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…..

When work follows you home….

I was on day shift the day my father passed away. My partner and I had been out to a couple of jobs but we were on standby in the mess room when I got the call. My partner realised there was something wrong as soon as I hung up. When they found out, they made me go home and contacted control to let them know. I remember driving home, having a shower (not sure why) and changing out of my uniform. The next thing I remember is receiving a call from a family member asking where I was. I was in a small village, some distance from home, on one of my favourite country roads for driving.

I went into hiding for the next three weeks and my friends gave me space. On reflection, possibly neither of those was a particularly good idea. Death was something that happened in other people’s lives. To me they were “jobs”, they had to be. Other people did the grieving, I walked away. Suddenly I was actually one of those other people…and I didn’t know how to be.

On the day I returned to work the second job of the day was to a local nursing home, run by the same company as the one my father had passed away in three weeks previously. The Ambulance screen claimed we were going to someone having a seizure, when we got there it turned out to be an elderly resident in complete cardiac arrest. We began work on the patient, until one of the nursing home staff tried to stop us. It transpired that the patient had a DNACPR order – Do Not Attempt CPR. This document was an ambulance crews’ nightmare, an end of life decision made by the patient or their family and their doctor. It is a legal document that prevents anyone from bringing a patient, usually with a poor quality of life, back from a fatal incident such as cardiac arrest. Unfortunately, until the document is presented, ambulance crews have a duty of care to do the opposite. We asked to see the document and the nurse presented us with a photocopy, not good enough. After 10 minutes of CPR the original document appeared and we stopped. It took around 40 more, long, minutes for all signs of life to completely disappear. 40 long minutes before our involvement was over. As I was doing the paperwork I heard two staff members talking – “That’s the second one this month. There was one in the other home three weeks ago.” my partner looked over at me to check I was ok. I nodded. Back in the Ambulance the screen lit up with the next job….

Some weeks later, it dawned on me that the nursing home my father was in was on the outskirts of my working area and I could have been called to that job

Cancer patients are regular jobs. Usually you gave them analgesia for the pain and took them to the cancer ward. Once dropped off, we’d go to the next job. To sit in a consultant’s office while they explain to you and your spouse that your spouse has cancer is not a situation you expect to be in, nor are you trained for. It is a genuinely surreal experience and it took some time to sink in. “This only happens to other people!!”. These are times when true friends get you both through.

There was no support from my ambulance service, no help offered. Thankfully surgery was successful, but I’m still waiting for any ambulance service manger to ask me how I’m doing, or even show an interest in that situation… or the loss of my father. The support my spouse and myself received was external, from cancer support charities. Without that support it would have been so much worse. The cancer is gone, the psychological effects are still there, but I can’t say enough about how amazing the support of those cancer charities is. If there are heroes out there, that’s where they work.

As always, this post is not about looking for sympathy in any form whatsoever. Ambulance crews face challenges every shift, and I am fully aware I am far from being the only one to face such situations. This post is to highlight yet another reason the Ambulance services across the UK need to step up their staff support, possibly even begin supporting in some areas of the country. We are all only human after all.

There’s that moon again

I spotted another full moon this week. It reminded me that the phenomenon isn’t just limited to night shifts (patients aren’t actually vampires. Vampires don’t get ill). The “less sensible” patient can require ambulance assistance any time and, while we might not know it’s there at the time, during the day when there is a full moon.

One such call appeared on my screen mid-morning one winter. There was a lot of snow on the roads, but they were drivable. The job was about 10 miles from our station and not a high priority, so we didn’t rush.

The on-screen navigation was known for its inaccuracies, and the maps it was based on were somewhat out of date. Thats where the job began to go wrong. The estate we were going to was very new and didn’t exist on the maps the system used, but it still plotted the “quickest route”…..or so we believed.

It was when we drove into an industrial building site we first queried its accuracy. My partner was driving and came to a rapid halt at the bottom of a snowy, muddy, hill. After realising we were off course I decided to look the address up on a well known mapping app on my phone. We were very off course!

My partner turned the Ambulance and drove up the hill, at least that was the intention. Part way up the wheels lost their grip and began to spin on the snow. “You’ll have to dig us out” my partner grinned. Yes, it was my job at that moment in time. I climbed out of the ambulance and opened one of the external side hatches, located the snow shovel (modern ambulances are equipped for most situations) and began to clear the snow away from the rear wheels. My partner slowly began to drive the ambulance clear, and kept going. Stopping at the top of the long hill, they radioed me, suggesting I hurried to join them as we were still en route to an emergency.

After updating control on our situation, we got back on course with the help of my phone. The job was an RTC – “4×4 vs house”. Neither of us was sure what to expect.

As we got closer, we knew we were at the correct location. There were an unusually high number of police cars and officers also making their way to the scene. We turned a corner into a cul-de-sac and knew we’d arrived.

There was a posh 4×4 holding up a spare bedroom, seriously. The driver was out of the vehicle. Their partner was away on business but had asked them to run the car every other day so it didn’t sieze up. Having gone to do so, the driver hadn’t realised the vehicle had been left in Drive and, lurching forwards as soon as the ignition was turned on, rather than brake they had accelerated. This had propelled them across the cul-de-sac and straight into the end wall of the garage attached to the house opposite. The garage the owners had built a spare bedroom above. The car literally was holding up the room as the supporting wall had mostly been destroyed.

The fire brigade had also arrived and we left them to the structural issues while we began to assess our patient. Their injuries? They had knocked their knee on the vehicle door when climbing out! Surprisingly, they declined a trip to A&E. When we asked why they had called for an ambulance they replied “isn’t that what you are supposed to do if there’s been a crash?”.

We later found out that the excessive police presence was because the house next door to the demolished garage belonged to one of the officers.

Around the same time, a city based colleague declared the full moon.

It’s genuinely a thing!

Who saves the life savers?

Someone told me about a TV program broadcast in Scotland recently. It suggested that almost one in ten paramedics suffered from PTSD, and one paramedic interviewed was diagnosed with it worse than had they been on a battlefield! They also said that the Ambulance Service had declined the opportunity to give a representative the chance to be interviewed.

These are the men and women who are responding to emergency calls daily, and their employer doesnt even have the desire to comment on national TV.

There was also talk of things that had been put in place to help crew members and front line staff, but what I hear from those front line staff is different. Other than proving that few in positions of management are actually aware of the reality that goes on outside their office doors, a fact that has been known by ambulance crews for many years, this is nothing new.

The above is not just limited to one part of the country either, it is widespread across all the ambulance services in the UK. I’ve spoken about the 5 minute breaks we used to get after bad jobs, and the phone numbers that get handed out – Call someone who you’ve never met before, who has never met you and never will, and tell them over a telephone line how you feel… Then hope that your colleagues don’t find out because you’ll feel like a failure and they might think that you are unfit to do the job.

That is the reality, that is what ambulance services need to address, and that is why crew members struggle on, until it gets too much and they can’t go on any longer.

I’ve held back slightly in previous posts, but I see no reason to any more. I could write things that would (or should) probably have ambulance service managers squirming, and can back them up with strong evidence, but that’s not the purpose of my blog.

When you watch people die in front of you and you have done everything possible. When you’re faced with an angry drug addict who’s life you just saved but who’s high you took away in doing so. When you face countless drunks who threaten to kill you and your family when you are just trying to help with the injuries they got from fighting. When you spend 30 minutes or more working on a patient, giving CPR, providing advanced life support, then you hear that A&E staff gave up shortly after you handed the patient over….and then you pass that person’s relatives in the corridor…

“Here’s a number you can call if it’s too much.”

This isn’t something that can be changed overnight, and I don’t have any answers or solutions, I only have my own experience and knowledge of what others have been through.

My strong hope is that the Ambulance Service in Scotland, now these issues have been highlighted, now has to act, positively. Maybe other television companies will pick up the story in England, Wales and Ireland. Until the public are aware of the quiet suffering that all emergency workers go through, suffering that sometimes costs their own lives, not much will change.

During my time on the road I saw how my colleagues reacted, I saw the brash, faux toughness, the hard act. I even did it myself. But there comes a time when that doesn’t work anymore. For me, that time was when I left the service. My defenses fell because they werent being topped up for another shift. My support mechanism (my colleagues) was gone. Suddenly I had to face everything I’d seen and done on my own. I can’t heap enough praise on the people around me, the ones who tolerated me at that time. But there were people who didn’t wish to tolerate it, and friendships ended, making it harder. Nevertheless, I got through it with the help of the ones who stayed, and I know of others in the same position.

I’ve spoken in other posts of one friend who didn’t. This post is for them, and the ones like them. For the families and people they leave behind.

Maybe it’s time to think about the health of the health workers. To start monitoring their mental health, to start giving them regular mental health checks. To start saving the lives of the people who save lives.

It started with a mist

Driving: Metal vehicles, adhered to the road by small areas of rubber compound. 14 year olds are taught about momentum and inertia in basic physics at school, but few people apply that knowledge once they’re in the driving seat.

At 20 mph the minimum stopping distance is more than 12 metres, but the average driver focuses 6 metres ahead of them. The average human reaction time is 1.5 seconds – at 70 mph a car has travelled about 483 metres before most drivers’ feet touch the brake pedal, almost half a kilometre!

These facts are not secrets, but people still think they can change the laws of physics, that they are good drivers. A traffic police officer once told me there’s no such thing as a good driver. Some may be better than others, but even they can’t control the weather, the lorry in front’s leaking fuel tank, the idiot drivers on the same road…

Please excuse the physics and driving lesson. The point I’m trying to make is simple – driving is dangerous. There have been significant advances in safety technology- once I turned up to an RTC to find a crumpled mess of a car. Thinking the worst, I ran to the traffic officer standing nearby, shaking their head. “Is the driver still inside?” I said. “No chum, this is them here. We’re talking about petrol or diesel engines. Which do you prefer?” – but despite all the safety improvements, no one is invincible.

Every time you pressed the “999” button, you knew it would bring out the worst in drivers around you. Some panic and don’t know what to do or where to go. Some try to outrun you to get out of the way, some actually stop dead, right in front of you, some even run red traffic lights to get out of your way. Many don’t actually see you!

When you are driving under emergency conditions your senses are heightened. You learn, ver quickly, to predict other drivers’ moves. When there’s a patient dying in the back of the ambulance seconds count, and the pressure is on you to get them to hospital quickly, smoothly and safely.

Sometimes this stress leads to anger, that’s when the red mist descends.

During emergency driver training we were taught about the red mist. It’s a dangerous thing and you have to learn to control your emotions very quickly. There is no place for anger in a diver, especially not one who has a patient’s life in their hands.

Tiredness can help bring on red mist, when the car in front won’t move out of your way, or someone stops in front of you. It’s tempting to drive too close to the unseeing driver, in the hope they hear your sirens better or see the blue lights. I actually did that myself, until I learned it only takes the driver in front to panic brake, and I’d have caused an RTC.

Learning to control my emotions during these situations was difficult for me, but it was an essential part of the job so I learned to do it. There’s no place for road rage, ever, especially not in an ambulance. We all had our pet names we’d hurl at drivers that caused us annoyance, but that was as far as it went, and it was usually in a jocular fashion because we’d probably never see them again.

One time I came up behind a very elderly neighbour of mine. They weren’t moving out of the way, and I followed them (at a safe distance!) for almost half a mile before I finally managed to overtake safely. I quizzed them about it at a later date, they had no idea what I was talking about!

Most drivers don’t get the training emergency drivers do, but that’s no excuse for some of the driving I saw. Anger, annoyance, road rage….red mist. None of those belong on the roads. Calming music (it makes a big difference!), slowed breathing, whatever works for you. Don’t let other drivers bad driving make you a bad driver.

Some may think the next part is obvious, my experience says otherwise – if an ambulance appears behind you with lights and sirens going, think. Think where the driver can go with the least amount of manoeuvring (there may be a lot going on in the back, every move of the steering wheel throws the passengers around). Think about safety, and move out of their way early and sensibly, making your moves obvious to other drivers.

It starts with a mist, don’t let it come to this:

Is this the real life? Is this just fantasy?

Some shifts felt like surreal dreams, they couldn’t have been real. When days off came round, you’d find yourself thinking “did that really happen?!”. But this is daily life in front line emergency care.

You meet your fair share of people lacking…”basic intelligence”…out there. Often alcohol or drugs are a contributor, sometimes it’s just how they are.

This is, in no way, a dig at any nation (#spottheparanoia). The job was an assault in the city centre, around 2300 (11pm). We arrived to find two police officers with a French person who had been set upon by some locals. I think, quite quickly, that I worked out what may have caused them to get the urge to do so. The patient instantly gave off an air of arrogance, and backed it up swiftly with their attitude. “are you a private service?” they asked, with a thick French accent. I stated we were NHS, and asked if they were on holiday or resident in the UK. We established, eventually, that they were studying in this country. Having managed to convince the patient that we were currently the best they were going to get, they, reluctantly, got into the back of the ambulance. Having done a full top to bottom examination it was clear that the injuries were mostly facial, but I advised they went to A&E in case there were any I had missed, possibly even a concussion (unseen injuries that result from blows to the head). The patient agreed. On the way they began to quiz me on the quality of care they should expect. “The same as everyone else” I stated. Then they asked about the broken teeth they had received during the assault. Would they be fixed at the hospital. I said it wasn’t likely. “then you must take me to the airport!” they demanded. They got agitated when I tried to explain the difference between an emergency ambulance and a taxi. Then they demanded an explanation as to why their teeth would not be fixed at A&E. In a moment of kindness I decided to save them from the wrath of the nurses he was about to meet, who would have no tolerance for his attitude. I began to explain in clear term what A&E was and what would probably happen there. I explained that their broken teeth were not a medical issue, that they were a cosmetic problem. “Cosmetic? What is cosmetic?” they said indignantly. I tried to explain but to no avail. Then I had a brilliant idea! This was the 21st Century, and I had a smartphone….with Google Translate! I typed in “cosmetic” – English to French. The translation arrived quickly. With a grin I read it out to the patient. Oh…”cosmetic”. It was exactly the same. The patient still didn’t get it, so I showed them. “ohhhh. “cosmeteek”” they said.

By this time we had arrived at hospital and my grinning partner was opening the rear doors of the ambulance. I stood up and walked out the vehicle. The patient followed me and, after a very brief handover, I left them in the less tollerant hands of the nurses. They would sort that attitude out.

Occasionally we would come across incidents that hadn’t been called in yet. One such incident occurred on a junction of two main roads as we were leaving the city to return to our station. A crowd was gathered just off the junction, in the middle of the road. As we slowed to have a better look, we saw someone lying on the road, the crowd having gathered around them – RTC. My partner pulled over and parked the ambulance in a position to protect our new patient and activated the vehicle’s blue lights. I jumped out and went to investigate the situation while my partner called control to inform them what was happening.

The patient had been on a bicycle and had been struck by a car at the traffic lights. A swift top to bottom examination revealed no neck or spinal injuries, and the patient’s headgear and clothing had protected most of their body. There was, however, the possibility of a fracture, maybe even two, to one of the patient’s ankles. I was on my knees beside the patient talking to them when I felt a tap on my back. “What’s their name?”. Confused, I turned round to someone on their mobile phone. “Sorry. What?” I said. “What’s their name?” the phone person repeated. “Erm…..Who are you? Why?…..What?” was the best I could muster. “It’s the ambulance. On the phone. They want to know their name!”. Okay. Think. What?! I pointed at the back of my uniform shirt, thinking the word AMBULANCE embroidered there might be a clue. Mobile phone person looked blankly at me, so I pointed at the big white van with the blue flashing lights. Nothing. “Can I talk to them?” I asked in despair, my hand held out for the phone. Still unsure of what was going on, the person handed me the phone and I identified myself to the call taker. “Oh hello, I think your partner is on the radio to your dispatcher.” “Uh-huh”. I updated them on the situation and the patient’s suspected injuries. I handed the phone back, just as the police arrived and moved the, still confused, owner away from the scene along with the rest of the spectators.

I found out later that the French patient tried to give the A&E staff grief and was swiftly asked to vacate the department by security. I wonder if mobile phone person has ever understood what happened. Probably not.

Those were two of many real jobs that seemed very unreal looking back. They happened though, I was there!

No more heroes anymore?

Being based in a large rural area involving lots of farms, many patients were slightly older and had resided in the area for years, often decades. Older country folks are a special breed – they don’t like anything modern, or anything they don’t understand. They don’t like a fuss being made over them, they don’t like causing a fuss, and they certainly don’t like hospitals. Many times I heard older patients tell me they didn’t want to waste my time, more than once those patients were in the process of having a heart attack.

Working outwith the city also meant longer journeys into hospital, sometimes up to 40 minutes or more. That’s a long time to chat with the patient (assuming they are conscious!). Those journeys were either hard going or a great experience. Older people have usually seen a lot of changes in their lives, especially if they’ve lived in the same area for a long time. That was usually my conversation starter. Most patients loved to talk about the things they had seen, things they had been through. Most didn’t like to talk about WWII. I did, however, have one patient who got quite upset regarding the war.

I began with my usual “you must have seen a lot of changes in your lifetime?”. The patient agreed, then said “but I did things I’m not proud of”. It transpired they had been part of a special forces group and, although they couldn’t tell me what they had been involved in, they did tell me they had taken enemy lives. This was clearly upsetting to them. I pointed out that, despite the unfortunate circumstances, their actions had actually helped ensure my freedom, and that made them a hero in my opinion. “but I killed people!” they said with tears in their eyes. Humility is too small a word to explain what I was feeling. The person in front of me had suffered all their lives for their part in my safety and my right to live free from dictatorship! I listened to stories I can’t write here, all the way to the hospital. By the time we got there I was speechless. Most people will never know that patient’s part in their lives, or their courage, but I will never forget.

I met a number of genuine heroes in my time with the service, all humble and very un-hero-like. I will always consider it an honour to have met them, a chance to try to care for them as best as I could, albeit nowhere near enough to show proper gratitude.

All heroes, all unwilling to accept that fact. A far cry from some of the so called “heroes” we see on our TV screens now – footballers, pop stars…??

Most who had active involvement in WWII will no longer be with us now, but I hope they, and their effect on our lives, will never be forgotten by us or future generations.