Tuesday, September 22, 2009

A disappointment

I know that first and foremost, I'm a software engineer. It's something that I'm good at, and that I do on a day-to-day basis. But I'm also an Emergency Transport Attendant (ETA) with St John Ambulance. That is something I don't do on a day-to-day basis, but which I do as a hobby. Consequently, it's something that I work incredibly hard to keep my skills up to date, and my knowledge moving forwards. I take this role seriously. And I work hard to ensure that I'm good at what I do.

That is why it annoys me whenever I hear of tales of others in the organisation who are clearly not up to scratch, and who show us up. We want to be taken seriously as a professional organisation, but we can not be taken as such if we're being let down by others.

Take for example, the following situation:

30 year old female, early stages of pregnancy, suffering contraction-like severe abdo pain which are getting worse, with PV bleeding. This patient was transported to hospital, but not with the same sense of urgency or severity that it should have attracted:

  • Taken in under normal road conditions (20-25 minutes through heavy traffic)
  • No pain relief given, despite the pain getting worse
  • Obs taken before transport was pulse, resps, BP and GCS. One set taken in transport, consisting of only a pulse. Yes, one set during the entire 25 minute run

When myself and a couple of other ETAs found out, we were shocked and appalled. There is the time and the place for going slow with jobs, but this was not one of those circumstances. And our ETA training teaches us to consider carefully what is best - to scoop and run, or to wait for a Paramedic. It often depends on how close we are to A&E, and how close the nearest Para is. In this case, A&E would have been obtainable in less than 6 minutes.

Unfortunately, cases like this do a great deal of damage to our reputation. So why have I spoken publicly about it? Mainly because this sort of thing winds me up so much, and because I feel that if just one person can take this tale and use it to help somebody else not make the mistake again, it will have been to our benefit.

There has been active drives within the organisation to improve the quality of our members, and this needs to keep happening. We have to do this, if we are to be taken seriously by others, and to stop the more offensive and derogatory comments being levelled as us.


GrumpyAmbulanceDriver said...

In all fairness their could be reasons behind it (stretching to very limit of my excuse making ability)

1)Pain too much to go in any faster or pain not that severe

2)Contraindicated - If suspecting a GI block then can't give it


I do feel I'm clutching at straws in trying to see the best in people though

The Explorer said...

Absolutely agree with you there. I've done up to PTA level so far and I have an interest in the ETA stuff. I'm very aware that I know little of the ETA stuff but, having been a volunteer casualty many a time for assessment days, I'm often shocked at the lack of knowledge of the basics that some members have.

Obviously there are many member that are absolutely excellent in their care of a casualty and their knowledge, but there are some where I'd rather take a random untrained member of the public and instruct them myself on how to treat me!

It saddens me because it only takes those few "bad" people to give the good ones a bad reputation that they don't deserve. I hope they further tighten up standards for the basic first aid and obs at every level as that's always what seems to let people down.

Chris Norton said...

Interesting post, you obviously strongly believe continual professional development is important. I have to agree with you - there is always something else to learn and ways in which we can better ourselves. Keep speaking out that's what I say.

Spara said...

Well without knowing all the details its hard to pass judgement however I can say with some conviction that if a Paramedic had done this, he would almost definately face a disciplinary hearing if not being striken off more or less. Although I appreciate the hard work ETA's put in and understand that sometimes their training does not cover all manor of incidents. I do no that they recieve a certain amount of training on Maternity cases that covers complications.

Im also slightly concerned that there was no Paramedic/Midwife sent to this job, I would query the ability of an SJA ETA being able to holistically and affectively manage an Obstetrics arrest with no assistance or supervision from an HCP. (Please dont take this as demeaning but I do know how serious Obstetric emergencies can be and how quickly things can deteriate and how they can benefit from interventions like rapid fluid replacement, syntometrine and affective management of a Post Labour baby).
The crew are not the only ones who should be held to account, however I can find little reason to justify the methodology in taking a full term HPV in with no stand by or on normal road terms.

Anonymous said...

Hi Nick I agree. My experience is 15 years in SJA, qualifying as an ETA in 2005 including cover for a regional Ambulance Trust. I qualified as a nurse in 2010.

Some volunteers talk as if they are paramedics but can barely apply the basics. They put themselves above the interest of the casualty / patient which could put patient care at risk. As a nurse I have been contradicted in front of casualties by less experienced Members and had advice ignored. Other volunteers have given advice about analgesia, in particular NSAIDS, (such as Ibuprofen) for which they are not qualified. Such disregard for the casualty / patient not only affects those who trust us but could also put professional registration such as mine at risk.

I believe ETA's should not do paid cover unless it is for patient transport (as distinct from urgent or Red calls) because we are not equipped technically or theoretically. For instance we do not carry glucometers(unless healthcare professional, until Member glucometer training is in place.)Or an ECG monitor. Also, importantly we are limited to the analgesia we can administer. The exception to the ETA emergency role should be voluntary duty emergency calls where we should notify ambulance control as to the severity of the casualty.