999--My Life on the Frontline of the Ambulance Service

by Dan Farnworth

  I’ve also been out to a fair few snapped banjo strings – or, more correctly, frenulums – which are the small tags of skin between the foreskin and the shaft of a penis. A snapped banjo string can cause major panic, because one minute someone might be making sweet love, the next the sheets are covered in claret. Usually by the time we’ve arrived on the scene, the bleeding has stopped. If it hasn’t, we’ll tell the patient to wrap their old chap in a tea towel and hop on the ambulance. I must have missed that day in training.

  I was eighteen years old, wet behind the ears, having just started work in the ambulance control room. A call came in, I got the guy to confirm his address and phone number and asked him what seemed to be the problem. The guy hesitated. He then started mumbling, so that I couldn’t understand him. So I asked him to tell me again, but this time clearer. A long pause. Then he began: ‘Well . . . I’ve just got out of the shower, slipped, fallen down the stairs, landed on top of the hoover, somehow turned it on and now my penis is stuck.’

  My immediate thought was, Is this bloke taking the mick? But we sent an ambulance to his house. To be fair to the bloke, it’s not as if he could have jumped in a taxi with a Dyson hanging off his John Thomas. I can’t remember how it turned out for this chap, but I assume they managed to free him. If not, he can’t be difficult to spot.

  It’s not uncommon for someone to present themselves at A&E with all sorts of objects stuck in their nether regions. The staff are obviously discreet and try to be rational about it: it’s the twenty-first century, people have sex toys and sometimes things get out of hand. But while most people like to keep their tales of experimentation gone wrong under wraps, one brave lady from Liverpool (a mother of one, no less) went public a few years ago, telling newspapers that she got a vibrator stuck up her backside in the throes of passion and that her boyfriend was unable to remove it, even with a fork handle (why?) and a pair of barbeque tongs (makes far more sense). Eventually, the woman went to hospital and a surgeon removed the (still buzzing) vibrator, before offering it to her as a keepsake. She declined. I’d love to know how she explained her absence to her daughter.

  Sometimes there are stories that blow the mind of even veteran medical professionals. A colleague of mine once went out to a guy who had inserted a dildo that was so long, it was almost coming out of his mouth. On the way there, my colleague was thinking, Why would he phone an ambulance? Why not just take himself to hospital? When he arrived, he realised why.

  For hours, this guy had been trying to extricate this dildo, to no avail. It’s not really the sort of thing Ask Jeeves will have the answer to on the internet, although I’m sure people have asked. He’d had his hand up there, as if he was playing a more risqué version of the claw crane game you see in seaside arcades. And when that had failed (as the claw crane game usually does), he’d decided to have a root around with one of those big serving spoons dinner ladies use in schools. He had caused himself quite major trauma, was bleeding heavily and my colleague had to take him in for major surgery.

  Clearly, the chap with the giant dildo up his bum desperately needed the NHS’s help. But you wouldn’t believe some of the nonsense ambulance people get sent to. Ask any ambulance person about the 111 helpline and they’ll give you a wry smile or raise an eyebrow. NHS 111 is partly staffed by non-clinicians with a checklist of questions, and they are quite risk-averse. I don’t blame the call handlers, because they’re doing an incredibly tough job. And the computer asks a lot of leading questions, such as, ‘Do you have chest pains? Are you coughing a lot?’ If the answer is, ‘Oh, aye, I am feeling a bit chesty, and I’m coughing my head off,’ an ambulance will likely be sent.

  A patient might have to wait a month for an appointment with their GP. And if the GP can’t find a solution to the problem, they’ll want to refer it to a specialist. But there might be a three-month wait to see a specialist, so either the GP or the patient will end up phoning 999 and an ambulance will be sent to whisk them to A&E. To compound the problem, patients are no longer able to make appointments out of hours, so they’ll be asked to phone 111 instead.

  Someone will pop into an NHS walk-in centre with a relatively minor ailment and a nurse or doctor will insist they go to hospital. The person will say, ‘Oh. Really? Okay, I’ve got my car outside.’ And the nurse or doctor will say, ‘No, we’ll call you an ambulance.’ I’ve seen it happen. In the old days, a nurse or doctor would have relied far more on their experience and clinical skills, so that there were a lot more diagnoses of ‘You’ll be all right.’

  How often do you hear the advice, ‘Don’t call for an ambulance unless you absolutely need it’? But it’s amazing how many women go into labour, still with plenty of time to spare, and call us to take them in to hospital. We call it ‘maternataxi’. We turn up and they say, ‘We haven’t got any money for a cab.’ Some women are genuinely skint, but others are perfectly well off. It’s like they’ve only just noticed they’re pregnant. It’s also not uncommon to arrive at the hospital and for the patient to jump out of the back of the ambulance and spark up a cigarette. I feel like saying, ‘Are you taking the piss?’ They’ve phoned 999, we’ve steamed over to their house, taken them in and they’re well enough to stop off for a leisurely smoke before going into A&E.

  Off the top of my head, I’ve heard of someone wanting an ambulance to be sent to resuscitate a dead pigeon, help find someone’s trousers, deal with a hedgehog in a garden, treat someone whose feet were bleeding from wearing new shoes and fix a dislodged (false) fingernail. The media loves compiling lists of ridiculous 999 calls, and they would be funny if they weren’t such a pain in the arse.

  And not all of the daftness gets filtered out. I’ve been out to someone who phoned 111 to report that his plaster cast was making his arm itchy. You can’t stop people from calling, all you can do is provide a service that filters out the time-wasters. As mad as phoning 111 to report an itchy arm is, the fact that we ended up at his house wasn’t really his fault, it was the fault of the system and how the questions were answered. What did I say when I turned up at Itchy’s house? I pinned him to the floor and broke his other arm. Nah. I smiled as usual, was nice and chipper, told him that everything was going to be okay and suggested he be a brave soldier and wait for the itch to go away. Thanks for calling 111! Had I not been nice and polite, he might have complained about my attitude.

  How long can the NHS continue sending ambulances out to patients who have diarrhoea or who have been sick a couple of times? At what point will it say enough is enough? Maybe we should have a system whereby people pay a smallish fee at the point of use. Not a lot, but enough to put people off. Then again, 20 quid to one person is a drop in the ocean, while to another it’s their kids’ dinner budget for the week.

  Rather than reduce the load on the ambulance service, the internet has made it worse. The internet is all-knowing, but it is so vast that it often throws up more questions than answers. While an older person is likely to have a more common sense and less dramatic reaction to going down with an illness (as well as drive themselves or a friend or family member to hospital) a younger person might find themselves with a spot of man flu, go on Dr Google and ten minutes later they’ll have convinced themselves that their headache is actually a brain tumour or they’ve got nine different diseases and only three days to live.

  I suspect younger people are also less likely to understand what the emergency services are for, and they’ve become accustomed to getting what they want at the drop of a hat, twenty-four hours a day, seven days a week, however urgent their need. What they need to understand is, the ambulance service does not operate along the same lines as a pizza delivery company. Well, sometimes it does. But it shouldn’t.

  There is also the issue of people trying to nick a few quid from insurance claims. Once, me and my partner were on our way to a bog-standard job when we got flagged down by a bus driver who was standing next to a double-decker that had had a minor prang with a car. I called the control room a
nd they dispatched a different crew to the other job. I jumped out of the ambulance and the first thing I said to the bus driver was, ‘Is everyone okay?’ The bus driver replied, ‘I think so. But I’ll just go and make sure.’

  We hopped on the bus, the driver asked if anyone was hurt and what happened next was like that scene from Spartacus: one hand went up and soon everyone had their hand up. So now I had fifty-two ‘patients’ all complaining of neck pain. Or, as we call it in the trade, ‘whipcash’.

  We were on the scene for hours, taking names and addresses and writing down fifty-two different versions of the same story, some far more dramatic than others. No one let on that it was all a con, but they knew that we knew. We could see it in each other’s eyes. What could we say? ‘Come on. You’re taking the mick. There’s nothing wrong with you!’ Instead, they went on their merry way, sent the paperwork off to the relevant people, along with a letter explaining that they’d been in a bus crash and had to be assessed by an ambulance person, and maybe got some compensation out of it.

  Mobile phones also play their part. Before mobiles, if someone saw a bloke slumped in the street, looking like he might need assistance, they might ask him if he was okay, or, far more likely, walk on by. If someone was punched outside a pub, they’d go home and put some ice on their eye. Now, you get a lot of people phoning 999 and saying stuff like, ‘I’ve just driven past someone in the doorway of a shop and he didn’t look very well. Could you send an ambulance?’ It’s lovely that people are looking out for their fellow human beings, but it means we get sent to a lot of situations that don’t require us to be there. Don’t get me wrong, I’m not discouraging people to call for help, but maybe it’s worth asking the person in the shop doorway first.

  One night, someone phoned to say they’d seen a man ‘walking sideways like a crab’. It wasn’t difficult to find him, because he was walking sideways like a crab. But the reason he was walking sideways like a crab was because he’d drunk about ten pints of strong European lager. I pointed him in the direction of the taxi rank, got on to the control room and shoehorned as many crab jokes into the conversation as I could: ‘Yes, we tracked him down, although he was a bit nippy. He’s scuttled off now. Little bit shellfish, didn’t even say thank you . . .’

  I’ve also been out to a nettle sting. No, I’m not making this up. This guy phoned 111, said he’d walked through some nettles and his legs hurt. All he needed to be told was, ‘Get yourself down to your local chemist, buy some ointment, put it on the affected area and you’ll be right as rain in no time.’ Instead, the call was passed to us, which was a classic example of the problems with computer-generated responses to people’s injuries and ailments. On the way to this guy’s house, I still wanted to give him the benefit of the doubt. I said to my partner, ‘All he did was phone for advice, he probably doesn’t even want us coming round.’ My partner replied, ‘Why would anyone phone 111 for advice about a nettle sting? Go out and find a bloody dock leaf!’ He had a point.

  The NHS has tried to find ways to combat the madness – just as the NHS tries to find ways to solve any problem thrown at it. Control rooms are now staffed with paramedics, nurses and even pharmacists, to whom less urgent calls are triaged. They might phone a caller back, reassess their situation and decide if there is an alternative to sending an ambulance. They might advise the caller to make their own way to hospital, or that they don’t require treatment at all. We also have a special team whose job is to visit frequent callers and see if they can teach them to understand the difference between an ailment and a genuine emergency. That’s good for the patient and good for the ambulance service, as is anything that helps takes the strain off.

  Every ambulance station has its regular customers, the so-called ‘frequent flyers’. An address will come on the screen and we know immediately that we’re heading back to Fred’s house on London Road. Some of the frequent flyers are genuinely ill and only call in an emergency. Others are after a hit of morphine or pain-relieving Entonox, more commonly known as gas and air. I suspect others look upon a trip to hospital in the back of an ambulance as a bit of excitement, a change from their usual humdrum existence.

  ______

  As well as tying up someone in the control room for a couple of minutes, while they could be dealing with someone having a heart attack, each phone call costs the ambulance service about £7, so one person making hundreds of calls a year can cost thousands of pounds. I’ve heard of people getting hit with ambulance ASBOs, which means that if they call and it’s discovered it’s not an emergency, they can end up in prison. But these people are sometimes impossible to ignore. The rule of thumb is that if someone calls complaining of chest pains, we will send an ambulance. Certain callers know this, and you can bet your life that if we ever decided not to send an ambulance, the caller would be having a genuine heart attack.

  People might assume ambulance people hold frequent flyers in contempt – at least those with nothing much physically wrong with them. But that’s not necessarily the case. Some of them are mentally ill. For example, they might have Munchausen’s syndrome, which means they’ll pretend to be ill because they crave the fuzzy feeling of being looked after. Then there’s fabricated or induced illness, which is when a parent will exaggerate or deliberately cause symptoms of illness in their child. But a lot of the time, frequent flyers are simply lonely. I know that, because they sometimes tell me.

  Like teachers, we shouldn’t really have favourites. But we do. One lad called Barry used to phone all the time, with ailments ranging from chest pains to shortness of breath to whatever he could think of on the day. Barry had been raised in children’s homes and supported by the state ever since. He had learning difficulties and while he knew that phoning us all the time was wrong, he couldn’t grasp the severity of it.

  He was a bit of a nuisance, but he was also a really nice guy who knew us all by name and made us laugh every time we went out to him. Barry had a wicked sense of humour. Once, I stalled the ambulance while he was in the back and he was roaring with laughter and slapping his knee, as if it was the funniest thing he’d ever seen. One Christmas, he brought out this wad of bank notes, gave them to us and said, ‘Get your missus something nice.’ Except they weren’t bank notes, they were pieces of toilet paper printed to look like bank notes.

  I once joked that we were going to remove the number nine button from his phone. He thought that was hilarious. The next time we went there, he told us that he’d hidden it. Sometimes we were quite stern with him – ‘Seriously, Barry, you mustn’t phone for an ambulance unless you really, really need one’ – and he’d promise not to do it again. But we’d be round there a couple of weeks later. It was impossible to be mad at him. Barry was just lonely and wanted a chat, which he even admitted towards the end.

  Some might argue that it’s wrong to get too close to these people, that we’re feeding their habit. But not everything is so black and white. And we’re only human. If someone seems like a genuinely good person, we’ll naturally be protective of them. And having witnessed their loneliness and desperation up close, we want things to get better for them once we’ve left the scene. But that’s not always the case. Barry was a big drinker and smoker and died young. Quite a few ambulance staff and nurses went to his funeral. Had we not, no one would have been there. In death, as in life, we were his only friends.

  11

  A LACK OF RESPECT

  Me and my partner are called to a male who has taken an overdose. Whenever anybody calls 999, it’s the job of the dispatcher to assess if the scene might be volatile or dangerous for the ambulance people. It’s often a tricky call to make, especially if the patient is calling for themselves, because they’re highly unlikely to say, ‘I’m not feeling too clever, but if you do send an ambulance round, I might try to fight them when they get here.’ This particular call is deemed as non-violent, so off we trot, with hardly a care in the world.

  On arrival at the scene, the front door is slightly ajar
. I knock, but no one answers. That’s not uncommon. I knock a second time and hear someone shout, ‘Come in!’ There is no one in the hallway, so I pop my head around the door of the living room. BOOM! Some unseen person punches me square in the face. I promptly hit the deck like a sack of spuds, but still have enough faculties to think, What did he do that for? We don’t get taught self-defence by the ambulance service. We do get taught breakaway techniques (how to break free from an aggressor in a safe manner), but like any tools, they become rusty when you don’t use them too often.

  Luckily, my partner is right behind me and quickly incapacitates my assailant (using the approved techniques, obviously). Punchy soon pipes down, and we have no choice but to sit on top of him until the police arrive, because every time we release the pressure, he starts trying to hit us again.

  It turns out this bloke is a regular caller, and the fact he’s chinned me suggests he’s high as a kite, although he might have a mental health or behavioural problem. Often, it’s difficult to tell. The following day, a police officer calls to tell me that my assailant has been given a formal warning and ordered to pay me compensation: £20, to be paid in instalments. Every week for the next two years, 20p will land in my account. There’s some more of that gallows humour I was talking about.

  You have to be very versatile to work in the ambulance service. A GP has to adapt to each individual patient and a variety of cases, but normally in a controlled and comfortable environment. Frontline ambulance workers have to adapt to strangers, a bewildering variety of cases and our surroundings. One minute we might be chatting with an old lady in a lovely big house, the next we might be dealing with an overdose in a drug den, the next we might be dealing with someone who has been punched unconscious in a banging nightclub.