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‘We are worn out and no one cares’: why ambulance staff in UK and Australia are ready to quit the profession

Research on both sides of the globe shows that unmanageable workloads is the main reason why many ambulance service staff are considering quitting the…

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The COVID-19 pandemic may be over, but its scars remain for those on the frontline of the health sector – not least in the ambulance services. And our research conducted separately in the UK and Australia shows things are getting worse across the globe.

Ambulance staff in many other countries, including Germany, France, Poland, Spain, USA, Japan, Israel and India, are also facing increased pressures. This is due to more people using ambulance services, more complex patient needs, not enough staff and resources, and unmanageable workloads. All these factors have made it difficult for many ambulance services to operate.

We studied two services similar in size and structure: the Welsh Ambulance Services NHS Trust in the UK, and Ambulance Victoria in Australia. We found that both services are close to a point where they may not be able to meet the needs of the people they serve. And we identified similar issues and problems in both locations which are causing many employees to consider leaving the profession.

We found that nearly 45% of ambulance staff in Wales and 29% in Victoria are considering quitting. And in Victoria, 16% of ambulance services staff said they were looking to leave the profession within the next year, while 23% of participants in Wales said the same.

Unmanageable workloads

These are highly skilled healthcare professionals who are thinking about leaving their jobs for good. The main reason staff in both services gave us is unmanageable workloads, with many echoing the sentiments of one another.

“The workload is huge and continues to grow. I regularly work 50 plus hours per week to keep on top of everything and still struggle.” (Wales)

“We are consistently given demands that are impossible to achieve. We are worn out and no one cares.” (Wales)

“I’m falling out of love with a job that I have loved and excelled at for nearly a decade and a half. Managers are pushing [targets] and budgets and times, while on road staff are exhausted.” (Victoria)

“Morale is the lowest I have ever seen in the ambulance service.” (Wales)

“Listening to the distressing phone calls I receive from road colleagues who are struggling … There is no respite of this pressure … I am hugely concerned for my frontline colleagues’ welfare.” (Wales)

These comments feed into the issues of staff retention in both services as demands intensify. However, there is a perceived lack of understanding and support from management and more critically, a lack of resources. The real concern lies in how this will impact the quality of care provided to patients in both places.

Our findings are supported by other research which indicates that ambulance services staff were the most likely to say their mental health had deteriorated following the COVID-19 pandemic, and by default, their ability to work effectively in the longer term.

Our research also shows that ambulance workers in Wales and Victoria, Australia are highly engaged and passionate about their work. They identify strongly with the job that they do. But they are approaching a crisis point due to increasing workload, burnout and low morale.

A Welsh Ambulance NHS trust ambulance. Ceri Breeze/Shutterstock

Potential solutions

The problems we found in our studies can be solved by ambulance management on either side of the globe. The most important thing is to provide more resources to support and retain this highly skilled workforce, which could help to reduce burnout and keep staff in this essential job.

Ambulance services must prioritise improving staff wellbeing, and efforts to do so should be inclusive, employee-led and proactive. Creating a stable and sustainable workforce could help in responding to changes in service and health needs. All levels of management should be given the appropriate training too. Taking these approaches could ensure that the work of ambulance services staff and other healthcare professionals is properly valued.

We hope that the findings from our studies will be used to create new ways to improve the workplace culture in Wales and Victoria. We also welcome other healthcare organisation using our findings to protect and support the wellbeing of their staff.

The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

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Researchers carry out first peer-reviewed study of fecal microbiota transplants in dolphins

Scientists have successfully carried out pioneering fecal microbiota transplantations on Navy bottlenose dolphins that showed signs of gastrointestinal…

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March 24, 2024

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Scientists have successfully carried out pioneering fecal microbiota transplantations on Navy bottlenose dolphins that showed signs of gastrointestinal disease.

Credit: U.S.Navy

Scientists have successfully carried out pioneering fecal microbiota transplantations on Navy bottlenose dolphins that showed signs of gastrointestinal disease.

One dolphin in particular who was outwardly ill was able to be taken off medication during the treatment course, with his appetite and energy returning to normal, according to the team at the National Marine Mammal Foundation.

The project was carried out jointly between the NMMF, the U.S. Navy Marine Mammal Program and the Gilbert Lab at UCSD School of Medicine and Scripps Institution of Oceanography, and its findings were published in the Journal of Applied Microbiology, an Applied Microbiology International publication.

Bottlenose dolphins with evidence of gastrointestinal disease were treated with fecal microbiota transplantations, and the changes to their gut microbiome were analyzed using metagenomic sequencing, corresponding author Dr Barb Linnehan said.

First of its kind

The paper is the first of its kind to describe the use of fecal microbiota transplants (FMTs) in dolphins in peer-reviewed literature. Prior to this work, there were only a handful of anecdotal cases of FMT use in marine mammals and there were no standardized methods to safely screen donors, effectively administer, or monitor its efficacy.

“This work is important to the veterinary community because it highlights a therapeutic option other than antibiotics to effectively treat gastrointestinal diseases in cetaceans, and describes a safe and effective protocol to alter the gut microbiome in animals with dysbiosis,” Dr Linnehan said.

“It was important to us to be as thorough and careful as possible to ensure safety of the dolphins as our top priority.

“In an effort to continually advance marine mammal medicine, we conducted this pilot project, pushing the boundaries in an area that had not been rigorously explored yet. There are numerous applications of FMTs beyond gastrointestinal disease, and this therapy holds so many future possibilities to investigate.”

Non-antibiotic option

Gastrointestinal disease is common in many animals, including wild and managed dolphins, and FMTs offer a non-antibiotic option aimed at restoring beneficial gut flora in dysbiotic animals. While FMT literature abounds in the human medical realm, there are only a handful of veterinary FMT studies published to date, across a variety of species.

The conception of this project was a collaboration between Dr. Maureen Carroll, a veterinary internal medicine doctor, and Dr. Barb Linnehan, a marine mammal veterinarian who was mentored by Dr. Carroll during her veterinary internship. At Angell Animal Medical Center in Boston, Dr. Carroll frequently uses FMTs to treat dogs with GI illnesses with great success.

When Dr. Linnehan was treating a Navy dolphin with dysbiosis, she reached out to Dr. Carroll to help extrapolate an FMT protocol for use in dolphins, based on the human and veterinary standards.

The first Navy dolphin who was treated with FMTs showed significant improvement and no longer required medications to manage GI illness. The success of this first pilot case is what led to this clinical project in collaboration with the Gilbert Lab, to more formally evaluate the science behind the dolphin FMTs.

Gut flora

The team first measured the baseline bacterial composition of dolphin fecal samples prior to any FMT treatments.

“We compared the gut flora from recipient dolphins, with histories of early antibiotic use and gastrointestinal disease, to the gut flora of the healthy donor dolphins,” Dr Linnehan said.

“With metagenomic analysis and comparison of these two groups of dolphins, we were interested to see if there was a distinct profile of a healthy dolphin gut microbiome versus a sick dolphin gut microbiome.

“We were surprised at this stage to see that each dolphin varied widely, and there was not a clear pattern in species present or abundances of certain species of microbes that described sick vs healthy dolphins – each dolphin was unique in microbial composition.

“However, there were also common ‘core’ microbial members that were found across a majority of the dolphins, including an unexpected strain from the bacterial phylum Candidatus Kryptonia which is typically associated with geothermal spring environments.”

Eight treatments

The researchers then performed eight FMT treatments on four recipient dolphins by combining thoroughly screened feces from healthy donor dolphins and giving it to the recipient dolphins trans-rectally.

“Importantly, we saw no adverse effects in the recipients. With shotgun metagenomics, we were also able to observe the engraftment of new donor species to the recipient microbiome following FMTs,” Dr Linnehan said.

“The degree of engraftment varied with each recipient dolphin. The dolphin who was outwardly ill at the beginning of the FMTs had the most dramatic response; he was successfully taken off of all medications and his appetite and energy returned to normal during the treatment course. The dolphin’s improved clinical outcomes coincided with increased microbial diversity following the FMT treatment.

Banking healthy feces

“During the project, we also came up with an effective protocol for banking healthy donor dolphin feces for later use. This has proven beneficial so that when an FMT is needed we have a healthy dolphin stool bank to pull from.”

This project was an important first step and building block for future studies to build upon, so that dolphin gut microbiome and FMT therapy science can advance, Dr Linnehan said.

“We’ve shown that FMTs can be done safely in dolphins and that they can be very effective in animals with gastrointestinal disease and dysbiosis,” she said.

Antimicrobial resistance

“As antimicrobial resistance and antimicrobial stewardship are hot topics in the medicine world, having this non-antimicrobial option as a therapeutic tool can be helpful for marine mammal veterinarians. These tools and techniques could also be applied to wild animals in rehabilitation settings, to include at-risk, threatened, and endangered dolphins.

“This study was just the beginning of exploring the use of FMT and microbial changes over time in the dolphin gut. As this was a small, clinical study that was disrupted by the global pandemic, future studies with larger sample sizes and over a longer time period are warranted.

“It would also be interesting to investigate gut microbiome changes with different diet composition (i.e. different fish types), during different times of year, or fluctuations with other external factors like environmental water quality. There are also numerous opportunities to investigate FMT for treatment of non-GI disorders as documented in other species, including behavioral conditions or to improve longevity.”

Marine mammals

The project was spearheaded by Dr. Barb Linnehan (veterinarian and Director of Animal Health and Welfare) at the National Marine Mammal Foundation with the help of Dr. Jack Gilbert and his laboratory team, including Sho Kodera (co-first-author, PhD student in marine biology at Scripps Institution of Oceanography). As part of the San Diego, CA based non-profit organization, the National Marine Mammal Foundation, Dr. Linnehan helps provide medical care to the U.S. Navy’s marine mammals. The Gilbert Lab is a highly interdisciplinary research group at UCSD’s Scripps Institution of Oceanography and the Department of Pediatrics, where they conduct research in medical and environmental microbiology, microbial ecology, and biotechnology development.

The project was funded as part of clinical care at the U.S. Navy Marine Mammal Program.

’Evaluation of the safety and efficacy of fecal microbiota transplantations in bottlenose dolphins (Tursiops truncatus) using metagenomic sequencing’ is published in the Journal of Applied Microbiology.

Notes to editors

1. The National Marine Mammal Foundation (NMMF) is a 501(c)(3) nonprofit organization recognized globally as a leader in marine mammal science, medicine, and conservation. Their team of experts is answering critical questions about the health of the world’s marine mammals and the ecosystems they rely on. The NMMF has a mission to improve and protect life for marine mammals, humans, and our shared oceans through science, service, and education. They advance their mission by conducting innovative research and collaborating with the world’s top scientists and institutions to translate their research into applicable medicine and species conservation. The NMMF provides technical, medical, and scientific expertise to help solve problems related to conservation medicine, human-made environmental change, and endangered species recovery. 

2. Applied Microbiology International (AMI) is the oldest microbiology society in the UK and with more than half of its membership outside the UK, is truly global, serving microbiologists based in universities, private industry and research institutes around the world. AMI provides funding to encourage research and broad participation at its events and to ensure diverse voices are around the table working together to solve the sustainability development goals it has chosen to support. AMI publishes leading industry magazine, The Microbiologist, and in partnership with Oxford University Press, publishes three internationally acclaimed journals. It gives a voice to applied microbiologists around the world, amplifying their collective influence and informing international, evidence-based, decision making. 

3. Oxford University Press (OUP) is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. OUP is the world’s largest university press with the widest global presence. OUP publishes more than 500 academic and research journals covering a broad range of subject areas, two-thirds of which are published in collaboration with learned societies and other international organizations. It has been publishing journals for more than a century and, as the world’s largest university press, has more than 500 years of publishing expertise.

Journal

Journal of Applied Microbiology

DOI

10.1093/jambio/lxae026

Subject of Research

Animals

Article Title

Evaluation of the safety and efficacy of fecal microbiota transplantations in bottlenose dolphins (Tursiops truncatus) using metagenomic sequencing

Article Publication Date

1-Feb-2024

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Guest Contribution: “Monetary Policy Reaction to Geopolitical Risks: Some Nonlinear Evidence”

Today we are pleased to present a guest contribution by Jamel Saadaoui (University of Strasbourg) and William Ginn (LabCorp, Artificial Intelligence)….

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March 24, 2024

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Today we are pleased to present a guest contribution by Jamel Saadaoui (University of Strasbourg) and William Ginn (LabCorp, Artificial Intelligence).

How do geopolitical risk shocks affect monetary policy? After the global financial crisis, international trade relations have been increasingly influenced by geopolitical considerations. Indeed, it is now widely recognized that geopolitical risks and bilateral political tensions can have a strong influence on the functioning of the economy (Caldara and Iacoviello, 2022). Geopolitical risk shocks affect the economy through different channels. Some of them are inflationary, such as the commodity price channel, especially the oil price (Mignon and Saadaoui, 2024) [Econbrowser post] and the currency channel (Gopinath, 2015). Furthermore, other channels are deflationary, such as the consumer sentiment channel and the financial condition channel (Forbes and Warnock, 2012). It is difficult to determine ex-ante whether geopolitical risk shocks are inflationary or deflationary. Recent research suggests that geopolitical shocks tend to be inflationary throughout history (Caldara et al., 2022).

Based on a panel of 20 economies, William Ginn and I develop and estimate an augmented panel Taylor rule via linear and nonlinear local projections (LP) regression models. First, the linear model suggests that the interest rate remains relatively unchanged in the event of a geopolitical risk shock. Second, the result turns out to be different in the nonlinear model, where the policy reaction is muted during an expansionary state, which is operating in a manner proportional to the transitory shock. However, geopolitical risks can amplify the policy reaction during a non-expansionary period.

To consider the global impact of geopolitical risk, we use a rich data set for industrial production, consumer price index (CPI), short-term interest rate, GPR, and EPU for 20 economies that represent around 82% of global GDP to analyze the effect of GPR on interest rates. These twenty economies include the following: Brazil (BRA), Switzerland (CHE), Chile (CHL), Canada (CAN), China (CHN), Columbia (COL), Czech Republic (CZE), Euro zone (19 countries; EUR), United Kingdom (GBR), Hungary (HUN), Ireland (IRL), India (IND), Israel (ISR), Japan (JPN), Mexico (MEX), South Korea (KOR), Poland (POL), Russia (RUS), Sweden (SWE) and the United States (USA). We use monthly data that cover January 1999 to February 2022.

 

The international data for the explained and explanatory variables of the 20 economies are shown in Figure 1. In the output growth data, we can clearly see three episodes of global slowdown, namely the Internet Bubble in 2001, the Global Financial Crisis in 2008-2009, and the pandemic in 2020. The graphs for inflation show a more dispersed situation over time and between countries, except for the global financial crisis and after the pandemic. In terms of monetary tightening and loosening, we also observe that the monetary cycles induced by the global financial crisis (easing) and after the pandemic (tightening) are the most synchronized episodes. Furthermore, Economic Policy Uncertainty is larger after the pandemic. During the most recent period, we can observe elevated levels of GPR due to the War in Ukraine. More generally, the GPR has known large spikes around 2001 due to 9/11 and after 2009 due to rising tensions between the United States and China and the election of Donald Trump, as discussed in Mignon and Saadaoui (2024).

Figure 1: International Data

 

The Taylor rule is designed to capture the reaction of central banks to deviations in inflation and output (Taylor, 1993). By examining the rule in expansionary and non-expansionary states, this research may offer insight into how central banks adjust interest rates in response to economic conditions in the presence of geopolitical shocks. The LP model, developed by Jordà (2005), is used to estimate an augmented Taylor rule based on a GPR shock. Periods marked by high GPR have potentially adverse consequences for an economy. Central banks, when implementing monetary policy, consider the prevailing economic conditions, including states of uncertainty and geopolitical tensions. The Taylor rule provides a framework for central banks to adjust interest rates based on economic indicators, where we test whether this adjustment can be influenced by the level of the GPR.

 

Figure 2: Linear LP model

Note: the shock is a one standard deviation shock to changes in GPR. Confidence intervals at 90%.

 

Figure 3: Non-linear LP model (Transition variable: twelve-month centered movingaverage of the output growth rate) – Baseline

Figure 4: Non-linear LP model (Transition variable: recession dummy)

 

Overall, the linear LP (Figure 2) model demonstrates a negative relationship between the monetary policy reaction and the GPR shocks, where the policy reaction declines and is statistically insignificant. The non-linear model (Figure 3 and 4) demonstrates that a GPR shock results in a muted interest rate policy response during an expansionary state. There is no policy dilemma where the interest rate response is operating in a manner that is proportional to the transitory nature of the shock and considering the effect of monetary policy comes with a lag. The impact of a GPR shock on monetary policy turns out to be different during a non-expansionary state. The findings show that the response becomes accommodative and is statistically significant for numerous periods. This last result is robust to the choice of the transition variable (GDP, OG with HP filter, dummy variables for recessions, EPU). That being said, this more accommodative monetary policy after geopolitical risk shocks is observed in the group of more independent central banks and in the group of emerging countries (Figure 5 to 8).

Figure 5: Baseline model Non-linear LP – Advanced Economies: CAN, CHE, DNK, EUR,  GBR, JPN, KOR, NOR, SWE, USA

Figure 6: Baseline model Non-linear LP – Emerging Economies:  BRA, CHL, CHN, COL, HUN, IND, ISR, MEX, POL, RUS

 

Figure 7: Baseline model Non-linear LP – More independent central banks (Central Bank Independence – Dincer and Eichengreen, 2014): CAN, CHL, EUR, HUN, MEX, NOR, RUS, SWE

Figure 8: Baseline model Non-linear LP – Less independent central banks (Central Bank Independence – Dincer and Eichengreen, 2014): CHN, COL, DNK, GBR, IND, ISR, JPN, KOR, POL, USA

 

Main references

Caldara, D., Conlisk, S., Iacoviello, M. and Penn, M. (2022), ‘Do geopolitical risks raise or lower inflation’, Federal Reserve Board of Governors.

Caldara, D. and Iacoviello, M. (2022), ‘Measuring geopolitical risk’, American Economic Review 112(4), 1194–1225.

Dincer, N. N., & Eichengreen, B. (2014), ‘Central Bank Transparency and Independence: Updates and new measures’, International Journal of Central Banking 10(1), 189-259.

Mignon, V. and Saadaoui, J. (2024), ‘How do political tensions and geopolitical risks impact oil prices?’, Energy Economics 129, 107219.

 

*  The authors thank Menzie Chinn for a useful suggestion and Elena Pesavento for guidance on state-dependent local projections. The interested readers can find the last version of the paper on SSRN: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4762672

 

This post written by  Jamel Saadaoui and William Ginn.

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Japanese Preprint Calls For mRNA VaccinesTo Be Suspended Over Blood Bank Contamination Concerns

Japanese Preprint Calls For mRNA VaccinesTo Be Suspended Over Blood Bank Contamination Concerns

Authored by Naveen Athrappully via The Epoch…

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1 day ago

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March 23, 2024

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Japanese Preprint Calls For mRNA VaccinesTo Be Suspended Over Blood Bank Contamination Concerns

Authored by Naveen Athrappully via The Epoch Times (emphasis ours),

Receiving blood transfusion from COVID-19-vaccinated individuals could pose a medical risk to unvaccinated recipients since numerous adverse events are being reported among vaccinated people worldwide, according to a recent study from Japan.

A volunteer draws the AstraZeneca vaccine as members of the public have their COVID-19 vaccinations at Fazl Mosque in Southfields, London, as it hosts a drop in clinic on June 8, 2021. (Dan Kitwood/Getty Images)

The preprint review, published on March 15, examined whether receiving blood from COVID-19-vaccinated individuals is safe or poses a health risk. Many nations have reported that mRNA vaccine usage has resulted in “post-vaccination thrombosis and subsequent cardiovascular damage, as well as a wide variety of diseases involving all organs and systems, including the nervous system,” it said.

Repeated vaccinations can make people more vulnerable to COVID-19, it said. If the blood contains spike proteins, it becomes necessary to remove these proteins prior to administration, and there is no such technology currently available, the authors wrote.

Contrary to earlier expectations, genes and proteins from genetic vaccines have been found to persist in the blood of vaccine recipients for “prolonged periods of time.”

In addition, “a variety of adverse events resulting from genetic vaccines are now being reported worldwide.” This includes a wide range of diseases related to blood and blood vessels.

Some studies have reported that the spike protein in the mRNA vaccines is neurotoxic and capable of crossing the blood-brain barrier, the review stated. “Thus, there is no longer any doubt that the spike protein used as an antigen in genetic vaccines is itself toxic.”

Moreover, people who have taken multiple shots of mRNA vaccines can have several exposures to the same antigen within a small time frame, which may lead to them being “imprinted with a preferential immune response to that antigen.”

This has resulted in COVID-19 vaccine recipients becoming “more susceptible to contracting COVID-19.”

Given such concerns, medical professionals should be aware of the “various risks associated with blood transfusions using blood products derived from people who have suffered from long COVID and from genetic vaccine recipients, including those who have received mRNA vaccines.”

The impact of such genetic vaccines on blood products as well as the actual damage caused by them are currently unknown, the authors wrote.

“In order to avoid these risks and prevent further expansion of blood contamination and complication of the situation, we strongly request that the vaccination campaign using genetic vaccines be suspended and that a harm–benefit assessment be carried out as early as possible.”

Repeated vaccination of genetic vaccines can also end up causing “alterations in immune function” among recipients. This raises the risk of serious illnesses due to opportunistic infections or pathogenic viruses, which would not have been an issue if the immune system were normal, the review said.

“Therefore, from the perspective of traditional containment of infectious diseases, greater caution is required in the collection of blood from genetic vaccine recipients and the subsequent handling of blood products, as well as during solid organ transplantation and even surgical procedures in order to avoid the risk of accidental blood-borne infection,” it stated.

The review was funded by members of the Japanese Society for Vaccine-related Complications and the Volunteer Medical Association. Authors did not declare any conflict of interest.

Dangers With Blood Transfusions

The review pointed out that the genetic vaccination status of blood donors is not collected by organizations even though the use of such blood may pose risks to patients. As such, authors recommended that when blood products are derived from such people, “it is necessary to confirm the presence or absence of spike protein or modified mRNA as in other tests for pathogens.”

“If the blood product is found to contain the spike protein or a modified gene derived from the genetic vaccine, it is essential to remove them,” it stated. “However, there is currently no reliable way to do so.”

Since “there is no way to reliably remove the pathogenic protein or mRNA, we suggest that all such blood products be discarded until a definitive solution is found.”

The authors pointed out that cases of encephalitis among people who received blood from dengue vaccine recipients were reported as recently as last year. This suggests that the present system of tracking and managing blood products “is not adequate.”

Since genetic vaccines were implemented on a global scale for a massive population, “it is expected that the situation will already be complicated” compared to previous drug disasters.

As such, there is an “urgent need” for legislation and international treaties related to the management of blood products, the authors wrote.

The issue of blood transfusion from COVID-19 vaccine recipients has been highly controversial. In 2022, a court in New Zealand ruled against the parents of a sick infant son after they refused blood transfusions from vaccinated people.

The parents had asked the health system to allow blood transfusion from unvaccinated individuals, with donors who were already prepared to contribute. In its ruling, the court stripped the parents of medical custody of their son.

In Canada, doctors have also reported the trend of people’s resistance to vaccinated blood transfusions. Speaking to CBC in 2022, Dr. Dave Sidhu, the southern Alberta medical lead for transfusion and transplant medicine, said that parents of sick children were requesting unvaccinated blood.

“We’re seeing it about once or twice a month, at this stage. And the worry is of course that these requests might increase,” he said at the time.

In Wyoming, Rep. Sarah Penn (R-Wyo.) has sponsored a bill mandating that blood donated by people who have taken COVID-19 shots be labeled. Doing so will allow recipients who do not wish to accept such blood to reject them.

In an interview with Cowboy State Daily, Ms. Penn said, “For various reasons, many people have purposefully strived to keep the mRNA therapies out of their bodies, even to the point that some lost their livelihoods … Their concerns are warranted.”

Tyler Durden Sat, 03/23/2024 - 19:50

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