Wednesday, 9 July 2014

Four nights shifts and an egg and spoon race

I'm very tired after this latest run of four. These nights seem to be getting longer and longer as we are continually hammered from the moment we sign on duty until we make our weak attempts to get home on time.

There is virtually no respite now. Everybody and his dog wants (or thinks they need) an ambulance. I'm spending longer periods at scene with patients - some of them very unwell indeed - because there are not enough ambulances to cover the demand.

And this is going to become a not-so-rare event. I already feel like my time is running out and now a colleague has felt the impact of what is one of the most dangerous enterprises in the country; running at high speed to calls that may or may not be life-threatening (but that are very likely NOT to be) in traffic and conditions that are against you all the way. Some motorists simply don't see us, or acknowledge us any more. Do they think that because we are running around on blue lights so often that we're just going on yet another drunk call? Maybe so. Maybe they're right to be so unimpressed.

But every now and then I have to treat a seriously unwell person; someone I want to save. Occasionally I will be thrown into a dramatic and eventful call where it matters what I do and it matters that I do it right. Is the constant pressure we are under, responding under emergency conditions to those who've drunk too much alcohol or who've been nursing a cough for two weeks but now feel they have chest pain or 'DIB' eventually going to cost so many of those genuinely unwell people that the game is no longer safe to play?

I can't say what my heart feels; it would cost me my job and my career no doubt. But I am sick of risking my life for those who need to grow up or get themselves educated. Sometimes a little first aid training will do the trick but even that is flawed. There are first aiders out there who would rather call an ambulance to a sore thumb than risk being sued - or so they would believe. Back-covering is just one aspect of this disease of complete reliance on the emergency services.

I know I speak on behalf of the majority of my colleagues - especially my fellow paramedics. We are expected to help bring life into this world and to ease the pain of those leaving it, as well as everything in-between for not a lot of pay. We stand for everything that is important in pre-hospital medicine - patients tend to trust us more than they do their own GPs. We spend more time with them. We listen to them and we fix them whenever we can. But we are struck off and disabled from our careers in an instant if we make a mistake or say the wrong thing to the wrong person at the the wrong time. Yet here is an example of simplicity in brotherhood. It applies to doctors but doesn't apply to us.

I reserve judgement in this case of course because I don't disagree that the boy may not have been saved and that is not my problem with it (tragic and sad as it was), but I'm pretty certain that if that had been a paramedic, making the same errors in clinical judgement and saying that 'in hindsight' he'd have done something differently, he or she would not have a job the next day and would be off the professional register! He or she would probably have put in a 12 hour shift, without a break and would very likely have been given a late job, forcing him or her into overtime he or she did not request or want - ultimately making safe clinical judgements, never mind the ability to drive at high speed safely, a real problem!

On behalf of all my colleagues, all over the country - I applaud you. God knows, very few others will. And what is it you want? Respect, courtesy and understanding. No amount of extra money is going to make any difference to the way you feel, right? You want people to know that your morale is sinking, if not already in the gutter. No wonder people are leaving the profession almost as quickly as they are joining it!

I love my job; I don't particularly love the way it runs. I want us to be strict about how we send emergency ambulances to calls. I want us to be clever about how we deal with non-emergency patients. Most of all, I want support and empathy when I am out there battling with my brothers and sisters. I want to help sick people; genuinely sick people.

We need our own professional register, run by paramedics for paramedics. We need our practices and disciplinary procedures to mirror those of the other medical professions, without what appears to be an overbearing emphasis on striking us off for much, much less than the example I've given. It's simply unfair that such a drastic mistake in known procedure is apparently just going to 'go away' because it was a doctor involved.

At the end of my tour of nights, I went straight home and straight onto a grassy track where my son's nursery school sports day was being held. I held an egg in a spoon and ran like a tired man to the finish line with four or five other dads. I made it to the line second to last because I believed one of the dads who said 'right chaps, lets not run' and I was far too tired to run anyway!

Be safe.

Monday, 9 June 2014

Human pigeons

THIS sort of thing says an awful lot about humanity. I'm all for protecting the privacy and security of people's homes. I'm sure nobody wants to have a 'rough sleeper' bedding down on their doorstep every night, and I'm almost certain that most of the outraged people petitioning about this would rather not have a homeless person migrating towards their neighbourhood.

However. Installing measures like this to ensure that people cannot lay down is a wee bit over the top in my opinion. We install very similar protrusions to stop pigeons from landing on window ledges and overhung building entrances. Are we now treating human beings like pests?

Over the course of a decade or so,  I have become acquainted with many of London's homeless souls and, apart from the rare exception, drunk or sober - they are just people whose luck has run out. They have nowhere to go and nothing to go to. They depend on charities and pure-hearted volunteers, who often get up at rotten-o'clock in the morning to go and feed them breakfast. That way, they have at least one good meal inside them as they wander the city.

In order to sleep and to stay safe, many of them will bed down in doorways and, believe it or not, even some the most high-brow establishments tolerate it, so long as they move on before the day's trade begins. This seems to me to be a fair and just trade-off, even if, every now and then, a little debris is left behind. Generally, however, rough sleeping individuals get up, pack their things and stroll off for the day. Some return to the same spot night after night, while others migrate around the Capital.

I have spoken to and listened to many of these people. You should know that they all have a story and it doesn't necessarily involve a decline into alcoholism, although even those stories have a relevant background plot. And never forget that we can all end up where they are. It just takes a chain of unfortunate events.

I hope these spikes are removed. I understand the building owner's desire to protect the residents and we don't actually know if there was a critical point at which this decision was made. For example, we don't know that sleeping in that spot was tolerated until it became abused. Or that the area was deliberately soiled with urine or excrement (this can happen unfortunately). But there are other ways of dealing with abusers; there are less inhumane methods of discouraging such behaviour.

We still get calls from premises informing us that there is an 'unconscious' person in the street or near a doorway and when we turn up it can smack of nothing more than the need to have an unsightly thing removed from the area. All we have to do is wake the sleeper up and ask him/her to find somewhere more private and out of the way to rest. Needless to say, this exercise has cost you, the taxpayer, hundreds of pounds and has potentially taken an ambulance away from someone in desperate need of one.

If you own a business or residence in the city and you don't like the look of someone on the ground or in a doorway, try going over to them and asking them to move along. Be nice. Be polite and explain that ambulances may be called for them when they don't really need one. You may be surprised by the reaction.

Unless of course you truly believe that it's too risky and that you may get hurt. In which case I'd ask this question of you. What makes you think it's okay for me or my colleagues to take similar risks? Why didn't you call the police?

No spikes. No pre-judgments. Try kindness.

Be safe.

Monday, 26 May 2014


It's not a word used very often, and when it is, the relevance is rarely on point. But, when you are in a group of mates, out for the night and getting loaded on alcohol (because that's the way its done nowadays), and you dump one of your friends because he or she is too drunk - that's abandonment.

I don't mean dropping them somewhere safe and warm to sleep it off; I'm talking about so-called friends who simply leave their drunken mate on a bus, in a taxi... or even worse, on the street. Shockingly, the vast majority of those I've attended in this situation are female. I'd always considered girls to be more protective about their friends, but suddenly at some point in the night, all of the close-knit, protective posturing goes out of the window because one of the group is too drunk to manage any longer. She can't walk to the next club or bar. She is vomiting too much, or she is practically unconscious and a dead weight on the night's proceedings.

A few years ago I was called to a young teenager who was found by a male passer-by in a doorway in the early hours of the morning during a weekend. She was curled up, half dressed and with vomit in her hair on the step of an office building entrance. When I got her awake and she was able to speak to me, she told me that her friends her left her and she'd tried to get a cab home alone. She'd thrown up in the back of the taxi and the driver had thrown her out. She'd staggered over to the step and curled up to sleep.

This young girl's temperature was hypothermic as I recall. She wouldn't have died but she was extremely vulnerable and at risk. You just have to watch what goes on in Leicester Square every weekend night to realise what a dangerous situation lone young girls are in. Men prey on them openly, pawing at them and trying to get them to go with them to God knows where. This young girl was far enough away from the hub of things to be invisible to those vultures but not necessarily safe from harm.

As it happened a young man called 999 when he saw her lying there. He didn't touch her, and he didn't try to wake her - he didn't want to frighten her.

The most recent call (and there have been dozens prior to this) was for a young woman who'd been left on a bus by her friends. They'd gone off to enjoy themselves without the responsibility she'd burdened them with when she got too drunk to be capable of anything any longer.

She was seen asleep on the bus and taken off by a complete stranger. This man sat her on the bench of a bus shelter and called an ambulance for her. She didn't really need to go to hospital but his reasoning was simple; she was alone and vulnerable.

So, I'm appealing to you if you are someone who'd drop a friend on a night out just because you want to continue and he or she is not fit to do so. Stop and consider what you are risking. Leaving your mate behind, alone and exposed, is not clever. Parts of London are not safe for lone young females (or males for that matter). Please think about the possible consequences of abandoning someone to their fate.

If you prefer to complete your night out and don't want your friend to drag you down, then consider monitoring how much and how quickly they drink. Warn them before they get too far into it that everyone's night will be ruined if they get so drunk that they cannot function.

A lot of our workload is taken up with this, because alcohol is consumed like water and I'm seeing more and more young females 'unconscious' in the street, or in the toilets, or on the floor of a club.

Please look after yourselves. Don't be stupid and stay well away from the drink-fast-drink-lots fad that seems to be sweeping the country. Be sensible with your drinking and keep it paced and measured.

Be safe

Tuesday, 22 April 2014

Wind shift

It has been more than a year since my last post and there have been many changes.

I have changed, my job has changed and the profession has changed. Its simply not what it used to be.

I am reluctant to write in the open and honest way that I used to; there are too many sensitive people out there. It's too easy to offend and bother, either by accident or by being truthful. The design of this blog was deliberate. I set out to let readers know what I experienced and how I experienced it. The result of this, over the years, has been that a number of individuals have become paramedics after reading and following the words I wrote.

A change in my posting methodology is required; I need to write only that which is relevant and neutral while I am professionally bound to one or the other. This is the way of things these days.

The profession is different too. We are answering emergency calls that can, at best, be described as not in the least life-threatening. Insect bites, toilet-tissue incidents and sore thumbs now, apparently, count as worth our lives and the risk of losing them while we run on blue lights and sirens through an ever-obstructive and seemingly non-caring driver world. In the year that has passed, I have had my life threatened directly, been verbally and physically abused by those I tried to help and have had less and less time with my family as the tide changes in favour of the thousands of callers who simply do not need an ambulance, but who call one because they think there is no other option, or they have little or no understanding of their medical or physical problem. All of this is well documented; all of this is on your TV in the shape of fly-on-the-wall entertainment. I am not saying anything here that you do not already know.

My colleagues are tired and depressed. They are leaving the profession, or going to places where there is still hope for pre-hospital care. Paramedics have become nomadic. Almost every ambulance service in the country is experiencing a filter-through of new and experienced personnel. Potentially, if enough of the more experienced paramedics leave their service, the patient knowledge-base will stagnate to only that which is within a few years scope of practice.

Perhaps this is the best way to develop the profession. I haven't met anyone yet who agrees that it is, but nothing here makes me right until it has run its course.

Paramedics are also still extremely vulnerable to losing all that they have worked so hard to achieve because we are still registered with a body that encompasses many other 'peripheral' medical professions. We are not registered alongside nurse or doctors, where I believe we should be. Neither do we have our own professional society - we have a college but its not a 'Royal College'. Not enough paramedics have signed up for it, so it doesn't have the teeth it needs to defend us when the smallest error and sometimes (as recent stories will confirm) doing what we thought was the right thing, can get you sacked and struck off. In comparison to other medical professions, we appear to be the ones set  up to fall the hardest. Where's our protection and assurance?

I still care deeply about my patients and I still love what I do (when I'm doing it properly) but I'm less passionate about my direction of travel. I can't see how on earth we are going to be able to sustain things as they are. Everyone wants an answer; everyone wants to know how we can save money and cut the NHS workload... but nobody is asking us.

What we need is a shift in the wind.