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.

All is Q on New Year’s Day…

The title is (for the benefit of the younger readers) a line from a U2 song from 1983. I omitted the rest of the “Q” word out if respect for the emergency workers who are on shift.

Basically, the main purpose of this post is to wish everyone, ambulance crews and not, a happy and unbusy transition period, from 2018 into 2019.

I’ve spoken of suicide season before, this is the time when some people can’t face another year of despair and misery. But it’s also a time when people see the opportunity to start afresh.

A few years ago, when I first left the Ambulance Service, I had a very difficult year where people I’d considered friends and colleagues turned their backs on me, and much more. I began to write my thoughts down during the sleepless nights and it actually helped me to find that there are actually positives in life, if you look for them.

I thought now might be a good time to share those thoughts, not because I think they’re necessarily right (they are simply my thoughts regarding my life), but because I hope they might help other people to make their own evaluations on their lives.

There are a lot of observations regarding friends, but that’s actually intentional and for a good reason. Friends are very important, but you are very much important as a friend to them too.

Here goes:

“201X was an educational year, and here are a few of the things I learned plus some I’ve relearned. There is no particular order, other than as things came to me. They also apply to no specific people, although some were prompted by things that happened. None are advice, all are my personal take on life:

I’ve earned that, if someone takes hours, or even days, to respond to a message, they may just be busy or I might not be as high on their list of priorities as I thought. But that’s ok.

I’ve learned that some “friends” are happy to be around when things are fine, but aren’t interested when you need them. They’re actually not friends.

I’ve learned that some people find it easier to ignore you, rather than act like adults and admit that they might actually have been wrong as well and talk it over. That’s ok too.

I’ve learned that sometimes, dropping someone a short message or a call, just to say “hi” can mean the world to them, instead of just “thinking about contacting them” or hoping that someone else will.

I’ve learned that it’s good to be spontaneous sometimes. Climb that tree, tell that person they have a lovely smile or nice eyes…. Why does it matter what strangers think? Who knows, you might make someone happy, or even make their day.

I’ve learned that true friends never go away, sometimes they’re just waiting in the wings for you to get in touch.

I’ve learned that new friends come from unexpected areas, and that real friends will climb that tree with you.

I’ve learned that true friendship is not, and never has been in any way whatsoever, connected to any social media “friends”list, and anyone who thinks otherwise is not a true friend.

I’ve learned that some people are happy to accept your help, but not willing to return the favour when you need theirs, but that’s ok too because there are always going to be friends who are.

I’ve learned that you should stand up for your rights. No person or organisation is big enough to beat honesty and trust when they’re in the wrong. It’s just a matter of time.

But, most of all, I’ve learned that, despite the negative things that happen in life, there are always positive things too. Newton’s Third Law states – For every action, there is an equal and opposite reaction. Sometimes the positive reaction is difficult to see, but good friends can help you with that.”

Here’s to 2019, where we might not get what we want, but I hope we all get what we need.

Have a happy and safe New Year!

’tis the season

Christmas and New Year – the festive period. Parties, celebrations, presents, cheer, making merry, over indulgence, fights, depression, suicide……

It’s difficult to feel festive sometimes when your Christmas is filled with the latter. It’s sometimes known as “Suicide Season” by emergency personnel, a time when it becomes too much for some people and they try (and often succeed) to end the pain inside. Depression becomes a bigger problem for many who suffer, as they see everyone around them having fun and enjoying themselves. I’m not going to apologise for painting a bleak picture. It’s a very real one, and many ambulance staff are in the middle of it. It’s difficult not to feel it when your eyes are opened in the back of an ambulance.

Regular calls to city centres for broken ankles caused by crazy high heels and icy conditions. Revellers, drunk and incapable, filling hospital beds because there is nowhere else to take them, and to send them home could be fatal. Ambulances stocked with space blankets (large, foil blankets designed to help retain body heat) to wrap half dressed patients sitting on kerbs, feeling sorry for themselves.

Then there’s the obligatory Christmas Day stroke/heart attack. One Christmas Day I was on shift with a probationer. We began our shift at 6am and I explained we’d have at least one “stroke” or “heart attack” call that day to somebody’s granny or grandad. They told me I was being negative and that it was going to be a good day, so I suggested a small wager. It was an icy day, no snow, and we had a number of calls to elderly patients who had slipped and fallen on the way to the car as families were drawing together around the country. All our patients, and their relatives, were in good humour that morning. Then came Christmas lunch.

We had taken our own Christmas lunch in, and a couple of other crew members dropped by with goodies. Then it came – an elderly relative was having a heart attack after their lunch and was unresponsive. My partner was a tad disgruntled as we rushed to the ambulance. Because we worked twelve hour shifts, we drove six hours and attended patients for six. I had been attending all morning, now I was driver. We rushed to the job as I explained to my, somewhat naive, partner that it was probably nothing, and that the patient was probably just having a snooze after a large lunch. They called me a cynic and prepared themselves for the worst; having to tell a family that their loved one has passed away on Christmas Day is never pleasant. We arrived at scene and my partner ran inside, to find the elderly patient fit, well and wide awake, also extremely confused about all the fuss. Tests proved the patient healthy and that nothing untoward had happened. We left the family to enjoy the rest of their day and returned to our station. There I explained further the parasympathetic nervous system – simply explained, after a large meal the body diverts energy to digestion. This is why many people feel like a nap after something like…..Christmas lunch. For many elderly people this can be a deep sleep, often mistaken for unresponsiveness and a stroke or heart attack.

Unfortunately, this isn’t always the case, and ambulance crews give sad news to many families, more poignant around this time of year. While the Ambulance crews walk away and go to the next job, the relatives are left mourning their loss, often tainting future Christmases for years to come.

I mentioned depression and suicide at the beginning of this post. It’s real, and we don’t always see it in daily life, but if you know someone who suffers from depression, you can make a difference by talking to them. Don’t overpower them, just let them know that you are there for them, watch them and their behaviour. If you suffer the horrible effects of depression yourself, and watching everyone else enjoying themselves takes you lower, talk to someone. Perhaps even write a blog!

Ambulance crews can go through a world full of other people’s emotions at this time of year. Some of those emotions can get through their defences sometimes. I watched a programme on TV this week that ended with some statistics, one being that 25% of the UK’s ambulance crews will experience PTSD, one in four! There is little or no support from most ambulance services, and little or nothing being done to lower these figures from inside. Often seeking support feels like, and is viewed as weakness or failure.

I’ve spoken about charities that offer support before, but public awareness is also important. PTSD999 is a charity that I’ve also highlighted, providing support to all types of emergency workers. They have just released a version of the song Heroes to raise funds for the work they do, and to raise awareness of the need for such services across all the emergency services. The band is, appropriately, called Burn Out and it costs a mere 99p to buy the song via iTunes and Amazon Music. So, among the festivities and gift giving, help support the people who make it safer. Here’s a link to the video on YouTube (please buy the single): https://youtu.be/SZA1plZxBY0

Another way you can lift emergency workers is to show your appreciation – a simple “thank you” if you see them out and about, buy them coffee if you see them at the petrol station on a night shift. Simple things go a long way.

As the great philosopher, Michael Buble, once said: “It’s beginning to look a lot like Christmas….”.

One out, one in. The prequel

One out….

You never forget the first patient you lose. Mine was a frail elderly person who lived close to my ambulance station at the time. The job came in as a cardiac arrest, and that’s exactly what it was. We got there very quickly, the patient’s heart had stopped, and it was my job to try to save them. I began CPR, the first few chest compressions broke some ribs. The dull crack is audible across the room. My partner was setting up the O2 bag and mask, they looked over at me and nodded encouragingly. That was a sound I would hear many times during my career. Some adrenaline injections (for the patient!), and 20 minutes of CPR without any signs of self sustained heart activity dictated we stopped and declared the patient’s life ‘extinct’. But this was my first. Surely there was more we could do, something we had missed? My partner handed me the paperwork and I filled it out, just like I had been taught during my training.

Later, I reflected on the broken ribs with my partner. “It’s perfectly normal” they said. That’s exactly what it became to me. It was an indication that we were pressing down hard enough to make the patient’s heart pump blood properly. “Broken ribs will repair, stopped hearts need help” – I remember my instructors telling us as raw recruits. They didn’t explain the heart-sinking feeling we would experience each time it happened. It was a blunt reminder that this was a real person you were dealing with.

I lost count of the deceased patients I saw, each one making me harder inside. I had to be to cope. You have to treat them as ‘jobs’ not people. You didn’t know most of them before, so you couldn’t be upset. We joked among ourselves about ‘killing’ patients each time deaths occurred during shifts, not because we were twisted or enjoyed it, but because it was a way of coping with it.

If the patient was ‘gone’ before we arrived then distancing yourself was easier. If you knew them, usually as a regular, it was a bit tougher. The really hard ones were the ones you were talking to when you arrived. The ones who went into some form of arrest in front of you.

One patient who arrested on me lived in a nursing home. The staff were quick to point out the patient had a DNAR (Do Not Attempt Resuscitation – a legal document that prevents medical intervention in such situations). We asked to see the document as, without it, we must continue life support. The document arrived and we watched as the patient slowly faded away. As we had accepted the duty of care for that patient, we couldn’t leave until there were no more signs of life. Watching a life slip away in front of you is a strange experience. It’s difficult to explain the emotions involved, but none are good.

Then the hard walls go up again and control gives you a meal break. It’s a bizarre thing, but even now there’s not much will put me off food.

Coping mechanisms keep you going…..until something comes along that weakens them.

Recently I’ve heard of some charities that offer physical and practical support for crew members. Charities, not ambulance services themselves, not the NHS, although it looks like most only operate in England and Wales. I have heard, however, that one ambulance service (possibly more) has recently implemented a more practical support service for its staff. It will be interesting to see how it works.

One such charity, PTSD999, has recently employed the services of a rock legend to help record a version of the late David Bowie’s song Heroes. Please look them up on iTunes or Amazon. The band is called Burn Out (enough said). Just 99p gets you an amazing song and helps them provide such an important service. The charity offers support to all types of emergency workers, please support these guys and other charities like them. We hope the song does well. Their tagline is “help save the lives of those that save yours”.

So yes, deaths affect us but, most importantly, don’t forget that each time one life fades away a new one is created somewhere. We could be heroes, but that’s not why we do it….

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….