Natalyha Surgison, a 22-year-old St John call handler, will never forget the image of a child finding a loved one who had taken their own life. Photo / Michael Craig
As ambulance crews hit one of their busiest times of year reaching up to 1650 callouts nationwide a day, health reporter Emma Russell spends a morning inside a St John 111 call centre.
Twenty seconds.
That's all a 111 St John call handler can have between listening to a woman set herself on fire and helping a new mum deliver a baby over the phone.
It's brutal. It's intense. But when you help save a life or bring a new one into the world it can be so rewarding, staff at Auckland's Mt Wellington call centre tell the Herald.
Natalyha Surgison, a 22-year-old St John call handler, will never forget hearing the detail of a child finding a loved one who had taken their own life.
"It was the most horrible day of their life and I just had to talk them through it."
Surgison, who is two years into her job, said the work could take a huge emotional toll and having good team-mates around for support was crucial.
"We get 20 seconds once a call ends, which can be a short time to process something that can be quite traumatic, before we take the next call."
But then she describes one of her most rewarding calls.
"It was a 17-year-old, pregnant with her first child.
"While we were on the phone she started getting contractions and going quite quickly through labour.
"And over the phone I had to coach her through delivering the baby, so it was quite a special moment when I heard the baby crying .... I was the only one there to help her."
The call gets directed to a Spark call handler who will ask the caller if they are wanting to contact police, fire or ambulance.
If it's an ambulance they are after, the call is diverted to one of three ambulance communications centres in Auckland, Christchurch or Wellington – which St John shares with Wellington Free Ambulance.
Surgison, or one of her colleagues, picks up the phone.
The St John call handler's first job is to get an address, which can sometimes be the most challenging part.
In a horrific recorded call used for training purposes, the Herald heard a St John call hander working patiently with a caller in shock yelling abuse down the phone line.
It takes six minutes to get the address before the caller hangs up leaving St John with no other information.
"Sometimes we just have to send an ambulance out there with no idea of the exact location or what they could be walking into," Stacey Ayre, St John Auckland Communications Centre operations manager, said.
Surgison sits at her desk wearing her smart green St John uniform, headset on and three computer screens planted in front of her.
One screen is a map, another tracks incoming calls which are colour-coordinated by priority, and the third shows a in-depth system for her to collect as much information about the patient as possible which is passed on to paramedics and other emergency workers.
While Surgison's phone rings, echoes of "are you in labour?" ..."can you feel a pulse?" ..."an ambulance is on its way sir" fade in and out. They are her colleagues taking other calls.
She seems to block them out when she picks up the phone. She doesn't hesitate. Her voice is calm, as if she is Prime Minister Jacinda Ardern telling the country not to panic during an unprecedented pandemic.
The call could be from someone anywhere in New Zealand. It's a man calling from Hamilton - he is frustrated the ambulance is not there yet to help save his dad's life.
"His pulse is very weak, where are they?," he tells Surgison, who quickly but calmly assures the man an ambulance is on the way. A weak pulse is new information so she updates his file and bumps him higher up the priority list.
Colours are used to categorise the priority of a patient - purple means a patient is in an immediately life-threatening condition, red is potentially life-threatening or time-critical.
Orange means urgent or potentially serious, while green and grey is non-urgent and could potentially be dealt with by a nurse over the phone.
Surgison then runs through everything the son can do to help his dad before the ambulance gets there.
In rural areas, it can take up to an hour for an ambulance to get to the scene, she told the Herald.
There are a total of 1029 St John ambulances and operational vehicles in the country.
Unlock the front door, get his medication out for paramedics to see, make sure the patient is lying still and as comfortable as possible, if he is experiencing chest pain give him aspirin if available, she says.
After ending the call, she takes off her headset, smiles and says "he's what we call a calm caller".
During her 12-hour shift, some days starting at 6am and others kicking off at 6pm, she alone takes close to 80 calls.
Heart attacks, assaults, overdoses, crashes, suicides, strokes - she hears them all.
Monday's tend to bring more medical events as a lot of people can't visit a doctor over the weekend so it's like catch-up, another St John team member said.
During the weekend, that's when you get more assaults, crashes and alcohol or drug-related conditions, they said.
During any call, Surgison will plug the patient's address into her computer, if she is able to get one, and another St John worker, known as an emergency medical dispatcher, will pick it up.
That might be Clay Taylor. He is an emergency medical dispatcher who sits on the other side of the near 20m-long room.
Each emergency dispatcher is in charge of one patch of the country. Today, Taylor's patch is the central North Island which covers Waikato, Bay of Plenty and the Lakes district.
The 22-year-old's four computer screens appear overwhelmingly complex - to the outside eye, anyway.
His job is to find an ambulance for each patient calling from his patch. There are 40 ambulances available in his patch.
But it has to be the right one - it needs to be close, have the right skilled workers (from intensive care paramedic to an emergency medical assistant), and the crew needs to have enough time before they are due for their next break.
A job comes up on his screen - he checks the ambulances available in the area and the best-suited one shows crew are on their break.
"Looks like they will have to finish their lunch later," he says.
Manager Ayre started out as a call handler in the UK 14 years ago.
One of the worst calls she took was a mentally unwell woman who rang threatening to set herself on fire.
"I tried to talk her out of it but then she did it."
She said that until recently post traumatic stress from 111 calls weren't taken seriously - and for years she buried that horrific image in the back of her mind. Only in the last couple of years did she start to talk about it and deal with it.
Ayre knows this job isn't for everyone.
Now part of the Auckland communication centre's recruitment process, Ayre said they didn't really care about CVs or qualifications.
"We just need to know they are the right person for the job ... people who have that balance of compassion and resilience," Ayre said.
All call handlers undergo five weeks of classroom-based training before another five weeks of mentoring with an experienced and trained mentor.
"Some do break down," Ayre said.
"It's not easy but the most important thing is that staff are supporting each other."
And some calls do bring a bit of humour to the office.
Ayre's team-mate Jackson Whitham, St John Operations Manager HTOC (Health Transport Operations Centre), said one time when he was working in the UK a person rang saying their baby wasn't breathing.
Paramedics got to the scene and the patient turned out to be a rabbit.
"That was an odd one."
Back in the day, an ambulance driver didn't do any medical work and was just in charge of transport.
"It used to be that a driver would get them in the back of the ambulance, drive them to hospital and that was it, they were literally just a driver," Katy Wilkinson, St John assistant director of operations ambulance communications, said.
Now, in an ambulance there tends to be two crew with varying qualifications who take turns at driving and treating the patient and they manage that themselves, she said.
Wilkinson - who used to be a paramedic for 12 years - said these days a lot of the treatment was done at the scene by well-trained clinicians.
"Now it's essentially a mobile healthcare service."
Ayre said technology advancements have also helped saved lives - one example being the ability to track down a patient's location.
In early 2018, this step was made easier after the Government introduced Emergency Caller Location Information (ECLI), which automatically provides emergency services with the caller's probable location.
"No exaggeration, it has literally helped saved lives," Ayre said.
But there's still a catch.
The caller needs to be using phones using Google's Android Emergency Location Service which uses wi-fi, GPS, and/or cell tower data.
Also, if the caller is a second party and not at the same location as the patient, an address is still needed verbally.
St John has contracts with Ministry of Health and ACC, who fund about 78 per cent of the operating costs for the emergency ambulance service. The balance is made up from ambulance part charges, third-party contracts and fundraising.
For the current financial year ( July 1, 2020 – June 30, 2021) St John has been given $230 million.
The figure varies slightly year-on-year, a St John spokeswoman said.
After paying its paramedics and frontline workers, it then has to pay 129 call handlers and emergency dispatchers in Auckland and Christchurch, where communication centres are based.
In November last year, a planned strike by some St John paramedics and ambulance workers was called off.
As at December 12, a proposal from St John was still being considered by its members.
It comes after concerns from union members of pay gaps and unsafe staffing levels.
At the end of her 12-hour shift, Surgison does her best to wind down before getting ready to do it all over again.
"For me personally winding down after shifts means spending time with friends and family and maintaining a healthy lifestyle by going to the gym and eating healthy.
"It's difficult not to take traumatic calls home with us, therefore maintaining a work-life balance is really important so that we can continue to help our callers."
And on the rare occasion, she might get to meet a patient she has helped saved.
Another St John call handler said: "It doesn't happen often but when it does it can be really special reminder of why we do what we do."
'He has disregarded our voice and continued with this divisive kaupapa.'