Happy New Year

Well observer’s curse certainly didn’t work this time.  Eight jobs, six of which were genuine, mostly people fitting.  I’ll write about one of them in the New Year – I’m off to see the New Year in with my family in Lincolnshire.

Happy New Year to you all, stay safe, and I’ll see you in 2006!

One Job

It was a rare shift last night - I only did one job in the whole shift.  And I got that just after I’d started washing the car, and had to go out with the car covered in soap.

It was to a 16 year old boy who was a known epileptic.  Poor bugger has at least one fit every day in the morning.  His mum and dad called us last night because he had a fit that lasted longer than normal.  The crew popped him down to the local hospital for a check up.

I did start running to another call as I was heading back to station to finish my shift, but got cancelled on the way.  So I only saw one patient last night.  That’s quite a result – I normally do 8+ jobs.

I hope its busier tonight – I’ve got an observer with me.  Observers curse will probably strike again though.

Allergic to...Bed Bugs

The job was given as an allergic reaction with the whole body swelling up.

This isn’t a good sign in an allergic reaction, as it could mean that the patient is going into anaphylactic shock, which is a very severe and life-threatening form of allergic reaction.

I arrived, and quickly made my way upstairs to where the patient was sitting on the floor in the bedroom.  She’d been diagnosed as being allergic to something four weeks ago, but as yet they hadn’t tracked down what she was allergic to.  She was a little swollen, but she wasn’t in a life-threatening condition, and she was continually scratching.  I did her blood pressure, and took a reading of her oxygen levels and her temperature, which were all normal.

The crew arrived quickly after me, so I did a quick handover, and left them to it.

When I spoke to the crew later, the girl that was attending said “Hey Steve, you know that woman?  Well half way to hospital she produced a jar with bugs in.  They were bed bugs that had grown, and she was covered in them which is why she was swollen and itchy.”

I took myself off the road and had a shower.  Its making me itchy just writing about it.

BBA - Catch!

I’m not at work today (which is probably a good thing after yesterday) so I’ll tell you about a job I did a few months ago while I was working with my last crewmate on an ambulance.

It was a night shift, and we were given a call to a BBA.  BBA means Born Before Arrival.  Not before the arrival of the ambulance, but before arrival at the hospital.
We arrived at the address, and we were met at the door by the dad-to-be.

“The head’s showing” he said as we entered the house.  “She’s upstairs on the bed.”
“Ok,” I said, and we made our way up the stairs. We often get told that the head’s showing, and when we arrive at the mum-to-be, there’s nothing of the sort.

I was attending, so I walked into the bedroom first, and there kneeling up on the edge of the bed with the “business end” hanging over the side was mum.  At a glance I saw that dad was correct.  The head was “crowning” which means it’s visible.  I turned to put the bags down that I was carrying, and as I did so, I just happened to glance back and saw that the head was out.  

I opened my mouth to tell mum to stop pushing, but before I could even say “Stop”, the rest of the baby was born with a rush.  It fell, head first onto the floor from the height of the bed, rupturing the umbilical cord in the process.  I keep looking back at that moment to see if there was any possibility that I could have caught the baby, but there wasn’t.  I had just been setting the bags down on the floor.  Had the baby popped out a few seconds later, then yes I would have caught it.

Fuck.  It was at this point that I really wanted the ground to open up and swallow me whole.

Instead, both me and my crewmate made a dive for the baby.  My crewmate got there first, and wrapped the end of the cord round his finger to stop the bleeding from it.  Babies don’t have much blood, so they really don’t want to lose any.  

Once he’d done that, I quickly checked baby to make sure it wasn’t injured from the fall, but it was fine and started to give a good cry.  We got mum to sit on the floor and I got hold of her end of the umbilical cord and got my crewmate to wrap it round a finger on his other hand.  He really looked quite funny sitting between mum and baby with the umbilical cord wrapped round a finger on each hand.  I opened the maternity pack, and got out three cord clamps.  Normally, we only need two – one for the baby, and one for mum, but because of the rupture, we decided to put two on baby’s side of the cord to make sure there wouldn’t be any further bleeding, then I put a clamp on mum’s cord.

We then gave mum her baby boy to cuddle, and we waited for the FRU to arrive after picking up a midwife from the local maternity unit.

She arrived shortly afterwards, and examined baby.  She was satisfied that there hadn’t been any adverse effects from baby’s first flying lesson, and went on to deliver the placenta, weigh the baby, and stitch mum where the baby had torn her as it made it’s dive for freedom.

After she’d finished, mum didn’t want to go to hospital unless it was necessary, and the midwife was happy for mum to stay at home, so we left the new family together and we took the midwife back to the hospital.

It’s a job I will never forget, and my then crewmate still laughs about it, saying the look on my face as the baby shot out was the funniest thing he’d seen for ages.  He threatened to buy me a baseball glove for Christmas (cheeky git) but he didn’t.  Anyway, I still think seeing him sitting on the floor with the umbilical cord wrapped around a finger on each hand was the funniest.

I’ll catch the next one!

Bloody Annoyed Now

I'm sorry, but my Christmas Cheer went out of the window this afternoon.

I went to a job where a GP weas on scene with a genuinely ill person (they were all genuine today - makes a change!) who didn't want to go to hospital. After completing the job, I went back to station to re-stock on oxygen and a few masks. I'd booked on station on the MDT, went to get the oxygen and masks, and the phone rang. I couldn't hear the MDT ringing with a job, so a bit confused, I answered.

"Hello, 50"
"Hiya - can you go out on standby please? Gold control don't want you on station."
"1) Ask them if they're authorising me to go out without oxygen and masks, and 2) don't they know it's Christmas Day?"
"Sorry, I know but they spotted you pressing green at station and have told us to ask you to go out on standby"

Now I don't mind working over Christmas - I don't have kids, so I like to work to allow those that have kids to spend Christmas Day with them. Or I did.

I've now cancelled my overtime for the new year period - I'm buggered if I'm going to go into work to help them out only to not be allowed to go near the ambulance station.

And I know I'm not the only one this has happened to, and I also know there are others who have cancelled overtime for next week because of it.

Bollocks to them

Christmas Day

Christmas Day is proving to be thankfully not very busy (trying to avoid using the "Q" word!)

I've only done one job so far today - sadly it means that for the family concerned, they'll remember this christmas for all the wrong reasons.

I received the call as an 85 year old male unconscious. The screen also reported he had a history of cardiac problems and that he had shallow breathing.

I arrived on scene to find the patient in the back of a taxi. Not a black cab, but one of the private-hire sort.

I opened the door, and quickly checked him. He wasn't breathing and had that familiar look of death about him.

Bollocks.

I was still on my own at this point, so I asked control to update the crew that the patient was suspended, then I had to drag him out of the car so I could lay him down on a hard surface in order to do chest compressions. He was bloody heavy too. I got him on the ground, and quickly cut his upper clothing so that I could attach the defibrillator pads, and found a Medic Alert necklace.

A Medic Alert necklace, or sometimes a bracelet, is worn by people with known medical conditions - angina, asthma, diabetics and epilepsy are the main conditions. This one showed that the patient had had previous heart attacks, was a diabetic, and was a renal patient, which means he had problems with his kidneys.

I cut it off him, as it was made of metal, and I might need to defibrillate him - give him an electric shock to try to re-start his heart.

I then applied the defibrillator pads, and turned the machine on. It showed he was in asystole, which is the flat line. That's not a good sign. As a general rule of thumb, if someone is in asystole, then they are dead. But as ever, there are always exceptions to the rule and you do occasionally get someone back from asystole.

I started chest compressions with one hand, while I was getting the bag and mask out with the other, then a nurse who was passing stopped and offered to help, (to be honest, she didn't have much choice because I'd blocked the road with my car) so I got her to do chest compressions while I used the bag and mask to breathe for him.

The crew arrived not long afterwards, and we got him on the back of the ambulance and we "blued" him in to hospital, where he was sadly pronounced dead.

So that, so far, was my one and only job today.

On a happier note, I have been up to the control room, where I bumped into Mark Myers. It was nice to put a face to a name. He was in civvies, as were most of the control room staff. Shame we couldn't do that ourselves on the road, but then I suppose we'd get some funny looks walking into houses in jeans and tee-shirts, and nobody would believe we were from the ambulance service.

Everyone is happy(ish) in there, and there are lots of sweets floating around, and they've even got a chocolate fountain going in their messroom. Lucky buggers. They've got a lovely spread on too, so I felt it necessary to assist them in eating some of it.

Well, it would've been rude not to really....

Merry Christmas

So the Christmas weekend is almost upon us.  I’m working day shifts tomorrow, Christmas Eve and Christmas Day, and it seems that all the other ambulance bloggers are too.

So if you see an FRU or an ambulance parked up on standby somewhere, feel free to go over and offer them a cup of tea or coffee and even a mince pie if they’re near where you live, and if you have the misfortune to have to call for an ambulance, try not to give the call-takers a hard time.

Better still, if you live near our HQ at Waterloo, our control staff will be grateful for any gifts of goodies.

I hope you all stay safe, and may I wish you a very Merry Christmas.

Where Are You??

There's an interesting topic being discussed on Tom Reynold's blog regarding the ease, or quite often, lack of ease in finding addresses.

My personal opinion is, where possible, have someone outside looking out for the ambulance and even better, have someone at the road end.

I've just done a call where this was the case - a person was standing on the corner, at the entrance to the car park, and round the building to where the nearest entrance to the patient was. This was fantastic, and definately saved no end of time getting to the patient.

As I have commented on Tom's blog, there is nothing worse than being given a job to someone seriously ill or suspended, and not being able to find them because they're in a hard-to-find place, and there's nobody to show you where the patient is.

Busy Night Expected

21.30 I'm hoping to keep updating this post as the night goes on.

It's supposed to be one of the busiest nights of the year for the LAS, with it being the last Friday before Christmas. We've had coverage on all the local news encouraging people to have a good time but think about how to get home and think carefully before calling an ambulance for a friend who is simply drunk.

At the time of writing, the number of calls has already topped 3,600, and I expect it will have risen to well over 4,000 by midnight. We have a way of seeing what ambulance is doing what call on station, which is how I know roughly how many calls have been taken by the call numbers next to the callsigns. I've just spoken to the FRU desk in control, and they sound knackered already.

Hope everyone (road and control staff) stays safe and has a relatively stress-free night.


00.40 Well as expected, control took at least 4,167 calls in the 24 hour period that was the 16th December. Already since midnight over 165 calls have been taken.

I've just been to an old man with a water infection which has caused him to become acutely confused (this is a common reaction to an infection in the waterworks), a call to a bloke who was in cardiac arrest after an assault. He must have recovered bloody quickly because he'd gone by the time I got there, and it only took me 6 minutes from the time of the call, and I've just spent an hour and twenty minutes on scene waiting for an ambulance with a lady who'd slipped down some steps, banged her head and possibly broken her foot.

I'm guessing the wait will only get longer now as late shift crews finish and go home for the night.

Just checked the call page again on the computer - we've now taken 201 calls in 47 minutes. Crazy.


02.00 Control has now taken 500 calls in 2 hours. It's going to be another busy day. I've just been to a young man who is nearly 2 years old, and was discharged from hospital yesterday with a respiratory infection. His mum called us because his temperature is still high, and she didn't want to take him to hospital in the car.

That'll be another free taxi ride then........


04.30 Just done my 6th job of the shift. This is a relatively quiet shift for me - I usually attract more than this, but I'm not complaining. I'm quite happy to have a quiet shift. My last patient was a chap with chest pains - he normally gets chest pains that are what's known as "referred" back pain. This means that the pain originates in the back, but manifests itself as pain in the chest. I think this is what's happened to him tonight, but the pain has taken a lot longer to go than it normally does. I left the crew on scene doing the ECG etc as they arrived just a few seconds after me, which makes a nice change for tonight.

In four and a half hours, we're up to 953 calls. At this rate, I'm guessing that will have risen to around 1,200 by the time I finish my shift at 06.30.

This is far busier than normal. I have full sympathy with the call-takers who must be getting some real ear-ache from people waiting for ambulances. The thing is, the people who complain about waiting the most are often the ones who need the ambulance the least.

07.00 Home after my night shift. Over 1,100 calls in six and a half hours - not quite my estimate but not far off. Right, time for bed, then back to do it all again tonight.

Suspended

I seem to have attracted it since starting work on the car.

Suspended, for those that don't know, is the term used to mean someone who isn't breathing (i.e. they have suspended breathing), and is quite often used to also mean cardiac arrests. Last week, I did three of them in three days. One at the patient's home, one outside a hospital with a minor injuries department, and one inside a hospital.

Scarily, with the two that involved hospitals, when I arrived on scene, there was the most appallingly ineffective CPR being performed.

The first one outside the hospital had a member of hospital staff (may have been a doctor, but probably not) and members of a private ambulance service doing compression only CPR with an oxygen mask on the patient's face.

That wasn't the problem I had, other than wondering why they weren't using a Bag and Mask. The problem I had was the compressions weren't deep enough, and were far too slow. So I ended up coaching them on CPR while setting up my Bag and Mask, and attaching the defibrillator to the patient. To cut a long story short, we did get a cardiac output back, and he was making respiratory effort by the time we got him into hospital, but I don't know if he survived.

The second one in a hospital for people with neurological disabilities, there was a doctor using the bag & mask, and a nurse doing effective chest compressions. What made the CPR ineffective was the doctor was gallantly using the bag & mask, but hadn't opened the airway, so no air was going in. I tried to explain it to him, but he just got confused, so I took over from him and he just stood there watching throughout the rest of the job as the crew arrived and a full drugs protocol was initiated. Despite our efforts however, that patient sadly died.

The one in the person's home was to an elderly gentleman who had been very ill for some time, and his daughter had found him in bed. There was nothing I could do for him, as he was cold and beyond our help. Quite often we can tell when its a "non-viable" resuscitation as soon as we walk through the door, and this was the case with this patient, because he had what I call the look of death. Its very difficult to describe, but anyone who has seen it will know what I mean.

Not back at work until this weekend, and hopefully, I won't have to deal with as much death.

New Resuscitation Guidelines

The procedures we follow for resuscitating patients in cardiac arrest are set out by the European Resuscitation Council, and the UK Resuscitation Council.

Well we expected the new version of the resuscitation guidelines to include some changes, but I don't think it was expected that virtually the whole bloody lot would change.

Pulse checks are definately out for Lay people, as is looking for signs of life. You now do 30 chest compressions to 2 ventilations instead of 15 to 2, and you don't start with rescue breathing anymore, you launch straight into the 30 compressions. And if you don't like the idea of doing mouth to mouth, then you just do chest compressions only while waiting for the ambulance to arrive.

Not only that, but if someone is breathing "abnormally" - that is to say, taking the odd gasp now and again every few seconds, then you also start CPR straight away. The only problem with this is that some people's respiration rates are quite slow anyway, which is normal for them, and I envisage us in future running to calls that are given as cardiac arrest only to arrive and find the patient trying to fight off their would-be rescuer.

The "compression only" cpr has been trialled by the LAS along with an ambulance firm in Seattle in order to collect evidence. It is not an exaggeration to say that my former crewmate and I noticed overnight the increased number of patients being "blued" in to hospital as post cardiac arrest, so we aren't at all surprised by this change.

However, the way an AED (Automatic External Defibrillator) is operated with a cardiac arrest has changed. Thse that have used one before will know that up until now, a patient whose heart is in what's called a "shockable rhythm" has received a salvo of up to three shocks at a time, with a minute's CPR in between each salvo. Now, you do two minutes CPR, deliver a shock (if in a shockable rhythm), immediately recommence another two minutes of CPR, then shock again, then another two minutes of CPR etc.

For paramedics and hospital staff, the drugs protocols have changed too, with adrenaline being given after every two rounds of CPR (30:2) which works out at approximately every 4 to 5 minutes.

This means that all AEDs have to be re-programmed. This is a huge task, considering all the AEDs in public places now, such as railway stations, airports, shopping centres etc.

It's a huge task for the LAS alone - I have no idea how many AEDs are owned by the LAS, but when you consider there is one on every ambulance (including the Patient Transport ambulances), FRU, Cycle Response Unit, Motorcycle Response Unit, and Duty Station Officer car, it has to be a vast number.

Knowing our luck, we'll spend the next few months and probably thousands of pounds getting these things re-programmed, and next year they'll decide that the original three shock salvo was the better option after all.

Not cynical at all.....

Update: I've just stumbled across the blog of an american paramedic who is really against these new guidelines. His reasons make an interesting read. You can find his blog here. Thanks to Mark Myers for putting the link to this chap's site on his page.

Don't move them!

I was just nodding off in the car at my standby point when the MDT rang with a job.

A woman had fallen and had a head injury. The possibilities crossed my mind as I drove to the address given - could be drunk, dizzy, could even be an accident. It was the latter.

I arrived to find the patient laying under the covers on a double bed. A bit confused, I asked what had happened. Her husband brought me up to speed. "She tripped over that," he said pointing to a weight bench in the corner of the room, "and fell banging her head on the bed frame." The bed frame was made of solid wood.

"How did she get into bed?"

"I picked her up and put her there."

I turned to the patient. "Do you have any pain anywhere?"

"Yes, my neck and back hurt and I've got a headache."

"Do you have any tingling anywhere?"

"Yes, in my left arm and my left leg."

Now there is a reason why people are always told not to move people. It's the one useful thing about programmes such as Casualty - I've turned up at calls before to be told "I haven't moved them because I saw on tv that you shouldn't." There is a very good reason for this. If someone has sustained an injury to their spinal column, horrendous damage could be done to the spinal cord if handled incorrectly leading to paralysis and even death depending on which part of the cord is damaged. And damaged nervous tissue will not get better.

I quickly assessed and compared the sensation in all limbs - when I touched her left leg, the patient said it felt different to when I touched the right leg, but the arms felt the same.

The crew arrived, and we carefully placed her on a "scoop" stretcher. It's called a scoop, because it splits lengthways so each side can be eased under the patient without moving them or with very minimal movement, and clipped back together. We strapped her to the scoop, and then the three of us carefully took her out of the bedroom, and carried her down the stairs and placed her on the ambulance trolleybed that had been brought in and left at the bottom of the stairs.

We then loaded her onto the ambulance, and after doing a few things like blood pressure etc, she was carted off to the hospital. Unfortunately one of the things about working on the car is that you don't get to hear what happened to the patient. Hopefully there wasn't any spinal damage and she'll make a full recovery.

But the moral of the story is, if someone falls and hits their head, don't move them!

St John & Football

I've not really mentioned much about my St John Ambulance life - it's what got me interested in working for the ambulance service in the first place, and allowed me to meet some great people already in the job who gave me invaluable advice for getting into the service.

I think St John still creates the image of people in black and white uniforms wearing a white satchel and handing out plasters. And to an extent, that is still true (apart from the satchels!) but it is also true that St John has changed quite a lot over the last decade or so. There is now extensive ambulance training - in total over 400 hours worth of training, all done in members own time.

This training includes the First Aid at Work course (every member gets that), manual handling, patient handling, fundamental care, AED (Automated External Defibrillator), Medical Gases (which includes airway management and using the Bag Valve Mask resuscitator), and Pre-hospital Fracture management, Ambulance Aid training, written assessment and practical assessment. Those courses are the ones I can think of off the top of my head.

As a St John member, I've crewed ambulances at the British Superbikes Championship, British Formula One Grand Prix at Silverstone, and various club motorcycle and car racing events. I've dealt with fatal motorcycle racing accidents, including a fatal accident at the British Superbikes event at Cadwell Park, Lincolnshire a few years ago.

This year, St John has provided first aid and ambulance cover for the London Marathon, Live 8, the Download Festival in Leicestershire, Brighton Gay Pride, and again at the major motor racing events.

That's another good reason to be a member - you get to go to loads of great events, and it doesn't cost you a penny to get in!

A lot of people in the ambulance service knock St John members as being "wannabes" - and to be fair, there are a few of those around. But there are far more very good members who are happy to just be a volunteer, do the best they can, and know when they're out of their depth and ask for further assistance. Unfortunately, as with any organisation, there will always be the odd few who think they know more than they do and spoil it for the others - it only takes one member to put across a poor image to tar everyone with the same brush.

So I got a phone call last week from one of the London District Area Officers. "Steve, can you help us out at a football match on Saturday? We're really short of members and I'd be very grateful if you could help," he said.

"Ok, I'll come along." So on Saturday, I hopped in my car, and drove down to the football ground.

As it was my first time at that ground, I was given a tour round so I was familiar with all the entrances & exits, and I was briefed on the major incident plan. I was placed in one of the "treatment centres" - a posh term for a room with a couple of beds. We'd just settled down at the start of the match, when we heard a call for one of the foot patrols to attend an incident in the stand where we were based.

We began to prepare for the arrival of the patient. When the patient was brought into us on the Carry Chair, it was one of our own members! I was pleased to see the members had put him on oxygen, and they'd done a good primary survey and gave a good handover. He'd been standing at the back of the stand, felt ill, and collapsed. We transferred him onto the bed, and I took his pulse, blood pressure, oxygen saturations, blood sugar levels and temperature. I couldn't find anything wrong, but he still wasn't well, so I decided to send him into hospital.

I'm still waiting to find out how he is - I hope to hear soon.

It was back to the paid job today on overtime - I'll post about that at a later date.