A Paramedic's Pandemic

A view from inside. Hilary Morgan gives us a window on her experience.

Rewind a year to early March 2020, an 80s music weekender at Butlin’s, Bognor Regis. Crowded dance floors, hot buffet food halls, no sign of facemasks or social distancing. And yet there was a hint of what was waiting for us all just around the corner, as hand sanitiser dispensers had been placed at entrances to all hotels and buildings on the resort and I felt compelled to wash my hands at every opportunity. That weekend, the number of confirmed Covid-19 cases in the UK rapidly increased above 200 and the first few deaths were reported. I recall arriving home from a fabulous fun weekend, unpacking the life size cardboard cut-out of Harry & Meghan that I’d won at Bingo Bango (!?), then rushing to the shop to buy cans of soup – no toilet roll hoarding here! By the following weekend the Cheltenham Racing Festival had gone ahead, but the Football Association had postponed all matches due to Covid-19. Another week later and the schools had closed along with, at very short notice, cafes, restaurants and pubs.

From 23 March, the public were being urged to “Stay at Home, Protect the NHS, Save Lives.”  Forty-eight hours later, our first two working NHS Doctors died from Covid-19. The following evening saw the inaugural clap for NHS workers, which I vividly recall because I was parked outside a patient’s house at 8pm while a paramedic colleague was inside carrying out an assessment – an example of crews attending solo where possible in an attempt to limit exposure to the virus. It was an emotional experience and something that continued to boost morale as we ploughed through the first wave of the pandemic.

Those familiar with me may recall that I joined the ambulance service in 2011, working full-time as an Emergency Care Assistant while studying for my paramedic qualification, which I achieved three years ago. I work from Salisbury ambulance station, spending much of my time in South Wiltshire but occasionally venturing down home to the Poole & Bournemouth areas. How could I have imagined the challenges that 2020/21 would bring when I changed careers a decade ago?

One of the biggest issues for paramedics has been the cascade of rapidly evolving changes to working practices. It’s impossible to express how overwhelmed everyone felt, particularly in the first few months of the pandemic, as update after update was received. Personal Protective Equipment (PPE) guidance, new respiratory assessment guidance, ever-changing hospital conveyance guidance (which differs for each individual hospital), management of cardiac arrest guidance, face-to-face assessment of covid-19 patients guidance, bypassing of A&E for paediatric patients guidance, new telephone numbers for urgent clinical advice, changes to Out of Hours GP services, introduction of dedicated respiratory assessment units, construction of temporary overflow morgue facilities, introduction of virtual covid-19 wards for patients managed home… I could go on!

The simplest but most obvious change was the wearing of face masks, aprons, gloves and eye protection for the assessment of every patient. This came with explicit instructions, in the form of a training video, on how to don and doff the PPE – yes, there is a right and wrong way to do this! What wasn’t included in the instructions was guidance on how best to inform my patients that there will be a delay entering their homes while I don PPE. In a profession where every second counts and staff time is monitored and reported upon by the minute, it feels as though the donning of PPE takes an eternity in the rear of an ambulance while a concerned relative waves at the crew from their front door. PPE has evolved from time to time, with my latest pair of goggles finally overcoming the issue of steaming-up;  I recall with some amusement my first time in goggles, when my crewmate’s prescription glasses fogged up so badly behind his face shield that we were overcome with laughter at the absurdity of the situation.

Then there were Easter eggs, hundreds of them donated by shops that were closed. Followed by other food supplied for free by local restaurants, then cases of non-alcoholic cider, hand cream, two new coffee machines from Nestle (with a lot of coffee & biscuits), discounts on takeaway food and packets of sweets left on ambulance windscreens. On Christmas Day, The Yew Tree Inn generously donated and delivered 18 three-course roast dinners to Salisbury ambulance station for the daytime duty crews.

In April 2020 I tested positive for Covid-19 and spent a very unpleasant week experiencing various mild to moderate symptoms. I wasn’t completely better until three weeks had passed, although I was able to return to work having missed only three shifts. The psychological effects of this illness were interesting, especially at night. Why are things always scarier in the dark? The media were hysterical with reporting Covid-19 at that time and, with stories of seemingly healthy working age people succumbing to the virus, I was almost afraid to go to sleep in case I didn’t wake up. I had a few prayerful debates with God during those hours!

Did I contract the virus at work? I think so and I believe that I could pinpoint the exact time that I caught it, having attended to a very unwell patient five days prior to the emergence of my symptoms. The patient unfortunately passed away the day after I conveyed them to hospital, from complications related to Covid-19. Was my illness inevitable, working as a paramedic? Probably... there aren’t many staff left at Salisbury ambulance station who haven’t contracted the virus over the past year, in spite of our PPE.

Like many, I have also endured lockdowns when not at work. The latest one from 5 January seemed particularly hard, coming as it did so soon after our cancelled Christmas gatherings and also combined with the adverse effects of cold, wintery weather. Lockdown in spring 2020 was so much more bearable with warm, sunny days and gardening tasks to busy us!  I think perhaps Joshua 1:9 has taken on extra meaning for me during everything that we have endured at home and at work over these months: “Haven’t I commanded you: be strong and courageous? Do not be afraid or discouraged, for the Lord your God is with you wherever you go.”

Hard though the past year has been in the ambulance service and wider NHS, I am personally pleased and perhaps a little proud that I have played a small part in tackling the effects of the Covid-19 pandemic. Even in the depths of January, when quite literally every other dispatch of my ambulance was to a patient with Covid related illness, I felt privileged to be able to enter other households when so many people were feeling the effects of isolation due to community stay at home orders. The circumstances were varied – sometimes my only role was to provide reassurance and advice, along with a cup of tea perhaps. At other times, when conveyance to hospital was required, or perhaps some immediate life-saving treatment was needed at the scene, my people skills mattered as much as my medical training. We care not only for the sick and dying, but for their families; the absolute hardest part of my job was explaining to patients, husbands, wives, sons and daughters, that escorting their loved-one in the ambulance could not be accommodated and that hospital visiting was also prohibited. All done from behind goggles and a mask!

For years it has been a practice of mine to encourage the people upon whom my patients rely the most to say their goodbyes before we leave their home, in whatever form they choose – a hand hold, a kiss, perhaps simply a wave. But since March 2020 this has taken on a new significance due to the restrictions placed upon NHS practice and accessibility. Every one of us longs for a return to normality and this is certainly one paramedic who will be rejoicing the day that PPE rules might be relaxed and my smile can once again be used to comfort my patients, their relatives and my colleagues in our work.

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