Tag Archives: Career

Ambulance Crew – A Basic Survival Guide

So, you’re thinking of joining the Ambulance Service. Have a seat, make a cuppa, and I’ll tell you what you need to know to survive being an Ambulance Person.

One of the most important things to realise about working for the Ambulance Service, is that it’s not all blood and guts. In fact, it’s been quite a while since I’ve seen any guts, or brains, or body parts that should be inside the body. A large amount of our work is medical complaints; chest pain; shortness of breath; abdominal pain; strokes; headaches etc. There’s also a very large portion of mental health and social concern cases. Because of that, you need my number one rule:

  • Be able to talk to anyone.

I once heard a Paramedic of 30 years say he could talk to anyone with an asshole. I thought he was joking, but actually, this is a skill you need to have. As you become more experienced and knowledgable, you’ll be able to talk about more specialist medical things, but first, being able to talk and not being scared of you own shadow is a good start. This brings me to point number two.

  • Trust in your training.

You’ll turn up to your first emergency call wearing the uniform of thousands before you and be expected to know what you are doing. Have faith, you won’t be on your own (hopefully) and your basic training will kick in, no matter what the call is. For a newbie, it’s all about A B C and not doing any harm. Increased skills and knowledge will come along in time. You won’t be expected to attend (by which I mean sit in the back of the ambulance and treat on the way to hospital) a very unwell patient, so you’ll be driving the truck more than your crew mate, and so:

  • ALWAYS drive to the condition of your patient.

During your driver training, you’re taught to drive as fast as it is safe to go. In reality, when driving a 6 tonne ambulance through narrow city streets with a seriously unwell patient in the back, speed is the last thing you want. Smoothness is the key! I learnt that very early on after a bollocking from my crew mate who nearly fell to the floor while treating an unwell child in the back of the ambulance while I drove on blues to the hospital. These vehicles do not handle well, they wallow around every corner and feel every bump! You’ll be thankful of this advice when the time comes for your crew mate to drive you to A&E with a patient in the back.

  • Support your crew mate

You’re with them for 12 hours (or likely more) a day in a very small space, during sometimes some very emotionally charged scenes. Unless the clinical decision is dangerous, always support your crew mate. It looks unprofessional to argue on scene and will create a difficult working environment for the two of you. You can always talk it out after you’ve dropped the patient off at A&E. I’ve done shifts with people I really haven’t liked, I’m talking about proper dicks, but when it came to the clinical stuff, you need to work together, especially when time is critical. Which brings me to point 5:

  • Don’t panic!

It will be tempting. You’ll have to stop and take a few deep breaths, you’re ears will be ringing and your vision narrows, you’ll feel your own heart punching you in the chest, your legs will feel weak and your brain will be moving so fast you’ll forget your own name. This will happen the first time you come across something serious like a horrific car crash. And subsequent times after that. Don’t worry about it, but don’t let it affect your care. Even the most experienced medics have that surge of adrenaline during incidents like this. The key is to take your time with things: like a swan – calm and smooth above water, but underneath paddling like fuck!! Your colleagues will be excellent and you’ll fit into the team. You’ll either know what to do, or be told what to do – both are absolutely fine.

  • You’ll have memories, good and bad

No need to elaborate too much here. You’ll see some of the funniest, strangest and most heartwarming things doing this job. You’ll also see things that will steal sleep from you, give you flashbacks and haunt you. You need to be ready for that. Take comfort in the fact that you won’t be alone, and there are support networks in place.

 

 

This list isn’t exhaustive, there are hundreds of survival tips I could throw at you, but that would make a very long post indeed.

Now probably the most important rule of all:

  • Never, I mean NEVER pass up the opportunity to go to the toilet. You might not see another one for 8 hours! (That ‘drive to the patient’s condition’ rule will soon go out the window when driving to hospital with a bladder the size of a small continent fit to burst!!)

This really is the best job in the world. The government won’t ever appreciate what we do, senior managers will alter your terms to make 12 hours seem harder and harder in the name of ‘efficiency’. You’ll miss your family and friends, spend Christmas Day in the houses of strangers and your body clock won’t know what hour of the day it is. But really, this job is like no other – you’re trusted with people’s lives, you offer relief to those who are anxious and ease the pain of those in need.

It’s not for everyone, but if you can stomach it, do it!

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Apologies

“Well, well, well”

I hear you say.

“It’s that bloody Ambulance bloke. I remember he used to write regular updates on his day-to-day life on a frontline Ambulance. I’d almost forgotten he existed.”

AHA! I have returned with an apology. It’s been a very long time since my last post but life has been very busy!

I went and got myself married, started my final section of studying for my degree in Paramedic Sciences and re-joined a band I was in many many years ago. I know it doesn’t sound that busy, but trust me, it is!

Anyway straight back into it, eh?!

On the subject of apologies, I did start a post I never finished which was along the lines of this:

On the ambulance, we carry a fairly limited range of pain relief, from Paracetamol tablets, to strong IV Morphine with basically only Entonox (gas & air) in between.

To enable us to give the strong pain relief, we need to get IV access with a cannula. This gives us access directly to a patient’s veins to give morphine or paracetamol in the form of a drip. But what if we can’t get access?

I was working in the city with a different crew mate. As soon as we booked onto the vehicles, the radio goes off:

“Morning chaps, sorry to be so prompt this morning. We have an outstanding call for a concern for welfare.”

“Roger, all received, on our way.”

On go the blue lights, no need for sirens at 0630, there’s no traffic about.

We quickly arrived to find a gathering of people, most in dressing gowns but all with bed hair!

It turns out the neighbour had got up for work and head shouting from the elderly lady next door. He went round but couldn’t get. He heard her shout that she was on the floor so called 999. They had also called the lady’s daughter who had a spare key.

We shouted through the letterbox to reassure her we were there and within a short time, her daughter arrived.

She unlocked the door and we walked in. It wasn’t pretty. The poor lady (who slept downstairs) had got up in the night and fallen forwards. She had scuffed her face down the wall as she fell. She’d landed face down and was unable to get up our to pain in her hip as well as general poor mobility and low strength. And there she stayed, for almost 4 hours until her neighbour heard her calling out for help.

We set to work. Quick ABC assessment revealed nothing immediately life threatening. Then we were concerned about a possible next injury as she’d hit her head. She had no central neck pain reducing the likelihood of a broken neck. We then assessed all the bones top-to-toe.

“Surely, just help the poor lady up” I hear you say. It’s certainly what we hear a lot, but if she’s broken a leg and can’t feel any pain due to nerve damage, then the bone pokes through the skin as we move her, that could prove fatal. So we methodically check top-to-toe.

Her injuries were some nasty facial skin tears, a laceration to her shoulder, a broken left wrist and a probable broken left hip. Unsurprisingly, she was in a lot of pain. We knew that before we moved her, we needed to try to get her pain under control. The best way to do so was with IV drugs.

This is where we got into trouble. My crew mate tried several times to get access, but her veins were so small that he couldn’t find one, when he did find one they just collapsed as soon as he touched them with the needle. While he attempted that, I made a plan to get us out of the house. It involved a second crew and moving most of the furniture into the garden. The plan would be to scoop her, carry her back into her bedroom, onto a vacuum mattress – which has hundreds of polystyrene balls in and we suck the air out of it to cocoon the person safely in – carry her through the house, up the front steps and to the stretcher on the pavement.

But, try and try as well did (the 4 of us) we couldn’t get any IV access. We decided to give her Oramorph (morphine drink) but it’s not as fast acting. We had to roll her onto her back before we could do anything.

We knew it would hurt, and so did she. When she was ready, and as quickly and smoothly as possible, we rolled her. She screamed and all we could to was apologise.

We were sorry that this had happened to her. We were sorry that nobody heard her shouting for 4 hours, we were sorry we couldn’t get into the house for a while and we were sorry we couldn’t get her pain under control before we moved her.

The rest of the plan worked like a dream. We dressed her wounds and drove her to A&E with the daughter.

My crew mate and I spoke about the job afterwards and both agreed that it is horrible when you can’t do what you think is best for a patient. It’s our job to ease pain, but when you can’t do that, you feel a little bit worthless. It may sound silly to you, but it’s true.

We returned to A&E an hour later with another patient and asked how she was doing. An x-ray confirmed a broken wrist and broken hip, but she was comfortable. We popped our head round the curtain and she was led there smiling. “Thank you both so much for helping me” she said.

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Morale

At this moment in time, morale is low in the ambulance service. This is evident as more and more articles are appearing in mainstream news raising concerns about how busy our crews are, fewer breaks being taken because there is so much outstanding work and finishing late at the end of every shift.

For decades, the ambulance service was quite a secretive organisation. Problems such as the above never made it to the papers because it was bad press for the NHS’ ambulance service, and crews didn’t want the public thinking they couldn’t cope with the job.

But here is the reality from the front line. The shift length of 12 hours is acceptable and is generally well liked in the service. It means we work fewer days per week and allows better 24 hour cover with less people. In my opinion, this is not the issue. The issue is not being able to take our breaks, and perpetual late finishes.

Years ago, the rules were; if you get back to your station, you are protected from being sent an emergency call until you’ve had your legal 30 minute break. However, while driving back to your station, you’re fair game. As workload increased, the likelihood of getting back to your station decreased – especially for remote, satellite stations like mine (we’re not stationed at hospitals as is popular belief). Crews would be sometimes 9 hours into their shift without a break and have to book unfit for duty until they’d had their break.

To rectify this, the Unions worked with our trust to introduce protected meal break windows. 5 hours into our shift, we cannot be sent an emergency call until we’ve driven back to our station and had a 30 minute break.

“Madness!” I hear you cry! You may think it ludicrous that crews, no matter where they are in their area (we could be 30 miles or more from our base stations) are driving all the way back to their station fully protected from emergency calls.

There’s two things to remember here, well, three if you think about the reason we ended up so far away from our station in the first place (lack of cover); Firstly. The front of an ambulance is like the front of a van except we have a computer terminal on which we receive calls and navigation details. What we don’t have, is a cool box or fridge. That delicious Chicken sandwich that’s been sat in a hot, sweaty cab of an ambulance for 8 hours, perspiring onto the now soggy bread doesn’t seem so appetising anymore! The trust will not install cool boxes as they consider it a health and safety risk if it is not cleaned. And we are not allowed to bring our own as we are not allowed to plug devices into the already overloaded vehicle electronics. This means our food is on our station. Also, on a winter’s night at -5, is it unreasonable to want a hot meal?

Secondly, we are never truly ‘protected’ from calls. What the trust took to doing was ‘general broadcasts’. Our radios are closed channel, so our dispatcher talks to one crew and nobody else, as is required by law for patient confidentiality. However, if there is an outstanding call that has been triaged as a “life threatening” emergency, they will broadcast it on open speech, thusly:

“Control to all mobiles, general broadcast. There is currently an outstanding Red call for a 60 year old male with chest pain in [town]. Currently responding a crew from [a town far away]. Anyone able to assist or render aid, please call up. Control standing by.”

So what do we do? We’re a mile away from a patient possibly having a heart attack. We do what we signed up for an answer the call. Even while legally protected, we can ‘volunteer’ to take an emergency.

“What a relief” I now hear you say. Perhaps. But the frequency of these general broadcasts is alarming. Such is the frequency and lack of cover, we might never get a rest break for answering them. So sometimes – very selectively mind you – we don’t answer them, so we may actually have a break. Let me elaborate before you faint.

If a broadcast goes out “child in cardiac arrest” control will be inundated with volunteers. Crews for miles and miles in any direction will be calling up to help.

If a broadcast goes out “25 year old male, tummy pain for 3 weeks”. What would you do? (The fact that triages as ‘life threatening’ is the subject for another post). If he’s had it 3 weeks, it can probably wait 30 minutes while I raise my blood sugar levels from 0.0!

Also, there is the subject of late finishes. We can be sent an emergency call any distance (sometimes we travel 35 miles to emergencies) minutes before the end of our shift. Looking back over last month, I worked 15 shifts and finished on time on 3 occasions! Lateness ranging from only 15 minutes to two hours! This overrun is enforced as we cannot turn down an emergency just because we’re due to finish in 10 minutes.

I know this post may seem a bit ‘moany’, and this is ‘the job we signed up for’ and please don’t misunderstand – I love my job, but don’t forget; we’re only human. Simple, fragile flesh and bone the same as the patients whom we help. After all the horrors and stresses we encounter, we only ask for a break and a reasonable finish time. It’s not too much to ask. But it is, apparently, and that’s why morale is currently lower than the shadow of shark shit!

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A Typical Day

I wanted this blog to give an insight into daily Ambulance life for an English Ambulance Service, but I’m aware that I tend to concentrate on specific cases of interest. So, I thought I’d write about today – a typical day.

Arrive at work 06:45 to relieve the night crew.

We say hello, ask how their night has been then set to checking the vehicle over for our shift. The night Paramedic signs over the Morphine to the day Paramedic and advises of any issues with the vehicle, any problems at local hospitals or any incidents requiring intervention from an Officer.

We are supposed to have 20 minutes to complete a Vehicle Daily Inspection (VDI), but such is the nature of the beast that if an emergency comes in at 1 minute passed starting time, we have to go.

Today however, we remained undisturbed for 20 minutes. We check that the defibrillator is functioning, that we have full cylinders of oxygen, all of the drugs we need to carry are fully stocked and in date, that our response bag has all of the diagnostic equipment we need, that we have all of the paper work that we need, that the heater works, that all the blue lights work, that all of the vehicle lights (headlights, brake lights etc) are functioning, that we have fuel and lots of other things. Quite a lot to squeeze into 20 minutes.

Anyway, here’s a run down of today’s emergencies:

1st call was to a male who had collapsed in the bathroom after having a shower. He had no recollection of fainting and awoke on the floor covered in blood. He had a nasty cut to the head which had bled heavily – he also took blood thinners which didn’t help! He alerted his wife who had called 999. We dressed the wound, fully assessed him and took him to A&E as he needed stitching and further assessment as to why he collapsed. Also, as he took blood thinners and had suffered a head injury, we wanted to check that he did not have a bleed on the brain as a result of the trauma.

Our second call was while we were heading back to our base station, a lorry driver parked in a lay-by flagged us down as his colleague had hit his head on part of the lorry causing it to bleed. By the way he was frantically waving we thought it was bad, but, it was a small nick the size of the nib of a pencil. We gave him a plaster, completed all of the other checks that we need to do, filled out our paperwork and let him back to work with instructions to see his own Doctor to check his Tetanus status.

As soon as we cleared from that call, we were sent details of a male who was possibly having a heart attack. It was a patient I had seen about 4 months ago when he had his first heart attack. He was at his Doctor’s surgery with atypical pain. His doctor was concerned that the pain he was experiencing in his shoulder was referred pain from his heart. One of our Rapid Response cars arrived shortly before us and conducted an ECG which showed no abnormalities. His Doctor had booked him directly into a medical assessment ward to bypass A&E so the car took him in as it was unlikely he would deteriorate.

We just got back to station for some lunch, and no sooner had I put my baked beans on the hob that we got sent to a nearby town for a male who had fallen more 8 feet from a crane and was unconscious. We were asked to provide an early update of the air ambulance. We arrived to find that the he was in fact fully conscious and alert with no serious injuries, so stood the helicopter down. He had been knocked out for less than a minute and sustained a relatively minor head injury and a probable broken wrist. We took him to A&E giving him some good pain relief on the way.

5th call was an urgent case (normal road speed admission) for a lady with a looooooong medical history of just about every ailment you can imagine. A recent blood test revealed that her kidney function had reduced so she needed to be admitted to a ward for treatment. The Doctor felt it appropriate to book an ambulance to transport her so she could receive a full set of medical observations and and ECG so we might correct any problems we encounter. Everything checked out fine and it was an uneventful transport.

Our final emergency was at a Doctor’s surgery for a lady who possibly had pneumonia. A middle-aged lady who had a 2 day history of a cough with shortness of breath. Her Oxygen levels were reduced below normal limits so she needed admission to A&E. We took a quick hand over from a very busy Doctor and took her to the ambulance. We listened to her chest and heard a pronounced wheeze, so we set up a nebuliser (oxygen mask with a drug to help with the breathing) which worked a treat. We performed an ECG to rule out a cardiac cause of the shortness of breath – it revealed no abnormalities. We did, however, note that she had a temperature and her blood sugars were slightly raised. That along with a fast heart rate (tachycardia) and increased respiratory rate meant it was possible she was septic following a chest infection, so we took her to A&E where they will perform blood tests and chest X-rays to diagnose the problem and treat as appropriate.

120 miles covered, 6 patients and 3 cups of tea. Not a bad day overall, even managed to eat my beans on toast in the end!

Hopefully this highlights how we have to be learned in a wide range of things, from life threatening trauma to routine medical problems. All part of the enjoyment of the job – you really never know what you’ll see next!

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Best job in the world, here’s why:

I feel it’s high time I sing the praises of the Ambulance Service as a career choice. It’s all too easy to moan about this and that but all jobs have their down points. Here are some of my favourite things about working for the Ambulance Service.

  • No matter what sort of day you’ve had, at the end of a shift you can always look back and think that you’ve helped at least one person. Just turning up in your ambulance with your kit makes people really happy, because when you arrive, the pressure’s off them. I’m not sure of any job outside the emergency services where simply arriving makes such an impact.
  • You get to use cool pieces of equipment. As a child I watched ‘Casualty’ (the English equivalent of ER in the USA) and see the Paramedics using spinal boards, stretchers and defibrillators. I NOW USE THESE!!…..ME!!……AS MY JOB!!! Cool!
  • You get to drive with blue lights and sirens. I don’t care what anyone says, even after almost three years doing the job, I still get a buzz from response driving. Sometimes I catch a reflection of my Ambulance in a shop window while on blue lights and can scarcely believe that it’s me driving it! I love the sight of cues of traffic parting like the Red Sea for ME!
  • You get to ease people’s worry. It’s a wonderful feeling being able to tell someone that they, or their loved one will be OK. The relief on their faces would warm even the coldest of souls.
  • You learn so much about such an interesting subject. There’s no doubt that most medical professions are vocational. I don’t think you could just turn around and say “right, today I’m going to become a Nurse/Doctor/Paramedic”, you have to really want it and want it for the right reasons. They say every day is a school day, in this job it is. There are so many unusual medical conditions and clever ways to treat them that in a whole career you won’t see everything. To learn something (almost) every day that truly amazes is magical.
  • You get to work outside. Not so good when it’s -3 and raining sideways, but lovely in the summer. Sat on the grass in the summer waiting for your next shout – it aint a bad life.
  • Once in a while, you actually save someone’s life. Not very often – the job isn’t as glamorous as the media would have you believe – but occasionally, you’ll come across a patient that without your treatment, would surely die. I don’t just mean driving them really fast to a hospital so the A&E Nurses and Doctors can work their magic, I mean the time when you have to give an injection of Adrenaline and Hydrocortisone to the Asthma patient who will stop breathing if you don’t. When you apply a tourniquet to someone with a catastrophic bleed, because they’ll haemorrhage to death if you don’t. When you give CPR and shocks to the patient in Cardiac Arrest because, well, because they’re technically dead and you want to bring them back to life.
  • We’re mostly respected by the public. “You guys do such a good job”, “you’re angels in green”, “I don’t know where we’d be without you” are some of the lovely things people say to us. You need to be modest to do this job 🙂

This isn’t the full list, just a highlight of the best bits of the Ambulance Service.

As I say to most people, “good days and bad days, but it’s the best job in the world”.

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