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A Day in the Life of a Paramedic

The news is full of reports about ambulance delays outside hospitals, and the job I left in January was very different to the job I started 8 years before. I have spent literally hundreds of hours caring for patients, some of whom were critically ill, inside the ambulance parked outside A&E. Over the last 3 years since lockdown, finishing on time was a rarity, and you counted yourself lucky if you got a break.

But every so often, a shift would surprise you. You’d need all your skills, move from proper job to proper job, and feel like you had made a difference. Those shifts reminded you why you’d signed up to be a Paramedic in the first place. This was one of those shifts…

Patient 1 - Alcohol dependent. Mid 40s, European male. 


My superpower as a Paramedic was the ability to smell ketones!  


Ketones are a chemical released when the liver breaks down fats and they smell sickly sweet, a bit like pear drops. They’re common when someone has high blood sugar, but only 60% of people can smell them. The presence of ketones is a sign of a condition called Diabetic KetoAcidosis - you can look that one up! But my super sensitive nose didn’t let me down and as soon as we walked into the house I knew what we were dealing with.


The patient had had his pancreas removed due to alcohol abuse and knew that his blood sugars were getting high 4 days before. It wasn’t the first time it had happened. Symptoms classically match the body’s efforts to get rid of the sugar any way it can… vomiting, sweating, drinking fluid, peeing excessively, diarrhoea - you get the picture!  He lived no more than a 10 minute walk from the hospital but hadn’t thought to make his way there over the 4 days he’d been ill.


Our kit allowed us to measure ketones and it confirmed what my nose had told me - his were dangerously high. We cannulated, got on the vehicle and alerted the patient to Resus on blue lights. 


We don’t judge, but there’s always a little surprise that someone with a chronic condition, who recognised a flare up, didn’t seek help sooner and ended up more seriously ill than they needed to be.

Patient 2 - Alcohol dependent. Early 50s, British female.


I had been to this patient before and our first clues as to what was happening came from a disgruntled neighbour (who had made the 999 call) who expressed frustration about regular police visits to the property, plus a front door that had signs of recent forced entry by the police.


Inside our patient was lying on a sofa, intoxicated. The duvet and sofa were soiled and the patient was unkempt. Straight away, the patient was abusive towards us. She hadn’t called for help, didn’t want us there and made it extremely clear that she didn’t want to go to hospital. But we have a duty of care. 


She refused all observations, though just from talking to her we knew she had a patent airway, was breathing, had a pulse and so nothing needed to be done immediately.


That said, the state of the property and patient indicated a fairly advanced stage of self neglect. The patient stated that she couldn’t walk - this is a red flag for the ambulance service as someone must be able to look after themselves if they remain at home. They must be able to get food and drinks, go to the toilet and be able to get out of the house in case of a fire. There’s also the issue of capacity because patients must have mental capacity and be able to make an informed decision about their care. 


A discussion ensued! We stated our intention to take the patient to hospital. We stated that as she was intoxicated and could’t walk, she had to go to hospital. The patient refused, but also refused to prove that she could walk. Despite our best efforts she still refused and the situation persisted for a significant time.


Though intoxicated, a lack of capacity isn’t a given, but it can complicate the issue. So we carried out what’s called a ‘functional test’. Our diagnostic test confirmed that the patient did have an impairment of the function of her mind or brain (due to being intoxicated). But the functional test goes into more detail.


Firstly, we gave the patient details of the reasons that we believed she needed to go to hospital - including self neglect and being unable to walk. Sometimes it’s necessary to be quite brutal in advising the patient and telling them that if they stay at home it could be a fatal decision. She stated that she understood the information.


The next part of the test involves the patient retaining the information and fully understanding it, in order to make an informed decision. Finally, the patient must prove to us that they have weighed up the information, come to that informed decision and communicate that back to us in their own words.


In this case, the patient did pass the test. Once she realised that her being able to walk was the deciding factor, she jumped up and walked to the kitchen and back with no difficulty at all. So, we made the decision to leave her at home. 


But our responsibility didn’t end there and we advised the patient that we would be completing a safeguarding report due to her self neglect. This report flags up a patient to Social Services and other agencies with the aim of providing support short or long term,  when hospital isn’t the right answer and isn’t the only answer.

Patient 3 - Alcohol dependent. Mid 40s, European male. 


Again, I had been to this patient before. As we walked in, the patient shouted to us from upstairs and his wife led the way. The patient was intoxicated and rolling around in bed. He suffered from pancreatitis and had been on an alcohol binge for a few days. Not surprisingly, his pancreas didn’t like it too much and flared up!


From the get go, the patient was abusive. We were repeatedly sworn at and despite his pain, he hadn’t thought to take any pain relief. We gave him some paracetamol - we use a stepwise approach to pain management and that’s the first step in most cases. 


Again this patient lived no more than 10 minutes walk from the hospital and in reality, could have made his own way there. But we told him we would happily take him and went downstairs to get the vehicle ready. At this point the patient turned around and said ‘you’d better not be taking me to that A&E place’. Which is fine, except it’s not like there’s anywhere else that we could take him. We explained the situation but he didn’t like it. 


The level of abuse increased. Fists were shaken in our direction and the patient told us to ‘xxxx’ off several times. His wife (who I felt sorry for) apologised for his behaviour. The patient refused to calm down and shouted that he wasn’t coming with us if he had to wait in A&E. When his brother joined in the abuse, we decided enough was enough, gave the patient one last chance to come with us, received more abuse for our trouble and left the property.


Sadly this kind of abuse (and worse) of Ambulance crews is pretty common and we were annoyed but not that worried by his behaviour. We reported the incident back to control and went to the next job.

Patient 4 - Alcohol dependent. Early 20s, British male.


There were two main issues with this job. 


1) The police should have been there but weren't. 

2) The caller gave a cover address - the incident was actually down a narrow, unlit alley opposite to the address and at the back of a property known to be a drug den.


The job came through as a stabbing with a neck injury and knowing the area, we suspected the worst. But on our arrival, the house was in darkness, with no one around. My colleague got out of the vehicle and was approached from the alley by someone claiming to be a cousin of the patient. She advised us that he was down the alley and was seriously hurt. But he was armed and we shouldn’t go near him as “he's very dangerous”. She also advised us that the attacker was still on scene. 


Our spidey sense immediately went into overdrive. We instructed the cousin to bring the patient to us and told her we would park around the corner. Police were requested. We moved our vehicle, locked ourselves in the back and got out all of the trauma kit and drugs we thought we’d need.


A few minutes later, we heard voices outside and opened the side door. A bloodsoaked patient was shoved inside, and our manager who’d just arrived, followed on. We locked ourselves in again. There was a lot of blood and the patient was holding a soaked tea towel to his neck. We got the patient onto the stretcher and the 3 of us got to work. The patient had a number of superficial wounds around his neck and had lost the top of an ear. But he had a deep laceration to his jugular vein. We couldn’t really pack the wound and it had mostly stopped bleeding, so we scrunched up some haemostatic dressing and the patient held it pressed into his neck.


But there was blood coming from somewhere else. The tuff cuts came out and an arterial bleed on his leg was located and swiftly dealt with. Blood pressure was low. The patient was cannulated, TXA started and fluids set up.  The patient wouldn’t give us any information other than a first name and that he was alcohol dependent. We left the scene, leaving the manager's car there. The police still hadn’t arrived. 


From the time the manager and our patient arrived at the vehicle, to the time we left was just SIX minutes! It felt like 6 hours.


With the patient safely in hospital and the ambulance cleaned up, we took the manager back to the car. The police were now in attendance and had made an arrest for attempted murder. Over the next few days statements were required and we had time to reflect on the job. Thankfully we had all stayed safe, but arriving on scene with no police, a patient so dangerous his own family advised us not to go near him, weapons and an attacker still on scene… we knew we’d been lucky and that it could all have ended very differently for us and the patient. 

Patient 5 - 100 years old, British female.


After all that excitement, we had a long drive to the next job, a 100 year old lady in a care home. Staff had called us as she had complained of some neck pain. But we quickly established that she’d had a neck problem since childhood and sometimes it was painful if she slept on it the wrong way. She wasn’t in any pain by the time we got there and to be honest, she didn’t really need an ambulance.


But we did all our checks to rule out any injury or illness, while the staff made us cups of tea and we enjoyed watching the sunrise, chatting to the lady about her fascinating life. A total contrast to the chaos and stress of the previous jobs that night, and a job that really renewed our faith in human nature. It was an honour to meet this lady and learn about her 100 years on the planet.


And I guess that’s it in a nutshell! The variety in the work of a Paramedic was one of the things I valued and enjoyed the most. There are few jobs where your shift can literally take you from birth to death, one patient to the next. Did we save any lives that night? Probably… Did we make a difference to anyone’s life? Maybe…


All in all, that shift highlighted some of the issues of alcohol and drug abuse in the UK. Four out of five patients were alcohol dependent and the attempted murder was drug related. We were verbally abused and physically threatened. It sounds dramatic, but we risked our lives to save someone else's. Being part of a team to get through a shift like that is a bonding experience. But at the end of the day (or night in this case!), we had the privilege of spending precious time with an incredible, 100 year old lady who I’ll remember forever!

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Guest blog: Jordan Lin

by Rachel Smith • 08 May, 2024
At Red Square Medical, we’re keen to support those who have a passion for maritime medicine. While we can’t provide placements for everyone, occasionally a request pops up at just the right time and we can provide some experience and insight into our unique and specialised world. Last year we were contacted by Jordan Lin, a medical student with a love of the ocean. This is his story… When I was a boy, my dad and I used to go fishing with a local fisherman off the Norfolk coast. I absolutely loved being on the sea and so for quite a long time, I wanted to be a fisherman. When I got a bit older I kind of forgot about this and think I may have been slightly put off by watching the TV series ‘World’s Deadliest Catch’! But I have always loved being on the water and spent a lot of time sailing dinghies; I was also a swimming teacher for children back in high school and college. Later, I decided to study medicine and I’m now a final year medical student at the University of Bristol where I completed an intercalated degree; a Masters in Health Sciences Research. I’m now looking forward to starting work as a qualified Doctor in August. Though having spent 6 years training, my next 2 years will be spent working for the required two foundation training years that must be completed before being able to work independently as a Doctor in the UK. At university, I joined the VITA network which is a group dedicated to developing a health and public health approach at the heart of any response to human trafficking and exploitation. I became the blog coordinator for the organisation and you can read the blogs, including those that I have written, here: https://vita-network.com/blog/ In my spare time, I have been involved with the Bristol University Hot Air Ballooning Society and trained through the society to get my Balloon pilots licence. So, I often spend weekends during the summer flying in a leisurely fashion over Bristol and the surrounding area!

That Lightbulb Moment!

by Rachel Smith • 24 Apr, 2024
At Red Square Medical, we’re fascinated by the learning process - it’s key to our business after all. But we often wonder what happens when our students leave the classroom. Do they remember what they’ve learnt? What if they’re faced with a real emergency, will they know what to do? Is there a lightbulb moment when it all clicks into place? Skill fade is a very real issue, as we wrote about in this blog , and we know that setting up drills and practice scenarios when you’re back in your environment, with your kit and crew, can make a massive difference. It’s great to get some feedback from our students too. Last year, we received photos from the Southern Ocean from a solo round the world sailor who was able to successfully steri-strip a cut eyebrow closed. Or the Captain who recognised a heart attack in a crew member because they looked just like the guy he saw in the video on one of our courses.

Worse Things Happen at Sea… a salty tale of dysentery, haemorrhoids, accidents, depression and death!

by Rachel Smith • 03 Apr, 2024
You might wonder about the title of this month’s guest blog, as Worse Things Happen at Sea is also the name of our monthly newsletter. But this month, we’re delighted to introduce Andrew Edwards as our Guest Blogger, and we felt his amazing story about life at sea really deserved a dramatic headline… Dysentery... In the summer of 1966, I was a cadet on a cargo ship that loaded in the UK for 9 ports in West, South and East Africa. Our first port of call was Luanda, the capital of Angola – which was then a colony of Portugal. Next, 300 miles down the coast we called in to Lobito – also in Angola. In Lobito two of the ship's company contracted dysentery; myself and a big Irishman called Reg. The shoreside Doctor we saw simply diagnosed the condition (amoebic dysentery) and said, ‘sorry but I have no antibiotics for this!’. Thankfully the ship’s purser stood our corner and demanded that the Doctor find some. The following day the antibiotics were flown in from the Belgian Congo. The Doctor gave us no advice as to how to deal with the condition, not a word about how contagious it was, not a word as to the importance of thoroughly washing our hands and maintaining scrupulous personal hygiene. Thankfully both Reg and I were quartered just a short sprint from the heads, and we were left to get on with it by our shipmates. It took about a week to get over the dysentery, by which time I had lost several stone in weight and was as weak as a kitten. By the time we arrived in Walvis Bay, South West Africa (now known as Namibia), a further 1000 miles south, I was just about fit enough to play football for the ship against a local team. Their football ground had a main road going right through the middle of it which made for some challenging moments, but they still beat us comfortably and they were playing in bare feet!

How does the Easter Bunny avoid Diabetes?

by Rachel Smith • 20 Mar, 2024
As it’s Easter, we thought that it would be a very appropriate time, what with all that chocolate around, to take a closer look at the subject of Diabetes and why it’s such a huge problem in the UK and across the world. The Easter Bunny always looks so cute and cuddly, but is he a diabetes case waiting to happen? Or does his diet of grass and all that hopping around for the rest of the year make an important difference? According to the WHO, diabetes is a chronic, metabolic disease which is characterised by elevated levels of blood glucose (or blood sugar). Over time, this leads to serious damage to the heart, blood vessels, eyes, kidneys and nerves. The most common is type 2 diabetes, and it usually develops with a late onset in adults. It occurs when the body becomes resistant to insulin or doesn't make enough insulin. Worryingly, in the past 3 decades the prevalence of type 2 diabetes has risen dramatically in countries of all income levels and is closely linked to obesity, poor diet, and an unhealthy lifestyle. Symptoms for type 2 diabetes are generally similar to those of type 1 diabetes (need to urinate often, thirst, constant hunger, weight loss, vision changes and fatigue), but are often less marked. As a result, the disease may be diagnosed several years after onset, after complications have already arisen. For this reason, it is important to be aware of risk factors. Effective approaches are available to prevent type 2 diabetes and to prevent the complications and premature death that can result from all types of diabetes. These include policies and practices across whole populations and within specific settings (school, home, workplace) that contribute to good health for everyone, regardless of whether they have diabetes, such as exercising regularly, eating healthily, avoiding smoking, and controlling blood pressure and lipids. Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself. Normal onset is in younger people, but can also be in adults. Symptoms of type 1 diabetes include the need to urinate often, thirst, constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly. Type 1 diabetes cannot currently be prevented. It’s thought to be caused by an autoimmune reaction which destroys the cells in the pancreas that make insulin. It can also be caused by genetics, viruses, trauma, tumours, removal of the pancreas or other damage to the pancreas. About 422 million people worldwide have diabetes, the majority living in low-and middle-income countries, and 1.5 million deaths are directly attributed to diabetes each year. But the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades. The starting point for living well with type one or type 2 diabetes is an early diagnosis – the longer a person lives with undiagnosed and untreated diabetes, the worse their health outcomes are likely to be. Easy access to basic diagnostics, such as blood glucose testing, should therefore be available in primary health care settings. Patients will need periodic specialist assessment or treatment for complications. A series of cost-effective interventions can improve patient outcomes, regardless of what type of diabetes they may have. These interventions include blood glucose control through a combination of diet, physical activity and, if necessary, medication; control of blood pressure and lipids to reduce cardiovascular risk and other complications; and regular screening for damage to the eyes, kidneys and feet to facilitate early treatment.

Reflective Practice and why it’s so important

by Rachel Smith • 21 Feb, 2024
Well, we’ve made it to February! How are your goals for the year going so far? As you’ll know, we do love a bit of goal setting at Red Square Medical HQ. But, we also understand the importance of Reflective Practice too. Especially in relation to setting goals. Want to know more? Please read on…

Guest Blog - Sam Kelly MSA

by Rachel Smith • 07 Feb, 2024
Today we start the first in a series of blogs in conjunction with our friends at the Maritime Skills Academy, and kicking it all off is a Guest Blog from MSAs Head of Training, Sam Kelly. Sam is 37 and lives in southeast Kent, in the quaint seaside town of Deal with with his wife, two children and a ‘Golden Doodle’ called Pringle. He has lived in the area ever since his father, a serving Royal Marine at the Deal Depot, and mother decided this was the place to raise their family. And it is, quite frankly, an excellent place to live. Here is his story… I’m the Head of Training for the Maritime Skills Academy, based in our head office in Dover. I oversee a team of Maritime Safety Instructors who deliver all STCW training for seafarers. Outside the Dover base, we have MSA Gibraltar. This location is operated in partnership with the University of Gibraltar and delivers Basic Safety Training and most recently Operational Firefighting, We are actually in the process of building a state-of-the-art Fire Training Module on ‘the Rock’.

Dry January!

by Rachel Smith • 17 Jan, 2024
So Christmas seems like years ago, and we’re all well into the New Year now. Did you make any resolutions? Some love to, some don’t. At Red Square Medical HQ, we love a goal or two and think the turn of the years can be a good prompt to make some positive changes. But, it’s well known that New Year resolutions don’t last. Forbes magazine tells us that 21% don’t make their resolution stick for even a month. While 34% state that it lasted for between one and three months. Is that a failure though? Or could it be all it takes to make some small changes that have a lasting impact? We thought it would be good to take a closer look at one of the most popular resolutions… Dry January! Now, let’s get one thing straight, the Red Square Medical team are not averse to a tipple or two! But as medics, we’re very aware of the short and long term benefits of giving our livers a little breather every so often. Of course, everyone responds differently to stopping drinking for a month, so the timeline below is just a guide. But it might help you to decide whether it’s a good idea to give the booze a break for a while, or work towards reducing your intake - we know it’s easy for it to creep up over time!

12 months since I left the NHS

by Rachel Smith • 03 Jan, 2024
What I miss most about the Ambulance Service… It’s been 12 months since I left the Ambulance service after 8 years of working frontline, and to be honest it’s flown by. A few weeks ago the team at Red Square Medical HQ were chatting about how life has changed in that time and what, if anything, I was missing from my former life! The list might just surprise you… Most of all, I miss my old colleagues and I definitely miss the patient contact. And driving on blue lights… that was one of the best parts of the job! Working in the ambulance service with regular partners who you get on well with really does create friendships for life. Or even doing a tricky job with someone you don’t know well provides a common bond forever. Every day you’re facing stressful situations and sometimes split second, life changing decisions. You rely on each other totally and make sure you keep each other safe in some difficult and challenging situations. I worked with 3 very different partners most of the time for my last few years and I miss them all. Happily though, I have some great new colleagues at Red Square Medical and Outreach Rescue, the other company that I work for.

Guest Blog - Rachel Smith

by Rachel Smith • 03 Jan, 2024
I was born in a tiny village in Northamptonshire but had a fairly nomadic childhood, eventually settling in the industrial town of St Helens in the north west. As a child I was horse mad, so boats never got a look in. Apparently ‘horse’ was the first word I said and despite the fact that we could never afford a horse, my dream was always to ride and work with horses. It’s perhaps an early indication of my goal-oriented side that I got a Saturday job as soon as I could. At the age of 13, I’d cycle a 12 mile round trip, twice a day, just to go and ‘muck out’ at a local farm where they bred Welsh ponies and Arab horses! There wasn’t even any riding. Later, I found myself working for the family of a young girl who would go on to represent Great Britain in dressage at the Olympics. The work was physically hard and the standards high. No corners were cut and I learnt the skills I needed the old fashioned way. I got to travel all over the UK in the branded horsebox which was pretty exciting for a teenager. But I think I will always be grateful for the solid work ethic and sense of responsibility that this job instilled in me. I always planned to leave school at 16 and go to ride racehorses. But I got quite reasonable exam results and a new degree course was announced in Equine Science and Business which changed the plan. So, after taking the required year out, when I worked in an eventing yard in Yorkshire, I started the 3 year course. For the two work placements, I opted to go abroad, to Italy and the USA, which supercharged my desire to travel. I continued working in the equestrian world for a couple more years, but the poor pay and prospects, plus a dose of pneumonia pushed me onto a different path. I got a job in telemarketing for a bank, and after putting forward the idea of finance for horses, I found myself transferred to Marketing for 6 months. 16 years later, I was still there!

Are they wearing a beer jacket??

by Rachel Smith • 20 Dec, 2023
Christmas is coming and the season of parties is upon us. Of course this means that most of us will overindulge in large amounts of luscious food and, of course, a tipple or two. At Red Square Medical HQ, we have a method of categorising drunk people. During our combined careers, we’ve dealt with more drunks than we can remember; it’s easily running into several hundred. What we’ve learnt, amongst other things, is that most people who are drunk fall into one of these categories. Now please don’t judge as it is purely observation and also makes for an interesting chat when delivering the STCW Medical training, because we all know at least one person from each category and sometimes… a person can be in multiple categories depending on many other factors, or, we might even have been there ourselves! Once we have established these categories there is a serious note to this blog so please do keep reading.
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