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Reflections on working through the COVID-19 crisis from a student Paramedic

2020 has been a challenging year for all of our students, due to the impact of the COVID-19 pandemic. We’re especially proud of those students who were selfless enough to step up to the plate and give their time and energy to helping those in need during this crisis. One of those students is Carl Dowling, a BSc Paramedic Science student. Carl spent time with the London Ambulance Service and, this experience led to him writing his first research papers. He took some time to reflect on his experience and give an honest view of working on the front-line of a national crisis.

“At the start of the pandemic, I desperately felt the urge to help people in some way. This is why I became a paramedic student - one of many reasons why I chose this job was to help people in their time of need. So I decided to look for an opportunity to work directly to support the efforts against the virus. In April, I found the opportunity I was looking for to work with a private ambulance service in London. I was based at a hospital near Cambridge where I worked out of the Intensive Care Unit (A.K.A, the COVID-19 Ward).

 My role was working as part of a team alongside specialists, doctors, nurses, HELIMED Crews (Air Ambulance) and anaesthetists. There was me single crewing one ambulance and two other teammates single crewing theirs. Our roles were to maintain the management and urgent transportation of COVID-19 patients who were severe or in a critical condition, as well as making sure they were ventilated/incubated and on extracorporeal membrane oxygenation (ECMO). Along with this, we also had to maintain infection control standards before and after each patient. I would travel as part of a single crew to any hospital within the London area, meet a team on a COVID-19 ward, prepare the patient for transportation and bring them back to my base of operations where better care could be provided in a ward specifically for COVID-19 patients.

I tried my best not to have any pre-existing ideas about what it would be like working from a COVID-19 ward, especially assisting in the care of the patients, but the very first thing I saw when entering the ward was a patient in a body bag who had sadly passed away. This immediately gave me a sense of urgency about what it was that I had gotten myself into. It also caused one of my teammates to feel high levels of anxiety, however, this helped me deal with my own anxiety, as my main focus became helping that individual and reassuring them. 

The first shift was difficult. There was no formal training involved, other than a tour of the base, parts of the equipment and a brief explanation. We just had to know how to use the appropriate PPE and when to dispose of it correctly. We also spent an hour after every patient deep cleaning the ambulance to prevent the spread of infection. My first transfer was to assist in the evacuation of one of the hospitals, due to a lack of oxygen.

The other two single crewed ambulances and I were deployed and we did what we could in terms of evacuating the hospital safely, but it wasn’t just a lack of time that was stressful, it was also the lack of equipment in terms of navigation systems, as they were unfortunately outdated and often would send us in the wrong direction. I had to use my phone’s navigation system on the majority of journeys. Control(ICU at our base of operations) were also not giving the most effective information so we weren’t always 100% sure where we had to be and how to get there. I changed this and created set questions that needed answering when giving us the details of a transfer, which worked better. 

When arriving to pick up a patient, the patient would not always be ready for transfer, as vital signs with COVID-19 can change dramatically in a very short space of time. This caused us sometimes to be stuck in one place for a large amount of time, whilst we attempted to get their vitals back up so that they were ready for transport. Unfortunately, it wasn’t always possible and as a result we lost some of our patients. 

There were so many COVID-19 patients that were either severe or critical, certain hospitals were struggling to find where to put them as they were running out of room and needed secondary areas to be able to maintain capacity and the safety of non-COVID patients. The more time I spent on these wards, the more I saw what treatment strategies were being used to help patients in severe and critical conditions. I noticed that there were treatments used to help manage the disease, but not many treatments were being utilised to help individual symptoms. This frustrated me, and I asked a lot of questions of doctors, nurses and specialists, unfortunately, no one was able to give me a straight answer. 

When I got home, I felt like a part of myself didn’t come back with me. I could not stop thinking about what I had experienced, the situations I had seen, and my feelings of frustration grew more and more each day, until eventually, I had had enough. After speaking with a classmate, I decided to write a reflection of my experience. After writing the reflection, I found that it highlighted certain questions that I felt needed answering, so I started conducting my own research, writing an editorial review. This led to my first paper, "Is There a Benefit in Using Non-Steroidal Anti-Inflammatory Drugs (Ibuprofen, Naproxen) in the Prevention of Cytokine Storms in the Treatment Against an Individual who is Infected with COVID-19?"

Researching this paper allowed me to see things for how they truly were. Everything and everyone in hospitals across the UK was rushed, stressed, unprepared, reactive, but in spite all of that, the staff at those hospitals were phenomenal and doing all that they could under the circumstances. Unfortunately, the UK’s healthcare systems follow an outdated healthcare model which focuses primarily on treating the disease, not individual symptoms, hence why all patients with COVID-19 were treated with the same treatment strategies., This didn’t take into account the fact that the virus was growing, and different individuals needed specific treatments to help further manage their symptoms and improve their chances of survival. Therefore, the treatment strategies that were being used quickly became ineffective.

When I came home from London, I had to self-isolate away from my family until it was safe to be with them again. Once I was able, I had to start readjusting back to family life. It was difficult after being away, but as time went on I was able to adapt, especially as I was focusing more on my research.

When there was talk that children in certain year groups were going to be going back to school, if the parents allowed it, my partner and I weren’t sure if we should send our little one back to school or not. So I used my skills, and did more research into children and the risks of contracting COVID-19, which lead to me finding out more on the new Paediatric Inflammatory Multi-system Syndrome. This, along with the safety measures put in place by the school, allowed me and my partner to understand the risks involved and  make a better informed decision. It also led to my second research paper, “Does the Measles, Mumps and Rubella (MMR) Vaccine Enhance One or More Specific Functions in Children and Can it Help Against this Novel Paediatric Inflammatory Multisystem Syndrome?” which I hope will help the scientific community in some way. 

We lost a lot of people along the way, even some of our own in the healthcare settings. They will all be missed, but never forgotten. All of the staff who put themselves on the line fighting an unknown virus during a pandemic deserve the greatest respect and I am grateful that I was able to help in some way during this difficult time, both through working on the front-line in London and publishing two papers in international journals. I appreciate all of the help and support I got from my team mates. I wish them all the best and hope they stay safe during this unprecedented time. What we can do now is support them the best we can by following the guidance given to us and maintaining common sense, protecting ourselves, our families and others.”

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