There were few positive conclusions to draw from last week’s commentary “Falling on a cold street” after the all too preventable death of a 47-year-old lady in South Wales in December.
When the chief executive of the local NHS trust said that “our staff share the same upset and frustrations as patients” one wonders if he’d forgotten that one of his patients had just died.
So instead of focusing on what went disastrously wrong for one family in South Wales on a single day, this week we’ll take a look at what went right for all families here in our Borough all year long.
A time to act
If any one thing stands out in resolving a true medical emergency, it’s the “golden time”. This is the interval between a serious injury or medical incident and the patient receiving medical treatment to prevent death.
Initially said to be based on the idea of the golden hour described by French physicians in World War 1, the term came into use in the mid 1970’s and has been argued about and investigated frequently.
In essence the golden time is a short period which varies from person to person and incident to incident. It can be as short as 2 or 3 minutes for a heart attack; 4 to 10 minutes for stopped breathing; or 15 to 100 minutes for serious bleeding from e.g. a road traffic accident.
Acting in time
However whether it’s a minute or an hour, there’s little dispute that the quicker the help arrives the better the outcome for the person involved.
The UK’s Ambulance Service has evolved over the past 50 years to cope with more types of medical issues. What used to be an adapted lorry back when the NHS was created, with two strong blokes and a stretcher to lift the person in and then race them to hospital, has long since gone.
A surgeon from 1947 would be astonished by the modern ambulance – a hospital in miniature with trained women and men who bring medical assistance to a person in distress wherever they are.
And while there might be an argument for having an ambulance on every street, not only would that be a tad cluttersome, but we couldn’t afford it either.
Therefore ambulances are stationed in chosen locations so as to give the best service that is both practical and affordable. As well as double crewed ambulances for getting the most seriously injured cases to hospital, there’s also single crewed rapid response cars with trained paramedics to get treatment to the patient quickly.
Regional Organisation
Ambulances around England are provided and managed by one of ten NHS Ambulance Trusts and in our borough, it’s the South Central Ambulance Service (SCAS).
But in addition to the SCAS managed cars and ambulances, they’ve introduced volunteer emergency medical services within the community in the form of teams of Community First Responders (CFRs).
As with all first responders in the UK, our CFRs are unpaid members of the public who volunteer their time and are trained by the NHS to make life-saving interventions.
CFRs are despatched centrally by the same 999 call centres at Bicester (N) and Otterbourne (S) who despatch SCAS ambulances and rapid response cars around the Berkshire, Hampshire, Buckinghamshire, Oxfordshire and Milton Keynes areas.
Our immediate area’s CFR network have bases in Swallowfield, Burghfield, Shinfield, Whitley, Barkham / Arborfield, Woodley, Hurst, Twyford and two in and around Wokingham town.
Community Action
The leader of the Swallowfield CFR team kindly agreed to be interviewed to help me learn more about the role of CFRs in the community and what they do. Much of this commentary results from his knowledge, wisdom and patience in guiding me through things.
It all starts with local people who volunteer their time.
Training is provided in CPR and defibrillation (to treat heart attacks), unblocking airways, and measuring temperature, blood pressure, blood oxygen and glucose levels at the scene. There’s also more specialised training in the use of lifting equipment in the case of falls, providing medical oxygen for breathing difficulties, Entonox for pain relief or aspirin as an anti-coagulant.
The work in the classroom is followed by practical training – going out with a double crewed ambulance or with a rapid response vehicle – during which time the trainee gets to learn how to cope with the patient and members of the public nearby and put their classroom learning to practical use. They’re keen to do more and they learn skills from the crews when circumstances permit.
The amount of time and number of call-outs varies from volunteer to volunteer, but 20 hours a month is a good average, being ‘on-call’ for 26 – 30 days per year. Of these, the CFR may get no calls on some days, but then might get up to 8 calls in a single shift. Because the CFRs are volunteers, they can choose their own shift length before handing over to a colleague in the same CFR group.
At the heart of the CFR group is the community vehicle and equipment. All bought and paid for locally. And that means attending hundreds and hundreds of fund raising events at fetes, schools and village halls. They depend on our donations that much.
Personal equipment such as branded shirts, safety boots, jackets, fluorescent vests etc are most often purchased by the CFR themselves.
The Last Word
I was at first surprised at what the volunteers take on, then simply impressed with what they’ve achieved. It was encouraging to learn the Swallowfield group won the Queen’s Award for Voluntary Service in 2017 and are in good company with others.
And whether you knew it or not, recent metrics show that in November CFRs attended an astonishing 20% of every single Category 1 call that was made in Berkshire. Across the year they provided essential comfort and assistance on hundreds of occasions – saving at least one life in the process. That’s the difference the local CFRs make to us.
However, I learned from other sources that SCAS have been changing their approach on CFRs recently and look forward to discovering how this will help them develop their brilliant service.
