Following the withdrawal of medicines from Staffordshire Ambulance First
Responders, a number are now considering their future with the service.
Michael Fabricant says: "I bitterly oppose this dumbing down of the
Staffordshire Ambulance Service. This is in direct contradiction to
promises made by Tony Blair to Staffordshire MPs and I have now tabled a
formal Parliamentary Question to the Prime Minister regarding this and
the removal of ResQPOD heart attack emergency equipment from our
ambulances." And today, Michael has been contacted by First Responders
and by the former Chief Executive of Staffordshire Ambulance Service.
Roger Thayne, former Chief Executive of the award winning Staffordshire
Ambulance Service has today told Michael Fabricant: "There is
absolutely no legal reason for banning any drugs from the list which
Ambulance Techs, CFRs and Health Care Workers are trained and allowed to
use. This is action taken against the advice of the Medicines and
Healthcare Products Regulation Agency who confirmed to the Trust in July
2006 that they could be used. Parliament was told that Staffordshire
Ambulance Service would remain a separate Trust. The Department of
Health ignored Parliament and has directed them to replace their
Directors with ones from West Midlands and work under West Midlands
direction. The result will be West Midlands performance standards and
therefore an increase in lives lost unnecessarily in Staffordshire."
Michael Fabricant says: "I agree."
And in a further development today, Cllr Frank Bartlett Chairman of
Whittington Staffordshire First Responders, has written the following
letter to the Acting Chief Executive of the Ambulance Service throwing
the future of the First Responders throughout Staffordshire into doubt:-
Thursday, October 19, 2006
Dear Mr. Catling
I write on behalf of Whittington Community First Responders to
acknowledge receipt and provide a personal response to your letter
withdrawing Atrovent, Diazepam Stesolid, GTN, Salbutamol, Pulmicort,
Midazolam, (Buccal) and Entonox from the medical armoury currently
available to CFR groups with immediate effect.
Their withdrawal leaves us unable to respond effectively to a neighbour
experiencing chest pain resulting from angina or cardiac infarction; a
child with croup; a person experiencing an epileptic episode or a life
threatening asthma attack, together without an inability to provide
effective pain relief in trauma situations. Such episodes provide a
major proportion of our responses.
Given a proven track record of effective interventions in such
situations by Staffordshire CFR groups over the years the withdrawal of
these drugs could well lead to loss of life and will certainly put us in
the totally unacceptable position of being tasked to life threatening
incidents with the knowledge and skills to intervene effectively, but
lacking the means to do so. This is not a position I could in conscience
I was not among those who opposed on principle the moves towards
combination into a regional service, preferring to believe assurances
that we would see a raising of the standard of service offered to the
highest level rather than a reduction to the lowest common denominator.
The changes that we have now seen and the context in which they occur
clearly make nonsense of such assurances.
A meeting will shortly be held to establish a Whittington CFR group
position and no doubt there will be a County level response, however I
believe that few will wish to continue given the limited role and
ability to respond that the new restrictions impose. We were enlisted,
trained and equipped by Staffordshire Ambulance Service to be in
position to respond in a meaningful and effective way to all medical
emergencies occurring in our locality. This is clearly no longer the
case. What a waste of the hundreds of hours of training, service and
fund raising freely given by members of the group and the wider local
community and what a tragedy for that community!
I go on to question:
* The assertion that the decision was made by Staffordshire;
* The basis of the legal advice on which the decision was made;
* The wider consequences to the service and elsewhere should the
decision not be rescinded.
Where the decision was made
Robert Lake, Chairman, Staffordshire Ambulance Service NHS Trust in his
e-mail of 18th October asserted that the withdrawal of the drugs
followed inevitably from advice from the Regional Strategic Health
"Geoff and I fully appreciate the consternation and,
indeed, anger felt by many of the CFRs on the issue of drug withdrawal.
However, on receiving the advice of the Regional SHA Pharmacists and the
SHA Chief Executive that CFRs are not covered, in law, to administer the
seven drugs in question, we had no option but to withdraw them."
The legal position
The above body however is not the regulatory authority on the
authorization of drug use. This role is undertaken at national level by
the Medicines and Healthcare Products Regulatory Agency.
In July of this year that body was supplied with a list of the drugs
available to Staffordshire CFR schemes and requested advice on the
legality of the situation.
Their reply asserts that Adrenaline and Glucagon are on the list of
parenteral medicines which may be administered by anyone for the purpose
of saving life in an emergency and goes on to say, "Medicines
legislation does not address the administration of non-parenteral
medicines so there is nothing to prevent CFRs administering the
remaining products listed in your letter."
Wider implications of the Regional Strategic Health Authority Advice
The advice would appear to be based upon an inappropriate application of
the Medicines Act of 1968. If that Act were to taken as the authority in
the matter, then the effect would be catastrophic not just for CFR
groups, but also the whole of the Ambulance Service and many other
organisations involved in healthcare. The Act very restrictively
describes those who may administer certain medicines and then goes on to
define a limited number of groups of people to whom exceptions apply.
Among these exceptions are paramedics but not technicians. It is thus
inescapable that the interpretation of the law currently being applied
to CFR groups, if correct, must also be applied to the technicians who
staff our ambulances and still have the full range of drugs available.
The ruling would also have to be applied to the many other caring
organisations such as schools with epileptic pupils who currently
administer either Diazepam or Midazolam.
In view of the advice from a more appropriate organisation than that on
whose advice the decision to withdraw the drugs was based, the wider
apparently unforeseen implications of the changes and the potentially
fatal reduction in the support we can offer to our community, I ask as a
matter of urgency that CFR groups’ ability to use the full range of
drugs referred to is restored pending a more considered, informed and
hopefully more consultative approach to the issue.
Cllr. Frank Bartlett
Chairman Whittington CFR