Heroes on our doorstep - why we should think before dialling 999 for ambulance

Thirteen ambulances are queued alongside the entrance of the A&E department at Pilgrim Hospital in Boston.

It is fair to assume patients remain in some of the ambulances waiting for a bay in the hospital to become free - ‘nursed’ by East Midlands Ambulance Service paramedics who are in constant liaison with hospital staff should the condition of the patient deteriorate, and they need to be prioritised.

My 10-hour shift observing paramedics Lee Street and Wayne Bontoft is almost at an end - but this tireless team who would normally be working longer may not be going home early.

As Wayne mops down the inside of the ambulance for the next day, Lee - a clinical support manager - is already wondering whether he should help co-ordinate the situation at A&E and help get things moving.

“There have been times when we’ve taken patients for scans while waiting for beds, to escalate care for patients,” he explained.

Recent headlines have done nothing to help the public opinion of our ambulance service.

Nationwide figures showed EMAS had the greatest number of long delays – one in eight calls (16.2 per cent) took over an hour when the national average is 6.32 per cent.

Experts claim the delays for ‘category 2’ 999 calls – meant to be reached in an average of 18 minutes – put lives at risk.

According to EMAS, a contributing factor to the time lost is handovers at the hospitals.

However, for the ambulance crews and hospital staff on the frontline receiving the criticism, it’s just a matter of ignoring the headlines and “getting on with it”.

“We understand people get upset when they have to wait for an ambulance, but there are many layers as to why that happens, especially along the East Coast of Lincolnshire because it is so rural,” said Lee.

“I’ve worked across the East Midlands for EMAS, and it is so different in cities because ambulances can be at a call in five minutes.

“Here, we may be on our way then another call comes in on a higher category where a condition is life-threatening, so the first one is downgraded and a backlog begins.”

In the east area EMAS has ambulance stations in Louth, Mablethorpe, Horncastle and Skegness as well as Boston, but paramedics can be deployed anywhere if there are no local ambulances available - known as a drift.

“There may be a certain hospital on call for urology patients that day which could mean you having to take them to Lincoln, putting you out of service travelling for two hours, which can add to the problem,” explained Lee.

EMAS had already had 414 calls across the region when we checked in with Andy Pafomow, clinical operations manager, at the Boston Ambulance Station at 8am on Monday for the start of the shift.

Our first call was to a care home in Boston to give paramedic support to a ‘tech’ team, where a decision had to be made on whether to take an elderly patient with no available care plan to hospital. It takes three years for a paramedics to qualify at university - enabling them to use more drugs and make use of all the technology available to them in the new fleet to assess the situation.

The decision was made to take her to hospital, and in this instance the handover went smoothly, with a bay becoming available in minutes.

However, the second patient was a different story. After a thorough examination it was decided the elderly man should be admitted and he was given fluid and a drug to stop his sickness while on the ambulance before setting off.

On arrival we were in a queue with the engine running to keep the patient warm and a member of hospital staff checked in during the wait. There were three patients waiting in ambulances and here it became clear why it is so difficult for EMAS to hit their targets.

“We may not be hitting targets, but behind the scenes ambulance staff are making gallant efforts,” said Lee.

“They are heroes who make a massive difference to people’s lives, who will work through their rest periods and even after they should have finished.”

Wayne looked at the clock in the ambulance: “We’ve been waiting over an hour now. Nurses are working as fast as they can, but paramedics take on the nursing role while we are waiting.

“Jobs have now begun backing up. Monday can be bad because doctors go out on calls after the weekend, and refer those needing to go to hospital.”

Lee added: “Even if you had 30 more ambulances, if there is no room at the ‘inn’ we could still get that backlog.”

A bay becomes free, and it is immediately evident how busy the hospital has become with three patients waiting on trolleys in the corridor - one asking to go to the toilet to anyone who passed by...

Paperwork done and the patient handed over, the morning was gone and it was time to grab a half-hour break.

“It’s so important that paramedics take on plenty of food and drinks during the day,” said Wayne, who has recently received his 30-year long service and good conduct award, after originally joining the NHS as a hospital porter.

Lee joined the NHS 15 years ago after being a medic in the RAF. He qualified as a paramedic 10 years ago and is involved in training as part of his role as clinical support manager.

The most recent course was at the training centre at Lincoln involving a number of different scenarios with very life-like mannequins.

“We had really good feedback from this,” said Lee. “We aim to work like a Formula 1 team - everyone with a specific job knowing what they are there to do.”

No sooner was the break over, than we were on our way to another elderly patient at a care home who has been off his food and fluids, and was unresponsive.

The man’s wife was present as the paramedics examined him and prepared to take him to hospital.

A drip was hung above the stretcher in the ambulance, and when the man was made comfortable a seat was made available for his wife to go along to the hospital with him.

We were allowed into a central area past the bays while one was made available, and a paramedic fetched a chair so the man’s wife could sit with him while we waited.

Once admitted, Lee began the paperwork.

I caught they eye of a patient reading a book while waiting for test results. “I really can’t complain about the NHS,” he said. “I’ve been here several times and they always look after me very well. But it is evident they are under so much pressure.”

The elderly man we brought in reached out for his wife’s hand - the first time he had shown any response to what was happening around him. A few minutes later he sat up.

“This is what makes our job worthwhile,” said Lee. “It’s always good to see a positive outcome, but it’s something we can’t dwell on. We just have to do our best for the patient during the time we are responsible for them.”

A call to Spalding was downgraded and we were directed to a pregnant woman in Boston who believed her waters had broken, and at just 23 weeks she feared she may be losing her baby.

The mum said she had called 111 and they arranged for the ambulance as she had no other way of getting to the hospital.

It was perhaps the easiest handover when the mum and her partner were delivered to the maternity team at the hospital, but for other crews, with 13 ambulances waiting outside A&E it was a different story.

“I’m not offsetting EMAS inefficiency against the hospital inability to admit patients when we arrive - but is is a factor,” said Lee.

“The NHS runs on goodwill - if it didn’t it would grind to a halt.

“I’ve been close to finishing before and a call comes in. If it’s a child and they are only five minutes away and you go home, all the time you are thinking what if that was my child?

“It’s not unusual for us to do 16 hour shifts and be back again the next day.

“From my experience, the ambulance crews in Lincolnshire are the most resilient - I am so proud to be working with them.”

After the shift, I spoke to EMAS bosses regarded the current situation.

Nichola Bramhall, Director of Quality Improvement and Patient Safety at East Midlands Ambulance Service, said:

“Throughout the year there has been a significant increase in the demand on our service, with an additional 36 responses per day experienced during the first 22 days of January 2020.

“Many of these patients are very poorly and need to go to hospital (in January 2020 75% of our responses were for patients reported to be either Category 1 – life threatening, or Category 2 – serious).

“To respond to the growing demand and other pressures, over the last 12 months we have recruited more than 300 clinical staff and 999 call handlers, and invested in new additional ambulances and other resources. We are now delivering faster average response times for category 1 calls compared to two years ago. We know our hospital colleagues have also seen significant pressures this winter, with flu and norovirus in particular bringing big increases in A&E attendances as well as taking ward beds out of action - these and other factors have combined to mean that in many cases after taking someone to an emergency department, our ambulances haven’t been able to get back on the road quickly and into the community to respond to other 999 calls.

“Every part of the local health and care system wants to tackle these issues, and is working together to do that, but it’s clear that the NHS will need to transform, and we will need a well-functioning social care service, if we’re going to meet the needs of our growing and ageing population over the coming years.

“This means greater emphasis on prevention, self-care and care closer to home where this is safe and appropriate, safeguarding our urgent and emergency services and hospital beds for those for whom these alternatives are not clinically appropriate. In the meantime, in Lincolnshire together with United Lincolnshire Hospitals NHS Trust, we have created a Rapid Handover Protocol to help reduce delays in ambulances.

“This is implemented when space and staffing at the hospital allows.”

WHAT ULHT HAD TO SAY ABOUT HANDOVER TIMES

As well as speaking to EMAS bosses, we spoke to United Lincolnshire Hospital Trust about the delays witnessed in admitting patients from the ambulances to the A&E department at Pilgrim Hospital - known as the handover process.

Chief Operating Officer Simon Evans said: “We work very closely with our colleagues from East Midlands Ambulance Service (EMAS) and are doing everything we can to improve handover processes and the flow in and through our emergency departments. We are also working with EMAS on new and novel ways to meet this increasing demand.

“At times when our emergency departments get extremely busy we can run out of space, which means ambulance crews have to wait until they are able to safely hand patients over to us.

“We always prioritise the most unwell patients, and when a handover cannot take place immediately, staff are allocated to work alongside ambulance crews to ensure those patients waiting are looked after.

“The announcement last year by Prime Minister Boris Johnson of national funding for Pilgrim hospital A&E will help us to expand the department, increase our capacity and better meet this demand. Securing the funding was the first major hurdle, and since then we have been busy liaising with our staff in the department, with colleagues across the Lincolnshire health and social care system, with national bodies, and with patient representatives, to start the process of coming up with a plan that will give us an emergency department that is fit for the future.”

HOW WE CAN EASE THE PRESSURES ON THE NHS

Treat aches, pains, coughs and colds at home. Stock up on your medicine cabinet, including pain killers, antihistamines, anti-diarrhoea and indigestion medicine. Order repeat prescriptions in plenty of time.

Pharmacy

Pharmacies offer advice about healthy lifestyles and treatmentsfor allergies, constipation, thrush, cold and flu symptoms, earache and fever and could save you a trip to GPs.

GP

If syptoms don’t improve or get worse, call a GP to access a healthcare professional or for referrals.

NHS111

The NHS111 hotline is available seven days a week and is free from landlines and mobiles. Health professionals can advise you on your best pathway to care.

A&E or 999

For critical and life-threatening situations, including acute fits, loss of consciousnesss, heavy blood loss, and severe chest pain, visit your nearest A&E or call 999.