Code 9. Cardiac arrest. No ambulance available. Code 9. Cardiac arrest. No ambulance...

I am one of many thousands who are both proud and privileged to call myself a paramedic. But it is getting harder and harder to do the job that I love effectively and safely, and people are dying as a result.

It takes years of study, continued self reflection and self-maintained learning to become a paramedic. These days, we work in GP surgeries, oil rigs, expeditions, even behind the scenes for TV and film work, but paramedics are still most frequently found in an ambulance. 

And, in 2022, that ambulance is probably sitting idling outside an A&E department near you.

Gone are the days of an ambulance being around the corner on station, waiting for their next call. The calls never end. Day or night. The list is endless.

General broadcasts are sent on an open channel to all units, hoping someone nearer to the call can help or, like today, hoping anyone can respond because there is not a single unit to dispatch.

Code 9 is the coding for cardiac arrest. 

“Category One, Code 9 in XXX, nearest vehicle is running from XXX. Any units able to assist please reply,” says the voice. But no crews reply. Minutes later the message repeats, but now with the caveat of “further Category One, call unassigned…”.

The pattern repeats. Sometimes it’s a vehicle that is 20+ miles away, or no crew to send, or maybe an unqualified apprentice crew who are learning on the job and need to be accompanied by an emergency medical technician (EMT) or a paramedic. 

Emergency care assistants (ECA) and emergency care support workers (ECSW) can attend calls of lower categories or high priorities if they are closest, but they should be backed up by a qualified crew as soon as possible. But it’s not always possible, and their limited skills can leave crews in the awkward position of looking the same as a paramedic, with the same vehicle and equipment, but without the training needed to use it or make a clinical decision.

I have worked my way up to become a fully-fledged paramedic. I’ve seen people come and go, policies change, then (in some instances) come back, CEOs with promises of positive changes, then departing when nothing comes to fruition.

The changes to the way we work are seemingly made with very little thought for the wider ramifications, with little or no justification or explanation.

Just before COVID hit, the paramedics on my team were informed of a change to our shift patterns. We were told that we must accept a ‘relief week’ every six weeks - meaning we could be asked to work anywhere and at any time during that period. Child care, work-life balance, holiday planning, all out the window. 

After many heated discussions and finally settling on the best worst scenario, we were told that the rota change wasn’t going ahead. All that extra stress and duress for nothing. Needless to say, we still end up miles from base, and finish our shifts hours later than planned. But at least the consultancy firm that suggested the changes got paid well.

So here we are, once again sitting outside an A&E, another patient waiting in the ambulance that should be offloaded within 15 minutes of arrival. As I type this, we have been here for an hour and have only just seen a nurse. There is no prospect of offloading anytime soon. 

My skills as a paramedic morph into that of a nurse - regular monitoring, refreshments, medication, paperwork, more monitoring, more reports. At least this hospital is proactive and sends nurses out to take a handover and health care assistants to collect blood samples. We even take patients to x-ray and return to the ambulance at times.

Issues we used to face only during winter pressures are now daily occurrences. Patients have died outside. Patients have suffered from extended waiting times for treatments. Patients have died awaiting an ambulance. This is the ‘norm’ now. 

Years of underfunding, scandals, privatisation, lack of investment, combined with Covid (both directly and indirectly), Brexit, and an ageing population, have led us to the gates of hell at which we sit, waiting for a space. 

Meanwhile, the callouts repeat. Another Code 9. There are no vehicles to send.

Now we are going on strike - following on from the historic decision by the Royal College of Nurses to take industrial action. It’s understandable. The pressures are like never before. We are still battling COVID, and feeling the effects of the cost of living crisis. We are close to our limit. 

We are humans too, and although we do our jobs to make a difference, we also need to consider our own wellbeing. The current rates of pay for paramedics amount to a real-terms pay cut versus inflation. We are also struggling with losing staff as private firms are offering salaries nearly twice what the NHS offers, and the hospitals are the same.

Broken people can’t fix broken people, and when you’re going through the worst day of your life, you don’t want someone who is mentally and physically exhausted to come to your aid. 

During the pandemic, we were regarded as indispensable ‘heroes’. But now, the media portrays us as villains. Headlines blame healthcare workers for delays, or vilify those who have been forced to strike. They say we are putting patients at risk - but surely the bigger risk to patients is not fixing this entirely broken system.

It goes without saying that I would prefer to offload my patient into a facility where proper care can be provided, rather than have them die in the back of my ambulance. The lack of dignity that I have witnessed is horrifying. 

I don’t want to quit and get a better paid job. I want to do this job, but be paid fairly. I want to be respected by those who spent millions on faulty PPE from friend’s businesses, copped off with the secretaries and had parties in Downing Street while I told families that their loved ones were dying of Covid in a muffled voice behind my mask and visor. 

I’m not bitter. I’m frustrated. I want to help. I want to make a positive impact on society, because that’s what a paramedic does. Or did prior to 2022.