THE county’s hard-pressed ambulance crews have come to expect abuse and threats on the job.

But physical attacks are still a “surprise” says response paramedic Jon Murray.

On paper, Herefordshire doesn’t have problem with violence and aggression towards its ambulance crews, the  figures for which are amongst the lowest in the West Midlands Ambulance Service (WMAS) area.

Over 2013-14, WMAS recorded no physical assaults against its Herefordshire crews and eight incidents of verbal or threatening abuse.

This year, to date, one physical assault has been recorded and  11 incidents of  verbal or threatening abuse.

WMAS, which has been highlighting the issue of assaults, abuse and threats against crews, says that while Herefordshire isn’t as bad as other parts of the West Midlands - in that no front-line staff from the county have been hospitalised from a physical assault for some time - it doesn’t mean it’s a good situation.

Frontline staff, the service says, are frequently threatened and verbally abused in “uncomfortable situations” and those on the receiving end view this as being as bad as physical violence.

Jon says he and his blue light response colleagues have come to expect abuse and threats over every shift.

Much of this - from “verbals” to spitting and lashing out - is drink or drug related, but occasionally it will involve a patient with a specific medical condition.

“And it’s not just Friday and Saturday nights now, it can come during any shift at any time,” he says.

Sustained physical attacks, though, are still a surprise.

“You get an instinct for when someone is ready to have a go, if you can’t calm a situation you pull away,”  says Jon.

Each responder can summon help by hitting an emergency broadcast button on their hand held radio and back up from the police, if needed, is “brilliant” says Jon.

 But when police shifts are as busy  as ambulance shifts “brilliant” becomes relative, especially for a crew that might need assistance beyond Hereford or the market towns.

Given the well-documented pressures on emergency care in the county, patient expectation has not proved as much of a catalyst for aggressive behaviour as it might.

Most patients will accept explanations of what can expected, says Jon.

Context to the current pressures crews were under came in a report put to Herefordshire Council’s health scrutiny committee in June this year.

By then, the Herefordshire Clinical Commissioning Group (HCCG) had been told that ambulance response to Red 1 calls, the most urgent, in the county became a “significant issue” over the past year.

HCCG buys and shapes health and care services, WMAS has the contract to provide ambulance services.

The scrutiny report put to council showed that while eight minute target performance picked up in February, it fell to 61 per cent in March, below the 75 per cent expectation.

In real terms, demand on the county’s 999 ambulance service is increasing year-on-year.

The period 2011-12 saw WMAS take an overall 19,528 calls from the county.

Figures for the past year show demand has jumped by some 20 per cent since.

All told, the service responded to 10,528 Red 1 and 2 calls across the county over 2013-13 – an average 28 a day.

Red calls are classed as immediately life-threatening and come with an eight minute response time.

Just over 66 per cent of Red 1 calls – cardiac arrest or life-threatening traumatic injuries – made the eight minute target.

Nearly 76 per cent of Red 2 calls – all other life-threatening emergencies – made the target.

Green calls, a category ranging from serious but not life-threatening to telephone assessment totalled 14,921 with target response rates between 95 per cent to 99 per cent.

Large parts of the Golden Valley and the north west of the county were identified  as “areas of concern” over Red 1 response performance.

There were also recognised Red 1 response concerns east of Ledbury and north of  Leominster.

Red 2 performance was stronger with concern recognised in responding to emergencies on the county’s borders.

At the time of the report, WMAS budgeted for 107 operational staff in Herefordshire with 97 posts filled.

On the report’s figures that’s 262 calls for each.