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

by Dan Farnworth

  To add to the stress, an ambulance person’s paperwork has to be as good at 5 a.m. as at 5 p.m., even if we’re so tired that we can barely see the page and the pen feels weird in our hand. Essentially, we have to show that we had a positive effect on a patient, and left them in less pain than before we arrived. I understand the need for good record-keeping, especially because people are so litigious nowadays. But it often takes as long to do the paperwork as it does to assess the patient. So you’re damned if you do, damned if you don’t.

  It’s the same for doctors. Whichever A&E department we walk into, we see them tapping away at computers, typing up their reports. That’s no fault of theirs, they’re just doing what they’ve been told to do. But, as with ambulance people, it takes up so much of their precious time and keeps them from what they’re really meant to be doing, which is treating patients and saving lives.

  The bosses have tried to trim our form-filling back as much as they can, but it’s still quite in-depth. A cardiac arrest is one of the easier jobs to do a report for, but it gets more complicated if you leave someone at home with a chest infection. We have to explain what’s wrong with the patient and what we’ve done to help them. We’ve got to speak to a doctor, and it might take ages for the doctor to call us back. Whenever he or she does, we then have to write up their findings and advice. I’ve been sat in a patient’s living room looking at my colleague, while the patient was looking at me and we were all looking at our watches and the clock on the wall and coughing and shifting awkwardly. Sometimes, it’s nice to be able to sit down and have a brew and a chat. But there are houses you don’t want to spend too much time in. You just want to do what you’re there to do and get out of Dodge as quick as you can.

  We never know when we’ll be hit with a complaint, because there’s a never-ending list of things we can do wrong. On one job, we picked a guy off the floor, walked him around his living room, asked him if he was in any pain and when he said no, we said our goodbyes and left. A month or so later, the bosses received a letter of complaint from the guy’s daughter, because it had been discovered that her dad had a hairline fracture of his femur.

  The fact was, the patient said he was fine and was walking around, so who were we to question it? That’s why before we leave someone’s house, we always say, ‘If you notice any changes or have any concerns, call your doctor or 999.’ Me and my partner submitted written statements and, until the bosses confirmed that we’d done nothing wrong, I lived in fear of the consequences. That fear of being disciplined or dismissed is always at the back of an ambulance person’s mind. It stems from the blame culture that exists in society. It’s not that easy to get sacked, but the fear is very real.

  Medicine is often a matter of opinion, particularly when you don’t have all the facts in front of you, which is usually the case in my job. We can have a look at a patient’s blood pressure, heart rate, blood sugar levels, oxygen levels and do an ECG reading. And on the back of all that, we decide whether they should be left at home or taken to hospital. But just as we don’t wear capes, neither do we have magic wands or x-ray eyes. An ambulance worker will do thousands of jobs in a year, and it’s impossible to get it right every time. We’re humans, so sometimes we miss things. People will argue that if an ambulance person always carries out a thorough assessment, they’ll never get it wrong. Frankly, that’s nonsense, because no person or system is infallible.

  It doesn’t matter what you do for a job, whether you’re a plumber or work in a supermarket, you’re going to make mistakes. The difference being, if someone stacks a shelf wrong, some boxes might fall on the floor, while mistakes made by medical professionals can have catastrophic consequences. Sometimes they’re not even mistakes, they’re unavoidable outcomes.

  Intubating – or putting tubes down people’s throats – is an art. In the ambulance service, it’s a skill reserved for paramedics and the last resort for patients who are not breathing. But anaesthetists purposely put people to sleep and take over their airway management, which is a hell of a responsibility. Recently, while I was doing some training, I offered to help an anaesthetist with a patient’s airway. The patient was having her gallbladder removed and, before she arrived, me and the anaesthetist discussed the different drugs he uses as a muscle relaxant, to facilitate intubation. He explained that his favourite is rocuronium, because there is a reversal for it which can be used if the patient has an adverse reaction. Naturally, I asked him if any of his patients had had an adverse reaction, and he told me that while adverse reactions do occur, it was very rare.

  This patient turned up and we had a bit of a chinwag, before the anaesthetist gave her a dose of numerous medications, including rocuronium, and off she nodded. I started to ventilate her (which basically involves squeezing an air bag connected to a mask, to inflate the patient’s lungs), but it soon became a bit tricky. The anaesthetist, probably thinking my technique was awry, took over the reins, but the next thing we knew, the woman was having bronchospasms – in other words, an adverse reaction to the rocuronium, which meant she was having trouble breathing. The anaesthetist administered the reversal drug, as well as others, only for the patient to go into cardiac arrest. He pulled the emergency cord and what seemed like every medical professional in the hospital arrived within a few seconds. If you’re going to have a cardiac arrest, this was the place to have it.

  When the patient had been stabilised, the anaesthetist said to me, ‘You’re not coming in my theatre again, mate.’ The patient spent a couple of days in intensive care but came out of it hunky-dory. But it made me realise that even fourteen years of training doesn’t make someone bulletproof. The anaesthetist hadn’t made a mistake, and neither had I, but things sometimes go wrong. In the medical world, you can never predict what will happen next with any degree of certainty.

  There is also misconception among the public about what powers we have. Paramedics and technicians aren’t trained to do all the things they can do in a hospital; we’re only trained to carry out certain interventions. People are pushing for paramedics to be able to carry out more complicated procedures and prescribe more drugs, which means it’s an interesting time to be in the job, but deciding whether a child should be left at home or not is a huge decision and not necessarily reflected in a paramedic’s pay cheque.

  The other weekend, I was called to a 111 referral. We turned up at this house to find a kid with a runny nose and a cough. I had to explain to the kid’s mum that we’re not paediatricians. Unless a kid is having an allergic reaction, cardiac arrest or something similarly serious, it’s not our area of expertise. Children are also less able to communicate their symptoms. We don’t carry around xray machines, brain scanners and all that other shiny, expensive gadgetry in our kit bags. It’s not a case of being work-shy, it’s a case of making sure the right people are making often monumental, life-changing decisions.

  ______

  I’m happy to admit that one of the things that attracted a teenage me to the job was the idea of being able to tear around the place, lights flashing and sirens blaring, with no risk of being flagged down by the police. But it’s not quite like that. Ambulances are very specialised machines. They’re not like cars or vans, they have a lot of intricate electronics and cabling. Our mechanics know the ambulances intimately and do what they can to keep them running smoothly, but these vehicles are working their socks off twenty-four hours a day, seven days a week. Usually, an ambulance will do a twelve-hour shift and be handed straight over to another crew for another twelve-hour shift. They do thousands of miles a week with barely a break, and some of them are about ten years old.

  And you know what’s funny? I once picked up a brand-new ambulance from the station with a sticker on it that said: ‘Please drive carefully for the first 1,000 miles while the engine breaks in.’ Imagine turning up to a job and saying, ‘Sorry we’re late. New ambulance, have to treat it gently . . .’

  Some ambulances drive like they’ve got square wheels. They creak a
nd groan as if they’re arthritic. You will need to know the knack just to get them off the starting block some mornings. I’ve had ambulances break down on me at least ten times, sometimes with patients in the back. Touch wood, it’s never been anything drastic, like a cardiac arrest. But I have heard about ambulances breaking down with seriously ill patients on board. In such cases, the patient has to wait for another ambulance to be sent.

  Not so long ago, before they started employing specialist teams, we’d transfer neonatal babies to specialist children’s hospitals. We used a special stretcher, which was basically an incubator that clipped into the back of the ambulance and was attached to the mains. It’s difficult to think of a more precious cargo. We’d want to get them to their destination as quickly as possible, while trying not to accelerate or go round corners too fast or brake too heavily. And we were acutely aware that we were driving a vehicle that wasn’t always the most reliable.

  To compound the problems, we don’t always drive the ambulances in perfect road conditions. In winter, we can end up on roads covered in black ice and deep snow. Bad weather is a particular problem for rural ambulance crews, who rely heavily on support from Mountain Rescue. Meanwhile, the public rely on hardy carers, who think nothing of wading through a couple of feet of snow to get to patients. But I have been on shifts when the snow has been almost impassable, and in those situations, you just have to do make do and mend. The skid car training has come in handy, but just the simple act of passing other vehicles becomes a nightmare, because you don’t really want to be forcing people into the deeper snow on the edges or in the middle, so that they end up stuck themselves. During the day, you can try to call in a helicopter ambulance, but that’s where the extra support ends. And at night, our helicopters are out of action anyway, because reduced visibility makes it too much of a risk to fly.

  One shift, we were sent to a child who was fitting. It was the middle of the night, the snow was a few inches deep on the roads and every corner we went around we’d lose the back end of the ambulance. When we finally arrived at the job, the child was even more unwell than we thought, which meant we had to get to the hospital as quick as we could. But because of the weather conditions, we were looking at the best part of forty minutes. That’s a very frustrating position to be in, and one for cool heads. We knew the child desperately needed a doctor’s help, but if I’d put my foot down and gone too fast, I probably would have lost it. And if we’d ended up wrapped around a lamp post or stuck in the snow, we might have never arrived at the hospital and instead been sat there for an hour waiting for another crew to relieve us. So we just had to navigate our way through the blizzard and keep everything crossed. Actually, that’s not a bad metaphor for what it takes to be an ambulance person when things are getting chaotic.

  17

  MESSED UP AND DARK

  It has been another common or garden morning when a job comes on our screen: CHILD FALLEN OVER IN SHOWER. UNCONSCIOUS. I always feel anxious whenever a child is involved. As a father of four young children, it would perhaps be strange if I didn’t. At the same time, experience has taught me not to always believe what I read on the screen. So I do wonder if this child is really unconscious. Although maybe it’s because I don’t want it to be true.

  Me and my old mate Paul are only a few miles from the house and we arrive within minutes, siren blaring and blue light flashing. The house is in a relatively deprived area on a terraced street, with cars parked all along it, which means we have to park blocking the road. No doubt we give one of the neighbours the hump. Oh well.

  Usually in jobs where kids are involved, the parents are waiting on the doorstep in a state of panic, so that we have to calm them down as well as deal with the emergency at hand. Not in this case. I knock on the door. No answer. I knock again. No answer. I think to myself, That’s odd, if my kid had fallen over and knocked themselves unconscious, I’d have that door wide open so that the ambulance people could turn up and sweep straight in.

  There is a little alleyway running next to the house, so we make our way down there with all our gear on, kicking and shouldering aside weeds and overhanging branches. We reach a dilapidated wooden gate, force it open, pick our way through more weeds and piles of rubbish, bang on the back door and shout ‘Ambulance!’ Again, no answer.

  I try the door and it’s locked. By now, we’re wondering if we have the right address. But suddenly, we hear the thud, thud, thud of big feet thundering down stairs. The door swings open to reveal a burly lad standing there with a limp child in his arms. Behind him, another toddler is peeping around a door. For a few seconds, the guy stands there staring at us, as if we’re a couple of sales-men flogging brushes. Eventually he says, ‘There you go, mate’, and shoves the child into my chest, as if she is nothing more precious than a pile of dirty washing or a tray of beers.

  When I look down, I can tell immediately that the girl, who is about two years old, has horrendous injuries. Her face is black and blue, as are her legs. Her eyes are half-closed, her pupils dilated and her breathing is noisy and slow, which is always a bad sign. She is also completely dry, which suggests that the story about her falling in the shower is concocted. Paul says, ‘She’s really poorly.’ I give him a look that says, ‘Let’s move quick.’

  We tell the guy to be as quick as he can and bring the other child with him. I hand the patient to Paul, who can feel her body clicking, which suggests she also has broken bones. We both know something is seriously amiss, but we can’t say that. We just have to try to save her life and leave it to the police to establish what has gone on. Meanwhile, a couple of cars are beeping their horns, their drivers only worried about themselves, not the little girl we are trying to save. The selfishness of some people is remarkable to behold. They couldn’t see exactly what we were doing, but that’s besides the point.

  I get on the radio and say, ‘Critically ill child, unconscious. We need the full team ready to receive us.’ Me and Paul have worked with each other so often that we have an almost telepathic understanding. We throw everything at her, but she soon stops breathing. I drive the ambulance to the hospital as if I’ve stolen it, but the journey seems to take for ever. And the whole way there I’m thinking, This girl reminds me so much of my kids – blonde hair, blue eyes, a beautiful little thing.

  When we arrive at the hospital, there is a full crash team ready to go: nurses, doctors, consultant, anaesthetist. We tell them everything we know – which isn’t very much – and what procedures we’ve carried out, and they take over from there. It’s always a privilege to watch a group of highly trained clinicians working together, as if they’re different parts of one perfectly calibrated machine. They manage to stabilise and intubate the little girl, but her injuries are such that it looks like she might go downhill very quickly. So a helicopter is called in to fly her to a specialist unit in another city. Me and Paul accompany the patient to the chopper and watch it take off, before trudging slowly back to A&E, neither of us saying a word.

  Back at the hospital, the man has now been joined by the little girl’s mother. The doctors have already told them that the situation is grave, but the bloke doesn’t seem to be registering. The mother, on the other hand, is in a right old state. From what I can work out, the man is the mother’s new boyfriend and had been looking after her kids while she was at work. The doctors agree with us that the girl’s injuries are non-accidental, so I get on to the police, tell them about our suspicions and they immediately instigate a serious investigation. We provide them with statements, make our exits and a short while later, the man is arrested.

  We drive to the ambulance station in stony silence. When we arrive, we both agree that we can’t possibly deal with anything else that day. We’ve done enough, it’s time to go home. In my ten years of service, I have never felt so low and utterly exhausted.

  At home, I can’t shake the image of the little girl in my arms, covered in bruises, wheezing and gasping for breath. She was just an innocent toddler, who
should have been playing in the garden or having fun with her friends. I also can’t stop thinking about the man’s seediness and apparent indifference. I sit there on the sofa for hours, thinking: What a messed-up world we live in.

  I told my wife what had happened and she took me out for tea and tried to take my mind off it. But I struggled to sleep that night. I kept playing things over and over in my mind. Had I done something wrong? Could I have done more? I could still smell the house, all burnt toast and overcooked vegetables. I could see the face of the other little girl, peeping round the door. I was assailed with images of that black and blue little body. Round and round it went. The next day, I asked Paul how he was feeling. He seemed to be dealing with it okay. I didn’t want to burden him, so I said I was fine as well. But I wasn’t fine at all, I had gone into a tailspin. I sat there, staring at the telly. Not watching, just staring. But in my head, the visions were becoming more vivid and more frenzied. When I did manage to doze off, my mind tried to put the pieces together. I could see the man hitting the screaming child, and the scene became ever more violent. I’d wake up soaked in sweat, my heart pounding. It reached the point where I was desperately fighting to stay awake instead.

  After two scheduled days off, I went back to work. I was quieter than normal, tried not to make eye contact and avoided engaging. That was probably me giving unconscious hints that I needed help. But nobody said anything. And why would they? They probably just thought I needed a bit of time to reacclimatise after a particularly rough job.

  In reality, I was rapidly descending to the bottom of a deep, dark hole and the world was passing by above my head. Unless I made a concerted effort to concentrate on whatever job was at hand, all I could see was the face of that poor battered girl. I was consumed by guilt and numb to anything that was going on around me. And when I got home, it got worse. Even the sound of the kids’ feet reminded me of the man stomping down the stairs.