A rainy Monday night. My assignment: to spend four hours in an ambulance. Thankfully, I've never been in one before, but I like the idea of travelling city streets at speed with sirens on.
Paramedics Lilah Barnett and Jill Heaslip meet me at the St John Ambulance's Pitt St base in the central city and take me to their communal kitchen. It's bustling as shifts swap over and dinner is eaten.
The two entered the profession from different backgrounds.
At 25, Lilah has been on the job for five years. She completed a bachelor of health sciences at AUT University. Jill, 33, trained directly through St John and has been employed for six years.
"You have to know a little about a lot and deal with whatever is presented to you," Lilah says. "I've been through lots of simulated scenarios but going on the road makes things click. It's when the textbook comes alive and you're able to rattle off signs and symptoms."
At any given time as many as 100 St John staff may be working throughout Auckland. Last year the agency responded to almost 150,000 callouts in the region - 5.2 per cent more than the previous year.
Staff at Pitt St deal with large numbers of people in high-rise buildings which can be challenging - along with incidents related to the CBD's nightlife. They back up other branches and often transport patients from Waiheke Island if the weather is bad and the Westpac Rescue Helicopter can't make it. Jill says weekends are the busiest time, unlike the South Auckland base where "every night's a busy night".
Ten or 15 years ago paramedics' nights were filled with medical jobs. Accidents have taken over - and changes in alcohol laws are the main reason.
"It's a lot more socially acceptable to go out drinking every night of the week and people aren't as aware about how to manage things for themselves," Jill says.
Added to that are calls for injuries that don't really require paramedic expertise. "Some people think it's normal to call an ambulance for a cut finger or common cold. They don't know what to do. We're seen as the first port of call for advice instead of going to the doctor."
That's no surprise, says Lilah, given increased ACC cover for medical incidents and that GPs no longer work at night. Auckland's increased ethnic diversity has brought challenges, too.
"In some countries you just throw people in the back of a van and take them straight to hospital - so people can get nervous if we spend more time at the scene than they expect," Lilah says.
All paramedics must complete a personal safety course as part of their training. They're taught, among other things, how to use their medical gear as protection from violent offenders.
Lilah has had to retreat from an increasing number of callouts where people are fighting. "We'll go to a safe forwarding point until the communication centre has been in touch. We won't rock in without the police."
The pager sounds. Our first job is in Mt Roskill, where a 52-year-old man is suffering abdominal pains, vomiting and diarrhoea.
We're there in a flash but he doesn't like the idea of a reporter watching him, so I wait outside while Jill and Lilah attend to him. We whisk him to Auckland Hospital and within minutes we're on our way to Orewa where a 92-year-old is unconscious. Just as we turn on to the Northern Motorway the ambulance pulls to the right - we've been diverted to Henderson.
Rain belts down as we plough through State Highway 16 traffic with lights flashing and siren blaring, my heart racing. Jill says she is not allowed to go more than 30km/h over the speed limit. That would be 130km/h here.
Someone driving a hatchback panics at the sound of a siren and almost causes an accident by coming to a halt in the middle of the Lincoln Rd off-ramp. Luckily, Jill slams her foot on the brake in time. She says it's surprising the number of people who don't know what to do when an ambulance comes up behind them, with lights flashing: for the record, it's pull over to the left.
We arrive at William and Hilda Evans' home. Mr Evans, 85, is having trouble breathing. His neighbours, Lyndsay and Peter King, are with him; so is his caregiver, Katrina Chander.
"Any existing health problems?" Lilah asks.
"You mention them, he's got them," Mrs Evans replies. "He's blind in one eye and deaf in one ear and he's got heart disease, kidney problems ... it's only been 10 days since he was last in hospital."
It's the third time an ambulance has been called for her husband this year. The paramedics check Mr Evans' crackly breathing and notice a rash on his stomach. "I feel funny ... it's not me," he says. They put an intravenous drip into his hand and he cries out in pain. "Stay nice and still. Just breathe for a few moments while I get a picture of your heart," Lilah says.
"They've been brilliant," Mrs Evans says to me. "I don't know what I'd do without them."
Mr Evans is carefully hoisted on to a stretcher and wheeled through his house. "This is the life, Peter," he tells his neighbour, his sense of humour plainly still intact. Waitakere Hospital is just around the corner: "We're here ... home sweet home!" he says as we pull into the ambulance bay. Mrs Evans is taking the situation in her stride but Lilah says it can be difficult when paramedics are exposed to emotions of family members.
"It's sad getting older. You come to the realisation their time is here and their partner won't be with them any more. That's really upsetting."
Children and old people pull on her heartstrings, but Lilah can't afford to get swept away by her feelings. "You have to give support, offer advice and be decisive. It's important not to bottle up and we'll have a chat about it afterwards to blow it out of our systems. But it's hard not to wonder how you'd feel if that was your relative."
Jill describes it as "putting on your job hat". "There's things we can and can't do. Sadly, we can't save everyone and it might just be someone's time."
"The most important thing is knowing you've done everything you can and acted in the most appropriate manner."
I leave the dedicated pair at 10pm, four hours into their shift. The adrenalin associated with their rescue missions has been surprisingly tiring for me.
Lilah and Jill look unfazed - which is just as well. They'll be doing this until 6am next morning.
ROUGH DEAL FOR NORTH?
Throughout New Zealand the St John Ambulance Service treats and transports about 400,000 people every year. It has more than 600 operational vehicles and 205 ambulance stations. Vehicles travel more than 17 million kilometres a year to 330,000 emergency incidents.
The cost of a St John call-out to for an accident is covered by ACC but medical jobs require a $76 part-payment. St John funds itself through contracts from the Ministry of Health (33 per cent), ACC (24 per cent), investments (32 per cent) grants, donations and bequests (9 per cent); and sale of supplies and services (2 per cent).
Mark Quin, chairman of the New Zealand Ambulance Association, says St John gets a "rough deal" from the Government compared with ambulance services overseas.
"We're behind the times for an essential service. The way it's funded at the moment is quite backward."
In his opinion, St John should be 100 per cent funded by the Government. Wellington's Ambulance service is fully funded by Capital Coast Health Care and the Wellington City Council, and Mr Quin wants a similar set-up in Auckland.
"You don't see the fire brigade asking the public for money," he says.
WHAT MONEY CAN BUY
June 18 to 24 is St John Appeal Week. You can give to street collectors, or call 0800 ST JOHN (0800 785 646). Also online at stjohnappeal.org.nz or any ASB branch. You can get your blood pressure tested for a gold coin donation at participating ASB branches.
St John's northern region spends about $260,000 a month on medical consumables.
Here's what your money can buy:
$5 Two packs of pain relief tablets
$10 Six wound dressing packs
$15 box of 200 disposable gloves
$22 Blood glucose meter (carried in every ambulance)
$28 Disposable stiff-neck support collar (St John uses 400 a month)
$33 50 blood glucose test strips
$215 Safety clothing, including helmets, to protect officers treating patients trapped in difficult locations
$500 90 doses of life saving medicine
$900 Portable radio
$2000 Combi carrier stretcher
$34,000 State of the art Philips MRx defibrillator
$200,000 Fully equipped ambulance
$500,000 Major incident command vehicle - vital for co-ordinating major emergency responses.
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