Morale

At this moment in time, morale is low in the ambulance service. This is evident as more and more articles are appearing in mainstream news raising concerns about how busy our crews are, fewer breaks being taken because there is so much outstanding work and finishing late at the end of every shift.

For decades, the ambulance service was quite a secretive organisation. Problems such as the above never made it to the papers because it was bad press for the NHS’ ambulance service, and crews didn’t want the public thinking they couldn’t cope with the job.

But here is the reality from the front line. The shift length of 12 hours is acceptable and is generally well liked in the service. It means we work fewer days per week and allows better 24 hour cover with less people. In my opinion, this is not the issue. The issue is not being able to take our breaks, and perpetual late finishes.

Years ago, the rules were; if you get back to your station, you are protected from being sent an emergency call until you’ve had your legal 30 minute break. However, while driving back to your station, you’re fair game. As workload increased, the likelihood of getting back to your station decreased – especially for remote, satellite stations like mine (we’re not stationed at hospitals as is popular belief). Crews would be sometimes 9 hours into their shift without a break and have to book unfit for duty until they’d had their break.

To rectify this, the Unions worked with our trust to introduce protected meal break windows. 5 hours into our shift, we cannot be sent an emergency call until we’ve driven back to our station and had a 30 minute break.

“Madness!” I hear you cry! You may think it ludicrous that crews, no matter where they are in their area (we could be 30 miles or more from our base stations) are driving all the way back to their station fully protected from emergency calls.

There’s two things to remember here, well, three if you think about the reason we ended up so far away from our station in the first place (lack of cover); Firstly. The front of an ambulance is like the front of a van except we have a computer terminal on which we receive calls and navigation details. What we don’t have, is a cool box or fridge. That delicious Chicken sandwich that’s been sat in a hot, sweaty cab of an ambulance for 8 hours, perspiring onto the now soggy bread doesn’t seem so appetising anymore! The trust will not install cool boxes as they consider it a health and safety risk if it is not cleaned. And we are not allowed to bring our own as we are not allowed to plug devices into the already overloaded vehicle electronics. This means our food is on our station. Also, on a winter’s night at -5, is it unreasonable to want a hot meal?

Secondly, we are never truly ‘protected’ from calls. What the trust took to doing was ‘general broadcasts’. Our radios are closed channel, so our dispatcher talks to one crew and nobody else, as is required by law for patient confidentiality. However, if there is an outstanding call that has been triaged as a “life threatening” emergency, they will broadcast it on open speech, thusly:

“Control to all mobiles, general broadcast. There is currently an outstanding Red call for a 60 year old male with chest pain in [town]. Currently responding a crew from [a town far away]. Anyone able to assist or render aid, please call up. Control standing by.”

So what do we do? We’re a mile away from a patient possibly having a heart attack. We do what we signed up for an answer the call. Even while legally protected, we can ‘volunteer’ to take an emergency.

“What a relief” I now hear you say. Perhaps. But the frequency of these general broadcasts is alarming. Such is the frequency and lack of cover, we might never get a rest break for answering them. So sometimes – very selectively mind you – we don’t answer them, so we may actually have a break. Let me elaborate before you faint.

If a broadcast goes out “child in cardiac arrest” control will be inundated with volunteers. Crews for miles and miles in any direction will be calling up to help.

If a broadcast goes out “25 year old male, tummy pain for 3 weeks”. What would you do? (The fact that triages as ‘life threatening’ is the subject for another post). If he’s had it 3 weeks, it can probably wait 30 minutes while I raise my blood sugar levels from 0.0!

Also, there is the subject of late finishes. We can be sent an emergency call any distance (sometimes we travel 35 miles to emergencies) minutes before the end of our shift. Looking back over last month, I worked 15 shifts and finished on time on 3 occasions! Lateness ranging from only 15 minutes to two hours! This overrun is enforced as we cannot turn down an emergency just because we’re due to finish in 10 minutes.

I know this post may seem a bit ‘moany’, and this is ‘the job we signed up for’ and please don’t misunderstand – I love my job, but don’t forget; we’re only human. Simple, fragile flesh and bone the same as the patients whom we help. After all the horrors and stresses we encounter, we only ask for a break and a reasonable finish time. It’s not too much to ask. But it is, apparently, and that’s why morale is currently lower than the shadow of shark shit!

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