An Unconvinced EMT

At one time, I used to post a lot of true stories about my time in the London Ambulance Service. Eventually, they can become repetitive, such is the nature of the job. And some are hard to believe, I understand that. Because truth really is stranger than fiction. If anyone has never read any, they can all be found in the ‘Categories’ on the right of any page, under ‘Ambulance Stories’. And you have my sworn promise that each and every one of them is 100% accurate.

However, there is one thing about doing that job that you may not be aware of. People lie.

In their desire to make sure that an emergency ambulance will be sent, members of the public are not above lying. In cases where they are not actually inventing an illness, they do not hesitate to ’embellish’ what symptoms might be presenting, until an everyday bellyache can be made to sound like a ruptured Aortic Aneurysm. Others with indegstion after consuming a huge Indian meal and six beers will say they are ‘having a heart attack’, without trying to take any antacid medicine first.

And you may find it hard to believe that some people actually want to be in hospital. They like the attention, the sympathy, the company, and the sense of drama as they are wheeled into the emergency room. Would you be surprised to know that some people actually call 999 for an ambulance as much as 100 times a year? Or that so-called ‘nuisance callers’ are actually sent letters telling them that no more ambulances will be sent in response to their frequent calls? And it is not rare, and not just lonely people, or elderly people. Neither are most of them mentally ill, in any form. They just like having the emergency services come to them.

Then there is the strange world of ‘Munchausen by Proxy’. If you have never heard of this, it is where someone calls you on behalf of a relative, and tells you that they are very ill or injured, and need medical treatment. In most cases I experienced, this was usually a female caller, asking for help for a baby or small child. In a few very sad cases, it was discovered later that they had actually injured the child themselves, or poisoned them in some way that proved they needed emergency treatment. When I joined up as an EMT, I never expected to be called to a child injured by its own mother just so that she could get attention. This is also more common than you might expect, especially in a huge city like London. Here is a proper explanation of it.

This also has a ‘twin’, in the singular ‘Munchausen’s Syndrome’, where the caller has injured or drugged themselves, or invented an illness in order to seek medical attention or admission to hospital.

As well as wasting the time of the control room call-takers, the ambulance crews that could be doing something better, and the overworked hospital staff, they create something else. After years of this, day in day out, ambulance staff become cynical, disbelieving, and jaded. Someone tells you that they have this disease, or that illness, and you don’t take their word for any of it. Don’t get me wrong here, they are still treated respectfully and professionally, but they have created a culture whereby only visible injury or diagnosed serious symptoms are considered to be ‘worthwhile’ by those doing the job.

By the time I had been in the job for fifteen years, this situation had become so widespread, that a term was invented for it. ‘Paramedic Burnout’.

Officially, this was used to describe working in a very stressful and often harrowing job for so long, that staff became overwhelmed by it, similar to PTSD. Unofficially, it was staff who were sick to death of constantly attending time-wasting calls, being lied to, and being verbally and physically abused. I got to the stage, and so did many of my colleagues, where I firmly believed that at the very least, around fifty percent of the calls we were being sent to were spurious, or did not require an emergency attendance.

It comes to something where going to a train crash where 30 people have been killed and over 400 injured, is referred to as a ‘good job’. Or when you walk over to the body of a young woman who has jumped from a twenty-second floor balcony, turn to your colleague and say “At least she meant to do it”.

The next time you move your car over for an ambulance coming past with lights flashing, and sirens blaring, thanks for doing that. As they take their lives in their hands to speed through traffic heading for the next emergency, let’s hope they are not just on their way to someone who has eaten too much spicy food.

Ambulance Stories (49)

Saving Lives.

On another blog, I was asked a question by the lovely Kim. That post told the story of how I drowned as a child, and how I was saved by a brave angler standing nearby. She commented there, and went on to see the connection, that my life was saved, and I later went on to work as an EMT, intent on saving lives myself.  It’s a reasonably straightforward question, “How many lives did you save?” It got me thinking, and led me to write this post, which I am including in my category of ‘Ambulance Stories’.

Most people presume that ambulance crews save lives. It’s a fair presumption, and reinforced by scenes on the news media, documentaries on TV, and scenes in films and dramas. The reality of working in emergency ambulances in a big city like London is very different though. Much of the day to day work is dealing with old people who have chronic conditions like Asthma, Heart Disease, Diabetes, and Circulatory Disease. Some have suffered strokes, others have Dementia, or one of the many other debilitating conditions that affect us all eventually. Constant calls are made to the 999 (911) service to attend to these old people, and they live their lives on a merry go round of hospital attendance, admission, discharge home, and back again.

Then there are the inter-hospital transfers. Taking a patient from one hospital to another can take up a lot of your time. These Emergency Transfers are usually accompanied by medical teams, and may be necessary for brain scans, severe burns, or premature babies. Given the distances involved, the preparation of the huge amounts of equipment needed, and delays at each hospital, a job like that could well take up half of an eight-hour shift.

Mental illness is also a huge part of working in emergency ambulances. Persistent callers, disturbed people who cannot cope alone, or are having a crisis. People with suicidal tendencies, or those who self-harm, suffer with Anorexia, or perhaps wish harm to others. With more and more of these patients discharged into the ‘Community’ to fend for themselves, their care has been transferred to calling for an ambulance, at least in the first instance. It is easily possible to do a run of shifts without ever attending what most people would consider to be an actual ’emergency’.

So, almost 22 years, and thousands of emergency calls later, did I actually ever save anyone’s life? Strange that you have to think about it, given the nature of the job. The main remit of the emergency ambulance when I joined was to get people into hospital alive if possible, to be handed over to expert nurses and doctors who then treated them. We had few drugs, and defibrillators were only ‘on trial’ back then. Most of our training was a legacy from the 1950s; bandages, splints, and the administration of oxygen, and nitrous oxide. The accepted practice was known as ‘swoop and scoop’. Arrive as soon as possible, and get the patient into the vehicle as painlessly as we could. Scoop them off the street, and get them to a hospital that was close by.

Over the years, that changed a great deal. New drugs, better diagnostic equipment, and the ability to treat more conditions on scene led to taking more time with the patients, and administering more treatment before leaving for a hospital. Those hospitals changed too. Certain areas developed specialist centres, and we could no longer just go to the one that happened to be the nearest to the job. Protocols and training updated all the time, and the technical aspects of being an ambulance worker became more complicated too, with the crews becoming more accountable for their actions. Today’s emergency ambulances are a world away from those I started on, and the job itself is very different too.

After all that, I have to answer Kim’s question. Did I actually save any lives?

Some, for sure. Recognising a problem that I might have overlooked was definitely a way of saving lives. Placenta previa can be fatal if not spotted and properly treated, so I do recall at least three occasions where that saved someone’s life. Correct diagnosis of a Diabetic coma, often mistaken for someone being drunk and aggressive, that can definitely save a life and was something I managed a few times. Something as simple as getting someone off of their back, so they do not inhale fluid or vomit; this can also save a life, and was something we did all the time. Delivering a baby at home, with all the potential complications for mother and baby. I recall fourteen occasions where I did this, though mostly I just ‘caught’ the baby as it slid out!

On a few occasions, I kept people with serious burns alive, at least long enough to get into hospital for specialist treatment. But whether or not that saved their life, I never found out. Then there is the difficult subject of CPR, which is very often shown as incredibly effective on TV shows and films. In truth, it rarely works, and depends how long the person has been left like that before we arrived. On one occasion, just the one, in all those years, we attended a lady who had suffered a cardiac arrest on an underground train. We just happened to be outside the station at the time, and a fellow passenger who was a doctor had already started CPR. We got the lady into hospital with an output, and she went for emergency heart surgery that morning. She later sent us a letter of thanks, so I can say that we all definitely saved her life.

One evening, I spent a long time sitting on the balcony of a flat at the top of a tower block. The female resident was perched on the ledge, intending to jump. I managed to talk her out of it by telling her how awful her body would look, once it had made contact with the street below. Perhaps vanity saved her life, along with my rather brutal description.

But most of the time, we just did our best. We did what we could, faced with the conditions we found, and using the equipment available. As they say in medicine, “First, do no harm.”

Ambulance life

For those who read my posts on a regular basis, you may see a pattern appearing in my ‘Ambulance Stories’ category. That pattern is that many of the calls we were sent to, differ greatly from the description given to us by Ambulance Control. This may seem fanciful and affected to the outsider, though I can assure you that all these stories are 100% accurate. Perhaps some explanation of general life as an Ambulanceman in London (at least when I was still in it ) will put some of this into better context.

At the time I joined, the London Ambulance Service was a very different organisation to the one it is today. It was short-staffed, under-funded, and the staff were poorly paid, and did the job with very little equipment. Many of the operational managers were ex-military types, and the uniform reflected this, in being totally unsuitable for the job. We were provided with made-to-measure jackets and trousers, from a well-known high street chain of tailors. There was a short gabardine overcoat issued, as well as gloves, rain mac, clip-on ties (for safety reasons) and of course, a cap. Shoes were provided, but they were issued for smartness, rather than practicality. The golden rule, was that both members of staff on the ambulance must be dressed the same at all times; so if you wanted to take off your jacket, your colleague had to do the same, and so on.

During training, we had to parade for pay, as in the Services; and we were divided into classes that would rotate around the different modules, mainly due to the chronic shortage of equipment. The exception was the driving course; this was up to Police standards, fully comprehensive, and taken very seriously. Otherwise, it was a Dad’s Army event, wooden splints, triangular bandages, blankets in abundance, and little technical skill necessary. This is no reflection on the Instructors, as they did the best they could, by imparting their own skills, and experience. The accepted standards of today’s Paramedic; Infusion, Intubation, Defibrillation, Drug Administration, that all came a lot later. After training, we would be assigned, as a pair, to a Training Supervisor, who would look after us for a six-week operational training period, always undertaken in Central London, at the busiest Ambulance Stations.

During this period, we learned to completely distrust and despise Ambulance Control. They were not Operational Staff, and few had ever been. Yet, they bossed us around as if they knew what was happening, and had the required rank to get us into serious trouble, if they so choose to do so. From a small Control Room in Waterloo, they lorded over the staff like kings, and spoke to us as if we were as low as could be. With notable exceptions, they were regarded as the enemy, and rightly so, in my opinion, then, and now.  As a consequence, we learned to argue with them all the time, and to disregard their sloppy diagnostic efforts, as well as to avoid all but necessary contact with them. In all the years that I served, I probably only respected five Control Staff, and all of them had once been operational.

There are three emergency services operating in London, and the LAS  was, by any examination, the poor relation, or the Cinderella service. The London Fire Brigade was the premier service. They took charge by default, whatever the situation we found ourselves in. This was a legacy of various events, and of better training, and equipment. We derided them with various nick-names; Smurfs, Water fairies, Window Cleaners, Yellow Trousers. They were muscle-men, locked in camaraderie, and with Local Council working conditions, much envied by the other 999 services. Their perceived intelligence was low, and they embraced their priority with an embarrassing fervour. After them, came the Metropolitan Police. They had a good working relationship with the LAS, and the same dislike and distrust of the Fire Brigade. If we went to an incident jointly, we had to operate under the instructions of the LFB, something that went against the grain, for both the LAS, and the Met Police.

So that was the structure. Fireman first, Police second, Ambulance third. I received the pitiful sum of £49 a week in 1980, that was after taxation and other stoppages, for a 40 hour week, on a full 24-hour shift rotation. Breaks were not guaranteed, and if we had no break all shift, we were paid £1.50p in allowances. With that in mind, it is obvious to anyone, that at least most of us, were doing the job for the right reasons, and with the best of intentions. So, whatever you may read in my blogs, you can now put it into context of the time and place, and the working conditions we faced. Hopefully, you may feel more sympathetic to the situation we were in, and understand more of the cynicism, and subsequent militancy that developed in time.

This is an overview of the early days. Things did change later, though not always for the better. That is another post though.

We all have a book in us

How many times has this been heard over the years? Approaching Retirement, I was often told, ‘now is the time to write that book’. After all, I had led a comparatively exciting working life. Over 20 years in a front line ambulance, followed by more than 10 years behind the scenes working for the Metropolitan Police. I had attended bombings, and major disasters. I had delivered babies, cared for victims of terrible burns and injuries, and ended my working life deploying firearms officers in Central London. There was also the possibility to inject humour, with unusual tales of quirky events, mistakes and errors made, and the strange characters that I had dealt with, or worked alongside. I had travelled a fair bit. What about experiences behind the ‘Iron Curtain’ in Soviet Russia, or visiting East Germany many years before the wall came down?
If this did not provide fertile enough ground for that book, there were always my personal interests. History, Civil Wars, Cameras and Photography, Dickensian London, and the development of weapons through the ages. Maybe I could use my experiences with the Police, to write about modern crime-fighting in the Metropolis? There was always the possibility that my new life in Norfolk would yield great material for a book about the transition from London to the countryside. I would definitely look into it. After all, didn’t my life deserve a printed legacy, or to be available as an electronic download? Surely I too deserved to be in the remainder bins at half price, or in the window of Waterstones as the cheapest of the ‘buy 3 get 1 free offer? Failing all that, I could adapt these experiences and interests, to write a work of fiction, loosely based on something I knew a bit about.

I considered all the options, starting with the obvious. My Life in the Ambulance Service. An interesting read, with a few chuckles, and lots of gasps. From the end of the 1970’s, to the start of the 21st century. Strikes, civil disorder, changes in the NHS, advancements in care, yet the job was essentially the same. There have been a few written already. They didn’t sell well. There was one exception to this, the marvellous ‘Bringing out the dead’, the only work to ever get inside the darker aspects of the job of a Paramedic. Generally though, people don’t want to read the truth about injury and illness. It just isn’t entertaining or informative.
What about Oliver Cromwell and the English Civil War? I have always been interested in that period. I am a member of the Cromwell Association, and I live in East Anglia, so research should be easy. I was forgetting Antonia Fraser. Her definitive biography of the man and his times, as thick as a telephone directory, immaculately researched, and a great read for anyone interested in the subject. No point trying to better that.
Perhaps a crime thriller, drawing on my Police contacts? I remembered the novel ‘By Reason of Insanity’. Probably the best book about a serial killer, and those hunting him, ever written. Then there were the books about forensic detectives, pathologists, or those with a gritty, authentic feel, like the ‘Rebus’ series. Could I do better than all these?

I doubt it.
How about a non-fiction work of importance, say the history of a great city like London? Oops, Peter Ackroyd beat me to that one.
This leaves the fish- out- of- water transition to a strange land, as my best bet. Hang on, am I forgetting Bill Bryson, or ‘A Year in Provence’? My feeble musings on a life in Norfolk are never going to hold a candle to these best sellers.
So, it had to be a well-researched, thought-provoking work about the unhappy lot of the working class in Victorian London. I would start right away. I had the credentials, as I came from the poorest district in South London, Rotherhithe. Nuzzling the south bank of the Thames, this was a place that had changed beyond recognition, from unspeakable slum, it had become a fashionable, dockside development. The docks had closed, and the inhabitants mostly moved away. There had to be some mileage in that surely? No. I had forgotten Charles Dickens, not to mention Mr Ackroyd (again).

My conclusion is that we do not all have a book ‘in us’. Writers and authors have books in them. They get up early, write long and hard. They research, they study, they read other books, and they strive for excellence. They are their own harshest critics, and they give their lives to their work. Families are shunned, homes re-mortgaged, lovers abandoned, luxuries are foregone. They also have good ideas, and act upon them.

The recent meteoric success of ‘Fifty Shades of Grey’ and its sequels, fuelled by social media sites on the Internet, is a good example. Written by a lady who waited until she had seen her family grow, and her career aspirations satisfied, she embarked on her trilogy of lust, bondage and dark love. It has probably made her a fortune, and she has the film rights to come as well.
I could have had that idea. I could imagine sex and bondage, vulnerable females, and a dark central character. It can’t be that difficult can it? But I didn’t have the idea, and if I had, I wouldn’t have acted on it. E. L James had the idea, and she did the work necessary to get it into print. She reaps a just reward, good luck to her. That is the difference between writers and readers. If you want to be a writer, you have to act on those ideas, and be prepared to work hard to make them appear on a page. They don’t always have to be new, but they must catch a mood, and be of their time. Just because you did something interesting, doesn’t necessarily make that thing, or you, interesting as well, when translated to the written page.

Keep reading, and enjoy those books. I choose to stop believing that I have a book ‘in me’. I don’t.