PURPLE CODE: On the front line with our paramedics
Our paramedics have a fight on their hands. Patients demanding immediate care are increasing, while the service suffers NHS-wide funding issues which make life difficult for these green angels of the road. We join them for a night shift.
Kit checked, belts on, ignition turns. The night shift begins, and not half a moment has passed since Paramedic Steve Cox signed onto the online EMAS system before the first alert comes in. This is the life of an ambulance crew. In their own words, it's constant.
East Midlands Ambulance Service responds to a call every 45 seconds. The fleet of some 800 vehicles cover over a million miles each year, and the stress of riding on ‘blues and twos’ throughout the day is only part of what makes life on an ambulance challenging.
Steve and his partner, Emergency care assistant Michaela Wain, 48, have started one of their busiest shifts to come. It’s the last Friday of the month – payday, which means the world and his dog has gone out for a drink, and it also means more work for them.
Steve and Michaela have been a team since she started on the service.
“He’s been my work husband for four years now,” she says. “We have that rapport, you get to understand each other and I know what he wants before he has to say it.
“All good mate?” she calls back from the driving seat.
“Good to go,” Steve replies from the back.
They go through everything together – the grueling 12-hour shifts, difficult patients, scared relatives, sometimes even violent ones. But you learn to deal with them
“Women are the worst when they’ve been drinking. They’re more gobby. Even if someone is sober and they’ve got someone they love seriously ill people probably aren’t acting how they normally would. So you have to forgive them and realise they’re not being themselves.”
Michaela is still in the starting role for a new paramedic. As an Emergency Care Assistant she aids Steve, or could be handling noon-emergency patient transport.
Some ECAs are happy to stay at that position and aid the paramedics. Others want to take on more responsibility.
“I want to move up. I’m at that stage now where I’m confident, and I know I can do more,” says the ECA, who is currently in the middle of a course before her exams to become a Technician, building more care skills, and enabling her to defibrillate and administer certain drugs like adrenaline.
I’m curious how they cope in a job like this.
“You’ve got each other. You may go through something and I have a little cry in the cab afterwards, and a chat with Steve. We’re only human, we’re not machines. But you have to dust yourself off and carry on.
“Everyone has hard days at work. It’s just your job, and that’s what man invented beer for,” says Steve.
And it’s not all doom and gloom, says Michaela.
“You meet some right characters, I love hearing people’s stories, they always want to tell you what they’ve got going on in their lives. I love that.”
And sometimes the job can even make you laugh.
“Steve fell in a river once, that had a patient in hysterics. And we had this one fella in the saying ‘I love you, I love you, give me your number’. I said ‘you’ve asked me enough’. He said ‘not you, him!’ Remember that Steve? You’re first proposal?”
“Don’t remind me,” says the 51-year-old paramedic, married with two children.
“You’ve got to keep a light side or you go a bit whatsit. Laughter’s the best medicine, that’s what I tell people,” adds Michaela before she starts singing along to the radio.
Our first call is to an elderly lady called Elaine, who needs an urgent medical assessment. The crew checks her blood pressure and heart rate – standard tests and questions to get a grasp of things before they take her to hospital.
But as soon as we arrive at an MA unit, the issues they struggle with daily start to show.
There’s a queue of six other patients waiting for beds, each of them with crews of two waiting with them.
Half an hour into a shift and we’re already running into problems, and will be waiting at least an hour, says a nurse.
Steve says calls are coming in – one every minute – and we’re stuck here waiting.
“We can’t respond, we need not to be here, really, but we can’t go until we get the trolley back.”“This happen often?” I ask. He gives me a look. No comment.
When Elaine is eventually admitted we’re back on the road.
The next call is for a man who has collapsed on the pavement, after a heavy night.
As the crew arrives he is being woken up by the first responder, a lone paramedic called Rob.
“You’ve got to take you to hospital,” says Rob. But the gentleman, believed to be on drugs, doesn’t want to come.
“I don’t want to go to hospital, I’m fine,” he says. He struggles away and the paramedics let him amble up the street as they call for police backup.
“We’ve not got the authority to detain him, but we can’t just let him wander off. We’ve got a duty of care. What he wandered into the road and got hit, or went home, fell asleep, threw up and choked on his own vomit. I couldn’t live with that.
“If he was sober and had the capacity to decide for himself that would be different, but by the look of him he doesn’t have the capacity.”
When the police arrive it takes some minutes to convince the man to come to hospital.
He’s assured that they’re not interested in what he’s been taking, they just want to make sure he’s safe and well.
“I’ve very grateful for the concern but I’m alright,” he replies, as he struggles to get away.
“If you don’t get in the ambulance I’m going to have to arrest you,” says an officer.
He eventually comes with us to A&E with a policeman present to make sure he doesn’t jump from the back of the cab (that can happen says Michaela).
At A&E there’s another queue, and more fines. In the same way that ambulances get a reprimand on their budget, so too does the department if they don’t complete a hand-over within 15 minutes.
The hospital was “fined” about Â£150,000 last year for delaying paramedics in hand-overs, says Steve. The Ambulance service itself has lost millions in revenue this year due to missed targets and it's 'Payments for Results' tarriff.
The logic of the fines system is to incentive people to push themselves, but realistically they are often caused by the lack of resources – as we saw earlier with the beds being full – so what sense does it make to punish a department by taking away more of their budget?
“I don’t know… It’s robbing Peter to pay Paul,” says Steve.
To get an idea of the pressure the teams are under, EMAS received 769,417 999 calls last year and the burden of mental health calls increases as the crew says they will go out to at least one 'psychiatric/suicide attempt' call a night.
In one month, the service had 60,604 emergency calls, and of these 50,034 received an ambulance response. 14 per cent of calls are dealt with on the phone. Close to 30 per cent are treated on site by a crew and 57 per cent are taken to A&E. There’s a sophisticated onboard system to streamline the processing of calls, and divvying them out to the nearest available team. 2.28 per cent of calls are top priority – Red 1, and 42 per cent are Red 2. A very low percentage, just over a 20th, are at the lowest end of the spectrum – Green 3 and 4.
Back at the station, and there is not a soul to be found – expect for Shaun Barsby, who’s in on his day off. Everyone else is on a call – the days of coming in for a rest between emergencies are long gone.
Shaun, from Nottingham, has been with the service for five years, and talks about some of the issues the service faces.
“We seeing a lot more urgent care pushed up. We do more chest infections, more people who are unwell and want help, but would ordinarily see a doctor. There’s such an increased demand so we refer more cases to a doctor than we used to.”
“Who set’s these targets, anyway?” says one crew member. “Eight minutes – who came up with that?”
Everyone has their gripes, Michaela says, but it’s best not to get embroiled in it all.
“If you become disillusioned by the politics, the management, it affects how you do the job.”
Because they all love the work they do, despite the pressure and the ‘funny’ systems.
Michaela tells of the incident that made her want to be a paramedic: “I was a community first responder. I was called to a friend of mine who sadly died, and his mum came to me with flowers. He son had just died and she wanted to thank me and make sure I was alright. That’s why I do this, it’s worth more than any amount of money.”
Seven o’clock and another crew comes in from their 12-hour shift.
“How was it?” I ask technician Paul Ward, 54.
“Constant,” he replies, and that says it all.
Your 999 call is assessed and responded to depending on how urgent it is:
RED 1 – Life threatening (cardiac arrest)
RED 2 – Life threatening (chest pain/ unconscious)
GREEN 1/2 – serious but not life threatening (breathing issues / RTC / haemorrhage)
GREEN 3/4 (5%) – not life threatening (sick/abdominal pain) – no ambulance required