I'm an NHS paramedic... AMA

[wherethewestwindblows]

I don't feel that the public have the greatest understanding of the realities of the job in the current climate, so I thought I'd open up the conversation. My answers are obviously my own opinion, however I believe many of them reflect that of a large proportion of my colleagues in the service I work for too (which is about the only question I won't answer for anonymity).

I will answer every question that is posted, however it may not be straight away.

Ps, I think you are all amazing. My 10 year old has learning disabilities and he always waves at paramedics, police and fire fighters when he sees them. They always wave back of they aren't rushing off to an emergency and he loves it.

Thank you for your hard work.

My question would be, what percentage of your time do you end up spending waiting at A&E and has this increased

If I've had a particularly stressful job, I de-stress immediately after the job rather than taking it home and needing to wind down from there. Stressful jobs require a lot of paperwork, so there's usually a lot of conversation with your crewmate, a cup of tea and maybe a cake if the hospital you're at has a cafe whilst you write, plus it's an opportunity to reflect on what's happened. Sometimes again, for a particularly bad job, you're sent back to station for a debrief and a further chance to chat about it. You usually find something to make light about as well, black humour wise.

Outside of work: the gym, spending time with my daughter and loved ones, focusing on my interests and improving my out of work skills in other areas.

Generally speaking though, I think the best way to destress is to practice gratitude. It's an incredibly grounding job if you choose to see it that way, and it really puts things (good and bad) into perspective.

What’s your experience of 111?

Can you share something about issues as more people are obese and may be too heavy to be lifted or carried? Are you aware of what NHS is planning for this issue?

In a similar manner if you come across a tall person - what is the limit to fit in okay?

Firstly - thank you for everything you do on a daily basis. Those of us who have needed an ambulance urgently appreciate you more than is often felt.
A couple of questions if that’s ok.
When a patient arrives at hospital, what are the criteria for the different areas - resus, majors etc.
When is the bag and mask thing used?
When my daughter had a huge seizure, the ambulance had to stop at the side of the road to work with her- why do they stop and not just get there faster?
Do you see much status epilepticus and how bad is it?

It depends on many factors, predominantly which hospital as some are more consistently busy whereas others their influxes are sporadic. Some hospitals I'd say their average wait time is at least 3 hours, but I've known plenty of crews be at hospital with a patient pretty much all shift.

As for whether after midnight is any quieter, that usually depends on how the day has gone. If there's a huge backlog from the day then it's not really any different. Theoretically less ambulances are taking patients in at night (because less people call) but if they're playing catch up...

Also, thank you. It's not a job that deserves the respect it once did though, IMHO.

What are your debriefing procedures like? When is a debrief called amongst paramedics? Can you call control and ask for a debrief if you feel like you need it?

I’m a nurse myself and always wondered. When I worked in A&E the paramedics would often disappear once we had finished stabilising the patient before I could ask if they were ok! There’s a few I still wonder about and haven’t seen since :(

How do you pass the time when waiting at the hospital. I imagine it is quite draining waiting around.

Practice and anticipation. You're constantly looking ahead and subconsciously planning how you're going to maneuver through traffic, but always anticipating people to do the opposite of what you're hoping. The key isn't speed but progression.

This knowledge is a bit out of my scope in all honesty. I wonder if this is linked to the SDECs (Same Day Emergency Care) that we can sometimes refer patients to at hospital to bypass waiting around in A&E, as these have cropped up in the last couple of years? If it is, then it works well but in a very small minority of cases. That may be due to the rather large exclusion criteria of these services or the fact that, like most changes, staff aren't properly informed of their potential, how to access them, etc.

We're taught not to bully other road users out of the way at red lights, as yes, if you cross the line and there is equipment designed to catch/fine people doing so, you will be liable to pay despite the reasoning.

Most ambulance crews will sit back, turn their sirens off and just wait if they're going to 95% of calls. We'll then turn them back on as soon as the lights are green and then expect to get past. If it's known to be an extremely serious job will we (and I hold my hands up to this too) do what we're taught not to and try to get you out of the way, because we know the 30-60 seconds we're going to have to wait will genuinely make a very big difference.

You can usually determine how serious we anticipate the job to be by the attitude of our driving.

Someone who was crushed, and (different job) a traumatic brain injury are probably the two most physically traumatic incidents I've seen.

But this is why "worst" is quite a non-specific way of describing jobs for us, because neither of those are things that have stuck with me from an emotional/difficult to process point of view.

Practically none.

Truly spontaneous acts of violence/aggression towards ambulance crews are quite rare. Behind, I would say the majority, of cases are one (or two) crew members who have antagonised/goaded (purposely or unintentionally with their attitude) a vulnerable patient into acting out. That's not to say the patient isn't acting like a dick in the first place, but if it escalates into something more, there's usually a reason.

When you work with a lot of different people in this job, it becomes very clear why some people claim to experience more hostility than others.

Are you frriends/friendly with the 999 dispatch team? I ask this after watching TV shows where they communicate over the radio. Is it strictly business or can you say a friendly hello?

If I wanted to start training as a paramedic, do I look for the job vacancies then apply or do I apply for some kind of training course first?

Whilst you were training, did you lose money? Would you recommend being a dispatcher first?

Thank you @wherethewestwindblows - I used to work in a hospital and observed similar. Just wondered if you are experiencing the kind of things reported in A&E departments. Glad to hear you are not finding this to be a problem for you.

Linking back to a point I made above, we don't drive at high speed to every job. Driving on blue lights under any condition, statistically, massively increases the risk of an accident for everyone, let alone if you chuck in increased speed in there too. The purpose of lights/sirens/exemptions is to allow us to make progress where it otherwise would be difficult/impossible to, which if we're not being obstructed from doing so will mean we look like we're just driving along like everyone else.

Especially in this day and age where we're being expected to drive on lights to jobs that have been outstanding for hours and hours, it's often an unnecessary risk as the amount of time they'll save us is negligible in the grand scheme of things, and not worth the danger it puts everyone at. We are obliged to do so though so we often will, but just drive "normally".

Years ago my friend (who's a nurse) did a shift with an ambulance crew.

She told me that really serious cases are transported under blue lights and sirens, but the ambulance is driven quite slowly in case of internal injuries.

Is that still the case?

I'm an NHS supplier, like most suppliers to the NHS we have to charge them much more, often 100% more than any other customer because of the sheer ammount of our staff time taken up by their bureaucratic processes.

Do you find that the bureaucracy in the NHS makes you less efficient, are you always being held up by their processes?

Do you routinely find out what happened to your patients after you've handed them over to the hospital? I realise you can't allow what you see to travel home with you, but do you ever wonder?

I'd like to think that the crew who treated and took my lovely mum to hospital after a traumatic accident were interested in what happened to her. She didn't make it but part of my grief journey is (weirdly) wondering what it was like for the people who tried to help her.

Do you have a family/ young kids? How do you manage? My dh is a paramedic and it's a job that is so tough on family life / marriage!

My experience of paramedics has been uniformly amazing, so thank you! I ended up in hospital for pain management due to a slipped disc and had to go in by ambulance as I couldn't walk or sit by that point, even once I'd been given morphine. Your colleagues were so kind to me and my mum (who'd come to try and help me, and quickly realised I needed more than just a hand to help me get up!). One even made mum a cup of tea while we were waiting in A&E - that act of kindness will always stay with me.

I was wondering, would a lot of the calls you attend be avoidable if other NHS treatment was more readily available? I know I'd never have needed to be in hospital if I'd been able to access treatment earlier.

This. I'd be an awesome paramedic but it's neither family friendly or well paid enough for me to do it. Shame. Everyone's loss.

Thank you. I have been in need of paramedics, and they have been kind, and efficient, and took me/ my ex seriously.
How common is it to go back to a call at the end of a shift? I'm guessing rare, as you must be knackered. Last time I was taken into A&E by an ambulance, the paramedics went back to my then-partner's flat at the end of their shift and did a debrief, which was really amazing as we were both somewhat traumatised (obviously I was still in hospital, but my ex said it was very helpful)