Who’s going to drive you home tonight?

Older people. We know they great, we know they come in many flavours – sweet, grumpy, old-fashioned…

With Christmas soon to be upon us again, along with the long nights and cold weather, it’s a time when ambulance crews are often called to elderly people suffering from hypothermia, or dehydration. Sometimes infections set in, chest, urine, kidney. All required a visit to hospital. Other times it was something simple that could be treated with medication at home. When I was in the service, the mentality of most of the city crews seemed to be that everyone went into hospital, that’s ok in a city where there is a good transport system, and non-emergency vehicles, dedicated to returning patients home, readily on hand.Because I worked in a large rural area, it was different. There was quite a long journey into the nearest main city hospital so, whenever possible, we and the decent GPs in the area would try to treat the patient in their own home. This was often the best policy as many had no relatives in the area and, as a result, no way to get home after treatment in the city.

On more than one occasion, and this still makes me angry, family members would push doctors or ambulance crews to take their elderly relative into hospital over Christmas or New Year so that they weren’t a burden on the family celebrations. My opinion was that the relative was probably better off in hospital surrounded by people who actually cared, and nursing staff often pull out all the stops for patients at Christmas.

Our biggest problem was, even if we could see a way to treat the patient at home, if they or a family member expressly asked us to take them to hospital, we were obliged to do so. Once at the Accident and Emergency Department, the staff would examine the patient, deem them to be fit to return home then discharge them. This did not mean they were thrown out into the car park, but often it meant a long wait, sometimes in the waiting room, sometimes on a hospital trolley in a corridor, until a relative or friend could be found to collect them or a nursing home arranged transport. Neither of these solutions were ideal. Sometimes, if the patient required transport on a stretcher, they had to wait until a non-emergency crew became available. That would be the next morning at the earliest.

I believe things have improved slightly since I left the job. Doctors have more ability to treat the patient at home, but still there are a lot of unnecessary calls made to the ambulance service, patients unnessarily transported to hospital, unneseccarily using resources and bed space that hospitals don’t have to spare. Sometimes its the fault of the relatives or care staff, calling an ambulance when it’s not really required, sometimes it’s just a problem with the system.

Wherever the issue lies, should you or a loved one find yourself stuck in an A&E department for hours waiting to get home, please don’t blame the ambulance crew. Part of their job is to take people to hospital, that’s all they did.

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.

This would be funny…

….if it wasn’t happening to me! A phrase that came to mind many times during my career as an ambulance crew member. Like the time we were called to a patient who had been bitten by her very small rodent a few hours earlier, or the guy with the Sunday morning hangover. I’ll make more of both of those in future posts.

There have been many books written about Ambulance life, most extremely good, but not many that I’ve read address the emotional highs and lows a person experiences on a daily basis. It’s taken as an expected part of the job, and Ambulance crews are hardy types but, when you leave the comfort and support of like-minded colleagues behind, suddenly the reality of what you have seen and dealt with becomes very different. It is my hope to share these emotions as best as I can in my posts. I have many stories to tell, some funny, some sad, but I will also try to explain the feelings involved too.

Please feel free to comment if you have any questions, or if you disagree with my views. If you can relate to anything I say I’d love to hear from you.