A Shoutout Across the Pond to our British EMS Bretheren

Mark in his British Paramedic Uniform

If you don’t know Mark Glencorse by now, you’re either very new to the EMS blogosphere or have been living under a rock. In addition to being a fine paramedic by all accounts, Mark runs the EMS blog www.999medic.com which is a member of the www.FireEMSblogs.com family of which I also am a member. Mark has a comfortable, familiar style of writing that brings you right there next to him as you read his articles. It’s almost like you’re running the calls with him, experiencing the joys and pain of a British Paramedic as he experiences them himself. He’s one of my Best Blogger Buddies and I’m proud that I can call him a friend. I read most everything he writes.

I hadn’t been to his blog for a few days though and thought that today would be a good time to catch up on what he’s been writing. He’s got some good stuff up lately, but in addition to some of his more educational articles, I found some things that just floored me.

We here in the United States can learn quite a bit from our brethren across the pond. They have aspects to their system that could be very valuable for us here in the states. Their EMS system is similar to ours in a lot of ways, not the least of which is the fact that they respond to largely the same types of calls that we do, but is also vastly different in terms of initial education, pay, respect, and capabilities.

I’m going to explore three of his recent posts here and see if other fellow US paramedics and EMTs will be just as floored as I was. Here goes:

“The Clash of the Assessments” – 999medic.com

This post explores some friction that he and his fellow paramedics have been having with “Walk In Centers” (WICs) that have sprouted up all over his country. He describes these clinics as such:

“In the UK over the last few years, we have seen hundreds of NHS Walk in Centres (WIC) sprout up around the country. These are primarily Nurse led units that are placed strategically in various towns and cities to provide care for those residents who are suffering from either minor injury or illness. They most definitely have a place in the wider primary health care environment, but ask any Medic what they think of them, and most will tell stories of picking up patients from the Walk In Centre to take up to the Accident and Emergency department who clearly do not have any specific life threatening or emergent need, and who, in the paramedics opinion should have been treat and discharged from the Walk in Centre.”

This sounds pretty familiar to me. Here in the US we have plenty of Urgent Care Centers that have sprouted up all over the American Healthcare landscape. They are staffed sometimes by a Physician, but are largely staffed by Physicians’ Assistants (PA-Cs) and Nurse Practitioners (ARNPs). They handle minor medical complaints and urgent-but-not-emergent medical conditions. Most of these centers are perfectly adequate for treating most patients with day-to-day illnesses and minor injuries. They cost much less than an emergency room visit and help save the ER from having to handle all of these minor cases. I fully support urgent care centers and their use in the spectrum of healthcare. However, my fellow medics and I can all point to times where we’ve responded to urgent care centers for complaints that we did not believe to warrant an emergency response and subsequent transport. I can emphasize with Mark and his coworkers about their problem with these kinds of transports.

Here’s what Mark describes as the “Rant” he’s trying not to have:

“My service has direct referral pathways to the Walk in Centres. If I have a patient who I think fits the fairly strict criteria for assessment and treatment at a WIC, then I can contact one of the nurse partitioners on the phone and discuss my patient so that they know what I am bringing in and more importantly that they know they are suitable for their level of care and will not need to be shipped out to the A&E department at a later time.”

Wait… What?

“My service has direct referral pathways to the Walk In Centres”

Dude!! We have been practically begging for that here in the US for some time! That’s AWESOME that the British can do that! Alternate treatment and transport pathways are one of the cornerstone ideas for EMS 2.0. This practice would save a great deal of healthcare dollars, would lessen the burden on the overcrowded ERs, would be remarkably more convenient for the patient, and would help keep the ERs available for the more serious of illnesses and injuries. This is a slam-dunk that we here in the US just can’t seem to figure out for ourselves and here we see the program is already active in the UK. We should steal that data and use it to help justify our own programs.

The next two articles I’m going to explore are pretty entertaining. Mark was selected to ride along in a multi-disciplinary unit of both civilian and military police officers in a busy urban center that has been having problems with alcohol and young people trying to mix too often. The set-up is pretty cool. He rides around with the police officers, helps them with what he is able to help them with, and is available to handle any medical problems that might arise with a 2 to 3 minute response time. The program sounds great, actually and I think that it could probably be employed with some success in many areas of the US… but read this account of his first EMS call while with the PD:

Mark (Right) with the rest of the British Team

“Less than a minute later, a police van turns up outside of a bar, the side door slides open, and out jumps a paramedic!” (Apparently it’s novel for the Police to be around with the Paramedics there)

“After a few quizzical looks, I get on with doing my usual job and assess the patient. He has a small cut to his forehead where someone punched him whilst wearing a ring. It is a minor wound but will need either stiching or gluing. There was no loss of consciousness, he has no other apparent injury and his observations are fine. Its still early in the night and he has only had a couple of drinks and doesn’t appear intoxicated.”

Man… so the patient is drunk and has a head injury… All you US paramedics know what that means. Here comes an ambulance in to transport the patient to the hospital. He can’t refuse because of the ETOH on board coupled with the head injury, and you know you don’t want to be sued… Let’s see what Mark did:

“I advise him that he needs to be assessed at the local hospital so that the wound can be closed. After dressing his forehead, he promptly jumps into a waiting taxi and heads off to the hospital less than 10 minutes away. I complete my paper work, Dave completes his log and we are off again.”

“From time of call to patient leaving scene – 8 minutes!”

WHAT!? OH COME ON NOW! That’s just not fair! You mean to tell me that Mark was able to use his clinical judgment, assess the guy for his injuries, and make a common-sense treatment and transport decision? He put the guy in a Taxi??

That would be a potentially career-ending move for a US paramedic. The Brits do it regularly. Could you just imagine what the ability to make those kind of decisions would mean for the US EMS system? Could you just Imagine what that would mean for EMS 2.0?

Let’s see what happens with the next patient encounter he describes:

“As we are sitting outside one of the shops, Dave hears one of the door staff calling for police assistance. He has been assaulted and has a head injury.”

“Again we are on scene in less than two minutes. This time the wound is a bit worse and is still freely bleeding. A dressing, some direct pressure and a quick assessment later and he is sitting next to me in the back of the police van whilst we drive him the short 5 minute journey to the local hospital. Again, no need for an ambulance, just transport to the hospital. In this case, and many others, the team are happy to use the police van instead of calling an ambulance into the town centre. It is a real benefit having the hospital so close to the centre of the town!”

“Even though we transported this patient to the hospital, we were again back in the town centre and patrolling in under 20 minutes from the time of the call.”

Apparently this is British Medical Control

So he brought the guy to the hospital in the Police car. Actually I’m familiar with the fact that they do this over there. Mark is regularly staffed to what they call a “Rapid Response Car” which is part of their “Front-Loaded Model” where they send a paramedic first to emergency calls to determine what the best course of action would be for the patient. Many times they don’t send an ambulance until the paramedic makes the transport decision. One of those potential decisions is to simply transport patients in the car with them instead of the ambulance.

You can find Part One of “Working A Police Medic Shift” – Here

And you can find Part Two – Here

I’m no fan of socialized medicine, but I have to give credit where credit is due. The US EMS system could learn a lot from the British system and I just can’t get over the fact that so many of the things we speak of for the EMS 2.0 movement here in the US are being done right now by our brothers across the pond. It would stand to reason that we could use the data that they’ve collected and created right now, steal a lot of their ideas, and begin to implement them right here in the good ol’ US of A.

Wouldn’t it be great if there was some kind of “Project” where an a British Paramedic could come to the US and explore the US EMS system? How about where an American Paramedic could come to the United Kingdom and learn about their system?

Oh wait, there is. The Chronicles of EMS has been doing just that very thing. If you’re a regular reader I’m sure you’ve already heard of it. If you’re not familiar with it, you should go right now to www.ChroniclesOfEMS.com and learn about it. It’s an amazing thing done by both Mark Glencorse and Justin “The Happy Medic” Schorr. If you’re an American EMS person, you really need to know about this and show them as much support as you possibly can.

And while you’re at it, check out some of the other fine British EMS Bloggers:

Insomniac Medic – http://insomniacmedic.blogspot.com/

“A Life in the Day of a Basics Doc” – http://basicsdoc.blogspot.com/

  • http://www.999medic.com Medic999

    “WHAT!? OH COME ON NOW! That’s just not fair! ”

    So funny mate, had me laughing out loud on station!

    Thanks for the write up.

    I agree we do some pretty cool things over here in certain situations, but I also think that it is important to remember that you guys over in the US of A are soooooo far ahead of us in other ways..

    CPAP – I wish!
    Therapeutic Hypothermia – The closest I get to that is when the heating wont work in the back of the ambulance.
    Synchronised Cardioversion – Not a chance
    Trans Cutaneous pacing – Nope
    Chemical Restraint – Oh Please!!
    We dont even have capnography yet – just colour change CO2 detectors.

    Wouldnt it be amazing if we could meet in the middle and take the best from both systems!

    • Zygote32964

      I have to say I am surprised that you do not provide the skills you just listed…I always considered the education system in England to be somewhat superior to the American system and by that reasoning, figured the English EMS system would be ahead of us in treatment protocols… I’d be interested in knowing what treatments you are allowed to provide and what types of medication you are allowed to push.

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  • Roger Heath

    This is a great article. I am best known as the inventor making possible the AED and have been studying these issues for some time. In recent years I became interested in nurse teletriage and now have brought this technology quite literally from London. I know my name is Heath (like the English toffee bar) but I am an American. (joke intended) When he says he makes clinical judgements it is using Decision Support Software (DSS) that drills down the symptoms and displays differential disgnoses and is all clinically referenced. We have brought this to the U.S. and major cities are now looking at this as a way to weed out nonemergent calls in safe legal fashion. That’s the way it is done in the UK. When this was done in the 1970′s it was very successful, but there were serious legal problems. But, they did not have this software to provide a complete audit or record that is completely clinically referenced. Now we have brought this here. It can be readily adopted for EMS 2.0. Now, in recent weeks we have become associated with a project with the IAFC which is to demonstrate exactly this. For lots of reference material see: http://www.lifebot.us.com/teletriage/

  • DaveO

    The only thing that makes the British/European systems work IS the NHS (or as many people like to call it, “socialized” healthcare). The reason it works is because everyone has the same health insurance and it’s accepted everywhere. It doesn’t depend on whether you’re employed, or if you are employed whether your employer actually offers health insurance , or what HMO you have etc. etc.
    Until we in the US figure that out we’ll have to continue transporting people to the ER for trivial problems.

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Chris Kaiser aka "Ckemtp"

I am a paramedic trying to advance the idea that the Emergency Medical Services can be made into the profession that we all want it, need it, and know it deserves to be.

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