RTC? RTA?……….. Crash!

No matter what you want to call it, the coming together of two objects often ends in injury, or worse. I had not long started when I was called to my first fatal RTC (Road Traffic Collision). I think they were still known as RTAs at that point (Accident) but later someone decided “accident” implied that no-one was at fault. I was still working in the big city, it was winter, the roads were icy and there were celebrations going on.

One driver, of a rather large car, had decided one for the road was not enough. Suitably oiled himself, he had taken a large corner too fast and slipped over to the opposite carriageway halfway round, straight into the path of an oncoming 4×4. Not a scrappy German, WAG taxi style 4×4, a real, solid built one. The result of the head on collision was spectacular!

On our arrival, two other crews were working in the rear of the large car in the middle of the road, while the fire brigade were busy dismantling what remained of it. The other vehicle was on the grass verge, looking like it belonged to a passer by who had simply stopped to help. It had a slightly cracked grille, scratched paint…..if you looked closely, and a broken light (not an exaggeration!). The driver was being checked over by a Dr who had come from a house nearby by seemed ok, other than a bit shaken.

There were three people in the large car. All were rather large, none were wearing seat belts. The crews on scene were working hard with the fire crews (aka, with utmost respect, “drip stands”) to extract the two passengers from the rear. Both were in critical condition.

There I was, barely qualified, already a number of RTAs under my belt, but never at night, never in the biting cold, never with so much noise from so many fire engines. I stopped before getting out of the Ambulance and turned to my partner, a veteran of many incidents. My heart was pounding, the noise was mind numbing. “Breathe, then assess the situation” they said in a calming voice. That advice stuck with me throughout my career.

By the time I left my ambulance I knew what my part was and what I had to do. The driver was my patient. Because work was going on in the rear of the car, I had to wait until the passengers were out before I could attempt to deal with the driver. I knew I had to keep his head straight, something important in every impact situation to try to keep the Spinal column straight and prevent any damage to the Spinal chord. I also had to keep them calm while their car was being cut apart around them. I grabbed a fireman and asked them to remove the front windscreen. Once done I was able to talk to them, making sure they were looking straight at me all the time, and not moving their head. Even the length of the bonnet away from them, the alcohol fumes were strong. I asked my partner to put an oxygen mask on the driver, then it was just them and me…..in the middle of a world of organised noise.

I stood in front of that car for, what seemed like an eternity, talking to the driver and finding out all about them. They had been to a party and had decided the roads would be quiet enough to drive home ok. My hands and face were numb with the cold by the time the first passenger was extracted from the rear of the car. I could tell from the looks on the peoples’ faces that it wasn’t going well. They disappeared off to A&E. Then the second passenger was extracted, my partner was helping and they shook their head as the lifeless body was wheeled to the other ambulance. The crew were giving CPR, but I could tell it was hopeless.

As soon as the fire chief gave me a thumbs up I was in the remains of the car, holding the driver’s head from behind their seat. I had already established that the whole front of the car was pushed back, the dashboard and steering wheel pressing against the drivers legs and chest. They had complained about pain in their right hand so I looked from behind them, now I was able to attend to them properly. “it will be ok, well get you sorted” I said, as reassuringly as I could muster. The hand was hanging by nerves and skin at 90 degrees to their arm. The broken ends of the bones were visible at the end of their arm, and sticking up from their hand. Mercifully there was no arterial bleeding!

The fire chief and myself quickly worked out a strategy and explained it to the patient, then they got to work removing the front of the car. The cutters made light work of the metal. Then the whole chassis broke in half, down the length of the car. My left leg was jarred down suddenly and the engine dropped on to the road at the front of the car. The oil sump cracked and oil ran everywhere.

We patched our patient up, extracted them with the help of a spinal board, then into the Ambulance. The journey to A&E was quick and we handed our patient over. As we walked away the patient said something, muffled by the oxygen mask. The nurse lifted it and the patient looked me in the eye and mumbled, still slightly drunkenly, “Thank you. Happy New year, when it comes”. My heart sank! Neither of the two passengers had survived as far as A&E. The driver would never drive again, possibly not even walk. Not a very happy new year.

The moral is simple, obvious, but there will always be those who think they know better. There will always be ambulance crews who will try their best to save them.

“I could never do your job!”

Not true! I went into the Ambulance Service as a non-emergency driver for nearly the first two years of my career. I was squeamish and had no medical background. I couldn’t even watch medical stuff on TV! One night, while working overtime taking discharged patients home, I was confronted by a non-emergency driver from another large organisation. He was grey, could hardly talk, looked terrible and was asking me for help. I had no idea what to do, so I called over to the receptionist who immediately called the crash team. Now I would instantly recognise the symptoms of a heart attack, but that night hit me hard. That was when I knew I could no longer be a bystander, the one who calls for help.

I had no intentions of becoming a hero, and I can honestly say I still don’t. I was trained by road experienced veterans, who drummed any aspirations of herodom out of us very quickly, and were keen to point out that you will never know everything, that your best resources of information are the long serving colleagues you will be working with. It worries me slightly that the current breed of youngsters have a different approach. The current training across many ambulance services is an academic one. The youngsters have no life experience, and leave training (approx. 3 months at a university in most areas) better qualified “on paper” than many older staff with vast experience. Many, not all, of these youngsters seem to believe they know everything they need to, and that they have been adorned with superhero status and the powers associated with that. I still see ambulances flying through traffic with a seemingly banzai attitude, crewed by youngsters who look like they should still be in school. I often joke with ex-colleagues that these young academics could write a patient a good essay, complete with Harvard referencing, but would they be able to spot a TIA or a PE quickly enough? Would they know when it’s more important to make an elderly patient a cup of tea and spend time with them, then refer them for a home visit from their favourite GP, simply because they’re lonely, rather uproot them and take them hospital because they can’t find a problem and don’t know what else to do? Having said all that, there are some who will become fantastic emergency medics.

During my years in the service, I told myself frequently – if one person in every thousand says “thank you”, then my job has been worthwhile. Shortly before I left the service I had the most humbling experience of meeting some who’s life would undoubtably have ended without my intervention. I’ve since heard of others, relatives of friends and, while I still maintain that I was only doing the job I was trained to do, I won’t even try to explain the amazing feeling news like that gives you. Well, not in this post.

Anyway, the point of I’m trying to make, in a very long winded way, is that anyone can be an emergency medic. If you have the urge to make a difference, if you don’t like being a bystander, consider it. Sqeamishness and other such things disappear when you’re doing your job, and your training and experience kicks in. Whether you’re picking up a very large, very drunk person who’s soiled themselves and spread it up their back by rolling around, or directing other emergency services at a bad crash on a busy main road, it’s still the best job in the world

Finally, if you really want to be a hero, I suggest you join the army!

One of those admin posts….

Firstly, thank you to my readers, followers, and likes. I started writing this blog in an attempt to get some things out of my system and to get some things out in the open. I wasn’t sure if anyone was actually going to read any of it, but it appears there are people who do. Some of the issues I post about are still problems within ambulance services up and down the country, most likely in other countries too. In the UK mental health problemi in crew members tend to be swept under the carpet and ignored, but they are becoming more and more of a problem. After all, ambulance staff are only human. A recent episode of the BBC series Ambulance showed a large scale incident in Birmingham last year, with numerous fatalities. Viewers saw a small window of how the medics were affected, then there was the debrief. In all my time as a medic, I was invited to one debrief, and it was by the A&E staff involved in a nasty job we had taken in. My partner and myself had to push our dispatcher hard to be allowed to go, and we were called to a job before the meeting ended.

Please share my blog, tell people about it. Maybe we can help make people aware of how ambulance crews are breaking every day. I mentioned in an earlier blog how I’ve already lost one friend because of the job, I know I’m not alone.

What I would like most though is if you would talk to me, share your own experiences via the contact option. Only I can see your personal details, and I will never share them publicly. If nothing else, it let’s me know what you all think of my posts. Most importantly, it’s good to talk, I know it’s helped me.

Nocturnal Admissions

Night shifts are a whole world of difference. Often, mostly at weekends, we’d be called into the big city to help the busy city crews. This could work well as we’d get the “real” jobs while the city crews dealt with the usual drunks and alcohol fuelled brawling. Sometimes it worked out the other way around. Either way, we all knew that it was going to get busier around closing time. That was when the alcohol seemed to make people braver, and by people I mean every gender. The girls were the worst! Nails, handbags, hair pulling, scratching……The guys just turned into (what their mashed up minds thought were) He-Men, and they felt the urge to attack anyone who dared look in their direction to show their dominance. On that note, I never understood why these males turned into sobbing messes in the back of the ambulance, some even asking to talk to their mothers (yes, seriously!). So, you can picture the scene – Saturday night, drunk people everywhere, you could almost smell the aggression in the air, and us….in a white van with very similar markings to a police van…..and wearing very similar high visibility jackets to the police officers. Police officers who seemed quite sparse on the streets.

We received a call to a regular in the city centre. He was an alcoholic, with a history of violence towards the uniformed personnel of all services, and he had his own area and MO. He used crutches (I never found out why) and used to prey on the soft heartedness of the late night revellers . He would take “fits”, conveniently next to a phone box, and passers by would call for an ambulance when they saw his performances. When the ambulance turned up he’d miraculously recover and swing his crutches at the crew. Our call wasn’t the first one to him that night. When my partner read the job on screen to me we both said his name together. So we rocked up, in our white van, and got out in our high visibility jackets. there he was, lying on the ground. ” He’s having a fit!!” cried the half dressed girl, struggling to stagger in high heels while clutching a bottle of some vile coloured alcopop. My unfortunate first thought was “that will look interesting in a sick bowl later!”, then we approached our patient. To the onlookers he looked pretty much unconscious, but we knew better. We stood either side of him, each with a foot on one of his crutches. “Come on *****. We have sick people to attend to”. One of the onlookers was about to voice their surprise at our approach, but was beaten to it by the “unconscious” patient. His eyes shot open with rage and he shouted/mumbled/sprayed “**** off! The lot of you!!”. He swung his arms at us, realised he had left his, now anchored, crutches behind, then lay back down and swore some more.

Then it all kicked off. There was a small street adjacent to the one we were on, that had a number of nightclubs along it. We heard the noise first, then saw the fighting spill out onto our street. Not drunken brawling, but real viscous fighting. there were around 15 males intent on seriously injuring each other, and it was all moving in our direction! We looked at **** and told him we were retiring to our ambulance , and that he’d be best vacating the area too. Miraculously, he recovered, and rapidly hobbled away. My partner dived into the ambulance as the mob got closer, and locked the doors. I banged on the opposite side window, just as one of the males’ heads sent the large wing mirror on his side squint.

He unlocked the doors and I jumped in. I pressed the Emergency Callback button on the dashboard display, and my partner put in an emergency call via his radio…….. Radio silence! We repeated the actions another time. Eventually, a very bored sounding dispatcher responded. I shouted “We require immediate police assistance at our location!”……….more silence. “6932 to control. Immediate police assistance required! Ambulance under attack!!!”. “Oh, I’ll see if they have any units free” came the reply. “6932 to control. Listen!”. “Oh……. Is that your ambulance making that noise?”. “Negative control. That’s somebody’s head being repeatedly slammed against the side of our vehicle. Get us multiple police units, and any spare ambulances here…..NOW!!!”. ” “Roger 6932. I’ll do that right away”. He’d woken up now. We were in the middle of expressing our views on our controller when the radio sounded again – “Erm….police en route with multiple units………… So.…….erm……..are you guys ok?”. We didn’t reply.

Less than a minute later the police arrived in force! Any of the mob still mobile scattered and we felt safe enough to unlock our vehicle and step outside. It felt like stepping into a war zone. There were bleeding revellers lying around everywhere, so we called it in and began to do our job. We never found out what caused the riot, and we didn’t hear from **** for a good while. Oddly, I felt safe outside the Ambulance at the start of it, before my partner let me in. I felt very unsafe in the city centre most nights, but I was there to do a job. That night, I was in the middle of a riot, but I almost felt like the rioters were avoiding me.

Other vehicles arrived and we dealt with all the wounded. After giving police statements, we cleared.

Perhaps completely unrelated, the next job was to an intoxicated female, who I’m still convinced could not be the one who spoke to us earlier but, just to add to our bizarre night, she managed to fill two sick bowls with half digested kebab……soaked in vile blue alcopop. You have to be careful what you wish for sometimes!!!

You only live…..once

Despite the James bond book/film that claims otherwise, the above is unfortunately very true! When it’s your turn, nothing can change it. Some people, however, choose to bring their time forward. Warning: this post is a blunt one!

Many times we’d be called to an “Overdose”. Sometimes it was a drug user who had overdone it unintentionally, often we could reverse the Overdose with a drug we carried, other times we were too late and the patient had passed away (usually before the 999 call was made). There were also the patients who wanted someone to pay them some attention. These were the ones who took 5 – 10 paracetamol or ibuprofen, thinking that it wouldn’t kill them. Some were spoiled kids who’s parents were too busy, others were so sad and low that you desperately wanted to hug them, but that wasn’t part of the job – all they wanted was someone to listen. None of the patent types I’ve mentioned actually wanted to die.

Then there were the ones who did. The ones who’s lives had gotten into such a state, or who had reached such a low point, that they saw no point continuing with their lives. These patients generally managed to see their wish through, and we were only called when someone found them.

Fatalities were part of the job, and I always managed to treat the majority as just that – jobs. I never knew them, I’d never met them, and I couldn’t tell you what they looked like once we left them. That was the easiest way to deal with death. They were someone else’s loved one, it was their job to grieve. But the ones who took their own lives, they were different. I was called to an unconscious patient, and rolled up to find a very drunk foreign gentleman. He was quite cheery and chatted a lot about how he had come to the UK to work, but he missed his family. Two weeks later, we were called to cut him down from a tree in the middle of nowhere. Another job involved a 15 year old, who was being cut down from a tree in their back garden by the police as we arrived. I remember that one, mostly because there was a strange peace about the scene, and the patient almost looked relieved. Then the mother came out and shattered the peace, understandably hysterical when they saw their dead child.

Then there was the parent who chose to end their life in the stairwell of their home, in full view when their ex when they brought their young children home. I’ll remember that as a job, their children will never forget it for many other reasons.

But we were given the usual 5 minute rest afterwards, then it was on to the next job. No support, no debrief, no health checks. Yes, we chose to do the job. Yes, it was all part of the job. No, no-one is hard or tough enough to deal with situations like that, or worse, and not be affected. The emotions involved in these jobs vary – anger at the selfishness, despair that society has let these people down, sadness for the family and friends.

Then the screen lights up and we go to the next job…..

“But that only happens to soldiers!”

That’s actually what a friend said to me recently when I told them another friend, who is still with the Ambulance Service, had been signed off with PTSD (Post Traumatic Stress Disorder). Until a few years ago, I’d have agreed with my friend, but now I know different.

It’s difficult to describe the emotional hardness you develop. When you walk into a drug den and see the addict, clearly dead, with the needle still in their arm. When you cut someone down from a tree. When you have to explain to someone that the last time they spoke to their partner was just that. I could go on, but there’s no need. The emotional hardness happens because the people you work with understand, and there’s an unconscious support there.

When I left the Ambulance Service that support ended overnight. I wasn’t aware at the time, but looking back I can see the signs and symptoms. My support mechanism ended overnight and I went through a form of PTSD. An ex-colleague and myself often chat about jobs we’d been called to, but sometimes…very often…that’s not enough. We recently lost another friend and fellow crew member that we both trained with, the job became too much and broke him. Now we have become acutely aware how huge the lack of support for ambulance crews all over the country is.

After a particularly nasty job, I was once given a phone number I could call, should I find I was struggling. For those who don’t know any ambulance crew members, they may appear kind and caring, and they are, but underneath they become a certain amount of tough and hard. It’s the only way they can survive. To call a number and talk to an anonymous person, who knows nothing about you, is beyond failure!

The purpose of this post is not to point the finger at the Ambulance service. It is to highlight the vulnerability of every person who works in an ambulance, and to highlight the need for a much greater system of support. I am fully aware that other services deal with the same situations, but perhaps someone else will write about it from their perspective.

Next time you see an ambulance go by with its lights flashing, spare a thought for the crew. Think about what might be going through their minds. When you go to sleep at night, think about the crew members, and what nightmares they might be having. If you know a crew member, show your support. Sometimes they look tough, but underneath they’re just normal people……….well, most of them are!

After I posted today’s blog, someone sent me this link. They only cover some parts of the country, but it’s a start: https://www.mind.org.uk/information-support/ambulance/mental-wellbeing-ambulance/

“I pay your wages”…. Pt II

If the people who use the above statement knew where scary amounts of their money were used, they may have a greater respect for ambulance crews. So here we go:

A significant number of the jobs I was called to involved drugs & alcohol. No great surprise, but the day after often saw more time wasters. While more of the jobs were to overdoses or D&Is (Drunk & Incapable), those patients were actually are at risk. The ones that call an ambulance because they have a severe hangover or are suffering strange after effects from legal highs…..those are the true time (and money) wasters. I once travelled 20 miles one Sunday morning, under lights & sirens, to a patient with a severe headache. This can sometimes be a symptom of a stroke, so we treat the job as such until we know better. But some things didn’t ring true. The patient was too young, there was no history, no overweight warning…

We arrived and he was walking about, looking rough. It took as a while to extract it from the pt, but the signs were all around us – empty cans and bottles, and a strong smell of alcohol. Eventually, once his friend had arrived and laughed at him, he admitted a huge bender the night before. My partner explained the concept of a hangover to him, then asked him if he wanted to go to hospital. His response was “No thanks, can you not just give me an aspirin or something”. Wrong answer! My partner calmly explained that we had come some distance, at speed therefore putting us and everyone around us at risk. We didn’t give out aspirin, but a well known pharmacy did and it was now open. Then they told the patient, in no uncertain terms, to man up and left the room. I shook my head at the stunned young man and followed.

Other time wasting jobs can be slightly amusing. One bizarre call I had was quite a distance, cross country. It came in as an emergency so we responded as such. The job claimed that our young patient had been bitten, some hours before, by their pet hamster… We went mobile and I radioed control to ask was this for real? Yes, it was! I stated that I had no intention of taking this patient to A&E as I’d be laughed out by the staff, and that instead I’d be referring them to the local out of hours gp. 2 minutes later we were stood down.

It’s unfortunate, but there are people who think the Ambulance service is also a taxi service. The clue is on the side of every vehicle – “Emergency Ambulance”. While that vehicle is attending hangovers, or small rodent bites, it is unavailable to save heart attack or stroke victims, or rescue people from car crashes.

Yes, the jobs I mentioned are amusing, and no one died (that I’m aware of) because of them. I suppose the point of this post is please use your emergency services appropriately. Think about how you might feel watching a loved one suffer because there are no ambulances available, because they are all………..”busy”.