Community first responders (CFRs) were never supposed to be direct replacements for ambulance workers. But when me and my colleagues first heard stories about ambulance services in other parts of the country exploring the possibility of using community first responders to drive 999 ambulances, there were conspiracy theorists who thought the time would soon come when they’d be delivering emergency treatment on the frontline, side by side with us. Thankfully, that never did happen.
CFRs are volunteers trained to provide first aid and immediate life support before a paramedic or technician can arrive on the scene. I know one CFR whose day job is testing fighter jets. As if that’s not stressful enough. They provide an invaluable service in rural areas, which might be half an hour from an ambulance station, and I’ve actually been out to a job where a CFR has saved a life. It was a cardiac arrest on a caravan park in the middle of nowhere and by the time we got there, the patient was sitting up. My immediate thought was, He can’t have had a cardiac arrest. But when we looked at the CFR’s defib, it showed it had delivered a shock. I should probably point out that this CFR happened to be in the caravan next door, but it demonstrated just how important quick defib and CPR are.
But CFRs shouldn’t exist to plug staffing gaps in ambulance services. It would be mad enough having them drive 999 ambulances – would you want a volunteer driving you to hospital in a blue-lit ambulance if you’d had a heart attack? – but the real fear is that they’ll eventually become de facto initial responders, especially in rural areas. If that happens, you can bet your life that they’ll be popping up in cities in no time.
In the past, ambulance crews would wait for 999 calls, and it’s still the public perception that they’ll dial 999 and an ambulance will come flying out of the station, like the Batmobile from the Batcave, and be on their doorstep in seconds. But we’re so extraordinarily busy nowadays that 999 calls wait for the ambulance most of the time, which means you might have to wait longer than you think.
When you phone an ambulance, your needs will be graded by a system that determines urgency, called triage. Response times are divided into categories. The first category means the job is immediately life threatening – for example, a cardiac arrest – and that we should be on the scene within eight minutes. The second category means the job is serious but not immediately life threatening – a stroke, chest pains – and that we should be on the scene within nineteen minutes. The bottom category means non-life threatening – an itchy arm, a nettle sting – and that we should get there as soon as we can.
Have a quick google and you’ll find desperate tales about pensioners lying for hours on pavements with broken pelvises and people waiting for hours in crashed cars. There was a story in the paper recently about a woman who fell and broke her hip. Her son travelled 200 miles from London to Devon and beat the ambulance to the scene by fifty minutes. This poor lady had been on a cold conservatory floor for seven hours, even though the ambulance station was ten minutes away. There hadn’t been a mix-up, and it wasn’t the fault of the frontline ambulance staff or managers, because they can only provide a service with the resources they’re given. And they are unable to predict when there will be a spike in activity.
I always treat every patient how I’d want members of my family to be treated. And if a member of my family called 999, I’d expect an ambulance crew to be there in minutes. So I understand why people get annoyed when we turn up late. And whenever we do arrive late, we’re immediately on the back foot. We’ll pull into the patient’s road and see people pacing up and down in front of their house, looking at their watch, so we immediately know they’re annoyed before we even get out of the ambulance. That’s not ideal.
Only the other day, a patient was kicking off because we turned up later than we should have: ‘You’ve broken the law! You were supposed to be here within eight minutes! It’s absolutely disgusting! I’m gonna sue you! I’m gonna sue you both!’ Eventually I said, ‘I’m sorry you’ve had to wait, but we’re here to help you. Please let us do that.’ He kept going on and on, so I said, ‘Look, we’re not the complaints department. Let us do what we have to do and if you still want to complain, we’ll give you the number you need.’
Presumably, this guy thought we’d seen his call on our screen and said, ‘Let him wait. We’ll potter over there once we’ve finished this brew.’ He apologised in the end. Before saying he was still going to complain. But despite his lack of awareness, he had a point, and just desperately wanted to vent his frustration. When your internet goes down and you need someone to shout at, it’s the poor person in the call centre who gets it in the neck, even though it’s got nothing to do with them. And it’s much the same when we turn up late. We take the flak without complaint, but we’re doing the best we can.
What do you say to the parents of a child who has been having a fit for an hour? What do you say to an elderly gentleman, someone who fought in the war or spent his working life serving his community, who has tripped on the stairs and soiled himself while waiting for an ambulance to turn up? The whole situation is terrible for the person who needs help, and shocks the public, but it’s not great for ambulance staff either.
Winter 2017–18 was particularly shocking. It’s not just people falling over on the snow and ice that create those ‘winter pressures’ you hear about on the news, it’s the so-called seasonal illnesses. Certain infections are more common when it’s cold, particularly flu, which can be lethal to vulnerable people, such as the elderly, and noro-virus, which is so contagious it’s been known to close entire wards. Throw in chest infections and the sad fact that a lot of people, many of them old and frail, can’t afford to heat their homes, and winter can send an A&E department into near meltdown.
Handovers (by which I mean handing over a patient to A&E staff at the hospital) are meant to be done within fifteen minutes, but handover times were a lot longer in the winter of 2017–18. Crews were waiting in corridors with patients on stretchers for hours. We can’t just dump a patient in a corridor. We’d never want to do that anyway, but there is also a practical consideration in that we only have one stretcher, and we only get it back when the patient is found a bed. So when there are no beds available, we stand and wait.
I’ve heard stories of colleagues waiting for four or five hours. One shift, almost every ambulance person from my station was at the hospital. The corridors were packed with stretchers and wheelchairs, each accompanied by two ambulance crew. And while we were standing around and waiting, who was available to be sent to emergencies?
Standing around in a hospital corridor is a break of sorts, but it’s not as if we can eat there. It’s not uncommon not to have eaten for ten hours, or even had a cup of tea, because we’re waiting to hand over patients, job after job after job. It’s soul-destroying. We’d far rather be out on the road, trying to save lives. And while we wait, we’re all thinking the same thing: This is bloody appalling. People will be rolling their eyes and making small talk, trying their best to ignore the elephant in the room. But we try to remain stoic.
It’s embarrassing and stressful for all the staff involved, including us, the nurses, the doctors and even the directors, who are in a very difficult situation. Our patients are in pain and desperate to see a doctor. We’ve told them that they need to come to hospital, and when they turn up, they end up lying in a corridor for hours. While I’m not aware of anyone dying in a corridor on my patch, I’ve seen people deteriorate. And I’ve never seen anyone get better. Certainly, people have died while waiting in corridors in other parts of the country. In 2017, two patients died while lying in a corridor at Worcestershire Royal Hospital. One had been waiting for thirty-five hours before she died of a heart attack, which is not what she went in for.
Over the years, I’ve got to know a lot of A&E staff very well and they are just amazing people. Some of them have always worked in A&E, always will work in A&E and I’ve become good friends with them. That said, I’m making fewer and fewer friends who are doctors
and nurses, because the turnover of A&E staff seems to be as high as it is in the ambulance service. But friends or not, they understand our role, we understand their role and we do everything we can to help each other out. We’re all just cogs in the same giant machine.
Because I’m currently studying for a paramedic diploma, I’ve been spending a lot of time working in A&E, inserting cannulas in patients, taking blood and a thousand other things. And working alongside A&E staff has made it abundantly clear what immense strain these people are under. While an ambulance person normally only has one patient to deal with at a time, A&E doctors and nurses might be dealing with four or five at once. Meanwhile, there might be a queue of patients snaking out the door. A&E has always been a stressful environment, but the pressure the staff are under appears to be getting worse and worse.
When it’s a Saturday night and it’s standing room only in the waiting room, people are lying on stretchers in corridors and abuse and punches are flying, it’s the doctors, nurses, healthcare assistants, cleaners, security guards, receptionists and people doing jobs you didn’t even know existed who are keeping the plates spinning. But while it would be very easy, even understandable, for A&E staff to treat patients impersonally, as if they were sausages being fed through a machine, they still manage to treat patients with the utmost care and respect. Their dedication to the job is unwavering, despite the workload, the hours, the abuse and the pay.
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At my interview for the job as an emergency technician, the manager behind the desk said, ‘You’re a young lad, if you join now, you’ll be able to retire at fifty-eight.’ But now the retirement age for ambulance clinicians has risen to sixty-seven, which is seven years later than police officers and firefighters. Previously, an ambulance person might have reached the age of forty-five and thought, I’ve only got another thirteen years, I’ve got a family to keep, kids at university, I can last out until retirement. Now that same person might think, There’s no way I can last until I’m sixty-seven; I’ll have to leave and find another for ever job now, while I’m still young enough.
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The ambulance service is losing so many experienced paramedics and technicians, because, for many, working in the ambulance service is no longer a lifetime’s vocation, it is a stepping stone to other things. And while an area losing three or four frontline staff a year might not sound like much, that might be sixty years’ experience of saving lives.
I’ve heard of a qualified paramedic leaving to become a train driver. He was very well educated, very good at his job, but has a family to look after. He’s now earning almost 60 grand a year, which is more than twice what he was earning before. I have other friends who were forced to retire in their fifties, too late to find another career, and are now scratching around trying to make ends meet. One mate retired and is now stacking shelves in Morrisons.
I’m struggling to do the job in my mid-thirties, so there’s no way I’m going to last until I’m sixty-seven. The oldest partner I’ve had was in his early sixties. Not only did he struggle with the physical side of the job, he also struggled to keep up with technological advances and equipment and procedural changes. Maybe there are 67-year-olds who are capable of doing it, but not many. And not me. Most of the job is about communicating, and there is equipment nowadays to lessen the physical strain. But there is no getting away from the fact that the job still involves long hours and a lot of heavy lifting. An ambulance person in action can resemble a packhorse. Oxygen tanks, defibrillators and bags brimming with gear weigh a ton. I try to keep myself in decent nick, but my back is knackered, just as almost every ambulance person’s back is knackered. And after we’ve lugged all our equipment to wherever it needs to be, we then have to treat someone, which can be exhausting in itself.
I recently went to a cardiac arrest and the patient was pretty big, and we don’t discriminate against size. It’s not like we can turn up and say, ‘Nah, sorry love, you’re too heavy. Good luck anyway.’ So there were four of us carrying this lady out on a board and just as I turned to see where the step was, I missed it and fell.
It should go without saying that my female colleagues are just as capable as my male colleagues, and often fitter and stronger. But prejudice, most of it unintentional, still exists among the public. I’ve been on a job with a female partner and the patient has started having a go at me for ‘making’ her carry equipment. This old fella was flat on his back, having just had a suspected heart attack, but still had the energy to chide me for my lack of chivalry.
I’ve dealt with other patients who couldn’t get their head around the fact that a woman was going to carry them down the stairs: ‘You can’t do that, you’re nine stone wet through. You’ll have to get your mate up here.’ Sometimes I’ll reply, ‘The ambulance service is an equal opportunity employer, it doesn’t discriminate. Women want to be treated the same as men, and they’re treated the same as men.’ And a bloody good job they are, otherwise my back would be even more knackered than it is.
16
A SCARY FEELING
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 fien
dishly 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.
999--My Life on the Frontline of the Ambulance Service Page 14