Category: Post, emergency pre-hospital care ponderings

Thoughts on how previous life as an emergency medical worker has possibly changed perspectives on many areas of life afterwards, and (hopefully) some insight into emotions involved then and now.

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 during 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.

Pour Some Sugar on Me

Drunks. Probably the most common job for ambulance crews across the UK. Alcoholics, Saturday night revellers that have had one too many… There are many reasons why a person night be drunk and incapable, but crews must be wary. Not only of the potential for an aggressive but also for misdiagnosis. Not everyone who appears drunk actually is drunk.

There have been jobs I was called to where we turned up and the patient was rolling around, cursing and swearing at onlookers, there was even the strong smell of spirits about them. But they weren’t drunk. The smell? Ketones. The problem? Diabetic Ketoacidosis.

Diabetes affects almost 4 Million people in the UK (approx figures, 2019). Many of those have it under control by their diet or by medication. Occasionally, or in some patients often, their blood sugar rises too high (hyperglycaemia). This can happen for many reasons, but whatever the reason, the results can be fatal. Excess levels of acid build up in the patient’s body and can cause organ failures. To onlookers the patient can seem, and smell, drunk. The only course of action an ambulance crew has in this situation is to take them to hospital where the patient’s blood sugar can be monitored and lowered in a controlled environment.

At the other end of the scale, diabetics can sometimes let their blood sugar drop below safe levels too (hypoglycemia). This too can be dangerous, but ambulance crews can do something more in this case. Initially, if the patient is conscious, there is a disgusting tasting gel that comes in tubes. In my day it was known, cleverly, as Hypostop. It usually did…what it said on the tube. In more severe cases where the patient may not have been quite so conscious, they carry a drug known as Glucagon. I’m not going into the chemistry here, if you want to know more details as to its function, there’s a lot of information on the Internet. Basically, it helps raise blood sugar levels. The only problem with the drug is that it needs to be injected into the patient’s arm or leg. Simple….you might think!

We had a few regulars in our area. People who didn’t control their blood sugar levels very well for various reasons. Two of them became quite aggressive when their blood sugar became low, one in particular. Ambulance crews have no ability to restrain a patient, and usually the police are called for such things if required, but in some circumstances there’s no time for that. We knew the drill, and we usually had the patient’s consent…afterwards, when they were stable. One of us would hold the patient down while the other injected the glucagon. We had a set routine and it worked well. Once the patients blood sugar began to rise, and they became more lucid, we’d give them some of the vile tasting gel and one of the family would make them some toast. They never went to hospital, there was no need, and we left on good terms.

An unwell diabetic incident can have many forms. Sometimes it can even look very much like a stroke. Yes, there are a lot of drunks out there, but I have been to many incidents where people have decided the patient is simply drunk and act in a very quite judgmental fashion. Important lesson No. 1 – never assume that what you see is caused by what you think it is. Ignorance is not an excuse for poor actions. Ambulance crews are trained to use the equipment they carry and diagnose based on their knowledge and experience. Leave them to do the diagnostics and treatment.

Turn to the Dark Side PtII

Angry post warning.

I’ve already spoken about ambulance crews’ dark humour and other coping strategies that they use. I mentioned how “normal” members of the public often don’t get it. Recently I was horrified to read an article relating to this.

It revolved around a message sent to ambulance crews, in their ambulances, telling them to “Please be mindful when outside A+E of how the public view your actions. Eg. Being on mobile phones/Snapchat or taking refreshments.”

Firstly, what narrow minded, uninformed person actually sent that message? Any member of any ambulance service should know what their staff go through. To send something like that to crews, while they are still on duty, is utterly thoughtless!

Secondly, the message began “Following a complaint from a member of the public…”. Whoever took that complaint should have put that member of public straight and explained what the crews actually go through on a daily basis and ended things there. It should never have made it past that first person.

There are blinkered people out there who think ambulance crews should go round expressionless and unemotional. Unfortunately robotics hasn’t progressed that far yet so the job is still done by humans, with emotions, and coping strategies.

Sometimes, after certain jobs, they just need to chat with a friend or a loved one, outside A&E, on their phones. Sometimes one of the few chances they get to drink coffee etc is after a job, outside A&E. Normally because they are so busy serving members of the public. They might even have been on their phone to a counsellor after a particularly traumatic incident.

Please don’t ever judge crews for being human. That “member of the public” probably had no idea what the crews they were complaining about had just dealt with. Maybe they actually just needed a break and a brew, perhaps they were taking the chance, between jobs, to check in with their loved ones they’d not seen for a long time because they’d been doing long shifts.

I hope the person who actually sent that message was suitably dealt with.

Finally, if you think I’m wrong, and if you think crews should behave differently, most ambulance services are usually recruiting – why not put yourself in their shoes and see if you are right.

It’s happy (mostly) hour again

Being part of an ambulance crew at a rural station frequently meant long journeys into the main hospital in the city. This often meant spending time in the back of the ambulance with a patient. If it was an emergency you were usually busy, and the patient was most likely unconscious. For a general admissions, the patient was conscious and it was our job to offer reassurance when necessary.

It was like being a barman inost situations – the patient would open up and talk about anything and everything. There was an unexplainable trust, like they knew they could tell you anything. Obviously there was the whole patient confidentiality that meant what was said in the back of the Ambulance went no further, but it was more than that.

I worked in a bar one summer, and I learned things about people because I was somebody they could comfortably share their problems with. Being in the back of an ambulance with a patient was the same.

Sometimes the patient was terminally ill. It was a privilege to be a listening ear to them. To help them by allowing them to get things out of their system to someone who was disconnected from their situation, but could still show sympathy.

Elderly people would talk of the changes the had seen, the difficult times during and after WWII. Some spoke of their experiences of war. Not as innocent victims at home, but as active soldiers involved first hand in the fight. I’ve spoke before of the heroes, not looking for glory.

But being in the back of an ambulance can also be a challenge. There are the aggressive patients – more than once I….”asked” a patient to leave the vehicle. There are some things that won’t be tolerated and, generally, if the patient is able to threaten the ambulance crew then they most likely don’t need their help.

I had many humbling experiences, I have many special memories of patients. It is very like being a barman, but a million times better!

The One and Only

They say everyone in frontline medical care has that one job. The one that sticks with them, sometimes forever.

Mine was an 11 year old, hit by a van while they were actually playing on a dual carriageway. The van driver had no chance of stopping or avoiding them. I often wonder how the driver fared afterwards. For a long time I was angry at the parent that allowed them to be there, but then I realised that they had lost much more than me. I drive past the location sometimes on the way to places, there are still flowers and other tributes tied to a lamp post near to the site.

I know for one colleague it was the 15 year old we cut down from a tree in their garden.

This is not about doom and gloom. It’s about the fact we are all human. No matter how tough the exterior image, we all have the sleepless nights where we wonder “could we have done more”. The answer is always no, but that doesn’t help.

“Stress” was a common ailment in my time. Only now is it being recognised as PTSD. Still the support is not there. Managers still tell you to call a helpline if you’re struggling, rather than recognising the fact that you are not coping and dealing with it themselves.

The title of this post, yes, it’s from the Chesney Hawkes song. It was the theme song of my group during my training. We knew what we were getting in to. Our instructors were veterans and held nothing back.

But still we all went into it. From the first death, the first CPR job – we toughened ourselves and went on to the next job. Most of the public didn’t care, they just wanted what they felt they were entitled to. We did our job, many still do. Not because of the glory, there is none, but because we made a difference. I always said for every hundred patients, if just one says “thank you” then the job was worth it.

It’s New Year and most of us will have made a toast at midnight on the 31st. Something positive and forward looking. I want to end this post with a toast a friend sent me. A friend who still serves with an ambulance service despite a severe period of diagnosed PTSD, after their one job:

“Here’s to getting out of bed when you don’t really want to. Here’s to going to work knowing no one really cares. To doing your bit. To making a difference, to getting by, helping them ambulance types that need it. To making yourself available to the ambulance types that haven’t realised yet that they need some help. Cheers!”