Driving the point home.

Bad drivers….. We’ve all seen it, some have been victims of it. When you’ve been to RTCs caused by it you find it hard not to get angry about it. Warning – controversial, blunt and slightly angry, comments ahead!

Bikers, or “organ donors” as they are known by some ambulance crews, are often the most annoying. Whoever stated they should be allowed to “filter” through queues of traffic (drive, usually at silly speeds, between rows of queued cars) must have been a bit disconnected with reality. Bikers, in my experience, come in two types – the sensible ones who act like genuine road users and the dangerous ones who think it’s fun to drive fast and have no interest in the potential devastation they could cause to other peoples’ lives. At this point I expect any bikers reading this to be cursing me. If you are one of those, I would love to give a list of relatives who have lost loved ones to bikers who were “having fun”, or lost relatives who were bikers. Maybe you could try to explain your thoughts on the matter to them?

From very dead motorcyclists to very injured ones, Bike vs Object was never a good job to be called to. As soon as you read that on the ambulance screen you know it won’t be a good outcome. Then a few days later we’d see the tributes – “They lived for their family” or “they died happy, doing something they loved”. There is no such thing as “dying happy”! Dying is always bad, dying as the result of a crash is often very painful and not something enjoyable. As for “living for their families” – it is selfish because children lose parents, partners lose loved ones. It’s also life changing for other innocent parties who may be caught up in it. I could describe jobs I was called to involving motorbikes, but I doubt it would change views. Surely, if a rider expects to be treated as a road user, they should then act like one? It’s not complicated.

Boy/girl racers! – I was called to my first RTC involving a racer early in my career. Cars are very safe these days, but not when modified and driven by idiots who think they can drive them well. My first experience of this was a young driver in a well known Japanese rally-style car. They had come out of a side street at great speed, straight into the side of an older driver’s car who happened to be directly in their path. On arrival, another crew had seen to the extraction of the older driver, who had sustained a number of broken bones. We attended the younger driver, who had foolishly got back into their car to wait for us. They seemed in great spirits, laughing and joking, not caring about the injuries they had inflicted on the innocent older person. Remaining professional, with great difficulty, I asked the driver if they had any pain in their back or neck. To this day, I still maintain that, at that point, they saw an opportunity to become a “victim”. “Yes” they said, suddenly appearing concerned for their own welfare. Immediately we began to treat them as protocol dictates for a spinal injury. I asked one of the police officers nearby to get into the back of the car and hold the driver’s head still so as to maintain their spinal alignment. Then I approached the fire chief and asked him to remove the roof of the car to allow us to extract the driver safely. At this point the driver became very agitated. Suddenly their pain disappeared, but they had claimed they was in pain in front of a number of uniformed personnel, we had a protocol to follow, and the police officer’s hold on their head tightened slightly as they protested. Resigned to their folly, the driver was extracted from their roofless car, immobilised so their spinal column was safe from further damage, and transported to hospital. Rightly or wrongly, I felt no guilt knowing his car was fit only for the scrapheap as soon as the roof was removed.

While it is not the job of an ambulance crew to judge a patient in any way, nor would they do so publicly, there were many jobs like the one above where we had to keep our thoughts to ourselves and remain professional. My job was to maintain life and protect the welfare of my patients, no matter what happened before my arrival on scene. The police however had a bit more interest in the events beforehand, and they could take action or give an opinion based on that.

The following happened on a major dual carriageway: A young driver had lost control of their vehicle, having taken a corner far too fast. We arrived to find a very dented car on the central reservation, the young driver standing next to their pride and joy with their head in their hands. My partner went to attend to the driver while I spotted a local traffic police officer we knew and went to find out what had happened. When I asked the officer if the driver had been travelling fast, they took me to the rear of the vehicle and pointed at the exhaust outlet pipe. It was huge! “any more questions?” he said, one eyebrow raised. I shook my head and walked back to the ambulance.

All of the above may sound like a bad prejudice against bikers and racers but, as I mentioned earlier in this post, there are the sensible ones. It is fun to have a fast bike or car, but public roads (there’s a clue in there – public) are not the place to have that fun. There are track days at many race tracks around the country where adrenaline rushes can be had. I’ve seen too much death and destruction, lives and relatives left behind lives’ destroyed by what can only be described as foolish acts of selfishness. I drove fast in my youth, but I was lucky enough to learn from other peoples’ mistakes.

The day after I completed my vehicle extrication training I received a phone call. A good friend had studied hard, worked his way up within his job had finally bought himself his dream car. That day he died in it, because he thought he could cope with driving it fast on a country road. I was devastated, and my instructors wanted to send me home, but I knew I had to continue so I could maybe save someone like him one day. So yes, I get angry when I see stupid driving. Yes, for me, every RTC was personal.

If you disagree with anything I’ve said above, please get in touch. I’d love to hear your views.

Chinese whispers, in African.

I had never seen a dead body before! I had been qualified only a couple of months and had, up till now, managed to avoid a fatality of any kind. We signed on to our night shift and all was well, then the call came – “59361, 999 call. Male fallen from 4th floor window.”. This was it! My first sight of a dead body, and it was going to be gruesome.

I was attendant that night so it was my job to deal with the patient, or what might be left of him. My partner, a veteran, read the terror on my face and began to rib me a bit. I was getting nervous, but this was part of the job, I had to get through this.

Further details began to come through as we sped to the scene. It was a block of flats we both knew, and the ground below was concrete. “middle aged African male. Fallen out of fourth floor”. There was little chance he could survive that.

The ribbing continued, my nerves grew.

We arrived and were met by another African gentleman. “in here! In here!”. He ushered us into the building. What kind of person takes a dead body inside?? Then he took us to the lift…

I was starting to get a bit shakey. “man up” my partner whispered, by way of encouragement.

We stopped on the fourth floor, and heard shouting as the lift doors opened. As we stepped out we were met by a strange scene. Two, rather large African men were being restrained by their friends, either end of the long corridor outside the flats. One of them had a cut lip which he immediately demanded attention for. I looked at it and politely suggested that he…..man up.

Seconds later the police arrived. Both men were arrested and we were stood down.

As we drove back to our station we were confused, bemused and very much relieved. Strangely, there was also a large feeling of anticlimax. Once more I had avoided a death, but how??

Then it dawned – there had been a fall out ON the fourth floor, not OF the fourth floor!!

We laughed a lot, and the call taker was reminded of it often.

I faced my first death shortly after, but that’s another story……

Every face tells a story

Well, most do. During my career I became good at reading some patients’ faces, in particular their eyes. You become good at being able to tell if they are lying, or hiding something. Then you start to notice sadness, hurt, sometimes happiness when you chat about certain subjects.

This is usually a good thing, but sometimes it’s not. Sometimes you’d see some sadness and, when you mentioned it, the defensive walls would crumble and the patient would open their heart to you. As helpful as this usually was to the patient it, more often than not, left you with an unexpected insight into that person’s hurts. Some of our regular alcoholics began to trust us because of this. We weren’t there to condemn them, we were there to help them. In front of their drunken chum’s they were mouthy and brave, alone in the back of the ambulance their true personality would often appear. Most had stories to tell, the reason they became dependent on alcohol, the wonderful lives they’d had before their addiction, the tragedy that made them look for comfort in a bottle….

She was in her late 20s, had come from another country to earn a PhD. While here, her father had died suddenly back home but she couldn’t afford to return to be with her family and attend his funeral. She saught comfort in alcohol and met a guy, already alcohol dependant, who dragged her into a dark world of alcohol abuse. We attended her lots, drunk and incapable, unable to stand or walk. Basically her “boyfriend” didn’t want to take responsibility for her care. She would sit in the Ambulance and cry as she told us how much she wanted her old life back, how much she wanted to get her life back together. Every time it left you a bit sore inside. Then it made you angry when you found out the A&E staff had discharged her because there was nothing they could do for her.

I transferred to my country station and didn’t see her for a long time. Then, one day I met a police officer I knew, at a job in the the city. I asked if she was still a regular. She had died some time after I had last seen her, drunk herself to death. No one seemed bothered at the bright academic light that had gone out.

He was a proud soldier who had served his country, then his wife became ill and passed away. His comfort was from a bottle. He liked to create a scene in public places, but in the back of an ambulance he was a hurting man with a proud history. I never found out his fate, but I did find out that, when sober, he gave regular significant donations to a certain charity.

Every face has a story to tell. Not all are obvious, not all are that interesting, but all are important to the person to whom the face belongs. Before you judge, be sure you have considered all of the facts.

Oh. Is that serious??

Medical terminology has long been a source of entertainment for many ambulance crews. There were the smart dispatchers who would try to use fancy medical words when they sent jobs to the crews, but the majority of patients had no idea what they meant. They did, however, brighten up the crews’ days. Whether laughing at the dispatcher or finding mirth in the words themselves, the effect was usually good.

“Ah yes Stan. You appear to be suffering from an acute case of epistaxis” (aka a nosebleed). It was ok to joke with the regulars, building a rapport with them was like a form of reassurance, and reassurance was one of the best tools we had. But medical terminology also made the mundane jobs more bearable, like the D&Is (Drunk & Incapable). We were often called to the results of drunken brawls and, assisted by the police, we had to decide whether or not the drunken individuals actually required transfer to A&E, or if they could safely be sent on their way. On initial examination, were the brawlers relatively compos mentis, we’d sometimes do some “unorthodox” tests. Nothing nasty or horrible, just silly things, like the straight line walk, the finger to nose test (often resulting in a poked eye!), and the medical terminology test – “I’m afraid you seem to be suffering from a bilateral, periorbital ecchymoses!”. This either resulted in a look of confusion, or a sudden look of horror. “Is that bad? Am I going to die?!” If we provoked the latter we would be quick to explain.

At this point I should probably clarify – we would never encourage fear in a patient, and if extracting a small bit of fun at the patients’ expense would never be taken beyond a simple laugh.

A periorbital ecchymoses means nothing more than a black eye. Bilateral meaning both eyes.

Fun with medical terminology was not restricted to the patients. We sometimes played Word(s) of the Day – a medical word, or expression, would be chosen and the challenge was to use said term in a meaningful patient handover to the staff member at A&E. There will never be a greater triumph in this game than my ex-colleague who managed to seamlessly fit the term “fecal smudging” into their handover. The patient was elderly, a queried hip fracture, and had been lying on the floor of their house for some time. The situation was perfect, the stage was set. On our arrival at A&E the word was spread around crews there, and a few select nurses. Like excited children we sneaked around the other side of the receiving area to watch. The jammy sod got a student nurse! My partner began their handover and the student nurse stood, listening intently and nodding their head in an almost knowledgeable fashion. Then it came – “………..significant fecal smudging up the patient’s back……….”.

My partner continued as if everything was normal, the student nurse continued nodding. That moment cost me coffees for a week! It was never forgotten. Other Words of the Day ranged from” bogey” to “butt plug”. The latter was involved in a failed attempt. Thankfully I was not there to see it!

None of the above involved any harm to anyone, but they were part of the mechanism that helped many ambulance crews cope with the more mundane parts of the job. In some cases they even helped ease the stresses of other jobs.

There has been much criticism of ambulance crews seen laughing on the way to jobs. Never underestimate the professionalism of ambulance crews at a job. But also, never query their coping mechanisms, unless you are willing to get out there and prove you could cope better with what they have to deal with!

It’s based on a true story… Honestly!

Of course I’m talking about the well know UK television show based in the ED of a well known, entirely fictional, English hospital. While I used to watch it purely for the clinical inaccuracies and the abnormally dramatic lives of the staff, now some of the the storylines are close (sometimes very) to jobs and realities I have dealt with. Most recently; Man down, the loss of a colleague. During my career that spanned more than a decade, a number of fellow ambulance colleagues passed away. Some through illness, others in accidents, one more tragic. Most I didn’t know too well, others i knew a bit better, all were sad and their loss was felt across the service. The latter I trained with.

I knew the person closely for 10 weeks, we trained together back at the start of my career. They were a major help towards me passing the exams, a close friend for those weeks away from home, then I never saw them again. but that didn’t ease the impact the news of their passing had. I don’t know the full story, but I know that the job we did had a big involvement in their passing, and that greater support and intervention may have prevented it. I recently met up with a friend who was closer to them. The loss has been very obvious in that friend’s life but, thankfully, support is finally in place for him. But it came from his GP, not from within an Ambulance Service.

The coming episodes of the TV series apparently show the paramedic, and other ED staff left behind after the loss of their colleague, slip into a dark places. I remember the last radio call for paramedic Jeff on the program, my colleague received none of that. Circumstances may be different, but the emotions are the same, as are the questions in peoples’ minds – once again, could more have been done to prevent it?

Ambulance services across the country need to step up care of their staff. I loved my job, but most ambulance crews see and go through things that change the way you view life. “here’s a number you can call….” never has, and never will be enough. I realise this post might ruffle a few feathers in a few ambulance divisions but I hope that, rather than the usual brushing problems under the carpet, they might try to change things if that’s the case. When someone feels unsafe, unsupported by the organisation they work for, something is very wrong!

The TV show may be fictional, but some of the characters and stories are closer to life than you might think. Yes, this post might read like an angry grumble about the lack of support available to ambulance crew members, probably because it is, but I’ve not even brushed the surface of the problem. No one should be abandoned for doing their job, for trying to save lives.

For every “Jeff”, every “Sam” and every “Iain” out there……

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!