999 FRONT LINE

In a brutally frank exposé of the crisis in our ambulance service, one beleaguered paramedic reveals the harsh reality of life on the...

ASMALL crowd rushes to meet me as I step out of my ambulance. It’s freezing, dark, about 7pm and I’ve just started a 12-hour night shift. I can tell from their faces that they’re angry.

‘It’s not on,’ barks one. ‘She’s been left there for two hours.’

A short way from the kerb, sitting at the foot of stairs leading to her house, is a woman who I guess to be in her late 70s.

People have given up their coats to cover her and keep her warm. She is shivering and can’t stand. Of course, the onlookers are right. Two hours to wait for an ambulance, in the cold, on a pavement, in agony is an awful, undignified thing for someone to go through.

But, upsetting as this might seem, this is how things have to be.

In the face of spiralling demand and ever fewer paramedics, decisions are stark: the woman had already been assessed on the phone and graded by a system that determines urgency, known as triage.

She’d fallen while out shopping and had been put in a cab that took her home, but then had not been able to get up the stairs.

Passers-by saw her in distress and called 999. She had a knee injury. And while this was difficult and upsetting for her, she was not going to die from it.

This is not how you would want an elderly woman to be treated. But she had to wait while other lifethreatening emergencies were dealt with. We warmed her up, made her feel better and took her to hospital.

HORROR STORIES AND BURN-OUT

IN THE past few weeks there has been a torrent of bad news about the ‘chaos’ facing British ambulance services. Reading the horror stories, you would think that, stressed to breaking point, the wheels had finally come off.

There was the 26-year-old waiting five hours to be attended to after suffering back injuries in a car crash; the pensioner who fell in the street in Dorset, breaking her hip, left for three hours before help arrived; the man aged 82 left on a freezing pavement for two hours in Weston-super-Mare as he waited for an ambulance after falling and smashing his pelvis.

These stories are becoming an almost daily occurrence, and it’s a tragedy. But there is a hidden story.

Yes, everyone should get a paramedic immediately. But there are not enough ambulances to go round.

The fact that non-critical calls are made to wait as we target the highpriority, life-or-death cases first is a sign that, under immense pressure, the system is working.

The recent National Audit Office report into the service found 10.7million calls were made to ambulance services last year. That’s a 30 per cent rise in four years.

Over the past few decades, London has seen the number of calls double, from about 2,500 to 5,000 a day.

But although demand is rising, the number of paramedics and ambulances has not grown proportionately. Last month one newspaper claimed there were 745 paramedic vacancies and that recruits were being offered £10,000 bonuses to sign-up.

Starting salaries are about £21,000, rising to £35,000 for a full-time senior like me.

I’ve heard of even larger sums being offered and, despite this, it doesn’t surprise me that they can’t recruit.

The job is backbreaking, literally. My back is ruined from years of lifting heavy patients in and out of chairs or beds and in and out of ambulances. It’s also gruelling. Night shifts are the worst. Typically, you do four in a row, sometimes more. You spend your days off recovering and you can be due back less than two full days later.

And so burn-out is rife. It’s generally accepted a paramedic will last about five years before looking for something else. These days paramedics are graduates, and can work less hard and for more money in other areas of healthcare.

HAMSTER BITES AND DRUNKS

I HAVE colleagues who blame ‘timewaster’ patients for the pressure on the system, but I don’t like that term. People don’t know who to call for medical help these days, and that isn’t their fault.

One survey, a few years back, showed that one in five Britons had never heard of 111, the NHS helpline set up in 2010 to handle problems that are urgent but nonlife-threatening. But everyone knows how to dial 999.

It’s difficult to see a GP at short notice these days, let alone out of hours. Meanwhile, the number of district nurses has been slashed. There are 4,000 now across Britain, down from 13,000 in the late 1990s, meaning elderly people at home

after operations or with chronic conditions are poorly managed.

We’re at the sharp end, mopping up the cases where, if a patient had been properly cared for at home, they wouldn’t have become so unwell in the first place. Accident & Emergency departments get the really bizarre stuff – people coming in with stubbed toes, hamster bites and needing help to remove false nails. These kinds of ‘injuries’ do seem to get filtered away from us by the telephone ‘triage’ system – but we do still get called out to visit patients who just have a really bad cold.

They have a virus, find that it doesn’t get better as quickly as they thought it would, then look online and panic.

The calls get to us because people will be complaining of persistent vomiting, chest pain, breathing problems, or other red-flag symptoms. It’s impossible to know it’s not serious without seeing them. Then again, sometimes you can spend a whole shift dealing with drunks.

RAPID RESPONSES AND DELAYS

AFTER my lady on the steps, our next two callouts of the day were to attend old boys with breathing problems: high-priority emergencies. In such cases, we are on the scene within eight minutes. In this case a Fast Response Unit was already there when we arrived. We are able to assess and stabilise a patient like this within about 20 minutes. But then getting them packed up and ready to go into hospital can take a while. Getting to hospital takes time and handing over to the team there takes 15 minutes or so, meaning the whole thing can take an hour and a half. I’ll have the ambulance cleaned and ready for the next patient in under 15 minutes. And maybe I’ll have time to go to the loo. People think this job is just us rushing round with lights blaring, scooping up the injured and rushing them to hospital. But it’s not. Even so, being a paramedic is an amazing job if you are interested in people, problem-solving and caring. We’re a safety net and I’m proud to live in a country that provides this service to everyone, without prejudice.

PRIDE... AND PRIVATISATION

SO WHAT does the future hold? To be honest, I believe we’ll be sold off, contracted out, bit by bit. It’s already happening. Private companies cover non-emergency patient transport services – taking people to and from hospital.

One major player is DHL, as in the parcel delivery company.

The problem is, they aren’t manned by paramedics. We have been called out by these ambulance drivers because something has gone wrong with a patient.

For now, when you call 999, you get NHS ambulances and paramedics. I know the system is struggling, but I still believe we are getting the right care to our most ill and vulnerable.

We pride ourselves in doing the best for our patients, sometimes against all odds.

I wonder if a private company, whose priority is profit, will feel the same?