Busy FRU day

My shift on the FRU was at a different ambulance station to where I normally work, so the first thing I needed to do was to go to my normal station to pick up my reflective coat and my stab vest.

I'd just arranged this with the FRU desk in control, and set off to my normal station when I received a call to a lady in a care home who was unconscious. It turned out she wasn't quite unconscious - she responded to me at least. She was diabetic, and her blood sugar was 3.1. Now our clinical guidelines state that you should only give an injection of Glucagon (which, put simply, stimulates the liver to release stored glucose) if the blood sugar level is less than 3.0, but there is a get out that allows for clinical judgement.

It would have been dangerous to try to give her some glucose gel or a drink, so I decided to give her the glucagon (a skill which EMTs aren't recognised for doing under Agenda for Change - see here for a post Tom Reynolds wrote about it one year on from its supposed implementation. I'll be posting an update regarding this farce.)

There. First job, and already I've cracked open a drugs pack.

Next a chest pain - which turned out to be belly ache, but to be fair it was a genuine call so I wasn't annoyed.

The next one annoyed me though. Very much so. A gentleman rang 999 because he wanted a lift to his local hospital so he could make an appointment with the physiotherapy department. It became a Category A (immediately life-threatening) because he said he was having severe difficulty in breathing. He was most upset when I turned up on the car - "What have they sent you in that for - I can't get in a car!" If I tell you any more, then I'm afraid I'll start swearing, so I won't.

Instead, I'll finish on a call that came in to control while I was standing at our sector desk on my last shift before I went on holiday. One of the questions that's asked is "Are you/the patient breathing normally". Well when I read the answer on the job ticket as it came out of the printer up on the dispatch desk, I nearly wet myself laughing. The answer had been:

"It's not as normal as it normally is, but apart from that it's normal!"

I'm pleased I wasn't on the crew that went to that patient - I think I'd have still been giggling when we walked in.

Ahh well - at least I can rest assured nothing's changed while I've been away.

By the way - Happy Halloween. Watch out for those witches and ghosties!

Home again

Just arrived home after my hols, which were very nice, and thank you to those who wished me a good break.

just time to go to bed before getting up at 5 am for an overtime shift on an FRU. Why did I agree to this the day after returning home? I must be mad!

Holiday

I am about to start my last shift before I go away on holiday to Norfolk. I come back a week tomorrow, so there will probably be a lack of posts during the next week, but I will try and post when possible.

In the meantime, please don't forget the other excellent blogs - Random Acts Of Reality, Nee Naw and Newbie at CAC, and I'll be back in a week.

Maternataxi

The following poem was written by my last crewmate and myself after we'd done our umpteenth "Maternity Taxi" job in 3 days.

Now I know there are mums-to-be that try not to call, and wait at home so that they don't go into hospital too early in labour just to be sent home and end up mis-timing it so we end up being called to deliver the baby.

Then there are those that forget that the more babies you have, the shorter the labour is and get the timing wrong. I don't mind those.

It's the ones that feel a contraction so call us. It mostly occurs with mums-to-be having their 1st baby, and I can understand that they might panic a little, but they've had 9 months to plan this moment! And then they sometimes insist on us carrying them. Why? I don't know. I know that labour is sodding painful, but it really doesn't stop your legs from working. Besides, walking while in labour can actually help the process.

So there now follows a slightly cynical poem entitled "Maternataxi".

MATERNATAXI

You’ve had this bump for 9 months now,
And things at home are ready.
So why sit there about to drop,
Watching good old tele.

Every day we are here,
You can count on us.
We are fast and cheaper than,
A Cab or London bus.

Just dial us now, the call is free,
You know we won’t be slow.
We have nothing better to do,
Than sit around you know.

You say you cannot make the stairs,
Of your 10th floor flat.
Yes OF COURSE we’ll carry you,
It’s only our backs.

We try and help all those in need,
We do that every day.
So why should we come and pick you up,
For transport you won’t pay.

PHONE 999 we will be fast,
If that is your wish.
Thank you for calling us,
And taking the P - - -.

Relatives Reactions

The way that relatives react to us when a member of their family needs medical assistance never ceases to amaze me. I'm sure it's because they don't really understand what is going on, so quite often, the reaction is nothing like you'd expect, and is usually completely out of context.

One example (and I've experienced this two or three times now) is at a cardiac arrest. You'd think that seeing a paramedic putting a tube down their loved one's throat, having a defibrillator attached to their chest and probably having an electric shock pumped through their chest and someone performing chest compressions would kind of give it away that they're somewhat rather ill to say the least.

But it's quite often not the case. You'll be asked what's wrong with them by relatives that are very calm and clearly are not switched on to what's occurring right in front of their faces. Maybe it's because they're hoping that it's not really as bad as it looks, or they're just refusing to believe the truth.

When this occurs, someone usually takes the relative to one side, but where they can still see what is happening and explain what's going on. We tend to send two crews to a cardiac arrest to assist with the removal of the patient, so there's usually one person who is able to spend time with relatives and explain exactly what we're doing and why. I personally think this is a very important part of the process, and helps them to understand that we are doing everything possible to save the life of their loved one.

The other reaction we tend to get is complete and utter panic, and a conviction that the injured person is going to die. This tends to occur with injuries such as a broken arm or leg. (And I'm not kidding either!) It also occurs when someone is simply suffering from a bellyache and is vomiting. The other time it happens, and I'm afraid I don't tend to have much sympathy, is when someone has become so drunk they've basically drunk themself unconscious. Believe me, they're fine, and deserve the stonking hangover they'll get the next day.

Drunks are another subject I'll write about in the future. That'll be a bit of a rant.

Newbie At CAC

Newbie At CAC is a blog by a new EMD (Emergency Medical Dispatcher) working in LAS control. He/she gives an insight into what it's like to work in "the room" as a newbie.

Hopefully he/she won't get the "oh God!" syndrome too soon. lol.

You can find it here. Read and enjoy.

Syndicate

A couple of commenters have requested that I syndicate my blog, so I am pleased to announce that you can find my blog syndicated here

Strange days

As the title says, it's been a strange couple of days. Yesterday we had a new university student on the paramedic science degree course out observing with us.

Normally when we get an observer to take out, it ends up being a relatively quiet day with no really interesting jobs, so we tend to go out looking for work, because it's pointless and boring for the observer to sit on station waiting for the phone to ring, and that's the way it panned out yesterday.

We went to a couple of obnoxious regulars, a woman who thought she was dying because she had an infection in her gums, and the most potentially interesting job was given as a body under a tree, which turned out to be a very conscious, but very drunk man. We only did about 5 jobs in total in a 10 hour shift, which is a shame for the observer. Even staying out hoping to pick up some work proved relatively futile. This is known in the job as the "Observer's Curse".

Now today, because we didn't have an observer out with us, we started the day with a hanging (chap of asian appearance had tied a belt round his neck and a railing on the landing of a block of flats and just sat down and strangled himself more than hang). When we arrived he was still warm so we worked on him, but he was pronounced dead shortly after arriving at hospital. It turns out he was a known psychiatric patient and had gone missing. The police had been urgently trying to find him as he was known to be at high risk of committing suicide. Unfortunately, it seems he got his wish.

We then went to a gentleman who was in cardiac failure with central chest pain, and rather poorly. Another good working job. He turned out to be fine in the end and as far as I know was released from hospital a few hours later.

After that we went to a 4 car RTC, with all involved only suffering minor injuries and a couple of whiplash injuries.

Finally we went to a chap, possibly drunk, unconscious on a bus. He didn't particularly smell of drink - certainly only probably one or two drinks. His blood glucose level was fine, but he was very sweaty, vomiting and the pupils of his eyes were pinpoint, which is usually a sign of use of opioid drugs, such as heroin. He wouldn't/couldn't talk to us, but nodded when asked if he'd taken any drugs, and nodded again when I mentioned cocaine. Although cocaine isn't an opioid drug, we couldn't rule out the use of such drugs, so we gave him an injection of the antidote (narcan). It wouldn't do any harm if he hadn't taken any, and it could help to bring him round a bit more.

It didn't work, so we took him in to hospital. On the way, he decided to vomit all over the back of the ambulance. Fortunately I saw it coming, so managed to move out of the way rather sharpish. We ended up being an hour late off work cos we had to mop the floor, clean the trolley bed, and wash the trolley straps that he'd also managed to get vomit over.

Glamorous job working for the ambulance service isn't it?? hehe.

Only four jobs in 10 hours today - but all were long winded and awkward jobs. Glad today's over - I'm knackered. Still, back for more tomorrow!

Triage

We rarely get to have a break during our shifts, and it's been getting worse lately. It's quite a normal thing now to go out right at shift start time, and to not get back to station at or after your finish time.

Part of the problem is AMPDS (Advanced Medical Priority Dispatch System) our computer triage system in control that is used to categorise every 999 call. There are three categories of call:

1. Red Calls. Also known as Category A calls. These are the calls classed as immediately life-threatening, from Chest Pain, fitting, difficulty in breathing, and high energy impact road collisions to Cardiac Arrest. We have to get a response to these calls within 8 minutes e.g. a fast response car, motorcycle response unit or an ambulance. Where one of the rapid response units achieves the 8 minutes, an ambulance should be on scene withing 14 minutes.

2. Amber Calls. These are category B calls. These are calls that are determined to be serious but not immediately life-threatening, and include problems such as assaults, falls, some RTAs , broken pelvis, abdo pain.

3. Green Calls, or category C calls. These are calls that are not deemed to be serious or life-threatening. These include the back pains for 4 weeks, broken legs, arms and ankles (these are painful, but not life-threatening) old folk that have fallen out of bed with no apparent injury but just need help to get up, early stages of labour (never really have understood why ladies in the early stages of labour call for an ambulance only to be sent back home from the delivery suite - and "maternataxi" calls will be the subject of a future post)

The problem with our system is that it over-triages the non life-threatening stuff, giving an inappropriate category, such as a category A because there is apparently serious bleeding and when we turn up it's a simple cut finger that a rinse under the tap and a plaster would easily do.

I hasten to add that this is not the fault of the call-takers, but the way the questions are phrased in the system. Another example is the question "are they breathing normally?" Well of course they're not if they're crying! But an answer of no to that question will cause the system to triage the patient as having Difficulty in Breathing because they're not breathing normally. So someone who is just crying, instead of being a green call will end up being an Amber call or even a Red call.

Having said that, the system really is sound legally, and nobody has successfully sued a service over a categorisation of a call.

Remember though, if you need to call for an ambulance, don't be worried that answering all the questions will delay the ambulance, cos it won't. As soon as the call is answered, it appears on the dispatchers screen as well as the call-takers, so as soon as the address where the ambulance is required is confirmed (which is the first question) the nearest ambulance can and will be dispatched. Don't give the call-takers grief - they're asking stuff that we on the ambulance need to know, as it can affect what equipment we take into the call.

If I get a message on the screen in the ambulance that a caller has been abusive or has refused to answer questions, I always challenge them about it. Some crews don't, but the way I look at it is if they're not told about it, they'll think it's acceptable to give verbal abuse down the phone.

Away

Sorry abouty the lack of posts - been away for the weekend. Normal service will resume tomorrow.

Big White Taxi Service

The Big White Taxi Service is an unofficial website for Ambulance personnel from all sections of the ambulance service across the country. It's basically a virtual messroom, and allows us to vent off some of the frustrations that get built up for a variety of reasons.

Please feel free to visit the site, but please bear in mind that there is bad language on the site, particularly in the forum, so it's really only suitable for people aged 18+. You may find some comments offensive, and may be led to think that we are not very professional, but please remember this is where we vent off, instead of venting off at patients. It's our way of coping with some of the stresses of the job, and EVERY patient is always treated with the best care we can give.

It's also the place where many staff came together following the London bombings on 7th July.

This is an entry from the guy on the FRU (Fast Response Car) who was first on scene at the Aldgate bomb. Ironically, he hadn't even been given the job by Control - he came across it as a "Running Call" (where you get flagged down by someone).

Glossary to some terms he uses:

LFB - London Fire Brigade
LAS - London Ambulance Service
HEMS - Helicopter Emergency Medical Service (Operate under the control of the LAS)

Unfair blame and a young Alcoholic

We finally hit the road today at 8am - an hour and a half late. My crewmate has to travel quite a distance to get to work, and had set his alarm for 4am for a 6.30am start. He swears blind he didn't hear the alarm and can't remember his wife waking him and telling him the alarm went off. He says it's her fault he was late cos she didn't make him get up!

We arranged to change our shift time to 0800 til 2000 so we didn't lose any hours overtime, plus we'd still work the same amount of time we'd already agreed to work.

During the early afternoon, we got a call to go to a 25 year old lady who had fainted in the street.
On questioning, it was discovered that she was on her way to a GP appointment to try to arrange a referral to a detox clinic to help her come off alcohol. She said she'd had about eight drinks today in a mixture of wine and beer. She should have been completely smashed, but she was managing to talk in completely coherant sentences, was alert and knew where she was.

We did the obligatory blood pressure checks, and checked her blood sugar level to make sure that wasn't the cause of the faint. We couldn't find anything much wrong with her, so we took her to her GP surgery so she could keep her appointment.

While my crewmate was talking to the GP to make sure they were happy to see her and didn't want us to take her to hospital, I did some probing about the drinking. She admitted she knew she had a problem, she knew what had driven her to drink, which was what she described as the usual relationship problems, money problems etc. She said that these were the sort of problems that other coped with easily.

I reassured her that there were a great many people who turned to drink with those sort of problems - she wasn't the first, and she wouldn't be the last. I congratulated her on recognising she had a problem, and for wanting to do something about it.

She then told me she had an Arts degree, and was just completing a Law degree.

This is one young self-confessed alcoholic who I do believe will manage to break her drink problem. She certainly seems to have the determination to do so, and I wish her the best of luck.

Late!

We've all done it. We've all gone to bed, safe in the knowledge that we've set the alarm for the overtime shift that starts earlier than we usually do.

The problem today, is that my crewmate's alarm went off, but he didn't hear it.

Still, he should be in sometime in the next 40 minutes.....

Drivers

We tend to have a bit of a problem when we are going to calls. It’s called traffic and other drivers.

Here are some common problems we come across:

If we're coming up behind a driver and there's a bollard ahead, the driver will stop next to the bollard thinking we can still get through.

As we approach a side road, a car will pull out in front of us, then immediately pull over so we can pass. This is not the good idea it may seem!

Drivers race ahead of us. This is not the thing to do and is potentially very dangerous. We are given an intensive 3 week advanced driving course, and we're taught to drive safely at speed. Most other drivers are not, and aren't looking for the hazards far enough ahead.

If there's an empty lane when approaching a red traffic light, someone will pull into it ahead of you to use you as an excuse to go through a red light

Driver's following dangerously close behind as a way of getting through traffic. More than once this has happened and the car following has gone into the back of the ambulance when it braked hard for the car at the side road!

Drivers blocking Keep Clear and Yellow Box areas on the road.

London bus drivers are extremely bad at pulling over. They only tend to stop when they reach the next bus stop. I had one bus once cause a delay of 4 minutes because he blocked a filter lane. He'd seen us coming before he got there too because he made eye contact through his mirror, but he just wouldn't pull over.

In fairness, most people do move out of the way and/or stop for us, but there will always be those who’s purpose in life is to be as big a pain in the arse for emergency vehicles as possible.

I think part of the problem is that people just don’t use their mirrors and don't look properly before pulling out. Drivers should be checking their mirrors at least every 10 – 15 seconds. Instead, it seems that mirrors are just there to make the car look pretty, and because the law says cars have to have them.

Others quite simply panic. I do think that learner drivers are not taught enough what to do when an emergency vehicle approaches them, either from behind, or in front of them.
When my other half passed her test, we went out for a drive and were approached from behind by an ambulance. She said she didn’t know what to do, so I had to coach her through pulling over and stopping in a safe place where the vehicle could get round us easily.

That’s the secret really. Keep an eye in the mirrors, and also look as far forward as you can see. That way you stand a good chance of spotting an emergency vehicle in good time, and seeing where you can safely pull over.

Keep an eye out for us, and do your best to help us get through. It could be your relative we're going to one day.

Urgents

There are really two main types of call we go to as part of the A&E section of the ambulance service.

The first is the Emergency call - the 999 calls, and can range from cardiac arrest to a ring stuck on a finger (yes, I've actually sat in control and listened to that call come in!)

The second is an Urgent call - called in by a doctor, nurse etc for a patient that requires transporting to hospital, but isn't in a life-threatening condition. Usually they give a time for the patient to be in by (known as a Scheduled Time of Arrival - or STA). We don't use blue lights to go to this type of call.

We were on our way back to the ambulance station after having the computer on our ambulance repaired when we were given an urgent call to an elderly lady. The doctor said she was suffering from Acute Shortness of Breath. The call taker had obviously asked the doctor if he wanted an ambulance to attend as an emergency, because the screen also told us the doctor had said an emergency response was not required.

The call was nearly out of time, and we had quite a way to go to get to the call, so we asked control if they'd like us to respond using blue lights due to the diagnosis and the fact that the call was nearly out of time. They agreed, so I switched on the blue lights and off we went.

We arrived about 9 minutes later (the journey without blue lights would have easily taken another half an hour) and walked through the door to the block of flats to find the doctor sitting on the stairs, which we thought was a bit odd. "The patient's upstairs on the landing," he told us.

A bit confused, we walked up the stairs, and there at the top, on the landing by the communal door, curled up in a ball on her knees was the patient. And she wasn't breathing. And she clearly hadn't been breathing for quite some time, as we could see evidence of hypostasis (when the blood pools at the lower part of the body after death has occured). For some reason, this poor woman had passed away on the landing of the block of flats, kneeling on the floor.

The doctor had followed us up the stairs. We asked him what he knew about her. He said he'd only spoken to her on the telephone about an hour before (rubbish!) and had told her he was sending an ambulance for her. He hadn't actually visited her, so hadn't realised how poorly she was. He'd found her in her current state when he'd arrived to deliver the letter for the hospital.

He'd already sent for the police. There was clearly nothing we could do, so we left the doctor waiting for the police to arrive.

This is the first time this has actually happened to me on an urgent call - although I've come bloody close in the past, having to blue light some critically ill people into hospital when the GP had said an emergency response wasn't required.

It really is quite rare for it to happen, but it is so frustrating when it does. The most annoying part about the above example, is that the doctor didn't consider calling us back to update us that the patient had died.

Hoax!

Our shift started at 7am. We'd been out since 6.50am as we'd taken an early job as a favour to control as they'd received a call for a cardiac arrest just down the road from our station. I was in the process of ironing my shirt at the time, and it was only half done. No time to finish it - we've got to go. Seconds mean everything in a cardiac arrest. As it turned out, the patient wasn't in cardiac arrest, but the call had been genuine enough. He'd fallen out of bed and banged his head on the wall, knocking himself out, so we took him to hospital.

We were on our way to an elderly lady who was feeling unwell and was very weak when we were cancelled off it for a "higher priority call" - a 71 year old lady in Cardiac Arrest, 9 miles away. Now 9 miles may not seem that far to most ambulance services, but in London, it is a very significant distance indeed, when you take into consideration that it is mostly built up, and the traffic is, quite frankly, appallingly bad. Not only that, but it was in the opposite direction to where we were going.

I quickly turned the ambulance round and floored the accelerator. We tore through the traffic, most cars giving way, apart from one which almost caused me to flat-spot the tyres when he pulled out of a side-road right in front of me. (Other drivers will be the subject of a further post - prepare for much ranting!)

We made the journey in 11 minutes. We jumped out of the ambulance, grabbed our kit, and ran up the 3 flights of stairs to the flat, after having to shout at some kids to get out of our way. The door was closed, so we hammered on the door - which was opened by a 71 year old lady, who was looking very well considering she was supposed to be dead.

We made a few enquiries via our control room, and discovered that the call had been made by a child from a payphone just down the road. It was a hoax.

So for the pleasure of some idiot, we had risked our lives and the lives of other road users driving 9 miles in 11 minutes through busy London traffic, we'd scared the living daylights out of a poor lady who we'd been told was dead, and a poorly elderly lady had been deprived of an ambulance as it had been diverted off her call.

Funny? I don't think so.