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.

Any tips for an interview? Have a couple of uni interviews for paramedic science coming up!

Bit of a weird one but what do you feel when police use 136 mental health and you have to be used as the transport to the hospital? Do you ever feel it’s not genuine and it’s just an excuse to get rid of a person onto the health service?

I was once in an ambulance and the paramedic said something like "no need to worry, but I don't really feel like sitting in traffic so I'll put the sirens on"

At the time, probably due to the significant amount of blood I'd lost, I just accepted this. But is it more likely that what he was really thinking was "this is actually more serious than you seem to realise, and we need to get you to hospital asap, but I don't want to you panic".

1. Not really. Those kinds of shows are more like the highlight reels of the job. They've gotten better in that they don't just show the big jobs and instead are somewhat more inclusive of the things we actually spend most of our time seeing, however they still cherry pick the patients who have notable stories to tell or dramatise their situation. They also, sometimes, heavily edit the jobs to make them look more dramatic or over exaggerate things that we wouldn't get excited about. For example there was one show that filmed some from my station; they made a big deal of how quickly the paramedic arrived on scene, however if you know the area then you'd know the street was only around the corner and amount of time they quoted was how quickly you'd expect to get there under normal conditions. Having known some of the crews who have appeared on these shows too, everything just seems a bit staged too, like unnatural.

2. I once met (and hugged) a woman whose airway I had been managing when she was in cardiac arrest. But I genuinely believe our actions occasionally have a much more profound effect than we ever realise or find out about, not always just in the instance whereby we literally save a life. And I know that because the entire trajectory of my own life was changed when I called for an ambulance once.

3. Taking more accountability for their own health. This certainly doesn't apply to everyone but a lot (more than it should be) of people we see expect us/doctors/the health care system to fix issues that they are unwilling to make the effort to improve themselves, because it's easier to blame someone/something else than to make changes.

I'm very pleased to hear your husband had such a positive outcome and best wishes for his continued health.

Do you get emotional training? You can't pick and choose what awful things you will see but what if some situations you couldn't bare? You don't have a choice and you just have to see whatever situation it may be, for example and I am sorry if this is a trigger for anyone but one of my fears is finding someone hanging. Do you go into the job knowing you will have to deal with any awful scene?

1. Yes, and sometimes. It depends on whether it's obvious that an ambulance has been called because of a genuine belief that one was necessary at the time, or whether it's because they are taking the piss. It's fairly easy to distinguish between the two after a while, even more so nowadays that we can see how many previous ambulances the person has had and what they were for.

2. Less so than we used to which I imagine is thanks to the widespread coverage of how long ambulances are sat outside of hospitals these days, but significantly more people calling because they know they'll be seen by a health care professional (and maybe a doctor if they're taken to hospital) much quicker than trying to get into the GP. Also a lot of people think that they'll bypass the waiting lists for routine procedures or referrals by going to A&E.

As for your son (and I'm sorry to hear that he went through that and hope he is getting the support he needs/has recovered now), I would say that you did the right thing for the reason you said. Depending on how the call was triaged, whether there were any resources available, where the nearest vehicle was and whether a higher priority call came in en route, the wait time alone could have exceeded the amount of time it took to get him to a definitive place of care.

Thank you ever so much @wherethewestwindblows x

It's 100% increased. Holding at hospital used to be relatively rare, and certainly not a consistent thing. I personally cover an area whereby we frequent 5 or 6 different hospitals, so how much of my shift is consumed by waiting depends on which hospitals I visit. Whereas I probably used to do around 6-7 jobs per shift however, now I average 4. So I suppose that's approximately 2-3 hours per shift extra at hospital as a rough figure.

Their risk adverse threshold for referring to 999 may one in a blue moon safety net a genuinely unwell patient, but the vast majority of the time we end up attending patients who don't need and weren't trying to get an ambulance. 999 is already inappropriately overused, and it's as though 111 think some people's criteria for when they should call is still too high.

This is a bit of a personal (to me) question but how do you feel about alcoholics? I’ve got a huge number of severe MH issues and have self-medicated with alcohol, also basically attempted suicide with it resulting in paramedics being called out - for vomiting neat blood, broken rib and collapsed lung, and I have accompanying issues and normally end up in diabetic ketoacidosis. I’ve seen and heard about violent drunks and read a couple of paramedic accounts of how they are really disliked as a group, but if you don’t mind me asking, is it really as simple as drunk=dislike/judge? I know it makes your job harder and I’m grateful for every member of NHS staff who has looked after me, and I’d understand if the answer is yes, we just don’t like them.

I don't think they have a proper contingency plan to be honest. Unless we're talking morbidly obese and requiring specialist services to help mobilise them, we're mostly expected to just figure out a way to get them onto the ambulance. I know our adaptations to our carry chairs are being trialled to make it easier to get patients with certain kinds of stairs down them, but that'll be useful only in a limited number of circumstances; it won't help when we need to lift over a step for example, which occurs at least once in most people's houses.

The fact that our lifting and handling assessment/sign off only uses a 10 stone weighed dummy speaks volumes I think.

Tall people are a bit more awkward sometimes (and it's not common for someone to be tall enough to cause any particular issues), but it's nothing like those carrying exceptional amounts of excess weight.

1. Resus is generally anyone systemically unstable who requires ongoing treatment, immediate assessment or intensive monitoring. Some conditions have more of a specific criteria (sepsis for example), whereas others it's moreso based on clinical judgement. Majors and minors are, at least in my region, a hospital thing. That is, we take everyone to either "A&E" or resus, and once they are triaged in A&E (post our involvement), they then decide in house whether that patient goes to majors or minors.

2. A bag and mask is used if someone needs assistance with their breathing. That could be someone not breathing at all or someone who's breathing inadequately.

3. Trying to actively manage a patient in the back of a moving ambulance isn't easy, especially when that ambulance is having to maneuver around other traffic. Driving even quicker in this scenario not only compromises patient care if the clinician in the back is struggling to treat the patient due to the movement of the vehicle, but also puts the person at risk of injury.

4. Status cases are rare; the majority of fitting cases we attend have stopped spontaneously prior to our arrival or respond to our anticonvulsants. They are particularly unpleasant jobs to attend as they are often very difficult to manage.

Awful, in all honesty. Paediatric deaths get one as standard, but unless it's something particularly traumatising, there isn't really any support offered just to make sure you're okay. I think in this day and age of them claiming to be all about staff welfare that you probably could ask control to return you for one, but I think most crews would almost be embarrassed to admit that they felt like they needed one after something we're usually expected to get on with. Sometimes if the critical care team are involved in the case, they'll be happy to go through the job with you whilst you're completing paperwork, but the service as a whole don't really care.

Chat to the patient, chat to your crewmate, go through some stuff with the student (if you have one), sit on your phone, go and get a drink/something to eat. You could do some CPD/brushing up on your knowledge but very few people are that proactive and motivated by the job anymore. I personally do a bit of side hussle work if I'm not in the back with the patient...

How prevalent would you say drug and alcohol misuse is among paramedics as a coping mechanism?

I am a RG working in a care home. We now have to call your team for ridiculous reasons!!! Ie resident falls over ,witnessed,but because they are taking blood thinners they have to go for CT …what a waste of NHS resources and not appropriate for a 90+ person!

Do you ever turn on you sirens just to get past traffic?

I'm sorry as a 111 health advisor all the inappropriate ambulances that we send. It must be very frustrating! Also why do the paramedics not have a direct number to the out of hours service? Surely it would be quicker than having to call 111?

I'm one of those patients
Ended up in an ambulance for a chest infection
Via 111
🤨
They don't seem to have much wiggle room - yes / no answers

Chest pain?
Yes... but with lung cancer and a chest infection, I would have, wouldn't I
Frustrating

@Tilllly yes but what stopped you from refusing the ambulance? Just because we offer it, doesn't mean you have to accept! I would say the amount of ambulances I've offered to people that don't need it, 9/10 people will accept an ambulance.

Frightened, in pain, on my own - being told several times that I really needed an ambulance

I think she'd worked thru a yes no list
If I'd spoken with a medic, it might've been a different outcome

@wherethewestwindblows I think you do one of the most incredible jobs. Thank you ❤️

Not a paramedic here but quite a lot of experience having ambulances sent out by 111. “Chest pain” is one of the trigger words and they’ll send one out and then I’m assuming the paramedics have to at least check you out even if they can’t force you to go to hospital. @Tilllly doesn’t need a hard time.

@CeciledeVolangesdeNouveau I wasn't giving @Tilllly a hard time. Just wanted to know why they complained 111 sent an ambulance. Yes, the chest pain pathway is very triggering. They have made the pathway more thorough now but it can still be difficult. I had a call yesterday and it triggered an ambulance when I knew it was a chest infection. I queried it with a clinician and they agreed they weren't having a heart attack so I didn't need to offer it. However, a lot of the times if people say for example they have a crushing chest pain we have to go with what they say.

I always feel guilty when I send an ambulance to someone that I think probably doesn't need it. Paramedics have to still do their checks and it probably wastes a lot of their time.

Thank you both

I'd explained I had a large tumour and had just finished ABs for an infection and was getting stabbing pains in my side and couldn't take a deep breath
My GP was shut - I just wanted to know if I needed more ABs now or if it could wait till morning
But that flexibility wasn't available to the operator

Tbf to 111, the paramedics were a little concerned by my heart rate etc after exertion and rang thru and were told to bring me in but the result was steroids and ABs

Probably could have waited for GP the next day but the operator didn't have the right sort of knowledge to make that call

I hate clogging up the system like that but if you ring oncology, they say come in anyway

On the plus side, I had a very handsome doctor in the hospital 😉