’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. 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. 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 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. Write a blog even!

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 song is, appropriately, Heroes and the band is called Burn Out. It costs 99p to buy on 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….

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…..man 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.