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….

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…..

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……

You only live…..once

Despite the James bond book/film that claims otherwise, the above is unfortunately very true! When it’s your turn, nothing can change it. Some people, however, choose to bring their time forward. Warning: this post is a blunt one!

Many times we’d be called to an “Overdose”. Sometimes it was a drug user who had overdone it unintentionally, often we could reverse the Overdose with a drug we carried, other times we were too late and the patient had passed away (usually before the 999 call was made). There were also the patients who wanted someone to pay them some attention. These were the ones who took 5 – 10 paracetamol or ibuprofen, thinking that it wouldn’t kill them. Some were spoiled kids who’s parents were too busy, others were so sad and low that you desperately wanted to hug them, but that wasn’t part of the job – all they wanted was someone to listen. None of the patent types I’ve mentioned actually wanted to die.

Then there were the ones who did. The ones who’s lives had gotten into such a state, or who had reached such a low point, that they saw no point continuing with their lives. These patients generally managed to see their wish through, and we were only called when someone found them.

Fatalities were part of the job, and I always managed to treat the majority as just that – jobs. I never knew them, I’d never met them, and I couldn’t tell you what they looked like once we left them. That was the easiest way to deal with death. They were someone else’s loved one, it was their job to grieve. But the ones who took their own lives, they were different. I was called to an unconscious patient, and rolled up to find a very drunk foreign gentleman. He was quite cheery and chatted a lot about how he had come to the UK to work, but he missed his family. Two weeks later, we were called to cut him down from a tree in the middle of nowhere. Another job involved a 15 year old, who was being cut down from a tree in their back garden by the police as we arrived. I remember that one, mostly because there was a strange peace about the scene, and the patient almost looked relieved. Then the mother came out and shattered the peace, understandably hysterical when they saw their dead child.

Then there was the parent who chose to end their life in the stairwell of their home, in full view when their ex when they brought their young children home. I’ll remember that as a job, their children will never forget it for many other reasons.

But we were given the usual 5 minute rest afterwards, then it was on to the next job. No support, no debrief, no health checks. Yes, we chose to do the job. Yes, it was all part of the job. No, no-one is hard or tough enough to deal with situations like that, or worse, and not be affected. The emotions involved in these jobs vary – anger at the selfishness, despair that society has let these people down, sadness for the family and friends.

Then the screen lights up and we go to the next job…..