Ambulance - what is their role?

metman

Before I start this post, I have a lot of time for the Ambulance service and the job they do. I know they are as stretched as we are and are at risk of assault as much as we are. However I'm beginning to wonder if the ambo service shouldn't just come clean and say openly that they won't turn out to any job involving possible violence without a police escort and that in an 'assist ambulance call' the word 'assist' actually means 'do the job of' the ambulance crew.

Two most recent examples from my own experience;

Tonight, report of a shooting. Turns out victim is pissed up and has fallen over and sustained minor scrape but has some gangsta fixation and thinks he's been shot. Usual rubbish. Anyways injured party is compliant, but drunk. Ambulance were reluctant to take the guy to hospital without one of us riding in the back of the ambulance.....exactly why I couldn't make out at first. Then it became clear that the female paramedic in the crew simply thought they should have a police guard in taking the guy to hospital as there had been a report of a shooting....albeit rubbish. Needless to say neither me nor my oppo went to hospital. Completely unnecessary and a police unit out of service for no valid reason.

The other day at an attempt suicide, we turn up to 'assist ambulance' and subsequently wind up trying to cajole the victim to hossie, ultimately going hands on to remove her to the ambulance while ambo stand back with their hands in their pockets. Ultimately had we stuck her in the back of our car, we wouldn't have needed ambo at all.

I know people differ and their interest level in their chosen profession differs, but more and more I'm encountering ambulance crews who seem reluctant to do the bare minimum without the police holding their hand. Can someone in the know advise if this is policy, or fear of litigation? Can someone tell me what for instance, at minimum, should an ambo crew be doing at the scene of an overdose/attempt suicide? I'm hoping its more than letting police into the building?

As far as I understand it, when police are called to assist ambulance its because ambulance believe/suspect an offence has occurred in which the police should get involved, the patient might prove violent or ambo need police to force entry to a premises etc and I don't have a problem in assisting here. However it seems to be the case that once police are on the scene ambo become mere spectators, washing their hands of their responsibility, even where no violence/aggression is present.

This is not fostering good inter-service relations.

dredre

I can only speak for the Irish scene; there are 2 main factors at play here.

1. If a call comes through with a report of violence, firearms or other weapons, then it is routine to wait for police back up. This is good practice and to argue otherwise is foolish. As with so many calls, the facts on the ground turn out to be different and it is down to the individual how they proceed. Bear in mind that if police back up is present and then stood down, management will not be the most supportive in the event of an incident!

2. The Gardai (and I presume the UK Police) have certain specified powers under law and the mental health act which allow them to restrain people. Paramedics have no such powers and are acting only under common law if they do. In a situation where a patient has to be persuaded or forced into the ambulance the crew may be understandably reluctant to do so when there is someone else present with explicit powers to restrain (and indeed training in restraint). In a worst case scenario, it could be argued that Paramedics becoming involved in restraint actually worsened the situation and impeded the Police's work.


Specifically at the case of an OD/Suicide attempt, the powers given to Gardai under the mental health act could be very important. It may also be the case on occasion that the presence of a blue uniform instills a brief period of 'cooperation' in the patient. Often the opposite I'm sure. From my end, in hospital, most OD and Suicide attempts that arrive by ambulance have had no police involvement.

All that said, I do appreciate what you are saying metman, but it may reflect individual crews rather than the whole service?

TheNog

In my own opinion I can understand the position of ambulance or Fire crews who call us for assistance and tbh if I even think a call for an assist is not really warranted, I still go and help out. If that results in them asking me to go to hospital in the back of the ambo, then so be it.

At the end of the day it is not my job to ensure adequate cover for the district. Safety of ES personnel is paramount

Paulzx

I most certainly don't expect the police to " do the job" of the ambulance or fire crew. Common sense has to apply. If a call comes in for a shooting, stabbing or any violent incident our control informs the Gardai as well as responding our own appliances. If we arrive first and the Gardai are not required i would always turn them back.

In Dublin we are in the lucky position of having a fire appliance turn out to serious ambo cases along with the ambo. At times, they're main role ends up being crowd control.

When dealing with drunks, if anyone gets aggressive with me i just bail out. I don't even look for the Gardai. I just inform our control that we have been threatened and are pulling out. If they subsequently send us back i will then look for the Gardai.

The issue of Gardai travelling in the back of the ambulance to me is pretty clearcut. If the patient requires treatment but is a danger to the ambo crew Gardai must travel. If not, he's not getting into my ambo. Generally there is absolutely no issue with individual Garda when asked to travel. However, one line i have heard is " the sgt won't let us travel in the back of ambo's as we are not covered to do so". B*ll*x!!!!. If every member of the public is covered to travel a Guard as a state employee is certainly covered.

drdre has explained the issue as regards restraining people. We just can't do it. You can obviously act in self defence but we cannot take someone to hospital against their will.

Metman,
We have a good working relationship with the Gardai and i don't think i've ever heard them giving out about being called out. If we are genuinely in trouble they normally arrive immediately. I've been told that Garda control will treat an urgent assistance call from DFB control the same as if a Guard was in trouble.

TheNog

Paulzx wrote: »

However, one line i have heard is " the sgt won't let us travel in the back of ambo's as we are not covered to do so". B*ll*x!!!!. If every member of the public is covered to travel a Guard as a state employee is certainly covered.

That would be coming from a Sgt who wants his members available on the ground no matter what could happen in an ambo.

Paulzx wrote: »

Metman,
We have a good working relationship with the Gardai and i don't think i've ever heard them giving out about being called out. If we are genuinely in trouble they normally arrive immediately. I've been told that Garda control will treat an urgent assistance call from DFB control the same as if a Guard was in trouble.

It is considered a priority call for assistance from any ES personnel who request it so would be treated the same as a Garda requesting urgent assistance.

metman

dredre wrote: »

All that said, I do appreciate what you are saying metman, but it may reflect individual crews rather than the whole service?

I think that's accurate. As I said the Ambulance Service do a good job under tough conditions, so its more likely disenchanted individuals rather than policy.

Paul - a call for assistance is treated the same way here as ultimately we're all reliant on each other.

Tango Alpha 51

Paulzx wrote: »

I most certainly don't expect the police to " do the job" of the ambulance or fire crew. Common sense has to apply. If a call comes in for a shooting, stabbing or any violent incident our control informs the Gardai as well as responding our own appliances. If we arrive first and the Gardai are not required i would always turn them back.

In Dublin we are in the lucky position of having a fire appliance turn out to serious ambo cases along with the ambo. At times, they're main role ends up being crowd control.

When dealing with drunks, if anyone gets aggressive with me i just bail out. I don't even look for the Gardai. I just inform our control that we have been threatened and are pulling out. If they subsequently send us back i will then look for the Gardai.

The issue of Gardai travelling in the back of the ambulance to me is pretty clearcut. If the patient requires treatment but is a danger to the ambo crew Gardai must travel. If not, he's not getting into my ambo. Generally there is absolutely no issue with individual Garda when asked to travel. However, one line i have heard is " the sgt won't let us travel in the back of ambo's as we are not covered to do so". B*ll*x!!!!. If every member of the public is covered to travel a Guard as a state employee is certainly covered.

drdre has explained the issue as regards restraining people. We just can't do it. You can obviously act in self defence but we cannot take someone to hospital against their will.

Metman,
We have a good working relationship with the Gardai and i don't think i've ever heard them giving out about being called out. If we are genuinely in trouble they normally arrive immediately. I've been told that Garda control will treat an urgent assistance call from DFB control the same as if a Guard was in trouble.

+1

Metman,
Paul beat me to to it but just to reiterate his point that like our colleagues in the DFB, we in the HSE National Ambulance Staff can't take someone to hospital against their will even if we think they need it.

metman

buzzman wrote: »

+1

Metman,
Paul beat me to to it but just to reiterate his point that like our colleagues in the DFB, we in the HSE National Ambulance Staff can't take someone to hospital against their will even if we think they need it.

Buzz I'm aware of the limitations of ambulance staff when it comes to sectioning people (its a police power to remove a person to a place of safety), however ambulance staff have recently been given a power under the mental capacity act 2005 to intervene and remove a person to hospital (if the patient refuses to go willingly) where in the view of the ambo personnel the person needs treatment but does not have the mental capacity to make the decision for themselves (by reason of disability/alcohol/drugs/depression etc etc). The police also can make use of this power.

I don't have an issue using these powers to assist the ambulance, and I don't think its really a good idea to have ambulance staff effectively sectioning people without police on standby....but what irritates me is personnel not making any attempt to talk the person round i.e, assisting us to get the person to hospital. Its simply a case of police are here, they can manhandle the patient to hospital. In my experience more often than not talking to the patient produces better results than dragging them kicking and screaming to a&e, yet this has been a skill thats been lacking in some of the crews I've dealt with (as above).

Paulzx

Metman,
We don't have that power here. Mentally unstable or not if someone is capable of saying no we have to abide by their wishes.

The only way we can take someone to hospital without their consent is if they are unconscious. The principle of implied consent operates here as in we can make the decision for them.

The ability of a patient to say no can be very important. Many a time i have seen families who want to farm an elderly person off to hospital so that they can continue drinking, drug taking, partying etc without having the responsibility of taking care of them. I know that this is a completely different situation but the ability to refuse to go somewhere against your wishes is very important when others are not looking out for your best interests

Tango Alpha 51

Met,
That's very interesting in relation to the Mental Capacity Act 2005. Unfortunately have perused the Irish Mental Health Act 2001, the same powers are not conferred on us.
However I do take your point that it is frustrating for you/AGS to be at a scene where the crew in question do nothing to help. Equally it's frustrating for one part of an ambulance crew to have a partner who is disinterested from helping for one reason or another. I too have worked with people who decide that once AGS are present that they have nothing else to do with the pt other than convey the pt to hospital. Sometimes after a period of talking the pt will decide to go anyway but other times physical restraints have to be used.

johnnyskeleton

metman wrote: »

As far as I understand it, when police are called to assist ambulance its because ambulance believe/suspect an offence has occurred in which the police should get involved, the patient might prove violent or ambo need police to force entry to a premises etc and I don't have a problem in assisting here. However it seems to be the case that once police are on the scene ambo become mere spectators, washing their hands of their responsibility, even where no violence/aggression is present.

Maybe they are told that when someone makes a complaint of a violent attack or other crime they should get the gardai involved in case the person wishes to make a statement of complaint, but are surprized when the gardai dismiss the complaint as rubbish and potter off to their station. Maybe they think the gardai are washing their hands of the situation.

metman

johnnyskeleton wrote: »

Maybe they are told that when someone makes a complaint of a violent attack or other crime they should get the gardai involved in case the person wishes to make a statement of complaint, but are surprized when the gardai dismiss the complaint as rubbish and potter off to their station. Maybe they think the gardai are washing their hands of the situation.

Have you an experience you wish to share with the group or are you just generalising?

johnnyskeleton

metman wrote: »

Have you an experience you wish to share with the group or are you just generalising?

Well, I'm looking at your post (after all, you were the one who wanted to post about how you can do paras job better than they can, so presumably you can take criticism too) and I can easily see how in the first situation the paramedics would be that you want to wash your hands of the situation. A complaint is made, you call out, have a look at the guy, he seems ok to you so you say "take him away" and go back to the station?

metman

Riiiiiiight.

Cheers for your input. Insightful as always

johnnyskeleton

metman wrote: »

Riiiiiiight.

Cheers for your input. Insightful as always

Don't want to engage with a view other than your own, no?

metman

TheNog wrote: »

In my own opinion I can understand the position of ambulance or Fire crews who call us for assistance and tbh if I even think a call for an assist is not really warranted, I still go and help out. If that results in them asking me to go to hospital in the back of the ambo, then so be it.

At the end of the day it is not my job to ensure adequate cover for the district. Safety of ES personnel is paramount

See I disagree with you there. Not every call justifies having a police officer in the back of the ambulance, in fact most do not. Some medics I have dealt with have made it clear that they feel it is the job of the police to accompany them when ferrying drunks with a bump on the head as exampled because something 'might' happen. IMO risk is inherent in any frontline ES role and while I'm happy to assist where assistance is required I'm do not feel it is the role of the police to be a security service babysitting compliant patients.

If you personally are happy to jump into said ambulance, even where its not warranted? Where do you draw the line? Are you going to stay in A&E while the person is dealt with in case they become violent, even though they haven't shown any aggression up to this point? If we are to continue this line of thinking, who then is going to actually 'police' while the police babysit patients in unwarranted circumstances?

TheNog

metman wrote: »

See I disagree with you there. Not every call justifies having a police officer in the back of the ambulance, in fact most do not. Some medics I have dealt with have made it clear that they feel it is the job of the police to accompany them when ferrying drunks with a bump on the head as exampled because something 'might' happen. IMO risk is inherent in any frontline ES role and while I'm happy to assist where assistance is required I'm do not feel it is the role of the police to be a security service babysitting compliant patients.

If you personally are happy to jump into said ambulance, even where its not warranted? Where do you draw the line? Are you going to stay in A&E while the person is dealt with in case they become violent, even though they haven't shown any aggression up to this point? If we are to continue this line of thinking, who then is going to actually 'police' while the police babysit patients in unwarranted circumstances?

I should have possibly made myself a litttle clearer. The EMTs I know, I have met them frequently so I know what they are like and I trust their judgement. It has happened before when I arrived a pt was compliant but before they were kicking off. I listened to the EMTs on what happened and I ask them to make a judgement call if they want a guard in the back of the ambulance or not. In all cases they said no but would see how it goes. Sometimes we may follow the ambulance for part of trip to the hospital to make sure they are alright.
What Im trying to say is that I trust their judgement. If they dont feel save then I or my oppo goes with them. No harm done if nothing happens, it just means that no EMT gets assaulted and they can respond to another call after the pt is dropped off.

I can see where you are coming though. I would not want any of us diverted from our job just cos an EMT does not try to talk a pt round.

foxtrot-oscar

TheNog wrote: »

I should have possibly made myself a litttle clearer. The EMTs I know, I have met them frequently so I know what they are like and I trust their judgement. It has happened before when I arrived a pt was compliant but before they were kicking off. I listened to the EMTs on what happened and I ask them to make a judgement call if they want a guard in the back of the ambulance or not. In all cases they said no but would see how it goes. Sometimes we may follow the ambulance for part of trip to the hospital to make sure they are alright.
What Im trying to say is that I trust their judgement. If they dont feel save then I or my oppo goes with them. No harm done if nothing happens, it just means that no EMT gets assaulted and they can respond to another call after the pt is dropped off.

I can see where you are coming though. I would not want any of us diverted from our job just cos an EMT does not try to talk a pt round.

Correction they're paramedics, wont see an emt working on a dfb or hse ambulance, all paramedics or ap's

TheNog

foxtrot-oscar wrote: »

Correction they're paramedics, wont see an emt working on a dfb or hse ambulance, all paramedics or ap's

and there was me thinking they were the same thing

foxtrot-oscar

Nah, paramedic is a higeher qualification, can do more, give more drugs etc.

The pre hospital emerency care council qualification ladder goes

Occupational first aider
Cardiac First Responder
Emergency First Responder
Emergency Medical Technician
Paramedic
Advanced Paramedic

Now you learn something new every day

boomer_ie

foxtrot-oscar wrote: »

Nah, paramedic is a higeher qualification, can do more, give more drugs etc.

The pre hospital emerency care council qualification ladder goes

Occupational first aider
Cardiac First Responder
Emergency First Responder
Emergency Medical Technician
Paramedic
Advanced Paramedic

Now you learn something new every day

They used to be known as EMTs but were renamed Paramedics by PHECC (although HSE still calls them EMTs for wages reasons).

The Qualification ladder goes:

Cardiac First Responder
Occupational first aider
Emergency First Responder
Emergency Medical Technician
Paramedic
Advanced Paramedic

Not as Foxtrot-Oscar had it.

foxtrot-oscar

Ahh throught it went ofa then cfr my mistake

Eru

johnnyskeleton wrote: »

Don't want to engage with a view other than your own, no?

You dont have a valid opinion as you have no working knowledge or experience of either agency or situations.

Police and ambulance crew do.


In relation to the topic,
If ambulance ask me to go along I will, the car can follow me for 5 minutes and once all is in order we can bugger off again. I have a problem being asked to wait in A&E with someone thats not a prisoner but thats not dfb's fault.

Theres bound to be occasions where a fireman or ambulance crew were less than courtious and a little windy but likewise if we started digging you will probable find plenty of occasions where dfb werent impressed with the garda response and attitude. None of us are prefect and we certainly arent on top form at every call.