Till death do us part

Author: Thijs Gras

Published in: Spring 2018 Edition of Ambulance Today Magazine

In one of my earlier columns (Spring 2017) I wrote about an undesirable development in the Netherlands in the domain of integration of control rooms and the strong ‘blue’ (police) influence in this respect. A recent interesting court case shines new light on my point and will certainly raise eyebrows (and mouth corners) with a number of colleagues.

Suppose you are a nurse working in the control room and an emergency call comes in. You talk to the caller and send an ambulance to what later turns out to bea crime scene: a woman is murdered and the caller – her ex-husband – is suspected to be the perpetrator. The police are very interested in this call and think they have the right to listen to it and, out of decency, ask the ambulance service for the recording. But to the utter disappointment of the police, the ambulance service refuses to hand over the call to them stating this is a matter of patient confidentiality. The police go to court but the court rules that the ambulance service is right and is not required to hand over the call. But this is murder! Surely this is important enough to violate the professional confidentiality of the nurse?

The police then appeal to the High Court. The ruling of this court – the highest we have in our country, so its decision is final and there are no further appeal options – is very interesting: they confirm the verdictof the lower court. The key point is patient confidentiality and the fact that the caller spoke to a certified nurse who has a duty to professional secrecy.

An important issue that is raised in this particular case is that of the two conflicting interests that oppose each other. On the one side it is in the interest of the police to find the truth, to conduct an inquiry and to bring culprits to justice. Everybody will agree this is a very important interest.

But on the other hand, there is the interest of – in this case – the ambulance service (but it could also have been a doctor or nursein the A&E department) that everybody should be able to call for emergency medical help no matter what the circumstances are and without fear that the call, or anything that is said to the medical caregiver, will have juridical consequences.

Both courts have been very clear in their ruling and I completely agree with them: patient confidentiality almost always prevails over finding the truth. In one of our laws about the medical profession it is stated very clearly that if one of the professionals mentioned in the law (such as doctors and nurses) is convinced that information given to him or her as a professional, specificallyif it is confided as secret or the professional can guess it is confidential, the professional can call upon the right of non-disclosure. Only in very rare and special cases can a doctor or registered nurse be forced to break this right.

I am glad and relieved because this meansI am better protected on the streets. Not against knives and bullets of course, but our neutrality and trust that everything we do is in our patient’s interest is a key point in our safety and security. This is why I am so critical about the growing influence of the police in our control rooms. I sincerely hope we as an ambulance service work well with the police on the street; we may share, on the control room level, buildings or even rooms but we must be very careful to keep everything elseseparate so that we as professional nurses can use our right of non-disclosure. This is not only important in individual cases forthe persons involved, but on a broader scale, for the trust of the public in the ambulance service and therefore for the safety of ambulance personnel. Any association with the police should be avoided.

Of course, we as ambulance people need the police for our safety and to protect us. They are the only ones in our society (apart from the military) who are allowed to use violence. They have the training and the means. That is okay. We both want to help people in need, but we both have our interests and sometimes these interests differ or even conflict with each other.

We tend to look at the emergency services in colours: white for the ambulance, blue for the police and red for the fire brigade. But what do you get when you mix these colours? An ugly sort of light brown. If we paint with this colour we get a very dull, inexpressive painting. If we want to createa beautiful and harmonious picture, it is far better to use the separate colours. Together, but distinct. That is the best way to serve the interests of the personnel and of the people we serve, in our case patients.

Increasing numbers of ambulance staff seek help from TASC

Published in: Autumn 2018 Edition of Ambulance Today Magazine

TASC The Ambulance Staff Charity is handling a near ve-fold increase in the number of ambulance personnel being referred or turning to it for help. TASC provides independent and confidential services which include psychological rehabilitation and counselling, including stress and PTSD support; physical rehabilitation; financial grants; debt advice; and welfare and bereavement support. 

Angie Crashley, TASC Support Services Manager

During the first year of operating, from April to December 2015, TASC dealt with a total of 59 cases, of which eight per cent involved mental health difficulties. However, so far in 2018, TASC has received 273 cases – a near five-fold increase – and more than eight in ten (84 per cent) relate to mental health problems of one kind or another.

TASC now has plans to take to the road to make more people aware of the support available to present and past ambulance staff and their families. The charity will use its new vehicles to travel across the country later this year to visit staff from both the NHS and independent sectors and share how it can support them at their time of need.

Angie Crashley, TASC’s Support Services Manager, said: “We have seen an increase of about 360 per cent in the number of cases we deal with from 59 in our first year in 2015 to 273 so far this year. 

“This is important news for the charity as it means that people know we are here for them and shows that there is a need for what we provide. We want our services and support to be as accessible as possible to both NHS staff and those in the independent sector, and the roadshows will help us to get the message out there.”

The roadshows will be run by a team of people including a TASC staff member, a debt advisor to help those struggling with financial difficulties, and a counsellor from The Red Poppy Company specialising in trauma support who will be able to offer on-site advice to anyone in immediate need. 

Angie and the team are also considering what other areas the roadshows might cover, which could include support for people dealing with the suicide of a friend or family member and welfare benefits advice. 

There will also be a range of information available for people to take away with them so they can learn more about the services on offer and how to get in touch if anyone needs TASC’s help. 

Angie added: “When we started in 2015 there was very little we could do for those who came to us with mental health difficulties. But we now have a number of different strands such as residential physical and psychological rehabilitation, and locally-based counselling with the help of The Red Poppy Company. 

“We have also provided additional funding to various staff member’s employers in order to continue their counselling should they need it.” As well as the increase in ambulance staff requiring support for mental health issues, there has also been a rise in cases of people seeking help for domestic abuse. 

All in all, TASC is currently receiving between five and eight new referrals a day. 

Angie finished: “The cases are more complex now. Someone with mental health problems may be facing financial issues as well, for example. And if someone has been physically injured, their mental health can also suffer”. 

“Everyone is treated individually and in total confidence – we don’t try to place anyone in boxes. It’s about getting the best long-term outcome for individuals – we don’t look to provide short-term sticking plaster remedies.” 

For more information about TASC’s support services call the TASC Support line on
0800 1032 999 or email: 
support@theasc.org.uk

Alternatively, you can make general enquiries on 0247 7987 922, 

email: enquiries@theasc.org.ukor visit www.theasc.org.uk.

For regular updates, follow TASC on Twitter (@TASCharity) and Facebook (@TASC The Ambulance Staff Charity). 

Special Message from Israel’s Deputy Health Minister

Author: M.K. Yakov Litzman

Published in: Summer 2018 Edition of Ambulance Today Magazine

M.K. Yakov Litzman, Deputy Minister of Health for Israel on Magom David Adom 

Magen David Adom is Israel’s National EMS and Blood Services Organisation as declared in the 1950 MDA law. MDA started out from humble roots 88 years ago with a single ambulance-style response in Tel Aviv, and now, along with the State of Israel that has just celebrated its 70th Independence Day, MDA has a great deal of which to be proud. It is Israel’s National EMS Provider, both in times of peace and war, which has the responsibility of preparing and responding to all kinds of emergencies. It is also a leading educator of both the general public as well as a wide variety of health care professionals, and is Israel’s largest volunteer organisation. 

MDA’s Paramedics and EMTs, who consist of more than 25,000 people, including all the first-responders’ organizations, are amongst the most highly trained and qualified in the world, providing professional and efficient pre-hospital emergency medical care to the millions of citizens in Israel, along with those visiting this special country. 

Magen David Adom instils the value of volunteering starting with the very young and through to the very old. MDA’s volunteers are a major driving force, learning the importance of life-saving skills, providing them to the public and then teaching these skills to others. It is a never-ending chain of survival. 

The State of Israel is proud that MDA is its representative both at home and abroad, having provided humanitarian aid at scenes of several natural disasters such as in Nepal or the Philippines and even in the USA. MDA has sent rescue teams to scenes of terror across the world too; both aiding local communities as well as repatriating Israelis back home. MDA has also provided Mass Casualty Incident training to many other organisations across the world and is recognised as a global leader on the subject. 

Alongside the provision of emergency pre-hospital care, Magen David Adom collects, processes and provides almost all of Israel’s blood and blood components, potentially saving three lives with every unit of blood that is collected. In this way, many more members of the community become a vital link in saving the lives of others. 

Magen David Adom is the pride of Israel – it is a showcase of its people, its technology and medical capabilities, and of its volunteer spirit. The Israeli Health Ministry appreciates and applauds Magen David Adom for all that it does to save lives, both here in Israel and across the world. 

With high esteem, 

Yours sincerely, 

M.K. Yakov Litzman 

Deputy Minister of Health, Israel 

Standing Guard At Jerusalem’s Crossings

Date: 2 June 2019

Jerusalem, June 2nd, 2019 – A new project has been taking place over the past few weeks in Jerusalem. During the hot days of Ramadan, United Hatzalah volunteer EMTs have been asked to join Israel’s border police and the military police in safeguarding the passage of Palestinians entering into Israel at two Jerusalem crossings, Kalandia and the 300 crossing by Rachel’s Tomb near Bethlehem. 

The request was initiated by the police in an effort to have a fully trained and equipped medical responder on hand at the checkpoint due to the heat of the past few weeks. The purpose of the additional personnel at the checkpoint was to safeguard the Palestinians who were crossing into Jerusalem should any of them suffer from the heat or the fast or a combination of both.

For the past few weeks, United Hatzalah volunteers have been on hand and treated numerous Palestinians at the checkpoint who were suffering from a variety of illnesses. This past Friday, the injuries included an asthma attack, high blood pressure, dehydration, chest pain, and shortness of breath.

“The crossings into Jerusalem are incredibly efficient now and Palestinians wishing to cross into Jerusalem are usually in and out relatively quickly,” said Vice President of Operations for United Hatzalah Dov Maisel. “We were asked to help provide medical coverage to the crossings should a medical emergency occur due to the fast of Ramadan, and the heat that Israel has experienced these past few weeks. We provide the first medical response and then if needed request an ambulance to transport the patient if needed.” 

Maisel said that just before Ramadan, United Hatzalah volunteers had responded to a cardiac arrest case at the 300 crossing and it was at this point that the Military Police began to ask whether or not the organization could send volunteers to be stationed at the crossings on a permanent basis during Ramadan and the days following during peak hours on Fridays, the  holiest day of the week for  Muslims.

“We were more than happy to help in this matter. Helping people stay safe and providing initial medical response is what United Hatzalah is all about. This is our mission and our volunteers were more than happy to jump at the chance to help with this important matter of safeguarding the lives of those who want to enter the city during their holiday,” Maisel concluded.

United Hatzalah volunteers have been stationed at the crossings for the past few weeks and will continue to provide emergency medical coverage again this coming Friday.   

Interrupting Prayers To Save A Choking Infant

Date: 7 August 2019

Jerusalem, July 2nd, 2019 – United Hatzalah volunteer Yisrael Shavit saved a young girl in Hadera from choking on Sunday evening. After arriving in less than a minute at the scene of the incident, Shavit managed to single-handedly treat and rescue an infant from what could have been her death. 

Shavit described the dramatic story. “I was davening Mincha at Shul and I received an alert on my bluebird radio from dispatch. The alert said that a young toddler, about six-months-old was choking right near my location. I raced to my ambucycle and jumped on and rushed to the address. I saw a group of people standing around two parents who were holding their child in front of them. The father was slapping an infant girl on the back. I asked to take the child. She was making choking noises which meant that her airway was partially blocked. She had started to turn blue. 

I looked inside her mouth and saw a small edge of what looked to be a bit of plastic stuck in her trachea. When I slapped her back, a bit more popped up. I stuck my finger in her mouth and after a few tries, was able to grab hold of and remove the plastic. It was a wrapper from an ice pop. Once the blockage was removed the child once again began crying.   

The girl’s parents were so thankful for my quick arrival and successful assistance that they kissed me on the forehead in the middle of the street just as other EMS volunteers began arriving. 

It was a few minutes before the ambulance came, they had a very healthy and stable patient who was taken to the hospital for follow-up care.

I’ve been at choking calls before but usually, you arrive after the person has choked and you need to do CPR. This is the first time I was able to arrive while it was still happening. I am happy that I was able to help and that I was a messenger of salvation in this instance. This is why I joined United Hatzalah. It is the reason the organization exists and why all of the volunteers do what we do.” 

Improving the chances of surviving a cardiac arrest in the North East

Improving the chances of survival for cardiac arrest patients is something close to North East Ambulance Service’s heart and their latest initiative is set to do just that.

If you or someone you cared about was having a cardiac arrest and just a short walk away from where you were, there was someone trained in lifesaving skills, would you want them to come and help?

Approximately 60,000 people suffer a cardiac arrest out of hospital in England every year and of these, 28,000 patients will have resuscitation started or continued by the ambulance service. Survival rates for these patients is 8.6%. This is significantly lower than for populations in other developed countries like Holland (21%), Seattle (20%) and Norway (25%).

The current rate of initial bystander CPR in England is reported as being 43% compared to up to 73% in other countries.

North East Ambulance Service has now switched on GoodSam, a mobile app that alerts community first responders to an incident, in an attempt to boost the numbers of people who survive cardiac arrest in the region.

GoodSAM connects with a community of first aid trained responders, willing to assist during a cardiac arrest.

NEAS will be switching on the system in the North East and inviting its clinically trained staff, trained in basic first aid and qualified to perform lifesaving cardiopulmonary resuscitation, to register initially.

GoodSAM will automatically notify nearby GoodSAM responders of a medical emergency. The platform connects those in need with those who have the skills to provide critical help before the emergency services arrive. The app is free to download on all smartphones.

GoodSAM is already working in partnership with ambulance services in London, North West, Wales and East Midlands as well as further afield in Australia, New Zealand, Ireland, USA, Canada and South Africa.

Gareth Campbell, Clinical Operations Manager says, “This is excellent news for the North East population and means that those special skills our workforce uses every day to help save lives are even more accessible.  By ensuring a patient has a clear airway and quality CPR is in place in those first few minutes, they are more likely to achieve a good outcome.”

With the system now switched on, the NEAS emergency operations centre will alert the three nearest responders to life threatening incidents and simultaneously dispatch an ambulance, giving the patient the best possible chance of survival. The partnership will not impact on or substitute standard ambulance dispatch, with crews continuing to be sent to scene in the usual way.

When a volunteer is alerted, they will be able to accept the alert via the GoodSAM app and make their way to the location of the incident. If a volunteer responder is not in a position to accept the alert, it can be declined and diverted to the next nearest responder.

Campbell continues, “Having seen how successfully this app works elsewhere, we wanted to bring GoodSAM to the North East for the benefit of our region’s patients. Thanks to funding from NESTA, we have been able to work in partnership with the GoodSAM team to bring this app to the North East.”


NEAS already has a team of Community First Responders who are everyday members of the general public trained by NEAS in basic first aid and life support. They are provided with oxygen and a defibrillator and are deployed by NEAS to life threatening emergencies, such as chest pain, breathing difficulties, cardiac arrests, and unconsciousness, if they are the nearest resource, followed by the next nearest emergency care crew.

This app provides an opportunity for those with first aid skills who volunteer and work for the service to join the robust community of first responders already working within the North East.

Campbell adds, “Responders will be able to provide immediate care to a patient where every second counts, administering life-saving first aid while an ambulance is on its way. A patient who suffers a cardiac arrest stands a much better chance of survival if someone with a defibrillator can attend the patient in the first minutes of collapse.”

Professor Mark Wilson, GoodSAM’s Medical Director and Co-Founder, said: “If a patient has a cardiac arrest, it’s the first few minutes after the incident that determine the outcome – life, death, or long-term brain damage”. 


“There are first aid trained people all around us but usually the first they know of a neighbour having a cardiac arrest is an ambulance appearing in their street. Our work with Ambulance Services, allows us to harness the lifesaving skills in the minutes before ambulance arrival. GoodSAM has saved lives globally and we look forward to working with NEAS to bring the benefits to the North East.”

Steve Dunn from Newton Aycliffe in County Durham has been a community first responder in the North East for eight years after he found himself coincidentally at the scene of two serious road traffic collisions in which he assisted patients whilst an ambulance was travelling.  Having formerly been registered with GoodSam in London, he’s really pleased to be able to connect in his own region.


He explains, “I was alerted by GoodSAM to an incident in St Pancras when I was in London recently on a business trip and I was really overwhelmed by the number of people nearby who also got the alert.  I was first on scene and between those of us who attended, the patient had the best chance of a good outcome.  On this occasion it wasn’t a cardiac arrest luckily.  It was really surprising and reassuring that so many people were willing to stop what they were doing and help and it’s great that we can do the same here.”

Compassion Fatigue vs Compassion Satisfaction

Author: Michael Emmerich

Published in: Summer 2019 Edition of Ambulance Today Magazine

“When you’re compassionate, you’re not running away from suffering, you’re not feeling overwhelmed by suffering, and you’re not pretending the suffering doesn’t exist. When you are practicing compassion, you can stay present with suffering.”

  • Sara Shairer: https://eftraining.co.uk/what-is-compassion-fatigue/

In the emergency first responder profession, where we witness trauma first-hand, it is at times difficult to be fully aware of the impact that “direct trauma” has on us as practitioners and how to differentiate between direct trauma and vicarious trauma. Research suggests that EMS personnel experience many reactions after exposure to a traumatic event. Admitting to being emotionally affected is regarded as difficult as it may lead to being perceived by their peers as not tough enough for the job. The attitude of ‘no one dies on my watch’ is common amongst EMS personnel. This leads to EMS personnel often suppressing their emotions and feelings associated with the reality of their work in order to live up to this image of being strong and resilient.

“Injury mortality rates in South Africa are approximately six times higher than the global average. One of a handful of studies conducted amongst EMS personnel in the Western Cape found higher prevalence of exposure to critical incidents compared to their counterparts in other low-income countries.” 

  • African Journal of Emergency Medicine Volume 5, Issue 1, March 2015

This Quarter we attempt to unpack and understand the lived experiences of compassion fatigue, vicarious/secondary trauma (ST), and burnout.

These three terms are complementary and yet different from one another.

-Compassion Fatigue (CF): Also called “vicarious traumatization” or secondary traumatization (Figley, 1995). The emotional residue or strain of exposure to working with those suffering from the consequences of traumatic events. It differs from burn-out but can co-exist. Compassion Fatigue can occur due to exposure on one case or can be due to a “cumulative” level of trauma. 

The American Institute of Stress – https://www.stress.org

-Vicarious Trauma (VT): is a process of change resulting from empathetic engagement with trauma survivors. Anyone who engages empathetically with survivors of traumatic incidents, torture, and material relating to their trauma, is potentially affected.

https://www.bma.org.uk

-Burnout: a “syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions: 1) feelings of energy depletion or exhaustion; 2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and 3) reduced professional efficacy.

The American Institute of Stress – https://www.stress.org

Despite the differing theories and terminology of the three concepts, each is directly associated with the concept of empathy. There are two key components:cognitive empathy, the ability to take someone’s perspective, and affective empathy, whereby an individual share a similar emotional response to others’ experiences(Smith, 2006).

With empathy holding sway as a common factor in CF, VT and burnout, it would make sense then to conclude that cognitive and affective empathy would impact differently on the life of the practitioner. For example, a professional empathising emotionally may experience more emotional consequences than an individual empathising cognitively. In addition to increased experiences of trauma, increased case load and less clinical experience, it is therefore suggested that the nature of empathetic engagement in work-related scenarios would therefore be an important dimension to consider in understanding the development and intensity of CF as experienced by EMS practitioners.

Conversely, burnout does not necessarily mean that our world views have been damaged or that we have lost the ability to feel compassion for others. Most importantly, burnout can be easily resolved; (but can it be in the current financially driven, dehumanised environment practitioners work in?)Conversely this is not the case for CF and VT.

As one is vicariously exposed to trauma, both directly and indirectly, one begins to exceed one’s resilience (or ability to cope) to these events, and one is then prone to develop CF (or sometimes also referred to as Secondary Distress Syndrome). Once our chronic exposure to trauma exceeds our coping mechanisms, CF then becomes evident. CF has been described as the convergence of secondary traumatic stress (STS) and cumulative burnout (BO); a state of physical and mental exhaustion caused by a depleted ability to cope with one’s everyday environment. This can impact standards of patient care, relationships with colleagues, or lead to more serious mental health conditions such as post-traumatic stress disorder (PTSD), anxiety or depression.

How do we then best protect vulnerable workers, to prevent not only CF, but also the health and economic consequences related to the ensuing, and more disabling, physical and mental health outcomes. To fully understand CF, we possibly need to move away from theoretical explanations and models and focus on a more relational understanding of professionals lived experience of their own and others’ (patients, peers and family) distress. This would involve a narrower focus on problem solving, via person centred compassionate care. Remember authentic and sustainable self-care begins with you. Understand that the pain and stress you feel are normal displays, resulting from the care giving work you perform on a regular basis.

Examine the positive and negative aspects of one’s work influences, and how it affects one’s professional quality of life. This leads us to a better understanding, whilst helping those who experience trauma and suffering. This can in turn improve our ability to aid them and keep our balance in this process.

Compassion Satisfaction and Compassion Fatigue are two aspects of Professional Quality of Life. They encompass the positive (Compassion Satisfaction) and the negative (Compassion Fatigue) parts of helping others who have experienced suffering. Compassion fatigue breaks into two parts. If working with others’ suffering changes you so deeply in negative ways that your understanding of yourself changes, this is vicarious traumatization. Learning from and understanding vicarious traumatization can lead one to vicarious transformation.

  • Dr. Beth Hudnall Stamm – ProQOL
sessional Quality of Life Model (Stamm, 2012)

An excellent article to read is Transforming Compassion Fatigue into Compassion Satisfaction: Top 12 Self-Care Tips for Helpers, by Françoise Mathieu, M.Ed., CCC– see the link below

In closing;

integrated intervention programmes are needed to assist EMS personnel working in this sustained high-stress environment. The findings can assist health care educators in the design of co-curricular activities intended to help in the development of resilience and the psychological wellbeing of EMS personnel.”

Exposure to daily trauma: The experiences and coping mechanism of Emergency – Llizane Minnie a,* Q3 , Suki Goodman b, Lee Wallis

Healing begins from within, and being committed to a self-care plan, with clear boundaries in both your personal and professional life and understanding one’s negative behaviours and their root cause. Internal self-healing in our profession is a life-long management plan, but as you continue to do the necessary internal work, life will and can, begin to change for the better.

References, websites and additional reading:

Cocker, F., & Joss, N. (2016). Compassion fatigue among healthcare, emergency and community service workers: A systematic review. International Journal of Environmental Research and Public Health

Hernandez-Wolfe, P., Killian, K., Engstrom, D., & Gangsei, D. (2015). Vicarious resilience, vicarious trauma, and awareness of equity in trauma work. Journal of Humanistic Psychology

Ray, S. L., Wong, C., White, D., & Heaslip, K. (2013). Compassion satisfaction, compassion fatigue, work life conditions, and burnout among frontline mental health care professionals. Traumatology

Sprang, G., Clark, J. J., & Whitt-Woosley, A. (2007). Compassion fatigue, compassion satisfaction, and burnout: Factors impacting a professional’s quality of life. Journal of Loss and Trauma

Mathhieu, F (2017) Transforming Compassion Fatigue into Compassion Satisfaction: Top 12 self-care tips for helpers. Workshop for helping professionals

Minnie L et al. Exposure to daily trauma: The experiences and coping mechanism of Emergency Medical Personnel. A cross-sectionalstudy, Afr J Emerg Med (2015), http://dx.doi.org/10.1016/j.afjem.2014.10.010

Healthier happier staff = healthier patients

Author: Alan Lofthouse

Published in: Summer 2018 Edition of Ambulance Today Magazine

At the end of 2014, and early 2015, we went through a period of industrial action in the NHS over pay involving two 4-hour stoppages. In the ambulance sector, many staff were not prepared to come to work, even under emergency life and limb cover arrangements. This led the government to put the army on standby. So, what happened and what have we learnt? 

Why were staff not prepared to come in? Well the answer lies in the fact that ambulance staff have been raising issues with workload, pressure, demand and lack of support for a number of years. Trouble was no one was listening. Performance dominated Trust boards and finance fixated commissioners missed the warning signs. 

Here came an opportunity for staff to make themselves heard. They voted with their feet in the knowledge that their legal right to take lawful industrial action would protect them. When it came to settling the dispute, we made sure that ambulance staff wellbeing was part of the final settlement. 

So, what has happened since then? Well, we have been working to develop a collaborative approach between Ambulance Employers, Trade Unions and NHS Employers to improve the mental health and wellbeing of the ambulance services workforce. 

We started by bringing together staff and employers to discuss the challenges each group faced. We have to recognise, whether we agree or not, that there is a policy of austerity in government meaning budgets are increasingly tight and the expectation is that employers will do more with less. However, this policy leads to problems for employers as staff leave jobs for less stressful and better paid work leading to recruitment and retention problems. 

Employers listened to staff concerns about working conditions, not just for the operational staff working on ambulances, but also the staff working in the contact centres and corporate services. Fewer people doing more work in an increasingly challenging environment. This is not easy listening for employers, many of whom work in managerial roles to help support staff in the delivery of 999, 111 and PTS services. Ultimately, they have little control of the government’s public sector funding policy. 

However, they do have to deal with the consequences – the dropping job satisfaction, morale and motivation; the loss of organisational commitment and discretionary behaviour. This leads to a worsening engagement, stress symptoms and burnout. Then they have to account for increasing absence rates and unfilled shifts. 

At first it seems like an impossible puzzle with too many pieces that don’t seem to fit together. How do you improve wellbeing, especially when you know what is making people unwell, but it feels out of your control and when taken as a whole it seems an impossible task? 

We started by grouping the pieces of the puzzle together based on the key issues. 

Mental health and resilience. Helped by Mind and the Blue Light Programme we know that ambulance staff are more likely to suffer from mental health problems but less likely to do anything about it. 

Bullying and harassment. Whether it is a manager and staff relationship, a control and road relationship or a hospital and ambulance relationship, we know they are already strained. Cultures in ambulance services need to change. External and internal pressures lead to poor behaviour but we need to eliminate bullying. 

Reducing violence and aggression. Too many times we read reports about staff being assaulted. I have written about this subject before and no one disagrees – we need to tackle this issue. With the right focus on prevention and prosecution we can reduce the harm caused by violence. 

Leadership behaviour. Ambulance staff take on managerial roles and then are not given the support or training needed to discharge their duties. We hear of senior management teams that are out of touch with staff. Line managers have a major role in supporting and developing staff. Senior management need to give them the training, autonomy and trust to support their staff. 

Working patterns and role design. Ambulance work takes years off your life! More and more evidence shows us that long hours, shift working and night working is bad for us and leads to preventable diseases. Some staff like working longer shifts to get longer periods of time off, but with no guaranteed meal breaks and the likelihood of a long shift overrun it’s time we looked seriously at this issue to make work less demanding but recognising peoples’ needs to spend time with their friends and family. 

Equality and inclusion. The experience of BME ambulance staff is of inequality in career progression, increased experiences of harassment and bullying and underrepresentation at senior level. 

Recognition and staff engagement. Each year the NHS Staff Survey shows how poorly engaged ambulance staff are. They are the lowest scores across the NHS. I do not honestly think it is deliberate but you get very little recognition for a job well done, whereas you do hear about a missed performance target or a complaint. Ambulance services need to get better and reap the rewards of telling staff they recognise the effort they are making, especially in difficult times. 

Healthy lifestyles. Last but by no means least. Ambulance work does not lend itself to healthy lifestyles. Shift work, late night snacking on poor quality food, combined with lack of consistent exercise and the physical demands of the job are a bad mix. However, looking after your own health is important and we want to see more employers supporting staff to live more healthily. 

The real trick for the national bodies, employers and trade unions will be getting the buy-in from staff and for them to trust that this is more than just a new initiative. The benefits are proven and what we have been saying for a long time. To get good patient care you need to start with good employee care. At the end of the day, healthier happier staff = healthier happier patients.