999--My Life on the Frontline of the Ambulance Service

by Dan Farnworth

  But I’d be lying if I said ambulance people don’t relish the different and the dramatic, because it challenges us to think outside the box and tests our training to its limits. There is something thrilling about doing a job that can chuck something new at you at any moment. I might spend eight hours on a shift dealing with coughs and colds, and then suddenly something comes in which has me sitting bolt upright in the ambulance thinking, I really need to have my wits about me for this next one. A child might have had an anaphylaxis – which is a severe allergic reaction – and will require the administration of a bucketload of drugs. Or someone might have jumped off the third floor of a multistorey car park and suffered traumatic injuries. At times like those, we need to be on our game.

  ______

  It was Christmas Day, although I can’t remember which year. It all tends to merge into one.

  A call comes on our screen: ELDERLY LADY STOPPED BREATHING. I put my foot down and we’re at the scene before you can say ‘may your days be merry and bright’. All the family are round for turkey dinner, wearing Christmas jumpers and paper hats. I ask where the patient is and her son leads us into a bedroom. As soon as I see her, flat on her back on the floor, I know she’s dead. It’s rare for anyone to go into cardiac arrest out of hospital and survive. We administer CPR, give drugs and intubate, to no avail. Normally if someone dies at home, we leave them for a private ambulance to come and take them to a place of rest, but it doesn’t feel right leaving that lady on the floor on Christmas Day. So we put her on a stretcher, place her in the back of the ambulance and take her to hospital. One job down, how many more to go?

  Next up, a childbirth. One out, one in, like some cosmic nightclub. When me and my partner arrive, a lady is sat on her living room floor, next to her partner. The baby’s head is already on its way out. ‘Hello,’ I say, ‘my name’s Dan.’ I don’t need to ask her what the problem is.

  I’m not a big fan of childbirth jobs. For starters, it’s just quite an awkward, invasive situation. It’s the first time you’ve ever met and she’s lying on the floor with her legs akimbo. It’s also not nice seeing someone in so much pain. The smell is sickly sweet and, when you’re crouched at the business end, it’s certainly not a sight for the squeamish. Not only that, an ambulance person can go months or even years without delivering a baby, which means we can get rusty. It’s not as if we can practise, like footballers practise penalties or golfers practise bunker shots. People say that delivering a baby is like riding a bike, but it isn’t. We forget things. But we can’t use that as an excuse for not delivering a baby safely.

  Childbirths are unpredictable, which makes them stressful. There are a million and one things to do, and they all need doing now. But we still need to do them in a measured, methodical way. An ambulance person is not really in control of a childbirth, the mother is. We’re just a coach, telling her to breathe and push at the right times. And when the deed is done, there are suddenly two patients: a mother who might be bleeding heavily and a baby who is at risk of all sorts of complications. All of the above is why we have midwives. Unfortunately, midwives don’t have blue lights and sirens.

  The key to keeping a patient calm, regardless of how uncertain we are about a situation, is appearing calm ourselves. If we can appear calm on the surface, however frantically we’re paddling underneath, we’ll be able to keep control of things. With this in mind, never play an ambulance person at poker.

  Another reason you’ll also hardly ever see an ambulance crew running into a house is that treating a patient, especially administering CPR or delivering a baby, can be bloody hard work. There’s no point huffing and puffing all over a patient when you’re supposed to be there to help them. So we usually go in slow and weigh up the scene, which can sometimes look like we’re dragging our feet. We do get people shouting at us, ‘Come on mate! Get a shift on!’ But we’re just making sure we’re on top of the situation. Or at least appear to be.

  I’m trying to talk this lady through what to do when it dawns on me that neither she nor her partner speak English. So I have to act it out instead. I usually don’t mind a game of Christmas Day charades, but this is on a different level. I spend about an hour demonstrating heavy breathing and making squeezing faces. It must look like I’m doing my best impression of a turkey, but it seems to be working, so I carry on.

  When the baby finally decides it wants to make its entrance, the umbilical cord is wrapped around its neck. We’re taught to flick the cord over a baby’s head, but I’m not able to. I’m fumbling and starting to panic, but can’t let the mum see that. Eventually I manage to get my fingers underneath, reduce the strain and, as a result of one last push, out pops the baby into my arms, like the proverbial bar of soap. Then, silence, which seems to go on for ever.

  When you’re in hospital and you think there might be something wrong with a baby, you pull a cord and before you know it, every man, woman and their dogs are in the room. But ambulance workers don’t have a magic cord. Mercifully, the baby starts crying eventually. I get Dad to cut the cord, dry the baby, wrap him up and pass him to Mum. Mission accomplished.

  When a woman has a baby, you can see the change in them immediately. When they look into that baby’s eyes for the first time, they forget about everything they’ve just been through. And so do we. It’s just so wonderful to see that instant love and utter devotion. How many people can say when they get home from work, ‘I delivered a baby today and brought joy to people’s lives’?

  I sometimes wonder where that baby is now. I hope he’s happy we brought him into the world. But there’s no time to stand, stare and wonder when we’re wading knee-deep through a twelve-hour shift. There’s not even time to return to the station for a brew – those days are gone. The calls are stacked up waiting for us, so that we’re almost always on the road, ready to respond. We dispose of our gloves, clean ourselves up and breathe. Two jobs down, on to the next one.

  Next up is a 97-year-old lady in a care home who has suffered a stroke. I deal with a lot of strokes. If a patient is treated within four hours of the stroke taking place, the hospital can administer a drug that will hopefully burst the blockage, stop tissue wastage in the brain and restore movement in limbs. If a patient has to wait more than four hours for said treatment, a different treatment will be administered that is less effective. Time is of the essence.

  I stagger through the door of the care home with every last bit of kit and caboodle – the day you try to predict what you’ll need is the day you leave that all-important piece of equipment in the back of the ambulance. A carer shows us upstairs (people always seem to get ill upstairs) and when we’re introduced to the patient, we’re relieved to discover that she still has all her faculties. She’s lost movement down one side, which is a sure sign of a stroke, but she knows what’s going on. The whole time we’re assessing her, we’re also speaking to her, explaining what we’re doing and why we’re doing it, to put her at ease. But when we suggest we take her to hospital, she’s adamant she doesn’t want to go. The mere mention of hospital has turned her to jelly. She’s probably thinking, If they take me there, I might never come out again.

  I completely understand, because that’s exactly what can happen. But this lady is within the four-hour treatment window and we want to give her the best possible chance of recovering, so, as far as we’re concerned, it’s all systems go. If she stays at home, she could die of her symptoms. But if someone doesn’t want to go to hospital, we can’t take them. We can’t force healthcare on people, drag them kicking and screaming into the back of an ambulance (unless a patient doesn’t have the mental capacity to make their own decisions, and even then you have to prove it’s in their best interests, which makes it a minefield).

  Being an ambulance person isn’t just tearing about at 100mph, a lot of the time it’s about patience and taking the time to explain the benefits of our actions. I spend ten or fifteen minutes addressing the lady’s fears, explaining why we should take her in and what
they might be able to do to help, and eventually she agrees.

  In the back of the ambulance, I can tell she’s still anxious. So I decide we need a few tunes. I carry a Bluetooth transmitter that plays music from my phone over the ambulance radio. If we’ve got kids on board, I might stick on a bit of Peppa Pig. If it’s a teenager, I might stick on some hip-hop. If it’s an adult, I might stick on some panpipes or whale sounds. Anything that might help to calm them down. In this case, I find some Second World War-era songs on Spotify, press play and the lady goes from being scared out of her wits to singing along to ‘We’ll Meet Again’. I join in and we end up having the time of our lives. I can’t help wondering what she’s thinking about while we’re singing along to Vera Lynn. Her husband? Old friends long gone? Whatever it is, to turn this horrible experience into a positive one is quite overwhelming.

  I love hearing old people’s stories from way back when, so I ask the lady what she did during the war. She tells me she worked in a munitions factory, about an explosion that killed a lot of people and how proud she was that she’d played her part. I want to help anyone who ends up in the back of my ambulance, but when it’s someone who has given so much, you desperately want to make their experience as comfortable as possible and repay them with your time. Otherwise it can feel like they’re part of a factory process, placed on a conveyor belt, quickly checked over, before being rushed back out again.

  A few days later, I hear that the lady passed away in hospital, which was her worst fear. But at least I made the end of her journey more bearable, simply by showing how much I cared. That was the best Christmas present I could have given anyone.

  As for my presents, I unwrap them while my kids are in bed. I kiss them goodnight, taking care not to wake them, make a turkey sandwich and have a couple of bottles of beer with my wife on the settee. That Christmas Day, I witnessed the start of one life and the end of two others. And whatever the outcome, I tried my very best. It sounds like something worth reflecting on. But reflecting is not something ambulance people do much of. We have private lives to lead, loved ones to look after and Christmas telly to watch.

  2

  THE HARDEST JOB

  I was eighteen years old and thought I knew everything. And then I got a girl pregnant. We weren’t really planning a family at that age, so it was kind of unexpected. When I told my mum, I was wearing the same Diadora T-shirt I’d had since I was about thirteen. Mum wasn’t exactly over the moon. But she soon calmed down and vowed that we’d bring up the baby between us. Dad is a man of few words. He had even less than usual to say about this particular matter.

  My daughter Maddison was a beautiful little thing, an absolute cracker. The one big problem was that me and her mother were just a couple of immature teenagers who didn’t get on particularly well. But I thought that I should at least give it a go. I didn’t want to be an absent parent and not be part of it, so I thought that maybe we’d spend the first year together, watching our daughter grow up. Then, about eleven months after Maddison was born, my girlfriend became pregnant again. Telling my mum was pretty much the same as the first time, except this time she was even more upset.

  A few months later, my girlfriend went for her first scan. The nurse said, ‘Right, I can see the baby there.’ Before adding, ‘Oh, I’ll just need to grab a doctor . . .’ I was standing there thinking, What the hell is wrong? The doctor came in, took one look at the scan and said, ‘Congratulations, it’s twins.’ I went home and said to Mum, ‘You know I said she was pregnant again? Well, she still is. But this time there’s two of them . . .’

  Twenty-seven weeks into the pregnancy, my girlfriend’s waters broke and she went into labour. The twins – Rhianna and Courtney – were born thirteen weeks early and transferred straight to intensive care. They looked like little aliens, but they were our little aliens, and we immediately loved them immensely. One of them had a collapsed lung; both of them were on ventilators. The doctor told us they were probably going to die. Never mind how old I was, this type of news would have ripped the heart out of anyone.

  I couldn’t live at the hospital, or even in my car, because we had another baby to look after. I stayed off work for a bit, but there’s only so much leeway your bosses can give you. So after about a month, I had to go back in. I can’t blame them. They didn’t tell me to have a kid, let alone three in eighteen months.

  I was already working for the ambulance service, and had been since two days after my eighteenth birthday, which made me their youngest ever employee. As such, you might think joining the ambulance service was a burning ambition, almost an inevitability. But I stumbled into it.

  ______

  School wasn’t really for me. Even at primary school, I struggled to fit in. I remember on a school trip to France, everyone writing down who they wanted to share a room with. The teacher reached the bottom of the list and I was the odd one out. I had a lot of pent-up frustration and would stand my ground. If anyone said anything I didn’t like, chances are I’d lump them.

  One of my fellow pupil’s dads, who was a policeman, took a particular dislike to me. He thought it necessary to visit the headteacher and tell him that, in his professional opinion, I was a bad person, destined to end up in prison and shouldn’t be in the school. It’s possible I’d punched his son. Mum and Dad were devastated. A copper deciding your son is a wrong ’un carries a lot of weight.

  Eventually, I was referred to an educational psychologist and diagnosed with dyslexia. And once that diagnosis was made, the frustration died down. I was given support, which changed everything. Once I understood that there was nothing wrong with me, I started to thrive.

  But secondary school wasn’t much better. I didn’t fit the template of a model student. I struggled to deal with people dictating to me the way things were supposed to be. There were certain things I wasn’t willing to accept, so I was always asking why. For example, I hated inequality. From an early age, I thought everybody should be treated the same, regardless of who or how old they were. I didn’t understand why we’d all be lining up outside in the rain while the teacher was inside drinking a cup of tea, looking at us through the window. I didn’t understand why we weren’t allowed to take our blazers off when it was 100 degrees in the classroom. I didn’t have an authority problem, I just didn’t like being treated differently from adults. A teacher said to me once, ‘Stop acting like a child!’ I replied, ‘Stop treating me like one!’ And he replied, ‘You’ll never be anything in your life if you don’t buck up!’ I spent the rest of that lesson in the corridor.

  So I muddled through school, before leaving with three GCSEs at C or above. I wasn’t thick, I just didn’t want to be there and couldn’t wait to escape. There must be so many kids like me.

  My uncle had a plumbing firm, so I started an apprenticeship with him. Summer was great, autumn less so. Then it got to February. I was carrying some lead up a ladder, dropped it on my toe and thought, You know what? Sod this. After that day, I never went back. I was already working weekends at a garden centre to bump up my wages and now I started working there full-time. I did a bit of sweeping and hoovering, restocking shelves, helping elderly ladies load compost into their car boots. It was wonderful, completely stress-free. And zipping around on the forklift made me feel like a man of the world. The whole way through secondary school, I’d wanted to be an adult. And now I was. At least I felt like one. Now I’m actually an adult, I want to be a kid again.

  My next job was working for a travel agency, selling holidays over the phone. I was trained by some lovely people, including a guy called Russell, who was an absolute legend and tragically died of an asthma attack some years later. It was also where I met Neil, who’s still my best mate. I had a whale of a time, but it was commission based, and I wasn’t always available on the phone. I was busy doing other things, like chasing girls in the café and enjoying the usual distractions of a teenage boy.

  I stayed at the travel agency for a year or so, before seeing an advert
in the newspaper for an emergency medical dispatcher (EMD), answering 999 calls and dispatching ambulances. I had a bit of telesales experience, quite fancied a job in the services (my parents both worked for the prison service – my mum in HR and my dad taking prisoners out to do community work), so I applied.

  Having the opportunity to do something exciting and make a difference appealed to me. This wasn’t a case of selling a service to the public; this was a case of the public desperately wanting a service from me. And the pay wasn’t based on commission.

  Up until this point, though, I hadn’t had much to do with the ambulance service, or even the NHS. But when I was working at the garden centre, a sign fell over and hit a lady on the head. What I remember most about that day is that while I was flapping, the person who answered my 999 call was so incredibly calm. That left a lasting impression on me.

  I was only seventeen when I went for the interview, so didn’t hold high hopes. But the guy who interviewed me recognised my desire and passion and offered me the job. They sent me on a four-week course, where I learned how to answer the calls – ‘Pick up the phone. Press that button. Stay calm. Ask these questions, based on the patient’s condition. Stay on the line and offer the relevant advice until the ambulance arrives. Put the phone down. And repeat’ – and that was pretty much it.

  Well, that’s not quite true. EMDs are at the lower end of the ambulance service pay scale, and among its least appreciated employees. When you think of the ambulance service, you don’t think of someone sat behind a desk, you think of paramedics bursting through a door, dripping with medical paraphernalia. But being an EMD was the hardest, most stressful job I’ve ever done. Whereas on the road I might do ten jobs a day, on the phones I might do fifteen jobs in half an hour. And you’ve got to be achieving. Everything you say can be listened to and a certain percentage of calls are audited, which is why I was a little bit worried the time my tapes got seized by the police for evidence, as they might have heard me ordering prawn crackers, crispy shredded beef, chicken kung po and egg fried rice on the previous call. Well, it was Chinese night. I just hope it never made it to court.