One out, one in. The prequel

One out….

You never forget the first patient you lose. Mine was a frail elderly person who lived close to my ambulance station at the time. The job came in as a cardiac arrest, and that’s exactly what it was. We got there very quickly, the patient’s heart had stopped, and it was my job to try to save them. I began CPR, the first few chest compressions broke some ribs. The dull crack is audible across the room. My partner was setting up the O2 bag and mask, they looked over at me and nodded encouragingly. That was a sound I would hear many times during my career. Some adrenaline injections (for the patient!), and 20 minutes of CPR without any signs of self sustained heart activity dictated we stopped and declared the patient’s life ‘extinct’. But this was my first. Surely there was more we could do, something we had missed? My partner handed me the paperwork and I filled it out, just like I had been taught during my training.

Later, I reflected on the broken ribs with my partner. “It’s perfectly normal” they said. That’s exactly what it became to me. It was an indication that we were pressing down hard enough to make the patient’s heart pump blood properly. “Broken ribs will repair, stopped hearts need help” – I remember my instructors telling us as raw recruits. They didn’t explain the heart-sinking feeling we would experience each time it happened. It was a blunt reminder that this was a real person you were dealing with.

I lost count of the deceased patients I saw, each one making me harder inside. I had to be to cope. You have to treat them as ‘jobs’ not people. You didn’t know most of them before, so you couldn’t be upset. We joked among ourselves about ‘killing’ patients each time deaths occurred during shifts, not because we were twisted or enjoyed it, but because it was a way of coping with it.

If the patient was ‘gone’ before we arrived then distancing yourself was easier. If you knew them, usually as a regular, it was a bit tougher. The really hard ones were the ones you were talking to when you arrived. The ones who went into some form of arrest in front of you.

One patient who arrested on me lived in a nursing home. The staff were quick to point out the patient had a DNAR (Do Not Attempt Resuscitation – a legal document that prevents medical intervention in such situations). We asked to see the document as, without it, we must continue life support. The document arrived and we watched as the patient slowly faded away. As we had accepted the duty of care for that patient, we couldn’t leave until there were no more signs of life. Watching a life slip away in front of you is a strange experience. It’s difficult to explain the emotions involved, but none are good.

Then the hard walls go up again and control gives you a meal break. It’s a bizarre thing, but even now there’s not much will put me off food.

Coping mechanisms keep you going…..until something comes along that weakens them.

Recently I’ve heard of some charities that offer physical and practical support for crew members. Charities, not ambulance services themselves, not the NHS, although it looks like most only operate in England and Wales. I have heard, however, that one ambulance service (possibly more) has recently implemented a more practical support service for its staff. It will be interesting to see how it works.

One such charity, PTSD999, has recently employed the services of a rock legend to help record a version of the late David Bowie’s song Heroes. Please look them up on iTunes or Amazon. The band is called Burn Out (enough said). Just 99p gets you an amazing song and helps them provide such an important service. The charity offers support to all types of emergency workers, please support these guys and other charities like them. We hope the song does well. Their tagline is “help save the lives of those that save yours”.

So yes, deaths affect us but, most importantly, don’t forget that each time one life fades away a new one is created somewhere. We could be heroes, but that’s not why we do it….

It’s based on a true story… Honestly!

Of course I’m talking about the well know UK television show based in the ED of a well known, entirely fictional, English hospital. While I used to watch it purely for the clinical inaccuracies and the abnormally dramatic lives of the staff, now some of the the storylines are close (sometimes very) to jobs and realities I have dealt with. Most recently; Man down, the loss of a colleague. During my career that spanned more than a decade, a number of fellow ambulance colleagues passed away. Some through illness, others in accidents, one more tragic. Most I didn’t know too well, others i knew a bit better, all were sad and their loss was felt across the service. The latter I trained with.

I knew the person closely for 10 weeks, we trained together back at the start of my career. They were a major help towards me passing the exams, a close friend for those weeks away from home, then I never saw them again. but that didn’t ease the impact the news of their passing had. I don’t know the full story, but I know that the job we did had a big involvement in their passing, and that greater support and intervention may have prevented it. I recently met up with a friend who was closer to them. The loss has been very obvious in that friend’s life but, thankfully, support is finally in place for him. But it came from his GP, not from within an Ambulance Service.

The coming episodes of the TV series apparently show the paramedic, and other ED staff left behind after the loss of their colleague, slip into a dark places. I remember the last radio call for paramedic Jeff on the program, my colleague received none of that. Circumstances may be different, but the emotions are the same, as are the questions in peoples’ minds – once again, could more have been done to prevent it?

Ambulance services across the country need to step up care of their staff. I loved my job, but most ambulance crews see and go through things that change the way you view life. “here’s a number you can call….” never has, and never will be enough. I realise this post might ruffle a few feathers in a few ambulance divisions but I hope that, rather than the usual brushing problems under the carpet, they might try to change things if that’s the case. When someone feels unsafe, unsupported by the organisation they work for, something is very wrong!

The TV show may be fictional, but some of the characters and stories are closer to life than you might think. Yes, this post might read like an angry grumble about the lack of support available to ambulance crew members, probably because it is, but I’ve not even brushed the surface of the problem. No one should be abandoned for doing their job, for trying to save lives.

For every “Jeff”, every “Sam” and every “Iain” out there……

“But that only happens to soldiers!”

That’s actually what a friend said to me recently when I told them another friend, who is still with the Ambulance Service, had been signed off with PTSD (Post Traumatic Stress Disorder). Until a few years ago, I’d have agreed with my friend, but now I know different.

It’s difficult to describe the emotional hardness you develop. When you walk into a drug den and see the addict, clearly dead, with the needle still in their arm. When you cut someone down from a tree. When you have to explain to someone that the last time they spoke to their partner was just that. I could go on, but there’s no need. The emotional hardness happens because the people you work with understand, and there’s an unconscious support there.

When I left the Ambulance Service that support ended overnight. I wasn’t aware at the time, but looking back I can see the signs and symptoms. My support mechanism ended overnight and I went through a form of PTSD. An ex-colleague and myself often chat about jobs we’d been called to, but sometimes…very often…that’s not enough. We recently lost another friend and fellow crew member that we both trained with, the job became too much and broke him. Now we have become acutely aware how huge the lack of support for ambulance crews all over the country is.

After a particularly nasty job, I was once given a phone number I could call, should I find I was struggling. For those who don’t know any ambulance crew members, they may appear kind and caring, and they are, but underneath they become a certain amount of tough and hard. It’s the only way they can survive. To call a number and talk to an anonymous person, who knows nothing about you, is beyond failure!

The purpose of this post is not to point the finger at the Ambulance service. It is to highlight the vulnerability of every person who works in an ambulance, and to highlight the need for a much greater system of support. I am fully aware that other services deal with the same situations, but perhaps someone else will write about it from their perspective.

Next time you see an ambulance go by with its lights flashing, spare a thought for the crew. Think about what might be going through their minds. When you go to sleep at night, think about the crew members, and what nightmares they might be having. If you know a crew member, show your support. Sometimes they look tough, but underneath they’re just normal people……….well, most of them are!

After I posted today’s blog, someone sent me this link. They only cover some parts of the country, but it’s a start: https://www.mind.org.uk/information-support/ambulance/mental-wellbeing-ambulance/

Another charity just released a single to help raise funds to provide assistance for emergency workers suffering PTSD. The charity is PTSD999, the band are Burn out and the song is (appropriately) a cover of the late David Bowie’s song Heroes. Download it from Amazon or iTunes for a meare 99p.