Sunday, 25 April 2010

Duty of care

As you know I work on the Clinical Support Desk and most of the time I'm advising and supporting crews and other staff with issues that need resolved or clarified. Sometimes the decisions we make on the desk are tough and necessary but it improves me as a paramedic. It's also opened my eyes to the difficulties faced by my colleagues in Control; calltakers talking hysterical parents through the resus of their babies; stabbing victims who lose consciousness while talking to them and angry, awkward and abusive people who just want to insult and denigrate them. Hats off to the lot of you on the 9's.

I've also learned how difficult it can be to persuade someone with a minor problem to take care of themselves or to find another pathway for care when ambulances are in short supply or are engaged on life-threatening calls and really can't be diverted to their 'sore foot' call. In fact, it would be easier to sell a leg of lamb to a vegetarian than it would be to talk some people into growing up and considering taking responsibility for themselves and this is one of the biggest problems we have as a society.

Our duty of care begins when you call us and say 'I need an ambulance'. We are duty-bound to send one if you insist, even though someone else's mum is having a heart attack and might need that same crew in a few minutes as they trundle towards your 'boil on bum' call. Yes, your breathing may not be 'normal' because you have a boil and it hurts but you will NOT die. Someone's mum WILL die of that heart attack.

What about your duty of care for yourself? Why don't you consider the possibility that you could get a taxi to A&E, call an out of hours doctor or make an appointment for an in-hours doctor? What about a walk-in centre or Minor Injuries Unit, emergency dentist or vet, where applicable, for that matter?

There are lots of complex social and psychological issues surrounding certain calls I know, but we are neither a Social Services or Psychiatric tool - we are an accident and emergency service and while we remain steadfastly committed to sending you an ambulance simply because we don't want to make a mistake, the cost to us all is rising annually and the risk to people in real need rises with it.

I'm going to vote on 6th May, like most of you and I can tell you right now that I won't be touching the two main political parties because they are spineless, often lie and (as we all now know) frequently cheat us out of our hard-earned taxes by stealing it through expenses, giving it away to various 'fringe' organisations and individuals who really shouldn't get it or squander it needlessly on pointless campaigns and exercises designed to keep us all quiet while the economy dies and our poor and suffering people go without. Governments have a duty of care too - they are supposed to do what WE ask of them - not what a few minorities wish or demand.

I watched Nick Clegg talk his way through a TV debate that changed the face of the current polls - he was impressive but he still had lies under his rhetoric - he didn't answer every question fully (they never do). I've also seen UKIP's policies and their bold statement 'rights for the innocent, no rights for criminals' and I agree with that. I am NOT liberal minded I'm afraid. I think that if someone steals from you or kills your brother, their rights should be totally suspended and they should pay an equal price. If one person in a gang stabs someone, the whole gang should be punished equally. As I said, it's a bold statement but will never become a reality because we lack the backbone to do it. Too many people will argue, using clever language and laws of convenience, that it would go wrong or that all men (and women) are equal, regardless. I see very little equality as it is.

The Tories tell us they will give us back the power to change things; to sack our MP's and to run our local affairs - I thought we had that right anyway, now it's a gift from them? They want parents to be able to run their own schools and to sack the head teacher if they feel like it. What? I want my kid to go to school and do as he is bloody well told! I want qualified teachers and a head teacher to do that for his own good. I don't want a little gang of twisted parents to influence my son's education and upbringing.

Similarly, I want to be able to do my job for the benefit of the patient. I don't expect to be told how to do it because it might upset a few people. Most of all I'd like to see people decide for themselves that their cut lip, or finger splinter or minor nose bleed does NOT require an ambulance and that they can deal with it themselves.

I'm willing to bet that, statistically, the number of people that die as the result of 999 abuse is greater than the number who would die as the result of the odd error in judgment made when deciding NOT to send an ambulance. Nobody has the guts to try it out though, so we will never know.

The NHS ambulance services, in my opinion, are second to none and the people working behind the scenes and on scene are generally dedicated and professional and only there for the benefit of genuine patients. The same applies to teachers - they exist to educate your child. In a few instances there will be problems and errors but attempting to cover every base by not taking on the duty of care mantle and passing it along to others is futile. The whole health and safety culture works like that, as does the growing greedy litigation thing. If you slip and fall at work because you weren't looking where you were going, is that necessarily someone else's fault?

A duty of care exists as soon as you call us but it remains with YOU until you pick up that phone and dial those 9's. Think about other people before you do; consider a more appropriate pathway for your condition. Don't lie in a pool of your own blood and worry about calling an ambulance because you need us! Get yourself drunk and incapable, however, and then blame a 'spiked' drink or the weather and you are being wholly irresponsible. You had a duty of care to yourself when you left the house to begin that drunken binge.



-Ross- said...

I agree with what you say about abuse of the service. I see ambulances around our student union looking after drunken students at least twice a week.

I totally agree that it's an amazing service. When I needed an ambulance most I was nebulised and taken to hospital, it arrived in minutes and the paramedics were amazing.

I'd hate to think that there are people that really need the service that can't access it.

Anonymous said...

I was going to vote UKIP – but then the local candidate’s literature informed me that England was a Christian country with Christian values and if I wasn’t prepared to adhere to Christian values then I should leave the country, now.

I’m a Yorkshireman. I can trace my ancestry in England back to the C18, one line back to C17.

I’m an Atheist. I have been since I realised that the fairy stories I was being made to listen to every Sunday nearly 60 years ago were actually believed by the people telling me these tales and further they expected me to believe their god existed because they said he did. I didn’t believe a word of these fantasies and never have done!

In the 60s & 70s I had Christians discriminate against me because of my Atheism.

I certainly resent any party candidate telling me that if I’m not going live my life according to his god I must leave my own country! And I most certainly am not going to vote for such a party or candidate.

They're all just out for themselves.


Chris said...

Totally agree. I had the misfortune to have a motorcycle accident. I did not have much say in whether an ambulance was called! However the professionalism shown by the crews was excellent. I can see how a call to a 'sore foot' must be very frustrating.

ambulanceamateur said...

Stuart, you said In a few instances there will be problems and errors but attempting to cover every base by not taking on the duty of care mantle and passing it along to others is futile. The whole health and safety culture works like that,

As a Health & Safety Officer, I have some sympathy there.

It's my job to make sure the workplace is as safe as is reasonably practicable. Unfortunately I spend more of my time trying to prevent idiots from following their natural inclination. The courts sometimes appear to want us to make a workplace so safe that even if someone ignores all the information they have been given, leaves their common sense at home and then decides to walk aroung with a knife pointing straight at a vital organ, they will not suffer any injury.

Ah well, such are the delights of being regulated by people who have never actually seen the sharp end of anything.

Anonymous said...

You speak so much sense, i'd vote for you.
Never ceases to amaze me (i work in the public sector, but my customers really don't want my services!) how we now pander to the "me,me,me" section of society and don't make them take resposibiliy for their own actions/lives. Nope, they go through life absolved of all resonsibiity for their own actions and the tax payer picks up the tab.

I fear i may start to rant. So i shall shut up now.


Rosie S said...

You will know very well what a chord this has struck with me. We've already talked about that so I'm not bringing it up again.

Just wanted to acknowledge what you're saying.

Tio said...


Normally a lurker but I enjoyed this post, I too often wonder why people can't take a bit of personal responsibility! I'll be voting for my LibDem candidate because of the reasons you've stated, not despite them.

Tom said...

A lot of your comments in this post make veryuncomfortable reading: simply because it is true.

I look at our society now, and cannot believe just how cosseted as a nation we have become. We now devolve personal responsibilty, including our own duty of care, to anyone, other than ourselves.

School is a place of learning. On open days, I was sure I heard mutterings of 'discontent' from the little darlings as the prospect of the old man going to school sent shudders of horror through their little bodies. Oh no, he's going to insist we have to learn.

Anyhow, I'll stop ranting now, and commend you for your insight once again.

Gravyboy said...

"Long time lurker, first time sharer" personal take on this is that the state has done a 'kick-ass' job of removing the need for personal responsibility/common sense. IMO it's this "someone else will tell us what to do" that's lead to the rise in Chavism/Neddism (depends where your from) and inability to make a reasoned, rational call on almost any issue. I blame the nanny state for much of the decline of current society (and personally believe it began around the late 90's - anyone see the coincidence?) and I really feel for those people (like Stu) who have to deal with the knock-on effects.

Fee said...


I'll be voting tactically I think. I live in a marginal, and I can't face the shame of being represented by a Tory if I use my vote as I'm tempted to, on the Green candidate. He's the only one who's been round knocking on doors, and I (to my horror) found myself agreeing with a (potential) politician. That's never happened before. The Tories usually avoid this part of the constituency - they get fed up being TTFO.

Michael said...

"Similarly, I want to be able to do my job for the benefit of the patient. I don't expect to be told how to do it because it might upset a few people."

I don't really see how this is compatible with support of UKIP.

I suppose you think that being employed by a private company which tenders for a franchise from a council to run an ambulance service will make it easier for you to work in the interests of the patient...

Xf said...


You seem to have misunderstood what I wrote. Did I say anything about supporting or voting for UKIP?

Xf said...


Health & Safety is important in order to protect employees, etc. but I'm glad you understood my that it should not reach into the territory of 'nannying' us all.

Xf said...


Yep, I agree. They are all out for themselves. It's a career move and nothing more. Unfortunately we are stuck with the lot of them.

Gwen said...

Any myths about first aid that you'd either like to edit on this list or add to this list???

Lynne said...

There's never been a system in history that humans couldn't or wouldn't abuse until it breaks. Sadly, that includes the medical system.

Ambulances are free in this country, so to be honest I don't find it surprising that people without even a smidgen of sense have started to treat them like an on-tap taxi service. It's just human nature, no extra added stupidity needed -- people always end up overexploiting whatever resources they have available, it seems to be the way we're wired. Certainly the whole trend of carefully protecting people from the consequences of their own actions doesn't help, though, I agree.

*sigh* I'm probably going to end up waving my cane in the air and shouting "you kids get offa my lawn!" next, but I can't help but reflect that in earlier eras, where the infrastructure to protect people from their own stupidity literally didn't exist, a lot more of these people would have ended up as bear food. I'm not sure it's a great improvement that now they just end up on YouTube.

Xf said...


Hmmm...somebody has forgotten that a few myths have been started by these trainers for these organisations too!

I don't appreciate the fact that they seem to think there's no way an ambulance can get to you within a minute or two because we can...not always but its likely, especially in Central London if we aren't swamped by drunken fools vomiting on pavements.

The article is a plug for SJA training.

Peter said...

As a call taker with an Ambulance service, thank you for this post. I try to do as much observation shifts as I can as I think there is a little too much detachment between control and you guys.

I've had calls from the RRV on scene where the paramedic has complained about the job, I've heard the call and whilst I can understand the paramedics point they haven't heard what the caller has said.

We do have paramedics in the control room as clinical supervisors but they have got rid of having training shifts in the control room a while ago, just as how they've got ridden of us doing Obsevration shifts with the crews as part of our training- you have to volunteer for it now.

On the election I will vote. I think the best thing that can realistically happen is a Lib Dem/conservative coalition. I believe in civil liberty and civil responsibility very strongly. ALas politics is the case for voting for you who dislike the least not lke the best.

Anonymous said...

totally agree with your comments re the lack of responsbility that some members of society take regarding their own health & well being. It is very frustrating when people abuse the emergency services and all health services, not yet part of our job descriptions!! keep up the good work.

Fiz said...

Xf, I really hope you get accepted as a doctor in the autumn. Far too much of your time is wasted by the "entitled" generation, most of whom have barely left home.

Uncle John said...

See the Times (1 May) - Xf is in their list of //40 bloggers who really count//