Lights flashing, sirens blaring, it's 8.54 am and I'm in the back seat of an ambulance hurtling its way through traffic on the Monash Freeway to the scene of an accident. Truck vs. motorcyclist. The early information doesn't sound good.
Situations like this see a '000' call dispatched to police and paramedics. In this instance, passing "fireys" were first on scene. One fire fighter had commenced chest compressions while awaiting our arrival, two others were holding up an emergency blanket to try and shield the scene from commuting Melburnians trying to take photos as they drove past.
We arrived moments later to the grim situation; the impact to the motorcyclist was extensive and unfortunately fatal. Time of death was declared shortly after 9 am and at that point the accident became a crime scene. With the matter handed over to the cops we jumped back in the ambulance to await our next dispatch. Then, siren blaring and lights blazing, off we went again.
I was spurred to reach out to the Ambulance Victoria CEO following a coffee-line conversation with a paramedic three months ago who was sporting a shiner of a black eye that he told me had occurred on the job. He said incidents like this weren't uncommon and that at least one instance of physical or verbal abuse would be registered every day by a paramedic across the fleet.
I was horrified. Front-line emergency personnel, responding to community calls for help being subject to abuse like this... it just didn't seem right. As I walked away from my coffee shop encounter, it struck me that aside from ambulance pay disputes and ambulance response times we hear very little about paramedics, the people who are at the bleeding edge of our community health. I reached out to ask if it would be possible for me to observe a shift in order to learn about (and share) a different side of our emergency services story.
The realities of the front line
A shift as a paramedic is akin to interval training on steroids, roving patrols are suddenly interrupted by dispatches from the '000' call centre that require rapid response, intense focus and energy. Timing matters on the front line. For example, for every minute a person who has stopped breathing goes without oxygen, their survival rate decreases by 10 percent.
The job demands extraordinary adaptiveness, no two situations are the same (particularly when it comes to trauma cases) and shifts are demand-driven. One day you might be run off your feet, the next you barely get a call out. However, on the whole, the utilisation of our ambulance fleet is high.
The job description has evolved substantially in the past 20 years -- it used to be a mature entry profession dominated by retired tradies that was more about "lifting and shifting" people to hospitals. Nowadays, it's a 3 or 4-year university qualification, coupled with a competitive post-study entry process. The growth in qualification parallels the rise in the clinical scope of the role. In the past ten years medical research in to long-term patient outcomes placed increasing importance on pre-hospital treatment and so the medical treatment paramedics could administer began to expand. The particularly significant game-changer occurred in 2007, when paramedics became able to clinically induce comas at the scene of an accident.
Clinical proficiency + incredible adaptiveness + heightened EQ = a brilliant paramedic. Put most people in this operating environment and they'd be utterly overwhelmed. And the latter part of the equation shouldn't be underestimated, as the paramedic I was patrolling with said, "TLC is the best weapon we've got".
The demands of emergency services
The high emotive (and sometimes volatile) operating environment isn't the only challenging part of the role. Unsurprisingly, the demanding nature of the job and the realities of confronting life and death situations add up. Paramedic mental health has become a topic of media conversation in recent years following a number of suicides and reports in to paramedic mental health.
Importantly, the paramedics I spoke to said that paramedic wellbeing had started to become a topic of internal conversation, a substantial cultural shift. They particularly called out the peer support mechanisms that were activated for any fatalities or emotionally demanding situations, and the broader cultural shift this represented for the profession -- a move to being able to talk about emotions after a tradition of just "getting on with the job". Confidential support lines exist; psychological support is available for paramedics (or their immediate family) without questions being asked. Having witnessed a fatality on my observer shift, I also received a peer support call to check on my wellbeing shortly after the conclusion of the shift.
What can we do?
1. Reserve '000' for when you need it.
There's an emergency and an "emergency", we need to do our best to know the difference. While I'd never want people to interpret that as suggesting not to call the ambulance in a time of need, it's about doing your best to make sure the surge of adrenaline that hits you in a moment of panic doesn't lead to an overreaction. There are a few too many ambulance call outs for blood noses. No, I'm not kidding. FYI -- trying to leapfrog the waiting room at the hospital isn't a reason to call an ambulance either. If paramedics are caught up on call outs for low-acuity matters it challenges the ability of the service to respond to critical matters.
2. Complete a first aid course
Make sure you've got a first aid certificate and know the basics of how to do CPR -- the importance of the role you can play in the minutes before an ambulance arrives shouldn't be underestimated, and while '000' will talk you through it on the phone, it helps if you've got a feel for what you need to do.
3. Give Thanks
You don't have to wait til the official 'Thank a Paramedic Day' in September. Use social media channels to give a shout out to the people who're on the front line of saving lives in our community every day.
*My sincere thanks to Ambulance Victoria for being so accommodating of my request to observe your work in action -- it's only deepened my respect and admiration for the work you do, and the people who do it.