Driving with the brakes on

Driving an ambulance is a scary business. It takes training and skill, plus a bit of bravery and fearless concentration. The training is similar to a traffic police officer’s and there is no room for mistakes when you are all that is between hope and death for a patient. That may sound somewhat dramatic but it’s often, unfortunately, true. That adds another element of stress to the driving – consideration for your partner working on the patient in the back. The drive must be urgent, but safe and smooth for everyone on board, and on the road around you. Progressive driving isn’t about speed, it’s about planning and constant awareness. That awareness becomes more sensitive with experience.

I’ve already written about a few incidents and near misses in other posts, here are a couple more:

We had dropped our patient off at A&E in the city and were on out way out of town, heading for our home station. A 999 call came in while we were on the main road across the city, a dual carriageway. I was driving, I checked around me and turned on our systems. Sirens howling, I moved to the outside lane. It was lunchtime and, as we approached traffic lights, I could see a long tailback across both lanes. Since there was no central reservation on this stretch of road, it was common practice to move over to the outside lane of the opposite carriageway. The speed limit was 40 and it was obvious to oncoming traffic that you were coming from a fair distance away. The roads were damp but the rain had stopped, visibility was good. I proceeded with caution down the outside of both lanes on my side, constantly changing the tone of my siren. The oncoming traffic I was facing was moving to their inside lane in plenty of time.

To this day, I have not managed to work out what insane brain process caused what happened next.

As I drove past the two lanes of traffic on my inside, someone who was stopped in a large car in the outside lane on my side decided to be impatient. They seemed to think that the traffic had stopped for no reason and that they could pull out into the oncoming traffic and overtake it, as we were doing. But they weren’t on their way to an emergency, nor were they an emergency vehicle with lights and sirens. Nor had they seen us. As they pulled out into oncoming traffic, it must have dawned on them slightly what was happening. When they saw me in their mirror, around 3 car lengths behind them rapidly approaching, lights and sirens in full swing, I think their folly may have become apparent to them. Despite my cursing, I was blessing the person who invented ABS braking systems as I stopped behind them with inches to spare. That was one of many “butt clenchers” throughout my career. Eventually, they moved back into their lane and we continued. There was no time, and no point stopping for a rant. I’m not sure who got the biggest scare, but I’d like to think they might have learned a lesson in patience that day.

Our ambulances were put through a lot during their active lives, and they were well looked after and maintained by some expert mechanics. This, however, did not prevent occasional failures. These often happened at the most inconvenient of times.

Before the reintroduction of tail lifts in ambulances, they had an automated ramp that folded out and the rear suspension could be lowered. This lowering was done by deflating airbags that the rear of the vehicle sat on. Once the ramp was raised , the airbags were inflated and the rear of the ambulance was raised again. This system worked well…mostly.

In winter especially, these airbags would sometimes burst.

Winter, night shift – we had received an emergency call to an elderly patient. On arrival, the duty out of hours doctor was on scene. We knew the doctor well and we suggested that, because of the patient’s condition, they travelled with us to hospital. They agreed and we left, en route for A&E in the city.

We managed around 3 miles before the loud bang! From there, the rear of the Ambulance was actually resting directly on the rear axle. We bounced along the road, very slowly, for a few yards, before I was able to park the vehicle in a small roadside supermarket car park. We radioed control and explained the situation, requesting an urgent back up vehicle from the city. Fifteen mins later, we saw the blue lights approaching us. The patient, doctor and my partner were all transferred to the new ambulance and disappeared off into the distance. I was left, alone, in the car park, waiting for the recovery truck. What felt like an eternity turned out to be around 2 hours. I finally caught up with my partner at A&E, drinking coffee and chatting to the nurses.

It looks glamourous on TV sometimes, but driving an ambulance is far from it. My initial driving instructor once told us “If you ever lose the buzz of driving to an emergency job, it’s time to retire.”.

They also said “If you want glamour, become an airline pilot. If you want to be a hero, join the army.”.

Go Greased Lightning..

There are many acronyms in the Ambulance Service as a whole, each division and each service will have its own. Some are common across the UK, some are local.

Examples such as GLF – “go like the wind!”, TFBUNDY – “this patient is unlikely to survive”, and ATIT – “I’d like to question the patient’s apparent unwellness” are probably still all used regularly.

The first, GLF, was a common one. A simple way to indicate to the driver the urgency of the situation, usually without distressing the patient or their relatives. While we were all trained to drive at speed and negotiate traffic, we were also taught to drive safely, constantly mindful of your partner and the patient (and their condition) in the back of the vehicle. Emergency driving is a skill that is taught at the start of your career, and is constantly assessed throughout.

One thing none of us, and no crew member in the UK will dispute, is “kiddy gear”! Every ambulance in the UK has a special gear for when the crew know a child is involved. It is, of course, a mythical gear, but it’s also an instinct that kicks in as soon as the job appears on screen. No matter what the job, the driver’s senses are heightened and kiddy gear is engaged. Often the attendant, the crew member dealing with the patients at that point, becomes more aware of the road and assists the driver. When you work closely with someone you learn to second guess them after a while.

I’ve already written about Red Mist, and how there is no place for it in an ambulance. But with heightened senses comes extra adrenaline and, when another driver makes a poor judgement (as happens frequently) the ambulance driver is likely to respond. They are only human. Each crew member usually has their favourite curse they use (most not printable here), often entirely out of habit then, once vocalised, it’s over. During the whole incident the driver will never lose control or concentration.

I was often asked what happens when you trigger a speed camera? It generates lots of paperwork and someone in an office somewhere has to show that the job in question merited excess speed at that point, otherwise the driver may be prosecuted. If the job was not an emergency we could not just use our lights and sirens. However, if the patient deteriorated or if we felt it was in the interests of the patient to hurry, we had to call in to Control and explain, then the controller would note that we were “proceeding on systems”. The stories of using blue lights to get back to the station for tea are extremely untrue!

There was, however, a road with a number of speed cameras on both sides, that may or may not have been subject to a local challenge…..strictly only ever on emergencies though, and always within the tight boundaries if safety.

Emergency Ambulance driving is not all breaking speed limits and driving fast. It’s about safely progressing through traffic and staying “shiny side up”. It’s not easy, it’s stressful, but it’s essential.

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.

The Journey Begins

The statement above was added by the hosting company for this blog. Initially, I thought about removing it, but then I thought it’s true. This is a journey into the unknown for me. I hope you, the readers, enjoy what you read. My intention is not to “whistle blow” or deliberately offend anyone, but I may get close to the bone, or controversial, on occasions. Life on the frontline of emergency medical care exposes you to things you could never expect, and it’s bound to affect your perceptions once you leave that life behind. Even the driver training required to drive a 2 tonne white van with blue lights in an emergency fashion affects the way you drive your own car forever. This blog will, hopefully, give me an outlet for my joys, sadnesses, frustrations, and moans. Sometimes sad, sometimes serious, but mostly funny (I hope). I’m very new to this, and no great writer, so please bear with me…

All thoughts and opinions expressed in this blog, unless otherwise stated, will be my own. Names will be changed to protect the (mostly) innocent, and patient confidentiality will always be a priority.