Monday, December 25, 2006

Christmas Day

I hope you have all had a wonderful day, and not got too drunk.

We've had a rather busy shift today. Our shift started at 06.30. At 06.45 we were off to out first job - a cardiac arrest at a nursing home. Good start to the shift.
When we arrived, we were met by one of the care staff, who told us that the patient was not for resus. She'd telephoned the out of hours GP service and explained this to them, but the GP had insisted she call an ambulance. On examining our 90 year old patient, we discovered it wouldn't have mattered if she was for resus or not, she was beyond our help. The family had been expecting her to die - her son had been to see her yesterday and had left with the feeling that his mum wouldn't make it through Christmas. Shame he was proved right.

Some of our other calls included:

A call to a 72 year old man who lived in sheltered accomodation. He'd gone out for an early morning stroll, and fallen. He was found by a "carer" after he'd been laying on the floor in the cold for nearly an hour. I've put quotes around the word carer, because she gave us the impression that she couldn't really care less. We took the poor man to hospital suffering from hypothermia. We later saw him in a much happier state about to be given a lift home.

Then an elderly lady who called us because when she woke up she could hear Land of Hope and Glory being sung. That, and her upstairs lights didn't work - and hadn't worked for three weeks. She'd been on to her solicitor to find out why the electricity was cut off upstairs but not downstairs. While the crew did the obs, I had a little hunt around and found the fuse box. I reset the trip switch for the upstairs lights, and hey presto - the lights worked again. The lady was very grateful, but I'm now concerned she'll start calling an ambulance every time her lights stop working.

Next, a man who'd had three fits. To have five fits in a row is apparently quite normal for him, so we were at a loss as to why we were called. We took him to hospital in case he had any more fits.

Then a man with chest pains. Turns out he's been having them on and off for a while after a chest infection, but he won't take any pain killers. His ECG was normal, but we still wanted to take him to hospital - he refused, so we arranged a GP to visit instead.

A lady who'd fallen and cut her leg. It was a green call (our lowest priority of emergency call) which we don't normally run to on lights and siren, but we were asked to because there was apparently "Serious bleeding". When we arrived, we found a lovely lady with a bandaged leg, and not a drop of blood in sight. "She insisted on finishing her Christmas dinner before we called an ambulance." I refrained from commenting - it is Christmas after all.

There were a couple of other calls, but our last call was to a man with a migraine for 12 hours. "Have you taken any pain killers?" asked my training crew.
"No, I didn't want to mask the symptoms!"
It was the first time my crew had heard that - they were gobsmacked. After we'd taken the patient to hospital, one of the crew said "Duh! That bloke has a migraine, refuses to take any pain killers for it, then wonders why it hurts so much it's making him sick!"

Welcome to the ambulance service......

Sunday, December 24, 2006

Plymouth to Dakar - In An Ambulance

Mark Whitfield, an EMT at the ambulance station I normally work at is taking an ex training vehicle over to Dakar, the capital of Senegal in Africa. It's one of the old LDV ambulances, which has a V8 engine. He is travelling with his partner, Viv and a friend, Jules.

Part of the journey will take them across the Sahara Desert, which they think will take three days. Once they arrive in Dakar, they are going to donate the ambulance to the main hospital there. Apparently Dakar has just two ambulances for about 1 million people, and our old P reg ambulance will be the newest vehicle they've got.

They arrived in France yesterday, and plan to spend Christmas Day in Paris, before continuing their epic journey.

They're keeping a blog of their journey, which you can find by clicking here. Any donations would be gratefully received.

Good luck guys.

Rest Breaks Suspended

You'll recall from a couple of posts ago that we have had a new rest break policy brought in, which allows us to have a rest break under the European Working Time Directive.

The fact that I haven't been given even one official break since this policy was brought in is neither here nor there - at least I got the chance to go home early because of not getting a break, which I've managed to do once.

Now, we are told that rest breaks have been cancelled during the festive period, starting from tomorrow, Christmas Day. This means that NO ambulance crews will be given a rest break, and will be expected to work straight through their entire shift, and not be able to go home early. We do however get a tenner and overtime at double time for working through our unpaid break.
I can understand this if there was a major incident - we can't all just bugger off and say we need a rest break, but I can't understand why otherwise?

So we have a rest break policy which we were told was given to us because the law said so, but it can be suspended at any time by senior managers. Maybe it's just me, but is this right?

Saturday, December 23, 2006

Sad But Good Jobs

We've just finished the second week in the TSing period. My trainees are working hard and coming along nicely, and they've had some good jobs too.

A woman in her 60's fell down a flight of stairs - 18 steps in total, and was far from well. We couldn't secure the airway on the patient - I did a quick check for signs of base of skull fracture, and in the absence of Cerebrospinal fluid from ears or nose, (although she was bleeding from the nose) and after quick consultation with the EMT on the car, I attempted to gently put in a naso-pharyngeal airway. There was resistance - which there usually is, and as there was already trauma to the patient's face, and the normal manoeuvres for getting the airway down didn't work, I didn't want to risk trying to push it down any harder in case it was a facial fracture that was preventing it going in. We couldn't get an airway in her mouth because she had trismus - where the jaw is clamped together.

To cut a long story short, we had HEMS and a BASICS doctor out, who did an RSI (Rapid Sequence Intubation), where they give drugs to interrupt the signals from the brain to the muscles - including the diaphragm so stopping the breathing so they can put a tube down the throat to secure and take control of the airway, then they "bag" the patient to breathe for them.

We took the patient to hospital, but she sadly died a few hours later from her injuries.

The crew have also seen their first "purple". We heard the call being given to a crew "the old fashioned way" over the radio as a suspended - LAS slang for cardiac arrest, and I quickly called up and asked if we could run as second crew to give the training crew experience.
When we arrived, the other crew and the FRU were already there, and as we got out of the ambulance, they called down to say that the patient was "purple", which is the LAS term for dead and beyond resuscitation.

We were able to show the crew what's known as Post Mortem Staining - the purple colour of blood pooling at the bottom of the body that occurs after death, and where the LAS term comes from, and also the onset of Rigor Mortis. It was sad because it was to have been his birthday the next day, and when we looked in his diary to see if we could find any next of kin details, we discovered he should have been going to a birthday meal with some friends that night.

Both were "sad" jobs, but also good, because the crew got some good experience. We're working Christmas Day, so hopefully we'll have a day of "nice" jobs. I somehow doubt it, but we'll see.

Merry Christmas to you all.

Saturday, December 16, 2006

Rest Breaks

Both Reynolds and Neenaw have written posts on our new rest break policy.

Mark reports that road staff/control staff relations appear to be at an all time low.

I'm really sorry that relations are being strained between control and road staff...but this situation should have been foreseen with the way the policy has been rushed through.

Don't get me wrong - I want a break, and in my last three shifts, I've not had a break and got off work late. In some ways I'm pleased, because it means I've got £30 in compensation for not having my break, but for two of the shifts, I've not eaten at all because I'm TSing, and the time I'd normally spend "grabbing" something to eat, I've been spending debriefing the crew or sorting out any problems for them.

The rest breaks have also increased workload for control staff, as they have to keep track of who's had a rest break and who hasn't, and log the crews that haven't and give a reason. Frankly, this must be a bloody nightmare trying to keep track of all this and still allocate calls to crews, take "blue calls" and pass them on to the hospital, arrange GPs for those that crews leave at home or who don't want to go to hospital, book delays for crews, and the countless other tasks they have to perform.

However, everyone is entitled to a break. I've heard radio ops getting a little shirty with crews who book themselves unavailable in the last half hour of their shift when they haven't been given a break. The crews aren't doing anything wrong - the rest break policy states they can do this. On behalf of crew staff who do this, please don't get the hump with us. We understand that you're probably frustrated because you're holding a screenful of calls, but please understand in return that we are only doing what the service management have said we are to do.

Reynolds points out the article in The Sun newspaper about our rest breaks, and tells of staff already receiving abuse from members of the public because we dare to have a break during our shifts.

I recently called into a supermarket close to our station whilst at work (I won't say which one) to buy one of their salad pots - I'm getting overweight, and I'm trying to do something about it.

At the checkout, I ended up in a row with the cashier because he said I should be out saving lives, not shopping for food. So I asked him how many hours he worked.
"Eight hours a day," he replied.
"Do you get a break where you can get something to eat, have a cup of coffee and relax?"
"How would you feel if your manager said you couldn't have a break today, and had to work through from the start of your shift to the end with nothing to eat?"
"I'd tell him to stuff his job"
"So why do you expect us to work through a 12 hour shift without getting some food or having a break?"

He looked stunned, and went a bit quiet after that. Other members of staff have been saying the same thing to those that give them verbal for daring to call in at the bakers etc, and have been getting the same response.

I'm sure it won't be long before people forget the newspaper article, and things settle down again. I just wish some people would stop and think before launching into a verbal tirade at the very people who may well be attending them and saving their life should the need arise.

Wednesday, December 13, 2006

A Few FRU Shifts it really that long since I posted? I'm very sorry for slacking off.

I've had some "fun" over the last couple of weeks - couple of weekends ago I was working nights, and my crewmate went off sick with a trapped nerve in his neck, so I got sent to another complex to work on an FRU.

Now one of the main things when working alone, is to have some idea of the area you're working in so that you don't go blindly into a dodgy area and walk into trouble. Fortunately, this didn't happen to me, but nevertheless, I hadn't a clue about the area, to the point that when I got a job, I didn't even know which way to go down the road until the Satellite Navigation gave me the directions. Sadly, out of the 6 jobs I did, only one would have been reached inside the 8 minute target response time......had it not been held for 7 minutes. Not that I'm complaining....the job sounded dodgy and the FRU desk was making sure it was safe to send a lone responder in, for which I am very grateful.

About 3am, a DSO came in and said "I've just had a look at your response times....they're not very good!"
"Sorry, but I've come over here as a favour to the resource centre, I haven't a clue about the area, so I'm having to wait for the Sat Nav to work out the route before I can even turn a wheel."
"Well you could head in the general direction of the call and let the Sat Nav catch up with you," persisted the officer.
"I don't even know which way to turn out of the station. Not a clue. They might as well be telling me the job's in Japan. Sorry, not a clue."
None of the jobs really needed an FRU - I still got to most of them first, but they were mainly along the lines of "I've had this belly ache for three weeks now...the Dr's given me some pain killers, but I haven't taken any....." Good to know some people are just as stupid in every area that you go to.

The next night, they sent me to work on a different FRU. Still not my area, but I did at least have a vague idea as I have a couple of friends who live in the area. It was a good shift to be fair....two stabbings, a car into a shop window, a couple of chest pains (thanks to the adverts - but that's what they're designed to do - make people call us) and a young lady with muscular neck pain (Cat A because of "Severe Respiratory Distress" - she was crying).

Then last Sunday I did a shift swap for someone so they could go to a Christmas Party, I got run miles for an unconscious 90 year old - the call had been held for 11 minutes before being given to me.

It was given to me because there was absolutely no other vehicle available, and I was asked to report on arrival as to how urgently an ambulance was needed as they currently had nothing at all in the area to send as they were already on calls.

When I arrived, I found a very ill elderly lady lying in the narrow hallway of her bungalow, with her equally elderly neighbour talking worriedly into the phone to a call-taker in control. The look of relief on her face when I walked through the door was absolute. It had taken me nine minutes to drive to the call, so she'd been on the phone to control for 20 mins with her very ill neighbour lying unconscious on the floor, making a snoring sound.

This was being caused by her tongue, which had dropped to the back of her mouth - the tongue is a muscle, and at the point of unconsciousness, all muscles relax. To clear it, I simply tilted her head back, which caused the tongue to stretch and flatten out so removing it from the back of the mouth. I then inserted a small curved plastic hollow tube, known as an OP (Oro-Pharyngeal) airway into her mouth. This then sits behind the tongue, preventing it from falling back again, and allows the patient to breathe through the tube.

After securing the airway and making sure the patient could breathe, I set about getting some baseline obs. Pulse, Oxygen saturations, Blood pressure, Blood glucose and Temperature. I wanted to be able to prove my case to control over the phone, otherwise any ambulance that became available might be sent on another call that didn't have a response already on scene, and I needed an ambulance urgently. This was confirmed when I couldn't get a pulse measurement or Oxygen Saturation level on the machine. I resorted to the tried and tested method - doing it myself. I found a radial pulse (pulse at the wrist), but it was very slow between 36 and 44.

I did the blood pressure, but it took 2 or three attempts because the pulse was so slow. It came up at 47/20. I reached for the phone to call control and tell them I needed an ambulance NOW, but they must have read my mind. As I called up the number, I heard an ambulance pull up outside. We got the patient quickly loaded, and the paramedic got IV access, took bloods and set up a bag of fluid to bring her blood pressure up. She was "blued" in to hospital, where the blood tests showed she'd taken an overdose of paracetamol. This must have been going on for quite some time, as paracetamol takes a long time to kill, and destroys the liver in the process. The woman must have been in some considerable pain, and continued taking the paracetamol or it's pain killer action.

I don't know if she is still alive, but we had certainly stabilised her before we got her to hospital, and had managed to improve her pulse rate and blood pressure.

Once again, it's a call I'll probably never get to know the full outcome of. Frustrating eh?