Baby Choking? Neighbourhood stabbing? Or do you just want the number of your nearest Pizza Hut? One woman has answered every 999 call imaginable

I am an Emergency Medical Dispatcher. In other words, I am the person on the other end of the phone when you dial 999 for an ambulance. If you were to walk into the London Ambulance Service’s control room — a dingy windowless pit housed in a 1970s monolith in Waterloo — and peer into the call-taking area, there I’d be, scribbling notes on the back of a rejected annual-leave slip.

The call-taker’s job is to follow protocol. The things that we are supposed to find out and the instructions we give are all scripted.

But there’s one thing you can’t write a script for, and that’s finding those magic words that get through to callers and get them to do whatever is necessary to help the patient. It’s about staying calm and detached when chaos reigns on the other end of the phone, without giving the impression that you don’t care. It’s about biting your tongue and staying professional when faced with timewasters. It’s about treating all callers as equal yet different.

The problem is, it isn’t like it is on TV. In soaps, characters often just call for an ambulance, bark an incomplete address and then hang up. And then — nee naw nee naw nee naw — the ambulance arrives. In real life, making a 999 call is considerably more like hard work — for both caller and call taker.

I was distracted today by fulfilling something that has been an ambition of mine since my first day at Ambulance Control. The location was the toilets of the Leek and Winkle pub in Romford. The poor mother-to-be had been out shopping and had suddenly gone into labour. She’d headed for the nearest pub to seek help. A member of staff had called 999, but as no one realised how close she was to giving birth the call was classified as green, meaning we’d not sent anyone yet.

After going back to check on the mother, the barmaid called 999 again and it was me who answered.

After finding her original call, I went through the questions again to see if the call needed upgrading. The signs all pointed towards “delivery imminent” but I wasn’t getting excited. A lot of people insist the mother is having contractions less than a minute apart when really she is walking around with her tights on and won’t deliver until sometime next week.

Well, that wasn’t the case here. I asked the barmaid to look between the mother’s legs. “I can see the head!” she exclaimed. It was all systems go from that point. I pulled up the maternity card on the computer and rattled off the instructions.

Me: As the baby’s head delivers, gently place the palm of your hand against the vagina to prevent it delivering too quickly.

Barmaid: OK . . . it’s coming out! What next?

Me: Support the baby’s head and shoulders as it delivers. Remember, the baby will be slippery – don’t drop it!

Baby: WAAAAAAAAAAAH!!!!

Fortunately, it was a straightforward birth — head first, cord not around neck, crying straight away, and all that needed to be done was to wrap the baby in a towel and give her to her shellshocked mother.

The ambulance crew entered seconds after the birth, right on cue, so I didn’t have to faff around with the cord and afterbirth, which is a good thing. One step at a time!

My first BBA is an important milestone for me. My others were my first cardiac arrest (which I had in my first week), my first cardiac arrest in a non-elderly person (which was a terminally ill eight-year-old — the way the parents seemed resigned to his death broke my heart), my first stabbing (utter chaos), my first rude person (an elderly man who was waiting for an ambulance to take him to a routine hospital appointment and didn’t understand that emergencies come first).

I’m still waiting for an embarrassing sexual accident, a suicide and a drowning. Not that I’m going to enjoy any of these things, of course — but I know they are coming and I know I need to get them over with. I want to know that I am able to cope with anything.

Death by milkshake August 23, 2005

I couldn’t sleep last night thinking about the 14-year-old boy who’d died. Perhaps it was the way that sentence hung in the air: “I told him not to do it.” What did he tell him not to do? I spoke to the ambulance crew who’d attended, and I told them what I’d heard on the phone.

“The scene was exactly as you described it,” said Steve, the paramedic. “I’ve never witnessed such grief and it was really heartbreaking. The lad was clearly beyond all help when we got there, but we gave it our best shot anyway — just so the parents would know we did everything we could. From what I could tell, he’d aspirated on a milkshake – that means it ‘went down the wrong way’, into his lungs and stopped him breathing. He basically choked to death.”

“That’s terrible,” I said. “I can’t believe it was something so simple. Oh, one more thing. His dad kept saying on the phone ‘I told him not to do it’. What did he tell him not to do?”

“Drugs,” said Steve. “There was some cannabis by his bed — I’m guessing he was having a spliff, got the munchies, went for one of those thick shakes but was so drowsy he didn’t drink it properly, and that’s how he died. His father must have thought it was the drugs that killed him, but really it was the milkshake.”

“Death by milkshake,” I said solemnly. “What a waste.”

There, I said The Word . . . November 22, 2005

Isn’t it funny how people are scared to say words connected with death? Here are some examples of what callers have said to me on finding a deceased body.

“I think the worst has happened.”

“He’s not conscious . . . quite the opposite.”

“He’s very cold and blue in the face.”

“She’s gone all black and smells bad.”

“He seems to be very seriously injured.”

“He’s been very depressed lately . . . I think he’s cut himself or something.”

The latter was the biggest understatement I had ever heard. The patient had slashed his wrists, taken an overdose and then hanged himself. The ambulance crew reported that the room had blood running down the walls and was like a scene from a horror movie. The “very seriously injured” man, meanwhile, was found 50m from his head after a run-in with a pillar while on his motorcycle.

The Ambulance Service is equally reticent about using words such as “death” and “dead”. There are specific pieces of ambulance jargon to get round ever having to use them. The first of these is the gloriously optimistic “suspended”, which refers to a patient who is unconscious and not breathing. All non-breathing patients are presumed to be in this state until the caller says otherwise, and we waste no time in doing everything we can to coax the caller into doing CPR [Cardio- Pulmonary Resusitation]. In most circumstances when someone has not been breathing for three minutes, they are beyond resuscitation. Then we put “purple” on the ticket (which, incidentally, is a randomly chosen code word and not a description of the colour of their face) — which lets the crew prepare themselves for comforting bereaved relatives rather than whipping out their bags and masks.

“Purple plus” is what we call a patient who is definitely dead. I’ve noticed that other call takers are very jumpy about declaring a patient to be dead; even if they dare to write “purple” or “suspended”, it’s usually prefixed with a “?”, as if writing that the patient has died on the ticket will increase the likelihood of this being the case. Sometimes, when feeling slightly delirious from lack of sleep, I feel like marking my tickets with “DEAD” instead of one of these namby-pamby euphemisms and sending it off like that in all its unadulterated starkness.

Call of the Day December 15, 2005

Caller: “I’ve eaten too much, and now I feel really sick. Can you die from eating too much? Can you die from eating too much in one go? How much would you have to eat?”

Vicar stabbed on parish round December 17, 2005

“Ambulance Service, what’s the problem?”

“The vicar’s been stabbed!”

It sounded like a screwed-up episode of Father Ted, but it was no joke.

“He just turned up at my door. He’s got a huge knife sticking out of his chest . . .” continued the poor parishioner.

“DON’T PULL IT OUT!” I said. I had just been reading a copy of Chat magazine where a clumsy DIYer had narrowly escaped death after inadvertently shooting himself with a nail gun and attempting to remove it with a pair of pliers, and I know from experience that when people see objects stuck in other people, their first reaction is to pull the object out. This usually does more harm than good.

I take a lot of calls about stabbings — usually in Romford at 2am on a Friday — and most of them are just a small flesh wound sustained in a scuffle. This time it was different, though.

In all the time I have been working here, I have never come across a more co-operative, sensible, quick-thinking caller. There were a lot of things to be done before the ambulance arrived, and he must have grown several extra pairs of hands to be able to do them all. He never once complained or thought it was too difficult. He just got on with it. First, he did as he was instructed to stop the bleeding (taking off his shirt and wrapping it around the wound, avoiding the knife itself ), then he got the vicar down on the floor and raised his legs (treating for shock) and followed my instructions to keep the vicar’s airway open as he was fast losing consciousness.

He shouted outside for help and some neighbours came, which meant one could hold the shirt on the wound and another could keep his airway open. I asked about the location of the attacker — the last thing we want is for the ambulance crew to get stabbed — and the caller managed to ascertain that he’d run away.

He then had the bright idea of asking the vicar various questions about what the man looked like. Unfortunately, the vicar was in no state to give much information and, three minutes into the call, he started to convulse. This, obviously, is not a good sign and I was relieved to look at the log and see that a Fast Response Unit (FRU), an ambulance, the police and a Helicopter Emergency Medical Service (HEMS) car were on their way.

The FRU pulled up at the scene a few seconds later and my job was done. I hung up, feeling very proud of the caller, because it doesn’t matter what instructions I give or how fast the ambulance gets there, having a caller who has a grip on the situation is the most important factor in those first vital minutes.

Crying Baby January 23, 2006

Me: Ambulance Service, what’s the problem?

Girl: My baby won’t stop crying! She is teething!

Me: Er, is there anything wrong with your baby? Do you think she might be ill?

Girl: No, she ain’t ill! She’s teething!

Me: So, let me get this straight — you want an ambulance because your baby is teething, and you’re sure there’s nothing else wrong?

Girl: I need some ’ELP ’ere! She won’t stop crying!

Me: OK, then. (And I launch into our “catch-all” sick-person protocol, which attempts to identify if the patient has any of the “priority symptoms” that we look for, and can sound quite oblique and nonsensical if they don’t.) Is she conscious? Is she breathing? Is she breathing normally?

Girl: Well, of course she is! There ain’t no need to ask sarky questions!

Psychiatric patients June 6, 2006

Psychiatric patients are some of my favourites, just behind deaf old people. I could sit and take calls from them all night. I had the following conversation with a psychiatric patient:

Me: Emergency Ambulance, what’s the problem?

Him: (In calm and friendly tone.) I think I need to go to A&E. I self-harmed yesterday.

(At this point I am thinking, “Yesterday? And you want an ambulance now? Timewaster!”) Me: How old are you? Are you feeling violent? Do you have any weapons?

Him: (Fairly cheerily) Thirty-eight. No, I’m not violent. I just think I need to see a psychiatrist and get myself sorted out.

Me: And when you self-harmed . . . what did you do? (I’m expecting him to say “I cut my arms” at this point.) Him: Well, I tried to cut my penis off! That’s not a good thing, is it? So I think I need to go to hospital to get my penis sorted out. And then some psychiatric help to make sure I don’t do it again. Oh yes! And I tried to burn my house down with me inside it. I managed to put the flames out! That was lucky, wasn’t it?

Me: Oh! Um! Er! Are you burnt? How is your penis?

Him: I’m not burnt. I managed to put it out in time. And my penis just has superficial cuts on it. It’s harder to cut it off than you think, you know.

The dispatch desk decided that our crew would wait for the police, and a few minutes later we got a message from a rather shocked police person: “Ambulance asap please! Call as given! Male is not very well!” We took him to the hospital and I hope he managed to get himself into a good psych ward somewhere. I still can’t quite get my head around the way he calmly and almost cheerfully described the events to me as if he were ringing about someone else.

Choking toddler June 7, 2006

“This is Snowball Nursery in Southall,” cried the panicking nursery nurse, “and we have a little boy choking on a rice cake!”

This was a proper case of complete obstruction choking — quite rare for us to come across as call takers, as most people realise that they have to do something straight away if someone is choking. Most of the choking calls we get are cases of partial obstruction, where all we do is encourage the patient to cough it up themselves and wait for the ambulance (backslapping in this case may completely block the airway). The toddler was completely unable to breathe, turning blue and losing consciousness. The nursery staff had tried backslaps and the Heimlich manoeuvre without success.

I was glad I had the software in front of me because this was a situation I had never dealt with before. I could give the instructions for an unconscious or suspended patient without even glancing at the screen, but definitely not for a choking patient. After telling the software the child’s age, current condition and what the nursery staff had already done, it told me that the next thing they should try was to straddle the child (who was now collapsed on the floor) and give an abdominal thrust from above. I passed this on to the nursery nurse, who instructed the child’s mother to do that. It’s not often that you get to tell people to punch a toddler in the stomach! She did this, making a delightful squidging sound.

“He looks a little less blue . . . yes, I can see that he’s breathing!” exclaimed the nursery nurse. I told her to look in the little boy’s mouth and fish out the offending rice cake. This she did.

“Youch!” she cried. “He bit me! Oh well, I suppose that’s a good sign . . .”

At this point the toddler started to cry.

“Oh, thank God for that!” said the nursery nurse. “I’ve never been so happy to hear a child crying!”

Suddenly she burst into tears and so did the child’s mother. It’s not often you hear people crying with relief/happiness so I even started to feel a bit misty eyed myself. I was really glad that they waited until the child was OK to fall to pieces. Perhaps it’s some kind of primitive instinct that makes us protect our offspring. Anyway, it was a couple more minutes until the ambulance arrived, so I had a nice chat with the nursery nurse. She asked for my name — perhaps the nursery will send me a thank-you letter. I hope so. I have never had a thank-you letter before!

No one died of a broken leg February 10, 2007

We got a call from a local rugby pitch with a substantial amount of graphic detail: “Rugby player has split leg open, bone protruding, foot pointing in wrong direction.” Yuck! My worst nightmare! It’s at times like this I am grateful I am the one sending the ambulance and not the one who has to witness such things.

I sent the nearest available ambulance. Three quarters of an hour later, the crew placed a blue call.

Although blue calls are usually for patients whose lives are in immediate danger, a serious injury like this can result in amputation. It needs surgery as soon as possible, as well as specialised trauma doctors, so the blue call helps the hospital to prepare.

It was literally seconds after the crew had given the blue call that we received a further call from the rugby club.

“Second patient,” it read. “Forty-year-old male has fainted.”

“Ha, ha, ha,” I laughed, “these rugby players aren’t as hard as they look. I bet he took one look at that fella’s leg and came over all funny.”

Then I stopped laughing. The call taker had updated the call.

“Patient has stopped breathing. CPR in progress.”

“Quick, Snowy,” I told the radio op, “GB [general broadcast]this for someone closer while I send a Greenwich crew from station.” Greenwich was four miles away — we needed someone closer than that.

“General broadcast all mobiles on channel 1, currently holding a Cat A call for Woolwich Rugby Club, a forty-year-old male in cardiac arrest . . .”

“Ding, ding, ding!” went the radio as two nearby crews offered to help. I cancelled the Greenwich crew and waited.

“Ding! “ went the radio again. This time it was the crew who were blueing in the patient with the broken leg.

“We’re going back to the rugby club,” they told Snowy. “Could you advise the hospital that we’re delayed bringing our blue call in? We were on our way but our patient heard your GB and insisted we turn back.”

“All received,” said Snowy. ‘There are two vehicles on the way to the rugby club, please render aid until they arrive and then I’ll show you continuing with your blue call.”

I felt so sorry for the guy with the broken leg. Imagine sitting in the back of an ambulance, in excruciating pain, worrying about whether you are going to lose a leg, thinking that things couldn’t get any worse, then hearing that one of your friends has just dropped dead — possibly due to the stress of seeing your injury!

Half an hour later, all three ambulances were at the hospital.

The guy with the broken leg went straight into surgery. The doctors crowded around his friend, pumping his chest, injecting him with drugs, attaching monitors, shocking him with the defibrillator. But there was nothing they could do. By the time the first patient woke up with a steel pin in his leg, the doctors working on his friend had called time of death, covered his face and taken the body to the mortuary.

I received a call from the crew who’d taken him in.

“Do you have the phone number the rugby club used to call 999?” they asked. “We only know his first name. I know we could ask the patient with the leg injury, but . . .”

She tailed off, but I knew exactly what she was thinking.

Broken-leg guy had been through enough for now. I gave her the number of the rugby club, thinking of that poor man’s family sitting at home waiting for him to come home from his match, dinner on the table, waiting and waiting until finally they received that phone call. I was grateful that, while this job involves lots of unenviable tasks, breaking the news to relatives isn’t one of them.

Top Ten Most Pointless 999 Calls I Have Ever Taken

There’s a bee in my front room!”

“I’ve stubbed my toe!”

“I had a dream my friend has been shot. I tried to ring him, but no one answered. Can you go round and make sure he is OK?”

“My cat has scratched me!’’

“I’ve just got a new SIM card, and I don’t know the number.

Could you tell me, please?”

“My boyfriend has a boil on his bottom and can’t sit down!”

“There’s a rat in my kitchen!”

“My child has stuck a pea up his nose!”

“I think I’m going to get an abscess in my mouth!”

“I had an accident last week and was taken to hospital by ambulance.

I’ve just been discharged and there is blood all over the carpet. Could you come round and clean it up?”

Common beliefs held by the public about 999 calls

1. The louder you shout, the faster the ambulance will come.

2. The faster you speak, the faster the ambulance will come.

3. Even though the call taker asked for the address of the emergency, what he really wants to hear is a detailed description of what happened, starting with the patient having his tonsils out in 1962.

4. The ambulance cannot possibly leave the ambulance station until you hang up. Hanging up several times will make the ambulance come twice as fast.

5. The call taker will never have taken a 999 call before so they need to be told that a man under a truck is a “serious emergency” and that the ambulance “had better get here quick”.

6. There is only one person who works for the Ambulance Service. If you call back, the person you speak to will know exactly which of the 3,500-plus daily calls you are talking about .

7. The Ambulance Service have an ambulance parked at the end of every road, enabling them to reach any location within 30 seconds.

8. If you don’t know the answer to a question, provide an irrelevant piece of information instead:

Q: “Is he changing colour?”

A: “He’s in a lot of pain.”

Q: “Has she passed out?”

A: “She is upstairs.”

Q: “Is she conscious?”

A: “She’s a black woman.”

9. “Conscious” and “unconscious” mean the same thing. Common causes of unconsciousness include: being in too much pain to talk, Alzheimer’s disease, being a bit upset.

10. Call takers work for British Telecom. They also have the phone number for your local hospital, GP, social services, Pizza Hut.

© Suzi Brent 2010 Extracted from Nee Naw: Real Life Dispatches from Ambulance Control, to be published by Penguin on March 4 at £7.99. Available from TimesBookshop for £7.59 (08452712134; tolbooks.co.uk )

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