I’ve been quite lucky in my career so far. I have worked on traditional ambulances, I have worked on rapid response cars. I’ve struggled to treat patients in fields in the middle of the night and I’ve treated them in field hospitals behind the main stage of a festival.

I’ve commenced treatment on VVIP in secure areas. I’ve worked on high profile sports events and in busy emergency departments. I’ve triaged over the phone and via video link.

There were many things I have picked up on the way from patients, situations and the people I have met along the way. I thought I’d share these with you.

1. Always arrive a few minutes early. Check your equipment. You never know what the day will bring and knowing your equipped for anything will make you feel a little more prepared.

2. Never run to anything. Running increases your heart rate, your gloves are harder to get on and your out of breath. Walking buys you headspace to make a plan.

3. Never underestimate a mother’s intuition. Ask them what they think is wrong with their child if you are treating them 9/10 times – they already know.

4. Oxygen tubing cut into pieces makes a great straw if a patient needs a drink.

5. If a patient says they feel like they’re dying – take them seriously. They probably are.

6. Create time for silence – a well timed pause can create opportunity. Wether it be a patient asking a question in this gap or the family seeking reassurance.

7. Holding someone’s hand is one of the best treatments you can give.

8. If it’s wet and sticky – don’t touch it.

9. If you get stuck – take the patients pulse. It buys time to create a plan.

10. Offer to clean. If you have just been to something traumatic then cleaning up after can be therapeutic. It buys time to reflect.

Any healthcare professional will tell you the value of your gut feeling in the assessment of a patient. The British Medical Journal published an article citing it as:

“clinician’s intuitive feeling that something is wrong, even after examination that suggests otherwise, appears to have diagnostic value, even greater diagnostic value than most symptoms and signs”

In this case, stood looking at the patient in front of me. I knew something was wrong. We were in the living room of a family home – children’s toys were strewn across the floor and we were surrounded by pictures, ornaments and children’s pieces of art.

I was working with a student paramedic and an emergency care assistant. It was the early hours of the morning after a busy night shift. The patients wife had phoned 999 – she did not speak any English and gaining a history from her was proving to be difficult.

The patient – a tall man in his 40s was sat on the chair on the sofa. He was leaning slightly forward. He was pale, clutching his head and vomiting.

The student was doing the initial observations – the patients blood pressure was extremely high and his pulse low. He had slurred speech. I asked the ECA to get us a chair.

In the ambulance service this is a code phrase – it means we need to get moving quickly. Whilst the ECA was doing this the patients daughter came downstairs.

The daughter was around 10, she was young. However, she was the only person there at the time that was able to tell us what had happened. Her dad was struggling to speak, her mum spoke very little English.

She told us that her dad had been working that night on the late night bus. She then started translating for her mum – she told us that the patient had come in and complained of a sudden, severe headache.

This was all I needed, I knew what this looked like. The patient was presenting with a subarachnoid haemorrhage – a dangerous bleed in the brain. He was very unwell.

We managed to get him onto the chair, our sense of urgency reflected by the flashing blue lights on the windows around us. We carried the patient out of his front door and down the steps outside.

At this point we noticed a change. The patient slumped to the side. His eyes fixed and glazed to the right. His arms were trying to draw up to his body – a position called decorticate posturing. The brain was injured and was pulling the limbs in to protect the bodies core and central organs.

We managed to get the patient onto the trolley. As we did so the patients wife was getting more upset. There, stood next to her. The patients daughter. She was silent.

I had to get my student to help me hold a limb straight. I needed to get a cannula in. The patient needed medication to stop him vomiting and protect his airway. We managed it between us.

I was acutely aware that the patient was possibly still aware. His eyes were open and fixed to the side, I was trying to reassure him as tears rolled down his cheek.

At this point – the patient started fitting. I quickly got my ECA to close up the ambulance and instructed the student to get the oxygen on the patient. I drew up the diazepam and administered it. The seizure stopped.

There was a gentle tap on the door. I opened it and found the daughter stood at the bottom. She asked me what had happened. I was honest. I told her that her dad was unwell, it was critical that we got him to hospital quickly.

She translated this to the patients wife, her mother. This 10 year old was having to deal with something that she would be dealing with for years to come. The mother vomitted. We got her a bowl.

“She wants to come with you”. The girl said.

We only had the seat in the front spare and one seat in the back. The daughter was doing a great job of remaining calm and collected as well as translating for me.

I kept her in the back. Wether or not this was the right thing to do, I am still unsure. I needed a translator. I also needed calm. She was both. She was amazing.

The patient remained stable the whole way to hospital. The daughter held his hand tight the whole way. The mother sat in the front.

Sadly, I don’t know the outcome of this job. I watched in the resuscitation room as the patient was put to sleep and prepared for transfer to a neurological unit.

I like to think the patient survived. The resolve in the face of the ten year old girl as she gripped her fathers hand as we raced towards hospital will forever be with me. Our treatment did half the job – she did the rest.

Sometimes holding a hand is the most important treatment you can give. It encourages hope, gives purpose; and sometimes – can make someone fight.

Working on your own on the rapid response car can be very rewarding. It forces you to make your own decisions about how you manage your patient based on your own assessment. However, at times it can make you very vulnerable.

On the night shift that this incident happened. I was working on my own on a rapid response vehicle. It was mid winter, so it was cold. However, it was a clear evening.

I was travelling to a job I had been dispatched to. On the way the mobile data terminal (MDT) blared to life.

“STAND DOWN” The electronic voice blared at me.

I pressed the button acknowledging the stand down, and with that another job flashed up. The radio started ringing.

“TGM1 this is control, we are dispatching you to a 55 Year Old Female. Difficulty in breathing”.

The address was in a rural part of the patch, where there are lots of farm houses and the distance to hospital can be quite far. I knew I had to decide what I was going to do early, in order to get back up running as soon as possible if the patient needed to attend a hospital.

As I drove down the country lane I turned the full beams on and the headlights lit up the road, allowing me to see clearly what was coming up. The reflection of the blue lights flashing bouncing off of the puddles on the road and lighting up the eyes of the odd dear or owl.

I started to approach the address on the sat nav so I started to slow ready to look for the house. Lucky really. There in the middle of the road, was a figure. I slammed on the breaks.

I took a deep a few seconds to steady myself. I was unnerved. It was the middle of a night, in the middle of nowhere and this woman was just stood in the middle of the road. Facing me. I changed the blue lights on the car to only flash from the rear of the vehicle as I did not want to dazzle her and left the headlights on.

I quickly activated the run-lock feature on the car, a feature that allows the engine to run with no key in the ignition. However, would cut the engine if any pressure was applied to the accelerator. That way I knew the lights would stay on and the car would stay warm.

I took ahold of my torch and stepped onto the road. I pulled on my hi-viz jacket and approached the figure.

“Ambulance Service, are you OK?” I called out.

“Yes, I called you. I couldn’t breathe.” Came the reply.

I was suddenly very aware of how alone I was. I ran the torch up and down the patient. She was a lady in her 40’s wearing jeans and a hoody.

“Do you live nearby?” I asked, slowly stepping towards her. I could see from the way she was standing that she was not struggling to breathe. Her shoulders weren’t moving, and there was no difficulty in taking a breath that I could see.

“No, I don’t. I didn’t want to die at home. So I went for a walk” she calmly replied.

“Ok, tell me what’s been happening and Ill see how we can help” I said.

The patient then went on to tell me how she had been under the mental health team for a while but thought they weren’t helping any more so cut all ties and stopped her medication. I enquired what medication she was on and she replied with the name of a potent anti-psychotic. She then said that she believed that she had been poisoned by her family; became short of breath whilst walking and so called 999.

I invited the patient to come and sit on the edge of the boot at the rear of the car, that way she would be partially sheltered and I could give her a blanket to stay warm.

“No thank you, its time for you to follow me” She stated.

“Follow you where?” I enquired

“Back to my house, its warm there and I can tell you more about what is happening” She suggested.

At this point. I definitely was not comfortable. I explained that an ambulance would be on the way and it would be warm and comfortable in the back of that.

By now my assessment was complete. Medically she was well, she had a fast heart rate (tachycardic) but this was due to her mental state. I told her I was going to ring the mental health crisis team for the area and walked to the front of my car.

As I discussed the patient to the crisis team I found out a few facts that put me more on edge. This patient was known to become aggressive – and was normally accompanied to appointments by a security guard. The nurse on the phone said that there was room in the 136 suite (a secure room that mental health patients can be kept in whilst being assessed).

Luckily, at this moment the trees in the distance started pulsing the familiar blue of my colleagues approaching with their lights on. I felt a wave of relief wash over me.

10 minutes later. The patient was handed over and on her way. I had to sit in the nearest fuel station forecourt to calm my nerves.

I took a deep breath. Pressed the “clear” button and watched the screen light up with the next job – an 85 year old male had fallen. Perfect. I fired up the lights and headed towards the patient.

I was working on an ambulance with an Emergency Care Assistant on a hot weekend in the summer. We had both just finished an ice cream that we managed to sneak in between calls and were looking out over the city from our standby viewpoint.

I was just starting to lull into a false sense of security when the screen came to life.

79 Year Old Female Difficulty in Breathing

The address of the job was an upmarket restaurant in the tourist district of the city. The ECA was driving so started the engine and we headed towards the location, blue lights flashing and sirens blaring.

We pulled up outside the restaurant and could see a long table inside with lots of balloons and people sat around. One of the waiting staff was stood outside.

“Thank you for coming so quickly, shes inside. Follow me” he said as he led us inside.

Sat at the table, leant forward and looking panicked was our patient. She was covered head to toe in a rash and I could hear a wheeze. She was having an anaphylactic reaction to something.

I asked the family what had happened whilst I started my assessment of the patient in the form of a primary survey (a 60-90 second assessment that highlights any life threatening conditions that need immediate management)

“We were having dinner for Grannys birthday. We all had a set menu that we chose for her. She was having her starter when she started to cough and feel strange. That was when we called you” A lady sat at the table answered.

“Has Granny got any allergies?” I asked.

“Shellfish” the lady answered.

“Ok, and what did she have for her starter?” I asked, quickly followed with: ” And did anyone near her have shellfish”

At this moment I could see the realisation hit her. Her facial expression changed and she went pale. I followed her gaze to the table just in front of her granny. There. Sat on the table, was a half eaten prawn cocktail.

“She ate a prawn cocktail!?” I asked, shocked.

“Yeah, we organised for us all to have the set menu as it was cheaper” the lady replied.

We quickly set about getting the patient to the ambulance. Anaphylaxis is life threatening if not treated quickly so I was preparing an injection of adrenaline to give her as well as a nebuliser. When we got on the ambulance I would give her the rest of the medication she needed through a cannula.

“Nice to see I’m going to get my Birthday shots!” The patient wheezed as I gave her the injection. She hadn’t lost her sense of humour.

Once on the ambulance I asked her why she had eaten the prawn cocktail.

“My family organised me a lovely meal, I don’t get to see them all very often and my eye sight isn’t brilliant. I wasnt sure if it was prawn so I just gave it a go. We were having such a lovely time and I didn’t want to make a fuss. I’ve certainly done that now!”

With that there was a knock on the side of the ambulance. The lady from earlier was waiting.

“How are you doing Granny?” She asked.

“Would you like the good news or the bad news?” The patient replied, the nebuliser hiss making her sound a lot like Darth Vader.

“Let’s start with the bad news” the lady replied.

“Thanks to this young man your attempts at getting your inheritance early have been thwarted”
The patient replied, smiling.

“The good news” she continued, “the bill will be cheaper”.

As paramedics sometimes we have to assist patients in their final stages of life. These jobs can prove to be challenging but extremely rewarding. It is an honor to enter someone’s home and ensure their comfort and dignity is maintained in those last moments.

“45 YEAR OLD MALE – DIFFICULTY IN BREATHING” The mobile data terminal in the car flashed up. I put the TV series I was watching down, fired up the engine and headed toward the address.

It was a Friday evening, the sun was setting and their was a warming orange glow to everything – the perfect night to be sat in the garden after a barbecue watching the world go by.

As I pulled up outside the address I quickly noted a couple of things – firstly, there was a lot of cars on the drive. Secondly, there was a boy – around 10 years old. Waving me down.

“My dad isn’t very well, mum is in there with him. I wanted to see if you came with flashing lights – you did!”

After greeting the boy I walked through the hallway of this well kept house – it was very homely. There were pictures all over the walls showing holidays, weddings and birthdays. In the centre of most of the pictures stood a tall man, smiling and happy.

“Through here!” A woman’s voice shouted from further down.

I walked into what would have been the living room and took in what was in front of me. The room looked like your average front room. However, one side of the room was partitioned off and there was a hospital bed.

On the bed, sat forward was the patient. He was in trouble. I could see that he was in pain, his breathing was fast. Too fast. With every breath he was struggling. Next to him, the figure of calm. The woman, who I would later learn was his wife was calm and coaching. She turned to me and smiled.

“Its ok Brian, someone is here now” she said. Sometimes you wonder who is more reassured – the patient or the relative. However, she was like a rock in a storm. Totally calm.

She quickly told me what was going on. Her name was Alison – she was Brian’s wife. She explained softly that Brian has terminal lung cancer and recently had been struggling to breathe due to the amount of secretions he was having to clear from his airway.

Secretions is a medical term for build up of fluid that comes from systemic failure. It is normally a lot like saliva and can be very hard to clear. It is described by some as drowning from the inside out.

Brian had been a train driver for most of his life, until he had started coughing up a little bit of blood a mere 6 months before. I could see the toll this had taken on the family. I knew then that I had to rethink my strategy. My goal here was not to save Brian’s life, it was to help him have a good death.

This was something that at that moment – he was not having. His breathing was erratic, shoulders heaving and I could hear his chest bubbling from where I was stood.

Most patients who are end of life within the UK have a box known as a “Just in Case Box”. Within this box their are various medications that have been prescribed for exactly this scenario; when it is out of hours and medication is needed in order to control symptoms and the patients distress. This is exactly what Brian needed.

I asked for the box and Alison took it out. She had read into the medication in there and wanted Brians secretions reduced; however, did not want any of the medications for agitation.

“At the moment he is still here, we don’t want him sedated”.

I drew up the drug she needed to be given through an injection. As I was doing this Alison was telling me about Brian. I heard all about his life and his family. I knew he had two kids who were currently upstairs doing their homework and with the mother in law who was staying to help look after Brian. They knew what was going on and the whole family had been honest with them throughout. I thought back to the boy who had been waiting for me earlier. He was so calm. I admired their way of dealing with this.

“We have called it Terminus”. Alison said.

She was referring to the cancer. I had heard of cancers being given names before. This name; however, was a new one to me. She must have sensed my confusion.

“When a train driver finishes their day working. The train returns to the end of the line. Terminus.”

This was how Brian’s family were dealing with this. This was their journey. Brian was a train driver. My job was to get Brian back on track.

I gave Brian the medication that would help reduce the secretions and assisted him in taking the oral morphine that would help with his erratic breathing. As he started to calm down and fall into a peaceful sleep Alison called the children.

Two boys came downstairs. The young one from earlier and an older boy. Around 15. Both of them kissed Brian and said goodnight. Brian was able to mumble a good night back, following it with a tender “love you”.

Alison dimmed the lights and pulled Brian’s duvet up.

“Thank you”

Being a paramedic isn’t about all the life saving interventions and fast pace. Although, this is the job we train for and we all get excited attending those jobs. Patients like Brian are just as rewarding. Getting in my car after this job knowing that Brian was comfortable, that the boys said goodnight and that Alison was reassured makes this job the best job in the world.

I managed to get Brian back on track following a minor delay. He is heading comfortably to Terminus and whatever awaits him after that. I just hope the rest of the journey is comfortable.

For Brian.

Whilst working on a Double Manned Ambulance on a day shift we were dispatched to a bus terminal to reports of an adult male collapsed. I was working with Tom; an Emergency Care Assistant and Mel, a first year Student Paramedic.

On the way to the job I was driving, so I had Mel in the front – a lot of the time students sit in the back so it’s nice to swap this around to get the full experience. It also meant I could ask her questions or run through scenarios on the way to the job – something that challenged the student and kept me focused.

“Talk me through your Primary Survey” I would ask. Mel would reel it off word for word, these algorithms were drilled into the students.

We also designated positions in case the patient was in cardiac arrest –“Mel, I would like you to do the immediate assessment and then if worst comes to worst you start the compressions from the patients side”

“Tom” I called through the divider that allowed me to look into the back of the ambulance when driving . “If needed you can get straight onto bagging and sort the airway while I do drugs and get access.”

With everyone prepped, we carried on toward the job. As we pulled up the bus staff were waving us in. As we got closer I looked over and could see a man lying on his back, star-fishing. At his head knelt a lady knelt down, doing mouth to mouth.

I heard Mel take a deep breath. I new the feeling – she was trying to quell the adrenaline that was now surging. I quickly re-iterated the roles I had delegated.

“Mel, make sure you arent distracted by the CPR. You need to quickly pause it, do a pulse check and then start chest compressions if you cant feel one. If your not sure just let me know.”

As I got out the drivers side I could hear the door slide open on the side. Tom jumped out and started handing out all of the kit we would need; the primary bag, the secondary ALS (Advanced Life Support ) bag, the oxygen, suction and monitor.

We approached the patient. As we walked towards the patient I took in the scene around me. This was a busy bus terminal – there were many people stood around. Most were watching. Some were filming. The police had arrived just behind us and were helping the bus station staff to get screens out to give us, and most importantly the patient some dignity.

The patient was lying on his back, his eyes were open and his head was bobbing off of the floor in time with the very effective compressions. Mel kneeled down at the head end and performed a head tilt chin lift to open the airway. All the while I was gaining a history from bystanders.

It turned out the patient had got off of a bus with friends when he looked a bit disorientated and fell to the floor. His friends however, were nowhere to be seen.

Mel quickly stopped the compressions and felt for a pulse.

“I have a pulse” she proclaimed. “No effort of breathing”

“Plan?” I asked her. In my head, I had already made it.

“I think we should start bagging” Mel stated. Excellent.

Without hesitation Tom passed Mel the equipment she needed to do this. It was all prepped. Tom had done the one thing I love in a good ECA. He had pre-empted what would be needed and had it ready. I made sure that Mel was OK with ventilating the patient. She had inserted a basic airway and was getting good chest rise – she was doing great. I told her.

Over the 60 seconds I quickly did a primary survey. I found the cause of the collapse pretty quickly. As soon as I cut the sleeves up the patients arm I found tract marks. He was an intravenous drug user.

I pointed this out quickly and asked Mel what the treatment was.

“Naloxone” She replied. Great.

We drew up a dose and gave it quickly by intranasal administration.

It was effective.

We got the patient onto the ambulance in order to facilitate his transfer to hospital. The patient was coming to a bit more – ideally I wanted to keep him groggy. In my experience, when you reverse the effects of an illicit drug that the patient has taken by administering the life saving medication that prevents the respiratory depressant action of said drug; it can go one of two ways:

A) They are grateful. They apologise for what’s happened and usually come to terms with the fact that they need to be transferred to hospital.

B) They aren’t grateful. They become agitated that you have in effect wasted their money. Despite the fact that in doing so you have saved their life.

This patient was a B.

“GET OFF OF ME” The patient yelled.

We reasoned with him. We attempted to calm him down. For a couple of minutes it worked. The patient explained that he had been on the bus for ages and decided that he would “shoot up” in order to make the trip faster. He had taken some heroin from a new dealer and in his own words:

“It was much stronger”

After this discussion the patient went about refusing treatment. This is often the case with heroin overdoses. Once assessed to have the capacity to make this decision we offered him the alternative, an injection with a loading dose of Naloxone in order to help mitigate any second pass effects of the drug and boost the existing dose. The patient agreed and this was given.

Up until this point the patient had been refusing treatment but had not been particularly aggressive. However, as soon as he looked down. This changed.

“Who cut my F****ing jacket!?” He yelled, looking down at the rags on his arm where the arms of his jacket should have been.

I explained that we had to cut his jacket in order to get to his arms when we tried to look for a vein to cannulate. With this he jumped off of the trolley.

Screaming and shouting incoherently the patient started moving towards Mel. She was between the trolley, monitor and attendant seat. Completely trapped.

Luckily, Tom had already seen this happening and managed to slide the response bag in front of the patient. This gave a bit of distance. Tom then slid open the side door. The door rolled open and to my amazement; there, arms crossed, were a couple of police officers.

The patient was grabbed and dragged off of the ambulance. Kicking and screaming. The police restrained him and he calmed. I explained the situation and the patient was still refusing treatment.

The police reasoned with the patient, took my concerns and communicated these to the patient. The patient still refused. Fortunately, the police had a plan for this – the patient had assaulted one of them in the struggle.

They explained that they would arrest him – and he would be monitored in custody by a clinician there. Although not ideal for the police, the patient would be safe.

Mel was fine. A little shaken, but fine. I realised this as soon as she thrust her portfolio towards me beaming.

“Airway management signatures please”.

I signed the competency. After all. She had earnt it.

• 

We booked onto our double crewed ambulance. Today, my ECA and I would be with an observer from the local hospital. He was a nurse who wanted some insight into pre-hospital care. I was happy to have him. It makes the day go quicker, and he brings some more hands to the party if needed.

We logged onto the MDT and radioed control. “BG01 to Control, Log on and Radio Check”

“BG01 this is control, we have received your log on and hope you have a good shift.“

We then set off from our station and did a few jobs. A fall, a chest pain and an abdominal pain. All was going well, with all of our patients left at home. However, the observer wanted to see more. He was hoping for a cardiac arrest, or as he put it “Something interesting” .

I had explained to him that ambulance work was 90% routine and 10% “interesting” so the chances of him going to a cardiac arrest for example were slim.

We were just cleaning the vehicle at hospital when my ECA pressed the button to say we were clear and ready for the next job.

Beep, Beep, Beep

The MDT came to life. Looking at the screen we could see that this job was to a 35 Year Old Male for “Mental Health”. The nurses interest peaked. He had never dealt with anyone with mental health before. He explained he had had very little training in mental health but always found it interesting. I explained that I was the same. However, I had undertaken more training to be able to assist me with these types of patients as unfortunately, it is something we come into contact with quite regularly.

Usually, mental health was all about communication. We would go in and build a rapport with the patient and see what we could do to help. Wether that was to refer him to a mental health unit, transport him to the emergency department or to a mental health facility. There were numerous options. I explained to the nurse that usually they are calling as they want assistance and are receptive to help.

I didn’t realise quite how wrong I would be.

We arrived at a block of flats and found the property. It was on the third floor. We gathered our kit and made our way up there. When we made it to the third floor we walked through a corridor filled with furniture. It looked like someone was either moving in or out.

One of the doors in the corridor opened and a man stepped out.

“She has been doing that all day, we can not seem to get her to stop”

I thanked him and then made my way to the address. I knocked on the door, which I noted had some repair work done from what looked like someone forcing entry in the past. The door opened and there stood the patient.

This was a middle aged lady, her hair was wild and she was wide eyed – she looked like she had been awake for weeks and not washed for longer.

“I told them I did not want any help”

I reasoned with her that we could just check her over and then give her the options and that we were there because people were concerned about her. She relented and let us in.

The flat was bare. She had clearly moved all of her possessions into the hallway. In what would have been the living room there was an arm chair and pile of books. On the wall there was a TV and on the arm chair was a remote control. The back of it was off and the batteries were loose on the chair. The windows were covered in newspaper, allowing a little light in but making it dark. Strangely, the curtains were open.

We introduced ourselves. I then asked how we could help and what had been going on. The patient seemed lucid and happy to converse. Initially.

We had managed to do a set of observations. The patients heart rate was 130, her blood pressure slightly elevated. As the ECA was getting these from her I was asking the usual questions about what had happened – I then asked about medical history. With this, something changed.

Suddenly the patient amped up her speech tempo. We were finding it increasingly difficult to get a word in and she was becoming agitated. Sensing the situation escalating my ECA started moving some of our kit into the hallway.

It was difficult to communicate with this patient, she was just escalating in front of my eyes. The ECA came back in.

“The nurse went downstairs to take a call”.

We both knew this was not the case – the nurse had been told to withdraw from the scene by my ECA. The patient was getting more and more agitated. Now she was pacing and had stopped making eye contact.

Ambulance service staff are trained to recognise when someone is becoming hostile. The conflict resolution training and experience ensures that when a situation is heading south, you know.

In the kitchen on the side, there were knives. We had noticed them earlier. The patient was slowly pacing towards them. She had also changed the subject. Now she was referring to voices. Voices telling her to kill.

At this point, the patient gave us an opportunity.

“My TV doesn’t work” She calmly switched back to apparent normality.

The ECA cleverly jumped on this. The patient was still clearly agitated. However, had stopped pacing. She was asked how it was broken.

“The batteries don’t work!” She snapped back.

With this the ECA asked her to show us – at the same time looking at me, and motioning towards the door. We were going to run.

At this point, everything slowed down. It was one of those moments. You become super aware of everything. The ECA went to pass the remote control to the patient, and dropped it. The patient bent, and we took off.

Unfortunately, the bags in the hallway had become a bit of an obstacle. Between us we grabbed them and carried on. In the background, the patient was screaming. It was not a scream I had heard before.

Not fear.

Not loss.

Not pain or frustration.

It was rage.

We got halfway down the corridor when I heard the sound of metal being slid off of a sideboard. The patient had a knife. At this point, it should have been time to press the “man-down” button on top of our radios. This is a panic button that opens a channel to all of the ambulance vehicles in the area as well as our control room; crucially allowing them to hear what was going on and arrange for immediate assistance. However, we both forgot.

I don’t remember how I got from the top of the stairs to the bottom. Somehow I was there. I looked up to the landing above in time to see the patient tearing out of her flat after us. Knives in each hand.

The door was in sight, the ambulance through the glass looking like safety. We pressed the exit button. The door slowly, painstakingly opened automatically and we got through. The nurse looking panicked stood by the vehicle.

“In! Get in the vehicle!” I shouted. He jumped in.

We climbed in the front. With no time to get the kit into the back as the nurse had shut the door I had it all on my lap. We drove out of the property and down the street. Parking over the road so we could see the doors and react if necessary.

I phoned control and explained the situation. I didn’t even have time to hang up before the first of many police cars arrived. We explained the situation. The police were not surprised – the patient had markers on her address for violence towards her mental health staff when in a state of crisis. The police had a plan in place to not enter the property without a team of them – all kitted in riot gear.

The police asked if she was medically well – we agreed. With that we were stood down and returned back into service ready for the next call.

“Well, that was interesting.” The nurse calmly said from the back.

I was returning to base for my lunch in the SRV when the radio sprang to life:

“BG1 from Control, we have a birth imminent in your locality, we are sending the job through now”

I took a deep breath. Historically, paramedics do not like delivering babies. The training we used to get was basic. More recently this has improved, and we are better prepared. However, this is still something I feel I could do with more exposure to.

The MDT flashed up with the details. What struck me was the location of the patient. She was in a bus stop.

As I drove up the road I could see a people carrier parked in a bus stop with a small group of people gathered round. I parked behind, partially blocking the busy road with my blue lights on to warn the traffic.

I went to the boot to grab my bags. I grabbed our maternity pack and put on an extra pair of gloves. These jobs are usually messy.

As I approached the car I could see the side door was slid open, and a lady in a healthcare tunic was leaning in. I peered in. In the back was a lady laying across some seats, between her legs was what could only be described as a massacre.

“Thank god your here” the lady in the tunic said. She quickly introduced herself as a healthcare support worker. For this we will call her Angeline.

Angeline told me she had been waiting for the bus when this car had pulled up. A man had got out and run around the side screaming for help. She had run forward to help, just as the door slid open.

There in the back of that car. She had delivered a baby girl, to a stranger she had never met. She struck me as calm. She didn’t know the patient, she had never delivered a baby. But to this occasions – she rose.

I quickly thanked her, and asked her to hang around. I then asked where dad was. She pointed to the bus stop. There, on one of the seats. Very pale. Sat a man in his mid thirties. He looked scared. I congratulated him and said I was going to check his partner over.

All of the above took seconds. I then leant into the car, and there between the patients legs laid a healthy looking baby girl. I quickly dried her off with a towel we carry and placed a blue hat on her head (we only carry blue or pink, and this little girl had been unlucky with my selection that day).

The baby was healthy, she was crying – pink and warm. Her breathing was good and her heat rate also normal. Brilliant.

I then turned my attention to mum. She told me this was her second baby and she had left it until later to go to the hospital as the first one took ages. They were nearly on the motorway when she felt the urge to push so they pulled over.

I explained that I was on a car, that an ambulance was coming and I needed to do some assessments. I apologised for how close I was to her – there wasn’t much room in the back of the car.

I quickly assessed her. What looked like a lot of blood loss on the seats of her car, was probably just the normal amount with birth.

She wasn’t shocked, she was no longer bleeding and she felt as though the worst was over. She hadn’t yet delivered the placenta – but that wasn’t concerning.

With that, an ambulance arrived. I quickly handed over and joined them in the back. The patient started pushing to deliver the placenta so we gave her some gas and air. Dad cut the cord. It all went really well.

I asked the couple if they had any names – they didn’t. They were waiting to see what the baby looked like.

We arrived at hospital and I handed over to the midwife. As I was about to leave the patient asked me who the lady was that delivered her baby in the bus stop.

I replied her name was Angeline.

A few weeks later I followed up on the patient. The midwife explained that the baby’s birth certificate would read:

“Angeline-Rose”

We were sat outside a busy Emergency Department on a cold winter night. It was closer to around three in the morning and we had nearly four hours to go. The emergency care assistant had just got in the attendants seat with our coffees when the MDT flashed to life.

CAT 3 – Concern for Welfare

I turned the key in the ignition and we set off towards the address we were given. On the way we were chatting about various things and then came onto guessing what this could be:

Me: “I think this will be the classic job where we turn up, let ourselves in and find the patient asleep in bed”

I was referring to the types of jobs I hate. You enter the property searching room to room. Enter the patients bedroom and find them fast asleep. The tension of the unknown is unbearable – as is the jump scare you get when the patient wakes up. Usually, they are confused as to why your there and explain that it was their medi-alert bracelet that has been pressed accidentally. Ultimately, you end up checking they are ok and leaving.

ECA: “ I reckon this will be a simple fall”

We were both wrong.

The property we were attending was above a boarded up shop. We grabbed our kit and headed towards the front door. We both took torches as it was down a dark alley to the side of the shop. The torch light casting eerie shadows as we approached.

Bang. Bang. Bang. We hammered on the door, hoping someone would answer and my theory would be proven. No answer.

“BG1 to control”

“Go ahead”

“No contact made, can you send fire to assist?”

With fire on the way my ECA tried the door. It was an old door with an old lock, it gave a little just turning the handle.

We called control back to advise that we thought we could gain entry by breaking the door. Control said they had no contact so as it was a call from the flat, confirmed by the care company we could gain entry.

In order to make a call using the care alarm system. Usually, you would either pull a cable or press a button. It took a physical action.

Bang. Bang. Crash. The door flew open.

We shone our torches in. A murky hallway came into light. The hallway was bare of any decoration and piles of post and takeaway menus were on the floor under our feet as we walked in. The doors in front and to our sides were closed.

One by one we opened the doors and shone our torches. All of the lights were either broken or there was no electricity. Each room we went into was empty. Bare. There was no furniture.

From the other room the ECA called me. “No one lives here! False alarm!”

That’s weird I thought. I turned to leave, and that’s when I saw it. The red alarm cable was swinging. It had been pulled.

Whilst working on a response car, I sat on standby watching the latest box set on a certain streaming platform that rhymes with betflix the MDT flashed to life.

“999 – Fire in progress – persons reported”

I started to head towards the job when my radio kicked in, our control room were trying to call me. However, this was not unusual as when working on the response car they like to tell you about updates as they come in ensure a safe drive.

“BG1 this is control, this job has been passed by fire who are on scene at a fire in a residential property. They are currently treating a 104 year old female and have requested our assistance”

I turned the corner in the street and were met by a car park full of fire engines. I got out of my car and met the paramedic team leader who was acting as the incident commander. He told me that fire had put the fire out and the patient was inside. I grabbed my response bag, defibrillator and oxygen. In my head I was going over my plan for airways compromise because of burns and also thinking about Mersey burns scores.

I walked into the hallway which was still full of acrid black smoke to be met by a firefighter turning on an industrial fan to try and clear the hallway. I walked into the room to be greeted by a carter and a firefighter. They were stood in front of the patient.

In the arm chair was a very frail old lady, with long hair which was a dirty grey, singed by the smoke that had been in the room not half an hour before. The right arm of her chair had various cigarette burns in it; as did her clothing and floor around her.

It was evident that this wasn’t the first time this had happened. It happened a lot. The firefighter explained that this wasn’t the first time they had been here. She also knew the crew by first name.

I quickly examined her and found her to be fine. I explained to the carers, patients and firefighters that she had been lucky. They explained that the patient has smoked since she was 12, had refused to stop but also had no mobility. She lights her cigarette, smokes it then tries to put it out. She normally misses. Usually, she sits with a fire blanket on her lap. It had fallen off.

The fire service were sorting the safeguarding out so I chose to talk to the patient.

“Has anyone talked to you about giving up?”

“Yes young man, many have tried. The thing is. This is all I have. I have not died yet and won’t die any time soon. I’m not sure what the fuss was about. I feel perfectly fine” – she croaked back.

“How about the fact you almost set yourself on fire?”

“Young man, don’t be so dramatic. The fire was out before these gentlemen arrived and they only come for the tea. ”

I looked around, the firefighters had explained this. The care staff were prepared for this. I was shocked.

The patient looked up again. “Young man, do you smoke?”

I shook my head, no.

“That’s good – it is a bad habit. My family only ever have one thing to say to me”

“What’s that then?”

“Smoking Kills”.