Now I’ve been qualified to crew an ambulance for more than a year, I’m able to go out and do shifts for the ambulance service. I’ve been hoping to do this for quite a while, but equally been a bit nervous, as I haven’t really got that much experience working in the back of an ambulance.
I’ve managed to get on three shifts so far, and to say they are have been eye-openers would be the understatement of the century. Aside from the tedium of quite a large amount of time waiting for things to do (apparently everyone had q word shifts those days…), I got to see a few things I would have seen as a volunteer at events.
Two particular patients stuck in my mind. I’ll be honest, I can’t remember their names, or their faces, but their stories, as I saw them, will remain with me for a long time.
One old lady. She had a stroke a couple of years ago, leaving her paralysed down one side, weak on the other, unable to speak beyond ‘yes’ and ‘no’, and bed bound. She needed round-the-clock care, had a catheter in-situ and was peg fed. She was going into hospital because she had developed a wheeze (which was not a good sign, as it could potentially be pneumonia).
She was obviously loved and cared for. Her daughters (not young themselves) spent a huge amount of time looking after her and making sure she was as healthy as they could manage.
Still, I can’t shake the feeling that this is no real quality of life. I can’t imagine being stuck in bed for the rest of my life, never to care for myself again, never even to speak properly again. Stuck in my head with no way of getting out. It’s certainly not something I’d wish on anyone.
My other patient was a 90-something year old man, the last job of the day. Living on his own, he had been highly active, right up until the last month or so. He had been experiencing complete lethargy, loss of appetite and a whole host of other generalised symptoms, and his doctor decided that he would need to go in to be checked over in the ward. In the past he had been diagnosed with some cancer or another, and his children feared this was a return of that condition.
Even getting him to the ambulance wore him out, and transferring him to the ward drained him so much he was practically asleep when he hit his bed.
My crew-mate and I made him comfortable, made sure he had everything he needed, handed over to the ward’s nurses, and then walked slowly back to the ambulance. The depression over us was almost palpable, and at almost the same moment we both said, “He’s not coming out again.”
Normally, I meet people who are generally healthy, and just need a little patching up to move on their way. Okay, I’ve seen the odd person with a serious medical condition, and the occasionally seriously injured patient, but almost everyone I had dealt with before had very good prognoses. On these two shifts, I saw what is likely to be the end times of their lives, something I will hopefully never have to see when delivering event cover. I just hope I was able to make what could have been one of their final journeys as comfortable as possible.
You are not well. In fact, it’s safe to say you are very unwell.
We are on both in the road, me sat, you lying, with my bike stood in a fend of position, blue lights beaming out a warning to all around. This is not a fun place to stay, but I’ve got no choice. You have just finished fitting for the second time in ten minutes, and I have no way of getting you somewhere safe without injuring one of us.
The person who flagged me down has wandered off, muttering something about leaving it to the professionals. This is a nuisance, as I could really do with another pair of hands. I have a coat under your head, a blanket draped over the rest of you (now you won’t strangle yourself with it), and my radio microphone in my hand. This is the bit I really want. Two fits in a row is not a great sign, and my instincts say your going to do it again. Somewhere on the way down you seem to have bashed your head, you have road rash on your bare legs and arms (it had been a hot day, a lovely time to go to the beach), and I haven’t even attempted to check you for anything else between fits. I really need help, and I really need it now.
The problem is, there’s nothing available. We have over half our local fleet on the road, and every one of them is busy. It’s so busy I can’t even start talking on the radio to give Control an update (and to try to get an ETA on that vehicle).
A gap forms in the radio chatter, and I draw a breath to start talking. Naturally, this is the moment you begin to fit again. Immediately the mic is dropped, the blanket is whipped away, and I check your head is still safe. Grabbing the mic on its upswing, I cut in on a pause in the current conversation.
“Priority, priority, Control 992.” I release the mic to hear someone talking over me. Blast. Keeping both eyes on my shaking patient, I try again. “Priority, priority, Control 992”
“All stations, wait. Priority call. Go ahead 992.”
“Control, upgrade my ambulance request to emergency. Patient unresponsive, actively convulsing, query status epilepticus.” I technically haven’t been on scene long enough to make that judgement, but every instinct I have says that these fits aren’t going to go away on their own.
“All received 992. Be advised, NHS vehicle en route. Please confirm precise location.” I give a little prayer to any passing deity, thanking them for shared ambulance control rooms.
“Location unchanged. Bike in fend off location, you can’t miss me.”
“All received 992. Control out.”
The radio conversation that had been going on before continued, and I mentally switched off to the radio, listening only for my call-sign. Once more you’ve stopped fitting, and once more I cover you with my blanket, pouring reassurances over you that you are safe and that help is on its way. I don’t know if you can hear me through the chaos the fits have reigned in your brain, but if nothing else it makes me feel better to do something.
In the distance I hear a siren. I’ve heard a few going to and fro, but this one is definitely getting nearer. It is the most welcome noise I’ve heard all evening, well, after the heavy sighs coming from you when I checked your breathing. The junction down the road fills with the glow of blue lights, and an RRV comes around the corner. Getting down close to you, to check your obs one more time, I speak to both myself and you. “This one’s yours, mate. The cavalry’s here.”
A collage of a couple of my recent patients, inspired by the WordPress Weekly Writing Challenge: The Sound of Blogging.
I was cycle responding at a music festival. It’s crowded, there are lots of jobs, and my partner and I are responding right left and centre, 999 calls, shouts for backup, the works.
So after a couple of interesting jobs (which I may or may not post about later), we’re sent on to a 999 call to a collapse. Full emergency conditions, which for us bikes means sirens, whistles (normally get us much more attention than a siren), blue lights if we have them (for all the minimal good they do) and dodging and weaving through people as quickly as we can (without hitting anyone). We’re making good progress, given the crowd density, and most people are fairly willing to get out of our way.
I’m trying to keep an eye on everything around me, hunting out a route that will let me progress, and so not really concentrating on what’s happening behind me. It’s a closed road, and we’re easily the fastest moving objects on it, so I’m not expecting anything that I’ve passed to affect me.
A bunch of people wonder in my way, and I can’t swing around them, so I stop briefly (I can impress one of my friends by briefly holding my bike at a stop without falling off), giving them a blast of my whistle (which is loud enough to make my ears ring) and my siren (which is a little pathetic) and then pulled away as they jumped aside. Almost immediately, I felt my bike swerve out underneath me, and I jumped off, trying to give my bike a graceful landing.
Turning around to get better leverage on the bike, I saw a girl holding on to my panniers, apparently helping me stabilise the bike. With it back upright, I thanked her, turned back around, mounted up and tried to go. And instantly feel my bike try to go out from under me again. This time I jumped off before it went, and swung around to find that girl still holding my panniers, laughing.
“Let go!” She just laughed again. “I said, let go. I’m busy.” She let go, but went to grab it again as I pushed my bike away. “Grab it again and I’ll call the police!” She continued to laugh, not saying anything, until some burly guy came out of the crowd, shouting at her as well. I took that as my cue to move on, fast.
Now I’ve heard stories of people chucking things at ambulances, and prank calls, and all the other things that waste ambulance time, and I’ve had people deliberately get in my way, but this is a new one on me. I still managed to catch up with my partner pretty quickly, the whole incident probably only lasted about a minute or so, but seriously, what the hell… It was fairly obvious I was in a hurry (the blue light and siren was a bit of a hint), and the markings saying ‘Ambulance’ are hardly subtle…
I just don’t understand what would possess someone to do something like that which would knock me off of my bike, particularly when I could have been going to a very unwell person.
As an organisation (or, at least, in my part of the organisation), we are very keen at helping out the local ambulance service. By this I mean we will send out crews on ambulances (and occasionally on bikes) to help the service respond to 999 calls. Understandably, this could only be done by experienced members, and one of the criteria for the ambulance work was a certain number of hours third crewing on those shifts. This means working with two experienced members to build up some experience dealing with patients potentially more serious than anything I’ve ever dealt with before, which I’m strongly in favour of. I don’t think I’d be happy going out on a shift without doing this first.
Unfortunately, since I qualified, it is no longer possible to third crew on any of our vehicles. Something to do with weight limits on the vehicles (which, given many of them are transit vans modified into ambulances, not necessarily their original design role). This is very frustrating for me, as it means I can’t gain the experience needed to do NHS support.
To make matters worse, there are very few of us in this position (probably about 3 or 4), and so nobody at county level cares enough to do something about it. As far as they’re concerned, there are enough people to cover the shifts, and so there isn’t a problem. This leaves me, and those few others, in a catch-22 situation: without having the needed experience, we aren’t able to gain the experience.
Needless to say, this is very frustrating.
A little while back, there was a possible solution. Our CRU lead sent us an email looking for interest in doing NHS cover on the bikes over Christmas. The roads get very busy in BigCity when everyone is doing their Christmas shopping, and the bikes can get around a lot easier than road ambulances. A load of us (apparently) applied, and it looked like it would go ahead. I even delayed heading home for Christmas around this. A couple of us entertained the thought that this might count towards us getting some experience towards the ambulance work.
Of cause, it never happened. And we only found that out for certain a couple of days before the period was due to end. The reasons given was lack of interest (yeah right), other duty commitments (*looks at depressingly empty duties book*) and lack of funding (*sigh*). Some of the more cynical amongst us suspect our useless County CRU lead is also to blame, but ho-hum.
All I’ve got to hope, in the nicest possible way to my patients, is that I get something interesting to do on the normal shift. Which, given my track record on a vehicle (nine or ten shifts, one patient transported for a minor injury) seems rather unlikely. The only time I might have had an interesting job, someone kicked me off my truck (story to follow).
I think, as far as possible, I’ll try to stick with the bikes. At least on them I get something to do (and some useful exercise), giving me some experience treating, even if it’s not transporting someone…
My friend and I are already planning what out of county events we want to do. Hopefully we’ll have a good yeah helping out our colleagues in the big city. At least there they know how well a bike unit can work…
- Ambulance Excitement (walkingplasterdispenser.wordpress.com)
One of the most common questions I am asked (along with ‘Are you paid for this?’ and ‘What’s the worst thing you’ve ever dealt with?’) is ‘How do you do this for free?’ This usually happens about the time when I’m trying to stop a drunk student from drowning in their own vomit, while avoiding getting vomited on myself, and their friend is on the other side trying not to vomit. My stock answer is ‘Because it’s fun!’
Even more often, when I’m knee-deep in the worst of the politics and fighting against the people who are too quick to tell us what we are incapable of doing and the people who don’t care and the people who don’t want to lose their power, I wonder why I do it. I spend hundreds of hours a year doing work for a cause I passionately believe in, and in return I get people try to work against me because I want to improve things and they don’t want to leave the happy little rut that they’ve dug themselves.
A short time ago, I dealt with a patient at a Half Marathon, while working on a bicycle. They weren’t particularly unwell, but they had fainted and were a bit shaken up. They hadn’t run anywhere near that distance before, and weren’t used to all the sensations of their body saying ‘that wasn’t such a good idea, let’s not do that again’. All put together, they got a bit worried, and worked themselves up in to what I’m pretty sure was a full-blown panic attack. And I don’t just mean a bit of hyperventilation that quickly cleared up. They were genuinely terrified, kept fainting from the unbalancing hyperventilation does to your body, which just kept making things worse.
In the end, I called an ambulance for them and got them shipped off to the main treatment center, where someone would have the time to care for them and help them calm down properly. As soon as they were sent off, I was sent to another collapse, and I put the entire incident out of my mind.
After the spending the rest of the day zipping up and down the course, I was stood down and headed to the main First Aid post to grab some personal kit and help pack everything up.
While I was there, I bumped in to my patient from earlier. They had just been discharged and were going home with their mother. They both stopped when they spotted me, and my patient asked if I had been the person with them out on the course.
“Yes, I think so. How are you now?” I replied.
“Much better now, thank you.”
“Do you know what was wrong?” The mother chimed in.
“I can’t say for absolute certain, but I think you had a panic attack.” I went to explain how a panic attack was a scary condition, but usually self-limiting and nothing to be overly concerned about. My patient nodded along with my explanation, and then commented that she couldn’t really remember what happened.
“I just remember being convinced that I was going to die, but I remember you being there, and talking to me, and holding my hand, and I knew that I would be okay.” I didn’t really know how to reply to that.
To me, the treatment didn’t seem that much. A simple, non-life-threatening condition that, even if I did nothing, would most likely pass on its own, which I passed on to someone as soon as it looked like it would take a long time to deal with. Fifteen-ish minutes on scene, before moving on to the next job, patient already out of my mind.
But in those fifteen minutes, I helped out a terrified person, taking away some of their fear just by being there. And to that person, I made all the difference.
This is why I volunteer.
We’re standing by outside the recruitment post. Our bikes are attracting a lot of attention: a push bike with Ambulance blazoned across it is an unusual sight.
“992, 992 from Control.”
I turn away from the kids I’ve been explaining the bikes to. “Go ahead Control.”
“Respond under emergency conditions to romeo-one-five. Collapsed child.”
I peer at my map, matching up R15 to where I currently am. Bloody hell, we’re the other side the city. I turn to see my partner already mounting up. To the kids: “Sorry guys, got to go.” I jump on to my bike, kick the stand away, and push off.
My partner pulls off ahead, and I slip in behind him. I was good, and left my bike in a low gear when I pulled up. We accelerate away, shifting up the gears until we’re racing along the road at a respectable rate.
It’s dusk, the perfect time for visibility. What’s left of the sunlight makes our fluorescent jackets glow, while it’s dark enough for the reflective strips shine in every light. Nobody should fail to see us as we race past.
We’re in luck. Most of the route is a closed road. We have the tarmac to ourselves. We make good time, getting half way to the far side of the event to the other before we know it.
We’re getting to the busy part now. Slowing down a little, we weave between clumps of people, earning a few glares as we take a turn faster than perhaps people would like. We shift down, cutting out speed to safely navigate around the dawdling obstacles.
The crowd thickens. The spaces between the groups narrow. We start to lose speed, stuck behind people wandering along, not expecting two cyclists to try to barge their way through.
On goes my siren. They sound a bit weird, too high-pitched, but they certainly grab people’s attention. People turn and stare. A path opens up in the crowd, and we regain a little of our lost momentum.
One group turn and stare. We approach, weaving left and right, trying to find a way past. My siren is still going full blast, and it’s joined by my partner’s electronic buzzer. The harsh sound cuts across the sounds of the crowd, making people wince, but still they stand, staring at us like rabbits in our headlights.
We’ve slowed to a crawl, nowhere to go. Frantically we wave at them. “Make a path!”
Comprehension dawns. They dawdle out of our way, and we pull off again. Finally, a clear path opens, the crowd finally getting the hint that the loud, horrible noise means ‘we’re in a hurry, get out of the way’, not ‘everyone stop and stare’.
We career around the last few corners, the road finally clear again. We almost reach a sprint as we close in on our destination. I’ve been listening in to the radio as much as I can, in the hope that we get stood down, or someone got their first. No such luck.
We skid to a halt at the mouth of the road, screeching disc brakes announcing our presence better than any siren. The road is short. If anyone was collapsed there, we’d be able to see them.
My partner circles up and down the road, scouting the area, while I hold a slightly breathless conversation on the radio, confirming the location of the call. Control tries to call back the original caller, while we lean up against our bikes, catching our breath.
Eventually they stand us down. Apparently our ‘collapse’ had got back up again when his parent’s didn’t give him all the fuss he wanted. Of cause, they hadn’t thought to stand us down.
We took the slow route back to the first aid post…
- Cycle Response (walkingplasterdispenser.wordpress.com)
- Cycle Response Training – Part 2 (walkingplasterdispenser.wordpress.com)
- Cycle Response Training – Part 1 (walkingplasterdispenser.wordpress.com)
- Four new cycle paramedics trained for Great Yarmouth (bbc.co.uk)
When talking about serious illnesses, either when helping train people or when just sharing war stories, I’m often asked ‘What was that like, dealing with that?’ Most of the time I just say ‘scary’. However, properly thinking about it, I think this is a very good analogy (though I say so myself):
“Imagine you have spent two or three years studying for a course. You’ve passed every test, done your final and got a decent mark. Everything is going well, and you’re just starting to relax.
“Then, when you’re least expecting it, you get told you have one more exam. Oh, and you got 5 minutes notice, and you’ve just realised that you can’t really remember anything. So your stomach’s rolling, the old fight or flight is kicking in, with the latter definitely looking inviting, and the adrenaline is making it hard to think in a straight line.
“Take that feeling. Add on the fact that you could be tested on anything you have ever learnt. Not to mention about three times as many things that you haven’t learnt. Then add the thought that if you fail, there are no re-sits. No do overs. If it goes wrong, that’s it. And it won’t be you who’ll suffer. It will be the trusting soul in front of you. Oh, and even if you do everything perfectly, you could still fail. And there’s nothing you can do about it.
“Then triple it all, because you know all this, and you are constantly second guessing everything you do. That probably comes close to it.”
I often then get asked,
“But why do you volunteer to do it then?”
“Because, when the fear is gone, and adrenaline wears off, and it hits you that what you’ve done has made someone better, or even just made them more comfortable, or hang on for just a little longer, that feeling easily outweighs anything bad that the world can throw at you. And you’ve done it, despite all that fear, and worry, and stress.”
Of cause, those incidents aren’t the worst. The worst are the ones were you don’t have time to think about what’s going on or how scared you are. The ones were you switch off the soft human bit and just work. And then, when it’s all done, it all hits you, and with the few times I’ve had it happen, it hits hard. Those are the ones that are scary.
It has occurred to me that on several occasions now I have responded to emergency 999 calls and dealt with the situation reasonably comfortably. It has also occurred to me that members of The Organisation routinely respond to such jobs, and handle them successfully until the statutory services arrive (if they’re even sent for).
We are, every one of us, volunteers. We don’t get paid. Very few of us are health-care professionals of any kind. While I have every respect for all the ‘real’ ambulance crews out there, I can’t help but to feel proud of this. Proud of what we as an Organisation are capable of, and what I as an individual have done. We’ve come a long way from summer fates and street parties (not that these aren’t just as important).
I can’t wait until my ambulance training starts, in about a month or so.
Well, actually this was on a river, but give me some license.
I’m sitting in the First Aid Unit with NavyMan1, a couple of colleagues from my old Unit, a youth member and supervising adult from somewhere else in the county, and a local ambulance officer.
We’re all chatting about something or other, when the ambulance officer disappears to talk on his radio. He’s back in a minute and has a quick chat with my boss, who says:
“We have a job. DIB2 at ThisBar.”
My colleagues jump up, grab a kit and head off.
A minute later: “Another job. DIB again, at ThatBar.” ThatBar is just down the road from ThisBar, so they could be a duplicate call (in fact, it was), but you never know. NavyMan and I stand up, grab our gear (him a response bag, me an O2 set) and move out.
We move just that bit faster through the crowd than the first team, NavyMan forcing a way through with me following closely behind, and catch them up just as they reach ThisBar. With nobody standing outside to meet them, they head in to the building. NavyMan and I carry on to ThatBar. Here, we find someone lounging on a table outside, who points us away from the bar, to the pontoon to our right. “They’re down there.” We turn around to see someone standing on the pontoon waving at us.
This is the point where I curse people who don’t give accurate information to call-takers. Heading back the way I’d just come, it’s my turn to force a route through the heaving throng. Few people argue with (or even notice…) a man in a hi-viz when they politely barge past (the Hi-Viz Effect for once working in my favour).
When we finally reach the patient, it’s blindingly obvious that she isn’t very well. Breathing rapidly, and clutching her chest, I ask her where the pain is. She replies that it is in her chest, jaw and arm. Oh, and the one in her chest is a crushing pain.
Without asking, NavyMan hands me the aspirin3, and a silently agree. She is displaying all the classic symptoms of a heart attack. While I instruct my patient to chew the tablet (much to her disgust4), he has a look around. There is no way we’re going to get a trolley cot down here, and a pontoon is hardly a safe place to use a carry chair. The next thing I hear is him making a priority call to Control on his radio, asking for an urgent ambulance and the boat to get her to it.
Satisfied that everything is going as well as is possible, I break out the oxygen. She suffers from COPD, so an oxygen mask is nothing new, and after a little fiddling with elastic, I have her comfortable. She starts feeling better straight away, which is gratifying, but she’s still not well by any measure.
Finally, after much to-ing and fro-ing between the sea of Hi-Viz that responded to my partner’s radio call and the harbour master, we finally get my patient on her way to the ambulance. I’m not insured to travel on the rigid-inflatable, so that’s the end of the job for me and NavyMan.
Or so I thought.
I barely get three steps from the scene before I get LittlePara (the Organisation Incident Officer of the day) debriefing me. I reel off my account of what happened, from beginning to end, and try to suppress the feeling of being second-guessed.
We finally we get back to the First Aid Unit only twenty minutes after having left. I sat down just in time, as the adrenaline chose that moment to wear off. For the next hour my hands, and my legs, wouldn’t stop shaking.
On the way home with LittlePara, I was pleased to hear that this patient was doing well in hospital. It turned out that, instead of a heart attack, the problem was an acute exacerbation of her COPD. However, LittlePara said that under the circumstances, he would have done exactly the same (had he not had his advanced paramedic skills), which made me feel better after the cross-examination early.
1 – A fellow student First Aider from another county. Who happens to be stunningly good-looking, really friendly… and straight… I sure know how to pick ’em…
2 – Oh how easily we all fall in to Death by Acronym…
3 – Standard treatment for a Heart Attack. It helps prevent the clots that cause them.
4 – Aspirin tastes disgusting, but chewing it gets it in to the bloodstream faster than swallowing it whole.
A quick request to any bystanders who call 999, 911, or 112 or whatever while they’re out and about:
If you are not with the patient, please tell the call-taker precisely where the patient is.
When I’m off hunting for someone who is having difficulty breathing (more on this patient in another post) on a boat, telling them that the patient is by the bar you happen to be in doesn’t help. Not when there’s a tall fence and a stretch of water between them and me, and I have to double back to get down to them.
It doesn’t sound like much, and fortunately in this case it wasn’t a drastic problem, but getting to a patient half a minute sooner can make all the difference.
Oh, and it would have prevented two teams being dispatched to the same incident, each having a different bar as the patient’s location…
This has been a public service announcement from the Walking Plaster Dispenser.