You Give Love a Bad Name.

I’ve read a lot of news stories and posts on the socials about ambulance waiting times, and people who may or may not have died as a result of ambulance delays (the fact they don’t get investigated makes me sceptical).

We all know news companies and media companies love scandal and sensationalism, but why have a go at ambulance crews?

I regularly get messages from a friend and former colleague about the waiting times at their local A&E department. 3 hours, 4 hours… An ambulance crew doesn’t just dump patients at the door and trot off to the next job. They must wait for a nurse or doctor and give a detailed handover before they can leave. I know of one major hospital where the A&E department that was rebuilt and doubled in size a few years ago, and is still manned by the same number of staff as the old department.

Nor do ambulance crews hang around once a job has been allocated to them. Whe someone calls 999 (or 112) and requests an emergency ambulance the call taker will ask questions and follow an algorithm on their screen. The result will add the job to a list according to the level of priority the system decides. Ambulance crews have no involvement in this process.

There are, and always have been faults in the above system, and paranoia on the part of the call takers can often make smaller jobs into bigger ones.

Then there are the time wasters, the ones who know all the key words to use to get up the list, when they don’t actually need to go to hospital at all. And the ones who call for an ambulance because the waiting time for an appointment at their local surgery is too long (yes, that happens…a lot!).

These things all add on to the time before the job is even allocated to an ambulance. I could list many other types of time wasters.

Maybe, instead of the Scottish government talking of using the army to drive ambulances (so they can add to the waiting times standing in the queues in A&E departments too?) they and the other politicians could look at the overall problems and maybe find a sensible solution to the whole problem.

In the meantime, don’t take it out on ambulance crews. This problem is far from new, it’s been an issue for many years now. Those ambulance crews (and call takers, dispatchers, A&E staff…) are doing their best with what they have.

Those ambulance crews are the same ones you made rainbows for, the same ones you stood on your doorstep and clapped for this time last year!!!

Cruel to be Kind?

Kindness costs nothing.

Being based in a small rural hospital, we were part of the community. That meant patients expected a certain standard of care. We did our best to oblige but it wasn’t always easy. Some tried to take advantage, the majority appreciated it

An example : in the city, if an elderly person fails out of bed the crew take them to hospital, at best they return them to bed, check them over and drive away. In the country, we’d check them over and return them to their bed if they were uninjured. We’d make the patient a cup of tea and call a friend to see if they could come around to sit with the patient for a while.

The powers that be didn’t like this because jobs took longer and the figures on their computer looked bad, but we still did it.

When I first began with the ambulance service I was an Ambulance Care Assistant, a non-emergency transport driver. Even then we had memos saying we were taking too long when dropping patients back home after hospital stays. That’s because we took the time to settle them and make sure they were comfortable. We put the “care” in Care Assistant into practice. Kindness is free, if ambulance crews can’t show that, who can??

I recently called my broadband service provider to upgrade my service. The person who took the call was friendly, caring and kind. They listened and made me feel like I mattered, something that doesn’t happen often with large companies. If that kind of care can happen elsewhere, why were we being told we were wrong to make patients feel valued?

Many years ago I worked for a large mobile phone retailer. The company was based on a number of principles (I may have mentioned this before), the most meaningful one, the one that has stayed with me, being: Treat Everyone the Way You Expect to be Treated Yourself.

There’s nothing cruel about kindness. Now, more than ever, show some everyday and who knows what might come back to you.

Keep the Faith

Recently I was sitting outside a café with some other people. We noticed a bit of a commotion across the other side of the road. Some large seagulls were attacking a young pigeon, quite savagely.

I stood up and walked over to the scene scaring the seagulls away but, as soon as I turned away they were back. The pigeon was in a bad way but alive so I picked it up and walked back towards the café.

As I walked past the café and the others joined me, the pigeon passed away in my hands.

The people in that café must have thought I was a bit nuts, maybe I was, but I wasn’t going to do nothing. It may have been “nature in action” but my instinct was to try.

It reminded me why I joined the ambulance service in the first place – because I’m a rubbish onlooker and I wanted to help. It also reminded me of the many jobs we did that didn’t have the outcome we wanted. Even when we knew the situation was hopeless, we still tried.

Early in my career an older paramedic told me: “If it’s someone’s time to go, there’s nothing and no-one can change that, but we don’t make that decision!”. At that time the figures showed CPR jobs were around 5-8% successful, but everyone we were called to was in the 92-95% group until we had done our job.

Sometimes that was difficult, especially when you knew the relatives were watching. It would have been so easy to do nothing and tell the family it was over, rather than letting them hold onto some hope as we worked, but there was hope in us too, hope that this patient was one of the 5-8%, and we would never give up until
protocols said we had to.

We never beat nature, the lost ones were always lost but, to shake the hand of the survivor, the one who would not be there if we’d lost our faith – there are no words.

Turn to the Dark Side PtII

Angry post warning.

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

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

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

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

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

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

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

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

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

It’s happy (mostly) hour again

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

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

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

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

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

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

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

Thanks for…..nothing

Patients and relatives sometimes felt the Ambulance crew that had attended them deserved a proper thank you. We were not allowed to accept gifts from patients or their families, something most of us were quite happy about about if the truth be told.

Instead, many sent in cards. In my area, these cards wod usually go to the main office for the area. Rather than send the relevant crew the card, the crew received a photocopy of the card and a stock letter of “commendation” from the main area manager…..signed by their secretary. I have a few of these photocopies and the accompanying letters, all say exactly the same, word for word. It showed no gratitude, no respect, no interest. Did the big boss even know their secretary had sent them to the crew? Were they even bothered? That’s how it felt when we opened the envelope.

But we knew that the originator cared, and that we had made a difference. That was worth so much more than the letter that went with it all.

My station won area team of the year once. I’m still not sure what that meant – no big congratulations, no rewards, no pat on the back or recognition…from anyone. We all got a photocopy of the certificate in our pigeon holes though, and we actually got to put the certificate on our mess room wall, in the frame we paid for ourselves. We also had to take it down each time there was an infection control inspection on the station.

During my training we were warned about taking sweets from patients. We were told the story, probably untrue and embellished more each time it was told, of the crew who went to take an elderly patient into hospital. As they put the patient onto the ambulance’s wheelchair to take them out of the house, the patient told them to take a bag of nuts for them to eat in the Ambulance. Gratefully, the crew accepted. On the trip to hospital the patient said to the attendant in the back “I hope you enjoy those nuts, I can’t eat them. I can suck the sugar coating off them but the nuts are too hard. It’s my teeth you see.”!

It was still the best job in the world, I said from the start that, if one in every few hundred people said thank you, it was worth it all, and the people who mattered were definitely grateful.

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.

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!

Bark at the moon

There’s a phenomenon know across all of the emergency services – the full moon. Ask any of them and there will be no doubts, a full moon brings out the crazies (can I call them that?).

Often during busy nights, when the jobs we’d be called to were of a strange nature, one of us would question the lunar status. Almost every time, the moon would be full.

Every job has to be treated as whatever appears on the information screen, until proven otherwise and, occasionally, it would be a genuine job. Even before starting a night shift, if we spotted the moon, we could confidently predict a surreal 12 hours ahead.

This also applied to being careful what you wished for. While on shift during a full moon, certain people (regulars) and certain types of job or ailments were never mentioned or they actualy came to be! I proved this one shift when I deliberately mentioned one regular patient and a couple of different illnesses at the start. Everything and everyone I mentioned appeared on our screen at some point during the next 12 hours!

I experienced one of my first stabbing incidents under a full moon. On reflection, I should have expected something abnormal. The job came through: a patient in their mid 30s, stab injury to their left leg with a bread knife. Most readers will know that a bread knife has a serrated edge that could do a lot of damage, on the way in…and on the way out. We ensured that the police were dispatched as we made our way to the scene, just in case the assailant was still in the area.

We arrived on scene at the same time as the police. I was attending so went into the house first. I walked in to the kitchen (where else would a bread knife be?) to find the patient sitting next to the kitchen table, with a rather large bread knife protruding from their left thigh. There wasn’t a whole lot of blood evident, but dangerous internal damage could not be ruled out. We would never remove a penetrating object anyway, that was for the staff at A&E to do after ensuring it was safe to do so.

I approached the patient, assessing them and the situation as I did so. They had been sitting with their head down, but raised it as I approached. Their face bore a manic smile that caused me to step back unexpectedly, standing on the foot of the police officer following behind me. “Good evening” I mumbled. “I’d stand up to greet you, but I have this stuck in my leg”. The patient made as if to take hold of the knife. I suddenly panicked that they were about to pull it out. “No! Let’s leave that there” I blurted out, images of arterial bleeds in my head.

One of the police officers began questioning the patient. They asked who had put the knife there. “They did” said the patient. “Who are they?” said the officer. “Them. Them”. Spotting our quizzical looks, the patient clarified – “Them!”, gesticulating wildly at their head. Alarm bells began ringing for us all. Loudly!

We had a mid-thirties patient with possible psychiatric issues, potentially armed with a large knife and a wound that could become highly concerning. Deep breath, reassess quickly. “Can you hear them just now?” said the police officer. “Don’t be stupid! They left when you arrived!”. Oddly, that made sense. The patient seemed calm and in control of themself. I explained that it would be bad to remove the knife, and that I wanted to wrap a bandage around it and their leg to hold it in place. They agreed, and I, cautiously, stepped closer to them.

While I was dressing the wound area, my partner had brought the folding wheelchair from the Ambulance. The, very compliant patient moved across to wheelchair and was wheeled out to the ambulance. “Thanks guys” said one of thd police officers as they were about to leave. Oh no! I wasn’t sitting in the rear of the ambulance with a somewhat disturbed patient on my own. The police have stab vests, ambulance crews have lovely thin uniforms. Reluctantly, one of the officers agreed to travel with me to the hospital while his partner followed in their police car.

The patient was unexpectedly relaxed for the journey, unsettling in itself. I handed over to a nurse at A&E and the on-call psychiatric nurse was called in to help.

I never found out what happened to that patient, mostly because I didn’t ask, but, if I think hard enough, I can still remember the manic look on their face when I first entered that kitchen.

I can’t think of any other job where I was completely on edge through the whole time I was with a patient. It took a bit of time to wind down after that job, but Control weren’t bothered. They had jobs stacking up.

The next job appeared on our screen and we went mobile….