There is a moment, on every job that happens in public, when you become aware of the audience.
You feel it before you see it. A change in the air around you. The sense that the pavement behind you is no longer empty. You glance up from what you are doing, and there they are. Phones out. Heads tilted. The slow shuffle of people who have somewhere to be but not, apparently, right at this minute. The general public.
Not the patient. Not the family. Not the wife in the hallway holding a tea towel because she does not know what else to do with her hands. Those people I will carry home with me. Those people, I understand. I am talking about the other ones.
The ones who see a person on the ground and reach for a phone before they reach for the person. The ones who dial 999 from a moving car and keep moving. The ones who stand in a half-circle, six feet back, watching like it is a piece of street theatre put on for their benefit.
The audience.
Most of them, I think, believe they are helping. That is the strange part. They will tell you so, afterwards, if you ask. They called the ambulance. They stayed to make sure we arrived. They told the man on the ground that help was on the way, from a distance, without crouching down, without taking his hand, without asking his name.
A name is the first thing. Before the kit comes out. Before the obs. Before any of it. A name and a hand on a shoulder and the simple sentence, ‘What happened to you?’ That is the bit that costs nothing and that nobody seems to want to give. Instead, we get the phone calls.
The man we drove past on the dual carriageway. The woman who looked unwell at the bus stop. The lad slumped in a doorway; see him there, by the off-licence. I’m just passing; I can’t stop; I’m late for work. Click. And then we are dispatched, blind, to a description and a postcode, looking for a person who might have moved, might have walked off, or might never have needed us in the first place, while somewhere a chest pain is waiting hours for a crew.
Stop.
If you see someone, stop. Walk over. Ask. That is all. You do not need a certificate for it. You do not need to be brave, clever, or trained in anything at all. You need thirty seconds and the willingness to bend down. But thirty seconds is a lot to ask of a Tuesday morning, apparently.
So, we arrive, and we find them, or we do not, and either way, the audience is gathering. They have appeared from nowhere, the way they always do. Out of shops. Out of cars. Out of doorways, they were never in a minute ago. Drawn to the green and yellow, the way moths are drawn to a porch light. I will tell you about a Friday night outside a club in Belfast.
A person on the ground, absolutely steaming with drink, lying on the pavement with the PSNI standing over them. They had called us. They had stepped back to let us work, the way good peelers do, giving us the room, the line of sight, and the bit of pavement we needed. I was on my knees beside them. My crewmate had the bag open. The patient was breathing, just about, and groaning the groans of a person who would feel exactly as bad tomorrow as he deserved to feel. I was halfway through my assessment when I was hit.
Not hit exactly. Shoved. A weight, coming in from my left, was hard enough to knock me sideways onto my elbow. A man. Drunk. Mid-thirties. Coat half off one shoulder. Roaring, at the top of his lungs, the words that I will remember to my grave.
I’m a first aider. I’m a first aider.
He was, at this point, attempting to roll my patient into the recovery position with the technique of a man who had once seen it done on the telly. Limbs were going everywhere. The patient grunted in protest. My kit was scattered across the wet pavement.
The PSNI were on him before I was off the ground.
Two of them, lifting him bodily off the patient and onto his feet, with the calm efficiency of men who do this several times a shift. The officer, to his credit, did not raise his voice. He just stood the man up and asked him, in the flat Belfast tone that gives nothing away, ‘Are you a doctor?’
No, it was the first reply.
Do you know this person on the ground?
Again, the answer was no. ‘Then you let these people do what they need to do, sir,’ the policeman replied.
Whilst the drunk was trying to stand, the policeman asked, What is your occupation, then, sir?.
The drunk man drew himself up to his full height, which was about five feet eight at a stretch, and informed the officer, with great dignity, that he was a solicitor.
The officer looked at him for a long moment. ‘Ah, right,’ he said. ‘So, you weren’t smart enough to be a doctor then.’
I have, in this job, rarely had to bite the inside of my cheek harder than I did at that moment. The drunk man took offence. The drunk man went off into the Belfast night, muttering, coat still half off, the dignity of his profession deeply wounded.
My crewmate did not look up from the bag. He just made a small sound through his nose, the way crewmates do, and we got on with it. The patient on the pavement, oblivious to all of it, groaned again and rolled his head to one side. We had a job to finish.
The first aiders are a category of their own. The off-duty nurses who are not off-duty nurses. The lads who have done a half-day course in 2009 and have been waiting ever since for their moment. The women who used to work in a care home in 1994, as if that care home had prepared them for an arrest on a pavement in 2024.
Another night, on the same kind of pavement, a group of off-duty nurses asked us, ‘Can you make the patient’s GCS safer?’ The patient was one of their friends, drunk on a night out. My crewmate and I looked at each other with the same bemused look, each of us thinking the same thing. What are they talking about?
They mean well, most of them. But meaning well and being useful are two different things, and meaning well, in the middle of a job, is sometimes the most expensive thing in the world.
Then there are the gawkers.
The gawkers do not pretend to help. The gawkers are honest, in their way. They just stand there. They watch. They have sometimes crossed the street to come and watch. They stand about four feet away, which is too close, and they look directly at you, then at the patient, then back at you, with the open, curious face of a child at a zoo. This gets up my goat, something shocking.
So, I have developed a thing. I have developed it over the years. I look up, mid-task, and I say, in the politest voice I can manage, I’m sorry, but do you know this person?.
‘No’ is the usual reply.
Oh, right. It’s just that you’ve come to stand over us and look at what’s happening, and I thought you were going to tell us something useful. Something that might help us. Something about who he is.
If they have crossed the street to come, I include that.
I noticed you came across the road there. Did you see what happened before?
Again, ‘No’ is the usual reply.
Can you help us with anything other than this patient?
That is usually enough. They go off sheepishly, the way people do when they have been caught at something they did not quite realise they were doing. The pleasure I take in this is small but real. It is sarcasm in the shape of helpfulness. It is the closest thing to power you get, on the pavement, in the middle of a job, when the rest of the situation is entirely out of your hands.
I am not proud of how much I enjoy it. But I am not going to pretend I do not enjoy it either.
Then there are the filmers.
I have been filmed doing CPR. Filmed talking to a man who was, at that moment, dying. Filmed lifting someone off a pavement with as much dignity as we could give them. Filmed kneeling on tarmac with my hands pressing on a chest that did not belong to me, while a teenager held a phone at chest height and angled it for the light.
I do not understand it. I have tried. I have stood at the back of an ambulance afterwards, sweating, hands still shaking, and tried to construct the thought process of the person who pressed record. I cannot get there. There is a wall in my head I cannot climb over.
The closest I can come is this. They do not see a person. They see content. That is the kindest version. The other versions are worse.
The other versions involve the words that come out of a teenager’s mouth when you ask him, politely, to stop. The shrug. The half step back is not really a step back. The phone was lowered briefly, then raised again the moment you turned your head. The face that says, “You cannot make me,” is right because we cannot. The pavement is public. The phone is his. The man on the ground does not get to consent to any of it because, by the time the video is uploaded, he is often unable to consent to anything ever again.
I think about his family sometimes. The people who will see that video later. Who will see their father, their husband, their son, in his worst minute, in front of strangers, with us working over him at the bottom of the frame? Not the man at the dinner table. Not the man on holiday. The man on the pavement, in poor light, with someone’s commentary over the top. That is what the phones do. They take the worst minute, and they make it the only minute.
Then there are the helpers.
The helpers are a different breed from the first aiders. The helpers have not done a course. The helpers have done something worse. The helpers have watched a series of Grey’s Anatomy. They have seen the BBC ambulance programme and would like you to know they now understand triage. They understand sepsis. They have views on how oxygen should be administered.
They are not consultants. They are not nurses. They are not anything at all. They are a man in a fleece who saw a thing on TV.
Mate, his lips are blue.
Yes, I can see that.
Should he not be on oxygen?
He is on oxygen.
Are you sure that’s the right mask?
I have been doing this job for a long time. I have had hands-on people in conditions you would not believe. I have made decisions in eight seconds that you would still be considering at eight minutes. And here is a man in a North Face fleece, with a coffee from Greggs in his hand, asking me if I am sure about the mask.
I always answer. That is the thing. I always answer politely, because the patient is right there and does not need to hear me lose my temper, and because somewhere underneath the irritation, I know that the man in the fleece is, in his own broken way, trying. But God, the tiredness of it.
The tiredness of being second-guessed by people who would not know which end of a stethoscope to use. The tiredness of explaining, again, why the protocol he saw on a Tuesday night drama is not, in fact, the protocol.
We are still on scene because the patient is not stable enough to move. Moving someone too soon is how people die in the back of ambulances. Not on the telly. In real life.
And then there are the can’t-waiters.
The cars were parked across from each other, narrowing the street. The driver behind us, leaning on his horn, is annoyed that we had stopped in the middle of his commute and would like us, please, to be somewhere else.
And where would you like me to park the ambulance, sir?
I say this to one once through the window. Inside that ambulance is a patient who is seriously ill and needs treatment. How would you feel if that were your loved one? Would you want us to drop everything to move the ambulance and let them die?
He looks at me as if I have spoken in another language, and then he reverses, slowly, with the face of a man who has been deeply inconvenienced.
That is the public space. That is the bit nobody warns you about at training. They prepare you for the medicine. They prepare you for the families. They do not prepare you for the bystanders, because nobody has the words for it, and because admitting that the public is part of the problem is something the service is not really allowed to say out loud.
So, we say nothing. We work around them. We ask the gawkers to step back, and they take half a step. We ask the filmers to stop, and they adjust the angle. We thread our trolley through a gap that should not be a gap, with a patient on it, and we get to the truck, and we close the doors, and only then, in the cab, with the engine running, do we let the breath out.
The doors of an ambulance, closing, are the most underrated sound on the job. They are the sound of the audience being shut out. The sound of the patient becoming, once more, just a patient, instead of a clip on someone’s phone, a story for someone’s dinner, or a thing that happened on the way to Tesco. I do not know what to do about any of it.
You cannot legislate kindness. You cannot make a man bend down to a stranger if he does not want to. You cannot make a teenager put a phone away, not really, not with a crowd watching and the algorithm waiting, but I will say this.
If you ever drive past someone, and you think they might not be alright, stop the car. Get out. Walk over. Ask the question. You are not going to make it worse. The worst thing has almost certainly already happened, and you turning up is the first piece of good news that person has had all day.
And if you arrive somewhere and we are already there, the kindest thing you can do is keep walking. Not because we do not value you. Not because we think we are above you. Because the man on the ground is having the worst minute of his life, and he does not need an audience for it, and you are not going to remember this in a week, but he is going to remember it forever, if he remembers anything at all.
Walk on. Put the phone away. Trust that we know what we are doing, because we do and because the alternative — the world in which everyone with a smartphone is also, briefly, a consultant — is a world I am too tired to live in any longer.
Give us the pavement back.
That is all I am asking.
Just the pavement.
