#simnight: lessons learned

My awesome friend Boo made this cool Storify for me, so you can do the TL;DR thing and laugh away at my increasingly erratic tweets through the night.

real life certified paramedic on the left, real life certified idiot on the right
real life certified paramedic on the left, real life certified idiot on the right

But a few lessons, thoughts and reflections picked up along the way:

This is a tough job, physically, mentally and emotionally.

It’s a funny thing – when you’re strung out at the end of a night shift, you can still respond to enquiries and requests, but try to think for yourself and you’re numb. At 6.45am Flatmate was trying to work out how to defrost a soup and I very competently worked my insanely complex microwave for her. However, seconds later I tried to prop open the living room door, picked up the doorstop and essentially tried to glare it into submitting to my will. Flatmate laughed until she cried, but I was just very woefully at the end of my tether.

Putting myself into the shoes of a working paramedic, I can see how you can still respond to patient need and direct instructions, but it probably takes years of training to be able to make good competent decisions at that point in the shift.

The skills required in working as a paramedic far outstrip what you think you know. 

One of my favourite sims was pretending to apply for a role as a paramedic – which required me to log into the NHS jobs portal and take a look at the application. So far, so normal, but I was really, really taken aback by the 12-page long list of competencies and key skills.

I’ve been applying for jobs lately – hey, it’s okay folks, I got it – and generally, most job frameworks can be dealt with in 2, maximum 3 pages. I should be clear – I’m not in medicine, but I like to think that my work (financial services regulation and management – yep, it’s really niche but I enjoy it) is challenging, specialist and fairly complex. It really doesn’t take a huge amount of description to understand what’s required of me in my role. Whether this is a general NHS thing, or public sector thing, I’m not sure, but my last role was public sector and they still valued succinctness is a job description.

Based on my review of the job description and competency framework for paramedics, it seems they’re required to demonstrate that they can be the following:

– taxi driver (“for emergency, urgent and routine” journeys.. so, that’s everything except the shopping, basically)
– basic mechanic – you have to make an assessment of the roadworthiness of your vehicle before your shift starts, including safety.
– cleaner – while you get help at most stations with cleaning up really horrible messes, you’re expected to wipe down and clean up the ambulance. I was given the job of cleaning our bathroom at nearly midnight, which I felt was unfair and awful. However, it’s just in a night’s work for most paramedics.
– facilities worker – if it’s broke, you gotta fix it – or return to station…
– radio operator – breaker breaker!
– drugs security person – qualified paramedics have a little box strapped to them with all the really cool drugs. But most ambulances have pretty cool drugs in them anyway, and the crew are responsible for checking them in and out of station, and accounting for all use while on the road. If the drugs go missing, your job is on the line.
– counsellor – most of the job is listening, and providing advice about health, including mental health.
– cabin crew (“ensure equipment on vehicles is stowed in a safe manner…”)
– medical practitioner – this is the only one I really expected to see…
– rescue crew
– record keeper
– data protection officer
– carer
– risk assessor
– psychologist
– enforcement/compliance officer (“ensure the Trust’s policies and procedures… are complied with at all times”)
– PR/ corporate reputation – you have to be impeccably presented and uphold professional standards at all times, even out of uniform
– financial/resources manager – its your responsibility to make sure you’re not wasting precious resources.
– health and safety officer
– team player
– manager (senior paramedics are expected to lead the situation they’re in)
– liaison with other services
– teacher
– leader

All in a 12 hour shift. CHUFFING. HECK. I’m not going to go into the whole pay thing in detail, but it would seem to me that for all of this, you’d expect the Lovely One to be earning as much as me, possibly more given that his job is – frankly – WAAAAY more responsible than mine. This is about saving lives and treating patients and all sorts of things. But Flo is paid just over half of what I am. I’m fairly sure I’m not overpaid, so there is a conclusion to be drawn in the other direction.

Put simply, if you work 4 shifts a week, you’re already on 48 hours. In the middle of the night, working on the last bundles of nerves and energy that you have available. You’d expect that to be reflected in the pay, but no.

When you’re trying to get through a nightshift, it pays to get comfy. 

NGL, guys, it was a bit of a cheat. Around 3am I got into my PJs. Not very sim, but my body cried out for comfiness. No such joy for our paramedics.

Even when you *know* it’s a simulation, you suddenly get thrown by certain situations 

One of my favourite things about the simnight was having new, different or unusual situations thrown at me. I’d settle in for a read of a journal or a watch of an instructional video, but I’d get a text instructing me to go to the local dry cleaners to “locate” a patient, which the Lovely One would tell me about once I was there. No running (against policy), but you could feel your heart thumping as you waited for the message telling you if you’d applied the right treatment or not.

We simmed a drunk who didn’t want treatment, some panicky parents who thought their child was having a fatal asthma attack and the classic Nandown – the latter was a real challenge at 5am as I had to move the sofa and get physical at a time when I was really exhausted. But the real test was the 10pm cardiac patient. Starting with a fit and ending in the tragic loss of my patient, I was still reeling from how quickly it had all happened when I was asked to think about how I was going to deliver the news of the death to the waiting family. All in a night’s work – but the rollacoaster of going from treating a seizure, to deciding what drugs I needed, to the physical effort of compressions, to counselling and cups of tea – it was CRAZY.

I found this exciting in a strange way, but there are some real risks in operating at this level of stress over time. I was genuinely crushed by the loss of my milk bottle, and can’t imagine how it would feel if it were a real person. Speaking to some of my backup crew and the Lovely One, they concede that the stuff that they see isn’t normal, and doesn’t exactly become normal, but that they just accept it. Over time, I wonder if that’s sustainable. Mark, one of the backup crew last night, put it really well: “last week I delivered a baby and attended two deaths. And that’s amazing when you think about it, but I just think ‘Oh, that’s what I did last week.‘ And it shouldn’t really be normal to say that sort of thing, but it is in this job.”

But the risks for paramedics over the long term is very real, horribly so:

The wonderful Aryeh has also written very movingly about his own experiences witnessing the effects of PTSD on operational paramedics. Formerly of this parish and now working in Israel, he truly has given me a real insight on the world that my partner and other inhabit.

I definitely get by with a little help from my friends

Flatmate and the Lovely One did sterling work, but I also had a lovely surprise visit from some off duty Paramedics who very kindly gave up their evening rest to come and play pretend with me. It was a real reminder that even if your loved ones are out on the road on their lonesome, they have an awesome team behind them. Colleagues like Zoe and Mark on the road too, or the guys on the end of the radio in the operations centres. They really kept up my morale as I got to the critical halfway point, and were kind enough not to take the piss too much when I revealed the following information:

  1. I was afraid to open the kitbag the Lovely One had left for me to look at, in case I broke anything
  2. What I did lift out (a PVC bag resuscitator), was so alien-looking to me I thought it may but a piece of “lady kit”, if you get what I mean. Fortunately they stopped me before I attempted to demonstrate usage. It could have been ugly.

Friends are awesome – and probably rescued my sanity last night. Thanks to everyone who followed along, helped keep my spirits up and have said such nice things about my rather crazy experiment. You’re all awesome, especially Florian who basically invented the concept of the #simnight and came up with all my cool tasks! You’re awesome.

Isn't he lovely?
Isn’t he lovely?
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