Not The Time Or The Place

In recent years the concept of the e-petition has got a lot bigger and in many cases has been used effectively. Like anything that can be created by anyone online it is left open to misuse. In America a similar principle led to a petition to get the US government to build the Death Star as seen Star Wars! The point of the e-petition as set out on the government website is 'If you have a strong opinion about an issue relating to our policies which you’d like to raise you can register it as an e-petition'. Recently The Oliver King Foundation petitioned for defibrillators to be installed in all schools and wanted legislation to back that up. Sadly the House of Commons debate didn't get the result we all wanted but it showed the power of the e-petition.

My issue, is with the misuse of e-petitions for personal gain. I'm sure I'll get a lot of complaints and abuse from my fellow professionals for this, but I am totally against a recent e-petition for more money for paramedics. Let me explain why!

Entitled 'Increase UK Paramedic Pay to NHS Agenda for Change pay Band 6' the title cuts to point but is this a) appropriate and b) how we want our profession to be portrayed? 

Paramedic training requires them to undertake Advanced Driving qualifications and attend an approved Paramedic Course via an Ambulance Service or University to register as a Paramedic. Many Paramedics go on to complete Bachelors and Masters Degrees and even Doctorates. As the Senior Ambulance Service healthcare professional the Paramedic takes complete clinical responsibility at accidents or medical emergencies. Paramedics assess patient's using and interpreting high-tech equipment, such as defibrillators, monitoring equipment, ECG’s, and spinal and traction splints. As autonomous clinicians they have over 40 drugs at their disposal and the ability to perform life saving procedures. Add to that the injuries caused by constantly carrying heavy equipment, manual handling of patients, abuse, assaults, ever increasing demand, cuts in Ambulance Service funding and public sector pensions, we ask you, the government, to pay Paramedics what they deserve.

Don't get me wrong, it is a challenging job and there are a lot of areas that need improving but asking for more money in this way is not the way to go about it. For starters, if an e-petition is being set up it needs to be done so by a body representative of the profession, not an individual. We are represented by the College of Paramedics but the fact they havn't even obtained a royal status due to lack of member speaks volumes about the lack of voice we have in the medical community. If we want a voice, we need to speak together. Add to that, the fact that the petition itself is badly written and reads like Oliver Twist asking for more gruel, it can give little confidence in the cause. It hardly paints us in a good image where we can be taken seriously when the petition a) refers to 'patient's' not 'patients' and b) is asking for money despite highlighting the ambulance service is facing a funding cut!

Sure, we have to do a driving course and yes, some have degrees. We do make clinical decisions and use the equipment we are trained to. It's true, we give lots of drugs and carry heavy patients and yes, the carrying of bags is a pain but that is the job we applied to do. We knew the salary when we applied, we knew patients and bags need carrying and we are compensated for it. Obviously, I would like more money, who wouldn't, but compared to the national average salary we are paid well. We are all in relatively secure jobs with sick pay, annual leave and a pension. In the economic climate where there are 1000's of people queuing for jobs when a new supermarket opens and 100,000s are facing the very real threat of unemployment, asking for a pay rise is hugely inappropriate. It is not the time, nor the place. 

The question of banding of salaries came about in the now outdated Agenda for Change and our job role has change a lot since then. Our skill-set has expanded and we now have a lot more clinical responsibility than we did. A registered paramedic is no longer a Band 5 job and I do think that the salary bands need modernising but an e-petition is not the way to do it. E-petitions should be left to things that benefit society as whole and will make a real difference to the country, not a small body of people.

We all know there is salary disparity across the country and it is wrong that a manager in McDonalds earns more than a paramedic but salaries cannot be quantified across the public and the private sector. If there is an e-petition for paramedics to get more money, there could be just as many reasons for a nurse to get more. And an HCA, an EMT, an ECA, an ECP, a junior doctor, the list is endless. There is no more money. The reason every department in the NHS is facing cuts is testament to this. Do we really think the government and even the general public are interested in increasing the wage bill when everyone else is feeling the pinch? We could debate for days and days the rights and wrongs of NHS cuts and the real cause of the economic climate we are facing but the fact is, as a country, we are in the shit. Now is the time to be securing people's jobs and securing the delivery of free health care to the masses, not lining our own pockets.

So, without further ado, I now open this post to debate and abuse. I'm expecting the same backlash as when I criticised the unions! Bring it! 

Invisible Wounds

"Female u/k age, tired, mental health problems"

"What's been going on?"

"About a year or so ago I witnessed something horrible. The death of a young man. I suppose, in the days / weeks that followed I expected to see his face in my thoughts. On the night itself I think the adrenaline kept me going until I got home. I just laid there on my bed and absorbed it all. I'd just watched someone die in the most horrific of circumstances and was helpless to stop it. Could I have done more? It was a helpless feeling that I just couldn't shift. His face. It was there all night. As the days past I thought about him less and less. I don't remember when his blood stained face stopped appearing in my dreams but within a month I'd say he was gone."

"So what's changed?"

"I found out his name. I was shown an online article about his death. I suddenly felt I knew who he was, what he was meant to be, what he had lost. His blood stained face came back. I'm plagued by flashbacks on an almost daily basis. I can't get his face to stop invading my dreams. It's weird though, now I almost take comfort in his presence. I can't imagine a day where he isn't present."

"And have you talked about this to anyone?"

"Sure, I've spoken to the people that were there and others. I feel like I'm the only one bothered by this. It's an overwhelming isolation which is eating away. Maybe it's just sleep I need. I can't remember the last good nights sleep I had. I've always had a problem sleeping but now it seems worse. After hours of trying I eventually get to sleep but once drifted off I'm awake again with an alarmingly predictability and the circle starts again. And again. Sometimes I just wake. Sometimes it's a nightmare. I picture his last moments again and again. Not from where I was though. It is as if I was watching it on TV. And I'm not looking at him really. I'm looking at me. It always ends the same though. His bloodied face, distorted, mutilated and swollen, lifeless. It's just......there."

I was clear just from looking at her eyes that this was taking it's toll. She looked drained.

"I have seen things that should upset me since but they don't. Maybe I'm hardened to it. I just feel numb. I try and keep busy to take my mind off it. The more tired I am the more I try and avoid thinking about how tired I am. I know if I think about sleep I'll think about him."

"What about your friends and family? Do they know?"

They do and they don't. They say they do yet I feel vilified for being irritable. Despite how I'm feeling they always have something trivial which is much much worse. Either that or I'm given happy clappy cliche advise about 'staying strong' etc. My mood swings back and forth and I try to only interact with them when I in a good place. It's just easier that way. I'll be fine, I'll get over it, I'm just tired."

"There is help available." 

A smile appeared on her face. Clearly I wasn't in on the joke.

"Yes I know, therapy, drugs, a sick note etc. No thanks. Can't be dealing with a disciplinary and P45 too! Work is a good distraction but they don't take kindly to mental frailties! Honestly, I'll be fine! Just venting!"

*          *          *          *          *

The 'patient' was me. The 'guy' was patient from '3am' (read). Post Traumatic Stress Disorder (PTSD) is very very real. It's often associated with the military due to the sights they see and the environment they are in. However, it is becoming more and more common, or more and more freely admitted in the Police and the Ambulance services. I have it, or had it, I'm not really sure. I'm also not really sure if it is ever something that goes. Maybe it is and it just hasn't gone yet. Maybe it is gone and what is left will stay. I don't really know. I wrote this post because of one I read on the One Police UK Facebook Page. It really hits hope what PTSD is all about. 

Despite what the PR department will say, there really is no provision within the emergency services for dealing with it. I tried accessing the 'free counselling' service that is offered and if anything just trying to make an appointment made me worse. Actually saying  'I have PTSD' was of huge importance, as cliche as it is. Not in the sense of standing in a circle and saying 'My name is....... and I have.....' but to admit that your mental health is affected is quite a big thing. Especially when until that point, you only ever had to deal with other people's mental health. In the ambulance service, the closest you come to your employers knowing something is wrong is going off sick with stress. And lets be honest, that only stands to give you a reputation for 'someone who goes off sick with stress'. i.e. chancer, faker, pulling a fast one, playing the game, abusing the system. It's true. That is how you will viewed by management. 

Admitting weaknesses isn't something that is done much in an environment full of black humour and bravado. Mess room banter probably wouldn't cope with someone saying 'actually no, I see his face in my sleep every night'. You just play the game. Put on the brave face and only confide in the ones you think won't judge your weakness. Let's be honest, it doesn't give much confidence in a new crew mate when a simple head injury causes you a panic attack. There a triggers everywhere, it's about learning to spot them and avoid them. Sadly, this job doesn't let you avoid seeing words like 'fall from height'. These are the invisible wounds that PTSD leaves behind.

The problem we and police have is it doesn't stop. There is always a new memory around the corner. '3am' has effected me. It was the last job of the shift, the last shift in a run and I had seven days off to dwell on it. Maybe PTSD in the emergency services is more about timing rather that the event. I have seen things that a more tragic and more disturbing since but they don't effect me. Part of me wishes that they did. 

Another traumatic death or a dead child. Maybe the one memory that stays is protecting us. If every traumatic sight we saw effected us in the same way we simply wouldn't function. There is very little time to process information. Very often I have written about seeing something which most people would see as probably the most traumatic event in their lifetime, only to go to another call five minutes later. Maybe this is why

PTSD isn't going away, it is a fact of life and although some efforts are being made to treat it and make it more accepted, until it is fully embraced and tolerated by employers little will change. Let's be honest though, the reason why it isn't widely tolerated as a genuine reason for sickness is money. We can't have our police officers and ambulance staff on long term sick can we! There are targets to be met.....

Don't forget to vote in the MAD Blog Awards 2013. I'm a finalist in the Best Writer category and all votes will be appreciated! VOTE NOW! Voting closes midnight tonight!

Experience

"28 year old female, lacking experience....."

Right! Rant time! This post was inspired by a twitter conversation with @butwhymummywhy about being judged as being too young! (see her musing on the same subject here) Tell me, who here has been told they were too young to do something? Which mothers have faced criticism for being to young to have a baby? I'm not talking the 13 and 14 year olds, they ARE too young. I'm not even talking about the '16 and pregnant' ones. I'm talking those in the low 20's. At what age is the 'right age'? Who has not been trusted at work because of their age? Who's opinions have been discounted because they were 'too young' or 'inexperienced'? Personally, I've been on the receiving end of a number of comments about being 'too young' throughout my relatively short life. Being a parent at 23?! What was I thinking! Far too young! Right?! Let me put this too you....

Let's say I went to university, graduated at 21, got a job, worked for 4 years, had a committed relationship and then had a baby at 27. Is that acceptable? Yes it is! How about leaving school at 16, working for 3 years, buying my own house, had a committed relationship, worked for another 4 years and had a baby at 23. I was earning more than most of the 23 year olds with degrees. I owned a house and had 7 years working and living as an adult under my belt. Am I any less qualified? Apparently so! Surely my degree from the University of Life counts for something?! It really pisses me off when age is used to undermine, with nothing to back it up other than a date of birth. 

Now take the work place. My work place. The ambulance service is a very strange working environment. There is a bizarre mentality amongst many that the more years of service you have done, the better you are. There is a culture of looking after the 'long timers' and the 'newbies' can deal with it. The relief rota is a case in point. Working 7/10 weekends indefinitely just because you are new if fine for a few years but 3? 4? 5? 6 years? When are you experienced enough to not have to do the shifts that the experienced staff don't want to?!

"68 year old female, chest pain"

I was working with a guy who had done 25 years on ambulances. The shift had been painful. He didn't have the time of day for me because I was a student. At no point did he bother to ask where in my training I was. He opened the days conversation with 'are you one of jumped up Uni medics or one of the Playmobil Paras?'. There is a lot of ambiguity in the service about university students. They are seen as stuck up 'know it alls'. OK, some are but similarly there are 'old hands' or 'dinosaurs' who swagger around with just as much self importance. It's not the training, it's the personality. Difference is I wouldn't call them a derogatory name to their face! This guy was giving me one of two labels regardless of what kind of clinician I was. For the record I was a 'Playmobil Para'. I get this label because my route to becoming a paramedic had a different name for the final exam than what used to be done. Therefor it stands to reason that I will be incompetent, useless, untrustworthy, unknowledgeable and a clinical liability. Right?

The hours past with stories about 'back in the day' and instructions not to do too many jobs in the shift etc. I was mocked for being thorough and told my extensive paperwork was a waste of time. I ignored it. It was the expected treatment for a relatively new student. By relatively new, I mean only 2 years. At 4 shifts a week, 10 jobs a shift, that equates to roughly 4,160 patients. In that time I had done 2 ECG recognition courses, a course in Trauma, plenty of home study, clinical updates, reflective practice and some other work related stuff. Yes I was new, yes I was still keen (still am) and no I didn't tell him what I'd done in my spare time.

We arrived on scene at the patients house and as the 'newbie' I carried all the bags while he followed with his hands in his pockets. The patient looked like crap. Pale, sweating and complaining of central chest pain radiating to her jaw. I did the ECG, looked at it and KNEW it was heart attack. I passed it to my crew mate of 25 years experience.

"Nah, it's just high take off."

A) Normal B) Heart Attack (NOT High Take Off!)

For those not down with ECG terminology, we look for ST segment elevation. I know that means nothing to most of you but all you need to know is high take off and elevation can look similar but are not the same. I explained my reasons why it wasn't high take off and the response I got was:

"You can use all the long words you like, that's high take off."

The reason this was a sticking point was, if it WAS a heart attack, we would be travelling a long way to a Heart Attack Centre and would be late off. It is wasn't, and was just high take off, we'd be going to the nearest A & E and would be off on time. 

"I've been doing this job for 25 years, you're a student, trust me, it's high take off."

"It's elevation, we are going to the HAC, you can call clinical support if you like. The history matches the ECG."

He muttered something under his breath about 'know it alls' with 'no experience' and stomped off to the cab. We drove to the HAC, the waiting cardiologist looked at the ECG and confirmed it was indeed ST elevation and she was indeed having a heart attack. 

Student 1 - 0 25 Years Experience

It made for an awkward journey home. I didn't gloat. I didn't say 'I told you so' but I didn't need to. He just ignored me. The silence was golden. My point isn't that I was great. On a day to day basic his wealth of experience would help him and me in many ways but just because I'm young and new doesn't mean I don't know what I'm doing. He hadn't done any training for years, no continual professional development. Therefor, is 25 years experience just 1 years experience repeated 25 times? I have uppermost respect for people who have done the job for so long but respect still has to be earned. Treating my like an idiot only earned my crewmate disdain. I don't know everything, far far far from it. I'm still learning. I'll always still be learning. The time I don't feel the need to learn more is the time I stop gaining experience.

People should be judged on ability not experience. People should be judged on how how well their children are brought up, not how old the parents are. Experience is relative. It's well known that discriminating against sex, race, religion and sexuality is not acceptable in today's society. Well, age isn't a reason to belittle / dismiss / ignore someone either. To label someone as too young to do something or to have done something, smacks to me as criticism to justify their own choices in life. There is no point in having experience if you've done sod all with it.

Rant over! 

Do I have enough experience ranting to call myself a well rounded ranter or am I too young?

Zig-Zags

"Bunch of parents being dangerous and selfish"

Being on a rest day I actually got to do the school run for a change. I took the car because a) the weather was grim and b) I had somewhere to be after I dropped the boy off at school. I turned up, parked about 50 meters down the road and walked him into school. As I passed the yellow Zig-Zags with huge KEEP CLEAR letters written on the road a car pulled in and parked. The mother got out, got her child out and walked in to school. 

"You can't park there." I said.

"Well I have." she said as she started walking off.

"Not only is it illegal, it's incredibly dangerous and selfish. Read the sign."

"How about you mind your own fucking business."

"How about you mind your language."

With that, she raised her chubby middle finger at me and walked off. Parenting at its best! Why is it so hard to NOT park on the 20 meter stretch of road?! 

It really really winds me up and there is sod all I can do about it. There are no teachers or school staff outside stopping it, there are no police or PCSO's outside stopping it so it just continues. Obviously, I don't expect the police to waste resources on it but surely something can be done. Why do these parents show such disregard for a) the law and b) the safety of children. They are there for a reason and I have been to several children injured because of it. 

To make my point I busted out the camera and took 3 photos while arriving and leaving:

This is the woman with the mouth like a toilet.

Culprit number two as I was leaving. Why walk when you can park?!

There was a legal space opposite but it needed parallel parking. Long!

All it is, is selfish laziness. Nothing more, nothing less. Pig headed ignorance. If all other parents who drive can park legally, a little further down the road why can't these morons do the same?!

I've written a letter to the school about it and hope something will be done. Do you have a similar problem at your school? Please share you thoughts! Am I over reacting?! Personally, I'd like to see zero tolerance. Park on school zig zags and if there is evidence of it, your car is crushed and you get 6 points on your licence. That'll soon stop it!

<a href="http://www.bloglovin.com/blog/4339449/?claim=2n598tpb9vh">Follow my blog with Bloglovin</a>

When God Made Paramedics

I found this randomly on the internet. It is written by an unknown author but it sums up well the job we all do. The text refers to paramedics but it applies to anyone who works in any ambulance service the world over! Enjoy!

NB: After posting this, I received the following message:

"Ella, When God created paramedics is not anonymous. It is plagerized almost word for word from a mother's day column by Erma Bombeck. Google "When God Created Mothers." This version has been making the rounds for over a year. The person who originally posted obviously did not understand that writing is a labor of love and that publishing another's work as a whole or with a little tweaking, is stealing."

I did google it and the original poem was written by Erma Bombeck. Writing is a labour of love and I wouldn't want anyone to tweak my writing and claim it as their own. This 'version' of the poem does convey the message about EMS but shouldn't be credited to anonymous. Thank you Erma Bombeck.

*          *          *          *          *

When God made paramedics, He was into His sixth day of overtime. An angel appeared and said, 

“You’re doing a lot of fiddling around on this one.” 

God said, 

“Have you read the specs on this order? A Paramedic has to be able to carry an injured person up a wet, grassy hill in the dark, dodge stray bullets to reach a dying child unarmed, enter homes the health inspector wouldn’t touch, and not wrinkle his uniform.”

“He has to be able to lift three times his own weight. Crawl into wrecked cars with barely enough room to move, and console a grieving mother as he is doing CPR on a baby he knows will never breathe again.”“He has to be in top mental condition at all times, running on no sleep, black coffee and half-eaten meals, and he has to have six pairs of hands.”The angel shook her head slowly and said, 

“Six pairs of hands…no way.” 

“It’s not the hands that are causing me problems,” God replied. 

“It’s the three pairs of eyes a medic has to have.” 

“That’s on the standard model?” asked the angel.

God nodded. 

“One pair that sees open sores as he’s drawing blood, always wondering if the patient is HIV positive.” (When he already knows and wishes he’d taken that accounting job) “Another pair here in the side of his head for his partner’s safety. And another pair of eyes here in front that can look reassuringly at a bleeding victim and say, “You’ll be alright ma’am when he knows it isn’t so.”

“Lord,” said the angel, touching His sleeve, “rest and work on this tomorrow.” 

“I can’t,” God replied. “I already have a model that can talk a 250 pound drunk out from behind a steering wheel without incident and feed a family of five on a public sector paycheck.” 

The angel circled the model of the Paramedic very slowly. “Can it think?” she asked.

“You bet”, God said. “It can tell you the symptoms of 100 illnesses; recite drug calculations in it’s sleep; intubate, defibrillate, medicate, and continue CPR nonstop over terrain that any doctor would fear… and it still keeps it’s sense of humour.”

“This medic also has phenomenal personal control. He can deal with a multi-victim trauma, coax a frightened elderly person to unlock their door, comfort a murder victim’s family, and then read in the daily paper how Paramedics were unable to locate a house quickly enough, allowing the person to die. A house that had no street sign, no house numbers, no phone to call back.”Finally, the angel bent over and ran her finger across the cheek of the Paramedic.“There’s a leak,” she pronounced. “I told You that You were trying to put too much into this model.” 

“That’s not a leak,” God replied, “It’s a tear.” 

“What’s the tear for?” asked the angel.

“It’s for bottled up emotions, for patients they’ve tried in vain to save, for commitment to that hope that they will make a difference in a person’s chance to survive, for life.”

“You’re a genius!” said the angel.

God looked somber.

“I didn't put it in there” He said.

–Editor unknown

Original poem 'When God Made Mothers' by Erma Bombeck