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Monday 17 January 2000
Reporter David Rose
Producer Kiran Soni

The reporter, David Rose, has written the following note dealing with the main criticisms that have been raised, about the programme Casualties.
Panorama reveals that shortcomings in the ambulance service are costing thousands of lives each year. We also discover huge regional discrepancies in the care paramedics provide, which means your chances of surviving a heart attack or a car crash may well depend on which county you happen to be in.

There is concern within the medical profession that the training for paramedics is inadequate. The standard classroom training for paramedics lasts only 6 weeks - much less than nurses.

After a short period attached to a hospital, paramedics then go out on the road - on probation- but required to administer vital treatments which a doctor would only be allowed to give after several years.

First on the scene - Paramedics need crucial judgement skills
The most crucial of all the skills paramedics need to learn is accurately to assess a critically ill patient. They have to be able to tell the difference between conditions which may have similar symptoms but require completely different treatments.

Incidents investigated by Panorama reveal that paramedics do make terrible misjudgements with fatal consequences.

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In one tragic case an ambulance was called out to a woman sprawled out on a street. The paramedic decided she was drunk, gave her a slap to bring her round and sent her home in a police car.

In fact the woman had been attacked, and two men are awaiting trial for her alleged murder. She died from head injuries a few hours later.

Kelly and Patrick Delaney
Her children Kelly and Patrick Delaney are devastated.

"She's gone through that attack, and then the people who've come to save her call her a drunk, slander and negligence - how can we ever live with that?" said Patrick.

It is not just poor training that is the problem. There is no consistency across the country about the types of lifesaving techniques paramedics can employ.

Victims of impact accidents like car crashes may sustain a punctured lung. This can lead to a life threatening build up of pressure in the chest cavity leaving the victim only minutes to live.

Needle Decompression
But the situation can be transformed if a relatively simple technique is employed quickly. A needle is inserted to release the build up of pressure in the chest cavity and the patient's condition rapidly improves.

Depending on where you suffer a punctured lung, your paramedic may or may not be allowed to use this procedure to save your life.

Regional variations in response times

Panorama also investigates why there is such a wide variation in ambulance response times - the time it takes them to reach a victim following the 999 call - across the country. The Department of Health has set demanding targets for improvement but most ambulance services are not coming close to meeting them.

Roger Thane. Chief Executive Staffordshire Ambulance Service
Staffordshire Ambulance Service is a notable exception and a model of good practice. Despite hard evidence of success in Staffordshire, Chief Executive Roger Thayne says he has been vilified by his peers, wrongly accused of fiddling his figures. He says he has felt like "public enemy number one of the ASA" at times.

I 've felt like public enemy number one of the ASA at times".

Roger Thane. Chief Exec. Staffs. Ambulance Service

But independent research has shown his system - which is based on having the right number of ambulances in the right place at the right time - is working.

Barry Johns, Vice President of the Ambulance Service Association admits to shortcomings in the ambulance service.
Not all ambulance services use best practice at the moment.

Barry Johns, Vice President ASA
Barry Johns also tells Panorama "Some services don't use certain skills, use certain drugs. Currently it's variable and I think it's that variability has been a strength, but also that strength has got to make sure that everybody has advantage to best practice"

The ASA is the body which oversees the 36 ambulance services that operate in the UK at a regional level and is responsible for promoting best practice within each service.

Related links:
Ambulance Service Association

Department of Health. Interactive regional map of ambulance emergency services.

Department of Health. Ambulance service emergency response times

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