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.

I work somewhere quite unique in that our control room is in the same building as our station, and so we physically see each other in the kitchen. Those that are more friendly with control are usually longer serving members of staff who have been on the same rota for a long time and so work parallel to the same control team a lot of the time. But I'd say on the whole throughout the service it's not an overly friendly dynamic, just two people interacting in a professional capacity within their roles.

It depends where you are in the country as to what routes into the role are available. Where I am, you can either apply to university and complete a 3 year degree then apply for a position as a graduate paramedic, or you can apply for the apprenticeship programme offered directly through the service and train in house.

Yes it cost me whilst I was training as I had to pay for said training out of my wages. There's no need to work your way up through control first though if you know your ultimate aim is to be a clinician as it won't give you much of a head start, other than knowing how some of the logistics work.

Ambulances are notoriously uncomfortable in the back and the suspension on them isn't brilliant. That combined with if a patient needs active management, as described in a previous post, more speed often means more risk (directly and indirectly). If you're suspecting an unstable spinal fracture then this will inevitably impact the delicacy of the driving, but I'd say internal injuries are a lesser consideration than allowing your crewmate to move around/draw up and administer drugs, etc whilst minimising the already increased risk of being in an ambulance whilst on lights.

One of my massive gripes (of many) is the way money in as good as burned in the service. 29p pack of paracetamol you could buy from the supermarket? We pay over £1. Drugs that we use once in a blue moon? We'll supply each ambulance with 10 doses at all times, 9-10 of which don't get used by their expiry dates and get chucked in the bin. We pay thousands for our responder bags. Thousands. It's such a scam how much of taxpayers money is wasted when it's not as though that money couldn't have one of hundreds of better uses that'd potentially go a fraction of the way to improving patient care.

But yes, bureaucracy is a huge detriment to everyone below senior management I'd say, not least the very people we are designed to be serving. If it's one thing that working in the NHS has taught me, is that at it's core it's nothing more than a business whose priority is to satisfy those with vested interests first.

I'm sorry to learn about your mum.

We don't routinely find out as technically (legally) we have no right to/business knowing what a patient's care is one they're 'discharged' from our care. That doesn't mean to say that we don't sometimes go back into the department later on in that shift to ask the outcome. Whether or not we get chance to find out though, it certainly doesn't stop the majority of us from at least wondering if it was a particularly notable job. If nothing more, we like to know whether our contribution pre-hospitally had a beneficial/positive impact on their outcome.

As low as morale is, when we're being more than taxi drivers/social workers/mobile GPs and actually getting to practice the job we trained to do, we do care about whether we did a good job for the patient.

Yes I have a young child. I'm part time these days because my partner also works shifts in the NHS full time and childcare would otherwise be impossible with the early starts and late finishes. It's hard because it means we work opposite a lot and then have our own personal commitments to do when we're both off and can tag team the childcare, so we rarely spend any time together as a family. It's why I'm looking to get out so that we can prioritise family first, as there's no bigger lesson that this job teaches you than the preciousness of life and health.

I don't have a question.
But thank you for doing what you do.

Absolutely. I mentioned previously that we are often utilised because people want more immediate health care than waiting 3 weeks to get into their GP, or 12 months for a specialist referral. We go to the elderly who have fallen a lot just to pick them up (although with how long it takes us to get to them, they ironically then need to attend hospital due to risk of kidney damage), whereas if we had a dedicated falls service again, our workload would be slightly smaller and people would be waiting much less time. There are so many things that could, or at one point could have, improved the efficiency of the NHS, but I'm fairly certain we've lost control of the situation now and we'll instead watch a controlled demolition of the NHS to be replaced by a privatised system.

Can I just say a huge thank you to all of you. You do such a good job and we would be lost without you. God bless x 🙏❤️🙏 also a very valid point about elderly people being stubborn and sometimes refusing help.....went through it with my mum. So thanks again x

What are you honest thoughts on keeping people alive past all quality of life? Do you agree that the NHS is a victim of its own success now?

Asking as a long time community HCSW and final year student nurse, the amount of people being given every treatment under the sun but not quality of life seems to be increasing although that is probably due to the increased ageing population of course. This also does not help from a social care standpoint with lack of carers, care home beds, community hospitals etc and it’s getting worse. We have people on our wards (currently on placement) who have been there for months and months as their family won’t agree to them going to the community hospital with the available bed etc there is sometimes too much choice given especially when it’s an acute bed being kept back. I don’t know what the answer is

In all honesty I've never known a crew return to a patient's relative to give them a debrief. The only time an ambulance would return (unlikely the same one mind) in our region is if the patient's relative became a patient themselves through some emotional/medical event arising from the distress of the initial incident.

Oh the irony 🤣🤣🤣🤣

So interesting OP! Maddest thing someone's said on gas and air? I was singing last time I had it 😁

I think calmness is as much of a skill as it is temperament. I'm not a particular calm person under stress depending on the circumstances, so what my patient's see is sometimes a facade rather than genuine calmness.

I think the role has made me more proactive and a better problem solver when it comes to stressful situations, but internally I don't necessarily feel any easier about them. I know when it came to the health of my child when they were a baby you'd never have known I had medical training as I worried a lot, but then I think sleep deprivation and hormones had a lot to answer for.

I have had two near misses as a cyclist with ambulances recently. Some insight would be helpful.

1. crossing a big intersection on my road bike with the lights, my ROW, not good visibility up the road to the left. Ambulance approaching from left, invisible to me, no lights or sirens. Decided to blast the siren on me as I was crossing at a decent speed (downhill). I had no choice but to pedal like a lunatic, but it was very scary. I had no way of knowing he was there or that he was in a hurry until such point that I could do nothing about it. This has caused me distress and also what would have happened if he had hit me?
2. with other cyclists just after dusk. Plenty of lights/high vis on us, all crossing at a roundabout, on the cycle path, with the lights in our favour. An ambulance car took it upon itself to cross over his white line into our cycle lane, again almost hit me, and actually because an ambulance in the traffic queue was trying to mobilise but again had no blue lights at this point.

both of the above happened within the last few weeks but I have noticed an increase in ambulance risk taking with vulnerable road users over the past months, mostly at things like crossings/lights. The main issue seems to be speed and inability to stop.

what is your take on this? Is there an official line?

I'll be keeping my child rear facing for as long as possible, the physiology behind why it mitigates risk of serious injury is just too significant not to. Only the other day did I attend someone so drunk that they couldn't stand up who had managed to drive onto a motorway and collide with the central reservation - thankfully no one else was involved but knowing how many utterly selfish and reckless people are on the road, I never assume it'll only happen to "someone else".

No question but I come into contact with the LAS on a regular basis because they help the injured, the psychiatrically altered, the drunk and drugged up quite often at the Tube stations I work at. They deal with each case with the utmost professionalism. So thank you. 💙

It takes approximately 3 years to train as a paramedic nowadays, as the role requires a BSc for those commencing training. Depending on which service she works for and what routes into the job are available, she could have been referencing an initial training period before going out onto the road as a "student paramedic", but that's the only explanation I can conjure.

We are ("of course") trained in ILS/ALS, but we don't hold a seperate qualification in it. From knowing a couple of people who are qualified ALS instructors, I think in my service it would be fair to say the rigorousness of our training could be questionable, but I believe a greater issue with regards to our competency in such situations whereby ALS is necessary is the lack of exposure we get to cardiac arrests and thus we are rusty. It's the same with most "big" jobs; we spend so much time doing primary care work that we don't practice what should be our bread and butter often enough to be particularly proficient at it, on the whole.

We have massive issues with poor outcomes in my service regarding cardiac arrests currently, when it should be our speciality.

We are limited to band 6 out on the road in our Trust, but then we are a regressive service rather than a progressive one. 🙃

Our obstetrics training is shocking. Given that if we deliver the baby, we have associated responsibility for their health until they're 21(?) years old, it's absolutely frightening how inexperienced we are compared to a midwife, and yet we are occasionally put into the same position.

Most paramedics I know hate maternity with a passion because they're so scared of something going wrong, with such little experience/exposure and training. Unless the baby is literally crowning when we arrive, almost everyone I know would very quickly usher the woman onto the ambulance and drive at speed and practically forget all else. It's like passing a hot potato quite honestly.

I have personal experience of homebirthing (without midwives in attendance) and I am a huge advocate for homebirthing under the right conditions. But if there is a chance you will be alone with a toddler, I wouldn't advise risking an ambulance being your only source of healthcare in that scenario intentionally.

Luckily I have recouped/refilled my compassion cup whilst being off, however I do want out of the service still. For me there is so much bureaucracy that means we can't work in the patient's best interest, and given that I came into the job to help people, it really bothers me that aside from the genuinely life threatening calls we attend (which are so few and far between), I feel as though I'm simply contributing to the problem because I can't offer people the help and advice that would really make a difference. I completely understand that perspective though as I certainly felt like that in the last year or so prior to my absence.

Hi @wherethewestwindblows thanks for an interesting thread!

I became extremely unwell a few years ago and was unconscious when an ambulance was called. I weighed 22 stone at the time and the fire brigade was called to get me down the stairs, which had a bend in the middle. I was mortified when I got well enough to be told this, and that embarrassment has been the catalyst to me beginning to lose weight. However I still live in fear that if I was to get ill again, I'd be too big to help. I suppose my question is, has there been a time when someone was too overweight to help them?

Weight is certainly a factor in how effectively we can help someone. If we need to get someone out of a house quickly to render immediate conveyance to hospital, if we have to lose time waiting for extraction then it can have dire outcomes.

I attended a bariatric cardiac arrest where due to the length of time and complexity of extrication, it was determined by all to stop all resuscitation, where as if the patient was of a more manageable weight we could of extracted quickly and the outcome may have been more positive

so yes weight definitely effects how we can help someone