Monday 17 January 2000
Reporter David Rose, Producer Kiran Soni
Below are links to items
pertaining to the above Panorama documentary.
'What you said' - comments from the
reporter David Rose
Statement from the Ambulance Service
Letter on behalf of
BBC Director General(14/02/2000)
2nd Statement from
the ASA (15/02/2000) *requires Adobe Acrobat
Reader to open pdf file
Panorama 'Casualties' Preview
text below is taken from the Panorama website previewing
the 'Casualties' documentary
"Panorama reveals that
shortcomings in the ambulance service are costing
thousands of lives each year. We also discover huge
regional discrepancies in the care paramedics
provide, which means your chances of surviving a
heart attack or a car crash may well depend on which
county you happen to be in. There is concern within
the medical profession that the training for
paramedics is inadequate. The standard classroom
training for paramedics lasts only 6 weeks - much
less than nurses. After a short period attached to a
hospital, paramedics then go out on the road - on
probation- but required to administer vital
treatments which a doctor would only be allowed to
give after several years.
The most crucial of all the skills
paramedics need to learn is accurately to assess a
critically ill patient. They have to be able to tell
the difference between conditions which may have
similar symptoms but require completely different
treatments. Incidents investigated by Panorama reveal
that paramedics do make terrible misjudgements with
In one tragic case an ambulance was
called out to a woman sprawled out on a street. The
paramedic decided she was drunk, gave her a slap to
bring her round and sent her home in a police car. In
fact the woman had been attacked, and two men are
awaiting trial for her alleged murder. She died from
head injuries a few hours later. Her children Kelly
and Patrick Delaney are devastated. "She's gone
through that attack, and then the people who've come
to save her call her a drunk, slander and negligence
- how can we ever live with that?" said Patrick.
It is not just poor training that is the problem.
There is no consistency across the country about the
types of lifesaving techniques paramedics can employ.
Victims of impact accidents like car crashes may
sustain a punctured lung. This can lead to a life
threatening build up of pressure in the chest cavity
leaving the victim only minutes to live.
But the situation can be
transformed if a relatively simple technique is
employed quickly. A needle is inserted to release the
build up of pressure in the chest cavity and the
patient's condition rapidly improves. Depending on
where you suffer a punctured lung, your paramedic may
or may not be allowed to use this procedure to save
Regional variations in response
Panorama also investigates why there is such a wide
variation in ambulance response times - the time it
takes them to reach a victim following the 999 call -
across the country. The Department of Health has set
demanding targets for improvement but most ambulance
services are not coming close to meeting them.
Staffordshire Ambulance Service is a notable
exception and a model of good practice. Despite hard
evidence of success in Staffordshire, Chief Executive
Roger Thayne says he has been vilified by his peers,
wrongly accused of fiddling his figures. He says he
has felt like "public enemy number one of the
ASA" at times. But independent research has
shown his system - which is based on having the right
number of ambulances in the right place at the right
time - is working.
Barry Johns, Vice President of the
Ambulance Service Association admits to shortcomings
in the ambulance service. Barry Johns also tells
Panorama "Some services don't use certain
skills, use certain drugs. Currently it's variable
and I think it's that variability has been a
strength, but also that strength has got to make sure
that everybody has advantage to best practice The ASA
is the body which oversees the 36 ambulance services
that operate in the UK at a regional level and is
responsible for promoting best practice within each
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A statement from Reporter David
I'm very sorry that some viewers,
particularly paramedics, construed the programme as
an attack on paramedics as individuals. Let me state
as explicitly as I can: I, together with my
colleagues in the production team, recognise that
most paramedics are very dedicated people, who have
to put up with conditions and pay that many would
find quite unacceptable, and who often experience
abuse and worse from those they are trying to save.
And often, they do save lives.
The point of the programme was not to criticise these
people, but the system in which they are forced to
work. This is a system in which the ASA vice
president, Barry Johns, could state to Panorama that
many services do not deliver best practice; a system
in which Mike Handy of East Midlands could turn away
from the camera and refuse to answer why a lifesaving
drug is available in part of his service area and not
in the rest. Above all, it is a system in which the
minimum requirements fall seriously below the
standards of paramedic education elsewhere.
My comment that technicians are 'basically drivers
with first aid' seems to have caused more anger than
anything else. Of course, there are many technicians
who have voluntarily gone well beyond this standard:
they have, for example, been trained to use
defibrillators, and to administer drugs such as
salbutamol. However, these 'add ons' are not included
in the IHCD technician syllabus, which, tellingly
perhaps, comes under the title 'Basic Ambulance Aid'.
Looked at in detail, the course does amount to
advanced first aid. It includes the techniques of
CPR, splinting, bandaging, oxygen therapy and entonox
pain relief. It does not include any invasive therapy
or advanced life support techniques. Useful as
technician experience will undoubtedly be for the
fledging paramedic, in no sense is the working
technician being 'trained' as a paramedic.
Similarly: while on the road experience after the
paramedic training course is of course vital, it
doesn't - as the programme stated - equate to the
intensive continuing education of a nursing degree. I
am aware of the new degree courses at Herts and
Sheffield. The problem is: as yet, there is no place
for graduates within the UK ambulance system.
Moreover, when the Government announced the target of
a paramedic on every ambulance, the abolition of
negative marking for the paramedic tests actually
reduced qualification standards. At a meeting of the
ASA education and training committee in September
1999, Mike Willis, chief executive of the West
Country ambulance trust, said half the paramedics
trying to transfer to his service from elsewhere were
'failing their assessments on national criteria' - as
the meeting's minutes clearly state.
It's claimed we took three exceptional cases out of
context. Well, within a few hours of the programme
finishing, we had received details via the website of
several further, equally disturbing cases, and we
already knew of two or three more. One of the
problems of UK ambulance care is that there isn't any
effective clinical audit of what happens. But as the
programme showed, academic research backs the
proposition that pre-hospital care is not as good as
it might be - however hard paramedics undoubtedly
The programme began by claiming that the shortcomings
of the ambulance service and of paramedic training
cost thousands of lives each year. It backed that
claim by examining lives lost through the following:
lack of training in general, and in the skills needed
to intubate semiconscious patients in particular; the
failure of some services to provide treatments which
are available elsewhere; and in the failure of the
ASA to acknowledge Staffordshire's dramatic
achievements in response times, and thus to emulate
its higher cardiac survival rate.
There are several culprits in this: the failure to
fund training centrally and the sluggishness of
ambulance management, to name but two. But these
avoidable deaths ought to be the starting point for
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Statement from the Ambulance
'shallow, selective and misleading'says ASA
Panorama's programme on ambulance
paramedics was a 'missed opportunity to inform the
public' the Ambulance Service Association said today.
The programme began with a deliberately misleading
statement - put to members of the public in Bristol -
that paramedics only trained for six weeks.
"No wonder the public were amazed," says an
ASA spokesman. "It simply isn't true."
In fact a paramedic trains for nearly three years,
including two 12-month periods of on the job training
under supervision. Nurse's train for three years and
doctors for seven, but the different professionals
shouldn't be compared because their training covers
different skills. Paramedics are trained in a
specific series of life-saving skills, not the full
range of care needed by a nurse or doctor, who
practice in very different circumstances.
The programme selected carefully from two interviews
with leading Chief Executives of Ambulance Trusts,
using just a couple of minutes in total from
interviews which both lasted over an hour with Barry
Johns of the ASA and Mike Handy of East Midlands.
It claimed 'thousands of lives could be saved' by
improved paramedic training, but presented no
evidence for that statement apart from anecdotes.
It focused on four cases of tragedies, which involved
paramedics over the last five years. Ambulance
paramedics are called to between two and three
million accidents and emergencies every single year.
The ASA can provide dozens of examples of lives saved
by paramedics within the last few weeks.
Panorama used one small scale study to show that out
of 179 cases of serious injuries one in 20 who died
might have been saved. This is the same level as
occurs in hospital, with doctors looking after the
patient. It proves nothing about the skills of
Paramedic training has improved dramatically over the
last ten years and the agreement by Parliament to
giving paramedics state-registered status was
achieved following a petition initiated by the ASA
The programme was littered with inaccuracies.
Paramedics are keen to use some of the new drugs, but
they cannot do so if the law says they cannot. All
local protocols are agreed by committees of hospital
All ambulance services are working with the ASA to
improve protocols all the time and the ASA is driving
through a new enhanced training programme which will
bring in more skills to further develop the way
paramedics care for critically ill patients.
The ASA embraces change. It represents all ambulance
services and is totally committed to improving
quality wherever possible, and in finding better ways
of delivering lifesaving care to patients. Every day
of the year paramedics save lives in this country.
In the end this was a deeply disappointing programme
because it failed to inform the public about the
great improvements that have been made in
pre-hospital emergency care over recent years.
By choosing instead selective reporting and
sensationalism it will unnecessarily alarm the public
about a service they should take great pride in, and
which they can feel very confident about.
Issued by the ASA on 17.1.2000
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