Driving with the brakes on

Driving an ambulance is a scary business. It takes training and skill, plus a bit of bravery and fearless concentration. The training is similar to a traffic police officer’s and there is no room for mistakes when you are all that is between hope and death for a patient. That may sound somewhat dramatic but it’s often, unfortunately, true. That adds another element of stress to the driving – consideration for your partner working on the patient in the back. The drive must be urgent, but safe and smooth for everyone on board, and on the road around you. Progressive driving isn’t about speed, it’s about planning and constant awareness. That awareness becomes more sensitive with experience.

I’ve already written about a few incidents and near misses in other posts, here are a couple more:

We had dropped our patient off at A&E in the city and were on out way out of town, heading for our home station. A 999 call came in while we were on the main road across the city, a dual carriageway. I was driving, I checked around me and turned on our systems. Sirens howling, I moved to the outside lane. It was lunchtime and, as we approached traffic lights, I could see a long tailback across both lanes. Since there was no central reservation on this stretch of road, it was common practice to move over to the outside lane of the opposite carriageway. The speed limit was 40 and it was obvious to oncoming traffic that you were coming from a fair distance away. The roads were damp but the rain had stopped, visibility was good. I proceeded with caution down the outside of both lanes on my side, constantly changing the tone of my siren. The oncoming traffic I was facing was moving to their inside lane in plenty of time.

To this day, I have not managed to work out what insane brain process caused what happened next.

As I drove past the two lanes of traffic on my inside, someone who was stopped in a large car in the outside lane on my side decided to be impatient. They seemed to think that the traffic had stopped for no reason and that they could pull out into the oncoming traffic and overtake it, as we were doing. But they weren’t on their way to an emergency, nor were they an emergency vehicle with lights and sirens. Nor had they seen us. As they pulled out into oncoming traffic, it must have dawned on them slightly what was happening. When they saw me in their mirror, around 3 car lengths behind them rapidly approaching, lights and sirens in full swing, I think their folly may have become apparent to them. Despite my cursing, I was blessing the person who invented ABS braking systems as I stopped behind them with inches to spare. That was one of many “butt clenchers” throughout my career. Eventually, they moved back into their lane and we continued. There was no time, and no point stopping for a rant. I’m not sure who got the biggest scare, but I’d like to think they might have learned a lesson in patience that day.

Our ambulances were put through a lot during their active lives, and they were well looked after and maintained by some expert mechanics. This, however, did not prevent occasional failures. These often happened at the most inconvenient of times.

Before the reintroduction of tail lifts in ambulances, they had an automated ramp that folded out and the rear suspension could be lowered. This lowering was done by deflating airbags that the rear of the vehicle sat on. Once the ramp was raised , the airbags were inflated and the rear of the ambulance was raised again. This system worked well…mostly.

In winter especially, these airbags would sometimes burst.

Winter, night shift – we had received an emergency call to an elderly patient. On arrival, the duty out of hours doctor was on scene. We knew the doctor well and we suggested that, because of the patient’s condition, they travelled with us to hospital. They agreed and we left, en route for A&E in the city.

We managed around 3 miles before the loud bang! From there, the rear of the Ambulance was actually resting directly on the rear axle. We bounced along the road, very slowly, for a few yards, before I was able to park the vehicle in a small roadside supermarket car park. We radioed control and explained the situation, requesting an urgent back up vehicle from the city. Fifteen mins later, we saw the blue lights approaching us. The patient, doctor and my partner were all transferred to the new ambulance and disappeared off into the distance. I was left, alone, in the car park, waiting for the recovery truck. What felt like an eternity turned out to be around 2 hours. I finally caught up with my partner at A&E, drinking coffee and chatting to the nurses.

It looks glamourous on TV sometimes, but driving an ambulance is far from it. My initial driving instructor once told us “If you ever lose the buzz of driving to an emergency job, it’s time to retire.”.

They also said “If you want glamour, become an airline pilot. If you want to be a hero, join the army.”.

Where do broken hearts go?

There are lots of amazing things a person sees in their lifetime. Some are lucky enough to be present when a life is brought into the world, then there are simple things like a stunning view, but few get to see a life saved right in front of their eyes. I was extremely lucky because I saw it more than once, and each time I was left in awe.

Time for a quick physiology lesson – your heart has blood vessels all around it, sometimes cholesterol can build up in these vessels and that constricts the flow of blood, similar to gunk building up in your water pipes at home which result in a blocked sink or washing machine. When this happens to your heart it is known as an MI: a Myocardial Infarction. Infarction meaning an obstruction to oxygen rich blood, causing the death of tissue in that area of the heart. This is a very simple explanation, and there are other causes of narrowing of the blood vessels, but it will hopefully help to make sense of the rest of this post.
Percutaneous Coronary Intervention, or PCI. It’s an instant life saving procedure. Basically, a surgeon places a spring like device, known as a stent, into a narrowed blood vessel then inflates a balloon inside it to open up the spring. Once the balloon is deflated, the spring keeps it’s new, enlarged, state and blood flow is improved.

We were allowed to see that happen, live!

When we received a call to a chest pain we always did a 12 lead ecg. This gave us a rough idea what was going on, but we weren’t cardiologists. If we had suspicions, we had the ability to transmit the ecg to the cardiac dept at the local hospital for examination by someone who knew a whole lot more than us. If they deemed it necessary, they called us to ask for more information and, if they diagnosed a narrowing of an artery, we were diverted to the PCI lab at the hospital. By the time we arrived with the patient the staff were all prepared and ready to go. The patient was transferred to the hospital trolley and wheeled through to the procedures room. The surgeon nearly always asked if we wanted to stay to watch. If circumstances allowed, we’d stay. We would be ushered into a small room, where we could watch proceedings through large windows and on large monitors. These monitors showed the patient’s live ecg, and x-ray type images of the process, again, in real-time.

The surgeon inserts a tube, usually into the femoral artery in the patient’s thigh, then advances it towards the blockage, before inserting and dilating the stent. Watching the almost immediate change in the cardiac rhythm was amazing. To think that, without intervention, the patient may have had a catastrophic cardiac event, possibly with a sad outcome, had this quick and relatively simple procedure not happened. It was real-time lifesaving, and we had been a part of it. Someone was going to live longer. Its a simple thing, with a huge outcome.

We’d head back to our ambulance knowing we’d been part of something amazing, and the effect was (literally) life changing for the patient. It was so quick and routine that sometimes we’d become a bit blazè about it, but we’d remember soon enough how special what had just happened was.

This post gives a very simplistic explanation of the PCI process, I’m no cardiac specialist and this is not about the medical aspects of PCI. The point of this post is purely to explain that, life is valuable, and to see a life undoubtedly saved right in front of you is indescribable.

Sharing isn’t always caring.

It’s a paranoid world out there, and humans have a knack of surviving germs and bugs. But every year we’re offered flu jabs. If we go on holiday to certain countries we’re given vaccinations against all sorts of diseases. The illnesses and diseases can kill, but humanity has survived this far by building up its immunities to some of them. Unfortunately, these days there are “super bugs” – MRSA, Clostridioides difficile (aka C-Diff) and others. Sadly, these super bugs tend to be contracted in medical facilities such as hospitals, so the health organisations in this country have gone a bit mad in an attempt to try to eradicate the germs at the source. This resulted in cleaning programmes in hospital wards, operating theatres, ambulances, ambulance mess rooms…

Yes, mess rooms. Places where ambulance crews relax while they wait to be called out. Someone is employed to make sure these facilities are kept within strict guidelines for infection control set out by people in offices. Our messroom was a small room with three smaller rooms attached to it. One of these rooms had once been a shower room but was now used to store equipment we used on jobs, and our PPE (Personal Protection Equipment) kit bags. Since it had once been a shower room, the light was turned on by means of a pull string attached to a switch in the ceiling. During one random infection control check, our messroom was failed because this short length of string was deemed to be an infection hazard, because it clearly had an impact on the way we did our jobs on the road… The solution – slip some tubing that came with an oxygen mask over it. The next visit it passed.

Understandably, the ambulance was a prime consideration. We did a good job of keeping our ambulance clinically clean. There was still a paranoia within the offices of management. Early in my career, when I was based in the big city, a 999 call came over the tannoy and we were next to respond. I was driver on this occasion. We walked through the garage and climbed into our ambulance. As I started the engine we heard the side door of the vehicle ooen and an alarm sounded in the cabin, then it stopped as the door closed again. My partner and I looked at each other confused, we had no observers on shift that day (junior doctors and nurses often joined crews on shifts to see what we did back then). I turned off the engine, got out of the ambulance and went back to see who had randomly got into the back of the vehicle. On opening the door I saw an ambulance officer with 3 pips on his shoulder. I enquired as to his reason fo being in our ambulance unannounced. The officer (earning vastly more than either of us) explained that they were there to check the crews’ hand hygiene at jobs. I asked for some ID as security of the ambulance was my concern as driver. Arrogantly, they stated that we had a 999 to respond to. I took out my radio and sent a call back request to control. Very quickly the officer produced their identity card. I suggested, politely, that they identify themselves before stepping into ambulances, shut the door and drove to the job.

We later found out that the officer had retired but had then been called back solely for the purpose of checking crews’ hand hygiene, at their original wage. Those checks didn’t last long

We constantly had new procedures, changed procedures too many procedures, all aimed at infection control. We often joked that, after certain jobs, our uniforms, possibly the Ambulance too, would need to be burned. If we followed the procedures to the letter, patients would be left in cars in fields, upside down cars at RTCs, people in dirty houses, drunks lying in vomit. We’d not be allowed to treat them because they were all in unsterile environments.

Thankfully, crews on the road had common sense, and most rules were adapted to allow us to do our job properly.

The world is not a clinically clean place, but I’ve not heard any stories of anyone being infected as a result of pre-hospital care. Besides, ambulance crews don’t want to catch diseases from patients either!

Ambulance crews work hard to care for their patients. Sometimes the people in offices need to trust them to have common sense, and just let them do the job they do well.

Who’s going to drive you home tonight?

Older people. We know they great, we know they come in many flavours – sweet, grumpy, old-fashioned…

With Christmas soon to be upon us again, along with the long nights and cold weather, it’s a time when ambulance crews are often called to elderly people suffering from hypothermia, or dehydration. Sometimes infections set in, chest, urine, kidney. All required a visit to hospital. Other times it was something simple that could be treated with medication at home. When I was in the service, the mentality of most of the city crews seemed to be that everyone went into hospital, that’s ok in a city where there is a good transport system, and non-emergency vehicles, dedicated to returning patients home, readily on hand.Because I worked in a large rural area, it was different. There was quite a long journey into the nearest main city hospital so, whenever possible, we and the decent GPs in the area would try to treat the patient in their own home. This was often the best policy as many had no relatives in the area and, as a result, no way to get home after treatment in the city.

On more than one occasion, and this still makes me angry, family members would push doctors or ambulance crews to take their elderly relative into hospital over Christmas or New Year so that they weren’t a burden on the family celebrations. My opinion was that the relative was probably better off in hospital surrounded by people who actually cared, and nursing staff often pull out all the stops for patients at Christmas.

Our biggest problem was, even if we could see a way to treat the patient at home, if they or a family member expressly asked us to take them to hospital, we were obliged to do so. Once at the Accident and Emergency Department, the staff would examine the patient, deem them to be fit to return home then discharge them. This did not mean they were thrown out into the car park, but often it meant a long wait, sometimes in the waiting room, sometimes on a hospital trolley in a corridor, until a relative or friend could be found to collect them or a nursing home arranged transport. Neither of these solutions were ideal. Sometimes, if the patient required transport on a stretcher, they had to wait until a non-emergency crew became available. That would be the next morning at the earliest.

I believe things have improved slightly since I left the job. Doctors have more ability to treat the patient at home, but still there are a lot of unnecessary calls made to the ambulance service, patients unnessarily transported to hospital, unneseccarily using resources and bed space that hospitals don’t have to spare. Sometimes its the fault of the relatives or care staff, calling an ambulance when it’s not really required, sometimes it’s just a problem with the system.

Wherever the issue lies, should you or a loved one find yourself stuck in an A&E department for hours waiting to get home, please don’t blame the ambulance crew. Part of their job is to take people to hospital, that’s all they did.

It doesn’t matter if you’re black or white.

Whatever you’re views on Michael Jackson, he had a point. It really doesn’t matter the colour of your skin or, for that matter, your gender orientation, religion, belief in unicorns….. We are who we are, and that’s an amazing thing.

Nowhere is this more important than in the back of an ambulance. Every person will bleed the same colour, no matter what the colour of their skin. Everyones’ heart works the same, beats the same, no matter what their religious beliefs. To an ambulance crew, you are first and very foremost, a patient, and all the same rules apply.

Granted, people with certain sexual orientation and drug users sometimes require extra infection control measures, but not because of who they are. People with certain religious beliefs require certain parts of their beliefs to be respected in their treatment too.

The bottom line is that there is, and there will never be, any place or time for racism, homophobia or any other form of bias in an ambulance!

It was a Friday or Saturday night, an alcohol fueled altercation in the city centre. My partner that night was a veteran paramedic, quite large, not to be argued with. We arrived to find two males had been involved. One was in a police car being interviewed, the other in a shop doorway also being interviewed by the police. I went to the police car to check on the person in there, my partner went to the person in the doorway. My “patient” had red knuckles, from the impact with the other person’s face, but no other injuries. My partner’s “patient” had a cut lip, also a result of the fist/face impact. This person also had darker skin……

The police were surprised when we appeared, but it transpired the victim had called us. We examined both people and determined no loss of consciousness, blurred vision, broken bones etc, therefore no requirement for hospitalisation. This didn’t go down well with the victim. As we walked away the victim shouted “You’re all just ****ing racists!”.

My partner stopped in their tracks. It felt like the whole world stopped for a moment, everything went silent. The police officers tensed up.

They slowly turned, walked back to the patient, looked him in the eye and slowly and clearly said “Don’t ever repeat that in my hearing! Man up, sort yourself out and get on with your life. I am following ambulance service protocols, protocols that apply to everyone. Now if you wish to discuss racism, let’s get one of these police officers across.”. The patient, now speechless, raised his hands by way of a stunned apology. My partner turned and walked back to the ambulance. I too was speechless as I drove away from the scene.

Then my partner turned to me “Coffee?”. We refuelled the ambulance and picked up a couple of strong brews. “That went surprisingly well” they said, and we both let out a sigh of relief.

I already wrote about affluent types, now colour, country of origin, religion, sexual persuasion….there is nothing in this world, other than your attitude, that will cause you to be treated differently to anyone else when you are a patient in an ambulance. Please bear this in mind should you be unfortunate enough to find yourself there. Ambulance crews are very unbiased, they have to be. Their job is to save or maintain “life”, not “certain lives”.

And they don’t appreciate malicious accusations.

Daytime Dramas

Daytime television. An unfortunate part of standby on many day shifts. We didn’t often spend much time on standby and, if we managed to do so, it didn’t usually last long, but the TV was always on.

Monday to Friday the mornings were filled with property programmes and “chat” shows. Afternoons were slightly more acceptable as they mostly consisted of antique shows and quiz shows. Occasionally there would be a good war movie on, but that could sometimes spark a war if one person didn’t want to watch it. Bank Holidays were a bit better because they generally involved a better class of movie.

In 2012 we were lucky to be able to watch some of the Olympics from London live.

Having only freeview TV on our station, we were slightly restricted. The crews on some ambulance stations joined together to pay for proper Sky TV so had seemingly unlimited channels to watch. To me, they were paying for more channels of the same daytime TV we were watching.

Weekends were more interesting. Saturdays involved programmes from large kitchens, and sport in the afternoons. Sundays were similar, with an ok movie in the afternoon, occasionally a Formula 1 race, although they regularly caused disharmony in the ranks. Not because of driver loyalties, but because usually one of the two crew members didn’t want to watch them – “it’s just cars going round and round…” or similar.

Most night shifts were too busy to spend much time in the mess room for much of the shift, but there were movies on most nights and, after the sensible people had gone to bed and the viewing options became limited, we would listen to the radio stations available via the TV.

The TV in our mess room was quite large, the mess room wasn’t. It had been bought with money gifted by the relatives of a patient, so we were proud of it. There was also a matching dvd player, and a pile of dvds that no-one had actually watched sat on a shelf on the opposite side of the room.

The only problem was allowing yourself to get interested in a programme, or caught up in a film. Guaranteed, just as things got tense or exciting, someone would become ill and we’d get the call to mobilise. This was never really a point of anger, it was our job to attend I’ll people after all. It was more a point of annoyance. Mostly annoyance at ourselves for becoming involved in whatever we were watching.

Sunday mornings were generally filled with soap opera omnibuses – a week’s worth of episodes, in one programme. Some of our crew members were slightly addicted. In those situations I’d quietly beg for a job, even a mundane transfer, to happen.

You knew it was bad when you began bringing things you had watched into conversations with friends, like a true daytime TV expert. But some programmes I despised. One in particular, the host as much as the show. I smiled out loud the day the production company announced its end, despite the sad and unfortunate event it took to make them see sense.

I learned things about properties I didn’t know, watched cringe-worthy movies, knew the names of soap opera characters. Mostly, I never saw the end of a lot of TV programmes and films, but it never bothered me.

Thanks for…..nothing

Patients and relatives sometimes felt the Ambulance crew that had attended them deserved a proper thank you. We were not allowed to accept gifts from patients or their families, something most of us were quite happy about about if the truth be told.

Instead, many sent in cards. In my area, these cards wod usually go to the main office for the area. Rather than send the relevant crew the card, the crew received a photocopy of the card and a stock letter of “commendation” from the main area manager…..signed by their secretary. I have a few of these photocopies and the accompanying letters, all say exactly the same, word for word. It showed no gratitude, no respect, no interest. Did the big boss even know their secretary had sent them to the crew? Were they even bothered? That’s how it felt when we opened the envelope.

But we knew that the originator cared, and that we had made a difference. That was worth so much more than the letter that went with it all.

My station won area team of the year once. I’m still not sure what that meant – no big congratulations, no rewards, no pat on the back or recognition…from anyone. We all got a photocopy of the certificate in our pigeon holes though, and we actually got to put the certificate on our mess room wall, in the frame we paid for ourselves. We also had to take it down each time there was an infection control inspection on the station.

During my training we were warned about taking sweets from patients. We were told the story, probably untrue and embellished more each time it was told, of the crew who went to take an elderly patient into hospital. As they put the patient onto the ambulance’s wheelchair to take them out of the house, the patient told them to take a bag of nuts for them to eat in the Ambulance. Gratefully, the crew accepted. On the trip to hospital the patient said to the attendant in the back “I hope you enjoy those nuts, I can’t eat them. I can suck the sugar coating off them but the nuts are too hard. It’s my teeth you see.”!

It was still the best job in the world, I said from the start that, if one in every few hundred people said thank you, it was worth it all, and the people who mattered were definitely grateful.