You Give Love a Bad Name.

I’ve read a lot of news stories and posts on the socials about ambulance waiting times, and people who may or may not have died as a result of ambulance delays (the fact they don’t get investigated makes me sceptical).

We all know news companies and media companies love scandal and sensationalism, but why have a go at ambulance crews?

I regularly get messages from a friend and former colleague about the waiting times at their local A&E department. 3 hours, 4 hours… An ambulance crew doesn’t just dump patients at the door and trot off to the next job. They must wait for a nurse or doctor and give a detailed handover before they can leave. I know of one major hospital where the A&E department that was rebuilt and doubled in size a few years ago, and is still manned by the same number of staff as the old department.

Nor do ambulance crews hang around once a job has been allocated to them. Whe someone calls 999 (or 112) and requests an emergency ambulance the call taker will ask questions and follow an algorithm on their screen. The result will add the job to a list according to the level of priority the system decides. Ambulance crews have no involvement in this process.

There are, and always have been faults in the above system, and paranoia on the part of the call takers can often make smaller jobs into bigger ones.

Then there are the time wasters, the ones who know all the key words to use to get up the list, when they don’t actually need to go to hospital at all. And the ones who call for an ambulance because the waiting time for an appointment at their local surgery is too long (yes, that happens…a lot!).

These things all add on to the time before the job is even allocated to an ambulance. I could list many other types of time wasters.

Maybe, instead of the Scottish government talking of using the army to drive ambulances (so they can add to the waiting times standing in the queues in A&E departments too?) they and the other politicians could look at the overall problems and maybe find a sensible solution to the whole problem.

In the meantime, don’t take it out on ambulance crews. This problem is far from new, it’s been an issue for many years now. Those ambulance crews (and call takers, dispatchers, A&E staff…) are doing their best with what they have.

Those ambulance crews are the same ones you made rainbows for, the same ones you stood on your doorstep and clapped for this time last year!!!

Cruel to be Kind?

Kindness costs nothing.

Being based in a small rural hospital, we were part of the community. That meant patients expected a certain standard of care. We did our best to oblige but it wasn’t always easy. Some tried to take advantage, the majority appreciated it

An example : in the city, if an elderly person fails out of bed the crew take them to hospital, at best they return them to bed, check them over and drive away. In the country, we’d check them over and return them to their bed if they were uninjured. We’d make the patient a cup of tea and call a friend to see if they could come around to sit with the patient for a while.

The powers that be didn’t like this because jobs took longer and the figures on their computer looked bad, but we still did it.

When I first began with the ambulance service I was an Ambulance Care Assistant, a non-emergency transport driver. Even then we had memos saying we were taking too long when dropping patients back home after hospital stays. That’s because we took the time to settle them and make sure they were comfortable. We put the “care” in Care Assistant into practice. Kindness is free, if ambulance crews can’t show that, who can??

I recently called my broadband service provider to upgrade my service. The person who took the call was friendly, caring and kind. They listened and made me feel like I mattered, something that doesn’t happen often with large companies. If that kind of care can happen elsewhere, why were we being told we were wrong to make patients feel valued?

Many years ago I worked for a large mobile phone retailer. The company was based on a number of principles (I may have mentioned this before), the most meaningful one, the one that has stayed with me, being: Treat Everyone the Way You Expect to be Treated Yourself.

There’s nothing cruel about kindness. Now, more than ever, show some everyday and who knows what might come back to you.

Keep the Faith

Recently I was sitting outside a café with some other people. We noticed a bit of a commotion across the other side of the road. Some large seagulls were attacking a young pigeon, quite savagely.

I stood up and walked over to the scene scaring the seagulls away but, as soon as I turned away they were back. The pigeon was in a bad way but alive so I picked it up and walked back towards the café.

As I walked past the café and the others joined me, the pigeon passed away in my hands.

The people in that café must have thought I was a bit nuts, maybe I was, but I wasn’t going to do nothing. It may have been “nature in action” but my instinct was to try.

It reminded me why I joined the ambulance service in the first place – because I’m a rubbish onlooker and I wanted to help. It also reminded me of the many jobs we did that didn’t have the outcome we wanted. Even when we knew the situation was hopeless, we still tried.

Early in my career an older paramedic told me: “If it’s someone’s time to go, there’s nothing and no-one can change that, but we don’t make that decision!”. At that time the figures showed CPR jobs were around 5-8% successful, but everyone we were called to was in the 92-95% group until we had done our job.

Sometimes that was difficult, especially when you knew the relatives were watching. It would have been so easy to do nothing and tell the family it was over, rather than letting them hold onto some hope as we worked, but there was hope in us too, hope that this patient was one of the 5-8%, and we would never give up until
protocols said we had to.

We never beat nature, the lost ones were always lost but, to shake the hand of the survivor, the one who would not be there if we’d lost our faith – there are no words.

I’m Dreaming of a White… Easter!

It’s Easter. The crocuses, daffodils and other spring-type flowers are out. Lambs are frolicking in fields, and it’s snowing!

We appear to be winning the fight with Covid 19, or at least bringing it better under control. I had my first vaccination yesterday. Since I left the ambulance service I’ve become even more adverse to people poking needles in me, but yesterday I felt no pain. I wasn’t even aware the vaccinator had done it. Afterwards I asked if they were a nurse. “Yes, how did you know?”. I recalled that the only people able to administrator injections painlessly (should they choose to do so) were nurses.

The day after: no adverse effects yet. A few minor aches and pains, most likely psychological though. Now I’m wondering if the second dose might floor me. I’ve heard stories of healthy people who were floored after one dose, others by the second one. For that reason I’d made no plans for the next two days. I wasn’t scared of a bad reaction. A bad reaction is actually good…in a medical sense. It means that your body is doing what it’s supposed to and that your immune system is relatively healthy. I just wasn’t looking forward to it.

Do I feel safer? No. Do I feel more comfortable in shops or out on the streets? No. It’s a start, but the false bravado it gives people is still concerning. It will help to cut down transmission and infection rates, but no Covid vaccine is 100% effective.

We’re back to the words and terms that no one used until March 2020 – “social distancing”, “face covering”, “hand washing”. All are still vital if we are to get on top of this and prevent further spikes. Spikes = lockdowns. Nobody wants another one.

A little bugbear: face coverings have been a legal requirement inside public buildings for a long time. Some people haven’t quite caught in and continue to walk about without or with them under their chins, noses etc. Some people think they’re for their own protection, oblivious to the fact they’re for the protection of those around them. It takes around 3 months to potty train a toddler, Covid-19 and mandatory face coverings have been around for a year.

So, have a snowy, safe Spring. There’s light at the end of the lockdown tunnel. Here’s hoping people are sensible as restrictions lift so we can enjoy Summer, hopefully without snow!

Pretty Vacant

Far be it from me to question the intelligence of the patients ambulance crews deal with on a daily basis. What I will never understand is why anyone would put something into their body not knowing what it will do to them?!

I’m talking about the evil known as the “legal high”. A mix of things unknown to anyone but the twisted manufacturer, made into a tablet or powder, packaged in a colourful bag and given an attractive name, then sold in any unscrupulous newsagent or corner store. Everyone reacts differently to these concoctions, sometimes fatally!

These things seemed to go through phases of popularity and we were often called to…patients (yes, I’m biting my tongue) having adverse reactions to the latest ones to hit the shelves. Symptoms ranged from tachycardia to hyperventilation, although the latter was generally a result of the panic brought on by other symptoms causing the patient to believe they were dying.

Our biggest problem was that we had no idea what was causing the tachycardia or other, genuine, symptoms. Panic attacks could be calmed, but we still didn’t know the contents of the substance, and neither did the patient. This caused further concern at the hospital as they didn’t know what to treat. There was no toxicology report available for “Screaming Banshee” or “Red Dragon”….

Every time the patient would show us the wrapper the offending substance came in. Short of a name, there was no further information. No ingredients, no manufacturer or supplier details. The retailer didn’t care, it wasn’t their responsibility and it was perfectly legal to sell.

Every time we would ask the patient if they knew what it would do to them. Every time the answer was the same – “No. Am I going to die?”. Sometimes we had to restrain ourselves, fighting the urge to reply “Maybe”. Sometimes harder than others. We would often ask the patients why they took an unknown substance, not knowing what it would do to them, or even if it would kill them? The response was usually shrugged shoulders orbmumbled variations of “I dunno”. We’d then ask why they were so surprised when it did bad things to them, and why they’d called an ambulance. Once again, the shoulders and “dunno”.

Now I’m no longer in the job, I can say what I think. Nobody asked anyone to buy it, there’s no addiction (apparently) and no one forced anyone to put the stuff in their bodies. But it must take a pretty gormless person, to waste everyone’s time for an outcome nobody can predict, to take an emergency crew off the road to deal with them, and to actually pay someone (who doesn’t actually care if they live or die) for the experience.

I make no apology for saying any of this. If it causes offence you are missing the point. Just ask any ambulance crew who have dealt with these jobs!

Tears in Heaven

I’ve mentioned this job in a post already but, since it was my “one job”, I feel like it deserves more. I realised that I’ve never written or spoken about it in any kind of detail before, but a recent conversation with a friend and colleague made me think perhaps I should.

The patient was 11 years old. Only 11 years old. Our screen said they were 7. I only found out a few days later what their true age was. I never knew their name, but I was the first person to look into their empty eyes after the life had gone from them.

I was attendant at that point, my partner driving. We had passed the point on the road, a main dual carriageway, minutes before the incident. There’s a strong chance we had seen them alive at the roadside. The job came up on our screen and we had to find a gap to turn the ambulance around. It was rush hour so traffic was heavy, our blue lights stopped the vehicles around us as we crossed onto the other side of the road and made our way back to the scene. The job was a “person vs vehicle”, never good on a main road. Then it was updated “7yo vs van”…

We passed the incident on the opposite carriageway and desperately looked for a gap in the central reservation. Traffic was at a standstill, making it hard to negotiate. As we approached the scene I jumped out and ran over to the patient. They were face down with people around them. I asked two of them to help me carefully turn the patient over while I managed their neck and head. As we rolled them over, I saw the head injury, in the shape of a large, open wound. Their eyes were empty and staring. I found a very weak pulse at their neck, they weren’t breathing. My partner arrived, having brought the ambulance closer. I asked for the immobilisation kit and a trolley, and explained the lack of output. The patient was rapidly immobilised and wheeled into the ambulance, a line in their arm, a tube for breathing. We agreed I’d drive, my partner was smaller than myself, so could fit in the gap between the trolley and the attendant’s chair performing cpr as we wound our way through the busy rush hour traffic. I took the keys and turned the ambulance carefully, then began the dangerous drive. We were around 10 miles away from the hospital, we had a number of hot spots to pass through.

The police hadn’t arrived, but we couldn’t wait. I called control on the way in with an update on the patient’s condition and requested the paediatric trauma team met us on arrival at the hospital. I recall talk of a police escort but we had no time to waste while it was being arranged.

I don’t remember much about the journey, but I broke a few speed limits (legally), and somehow made it through traffic in record time. Oddly I felt no satisfaction in that for a long time.

The staff at hospital were indeed there to meet us, and they took over CPR. After a swift hand over we went back to the ambulance and sat. Said nothing, just sat, then we had to go back to our station as our shift was over.

I was on days off the next few days, probably not the best thing as it played on my mind as I sat at home. Calling the counselling service was not an option, that would be seen as failure. Three days later I went back to work, to find out my partner had taken 2 days off because of it all.

We were invited to join the A&E staff at their debrief meeting, there we found the patient’s true age, and the fact that they were dead before we reached them the impact had crushed the base of their brain. It wouldn’t have changed what we did.

I have vague recollections of a conversation with the van driver. I sincerely hope they had some kind of support. Also the patient’s 7 year old sibling, who saw the whole thing and stood at the roadside watching as we tried to save them. There are often fresh flowers at the scene that remind me, but now I’ve put the incident where it belongs, in my memories. I did my job, now it’s not for me to grieve.

In the months after I left the service I turned that young, lifeless patient over on that road lots of times in my head, in my dreams. I knew there was nothing else we could have done for them, but still it played over and over. No one in the service cared. Why would they? It was my job, I signed up for it.

Today I found out a close friend had a similar job in another part of the country. This is their one job. The service has done nothing. Offered no support.

Crews go through this on a regular basis, and there are no official checks or support. Stress, PTSD and suicide are all very real and far too common results.

Something needs to change, but it has to start in the offices of managers.

More Than Words

It’s been months…

Life has changed dramatically, and we’ve learned new words and phrases: “lockdown”, “social distancing”, “keyworkers”, “shielding”, “Coronavirus”, and more recent ones such as “local lockdown”, “covidiots”…… Words and terms we’d never heard or used before, now they’re used daily.

What does it mean though? What’s it all about? Why does it affect every one of us, everywhere?

I was on the front line for the avian flu “crisis” a few years ago. It was worrying as a frontline worker, A&E departments were concerned and hospitals had to put measures in place to handle it all. But the general public didn’t really have much idea of the seriousness, and it lasted a relatively short time. Coronavirus, aka Covid-19, is a whole world different, and it has created a different world.

We’ve all been in various stages of lockdown for months, travel restrictions are in place, people are fed up and, of course, there are the conspiracy theories!

How on earth in the 20th Century can (even slightly) educated people believe that a mobile data communication method (5G) could spread Covid-19?? It’s a virus (not of the computer variety)!! Why, when people are clearly dying, do people believe that Covid-19 is not real and think its some kind of government plot?? And why do grown people not realise that their noses are connected to their mouths and they must cover both with their face mask to help prevent the virus spreading effectively?

As I write this post, a number of cities in the UK have been placed in a state of local lockdown. A second wave has been predicted. Having walked city streets, and been in public places, I’m not surprised. Social distancing is non-existent, its more like social risk-taking, an face coverings are scarce. Many are being worn in completely ineffective ways. It’s very frustrating, but no one is doing anything about it. Daily, the government is adding countries to the ‘quarantine list’, stating travellers must self isolate fir 14 days if they are returning from any of them, but who polices that? People are holding protests against lockdown and being told to wear face coverings but, by doing so, are they not extending the need for measures they’re protesting about?! Nobody really has the answers, it’s new land and unknown to everyone, but casting blame wherever possible isn’t going to help.

Companies are folding on a daily basis, businesses are closing, online sales are rocketing. Will we ever see the ‘normal’ we used to know?

NHS staff are being hailed as heroes, but they’re not being given the correct equipment, in high enough quantities, to protect themselves as they do their job.

These are times like the world has not experienced for decades, centuries. Stresses are high, lives are being lost, not just from the killer virus among us. But we can get through this. Not by protesting about whatever is fashionable this week, not by complaining, and not by trying to do it on our own.

By simply following the rules; wearing a face covering in public, hand hygiene and looking after each other, checking others are doing ok, this will soon be nothing more than another memorae period in history. If we don’t, it will drag on and on. There are many of the rules that are ‘inconveniences’, but surely those inconveniences are tolerable for the short period of time necessary? They’re not just new words, this is all real and it’s happening to everyone, everywhere.

As those great philosophers, Bill & Ted, once said – “Be excellent to each other”. By doing so, we’ll see some form of normality again much sooner.

Then there’s Brexit……

Hold Back the River (or Flood, Sweat and Tea).

It began like any normal nightshift… We had a couple of simple jobs, they went into the main hospital in the city. On our return we drove into a world of chaos.

There had been heavy rains for a while, although that night was dry. Reports of flooding across the whole country dominated the daily news. The town I was based in was small, built on two small rivers and directly on to the sea front. There was a beach, a wall then lots of buildings, many of them housing sheltered accommodation. It was a relatively tranquil town, until that night.

The rains in the hills inland had caused much damage anywhere that a river fed by them ran through. Finally the waters reached the sea, and the two rivers in my town flooded with devastating results. As we came down the hill into the town the night was lit up with blue. Police cars and vans, and fire engines blocked the streets. the noise of pumps and vehicle engines was deafening. My partner called in to Control to inform them of the situation. They already knew, a lone paramedic had been coordinating rescues since the flooding began. We were instructed to standby and be available to help evacute people and transport them to a community hall above the flood water line.

The police and fire service incident officers saw us and came over. An oxygen dependant pensioner was trapped in their second floor apartment, the flood water around four feet deep at ground floor level. My partner was the smaller of the two of us so we decided they would be the one to go on the fire service raft to evacuate the patient. We put our usual response equipment, and plenty of oxygen, into the large raft and, with four fire fighters at each side they began walking with the raft. The water was only a few inches deep near the ambulance, but it got deeper very quickly, and soon the fire fighters were waist deep. off my partner went at the front of the raft, into the darkness. I;m sure I heard singing – “Near…far……whereeeeeeever you are….”, then just the noise of the pumps and fire engines.

I was left by the ambulance, feeling alone, helpless, then a local police sargeant came from the mass of vehicles. They updated me fully on the situation, then made my night. “there’s coffee and biscuits going in that gentleman’s camper van. Get stuck in!”. I didn;t need to be asked twice! A local had set up a small refreshments area in his motorhome parked in the middle of the fire engines, just above the water line. I instantly recognised him as a patient and we spoke for what felt like ages, Suddenly my radio bleeped. I answered – “3863. Go ahead.”. “That’s us on our way back now. We’ll be at the ambulance in 5.” .”Roger. I’ll meet you there. I went back to the ambulance and prepared the trolley and set up an oxygen mask, ready to go.

Five minutes later, out of the darkness, my partner appeared on the raft. The patient was sitting upright next to them as the fire fighters waded through the water. Patient safely onboard the ambulance, we headed to the local hospital with them.

We transfered a few more people to the fry hall that night. Many homes and businesses were badly damaged that night, but there were no medical casualties.

A couple of weeks later we had a station outing. I parked my car in the town square and we had a good night out. Withing hours of me driving my car home, the space i had parked in was flooded. This time worse than before. Although the water came higher the second time, by some strange twist of fate, there were no residents in the flooded buildings as they were all still in temporary accomodation following the damage from the first flood.

Lessons were learned that year and there has been no flooding since. The town took a long time to recover from the damage, but now there are practically no signs to be seen. I still remember, vividly, my partner disappearing into the dark on that barge. “Near…..far…wheeeeeever you are….”.

I See Your True Colours Shining Through

This post is not the type of post I normally write. I started writing it a week ago, when Covid-19 was wreaking havoc in Italy. Now the whole of the UK is in lock down too. Phrases such as “self isolating” and “social distancing” are heard daily. Panic buying is gripping the country and creating scarcities of…toilet rolls and pasta, among other strangely random items. This is a very real threat to everyone’s health but, managed correctly and sensibly, the threat can be minimised.

As humorous as this may seem, and I hope these panic buyers are left with their stockpiles after this is all over, we are a country in genuine crisis and we need to think of other people’s needs too.

I was in the ambulance service during the avian flu crisis around 2007. There was similar panic in some areas, but nowhere near the scale we are seeing now.

Last night Britain applauded the NHS workers. People stood on their doorsteps up and down the country clapping. Some cities lit up blue in support too. This morning there are reports of someone who died “because paramedics left her at home”. Paramedics who have never seen anything like this before but are expected to know what to do. Paramedics who are out there ill equipped with protective wear, doing their best in an unknown situation.

Now is not time for sensationalism. Its a time to pull together, to recognise the work people are doing to try to keep us safe. Not a time for negativity and blame.

It seems to be a time when people’s true colours are starting to show: people refusing to stay at home to contain the virus spread, shops and other unscrupulous people trying to charge extreme prices for essential items like toilet rolls and bottles of hand gel. Peopled stockpiling those items unnecessarily to the extent that there are no stocks available for other people who actually need them. Today I heard of youths going round coughing and spitting on people, threatening to ‘give them the virus’!

But more and more, people are rising above this. Every day there are stories of how people and companies are showing support, stories of acts of kindness.

I recently spoke with a bus driver friend who told me of a wheelchair user struggling to get on their bus. Someone helped push the wheelchair on the bus then, rather than get on the bus as a passenger, they walked away. It transpired that the wheelchair user didn’t actually know them, a random stranger, not afraid to help or scared to touch the wheelchair lest they contracted Covid-19.

Another friend saw an elderly person fall while trying to walk up a steep incline near some houses. They were helped by three random strangers who crossed a main road to assist. Yes, we need to exercise caution, but we also need to practice common sense. At a time when social distancing and caution are very important, concern, care and kindness are also equally important.

Ambulance crews, nurses, doctors and all the support staff are working hard to cope with the Covid-19 outbreak. No-one knows how long the crisis will last, no-one knows how long it will be before a vaccine is discovered. Still these people go to work, knowing they will have a busy day ahead. But it’s not just about them. The country still needs to keep going – bus drivers to take people to work, store staff who put up with still rude and selfish shoppers, lorry drivers who tirelessly keep supermarkets stocked, Police officers, Fire crews….right down to the people who keep the streets clean. All deserve some kind of thanks for keeping the country going. Some coffee and fast food retailers were offering items free to emergency workers, but that ended when they were forced to close.

Most of you readers will know much of this already, but how many of us show kindness to these people ourselves? How many of us keep an eye on our elderly neighbours or offer to do shopping for others when we’re doing our own? How many of us say “thank you” to the bus drivers, say nice things to the supermarket staff, or give a thumbs up to the emergency workers? Now, more than ever, we need to stay positive. Boris Johnston was recently likened to Winston Churchill, and I suppose the Second World War was probably the last time the whole world saw times similar to these. We are all in this together, whether we like that idea or not. Kindness is free, and it actually feels good. If we all act together it will make this crisis a whole lot more bearable.

Please listen to the experts – Stay at home whenever possible! Wash your hands as often as you can. Social distancing and all the other rules were devised for everyone’s safety. To defy them unnecessarily is selfish and also puts yourself at risk.

During times like these we tend to see peoples’ true colours coming through. Are yours something you will be proud of when it’s all, finally, over?

Time after time.

Clock stopping. The thing that drives dispatchers everywhere – the time between receiving a call and some form of response arriving on scene. Unfortunately this is often seen as more important than the patient and their ailment.

I was sent to a fall once, when I was single crewed. Falls are jobs that ambulance service SOPs (Safe Operating Practices) dictate should be attended by 2 or more staff. There was no way I was helping this patient from the floor myself. There were no injuries so, once I had made the patient comfortable, I updated control. Well over an hour later a second, double crewed, ambulance arrived and the patient was helped to their bed. The patient lay on the floor for almost 2 hours from the initial call, but the job was classed as a success because I got there in the prescribed time and the clock was stopped.

In 1974 the ORCON (Operational Research Consultancy) standard was created. ORCON was a way to monitor the performance of ambulances (and crews). The biggest thing being the ability for crews to get to a Category A call (cardiac arrest etc) within 8 minutes. By this standard, if a crew arrived at a job within 8 minutes and the patient died, the job would be seen as a success. Should the patient survive but the crew took longer than 8 minutes to arrive, the job would be a failure…

Much has changed in ambulance services, and ambulance crew abilities, since 1974. The type of jobs and public expectations have changed too, but ORCON is still the standard used to measure success. Time is still more important than anything, sometimes including crew safety. “Would you assess and withdraw until the police arrive if you feel it’s unsafe?” was a radio message I heard more than once on the way to a job. The response was usually “No” because the police had stab vests and batons, we had neither!

Crews joke about The Great God Orcon, but it’s a real thing, and it’s become more important than crew or patient safety sometimes.

On another occasion my partner and myself had dropped a patient at A&E. They had been in an RTC so had been fully immobilised. We were waiting for our immobilisation equipment to be returned by the A&E staff. The Radios went off – control asking if we could clear and go to a job. We informed them that we had no immobilisation equipment so we couldn’t attend a fall or any other job requiring the patient to be immobilised. We were informed it was just a minor head injury, so off we went. On arrival we found the head injury was caused by a loss of consciousness….wich caused a significant fall! We spoke to the call taker who informed us they had fully informed control of this right at the start of the call. We radioed in, no response. After 10 minutes of trying to call in I put an emergency call in. I got a response after a few minutes (good job we weren’t being attacked). Our dispatcher had been “called to a meeting” (why leave a whole area with no radio contact??). We explained the situation and our inability to deal with the patient properly. The dispatcher informed us that no other crews were available. Our patient was transported to A&E immobilised with blankets, bits of wood, lots of surgical tape, and other things we found on scene. After explaining to the staff at A&E we lodged a formal complaint against the dispatcher. Nothing ever happened.

There were many “clock stopping” occasions during my career. Most not life threatening, but many questionable as to the dispatcher’s motivation. I know it still happens. It’s worrying that a clock is still more important than the health of the patient, and sometimes even the safety of the ambulance crew.