"Many Photos" - Wonder how an ambulance can take hours? This paramedic diary exposes how idiots waste their time

The story typified the ambulance service in crisis. This month, a man travelled nearly 200 miles to reach his injured 77-year-old mother — and arrived before the ambulance crew, who took seven hours to turn up.

Mark Clements travelled from London to Exmouth in Devon after his mother fell and broke her hip. 

While South Western Ambulance Service was heavily criticised, other paramedics around the country leapt to its defence, pointing out how cutbacks to social care and mental health services are putting crews under more pressure than ever.

Ambulance crews get a lot of criticism and I agree the service needs better management. If someone ran their own company like this, they'd be out of business within months. But that doesn't mean it should be privatised [File photo]

It has led to dedicated staff leaving in their droves, due to burn-out, poor pay and unsociable hours. Anthony Taylor*, 33, is a paramedic for one of the NHS Trusts in the North-East. Here, he shares his diary of being on the ambulance frontline last week . . .

Saturday, February 9: You just can't fix stupid

My colleagues and I have a saying: 'You can't fix stupid, only sedate it.' Arriving at 1pm for my 12-hour shift, I'm resigned to the fact that a third of the call-outs today will be from people who don't need an ambulance at all.

I've been a regular crewmate with John for the last year. He's an Emergency Medical Technician (EMT), one of three grades of clinician in an ambulance crew.

Paramedics are at the top end of the scale, an EMT is in the middle and there are also Emergency Care Assistants (ECA), but there's little difference between us, skills wise.

Calls are coded into categories one to four, with one being most life-threatening and four being things like falls where there appears to be no bleeding or difficulty in breathing. We aim to arrive at a category one within eight minutes, but those in category four can be waiting for many hours [File photo]

Pay-wise it makes a difference. I'm on around £14 an hour, while John earns around £10 an hour. An ECA is on a lot less. He could probably earn just as much serving tables or working behind a bar.

Several of my colleagues have quit for better salaries and most are leaving because of the increasing pressure and bad management. But those of us who stay feel we are making a difference.

The most incidents I've attended in a day is 14 — but today it's eight. I had a couple of elderly patients with urine infections who needed their out-of-hours GP rather than a trip to hospital. Another elderly gentleman had fallen, but we checked him out and he was fine to stay at home.

Of course, it annoys us when we hear about pensioners being left waiting in agony for hours at a time. Sometimes I leave my shift and arrive back 12 hours later to find there are patients who have been waiting longer than I've been off duty.

But it's the system, not the crew's fault and call handlers are at the mercy of a strict set of questions they have to ask each caller. 

Calls are coded into categories one to four, with one being most life-threatening and four being things like falls where there appears to be no bleeding or difficulty in breathing. 

We aim to arrive at a category one within eight minutes, but those in category four can be waiting for many hours.

Personally, I'd prioritise elderly patients because they're the people who made the NHS what it is. But they're a stoic bunch. Ask a teenager how painful a paper cut is and they'll say eight out of ten on the pain scale. 

I think 111 is a useless service. They have a difficult job, but we probably only take 5 per cent of 111 referrals to hospital. Patients would be better going to a pharmacy or their GP but, of course, the call handlers at 111 never want to be the one who makes a fatal error [File photo]

But ask an 89-year-old about her broken hip and she'll say she's only a three or four. So she gets shunted down the queue. The system really lets them down but, as crews, we can only do our best.

The shift ends with us attending a man having a mental health crisis. Due to cutbacks in social services and mental health services, the number of incidents like this have increased about tenfold in the last five years.

We become the service that picks up the pieces when no one knows who else to call. He's threatening to self-harm so after 30 minutes of trying to calm him down, we usher him to the ambulance and take him to hospital.

He doesn't need medical attention and, thanks to underfunding, most mental health nurses only work office hours. It's nearly midnight, the A&E nurses are rushed off their feet, so I doubt he'll get seen until the morning. Chances are, he'll probably just walk out — and another ambulance will be called tomorrow.

Sunday: A broken leg and a drug addict

When I joined the ambulance service at 19 my body could handle all the different day and night shifts, but it's not easy as you get older. 

Ambulance crew members tend to die young. You hear about colleagues retiring at 55 and dropping dead months later. I'm convinced it's because our body clocks have never recovered.

Today was busier. We attended a man in his 50s who had broken his leg and kept passing out because of the pain. We were called to the city centre to a drug addict who had overdosed, probably on the psychotic drugs Mamba or Spice. 

Several of my colleagues have quit for better salaries and most are leaving because of the increasing pressure and bad management. But those of us who stay feel we are making a difference [File photo]

When we arrived, his mate — also clearly on drugs — started getting aggressive, so while John treated the patient, I tried to calm down the friend.

I'm a big guy — 6ft and 16st — so I have a big physical presence, which is usually enough to stop me getting attacked, but not always.

Once a guy came at me with a machete while I was attending a man with chest pain. I threw an oxygen bottle at him and knocked him out.

But that's rare and most of the time I'm able to reason with anyone getting aggressive. Most of the female clinicians I work with are tough, they have to be. We have one EMT who is a kick-boxer and I pity anyone who tries to mess with her.

Monday: 30 minutes with a time-waster

Thankfully, hoaxes are rare, but we can turn up at an incident and the patient isn't there. 

You find this a lot with heart attacks, where people call us but then decide they're well enough to take themselves into A&E and don't want to wait.

Today, a woman called to say her husband was having difficulty breathing. We arrived within 15 minutes, but he had disappeared. 

His wife said: 'Oh, we weren't expecting you this quickly, he's gone to the shops to get some cigarettes.'

When he got back, we carry out the necessary checks — it's not worth the risk. Ambulance crews are nervous about upsetting a coroner. We assess this patient's mental capacity, his medical history, take his pulse, temperature, blood pressure and check his pupils to see if there might be any underlying neurological issues.

It takes around half an hour. And, yes, he's absolutely fine. That's half an hour someone, somewhere, could have been lying in agony. 

I am paid, but it means I'm regularly away from home for 15 hours. Thankfully, my wife is very understanding, but I know some paramedics on their fourth marriages. This line of work is very unforgiving on relationships [File photo]

But what can you do? Thankfully, we never see a list of jobs on our screens — we are only told about them one at a time, which is probably wise.

I'm sure I'd be more distracted if I was dealing with a time-waster when I was aware of an emergency nearby. About 80 per cent of the time, I end up working around an hour overtime at the end of the shift because if I'm in the middle of a call out, you can't just leave.

I am paid, but it means I'm regularly away from home for 15 hours. Thankfully, my wife is very understanding, but I know some paramedics on their fourth marriages. This line of work is very unforgiving on relationships.

Tuesday: A cut from clipping toenails

We arrive at a lady's house this afternoon and she's shocked to see us. She's dialled 111 because she's cut her toe clipping her nails, but she's on blood-thinning drugs and diabetic, so she was concerned. The people at 111 said a clinician would ring her back, but instead they sent us.

I think 111 is a useless service. They have a difficult job, but we probably only take 5 per cent of 111 referrals to hospital. 

Patients would be better going to a pharmacy or their GP but, of course, the call handlers at 111 never want to be the one who makes a fatal error. They could lose their jobs.

Sometimes we get the reverse situation where someone calls 111, but needs 999. I've lost count of the number of older people who have fallen over and broken a hip, but they'll sit for two days without even pressing the emergency button on their necklace because 'they don't want to bother anyone'.

One time, a chap called 111 because his wife had stopped breathing and we were referred straight away. When we asked him why he hadn't called 999 he said he didn't think it was 'urgent' enough. Thankfully, we got to her in time.

There are other times that surprise us. I was called to a 28-year-old girl who was complaining of a headache on New Year's Day.

As I set off, I was thinking, 'Silly girl, of course she's got a headache on New Year's Day,' but when I walked in and saw her, I knew immediately we had to get her to hospital. She had meningitis.

Wednesday: Derek, the repeat offender

It can be crushing when we're accused of being slow. But if you're wondering why your ambulance isn't turning up within minutes, perhaps have a pop at the Dereks of this world, rather than us.

He enjoys calling the ambulance service three or four times a day. I see him more than I see my own wife some weeks.

He lives near the football ground and when there's a match on he gets a kick out of seeing the blue lights trying to navigate their way through the traffic.

Whenever his address appears on our screen, we know he doesn't need an ambulance. But he knows all the right things to say to the call handler — chest pains, unable to breathe — so we have to attend.

I used to find repeat offenders infuriating. What if a child was choking or someone was bleeding to death in a car accident while I'm attending this time-waster?

I've learned to accept them calmly as part of the job. We can't take these things personally, otherwise we couldn't do our jobs.

We get one unpaid half-hour break each day to grab a sandwich and a coffee. Of course, if we're disturbed by a call-out, then lunch is abandoned.

When you've been in this job a long time, you develop a gallows humour and a sixth sense. John and I play a game guessing what our next job will be — a road traffic accident or a 'Nan Down' — meaning an elderly person who has fallen. Nine times out of ten we'll be correct.

Today is no different. We've just finished our sandwich when we are called to a 79-year-old lady who's fallen in her home and we take her to hospital with a suspected broken hip. She's been waiting a couple of hours, the poor thing, but doesn't complain.

Thursday: I actually make a difference

A woman calls 999 because she's worried about her friend. We arrive and I'm surprised when the patient answers the door. She's thin and pale, but very apologetic. She says she doesn't need an ambulance. I ask to come in and ask a few questions, just to be sure.

She reveals that the dog she loved for 15 years has died and she's grieving. She hasn't eaten for days. A lot of people would criticise us for spending even another minute with this woman, but experience teaches me that I have to look at the bigger picture.

When you've been in this job a long time, you develop a gallows humour and a sixth sense. John and I play a game guessing what our next job will be — a road traffic accident or a 'Nan Down' — meaning an elderly person who has fallen. Nine times out of ten we'll be correct [File photo]

If we leave her in this state, she might collapse unconscious or develop kidney problems thanks to not eating or drinking. I make her a sandwich and fetch a drink of water. I tell her I'm an animal lover, too, and she opens up to me and eats something. I'm there for 40 minutes. Even though it's not been life or death, I've made a difference.

The next job is at a GP's surgery 20 minutes away. A two-year-old is fitting and has a temperature of 42 degrees. He stops breathing in the ambulance and we have to ventilate.

You don't have time to get emotional. Even if it's a baby, you go on to autopilot, so you can do your job correctly.

I'm rarely traumatised. Whether it's someone who has jumped in front of a train or a particular bad road traffic accident, I've seen it all. The worst incident I've ever been to was several years ago when a two-year-old had been murdered by the mother who thought the child was possessed by the devil. That stayed with me.

When I first joined the service, there was something of a stigma if you asked for counselling. Your manager would look at you as if to say: 'Are you in the right job?'

Personally, I've always found it enough to talk to colleagues or my wife.

As I leave my shift that night, utterly shattered, I instantly blot the last 12 hours from my memory. Some days I get home and I'm too tired to even take my boots off.

Ambulance crews get a lot of criticism and I agree the service needs better management. If someone ran their own company like this, they'd be out of business within months. But that doesn't mean it should be privatised. Too many private firms — including ambulance firms — are making a fortune out of the NHS.

The sad truth is, there are too many middle managers taking the NHS's money and not enough ambulance staff on the frontline.

Every month I see highly-skilled colleagues quitting to work elsewhere or to work for private ambulance companies for more money. Who can blame them? I know I will probably do the same.

* Names have been changed. Interview by Jill Foster.

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News Photo Wonder how an ambulance can take hours? This paramedic diary exposes how idiots waste their time
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