Today I learned about the START system of triage. That’s what I do. Not triage, I learn about stuff. I leave triage to one of my ‘must read’ blog pals, Reynolds (Random Acts of Reality). He’s a London-based E.M.T. (Emergency Medical Technician – like a paramedic, only not as well paid) working for the London Ambulance Service. I learned today that apparently the time expected/allowed/allocated for triage in the UK is 60 seconds. In the USA it’s 15 seconds. Which perhaps explains why the British could never make ‘Rambo’. Thankfully.
Who cares if, in the scene where Rambo jumps from the cliff and falls through the trees, Sylvester Stallone not only did the stunt himself, but he broke three ribs for full authenticity? It was filmed, and it is in the movie. But so what? It’s just the movies. Hardly tough really.
What is tough is Reynolds today writes on a topic that may cost him his job, or at the least, may well be a CLM – a career limiting move. He starts with some basic assumptions –
(1) Ambulance workers are human beings, human beings require food.
(2) The government wants the NHS to spend less money.
(3) People who use the NHS have high expectations.
And then the story unfolds… it could be that Reynolds is just another moaning medical – it’s hard to engage with the endless whining from that corner of the economy. But then, why would he? Why would he burst into very public print, to shaft his own job and cash flow? From the article:
On the breaks themselves – in a 12 hour shift we are paid for 11 1/2 hours, we have half an hour unpaid break and 10 minutes that are interruptible. If our break is interrupted in those last 10 minutes then we receive a payment of £10.
Sounds like a man fed up. I can’t believe that British labour laws allow a worker (particularly one working in such responsible role) only 30 minutes break in a 12 hour day. I don’t doubt Reynolds, I’ve done those kinds of hours myself in a few job roles before today, but never in role that required life or death decision making. It doesn’t seem responsible.
Due to the budget pressures we have been put under recently there was essentially no overtime available. While we are supposedly fully manned it still meant that there were plenty of ambulances unstaffed. This situation was brought about by the government cutting our money, all at the risk of patient care.
When we have to provide the government with our response time figures we’ll flood the area with ambulances so that we can make it in a ‘big push’. Budget be damned. It used to be if we didn’t make the target then our budget would be cut – now they cut it regardless of us making our targets.
Oh, now that’s good. Brilliant, in fact. I can see how cutting budgets when targets are met can be good for morale. If we were making a movie about this it is increasingly sounding like Brazil II. Laughable, in the delicious British black comedy tradition. Except lives are at stake.
Clearly, the situation appears to be riddled with too many questions with too few answers. Wellington has a free ambulance service. To the best of my knowledge, that’s unique in New Zealand. I’m not sure how it is funded, other than I know there are street appeals, and it is possible they contract the service from central and local governments. What I have seen is locals exhibiting a strong sense of loyalty if not love, and gratitude for one of the only free medical services available. Everyone seems to have a very warm feeling towards the service – a feeling of some pride. I’m probably wrong, but I don’t imagine there would be too many people ringing them on 111 as Reynolds notes, because they can’t find their trousers.
Solutions? Reynolds offers four – first – to lower the expectations of the public toward ambulance care and possibly the NHS. He discounts this.
Second – reduce the number of calls either by filtering the calls or educating people to not abuse the service. He doesn’t like the idea of user pays. Well, that’s it for the New Zealand solutions – user pays coupled with crap service.
Third is for the government to invest more money and to stop stuffing the service around. Reynolds correctly observes that if you’re running a business you wouldn’t expect to be able to expand your company without some form of investment. In my opinion it is unreasonable for the tax payer to stump up for a service without having some expectation that there will be accountability for the return on the investment. I think there’s some tension there between the for-profit model in what is essentially a not-for-profit, service based industry.
The fourth solution is about forcing the government to pay attention. A kind of work-to-rule based on the refusal to supply stats. It sounds a bit like a frustrated person wanting to slap them back. No surprises there. We need to take a rolled up newspaper, strike across the dog’s nose and in a firm and clear voice say , “No!”. Well, it is the year of the dog, after all.
I’d like to humbly offer a fifth solution. There was something else I learned today. On the 29 December 2006, Economic Secretary Ed Balls announced that the British government finally paid off the USA and Canadian governments for money borrowed to fund World War II. Some sixty years later, the final payments of $US 83.25 million to the USA and $US 22.7 million to Canada were sent. Done. Finished. Finally, Britain is free from the annual installment plan negotiated by none other than John Maynard Keynes himself.
Oh, Reynolds, I know what you’re thinking. Jeepers, that’d give us $US 105.95 million – approx 53.59 million pounds, or, 79.54 million euros extra in the kitty. I’m guessing that running an ambulance service for Britain is extremely expensive, but I bet it would be better for having a million pounds a week poured in. There’s be 1.59 million pounds left over at the end of the year.
Let’s split it – say half each, less a new pair of trou for that mad buggar who has to dial 999 to find his…