Posted by: medicblog999 | April 12, 2009

Patient Collapsed – First aider on scene!!

first-aider

“Pt Collapse – First aider on scene”

When that comes up on the terrafix system in the cab, it always seems to bring some remark from the staff on the ambulance, and not always a positive one. This isn’t through any inherent dislike or disregard for the abilities of first aiders, or the crucial assistance they can give both before we arrive and once we are there. It is through direct experience of dealing with many, many first aiders either in the work place on in large public shopping centres, just like the one directly opposite my station, less than a mile away.

Over the last 9 years I have seen both very good and very bad first aiders. I have seen a patient conscious on the floor trying to pull off defib pads whilst a automatic defib is announcing loudly

“Please wait – assessing rhythm!!”

I have also seen excellent CPR which undoubtedly made the difference in a successful ressus we attended there a couple of years ago. I have gone through years of feeling frustrated with the calls that they decide require an ambulance response, even when the patient tells us that they didn’t want an ambulance but the security staff/first aiders made them wait whilst they called for one.

There are unfortunately, many of us out there who, I feel, do not treat first aiders with any respect, and instead approach them and listen to their handovers with a bit of contempt and dis-interest. I have to be honest, and say that I used to feel like that too. Whether this was because of some inflated sense of self-importance (what can they tell me that I don’t already know or that I can get from the patient themselves?), lack of understanding of their role in the great scheme of things or just frustration, things have changed recently which have made me look on them in a different light and in return, I am now having a very productive and positive relationship with those I deal with on a regular basis.

Its not until you step back and think what it must be like for a first aider, that you start to understand why we get the apparently inappropriate calls. There have been times when I have got on scene and after assessing the patient and informing them that they do not need to go to hospital, once the patient leaves, I have a chat with the first aider/security staff who called us. The conversation tended to go like this:

M999: “She was absolutely fine, what made you think she needed an ambulance?”

FA:       “Well, she tripped over and fell against the display cabinet, she said she was okay, but we didn’t want to let her get up until you came and said she was ok!”

M999: “Alright, would you have called an ambulance if it was you that had fallen?”

FA:       “Of course not, but I have to be responsible for what happens with her. If I had gotten her up and it turned out she had hurt her legs/hips/back, I would get into trouble”

And there is the crux of the matter, and its exactly the same for us as ambulance staff.

Where does the responsibility end? On who’s shoulders does the buck stop at?

Sometimes, I will take a patient to hospital when I am pretty sure they do not need to go. There might be just something niggling away at the back of my mind about them, so my decision is to take them to the A&E for the doctor to check them out (i.e the buck now stops with the doctor). This is after 3 years nurse training, 3 years practicing as a registered nurse, 3 years as an advanced ambulance technician and a further 6 years as a paramedic. That’s alot of health care experience, yet I used to get frustrated when a normal member of the public with a 4 or 5 day course in first aid is not willing to make a treatment decision!

Looking at it like that, I am almost ashamed at some of the attitude I know I used to give off when working alongside the first aiders/security staff at my local large out of town shopping complex (it would be much easier to say shopping mall!). I have changed though, and I have noticed it mostly over the last year or two. At times I can be called the the shopping centre 6 or 7 times in 3 shifts. One day I decided to start to get to know the first aiders a bit more, we started to have a chat whilst on the way to the patient, and not just about the incident. I started to look forward to going there for jobs, to see who was on duty and just to say hello. I listened properly to their handovers, and if the patient was proper poorly (there’s a north east saying for you!), then I would get them involved in their care and try to teach them a bit as I go along. If I am on the car, once the crew arrive and take over care, I will thank them for their help and if needed we will have a little chat about what happened and if there was anything to learn from it. I figure, the more they feel confident and comfortable with what is going on, the better we will work together if the proverbial does hit the fan!

I have definitely changed. I now realise that these are people who have put themselves forward to have the responsibility to try and help someone in need. Lets not forget that the vast majority of the public would rather walk past someone in dire straits than actually stop and help. They have had minimal training and in most cases, even less experience of dealing with the scenarios they learnt on their courses. Sometimes you can see the relief on their faces just as much as the patients when the ambulance turns up. Yet, they are still there every day, waiting for the opportunity to make a difference for someone. They are an essential part of the “chain of survival” especially in cases of cardiac arrest.

chain

Looking at the chain above, as paramedics, we dont really come in until the last link.  A good first aider will be able to deal with the first three before we even get there (assuming they have access to an automatic defib).

I hope there is one around if I ever drop down…..

So, this post is for all the security staff and first aiders at the Metro Centre in Gateshead! Thanks for helping me out over the last few years (and carrying my bags for me!!) I will probably see you in a couple of hours when you open the doors!

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Responses

  1. Having been fascinated by your blog for several weeks now and following on from this post I wonder whether you might like to say something on your experiences (if any) with CFRs? I declare an interest as a CFR of some 12 months’ experience in the North west.

    In the meantime keep up the interesting posts. They are much appreciated.

    • Hi Blueberry,

      Unfortunately, I have not had any experience with community first responders. My station is fairly central in a large urban area and all of our community responders are located in the rural areas on the outskirts of our service area.
      We are constantly looking for more CFR, and I have no doubt that as we all struggle with response times etc, there is a place for CFR in built up areas as well as rural.
      From what I have heard though, the experience on both sides is the same as my post on first aiders. We have some excellent first responders and some good first responders. The couple I have managed to talk to in various forums have had the experience of working with some very good and approachable paramedics and some not so welcoming.
      Personally, I will always be appreciative of another pair of hands on scene, and I would love to take a patient from a CFR and genuinely say that they have really made a difference in saving that patients life!

  2. I’ve been reading your blog for a while, but never commented because as a first aider (and a fairly new one at that) I don’t feel like I’ve got a lot to contribute.

    I’ve been a volunteer first aider for about 6 months now, and it’s unbelievably intimidating. Fortunately, our volunteer group is directly sponsored by the local paramedic service. It was, in fact, an initiative started by the service just a few years ago, and it goes beyond just paramedics teaching us some basic first aid skills. They also take the time to show us the ambulances and the equipment in them, how dispatch works, how to use the radios without sounding like an idiot, and just overall provide a lot of ongoing training both for first aid, and for understanding and collaborating with the paramedics who arrive on scene.

    Obviously there are some who’d prefer we stay out of the way, but there are enough who are friendly, supportive and take on roles as our mentors that a large number of our volunteer group do go on to become fantastic paramedics and nurses. I certainly hope that in a few years I won’t be just another volunteer underfoot, but a paramedic with the service, and perhaps a mentor for others looking to “get their feet wet” before fully deciding to pursue paramedicine as a career.

    • Hi TJ,
      Thanks for commenting. Please dont feel that you dont have anything to contribute, you are in this wonderful blogosphere community now, and your views and opinions are always welcome here (as are any questions you have about any of the posts!)
      I have to say that the scheme you are part of seem fantastically run, more like a community first responder scheme than a first aid programme. Its great that you get so much support and input from yourambulance service. Im sure that if you decide on paramedicine as a career, the experience you are gaining now will be invaluable.
      Do you have the opportunity to go out observing with crews? If so, take the plunge and get to know some of the crews and see what its like in the job on a day to day basis!
      Thanks again.

  3. There’s only one thing worse than a first aider……..

    And thats a drunk first aider!!!!

    Said tongue in cheek don’t worry. ;o)

    • No Mart,
      I think you`ll find that what is worse than a drunk first aider is 14 drunk paramedics!! Long story, maybe I will share it one day

      Mark.

    • That sounds a decent story – My missus is a Geordie – I know how you can put the alcohol away – I am a positive lightweight in comparisson!

  4. It was very interesting reading this particular post, in regard to one of my recent posts on my blog (no advertising, I promise!) I was acting as a first aider, as I was in a pizza restaurant with my family at the time. The way the crew seemed completely disinterested in my handover, and in me as a person, was a real eye-opener.

  5. Like Blueberry, I’m a CFR (with EMAS).

    The majority of crews and solo paramedics I get to deal with are brilliant. There are some, a small minority, who think that we’re either a nuisance or (worse) being used instead of professional personnel. Dream on if you think abolishing CFRs will get more full-time crews.

    Most of the paramedics and techs I deal with want me to learn more. They want us up to FPOS 2 at least.

    Ambulance Control sometimes get the cry “Where’s my bloody Responder?” from the solo paramedic if we have no one available to cover the shift.

    It’s not always been like that with our unit, but we’ve worked on getting to know the crews and CPs.

    Incidentally, some of the greatest respect I’ve had was from a “three-pip” who was keeping his eye in as a paramedic.

    • One of the best responses I’ve had while I was a CFR (I left due to Ambulance politics, but that’s a different story) was a paramedic who, on arriving on scene, held his hand up and stopped everyone else from talking until I’d finished my handover. He asked a few extra questions and then asked me to continue my care while he prepared some of the more advanced care he was about to give. It left me feeling like a valued part of the team.

  6. As with tj above I am a regular reader of your excellent blog but have never commented as I am “just” a St John Ambulance volunteer (I am trained to ambulance crew level with SJA but still attend many events as a First Aider).

    Your recognition of the role of the First Aider is creditworthy in my opinion and your understanding of the feeling you can have as First Aider, who may have little knowledge of what is happening to their patient, and may have no real idea what to do next is excellent.

    I wish all Paramedics who arrive to find a First Aider on scene were as understanding and, where possible, gave the First Aider a debrief with some constructive criticism where necessary.
    Some Paramedics are even worse when the arrive and find a uniformed “Johnnie” attending and can be very rude and dismissive.

    I know some professional ambulance crews hate SJA, assuming all members are either well intentioned buffoons or failed/wanabe Paramedics. I would be interested in your opinion.

    I often wonder why when we are in trouble up a mountain or at sea we are happy to see a team of dedicated and well trained volunteers turn up and think them heroes (quite rightly) but if a SJA ambulance turns up it is seen as second rate service – I assume it is because there is a professional alternative but I still think it is a bit unfair.

    Keep up the good work and, don’t worry, I will continue reading even if you are a “Johnnie hater”

    • Hi Nick,

      Dont worry, I am not a Johnie hater, far from it!!

      However, I do have some opinions, but I think that will make a decent blog post. Ill try and write it today.
      Look forward to your comments on it!

      Mark

  7. I’ve had a range of responses from Ambulance staff, and it’s interesting to note them. Most of my contact with ambulance staff has been as a CFR, but I’m also a mountain rescue medic. The MR training is a lot more technical than the local CFR protocols (which are basically BLS+Oxy+Defib) and the local ambulance staff seem to know this as I would get very different responses when they dealt with me as MR than when they dealt with me as CFR.

    I’ve mentioned above the best response I’ve had as a CFR – I’ve also spent some fantastic shifts “observing” on an RRV in Caerphilly with two excellent Paramedics, both of whom are not only obviously highly skiled clinicians, but are also excellent teachers. I can’t commend them highly enough for their attitude – not one of dismissive derision, but recognising the value of the first aider and trying to help us improve our skills to make us more useful.

    This is unfortunately however the extreme on the good side. The typical response is not so much active disrespect as just a general apathy. The one thing I’ve found that makes a big difference here is the handover. If I give a professional and thorough handover, the response is usually surprise before they indicate a general happiness to work with me in caring for the patient.

    Finally, I’ve also seen some bad responses. Outright rude refusal to swap an empty Oxygen cylinder for a full one when the ambulance is well stocked was something I came across several times. I’ve also had one medic who had responded for a 999 call to a hillside to deal with a patient who refused to handover the patient to mountain rescue (and did so in a very rude and dismissive manner and with no clinical reason) when we arrived when he, the medic, was clearly starting to suffer from hypothermia. His colleague was visibly embarassed by his behaviour and it left us in a very awkward and difficult position.

    I’m very glad to see this issue being raised in public – it’s a very emotive subject especially as Ambulance services look to cut costs and provide a more “efficient” service, some ambulance staff will see volunteer assistance as jeapordising their jobs.

    Thanks for a good post and an informative and interesting blog.

    Cheers,
    Aled.

  8. Just started reading your blog last night and backtracking through alot of the posts! Very good i must say!

    On this topic, i too know many people who claim to be first aiders but all they do with a patient is comfort them, no medical input, now thats grand aswell, it has its place.

    Whenever i come somone in the road/street or wherever, i always make a point of giving them the best care possible until someone else arrives. On handover, i always make sure to give details of incident, and my initial assesment(pulse/gcs/allergies/meds/cap refill/resp rate/location of pain/pain scale etc) Any of the paramedics ive come aross have been very gratefull for this because it gives them an insight into the patient before they had got on scene.

    So i suppose i can see both sides of this argument, and also the thinking of paramedics when they see first aider on scene!

    • Hi Niall,
      Welcome to the blog and thanks for reading!


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