I have decided to finish off my discussion about my shifts on the Ambulance with a general discussion about my thoughts from my two shifts. What was good? What was not so good??
A couple of days ago, you read about my initial thoughts of the SFFD Ambulances. I said at that time, not to judge me for what I thought, and this is the reason why….
When Justin opened the back doors of Medic999, I just thought
“What a load of Rubbish”
As I looked around the vehicle, I saw things that would legally not be allowed in a UK Ambulance. Stock left loose on the bench next to the stretcher, open bins on the floor of the vehicle, bags lying unsecured in open cupboards and a manually lifted stretcher.
In the UK, our ambulance designs are now becoming a standard throughout the country. Everything has to conform to certain EU standards, specifically relating to roll over testing. Everything has to be secured either directly to the walls of the vehicle or behind cupboard doors. This leaves the inside of the Ambulance very clean looking and very clinical. It also leaves alot of space to work in, which seems like a good idea, doesn’t it?
It wasn’t until I got back to the UK and started working on my Ambulance that I realised how difficult it can be to work on a UK ambulance. Yes everything looks clean and clinical, but once a patient is on the back and a relative is sitting in the captains chair, then it becomes difficult to get into the cupboard, difficult to reach the sharps bin and difficult to gain access to alot of the equipment.
The SFFD Ambulance may look a little behind the times, but I became quite jealous of Justin sitting on the bench seat opposite the patient and just being able to get whatever he needed with the minimal amount of fuss.
Again, I think this is one of those cases where the best thing would be to find some ‘happy compromise’.
There are some things on my ambulance that I am sure would go down well in the states though, like a tail lift, to save the inevitable chronic back injuries from lifting the stretcher in and out of the vehicle. Also the ability to have access to both sides of the patient can be very handy in certain cases. Having a hydraulic stretcher is also a great help at times, although I do love the ability of the stretchers that SFFD use to convert from a stretcher to a wheel chair.
The first time I saw Jim do that little trick was definitely a ‘wow’ moment.
All in all, it really was like going back in time 7 or 8 years. Our Ambulances have moved on many times since we had that style of vehicle, and they continue to be revised and altered every couple of years based on staff views and opinions. They are not perfect by a long way, but I can definitely see the benefit is the layout of the SFFD Ambulances too.
Maybe if we didn’t have to comply with EU legislation all the time, we could really have an ambulance that is fit for the job and makes our working life as easy as possible. Like I said, let’s find a happy compromise.
Through my brief foray into blogging (nearly a year!) and my recent trip to the U.S, I have come to realise one thing above all others – EMS professionals around the world are basically the same type of people with the same concerns, aspirations and hopes for their profession. The Paramedics and EMT’s working for the SFFD have gone through a very tough time over the last 10-20 years and it seems that it is going to continue for some time to come.
Again, the similarities are striking, between our two countries.
First came the SFFD merger with the Ambulance service. Justin told me about the time that the Paramedics first arrived in the Fire Houses and had to take the ‘seat’ of one of the members of the Engine crew, resulting in that person being moved to a different station. Can you imagine how that felt to be the paramedic responsible for moving someone out of a long standing team?
It took some strong personalities and some excellent diplomacy from the staff on the road to make it work, and from what I saw, the Paramedics are now seen as part of the team in the Engine house as well as on the Ambulance.
We don’t have that worry yet in the UK, but it is always something that is mentioned in circles relating to cost efficiency and future plans. I can honestly never imagine it happening, and I sincerely hope it doesn’t. My Service finds it hard enough to have a corporate image and a sense of identity already, and I would hate to see us swallowed up by the Fire Service.
Then there is the constant change to the skill sets of the staff working on the ambulances. Whilst I was there I was speaking to a Paramedic fire fighter who had just been promoted and due to the promotion, was not allowed to keep practicing as a paramedic, but instead was to be classed as an EMT instead. What’s that all about then??
I was given the opportunity to discuss this with the 2nd in charge of EMS for the SFFD over the most beautiful steak I have ever had the pleasure to eat. Alot of the reclassification of some staff had to do with the good old intubation debate along with the constant discussion over retention of skills in those staff that do not frequently get to use advanced skills.
Chief Wong was a very open and interesting man to speak to and seemed genuinely interested in some of the things I had to say when he took Justin and I out for a meal one night. One of my personal highlights was when we were discussing a certain issue currently affecting the SFFD, and after I had given my view and opinion on a different course of action, he stopped for a moment, looked very thoughtful then said:
“I may well have to rethink that one a bit, thank you for that!”
Wow, did that really happen. Could a mere paramedic team leader from across the Atlantic really influence rather a big decision on the provision of EMS in San Francisco?
Who knows, maybe Chief Wong was just being polite, but I am happy enough knowing that I have planted the seed of a different outlook in his head.
Chief Wong then went on to embrace the Chronicles of EMS as well as our blogs and our Facebook pages. He seems to really ‘get’ social media, and in that respect, I am Jealous of those of you in the SFFD that you have senior management who are willing to embrace this wonderful new media and means of sharing ideas and best practice.
Both of our services will always change and adapt to the needs of the politicians, the management and hopefully the patients that we care for. One thing is for sure though…The change cycle will NEVER end.
The Treatment given
What I didn’t get the opportunity to see was Justin using all of his skills. In fact, when I think about it, the only advanced practical skill I saw him perform was cannulation and yes, he did hit every vein!
I would have loved to have seen some of his cardiac interventions that he has access to, which is where the SFFD is quite a number of years ahead of NEAS. Adenosine for SVT, Synchronised Cardio version, Transcutaneous Pacing, were all things that I would like to have seen so that I could push for them to be trailed back in the UK.
Oh, and of course CPAP!
But, just like reality, it’s not every day or even every week that we get the opportunity to really intervene and affect a patient’s recovery.
What I did get to see though was the routine, everyday use of the system to care for people and also the routine everyday abuse of the system by those who know the magic words to get them where they want to be for whatever reason they can think up!
The frustration is palpable in the professionals who work on the ambulances in the SFFD. I am no better than they are just because I can tell someone they don’t need to go to hospital. I am no more skilled in assessment because I can refer a patient to an out of hours nursing team rather than driving them to the local hospital. My knowledge is not greater just because I can decide what is the appropriate pathway of care to set my patient moving along. I just have the back up of my service and ultimately my government, to allow me to work with my patients to ensure they receive the right care at the right time and in the right place.
All of the Ambulance staff that I had the pleasure to work alongside all think the same things as I do and all would probably come to the same diagnostic and treatment decisions as I do, but they have to worry about getting sued each and every day.
M999: “Why did you do that Justin?”
HM: “Because I will get sued if I didn’t”
M999: “Why did he have to have that treatment?”
HM: “Because I will get sued if I didn’t do it for him”
M999: “Why did you have to take him to that hospital and not this one?”
HM: “Because I am legally obliged to take him to where he wants to go, unless it is a specific life threatening emergency”
The men and women of the EMS system of San Francisco have their arms tied so tight they may as well be in a straight jacket.
It is not any one person’s fault that it is like this. It is years of expectations, years of litigation and a system that does not have the support from above to change for the better. All I spoke to whilst there said that the Health Care Reform Act would not have any significant effect in the way that they do their jobs. Most were pretty sure that it won’t get through the next stage either, but all want to see some change to allow them to do the jobs that they want to do.
I only had the two shifts on the Ambulance, but it was enough to get a feel for what they do and how our jobs are different. My next challenge was to move onto the Engine and experience what it is like to be a paramedic and a Firefighter at the same time.
It should be interesting and I was really looking forward to being part of a larger ‘family’ for the next few days.