Rest in peace.

I’m feeling controversial….again.

Working 12 hour shifts requires energy. Some dispatchers seem to think ambulance crews have unlimited supplies of energy.

When I first began we had the option to choose “uninterruptable” meal breaks. That meant that the dispatcher could only assign us a job once the meal break was over. Almost every time, within seconds of the break finishing we would be given a job. Crews set stopwatches at the start of breaks and proved this.

Many of the old school crews initially chose to remain interruptable, any other way showed a complete lack of dedication in their eyes. Most changed to be uninterruptable after being pushed hard and realising they were changing nothing but their own health.

A prime example of this was an older crew member I worked with when I first moved to the rural station. They worked late, took extra shifts (“not because of the money, but because the community needed us!”) and basically ran their body into the ground. They became a hazard on shift because their body was no longer coping. Finally they retired and, after a handshake from some senior officer who’d never worked with them or particularly knew much about them, they never heard from the service again. They have their NHS pension, but two knee replacements later, no one has shown them any form of gratitude whatsoever for their decades of service, dedication and long term severe body wear and tear.

We enjoyed our breaks, we enjoyed the peace, a short period of time to switch off from the day’s jobs, sometimes to talk about the bad ones.

Then one day it happened – somewhere in a remote village, a trainee crew member was accused of letting a patient die while they were on a meal break. There was public outcry! The newspapers reported “Patient dies while ambulance paramedic drinks tea!” and other dramatisations. Details still appear to be sketchy regarding the whole incident, and the crew member was later found completely innocent, but the outcome was the removal of uninterruptable meal breaks nationally. Rumour has it that the patient actually died of hypothermia, not something that becomes fatal in the relatively short time it takes to drink a cup of tea, but no ambulance service officer ever stepped up to verify this, or defend the crew member in any other way.

For months, ambulance crews were being run for hours without breaks. Stories began circulating of crews testing their own blood sugar levels, finding them lower than acceptable levels then signing off unwell. The most I was was run was over 8 hours without a break. Finally the unions stepped in…

The union in my area was pointless. The reps knew the rules and they knew how to argue, but they were too close to management. “Yes” men, so nothing changed quickly. Eventually, nationally as far as I’m aware, rules were put in place whereby time windows were created within which crews must be given breaks, now known adamantly as “rest periods” by dispatchers. The only problem was that they could be given said rest period anywhere, and there were strict rules about being able to carry food, and consume it, in ambulances. Also, in winter especially, crews wanted access to microwave ovens to heat their soup etc.

Finally, after a number of incidents across the country, it was decided that crews would be returned to their home stations “wherever possible” for their rest periods. These rest periods could still be interrupted for a high priority job, but they had to return you as soon as possible for the remainder of the break.

For months, the distain was audible in the dispatchers’ voices over the radio as they returned you to your home station. For months they gleefully called, just as the microwave pinged, to send us to Cat A (the highest category) jobs. They also became experts in emotional blackmail, knowing that we would never turn down certain jobs. We got used to cold food, just as we had with cold coffee.

Things eventually settled, and dispatchers realised crews were actually happier after food…or rest. The public never knew any of this. Heaven forbid a patient found out the crew that was sent to them was tired and very hungry, possibly with reduced functionality, possibly with baseline observations unhealthier than their own.

There are many things the public don’t know about the Ambulance Services in the UK…….

Afternoons and coffee spoons.

If an army marches on its stomach, many ambulances run on caffeine. I once heard someone in a coffee shop, in the queue behind me, state “if you want to know where the good coffee is, look for the Ambulance outside.”. Its the only time I got away with parking on yellow lines. Traffic wardens (or whatever their title is at the moment) used to wave at us, often from behind us in the queue!

12 hour shifts, especially night shifts, often required multiple cups of coffee to keep me going. The only problem was trying to sleep when I got home. Worryingly, I found, over time, that stopped being a problem.

A family member got involved in the coffee culture in the city they live in a long time ago. Their coffee snobbery turned me slightly snobby. I had already lost my taste for most instant coffee, then the “microground” varieties became popular. A small tin would last a week or so, but I blame that on the fact they were so small. I knew all the good places to buy coffee in my city, and the ones who made it quickly for ambulance crews. The staff in one store, part of a huge chain, even started making mine as soon as we pulled up outside, and it was ready at the end of the bar by the time I got inside, free of charge.

I knew it was bad when one of the dispatchers deliberately sent us to the areas of certain coffee shops when they put us on standby in the city. We were always happy to do them favours. One of the local petrol stations, with a good coffee shop attached, even started to offer ambulance crews free coffee through the night. The intention was obviously to get us to fill our vehicles there, but we didn’t mind because we didn’t pay for the diesel. Unfortunately that ended because some crews abused the kindness.

Probably 75% of the time we would end up drinking our coffee, whatever the origin, lukewarm or cold. Inevitably we’d get a job, or a few in succession, shortly after the kettle went on or we left the coffee shop. Friends still comment on how long I leave my coffee before drinking it, even though I’m no longer waiting for an emergency call.

Now I get to sit and enjoy my coffees more. I drink less, I think, but I’m still a bit of a coffee snob.

I don’t think it’s an addiction, more of an appreciation…

Turn to the dark side

In-jokes are a part of every job. If you’re easily offended, I suggest you close this post now. I make no apologies for what’s coming.

My first days in an ambulance mess room were memorable for many reasons, some more than others, but it was the first time I had truly encountered that dark humour of the ambulance crew. It’s a humour I struggle with now I’m back in “normal life”, because no one else gets it. To many people it’s offensive, to ambulance crews it’s essential.

I was based in the big city at the beginning, the mess room was a busy place. A crew had just come in from a suicide attempt, a hanging. When asked about the job the jokes began about “hanging out with the patient”, the patient was “hanging around” when they arrived. The puns went on. I was horrified. How could they be so disrespectful, so blasé about the loss of a life? Another job, also a suicide. This one reported in the papers, stating “unfortunately the patient died before the ambulance arrived”, brought ridicule on the crew for taking so long to get there. The fact the patient was very dead before anyone had called for an ambulance was irrelevant.

I learned very quickly why this humour exists. It’s a coping mechanism. A way of dehumanising jobs. A way to make the things we saw acceptable, bearable. Nobody saw what we did. Nobody else understands. When we got home our partners didn’t ask how our day had gone, not because the weren’t good partners but because they hadn’t seen the things we had that day, they hadn’t experienced the emotions we had, they could listen but they would never understand. Most did the right thing and didn’t try.

During my time a crew was reported for being seen laughing in the front of the ambulance on the way to an emergency. I still don’t know what was going on in the head of the person who made that complaint. Not sympathy, not care, not gratitude. Nothing good. I know what the crew were going to, and what they saw. I know why they were acting the way they were and I know it fully justified.

Frontline emergency care can be a dark place. Your crew mates are your only support because they are the only ones that actually know what you are going through because they are going through it too. There is no room for uneducated “do gooders” or interfering members of the public who think they know best.

Being a front line member of any ambulance service is a unique way of life, and the lows are mostly bearable because of the highs, but until you have experienced the life first hand, please don’t condemn the seemingly twisted humour. Don’t frown when a crew member says something that sounds uncaring. If they didn’t care, they’d not sign on again and again, knowing there was yet another heartache out there….waiting, ready to take on their defenses. And if they make a joke that you find unfunny, or possibly even offensive, show your support and laugh anyway. And please don’t look down your nose next time you see the crew of an ambulance laughing on the way to a job. Their professionalism, dedication and commitment is being demonstrated right there – they are potentially on their way to something most people will never have to see or deal with, what you are seeing in that cabin is nothing more than their way of coping.

“Alpha 62. Purple call…..”

Paparazzi

It’s 2019 and most people in the UK have mobile telephones. Most of those phones are smartphones, and most of those smartphones have cameras built in. Now, almost everywhere you go, someone will have access to a camera that is connected to the Internet. While this can be fun, it can also be very wrong.

A number of times I attended incidents where some onlooker felt the twisted urge to film the emergency services in action. Often the focus of their attention was the victim(s), on occasion these jobs were fatalities. It is a fair assumption that this filming was not for personal usage and that it would make its way onto the public domain at some point. Usually, once spotted, the police would move the individual on, sometimes after ensuring the footage was first deleted. Other times the camera person would run once rumbled.

One of my fondest memories of payback occurred during the summertime. A small village by the sea was having a music festival in it’s small harbour area. The area was busy and an outsider had got caught in the crowd in their car. They had decided to attempt to negotiate their way out of the village and drove very slowly through the crowd. The crowd were in good spirits and happily moved out of the way…..except for one.

A small group of teens decided it would be funny to push one of their own in front of the car. Being a hot day, the tar of the road had softened and the unfortunate teen’s trendy trainers became quite grippy. The car driver reacted quickly and stopped the car, but, not giving way, the grippy trainers held the poor teen’s feet to the ground and both bones in their lower leg snapped.

We rocked up to a huge audience, all in a party mood. It took a couple of blasts of the sirens to clear the crowd. Happily, the band on the other side of the harbour kept playing, so there was a bit of a distraction. The police arrived just behind us, but they encountered little resistance.

It was very apparent the teen’s leg was broken. After the police had cleared the area so we had room to work, we set about administering some pain relief and applying a splint to the leg. The teen was taken into the Ambulance and I left them with my partner as I got out to try to get some details about the teen and the circumstances of the incident.

I noticed a bit of a ruckus going on a few meters away near the harbour wall. Two onlookers appeared to be in a heated discussion. Not wanting a second incident, I approached and asked what the problem was. “This person has a problem with me filming the incident. It’s a public place!”. At that point the other person took the filmer’s phone and tossed it over the wall into the harbour. “That’s my phone!!” exclaimed the filmer. The other person leaned forward so they were very close and in a cool voice, while pointing at the rear of the Ambulance stated “That’s my child!”.

After a moment of shocked silence, the filmer recomposed the self and demanded to speak to a police officer. Aware of the disturbance, two were already on their way over. One of the, a local sergeant, asked what the problem was. The filmer quickly explained. I pulled the sergeant aside and briefly explained what I had witnessed. The sergeant approached the parent. “Is this true?”. “Yes, that’s my child in there”. The sergeant stretched out his hand and shook theirs. “Thank you, you’ve saved us some work. And this person owes you thanks too. Without evidence we have no grounds to arrest them for a string of offences.”. Then they turned to a somewhat silent filmer. “Was there a problem you wished to discuss?”. “Erm….no.” they said in a sheepish voice. “Then I hope you’re a good swimmer!” said the sergeant as he walked away.

Filming incidents, other peoples’ misfortunes, is not cool. It’s rather sad that there are people out there who think it is. Who feel the need to post these photos and videos online to make them look better.

I’ve seen the effects these incidents have on the victims, and their relatives. Making them objects for twisted peoples’ entertainment is not helpful. Show respect, be thoughtful. It actually might be you one day….

When I’m 64(ish)

Older people are great. They’ve been through a lot, they’ve seen a lot, and some have given a lot, but many don’t expect much in return.

“I don’t want to bother you”, “someone else needs the Ambulance more than me”. Both phrases heard on a regular basis by ambulance crews, often from very ill patients.

One patient was in the middle of a huge heart attack when they said that, as my partner and myself watched it develop on the defibrillator screen. They were put straight and rushed into hospital! A common one was the patient lying on the floor with a broken hip. The ball at the top of the femur can be fragile in some older people, and often broke off. The fracture was known as a #NOF – fractured Neck Of Femur. We’d regularly turn up to such jobs to be told “I’m sorry for wasting your time”, the patient in agony and unable to move!

Many times the patient had just fallen out of bed and, although uninjured, they just couldn’t get up and back into bed. Sometimes this was a more serious event and further action was taken. Often they just required us to help them back into bed. We rarely stopped there. Whenever possible, we’d put the patient’s kettle on and make them a warm drink, settle them before we left (most had catheters, in case you’re thinking the obvious).

I realised quickly that, other than a carer, we may be the only other people that the patient might see in a day. Sometimes we’d sit by the bed as they drank their tea and listen to their fascinating stories. All they wanted was someone to chat to, and we were there to care for them so it was our job to listen.

Sometimes Control would radio to “check we were ok”. Ie. They needed a crew for another job. If it was serious we’d go, if not, we’d stay a bit longer. An executive put out a memo once stating that crews were spending too long at jobs and suggesting a time we should allocate to each job. This executive had clearly no idea what our job actually was, otherwise he’d have not chosen to make a complete fool of himself. That memo was instantly filed in File 13 – 🗑️

Older people deserved respect, and we weren’t going to deny them that so the figures on a computer screen somewhere looked good (the same went for other types of call). We did our job and targets had no place in there.

I once discovered we weren’t the only ones that respected older people: We had been called to a house, somewhere in the middle of nowhere for a patient who had fallen in their living room (?#NOF) , along a narrow country road. As we got closer we discovered a long stretch of roadworks ahead, closing one direction of travel, under the control of stop/go boards at each end. As we approached, Blue light on, the worker with the stop/go board at our end Bbegan frantically talking into his radio. He held his hand up to stop us and we waited until a couple of cars came through, then he waved us on. The satellite navigation showed us the house was somewhere along the stretch of roadworks, but we couldn’t find the access road. We got to the other end and asked the road worker to hold the traffic while we did a u-turn and had a second look. We reached the other end and the first road worker flagged us down. They asked where we were looking for and he looked blank, then he asked who the patient was. My partner and myself were pretty sure we couldn’t give out that information “Is it *****?” they said. “Erm….yes actually”. Ah right. Again he spoke into his radio. “Two of our chaps are with them. They went up to the house for their tea break. It was them that called you”. It turned out that the workers had closed off the original entrance because of its location, and we were swiftly directed to the new one. The road workers had been checking up on the patient daily, looking after them.

Never underestimate what an older person may have done for you. Don’t be disrespectful. What you are able to have and do may, in some part, be because of these people. Simple acts of kindness go a long way.

All by myself (aka. Here I go again… PtII).

No one has invented a word yet for the feelings and emotions you experience after you have just explained to someone that the last time they spoke to their loved one was, actually, suddenly, very unexpectedly, the last time they would ever speak to them alive.

I had been single crewed since the start of my night shift, not very busy as it was midweek and in the middle of the month. It was also summertime so lots of people were on holiday, or feeling the pinch having just been on holiday. I was in the mess room alone, the volunteers had finished and gone home. The messroom radio was playing music and I was relaxing. My handheld radio screeched and vibrated on my belt and brought me back to earth rapidly! The call was a code purple – “life status questionable”. On my way to the Ambulance the radio rang and the dispatcher apologised for sending me alone, but there was no one available to back me up. The city was obviously busier than the rural areas. The dispatcher was a favourite of mine, so I knew they were struggling and I was the last resort. I arrived at the scene and rushed into the residence with all my equipment. I was met by the patient’s distraught partner.

An elderly couple, they had been on holiday recently, as both were tanned. The patient had then been away for work and had returned late the night before. A young grandchild had stayed over and was sleeping in bed with the partner so the patient had slept on the sofa in the living room. When the partner woke, they had gone through to the living room and attempted to wake the patient. As soon as I began to examine the patient it became very apparent they had been dead for some time. Rigor mortis had set in and they were cold. There were other indicators too. This was when I had to explain it to the partner.

I sat them down and explained as sympathetically as I could that there was nothing I could do, their loved one was gone, and I was very sorry for their loss. “There must be something you can do?!”. I shook my head an suggested we put the kettle on and that I should call a relative or friend. This was partially to take the partner out of the room the patient was in. I called the couples’ oldest child (who was in their 50s) and, thankfully, the phone was answered by their partner. I explained the situation and they said they would be at the scene shortly.

I had to do some official paperwork and, because it was still an unexplained death, had to contact Control to arrange for the police to attend. I couldn’t leave until the police had arrived. 5 minutes later the peace was shattered! The patient’s oldest child arrived and went into hysterics – “They’re not dead! They’re just sleeping! Look!”. Trying to explain to a relative that their loved one is currently a crime scene is a very definite never. Trying to stop said relative from shaking the deceased patient is difficult, physically and emotionally. Thankfully their partner intervened.

I felt extremely lonely, the bearer of bad tidings, the outsider in a moment of family grief. I took the words of a close friend seriously at that moment – “a wise man once said….nothing”. The police finally arrived and I handed over to them, gave them my paperwork and left. There was no point talking to the deceased patient’s partner, there was nothing I could do or say that would help. Their child’s partner nodded at me on my way out, a “thank you”, accompanied by a painful smile. It made me feel slightly better.

A different shift, still single crewed, night shift again. The radio came to life as I drank another cup of coffee. “Pt fallen down stairs, ?#L arm”(query fractured left arm). It sounded simple enough. Then the radio rang – “5638. Apologies for sending you to this job single crewed, we are aware of protocols”….uh oh… “Pt is a known alcoholic and is intoxicated, backup will be en route as soon as I have someone available”. Single crewed personnel should not be sent to alcohol related jobs, a rule frequently broken by desperate dispatchers.

I arrived to find a very drunk patient screaming in pain, their partner at breaking point, not knowing what to do anymore. The reason for the screaming became apparent very quickly – the patient was in severe pain, having fractured their humerus (the thick bone between the shoulder and elbow) and was waving their arm around in a grotesque fashion! Crepitis was a word I’d learned during training – when the two ends of a fractured bone rub together. I’d felt it before in various patients’ bones, that night I heard it from the other side of the room!

The involvement of large quantities of alcohol negated my ability to use most of the analgesia we carried, so I called control to get a second opinion from the duty Paramedic Advisor (more to have a backup should anything go wrong). We agreed that entonox, “gas and air”, would be acceptable. This might have worked, had the patient been more sober and willing.

I tried to explain the benefit to the patient, their weary partner tried too. More screaming and screeching. Eventually I managed to get some form of sling attached to the patient and secured the elbow to the patient’s body, a slight immobilisation of the arm. Backup finally arrived. I explained the situation and they took the patient away. I’m not sure who was most relieved, myself or the patient’s partner. I met the crew that had backed me up at a few more jobs that night, and at each job they commented on how they’d struggled with the patients all the way to hospital, and how I must have struggled on my own.

Thankfully, I’m reliably informed, single crewed shifts are less common now. Although I found it was a very good way to learn fast.


Here I go again on my own…

“Ambulances will never be single crewed”….promised one high powered ambulance service officer once on a public forum.

A single crewed ambulance isn’t always a good thing. In a true emergency, one crew member can stabilise a patient, but a single crew member will never transport a patient. Ever. No matter what the person in ambulance Control thinks. It is quite embarrassing to turn up at a patient’s house after they have been waiting a while, expecting to be taken to hospital, to have to tell them that you are not able to. There is little or no communication between a patient in the back of an ambulance and the driver. If the patient’s condition were to deteriorate, the driver would be unaware. Still controllers expected us to oblige. Then there was the standing around in the patient’s House uncomfortably waiting for a second vehicle to arrive, with two crew members.

Working from a small station, we only operated one ambulance so there weren’t many of us based there. The unexpected and sudden departure of one crew member, one I worked frequently with, brought on quite a lot of single crewed shifts for me shortly after I transferred there. This continued for an unexpectedly long time, until the service got around to arranging a replacement.

My first one was the day they departed. I turned up, on a hot summer evening, ready for my night shift to be told I was on my own. Our ambulance covered a rural area with a radius of around 30 or more miles, and a main dual carriageway. I had never worked on my own before….

The first call was to an older patient with breathing difficulties. They were asthmatic and known to me as a regular. I drove the short distance to their house quickly and went inside. A family member was there and they were as nice as the patient. I quickly set up a nebuliser to open up the patient’s airway a bit, and began to take some observations. Everything was improving well with the nebuliser, but the patient had raised temperature and a bit of a wheeze when I listened to their chest with my stethoscope – queried chest infection. They had to go to hospital, so I radioed control and requested a second ambulance. A disgruntled controller agreed to send one from the city, almost 20 miles away. “Better put the kettle on then” said the relative.

Having returned to base after seeing my patient taken away by a city crew, I felt the shift was going well. We operated a volunteer scheme from our station – ambulance service trained volunteers with basic life support skills who could attend certain types of job if the Ambulance was unavailable at the time. That night the two designated volunteers arrived in station shortly after I returned. We were chatting away when the next job came in.

It was a call to the river at one end of the town. A drunk had fallen down an embankment and had trapped a foot. ?# (? Before a word implies “queried”, # means “fracture”). I rushed down to the location, to discover I had been directed to the wrong side of the river.

It wasn’t a large river, and there was a small foot bridge next to where I had stopped. It would take too long to take the Ambulance to the next vehicle crossing, so I grabbed my equipment and carried it over the footbridge. As I was leaving the Ambulance, one of the local fire units pulled up behind me, having had the same instructions.

I arrived at the scene – the person had fallen down a bank approximately 2 metres, getting their leg stuck in the loop created by a tree root sticking out of the bank, almost doubling their foot back on their leg. The patients head was almost at the waterline, but being a seaside town, the river was tidal and the tide was coming in.

A quick head to toe confirmed no major damage, other than that foot, and the patient was in good spirits, having sobered up slightly. They had no feeling in that foot, but there was a good pedal pulse present. I examined the scene and began to put together a plan of action. Firstly, a second ambulance, this patient was going to hospital. Next, the two volunteers sitting at the station. They were experienced and their help would be valuable until the second ambulance arrived. I radioed control and requested both. Next, secure the patient’s head, safe from the rising waterline. One of the fire crew supplied a plastic pillow which raised to patient’s head acceptably (neck pain/trauma had been ruled out beforehand, in case anyone is concerned). I began taking some observations, all good. The volunteers turned up and stood at the top of the bank, handing me down equipment as I asked for it. By now, I was standing with my feet on two large rocks, an around a foot of water. A fireman had fitted the patient with a small life vest while I was talking to them and repeating my observations. Suddenly I felt a pair of hand on my shoulder. “You might need this”. One hand stayed on my shoulder and the other one appeared between my legs, as I was also supplied with a safety vest. “You could at least have bought me a drink first” I joked with the fire person. “Would you like me to?” they grinned back.

The fire crew successfully cut through the root and the patient’s foot was released. Miraculously there was only some nasty tissue damage, but no fracture. The patient was strapped to a spinal board, lifted up the bank and taken to the second ambulance that had arrived. One of the volunteers had directed them to the correct side of the river.

I got back to the ambulance station quite please with myself. I had managed that job quite well. The volunteers arrived back before me and, as as I walked in to the messroom one of them said “what happened to your arms??”. I looked at them – they looked like salami! Because we wore short sleeves, every insect in the area must have had a nibble at my arms.

There are rules about what type of jobs a single crewed vehicle can attend. Those were probably the reason the rest of my night was unbusy. That was the first of many on my own, but it’s a great way to learn fast…..