Voluntary services in the thick of it

I’m a regular reader of The Paramedic’s Diary and couldn’t help but notice the new poll question - Should the voluntary services support the ambulance service on frontline duties?

This likely comes from a recent diary post of his and I felt compelled to write just a bit about it.

Firstly, I’m commenting on this as it would be under usual circumstances - in the event of a major incident (London bombings, etc) then things are obviously different. I’m also basing this mainly on experience in St Andrew’s. I’ll be the first to admit St John’s are quite different on a number of aspects although I’ve tried to come at it from a combined VAS point of view.

The problem with this is how the definition of “support” is taken. If it means relying on a VAS crew attending any type of 999 call then I’d have to say no. Whilst training for some of the St John’s advanced courses (say Emergency Transport Attendant) is undoubtedly tough it is still nowhere near the level required for technicians and paramedics. A VAS crew turning up at a large RTC would, I feel, be quite overwhelmed and wouldn’t have the experience to help them.

Taking another situation, lets say a complication in late pregnancy, would possibly be worse still. Not only is there the medical condition to deal with but there is also a highly emotional situation that a number of professionals would probably not like to be in.

Further, what if there were complications in relation to the actions of the VAS crew? Insurance exists, yes, but to what level? What about regulation? A registered paramedic could face being struck off in a serious situation, but what would happen to a voluntary member? Would communication be effective enough to impose levels of discipline?

These may seem a bit far-fetched, but are foreseeable problems.

On the other hand if we take the situation where a patient is assessed by a technician/paramedic and that professional requests and is confident allowing the care to pass to the voluntary crew then that really is a different matter. Transporting a stable patient doesn’t carry quite the same risk as attending an unknown.

But in the event of a cardiac arrest when even basic lifesaving skills can help, this doesn’t really apply. I might even go as far to pick a VAS crew over a number of GPs I’ve met, basic lifesaving having long since left them.

I guess my point then is that VAS crews might have a use, particularly in busy or definite emergencies. The problems will start when they become preferential to qualified professions which, in today’s cost-effective health service, seems all too likely.

I often comment on St Andrew’s rather slow expansion capacity but if we ever get to the point of covering 999 calls I’d want to be damn sure we covered all the bases.

I’d be interested to hear other views on this and I’ll happily admit I’m not totally knowledgeable about the current policies.

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Company, Attention!

We had our inspection this week as planned and, thankfully, a new inspecting officer had to be drafted in at the last minute. She hadn’t, so I guessed, severed any length of time in the forces and as such wasn’t quite checking whether both boots had enough polish on them or not. Once she checked the line of members we got taken in to another room 3 at a time and asked just 3 questions, mine where:

• What is angina? (Would’ve been killed if I hadn’t got that right)
• How do you treat a nosebleed?
• How do you treat food poisoning?

In all, pretty painless and a lot less stressful than I was expecting. It was followed by a rather small buffet and then that was that. Done for another year.

Personally, I’d make it much more practical. Get people to attend in uniform and ask them to demonstrate a number of tasks as a company on each other. Then walk through them and ask questions. Would’ve been done so much quicker and probably highlighted anyone struggling (which there would be, under pressure).

In the morning I had a duty in the Kelvin Hall with my other medical student colleague. As we (and 900 primary kids) arrived we realised that we didn’t have access to our trolley beds and carry chair which are in the Kelvin Hall. If any relative serious happened (fracture or dislocation is what we were thinking of) we would have no real option but to keep them on the floor until an ambulance arrived. Since we were rather new we felt it would be the exact time that something serious would happen, but thankfully it didn’t.

Ice, plasters and TLC got us through the event.

We did manage to entertain a local newspaper photographer/journalist. He decided to take a picture of us with the possibility of it being included. Unfortunately I have no idea where I can get it so I can only hope it’ll catch my eye.

After that we both went to HQ (my first visit!) to get some uniform sorted. The fact it’s taken 5 and a bit months for me to get this bit of uniform (it’s technically what we wear outdoors) speaks volumes. The money (£60!) also comes out my expenses so for 15 duties I will receive no contribution towards travel. This really annoys me, since the event organisers are paying what I don’t imagine will be a small amount to get cover. I have no real problem with being a volunteer I just feel that out-of-pocket expenses should be covered, especially by an association which is in the position to do so.

In the evening I was attending the Scotland vs. Croatia friendly at Hampden. Unlike my last big match at Hampden, I was much more confident for some reason and we had a greater number of first aiders available. The event went without any significant injuries. We had a young (perhaps a bit younger than me) French-turn-Scottish fan start chatting to us before the match and he dutifully returned at half-time. I wasn’t too sure if he was drunk - I couldn’t smell anything - or just very excited to be there but he was an interesting character and I hope he enjoyed it.

As far as casualties went we had a middle aged chap looking for some paracetamol for a migraine. He got sent to the docs and got some co-codamol instead. We were expecting him to be back later in the game but that must’ve helped as we heard no word from him again.

Radio problems were all the rage on the night. We had a visit from two other first aiders to tell us our radio wasn’t working. By the end of the match we had to go back and tell them the same thing. Thankfully my colleague was dealing with the radio and was happy to do so because I could hear a lot of interference.

I was almost not going to be allowed to go to the game as our company were at odds with the exec over nothing other than money. I don’t even pretend to be interested in these debates - we’re volunteers and we’re not concerned about money. When we’re not allowed to go to an event we want to (and they’re struggling to get first aiders to cover it) then I don’t see why I shouldn’t move. In the end we were allowed and we made up about a 1/5th of the first aiders.

The form for covering T in the Park has been made available on the website. I really do want to do it (it may be my only year!) but I just don’t know what days I can do due to my (*shudder*) job. I’m thinking of just putting down the Friday/Saturday and sort work out when I’m actually employed. Will wait and see if I can gather up any support.

When is something “urgent”?

So there I was, dashing from shop to shop in the rain (although, thankfully, nothing like that’s been hitting our friends down south) when I receive a text message from my commandant. Normally when I receive a message at this time of day when we have training at night it is to tell me it has been cancelled. However, not so on this occasion.The message read something along the lines of “please attend tonight, letter received, urgent”.

My companion at the time started asking me what I had done wrong, assuming the message had been sent to just me. I racked my previous duties to consider if I had done anything worthy of a letter from above. They best I could come up with at the time was this poor blog. I wondered if someone somewhere had found it and had a problem with what I was writing.

As we pondered, I dropped a quick message in to one of my colleagues who also happens to be a Glasgow medic. They eventually got back to me to let me know that they might struggle to make it, being out of Glasgow and having a fair bit of work to do and I inferred (correctly) that she too had received the message. I also had a lot to be getting on with as my essay at that stage was far from finished. However, being urgent, I attended dutifully.

Was it urgent?

No.

I don’t think so anyway.

It was referring to the possible increase in insurance that might happen due to a lack of people attending moving and handling courses. This fee might even have to be paid by members! However, if that was to happen the company would pay it on our behalf. So all in all the letter was meaningless.

My colleague was really annoyed at this, as she could’ve been doing her work due in tomorrow. I was only mildly annoyed as I hadn’t really expected anything big. However, it raises a point.

If this is to keep happening for trivial matters (we have an AGM in 3 weeks, could’ve waited till then, no?) then when something that is actually urgent occurs I may be inclined to ignore it.

That said, something positive did take place which fully justified attending. We each received a new and improved first aid bag. They’re only about a month and a bit behind, but that’s not too bad I guess. Here’s a snap of the new (left) and old bag, with a pen for size comparison.

Ignoring the fact it’s a really bad picture, you can see why it’s such an improvement. Now all I need is some stuff to put in it. I think I’ve bought enough so I’ll just keep my eye of for free supplies.

Another benefit of attending was the chance to put my name down for a rather big event at the end of the month. Not 100% sure I can make it, but I’ll hopefully find a way to get there. All I need to try and do now is get a hard hat and blue suit before then. Heh, one can dream.

A few good days

Quite rare, but they do happen.

Just yesterday, when I talked to my mum and decided not to work at all over Easter and instead face financial mayhem, do I hear about an interview for a phlebotomy job. Considering I’ve applied for that about 3 times in the past, it’s progress. It’s next Wednesday and I just so happen to be free that day. Call it fate. We’ll see.

Even more impressive was my mum taking me to see cars and end up buying one. Sadly it’s not for me but I was still amazed at the abruptness of her decision.

Pain management is rolling along nicely. We have only one more clinical day outstanding and it’s paediatrics, which should be excellent. I have so far this SSM seen - people in pain, gynae day surgery, more people in pain, impressive surgery involving blood with colourful stuff in it, difficult intubations and difficult sedated patients, 2 caesarian sections (both girls, all well), fractured femurs and difficult hips, knee replacements and acupuncture. Quite a lot for 2 weeks! It’s been an excellent module and now I have to start thinking more about the report. I’ll probably stick with PCA as it’s quite a wide topic. Not sure if I’ll get it buffed up to the size required for the essay competition - it’s possible.

We have a tutorial tomorrow to discuss it with our supervisor so I’ll see what’s mentioned then. Following that I have what can only be described as a weekend of first aid - kids hockey, adults boxing (both Friday), Saturday football and helping out at a first aid class on Sunday. I didn’t quite plan it to happen like that, but if phlebotomy goes forward I may not have many free weekends left!

The importance of the web

Personally, I would say the internet is one of the most important mediums these days. Access is almost national and an organisation that didn’t have a web site would probably look rather silly. I’m sure most people would agree with me so far.

I wish St Andrew’s would.

The main site is pretty decent, a few technical errors but the content is good and pretty up to date. It provides a reasonably welcoming approach to volunteering and details of where people can go to find out more.

If you move from here onto the Glasgow Executive site then already the colours have changed, layout is different and personally it just doesn’t look as good. However, you’re going to have difficulties getting there anyway as the main page does not link to the Exec one. This sublevel is also not quite as up to date and certainly doesn’t have a very welcoming spiel for potential volunteers.

If we go even deeper into the actual company level, you’ll only find a few with proper web sites. Even then there are those with web sites and they have no incoming links. At this stage the layout resembles nothing of the main page and could be way out of date. The majority of them have no attraction for potential volunteers save perhaps an email address.

Ideally there should be some uniformity. I’d also like to see the same colours preserved across the sites, making it obvious that they’re all St Andrew’s. Further, there should be a contact form, as well as an email address, for potential volunteers. Further things such as calendars (which need to be up to date or are pointless) and pictures do nothing but add depth and hopefully spark interest.

I feel that St Andrew’s is very much an “old man’s” company. It’s resisting change as much as possible by sticking to phone numbers and sparse web sites (amongst other things). If it was to modernise just a little bit, it may bring in younger members who’re more enthusiastic about doing duties.

I really like the Grampian site - it looks by a large a lot more professional than the others and yet isn’t difficult to use. It’s also up to date (ish) and has a generally inviting feel (you can disagree with me if you like).

However my favourite so far has to go the Durham LINKS site. It’s a St John’s page so I’m slightly cheating a bit but to me it’s using the net to its best.

I have volunteered to help my company with the website but I’ve got no response. Maybe that’s a good thing as I’d be overly tempted to turn it into more than it probably should be. Then again, since our latest member found us on the web (though not the company site) maybe I’ve got a decent point?

What do you do?

You’re covering First Aid at an event when a member of staff from another, nearby, event asks you to look at someone from the other event.

However, they’re not paying for First Aid cover.

Do you decline, or agree to have a look?

Don’t really want to add any more specifics than that, although I know my answer would start with “It depends…”

Moving up

So I got to up my St Andrew’s experience this week by going to my largest event so far at the Rangers vs. Hearts CIS semi-final. The turnout as far as crowd’s concerned was 31000, give or take. To compensate we had 14 first aiders, 4 of which have to be available on the sidelines to staff the scoop stretcher. Another couple were in the first aid room and 2 were duty officers. This gives about 6 to actually staff the crowd. I got the impression, and well it was kind of obvious, that this was a bit few.

The thing I’m not sure about is why. For me to get there I had to do a bit of persevering but if they’re that desperate then I shouldn’t need to. There’s talk about us maybe losing the contract to do the football. I can’t really see that happening because there isn’t really anyone else to do it. Anything is possible though, I guess.

The actual event was pretty good, and a fair bit different from a Queen’s Park game. I had a good conversation with the other first aider I was on with and she filled me in on a lot of basics which I had kind of gathered by now myself. I was just below a bulk of Hearts fans, who were understandably disappointed, but loved making quite comments about the ridiculous hats we have to wear. I understand that there might be some things thrown at us that wouldn’t be comforting were they to hit us on the head. That said, neither the ambulance staff, security staff or stewards have anything of the sort. A bit excessive if you ask me.

I did, however, get a kit bag! It’s one of the old ones but damn it’s better than nothing. Now all I need is a little bit free cash to stock it properly. Phlebotomy anyone? It’s worth (another) shot I think. Maybe.

To intubate or incubate….

Maybe I’m just a trauma buff (which sounds horribly morbid and quite unwelcoming, I agree) but I would expect most 2nd year medics to know what is meant by intubation. Apparently not, as I found out the other day when a friend was stumped by the word, apparently taking it to be a typo of incubate.

I don’t know about anyone else, but I’d rather not be incubated when I needed intubated!

This might seem like a simple slip up and I was quick to correct him. However, it highlights a much more worrying aspect of our acute clinical knowledge.

I’d maybe be extending my ego slightly but I feel that if someone were to collapse in the middle of Morrisons (or wherever) I’d be able to assess them, assist them and maybe even take a stab at a possible differential. Ignoring the last, how many of my colleagues would be able to do so, competently if not confidently? Probably not very many and I know a few that would panic.

I feel there is a general lack of very basic acute training in the course (at least, so far). We’ve had 30 minutes, at a push, of CPR in year 1. This is examinable in our year 2 OSCE (which makes a lot of people worried!) but other than that we’ll receive nothing more till our final year when we are expected to deal with Advanced Life Support.

There is a course, Immediate Life Support, run in conjunction with the UK Resuscitation Council - which I’m trying (with minimal success) to get on - that provides an intermediate between BLS and ALS.

This, or something similar, should be taught to junior medical students at some point. Not only would it possibly save someone’s life but would also mean the medical student who’s always telling first aiders on duty what to do, actually has a clue of what they should be doing.

The beauty of it all is that whether I get to sit this course or not is completely irrelevant by St Andrew’s. They (unlike BRC) don’t recognise external courses and still wouldn’t let me take an AED course until I’d been a member for a year.

This then begs the question: if a situation arose where I was faced with using a defib or not, understanding the potential benefits and unlikely consequences, would I do so?

Honestly, I just don’t know. But if St Andrew’s aren’t happy to use me, I’m sure BRC would be!

St Andrew’s woes

Disclaimer - This is not meant to offend anyone and should not be taken as such. It is simply observations I’m making about my first 2-3 months as a member. My views my change over time or I may end up correcting some of these myself in the future (who knows?). I do enjoy it, regardless of what’s here

Around the start of November in my 1st year (06) I finally discovered the existence of the voluntary first aid societies (applicable to me were the British Red Cross (BRC) and St Andrews Ambulance Association (StAAA)). I’ve still got my initial email enquiries to firstly StAAA HQ trying to sell myself to them and desperate for further information. After a while (over a month of getting sent from HQ -> Exec -> Company) I got an offer to come to some room in Caledonia University on a Monday night. By this point I was home or going home for Christmas so I didn’t go. I’m a pretty shy person and was really looking for information, not being invited to some strange place.

In the end I tried the Red Cross. They scared me asking for references, birth certificates and more for an interview (in some far away location) by the end of a week. I apologies, explained the difficulties, and left it at that. March became August before I got round to trying to find out more. This was a combination of exam and summer holidays, but I wish I’d got my finger out earlier, I really do.

I got another invitation to come to some night. I didn’t want to do this, I wanted to know more first. The same people giving my the invitation were holding a public first aid class for 4 Sundays which I would finish just before going back for 2nd year. After a few more emails and cheque problems I got on the course and met some pretty decent people. I was still terrified going into the first class but the difference here was a hotel in the middle of the city and I knew the area reasonably well, instead of a office in the south of Glasgow or a Uni towards the north(ish).

After the 4 weeks I probed into joining the company. I’d already met a number of the members (though I knew it not) and all I had to do was get a Disclosure and some references….simple! The Disclosure was a major cock-up. I handed it in at the start of September and finally got in back in November, only because I phoned and found out it hadn’t been received. It was well over a year now than when I first contacted someone to volunteer before being considered a member.

—-
My aim here was to show the very negative impression I got out of these people. Why should volunteering be a chore for the potential volunteer? If I’d been given a standard reply to my enquiry providing my with information potential recruits would need, such as:

• What volunteering would required
• The structure of StAAA
• The contacts of exec’s and companies (which is available in the members section of the website, for some confusing reason)
• A general welcoming reply, without being ignored for a month in an email inbox

This would be a short document, kept accessible publicly on their website. How many potential volunteers are lost because of lack of information or by not being as persevering as myself?

But that’s all in the past. I’m here now. Boy, was my selling myself not required.

Being honest, and polite, I can only call what I’ve seen and heard so far as a bureaucratic mess. At the shop floor level things are pretty dandy - we attend, we treat, we leave. The problem comes higher up. A sample of problems:

• After ~3 months of being a fully Disclosed, uniformed member I still have no equipment or bag. I would buy my own but it needs to match everyone else’s. I’ve bought my own belt, cool packs, torch, face mask, gloves, etc but can’t do anything as I’ve nowhere to put them.
• I was never, ever, properly told about who does what in the company. What I know stems from the website and StAAA regulations (which I haven’t been given, found them in the lost pages of another company).
• Company training nights very rarely involve any training.
• There is a general attitude that you can’t “fail” at First Aid. I disagree. If you can’t perform basic clinical tasks you should not be allowed on duty.
• Things are far too hidden and secret, both at a company, exec and national level. Council meets regularly (I can now see dates!). Surely these meetings are recorded as minutes? Why aren’t they available? There is a distinct lack of any communication from above the company tier. Arguments at a company level are unresolved, left to brew until they spill over into public view.
• I only just got access to the member pages in the last 2 weeks. It takes that long to come up with an ID number and badge?
• I want someone please to show me how to claim expenses…
• I want someone please to tell me radio protocol (although I’ve read all about it in the regulations…which I don’t have)
• I want someone please to explain why I need to be a member for a year before being put on a training course for a machine designed for people without training.
• I want someone (please?) to show me how to put someone on a scoop.
• I want to feel as confident as people seem to think I am when I go on duty.

At lot of this could be addressed by having 2 or 3 of the training nights separating new members and running through a quick session. Nothing explicitly formal but things that are relevant and not included in a standard first aid course. We get new members all the time (about 3 since I’ve been in, most following a public class). This could be developed into a small handbook available for them to read. I may even prepare my own if I see new members struggling to work out what’s going on.

I have other, wider concerns about fitness for members on a duty. I won’t lengthen this post any longer by putting them in here so they’ll be later.

I have no idea if anyone interested will ever find this post, but that’s not really the point. If you do though and are wondering whether to join StAAA/BRC or have joined and are major confused, please feel free to contact me (up to date email address on about page). I won’t bite and might be able to answer some questions.

Above all I do enjoy the work, however much the above might not suggest it.

Goodbye 2007!

So it’s almost the end of another year. It also means I’ve had a blog for about 8 months. I’ve not wrote as much as I’d have liked but, looking back, I’ve done not bad. No idea who is or why anyone is reading this but I hope it’s at least vaguely interesting.

Christmas was pretty good. My brother got a Wii, which is slightly shared with me, so that dominated most of Christmas Day and a good deal of Boxing Day too. Went to the sales on the morning of Boxing Day but couldn’t find much that interested me. Still managed to spend a bit on clothes. My other vouchers will go on stuff for my bike most likely which I think I’m taking back with me to Glasgow

After Boxing Day I went back to Glasgow to do some St Andrew’s work on the Ice at George Square. I managed, somehow, to get the wrong day - I went on the 27th and wasn’t meant to be doing anything till the 28th. So I went and bought a copy of Runner’s World (in an attempt to motivate me, not sure if it’ll work) and also another paramedic blog book and went back to my (rather empty) flat.

The day later I was back on the ice proper, although the weather was terribly and we were some of the few. I met 2 British Red Cross members who were on with us and learned a lot of interesting details about the differences between StAA and BRC. It’s not really too relevant to me since, at the end of the day (hopefully), I’ll be a fully fledged doc. However for those looking to maybe go into the ambulance service, the training provided by the Red Cross is far beyond any offered by StAA and within about a year they’ll be almost training to the level of an EMT.

Some of the differences are common sense (anaphylaxis is integrated into the standard first aid), others seem to cut down the red tap - I wouldn’t have to be a member for a year to take an AED training course - and then there is the general higher training level, involving medical gases and transport to hospitals.

I’m not really in the mood to convert over - not yet anyway - but had I known any of this before joining StAA I may have been tempted the other way.

Anyway, the event itself was dead. We had only a couple simple casualties. I did, however, get asked to come back the day later. Unfortunately there was relatively little for us to do that day as well, despite the much increased number of people on the ice. I did marvel at the insistence of one mother who wasn’t having any of her son’s injured knee and made him walk home. Mother’s know best, apparently.

I could be at the castle for hogmanay, thankfully not doing any first aid. See you in 2008!

[Posted a bit late, but I did write it in 2007...]