Before I commenced drafting this report, I looked back through my diaries to refresh my memory of events over the past 12 months and that caused me to look back even further. As a result, I have concluded that since I first became a safety representative and entered the world of accidents, hazards, injuries, sickness and litigation, the year 2016 must surely rank as my Annus Horribilis. The number of incidents that required looking into, the number of reports that required time to prepare, the number of times I had to “divert” my phone or make my emails “not available” to enable me to regroup and take some down time; and the number of Solicitors contacting me as a result of an employee being injured, have all increased tenfold. All these and more indicated that 2016 has been the worst year so far with regard to health and safety in our workplace.
To compile a full appreciation of events would take several days and the end result would no doubt bore the average reader; I will therefore bullet-point the year as best I can, covering the issues and concerns that have occupied my life for the last year.
Vehicle Daily Inspections: along with the mandatory roadworthy checks of our ambulances and RRVs (Rapid Response Vehicles) are still being interrupted for 999 calls before completion and this is a reflection of the extremely high demands being placed upon our call takers and dispatchers within our Emergency Operation Centres (EOC’s). It is clear that not all areas are using the VDI checklist and those that do have different ways of storing the completed document. The way forward has to be that the MDT system is configured so that crews can hit a button to confirm VDI completed or another button “not completed”. The latter case should result in an out of service (OOS) code generating when the crew become clear, to resume their VDI.
RRVs (and FRVs “Fast Response Vehicles”): Developments saw the disappearance of the Mondeo mobile office desk, but with the new vehicles came issues which could not be foreseen. The fix position of the MDT screen can cause distracting glare which can affect safety when driving in periods of darkness. One potential solution is a tinted screen that could be placed over it… The majority of equipment is carried in the rear section and a sliding shelf has been installed to facilitate the removal and replacing of equipment. However, not all RRV (FRV) crews were aware about the sliding option… There is also an ongoing issue regarding some members of staff overloading the RRV (FRV) with excessive kit, far more than could ever be justified. Loading lists are agreed for all Trust vehicles and these should be adhered to.
CEN Compliance: The stretchers in our ambulances are CEN compliant and this means there is a mandatory requirement for all components to in situ when a patient is being conveyed, if the certification is not to be corrupted. The head rest extension along with the shoulder harness and lateral straps must be utilised. If there are any medical reasons why this is not complied with we must record it on the MDT system before leaving scene, so that it is time-lined and recorded.
Canine Parvo Virus: Concerns were raised following a confirmed outbreak in part of our region. The bacteria are found in dog stools, can remain resistant to rain for up to a year, and can be transmitted via direct contact with an infected dog or via the faecal-oral route. The concern was also raised that it can be transferred on the soles of footwear or the underside of our equipment and bags, and be introduced to a non-infected area or healthy dog environment. Tests have proven that household bleach is an effective cleaning agent.
Chemical Concerns: There was a regional concern regarding the use of Glyphosate weed killer, but the Trust has confirmed that it does not use this chemical product which is a systemic herbicide for weed clearance.
Speed Cameras: A new style of speed camera was introduced and the major difference with this one is that it fires off a red FLASH towards the offending vehicle, in order to facilitate the camera capturing the image of the driver. Having experienced the sudden and unexpected loss of vision and disorientation when it happened on several occasions (and raised a Datix report) I would advise all drivers to report all instances where the speed camera has been activated and the red flash has affected their driving or vision.
Back Pain: The Trust is always looking at ways to reduce the incidence of back pain amongst members of staff, especially those who are employed in a sedentary manner or those whose work entails lifting and carrying. The “Handle With Care” manual covers best practices and states that “the desks in EOC have the facility to allow you to work standing up”. If this is not correct, then please inform your supervisor and your workplace health and safety representative. When contemplating moving heavy items always refer to the TILE assessment.
Fire Safety: There have been a couple of incidents within the Trust and as a result it was finally recognised that despite the creation of our service in 2006, we are still fragmented and our policies are still not harmonised. This is particularly relevant with regard to fire safety. I have constantly challenged the Trust on the grounds that members of staff are not afforded any practical hands-on fire extinguisher training and all reference to fire safety is via booklet, handbook or video, despite previous Fire Risk Assessments stating that the use of booklets, videos, DVDs and talk cannot ever replace or be considered adequate replacement for actual handson fire training.
Despite these constant representations, Fire Safety is referred to in the annual refresher training handbook, there are references to the use of fire extinguishers in risk assessments and contradictory references that state members of staff are not expected to use fire extinguishers. Additionally, I raised my concerns on numerous occasions that the variations within the Trust in respect of fire safety was far from adequate and in fact was potentially placing members of staff (and visitors to the premises) at risk.
The major concerns regarding Fire Safety are (a) Lack of practical training (b) Failure to test fire alarms on a weekly basis, (c) lack of evacuation / fire drills, (d) Out-of-date fire extinguishers and a failure to maintain the Fire Safety Log Books in premises.
In addition concerns were raised that the level of fire safety and the approach to the application of fire safety across the Trust falls far below what Unison considers to be an acceptable level. Consequently the Trust instigated a Fire Safety Review Group to look at all the issues within the Trust and to review / improve the Fire Safety Policy and its application processes. Having attended several meetings I am still of the opinion that Fire Safety is still at an unacceptable level despite raising my concerns at each meeting.
Building Security: There have been several instances where the security of our premises has been compromised and breached. Windows and external doors are often left open during periods of hot weather, but that can be viewed as inviting unauthorised persons to enter them. Not all our premises have a perimeter security fence and these are also exposed to random visits by miscreants. We are expected to challenge everyone who we do not recognise and ask for proof of identity; if you are still unsure, ask them the purpose of their visit, who they are visiting, and then contract that person to come and greet their visitor.
Airwave Radios: Concerns have been raised that not all members of operational staff are aware of the ambient listening facility, when or how it should be used. This has become apparent during conversations with new members of staff, out on the road. The reasons for this have yet to be established, but every member of the team must know how to use the airwave radio for operational and safety reasons.
When requesting ambient listening it alerts EOC to your predicament and warnings go off in EOC, a report must be raised by the EOC senior and Unison are also made aware. Ambient listening turns your radio into a microphone and EOC can listen in to what is being said at your position. It is a safety feature which can be used to record threats to individual members of staff and also to initiate a safety response to your location. It is against the Trust Policy for EOC to randomly listen in on crews via the ambient listening facility.
General Broadcasts: The number of GB’s is escalating to the point that they are now an everyday occurrence and as a result they may be suffering from the same response as the boy who cried wolf. Unison has repeatedly asked why the GBs are being made, when EOC know the location of all Ambulances &RRVs and the reason provided is that there may be an officer or other resource in the area, that has a radio but their vehicle does not have a tracking device. If this is the reason the reason for the high number of GB calls being made then to protect the importance of the GB calls it may be prudent of the Trust to install tracking devices in all fleet and lease vehicles. That way there would be a dramatic reduction in the number of general broadcasts and they would become more respected.
Equipment Back Packs: There has been a lot of contention and discussions around the equipment bags that ambulance crew may be required to carry as part of their duty and Unison Health & Safety has not always been involved at the early stages when it would have been netter placed to offer advice or guidance. Consequently, changes have been implemented which have not been well received by the work force. Unison has and always will offer to engage with the Trust on matters relating to the health, safety and welfare of employees, but we must be released from duty to attend meetings which the Trust schedules on our rostered shift days. There has been a large number of complaints that some members of staff re grossly overloading the grab bags with extra items of kit that is not needed. Only the number items on the loading list should be in the grab bags. I you remove items to make the bag easier for you to carry, you must replace them at the end of your shift.
Ambulance Blue Lights: When the vehicle working group (VWG) were in the early planning stages of the current ambulance fleet, consideration and changes were incorporated into the design in response to ideas and suggestions from the crews that would be working on the ambulances. However, not all suggestions came to fruition and some that were incorporated have generated further discussion.
One of the major complaints from crews was the poor intensity of the blue lights and some suggested that the same type of lights that were on RRVs should be incorporated into the new DSA fleet, which was actioned, but now there are issues arising after complaints have been received from members of staff that the blue lights are too bright !!! There are switches on the central emergency response panel which reduce the intensity of lights and also cancel certain lights; Drivers are expected to know where all the switches are on the vehicles they drive, and what function they play.
(Robert Mitchum once said “There just isn’t pleasing some people. The trick is to stop trying”.)
Ambulance Sirens: The Trust has received complaints that some ambulance crews are using their sirens at inappropriate times during hours of darkness. The use of sirens should be to warn other road users and pedestrians who may not have seen the ambulance, and the use of the sirens should be at the discretion of the driver. There is an exemption which can be claimed between 23:30 and 07.00 hours but this exemption must be justified at the time of claiming. We must protect our exemptions and not risk losing them.
Lifejackets: Ambulance crews that are based near dark and dangerous fast flowing rivers used to have life jackets on board, but these were removed during harmonisation so that all ambulances were kitted the same. Despite protests from Unison, the Trust refuses to place life jackets back on the ambulances “in case it encourages employees to take risks that they would otherwise not take”. Unison health and safety is still campaigning for the return of these life jackets. H.A.R.T has stated “crews should not be tasked to work on, over or nearer than 3 metres to water” and in these circumstances the crew should consider requesting the attendance of H.A.R.T. who do have the appropriate level of water oriented PPE.
The absence of life jackets on our ambulances places a realistic and unnecessary pressure on employees that find themselves deployed to a call near to water because it increases their stress level and delays the delivery of the medical care for which they were dispatched in the first place.
The Coastguard wear life jackets when walking on the beaches near to the sea or along river banks; the Fire Service have a water borne response vehicle and team with the appropriate level of PPE and so do the RNLI. However, following complaints from its members, Unison is still pursuing the replacement of life jackets because our members are regularly assigned to emergency 999 calls to members of the public who are on boats, houseboats, barges; and access to these patients can invariably involve abandoning the vehicle at a car park and walking along riverside tow paths which are grassy, wet, muddy and unlit with the high risk of the employee losing their footing and slipping into the water.
The recommendation from Unison is that until such time that the Trust reinstates the lifejackets, members that are assigned to any call that is on, over or within 3 metres of water, should make an immediate request for back up by H.A.R.T because they have stated it is better for them to be alerted sooner rather than later, and an earlier request should be the normal course of action.
Violence and Aggression: Members of staff are still raising their concerns that they are facing threats of violence and or aggression when they are working in the public domain. Unison has stated that there must be a stronger deterrent in order to protect our workers. The Trust has stated that staff should hold off at a safe distance if they perceived the area might be unsafe, however, violence and aggression can flare up at any time and from any direction.
The only way to gain a full and proper appreciation of how widespread these concerns are is for members to raise a Datix for each and every occasion when they have been placed at risk either by perceived or actual violence or aggression. Remember; if there are two members involved that is two people too many.
The Trust has indicated that it wishes to introduce body mounted cameras, but Unison has reservations about how they might be mismanaged and used against crews. Unison has sought for body armour but the Trust views them as unnecessary. If they are unnecessary, why consider body mounted cameras?
GP Urgent Calls: There have been numerous complaints from road crews that when they have been assigned to a GP Urgent call that has been upgraded top a RED call, on arrival they found the patient had not deteriorated and the upgrade was made purely on the basis of having over ran the pick-up time. Unison health and safety views this as unacceptable because it needlessly places the crew and other road users at increased risk for the duration that the crew are expected to respond under emergency road conditions.
When ambulance crews consider claiming any exemptions to the Highway Code, it must be safe to do so and the grounds for claiming said exemptions must be justifiable at the time when the exemptions are being claimed. The driver cannot claim an exemption in the hope that at journeys end it will have been justified. The advice to members of staff is that on each and every occasion that they find that they have been sent RED to an upgraded GP Urgent call and on arrival the medical status of the patient has not deteriorated, a Datix report must be raised. With all Datix reports it is essential to include the CAD number and the narrative must be factual. If the drop down box does not offer to inform your health and safety representative, include your request in the narrative.
Bare Below Elbows: To summarise: Clinicians are required to be “bare from the elbow downwards” at the point at which clinical care is being delivered. If you are not actually assessing your patient or delivering clinical care, you can wear clothing which covers your arms.
Clinical Grades: There have been instances in the past where members of the public and also members of our service have not be certain about the clinical grade of the person they have either been treated by or are working with. This matter was given great importance by a Coroner and it would not bode well for any member of staff if they were to become embroiled in a case where their clinical grade was not clearly visible on their uniform. This matter has been raised by Unison health and safety on numerous occasions over the years and it still does not seem to have been rectified.
Members of staff who are employed in a patient facing role must wear their epaulettes on their uniform and they must be the correct epaulettes appropriate to their grade. There is currently no agreed epaulette for “Senior Paramedic” or “Paramedic Mentor” because these designations are included on the identity card. Where the system falls down and this has the potential for a clinical disaster to happen, is that there are managers out there who wear officer grade epaulettes and to the unsuspecting, they appear to be senior to anyone else on scene.
Unison health and safety has requested on numerous occasions that regardless of what managerial role the individual is undertaking, if the officer is a Doctor, Paramedic or Nurse, as defined by their registration, then they must have those words included on their epaulettes. It is too easy to make the mistake that an officer is of a higher clinical grade, and no one wants to intentionally embarrass anyone else or delay the provision of
the correct level of care, by challenging the officer; but if the Coroner states that our clinical grade must be clearly visible, then it MUST be clearly visible.
If you are on a call and are unsure who is the senior clinician on scene: ASK.
Tethered Response Vehicles: In some areas, resources are tethered to a particular location because it enables a much faster response to emergency calls in that area which is deemed to be a high risk area. Because of that, some vehicles always return to that location when they come clear of a call. However, in the interest of patient care and to enable the Trust to respond to calls whenever and wherever they may be, the Trust may need to move that tethered vehicle to a different location due to the high level of incoming 999 calls that is being experience and no other resources being available. This flexibility enables the EOC staff to meet operational demands. When resources return to their normally expected levels the tethered vehicle should be returned to its main location.
Safety Representatives and Safety Committee Regulations: The SRSC regulations place a requirement on employers that they must engage with the elected safety representatives of their workforce whenever there are planned changes to the working environment or equipment, which may have a significant impact on the workers. This is not always the case despite the legal requirement that Unison health and safety should be closely involved in all negotiations with the employer on matters which have the potential to impact on the health, safety and welfare of the workforce. The fact that we may not be aware of a specific matter does not mean that we have no desire to become involved with the issue, it is most likely that management have not included your safety representatives in the list of attendees because the Trust either does not wish to engage with us (which is in total disregard for their legal obligations) or they organise meetings at times when we are scheduled to be carrying out our core duty and they do not want to abstract us to attend the meeting. Either way, to exclude Unison health and safety representatives from the relevant meetings is breaking the law.
Bariatric Patients: It has been nationally recognised that the number of bariatric patients in the UK is on the increase and this places additional demands upon our ambulance service due to the complex patient needs that this creates. The Trust has provided a limited number of specialised Bariatric capable vehicles and these have been kitted out with equipment that is physically capable of taking the weight of a bariatric patient. However, following discussions with the members of staff that are assigned to crew these vehicles it appears that we are not able to deploy these specialist vehicles to the best of our ability.
The Trust has taken the decision only to train the small number of key staff that operates these vehicles on a regular day to day basis, with the addition of some managers in each locality. According to members that I spoke with, during my visits, not all of the dedicated staff had been trained in how to use all the specialised equipment and were still being deployed and expected to use it. Where there was no dedicated crew available and a request for a bariatric vehicle has been made by a road crew, the vehicle has been taken to the scene by a manager who had been trained in how to use the specialist equipment, but the waiting road crew were not trained in how to assist the manager in its use. This is not acceptable and completely goes against the Provision and Use of Working Equipment Regulations (P.U.W.E.R,) which were enacted to prevent anyone from being required to use a piece of equipment or machinery, before they had undergone the appropriate training in how to use it safely and how to recognise when it is faulty or unsafe. Any member of staff that is put
in a position where they are required to use any piece of equipment, machinery or vehicle which they have not had complete training, should point this out to the person giving them the directive to use it and follow that directive with a Datix report, stating what equipment was involved, what was expected of them and who gave the directive.
Standby Locations: The Trust currently has three levels of standby location, the first of which is the Dynamic Activation Post (DAP) and the only requirements are that the crew must have access to toilets and refreshments. The maximum time that can be spent at a DAP is 45 minutes and the next standby should be at a Response Post (RP). The Response Post has no maximum time which the crew can be at that location and it must have all the requirements which are listed in the Response Post Checklist. These include comfortable seating, facilities to have your meal break, to make drinks and a level of entertainment.
The Trust is moving towards a third tier and these will be Reporting Posts and as the name infers, staff will be reporting to these locations to start and finish their shifts so these locations will require a higher level of facilities to enable the crews to access emails, securely stow drugs and confidential documents. A trial of the Reporting Post Checklist will be made when the Great Yarmouth Fire Station comes on line as a Reporting Post and following this an assessment will be made to establish of the checklist is adequate
Late Finishes and Start Times: This is not a matter that can be discussed briefly or swept aside and needs to be resolved before members of staff become pressurised into reporting for duty when they are not fully rested and an accident happens as a result.
In a nutshell if you work beyond your contracted hours you are entitled to be paid for that enforced overtime which is currently at time and a half. Regardless of what time you finish your shift the Trust has been agreed with Unison that if you are employed on a permanent line position you are entitled to have 11 hours rest in between your shifts. If you are county relief then you are entitled to 10 ½ hours at home with reasonable travel time between your home and places of work. This agreement is currently being challenged by some managers because they are informing employees that they can only have one or the other. Unison health and safety is of the mind that all employees are entitled to be paid for all work they carry out and that when an employee is forced to undertake overtime that causes them to finish their planned shift at a much later time, that individual must still be allowed to benefit from their agreed rest period before next reporting for duty.
How this matter will be resolved is as yet uncertain, however as previously stated “In accordance with the Safety Representatives and Safety Committee Regulations” the employer is required to engage with the elected safety representatives in all negotiations on matters relating to the health and safety of the workforce; and as such Unison Health and Safety has not been invited to the engage with the Trust on these matters which is in contravention of the SRSC Regulations.
In addition to all these matters, I have been involved in discussions about working in reduced lighting (the need for individually issued torches) the failure of buckles on grab bags, secured the removal of the Cromwell helmets from service, and campaigned for proper supervised practical training in donning and doffing the PPE for Ebola and VHF patients. I am currently responding to requests from Solicitors who seeking information regarding the level and breadth of training which may or may not have been provided to members who have sustained workplace injuries and am liaising with other ambulance services over matters which we are jointly experiencing. In the past twelve months I have attended meetings of the Local Partnership Forums (LPF),
Vehicle Working Group (VWG), Health and Safety Committee (HSC), Regional Council, Regional Health and Safety Committee and also the Unison Regional Executive Committee. 2016 was a very busy year and there is still a lot more work to do before I can say we are Safe and there is nothing left to stop Jeff getting bored.
Jeff Pittman East of England Ambulance Service Unison 20106 Branch Health & Safety Officer