Wednesday, June 14, 2006

Surgical Spirit

I’ve often thought that the activation phone on station is linked to the boiler in the kitchen.  I was just pouring a cup of coffee for me and my new crewmate, Graham, when it rang.

“We’ve got someone unconscious on a bus,” said the cheerful dispatcher.
It was just round the corner, and the police were on scene when we arrived.  

“We can’t rouse him – we’ve tried inflicting some pain but we’ve got no response.  We found these next to him,” said one of the officers.

“These” were two 200ml bottles of Surgical Spirit.
We strongly suspected him of having drunk them.  He was definitely unconscious – he scored 3 on the Glasgow Coma Scale (GCS).  None of the usual stimulus techniques worked.  We put in a nasal airway (a tube up his right nostril), started him on 100% oxygen and took a blood glucose level reading, which was normal.  We managed to get the bed onto the bus, as it had a wheelchair ramp on the exit doors.  With the help of the police and the bus driver, we got him onto the bed.

Back on the ambulance, I attached the blood pressure cuff, and took his temperature while Graham got IV access and took bloods ready for the hospital.  His blood pressure was low, so while Graham secured the cannula, I set up a bag of fluid.  The police looked through his belongings and found a card with his name on it.  He was still unconscious, so we put in a “blue call” to let the hospital know we were coming, and telling them that he had a GCS of 3.

The patient started to regain consciousness on the way in to hospital, and by the time we arrived, he was beginning to become slightly agitated.  We took him into the resuscitation room, and after handing over to the doctor and explaining that the patient had a GCS of 3 on scene and had started to regain consciousness on route to hospital, we transferred him to the hospital trolley.  Graham took the trolley out while I knelt down to plug the oxygen mask into the hospital supply (why it’s almost on the floor I have no idea.  It’s the only hospital I’ve noticed this in).  

It must’ve been a case of “Out of sight, out of mind”, but the doctor spoke to the patient and told him to open his eyes, and when he did (because his level of consciousness had started to improve as we’d just told him) he said “GCS of three, yeah right!”

I got up from attaching the oxygen and said to the doctor, “Actually, he did have a GCS of 3 while on scene, but as we’ve just told you, he started to come round on the way in to hospital.  Clearly our treatment was beginning to work!”

It bugs me that some hospital staff clearly think we are telling them rubbish simply because a patient’s condition has improved during transport to hospital.  Surely improving a patient’s condition is our goal isn’t it?

I’m doing overtime on the FRU tonight and tomorrow night.  I hope there’ll be some interesting calls I can write about, although England are playing again tomorrow – there’ll probably be a sudden increase in calls when the match ends….


Anonymous Anonymous said...

I understand your irritation totally and really appreciate and respect the job you guys do but as an A&E doc, I can tell you we quite often get told complete rubbish about what you guys are bringing in. For instance, the other day amb control told us RTA coming in - 1 major pt, 1 minor, 30 mins away. Major pt turned up, quite unwell but not life threatening, minor turned up - laceration to carotid and had emptied most of his circulating volume onto the floor. We were only prepared for one and therefore had to put out a very delayed call for Consultant from home plus emergency ENT, vascular and general surgical assisstance. Instances like these build up and in a stressfull environment can cause some annoyance!! That's not to say that the Doctor had an excuse if you'd specifically told him that he'd improved en route!! Keep up the good work!

7:23 pm  
Blogger Steve said...

We quite often get looked at as though we're stupid when we turn up with a patient that has improved - sometimes dramatically so. As an example, a couple of years ago when I was still a trainee, I had a guy arrest on me in the back of the ambulance. One pre-cordial thump and a round of CPR later, he had a pulse, and by the time we'd arrived at hospital with a blue call of "post cardiac-arrest" he was asking to sit up.

The staff looked at us as though we were taking the p**s, and clearly didn't believe us when we assured them he had definately arrested on us.

I'm sure you do get told things by control that are coming in, only to find something completely different when they arrive, but it's important to remember that things do change on the way in, sometimes for the better, and sometimes for the worse.

Of course, I can't comment on the job you describe as I don't know the full details, and I wasn't there when they put the call in.

2:06 am  
Anonymous Anonymous said...

Do you take bloods now on the ambulance - sounds like a great idea - IV access and bloods taken so patient doesn't necessarily need a 2nd line putting in. When did this begin - is it all across London?

11:26 pm  
Blogger Steve said...

We're doing a trial with a couple of hospitals in south-west London with paramedics taking bloods. The hospitals provide the vaccutainers and adapters to connect to the cannula. Patients rarely get a 2nd line now and it's amazing the amount of time that's saved by us taking the bloods. I'm told it can save up to an hour.

We're hoping to be able to persuade the other hospitals in London to follow suit and allow us to take bloods for them.

12:25 am  
Anonymous Anonymous said...

Are you being trained to know which bloods need done or are you just taking basics like FBC, U&E?

12:39 am  
Blogger Steve said...

We have five (I think off the top of my head) different vaccutainers, and a list of which ones to fill according to what we're treating for.

3:26 am  

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