Paramedic Specialists Brian Twaites and David Hilder of B.C. Ambulance debrief after responding to a drug overdose in downtown Vancouver.
We know their wailing sirens and the look of the large, flashy ambulance racing down the road.
Paramedics are there for people on their worst days. It’s a tough job for the 3,000 B.C. Ambulance Service paramedics and 5,000 emergency medical-call takers, dispatchers and other professionals who respond to 911 calls.
While job stress is high – a critical incident stress program that helps paramedics deal with traumatic incidents was accessed 3,636 times in 2022 – paramedics tend to stay on the job for a full three to four decades, says Andy Watson, communications manager for B.C. Emergency Health Services.
It’s also an industry that’s being impacted by the ongoing drug and climate crises. Heat waves can overwhelm the emergency health system.
When things are working well, however, most members of the public may remain pretty unfamiliar with what a paramedic’s day-to-day looks like on the ground.
The Tyee called Brian Twaites, who has been a paramedic for 36 years, 25 of those as an advanced care paramedic and paramedic specialist. Twaites spent the majority of his career in Vancouver’s Downtown Eastside, and now works as B.C. Ambulance’s public information officer.
The Tyee: So what happens when someone calls 911?
Twaites: When you call 911 you’ll speak with a dispatcher or emergency medical call taker who is the first line of response. They’ll ask questions to learn who you are, where you are and what the emergency is. They’ll dispatch help right away and then stay on the phone because they’re trained to guide people through things like CPR, a birth, a drug overdose or dangerous bleeding.
If someone is having a serious medical emergency we want them to call 911.
They can also call 811 or visit an Urgent and Primary Care Centre if it’s not a life-threatening emergency. This cuts down on call load so paramedics can get to the most in-need people and helps unclog emergency care centres.
The Tyee: What happens when a paramedic arrives?
Twaites: That depends. In B.C. and across the country there’s a variety of different levels of training for paramedics.
The entry level is an emergency medical responder. They can do basic emergency life-saving care. In smaller communities across the province some fire crews are trained as emergency medical responders too.
Next level up is a primary care paramedic. This is what most paramedics in the province are trained as. They can give you IVs, Ventolin for respiratory issues, clotting agents or epinephrin.
On a similar level of training is a community paramedic. They work in smaller communities around the province and can provide non-emergency care within someone’s home, saving them a trip to the hospital. It’s a bit like a community nurse but more focused on paramedic care. Community paramedics are often trained as primary care paramedics.
Advanced care paramedics deal with advanced resuscitation, cardiac and respiratory calls. They can run full cardiac arrests from your living room. They respond to cardiac arrest, choking, severe allergic reaction.
Critical care paramedics have the highest level of training in the province.
[Watson adds that critical care paramedics focus on acute interfacility transport, air medical response and infant, child and perinatal care. Paramedic specialists like Twaites are advanced care and critical care paramedics who provide on-scene technical support for high-risk situations, mass and complex patient events as well as telephone support to paramedics and patients.]
The intensive care unit consists of paramedics that fly around the province to pick up and transport people to places where they can receive specialized care.
When you see an ambulance racing down the street with lights and sirens but they suddenly turn them off, it could be because they’re part of a multi-layered response. Multiple levels of paramedics were dispatched to a call about serious trauma. Most likely the first to arrive will be primary care paramedics because we have more of them, and they assessed the scene and said we don’t need advanced care here, cancel them. That’s good news for the patient.
The Tyee: What does a regular day look like for a paramedic?
Twaites: The majority of paramedics in B.C. work a four-and-four pattern of two 12-hour day shifts starting at 6:30 a.m. to 6:30 p.m., followed by two-night shifts from 6:30 p.m. to 6:30 a.m. Then you get four days off. It’s always a revolving week.
You always try to get to the station a little early because it’s nice to send your co-workers home after a long night. You get changed and head down to the ambulance bay where you check out the vehicle, the batteries for the defibrillator and necessary medical equipment like oxygen, supplies and drugs.
Depending on where you are and how heavy the call volume is you may be out the door for hours at a time.
Ambulance stations are located around the province and most have a storeroom, kitchenette and a rest area where you can recline in between calls. But usually crews will be at the hospital for long stretches of time because that’s where you take the patient.
You can get food in between calls and you carry a large water bottle to stay hydrated, maybe pack a lunch you can take with you. As soon as your shift starts you’re on, so you have to fit food, coffee and the bathroom in between calls. On a night shift maybe you can get some sleep but you’ll always know that your phone can ring and you gotta go.
Shiftwork is rough for everyone. A 12-hour day is a long time to be on shift and it’s a physically and emotionally tough job.
The Tyee: You’ve lasted for 36 years in the industry. How?
Twaites: There’s so many tricks of the trade. I’d never sleep on a night shift because it would ruin my circadian rhythm.
As a first responder you can see and deal with things that are traumatic.
I’ve got quite a supportive family and friends and that helps.
Plus you want to be physically fit because you’ll be doing CPR for long periods of time, carrying people down stairs, carrying 30 pounds of gear up a big flight of stairs or getting into wrecked cars.
One great thing that happened during my career is we got stretchers that have a motorized lift in them which dramatically decreased the amount of lifting a paramedic has to do. When I started, getting people into the back of the ambulance meant we had to deadlift them, plus the hundred pounds of stretcher they were on. That adds up to a lot of wear and tear on the body over the years. We also used to have to carry people up and down stairs on stretchers and now we have a chair with a seatbelt that can roll people safely down stairs while they’re sitting up.
The Tyee: What do you do to destress, shake work off and go home?
Twaites: I mentioned earlier how I’ve got a great support mechanism at home.
There is stress in the job, no question. Our organization has a very robust critical incident stress program. People are realizing this is more of an issue. If a call hits a certain criteria or if someone on the call says it’s brutal the critical incident stress program is activated. You get a confidential call from an experienced peer debriefer. They can hear things even if someone tries to say they’re fine.
