I'm an NHS paramedic. Coronavirus could push our struggling service over the edge
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Version 0 of 1. While most people distance themselves, ambulance crews are helping vulnerable strangers. We can’t do it without support, says paramedic Jake Jones Coronavirus is currently having a serious impact on the ambulance service. Call numbers are soaring, interactions with patients are changing, and staff on the road and in the control centres are under acute pressure. At a time when most people are distancing themselves from others, ambulance crews are doing what they always do: going into the homes of sick and vulnerable strangers to offer help. As a frontline paramedic, I can only speak from my experiences, but I believe they’re fairly representative of the pressures on a service that, even at the best of times, operates near to the limits of capacity. The ambulance service where I work is busier than I’ve seen it in 10 years of service. Although patients are rightly concerned about attending hospital, that same reticence is not being extended to calling 999. Ambulance services have reiterated instructions to seek advice via the internet if you possibly can, and leave 111 and 999 open for the vulnerable and seriously ill. Yet crews are still going to patients with mild symptoms – the same people who are being told to self-isolate. Many of them are anxious. Some want reassurance, some want to know if they’ve “got corona”. But of course we can’t tell them, and in treatment terms, it doesn’t really matter. As long as their bodies are coping, the advice is the same: isolation, rest, fluids, paracetamol. Worryingly, the biggest challenges of the crisis, such as large numbers of calls to seriously ill Covid-19 patients and widespread staff absences, haven’t yet taken effect. As more possible coronavirus patients present, equipment supplies are being stretched, ambulances are going off the road for cleaning, and job cycle times are growing. There’s a sense of stoic acceptance among staff that things are likely to get much worse. Friends ask about morale. Ambulance crews tend to be fairly pragmatic, but I sense an underlying concern about what the future holds. We’re facing a decent chance of exposure ourselves. In terms of proximity and duration, the pre-hospital encounter with a patient is well suited to transmission, especially when we’re still having to tell some patients to cover their mouths (or keep their masks on) when they cough. Without more testing, nobody has a sense of the likelihood of transmission in either direction. An increase in testing would not prevent all exposures, but it would give health workers a more dynamic understanding of how the disease spreads, and instil trust that the measures we’re taking – such as which mask is suitable for which patient encounter – are effective in protecting us and our patients. You’d be forgiven for thinking that Covid-19 is the only illness around at the moment. But people are still collapsing, still having asthma attacks, still suffering strokes and heart attacks and cardiac arrests. On our recent night shifts, my crewmate and I also went to patients suffering with anxiety, patients who’d fallen and hit their heads, frequent callers, and patients who’d had too much to drink and then urinated in the back of the ambulance. Some things never change. Many of our patients waited longer than they should for us to arrive. Thankfully, family members, carers and bystanders stepped in to provide calm and sensible care in the meantime. Such helpful attitudes will be invaluable in the coming weeks – but there’s a limit to what people can do in a genuine emergency. As well as the obvious pressures of Covid-19, I believe there will be other, less foreseeable impacts from the virus. Ambulance crews often deal with vulnerable patients who lack proper support networks: the elderly, the lonely, those with addictions, those with mental health conditions. We can only anticipate that as people’s routines are disrupted and their worlds shrink, the effects of loneliness and isolation, on both physical and mental health, will manifest more widely in the kinds of crises that require the attention of the emergency services. Yet there’s one way in which the current situation is similar to “normal” times. Only a small proportion of ambulance calls are for genuine emergencies. Even in extraordinary times, those non-emergency calls are still coming in. Whether it’s from Covid-19 or some other medical condition, we’re primarily here for people who require urgent interventions and transport to definitive care. We shouldn’t discourage people with emergency symptoms from calling for help: these patients must be our focus. But like the rest of the health service, the vital resource of the emergency ambulance is under an unprecedented strain, and it’s likely to get worse. So if ever there was a time to resist the urge to call for a non-emergency, then surely that time is now. • Jake Jones is the pseudonym of an NHS paramedic. He is the author of Can You Hear Me? A Paramedic’s Encounters with Life and Death • Comments on this piece are premoderated to ensure discussion remains on topics raised by the writer. Please be aware there may be a short delay in comments appearing on the site. |