Poorly Children

It's at this time of year when it gets cold that kids start getting colds, chest infections etc.

The last two nights on the car, I seem to have done nothing but go charging around to kids who are vomiting, lethargic, not eating very well, not breathing "normally", and sleeping more than normal.

It's quite simple really. Think about how you feel when you're not well. Had a chest infection? What was it like to breathe - a bit rattly probably with lots of coughing. Had to work at it more than usual? Probably.

How did you feel - tired all the time? Didn't really want to do much? Didn't really feel hungry?

It certainly isn't rocket science. I went to a little girl last night, the call was given as unconscious. I turned up to be surrounded by about four adults, God knows how many kids, all wailing (yes including the men) because the girl was "unconscious".

She wasn't unconscious, and it must have been bloody uncomfortable laid on her front across dad's knee with his huge fingers in her mouth. I took her off him, and gently laid her on her side on the floor. She was rather "chesty", and had a temperature. She'd been given anti-biotics by the GP, but because she wasn't her normal chirpy self, the family had panicked.

It is perfectly understandable that parents get scared when their kids are ill, but they normally relax when the ambulance man/woman/crew turn up and tell them that their child is fine, but has a bit of a chest infection. Usually this is because it's what they've already been told by the GP.

But this family continued to bawl and wail with floods of tears even after I assured them the little girl was going to be fine, that she had a bit if a chest infection and a temperature, and that being lethargic and not wanting to do very much is quite normal for anyone, let alone a child who is not feeling well.

The other side of the coin, I later went to another child who'd been vomiting - and mum was quite embarrassed that she'd called when I arrived because her young son was looking much better (again, how many times have you felt much better after a good vomit?) I assured her that it wasn't a problem calling us. I examined the child, and found nothing particularly wrong with him. Mum didn't really want to go to hospital unless it was absolutely necessary (it wasn't) so I cancelled the crew and arranged for a GP to visit.

A satisfying job - mum had her head screwed on, but had a moment of panic - understandable as I've said before, and I was able to cancel the crew and free them up for the other calls that were being held.

FRU

Well my last week with my crewmate was relatively unexciting. I did think we were in for a good week when on Monday we only took three to hospital but each of those were a "blue call" (Pre-hospital alert). But I knew it was too good to last.....

We were soon back to 27 year old men with man-flu, and people with headaches, but hadn't taken any pain killers because they "didn't want to mask the symptoms"! Well hello!! That's the whole point of taking pain killers - they kill the pain. They do exactly what it says on the packet.

We're both going on the FRU - but believe it or not, out of the four week rota, there are only two days when we are both off at the same time, so we've already agreed we'll do overtime on an ambulance somewhere.

My first rota'd shift is on Tuesday night, but I'm doing overtime tomorrow night, so I guess you can say my secondment on the car starts tomorrow.

It's been a blast working with my crewmate - he knows I blog and the site, so I'd like to thank him publicly for a great year working with him. As I said before, we both get on very well and it makes the job a whole lot easier. We also socialise away from work, which is nice.

Apparently I've got to have another assessment driving the car. This is because people keep crashing them because they go very fast - we use Vauxhall Astras at the moment - and certainly the one I'm working on has been shown to be faster than the Police Astras. It seems this is catching some of our folks out.

I don't think it's a bad thing to have driving assessments every so often. It can only help to improve your driving. One of the complexes in the South West managed to crash three cars last weekend, so maybe it's a bit overdue.

Agenda For Change - The Truth

Finally the truth about how Emergency Medical Technicians (EMTs) are going to be "assimilated" onto Agenda for Change has come out, with staff now receiving their updated contracts.

Up until now, there have been three grades of EMT.

Grade 1 is the intermediate tier, now known as Urgent Care, who deal with Dr's Urgent Admissions (Urgents) and the lowest priority emergency calls. Not qualified to the same standard as "ordinary" EMT's.

Grade 2 is the trainee IHCD (Institute for Health Care Development) Certificated EMT. They hold this grade for one year, then take a final round of exams, including written and practical assessments. They then have to complete a ride-out (like a check ride) with a training officer assessing them on the road. Once they have successfully completed these assessments, they then become qualified. (Pay band 4, pay point 12 - basic pay of £16,004).

EMT Grade 3. Which is the IHCD Certificated Qualified Emergency Medical Technician. The level I am at now. (Pay band 4, pay point 18 - basic pay of £19,248).

Now as of October this year, there is a new grade of EMT - grade 4 (Pay band 5, pay point 18 - basic pay of £19,248). This is open to EMT 3s who have been qualified for three years. Personally I think this arrangement is a joke, as an EMT 3 can apply to do the paramedic course after being qualified for a year.

Now here's where it becomes confusing. I successfully completed my ride-out assessment on 30th September 2004. My EMT 3 status became affective as of 1st October 2004, the same day that the Agenda for Change terms and conditions officially started.

However, my certificate wasn't issued until 6th October 2004. This has obviously confused the service as they are currently trying to assimilate me as being an EMT 2 on 1st October 2004. They can sod right off with that one - I was an EMT 3, and as such I will be demanding payment as an EMT 3 from 1st October 2004.

Being realistic though, I know what this service is like, and I may end up having to put up with EMT 2 pay for the 6 days between my qualifying and my certificate being issued.

Now, as a matter of interest, and an unofficial survey, I'd like to give you the main points of the role of an EMT 3 and post links to the Band 4 and Band 5 profiles, and allow you to judge for yourself which band you think EMT 3s should be in.

We undertake daily vehicle inspections, ensuring all equipment is on the vehicle that should be there.

We drive to emergency calls, often in heavy traffic.

We assess and treat patients symptoms according to the current clinical guidelines.

We give drug therapy where required, including Adrenaline injection for Life-threatening Anaphylaxis and Asthma, Glucagon injection and Hypostop for Diabetic Emergencies where low blood sugar levels is the cause, Aspirin and GTN for suspected acute cardiac problems, Paracetamol for management of high temperature, Entonox for pain relief (otherwise known as Gas and Air - the stuff women in labour are often given), Oxygen (speaks for itself), Salbutamol Nebuliser for Asthma and other breathing disorders.
We're also responsible for the booking out and returning drugs packs at the start and end of our shift.

We perform and interpret 12-lead ECGs autonomously to detect heart attacks, and where these are confirmed, we can directly admit the patient for an operation known as "Primary Angioplasty" to clear the blocked coronary artery. (One patient I had was on the operating table within an hour of the onset of chest pain. This definately saved his life and prolonged his survival.)

We supervise EMT 1s and EMT 2s assessing and treating patients and accept clinical responsibility for their actions.

These are the main points. Please now have a look at the profiles for Band 4 and Band 5, and let me know which band you think we fit into.

The results could prove very interesting.

BBC: 7/7 The Day The Bombs Came

You may have seen on the television last week the above programme.

Myself and colleagues within the LAS are disappointed, upset and angry that the programme did not recognise the efforts made by my colleagues on that day.

Not one person from the LAS was shown being interviewed, despite several interviews having taken place. Many interviewees had never even spoken to a stranger about what happened on that day, let alone on camera, and some understandably found the experience very stressful to put it mildly.

The LAS has written a letter of complaint to the BBC, and I include it here:

BBC documentary: ‘7/7 the day the bombs came’

Further to the preview screening of ‘7/7 the day the bombs came’ and your telephone conversation earlier this week with my Head of Communications, I wanted to express in writing our deep disappointment at the decision to omit the London Ambulance Service from your imminent documentary.

We appreciate that you had a lot of material to work with, and that it was only at the last minute that you decided to drop an interview with a member of our staff because you had the opportunity to speak to one of the survivors of 7 July; however, it is baffling that a high-profile BBC documentary about the emergency services’ response includes no interviews whatsoever with personnel from one of the key responding agencies.

The London Ambulance Service – the largest and busiest ambulance service in the world -played a vital role on 7 July. Many of our staff witnessed the harrowing impact of the explosions first-hand. They did an excellent job in providing medical care to hundreds of patients, some withatrocious injuries, and there is no doubt that their professionalism and dedication saved many lives.

Of course, the Service could not have responded so well alone. It was the joint efforts of theemergency services, the London Underground and members of the public that ensured the smooth management of these incidents. However, the London Ambulance Service had a uniquerole at this terrible event, being the only emergency service with comprehensive medical skills and a duty of care to patients. Our partners play a key role in helping us to provide this care butthey cannot deliver it themselves.

By not telling our side of the story you overlook a significant part of the 7 July rescue effort. The triage of patients was undertaken by the London Ambulance Service, the removal of many patients by the police and fire brigade was overseen by our clinically trained staff. Ultimately, the saving of patients’ lives was orchestrated entirely by experts from our Service, albeit with the crucial support of our partners.

We have worked closely with you over recent months and have tried to meet all of your requests no matter how difficult or time-consuming. During the early stages of production, we identified staff for your research needs, we then gave you access to these staff for interview. For many of these people it was the first time that they had discussed their experiences to a stranger, let alone on camera. These individuals are not media-trained and gave you the best account they could in the circumstances. The callous decision to cut them entirely from the programme will no doubt damage their trust in our department and the BBC.

On no occasion did you indicate that these interviews would not be strong enough to make the final edit. Had you done so, my team would have made every effort to provide and coach more staff for interview and would have had time to ‘let down’ sensitively those whose accounts would not be included. The staff who have been cut will no doubt have told colleagues and friends that they are due to appear and I feel sure will have been very proud to have represented the Service in this way.

Many of our other 4000 staff will watch this programme, and I know that they too will be deeply hurt and extremely disappointed (I do not exaggerate) to find that the Service is not featured. We will almost certainly be asked why this is the case, with some people’s initial reactions being that my team has not done its job in getting the Service involved.

It is frustrating for members of the communications team, who went out of their way to help you. On this occasion, I think we gave you more material than others, particularly regarding facts and figures. Furthermore, this is not the first occasion that the same production team has let us down. On 8 July, under extreme operational and media pressure, we spent an entire day taking staff off duty to film for a Panorama documentary that did not materialise, providing hours of footage that was later lost.

We appreciate that your story has been shaped as the interviews have unfolded and that much of the finished programme focuses on the scene of the King’s Cross and Russell Square train. However, if we had been told this, we would have been more than happy to find more interviewees and accommodate any further needs. With the time already invested with your team and the relationship formed during the filming of both programmes it should have been clear that we would do all that we could to help.

Our relationship with the BBC is mutually valuable, and by not co-operating in the future it would do both of us a disservice. But if we are to work together again I would urge that more thought be given to what you really need from us and more confidence be shown in our ability to help you, so we are not left feeling aggrieved again."

The BBC has sent this reply to the service:

"I completely agree with you on the magnificent work done by the LAS on the 7th July and the importance of the work done by members of your organisation to help save as many lives as possible. I understand that many of your staff had very harrowing experiences and were faced with dealing with people who had the most appalling injuries and salute their professionalism and dedication.

It would never be possible for our film to feature interviews with every agency that formed part of the response to the July 7th attacks without it having a serious impact on the power of the story we are telling. Whilst the interviewees in the film may not be from the LAS a large proportion of the visual images in the film is dominated by LAS staff and equipment and it is our belief that most of the public see the efforts of the emergency services that day, not in terms of the individual agencies but as a whole.

It was always our intention that our film would serve as a tribute to the Emergency services as a whole although I am acutely aware of the sensitivities of your staff and the feeling that in some way the LAS has been overlooked. However we feel that the film will only increase the feelings of pride and honour that the general public and Londoners in particular, have in their emergency services and will see, as we do, the testimony that we feature as symbolic of the work done by every member of each of the emergency services on that day in July."

Personally, I think the response of the BBC to be almost insulting. They should hang their heads in shame.

We don't want people to say "Oh you are such heros". We just want the recognition that is deserved of the staff that were there on the day and did the service proud. I and many others were proud to say that day, "We work for the London Ambulance Service".

Changes

It's going to be all change after Friday's shift, cos this is my last week working with my current crewmate. It's a shame, because we both get on very well, and we both know what the other is going to do, which makes the job a whole lot easier.

After Friday, I'm going to be working on the FRU for three months before taking up a line at another ambulance station.

I've got a list of jobs I haven't done yet, and I'm hoping to get some of them completed before I start working on my own. The main ones are a shooting, a fatal RTA and a "one under" (a person under a train).

I don't know why I'm worried about going to a one under on my own, because by the time the power to the rails has been turned off and we get clearance to go onto the track, the world and his bloody wife will be there - Paramedics, HEMS, duty officer etc.

I'm not really looking forward to going to one - I know how much space there is under trains (we have to do a training day at the London Underground depot at Acton including extricating someone from under a train) and there's only just enough room to crawl along on your belly, but I just want to do one to get it out of the way, and then everyone else is welcome to them!

However, I usually attract the calls that if truth be told don't really need an ambulance (known in the job as crap calls), and my crewmate attracts awkward and complicated jobs, so between us we attract awkward, complicated crap. It's actually quite rare for us to get a decent trauma job or a "working" cardiac arrest, where we do the CPR, intubate (put a tube down in their airway) etc. Normally the cardiac arrests we go to have been dead for some time meaning that sadly there is nothing we can do for them.

But we'll see what the week brings.

Late Off

Our shift was 0700 - 1500. It was a busy shift, but there hadn't been anything too taxing. We managed to get back to station at 1430 - half an hour to go.

Five minutes later, the activation phone rang. "We've got an urgent for you. You can choose between two," said the dispatcher.

Now if we're into the last hour of the shift, we can turn down an urgent, and it will be held either for a vehicle to come available at hospital, or for the next shift which was to start at 1500.

"We're off in 25 minutes," I said.
"No Problem, forget I called," and she hung up.

Lovely. Still a chance we could get off on time.

No such luck.

Five minutes later, the phone goes again. My crewmate said a rude word, and I said an even ruder one. We were going to be late off. I answered the phone again.

"Sorry love," said the dispatcher, "but we've got an amber call that we can't hold. It's a bloke that's fallen downstairs." We walked out to the truck, muttering not quite under our breaths, and off we went.

Now I've had my ambulance driving described before as "driving like you stole it". Happily, I'm not the only one who drives like that - my crewmate drives in exactly the same way. But this job, I have to admit, I drove like a loony. Hopefully it would all be minor injuries, we could get him on the back, nip him into hospital and not be much later off that half an hour.

We turned up, and found the chap laying on his back on the floor in the lounge. Good. If he managed to move himself, it might only be minor.

A lady on scene (his partner I think, but I'm not sure) said he'd come out of the toilet, tripped over the vaccuum cleaner cable, and fallen down the stairs. He'd staggered into the lounge and passed out where we found him.

Five weeks earlier, he'd had an accident and suffered a "smashed dislocation" of his shoulder.

Now his left arm was numb, he had neck and back pain, and he had pins and needles down most of his body.

Not only that, he was in so much pain, he kept tensing up, causing his back muscles to spasm.

Shit. This wasn't going to be a quick job after all. Never is when you want it to be.

My crewmate rang control to get HEMS (Helicopter Emergency Medical Service) out to us primarily so a doctor could give him a muscle relaxant and strong pain killer, and also to advise us on further treatment.

While he was doing that, I went and fetched the scoop stretcher (a metal stretcher that can be split in half so we can put someone on it without moving them) and head blocks (to help keep his head still), neck collars, the suction unit (in case the patient vomited), the Lifepak 12 (to monitor his blood pressure, pulse, oxygen levels, and ecg). I dumped it all on the trolley bed, and wheeled it to the front door.

Once back inside, my crewmate set about getting IV access ready for the HEMS doctor to give the pain killer and muscle relaxant, while I attached the monitoring equipment to him - putting ECG leads on his chest, the blood pressure cuff on his arm, and the finger probe on his finger to tell us how much oxygen he had in his blood.

Then we cut his clothes off so we could make sure there were no other injuries that we hadn't found yet.

We put the neck collar on to help stabilise his neck. We waited until now, because the collar gives better support if it is in contact with skin rather than being put on top of clothing.

We'd virtually done everything short of putting him on the scoop, and were almost twiddling our thumbs waiting for the doctor to arrive, when he did. He gave the patient some morphine, which both acts as a muscle relaxant, and is a very strong pain killer. Paramedics in London are about to be issued with morphine, but we haven't got it just yet.

The HEMS paramedic did an ultrasound on the patient's chest to check that neither of his lungs had collapsed, which they hadn't, then we put him on the scoop, first one side, then the other.

We were about to lift him to put him on the trolley when the doctor's phone rang. Another crew were requesting them, and it sounded a serious job - two people unconscious after falling through a glass roof. We assured the doctor we'd be fine now, and he left us.

We loaded the patient onto the ambulance, with the police carrying all our equipment (apparently they always turn out whenever the helicopter is called - it's a new protocol) and my crewmate's paramedic bag - it's bloody heavy - I'm sure he carries half the ambulance in it!

We put in a "blue call" (a pre-alert call) so the hospital could get the trauma team together ready for when we arrived, and took him in on blue lights.

By now it was 4 o'clock - already an hour late off. But for once it was worth it - it was a genuine job that actually required our skills.

By the time we'd finished clearing up, and restocking my crewmate's bag, left the hospital and got back to station, we were two hours late off.

My other half was going mad with worry because I was supposed to have picked her up at 4 o'clock, but I couldn't ring her to tell her because I'd left my phone at home. My crewmate rang her and told her as we left the hospital. She was fine once she knew.

The ambulance service is a good job - but not for clock watchers. We're quite often late off work, but it's not often we're as much as two hours late off.

Rumbled

Ok. I've been rumbled at work and people now know who I am.

I knew it wouldn't take long. All I ask is that those who have worked it out, please keep it to yourself.

Thanks

Another Life Wasted

It really puts the wind up you.

You turn up to a job given as a male fitting to find half the Metropolitan Police at the address and the patient sitting on the landing going what can only be described as berserk, trying to kick the banister, pull down curtains, lashing out, look of terror mixed with rage on his face.

We were going nowhere near him that's for sure. We're not paid anywhere near enough to get a walloping.

A relative told us that they'd been on a two day alcohol and cocaine bender, with no food eaten and no sleep. A recipe for disaster, and it came a few minutes later when it suddenly went quiet and one of the officers shouted to us that the patient was fitting.

We quickly ran upstairs, cannulated him (put a needle into his vein, often referred to as putting in an IV) and gave him a drug to stop him fitting. It was as this drug was going in that the breathing stopped, followed shortly afterwards by his heart. We immediately started resuscitation and I got a police officer to call on our radio for a second crew to help us.

I got the trolley bed to the door downstairs, while my crewmate continued CPR with the assistance of another police officer, then four officers helped us to carry the patient down the stairs. As we were putting him on the trolley, the second ambulance arrived. It was single manned, but he'd heard the call for help go out and told control he'd come to us as he was literally just up the road. He helped my crewmate with resuscitation while I drove to hospital.

At hospital, we helped the A&E staff with CPR, and we managed to get his heart beating again on its own, but he still wasn't making any effort to breathe so we had to continue to breath for him using a ventilator. When we left an hour later after clearing up the truck, putting my crewmate's paramedic bag back together, cleaning the re-usable equipment we'd used and writing the paperwork, he still had a pulse but wasn't breathing on his own.

I fear that he has suffered brain damage due to the lack of oxygen to his brain while he was in cardiac arrest (CPR is only about 20% as effective as the heart beating normally, but anything is better than nothing) and possibly from the cocaine abuse.

It is likely that he will still die, but if not I fear he will spend the rest of his life in a hospital for permanent neuro damage - and possibly on a ventilator for the rest of his life if he won't start breathing again on his own. You may be surprised to learn that there are a significant number of people who are like this.

So this is basically a 30 year old chap, who's thrown away his life after spending the whole weekend drinking and taking cocaine.

I do hope he recovers, but I can't help feeling that he won't.

Very sad.

**Update 14/11/05**

We learned over the weekend that the gentleman has since died. It won't be long now before we get the request for a statement from the coroner I'm sure.

Drunks & Food

It must have been some sort of epidemic last night. Every single call last night bar one involved someone who was virtually legless. The only patient that really needed an ambulance was a young lady who was having an asthma attack, but a dose of a salbutamol nebuliser soon had her breathing sorted out and she didn't need to go to hospital.

The night had started with a call to a gentleman who had belly ache, was cold and shivering. It was a category Green 2 - our lowest priority of call, and it had clearly been a busy day - he'd rung for an ambulance at 17:30 and we were sent on it just after our shift start time of 19:00. On the way, we asked control to ring the caller back to a) find out if we were still required and b) to try and make sure we didn't get a hostile reception because of the hour and a half wait.

He told control we were still required, and he was told we were on our way with apologies for the delay, but when we arrived, the patient had walked to the hospital and hadn't bothered telling control. We only found out he was at the hospital when control rang the A&E department to see if he'd booked himself in, which he had.

That set the tone for the night really - it was going to be a night of unexciting calls. It was then drunk after drunk after drunk. At 1 am, we were finally left alone long enough to call at the kebab shop so we could get some food. We were both on the verge of being hypo at this point.

My crewmate went in to get the kebabs and I stayed in the ambulance as we were showing in control as available for calls and so one of us had to stay in case we got a job. The kebab shop was quite busy, but fortunately the owners let us jump the queue and get served quickly. I could see that they were just wrapping our kebabs up when the MDT sprang to life with a call. A young girl was having a panic attack and apparently going in and out of consciousness. I put the blue lights on to attract my crewmate's attention and let him know we'd got a job, and a woman standing in the doorway said "Oh that's good, there's an emergency and the ambulance crew are ordering kebabs. Someone might need CPR and they'll have kebab breath!" to which my crewmate replied as he walked passed her "We are only human - we do need to eat as well you know." Besides, if someone needed CPR I don't think they'd mind too much if we had the smell of kebab on our breath.

I'd already got a blanket out to wrap the kebabs in to keep them warm if it had been needed, so while I drove to the call, my crewmate wrapped the food up in the blanket. We arrived to "windmills" galore. A windmill is where someone stands waving their arms about to attract our attention. We walked into the girl's room to be greeted with the sight of a very drunk young lady who was hyperventilating. "she keeps going unconscious" said the girl who was propping her friend up. Right on cue, the patient flopped her head back and "stopped breathing". I've seen this countless times before. One of the tests to ascertain genuine unconsciousness is the flick the eyelashes. If they're pretending to be unconscious, their eye will flicker and they can't stop it happening either. Her eye flickered.

"Right, stop holding your breath and open your eyes. I know you can hear me," I told her. It was like a miracle cure. She gasped a breath and opened her eyes. Fortunately she knew the game was up and didnt try it again, although she was still breathing too fast. We took her to hospital, and I coached her breathing on the way. By the time we arrived, some seven minutes later, she was breathing normally and laughing and joking with her friends.

The job with the most potential for being interesting was a pedestrian who'd been hit by a car. It wasn't interesting - it was another drunk who'd staggered out in front of a car and been hit with a glancing blow. All he had was a bit of a cut to his head, and a loud abusive mouth. We left him at hospital being unco-operative with the nurses.

DIY

Since my overtime shift on the FRU on Monday, it's been a busy old week. My crewmate and his wife (who is also a paramedic in the LAS) moved into their new home last Friday.

The last few days have been spent at their house helping with painting, replacing floorboards, laying carpets, building shoe cabinets and bookcases (the flat pack ones from Argos - not from scratch....I'm not that clever!) and putting shelves up. Not to mention catching the cat to inject it with insulin - the first insulin dependant diabetic feline I've come across!

I'm knackered now - I feel like I need another holiday! Still, no time for that.....back to work on the ambulance tomorrow night. Weekend nights over the bonfire night weekend - deep joy! Got an observer out with us on Saturday night - I hope the "observers curse" strikes again.