Archive for category: Uncategorized

Date: 24 July 2019

A man has been reunited with staff from London Ambulance Service who saved his life after he collapsed at home in cardiac arrest.

Andreas Kallis, 68, and his family visited Walthamstow ambulance station recently for the opportunity to meet and personally thank all those involved.

His wife Tina, 63, recalls the moment her daughter, Christina, 37, alerted her to Andreas’s collapse at their home back in February 2018: “All of a sudden my daughter came to me and said: ‘Mum, I don’t know if dads asleep or ignoring me’.”

After running into the sitting room and checking if he was breathing, they immediately dialled 999.  They spoke to Emergency Call Coordinator, Fran De Wet, working in the London Ambulance Service control room, who started directing them through cardiopulmonary resuscitation (CPR).

“Fran told us precisely how to do CPR and the rhythm as well. I did so much better than I thought and that’s because of her help.”

An ambulance was quickly dispatched and London Ambulance Service paramedic crew Esme Choonara and Amanda Gowing responded to the scene.

They managed to get a pulse and rushed Andreas into Barts Heart Centre at St Bartholomew’s Hospital, where with the help of doctors and nurses has made a full recovery.

At the emotional reunion Andreas and Tina were joined by Fran, Esme and Amanda.

Andreas said: “I must be really lucky to survive. If it wasn’t for the London Ambulance Service, my wife and daughter I wouldn’t be here now. It was wonderful to be able to thank them all personally.”

Call handler Fran said: “This is why we do the job. That feeling of knowing that something you’ve done has really helped someone and their family.”

“In over twelve years working for the Service I have taken several cardiac arrest calls. But I have only ever received three letters to tell me that those patients have returned to normal life and have walked out of hospital. So to actually meet Mr Kallis is truly amazing.

“The whole experience has been overwhelming – I promised I wouldn’t cry but I did.”

The family wants to raise awareness of the importance of the general public learning lifesaving skills such as CPR. Tina said: “I had done a bit of CPR training years ago, but you never really think that something like this is going to happen to you.

“I just feel so good that I was able to help save him.”

“We are so grateful to all of the ambulance staff and everyone at St Bartholomew’s Hospital, the nurses, the doctors and the police who also attended that day. It feels like it is the closure we needed.  To thank them and to see them in lovely surroundings not in that traumatic, horrendous way.”

Author: Michael Emmerich

Published in: Summer 2019 Edition of Ambulance Today Magazine

“When you’re compassionate, you’re not running away from suffering, you’re not feeling overwhelmed by suffering, and you’re not pretending the suffering doesn’t exist. When you are practicing compassion, you can stay present with suffering.”

• Sara Shairer: https://eftraining.co.uk/what-is-compassion-fatigue/

In the emergency first responder profession, where we witness trauma first-hand, it is at times difficult to be fully aware of the impact that “direct trauma” has on us as practitioners and how to differentiate between direct trauma and vicarious trauma. Research suggests that EMS personnel experience many reactions after exposure to a traumatic event. Admitting to being emotionally affected is regarded as difficult as it may lead to being perceived by their peers as not tough enough for the job. The attitude of ‘no one dies on my watch’ is common amongst EMS personnel. This leads to EMS personnel often suppressing their emotions and feelings associated with the reality of their work in order to live up to this image of being strong and resilient.

“Injury mortality rates in South Africa are approximately six times higher than the global average. One of a handful of studies conducted amongst EMS personnel in the Western Cape found higher prevalence of exposure to critical incidents compared to their counterparts in other low-income countries.”

• African Journal of Emergency Medicine Volume 5, Issue 1, March 2015

This Quarter we attempt to unpack and understand the lived experiences of compassion fatigue, vicarious/secondary trauma (ST), and burnout.

These three terms are complementary and yet different from one another.

-Compassion Fatigue (CF): Also called “vicarious traumatization” or secondary traumatization (Figley, 1995). The emotional residue or strain of exposure to working with those suffering from the consequences of traumatic events. It differs from burn-out but can co-exist. Compassion Fatigue can occur due to exposure on one case or can be due to a “cumulative” level of trauma. 

The American Institute of Stress - https://www.stress.org

-Vicarious Trauma (VT): is a process of change resulting from empathetic engagement with trauma survivors. Anyone who engages empathetically with survivors of traumatic incidents, torture, and material relating to their trauma, is potentially affected.

https://www.bma.org.uk

-Burnout: a “syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: 1) feelings of energy depletion or exhaustion; 2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and 3) reduced professional efficacy.

The American Institute of Stress - https://www.stress.org

Despite the differing theories and terminology of the three concepts, each is directly associated with the concept of empathy. There are two key components:cognitive empathy, the ability to take someone’s perspective, and affective empathy, whereby an individual share a similar emotional response to others’ experiences(Smith, 2006).

With empathy holding sway as a common factor in CF, VT and burnout, it would make sense then to conclude that cognitive and affective empathy would impact differently on the life of the practitioner. For example, a professional empathising emotionally may experience more emotional consequences than an individual empathising cognitively. In addition to increased experiences of trauma, increased case load and less clinical experience, it is therefore suggested that the nature of empathetic engagement in work-related scenarios would therefore be an important dimension to consider in understanding the development and intensity of CF as experienced by EMS practitioners.

Conversely, burnout does not necessarily mean that our world views have been damaged or that we have lost the ability to feel compassion for others. Most importantly, burnout can be easily resolved; (but can it be in the current financially driven, dehumanised environment practitioners work in?)Conversely this is not the case for CF and VT.

As one is vicariously exposed to trauma, both directly and indirectly, one begins to exceed one’s resilience (or ability to cope) to these events, and one is then prone to develop CF (or sometimes also referred to as Secondary Distress Syndrome). Once our chronic exposure to trauma exceeds our coping mechanisms, CF then becomes evident. CF has been described as the convergence of secondary traumatic stress (STS) and cumulative burnout (BO); a state of physical and mental exhaustion caused by a depleted ability to cope with one’s everyday environment. This can impact standards of patient care, relationships with colleagues, or lead to more serious mental health conditions such as post-traumatic stress disorder (PTSD), anxiety or depression.

How do we then best protect vulnerable workers, to prevent not only CF, but also the health and economic consequences related to the ensuing, and more disabling, physical and mental health outcomes. To fully understand CF, we possibly need to move away from theoretical explanations and models and focus on a more relational understanding of professionals lived experience of their own and others’ (patients, peers and family) distress. This would involve a narrower focus on problem solving, via person centred compassionate care. Remember authentic and sustainable self-care begins with you. Understand that the pain and stress you feel are normal displays, resulting from the care giving work you perform on a regular basis.

Examine the positive and negative aspects of one’s work influences, and how it affects one’s professional quality of life. This leads us to a better understanding, whilst helping those who experience trauma and suffering. This can in turn improve our ability to aid them and keep our balance in this process.

Compassion Satisfaction and Compassion Fatigue are two aspects of Professional Quality of Life. They encompass the positive (Compassion Satisfaction) and the negative (Compassion Fatigue) parts of helping others who have experienced suffering. Compassion fatigue breaks into two parts. If working with others’ suffering changes you so deeply in negative ways that your understanding of yourself changes, this is vicarious traumatization. Learning from and understanding vicarious traumatization can lead one to vicarious transformation.

• Dr. Beth Hudnall Stamm – ProQOL

An excellent article to read is Transforming Compassion Fatigue into Compassion Satisfaction: Top 12 Self-Care Tips for Helpers, by Françoise Mathieu, M.Ed., CCC– see the link below

In closing;

“integrated intervention programmes are needed to assist EMS personnel working in this sustained high-stress environment. The findings can assist health care educators in the design of co-curricular activities intended to help in the development of resilience and the psychological wellbeing of EMS personnel.”

Exposure to daily trauma: The experiences and coping mechanism of Emergency - Llizane Minnie a,* Q3 , Suki Goodman b, Lee Wallis

Healing begins from within, and being committed to a self-care plan, with clear boundaries in both your personal and professional life and understanding one’s negative behaviours and their root cause. Internal self-healing in our profession is a life-long management plan, but as you continue to do the necessary internal work, life will and can, begin to change for the better.

References, websites and additional reading:

Cocker, F., & Joss, N. (2016). Compassion fatigue among healthcare, emergency and community service workers: A systematic review. International Journal of Environmental Research and Public Health

Hernandez-Wolfe, P., Killian, K., Engstrom, D., & Gangsei, D. (2015). Vicarious resilience, vicarious trauma, and awareness of equity in trauma work. Journal of Humanistic Psychology

Ray, S. L., Wong, C., White, D., & Heaslip, K. (2013). Compassion satisfaction, compassion fatigue, work life conditions, and burnout among frontline mental health care professionals. Traumatology

Sprang, G., Clark, J. J., & Whitt-Woosley, A. (2007). Compassion fatigue, compassion satisfaction, and burnout: Factors impacting a professional’s quality of life. Journal of Loss and Trauma

Mathhieu, F (2017) Transforming Compassion Fatigue into Compassion Satisfaction: Top 12 self-care tips for helpers. Workshop for helping professionals

Minnie L et al. Exposure to daily trauma: The experiences and coping mechanism of Emergency Medical Personnel. A cross-sectionalstudy, Afr J Emerg Med (2015), http://dx.doi.org/10.1016/j.afjem.2014.10.010

Date: 7 August 2019

Celebrating those who have demonstrated the highest levels of patient care and innovation across Cheshire and Merseyside, North West Ambulance Service (NWAS) has held its second ever Achieving Clinical Excellence (ACE) Awards last week. 

The ceremony, which took place on Tuesday 30 July at Formby Hall Golf Club, was hosted by Dave Kitchin, Head of Service. Chief Executive, Daren Mochrie and Chair, Peter White presented eleven awards to individuals, teams of staff and also external agencies. Winners were rewarded for their clinical excellence and achievements over the past year.

Daren Mochrie, Chief Executive says: “The awards are an opportunity to reward our professional employees who are committed to delivering the highest quality of patient care as well as members of the public who have stepped in to make a real difference.  As chief executive I am extremely proud to recognise such outstanding achievements.”

The categories and award winners were:

•                Consultant Paramedic Award – Leona Blayney, Craig Butterworth, Gary Fitzpatrick, Gareth Owen, Jade Parry, Danielle Shaw

•                Advanced Paramedic Award – Wayne Evans, Dylan Hughes, Jessica Heath

•                Clinical Leadership Award – Andy Baines 

•                Supporting Clinical Excellence Award – Cheshire & Mersey Fleet Team

•                Mentor of the Year – Paul Campbell

•                Student of the Year – Samuel Hebden

•                Communication Centre Award – EOC Orange Team

•                Innovation and Change Award – Darren Earley 

•                Patient Choice Award – Sarah Camplin, Andrew Hazley, Michael Jackson, Diane McGann, Aaron Murray, Michael Quirk, Stephen Rickards

•                Everyday Hero Award – Total Fitness, Crewe

• The John Harrison Award for Outstanding Achievement – Peter Fisher, Danielle Phelan and Andrew Carter-Sweeney

Winners were selected from peer nominations by a judging panel consisting of Head of Service, Dave Kitchin, Consultant Paramedics for Cheshire and Mersey, Nick Sutcliffe and John Collins alongside the trust’s Medical Director, Dr Chris Grant.

Maxine Power, Director of Quality, Innovation and Improvement chose the winner of the Innovation and Change Award. This was presented to Senior Paramedic Team Leader, Darren Earley who has developed a tool to support NWAS clinicians when treating patients with mental health concerns. 

The John Harrison Award is in memory of Dr John Harrison, the trust’s former associate medical director who exemplified the highest clinical standards of care. The recipient of this award was emergency services team, Peter Fisher, Danielle Phelan and Andrew Carter-Sweeney who were recognised for outstanding professionalism when faced with a colleague having a medical emergency. Their award was presented by John Harrison’s wife, Margaret, along with their colleague who thanked the team for their life-saving actions. 

Staff from Total Fitness in Crewe were given this year’s Everyday Hero Award. Thanks to their training, quick thinking and use of the defibrillator on site, the team were able to help save the lives of two people in separate incidents just three months apart. 

All winners were presented with a certificate and award to recognise their actions.

Author: Jerry Overton

Published in Spring 2019 Edition of Ambulance Today Magazine

In this column, Jerry Overton- who is viewed by many world EMS and healthcare leaders as one of the best when it comes to improving ambulance systems globally- gives his opinion on the allocation of funding in theEMS system. He identifies some of the issues within EMS systems globally and, whether it’s saving ambulance hours or reallocating funds, you can trust Jerry to have a pretty good idea on how to improve on the system.

Oh, a storm is threat’ning

My very life today

If I don’t get some shelter


Oh yeah, I’m gonna fade away

 -“Gimme Shelter”

Yes, it is a storm that is constantly threatening, and it threatens us all. Cardiac events know no shelter; they
do not “fade away”. How sadly ironic
it is that the emphasis on this issue
of Ambulance Today is the recent London Cardiac Arrest Symposium last December, an event that Dec, lover of the Rolling Stones, had planned to cover. This all still just does not make any sense.

As always, the symposium was excellent, and I am sure the specifics will be comprehensively reported elsewhere. From this perspective, the welcome change was less on research and more on resources; human resources. The first, “Community CPR”, and second, “Kids Saving Lives”, really hit the mark.

This does not mean that cardiac research is not important, because itis. But, at the end of the day, whenone considers the amount of money committed to research compared to the amount of money needed to increaseour resources, one wonders if it is not time to discuss priorities.

Back in the day (okay, my day), the initial intervention for an out of hospital cardiac arrest was the precordial thump and if that did not work, there was always intracardiac epinephrine and sodium bicarb. Other meds came and went, depending on the latest research, and sometimes even who did the research. The contents of the drug box varied from system to system and the decisions of the local medical director. Sadly, ROSC rates failed to show any real improvement, whether in the United States, the United Kingdom, or Asia.

Today, every responder knows that two interventions make a difference, timely CPR and timely defibrillation, stressing the word “timely”. The question now, though, is what constitutes “timely”. It sure is not an eight-minute requirement. As has long been stressed by any paramedic, there will be little difference in outcome if the response time is 9 minutes 1 second rather than 8 minutes 59 seconds.

Response times are outputs, and what is needed are outcomes. And to achieve outcomes, we need resources. That, clearly, requires our most important resource, which is our people. If we really do have money for new programs, it is time to invest in the “research” necessary to seriously examine howwe can better recruit and retain those that can change patient outcomes. And if we do not have any “new”, perhaps reallocation of funds is in order.

There can be no debate that shaving seconds in telephone CPR instruction is important, but if there are insufficient dispatchers to answer the increasing number of calls, those seconds will make little difference. It is an under appreciated, almost invisible position, that drives the first link of the Chain of Survival.

The shortage of paramedics is even more acute. In the U.K., a 2017 report by the Comptroller and Auditor General of NHS England, reported 10 percent vacancy rate, with Trusts “struggling to recruit the staff they need and then retain them.” The U.S. is facing a similar problem. A recent broadcast from CNBC news reported that in the next six years, a 15 percent increase of paramedics would be required at a time “when unemployment continues to hover near historic lows”.

Of course, it is not just the out of hospital care world that is facing a crisis, other sectors of health care are also, and it directly impacts our ability to respond. That same 2017 report by the Comptroller and Auditor General found that in “2015-16, approximately 500,000 ambulance hours were lostdue to turnaround at accident and emergency departments taking more than 30 minutes, which equates to 41,000 12-hour ambulance shifts.”That is an almost unbelievable (but it is) staggering waste of both human AND financial resources.

Longer hours, more responsibility, higher utilization, fatigue, inequitable pay, and, of course, working conditions when considered together would make any sane person wonder why another sane person would ever consider makingthe commitment to a dispatcher or paramedic. The answer is, obviously, EMS personnel give a damn.

All too often, that is forgotten. It was just under three years ago that the first European congress dedicated to EMS was held in Copenhagen, EMS2016. The theme of that congress, and the subsequent congresses, was “It takesa system to save a life,” and indeed,it does. But the foundation for that system, or any system, is its people. In other words, without you, it is nothing.

That is my point. If we are ever to increase cardiac arrest outcomes,it will be done by human resources that have the education, experience, and motivation to make a difference. Telephone CPR does little good if a call goes unanswered. A medication has little impact if there is no paramedic to administer it.

Just like human resources, economic resources are limited. And it is a basic tenet of EMS that “nothing in life is free”. That includes community and kids’ CPR. Wisely using the financial resources that we do have is key, and if that means reallocating research grant funds away from the latest in drone delivery systems that could potentially increase survival one-half of one-half percent (yes, that is sarcasm), it needs to happen if those same funds can help us better find the keys to retain the human resources that WILL make a difference (No, I am not naive, higher wages is definitely a major key!!!).

And just when you think that all of us have at least a basic understanding for the need for a resource, any resource, that can respond and make a difference, comes this from the western section of the United States. It seems that officials in a Pacific Northwestern state have decided that call taking in dispatch centers has become so structured, and telephone CPR so protocol driven that they are proposing a rule change that would permit local agencies to no longer require its dispatchers to be certified in CPR. Yes, you read that correctly, public safety responders will not need to know CPR.

It is not like a fellow dispatcher has not arrested in a control center, because it has happened. It is notlike a fellow public safety officer has not arrested at headquarters, becauseit has happened. And it is not likea dispatcher has never witnessed a cardiac arrest as a layperson, because it has happened. Whether the proposal passes will be decided in early spring. And, interestingly, most local public safety agencies are AGAINST it. Perhaps those state officials need to take a step back and consider this from the Rolling Stones. It certainly fits.

You can’t always get what you want

You can’t always get what you want

You can’t always get what you want

 But if you try sometimes well you just might find

 You get what you need
 

“You Can’t Always Get What You Want”

Author: Alan Lofthouse

Published in: Summer 2018 Edition of Ambulance Today Magazine

At the end of 2014, and early 2015, we went through a period of industrial action in the NHS over pay involving two 4-hour stoppages. In the ambulance sector, many staff were not prepared to come to work, even under emergency life and limb cover arrangements. This led the government to put the army on standby. So, what happened and what have we learnt? 

Why were staff not prepared to come in? Well the answer lies in the fact that ambulance staff have been raising issues with workload, pressure, demand and lack of support for a number of years. Trouble was no one was listening. Performance dominated Trust boards and finance fixated commissioners missed the warning signs. 

Here came an opportunity for staff to make themselves heard. They voted with their feet in the knowledge that their legal right to take lawful industrial action would protect them. When it came to settling the dispute, we made sure that ambulance staff wellbeing was part of the final settlement. 

So, what has happened since then? Well, we have been working to develop a collaborative approach between Ambulance Employers, Trade Unions and NHS Employers to improve the mental health and wellbeing of the ambulance services workforce. 

We started by bringing together staff and employers to discuss the challenges each group faced. We have to recognise, whether we agree or not, that there is a policy of austerity in government meaning budgets are increasingly tight and the expectation is that employers will do more with less. However, this policy leads to problems for employers as staff leave jobs for less stressful and better paid work leading to recruitment and retention problems. 

Employers listened to staff concerns about working conditions, not just for the operational staff working on ambulances, but also the staff working in the contact centres and corporate services. Fewer people doing more work in an increasingly challenging environment. This is not easy listening for employers, many of whom work in managerial roles to help support staff in the delivery of 999, 111 and PTS services. Ultimately, they have little control of the government’s public sector funding policy. 

However, they do have to deal with the consequences – the dropping job satisfaction, morale and motivation; the loss of organisational commitment and discretionary behaviour. This leads to a worsening engagement, stress symptoms and burnout. Then they have to account for increasing absence rates and unfilled shifts. 

At first it seems like an impossible puzzle with too many pieces that don’t seem to fit together. How do you improve wellbeing, especially when you know what is making people unwell, but it feels out of your control and when taken as a whole it seems an impossible task? 

We started by grouping the pieces of the puzzle together based on the key issues. 

Mental health and resilience. Helped by Mind and the Blue Light Programme we know that ambulance staff are more likely to suffer from mental health problems but less likely to do anything about it. 

Bullying and harassment. Whether it is a manager and staff relationship, a control and road relationship or a hospital and ambulance relationship, we know they are already strained. Cultures in ambulance services need to change. External and internal pressures lead to poor behaviour but we need to eliminate bullying. 

Reducing violence and aggression. Too many times we read reports about staff being assaulted. I have written about this subject before and no one disagrees - we need to tackle this issue. With the right focus on prevention and prosecution we can reduce the harm caused by violence. 

Leadership behaviour. Ambulance staff take on managerial roles and then are not given the support or training needed to discharge their duties. We hear of senior management teams that are out of touch with staff. Line managers have a major role in supporting and developing staff. Senior management need to give them the training, autonomy and trust to support their staff. 

Working patterns and role design. Ambulance work takes years off your life! More and more evidence shows us that long hours, shift working and night working is bad for us and leads to preventable diseases. Some staff like working longer shifts to get longer periods of time off, but with no guaranteed meal breaks and the likelihood of a long shift overrun it’s time we looked seriously at this issue to make work less demanding but recognising peoples’ needs to spend time with their friends and family. 

Equality and inclusion. The experience of BME ambulance staff is of inequality in career progression, increased experiences of harassment and bullying and underrepresentation at senior level. 

Recognition and staff engagement. Each year the NHS Staff Survey shows how poorly engaged ambulance staff are. They are the lowest scores across the NHS. I do not honestly think it is deliberate but you get very little recognition for a job well done, whereas you do hear about a missed performance target or a complaint. Ambulance services need to get better and reap the rewards of telling staff they recognise the effort they are making, especially in difficult times. 

Healthy lifestyles. Last but by no means least. Ambulance work does not lend itself to healthy lifestyles. Shift work, late night snacking on poor quality food, combined with lack of consistent exercise and the physical demands of the job are a bad mix. However, looking after your own health is important and we want to see more employers supporting staff to live more healthily. 

The real trick for the national bodies, employers and trade unions will be getting the buy-in from staff and for them to trust that this is more than just a new initiative. The benefits are proven and what we have been saying for a long time. To get good patient care you need to start with good employee care. At the end of the day, healthier happier staff = healthier happier patients.