Time after time.

Clock stopping. The thing that drives dispatchers everywhere – the time between receiving a call and some form of response arriving on scene. Unfortunately this is often seen as more important than the patient and their ailment.

I was sent to a fall once, when I was single crewed. Falls are jobs that ambulance service SOPs (Safe Operating Practices) dictate should be attended by 2 or more staff. There was no way I was helping this patient from the floor myself. There were no injuries so, once I had made the patient comfortable, I updated control. Well over an hour later a second, double crewed, ambulance arrived and the patient was helped to their bed. The patient lay on the floor for almost 2 hours from the initial call, but the job was classed as a success because I got there in the prescribed time and the clock was stopped.

In 1974 the ORCON (Operational Research Consultancy) standard was created. ORCON was a way to monitor the performance of ambulances (and crews). The biggest thing being the ability for crews to get to a Category A call (cardiac arrest etc) within 8 minutes. By this standard, if a crew arrived at a job within 8 minutes and the patient died, the job would be seen as a success. Should the patient survive but the crew took longer than 8 minutes to arrive, the job would be a failure…

Much has changed in ambulance services, and ambulance crew abilities, since 1974. The type of jobs and public expectations have changed too, but ORCON is still the standard used to measure success. Time is still more important than anything, sometimes including crew safety. “Would you assess and withdraw until the police arrive if you feel it’s unsafe?” was a radio message I heard more than once on the way to a job. The response was usually “No” because the police had stab vests and batons, we had neither!

Crews joke about The “Great God Orcon”, but it’s a real thing, and it’s become more important than crew or patient safety sometimes.

On another occasion my partner and myself had dropped a patient at A&E. They had been in an RTC so had been fully immobilised. We were waiting for our immobilisation equipment to be returned by the A&E staff. The Radios went off – control asking if we could clear and go to a job. We informed them that we had no immobilisation equipment so we couldn’t attend a fall or any other job requiring the patient to be immobilised. We were informed it was just a minor head injury, so off we went. On arrival we found the head injury was caused by a loss of consciousness….wich caused a significant fall! We spoke to the call taker who informed us they had fully informed control of this right at the start of the call. We radioed in, no response. After 10 minutes of trying to call in I put an emergency call in. I got a response after a few minutes (good job we weren’t being attacked). Our dispatcher had been “called to a meeting” (why leave a whole area with no radio contact??). We explained the situation and our inability to deal with the patient properly. The dispatcher informed us that no other crews were available. Our patient was transported to A&E immobilised with blankets, bits of wood, lots of surgical tape, and other things we found on scene. After explaining to the staff at A&E we lodged a formal complaint against the dispatcher. Nothing ever happened.

There were many “clock stopping” occasions during my career. Most not life threatening, but many questionable as to the dispatcher’s motivation. I know it still happens. It’s worrying that a clock is still more important than the health of the patient, and sometimes even the safety of the ambulance crew.

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