A paramedic’s firsthand account of his ‘soul-destroying’ day at work

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Last month, more than 16,000 ambulances in England were delayed by more than an hour waiting outside A&E with wait times of ten hours at hospitals now commonplace. Here, one paramedic has shared his experience, revealing “relentless” shifts, facing angry patients and family members, driving on blue lights exhausted, and being stuck with deteriorating patients in ambulances with limited equipment.

Ben (not his real name) has worked for one of the UK ambulance services for more than 20 years as a specialist paramedic. Over his long career, he has witnessed the tragedy of the NHS descending into “chaos”, a situation that he said has been “20 years in the making”. 

Speaking to between shifts, he reflected on his recent day-to-day working life. “A&E is chaos”, he said. “It’s busier than you can possibly imagine with huge numbers of patients in the waiting rooms, a lot of ambulances parked outside unable to offload their patients and the hospital staff working tirelessly to try and get patients seen and admitted.”

He said he remembers feeling shocked when he was first asked to wait with a patient in the corridor in the early 2000s, but now he is unable to get into the hospital let alone the corridor. 

The guidance is that an ambulance should be able to offload within 15 minutes, Ben explained, but now it is the “norm” for hours to be spent waiting outside in a cold ambulance. The longest he has spent outside the Emergency Department was eight hours — more than 60 percent of his shift. 

“Some crews spend their entire 12-hour shift looking after the same patient. You’re in limbo because you’re limited by equipment you have in the vehicle — it’s for the immediate saving of life,” he explained. 

What happens during these waits? 

“Ambulances are now treated as an extension of the emergency department but we don’t have the facilities, for example, to feed patients or a toilet for them to use,” Ben said. 

“If the patient can eat then they are often given a sandwich and if they can stand then they can be taken inside to use a toilet but often patients need the paramedics’ help doing this which can be undignifying. 

“Caring for people is part of the job but this is a stretch. If we have double male crews caring for an 80 or 90-year-old lady, it is a very inmate and personal process for the patient to go to the toilet,” he continued.

“You can imagine a patient in pain and they’re busting for the toilet and then they’ve got to deal with that. This is also frustrating for crews as they’ve been turned into healthcare assistants without the appropriate facilities.

“It’s soul-destroying, heartbreaking, and demoralising. It’s those little things that make the situation so much more difficult to deal with.” 

While the ambulances are waiting, other patients — often in uncomfortable situations such as stuck lying on the floor with a broken hip — are waiting for ambulances for four to eight hour-long waits, sometimes longer. 

“It’s demoralising” 

The work conditions have compounded what is an already difficult job. Ben is under no illusion that he signed up for a tough job, but during what can be a 15-hour shift, it is now commonplace to miss breaks altogether.

“The pace of work is relentless and the emotional and mental toll is massive,” he continued. “There is no time to decompress or reflect, you start second guessing yourself because you’re exhausted, you’re driving around on blue lights tired, crossing your legs with patients because you need the toilet — all of that inevitably takes a toll on you. You can be stuck in the back of an ambulance for eight hours leaving you feeling totally isolated with a patient who is gradually deteriorating.”

He explained that the delays mean job satisfaction has essentially “evaporated” as they are unable to provide high-quality, timely care. 

“We’re turning up to patients hours and hours late. The first thing we have to do is apologise for how long it’s taken to get there and pacify upset family members. Often whatever event has led them to call 999 is less treatable now because of the time gap such as a heart attack. You want to stop it as soon as you can after it starts. 

“Time is muscle and delays can lead to lifelong repercussions. That weighs on you, that guilt, which shouldn’t be yours to bear, but you don’t forget. I carry around in my head jobs from 20 years ago that were particularly traumatic or unusual. I’m left wondering ‘if only we’d been able to get to the hospital quicker?’ That’s a hard emotional burden to carry.”

Delays can also lead to frustration and anger from patients and family members. Ben recalled witnessing people headbutting the ambulance, throwing equipment, and attacking and spitting on paramedics. 

“We understand why, but it helps nobody attacking NHS staff. It puts more strain on staff if the vehicle is damaged or a staff member has to go home,” he added. “Despite all of that, I personally feel very privileged to be in a situation where I can help people and there’s still moments of great satisfaction when I’m able to save a life or deliver a baby.”

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Is there a solution? 

“Fundamentally, the problem is chronic underfunding and there’s no easy fix for that,” Ben said. “Like the environment, it’s now or never: we have to reverse the downward trends otherwise the consequences are dire. The system has not kept up with the demand of the ever-ageing population. We’re swimming up the waterfall of demand.”

Most of the patients Ben encounters are in their 70s and 80s with long-term health problems with become more complex with age, a symptom of an ageing population. 

“It’s a multifaceted problem, but it all comes down to money. We’ve got to do everything as individuals and as a government to save the NHS because the alternatives are not very palatable. I’m a strong advocate for NHS; it would be a devastating loss for this country.

“Recruitment into the ambulance service has not kept up with demand. With the system as it is, you could put on an extra ten ambulance crews you would just have more ambulances outside A&E. As someone with elderly relatives and children, I worry about the NHS collapsing. I want that excellent service that can be provided to be there for my children’s entire lives.”

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