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

by Dan Farnworth

  In New Orleans, I looked at a few more left-field treatments, such as music therapy and even beer yoga. Supping on a beer while in the downward dog position was surprisingly relaxing, although I’m not sure the bosses back home would be sold on the idea. New Orleans was a real eye-opener in terms of the level of crime their emergency services have to deal with. I spent a few hours with a New Orleans police officer, and that day he’d been to an armed robbery at a petrol station in which the man behind the till was shot dead at point blank range, and a drive-by shooting which left three people dead and a ten-year-old injured. That’s probably the same number of murders I’ve dealt with in fifteen years working for the ambulance service in the UK.

  I was blown away by the ambulance services up in Canada. In Ottawa, they have a great peer support network, but arguably more important than that, mental health support is written into law. So instead of asking the emergency services to improve mental health provision for their staff, the authorities told them they had to. That’s a big difference, because you can put all the pretty pleases in the world at the end of a request and it can still be ignored. But if you write something into law and make it part of management’s targets, they will jump to attention. Managers in Canada not having a choice meant their workplace policies were a country mile ahead of ours.

  Ambulance workers in Ottawa had the very best vehicles, the very best kit, the very best equipment and the very best uniforms. Everything seemed to be bang on. They also had ‘make-ready teams’, whose job was to prepare each ambulance before it went out for a shift. All the paramedics had to do was turn up, grab the keys and go, without having to worry if anyone had nicked a cylinder of Entonox from the back.

  They also employed a traffic light self-assessment tool to encourage staff to talk about any mental health issues. You turn up at work and someone will say, ‘Are you in your green today?’ If the answer is no, you’re feeling amber, then it might be time to have a chinwag with someone, even if the issue isn’t directly related to work. If you’re in the red, it’s definitely time for a chinwag. It might sound a bit corny to a cynical British readership, but the overriding feedback from the rank and file staff was that they felt valued. And there is an understanding from bosses that if you value your staff, you will reduce sickness, increase retention and make working for the ambulance service feel less thankless.

  Not that the nitty-gritty of the job was much different. Riding in an Ottawa ambulance as an observer, the first job we went to was an attempted suicide. A woman just out of the army and struggling to come to terms with civilian life had driven her car into a lamp post. When we got back to the station at the end of the shift, there were staff there who had just been to another traumatic incident. No one was talking, a couple of them were teary. And then a therapy dog came bouncing in, acting daft as a brush. Everyone was stroking and cuddling it, and suddenly the same people who had been silent and crying were laughing and chatting about the job they’d just been to. It was miraculous. The dog even went out to jobs in an ambulance car. I understand there are businesses trialling therapy dogs in the UK. And they work – I’ve seen it! – and are testament to the benefits of thinking outside the box.

  In Maryland, I spent time with the Bladensburg Fire Department. Bladensburg is a little bit rough around the edges and most famous for an 1812 battle in which the British routed the Americans, but the locals didn’t seem to mind me being there. On my first morning, I was having a nice cup of coffee in the station when the hooter went off. Me and the lads piled into the engine and we tear-arsed towards a house fire. There was no holding back, they went straight into this burning wooden building with their hose pipe and seemingly no regard for their own safety.

  A few minutes later, another engine turned up from another station, and I couldn’t help picking up on a bit of animosity between the two crews. It was only afterwards I learned that both sets of crews were volunteers, and there was something close to a sporting rivalry between them. That’s not ideal, but what I learned from the Bladensburg lads was the benefit of an emergency service operating as a tightknit team. They were a community, a family. And they loved their job, even though they weren’t even being paid for putting their lives at risk. There were no formal support networks in place, they just had each other. It confirmed my belief that mental health provision isn’t just the responsibility of employers, it’s the responsibility of all of us.

  I wasn’t a fan of their leather helmets, though. One bloke got hit on the head by a piece of wood and a nail went into his face. I said to him afterwards, ‘Why don’t you get some decent lids?’ He replied, ‘We’ve had these for years, we’d never change them.’ It just goes to show that workers all over the world can get stuck in their ways and you will always find things that can be done better.

  In Paramus, New Jersey, I spent time with two lovely ladies who had set up something called the Paramus Stigma-Free Zone. Their aim is a grand one: to build a society in which people are free of the stigma of mental illness and can access the help they need without fear of being judged. They put up signs in schools, offices and first responder stations, declaring them stigma-free zones. Anyone can sign up, and a lot of people have.

  When you sign up, you have to pledge to do something to reduce the stigma of mental illness. That might be organising a stigma-free football game or barbeque – or any event where people can gather and feel comfortable talking about their mental wellbeing. It’s about giving people the tools to be able to discuss mental health and change the way society views it. They loved the fact that I was this guy who had travelled all the way from England to learn from them. That, in a nutshell, is what a Churchill Fellowship is all about.

  Stigma-free zones will feature prominently in my fellowship report. But aside from my report, I need advocates in Parliament. You would think a pledge to look after 999 workers better would be a vote winner, but at the moment workplace wellbeing isn’t even on Parliament’s agenda. Finding politicians to push my recommendations is the easy part. Finding politicians who are genuinely passionate about the issue might be more difficult. I also need to gather more empirical evidence. If I can say to the powers that be, ‘By investing x amount of money in each ambulance worker’s wellbeing, you will save x amount of money further down the line, by reducing sick leave and increasing retention,’ then I’ll have their attention. Appealing to the emotions of these people is one thing; you need to waft cold, hard numbers under their noses to get them to take action.

  I’d love the fellowship paper to lead to legislative change and I’m always hopeful. Perfect legislation would include resilience training before we even start out on the road, a clear referral pathway, regular mental health ‘MOTs’ and mental health professionals with an intimate knowledge of the problems faced by ambulance workers, on tap. Weaved into that would be a directive for bosses to implement visible peer-led grassroots support. I’d also like guaranteed funding for the NHS to enable all this to happen. But never mind money, it needs to happen because it’s the right thing to happen.

  23

  SOFTENING THE BLOW

  Recently, I moved to a different area within the same service. I fancied somewhere a bit more rural, away from the smoke. And, just maybe, with a bit less stress. After my final shift working out of my old station, I parked up the ambulance, hung up the keys and went home. That was that.

  Ambulance people are defined by the work they do. But one day you’re Joe Bloggs the paramedic, the next you’re out of the service and no longer that person. Who are you now? Where does life take you from there? I call it career bereavement. And often when ambulance workers retire, they’re suddenly stuck in an armchair all day, mulling over twenty or thirty years of trauma, with no one to talk to and all the horrible stuff they’ve dealt with swirling around their heads.

  A few of my retired colleagues have come to me for help, including one chap who had moved abroad and I assumed was enjoying his retirement in the sun. One day, he phoned me in tear
s. He told me about his nightmares and that he felt betrayed by the ambulance service. He was one of the loveliest, most respected guys I’d ever worked with, and he thought he’d been part of this special organisation, something like a family. But when he retired, he realised he was just a counter in a game, swept off the board and forgotten. That might be fine if you worked in an office for thirty years, but not if you’ve been exposed to the things he was exposed to in the course of his career.

  I spent a few hours on the phone to him and we’ve kept in contact since. I send him snippets of gossip from the station, so that he feels like he’s still part of the gang. I hope he takes some comfort from that. But the ambulance service shouldn’t be allowing people to feel neglected. This guy gained his mental scars serving his country with the ambulance service for decades, so why is the ambulance service not supporting him in his retirement? Recently, the manager who suggested a job on the frontline of the ambulance service might not be for me took me aside and said, ‘I was wrong, you’ve opened my eyes.’ But another manager told me that by raising awareness of mental illness, I was creating problems. He thought my campaigning was counter-productive, because it was making staff question themselves. I understood his point. There is a fine line. Can you offer too much support, so that people who don’t have a problem convince themselves they do have a problem? Maybe you can be too insistent:

  ‘Are you okay?’

  ‘Yes, I’m fine.’

  ‘Are you absolutely sure you’re okay?’

  ‘Yes! Stop mithering me about it!’

  Maybe there is something to be said for being stoic and plodding along, like in the old days. And maybe there are psychiatrists who would say that some things are best left buried. But it’s not something I was able to do.

  There are colleagues who haven’t spoken to me since I went down with PTSD and started talking about it. Maybe they think that mental illness is something that shouldn’t be discussed. Maybe they think I’m a loon. There were certainly people who thought I was milking the situation and enjoying the limelight a bit too much. One colleague said to me, ‘I’ve been in this job twenty-five years and I’ve never been given opportunities like you have.’ I replied, ‘It’s not about me getting to meet the royal family. It’s about highlighting the lack of support for mental illness in the service – the service you work for! It’s about the thousands of people we’ve been able to reach and help.’

  If there are a couple of people who think I’m milking my PTSD and what I’m trying to achieve is a waste of time, I can live with that. Most people love what we’re doing; the naysayers are few and far between. The stigma of mental illness is being reduced on the shop floor, in that people are generally more accepting and open about the subject. We’ve got people talking, which is great. Senior managers and politicians have to take recommendations on board and join the discussion. Only then will major legislative changes be made. But it’s going to take time for that attitude to work its way up the food chain.

  When I first started campaigning, the bosses really got on board with it. But as soon as Mind wound up their Blue Light Programme and my work with the royal family tailed off, so did the ambulance service’s enthusiasm. A phone number for a counsellor pinned to a notice board is not nearly enough.

  An attempt to set up a network of emergency services across the whole of my region, so that they could share knowledge, also foundered. The hope was that if one service created something that worked, they could share their idea with the others. A few of the services who really wanted to improve their mental health provision bought into it, but not everyone shared their enthusiasm. It was disappointing, but I wasn’t surprised. I guess it’s something that still makes some people feel uncomfortable.

  Indifference and scepticism are sometimes difficult to deal with. But – and this is a sentence I thought I’d never write – I found that poetry helped. While I was in America, I attended a couple of poetry readings in bars and discovered ‘If’ by Rudyard Kipling. It seemed like a good lesson in how to be a genuine person, which is what I was striving to be. Every now and again, when I’m feeling a bit unsure of myself or the direction I’ve taken, I’ll pull it up on my phone and reread it. There are certainly a few lines in there that any ambulance person can relate to, not least, ‘If you can trust yourself when all men doubt you, But make allowance for their doubting too.’

  ______

  I’ve not become immune to the things I see, but I’ve become more hardened to them. They call that post traumatic resilience and growth. Being laid low by PTSD was a horrible time in my life, and sometimes when I think about what happened it scares me. But the crumbling brickwork that undermined me has been cemented solid. I’m no longer having counselling and I feel a lot more robust and able to deal with the trauma I’m exposed to. And it’s made me a better person. I’m more aware of my feelings and the feelings of people around me, and I draw strength from helping people through difficult times, whether they be current or former colleagues, people from other emergency services or other walks of life completely.

  The story about the seven-week-old baby at the beginning of this book happened fairly recently. It is yet more proof that you never get used to dealing with jobs as harrowing as that. But you can learn how to soften the blow. After trying and failing to save that baby, I filled out the necessary paperwork before talking to the doctors and nurses in A&E. I found that therapeutic, and I think they did, too. Back at the station, I discussed it with my colleagues. They were genuinely interested from a technical point of view, because they wondered what they would have done in the same situation. I took a lot of comfort from just chewing the fat. Before my downfall, I might not have even mentioned it.

  I made sure to tell my partner on the job, who was fairly new and had never dealt with anything as harrowing, that she didn’t have to bottle up what she’d seen, that she could have a chat with me any time and that there were other people who could help. I was also able to tell her that, despite being laid low by the things I’d seen in the past, I was still doing the very best I could.

  I hadn’t slept for twenty-four hours, so you’d think I’d have staggered through my front door and crashed out on the sofa. Instead, I stared at the ceiling, haunted by the screams and laments of the baby’s parents. And when I finally drifted off, I had a nightmare, in which I saw the baby dying all over again. I can still see that baby now, even when I’m wide awake. I doubt I’ll ever forget her face. But now I feel strong enough to deal with the memory.

  24

  TREMENDOUSLY PROUD

  I’ve had a strange life in some ways. Certainly, some strange stuff has happened to me. Then again, I don’t think any ambulance person would say any different. But I wouldn’t change a thing, because I’ve also had some incredible opportunities. I’ve had a ringside seat for the very best and the very worst of humanity. I’ve witnessed humbling kindness and breath-taking depravity. I’ve dealt with wonderful people I’ve forgotten and awful people I can’t erase from my memory. And having been floored by the job and bounced off the deck still punching, I feel like it’s my responsibility to inspire people.

  Hopefully, people will read this book and realise that mental illness doesn’t have to define you, that you can still lead a worthwhile and fulfilling life. Despite what happened to me, I’m still cracking on with things, raising my kids and managing to do a challenging job to a high standard, day in, day out.

  I’ve been let down a lot in my life. But one of the biggest let-downs was how I felt I was treated by my employers when I was struggling with the stresses of the job. I don’t want that to happen to anyone else. I’ve always been fuelled by injustice, and an ambulance service without proper mental health and wellbeing provision is not a just ambulance service. But if changes are made, future generations of ambulance workers – and workers in general – will feel safer and more valued in the workplace. That’s why I’d love to set up a service that offers health and wellbeing solutions to compan
ies. I’d go in and give resilience training to staff. Make sure they know when they’re well and when they’re not. Explain to them that everyone is susceptible to mental illness, that there is nothing to be gained from hiding problems and no shame in asking for help.

  I’ve managed to get people talking, but that’s just the first step. Charitable campaigns come and go. Mind’s Blue Light Programme was funded by Libor fines, but that funding was pulled in 2018. As a result, there is no longer targeted funding for mental health awareness in the emergency services. But there are still some good charities doing sterling work and a lot of different people looking into the problem. And I’m more determined than ever to persuade the powers that be to act. I won’t stop until mental health and workplace wellbeing is treated as seriously as it should be. PTSD couldn’t beat me, so I won’t let a little thing like Parliament get in my way.

  I try to practise what I preach. After the incident with the seven-week-old baby, and despite my harrowing nightmare, I didn’t feel the need to see a professional counsellor. Because I’d already been through similar, I was more resilient and able to self-assess. I talked it over with colleagues and drew strength from their empathy. That was enough for me, although it might not be enough for everyone.

  I phone my mum on the way home from work every single day. She and my dad have been with me every step of the way, including through my struggles with PTSD. Mum’s my safe person, someone to offload on, no different to a counsellor. I mainly talk and she mainly listens. It makes perfect sense, but how many people do the same? My mum and dad were instrumental in making my four kids the amazing people they are, having pulled out all the stops when things went wrong for me. I don’t know what I would have been without their help. As it is, my kids are also my four best friends and mean absolutely everything to me. Now, all I aspire to be in life is the best parent I can possibly be.