Panorama – Dial 999.. and wait..

My understanding is that the actual outcomes for patients are significantly better with experienced, dedicated and better resourced trauma teams, rather than numerous, smaller A&E departments which don’t carry the same resources or experience.

Maybe for Trauma yes but given that everything has to be transported to these hospitals, easily an hours journey, crew are often taken away from an area for around 3 hours. This may be for a minor injury that could have previously been treat at a local Casualty which now won’t treat the patient. Mean time the Trauma patient in question has to wait for a response because the ambulance is transferring the patient with the minor injury.

This is why they are prioritising responses as I mentioned above workloads and unnecessary call outs are putting pressure on the few resources we have. The services are looking at various ways to deal with this but they also have to save money so makes it very difficult. As a side note government funded Air Ambulances are not the answer at all.

That is true in many cases zulu, particularly major trauma.

It is however, another reason why the ambulance service is so stretched, as instead of getting a patient to a local hospital within a few minutes, they may have a journey of many miles and then have to get back again to provide cover for that area. Ask Drac 😉

Edit: He beat me to it 😀

[devil’s advocate]Back when we had 3 round-the-clock Casualty departments (as they were then known) within five miles of the city centre, if you were hurt enough to go there, but not so much that you needed an ambulance to get you there, you had what the government likes to call “choice”.

My understanding is that the actual outcomes for patients are significantly better with experienced, dedicated and better resourced trauma teams, rather than numerous, smaller A&E departments which don’t carry the same resources or experience.

Indeed, although one of our now-closed Casualty departments had a great reputaion for managing complicated fractures, much of the expertise from that department went up to the big hospital that didn’t close.

The same principle of concentrated expertise also follows for hip/knee replacements, dialysis and all manner of other complicated procedures and care pathways that are currently being sold off to “any willing provider” across multiple sites and employers/agencies/organisations. All in the name of “choice”. 👿

Entirely fair points

I read the random acts of reality blog since the start, and very much got the impression that the main problems he encountered (in london) were LOB jobs that had been allocated priority based upon the call centre computers (bad cold = difficulty breathing = priority) – is that still the case, or have they improved things now ?

(Drac, bearing in mind that I lived in Kielder for a couple of years, you’ll understand that I can see your point 100% – to be honest, we pretty much knew that we were on our own for a good while if anything happened, obviously before the community responder scheme)

Or why my wife’s work is so short staffed that they had to transport a patient 70 odd miles away.

1 Ambulance 2 ambo staff 1 midwife fuel etc. she was 1 hr late home no overtime for that. Its happening daily at her work. Worse if they have to take the air ambulance to edinburgh/glasgow as they then have to make their own way home if the air transport is required elsewhere. Dumped in another city by your employer.

.

Very understanding living in Kielder Zulu, Bellingham being the nearest station which is now a single manned crew.

I read the random acts of reality blog since the start, and very much got the impression that the main problems he encountered (in london) were LOB jobs that had been allocated priority based upon the call centre computers (bad cold = difficulty breathing = priority) – is that still the case, or have they improved things now ?

I’m on the road here in London and I can honestly say that nothing’s improved.
They try and mess about with the triage system and when they downgrade one load of rubbish, they upgrade others. One of the biggest culprits are GP’s. They claim that everyone they call an ambulance for needs an immediately sense as the condition is immediately life threatening. Very rarely is that the case, more often than not they just want the mildly ill person removed from their surgery.

I’m not sure what the answer to the problem is. The service down here seems to think that micro-management along with bullying staff is the answer. Needless to say, it’s not working for them.

We are currently losing a huge number of staff to outer counties services as well as losing them to sunnier climes, at the rate we’re going now, the problem will not get worse.

Over the past 2 weeks my service have been testing responses designed to put the patient first rather than just meeting targets

I think this is a huge issue for my work. It seems to have lost its focus that its a service to the public and trying to be run more like a business with targets to meet … which ultimately is a goal driven by the government for the service to be ‘accountable’ and have measured improvments … even though the measurements are not a true reflection of the service provided.

currently being sold off to “any willing provider” across multiple sites and employers/agencies/organisations

This – especially given that these dumbass reforms are being fudged in alongside existing efficiency-savings.

In my part of the world, emergency surgical admissions has always been busy – but now the trauma lists are getting ridiculously backed-up, with fractured NOFs etc being cancelled 2 or 3 times in a row (i.e. elderly patients are being repeatedly starved for theatre). And A+E is increasingly rammed (whether inappropriately or not) – as services are fragmented, I suspect people will feel they have nowhere else to go.

Hiving-off elective activity was always going to have a knock-on effect on emergency capacity & workforce training – indeed, Lansley & his DOH minions were specifically warned about the likely consequences. I hope new boy Hunt is prepared for what is coming his way… 👿

loved the responce from the fire person about the new landrover fire engines they carry 1 minutes worth of water.

ok for washing a bike tyre then.

a big fire in deeside, north wales last week, so they sent vehicles from all over north wales, instead of asking cheshire just down the road, or merseyside to send some, as they have a few more,that probably left a major chunk of north wales without cover,

To add some perspective, my mother had a health incident in the middle of the night in their beach house about an hour drive north of Wellington, in NZ. My dad called the emergency services, and was told to stick her in the car and drive to the nearest hospital, as that would be quicker then the ambulance could get there, and did they have their credit card with them ??

Town I grew up in only had a volunteer fire service, a big siren went off at the bottom of the valley and we would run to the window to watch the neighbour run out of his house in his dacks, run to his car and fly off down the hill.