Ride it out

A North West Ambulance Service paramedic reveals the reality of what it's like on the frontline. As told to Marcus Raymond

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It’s the things outside my control that affect me most. When a patient deteriorates because we couldn’t get there quickly enough, that hurts. Though it’s not our fault, I feel so guilty. Yet sometimes this is when families are most understanding.

It’s been getting worse for years, going to patients waiting so long for ambulances. It would have come to this regardless of coronavirus. Something needs to change from a patient safety perspective.

A few years ago, in a 12-hour shift, we might see eight patients and feel we were having a positive impact. Last month, there was a shift where we saw four. The knock-on effect is patients waiting eight, ten hours and deteriorating.

Because we’re queuing that much longer at hospitals, we are not as mobile or able to wait to go to jobs, and people are suffering. When you’re in those queues, you worry the patient might have to deteriorate to get appropriate treatment, when it should be looked at proactively.

Minutes are vital in any medical emergency. Out-of-hospital cardiac arrest requires early CPR and defibrillation, as every second your heart isn’t beating, your prognosis is worsening.

I’ve been to patients having heart attacks that have waited too long. Though they haven’t deteriorated in that short time, the long-term effects on their health will be huge.

If an elderly patient has a fall and is in pain, family members are often advised to leave them where they are until we arrive. But if you’re frail and on a hard surface more than 90 minutes, you need hospital blood tests due to risk of crush injuries. So we end up taking people who could have avoided hospital in the first place. If they are admitted due to injuries from being on the floor so long, they may need more care due to significant muscle wastage. This vicious cycle puts more strain on the whole system.

Every day you wish you could do more, as patients are often at substantially greater risk than they should be. You have to try compartmentalising and reminding yourself you can only do one job at a time.

There are targets for how quickly we’re supposed to reach each patient category. We can’t have hit many this last 18 months.

Sometimes patients think we don’t care, but we do. It affects us too. A friend lost a loved one after a long wait for an ambulance. It brought a tear to my eye.

I sometimes encourage families to complain, if I think they were left with inappropriate treatment. I’ve received abuse on several occasions, due to waiting times. They’ve threatened to complain and report me.

Since coronavirus, we’ve had the army in to help, plus Patient Transport who have next to no clinical training. They volunteer, mainly to drive. Though the idea is to upskill the service by helping, in my opinion all this actually makes it more difficult.

We often subcontract to private companies, because we haven’t got the resources to deal with demand. They earn an absolute mint.

You’re expected to go straight out on shift and work until finish. There’s little downtime to let your brain rest and check emails to review bulletins or clinical guidance – unless you do it before you start.

But there’s become acceptance in staff teams now – this is the way it is. I honestly feel with every patient I go to, I do as much as I can. Yet when you’re leaving work and go past the office and they are looking at the list of jobs, 200 waiting in Greater Manchester just isn’t right.

Even if every crew stayed on and did an extra job, we wouldn’t cover 10 per cent of those and then the crews involved wouldn’t perform the next day. So you accept there’s a limit to what you can achieve.

If we think a patient has come to harm because we took too long to arrive, ideally we should report it as an incident. But this would be in your own time, after a 12-hour shift. I think a lot of staff feel this won’t change anything, so I imagine lots goes unreported.

I started in an entry-level position around eight years ago and worked up to becoming a paramedic. Back then, there was an understanding things were a little stretched, but patients weren’t waiting 12 hours. Now, that’s a regular occurrence. There aren’t enough of us and we’re not capable of properly doing what we need to.

Still, at the start I was in at the deep end, getting an adrenaline rush on every job. It probably took a year to get my feet on the ground and feel I knew what I was doing.

More experienced staff than me talk about night shifts before I started. When there were no jobs to go to, they got downtime to decompress at the station.

Most people I work with either have up to six years’ experience or are approaching retirement. There’s a big gap in between where you are missing experienced clinicians. These demographics show long-term burnout and people leaving for better conditions. It used to be a job for life.

Because tuition fees are no longer covered, most newly qualified paramedics are in their early twenties – their lack of life experience can really show sometimes.

Several colleagues have gone off sick after it all just got on top of them. Some just needed a few weeks to get their heads straight, but others have gone on long-term sick and never returned. After 20 years in the job, one colleague went into construction because he just couldn’t cope any more.

Taking more time to get to patients can build up on you. Pressure can provoke badly informed decisions too. If you don’t debrief, you’re more likely to burnout. We get the chance sometimes, but generally there’s an expectation that you deal with it and just get past seeing difficult things. Everyone has triggers though.

We can be referred to counselling and speak to line managers. But mental health stigma is difficult, not helped by the fact we already know the people we can reach out to, so you keep up a character they know you to be.

Lots of problems stem from people waiting weeks to see their GP, not getting that first point of contact in early. It’s like a trickle-down system. Sorting initial issues out would relieve pressure at the top. But as the ambulance service, we are like the net underneath, trying to catch everything that gets through.

Certain situations need ambulances like heart attacks and strokes. What we’re here for is pain relief, stabilising really ill patients and getting them to definitive care when necessary.

But we’re not a big yellow taxi. Plus, arriving by ambulance won’t get you seen quicker. Campaigns ask that people only ring 999 in a life-threatening emergency, but not everyone listens or cares.

Conversely, I’ve had people say they have had chest pains for three days, but hadn’t done anything as they’re concerned we’re busy and it feels like heartburn. Tests might show it’s a heart attack. Sometimes the people needing us most are expecting to wait and not seeking help.

Social media drives fear, conspiracy theories and vaccine misinformation. People with Covid are ringing up saying they can’t breathe – we get there and everything’s fine. Because each incident takes around 60-90 minutes of our time, you can see how every unnecessary call quickly adds to ambulance hours lost.

But despite the many challenges, I do love it. There aren’t many other careers I would change to. I like my colleagues and being out and about. I’m really privileged to meet lots of different people and have a positive impact on their lives. It might not always be to the extent I want, but the best, fulfilling part is helping people, putting smiles on faces, feeling I’ve made a difference. When I can’t do that, it bothers me.

Every job has ups and downs, and you have to ride them out.

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