Right or Wrong?

"40 year old female, won't get off the floor"

Doing the kind of work I do brings with it some fantastic opportunities. I work for a number of different companies doing various event work ranging from sports events to concerts and festivals. This weekend I was lucky enough to be able to work at the Red Hot Chilli Peppers concert in Knebworth. For most of the day I was working on the cycle response unit but occasionally I was required in 'the pit'. The pit is the area between the stage and the crowd. When crowd surfers or people who can't stand the crush get to the front they are escorted back into the crowd by security. The reason I was there was in case anyone came 'over the top' injured. I have done a lot of festivals and you would be amazing what medical problems come flying over the top into the waiting arms of security; unconscious people, seizures, open fractures, neck injuries, crush injuries and 6 year olds! Nothing surprises me anymore! Being up front for the headlining act is a sought after place and people literally wait there all day and night! Saturday was no different. As soon as the gates opened people ran to the front to wait! One of the eager few was a woman in a wheel chair. 

She had arrived early, sat in the rain, queued like everyone else and had wheeled herself to the front and sat there all day. She was told as soon as she arrived at the front by security that she probably would not be allowed to stay there but she wouldn't move. The issues surrounding her being there are down to 'health and safety'. I can hear some of you groan already but in this instance I'm with the H & S bods (To a point!). A crowd, 80,000 strong, all crushing up to the barrier causes injury in itself. Stick a woman in an electric wheelchair in there and not only is there a danger to her but to others too. As the day went by the 'wheelchair in the pit' situation was monitored and despite every effort by security to get her to move to the disabled viewing platform she wouldn't. About an hour before the Chilli Peppers were due on stage the decision was made by the event organiser that for her own safety she had to be removed along with her very heavy chair. Against her will, she was lifted over the barrier, followed by her chair and moved out of sight of the crowd whilst a plan of where she could go was made. From here things took a turn for the worse. She refused to get back into her chair. Instead, she threw herself on the wet floor.

There she sat, refusing to be lifted, refusing to move and getting further soaked by the rain. She quoted legal legislation to prevent anyone from touching her and although, technically they could have moved her as she was causing an obstruction to an emergency route, they opted for diplomacy instead. This approach however was futile. She was livid that she had been moved and part of me understood why. That part was my heart understanding her frustration. My head however felt she shouldn't have put herself in that position and should have just gone to one of the three disabled viewing platforms. This was offered but she wasn't interested. Again, I get why, I can only imagine being on a platform would make her feel like a spectacle. She just wanted to be in the crowd, soak up the atmosphere like everyone else. After an hour she agreed to be taken into our field hospital to warm up. This happened just as the Chilli Peppers were starting. The event organisers offered for her to sit on her chair in 'the pit'. She would have had a perfectly good view, better than what she would have had stuck behind a barrier, but she wasn't interested. She turned down all viewing platforms and every offer that was put to her. Now, she was simply cutting of her nose to spite her face. Again, I get why! It had been a horrible, embarrassing experience and to be fair, I would probably have acted the same. She sat on the hospital bed for all of the concert and once it had finished refused to leave the hospital until she was given a refund for the entire concert. The problem was at 11pm on a Saturday night the security staff and the hospital have no power to issue a refund and the event organisers are busy! Sadly, she was taken away punching and screaming by police.

Should it have come to that? No. Could it have been avoided? I don't think so. I am all for disabled people doing everything they can to have a normal life; I have close friends in wheelchairs. Unfortunately, no matter how much will they have, there are some things people's injuries or illnesses will not permit them to do. That is life. No it's not fair but life isn't. A wheelchair has no place in a mosh pit. I'm sorry but it doesn't. Event organisers have to think about everyone there and to accommodate wheelchair users there are viewing platforms with an unrestricted view, toilets and clear pathways. The fact is, rules are rules, right or wrong. The argument over whether the organisers should or shouldn't allow wheelchairs in the crush is another debate. If a wheelchair user pays for a full price ticket then surely she has the right to go where she wants. Unfortunately, she can't, and was told so from the outset and as horrible as it was watching it unfold the ones taking the action did not make the rule. I felt guilty looking at her on the hospital bed, she looked like a drowned rat. I know being in a wheel chair was not her choice and she is trying to lead a normal life and do things that everyone else does, but in this instance I feel she was playing on her disability to make a point. She wasn't removed from the crowd out of spite or malice, it was done with her best interests in mind and I agree with that decision. Were they wrong? Were they mean? Should she have been allowed to stay? Please tell me because I am split on this one!

Hydration therapy

"28 year old male, severely dehydrated"

Isn't summer great!? Beaches, sea, sand, ice cream and sun! Days in the park, evenings in a beer garden and holidays! The only problem with summer is that it has been and gone! Yep... remember those three hot days in early June? That was it! The big drought, the hosepipe ban, the sunburn and the change of wardrobe gone for another year. Normally with the 'summer' we experience a spike in heat related illnesses; sun stroke, heat exhaustion and even sunburn. Yes, people do call an ambulance for sunburn! Obviously, with the heat comes dehydration; when people don't drink and continue to lark about in the sun. You can imagine my surprise when I got this call in the pissing rain, a bit muggy but still, dehydration, at that age?! I tried not to judge; people can get dehydrated at any time but it isn't something people normally call an ambulance for, it's something we find during an examination and it is normally the elderly. Anyway, we headed off to the 'outside' location that we were given. The rain was pelting against the windscreen, the wipers could not wipe fast enough. We pulled up outside the address to find it was a newsagents. Outside, under the cover, was our patient. My initial thought was 'you're outside a shop, you're dehydrated, buy a bloody drink'! I kept that thought in my head, opened the side door to the ambulance and let him on.

"Hello there, what the problem today?"

"I'm really dehydrated"

"In what way?" (He didn't look dehydrated, his lips were not dry and pursed, nor was his skin dry)

"I'm just really really thirsty, it feels like really bad dehydration"

'Feels like really bad dehydration'?! What is that?! I'm no doctor, but this was the first time I had been in this line of questioning?! Has he been dehydrated many times before and know the difference better mild, bad and really bad?! It wasn't like pain that we can quantify and score. It wasn't if we could score the dehydration out of 10! Or was it?!

"When you say really bad, how bad are we talking on a scale of 0-10. 0 being perfectly hydrated and 10 being having a mouth full of sand?!"

"A 10"

"So just to clarify, it feels like your mouth is full of sand?"

"Yeah"

"OK, have you been drinking plenty of water?"

"I've had some, but not much"

"Why not? If your mouth is dry, drinking water may help"

"Because I read that when you are dehydrated drinking water won't be enough, you need fluids and stuff"

*sigh* "Have you passed any water recently? Any problems with your waterworks?"

"I did a wee about half an hour ago"

"And what colour was it? Dark?"

"Nah it was really light, almost clear"

"To be honest, it doesn't sound like you are dehydrated, just thirsty. What makes you think you are dehydrated?"

"My flat is really hot inside"

What can I say? What can I do?! Seriously, thirsty is now a reason to call an ambulance?! What next? An itch someone can't reach? A mouth ulcer? Why can these questions not be asked over the phone?! I could keep asking questions but no one has the answers. There is no cure for stupid. Would education help? No! He wasn't born or schooled in this country. No one will ever say no to him because of the fear that on the one occasion they say that to someone, they will drop down dead and then a finger has to be pointed. At least if they send an ambulance and he drops down dead they can point the finger at us! And what can I say to him? Sure, I can lecture him but then face a possible complaint on my record. I don't want that, no one does. Instead, I just advise him what to do if he becomes thirsty again, get him to sign my paperwork and head off to satisfy someone's itch. Living the dream!

Snap out of it

“27 year old female, feeling unwell, tired"

Just another day, another dollar. The usual routine; wake up, shower, get dressed, make lunch, drive to work, get crap out of locker, chuck it on a truck, check the bags, check the cupboards, drive off for 12 hours of the usual. Job to job to job; the same old patients, the same frustrations and no thanks for it. It really does get you down sometimes! As for the patient, man up springs to mind!

She lived in a nice area, her flat was a nice size, clean and tidy, nothing out of place and she was well dressed and well presented. She was well spoken and very polite. What could possibly be wrong? She didn’t seem in any pain, she had a smile on her face and cracked jokes. She couldn’t really explain what the problem was and knew it was nothing she needed an ambulance for, but she didn’t want to go back to the GP. The last time she did she was fobbed off with a prescription and told to diet and exercise.  She was just... feeling unwell. So here we are. What is the problem?!

She took a deep breath... “OK, from the beginning...

...I suppose it started during my teenage years to a point; broken family etc blah blah blah, always a brave face but I suppose it took its toll. Self esteem was low, confidence was low but I suppose you just cope don’t you? A marriage painted over the cracks, 6 years of happiness and distractions and a lovely child to add to the mix made everything seem OK. After the marriage ended there was a rebound relationship that painted over more cracks. I suppose that wasted year gradually chipped away at any remaining confidence there was and after being left a shell, rock bottom was reached. All the while though, a well painted exterior left no one the wiser. Even my closest allies were unaware. Panic attacks began, intrusive thoughts plagued me and sleep became an issue. 3 months of 2-3 hours sleep a night took its toll. Bags under eyes is not a good look on me!


Despite the self-inflicted isolation and a full box of prescribed anti-depressants that I refused to touch, I found a way out. I suppose being as low as can be makes improvement all the more possible. I climbed out of the swamp of self pity and changed my lifestyle. The fake smile was more sincere and I felt good again. This lasted for 6 months. I found ways to deal with my insecurities and achieved a lot of personal goals. I had a good relationship with my ex which my son benefited from, I was fit, active, had a close group of loyal friends, I got this lovely flat in a lovely area, my family is caring and supportive, I live comfortably, I eat well, I could do what I want when I want. What is there to be miserable about? Nothing!


Not so. Despite my new found ‘happiness’ there was also an inherent loneliness. A void that was not being filled. A cloud I was unable to see through. A cloud that engulfed me. The unspoken D was looming again, threatening to rear its ugly head. No one could spot the signs as no one knew it had been there in the first place. For 4 months now I have not been sleeping. I don’t mean the odd night of broken sleep, I mean not sleeping. My job is demanding and exhausting; after an 84 hour week I should be tired enough to sleep but I can’t. I can’t switch off. I lie awake for hours on end. 1am, 2am, 3am, 4am, 5am, now it’s time for an hours kip, 6am, hours kip, 7am, wide awake. The next day I am back to work. The annoying thing is it was work that triggered my current demise. There was an incident in which I was hospitalised which caused a long spell on my sofa. A long time to think, take stock and over think. I couldn't exercise, I couldn't really socialise and it felt like all the positive changes I had made were being undone. It was like I was watching it happen but unable to stop it snowballing. It knocked my confidence and left me resentment about the job I loved. Once back to work the damage was done,and I was left feeling like I was existing, not living, yet all the while the smile is still there. 


I hear people talking of depression and saying ‘why don’t they just snap out of it’. I want to. I can’t. It isn’t a choice. If I had a choice between a physical illness or a mental one I’d choose the former. Instead I get both. Maybe that is the problem. If it's not one it's the other. I don’t know. Looking in from the outside I have nothing to stress about. I have more than most people. I have a lovely, happy, healthy son who lights up my world. Surely that is enough? I have a job that pays well compared to a lot of people. I am not isolated from friends or family even though I feel it and isolate myself. I have a roof over my head. Seriously, surely I can just snap out of it?


It’s a cycle. You lie awake not able to sleep. Because you are awake your mind is at work. 5 hours awake in the dark gives you time to over think everything. You confuse yourself. You upset yourself. You feel alone. You wake up exhausted. You feel like you have been hit by a bus. Every day it becomes more and more of a struggle to leave the house. Your motivation is completely gone. The simplest of tasks become a chore. You feel lazy but there is no willingness to be pro-active. You feel horrible about yourself because you are so tired you are snappish. You start to snap at the people who are close to you but they just think ‘someone woke up on the wrong side of the bed’. You feel guilty and obsess over everything you are doing or saying. Tired and weary you get back into bed. Now you are stressed about your behaviour and your relationships in your life and can’t sleep or switch of. 1am, 2am, 3am, 4am, 5am, now it’s time for an hours kip, 6am, hours kip, 7am wide awake. It eats away your confidence and your self esteem. You feel like a shell.

Work doesn't help. I see things every day that add to my problems. I do have forums to vent and talk it out but I would be lying if I said things don't get to me. They do. I'm haunted by a lot. I struggle to deal with what life throws at people. A lot of the time I am fed up with hearing everyone else's problems. What about mine?! I can't avoid my work, I have to drag myself in every single day knowing that there is a high chance I'll be lying in bed later thinking about it. 

When does it stop? I don’t want to be that medicated patient. I don’t want to list antidepressants to the ambulance crew. I don’t want the big D on my medical record. I don’t want to talk to my GP about it; I won’t talk to best friend about it so the GP doesn’t stand a chance! Maybe I’ll just carry on smiling. No one will know. I don’t know. I think I’ll just stay here.” 

She didn't need hospital and didn't go, she just needed to talk it out, but it does raise questions. It’s a very common job, a very common problem. It’s probably more common that the stats suggest. How many people are suffering in silence? It isn’t an emergency and doesn’t warrant an ambulance but it does need addressing. Like all mental health, there is a stigma around it, a perception of weakness and misery that is not true. The fact that it can go so well hidden is testament to that. You can't just snap out of it. There is help out there, it just takes the courage to admit and find it. Unfortunately, until it is accepted as a genuine illness people will hide from it, deny it and do nothing about it. Luckily, she isn't hiding from it, denying it and is doing something about it.

The she is me.

If you are struggling with any of the issues raised in this post I highly recommend The Blurt Foundation. They are great to talk to, in total confidence, anonymously and online. 

Breakfast

"A giggle of ambulance folk talking shop"

I pulled into the car park at 06:45 and struggled to find a space. We don't have the biggest of ambulance stations and parking is often tight but this time of day is often the worst. You have all the 6am and 7am crews who are starting, the early turn FRUs, the team leaders are in, as are the duty station officers and training officers. On top of that there are the night crews, the night FRU's and any night officers, all finishing at 7am. I dragged my weary arse out of my car and headed over to the fire door in the hope someone would be in the mess room to let me in! There was, 'Morning' 'Morning' 'Morning' 'Morning' 'Morning'. The usual pleasantries were exchanged and then I went to see if there was a truck for me. Nope! Result! Back to the mess room I went! A few friends were in there, eating breakfast, drinking coffee and checking emails. 

"How's it going?"

"Yeah not bad, wish I wasn't still here but can't complain!"

"Yep, sounds about right! Good night?"

"It was mental, non stop"

"Get a break?"

"Hah, good one!"

"Any good jobs?"

"Actually we did, makes a bloody change! Had a cardiac arrest in the street!"

"Nice! How old?"

"60 odd, proper dead though"

"Dead dead?"

"Yeah, classic dead face, did 20 minutes ALS and ROLE'd it, backs killing me now!"

"I bet!"

"Had one you would've loved, this geezer was rat arsed and tripped over, head butting a wall on the way down. A proper flap of skin, skull showing and all sorts! Seriously, it was a mess, he'd done a proper number on himself!"

"Awesome! Trauma center?"

"Yeah, massive pain in the arse though, spent most of the night down"

"At least it was a decent job!

"Thing is it wasn't, he was rude and gobby, giving it all the big'un and had pissed himself. We had already been dragged down that way so the trauma center was actually the nearest."

"You made it back though!"

"Yeah some old dear chucked up everywhere, just been mopping out. It was literally everywhere, cupboard door, the bins, the bed, the runners, it was trickling towards our bags, I had to chuck everything in the front. Nightmare!"

"Grim, I had a good job yesterday, pretty horrible though. Lovely old guy with tongue cancer, we were pulling clots the size of golf balls out of his mouth. They just wouldn't stop coming, I felt a little queazy afterwards!"

"Ah mate, I had one of those before, it's rotten! Was he alright?"

"Don't know, it was our off job so we never made it back to check on him"

"Right, that's me done, bed time! Have a good one!"

"You too, have a good sleep!"

"Yeah right!"

That is a normal morning conversation! Piss, blood, vomit and dead people over breakfast! Like I have said before, there is a lot of gallows humour in this job, there has to be. It is no different to any other colleagues in any other job talking shop before and after work. The only difference is the setting. We wouldn't bat an eyelid at talking about dismemberment over a slap up meal because that is what we know. We wouldn't do the job if it grossed us out! When I read the conversation back in black and white I suppose it looks a bit cold. Talking about the dead in a passing comment, 'dead dead', 'dead face', they are just ways we talk about jobs. Dead people do have a dead face, it is unmistakable. Mouth open, eyes looking up and glazed over, it is just a look we have come to know. Normally you know within a minute of hearing the history and looking at the patient if they are going to make it. If they are not, you quickly detach yourself from it. Maybe we are sick in the head? We certainly all have a screw loose! Someone's bad day can make ours a good day. It is simply different perspectives! 

One tape fixes all

"9 year old ambulance, not feeling well"

When we all buy cars we want something that won't break down. We look at the body work, the interior  and the mileage. Low mileage is always a selling point! When we insure the car the insurance company ask your annual mileage and it varies from person to person depending on the commute. Now take an ambulance; many of them are 24 hour vehicles, 07:00 to 19:00, then a crew change to the night turn on 19:00 to 07:00. This is repeated every day, 7 days a week, 52 weeks a year and only gets a rest when it breaks down. The driving that it puts up with isn't your average drive either. It is driven at speed, at high revs, it's swung around corners, there is repeated heavy breaking and it is pushed to its limits every day. We have a team of fitters who try their best to keep them working but invariably they break, and break often. There are so many vehicles breaking down that they are left doing quick fix after quick fix, and it is not just the mechanical side of things that go wrong. There are cupboards, trolley beds, carry chairs, blue lights, reversing cameras, 2 sets of steps, signage, clocks, Sat Navs, MDT screens, radios and tail lifts; all which get used and abused. 

The other day I was working on a 9 year old Mercedes Sprinter. It had 248,000 miles on the clock and, to be honest, had seen better days. There was a hole where the radio once was, the sat nav was hanging off, all the air con vents were missing, the air con wasn't working, there were no lids for the bins, a cupboard door was missing, there were holes in the seats covered with gaffa tape and the oxygen mounting was held on with micropore tape.

Micropore! The entire ambulance service, infact the entire NHS, is held together with micropore. It is used for everything. It has become a running joke that if something breaks, it's nothing that micropore tape cannot fix. You would struggle to find an ambulance in service that doesn't have micropore tape holding something together. The same applies to the newest vehicles. As with everything in the NHS our vehicles are provided by the lowest bidder and as such the quality of workmanship and materials used is poor. There are 100s of vehicles less than 3 years old and a quick look through their defect books will reveal just how much has gone wrong with them in such a short space of time! It can be embarrassing when a patient gets on board and you see them looking around at the bodge-job of a truck they are in!

About 3 hours into our shift, we were called to an unconscious male in the street. We pulled up to the bus stop to find him lying face down on the floor. Once we were within 6 feet of him it was clear he was an alcoholic; the smell was awful, his clothes were dirty, his hands filthy, his face was flushed and he had the drinkers nose. A quick shake and he was mumbling and groaning away. Unfortunately for our backs he was in no state to stand and stagger without assistance. We opened the tail-lift to get the bed out but it wouldn't open. Nothing we did would make it budge. Bugger! Back to the pre-tail lift way of doing things. We picked him up off the floor, onto our chair, and then lifted him up the steps and onto the bed. We took him to hospital and did the same at the other end. Job done! We then informed control that our vehicle was broken and were told to wait where we were for an engineer to come to us. An hour later he arrived. He looked at the tail lift, opened it as far as we had been able to and then said:

"You got any micropore?"

Micropore in action! 'Now get back to work'

I laughed and handed him the roll of tape attached to my trousers. Sure enough, he had seen the issue and binding the loose switch with tape would fix the problem. Taping complete the tail lift was working like a dream! Off we went to the next job. 14 miles away through traffic, engine screaming, heavy breaking and taking corners at speed. I could hear the vehicle crying in pain.

I guarantee everyone, in any ambulance service, all over the world has used or seen micropore used for something other than what it was intended! It really is the glue that holds everything together! Without it there would be no ambulances on the road! I know in an ideal world broken parts would be replaced, things would be fixed properly, and vehicles would be replaced after a certain amount of years served. Sadly, our government won't allow that. I shudder to think how many ambulances could have been bought with the fines for missed targets. Services are left with making the best of a bad situation. I just wonder how David Cameron would feel if it was his loved one in cardiac arrest in the back of an ambulance and there is a delay getting them into hospital because the micropore on the tail lift has come off?! Hmmmm... maybe taking the money and resources away from the emergency services wasn't such a good idea after all!

We all make do, we all carry our micropore and, in general, make it work for us.