Nee Naw

1) The LOUDER you shout, the quicker the ambulance will come.
2) The QUICKER you speak, the quicker the ambulance will come.
3) Even though the call taker asked for the address of the emergency, what he really wants to hear is a detailed description of what happened, starting with the patient having his tonsils out in 1962.
4) The ambulance cannot possibly leave the ambulance station until you hang up, so it is imperative to hang up as soon as possible, even if the call taker is trying to tell you something. Hanging up several times will make the ambulance come twice as fast.
5) A good call taker should just take the address and send the ambulance. A bad call taker will find out what has happened, prioritise the call and give you instructions on what to do next, thus wasting precious time when you could have been running round the house screaming.
6) The call taker will never have taken a 999 call before so they need to be told that a man under a truck is a “serious emergency” and that “you’d better get there quick”. (Or more commonly, that a 29-year-old with belly ache is a “serious emergency” and that “you’d better get here quick”).
7) There is only one person who works for the ambulance service. That person takes the call and then jumps in the ambulance. If you call back, the person you speak to will know exactly which of the 2000+ calls that day you are talking about without you giving them irrelevant details such as the address.
8) The Nee Naw Service have an ambulance parked at the end of every road enabling them to reach any location within 30 seconds. If they take longer than this to reach an emergency, it is due to incompetence and slacking.
9) Ambulance crews who drink cups of tea outside A+E are terrible slackers, as those who work in emergency services should be expected to work a twelve hour shift without a single break.
10) Strokes are a heart complaint.
11) If you don’t know the answer to a question, provide an irrelevant piece of information instead: “Is he changing colour?” “He’s in a lot of pain”. “Has she passed out?” “She is upstairs”. “Is she conscious?” “She’s a black woman”.
12) “Conscious” and “unconscious” mean exactly the same thing. Common causes of unconsciousness include: being in too much pain to talk, Alzheimer’s disease, being a bit upset.
13) (Chat Magazine readers) Call takers work for British Telecom, they know nothing about medical stuff or ambulances, but a lot about switchboards. They also have the phone number for your local hospital, GP, social services, Pizza Hut…
13) Never say “please” or “thank you” — call takers find this highly insulting and will cancel the ambulance and send you the police instead.

“Nee naw service, what is the address of the emergency?”
“I’m in Wimbledon High Street… at the bottom of the High Street where the tarmac is purple… between the lion enclosure and the place where the aeroplanes land”.

Okay… this sounds a little strange to me, but I’ve never been to Wimbledon, and after checking that these details are correct several times, I move on to the rest of the questions. I would think the whole call was a piss take, if it wasn’t for the fact that I can hear the patient in the background, clearly in distress.

“What’s the problem?” I ask. Well, apparently the caller’s friend has been “overdoing it” a little at a club and gone barmy! Three of his friends are having to hold him down and they just don’t know what to do with him. I proceed with the questions, and get increasing bizarre answers or inappropriate laughter. How old is he? Old enough to know better! Is he violent? Violently sick! Is he completely awake? HAAAHAAAHAA, he said completely awake.

You probably know what’s coming next.

“So, what has he taken?”
“Three trips and some magic mushrooms.”
“Have you been taking them too?”
“Ummm… HAHAHAHAHAHAHAAA!!!”

Since writing this blog, I have noticed that my often I give our callers bad press. This is unfair. I have been giving far more airtime to those who are abusive and unco-operative than to those who are polite, helpful and grateful for the help we’ve given them. So I hope to redress the balance by talking about some callers who I really think deserve the Nee Naw Award for Textbook Ambulance calling.

Easily the best example of this from today’s calls would be the elderly wife and seven year old granddaughter of a seventy-something year old gentleman with multiple lung problems who unexpectedly collapsed and stopped breathing at home in front of their very eyes. The first three minutes after someone stops breathing are critical, and it’s fairly uncommon to get a call within that all-important window, so when I do, I try to waste no time at all starting CPR. Unfortunately, neither a disabled seventy-something nor a small child is great at this (CPR is more strenuous than it looks, and really hard on the knees!) so I wondered what we were going to do. I’ve had healthy 20 somethings, nurses, and care home staff fall to pieces in the face of the non breathing casualty (er, not literally) and a common attitude is “I might not do it right, so I won’t do anything” which is terribly frustrating for me, knowing that anything is better than nothing and that even if the ambulance arrives in half the time the government says it has to, that will still be too late.

But this supergran didn’t say anything like that. She bounded over to the other side of the room with the aid of her magic walking stick, and tried to get her husband flat on his back on the floor, as per CPR instructions. Meanwhile, the granddaughter picked up the phone on her gran’s instructions and I heard a faint snivelling.

“Hello” I said, and asked the child her age. I didn’t hold up too much hope when she said she was seven, but she was the only person there, so I ploughed on: “I’m an ambulance person and we’re going to help your granddad. There’s an ambulance on its way to you now but we need to help him before it gets there, so I need you to be really brave for me.”

“Okay” said a little voice, “what do I do?” And the snivelling stopped. Just like that. This never happens with adults.

“Tell me what granny is doing?”

The little girl told me that granny was trying to get granddad on to the floor, but not getting very far. She then described that granddad was on the sofa, so I told her to shout out to gran…

“Granny!” she said authoritatively. “Ambulance man says just get him on his back on the sofa, as flat as you can. No, flatter, granny!”

Next I got the little girl to tell me every time granddad took a breath. From this, I could determine that his breathing was not totally absent, but following the agonal pattern, which is not really breathing but what happens as someone is dying. It is also easier to reverse than the state of not breathing at all.

I wondered what was going to happen with the next bits of the instructions: they’re not designed for seven year olds after all, but the little girl did not seem to care that she had no idea what I was talking about. Granny did the CPR for a good minute or two, without stopping, complaining or asking where the ambulance was. Then I saw the ambulance was pulling up outside (wonderful new computers!!) so I sent her out to meet the crew.

Somewhat voyeuristically, I like to say on line for a couple of minutes after the ambulance arrives it it’s quiet enough, and listen to what’s going on. In this case I heard the pitter patter of London Ambulance Service steel toed boots, the rustle of bag and mask and suddenly our little hero burst into noisy, childish sobs now she didn’t have to be a brave grown up any more.

This story has a tentatively happy ending. The man was taken to hospital and was actually breathing at the time. I imagine whatever our wonderful ambulance crew did when they got there got him breathing again, but if it wasn’t for the co-operation and calmness of this unlikely duo, I don’t think they would have been able to do anything. Who knows if the man lived another hour, another day, another month or another year, but however long he lived, his wife and granddaughter should feel proud that they overcame their fears and physical barriers to give him the best chance of survival.

Me: Nee Naw Service, what is the address of the emergency?
Him: Yes. (pause)
Me: Hello?
Him: Hello!
Me: What - is - the - ADDRESS - of - the - emergency?
Him: Yes please, my mum is not good.
Me: Where - do - you - live?
Him: Aaah… 8 Heath Road, London, NW8
Me: What is the phone number you are calling from?
Him: Yes, please!
Me: Tell - me - your - phone - number!
Him: NW8 9HG
Me: PHONE - NUMBER!
Him: Ah… 0208 898 1098 (and yes, he did put the 8 with the 020)
Me: What’s the problem with your mum? Tell me exactly what happened.
Him: Is not good. Not sleep all night.
Me: What’s wrong with her? Would you like an interpreter?
Him: No interpreter. Is not good!
Me: In what way is she not good? Does she have chest pains, breathing difficulties, the flu, stomach ache…
Him: IS NOT GOOD! Has eddack!
Me: Eddack??
Him: Yes! Her edd is not good. It ACKS!
Me: Her head is not good? It aches?
Him: Yes! That is what I said!
Me: Okay. I need to ask some questions. This won’t delay the ambulance at all. Are you with your mother now? How old is she? Is she conscious?
Him: I not understand!
Me: Would you like an interpreter?
Him: No, I not need. You just send ambulance.
Me: Is - she - conscious?
Him: What?
Me: Conscious? Awake?
Him: Walk? No, she cannot walk. Is too far.
Me: I think I will get the interpreter anyway. Which language do you speak?
Him: (cites an obscure African language)
Language Line: Hello, Language Line… which language please?
Me: [obscure African language]
Language Line: Oh dear, it might be a bit hard to get hold of a [that language] interpreter today. Caller, do you speak any other languages?
Him: Yes! I speak ENGLISH!!

Edit: I should point out that my pet hate is not foreigners, people with sick mothers or people who cannot pronounce “headache”. It is people who cannot swallow their pride and use one of our nice interpreters when one is needed, labouring on in English despite not understanding a word that I am saying.

Nine minutes to seven, and one last call before going home. It couldn’t get any worse after starting the day with a cot death, could it? What happened to these parents was worse, at least to listen to. The mother made the initial call, she was crying too much to be understood. Fortunately she was ringing from her landline, so I managed to decipher the address. When she sobbed “My son… not breathing” I had visions of another cot death, but then I asked the age. “Fourteen,” she wailed. I was about to instruct her on CPR, but suddenly she had a brainwave and shouted, almost intelligibly, “I’m a first aider! I’m going to do resuscitation” and then she dropped the phone and ran off to do it.

In the background I heard, faintly at first, shouting and banging. At first I thought there was a fight going on and that this was how the son came to be in such a predicament, but as the source of the noise I approached the phone I realised this was the patient’s father, who was utterly, utterly hysterical and smashing things. The man grabbed the phone and shouted the address down it, again and again. He didn’t let me get a word in edgways and it was as if he couldn’t hear what I was saying to him at all. I eventually got his attention by bellowing in a very loud voice which could probably be heard in the ambulance station below. It’s never nice to have to bellow at people whose relatives are seriously ill, but sometimes you have to be cruel to be kind — increased volume is the only way to get their attention, and getting their attention might just achieve that piece of communication that saves the patient’s life. Whilst having his attention, I asked what had happened. It was very hard to understand what he was saying at first. Then I realised he was describing the appearance of his son. Face purple, eyes wide, unblinking, popping out of his head, bleeding from the mouth, stiff, cold, dead. I had to (inwardly) admit, it didn’t sound like there was much chance.

As I was listening to this, a piece of paper, passed down Chinese Whispers style from dispatch, landed on my desk. It said “Sector have nothing to send yet. Sorry”. My eyes nearly popped out of my head at that point. I looked at the clock, and it had only been a couple of minutes since the call started, but at times like this, time slows down and two minutes feel like half an hour. 1851 isn’t a good time to call for an ambulance, by the way. Crews, like control staff, change over at 7pm, so everyone’s loading their ambulances, adjusting their uniform or stuck in traffic on the way to the nee naw station. If you call for something non life threatening at this time, it may well be held until 7; if you call for a Proper Emergency you will end up with a grumpy crew who’ve just worked a twelve hour shift and who thought they were on their way home.

The man continued howling and wailing and repeating himself and not making much sense. I gathered that he’d just come home and found his son like that, earlier the son had gone to do [something] and his father had told him not to do [whatever it was]. Whatever the patient had been doing was lost in the midst of hysterics, but he told him not to do it, he told him not to. He was my only son, he was my life, he is dead, crunch, bang, I told him not to do it.

The ambulance arrived at 1901. It was the longest ten minute phone call of my entire career. I never did work out what he told him not to do.

I have just had my first cot death.

Since I’ve been at Nee Naw Control, this is the call I’ve been dreading. Cot deaths tend to come in at the very beginning of a day shift or the very end of a night shift — around 7am — because this is the time the baby’s mother or father wakes up (perhaps having had a short lie in because for once the baby isn’t crying) and finds them dead in their cot. Around this time of day, nee naw control is quiet because most of the world is asleep and those who do call in have just woken up and want to be spoken to in a quiet voice. The sound of the call taker receiving the cot death will ring out above those sleepy whispers, and every time it’s happened I’ve thanked the nee naw gods that that call didn’t come through to me and that my next call will be a nice old lady who’s fallen out of bed. Up until now, every call I’ve had about a patient who isn’t breathing (”suspended”, we call it) has been either an old person or someone who has been involved in a road traffic accident. Of course, I don’t place any more value on a child’s life than anyone else’s, but there is a certain horror in the death of a child that isn’t there when a 80 year old passes away. As soon as you become aware of death, you realise that one day you’re going to have to face the death of your parents and grandparents, but no-one bargains that they are going to face the death of the child — especially with no prior warning, before they’ve even had a chance to live.

Of course, one day it had to be me who got the call. It happened just after 7am, at the beginning of my first shift of the week. Saying all that, it wasn’t as nearly bad as I was expecting, actually (for me, that is, obviously it wasn’t great for the baby in question). The baby’s mother wasn’t exactly *calm*, but she did still have her wits about her and figured that answering the questions and doing as she was told would get her further than screaming “ambulance ambulance ambulance” like a lot of callers do. Then a neighbour arrived on scene so we were able to co-ordinate CPR and ambulance meeting with military precision. The ambulance also took less than five minutes to arrive (although five minutes seems like five hours at times like these) so the situation did not get out of hand. There was no hysteria, no mention of death, all efforts were concentrated on doing everything for the child.

I went up to the dispatch desk to ask what had happened next - all they could tell me that was the baby had been rushed into hospital with them still trying to resuscitate him. That doesn’t mean much, though, as they tend to take any non-breathing baby to hospital, even if it’s been dead for a week, just in case. When I am in cynical mode, I think this is just to avoid any chance of being sued, but I suppose it must be a comfort to the baby’s parents to know absolutely everything was done and that we didn’t give up easily.

I volunteered myself for the doctor’s lines for the next few hours — that call was quite enough drama for one day.

Edit 6.10pm
The sector controller came down and told me that the baby didn’t survive. This was as I suspected. She said there was nothing I (or anyone else for that matter) could have done and that the baby had probably been dead hours by the time he was found. Sometimes calls will play on my mind at the end of the day and I will go home and keep thinking about them until I go to bed and go back to work and take some more calls which wipe it out. This wasn’t one of them. I am beginning to realise that it is not the content of the call that can be disturbing, but the feeling that I could have done more, or that it was something I did that stopped the patient from surviving. Even if it’s the caller’s behaviour that caused the problem, it is still my job to calm them down and get them to do the best thing for the patient. That wasn’t the case in this call. I did everything right, the baby’s mother did everything right, the neighbour did everything right, the ambulance turned up well ahead of schedule, and no doubt the crew and hospital staff also did everything right.

And yet a one month old baby still died. Well, no-one said these nee naw stories always had happy endings.

I am never terribly sympathetic towards the callers we get during weekend day shifts. Usually, their ailments have been by doing the very things that I would be doing if I didn’t have to spend my weekend in work listening to their whinging. One caller, however, really did take the proverbial biscuit. He was an eighteen year old living in an exceedingly posh area, and rang at 9.30am to report that he had had a lot of vodka and red bulls the night before and was now feeling extremely bad. Dizzy, headache, vomiting. Yes, that is called a hangover! That is what happens when you have too much to drink! That is how I feel every weekend! I would have liked to have told him to go back to sleep and then order pizza when Pizza Hut opens at twelve, but unfortunately call takers do not have the privilege of being allowed to tell callers that their calls are rubbish.

The caller said that he was going to wait outside his big posh house because he didn’t want Mummy and Daddy (okay, he didn’t really call them that) to know he had been drinking. I hope that a) it was raining b) he had a very long wait and then was called back by Telephone Advice with my aforementioned advice re. sleep and pizza c) failing that, an ambulance was sent with the nee naw siren on its loudest setting so as to wake up his parents and all the neighbours and really hurt his poor fragile head.

On Sunday, while I was working on dispatch, there were huge amounts of mirth when when an Embarrassing Sexual Accident call popped up on the screen. A man had been having sex with a woman when suddenly, inexplicably, they had got stuck in the coital position and he found himself unable to remove his member from her orifice. Don’t ask me how this happened. The call was made infinitely more amusing by a) the call taker’s report of the situation: “Female is not in pain, but male is feeling the pinch somewhat” and b) the fact that the caller’s name had been recorded as “Male - friend on scene”. What on earth was their male friend doing observing this spectacle? The mind boggles.

Since delivering my first baby, my Call Taking Ambition has moved on to the next item on the list: the Embarrassing Sexual Accident. This was fulfilled late on a Saturday night, when I received a call from a rather shamefaced, tearful gentleman in a rather embarrassing predictament. The man’s girlfriend had “got a bit carried away” with a vibrator and now the offending sex aid was lodged deep inside his anal passage. Understandably, he was extremely ashamed of the mess he had got himself into. I tried to convince him that we see this kind of thing every day and in no way would the A+E staff, ambulance crew and entire population of Nee Naw Control be sniggering about this until the end of the shift. I wish this were true, but in fact such incidents aren’t that common, at least from an ambulance point of view (I suspect the majority of those thus afflicted go to A+E by taxi, thus reducing the number of people they have to explain the problem to). His was, in fact, the first lost vibrator I have encountered in my six months at Nee Naw Control (a few months ago, the person next to me took a call about a hairspray can stuck in a vagina, but that is as close as I’ve got), but I didn’t think it would be prudent to share this fact with him, nor exclaim “All the way up! That’s kind of impressive!” Neither did I ask the question which was on everyone’s lips for the rest of the night, which was “Is the vibrator still switched on?”

Anyway, the poor man told me that the embarassment was too much, and that he couldn’t face waking up his small children and facing an inquisition from them (the perpetrating girlfriend had left the premises, leaving him right in the lurch) and that he would try to remove it himself (I didn’t enquire how). I suggested that he ring NHS Direct for advice. I don’t suppose they were able to help; I just wanted revenge on them for continually putting rubbish calls through to us. (But that’s a whole new post…)

About an hour later, the man rang back and came through to Freda, sitting a few desks down from me. He had conceded defeat and the call priority had now gone up from a Green 2 (bottom of the tree) “Object Stuck” to a Red 3 (high priority) “Dangerous Haemorrhage” due to rectal bleeding. A nee naw was dispatched (I bet the dispatch desk deliberately chose an all female crew) but the man remained very concerned about his children, whom he neither wanted to bring with him nor place in the care of his girlfriend or anyone else. At this point he let slip to Freda that his wife was away, and the penny dropped that his reluctance to get seen to was not just embarrassment at having the cast of Casualty poke around his passageways but the fact that when his wife returned, he was going to have some serious explaining to do as to who was inserting vibrators into his rectum while she was on holiday and their two small children were asleep in the next room…

He could always give it the old “I slipped and fell on a cucumber” line, I suppose.

A large percentage of what us Nee Naw Controllers were taught back at Nee Naw Training School wasn’t about helping patients. A lot of it was about not letting the ambulance service get sued. For instance, when we talk to a caller we are not supposed to say the word “ambulance” (we must be the only company in the world where you are not allowed to mention the name of the thing you provide), because this increases the caller’s expectation that they will get an ambulance, as opposed to a car, motorcycle, helicopter or a call from the Telephone Advice Service. Another thing you are not allowed to do is tell them how long they will have to wait (for reasons I will come to). This makes some phone calls a bit like that childhood game where you have to talk about something without mentioning the name of the thing. For instance:

“Lock away any family pets, get together the patient’s medication, unlock the door and get someone waiting outside to meet the, er, um… thingy”

“Are you sending an ambulance or what?”

“Help will be with you as soon as possible!”

“Help will be with you as soon as possible” is supposed to be our answer to anything like that. I feel sorry for the callers when I say this, because what they really want to hear is a precise rundown such as “right, the ambulance is now leaving Islington ambulance station, it’ll be with you in three minutes and twenty one seconds”. The reason we can’t say this is because the ambulance might get stuck in traffic, break down, or be rerouted to a higher priority call, and if I tell a caller that an ambulance is three minutes away and none materialises, then I’ve lied, and that caller is quite free to sue me. (And yes, it would be me, not the Ambulance Service, because by telling them that, I would have broken protocol).

A few weeks ago, I got a call from a posh, intelligent-sounding man whose father had just collapsed, unconscious and not breathing. My job as a call taker was to take the details and get the man performing CPR until the ambulance arrived — someone else upstairs on dispatch would be sorting out the ambulance. This man would not accept the stock placitudes of “help will be with you as soon as possible” and “talking to me will not delay the ambulance”, and wasn’t going to listen to anything I said until I said that the ambulance was definitely 100% on its way. He had picked up on the fact that I wasn’t going to state an ambulance had been sent, and interpreted it as me saying one hadn’t been sent. At the time, this information wasn’t available at all to call takers, the only way to get it was from the supervisor, which I did, putting the man on hold for a few seconds. By the time I came back to him, the man was furious, panicking, and ranting (ironically) about sueing the ambulance service, and any attempts to get him to perform CPR were futile. I couldn’t help but think, if I had been able to tell him how far the ambulance was to begin with, maybe I’d have got him to do as I asked.

The reason I bring this up now is because things have changed. The log which shows if an ambulance has been dispatched and how long it will be is now visible to call takers. But the protocol is still not to give this information to callers, at risk of being sued. Personally I’d prefer to say something like “the ambulance will be with you in six minutes, unforeseen circumstances permitting”, just to set the callers’ minds at rest.

I don’t blame the ambulance service for this; I understand they’re trying to cover their backs (and ours). I just think it’s sad that the “sueing culture” makes us scared to do something which would be beneficial to so many people.