Angry Paramedic
There’s a letter in this month’s London Ambulance Service News that has got a lot of control staff up in arms. It’s from a very angry paramedic who has been to one too many “category A” calls on blue lights and sirens only to find a baby who was described as “choking” sitting up and playing with toys on arrival. The child’s parents told the paramedic that they categorically did not state that the child was choking, so the paramedic seems to have concluded that everyone in control is useless and deliberately “sexes up” low priority calls for the sheer hell of it.
I wonder if he’s ever done an observation shift in Control? Mr Angry Paramedic, if you’re reading this, I’d like to invite you to come and listen to some calls, and you’ll see what we’re up against:
a) Callers Lie. You don’t have to be brain of Britain to work out that the worse you make something sound, the quicker you get an ambulance. We have a good idea when they are lying, but what can we do? We’d be hauled into QA faster than you can say “disciplinary” if we accused them of it. Of course when the ambulance turns up, they will say “I never said he was choking!” They are big fat liars.
b) Callers panic. Callers have not been sitting reading medical dictionaries in preparation for dialling 999. “Choking” to us means “has an object lodged in his throat”. “Choking” to a caller can mean “making a choking noise when breathing even though breathing normally”. If the caller says “choking” in the first five seconds, and it takes five minutes to establish what is really happening, then sometimes the ambulance will already be there by the time the ticket is updated.
c) We hate AMPDS as much as you do. See below.
The Angry Paramedic also complains in his letter about AMPDS and the fact that it churns out category A “Severe difficulty in breathing” for a call that is known in the business as “A load of old rubbish”. This is a complaint that I sympathise with entirely and have made myself in the past. Management are always talking about reaching category A calls on target but for some reason have failed to implement the one change which would slash the number of false category A calls and enable them to get to all the proper ones on time and meet their precious target. That change would be to replace the AMPDS question “Is he breathing normally?” with “Is he having difficulty breathing?”
Anyway, calling all London Ambulance Service crews! There’s a form called an LA410 you can fill out every time you get a call that you think was inappropriately categorised. You can download it here (the link will only work if you’re on a London Ambulance Service computer). Print off a bundle, and fill one out EVERY time you go to a “Severe Respiratory Distress” call that turns out to anything but. Several times a shift, if need be. Pop them in the internal post to the QA office, and they’ll soon be drowning in so much paper that they will *have* to do something about it.
Call takers hate, hate, hate making category As out of rubbish calls as much as Angry Paramedics do. Whilst crews are worried about running people down whilst attending these calls on blue lights, call takers tend to focus more on patients who lose out on an ambulance as a result. We’ve all had an experience when we’ve been staying on line with someone who has been pleading for an ambulance for a seriously ill relative, when we know we’ve just sent the last available ambulance to someone round the corner with flu. Stop this nonsense! Fill out your LA410s today!!
on March 31st, 2006 at 12:29 pm
We all know - those of us in the business - that both AMPDS and government response targets are an utterly useless waste of time and money. How many patients need an ambulance within eight minutes? In my ten-plus years’ experience, I can recall just one whose life was definitely saved by swift intervention - and that was only by a quick-thinking paramedic working outside our (often lame) protocols. The vast majority, it has to be said, don’t need an ambulance at all.
We know it’s not your fault that calls are wrongly categorized, but that of the software, which should be scrapped forthwith. Bring back human judgement, I say, and a little old-fashioned common sense.
To bombard our managers with LA410s - a form I’ve never previously encountered - is a marvellous idea, and I shall do just that with immediate effect. Well done!
on March 31st, 2006 at 12:51 pm
When we get firecrews visit us in Control, most of the time they leave with their mouths open, gobsmacked at the work we do. Some of the common complaints are, you always send us on relief duties because someone upset you, you hang onto calls at change of shift so we dont get the overtime, you big up the calls so more engines get to go etc…. things so pathetic you cant believe its coming from grown ups! From my point of view, if only I had to the time to worry about such trivia, to mess around with resources and to ’sex’ things up!
Sometimes frontline staff are more than happy to take all credit when things go right, yet fail to acknowledge the very fact that they are responding is due to control being able to send them to it in the first place. Like every organisation, some people are full of their own self importance to understand the way the ‘team’ works.
Others, I am pleased to state, are fully aware of the pressures of being in a control room and wouldn’t ‘dare’ upset us!!!
Let hope Mr Angry gets to visit you and puts pen to paper to apologise!!
on March 31st, 2006 at 1:44 pm
You record all calls, right? Is it easy to play back bits to the caller / paramedics to prove they really did say “choking”?
on March 31st, 2006 at 3:14 pm
Rup - Yup, we have all the calls archived. I imagine they get listened to every time someone fills out one of those LA410s or otherwise submits a complaint.
on March 31st, 2006 at 3:17 pm
you hang onto calls at change of shift so we dont get the overtime
Miranda, this made me laugh. Our crews are always having a go because we send them on jobs just before the end of shift when they want to go home! You just can’t win sometimes!
That said, it’s very rare that I have a problem with crews. Even their complaints (”Are we the nearest?” being by far the most common) are generally polite and good natured, and I can usually see where they are coming from. I’d rather speak to crews than callers any day!
on March 31st, 2006 at 3:42 pm
It’s a bit like the calls we get for an “unconscious” patient. When we get there, heart thumpin’, primed, ready for action, carrying every bit of kit we can think of…
“where’s the patient then?”
“er, that’d be me” The person who answered the door.
“Oh, my mistake, somehow I expected you to be out cold, flat on the floor! You’ve made a miraculous recovery then, just knowing we were on the way”
Another life saved! God we’re good!!
I somtimes wonder whether some callers actually understand what “unconscious” means.
on March 31st, 2006 at 3:49 pm
It was on the news once that 60% of people fail to define it correct. I find that callers either:
a) Get conscious and unconscious confused. (”Is he conscious? No, he’s fine). This is, for some reason, particularly common in carers.
b) Think conscious means “unable to talk” or “not completely alert”.
I often try asking if the patient is awake too, just to clear things up, but it doesn’t really work. Half the patients are asleep at night, and half the callers, for some bizarre reason, think you are asking “is he white?” as if ethnic origin plays an important part in getting you an ambulance. Sometimes they think you’ve asked them for the patient’s “weight” too. Groan!!
on March 31st, 2006 at 4:30 pm
Its coming up to a certain religious festival. If my daughter and her class spent four hours on a first aid course at school instead of making an easter bloody bonnet I’d be so much happier, you’d have less work and a lot less rubbish calls.
on March 31st, 2006 at 6:03 pm
Do you have to stick to the script so closely? Are you not allowed to use a little initiative and ask “Is he having difficulty breathing?” instead of “Is he breathing normally?” Especially if you suspect the caller is talking rubbish. What would happen if you did, disciplinary procedures?
If you’re not allowed to use some nouse on this why do they employ people at all? An computerized system wouldn’t get stressed about it, and the paramedics couldn’t moan. Perhaps this is the grand plan. A pants one though.
on March 31st, 2006 at 6:31 pm
The longer I live, the closer I get to being an anarchist. 90% of the world’s problems seem to be asinine directives from the top. Great idea, to flood management with forms. Homeopathy is the one thing that works on bureaucracies.
The closest I’ve come to dealing with some of the caller issues was answering a poison control line for potential plant-related porblems (I’m a botanist). I was filling in for a day, and all of one call needed my help. It went something like this:
“My son ate some blue berries! Is he going to die?”
“I doubt it very much, ma’am. [They wouldn’t be referring the question to me if the kid was writhing on the floor, unconscious.] Let’s try to figure out what he ate. Were the berries the size of blueberries, or were they larger?” [Belladonna was the only dangerous blue berried plant in that area that he was likely to find.]
“They were blue berries!”
“Yes, ma’am. Were they pretty small, like the blueberries you buy in stores, or were they larger, shiny, and almost black?”
“They were blue berries! Oh my God, he’s going to die!”
“Is your son sick right now?”
“No, but he just ate them. God only knows what it was. It’s probably too late already.”
[Me, thinking, “yeah, right.”] “Well, let’s try to figure out what it was. Could you tell me whether they looked just like blueberries, or were they a bit different?”
“I don’t know! The were just blue berries! This could be really dangerous!”
And so it went.
I consoled myself later that I did serve a useful function because she talked to me for so long, that after about 25 minutes I could tell her that if her son was still showing no symptoms whatsoever, the blue berries were not toxic. So that was one ambulance that didn’t have to waste time.
on March 31st, 2006 at 11:08 pm
Hey Mark,
AFAIK the reason ambulance services are so attached to AMPDS is that because if a call is mis-triaged then the AMPDS company can be sued, whereas a LAS-invented system would leave the LAS entirely responsible.
Also, I feel your pain - neither half knows how the other really lives. Having spent a bit of time in control, as well as on the road, I can confidently assert that in my service the dispatchers are the hardest workers. Your results may vary.
on April 1st, 2006 at 11:54 am
It is just typical of some people to complain like that without taking it up with the people they should be. If he is so outraged by it, why has he not brought it up with his officer? If he had then perhaps he would of been brought in to hear the call and would of seen for himself that us calltakers have better things to do with our time than make up fake calls to keep the paramedics busy!! In our control we try to get all the road staff in at some point to spend some time in the control to see if from the other side! He needs to be dragged over the coals!!
on April 1st, 2006 at 3:33 pm
read the letter in LAS news and from a paramedics point of few it came across as whiney, moaney and totally unjustified. We do get frustrated with crap calls being CAT A but those of us with common sense realise it is a) the caller giving inaccurate info b) AMPDS not working as well as it should.
don’t let the b@st@rds grind ya dahn!
on April 1st, 2006 at 4:48 pm
Lucy: We are allowed to make changes to the script to clarify the questions, but not to change the meaning of the questions. I’ve asked QA and they say that “not breathing normally” and “having difficulty breathing” are different things, therefore changing it would mean trouble.
on April 1st, 2006 at 11:06 pm
I dont crew a ambulance for a day job. but i am carefull to what i call one for, unlike some of the first aiders on site.
i call a ambo to a injury in the street, the ambo took its time turning up. i asked the crew if they been on a crap call, the reply was “a first aider dump” i commented that a first aider the local college does tricks like that. a upset look and a discription of the first aider in question was the next thing out of the techs mouth. along with the word flu.
the First aider had a few choice word in they ear, then i saw them next. about when to call and not to play the systems.
on April 2nd, 2006 at 2:26 am
I work for the police and we have the same problem. KNife, guns and other weapons are all invented to get us there.
One I can react on is when I get a complaint of a noisy party. When I tell the caller we don’t have any powers to deal the next comment 99 times out of 100 is “Well they are taking drugs in there” to which the caller no doubt expects us to rush round and break the door down, so my answer “Thanks I’ll pass that to the intel lads as we need a warrant for a drugs raid” always leaves them speechless.
on April 3rd, 2006 at 2:12 pm
The call system leaves me confused too. The other week I called an ambulance from my surgery for a guy who apparently had unstable angina - except he’d had it about 3 hours before and I didn’t believe him anyway. I know him. If he ever is actually ill I’m sure I’ll know it but he wasn’t that day. But I had to send him to a and e for an ecg and bloods otherwise I’d be in big trouble if I guessed wrong. But I asked for an ambulance within the hour not blue light - they insisted it had to be blue light because I’d mentioned unstable angina. When the paramedic arrived he got very angry I hadn’t given aspirin - but I knew the guy was making it up (and I was right) and the one time he actually was ill in his life it was for a duodenal ulcer - but I still got into trouble with the paramedic…. And it seemed crazy to me that I was trying to save the Ambulance service an urgent call-out but we got one anyway….
on April 4th, 2006 at 2:31 am
And talking of people lying, don’t all you paras etc hate it when your patient swears up down and sideways that they have no chest pain, no chest tightness, not funny feelings in their chest at all, then the second the triage nurse walks up and says, ’so do you have any chest pain?’ they start describing this symptom they’ve had for ages???????????????? Why, god, why????
on April 5th, 2006 at 6:36 pm
Hello from across the pond…I’ve recently found your blog and have been enjoying it. As a former Emergency Medical Technician here, I can relate to so much of what you exprerience. I do, however, have one question, as regards this particular post. Are your incoming calls not recorded? With the idea that if the patient insists “I never said he was choking”…someone can go back and hear what was said? Being able to hear a sampling of that might silence the Angry Paramedic and his colleagues. Thanks for the really important and extremely difficult job you do!
on April 5th, 2006 at 6:46 pm
The calls are recorded, but a paramedic wouldn’t be able to listen to them unless he came to the control room. Someone could listen to it for him and tell him what was said, but only if he asked someone in the control room instead of going straight to the service magazine!
on April 10th, 2006 at 9:48 pm
I just wanted to include this in the conversation. If an operator, JUST ONCE, doesn’t take the call seriously, this is what can happen:
http://www.cnn.com/2006/US/04/10/call.death.ap/index.html
911 operator scolds dying woman’s son
Monday, April 10, 2006; Posted: 8:27 a.m. EDT (12:27 GMT)
“She thought I was playing on the phone,” Robert Turner said of the 911 operator who took his call.
DETROIT, Michigan (AP) — A lawyer said he plans a lawsuit over the death of a woman whose young son called 911 to report she had collapsed, only to be told he shouldn’t be playing on the phone.
Fieger said Sherrill Turner, who had an enlarged heart, would have survived February 20 if help had been sent immediately.
“She thought I was playing on the phone,” Robert said.
By the time authorities arrived, Sherrill Turner, 46, was dead.
on June 15th, 2006 at 3:28 am
the thing about “is he breathing normally” versus “is he having trouble breathing” should definitely be changed. I had to call an ambulance a while back when my dad tripped and whacked his head on a gate post - he’s 81, and this was about 18 months ago, so I was pretty worried he’d done something horrible to himself. But I’ll tell the whole story, since in hindsight it’s kinda funny.
About 11:30 at night I let the dog out before bed. It was a very windy night, and she was out for a long time, so I went out to look for her, and noticed that the gate had been blown over. Now, the dog tends to escape through that gate given a chance, so I when I couldn’t find her I charged off down the street looking for her on foot as fast as I can go. No dog.
Eventually I gave up and heading back, only to discover the dear little creature had not run off, but was happily sleeping in her basket without a care in the world.
So, my Dad as I figured we should do something about the gate, so we headed out to sort it out, and it’s then that my Dad tripped over a brick and went headlong into a gatepost like a felled tree. He was a bit shocked by all this, not surprisingly, and bleeding quite a lot - leaving a puddle of blood on the ground so I called 999.
I’d still not got my breath back from running down the street after the dog (that wasn’t there) so I think the dispatcher must have thought I was panicing but then they asked the “breathing” question. I don’t actually remember what I said, but I remember thinking “what the hell do they mean by that?”. Clearly Dad was not breathing normally, he was a bit shocked from having hit the deck, hell, I wasn’t breathing normally having just run down the street! But his breathing wasn’t a problem - he wasn’t having difficulty with it, and that wasn’t what I was worried about.
So even though I was trying to give the best, most accurate information to the dispatcher I might have inadvertently upgraded the call to an A. So, yes - change the question - it’s confusing. The crew when they arrived were very kind though although they did talk to me like an idiot, probably been told I had utterly lost it! So embarrassing!