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:

Is this the real life? Is this just fantasy?

Some shifts felt like surreal dreams, they couldn’t have been real. When days off came round, you’d find yourself thinking “did that really happen?!”. But this is daily life in front line emergency care.

You meet your fair share of people lacking…”basic intelligence”…out there. Often alcohol or drugs are a contributor, sometimes it’s just how they are.

This is, in no way, a dig at any nation (#spottheparanoia). The job was an assault in the city centre, around 2300 (11pm). We arrived to find two police officers with a French person who had been set upon by some locals. I think, quite quickly, that I worked out what may have caused them to get the urge to do so. The patient instantly gave off an air of arrogance, and backed it up swiftly with their attitude. “are you a private service?” they asked, with a thick French accent. I stated we were NHS, and asked if they were on holiday or resident in the UK. We established, eventually, that they were studying in this country. Having managed to convince the patient that we were currently the best they were going to get, they, reluctantly, got into the back of the ambulance. Having done a full top to bottom examination it was clear that the injuries were mostly facial, but I advised they went to A&E in case there were any I had missed, possibly even a concussion (unseen injuries that result from blows to the head). The patient agreed. On the way they began to quiz me on the quality of care they should expect. “The same as everyone else” I stated. Then they asked about the broken teeth they had received during the assault. Would they be fixed at the hospital. I said it wasn’t likely. “then you must take me to the airport!” they demanded. They got agitated when I tried to explain the difference between an emergency ambulance and a taxi. Then they demanded an explanation as to why their teeth would not be fixed at A&E. In a moment of kindness I decided to save them from the wrath of the nurses he was about to meet, who would have no tolerance for his attitude. I began to explain in clear term what A&E was and what would probably happen there. I explained that their broken teeth were not a medical issue, that they were a cosmetic problem. “Cosmetic? What is cosmetic?” they said indignantly. I tried to explain but to no avail. Then I had a brilliant idea! This was the 21st Century, and I had a smartphone….with Google Translate! I typed in “cosmetic” – English to French. The translation arrived quickly. With a grin I read it out to the patient. Oh…”cosmetic”. It was exactly the same. The patient still didn’t get it, so I showed them. “ohhhh. “cosmeteek”” they said.

By this time we had arrived at hospital and my grinning partner was opening the rear doors of the ambulance. I stood up and walked out the vehicle. The patient followed me and, after a very brief handover, I left them in the less tollerant hands of the nurses. They would sort that attitude out.

Occasionally we would come across incidents that hadn’t been called in yet. One such incident occurred on a junction of two main roads as we were leaving the city to return to our station. A crowd was gathered just off the junction, in the middle of the road. As we slowed to have a better look, we saw someone lying on the road, the crowd having gathered around them – RTC. My partner pulled over and parked the ambulance in a position to protect our new patient and activated the vehicle’s blue lights. I jumped out and went to investigate the situation while my partner called control to inform them what was happening.

The patient had been on a bicycle and had been struck by a car at the traffic lights. A swift top to bottom examination revealed no neck or spinal injuries, and the patient’s headgear and clothing had protected most of their body. There was, however, the possibility of a fracture, maybe even two, to one of the patient’s ankles. I was on my knees beside the patient talking to them when I felt a tap on my back. “What’s their name?”. Confused, I turned round to someone on their mobile phone. “Sorry. What?” I said. “What’s their name?” the phone person repeated. “Erm…..Who are you? Why?…..What?” was the best I could muster. “It’s the ambulance. On the phone. They want to know their name!”. Okay. Think. What?! I pointed at the back of my uniform shirt, thinking the word AMBULANCE embroidered there might be a clue. Mobile phone person looked blankly at me, so I pointed at the big white van with the blue flashing lights. Nothing. “Can I talk to them?” I asked in despair, my hand held out for the phone. Still unsure of what was going on, the person handed me the phone and I identified myself to the call taker. “Oh hello, I think your partner is on the radio to your dispatcher.” “Uh-huh”. I updated them on the situation and the patient’s suspected injuries. I handed the phone back, just as the police arrived and moved the, still confused, owner away from the scene along with the rest of the spectators.

I found out later that the French patient tried to give the A&E staff grief and was swiftly asked to vacate the department by security. I wonder if mobile phone person has ever understood what happened. Probably not.

Those were two of many real jobs that seemed very unreal looking back. They happened though, I was there!

No more heroes anymore?

Being based in a large rural area involving lots of farms, many patients were slightly older and had resided in the area for years, often decades. Older country folks are a special breed – they don’t like anything modern, or anything they don’t understand. They don’t like a fuss being made over them, they don’t like causing a fuss, and they certainly don’t like hospitals. Many times I heard older patients tell me they didn’t want to waste my time, more than once those patients were in the process of having a heart attack.

Working outwith the city also meant longer journeys into hospital, sometimes up to 40 minutes or more. That’s a long time to chat with the patient (assuming they are conscious!). Those journeys were either hard going or a great experience. Older people have usually seen a lot of changes in their lives, especially if they’ve lived in the same area for a long time. That was usually my conversation starter. Most patients loved to talk about the things they had seen, things they had been through. Most didn’t like to talk about WWII. I did, however, have one patient who got quite upset regarding the war.

I began with my usual “you must have seen a lot of changes in your lifetime?”. The patient agreed, then said “but I did things I’m not proud of”. It transpired they had been part of a special forces group and, although they couldn’t tell me what they had been involved in, they did tell me they had taken enemy lives. This was clearly upsetting to them. I pointed out that, despite the unfortunate circumstances, their actions had actually helped ensure my freedom, and that made them a hero in my opinion. “but I killed people!” they said with tears in their eyes. Humility is too small a word to explain what I was feeling. The person in front of me had suffered all their lives for their part in my safety and my right to live free from dictatorship! I listened to stories I can’t write here, all the way to the hospital. By the time we got there I was speechless. Most people will never know that patient’s part in their lives, or their courage, but I will never forget.

I met a number of genuine heroes in my time with the service, all humble and very un-hero-like. I will always consider it an honour to have met them, a chance to try to care for them as best as I could, albeit nowhere near enough to show proper gratitude.

All heroes, all unwilling to accept that fact. A far cry from some of the so called “heroes” we see on our TV screens now – footballers, pop stars…??

Most who had active involvement in WWII will no longer be with us now, but I hope they, and their effect on our lives, will never be forgotten by us or future generations.

Driving in a winter wonder land.

As snowy conditions are upon us, everyone has seen it – the crazy driver in the middle of a blizzard, driving as if it were a lovely summer day. More than once, I was called to the result of such driving, more than once it was the other driver who was the patient.

In my day, ambulance drivers went through an intensive driver training program, similar to the basic one traffic police officers go through. Part of that was skid avoidance and vehicle control. That part was invaluable when trying to rush an injured driver, fully immobilised in the back of your 2 tonne vehicle, smoothly and safely to hospital. Difficult at the best of times, but worse when you can barely see the road and there are drivers, who think they are much better than they actually are, out there.

I hear “rear wheel drive is rubbish in snow” a lot, but we took our, rear wheel drive, 2 tonne, ambulance lots of places many car drivers clearly didn’t manage.

We signed on at 6pm for a 12 hour night shift. It was cold and icy, but the roads were clear. By 7pm there were a couple of inches of snow….on top of anever thickening layer of ice. The first job we were called to was put of our area and involved a twisty country road. My partner was driving and instantly realised the road was unsafe. I radioed control and informed them of this, and that we would be taking a very long time to get there. Two minutes later they called back and stood us down. We turned round as soon as we found a convenient place, and began our return to the Ambulance station. As we pulled on to the dual carriageway for the final 2 miles of our journey, we noticed headlights, actually, one headlight, pointing at us from our side of the central reservation. By this time the outside lane was buried under a thick layer of snow. We approached the…light gingerly and turned on our blue lights to warn other drivers the outside lane was blocked. As we got closer we saw a car on the central reservation, up against the barrier, facing towards us. The passenger side was smashed at the front and the headlight was gone. Only the driver’s side headlight was still working. We radioed control and updated them. They suggested we took the vehicle’s occupants to the small hospital we were based in as it wod be warm and safe for them to wait for whatever recovery plans they might have. Our controller would inform the police of this.

We dropped our passengers off (all having been given a suitable examination….for the pedantic among us) and pressed “clear”. Immediately the radio went. Control was receiving multiple calls of crashes on the stretch of dual carriageway we had just left and wanted us to go back and have a look. As we pulled onto the road and drove to the area in question, a straight stretch about half a mile long, we were met by carnage. Cars in the ditch, cars facing the wrong direction… Most were accompanied by police vehicles, and we quickly ascertained that most had been low speed incidents and no-one was injured. By now the outside lane was completely obscured by snow. My partner noticed a police car in the distance at our original incident. We decided to drive over to inform them of the occupants’ whereabouts. As we drew closer we saw a third car at the site. We stopped in the invisible outslde lane…eventually, and put on blue lights again. As we stepped out of the Ambulance one of the police officers approached us. I explained our previous involvement and enquired about the third car. It seemed the driver had thought it would be cool to overtake the slow moving traffic in the non-existent outside lane, having not seen the blue lights of the police car blocking the lane in the distance. By the time he saw the policeman with his hand held up it was too late. As soon as his foot slammed the brakes on in panic, the car went out of control. It mounted the central reservation and scraped along the barrier until it came to a standstill, a few metres from the rear of the police car. “both occupants seem ok, but I think the driver’s ego is injured”. I went for a look. I leaned in through the drivers window and asked the usual questions. They were fine. No airbags deployed, no pain, no need to go to hospital. “Good. I’m currently in the process of charging him.” said the police officer. We left them to it and returned to base.

We encountered 6 RTCs on that journey, 7 including the original one. There were others that night, none involved injuries, many could have been prevented.

We took our ambulance places it should not have gone that winter, thanks to our driver training and the experience we gained after it. Places even “4×4” drivers didn’t manage (that’s another story). My prize drive was getting the patient in labour to hospital in a blizzard, before the baby was born.

Snow can certainly create a wonder land, where you wonder far too often what on earth goes through some drivers’ minds!!

Bark at the moon

There’s a phenomenon know across all of the emergency services – the full moon. Ask any of them and there will be no doubts, a full moon brings out the crazies (can I call them that?).

Often during busy nights, when the jobs we’d be called to were of a strange nature, one of us would question the lunar status. Almost every time, the moon would be full.

Every job has to be treated as whatever appears on the information screen, until proven otherwise and, occasionally, it would be a genuine job. Even before starting a night shift, if we spotted the moon, we could confidently predict a surreal 12 hours ahead.

This also applied to being careful what you wished for. While on shift during a full moon, certain people (regulars) and certain types of job or ailments were never mentioned or they actualy came to be! I proved this one shift when I deliberately mentioned one regular patient and a couple of different illnesses at the start. Everything and everyone I mentioned appeared on our screen at some point during the next 12 hours!

I experienced one of my first stabbing incidents under a full moon. On reflection, I should have expected something abnormal. The job came through: a patient in their mid 30s, stab injury to their left leg with a bread knife. Most readers will know that a bread knife has a serrated edge that could do a lot of damage, on the way in…and on the way out. We ensured that the police were dispatched as we made our way to the scene, just in case the assailant was still in the area.

We arrived on scene at the same time as the police. I was attending so went into the house first. I walked in to the kitchen (where else would a bread knife be?) to find the patient sitting next to the kitchen table, with a rather large bread knife protruding from their left thigh. There wasn’t a whole lot of blood evident, but dangerous internal damage could not be ruled out. We would never remove a penetrating object anyway, that was for the staff at A&E to do after ensuring it was safe to do so.

I approached the patient, assessing them and the situation as I did so. They had been sitting with their head down, but raised it as I approached. Their face bore a manic smile that caused me to step back unexpectedly, standing on the foot of the police officer following behind me. “Good evening” I mumbled. “I’d stand up to greet you, but I have this stuck in my leg”. The patient made as if to take hold of the knife. I suddenly panicked that they were about to pull it out. “No! Let’s leave that there” I blurted out, images of arterial bleeds in my head.

One of the police officers began questioning the patient. They asked who had put the knife there. “They did” said the patient. “Who are they?” said the officer. “Them. Them”. Spotting our quizzical looks, the patient clarified – “Them!”, gesticulating wildly at their head. Alarm bells began ringing for us all. Loudly!

We had a mid-thirties patient with possible psychiatric issues, potentially armed with a large knife and a wound that could become highly concerning. Deep breath, reassess quickly. “Can you hear them just now?” said the police officer. “Don’t be stupid! They left when you arrived!”. Oddly, that made sense. The patient seemed calm and in control of themself. I explained that it would be bad to remove the knife, and that I wanted to wrap a bandage around it and their leg to hold it in place. They agreed, and I, cautiously, stepped closer to them.

While I was dressing the wound area, my partner had brought the folding wheelchair from the Ambulance. The, very compliant patient moved across to wheelchair and was wheeled out to the ambulance. “Thanks guys” said one of thd police officers as they were about to leave. Oh no! I wasn’t sitting in the rear of the ambulance with a somewhat disturbed patient on my own. The police have stab vests, ambulance crews have lovely thin uniforms. Reluctantly, one of the officers agreed to travel with me to the hospital while his partner followed in their police car.

The patient was unexpectedly relaxed for the journey, unsettling in itself. I handed over to a nurse at A&E and the on-call psychiatric nurse was called in to help.

I never found out what happened to that patient, mostly because I didn’t ask, but, if I think hard enough, I can still remember the manic look on their face when I first entered that kitchen.

I can’t think of any other job where I was completely on edge through the whole time I was with a patient. It took a bit of time to wind down after that job, but Control weren’t bothered. They had jobs stacking up.

The next job appeared on our screen and we went mobile….

Money talks

It’s true, money can tell you a lot about a person. I said this many times during my career – it didn’t matter if you were a multi-millionaire or a homeless alcoholic, everyone got the same treatment in my ambulance. Ambulance crews can’t afford to differentiate. Yes, there are annoying patients, “regular offenders”, those who obviously don’t need to be there, people who are clearly abusing the system, but in these situations you must put your personal feelings aside and remember why you are there.

After a slow start to the shift, around 20:00 we got a call to an RTC on one of the local country roads. It was a well known corner, a hotspot for accidents. I say “accidents”, but it was nearly always bad driving that caused the incidents.

Sure enough, as we pulled up the cause became apparent. The incident involved an older small car and a large, white, 4×4 that had clearly never been off-road in it’s life. The small car was a bit of a mess and the driver was still in it, the 4×4 was damaged at the front but still drivable, and empty.

We approached carefully and assumed the “fend off” position in the road, completely closing it to traffic from behind. The fend-off position is when an ambulance, or other vehicle, parks diagonally across a carriageway with full emergency lighting on, effectively blocking one or more lanes in an attempt to protect the scene and the people working at it.

I was driving, so my partner quickly got out of the ambulance and went to assess the driver of the small car. I got out and began to look for the driver of the 4×4. I quickly found them! They were strutting round, most upset that their vehicle had been damaged and, quite arrogantly, demanding that their “whiplash” be assessed. I explained that the driver of the other vehicle was trapped and therefore was our priority.

This seemed to be the wrong response. The 4×4 driver was clearly a person of wealth, their vehicle a top of the range model with a private registration. A tirade of disgust and accusations of “******* useless NHS paramedics!” bounced off my back as I turned away and went to get an update from my partner so I could update Control.

The disgruntled 4×4 driver was not finished – they continued to rant at us as the first fire unit arrived and we discussed with the crew how best to get the young driver out of the badly damaged car. The roof and doors were removed by the, ever obliging, fire crews. A second fire unit had arrived by this time and assumed the fend-off on the other side of the incident, completely closing the road.

As we extracted the injured driver of the small car, the 4×4 driver was still determined to be examined. We took the injured driver into the ambulance for a full examination and left the fire crews to make the remains of the car safe.

At this point the police had not arrived.

My partner began to assess the young driver. They had some bad injuries, but none were life threatning. Then the rear doors of the ambulance opened…

“I’m in agony here! I demand you examine me. Whiplash needs to be assessed early!!”

The mist descended and I made my way to the back doors. Barely holding on to my composure, I did my best to politely explain that whiplash was not a priority at this point, and the other driver was. “Call me another ambulance then!!”. I offered to call them a taxi. “My car is also in a terrible condition too. Who’s going to take responsibility for that?!”

Luckily for them, the police arrived at that, potentially explosive, point.

A local traffic unit pulled up rapidly and stopped behind the ambulance. The local officers, known well to my partner and myself (an ambulance messroom is a good source of cups of tea for police officers during slow shifts), jumped out. “Sir! Step away from the ambulance and let the crew do their job!” said one of them, surprisingly forecefully. The 4×4 driver was as taken aback as myself. Then they began their tirade on the police officers. Bad move!

Both police officers made a quick assessment of the scene. “what direction were you travelling in sir?” they asked the 4×4 driver. He indicated his side of the road, then began to complain about the other driver. The small car was a very sporty japanese vehicle, driven by a youngster.

“He came screaming round the corner on the wrong side of the road!” the 4×4 driver ranted. “Hmm…….” said the first traffic officer. “did you move the vehicles after the impact?” The 4×4 driver looked surprised. “Its just that there are very long skid tracks on your side of the road before the corner, that cross to the other side of the road on the corner, and stop under the tyres of your car….Sir”. The 4×4 driver went silent. “That implies that you were speeding, and took the corner far too fast…on the wrong side of the road….Sir”. The 4×4 driver retorted “But….but…he was driving ridiculously fast!”. “Not according to the marks on the road from his car….Sir. Would you mind stepping into the back of our car?” . I’m sure I spotted a wink from one of the officers before they disappeared into the car with the driver.

I returned to the rear of the ambulance where my partner was chatting with the other driver. They were talking about the small car. Aparently it was a vintage, collectable sports car. One of the poice officers knocked on the rear doors so I let them in. They had come to take a statement from the young driver. “I’m sorry this has happened. The road markings are already showing you did nothing wrong, but the official investigation will easily prove it”, The young driver was more concerned about their car. “There are only 250 of them in the UK” they said. “249 now” the officer said remorsefully. “But the other driver won’t drive again for a long time when we’re finished. He’s currently on the phone to his expensive lawyer , trying to explain he’s in big trouble. I don’t think any amount of money will get him out of this one!”

There were many other incidents during my career where money said something about people. Mostly it said about them”I’m arrogant and I intend to use my money to attempt to buy me out of this situation I’ve gotten myself into”. This may sound like some kind of inverse-snob attitude but, unfortunately, nothing on this blog site is made up. It is all based on actual situations and experiences.

So yes, money does talk. But it can’t hide the truth or, in this case, the convicting road makings. And it wil never pull the wool over experienced traffic police officers’ eyes.