One out, one in.

The Ambulance Service, possibly the whole NHS, has a number of “superstitions” or beliefs – the word ‘cancer’ isn’t mentioned much, usually replaced by ‘ca’, the word ‘quiet’ is never used for fear of unleashing mayhem and madness. Then there’s the belief among many crews that, when a person dies, somewhere a new life is born. That one worried me most.

I had never been a fan of babies. In our training we were told they were aliens, that their bodies didn’t behave in the same way as adult bodies, and that they had ways of controlling your mind through loud, sustained noises. Also that the substances their bodies produce require hazchem protocols to be in place. That’s probably why I managed to avoid any being delivered in my ambulance during my career.

I had a few near misses – a long emergency drive in blizzard conditions, using every driving skill I’d been taught, terrified some other driver would do something silly that might cause us to crash, but I got us to the maternity hospital in time! Dropping an expectant mother off then hearing the new baby cry as we wheeled our trolly out of the ward.

One memorable birth involved a father who was known to be violent to emergency personnel. We were told to wait in the vacinity of the flat until the police arrived before entering. Little did we realise that we had parked in a spot visible to the flat. The first we knew was the father tapping on the passenger window of the ambulance. My partner lowered the window slightly, expecting something bad. “it’s out! The baby is out. What should I do?” he said excitedly. We established that the baby was breathing and the mother was well, then advised him to let the mum hold the baby and make sure baby was kept warm, and that we’d be there as soon as the police arrived.” ok” he said cheerily, and trotted back to see his new child. Once the police arrived we went in. All was indeed well, and we let the father cut the chord. So much for violent, there were happy tears in that man’s eyes, it was heartwarming.

I’m not really proud of the fact none were born in my ambulance, but I am slightly relieved. New life is an amazing thing, genuinely a miracle of nature, but babies are terrifying!

One out, one in. I’ll try to explain the first half next time….

High but not mighty.

“Recreational drugs – relating to or denoting drugs taken on an occasional basis for enjoyment”

Above is a definition given when one searches the word “recreational” in a famous search engine. My experiences were very different. None of the users I was called to were occasional users, none of them were particularly enjoying life.

Having never used non-prescribed drugs, I can’t talk about the feelings they give the user, having deemed life extinct as a result of their use more than once, I can talk about the feelings they caused in me. Anger, despair, sadness…the list goes on.

I will never understand why someone feels the need to use drugs to “enhance” their lives, knowing the addictive properties and the devastation they cause, but they do.

I’ve mentioned Narcan/Naloxone before in a previous post, a drug ambulance crews carry that blocks the effect of opioids (heroin etc),for a short time. Time enough for the patient to recover rapidly and realise that the hit they needed, that they’d paid for, had been removed. This was often met with anger and, with it, violence. It also meant that, if the patient had taken a significant amount of their chosen drug (generally the case in an overdose situation), the effect of Narcan would not last as long as the effect of the overdose. The use of this life saving drug relied on the ambulance arriving ,and the drug being administered, in plenty of time. More than one person asked me during my career – did I ever think of taking a little bit longer to get to jobs, thus allowing the drug user pass away and easing the burden of drug users on society. My answer was, and always will be, a very definite no! My job was never to play God. No ambulance crew member anywhere has the right to decide who lives and who dies, their job is, unquestionably, to preserve life. Millionaire in a mansion or homeless in a cardboard box, the level of care is the same in the back of an ambulance.

The job came on our screen as a drug overdose in one of the “less salubrious” parts of town. We rushed over and arrived at the same time as one of the single crewed fast response cars. All three of us ran into the building and up to the correct flat. We were met at the door by a strangely cheery person with a needled syringe behind their ear. Needles are always a concern to crews in drug-related incidents, but this person assured us they would deal with it correctly and guided us through to their friend. The patient was unresponsive and breathing worryingly slowly, but their heart was still beating. My partner got to work with the bag and mask, a way of pushing pure oxygen into the patient’s lungs and ensuring that oxygen was fed to their vital organs (assuming their heart was still working) , while I began preparing the Naloxone injection. The third crew member began inserting a tube (known as a cannula) directly into a vein in the patient’s arm. I injected an amount into the drug directly into the patient’s arm, just below the shoulder. This would not work as quickly as if it was injected directly into their bloodstream, but at least it would have some effect before the cannula was in place. Once the paramedic had the cannula inserted I inserted a further dose straight into the patient’s bloodstream. The effect was almost instantaneous, but we had all anticipated this and had stepped away far enough to be at a safe distance when the patient came round and realised what had happened.. Once they had calmed down and we had explained what happened, the patient refused transport to hospital, so we filled in the relevant paperwork and left. As we walked back to the vehicles the fast response car driver suddenly shouted “SH*T!!”, and ran back to the flat. It transpired he had left the cannula in the patient’s arm, a drug user’s dream – direct access to a vein!

Drug related deaths always seemed so pointless, a waste. They also had their own hazards, as I’ve already mentioned, needles. One job we were called to, My partner was about to kneel beside the patient, just as I caught a flash of an uncovered needle on the floor, right where my partner was about to put their knee! then there are the patients who become suddenly extremely violent and threaten crew members with whatever comes to hand – needles, kitchen knives…. Often you don’t feel fear in the situation, but it comes afterwards when the reality of the potential outcomes hit you.

Legal highs are becoming more and more popular. They are available from corner shops everywhere, the owners happy to cash in on legalised drug dealing, not giving a thought to the harm they are causing. Many times I was called to patients who were having bad trips, or who felt like their hearts were trying to leave their bodies. When asked if they knew what they were taking, not one of them did. They all seemed surprised that some unknown drug was affecting their body in unexpected ways, thus was the rationale of the drug user.

There have been campaigns telling us the perils of drug use for decades, but there are still people who think it will be different for them. There is no convincing some people, even some who have lost friends though drug abuse, such is the grip addiction has. Ambulance crews across the country will continue to take their abuse, and will continue to put themselves at risk to try to save people who have no respect for their own, or anyone else’s life. Ambulance Service management will continue to tell crews they will never put them at risk, that they should always put their safety first……….but the same managers will still expect their ambulance crews to go to these jobs on a regular basis, because targets must be met…..

Driving the point home.

Bad drivers….. We’ve all seen it, some have been victims of it. When you’ve been to RTCs caused by it you find it hard not to get angry about it. Warning – controversial, blunt and slightly angry, comments ahead!

Bikers, or “organ donors” as they are known by some ambulance crews, are often the most annoying. Whoever stated they should be allowed to “filter” through queues of traffic (drive, usually at silly speeds, between rows of queued cars) must have been a bit disconnected with reality. Bikers, in my experience, come in two types – the sensible ones who act like genuine road users and the dangerous ones who think it’s fun to drive fast and have no interest in the potential devastation they could cause to other peoples’ lives. At this point I expect any bikers reading this to be cursing me. If you are one of those, I would love to give a list of relatives who have lost loved ones to bikers who were “having fun”, or lost relatives who were bikers. Maybe you could try to explain your thoughts on the matter to them?

From very dead motorcyclists to very injured ones, Bike vs Object was never a good job to be called to. As soon as you read that on the ambulance screen you know it won’t be a good outcome. Then a few days later we’d see the tributes – “They lived for their family” or “they died happy, doing something they loved”. There is no such thing as “dying happy”! Dying is always bad, dying as the result of a crash is often very painful and not something enjoyable. As for “living for their families” – it is selfish because children lose parents, partners lose loved ones. It’s also life changing for other innocent parties who may be caught up in it. I could describe jobs I was called to involving motorbikes, but I doubt it would change views. Surely, if a rider expects to be treated as a road user, they should then act like one? It’s not complicated.

Boy/girl racers! – I was called to my first RTC involving a racer early in my career. Cars are very safe these days, but not when modified and driven by idiots who think they can drive them well. My first experience of this was a young driver in a well known Japanese rally-style car. They had come out of a side street at great speed, straight into the side of an older driver’s car who happened to be directly in their path. On arrival, another crew had seen to the extraction of the older driver, who had sustained a number of broken bones. We attended the younger driver, who had foolishly got back into their car to wait for us. They seemed in great spirits, laughing and joking, not caring about the injuries they had inflicted on the innocent older person. Remaining professional, with great difficulty, I asked the driver if they had any pain in their back or neck. To this day, I still maintain that, at that point, they saw an opportunity to become a “victim”. “Yes” they said, suddenly appearing concerned for their own welfare. Immediately we began to treat them as protocol dictates for a spinal injury. I asked one of the police officers nearby to get into the back of the car and hold the driver’s head still so as to maintain their spinal alignment. Then I approached the fire chief and asked him to remove the roof of the car to allow us to extract the driver safely. At this point the driver became very agitated. Suddenly their pain disappeared, but they had claimed they was in pain in front of a number of uniformed personnel, we had a protocol to follow, and the police officer’s hold on their head tightened slightly as they protested. Resigned to their folly, the driver was extracted from their roofless car, immobilised so their spinal column was safe from further damage, and transported to hospital. Rightly or wrongly, I felt no guilt knowing his car was fit only for the scrapheap as soon as the roof was removed.

While it is not the job of an ambulance crew to judge a patient in any way, nor would they do so publicly, there were many jobs like the one above where we had to keep our thoughts to ourselves and remain professional. My job was to maintain life and protect the welfare of my patients, no matter what happened before my arrival on scene. The police however had a bit more interest in the events beforehand, and they could take action or give an opinion based on that.

The following happened on a major dual carriageway: A young driver had lost control of their vehicle, having taken a corner far too fast. We arrived to find a very dented car on the central reservation, the young driver standing next to their pride and joy with their head in their hands. My partner went to attend to the driver while I spotted a local traffic police officer we knew and went to find out what had happened. When I asked the officer if the driver had been travelling fast, they took me to the rear of the vehicle and pointed at the exhaust outlet pipe. It was huge! “any more questions?” he said, one eyebrow raised. I shook my head and walked back to the ambulance.

All of the above may sound like a bad prejudice against bikers and racers but, as I mentioned earlier in this post, there are the sensible ones. It is fun to have a fast bike or car, but public roads (there’s a clue in there – public) are not the place to have that fun. There are track days at many race tracks around the country where adrenaline rushes can be had. I’ve seen too much death and destruction, lives and relatives left behind lives’ destroyed by what can only be described as foolish acts of selfishness. I drove fast in my youth, but I was lucky enough to learn from other peoples’ mistakes.

The day after I completed my vehicle extrication training I received a phone call. A good friend had studied hard, worked his way up within his job had finally bought himself his dream car. That day he died in it, because he thought he could cope with driving it fast on a country road. I was devastated, and my instructors wanted to send me home, but I knew I had to continue so I could maybe save someone like him one day. So yes, I get angry when I see stupid driving. Yes, for me, every RTC was personal.

If you disagree with anything I’ve said above, please get in touch. I’d love to hear your views.

Chinese whispers, in African.

I had never seen a dead body before! I had been qualified only a couple of months and had, up till now, managed to avoid a fatality of any kind. We signed on to our night shift and all was well, then the call came – “59361, 999 call. Male fallen from 4th floor window.”. This was it! My first sight of a dead body, and it was going to be gruesome.

I was attendant that night so it was my job to deal with the patient, or what might be left of him. My partner, a veteran, read the terror on my face and began to rib me a bit. I was getting nervous, but this was part of the job, I had to get through this.

Further details began to come through as we sped to the scene. It was a block of flats we both knew, and the ground below was concrete. “middle aged African male. Fallen out of fourth floor”. There was little chance he could survive that.

The ribbing continued, my nerves grew.

We arrived and were met by another African gentleman. “in here! In here!”. He ushered us into the building. What kind of person takes a dead body inside?? Then he took us to the lift…

I was starting to get a bit shakey. “man up” my partner whispered, by way of encouragement.

We stopped on the fourth floor, and heard shouting as the lift doors opened. As we stepped out we were met by a strange scene. Two, rather large African men were being restrained by their friends, either end of the long corridor outside the flats. One of them had a cut lip which he immediately demanded attention for. I looked at it and politely suggested that he… up.

Seconds later the police arrived. Both men were arrested and we were stood down.

As we drove back to our station we were confused, bemused and very much relieved. Strangely, there was also a large feeling of anticlimax. Once more I had avoided a death, but how??

Then it dawned – there had been a fall out ON the fourth floor, not OF the fourth floor!!

We laughed a lot, and the call taker was reminded of it often.

I faced my first death shortly after, but that’s another story……

Every face tells a story

Well, most do. During my career I became good at reading some patients’ faces, in particular their eyes. You become good at being able to tell if they are lying, or hiding something. Then you start to notice sadness, hurt, sometimes happiness when you chat about certain subjects.

This is usually a good thing, but sometimes it’s not. Sometimes you’d see some sadness and, when you mentioned it, the defensive walls would crumble and the patient would open their heart to you. As helpful as this usually was to the patient it, more often than not, left you with an unexpected insight into that person’s hurts. Some of our regular alcoholics began to trust us because of this. We weren’t there to condemn them, we were there to help them. In front of their drunken chum’s they were mouthy and brave, alone in the back of the ambulance their true personality would often appear. Most had stories to tell, the reason they became dependent on alcohol, the wonderful lives they’d had before their addiction, the tragedy that made them look for comfort in a bottle….

She was in her late 20s, had come from another country to earn a PhD. While here, her father had died suddenly back home but she couldn’t afford to return to be with her family and attend his funeral. She saught comfort in alcohol and met a guy, already alcohol dependant, who dragged her into a dark world of alcohol abuse. We attended her lots, drunk and incapable, unable to stand or walk. Basically her “boyfriend” didn’t want to take responsibility for her care. She would sit in the Ambulance and cry as she told us how much she wanted her old life back, how much she wanted to get her life back together. Every time it left you a bit sore inside. Then it made you angry when you found out the A&E staff had discharged her because there was nothing they could do for her.

I transferred to my country station and didn’t see her for a long time. Then, one day I met a police officer I knew, at a job in the the city. I asked if she was still a regular. She had died some time after I had last seen her, drunk herself to death. No one seemed bothered at the bright academic light that had gone out.

He was a proud soldier who had served his country, then his wife became ill and passed away. His comfort was from a bottle. He liked to create a scene in public places, but in the back of an ambulance he was a hurting man with a proud history. I never found out his fate, but I did find out that, when sober, he gave regular significant donations to a certain charity.

Every face has a story to tell. Not all are obvious, not all are that interesting, but all are important to the person to whom the face belongs. Before you judge, be sure you have considered all of the facts.

Oh. Is that serious??

Medical terminology has long been a source of entertainment for many ambulance crews. There were the smart dispatchers who would try to use fancy medical words when they sent jobs to the crews, but the majority of patients had no idea what they meant. They did, however, brighten up the crews’ days. Whether laughing at the dispatcher or finding mirth in the words themselves, the effect was usually good.

“Ah yes Stan. You appear to be suffering from an acute case of epistaxis” (aka a nosebleed). It was ok to joke with the regulars, building a rapport with them was like a form of reassurance, and reassurance was one of the best tools we had. But medical terminology also made the mundane jobs more bearable, like the D&Is (Drunk & Incapable). We were often called to the results of drunken brawls and, assisted by the police, we had to decide whether or not the drunken individuals actually required transfer to A&E, or if they could safely be sent on their way. On initial examination, were the brawlers relatively compos mentis, we’d sometimes do some “unorthodox” tests. Nothing nasty or horrible, just silly things, like the straight line walk, the finger to nose test (often resulting in a poked eye!), and the medical terminology test – “I’m afraid you seem to be suffering from a bilateral, periorbital ecchymoses!”. This either resulted in a look of confusion, or a sudden look of horror. “Is that bad? Am I going to die?!” If we provoked the latter we would be quick to explain.

At this point I should probably clarify – we would never encourage fear in a patient, and if extracting a small bit of fun at the patients’ expense would never be taken beyond a simple laugh.

A periorbital ecchymoses means nothing more than a black eye. Bilateral meaning both eyes.

Fun with medical terminology was not restricted to the patients. We sometimes played Word(s) of the Day – a medical word, or expression, would be chosen and the challenge was to use said term in a meaningful patient handover to the staff member at A&E. There will never be a greater triumph in this game than my ex-colleague who managed to seamlessly fit the term “fecal smudging” into their handover. The patient was elderly, a queried hip fracture, and had been lying on the floor of their house for some time. The situation was perfect, the stage was set. On our arrival at A&E the word was spread around crews there, and a few select nurses. Like excited children we sneaked around the other side of the receiving area to watch. The jammy sod got a student nurse! My partner began their handover and the student nurse stood, listening intently and nodding their head in an almost knowledgeable fashion. Then it came – “………..significant fecal smudging up the patient’s back……….”.

My partner continued as if everything was normal, the student nurse continued nodding. That moment cost me coffees for a week! It was never forgotten. Other Words of the Day ranged from” bogey” to “butt plug”. The latter was involved in a failed attempt. Thankfully I was not there to see it!

None of the above involved any harm to anyone, but they were part of the mechanism that helped many ambulance crews cope with the more mundane parts of the job. In some cases they even helped ease the stresses of other jobs.

There has been much criticism of ambulance crews seen laughing on the way to jobs. Never underestimate the professionalism of ambulance crews at a job. But also, never query their coping mechanisms, unless you are willing to get out there and prove you could cope better with what they have to deal with!

It’s based on a true story… Honestly!

Of course I’m talking about the well know UK television show based in the ED of a well known, entirely fictional, English hospital. While I used to watch it purely for the clinical inaccuracies and the abnormally dramatic lives of the staff, now some of the the storylines are close (sometimes very) to jobs and realities I have dealt with. Most recently; Man down, the loss of a colleague. During my career that spanned more than a decade, a number of fellow ambulance colleagues passed away. Some through illness, others in accidents, one more tragic. Most I didn’t know too well, others i knew a bit better, all were sad and their loss was felt across the service. The latter I trained with.

I knew the person closely for 10 weeks, we trained together back at the start of my career. They were a major help towards me passing the exams, a close friend for those weeks away from home, then I never saw them again. but that didn’t ease the impact the news of their passing had. I don’t know the full story, but I know that the job we did had a big involvement in their passing, and that greater support and intervention may have prevented it. I recently met up with a friend who was closer to them. The loss has been very obvious in that friend’s life but, thankfully, support is finally in place for him. But it came from his GP, not from within an Ambulance Service.

The coming episodes of the TV series apparently show the paramedic, and other ED staff left behind after the loss of their colleague, slip into a dark places. I remember the last radio call for paramedic Jeff on the program, my colleague received none of that. Circumstances may be different, but the emotions are the same, as are the questions in peoples’ minds – once again, could more have been done to prevent it?

Ambulance services across the country need to step up care of their staff. I loved my job, but most ambulance crews see and go through things that change the way you view life. “here’s a number you can call….” never has, and never will be enough. I realise this post might ruffle a few feathers in a few ambulance divisions but I hope that, rather than the usual brushing problems under the carpet, they might try to change things if that’s the case. When someone feels unsafe, unsupported by the organisation they work for, something is very wrong!

The TV show may be fictional, but some of the characters and stories are closer to life than you might think. Yes, this post might read like an angry grumble about the lack of support available to ambulance crew members, probably because it is, but I’ve not even brushed the surface of the problem. No one should be abandoned for doing their job, for trying to save lives.

For every “Jeff”, every “Sam” and every “Iain” out there……