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.

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.

When I’m 64(ish)

Older people are great. They’ve been through a lot, they’ve seen a lot, and some have given a lot, but many don’t expect much in return.

“I don’t want to bother you”, “someone else needs the Ambulance more than me”. Both phrases heard on a regular basis by ambulance crews, often from very ill patients.

One patient was in the middle of a huge heart attack when they said that, as my partner and myself watched it develop on the defibrillator screen. They were put straight and rushed into hospital! A common one was the patient lying on the floor with a broken hip. The ball at the top of the femur can be fragile in some older people, and often broke off. The fracture was known as a #NOF – fractured Neck Of Femur. We’d regularly turn up to such jobs to be told “I’m sorry for wasting your time”, the patient in agony and unable to move!

Many times the patient had just fallen out of bed and, although uninjured, they just couldn’t get up and back into bed. Sometimes this was a more serious event and further action was taken. Often they just required us to help them back into bed. We rarely stopped there. Whenever possible, we’d put the patient’s kettle on and make them a warm drink, settle them before we left (most had catheters, in case you’re thinking the obvious).

I realised quickly that, other than a carer, we may be the only other people that the patient might see in a day. Sometimes we’d sit by the bed as they drank their tea and listen to their fascinating stories. All they wanted was someone to chat to, and we were there to care for them so it was our job to listen.

Sometimes Control would radio to “check we were ok”. Ie. They needed a crew for another job. If it was serious we’d go, if not, we’d stay a bit longer. An executive put out a memo once stating that crews were spending too long at jobs and suggesting a time we should allocate to each job. This executive had clearly no idea what our job actually was, otherwise he’d have not chosen to make a complete fool of himself. That memo was instantly filed in File 13 – 🗑️

Older people deserved respect, and we weren’t going to deny them that so the figures on a computer screen somewhere looked good (the same went for other types of call). We did our job and targets had no place in there.

I once discovered we weren’t the only ones that respected older people: We had been called to a house, somewhere in the middle of nowhere for a patient who had fallen in their living room (?#NOF) , along a narrow country road. As we got closer we discovered a long stretch of roadworks ahead, closing one direction of travel, under the control of stop/go boards at each end. As we approached, Blue light on, the worker with the stop/go board at our end Bbegan frantically talking into his radio. He held his hand up to stop us and we waited until a couple of cars came through, then he waved us on. The satellite navigation showed us the house was somewhere along the stretch of roadworks, but we couldn’t find the access road. We got to the other end and asked the road worker to hold the traffic while we did a u-turn and had a second look. We reached the other end and the first road worker flagged us down. They asked where we were looking for and he looked blank, then he asked who the patient was. My partner and myself were pretty sure we couldn’t give out that information “Is it *****?” they said. “Erm….yes actually”. Ah right. Again he spoke into his radio. “Two of our chaps are with them. They went up to the house for their tea break. It was them that called you”. It turned out that the workers had closed off the original entrance because of its location, and we were swiftly directed to the new one. The road workers had been checking up on the patient daily, looking after them.

Never underestimate what an older person may have done for you. Don’t be disrespectful. What you are able to have and do may, in some part, be because of these people. Simple acts of kindness go a long way.