A paramedic with the Welsh Ambulance Service has given a candid and brutally honest account of his experiences on the frontline during the Covid-19 outbreak.
The experienced NHS employee, who works in south Wales, admitted that many of his colleagues are "terrified" of going into work with many never dealing with anything so traumatic.
He said while the service was well-equipped to deal with coronavirus patients when the first few cases were being identified, it was now proving more difficult to keep the public and staff safe.
The whistleblower went on to warn that he only knew of one paramedic being tested for the life-threatening disease so far.
"There's a lot of fear. Some colleagues are absolutely terrified of this and just don't want to go into work," he said.
"I never thought I would be involved in something like this. It's absolutely exhausting working on the frontline."
The paramedic said the majority of his call-outs were now related to Covid-19 with many patients needing the highest levels of treatment, including CPR.
He said in the most serious 'red' cases he is required to wear a full white suit as well as goggles, a mask, apron and gloves.
"When the elderly, in particular, are told that they have got coronavirus, you can see the fear in their faces," he admitted.
"A lot of the patients with the virus have a similar look – it's hard to explain it. Their faces are a little puffy and sometimes a slightly different colour. Their hands and feet are also discoloured due to circulation problems."
Coronavirus map by health board
Ambulance crews, along with pandemic teams, were having to make very difficult decisions about who they took to hospital and who they told to stay at home, he added.
He feared that vulnerable patients with particularly severe underlying health problems could be "wiped out" by this virus.
"Every patient needs to be assessed. But if they are young and just have a temperature or cough we will leave them at home wherever possible," he said.
"Similarly we've seen patients who have been discharged from hospital to recuperate at home only to deteriorate again.
"And it's frightening how quickly our local A&E has changed. The triage areas have been completely rebuilt and each cubicle is now separated by proper walls rather than curtains."
The paramedic said carrying out CPR in full PPE gear was a difficult task.
"The suits are absolutely boiling and when you're carrying out CPR and the sun is coming into the room it's off the scale," he said.
"We need to work in pairs as we can't put all the equipment on ourselves. Most solo working has had to stop."
He said that after treating every Covid-19 patient the ambulance needs to be thoroughly cleaned which can take up to an hour.
"This is destroying us," he said. "We need to mop the floor and wipe down the surfaces after every patient. I've seen colleagues' hands completely raw and cracked from all the cleaning."
Another aspect of the job which he claims is having a detrimental effect on staff morale is a lack of leadership.
"A lot of local managers are being moved around and we feel there's no station leadership. That point of contact has disappeared," he said. "The poor supervisors are being left to pick up the pieces."
He concluded that while the Welsh Ambulance Service was excellent in its response to the first Covid-19 cases the same level of care and protection has not been sustained.
"The Welsh Ambulance Service were doing their very, very best to start off with but as it has escalated the supply chain has deteriorated," he said.
"At the very start every time there was a suspected case of Covid-19 we would go to specific stations to get trucks designed with battery-powered hoods on them.
"But now things have been ramped up there's no way we can use this equipment every time."
He added: "Thankfully a lot of our 'bread and butter calls' have stopped so maybe a lot of those people never needed an ambulance in the first place."
In response to the paramedic's claims Welsh Ambulance Service chief executive Jason Killens said the trust was doing "as much as possible" to communicate with all staff.
"I had an hour-long video session with 1,000 of our staff and we are now doing this every week," he said.
"I fully recognise that we have people out there whose emotions range from concerned to anxious to frightened. And that's not only for themselves but for their families and kids at home.
"A lot of the work we are doing is about getting as much information as possible out to them. But you have to strike a balance between overwhelming them with information and giving them the sufficient information they need."
Mr Killens said the Welsh Ambulance Service was compliant with UK-wide guidance on personal protective equipment (PPE) but admitted that some staff did not believe the guidance was sufficient in keeping them safe.
"There is the suitable kit there. There may have been some supply issues to stations in the past, that's fair to say, but big stocks of this have now come in."
Commenting on the ambulance clean-up job after every Covid-19 patient, Mr Killens said that paramedics' routine did not differ from previous guidance before the outbreak.
"If any deeper clean is needed there are make-ready teams in depots who are qualified to take the ambulance off the road," he said.
"We are working with industry to see if we can develop a more rapid and deeper cleaning capability with some technology put in the back of vehicles on a more frequent basis."
Mr Killens said corporate staff had been redeployed to other duties to work in areas of patient contact such as the 111 service.
There were also local pandemic teams and those part of Wales' four local resilience fora who were working 24 hours a day to answer queries of ambulance employees.
He concluded: "This a completely unprecedented issue and there's no playbook we can turn to where this has happened before.
"There will be lumps and bumps along the way. If any staff are frightened they need to talk to us."
