My last couple of weeks at work haven’t had anything really out of the ordinary in them. It’s been a very ordinary run of chest pains, back pains, abdominal pains, breathing problems, bleeding, and passed-out drunk people. It’s left me thinking about impostor syndrome — something I come across both as a developer and now as a 999 call handler — and, more widely, about something I’m calling organisational self-importance syndrome: how the ambulance service often likes to think of itself as the people swooping in to save the day. It’s not the only kind of organisation guilty of that, but there’s something about being an emergency service that seems to give it that kind of air.

Impostor Syndrome

Impostor syndrome isn’t really what I’m talking about, but it’s the best name I’ve got for it. True impostor syndrome would be feeling that I don’t belong in the job or the environment that I’m working in — that’s not what this is. What I’m talking about is a quiet nagging voice asking if we’re really helping by doing what we do.

I’ve written before about how 999 isn’t great at dealing with mental health emergencies. That’s one area where we’re really not great at helping and I’d love to see us improve there, but it’s not the only one. One of the things we’re taught in training is that every call is the caller’s emergency — which is true almost without exception. Situations that are medically non-emergency can still be a major problem for the people going through them: abdominal and back pain are great examples, because they’re both usually not a medical emergency, but can still be debilitatingly painful and stop people from doing the things they normally would. Frequent callers are another one: frequent calls for the same thing with the same non-emergency outcome every time can be very frustrating for the service and the people dealing with it, but there are almost always reasons why people make frequent calls for the same thing.

I’m not the only one who finds these calls frustrating. The common refrain is “why are you calling us?”, but really the reason is pretty obvious: what else do you do? GP services are overworked and often slow; 111 can also be a slow process and isn’t actually very well-known, and if you go to A&E you’ll be sitting in a long queue because it’s not an emergency. Trouble is, there’s not much an ambulance can do for you: temporary pain relief, sure, but you’ll be waiting hours for them to get to you, and then they’ll just take you to A&E, where… you’ll be sitting in a long queue because it’s not an emergency.

I think how we deal with calls like these is one of the problems facing the ambulance service. At the moment (speaking only from my experience in my own service, here), we signpost these calls to 111. This often doesn’t go down well: “are you telling me this isn’t an emergency?” Well… yes: I’m not saying you don’t need medical help, but it’s not a medical emergency — but that doesn’t go down well. My current strategy is to explain that an emergency ambulance would not be the quickest way to get help, whereas 111 will be quicker, which seems to be working more of the time, but still isn’t perfect.

The wider question is whether we should remain an emergency service, or whether we should adapt to how the public are trying to use the service and expand to include non-emergency situations — effectively bringing as much of the hospital to the patient as possible. Our Advanced Paramedics in Urgent Care are a bit of an exploratory measure in that direction already: they can do a lot of the things a hospital can do, barring things like X-rays and scans which we just don’t have the kit for. If we’re expanding like that, how do we ensure we keep our capability to respond to emergency calls as quickly as we do? Are we going to expect call handlers to triage non-emergency situations in more detail to prioritise a non-emergency response in more detail? How do we deal with the funding and staffing issues all of that causes? Or do we continue to be emergency-only — in which case we need to review how we ensure non-emergency cases are sent to the correct care?

Organisational Self-Importance

This is a similar problem, but the same core issue. The ambulance service is generally well-liked and recognised as being good at what we do — but that can also result in organisational ego fairly easily. London is especially prone to this, being both the country’s capital and (as far as I’m aware) the biggest single ambulance service anywhere in the world (other major urban centres being served either by multiple or by private ambulance services).

Ego does us no good: yes, recognising where we do well is as important as recognising where we need to improve, but resting on the laurels of a hero complex risks stagnation and, ultimately, patients’ safety. We do try to recognise this and keep it at bay, with mixed success — working as an emergency responder seems to bring out either the best or the worst in people, and that’s mirrored in the organisation.

The service exists to help people in emergencies, and we’re generally very good at that; what we’re less good at is the non-emergency or less critical situations. Attitudes vary from those thinking they’re perfectly valid calls for help to those viewing non-emergency situations as beneath the ambulance service. There’s little direction on these from higher up in the organisation: sure, if it’s anything above a Category 5 then we’ll respond to it, but to some a Category 3 call is the same as any other, while to others it’s a patient who should be in a taxi to hospital. We could really do with some leadership and direction there.

Do we really help? There’s plenty of calls where we do — critical emergencies are our bread and butter and there’s no shortage of lives that have been saved by what we do — but is that all we want to be good for?