‘I am a paramedic working in the coronavirus crisis – some patients have left it too late to call’

The Independent’s ‘Dispatches from the Covid-19 frontline’ is an interview series detailing the reality behind the headlines as told by the nation’s vital key workers. Paramedic John Children tells Lawrence Ostlere what it’s like to work in an ambulance during the greatest medical challenge of the NHS's 72-year history.

The biggest adjustment since the start of the coronavirus outbreak has been working in personal protective equipment (PPE), as well as trying to limit the risk of contracting the virus to ambulance staff and of course to our patients.

We use level two PPE as a minimum for every patient we encounter: this consists of a face mask, gloves, apron and goggles. Along with regular hand washing this offers some protection and is appropriate for most situations. But if the patient requires support of their airways or breathing (what is known as an AGP or ‘aerosol generating procedure’), we have to put on level three PPE which is the full body gown, FFP3 mask, visor and gloves you’ve probably seen on the news.

To make matters more complicated the medical community still cannot decide what constitutes an AGP: some consider chest compressions (CPR) for example, while others, like my local guidelines, say it is not. Although this might seem like a small point the different approaches have led to much concern and questioning about whether we’re taking the necessary precautions in our work. Naturally it takes time to form a consensus but this feels too slow when it makes a difference to our everyday safety.

When caring for patients in level three PPE you get hot quickly, there is a significant physical dimension to the work and staying hydrated is key. Communication and logistics is also hard. The hood of the suits cover your head, which reduces hearing slightly, and the masks muffle voices so talking to each other is challenging. Most of us are writing our names on suits or using stickers to help identify individuals and roles.

The PPE calls for us to be as disciplined as possible. We have to think carefully about exactly what equipment we do and do not need and try to limit what we bring in close proximity to the sickest patients. Usually I would use my phone to check drug doses and get advice from on-call consultants, however now I can’t just reach into my pocket. I use a waterproof phone case so I can keep it close by and clean it after each job with chlorine disinfectant.

There has also been little to no training in my service on how to correctly take off PPE. This is an incredibly important step because it is a moment of high risk for cross contamination. On multiple occasions I have come across staff who were putting themselves (and their families, colleagues and patients) at risk because they did not know or understand how to work in the correct and safe way.

We know there is a risk, however well we clean, of contaminating ourselves or our next patient.

So far I haven’t worked a shift where I have had no access to PPE, and that is thanks to the combined efforts of many, but it hasn’t all been positive. As documented there were significant delays in fit-testing staff for FFP3 face masks. On the 20 April I found out the majority of FFP3 facemasks we have been using are ‘unshrouded’, which means the filter will not protect from splashes, and face shields are required for more definitive protection. Face shields were not on ambulance vehicles at the time (although they are now).

In addition the masks get crushed in the bags they are stored in. It causes them to lose the integrity of their seal, which is essential if they are going to protect us. Now we carry them loose but clearly this was never seriously considered before.

Sometimes staff report feelings of guilt that we are using a new set of PPE for every patient when considering the other countries and even other settings in the UK that do not have enough, such as the now reported situation in care homes. Just as PPE is a precious resource, like our drugs and equipment, so are the people who use it and they must be protected so they can continue to do their job. I think of countries worse off and I’m truly grateful for what we have. However, the UK is the sixth largest economy, there should be no room for excuses or complacency.

There are also psychological and emotional hurdles to face. Many colleagues have mentioned the almost claustrophobic experience of attending patients in their homes who have deteriorated very suddenly and are incredibly sick with dangerously low oxygen levels. We work in confined spaces, very close to the patient and not infrequently next to other household members who can also all be coughing. We rarely find out whether or not they had Covid-19.

There is obviously a very real risk of transmitting the disease from them to us but also vice versa. Bringing the virus home is a real risk and it is now routine to shower at work immediately after a shift and bag up work clothes to wash at home.

Ambulance staff are used to operating in emotive and stressful situations but there is a heightened sense of tension in these conditions. During emergencies there is less time than you would like to fully explain the situation or connect with family and offer them support. There can be a sense of guilt at not effectively expressing empathy.

Seeing us with our full PPE, all white and almost faceless, and with muffled voices working around a seriously ill person while their loved one watches from the side is a sharp visual reminder to me of just how alone a family member, friend or carer must feel during these events. At the worst moment of their life and we cannot even give them the human touch that is so important and valuable.

Seeing that is tragic. Of course, we can and do feel deeply for these people and hopefully it comes across.

Usually we’re always busy, and often with patients who need simple self care advice or who have complex social issues which we cannot resolve. Day or night, weekday or weekend, most of the crews I talk to would usually book on for their shift and are straight out the door, seeing patients for 12 hours straight bar their 30-minute meal break.

One of the strangest aspects during coronavirus has been the volume of work. I had mentally prepared myself for a period of ‘war time’ conditions that would be incredibly tough, and although there are challenges to the work, the last weeks have been some of the quietest for me in years.

There is a concern that some people who need an ambulance, for example those with chest pain or stroke symptoms, are scared of calling or do not want to burden the NHS, and this has led to some urgent and emergency incidents being tragically ignored. I have been to patients who have waited for 12 hours on the floor with a broken hip.

I have seen patients who have left it too late to call and tragically they will not be counted among the statistics of Covid-19. They and many other patients should be calling for an ambulance when they need it. But some of the new quiet is also the worried well not calling 999 with every cough, cold, ache and sprain.

Overall I have been struck and humbled by the great sense of togetherness and determination, as well as the examples of humour and kindness.I love going for a run and seeing the rainbows in windows and chalk on pavements. We’ve enjoyed free groceries, Easter eggs, bacon sarnies and more. It is not hard to be inspired by patients, their friends, families, carers and even by total strangers. Hope is everywhere.

Are you a keyworker happy to tell your story? Get in touch by emailing IndyLifestyle@assocnews.co.uk