“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.
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!