Last night shift of a Year 2 paramedic placement

Alex describes his ambulance placement shift with the Joint Response Unit (JRU). It's a branch of special operations where a paramedic will only respond to police-generated calls or emergency 'Red 1' call-outs.

What is a Joint Response Unit for?

For my final night shift on placement with London Ambulance Service, I was with the Joint Response Unit (JRU). It's a branch off special operations where a paramedic will only respond to police-generated calls and requests, as well as uncovered, emergency 'Red 1' call-outs.

I was excited to see how this unit works as I have a great interest in multi-agency responding, especially with the Metropolitan Police. I was working at Cody Road and our call-sign was Charlie November Medic, covering Central North (CN).

What kind of calls the JRU gets

The first few calls for us were to intoxications and mental health; very common calls for the ambulance service. All through the night the JRU operative would have no less than three radios on at any one time – one of which is the police radio, which is an open channel. This means everybody talks to control openly on one channel, so anyone else on that channel is able to hear the communication. Maintaining a conversation in person was a challenge due to the constant radio chit-chat.

Because of the open channel system, a police unit only has to openly transmit 'Requesting CN medic to my location' and we are on our way! On three occasions we were dispatched to stabbings. All three were no trace; typical observer's luck!

In the early hours of the morning we had been requested to be on standby for when tactical police were going to raid and storm a house. We learnt that there had been an acid attack earlier on in the night and police had chased the suspects to a house, where they had surrounded it for some time. With the tactical support group (TSG) from the Met about to enter the property, we eagerly awaited the end of the operation. Thankfully we were not required.

Responding to a Red 1 call

At 5.15am, only a few minutes before finishing for the night, we were dispatched via London Ambulance Service to a Red 1: 'Male in his 60s, unconscious, noisy breathing'. Another ambulance was en route but we were the first resource to arrive on scene, and we did so within a few minutes. The patient was in a less than one-metre gap between a double bed and a wall, lying head-end in the doorway. I knelt down and checked for a pulse and presence of breathing. I confirmed cardiac arrest on the radio and began chest compressions whilst the JRU paramedic applied the defibrillator pads. Our patient was in VF and we gave one shock, which put him into asystole (a non-shockable rhythm). Upon arrival of the ambulance I assigned roles and used a laryngoscope to place an I-gel and gained IV access within minutes.

After the first set of adrenaline was administered he went into pulseless VT, to which we shocked him back into VF. In total, we delivered eight defibrillation shocks and achieved a return of spontaneous circulation three times. Throughout the entire cardiac arrest I was able to direct each member (of which there were four) and communicate with the family what had happened to their loved one. We were backed up by HART for assistance with extrication and proceeded to blue him in to the nearest heart attack centre. I handed over to the team of cardiologists and consoled the family that arrived shortly after. It was a stressful arrest where the scene was cluttered, with minimal space, and the constant change in heart rhythm meant we had to keep on our toes. All the more importantly, he arrived at hospital with a pulse and remains in intensive care. I hope to follow up this patient soon to be updated on the outcome/prognosis. We arrived back at Cody Road four hours late, but that’s just the nature of the beast.

Back to ARU

There concludes my final ambulance placement for the second year of the Paramedic Science degree. I have experienced many unforgettable moments which will stay with me for the rest of my career, and have put myself forward in challenging situations. 

For now, it’s a brief return to University life to complete a 2,000-word case study review essay as well as a 30-minute OSCE* to complete Year 2.

*Objective structured clinical examination

Alex studied Paramedic Science at ARU. You can find out more about this and other degree courses at one of our Open Days.