I’ll stand by you.

It’s coming up to that time of year again. The time when all the charities ramp up their appeals on TV and on the streets. All the main organisations have started. In his post, I’m not going to tell you who to give your money to. I just want to mention a few causes that I feel deserve extra support around now, a couple not often thought about. All have already been mentioned in previous posts but they are still important, perhaps more so to me because of my personal experiences with them (that is what this blog is all about after all).

Firstly, elderly people. Winter is a dangerous time for many. With fuel costs rising, hypothermia becomes an actual killer. When you casualty turn up your heating without, think of the older ones who can’t afford to. Loneliness is a huge problem too. Some elderly people may have recently lost their partner of many years, possibly facing their first Christmas alone. More than once I was called to such a person around this time of year, who saw no reason left to live any more and just gave up.

Those are the people who need practical support. Friendship, food, heat, people who show they still care about them.

Secondly, not only the people with terminal illnesses – also the frequently unsung heroes who support them. Family members, who are terrified that this might be their last Christmas with the loved one they are supporting. Also the support charities. The people who try to help it all be that little bit more bearable for everyone, while trying to walk away and hold on to anything they can to keep themselves going.

There are many others but finally, I want to mention one very close to my heart – of course, emergency crews, primarily ambulance crews. I’ve already highlighted PTSD, stress, depression…all the problems brought on by giving everything they have to help other people, while very few people give anything to help them cope. Suicide season is near, it’s a difficult time for ambulance crews. The ones who cut down bodies, who try to save someone after an overdose. Many times the patient doesn’t want to die, their “attempted suicide” is a cry for some attention, someone to show them that they are interested. That’s hard to walk away from at the end of a callout, but ambulance crews have to do it.

This next part is not an appeal, I just want to highlight a few charities that help with the situations I’ve mentioned, a couple I have been involved with personally:

For the elderly –

Help the Aged. Essential work with elderly people, especially at this time of year, with your support.

For victims of cancer, and their families –

Maggie’s cancer support centres. They provided a lot of valuable support to my partner after surgery. The staff are amazing and give more than we could have ever expected.

Two(ish) for the Ambulance crews –

PTSD999. PTSD is starting to be recognised more and more in our emergency crews, it’s not rocket science, but no one thinks about that when they see ambulances around towns and cities. PTSD999 is one of a number of charities highlighting this, and helping emergency crews up and down the country.

Frontline Coffee (https://frontlinecoffee.co.uk). Set up by ex-firemen, they have created a number of different very high quality coffees in various forms (beans, ground…), the profits of which support different emergency services. One of the blends is specifically for Tasc, an ambulance support charity that I know does good work from inside the service. They also give you the opportunity to send a bag of coffee to your favourite emergency services station so you can show practical support. Coffee and emergency services – genius!

And finally, one for all of the above –

You! You can give practical help to them all –

Keep an eye on elderly neighbours, cook something for them, show them you are interested in their welfare.

Ask cancer support groups how you can help, many require volunteers for events etc.

Emergency crews love when someone shows their support by dropping a box of chocolates or biscuits at their local station, or drops by on Christmas Day with a wee gift. I know this because I spent one Christmas Day single crewed, and was visited by a few people who made the shift much more bearable.

I hope this post hasn’t been boring, and that it has made you consider some of the groups I’ve written about. Don’t leave it to “somebody else”, be that somebody. They say Christmas is about sharing, I say it’s about caring too.

Gone, but never forgotten

This post is a tribute to two people, but it also applies to many others around the world. The ones for whom the job becomes too much and they see no alternative. The ones who the system fails to recognise and support.

We trained together, without their help and motivation I might not have been as driven as I was. Then we lost touch. I heard about them through another training friend, the one who found them. It had been thought through, and there was no going back. On reflection, there may have been warning signs, but we deal with death and dying every day. We’re supposed to be immune to it, or so people think. Management don’t care, they are insulated from it in their offices. Forgotten by management, unknown by the public, never forgotten by us. One of us.

A trauma gp, a paediatrician, an anaesthetist… Those were a few of this person’s skills. They were trained to drive with systems by the Ambulance Service and they’d be on call for incidents involving trauma. Because they lived near my station we’d see them often at RTCs. When you felt their hand on your shoulder, and heard their voice, you knew everything would be ok. They didn’t take over, their voice usually said “hey, what can I do to help?”. That’s the kind of person they were. No one guessed there was a problem, until it was too late.

I’ll tell memories of both in later posts, this one is to remember them.

Gone, but never forgotten. To all the emergency workers who have passed away because the job got too much and the support just wasn’t there. Hopefully we learn from the tragic loss before many more die, saving other people’s lives….

Oh, no doubt about it.

“You couldn’t make it up if you tried”. That’s what they told us in basic training, and it turned out they were correct. I came across many bizarre situations, some funny, others sad. “Never a dull moment”.

Situations like the time we drove 15 miles, well my partner did, as I gingerly held an empty coffee jar at arms length. Empty other than the Scorpion that had hitched a ride in a bunch of bananas then stung a superstore worker as they laid out said bananas on display in the store. It stung them on the back of the hand, when we arrived the worker said it felt like their hand had been hit with a hammer. We took the Scorpion with us so the staff at A&e could identify the species and apply the correct antioxin if necessary. It later transpired the poor Scorpion was in a mildly dormant state after being chilled with the bananas during transport, making it a lot less toxic than it could have been. It saw its days out, spoiled, in a university laboratory.

I’m no fan of football, but I worked at a couple of games as overtime. One was against a German football team. I was placed next to the Ambulance, and the German TV crew. I’d often seen toilet rolls being thrown around at football games. At this game somebody, in what must have been a moment of madness, decided that till rolls would be left under the seats of the highest levels of the stands, and these would be opened and thrown over the side when the local team scored creating a huge ticker-tape-like display.

These fans were not interested in such dramatic displays. Within seconds of the home team scoring a goal, the calls came in – head injuries, wrist injuries…all the kinds of injuries imaginable that can be caused from being struck by an unopened till roll thrown from a great height. We got busy.

That was not the end of it that night. I have no idea what the final result was, but the German presenter decided to do a live broadcast from the pitch side once most of the fans had left. A podium was set up and they went live. Right in front of the home team’s disabled stand, who were waiting until the rest of the fans had gone before leaving. I tried not laugh out loud as they heckled him on live TV.

The joke was sometimes on us, not always our fault. “Alpha362, 999 call to ******. Patient in respiratory distress”. The coffee cups were put down and we went to the Ambulance. The address was in the city so we had a long drive. We radioed Control for an update but they had nothing, the job had been passed from the out of hours service. Eventually we arrived, blue lights flashing, expecting to find a very ill patient. Instead, the door was answered by a relatively healthy, and very confused person. “Why are you here? Did you bring an inhaler? I’m not that desperate!”. It transpired that they had called the out of hours service to ask what pharmacies were open late because their inhaler was running low and they had a prescription for a new one. They were going on a trip and wanted to collect the prescription before they left!

The snow is always an object of happiness for rural ambulance crews. It makes the countryside look pretty, it creates car crashes (usually slow speed) and it’s a challenge to drive in. Rural crews are usually proud of their adverse weather driving abilities, compared to city crews.

Snow is also a means of stress relief. Snowmen (snow people?) usually appear outside stations, adorned spare items of uniform and medical equipment. It’s amazing how physiologically accurate some crews can be…

I wrote about some snow related jobs previously. During one of those situations it was suggested we created snow angels in the central reservation of the dual carriageway, but we decided against as it was right under a railway bridge and we didn’t want to end up all over social media should a train go by as we lay in the snow. And it might have seemed slightly unprofessional, maybe. That was the year a police officer had been disciplined for using their riot shield as a sledge, ironically it was a police officer who suggested the snow angels.

I did, however, get a wet posterior that year from the snow – as we were leaving the Ambulance on arrival at a job, my partner got out first since I was driving. They were in the process of shouting “watch out for the ice!” as I found out it was icy underfoot, covered by a fresh layer of snow. As I picked myself up I discovered my bum was very wet and very cold. I tried to cover it up as we walked into A&E later, but the staff got a lot of mirth from it for a long time after the night.

I could go on. Full moons, Black Friday…. Maybe I’ll write about more some other time.

Driving with the brakes on

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

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

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

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

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

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

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

In winter especially, these airbags would sometimes burst.

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

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

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

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

Where do broken hearts go?

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

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

We were allowed to see that happen, live!

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

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

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

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

Sharing isn’t always caring.

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

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

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

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

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

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

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

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

Who’s going to drive you home tonight?

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

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

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

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

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

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