Health & Safety Postbag

February 2015

Over the past three years a lot of my time has been taken up with issues and concerns in respect of ambulance crew safety.  My work has mainly been focused upon the impact of our crews as a result of:

  • The increase in 999 emergency calls
  • Pressures to meet “motoring” targets as opposed to clinical outcomes
  • Pressures to meet hospital turnaround times
  • Pressures of not being able to ensure the vehicles are checked at shift starts
  • Pressures of General Broadcasts reminding crews of outstanding RED calls
  • Pressures, pressures, pressures.

This may give the incorrect impression that my work has been solely focused on frontline crews. This is not so. I have visited many localities, met with staff and questioned them about their work environment and any issues which they may have been experiencing. From the responses I received it became clear that pressures from above are forced downwards, through the work force until they finally end up impacting on the road crews.

Over the past few days, a decision was taken by the Trust to implement 15 minutes protected time at the start of the shift to enable crews to check their vehicles in an effort to meet the expectations of all road users in the UK. The underlying rules are quite simple; the driver is totally responsible for the state and condition of their vehicle when they take it out on the highway. Whatever the Trust, The AA, RAC, or ROSPA may say on the subject, it remains the jurisdiction of the Police to enforce the Law and take action against any driver that fails to meet their legal obligations by carrying out the mandatory checks of their vehicle prior to using it.

During my time in Office I have constantly strived towards improving our vehicles and the manner in which are crews are portrayed when we are responding to emergency call.  At all times we are expected to be professional in our appearance, professional in our clinical skills and also professional in the way that we approach our driving and that starts with the mandatory roadworthy checks.

It has been said that Unison and The Trust were working towards an agreement whereby our crews would be afforded protected time to check our vehicles at the start of the shift. I cannot deny that in some areas it has become practice for some crews to start their shift 15 or 30 minutes early to ensure that they could carry out these checks (and get paid overtime rate at time and a half for the time taken). If everyone did that it would soon rack up a vast bill and the finance department would most probably have kittens.

So Unison has grafted long and hard in an effort to work in partnership with the Trust to reach an agreement to secure protected time so crews would not have to come in early and needlessly extend their working day.  Unfortunately, at the 11th hour a full agreement could not be reached and the Trust has gone ahead and issued its operational instruction on carrying out Pre Response Checks at the start of the shift. So where was the discord? you might ask.

The Trust accepted that a formal check list needed to be created and this was drafted and included 4 sections. As you can imagine, section one was the most important part and MUST be carried out before the vehicle is deployed, thereby meeting the legal obligations. However, the Trust wanted to include certain items of clinical equipment into section one because they were deemed to be Very Import as they had the potential for serious harm to patients if they were not checked before the vehicle was deployed. These clinical items do not form part of any obligations as listed in the Highway Code, Road Traffic Act, Vehicle Construction and Use or any other law affecting road users.

The items were listed in section one in the general order that one would expect then to be carried out:

  1. Vehicle bodywork exterior, reflective marking etc.
  2. Tyres and wheels
  3. Under the bonnet fluid levels
  4. In cab checks including all electrics

There were approximately 20 items all clearly listed and following these the Trust added the clinical equipment which they deemed as being of equal importance. Additionally, the time that Unison considered to be reasonable and fair, for a DSA crews to complete their pre-response checks was 15 minutes. Unison also maintains that it should be 20 minutes for an RRV or SSA to complete their checks because they work alone and have no crew partner to assist them.

The problem then arose when the Trust wanted to put a caveat into the protected time so that if a 999 call came in while the crew were checking their vehicle and there was no other resource available AND the call was a Predicted or Confirmed RED 1 that the crew should cease their checks and respond to the call. Also, If the call was subsequently downgraded the crew could ask to be stood down and pull over to complete the checks.

The issues that Unison saw with this caveat are that if the call is a predicted Red One the crew should complete the checks until it was confirmed. Unison asked for a breakdown of how many Predicted Red Ones are ultimately downgraded but no details have been forthcoming. Furthermore, if the call is subsequently downgraded the crew could ASK to be stood down to complete their checks but this was not a guarantee that the request would be granted.

Unison recognised that while a crew were checking their vehicle, if a Confirmed RED ONE came in and they were the only resource, we believed that all crews would respond immediately and that the Trust would stand by them should anything happen out on the road. Where we have the issue is in relation to the PREDICTED red one calls and the fact that if the call was downgraded the crew would not automatically be stood down.

By putting equal importance on the checking of clinical equipment, the Trust has increased the amount of checks to be carried out in the 15 minutes protected time. Because the entirety of this work has been focussed on securing protected time to complete the checks that are expected of every user of road vehicles, the inclusion of clinical equipment within the 15 minutes reduces the amount of time the crew have to check the road vehicle aspects.

 

This situation is also recognised by Unison as having the potential to increase the pressures that may start to have impact on EOC staff, (the call takers and dispatchers) who are at the receiving end of 999 calls made by members of the public. With limited resources and “only a limited number of chess pieces to move around the bard” the stressors will inevitably start to have a negative effect on the hard pressed staff in our call centres.

Given these facts, Unison believe that it will become clear and obvious to the average man in the street, that to meet the requirements expected of vehicle drivers by Law, crews or solo driver should focus their attention primarily on the vehicle components listed within section one of the vehicle check list and once these specific areas have been completed (and corrected where required) their attention can then be moved to the clinical equipment.

If through the process of time and motion study it becomes apparent that 15 minutes is NOT adequate or realistic time to complete the mandatory roadworthy checks AND the clinical equipment listed in section one, then common sense and logic would say that the 15 minutes should be extended to 20 or even further to enable the additional checks required by the Trust to be carried out.

In the meantime Unison would advise all crews to sign on via MD at the start if their shift, commence their mandatory roadworthy checks and to record on MDT and Datix whenever they are sent out on a red call before they have completed these pre-response checks.

Regards

Jeff Pittman

Branch Health & Safety Officer

East of England Ambulance Unison 20106

19 February 2015