You Give Love a Bad Name.

I’ve read a lot of news stories and posts on the socials about ambulance waiting times, and people who may or may not have died as a result of ambulance delays (the fact they don’t get investigated makes me sceptical).

We all know news companies and media companies love scandal and sensationalism, but why have a go at ambulance crews?

I regularly get messages from a friend and former colleague about the waiting times at their local A&E department. 3 hours, 4 hours… An ambulance crew doesn’t just dump patients at the door and trot off to the next job. They must wait for a nurse or doctor and give a detailed handover before they can leave. I know of one major hospital where the A&E department that was rebuilt and doubled in size a few years ago, and is still manned by the same number of staff as the old department.

Nor do ambulance crews hang around once a job has been allocated to them. Whe someone calls 999 (or 112) and requests an emergency ambulance the call taker will ask questions and follow an algorithm on their screen. The result will add the job to a list according to the level of priority the system decides. Ambulance crews have no involvement in this process.

There are, and always have been faults in the above system, and paranoia on the part of the call takers can often make smaller jobs into bigger ones.

Then there are the time wasters, the ones who know all the key words to use to get up the list, when they don’t actually need to go to hospital at all. And the ones who call for an ambulance because the waiting time for an appointment at their local surgery is too long (yes, that happens…a lot!).

These things all add on to the time before the job is even allocated to an ambulance. I could list many other types of time wasters.

Maybe, instead of the Scottish government talking of using the army to drive ambulances (so they can add to the waiting times standing in the queues in A&E departments too?) they and the other politicians could look at the overall problems and maybe find a sensible solution to the whole problem.

In the meantime, don’t take it out on ambulance crews. This problem is far from new, it’s been an issue for many years now. Those ambulance crews (and call takers, dispatchers, A&E staff…) are doing their best with what they have.

Those ambulance crews are the same ones you made rainbows for, the same ones you stood on your doorstep and clapped for this time last year!!!

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 all very real and far too common results.

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

Here I go again on my own…

“Ambulances will never be single crewed”….promised one high powered ambulance service officer once on a public forum.

A single crewed ambulance isn’t always a good thing. In a true emergency, one crew member can stabilise a patient, but a single crew member will never transport a patient. Ever. No matter what the person in ambulance Control thinks. It is quite embarrassing to turn up at a patient’s house after they have been waiting a while, expecting to be taken to hospital, to have to tell them that you are not able to. There is little or no communication between a patient in the back of an ambulance and the driver. If the patient’s condition were to deteriorate, the driver would be unaware. Still controllers expected us to oblige. Then there was the standing around in the patient’s House uncomfortably waiting for a second vehicle to arrive, with two crew members.

Working from a small station, we only operated one ambulance so there weren’t many of us based there. The unexpected and sudden departure of one crew member, one I worked frequently with, brought on quite a lot of single crewed shifts for me shortly after I transferred there. This continued for an unexpectedly long time, until the service got around to arranging a replacement.

My first one was the day they departed. I turned up, on a hot summer evening, ready for my night shift to be told I was on my own. Our ambulance covered a rural area with a radius of around 30 or more miles, and a main dual carriageway. I had never worked on my own before….

The first call was to an older patient with breathing difficulties. They were asthmatic and known to me as a regular. I drove the short distance to their house quickly and went inside. A family member was there and they were as nice as the patient. I quickly set up a nebuliser to open up the patient’s airway a bit, and began to take some observations. Everything was improving well with the nebuliser, but the patient had raised temperature and a bit of a wheeze when I listened to their chest with my stethoscope – queried chest infection. They had to go to hospital, so I radioed control and requested a second ambulance. A disgruntled controller agreed to send one from the city, almost 20 miles away. “Better put the kettle on then” said the relative.

Having returned to base after seeing my patient taken away by a city crew, I felt the shift was going well. We operated a volunteer scheme from our station – ambulance service trained volunteers with basic life support skills who could attend certain types of job if the Ambulance was unavailable at the time. That night the two designated volunteers arrived in station shortly after I returned. We were chatting away when the next job came in.

It was a call to the river at one end of the town. A drunk had fallen down an embankment and had trapped a foot. ?# (? Before a word implies “queried”, # means “fracture”). I rushed down to the location, to discover I had been directed to the wrong side of the river.

It wasn’t a large river, and there was a small foot bridge next to where I had stopped. It would take too long to take the Ambulance to the next vehicle crossing, so I grabbed my equipment and carried it over the footbridge. As I was leaving the Ambulance, one of the local fire units pulled up behind me, having had the same instructions.

I arrived at the scene – the person had fallen down a bank approximately 2 metres, getting their leg stuck in the loop created by a tree root sticking out of the bank, almost doubling their foot back on their leg. The patients head was almost at the waterline, but being a seaside town, the river was tidal and the tide was coming in.

A quick head to toe confirmed no major damage, other than that foot, and the patient was in good spirits, having sobered up slightly. They had no feeling in that foot, but there was a good pedal pulse present. I examined the scene and began to put together a plan of action. Firstly, a second ambulance, this patient was going to hospital. Next, the two volunteers sitting at the station. They were experienced and their help would be valuable until the second ambulance arrived. I radioed control and requested both. Next, secure the patient’s head, safe from the rising waterline. One of the fire crew supplied a plastic pillow which raised to patient’s head acceptably (neck pain/trauma had been ruled out beforehand, in case anyone is concerned). I began taking some observations, all good. The volunteers turned up and stood at the top of the bank, handing me down equipment as I asked for it. By now, I was standing with my feet on two large rocks, an around a foot of water. A fireman had fitted the patient with a small life vest while I was talking to them and repeating my observations. Suddenly I felt a pair of hand on my shoulder. “You might need this”. One hand stayed on my shoulder and the other one appeared between my legs, as I was also supplied with a safety vest. “You could at least have bought me a drink first” I joked with the fire person. “Would you like me to?” they grinned back.

The fire crew successfully cut through the root and the patient’s foot was released. Miraculously there was only some nasty tissue damage, but no fracture. The patient was strapped to a spinal board, lifted up the bank and taken to the second ambulance that had arrived. One of the volunteers had directed them to the correct side of the river.

I got back to the ambulance station quite please with myself. I had managed that job quite well. The volunteers arrived back before me and, as as I walked in to the messroom one of them said “what happened to your arms??”. I looked at them – they looked like salami! Because we wore short sleeves, every insect in the area must have had a nibble at my arms.

There are rules about what type of jobs a single crewed vehicle can attend. Those were probably the reason the rest of my night was unbusy. That was the first of many on my own, but it’s a great way to learn fast…..