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

by Dan Farnworth

  ______

  To the layman, a technician looks no different to a paramedic. The key differences between a technician and a paramedic are that paramedics receive more training and can administer many more drugs, which are critical in life-threatening situations. But we’re both on the frontline together. Technician or paramedic, a lot of people still think of us as ambulance drivers. That’s fine with me – we do have to drive the ambulances – but it will upset some of the ambulance service’s more sensitive souls. Lots of people also call us first responders, but that’s because they watch too much American TV. First responder applies to anyone who is among the first to arrive at an emergency, whether they be a technician, a paramedic, a police officer or a firefighter. (That said, community first responders do exist in the UK, and are volunteers who are dispatched to attend emergencies, often in rural areas, when an ambulance might take longer to arrive.)

  When I got the job, I was thrilled. The pay rise was negligible, but I loved the idea of being able to physically help people, rather than blindly guide them over a phone. It takes about ten years to qualify as a GP. If you want to become an anaesthetist, it will take you about fourteen years. Training to be a technician lasts about four months, or at least did in my day. That might not sound very long, but it was very intense, and I had to graft my backside off to pass the course. During those four months, I learned anatomy and physiology; the basic workings of the human body; a manual’s worth of medical terminology; how to recognise a host of different illnesses as well as how to treat them; wound care; resuscitation and how to use defibrillators and an ambulance full of equipment; manual moving and handling; infection control and prevention; scene management. Oh, and delivering babies.

  Things I didn’t learn during training but which might have come in handy included: how to handle being spat at, called every name under the sun, hold a wee for hours at a time, survive hours without an official break and carry patients down spiral staircases. And that’s not even the half of it. Real-world incidents are rarely like training scenarios. Perhaps more than any other vocation, being a frontline ambulance clinician is a lifelong apprenticeship – almost every day we are presented with a familiar puzzle assembled in a slightly different way and we have to do what we can to solve it.

  The driving course was very full-on, as it should be, given that ambulance folk are allowed to drive with some disregard for the Road Traffic Act. But it was also an enormous amount of fun. We got to drive a skid car, which meant tear-arsing around a disused runway, and the course ended with a time trial. After four weeks, I felt like I could have tackled the Dakar Rally.

  When I turned up for my first shift, the paramedic said to me, ‘Tell you what, son, you get used to driving this ambulance today and I’ll do all the other bits. We’ll build it up from there.’ But when I jumped in the cab, I said, ‘Where’s the clutch?’ The paramedic chuckled and replied, ‘There’s no clutch, it’s automatic.’

  At no point during my training had I driven an automatic ambulance. At no point in my life had I driven any kind of automatic vehicle. I know what you’re thinking: the whole point of automatics is that they’re a piece of cake to drive. Basically, you rev and go. Unfortunately, where once was the clutch was now a pedal that turned the siren on and off. So every time I thought I was changing gear, the siren started blaring. Thankfully, I understand this slight oversight in our training package has now been reviewed and corrected.

  Having informed my partner that, in my hands, the ambulance would perform more like a clown’s car, he suggested we grab a brew and take it for a test drive around the station car park. But just as I was getting the hang of things, my first job appeared on the screen: a hot-air balloon had crashed into an electricity pylon and we needed to get there, pronto. My partner said to me, ‘You’re gonna have to drive with blue lights for this one. I’ll talk you through it.’ I was thinking, I didn’t see anything about hot-air balloon crashes in the text book. That said, I couldn’t wait to get there and see what was what. Would there be journalists and camera crews? Would it be on the news? This is what I’d envisaged before I’d signed up – helping to save lives at major incidents. I couldn’t help thinking of black and white footage from the First World War of burning zeppelins crashing to the ground.

  The whole way there, I kept pressing the clutch, which wasn’t a clutch but turned the siren on and off: press once and the siren came on, press twice and it played an even more hideous tune, press thrice and it turned off. By the time we arrived at the scene, I thought I’d mastered it. I parked up the ambulance with clammy hands, sweat trickling down my back. I mentally prepared myself for the carnage I might be about to see and ran through the various treatments I might have to administer. It was a case of cometh the hour, cometh the Dan.

  I jumped out of the ambulance and made for the back like a greyhound let loose from his trap. Just then a police officer wandered over and said, ‘It’s all right lads, you’re not needed. It came down with a bit of a bump, but nothing serious.’ I didn’t know if I was relieved, annoyed or frustrated. All the balloon passengers were fine and everyone was calm. That is, until I jumped back into the ambulance, stuck my foot on the ‘clutch’ and the siren started blaring.

  ‘What the hell are you doing that for?’ shouted the copper.

  ‘Because I don’t know what the hell I’m doing,’ I should have replied. But no one needs to hear an ambulance person say that. So I shrugged instead.

  ______

  Before joining the ambulance service, the only dead body I’d seen was my auntie. She fell down the stairs, was going to die, then wasn’t. My mum and dad had arranged to take me and my sister to visit her in intensive care, before getting a phone call to say, ‘Leave the kids at home, you need to come and say your goodbyes.’ That same day, my auntie passed away. She was thirty-six.

  A couple of days later, we visited the funeral home. Mum and Dad gave me and my sister the choice of whether we wanted to see our auntie or not, and I decided to take a look and say goodbye. She’d been cleaned up by the undertaker and given a bit of make-up, but when I looked at her, I froze. She was still someone I knew, but it wasn’t her any more. It was a bit late for goodbyes. To be honest, it creeped me out. I had nightmares for weeks.

  Seeing my first dead body on the job is etched on my mind. I’m in the station – back in the days when we spent time in the station – the radio starts crackling, and me and my partner, an experienced paramedic, calmly make our way to our ambulance and hop in. I say ‘calmly’, but my legs feel like fag ash. And when I see the job on the dispatch screen – MALE, CARDIAC ARREST – it feels like my head might explode. Before you do your first job of the day, you are required to log in using a pin number. I’ve forgotten mine. So there I am, fumbling through my diary, trying to find it. I desperately need the toilet. I believe this is what is technically known as ‘shitting oneself’.

  It’s a short drive to the job with blues and twos (lights flashing and sirens blaring). When we arrive on the scene, my partner jumps out of the ambulance and heads for the front door of the house, while I follow with all the equipment clanging against my hips and knees. The patient’s wife is waiting for us in the living room. She matter-of-factly informs us that her husband is upstairs in the bedroom, so my partner asks her to lead the way. As soon as my partner sees the lady’s husband, laid on the bed, he knows he’s already dead. I thought people died with their eyes shut, but this guy is staring straight at the ceiling. As gently as I can, I ask the lady to return downstairs so that we can assess her husband.

  My partner asks if I’ve seen a dead body before. I tell him I haven’t, apart from my auntie, and she was in a coffin. It doesn’t look like a person. It’s just the shell of someone who had been using that body and recently checked out. I’m wearing rubber gloves, but I’m scared to touch it. My partner, sensing my discomfort, calmly talks me through the symptoms of death, including how to check for rigor mortis. Before then, I thought rigor mortis
made a body shake. I must have seen a film or something in which a corpse was twitching. But rigor mortis just stiffens the joints, hence the phrase, ‘stiff as a board’.

  I’m stood there like a lemon thinking, What happens next?, when my partner does something that’s humbling: he closes the man’s eyes, to make it look like he’s doing nothing more dramatic than having a nice snooze. As he’s doing it, he chats to the body: ‘I’m just gonna shut your eyes, me old mate, to make you look a bit more peaceful . . .’ That little act of making the man look like he’s asleep instead of dead might save his family some anguish. Yes, he’s gone, but at least they can say he went in his sleep. My partner is treating this man with so much respect, almost like he’s still alive. To the extent that I’m thinking, Is he? I suppose that’s the point: dead or alive, he’s still a person.

  Back downstairs in the living room, my partner breaks the bad news to the dead man’s wife: ‘Unfortunately, your husband has passed away in his sleep. We don’t know what happened, but it was sudden and peaceful, and he wouldn’t have known anything about it.’ He’s just so caring and his actions teach me a valuable lesson that I will never forget: an ambulance person’s job isn’t just to treat the injured and sick, or deal sensitively with the dead, it is also to bring calm and dignity and counsel the bereaved. I learn more in those few minutes than in the whole of my four or five months of training.

  5

  AN ALARMING REGULARITY

  It’s impossible to mentally prepare yourself for what you might see as an ambulance worker. Some might argue that’s a good thing. If someone said to you, ‘In five hours, you’ll be sent to a five-year-old boy who’s not breathing,’ chances are that by the time you turned up, you’d be a nervous wreck.

  Ever since switching to the frontline, I’d been worried about how I might react to having to deal with a stabbing, given what had happened to me. But when the inevitable call came in, there was no time to be nervous or upset. The adrenalin was pumping, because I knew I’d have to be in tip-top form. But I also slipped straight into work mode, completely focused on the job in hand.

  A lad has been stabbed behind the bins at the bottom of some high-rise flats. When we arrive on the scene, he’s slumped over and full of holes, like a cheese grater. He must be about nineteen, the same age as me when I got attacked. But I don’t have the luxury of reflection, because this kid’s life is in our hands.

  A stabbing is one of the jobs where an ambulance person can make a big difference. The decisions we make in the first couple of minutes after arriving on the scene – about which wound to pack first, which drugs to administer and in what dosages – will potentially save the patient’s life. Or not. Although sometimes we can’t do anything to help – for example, if the aorta, the largest artery which runs straight down the middle of the body, is severed.

  My partner and I do everything we can. We can’t really diagnose the big stuff, such as whether his organs are damaged. The doctors and specialists at the hospital will discover the real extent of the trauma. What we need to do is stop this kid from bleeding out on to the floor and dying at the scene. We pack the wound with dressing, including haemostatic gauze, which coagulates the blood. We also administer a drug that helps stem the bleeding. Thankfully, it doesn’t appear that his lungs have been damaged, because that would mean sticking a needle in his chest and letting the air out, which is not a nice thing to do – especially on someone still conscious. The whole time we’re talking to him, telling him loudly and clearly to stick with us, because while all his other senses might have left him, he can still hear. After giving him some fluids, we put him in the ambulance and hot-foot it to hospital. It isn’t until afterwards that I think, Shit, that kid was me not so long ago. I can literally feel his pain. Thankfully, and also like me, he lives to fight another day.

  ______

  Gallows humour, however dark and seemingly callous or inappropriate, is as essential to an ambulance person as body armour is to a soldier or a shield is to a riot police officer. Gallows humour is one of the few coping strategies we have, and acts as a buffer between us and the reality of what we’re dealing with. So, for example, if we’re sent to a bloke who’s drunk and on the deck, we might refer to it as a ‘PFO’ – Pissed and Fallen Over. And if we’re sent to an elderly lady who’s taken a tumble, we might refer to it as a ‘Granny Down’.

  Now, before anyone starts penning a letter of complaint to my publisher, I should at this point say that I love grannies to bits. They’re always grateful to see us and once we’ve got them up and put them back in their chair (assuming they haven’t done themselves a mischief), we often stick around, make them a cup of tea and natter about old times. Although, I’m not going to lie to you, I don’t have the same affection for the PFO.

  The ambulance service isn’t like Inspector Morse or The Sweeney, where the characters work with the same partner all the time. That could never happen, simply because people work different shift patterns. But there are colleagues you pair up with more often than others. One of my regular partners was Paul, who ended up being a great pal in and out of work. We used to go for breakfast together and he’d tell me about his life, which was apparently quite turbulent. He always called me ‘brother’ in his text messages and we became close enough that I suppose you could call our relationship a bromance.

  Paul had a particularly wicked sense of humour. Before he joined the ambulance service, he worked as a lifeguard at a swimming pool. One day, he and his mate dressed up a CPR mannequin, tied a rope around its neck and hung it from the ceiling. Obviously, when their other colleague discovered it, he almost keeled over with fright. But when Paul and his mate heard the commotion and wandered in, they pretended they couldn’t see anything: ‘What are you on about? There’s nobody there . . .’ That’s what you call a dark sense of humour and probably why he fitted right in when he joined the ambulance service.

  Paul could be a bit of a nightmare to work with, mainly because I found him so funny. He could also get a bit giddy at times. One night, he was so keen to finish on time that he attempted a sharp turn and got the front of his ambulance stuck on someone’s front lawn. Eventually, the whole vehicle was on there, from where he’d tried to nudge it forwards and backwards. Paul was there for about two hours before the recovery man arrived to tow him out.

  Whoever I’m working with, I might start giggling at the most inappropriate times. We might be working on a patient, chatting about what went on at the works do and some piece of scandal will crease us up. Very occasionally, something inappropriate will slip out. One time, we turned up to a lady in a fortune-telling booth. While I was checking her over, I couldn’t resist saying, ‘If you can see into the future, why weren’t you already at the hospital when you started getting chest pains?’ I said it with a smile and she found it funny. But maybe I shouldn’t have said it at all.

  But, at least as far as I’m concerned, an ambulance person has to grab every bit of light relief they can, because those nice little chats with grannies are all too rare and those little pockets of humour are like pretty bubbles floating in the air – there one second, gone the next, replaced by a deafening clap of thunder. Laughter is the mind’s antiseptic cream and gallows humour is our coping mechanism, no different to soldiers trying to take their minds off the realities of their job with sick pranks and dark jokes.

  ______

  It’s a run-of-the-mill day. You know the drill by now. Me and my partner have just got an elderly lady back to her feet, brushed her off, called her neighbours and made them all a brew, when a shout comes up on our screen with a pub’s address. We turn on the hooters and tooters, head for the pub and the details appear: FEMALE COVERED IN BRUISES AND BLOOD. I’m with a paramedic I’ve never worked with before, but that doesn’t matter. Like soldiers in a crack unit, we mix and match, because we have an almost telepathic understanding and instinctively know what each other is capable of.

  We both know something is badly amiss before we arri
ve on the scene, simply from the job description. Anyone covered in bruises and blood is never a good thing. We pull up outside the pub, an ambulance car paramedic waves us in and we grab our gear and follow him upstairs. In a utility room off the corridor, a woman has been beaten to death. Sometimes, the job descriptions that appear on our screens are a little bit understated, and we can immediately tell she’s been dead for some time. But she still looks scared. She’d been found by her son, who was asleep in his bedroom when the murder took place. The family dog was in there with her. As we’re appraising the scene, the woman’s other son turns up with his girlfriend. I intercept them at the top of the stairs and lead them to the furthest room from the murder scene. As we all sit down on the sofa, I still haven’t worked out how I’m going to break the news to them.

  How are you supposed to tell someone something like that? I have no idea, because I haven’t been taught. Frontline ambulance staff still aren’t taught today. That’s remarkable, given that it’s the worst thing someone will ever hear. Not only that, but the way someone is dealt with in the first few hours after receiving terrible news can have a big impact on how they heal. Today, I take a lot of pride in having a caring manner, but I had to stumble across my own technique, having consciously and unconsciously picked up skills from more experienced colleagues. In this particular case, I take a deep breath and just go for it: ‘I’m really sorry, but unfortunately your mum has passed away. It would appear she was the victim of an assault.’ I think – I hope – I do okay.

  The son is obviously very upset but manages to hold it together. He tells us that his mum’s boyfriend had a habit of knocking her about and that it was no doubt him who killed her. As he’s telling us this, he picks up a cushion and places it on his knee. Underneath where it had been is a large blood stain. Thankfully, and inexplicably, neither the son or his girlfriend notice, and I’m able to discreetly cover the stain with another cushion. Presumably, the woman was murdered on the sofa before being dragged into the utility room. And it suddenly dawns on me that we’re sitting slap-bang in the middle of a crime scene and potentially destroying vital evidence.