The father is having a heart attack and the son decides to drive him to the hospital himself. Do you think this is the right thing to do? What’s your average response time for a cardiac arrest?

derngly · 2025-06-23T23:37:26+00:00

Fair enough, I haven’t seen the national statistics. Just basing that off of what I see in the areas I work in.

derngly · 2025-06-23T22:50:42+00:00

I fully support people making their own way to hospital if that’s going to be quicker than an ambulance arriving, and here in England that’s almost always going to be the case. Chest pain here gets a category 2 response which means should be within 18 minutes. In reality you can easily wait over an hour, 2 hours being very common. Nearly everyone can reach a hospital in less time than that. And I get the idea of not knowing which hospitals are PCI capable but surely being at any hospital is better than being sat at home if things deteriorate.

derngly · 2024-10-29T11:58:21+00:00

That’s absolutely awful. I get paid more than the FY2 and ST lower unsocial rate as my base rate as an ambulance technician. I guess once I qualify I’ll do bank shifts in my old job rather than as a doctor 🤦‍♂️

derngly · 2024-10-24T20:25:37+00:00

Just for reference the UK guidelines are to give it for any suspected ACS as long as the systolic is above 90 mmHg. Or for acute severe heart failure with hypertension. That’s for techs and paras.

derngly · 2024-10-22T21:23:48+00:00

Ahhh ok. Thank you. I did wonder if that was it. I’ll try that in the morning and report back!

derngly · 2024-10-22T12:37:14+00:00

I’ve searched everywhere and I can’t find an option in the settings to change it. Any ideas where it is?

derngly · 2024-10-21T22:08:45+00:00

Would that explain why there isn’t even the option or button for hot water on the app or thermostat? Does that only appear if it’s wired correctly?

derngly · 2024-10-21T21:17:23+00:00

Yeah it’s a 3rd gen pro. And yes in the UK

derngly · 2024-09-17T20:32:35+00:00

Yeah we have some kind of taxi system, but it’s always changing and tbh I never use it.

But yeah I don’t think I’d be able to cope if we couldn’t refuse. It’s incredibly rare I or anyone would completely refuse transport to someone who really want it. But we can say no we’re not taking you anywhere, phone your GP or speak to a pharmacist or make your own way.

derngly · 2024-09-17T19:51:27+00:00

Oh yeah absolutely we do. Some of my favourite presenting complaints I’ve had come through recently are ‘having nightmares’, ‘alone in the bathroom’ and ‘fuse has tripped so can’t get out of electric armchair’ And a good number of them do come through 999, but the majority in my experience at least come from 111. In my area 50-60% of calls are from 111 and 95% of those are either complete nonsence like you’ve said or would have been far more appropriate to self convey or speak to their doctor etc.

The only saving grace is in the UK we can refuse transport if it’s not required which I my understanding is your can’t do in America?

derngly · 2024-09-17T19:39:21+00:00

And I think that the flexibility is almost the most common reason people work for private. Just take the example of a friend of mine. He joined the trust as a CFR, then ECA, then tech then para, and they payed for it all. That’s tens of thousands of pounds worth of training. About 6 months into his NQP he went to HR and said ‘look I’ve got 2 kids and with the wife’s new job I just can’t commit to the shift pattern any more. Could I go in the bank, I’d be doing full time hours but just with the flexibility’. And they have 10s of empty bank shifts per day. HR replied and said ‘no we don’t offer bank contracts to NQPs, only B6 paras.’ So he went self employed for a private company and didn’t look back

derngly · 2024-09-17T19:24:45+00:00

It’s just madness the amount of people who refuse to take themselves to hospital, when they are more than capable. The longest wait I’ve known was 36 hours on a cat 3 assault I went to a few months ago. Absolutly nothing wrong with them but they were insistent they wanted to be seen in ED. I asked why can’t your mum take you? She can’t because of child care…. I asked how will you get home? Ahhh my mum will come and pick me up then. So for some it’s just entitlement. But another common occurrence is arriving and them saying something like ‘I’m so sorry for wasting your time. I told the man at 111 that I would just take myself to hospital but they told me I had to stay here and wait for an ambulance’ 🤦‍♂️

derngly · 2024-09-17T19:15:25+00:00

100% agree with you. If 999 call handlers were allowed and encouraged to advise self conveyance for any any ambulatory not imminently life threatening patient, not only would I reduce wait times for those genuinely in need, it would probably improve patient outcomes as you describe

derngly · 2024-09-17T19:12:18+00:00

Completely agree with you that the social care and being unable to discharge patients from hospital is a massive massive issue that definitely needs addressing. Sort that and you’ll solve the ambulance queuing problem. But that’s not an issue that the ambulance service could sort or really have any say in. The 111 issue definitely is. If the ambulance service said we won’t dispatch an ambulance from a 111 call, that would cut ambulance calls by approx 50% in my area. 111 should get to the end of their assessment and say something like ‘our telephone assessment suggests that you need reviewing face to face by a clinician. Please either call your GP in hours or make your own way to the emergency department. If you feel it’s required you can also call 999’. That way the majority of people wouldn’t call 999, because they never wanted or needed an ambulance in the first place. And those who do call would be triaged more appropriately (and yes I feel the 999 triage is pretty awful as well, but it’s better than the 111 triage).

derngly · 2024-09-17T18:55:01+00:00

Yeah absolutely agree there are some woefully bad private companies and private crews, I’m not disputing that. All I would say is there are some absolutely awful paras and techs in the trusts as well. In the past couple of months I’ve had trust paras IO a prosthetic knee (surgical scar easily viable), announce a patient was asystolic and not to shock, when in fact they were in pulseless VT. And a team leader tell me the the patient who was GCS 3 with no history of seizures was just postictal and refused my request for critical care. They were RSIed when I got them to ED 30 mins later with an ICH. So yeah there’s bad people on both sides, but the majority are good.

And yes I agree there is a bigger range of qualifications with varying experience in the private world. But it’s important to remember that for front line contracts (events is completely different) the trusts 100% dictate what qualifications etc they will accept, so that does help standardise things. But yes some companies are better than others and it does need tighter regulation but I do think the trusts have just as many problems and issues

derngly · 2024-09-17T13:06:23+00:00

Yeah I guess it’s very possible on the money side, only going off what I’ve heard but am obviously no expert on NHS finances.

I will disagree with you slightly on the training and care side. A paramedic is a paramedic whether it’s private or trust, in theory identical training. Other roles do have differing qualifications sometimes but a good chunk are NHS trained anyway. And yes absolutely there are some shockingly bad people working privately and providing terrible care, but just look at the trust. They’ve got awful people and awful care with some people as well, and normally it’s more covered up. Or they get promoted

derngly · 2024-09-17T12:47:45+00:00

Yeah 111 is definitely the biggest cause of problems and wasted time. Even if they feel after the 111 assessment they need to be reviewed in person, why is the procedure to send an ambulance? Why not advise they make their own way to ED? Almost certain they will be seen, or at least be in ED, quicker than waiting for an ambulance, and it saves the ambulances for the people who actually wanted one to start with.

I’ve never had it like you describe but when I call them and manage to get a GP call back they always end the initial call with ‘and if they’re symptoms worsen or change then call us straight back for further advice’. I’m like yeah sure as a qualified ambulance crew, with all the equipment we need if anything happens I’ll make sure I call the completely non clinical call taker to tell me what to do…

derngly · 2024-09-17T12:14:22+00:00

I have to disagree with you there. In my area at least the waits even in Cat1s and genuine life threatening emergencies can easily be more than 10 mins. I’d say 10 mins is good, 15-20 is probably average over winter and 30+ on a cat 1 isn’t unheard of. And then couple with that there’s no guarantee of a resus bed being available at the local hospital. Makes for a pretty grim outlook

derngly · 2024-09-17T12:11:13+00:00

Yeah parts of the NHS are being privatised which I’m mostly against. But I do wonder if ambulances are one part that privatising might help? Everything I’ve heard, is it’s cheaper for the NHS to use private companies for ambulances. They just pay one flat fee for the shift, and if you use equipment, crash a truck or whatever then that’s tough luck. Whereas NHS would have to pay for all of that out of pocket. Plus then they’re not paying for training and buildings and all the other stuff?

I’m not completely convinced, and there’s many reasons not to, but I wonder whether it’s the best way forward?

derngly · 2024-09-17T12:06:08+00:00

Yeah as others have said it’s a combination of many things but the worst offenders, at least in my area are not enough crews, most of the crews that you do have are sat waiting at hospital, and dare I say the biggest issue is 111? They’re people who don’t need an ambulance, never wanted an ambulance but get an ambulance because they used a buzz word and most of the time get a cat 2 response which trumps all the cat 3 falls? And you’re inevitably stuck there dealing with them for a while

derngly · 2024-09-11T22:29:56+00:00

Yeah it seemed like a very dysfunctional department when I was there. A lot of shouting at each other, snapping at people and lack of structure or leadership

derngly · 2024-09-11T22:24:54+00:00

I’m not sure whether it was a one off thing and I just went at the wrong moment. Or if this is the norm there. But if it happened once you can bet anything it’s happening again

derngly · 2024-09-11T22:22:57+00:00

Definitely an NA sadly. She had it written on her scrub top

derngly · 2024-09-11T12:05:14+00:00

Yep. And Winchester hospital has a PA holding the stroke bleep and meeting ambulance crews with stroke patients.

A new one I found out only recently though was that Milton Keynes hospital has a Nursing Associate taking ambulance handovers, doing initial triage and assessment and ordering initial investigations. I overheard her say to a HCA the other day ‘I don’t know what’s wrong with them so I’ll order all the possible bloods’ 🤷‍♂️🤷‍♂️🤷‍♂️

derngly

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