how common it is for us to be attacked as we try to help people. It’s a strange world where ambulance service staff need to wear stab vests as they go about their duties. But it should be borne in mind that the majority of these assaults are drug-or alcohol-related. And they tend to happen more frequently at night or on weekends. It’s also worth remembering that while the average ambulance person may see about 50 patients a week, most of these call-outs are fairly ordinary stuff.
Major trauma is rare. And life-threatening incidents account for less than 10 per cent of our workload. So it’s not 24/7 excitement like Casualty, ER or Holby City – and unfortunately very few of the doctors are George Clooney lookalikes.
So what personal qualities do you need to work in the ambulance service? High on the list, training aside, are lots of patience, good listening skills and bucketloads of common sense. Bystanders or relatives, whether well-meaning, interfering or aggressive, can create challenges for us. So you really do need to be able to think on your feet – whatever is thrown at you. Adverse weather conditions and environmental factors can complicate the picture too. And last but not least, you need to be able to lift very heavy people and equipment up and down stairs and over distances.
Unfortunately, when working for the ambulance service you have to get used to the fact that you don’t always know what happens to the people you treat. You may be briefly very involved with them. They might tell you everything and you may be there with them, sharing the most distressing, painful or upsetting event of their life. The feelings involved may be quite intense. But our job is to do our very best for them – and then to hand them over to the hospital. We’re not always routinely told how things have turned out, mainly because of patient confidentiality issues. Of course, if we’ve taken someone to our local hospital we may well see them the next time we go there. But usually we don’t get to know what’s happened. That’s also part of the job that we have to take in our stride.
The people I work with in the ambulance service are a fantastic bunch. I never laugh as loud – or as heartily – as when I’m sharing a joke in the mess room with my friends and colleagues. There’s a real sense of fun between us and we socialise a lot. In fact, I believe there are very few work environments that share our sense of camaraderie. And that’s one reason why so many staff date or marry each other. I’m a testament to that, of course, as I married Steve. It isn’t unusual for ambulance staff to marry nurses, doctors or workers in other emergency services too. I guess that’s because we all have so much in common, like dealing with unsocial shift patterns. And, of course, life and death.
A heroin overdose usually comes through to us as ‘young male collapsed’ or ‘difficulty breathing’ – an overdose will stop you breathing. But when someone dials 999 to report such an incident, they’re unlikely to want to flag up the truth. If they’re heroin users, their main concern is not alerting the police.
Addicts buying heroin sold on the street don’t really know the purity of what they’re buying. It could be cut with other stuff. Or they might get the dose wrong. Seconds after injecting what they think is the right dose into their vein, they turn grey-purple. Their breathing stops. And that leads the heart to stop through lack of oxygen.
There are times when a heroin overdose can be a very quick end. But in some cases the person’s breathing just trails off. So if we are called there in time, there’s a chance we can save them. In this situation we can give them a drug we carry at all times. It’s called Narcan and it reverses the effect of any narcotic-based drugs like morphine or heroin. It can actually reverse the effect of an overdose within minutes.
But amazingly to us, heroin users are not always grateful or relieved if we manage to save them from a sad end. Often, once the effect is reversed by the Narcan, they’re up, alert – and angry. Their view is they’ve spent their money on heroin and we’ve gone and wiped out all the ‘benefits’ as far as they’re concerned! Amazing, isn’t it? But we don’t say, ‘Excuse me, you were dead a minute ago and you’re still worried about your drugs?’ But that’s really what they’re thinking. Sometimes they’ll just walk away from us.
This can be more dangerous than you’d think. Because the life of the heroin still in their bloodstream is longer than the life of the antidote, there’s a chance they’ll go into respiratory arrest again. If we can sense that they’re likely to run off straight away – and you sometimes get to spot the signs – we may give them another injection of Narcan. We don’t want them to collapse. For us, it’s a case of making the best of a bad job. But only if they let us.
Drug addicts are occasionally verbally abusive. But over time you realise that the verbal abuse you might get from them isn’t really personal. It’s just aimed at whoever is doing the job. If you’re female, the abuse is ‘fucking blonde bitch’ or ‘stupid blonde cow’. If you wear glasses, you’re a ‘speccy git’. A bald paramedic (like my husband) is a ‘bald git’. And so on. The abuse or aggression can be much worse when you’re trying to help someone on crack. Heroin’s a bit of a downer but there’s no reasoning with someone on crack. You’re wasting your time.
Tonight I’m called out with my husband Steve to a familiar address. It’s a rundown bed-and-breakfast, a hideously depressing building, tatty, seedy, hasn’t been decorated or touched for years. At the front desk there’s a scruffy, unshaven, unkempt individual with a fag clamped firmly to his lips resembling Onslow, the slob played by Geoffrey Hughes in Keeping Up Appearances. The whole place reeks of tobacco, stale sweat – and despair.
‘Have you got a room for two weeks in August?’ quips Steve, deploying gallows humour: we know we’re probably going to need it. The call’s come through as ‘breathing difficulties’ – but we’re pretty sure someone’s overdosed on heroin.
‘I’ve never been called out to this place for anything else,’ I remark to Steve as we follow Onslow down the shabby corridor to a squalid room. It reeks overwhelmingly of cannabis.
Sitting by the window is a 20-something man slumped in a chair. He’s not a pretty sight. His skin is mottled, purple. A crust of dried vomit is covering his face and chest. Three other people, two men and a girl, are just standing there blankly, no flicker of any kind of emotion from anyone. They’re completely spaced out.
One of the men gestures to the chair. ‘He’s not very well,’ he says in a matter-of-fact way. ‘We had to resuscitate him.’
‘When did he last talk to you?’ I ask, putting down my bag.
‘Oh, just a few minutes ago.’
Steve and I start to move the man from the chair to the floor so that we can get going on resuscitating him. But it’s impossible to move him. He’s as stiff as a board. It’s almost as if he’s moulded to the chair. Now I’m confused. Stiff means rigor mortis, when all the muscles in the body become stiff and inflexible. It’s a good indication of death, because you find it happening in the body in the first two hours after death – and after about 8–12 hours the body becomes completely stiff. So this man’s been dead for hours. Not minutes.
‘Are you completely sure he was talking to you a few minutes back?’ says Steve.
‘Yeah, he was movin’ around an’ everything.’
Unlikely.
As paramedics, Steve and I know there’s no way in the world that this is true. The man is very, very
