IamA Paramedic working in the South of the UK AMA!

Just how much of a fairy is everyone down there?

Ha, as a northerner myself I find this question difficult to answer without offending my southern colleagues.

Read as: 'Fairy levels are reading off the chart'

I was shocked to find that some even mix beer with their lemonade.

I've heard rumours of this shady practice. Alas I have never seen it done, perhaps they have 'Shandy Brothels' somewhere?

What do you think about the government talks about privatising the NHS?

I'd just like to add to this that if it ever comes to a time that a patients financial status comes between me and treating them then that will be the day I hand in my notice.

Nice! But do you think this will happen any time soon, or maybe in a few years?

Tbh, probably not, I really do hope we would have the strength as a group to stand up to any changes of that kind that come in. The problem is its a bit of an insidious process, one small thing is changed at a time, so we accept each small change, then suddenly we don't recognise our system.

The current tactic seems to be to devalue the service that is provided, which is what this 'ImInWorkJeremy' thing is all about.

I honestly think that privatisation is a bad idea. The service that the ambulance service in the UK provides is currently one of the best in the world. The Commonwealth Fund voted the NHS the top health care organisation out of 11 western countries, and we spend less money per capita on health care than many of the other european countries.

Unfortunately my personal experience of privatisation has not been particularly positive. We have some Private Ambulance Providers in our area (same as most services in the UK), but they often don't carry as much equipment as the NHS vehicles, the staff often have less training and they are more difficult to monitor, in addition to this they are paid more than the NHS paramedics, out of our budget!

I think it'd be a great shame to lose our NHS!

What would you say was your craziest call?

There are so many I could tell you about, All crazy for different reasons. I remember one when I was a student when we picked this guy up who was just acting very strangely (later turned out to be drugs). He absconded from the ambulance and sprinted across a live dual carriageway, somehow not being taken out by any of the four lanes of traffic. He then walked into a parked car outside our station (The call was like 2 minutes away, first one of the shift). We ended up struggling to get him into the back of the vehicle so he didn't end up getting killed. He kept going from so viscously angry (so much so we were pinning having to pin him down on the stretcher) to chilled out every couple of minutes. We pressed our emergency buttons and another crew came to help us. We eventually got him into A&E between the five of us.

Sounds legit, I bet it hard to keep your cool in those situations.

Its very strange but when you put the uniform on, its almost like a mental suit of armour. You feel that if someone is angry at you, they're not really angry at you per se, so much as the uniform, this makes it a whole lot easier to deal with if that makes sense?

Yeah I can relate, I'm in the U.S. Armed Forces and the second I put my uniform on its like a whole different mind set.

Absolutely, we have a lot of ex-forces guy come and work for the ambulance service over here when they get back onto 'civvy street'. I think while the roles are totally different, forces guys just seem to make good paramedics!

How many call-outs for collapse or non-responsive end up just being "give them a sugary biscuit and wait ten minutes"?

Unfortunately my vehicle doesn't stock sugary biscuits, and if it did there would never be any left for the patients! ;)

The area I work is semi-rural, and has quite a large elderly population, so many of the collapses we go to often end up being genuine problems. Quite commonly we'll go to collapses where (often elderly) people faint after they've just eaten a big meal and been sat down for a long time, a good deal of their circulating volume is redirected to aid digestion, they stand up, their blood pressure drops and down they go (often vomiting profusely).

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I used to work in a big city, and there was much more in the way of alcohol related call outs. On a Friday/Saturday night shift sometimes 90% of your calls were directly alcohol related.

Friend of mine is also a paramedic (their first "placement" was during the London Marathon) and they get extremely offended by the notion of being called an ambulance driver. Does this bother you as much?

Many of my colleagues say 'Do you call the police 'police car drivers', or the firemen, 'fire truck drivers''. I think the reason that we get offended by that statement is the massive range of skills we actually possess, driving just being one of them. The care you give defines you more as a paramedic than the van, if you catch my drift?

Even so, I think most people say it just out of not knowing; before I started my training I had little idea of what a Paramedic role involved, and in the same way I wouldn't expect a lay person to fully understand my job role. I don't fully understand of the role of a Pilot, or an electrician or even our executive team.

So I wouldn't say I get offended at all really.

How's the tea?

I'm seen as a bit of an 'odd one' in the service due to my lack of addiction to caffeinated beverages! Strangely I occasionally do get sense memories when I drink tea, as people normally make you a drink after stressful jobs, and you just drink it regardless!

Hello! As someone with significant mental health issues, I previously was terrified of paramedics 'judging me' when I overdosed several months ago. I felt like a waste of time and space, when really I am battling an illness that is incredibly insidious. I encountered one beautiful soul paramedic who put me at ease, and two insensitive paramedics who very much did not.

I would love to hear your view of mental illness related call outs and how you and your colleagues view them - put some of our paranoid minds at ease. Have you experienced mental health related call outs where you have been able to impact someone's life in a huge way by being compassionate? Are we viewed as wasters of time? On non-mental health related call outs, are self harm injuries judged or do they result in inferior treatment?

Thanks!

First of all, sorry to hear about your negative experience. Unfortunately like in any job there are good paramedics and bad paramedics, though I would say in the most part i'm lucky to work with some excellent, compassionate colleagues.

I think the way that MH issues are being seen in the UK is changing, not only by members of the public but by a lot of ambulance staff too. Without going into it too much the ambulance service is still quite a young profession, and it isn't so long since we were just drivers. This means that there is still little bit of the old attitude around of 'Why would you do that to yourself, and if so why phone us', This thankfully is dying off and now the vast majority of us have a better (but still not as good as we'd like it to be) knowledge of Mental Health.

I always tell anyone with mental health problems they are not wasting our time, because due to the nature of some MH problems, suicide attempts are quite common in this patient group. I think in times of crisis, these patients need to have a low threshold for asking for help, so that they ask BEFORE they do something not after. I also always say that just because you cannot see something, does not mean it is not a problem, and that 'your problem is no different (in terms of requiring treatment and assessment) than someone with chest pain'. Ultimately, it is not a waste of time. As I said somewhere above, we do get frustrated as we often feel we cannot really help as much as we'd like to.

I would say I genuinely have never seen inferior treatment of someone with self harm, and the only judging I personally do of self harm, is how deep the would is and what treatment it will need. We are not paid to judge and I would say the vast majority don't.

I once discussed how a friend of mine had beaten depression with a patient I was attending to. What I didn't realise was that he had never been exposed to any stories of success. He felt this was something he would have to deal with forever, and while I couldn't categorically say that wouldn't happen for him. His whole demeanour changed, as if someone had turned the light on at the end of the tunnel. That was one of my favourite calls.

How do you handle being called out to suicides, attempted suicides, or self harm situations?

Went to a couple of these types of call yesterday. Everyone handles it differently. I often think 'There but for the grace of god, goes I' (I'm not a religious man, but the saying perfectly justifies how I feel). It could just as easily be any one of us, and often many of the stories I hear I think 'Yeah, if I was you, I'd probably feel exactly the same way'.

The main issue I have with these type of calls is the lack of input we can really have as Paramedics and Ambulance staff. We can be nice, and understanding and try and talk through their problems with them, but ultimately we receive very little training in this area and often are just transport to the place where people can get the help they need. Paramedics by their very nature are interventionists, we like to see the results of our work, so it can be very difficult to know you can't really do anything to help someone.

What call out was the one that stuck with you the longest? Happy, sad, crazy, whatever.

Many of my colleagues say that when you first start your career you think the calls that will stay with you are the death, but often its the innocuous ones that get you. The ones that stay with me are the calls where people are socially isolated, I can't imagine anything worse than being old and alone and having a family that don't care and no-one to talk to. The current call thats rattling around in my head from the last few weeks is an elderly lady who was assaulted in her own home by burglars. I just wonder how you could do that to someone?

On a lighter note, some calls that are hilarious will stay with you forever, you meet some real characters doing this job!

Can we have some examples of hilarious calls?

I heard of a call recently where a patient was insisting that his mother worked at a hospital where there had been an Ebola outbreak, and he had since fallen ill (he was exhibiting fever, vomiting etc) So his entire workplace was practically shut down, the crew tried to dig a bit deeper, but the patient wasn't exactly what you would call a good historian.

Only after they had cleared his entire workplace and the crew had put on all their PPE (Personal Protective Equipment) so they looked like something out of 28 days later, did the guy mention he hadn't seen his mother in a few months. To which the crew were just a bit like, 'Well you can't catch it if you haven't seen her, can we call her?'

Anyway, long story short turns out it was a Norovirus outbreak, cue the crews tearing off all their PPE and much eye rolling all around.

EDIT

I also heard of a 80ish year old patient who came through as having a stroke, a friend of mine attended and when they arrived the patient was indeed having a stroke, he was listing to one side with facial droop and left arm weakness. Unfortunately, it was the right arm that was more concerning, as he was, and I quote 'furiously masturbating'. Apparently he was quite into it and it took quite a lot of convincing to get him to stop so they could transport him!

Do you get a lot of people who think they are having a heart attack when they are fine a lot?

Yes and no.

We had the big campaign a few years ago about dialling 999 when you have chest pain, from my point of view, people seem to be very good at spotting when they need help and calling, occasionally you get the chap who has overworked it a bit at the gym and has muscular chest pain and due to the triage system has had an ambulance dispatched, on the other end of the spectrum you get the guy who has had severe chest pain for 3 days but not told anyone because he 'doesn't want to be a burden'.

One problem we do face is that a normal ECG doesn't necessarily mean that someone isn't having a heart attack, so we often transport people to A&E for blood tests which will rule in or out whether they are having one. So from that side of things, we too have a lot of people who we consider to be 'possibly' having a heart attack when they actually are not.

I am that guy. I have chest pain a lot and i just never tell anyone.

If you're getting it regularly, go see your GP. Things to look out for are:

• Pain that comes on with exercise/exertion
• Pain that comes on gradually (over 10-20 mins)
• Pain that is dull or heavy in nature
• Pain that radiates into arms/jaw/back
• Pain that doesn't change when you push on your chest.
• Pain that doesn't change when you take a deep breath in.

This list is not complete, and everyone describes their own symptoms differently, so just because it isn't on here doesn't mean it isn't significant.

What sort of advice would you give to bystanders to make them more useful/ less of a problem?

(eg, it would be appreciated if you could put the kettle on for a cup of tea, or try to learn the recovery position, or for the love of god don't touch anything until the response team gets there, etc)

Firstly I'd jut like to preface this by saying most of the people we deal with are really nice and helpful.

• 1) Don't be rude to the call taker, they do an incredibly difficult job and they often get a great deal of abuse for 'delaying the ambulance', even though they can help you a lot in the mean time! If unsure and you think it warrants 999, they will talk you through what to do!
• 2)Stay with the patient if safe to do so We often get calls that say 'remote observer' I.E someone has seen something and called it in but has decided not to hang around. The first thing I'd say is never put yourself in danger, equally, when we get called to the 'unconscious' homeless man, who is actually just sleeping, it can become frustrating. Its not that hard to just shout 'Hey mate, are you asleep?!'
• 3) Don't try and tell the crews how to do their jobs We sometimes get told 'you're gonna have to do x' or 'you'll have to do y', this annoys some people more than others, but what i'd say is just report on the facts of what you know to the crew, they will do the rest, that is what they are paid for.
• 4) Don't be scared of helping There are laws in the UK to protect 'Good Samaritans', so long as you think you're doing the right thing at the time, you cannot be prosecuted. And sometimes, inaction is worse than action. If someone is unconscious on their back with vomit in their mouth, you do more damage by not turning them on their side than you would do even if they had a spinal injury and you moved them.

• 5)The Recovery Position As you mention this, yes, it is a good idea, as is knowing CPR, These should be compulsory in the school curriculum IMHO. In terms of the recovery position, if you do it once in a classroom, you may not remember what to do in a situation where you're full of adrenaline, so i'd say, if in doubt just get them on their side, you don't have to do any complicated arm or leg stuff.

• Unconscious and breathing -> Turn on their Side/Recovery Position

• Unconscious and NOT breathing -> CPR

• 6) Finally, do your best and use common sense, we do this every day, you don't, we understand that.

Are you Tom Cruise?

No, Are you Tom Cruise?

How many rigs do you guys run a shift and what is the occupancy of the city?

It varies massively from day to night, and we vary on mix of vehicles. We don't actually work in a city we cover several towns so its kind of more of a mix of semi-urban/rural stuff, still busy though.

Some days we will have as many as 28 resources (mix of cars and trucks) and some nights we'll have as few as 4 or 5 ambulances and a few cars. Generally we are on the go all the time at the moment, nights tend to be busier than days due to the lack of resources.

Serious question, you type like my friend Jamie. Are you Jamie?

No, its Becky ;)

But seriously, I am not Jamie. You're welcome to keep guessing though :)

How bad is the drunken idiots at the weekend for you guys ?

We are quite lucky as we have a few centres that deal with the drunks. They are run by volunteers and tend to filter out a lot of the ones who are just drunk, as opposed to those who are comatose following drug overdoses/'legal highs'.

How far is your range from an A&E department? What sort of distance would you consider as a maximum?

(keep up the good work!)

We cover a massive area, we go to probably 5 or 6 departments, to put it another way my service covers 3 counties, and I have been to all three on calls. We also have a major trauma centre in a different county too.

Sometimes we'll do 200+ miles in a shift, and I have in the past when it is very busy, done blue light runs that indicate up to 1 hour away on sat nav to calls, simply because demand outstrips resources.

That sounds desperate. 3 counties is huge! The reason I asked was that I live in Cornwall and have a 30 min response time if its quiet for an Ambulance and 45 min + to the closest A&E, and was wondering how this compared to other parts of the UK.

Yeah, don't get me wrong, 1hr isn't a common occurrence, crews will remark if it is that long, and we tend to stay in our own county but not always.

Its funny because people who live in really rural areas often still expect a fast response, but realistically it is not financially practical or achievable to have an ambulance stationed in every village.

I wouldn't say we're worse off than any other trust. I'm sure your area has some horrendous blue light runs.

first of all thank you for your service , always have a massive respect for paramedics , do you drive the small car of the full blown ambulance ? and got ant good stories about using your sirens ? ;)

No problem. I do both, my rota involves around 10 weeks of working on the Ambulance and 4 weeks of working on the response car, so its a nice mix.

I probably shouldn't admit to this but sometimes me and my crewmate laugh when people jump out of their skin as you turn the siren on, obviously we don't do it on purpose though ;)

I know of a colleague who was working on a car. It was 3am when he started it on a quiet residential street and the sirens just jammed on. There was no way to disable them... Awkward....

Paramedic in US. Almost all of my patients repeatedly ask for water and/or food while in the back of my unit. I cannot stand this. They bug you about that shit, too?

We do get that too, more for water than food though. Our vehicles are too tall to fit through drive-thru's anyway!

Our service carries small pots of water, which are great as probably 60% of our patients complain of feeling thirsty!

I am going to move to the uk soon, so i've gotta ask How much do you get paid? do you live in detached, semi detached, terraced house, or flat?

Paramedics in the UK are under Band 5 of Agenda for Change (this is a contentious issue but i'll stay away from the politics)

This means our salary is £21,692 - £28,180/Year. All services provide a 25% unsocial hours payment, so 25% of your salary on top, and there is always overtime going, some services are even providing additional incentive payments for overtime due to demand (though not all, my service isn't).

I currently rent a semi-detached with some friends. It depends where you're going, its much cheaper to buy up north than it is down south.

Thanks! Another quick question. Is that a good salary in the uk? above average? I currently live in a third world country, and £20k a year seems like a huge sum for our prices. how does it work with yours?

That is a really difficult question to answer, obviously living costs are much higher here in the uk, in the south you can pay around £250,000 for a relatively small house. A quick google search shows the average (median) uk salary to be £26,000.

The best person to ask would probably be someone who knows a bit more about economics than I do, I don't even have to handle any money at my job!

Which trust are you with?

Do you have experience with community responders? How do you find them?

I'm trying to avoid mentioning the trust on the off chance I say anything that could be misconstrued as criticism. Sorry!

The CFR's on the whole are great people and just want to help and learn, they're very generous with their own time, especially as many have their own jobs. They're an excellent resource especially at resuscitations/ 'busy jobs'. If you want to join the service, CFR is an excellent way to get exposure.

In terms of the system I'm not sure that in the grand scheme of things there is always a vehicle sent as quickly as if no-one was on scene. I don't have any proof of this, but logically if you have 2 calls with someone on scene then you're gonna divert to the other job aren't you? This said, if there are 2 calls and a CFR is on one then at least thats one covered.

Hi Mr. Paramedic man.

What type emergency that you have to respond to frustrates you the most?

What's an emergency you wish you could respond to more frequently (apart from obviously saving a life).

Hello!

I think the frustrating ones are the ones where you think 'Couldn't you have just got in the car and driven 5 mins to A&E', broken wrists, things like that. I appreciate they're unpleasant, but they're certainly not life threatening.

There is no greater feeling than saving a life, me and my student got a guy back from cardiac arrest a little while ago and to the hospital where his heart attack was treated. The adrenaline high afterwards was amazing. The next few days, everything was awesome. So that, always that.

But any call where you make a difference. The elderly patient with recurrent falls that is referred to the falls service and managed properly will see a bigger improvement to their quality of life than you could ever hope to achieve in someone with a massive head injury etc.

What is the most challenging experience you had while doing your daily routine job?

Again I could list hundreds of different calls.

One that sticks out in my mind was about 8 months after I qualified being called to a chap who was 25+ stone and in cardiac arrest in the passenger seat of a car, in the car park of a doctors surgery. It was an absolute nightmare to get him out of the car (The control room asked for the family to lay the chair back so CPR could be performed, which made it so difficult to get him out). When patients are that size, everything is more difficult, it is harder work to do chest compressions, (you need to push harder to achieve the same depth of compression so you get tired more quickly) they are more difficult to intubate (Place a tube into their lungs to breath for them), harder to cannulate (place a port for giving drugs into their vein) and generally just treat in general.

I was unable to intubate him, so I had to use one of the other types of airway support devices we carry. His veins appeared none existent. This normally wouldn't be an issue as the device we have for when we can't cannulate is a device that you drill into someones tibia (leg bone) with, you remove the drill bit and a hollow tube is left for drugs to be injected - this is only used in extremis for obvious reasons. Unfortunately, the needle wasn't long enough on the drill to reach through the fatty tissue surrounding his leg to get to his leg bone. Add to that that all this needs to be done in a timely fashion, there was a crowd standing around us including his family, I was the only paramedic on scene who could perform those skills (although I did have a great team) and there were no other paramedics available at that time to back me. All these factors made it one of the defining calls of my early career. A call that my colleagues would refer to as 'a nightmare job'.

Dont leave us hanging! how did it play out ?

Yeah pls tell us what happened OP

It was a very sad outcome in the end. Unfortunately there was nothing more we could do, and after a long and hard resuscitation attempt, we called it.

Sorry to hear that.

Never good to have to break that news to a family. It always amazes me how selfless people are though, they still thanked us 3 or 4 times despite their loss. Nice people, sad day.

I am about to start paramedic school in the US, is there any advice you could give for an aspiring emergency service provider? Secondly I would be very curious to know about similarities and differences between EMS systems and/or procedures between US and UK if anything comes to mind.

Firstly I can only really draw on my own experiences for this one. We do a lot of primary care work (Not sure if its the same in the US, but we often end up referring patients back to General Practitioners etc) I think I would have benefitted from a great deal more training in clinical decision making in the 'slightly sick, but not sick enough to go to A&E' patient.

All of what I know about US EMS comes from what I've heard and the TV show 'Nightwatch', so to say that my knowledge is limited would be an understatement. I'll try and answer a few bit though. We are not integrated in any way with the fire service like EMS is in the States, The Fire & Rescue service is used for literally just that.

Over here we work to JRCALC (Joint Royal Colleges Ambulance Liaison Committee) Guidelines, which are produced by the above organisation. These include what drugs we can give and treatment guidelines etc. These are however just guidelines and many services adopt local policies and add additional drugs through PGD's (Patient Group Directives), for example some services are adding Ketamine and Midazolam to specialist paramedics, as well as antibiotics. Paramedics in the UK are autonomous and don't answer to anyone as such in terms of justifying their treatment, although obviously any issues will be raised by senior staff.

Hats off to you. I always considered becoming a paramedic but anxiety, IBS and crippling travel sickness stopped me (I'm going into Occupational Therapy instead). I think it would be the multiple car pile ups that would get me. Wouldn't be able to do the suicide attempts either...

Are you with South Central then? What do you feel about private ambulance firms? We see a lot in the hospital I work in (community hospital in Bucks) and I always wondered a) what the point was and b) whether or not they're actually, you know, trained.

I have a friend who is an OT, sounds like a great bag to be honest!

I don't work for SCAS, but I have friends that do. I think the main issue is that we simply cannot recruit fast enough. Statistics show that the call volume is going up year on year, we have had cuts (no matter what any politician tells you), sickness is up, anecdotally we have higher levels of burnout and people are leaving, this is affecting all of the services. I have friends who qualified at the same time as me and are already looking to leave. Which is sad. This is where the privates come in, they're essentially having throw money at the problem, because we're in a bit of a problematic cycle. The government have introduced a system whereby if we don't hit targets we get fined, but then we have less money to spend on overtime/staff, so we hit less targets, get fined and so it goes on. Essentially its a big problem. Paramedics now also take 2-3 years to train as opposed to the 6 week course we used to do, so it takes so much longer to get new paras, which confounds the issue. We also have ECA's/ECSW's/Techs which are trained in service who work with paramedics/sometimes alone, and they train up to paramedic in service (but still go to uni).

Oh tell me about it - my main job role is recruiting nurses for my trust so you can probably guess how I feel about cuts! Sorry to hear it's happening to you guys as well; I truly believe the Tory plan is to cut back the NHS so far that the patients suffer and then turn around and go 'We need a better system!' Thus giving them free reign the introduce a privatised health service... I'm such a pessimist :p

Interesting that you say that about private, we're getting slammed for having too many agency workers at the moment as their salaries are about good 40% higher than a nurse of the same experience employed by us. We are told to cut agency spending, we get blasted in the press for going overseas to recruit, we can't recruit in the UK unless you're a massively well funded and well known trust like GOSH... They're not training nurses! And to top it off in three years time all our excellent non EU nurses will be booted because they can't earn enough to meet the new Visa thresholds. The NHS is in such a bloody mess.

And who suffers? The people who need it the most :( I'll get off my soapbox now, haha.

What do you think the most interesting thing you've seen is?

I'd totally agree with everything you said there, if you changed the word 'hospital' to 'service' and 'nurse' to 'paramedic' then you're there. We're recruiting overseas too atm (Aussies mostly).

I've seen some really interesting wounds, full thickness wounds to the skull that area flapped back like someone has been scalped.

I've also seen a thorocostomy done on the roadside by HEMS for a motorcylist with a Tension Pneumo that we decompressed.

Hey, thanks for doing this.

What is an average day like? Are you always paired with another paramedic?

No worries! As Luke says you're often paired with others, or you work solo on a response car.

There is no average day, which is what makes it amazing, but loosely.

Your first call will probably be an elderly person who has fallen when getting out of bed (this is quite a lot of our workload), you'll generally get at least one chest pain/shortness of breath/abdo pain call per day. RTC's (Road Traffic Collisions) are pretty rare, maybe 1 or 2 a month? (weather depending) Rarely serious, cars are so safe nowadays. Maybe I'll record my calls one shift and come back to you.

How much of your day is spent dealing with the elderly who have had a fall?

I mean, I know it's a lot, but how much?

It varies, as above its commonly your first call of the day, but sometimes you'll do 3 or 4 in a shift, even if its none injury, you have to fully check them, do observations and paperwork, and we may refer to falls team/GP, so it can take up to 1.5hrs/call. (It often takes longer to leave someone at home than it does to take them to hospital).

What's the scariest call you've been on?

I think the scariest ones where are where the patients are dying and you've run out of ways to help them. They're hard to deal with because often the patient knows what is coming, and you do too. All you can do is prepare for what is about to happen, and reassure the patient and just hope you can get them to hospital in time. I had one of these calls when I was new and it was very tough to deal with. If you arrive and they're alive and when you leave they are not you feel like you've failed.

Obviously calls where knives etc are reported are not nice, but they're still easier than the above.

Obviously I know that they're bringing Hazardous Area Response Teams in across the UK but what sort of training do you receive to handle mass shootings and bombings (as much as you're allowed to tell us, anyway)?

We have clinical updates every year, I've just done mine and it involved some updates on mass decontamination for dirty bombs etc. To be honest its one of those things where you really can't prepare because there are so many variables. I believe the service has managers attend courses on how to deal with this sort of thing.

We were told on my update 2 years ago that 'if we have an active shooter, we expect to lose the first couple of crews'... which was reassuring...

do you guys drink a lot of tea in between your emergency call rushes?

Some do, I don't. I drink a lot of water because you're always on the move. Plus caffeine is a diuretic, and its not always convenient to find a loo!

Is paramedic something that requires great grades? I imagine it would be

Yes and no, I did okay at school, but my grade weren't amazing, but the exams at uni were very tough and cleared out a lot of those that could and those that couldn't (or rather those that would study and those that wouldn't).

Is working in a hospital/medicine anything like Scrubs the TV show?

First of all I love Scrubs. I read somewhere that it was the most medically accurate TV show ahead of House and ER etc.

I think the most similar thing is the sense of humour, the dark, and the silly, and the downright ridiculous to cope with what we see day-to-day. I think the character types were obviously written by someone who had spent a fair bit of time around medical types. My lecturer was just like Dr. Cox at uni, and I've met a few JD's in my time too!

What are your bosses like? Do you feel like you are managed well? What niggles and gripes do you have, if any, about the organisation?

I have a really good line manager, he's a really chilled out guy and just lets me get on with it, which is what I like.

We have a few managers I wouldn't trust as far as I could throw, and we have a few that are brilliant and I feel i could tell them anything.

I'm probably still not that disillusioned, I actually think that the service I work for is very good, progressive etc. I don't like the way some of the managers like to question people on inane subjects that are not really relevant, to make the staff say they don't know. Some like to exert their authority in this way, but again this is the minority.

Often the road paramedics now have a greater knowledge than the managers because they have been through uni, which is leading to quite an interesting power shift within the service. Its less military, now. We are no longer managed, we are now 'guided', or something like that.

How do physicians treat you as a paramedic? Are they collegial? Do they look down upon you?

Again, some really good, some think you know nothing.

Generally I find if you ask a question, the doctors are more than happy to answer and try and guide you for your future practice. This is especially the case when you see the same doctors repeatedly and you can build up a relationship with them.

Are you put off from cycling because of the number of cyclist accidents you've been called out to?

I actually purchased a road bike last year and began cycling properly this year. The job exposes you to risk, and you see what CAN go wrong, but it also makes you realise that life is short, and if you love something you should do it.

In any case I don't often go out to cyclist vs car calls, which is amazing considering some of the roads around here!

What's the weirdest injury you've seen?

I met a guy whose foreskin was stuck behind the head of his penis.

Paraphimosis Apparently.

Have you had any particularly violent or gory encounters as of yet? I ask because both my parents were ambulance crew in the UK and I have heard many stories.

Once had a guy threatening to kill me and my crewmate, had to press the emergency button. Most of the assaults we come closer to getting are actually from 90 year old dementia patients, but don't be fooled, they hit harder than Mike Tyson!

How did you become a paramedic? It is something that I have always wanted to do but I have never had the money to go to university.

There are two main ways in the UK, Either:

• Join the service as an ECSW/ECA, you will be on a lower wage than paramedics to begin with, and if you're similar to most of our ECSW's who join a bit later in life you'll probably take a wage cut, but they will pay you whilst you train up to paramedic level, and I believe they also pay the university fees for you too.
• The other way to do it is to get a student loan and get yourself into uni on a 2-3 year para course.

Have you ever had to respond to a burn victim?

Yeah, recently, went to a lady who had a cold and was inhaling steam from a bowl full of just boiled water (an excellent example of self care), unfortunately she heard the phone ring and jumped up, which resulted in blistering from her belly button to just above her knees.

What's the most infuriating thing you have to see/deal with on the job?

(Thanks for doing this AMA and for the great work.)

No Problem. Keep the questions coming!

I have a big issue with families that just abandon their loved ones as they get older. Some people just don't care as much about the people that raised them as they do about themselves. There is a bit of a practice of 'granny dumping' that happens around xmas time, where families will call for us and make up or exaggerate issues so that their elderly relatives get taken to A&E over the festive period. This is done so that the families don't have to 'deal with them'. Its just sad.

Its also hard not to get annoyed by the drug seekers that call us, wanting us to load them up with Morphine/Entonox. You just have to keep your professional head on and be calm with them.

Have you ever had to deal with a gunshot wound? As an American in a decent sized city, we have shootings regularly. But I'd assume in the UK that is a rarity.

Never been to a GSW, probably more common in London/other big cities. Been to quite a few stabbings. We generally go to more accidental trauma in our area. We're quite lucky with guns (or lack thereof) in the UK. Without being too political, I think we have a good stance.

Although I have not seen any specific recruitment, I have heard of the possibility of U.S. paramedics being recruited to move to the UK. Have you heard of this and if so, what do you know about the process and success?

I think the main issue with the move is that we are a registered profession in the UK, so it can be a bit tough if you have not done a HCPC sanctioned course. That said, we have a good deal of Aussies that have just joined us, so its obviously not impossible. The services over here are crying out for staff, so I can't see any reason they wouldn't try to help you. If you want more info PM me and I'll send you some further details.

What are your policies on "Do Not Resuscitate"? I ask because in the U.S paramedics can get fired/sued if they resuscitated someone who was a DNR.

If they have a DNR we do not start. If the family are asking us to we generally try and reason with them and suggest they follow what the patient would have wanted.

Luckily never been in the situation of conflicting views. Personally I think things are getting better with people getting DNR status and generally most families are happy to see their loved ones pass peacefully.

Do you get a rest between callouts?

It totally depends, normally we get a 30 min meal break in 12 hours. Some shifts (like last night) it is call after call, without a rest. Other days you'll get sent to head towards a standby point but never make it and get diverted to a call on the way. Other days (bit of a rarity now) you'll get a few hours on a standby (sunday mornings are usually a bit of a slower start).

What is the most frequently asked question you get about your job, and what is your defacto answer?

A common one is what the worst call was, which is a difficult one to answer because no-one wants to actually hear the real answer when I say it no matter how much they think they do.

We also get asked about the shift lengths (mostly 12 hours, some 10, a few 8) - thats often by patients on scene.

The most common question the crews ask each other is 'So... You been busy?', which kind of unites the crews because you feel a bit better when you're totally destroyed at 4am without having had a meal break, when no-one else has had one either. Shared misery I think its called? ha.

I think the hardest thing to explain is the randomness to the job, 'describe your average day' is such a tough one, because there is just very little pattern, there are slight trends (falls in the morning, more car accidents in bad weather etc) but thats about as far as it goes.