This article is based on conversations with a paramedic and emergency care assistant working for a major ambulance trust in the south of England. She wishes to remain anonymous and not to name her ambulance service so that she can write openly. It has been adapted and updated from a 7 January 2022 article.
Across the country, work is becoming unsustainable for us paramedics. Patients are dying because we can’t reach them on time, or stuck deteriorating in the back of our ambulances as there are no hospital beds free. These working conditions weigh on our consciences. It is no surprise so many of my colleagues are going on strike.
To explain what the conditions are like for us, I want to take you on a journey – often a very slow one – from picking up a patient to what happens when we are outside of hospital.
Upon arrival at hospital, the patient enters what we call the “rat” (rapid assessment and triage) area, where they are assessed, blood tests are undertaken and scans booked, all as required. Once this is done, we take the patient back onto the ambulance to wait. And we wait, and wait.
All the while, we can see in real-time how much sicker the patient is getting. While they are stuck in the ambulance with us, we have to monitor the patient ourselves – regularly doing clinical observations (blood pressure, heart rate, ECG, temperature, blood sugar, and oxygen saturations). We also do continual neurological tests to look out for any change in function for someone with a suspected stroke, for example.
We continue to treat the patient onboard, using the medications we have on board the ambulance that we’re allowed to use, but we are also asked to administer other medication prescribed by the hospital doctors, like antibiotics on a drip. We document all our findings on the electronic clinical patient record. There’s not much else we can do.
Long waits in the back of an ambulance queuing in a hospital car park can be extremely stressful for both the ambulance crew and the patient – especially if the patient is clinically unstable, or deteriorates while on board the ambulance. Often, we have extremely unwell patients to care for, and it is a worry when driving to the hospital now because you don’t know how long the wait will be before we can enter the hospital with them.
A long ambulance wait is really unpleasant for the patient, in terms of comfort. Ambulance stretchers are not like hospital beds: they have very little padding, and are not designed for patients to be lying on them for long periods of time.
Imagine an elderly patient who has fallen over and broken their hip; they now are often waiting for hours on the floor, sometimes outdoors in the cold, for an ambulance to arrive. When we get there, we assess and stabilise them, give them pain relief, and then remove them from their home or wherever they to take them to hospital – only arrive and wait several more hours just to go in. We try and pad out the sides of stretchers with blankets in an effort to make them comfortable, but there is only so much we can do.
Not only that, but while we are with our patient queuing at hospital, we can hear our radios going off, with control asking if there are any resources that can make themselves available to respond to category one calls (the most life-threatening), as they now have no crews available to send out. To not be able to respond is causing moral injury among staff, both in control and out on the road. That’s why 999 call handlers are striking as well as paramedics.
This isn’t new. We were operating like this during the pandemic, but it was less publicised. I feared for my own safety as well as those of my colleagues, as we had to wait with Covid-positive patients in an ambulance for several hours before we could enter the hospital. The viral load we were exposed to in those instances must have been enormous. That’s probably why ambulance and patient transport staff had the highest death rate of all healthcare workers.
Now, we are burnt out from those days, and having to deal with longer waits and more harrowing situations. Often, we have extremely unwell patients to care for, and it is a worry when driving to the hospital now because you don’t know how long the wait will be before we can enter the hospital with them.
Recently, I was with just one patient in the back of an ambulance for a whole 12-hour overnight shift, from 6pm to 6am. At the end of that shift, I was still waiting to hand the patient over – two and half hours of overtime. Eventually, I could hand him over to the day crew from another ambulance station, transferring him from one ambulance to another – I don’t know how much longer he waited until being admitted.
Why is this happening? The main problem I can see is the lack of social care provision, which would enable more patients to be safely discharged back into the community. This lack of social care causes “bed blocking”, which creates a log-jam and causes patient flow in the hospital to back up right through the system. Essentially, if people aren’t being discharged, then patients cannot be admitted.
I hope that something will change in future as this just isn’t sustainable.
This piece has been adapted and updated from a 7 January 2022 article.
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