Why We Do It
When I was writing my last post, I was feeling a bit down and fed up after a run of shifts where not much happened, taking lots of non-emergency, low-acuity calls. This post is the complete opposite: this shift gave me a reminder of why we do what we do — because we save lives and help people.
This is the story of a shift where everything happened.
This post is probably going to sound like me boasting, but that’s not what I’m trying to do — I’m proud of what we do and I felt like writing about it.
My shift starts at 18:30. Book on, log in, press the green button to go available.
“Emergency ambulance, is the patient breathing?”
A cardiac arrest as the first call of the day certainly wakes you up. This particular call starts with an elderly lady just barely breathing and just barely conscious, but by the time we’ve got the address and a few details, she’s stopped breathing altogether. Most cardiac arrests we take are several minutes or hours old by the time someone calls us; this is a cardiac arrest in progress. Her heart hasn’t yet stopped, but without oxygen it’ll stop within the next minute or so. She has seconds left to live.
So we do CPR. Start pumping her chest, 1-2-3-4, 1-2-3-4. You can tell it’s being done right — you can hear her ribs cracking, the caller out of breath. Send the crews — just booked on for the shift — flying through empty Sunday evening streets. Past the end of my road — I’ve only just noticed that this call is only a few hundred metres away from where I live. Two fast response cars, an ambulance, a clinical team leader, an advanced paramedic responder. The two cars arrive first, almost simultaneously, paramedics getting PPE on and response bags out.
Then they’re there, by her side, taking over CPR and getting drugs and defibrillation ready, and the call goes dead as my caller hangs up. Confirm the number please, exchange?
Then… nothing. This is one of the hardest parts of my job. I’m sitting there, adrenaline still running — not as much as it was the first few times I took these calls, but never gone completely — with no way of telling what’s happening.
This one’s got to me, for whatever reason. You can’t always tell which calls will, or why, but I got invested in this one and now I don’t know what’s happening.
I take a 5 minute break. I go available again.
“Tell me exactly what happened.”
“Well I was making breakfast, I was cutting sausages apart, and I slipped with the knife and I cut my neck and it’s really bleeding, it squirted onto the wall, what should I do with it?”
I’ve already sent a Category 1 response at this point. Blood that’s squirting onto the walls, from his neck? That’s definitely arterial. This man has minutes to live. It sounds like he’s only nicked an artery, fortunately, or he’d already be unconscious and bleeding out. (I didn’t ask how he managed to cut his neck… some things you don’t want to know.)
This is a much calmer call overall — he hasn’t realised how serious this is, so I’m going to keep it that way. This is a big part of what I do — controlling the call and the caller, giving a sense of urgency in getting the bleeding under control but trying to keep him from realising how serious this is and panicking. Panic helps nobody here.
This patient lives on a main road. Same story: we send crews, just booked on for the shift, screaming at 70 down the main road. Only two units this time — fast response and the ambulance — but just as much urgency. I’ve got the caller keeping pressure on the wound and the bleeding is only slow now, but if he lets up he’ll be unconscious inside a minute, dead in less than five.
And the crews arrive and take over, and the call goes dead. Confirm the number please, exchange?
I close the call. I go available again.
Beep. Chest pain. Send C2. Close.
Beep. Fall. Send C3. Close.
Beep. Toothache. 111. Close.
“I was with my friends and they ran off ahead but I tripped on something and now I’m in a bush and my leg’s broken and I’m scared and I need help!”
The girl who’s calling me now is in her early teens. She’s been out with friends in the park but they’ve left her behind and now she’s injured, can’t move to get help, and there’s nobody around. It’s half past nine, it’s long since dark, and she’s in the middle of a big dark park but can’t tell me where exactly.
Okay. Which park? That one. Fine. Where exactly? She doesn’t know. Not so good. Okay, let’s triage the call, we can get more detail later. Problem is, I know this is going to come out as a Category 3 at most, if not C5. Broken bones are painful, sure, but in most cases not life threatening.
It comes out as a Category 5. Damn. That would usually mean I refer the caller to 111 for further assessment, but while there’s technically no reason I shouldn’t here, I’m not going to do that. I call our advanced paramedic team and get them on the line with her to get her assessed by a medic. Turns out she’s got an open fracture and she can see the bone, so an advanced paramedic responder is sent to her.
But it’s a night shift. There’s only two advanced paramedics working tonight. One of them is close by, but tied up on another job. The other one is halfway across the city and won’t get there for half an hour, even on blue lights. Okay, no problem, I can justify staying on the phone with her to help reassure her and monitor how she’s doing until they get there. While I’m doing that, I’ll get more details on the location from her, perhaps see if I can get a W3W1 location from her so I can point the medics straight there. If she knows her parents’ numbers, I’ll give them a call too to save her that anxious phone call.
So we chat for half an hour. School, exams coming up, unhelpful friends, lockdown stress, life. She wants to do what I do when she turns 18. I tell her it’s not for the faint-hearted and that only makes her more determined. She wants to help people. I hope she ends up on my watch.
And the paramedic shows up. Take care, hope it mends itself soon.
I close the call. I go available again.
“Can you call my parents and tell them what’s happened? Tell them it’s not their fault… I can’t face them…”
These calls are rare, and completely unpredictable. She’s twenty-something. She’s stood on the wrong side of the railings on a bridge over the river. She doesn’t want to be alive.
Every person’s mental health is different. I don’t know if, for her, that means that she’s about to jump, or if it means that she’s having second thoughts. I don’t have time to work it out. So I do what people do best: talk. Not healthcare provider to patient, just human to broken human. Tell me what’s going on for you.
There’s an inshore lifeboat a mile upstream. Station permanently staffed. 90 seconds to deploy. 90 seconds at 40 knots to scene. Too long. If she jumps now, she could be anywhere in 3 minutes — most likely she’ll be dead. Which is what she wants… right? “I don’t know what to do!”
Talk to me. Her boyfriend of 5 months came out of prison last year. She didn’t know that, until a friend looked him up and told her. Now she’s not allowed to see her friends without him there. Now she gets blamed — and beaten, and raped — whenever they do something he doesn’t like. She can’t leave for fear he’ll kill her. So she’s going to go out on her own terms.
The lifeboat’s standing by under the bridge, ready to pull her out. The police have closed the bridge, and they’re coming over. She’s scared — she’s not allowed to talk to the police. I’m not the police, keep talking to me. Talk to the ambulance crew, they just arrived. Talk to them? We’ll help you. We can get you out. Just… step over the railing for me.
And they’re with her, they’re wrapping her up and taking her to the ambulance, and she whispers into the phone.
“I don’t want to die…”
I take a break.
“I’m her neighbour, I come round every day to check on her. She seemed a bit off earlier, but now she’s really confused, she keeps trying to throw the covers off and open windows but it’s already really cold in here. I don’t know if she needs an ambulance or not…”
Alarm bells ringing. I appreciate it when people think before calling us, I really do, but this lady certainly does need an ambulance. Confusion on its own is mildly concerning — could be a UTI, could be sepsis, could be a number of other things, none of them particularly good — but that description is screaming hypothermia at me. I’m not there, I can’t diagnose, but… I’ll be very surprised if it’s not — and if I’m right, she’s a long way gone and cardiac arrest isn’t far away.
I’m not a clinician and I’m not allowed to make a diagnosis, so triage as normal. C2, fine, they’ll get there quickly enough on that. I’ll stay on the line for this one — this isn’t a panicky or critical call, not anything really remarkable, but just in case…
The ambulance is delayed. Local councils do like changing road closures without telling us about it… but they’re there in not very long and they can take it from here. I’ll check back later. Take care, bye.
I go available again.
Beep. Back pain. 111. Close.
Beep. Abdo pain. 111. Close.
Beep. Stroke. Send C2. Close.
Into the Breech
“Is the patient breathing?”
“It’s me, I’m 24 weeks pregnant and both legs have come out, what do I do?”
Well… that’s not good. Babies have a nasty habit of arriving at early hours of the morning when everything’s calmed down, but not usually at 24 weeks, and very not usually legs-first. Okay. Run through triage quickly to get the basic details. Done. Start giving instructions and reassurance — this is what you do, crews are on the way, don’t panic, let me know if anything changes and I’ll take you through it. This is the swan effect: calm, serene, gliding along on the surface, keeping the caller reassured; paddling like mad underwater because this is a set of instructions I’ve never given before and a situation I’ve never had to manage. How am I responsible for this?
We’ve got the works running on this one. Two ambulances, two fast response cars, a team leader, an advanced paramedic. They look at the call and request a second advanced paramedic2 with obstetric experience and an incident response officer. They wake half a neighbourhood up screaming through the streets from all directions.
There’s not much I can do. I’ve given all the instructions I’ve got in front of me. I’m just waiting for the crews to arrive — or the baby, whichever comes first. Praying it’s not the baby. I don’t fancy its chances.
But they’re pulling up, grabbing bags, donning PPE, taking over. Best of luck.
I take a moment to pull myself together.
My relief arrives.
I checked back on these calls in the few shifts after this one.
The man who’d sliced his neck open had lost about a litre of blood (you only have about 5 in total, so that’s a hell of a lot). Observations were mostly fine, other than (unsurprisingly) a low blood pressure.
The open fracture was fairly simple, truth be told — something we see every day, as a service. This one only stood out because of how young and scared my caller was. She was okay once they got her in a nice warm ambulance.
I was dead-on right about the hypothermic shock: death was hovering over looking distinctly interested. When they raced her to hospital under blue lights, she had a body temperature of 26°C — when anything under about 30°C can be life-threatening, even in young healthy patients.
The breech birth… the service is still dealing with the implications of, so I won’t say too much. Very sadly, we lost the baby. I can only imagine what that would-be-mother is going through, and I can only hope I brought some calm and reassurance to one person’s worst day.
The trapped suicidal young woman I really can’t say much about, other than that it was a good outcome.
The most remarkable was the cardiac arrest, which was a true arrest-in-progress. When they arrived, her heart was stopping — slipping between shockable and pulseless rhythms. My caller was doing CPR — full credit to him: good, effective CPR. They got an IV line in, got an airway in, gave drugs, fluids, rebalanced her vitals, shocked her — and got a full ROSC3. When they left, she was GCS4 3; when they arrived at hospital, GCS 15, awake and talking to the nurses. ROSC alone is ridiculously rare; to be awake and talking even more so; to survive to discharge, almost unimaginably impossible.
In one night, in these 6 calls alone, we saved at least two lives, possibly three or four, and brought reassurance and safety to 6 patients — and 6 families — when they needed it most. There are people out there, at home with family tonight, because we cared enough. If that’s not why we do it…
This remains, to this day, the only call I or many of my colleagues have ever seen to have two advanced paramedics dispatched on the same call. We only had two that night. ↩
Return of Spontaneous Circulation — when a heart starts beating for itself again. ↩