round.
Hope you’ve recovered from your man-flu.
on November 29th, 2006 at 6:32 pm
That’s good to know. All we need now is to teach the general public that not every seizure needs an ambulance.
on November 29th, 2006 at 7:19 pm
All this diazepam stuff is a little unnerving, as I currently have about 50 tablets of it (on prescription) dotted about the place - half-used blister sheets in my handbag, at my boyfriend’s house, and at my mum’s house; and then the rest are in an unlocked drawer at my flat along with the rest of my personal mini-pharmacy.
The way you lot are talking about it I’m starting to wonder if I should store it in a safe and only handle it with lead-lined gloves or something.
I mean, sure, it’s addictive, and has the usual array of possible side-effects, you don’t want enough of it on the car/truck to be robbed for it and you don’t want it being handed out like smarties to every caller who’s having a panic attack. But it’s not exactly morphine…
on November 29th, 2006 at 8:29 pm
I don’t understand why the woman in the article didn’t have whatever medication the girl needed on her, if she was known to be an epileptic.
on November 29th, 2006 at 8:34 pm
Yeah, that’s a good question. We often get calls to epileptics where the caller says they’ve already administered rectal diazepam. I can’t find any article that mentions why Kayleigh’s family didn’t have any at their home.
on November 29th, 2006 at 11:32 pm
Diazepam is class C, our Techs give it (same principles involved as Magwitch), you guys don’t need a change in the law, you need your Medical Director to pull their finger out and sort a PGD.
SD
;-)
on November 29th, 2006 at 11:36 pm
On the subject of why the family didn’t have any to administer themselves I can’t see why they wouldn’t have had any, I still come across kids who are administered paraldehyde rectally by their parents.
Like I said in a previous posting on this subject, the families vilification of LAS over this could well be related to feelings of guilt over not having/administering diazepam.
Mmmmmm, I love the smell of paraldehyde in the morning……….
SD
;-)
on November 30th, 2006 at 12:40 am
A relative of mine who is disabled and epileptic, is currently prescribed and has been for many years, rectal diazepam. We as family/carers are shown how to do this once if we’re lucky as its really not rocket science once a PSP (pt specific protocol) is in situ, i.e. we give according to time and severity of a fit. At no point when discussing my relatives care several years back were we offered any BLS training.
Rectal diazepam has a ‘negative’ effect on the physiology of the body, it can cause respiratory depression ergo causing respiratory arrest. Did i mention as carers we are not given basic life support training?
Now as an EMT4, i have had BLS drummed into me since day dot, as does every trainee, and it saddens me as if faced with this situation i could administer and treat with my eyes closed but im not allowed to (luckily i work with a medic then).
The PGD needs to be changed or at least reviewed, the maximum dosages given by -for example - the LAS, are really not that dangerous and im positive every competent tech out there could manage.
on November 30th, 2006 at 8:41 pm
It’s hardly rocket science to administer it….it only because the NHS does not want to spend the money on training that they don’t train the techs to administer it! Yet whats a day’s training course whne it comes to someones life??
on November 30th, 2006 at 11:14 pm
Could it be that it counts as another drug route and that sort of thing might count towards pushing techs into payband 5 on A4C…and that might cost lots of money…….?
on November 30th, 2006 at 11:43 pm
RuralPara
It didn’t over here!
SD
;-)
on December 1st, 2006 at 12:48 am
Hi its Martin Nilan again ,
Can i call ur attention to an article in todays Islington Gazette,[frount page]
about Responnce time ; OVER 9 MINUTES, AND CODE RED CALL ;EMT WAS SENT. Why are LAS STILL sending EMT to CODE RED ???
Im amazed that they still are doing this . The rapid response cars were given to LAS purely to be staffed by paramedics , werent they ?
Kayleighs death and petition have brought about a new system that will show what type staff are in each vehicle, thats a start . We got 15,550 names on our petition we took to downing st.to get MORE FUNDING for LAS. Story in ISLINGTON GAZETTE on page 7. please take a look.
on December 1st, 2006 at 1:17 am
Hello again Martin. I think I’ve explained my views on this before. Have you seen the LAS response which I referred to in this post? It also contains a lot of information about what paramedics and EMTs do, and what the difference is. An EMT can deal with the majority of Cat A calls (”code red” calls if you like) including heart attacks, asthma attacks and unconscious diabetics. It is not a mistake to send an EMT crew/FRU to a category A call. In the case of this call, the EMT would have been able to start treatment straight away, and the paramedic on the ambulance would have administered the drugs. The initial treatment can be done by either a paramedic or an EMT. If you have not seen this report I think you should ask the LAS to send it to you straight away as I think you will find it informative.
I don’t live in Islington so I can’t see which story is on the front page. Looking on their website I can only see this story, which states the ambulance took six minutes to arrive (the children started CPR before calling 999, which is where the figure of 9 minutes comes from), the FRU was an EMT, and the patient was *saved*. Is this the story you are talking about? If so, I really fail to see what the problem is here. The article is a success story.
I agree wholeheartedly with your moves to get more funding for the LAS, and that we need more ambulances and to review our use of paramedics. However I cannot agree that we need a paramedic on every ambulance; in fact I think this would be detrimental to the service we provide. I also disagree strongly with the sentiments that the LAS is failing. Yes, there were serious and tragic mistakes made that day, but this campaign is spoiling people’s faith in the service as a whole, especially regarding the skills of EMTs. Please take some time to look for stories of people who have been saved by the LAS which will hopefully redress the balance somewhat.
Once again I am very sorry for the loss of Kayleigh and hope that nothing similar will ever happen again.
on December 2nd, 2006 at 12:55 am
Hi mark, its martin again. When we met up with LAS to discuss our complaint we also had a major TIME difference..ie. sat nav system said it had arrived when in fact it was at another part of estate .vital minutes were lost and LAS have agreed with us on this. On this story it still seems that LAS are still addressing GOVERNMENT TARGETS 8MINS more than getting a paramedic there in 8 mins which is what FRU were given to LAS at first instance for. The family worked on dad for 9MINS and no mention of taking over of EMT within this time. Can i just say IM NOT IN ANY SHAPE OR FORM KNOCKING EMTs, AMBULANCE CREWS, OR ANY STAFF CONNECTED. Im merely commenting on what LAS promised us that nothing like this will happen again.Luckly the kids acted fast and got things working on their dad. Luckly it was a success story, but there is also the other side of the coin which we were dealt.
on December 2nd, 2006 at 5:14 pm
Martin, now we agree on something - the sat nav system (and in particular the mapping system used by call takers) are really not up to scratch and yours is by far not the only case of an ambulance being misdirected by the sat nav. We definitely need a better mapping system. Apparently the system used by the police cost several times what ours cost, but we’re not allowed the funding for it.
I may be wrong, but I read the gazette story to mean that the children started CPR and then went to call 999 - the six minutes being the time from when the call-taker got all the details to when the ambulance arrived. I could be wrong though, the article isn’t entirely clear. It’s worth bearing in mind that whether it was six or nine minutes, the longest someone can survive not breathing without CPR is three minutes, so it would have been almost impossible to save the patient without the children’s CPR.
There are some people in the ambulance service, particularly higher up the ranks, who are obsessed with targets, but I can assure you that the majority of crews and control staff couldn’t care less about targets. If I get an ambulance to someone in 10 minutes and they live, that’s a success to me. If I get one there in 5 and the patient dies, how can anyone say that is a success?
I know you say you are not knocking EMTs, but a lot of what I’ve read, both on the Kayleigh website and the press, gives the impression that EMTs are just glorified first aiders/ambulance drivers. My worry is that someone might see this, then later when they are (eg) having a heart attack call an ambulance and receive an EMT crew, then refuse to be treated by anyone except a paramedic because they don’t think EMTs are competent.
on December 3rd, 2006 at 1:29 am
Hi guys,
I was saddened to read the original posting by Mark, about the tragic circumstances of Kayleigh’s death. I think he has the right balance and speaks more or less for all of us technicians. I’ve read the website that has been set up in Kayleigh’s memory and agree that it would be lovely to have a paramedic on every vehicle. But also very expensive.
We now have paramedics who will be qualifying straight from university who will have approximately 28 weeks ‘on the road’ experience (spread over two years) before they are allowed to go solo as state registered paramedics. They will have completed an intensive two year degree course and have a lot of theoretical knowledge. From what I’ve seen they tend to be on the younger side of 25 but with ‘good ‘eads on their shoulders’ as my Dad would say. However in cases I’ve come across they don’t have a lot of ‘life’ experience.
Take now your average technician. In my particular case we did a 6 week theory residential course at an ambulance service college. The average age was 28 and pretty much everyone had a lot of life experience. We were still not allowed to go solo until we’d completed a portfolio of clinical evidence over a year of supervised on the road experience. This showed the type of jobs that we’d been to and was assessed by a senior (director level) officer. If we hadn’t come across a certain situation, we had to write a detailed project (almost to paramedic level) and undergo a Q & A session with a training officer.
These techs that attend jobs as solos will have all worked with paramedics (on their years probation). They will know all the paramedic drugs and pretty much what the drugs do. What they won’t have is the deep (now a thirty week course) theory knowledge of what the drugs do at a cellular level. It’s this clinical knowledge that allows a paramedic to deviate from the JRCALC guidelines (they were protocols that allowed no deviation) to give a patient the best treatment.
So my question is this, would you ratheryour solo to be a fresh faced 20 year old who has 1 day on the road solo and is over confident because they have loads of theoretical knowledge, or a technician who has a thorough understanding of what’s going on because of more than a years training and supervised practice?
Obviously you want a combination of both. It may be worth Kayleigh’s family seeing if they can talk to some ambulance staff on the ground who aren’t management. They will be able to tell them how it is at the coal face. The majority of us love our job in the A & E arena and will always be doing our best for the patient. And most of us techs can’t wait to get on a paramedic course to enhance our practical knowledge with the theory and get our paramedic ticket. Obviously I talk about my own rural service and my own experiences. I wish her family well.
on December 5th, 2006 at 10:47 pm
Hi all, its martin nilan here. There seems to be a lot of confusion surrounding our petition and our reasons for it. I was BEGGED firstly by a PARAMEDIC to PLEASE DO SOMETHING ABOUT THIS. They were sick and tired of this happening….WHAT ? This had happned before and WILL happen again if nothing gets sorted out. We were even more determent now to HELP SORT OUT SOMETHING. Since we lodged our complaint and LAS also got an INHOUSE COMPLAINT ,changes [be it only a few] have taken place. We also want MORE FUNDING for LAS and they are now moving to have TECS give dimazipan etc.. We are on your side and we want to help LAS improve with more FUNDING…
on December 5th, 2006 at 11:35 pm
Martin — I know you’re trying to help us and I’m sorry if it sounds like I don’t appreciate that. Believe me, if the petition was for “improve the LAS” or “more funding for the LAS” I’d be 100% behind you. But the petition was specifically for a paramedic on every ambulance, which is something I personally do not agree with. Most of the calls we get can be handled without paramedics, and it would simply be a waste of money. The money would have to come from somewhere, probably resulting in less ambulances over all, longer waits, and people dying as a consequence. Of course opinions differ, and one paramedic may have agreed with you, but the majority of the readers of this blog seem to agree with me, as do LAS management.
If we did get more funding, I’d like to see it used on a better sat nav/mapping system and more ambulances overall - including more technician and intermediate tier crews. We also need to change the way we use the paramedics we already have, and not just send the nearest crew to every call, because this results in paramedics being tied up on calls which could have been handled by a technician. Changes are already afoot in regard to this, and I hope there will be more to come.
It’s a shame that your good intentions — to help the LAS gain more funding — have been turned into something negative by the press, who seem to want people to believe that the LAS are a failure and that you are not safe in their hands. This is completely non-productive and just increases the amount of abuse crews and other staff have to take, while putting patients off calling us when they need us.
on December 11th, 2006 at 12:47 pm
Very well put Mark.
Tj
on April 15th, 2007 at 7:04 pm
I’ve just seen about this on our news…
it scared me, I have to admit…
My heart really goes out to you…my daughter is 14 and developed the kind of epilepsy that girls can get when their bodies are struggling with the influx of hormones, just after her 13th birthday…when I didn’t know what was going on and had to call an ambulance…
Quote:[One was dispatched straight away, but on the way to Kayleigh’s house, it came across a serious road traffic accident and had to stop and help]:end quote
I SO pray this will not happen again - that they will understand…and, my dear ‘fellow mom’…please know that I am praying for you…nothing can replace your daughter, I know…my words seem so inadequate…sorry…I just want to let you know I care, and understand some of it.
on April 15th, 2007 at 7:25 pm
Quote:[One was dispatched straight away, but on the way to Kayleigh’s house, it came across a serious road traffic accident and had to stop and help]:end quote
I SO pray this will not happen again
An ambulance en route to a call will always have to stop if it comes across another incident (a ‘running call’) on the way. They then either call for another ambulance and carry on, or deal with that incident and ask for a second ambulance to be sent to the original call. The crew had no way of knowing that the epileptic fit call was more serious than the RTA - in fact, if they had continued to the fit call, maybe the person in the RTA would have died instead. I don’t think we can do anything about running calls — they are just a fact of life, but what we can do is make sure continuous/multiple fitting is a top priority, and that someone who is able to administer diazepam is always sent. And we have done that.