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 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:

High but not mighty.

“Recreational drugs – relating to or denoting drugs taken on an occasional basis for enjoyment”

Above is a definition given when one searches the word “recreational” in a famous search engine. My experiences were very different. None of the users I was called to were occasional users, none of them were particularly enjoying life.

Having never used non-prescribed drugs, I can’t talk about the feelings they give the user, having deemed life extinct as a result of their use more than once, I can talk about the feelings they caused in me. Anger, despair, sadness…the list goes on.

I will never understand why someone feels the need to use drugs to “enhance” their lives, knowing the addictive properties and the devastation they cause, but they do.

I’ve mentioned Narcan/Naloxone before in a previous post, a drug ambulance crews carry that blocks the effect of opioids (heroin etc),for a short time. Time enough for the patient to recover rapidly and realise that the hit they needed, that they’d paid for, had been removed. This was often met with anger and, with it, violence. It also meant that, if the patient had taken a significant amount of their chosen drug (generally the case in an overdose situation), the effect of Narcan would not last as long as the effect of the overdose. The use of this life saving drug relied on the ambulance arriving ,and the drug being administered, in plenty of time. More than one person asked me during my career – did I ever think of taking a little bit longer to get to jobs, thus allowing the drug user pass away and easing the burden of drug users on society. My answer was, and always will be, a very definite no! My job was never to play God. No ambulance crew member anywhere has the right to decide who lives and who dies, their job is, unquestionably, to preserve life. Millionaire in a mansion or homeless in a cardboard box, the level of care is the same in the back of an ambulance.

The job came on our screen as a drug overdose in one of the “less salubrious” parts of town. We rushed over and arrived at the same time as one of the single crewed fast response cars. All three of us ran into the building and up to the correct flat. We were met at the door by a strangely cheery person with a needled syringe behind their ear. Needles are always a concern to crews in drug-related incidents, but this person assured us they would deal with it correctly and guided us through to their friend. The patient was unresponsive and breathing worryingly slowly, but their heart was still beating. My partner got to work with the bag and mask, a way of pushing pure oxygen into the patient’s lungs and ensuring that oxygen was fed to their vital organs (assuming their heart was still working) , while I began preparing the Naloxone injection. The third crew member began inserting a tube (known as a cannula) directly into a vein in the patient’s arm. I injected an amount into the drug directly into the patient’s arm, just below the shoulder. This would not work as quickly as if it was injected directly into their bloodstream, but at least it would have some effect before the cannula was in place. Once the paramedic had the cannula inserted I inserted a further dose straight into the patient’s bloodstream. The effect was almost instantaneous, but we had all anticipated this and had stepped away far enough to be at a safe distance when the patient came round and realised what had happened.. Once they had calmed down and we had explained what happened, the patient refused transport to hospital, so we filled in the relevant paperwork and left. As we walked back to the vehicles the fast response car driver suddenly shouted “SH*T!!”, and ran back to the flat. It transpired he had left the cannula in the patient’s arm, a drug user’s dream – direct access to a vein!

Drug related deaths always seemed so pointless, a waste. They also had their own hazards, as I’ve already mentioned, needles. One job we were called to, My partner was about to kneel beside the patient, just as I caught a flash of an uncovered needle on the floor, right where my partner was about to put their knee! then there are the patients who become suddenly extremely violent and threaten crew members with whatever comes to hand – needles, kitchen knives…. Often you don’t feel fear in the situation, but it comes afterwards when the reality of the potential outcomes hit you.

Legal highs are becoming more and more popular. They are available from corner shops everywhere, the owners happy to cash in on legalised drug dealing, not giving a thought to the harm they are causing. Many times I was called to patients who were having bad trips, or who felt like their hearts were trying to leave their bodies. When asked if they knew what they were taking, not one of them did. They all seemed surprised that some unknown drug was affecting their body in unexpected ways, thus was the rationale of the drug user.

There have been campaigns telling us the perils of drug use for decades, but there are still people who think it will be different for them. There is no convincing some people, even some who have lost friends though drug abuse, such is the grip addiction has. Ambulance crews across the country will continue to take their abuse, and will continue to put themselves at risk to try to save people who have no respect for their own, or anyone else’s life. Ambulance Service management will continue to tell crews they will never put them at risk, that they should always put their safety first……….but the same managers will still expect their ambulance crews to go to these jobs on a regular basis, because targets must be met…..

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.

“You can’t park here mate!”

Firstly, when did I choose to become “mates” with an arrogant, selfish person? At that point, the anger you feel is quite difficult to control. You want to retaliate strongly, but you have to prevent the situation from escalating unnecessarily and try to resolve it in the best way for everyone.

The last time I heard it, we had been called to a cardiac arrest. The patient’s heart had stopped and time was important. I didn’t look for a parking space, I stopped outside the patient’s house, pulled on the handbrake and we made haste inside to deal with the poor soul. We got them onto the trolley (stretcher) and took them out to the Ambulance to attempt to stabilise them before transporting them to hospital, swiftly.

That was when it happened – there was a loud banging on the back door. Already firing on adrenaline, we both looked at each other with angry eyes. My colleague was doing chest compressions and I was ventilating the patient – CPR. I went to the back door and opened it slightly. “You can’t park here mate!” he said angrily. I wanted to respond in kind, but I was a professional in uniform. Instead I said “I’m sorry sir, we’re a bit busy trying to save a life at the moment. We’ll be moving soon.”. “you’ll be moving now!” he proclaimed, as I moved around to prevent him from peering morbidly into the ambulance. I very much wanted to speak my mind, but I had a very sick patient to deal with. He ranted a bit more, then said “I’m going to call the police!”. Trying to contain my ever increasing anger as my adrenaline level rose further, I gritted my teeth and said “Sir, let me do it for you. I can have them here much quicker.”. I then put an urgent call into our control centre requesting immediate police assistance.

Suddenly his attitude changed. “They don’t need to hurry. I’m sure you’ll be finished soon”. The patient in the Ambulance was barely alive, and he had tried to tell me, where I parked my emergency vehicle was more important, I wanted them there quickly! I told him to stay where he was and that the police would be here shortly to deal with his complaint.

The police did arrive shortly, and I briefed them on the situation as I rushed round the ambulance to get in the front and drive the patient to hospital. Strangely, the gentleman had not waited around for them to arrive, but he was quickly spotted peering out of one of the house windows in the near vacinity.

Our patient lost their fight and passed away shortly after we handed them over to the staff at A&E. I later found out that the police had stern words with the grumpy man after we left. Nothing would have changed the outcome for the patient, but the anger seemed to add to the sense of failure we felt. There was no need for that job to go horribly. We had done our best for the patient, but it was sadder that their final moments should be made worse by that selfish, grumpy guy.

The anger of that moment is back as I write. Finding a parking space takes time. The Oxford dictionary describes an emergency as ‘A serious, unexpected, and often dangerous situation requiring immediate action.‘. Ie. No time to box park!

Next time you see an ambulance blocking the street, consider why it might be there. Weigh up your inconvenience with that of the sick person they are attending. Be patient, and let the crew do their job without interference or threats. One day it might be one of your relatives, or even you, they are there for!

Shortly after I first posted this I read a story in the news about someone who had left a note on an ambulance windscreen, with some money, telling the crew they were blocking the note writer’s driveway but it was ok. The money was for a well deserved coffee. That is how to treat an ambulance crew! There are a lot of kind people out there 🙂