CRUs
I was doing some thinking the other day (scary, I know), and was trying to quantitively answer the question:
Firstly, what am I talking about? I'm talking about these:
A St John Cycle Responder Unit (CRU) is a St John member mounted on a push bike, with relevant equipment and training which can then respond to certain incidents.
To answer the question, the first shred of evidence is the fact that more St John counties are investing in CRUs, so people clearly consider them to be worth the money. Secondly, there are numerous Ambulance Services that have CRUs. York itself has the lifecycle, which regularly first responds to jobs in and around the city centre. Not that many people can be crazy, surely?
Now, what about the morale factor? Imagine you're a member of the general public at an event and you've asked security / a porter / a steward / a muppet to get you an Ambulance for your critically ill relative. A St John member on a push bike pedals up to you. What is your first reaction going to be? "Thank God, the Ambulance has arrived. Uncle Bertie will be OK now!" or is it going to be "Oh Sweet Mother of Mary, why've they sent a pimply youngster just out of diapers on a bloody pushbike when I asked for an Ambulance!" I can't envisage rational thought having too much involvement at this point in time.
Next, imagine the effect on the responder. I know of jobs where the Cycle Responder has had to wait a very long time to get a vehicle, despite the fact that the patient is critically ill. Tom Reynolds' regularly spoke of the frustation that he felt as a First Responder at having to sit with ill patients waiting for an Ambulance to arrive. The same is going to happen to the poor sod on that push bike. There's a limit to the number of times you can tell a patient's relatives/friends, "Don't worry. The Ambulance will be here soon".
So again, I come back to the question, should we be investing in them?
They're expensive. A proper St John bike with panniers, etc will cost you nearly £2000 to buy. And then it needs kitting appropriately. If you're putting an AED on it (and I sincerely hope that you are), that's at least another grand, depending on which model you go for. Oh, and then there's the cost of the training. IPMBA cycle training is about £500. Oh, and not to forget, there's the uniform! That's also expensive! So, even before we've managed to get the CRU out and about on duty, we're already pushing probably £5000s worth of expenditure.
5 grand. Can we not think of a better use for that money?
Realistically, I'd argue no. I can't actually think of a better use of that money. St John spend £70'000 or more on new Ambulances, Treatment Centres, etc. Some of that money would be much better spent on CRUs.
Oh, and like all good Goverment officials, I fiddled the figures. That's £5000 for a new bike and a single rider. The cost of the bike is probably around £4300 and the cost of a single rider around £700. So once the bike has been bought, it's cheaper to get more riders for it, in the same way that we don't buy each member an individual Ambulance, we shouldn't be buying each member an individual CRU (although I've been told some counties do, and which I think is an awful idea).
So why are CRUs so great?
They make very handy Logistics Support vehicles on busy duties. If you need to shift equipment between two locations, the CRU is a fantastic way to do that. As is regular demonstrated.
It can respond to most jobs faster than a person on foot, and can go through crowds much safer and faster than any Ambulance can. It can carry a lot more equipment than a single person can over much greater ranges, and thus makes a brilliant first responder.
And then there's the "Ooooh" factor of them. A CRU gets a huge amount of attention. Even on my CRU training, I was getting people admiring it, even though the rear panniers had been removed. When North Yorkshire and Teesside's CRUs went on duty at a cycle show recently, the riders were inundated in people coming up admiring them. The bikes that is, not the riders.
Some St John counties own First Response Cars, which I simply do not see the point in (Member Support Cars, yes - Fast/First Response Cars, no). But a First Response Cycle? Oh hell yes! I can see lot of point to that. Anywhere that we have a large presence is a potential candidate for fielding a CRU. If members of the public are likely to be walking around an outdoor event, chances are the CRU can be deployed there too. It's much safer to move a CRU through a crowd to assess a patient than an Ambulance, and faster than sending a First Aid team. The skill set of the rider may also be greater than that on the response team, allowing them to back up a team and determine whether an Ambulance is required or not.
So yeah, I'm definitely in favour of them. They are a great asset when utilised correctly.
4 comments;:
Who is that stunningly gorgeous guy (other than the gurn) on the bike then? Love the cycling in the approved IPUMBA "one hand on the handlebars, chilling out" style....
Anywho, good review of the benefit:cost of the bikes. Though it's worth noting that we have the bikes for a very different reason to the stautory services (at least, most counties do) because theirs are there to meet targets.
The Lifecycle in York for example probably does more jobs in a week than the NY&T bikes would do in a year (even with the Jonah Twins taking them to events where they're not even supposed to be providing FA cover), so their benefit is measured in how many times they meet a cat A time (and so how much money they stop the government taking off YAS) and how many times they can stand down an ambulance (saving ~£200 a go). By that measure, if it can stand down 25 vans a year, it's payed for itself, let alone the dent it makes in cat A times. Then there's the benefit to the patients on having an AEMT/para on scene quickly, but that doesn't count in this target and cost based modern NHS :P
SJA bikes on the other hand provide the same level of cover as an ETA on a response team, but just get their quicker. They don't help us save or make money directly (unless we start charging extra for the bike, which is only starting to come in), they're more there for patient benefit than for making money. However, they can raise money for the organisation by providing advertisement for SJA, both in covering duties (I managed to blag three bookings by one blue light run at a rowing event) and in commercial training (which is an argument for not seperating training and ops within SJA... another rant entirely...)
However, the key point of your argument is solid. If we're going on benefit to the public, the bikes, at a tenth of the cost of a "response car" are worth far more to the patient, especially as I haven't yet been to an event where a response car has been used in a capacity other than transporting people around who have too much birdshit on their shoulders and cap to be able to move under their own steam. They also provide better advertisement - everyone and their dog has seen response cars before, CRUs are still a novelty that will draw people's attention, and through personal experience I know people will look and see it as an SJA vehicle.
Agreed about FRUs in St John!
The biggest problem I see with CRU members is when the CRU is made up of non-ambulance aiders - there seems to be a belief that being on the CRU = more qualified.
I've seen the CRU used to go and "assess the casualty, and let us know whether an ambulance is required" when there is a more qualified member on scene who has asked for the ambulance in the first place.
I've seen the CRU used to reduce the number of O2 cylinders/AEDs needed at an event - if a foot team need them, send the CRU - they've got O2 and an AED. One particular example, a team of 4 first aiders called in to say that they had a casualty who had a condition which called for O2 (can't remember what it was) 2 member CRU was sent to provide O2, then an ambulance to transport. 8 people on scene is just daft.
Add in an AFA CRU team who, recognising that they couldn't deal with the casualty, called for paramedic assistance (ETAs could have coped), and you have more Johnners there than can be kept occupied.
If we're going to use CRUs (as I believe we should), there needs to be some thought as to how we are going to use them effectively
@Chris Yeah, that is a problem. Here there seems to be an official unofficial AFA+gas or upwards rule (though I haven't asked for exact clarification - like he'd know anyway!). These *should* be more than competant and experienced enough to decide what skillset is required. However it doesn't overcome the issue of DMs sending bikes to routine patients that an ambulance aider has already assessed, that's just stupid.
In Cambs, anyone from AFA up can ride the bikes, but that's because we work mostly as a two bike unit, one of whom should be an ETA.
Chris,
I think your closing statement sums it up nicely. How the CRU is to be deployed needs careful consideration.
Sending it to assess a patient who has already been classed by an ETA as needing Ambulance transport is just stupid. And is a failing by the DM of that event.
Post a Comment