An NHS paramedic's diary: Four shifts of shocking hospital queues … – iNews

NHS emergency workers want the public to understand the toughest of realities they are facing this winter: people are dying because of ambulance delays. One paramedic in his early 30s, who we shall call Finn, has faced this situation several times in recent years. 
“I’ve had patients where a 999 call has come through to us for a chest pain. You turn up seven or eight hours later and there’s no answer at the door, you have to get the fire service to break it down, and you find someone dead in bed.” 
Finn, whose real name we are withholding to protect him and patients, has shared with i anonymised accounts from colleagues who say on social media they had similar experiences just last week.
There was the 49-year-old who called suffering from severe chest pain and nausea, only to be found by an ambulance crew “dead on the floor, vomit on the floor”. One of the paramedics involved writes: “He called us for help. He was alone and we didn’t have anyone to send for two hours.” 
Another describes a woman who had fallen over and couldn’t get up. She wasn’t reached until nine hours after their call. “The poor pt [patient] was deceased, and had been for some hours,” they write. “How awful it must be, being alone, calling for help and nobody comes until it’s too late.”
In a GMB poll in July, 35 per cent of ambulance workers said they had handled cases where a patient’s death was linked to response delays. This month, statistics released to the BBC showed the number of deaths linked to delays in calls handled by West Midlands Ambulance Service, one of England’s worst-performing units, had vastly increased from one death in 2020 to 37 in the first nine months of 2022.
Experiences like these are adding to tensions in the workforce. Finn is among more than 10,000 ambulance workers in England and Wales striking on Wednesday and again on 28 December. He is a member of the GMB union, which is taking industrial action together with Unison and Unite.
The dispute is primarily over a 4 per cent annual pay award, a significant real-terms pay cut. The unions are demanding an above-inflation rise. Similar strikes in Scotland have been called off after ambulance workers accepted an improved 7.5 per cent pay offer.
The Department for Health and Social Care did not comment on the issue of patient deaths due to delays. But it says its pay offer to health workers “strikes a careful balance between recognising the vital importance of public sector workers whilst minimising inflationary pressures and managing the country’s debt”.
Finn argues that low pay is one cause of high vacancy numbers that are contributing to declining standards of care in the NHS, especially during what is expected to be the worst winter crisis ever. Ambulance and A&E delays have been worsened by staff recruitment and retention problems, as well as hospitals being unable to discharge many patients because availability of social care to help them at home is low.
“This is our last resort,” says Finn. “There have been warnings about crisis in the NHS for years but nothing’s changed. If we didn’t go on strike, we’d essentially be saying we accept this.” 
Finn, who is in his early 30s, has been working in the London area for several years, having moving to the UK from the Commonwealth after finishing his paramedic degree. He had worked as an ambulance volunteer in his home country for nearly a decade, but they were not recruiting paid full-time roles. He heard the NHS was hiring overseas, applied to a trust in England, and emigrated a few months later. 
The reality of conditions hit him quickly. “I got into an argument with a hospital triage nurse in my first shift,” he says. “Back home, never in my life had I waited more than 15 minutes to hand over a patient. But when we got to the hospital, we were waiting and waiting, the staff were walking past and didn’t say anything. I thought: ‘What is going on?’
“I approached him and said: ‘Are you going to take my handover? We’ve been standing here for 40 minutes.’ The nurse got quite uppity and said: ‘You need to calm down.’ I went to my mentor and he said: ‘This is normal here.’” 
Things have since become much worse. “Finishing work many hours late due to long delays at hospital is almost the norm now,” he said.
Most times, the biggest problem isn’t a patient left waiting in an ambulance – that delay often won’t affect outcomes for them, and if it really is urgent, normally space can be found. The more urgent issue is the ambulances stuck waiting outside hospitals when they could be dashing to genuinely life-threatening emergencies. 
Even minor injuries, however, can become significant problems because of delays. Finn explains: “Say an elderly person has fallen and torn the skin on their arm. Normally that would be a simple fix if it’s treated quickly, but they’ve sat there all day waiting for an ambulance. By the time you get there, that skin is dead and will need to be cut off, they’re going to need skin grafts and there’s a huge risk of infection. 
“When these patients are 90, it’s unfortunate but we look at them and go: ‘This skin tear is going to kill you. You’re not going to come out of hospital from this.’ Seemingly minor injuries are causing big mortality now.” 
To understand the realities of the workload facing paramedics and the kinds of delays they are encountering, I spoke to Finn after each of his shifts for four days running. What follows is his account. 
Saturday day shift: The patient who thought she was dead
I was up at 5:30am for a 6:45 start. When we arrive, we’re supposed to have 10 minutes to check the vehicle – the oil, the lights, the tyres – and our equipment, plus sign a batch of drugs out for the day. They’re not supposed to give us jobs in that time. In reality, they put one straight on us. 
This one came through immediately: 17-year-old female, throat closed up, struggling to breathe. We typically get one sentence about what’s wrong; often it isn’t accurate. 
All jobs are categorised based on their 999 call. Number one is the highest priority, for things like cardiac arrest, respiratory arrest, choking – where someone needs us to keep them alive. Two might be chest pain, shortness of breath, allergic reactions, head injuries. Three could be a sprained ankle or a fever. Four doesn’t need an ambulance and can be managed over the phone or ignored – some people call about paper cuts. 
This job was category two. The response standard for that is 18 minutes, from the emergency call to an ambulance arriving. We took three hours. Waiting that long when you’re struggling to breathe, you’re going to be worried. 
The patient was in a council flat and had called at 4:10am. She answered the door and was anxious because she couldn’t catch her breath. When we checked her out in her living room, we found she had quinsy: a large abscess from tonsillitis that swells and can block your airway. She was doing ok but we blue lighted her into hospital – it needing seeing to urgently. 
A doctor there was able to see her in 25 minutes and then we were onto our next call. There’s never any downtime – we push the green button on our computer and a job comes in.
Next was a 92-year-old female, lower back pain, kidney pain, delirious. Another category two. We got there after 40 minutes. That might not sound too bad but it’s double what it should be. It could have been someone having a heart attack. 
She was a south Asian lady living with her family in a council property. Her great-granddaughter couldn’t wake her up. She had a fever, a high heart rate and was breathing fast. We discovered she had sepsis
She needed antibiotics as fast as possible, but it’s frustrating that in the UK the vast majority of ordinary paramedics aren’t allowed to administer antibiotics – generally only advanced paramedics can do that and there’s just a few hundred of them in the whole country. We’re told it’s better getting them into hospital. But that can take hours. In my home country, if someone needs antibiotics, we get them started asap. 
The patient was confused and didn’t speak any English. With her daughter translating, she asked: ‘When I get in the ambulance, will I be alive again?’ We said: ‘What do you mean?’ Through some charades, it transpired she thought she was already dead. When she realised the truth, her relief was subtler than you might expect. 
We blue lighted her into hospital and handover took about 40 minutes. 
Next was a 71-year-old lady who had a pulse of 215. We got to her in 15 minutes. She had a condition called SVT where her heart had an abnormally fast rhythm. We tried to revert it but couldn’t, so we called for an advanced paramedic with medication. They were all busy. 
We blue lighted her to hospital but had a two-hour wait. Her heart was still racing at over 200, which could damage the organ going on for that long. We needed a cardiologist but he was busy. 
Again, this was frustrating because in my home country I would have the medication we needed: adenosine. It is used safely in other ambulance services across the world. Instead, she had to wait.
In all, we had six calls today. The next was a four-year-old girl, supposedly with a fever and breathing fast, but it turned out she just had a cough. We referred her back to her GP. You might wonder why the 999 call handler assigned an ambulance, but it’s hard to assess a patient over the phone and we can’t take risks. 
By this time it was 3pm and we hadn’t had any lunch. My crewmate and I shared a bag of jelly snakes while driving. We try to prepare food the night before, but in a run of 12-hour shifts, finding time for that besides everything else in life is hard. 
Most patients offer us drinks, which is kind, but to be honest most of the homes we go into are sadly not in a condition where it’s very appealing to say yes. Sometimes we can pick up a sandwich at a hospital after a job, but often we’re going from one patient’s house to another. (We probably leave about 50 per cent of our patients at home and might go three days without giving a single medication, like a GP service on wheels rather than an emergency service.) 
We didn’t have any break today. Standard labour laws apply, but those are overridden when there’s an emergency and every job is one of those. 
It definitely hits your energy levels. Sometimes I’m writing discharge papers at someone’s home and I’m nodding off. Once, two staff members both fell asleep in chairs at someone’s house; the patient put blankets on them and let them snooze because they looked so tired. They woke up and said: ‘Oh my God, how long have we been here?’ 
Next was an 80-year-old male in a care home: very weak, unable to stand or sit, not fully awake. That was 1.5-hour ambulance response. Last week I took him into hospital with sepsis, but this time he had just stood up too quickly and felt dizzy. Everything was fine. 
Our last job was at a secure mental health unit, where convicted offenders can be sent by courts or prisons if they have disorders that need treatment. Every room needs a key, even the lift, and all the patients have trackers. We had a 15-minute response and drove in through an air lock system, where the gate behind you has to shut before the next one opens. 
The patient was a 42-year-old man: shallow breathing, unsteady on his feet. He had fallen and hit his head on a sink. He seemed confused, his speech slurred. He was in an isolation room and he wasn’t strapped down. He had a background of schizophrenia and personality disorders but I didn’t ask why he wasn’t detained; it wasn’t relevant. 
He had been deteroriating and might have had a spontaneous brain bleed, so we blue lighted him to hospital and only waited 20 minutes. 
That was our last call. Things went relatively smoothly today, probably because it’s a weekend. People don’t like going to hospital on a day off. 
I’m not feeling too exhausted. Tonight I’ll drive home, cook some dinner with my partner, watch some TV and aim to be in bed by 10:30pm. 
“We didn’t have any break today… It definitely hits your energy levels”
Sunday day shift: The patient who waited eight hours
An 88-year-old woman had called 999 at 4am after a fall. We got to her at midday. An ambulance should have been with her in 18 minutes; it took eight hours. 
Her nephew had arrived one hour before us. She lived in East London and he’d come from Southend-on-Sea, so the fact that he managed to reach his auntie before an ambulance was embarrassing.  
She lived alone in a townhouse. Her nephew opened the door. She was looking miserable on her couch, still in her dressing gown. She’d got up in the night to use the toilet but fell onto her sink, hitting her chest. She took paracetamol but that wasn’t working. When we got there, we realised she had fractured her sternum – her breastbone was broken in half. 
That has a high risk of internal injuries: it can collapse your lung, even puncture your heart. Normally you’d wait for an X-ray for diagnosis but this case was obvious. 
It must have been very sore but she was quite a trooper – one of those patients always saying, ‘Thank you very much, it’s not a bother, I don’t mind.’ We gave her pain relief but that led to painful vomiting. 
Keeping her waiting so long was poor. Eight hours is my longest delay in recent times, though my record since in the UK is 18 hours. That was a year ago – someone with a chest pain called one afternoon, we showed up the next morning. 
You have to say sorry immediately – it’s not good enough. There had been multiple callbacks to her, reassuring her someone was coming, but she was quite deaf and couldn’t hear what they said. 
While we took her into A&E, she was saying: ‘I don’t want surgery; I don’t know if I’ll make it.’ We tried to keep her spirits up.
Another job that stood out today was unusual. Our fuel light had come on, so we booked ourselves off the road to buy diesel. While driving to the petrol station, we were flagged down by a mechanic in an RAC van. It turned out there was a mental-health nurse on the pavement with a patient from the same psychiatric ward we went to yesterday. 
The patient was on a supervised outing to buy a canned drink from a corner shop, but he didn’t have enough money and got in an argument with the nurse. He said: I’m not going back to the ward, if you follow me I’ll throw you off a bridge. She trailed him about a mile and a half to a roundabout where we met them. He was just in a T-shirt and tracksuit bottoms, no shoes on. 
He ran onto an A-road in front of traffic, I tried to grab him but he swung at me. He was really aggressive and threatened us with a big piece of timber. The RAC man tried to stop the cars on this three-lane dual carriageway because he was trying to kill himself. 
Legally we can restrain people if there’s an immediate threat to life. The problem is our physical ability to do that. He was six foot five, built like a brick. I’ve got no defences – I couldn’t safely drag this man into an ambulance. 
Incredibly, the nurse left to go back to the mental health ward. We called the police for backup but had to wait 40 minutes. Meantime he was walking into the traffic and drivers were getting frustrated with us. 
Eventually he calmed down. When the police turned up, their presence convinced him to get into the ambulance. You feel like a fraud when officers turn up and don’t have to do anything. 
It turned out he had committed GBH on his wife but wasn’t mentally fit for prison, so he was sectioned. Back at the mental health unit, we told the team how unacceptable the situation had been. They basically said their policy is that if they’re threatened, they retreat and call the police.
We had five other jobs today.  
There was a 61-year-old female who’d been wheezing, but she was better when we got there; she apologised for panicking. 
Another call came through as a 73-year-old man in cardiac arrest. It turned out he just had a sore neck from sleeping on it funny. His wife had called 999; when they asked if he was alert, she just freaked out. 
A gentleman in his 60s was convinced he was having a heart attack for no other reason than ‘a feeling’. There were some mental health problems involved but he was adamant he wanted to go to hospital, so we took him for a check-up. 
A 33-year-old female was short of breath and couldn’t feel her hands. It emerged she’d had bad period pains that triggered an anxiety attack.  
Our last job was a 34-year-old male, short of breath. He had bad asthma on top of a chest infection. We treated him and hoped to leave him at home, but he needed some antibiotics. It had just gone 5pm, all the GP services were shut – [as if] people only get sick in office hours. 
We have access to a response unit who can come out with simple medications, but they were all on other calls. We had to take him into hospital. It was a waste of his time and ours. 
We only finished 15 minutes late. No break again today, but I had some leftover spaghetti and meatballs from last night that I heated up in a hospital staff room while waiting on a handover. 
I’m onto night shifts tomorrow, 7pm to 7am. We have far less staffing on those, in both ambulances and hospitals, and there are often more mental-health problems to deal with, causing big delays. 
“You have to say sorry immediately – it’s not good enough”
Monday night shift: The time we ran out of pain relief
Our first call was an 86-year man who’d been knocked over by an e-bike while crossing the road. The rider never stopped. He’d broken his nose and cut his face badly. He’d waited two hours, sitting on the side of the road with strangers who stopped to help him. It was chilly and they wrapped him in their jackets, but he was quite cold. 
One of the bystanders had a go at us: ‘Why have you taken so long?’ We try not to take it to heart but it’s a bit soul destroying – it’s not our fault. And while this case was a perfectly valid call, no question, someone could have put him in a taxi or driven him to hospital instead. The lack of common sense was a bit frustrating. 
When we got to hospital, five ambulances were ahead of us. We waited two and a half hours. While we were there, a general broadcast came through for a cardiac arrest they had no ambulance to respond with – ‘If anyone’s free, please let us know, because we’ve got no one’. I don’t know what happened to that patient.
Our second job was a severely disabled 69-year-old male. He had MS and a few years ago he’d been resuscitated after a cardiac arrest. We arrived an hour after their call, getting there at 10pm. He had abdominal pain after using the toilet; we thought maybe he’d caused himself a hernia.  
We had a three-hour wait outside the hospital. Doctors came out to do blood tests and an ultrasound on him in the vehicle. At one point we took him inside for an X-ray, but then had to load him back into the ambulance because there were still no beds. 
While waiting, we ran out of pain relief. Because we’d not handed him over to the hospital staff, the rules meant we couldn’t use their stocks. I can understand the reasons behind that, and he was very stoic, but it was tough on him. 
Once we finally got him into hospital, we tried to find a doctor or a nurse to help him as soon as possible, but there was only one doctor available for the entire ward of this A&E and he was busy, so the pain relief took another 45 minutes.
Onto the third call: an 86-year-old lady who’d fallen and hit her head on a doorframe. We got there about 2am. She was on blood thinners and needed a CT scan to ensure she wasn’t bleeding internally. After our 45-minute response to reach her, we had a 1.5-hour delay outside hospital. 
While we were waiting to handover in the ambulance bay, a car screamed in and a woman jumped out. Her husband was in the back. She’d called an ambulance but nothing turned up. She asked for help. He was having significant respiratory failure, so we rushed him in – and then he had a cardiac arrest in the A&E. We jumped into the resuscitation room to help the staff. Luckily we got him back – we got his heart started again. 
Our final call was the most urgent kind – category one – but it was nine miles away. We were the closest ambulance. 
It was a gentleman who had a colonoscopy a few days ago – basically, a camera up his bottom – and at 9pm he began bleeding. He called 999 and was told an ambulance would come but it was a low-priority call. While he was waiting, he lost a lot more blood and passed out, waking on the bathroom floor. He called a neighbour, who called us. By the time we got there it was 5:30am. We blue lighted him into hospital. 
We got off an hour late, at 8am, but we only managed to see four patients. 
Everyone’s a bit different after a night shift. Some people go to the gym or have breakfast with their family. These days, we’re so run off our feet that I usually go straight to bed. I’ll be on dinner duties for me and my partner tonight before I get ready to work and head off at 6pm. With a few night shifts like this, it’s basically just work, sleep, work, sleep. 
“A general broadcast came through for a cardiac arrest they had no ambulance to respond with”
Tuesday night shift: My longest wait outside hospital
We only saw two patients all night because of hospital delays. 
Our first call was for a 35-year-old woman with vomiting and shortness of breath. She had called her GP but they said: ‘I don’t have time to assess you over the phone, I’m too full up with patients, call an ambulance.’ Like we have more time. 
When we got to her – four hours after she called – it turned out she had sepsis. We took her to hospital but got stuck there for eight and a half hours, with 11 ambulances in front of us. 
Sepsis, essentially, is an infection that completely overwhelms your body’s defence mechanisms and can make your blood pressure drop so low it causes multiple organ failure. It can kill. It’s especially dangerous in young people because their bodies can hide it while it builds and builds, until they crash – whereas warning signs for the elderly are more obvious. 
Patients need antibiotics as quickly as possible – but as I’ve explained, we don’t have any. She had to wait. 
Her blood pressure was low, her heart rate was fast. We told staff we were worried but they couldn’t speed things up. 
We waited in the ambulance. Her husband was there as well. They were both teachers, so we had a chat about strikes and the state of everything at the moment.
When you’re sitting in the back of an ambulance for that long with someone, you have some deep conversations. It seems that no matter who people have been voting for, they are critical of the government over the NHS. They recognise it’s because of underfunding and poor staffing.
Eventually we managed to get her into a hospital hallway at least, but there were still no beds. We kept treating her there. Finally they took her at 5am.
We were freed for our next call. It was a category one: a 26-year-old woman in labour. Thankfully a car reserved for the most urgent of cases had responded before we’d even got there. 
She was long overdue, over 40 weeks. She was with her husband and fairly close to giving birth, we thought the baby might come in the ambulance, but she held off just in time and it was a quick transfer. 
There is a shortage of midwives – there are vacancies in just about every role nationally – but generally birthing suites always have a team on standby. I don’t think ever I’ve taken someone in during labour and had to wait. 
The couple probably could have made their own way in but having a baby is scary, I don’t blame them for giving us a ring. If I was pregnant, I wouldn’t want to risk ordering an Uber and the driver refusing once he realised. 
We were lucky to finish on time and not get stuck in another eight-hour queue in that same hospital. I’ve got four days rest now – before the next run of four 12-hour shifts – and I need it.
“We told staff we were worried but they couldn’t speed things up”
On top of the experiences Finn describes here, many paramedics – like so many other NHS staff – are still haunted by memories from the height of the pandemic and the burnout inflicted on them
Finn hit rock bottom midway through 2021. “It was awful,” he says. “I had a bit of a meltdown in a patient’s house. I felt terrible, like we were just abandoning this patient to die. I was sitting on this poor woman’s couch crying. I was thinking: I don’t know what to do anymore.” 
The pressure felt even greater because for the first two years of the pandemic he worked as the sole medic for every call, joined by a police officer or firefighter instead of another paramedic or an emergency medical technician. He had to make healthcare decisions alone.
Recalling what happened, Finn explains: “We’d gone to an elderly woman who had Covid. She lived in her own flat in supported accommodation. She’d called because she was short of breath. She was very unwell but not at a level of clinical need where there was anything A&E could do for her. 
“She had high fever, she was vomiting and had diarrhea. She had poor mobility and found it very difficult to get to the toilet. She would normally be cooking her own meals but didn’t have the energy. We needed to get someone in to help her. 
“We went to speak with the warden to allow this woman’s daughter to come and help. They basically said: ‘No, absolutely not. We’ve banned visitors and she cannot come.’ I was stuck. I couldn’t take her to hospital because they’d send her back, but I couldn’t get anyone in to help her, and without help she would die. That was the point I just… Sorry, excuse me.” 
Finn is welling up. Over the phone, I can hear him fighting to hold back tears. But he wants to finish his story.
“We spoke to the staff and basically I said: ‘You will let her daughter in or I’ll call the police. You cannot stop someone caring for this woman.’ Eventually, they allowed it. But at that point, I knew I needed some time away.”
Finn took two months off. 
He still loves the job. “For me, the biggest thing is bringing order to chaos,” he says. “I like being able to walk into a situation where people are panicked and have no idea what to do – and I’m able to take control, bring that anxiety back to zero and say: ‘Everything’s ok, we can fix this’. That’s what keeps me going.” 
Whether he can continue his role in the NHS is another matter. 
“I’m seriously considering going home. I’m in the middle of job applications,” says Finn. “The only reason I’m still here is because my partner is stuck in London for work reasons. If it weren’t for that, I probably would have left a year ago. The NHS is in a permanent crisis now.”
Twitter: @robhastings
“I had a bit of a meltdown in a patient’s house”
All rights reserved. © 2021 Associated Newspapers Limited.


Related Posts

Leave a Reply

© 2024 Health Jobs in the UK - Theme by WPEnjoy · Powered by WordPress