Ambulance / EMS Documentaries - What is their value and impact?

Followers of all matters EMS have lately been spoilt for choice for fly on the wall type documentaries and insights into the role and day to day life of those working in the ambulance / EMS world.  The BBC broadcast series Ambulance and Paramedics on Scene, plus Ambulance Australia, Emergency, Paramedics, and various HEMS based programmes have given the public a realistic look into the goings on within the pre-hospital emergency care world.

Whilst these have invariably been promoted as offering an unprecedented insight into the pressures and dilemmas facing EMS personnel in their daily lives, the value of the content gathered is reliant on the level of investment in the production, and thus aspects such as the amount of time available for filming, along with the gargantuan task of obtaining the requisite permissions from patients and other interested parties to use the footage. 

Insiders will know that the very best examples of ambulance work, including compassion, technical and clinical skills and bravery often don’t get included in final productions, either due to the issue of permissions or due to the unfortunate outcome for some of those affected. These productions have so far had extremely high quality standards of production and some of the most difficult, grittiest stories have been captured in adverse conditions and may not have been seen as suitable for broadcast due to the technical quality. However, the public reaction to what they have been shown has been exceptionally positive, as reported in The Telegraph -"All human life was here. We witnessed birth, death and resurrection in the space of just two shifts.” Some of these shows have also managed to get across that emergency ambulance work can also be immensely frustrating, routine and mundane.

Of course the real thing is supplemented by many hospital based drama productions, some with a pre-hospital aspect, some of which portray such work with a degree of accuracy and occasionally, seemingly, political bias. So do these productions help to promote the work of the ambulance  / EMS world and does raising the profile of the work translate into a changes in public behaviour such as lower call rates for minor injury or aspects such as additional or better informed investment decisions by commissioners? 

Well, I’m not aware of any evidence as such, but these things are very positive in terms of staff morale and do assist to address concerns about the role being misunderstood, undervalued or underrepresented in comparison with other agencies and responders. They also lead to some generally good-humoured banter in mess rooms and on discussion boards. However, it would certainly be interesting to be able to evaluate these potential positives in a meaningful way.

One offering that I had overlooked was the BBC series Dom does America (available on the BBC iPlayer) in which the presenter spends 24 hours undertaking or working on the inside of some of the toughest jobs in America. In one episode, presenter Dom works on an ambulance with a paramedic and EMT crew in Austin, Texas.

No surprise that they have a busy shift, the continually rising workload of the ambulance / EMS around the world has been shown in every documentary, but the standout issue for Dom has been reported as “the harsh reality of the insurance system the US has.” This is probably true of anyone brought up in the ‘free at the point of care’ ethos of the NHS. For most of us in the UK, care based on the ability to pay or care dictated by the quality an insurance policy is invariably regarded as unpalatable. Conversely I have met US citizens who believe that any additional individual taxation to pay for universal health care is unpalatable, so opinions clearly differ.

Dom is quoted as having said that, “One paramedic is working on the victim and the other one is taking credit card details and insurance details.” “That makes you realise what the amazing system we have with our NHS where it’s care first and it's not about the money and making a profit.”

However, this was not the part of the story that interested me most. I’ve seen some correspondence on the subject of the use of 24-hour shifts in the US EMS. The 24-hour shift duration has been reported to have arisen from the Fire Department shift system, where the likelihood of multiple calls is very low and long periods on base are the norm. 

How this has become workable for the EMS is subject to some debate.

Many UK crews have reported fatigue and exhaustion on a 12-hour shift pattern, often with planned breaks (37.5 hour week). The US system shown in the documentary seemed to have no planned breaks and the crew could be driving to emergency calls 20 hours into a relentless shift. Of course whilst tiring, UK crews have so far generally very much resisted any move to return to historic 8 hour shifts, due to the advantages of time off that 12 hour shifts provide and how they can be used to extend periods of annual leave. From the employers’ standpoint of course, scheduling resources to meet patterns of emergency demand become easier with shorter shifts. It would be interesting to see a comparison of accidents rates, adverse events and near misses for staff on each of these shift patterns.

Personally, I would favour even greater access by documentary makers to the ambulance / EMS system. However, I would also like to see a comparison of systems in different countries and I would like to see specific aspects highlighted such as SORT / HART and other specialised teams, advanced care, and innovation. From my own perspective, I would also like to see a proper piece of journalism into the cost v call rates v impact of emergency services and include private providers and also look at the quality and value of care given at mass gatherings and major incidents. At the end of the day, I would suggest that whatever is offered needs to educate, inform, enlighten, influence and if possible, show the humanity and sense of humour present across the ambulance / EMS world.