Perhaps It's Just Me

"Is it really possible to have a career in EMS and be emotionally unaffected by the things we see?"

This is the question I posed on Twitter a few days ago. Many seemed to think that it's an impossible task, that, after all, we're human too. However, there were some who seemed to think it possible. To work through a career and remain untouched. Unharmed.

It seems I have joined an ambulance service where macho-ism, for all its pros and cons,  appears paramount, or at the very least, a lot more visible. Whereas in my previous place of work the male-female ratio was split almost straight down the middle, my new place of work is staffed mainly by males. Perhaps that lends itself to a culture of bravado. Perhaps having more females around allows for everyone to be braver with their emotions, whereas having fewer means that those left must be impressed. Perhaps I'm imagining it or over-analysing it. Or perhaps, as I'm beginning to suspect, it's just me.

Other thoughts have taken root. Paramedic burnout seems faster here. Turnaround is high. New paramedics are qualifying all the time, only to find that their best career options lie elsewhere, away from the front line and away from patients. Patient empathy seems less common and the emotional toll seems negligible. Maybe that's the answer. Ignore the reality around you, and treat every shift as another day on the production floor. No emotional involvement. All the while, I'm still taking calls home with me.

Questions still run through my mind. Are the hardened souls really that hardened, or do they hide their torment better than I can? Are the tougher types really that tough, their souls numb to the humanity we witness every day, or have they just learnt to compartmentalise better than I can? Are they just burnt out, their hearts and minds numbed after seeing so much, too much? Or perhaps, as I'm beginning to suspect, it's just me.

Perhaps it's a cultural issue? Perhaps I'm not quite as "at home" as I think I am? Perhaps I'm just being ridiculous?

PTSD amongst EMS staff is well documented, if not well recognised or well accepted. At least not well enough. There's too much stigma still attached. Those affected are seen as weak, not "man enough" for the job. Not strong enough. Too attached. Too emotional. Too ridiculous. 

I don't think I'm any of them. I don't think that anyone who carries these feelings with them is any of them. I think that perhaps they, we, just have a different way of connecting with our patients. Some see their patients as the latest gadget on a production line. Some see their patients as their next challenge. And some see their patients, imagining them as their very own parent, or grandparent, or child, or best friend. Not every patient, but enough of them. Enough to make the emotion raw enough, real enough, for it to affect them in the longer term.

I'm not sure whether that's a healthy thing, but I strongly believe it makes me a better paramedic.

But perhaps it's just me.

War and EMS

This is a post I have written, deleted and rewritten several times. It is a risky post, as it has the

potential to delve into political wranglings that I do not wish to enter. Nevertheless, I want to write about a side to EMS that very few have seen.

Those of you who have followed this blog for any time, will know that just over two years ago, I left the relatively safe shores of the UK and headed to continue my life and my career in Israel. Just the name of this country evokes images in people's minds that I cannot control. Some for better, some for worse. Living here is a complex mix of normality and insanity, of the usual and the unusual, of war and peace. Few places in the world stir up as much feeling as Israel does. There are lovers and haters, there are the passionate and reserved, but there are very few who have no feelings one way or the other when it comes to Israel. That, despite the fact that too few could point it out on a map or describe its size. (Look on a world map for the eastern edge of the Mediterranean Sea in between Egypt, Jordan, Syria and Lebanon for a dot about the size of Wales, or New Jersey...)

The national ambulance service is called Magen David Adom - Red Shield of David - (follow them on Twitter here) and is an affiliate of the international Red Cross. It serves a population of some eight million people in times of peace and war. It has in the past sent crews to disaster zones such as the Philippines, Haiti and Turkey. It has dealt with mass casualty incidents from which the world has come to learn. It is, however, or at least tries to be when circumstances allow, just an ambulance service treating its population for all manner of illness and injury as is seen in any normal (for want of a better word) part of the world. 

The last two weeks have been a little unusual, to say the very least. Treating patients has taken on a different sort of urgency, when the decision making process doesn't only include what the best treatment options are, but also where is the nearest point of safety for when the air-raid siren sounds. Each ambulance now carries ballistic vests and helmets. Enough for each crew member plus one patient. 

However, what if there is more than one patient? What if someone is accompanying our patient? If the siren sounds, do we stop and seek shelter, taking time to help our patient out of the ambulance and into hiding and increasing the risk for all of us, or do we keep going to the hospital and hope that the inbound missile heads elsewhere? 

We have been sat on station when the siren has sounded. At the same time, a call comes in. The rules dictate that after any siren, we need to take shelter for ten minutes, giving time for the threat to disappear, for any shell fragments to stop falling, for the Iron Dome anti-missile system to do its job and destroy the inbound terror. Do we wait for those ten minutes? Do we follow the rules, or do we break them, heading out for whatever that call is that has just come in? What if the call is for someone having a heart attack? Or someone having a baby? Or for someone who has stopped breathing? 

At times when seconds count, can we afford the luxury of minutes? 

I'm fairly lucky. I'm not near where most of the missiles are landing. Parts of Israel, particularly the southern region near the Gaza border, are facing dozens of missiles every single day. Paramedics there are making these decisions call by call, minute by minute, whereas I've only had to think about it on a few occasions. 

It is somewhat of an understatement to say that these are very strange days and this is a very strange place to be part of the world of EMS. However, it is times like this that the significance of this choice of career is suddenly very much in evidence. 

I look forwards to calmer days, where my decision making process goes back to the best treatment and the most appropriate hospital for my patient, and that the list of decisions and thought processes don't include where all the available bomb shelters are on my route from station to patient to hospital. 

Trust

There are several posts, in fact dozens of them, sitting in the drafts folder, waiting to see the light of day. At times, I sit at the keyboard and, just like the ad for Yellow Pages used to say, let my fingers do the walking. Or, as in this case, talking. I wrote most of this post over two years ago, but wasn't ready to share it. Everything within it is still true today. 

There are times where I don't write the posts, don't compose the stories, they just magic themselves from memory to fingertips, skipping out any thought processes along the way. Sometimes, the opposite is true. There is a tale I wish to tell, if only I could find the way; if only confidentiality issues, or lack of descriptive skill, or plain and simple fear weren't preventing me from doing so. For me, writing is often a type of therapy, giving voice to the sights and sounds that sometimes torment or trouble or even tickle my thoughts.

I've never been one to talk about how I feel. I find it uncomfortable and always worry that the skeletons I keep hidden behind lock and key will be too much of a burden to anyone else, be they family, friends or total strangers. It takes a certain amount of bravery to open up and bare one's soul. Over the years, I've watched colleagues who seem to take everything in their stride, who never appear to be bothered or upset by even the most gruesome of scenes. I've wondered if perhaps I am the odd one out. 

Perhaps I'm the only one who's affected by the horrors of the scenes we see. Perhaps I just had an overload of them. If you've read my writings for any length of time, you'll know that I tend to attract more of the serious calls than would be a fair average. My colleagues look at me and wonder if the black cloud that follows me will be blown away on the winds, leaving a clear sky, or whether it's planning on raining down with a particularly torrential downpour. I've never asked or prayed for that to change. All I can do is face up to the challenges as and when they present themselves and hope that I deal with them to the best of my ability. 

This blog has been, and continues to be, a revelation to me. Despite the fact that I'd kept an old-fashioned (and now destroyed) diary for years before starting to write here, the realisation that there was someone, anyone, out there who would want to read about my thoughts and experiences was astonishing. As I head towards half a million readers, that realisation is all the more powerful. It is also daunting in the extreme.

MrsInsomniac has spent years trying to get me to open up, to be less afraid to trust others. Trust someone enough to reveal what I'm really going through. To talk. Not the babbling gibberish and hyperactive nonsense that I talk most of the time, but really talk. Express what I was going through. Describe the scenes, the experiences, the thoughts, the fears, the triumphs and tribulations. 

On the one hand, to talk about what it feels like when all I want is not to feel anything. To talk about what it feels like when despite all the knowledge, despite all the learning, despite all the experience, to turn up to a scene and realise with cool composure that there is nothing left to do. 

On the other hand, to talk about the scene that is so chaotic and confused and unusual when we arrive, with instructions and treatments and decisions flying in all directions, yet by the time we leave, all is much calmer, and there is warmth and a smile and appreciation and thanks.  

And in both of these possibilities, when we have either done good or when we have done nothing, is it right that sometimes I feel something when I shouldn't, yet at other times I feel nothing at all when perhaps I really should?

Honour

There is no honour in a so-called "honour killing." 

These horrendous pieces of news reach our eyes and ears all too often, streaming in from media the world over, yet for as many of these horrendous news items that make it to the front pages, there are so many others stories that never see the light of day. The trauma affects only those closely connected to the victim and the world can't share the pain, even if only for a brief, fleeting moment of reading a hastily clicked-away internet screen. 

I know these cases exist. I have seen them, or at least their results. A woman lies dead in the street. A man she chose to live her life with was found not far away. Their families, disapproving of their relationship, made an unholy union in order to sever theirs. Calm is restored. At least until the next victim in the cycle finds themselves at the wrong end of a knife or gun or blunt instrument; harbingers of doom; revokers of life; restorers of so-called honour. 

The cycle continued. One death led to another, each family seeking the upper hand, the glory. There would be news of a shooting, or a stabbing, or an inexplicable car accident. Then there would be quiet. Sometimes days, sometimes weeks or longer, but still the air was filled with the constant threat of the next retaliation. 

We were traveling through one of the tougher parts of town. The roads have more holes and fewer rules, housing is a mish-mash of prefabricated buildings and run-down apartment blocks, street signs and street lights are almost non-existent and the numbering system no better than guesswork. 

Only a few days had passed since the last honour killing. The latest in the neverending cycle of deaths that proved nothing except that yet another gun had tried to restore its owner's pride, yet at the same time now made him, or those closest to him, the next likely target. In the darkness, we could see the hazard lights of a car parked a few hundred metres ahead. The driver's door and the rear door directly behind it were both open, and all we could see was a pair of legs sticking out. As he heard us approach, he jumped out. 

He was wearing nothing but a pair of boxer shorts. No shoes, no trousers, no shirt, nothing. As we pulled up behind the car, the first thing we noticed was that he was covered in blood. 

"She's in here! I don't know if she's breathing!" It seemed as though the latest victim of honour was in the back of an almost-naked man's car. 

We jumped out of the ambulance, grabbed the bed so that we could at least move her into the ambulance and be able to see to start treating whatever gruesome injury was about to reveal itself to us. The man who greeted us jumped over the clots of blood that were lying on the floor by the passenger door and looked as though he was about to faint. He sat back down in the driver's seat with his head between his knees and his hands on his face. 

"Just help her. Please. Just help her." 

Two steps later, we could see that our victim was no victim at all, sitting as she was, cradling the baby boy that she had just delivered. 

Sounds of Life

We arrive at the hospital gates
mere seconds apart.
Two ambulances with lights flashing,
Sirens trailing off as we pull up
At the kerb.

They open their doors first,
Exposing their patient to nosey bystanders.
Some look shocked.
Some smile.
Some look away.
Pretend they don't see.
Or hear.
The hiss of the oxygen,
The ping of the monitor,
The instructions of the crew,
All the Sounds of a Life
being saved.

They turn right and disappear,
and as they do,
We turn left.

Our patient is bursting with life, albeit
In pain.
She's Expectant,
Ready,
Anxious.
Scared and excited all at once.
All of a sudden, she screams.
She screams and curses and yells and cries.
And then another noise. A sigh.
And a second cry.
All the Sounds of a Life
being born.

Birthdays

Five o'clock in the morning and for the first time all night, we finally arrive back on station. Within seconds, before the engine has had the chance to cool, or the water in the kettle given the chance to boil, the phone rings again, sending us out on our next call. It had been one of those shifts. Job to job, patient to patient, hospital to hospital. With barely the chance for a bite to eat, we had inhaled cups of coffee throughout the night to keep our energies, as well as our hopes, alive and kicking.

Five minutes later we arrive at the address, still with no real details of what awaited us on the second floor of the dilapidated building. The only information we knew was that an elderly lady had pressed an emergency button and there had been no contact with her since then. The three of us grabbed the four bags of equipment and a carry chair between us and started the march up the stairs. Any hopes of there being a lift in the building were dashed the second we pulled up outside and saw its age. 

A tired, but determined voice answered our first knock. "I'm almost there, just give me a minute!" We waited, each silently praying for the clock to tick a little faster, for the end of the shift to arrive, for the calls to end so we could go home. As we did so, a shuffling sound from indoors became louder, like a dog scratching on a door trying to get out. Eventually we heard a key turn and the door opened just enough for us to peer in. 

"You'll have to push the door to get in, I've got no more energy left." Gently we did as were asked, guessing that she was leaning against the door, when after a moment we were able to squeeze in through the gap that had opened. The smile that greeted us was like that of a child seeing its very first snow. Pure delight shone from Eva's face, as if she had stored up ninety years of smiles for just this one freeze-frame. 

"I'm fine, really I am. I just need help to get up off the floor. I've been here for a little while, thought I could manage to get up on my own. Looks like I was wrong." 

"How long have you been there?" 

"Since nine o'clock last night." All three of us do the mental maths. Eight hours on the floor. Eight hours trying to solve the problem by herself that we would now solve in thirty seconds. We checked Eva for any injuries and found that, other than a small graze on her elbow, she seemed to escape unscathed. "I need two things from you please," she asked, almost pleaded. "First, I need you to make sure I'm steady enough to get to and from the bathroom. Eight hours stuck leaves a lady just a little in need of refreshment." 

She smiled her child-like smile again. 

"Second, and more importantly, I'd like five more minutes of your time. Just to have a look at something for me." Presumably a medical issue had been bothering her and now that she had readily available access, she would use the opportunity. 

"We're not going anywhere. Get yourself settled and I'll make you a drink first whilst you do." Once Eva was up on her feet, it took only seconds before she regained her balance, walking around the flat in a manner almost as spritely as a  teenager rather than a nonagenarian. 

"Just a few minutes. I promise. No more." 

When Eva returned, she asked us to follow her into the lounge, where we were greeted to a picture gallery of immense proportions. Every wall was covered, every bookcase had pictures on the shelves, every picture frame hid several pictures within it. Hundreds upon hundreds of pictures, each with smiling faces that crossed ages, generations, and eras.  

"These are my children. And my grandchildren. And my great grandchildren. I should have lost count by now, but I know. I know all their names, I know all their birthdays. Sometimes I might need a small reminder, just that the date is coming up, not that it's their birthday." She stopped just long enough to look once all the way around the room. "It's a birthday today, too, so I'm glad I'm up in time to go and celebrate." 

"Whose birthday? Which generation?" 

"Mine," she said with a wicked grin. "And," as she pulled out a hidden envelope with an old photograph of a young couple at their wedding, "my husband's too." 

I'd had a quick look around when I looked for the kitchen to make her a drink. There was no-one else there. Just Eva and now an ambulance crew. Definitely no husband. 

"Where is he? Your husband?" 

"He's in a home, just a few minutes walk, not far away. When his mind started to wander, his body sometimes followed and he would end up lost, so about five years ago we decided it would be safer to have him move into a home. I see him every day except Tuesdays. That's when I meet with friends for a coffee. Every other day, I always leave the house at six in the morning to get to the home in time to make his coffee and have breakfast with him." 

All three of us looked at our watches. Almost six o'clock. 

"I'm presuming you don't want to go to hospital and get yourself checked after your eventful night on the floor?" 

"Don't be ridiculous. Spend my birthday, my Izzy's birthday in hospital? No way. The only place I'm going is to visit him. And if you people are as kind as you look, you'll help me get down these stairs." 

"We'll carry you down if you like!" 

"Most definitely not. I've still got legs that work, haven't I?" None of us dared argue.

With one of us either side, we slowly walked Eva down the flights of stairs to the entrance of the building. She refused any further offers of help, from us accompanying her on foot, to the offer of a lift in the ambulance. 

"It's only five minutes away, I'll get there the same way I do every day." 

"Happy birthday," the three of us called after her as she started to walk away. 

She stopped, turned around and smiled that smile once more. "Thank you for making it so." 

Thoughts on a Difficult Week

Each Friday, I post a poem, a rhyme, some silliness, to my family and friends on Facebook. Each week I look back, think of the events we have had as a family and as a way of keeping in touch with people, I share a little of what we have experienced. Some weeks it'll take me a dozen attempts to post something I like, even if it really is only a little moment of daftness. This week, the words just flowed, and I thought I'd share them with you too. 

Stay safe and have a good weekend. 

Thoughts on a Difficult Week

What happened this week? What passed us all by? 
Who did we see? Did we laugh? Did we cry? 
Where did we go? Was it slow or quite fast? 
Why did we do it? Will the memories last? 

Did we take some time out with our families and friends? 
Did we need to say sorry, to perhaps, make amends? 
Did we travel a little, did we smile a lot? 
Did we help someone whose needs they'd felt were long forgot? 

Some shifts make me look with a new pair of eyes,
As sun rises each day, or sets in the skies.
Some shifts leave me cursing at cruelty unbound,
Yet counting my blessings at the goodness all round.

As a change, just for once, from the silly and daft,
I thought I'd make you think back to the last time you laughed.
Spend time this weekend, with those who make you smile,
And carry those smiles through the week for a while. 

Footprints

Bright red footprints, like they'd been painted in a playground, appeared on the steps that we were hurriedly climbing. Not every step, only some. Every second or third stair was marked by a print hastily left by whomever it was that had either caused this horror or, at the very least, discovered it. We would never know whose prints they were, but a clue had been left for the police to use in their hunt. Each mark, no more than half the sole of a shoe or a boot, was as red as the next, each as incriminating as the next, each as foreboding as the next. As we ascended three flights of stairs, the footprints descended at speed. 

The floor and the walls are awash with red; pools and clots and smears and streaks. And footprints. And in the middle of it all, she lies, barely breathing, barely conscious, barely alive. Two police officers search the house as we start to treat her. The scene is no better in the tiny bedroom or bathroom. She had tried to escape and was cornered, prevented from fleeing by the force of a knife, and by her lifeblood draining away. Eventually, she fell by the front door and there she lay, waiting, in a motionless race against time. 

It took time to get her out, as we stepped out of the sea of red, time she didn't have. We couldn't bandage each wound; they were too many, and the minutes too few. We could barely stem the bleeding, although, ominously, it seemed to be slowing of its own accord. Four pairs of hands carried her on the backboard down the stairs, following the footprints and leaving some more, but this time each step was marked. Prints of different sizes, different shapes, but each dipped in the same red paint. 

At the hospital, they're ready for her. Bags of fluids and blood hang at the ready the instant we set foot in the resuscitation room. Oxygen can already be heard hissing out of the tap. Nurses and doctors take over the treatment. Orders are barked, instructions carried out, messages relayed. She's still breathing, still conscious, still alive. 

Outside, as we start to clean up, the police are waiting for us. They want the prints from all our boots. One by one, each police officer who had entered the scene, each paramedic who took part in the call, steps somberly on and off shoe-shaped pieces of card. Each leaving a pair of gruesome footprints - the imprints that would rule them out of the investigation - but would leave a mark in their minds. 

Inside, in the meantime, as the footprints dry, she dies.  

Unwritten Rules

The first clue was the fact that the apartment was on the fourth floor. It's the internationally recognised, first unwritten rule of ambulance work that the higher up the patient is in the building, particularly if there's no lift, the more likely they are to need carrying down. A voice hollers out of the window, through the security bars that seem totally unnecessary on a window so high up. 

"Bring some bandages, you're going to need them!" 

We're already carrying a supply, along with oxygen, a defibrillator, a carry chair and all other manner of equipment that we may or may not need. Unwritten rule number two is that whatever piece of kit you leave behind, is exactly the one you're going to need for the patient, so often we carry too much, rather than be stuck with too little. 

The trail of blood that greets us at the front door leads us to Berhanu, an ancient looking Ethiopian man, surrounded by concerned family. Three people start talking to us at once. 

"It happened yesterday too!" 

"He's on all these tablets!" 

"We tried to stop it, but it keeps filling up again!" 

Eventually, we calm the scene and reach Berhanu, finding him chirpy and unconcerned, unwritten rule number three proving yet again that often the family panics a great deal more than the patient. He was sporting a self-made blood collecting device around his foot, proudly showing off the handiwork that we were just about to dismantle. First, we remove the plastic bag, within which must have been a couple of hundred millilitres of blood. Next, we gently removed the DIY bandage that was held in place by sellotape and electrical tape, and that was made up of blood-soaked tissues, cotton wool and torn up pieces of newspaper. Finally we could see the ruptured vein just above the ankle. It was pouring out his blood as though someone had left a tap running. The tourniquet that he'd fashioned out of several elastic bands was doing nothing other than leave nasty marks further up his leg.

Within seconds, we applied a new bandage, lots of pressure and raised his leg, all in an attempt to stem the flow. It took some time, but eventually it slowed to just a trickle and then all but stopped, meaning it was stable enough for us to move Berhanu to hospital. 

"I'll walk!" he says, watching me open the carry chair. 

"I think it's better if you don't. We don't want that to start bleeding again." 

"I have walked every day of my life for the last eighty-five years, and up and down those flights of stairs for the last ten. You're not carrying me!" 

We pleaded with him. His family suggested, begged, shouted, instructed and cried at him. Nothing would convince Berhanu to sit in the carry chair. As a final attempt, my crew mate told him that the rules said that anyone who was bleeding, even a little, had to be carried. 

"Where does it say that?" 

"In my rulebook!" 

"Show me." 

"I don't have it with me. But believe me, it's there." 

"I don't believe you, and I won't be carried. Rules or no rules." 

He stands up, refusing all offers of assistance and takes a step towards the front door. All of a sudden, a trickle of blood appears below the bandage and within seconds it's dripping onto the floor at an ever-increasing rate. Defeated, he sits down again, allowing us to start the process all over; redress the wound, raise the leg and wait until the pressure and some gravity do the job again. 

When we're ready, Berhanu looks up at us and motions towards to the carry chair. 

"Good choice, we don't want to go through that again." 

"It's not really in the rulebook, is it, carrying bleeding people?" 

"Well, not specifically, no." 

"Unwritten rules, I guess. I suppose you have to have them too." 

Then and Now

At a Remembrance Day parade, several hundred war veterans, many of them well into their eighties and nineties, marched past an equal number of supporters who lined the streets of Whitehall, me amongst them. As long as I was in the country, I had attended every single parade for as many years as I could remember, supporting my grandfather, my great-uncle as well as all the other veterans. As they reached the Cenotaph, the cold, grey war memorial reflected the overhead skies. A fine drizzle had fallen all morning, coating the roads and pavements, but in an apparent show of respect had stopped falling as the veterans started to march. The Royal Air Force band escorted the veterans, the mix of young and old stark, but reassuring. A continuation of the generations, a knowledge that freedoms had been bought at huge cost, but that there were still those who would go on paying the price. It is both encouraging and tragic all at once, the knowledge that there are those who will continue to fight, alongside the reality that the need still exists. 

At the sound of the bugle, the flags are lowered and heads are bowed. An air of solemnity replaces the noise as a minute's silence begins, a silence crudely broken by the crackle of a police radio nearby and the words "Possible cardiac arrest on parade, St John Ambulance staff on way." 

When I look up from my place in the crowd, I can see the first shuffling of feet, clearing a path for the medical team and I approach the police officer to offer my help. He immediately pulls the gate aside and allows me through. I arrive at the same time as the team, explain who I am, and they gratefully welcome an extra pair of hands.  

The normal frenzied actions of a full resuscitation attempt are underway, but there is an acute awareness of the moment. Instructions are whispered, actions carried out in silence, even the ambulance arrives with blue lights flashing but the siren mute. The only loud instructions come from the defibrillator, as it advises to all who care to hear "Shock advised! Stand clear!" The orange button lights up and I press the button, wishing that there was another button to be pressed that would silence the instructions too. 

I never found out my patient's name, and the last I saw of him was in the back of the ambulance as he was taken to hospital, his chances of survival in single percentage figures. 

Against the odds, a few months later I found out through the grapevine that he had survived, and at the following year's parade, my grandfather pointed him out as he stood proudly alongside his comrades once more. 

Over a decade has passed since that day. Since then, I have left London, moved countries, and started on a new EMS path with a new organisation. The system may be different, but the patients are the same. They call when they are at a loss for any other options, sometimes they really need us, sometimes they just don't know where else to turn and hope for someone to share the burden and hopefully offload it.

Outside of work, we have made our home in a welcoming community, have made new friends as well as reconnecting with friends from days of yore, have moved nearer to some family whilst leaving others further away than ever. The number of expats is also fairly large, and so there are frequent visitors from overseas. Yesterday, I was introduced to one of the visitors, a friend's mother.

"Oh, so you're the paramedic?"

I'm not sure why I still find that question a little ominous.

"That's me."

"Did my son ever tell you about our story with ambulances?"

"Don't think so!"

"Well, about ten or eleven years ago, my dad was on a Remembrance Day parade and collapsed. St John Ambulance were there, they started doing CPR and they got his heart started again, and..."

I finished the sentence for her.

"And he was on parade the following year."

We both stopped in our tracks; the coincidence incomprehensible. She went on to tell me that her father lived another seven years after that day, long enough to meet his great-grandchildren, to see how the family continued to grow.

It is an occupational hazard, the knowledge that we almost never find out what happens to our patients once they are conveyed to hospital. But every so often, even if it takes a decade, we hear of remarkable stories such as this one.

My first successful resuscitation was on a gentleman whose grandson, years later, became my friend.

Code STEMI

At eighteen, I was the sort of squeamish person that everyone laughed at, as I'd feel faint at the mere smell of alcohol gel at the entrance to a hospital of doctor's surgery. The mere thought of visiting someone in hospital would give me a cold shiver down my spine. The threat of a needle would be enough to tip me over the edge into hysteria. Just a few years later, I joined the world of EMS. I guess you could say I got over my squeamishness. Although I still hate anything to do with teeth, dentists or anything in between. Don't get me wrong, some of my best friends are dentists. But only when I meet them outside of a quarter-mile radius of any dental surgery. 

The London Ambulance Service was my introduction into a world that I could never imagine, and my chance to discover that being squeamish is much the same as any other fear - the best way to overcome it is to face it head on. 

At first, as an EMT, I performed my duties almost by rote. Unthinking actions, following the script that had been drilled into my head throughout the initial weeks of training. But then, after a short while, as my confidence grew, I wanted to actually treat people, not just patients. I wanted to understand more about what I was doing and why I was doing it. And through this, despite the somewhat morbid attraction that many in the world of EMS have to trauma, I grew to love the heart just as much. I would sit and look at ECGs (replace C with K depending on which part of the world you happen to be in), try to delve into their mysteries and unravel the secrets that they held within the squiggly lines. 

Cardiac patients fascinated me. Within a short time of me joining the LAS, a new system was introduced for patients experiencing a heart attack, or STEMI. These patients would be diagnosed by the ambulance crew as having an acute STEMI and immediately conveyed to a cardiac unit for angiogram and angioplasty if required. Many patients have benefited from this life saving procedure, thanks not only to the skill of the doctors in the hospital, but to the skill of EMS providers in the field. More than once, having delivered a STEMI patient into the hands of the cardiac teams, we would stay to watch the procedure itself and get to see how the squiggly lines translated back and forth into what was happening on the inside. 

London became one of the pioneers in the field, leading the way in training all its staff to analyse ECGs and recognise the immediacy of the STEMI. It was exciting to be a part of something innovative and that was proving a great success. 

Recently, a team of paramedics and film-makers joined up, headed across the Atlantic from the USA to London, and joined crews there to see it all in action and share it with the world. Ted Setla and Tom Bouthillet put together a series of short films, taking in EMS systems around the world, with the London Ambulance Service - "The busiest EMS system in the world" - taking pride of place. 

CodeSTEMI (a hashtag with this name is also used on Twitter) is well worth the watch. In just under half an hour, the viewer is introduced into the world of the ambulance service and invited into the lives of people who have survived a threat that just over a decade ago would have meant  a much higher likelihood of death. It concentrates on the patients, on the crews and on the system that has helped raise the chances of survival of a cardiac arrest from single-figure percentages to somewhere over 30 percent in just a few years. 

The film doesn't sugar-coat reality, but it does show the human side of EMS, from the viewpoints of both patient and provider. And in these days where everything seems to depend on what can be done to bring down costs, whatever the cost, it's refreshing to see how people with a passion can still help to make a difference. 

It's been a year, almost to the day, since my last shift with the LAS. I'm proud to have them on my resumé, and smile when I look back, even as I'm still looking forward. It'll be strange to be the new-boy again when I finally wade through the sea of red-tape that is gradually running out (I hope), but at least this time I'll be able to do it with a decade's worth of experience. 

And I'll have all the inspiration I need by just looking back over my shoulder. 

The View from the Back Row of the Classroom

Over the past few weeks, I've gone back to school. I've been sitting in the classroom listening to lectures I've heard before, albeit in a different language, surrounded by a group of paramedic students who are just about ready to be unleashed on an unsuspecting but hopefully grateful public. The vast majority of the students are about to start their lives as combat medics which has made for some interesting scenarios, but one or two are heading for civilian roles. And then, there's me. I've sat at the back of the room that is fit to burst, writing bilingual, multi-directional notes, taken a few exams and hopefully come out the other side unscathed and ready for the front line once more. 

It's been a bit of a struggle to get my paramedic licence recognised and accepted here, and has involved two steps backwards of bureaucracy for every one step forward in actual physical achievement. It's been frustrating. I've been on the ambulances, but in a limited capacity. My paramedic skills have been safely tucked away until the piece of paper that I need is finally spat out of the machine, hopefully sometime very soon. 

I don't mind jumping through the relevant hoops. I don't mind sitting in classes I've heard before, because the reminders that they're providing are more than useful. It has been, however, somewhat disheartening that it has taken this long to make the progress that I'm finally making. 

Yet, as always, there is a silver lining to the cloud. Going back to school has given me the opportunity to see another generation of people who are already loving their chosen path. There are those who are looking far into their futures, planning to change the world, or at least their little part of it. There are those who are talking about being a part of something bigger, part of an EMS world that is looking to expand, to improve, to change, to evolve into something better than it already is. I've had the chance to introduce some of these students to forums, to various forms of social media, to blogs, to ideas, to people, at least virtually, who share their vision. 

(In the meantime, I have another day in the classroom tomorrow, and a rather daunting exam, the equivalent of the end of the paramedic course, on Tuesday. No public holiday here. So those of you celebrating Christmas, spare a thought and send some positive vibes just before you tuck into your turkey and mulled wine.)

From my seat at the back of the class, the future is looking good. Hopefully, once I've defeated the monster that is bureaucracy I'm embedded a little more in the system, I'll be able to be a part of that future. I might even tell them that I know the person who writes this blog... 

Rules for EMS

I have, unashamedly, stolen this list verbatim (with permission, I hasten to add). I haven't changed a word, or the order in which these rules appear, although I think that number 18 should be much nearer number 1, if not the top one itself. Rule number 38 I'd consider removing. Scene time is dictated by the scene, not by the rule book. Expediency is important; rushing, isn't. Many of these rules are not just for EMS, so even if you're looking in from the outside, take a moment. Oh, and I have no idea what the last one is trying to say. If someone wishes to enlighten me, feel free! 

(To my UK readers, this was obviously stolen from someone US-based. I haven't corrected fixed changed the spelling.) 

So, EMS providers, which would you remove, which would you change, and what would you add? I have also noticed that social media doesn't make any sort of appearance. That should probably change! 

And as potential patients (although I wish this on no-one), what would you do with this list. The floor, as they say in the classics, is yours! 

1. You are there to solve a problem, not cause one. 

2. The ABCs will save you every time.

3. The scene is not the venue for retraining. 

4. Interview the patient, not the clipboard.

5. The patient should not be the recipient of your problems.

6. Treat the patient to the best of your ability.

7. We are guests in their domain.
8. Look for reasons to transport, not turf.

9. Do not base treatments on lifestyles.

10. Expect no more from others than you can provide.

11. Handle the call you are on, not the one that might happen.

12. The acuity of the situation is due to the patient’s condition, not your anxiety.

13. We do not interrogate over the radio.

14. We do not yell at the family or patient; we explain the problem.

15. Being nice never hurt anyone or cost money.

16. Do not judge lifestyles.

17. A clean ambulance is a happy ambulance.

18. Obey your gut instinct.

19. Being nice does not indicate that you are weak or naïve.

20. Leave tunnel vision for the Amtrak folks.

21. 35 mph is good for patient care.

22. The closest hospital is not always true.

23. Document truthfully; you never know.

24. Know your equipment.

25. Continue to study; dormant minds make Jell-O look smart.

26. Show me what you know, don’t tell me.

27. Level of certification does not guarantee respect.

28. Talk to the patient first, then everyone else—when possible.

29. If nothing else, do the ABCs, treat the problem, use TLC, keep the patient warm, transport.

30. Trouble breathing equals lung sounds.

31. Regardless of whether you are a career or volunteer provider, you are there to do the “JOB.”

32. It takes less energy to be pleasant; anger festers for the whole shift.

33. Each call is a new one.

34. If they can take a tube, they needed one.

35. Be nice to yourself; you have to start somewhere.

36. Scene survey, ABCs, pick a game plan, make a decision.

37. Have people doing things.

38. Ten-minute scene times are a good thing.

39. Certification cards x patches = ????

Five Words

Stepping into the office with an envelope in my hand, I was about to take one of the biggest steps in almost a decade.

"Need my signature on an application form, do you?"

It was an obvious question for my boss to ask considering the fact that once again, the coveted places on the air ambulance had been advertised. That, and the fact that he had no idea of my real motives.

"Not quite!" I answered, handing him one of the copies of the letter. He looked down at the piece of paper, the cheap and nasty stuff that the ambulance service has started to use recently in yet another cost-cutting exercise. The confusion on his face said it all.

"You're sure about this are you?"

"Quite sure."

"Can we do anything to change your mind?"

"Not unless you're packing the LAS into a suitcase and sending it with me."

Handing in my notice was a great deal more traumatic than I had ever anticipated. I have loved my job. If not every minute of it, certainly as a career, as a way of life, I have loved it. But the time had come for a change that MrsInsomniac and I had been planning for some time. I'll write more about the change we're making in another post.

I've already had my final shift. It was initially scheduled to be a lonely solo shift on a rapid response unit, but luck had it that there was a student who needed a few extra hours out and about, so she joined me, hoping that my reputation for attracting "real" jobs would prove itself in reality. It didn't, but it gave us time to talk. Time for me to pass on a little of my questionable wisdom and for her to ask questions, question my answers and answer my challenges too.

Towards the end of the shift, she threw me a curve-ball.

"If you had to sum up your career in four words, how would you do it?"

"Four words? I'm not sure I can. Am I allowed five?"

"You can have five. It's my leaving present."

It took me some time. We attended another call, handed another patient to yet another crew and still my mind's rusty cogs whined and creaked to come up with some cohesive thought. Eventually, in a dull flash of panicked inspiration, I had it.

"Tried to make a difference." It really does some it all up.

It speaks of the patients who had no-one else to care for them, it speaks of the families suddenly bereaved, it speaks of the babies brought into the world.

It speaks of the children who were left battered and bruised by their very own flesh and blood, and others who were nothing if not heroes to their families.

It speaks of the people who just needed to hear a voice tell them that help is at hand, and it speaks of those pleading for help for their loved ones.

I hope it speaks of the students I worked with, studied with, taught and learned from.

I hope it speaks of the people who read this blog, those in the know and those who hope that they will become more in the know by reading it.

I tried. Sometimes I succeeded, sometimes I failed, but I tried. In most cases, I'll never really know.

My move takes me away from the London Ambulance Service, but not away from the world of the ambulance. The blog will continue (considering the accolade it has just received, it couldn't really not). For some time it'll be based on the scribbled notes that already sit in my diary, and soon stories will be told from new notes, new patients, whilst looking out over new horizons.

And if nothing else works out, I'm still proud of who I've become, what I've achieved, and the experience that I've gained. I'm proud of this blog. I'm proud to call some of the best ambulance staff out there my friends. And I'm still proud of those five words.

VOTING NOW OPEN!!!

 

Right then, loyal readers, the voting is now open for the EMS Blog of the Year. 

I have, miraculously, been shortlisted. You now have seven days of nagging to look forward to. 

Therefore, GO VOTE! 

Subtle, ain't I? Or maybe, Subtle ain't me. Anyway, I'm up against some serious competition, most of whom I read regularly, and two of them I even nominated in the first place, so I really, REALLY need your votes. You get one vote each - so make 'em count! 

Thanks to all those who nominated me in the first place - I'm honoured to be on a list with some great bloggers. 

AHEM!!!

So, the nominations for the Fire and EMS Blog of the Year have opened.

Know anyone you want to nominate? Well, do you?

Go on. You know you want to. Click here to nominate.

Transcript

The following is an almost word by word transcript of a phone conversation I had not long ago. It has nothing to do with EMS, ambulances or anything such like, except for the fact that the conversation took place when I was woken up by the phone ringing less than an hour after going to bed after a night shift. 

It was a conversation between ColdCaller (CC) and a slightly disgruntled, but surprisingly ever calm InsomniacMedic (IM). For the purposes of this conversation, IM lives at 123 High Street, Neartown, Z99 9ZZ. 

*RING RING* *RING RING*

IM: Unintelligible... "Hello?" 

CC: Overseas call pause and click... "Is this Mr IM?" 

IM: "Who's this?" 

CC: "This is Bill from PPI International. I'm calling you to help save you money."

IM: "Whatever you're selling, I'm not buying." 

CC: "I'm not selling anything sir. I'm offering you a service."

IM: "And what service might that be?" 

CC: "Like I said, I'm calling to help you save money, by claiming back payments on a loan that you shouldn't have made."

IM: "Which loan would that be?" 

CC: "You know the one, the loan you took out some time ago." 

IM: "Hedging your bets there, aren't you?" 

CC: "I'm sorry, I don't understand."

IM: "Never mind. Can you tell me the name of your company again please and where you're based?" 

CC: "PPI International, and our headquarters are in Karachi." 

IM: "And you're not selling anything, just offering a service, right?" 

CC: "Correct." 

IM: "Is this a free service?" 

CC: "Well, no, it is not free, we charge a fee." 

IM: "So you are selling something then?"

CC: "It is not selling, it is providing a service for a fee." 

IM: "Right. OK then. And who's the CEO of your company?" 

CC: "Why do you ask?" 

IM: "I like to know about any company which randomly calls and offers to help me. I just want to do some research and make sure that you are who you say you are." 

CC: "The CEO is Mr Khan." 

IM: "You say that your HQ is in Karachi. Where exactly is your office?" 

CC: "You want to know where my office is?" 

IM: "Exactly. Where do you go every day to make these phone calls?"

CC: "I'm not sure of the exact address." 

IM: "You don't know where you go to work every day?" 

CC: "I know where I go, I just don't know the address." 

IM: "I'll ask you one more time, and if you can't answer the question, I'm hanging up. Where do you go to work every day?" 

CC: Short pause. "OK, I don't normally give out my work address, but it is 123 High Street, Neartown."

IM: "Pardon? Can you repeat that? And tell me the postcode too please." 

CC: "My work address is 123 High Street, Neartown, Z99 9ZZ." 

IM: "You're sure? That's your work address? That's where you start and finish every working day?" 

CC: "Yes, that's right." 

IM: "Well then, how do you like your coffee???" 

CC: "Umm... Err..." Click, Beeeep

Moral of the story? Never, never, wake up an already sleep-deprived insomniac.