Turn to the Dark Side PtII

Angry post warning.

I’ve already spoken about ambulance crews’ dark humour and other coping strategies that they use. I mentioned how “normal” members of the public often don’t get it. Recently I was horrified to read an article relating to this.

It revolved around a message sent to ambulance crews, in their ambulances, telling them to “Please be mindful when outside A+E of how the public view your actions. Eg. Being on mobile phones/Snapchat or taking refreshments.

Firstly, what narrow minded, uninformed person actually sent that message? Any member of any ambulance service should know what their staff go through. To send something like that to crews, while they are still on duty, is utterly thoughtless!

Secondly, the message began “Following a complaint from a member of the public…”. Whoever took that complaint should have put that member of public straight and explained what the crews actually go through on a daily basis and ended things there. It should never have made it past that first person.

There are blinkered people out there who think ambulance crews should go round expressionless and unemotional. Unfortunately robotics hasn’t progressed that far yet so the job is still done by humans, with emotions, and coping strategies.

Sometimes, after certain jobs, they just need to chat with a friend or a loved one, outside A&E, on their phones. Sometimes one of the few chances they get to drink coffee etc is after a job, outside A&E. Normally because they are so busy serving members of the public. They might even have been on their phone to a counsellor after a particularly traumatic incident.

Please don’t ever judge crews for being human. That “member of the public” probably had no idea what the crews they were complaining about had just dealt with. Maybe they actually just needed a break and a brew, perhaps they were taking the chance, between jobs, to check in with their loved ones they’d not seen for a long time because they’d been doing long shifts.

I hope the person who actually sent that message was suitably dealt with.

Finally, if you think I’m wrong, and if you think crews should behave differently, most ambulance services are usually recruiting – why not put yourself in their shoes and see if you are right.

The show must go on.

Someone recently asked me how I coped with the death and dying when I was in the Ambulance Service. I spoke in a previous post about how the crew depersonalise jobs. It’s something you learn the importance of very quickly. Often a crew will be required to give a police statement regarding a death, if a patient’s death is unexplained (usually the case, until a doctor writes a death certificate or a post mortem is carried out). One of the questions always asked is “Would you recognise the patient again?” to which I always answered “No”. The patient could be lying in the next room, but I had blanked their face from my mind, I had to. Occasionally the patient would be someone we had dealt with a number of times, one with an ongoing illness, someone you had built a rapport with. On those occasions there was sadness, and the family usually appreciated your precence.

On one occasion, I took my old school master in to hospital for a planned stay. I didn’t recognise them initially but, when I did, the respect came back as I remembered this kind person who had helped shape me and my school mates. Little did I know this would be their last journey, but I’m glad I was able to pay some kind of respect before they passed away.

The terminally ill patients were frequently inspiring. They knew the life they has left was short but they spent their time preparing, and preparing the people around them. “Live every day as if it’s your last” one of them said to me. Something I still need to remind myself of constantly. Those were the ones who lived life to the full, who often saw so many positives, even when facing their own end.

“There’s always someone worse off than you”. Words from another terminally ill patient. Words that kept me going often during my time in the service.

Some didn’t know death was coming – cardiac arrests, RTCs… The patients who had passed away before we arrived were the ones that were easy to blank out. The ones who we worked hard to save, only to have the A&E staff make the difficult decision that it was hopeless to continue, those were difficult to blank. While still being able to depersonalise the job, it was still hard to forget the effort we put in. Sometimes there was anger – anger at the patient for dying, anger at the hospital staff for giving up…anger at ourselves for failing to save a life.

I remember my first cardiac arrest. It was also my first real CPR. The horror of breaking ribs lasted seconds as we worked hard to save the patient. We rushed them to hospital but it was all hopeless. I thought I had come to terms with it until we returned to A&E the same day. One of the nurses pointed out the patient’s family being shown to the relatives room. They looked up at us as they walked past, and my heart sank as they tried to smile, grateful smiles for our efforts. Our part in it all would be forgotten quickly, but at that point in time we had done our jobs as best we could.

Sometimes relatives would ask to see us so they could thank us for our efforts. The first time I initially declined because I felt that I was “only doing the job I was being paid to do”, but a nurse politely explained how it was part of the families’ grieving process. Those moments were hard. This was someone elses’ grief, but I was being involved in it.

I saw death in many forms. While the memories of the lost ones will live on in those close to them, most will be forgotten by me over time. But there are those that will stay with me – some for good reasons, inspirational patients, some for bad reasons, the circumstances around their death. But all will have one thing in common – I don’t remember their faces.

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.

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……

This would be funny…

….if it wasn’t happening to me! A phrase that came to mind many times during my career as an ambulance crew member. Like the time we were called to a patient who had been bitten by her very small rodent a few hours earlier, or the guy with the Sunday morning hangover. I’ll make more of both of those in future posts.

There have been many books written about Ambulance life, most extremely good, but not many that I’ve read address the emotional highs and lows a person experiences on a daily basis. It’s taken as an expected part of the job, and Ambulance crews are hardy types but, when you leave the comfort and support of like-minded colleagues behind, suddenly the reality of what you have seen and dealt with becomes very different. It is my hope to share these emotions as best as I can in my posts. I have many stories to tell, some funny, some sad, but I will also try to explain the feelings involved too.

Please feel free to comment if you have any questions, or if you disagree with my views. If you can relate to anything I say I’d love to hear from you.