Nee Naw

One of my friends, who lives on the sector on which I usually work, had to call an ambulance yesterday. She was in labour and things happened much more quickly than expected, plus she was a little early, and the midwife thought she was about to deliver at home. Fortunately they managed to get her to hospital just in time. If she’d delivered in the ambulance they would have to had called it Nina. And yes, that is about the fifth time that joke has been made on this blog. I never get tired of it.

The annoying thing about this is that I was not at work at the time and therefore missed a prime opportunity to dispatch an ambulance to my friend, and thus write a fascinating blog entry from the point of view of both patient and dispatcher. I can just imagine feeling horrified at seeing her address on my screen and then relieved as there was nothing seriously wrong. In fact, I could have dispatched Steve or Reynolds to the call and then we’d have had all three sides of the story.

Still it was not to be, but the main thing is, mother and baby girl are well and happy, so many congratulations to the family from me, and next time, try to hang on until I’m on duty ; -)

Bunslinger asked:

Those harrowing nasties you mentioned.. how DO you deal with them? What’s your coping strategy..?

In fact, how do you deal with the shouty ones who don’t like being told “no you can’t have an ambulance”?

The “harrowing nasties” are in fact much easier to deal with than the timewasters. While I’m on a call, if the patient is unconscious or suspended, I try not to allow myself to think of the patient as a person at all - they are just a resus Annie and this is a training exercise. Better still, this is an episode of Casualty and we’re making it up as we go along. In my head, no-one is beyond hope until the death certificate is written, so there’s no point in anyone getting upset. There’s a procedure to follow. Two breaths, fifteen pumps. Two breaths, fifteen pumps. Keep going, we’re almost there. You’re doing really well. Two breaths, fifteen pumps…

Road Traffic Accidents and other gory accidents are not as bad to deal with as they sound, even though the events themselves can be quite horrific. For instance, once I took a call about a motorcyclist who had hit a pillar in a tunnel and been separated from his head by several metres. Another time a woman had been caught under the wheels of the lorry and, in the words of the caller “was in pieces all the way down the road”. The reason these aren’t so bad is because the caller is just a bystander, not a hysterical relative, so again it’s easy not to think of the patient as a person. It sounds horrible to say I don’t treat patients like people, but the truth is, if I did, I’d go mad and I’d not be able to do my job. Of course, this only applies to dead/dying/unconscious patients - if they’re reasonably stable then my fabulous interpersonal skills and milk of human kindness come flooding back! (Right up until the moment they tell me they’re calling for a toothache).

After work, the best method I’ve found of dealing with nasties is this blog! Writing things down is a good way of getting them out of your system. Another thing I’ve learned is that you must not under any circumstances torture yourself thinking “what if I did this or that?” There’s been a couple of calls where I did worry - for instance, I thought should have recognised this patient’s agonal breathing quicker, and I still don’t know how this panic attack resulted in a dead body. Talking to the crews helps, or to other people in the room.

The shouty rude timewasters (and the shouty rude people who have a genuine need for an ambulance for that matter, though for some reason these are rarer), on the other hand, still have the capacity to interfere with my sanity despite my best efforts to eradicate them from my brain. You are kind of limited in what you can say to them, because you are of course not allowed to be rude and you are also not allowed to say “you can’t have an ambulance” or point them in the direction of the nearest cab firm/pharmacy etc (a policy I have to say I do not entirely agree with). This means you are so busy biting your tongue that the shouty rude person can take over the conversation a bit and you also end up suffering from esprit d’escalier, in other words, thinking of something you could have said which would have put them in their place without breaking any rules halfway through the next call.

The best way of coping with these calls is making a note of their ticket numbers and checking back in a couple of hours time to find they got a call back from TAS telling them that they were wasting our time and needed to see a GP, or even better, got an ambulance accompanied by a stern looking police officer who proceeded to lecture them on being abusive and threatening towards control room staff. That’ll teach ‘em.

Two summers ago, after a two day induction at Millwall football ground, where we watched a lot of slide shows and not any football, I started at Nee Naw Training school. This takes place at our back up control centre in Bow, which is in the middle of an industrial estate and a long way from civilisation, but much nicer and shiner than Nee Naw Control proper.

The course went something like this (this is off the top of my head and is going back a couple of years, so is a bit sketchy in places. Apologies for any inaccuracies.)

First couple of days: Stuff like fire regulations, who to ring when you are sick, how many pips a team leader has on his shoulders, etc etc. Not terribly fascinating stuff.
Four days: First aid course. A bit like the St John Ambulance First Aid At Work course, covering bandages, slings, CPR, positioning, drawing diagrams of hearts on the blackboard, basic treatment for sunstroke, hypos, that sort of thing.
Second week: A bit of stuff about how to calm down hysterical callers (although this is something you really have to learn “on the job”), how to avoid being sued, what you are and aren’t allowed to say (eg. “do not use the word ambulance”), etc. Followed by course on AMPDS (the priority dispatch system used to triage the calls).
Third week: General stuff about what information you need to get for different types of locations and calls. Eg. if it’s a block of flats, get which floor it’s on. If it’s the Fire Brigade calling about a fire, as how many pumps. If it’s an airport, is it landside or airside. And so on. There are lots of different types of call, so this goes on forever. Also included in this bit is how to take bookings for doctors’ urgent and non-urgent calls.

There is an exam at the end of each bit and we needed 80% to pass. I think there were resits if you failed, but I am obviously not as thick as I look and got through.

Next came a period of “consolidation” in the room. I started out by listening to a more experienced member of staff take calls, then typed as she talked, then talked as she typed, then talked and typed as she listened. If I started to look bewildered, she’d mouth instructions at me. After fourteen shifts of this, I was signed off and given permission to go it alone.

After a couple of weeks getting used to call taking, it was back to Training School for the Dispatch Course. (As I’ve mentioned before, the room is split into two halves, with the call takers downstairs and dispatch desks upstairs. Each dispatch desk contains a dispatcher, a radio operator and an allocator. New people are not allowed to be radio operators or allocators). The dispatch course was very long winded when I did it - I believe they’ve now cut it down to a week. Most of it was learning how to fill out the pink, orange, green and yellow forms we have to fill out every time an ambulance does something. I initially found dispatch very tedious because I seemed to be drowning in paperwork all the time and not really doing anything ambulancy. Once I got my head around the paperwork, it was far more interesting as I got to chat to the crews, sort out problems, liaise with the police and keep an eye open for potential blog entries!

After a year alternating between dispatch and call taking, I was allowed to take to the radio. This is where I now spend the majority of shifts. There was no return to training school for this; one of the more experienced radio operators taught me as I went along. I made a few guffs in my first couple of weeks, for example on my first day on the radio I pressed a button and said “Can all the ambulances hear me if I press this?” and all the ambulances replied “yes, we can”. Another time I accidentally said “load of rubbish” over the air and was chastised for sounding unprofessional. I’ve got the hang of it now, although I have a tendency to say “over”, indicating that I have finished talking, and then remember I have something else to say. Also, sometimes I get home from work and forget I am not on the radio and say “Roger that” and “Red base out” to real life people who look at me like I am mad.

I am not allowed to be an allocator yet because I have not been there long enough, and with any luck by that time I will have passed my stinking rotten driving test and be allowed out on the road.

I’ve had a few suggestions on my last post, and am going to be answering your questions one by one. First up, Miranda asked how one becomes a Nee Naw Worker.

Like with most other jobs, the process started with a bog standard applications form with all the usual questions about how many GCSEs you have and why you want to work for the Nee Naw Service. The LAS recruitment page is fairly non-specific about who can and can’t apply. As far as I know, there are no minimum qualifications (so I needn’t have bothered with that Master’s degree) and no specific experience you need, though I seem to recall that any kind of medical experience (I worked in a GP surgery for two years and in various very boring medical admin jobs) and any kind of telephone working (I used to work in IT support) were seen as an advantage.

Though there are no formal prerequisites, the following will (in my opinion, which in no way reflects the opinion of the Nee Naw Service) make you a lot more suited to the job:

• Basic medical knowledge.
• Experience working with impatient, abusive drunks. Try a stint at McDonalds at pub closing time and imagine getting a Big Mac in 8 minutes is a life and death matter.
• Experience working with elderly people.
• Local knowledge. This is particularly important in London where a lot of foreign residents don’t seem to know the name of the area in which they live or how to spell/pronounce it.
• Ability to get up at 5am or earlier with absolutely no room for lateness. Willingness to sacrifice weekends, social life, Christmas and the feeling of being completely awake for the forseeable future.
• A heart of steel. If you cry at Casualty, this job is not for you. Being compassionate is important, but not nearly as important as being able to take charge of a harrowing situation. If someone’s baby is not breathing, they don’t need your compassion, they need you to behave like this is a problem that can be solved.
• A thick skin. People can and will call you bad names on a daily basis. And that’s just management, hahaha.
• It also helps if you look good in green. Not many people do.

My application form was (obviously) successful and I was invited back to the Training Department in Bow to do some tests with other Nee Naw Control hopefuls. These were:

• Dictation. Someone read out a paragraph about ambulances and the Nee Naw Service and you had to write it down without making any spelling mistakes. This was pretty easy and there wasn’t any complicated medical terminology in it. In my opinion they should make this a bit harder because there are plenty of people in Control who spell “vomiting” with two Ts and make a complete hash of “diarrhoea” and it absolutely drives me up the wall.
• Logical reasoning. Lots of questions a bit like this where you have to read a passage and then say if various statements are true based on the information in the passage. I guess this is because we spend a lot time trying to squeeze information out of callers who are talking a lot of nonsense.
• Digit recall. This is the one that I thought I’d failed on. I can’t remember exactly how it worked, other than lots of numbers were read out and you had to look at a sheet and pick out the sequence you had just heard, or something like that. This sort of thing confuses me easily but it is necessary because you spend a lot of time writing down phone numbers, call signs, fleet numbers etc and you can’t go getting them muddled. I was lucky to scrape through on this one; even now I get my numbers mixed up and call L104 L401 and suchlike.
• Typing. You don’t have to be any great typist but they do measure your typing speed to make sure you’re not jabbing away one fingered as when you are call taking you need to be able to type fast to get the details up to dispatch. This was a breeze for me as with all the rubbish admin jobs and the amount of time spent on the internet I have a typing speed of 70wpm.

A couple of days after the tests, I had to make a nerve-wracking phone call to LAS recruitment from the toilets of the hospital I was working in. Much to my surprise, they told me I’d passed, even the digit test, and I was invited back for the interview proper.

I have to say it was the worst interview of my entire life. Most of the interviews I’d been to in the past went on the lines of “Do you know how to switch the computer on? Well done, you’re hired!” but this was an excrutiating affair that went on for hours. I prefer the sort of questions which you could answer from the top of your head eg. “What would you do if such and such happened…” or “Why do you like ambulances?” but there weren’t any of those, just lots of “Give us an example of when you were in a situation where [something happened]. Tell us about it and how you dealt with it.” One question was “… when someone interrupted a task you were doing to ask you to do something else” and the only example I could think of was something very lame about “I was fixing a computer then someone else asked me to, er, fix their computer and I said the first computer would have to wait because the second one was used for accessing patient records in A+E whereas the first belongs to a secretary”. I didn’t really have much relevant experience so I was plucking examples from university and rubbish temp jobs that had only lasted a couple of weeks. There was also a long lecture about uniform and sickness and how the service is very strict on these. I came over all paranoid and thought they’d been talking to my then-boss, who was constantly chastising me for late arrival and lamenting the fact I’d just had a week off with a wisdom tooth related malady. This wasn’t the case, they say that to everyone.

I don’t know if the interview went better than I thought or if they were just desperate for employees, but I got through, and here I am.

Later, in part 2: Training School!

Thanks to those of you who contacted me recently to complain (I mean, express concern) about my recent lack of posts. I haven’t gone anywhere, but there are two things that have been keeping me away from the computer. The first is the fact that I’ve just been too damn busy to sit down and write anything. The second is that just lately I’ve hardly done any shifts on call taking. Most nights I’m up on the dispatch desks doing the radio. This is probably more enjoyable for me, but it doesn’t make for such interesting blogging as I only get the stories second hand. Try as I might, though, I can’t quite bring myself to ask for more shifts on call taking simply because it can be so stressful — not because of the harrowing nasties that you hear, I can deal with those, but because of the rude people and the timewasters. Some of the people who only work upstairs might feel antagonistic towards ambulance crews but personally I’d much rather have “are we the nearest?” and “haven’t you got any green trucks?” than “hurry up, never mind the address, just send the ambulance, he’s DYING” and “You won’t send me an ambulance for my blocked nose? You are a ****** ***** ****** and I am going to sue you and murder your family!” Crews are not allowed to say things like this to us, even if we send them four miles for a patient with flu five minutes before their shift is due to end (which, incidentally, is something I try never to do, because if everything goes to plan one day I will be a crew and karma will come back to haunt me).

Anyway, the point of all this was to say that I am going to put in for some overtime for the next couple of months in order to get some good call taking stories for the blog, but in the meantime, I’m going to try to find some slightly different ambulance-related stuff to write about. Is there anything you lot want to hear about?

For some reason or other (omninous thundery weather? a proliferation of football?) we’ve had one of the busiest weeks ever. It’s been one assault after another. Maybe it’s because summer is over and people can’t sunbathe any more so they switch to killing each other instead. We had one incident where a man fatally stabbed his girlfriend then killed himself by jumping in front of a train, another when a man stabbed a woman and then, when the police arrived, started stabbing himself. A seventeen year old was bashed to death with a metal pole. Things came to a peak on Tuesday night when I was working on one of the busiest sectors and two crews pressed their priority button at exactly the same time. (Crews press their priority button when they want to “blue in” a patient - that is, they rush the patient in on blue lights and get us to warn the hospital that they are coming). I told the first crew to go ahead, but the second crew (not realising that the other crew had also pressed their priority button) thought I’d said the wrong callsign and started giving me the blue call. The trouble with our radio system is that when crews are talking, they can’t hear us or each other, so if they are both talking at once, there is no way to stop them. What I heard was this:

“This is G603… EC39… blue to the Royal Free with… the Royal London… sixteen year old male assaulted… multiple stab wounds to the chest and head… and back, was unconscious now GCS 14… ? arterial… blood pressure 110/80, pulse 94… blood pressure 84/60… 5mg morphine given… eta 6 mins…. and we’ll be there in 2 mins.”

In other words, a load of gibberish. I’m fairly good at multitasking, but there was no way I could separate these two out, especially as the calls were so similar.

“G603 and Ec39, you were both coming through at the same time. Did not receive you. EC39, standby please, G603, go again…”

“I said, this is G603, blue to the Royal Free with a 16 year old male assaulted, kicked in the head and…”

EC39 press their priority button again and talk over the top. “Sorry, I know you said standby, but our ETA to the Royal London is 1 minute…” G603, meanwhile, are still talking.

So in the end, the Royal London got the world’s sketchiest ever blue call and I ended up seriously cursing the people of East London for all attacking each other at once.

September 11th 2001 was long before my time in Nee Naw Control. I was working in Great Ormond Street hospital in an exceedingly boring admin role. Mid afternoon, I was halfway through a game of minesweeper when one of the doctors ran into the room.

“They’ve flown a plane into the World Trade Center!” she exclaimed.

We didn’t have the internet back in those dark days, so we had to rely on a radio to keep us posted.

One of the women across the office, Sabrina, burst into tears. We all gathered round proferring hankies as she explained, between sobs, that her brother lived in New York, worked in Manhattan and frequehtly visited the World Trade Center on business. She’d been trying to ring him, but his number was unobtainable. She feared the worst.

We later found out that it was impossible to get through to pretty much anyone in America that day, and Sabrina’s brother was safely away on business in another state. So that was one happy ending at least.

I watched a documentary about the Twin Towers the other day which featured reconstructions of the events inside based on 911 calls made that day. Apparently the “switchboards were jammed” with people dialling 911 to report that the WTC was on fire which made me laugh - whenever there’s a traffic accident we always get 20 odd people ringing in saying “Just in case no-one else has reported it…” so I can imagine the streets of Manhattan being lined with thousands of people dialling 911 to report a passenger jet flying into a 120 storey building - you know, just in case it had gone unnoticed… I don’t know how true this is, but someone told me people were even dialling 999 here in the UK!

More sobering were the calls made from inside the building. One scene showed people several floors above impact trapped in their office. They repeatedly dialled 911 because, well, that’s what you do in an emergency, isn’t it? They were asking the people on the other end - the American equivalents of me - what should they do? Should they stay put and wait for rescue? Should they go up to the roof and wait for helicopters? Try to make their way down? Could they break a window to get more air? Should they jump out the window to a certain death or wait inside and risk being burned alive?

Trying to put myself in the position of those dispatchers, I realised that occasionally a situation occurs that there was no protocol for. The instructions those callers were given could make the difference between life and death but no-one knew what the right answer was and no-one could have predicted what was going to happen. I just hope I never find myself in a situation where there’s a question I can’t answer.