Wednesday, 31 December 2008


Day shift: Five calls; all by ambulance.

Stats: 1 High temperature; 1 Abdo pain; 1 Head injury; 1 RTC with ? injuries; 1 Collapse ? cause.

A mum and baby were ill somewhere in the north and I was sent to check them out. Two ambulances were already in the same street attending to someone else when I arrived and a vehicle was parked outside the address I was going into. The crew was inside the flat dealing with a mum who complained of ‘pain all over’ and a baby with a high temperature (30c). The baby needed to go to hospital without a doubt; the mother didn’t seem to have anything wrong with her except lethargy.

And a 34 year-old woman told us she had chest pain and DIB but didn’t. She had abdominal pain which she’d suffered for three days. She didn’t call her G.P. and thought an ambulance would be more suitable.

On Oxford Street I raced to an 18 year-old boy who’d walked into a lamp post and collapsed. When I got on scene his father came up to the car and said ‘don’t worry, take your time…it’s not an emergency’. So just to make sure we’d ‘dotted our I’s’, the MRU arrived on lights and sirens. HEMS wasn’t coming thankfully.

The Australian lad had simply walked into a post when he wasn’t looking (probably distracted by all the sights of Oxford Street…and the shops). He’d smacked his head hard, wobbled a bit then collapsed in the street for a few seconds. I found him sitting at a table outside a cafĂ© looking none the worse for wear except for a tiny cut above his eye.

My MRU colleague left when it became clear he was redundant and the ambulance appeared a few minutes after I’d settled the young man into the back seat of the car for obs as his father and brother waited outside. His trip to hospital may be less of a story to tell back home than his experience with the rapid and somewhat overwhelming emergency response he got in Central London. Still, we try to please…

When cars hit people we expect an injury or two but the RTC I was called to – one that caused a fair amount of traffic chaos – was a non-runner for me as the patient seemed to be completely unhurt. A crew was on scene and after a cursory check that I wasn’t required (I wasn’t) I left them to it.

One of those infamous Red1 calls for ‘life status questionable’ but for a completely understandable reason…and one I think we could probably go some way to resolving. The caller didn’t speak any English, so when he was asked about breathing and the condition of the patient (a man who’d simply fallen down) he couldn’t answer. For that reason the big panic buttons were pressed because there is no other option – if the question cannot be answered in the affirmative then it is deemed to be negative. So, he might not be breathing; therefore Red1. When I got there the crew was chatting to the supposed non-breathing man and me and my MRU colleague (who’d arrived just ahead of me) left the scene.

Here’s my solution to this problem. We should hire a multi-lingual person and put them on a desk in Control. They needn’t be clinical, all they’d do is speak to non-English speaking callers and translate so that the patient-picture is clear and the response is appropriate. This person would only have to speak a few specific languages that are relevant to the diverse population of London and the highest statistical sample that we are likely to receive calls from. I know of at least one person on staff who already speaks up to ten languages fluently…why don’t we give him a job reducing unnecessary priority calls?

Okay, in reality I don’t know how many language-barrier type calls we receive that ultimately trigger ‘Category A’ responses but I’m willing to bet there are enough to justify a useful tool for reducing them. Just a thought.

Be safe.


miss emma said...

What are the main languages that you encounter problems with (in EOC and on the frontline)?
I'm learning Polish in the hope that it will improve my chances of getting a job in EOC (and then eventually as a paramedic)

Hope new year wasn't too stressful for you! x

Anonymous said...

Well, there is the option of using Language Line interpreters but often the caller will insist that their "English" is perfectly fine, and that they don't need a translator. Plus there's the costs involved; these services don't come cheap and sometimes it's better to muddle through as best you can and hope that the money is better spent on extra ambulances and the like.

thankyou said...

I've been reading your blog for a few months and unexpectedly needed the services of LAS this week. (I really was coughing up frank blood, and a fair amount of it.) All I can say is that everyone I met, from the ambulance crew to all the hospital staff in my subsequent stay, treated me with care and respect. Thank-you for doing the job you do.

Bouncy EMD/SP said...

Having gone through the selection process for both jobs, I doubt if having a second language would have a huge effect on your chances of working in EOC as they're fairly happy with the language line method of dealing with language barriers.
The example Stuart gave shouldn't really happen as the Red1 response for the 'unknown' answer to the breathing and conscious questions only applies when the caller themselves cannot tell whether the patient is breathing. Since this is not the case, the response can be got around by changing the answer to 'is the caller with the patient?' to 'no'. This gives the system a good reason why we don't know if the patient is breathing and generates a more appropriate Amber response.
This is one of many ways that a call-taker with some common sense can be flexible with the system without going off their protocol (I did discuss this with a quality assurance manager, and they said it was OK).
But back to the language thing, until recently, if a call-taker happened to speak the required language in the situation above, they would still be required to use language line to translate. We all thought this was ridiculous, not least because language-line, and the alternative company that they were trying when I left EOC, are quite rubbish. However, I heard a rumour that multi-lingual control staff were to be given the chance to 'register' themselves in EOC as being able to speak certain languages and take calls in them. Not sure what became of that.

You may find that speaking another language would be more useful in getting through recruitment for paramedic. They seemed to focus more on that kind of thing in the interview.

Best of luck!

miss emma said...

Bouncy EMD/SP - Thanks for your input, it's been very useful! I originally started learning Polish because I never enjoyed French or German when I was in school but now I'm in college I feel I missed out on it. Polish seemed an obvious choice for me as I live in an area with a large Polish population. It was only after I had started learning that my mum suggested it might help my applications later on .
Thanks again!

Fiz said...

First off, I don't mean this to sound racist and if Stuart thinks it is, then I hope he won't post it. There's something that bothers me here. You all feel that the onus is on you as ambulance staff to learn foreign languages, but this is the UK. We speak English here. It should be the responsiblity of those who do not speak English to learn it. Problem solved. Why should you all have to change?

CIO said...

Working for the UK Border Agency (formerly UK Immigration Service) we have a Language Allowance system which enables front-line staff to claim certain allowances if they speak and/or write foreign languages. You get more for "exotic" languages and less for the more mundane European ones. Staff are tested regularly to ensure they still qualify (exemptions exist for native speakers etc). The main benefit is, as Bouncy suggests above, having a pool of people in the office who can interpret (and have no excuses as they are paid extra to do so). Seems to work well for us - we use Big Word / Languageline as well if we need to though...

Fiz said...

More tax payers cash wasted. We're squeezed till the pips squeak, and what a wonderful to extract more!

Anonymous said...

I work for a local authority we translate if we can and are required we gat paid nothing - comes under any other duties !!

Doesnt bother me tho...

Anonymous said...

I know this comment is rather late and I'm not sure if anyone reads it, but I feel I have to respond to Fiz's comment.

I use English frequently in business conversations and I do believe that my grasp of the language is not too bad. However, I'm quite sure that in an emergency situation I'd have quite some troubles to understand everything clearly, find the appropriate words or form concise sentences.

Please do not forget that when calling 999, the callers or their loved ones are injured or sick, plus there may be additional problems like a noisy environment, bad phone connection or call taker's accent.