It takes a system to save a life

Adobe Spark (3)Last month saw pre-hospital and emergency care professionals from around the globe gather for the first European Emergency Medical Services (EMS) Congress in Copenhagen. Opened by Her Royal Highness Crown Princess Mary of Denmark, the 3-day event aimed to set new standards for research and treatment, as well as to establish an EMS Leadership Network in Europe, targeted at strengthening cross-national collaboration. Running under the theme of ‘It takes a system to save a life’, presentations emphasised the need for cooperation between the dispatch centre, ambulance services and the emergency departments for lives to be saved.

Denmark has made an impressive contribution to the field of resuscitation medicine. The congress was used as a platform to highlight the latest figures from the Danish Cardiac Arrest Registry, which collects nationwide data relating to out-of-hospital cardiac arrest. They revealed that in Denmark nearly one in four survive sudden cardiac arrest in public spaces. This is due, in part, because of the remarkable increase in the number of bystanders performing CPR before the arrival of EMS (19.4%–65.8% from 2001–2014). This is worth taking note, as approximately 1 in 8 out-of-hospital cardiac arrest patients survive if bystander CPR is initiated, compared to 1 in 30 when it is not. This provides a valid argument for implementing CPR training in schools, as well as illustrating how involvement of the community should be an integral part of any EMS.

The congress was also used to launch the Global Resuscitation Alliance, a network focused on collaborating to increase survival from sudden cardiac arrest. This agreement, signed in Copenhagen at an Utstein meeting prior to the congress, constitutes the culmination of three decades of international work, and is a major and decisive step in global efforts to save more lives from sudden cardiac arrest. Participants of the alliance have committed themselves to the ambitious target of increasing survival rates by 50%.

Alongside the scientific programme, sponsored symposia and workshops offered delegates the opportunity to expand their knowledge on areas such as managing the everyday critically ill patient, and improve their competence with a hands-on procedural cadaver lab.

Additionally, 13 teams from around the world competed in the European EMS Championship. The competition consisted of scenario-based events that tested each team’s ability to manage patients in various circumstances with common critical medical conditions and trauma. London Ambulance Service NHS Trust (LAS) walked away with the top prize, fighting off stiff competition from Turkey and Denmark in the final. Judges praised LAS for their extraordinary skills and team work in the final scenario: a canoe accident on a Copenhagen beach.

This would easily have been enough to satisfy those attending the congress, yet a number of excellent social events were also added to the mix. From morning runs and swims to an emergency management scenario at Copenhagen City Hall Square and a Gala Dinner, organisers went to every effort to ensure the event was a success. Delegates will undoubtedly be itching to return in 2017.

Taken from International Paramedic Practice, published 22 June 2016.

Ambulance service at creaking point

Adobe SparkRecent figures published by NHS England reveal the ambulance service is continuing to fail to meet Government standards for responding to Category A (Red 1 and Red 2) calls. The figures for March 2016 showed only 66.5% of Red 1 calls were responded to within 8 minutes, while 72.3% of Red 2 calls received a response within the same timeframe (NHS England, 2016). This is compared to 73.4% and 69.6%, respectively for the same period in 2015. It marks 10 months that services in England as a whole have failed to meet the Government target of 75% for Red 1 Calls. The response to Red 2 calls is the lowest proportion recorded since the data collection began in June 2012. However, it must be highlighted that Red 2 data from February 2015 onwards are not completely comparable across England due to the introduction of Dispatch on Disposition, allowing up to two additional minutes for triage to identify the clinical situation and take appropriate action.

It has been a tough year for ambulance services, with London Ambulance Service NHS Trust being placed under special measures by the Care Quality Commission (CQC) in November 2015 and East Midlands Ambulance Service NHS Trust being recently rated inadequate by the CQC for safety due to insufficient staff numbers and a consensus that the skill mix of staff deployed was not always safe (CQC, 2016).

The fact of the matter is that demand for ambulance services continues to rise and services are struggling to keep up. The ambulance service in England received 861 853 phone calls in March 2016, compared to 694 188 in March 2015 (NHS England, 2015; 2016), a rise of 24%. However, Trusts have not been able to increase their numbers of staff to meet this demand. This creates greater work pressures and stress for existing employees, brought on by longer working hours and missed meal breaks. The result? High staff attrition within Trusts. Those that remain will no doubt be questioning whether this is sustainable. With staff currently being balloted by unions over industrial action on pay, the possibility of a crisis within the ambulance service cannot be dismissed as hearsay.

If this is to be avoided, a number of things have to change. Trusts must ensure front-line vacancies are filled and staff do not leave. This can only be done by fostering a work environment in which staff are happy to remain. The over triage of patients must be minimised so that appropriate resources are dispatched. And, where possible, patients’ needs must be addressed at the point of contact and unnecessary transfers to hospital must be avoided. If the ambulance service carries on as it is, it is difficult to see how it will continue to operate in 10 years’ time. By focusing on employee welfare, this crisis may be averted.

References

Care Quality Commission (2015) London Ambulance Service NHS Trust Quality Report, 27 November 2015. http://tinyurl.com/hxdhwpr (accessed 26 May 2016)

Care Quality Commission (2016) East Midlands Ambulance Service NHS Trust Quality Report, 10 May 2016. http://tinyurl.com/h5r4wfv (accessed 26 May 2016)

NHS England (2015) Ambulance Quality Indicators Data 2014–15. http://tinyurl.com/zf2p5jf (accessed 26 May 2016)

NHS England (2016) Ambulance Quality Indicators Data 2015–16. http://tinyurl.com/jyls6rt (accessed 26 May 2016)

Taken from Journal of Paramedic Practice, published 27 May 2016.

Special measures for struggling services

In November of last year, London Ambulance Service NHS Trust (LAS) became the first ambulance Trust to be placed under special measures following an inspection of the service by the Care Quality Commission (CQC) in June 2015. The overall rating given by England’s chief inspector of hospitals, Prof Sir Mike Richards, was that the service was inadequate, and it was acknowledged that improvements were needed on safety, effectiveness, responsiveness and leadership (CQC, 2015b).

Of the key findings, it was noted that LAS had a high number of front-line vacancies, with some employees saying that there were not enough appropriately trained staff to ensure that patients were consistently safe and received the right level of care (CQC, 2015a). As a result of staff working long hours, many reported feeling high levels of stress and fatigue. Additionally, while the CQC recognised that staff were ‘overwhelmingly dedicated, hardworking and compassionate,’ they revealed that ‘some reported a culture of harassment and bullying’ (CQC, 2015a). It was highlighted how until March 2014, LAS was consistently the best performing service in the country to category A calls. However, since then there has been a substantial decline in performance, and the target time of 75% of calls being responded to within 8 minutes has not been met. This is something that has been affecting ambulance services across England, although LAS response times for Red 1 and Red 2 category A calls were reported as being the worst in the country. Serious concerns were also identified about the service’s Hazardous Area Response Team (HART) capability due to an insufficient number of paramedics. The result was the feeling that there was not a safe system of working where an effective HART response could be utilised (CQC, 2015b).

The decision to place LAS under special measures is a considerable blow, not just to the service, but to all members of ambulance Trusts. Fundamentally it highlights the CQC’s belief that LAS is unable to provide the level of care expected of it. This is despite the dedication and commitment that is clearly apparent in front-line staff, alluded to in the report. But while it is easy to consider the negative connotations of the CQC’s report, it is important to remember that one of the key reasons why services are placed under special measures is to ensure they get the support they need to improve. External partners such as the NHS Trust Development Authority and NHS England will give LAS access to a package of additional resources and support.

Ambulance services throughout the country are struggling to deal with increasing pressures, a national shortage of paramedics and insufficient funding. It is hoped that other ambulance services will not suffer similar findings from the CQC, but it should be reassuring to know that there is a system in place to offer support to services that are unable to make improvements required of them on their own.

References

Care Quality Commission (2015a) Chief Inspector of Hospitals recommends London Ambulance Service NHS Trust is placed into special measures. CQC, London. http://www.cqc.org.uk/content/chief-inspector-hospitals-recommends-london-ambulance-service-nhs-trust-placed-special (accessed 4 January 2015)

Care Quality Commission (2015b) London Ambulance Service NHS Trust Quality Report. CQC, London. http://www.cqc.org.uk/sites/default/files/new_reports/AAAD5514.pdf (accessed 4 January 2016)

Taken from Journal of Paramedic Practice, published 8 January 2016.

London Ambulance Service to recruit more Australian paramedics

London Ambulance Service NHS Trust (LAS) is set to return to Australia in September to recruit additional paramedics, after making employment offers to 393 paramedics during previous visits in September 2014 and March 2015.

A team of recruitment and operational staff from LAS will interview and assess approximately 200 experienced paramedics or paramedics who will have recently graduated.

LAS will be in Sydney between Monday 7 September and Friday 11 September at The Westin Hotel, 1 Martin Place, Sydney, New South Wales (NSW) 2000 and Melbourne between Monday 14 September and Friday 18 September at the Melbourne Exhibition Centre, 2 Clarendon Street, South Wharf, Melbourne.

The emphasis of this forthcoming campaign is to specifically target qualified, experienced paramedics, or those who will be qualified by the end of 2015.

Karen Broughton, LAS director of transformation, strategy and workforce, said: ‘If you’re a qualified paramedic or will be qualified by the end of 2015, we would love to see you. Please sign up for our assessment days and find out about working for the world’s busiest ambulance service.

‘The Australian paramedics that we’ve already recruited are doing a fantastic job and form a crucial part of our workforce. They’re extremely enthusiastic, have a great work ethic and are keen to progress, which is why we’re going back to recruit more. They are really enjoying London and all that the city has to offer.

‘As well as recruiting from the UK, we’re recruiting Australian paramedics because their skills closely match those of our paramedics here. To support them in taking up their new jobs in London we provide a three-week familiarisation course and driver training, so that they have all they need before beginning work with us.’

More paramedics are needed in London due to year-on-year increases in demand and a national shortage of paramedics making it difficult to recruit within the UK.

While LAS is working with universities to increase paramedic places on courses, and training paramedics in-house, more are needed to bridge the gap until these are qualified.

The team will also visit universities and hold opening evenings in Sydney and Melbourne to urge experienced and graduating paramedic graduates to consider a career with LAS.

Taken from Journal of Paramedic Practice, published 19 August 2015.

Surge in overseas recruitment

Ambulance services within the UK are increasingly looking overseas to recruit staff as a result of a nationwide shortage of paramedics. The need for the drive has been brought on, in part, following the recommendation for paramedics to be added to the shortage occupation list for the first time (Migratory Advisory Committee, 2015). Significant increases in demand for ambulances in the UK following the shift in focus to treat people at home rather than in A&E; high staff attrition due to work pressures and stress brought on by longer working hours; and growing opportunities for paramedics to take on roles in alternative areas, have all contributed to the shortage.

While only one paramedic was recruited from overseas from 2013–2014, 183 have already been recruited from 2014–2015, with additional recruitment planned for the rest of the year (Renaud-Komiya and Calkin, 2015). Many of the staff now employed by the London Ambulance Service NHS Trust (LAS) have come over from Australia and New Zealand, where paramedics share a similar skillset with the UK. There is also the added benefit of a mutual language. Conversely, South Central Ambulance Service NHS Foundation Trust has turned to Poland to help combat their shortage of paramedics. The assessment process within the LAS involves completing a clinical paper, a lifting assessment, and a practical assessment on advanced life support, as well as an oral interview.

However, it is worth noting that the migration of healthcare workers brings with it ethical issues, as services abroad may suffer as a result of their own falling numbers (Peate, 2014). An article in the Herald Sun referred to the ‘aggressive’ campaign being undertaken by LAS as an attempt to ‘poach’ Victorian paramedics (Van den Berg, 2014).

The UK is not alone in looking overseas for recruitment. Many paramedics who trained in the UK now work in countries such as Australia or the United Arab Emirates. However, the extent at which paramedics from other countries are being targeted for recruitment is certainly an anomaly within the UK. While it certainly offers a short-term solution for the current shortage ‘crisis’, it is questionable whether it presents a real answer to the problem. It is undoubted that national investment is needed in the paramedic profession.

That being said, the positives of overseas recruitment shouldn’t be overlooked. Working abroad, even if only temporarily, offers opportunities for intercultural awareness and the development of global perspectives of issues, as well as an insight into alternative pathways of care, service provision and paramedic practice to one’s own country.

References

Migratory Advisory Committee (2015) Partial review of the Shortage Occupation Lists for the UK and Scotland. MAC, London. http://tinyurl.com/qdaqbbl (accessed 26 March 2015)

Peate I (2014) Ethical recruitment and employment of internationally educated paramedics. Journal of Paramedic Practice 6(10): 500–501. doi: 10.12968/jpar.2014.6.10.500

Renaud-Komiya N, Calkin S (2015) Trusts forced to look overseas to plug paramedic gaps. HSJ. http://tinyurl.com/pqeo4k5 (accessed 27 March 2015)

Van den Berg L (2014) London in bid to lure Victorian paramedics. Herald Sun. http:// http://www.heraldsun.com.au/news/victoria/londonin- bid-to-lure-victorian-paramedics/storyfni0fit3- 1227011369042 (accessed 17 September 2014)

Taken from International Paramedic Practice, published 8 April 2015.

Rise in number or paramedics leaving NHS ambulance services

The numbers of paramedics leaving NHS ambulance services is increasing, according to figures obtained from ambulance Trusts.

At least 1,015 paramedics left their job in 2013–14, compared with 593 in the same period two years earlier.

This has meant crews are under greater pressure than ever before to meet demand.

As the amount of emergency calls continues to rise each year, there has failed to be an equivalent rise in the number of qualified ambulance staff.

Anthony Marsh, chairman of the Association of Ambulance Chief Executives, says that a surge in 999 calls this year and higher numbers of paramedics leaving some services, means the remaining front-line staff are facing pressures that are ‘greater than they’ve ever been.’

He added: ‘Traditionally, ambulance services receive just over 4% more 999 calls each year, and we have done for the last 10 years—some years a little bit more than that, some a bit less—but this year we’re seeing substantially more 999 calls.’

Dr Fiona Moore, medical director for London Ambulance Service NHS Trust, said:

‘We’ve seen an increase in calls from the 21- to 30-year-old group, and I think that now reflects the sort of supermarket culture we now have, so if you can buy a loaf of bread at 04:00 in the morning, why can’t you access you healthcare when it is convenient to you?’

Taken from Journal of Paramedic Practice, published 20 October 2014.

Investigation launched by London Ambulance Service into alleged exam cheating

London Ambulance Service NHS Trust (LAS) has had to suspend its paramedic final examinations following claims by an anonymous whistle blower that student paramedics had access to their final papers.

An external investigation has been launched that will look into the allegations that students going through the Trust’s in-house training programme between 2008 and 2012 had access to exam papers.

850 students went through the training programme during the four years but it is unclear as to the number who had access to the papers or how they may have gained access to them.

Ann Radmore, chief executive of LAS, said:

‘I was shocked and disappointed to hear this anonymous allegation and will not tolerate any form of cheating.

‘I am committed to sharing the findings of this independent investigation and being transparent throughout.’

It is unclear how long the investigation will take but it is thought the suspension of exams may cause a short delay in paramedics qualifying.

The external investigation will be led by Simon Brown, assistant medical director, north, for South Central Ambulance Service Trust, and chair of the Joint Royal Colleges Ambulance Liaison Committee Guidelines Subcommittee.

Taken from Journal of Paramedic Practice, published 2 June 2014.