True Colours II

“Ah wow! You must have seen some sights. What’s the worst thing you’ve seen?”

Because I’m meeting lots of new people, my past employment has come up a few times in conversation lately, and the above is the usual response. Even people I met months ago have asked when they find out.

I’ve not yet found a polite or sensitive way to tell them that “the worst thing I’ve seen” is actually part of the reason I don’t do the job anymore, and I really don’t want to have to remember it again. I know their intentions are innocent, but even though I have mostly come to terms with the things I did and saw, recounting them as stories can still sometimes still trigger unwanted memories.

For that reason I have my list of stock stories I tell. Some gruesome, some funny, some “sad”, but all detached from my emotions long ago.

But sometimes they want more. They ask probing questions and those aren’t helpful.

I recently applied for a different job with my current employer. Basically it was to run a hospital simulation suite where future medical staff might get as close to realism as they can before they are dropped into the big bad world.

During the interview I was asked why there was an inconsistency in my job history after leaving the ambulance service, a few different jobs, all short term. Feeling brave and thinking maybe it’s time, I mentioned the possiblity of PTSD. One of the interviewers jumped on this and asked if I’d be able to cope with the job I was applying for because of this. Completely thrown by the question I stumbled a bit and realised that the interview was over and it was pointless continuing!

The public don’t know most of what medical staff see or go through, from the person who takes the 999 call to the person who discharges the patient. Sometimes just a smile or a “good for you” is enough when you find out what someone’s history involves. Often they don’t want to talk about the specifics. It will definitely have affected how they see so many things in life, but let us volunteer that. Let us choose when and what we share, when we choose to. Don’t try to remind us why we don’t do it anymore.

The other thing I often get asked is “Who is Moreton Rhodes?”. No, it’s not my real name…obviously. Moreton is a toy mouse that has been round the world with work or leisure trips. Rhodes was probably the worst holiday I can remember. There’s no significance in either but I thought they sounded good together.

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.

The One and Only

They say everyone in frontline medical care has that one job. The one that sticks with them, sometimes forever.

Mine was an 11 year old, hit by a van while they were actually playing on a dual carriageway. The van driver had no chance of stopping or avoiding them. I often wonder how the driver fared afterwards. For a long time I was angry at the parent that allowed them to be there, but then I realised that they had lost much more than me. I drive past the location sometimes on the way to places, there are still flowers and other tributes tied to a lamp post near to the site.

I know for one colleague it was the 15 year old we cut down from a tree in their garden.

This is not about doom and gloom. It’s about the fact we are all human. No matter how tough the exterior image, we all have the sleepless nights where we wonder “could we have done more”. The answer is always no, but that doesn’t help.

“Stress” was a common ailment in my time. Only now is it being recognised as PTSD. Still the support is not there. Managers still tell you to call a helpline if you’re struggling, rather than recognising the fact that you are not coping and dealing with it themselves.

The title of this post, yes, it’s from the Chesney Hawkes song. It was the theme song of my group during my training. We knew what we were getting in to. Our instructors were veterans and held nothing back.

But still we all went into it. From the first death, the first CPR job – we toughened ourselves and went on to the next job. Most of the public didn’t care, they just wanted what they felt they were entitled to. We did our job, many still do. Not because of the glory, there is none, but because we made a difference. I always said for every hundred patients, if just one says “thank you” then the job was worth it.

It’s New Year and most of us will have made a toast at midnight on the 31st. Something positive and forward looking. I want to end this post with a toast a friend sent me. A friend who still serves with an ambulance service despite a severe period of diagnosed PTSD, after their one job:

“Here’s to getting out of bed when you don’t really want to. Here’s to going to work knowing no one really cares. To doing your bit. To making a difference, to getting by, helping them ambulance types that need it. To making yourself available to the ambulance types that haven’t realised yet that they need some help. Cheers!”

I’ll stand by you.

It’s coming up to that time of year again. The time when all the charities ramp up their appeals on TV and on the streets. All the main organisations have started. In this post, I’m not going to tell you who to give your money to. I just want to mention a few causes that I feel deserve extra support around now, a couple not often thought about. All have already been mentioned in previous posts but they are still important, perhaps more so to me because of my personal experiences with them (that is what this blog is all about after all).

Firstly, elderly people. Winter is a dangerous time for many. With fuel costs rising, hypothermia becomes an actual killer. When you casualty turn up your heating without, think of the older ones who can’t afford to. Loneliness is a huge problem too. Some elderly people may have recently lost their partner of many years, possibly facing their first Christmas alone. More than once I was called to such a person around this time of year, who saw no reason left to live any more and just gave up.

Those are the people who need practical support. Friendship, food, heat, people who show they still care about them.

Secondly, not only the people with terminal illnesses – also the frequently unsung heroes who support them. Family members, who are terrified that this might be their last Christmas with the loved one they are supporting. Also the support charities. The people who try to help it all be that little bit more bearable for everyone, while trying to walk away and hold on to anything they can to keep themselves going.

There are many others but finally, I want to mention one very close to my heart – of course, emergency crews, primarily ambulance crews. I’ve already highlighted PTSD, stress, depression…all the problems brought on by giving everything they have to help other people, while very few people give anything to help them cope. Suicide season is near, it’s a difficult time for ambulance crews. The ones who cut down bodies, who try to save someone after an overdose. Many times the patient doesn’t want to die, their “attempted suicide” is a cry for some attention, someone to show them that they are interested. That’s hard to walk away from at the end of a callout, but ambulance crews have to do it.

This next part is not an appeal, I just want to highlight a few charities that help with the situations I’ve mentioned, a couple I have been involved with personally:

For the elderly –

Help the Aged. Essential work with elderly people, especially at this time of year, with your support.

For victims of cancer, and their families –

Maggie’s cancer support centres. They provided a lot of valuable support to my partner after surgery. The staff are amazing and give more than we could have ever expected.

Two(ish) for the Ambulance crews –

PTSD999. PTSD is starting to be recognised more and more in our emergency crews, it’s not rocket science, but no one thinks about that when they see ambulances around towns and cities. PTSD999 is one of a number of charities highlighting this, and helping emergency crews up and down the country.

Frontline Coffee (https://frontlinecoffee.co.uk). Set up by ex-firemen, they have created a number of different very high quality coffees in various forms (beans, ground…), the profits of which support different emergency services. One of the blends is specifically for Tasc, an ambulance support charity that I know does good work from inside the service. They also give you the opportunity to send a bag of coffee to your favourite emergency services station so you can show practical support. Coffee and emergency services – genius!

And finally, one for all of the above –

You! You can give practical help to them all –

Keep an eye on elderly neighbours, cook something for them, show them you are interested in their welfare.

Ask cancer support groups how you can help, many require volunteers for events etc.

Emergency crews love when someone shows their support by dropping a box of chocolates or biscuits at their local station, or drops by on Christmas Day with a wee gift. I know this because I spent one Christmas Day single crewed, and was visited by a few people who made the shift much more bearable.

I hope this post hasn’t been boring, and that it has made you consider some of the groups I’ve written about. Don’t leave it to “somebody else”, be that somebody. They say Christmas is about sharing, I say it’s about caring too.

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.

’tis the season

Christmas and New Year – the festive period. Parties, celebrations, presents, cheer, making merry, over indulgence, fights, depression, suicide……

It’s difficult to feel festive sometimes when your Christmas is filled with the latter. It’s sometimes known as “Suicide Season” by emergency personnel, a time when it becomes too much for some people and they try (and often succeed) to end the pain inside. Depression becomes a bigger problem for many who suffer, as they see everyone around them having fun and enjoying themselves. I’m not going to apologise for painting a bleak picture. It’s a very real one, and many ambulance staff are in the middle of it. It’s difficult not to feel it when your eyes are opened in the back of an ambulance.

Regular calls to city centres for broken ankles caused by crazy high heels and icy conditions. Revellers, drunk and incapable, filling hospital beds because there is nowhere else to take them, and to send them home could be fatal. Ambulances stocked with space blankets (large, foil blankets designed to help retain body heat) to wrap half dressed patients sitting on kerbs, feeling sorry for themselves.

Then there’s the obligatory Christmas Day stroke/heart attack. One Christmas Day I was on shift with a probationer. We began our shift at 6am and I explained we’d have at least one “stroke” or “heart attack” call that day to somebody’s granny or grandad. They told me I was being negative and that it was going to be a good day, so I suggested a small wager. It was an icy day, no snow, and we had a number of calls to elderly patients who had slipped and fallen on the way to the car as families were drawing together around the country. All our patients, and their relatives, were in good humour that morning. Then came Christmas lunch.

We had taken our own Christmas lunch in, and a couple of other crew members dropped by with goodies. Then it came – an elderly relative was having a heart attack after their lunch and was unresponsive. My partner was a tad disgruntled as we rushed to the ambulance. Because we worked twelve hour shifts, we drove six hours and attended patients for six. I had been attending all morning, now I was driver. We rushed to the job as I explained to my, somewhat naive, partner that it was probably nothing, and that the patient was probably just having a snooze after a large lunch. They called me a cynic and prepared themselves for the worst; having to tell a family that their loved one has passed away on Christmas Day is never pleasant (nor any other day). We arrived at scene and my partner ran inside, to find the elderly patient fit, well and wide awake, also extremely confused about all the fuss. Tests proved the patient healthy and that nothing untoward had happened. We left the family to enjoy the rest of their day and returned to our station. There I explained further the parasympathetic nervous system – simply explained, after a large meal the body diverts energy to digestion. This is why many people feel like a nap after something like…..Christmas lunch. For many elderly people this can be a deep sleep, often mistaken for unresponsiveness and a stroke or heart attack.

Unfortunately, this isn’t always the case, and ambulance crews give sad news to many families, more poignant around this time of year. While the Ambulance crews walk away and go to the next job, the relatives are left mourning their loss, often tainting future Christmases for years to come.

I mentioned depression and suicide at the beginning of this post. It’s real, and we don’t always see it in daily life, but if you know someone who suffers from depression, you can make a difference by talking to them. Don’t overpower them, just let them know that you are there for them, watch them and their behaviour. If you suffer the horrible effects of depression yourself, and watching everyone else enjoying themselves takes you lower, talk to someone. Perhaps even write a blog!

Ambulance crews can go through a world full of other people’s emotions at this time of year. Some of those emotions can get through their defences sometimes. I watched a programme on TV this week that ended with some statistics, one being that 25% of the UK’s ambulance crews will experience PTSD, one in four! There is little or no support from most ambulance services, and little or nothing being done to lower these figures from inside. Often seeking support feels like, and is viewed as weakness or failure.

I’ve spoken about charities that offer support before, but public awareness is also important. PTSD999 is a charity that I’ve also highlighted, providing support to all types of emergency workers. They have just released a version of the song Heroes to raise funds for the work they do, and to raise awareness of the need for such services across all the emergency services. The band is, appropriately, called Burn Out and it costs a mere 99p to buy the song via iTunes and Amazon Music. So, among the festivities and gift giving, help support the people who make it safer.

Another way you can lift emergency workers is to show your appreciation – a simple “thank you” if you see them out and about, buy them coffee if you see them at the petrol station on a night shift. Simple things go a long way.

As the great philosopher, Michael Buble, once said: “It’s beginning to look a lot like Christmas….”.

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….

“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.