CFRs are not trained in as much depth as ECAs, let alone paramedics. However, I feel that sometimes we let down patients because we cannot give them the care that they deserve, yet we could learn without too much of an issue. I live in a region of a 2-3.5 million people, within a conurbation of 2-3 million. OK, there are a few fields around us (it’s two main cities, some large towns and a scattering of villages with fields between) but essentially it’s urban.
Sometimes the professionals can take a fair while to get to a scene – the nearest one or two could already be on calls or there could be a major traffic holdup that even blue lights can’t get through (rare as that is) – and we need to do a bit more.
If CFRs were given further training, we could have a lot of the obs done before the professionals arrive. Sure, we won’t be carrying ECG machines (because most units couldn’t afford them) but there are other things.
For instance, I’ve been asked by paramedics to do the BM reading (after they’ve checked that I know what I’m doing) whilst they get on with other things. At one company I worked at, most First Aiders were trained in the use of Entonox, just in case a problem with severe pain came up whilst we had no nurse on shift (and shifts without a nurse were rare). As a CFR I can’t officially do either. However, these could benefit the patient.
Now, I’m very aware that not every CFR would wish to use these techniques. Some will be happy just to carry on with the skills they already have, and fair play to them. They/we are doing a good job.
However, for those of us who would like to go further, shouldn’t there be a possibility of doing so? We could deal with more cases thus often ensuring a faster response to a patient (and better times for our Ambulance Trust!). We’d also get more exprience – although my patch contains 50,000+ people, I can be on call for 12 hours and get ONE call (happened recently).
I know that not every CFR would be happy doing the extra, so I wouldn’t make it compulsory. We could have more than one grade of CFR, just as there are ECAs, Techs and Paramedics in the Ambulance Service.
I wouldn’t give us too many extra skills at first, just to see how things go. The Trust would also have to be careful as to how quickly they went along this route, and provide the relevant training. However, if the right people were picked, it would enhance patient care. Sure, we’d all like it if there was one ambulance for every 10 streets, but that isn’t going to happen.
You’d also have to pick the right people. I’d suggest a basic test and an interview to get on the course, with a rigorous but realistic exam at the end of it. However, I reckon the better CFRs would be well up to this. I can’t be the only CFR with a Science degree, and many have native intelligence anyway.
I’d definitely have two grades of CFR as well. Not every CFR would welcome the new skills or necessarily be able to do them. These people are still useful, as useful as we all are now. No, this advanced training would be an extra; you could have CFRs as now, and (say) AFRs – Advanced First Responders.
There should NOT be any reduction in manning levels within the Ambulance Service, though I can see this happening anyway in the near future as the public finances come under strain. CFRs are their to assist the service, not to replace it. We’d just be enhancing patient care and assisting our professional colleagues more.
(Incidentally, I’d like to say how great it is to address ECAs, Techs and Paramedics as colleagues. It’s a real priviledge – and I really mean that.)
Posted by ambulanceamateur on August 20, 2010 at 00:14
Whoops! I seem to have given two different populations for our region. Wrote the first one, realised I’d overestimated and then wrote something more accurate. Unfortunately, I didn’t delete the first bit, and now I’ve published I can’t alter it!?
Incidentally, I didn’t mean to imply that the whole 3 million are within my “travel-to-work” bit; that’s about 35-40,000 people.
Posted by EmilyT on August 20, 2010 at 17:09
I like the idea, even if it’s “just” taking someone more to the level of a (SJA) Advanced First Aider (First Aid + Gases + Defib). I’m sure you’ve done the whole “chain of survival” and Defib’s can be invaluable in giving people that little extra chance – it may not be something you’re knowingly sent to but it’s not often something is exactly as described once Chinese Whispers has had a hand in things! Also pain relief in the form of Entonox can help to massively calm down a casualty and keep their body under less stress until they can receive the more advanced care they may require.
Posted by Ambulance Amateur on August 20, 2010 at 20:50
We do carry defibs and O2, but are not allowed Entonox. Just recently we’ve been allowed to carry salbutamol for nebs, and I’ve already used it once.
Posted by Tessa on August 28, 2010 at 08:27
We used to be able to carry entonox but have just had it removed; IMO we haven’t had a coherent reason why from the Trust. We miss it badly – we didn’t use it very often (3% of our calls apparently) but when we did it made a huge amount of difference. Not having it has meant I have actually turned away some calls I would previously have gone to like small fractures; I hate going to a ?#nof knowing that I am qualified to give pain relief when I have one hat on but not qualified when I am acting as a CFR and am actually likely to need it!
I think having an advanced level is going to be crucial to keep experienced CFRs motivated – at the moment the only progression there is is to Team Leader and that is not the same thing at all.
Posted by ambulanceamateur on September 1, 2010 at 00:44
Hi Tessa,
In our Trust, CFRs are not allowed to attend if injury is the main complaint. We are only sent to illness – ideally MI and stroke, but “feeling lousy” will sometimes do! As the vast majority of us have FAW or more, that seems to be a waste.
We know we can’t replace the professionals – sometimes seeing the blue lights outside the window is SUCH a relief! However, we could do a lot more than we do at the moment.
I trained in entonox when I was with a very good manufacturing company I worked for. Each shift had a nurse, but sometimes she wasn’t with us because of meetings etc and the agency couldn’t supply a replacement. All First Aiders who wanted the training were given it. (That would be all of us then!) We were also trained in O2 and one or two other bits that don’t usually come within FAW, like defib.
I know that ambulance trusts are worried about liability and insurance, but if we’re properly trained, where is the problem?