Monday, March 20, 2006

Care Home - Or Not

Both Reynolds from Random Acts of Reality and Mark from Neenaw have recently posted about care homes – or the lack of care.

After a job yesterday, it’s now my turn.

The call was given as “85f suspended post choking”.

I arrived with the crew, and when we go to the patient, there was no sign of the staff having done CPR, but they said they’d tried doing the Heimlich manoeuvre to clear her throat, but it hadn’t worked.

The paramedic managed to remove a large piece of meat from her throat, and we started resuscitation. We managed to get a cardiac output back, but she sadly died shortly after arrival at hospital.

I’d gone with the crew to give them a hand, and they called control and asked them to let the FRU desk know I had gone with them in the ambulance. Control informed us that the call-taker was putting in a complaint about the home, as when they were initially put through, they asked for advice on what to do with a dead body! Apparently, they had waited 15 minutes after the patient had stopped breathing before calling.

It leaves me speechless, and makes me wonder if the outcome would have been different had they called us straight away, considering 15 minutes delay in calling, plus 6 minutes running time to get there, plus a further 2 minutes to get to the patient (they weren’t exactly very quick answering the door), a total of 23 minutes, and we still got a cardiac output back! Could we have saved her? I guess we’ll never know.

It’s just affirmed my decision that should my dad ever come to the point of needing round the clock care, there is absolutely no way on God’s earth that I will put him into a care/nursing home.

Monday, March 13, 2006

Another Regular

I’ve been taking some leave because I had to use some up or lose it at the end of the month, but I went in for a shift last night.

I arrived to find a different car than the normal one I use.  Apparently the normal one had thrown a piston and has been sent away for repair, and whoever was covering my shift on Saturday night crashed the replacement car.  He’s ok by all accounts, which is good news, but it left me with the spare spare car.  As you can imagine, it’s pretty old, but my God does it go!  I would even say it goes better than the usual car.

It didn’t stop me missing Orcon on one call though.  Orcon is the name for the 8 minute target response time for all Category A’s, and on this call, it took me 9 minutes to get there as it was quite a distance away from where I was.

To be fair, I didn’t hammer it to the call, because it was to one of our regular callers, an 80 year old lady who lives alone.  She has friends come and be with her during the day, but she panics at night on her own and ends up calling us.  It’s always a Cat A because she hyperventilates, so is therefore “not breathing normally”, but it always ends up the same, with us checking her over, coaching her breathing to slow it down and making her a cup of tea before we leave her.  She always refuses to go to hospital, and short of kidnapping her, we can’t force her to go.

Last night, control rang me as I made my way to the call.

“Sector aren’t sending an ambulance until you’ve assessed her.  If she needs to go in, let us know and we’ll assign an ambulance.”

We’ve been under an awful lot of pressure in the last few months and weeks to reach our target of 75% of Category A calls reached in 8 minutes for the year, even to the point that one of our directors issued a notice to staff which practically asked us to drive faster to calls – it was later denied that that was what the bulletin meant, but we all understood it perfectly clearly.
So I was a little annoyed that they wanted me to drive like a lunatic to a call that was quite literally miles away to get there in 8 minutes, but they weren’t going to send a much closer ambulance that would have beaten me there by a long way.  

So I slowed down.  If they’re going to run me on blue lights to go and make an old lady a cup of tea, I’m certainly not going to break my neck getting there.

I arrived, and it followed the usual pattern – sorry to have called you….I got myself in a panic….you must think I’m a pain in the arse (no comment)……oh I am thirsty.

Ah, that’s the cue to go and make the cup of tea.

I do feel sorry for her, but we’ve had to refer her to our Patient Advice and Liaison service to see what can be done to stop her calling for ambulances all the time.  This is one of the reasons that ambulances aren’t available for real life-threatening calls, but that’s a whole other post.

Overtime tomorrow.

Friday, March 10, 2006

Observing Control

I haven’t posted for a while because there’s been a few things personally that I’ve needed to sort out, but hopefully normal service is now resumed.

After Mark Myers came out on an observation shift on the car the other week, it was my turn to go and spend time listening to him taking some calls.  My plan at first was to make a note of each call that was taken, then pick the best ones to write about.  That soon went out of the window when Mark had taken 10 or 11 calls in half an hour.  I’ve got a good list, and I’ll pick and choose from what I’ve got.

A supervisor let me borrow his headset, and Mark plugged it in to the telephone so I could listen in.  It wasn’t long before I heard two “pings” in my ear.

Call #1 – Flowers

As ambulance crew, we often moan about the rubbish calls we get sent on, but we never get to hear the calls that we don’t get sent on.  The first call was one of these:

“Hello emergency ambulance, tell me what the problem is,” said Mark.
A male voice answered from a noisy phone box.  “Hello, my friend died in hospital last week and I want to send some flowers to the funeral.”
“Er..sorry?”  I was pleased I wasn’t the only one to think I hadn’t heard him correctly.
“My friend died in hospital last week and I want to send some flowers.  Do you know which hospital he was taken to?”
“I’m sorry, this is the ambulance service.  I’m afraid I don’t have any information about where your friend will have been taken to.  Do you need an ambulance?”  
Mark was being very professional, but I was on the verge of hysterical laughter.
“No, I just want to know where my friend was taken so I can send some flowers.”
“I’m very sorry sir I can’t help you, that information is not available to me.”
“Ok thanks, bye,” said the chap, then he hung up.
Mark made an entry on the computer screen saying what the man had wanted and that no ambulance was required.

So that was the first call. “He’ll probably ring back later,” said Mark, and three calls later, he did from a different phone box.

“Hello, I want to send some flowers to my friend’s funeral,” said a familiar voice.
“Did you call a few moments ago?” Mark asked.
“Yes, but the man I spoke to said he couldn’t help.”
“That was me sir, and I’m very sorry, but I still can’t help you.”
The caller hung up.

Call #2 – Collapse

“A lady has just collapsed on the bus,” a female voice said in my ear.
Mark asked her which bus they were on and where they were.
“Are you with the patient now?” asked Mark.
“Yes, I’m a first aider,” said the lady.
“Ok, I need to ask you some questions, it won’t delay any help.”
Mark ran through the list of questions that came up on the screen from the AMPDS software.
It came out as an Amber 2 (Category B) call.
It’s amazing how many calls we get to buses in London.  When I was a bus driver in Lincolnshire, I could count on one hand the number of times an ambulance had been called to a bus in the four years I did the job, and still have fingers to spare.
“Stay with her, get someone to look out for the ambulance, and if her condition worsens before help arrives call us back for further instructions,” said Mark.
“I will do, thank you.”

Call #3 – Dr’s Urgent

Once again, the ping in my ear.

This time the call had come through on the number that is used usually by doctors to book urgent admissions to hospital.

It was from a Social Worker who wanted to admit one of his clients to a psychiatric hospital under section 3 of the Mental Health Act.  He had booked the police to attend, as this would involve removing the patient from their home.  When I’ve done calls like this, I’ve often wondered whether the social worker should be admitted too, and listening to this call, the thought crossed my mind again.  Mark was having real difficulty getting information out of him.  Control like to have the mobile phone number of the social worker who is going to be attending, as the will ring them to tell them that the crew is outside.  Crews will usually wait outside the address until the social worker has come out and seen them and briefed them on the current mental state of the patient.
The social worker kept trying to give Mark the patient’s phone number.  After being asked for the fourth time, the penny finally dropped and he gave his mobile number.

Call #4 – Collapse

An emergency call.  A lady had called because she had found a woman who had collapsed in the street and was unconscious.  Mark started running through the usual questions, was the patient breathing, was she having any difficulty in breathing, was she bleeding etc.  Suddenly, a male voice came on the line.  He said he was a paramedic from South Africa, but we began to doubt him when he was unable to tell Mark if the patient was alert, and didn’t really sound as though he knew what he was talking about.

Mark put a note on the screen that there was a man on scene who “states he is a paramedic”, to warn the crew.

Call #5 – Fall from Ladder

Another call from a lady.  Her decorator had fallen off the ladder while doing the painting.  I couldn’t believe my ears when she said the ladder had been on the bed.  It sounded like the sort of silly scenario we tend to set up for St John training nights.

It didn’t sound as though he was seriously hurt, and I don’t know what the outcome was, but I imagine he won’t be putting a ladder on a bed in the future.

Call #6 – Fall

This was possibly the funniest sounding call of the day.  A call from a young chap who was worried about a disabled elderly male neighbour of his who had fallen out of his 3-wheeled electric tricycle.  He’d helped him back into his buggy, and now the man just kept driving his buggy into the wall.  That was the bit that set me off giggling.  I could just imagine this chap driving into the wall, reversing, and driving into it again.

I know most people won’t find that funny, but it tickled the black sense of humour that ambulance staff develop after seeing some of the tragedies, death and destruction that life throws at people.

So far, all the calls had been from nice people, and nobody had screamed “Just bloody get here now” or “I called for an ambulance 30 seconds ago and it’s not here yet!” but it wasn’t to last.

Call #7 – Headache

A young woman came on the line.  “I called for an ambulance 5 minutes ago because I’ve a bad headache and I can’t feel my hands, but it isn’t here yet.  How long will it be?”
I’ve always thought the standard answer to this question should be “About 12 feet.”
Mark looked up the original call.  It was a Green 2 – our lowest priority call, and it had been passed to the Clinical Telephone Advice desk.  He told her that help was being organised.  He checked that her condition hadn’t changed, which it hadn’t.  She wasn’t impressed, but thanked Mark anyway and hung up.

It was getting towards the end of the shift, and Mark had been promising me a “suspended” call all day.  I was beginning to think it wasn’t going to happen, but it came with the final call.

Call #8 – Suspended


“Emergency Ambulance, what’s the problem, tell me exactly what’s happ-”
“He’s dead!” screamed a voice in my ear.
Mark flashed me a “I told you we’d get one” grin.
“What’s happened?” Mark asked again.
“This is a sheltered housing place and I’m the warden, and I’ve just found one of my clients dead!” he was shouting, and there was screaming in the background.
Mark brought up the CPR instructions on the screen.  “Are you prepared to do CPR?  I can talk you through it,” asked Mark.
“No, there’s no point – he’s obviously dead,” said the man.
“Ok, help is on the way.”

It turned out to be a young man in his twenties, the last I heard, the police were treating it as a suspicious death.

And that was my day in control listening to Mark taking some calls.  It was all fairly run of the mill stuff for Mark, but it re-affirmed my belief that I am happier on the road – control is a bloody hard job, and I don’t think I could handle the stress of staying on the line with a  seriously ill patient, knowing that the nearest ambulance is dealing with someone with man ‘flu.

You do an excellent job Mark, and thank you for letting me listen in.