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 BC 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 help 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 BC Emergency Health Services.
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.
To demystify the job, 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 the Downtown Eastside, and now works as BC Ambulance’s public information officer.
This interview has been edited for length and clarity.
The Tyee: So what happens when someone calls 911?
Brian 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.
All calls are graded using the Medical Priority Dispatch System. The highest level is a code purple, for things like a cardiac arrest. Red is the next level down, for calls like someone is having chest pain and has a history. Then orange, yellow, green and blue.
Paramedics prioritize who needs care first. If someone has a code green or code blue situation, they’ll likely be waiting for an ambulance for a long time. They may get a call back from a paramedic who will reassess them and see if they can help them get seen at a nearby Urgent and Primary Care Centre.
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.
What happens when a paramedic arrives?
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.
What does a regular day look like for a paramedic?
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.
You’ve lasted for 36 years in the industry. How?
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 quite 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. I go to the gym and do yoga.
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 dead lift 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.
How many patients will you see in a typical day?
That varies depending on what community you’re in. If you’re in a small town there may be less calls, or you’ll be really busy because you’re the only paramedic covering the entire community.
I was working in the Downtown Eastside at the start of the toxic drug supply crisis as a paramedic specialist. When fentanyl first hit the streets I did 26 calls in one shift, most of them toxic-drug related and even including a couple deaths.
Extreme weather also impacts this, like we saw during the 2021 heat dome.
How long is a typical call?
Again that depends on the call. We bring the emergency room to you.
If someone is in cardiac arrest you’ll resuscitate them at their home or on the street before you move them, unless they need a heart surgeon.
If there’s a bad accident, stabbing or shooting we want to get you to the hospital fast. There’s a lot of health care that happens in the back of an ambulance. If you see it driving lights and sirens but not moving very fast there’s likely multiple paramedics in the back trying to save someone’s life. Emergency care at 70 kilometres an hour is a little rough and bumpy.
Have you noticed any trends of who ends up in crisis and needs emergency care?
That’s a hard one. Again it depends on where you’re working and what communities you’re in. We’ve got an aging population and that can mean more health requirements for people but we’ve also seen advances in health care and how we manage chronic conditions.
And with the toxic drug supply we see overdose calls everywhere in the province. It can be in the Downtown Eastside and it can just as easily be behind a white picket fence in a small town.
What’s the most stressful thing you deal with on a daily basis?
You’re not going to believe it but it’s actually when I get the call and am driving lights and sirens in traffic. I have to get somewhere as fast and as safely as possible.
When I started working there was a map book in black and white and your partner would look at it and say “next left!” Now we have GPS but your mind is still set on the call you’re going to. There are different challenges for each call.
The general public could help by safely pulling to the side of the road and turning on their indicators. Don’t slam on your brakes when an ambulance comes up behind you. I’ve seen an accident happen when people were trying to get out of the way. Take a deep breath, look around and safely pull over.
As a higher-level paramedic you may have a longer drive to get to a call. If there’s a large accident in Whistler or on the Coquihalla you may be driving code three [lights and sirens] for hours.
What are the most meaningful or joyful things you experience at work?
Paramedics are part of an interesting world. We get invited into people’s homes and lives during big moments like having a baby, or at the end of a life. I’ve been there for numerous deliveries and helped the moms deliver babies and that’s an amazing experience to take part in.
But the most incredible thing is cardiac resuscitation. If you’re in cardiac arrest you’re clinically dead. If you’re part of a team where you resuscitate someone, you bring them back to life. They can go home, carry on with friends and family for years to come. I call those "retirement calls" where you get one of those and you can retire happy.
It’s all about being able to help people. Something about making someone’s life a bit better, whatever the situation is. Maybe they’ve had a fall and need assistance getting back in their chair. You can check on them. Maybe they don’t need to go to a hospital but you can make them feel better.
I’ve also met so many interesting people like war veterans or distant cousins.
Do you think people have a good sense of what you do for work?
They’re always amazed to learn about the training we have. We’re not ambulance drivers — we’re paramedics.
A lot of people don’t realize who we are and what we do until they need us. How many times do people need to call an ambulance in their lives? Hopefully none.
How has the toxic drug supply crisis changed your job as a paramedic?
We’ve gone through a couple big changes. With heroin in the early ’90s we couldn’t believe the volume of overdoses that were hitting us. That was organic heroin and we have naloxone, or Narcan, which can reverse an overdose quickly.
Then fentanyl hit us. It’s synthetic so naloxone takes longer to work and you might need more to save someone.
Overdose calls are very time-consuming. An overdose means someone is close to death. They’ve stopped breathing and there’s four to six minutes before the brain starts to die, or your heart will stop and you die.
We have to support their breathing and establish an airway, not just shoot them full of naloxone.
Now we’re seeing drugs mixed with benzodiazepines, or benzos. This mixes two nervous system depressants so people are deeply unconscious. We used to be able to bring people back in five minutes. Now it’s taking 20 to 30 minutes for patients to respond to treatment.
We need to work out if this is an overdose or if the patient could have a serious brain hemorrhage that is masked by an overdose. Maybe they’re a diabetic. A lot of care gets packed into that call.
The government has done a great job at distributing naloxone kits. Get one, carry it with you. If you carry one you care about people.
[Editor’s note: You can find more information about naloxone, including training and places to get it at Toward the Heart.]
What do you do to destress, shake work off and go home?
I mentioned earlier how I’ve got a great support mechanism at home. There’s also bumper talk, where paramedics hang out at the hospital together. When there’s a big trauma call, a cardiac arrest or just something that bugs you, it’s good to talk with other paramedics. We talk through it, debrief, look after one another and that helps get rid of some stress.
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.
But bumper talk is really the best stuff in the world.
How could the public better support paramedics in what they do?
There’s lots of little things. Shovel your walkway or your elderly neighbour’s drive. Make sure your house numbers are visible so we can find you, make sure the lights work. When you call 911 be prepared to answer questions and do what the call taker is asking you to do. We understand this is a crisis but we still need to get information. Stay calm. Unlock your front door, put a pet in another room. Little things like that.
Have you noticed that wait times for people calling 911 have changed over your career?
Everything affects wait times. Call volume, busy days, heat stress, atmospheric rivers, population increase, aging population. Off the top of my head we’ve seen a 25- to 30-per-cent increase over the last 10 years. That’s a lot.
It also depends where you are in the province. In rural communities transport time to a call or to a hospital may be longer too.