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.

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.