'Blue lights and sirens; A Paramedic's perspective of caring for older people' - an interesting piece to read

I read a piece by a paramedic, Duncan Robertson, yesterday - he pointed at it within Twitter. The piece 'Blue lights and sirens; A Paramedic's perspective of caring for older people' is at:

https://britishgeriatricssociety.wordpress.com/2016/07/20/blue-lights-and-sirens-a-paramedics-perspective-of-caring-for-older-people/

I joined Twitter a few weeks ago - trying to track down, and engage with, some 999 paramedics on Twitter is one of my current aims.

Duncan writes about the day-to-day life of paramedics, and he points out that the population - in other words the 'service users' - is becoming increasingly elderly. He also raises the question of how can these elderly patients best be served by 999: this question is hardly novel, because it is widely understood that taking 'the dying elderly' from home to hospital, is very often not a good thing to do. Correctly he stresses education. training and what I will call 'integration'.

I will slightly digress from 'my main thrust', and briefly discuss this, which he writes in his paper:

'... We are their [the/our patients'] advocates'

With whom, do 999 paramedics 'advocate' ?

You can't advocate 'with yourself' - advocating 'against the patient' seems to be a nonsense - so, who would the paramedics being 'advocating' against ?

The only other people present - unless 999 was called by a GP or nurse (and Duncan does state that 'Of the 1.15 m 999 calls, there were nearly five hundred thousand patients aged over 65 years old from which the top three reasons for calling 999 were calls by a fellow health care professional, following a fall, or from breathing difficulties') - will probably be family carers or relatives: I see the role of family carers and relatives as including 'advocating for the patient' if anybody is going to perform such 'advocacy' (in fact, I dislike this 'advocacy' concept: it is clearer to analyse behaviour in terms of decision-making, and 'advocacy' becomes essentially 'redundant' if you analyse decision-making correctly). The idea that paramedics 'are advocates against nurses and GPs' is interesting - but for Duncan to expand on, not me.

There is a really fundamental problem, with the interaction between family carers and 999 paramedics, when patients are terminally diagnosed. And in my view, the current attempts to supposedly improve end-of-life, such as 'ReSPECT', if anything are going to make the problem worse.

Put simply, family carers have been able to listen to the patient, and I believe that the rule for most family carers amounts to 'we should be doing what my dad wanted - if you are doing something I know my dad did not want, then you are doing something wrong'.

But the 999 Services, want to be 'led by a records trail'. A records trail 'controlled by the GP and the senior district nurses' - a records trail which deliberately excludes the signatures of family carers and relatives: and a records trail which can very easily be less up-to-date than is the understanding of the family carer who has been able to talk to the patient since the records were last updated.

A potentially huge, and fundamentally incompatible, conflict there !

See, for a rather detailed 'attack on ReSPECT', my piece at:

http://www.bmj.com/content/356/bmj.j876/rr-7

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