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Anything which has the ability to cause harm, loss of life or permanent disablement to someone or something is termed as a hazard. The likelihood that an individual may be harmed when in contact with a hazard is termed as risk. Identifying and evaluating the risks helps to overcome the hazards and associated risks which is done through risk assessment.
North East Ambulance Service NHS Foundation Trust (NEAS), is an organisation that provides National Health Service (NHS) ambulance services across various locations in North East England. Spread across an area of 3200 sq. miles, comprising Darlington, Tyne and Wear, County Durham, Northumberland, and Teesside, they provide two types of care services, namely scheduled and unscheduled, wherein the primary, they make arrangements for non-emergency patient transport within the vicinity, whereas in the latter, they respond to emergency calls.
Everybody needs a safe working environment. This can be accomplished through risk assessment. It determines various threats/hazards and their corresponding risks within an environment so that it can be monitored and controlled, thereby ensuring, that no one is at danger. It can be broken down into 5 steps:
This can be approached via two techniques, namely qualitative and quantitative. The qualitative risk evaluation method is a subjective assessment, plotting the probability of risk occurrence against the impact of its outcome, thereby establishing its overall severity. It is generally carried out with the help of a rating scale which rates probability from 0 to 1 and severity of the risk from 1 to 5. Quantitative on the other hand is an objective assessment which develops a numerical value that predicts the probability of risk outcome. Table 1. gives an outline of both risk assessment methods detailing its merits as well as acknowledg-ing its limitations. Qualitative analysis was chosen to assess the NEAS since the site visit was short and brief. It was almost impossible to carry out the quantitative method as it would take time. In addition, to do a quantitative assessment, the values were missing. Moreover, the qualitative method is simple and easier.
ApproachQualitative AnalysisQuantitative AnalysisAdvantagesSimple and quickNo expense No quantitative calculations necessaryNot necessary to determine the cost analysis of measures Identifies pivotal risks within a short timeObjective evaluation In-depth analysis of management performanceImproved accuracy of data Cost analysis can be made to determine the best measuresProvides a detailed picture of riskLimitationsComplexion in the cost-benefit determination of control measuresSubjective evaluation Chances of misperception of the realityComplex calculations Time-consumingComplex process Poor understanding of results by inexperienced people
There are a wide variety of hazards that can affect NEAS including but not limited to biological factors, chemical factors, electricity, explosion, fire, falling objects, manual material handling, radiation, violence, stress, musculoskeletal disorders, road accidents etc. Of these, one of the most ubiquitous and disturbing hazards which they face is violence due to alcohol assaults. In accordance with a study conducted within 358 paramedical staff in 2014 by NEAS along with North East Alcohol Office, Balance released a horrendous fact, that almost 50% of the North East paramedical staff has faced assaults both physically and mentally, thriven by alcohol. As per the report, nine out of ten paramedic individuals revealed they had been menaced by patients or the public who were inebriated. Two-thirds of them mentioned at least 50% accountancy for alcohol-related incidences during weekend evenings and that they were at physical assault risk during the nights. That is what the fundamental issue is, as the drunkards, especially those weekend revellers, deliberately annoy the NEAS personnel. This worsens the scenario when the callers become aggressive, shooting up the paramedics’ stress level. Another study, conducted by Newcastle University and NEAS along with Balance revealed that between 2009 and 2010, out of the entire calls they attended, more than one in ten were alcohol-related.
It is indeed alarming that the NEAS is under enormous pressure handling alcohol-ic offenders. It is truly shocking that people who protect other’s life are feeling unsafe because of others’ acts of violence. One of the most important and terrifying risks that the NEAS personnel are now at is Post Traumatic Stress Disorder (PTSD). It is an anxiety disorder that is purely caused by witnessing or experiencing certain events which are catastrophic or disastrous in nature. It is found that nearly 40% of paramedical staff under PTSD are predominantly due to alcohol assaults, as per a study. Some even feel regretful about the situations they encountered, questioning themselves about what else could have been done. They were not able to socialize with their team members or even with their families after facing certain traumatic circumstances.
Another risk associated with the hazard is resource abuse. From the NEAS staff, it was understood that intoxicated individuals take up a whole lot of time to triage, which becomes worst when they become arrogant. They take almost double the time of general callouts. Alcohol-related cases account for around 37% of ambulance time. This makes the vehicle unavailable for those patients in need of it. Every hour, 2 ambulances were required to take alcohol-poisoned individuals to hospitals, in 2013-14. Financial loss is another major concern to NEAS arising from the hazard. In a span of one year, from 2009-2010, the total cost to NEAS was about £9m, just by attending 31000 alcohol-related calls. What is more, NEAS personnel has also faced atrocities varying from urinating in the vehicle, lighting up the fire in the vehicle, having spat at, things being thrown at them, gadgets/instruments stolen from the vehicle etc. Physical harm is also prevailing. There are cases where attacks have left the ambulance staff losing their ability to have children due to the injuries sustained from the attack.
Currently, the situation has improved. NEAS has taken adequate measures to tackle these risks. To overcome PTSD, rapid response telephone services and counselling services are made accessible to all of its staff by the occupational health section of NEAS. In addition, a debrief session is also made available by frontline managers who are well trained in stress awareness and its risk analysis to help those who have witnessed disheartening events. Paramedical personnel are trained on how to resolve a conflict but they aren’t on how to defend themselves against attacks. It still remains unanswered as to why. NEAS was the first ambulance service in the UK to trial body cameras to record the proof of violence/attacks when they occur. It was for a 3-month period and was said that a decision would be taken whether or not to use it afterwards. To date, no updates are out yet. Another significant step taken against the offence is As-sault on Emergency Workers Act 2018.
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