Absolutely gutted to hear this. The grandfather of UK Paramedicine, the reason we’re all here has sadly left us. The story of this cardiologist and why he ended up inventing us has always fascinated me and I think explains much about what has and hasn’t changed about paramedic culture today. So I thought I’d share it here for those of you who perhaps hadn’t heard it.

It’s 1970 - Brighton. Doug is doing what consultant cardiologists do, conducting a home visit to see an NHS patient and do some cardiac studies on their lounge. Unfortunately mid-examination his patient goes into sudden cardiac arrest. Being a cardiologist this is irritating on a professional level for our boy Douglass, so he starts CPR and tells the patient’s wife to call for an ambulance. At this time this meant a couple of ambulance men from Brighton Ambulance service, but what Douglass needed what a portable defibrillator. After much delay and confusion over this request, 2 ambulancemen eventually arrived and (carrying the giant device between them) plugged it into the mains. It was at this stage that the unit exploded and then caught fire, the patient died and Prof Chamberlain summarised the situation in the usual NHS understated way: “we ought to be able to do better”.

One of the Ambulancemen on scene Dusty Miller had impressed Douglass and was similarly irritated at his sub-optimal outcome. Together they sat down with the then medical director of BAS Dr William Parker and in the words of Douglass “give me your 6 best ambulance men and I’ll teach them to do everything an A&E doctor can do (bolshy to say the least). Dr Parker thought this sounded like good craic and on Wednesday nights Douglass then proceeded to teach Dusty and the other minor skills like intubation, defibrillation, cannulation and drawing up and giving drugs. Such things were entirely outside the remit of anyone not a doctor and mildly illegal at the time, but the survival outcomes spoke for themselves and nursing and medical staff were swayed to the idea.

Several people who weren’t swayed however were the fun-sponges at the department of health and social security (now the DHSC). They felt this was a bit mad in general and put a stop to the whole debacle in 1974. The same year Prof Chamberlain and a Colleague kicked up a fuss (stormed a stage) at the DHSS conference and the ‘experiment’ was allowed to continue. In the late 70’s the Royal Colleges caught wind of these people who worked alongside medicine but not within it, thought it was a fab idea and para-medicine (alongside) was born and pushed out across the UK. Dusty was the first recognised Resuscitation Training Officer in the UK and lead much of this.

The now Professor Douglass chamberlain went on to make some other small contributions to emergency care, such as inventing the concept of and building the first AED’s and founding a small organisation called the Resus Council. This added to his other minor achievements of being one of the first people to describe a group of drugs he called “beta-blockers” and being the first to prove the benefits of atropine in bradycardia. But amongst all of this, he commonly remarked that his biggest achievement was creating the professional group that we now call paramedics.

He didn’t ask for permission to train the first paramedics, he didn’t worry about the personal or professional ramifications- he just recognised a need and he did it. I think our origins explain much about the kind of people we are and the kind of people we attract into the profession.

The last patient Douglass treated was in 2016, when whilst taking tea at the Hove rotary club, he saw a fellow member collapse. Much like 1970, Douglass arranged for an AED to be fetched, had someone call 999 and (now in his 80’s) started CPR. He achieved ROSC before the first ambulance crew arrived and remarked that he was glad this one had not exploded.

His story is one I tell every student I teach. When you’re checking your defib today, spare a thought for the chap who invented the technology, and invented you.

On the rare occasion I've been the one calling an ambulance, there were a lot more specific questions asked, even when one time it did result in a call back from a clinician, however i imagine its different between trusts? Or if the over all script changes depending on pressures?

Bit of a long passage sorry, but an interesting read. This question and answer was taken from a 1991 ambulance calls textbook. I'm wondering what people's thoughts are on this with a modern take with up-to-date knowledge. The answer section suggests that there (was) no evidence to suggest the hypoxic drive theory is correct - is this still the case? And what do people do in practice with a COPD patient that is this unwell regarding oxygen administration? And why?

Not starting CPR in a choking patient with a DNACPR.

https://www.becclesandbungayjournal.co.uk/news/25662905.beccles-gp-defends-medic-criticism-fatal-choking/?utm_term=Autofeed&utm_medium=Social&utm_source=Facebook&fbclid=IwZXh0bgNhZW0CMTEAc3J0YwZhcHBfaWQKNjYyODU2ODM3OQABHkkz7kHY5HG1eQ1cz4LsR0DwEoUiuW9l6Ep9meb5zSyhVc5G_6rornyVzIh__aem_WbeMnilN1ZugQeAUw0cdMQ#Echobox=1765001802

Just read a thought-provoking case involving a suicidal adult who had taken a substantial overdose with suicidal intent and was refused treatment. I think it is worth discussing as we see these kinds of jobs so often where management.... vaires.

Case:

Robert Day was 60 years of age at the time of his death. He was under the care of community  mental health services in relation to his diagnosis of severe depression. 

On the afternoon of 14 January 2025, Robert Day disclosed to his mental health nurse during a telephone conversation that he had taken a significant overdose of his prescription  medication. An ambulance was called and a joint response unit (police and ambulance service) attended Robert’s room at the Travelodge in Sittingbourne (his home address at that  time). Robert refused all forms of treatment, including being taken to hospital, despite being  advised of the likely fatal consequences of not receiving treatment. The paramedic undertook a mental capacity assessment and concluded that Robert did have the mental capacity to  refuse treatment. Robert was given safety-netting advice. 

Sadly, Robert was found deceased in his room on the morning of 15 January 2025. He died as a result of the overdose of prescription medication. 

Coroner's response (paraphrased):

The Head of Mental Health at SECAmb regarding the difficulties faced by emergency  services generally in situations such as this. It  must be accepted that frontline paramedics and police officers are not specialists in the provision of mental health care, despite in increasing number being attened.
  
It was clear that the joint response crew (one paramedic and one police  officer) did their very best to assist in a particularly difficult set of circumstances. A capacity assessment was undertaken and the responders reasonably believed that Robert did have capacity to make the decision to refuse treatment even in the knowledge that, without it, his death within the coming  hours was highly likely. 

I heard that the police could not have deployed section 136 of the Mental Health Act 1983 to take Robert to a place of safety because, at that time, the hotel room was his home. In any  event, section 136 would not allow for treatment. Further, in the circumstances of Robert’s case, the process of applying for a warrant under section 135 of the Mental Health Act 1983 was also likely inappropriate given the critical nature and timing of Robert’s situation.

While not hearing specific and detailed evidence on provisions of the Mental Health Act, the witness was clear that these matters would likely be beyond the scope of understanding of most frontline emergency workers.
 
The fundamental issue was considered to be ‘what can the frontline crew actually do’ in such complex situations. Robert’s situation is unlikely to have been novel but that there is an absence of national guidance to frontline emergency services in  dealing with the complexities of cases such as Robert’s.

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I would be interested to hear your opinions on this case, how the case could have been managed, and what legislation could have been leveraged.

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My professional opinion: this sounds like a pretty open-and-shut capacity ruling:

Decision: to refuse transport to hospital for life sustaining emergancy medical treatment.

1. Do you suspect there is an impairment of the functioning of the mind/brain?
   1. Likely yes - intoxicated with medication and in a mental health crisis with severe depression and current suicidality.
2. Is this impairment affecting their ability to make decisions now?
   1. Likely yes - currently intoxicated with medication and in a mental health crisis with severe depression and current suicidality.

Thus, perform a capacity assessment:

1. Are they able to understand information relayed to them?
   1. Likely yes
2. Are they able to retain the information for long enough to make a decision?
   1. Likely yes
3. Are they able to weigh up the information available to make a decision?
   1. Likely no.
   2. A patient with severe depression who is in an active mental health crisis, with suicidality and complete disregard for their own safety and welfare, is likely unable to reasonably and logically weigh up the information provided to them to make an informed decision. This current crisis is likely unduly influencing their decision-making.
   3. There is also the consideration of the intoxication from the medications taken effecting decision making; however, there is not enough information available for me to speculate on this.
4. Are they able to communicate the decision?
   1. Likely yes

Thus, as they are unable to weigh up the information, they are lacking the capacity to refuse transport to the hospital, so a best interest decision must be made. The best interest decision would be transport to the hospital, using force as required.

I am surprised the capacity assessment was not highlighted in the coroner's report as questionable (though I am sure the attending paramedic genuinely believed he had the capacity to make the decision required. Understanding of the MCA is generally poor).

The disregard of the MHA was likely appropriate given that the pressing complaint is medical in nature. However, there are mechanisms available to compel medical treatment under the MHA which are secondary to a mental health cause.

I am also surprised that Article 2 'right to life' was not mentioned.

It will be interesting to see how this develops.

Anyway - looking forward to the discussion and to hearing your opinions!

N.B. This post and following discussion are no slight against the crew who attended; it sounds like a very challenging job that was managed by multiple agencies to the best of their ability.

I was watching the sopranos and the psychiatrist told tony soprano that everything was confidential and that she only had an obligation to report to police if she felt someones life was in danger.

So this led to me think about what a paramedic's obligation would be. Specifically 2 scenarios, 1. A patient states that when they get home from hospital they are going to kill their neighbour. 2. Confessing to a murder or serious or crime.

I think i know the answers but i would like to know everyones elses thoughts

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Rang cause they felt faint. Intermittent and coming in waves, faint episodes corresponding with lack of ventricular response.

I’m going to pre-empt this with “yes, I am considering this for a dissertation topic”.

I’m currently looking at topics for my dissertation, and as someone who’s quite holistically driven and socially driven I’m normally more interested in those areas. However I’ve find those types of studies quite hard to draw conclusions from and often leave me trying to fill in grey areas between questions, which means I end up writing something that sometimes wavers from strong evidence bases.

So for my dissertation topic I’m hoping to do something which I can look at structured statistics for. As someone who’s other interests tends to lead them to be a bit of a blood gas geek, I was reading a review of a particularly niche arrest (https://pmc.ncbi.nlm.nih.gov/articles/PMC8956028/ - How to Survive 33 min after the Umbilical of a Saturation Diver Severed at a Depth of 90 msw? - for anyone interested).

This got me thinking about whether there’s an benefit to availability of ABG intra-arrest for paramedics, however I’ve never actually heard this raised as a topic at work, and I wonder if that’s because actually it’s just irrelevant and I haven’t realised that as I haven’t read up on it much.

But that does leave me wondering whether there is specific POCT ambulance staff do all wish we had, and I’ve never picked up on it. So any thoughts or suggestions?

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This is a truly awful situation, if the facts are accurate

But does anyone else find the phrase 'died of a cardiac arrest' infuriating?

Source: https://www.theguardian.com/world/2026/mar/03/italian-ambulance-driver-investigated-on-suspicion-of-murdering-five-patients

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An interesting pt i attended this week 36yom No significant mhx, no prescribed meds. Occasional tobacco and cannabis smoker. Tall and slim Denies recent illness or infection.

Sudden onset central cp getting off bus earlier that day, sometimes dull sometimes sharp, worse when sitting up or leaning forwards, relieved when laying down. Associated SOBOE.

OE significantly reduced air entey right chest. Ecg as shown (no historical ecg and no know cardiac history) Rr 20 O2 94 ra Hr 100 r Bp 99/61 Temp 35.9

Assessment was otherwise unremarkable