Camping

I'm away camping with my family this weekend so I won't be around to post or to read e-mails and moderate comments.

It's the first time I'll have been away camping with my dad since my mum died of cancer one month before I joined the ambulance service, so I plan on making it a good one for us all - including spending a while in the pub drinking plenty of "falling down water".

Normal service will resume on Wednesday

HEMS Fundraiser

I know both Mark Myers and Tom Reynolds have posted about the up and coming fundraiser for HEMS, but Elliot has also e-mailed me today and asked if I would also advertise it for him.

He writes:

"After a night out on the town and a few beers, myself and a colleague
from White Star Medical Ltd have agreed to have our chest, belly and
legs waxed in aid of London Air Ambulance (White Star Medical's charity
of the year).

This event is planned for 2nd October 2006 at The Blind Beggar public
house in Whitechapel by The Royal London Hospital where the London Air
Ambulance is based.

It costs £1,000 just for the London Air Ambulance to take off and save
lives! They take off 3 - 4 times a day and this financial year will need
£750,000 to cover rising costs of fuel, insurance and so on.

It's going to hurt, so help the pain with a donation!

*** If I make the target of £2,000 I will put a movie from the event on
the Internet for everyone to see ***

http://www.smartgive.com/funds/chesthairgone/"


I wish Elliot and his colleagues great success with their event, and I will be making a donation after pay day.

Good luck guys!

E-mail

For some reason, hotmail has decided to close my e-mail account. It's probably because I haven't checked it for a while, so if you've e-mailed me and I've not replied, then I apologise.

I now have a new e-mail address which will deliver e-mails directly to my desktop mail client.

It's stevegibbs999@aol.com

I have also updated the e-mail link on the right.

But the bus won't get through

The call was given as "89 year old female, ?suspended". I was working on overtime with another EMT, so the first thing we did was ask control to make sure the FRU was being sent, as it had a paramedic on it.

At the start of a shift with someone I don't normally work with, I always ask them what they'd like to do, as I really don't mind whether I drive or attend - especially when I'm on overtime. My crewmate had opted to attend, so as with every cardiac arrest, or "suspended" call, I put my foot down just that little bit harder.
On the way to the call, my crewmate clearly felt he was helping by shouting through the windscreen at traffic to "get out of the bloody way", even though they couldn't hear him.

I threw the ambulance round into the not-too-wide-but-not-exactly-narrow road of the address and parked it (or rather, dumped it) unceremoniously behind the FRU that was already on scene, leaving the blue lights on to indicate there was a good reason for not parking properly.

As we were grabbing our kit from the side door, a middle-aged woman came storming out of a neighbouring house.
"Oi!" she shouted. I looked around to see who she was talking to - surely she wasn't talking to us.
"Don't start looking round, I'm bloody well talking to you!"
"Sorry love, we're a bit busy at the moment," I replied, continuing to grab the resuscitation equipment.
"You can't leave your ambulance like that - the bus won't be able to get through!"
I stopped.
"I beg your pardon?" I couldn't believe what I'd just heard.
"I said you'll have to move your ambulance - the bus won't be able to get through - it's due in a few minutes."
There was one of her neighbours - a well liked lady in the street I found out later - apparently at deaths door, and this stupid woman was concerned about a bloody bus.
"Well it'll just have to wait," I retorted, and hurried off after my crewmate who'd already gone inside.
"But how's the bus going to get through?" the woman called after me. I ignored her.

It turned out that the 89 year old lady had been asleep, having a lay-in and her other neighbour who checked in on her every day had been unable to wake her up by knocking on the window and feared the worst.

We gave her a check-over anyway, and I waited until my crewmate had finished doing the lady's obs before wandering back out to the ambulance ten minutes later. There was no sign of the bus, but the irate neighbour was still there.
"Now I'll move the ambulance," I told her, and parked it properly, before retrieving the folder with the patient report forms in for my crewmate. The lady didn't want to go to hospital (and she didn't need to) so we were going to complete some paperwork and leave her in the care of her neighbour.
"I was worried the bus wouldn't get through," said the woman.
"I was worried your neighbour needed her life saving," I replied evenly.
"Is she ok then? She's a lovely lady."
"Yes, but she may not have been - and you delayed us. I suggest you re-consider your priorities before you have the unfortunate need to call us for a member of your family - how would you feel if we took a bit longer because we had to consider the way we parked above the need of a sick family member?"

She didn't reply, but returned to her house looking rather sheepish.

A Good GP

I hate to say it, but it's not very often we come across a good GP. Usually, we turn up at a surgery for a patient with chest pain to find the patient sitting in the waiting room looking rather unwell. This irks me. If a GP is concerned enough to call us for a possible heart attack, then the last place they should be putting the patient is in the waiting room, unsupervised, without giving anything for the pain or putting them on oxygen.

But this call was different.

I was doing a shift on the car. The call was at a doctor's surgery and was given as chest pain, and as I was just up the road from the call when I got it, I was on scene within 2 minutes. This was a brand spanking new surgery, the practice having moved into their new building from a couple of streets away. A receptionist was waiting at the door for me when I arrived and lead me through to the consulting room. Having a receptionist waiting for us never normally happens so that was my first pleasant surprise. I told her that the ambulance crew would be here shortly, so she went back to the door to wait for them.

The doctor introduced me to Dave, who had come to see her about another matter. Whilst in the waiting room, a receptionist had noticed that he'd become very pale and was holding a hand to his chest. The doctor had seen him straight away, and instructed the receptionist to call us.

By the time I'd arrived, the doctor had Dave on oxygen, laid him on the examination couch, had taken all his obs except his blood sugar level, including pulse, blood pressure, oxygen saturation levels, and respiration rate, and she had given him aspirin and GTN to help alleviate the pain. She had even found time to print off Dave's details for me, including his medical history.

I did a blood sugar reading, which showed his sugar level was slightly high - which could indicate a cardiac problem if associated with chest pain, and while we waited for the ambulance, the doctor put a cannula in Dave's arm and took bloods ready for the crew to take with them.

The only other thing she hadn't done was a 12-lead ECG which would have allowed us to look for signs of a heart attack - and for this she apologised profusely, explaining that it was all going to be linked in to the computer system but this hadn't been completed yet, otherwise the ecg would have been waiting for me when I got there.

The crew arrived and took Dave to the ambulance. They too were suitably impressed at how much the GP had done. Their 12-lead showed that Dave was indeed having a heart attack. The GP had said that she'd spoken to the nearest A&E and that they were expecting him, but we wanted to take Dave to another hospital where we could directly admit him for Primary Angioplasty, a procedure to re-open the blocked artery in his heart. I explained this to the GP, and she readily agreed this was by far the more appropriate option. She said she would inform the nearest A&E of the change of plan.

Since then, it's been back to the usual of finding chest pain patients in the waiting room, and once even turning up at a surgery to be told that the patient had been told to walk home to get his things together.

But I know if I have to go back to the new surgery for a patient, they will have received the best possible care, which will still be ongoing when I arrive. My faith, in part, has been restored.

Another Hoax

I suppose I've been quite lucky in that in the three years that I've worked for the London Ambulance Service, I've only ever been to two hoaxes. Both were in the last 10 months.

The first was just after I started this blog.

The second was a couple of weeks ago. We'd called in at our main ambulance station to collect some urgently required stores for our station, and as I was sorting out the paperwork for it, Graham hurried in from the ambulance.

"We've got someone who's been stabbed several times in the chest," he told me.
"Ok, I've just got to sign this and I'm done."

I scribbled my signature on the paper, grabbed the equipment and hurried to the ambulance. I glanced at the address to see where we were going to and paused. The address rang an alarm bell in the back of my mind.
"I know this address from somewhere, but I can't remember why. Have control asked the police to attend?"
In answer, the MDT in the cab rang with a message to say that police had been assigned.

I put my foot down. We didn't know the extent of the injuries, and with a stabbing in the chest, there was the possibility of damage to the lungs and/or heart. Control asked us to report for HEMS on arrival.

As we turned into the road, the alarm bell rang loud and proud in my mind, and I now knew why.

"I came to a hoax here a few months ago before I started working on the car," I told Graham, "I'm sure it's the exact same address too."

As we rounded the bend, sure enough, there were the police. And the fire brigade.

"Why have the fire brigade been sent?" wondered Graham. The answer soon came when a police officer walked up to the window.
"Are you here for the stabbing?" he asked.
"Yes."
"It's a hoax. Sorry guys."
"No problem - it's not your fault. Why are the fire boys here?"
"They got a call to say there was a fire at the same address. Also a hoax."

So well done to the idiot that called. You managed to waste the time of all three emergency services. May you rest safe in the knowledge that your foolish actions could well have prevented an ambulance getting to a real life-threatening call, a fire engine from attending a persons reported fire, and the police helping someone being assaulted/robbed etc.

There's only one name that suits you, and I apologise to any reader who's offended - unless it was you.

WANKER!

Post Cardiac Arrest

I went to a "suspended" patient the other day. It was given as "68 female, ?suspended, looks purple, CPR in progress".

In English, it read "68 year old female, in cardiac arrest, possibly beyond help, but someone's having a go anyway."

It was just round the corner from the hospital we'd just become available at, and we were on scene in 2 minutes, beating the 2nd ambulance and the FRU. We were met by a tearful young lady who led us up two floors to the patient. It's an unwritten law in ambulance work that the poorliest patients will always be on the top floor of a house or block of flats.

A neighbour was knelt in the doorway of the flat, doing good compression-only CPR on our patient. She explained that she checked in on the lady daily, and had opened the door to find her laying on the floor, looking as though she'd collapsed off the toilet - you may be surprised to learn that this is common in older people. I've been to several old folk who've found the strain of going to the toilet just a little too much and virtually dropped dead off it.

I took over CPR, and as I was getting good air entry using our bag and mask resuscitator, Graham decided to cannulate before her veins shut down. The second crew arrived as I was switching on the Defibrillator, which showed the patient's heart had what appeared to be the normal electrical activity, but very very slow, and no pulse. This is known as PEA or Pulseless Electrical Activity. It was vital we got IV access to give Adrenaline to stimulate the heart and to start IV fluids to replace blood volume. The second paramedic started to help Graham gain IV access, while I continued CPR. Then disaster. The patient's airway filled with vomit. Suddenly I was back at "A" in our "ABC of Resuscitation". A=Airway, B=Breathing, C=Circulation.

I suctioned the vomit out, and after making sure the airway was now clear, I started ventilating the patient again. She filled with vomit again. Bugger - I still couldn't get passed "A". As luck would have it, the FRU arrived, with another paramedic on board. He poked his head round the door, and was greeted with me asking him to intubate - put a tube down the trachea to secure the airway. It wouldn't matter if she vomited then - the tube would stop any of it going down into her lungs and drowning her.

It all went well after that - to the point where we were just about to move her when there was a rhythm change on the screen. It showed a good regular electrical rhythm at a good rate. I felt for a pulse at the carotid artery in the neck. I found it! We'd got a cardiac output back. All we had to do now was breathe for her. We connected the automatic ventilator. We then carried the patient head first downstairs to let gravity help keep oxygenated blood going to where it was needed most - the brain. As the others loaded her onto the back of the ambulance, I put in the "blue call". I did it now, because we were a minute - two at the most from the hospital, they'd need time to get the team together, and it would be about 4 or 5 minutes before we were ready to go. I pressed the red priority button on the radio.

"W701 go ahead with your priority," said the dispatcher.
"Thank you, it's a blue call to St Steven's Hospital, 68 year old female, post cardiac arrest, now respiratory arrest. Intubated & cannulated, ETA 5 minutes."
When we put in a "blue call", the radio operator in control reads it back to us to make sure they've got it right. We then either correct anything they've miss-heard, or confirm it's correct.
There's been an influx of new people in control, so we're getting new and nervous voices on the radio, and they're obviously making mistakes along the way as they learn the ropes, but this readback was a blinder.

"Roger, that's blue to St Stevens, ETA 5 minutes, 68 year old female, post cardiac arrest, now severe DIB." I was sorely tempted to say "actually she's not having severe difficulty in breathing - she just isn't breathing", but I knew I was talking to a "newbie".

"Negative, I'll repeat the blue call for you..." and I repeated the whole call. This time it was read back fine, and I confirmed it was correct and thanked the dispatcher. Even so, the information that the patient was intubated and cannulated hadn't been passed on to the hospital, but that was a minor point really. I put it down to the suprise that we were taking in a patient who we had got a pulse back on. It doesn't happen very often, but it is happening more since the new resuscitation guidelines have been introduced.

The patient arrested again just as we were leaving scene, but we'd got an output back again just before we took her off the ambulance at the hospital.

Sadly, the patient lost her pulse again in hospital, and this time they were unable to restore it.