Posted by: medicblog999 | February 11, 2009

Car or Ambulance?

I am fortunate where I work. We have both a rapid response car and 2 traditional Ambulances on our Station. The rota works so that you work 8 weeks on the vehicle, then 4 weeks on the Rapid Response car.

When we initially gained the car onto the station rota a couple of years ago, there were various views on it. Some staff liked the thought of it, some didn’t want to work alone. Traditionally, if you wanted to work on a car, you had to apply for a position on a rapid response station and move onto the cars permanently. I used to work alot of shifts on overtime on the car before it came to us and I can honestly say that I enjoyed it very much, and was very positive about it coming to our station. Best of both worlds some may say.

So, is there a difference in the job when you work on the car compared with on the vehicle?

imgp0477The Ambulance

Working on the vehicle, you are part of a two person crew, usually consisting of a paramedic and an ECSW (Emergency care support worker) ECSW`s primarily drive to the emergencies then are trained to assist the paramedic in patient assessment and care of the patient on the scene. If a patient has no clinical need for paramedic intervention or close monitoring, then the ECSW may “observe the patient” on the way to hospital, but in the vast majority of cases the Paramedic will attend to the patient en route to A&E.

Working on the Ambulance, you are sent to all emergencies, no matter what the patient presents with. The crew is also dispatched to GP urgent admissions and inter-hospital transfers, and we can be sent on “dynamic standby” which places us in areas where the command and control computers predict that the next emergency may come in. Sometimes this works, sometimes not, but in essence if a neighbouring station has their crews out on jobs and both of our vehicles are in then one vehicle will be sent either to the station or in between the stations to cover the area.

22072007306The Rapid Response Car

When on the car, you work as a single responder, acting as an initial response to assess and stabilise a patient before a Ambulance crew arrives to take over care of the patient. The car is primarily used from standby locations. This isn’t to everyones liking but personally, I don’t mind sitting in a car park or lay-by as long as I have my iPod touch with a full battery and plenty of movies on it to watch (sorry, I meant as long as I have plenty of clinical journals to read!!!)

Rapid response is definitely, not for everyone though. All paramedics are capable of working on the car but some just don’t feel comfortable working alone, or attending to a critical patient and not being able to “get them in to hospital immediately”. To work on the car you have to be very confident in you assessment and clinical decision making. There is no safety blanket of being able to ask your crew mate what they think. However I also think that it develops Paramedics into being more confident as long as there is some support available to new Paramedics if they have to work on the car straight away.

As I stated earlier, I feel really fortunate that I have the option of working on both types of vehicle regularly, but I can feel myself being drawn more and more to working on the car whenever I can. If a position came up on a Rapid Response station I would seriously consider going for it. I enjoy working by myself, but it is not a lonely job. With virtually every emergency, you get to see various crews that are backing you up. You get the opportunity to catch up with alot of different people, and if the patient is a minor injury/illness then I will take them to hospital in the car rather than use another ambulance, so I get to keep in touch with the A&E staff too.  There seems to be a better relationship with control when you are on the car as instead of being just a call sign, they tend to call you by your name and the conversation seems to flow easier.

I thrive on arriving at a “proper” job, and being by myself. I like to make my decisions and treat the patient how I feel they should be. I am known as being a paramedic who likes things done “by the book” or at least with sound clinical reasoning. When you are by yourself you don’t have to suggest to a colleague that maybe they should do……. or have you thought about……? You just get on and do it!

Working on the car, you only respond to emergencies, no GP urgents or hospital transfers (obviously). The main difference however is that the car does not get sent to jobs where the patient is known to be intoxicated, if violence is the cause of the incident or if there is suggestion of drug use or overdose.

This is all down to safety issues of working alone. There are frequent times that these job slip through the net and you find yourself in a situation which you really shouldn’t be in, but ultimately, if the caller doesn’t tell the call taker the whole truth, then the true facts cannot be passed to me in my car.

So, yes, there is definitely a difference working on the car compared with the ambulance, but ultimately, we are all paramedics working together for the benefit of the patient who has called 999.

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