Nee Naw

I don’t like children. However, when it comes to the ordering of ambulances, I wish adults could be more like them. I had a call this morning from a seven year old who had found her mother unconscious (”Very sick! Not moving or talking and she is asleep and I can’t wake her up!”) If this had come from an adult, it would have undoubtably been “Hurry up!” and “*%^&**!?” and “Stop asking me stupid questions!” and “Eww! I’m not touching her!” and “Just send me an ambulance, it doesn’t matter where I live or what’s wrong!” Children, however, always manage to remain calm, answer questions and do as they are told. Why don’t they behave like this in real life?

Nursing homes, on the other hand, make for nightmare calls. No relative of mine will ever find themselves in one of these. Yesterday morning, I had a call from one of them who had found a patient apparently dead. I started to give the CPR instructions, got as far as the bit about tipping the patient’s head back, and there was a loud shriek and an elderly man could be heard shouting “GERROFF!!” I guess he wasn’t dead after all, then.

Originally written in January this year

There were TV cameras in Ambulance Control last night! They were filming for the new series of Trauma, which is like Airline with ambulances instead of aeroplanes. Unfortunately, no-one was interested in us lowly call takers and dispatchers — they were filming the HEMS (helicopter ambulance) desk, although the camera did pan around the room once or twice. As you can imagine, everyone kept on finding excuses to run up to the HEMS desk and ask them something in an attempt to get their mugs on TV:

“Hello HEMS, are you on your way to this?”
“No. It’s a five year old with a grazed knee.”

Otherwise, work has been rather quiet these last few days. There is almost a complete absence of drunks; everyone must have drunk themselves dry over the festering season. There is still an influx of old people snuffing it because of the cold, but the control room is full of call takers doing overtime to pay off their festive debts, so these are quite widely spread. Last night, I was averaging fifteen minutes between calls after midnight.

Some ambulance funnies:

Monday I got to fulfil something which has been an ambition of mine since I started at the Nee Naw Service. I delivered my first baby! The location couldn’t have been better — the unfortunate mother to be had been caught short in the toilets of The Slug and Lettuce in Romford. (Funnily enough, I went to that very pub a couple of years ago, and the toilets were very glamorous…). An ambulance had been called for already, but it sounded at that point like the baby had a while to wait before making her entrance, but the barmaid rang back in a panic to say that she seemed in rather a hurry. I’ve heard this all before, so ask the barmaid to perform the dubious task of looking between the mother to be’s legs. What I haven’t heard before is “I can see the head!!” It was all systems go from that point, and the lucky barmaid was given the night off from pint pulling to deliver the baby with me shouting instructions down the phone. Fortunately, it was a straightforward birth - head first, cord not around neck, and I was amazed at how little time it took between the head appearing and the rest of it being out. The few seconds in which the barmaid was wiping some nasty stuff out of the baby’s mouth to start her breathing by herself seemed to take forever, and then there was a resounding WAAAAAH!, and it was just like TV. Then the ambulance crew walked in, right on cue, so I didn’t have to faff around with cords or afterbirths, which is a good thing.

An article later appeared in the Romford gazette where the barmaid was quoted as saying “I rang for an ambulance, but they told me they were very busy and couldn’t get an ambulance there for half an hour, so I hung up and took charge of the situation myself”. My dreams of being featured in said local rag or even having the baby named after me (okay, so it was a girl, but how about Marcia?) were shattered. Still, I suppose “Barmaid delivers baby” is a better headline than “Ambulance dispatcher does job properly”, and anyway, anyone who is anyone has been misrepresented by the press at some time in their life.

It was getting to the last hour in the shift from hell and I answered the phone in the usual way to hear a very small voice on the other end of the line:
Her: Hello… I’m sorry to bother you, ambulance service, but I can’t get hold of my GP… and I think I need someone to check me over to see if I am alright.
Me: (Slightly confused) Well, what’s wrong? Are you ill? In pain? Had an accident?
Her: No… no… I have a mental health problem.
Me: (Penny drops) Ah! Well, what seems to be the problem? Are you depressed? Suicidal? Paranoid? Do you have a radio in your head controlled by Fidel Castro?* We could send you an ambulance to check you over, if you like?
Her: No… no… I don’t want an ambulance… er…
Me: How about calling the emergency doctor then?
Her: Well, actually… it’s not an emergency… I just wanted to talk to someone…
Me: How about the Samaritans then? They’re really good to talk to and can help you if you’re feeling sad or lonely.
Her: Um, no… you see, I’m not… I actually had a really good day (starts to cry) and… I just wanted to tell someone… I don’t very often have good days, you see… I just wanted someone to tell me I am going to be alright…

*Those weren’t my exact words. Sometimes you might find I use a bit of poetic licence in my posts.

This call almost made me cry too. I am such a sap.

On our first day at Nee Naw Training School, we were played a tape of an American nee naw dispatcher talking to a child whose father had gone into anaphylactic shock after being stuck by a bee, to which he was allergic, whilst on a picnic in the middle of nowhere. The call started with the father talking lucidly in the background and ended with child performing CPR on his comatose father until the American version of HEMS was heard hovering overhead. This temporarily gave us virgin nee naw dispatchers that our jobs were going to be full of high drama and life saving incidents and that we wouldn’t spend hours on end talking to people convinced they are dying of stomach aches, old ladies who have fallen out of bed and footballers who have twisted their ankles.

The reason why I mention this is because on Friday I got my first ever case of anaphylaxis. If there is such a thing as a good call, this ticked all the boxes. The patient had collapsed after inadvertantly coming into contact with nuts and her colleague had called the ambulance. At first the patient was conscious and alert, but unable to talk because of her breathing, but her condition soon deteriorated and she was unconscious, barely breathing and making an ominous gurgling sound. The reason this was a “good” call, other than the genuine needs of the patient, was because of the helpfulness of her colleague. She did everything she was told, including getting the patient into the correct position, getting someone outside to meet the ambulance, and then she gave me a full report on everything that was happening to the patient, telling me every time she took a breath and not once saying “Hurry up!” or “Never mind all this ‘trying to help her’ business, just send me an ambulance!” The ambulance ended up turning up in a target busting four minutes and the good news is that after a bit of adrenaline the patient looked a whole lot more perky and was conscious by the time she got to hospital.

Another dramatic call came from a posh woman whose elderly father had developed breathing difficulties and “couldn’t be woken up”. This woman was not a great help, and to my dismay, the old man decided to stop breathing halfway through the call. Obviously, it is cases like this where CPR really matters — most times, you are just going through the motions on a long dead patient to help the relative feel that “I did everything I could”. The posh woman wasn’t exactly rude, but it felt at times as if she was being deliberately obstructive. The caller refused to make any attempt to get the patient out of his wheelchair. Maybe he was too heavy to lift, but I don’t understand why she wouldn’t even try. I explained what felt like a million times that the ambulance had already been sent but that we needed to help him now but all she kept saying was “Make them hurry up!” and “Get me some help!” I tried to keep my patience and explain that I couldn’t make them ambulance go any faster and that was I was actually trying to help. I decided to get the caller’s husband to start CPR with the patient still in his wheelchair (which isn’t something generally recommended, but better than nothing), since she refused to try to lift him but it was met with opposition at every single step: “I can’t do that!” “That won’t work!” “I don’t know how to do this!”

It’s funny that people ring and ask you for help but when you try to help, they don’t want to know. It is almost as if they think that if they do anything for themselves the ambulance crew will think they are doing fine on their own and turn round and drive back to the station. I don’t think her father made it. He was still in cardiac arrest when they got him to the hospital, although they hadn’t given up resuscitating him yet.

On a lighter note, the most pointless call of the weekend was from a man who wanted the phone number for Pizza Hut. This was one of those occasions when it was difficult to remain polite. It always mystifies me that people dial 999 and then ask for “ambulance” rather than police, fire, coastguard or mountain rescue for these kinds of call. I know sometimes it feels like the need for a pizza is a dire emergency, but really, it’s not. Have these people not heard of directory enquiries? Mind you, the idea of pizza appearing on blue lights and sirens is quite amusing.

Finally, a warning to us all. Do watch what you’re buying next time you’re in the supermarket. Yesterday, I had a call for a very indignant man. It’s not an emergency, he said, I just needed to tell someone. What he needed to tell someone was that he had found a dead mouse in a loaf of a well known brand of bread. He wanted me to make an official record that he had called the ambulance service about this, which I did, not that it will mean anything to anyone. I then expressed disgust and then exclaimed in a horrified manner that the ambulance service canteen stocked that particular brand for our morning toast, and, sorry, I had to go to warn my fellow coworkers. The man went away happy. Sometimes all you need to do is express a suitable amount of sympathy and shock at a caller’s predicament and they are as satisfied as they would be if you sent them an entire battlelion of nee naws with their light flashing in unison.

(The title of the post is the motto on the new London Ambulance mouse mats dotted about control, most of which have already been pinched).

Last Friday (that is, the Friday before I originally wrote this post) was the busiest day the Nee Naw service have had this year, with a total of five thousand and something calls, even more than we received on New Year’s day. Not only was it topping 30°, it was Friday night (always busy) and it was the last weekend of the month, meaning people everywhere were rushing to pub gardens to spend their newly acquired wages and have alcohol related accidents. The upshot of an increase in demand is inevitably an increase in waiting times. You’ve probably seen at some point a TV documentary about someone’s gran who died whilst waiting hours for an ambulance that never came; this is by no means a common occurence in Nee Naw Control but on days like this it does happen and when it does, Nee Naw Control is not a nice place to work. There is a horrible sinking feeling because you know that the service is completely unable to meet the demand. A red flashing light above the call takers’ heads inform us how many calls are waiting to get through (the highest number I saw on Friday was fifty-one, which means someone could wait ten minutes just to be connected) and behind the dispatch desks there are piles and piles of pink call receipts waiting to be given out. Half the calls that come through are The Operator informing us that someone has hung up whilst queueing to be answered, people ringing back to see where the ambulance is, and people wanting the complaints number because of the time they’ve had to wait.

One of the worst examples of the consequences of the increased workload was a call I received from a desperately-trying-to-remain-polite woman who had stumbled across a man possibly having a heart attack on the street. The call had initially been received as “chest pain”; now she was ringing back because, fifteen minutes after making the call, the patient’s condition was deteriorating and there was no sign of the ambulance. The nee naw service’s target for a call like this is to be on scene within eight minutes; 75% of the time we manage it. I checked with the supervisor and was told we were still holding the call. Because the patient was now unconscious, I retriaged the call, it went up a notch from a “red 3″ to a “red 2″ and finally it was top of the queue and got the next ambulance. I stayed with the woman on the phone for another ten minutes until the ambulance arrived. She did everything by the book, and although her frustration was obvious, she did not lose her temper and start shouting “Just send me a b*****y ambulance!” (unlike most of that day’s callers). Despite this, the man’s condition continued to deteriorate. His breathing became slow and rasping and eventually she wasn’t sure if he was breathing at all. We began CPR, and finally nee naw sirens were heard in the distance.

After a call where life has been hanging in the balance, I usually pop up to dispatch on my next break to see what happened next, but on this occasion I didn’t really want to. I think I heard that man die before my eyes (well, my ears) and all due to the fact we couldn’t send him an ambulance in time. It wasn’t a very nice feeling.

Another consequence of the increased demand is that, while the serious calls receive an ambulance late, the non serious calls sometimes don’t receive one at all. Calls are given out in such a way that the top priority calls always jump to the top of the queue and the low priority calls are only given out when there are free ambulances and no higher priority calls waiting. Low priority calls are stuff like broken arms, backache, stomachache and women in the early stages of labour. Most of these calls can be dealt with by TAS (telephone advice) or suddenly develop an ability to get in a taxi when they realise how long they will have to wait for a free ride. There’s always one that won’t give up, though, and this was a pregnant woman who’d called for an ambulance the second she went into labour. It was her first baby, the contractions were miles apart, the birth wasn’t going to happen any time soon, but she insisted she couldn’t get in a taxi. This is not true, pregnant women are perfectly capable of getting into taxis. I explain that she’d have to wait, and that unfortunately I didn’t know how long and she became irate and started shouting, saying “What do you want me to do? You want me to have my baby here before I get an ambulance?” The thing is that that situation would constitute an emergency, whereas the early stages of labour do not. I tried to explain this, and the woman threatened to report me to the complaints department. I am not bothered; the complaints department would be on my side as I was only Following The Protocol and they have enough on their hands at the moment dealing with deserving complaints about long ambulance waits. Besides, I’m sure the new arrival will make that woman forget all about the trouble she had getting to hospital.

I think the problem here is that people think ambulances deal with the prevention of emergencies, rather than emergencies that are actually happening. They call us out because of something that they think might happen, which isn’t what ambulances are for. There simply aren’t enough of them to give people lifts to hospital as a precautionary measure. Of course it’s better to be safe than sorry, but there are appropriate channels to go through. If the pregnant woman had asked her midwife, she would have been told it was perfectly safe to travel in the car (and if the midwife thought she should go by ambulance, the midwife could have rung us to authorise the ambulance).

I always wondered what it would have been like to be a nee naw dispatcher in New York on September 11th. Yesterday, hopefully, is the closest I will ever come to finding out. 7th July started off as a normal day. Between seven am and ten to eight there was the usual steady trickle of miscarriages, labours, old women fallen out of bed and the like. Then, at 0853 we took the first call, from the Fire Brigade. This was rather sparse in information — there had been an explosion at Liverpool Street, could we have an ambulance (just the one) on standby as a precaution. I didn’t take too much notice, things explode all the time, it was probably, I thought, a stink bomb or something. The result of prolonged call taking is that you automatically assume anything you hear is less serious than the caller thinks.

Then a call taker sitting opposite me took a call from a member of staff at Aldgate East station.

“There’s been an explosion,” she said, “there are walking wounded coming out with cuts and soot and debris in their hair.”

The woman was panicking, it took a while for the call taker to get any information out of her, and while they were on the phone, call takers on the other side of the room took calls from Aldgate, King’s Cross and Russell Square. We started to wonder what on earth was going on — initially, I thought that there had been one explosion and the authorities couldn’t get their act together and decide where it was; when this hypothesis fell flat on its face, someone offered up the power surge theory. Since a power surge would potentially affect every station, this was cause for ambulance bigwigs to declare a major incident. Senior members of staff (not me) donned yellow, fluorescent jackets and set up a Major Incident Desk in the PTS office. The dispatch desks went crazy. The resource centre rang up all those who had the day off and asked them to come in. People ran round the room flapping bits of paper at each other. Office based members of staff left the office and came to the control room to add to the sudden bustle of activity.

At about 0920, I took a call from a rather flustered sounding policewoman from Paddington police station.

“There’s been an incident at Edgware Road station!” she said.

“An explosion?” I said.

“How did you know?” she said, confused.

I explained that there had been explosions reported at umpteen other stations too and we thought it was due to a power surge. At that point, we didn’t know how many explosions there had been, we only knew how many stations were affected (Liverpool Street, Aldgate, Aldgate East, Kings Cross, Russell Square, and now Edgware Road and Paddington) so we thought the situation was even worse than it was.

Inevitably, at this point, conjecture regarding bombs began. The predictable jokes about revenge of the French were bandied about. Suddenly, there was a small surge in call levels, with about six call takers simultaneously receiving abandoned calls from Tavistock Square, between Euston and Russell Square. (An abandoned call means someone dials 999, says “ambulance” and then hangs up). No-one was able to get through to their caller on ringback, but some of the callers had said something about an exploding bus to the operator before asking for the ambulance. Seconds later, the police informed us what had happened to the bus. The calls had all been dropped because the police had ordered all the buildings to be evacuated immediately. This, of course, put paid to the power surge theories.

We were allowed out of the room for ten minutes each to perform essential functions. After calling my girlfriend and my mother (neither of whom had any idea anything was wrong, and wondered what on earth I was talking about), I ran to the mess room and checked an internet site, where my friends were posting messages to say they were okay and advertise for news of anyone who hadn’t checked in. I was relieved to learn everyone was accounted for and posted my own message to let everyone know I was okay but working very hard and going to be incommunicado for the rest of the day. This gave me a couple of minutes left to catch the news, which was slowly catching up (it was still talking about Aldgate East and power surges at this point) and stock up on the free sandwiches, chocolate, crisps and fizzy drinks that had been provided in lieu of lunch breaks. (It is a good job we do not get Major Incidents every day — I would get really fat). I stuck my head outside nee naw control and I was pleased to see we had been turned into Fort Knox with a battalion of nee naws blocking the road, half the police force eating sandwiches on the steps and a big marquee full of important goings on.
Back in the room, call taking for the next few hours was a steady stream of panicked hospital staff asking what we were going to bring to them and other medical services offering their help, peppered with a steady stream of oblivious 999 callers labouring under the misapprehension they would be able to get an ambulance in the next six hours. All calls that were triaged as “green” (low priority) were refused an ambulance and told to get in a taxi; soon after “amber” calls (which can be quite serious, although not immediately life threatening) went the same way. On the whole, people took this quite well when the bomb situation was explained, but there were still a few less understanding people who said things like “I don’t care if there’s a major incident going on, get me an ambulance… I’ve got a BLACK EYE!” These were firmly in the minority, though, and a lot of people who were deserving cases (chest pain and traffic accident patients, for instance) changed their mind and said they’d make their own way. After a while, the LAS were running short of bandages, and medical supplies companies were having difficulty getting into central London. Fortunately, other ambulance services came to our rescue, sending resources from Kent, East Anglia and Warwickshire (possibly others too – those were the ones I spoke to). Warwickshire even sent their helicopter to drop supplies and then help out at the scene.

After the initial buzz, call taking suddenly went very quiet. This was due to multiple factors: a) people realising all ambulances had gone to the incident and not even bothering b) mobile signal dropped due to police thinking mobile phones were being used to set off bombs c) entire staff of London Ambulance being in the room thus having twice as many people to answer half as many calls. Major incidents don’t tend to provoke many calls, either — at the time of the incident, everyone is too busy getting the hell out to call 999, and the ambulances would have been on scene in droves within minutes anyway. I believe the most calls we got for one incident were the six about the bus, and none of those were from anyone actually on scene with the patients. Compare this to your average motorway accident, where there can easily be twenty calls. This was fortunate for us call takers, as we did not have to deal with anything particularly gory. In fact, we were spared the casualty details. Part of me wished I could be on dispatch or the major incident room to see what exactly was going on, but I suspect this is a case of “be careful of what you wish for”.

The quietness then spread up to the dispatch area. Since all the ambulances were at the Incident and not coming back and we weren’t getting any calls and even if we did we weren’t sending anyone to them, nothing was happening. We all got to eat our sandwiches, and then it was decided we could start accepting calls again, although waiting times were horrific (I saw one patient, who had been assaulted, receive an ambulance after a nine hour wait) and hospitals were only accepting emergency cases. GPs were sending those patients that couldn’t wait for treatment to Welwyn Garden City, Watford, East Grinstead and the like.

Eventually, hometime arrived and everyone started worrying about how to get home. The managers started co-ordinating lifts but no-one was going to East London, so I got a ride home in a PTS ambulance which had somehow drifted from Kingston to Waterloo. The driver had no idea where he was going and kept driving round Aldgate in circles. This was not a good thing.

I went home thinking that this is the sort of incident that really sets apart what paramedics and ambulance technicians (and polices and fire engines) do from what I do. Yes, I get faced with some harrowing stuff, but that stuff is at the end of a phone line and it can’t hurt me if I don’t let it. While everyone else is trying to get away from the bomb sites, paramedics etc are running towards it and putting their lives in danger in order to save others. I can control whether listening to dying people affects me; you can’t control whether a bomb blows your arms and legs off. I hope that when I am a paramedic — and I will be, yesterday’s experiences have made me even more determined — I will be as brave as those who were on duty today and not go and hide in the wheel arch when they give me the call to say there has been another major incident.