Posted by: medicblog999 | April 14, 2009

One big happy Pre-Hospital Family?


This post is in direct reply to a comment made by NickF on my recent post “Patient collapsed – First aider on scene”. If you haven’t read his comment, have a quick flick back and see he questions before you read on! Specifically, the point I want to discuss is :

“I know some professional ambulance crews hate SJA, assuming all members are either well intentioned buffoons or failed/wannabe 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.”

Right, lets crack on then…..

Firstly Nick, I think you are spot on with the part about mountain rescue, and it is the fact that they are so highly trained in a very specialised skill that they are invaluable in some situations, and no-one is better at doing that job than they are. Mountain rescue teams are often made up of some paramedics, doctors and other health care staff as well, so even though they are volunteers, some still have advanced health care skills, above and beyond that of mountain/outdoors medicine. Because they hold such a unique position in their communities they are quite rightly highly respected.

I understand your frustration of how the St Johns Ambulance service is seen in this country, and to be honest, I am sure there are many of us, and the public, out there who do hold the view of “well intentioned buffoons or failed/wannabe Paramedics” (your words, not mine!!). The tough part is how to get past that.

Again, its all down to mutual respect and understanding. I work alongside St Johns on many occasions throughout the year, usually at events such as concerts, football matches, great north run etc etc. These are the places where St Johns and other voluntary services excel, and lets be honest, without your presence, along with the other emergency services, the event wouldn’t even be allowed to go ahead. I may well be wrong here (please correct me if I am) but the majority of the St Johns ranks are first aiders, with a proportion of them trained to the level of ambulance aid which allows those to transport patients to hospital.

I think that paramedics and ambulance staff only have issues when St Johns and Red Cross etc are used inappropriately (in thier opinion).

Let me give you an example. Every year the North East Ambulance Service is supported by Red Cross and St Johns Ambulance during the wonderful “winter pressures” and over the festive season. Your volunteers come out in their very nicely equipped vehicles and help bolster our numbers, so hopefully the paramedic crews can deal with the “proper poorly” patients! Your service and assistance is invaluable to us and should be recognised by every paramedic out there…BUT…. if you are sent to deal with calls that are not really appropriate for your level of training, then that is when the public and sometimes the paramedics can start to show their opinions. Its not the St Johns ambulance crews fault (most of the time) but instead it is the jobs they are dispatched to from our control room, and again, its not their fault either, as they can only make dispatch decisions based on what they caller tells them over the phone.
Used correctly it gives the St John and Red Cross staff valuable experience in the 999 setting and let’s be honest, the most of what we go to, especially, over the holiday period is usually minor injury and illness which is very appropriate for the voluntary agencies to deal with.

However, If I was having a MI (heart attack) and a St Johns Ambulance crew turned up at my door after I or one of my family had called 999, I would be asking when the “proper” ambulance would turn up. Nothing against you guys, but I would want my 12 lead ECG transmitted to the local PPCI centre, I would want my aspirin, buccal GTN, cannula and Morphine. I would want to know that If I arrested en route or went into acute LVF (left ventricular failure), that the member of staff looking after me could give me the best that the North East Ambulance service can provide. If you turned up, you could still provide an essential service to me as a “first responder” and if I arrested you could hopefully keep me viable until the advanced care arrived.

That is where the voluntary service helps the Ambulance service, and that is why every time I see a St Johns or Red Cross ambulance driving past me in my rapid response car or Ambulance I will wave. If I see you in or outside the A&E department, I will stop and see how you are getting on, if you are having a good/busy day, and that is why if we are working on a patient together, I will value your opinion, be grateful for your help and appreciate your input.

We are all pre-hospital care providers, but we all fit into various sections of the spectrum. Its like when I joined the ambulance service from being a nurse, people thought I would have a head start at being a paramedic. The truth of the matter is that being a nurse teaches you very little about emergency situations outside of the hospital (unless you are an A&E or ER nurse). St Johns, Red Cross , community first aiders, and mountain rescue are trained to deal with specific circumstances and types of patients and each have their very own place in providing emergency care and first aid to the community they serve. When we work together, we make a great team, as long as we all understand, respect and value each others contributions.

I know for a fact that many people join the voluntary emergency services as they want to dip into that side of things before they try the ambulance service for a career. Mrs Medic999 was one of those people. She used to be a St Johns trainer in her youth (some of the stories she can tell about the camps !!!!). Our very own Clinical Practice Manager for the service comes from a Red Cross background, and I know quite a few paramedics who are still active members of the Red Cross and St Johns Ambulance Service.

Finally, I have never heard of the term “Johnie haters”. It brings a whole other image to mind for me!!!

I really hope this hasn’t come out wrong. I am just trying to reinforce the point that we all have a service to provide and each is valuable, but is distinct in its own way. The only trouble we get into is when the edges get a bit blurred and we start to overlap into someone elses expertise (without the relevant training), although you would never, ever, get me absailing down a cliff to get to a casualty. I`ll be the one sitting in the back of the nice ambulance waiting for the lovely packaged patient!!

If you think I am talking a whole load of rubbish, please let me know in the comments!


  1. I’m at St John first aider and have found the few ambulance crews I’ve personally dealt with to be very appreciative. The BASICS chaps were pretty friendly too, though I’ve not dealt with them ‘professionally’!

  2. I’ve been in st john for over 20 years an have seen attitudes change and change back.when i started remarks like depriving ambulancemen of overtime abounded.when our service went trust we were classed as rivals?
    lately we have a very good relationship as we are seen as useful backup.recently spent 1/2 hour in a car supporting a neck injury(multiple minor casualties)treated very well by paramedics.i agree we have some problem members but most just want to help.i know my limits and can scream very loudly for help. some of my friends are trained to a higher standard and have used those skills more than once.i am trained to advanced first aider and that’s as far as i am comfortable.we have nurses doctors and paramedics in st john and we will match the needs of the duty with the people we send.we are’nt prtending to be a full ambulance service but we can plug some of the holes.

  3. I am one of the erstwhile silent lurkers … I really enjoy reading your blog.

    I am a member of St John Ambulance; I crew the ambulance, I’m a (commercial) trainer, and I also work occasionally as bank staff for the Patient Transport Service.

    Generally speaking, we have an excellent relationship with the professional ambulance staff – no doubt helped by the fact that they know that we are trained (and assessed) by ambulance professionals. In our area, we have some very large community events which could not happen if we were not present – the ambulance service simply does not have the resources (personnel or vehicles) to staff them. On these occasions, we effectively become part of the ambulance service – if there is a 999 call, we will usually be the first response (road closures make this pretty much a necessity), but HCP back-up is always available to us (our own paramedics, technicians, nurses and sometimes doctors if the ambulance service personnel are already busy with casualties). We are frequently used to transport casualties to hospital – including on ‘blues and twos’ – but always after a full and careful handover from the ECP / paramedic.

    We often don’t get the same sort of respect shown to us when we try to hand over the casualties at A & E!

    A trend which I find worrying, though, is that (at other times of the year), if we are on duty and request (professional!) ambulance attendance, we are sometimes asked by the control staff, “Can’t you take them to hospital?”. Umm, actually, no. We know our limits, and if we’ve asked for back-up, it’s because our assessment of the casualty is that they need more treatment than we can provide (perhaps stronger pain relief than the Entonox we can administer). What’s your take on this, Mark?

    PS We are St *JOHN* Ambulance (notice – only one S, at the beginning of ‘Saint’). Thank you!
    **climbs down from soapbox**

    • I have to laugh!!, I got one of my mates at work to proof read this post before I put it on as I was trying to make sure that what I wanted to say came out the right way.
      The only comment he made was
      “Ohh, someone will say something about you calling it St Johns, instead of St John!!!”
      How right he was.

      As far as control asking you to take patients to hospital, the easy way to deal with it, is to inform them that the patient requires care beyond the scope that can be delivered by the St John crew looking after him/her. If control tries to “persuade” you to take them you have to be firm in what you said.
      If the proverbial hits the fan and something goes off in the back of the ambulance whilst you ae transporting the patient, it will be on your heads, even if you requested a crew.
      There may be some very rare occassions where the delay in waiting for a full A&E crew may take longer than the journey that you could give the patient to the A&E. If that was the case and you truly felt it was life threatening, then you and your crew mate would have to make the decsion in the best interest of the patient. As long as you can give good clinical rationale for your decisions, you will be safe.
      As I said in the post, we all have our areas of patient care, the skill is to know when to ask for help and when you are safe to deal with the patient in front of you.
      You certainly seem to have cracked it!!!

  4. Mark,
    What an excellent and well balanced response to my original comment.

    I must admit I am slightly embarrassed that my comment has brought about a complete post from yourself.

    Looking back at my original comment I think I may have been wrong to use the word “hate” to describe the way that some NHS ambulance staff seem to regard us, I think perhaps disdain or contempt would have been a better word.

    I think you are spot on when you say a SJA crew on NHS cover should be treated as a first response to an MI and a Paramedic should automatically also be responding, but you and I know that isn’t always possible within a reasonable time and so the SJA crew are then in a difficult position – do they load and go or wait for the Paramedic with all the right tools and skills. Sometimes the answer must be load and go even though we are relying on our somewhat limited arsenal of Aspirin, O2 and an AED.

    I am glad you take the time to speak to volunteer crews when you come across them – you perhaps may not realise how much something like that is appreciated by us. I would also say that a “well done” to the First Aider who may only very occasionally need to call an ambulance is always appreciated.

    I think some time with SJA ETA’s (Emergency Transport Attendants) 3rd manning with NHS crews would be a good thing that would, hopefully, build some respect for the St John crews but this does not seem possible in our area. I expect there are some insurance/H&S issues.

    Thanks once again for such a good post – I see you have been properly chastised for the sin of adding an “s” so I won’t comment on that.

    I look forward to your next post.

  5. As a Community First Responder, I know my place! We are there simply as a first response and we know that a crew or Community Paramedic will be backing us up.

    When they arrive, our job is effectively done but we’ll often stay either to learn a bit or to act as bag carriers. Obviously there are some circumstances (e.g. cardiac arrest) where we can take a more active role even after the crew arrives.

    Our CFR Unit is part of St John but we run autonomously from the local Division, reporting to County.


    I doubt that there would be any problems with you 3rd manning as an “observer” with a crew. As CFRs, we are encouraged to spend two shifts a year with either a crew or an FRV. I try to do more, as I find it a great learning opportunity.

    Get your Superintendant to liaise with the relevant duty manager. I find these blokes really keen to get volunteers.

    Mind you, I did New Years Eve nightshift with a FRV. Soooo boring – about 5 calls all (12 hour) shift.

  6. Thank you for your advice and encouragement, Mark – and I hope that my ‘soapbox’ reference meant that you realised that my chastising was of the gentle, twinkle-in-the-eye variety!

    When we have been asked to transport, the reason seems to have been to avoid tying up NHS crews, rather than their non-availability. Thus far, we have stood our ground, and have then had a fairly quick response!

    A few years back, though, some of my colleagues were in the sort of situation you described: a casualty with serious injuries, A&E about 30 minutes away on blues and twos, and the nearest NHS crew about 40 minutes away (beyond the hospital). After discussion with ambulance control, they transported the casualty, met the NHS ambulance en route, and the paramedic transferred into their vehicle for the remainder of the journey. Not ideal, perhaps, but it meant that the casualty arrived at A&E – with paramedic care – much sooner than he would have done if they had waited for the NHS ambulance.

  7. Valid points, the back up by SJA & Red Cross is the only thing that stops the system crumbling, I’ve even travelled, with a patient, to A & E in the back of a Red Cross Ambulance and the crew were keen and helpful, if I was back on the road I’d rather have their help than none at all…

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