What is the FRU?

A commenter has asked what the FRU is.

FRU stands for Fast Response Unit. It’s the job of the FRU to get to category A calls first to start emergency treatment before the ambulance arrives. It’s also the job of the FRU to get there in the 8 minute response target for category A calls.

We use Vauxhall Astra cars (pictured below) although the service is currently in the process of replacing all the Astras with Vauxhall Zafiras.

Off The Car

Well yesterday was my last rota’d shift on the FRU.  I go back to working on an ambulance next week.  I’m looking forward to it – to be honest, I’m ready to come off the car.  I don’t know how some staff can work on it for years.  Having said that, I am going to be doing some overtime shifts on it.

I had hoped to have some good calls to write about from my last week, but apart from the young lady knocked off her cycle, I haven’t done anything worth mentioning.  I’ve run on loads of jobs, but been cancelled before I’ve got there either because there was another vehicle nearer to the call, or the call was downgraded.

Yesterday, I did manage to see one patient – I ran on nine calls, but was cancelled off eight of them!

It was to a woman in her thirties who had fainted after finding her house on fire.  She’d recovered by the time I got there, so I did a few obs for the paperwork, handed over to the crew and left.

Still, I managed to finish reading my book…..

Last FRU Shifts

It’s my last four shifts working on the FRU this week.  I go back to working on an ambulance from next week, but I’ll still be doing some overtime shifts on the car.

I’ve not been to anything particularly exciting today – the most promising call being to an 8 year old girl who’d been knocked off her bike and was complaining of back pain, with tenderness over the thoracic and lumbar spine.
Her parents had got her up onto her feet before I’d arrived.  I gave them a polite lecture on the necessity of keeping people with back pain still and waiting for us to arrive.  I also strongly suggested they buy her a cycle helmet.  It has to be said that they didn’t seem overly concerned.

Dreaded Call

There is one call that sends a chill through every person who works for the ambulance service, from the newest trainees right through to the paramedics with 20+ years under their belt. It brings every ambulance person across the world out in a cold sweat. It's probably also the one call that will make any ambulance person drive to the call just that little bit quicker.  I got it last night.

I was sitting on station, just about to tuck in to my bag of chips when my phone rang.

"There's a job in the car for you - it's a 3 month old not breathing."
Shit.
"Where is it?" I asked.
"It's in SE20" (not the real location)
Double shit.  
It was a good 3 miles away, if not more.
"Is there a crew running?"
"Yes, they're a lot closer than you, so they should get there first."
"OK, I'll go and lend a hand."

I set off, driving as fast as I dare while making sure I drove safely.  I arrived in 6 minutes, just ahead of the ambulance crew who pulled up behind me as I was getting my oxygen bag.
“I’ve got the bag and mask” called the paramedic on the crew.
“Right, I’ve got the oxygen.”
There wasn’t much point in taking anything else in – if the baby really was “suspended”, we weren’t going to be hanging around to do very much more than the basics.  The baby would be whisked straight out onto the ambulance and the advanced interventions done en route to hospital.
We charged into the house to find mum holding the baby protectively against her.  .  There was an audible sigh of relief from all three ambulance staff – the baby was breathing, but clearly was not well at all.
“It’s Emily,” mum told us, indicating the baby with her head.  “I was reading a book when I glanced up and saw that she was foaming at the mouth, and she’d stopped breathing.”
“How long did she stop breathing for?” I asked
“About 30 seconds.”
“Did she start to breathe again on her own?” asked the paramedic.
“Yes.”

While the questioning was going on, we were assessing the baby.  She was unconscious, and when we pricked the heal of her foot to check her blood sugar level, she grimaced but didn’t cry.

Mum carried Emily out to the ambulance.  The paramedic asked me if I could lead them into hospital as his crewmate had been sent over from another ambulance station to work with him and didn’t know the area.  We were going to take Emily in on blue lights, asking control to let the hospital know what had happened and how long we would be so they could be ready.  This is known in London as a “Blue Call”.

I changed the channel on the radio in the car to listen for the crew putting in the blue call – that would be my signal that they were ready to go, then we set off.

Emily was still unresponsive when we arrived at the hospital, but she was now a healthy pink.  A nurse gently took her from mum and whisked her into the paediatrics area.  By the time we’d done the handover and they’d done their checks, Emily had started to come round and began to cry.

It was the best sound I’d heard in a long time!  A suspended baby is the job that we all dread, so I was delighted that this was going to be a happy ending.

Corpse In The Bushes - Part 2

For part one, click here

I was sitting in the car on standby trying to decide what to have for breakfast when the MDT (computer in the car) rang with a job.

The location was given as “West Common Road, near the church”.  I knew where it was without checking the map.   It was literally just down the road.   I read further, “Male lying on the floor in the bushes, possibly deceased.”

These calls usually turn out to be one of two things.  Either it’s someone who’s been out drinking, got completely trolleyed and decided to sleep it off in the bushes, or it really is a dead body.

I set off and, as is common, the MDT rang with an update.  A quick glance showed me that there wasn’t a lot of extra text on the screen which might indicate safety concerns, but the word “deceased” had changed to “dead”.

I’ve got to know Mark Myers quite well, and was joking with him only the other week about how he keeps putting “dead” on the screen instead of the more usual “suspended”, “purple” (LAS slang for dead) or “deceased”, so I knew it must have been him that was taking the call and had noticed that it was me that was running on it.  It was his way of saying “Hello Steve!”

I arrived at the location given and was met by the police. “We’ve had a look up and down the road, but we can’t see anyone lying in the bushes.  We’re going to get the informant to come and show us where this body is.”  They shot off, and squealed round the corner into a side-road.  

I updated control, and they told me that an ambulance, callsign Z302 was on the way.  I knew the crew had just got back to station and there was a crew already there, so the other crew should have come out first.  Then I remembered that there was a new trainee technician on Z302 on her “training supervisor” period – this is when trainees first come out after completing their course, and start working as a third person so that they can be guided through their first few calls.  They must have said they’d do it because it was possibly a dead body – and it’s nice to get the first one over and done with when your still with a friendly supervisor!

The crew arrived while I was waiting for the police to return. I asked them if they’d been given the update, but they hadn’t.  I filled them in, and then the police returned.  “It’s in the bushes opposite Friend Street.” The crew piled back into the ambulance and I got in my car, and the convoy shot off down the street with blue lights  flashing and sirens blaring (great at 8.30 on a Sunday morning eh?  Still, I’ve had to get out of bed early…..)

We trampled through the bushes, and eventually spotted what looked like a leg.  As we made our way over, I saw a hand move.  

The patient was lying under what used to be a large tree branch.  We lifted the branch out of the way, and Liz, the trainee, started to assess the patient.  The smell of alcohol was almost palpable.
“Hello, we’re from the London Ambulance Service, can you hear me?”  This was a fair enough start – always start politely.  He was having none of it.  He’d decided to be “unconscious”.

Liz tried again, this time also pinching his ear to assess for painful stimulus, but it’s surprising how many people can stand the ear pinch.  She was beginning to get a little flustered, so I decided to help.  

As a new trainee – and we’ve all been there – you’re never really quite sure how far to go with pain stimulus, but once you’ve been to a few drunks and been verbally abused, spat at, had vomit spat at you, had to duck a fist or two, you soon get any sympathy for them knocked out of you, so you’re happy to take it a bit further than the ear pinch.

I pressed hard onto his chest with my knuckles, rubbed them up and down the breast bone (this bloody hurts, but doesn’t harm the patient) and shouted “Come on matey, wakey wakey.”  
That did the trick.  He opened his eyes and swore at me.  We dragged him up into a sitting position and Liz tried again, but all he would say was, “I Polish”.

After making sure he wasn’t hurt, we got him to his feet and, after he’d initially refused to come with us and was threatened with being arrested by the police, walked him to the ambulance.

Considering he’d been laying in the bushes all night, he was surprisingly warm, and all his obs – pulse, blood pressure etc – were good.  The police asked him a few questions then left, and I left the crew to it and returned to my car.

I was doing the paperwork, and glanced up to see our patient walking surprisingly well down the street.  After the police had gone, he’d refused to go to hospital and walked off the ambulance.  We’ve got no powers of detention, so all we could do was let him go and hope we didn’t get a call back to him.

I finished the paperwork, and then sent a text message to Mark, asking if he was working today.  We thought it might be a good idea to let you see how a call works from beginning with the 999 call to the end when we finish with the patient.  We know it’s a bit of an anti-climax with the possibility of a corpse in the bushes ending up with a drunken man staggering off down the street, but it shows that sometimes calls just don’t turn out to be as they originally seem.          

Update:  We decided to try doing this when we realised we’d been involved with the same call – is this something you’d like us to try and do again in the future?  Did you think it worked well? Let us know what you think

Failed

I’m not going to be a paramedic this year.  I failed the essay paper.  I had a feeling I had.

Next time…..

Fall From Tree

I did a shift on an ambulance recently – I’ve been meaning to since I went on the FRU to keep my hand in working as a crew.

One of the calls was to a local park and was given as a 14 year old boy had fallen out of a tree and had a leg injury, possibly broken.

We arrived at the park, and were shown to where our patient was half laying, propping himself up on one elbow.

Daniel had been climbing a tree. A big tree. He had managed to get about 20 feet off the ground before his luck ran out, and a branch he’d grabbed onto broke off, causing him to fall feet first onto the ground. His left leg was bent at a funny angle just above his ankle, dismissing any thoughts that the leg was possibly broken. It was definitely broken, and more than likely both the bones in his lower leg.

I started to give him Entonox – the pain killing gas given to women in labour. This is usually very good for pain relief, begins to work after only a couple of minutes, but doesn’t mask any pain because the effects wear off very quickly when the patient stops taking it. While I was doing this, Martin, my crewmate, went to fetch the necessary equipment for moving the patient.

The Entonox didn’t have the desired effect this time – it doesn’t work on everyone so I wasn’t worried. Martin put a needle in Daniel's arm and gave him some morphine instead, with the comment “There you go – you can now say you’re the first person in your class to say you’ve had a class A drug legally!” That brought a smile to his face. We left it a few minutes to give the morphine time to work, then asked Daniel if the pain had eased at all. He said no, but I think it must have taken the edge off because we were able to get him to roll onto his back and straightened his leg so we could put it in a splint, and although he cried out in pain, it wasn’t as bad as I was anticipating – but we couldn’t just leave him there.

I cut the laces of his trainers, slipped his shoe off, and cut his sock off to prevent unnecessary movement of his leg. I felt his foot, which was warm, and I found a good strong pulse on the top of his foot. This was really good. With the shape Daniel's leg was still in, and the pale colour in his foot, I wasn’t sure if he’d still have circulation – the pulse and the warm foot proved he had good circulation to his foot. I drew a cross on his foot where the pulse was to show the hospital staff I’d found it. We do this because it can sometimes be quite difficult to find a pulse in the foot and often takes a bit of poking around before you find it.

Even though Daniel wasn’t complaining of any neck or back pain and nothing felt out of place there, we collared and boarded him due to the fact that he’d fallen a long way and the chance that the pain in his leg could distract his attention from any neck or back pain.

We “blued” him in to hospital because even with the morphine, we were having a problem controlling his pain. The hospital had decided that due to the long fall and the high potential for serious injury from it, they would assemble a trauma team, and I handed over to the gathering of doctors and nurses waiting to greet us.

It turns out that his only injury was the breaking of the two bones in the lower leg – the tibia (shin bone) and the fibula, which is the small bone that sits behind the tibia and assists with the walking motion in the lower leg.

He’s a lucky lad, but I bet he won’t be climbing tall trees again in a hurry!

GCS 14

GCS 14 is the blog of Rob, an Australian paramedic working in the Melbourne area.

It's comforting to know that we don't have the monopoly of sometimes having to deal with idiots.

You can read his blog here.

Paramedic Pre-entry Assessments

I’ve not posted anything lately because I’ve been spending the time with my head in the books studying for the written part of the paramedic pre-entry assessment – which I took yesterday.  It comprises of two papers – firstly a true/false and multiple choice question paper, for which you get an hour to complete, which is then marked.  If successful, then you go on to do the second paper, which is the Short Answer Essay paper – five questions, often with more than one part to each question, for which you get two hours to write the lot.

First we had the true/false and Multiple Choice question paper, comprising of 100 questions, and a pass mark of 85%.

I looked at the first question and my heart sank.  I hadn’t a clue and had to guess.   Can’t say what the question was because others waiting to do the assessment might see and that would be cheating.

I was convinced that I had failed it, and made sure I’d taken all of my belongings out of the examination room at the end.  Imagine my shock when I had to go back in to do the essay paper – I’d been successful in the true/false and multiple choice paper.

I don’t know the outcome of the essay paper – I managed to answer all 5 questions, but I didn’t manage to finish the last question.  I can only hope I’ve done enough to get through.  I’ll find out in the next 2 or 3 weeks if I’ve got through – but to be honest, I don’t hold out much hope.  If I have been successful, I’ll have to go for a practical assessment, involving managing a cardiac arrest scenario, and a patient assessment scenario.

My fingers are crossed – but I’m not holding my breath!