Why I Will Vote To Strike

I haven’t posted in awhile for that I’m sorry, just been thinking of what to actually write. For awhile now my motivation working in the NHS has been very low, the lowest for the last 7 years I’ve been in the ambulance service for.

So, the current climate in the UK has forced the NHS to ballot for strike action.

Why I’m voting to strike: people say you guys can’t strike people will die. Colleagues in the service are also saying they won’t as patients will die.  Unfortunately, our patients are already dying. It’s become all to common to see 12, 13, 14 + ambulances queued outside of A&E departments all waiting for a hospital bed. Only too recently I took over a bigger crew looking after a 90year old who was having a stroke, who hadn’t been picked up by that night crew, nor the day crew before them but the night crew before them!! 35 hours in total that 90 year old spent laying on a uncomfortable ambulance bed in the same ambulance they were originally picked up from. 35hours!!!!!! And in that time despite multiple requests for food none ever appeared!! As they were on soft food only made it difficult for us to just grab them food. 35 hours!! And that’s not even the longest wait for a patient to be offloaded. Due to these waits patients in the community can’t get an ambulance as there isn’t any to send. It is now all to common for patients to wait 6+hours for an ambulance to be able to get to them. This is not the job I got into. I am currently unable to do my job. I have zero faith in the NHS to be able to treat my own family members in a timely fashion due to these delays.

Now you maybe thinking if you strike how is that going to help. Well, the ambulance service and the NHS will not just refuse to come into work. Chances are strike action will more likely be a work to rule if on shift with some calls being redirected to self travel which to be honest would be quicker than waiting for an ambulance. Those who are off shift will be invited to picket lines I’m guessing outside of the ambulance stations. So patient care will not be compromised anymore than it already is.

The NHS staff are massively underpaid and haven’t received a liveable above inflation pay raise in well ever. So every pay rise has resulted in a real terms pay cut. Remember the big Brexit argument 250million per week goes to the EU let’s find the NHS instead. How the Tories said all that was never a thing. But don’t worry they came out and clapped us all during the toughest period the NHS has ever faced. That’ll pay the ever increasing bills, the ever increasing fuel costs, the increasing Morgage rates. 5.58% currently the cheapest when me and my partner looked to buy a house this week.

Now the only way anything is ever gonna change is if we take action! No one who works for the NHS wants to strike but we have been backed into a corner to much and now we left with no choice. I’m lucky that my living situation is favourable. However, many are not lucky enough. The pay is peanuts, considering the life saving decisions we make day in day out. As I am unable to do my job and help people who need us the most, seeing patients die preventable deaths if we could just be able to do our basic jobs. The very thing that made us able to do our role for the poor pay, the long hours, the destruction of our own mental well-being, facing abuse and assaults, the knowledge and skills we possess knowing that we are the only thing standing between life and death of someone no longer has any weight, as we are unable to use the skills, the knowledge, gained over years of training and hard work. There is no greater feeling saving someone’s life bringing them back from the dead to get discharged from hospital to the loving arms of their family, to stop someone on the brink of death of making their way to the pearly gates and helping them to recovery and prolonging their time on this earth with the people they love. We can not do this anymore. Instead our mental well-being is taking massive hits constantly seeing preventable deaths and saying the word SORRY over and over and over again for the delays. This strike won’t just be over our rightful pay rise that will allow us to live, but a highlight of things need to change. Many colleagues in the ambulance service and nurses, hospital staff and doctors have been forced to leave due to pay making a move to better paying jobs and the need to use food banks.

People with respected jobs, dedication to helping others, day in day out, forced to use food banks and to decide whether to heat their home or feed their kids!! How is this right? That is why we are voting to strike or not to. That is why I am voting to strike!!!!

It’s okay to not be okay

Did you know emergency service workers are 3 times more likely to suffer from major depression and PTSD than the general public.

The ambulance service has a high risk of development of PTSD than the other emergency services and military. A prevalence rate of 14.6% in the ambulance service compared to the general population of 3.7(males)- 5.1%(females) military in combat roles 4.7%, Police 3.9% and Fire 7.3%.

John Langtry, Marcin Owczarek, [...], and Mark Shevlin,. (2021) Predictors of PTSD and CPTSD in UK firefighters. Eur J Psychotraumatol. 2021; 12(1): 1849524. doi: 10.1080/20008198.2020.1849524

My time on the road as a student and a paramedic I have been exposed to numerous incidents that had the potential to negatively affect my mental well-being. Some of which did impact it and to this day still etched into the forefront of my memories. So what do we do. Lock it up and move on.

Mental Health Stigmatisation within the emergency services is very much present, although there are some positive advancements in mental well-being within the services, some better than others. I can only talk about my experiences within the ambulance trusts I have worked in and one is a lot better than the other. Night and day differences unfortunately. My time in the ambulance service I have played a large role in staff well-being. The new service I joined I am attempting to develop their staff well-being network a monumental task.

Surprisingly the BBC show Casualty (season 33) done a fantastic job highlighting the problems with PTSD in the ambulance service through their character Ian, a paramedic that ends up fighting against himself and his mental health.

In 2020 Mars et al., released a study looking into suicides within the ambulance service. Their research found 15 members of the ambulance service had committed suicide in 2019. This research was conducted prior to the covid 19 pandemic, thus unfortunately would likely be higher as a result of the difficulties we faced during.

Mars, B., Hird, K., Bell, F., James, C. and Gunnell, D., 2020. Suicide among ambulance service staff: a review of coroner and employment records. British paramedic journal, 4(4), pp. 10-15. 10.29045/14784726.2020.12.4.4.10

There are a number of charities and helplines set up to assist emergency services. Some I have had personal experience** with and couldn’t recommend them highly enough. Below I have added details of mental health services. If you are struggling. Speak up.

End The Stigmatisation of Mental Health.

It’s Okay, to Not be Okay

**https://www.frontline19.com**

https://uksobs.org/about/?doing_wp_cron=1632207513.4261920452117919921875

https://able-futures.co.uk

“No matter what I accomplish, it doesn’t seem like much compared to surviving Auschwitz.” ~ Art Spiegelman

One of the best parts of this job, is that we get to see people at their homes from all different walks of life. Different cultures, religions, creeds and past experiences. A group of patients I have always loved speaking to, are those who served in World War II (WW2). I could sit for hours and listen to the different stories. I’ve been to patients that fought on the beaches at D-Day, flew spitfires during the Battle of Britain, Lancaster bomber crew members flying missions into Deep Germany, not forgetting those at home, children, parents civilians having to take cover in bomb shelters and the London Underground as the Luftwaffe carried out multiple bombing runs day and night. The most memorable of the lot. An Auschwitz survivor.

We got called to a flat by the patients mental health team for a concern of welfare as the patient was refusing to speak to them and hadn’t been taking his medication among other complaints. When we arrived their case worker informed us that they were a survivor of the most horrific event in world history. The holocaust. The case worker told us that the patient was terrified of people in uniform especially men in uniform. We tried to speak to the patient through the doors letterbox. While attempting to speak to the patient the police had arrived for the same reason as we were called. Thankfully, the patient opened the door and allowed us entry before the police had to resort to forcing entry and terrifying the patient. On entry I will never forget the minimalistic flat. Opening the door there was a small square corridor with 5 doors leading off. As you stepped in on the left was a small box room. Inside was a single bed perfectly made with a beige cover and cream sheet with a single pillow. On the left side as you walked in was a small dressing table and on the right was a wardrobe. On the dresser was a pair of gloves laid out with the left glove pressed on the left and the right on the, well the right. Next to them was a sock one on the left one on the right. Around them was dust clearly indicating everything has a very specific spot these items have to be laid out. In the wardrobe hung up was, a single tweed jacket, 2 white shirts and a pair of light navy trousers. The next room was the bathroom toilet, sink, bathtub. There was a small glass on the left side of the sink, a well used toothbrush laying flat in between the taps and a tube of toothpaste on the right. The bath tub had one bar of soap in a soap tray on the right side against the wall next to the tap. The next room was another bedroom but the patient used this for storage. Boxes filled the room with a small pathway filled with old newspapers, files some dated during the war years some after. Some about the holocaust and some about the Nazis being captured for their roles in the war crimes committed by the third reich. The next room was their sitting room. A single well used armchair on the right side close to the doorway wall with a old small black and white tv in the middle of the room. The far wall contained a single China cabinet with some very old and dusty China inside. The next room was their kitchen a small long room barley enough for two to walk side by side. The cupboards contained very little food just enough to get by day by day. Around the flat pined onto the walls in every room were typewriter written notes. Some states their wishes after death, some were notes about the war. An eerie but unique item.

I will never forget the moment I noticed the distinctive tattoo that was given to the people who got forced into Auschwitz. You could still make out the each individual number etched permanently into their flesh. After checking the patient over for their physical health ruling out organic causes of the presenting symptoms. We turned to manage their mental health. The patient needed to attend hospital due to their symptoms. They were a danger to themselves and risked further harm due to their own neglect. The reason the mental health team and case worker were there was to issue a mental health section. However there was no way I was forcing this person out of their property using any amount of force. I had fully committed staying their until I could convince them to come with us at their own free will. The patient started telling us about their experience during the war.

Like many they were hiding in an attic in nazi occupied territory, with their mum, dad, sister and another family. Everyday, they said they woke up feeling like this was the last day, today is the day we get caught. Unfortunately, one day the gestapo found them. The patient recalls the moment the gestapo broke down the door that lead to their hiding place as they came running into the room guns drawn pointing at them shouting at them, calling them all filth. They forced them out into the street and into trucks. The patient tells me that was the last time that they ever saw their family and the others that were in hiding. Eventually, they were loaded into a train and taken to the infamous camp. They got the famous tattoo and forced into labour. They watched multiple get murdered in front of them and the bodies left for days rotting away until the guards forced prisoners to move the bodies. They recall seeing the smoke coming from the chimneys of crematoriums daily. Wondering each day if they would be selected. Finally, they recall how the guards started shouting many people after leading large groups out of the camp. They told us how they hid in one of the cabins when the shooting stopped. They laid their for what felt like weeks until they heard Russian soldiers outside when they liberated the camp.

I have watched multiple documentaries on the holocaust, visited museums and who hasn’t watched Schindlers List. All have had their different impacts but hearing a first hand account face to face is quite frankly a privilege. The horrors endured by the victims should never be forgotten and never repeated. 

Mental Health vs Religion.

As the previous post said mental health is vastly under taught during ambulance training. A lot of mental health comes in conjunction with religious beliefs. Both the patient and the patients family. I’m sure many of you have seen the film ‘The exorcism of Emily Rose’ and did you know it was based on the true story of a German girl called Annneliese Michel in the 1970s? Today there remains a belief that demonic possession is the reason for mental health patients symptoms. I had seen the film and had read into the story behind it, even writing a paper on the matter after travelling in a medical capacity to a different nation and culture and hearing their first hand accounts of their beliefs with demonic forces. None of this prepared me for a mental health job I walked into.

The call came from a child stating their family member was acting strangely muttering to themselves and having conversations with people who weren’t there. Information we received in our screen. Child caller, mental health, hallucinating. When we arrived on scene we were met by 10-12 adult family members outside the front door. They denied calling an ambulance or even needing one. A prank call we thought so walked back to the ambulance and updated control. Shortly after there was a knock in the ambulance door. A young girl around 10 was knocking. I opened the door and asked her if everything was ok? She said no, that her sister needs our help. She appeared extremely concerned. I asked what’s happened and where is she. The address she gave us surprised us, as it was the address we had just approached and got turned away from. She said her sister is talking to herself, shouting at mummy and daddy, making strange noises and scary faces. She appeared very scared. I got her to take a seat in the back of the ambulance asked her sisters name and walked back to the address leaving my colleague with her. When I asked the family outside if I could speak to Sarah (not her real name) I was told she not here and for me to leave. The family were all muttering amongst themselves. None of them were welcoming towards me and none of them wanted me to enter the house. I returned to the ambulance and let my colleague know. In the mean time he had been talking to the little girl finding out more information. We decided we needed police Immediately. They sent two response cars and filled them in on what we had been told and witnessed. The police decided this was enough for probable cause to force entry to search the property for the patient. I returned with the 4 police officers. Again the family tried to turn us away but this time we told them we were entering the property to search for Sarah and if she wasn’t there we would leave. They argued and argued until one of them said she’s upstairs in the bedroom. We entered the property with the mother and father shouting at us to get out that we don’t know what we are doing. I agreed to the police that I should enter the room first while they ensure the family stayed outside and a female police officer would enter with me. The door was locked from the outside and I unlocked it. The adrenaline was already racing and now faced with the unknowing was through the roof. I opened the door and what we witnessed shocked us. I glanced around the dark room the only light coming from the open door and between the curtains. And the wall. I opened the door fully the light filling the room and turned the light switch on. Every wall was covered in crucifixs and crosses. Bibles were laid on the floor all around the bed. On the bed we found Sarah. Tied by rope to the 4 corners of the bed muttering to herself. Her appearance was very dishevelled, dirty. With the police officers help we untied her. Rad rope burns etched into her ankles and wrists. The smell of urine and faeces filled the room as we noticed the bed was saturated in bodily fluids. We heard the parents getting arrested and they continued to plead their innocence. They were shouting at us saying over and over that we did not know what we were doing. That she needed to be exorcised that a priest was coming and that the devil had had her and for us to put her back and leave. Tears were streaming from their parents eyes. As they plead with us to let them go. We got the patient to the ambulance and onto the bed, her sister looking relieved now that her sister was safe.

We took the patient to hospital where she was diagnosed with schizophrenia. Physically at the time she was diagnosed with malnutrition and dehydration. Thankfully, no physical injuries just the superficial rope burns. Sarah made a full recovery and medicated for her mental health and as far as I am aware still lives a full normal life. Her parents and family were sentenced in court and received prison sentences. The deep religious beliefs that this family had resulted in the belief that Sarah was Possessed by the devil and that the only way to help her was an exorcism. Unfortunately this is not the only case like this in the UK and with t be the last. Sarah is lucky that her younger sister had the courage to challenge their families beliefs and recognised that Sarah needed medical help. 

Mental Health

Mental health is a range of complex psychological conditions. A large number of calls received by the ambulance service involve mental health conditions, so you would think mental health training in the ambulance service would have the same consideration as your medical and traumatic conditions. If you thought that, sorry, you’re wrong. My training involved 2 hours of 2 mental health service users coming in and telling us about their experience. After that, I could tell you what not to say to the two of them but I couldn’t tell you what the difference is between psychosis and schizophrenia. Majority of people learn about mental health on the job some do additional courses, some do independent reading and others couldn’t care less and believe mental health should not be a job that ambulance attends.

My view is that mental health services are very poor, and ambulance personnel should be attending to mental health calls and should receive way more training in mental health conditions. Not only that but paramedics should be able to train as AMHP (Approved Mental Health Professionals/Practitioner). I’m sure some will disagree. Now why do I believe the Paramedics would make good AMHPs? When people have an emergency with their body or their loved ones, they call 999 and ask for the ambulance service. Someone acting strange out in public, police are called and they call for ambulance assistance. We have the ability to rule out organic causes first such as metabolic conditions. We often attend peoples homes and have a larger insight into their life style than most. It’s harder to hide their true feelings and thoughts when they’re in their safe place than in a strangers office or GP practice. Most mental health services that I have worked with do not operate out of hours, thus what is the ambulance service meant to do?? Most will take the patient to A&E, now, is this the most appropriate place for them? For instance, a paranoid schizophrenic who believes everyone is trying to kill them gets taken to A&E surrounded by multiple sick people. Who’s to say that patient isn’t going to attack someone due to their belief or run away scared and get hurt. Now if paramedics could train as AMHP they could utilise the Mental Health Act issue a section and arrange for the patient to be admitted to a mental health hospital for further assessment or treatment. Police can utilise sections 135/136 or the Mental Health Act, however, S135 requires a magistrate to issue a court warrant and S136 the police had the ability to detain someone in a public place if they appear to be a danger to themselves or others.

What about the Mental Capacity Act? Yes, the ambulance service has the ability to use this act, one I have used many many times for both mental health and medical conditions. The problem with this act and it’s use in mental health conditions: Any act done, or a decision made, under this Act or on behalf of a person who lacks capacity must be done, or made, in his best interests. Best interest. Now, is is in their best interest to be taken to an A&E department to sit amongst sick people watching them due to their behaviour? Absolutely not. Due to lack of training or understanding many ambulance crews will remove the patient, sometimes by force with assistance from police to an A&E department.

2 patients both with similar presentations this is why I did for them:

The first patient lived in a MH sheltered accommodation. Known schizophrenic. Police had attended earlier due to the patient assaulting a member of staff and destruction of property. When we arrived we found the patient standing at the top of the stairs aggressive, swearing, shouting talking to someone who wasn’t there. The patient kept pulling frames off the walls and breaking them. Any engagement attempts with the patient were unsuccessful multiple different methods attempted. The patient lacked capacity, and the mental capacity act was used. We requested the police for assistance. We had to restrain the patient due to their aggression. Prior to leave scene I contacted the local hospital to let them know we were coming and this patient will need a secure room and sedating. When we arrived at hospital we were told to wait in the corridor. The patient continued screaming at the top of their voice continually, barely stopping for a breath. Members of public walking past, sick patients nearby in a queue ranging in ages from 6-98. Eventually, the hospital moved us to a cubical where the patient continued screaming continuously where every patient in the department could hear them. We had elderly patients shouting for them to “shut up”. Myself and the police tried explaining they can’t help it and that they are just as unwell as they were. After nagging the nurses and doctors. We finally got moved into a double door cubical and the patient was sedated. We spent 3 hours with this patient 2 of which were spent waiting for a bed and sedating. Now was this the best place for the patient? Well, yes and no. Yes they needed to be removed from their address for their own safety, other resident and staff. Was A&E the best place for them, no, did we have any alternative? No. Therefore did we act in their best interest? Absolutely. We did everything in our power to ensure their welfare and dignity, but let down by the hospital.

Patient 2:

Same presentation lives alone but currently at their parents address. Refuses to engage with us and their parents. Again multiple different methods attempted. At this point they had not tried to hurt themselves or their parents. But aggressive and scratching the walls and tables. Talking to people who were not there. We deemed the patient to lack capacity and acted in their best interest. I spoke to their parents telling them the options we have. We could request police and use reasonable force to remove the patient to A&E if they wanted them out of the house or we could arrange for a mental health assessment to be carried out there. The parents did not want their adult child to be dragged out in the middle of the night kicking and screaming. Understandable. So I phoned the local AMHP to arrange an assessment. They told me they wouldn’t come out during out of hours but will arrange local mental health team to come in the morning. Excellent. Acting in their best interest achieved. All documented paperwork left with the parents and worsening advice given. The next evening a friend on another ambulance attended the same address. The parents had had enough and wanted them out of the house. It turns out the mental health team never arrived which left no option but to get the police and force the patient to A&E. Again let down by an alternative service.

Now both these outcomes could have been avoided if paramedics could use the mental health act and qualify as AMHPs. Ultimately, improving patient care. The ambulance service will always be called to mental health incidents. With todays climate is a sure thing to increase!! It’s okay to not be okay!

What’s the worst thing that you have seen?

Every paramedic, ambulance technician, nurse, doctor, police and fire fighter will at some point get asked “what’s the worst thing that you have seen?” I’m not quite sure how to respond. Are they asking what keeps me up a night, what job has burned itself on the back of my eyes, that every time I fall asleep it’s the last thing I see and when I wake up it’s the first thing, that similarities with other incidents brings the memories flooding back to the forefront, or do they just want to hear about all the blood and the guts and the gore. It’s a strange thing to ask a member of the emergency services or military. Looking back I think one of the strangest things I’ve been asked was “how many dead bodies have you seen?” I’ve been asked a number of different questions throughout the years. “What’s the worst thing? what’s the most interesting thing? How many dead bodies? What’s the best part of the job? What’s the worst part of the job? How many lives have you saved? What’s your favourite job to attend? Your job must be frustrating at times? Although that’s more of a statement than a question but nethertheless the person expected a reply. The one I can not recall ever being asked is what are the biggest non ambulance jobs have you been sent to. So here are some of mine:

Cat 2 chest pain - Back sunburnt unable to put cream on it

Cat 1 fitting - 19 year old had a nightmare

Cat2/3 Cold & flu multiple times - told to sleep it off drink fluids and take paracetamol.

Cat 2 unconscious - Unable to turn the tv/light off

Cat 2 chest pain - Carers haven’t arrived on time

Cat 2 unconscious multiple - Passerby calls for someone unconscious but won’t go near them or remain at location - homeless and doesn’t want/need help

Cat 2 respiratory distress - White things in babies gums known to be teething was in fact teething

Cat 1 ineffective breathing - Put rubbish in the bin with a barrage of abuse when refused

Cat 2 vomiting - Vomiting 3 times in an hour

Cat 2 ACS - 1 episode of loose stools

Cat 1 major haemorrhage - Drunk alcohol and wants a lift home 20miles away

Cat 1 major haemorrhage - Needs their urine catheter emptying, more than capable of walking to a toilet

Cat 2 not alert - Check their house thermostat

Cat 2 unwell not alert - wanted us to give them paracetamol

Cat 2 chest pain - needs help to commode. - same patient calls back 6 hours later saying we have left equipment there, next crew arrived again wanted help to toilet. (Capable of moving to commode themselves)

Cat 2 not alert - elderly man watching hardcore porn wanted a paracetamol to make him feel better. Nothing actually wrong with him no pain or temperature.

Cat 2 chest pain - tired wanted a prescription for sleeping tablets, ongoing condition investigated by multiple doctors. Had a go at us for not giving her any medication because in Poland the ambulance service turns up and gives you tablets.

Cat 1 2year old cardiac arrest from 111. On phone to parent telling mother to do CPR. On arrival kid turns me into a climbing frame. Kid is running around house playing and laughing. Had slight temperature. Mother told call handler patient not in cardiac arrest.

Cat 2 DIB - 3rd ambulance to attended 2nd within an hour. Anxious called back as symptoms changed from previous. But didn’t want to go to hospital due to Covid risk refused obs as they had been done despite condition apparently changing.

Cat 1 cardiac arrest - drunk 15yo pretending to be in cardiac arrest friends done CPR they remembered everything and told me they had faked it, now has mild chest pain. Informed parents.

Cat 2 unconscious drunk, - on underground platform 26yom. Not responding to us. Carried up 4 flights of stairs 2 escalators onto ambulance no response but not unconscious. Taken to a&e. While at hospital opens eyes tells me they wasn’t unconscious that they didn’t response as was scared when we showed up and throughout journey in ambulance. Allowed themselves to be “kidnapped” because they was scared Of who we could have been despite telling them we are the ambulance service.

Cat 1 111 cardiac arrest - Patient on phone out of hours doctor wanted ambulance there quickly patient not in cardiac arrest. Wife has a go at us for not taking patient to hospital on blue lights and driving to the speed limit despite no clinical Reason to.

Cat 2 sepsis - GP surgery pat made to sit by GP in waiting room alone. NEWS-0 Was not septic at all.

Cat 2 meningitis - in GP surgery. Stating photophobia and neck stiffness. Bright as a million suns in gp room kid looking all round eyes wide open. No rash playing as normal, no signs of meningitis.

Cat 2 unresponsive - MDT message - known hoax caller, if call hoax please contacted police. Was in fact a hoax call nothing wrong with patient just made inappropriate comments to female crew member.

Cat 1 stabbed - abdominal stabbing in phone box loosing consciousness, call handler hears phone drop and bang. 1 Air ambulance, 2 DCA (double crewed ambulance), 2 fast response car (FRU/RRV), 1 clinical manager, 1 incident response manager, 1 advanced paramedic, 4 armed police response vehicles, police helicopter (NPAS) and multiple response officers. No patient at location, through search of surrounding area. No patient found. Leave scene called back to same phone box for collapsed patient again no patient found.

I’ve had a few patients also tell me that I have to do what they want me to as they pay taxes and therefore my wages and they demand I do what they tell me. My reply is often, I pay my own taxes, I therefore pay my own wages, I do not pay myself to be spoken to by people like you, goodbye.

These calls and people who think this is appropriate need to understand that their actions have direct implications on people who actually need an ambulance. By them calling in for these things and similar, delays us from arriving to patients who need us and people do die because of this (more on that in another post to come).

Please only call 999 in an emergency! Think before you call. Think before asking someone what’s the worst thing you have seen!

My First Time

Working in the ambulance service, you find there are many first times. First day, first dispatch, first patient, first trauma, first baby, first death and first mistake. As a paramedic, your first cardiac arrest will always stick with you. I remember mine like it happened today, where it was, what the patient looked like, staff that was on scene even the weather. It wasn’t what some would say was traumatic and that’s why i remember it so vividly. Before this I had already seen death a couple of times, it wasn’t something that bothered me to be honest. All the cardiac arrest training you do at university, the repeated scenarios and OSCEs (practical exams) lead to this moment, this is what the ambulance service do, and do well (for the most part). An out of hospital cardiac arrest is as a life and death emergency as you can get (state the obvious).

It was a warm overcast day with rain in the air. I was a frist year student on my first front line placement. At this point I had been in the class room for 6 months and completed a patient transport placement where we just spoke to patients on their way to hospitals and home. The MDT goes off, RED1 - 47 year old female cardiac arrest in a mental health facility. We had just cleared at hospital and were ready to go, the blue lights go on the sirens wailing off we go through the streets making the 3 mile run to the patient who needs us. My first cardiac arrest in the ambulance service, my mind running through everything we have been taught, DRABC, defibrillation pads, advanced airways, cannulation, drugs, reversible causes 4H’s 4T’s (below), End-Tidal Carbon Dioxide (ETCO2) readings etc.

As we arrive there is already a FRU/RRV (fast Response Unit/Rapid Response Vehicle) and another DCA (Double Crewed Ambulance) on scene. We entered the hospital, lead by a member of staff and made our way into the lift and up 1 floor. Out of the lift we turn right through a keycard entry door and into a corridor with our patient located second room on the right. As we entered the corridor the rhythmic tones of the defibrillators metronome fill the air, tick tick tick tick ventilate, ventilate tick tick tick……… when we arrived clinically everything had been done, the patient was intubated being bagged with a good ETCO2 reading, cannulation and drugs had been given, reversible causes assessment was just starting to be conducted now that advanced life support was up and running. I got on the chest doing chest compressions on the patients left side, listening to the metronome tick tick tick instructing me on the speed of my compressions. 1,2,3,4,5…..25,26,27,28,29,30 Pause - VENTILATE, VENTILATE and back on the chest for another round. 5 rounds time to reassess the patients cardiac rhythm we all look at the defibrillators screen - sinus rhythm a 3 point pulse check (carotid, Femoral and distal) no pulse, damn PEA (pulseless electrical activity). I have a break and a colleague takes over on the chest. They do 2 minutes time for a rhythm check. Again PEA damn! And I’m back on the chest. As I’m doing chest compressions I look into the patients eyes. It was a strange image, one that’s hard to explain. i could see there was no one there, no light, just emptiness. She had hazel coloured eyes but behind them. Nothing. 20 minutes of ALS (Advanced Life Support) and no changes still PEA. We decide to convey to the nearest hospital with ongoing resuscitation attempts.

I was stood up in the back carrying on chest compressions no on her right side. We go a little to quick around a right hand bend and I loose my balance I fall backward and try to grab the hand rest in the bed I missed and caught the patients arm, as I’m falling my hand move closer to the cannula so I leave go. I smack my head on the side door hand rail. Ouch. Doesn’t matter back to it, back on the chest 1&2&3&4…….. no sense no feeling. We arrive at A&E (Accident & Emergency) and start taking her in. I’m still on the chest as we walking in, trying to keep up with the trolley and keep going with the chest compressions. As we enter the hospital via the ambulance entrance my phone goes off. My ringtone is the men behaving badly theme, as ringtones go in that moment it’s not the worst and not the best, being that we were an all male crew with a female patient. We go into resus and there’s a full team of doctors and nurses waiting for us. A nurse asks if I’m alright on the chest. I’m knackard I reply. Ready brace slide and the patient is over onto the hospital bed and the hospital staff take over. Shortly after arriving and blood tests come back the lead consultant decides any further attempts would be futile and declares the patient life extinct. Throughout, I never did think we would get her heart beating again. Just from looking into her eyes, in that moment I knew there was no coming back, a shame really. As cardiac arrest go, this went quite well, we done everything we could to gain a positive outcome. The background we had was that she had gotten sectioned the day before and started complaining of chest pain. I have no idea what the actual cause of death was, it’s not something we commonly get told unfortunately.

Although I have gone into a lot of detail, all the cardiac arrests I go to I remember vividly. I don’t really know why, I have always had a photographic memory with random things throughout my life, nothing of any use though. In a way it’s good, we meet patients for a short period of time on their lives, often it’s the worst time of their lives. We often find out the patients date of birth, date of death, 01/01/1941-06/07/2022 but what’s the dash in between. What has that person done between those dates that lead to this moment, that’s the important bit, maybe me remembering every cardiac arrest I’ve gone to, is my subconscious way of keeping their memory alive, just like the film Coco. Who knows.

Reversible causes in cardiac arrest

4H’s

Hypo/hyperkalemia

Hypovalemia

Hypoxia

Hypothermia

4T’s

Tamponade (cardiac)

Toxins

Tension pneumothorax

Thrombosis

Out of the Frying Pan and into the Fire

When I started with the ambulance service, I started on my emergency driving course. 4 weeks of driving around in an ambulance with my mates. Just what the doctor ordered after 3 years of studying and exams to pass. For 3 weeks we spent driving around in normal driving conditions, visiting museums, the white cliffs of dover, beaches, castles, even a secret nuclear shelter that’s signposted on all major roads in the area haha. Great fun and really interesting going to these places I wouldn’t normally go. During these 3 weeks we had exams to pass. All on the Highway Code which you had to pass to move on to week 4. Blue light driving was great. It’s amazing though how many people fail to notice an ambulance with blue lights and sirens blaring behind you. Either way, speeding through the streets, going through red lights, making progress through standing traffic and seeing two lanes of standstill traffic part in front of you like Moses and the Red Sea, is amazing fun. At the end we had a driving exam, similar to that done to get your driving license but a lot stricter and on blue lights. Speeding. Going through red lights. Maintain a smooth and safe drive throughout. After all that, I passed, I could now drive an ambulance in emergency conditions. Yes! The next 3 weeks was trust induction another 3 weeks hanging around with mates in a classroom going through trust specific policies and training as well has practical exams to pass. Other than the travelling to the venue due to parking problems. It was good. At the end, our course lead called us up individually and knighted us with our paramedic epaulets. Literally, right in front of the whole class, we fell to one knee, tapped both our shoulders with our epaulets told us to arise as Newley Qualified Paramedics (NQP). What a feeling that was! But finally I could proudly wear my uniform with Paramedic on my shoulders instead of student paramedic. Shortly after the realisation hit. I am now responsible for peoples lives!!

Instead of being engulfed with a wave of fear. An unusual calmness fell over me. Instead of the weight of the world on my shoulders I felt lighter than I ever have. With the realisation of responsibility of life on my shoulders, also came the realisation of my lifelong long dream of being a paramedic was achieved.

After completing the induction course, I went to a Operational Placement Centre (OPC). A few weeks responding to emergency calls with a mate and a mentor. This period we had a OPC Record Book to complete and get signed off by our mentor saying we were safe and competent to go into the big wide world alone. We had some very interesting, complex calls during these training weeks. Cardiac arrests, successful suicides, sexual assaults of a minor, neglect of children, major trauma, complex mental health jobs, to name but a few.

During this time I had my first coroners statement. Well that didn’t take long. When I received the email saying I had to do a statement. A sheer wave of panic came over me, instantly thinking back to all the jobs I had gone to where the patient had died, trying to figure out what it was i had gotten wrong. My next shift I was stood down (time on shift not responding to emergency calls) for the first hour to write my statement. I was given the call details and my paperwork and a template to follow in order to complete this statement.

A CAT 1 (category of calls 1-5, 1 highest priority - 5 lowest) 19 year old, Welfare check. When we arrived at the block of flats there was police on scene. I came across one in the stairwell as I was going up they were coming down. I asked “is the patient there” she replied “yes, my colleague is there”. I walked past 3 other flats on the external balcony and enter led the property. It was a student let. As you walk in, there was a small kitchen immediately on the left. Straight in front was another door with stairs leading up on the left of it. Stood in this doorway which had clearly been knocked open with the big red key (police enforcer tool used to knock down doors), stood a police officer. I walked forward into the patients bed room where he was laying facedown in bed under his quilt, not moving. I approached said hello put my hand on his shoulder and realised that he was dead. I took his temperature and was 28°C he had been dead for some time. We waited for the second police officer to return before removing the quilt. At this point there was no smell none at all. As soon as I removed the quilt. The smell hit us, the police scrambled for the window and to open the door which lead to a outside balcony. He had post-mortem (PM) staining (purple colour similar to bruising where blood pools in death) all over his back. We done a 3lead ECG which showed asystole (flat line, no electrical activity of the heart) With assistance of the police we rolled him over onto his back to look for any obvious signs of injuries or a obvious cause of death. Rigour Mortis was still present (stiffening of the limbs, happens after death). His arms folded under him stiff and more advanced PM staining all over accept around his mouth and nose. This area was pale. Often a sign of pressure during death. His face when I arrived at his face was buried into the pillow. A good indication he had died by suffocation. On a table in his room was a handgun a looked very very real. But the police couldn’t be sure so requested firearms to attend. The police had spoken to his mother who said they had called 999 on the Wednesday, due to him having a seizure on the Sunday but hadn’t heard from him since, and couldn’t get hold of him. I never found out what was the cause of death or if the gun turned out to be real or a replica. I would have said he had another seizure at some point while laying prone (facedown) in bed which caused his face be pressed against the pillow and suffocated himself. Unfortunately, any attempts of resuscitation would have been futile due to the length of time he had been dead. I had to write the coroners statement as the family needed closure, they needed to know why we didn’t attempt to save him. A complete and understandable reaction. Even now, this happened years ago and I can remember the job like it happened yesterday.

Becoming a Paramedic

I first realised I wanted to be a paramedic when I was 7. Both my parents were nurses, so I was always interested in medicine and helping people. When I was 7 I had a febrile convulsion (a fit caused by high temperature common in children), I remember feeling unwell in the morning and told my mum I was to sick to go to school. Typical 90s fashion and medical parents, unless you’re dying you’re going to school. I spent most the day with my coat on feeling cold to the bone and sitting next to radiators and putting my coat around the hand dryers to warm me up. Of course, I ended up cooking myself. My teacher noticed I looked pale, felt my forehead and decided I needed to go home. When I got home my mum asked if I wanted anything to eat. In true sickness fashion. Tomato soup and bread was on the menu! While my mum was in the kitchen preparing my gourmet meal i fell asleep on the sofa. Next thing I knew I woke up outside the hospital in the back of the ambulance with my mum and sister looking down at me on my right with the paramedic sitting behind my head. I remember looking up, being very confused but felt immediately safe with a superhero watching over me. From that moment, I knew one day that man will be me.

I was not the best at school I hated it! Bullied. Fights daily. Called an idiot and told to give up on hobbies from the very people who are meant to inspire you. Turns out when I was 26 I was diagnosed with dyslexia, which caused the many aspects I struggled with at school (more on that later). I tried for years to get my foot in the door with my local ambulance trust. Applying for non emergency transport, patient transport, emergency medical technicians control room staff, no matter what it was I applied. However, I could never get through that door. I’m that time I went to college straight out of school, qualified as a car mechanic, worked in a bar, Amazon warehouse, nursing homes, private security, sales assistant, builder. No matter what job I did I always felt there is only one thing in life I want to do. Paramedic! I was 23 just broke up with my partner and heading back to live in my mums house. I thought to myself, no more! If I don’t do it now. I will never do it. My investigations begin. I phoned my local university that teachers paramedic science and asked the course lead, what is the best course to do to get in. That September I had signed up back to college part time 2 evenings classes a week for 2 years studying Access to Health Professions. I worked hard and it paid off. I passed the course. I applied for 6 universities and had interviews with 2. The first one, I loved the place. Great connections with ambulance trusts, but couldn’t get down to an open day due to work. I was lucky and the course reps showed me around the facilities available. I was offered a place here and already had the grades to get in. I couldn’t believe it! I. Was. Going. To. Be. A. Paramedic. I attended the second university just in case. But as soon as I walked through the door, I took an instant dislike to the place. No matter my dream was happening.

September 2015 I started university. I loved it. Considering how much I didn’t want to go to university to become a paramedic. I loved it and wish I had done it sooner. 3 years studying hard. Placements, practicals and lectures. Passing each one some better than others but a pass is a pass. During my first year placements, my paramedic mentor, while looking through my paperwork on incidents asked, “are you dyslexic, my daughter is and you spell words just like her” I said “nope never diagnosed”. I did a dyslexia exam. Turns out, I am (sorry for any spelling mistakes poor grammar etc).

Despite the lack of support from some of my high school teachers I passed! I achieved what I had set out to do!! I was going to be a paramedic!!! I was going to be that hero I saw when I was 7!! I applied for two different trusts, the home trust and my university placement trust. I interviewed for both and got offered both jobs. The first time in my life I had the ability to say yes or no to an employer. I picked the trust i done my placements with and moved there beginning my career with the NHS ambulance service.