Tears in Heaven

I’ve mentioned this job in a post already but, since it was my “one job”, I feel like it deserves more. I realised that I’ve never written or spoken about it in any kind of detail before, but a recent conversation with a friend and colleague made me think perhaps I should.

The patient was 11 years old. Only 11 years old. Our screen said they were 7. I only found out a few days later what their true age was. I never knew their name, but I was the first person to look into their empty eyes after the life had gone from them.

I was attendant at that point, my partner driving. We had passed the point on the road, a main dual carriageway, minutes before the incident. There’s a strong chance we had seen them alive at the roadside. The job came up on our screen and we had to find a gap to turn the ambulance around. It was rush hour so traffic was heavy, our blue lights stopped the vehicles around us as we crossed onto the other side of the road and made our way back to the scene. The job was a “person vs vehicle”, never good on a main road. Then it was updated “7yo vs van”…

We passed the incident on the opposite carriageway and desperately looked for a gap in the central reservation. Traffic was at a standstill, making it hard to negotiate. As we approached the scene I jumped out and ran over to the patient. They were face down with people around them. I asked two of them to help me carefully turn the patient over while I managed their neck and head. As we rolled them over, I saw the head injury, in the shape of a large, open wound. Their eyes were empty and staring. I found a very weak pulse at their neck, they weren’t breathing. My partner arrived, having brought the ambulance closer. I asked for the immobilisation kit and a trolley, and explained the lack of output. The patient was rapidly immobilised and wheeled into the ambulance, a line in their arm, a tube for breathing. We agreed I’d drive, my partner was smaller than myself, so could fit in the gap between the trolley and the attendant’s chair performing cpr as we wound our way through the busy rush hour traffic. I took the keys and turned the ambulance carefully, then began the dangerous drive. We were around 10 miles away from the hospital, we had a number of hot spots to pass through.

The police hadn’t arrived, but we couldn’t wait. I called control on the way in with an update on the patient’s condition and requested the paediatric trauma team met us on arrival at the hospital. I recall talk of a police escort but we had no time to waste while it was being arranged.

I don’t remember much about the journey, but I broke a few speed limits (legally), and somehow made it through traffic in record time. Oddly I felt no satisfaction in that for a long time.

The staff at hospital were indeed there to meet us, and they took over CPR. After a swift hand over we went back to the ambulance and sat. Said nothing, just sat, then we had to go back to our station as our shift was over.

I was on days off the next few days, probably not the best thing as it played on my mind as I sat at home. Calling the counselling service was not an option, that would be seen as failure. Three days later I went back to work, to find out my partner had taken 2 days off because of it all.

We were invited to join the A&E staff at their debrief meeting, there we found the patient’s true age, and the fact that they were dead before we reached them the impact had crushed the base of their brain. It wouldn’t have changed what we did.

I have vague recollections of a conversation with the van driver. I sincerely hope they had some kind of support. Also the patient’s 7 year old sibling, who saw the whole thing and stood at the roadside watching as we tried to save them. There are often fresh flowers at the scene that remind me, but now I’ve put the incident where it belongs, in my memories. I did my job, now it’s not for me to grieve.

In the months after I left the service I turned that young, lifeless patient over on that road lots of times in my head, in my dreams. I knew there was nothing else we could have done for them, but still it played over and over. No one in the service cared. Why would they? It was my job, I signed up for it.

Today I found out a close friend had a similar job in another part of the country. This is their one job. The service has done nothing. Offered no support.

Crews go through this on a regular basis, and there are no official checks or support. Stress, PTSD and suicide are allvery real and far too common results.

Something needs to change, but it has to start in the offices of managers.

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.