In the fast lane

With demand for emergency health services at a high, the rapid response vehicle is right at the frontline

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Twelve hours? It sounds like forever but, dashing from one job to another, with blue flashing lights and sirens, at speeds exceeding the national limit, the time goes by remarkably quickly.

A meticulous inspection of the North West Ambulance Service Rapid Response Vehicle was carried out before paramedic Chris Fraser-Clarke, mobilised.

The basic life support bag and all its contents – check; gas levels in the oxygen bottle – check; new batteries fitted in the vital signs monitoring equipment – check; tags cross-referenced on the medication and drugs bags – check.

Only once everything had been ticked did Fraser-Clarke leave the station to stand by in Waterfoot. Less than a minute later the RRV was relocated to outside McDonald’s in Rising Bridge, on the outskirts of Accrington, to cover both areas. An hour passed and the snow fell.

“If a red call comes in, I can get there faster and then the ambulance backs me up.”

Fraser-Clarke, 48, from Darwen, said: “I became a paramedic in 1990. I used to be a lifeguard at a swimming baths and someone had a cardiac arrest. I had done CPR and helped out in the back of the ambulance when the patient was on his way to hospital. Two weeks later I saw a job advertised and started work in A&E as an ambulance man.

“The ambulance service is a lot busier than when I first started and that means that sometimes when you shout for an ambulance it can take longer than you would like. If I am in the RRV and a red call comes in, then I can get there faster and then the ambulance backs me up, but if the ambulance is delayed then that is me out of the system and unable to respond to more emergencies.”

He checked with control if it was OK to head back towards the centre of Rossendale and as he drove towards Rawtenstall there was a call. At 11.16am the first job was in Stacksteads.

Fraser-Clarke clicked the blue flashing lights and speeded up over the moorland route, adding sirens when the car encountered other vehicles. Thankfully most drivers paid attention and quickly and safely got out of the way. He slowly traversed one of Rawtenstall’s busiest junctions, going through the lights at red, then headed over the tops to the location.

Fraser-Clarke arrived at the terraced street in Stacksteads after nine minutes, just a minute off the desired response time. In the house was a woman who had felt dizzy and suffered numbness down one side. She had called her GP who, when informed of the symptoms, had recommended she call an ambulance.

Fraser-Clarke put the patient at ease, calmly – and with a hint of humour – garnering the necessary information. As he would go on to do with all the six patients on his shift, he took vital signs – saturation, blood pressure, temperature and blood sugar levels – and judged that an emergency ambulance was required. Less than 10 minutes later a crew from Rawtenstall was at the door. The transfer was swift and within 10 minutes the patient was being conveyed to hospital and the car was available to respond to more calls.

It took an hour from the time the ambulance crew arriving at Royal Blackburn Hospital and notifying staff to the patient being handed over into the care of the hospital.

The next call came in at 12.40pm to a home for the elderly in Bacup, where a nurse practitioner from the local surgery had called for an ambulance transfer after staff found rehabilitation resident Alan Gardner, 63, struggling for breath and looking purplish in the face. The nurse had taken his oxygen saturation – sats – and left a detailed letter.

Fraser-Clarke explained: “This is a more unusual call because when the call came in it was initially rated as a green, which would not prompt an urgent response, but the ambulance crew voiced their concerns that the classification might be wrong so, as I am nearby, I am going to assess the patient.”

After three minutes Fraser-Clarke arrived at the home and discovered Gardner had only recently been discharged from hospital after a fall, had lung disease and was struggling to say more than one word per breath.

He repeated Gardner’s oxygen sats and discovered the former joiner’s levels were low so administered oxygen. He also upgraded the job to red – meaning the ambulance was called immediately. The Altham crew arrived swiftly and by 1.25pm Gardner had been transported in a wheelchair from the home and was in the ambulance.

“They have done a good job for me today. I am feeling fine now,” said Gardner, whose breathing had improved.

Handover time at hospital – nearly 50 minutes.

Back in the car and just a couple of miles down the road, at 1.33pm the next call came in. The RRV did a quick U-turn on the main road and headed to Burnley where a caller had described a woman drifting in and out of consciousness.

On arrival at the terraced house, Fraser-Clarke carried out checks and administered Entonox – nitrous oxide and oxygen – for pain relief and called for an ambulance. This time a Burnley crew attended and helped the woman down steep stairs before taking her for an assessment at hospital.

Handover time at hospital – nearly 48 minutes.

As the RRV left the house in Burnley it was immediately sent to Haslingden and Fraser-Clarke headed speedily over to sheltered accommodation via the M65 and A56, arriving at 2.50pm.

A carer had found an elderly woman on the floor of her flat after she slid off her settee. She was still on the floor on arrival and was helped back onto the settee. Her oxygen levels gave cause for concern, calling for a red response. The pensioner was given medicine through a nebuliser and oxygen, before a different crew from Burnley arrived to help her into a wheelchair and take her to hospital.

Handover time at the hospital was just over an hour.

Heading back from Haslingden towards Stacksteads at 4.08pm, Fraser-Clarke received an alert to a “man stuck under rollers” at steel fabricators James Killelea in Crawshawbooth. The lights and sirens were on and Fraser-Clarke was informed that an emergency ambulance and an advanced paramedic had been called, along with Helimed – the air ambulance. Although fading light meant the helicopter would not be able to transport the patient, it would bring two doctors to the scene. Fraser-Clarke asked for the Hazardous Area Response Team (HART) team to be notified because of the potential seriousness of the incident.

Once again Fraser-Clarke was the first to arrive. Two workers pointed towards the premises entrance. He parked inside the building and Fraser-Clarke  found the worker had already been freed from the girder that had trapped him. He was propped up and was being attended to by staff.

Vital signs were monitored and Fraser-Clarke removed the worker’s boot and cut away his jeans to reveal injuries that appeared to be isolated to his right leg and foot. Fraser-Clarke stood down Helimed and HART and informed control that the patient was no longer trapped.

Within minutes, police, firefighters, ambulance and an advanced paramedic were on the scene and a strong painkiller was administered to the casualty, while a plan to remove him to the waiting ambulance from Burnley was agreed. A splint was fitted around the injured leg and the worker was carefully moved onto a scoop stretcher and strapped in before three firefighters and three paramedics carefully carried him off a platform and out of the building.

Although the ambulance spent 40 minutes at the hospital for some of that time ambulance staff were working on the patient. The handover time once staff had been notified was just five seconds.

After 30 minutes off duty, the RRV was back on the road at 6.29pm responding to a call from a woman in a house in Haslingden. She had been felling unwell, had neurological problems and her doctor had suggested she call an ambulance.

On arrival a community first responder, a trained volunteer who assists the ambulance service, also parked up and helped Fraser-Clarke carry out the checks. Fraser-Clarke requested an ambulance so the symptoms could be further investigated and by 7.30pm the patient was on her way to Blackburn.

The hospital handover time was 25 minutes.

By the end of the shift, Fraser-Clarke had attended to six patients. From the first call to the last, the level of professionalism and courtesy shown by the ambulance crews to the patients, no matter what their circumstances, remained high.

Right on queue

A queue of up to 11 ambulances waiting to hand over patients has been observed by a nurse working at Royal Blackburn Hospital, recently the subject of a BBC documentary and now rated “good” after emerging from special measures.

The nurse, who did not want to be named, said: “On average there is an ambulance arriving every nine minutes and I have seen up to 11 queuing to hand over patients.

“You see patients waiting on trolleys in the corridors with the ambulance personnel. I have seen all the eight beds in resus [resuscitation area] full and people waiting on beds outside because there was nowhere for them to go.

“Sometimes patients come to A&E with an infected finger or because of a road traffic accident that happened seven days ago. They should be going to their GP or to a walk-in centre.

“They are now talking about GPs working seven days a week but there are not enough GPs to man such a service. We are struggling to fill vacancies at the hospital.

“Two years ago they extended the emergency department at Royal Blackburn because they realised it was too small to cope with demand, but it is already full to capacity nearly every day when I go to work.”

The nurse said one of the main problems was a lack of social care funding, which was making it harder to move patients on when they were ready to be discharged because the care was not available for them to be looked after at home. This resulted in beds not being available to take patients from the A&E department into the hospital.

In Rossendale a community specialist paramedic, Richard Peters, has been appointed to help manage frequent callers and educate staff at homes for the elderly. He also advises paramedics on the most appropriate referral route for patients, which is not always A&E.

Peters has also been appointed because the rural location of Rossendale can sometimes hinder the ambulance service goal of an eight-minute response time to the most serious calls.

He said: “Demand for frontline emergency ambulance response has risen by 90 per cent in the North West since 1997 and in Rossendale crews respond to around 310 of the most serious red calls each month.

“It is now 6pm and the average is 10 calls a day, but in Rossendale we have already had nine reds within the BB4 postcode and two in the OL13 area and there are still six hours of the day left so this area is significantly busier than average.

“There are also all the non-life threatening calls that haven’t yet been attended to because the crews are busy attending to reds.”

Dr Damian Riley, executive medical director at East Lancashire Hospitals NHS Trust, said that when an ambulance arrived at A&E, patients were brought into the department without delay.

He said: “The patient is checked in by the ambulance staff, and then a formal handover to nursing and medical staff takes place.

“Patients are prioritised on the basis of clinical need, and the most urgent and critically ill patients are moved to a high priority resuscitation area. We do not allow any patients to stay in the ambulance unattended.

“We are aware that at times of peak demand, there may be a large number of 999 ambulances arriving in quick succession and this can lead to a delay in handover of patients.

“Patient safety has to be our first priority and, in agreement with the ambulance service, a member of the ambulance crew will stay with a patient who has not been handed over. It is important to stress that trained staff are on hand at all times.”

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