A day in the life of a Cumbrian paramedic

It's his second fall that day, following a heavy bout of the flu that has left them both feeling weak and unsteady.

The North West Ambulance Service are soon there to help.

Although distressing for those involved, these types of fall are seen all too regularly by 999 crews - and particularly in Cumbria where there is a high proportion of elderly residents.

Advanced paramedic Vinny Romano is first on the scene, followed closely by a local ambulance crew.

The fall is just one of a series of urgent incidents they will see on a typical winter's day in Cumbria.

On this particular shift, the call-outs also include an elderly woman who has suffered a suspected cardiac arrest at home and a man struck down by chest pains while at work in a local factory.

As an advanced paramedic, Vinny works across the area, seeking out the most serious or complicated incidents.

His aim is to assist the ambulance crews at the scene, provide a fresh perspective and give specialised treatment. He is also on the end of the phone for crews who need specialist advice.

Living in Cumbria with his wife and four kids, Vinny became a paramedic after working in the patient transport service.

Usually he would take people to and from hospital, but occasionally he would attend urgent call outs - including a train crash, caused by a landslide, near Kirkby Stephen in 1999.

"We just got a call to say there had been a train crash and they wanted us to go. It was mildly terrifying going to something like that.

"But there was also a sense of excitement. It made me realise what I wanted to do and I applied to be a technician," he said.

Nowadays ambulance staff need to complete a degree but back then the entry route was slightly different.

Vinny was sent on an intensive residential training course, studying every day for nine weeks to get qualified.

He still remembers one of his first jobs, rushing to the scene of a car crash near Penrith with his blue lights and sirens on.

"The training prepares you well but there was also this rush of adrenaline. I still feel that now. I still love coming into work - if I won the lottery I'd still come in for my shift," he said.

Vinny went on to train as a paramedic, then later an advanced paramedic (AP) - a role he has now had for seven years.

He is now one of six APs across the north Cumbria and Morecambe Bay region, plus one consultant paramedic. Each had their own care, stocked with specialist kit and drugs, ready for most emergencies.

On this particular day, one of his first calls is to the west of the county for a suspected cardiac arrest. These are the most serious incidents the ambulance service deals with as the heart is failing quickly and patients have only a slim chance of survival.

As an AP, Vinny is on high alert for these incidents. Where possible he will rush to the scene and assist the ambulance crew, managing the scene to ensure the patient gets optimum CPR.

Sadly on this occasion the patient - a woman in her sixties - cannot be saved. She has died in her sleep.

For the crew, attention turns to the rest of the family. The woman's partner has his own health issues and they need to make sure he has the support he needs before leaving the scene.

Shortly afterwards and another 999 call comes in. This time it is the elderly man who has fallen in his bathroom.

They carry out various tests to try and determine why he has fallen, then use specialist equipment to help him up off the cold floor.

He isn't seriously hurt, but is in his seventies, quite shaken and has a long list of other potentially serious health conditions.

The crew ask questions about his medication, recent illnesses and carry out tests to see if there are any obvious reasons he may have fallen. Ideally they want to avoid admitting him to hospital, as it will increase his risk of infection and different surroundings can leave elderly patients disorientated and at risk of further falls.

But on this occasion, because it is his second fall that day, there is no clear explanation and he would be likely to fall again at home, it is decided he needs taken in for further tests.

The next call for Vinny is to a man in his forties who is suffering chest pain, and potentially a heart attack, at work.

Vinny rushes to the factory, arriving just after the ambulance. The team carry out an ECG to monitor the heart and the worker explains that he suffered similar strong pains the previous day.

After a detailed assessment, he concludes that it is unlikely - but not impossible - that it is a heart attack. However, the only way to find out for sure is to go to hospital for further tests.

During the day, Vinny also gets mobilised to a number of reports of road crashes, though is stood down as none turn out to be serious.

Trauma injuries are another specialism of his, so these road traffic collisions (RTCs) are also high on his agenda.

He spends some of his time at the NWAS control centre in Broughton, near Preston, advising crews who come across serious trauma on how to handle complicated medical emergencies. This can include stabbing and shootings, though in Cumbria it is mainly RTCs.

He said that the way cars are designed now, they can often turn up to a scene to find a vehicle destroyed but the driver uninjured.

But in those that are more serious, they are dealing with potentially fatal or life-changing injuries - complicated fractures, chest injuries, internal bleeding and head injuries.

He recalls one recent crash, in an isolated Cumbrian valley, where a car had crashed down a steep embankment. The female driver was trapped inside and mountain rescue team were needed to assist.

When they finally got her out she needed urgent treatment, and Vinny found himself accompanying the seriously-ill woman to hospital on board a rescue helicopter.

The other most urgent calls he deals with include severe bleeding and strokes. Again, time is key.

"With strokes, there's a window of opportunity for these patients. We hear a lot in the press about the signs - face, arm, speech.

"They say time is brain basically. It can be the difference between a normal life afterwards or being wheelchair bound," he said.

Vinny said the aim is to get them to a stroke unit for an emergency CT scan, to determine whether it is a clot or bleed on the brain.

If it is the former, a clot-busting drug can be administered to clear the blockage urgently and get oxygen back to the brain - reducing the risk of death and long term disability.

However if it is a bleed, the drug would make it worse - hence the need for the scan before anything is done.

However for all the high level emergencies that ambulance crews attend, there are also many other incidents they are called to. Often it can be people with mental health problems, or elderly people with long term health problems that have flared up.

Vinny said that whatever the call, they always do everything they can to help their patient. It is that one-to-one care that really drives Vinny, to be there in someone's hour of need.

"I'm really passionate about the ambulance service. I see how we go above and beyond every single day.

"We make a cup of tea, put the bins out - I've even seen crews re-tune a patient's TV," he said.

"The way I see it is that's your grandmother sat there, your own family member. You want to walk away thinking you've done everything you can. Sometimes it's not enough. Sadly we can't save everyone, but you have to have done everything in your ability.

"Sometimes you do take it with you. You have a little cry sometimes or cope with it in your own way.

"But whatever has happened - a car crash, cardiac arrest, someone falling down the stairs - has happened before you got there. You've just got to do your best in each situation."