Tag Archives: Paramedic

Treating a dying child made me reflect on my role as a paramedic

We arrived at the scene in an ambulance to see the usual collection of bystanders clustered around a body. It was a child. She was still alive. A pale grey face, mumbling and moaning, eyes half shut and flickering. There was blood pooling from a wound to the back of her head and one of her legs was facing the wrong way.

The five-year-old girl had been struck by a car. The driver hadn’t been speeding or driving recklessly. The road was quiet. She had been out on her scooter. Suddenly, with a child’s spontaneity, she rode her scooter off the pavement and onto the road. The driver didn’t have time to brake.

We started high-flow oxygen and inserted a plastic airway into her mouth to stop her tongue blocking her airway, taking extreme care not to move her head in case she had a spinal injury. A dressing was placed under her head and her leg was realigned to a neutral position to prevent further tissue damage. Although she was breathing and her lungs sounded normal, we placed a bag valve mask over her mouth.

I shone a light into the child’s eyes. The right pupil was fixed and dilated. I advised the rest of the team of my finding and a colleague started to cry as she knew it meant bad news.

When the helicopter arrived, the doctor administered anaesthetic drugs and passed a tube down the child’s throat to manually control her breathing.

At some point the parents arrived. I can’t remember when, but it was before the helicopter had landed. I remember the mother running up to our huddle of green paramedic shirts and seeing her daughter lying there, her hands clamping over her mouth in horror. I cannot begin to imagine what she was going through. Seeing your small child, grey, moaning, bleeding and unable to respond to you is something no parent should experience. We encouraged her to kneel next to her daughter’s head, hold her hand and keep talking to her. Even now, years later, I’m crying while typing this.

As the crescendo of the ascending helicopter became a distant clatter I reflected on the picturesque setting. This was a tranquil village – in complete contrast to the trauma that had unfolded at its centre.

In the post adrenaline-fuelled, great-team-work atmosphere we bantered with each other. There was dark, dark humour as we checked over our shoulders to make sure the bystanders were out of range. Lots of swearing and jokes that only paramedics remain hardened to. Each of us adding another layer of veneer to shield our bravado.

After a quick debrief back at base we were back on the road, dealing with all the usual mundane shit.

I thought I would be ok.

When I got home my seven-year-old wanted to dance with me in the kitchen while my wife was preparing dinner. I remembered how three short years ago he had been riding his green scooter around our neighbourhood, carefree and happy, jumping off curbs crying: “Watch me do this, watch me do this.”

During dinner I held his hands and remembered how I had held smaller hands a few hours earlier, my blue examination gloves sticky with blood.

I remember an anecdote about a city where the ambulance service went on strike. The police were called upon to fill the gap in emergency medical response. When someone dialled the emergency number they would turn up, throw the patient in the back of a police car, no matter how serious the condition, and rush them to hospital. It was reported that patient survival rates significantly increased during this period, which caused the public to question the utility of the ambulance service.

I was left with similar questions. Two ambulances and a helicopter didn’t make any real difference to the outcome for this little girl. We made a difference to the parents and the bystanders. For as long as we were still treating their child, they held on to the fragile hope that everything would be ok in the end.

I guess sometimes that’s the only difference you can make.

Some details have been changed.

If you would like to contribute to our Blood, sweat and tears series about experiences in healthcare, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs.

I’m a paramedic who has considered suicide and I’m not getting support

When I was 15, a teacher found me during lunch break and asked if she could have a word. Confused, as I was generally well behaved, I followed her to the office. I was told that a close friend of mine had been found by his parents that morning hanging in his bedroom. He was in intensive care at the local hospital but his family had been asked to prepare for the possibility that he would die shortly. Growing up, the ideas of major depressive illnesses, self-harm and suicide were almost entirely foreign to me.

People often ask whether this was what motivated me to enter healthcare at 17 and eventually land in my current position as a paramedic by 20. Frankly, I don’t know. What I do know, though, is that while suicide was a foreign concept to me at 15, it certainly isn’t now.

Almost a quarter of ­ambulance staff have post traumatic stress disorder, according to research published in the British Medical Journal, and about one in three suffer from mental health problems. Statistics are hard to come by, but reports of paramedics killing themselves suggest suicide in the profession is a problem. The Age in Australia reported that the rate of suicide among paramedics for the year to April 2010 was about 20 times higher than that of the general population.

I require antidepressants daily to numb thoughts of self-harm and suicide. I was diagnosed with major depressive disorder nine months after starting work with the ambulance service. When I attend call-outs to patients in a depressive crisis or who have self-harmed, it is like looking in the mirror. When resuscitating patients who have tried taking their own lives, it is akin to looking at what could have been.

It was after one such callout to a young man who had hanged himself in the living room to be found by his wife and young child, that I broke down.

I was in the middle of my fifth 12-hour shift, I had just had to pronounce a man not much older than myself deceased, counsel a grieving wife, assist the police with their investigations and ensure appropriate members of family and friends were coming to be with her. Having never called in sick in five years, I radioed the operations centre and asked them to stand me down as I would be going home for mental health issues. I was weeping, I was trembling, I was unsafe to continue working.

I will never forget the words that came back to me through the radio that night. “But there are calls waiting, can you not just wait until your days off?”

After explaining I was no longer safe to work, I was begrudgingly allowed to return home. I sat in silence for hours. The emotions of every patient I couldn’t save, every patient who had tried to hit me, every patient who had shouted at me while I worked to save them or their family came crashing over me like a wave.

Publicity around paramedic suicide generally focuses on the traumatic aspect of life on the road. What is either less known, or perhaps conveniently ignored, is the pervasive culture in ambulance services seemingly designed to incite suicide. Rostered 12-hour shifts which almost never finish in under 13 hours; missed meal breaks to attend more calls; threats to place poor performance markers on our record if we book ourselves unavailable to use the restroom more than once per shift; and, of course, frequent exposure to trauma most people will experience just once in their life are some of the stresses of the job.

Rather than immediate referral for six sessions with a psychotherapist, available to all employees, any request for help is almost universally met with the question: “Are you sure this is the right career for you?” This is followed by almost daily phone calls hounding for a return to work and questioning our commitment to the communities we serve.

This leads to any paramedic in a mental health crisis feeling unsupported and, worse, feeling they are weak. The worst part is, we all believe it subconsciously. We are afraid to take days off for mental health, fearing what our colleagues will think, fearing they will think we are weak, fearing what management will do. It is this dark undercurrent in ambulance services that continues to push paramedics to take their own lives rather than face their mental health problems.

  • In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.

If you would like to contribute to our Blood, sweat and tears series about memorable moments in healthcare, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs.

I’m a paramedic who has considered suicide and I’m not getting support

When I was 15, a teacher found me during lunch break and asked if she could have a word. Confused, as I was generally well behaved, I followed her to the office. I was told that a close friend of mine had been found by his parents that morning hanging in his bedroom. He was in intensive care at the local hospital but his family had been asked to prepare for the possibility that he would die shortly. Growing up, the ideas of major depressive illnesses, self-harm and suicide were almost entirely foreign to me.

People often ask whether this was what motivated me to enter healthcare at 17 and eventually land in my current position as a paramedic by 20. Frankly, I don’t know. What I do know, though, is that while suicide was a foreign concept to me at 15, it certainly isn’t now.

Almost a quarter of ­ambulance staff have post traumatic stress disorder, according to research published in the British Medical Journal, and about one in three suffer from mental health problems. Statistics are hard to come by, but reports of paramedics killing themselves suggest suicide in the profession is a problem. The Age in Australia reported that the rate of suicide among paramedics for the year to April 2010 was about 20 times higher than that of the general population.

I require antidepressants daily to numb thoughts of self-harm and suicide. I was diagnosed with major depressive disorder nine months after starting work with the ambulance service. When I attend call-outs to patients in a depressive crisis or who have self-harmed, it is like looking in the mirror. When resuscitating patients who have tried taking their own lives, it is akin to looking at what could have been.

It was after one such callout to a young man who had hanged himself in the living room to be found by his wife and young child, that I broke down.

I was in the middle of my fifth 12-hour shift, I had just had to pronounce a man not much older than myself deceased, counsel a grieving wife, assist the police with their investigations and ensure appropriate members of family and friends were coming to be with her. Having never called in sick in five years, I radioed the operations centre and asked them to stand me down as I would be going home for mental health issues. I was weeping, I was trembling, I was unsafe to continue working.

I will never forget the words that came back to me through the radio that night. “But there are calls waiting, can you not just wait until your days off?”

After explaining I was no longer safe to work, I was begrudgingly allowed to return home. I sat in silence for hours. The emotions of every patient I couldn’t save, every patient who had tried to hit me, every patient who had shouted at me while I worked to save them or their family came crashing over me like a wave.

Publicity around paramedic suicide generally focuses on the traumatic aspect of life on the road. What is either less known, or perhaps conveniently ignored, is the pervasive culture in ambulance services seemingly designed to incite suicide. Rostered 12-hour shifts which almost never finish in under 13 hours; missed meal breaks to attend more calls; threats to place poor performance markers on our record if we book ourselves unavailable to use the restroom more than once per shift; and, of course, frequent exposure to trauma most people will experience just once in their life are some of the stresses of the job.

Rather than immediate referral for six sessions with a psychotherapist, available to all employees, any request for help is almost universally met with the question: “Are you sure this is the right career for you?” This is followed by almost daily phone calls hounding for a return to work and questioning our commitment to the communities we serve.

This leads to any paramedic in a mental health crisis feeling unsupported and, worse, feeling they are weak. The worst part is, we all believe it subconsciously. We are afraid to take days off for mental health, fearing what our colleagues will think, fearing they will think we are weak, fearing what management will do. It is this dark undercurrent in ambulance services that continues to push paramedics to take their own lives rather than face their mental health problems.

  • In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.

If you would like to contribute to our Blood, sweat and tears series about memorable moments in healthcare, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs.

Paramedic stress: ‘We’re micro-managed by people checking response times’

Peter (not his real name) has been a paramedic with an NHS regional ambulance service in the south of England for almost 20 years. He took two months’ sick leave because of stress in 2015.

I once turned up at a house where a woman and her daughter were crying hysterically because her husband – a man in his 30s – had passed away from a heart attack. And then the couple’s son came home from school to find his dad lying there and his mum and sister in that state. It was awful. I ended up crying with the family while we waited an hour for the police to arrive.

You do become emotionally involved. You end up putting things like that, which you have witnessed or dealt with, into a filing cabinet in your head, but over the course of a career that filing cabinet fills up.

Paramedics get stressed for many reasons and the dramatically increased demands on NHS ambulance services in the last four or five years have only made that worse.

The job can be stressful and upsetting anyway, given you’re treating an injury or illness or dealing with someone who might die. You’ve got to treat the patient, and deal with anxious relatives. That’s all very tiring and pressurising and very stressful.

And we’re under growing stress because there are too few paramedics to deal properly with the number of people calling 999 and then being sent an ambulance. We’re busy all the time. The response times we’re meant to stick to are a big part of that.

The bosses transfer the pressure they’re under to meet those performance targets on to us. We’re micro-managed by people who spend all day looking at computer screens, checking how response times are going.

We’re supposed to answer Red 1 and Red 2 calls – the most urgent ones – within eight minutes. But the reality of an understaffed service that hasn’t invested in more staff to keep up with growing demand means that that can take 20-30 minutes.

My ambulance service covers a rural part of the country. I’ve ended up driving 50-60 miles to respond to an urgent call, because there was no one else nearer to attend. Driving all that way at high speed, with a blue light on, is very stressful, believe me.

Then there’s the hours. We’re meant to work 12-hour shifts. But it’s never just 12 hours; it’s usually 13, 14 or 15. And we do four shifts in a row. The closure of ambulance stations is a massive issue too. Traditionally paramedics have seen them as almost their homes and the other people working there as like their family, but closures mean we have fewer and fewer of such places that we can come back to and discuss the ups and downs of the day with people who understand.

Stress is very common, especially among those who’ve been on the job for 15-20 years; their coping mechanisms aren’t as fresh as among the younger paramedics. Four of the 30 paramedics at my ambulance station have been off with stress over the last few years. They just couldn’t face coming in for another run of 14- or 15-hour shifts.

I’ve had time off myself for that reason. Two years ago I needed almost two months off because I was so stressed from the demands of the job. The pressure on me had become unreasonable. My stress was quite severe and I’ve never fully recovered, to be honest. My family say it’s really aged me. It’s taken a massive toll.

I’ve seen colleagues with 30 years in the service suddenly decide that they can’t do the job any longer because they can’t cope with all the different demands on us. I’ve got to the point where I don’t want to put my green uniform on any more.

Ambulance services face paramedic shortage this winter, NHS data shows

Ambulance services are facing serious shortages of paramedics just as 999 calls hit new peaks and hospitals gear up for a potential winter crisis, new official NHS figures reveal.

The 10 regional ambulance services in England are short of 873 paramedics, data shows, and some are recruiting paramedics from Poland, Finland and Australia to plug gaps in winter services.

The figures emerged as NHS England said 36 A&E units had to temporarily divert new arrivals to other hospitals last week because they could not cope with demand. It was also revealed that 1,061 beds had to be taken out of supply due to the risk of spreading norovirus, the diarrhoea and vomiting bug.

Health unions said the high number of unfilled posts showed paramedics were quitting because of “intolerable” pressures, including working long shifts that can overrun by two hours.

Jonathan Ashworth, the shadow health secretary who obtained the data, said: “These new figures showing there is a national shortage of paramedics will make worrying reading for patients this Christmas. This news comes at a time when ambulance trusts are missing key targets to respond to serious calls, and A&E departments are bursting at the seams.”

The North-West ambulance service has 204 vacancies, the largest number of empty posts, though that is fewer than the 250 it had last year. It told Ashworth that paramedic recruitment is “currently an issue nationally as there aren’t enough trained paramedics available to fill all of the vacancies”. It is “recruiting trained paramedics from European countries including Poland and Finland”.

South Central ambulance service is short of 184 paramedics, a slight improvement on last year’s 217. In recent board papers, the service admitted that finding enough paramedics “is a significant challenge and is diverging from plan in frontline staff”. It said it was “forecasting that the end-of-year vacancy position for clinical staff [paramedics] will be at 18%”. However, growing numbers of Australians are applying to join the service.

South-East Coast ambulance service has more empty posts than last year, with 138 vacancies compared with 105 in 2015. “Unfilled posts are filled by a combination of overtime and the provision of third-party resources,” it said.

Vacancies are also increasing at the London ambulance service. It currently has 135, up from last year’s 112. Overall, vacancies have fallen from 917 last year to 873.

Sarah Carpenter, head of health at the union Unite, said a new pay deal for paramedics announced recently would help mitigate staff shortages.

“However, it’s not just about the money. Older paramedics, who have protected pensions, are voting with their feet because they simply had enough,” she said. “In some ambulance services, we have reports of long, busy shifts, late or non-existent meal breaks, an ever increasing punitive management approach to sickness and conduct and, of course, the continuing levels of sickness due to anxiety and stress.”

Christina McAnea, Unison’s head of health, said only a major NHS cash boost would improve paramedic recruitment which is “at crisis levels”. She said: “With crews stretched far too thinly, the pressures on staff are intolerable. Many experienced paramedics are leaving in search of less stressful jobs, which don’t take such a toll on their health and home lives.

“The end result means delays, with many ambulances taking too long to reach patients with life-threatening conditions.”

The shortage of paramedics is contributing to ambulances often failing to turn up at the scene of medical emergencies within the eight-minute maximum response time, Ashworth added. Just 67.3% of Red 1 999 calls – the most serious sort – received an ambulance within eight minutes in October, when it should be 75%, NHS England data shows.

Delays are also occurring because ambulances are spending record amounts of time outside A&E units with a patient who cannot be discharged because staff inside are so busy.

The East of England, West Midlands and Yorkshire ambulance services all claimed to have no vacancies. East Midlands ambulance service said it had some but could not say how many.

The Department of Health said it had recruited 2,200 more paramedics since 2010 and increased the number of training places by 60% this year.

“In recognition of their increased responsibilities, we recently announced a better pay deal for paramedics as part of our wider commitment to recruiting and retaining paramedics in the future to ensure patients continue to get the very best care,” added a DH spokesman.

Woman died after paramedic told her to take paracetamol for chest pains

An ambulance service has apologised for the death of a woman after a paramedic told her to take paracetamol for chest pains.

Carol Wilson’s husband, Peter, called 111 on New Year’s Day in 2015 after she had been suffering from chest pains for a few days, as well as severe throat and ear pain, and pain on breathing.

The 111 service sent a paramedic to the couple’s Sheffield home at about 7am but, rather than giving her a heart scan or taking her to hospital, they said she should take paracetamol.

Wilson, 70, who had three sons, died in her sleep two days later as the result of a heart condition.

Medical negligence lawyers at Irwin Mitchell investigated her treatment and found the paramedic had failed to carry out an ECG scan, which would have identified abnormalities that needed hospital treatment.

Lawyers argued that if Wilson had been admitted to hospital, it is likely that pericarditis – a swelling of the fluid-filled sac surrounding the heart that causes chest and breathing pain – would have been picked up and treated.

Yorkshire ambulance service trust has admitted that, on the balance of probabilities, Wilson’s death could have been prevented if she had been given an ECG and sent to hospital by the paramedic.

Peter Wilson, 72, a retired HR director, said: “Since those three days at the start of 2015, my life has been turned upside down. We’d been married for over 40 years and I don’t think I will ever truly get over Carol’s death and I’m still devastated thinking about it now.

“Carol was an active, healthy woman who practised yoga on a daily basis, walked regularly and ate healthily. Her sudden illness was just such a shock.

“Nothing can turn back the clock, but I just hope that the trust will learn the importance of investigating chest pain in the future.

“Carol was devoted to her family. She was proud of her sons and adored her young grandchildren, who she thought she would see progress at school and beyond. She was cruelly denied that opportunity.”

Hayley Smith, a medical negligence lawyer at Irwin Mitchell in Sheffield, representing Mr Wilson, said: “Peter was understandably distraught at his wife’s unexpected death and wanted answers about what happened to her.

“One minute he was being told to get paracetamol and just two days later, his wife had died during her sleep.

“After our investigation the NHS trust has admitted its mistakes and apologised for the substandard care provided. Although paramedics do a difficult job and have to make split-second decisions, the symptoms and medical history in this case clearly show that more should have been done to diagnose Carol’s chest pain.

“Patient safety should be the number one priority of the NHS and Peter hopes that lessons will now be learned from this tragic incident to reduce the risk of other families suffering in similar circumstances.”

Steve Page, executive director of quality, governance and performance assurance at the ambulance service, said: “First and foremost our thoughts are with Carol Wilson’s family following their sad loss.

“We would like to apologise for the standard of care that was provided to Mrs Wilson on 1st January 2015. The assessment carried out by a member of our staff was not reflective of the high-quality clinical care provided by the trust and actions have been taken as a result of this incident to prevent such an occurrence in the future.

“We would like to reassure members of the public that we take very seriously any concerns that are raised by patients and their relatives and we are committed to being open and honest with them.”

Paramedic left heart assault victim to die 4 many years right after failing to spot toddler’s fatal injury

The North West Ambulance Services paramedic only assessed the toddler for 15 minutes and explained he did not want urgent hospital treatment.

Even so for the duration of the evening, the toddler misplaced consciousness and died with a 56-gram blood clot soon after Orme failed to advise the toddler’s parents to check out on their son at normal intervals for the duration of the evening.

The paramedic then had to go before the Wellness Professions Council (HPC) in 2010 and obtained a four-yr caution but was permitted to proceed treating individuals.

The panel ruled he was not responsible for the toddler’s death.

In the situation of Mrs Davies, Orme made a decision to quit as a paramedic and prevented a 2nd disciplinary hearing by removing himself from the register of approved health-related pros.

Orme admitted to a series of failings prior to the Tuesday’s hearing and wrote to the HPC panel asking to be struck off the register.

The allegations which Orme admitted to in the course of his employment incorporate failing to supply adequate care, failing to enquire about Mrs Davies’s past health care history and leaving her with junior workers despite her essential issue.

He also admitted to failing to perform an ECG, which can aid detect issues with heart fee or heart rhythm, as nicely as failing to travel with the patient to hospital.

The paramedic admitted to leaving the scene ahead of the ambulance went to the hospital and failing to give an adequate handover to the attending crew.

Orme has agreed not to apply to be readmitted to the HCPC register.

HCPC panel chairman Helen Carter explained a full hearing was not in the public interest, and would danger upsetting family members of Mrs Davies.

Ms Carter said: “The balance falls in favour of permitting the voluntary removal, especially as there is an unequivocal admission of the allegations and it will be known that Mr Orme will no longer be on the paramedic part of the HCPC register and will no longer be ready to practise as a paramedic.”

She extra elements of the hearing would have been limited to go over Orme’s overall health troubles.

A spokesman for North West Ambulance Service said: “We provide our sincere condolences to the households of the sufferers concerned in these incidents and value that occasions such as this hearing must be a challenging time for them.

“In line with Trust policies and procedures, the workers member and his carry out was entirely investigated, resulting in the elimination of paramedic standing inside of the Trust and referral to the HPC. We will take into account the suggestions and outcomes from the hearing.”

Paramedic admits he gave up on CPR as well early on girl who died right after asthma attack

Around thirty minutes later, Bella collapsed and her mom right away referred to as 999, and paramedics attended the handle eight minutes right after the get in touch with.

Mr McKenna was initial on the scene and carried out CPR for roughly ten minutes just before concluding that practically nothing else could be accomplished to conserve the youngster.

But the inquest heard that it was protocol for paramedics treating a kid to carry on with existence support until finally the level when the youngster is brought to hospital.

Giving proof in court yesterday (Weds), Mr McKenna stated that when he arrived at three.13am Bella was “pale, with blue lips and unresponsive” but he started to execute fundamental life help and asked a police officer to do chest compressions on Bella.

He mentioned: “There was practically nothing a lot more we could do. I carried on with CPR but quickly knew there was not going to be a response.

“Simply because of her age, I now know it is protocol that she ought to have been transferred to hospital but I was beneath the impression that because of her age she would be classed as an grownup – she wasn’t a little one.”

He added: “Bella must have been transferred to hospital but I do not believe it would have made considerably difference since of the tests I carried out.”

But the court heard that Mr McKenna had received a wonderful deal of coaching and ought to have known which process to adhere to.

Two superior technicians, who arrived minutes soon after Mr McKenna, described their “shock” and “shock” that Mr McKenna had given up on CPR so quickly.

Stephen Harrison, who arrived at Bella’s home minutes right after Mr McKenna, stated: “I felt some thing was amiss but there was practically nothing I could do about it.”

Asked if he had been told that CPR had been performed for close to 10 minutes Mr Harrison said: “I would have stated ‘let me carry on with CPR’.”

Colleague Dawn Vacation stated: “I was really shocked, it wasn’t what we had been expecting to see when we arrived.

“We full anticipated CPR to be in method when we arrived. I left the ambulance operating on the street and I total expected there would be a youngster there to get to hospital.”