"There's no protocol if someone
dies on the phone," says Glen Griffiths. "You have to give what
advice you can and afterwards you agonise over whether you could have done
something differently and saved the life."
Griffiths has been an emergency
medical dispatcher for the London Ambulance Service for two years. His is one
of the voices callers hear when they dial 999 and ask for an ambulance and, at
21, he has dealt with almost every emergency conceivable. "Electrocution,
explosions, a monkey attack and people getting objects stuck where they
shouldn't be. A lot of the calls are about choking," he says. "It
puts the heat on me; I get in a panic and try to find out where they are and
suddenly they say calmly, 'It's OK, the obstruction's cleared now', and they
put the phone down."
Griffiths found his way into the emergency
services via Sainsbury's. "I was working in the internet
shopping section dispatching deliveries and it was not challenging," he
says. "My dad works for the London Ambulance Service and my mother is a
nurse, so healthcare is in my blood, and the hair-raising dinner table
conversations they had at home mean I'm not squeamish. I'd just never considered
being qualified to work in health myself until my dad mentioned there were
vacancies."
Here comes the second surprise of the
evening. No university degree or healthcare background is required to be a call
handler. Four weeks of training in first aid and relevant computer programs and
one-to-one support for the first 10 shifts are all that is needed to equip new
recruits to cope with medical emergencies. "All the medical knowledge is
built into the computer systems and we have a lot of support from our supervisors,"
says Griffiths. "We're not clinicians."
No training can fully prepare a
beginner for the stress of taking calls from casualties or bystanders in
desperate situations. "I was extremely nervous the first time," he
says. "My first ever call was from a lady who'd fallen over inside a
friend's flat and her mobile kept cutting out. I had to try to work out where
the building was from call signals.
"There are so many different
types of call that until you've taken a handful you're still nervous. Even now,
some can throw you into the unknown, like cases breathing difficulties, because
there can be a range of causes from seizures to hanging. Then there might be a
language barrier or aggression at the scene and often people haven't a clue
where they are, especially if they're on a motorway."
It's a strange limbo that the medical
dispatchers inhabit. The lack of windows seals them off from the outside world
they are so urgently assisting. There is no indication of whether it's day or
night, fine or stormy, and frequent 12-hour night shifts mean they go home to
dinner as the rest of London is breakfasting. Social interaction with
colleagues is conducted in half sentences, severed when a bleep through the
headphones announces a new call. "It's odd when we all meet in the pub
after a shift," says Griffiths. "We talk hesitantly because we keep
thinking we hear a bleep in our ear."
Mostly it's not worth attempting
a conversation and the dispatchers sit in silence, poised for the next
alert. They talk callers through what is often one of the most desperate
experiences of their lives and yet they never meet those they hand-hold and
never find out what happened to them after the ambulance has collected them.
Despite this, Griffiths finds the job
intensely fulfilling. "It's very satisfying to know that help has arrived
for somebody," he says. "Although you often wonder what the outcome
was."
Sometimes the outcome is
traumatically evident: the casualty dies while still on the line. Griffiths
reckons that two years has inured him to most situations, but occasional cases
have reduced him to tears and a couple have forced him to take stress breaks.
"There was a teenager who called because his 10-year-old sister had taken
an overdose and, while I was instructing him in CPR, she vomited blood. She
didn't make it," he says. "Different things can hit a nerve. If
you're newly wed and someone's wife is taken ill, for instance, or if you've
just had a baby and someone calls with a seriously ill child. Supervisors can
always tell when someone has taken a difficult call and they send them off for
a coffee break."
Pictures of lakes, flowers and
seascapes dot the walls of the Pit, although their calming purpose is mocked by
the staff. "We call that one Despair, that one Anguish," says a wag
beside Griffiths before a call cuts him short, mid-jest.
It's extraordinary to see how
Griffiths and his colleagues can switch from a casual conversation to emergency
mode, without any alteration in their tone. The prompts from the computer are
so familiar – address of the caller, nature of the problem, whether the
casualty is conscious – that they can run through them dispassionately while
speed-typing each detail on to the screen. The computer does most of the
thinking, automatically dispatching an ambulance as soon as an address is typed
in, deciding which of several described symptoms is the most critical and
classing the case into one of four levels of urgency. A line of icons will
click through to diagnostic questions for 35 different scenarios from gunshot
wounds to animal bites.
But occasionally the dispatchers have
to veer from the script to calm distraught callers or stabilise an aggressive
situation. "You get strange reactions from people under pressure,"
Griffiths says. "Some are completely deadpan, almost robotic until the
ambulance comes and then they break down. Some are abusive and some simply
scream and you have to use repetitive persistence, asking the same question
over and over, to get through to them. The most frustrating thing is when somebody
rings on a mobile to say their friend has been shot, then they put the phone
down. People assume you know where they are."
The two dozen staff on each shift sit
in pods before two computer screens, one to interpret and act upon the clinical
data and one displaying a map of London. On it, coloured circles denote
ambulances en route – amber signifies help on its way, red shows the crew has
arrived at the scene or are returning to hospital.
The first call of Griffiths' shift is
from a carer who has found her elderly charge on the floor with a suspected
stroke. Within minutes a moving orange circle shows an ambulance on its way.
"Some people here are
superstitious and think that certain chairs attract more trauma,"
Griffiths says. "I'm a bit of a trauma magnet. The air ambulance crews get
sick of me."
The biggest event he has had to cope
with was the London riots: "There were a lot of assaults." Other
cases stick in his mind because they are so unusual. "A man called because
his hand was stuck behind a radiator and he knew his central heating was about
to come on," he says. "Another man called because his wife had gone
into labour [Griffiths has delivered five babies over the phone]. He was
perfectly calm until he realised the baby was going to be born on his new sofa.
He began shouting that he hadn't paid it off yet, and his mother-in-law had to
send him from the room."
This evening's shift is proving
unusually quiet. A woman calls because her brother has a nose bleed and an
assault victim rings for a second time because his bleeding chin is staining
his carpet. Both cases are ranked low priority by the computer. The casualties
will probably get a call from a clinical team dedicated to non-urgent maladies.
"We get a lot of trivial calls –
people who have seen a fox run over. But we have to understand that for them
it's a frightening experience and we direct them to a more suitable source of
help," he says. "Then you get people who have experienced real trauma
such as the second world war, who don't like to bother us. My trainer took a
call from an elderly lady who had fallen in her bathroom on a Friday evening.
She kept herself alive over the weekend by drinking bath water and rang us on
the Monday to ask if we were open."
It would be understandable if the
continual stream of disasters that filters through Griffiths' headphones made
him nervous about life's unpredictability. Instead it makes him sanguine.
"It's inevitable that accidents happen and if one occurred around me I'd
switch into work mode," he says. "Friends find me unsympathetic if
they are unwell because I'm used to so much worse."
He has, however, no desire to put himself on the scene of
a crisis and train to be an ambulance technician or paramedic. "I can deal
with blood and guts," he says. "But the smell of vomit undoes me. I'd
rather be safely on the end of a telephone line."
By Anna Tims
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