Pensions Remain Top on the List of Priorities for Ambulance Staff

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By Colm Porter, National Ambulance Officer, UNISON
Published in Ambulance Today, Issue 3, Volume 16, Ahead of the Curve, Education and Technology Special, Autumn 2019

With all the focus of Brexit you mightn’t have noticed but public sector pensions are back in the news.

In 2015, for an overwhelming proportion of NHS pension scheme members, their retirement conditions deteriorated when the Tories forced through the introduction of the 2015 scheme despite a hard-fought campaign by UNISON to stop this.

A recent legal case, however, has found that elements of the firefighters and judges pension schemes to be discriminatory based on age.

Specifically, the protections that were introduced for scheme members who were closest to retirement when changes to the public sector pension schemes were introduced.

The government have stated that this judgment applies to all public sectors pension schemes, including the NHS, that have similar protection arrangements in place.

Take the example of the protection arrangements in the NHS; if you were within 10 years of your retirement on 1 April 2012 you received full protection, meaning you retained all the benefits of your old scheme.

If you were between 10 and 13.5 years of retirement you continued to build up benefits in your old scheme and moved to the 2015 NHS Pension Scheme but at a later date (this is called tapered protection), while those with more than 13.5 years before their retirement moved into the 2015 scheme on 1 April 2015.

According to the government the difference in treatment provided by the transitional arrangements will need to be remedied across all public sector pension schemes including the NHS.

What form this remedy will take is still unknown but UNISON is working with the other NHS trade unions, employers and government departments to understand the implications this will have on the NHS pension scheme.

In other pensions news, an influential conservative think tank, that’s fronted by Tory grandee Iain Duncan Smith and ironically called the Centre for Social Justice (CSJ), has called for the state pension age to rise to 75 over the next 16 years.

While this is not yet government policy given the CSJ’s influence it’s not impossible to imagine a greatly increased state pension age in years to come.

This stance brings sharply into focus not only the ongoing issue of retirement age in the ambulance service but how out of touch elements of the government are when it comes to ambulance work.

If you follow the logic through, the impact this would have on ambulance workers is staggering. The normal pension age in the 2015 NHS Pension Scheme, which is the age you can take your pension unreduced, is linked to your state pension age.

This means that, if the recommendation from the CSJ was accepted, from 2035, paramedics and other ambulance staff would be working until they are 75 before receiving their full NHS pension.

Something that would be bad for staff, bad for the service and ultimately bad for patients!

At our annual health conference in April, UNISON renewed our commitment to reduce the pension age for ambulance staff.

A motion from the UNISON North West Ambulance branch, which was carried unanimously by conference delegates, called for ambulance staff to have a retirement age of 60 which would bring them in line with the other blue light services.

The ambulance service often suffers from an identity crisis—is it the medical wing of the emergency services or the emergency services wing of the NHS?

At times it feels like the ambulance service gets the worst of both worlds and retirement age is one of the areas where this issue manifests.

However, the fact remains that someone joining the ambulance service today fresh out of school or university won’t have the opportunity to retire until they are 68, while if you were to join either the police or fire service you could retire at 60.

Considering the physical and physiological demands on staff working in blue light services, to have staff in one of these key services working until they are 68 is simply unfair and, as demands on the ambulance service show no sign of slowing down, it is also becoming increasingly untenable.

UNISON believes that this is a problem created by the government and is fundamentally down to them to fix but we would also call on ambulance employers and the Association of Ambulance Chief Executives (AACE) to publicly support a retirement age for ambulance staff that is in line with the other blue light services.

It is only when ambulance employers and trade unions are working together that we will get governments to act on this matter.

Colm welcomes feedback from ambulance staff and can be contacted at:

Email: [email protected]
Facebook: Facebook.com/unisonambulance
Twitter: Twitter.com/UNISONAmbulance

Dealing with Compassion Fatigue- Front line responders gather in Glasgow

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A group of over 80 front line responders gathered in Glasgow last week (24 October) to take part in C7 Church’s seminar on compassion fatigue led by renowned US-based licenced psychologist and PTSD specialist, Dr Don Lichi.

In his first visit to the UK, Dr Lichi delivered a free, interactive seminar to an audience which included members of the NHS, first responders, teachers, farmers, community volunteers and charity workers.

During Dealing with Burnout and Compassion Fatigue, Dr Lichi explained to participants how burnout is caused and how to recognise the symptoms of compassion fatigue. He shared tangible tips with participants to help regain strength for work and tangible steps to take to avoid future burnout and achieve a healthier way of life.

Dr Lichi, said:

“For the past 40 years, I have worked with people who are in ‘care giving’ professions where compassion fatigue is prevalent so to share this knowledge with the people of Glasgow is an honour.

“These front line responders are there for us at times when we are in the greatest need and it is essential that their self-care needs are recognised in return. Simple steps such as building good friendships, taking care of your body and mind, checking in with your emotions and developing good relationships all help to combat burnout.

“Participants were open and welcoming and I am grateful to Pastor Jason Cask, Senior Pastor at C7 Church, for inviting me to Scotland to deliver this seminar.”

Pastor Jason Cask said:

“At the heart of everything we do at C7 Church is the community and we really wanted to do something which would help the people of Glasgow. 

“Having met Dr Lichi in 2018, I knew he could really help our city’s front line workers. The seminar was fantastic, he really unpacked compassion fatigue and provided all participants with practical tools to help them in their day to day life.”

From the Africa Desk of Ambulance Today: The Challenge of Critical Thinking in EMS

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A portrait photograph of the author, Michael Emmerich, smiling whilst wearing a cream coloured suit with a white shit.
By Michael Emmerich
Published in Ambulance Today, Issue 3, Volume 16, Ahead of the Curve, Education and Technology Special, Autumn 2019

This Africa Quarterly will be exploring the advantages of being a critical thinking emergency medicine practitioner, and how it can positively benefit, us, our colleagues and our patients; and most importantly why we don’t really have an option but to be critical thinkers.

In Rosen’s Emergency Medicine, Chapman, et al, describes the critical thinking process as having three parts: medical inquiry (history, physical exam and diagnostic testing), clinical decision-making (a cognitive process that evaluates information to diagnose or manage a patient’s condition) and clinical reasoning, which involves both medical inquiry and clinical decision-making.

The challenge of the EMS educator/facilitator is how to instil those 3 concepts into the practitioner’s patient care approach, as the result will be a more focused practitioner who has learnt the value of critical thinking and life-long learning. Critically thinking is to be desired by EMS providers at every level, yet the concept isn’t easily defined, quantified or taught.

That’s because critical thinking only becomes real in practice; clinicians, critical and lateral thinkers are moulded in the field. Theory, guidelines, protocols and linear thinking is learnt in the classroom. That is not to downplay the importance of class time, as that is the foundation on which critical thinking rests. What follows on, is experience, continuing education, currency of competency and clinical mentoring. Learning that patient treatment plans fit into the continuum of clinical reasoning, as all patients are different. On the streets, patients don’t follow the script as per your last patient simulation. Thus, the gravity of responsibility you have, becomes intimidating.

Professional Development Word Circle Concept with great terms such as learning, mentoring, practice and more.

Carl von Clausewitz, in his treatise “On War” wrote: “Any complex activity, if it is to be carried on with any degree of virtuosity, calls for appropriate gifts of intellect and temperament.”

This doesn’t mean that everyone who learns something, immediately becomes an expert. For the lifelong learner, everyone has something of value to contribute, irrespective of what environment or years of experience are on the table. Part of lifelong learning is contributing to the pool of knowledge. Effective teaching, just like effective learning, begins with listening before talking. Lifelong learning is a commitment to taking moments out of each day, reflecting on the processes and patients, pushing to improve our knowledge, skills, patient care and attitudes.

Every patient contact is a clinical mystery waiting to be solved, by you the (detective) practitioner. They are relying on your educational experience, critical thinking, your knowledge that you integrate and update continuously – right down to that “interesting paper” you read last night! No patients are created equal, today’s cardiac patient will not match tomorrow’s, not all cardiac arrests are equal. Hence, we cannot rely on overly simplistic guidelines/protocols. We need to critically analyse each patient and rhythm strip against our font of knowledge and our vested clinical practice guidelines.

Critical thinking skills ask us to use our brain and not blindly follow a pre-set protocol. Evidence-based medicine keeps changing and blindly following a protocol would be short sighted and not always in the best interest of optimal patient outcomes. Seeking, questioning, evaluating, integrating and sharing every day is an opportunity to get better at our passion (chosen profession), where patients rely on us for their lives. Knowledge and decision-making should be based on clinical findings on that case on that day—it’s not just a set of psychomotor skills and blindly followed protocols.

As a thoughtful science-based practitioner, learn to be iconoclastic, adopt a questioning, reflective approach to your practice. My mantra when looking at new and/or challenging concepts/modalities is as follows: “Is it evidence based, current, documented, cross referenced and is there a perceived bias (mine or the writer’s)?”

As a thoughtful science-based practitioner, learn to be iconoclastic, adopt a questioning, reflective approach to your practice. My mantra when looking at new and/or challenging concepts/modalities is as follows: “Is it evidence based, current, documented, cross referenced and is there a perceived bias (mine or the writer’s)?”

All pre-hospital emergency care practitioners should strive to be clinicians/critical thinkers, irrespective of their level of care, age or experience. Continuous lifelong learning ensures competence and confidence, allowing you to have the lateral thinking skills to break the linear cookbook approach to patient care. So, where to from here?

“Paramedics displayed the ability to problem solve, critically analyse, perform complex reasoning and work cohesively with the patient as well as in a group. They were adept at rapidly forming clinical impressions in the critically ill with minimal information, and were able to modulate their interventions accordingly, while simultaneously continuing to gather data as they performed life-saving measures. Experienced paramedics are seen to gather, process and utilise information differently to the new graduate, portraying an interconnectedness of conscious and sub-conscious processing drawing on information from multiple sources culminating from both professional and personal experiences.”

Paramedic Judgement, Decision-Making and Cognitive Processing: A Review of the Literature Australasian Journal of Paramedicine: 2019;16 Meriem Perona, Muhammad Aziz Rahman, Peter O’Meara BHA

The implications of this need to be reflected in our practice through ongoing mentoring, partnering the experienced with the novice, reflection and feedback post scene time, all which will go some way to encourage improvement in skills, competency and learning, which then translates into improved patient outcomes.

Tell Michael what you think about this article through WhatsApp via the following link:

https://chat.whatsapp.com/Africa Desk Feedback

If you have any ideas for special feature articles on ambulance care in any part of Africa, we would like to speak with you about them.

Equally, if you have any news items you would like us to run either in our magazine or digitally then please email the editor via: [email protected]

Ronnie ‘Thankful’ For Cardiac Arrest

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Cardiac arrest is probably the most serious type of medical emergency. It is literally a heart-stopping event, and the chance of survival is slim.

But since he came through a triple cardiac arrest earlier this year, Ronnie Lee says his life has been transformed for the better.

“If I could turn-back time and stop it happening, I wouldn’t,” says the 40-year-old from Gloucester.  

“My life was in a downward spiral. I wasn’t looking after myself, and I was praying to God for help.

“This is the biggest second chance I could have asked for.

“My life has changed for the better. I have stopped smoking, and I’m trying to lose weight. I feel like a totally different person now. It’s been the blessing of my life.

“I know I wasn’t supposed to die that day,” he added. “Thank you from the bottom of my heart to everyone. I’m alive.”

Ronnie experienced pain experienced pain in the centre of his chest when he was at home in March. He called South Western Ambulance Service NHS Foundation Trust (SWASFT) for help.

He spoke with 999 call handler Steph Ruby, but the pain worsened and he had difficulty breathing. Ronnie was having a heart attack.

Neighbour Andy Evans came to his aid, and continued the emergency call until crews arrived.

Paramedic Aimee Scott and ambulance crew Lauren Gardner and Rebecca Crabb treated Ronnie at his flat and conveyed him to hospital. They were supported by a volunteer community first responder.

But when Ronnie’s heart stopped in the ambulance, the situation became even more critical.

Thankfully the paramedics managed to restart his heart by giving him immediate CPR and shocks with a defibrillator.

His heart stopped twice more in the ambulance, but on each occasion the paramedics managed to resuscitate him.

After being stabilised in Gloucester Royal Hospital, he was transferred to Bristol for surgery to unblock two of his arteries.

Despite being briefly re-admitted to hospital in August, Ronnie has been able to do much of his recovery at home.

He visited Staverton Ambulance Station on Wednesday 23 October to thank the ambulance team in person. 

Paramedic Aimee Scott said: “Ronnie recognised something was wrong and dialled 999. He was supported by his caring neighbour who stayed on the line with the Control Hub until assistance arrived.

“Ronnie was experiencing a Myocardial Infarction (heart attack). He was extremely unstable, resulting in him going into cardiac arrest multiple times in the ambulance. This required us to complete immediate CPR and defibrillation. Thankfully we were able to achieve ROSC, which is a spontaneous return of circulation.

“As he remained unstable, we had to divert to the nearest hospital for staff to stabilise him and continue with his care prior to a secondary ambulance transfer to the heart specialists.

“Ronnie proves that starting the chain of survival with early CPR and defibrillation improves patient outcome. It is an honour to be part of such a fantastic team where we have achieved such an amazing outcome. I am grateful that I have been able to meet Ronnie and see how well he is doing!”

Outstanding young life savers recognised at the St John Ambulance Everyday Heroes Awards 2019

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London – Monday 7 October 2019 - A remarkable 11-year-old boy who helped save the life of his Grandad when he had a heart attack and a quick-thinking teenager who went to his brother’s aid after a serious biking accident were among the outstanding winners honoured at St John Ambulance’s Everyday Heroes awards, held at the Hilton London Bankside this evening.

Logan Chatfield – who was just 10 years old when he was called on to save Grandad Paul Walsh’s life – is one of the youngest ever recipients of the charity’s Young Hero award, which recognises outstanding bravery and first aid skills. He had learned the first aid procedure for heart attacks only a week before, as part of his training to become a St John Ambulance Cadet. 

15-year-old Jack Smith from Leeds was also honoured with another Young Hero award for stepping in when his younger brother Connor sustained life threatening injuries after crashing his bike. Connor was impaled on the handlebars, severing his femoral vein, but army cadet Jack immediately put his first aid training into action, stemming the blood flow while calling for emergency help.

The third Young Hero award of the night went to two teenage brothers aged 15 and 16 who went to the aid of a neighbour they had never met after he tried to take his own life. Gabriel Walker, who learned St John Ambulance first aid at army cadets, performed chest compressions, while his brother, Jack, relayed information to and from the emergency services. 

These inspirational young people were celebrated for their bravery, courage and life saving skills at the annual Everyday Heroes event. This honours individuals, volunteers and teams who step forward in their communities and in the moments that matter to help loved ones, colleagues, customers or even strangers in need. 

Now in its eighth year, the awards – sponsored by Zoll – were hosted for the second time by Reverend Richard Coles, celebrity vicar and one half of 80s band The Communards.  

Richard Coles said “I was honoured to be invited to host the Everyday Heroes awards again this year and had no doubt that I’d hear another set of amazing stories – I certainly haven’t been disappointed. The young people commended tonight have really stood out and I believe the future of our communities is in good hands if they are anything to go by. I hope their stories will inspire many others to volunteer, learn new skills and be confident to help when it really matters.” 

As well as recognition for young people, Everyday Heroes also rewards the kindness of strangers, colleagues and St John volunteers in three other categories: Community Hero, Workplace Hero and Volunteer Hero.  

Winners included: 

·         St John Ambulance’s Homeless Service in Hastings, which has been improving access to healthcare and providing support for homeless and vulnerably housed people in Hastings and St Leonards-on-Sea for 15 years 

·         a racecourse groundskeeper who performed CPR on a colleague and  

· two St John volunteers who talked a young suicidal male down from the edge of a cliff.

St John Ambulance’s Chief Executive, Martin Houghton-Brown congratulated all the award winners, saying: “This evening I have had the honour of celebrating with the truly incredible ordinary people whose moments of extraordinary heroism allow us to put their humanity, care and courage in the spotlight. 

“Many of these are young people, who are the healthcare professionals and community leaders of the future, and their courage is just what our communities need and want. St John has been equipping people like this for 140 years and I am delighted that we can honour this long history with a celebration of our Everyday Heroes tonight.” 

Mum and Baby Reunited With Crew After Emergency Birth

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A baby boy and his mum have been reunited with a South Western Ambulance Service NHS Foundation Trust (SWASFT) crew – six months after they delivered him in an emergency home birth.

Ellee Styles, 21, went into labour unexpectedly during the early hours of 7 April in her bathroom in the Penhill area of Swindon.

Family members came together to help, and Ellee’s mum called 999 when she started bleeding.

The crew ensured baby Freddy was delivered safely at 3.14am, almost two weeks ahead of his due date. He weighted just 4lb 12oz at birth, and is Ellee’s first child.

Ellee and Freddy went to Swindon Ambulance Station on Monday 7 October to meet-up with the crew.

Ellee, who works as a barmaid in a local pub, said: “I didn’t know I was in labour. But during the night I felt some discomfort, and told my dad I needed to push. Then what felt like seconds later I gave birth.

“My pregnancy wasn’t great, but with help from South Western Ambulance Service my birth couldn’t have gone any smoother. Thank you to the call handler who advised us and to the crew who attended and delivered my tiny baby boy into the world.”

Ellee had been in hospital for a check-up hours before the birth, but she was discharged because she wasn’t showing any signs of labour.

Gerard Plunkett, a 999 call handler in the SWASFT 999 Control Centre, instructed the family how to prepare for the birth, while the crew were on the way. 

Paramedic Gary Ratcliffe and Emergency Care Assistant Christina Clifford arrived minutes later, as Freddy’s head began to emerge.

They were forced to take the door off the bathroom, so they could assist Ellee inside. It was Gary’s 29th emergency baby delivery and Christina’s first.

After the birth they drove Ellee and Freddy by ambulance to the Great Western Hospital’s maternity unit. 

Ellee added: “The call handler was absolutely amazing. He helped my mum to stay calm and do everything she needed to do in case my son was born before medical help arrived.

“Freddy just wasn’t waiting in the tiny box bathroom, and as the crew arrived I was ready to push. They were so calm and encouraging.

“It didn’t really sink in until we arrived home from hospital the next day.”

Gary said: “It’s always lovely to help bring life into the world. And being able to meet up patients afterwards makes our job all the more rewarding.”