When I started in the ambulance service, there was a snooker table in the station. We even had film Sundays, where a few of us would sit around and watch a DVD. The odd crew would go out, deal with a job and often be back in time for the end. That’s how it should be. It’s an extremely stressful job. We could be called to a dying child or road traffic accident at any moment. So I don’t think anyone would begrudge us taking a bit of time out to process our thoughts and catch our breath.
Plus, there were other things that we could get on with at the station. Those breaks allowed us to prepare our vehicles properly. Now that the calls wait for us, we don’t have time to go to the toilet, let alone make sure our ambulances are shipshape and Bristol fashion. It’s not uncommon to be on a job, open a bag and discover something is missing. There are excess supplies in the back of the ambulance, but it’s not ideal having to say to your patient, ‘Sorry old chap, back in a minute . . .’ Proper prep is arguably the most important part of any job. If a soldier went into battle without squaring his kit and something went wrong, he’d be hauled over the coals.
You see those signs on the motorway: TIREDNESS CAN KILL. TAKE A BREAK. That makes perfect sense. So why would you expect an ambulance person to work for ten or more hours without pulling over for a coffee and a KitKat? The official rules state that we are entitled to a thirty-minute break during a twelve-hour shift, plus another twenty-minute one. If you’re organised, you bring a packed lunch in, but often you don’t get a chance to sit down and eat it. Often, I’ll find myself driving the ambulance with a sweaty butty hanging out of my mouth. They say that’s why our ambulances are automatics (although they’re going back to manuals, and when that happens we won’t even have a spare hand to eat with).
If we are able to make it back to base, by the time we’ve heated something up in the microwave, served it up and eaten it, we have to be straight back out the door again, probably while still chewing. You can spot ambulance people a mile off in restaurants (not when they’re on shift!), because they’ll be eating twice as fast as everyone else.
An ambulance person never knows when they’re going to see the porcelain next, which means I do a lot of panic weeing. If I make it back to the station, I’ll try to squeeze two or three wees out. If I’m in A&E, I’ll try to have a couple of wees. I usually ask if I can have a wee in a patient’s house. Whenever and wherever I can possibly wee, I try to sneak at least one in.
I’ve been on many shifts when I’ve been thinking, I’m really not feeling up to the job today. It’s a scary feeling. The body is tired, the mind is tired and you’re walking around with the screensaver on. Suddenly you’re driving 5 tons of ambulance at tear-arse speed on the way to a cardiac arrest with a load of drugs in your bag that need to be administered properly. You arrive at a scene and start second-guessing yourself. Did I do that right? Did I forget something? When you’re knackered, regulation tasks can suddenly become fiendishly difficult, whether it’s doing a quick crossword or applying a dressing to a wound. At times like that, an ambulance person relies on their partner to pull them through. If you’re both knackered, you just have to dig as deep as you can.
I actually have a funny story relating to fatigue. A few of my colleagues used to claim our station was haunted by a child who was trampled by an elephant. Apparently – and there is absolutely no proof that this is the case – the station is on the site of a Victorian circus. One night, a colleague claimed he couldn’t get out of his chair, because there was an invisible force holding him down (I’m not sure if he thought it was the child or the elephant). Either way, his mates were quick to point out that he’d just worked ten hours without a break or anything to eat, and the invisible force was probably chronic lethargy.
No wonder we have a phenomenon in the ambulance service known as ‘bell tension’. Bell tension occurs on the rare occasions you’re in the station and you’re watching the seconds tick down to the end of your shift. You’ll be staring at the clock, pacing the room, getting a bit clammy, hoping beyond hope that another job doesn’t come in and you can get home on time. Sometimes, I’ll be able to hear the Countdown music in my head.
When it gets to about five minutes left, we’ll start putting gear away – apprehensively, because we don’t want to tempt fate. But that doesn’t always do the trick. Once, there were literally five seconds to go when a job came in. It was a category one response (a patient was gasping for breath, and once someone in the control room hears the word ‘gasping’ they immediately send an ambulance) and we were the only vehicle available. It can be frustrating, but it’s what we signed up for. It doesn’t matter if that one last job means we end up working a fourteen-hour shift, if someone needs saving, we’ll hop to it.
To add to the stress, an ambulance person’s paperwork has to be as good at 5 a.m. as at 5 p.m., even if we’re so tired that we can barely see the page and the pen feels weird in our hand. Essentially, we have to show that we had a positive effect on a patient, and left them in less pain than before we arrived. I understand the need for good record-keeping, especially because people are so litigious nowadays. But it often takes as long to do the paperwork as it does to assess the patient. So you’re damned if you do, damned if you don’t.
It’s the same for doctors. Whichever A&E department we walk into, we see them tapping away at computers, typing up their reports. That’s no fault of theirs, they’re just doing what they’ve been told to do. But, as with ambulance people, it takes up so much of their precious time and keeps them from what they’re really meant to be doing, which is treating patients and saving lives.
The bosses have tried to trim our form-filling back as much as they can, but it’s still quite in-depth. A cardiac arrest is one of the easier jobs to do a report for, but it gets more complicated if you leave someone at home with a chest infection. We have to explain what’s wrong with the patient and what we’ve done to help them. We’ve got to speak to a doctor, and it might take ages for the doctor to call us back. Whenever he or she does, we then have to write up their findings and advice. I’ve been sat in a patient’s living room looking at my colleague, while the patient was looking at me and we were all looking at our watches and the clock on the wall and coughing and shifting awkwardly. Sometimes, it’s nice to be able to sit down and have a brew and a chat. But there are houses you don’t want to spend too much time in. You just want to do what you’re there to do and get out of Dodge as quick as you can.
We never know when we’ll be hit with a complaint, because there’s a never-ending list of things we can do wrong. On one job, we picked a guy off the floor, walked him around his living room, asked him if he was in any pain and when he said no, we said our goodbyes and left. A month or so later, the bosses received a letter of complaint from the guy’s daughter, because it had been discovered that her dad had a hairline fracture of his femur.
The fact was, the patient said he was fine and was walking around, so who were we to question it? That’s why before we leave someone’s house, we always say, ‘If you notice any changes or have any concerns, call your doctor or 999.’ Me and my partner submitted written statements and, until the bosses confirmed that we’d done nothing wrong, I lived in fear of the consequences. That fear of being disciplined or dismissed is always at the back of an ambulance person’s mind. It stems from the blame culture that exists in society. It’s not that easy to get sacked, but the fear is very real.
Medicine is often a matter of opinion, particularly when you don’t have all the facts in front of you, which is usually the case in my job. We can have a look at a patient’s blood pressure, heart rate, blood sugar levels, oxygen levels and do an ECG reading. And on the back of all that, we decide whether they should be left at home or taken to hospital. But just as we don’t wear capes, neither do we have magic wands or x-ray eyes. An ambulance worker will do thousands of jobs in a year, and it’s impossible to get it right every time. We’re humans, so sometimes we miss things. People will argue that if an ambulance person always carries out a thorough assessment, they’ll never get it wrong. Frankly, that’s nonsense, because no person or system is infallible.
It doesn’t matter what you do for a job, whether you’re a plumber or work in a supermarket, you’re going to make mistakes. The difference being, if someone stacks a shelf wrong, some boxes might fall on the floor, while mistakes made by medical professionals can have catastrophic consequences. Sometimes they’re not even mistakes, they’re unavoidable outcomes.
Intubating – or putting tubes down people’s throats – is an art. In the ambulance service, it’s a skill reserved for paramedics and the last resort for patients who are not breathing. But anaesthetists purposely put people to sleep and take over their airway management, which is a hell of a responsibility. Recently, while I was doing some training, I offered to help an anaesthetist with a patient’s airway. The patient was having her gallbladder removed and, before she arrived, me and the anaesthetist discussed the different drugs he uses as a muscle relaxant, to facilitate intubation. He explained that his favourite is rocuronium, because there is a reversal for it which can be used if the patient has an adverse reaction. Naturally, I asked him if any of his patients had had an adverse reaction, and he told me that while adverse reactions do occur, it was very rare.
This patient turned up and we had a bit of a chinwag, before the anaesthetist gave her a dose of numerous medications, including rocuronium, and off she nodded. I started to ventilate her (which basically involves squeezing an air bag connected to a mask, to inflate the patient’s lungs), but it soon became a bit tricky. The anaesthetist, probably thinking my technique was awry, took over the reins, but the next thing we knew, the woman was having bronchospasms – in other words, an adverse reaction to the rocuronium, which meant she was having trouble breathing. The anaesthetist administered the reversal drug, as well as others, only for the patient to go into cardiac arrest. He pulled the emergency cord and what seemed like every medical professional in the hospital arrived within a few seconds. If you’re going to have a cardiac arrest, this was the place to have it.
When the patient had been stabilised, the anaesthetist said to me, ‘You’re not coming in my theatre again, mate.’ The patient spent a couple of days in intensive care but came out of it hunky-dory. But it made me realise that even fourteen years of training doesn’t make someone bulletproof. The anaesthetist hadn’t made a mistake, and neither had I, but things sometimes go wrong. In the medical world, you can never predict what will happen next with any degree of certainty.
There is also misconception among the public about what powers we have. Paramedics and technicians aren’t trained to do all the things they can do in a hospital; we’re only trained to carry out certain interventions. People are pushing for paramedics to be able to carry out more complicated procedures and prescribe more drugs, which means it’s an interesting time to be in the job, but deciding whether a child should be left at home or not is a huge decision and not necessarily reflected in a paramedic’s pay cheque.
The other weekend, I was called to a 111 referral. We turned up at this house to find a kid with a runny nose and a cough. I had to explain to the kid’s mum that we’re not paediatricians. Unless a kid is having an allergic reaction, cardiac arrest or something similarly serious, it’s not our area of expertise. Children are also less able to communicate their symptoms. We don’t carry around xray machines, brain scanners and all that other shiny, expensive gadgetry in our kit bags. It’s not a case of being work-shy, it’s a case of making sure the right people are making often monumental, life-changing decisions.
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I’m happy to admit that one of the things that attracted a teenage me to the job was the idea of being able to tear around the place, lights flashing and sirens blaring, with no risk of being flagged down by the police. But it’s not quite like that. Ambulances are very specialised machines. They’re not like cars or vans, they have a lot of intricate electronics and cabling. Our mechanics know the ambulances intimately and do what they can to keep them running smoothly, but these vehicles are working their socks off twenty-four hours a day, seven days a week. Usually, an ambulance will do a twelve-hour shift and be handed straight over to another crew for another twelve-hour shift. They do thousands of miles a week with barely a break, and some of them are about ten years old.
And you know what’s funny? I once picked up a brand-new ambulance from the station with a sticker on it that said: ‘Please drive carefully for the first 1,000 miles while the engine breaks in.’ Imagine turning up to a job and saying, ‘Sorry we’re late. New ambulance, have to treat it gently . . .’
Some ambulances drive like they’ve got square wheels. They creak and groan as if they’re arthritic. You will need to know the knack just to get them off the starting block some mornings. I’ve had ambulances break down on me at least ten times, sometimes with patients in the back. Touch wood, it’s never been anything drastic, like a cardiac arrest. But I have heard about ambulances breaking down with seriously ill patients on board. In such cases, the patient has to wait for another ambulance to be sent.
Not so long ago, before they started employing specialist teams, we’d transfer neonatal babies to specialist children’s hospitals. We used a special stretcher, which was basically an incubator that clipped into the back of the ambulance and was attached to the mains. It’s difficult to think of a more precious cargo. We’d want to get them to their destination as quickly as possible, while trying not to accelerate or go round corners too fast or brake too heavily. And we were acutely aware that we were driving a vehicle that wasn’t always the most reliable.
To compound the problems, we don’t always drive the ambulances in perfect road conditions. In winter, we can end up on roads covered in black ice and deep snow. Bad weather is a particular problem for rural ambulance crews, who rely heavily on support from Mountain Rescue. Meanwhile, the public rely on hardy carers, who think nothing of wading through a couple of feet of snow to get to patients. But I have been on shifts when the snow has been almost impassable, and in those situations, you just have to do make do and mend. The skid car training has come in handy, but just the simple act of passing other vehicles becomes a nightmare, because you don’t really want to be forcing people into the deeper snow on the edges or in the middle, so that they end up stuck themselves. During the day, you can try to call in a helicopter ambulance, but that’s where the extra support ends. And at night, our helicopters are out of action anyway, because reduced visibility makes it too much of a risk to fly.
One shift, we were sent to a child who was fitting. It was the middle of the night, the snow was a few inches deep on the roads and every corner we went around we’d lose the back end of the ambulance. When we finally arrived at the job, the child was even more unwell than we thought, which meant we had to get to the hospital as quick as we could. But because of the weather conditions, we were looking at the best part of forty minutes. That’s a very frustrating position to be in, and one for cool heads. We knew the child desperately needed a doctor’s help, but if I’d put my foot down and gone too fast, I probably would have lost it. And if we’d ended up wrapped around a lamp post or stuck in the snow, we might have never arrived at the hospital and instead been sat there for an hour waiting for another crew to relieve us. So we just had to navigate our way through the blizzard and keep everything crossed. Actually, that’s not a bad metaphor for what it takes to be an ambulance person when things are getting chaotic.