On the Ambo in the UK

Subtitle for this post: Can you reach that for me?

Coming off a superb time on the Rapid Response Car, nappy time aside, we’re on the vehicle today.  The vehicle is what you and I would call an ambulance, but since anything that can take people to the hospital is an ambulance, it needs to be narrowed down a bit.

The car is certified as an ambulance since it can take people.

The vehicle can, as that is the main purpose of it.

But hiding around town, and just out of camera range as we drove by were swarms of non emergency ambulances, almost buses in their capacity.  When asked their function, Mark and our ECSW Becky (more on her later) informed me they take folks to their appointments, get tests and from one facility to another.

Collecting my jaw from the floor I explained to them and reminded Mark how many times we activated 6 people to do just that.  Becky shot me a look from the driver’s seat of the vehicle and asked a great question I still can’t answer.

“Why not just give them a ride in a van or bus?  Why send the ambulance?’

Why indeed Becky, why indeed.

I could try to explain to her how, in America, people have become so expectant of lights and sirens whenever they want them that they’re willing to sue if they don’t get them.  Regardless of the condition, reason or outcome, folks will threaten a lawsuit and managers will blink and change protocol. Why inconvenience the few when we can just take them and inconvenience the many, right?

That was the start of my shift on the vehicle.  I’d love to tell you that life on a UK ambulance is so much different than in the US.  But when it finally gets to comparing apples to apples in these systems, having someone in the back is it.

Previous posts have covered my impressions of the ambulance layout and ways I think they can be improved to benefit patient care and provider comfort and safety.

Mark had difficulty accessing most of his equipment from the cabinets.  Everything he needed he got to, but not without ducking around the patient, around the family member, then leaning over.  The trash was also oddly placed, lying directly behind the family member so that to dispose of bloody mess you have to ask them to lean aside.

But that being said, with the current layout based on “safety” there is no other place to put these things.

Mark described to me the regulations in place to protect the persons traveling in the back of the vehicles and it makes perfect sense.  Until we have to actually do patient care.

After my description of the ambulances in a previous post I was contacted by an ambulance manufacturer who wishes to remain anonymous, I’ll call them Box inc.  Box inc wanted my thoughts on what makes the perfect ambulance and I told them I have yet to see it.  But, Box inc had some new ideas about making your ambulance more versatile when on post, more on that another day.  But Box inc will still take a van or pickup truck, rip off the back, slap on a place for a cot and make it flash, there really isn’t another option at this point.

But back to Newcastle and the McDonald’s parking lot.

Yes, we’ve found our way to the parking lot at the McDonald’s, on post if you can believe that, so I snuck in for a coffee.  It’s an addiction, I know.  We had a chance to talk on camera about Becky’s role in the NHS and what an ECSW is.  But as we talk about it, a few points to look for first.

I am sitting on the cot and Mark in the chair for family members.  The pass through to the cab behind him has a small door on the top that leads to the trash bin behind that seat he’s in.

The cabinets behind us and between as as we talk contain all of Mark’s equipment.  Just from the layout you can see how challenging it could be to access them with a poorly patient in the back.

When I said that Becky was above an EMT, the comments section at youtube went insane.  What I meant was that she can give pain relief without medical direction.  She can do something I can’t do, mainly because I’m told I need more education and training to deliver pain gas to those in need.  Becky is proof I do not.  So when I said she is above an EMT, I was referring to her ability to medicate them in that manner.  An EMT can transport, Becky can not.  Apples and Oranges folks.

Our jobs on the vehicle were similar to what Mark and I saw on Medic 99 in the City, moving folks with this complaint over there and that complaint over here.

It was on the vehicle that we encountered the only person, out of dozens, who demanded transport.

As you all plainly know, my clients demand transport 90% of the time and need it 5% of the time.  Newcastle respects their Paramedic’s opinions, likely because they can get in and get seen outside the A&E in a reasonable amount of time compared to here in the US.

This person activated 999 to report an assault and we entered the house cautiously.  It was quite a bit reassuring knowing that the occupant was most likely not carrying a weapon that could mow us down from 40 feet away.  I’m no ninja but I’ll take a clipboard to a knife fight over a knife to a gun fight any day.

The local police were close on our heels, again, without firearms (hard to get used to) and the scene was more than secure.  Very secure the police confirmed, poking holes in our patient’s story.  Then there was the recounting and description of the event given and none of that matched what we were looking at.

Clearly there were behavioral issues in play and the decision was made to transport based on the inability to confirm normal mental status.  We’ve all been there and trying to communicate with eye movements and physical gestures must have appeared as though Becky and I were flirting.

My eyes said “Look at the door, the things piled in front of it, it opens inward, no one broke in there.”

Her eyes said “What?”

My body, arms crossed, said ‘Over there, look, the door!”

Her body, arms raised to the side and shoulders up said, “Huh?”

Mark’s eyes said “Stop it!”

Mark does not ring down, or pre-alert, the hospital himself, but relays it through his control center.  When I saw what the control center did the next day, I decided that was unnecessary.  If your service relays patient reports trough a third person you are introducing another player in the telephone game and just another chance for pertinent information to get lost.  I would love to be able to forward my report to that point to the hospital and they can move that information to a bed and await our arrival.

Oh, did I nod off?

Right now my service gives audio radio reports to whichever nurse lost the coin toss that day and has to answer the radio.  I tell them what I have and why, vitals and hang up.

 

Many Americans may shudder at the idea of waiting 2 hours for an ambulance but I met a woman who disagrees.

Mary, I’ll call her, fell down on a friday afternoon and injured her hip. Being of a stoic generation, she didn’t want to bother anyone with her trouble, so she hobbles through the weekend until her doctor’s office opened monday morning. She called the office and spoke to her doctor who advised her to go into the A&E to be evaluated since his office had no x-ray capabilities.

The doctor called the ambulance and the call was classified as an €œurgent€ meaning there was no life threat, but still a need for a transport. This call is then put in hold in the system with a maximum wait time and an ambulance is assigned as soon as the system has the available resources.

Mary met us at the front door and walked us in with a slight limp, dressed and ready for her trip to the A&E like many of my lights and sirens patients. We took our time making sure her medications were gathered and the stove turned off, then into the chair and down to the ambulance.

Because this trip was arranged her medical records were waiting at the hospital, as was a bed reserved for her and she was seen as soon as she arrived. I asked her if the 2 hour wait was too long and she looked at me as if I asked her what color the sky was.

€œI waited all weekend to call, another few hours wasn’t going to kill me, son.€

I wanted to hug Mary right then and there.

After a day of back and forths on the vehicle and torturing Becky with the American and the camera duties, we were close to finishing our shift when that dreaded job came in.

The late job.

We were planning on meeting some of the rank and file for a social evening and this job would put us over our shift and we’d be late.

We screamed through the streets of Newcastle, pushing old women off the road and opposing traffic wherever we could.  OK, not really, we were sent on a common case that would later bring out our common response “Same patient, different country.”

With the patient on board and her friend safely secured we made our way through the evening traffic to St Farthest, all the while talking and keeping our patient in good spirits.

The day went fast in retrospect.  Traffic still doesn’t get out of the way when you’re rolling lights and sirens, you still have to go hunting for the extra blanket at the hospital and the nursing staff is still often glad to see you when it counts.

The evening was a night out with some of Mark and Sandra’s co-workers, we were fashionably late after some creative dropping off and ride sharing.  I got to talk to them about Mark without him listening and their opinions were high and genuine.  Mark is a respected and admired Team Leader in his station and his system.

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9 thoughts on “On the Ambo in the UK”

  1. Hi Justin

    Not all ambulances have the same layout throughout the UK. It depends on the particular Ambulance Trust and on the type of vehicle.

    Our trust does not have the waste situated behind the relly's seat, but in a locker (on most vehicles), this taking up useful locker space. Oh yes, it's a floor locker, not an overhead – we try not to drip body fluids on the patient in the odd case where it may leak.

    I'm sure most ambulance crews would give their eye teeth for your larger vehicles, but I doubt if they'd be practical. Many of our streets are narrow, and were built before the motor car was even a gleam in Benz's eye. Even those built later didn't have a place to park a car, as those were the preserve of well-off people.

    The result of this is that many streets have cars parked both sides, making a single-track road. (This is actually illegal, but it can't be enforced.) It can be hard to get a car down the middle sometimes, let alone one of our ambulances. One of yours would stand no chance.

  2. Hi Justin

    Not all ambulances have the same layout throughout the UK. It depends on the particular Ambulance Trust and on the type of vehicle.

    Our trust does not have the waste situated behind the relly’s seat, but in a locker (on most vehicles), this taking up useful locker space. Oh yes, it’s a floor locker, not an overhead – we try not to drip body fluids on the patient in the odd case where it may leak.

    I’m sure most ambulance crews would give their eye teeth for your larger vehicles, but I doubt if they’d be practical. Many of our streets are narrow, and were built before the motor car was even a gleam in Benz’s eye. Even those built later didn’t have a place to park a car, as those were the preserve of well-off people.

    The result of this is that many streets have cars parked both sides, making a single-track road. (This is actually illegal, but it can’t be enforced.) It can be hard to get a car down the middle sometimes, let alone one of our ambulances. One of yours would stand no chance.

  3. Hi Justin

    Not all ambulances have the same layout throughout the UK. It depends on the particular Ambulance Trust and on the type of vehicle.

    Our trust does not have the waste situated behind the relly's seat, but in a locker (on most vehicles), this taking up useful locker space. Oh yes, it's a floor locker, not an overhead – we try not to drip body fluids on the patient in the odd case where it may leak.

    I'm sure most ambulance crews would give their eye teeth for your larger vehicles, but I doubt if they'd be practical. Many of our streets are narrow, and were built before the motor car was even a gleam in Benz's eye. Even those built later didn't have a place to park a car, as those were the preserve of well-off people.

    The result of this is that many streets have cars parked both sides, making a single-track road. (This is actually illegal, but it can't be enforced.) It can be hard to get a car down the middle sometimes, let alone one of our ambulances. One of yours would stand no chance.

  4. Hi Justin

    Not all ambulances have the same layout throughout the UK. It depends on the particular Ambulance Trust and on the type of vehicle.

    Our trust does not have the waste situated behind the relly's seat, but in a locker (on most vehicles), this taking up useful locker space. Oh yes, it's a floor locker, not an overhead – we try not to drip body fluids on the patient in the odd case where it may leak.

    I'm sure most ambulance crews would give their eye teeth for your larger vehicles, but I doubt if they'd be practical. Many of our streets are narrow, and were built before the motor car was even a gleam in Benz's eye. Even those built later didn't have a place to park a car, as those were the preserve of well-off people.

    The result of this is that many streets have cars parked both sides, making a single-track road. (This is actually illegal, but it can't be enforced.) It can be hard to get a car down the middle sometimes, let alone one of our ambulances. One of yours would stand no chance.

  5. Justin,
    Speaking of the non-emergency ambulances…aren't those simply patient transport units? Or is that something that you don't have in the states? I'm from Canada and our EMS service certainly gets it's share of non-emergency calls and transfers, but we do have (my province at least) some designated patient transport vehicles. I also just started working for a private patient transport company that contracts to nursing homes and takes private trips from home to hospice. Some changes have been made in that we are no longer allowed to do inter-hospital transfers (apparently the powers that be would rather take paramedics and emergency vehicles off the road to transfer stable patients than have them respond to emergencies) but it works well for what the nursing homes and other patients require. Is there anything of this type in San Francisco?

  6. Hi, Justin

    What a GREAT post, I’d love to hear more. Its an interesting picture of a completely different system with similar patients with different attitudes. Why do you think that is? Is it because its always just “been that way” much like the “you call we hall thats all” concept has always been present here in the US?

    Is it the way we have things structured here? Is the desire to see a high transport rate not just from the Patients side of the coin but from the Management’s side as well? I’d argue that it is. We contribute to the problem equally because from the provider side of things, I dont think we take enough time to explore the option for other outcomes because ultimately, the ambulance business is driven by the all mighty dollar.

    How is the UK Ambulance funded? Do they get money for their non-transports? I’d be interested to know.

    Again, great post, my friend.. well written!!!

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