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.

Time after time.

Clock stopping. The thing that drives dispatchers everywhere – the time between receiving a call and some form of response arriving on scene. Unfortunately this is often seen as more important than the patient and their ailment.

I was sent to a fall once, when I was single crewed. Falls are jobs that ambulance service SOPs (Safe Operating Practices) dictate should be attended by 2 or more staff. There was no way I was helping this patient from the floor myself. There were no injuries so, once I had made the patient comfortable, I updated control. Well over an hour later a second, double crewed, ambulance arrived and the patient was helped to their bed. The patient lay on the floor for almost 2 hours from the initial call, but the job was classed as a success because I got there in the prescribed time and the clock was stopped.

In 1974 the ORCON (Operational Research Consultancy) standard was created. ORCON was a way to monitor the performance of ambulances (and crews). The biggest thing being the ability for crews to get to a Category A call (cardiac arrest etc) within 8 minutes. By this standard, if a crew arrived at a job within 8 minutes and the patient died, the job would be seen as a success. Should the patient survive but the crew took longer than 8 minutes to arrive, the job would be a failure…

Much has changed in ambulance services, and ambulance crew abilities, since 1974. The type of jobs and public expectations have changed too, but ORCON is still the standard used to measure success. Time is still more important than anything, sometimes including crew safety. “Would you assess and withdraw until the police arrive if you feel it’s unsafe?” was a radio message I heard more than once on the way to a job. The response was usually “No” because the police had stab vests and batons, we had neither!

Crews joke about The Great God Orcon, but it’s a real thing, and it’s become more important than crew or patient safety sometimes.

On another occasion my partner and myself had dropped a patient at A&E. They had been in an RTC so had been fully immobilised. We were waiting for our immobilisation equipment to be returned by the A&E staff. The Radios went off – control asking if we could clear and go to a job. We informed them that we had no immobilisation equipment so we couldn’t attend a fall or any other job requiring the patient to be immobilised. We were informed it was just a minor head injury, so off we went. On arrival we found the head injury was caused by a loss of consciousness….wich caused a significant fall! We spoke to the call taker who informed us they had fully informed control of this right at the start of the call. We radioed in, no response. After 10 minutes of trying to call in I put an emergency call in. I got a response after a few minutes (good job we weren’t being attacked). Our dispatcher had been “called to a meeting” (why leave a whole area with no radio contact??). We explained the situation and our inability to deal with the patient properly. The dispatcher informed us that no other crews were available. Our patient was transported to A&E immobilised with blankets, bits of wood, lots of surgical tape, and other things we found on scene. After explaining to the staff at A&E we lodged a formal complaint against the dispatcher. Nothing ever happened.

There were many “clock stopping” occasions during my career. Most not life threatening, but many questionable as to the dispatcher’s motivation. I know it still happens. It’s worrying that a clock is still more important than the health of the patient, and sometimes even the safety of the ambulance crew.