The Paramedic at Work: A Sociology of a New Profession PDF
Preview The Paramedic at Work: A Sociology of a New Profession
TheParamedicatWork The Paramedic at Work ASociologyofaNewProfession Leo McCann GreatClarendonStreet,Oxford,OX26DP, UnitedKingdom OxfordUniversityPressisadepartmentoftheUniversityofOxford. ItfurtherstheUniversity’sobjectiveofexcellenceinresearch,scholarship, andeducationbypublishingworldwide.Oxfordisaregisteredtrademarkof OxfordUniversityPressintheUKandincertainothercountries ©LeoMcCann2022 Themoralrightsoftheauthorhavebeenasserted Impression:1 Allrightsreserved.Nopartofthispublicationmaybereproduced,storedin aretrievalsystem,ortransmitted,inanyformorbyanymeans,withoutthe priorpermissioninwritingofOxfordUniversityPress,orasexpresslypermitted bylaw,bylicenceorundertermsagreedwiththeappropriatereprographics rightsorganization.Enquiriesconcerningreproductionoutsidethescopeofthe aboveshouldbesenttotheRightsDepartment,OxfordUniversityPress,atthe addressabove Youmustnotcirculatethisworkinanyotherform andyoumustimposethissameconditiononanyacquirer PublishedintheUnitedStatesofAmericabyOxfordUniversityPress 198MadisonAvenue,NewYork,NY10016,UnitedStatesofAmerica BritishLibraryCataloguinginPublicationData Dataavailable LibraryofCongressControlNumber:2021952511 ISBN978–0–19–881636–2 DOI:10.1093/oso/9780198816362.001.0001 Printedandboundby CPIGroup(UK)Ltd,Croydon,CR04YY LinkstothirdpartywebsitesareprovidedbyOxfordingoodfaithand forinformationonly.Oxforddisclaimsanyresponsibilityforthematerials containedinanythirdpartywebsitereferencedinthiswork. Preface There had been warnings about this for decades. Risk assessments and preparednessauditsburieddeepinforgottenfilestores.Principles,proce- dures, and colour-coded flowcharts describing the likely trajectories of a deadlynewdiseasepandemic.AgovernmentsimulationinOctober2016, known as Exercise Cygnus, roleplayed the response of healthcare, local government,police,fireandrescue,andmilitaryorganizationstoaflu-like disease outbreak. It found major shortages and deficiencies in the pan- demicresponse,withthehealthserviceoverwhelmed.Itpredicted400,000 deaths. The findings of Cygnus were deemed ‘too terrifying’ for public consumptionandthereportwasinitiallysupressed.1 Justoverthreeyearslateradangerousnewvirusbrokeoutforreal.The SARS-CoV-2virushittheUKextremelyhard,acrossthreegiantwavesof infectioninthespringof2020,theautumn/winterof2020–2021,andagain in the autumn/winter of 2021-2022. The National Health Service came closetobeingoverwhelmedinthefirsttwopeaks.Atthetimeofwriting therehavebeenmorethanfifteenmillioninfectionsandover15,000deaths attributedtotheCovid-19disease. Working conditions for almost all people were upended by regional and national lockdowns, travel bans, and social distancing measures; by bankruptcy and closure of facilities; and by job cuts and staff sickness absence.Healthcarewasoneofthemosttraumatic,exhausting,andrisky work environments imaginable. Frontline healthcare professionals of all kinds, as well as support, logistical, and administrative staff, had little or nooptionofworkingfromhome.Instead,theycontinuedworkingatthe heartofadreadfulandprolongedcrisis.Newsmediatendedtofocusmost oftheirattentiononhospitalsandonthedoctors,nurses,andotherclin- icianstreatingcriticallyillpatientsinspecialistCovid-19isolationwards. Thehospitalbecameasceneofdesperatebleakness.Staffwereshatteredby theworkload,waryoftheextremeriskofcontractingthevirusthemselves, 1‘ExerciseCygnusuncovered:thepandemicwarningsburiedbythegovernment’,TheTelegraph,28 March2019. vi Preface and emotionally drained by constant trauma coupled with the unbear- ablelonelinessimposedbyisolationmeasures.Patientsweresufferingand dyingwithoutthecomfortoflovedonesatthebedside. Amodernhealthcaresystemisbroadandcomplex,encompassingmany other professions and sites. The clinical workers who are the focus of thisbookworkoutinthecommunity,operatingina‘pre-hospital’work- ingenvironmentthatisatoncecomplex,dynamic,uncertain,andpoorly understood.ClearlythefirstUK-widelockdownofMarch–July2020was extremely challenging for frontline paramedics and for ambulance ser- vices,especiallythecrisisthatenvelopedcarehomes.But,asthepandemic evolved, some elements of working life for ambulance crews were not quite as dreadful as first feared. Paramedics and ambulance services felt the impacts of the Covid-19 pandemic in ways that were distinct and idiosyncratic.Thegeneralpopulationwasextremelycautious,heedingthe government message to stay indoors and massively restricting interper- sonal contact. Members of the public were especially reluctant to go to hospital, and thought long and hard before calling 999 and running the risk of being taken there by an ambulance crew. The broader NHS had alsopostponedorcancelledallnon-urgentconsultationsandprocedures, turningmostoftheirattentiontoCovidpatients.Everydayactivitiesthat often result in people getting injured or sick happened much less often. Therewerefarfewerroadtrafficaccidents.Therewerenoentertainmentor sportseventsforwhichemergencyserviceswouldprovidebackup.There werenocalloutstodrunksortopeoplewithinjuriesfromfighting.Even the psychiatric calls dropped off in volume; many of those often driven by anxiety or depression to call 111 or 999 found ways to suppress that tendency. Ambulances were mostly being dispatched, therefore, to Covid-related calls that were ‘genuine’ emergencies. Emergency funding provided for extra crews on shift, and some locations had support from the Fire and Rescue Service and the Army. Ambulance stations were busy with staff waitingforcalls,meaningthat—unusually—therewastimeforstaffinter- action,toshareadvice,andto‘decompress’afterstressful andexhausting shifts. Each individual crew didn’t receive as many calls as they usually would,butwhenacalldidcomein,itwastypicallyseriousandchallenging. Patientstreatedbyparamedicstendedtobeverysickindeed.Therewere thousandsofcallstopatientsstrickenwithlife-threateningCovid-related conditionssuchaspneumonia,hypoxia,andheartattacks.Forashorttime, thechangedrhythmandactivityduringthepandemicremindedcrewsof Preface vii ‘theolddays’;12-hourshiftsfeaturingonlyaroundfourorfivecallouts,but eachtoapatientfacingagenuinelydangeroushealthemergency.2 The first lockdown was eventually successful in suppressing infection rates,hospitalizations,anddeaths,andUKsocietystartedtoreopeninJuly 2020. But, predictably enough, the rates of Covid infection slowly crept back up throughout late summer and accelerated in autumn. With win- teronthehorizon,thehealthcareeconomywasbuildingtowardsdisaster. By January 2021, the country was back into a lockdown almost as severe as the first one in March 2020. Covid-19 infection rates exploded, peak- ingataround60,000knowninfectionsperday.Hospitalswereonceagain overwhelmed with coronavirus patients. Over a thousand Covid patients were dying every day. Calls to ambulance services now hit record lev- els, such as 8,500 calls per day to London Ambulance Service, instead of the usual 5,000–6,000.3 All around the country, ambulances were stuck in long queues outside hospitals, unable to offload Covid patients for hours because of a lack of available beds inside. Hospitals had tried to keep routine and elective appointments going, only dropping this work- loadtoaccommodatethesecondwavewhentheyhadnootherchoice.The ‘normal’ calls to the ambulance service didn’t drop off. The more recent lockdownwaslessstrictlyadheredtothanthefirst.Thepopulationwasalso stressed,isolated,andexhaustedbyninemonthsoflifeinapandemic,so thementalhealthcallscameback.Virusoutbreaksoccurredwithinambu- lancecontrolcentresandHQs,leadingtoprolongedillness,staffshortages, andworkoverload.Thistimearound,noneoftheparamedicsoutonthe streetsweremakingallusionsto‘thegoodolddays’.Instead,theywere,in thewordsofparamedicandauthorJakeJones,‘frustrated,drained,[and] powerlesstohelp’.⁴ Concerns started to circulate about the probable inadequacy of the personal protective equipment (PPE) issued to ambulance crews. It con- sistedofLevel2PPEtobeworntoallcalls(surgicalfacemask,disposable gloves,andapron),andLevel3PPE(FFP3maskorrespiratorhood,fluid repellentoveralls)tobeusedwhencrewscarryout‘aerosolgeneratingpro- cedures’suchaschestcompressions.OneparamedicdescribedLevel2to 2Anofficialoverviewofthepandemicfromtheperspectiveofambulanceserviceemployersis AACE(2021).Forapersonalblogfromaparamedic,see‘Onthefrontline’,UKClimbing,14April 2020,availableat:https://www.ukclimbing.com/articles/features/on_the_front_line-12718 3‘LondonAmbulanceService:‘Wetakethousandsofcallsaday–it’stough’,BBCNews,18January 2021. ⁴‘EvenastheCovidcrisisaccelerates,paramedicslikemeseepeopletakingrisks’,TheGuardian6 January2021. viii Preface me as little more than ‘a plastic pinny you’d use for making sandwiches’. ParamedicswereseatedwithCovid-infectedpatientsintheconfinedspace ofanambulanceinterior,waitingforhoursatatimeashospitalsstruggled tofindspacetoadmitnewpatients.Staffwerewarnednottobreakproto- colandupgradethemselvestoLevel3insuchsituations.Doingsoinany casewouldoftenseeminappropriateandwouldoffendaparamedic’sun- derstandingofappropriatepatienttreatment—respiratorsorhoodsmake interactionextremelydifficult,withoneparamediccommentingonTwit- ter that the Level 3 gear in use in his Trust makes the wearer look like Darth Vader.⁵ Many broke the rules and donned the gear. Some resorted tobuyingtheirownFFP3masksfromScrewfix. By October 2020, around 1 in 12 paramedics had tested positive for Covid-19andbyJanuary2021,atleast18frontlineambulanceworkersin the UK had died of the disease.⁶ Mercifully, ambulance staff were finally inoculatedbytheendofJanuary2021,withvaccinesprovidingawayout ofthenightmarethatthey,andotherNHSstaff,hadsufferedforsolong. Thevaccinesdidnotfullypreventnewinfections,butwereveryeffective inbreakingthelinkbetweeninfectionandseriousillness.Afurther,pro- longedwaveofinfectionintheautumnandwinterof2021waslesssevere thantheprevioustwo.Thevirusbecameendemic,andalargelyvaccinated society learnt to adapt to live with it without lockdowns and social dis- tancing measures. Still, the NHS as a whole faced a terrible backlog of postponed patient care, and found itself facing drastic operational diffi- culties throughout the year even before it headed into its always-difficult wintermonths.⁷ Iwroteabouthalfofthisbookduringtheyears2020–21.Ihadplanned to finish it long before 2020, and the research data upon which it is based predate the Covid-19 pandemic by several years. But I had to reflectonthesecontemporaryeventssomewhereinthetext.Evenwithout the pandemic, a central theme of the book was of professionals fac- ing stress and burnout, and of trying to serve the public in extremely trying circumstances and with limited support. Already struggling with ⁵Tweetby@ClipboardUK,3January2021,availableat: https://twitter.com/ClipboardUK/status/1345893679244963841?s=20 ⁶TraceyNicholls,ChiefExecutiveoftheUKCollegeofParamedics,toRtHonMattHancock,Secre- taryofStateforHealthandSocialCare,January6,2021.Availableat:https://www.collegeofparamedics. co.uk/COP/News/Rtcollege_of_paramedics_writes_to_the_rt_hon_matt_hancock_regarding_PPE_ for_paramedics.aspx ⁷‘Hospitalsturningambulancesawayasdemandsoars,A&Echiefsays’,TheGuardian,25September 2021;‘Livesatriskfromlongambulancewaits,sayparamedics’,BBCNews,11November2021. Preface ix whatisademanding,exhaustingandprofessionallyunderappreciatedrole, paramedicsfoundthemselvesinthegripofapublichealthcrisisofdisas- trousproportions.Theyhadtodigdeeptofindyetanotherwellofenergy, resilience, and goodwill. Somehow they found it. Ambulance staff work- ingdayandnightduringthepandemicplayedacriticalroleincaringfor peopleindireneed,justastheyalwayshavedoneandcontinuetodo.This bookisdedicatedtothem.
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