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

by Dan Farnworth

  I should make clear that I don’t describe jobs in such graphic detail for reasons of gratuitousness or vicarious voyeurism, but to impress upon the reader the stark realities of an ambulance person’s existence. Because if the reader doesn’t understand the stark realities of an ambulance person’s existence, they will never begin to understand what happened to me.

  Before I started working out on the road as a technician, I received nothing at all in terms of psychological training. No old sweats came in and described what they’d seen and what we should expect. Nobody took us to the morgue to view dead bodies. Nobody told us that we’d probably see decapitated bodies at traffic accidents, people swinging from ropes in lofts, dead babies and screaming relatives. And I didn’t ask. It’s not as if I didn’t want to get a reputation as someone who asks difficult questions – or, in other words, a trouble-maker – I didn’t even think it was odd. And had I asked, ‘What are the possible mental effects of what I’m about to do?’ I’m pretty sure someone would have said, ‘What you on about, son? Just watch and learn.’

  After seeing my first dead body on the job, my colleague said to me, ‘Are you okay? Because you’ll see this a lot.’ What if I wasn’t? Tough, get on with it. Those in charge would no doubt argue that nothing can prepare an ambulance person for the things they’ll see. As I’ve already illustrated, in some ways they’re right. But I think more of an effort needs to be made.

  Every ambulance person has their kryptonite, and mine is bones sticking out of bodies. I see a fair few bones pointing where they shouldn’t be on football and rugby pitches on Saturday and Sunday mornings. I went to a rugby match once and this bloke’s shin bone was sticking out at a right angle, piercing the skin. Its brilliant whiteness amazed me. But once I’d stopped appreciating its strange beauty, all I could think was, Oh. My. God. What the hell are we gonna do here?

  First thing, pain relief – although we were never going to be able to relieve the pain completely. We wrapped a vacuum splint around the joint, placed the patient on the trolley, made sure he was as comfortable as possible and ferried him to hospital, where hopefully the surgeons put him on the road to recovery.

  Another time, I went to a little girl who had been hit by a car after getting off the school bus and running into the road. She told me her leg hurt, but I couldn’t work out what the problem was. I didn’t want to be cutting her clothes off in the middle of the street, so I said to her, ‘You know what I’ll do? I’ll carry you to the ambulance so that we can get away from all these people watching.’ When I picked the girl up, I looked down and saw that her thigh was snapped in two and hanging limp. When I lifted it back up, she started screaming, which made me think that I shouldn’t have moved her. In the ambulance game we call that ‘continuing professional development’, which means learning from mistakes.

  I also attended a guy who had slipped over getting out of the shower. His leg was broken so badly and at such a strange angle that we couldn’t get him down the stairs without banging it against the bannisters. You become good at problem-solving in the ambulance service, what with all the moving and handling we do. But this poor chap was more precious than an odd-shaped piece of furniture. So we had no choice but to call the fire service, who removed an upstairs window and brought him down in a cherry picker.

  Another time, we were sent to an 18-year-old lad who was described as generally unwell, vomiting and suffering with a high temperature. On the way there, I thought it would be another patient with a bit of man flu. But when we turned up, this lad was yellow, so that he looked like one of the Simpsons, and clearly had some organ failure going on. We got him into the ambulance, gave him some fluids through a drip and raced him off to the hospital. The doctors diagnosed something called leptospirosis (or Weil’s disease), which is an infection spread in the urine of animals. This lad had been working in a pub cellar changing barrels and presumably caught the infection from rat wee. He nearly died, just from biting his nails, and was in intensive care for a month. And his poor mum and dad had been telling him to sleep it off. They weren’t to know what was wrong with him, and it’s not something ambulance people are trained to spot either. The lad made a full recovery, but it was a close shave.

  And it’s not just the dramatic stuff that can make a dent in an ambulance person’s armour. The seemingly humdrum can drip, drip, drip and act like water wearing down a stone. If the public knew about everything that happened out there, they’d be horrified. If journalists reported everything that happened in a 24-hour period, the local paper would be like a copy of the Yellow Pages. So many of the patients I’ve treated were just going about their daily lives and – BOOM – everything changed in an instant. A bit of water on a bathroom floor, some spilt soup in a kitchen, a slight lapse of concentration while driving, and suddenly I’m looking down on them or peering at them through a mangled car door. And, at that moment, I’m the only face they want to see. My job gives me a very acute appreciation of the fragility of life. Including mine.

  In the ambulance service, one small slip can cause months of almost unbearable stress. Needle-stick or sharps injuries are the bane of anyone who works in healthcare. If you accidentally prick yourself with a needle when treating a patient, you can be at risk of HIV, hepatitis B and C and all sorts of other nasty stuff. Needle-stick injuries are often the result of carelessness but can also happen if a patient is being a bit combative or thrashing about. If you do suffer a needle-stick injury, occupational health will put you on hardcore anti-viral medication called PEP (post-exposure prophylaxis), which can have severe side-effects, including diarrhoea, headaches, nausea, vomiting and fatigue. But worse than that is the months of waiting to be given the all-clear.

  I’ve never suffered a needle-stick injury (touch wood), but I was once doing CPR on a guy in cardiac arrest, went to open his airwave and he spewed blood all over my face. Occupational health asked if I washed my face straightaway, to which I replied I didn’t, because I was busy trying to save this guy’s life. He was ninety years old, so occupational health classed him as low risk (high risk patients are usually drug users). My problem was that the patient died, so they couldn’t get his permission to take a blood sample. They didn’t put me on PEP, but I had to go on a six-month watch list, which involved regular blood tests. I wasn’t overly stressed, and I was eventually given the all-clear, but it gave me an insight into how horrible it must be for those colleagues who have suffered a needle-stick injury while treating someone with HIV or hepatitis C.

  On any given day, I might fail to resuscitate an elderly man who’s had a cardiac arrest, successfully treat a fitting child and tell someone that their mum has died. I couldn’t tell you how many people I’ve seen dead on a toilet. It wasn’t just Elvis Presley who breathed his last on the throne. It’s so common, we call it the ‘death poo’. We went to one woman in a care home who died mid-evacuation. At least I think she did, I didn’t check. The family were on their way, so me and my partner grabbed an arm and a leg each, lugged the woman over to the bed, put her under the bedclothes and tucked her in, so that when her family arrived, she looked nice and peaceful. We also tidied the room up, swept the floor and straightened her hair. I’ve picked up so many tips like this during my years on the job, little things that make a horrible situation a little more tolerable. Obviously, we had to tell her family that she’d passed away in the toilet, but they didn’t need to see that.

  However, while it’s part of our job to make a loved one’s death easier to deal with, we don’t get to choose what we do and don’t see.

  I once turned up to someone who had died in front of a fire. Imagine a slow-cooked piece of pork and you’re in the right area. I went to another lady who had been dead for over a week. When we tried to roll her over, half her face remained stuck to the carpet. I’ve crept through a graveyard in the middle of the night, trying to find someone who was suicidal. He’d sat down next to his mum’s grave, popped a load of pills and called us. Unfortunately, we didn’t
know where his mum’s plot was. While we were looking, plastic windmills on gravestones whistled in the wind. I don’t know what was spookier, the sound of those windmills or the uncontrollable sobbing of the patient, somewhere in the darkness. I’ve driven an ambulance around a park for half an hour, trying to locate a patient with chest pains. When we finally found our man, slumped on a bench, I jumped on top of him and gave him CPR, only for him to die on me.

  People often think heart attacks and cardiac arrests are the same, but they’re not. Symptoms of a heart attack (otherwise known as a myocardial infarction, or MI) include tightness or aching in the chest, which might spread to the neck, jaw or back; nausea, indigestion, heartburn or abdominal pain; shortness of breath; cold sweats; fatigue and dizziness. But someone can have a heart attack and not even know it. And these days, if you’re having a heart attack and it’s dealt with in good time, the survival rate is quite high. When we turn up, we’ll do an ECG and if the patient is having a heart attack, we take them into a specialist heart centre. After the surgeons have done a PPCI (primary percutaneous coronary intervention, or angioplasty, which is a procedure used to treat the narrowed coronary arteries of the heart), the patient might be back home in a couple of days.

  A cardiac arrest is when a patient’s heart suddenly stops pumping blood around the body, which means their brain gets starved of oxygen. As a result, there are no symptoms. And once someone has had a cardiac arrest, there is only about a 10 per cent chance of survival. That surprises a lot of people, probably because they’ve watched a lot of medical dramas on TV, in which people are regularly brought back from the brink with CPR. At the same time, most of the people I’ve managed to save were the beneficiaries of good quality CPR before we arrived on the scene.

  One time, we were called to a guy who had collapsed on a treadmill in a gym. The gym staff did their bit before we turned up and gave him a whack of the old defib. By the time we arrived at A&E, he was sat up talking. But that was one of the few occasions I’ve seen someone survive a cardiac arrest outside of hospital. There have been other times I’ve turned up to a patient who has already received CPR and seems right as rain. Of course, they might not have had a cardiac arrest in the first place, although that’s just me being cynical.

  Teaching CPR is easy enough and if everyone knew how to do it, it would save lives. We saw that recently, when the former footballer and England manager Glenn Hoddle had a cardiac arrest in a studio and a sound engineer who knew CPR kept him alive until an ambulance arrived. They’re talking about teaching it in schools, which would be the right thing to do. It would take ten minutes during morning assembly. That said, while it’s easy enough to teach how to spot when someone has had a cardiac arrest – usually it’s a case of bang, they’re suddenly on the floor – and administering it is pretty simple (no mouth to mouth any more, just hard and fast pressing on the centre of the chest, like Vinnie Jones says on the advert), you’re only supposed to administer CPR when someone’s not breathing or their heart’s not beating. And teaching people how to feel for a pulse is more difficult.

  Even we get confused sometimes. I turned up at one job in a working men’s club to find a motorcycle paramedic already on the scene. This lad was doing CPR and every time he pounded on the patient’s chest, his arms started rising up, as if he was trying to push the paramedic off. I didn’t know the paramedic very well, but I knew this wasn’t supposed to happen. So I said to him, ‘Mate, what are you doing?’ And he replied, ‘I’ve got no idea what’s going on here, but as soon as I stop, his heart stops as well.’ So I let him get on with it. I looked it up afterwards and discovered it’s called CPR induced consciousness. The CPR the guy was administering was so good, every time he pounded on the patient’s chest, it was getting the circulation to his head.

  Very occasionally, a member of the public knows too much. Or thinks they do. I turned up at one job to find a woman performing CPR on a patient. When we asked her to step aside, she replied, ‘It’s okay, I’m a veterinary nurse.’ What did she expect us to say? ‘Oh, I didn’t realise. We’ll leave it with you . . .’ To be fair, she probably knew what she was doing, because most mammals are similar once you cut them open. But can you imagine if a dog keeled over, I happened to be on the scene and a veterinary nurse turned up? ‘As you were, these poodles aren’t much different to humans . . .’

  I’ve given patients CPR while a husband has stood over me shouting: ‘Why are you still here? Why haven’t you taken her to hospital? Help her!’ It’s part of my job to explain that I’m doing what I’m doing to give their loved one the best chance of survival, because it’s so difficult to administer good CPR in a moving ambulance (although new CPR machines are being rolled out across the country, which allow us to get on with the other jobs we need to do during a resuscitation attempt).

  People respond to trauma in lots of different ways. I can tell one person they’re having a heart attack (which is a strange thing to have to tell someone, and a big responsibility) and they’ll be completely unfazed: ‘Oh, okay. So what now?’ I told one guy he was probably having a heart attack and he replied, ‘Erm, the problem is, it’s my wedding day. I’m supposed to be getting married in three hours . . .’ Obviously, we still had to take him into hospital and I can only assume his big day was cancelled. I hope his bride-to-be understood. I’m sure some people suspect they’ve had a heart attack and don’t even report it, because they’re afraid of hospitals or simply too busy.

  Another person will be terrified (as I would be) and shaking like a leaf. So it’s my job to try to keep a lid on things. We don’t just burst into someone’s living room, do our assessments, suddenly announce the patient is having a heart attack and bundle them into the ambulance. The last thing you want when someone is having a heart attack is to get their heart racing. Instead, we’ll say something like, ‘The ECG suggests you’re having a heart attack. The good news is, the medical world has come a long way. We’ll take you direct to a specialist healthcare facility, where they’ll hopefully be able to rectify the problem.’ We don’t hang about, but we calmly explain what the hospital procedure will involve: ‘Don’t worry, it’s nothing major. They’ll go straight into a vein, normally one in your wrist or your leg, pop a couple of tubes in to keep the artery from becoming blocked again and hopefully you’ll be out in a couple of days.’ We can usually see the relief on the patient’s face. They realize they’re in kind hands and they’re going to get the best treatment possible.

  There’s no real good way of delivering bad news, but there are better ways than others. Ambulance people can’t administer sedative drugs, so we use words as sedatives instead. As Frank Carson used to say, it’s the way you tell ’em.

  13

  RIGHT PLACE, RIGHT TIME

  I might think I’m on my way to a routine job and then something else comes up that we need to attend instead. I suppose it’s being in the right place at the right time. Once, I was driving to the hospital when I saw a little girl of about three pushing a toy pram down the street. My first reaction was, ‘Aah, look at that little girl with the pram.’ But then I realised she had no shoes on and there were no adults with her. I pulled over, asked her where her mummy and daddy were, where she lived and where she was going. She didn’t know the answer to any of my questions. We didn’t know what to do with her, so we called the police. They had a report of a missing child and managed to reunite the girl with her parents at the hospital. I assume social services had a look at that one, because if we hadn’t driven past, anything could have happened to her.

  Two colleagues of mine were once flagged down by a woman in the process of giving birth in her car. She’d driven to hospital and the baby had started emerging while she was in the car park of the maternity department. That’s a tough enough job as it is, but try doing it when the mum is sat in the driver’s seat of a Fiat Panda. Personally, I would have run and got a midwife, but these two lads got stuck in and delivered the baby with no hitches. I’ve also heard s
tories about babies being delivered in lay-bys, a post office, the car park of a Chinese restaurant and on the pavement outside Primark.

  Sometimes, though, something comes out of the blue and takes the wind out of me. We’re halfway through a shift and on our way to a headache. To be fair, there are such things as thunderclap headaches, which are apparently agonising. Or a headache might be a bleed on the brain and therefore life-threatening. But usually they’re just headaches. Trundling along the motorway, we pass a moped. Its exhaust falls off, gets caught on the wheel and the woman riding on the back somersaults through the air and lands on her face. The headache is on ice.

  Jobs on motorways are some of the hairiest we can do. Whenever I’m called to one, I always hope the police have arrived before us, so that they’ve already closed the road. Once, I beat them to a rollover and turned up to find a car upside down in the middle lane. People have their own business to attend to and only care about getting through before the motorway gets closed, so even after we’ve parked in the so-called fend-off position – diagonally across the road so that we block off two lanes – cars will try to squeeze past us. They might be on their way to see a dying relative. But probably not.

  On this occasion, cars pull over to let us through, we put the blue lights on, park up, put on our high-vis jackets and grab everything from the back (we’re not allowed to go back in case someone crashes into us). My mate jumps out of the ambulance while I call the control room to tell them we’re going to have to bin off the other job and ask them to send the police. Meanwhile, my mate is shouting at me to come quick. I can tell straightaway that this woman has done herself some serious mischief. She’s wearing one of those helmets that only covers the head and not the face, which is a bloody mess. Worse, she isn’t breathing. We immediately start CPR and all I can hear in the background is the rider of the moped, who I assume is her partner, shouting, ‘No! No! No!’