High but not mighty.

“Recreational drugs – relating to or denoting drugs taken on an occasional basis for enjoyment”

Above is a definition given when one searches the word “recreational” in a famous search engine. My experiences were very different. None of the users I was called to were occasional users, none of them were particularly enjoying life.

Having never used non-prescribed drugs, I can’t talk about the feelings they give the user, having deemed life extinct as a result of their use more than once, I can talk about the feelings they caused in me. Anger, despair, sadness…the list goes on.

I will never understand why someone feels the need to use drugs to “enhance” their lives, knowing the addictive properties and the devastation they cause, but they do.

I’ve mentioned Narcan/Naloxone before in a previous post, a drug ambulance crews carry that blocks the effect of opioids (heroin etc),for a short time. Time enough for the patient to recover rapidly and realise that the hit they needed, that they’d paid for, had been removed. This was often met with anger and, with it, violence. It also meant that, if the patient had taken a significant amount of their chosen drug (generally the case in an overdose situation), the effect of Narcan would not last as long as the effect of the overdose. The use of this life saving drug relied on the ambulance arriving ,and the drug being administered, in plenty of time. More than one person asked me during my career – did I ever think of taking a little bit longer to get to jobs, thus allowing the drug user pass away and easing the burden of drug users on society. My answer was, and always will be, a very definite no! My job was never to play God. No ambulance crew member anywhere has the right to decide who lives and who dies, their job is, unquestionably, to preserve life. Millionaire in a mansion or homeless in a cardboard box, the level of care is the same in the back of an ambulance.

The job came on our screen as a drug overdose in one of the “less salubrious” parts of town. We rushed over and arrived at the same time as one of the single crewed fast response cars. All three of us ran into the building and up to the correct flat. We were met at the door by a strangely cheery person with a needled syringe behind their ear. Needles are always a concern to crews in drug-related incidents, but this person assured us they would deal with it correctly and guided us through to their friend. The patient was unresponsive and breathing worryingly slowly, but their heart was still beating. My partner got to work with the bag and mask, a way of pushing pure oxygen into the patient’s lungs and ensuring that oxygen was fed to their vital organs (assuming their heart was still working) , while I began preparing the Naloxone injection. The third crew member began inserting a tube (known as a cannula) directly into a vein in the patient’s arm. I injected an amount into the drug directly into the patient’s arm, just below the shoulder. This would not work as quickly as if it was injected directly into their bloodstream, but at least it would have some effect before the cannula was in place. Once the paramedic had the cannula inserted I inserted a further dose straight into the patient’s bloodstream. The effect was almost instantaneous, but we had all anticipated this and had stepped away far enough to be at a safe distance when the patient came round and realised what had happened.. Once they had calmed down and we had explained what happened, the patient refused transport to hospital, so we filled in the relevant paperwork and left. As we walked back to the vehicles the fast response car driver suddenly shouted “SH*T!!”, and ran back to the flat. It transpired he had left the cannula in the patient’s arm, a drug user’s dream – direct access to a vein!

Drug related deaths always seemed so pointless, a waste. They also had their own hazards, as I’ve already mentioned, needles. One job we were called to, My partner was about to kneel beside the patient, just as I caught a flash of an uncovered needle on the floor, right where my partner was about to put their knee! then there are the patients who become suddenly extremely violent and threaten crew members with whatever comes to hand – needles, kitchen knives…. Often you don’t feel fear in the situation, but it comes afterwards when the reality of the potential outcomes hit you.

Legal highs are becoming more and more popular. They are available from corner shops everywhere, the owners happy to cash in on legalised drug dealing, not giving a thought to the harm they are causing. Many times I was called to patients who were having bad trips, or who felt like their hearts were trying to leave their bodies. When asked if they knew what they were taking, not one of them did. They all seemed surprised that some unknown drug was affecting their body in unexpected ways, thus was the rationale of the drug user.

There have been campaigns telling us the perils of drug use for decades, but there are still people who think it will be different for them. There is no convincing some people, even some who have lost friends though drug abuse, such is the grip addiction has. Ambulance crews across the country will continue to take their abuse, and will continue to put themselves at risk to try to save people who have no respect for their own, or anyone else’s life. Ambulance Service management will continue to tell crews they will never put them at risk, that they should always put their safety first……….but the same managers will still expect their ambulance crews to go to these jobs on a regular basis, because targets must be met…..

Driving the point home.

Bad drivers….. We’ve all seen it, some have been victims of it. When you’ve been to RTCs caused by it you find it hard not to get angry about it. Warning – controversial, blunt and slightly angry, comments ahead!

Bikers, or “organ donors” as they are known by some ambulance crews, are often the most annoying. Whoever stated they should be allowed to “filter” through queues of traffic (drive, usually at silly speeds, between rows of queued cars) must have been a bit disconnected with reality. Bikers, in my experience, come in two types – the sensible ones who act like genuine road users and the dangerous ones who think it’s fun to drive fast and have no interest in the potential devastation they could cause to other peoples’ lives. At this point I expect any bikers reading this to be cursing me. If you are one of those, I would love to give a list of relatives who have lost loved ones to bikers who were “having fun”, or lost relatives who were bikers. Maybe you could try to explain your thoughts on the matter to them?

From very dead motorcyclists to very injured ones, Bike vs Object was never a good job to be called to. As soon as you read that on the ambulance screen you know it won’t be a good outcome. Then a few days later we’d see the tributes – “They lived for their family” or “they died happy, doing something they loved”. There is no such thing as “dying happy”! Dying is always bad, dying as the result of a crash is often very painful and not something enjoyable. As for “living for their families” – it is selfish because children lose parents, partners lose loved ones. It’s also life changing for other innocent parties who may be caught up in it. I could describe jobs I was called to involving motorbikes, but I doubt it would change views. Surely, if a rider expects to be treated as a road user, they should then act like one? It’s not complicated.

Boy/girl racers! – I was called to my first RTC involving a racer early in my career. Cars are very safe these days, but not when modified and driven by idiots who think they can drive them well. My first experience of this was a young driver in a well known Japanese rally-style car. They had come out of a side street at great speed, straight into the side of an older driver’s car who happened to be directly in their path. On arrival, another crew had seen to the extraction of the older driver, who had sustained a number of broken bones. We attended the younger driver, who had foolishly got back into their car to wait for us. They seemed in great spirits, laughing and joking, not caring about the injuries they had inflicted on the innocent older person. Remaining professional, with great difficulty, I asked the driver if they had any pain in their back or neck. To this day, I still maintain that, at that point, they saw an opportunity to become a “victim”. “Yes” they said, suddenly appearing concerned for their own welfare. Immediately we began to treat them as protocol dictates for a spinal injury. I asked one of the police officers nearby to get into the back of the car and hold the driver’s head still so as to maintain their spinal alignment. Then I approached the fire chief and asked him to remove the roof of the car to allow us to extract the driver safely. At this point the driver became very agitated. Suddenly their pain disappeared, but they had claimed they was in pain in front of a number of uniformed personnel, we had a protocol to follow, and the police officer’s hold on their head tightened slightly as they protested. Resigned to their folly, the driver was extracted from their roofless car, immobilised so their spinal column was safe from further damage, and transported to hospital. Rightly or wrongly, I felt no guilt knowing his car was fit only for the scrapheap as soon as the roof was removed.

While it is not the job of an ambulance crew to judge a patient in any way, nor would they do so publicly, there were many jobs like the one above where we had to keep our thoughts to ourselves and remain professional. My job was to maintain life and protect the welfare of my patients, no matter what happened before my arrival on scene. The police however had a bit more interest in the events beforehand, and they could take action or give an opinion based on that.

The following happened on a major dual carriageway: A young driver had lost control of their vehicle, having taken a corner far too fast. We arrived to find a very dented car on the central reservation, the young driver standing next to their pride and joy with their head in their hands. My partner went to attend to the driver while I spotted a local traffic police officer we knew and went to find out what had happened. When I asked the officer if the driver had been travelling fast, they took me to the rear of the vehicle and pointed at the exhaust outlet pipe. It was huge! “any more questions?” he said, one eyebrow raised. I shook my head and walked back to the ambulance.

All of the above may sound like a bad prejudice against bikers and racers but, as I mentioned earlier in this post, there are the sensible ones. It is fun to have a fast bike or car, but public roads (there’s a clue in there – public) are not the place to have that fun. There are track days at many race tracks around the country where adrenaline rushes can be had. I’ve seen too much death and destruction, lives and relatives left behind lives’ destroyed by what can only be described as foolish acts of selfishness. I drove fast in my youth, but I was lucky enough to learn from other peoples’ mistakes.

The day after I completed my vehicle extrication training I received a phone call. A good friend had studied hard, worked his way up within his job had finally bought himself his dream car. That day he died in it, because he thought he could cope with driving it fast on a country road. I was devastated, and my instructors wanted to send me home, but I knew I had to continue so I could maybe save someone like him one day. So yes, I get angry when I see stupid driving. Yes, for me, every RTC was personal.

If you disagree with anything I’ve said above, please get in touch. I’d love to hear your views.