Goodbye to a good man

I've had plenty to write about but have lost the heart to write it in the past year. You know how much we are being crushed under the weight of it all. Too many people need (or think they need) an ambulance and there's far too few of us to help them.

This post isn't about all that and I may just possibly find the impulse to post regularly again next year, we'll see.

I'm posting to say thank you to Sahib Lalli, the police officer who died last week at a young age. My colleagues were unable to save him and I guess that's where our territories divide; greater powers than us decide the outcome, especially for the best of us.

I knew this officer, as I do many of the men and women who work the West End of London. I have spent many hours over the years chatting to the people of the Met and finding out just how human they are... and how vulnerable at times.

Of course, opinions vary when it comes to what we think of our police officers but, as a front line professional, I've needed them and they've needed me on so many occasions that you simply cannot distinguish some of them from your own family.

So, here's to you PC Sab Lal; rest in peace.

Xf

Devolution

What's to be done? I'm actually starting to feel some despair about the situation.

I was sitting in my response car at the scene of a call. There was an ambulance behind me - the crew was in the back treating the patient, who'd felt faint but hadn't actually passed out. I was on the phone to a fellow paramedic when a man approached me and asked me to wind down my window, which I duly did (although these days I'm a little bit more cautious about doing so).

The following exchange then took place.

Man: "Sorry for interrupting but I pay for the NHS too, so can you tell me why there are so many ambulances parked on this road?" (I should remind you that there were two!)

He went on to ask, "Are you waiting for something?" to which I replied, "We are dealing with an emergency call"

Man: "Are you on stand-by?"

Me: "No sir, we are dealing with a patient. The crew in the ambulance is treating her right now".

Man: "And you are doing what?"

I have to admit I was mildly shocked at this question. I suppose being on the phone and not doing anything relevant to my role must have irked him in some way. I'm not really sure.

So I replied, "I am talking to a colleague on the phone while I wait for my colleagues to tell me what the results of their tests are".

I was waiting, as I normally do, for my colleagues to pass me the ECG. They were treating a young woman for near-faint, so an ECG is in order. However, I usually leave the ambulance to reduce the number of males present for this check. That way the young lady's dignity is preserved.

Man: "Oh, I apologise profusely".

He then staggered down the road. He had been drinking but he was not completely wasted on alcohol.

One of the crew from the ambulance appeared a few minutes later and I told her what had happened and she told me that a man had opened the back door of the ambulance just as they were covering the patient up. He looked in and asked them if they could spare a pound!

This stuff may seem funny but its not. The pigeon story says a lot about where we are heading and what is going wrong but nobody dares say it or hint at it for fear of being punished.

I had a conversation recently with someone about my own views on certain incidents that have taken place in the world and I got an extremely incendiary response. I found myself backing away from the subject simply because the other person couldn't hold another view or entertain the possibility that the 'popular' truth was not so. This is denial and it stems from fear.

We should be talking openly and honestly - as brutally as required - so that we can get to the bottom of our problems and solve them. We need not scapegoat people or organisations but we must dismantle this multi-layered approach to system preservation at all costs. If it doesn't work, own up and take it apart.

I am reminded so often of our condition when I watch Gordon Ramsay go head-to-head with a stubborn restaurant owner who is convinced his food is great when every single customer he has is telling him otherwise!

We have a problem and it is bigger than the NHS and the Government. It is human and it is devolving.

Be safe.

Elephants

It has been a long time since my last post but my family and career must come first and if anything I write threatens them, I need to temper my emotions; thus less to say of pertinence.

This week I was invited to sit on a panel during a live national television debate on the 'NHS Crisis' and so, after four busy night shifts in a row, I appeared, bleary-eyed, in front of the nation, along with other healthcare professionals and an assortment of politicians, celebrities and members of the public with a story to tell.

The programme, called 'NHS in crisis - the live debate', which you can see here, discussed the failings of our great healthcare system - the strain it is under and the possible causes. It ran for an hour and I sat, for the most part, in the audience, whilst waiting to take my seat in front of the cameras to say my piece.

I watched the audience and I listened to the panels that came before mine and it became clear that there was an awful lot of hatred for the Government and its policies. Fair enough, there is indeed a major problem with the way the NHS is being run and financed and politicians seem to be avoiding the issues that could break the system. But money gets thrown at it from all angles; every time there is a warning of impending collapse, it seems like a few more hundred million is injected into it. This, to me, is much like injecting antibiotics into the body of someone with a deadly viral condition.

At times I felt overpowered by the feelings of hostility and a few totally irrelevant things were said; things that will go nowhere and do nothing to fix the NHS. One extremely angry woman almost spat venom in her attempt to get a point across but it was anger that would serve to change absolutely nothing about the way the system works and the way I operate within it. It did, however, lend us all a moment of the public's frustration.

I was given a very short time to make a single point - I had many points to make and a lot to debate but I got nowhere near the time I needed to do so. The NHS 'front-line' was heavily represented by doctors and nurses. Apart from myself, there was just one other paramedic present to say something, and he only got seconds to make a statement from the audience.

Now I don't mean to be picky here, but let's define the 'front-line'. A hospital, and therefore its medical staff, is not on the front-line. Patients either present themselves there or are referred there by other healthcare professionals. Doctors and nurses working in hospitals do not go out and get these patients; they do not see them when they are at their worst, or at the moment of their deaths in the streets or at home. They are not subject to the same level of unprotected aggression and violence that ambulance professionals are.

They do an amazing job under very difficult circumstances and they are under extreme pressure, just as we are, but unless they are face-to-face with a patient, away from the protection and backup of a hospital or surgery, they are not truly front-line.

There are very few doctors and nurses working on the front-line as I see it. HEMS teams do and out of hours GPs and nurses do (when they actually go out).

Why does this make a difference? How can you debate the failings of a system like the NHS unless you are at the raw edge of it and can actually see what some (not all) of the problems might be.

The NHS is an old system, designed for a post-war population, when people were generally a lot more responsible for their own health. I find it highly unlikely that as soon as the doors opened to the first Accident and Emergency department, it was inundated with individuals with sore throats, mild back pain and drunkards. I wasn't around then so point me in the direction of a news item or photograph that says otherwise.

A proper debate on the subject needs to be given a balanced representation. Those not on the front-line will see the political problem, whereas we tend to see the root problems.

The cheering and applause was loudest for anyone who said something about Government policy and how they are to blame. Most of the negative responses, especially by some of the doctors and nurses in the audience, were elicited by any comment that appeared to blame the patients themselves.

In the audience sat an obese man who knew he'd brought it upon himself but still felt the NHS should pay for his treatment. And a young man who is suing the NHS because of a nose-job gone wrong. In both cases, when the presenter attempted to shine a light on the possibility that they represented part of the problem, the audience jumped up and down about it. I got a real sense of a massive drop in value of common sense and truth and I have to say, I found it unnerving. We seem to be a nation that defends those who may actually be contributing to the situation because we feel its better to blame a Government rather than an individual.

And of course, no individual is to blame for all of the problems of the NHS but if we don't open our eyes and see the little contributions to impending disaster, we are going to implode.

I spoke about young binge drinkers - those individuals who go out for a night and get so drunk that they end up in hospital. I felt this was a very important point to make but I could feel the audience distancing themselves from the suggestion that those individuals should be fined and that they should pay for their stay in A&E. Its simple; we bring them in because they are not fit and unsafe. A doctor examines them and declares them to be drunk (as if that really needs a medical exam to confirm). They sober up and they get a penalty ticket for £75 or whatever would be seen as suitable.

Drunk people take up a large number of beds in hospitals. In fact, alcohol-related visits to A&E account for most of the violence and wasted time experienced by staff. They are also a major cause of delays when it comes to getting ambulances to truly sick and vulnerable people. We still get calls to elderly people who are on the floor and have been for hours, especially during the weekend. A 19 year-old female who is said to be 'non-responsive' or 'unconscious' or 'not breathing properly' due to drinking, is likely to get a faster response than an 80 year-old on the floor and 'can't get up'. We are all sick of it, and when you look at the descriptions I've given for the young girl, don't they just sound like the sort of things that happen when you are very, very drunk?

How many drunken young people have died in the street or in a club or pub because an ambulance wasn't called or was delayed for hours? How many elderly people have, or could have died waiting for us? To me, the sums are easy.

The debate solved nothing and it created no force for change. Only one of the doctor guests (most of the doctors on the panels were TV celebs), made a statement about people taking responsibility for their own health. She got nothing back from the audience. Obviously, like myself, she was blaming the patient and not the Government. What she was doing was telling it like it is.

On my panel, a doctor stated that there was 'an elephant in the room' but failed to make the point. Funding and Government inadequacies are not elephants in rooms because they are plain and obvious problems and we all shout about them. The elephants are the problems we dare not talk about for fear of ridicule or attack from people who believe everything going wrong is the fault of the ruling party.

Sure, we need a cash injection to help modernise the NHS and bring it up to date. We need to pay doctors, nurses and paramedics what they deserve. We need to change the way the system works to better cope with a larger and more elderly population. But we also need to be honest and stop pretending that it's all about money - it's also about attitude and responsibility.

Demand for emergency services has risen dramatically because we are importing large numbers of people who use them because they are free. More and more tourists are descending on the country each year and they don't know how to use the NHS. Alcohol-related calls are increasing and nothing seems to be slowing the tidal wave of irresponsible youth. The elderly population is on the rise because people are living longer, ironically thanks in part to the NHS - these people fall a lot, they injure themselves and they have chronic or terminal illnesses that require treatment and emergency care.

The social care structure is also failing because emergency ambulances are being asked to go to more and more calls where the problem is social, emotional or mental health related. We can do nothing for these patients, so why are we there?

We bring all of this, and more, into hospital A&E departments, or we use another clinical pathway and we turn a steady flow into a Tsunami. If we just took care of one of these elements, we could start to reduce the flood. I suggested penalising those who get drunk and then expect the tax payer to pick up the bill for their night out. I'm suggesting making them responsible for their actions. That's just one idea and it might, just might, make weekends in A&E that little bit less critical.

I noticed that on New Year's Eve we had fewer drunken patients to deal with. This was the year that Boris Johnson charged an entry fee. If you wanted to get into Central London and watch the fireworks at midnight, you had to pay a tenner. I can't say for sure, but I think that small penalty put a lot of people off and therefore a lot of irresponsible drinkers (who'd rather have the extra money for alcohol) simply didn't show up. Voila!

This is a complex argument, I know and it's almost impossible to debate this subject without provoking anger and upsetting people. We all have different views but I think this live debate was mainly about what doctors, nurses and politicians had to say. The input from paramedics was dilute at best and that's a shame because if you had a room full of us, you'd soon get ideas for solving some of this crisis. Many won't like them and they may not be popular but they'd all make people responsible for their actions and more aware of their own health.

The alternative is to spend billions more and keep throwing money at it until another generation inherits the wreck of it. That's what we seem to do best.

Be safe.

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.

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.

Abandonment

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

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.