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.

Who saves the life savers?

Someone told me about a TV program broadcast in Scotland recently. It suggested that almost one in ten paramedics suffered from PTSD, and one paramedic interviewed was diagnosed with it worse than had they been on a battlefield! They also said that the Ambulance Service had declined the opportunity to give a representative the chance to be interviewed.

These are the men and women who are responding to emergency calls daily, and their employer doesnt even have the desire to comment on national TV.

There was also talk of things that had been put in place to help crew members and front line staff, but what I hear from those front line staff is different. Other than proving that few in positions of management are actually aware of the reality that goes on outside their office doors, a fact that has been known by ambulance crews for many years, this is nothing new.

The above is not just limited to one part of the country either, it is widespread across all the ambulance services in the UK. I’ve spoken about the 5 minute breaks we used to get after bad jobs, and the phone numbers that get handed out – Call someone who you’ve never met before, who has never met you and never will, and tell them over a telephone line how you feel… Then hope that your colleagues don’t find out because you’ll feel like a failure and they might think that you are unfit to do the job.

That is the reality, that is what ambulance services need to address, and that is why crew members struggle on, until it gets too much and they can’t go on any longer.

I’ve held back slightly in previous posts, but I see no reason to any more. I could write things that would (or should) probably have ambulance service managers squirming, and can back them up with strong evidence, but that’s not the purpose of my blog.

When you watch people die in front of you and you have done everything possible. When you’re faced with an angry drug addict who’s life you just saved but who’s high you took away in doing so. When you face countless drunks who threaten to kill you and your family when you are just trying to help with the injuries they got from fighting. When you spend 30 minutes or more working on a patient, giving CPR, providing advanced life support, then you hear that A&E staff gave up shortly after you handed the patient over….and then you pass that person’s relatives in the corridor…

“Here’s a number you can call if it’s too much.”

This isn’t something that can be changed overnight, and I don’t have any answers or solutions, I only have my own experience and knowledge of what others have been through.

My strong hope is that the Ambulance Service in Scotland, now these issues have been highlighted, now has to act, positively. Maybe other television companies will pick up the story in England, Wales and Ireland. Until the public are aware of the quiet suffering that all emergency workers go through, suffering that sometimes costs their own lives, not much will change.

During my time on the road I saw how my colleagues reacted, I saw the brash, faux toughness, the hard act. I even did it myself. But there comes a time when that doesn’t work anymore. For me, that time was when I left the service. My defenses fell because they werent being topped up for another shift. My support mechanism (my colleagues) was gone. Suddenly I had to face everything I’d seen and done on my own. I can’t heap enough praise on the people around me, the ones who tolerated me at that time. But there were people who didn’t wish to tolerate it, and friendships ended, making it harder. Nevertheless, I got through it with the help of the ones who stayed, and I know of others in the same position.

I’ve spoken in other posts of one friend who didn’t. This post is for them, and the ones like them. For the families and people they leave behind.

Maybe it’s time to think about the health of the health workers. To start monitoring their mental health, to start giving them regular mental health checks. To start saving the lives of the people who save lives.

’tis the season

Christmas and New Year – the festive period. Parties, celebrations, presents, cheer, making merry, over indulgence, fights, depression, suicide……

It’s difficult to feel festive sometimes when your Christmas is filled with the latter. It’s sometimes known as “Suicide Season” by emergency personnel, a time when it becomes too much for some people and they try (and often succeed) to end the pain inside. Depression becomes a bigger problem for many who suffer, as they see everyone around them having fun and enjoying themselves. I’m not going to apologise for painting a bleak picture. It’s a very real one, and many ambulance staff are in the middle of it. It’s difficult not to feel it when your eyes are opened in the back of an ambulance.

Regular calls to city centres for broken ankles caused by crazy high heels and icy conditions. Revellers, drunk and incapable, filling hospital beds because there is nowhere else to take them, and to send them home could be fatal. Ambulances stocked with space blankets (large, foil blankets designed to help retain body heat) to wrap half dressed patients sitting on kerbs, feeling sorry for themselves.

Then there’s the obligatory Christmas Day stroke/heart attack. One Christmas Day I was on shift with a probationer. We began our shift at 6am and I explained we’d have at least one “stroke” or “heart attack” call that day to somebody’s granny or grandad. They told me I was being negative and that it was going to be a good day, so I suggested a small wager. It was an icy day, no snow, and we had a number of calls to elderly patients who had slipped and fallen on the way to the car as families were drawing together around the country. All our patients, and their relatives, were in good humour that morning. Then came Christmas lunch.

We had taken our own Christmas lunch in, and a couple of other crew members dropped by with goodies. Then it came – an elderly relative was having a heart attack after their lunch and was unresponsive. My partner was a tad disgruntled as we rushed to the ambulance. Because we worked twelve hour shifts, we drove six hours and attended patients for six. I had been attending all morning, now I was driver. We rushed to the job as I explained to my, somewhat naive, partner that it was probably nothing, and that the patient was probably just having a snooze after a large lunch. They called me a cynic and prepared themselves for the worst; having to tell a family that their loved one has passed away on Christmas Day is never pleasant (nor any other day). We arrived at scene and my partner ran inside, to find the elderly patient fit, well and wide awake, also extremely confused about all the fuss. Tests proved the patient healthy and that nothing untoward had happened. We left the family to enjoy the rest of their day and returned to our station. There I explained further the parasympathetic nervous system – simply explained, after a large meal the body diverts energy to digestion. This is why many people feel like a nap after something like…..Christmas lunch. For many elderly people this can be a deep sleep, often mistaken for unresponsiveness and a stroke or heart attack.

Unfortunately, this isn’t always the case, and ambulance crews give sad news to many families, more poignant around this time of year. While the Ambulance crews walk away and go to the next job, the relatives are left mourning their loss, often tainting future Christmases for years to come.

I mentioned depression and suicide at the beginning of this post. It’s real, and we don’t always see it in daily life, but if you know someone who suffers from depression, you can make a difference by talking to them. Don’t overpower them, just let them know that you are there for them, watch them and their behaviour. If you suffer the horrible effects of depression yourself, and watching everyone else enjoying themselves takes you lower, talk to someone. Perhaps even write a blog!

Ambulance crews can go through a world full of other people’s emotions at this time of year. Some of those emotions can get through their defences sometimes. I watched a programme on TV this week that ended with some statistics, one being that 25% of the UK’s ambulance crews will experience PTSD, one in four! There is little or no support from most ambulance services, and little or nothing being done to lower these figures from inside. Often seeking support feels like, and is viewed as weakness or failure.

I’ve spoken about charities that offer support before, but public awareness is also important. PTSD999 is a charity that I’ve also highlighted, providing support to all types of emergency workers. They have just released a version of the song Heroes to raise funds for the work they do, and to raise awareness of the need for such services across all the emergency services. The band is, appropriately, called Burn Out and it costs a mere 99p to buy the song via iTunes and Amazon Music. So, among the festivities and gift giving, help support the people who make it safer.

Another way you can lift emergency workers is to show your appreciation – a simple “thank you” if you see them out and about, buy them coffee if you see them at the petrol station on a night shift. Simple things go a long way.

As the great philosopher, Michael Buble, once said: “It’s beginning to look a lot like Christmas….”.