It is 6am when I arrive at the Ambulance Garage. In my vast experience in the Emergency Department – nine years as a porter, which is an assistant to an ambulance driver; followed by four years as a chauffeur and two years as a supervisor – driving the ambulance is the work I prefer.

I go to the staff room to greet the drivers who were on night shift. They will knock off at 7am, while those on day shift duty arrive at 6.30am. An ambulance driver works typically 12½ hour-shifts on a day-day-night-rest-off rotation, amounting to 46? hours per week.

The overlapping half-hour sees a hand-over of the vehicle from one man to the next. The new man on duty checks the oil and water in the vehicle, the oxygen levels in the cylinders, that all accessories are there and that all equipment is in order; he will check the spinal board, scoop, masks, bags with collars, splints and that there are enough sheets and blankets.

The driver knows what should be in the ambulance, and ensures it is fully equipped. It is better if a driver could always drive the same vehicle, because there is a tendency to take better care of something you always have to work with, while you get to know its usual sounds and where things are, however now the fleet has reduced.

I look at the parked ambulances, ready for action – although I have been a supervisor for two years, I would revert to driving one even if it means demotion, if only I could retain my current conditions! Although driving an ambulance is a very stressful job – driving for a patient and driving back to the hospital with a patient is totally different from regular driving – I find it most fulfilling as I could feel that I was helping as much as possible to bring a patient in for medical care safe and sound. When I received so much as a thank you card it was worth more than bread in my mouth. Not that any driver will want or expect thanks, but it feels rewarding to receive appreciation.

I remember how once I was driving an ambulance to Bulebel on a call, when we saw a young girl fly as she was hit by a car on Tal-Barrani road. Following the instructions of the nurse, we promptly stopped to give her assistance, asking for another ambulance to go to Bulebel instead. In the end it turned out that there was a false alarm in Bulebel and it is amazing that we were right on site to give her immediate help. I was so warmed by the experience that I kept visiting her in the ward and we are still friends!

On the other hand, occasionally I reached a site only to find relatives aggravated for the length of time taken in reaching the location, without appreciating the stress involved and the lengths taken to arrive through busy roads. Sometimes ambulances drive as fast as 140km per hour but they are not exempt from red lights; they must stop and look before proceeding otherwise they may cause further accident.

One of the most stressful events I recall was when we received a call to Razzett tal-Hbiberija, where a car had run over two people on the pavement. On arrival we found a mother with her two-year old child.

The nurse established that the child was in such danger that we had to head to the hospital immediately. Unfortunately, we had to leave the mother on site because she had broken bones and it would have taken too much time making splints and moving her.

We fled to the hospital with the child. I drove madly. I scraped cars that were not moving out of the way in time. I had to reach the hospital as soon as possible. This is why the age and reflexes of a driver can be important factors.

The child was still alive when we reached the hospital but alas passed away later, however only after getting the chance to receive proper medical attention in time. Cases involving children are more strenuous, especially if you have your own. I think of my thirteen-year-old daughter and two fostered children, two girls aged ten and four. Somehow it is not as heart-wrenching and stressful when an older person is involved, although we give everybody our best.

It is, however, a shame that the average driver is not sufficiently informed on what to do when an ambulance is approaching. Although people are usually eager to cooperate, sometimes what they do turns out to cause more complications.

In narrow roads it is wiser for drivers to just keep going than pull up to the side and block the way, while sometimes the siren is on and we must drive slowly because of a piercing object or a spinal injury, but people do not understand this and assume we simply have the siren on for fun.

On the other hand, sometimes we must drive really fast through a place like Marsa, with so many lanes, but suddenly all we see are indicators flashing left and right in frantic worry during attempts to move out of the way. In such cases it would be better if they simply drove more slowly or stopped altogether so that the ambulance can easily swerve around the traffic.

However the worst situation is certainly when a severe emergency case requires CPR en-route. The nurse is standing and it is necessary to open the inside window and yell, “Hey I am about to turn right!” and so on, so that the nurse does not fall over. There have been cases when the nurse has been hurt. Communication is extremely important during emergencies.

The phone rings again. The centre of communication is the emergency control room, where emergency telephone calls are received. It coordinates the ambulances, doctors, rooms and equipment according to necessity. Ambulances go out on approximately 2,000 emergency calls per month; this does not include out-patients. A driver makes an average of six trips per shift. When one night I received no calls I was so concerned that I checked with the control room to ensure that everything was in order!

Monitoring is being carried out to reduce the number of unnecessary calls. Ambulances no longer go on calls where it has been ascertained that there is no imminent danger and therefore the patient can reach the hospital by other means. For outpatients, ambulances should only deal with stretcher and wheelchair cases, and not be regarded as a minibus service. People should become more conscious and have more concern for more serious or urgent cases. Especially there should be no prank-calls.

The role of the supervisor includes registering all ambulance calls in a log book, including the drivers’ name, ambulance number, time of call, nurse that passed the call, time out, name of patient, address, time finished and mileage. Each ambulance also has its own individual log book including all its calls and their date, time, mileage, destination and driver.

I go to the staff room to assign the call. Ambulance men from the garage take up the non-urgent cases which do not require the presence of a nurse. The driver will take the address and establish the location prior to departure, either by using a maze or landmarks, because it is not long before he will learn to get around the island very well, including all the short-cuts!

From the garage the ambulance will pick up a porter from the emergency area to assist in bringing the patient to the hospital safely. When there is no nurse present, an ambulance driver must talk with the patient and relax them about the prospective visit to the hospital. Sometimes a patient might faint and, not knowing what to do, the siren goes on and quickly we go! Ambulance drivers want to attend first-aid courses because of the nature of the job, but sometimes bureaucracy is a hindrance.

I walk up to the casualty area to see the ambulance drivers stationed there. Ambulance drivers work shifts in rotation to include the garage, casualty and Mosta polyclinic, which deals with calls from Balzan northwards. In Mosta, one ambulance driver waits on-call at the polyclinic desk. In the hospital’s ambulance garage, four drivers wait on-call in the staff room while two persons dealing with casualty wait just outside the emergency rooms.

Casualty is the most exciting role. The driver cannot be absent from his post outside the emergency rooms for even a moment unless there is somebody else to take over in case of emergency, since in urgent cases no time can be lost. The nurse and porter will come out of the hospital, ride and go!

In cases of extreme emergency, which we coin, ‘resus,’ for resuscitation, the ambulance will sometimes drive all the way to the emergency entrance with the siren on, although it should not be necessary since the roads should be clear from near the hospital gates. However, at that moment all you can think is to bring the patient alive to the hospital.

There are three resuscitation rooms just at the entrance of the emergency area, and the stretcher in the ambulance can be wheeled directly inside where the patient can be shifted onto a couch. In every case, at that point the driver must return the stretcher, clean the ambulance and be ready for another emergency call.

When the ambulance needs washing, such as in cases of extreme blood loss, the ambulance is brought to the wash base and another is sent up from the garage. I recall the Al Faroud explosion, about 10 years ago, as the only time when we had to make several trips without time to clean the ambulance. I remember the calls came in at 9.45pm and I was a porter on night shift.

When there is a case that is considered a national disaster, such as the recent explosions in Naxxar, both casualty ambulances depart immediately while the alarm goes around to be prepared. We may even call the outpatients ambulances and NGOs such as St John’s and the Red Cross to ensure we have enough backup if necessary. The National Disaster Van contains enough equipment for twenty nurses to deal with such cases.

I return to the staff room and look at the men sitting, apparently peacefully, watching TV together until their services are required. But I know that you must be very dedicated to be able to do an ambulance driver’s job. How else can you bring yourself to remove vomit and blood and risk your life on a regular basis?

Each case is different and although in some way it does become the run of things, the fact is that an ambulance driver is constantly risking his life. Apart from the driving itself, ambulance drivers regularly carry adults down several flights of steps, enter scenes of disaster that are still at risk of fire and explosion, and are occasionally required to take medication because of coming into contact with blood, like in the case of Hepatitis B.

Work is part of you and without intention you end up sharing the day’s experiences with your wife. However, working in emergency, there are one-offs you simply cannot discuss with the family.

Especially disturbing is the siren which can often be heard inside one’s head long after home is reached.

Not anyone can do this job, with an attitude of just do the hours and get the wage. An ambulance driver must have an inner tendency to want to help. I never met any of my colleagues who could do this job without dedication... otherwise after a short time it would be impossible to stick it out.

For information contact:

Parliamentary Secretariat for Health

Tel: 2299-2406

www.sahha.gov.mt

This is the 9th of Melanie Drury’s series, “A Day in the Life of...” The next is due on 1 September.

www.melaniedrury.com

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