London calling
The ambulance service is never fast enough
We know about the shouting, and the pushing of trolleys. We’ve witnessed, on countless TV dramas, the showy arrival of the paramedics with their busy hands and you’ll-be-fines. Less widely understood is the role of statistics, engineering and design in the business of life-saving.
First, the stats. The ambulance service is not at the leading edge of medical science. Paramedics don’t publish findings in learned journals. To improve their work, their best hope is to increase efficiency – and to do that they must first look at the numbers.
Take London. There are 395 ambulances – each worth about £75,000 – operated by 667 paramedics and approximately 1,300 ambulance technicians. Last year, London Ambulance Service (LAS) received more than a million emergency calls. That’s a quarter of all emergency calls in England and Wales, or one every eight seconds. And the number keeps rising: up 50 per cent over eight years.
Londoners with flu are three times more likely to call an ambulance than people in other UK cities. More frivolously, London callers over the past two months have included: a 16-year-old Southwark man reporting a bloodshot eye; a woman from Balham requesting an ambulance for her husband because he doesn’t listen to her; a man from SE17 who cut his toe while clipping his toenails, and another, from Maida Vale, who felt ill after picking his nose then dipping his finger in jam and eating it. These callers presumably didn’t realise that ambulance journeys cost the taxpayer, on average, £120.
For Category A calls, with loss of life a real possibility, ambulances aim to arrive within eight minutes. The government expects 55 per cent of such calls to get that speedy response, but amid ever-worsening traffic LAS has so far managed only occasionally to meet the target. “Seconds really do make a difference,” says Steve Furnell, a community resuscitation officer. Nothing illustrates the truth of this more starkly than the figures for cardiac arrests: currently just 2.5 per cent of the 7,000 Londoners suffering a cardiac arrest out of hospital are still alive a year later.
Confronted with such a case, paramedics speedily unpack defibrillators and administer an electric shock to the heart. “The chance of survival drops by seven to 10 per cent for every minute defibrillation is delayed,” says Furnell, before showing off the latest “defib”. The FR2, he says, is much better than the First Medic 710 which it replaces. It weighs less and can be used on adults but also – unlike the 710 – on most children. And the electric shock it delivers is two-way, so the FR2 can achieve the same effect as the 710 with a lower charge, reducing long-term damage to the heart muscle.
Moving along, Furnell introduces the even more impressive Lifepak 12. This machine enables paramedics to diagnose the type and severity of heart attacks and relay the information to hospitals before they arrive. In a pilot study, this saved an average of 25 minutes on the time it took doctors to administer clot-busting drugs. To put a Lifepak 12 on every vehicle and train staff to use them will cost £4.3m.
In an ordinary shift of 12 hours, ambulance crews such as Martin McTigue (paramedic) and Emma Stopford (technician) deal with up to 10 emergencies. The best thing about the job, says McTigue, is the adrenalin rush. (It’s certainly not the money: paramedics earn £22,101 a year, which doesn’t go far in London.) “You might be climbing up a crane or dealing with a difficult patient,” he says. “You try to turn that round, and stop them being violent or aggressive.” That’s not always possible. In December 2000, a paramedic from Shoreditch in east London, Simon Spencer, was stabbed in the hands, head and abdomen while attending a call in north London.
Driving, in emergencies, can also be difficult: “You learn to look six cars ahead, not one,” says McTigue. It’s common to see cars rushing into the ambulance’s slipstream, he says, but it came as a shock the time somebody actually attempted to overtake. Not surprisingly, he’s had accidents.
The vehicles driven by crews vary from day to day, but because they’re equipped identically each one feels like home. At the risk of stating the obvious, paramedics need to know at once where to find what they need. And that’s where design comes in: ambulances are configured to accommodate huge quantities of kit as tidily as possible. McTigue, rising from his seat in the back of the parked vehicle, shows me how. Behind the seat – at the pillow end of the bed – there are gas tanks. These feed oxygen through tubes fixed to both walls. To the left, there’s a suction unit (for clearing blocked airways, among other things).
Running round the walls, at ceiling height, are several cupboards. The first contains gear for resuscitating children, such as dinky laryngoscopes for keeping small tongues out of small throats. Next, the “Saturday night special”, as McTigue calls it: fluids, cleaning materials and vomit bowls. After that: neck collars, splints, maternity packs and a burns box with costly gel dressings. Of these items, several can also be reached from outside the ambulance, through a side door where stretchers are stowed.
The only kit that does not stay in the vehicle is the bag of drugs issued to paramedics personally. Between them, these drugs thin the blood, bring patients round, relieve pain, aid breathing, replace fluid or cause it to be eliminated, prevent fits, stop bleeding and remedy anaphylactic shocks. To prevent paramedics falling victim to muggers looking for drugs, the service issues painkillers that produce no euphoria. But that doesn’t mean they lack magical effects. “The great thing about the drugs we carry is that the effects are immediate,” says McTigue. “You give someone a drug for a heroin overdose. They’re at death’s door – and five minutes later they’re talking to you.”
19 January 02