Ambulance Stories (49)

Saving Lives.

On another blog, I was asked a question by the lovely Kim. That post told the story of how I drowned as a child, and how I was saved by a brave angler standing nearby. She commented there, and went on to see the connection, that my life was saved, and I later went on to work as an EMT, intent on saving lives myself.  It’s a reasonably straightforward question, “How many lives did you save?” It got me thinking, and led me to write this post, which I am including in my category of ‘Ambulance Stories’.

Most people presume that ambulance crews save lives. It’s a fair presumption, and reinforced by scenes on the news media, documentaries on TV, and scenes in films and dramas. The reality of working in emergency ambulances in a big city like London is very different though. Much of the day to day work is dealing with old people who have chronic conditions like Asthma, Heart Disease, Diabetes, and Circulatory Disease. Some have suffered strokes, others have Dementia, or one of the many other debilitating conditions that affect us all eventually. Constant calls are made to the 999 (911) service to attend to these old people, and they live their lives on a merry go round of hospital attendance, admission, discharge home, and back again.

Then there are the inter-hospital transfers. Taking a patient from one hospital to another can take up a lot of your time. These Emergency Transfers are usually accompanied by medical teams, and may be necessary for brain scans, severe burns, or premature babies. Given the distances involved, the preparation of the huge amounts of equipment needed, and delays at each hospital, a job like that could well take up half of an eight-hour shift.

Mental illness is also a huge part of working in emergency ambulances. Persistent callers, disturbed people who cannot cope alone, or are having a crisis. People with suicidal tendencies, or those who self-harm, suffer with Anorexia, or perhaps wish harm to others. With more and more of these patients discharged into the ‘Community’ to fend for themselves, their care has been transferred to calling for an ambulance, at least in the first instance. It is easily possible to do a run of shifts without ever attending what most people would consider to be an actual ’emergency’.

So, almost 22 years, and thousands of emergency calls later, did I actually ever save anyone’s life? Strange that you have to think about it, given the nature of the job. The main remit of the emergency ambulance when I joined was to get people into hospital alive if possible, to be handed over to expert nurses and doctors who then treated them. We had few drugs, and defibrillators were only ‘on trial’ back then. Most of our training was a legacy from the 1950s; bandages, splints, and the administration of oxygen, and nitrous oxide. The accepted practice was known as ‘swoop and scoop’. Arrive as soon as possible, and get the patient into the vehicle as painlessly as we could. Scoop them off the street, and get them to a hospital that was close by.

Over the years, that changed a great deal. New drugs, better diagnostic equipment, and the ability to treat more conditions on scene led to taking more time with the patients, and administering more treatment before leaving for a hospital. Those hospitals changed too. Certain areas developed specialist centres, and we could no longer just go to the one that happened to be the nearest to the job. Protocols and training updated all the time, and the technical aspects of being an ambulance worker became more complicated too, with the crews becoming more accountable for their actions. Today’s emergency ambulances are a world away from those I started on, and the job itself is very different too.

After all that, I have to answer Kim’s question. Did I actually save any lives?

Some, for sure. Recognising a problem that I might have overlooked was definitely a way of saving lives. Placenta previa can be fatal if not spotted and properly treated, so I do recall at least three occasions where that saved someone’s life. Correct diagnosis of a Diabetic coma, often mistaken for someone being drunk and aggressive, that can definitely save a life and was something I managed a few times. Something as simple as getting someone off of their back, so they do not inhale fluid or vomit; this can also save a life, and was something we did all the time. Delivering a baby at home, with all the potential complications for mother and baby. I recall fourteen occasions where I did this, though mostly I just ‘caught’ the baby as it slid out!

On a few occasions, I kept people with serious burns alive, at least long enough to get into hospital for specialist treatment. But whether or not that saved their life, I never found out. Then there is the difficult subject of CPR, which is very often shown as incredibly effective on TV shows and films. In truth, it rarely works, and depends how long the person has been left like that before we arrived. On one occasion, just the one, in all those years, we attended a lady who had suffered a cardiac arrest on an underground train. We just happened to be outside the station at the time, and a fellow passenger who was a doctor had already started CPR. We got the lady into hospital with an output, and she went for emergency heart surgery that morning. She later sent us a letter of thanks, so I can say that we all definitely saved her life.

One evening, I spent a long time sitting on the balcony of a flat at the top of a tower block. The female resident was perched on the ledge, intending to jump. I managed to talk her out of it by telling her how awful her body would look, once it had made contact with the street below. Perhaps vanity saved her life, along with my rather brutal description.

But most of the time, we just did our best. We did what we could, faced with the conditions we found, and using the equipment available. As they say in medicine, “First, do no harm.”

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Ambulance Stories (48)

Nostalgia

I have just seen a link posted by a good friend who still works in the London Ambulance Service. It is to a You Tube film, a documentary from 1974. It is a serious current affairs programme from the time, probably from the BBC. I don’t recall seeing it back then, but it was broadcast five years before I applied to join. Despite that, it is incredibly familiar. Many of those featured were well-known to me later on, and I worked with some of them on occasion. It was filmed in London and Yorkshire, but predominantly set in and around North Kensington Ambulance Station, where I worked for over twenty years.

By the time I was there, nothing had changed from how it is shown in the film. I wore the same uniform, used the same equipment, and probably even drove some of the same vehicles. The emergency calls shown in the film are all genuine, and the way they are dealt with is exactly as I would have dealt with them at the start of my career. The interior of the Ambulance station was the same, and the descriptions of laundering the blankets, washing the vehicles, and even cleaning the toilets, all too familiar.

Much of the film deals with the period of transition that the Ambulance Service was going through during the mid-1970s. Where the crews had once been competent drivers, trained only in basic First Aid, they were starting to get the first items of real life-saving equipment, and beginning to be trained to become the professional service we would soon see. They still had employment issues and were receiving pitifully low pay, and these problems were causing dissent, which resulted in strike action. The film is very much on their side, showing them as ordinary people; caring individuals doing their best in the situations they encountered. It is also a wonderful fifty-minute snapshot of England in the 1970s, and makes forty-one years ago seem more like seventy. Hard to believe now, but wonderful to behold.

The uniforms have changed, the vehicles and equipment are different, and the training is in another league. But the job is still the job, and that Ambulance Station is still there, as busy as ever.

Here’s the link. If you know anyone who ever worked in any Ambulance Service, or if they are just interested in fascinating social history, please share it.

Ambulance Stories (47)

PTSD

Post Traumatic Stress Disorder is a subject much in the news these days. It can affect anyone, in a variety of situations; from a soldier returning from a combat zone, to someone who witnessed a bad traffic accident. I found this recent definition of the condition on the NHS website.

The type of events that can cause PTSD include:
serious road accidents
violent personal assaults, such as sexual assault, mugging or robbery
prolonged sexual abuse, violence or severe neglect
witnessing violent deaths
military combat
being held hostage
terrorist attacks
natural disasters, such as severe floods, earthquakes or tsunamis
PTSD can develop immediately after someone experiences a disturbing event or it can occur weeks, months or even years later.
PTSD is estimated to affect about 1 in every 3 people who have a traumatic experience, but it’s not clear exactly why some people develop the condition and others don’t.’

You notice that there is nothing in that list specifically about working for the Emergency Services. I suppose that if you choose to embark on a career in the Ambulance Service, or the Fire Service, and The Police, you should anticipate the likelihood of having to deal with a lot of unpleasant things, and that you will be witnessing things that others never see. The same applies to those who choose a career in the Armed Forces, but they are on the list, given the extreme nature of their role I presume. It would appear that being the victim of something, rather than just witnessing it, or dealing with the outcome as part of your job, is the defining factor here. So how does this manifest itself, what are the tell-tale signs? This is again from the NHS website.

Signs and symptoms
‘Someone with PTSD will often relive the traumatic event through nightmares and flashbacks, and may experience feelings of isolation, irritability and guilt.
They may also have problems sleeping, such as insomnia, and find concentrating difficult.
These symptoms are often severe and persistent enough to have a significant impact on the person’s day-to-day life.’

For more than twenty years, I witnessed all sorts of unspeakable things working on an Ambulance in Central London. Countless dead bodies, attempted resuscitation of people of all ages, including babies. Finding corpses that had been neglected and were decaying, traumatic limb amputations, decapitations, murders, sexual assaults, and violent crimes. Sufferers of terminal illnesses, people who had jumped from a great height to their deaths, or under trains, or sometimes into water. Suicide by drug overdose, death from drug addiction, victims of shootings and stabbings, others seriously injured in road accidents. I saw them all, and dealt with them accordingly. There was a lighter side. Delivering babies, chatting to interesting elderly people, the banter with colleagues and hospital staff. But generally, it was mostly unpleasant, and often downright nasty.

We were threatened and attacked too. I was physically assaulted a few times, and verbally abused daily. I have been threatened with violence, had knives waved at me, and on two occasions, even a gun was brandished. We were fair game, and enjoyed little respect. Writing the stories about my experiences on this blog has brought back many recollections of my time there; and as memories, they are mostly good ones, surprisingly. When you are dealing with the victims of terrorist bombings for example, you don’t really have time to think about stress, or trauma to the mind. You just do the job you signed up for, and move on to the next one. The day after that, you turn up for work, and deal with whatever is thrown at you, starting all over again, from scratch.

I did my last shift in an Ambulance in November 2001, before moving on to pastures new, as a Communications Officer with the Metropolitan Police. I can honestly say that I didn’t miss the job at all, just some of the people. I joined at the right time for me, and left when it no longer felt right. Since retiring in 2012, I often have vivid dreams. About 70% of those dreams happen to be related to working in an ambulance. Two nights ago, I woke from one such dream at around 3AM. I had been driving an ambulance, and I had got lost, unable to find the location of the job I was required to go to. Rather than being in London, I was on the coast somewhere, driving near the edge of a cliff. The person beside me was unfamiliar, not one of my old crew-mates at all. This is a recurring dream, though often the person with me is someone I know well, or a person that I could never have known at the time, but have met since. They are not unpleasant dreams, but they usually concern lots of driving, and getting nowhere fast. Perhaps someone skilled in interpretation of dreams can explain them, I know that I cannot.

I suppose I always suspected that PTSD might be the legacy of a third of my life spent attending 999 calls. But it wasn’t. I didn’t get it, though some others surely did. I was one of the lucky ones.

Ambulance Stories (46)

Clean up after your dog

As a responsible dog owner, I always clean up after my dog. There are plenty of dog-poo bins in areas where dog-walking is popular, so no excuse to leave anything unhygienic around. It may not be one of the best things about owning a dog, but it just has to be done. Sadly, in many parts of London, there is little evidence that the dog owners of that city follow suit. This story is as much about the bystander involved, as the victim. It is not a pleasant tale, but then many aspects of life and death are far from pleasant.

One morning, we were called to a main road nearby. The job was given as, ‘man fallen, not moving.’ At the end of the rush hour, Holland Park Avenue in west London is still a busy thoroughfare. You will encounter heavy traffic, late commuters still hurrying to the underground station, and morning shoppers waiting for shops to open. When we arrived on scene, we were met by a middle-aged lady. In that area, eccentric people are common, so her appearance was not that unusual. She was dressed in a style that you might describe as ‘retro-sixties’, except that her hippy clothing was almost certainly original. She was short, and overweight, and despite the cold morning, large hairy toes protruded from the sandals she wore. She carried a substantial handbag, and I could see the head of a cat sticking out from one end. The zip was fastened sufficiently far along to prevent the feline escaping, though it was obvious from its wriggling, that this was just what the unfortunate animal was attempting to do. In looks, she resembled the genetically-engineered outcome of a cross between Catweazle, and Miriam Margolyes. (See links)

She told us that she had been waiting for the nearby grocery shop to open, so that she could buy some milk. A well-dressed man had been walking towards her, heading in the direction of the underground station. She related how he had suddenly stopped still, and had then fallen straight down, with no attempt to break his fall. She said that it was, “as if an unseen cable had suddenly pulled him forwards, into the pavement.” I thought this was a very good description of someone collapsing after they were already dead; possibly from a brain haemorrhage, or something similar, giving them no time to contemplate their demise. My colleague walked over to the prone figure of a tall man. His head was covered by a plastic carrier bag, draped across the rear of his neck. The lady offered an explanation. “I did that, it’s not very nice under there, poor man.” My partner recoiled as he removed the bag. All around the dead man’s face was a foul substance, giving off a terrible smell. The lady nodded. “I told you, it’s dog shit,” she loudly exclaimed.

We got the man into the vehicle. He appeared to be in his sixties, and was dressed in smart business clothes. We tried as best as we could to carry out our normal resuscitation procedures. This meant cleaning the excrement from his mouth and nose, before using suction to remove what we could not get out from the inside of those orifices. He was obviously ‘well-dead’, a phrase we used often; but as he was in a public place, and the incident was not that old, we were naturally compelled to try as hard as possible to revive him. Continuing with all of our usual protocols, we took him off to the nearby casualty department, alerting them of our arrival. Despite the presence of the dog muck all over his head, hospital staff continued the attempt at resuscitation for some time, but could get no output. Without the benefit of knowing the results of a post-mortem, we could only conclude that something had killed him instantly, as he walked briskly to the station. He had been doubly unfortunate, as he had fallen face first into a very large pile of dog poo, left on that street by an inconsiderate dog owner. We threw away much of the equipment used, in case of any infection, and had to spend ages deep-cleaning the larger items, before returning to disinfect the whole vehicle on the inside. Dog waste can carry a disease called Toxocariasis, and this can cause blindness, particularly in children.

I often think of this poor man. Not only did he die in public, he died with a lack of dignity, caused by a thoughtless individual, who could have cleaned this up in a moment. At least the strange lady tried to spare him some of that.

https://www.google.co.uk/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=miriam%20margolyes
https://www.google.co.uk/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=catweazle
http://en.wikipedia.org/wiki/Toxocariasis

Ambulance Stories (45)

Drunk, or Diabetic?

At the time I joined the Ambulance Service in London, equipment and diagnostics were still fairly basic. We didn’t have defibrillators until later, and blood pressure had to be taken manually, with a stethoscope and wrap-around cuff. There was nothing to take a temperature with, and drug administration was restricted to the gases Oxygen and Entonox. It was to be some years before we progressed to things like blood sugar testing kits, pulse oximeters, and intravenous drugs. As as consequence, I once made a major mistake, and this the first time I have ‘gone public’ with it. Fortunately, it did not have any serious effects on the patient, or on my reputation.

When a person is affected by low blood sugar, the symptoms can vary, depending on the severity, or the individual. Some patients can quickly realise that they are about to experience problems, and can counter this by eating or drinking something sweet. This will give them a temporary respite, and allow them to seek medical help, or manage the problem themselves. Our main treatment of known Diabetics back then was to get some sugary fluid, or even powdered sugar, into their system as soon as possible, to help them recover enough to take them to hospital. If this failed, we had to move them on stretchers, unconscious, or semi-conscious, and convey them to the nearest casualty department. This worked reasonably well, if you knew the medical history of the person concerned. In their home, or perhaps that of a friend or relative, there was normally someone else to give you the patient’s history of Diabetes. On the street, or in public places like stations, you might discover a ‘medic-alert’ bracelet or neck-chain being worn. This distinctive item of jewellery opens up to give you the necessary information to confirm a diagnosis, and you can act accordingly. There are other situations where none of this information is available, and where the patient is not necessarily presenting with recognisable symptoms.

On one occasion, we had started a night shift at 22.00. After going straight out to do a transfer from one hospital to another, the next job was given as ‘a male in a collapsed state’. The address was outside a pub, and it was almost an hour after closing time. It is fair to say that we went off to this job expecting to find a drunk lying in the street, having had too much to drink in that very pub. As we arrived, we were directed by bystanders to a man rolling around the pavement, in an alleyway beside the building. He was shouting incoherently, and he appeared to have urinated in his trousers. When we approached him, he swung his arms at us, and kicked out violently. He continued to shout and swear, though it was hard to make out anything he was saying. Trying to make some examination of him was difficult. He looked to be in his early forties, and although he was reasonably smartly dressed, his clothes were filthy, from contact with the ground. He stared at us aggressively, and opened his eyes wide. He was spitting and slurring, and kept lashing out at us with his feet. We decided that it wasn’t worth the trouble of getting too close, and having to end up in a fight with this man. So we called the Police.

At that time, it was perfectly acceptable for the Police to remove someone who was being violent to an ambulance crew. Anyone refusing to cooperate with us was fair game, and very likely to be arrested. When the local van turned up some ten minutes later, the two officers tried to reason with the man, and to get him to stand up. He refused to assist them, and eventually managed to kick one of them in the leg. He was arrested for being drunk and disorderly, and for assaulting a Police Officer. They dragged him into the back of their van, and handcuffed him. We considered ourselves lucky to have passed him onto them, and continued with our shift. After a busy night of constant calls, we finally managed to get back to the base at about 04.30. I was just about to make some coffee, when the emergency phone went, and we received another job. This time, it was to the cells at Notting Hill Police Station. Apparently, they had an ‘unrousable male’ detained there, and they had called out the Police Surgeon (an on-call doctor) to examine him.

Of course, it was the man from earlier on, the aggressive drunken male, who had been collapsed outside the pub. The Police Doctor had determined that he was almost certainly in a diabetic coma, having been able to take a reading of his blood sugar. Occasionally, the symptoms of  diabetic coma are very similar to drunkenness. Slurred speech, incoherent phrases, disorientation, and violent behaviour. This man was very unwell. He had not been drinking at all, and it turned out that he had been on his way to work on a night shift in a local factory, when he happened to collapse outside the pub. The doctor had no idea that we had previously attended him. The Police had said nothing, save the fact that he had been arrested as a suspected drunk. We took him off to hospital in Paddington, where he was given glucose via an intravenous drip, and soon made a full recovery. He remembered nothing of the original incident, or of being detained in a police cell. Chatting to staff in the early hours, we managed to get the full history of his case.

Nobody had mentioned us, or what served as our neglect of this diabetic patient. Some time after, Police would no longer take drunks in charge, in case underlying causes of illness surfaced later. We also received instructions to treat all ‘drunks’ as potentially unwell from other causes, and the hospitals had to cope with a sudden influx of drink-related problems. I learned a valuable lesson. Look beyond what you perceive to be obvious. Diabetes was and still is a massive problem, and the symptoms of coma are so easily confused with other problems, like being drunk, or a stroke. I escaped serious consequences that night, and fortunately, so did our unlucky patient. I didn’t repeat that mistake, during my remaining years in the job.

Blatant Advertising

I am unusually puffed up once again today. For the third time, I have had an article published on a film website. These small things may seem unimportant, and carry an element of ‘so what’? To me, it is very exciting, to see my name in print, somewhere else, under a piece of writing.

As this is not a re-blog, and was written specifically for the other site, I will not publish it on beetleypete. What I will do though, is post a link here, and hope that any readers who are interested in film, and my writing, will go over and have a look at it.

The rest of the site is well worth a visit, with interesting, intelligent, and well-written reviews of films, cinema articles, and everything connected to both. (And that’s just my stuff! Only joking)

Thanks in advance for looking at it. Pete.

http://curnblog.com/2014/01/23/blood-bandages-paramedics-film/

Ambulance Stories (44)

The National Dispute

By the autumn of 1989, relations between the Trades Unions and the Thatcher government were at an all-time low. The Tories were determined to use their large majority in Parliament to crush the unions, and remove any power that they once had. Empowered by the guarantee of government support, managers in Ambulance Services all over the UK were standing firm against any requests for pay rises, or better conditions for staff. In London, the managers were going one better, introducing changes in working practices, with little or no consultation. It was all getting very serious, and we could see that it would soon come to a head.

One of the new demands was that we move from our normal place of work, if our crew-mate was off sick, or on holiday. This might seem reasonable, but the previous arrangement had relied on overtime being offered to staff on days off, ensuring a full complement of emergency ambulances was available in all areas of London. If one of us moved to another base, up to ten miles away, we would operate from there, leaving our normal station undermanned by at least one vehicle. This not only left the remaining staff with a greater workload, it also meant that the local population did not have the guaranteed vehicles available to them, in the event of an emergency. The decision on who moved, and where to, was left to Control Room staff, often with no operational experience.

Protracted pay negotiations had got nowhere, and there was already a limited work-to-rule in place. This simply meant that we did the job properly, by the rule book. We took vehicles to be re-fuelled, refused to operate without adequate supplies of oxygen, or with faulty equipment, and carried out all the necessary checks, before commencing duty. Any defects with the vehicles, normally tolerated for the shift, would result in that vehicle not being used. All of these were safety rules, and for the benefit of the patients. They were routinely flouted at other times, just so the workload could be managed, and always at the suggestion of the managers, who used guilt and custom as leverage. Another rule, also ignored normally, was that no Ambulance should be operated, under any circumstances, by one person. There was limited rearward visibility, and also the chance that you would be flagged down to attend an incident, when you were alone, and unable to properly assist. Working to rule meant that we refused to operate vehicles on our own, so could not travel to other bases in them. We could not use our own transport, if we had any, as this would have necessitated insuring our own cars for business use. Public transport was not really an option either, due to the location of some bases, and the long journey times involved.

In an atmosphere of antipathy, an attitude of non-cooperation developed, and this was made worse, by the belligerent attitude shown by some managers. Despite the problems over pay and conditions, and the many factors affecting our working lives, it was the issue of moving bases, which was to become the spark that ignited one of the longest, and most acrimonious disputes, in the history of the National Health Service. As the Union Shop Steward at my Ambulance Station, it also fell to me, to become the instigator of this whole dispute, as it just so happened, that on that day, I had nobody to work with. On that morning in September, I had no idea that the outcome of my decision would result in a bitter six-month dispute, that would see us through a harsh winter, with no pay; staff losing their houses, marriages breaking up, and deep resentments being formed. It would never be the same afterwards, and the long-lasting effects would stay with me, through a further twelve years of service.

When Control asked if I was fully crewed that day, I replied no, and asked them to find someone on overtime, to work with me on that shift. After a few minutes had passed, they called back, and instructed me to take the ambulance, and to report to Chiswick Ambulance Station, to work with someone there, who was also single-crewed. I refused, advising them that I was unable to use the vehicle on my own, by their own rules. I then telephoned the person at Chiswick, telling him to expect a call, instructing him to drive over to work with me, as I anticipated that this would be the next step. Sure enough, that was what happened, and he also refused to move, citing the same rules. They called me back, someone more senior this time, and gave me a ‘direct order’ to do as they asked. I refused once more, and I was told that I would be suspended from duty, pending disciplinary action. Ten minutes later, the same scenario was played out with the man at Chiswick, and within an hour of starting work, we were both suspended, and potentially unpaid, unless we relented, and agreed to move.

I advised the other crew members on my station, and at Chiswick, and they all withdrew their labour, in support of both of us, demanding that the suspension be withdrawn, and the threats rescinded. I then contacted the next nearest base, at St john’s wood, and told them what was happening. They in turn, contacted Camden, Willesden, and Park Royal, and before long, almost the whole of West London was ‘on strike’, until we were reinstated. This soon got through to the full-time union officials, and the local media. I gave an interview to the local TV news programme outside the Ambulance Station, explaining the reasons for the action, and it was shown at lunchtime, and again that night. By now, we were occupying the bases, and the unions were running scared, fearful of having their funds sequestered, as this was unofficial action. They tried to get me to return to work, pending negotiations, but they were overtaken by events, as the dispute spread all over Greater London, the staff angry and frustrated by management attitudes, and frightened unions.

During the rest of that day, we had local meetings, and agreed that we were not on strike, and that we were still prepared to answer emergency calls, based on the terms and conditions that preceded the current dispute. However, the managers had seen their chance to break us, and refused to pass calls to the individual bases, telling the media that we were on strike. They began to use the Police, and called in volunteers from the Red Cross, and St John Ambulance, to respond to calls. They also used private ambulance companies for non-emergency work, and tried to portray themselves as the unfortunate victims of union agitators. Some operational managers took vehicles from Headquarters, and attended calls. We put up posters and banners, advising the public that we were still working, even though we were not being paid, and we gave them direct phone numbers, so they could ring in straight to us. We also told the Police and the local hospitals the same thing, and by the time night duty arrived, we were answering calls at our own instigation.

Some staff were still working normally, refusing to cooperate with their colleagues. Some had political, or religious reasons, some were scared of not being paid, and others just disliked some of us who were seen to be on strike. They had to be moved, so that they all worked in the same area. They were in no danger from us, we just lost respect for them, and they were never fully accepted again afterwards. They were surprisingly few in number, with the dispute, as we began to call it (as we were not on strike) gaining overwhelming support from the vast majority of staff. The whole thing escalated, and began to go national. Staff in all parts of the UK were joining in, and soon the unions could no longer ignore the overwhelming feelings of their members. In most of the major cities, solidarity was total, and we all still made our best efforts to provide cover for emergencies. Some bases actually attended more calls during some parts of the dispute, than they had when working normally.

This soon became front page news, and the first item on all the TV news stations. Government ministers were interviewed, union officials gave our side of the argument, and cameras appeared outside casualty departments, and the larger ambulance stations around the country. To the surprise of our management, the Government, and to some extent, those involved on the ground, the general view was sympathetic. Members of the public supported us overwhelmingly, and ninety percent of media reports were also very favourable. We were seen as the maligned carers, the professionals who put up with low pay, little recognition, and carried on uncomplainingly. For us to be in dispute, something bad must really be happening. The public believed in us, the hospitals believed in us, even the Police believed in us. It was left to our own management, and Tory politicians, to spread untruths about our motives, and to paint a picture of us as ungrateful strikers, callously disregarding the unfortunate sick and injured. Everyone wanted us to be paid more, and to receive decent conditions too. Opinion polls suggested massive support, and there were suggestions for a plan to pay more taxes, or higher National Insurance, to fund the changes, and to put an end to the dispute. The managers were on the back foot, and the government under pressure. They reacted spitefully, as you might expect.

Our occupation of the bases was declared unlawful, and they tried to get us evicted for tresspassing, but could find nobody willing to enforce this. They then technically sacked us all, withdrawing our right to use the ambulances, and the equipment owned by the services involved. They reported us to the Police, for ‘stealing’ ambulances that we were using to respond to calls. Again, the Police refused to enforce this, not wanting any part of a dispute that had caught the imagination of the public, who had soon realised that we were not actually striking. The attitude of all the staff was indeed admirable. Everyone continued to turn up for work, and to man all the shifts, even the most unsocial ones. Those on days off turned up anyway, to help with the occupation of the buildings, talking to the public, and answering the telephones. As the weather got colder, we had braziers burning to keep warm, and people turned up unannounced, with wood for the fires, and gifts and food for the staff. People also began to give us money. At first, we declined, feeling uncomfortable about this. We did get some hardship pay from the unions, but it was only a small amount, nowhere near enough to survive on. The donations were used to buy badges, stickers, and information leaflets, all handed out to the public, to advise them of our reasons for the dispute, and to ask them to wear the badges and stickers, to show support.

Staff began to attend busy areas with these; outside main railway and tube stations, at major junctions, like Oxford Circus, and also busy street markets, in our case, Portobello Road. We took banners, and boxes of badges, and we were soon overwhelmed by cash donations. From old ladies emptying their purses, to local celebrities giving wads of notes, the money started to flow in. By December, at least in London, we were receiving sufficient donations to almost pay staff the same wage they got when working normally. This stiffened our resolve, and made the earlier hardships seem worthwhile. With this continued level of support, we felt sure that we could win.

Without us ever imagining it, we were taking part in the most popular dispute in union history. We felt that we owed it to the public to continue, and we owed it to ourselves too.

Day to day, life was still hard. Staff divided into three groups. One would work on the ambulances, answering those calls we got through. Another would occupy the base, picketing outside, keeping the braziers burning, and putting on a brave face for the public. The third group would go and stand somewhere, advertising the dispute, receiving money from donations, and distributing badges. We had caps made as well, with our slogans on them, and often family members would assist too, standing with their husbands and wives, or mums and dads, showing solidarity with our cause. Each week, the donations would be divided, those with bigger families, or larger mortgages, getting the biggest shares. The meetings continued, locked in stalemate. The media kept the story alive, but also reported the tragedies that had happened, hinting that they might not have happened, if we were working normally. Army ambulances were brought in; unsuitable vehicles, doing an unfamiliar job, escorted by Police cars, as they did not know the areas. The managers, and more importantly, the government ministers, refused to budge on anything unless we first returned to normal duties. We endured a very cold, and miserable Christmas, with little hope held out, for a resolution in 1990.

Amazingly, public support never wavered. The donations kept coming, and the kind words too. We started the new year in an atmosphere of grim determination, on both sides. By now, former colleagues in supervisory roles had become bitter enemies. We no longer spoke to any managers, or control room staff. There was no local negotiation, of any kind, and all meetings were being held by union officials, with NHS management, and government ministers. We had become detached from the process, trying to deal with daily survival. I developed a deep personal hatred for some individuals, and for the voluntary workers, who were taking holiday time, to do our jobs when we were in dispute. For me, that never diminished, and remains with me, to this day. On the other hand, we formed bonds and friendships as well, with hospital staff, some police officers, and colleagues, that are unbroken as I write. Over 200.000 people attended a rally of support in Central London, and large events like this were seen all over the UK.

By the end of February, the unions were beginning to buckle. The management was willing to concede some points, but pay increases were a national issue, controlled by the government, and that was intransigent. Leading union officials began to hint at a possible solution, and this was accelerated by renewed media interest. The staff wanted none of it. We wanted to hold out, for all the reasons we had started on this five-month dispute, and could see no point going back to working normally, unless we got all our demands. The volunteers doing our job were running out of time, and would have to go back to their normal jobs. The cost of paying the police and army to carry on  was prohibitive. The total costs of the dispute already far exceeded what it would have cost to settle in the first place, but they would not back down. After meetings at the end of the month, the NUPE union leader, Roger Poole, announced that an agreement had been reached, and that we would return to work in March, six months after we began the work to rule. He didn’t think to ask us what we thought. He famously announced on TV, that he had ‘driven a coach and horses through Tory pay policy’.  And he wasn’t even embarrassed. What he failed to add, was that he had agreed, on our behalf, to accept the derisory pay increase that we had been offered originally, and that he had also agreed to the changes in conditions and practices that had brought us to this in the first place.

Some staff, me included, wanted to ignore the unions, and carry on. But there was no widespread support for this, and that was understandable. Some staff had suffered marriage break-ups, others had seen their homes repossessed. Many had just left, or resigned soon after, broken and disillusioned. All of us had endured six months with no pay, dependent on public goodwill from donations, and sticking through a harsh winter, with no end in sight. We went back to work in March, as if nothing had happened; though some people were shunned, others transferred by request, and some managers moved around. Our relationship with the unions was never to be the same again. I left the NHS union, COHSE, and joined TGWU, as a small personal protest. I had also stopped being the union rep for our base, as I had simply had enough at the time, though I did do it again, later on. We had lost, and it wasn’t a good feeling.

Or had we?

Within a short space of time, most of the old management was gone. Pushed out, retired early, or plonked behind obscure desks. Our public profile was raised beyond recognition, and training was brought into the 20th Century, with new skills, new equipment, and modern vehicles. Paramedics and Technicians were beginning to be portrayed in TV programmes, as an essential part of the emergency services, and as having a vital role in the NHS. They were filmed in documentaries, the often thankless job shown for all to see, actually as it happened. Other branches were introduced, rapid-response vehicles, motorcycles, and even a helicopter. (Actually run by the London Hospital) By the year 2000, ten years after the dispute ended, the job was being paid at a fair rate, and finally given the respect it was always due.

I don’t believe that this would ever have happened, without those six months of hardship, between 1989-1990. I am proud to have been a part of it, and always will be.