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Casualties 17.01.00.
Comments taken from the Panorama website following the above programme
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Panorama
has received a very high number of comments on our programme on paramedics. There is both strong support for the programme and equally powerful criticism of it. Given the hundreds of messages we have received it is not possible to respond to every comment in detail, or to post all of them to the site.

What You Said :

As the lead negotiator for UK Ambulance staff, on behalf of UNISON, the union of which the majority of ambulance staff are members, I was appalled at the lack of balance and the inaccuracies contained in the Panorama programme "Casualties" broadcast on 17th January. Thousands of highly skilled, motivated and dedicated ambulance paramedics and technicians are today angry and disappointed that you portrayed them as poorly trained and uncaring. On the basis of a three tragic incidents you made sweeping assertions. In my view these were irresponsible as well as inaccurate. Today all over the UK thousands of people will have dialled 999 and received expert and caring treatment by a paramedic crew. The public can have confidence in the professionalism of all ambulance staff. I just hope that your programme will not stop someone phoning 999 in an emergency. UNISON has consistently argued for centrally funded and universal training standards and qualifications and led the campaign for registration of paramedics in the interests of public safety. These real issues were not addressed in your sensationalist treatment of this vital service. We hope that Channel 4 will give the opportunity for one of our paramedic members to redress the balance in their programme "Right to Reply" on Friday 21st UNISON would have been delighted to have participated in the programme if we had been invited. We would happy to cooperate in a future more accurate and balanced programme on the delivery of ambulance services. UNISON says "well done" to all ambulance paramedics and technicians. Keep up the good work.
Maggie Dunn Senior National Officer UNISON UNISON 1 Mabledon Place, London WC1 H 9AJ

I am writing on behalf of a complete ambulance station that works in one of the largest areas. We are amazed that you can only pick out three bad incidents out of the millions of calls we do each year. I would agree that there are good and bad personnel in every area of the health profession that includes in and out of the hospital environment. Many of the cutting remarks made by your documentary, would in our opinion, lose the trust of the public, which could result in unnecessary deaths occurring. We do not kill our patients, as it came across in your programme. Most of us, infact 99 per cent, are dedicated to the job in which we are employed to do. Thanks for demoralising an already very low esteem. Yours, very fed up ambulance crews.
London Ambulance Crews

I am the Training Co-ordinator for the Sussex Community Resuscitation Scheme based at the Royal Sussex County Hospital in Brighton. Previous to this I was a Paramedic with the Sussex Ambulance Service. One of my present tasks is to audit "out of hospital resuscitations" This give me a close insight in to the ambulance service . There has been a steady decline in the standard of care over the last 10 years. I was one of the first to be trained in advanced life support skills. I see the present situation not as a matter of inadequate training although it does need improving considerably. But a lack of discipline and a total lack of enthusiasm for the profession due to a management committed only to saving money. Most of the general public can recognise cardiac arrest and would not mistake it for an asthma attack specially if CPR was being administered. This "do not care less attitude" will continue under the present NHS management. It will only improve if it is placed under the Home Office linking the Fire Rescue Service with the Emergency Ambulances. In that way discipline will return, the service the public expect and standard of care will improve dramatically. Get rid of the old Chief Ambulance Officers who are with some notable exceptions no better than transport managers.
Douglas Coombes
Brighton

As the UKs newest Trade Union, we seek to represent the views of all Ambulance Service employees. The Panorama programme has raised a number of issues which are of very great concern to all Ambulance staff. Sadly, the programme whilst incisive and thought provoking in many ways, failed to present a balanced view of the Ambulance Service. It concentrated too much on the negative and not enough on the positive improvements which have taken place in the service over the last 10 years. Failure to mention that all Paramedics have to complete 1 year service as a Technician before they can enter the Paramedic training programme significantly failed to mention that Paramedics, unlike other NHS groups, including Doctors and Nurses are subject throughout their careers to Annual assessments; Post-proficiency courses every 2 1/2 years and full re-certification courses every 3 years. It also failed to put the distressing cases it highlighted into the context of the number of calls dealt with by UK Ambulance Services each year. The Ambulance Service Union fully supports the need highlighted in programme for uniformity of standards throughout the Country and for this to be funded centrally. Indeed, we would call for the debate to begin in earnest on the establishment of a National Ambulance Service, replacing the current practice of 36 competing fiefdoms. Paramedics want, and the public deserve an Ambulance Service which can match any other in the world.
Steve Rice
Liverpool

After watching the programme about Paramedics I feel I must write in utter disgust at the manner at which the programme was based and the complete lack of understanding that your reporters have on the subject of Pre-Hospital care. Did at any point throughout the filming of the programme the camera crew go out with an ambulance service and see exactly what it is like walking into a strangers house at 2:00 am faced with three highly abusive drunks and a 15 year old girl who has taken a chemists shop worth of pills, or watching someones life slip away as blood pours out of a knife wound to their neck? Paramedics and Technicians carry out a very hard job, that many Doctors and Nurses could not cope with because of the often traumatic nature of the accident, for example entrapment in a burning car. Perhaps an apology could be broadcast for this complete mis-representation of highly trained and experienced staff who carry out tasks many "first aiders" would find difficult or too traumatic to handle based on their short courses not involving actual real-life experiences.
Mr Andrew Black FR, Emergency Ambulance Technician.
Shrewsbury

As a member of St John Ambulance I found your programme broadcast tonight most interesting. Increasingly members of St John Ambulance are expected to be trained up to the level of Ambulance Technician transporting and treating patients in critical conditions rather than call out the NHS ambulance service. If the programme portrays some NHS Paramedics and Ambulance Technicians as incompetent, then you should look at the training St John members receive who work at a similar level to Ambulance Technicians. There is no structured training course at present (although one is being implemented), so members are trained according to what their county teaches them. They then go out and provide an emergency ambulance service at major events with sometimes no professional medical support. Yet they are rarely using their skills and are an accident waiting to happen, when they do get to deal with a patient in a life threatening situation.
Anon
Essex

I am a BASICS doctor and a member of NARS, the Norfolk Accident Rescue Service. I am often called to 999 emergencies and therefore have first hand knowledge of what happens "in the field". I have never come across the type of attitude and lack of care as depicted in your programme in any of the paramedic crews I have worked with. Life is not cheap and there will always be room for improvement in any service but I feel your programme was biased and unfair to the great majority of paramedics who always do their best under sometimes very difficult circumstances. As always provision of good medical treatment from the best trained staff of whatever grade is very expensive. But it is what we all want. When will he government grasp the nettle, fund the NHS properly, however it is done, and be prepared to tell us the unpalatable truth that it will cost us a lot more.
Ken Doran
Wisbech

This programme was an unfair and yet very accurate portrayal of the ambulance service today. It was unfair to the many paramedics who take their job seriously and struggle with the constraints imposed by the services they work for to deliver a decent standard of patient care. Many paramedics pursue additional training in their own time and at their own cost to increase the depth of their knowledge and experience, whilst trying to argue and cajole their services into providing this and raising the standards of service to a level where we would be happy to know that any of our colleagues were attending to a member of our families and not just the few whom we trusted. I must agree with the proposal that paramedics in this country need more training, and that a more uniform structure needs to be introduced. hopefully as we move towards professional registration, a move that many of us have sought for many years, the training that we are given will also move towards a more professional level. I do feel, however, that this programme has done a dis-service to the many of us who strive, for little recognition, to provide the very best that we can for the people who place their trust in us. I have been an ambulance man for nine years and a paramedic for nearly six. in addition I am a Resus council ALS and PALS instructor and teach adult and paediatric resusitation to doctors and nurses on hospital run courses.
Roy Pryer
Worthing

The programme has highlighted what some people have known for many years. Unfortunately without national legislation paramedic training will not alter. Eminent clinicians who were a part of the program from the early 70's stated 11 years ago that by having one paramedic on each ambulance would mean that our training would be restricted to teaching the lowest common denominator the practices of paramedic skills and that this would dictate the level of training. I a surpassed it has taken this long to come to the surface. If something good is to come out of this documentary let it be positive discussion on the way forward. I know most ambulance services would like to see it but their hands are tied by the legislation handed to them.
Michael Bjarkoy
Brighton

I am an operational paramedic training officer within the Scottish Ambulance service. I Agree with 75% of your program the one most being is of course MONEY the SAS has NOT trained Paramedics since 1998 due to government cut backs. In Scotland all staff must be operational for at least 18 to 24 months before being considered for paramedic training after which intense study of anatomy and physiology before sitting entry exam.Overall it could take a minimum of three years to qualify as a paramedic. I would like to close on saying the three crews who neglected their duties and should be re-trained or dismissed.
Gordon McCulloch
East Kilbride. Scotland.

My daughter Lucie died due to a peanut allergy. The paramedics who attended on that evening, lied about the treatment they offered. We live 4 minutes from the hospital, they took 35 minutes and 2 ,999 calls to arrive, they lost the print out from the LSU, AND the sample jar which contained contents of her throat he claimed to clear vomit from. I was in the ambulance with my already dead child.THEY DID NOTHING EXCEPT TRY TO GIVE OXYGEN. THEY SAID SHE HAD A PULSE, THE DOCTOR INCHARGE, SAID SHE HAD BEEN DEAD FOR 30 TO 35 MINUTES BEFORE HER ARRIVAL TO HOSPITAL.
Garry Crawford

Thank you Panorama for finally allowing the General Public to witness what I and others of the Healthcare profession have put up with for the past 10+ years. Whilst the majority of Ambulance Technicians (who I may say are NOT just drivers with first aid experience) and Paramedics do a great job within the constraints they have to work under, there is a growing number of Paramedics who think & some believe that they are better than Doctors, they delay "on scene" times far beyond the "Golden Hour" & "Platinum 10 minutes" which does jeopardise the very patients they are supposed to be treating. Ambulance Technicians however, are aware of there skill levels, and as your programme rightly pointed out, give patients a better prognosis than their 'highly trained' colleagues. As for Management, there is a growing need for the Ambulance Service to be run more on a Country not County wide basis, with a set regulatory body for training and service development to enable the general public to benefit no matter where they live. There also needs to be a greater number of opportunities for people not related or working within the Ambulance Service to apply for vacancies to bring new ideas and working practices to a sector of the health service that is in dire need of and injection of fresh blood.....

I am in total agreement with your program tonight. I have had several years of working in the Scottish ambulance service and have first hand experience of what your program was about. Unfortunately I am too worried about my job to speak openly to you about these problems. However through the above Web site, some staff can voice the general opinions without fear of reprisals by management. STAND UP FOR THE TRUTH!
Anon
GLASGOW

Found the programme very disturbing but not surprising. After 28 years service in RAF Medical Services as a Medic and the last 5 years as a Paramedic Training Officer I was appalled at the lack of basic knowledge displayed by the few Paramedics I have come into contact with since leaving the service. My local Ambulance Service, East Anglian Trust seems to operate a policy of only training its own staff for Ambulance Technician and Paramedic posts. I attended a Selection Day along with 11 other "candidates" scored extremely highly in all respects of the tests, had years of experience but was not selected even though qualified as a Paramedic, when the job on offer was only for an Ambulance Technician. None of the candidates were selected but two days later the local paper was advertising for Ambulance Care Assistants. Nepotism or what? Clearly, those in positions of power are more concerned with their own careers than providing a 1st class service to the public.
S Wilson

This excellent programme reminded me of an experience I had recently. I'm a special constable in the MET and got a call from the LAS on 30/12/99 to a collapsed male, on arrival paramedics who had been with him for an hour said he was drunk and would let us take him, we took him into custody for his own safety but once in custody he started being sick and was rushed into hospital again by another paramedic unit, he was put into intensive care!. then me and my colleague were investigated by CIB for a near death in custody!, The man recovered the next day and we was cleared. it is no small thing having your clothing taken for evidence, custody suite being closed, the scene sealed off as a crime scene and the prospect of being interviewed by the infamous CIB!, how I look at paramedics in a different light now! This could have easily been another scene on your programme had he died.
Richard Pelling
London

I found the Panorama Casualties programme very shocking but frighteningly reflective of my own experience of the ambulance service. My husband died on July 31st at the age of 27 after a freak fall in which he sustained major head injuries. The first paramedic to arrive at the accident appeared to go into shock when she saw my husband's injuries and a friend that was with us had to shout at her to bring her round. Our friend who only has basic first aid training had to instruct the paramedic to bandage my husbands head to protect his eye and try to stop the bleeding. At some point a second ambulance team arrived and I am not clear which of the paramedic's actually carried out the intubation, however the next day when I went through my husbands hospital notes I discovered that the paramedic had not successfully intubated my husband and the procedure had to be repeated on arrival at the hospital. In my husbands case, his head injuries were so severe that I believe that it was better that the medics were unable to re-start his heart and that the failed intubation attempt by the paramedic did not change the outcome of the accident. However the fact that one of the paramedics could not cope with seeing an horrific accident and the intubation was not carried out successfully could affect the outcome of other accidents. I would like to thank panorama for revealing the truth about the ambulance service and I hope that increased public awareness of the failings of paramedic training may precipitate some changes in the system.
Rhian Davies
Brighton

What was the point of this programme? If it was to de-motivate the entire ambulance service then very well done! You achieved everything you set out to do. You have projected the image of all paramedics as a bunch of incompetent morons. I have read some of the comments made to you on your web site and one person suggests that a washing machine repair man has better training for his job. What a fantastic impression you made. How many backhanded comments do you think the general public will make to them. For 1,100 basic pay per month it is worth putting up with and that's not forgetting the shift work of course. You failed to mention that every year Paramedics have an audit. Every 3 years they have to re-take their exams to keep their jobs - something that not even doctors have to do. A fundamental point I would think. Totally missing from your programme. I would be really interested to know if anyone dies as a result of your programme. Dramatic you may think but surely that was your intention - to scare everyone to death, literally. Don't call an ambulance the crew will kill you. Well I wonder, lets see if some people decided to try to drive a patient in to hospital or treat them themselves after what they heard last night. If they do lets make sure you and your production team stand up and are accountable for that. You owe the entire ambulance service an apology.
Janet Noles
Guildford

Every member of the N.H.S. Ambulance service who are active on front line duties are trained to a national level. This training comes from, THE N.H.S. TRAINING DIVISION Known in the ambulance service as the basic training manual. Whilst I do realise the paramedics in a couple of your reconstructions were way below par, and i feel very sad for the families concerned. I do however resent being tarred with the same brush. The point constantly forced into the general publics mind by your program, regarding paramedics only getting six weeks training was laughable,and calling technicians "drivers with a first aid certificate was a discussing uneducated piece of journalism. How the program makers can show a program about a profession without actually interviewing any paramedics or technicians in that profession is beyond all comprehention. Not once did you mention the thousands upon thousands of assist calls, helping the elderly or disabled back to bed after a fall with no injuries. Not once did you mention the many times ambulance staff are faced with going into unsafe conditions to save someone, even though our protocols say that we should not. Not once did you have the respect to admit that day in day out ambulance staff go into buildings with good intentions of helping someone ,only to be verbally or even worse physically abused, not once did you mention that this hard working bunch of individuals are badly paid even though they are expected to deal with any kind of medical emergency..London Ambulance Service.
JIM DALY
WATFORD, HERTS

It is a pity that your excellent programme never realised the discrimination within the civilian ambulance service against former well trained paramedics from the Royal Army Medical Corps. Our training is developed over three years, with three levels of paramedical ability, we work in the Civilian ambulance service for training, we work in Military hospitals for training. I am a class 2 Paramedic from the armed forces, I was an assistant mortician, had a lot more experience than the civilian service. Left the Army, to hopefully go into the Civilian Ambulance service. I have been told by some ambulance men, former Army Medical Services Personnel applying to the civilian ambulance do not stand a chance..........Can you find one, maybe two...Discrimination and a disgusting situation
Robert Gorton
Drongan (Scotland)

I would like to agree that paramedics are treated like Dr's or Gods when in reality they are little more than 1st aiders with a few extended skills. I am an experienced A&E nurse (over 7 years) with extra training but regulated by a central body. The public need to be made aware that these people have very limited training. Like all professions there are good and bad but in this one the bad remain. The number of times I've stopped to help at an RTA or similar incident only to be pushed aside by the Paramedic. Finally well done brilliant reporting
RGN
Derby

Clearly changes need to be made to the Paramedic service - and cost was raised as a problem. Yet the head of the Ambulance Service in Staffordshire appears to have improved the service in that county, whilst saving money! Surely he should be appointed to head up all such services in the UK and no matter how 'unpopular' he is within the ASA given the support and power to implement his innovative programme nationally. The Health Minister should take note of the contents of this programme - and do something radical!
Steve Gibson
Hereford

I am 19 and training to become a state registered Biomedical Scientist. Although my true ambition is to become a Paramedic. I was disgusted by the performance of those paramedics that let the true meaning of what a paramedic does, down. I want to be a paramedic purely to help those that need my help The degree I am doing currently seems perfect for a paramedic, going into the way the body functions, when things go wrong. I believe this course will be beneficial to me when I am a paramedic. I cannot understand though how the ambulance service allows bad paramedics as shown in the programme, continue working within the service. Panorama has not put me off achieving my dream, if more than anything has encouraged me more, to show the public the true meaning and importance of the paramedic. Panorama has opened my eyes up to a profession that I want to go into.
Emma Townsend.
Southampton

Having just watched what I could only call a character assination of a breed of people willing to work all hours to save lives I work for the London Ambulance Service and we treat over 3,000 people a day, your slanderous programme mentioned 3-4 very sad but isolated incidents. There is a saying until you can walk in another mans shoes dont critise his shadow. The only thing that comforts me is that any of the people associated with the programme were to become injured they would dial 999 without hesitation!!!
Ambulanceman
London

One way of funding additional Training/providing more services would be to stop using the Ambulance Service as a taxi service for drunks or for people who are entirely capable of making their own way to hospital (if indeed they need hospital treatment) Whilst I can appreciate an unwillingness to deny help to people using the 999 service, those abusing the service should be made to bear the financial cost of this abuse
Phil Taylor
Lancaster

Great programme tonight (paramedics) this subject has long needed aired. I left the Scottish Ambulance Service NHS Trust two years ago after thirteen and a half years service, much of it as a paramedic. In addition to the points raised in your programme, there is evidence to support that many ambulance officers are untrained/unsuitable for their tasks both academically and operationally, and that many services are manipulating response times, covering up disturbing information from the public and failing to run their services properly. Look at how many court cases have been settled out of court by some of the various services up and down the country for example. I could go on but I would be here all night. Keep up the good work Panorama. \par Mr L McKenzie\par Forfar, Angus \par \par As a GP I endorse the sentiments expressed in your programme tonight. On more than one occasion I have watched paramedics spend more than 30 minutes attempting to insert iv lines into cardiac patients when the hospital was only 15 minutes away.
Dr.A.M.Robbins-Cherry
Saxilby, Lincoln

I worked on the street as a Emergency medical tech for 17 years and our training in the USA was better at basic level than the paras here, apparently had at basic level. There was 110 hours training and you had to have at least 6 months experience with an experienced crew before you could be on your own. At the next level up you had to have 1 year on the street before you could be recommend to go on to cardiac tech or paramedic cardiac tech training. It took about 3 months and again you needed a lot of time to be allowed to make any runs on your own.
Tom
Cambridgeshire

Tonight's programme was a timely reminder of how poor a significant number of our paramedics are performing. As a qualified general surgeon with experience in the dealing of major trauma in both South Africa, the USA, and the UK, I see major differences between the care of trauma in these respective countries. This in part is due to the level of exposure to major trauma seen. However, the lack of training in this country for paramedics has been unrecognised for too long. Training by itself in the classroom does not compensate for on the road exposure, but at least it is a start. Far too frequently I have witnessed inadequate resuscitation of the major trauma victims arriving in our A+E departments. Sometimes over enthusiastic but misplaced resuscitation occurs, costing minutes and ultimately lives. I know which country I would have a car crash in. We should defend the actions of the maverick Staffordshire chief and applaud his lonely crusade in wanting to improve his service. Well done Panorama
Dr Jones
Newcastle

Why are so many people defending the paramedics? Criticism is being directed towards the decision makers who deem a relatively short period of training (6 weeks / 6 months, it's irrelevant) as sufficient for individuals responsible for life and death, day in day out. Don't defend the profession, demand better! Perplexed of Surrey
Stephen Piper
Camberley

I am a paramedic in Herts and to be honest your programme did raise some true points of concern - there are staff on the road who are not competent but as there is no supervision or support for staff anyone can get away with it. However this is a small minority and it was a small minority of your programme that wasn't laughably inaccurate. How can you not have one single paramedic giving there side?
James Grierson
Ware

Thank you - a real eye opener of a programme, and a very worrying one. I realise that as in most professions there is the odd 'bad egg' but with the Ambulance Service you would have thought that they would have been 'weeded out' before they got to the stage where their actions or non-action would have had such dire consequences. I hope that your programme will have the right effect - After all, who else can we turn to at a time of crisis?
Paul M. Knight
Lichfield

I bet you won't publish this! I think of your reporter and producer after this programme, as your programme thinks of Paramedics and Ambulance Technicians. Reporting at its worst, lazy, one-sided, ill-informed and harmful to public health. When will the BBC re-train them? Do they have yearly re-qualification exams? Who says they are competent?
Bernard Fox (A driver with first aid skills)
Leicester

I must say, I love the way you only publish the responses that say your programme is excellent. I am dissapointed that the BBC, an independant media acts in this way. It's something I would expect of something affilliated with Rupert Murdoch.
Sidney Lobb
Web site Producer reply: The purpose of this forum is to publish a representative range of comments from the hundreds we receive - reflecting all opinions on our programmes, negative and positive.

Having read the "What you've said" web page, most of my anger at the inaccuracies of your programme has already been voiced. However, in your opening story of the unfortunate drowning of a young girl you quoted 2 actions of the ambulance personnel that need defending. The first is that time was "wasted" trying to intubate the girl. If you have ever tried to resuscitate a drowning patient, you will soon realise that the only way to ensure a patent airway is by intubation (I will spare you the details why), I suspect this is why it was attempted. Secondly, you said that a defibrillator was not used initially. To defibrillate a person, the heart has to be in a certain condition electrically. If it has no electrical activity a defibrillator is useless. The fact that it was used later suggests that actions by the ambulance crew (eg drug therapy) enabled this to happen. Finally; it's vital that poor working practice is brought to light but not at the expense of the majority who are very professional at their work. Please try to balance your programme and give it some credibility.
Armed Forces Medical Technician

How dare you be so conservative, only taking a small part of the ambulance service. But for our paramedics in Lancaster, my Husband would now be dead. I dialled 999 because he was having a very bad angina attack, very bad, the operator kept me talking and asking questions, whilst trying to keep me calm, within less than seven minutes, the paramedics where outside my door, straight upstairs, first things, oxygen, then injection THEN ASKED QUESTIONS, my husband was then transported to hospital for further treatment. Your programme was very biased and I take exception to that, you DID NOT LOOK AT THE COUNTRY AS A WHOLE, HOW DARE YOU PUT OUT SUCH A DEROGATORY PROGRAMME WITHOUT RESEARCHING THE WHOLE OF THE COUNTRY.
MYRA ROWETT
LANCASTER

I had a heart attack and nearly died due to misdiagnosis by the crew of the ambulance that eventually arrived, they thought that a forty year old man should not be having an m.i. and so presumed it to be a panic attack. The 1st aider told them that with blue lips and ears, shortness of breath and extreme chest pains it couldn't possibly be a panic attack!! They still put a bag over my face, and insisted that I walk the 250-300 yards to the ambulance (because in his words "I'm going to strain my back lifting you"). There were a number of further crass mistakes made that having formerly worked many years in the health service I was amazed at! Can you tell me if there is anyone I could talk to about this. N.B. these actions were witnessed by very capable 1st aiders who whenever they complained about my treatment were belittled/humbled into silence.
C J.Hargreaves
Exeter

The report on the ambulance service was both alarming and disturbing. Panorama are to be congratulated, once again, for making the public aware of the real situation that exist. I hope it will have some affect on the people in control and make them realise that far better training is required and a uniform standard of service essential. Thank you for a most interesting programme.
Mr. Les Holley
Harrow, Middx.

A very worrying programme. I was totally surprised at what appears to be the lack of training the paramedics receive. I also do not understand why there is no National minimum standard for a paramedic.
Mr Beaumont
Nottingham

Well Done - I could have been watching CH 5 for all the truth that I witness tonight on your programme. You forgot to mention that ambulance staff get paid less than most nurse's, and that when you hear about all the violence towards nurses and doctors it has been us who first meet this person and who was first assaulted by this person. Today it was reported that nurses and doctors were getting a pay increase, about time they deserve it. When was the last time the Ambulance staff got such recognition of its needs?
Anon
Leeds

6 weeks - that's the same amount of training that washing machine repair men get. One more sad indictment of the failing NHS - and the programme timing coming directly after the recent well publicised bed problems shows how bad things are. It is all down to money we are told, but in the UK we are already highly taxed so the argument and excuses are a bit thin. Time to redirect the budgets I think.....
Mike Noble
London

I felt that the programme was poorly researched and very biased. Your programme did little to show the successes of the ambulance services and failed to enlighten the public to the issues relevant to Paramedics.Your programme again failed to mention the fact that the INTUBATION training is given by the local teaching hospital in that particular region. Training takes place in Theatre and is sustained for 6 weeks. In the field the paramedic is expected to perform an INTUBATION in 27 seconds. This, I believe is the standard to pass the paramedic exam. You failed to mention the very poor salary offered to these life savers, approx 16,000 (may be the same as a trainee Sales Rep!) Why pick on a paramedic ? A doctor could have qualified 40 years ago and is still respected today even though he's 40 years out of date ! Paramedics are assessed annually. If you want to feature the role of a paramedic why not feature the time wasters and violent people they have to help. (No I'm not a Paramedic)
T A Ashby
Selby

In investigating the current state of the nations' ambulance service, I am afraid to say that Panorama provided a totally biased and damning report. As another Paramedic degree student (!!), I found the report to be disheartening, and I am very angry that the majority of the general public will now have adopted the view portrayed by the programme. Our course is a three year course in which we not only learn about the anatomy, physiology and techniques of pre-hospital care, but also sociology, psychology and a professional practise approach. Existing Paramedics (of which I have encountered many) are very dedicated and would not have entered the profession 'to sit for 40 minutes in an armchair', rather to help the sick, and save lives. In a profession where there are thousands of staff who handle thousands of cases a month, these four highlighted cases were a limited view of an essential, hard working profession.
Liam Whittaker
Hatfield

Regional treatment protocols: Ambulance services are required to follow the regional health authority (Service purchasers) protocols. Local paramedic steering committees made up of doctors decide the treatment regimes that are to be used in that area. Additional paramedical skills are sought after by many in the service, however, as each skill is brought in, training for every paramedic in the service is expensive - the last two drugs which were brought out in an ambulance service were implemented with no training, only a bulletin on their use. Also many feel strongly about the issue of extra skills and extra responsibilities being forced upon paramedics without due recognition of those skills. I have watched tonight's programme with many feelings, disgust at the treatment that some have received, relief that important issues have been brought to the attention of the many. There are many paramedics in services up and down the country who provide a service to be proud of, to the high standards that are expected of them. Whilst we have seen the evidence of the bad ones, don't forget the good ones out there.
Al
North West

I was impressed at the frankness of your programme and I can only agree with the conclusions that you have come up with. For years the NHS in what ever guise has been appallingly under funded and full of politically correct sound bite administrators. Ambulancemen are badly paid Immediate care doctors, and I have been one for 15 years. We have grandiose schemes like Air Ambulances totally unproven and according to research a complete waste of money. We have first responder schemes which are also totally unproven. Lots of hype, when in fact some of the ambulances on the roads have done 250000 miles and the crews may have been working days and night for 6 or 7 days on the trot.
Dr Alastair Bell
Spalding

Sensationalism worthy of ITV was what I watched tonight. And reading some of the comments I have seen the harm it is doing, with members of the public poisoned against people who 99% are superb. Every walk of life has room for improvement but an attack like this is unwarranted. It is 30 years since technicians stopped being "drivers with first aid training" to becoming highly skilled practitioners & the advent of extended skills staff AKA paramedics has saved more lives than if they had never existed. I'm not in the NHS Ambulance Service, but as an ambulance person in a Voluntary Aid Society have worked alongside paramedics & technicians & know what great people the majority are. The programme did have some grains of a valid argument but preferred to stage a witch-hunt rather than an adult discussion.
Anthony Buck
Huddersfield/Sheffield

Having just viewed your programme and having been a paramedic for 6 years in New Zealand I am disgusted with the lack of knowledge, ability and down right caring shown by paramedics in your programme. I cannot believe that there is not a national curriculum for training and that all paramedics are of the same standard and trained in the same techniques. I applied for a job in Derbyshire, Nottinghamshire and Leicestershire ambulance service and was told that they would not recognise my qualifications and I would have to start at the bottom on 8200 PA. I told them to jump, Staffordshire service were the only outfit that would even send me an application form. I cannot believe that there are qualified paramedics walking the streets in this country unemployed and not being allowed to even sit an entrance exam to be accepted. I treated a cardiac arrest victim in my the high street of my local town last year and it took over 20 minutes for an ambulance to arrive and when it did finally get there the crew on board were incapable of treating my casualty and had to wait for a second ambulance to arrive to administer the treatment, by then sadly it was to late and a 52 year old man died upon arrival in hospital. I was disgusted. I actually made it to the hospital with the gentlemen's wife which was 16 miles away and was sitting waiting and yet the ambulance had not even left our high street. This would never happen in New Zealand. Dont blame the paramedics they can only administer what they know and by what I've seen tonight that's not very much.
Campbell Downie
Swadlincote

I think your programme's underlying arguments are valid : all ambulance services should adopt the same "best practices" as regards drug protocols and skills; paramedic training probably is lacking in some areas; and all ambulance services are under-funded. However, the examples you used in the programme were somewhat irrelevant to your arguments. They all appeared to be cases of incompetence or negligence on the part of individuals, which I am sure could be found in many other professions. Rather than highlight the gross under-investment in Britain's ambulance services, I am afraid that your programme has cast all paramedics as cynical incompetents.
M.Drover
Isle of Wight

I feel that your programme raised many important issues, such as the lack of co-ordination of protocols. However, Paramedics have to complete weeks of technician training and have considerable experience before receiving paramedic training, which leads to far longer than the 6 weeks quoted. Technicians are not 'first aiders that drive' as you stated, but highly trained professionals. There is a massive difference between the skills of first aiders and technicians. The programme quoted no statistics as to the number of complaints or serious incidents relating to Paramedics which produced a biased view based on a very small minority of incidents. As a paramedic degree student I have to study 3 years full time to become a paramedic and I am concerned that your program will affect the view of the public about these professionals who work in extremely difficult and demanding conditions.
Adrian South
Hatfield, Herts.

I can't help but recall the system used by Preston Ambulance Service way back in the '60's. An ambulance crew would go out to a given area to await a call. This was to try and ensure that they could get to the scene in 5 min. On arrival after receiving a call, they'd radio in to control giving details and whether they required backup or not. After 15 min control would contact them wanting to know why they were not enroute to Hospital. Failure to respond would mean another vehicle or police despatched to the scene. Is it me or have our services gone downhill since those days?
D. Minchin
Errol

Your reporter would have done better to have gone out with a crew to a multiple car smash and watch the paramedics doing their damnest to help people under the most horrific circumstances. Yes some of the victims die, but more importantly thanks to the paramedics, some survive. I for one breath a deep sigh of relief when I see them arrive on scene. In an ideal world a doctor would be in every ambulance, but we do not live in an ideal world. Paramedics do a fantastic job, as usual for better journalism, you use the example of the bad and ignore the example of the good.
Police Officer.
Norfolk.

I believe that the reason that the NHS gets away with sending Paramedics out to practice on so little training has a feminist link. Because it is predominantly a woman's profession, nurses put up with a 3-year training on a bursary of around 5,000. Paramedics on the other hand is predominantly a male profession and I believe that they would not be prepared to take extended training with such little financial incentive
Kerry Hullett
Hayling Island

My son was seriously injured with head and chest injuries, he was taken to Rugby St Cross where the anaethestist sedated and intubated him incorrectly, he was then transferred to Walsgrave Hospital (Coventry) they resuscitated him on the way across. He arrived at the hospital acutely hypoxic. At no time did anyone suggest that the paramedic flying squad from Birmingham be called out. I was not allowed to travel in the ambulance with my 2.5 year old son. This was only an ordinary ambulance not a paramedic and I strongly feel that had we had paramedic with us then Tom would not have received the brain damage from the hypoxia. We live on a major crossroads and dependent on which ambulance we get from Leicestershire or Warickshire is a matter of concern. It can take as long as 35 minutes to get help when we have dying people to take care of, yet we are supposed to be in the centre for emergencies.
Jain
Hinckley

Every business has people who are not capable of keeping up to standards. The Ambulance Service Association has those few paramedics featured, Panorama has the producer that did "Casualties".
Anon.

What happened to the excellent DRI A&E FLYING SQUAD? For many years the Derby's Ambulance Service tried to take this PUBLIC subscripted cum NHS service over. Everybody in Derbyshire, I'm sure, will want to know where it is now. An excellent service founded by John Collins who used Taxis to get to accidents in its early days. The Ambulance Service now has what appears to be an incompetent Paramedic Service whereas the Flying Squad was excellent. Any town would have been happy with the service AND WOULD PROVIDE funds for such an excellent service. The BBC (I think) did at least one profile on the service.
Brian Douglas
DERBY

The facts detailed in this evenings programme come as no great surprise to me. I am a qualified nurse in a moderately sized hospital.The scenarios mentioned this evening are merely the tip of the iceberg in what is rapidly becoming a lottery with patients lives. We are exposed to such practices on a daily basis and despite expressing concerns to managers we are encouraged to "keep an even keel". Staff are frequently intimidated into silencing their concerns at such situations lest complaints are brought. The truth is that bereaved families often see only the final result of any given scenario and as a consequence are left believing that all possible had been done for their relative. I for one am unable to work within such confines, and will be leaving the profession shortly. I would urge any relatives who feel more could have been done, to pursue the matter further - it won't bring back their relative but it may well prevent another family going through a similar experience.
Mrs Gelertis
Wales

I notice from your programme that no mention of the London Ambulance Service was made. When you make a programme referring to "paramedics" you must realise that you tar everyone with the same brush. I notice that you do not have any Doctor's from the top London Hospitals or any top anaesthetists talking - perhaps you should justify. I found your documentary very behind the times - I have been studying for a degree in paramedic science for the past two years - I don't consider that 6 weeks training! Perhaps you would like to interview me?
Jeannette Yeoell
Purley

Having watched your programme tonight I feel that it was biased, and your reporter failed to identify the successful outcomes from severely traumatised and cardiac related cases. It was also interesting to note that all of the reports concentrated on the midlands and north England. Surely the programme should have covered all of the U.K. to give a better representation on the training paramedics undertake. Ambulance technicians are not just drivers with a first aid certificate. They undertake an intensive training course and have to complete an N.V.Q competency based portfolio on all aspects of ambulance emergency aid.
John Nicholls
Colchester

I enjoyed your programme very much. It was, as they would say, an eye opener. You highlighted something that has been spoken about in ambulance stations for years. The question of drug protocols in different counties. Why are they different? In the South or be it the North you should be entitled to any drug available that could help to save your life. You shouldn't have to worry about living in the wrong county. However it must be pointed out that doctors decide upon these protocols so is it fair to criticise the Paramedic?
Nick Black
Kingston

Outstanding ! You've managed to totally humiliate - and undermine all of the Nations Pre Hospital Emergency crews in just 40 minutes. Mr Rose well done. I'm really looking forward to my next 12 hours duty, and there was I thinking I did a worthwhile job - hell, just goes to show how wrong a person can be. After all I'm only a driver with first aid knowledge! Once again thanks
Simon Moorwood
Poole

My father is an ambulance technician in the West Midlands service. What I think your programme did not emphasise or even take into account is the constant risk these life savers put their own lives in to save ours. I hear about how abuse is always hailed at him how he is threatened, this was not mentioned tonight. A colleague of his was assaulted the other week and is still not fully recovered, an ambulance was stolen and set fire to, I think one of these ambulances cost \'a335,000 a lot of money which could of been saved. If you had to live with the stress of the thought of your father been attacked for doing the right thing and helping someone then I imagine the programme may not of been so critical of them. Several times the BBC has asked my father to take part in the 999 series, and each time he has declined this invitation stating he is only doing his job and that he should not receive unnecessary praise. So maybe next time my father or one of his colleagues is attacked or threatened it will be due to the fact someone has watched your programme and feels no trust for them.
Czes Damyon Mowinski
Coventry

I feel that difficulties arose in the Ambulance service when it split into trusts. Each trust responsible for its own budget and spending. Training, equipment and manpower had to be managed very carefully and savings constantly sought. A national agreed DRUGS and invasive techniques protocol should be agreed upon, and not as is at the present, a system that clinical advisory groups of each trust has to agree upon and sanction. A national training school could be set up in conjunction with the fire brigade utilising their training facility at Moreton in the Marsh. The ambulance service have to work alongside the fire service, so why not train with them. Why close Moreton in the Marsh, it is purpose built for the training of the emergency services.
S Clifton
Hereford

This programme had me shouting aloud at the screen more than any programme I can remember for a long time. Surely the whole point that came out here was that in any profession there are those that go through the motions and take the money. But the vast majority are dedicated to their jobs and take great pride in doing it to the very best of their abilities. I was taught that the ambulance service is a vital link in the survival chain, listening to some of the knockers one could be led to believe that the ambulance is now a portable operating theatre.
Pat Halpin
Grays, Essex

I actually predicted this programme a few years ago, just when the media was beginning to "hype up" paramedics. A term I hasten to add that my particular service (then Cornwall, now Westcountry, - incorporating Devon and Somerset) said from the onset was an Americanism and we were not paramedics as defined in America, but extended trained ambulance persons.This programme I found insulting to me personally as a paramedic, and just increases my distrust of the media "build us up, then watch us fall" springs to mind. The man representing me from the ASA was not given a fair hearing, probably the full explanations to your questions ending up on the film cutting room floor!
Anon
Cornwall

I found your programme very interesting - I'm a specialist registrar in Accident and Emergency Medicine, currently seconded to do intensive care & research. I'm surprised that you didn't ask an accident and emergency specialist to comment on your programme. We have more contact with paramedics than any other speciality and are therefore in a unique position to judge their performance. Firstly, there is more room for improved training and A&E should take the lead in this in assisting the ambulance service - we have a lot to offer. However I disagree with the comments of Doctor Charles Deakin regarding airway control. It should be possible in the vast majority of cases to maintain a patient's airway with simple basic measures such as oral airways and 'jaw thrust' rather than having to result to (time-consuming and risky) intubation, these patients should then be brought immediately to a well lit A&E where they can be more safely intubated. In some cases though, I think that paramedics have done amazingly well to intubate patients trapped at scene etc and have surely saved lives by doing so. I think that the programme raised important issues but I think that paramedics on the whole do a good job - I have personally seen many patients whose lives have been saved and perhaps this should have been acknowledged. The tragic cases illustrated show that there is room for improvement but my overwhelming experience is that most paramedics are very motivated to learn.
Dr Francis Andrews FFAEM Lecturer in Intensive Care, Liverpool
Prescot, Merseyside

Your programme on tonight's Panorama programme did nothing to inform the public of the many thousands of lives saved by the dedicated members of the paramedics of this country.. Your programme highlighted difficulties in the mainly rural areas of Great Britain. I can personally assure all members of the public that 99% of Great Britain's Paramedic membership WILL save your life. The remaining 1% will have the whistle blown on them, as illustrated in your programme,so as to maintain their pride in the work they have been trained to do. I am a State Registered Nurse and would be the first person to call on the Paramedics in the event of a crisis. Their Knowledge in prioritising life threatening situations is second to none when it comes to administering "First Aid". Lets have some praise for these underpaid and underfunded members of this elite force. They are the cinderella of the 999 services and are always the last to be thanked for saving a life.
Linda Williams
West Molesey Surrey

My brother is a paramedic. He has spent the greater part of his adult life as (in his own words) a 'glorified taxi driver', ferrying us and our loved ones, in whatever state of personal distress or decay, between various locations. He has comforted the elderly and joked with the young. He works 12 hour shifts, whatever the weather, yet somehow manages to enjoy what he does and to talk proudly about the service he and his colleagues provide. Oh, and he saves lives. Day and night. For this we, as a society, deem him worthy of 16,000 a year basic + overtime. As with many other areas of our society, I'm afraid we get what we pay for. Sometimes we get a bargain, sometimes we are disappointed. Until we learn to pay good money for the things in life that really matter, we have only ourselves to blame. What use to you is a TV producer when you're lying, in several expensively manicured pieces, on the cold tarmac?
Nick Mandeville
London

Having just watched your programme "Casualties" on TV, I don't think I have ever got so angry in my life. I am one of your 6 week trained paramedics and not once did you mention the weeks, months of study you have to cover before you even consider going to the college, also not once did you mention the Scottish Ambulance Service but as usual you only concentrated on the English service, silly me thinking that Scotland was part of the UK.
Alison Fairfield
Alness

Having just watched "Casualties" I must say that I am appalled by what I can only describe as an ill informed and sensationalistic programme. As a working Ambulance Technician I found the reporter's comment about Technicians being nothing more than "drivers with a first aid qualification" very deeply offensive. I suggest that you research this subject more thoroughly before you decide to make another similar programme and would also suggest that you have made my job and that of hundreds more like me across the country so much more difficult as the back-lash from the public by way of lost confidence in our service is likely to be huge. I am horrified that you saw fit to broadcast such a poorly researched and frankly damning report on a programme such as Panorama. I would have expected better from the BBC. I would also hope that in the near future due to an overwhelming response similar to my own you will be forced to apologise to some degree to all of the active Ambulance staff across the UK for what I see as a terrible slander on their ability and Professionalism.
H Isaac
Bridgend

The header on this site called Panorama a "flagship investigative current affairs programme", it seemed more like a hwitch-hunt to me. We, my husband and I, are great supporters of the BBC but tonight we both felt deeply shocked at the standard of this show, we felt as though it were more like a cable programme. Do not misjudge us, we feel deeply sorry for the families involved. They have lost loved ones. I work in A&E frequently and have deep respect for our ambulance crews. This does not bias my views. The "reporter" in this programme however frequently did not allow those who he was interviewing to have their say, the technical information was inaccurate and he also misquoted statements. We frequently watch this programme but tonight it seemed as though it was used as an excuse for the reporter to voice his own opinions, as opposed to being a piece of "investigative current affairs".
Mrs. T. Borland
Cumbernauld, Scotland

It was a deeply disturbing experience to watch Panorama tonight. When my husband was taken by ambulance with a heart attack I had every confidence. On that occasion everything ended well, but after tonight my confidence in the ambulance service has disappeared. Why cannot all the different areas run with the same rules? Why can't every ambulance service train their medics to use the latest medicines and methods? It just seems crazy that a country like Britain with all its fantastic medication has to put up with the lack of training for these men, who we rely upon in an emergency. Why do we put up with it? They need at least as much training as nurses, surely?
SMP
STOCKPORT

I have been in the London Ambulance Service for 14 years and a Technician for 10 years of that. I strongly object to be called a driver who administers first aid. I suggest your research people get their facts straight. Our Technicians administer life saving drugs as well as Paramedics. We also have to put up with physical and verbal abuse on a daily basis. Don't you think we are under enough pressure without a programme like yours discrediting us and leaving us open for more abuse by the general public.
Andrew Goldfinch
Hayes

I have just watched the most biased and one sided Panorama programme ever seen. It was a very poor representation of the facts. I accept that mistakes are sometimes made and unfortunately in this job they can be fatal. However you have just shown four incidents where paramedics have been totally unprofessional and no one condones that. I have been on the emergency side of the ambulance service for approximately six months. This I hasten to add is in fact after one week of basic first aid, followed by six weeks intensive classroom theory, followed by three weeks driving, followed by five weeks practical working with a paramedic work based trainer. I will have to spend the next year submitting essays on every medical subject concerning pre hospital care along with full written reports of the majority of incidents that I deal with. I will then have to submit a portfolio for assessment and then and only then if it comes up to the required standard will I become a qualified technician. I think you will agree that is a lot of training for a "driver with first aid".
Nick Cox
Sheffield

I think your reporters, editors and the rest of the team do a great job uncovering the truth for the general public. Your show really opened my eyes. How long did the government think they could keep information like this from us? It's shows like yours that spur us all to demand change in the system. My heart goes out to Mrs Turnbull, Leicestershire, and her family, whos father died through paramedic negligence. Indeed I feel for all of the people who have lost a loved one through this basic failing in the Health Service. Keep up the good work, and don't spare any expense to stop the injustice in this world.
Mr Dempster
Leicester

It appears that the programme has neglected to highlight the work of the Ambulance Service Associations National Clinical Effectiveness Project which is directed by its Clinical Effectiveness Committee jointly with the Joint Royal Colleges Ambulance Liaison Committee. The work of the committee and the project is to reduce the variation in practice and outcome through the promotion of clinically effective and evidence based practice collated from all UK ambulance services. The project is funded by and works closely with the National Institute for Clinical Excellence.
Stuart Nicholls
Ashford

Excellent, just the sort of programme that shows how good the BBC can be when it puts it's mind to it. It was frightening to see how bad the service is and cut through the hype and spin that is forced down our throats these days.
Gary Jameson
Ealing

Excellent programme that was very worrying , I could not believe the lack of training that the paramedics got. The stories about the lack of caring was outrageous especially with they with the old man with the heart attack and even worse about the young girl at the swimming pool. Even a non medical person would have tried all they could for a young person. Is the paramedic training in Scotland better or worse?
Jamieson Shearer
Huntly

Great programme. The problem is that people see Casualty and think they are Gods. We are letting them down by not training them to the level needed. Why is the Ambulance service County based? this is a NATIONAL service. Don't leave it there do a follow up programme & if that pompous arrogant man from the Ambulance service is still in a job then you will know that you have got nowhere
Geoff Weaver
Chipping Campden

To become a Paramedic you first have to pass as a Technician and do this for 2 years.The training for this is 6 weeks basic ambulance skills and a 2 week driving course.To become a Paramedic you go through a 4 week training course and 4 weeks in hospital under assessment by doctors. From then on we are tested every year to make sure our skills are up to date.In a 3 year period I have to sit 5 exams, who else in the health service does this- Answer - no one!!! The Ambulance service like all the N.H.S is under-funded and there is not enough vehicles on the road.Response times will therefore be down. This program will have the effect of the ambulance service losing public faith and might stop people ringing for us.If this costs lives I hope you can sleep and live with yourselves. If you were in a road accident or in need of medical help who would you ring? I suggest you make your own way to hospital as we are no good in your eyes.
A Paramedic
Manchester

This was another excellent "eye-opener" report. It's beyond belief that UK paramedics are on the road with only 6 weeks training, where in the USA it's 2 years. Also there is no common standard of skills and drugs and equipment held, across the UK. This country needs to get it's act together, and get up to an acceptable standard of service, to mirror other top European countries and the USA. Where's the governments action ? in an area where we need it ?, it's ok. to spend millions on a large tent in London, what about basics ?
John Cook
Felixstowe

Astonishing. Like many people I thought that the paramedics were the most highly trained members of the ambulance service and they, in effect, brought the casualty department to the roadside. Your program showed that trust and confidence to be misplaced. The public need to know what standard our county ambulance staff come up to, what we can expect and not expect from our ambulance service. We need to know this in advance of when we actually need their support - not during an investigation after a mistake. Good Programme.
Stephen Poulton
Bury St Edmunds

Tabloid television at its worst, which I watched with growing distaste and anger. Where was objective criticism? Where was disinterested analysis? Where was a desire to get to the real truth, the real facts, the real issues? The whole programme was cheap and nasty. The reconstruction's were ridiculous. The interviews of victims, always in pairs, artistically in and out of focus, shocking. There are no doubt problems with the Ambulance Service, poor paramedics and the usual issues of an under funded health care system. Families who have suffered loss deserve our sympathy. But such poor TV will not help us understand them, or begin to tackle them: it clouds the issues and can therefore only make things worse.
Gareth Baynham-Hughes
London

Isn't it time that the Government listened to the people, having lost my husband to the incompetence of the NHS five years ago, and having watched my son ill last year and not believed by a local consultant. How much more are we, the British people, supposed to take having paid for the NHS all of our lives, and in my late husbands case having fought in the Burma campaign - was it really worth it?
Mrs Anna Cottag
Clacton-On-Sea, Essex

The statement about technicians being only drivers is totally misleading to the general public. These men / women are dedicated professionals who give many hours of their own time not listed as training time to extend their own personal knowledge and skills. Th Scottish ambulance service gives very high standards of training to their staff and also encourage the individual to continue with their own studies. In an ideal world funding would be available to them for extra training but at the end of the day it is down to the individual to put the effort in and become the best you can for your patients. I feel hurt and angry knowing the time and care that not only I as an individual but that my station as a whole, gives to our patients and the extra training we do on station and in our own time to the best that is humanly possible. We also have an excellent working relationship with the consultants who we deal with daily and I know would be the first to criticise any of our team if we failed to give our patients the optimum care available
Anon

I agree with your programme that 6 weeks training is not sufficient for paramedics. Are you aware that Sheffield University's Dept. of Anaesthesia runs a three year degree course in Paramedical Sciences at the end of which the student becomes a qualified paramedic subject to rigourous assessment? This course incorporates both practical and academic elements. This course is now in it's fourth year. I would also suggest that your reporter was irresponsible in saying that it would take "only a day" to learn how to use Frusemide. People who have only six weeks training will obviously not have the relevant pharmacological or physiological knowledge to safely administer this drug, especially not after "a day's training".
Anne Hart
Sheffield

I would like to say that your programme had a disturbing insight into the horrific truth about paramedic training. What your programme didn't show were the many successful case that the paramedics deal with, or the abuse and injuries that the paramedics have to endure. I am a first aider and have worked with and been an observer with ambulance crews and see the good work that they do. They shouldn't be left open to blanket criticism, especially since they do a lot of good. Yes they can make mistakes and your programme highlighted these. The people that should be criticised are the chief executives who waste money on desks and filing cabinets rather than new equipment, drugs and training! The other worrying factor is what about Scotland? Did your programme include it in its statistics, the DOH site listed on your page certainly doesn't!
Mike
Scotland

I'm absolutely amazed at the contents of the programme tonight. I, like most of the population, would have thought it was absolutely necessary to have a period of training at least commensurate with that of nursing staff. What ARE we doing spending millions of pounds constructing a Millennium Dome and letting off thousands of pounds worth of fireworks to "celebrate" a fraction of a second of time, when so much could be done for EVERY person in this country?
Martin Fletcher
Reigate

A very well presented programme which I believe provided an extremely worrying insight into the level of training and proficiency which paramedics possess. Some of the case studies chosen should I think have resulted in immediate dismissal of the persons concerned. From the interviews with the public the general perception is that paramedics are highly trained and expert at treatment of trauma. In actual fact it would appear that it is very much a matter of luck as to whether you may have a more than even chance of survival. The present situation should not be allowed to continue. Congratulations to the team who through this investigative journalism appear to have had an immediate effect in jolting the authorities into action. This would seem to be the only way to get vitally important things done these days.
Mr Philip Cooke
Seaford E. Sussex

I resent being called an ambulance driver with only first aid skills by a consultant surgeon who would probably be lost outside his operating theatre. I am saddened that Panorama decided to screen a report in such a biased and confrontative manner towards the ambulance profession, who's members in the main are dedicated caring people. I do not think that this report has done any justice to the majority of paramedics and technicians who do their jobs properly every day. Maybe you should start investigating the shortcuts and numbers of patients killed by doctors every day through negligence or just downright incompetence? All this programme has done is to alienate and promote distrust of paramedics to the general public. Naturally there are always bad apples in every barrel, as in the three cases highlighted in the programme, but the majority are professionals. Admittedly bad management must be considered, but to have a bash when moral is at its lowest amongst the service as a whole is out of order.
Bernard Fox (EMT. F.A.Inst.)
Leicester

The part that interests myself is that of the ASA trying to gain national registration. I myself am a Senior Operating Department Practitioner. During my career I have helped many trainee paramedics to gain experience in putting up drips on patients and and maintaining airways, but like the paramedics we as a profession that is nationally registered. Things must change and the public be made more aware of all healthcare workers and what they do. If you ask people in hospitals "what is an ODP"? A High percentage would not know what they do,but ask any anaesthetist if he/she would administer a general anaesthetic without the skilled help of a ODA/ODP and the answer would be no. We need to educate people more so they can understand more.
Paul Anthony Holt
Morden,Surrey.

I have just watched your programme on the ambulance service with utter shock & horror. Like most people in this country we believed this service to be very different from the one just screened by Panorama. The arrogance, complacency and little grasp of the situation clearly shown by one Chief Executive of a poor provider of an ambulance service, coupled with the vice president! of the Ambulance Association against another Chief Executive offering a vastly improved service provider appears to be as big as the Grand canyon. As a result of your programme I will now lobby my local MP, as I hope others will, to vastly improve the ambulance service to at least a level resembling Casualty!. Thank you Panorama, as a result of your excellent albeit horror programme we will be better prepared for the future.
Brian Gilroy\
Thornbury, Bristol

An interesting program and controversial as always. As a paramedic I feel you did little to portray the work we do, often under difficult conditions. I agree on the regional training/clinical protocol divide - we have a national training organisation but each trust does its own thing. We are lucky here and can provide most of the drugs/skills mentioned in your program and some. The training can be compared to an apprenticeship, we do our basic training, followed by a years work based competency followed by a further year prior to starting paramedic training. Following classroom and hospital training blocks, its a further 6 months work based competency, and we re-qualify every 3 years.
P.Mitchell
Newbury. Berkshire

I feel absolutely dismayed that the BBC has broadcast such misleading and damning information on our nation's Paramedics. The general public now believes they are receiving emergency care from incompetent, ignorant ambulance drivers, who have little more training than first aiders. HOW WRONG. To suggest that Paramedics are let loose on the public after 6 weeks training is sheer fantasy. In 40 minutes you have severely damaged the morale of a group of professionals who work under extreme and stressful circumstances, for very little reward. I only hope the general public will see through this sensationalised and biased reporting.
JOANNE CLAPPERTON
NORTH YORKSHIRE

Firstly may we congratulate you on producing a very negative and damaging programme. As paramedics we are confronted with terrible sights, highly charged emotional situations not to mention the physical and verbal abuse that is becoming a daily occurrence and an increasing number of inappropriate calls that results in delayed response times to real emergencies. Our training is far greater than the 4 weeks that you mentioned, is continuous throughout our working life and constantly updated. Hopefully your programme will not have deterred any person from ringing an ambulance in an emergency possibly resulting in loss of life.
A.S.M
West Midlands

I am a paramedic and feel totally humiliated and degraded by your programme. The very sad case's you reported tonight in which people died were not due to the training given to Paramedics, but due to ambulance crews who were grossly negligent and incompetent, and to label all ambulance Technicians and Paramedics the same is deeply offensive. To publicly belittle Technicians by calling them 'drivers with first aid skills' is degrading to all my colleagues up and down the country. We have all had to go through extensive training both in school and in hospital. How many first aiders can defibrillate, administer Oxygen, know when Entenox is indicated or contra indicated. If your supposed to be objective why did your report give such a one sided view, surely you could have interviewed any number of people who's lives have been saved as a direct result of Paramedic and Technician treatment. Thank you Mr Rose for giving us a really good kick in the teeth.
A Paramedic

Since I did my Paramedic training in early 1993, I have on numerous occasions stated to both work colleagues, training officers & managers that I felt our training to be lacking. This can be highlighted by my numerous visits to the U.S.A. in the last 10 years - where I have done "ride alongs" with their Paramedics. Through the friends that I have made out there & the discussions I've had with them, it has become even more apparent how lacking our training is compared to theirs. I have gained the impression that in the early 90's the Government have jumped on the band wagon in respect of the word "Paramedic" without the having the necessary insight & thought as to what the word actually represents and how best that word can be served. I have always found it strange that although the actual Paramedic course is a national one we as individual Counties still maintain our own protocols and individual practices. I cannot speak for Europe, however I believe that we should look to the U.S.A and Australia, to utilise the valuable experience they have had in their development of their Pre hospital care, to develop our "best practice". After all the majority of our Pre-hospital care literature is North American based. I was disappointed, however that the programme took such a negative and biased approach to such a large issue. There are many positive actions being taken by these Paramedics and Technicians.
Anon
South West

Good grief. Hang on a minute, am I a biased Paramedic from Northern Ireland or am I right in thinking I've just witnessed an entire service being rubbished by a hugely important, widely respected, current affairs program on the bases of some of the services' poor staff decisions? Are their no bad reporters? How much training does it take to produce that much controversial television around three or four abysmal ambulance crews?
John Wright
Holywood, Co.Down

I am a Member of the Council for the Professions Supplementary to Medicine. The viewers of your Panorama program of the 17th January should know that I was led to believe, prior to the admission of the Paramedics to Council, that the training and expertise of Paramedics to be registered with Council were commensurate with the standard of training and expertise of the other professions registered with Council. Generally these professions have a three years full-time training at or approximating degree level. Your viewers should also be aware that the Government plans in the near future to abolish the Council for the Professions Supplementary to Medicine and its Boards and to replace it with a larger Council for all the supplementary profession,, without uni-professional Boards to regulate each profession. I predict that these new arrangements far from enhancing public protection and improving the standards of regulation and training of the professions will prove to be an overlarge and bureaucratic paper tiger, a convenient body to take the blame in future for any failure of the NHS Trusts and the Government to improve standards. Currently the statutory Board of each profession is able within the limits of the current legislation to exercise considerable control over the training and discipline of registrants. In future these Boards will no longer exist and with them will go public protection and responsibility for training and standards. I suggest Panorama revisit this topic in three years time to see just how little progress will have been made. A.Ramon Ariori Member of the Council for the Professions Supplementary to Medicine Chairman of the Chiropodists Board.
Mr A.Ramon Ariori
Colchester

I was a contributor to the Panorama programme and consider that the Producer and David Rose produced a first class programme which allowed the public an insight to the emergency ambulance services on which they depend in the event of a life threatening emergency. Clearly many paramedic and technicians saw the programme as an affront to their professional standing and capabilities. We cannot refute the statement that ambulance technicians receive driving and advanced first aid training over 9 weeks (5 weeks traing, one week of assessments and 3 weeks emergency driving) and that paramedics receive 4 weeks theorectical training followed by 4 weeks hospital experience. Such basic training is rightly considered to be inadequate by any sensible Chief Executive of any Ambulance Service and by any honest paramedic or technician. That is not to deny that all ambulance staff carry out a good deal of private study and gain their most valuable experience "on the road." David Rose and ! ! the Panorama team aimed to show both the inadequacy of the training and the poor systems in which ambulance paramedics are required to operate. Systems which are unable, in some cases to ensure that the emergency ambulance arrives speedily enough to maximise their life threatening skills. As an Ambulance Service Chief Executive I am full of praise for the skill of both paramedics and technicians for what they achieve despite the limited training. My UNISON Branch are constantly demanding more training. Unfortunately, the NHS makes no provision for ambulance service training and therefore vcry minimal funding is available. the programme highlioghted the variance in ambulance service response and clinical performance and subsequent outcomes which should not arise in a National Health Service. The improvements in Staffordshire have not only been ignored by colleagues in other Ambulance Services there have been deliberate attempts to deny the response figures and the clinica! ! l outcomes achieved. The programme has aired these problems and differences and I sincerely hope they remind those very highly paid colleagues that their role is to provide the best service to their patients their funding will allow. Their is no excuse for any Ambulance Service not achieving the same results as our service in Staffordshire. The staff are the same quality as we have in Staffordshire. They have a responsibility to follow and reciprocate good practice for the benefit of their public. Thank you Panorama for drawing the public's attention to a situation that has been allowed to drag on to long at too great a cost to many lives. For the general public but remember the Ambulance Service belongs to you and should meet your requirements.
R C Thayne
Stafford

I am a member of a team at De Montfort University, which has been commissioned by the Departments of Health for the UK (England, Scotland, Wales & N Ireland) to undertake a review of the case for and against the regulation of health care support workers and support workers working in health care settings. There have been proposals for setting up of a General Socal Care Council for social care support workers - what forms of regulation are most appropriate for health care support workers. The programme mentioned the Council for Professions supplementary to Medicine, which covers a variety of occupations: the review we are preparing will consider other job titles and those not covered by existing regulatory frameworks. We are holding a series of workshops on these issues, and would welcome feedback or attendance (which is free!) - please see our website for details: www.dmu.ac.uk/seacole e-mail: [email protected]
Dr Mark Johnson
Leicester

As the UKs newest Trade Union, we seek to represent the views of all Ambulance Service employees. The Panorama programme has raised a number of issues which are of very great concern to all Ambulance staff. Sadly, the programme whilst incisive and thought provoking in many ways, failed to present a balanced view of the Ambulance Service. It concentrated too much on the negative and not enough on the positive improvements which have taken place in the service over the last 10 years. Failure to mention that all Paramedics have to complete 1 year service as a Technician before they can enter the Paramedic training programme significantly failed to mention that Paramedics, unlike other NHS groups, including Doctors and Nurses are subject throughout their careers to Annual assessments; Post-proficiency courses every 2 1/2 years and full re-certification courses every 3 years. It also failed to put the distressing cases it highlighted into the context of the number of calls dealt with by UK Ambulance Services each year. The Ambulance Service Union fully supports the need highlighted in programme for uniformity of standards throughout the Country and for this to be funded centrally. Indeed, we would call for the debate to begin in earnest on the establishment of a National Ambulance Service, replacing the current practice of 36 competing fiefdoms. Paramedics want, and the public deserve an Ambulance Service which can match any other in the world.
Steve Rice
Liverpool

After watching the programme about Paramedics I feel I must write in utter disgust at the manner at which the programme was based and the complete lack of understanding that your reporters have on the subject of Pre-Hospital care. Did at any point throughout the filming of the programme the camera crew go out with an ambulance service and see exactly what it is like walking into a strangers house at 2:00 am faced with three highly abusive drunks and a 15 year old girl who has taken a chemists shop worth of pills, or watching someones life slip away as blood pours out of a knife wound to their neck? Paramedics and Technicians carry out a very hard job, that many Doctors and Nurses could not cope with because of the often traumatic nature of the accident, for example entrapment in a burning car. Perhaps an apology could be broadcast for this complete mis-representation of highly trained and experienced staff who carry out tasks many "first aiders" would find difficult or too traumatic to handle based on their short courses not involving actual real-life experiences.
Mr Andrew Black FR, Emergency Ambulance Technician.
Shrewsbury

This was one of the best documentaries I've seen in ages: to the point, fair, giving both sides of the "argument" chance to have their say. It reminded me of the very best "Panoramas" with which I grew up in UK in the late 1960s - I've been "away" from Panorama for too long, if this is their regular standard. Don't forget: if all was well in the paramedic service, there would have been no point in making the programme.
Stephen D'Arcy
Brussels

This programme distorted the facts and cases in true tabloid style with no regard for the consequences to the Ambulance Technicians and Paramedics who, despite high levels of training, skill and dedication, will have their actions and intentions questioned - possibly with disastrous results - because of ignorance generated by Mr. Rose's reporting. He maintained a bias bordering on fanaticism while suppressing any balance in the arguments, no doubt by withholding relevant information and by selective editing. There is a real point to be made about levels of training, relevant experience and when best to apply paramedical interventions but this programme chose to ignore a real investigation with balanced arguments and went straight for banner headline sensationalism.
ANON

I'm afraid that the comments on this web site reflect your programme. Some are perfectly justified, and some are extremely ill informed. I have worked in the Ambulance Service for 17 years. I have been an Instructor for 5 years, and am now a Clinical Manager. The thing I find amazing is that nobody has actually mentioned the fact that ambulance training is, and has been for a number of years, undertaken to a national standard. This standard is set by our awarding body, the Institute of Health & Care Development (IHCD). I'm afraid that it's the interpretation by local training centres, and quite often, the standard of instruction that causes the problems. If the national guidelines are followed, it should take at least 30 months to qualify as a paramedic (unless you have accredited prior learning such as a nursing background). Another problem is that there are no minimum national standards for recruitment and selection. I have been horrified by the standard of recruit I have seen in some ambulance services. The comments from the military chap about our recruitment standards in East Anglia are totally unjustified, and sound like 'sour grapes'. The vast majority of student places here go to outsiders, many of whom are RGNs or have degrees. On average, only 2 out of 12 'insiders' get posts, as they face stiff competition from outside. I fully support the introduction of a compulsory paramedic degree. My Service already provides a standard of Ambulance Technician and Paramedic education and training which far exceeds the national standards. Finally, poor practice is often the result of poor management, and poor supervision. Most crews work totally unsupervised, with no checks on the quality of care they deliver. Work based training, and clinical supervision should be compulsory throughout the country. I totally agree with Mr Thayne (CEO of Staffordshire). Managers need to get away from their desks and monitor the delivery of care. I would like to reassure my fellow citizens of Cambridge that if they dial 999, they will get a highly trained and responsible crew 99% of the time (well, nobody is perfect, not even Panorama).
Simon Butler Cambridge
Cambridge

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