Monday, 18 June 2012


I sit and write this at the most despised moment in the Western World. 

Monday morning. 

Luckily, by the time Monday morning arrives here, we already have 24 hours of the working week under our belt and that Monday feeling already happened on Sunday. There's good and bad in that. The kids go to school six days a week, which they hate, but finish around lunchtime each day, which they love. They've also suddenly realised that the upcoming summer holidays are some three weeks longer than they would have had back in the UK, but that's just by the by. 

Monday to Friday. The so called normal working week. Or, as those in EMS (and other emergency services too, I guess) call it, Monday to Friday. There's no such thing in the twenty-four/seven world of EMS as the normal working week. Our Friday feeling can arrive any day of the week and any time of the day. Nights turn into days, days into nights, weekends into weekdays and vice versa. There's no real pattern that means anything to an outsider, when the weekend can just as easily begin on a Tuesday. 

"So how many days a week do you work?" is a common question from many who are looking from the outside, in. To answer it, first you need to define the terms 'days' and 'weeks'. 

The past few (normal) weeks as an unemployed paramedic have been a little frustrating. Bureaucracy has a wonderful knack of driving the sane to distraction and I was only semi-sane to start with. We're getting there, slowly but surely. Everywhere I've been and everyone I've spoken to has told me that they're desperate for paramedics, but it just takes time to get through the red tape. 

I have, however, found a new love for the concept of the real weekend, shortened as it may be. Saturday afternoons now involve leaving the kids to their own devices and sitting down with a good book, or if I'm really lucky, like last weekend, even a nap. 

Apparently, however, even an unemployed paramedic is still on call, especially when they're asleep. A crash of the front door is swiftly followed by a bash on the bedroom door.

"Somebody's collapsed in the park!" yells a child's voice. "Come quick!"

Thirty seconds later, somewhat more bedraggled than I would normally be when responding to an emergency, I meet my first real patient for a couple of months. He's young, eighteen at most, looks pale but indicates that he's pain free. The fact that it's 30 degrees Celsius means that it's a little difficult to ascertain whether the sweat is heat related or otherwise, but a sixth sense and a weak pulse make me opt for medical rather than atmospheric. 

As if I'd never been away, I start asking my questions, going through the mental list that has formed my initial patient assessment for years, but this time, in Hebrew. 

"I'm sorry," says the patient, looking a little confused and embarrassed, "but do you speak English?" 

As it turns out, had he have been at home, rather than on an extended stay with relatives, he could still quite easily have been my patient, living within spitting distance of my London ambulance station. Instead, I get to treat him in Israel. Treat may be pushing the boat out a little, as I had no equipment with me, but at least start to get some sort of history. 

In the meantime, someone had called for an ambulance. The first responder arrived three, maybe four minutes later, immediately followed by another, both on bikes. They're volunteers, much like the community responders in certain parts of London, who help back up the ambulance service which is spread too thin. So far, so familiar. They strolled over to where we were, hands in their pockets and with no equipment. My patient looked up and his first words were shocking. 

"Don't let them near me, they hate me." 


"The same thing happened last week and these two turned up then, too. They basically called me a liar and told me I was faking." He told me about the treatment that he'd received, but more importantly, the attitude with which it was delivered. 

I didn't think he was faking, but I did hear one of the responders mutter something to the effect of Oh, him again. I sent one of them back to the bike to get me some kit, so I could check the basics at the very least and then try to make an informed decision as to a plan of action. The ambulance arrived shortly after I had checked the blood pressure and following a handover to the crew, I left them to continue the treatment. 

I walked away reeling from the patient's comment. They hate me, he said. They told me I was faking. Maybe he was, maybe he wasn't. I wasn't there the previous time, but I certainly didn't think he was lying on this occasion. These two responders fell into the most dangerous trap there is for an EMS provider. 


We're all guilty of it. When you meet your regular leg-pain caller for the umpteenth time that month in the same phone box, it's difficult to act with the sympathy and open mind that you would otherwise have for somebody else. To fall into this trap, however, based on very minimal previous experience or exposure and all before you've actually seen the patient, is not only dangerous, but, to be honest, stupid and unprofessional. 

If you're a student reading this, or a fairly new EMS provider, you'll swear blind that you'll never do it. You'll never fall for it like the old hands do. I warn you now - you will. It's what defines you as an old hand. The trick to learn along the way, however, is when, how and at what speed can you recognise that you're doing it, that sometimes you're wrong, and what you need to do to put it right. 

The other trick, is to not become an old hand before you've earned that right. There's a fine line between confidence and over-confidence. Crossing that line can take you, very quickly, into territory that will not only grate on the nerves of anyone you work with, but also into a danger-zone for you and, most importantly, your patients. 

You need to constantly assess and reassess not only your patient, but your treatments and attitudes too. That way, you'll be safe in the knowledge that you'll be able to relax when you get to your weekend. 

Even if it is on a Tuesday. 


TAZ THE AMBO said...

Hello IM,

After 10yrs in the big city I have that 'oh it's them' as I pull up. What I have developed is the awareness of the possability of something new, different or unusual about the regular caller and try to explain and develop it in my workmates, peer or junior.

StPMedic said...

Sounds like you're settling in nicely!

I'm a student paramedic and on many occasions I've been to jobs where the crew have already presumed they know what they're going to based on the address. The attitude to these patients has then been substandard. Definitely a concern to be had, but changing this is unlikely to happen I don't think...

Mary Jones said...

As a community first responder I have to say I am appauled by the behaviour of the 2 men in your blog. Sure, we all have regular callers that don't really have any medical need, often they are just lonely and need someone to talk to for a few minutes. For some we are the only human contact they have and that is really sad.

As CFRs we are nowhere near qualified to decide if someone is faking or not, we might have a gut feeling but I wouldn't want to be the one to refuse to help only to find out later that the patient really was sick!

Their behaviour of the Israeli CFRs makes me wonder why they volunteered in the first place? They don't sound very caring or empathetic.