Stressed Out

You'll find that normally, when I'm talking about the Daily Mail, it's under the heading of the 'Daily Fail' and I'm generally less than complimentary about their flawed research and criticism of people who should be getting praise. This time however, their article about sick leave for stress in the ambulance service is mainly factual and really highlights the issue. Obviously, the headline calling us all 'ambulance drivers' made my blood boil but that rant is for another day! So, the article in full.....

The number of sick days taken by stressed-out paramedics has soared by 40 per cent in two years. 

New figures released by ambulance trusts show they took 43,680 days off because of stress during 2011-12 compared with 31,268 in 2009-10. 

The number of ambulance workers suffering from stress has also increased by 42 per cent during the same period, from 728 to 1,035.

Union bosses say the widespread closure of hospital A&Es and rising numbers of 999 calls has taken its toll on ambulance crews, who are breaking down under the stress of the extra workload. 

Research by The Mail on Sunday has revealed 33 casualty units across England and Wales have either already closed or are under threat of being closed or downgraded.

The number of 999 calls has also risen by more than ten per cent in a year for most ambulance trusts across the country.

Adrian Gilbert, Acting General Secretary for the Association of Professional Ambulance Personnel, said: ‘Ambulance staff are run ragged on shifts and it’s no wonder the number of staff off for stress has increased. 

‘They are coming in to do a 12-hour shift and instead it has gone on for 14 hours. You have got hospitals closing A&Es across the country and this means ambulances are having to go farther afield.

‘So instead of a five-mile journey to the nearest hospital, it can sometimes be a 25-mile journey.

Threat: There are growing concerns that closures and increasing numbers of calls are having an affect on drivers, as research shows that 33 casualty units across England and Wales have either already closed or are under threat.

‘If there are three or four vehicles out of the area, it means the ambulance crews who are still in the area are being run ragged.’ 

The new figures come after a Freedom of Information request to England’s 12 ambulance trusts.

Last week Shadow Health Secretary Andy Burnham revealed ambulances were being forced to wait with patients outside A&E for more than five hours – because of congestion inside.

It is a massive problem and one which can't be ignore, however, I don't think it's as simple as blaming it  on being run ragged. There are a number of factors involved in the high and rising amount of stress leave taken, some that won't change and some that will. 

As eluded to in the article working conditions plays a huge part. 14 hours without a recognised break is a major problem and as highlighted in various news articles about crews being on rest breaks, there is no easy solution. Well, there is, give us breaks! Playing devil's advocate though, for so long, the ambulance services have become accustomed to have the staff available all shift, that if you suddenly take them away, there would be a huge shortfall in resources. 

Being at work with no breaks, alone, isn't the cause of stress but the culmination of things that are done to make our days harder all add up. Waiting for hours in the corridor in hospitals is frustrating. Not our fault or the hospitals but for the hospitals to ban ambulance staff from drinking tea or coffee and refusing to allow us to heat up food in their microwaves means we are left with only cold food and drink for 14 hours when it's minus 3 and we have to wear short sleeved shirts!

Then there is the job related problems. Arriving at scene 3 hours after someone called an ambulance and getting the ear bashing. Chasing your tail for hours on end with cancellation after cancellation, being refused to be stood down to go to the toilet despite not being at a hospital for 5 hours. Being made to transport patients with the fuel light on because you've had 4 requests for fuel turn down. Having your activation times monitored, being harassed to make yourself available quickly at hospital and being badgered when you have spent to long on scene with a patient. Then there is being rushed out at the start of the shift without all the kit you need and the guarantee of NEVER finishing a shift on time. EVER. On their own, they are no real biggie but when it's ALL happening every single day, combined with some of the horrors we see, the abuse we take and the emotional turmoil we can be involved with, it is of little surprise so many are off sick. Or even worse, throwing the towel in all together.

Finally, there is the issue of sick leave in general. The ambulance service has a tradition of high sick leave. No surprise when we are around sick people all the time and don't eat properly but also because of the way sick leave is managed. There is a huge fear of being off sick because of the disciplinary procedures that are in place. If you are off for a week with Norovirus in December and then in January you get another bout of D & V and are off for another day, you start the disciplinary procedure. Another other time off in the next 12 months and the disciplinary process will be escalated. I was hospitalised whilst at work a while ago and came back to a rather threatening letter in my pigeon hole. This is just one example of many which I think go a long way to causing people to work on regardless until they are burnt out. The other issue this policy raises is that of people playing the system. Across every service there are the people who are off for long periods every year, often with stress, and do so year in and year out. Stress is something that can easily be faked and allows people to be off for considerable time with little consequence. The ambulance service has become a victim of it's own management strategy which targets the wrong people.

With all factors at play the amount of sick days will continue to rise year on year. Like everything within the NHS there is too much focus on cure rather than prevention and because of that, it's the staff that are targeted for multi-agency failings and this in turn leads to a workforce of disillusioned, down trodden, tired people. 

http://www.dailymail.co.uk/news/article-2272517/Stressed-ambulance-drivers-43-680-sick-days--40-rise-years.html#axzz2Jp4ocYMu

Man Flu

“25 year old male, DIB, chest pain, abdo pain, nausea, vomiting, fever, sweating, headache, dizzy, not alert”

Hands up if you’ve had a cold! OK, i’m assuming everyone has their hands in the air! Now, hands up if you’ve had a really bad cold! Again, i’m expecting everyone to have suffered this fate! Now, this one to the guys! Hands up if you have suffered from man-flu. As we all know, men don’t just suffer from cold, a bad cold or even flu, oh no. It is something much much worse. The debilitating, near life threatening man flu can grip any male at any time. Sufferers may experience the same symptoms women suffer during a cold but much much worse. Hurty brain, burny head, hurty tummy, über achy, extra sniffly, the worst cough ever, more lethargic than an over tired sloth and an overwhelming inability to do even the simplest of tasks. Treatment includes patting on the head, rubbing of the tummy, waiting on hand and foot and constant sympathy and reassurance. In extreme cases an ambulance may be required to give extra instructions to loved ones and how to treat this crippling condition. The less sympathy the victim receives the longer it will take to cure.

Jokes aside, you would be shocked at how many people we go to suffering from the symptoms of a cold. Some take our advise to rest up, take Paracetomol, Ibuprofen, Lemsip, Beechams, Buttercup syrup and any other remedies they can get their hands on. Others insist on a trip to hospital to sit on a metal bench in a waiting room full of sick people for 4-6 hours to be told to go home, rest up, take Paracetomol, Ibuprofen, Lemsip, Beechams, Buttercup syrup and any other remedies they can get their hands on. 

As soon as the job appeared on our screen the usual moans and groans about people needing to man-the-f**k-up began. Obviously, he could be ill, he could have meningitis or something else and all the necessary checks would be made before we drew a conclusion but that list of presenting complaints looked suspiciously like man-flu. It also seemed like the caller just said ‘yes’ to every question they were asked. We arrived at the address after driving on lights and sirens through the rush hour traffic. The blues and twos are used for all life threatening or potentially life threatening conditions and the DIB alone meant he was going to get an ambulance and car. As we parked up the FRU pulled in alone side us and we went in the house on mass! Lying on the sofa with a pillow on his head was our patient surrounded by about 8 members of his family across 3 generations. 

“Hello sir, whats the problem today?”

No response.

“Come on sir, we can’t help you if you don’t talk to us”

He let out a groan.

“Can you sit up and talk to us?”

A muffled “I caaaaan’t” was the responce.

At this point the family began flocking around him telling us he was really ill and needed to go to hospital and couldn’t walk. 

NB: ALL AMBULANCE CREWS HATE BEING TOLD THAT SOMEONE CANNOT WALK

After a further 10 minutes of conversation which was like drawing blood from a stone our patient was sitting up, kind of talking and showing all the signs and symptoms of man-flu. There was no rash, he didn’t even have a temperature but despite our best efforts to convince him and his family otherwise, hospital was where he NEEDED to be because he NEEDED to be seen by a SPECIALIST. As we suggested coming to the ambulance he coughed.

“Bruvs, your lungs are fucked innit”

That was the response from his brother. We asked him to stand up and come with us. He slumped into the back of the chair. 

“I can’t walk.”

The female members of the family then started dressing him. Socks, joggers and shoes. Laces tied and all. This was serious man flu. Then came the standing up ceremony. As they helped him stand up he threw himself to the floor. The women flocked around him, the grandmother was putting a spectacular effort to physically lift him to the floor.

“Right, can you all step back please. Look mate, your’e 25 years old, you are unwell, you have a bad cold, I get it, you feel rough, but you are a grown man. If you want to come to hospital with us stand up and walk to the ambulance. Don’t make you mother, grandmother and younger sister pick you up off the floor and carry you, you are not dying”

There was a moment of silence. Had I overstepped the mark? Was I being too harsh? Had we missed something? 

I thought to myself ‘well this is awkward!’

Then, like a phoenix rising from the flames, like Lazarus rising from the dead, like Rocky Balboa wrenching himself off the canvas, he rose from the floor to standing, pushed passed us, grabbed his coat and stomped down to the ambulance! 

What was awkward was the journey to hospital, he gave me the silent treatment like a moody seven year old who just had their remote control car confiscated for not eating their peas. We handed him over to the nurse in the ACCIDENT and EMERGENCY department where he was sent to the waiting room and informed of the 4-6 hour wait. 

Another life saved.

Blue Light Taxonomy

Following on from my last blog '21 Miles' I thought it would be appropriate to share this is a fabulous post by Bobby McPeel, a Police Office and blogger who I have recently discovered! I go on and on about peoples bad driving and bizarre actions when confronted with a big yellow ambulance, flashing blue lights and sirens. Bobby McPeel sums up what they do perfectly. It may be police cars but peoples reactions are the same. Please just thing back to your highway code or 'Drivers: Take Note'! No where does it say slam on your breaks in the middle of a duel carriageway! Anyway I hope you enjoy this post as much as I did!

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Blue Light Taxonomy

Blue flashing lights and sirens on an emergency vehicles often cause other drivers to do strange and crazy things. Over the years I have developed my own classification system for different drivers.

THE KERB CRUNCHER

Upon seeing blue lights in their rear view mirror, this driver mounts the kerb or verge, regardless of the capability of their vehicle for off-road pursuits, and often to the horror of a passing pedestrian.

THE TWITCHER

This driver pootles along without a care in the world until a big noisy police car appears from behind them. This will result in a ‘twitch of recognition’ which essentially is a reflex action involving a sharp turn of the steering wheel to the left, combined with the application of the brakes, causing the car to come to an abrupt halt. Often accompanied with a look of panic or shock.

THE DRIFTER

A motorist who neither stops to pull over, nor maintains a reasonable speed. These are the most awkward and infuriating to pass because they gradually slow down, or ease off the gas a little and drift into a crawl, usually on a left hand bend or the brow of a hill, or directly opposite a vehicle coming the other way

THE STAMPER

Similar to the Twitcher but without the steering element. When glancing in their rear view mirror the driver will ”stamp” on the brake pedal, bringing the car to an immediate halt, usually in the middle of the road. Keeps the police driver on their toes and tests their reflexes to the limit.

THE DAYDREAMER

No amount of blue strobe lights, siren changes, headlight flashing or gesticulating will wake this driver from their road slumber, nor deter them from their chosen course. Mirrors come as optional extras on their vehicles and many drive white vans.

THE LEAPFROGGER

A very distinctive driver who will see a car in front pull to the side of the road, not think to check behind, and overtake the car that has stopped, right into the path of the approaching police vehicle that will take evasive action. On occasion two of this species will meet at the same point, resulting multiple leapfrogging.

THE WEAVER

An indecisive and unpredictable motorist who can’t decide which way to go at the sight of a police car to the rear. A bit like a confused rabbit, darting left and right in a state of panic.

THE CHANCER

This particular driver exhibits a variety of different behaviours. Some will take the opportunity of a police vehicle passing by and use the gaps in the gaps created in the traffic for their own gain. Others will commit a wide range of traffic offences right under the nose of the passing police officers, in the knowledge that they probably won’t be stopped – although sometimes the police have the last laugh and will come knocking later on!

There is a serious point to this article. Drivers should be aware of their surroundings whilst on the road and be ready to react safely and sensibly when an emergency vehicle is approaching. There is an excellent video that gives guidance on how to react to emergency vehicles:

You can follow Bobby McPeel on Twitter or go and check out his great blog!

21 miles

"41 year old female, vomiting"

I've spoken before about the first night shift in a run of shifts. Not pleasant at the best of times! As is customary, we arrived at work early to get our vehicle ready. Unfortunately the garage was empty so it was a case of waiting! We were due to start at 18:00 and at 17:59 the early turn arrived back. As they unloaded their stuff the phone rang. It was EOC with a job for the night vehicle. Of course it was! It's not as if we need time to do the legal checks on the vehicle, put our stuff on, make sure the vehicle is kitted up and do all the necessary paperwork! Oh no! So, with bags, hi-vis jackets and stab vests unceremoniously thrown into the truck, off we went!

How far?! 10.6 miles! In the rush hour! For vomiting! I understand that we are utilised by our service how they deem fit but in the time it takes to get there I refuse to believe another vehicle would come up available. It really is a sorry state of affairs if we are the only available vehicle in 20 mile radius from the job. That's an area 352 square miles (if my maths serves me correctly) with no other available ambulances?! More than half of the entire city and this year the Quality Care Commission were assured that there were enough ambulances to cover demand?! Someones been telling fibs! It wasn't even a high priority call. I hate leaving station in a rush. The reason most staff come in early is for this very reason. We are not paid for that time but there is so much to do, if you don't do it, you'll end up having to leave without something and to be honest, I don't like being in a situation where I need something and it isn't there! 

The journey itself was an absolute nightmare. It seemed that every single person on the road was there purely to get under my skin. They were stopping in front of me, ignoring my existence, blocking my lane and indicating left but not actually moving. Every turn I made someone caused my blood pressure to rise. After about 15 minutes we'd reached the half-way point and EOC were still yet to answer our request to speak to them. Funny that. The nearer we got, the more we realised that we were actually going to have to deal with this patient so my crew mate started writing stuff onto the PRF (Patient Report Form). Despite the flashing lights and sirens it seemed that my 'bull horn' was permanently being used and no matter where I went the general public were dead set on ruining my day. Luckily there was only 0.3 miles to go!

CANCELLED. HIGHER PRIORITY CALL.

Aaaaarrrrrggggghhhh! Are you serious?! We accepted the cancelled to a chorus of expletives and waited patiently until the higher priority was sent to us.

"46 year old female, feeling dizzy, not alert"

How far?! 10.8 miles! In the rush hour! A cursory glance at the map sent me apoplectic! The address was only 400 yards from our ambulance station! THIS is why crews get so frustrated about being sent miles across the city unnecessarily! There is an element of danger in blue light driving. You can make all the allowances in the world and reduce risks as much as possible but you cannot take into account the actions of idiot drivers! Driving on the wrong side of the road, going through red lights and weaving through traffic is a calculated risk which we are happy to take but it becomes very frustrating when you do that for nothing. Also, the further you get away from your area, the less you know the roads and this makes driving on them much much harder. Anyway, what is done, is done, so off we went, through the traffic.

The job kept on updating as we drove, making the journey on blue lights seem all the more futile! It turns out the patient had been having dizzy spells for 4 months and was yet to see the GP. She had called NHS Direct for advise and true to form, they re-directed her to an emergency ambulance for something that was a primary care issue. Despite this information we carried on, weaving in and out of traffic, going through red lights and getting blocked at traffic islands by numpties! All the while I could feel my blood pressure rising and rising and rising! 

I was so angry! I have a tendency to take everything personally. My crew mate is forever telling me off about it. If a driver does something stupid I take it as a slight on me and therefor react to reflect that! In the return journey I don't think i've ever used the horn so much in such a short space of time. In hindsight, I don't think that the drivers were driving any worse than normal, but having to leave in a rush, being sent miles away for a 'vomiting' and being cancelled so close to the house had put me on the edge of reason! It also doesn't help passing another ambulance on blue lights in the opposite direction and wandering why a) you are not doing their job and b) why they are not doing your job!! Crazy!

We passed the ambulance station where this nightmare had begun and as we did so I glared at it! As we approached the turning I said to my crew mate, 'this had been the worst 50 minutes of my life'.

CANCELLED. NO LONGER REQUIRED.

I will spare you what happened in that moment. You can imagine though! My throat is still sore from the screaming! I turned around and drove back into station. 53 minutes had passed since my shift had begun and all I had done was drive 21 miles. In that time, I had gone from a good mood to possibly the worst mood of my entire life and for what?! What was the point of it?! Im dying to know! Every cloud has a silver lining though doesn't it! I turned the engine off and got out to check the vehicle over at last.

"98 year old female, fall, unable to get up"

I'll check the vehicle later........

Death Becomes Her

“51 year old female, collapsed in street, ? unconscious O/S”

Remember me banging on about presumption?! Well, this is the kind of job where the jilted cynic in me says that it will be a load of tosh. It’s where I decide or suspect before we arrive on scene that alcohol will be involved. The fact that the call was made by a passer-by immediately makes me suspect they haven’t checked the patient and instead call 999 and walked off. This job would be a simple walk-on, walk-off kind off job. Let’s be honest, i’m usually right! Maybe repeated success can lead to complacency, I don’t know. As bad a habit as it is, doing the job we do and seeing the stuff we do I think it’s impossible not to pre-judge based on information given. People’s behavior and thought processes are based on experiences. That’s what makes us who we are. All I can say in my defense, is despite any pre-assumptions that I have made I approach every job in the same way. I still take all the bags with me and until my suspicions are confirmed I remain open to any outcome. This is why!

Having raced through the busy streets, jumping red rights, driving on the wrong side of the road and under taking down a bus lane we pulled up on scene 7 minutes and 52 seconds after the call begun. The clock is stopped, everyone take a bow, this job is a resounding success. Lying on the pavement about 6 feet from us was our patient. She was conscious and surrounded by 5 or 6 people; the same 5-6 people who had frantically waved en masse as we pulled into the road! I’ve mentioned before that people who are really ill, look ill and people who think they are really ill but are not, don’t! Well, despite my previous presumptions I was wrong. She was sober, well dressed and looked like crap. The world of medical diagnosis is all about best guess. Based on how she looked, by best guess was that this was a cardiac problem. I took some basic obs off her and to my surprise everything was normal; her pulse, blood sugar, blood pressure and oxygen saturation we fine. Despite that we got her up, on a chair and inside the truck, out of the glare from the crowd and the rubber-neckers.

The weird thing about this job, was that she wasn’t complaining of anything specific. She kept saying she didn’t feel right but that was about it. No pain, occasional light headedness but nothing that led us to suspect anything we could treat. We did an ECG, that was completely normal. We did a neurological exam, an abdominal and respiratory assessment yet still couldn’t find anything wrong. The only thing that was obvious was she appeared to be getting worse. She was sweating more, appearing more drowsy, talking was becoming more of a problem and she was panicking slightly. We decided to just go, we put in a blue call for a ’51 year old female, collapse ? cause’ and off we went. It was only a 4 minute drive to hospital. In the end it took a while longer. 

After a minute of driving she started going blue. Extremely blue. I watched over a 10-15 second period as her oxygen saturation dropped at alarming speed from 98% to <50%. I put her on full flow oxygen but it didn’t change for the better. I silenced the oxygen alarm on the monitor, only for the respiration alarm to start going off. Her resp rate had dropped from 24 a minute down to 14, then 8, then 4 and the 0. F**K!! 

“Pull over, she’s gone into respiratory arrest.”

“F**K!”

At no point before that did I think that the Angel of Death had been circling above. I grabbed the Bag Valve Mask (BVM) and started bagging her whilst my crewmate got the defib pads attached to her. Within about 20 seconds of the ambulance stopping her heart had also stopped. My crewmate started CPR. An ominous flatline appeared on the screen as we checked for a rhythm. What the hell had we missed?! We had done everything?! I called control and told them to update the hospital that the patient was now in cardiac arrest and we would be there in 3 minutes. We decided that as there was just 2 of us and we were so close, we would just go and give basic life support on route rather than waste time at the roadside delaying definitive treatment. Some crews would act differnetly but these decisions are made in a split moment based on what is in front of you. We felt her best chance would be a crash team at the hospital. 

Off we went for the second time, this time with me doing CPR with one hand whilst hanging onto the ceiling bar. As we pulled into hospital the crash team were waiting outside. The back door swung open and to my relief a nurse jumped on to help out. Because she had just gone on us without warning we were not ready for it. When transporting a patient in cardiac arrest, you do so in a way that transferring at the hospital is easier. This patient however, was attached to the main oxygen, the blood pressure cuff, the ECG leads, the CO2 lead, the pulse ox, everything. After basically ripping everything off we got her inside and onto the hospital bed while I gave a pretty vague handover. 

“This is a 51 year old lady who collapsed in the street. No memory of the event. Denied any pain, complaint of slight light headedness. On arrival she was sweating and pale but all her observations were normal. She was FAST negative, her ECG showed a normal sinus rhythm and there was nothing untoward on a neuro exam. Same with resp and abdo. No recent travel or surgeries, no allergies, normally fit and well, doesn’t take any regualr medication. On route she became heavily cyanosed and rapidly desaturated. Within 30 seconds she was in respiratory arrest and about 30 seconds after that went into cardiac arrest. She has been in asystole (flatline) throughout. She has been down now for 5 minutes give or take.”

We left the department scratching our heads as to what had just happened. I suppose that’s healthcare right there. Whether you are a paramedic, a nurse, a health care assistant, a doctor or porter, at some point in your career someone will die whilst in your care. It isn’t nice and isn’t something that sits well with me but it’s true. I have gone over this job from start to finish over and over and over and over again. As has my crewmate. She should not have just died like that. How can someone who is fit and well, and relatively young just die without any obvious cause. I think that is what troubles me still. What did we miss?! It is hard feeling to describe watching someone die. I watched the life drain from her as death took over and I was absolutely powerless to stop it. It’s one thing to die at home alone but when inside an ambulance surrounded by medical professionals? I hate to think what was going through her mind. She must have known. I remember her eyes fixing on me, gripped with fear. I can only imagine what my face looked like. 

Normally i’m very blasé about death. I'm very much a ‘when it’s your time, it your time’ kind of person but it’s a very different dynamic when you arrive on scene to someone who has already died or is dying. Be it old age, a stoke, a heart attack, a fall from height or an RTC you can distance yourself from it and follow your cardiac arrest rule book. When it happens unexpectedly in front of you there are no coping mechanisms in place to rationalise it. Problem is, I couldn’t dwell on it, I had to get to a 27 year old with a 4 day history of lower back pain to rush off to....