When I’m 64(ish)

Older people are great. They’ve been through a lot, they’ve seen a lot, and some have given a lot, but many don’t expect much in return.

“I don’t want to bother you”, “someone else needs the Ambulance more than me”. Both phrases heard on a regular basis by ambulance crews, often from very ill patients.

One patient was in the middle of a huge heart attack when they said that, as my partner and myself watched it develop on the defibrillator screen. They were put straight and rushed into hospital! A common one was the patient lying on the floor with a broken hip. The ball at the top of the femur can be fragile in some older people, and often broke off. The fracture was known as a #NOF – fractured Neck Of Femur. We’d regularly turn up to such jobs to be told “I’m sorry for wasting your time”, the patient in agony and unable to move!

Many times the patient had just fallen out of bed and, although uninjured, they just couldn’t get up and back into bed. Sometimes this was a more serious event and further action was taken. Often they just required us to help them back into bed. We rarely stopped there. Whenever possible, we’d put the patient’s kettle on and make them a warm drink, settle them before we left (most had catheters, in case you’re thinking the obvious).

I realised quickly that, other than a carer, we may be the only other people that the patient might see in a day. Sometimes we’d sit by the bed as they drank their tea and listen to their fascinating stories. All they wanted was someone to chat to, and we were there to care for them so it was our job to listen.

Sometimes Control would radio to “check we were ok”. Ie. They needed a crew for another job. If it was serious we’d go, if not, we’d stay a bit longer. An executive put out a memo once stating that crews were spending too long at jobs and suggesting a time we should allocate to each job. This executive had clearly no idea what our job actually was, otherwise he’d have not chosen to make a complete fool of himself. That memo was instantly filed in File 13 – 🗑️

Older people deserved respect, and we weren’t going to deny them that so the figures on a computer screen somewhere looked good (the same went for other types of call). We did our job and targets had no place in there.

I once discovered we weren’t the only ones that respected older people: We had been called to a house, somewhere in the middle of nowhere for a patient who had fallen in their living room (?#NOF) , along a narrow country road. As we got closer we discovered a long stretch of roadworks ahead, closing one direction of travel, under the control of stop/go boards at each end. As we approached, Blue light on, the worker with the stop/go board at our end Bbegan frantically talking into his radio. He held his hand up to stop us and we waited until a couple of cars came through, then he waved us on. The satellite navigation showed us the house was somewhere along the stretch of roadworks, but we couldn’t find the access road. We got to the other end and asked the road worker to hold the traffic while we did a u-turn and had a second look. We reached the other end and the first road worker flagged us down. They asked where we were looking for and he looked blank, then he asked who the patient was. My partner and myself were pretty sure we couldn’t give out that information “Is it *****?” they said. “Erm….yes actually”. Ah right. Again he spoke into his radio. “Two of our chaps are with them. They went up to the house for their tea break. It was them that called you”. It turned out that the workers had closed off the original entrance because of its location, and we were swiftly directed to the new one. The road workers had been checking up on the patient daily, looking after them.

Never underestimate what an older person may have done for you. Don’t be disrespectful. What you are able to have and do may, in some part, be because of these people. Simple acts of kindness go a long way.

All by myself (aka. Here I go again… PtII).

No one has invented a word yet for the feelings and emotions you experience after you have just explained to someone that the last time they spoke to their loved one was, actually, suddenly, very unexpectedly, the last time they would ever speak to them alive.

I had been single crewed since the start of my night shift, not very busy as it was midweek and in the middle of the month. It was also summertime so lots of people were on holiday, or feeling the pinch having just been on holiday. I was in the mess room alone, the volunteers had finished and gone home. The messroom radio was playing music and I was relaxing. My handheld radio screeched and vibrated on my belt and brought me back to earth rapidly! The call was a code purple – “life status questionable”. On my way to the Ambulance the radio rang and the dispatcher apologised for sending me alone, but there was no one available to back me up. The city was obviously busier than the rural areas. The dispatcher was a favourite of mine, so I knew they were struggling and I was the last resort. I arrived at the scene and rushed into the residence with all my equipment. I was met by the patient’s distraught partner.

An elderly couple, they had been on holiday recently, as both were tanned. The patient had then been away for work and had returned late the night before. A young grandchild had stayed over and was sleeping in bed with the partner so the patient had slept on the sofa in the living room. When the partner woke, they had gone through to the living room and attempted to wake the patient. As soon as I began to examine the patient it became very apparent they had been dead for some time. Rigor mortis had set in and they were cold. There were other indicators too. This was when I had to explain it to the partner.

I sat them down and explained as sympathetically as I could that there was nothing I could do, their loved one was gone, and I was very sorry for their loss. “There must be something you can do?!”. I shook my head an suggested we put the kettle on and that I should call a relative or friend. This was partially to take the partner out of the room the patient was in. I called the couples’ oldest child (who was in their 50s) and, thankfully, the phone was answered by their partner. I explained the situation and they said they would be at the scene shortly.

I had to do some official paperwork and, because it was still an unexplained death, had to contact Control to arrange for the police to attend. I couldn’t leave until the police had arrived. 5 minutes later the peace was shattered! The patient’s oldest child arrived and went into hysterics – “They’re not dead! They’re just sleeping! Look!”. Trying to explain to a relative that their loved one is currently a crime scene is a very definite never. Trying to stop said relative from shaking the deceased patient is difficult, physically and emotionally. Thankfully their partner intervened.

I felt extremely lonely, the bearer of bad tidings, the outsider in a moment of family grief. I took the words of a close friend seriously at that moment – “a wise man once said….nothing”. The police finally arrived and I handed over to them, gave them my paperwork and left. There was no point talking to the deceased patient’s partner, there was nothing I could do or say that would help. Their child’s partner nodded at me on my way out, a “thank you”, accompanied by a painful smile. It made me feel slightly better.

A different shift, still single crewed, night shift again. The radio came to life as I drank another cup of coffee. “Pt fallen down stairs, ?#L arm”(query fractured left arm). It sounded simple enough. Then the radio rang – “5638. Apologies for sending you to this job single crewed, we are aware of protocols”….uh oh… “Pt is a known alcoholic and is intoxicated, backup will be en route as soon as I have someone available”. Single crewed personnel should not be sent to alcohol related jobs, a rule frequently broken by desperate dispatchers.

I arrived to find a very drunk patient screaming in pain, their partner at breaking point, not knowing what to do anymore. The reason for the screaming became apparent very quickly – the patient was in severe pain, having fractured their humerus (the thick bone between the shoulder and elbow) and was waving their arm around in a grotesque fashion! Crepitis was a word I’d learned during training – when the two ends of a fractured bone rub together. I’d felt it before in various patients’ bones, that night I heard it from the other side of the room!

The involvement of large quantities of alcohol negated my ability to use most of the analgesia we carried, so I called control to get a second opinion from the duty Paramedic Advisor (more to have a backup should anything go wrong). We agreed that entonox, “gas and air”, would be acceptable. This might have worked, had the patient been more sober and willing.

I tried to explain the benefit to the patient, their weary partner tried too. More screaming and screeching. Eventually I managed to get some form of sling attached to the patient and secured the elbow to the patient’s body, a slight immobilisation of the arm. Backup finally arrived. I explained the situation and they took the patient away. I’m not sure who was most relieved, myself or the patient’s partner. I met the crew that had backed me up at a few more jobs that night, and at each job they commented on how they’d struggled with the patients all the way to hospital, and how I must have struggled on my own.

Thankfully, I’m reliably informed, single crewed shifts are less common now. Although I found it was a very good way to learn fast.

Here I go again on my own…

“Ambulances will never be single crewed”….promised one high powered ambulance service officer once on a public forum.

A single crewed ambulance isn’t always a good thing. In a true emergency, one crew member can stabilise a patient, but a single crew member will never transport a patient. Ever. No matter what the person in ambulance Control thinks. It is quite embarrassing to turn up at a patient’s house after they have been waiting a while, expecting to be taken to hospital, to have to tell them that you are not able to. There is little or no communication between a patient in the back of an ambulance and the driver. If the patient’s condition were to deteriorate, the driver would be unaware. Still controllers expected us to oblige. Then there was the standing around in the patient’s House uncomfortably waiting for a second vehicle to arrive, with two crew members.

Working from a small station, we only operated one ambulance so there weren’t many of us based there. The unexpected and sudden departure of one crew member, one I worked frequently with, brought on quite a lot of single crewed shifts for me shortly after I transferred there. This continued for an unexpectedly long time, until the service got around to arranging a replacement.

My first one was the day they departed. I turned up, on a hot summer evening, ready for my night shift to be told I was on my own. Our ambulance covered a rural area with a radius of around 30 or more miles, and a main dual carriageway. I had never worked on my own before….

The first call was to an older patient with breathing difficulties. They were asthmatic and known to me as a regular. I drove the short distance to their house quickly and went inside. A family member was there and they were as nice as the patient. I quickly set up a nebuliser to open up the patient’s airway a bit, and began to take some observations. Everything was improving well with the nebuliser, but the patient had raised temperature and a bit of a wheeze when I listened to their chest with my stethoscope – queried chest infection. They had to go to hospital, so I radioed control and requested a second ambulance. A disgruntled controller agreed to send one from the city, almost 20 miles away. “Better put the kettle on then” said the relative.

Having returned to base after seeing my patient taken away by a city crew, I felt the shift was going well. We operated a volunteer scheme from our station – ambulance service trained volunteers with basic life support skills who could attend certain types of job if the Ambulance was unavailable at the time. That night the two designated volunteers arrived in station shortly after I returned. We were chatting away when the next job came in.

It was a call to the river at one end of the town. A drunk had fallen down an embankment and had trapped a foot. ?# (? Before a word implies “queried”, # means “fracture”). I rushed down to the location, to discover I had been directed to the wrong side of the river.

It wasn’t a large river, and there was a small foot bridge next to where I had stopped. It would take too long to take the Ambulance to the next vehicle crossing, so I grabbed my equipment and carried it over the footbridge. As I was leaving the Ambulance, one of the local fire units pulled up behind me, having had the same instructions.

I arrived at the scene – the person had fallen down a bank approximately 2 metres, getting their leg stuck in the loop created by a tree root sticking out of the bank, almost doubling their foot back on their leg. The patients head was almost at the waterline, but being a seaside town, the river was tidal and the tide was coming in.

A quick head to toe confirmed no major damage, other than that foot, and the patient was in good spirits, having sobered up slightly. They had no feeling in that foot, but there was a good pedal pulse present. I examined the scene and began to put together a plan of action. Firstly, a second ambulance, this patient was going to hospital. Next, the two volunteers sitting at the station. They were experienced and their help would be valuable until the second ambulance arrived. I radioed control and requested both. Next, secure the patient’s head, safe from the rising waterline. One of the fire crew supplied a plastic pillow which raised to patient’s head acceptably (neck pain/trauma had been ruled out beforehand, in case anyone is concerned). I began taking some observations, all good. The volunteers turned up and stood at the top of the bank, handing me down equipment as I asked for it. By now, I was standing with my feet on two large rocks, an around a foot of water. A fireman had fitted the patient with a small life vest while I was talking to them and repeating my observations. Suddenly I felt a pair of hand on my shoulder. “You might need this”. One hand stayed on my shoulder and the other one appeared between my legs, as I was also supplied with a safety vest. “You could at least have bought me a drink first” I joked with the fire person. “Would you like me to?” they grinned back.

The fire crew successfully cut through the root and the patient’s foot was released. Miraculously there was only some nasty tissue damage, but no fracture. The patient was strapped to a spinal board, lifted up the bank and taken to the second ambulance that had arrived. One of the volunteers had directed them to the correct side of the river.

I got back to the ambulance station quite please with myself. I had managed that job quite well. The volunteers arrived back before me and, as as I walked in to the messroom one of them said “what happened to your arms??”. I looked at them – they looked like salami! Because we wore short sleeves, every insect in the area must have had a nibble at my arms.

There are rules about what type of jobs a single crewed vehicle can attend. Those were probably the reason the rest of my night was unbusy. That was the first of many on my own, but it’s a great way to learn fast…..

When work follows you home….

I was on day shift the day my father passed away. My partner and I had been out to a couple of jobs but we were on standby in the mess room when I got the call. My partner realised there was something wrong as soon as I hung up. When they found out, they made me go home and contacted control to let them know. I remember driving home, having a shower (not sure why) and changing out of my uniform. The next thing I remember is receiving a call from a family member asking where I was. I was in a small village, some distance from home, on one of my favourite country roads for driving.

I went into hiding for the next three weeks and my friends gave me space. On reflection, possibly neither of those was a particularly good idea. Death was something that happened in other people’s lives. To me they were “jobs”, they had to be. Other people did the grieving, I walked away. Suddenly I was actually one of those other people…and I didn’t know how to be.

On the day I returned to work the second job of the day was to a local nursing home, run by the same company as the one my father had passed away in three weeks previously. The Ambulance screen claimed we were going to someone having a seizure, when we got there it turned out to be an elderly resident in complete cardiac arrest. We began work on the patient, until one of the nursing home staff tried to stop us. It transpired that the patient had a DNACPR order – Do Not Attempt CPR. This document was an ambulance crews’ nightmare, an end of life decision made by the patient or their family and their doctor. It is a legal document that prevents anyone from bringing a patient, usually with a poor quality of life, back from a fatal incident such as cardiac arrest. Unfortunately, until the document is presented, ambulance crews have a duty of care to do the opposite. We asked to see the document and the nurse presented us with a photocopy, not good enough. After 10 minutes of CPR the original document appeared and we stopped. It took around 40 more, long, minutes for all signs of life to completely disappear. 40 long minutes before our involvement was over. As I was doing the paperwork I heard two staff members talking – “That’s the second one this month. There was one in the other home three weeks ago.” my partner looked over at me to check I was ok. I nodded. Back in the Ambulance the screen lit up with the next job….

Some weeks later, it dawned on me that the nursing home my father was in was on the outskirts of my working area and I could have been called to that job

Cancer patients are regular jobs. Usually you gave them analgesia for the pain and took them to the cancer ward. Once dropped off, we’d go to the next job. To sit in a consultant’s office while they explain to you and your spouse that your spouse has cancer is not a situation you expect to be in, nor are you trained for. It is a genuinely surreal experience and it took some time to sink in. “This only happens to other people!!”. These are times when true friends get you both through.

There was no support from my ambulance service, no help offered. Thankfully surgery was successful, but I’m still waiting for any ambulance service manger to ask me how I’m doing, or even show an interest in that situation… or the loss of my father. The support my spouse and myself received was external, from cancer support charities. Without that support it would have been so much worse. The cancer is gone, the psychological effects are still there, but I can’t say enough about how amazing the support of those cancer charities is. If there are heroes out there, that’s where they work.

As always, this post is not about looking for sympathy in any form whatsoever. Ambulance crews face challenges every shift, and I am fully aware I am far from being the only one to face such situations. This post is to highlight yet another reason the Ambulance services across the UK need to step up their staff support, possibly even begin supporting in some areas of the country. We are all only human after all.

There’s that moon again

I spotted another full moon this week. It reminded me that the phenomenon isn’t just limited to night shifts (patients aren’t actually vampires. Vampires don’t get ill). The “less sensible” patient can require ambulance assistance any time and, while we might not know it’s there at the time, during the day when there is a full moon.

One such call appeared on my screen mid-morning one winter. There was a lot of snow on the roads, but they were drivable. The job was about 10 miles from our station and not a high priority, so we didn’t rush.

The on-screen navigation was known for its inaccuracies, and the maps it was based on were somewhat out of date. Thats where the job began to go wrong. The estate we were going to was very new and didn’t exist on the maps the system used, but it still plotted the “quickest route”…..or so we believed.

It was when we drove into an industrial building site we first queried its accuracy. My partner was driving and came to a rapid halt at the bottom of a snowy, muddy, hill. After realising we were off course I decided to look the address up on a well known mapping app on my phone. We were very off course!

My partner turned the Ambulance and drove up the hill, at least that was the intention. Part way up the wheels lost their grip and began to spin on the snow. “You’ll have to dig us out” my partner grinned. Yes, it was my job at that moment in time. I climbed out of the ambulance and opened one of the external side hatches, located the snow shovel (modern ambulances are equipped for most situations) and began to clear the snow away from the rear wheels. My partner slowly began to drive the ambulance clear, and kept going. Stopping at the top of the long hill, they radioed me, suggesting I hurried to join them as we were still en route to an emergency.

After updating control on our situation, we got back on course with the help of my phone. The job was an RTC – “4×4 vs house”. Neither of us was sure what to expect.

As we got closer, we knew we were at the correct location. There were an unusually high number of police cars and officers also making their way to the scene. We turned a corner into a cul-de-sac and knew we’d arrived.

There was a posh 4×4 holding up a spare bedroom, seriously. The driver was out of the vehicle. Their partner was away on business but had asked them to run the car every other day so it didn’t sieze up. Having gone to do so, the driver hadn’t realised the vehicle had been left in Drive and, lurching forwards as soon as the ignition was turned on, rather than brake they had accelerated. This had propelled them across the cul-de-sac and straight into the end wall of the garage attached to the house opposite. The garage the owners had built a spare bedroom above. The car literally was holding up the room as the supporting wall had mostly been destroyed.

The fire brigade had also arrived and we left them to the structural issues while we began to assess our patient. Their injuries? They had knocked their knee on the vehicle door when climbing out! Surprisingly, they declined a trip to A&E. When we asked why they had called for an ambulance they replied “isn’t that what you are supposed to do if there’s been a crash?”.

We later found out that the excessive police presence was because the house next door to the demolished garage belonged to one of the officers.

Around the same time, a city based colleague declared the full moon.

It’s genuinely a thing!

Who saves the life savers?

Someone told me about a TV program broadcast in Scotland recently. It suggested that almost one in ten paramedics suffered from PTSD, and one paramedic interviewed was diagnosed with it worse than had they been on a battlefield! They also said that the Ambulance Service had declined the opportunity to give a representative the chance to be interviewed.

These are the men and women who are responding to emergency calls daily, and their employer doesnt even have the desire to comment on national TV.

There was also talk of things that had been put in place to help crew members and front line staff, but what I hear from those front line staff is different. Other than proving that few in positions of management are actually aware of the reality that goes on outside their office doors, a fact that has been known by ambulance crews for many years, this is nothing new.

The above is not just limited to one part of the country either, it is widespread across all the ambulance services in the UK. I’ve spoken about the 5 minute breaks we used to get after bad jobs, and the phone numbers that get handed out – Call someone who you’ve never met before, who has never met you and never will, and tell them over a telephone line how you feel… Then hope that your colleagues don’t find out because you’ll feel like a failure and they might think that you are unfit to do the job.

That is the reality, that is what ambulance services need to address, and that is why crew members struggle on, until it gets too much and they can’t go on any longer.

I’ve held back slightly in previous posts, but I see no reason to any more. I could write things that would (or should) probably have ambulance service managers squirming, and can back them up with strong evidence, but that’s not the purpose of my blog.

When you watch people die in front of you and you have done everything possible. When you’re faced with an angry drug addict who’s life you just saved but who’s high you took away in doing so. When you face countless drunks who threaten to kill you and your family when you are just trying to help with the injuries they got from fighting. When you spend 30 minutes or more working on a patient, giving CPR, providing advanced life support, then you hear that A&E staff gave up shortly after you handed the patient over….and then you pass that person’s relatives in the corridor…

“Here’s a number you can call if it’s too much.”

This isn’t something that can be changed overnight, and I don’t have any answers or solutions, I only have my own experience and knowledge of what others have been through.

My strong hope is that the Ambulance Service in Scotland, now these issues have been highlighted, now has to act, positively. Maybe other television companies will pick up the story in England, Wales and Ireland. Until the public are aware of the quiet suffering that all emergency workers go through, suffering that sometimes costs their own lives, not much will change.

During my time on the road I saw how my colleagues reacted, I saw the brash, faux toughness, the hard act. I even did it myself. But there comes a time when that doesn’t work anymore. For me, that time was when I left the service. My defenses fell because they werent being topped up for another shift. My support mechanism (my colleagues) was gone. Suddenly I had to face everything I’d seen and done on my own. I can’t heap enough praise on the people around me, the ones who tolerated me at that time. But there were people who didn’t wish to tolerate it, and friendships ended, making it harder. Nevertheless, I got through it with the help of the ones who stayed, and I know of others in the same position.

I’ve spoken in other posts of one friend who didn’t. This post is for them, and the ones like them. For the families and people they leave behind.

Maybe it’s time to think about the health of the health workers. To start monitoring their mental health, to start giving them regular mental health checks. To start saving the lives of the people who save lives.

It started with a mist

Driving: Metal vehicles, adhered to the road by small areas of rubber compound. 14 year olds are taught about momentum and inertia in basic physics at school, but few people apply that knowledge once they’re in the driving seat.

At 20 mph the minimum stopping distance is more than 12 metres, but the average driver focuses 6 metres ahead of them. The average human reaction time is 1.5 seconds – at 70 mph a car has travelled about 483 metres before most drivers’ feet touch the brake pedal, almost half a kilometre!

These facts are not secrets, but people still think they can change the laws of physics, that they are good drivers. A traffic police officer once told me there’s no such thing as a good driver. Some may be better than others, but even they can’t control the weather, the lorry in front’s leaking fuel tank, the idiot drivers on the same road…

Please excuse the physics and driving lesson. The point I’m trying to make is simple – driving is dangerous. There have been significant advances in safety technology- once I turned up to an RTC to find a crumpled mess of a car. Thinking the worst, I ran to the traffic officer standing nearby, shaking their head. “Is the driver still inside?” I said. “No chum, this is them here. We’re talking about petrol or diesel engines. Which do you prefer?” – but despite all the safety improvements, no one is invincible.

Every time you pressed the “999” button, you knew it would bring out the worst in drivers around you. Some panic and don’t know what to do or where to go. Some try to outrun you to get out of the way, some actually stop dead, right in front of you, some even run red traffic lights to get out of your way. Many don’t actually see you!

When you are driving under emergency conditions your senses are heightened. You learn, ver quickly, to predict other drivers’ moves. When there’s a patient dying in the back of the ambulance seconds count, and the pressure is on you to get them to hospital quickly, smoothly and safely.

Sometimes this stress leads to anger, that’s when the red mist descends.

During emergency driver training we were taught about the red mist. It’s a dangerous thing and you have to learn to control your emotions very quickly. There is no place for anger in a diver, especially not one who has a patient’s life in their hands.

Tiredness can help bring on red mist, when the car in front won’t move out of your way, or someone stops in front of you. It’s tempting to drive too close to the unseeing driver, in the hope they hear your sirens better or see the blue lights. I actually did that myself, until I learned it only takes the driver in front to panic brake, and I’d have caused an RTC.

Learning to control my emotions during these situations was difficult for me, but it was an essential part of the job so I learned to do it. There’s no place for road rage, ever, especially not in an ambulance. We all had our pet names we’d hurl at drivers that caused us annoyance, but that was as far as it went, and it was usually in a jocular fashion because we’d probably never see them again.

One time I came up behind a very elderly neighbour of mine. They weren’t moving out of the way, and I followed them (at a safe distance!) for almost half a mile before I finally managed to overtake safely. I quizzed them about it at a later date, they had no idea what I was talking about!

Most drivers don’t get the training emergency drivers do, but that’s no excuse for some of the driving I saw. Anger, annoyance, road rage….red mist. None of those belong on the roads. Calming music (it makes a big difference!), slowed breathing, whatever works for you. Don’t let other drivers bad driving make you a bad driver.

Some may think the next part is obvious, my experience says otherwise – if an ambulance appears behind you with lights and sirens going, think. Think where the driver can go with the least amount of manoeuvring (there may be a lot going on in the back, every move of the steering wheel throws the passengers around). Think about safety, and move out of their way early and sensibly, making your moves obvious to other drivers.

It starts with a mist, don’t let it come to this: