The World Through The Eyes of a Paramedic

Imagine

2010-08-20T23:15:00.002+01:00

You're 10 years old and on holiday. Dad's sleeping on the sofa cos he's not been very well.

Then mum, uncle, aunty and gran start looking worried. Dad won't wake up.

They call an ambulance.

When it arrives, the paramedic has a look at dad.

You then hear him tell mum that dad has died.

Our job is shit sometimes....

A "London" Day

2010-08-11T22:26:00.003+01:00

Today was full of jobs that reminded me of working in London.

We started with a run of the mill back pain. The lady had been doing some gardening, had bent over, and felt her back "go". When we arrived, she was on the kitchen floor, unable to move because of the pain. A community responder had already arrived (to "stop the clock") and was offering sympathetic words and making encouraging noises. A few whiffs of entonox later, and we had the patient on her feet, and out to the ambulance. We took her to hospital for further assessment and treatment.

The next job was given as a 20 year old girl, ?stroke. It turns out she had numbness on the right side of her face, right arm, and the sole of her right foot was numb. She was still able to walk about on it ok, and insisted on walking to the ambulance. We left her at hospital having a CT scan arranged.

Next, the poor patient of a crap doctor. Every area has a crap doctor, and in a rural service, it seems every village and small town has a crap doctor. This was a doctor's urgent into A&E for an elderly lady with an ankle injury. The doctor thought it was broken. We were half way there when control informed us the doctor had upgraded the call to an emergency and we were to run on blue lights. When we arrived, the poor lady with her broken ankle was walking happily off to go to the toilet. I don't know what sort of assessment the doctor did, but he/she certainly didn't think to ask if the patient could bear weight on it. I told her it was highly unlikely she'd done anything too drastic. Apparently the doctor had visited and had said something along the lines of "Oh, it looks like you've done something to that - I'll call an ambulance." The ankle was swollen, and at first I thought it was a sprain, but when I touched it, it was very warm, so I now think she had an infection. Unfortunately I didn't get the opportunity to follow it up later.

We finished the day going to a 17 year old who'd taken an overdose of 15 paracetamol. It turns out she's doing a holiday job and the romances weren't what she thought they'd be.

All in all, a day of easy jobs, and all of them reminded me of the kind of calls I was missing in London. I know someone will comment that we only did four jobs, but we ran 15 - 30 miles for each one. Where I am now, the calls tend to be of a more genuine nature, apart from one in my first week here, which I shall write about at some point in the future - it's another crap doctor story...

Ooops

2010-08-09T19:05:00.001+01:00

I *may* have tested the siren while my crewmate was checking the oil. It was accidentally on purpose. He may have sworn at me.

Nee Naw

2010-08-09T09:30:00.003+01:00

One of my friends who I met thanks to this blog has just posted her last blogpost

Suzi has inspired many people and helped even more to remain calm whilst doing something you never really get training for in life - making a 999 call for an ambulance. However, her bosses have seen fit to tell her to stop blogging. I won't go into details about why, but suffice to say their reasons are frankly complete bollocks.
Suzi has written some really useful posts, including Common beliefs held by the public about calling 999 along with What to expect when you make a 999 call for an ambulance and how the public often think time is being wasted with stupid questions

There are loads of others - why not visit the site if you've not seen it before? Have a flick through the archives - there are even a couple of cross-blog posts with me.

Good luck for the future Suzi, and I hope that one day, you'll be able to return to blogging.

moved services

2010-08-07T21:27:00.003+01:00

Ahh, there you are. I know I went quiet again, but it's because I've been moving ambulance services - not actually picking them up and shuffling them around, but rather moving from one to a different one. In order to ensure I maintain patient confidentiality, I will not be revealing which ambulance service I now work for.

I've been there 2 weeks now, and to be honest, it's not much different to London - we're still out all day, but doing less jobs because we have much longer running times to get to calls and also to hospitals. Management is pretty much the same - I've had to sort out my own passwords and other important things by myself. The best bit is I no longer work nights or weekends for the forseeable future - and it's doing me the power of good.

I've already identified one hospital that I don't want to be taken to if I'm ill - ever! I've also already been offered bank work at one of the neighbouring services. Seems there's a shortage of Paramedics everywhere - perhaps they should pay us more...

Working Hard

2010-03-24T13:59:00.000Z

It's been a busy weekend...going out right at the start of the shift, not getting a break, and coming back after the end of the shift. That's the way it goes sometimes....but especially at weekends for some reason.

We've had a mixture of interesting and rubbish calls. We were sent to a young man with a cut hand. He met us as we pulled up outside his address, his hand wrapped in a bath towel. We thought he might have a quite nasty injury from the way he was holding it. When he took the towel off, it was all I could do to stop myself blurting out "Is that it??".

It was small cut on the hand, but it had gone fairly deep, but calling an ambulance was still a bit over the top. We took him to the local minor injury unit, where they made sure it was properly cleaned and dressed it, before politely telling him off for calling an ambulance for something that wasn't an emergency.

Later, we were sent on a Cat A call for an elderly man who'd fallen and banged his head. Normally these are green calls - our lowest priority of call, or an Amber call at the most. There was nothing on the screen to indicate why the call was a Cat A - he was apparently conscious and breathing, no mention of bleeding or breathing difficulties. But we can't see the answers to all the questions on our screen, so we guessed there was more to it than meets the eye.

The FRU was already there when we arrived, and we found the patient unconscious on the bathroom floor, with blood pressure so low it wasn't measurable. We actually listened to his chest to see if we could hear the heart....we could, so we knew it was beating, but his breathing rate was falling. We started to "assist ventilations" with a bag and mask, and I went to the ambulance to call for a second crew, because we were two floors up, and the lift wasn't big enough to take our patient flat. Because his blood pressure was so low, we didn't want to sit him up - it would probably have killed him, so we wanted to take him out flat on a board. Unfortunately, the stairs were very twisty, so it was going to be a nightmare getting him out, and we'd need a couple of extra pairs of hands.

While we waited for the other crew, we got him onto the board and strapped him down tightly - we didn't want him to fall off as we moved him. Barry put a line in one arm, while the FRU Paramedic put a line in the other arm. If he did suspend on us, we wanted to make sure we'd got good access into his veins. We put a bag of fluid up and started running it through as fast as it would go.

When the second crew arrived, we manhandled him down the stairs and onto the trolleybed. We all agreed it was the best physical workout we'd had for ages!

We blued him in to hospital, where by the time we arrived, the bag of fluid had brought his blood pressure up a bit, and he was a bit more with it.

I still don't know why the call had come out as a Cat A. It's not very often a Cat A turns out to be a "proper" life-threatening call, but this one certainly was.

I wrote this a couple of years ago, but only just finished it because I forgot about it, so I can't remember the outcome of the call. I have a feeling he pulled through though.

Back Blogging

2010-03-23T20:57:00.001Z

I've not written on here for a long time now. Partly because I've not really found the time to, but also because I fancied a break.

I feel ready to start again.

Hero

2009-07-20T21:22:00.006+01:00

The call isn't for a serious problem. In fact it's for a very minor problem, but the carer panicked.

But I don't mind.

Because the lovely old man I'm talking to fought in WWII and was in the D-Day Landings.

And got his legs crushed by a tank.

But he doesn't complain about his scarred legs.

He thinks himself lucky because he can still manage to walk around using his stick, and only takes two tablets a day.

He's not doing bad for a 91 year old war veteran.

And talking to him, he remembers every detail of what he saw and did as though it was yesterday. You can see in his eyes that he's proud of what he did that day.

And that's why I don't mind just sitting and talking to him.

He's a real hero.

AMPDS again

2008-12-11T16:54:00.002Z

Last weekend was really busy for the LAS. We were working nights, and spent the vast majority of our shifts running round after people who'd been going to Christmas parties, drinking too much and falling over.

This is where I have a problem with our AMPDS system that our colleagues in control have to follow. Almost all calls for drunks are Cat A calls because the patient is "unconscious", meaning they get priority over other calls to people who are actually ill as opposed to being drunk, with a cardiac arrest being the only type of call that would get a higher priority.

So at half past two in the morning, after going to a flurry of calls to drunk people, we were sent to an underground station for an elderly woman who'd been knocked over by someone running for a train and was now lying on a cold platform with a hip injury. Because this call was an Amber call (Cat B), it had been held for two hours, no doubt in favour of the Cat A drunks. This is not the fault of our dispatchers - it's the system that demands we send ambulances to the Cat A calls first, regardless of what is actually wrong with them.

The woman was in a lot of pain, and may well have broken her hip. She was surprisingly still in very good spirits and laughed and joked with us as we gave her a pain killer before moving her to the ambulance.

This is when AMPDS is wrong in my opinion. This lady needed an ambulance far more than any of the drunks we'd been to, all of whom could have made it home with a little help from their friends, but calling 999 for an ambulance is so much easier! She'd been waiting so long that the last train was long gone and the station had closed. I have no doubt that if dispatchers were allowed to use common sense, then this lady would have had an ambulance much quicker. But they're not.

For our management, getting to those Cat As is what matters, cos we have to hit the targets, so our dispatchers have to send on what they know will be just another drunk, or a violent person who will kick the crap out of some poor unsuspecting FRU person. Get well soon "Fred"

Crossover Post With Beaker

2008-11-18T16:58:00.003Z

The call seemed to be a run-of-the-mill straightforward call.

"30 year old female, unconscious in clothes shop," said the screen - well, actually it named the shop, but I'm not going to here. "Patient woke up, but has gone back to sleep again," the screen updated. Probably a bit of attention seeking going on.
My phone beeped - it was Beaker. "I've taken your call - beep beep, shit truck coming through!" It had become a bit of an in-joke after the total rubbish we went to the last time our shifts coincided.
"Probably seen the price of the jeans," I joked to my crewmate as we made our way to the call.

We arrived at the address. It wasn't a clothes shop, it was a general corner shop. The caller had given the wrong name for the shop. I made a mental note to tease Beaker about it later.

As we walked to the door, I noticed a woman sitting in the window of another section of the shop. She was reaching to shelves on either side of her, pulling things off them, ripping them apart, throwing some on the floor, and shoving some into her mouth.

We entered, making sure to keep a safe distance from her while we assessed what was going on.
My crewmate spoke to the patient, who replied by turning round and spitting at her, spraying the shop with half chewed bread and sesame seeds.
"I'll get the police," I said, and made my way back to the truck. I was waiting for control to acknowledge my request to speak to them, when I was tapped on the shoulder. I turned round, and a man said "She's come out of the shop now, and is sitting in front of a bus." He pointed to where the woman was. I stepped back so I could see her - sure enough, she was sitting in front of a bus. Then she crawled under it. She'd managed to bring a very busy high street to a stand still, and there was quite a crowd gathering to watch. I pressed the priority button on the radio, and asked for urgent police.

While we waited for the police, the bus driver got off and took a picture of her on his phone. "My boss'll never believe me if I don't," he said, then added he would be adding it to facebook later!

The police arrived, dragged her out from under the bus, and then detained her under section 136 of the Mental Health Act 1983. This is where the fun really started.

None of the local mental health units had any space, so we waited while the police tried to find a bed for the patient. One unit was closed due to lack of staff, another wasn't taking patients in because there was an "incident" going on, and one refused point blank because the patient was on "their" patch.

Eventually, after about 2 hours sitting at the side of the road, and the Chief Inspector had got involved and lost his temper with the police Mental Health Liason, a bed was found at a hospital miles away. We set off, arriving half an hour later. We pressed the buzzer at the door of the secure unit, and a nurse came to the door. He proceeded to have what became quite a heated argument with the police as he refused to accept the patient, again because she hadn't been picked up locally.

The officers with us got back on to the Chief Inspector. He was far from happy, and told us to stay where we were while he made a few more phone calls. We waited, and waited. Then we waited some more.

Finally he came back to us, telling us the nurse would be reappearing shortly with good news. He did, and we were able to leave our patient in the care of the mental health team.

We'd spent over 4 hours on that job. It never ceases to amaze me that if the local unit is full, it can be an absolute bloody nightmare finding a bed for a patient in need of help from a mental health unit. I don't understand how a unit can refuse to accept a patient when they have the space available, just because they were picked up in a different area. It annoys me immensley - these patients need help, not to be used as a human tennis ball being batted around between units who fight amongst themselves over who's going to take them. Meanwhile, the police and ambulance are stuck, unable to become available for the next person needing help.

Still, despite the eventual result of the patient getting appropriate help from the appropriate team, the government will still see this as a failure - we arrived on scene 10 minutes after the cll had been answered by Beaker - the government says we should have got there in 8 minutes, because it was a category A call.

Ah well....bugger 'em!

Full Circle

2008-11-08T01:09:00.002Z

In the last week, in consecutive jobs, I've seen the full circle of life - albeit back to front.

The last job of my last shift last week was a cardiac arrest. Despite the job running exactly as it should, the patient sadly died on scene.

The first job of the week this week was what's known as a "BBA" - Born Before Arrival (at hospital). I delivered a beautiful baby girl.

It's strange how the job goes sometimes, but these events remind me that as well as the tragedy of a family losing a loved one, we also see the joy of a new addition to a family.

I also recognise that I have witnessed in consecutive shifts, the balance of nature.

Transfer

2008-10-20T20:57:00.005+01:00

Our break had been finished for a couple of minutes when the Activation Phone rang on station.
"We've got a job for you - it's a transfer for a patient post cardiac arrest," said the dispatcher.
"Where's it going?" I asked.
"Dunno yet, the call's still in progress, but given the diagnosis I thought it best to get you running straight away."
"No problem," and we set off for the local hospital.

We were on one of the old white LDV ambulances because the nice Mercedes ambulance had developed a gearbox problem. There's not much room on LDVs at the best of times, and I knew it would be a squash in the back with me, a doctor and nurse, plus of course the patient, and all the monitors and syringe pumps that he'd be attached to.

The screen updated - he was undergoing Respiratory Weening* (initially it said respiratory whining - lol) and that he was going to a hospital about as far north-east of London as you can get - we were heading into the territory controlled by Mark on the north-east desk. My crewmate grumbled about having to drive all that way in the old truck and about having to lift the trolleybed. I couldn't blame her really - we were working in a heap of junk.

At the hospital, we had a little wait while the staff finished preparing the patient for the transfer. While we waited, I sent Mark a text telling him we were headed into his area, and would he kindly try not to use us when we greened up as we would be trying to get back to finish on time. He promised to keep an eye out for us and that he wouldn't use us unless it was absolutely necessary, like a cardiac arrest that we were right on top of.
As expected, our patient was attached to a wide variety of equipment, including a monitor, a ventilator, a couple of syringe pumps and a few other bits and pieces. Some of it would have to sit on the floor, so I knew I'd have to make sure everything I needed to do was done before we set off so that I wouldn't be falling over equipment trying to move around the ambulance whilst it was moving.

Our patient had suffered a cardiac arrest in the airport after arriving back in the UK from a holiday in the sun. He'd been successfully resuscitated and transferred to the local hospital, where they discovered he'd suffered a heart attack, where one of the arteries in the heart had become blocked. This had caused the cardiac arrest. He'd then been transferred to the hospital where we'd picked him up from, and he was now finally well enough to be transferred to the hospital closer to his home.

After a bit of a juggling act with wires, tubes and the other equipment, we loaded the patient onto the ambulance, connected the ventilator to the main oxygen supply on the ambulance, arranged the other equipment on the floor where it could be easily seen, the doctor sitting in the chair at the head end of the bed, the nurse in the side chair, and I settled in to the back seat. We set off on blue lights. Even on blues, it was going to take us about an hour. After about 50 mins, Mark sent me a text. "I can see you on the mapping screen!" he told me. It was a bit of a relief really - I had no idea where we were.

We finally reached the hospital. This is where after making our way from one end of London to the other, things started to go wrong. This is because some idiot decided to build the hospital in the middle of a shopping centre. Either that, or some idiot built a shopping centre around the hospital. Either way, we managed to get lost in the car parks, and had cars beeping at us as we floundered around trying to find the entrance to the hospital. Mark tried to help by giving directions - all of them in one text. "Go right, turn around, turn left, straight on," I read. I couldn't help but laugh. After what seemed an eternity, we found the entrance, and did the reverse juggle to get the patient off the ambulance. A porter lead us to ITU where we transferred the patient onto a bed, and the doctor did the handover.

After our long journey, we were delighted to find the staff were really friendly. A cup of tea was thrust into our hands, and we were invited to help ourselves from a packet of Wagon Wheels - I haven't eaten one of those for years!

We set off back to our own area - under advise, we returned via the M25. Just as we pulled out of the hospital however, the MDT rang with a job - a green call in Dagenham. My crewmate muttered. I waited....and sure enough, we got cancelled. "Thank you," I sent Mark.
"I couldn't resist teasing you with that," came the reply. Little sod!

We almost made it back, but as we got close to home, we were sent to a panic attack. It was a load of rubbish - the patient didn't want an ambulance - she suffers from panic attacks regularly, and knows how to get herself out of them, but a Police Community Support Officer (Plastic Police I call them, cos they have no real powers) had called us despite her begging them not to. We left her where she was to recover, and got back to station. We were only a few minutes late finishing.

Thanks Mark for ensuring we didn't get stuck in the north-east sector.

* Respiratory Weening - this is where a patient who is being ventilated is encouraged to start to breathe for himself again, with the ventilator still doing most of the breathing for him. The number of breaths per minute being delivered is gradually reduced until the patient is breathing fully for himself.

PS: Just a little tease - there's a cross-blog post with Beaker coming up soon

Corrie

2008-10-11T14:41:00.002+01:00

The call was to a diabetic patient "behaving strangely".

Mary* is an elderly lady, whose sister was visiting from Canada. She'd woken up, shouting something about a daughter. The sister knew she didn't have a daughter, and couldn't understand what she was talking about, so fearing that the patient's blood sugar was low, she called an ambulance.

"Who's there?" shouted the patient as we trudged up the stairs.
"Ambulance service," I replied.
"I don't want the ambulance, it's the police I want. I've got information about a girl that's gone missing - my daughter, Rosie...." and she went on for a few minutes. Her sister told us she hadn't got a daughter. I tested her blood sugar while we talked - or rather, I listened while she talked. The reading was normal, so we'd ruled out a hypo. I still had no idea what this woman was talking about, until my crewmate told me she was talking about a storyline in Coronation Street that involved a girl going missing. I don't watch soaps, so I had no idea.
"....so I want the police to come so I can tell them the information I've found out," finished Mary.
"Mary," I ventured, "do you think you might have been dreaming about Coronation Street?"
Mary paused for a moment to consider that. "Maybe you've been watching too much TV," I suggested, smiling.
"Do you know, I think you're right," she said. "I do feel foolish."

I reassured Mary it wasn't a problem, and told her sister she'd done the right thing. I recorded her blood pressure & pulse.
"My son works for the ambulance service - you won't tell him will you?" she asked, looking worried. I assured her that her secret was safe with me, and we left her drinking a cup of tea.

The computer system in control that sends calls down to our screens in the ambulance had been taken offline for some maintenance, so we were doing everything "the old fashioned way", so I had to tell control the outcome of the call and let them know we were available again.
Much to my amusement, Beaker was the radio op. I pressed the button on the radio that let her know I wanted to talk to her.

"Go ahead," she said.
"You're going to love this," I said, and told her briefly what had happened, and that we'd left the patient at home in the care of her sister. There was a long pause. I knew she was laughing. Beaker was still laughing when she had finally gained enough control of herself to acknowledge me and confirm that we were available again. I managed to keep a straight face as I told her not to laugh as it was unprofessional.
"Sorry, I'd answer you but I'm too busy laughing!"

We drove back to the ambulance station - still laughing. I love it when we get funny calls like that - Mary brightened up what was otherwise a very boring week as far as calls go.

*not her real name - I never use a person's real name, but if I don't write this, I always get an e-mail from someone accusing me of identifying the patient

Good Week

2008-10-04T08:09:00.005+01:00

I've had quite a good week this week.

I started working with my new crewmate and we were working as an EMT crew as my registration hadn't been processed yet, so I couldn't work as a Paramedic unless we went to a job where another Paramedic turned up, then I could have. We had a new student paramedic come out observing with us for a couple of days, and my HPC registration finally came through yesterday.

We took our new student up to EOC (Emergency Operations Centre) as I always try to do with new students so they get an opportunity to have a look at the desk that's dispatching us. The bonus for me when I do this is that I get to meet our dispatch team face to face and have a chat so that I can put a face to a voice and a name to the initials. Who should be there when I walked in? Beaker. So I've finally met her, and we had a good chat for a while. As for our student, it turns out he used to work there, so knew more about it than I did - infact it was he that trained Beaker on dispatch! Small world eh?

Mark from Neenaw was there too, call-taking again. He was having a better day than the previous time. He showed me the new Gazetteer, which can give the full address from the minimum information, such as "It's outside Tescos in Purley". I was quite impressed, although I gather not many call-takers are using it as it's still got some bugs.

Jobs this week included an old lady who'd fallen down an escalator and grazed her knee and elbow, and a man with a nasty gash on the back of his head who couldn't remember how it happened.

I've decided our student is a blood magnet. We went to a delivery man who'd had a cage fall on him and virtually amputated his index finger just below the nail. It was hanging on by a small piece of skin (this had originally been a Green call - lowest priority - and had been sent up to our clinical advice desk!!). It wasn't too badly mangled and there was a possibility that the finger could be saved, so we moved the finger back into its normal anatomical position, bandaged it up, and although we didn't put in a blue call (alert the hospital), we did push through the traffic on blue lights. The last we heard they were debating whether to re-attach or remove it. The job before that had been a man in his early 70s who had a nose bleed. It had been bleeding for 2 hours, and it was literally running out of him. He'd tried to get a taxi to take him to hospital, but they'd refused to take him. After going through three large dressings and counting, we bit the bullet and blued him in.

Our student's second day started with an RTC. We were going as a second vehicle to a motorcyclist who'd collided with a car and fallen off his bike. The first crew had been forced to abandon their ambulance in the traffic queue that had resulted, and walked some distance to where the patient was. As our ambulance station was in the other direction, we'd been sent to transport the patient.
A few run of the mill jobs after that, then after visiting EOC, we finished the day with a lovely lady who'd gone to help her mum who was being robbed. She'd been dragged along the floor by the robber for a few feet, and had a number of bruises and grazes. I gave her grazes a clean, and patched them up, and as she didn't want to go to hospital because she was trying to get through to the bank to cancel her cards and cheque book etc, I told her that she'd be a little sore for a few days, and advised her to go to the local Walk-In-Centre later on if she got worried.

And then yesterday afternoon, I got a text from my other half.
"Put your Paramedic slides on!" She'd checked the HPC website to see if my registration had come through, and told me my registration number. I think she'd got fed up of my moaning that I'd put my application in ages ago and still wasn't registered. I'd been frustrated cos we'd been doing jobs that I could easily have used my new "tricks" on (as Mark calls them).
So I finished off the shift as a Paramedic - but to save confusing the control desk I didn't tell them, as I didn't have a Paramedic drugs pack. Needless to say, now that I could use my new tricks, we didn't do one job where I could have justified so much as a cannula.

Oh well, there's always next week.

Change

2008-09-21T22:52:00.006+01:00

There will always be change in one form or another.

I've changed from being an EMT to being a Paramedic, which means a change in crewmate, and a change in rota - twice in a month, but that is only to be expected when you start working in a new role.

Our ambulances are in the process of change - we're finally starting to see the back of the old LDVs, and the service are buying more Mercedes ambulances.

The Orcon start time has been changed from the time the address and chief complaint were established to being from the moment the call is answered in our control room.

Our standby arrangements have faced change to try and shave a few seconds off us going mobile to a call. This is now known as Active Area Cover, Tom Reynolds has already posted about this. It has been and remains a rather controversial change.

Staff morale has changed from being really quite good when I joined the service to being lower than any other job I've done.

Another change that is contributing to this drop in morale is the pressure being placed on our EOC colleagues and crews by management. It seems to me that we're apparently not allowed to take our time and actually care for our patients anymore. A couple of weeks ago we were attending to a poor lady who'd been visited by her GP who'd arranged for her to be admitted into hospital for being "off her legs". According to the family, the GP had been rather abrupt with her to say the least and it had left her quite upset, so we were taking our time, ensuring that we explained everything we were doing, putting her at ease, whilst making sure she received all the treatment she needed. Because this took just over an hour, we got a message on our MDT asking us what the delay was. I told them the delay was I was treating my patient.

This just seemed to confirm to me that targets are the be all and end all for management now, and that patient care is now second. Of course they'll deny it til they're blue in the face, but it is clear to roadstaff.

I know that Beaker is planning a post about the extra pressure being placed on our control staff by management to hassle crews, with the threat of disciplinary action if they don't. I'll let her explain when she has the time to write the post.

The LAS is not a happy place to work at the moment.

*Update: Beaker's split her post into two parts. Part one here and part two here

New Crewmate

2008-09-12T15:44:00.002+01:00

I knew it would be all change after I'd finished my paramedic course. I finished my last mentoring shift with Barry this morning. I'm now on relief for two weeks, then I'm going on a different line at my current station to work with a young lady. I've worked with her a few times when she was on relief and we seem to get on ok, so I'm looking forward to it.

The only hiccup is that the IHCD have messed up my certificate by putting the wrong date on it and it's had to be sent back, so I can't register as a Paramedic yet. This means that until it comes through, I can only work as a Paramedic if I'm working with another Paramedic. The rest of the time I'll have to work as an EMT until I can register.

Hopefully it'll all be sorted soon.

In At The Deep End

2008-08-18T19:57:00.003+01:00

There's nothing like being thrown in at the deep end to see if you'll sink or swim.

That's pretty much what happened to me today on my first job in my new role.
The call was given as a 58 year old male who'd fallen over twice and now had rapid breathing.

On arrival, the man was sitting on his bed. He was alert, and breathing far too fast. He was also complaining of some back pain over his right kidney. I coached his breathing and calmed him down, and after questioning both him and his carer, discovered that he had a tumour on his right kidney, and was waiting to go into hospital for an operation to remove the kidney. He'd also had his medication changed in the last couple of days, and seemed to be confused as to what he should be taking and when. I couldn't rule out the possibility of an accidental overdose.

Although he didn't look acutely unwell, there was something about him that niggled my mind, but I couldn't put a finger on what it was. I asked my crewmate to go and fetch the chair - I didn't want to walk him down to the ambulance.

At the patient's request, I fetched his trousers for him, and he put them on. He stood up and fastened them up. It was then it happened.

He seemed to throw himself backwards across his bed. My immediate thought was perhaps he'd had a jolt of pain which had made him faint. However as I leaned over him to reassess him, I realised his rapid breathing had become slow, gasping and irregular - known as Agonal Breathing. This is seen when a patient goes into cardiac arrest. I quickly attached the defibrillator. If he was in ventricular fibrillation - a shockable heart rhythm - a rapid shock may get his heart beating again. He wasn't - he was in PEA, which looks like a normal heart rhythm on the screen but there's no pulse.
Bugger.
"Is he alright?" asked the carer.
"Err...not really," I replied as my crewmate appeared with the chair.
"Give me a hand to get him on the floor," I said to my puzzled looking crewmate. "He's suspended."

One of the rules for a cardiac arrest is the first paramedic on scene runs the resuscitation, regardless of who else turns up, unless it's a doctor that arrives of course. As he'd arrested in front of me, it was down to me to run the job.
So we got him off the bed, and as I started CPR, my crewmate rang control and asked for a second crew.
"What do you want out of your bag?" he asked.
"The intubation roll. I've set it up so it's got everything you'd need for a cardiac arrest," I replied.
My crewmate attempted to get IV access, but blew the vein as the patient had "shut down", which means his veins had contracted and were difficult to find.
It was quite a small room, and space was tight. At the head end, I was right up against the bed - no way I'd get low enough to see the vocal cords to intubate, so I grabbed an LMA, and put that in instead, and attached the automatic ventilator while my crewmate took over chest compressions.

Next, I got IV access in the neck - the External Jugular Vein (EJV). This went in, and I gave adrenaline to try and stimulate the heart back into action.
One of the paramedics on the second crew helped me to secure the cannula in place, but in doing so, I must have knocked the cannula either out or through the vein, because it blew. I muttered a few naughty words, and set about getting a cannula in another vein. At one point, there were three paramedics attempting to cannulate whilst the fourth did chest compressions. I finally got access in a vein in the back of the hand, and wasted no time in securing it down and ensuring it was working.
More adrenaline, and as the rate of the electrical impulses had slowed down, I gave Atropine, which blocks the part of the nervous system that slows the heart rate, and so should cause the rate to speed up again. It did, which was good. I set up and connected a bag of fluid.

We got the patient downstairs and onto the back of the ambulance. One of the paramedics from the second vehicle jumped in the back to give me a hand.
"Right, let's reassess everything," I said. I rechecked the airway to make sure the LMA hadn't been dislodged as we'd brought him out. It hadn't, we were getting a good CO2 reading, which meant that good ventilation was being achieved, and I could hear the air entering his lungs when I listened to his chest with the stethoscope. As I listened, I also heard something else - was that the heart beating?
"Check the pulse!"
The other paramedic didn't think he could feel one, but could see the neck veins pulsing which proved the heart was beating. I felt for the pulse - and found it. We'd got him back!
He still wasn't breathing for himself, so we left him on the ventilator. My crewmate jumped in the driving seat and picked up the microphone to put in the blue call to alert the hospital we were coming. "I'll put it in as a cardiac arrest yeah?" he said.
"No, post cardiac arrest - we've got him back!" I said.
"Stop messing about." Clearly, he didn't believe me, despite the fact I was just getting a blood pressure.
"No, we've got a pulse - put it in as post cardiac arrest."
"It won't matter if I just say cardiac arrest," he said.
"Yes it will - if he arrests again on the way to hospital, they won't stop the resus as soon as we get him there - they'll work a bit longer"
So the call was put in as post cardiac arrest.
He did lose his pulse again on the way to hospital, so more adrenaline, more fluid, and more CPR.

Putting the call in as post cardiac arrest did make a difference. As we got to the hospital, the patient was starting to show signs of having suffered an internal bleed, so the doctors tried giving blood to see if the bleeding was the cause of the cardiac arrest.

Shortly after, the electrical activity in the patient's heart stopped altogether. He was in Asystole.

Resuscitation was terminated - he'd died. I was disappointed, but not unduly upset. You can't let yourself get upset when a patient dies. You simply cannot save them all.
My colleagues reminded me of this, and reassured me the resus had been a good one that I had run really well.
"After all, you did get him back at one point," said one.
"We got him back you mean - it was a team effort," I said.
"But you ran the team. It was your decisions that we followed, so technically you got him back. And you got an EJV in - it doesn't matter that it was lost for whatever reason, you still got it."

I felt better. Then I looked at my new paramedic bag. It was completely trashed. My intubation roll had bits strewn all over, my cannulation roll had been opened and trashed when three of us were trying to cannulate, and my drugs pack had only three adrenalines left.

"We need to get your bag restocked," said my crewmate. I nodded, and booked us off the road to go back to station to put my bag back together.

It had been a good job, and when thrown in at the deep end - I'd swum. It was a good feeling.

Title Changed

2008-08-17T06:49:00.002+01:00

Yep - it's finally happened. I've finished my hospital placement, and can now apply for my registration with the Health Professions Council.

I start my mentoring tomorrow, which means although I'm not yet registered, I can use my new paramedic skills as long as I'm being supervised by a registered paramedic. As it's gonna cost me £86 to register, it's gonna have to wait until pay day in 10 days time before I can apply.

So the blog name has changed, although the web address remains the same for simplicity.

CCU

2008-07-26T18:17:00.003+01:00

The first week of my hospital placement was in the Critical Care Unit - this combines the Cardiac Care Unit, High Dependency Unit and the Intensive Care Unit.

Most of the week I've been helping to look after the Intensive Care patients, and the Consultant Anaesthetist, Dr West (not her real name) who's turn it was to work in CCU for the week ensured I missed nothing. I'm very grateful to her, because there are some anaesthetists who really do not like paramedics, because they don't believe we should be intubating. This consultant was clearly not one of them. Anything going on that was even remotely interesting, she either sent someone to get me, or came and fetched me herself.

Most of the patients in CCU are sedated, intubated and ventilated. The drugs and fluids dosages are calculated down to the microgram per kilogram per minute. Vomit, urine and bowel movements are measured to the millilitre so they know exactly how much is going into the patient, and how much is coming out of them. This is to make sure that the proper fluid balance and acid base balance is maintained. The calculations are mind blowing, and it will need someone far cleverer than I to tell you much more about it.

I was invited to watch a patient having a tracheostomy. This is where a hole is surgically created in a patient's neck just below the thyroid cartilage (adam's apple), and is done so that they can wake a patient up, while maintaining full control of the airway without the patient having the discomfort of a tube sticking out of their mouth. It was done using a bronchoscope - a fibre-optic camera inserted into the ET tube so the anaesthetist can see exactly where the tracheostomy is going to be. The tube is pulled back so that it sits just in the vocal cords, allowing the trachy to be made in the correct place.

The Sister in charge told me where to stand so that I wasn't in the way, but could still see clearly what was happening. The anaesthetist had a couple of other doctors to assist her, as well as a chap who was wearing a badge that idientified him as being on work experience.

"Steve, don't stand there, you won't be able to see the anatomy of the airway when I 'scope him," said Dr West, and directed me to stand just behind her right shoulder. To the others, she said, "Steve's a Paramedic, and he'll be doing harder intubations than we will ever do in theatres, so I'd like him to see this. We can get the patient into the position that suits us. Steve will be lying on the floor, in the dark, and sometimes in the rain or even snow to intubate." The other doctors looked at me with blank expressions. What was behind those expressions I don't know, but I felt a little embarrassed.

She inserted the laryngoscope, moved the tongue to the left, and lifted. Standing just behind her and looking over her shoulder, I could clearly see the epiglottis, and the larynx with the ET tube passing through it.
"Steve, can you deflate the cuff* please?". A 10ml syringe appeared in a nurse's hand out of apparently nowhere and was held out for me. I delflated the cuff, and Dr West carefully pulled the tube back.
"Ok, inflate it again. You won't be able to get the full 10mls in, but don't worry." I re-inflated the cuff until I felt resistance against the plunger.
"That's enough," said the Dr.
The procedure then went ahead, with me watching events closely on the monitor. I watched them insert a needle, confirm it was in the right place, then insert something called a Rhino Horn to widen the hole made by the needle. Then the Tracheostomy tube was inserted and sutured into place. Then Dr West "hoovered" (her words) the airway, including right into each lung, to clear it of secretions and other gunk, some of which was quite thick mucus. I was able to see easily how the airways divided up inside the lungs. The whole operation took 15-20 minutes.

Yesterday, I was walking back to the unit after lunch when I was spotted by Dr West.
"Steve, come with me," she called down the corridor to me. I hurried after her, and we went into one of the operating theatres. There were a lot of people in the room, some of which I discovered were medical students.
As I neared the operating table, I saw a small baby, who appeared to be just a few days old. She'd obviously been anaesthetised, and the consultant anaesthetist already there was "bagging" her - breathing for her using a bag and mask.
Apparently they'd been having some difficulty intubating her. The anaesthetist in the room looked dejected.
"It's the first time in 15 years I've failed to intubate a baby," he said, picking up the tiny larygnoscope to try again.
He inserted it, and spent a few seconds trying to identify the vocal cords. I watched the monitors intently, with my attention flitting between them and watching what the anaesthetist was doing.
"This is really tricky," he muttered.
"Oxygen saturation is still 100%, keep going," said Dr West, then added, "Steve, keep an eye on the monitor - tell us the moment the Sats start dropping." Again to the crowded operating theatre she announced, "Steve'a a paramedic." Thankfully, she didn't add the difficult intubations line - probably due to the problems being encountered with intubating this little baby. In any case, in a crowded room of medical students, I was grateful for the omission.

From that moment, I glued my eyes to the monitor. The anaesthetist continued to try to see the anatomy of the airway, but was clearly having problems. Then the oxygen saturation dropped to 99%, which I announced.
"Damn," muttered the anaesthetist, removed the larygoscope, and started bagging. By this point, the saturations had plummeted to 83%. I held my breath, watching the monitor and willing them to rise again as the baby was bagged once again. Finally, after what seemed like an eternity, but in reality was probably no more than 10 seconds, the sats shot back up to 100%.

They ventilated the baby for a bit longer, then Dr West was invited to try. Again, I glued my eyes to the monitor, with only very quick glances to see what was happening. Dr West picked up a tube, inserted it, took out the larygoscope, connected the bag and squeezed. The stomach inflated.
"Shit," she said, taking the tube out and ventilating the baby again.

After a few more attempts, they got a fibre-optic scope to have a look at the airway. They found the vocal cords, and they were very inflamed and almost closed. This wasn't because of the attempts being made to intubate, but rather an existing infection. It was this that was causing the difficulty intubating.
After consulting the surgeon, it was decided to abandon the operation, wake the baby up, and send her to another hospital that had better equipment and paediatric anaesthetists who would have a better chance to intubate.

This was useful for me to see - probably not necessarily for the reason Dr West had intended, but it proved to me that even very experienced Consultant Anaesthestists who intubate numerous times every day sometimes don't manage to get the tube in. I'll remember that whenever I fail to intubate a patient for whatever reason.

I'm in A&E next week to get my cannulas and infusions signed off, then theatres for the two weeks after that for intubations and LMAs.

*the cuff on an ET Tube is like a balloon that surrounds the tube, and is inflated to a) hold the tube in place and b) prevent any fluids such as vomit from getting in to the lungs.

Do I Need A New Blog Title?

2008-07-19T19:33:00.003+01:00

So the course has drawn to an end, all the exams and practical assessments have been completed, and the question on your lips is:

"Did he pass?"

Well.....

Yes!

I start my hospital placement on Monday. I'm there for four weeks to get signed off on LMAs and intubations (sticking tubes down throats and managing the airway) on real people, not just plastic manikins, and also to get signed off on cannulating people, and putting up bags of fluids etc.

Once I've done all that, I can register with the Health Professions Council and then I can start practising as a Paramedic on my own. Until my registration comes through, I can still practise as a Paramedic, but I have to be directly supervised by registered Paramedic.

Does that make sense?

So I need to start thinking about a new blog name, and here's where I throw it open to you, dear reader.

There is always the option of simply changing it to "The World Through The Eyes Of A Paramedic", but I am open to other ideas.

Good luck to the new course which starts tomorrow - don't worry if you don't pass the Mod G exam first time - half my course failed it first time round but all got through on the resit (including me!)

A Quick Update

2008-06-22T19:22:00.002+01:00

Just thought I'd write a quick post while I have a few minutes.

The course is going well, I've passed what many see as the hardest part of the course - module G. I have no idea how I passed the essay paper - the trainers marking it must have taken pity on me or something!

I've just finished 2 weeks on the road which was to consolidate the new patient assessment skills that we learned during the first 2 weeks of the course. I was back with Barry - and said I wanted to go to the training room at our main station to run through a couple of Advanced Life Support scenarios as we have those coming up on Thursday. He somehow managed to find me two real cardiac arrests, so he got me to run them and say what should be done, while he did it. Not quite the practice I was anticipating, but it was good to run both of the resuscitations with my new thinking paramedic head on.

Just a quick public thanks to Barry and our uni student who was out this last week on a set of observation shifts for putting up with me this week - I've been a bit of a stress-head! So sorry to both of you.

Back to the classroom this week - we have the drugs exam on Tuesday, and we have our patient assessment practical exams this week too.

I'll try to updat when I can, but the course will obviously come first, so August is still the target month for a full return of service.

Thanks for your best wishes so far.

Not Gonna Blog Til August

2008-04-18T04:39:00.003+01:00

Pretty much as it says in the title really.

The reasons for no blogging lately are:

1) Thanks to FREDA, we're getting off late more than getting off on time

2) Studying for my upcoming paramedic course as we have to learn the first module before we go as the exam for it is on the first day, and we have to learn all the A&P for Respiratory,
Cardiovascular, and Nervous systems - questions like "Briefly describe the components of
somatic and autonomic reflex arcs and explain their role in maintaining homeostasis".
We also have to learn Pharmacology, Drug administration and the theory behind cannulation
(putting a needle in somone's arm to give drugs - IV Access) and intubation (putting a tube
down the throat to secure the airway).

3) Thanks to the above two points, by the time I've got home, eaten and done some study, it's
time for bed, so I can get up the next day and do it all over again.

So I hope you'll forgive me, but I probably won't be updating my blog until August when I finish my paramedic course. Then I'll need to change my blog title. Providing I pass the course that is.

Be Careful What you Wish For (Part 2)

2008-02-06T20:02:00.000Z

For part one of this post, see Mark's post here

Barry's off sick at the moment, and I've been single manned for most of this week, so I was asked to work on the FRU for a few days.

Since I stopped working on the FRU a few months ago, car staff have been asked to update control about cancelling ambulances/needing them on the hurry-up directly to the appropriate sector channel, so our radio in the car is now left on the SW channel.

I'd just parked up on standby when I heard a familiar voice on the radio. I couldn't quite place it until there was a General Broadcast (done when a call is being held and they're looking for any ambulances to come available,) which ended with the initials that confirmed my suspicions..."General Broadcast at 24*, my initials Mike Mike, Red Base out."

I'd done a couple of jobs that were, frankly, ridiculous calls that could have easily been dealt with by the GP when I got the Vaginal Pain for two weeks call. I'd sent Mark a text message and said I'd find an excuse to call up when he was on the radio. This was the perfect opportunity, as the call certainly didn't warrant receiving attention from a Fast Response Unit, especially with the patient already having been given pain killers by the hospital, so I called up. I could hear the humour in Mark's voice as he answered me.**

I was only joking when I asked him to find me a suspended. His reply had been "If someone calls in your area, I'll get them to murder someone". He was, of course, only joking. When the call came down to the screen. "Cardiac Arrest - Not Breathing At All" I realised it was a bit of a run, so I set off, briefly wondering if Mark was taking the call, but wasn't sure cos the text on the screen didn't say "dead" - Mark's the only person I know in control who will put that word on the screen.

It was a cancer patient, just 68 years old.

I arrived at the address***, and hurried up to the first floor with my kit, the ambulance pulling up just as I got into the flat. The patient was in the bedroom - up another flight of stairs.
As I entered the room, I was faced with pandemonium. The son was fighting back tears, his wife was crying as she was doing CPR, and their daughter was hysterical in her bedroom.
Unfortunately, the daughter-in-law was doing CPR with the patient on the bed. My heart sank. Good effective CPR is only possible if the patient is lying on a firm surface. Because she was on the bed, I had to mark it on my paperwork later as "ineffective CPR" which is a shame, because apart from the patient being on a soft bed, the daughter-in-law was doing good CPR.
I introduced myself, and the son said "It's ok, the paramedic's here" and hung up. I appreciated the senitment, but I haven't done my paramedic course yet...

I got the son to help me get his mum onto the floor, and I started CPR just as the crew came in.
I was relieved to see they were both paramedics. I continued CPR while one paramedic attached the defibrillator, and the other started preparing to put a tube down the patient's throat to secure the airway and put a needle in a vein to give the vital drugs to try and stimulate the heart back into action.

The defib showed the patient was in asystole (flat line). We carried on with the resuscitation attempt, with the son and his wife looking on, trying to hold their mum's hand, but only succeeding in getting in our way, and shouting encouragement to her, hoping that their words would somehow make her start breathing again. Meanwhile, the grand-daughter kept running in, screaming hysterically, and running out again. The crew got the patient intubated and cannulated, and we did over twenty minutes of resuscitation with all the drugs etc that the hospital would have given her. When we still had asystole after 15 minutes, the son asked if we were unsuccessful, not to take her to hospital. Up to that point, we'd been preparing to take her - purely for the family so that they could see we'd done all we could, but the son said they knew we were doing everything possible.
The last dose of Adrenaline was given, followed by two minutes of CPR. At the end of it, the defib still showed asystole. We all agreed that it was right to abandon resuscitation.
We pronounced life extinct at 1546.
The son cried.
The wife cried.
The grand-daughter came in and asked what was happening. I looked at her dad, a question in my eyes and he nodded. "I'm sorry sweetheart, you're Nan's died."
The house erupted in sorrow. It was heart-wrenching. I knew exactly how they felt - my mum died from cancer nearly 5 years ago at just 63 years old.

We put the patient back on the bed, removed the tube (we should really leave this in, but the family asked us to take it out because they wanted the children to say goodbye and they didn't want them to be scared by it) and made her look comfortable and peaceful.

The family just kept saying thank you to us. We'd failed to bring their mum/nan back to life, but they still thanked us for what we'd done. We felt very humbled, and left them in peace to do our paperwork and summon the GP.

I only knew Mark had taken the call when he e-mailed me to say how freaky it was that we'd joked about him taking a call for a suspended on my patch, although this wasn't really my patch, but get pulled into that area quite often.

I'm working on the car again tomorrow, and Mark said he might end up on the FRU desk - you never know, we might get another cross-blog post out.

Our last cross-blog post was so well received, not to mention so long ago, we jumped at the chance to do it again. Maybe next time we'll get a happier outcome.

* 24 is the minutes past the hour, so in long hand he would have said "General Broadcast at 0924, my initials Mike Mike, Red Base out."

** I wasn't really complaining about being sent - I simply asked if he was running an ambulance that might be nearer. In the end, she waited over an hour at least - she only lived ten minutes walk from the hospital.

***To add to the freakiness (is that a word?) of this call, three years ago, I went to a cardiac arrest in the flat directly below this one.

My New Year

2008-01-09T10:55:00.000Z

New Year's Eve, Barry had the night off - he was going up to the Embankment to watch the fireworks. Meanwhile, I hadn't been lucky enough to get the night off, so I was working. I can't remember all the calls, but those I can are related here....

The shift didn't start well - first was a 30-something woman who'd been drinking vodka since 10 o'clock in the morning, had fallen over and "cut" the fleshy part of the base of her thumb on some glass. Well, to say cut is a bit of an over reaction. She had two very small scratches. She asked if she was going to die. I got her to wash it under the tap, then she decided to put a plaster on. We left her at home.

Later, after being given a break (my first in 4 months) we went to a pregnant lady who had some bleeding. She'd noticed the blood on the toilet paper earlier in the evening, but there hadn't been any bleeding noticed the last two times she went to the toilet. She had rung 999 for advice only. As our call takers don't give advice, and the call couldn't be sent to our Clinical Telephone Advice service because it had come up as a Cat A, an ambulance - us - had been sent, along with an FRU.
"Have you rung the hospital and spoken to a midwife there?" I asked.
"No, I don't have the number cos I lost my notes after leaving them on the bus."
We got the number for the hospital from our control, and I spoke to a midwife. I explained what the patient had told me, and the midwife said "Good grief - she's called an ambulance?"
I explained about the notes. "Oh for goodness sake. OK, I'll speak to her, can you put her on please?"
I handed the phone over, and after a lengthy consultation, the midwife had obviously said she wanted the patient to go to hospital, and the patient was refusing. The call ended. We tried to persuade her to go:

Me: Look, you rang for advice, you got us, we've found you the number for the midwife, you've spoken to her, and the advice you wanted is that you should go to hospital. We're here now, and we'll take you.
Patient: Yeah but who's going to look after my other child?
Me: Is there no family close by who you can call and ask them to come over? We'll wait for them.
Patient: No, nobody. I'll wait to see if the bleeding starts again, if it does, then I'll ring again for an ambulance. (This is what she had said on the phone as well)
Me: But I'm sure the midwife has just told you not to call another ambulance?
Patient: Yeah, but it's New Year's Eve - I won't get a taxi for hours.
Me: After midnight, you won't get an ambulance for hours either, cos there'll be far more calls then there are ambulances, so some will have to wait.
Patient: (bear in mind the answer to someone looking after her child) Oh, well I'll call my sister who lives round the corner to take me.

We gave up, did the paperwork and left her.

By now it was almost midnight, and we decided we'd go and sit on one of the bridges to see the New Year in and hopefully see some of the fireworks. I pressed the "Green Mobile" button, and selected "Declined Aid Against Advice" and "Send".

Almost instantly, we got another call. "Red 1, 59YOM Cardiac Arrest, Purple"
Red 1 is our highest category of call, Cardiac Arrest speaks for itself, and Purple meant beyond help. The call had just come in, and we were only around the corner. We were with the patient inside two minutes of the call.

The patient was laid in bed, and he was indeed in cardiac arrest. I pulled back the covers, and put my hand on his chest. He was still as warm as you and I are. He'd clearly only just arrested. We got him onto the floor, and I started CPR while my crewmate set up the Defibrillator. The machine showed Asystole (flat line). A paramedic arrived on an FRU, I briefed him, and we continued to work on the patient for the next 20 minutes using cardiac drugs to help stimulate his heart back into action. It didn't work, and after 20 minutes, with the patient still in Asystole, the paramedic asked us if we agreed to terminating resuscitation. We did, and the patient was declared deceased. We checked our watches to get the time of death, and realised it had gone midnight.

There were now various bits of paperwork to be completed, and the paramedic said he would deal with it all. We wished each other a Happy New Year, and we left.

Next was a panic attack, which with everything I could hear kicking off on the radio, I suspected the hospital wouldn't have been impressed with us taking in, so we spent an hour and a half talking the patient out of the panic attack. We succeeded, and it turned out she was a student nurse, and felt very silly that someone had called an ambulance for her, had never had a panic attack before, and said she would go to see her GP about it.

Two or three more calls that I can't remember, and we were looking for our "off job" - a call that is fairly easy, goes to hospital, then we go home. What we got was a call miles away to a care home, where a little old lady had fallen out of bed, and waited almost three hours for an ambulance.
It was a care home that actually does care. If you read ambulance blogs regularly, you'll know that they are few and far between in our experience, so this made a welcome change.
At first, it seemed our patient hadn't hurt herself, and we got her up and watched her walk with her frame. She was limping. "Is that normal for Mavis?*" I asked her carer.
"No, apart from using a frame, she usually walks normally."
Bugger. I really hadn't wanted to take this lovely old lady to an A&E bursting with loud abusive drunks vomiting all over the place and trying to pick fights with each other, but now I'd have to.
"Which hospital does she normally go to?" I asked, stealing myself to be told a hospital that was even further away from home.
"Town Hospital," said the carer. Oh yes, someone was watching over us, it was the hospital nearest to our ambulance station. I gave a silent thank you, we got Mavis into our chair, and we took her to hospital. It wasn't as full as I'd expected, but the nurses were pleased to see someone that wasn't drunk for a change.

I arrived back on station to find Barry, his girlfriend, and my girlfriend (Barry had taken her with them so she wasn't on her own for New Year) all sleeping on the sofas. I accidentally-on-purpose dropped something heavy and woke them up. "What are you lot doing here?"
"Can you take us home? We missed the fireworks - we were stuck on Waterloo Station - there were so many people trying to get out that the police closed all the exits and kept us in there. All we heard of the fireworks were faint pops."
They'd finally managed to find an exit that nobody else had, and got out of the station just in time for the fireworks to finish. Then they couldn't get back into the station to get a train home, and had spent the next five hours trying to get to the ambulance station to ask me to take them home.
I told them we'd missed New Year too doing a resus, and we all commiserated each other.
We'd Sky Plussed the BBC's New Year programme, so last Saturday, Barry and his girlfriend came round to us, and I started the programme at 11.10, as it had on New Year's Eve, and at midnight, I opened a bottle of champagne. We sang Auld Lang Syne very drunkenly, and had our own little New Year celebration, watching the fireworks on the TV**. The neighbours must've wondered what on earth was going on, but we enjoyed ourselves.

Happy New Year everyone!

*Mavis isn't the patient's real name

** Note to the BBC's director - next year, we'd like to actually see the fireworks, not watch two blokes racing up and down the Thames in a boat, and the crowds going "Ooh" and "Ahh". Thanks.

Happy New Year

2007-12-31T17:01:00.000Z

Like Mark I should make a resolution to update my blog more often - but as research shows the vast majority of new year resolutions are broken, I won't make any at all.

I'll do my best to do an update at least once a week, but that will taper off during my paramedic course whenever that is in the coming year.

I'm gearing up for working tonight - Barry has got the night off and is going up to see the new year in on the Embankment, so I'm working with a trainee tonight.

To all the EMD's working tonight - in whatever service you work in - be nice to the crews. A thank you every so often on the radio doesn't go amiss. That also applies to the crews working tonight.

Everyone stay safe, and have a happy, and hopefully peaceful (unlikely in our job) New Year.

See you in 2008

Merry Christmas

2007-12-24T20:46:00.000Z

I'd just like to wish all my readers a very Merry Christmas. Spare a thought for those from all the emergency services working to keep everyone safe.

I'm working the big day itself, and nights New Years Eve - it's just the way my rota's fallen.

Stay safe, and don't eat too much turkey & mince pies!

FREDA

2007-12-12T15:12:00.000Z

You may remember that I had a bit of a whinge about FRED. Well now, we have FREDA. Beaker has posted in more detail about her.

In short, Freda is pretty much the same as FRED except it's for ambulances, has a larger mileage range, and works in a more complicated way. This could be the reason why when it was first switched on, it had crashed the entire system inside 30 seconds.

Well Freda's now been "sorted" and has been switched on.

The word "sorted" is being used very loosely - a crew got sent to Notting Hill from just outside Putney station, and the other night, Barry & I ended up seeing Canary Wharf, and after begging control to "hide" us from her, we managed to get most of the way back to our own area via the Limehouse Link (it's always mentioned on radio travel bulletins, but I didn't know where it was until the early hours of Saturday morning) and Tower Bridge. To add to the pandemonium, Freda was tagging every job, including jobs in the street, as a high risk address - it tells you to contact EOC immediately - so of course, crews did.

I really felt sorry for the team on our desk in control. Freda was clearly causing havoc. They were trying to overrule her, cancelling crews that were being sent stupid distances, but Freda just insisted sending the job straight back down. It seemed from our perspective that the Humans were fighting the Computer for control of the service.

I really hope they switch her off on New Year's Eve - I'm working nights, and have visions of ending up in Hendon!

Update

2007-12-06T11:46:00.000Z

I haven't posted for ages, I know. Sorry about that, but I've had my head in the books studying for my Paramedic Pre-entry Assessments.

I passed.

I just have to wait for a date for my Paramedic course. However, I did come away from the day with a ton of books, as we have to self teach the first module, with the exam on the very first day of the course.

I've had some e-mails asking about Tom - he's fine and back at work. The police haven't caught the little buggers that did it, and he has to pay an absolute fortune to have a tooth implant fitted, but he is in good spirits.

I should now be able to post regularly again - until I get on my paramedic course. Then I'll probably be spending every waking moment with my head in the books again.

Beaten

2007-10-12T08:46:00.000+01:00

Why is it always the good guys that get picked on?

To help out an EMT who was single, but who doesn't work on an FRU, Barry and I agreed to split, allowing the single to work with Barry whilst I spent the shift working on the car. We don't mind occasionally helping out like that, even when it is for another station that doesn't belong to "our group" of stations.

A few hours later, the phone rang in the car. It was Barry.
"You know Tom, the Emergency Nurse Practitioner from the local Minor Injuries Unit?"
I did. He's a lovely guy who recently came out on a rideout with us. He's the sort of guy who will do anything to help someone, I'd even go as far as to say he'd give the shirt off his back if he thought it would help.

"I've just seen him in A&E," Barry continued, "He's had a right pasting - so much so I didn't recognise him until he spoke to me. I asked him if he was alright*, he said 'No, not really Barry - I'm bloody scared!' and burst into tears."

Apparently he was sitting at home watching the TV and decided he fancied a beer, so he went to the pub, had two or three pints, and had been jumped on and beaten, with a few kicks to the head for good measure and his wallet stolen as he left, sustaining some nasty bruising and swelling to his face, and having both front teeth knocked out. He'd been left sitting at the front of the treatment area on his own, and had made a bit of a fuss (the staff on duty described it as "cocky" more than anything else), which is completely out of character for him, even when he's had a few beers.

Barry explained that Tom is a nurse - and a bloody good one at that - and had actually worked in the department before his current job. He also explained his normal character and suggested they considered his behaviour a result of a head injury. Then one of the security staff recognised him. "Bloody Hell!" he said, "no that's not like him at all."

He was sorted out quite quickly after that, and admitted overnight for observation. We'll be going to see him at work next week to see if he's back, and how he's getting on.

I hope the scroates that did this are pleased with themselves. Hopefully Tom will recognise them if they go to him for help, and that he keeps them waiting a very long time.

* bloody stupid question, but we all do it. Of course he's not alright otherwise he wouldn't be in hospital would he?!

Back in the UK

2007-09-11T14:13:00.001+01:00

For now at least anyway. Had a great flight back - free upgrade to business class. Huge seats, fully reclining, the flight was nowhere near full, so I got the whole row to myself. Champagne before take-off, mixed grill breakfast, given a free mini-travel kit with blindfold, earplugs, and personal hygiene kit.

Got back to the office to return my kit, only to be given another job out to Istanbul on Thursday. Then Friday, it's back to the normal work....weekend night shifts. We've got a Uni student doing his TSing - it's his last three shifts with us this weekend. He's done very well, and both Barry and I are very pleased with his progress.

I'm tired and falling asleep in front of the computer......my bed awaits.

Part Time Job

2007-09-10T22:24:00.000+01:00

Whilst overtime is currently available again with the LAS, there is no knowing when it will be stopped again.

It is for this reason that I have got myself a part time job that works around when I am available, doing medical escort work for repatriations etc. Hence the reason I write this post sitting in the BA Executive Lounge at Dakar Airport in Senegal.

Senegal is a French speaking country, so I have had to put into practice my limited knowledge of French that I learned in school. I've got by so far.

They also have very odd computer keyboards. A is where Q should be, Q is where A should be, W is in the place of Z and vice-versa, and M is on the middle line on the far right, so I'm putting the delete key to good use!

I fly back to London in a few hours, landing at about 10am. If I get chance, I'll update this post using a familiar keyboard!

Overtime

2007-08-18T17:13:00.000+01:00

I'm just about to leave home for a night shift on overtime. Since the attempted bombings in London and Glasgow, we've been having no problems getting overtime at the moment. I think that will change soon though as things start to ease off again.

Still, I must be mad going in for an overtime night shift on a Saturday.

Barry and I start TSing a University Student on Monday. We also have to mentor him for his placements during his paramedic course. We went on a one day course to do it, but since then a few things have changed, so we'll be winging it for a while until we find out just what is going on.

Stolen!

2007-08-13T23:01:00.000+01:00

We've got some training crews running out of our station again at the moment. One of the crews last night were on a call, and when they returned to the ambulance, discovered that some chavvy git had stolen the screen for the Satellite Navigation. As a result, that's an ambulance now off the road until it can have a replacement screen fitted.

People still don't get it....the screen on its own is useless. The computer that makes it work is buried so deep in the guts of the ambulance, even the road staff don't know where it is.

I hope the person who stole the screen is the person who suffers because they have to wait longer for an ambulance because the one that would have come to them is off the road cos it's had it's Sat Nav screen nicked.

Another Regular

2007-07-21T15:24:00.000+01:00

I've mentioned regular callers on here before....but we've started going to one of them more and more recently.

Joe is a lovely old man, but he is becoming a bit of a pain in the proverbial, because he has now had an ambulance every night this week while I have been at work. His list of previous attendances at the hospital shows he has been there every night for the last month.

I've been to him twice this week - two nights running. He always calls for chest pain, but the reality is that he's quite lonely, and just isn't looking after himself properly, wearing the same clothes every day. He doesn't have a carer to help him - he refuses to accept that he needs some help. Instead, he calls us every night to go to hospital, saying he has chest pain. It should annoy both us and the hospital, but for some reason, many staff feel sorry for him.

When we go, we always do the usual things for chest pain patients - but we're more reluctant to "blue" him in, because as soon as we get him to hospital, he gets up and walks around the department, chatting to staff, and getting himself a cup of tea from the machine. He also seems to "forget" his chest pain when he thinks nobody is watching him, only clutching his chest and groaning when he spots us looking.

This shows us that he wants the company more than him having chest pain. So after we've done the 12-lead ECG which invariably shows us he isn't having a heart attack, we trundle in to hospital, where all the staff greet him with "Hello Joe, back again eh?"

Unfortunately, we're at the stage where we're having to start doing something about the number of calls he is making. I discovered the other night when we took him in that this was is fourth visit of the day to A&E. It seems he is being assessed, then after a few hours observation (because he has called for chest pain) he's discharged. The once home, he simply calls another ambulance.

Because of his apparent self-neglect and the continuing calls for the ambulance, I filled out one of our Vulnerable Adult forms for him the other night. This should highlight him to social services who should go and assess Joe and see what help they can give. It should also cause our Patient Advice and liaison service (PALS) to monitor the number of calls we get from him. Doing something about it will be somewhat problematic because he always calls for chest pain, generating a category A response.

Until an alternative form of care can be implemented for Joe, we'll just have to keep going to him, doing the ECG, and taking him to hospital.

Firsts

2007-07-06T20:26:00.000+01:00

We've spent the last couple of weeks going to "silly" calls - including a job to a 17 year old girl actually given as "Bleeding PV, on period."

But my crewmate (who's asked me to call him Barry on my blog) was on his block leave at the beginning of the month. We've found whenever one of us is off, the other gets interesting jobs.

While Barry was on his hols, I went to a woman about to give birth to twins. My crewmate for the day and I decided we just had enough time to "blue" her through the traffic and get her into hospital before she gave birth. Normally, I moan as loudly as anyone about doing "Maternataxis" but in this case it was justified....the woman and her husband had been trying to get to hospital in the car, and had got stuck in gridlocked traffic. We had some difficulty getting to her because of it all, but we managed to get her in with a little time to spare.

The next job the same day was a young woman in her twenties who'd died sitting on her sofa. She'd been found by her brother who'd broken in when he got no reply at the door. There was no sign of self harm, and the brother told us that she suffered from asthma. We can only guess that she had an asthma attack and died.

Then later, again the same day, we went to a call given as a "Collapse Behind Locked Doors."
These usually turn out to be people who've gone out and not told anyone, so we get called by concerned family or neighbours who can't get a reply and think something must be wrong. I've lost count of the number of times we've done one of these calls and had the police break the door down only to find the occupier has gone shopping, or popped out for a pint of milk.
This one seemed genuine though. We'd been called by the district nurse, who'd called to check on the patient as he had just recently had an operation on his heart, and wanted to see if he needed anything to help him. We knocked very loudly, in case he was deaf and simply hadn't heard the door, then we pushed the letterbox open and looked through to see if we could see anything. All we could see were stairs leading up to a first floor flat. And there was a pungent smell.
The police kicked the door in, and we told the nurse to stay outside. We went upstairs, where the smell was almost overpowering. He wasn't in the bedroom or the lounge, so we made our way down the hallway. The kitchen door was open - he wasn't in there.
"He's in here," called one of the police officers, holding his nose.
We peered round into the bathroom. There he was, laid in the bath, which was empty of water, and he was in an advanced state of decomposition.
It was the first advanced decomp I've been to, and I had often wondered how I would react when I finally went to one. I've been to plenty of people who've passed away, but none had been much more than the very early stages of decomp but never anything like this. Apart from having the smell up my nose for a week afterwards, I was pleased to realise that it didn't really bother me that much.

At the end of the shift, after a few more calls, we considered the days jobs. We thought we'd just had a day where we were somehow involved in the balancing forces of nature. We'd been to a woman who'd been just about to give birth to twins, then later been to two people who'd passed away.

Two days later, another first for me - a shooting. I was working with a relatively new trainee when we got the call which had come from the police. "Male has committed suicide using a firearm" read the screen. I had to smile when control sent a message to the screen telling us "A rifle is involved." No, really?! I knew what they meant though. It was a message for our safety, which is always very much appreciated.
It reminded me of a scene from CSI - a man sitting in an office chair in the middle of the room, back to the door, still clutching the gun. A small exit wound to the back of his head, and blood spatter mixed with brain on the ceiling.
We made the formal declaration that the gentleman was beyond saving - the reason we'd been called because the police aren't allowed to officially recognise death - even when it's obvious, then we left. We'd been careful where we'd walked and made sure not to touch anything so we didn't get any of our uniform or equipment taken from us for evidence, so we were allowed to leave after completing the paperwork.

The next week, Barry came back....and we've been doing rubbish calls since. Mind you, after the week before, I didn't mind too much.

Family Reactions

2007-06-03T00:47:00.000+01:00

Mark's posted about a "Purple Plus" we went to while he was out with us.

A comment from one of his readers (who I assume is also one of my readers as I'm linked from her blog) reminded me of a job I went to when I was a mere trainee.

EmmaC said she felt like she "wanted to shake them and hit them , make them save him" with regards to the tragic death of her son.

It reminded me of a job a did a few years ago.

I was on a long term secondment covering the line of a technician who had gone on the car.
The job was given as an elderly female in cardiac arrest.

We'd just come "green" after a job into the hospital that was literally just around the corner from the call. We made our way there, and were second on scene behind the FRU.
As I got out of the ambulance, a plate smashed against the side of the ambulance. I dived back in. A moment later, the paramedic on the FRU appeared, and informed us that the patient was "purple", i.e. dead, and there was nothing we could do to change it. The son, who was on scene, had been told this by the FRU, and had gone "mad". The FRU paramedic had left the flat in a hurry in fear of her safety, leaving her kit on scene.

The police arrived in double-quick time, but we made it clear to them that the reason for the male to be violent was probable because he found it hard to believe his mum had passed away.

They subdued him, without arresting him, which I was pleased about, and we were able to formally fullfil the necessary requirements for the recognition of adult death.

We don't like not being able to do anything for a patient, even if it's the right thing at the time, but we accept it as part of the job.

Even when the family think there is something we can still do. We do have every sympathy for the families this type of event affects, and we hope we don't get too many of them....but dealing with them is part of our job. And that sometimes means realising that families sometimes think that we should be able to do more than we can. All we can do is offer our sympathies and care for the families as much as we can at the time.

One Of Those Days

2007-05-28T19:37:00.000+01:00

You can tell it's a Bank Holiday. It's been one of those days where you wonder why you spent 16 weeks in a classroom learning about anatomy and physiology, numerous illnesses, their causes, the symptoms, the airway management techniques, the drugs etc, then spent a further year on the road as a trainee before taking an end of year assessment to qualify as an EMT. For my crewmate it's worse. He's done the "old" paramedic course, and is this year starting the fourth year of the paramedic science degree.

Today, we both asked why?

We've gone, without exception, to the biggest pile of drivel anyone could imagine. First there was the 17 year old with a bit of a temperature and the shivers (because he's got the temperature.)

We arrived at the address to find two large cars on the drive, and inside the house, our patient was in bed under no less than three duvets, with his mum sitting on the edge of the bed fussing.

"Hello, what's the problem, why have you called an ambulance today?" I've started approaching every call in this manner, as you get straight to the immediate problem without going through their life story first.
"Because he's ill - look! He's shivering!"
I took his temperature. It was quite high.
"He's shivering because he's so hot," I explained as I wrestled the three duvets from the patient.
"The last thing he needs are three duvets over him, he needs to cool down."
I thought his mum was going to explode.
"Cool down??!! He's shivering!" It was like a stuck record.
"Trust me, he's feeling cold because his body temperature is so high. Really, he needs to cool down. Has he had any paracetamol?"
She looked at me as though I was stupid. "No, he hasn't got a headache."
"Well the paracetamol will help to bring the temperature down. Have you got any in the house?"
I got him to take some paracetamol, and we took him to the hospital, where the staff had stiff words with his family for calling an ambulance.

Then there was the poor 98 year old man in the "don't care home" (Mark if you're reading this, the one you went to with me on the car) who'd pulled his catheter out.
"Have you tried calling out the on-call district nurse?" I asked. I really didn't want to drag this poor man to hospital just to have his catheter re-sited (about a 5 minute job) only for another ambulance to be called to take him back to the don't-care-home.
"Yes, I called 999," said the bemused nurse.
"No Love, that's us," I said, my crewmate trying hard not to laugh. "I'm talking about the district nurse, who could come and deal with this here."
"No, no district nurse today, it's a holiday."
This went on for a few more minutes, and in the end, I gave up and took the poor man to hospital. The hospital staff told me they've been having the same battle with this home for years, and it's like talking to a brick wall.

And that's pretty much how the day carried on really.

Hope it's better later this week....a certain other LAS blogger is venturing south of the river to join my crewmate and I on another rideout. We will, of course, be trying to avoid vomity calls but trying to find the ever elusive "Suspended" call.

Tired

2007-05-21T22:18:00.001+01:00

It's been a long weekend. Done loads of jobs....some good, some interesting, others utter rubbish.

I'll write about a couple of them when I've got some more energy.

Still another 8 hour shift to go before I get a day off....

Back on an Ambulance & Trevor McDonald

2007-04-30T23:24:00.000+01:00

Well what a month it's been.

Fred's been programmed now to send us to Amber (Category B) calls. To be honest, quite a few of the Amber calls are more genuine than many of the Red calls that we go to, but I've found it to be a real pain in the arse.
The reason is that when Fred sends you an Amber call, if an ambulance has also been assigned, then the FRU desk is cancelling the car. Not a problem, and sensible because it then means the car is again available for the Cat A calls.
The trouble comes when the next amber call comes in - Fred sends it down to you, and a few seconds later, down comes the cancellation because an ambulance has been assigned. As a result, we've gone back to how it was in January, with us running backwards and forwards on blue lights on call after call, but not actually getting to any patients.
Last night for example, I was sent on 15 calls. 12 of them were cancelled. This is why I'm pleased that last night was my last shift on the car. I return to working on an ambulance as of Wednesday.

As I've mentioned before, morale is somewhat low in the ambulance service at the moment, and it wasn't helped by the Trevor McDonald programme a couple of weeks ago. If you didn't see it, the programme basically stated that if you wanted any chance of surviving if you need an ambulance, then you need a paramedic to attend, and not an EMT, virtually implying that EMTs are not fully trained. The bit that really angered me, was when the journalist asked the health minister who he'd want to come if he had to dial 999 - a paramedic, or an EMT, and suggested that if an EMT arrived, then you would receive substandard care.

In all fairness, the programme did make some very good points regarding getting paramedics to patients who are fitting or choking etc, and laid the blame at the door of management and government. It did say that these problems weren't the fault of the staff on the road, but it really made a meal out of the things that EMTs can't do. No mention was made of the life saving skills that we do have - 12-lead ECG interpretation, the ability to bypass A&E altogether in cases of heart attack being confirmed by ECG and instead taking them directly to a cardiac unit for an emergency procedure, giving nebulisers for asthma and patients with chronic airway diseases such as emphysema, giving adrenaline injections for anaphylaxis and life-threatening asthma attacks, glucagon injections for diabetics with low blood sugar. Technicians can now give the antidote for overdoses, and we will soon be able to give a drug to stop people fitting.

The programme also said that response cars should all be staffed by a paramedic, and featured a cardiac arrest where a technician had arrived, but to the horror of the patient's daughter, who's a nurse, was unable to cannulate (put a needle in a vein to administer drugs) or intubate (put a tube down the throat to secure the airway). Just to make a point, even if a paramedic arrives first at a cardiac arrest, he/she would only carry out basic CPR until an ambulance crew arrived to help, because while he/she was intubating and cannulating, no CPR would be being done.

I went to work the next day with some trepidation, expecting to get all kinds of verbal from patients and/or their friends and relatives because I'm "only" a technician. I knew other techs felt the same way, especially when one who never normally lets anything get to him admitted the programme made him "feel like shit, and no use to anybody".
I think I must've been really lucky, because up until the other night, I'd not had one negative comment about being just a technician.
The one comment I did get the other night was indirect, but it was made perfectly clear exactly what was being got at. I'd called in at a shop to buy a sandwich. I was waiting in the queue to pay, and a chap turned, saw me and kindly said I could go first because I had a more important job to do. The girl that was with him looked pointedly at my EMT epaulets and said, "Hmmph. I doubt it!"
I didn't say anything - I couldn't be bothered. Besides, the looks she got from other people in the queue said it all for me.

I still love my job.

Unusual Weekend

2007-04-09T16:19:00.000+01:00

It's been a bit of an unusual weekend for me....in that I've actually done three jobs that were actually worth going to as they really did need an ambulance.

The first one wasn't actually a category A call, it was an Amber 2, but I could see why they'd sent me. It was given as a male who'd amputated four fingers. I arrived to find the patient holding a dirty rag over his hand, and walking up and down trying to find the shattered ends of his fingers. His friend was talking animatedly in Polish to a friend on the phone, and thrust the phone towards me as I walked through the door.
"Can you talk to my friend please?"
"Err...no. I need to assess your friend first," I told him. He resumed his conversation.
"What exactly happened?" No response. The patient continued looking for his finger ends, and the friend continued his telephone conversation.
I spotted a makeshift tourniquet tied round the wrist of the injured hand. I managed to stop the patient (who spoke very little English) looking for his finger ends long enough for me to remove the tourniquet, and the dirty rag from the hand. Amputations actually bleed very little, because of the body's natural reaction to this type of injury is to narrow off the blood vessels to limit blood loss - indeed there were only a few small drops of blood on the floor, and little on the rag, so the tourniquet wasn't really needed. I examined the damage, and found that he'd "only" cut the ends off his index and ring fingers, but they were rather mangled. I dressed his hand with a large dressing to cover all of his fingers. It turned out that he'd been cutting a piece of wood lengthways with a jig-saw when he'd failed to stop at his hand, and lopped his finger ends off. Quite how he missed his middle finger, I do not know. I joined the search for viable pieces of his fingers that a surgeon could re-attach, but they'd all been sliced quite thinly. The one sizeable chunk appeared to be from his index finger, but that was rather mangled and the patient had apparently stood on it a few times in his search, so it was unusable. The crew arrived, I handed over, and they took him off to hospital.

The second was an RTC - given as Car Vs Pedestrian. It turned out to be a woman who'd been crossing the road between stationary traffic, but hadn't realised that the traffic in the opposite direction was still moving freely, and she'd simply walked out in front of a car, which had side-swiped her at about 35mph. fortunately, the two dogs she was walking at the time escaped without being hit and whilst clearly upset that their owner was hurt, were unhurt.
The police had just arrived when I got there. There were only two officers, one of which was knelt next to my patient who was writhing around in pain on the road. I went across, and began assessing the patient. She was complaining of head, neck, back pain, and she had pain in her right foot. With that, I took hold of her head to stabilise the neck, and then had to try and persuade her to keep still - which wasn't easy because she wasn't very compliant, which is a sign of head injury.
The two officers were now involved with keeping the nosey bystanders at bay and directing traffic arround us to keep us safe, so I couldn't ask them to get more equipment out of the car for me. Fortunately the crew arrived about a minute later, and seeing me kneeling holding the head, straight away got the neck collars and other equipment, as a second FRU arrived to help. I maintained control of the head as the crew and 2nd FRU applied the collar, looked for other injuries, and got her onto a metal stretcher and strapped her down to stop her moving about.
One of the crew cut the shoe and sock off the right foot, and found that it had been "de-gloved" which means the skin had been torn off and the bones of the foot were visible.
We got her onto the ambulance, and the crew blued her in to the hospital which was about three minutes down the road.
The police had requested that the RSPCA attend to check the dogs were ok, which they were, and then they were taken home where there was someone to look after them.

When I first got the third job, I thought it had been sent to the wrong car by mistake. It was given as an 88 year old female, not responding, difficulty in breathing and blue round the lips, and it was miles away. I was just about to ask control on the radio if they'd meant to send it to me when the phone rang.
"Sorry, I know this job's a bit of a trek for you, but we've nothing else to send. Everything's busy on calls, and the FRU for that area is on a resus. Can you go and have a look for us, and we'll make sure we get the first available ambulance to you." I'd heard that before, when I'd covered a shift for someone.
So off I went. It was to a nursing home. I prepared myself for staff that knew nothing about the patient and a long wait at the door.
The wait wasn't as long as I've known before, but someone came, saw me through the glass of the door, and instead of letting me in, walked off in a hurry shouting "There's an ambulance guy at the door!" Someone eventually let me in, and after asking a few people who we'd been called for, led me to the room of one of the residents, ambling down the corridor as if there wasn't anything particularly to worry about.
I entered the room, to find a male nurse doing CPR on the patient. The patient was on the bed, and the patient was bouncing up and down on the mattress with each chest compression.
The nurse stopped as soon as he saw me. "Don't stop!" I told him, and worked on lowering the sides of the bed. "Right, let's get her on the floor." This would make the chest compressions much more effective. We lifted her from the bed, the nurse at the head end, and as we were loweering her onto the floor, he dropped her, her head hitting the floor rather hard.
"Sorry, sorry," he kept saying. I pushed him out of the way, and instructed him to continue with chest compressions. I attached the defibrillator and switched it on, which showed asystole - flat line. I hoped there was a paramedic on the crew so that we could terminate resuscitation if there was no response after doing CPR for a certain amount of time. I ventilated the patient, and whilst doing so, rang control to tell them I needed an ambulance urgently as the patient was now in cardiac arrest. They told me the crew had just pulled up outside. They were a double technician crew. One of them took over chest compressions, while the other went to fetch the trolley bed. A second crew arrived to help....also a double technician crew. We got her onto the trolley and into the back of the ambulance. We paused for the defibrillator to analyse the electrical activity in the heart. It showed a normal rhythm, but there was no pulse - PEA.
We continued CPR for a further two minutes, while we were being driven to the hospital. Another pause to analyse. During this pause, I looked at the patient's chest. I could see movement as the heart pumped beneath. "We've got an output," I said, feeling for a pulse. I still couldn't find one. I looked at the chest again. It was still there. By this time, we were just pulling into the hospital, so didn't have time to get a blood pressure. I handed over to the hospital staff, and a nurse said, "Oh she's apparently got an output."
"I can't feel anything," said a doctor feeling for a pulse at the neck.
"Shall I start CPR?" asked another.
I could still see the movement in the chest, and I pointed it out to one of the doctors. They remained unconvinced. Then a nurse feeling for a pulse at the femoral artery at the very top of the leg said she could feel a pulse.
We left the staff to it, and went out to the ambulance to do the paperwork. I went back in to pick up some equipment, and saw that everything had been disconnected. The patient had died.

Sometimes we can only try and hope. The simple fact is that most people who suffer a cardiac arrest don't recover. Having said that, since the new resuscitation guidelines came in last year, more and more success stories are being reported. I was convinced that this lady would stay in asystole all the way to hospital, and that the resuscitation effort would be stopped almost as soon as we'd got through the door. The fact that we got an output back shows how important it is to learn CPR and be prepared to provide it if and when it is needed.
When I arrived, the nurse was providing good compression-only CPR, albeit on the bed, which is what probably lead to us being able to get the heart going again, but it seems it was just this lady's time to go.

Both St John Ambulance and the British Red Cross provide basic first aid courses, including CPR training. You can find the number for your local branch via the website or in the phone book. In London, you can also contact the Community Resuscitation Team for details of courses. The contact details can be found on the London Ambulance Service website.

Remind Me Why?

2007-04-03T15:17:00.000+01:00

Every so often, everyone wonders why they do their job. Usually it's because something's gone wrong, and you're having a stressful day, or maybe its simply because you're in a bad mood.

Staff at the Great Western Ambulance Service, as with every other service, took part in the annual staff survey carried out by the Health Commission, and it was found that they are among the most unhappy ambulance crews in the country due to working conditions with 88% of their staff working extra hours to keep the service afloat, the verbal and physical abuse
they receive, and even the bullying they get from patients and their friends and relatives.

The survey was reported on in a local paper in Swindon. After reading the comments, it makes me stop to wonder why we choose to do a job where we have to go out and show compassion and care to these idiots.....

Good Care Home

2007-03-18T20:34:00.000Z

Yes you have read the title correctly. I know there aren't many of them about, but there is one on my patch that really is very good, and the staff care a lot.

It's a care home for people with learning difficulties, who usually have other chronic conditions as well. Usually when we get called there, our patient is genuinely quite ill, so we don't mind getting the odd call there for an over-reaction because they are far outweighed by the number of genuine calls.

FRED gave me the call. It was to a 57 year old lady who was confused, not alert and complaining of a headache. When I arrived, I was met at the door by the carer (who was waiting for me - usually at care homes, you have to ring the bell two or three times, and finally someone will come ambling up to the door) who told me that Sue had fallen on her way back to her room from the toilet, and since then had been complaining of a headache and was quite confused. She was also scared of ambulances. I had a bargaining tool to get her to let me assess her - I'd come in a car, not an ambulance!

I walked into the room, and found Sue laying in bed. I went up and spoke to her. She took one look at me, and buried herself under the duvet.
"I don't want an ambulance," came a voice from under the duvet.
Time to play my card. "I've not come in an ambulance. I've come in a car because your carer's worried about you."
She poked her face out from under the duvet. "It's ok, I just want to have a look at you and make sure you're ok."
"I'm alright." Under the duvet again.
"Let me have a look, you might not need to go to hospital. Can I take your pulse?"
An arm appeared. I took her pulse, and with a little more gentle persuasion, I managed to get her to come out from under the duvet and let me take some obs.
"Am I alright doctor?" asked Sue when I'd finished.
Then the crew arrived.

I explained what I knew, and that Sue was frightened of ambulances. Mary, the EMT on the ambulance squatted down to talk to Sue.
"Shall we take you to hospital Sue?" Sue disappeared under the duvet again.
"No, I want to go to sleep. My bed's nice and warm."
As Mary did some gentle persuasion of her own, one of the carers came in with Sue's file. She gave us a full history, adding to what had already been told to us by the other staff. It makes a nice change to have care staff who actually know about the people they're caring for.

We eventually managed to persuade Sue to let us take her to "see the doctor", and when I said goodbye, Sue became grumpy. "I want you to stay with me," she said sulkily.
"I've got to go and see some more people who aren't well. Mary will stay in the back of the ambulance with you."

I left Sue sulking in the ambulance. I'd thoroughly enjoyed that call. Sue hadn't been particularly ill, but she was a joy to deal with. I could go to Sue's all day.

All Change - again!

2007-03-18T16:38:00.000Z

It's been confirmed now that I'm moving back to my old ambulance station, to work with my old crewmate. My current station is great, and I get on well with my current crewmate, but I'd made it no secret that I would prefer to work at my old station.

Someone on my old station wanted to come and work at my current station, so the DSO who deals with the internal line shuffles rang me and asked me if I still wanted to go back.

So no longer should I have shifts with obervers where we only do two calls.....at the station I'm going back to, we're often out from start of shift (sometimes before if we take an early job) and get back after the end. And I get to hurl abuse at my ex-old crewmate.

It also means that I have already worked my last shift with my current crewmate, because I'm working on the car until the end of April. It's been a pleasure to work with him, and I wish him all the best with his new crewmate and his new baby.

I've Decided

2007-03-11T13:54:00.000Z

I'm going with the suggestion that I just call myself Steve. It means I don't have to keep looking through the e-mail lists to see if anyone's got the same name as I'm thinking of using.

I'm writing this in my rest break at work. I've not written much lately, frankly because I feel so demoralised at the moment. I maintain this is the best job in the world, but I'm finding the rate of change in the working practices, rest breaks and the way calls are being dispatched simply overwhelming.

I never realised what a difference my £5 per day meals subs made until the new rest break system was brought in....now we only get £10 if we don't get a break and don't get to leave early, or if your break is interrupted. As a result, I'm skint. I've had to cut right back on some spending (buying all the really cheap crap at the supermarket etc), and even then, it's becoming a struggle. I can't remember the last time we could afford to go out for a meal.

Tom points out that EMTs are paid between £7 and £10 per hour depending on whether your qualified or not. Thinking back, I used to get paid £6 per hour just for driving a bus in a rural county - not exactly stressful - apart from the school buses! And Mr Brown wants to cap our pay rises to less than inflation.

Happy days.....

New Name

2007-02-26T09:58:00.000Z

Right, I've got an idea for the new name, but I first need to check that there's nobody who works for the LAS with the same name - I'm not going to make the same mistake twice!

I'm doing some overtime today and tomorrow - I wouldn't, except my bank managers not too happy with me, so I need to earn some extra cash - so I'll check today.

I'll be keeping Steve - it's just the last name I need to check on.

Watch this space

New Pseudonym

2007-01-20T23:31:00.000Z

I need to change my Pseudonym name, because it's been pointed out to me that there really is a Steve Gibbs that works for the LAS, so it's clearly impractical for me to continue to use this name.

Any suggestions?

Fred

2007-01-20T23:03:00.000Z

There's a new member of the control team. His name is Fred.

Fred is a computer that monitors all the FRUs and automatically sends Category A calls, or calls that it recognises as going to be category A, to the nearest available FRU.

Fred has a slight flaw though. He judges which car is nearest "as the crow flies", which means that as far as Fred is concerned, you're quite close to a call, when in reality, you're miles away from it, because we have to drive round buildings, find bridges to cross the river, and negotiate one way systems.

So the other night, I was activated to 14 calls. Only 6 of which I actually got to, because the others were just miles too far away, and I was cancelled. This meant that I spent more time driving around on blue lights than dealing with patients. This might not seem to be a problem, but I don't see why we should be running at faster than the speed limit, driving through red lights (even though we do it very carefully), putting ourselves and potentially other road users at risk.

Not only that, but the increased concentration levels required when driving on blue lights means that when we get cancelled, and Fred sends down another job straight away, and this happens three or four times on the trot, you can be driving for extended periods, meaning you're absolutely knackered by the time you do actually make it to a call and see the patient. All I can say is thank God none of my patients were suspended, cos I'm not sure I'd have had the energy left to do resus on anyone.

I've mentioned my concerns to one of the officers on my station, but it sounds like Fred's effectiveness won't be evaluated for at least another three months, so I'm now going to query all calls that are miles away to make sure they want me to go before I set off, only to be cancelled again.

So I apologise to the folks on the FRU desk, but safety comes first.

Back On The Car

2007-01-16T15:48:00.000Z

Firstly, I'd like to say thanks to all for your supportive comments to my last post.

I finished my last shift with my training crew on Sunday. They have both done well, are aware of their weaknesses, and are determined to work on them, which is great news. I wish them well at their new stations.

As I'd hoped, I've learnt a lot from the experience of TSing a crew, and in the process of answering their questions, discovered I knew stuff that I'd forgotten I knew. A great experience, and something I'd like to do again.

I'm back on the car now for three months, starting from tonight. I'm hoping for an easy shift to get me back into the swing of working on an FRU, but of course, that's not guaranteed.

I'll probably be hammered all shift now...

Why Blog?

2007-01-09T16:27:00.000Z

A colleague has asked the following question:

"having been a paramedic for over 30 years i would ask why you need to publish things like this on the web?there is so many people putting stuff like this on here and writing books on the subject it becomes boring.the job has and always will be something we do not for praise but because we want to help people and as such should be kept within the confines of the service.i notice your a member of st.johns in which case this type of thing is best suited to telling your mates there and not on here."

To be fair, it's a question I've thought about since I first started this blog. At first, it just seemed like a good idea, but as time's gone on, I realise that I do it as a release for frustrations.

Someone has said to my face that I come across as "old hand who doesn't give a toss, which I personally know to be a false image". I probably do in some posts, but those that know me will know that I take my time and treat everyone in the same professional manner. Even if inside I do feel that they're wasting my time.

I certainly don't do it for praise - if I wanted praise, I'd hand out cards for thank you letters from the patients and/or relatives (I know some people do - that is just sad!).

If in the process of writing this blog it helps to go some way to educating those that call us unnecessarily for stubbed toes and back ache for 3 months, then why not?

Since the recent newspaper reports about our rest breaks, people in the service have been saying the public simply don't understand what the job is like, so why not use sites like this to tell people what the job is like - coming in at the start of shift, going straight out, being hammered all day running round after people who for the most part could use common sense and see their GP, get a taxi/friend to take them to hospital instead of calling us and coming back usually after the end of the shift?

If people find it boring, then simply go and read something else :)

If you think I'm a sad bastard for doing this, oh well never mind. I've been called worse by drunks and drug addicts.

As for being a St John member, that is something I'm currently seriously reconsidering, as at the moment I'm finding it more trouble than it's worth.....and I don't mean from pressure or p*ss taking from service colleagues.

New Year

2007-01-09T11:43:00.000Z

From the sound of things, I'm pleased that I was off over New Year. New Years Eve night shift itself is usually a slow start, with all Hell breaking loose just after the Big Ben Bell tolls at midnight, then people start fighting, stabbing each other, and falling over because they've drunk far too much. And they all do it at once.

This year, apparently it was mayhem for the whole night, with crews doing anywhere between 12 and 16 jobs in the 12 hour shifft. I'm sure there were crews who did more than this too.
One FRU that I know of was due to finish his shift at 6.30am, but got a job at 6.28. The CAD number (which shows how many calls have been received by control) was over 3,700. That's around the number of calls that we usually end the day on. I've no idea what the final tally was by the end of the day.

Well done to all those working that night - I don't envy you in the slightest.

Happy New Year!

Christmas Day

2006-12-25T20:33:00.000Z

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......

Plymouth to Dakar - In An Ambulance

2006-12-24T14:35:00.000Z

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

2006-12-24T14:07:00.000Z

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?

Sad But Good Jobs

2006-12-23T11:57:00.000Z

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.

Rest Breaks

2006-12-16T14:47:00.000Z

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?"
"Yes"
"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.

A Few FRU Shifts

2006-12-13T01:25:00.000Z

Wow....is 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?

AMPDS Strikes Again

2006-11-24T03:52:00.000Z

We were sent to a green call (one of our lowest priority calls) the other day for an old lady who'd fallen downstairs. That raised my eyebrow a little, but I assumed that she'd just slipped a couple of steps. Even so, I thought it ought to have been an amber call at least. We were just round the corner, so rather than waste time questioning control over it, we just made our way there, arriving literally just as the caller was putting the phone down from control.

It turned out the lady had lost her balance when one of her legs "gave way" and had fallen down eleven carpeted stairs. She insisted she wasn't hurt, but we didn't take any chances and examined her very carefully. Indeed, we couldn't find any tender areas, and she had full movement in all four limbs. She was adamant she hadn't hit her head and didn't have any neck or back pain.

We got her onto our trolley and took her out to the ambulance, where we did all the usual checks. The alarm bells started ringing when we took her pulse. It was 31. They were ringing loudly by the time we took her BP, which was very low. We were amazed the woman was conscious at all, let alone fully alert, and began to strongly suspect that these findings were probably the real cause of the tumble downstairs.

My crewmate took bloods and started a bag of fluid to try to raise her blood pressure, and gave her a drug to speed up her heart rate. It only raised the pulse by 10 beats per minute, so we "blued" her in.

That was a call that was categorised as none-life threatening. It was fortunate that we had been sent on it straight away, as it could easily have been held onto for half an hour or more while calls categorised as a higher priority got the ambulance.

Our next job was a Red 2. A male apparently unconscious. He was drunk, and not unconscious at all. We saw the irony that a very ill woman got a low priority category, while a drunk got one of the highest priority categories.

I don't know if it was the system or the call-taking. I assume it was the system, as I don't know enough about the call-taking to comment on that. Perhaps a control bod would like to comment?

As an aside, the young lady from a couple of posts ago had broken her arm - right at the joint with the wrist, and apparently a quite nasty break too.

Taking Calls The Old Fashioned Way

2006-11-15T20:24:00.000Z

I've said it on here before, but I really quite enjoy it when the MDT system crashes or is taken off-line for maintenance, even though it is a bloody nightmare for those who work in control.

Yesterday started with the MDT's apparently off-line for maintenance, although I suspect there was more to it than that, because they were down for far longer than usual. The maintenance is usually done between 4am and 6am - probably because that's when the call-rate is usually at it lowest, but yesterday it was down until lunchtime.

Listening to crews green up reminded me how many staff have started on the road since the MDTs came in to use. There were rather nervous voices clearly not sure of what they should be saying. The way it should be done, is you press a button on the radio which highlights your callsign on the screen in control and adds it to the list of crews wanting attention. When the radio-op acknowledges and tells you to "go ahead", you tell them you're "Green at [hospital]* on scene at [scenetime]*", unless it was a doctor's urgent, in which case you just need to say your green at [hospital].

There is usually a short pause while they look to see if there's another call for you, then they either tell you to "return" or give you another call.

Yesterday it was more like "Y123, we're green at hospital and we've started returning."

Trainees already on the road tell me that their radio training consists of a couple of hours messing around with handsets that are crap and don't work very well. This has made me determined that when I'm TSing, I will make sure the recruits know how to take a call "the old fashioned way", and what to say when they green up afterwards.

* Insert hospital name and the time arrived on scene here

Bad News and a Broken Arm

2006-11-15T07:44:00.000Z

As I thought, my paramedic application has failed. It was my own fault really, but they've changed the selection process for this round of applications and I hadn't realised. My training officer is steaming mad. Not with me, but because the selection process seems to keep changing from course to course. Still, I know what to do for next time now.....I think.

Anyway, it's been a while since I blogged about a job, so here's one I did yesterday.

We were called to a school where 11 year old Emma had been accidentally pushed into a wall when one of her friends fell over. She'd hit the wall with her hand, and heard a crack in her wrist. Emma was petrified because she'd never been in an ambulance or been to hospital before.

I reassured her, and gently felt the injured wrist. I thought I could feel a deformity in the bone, so I carefully applied a sling and we took her out to the ambulance. The school was having a job getting hold of mum, so they sent a teacher along with us. we stopped by reception on the way out to get a print out of the girl's details so I could book her in (she couldn't remember all the details we needed) and they told us they'd just got hold of mum, and she would meet us at the hospital.

On the way to hospital, I tried to distract Emma from her injury by talking about favourite subjects at school and television programmes. It was at this point I realised I need to watch some kids TV so I know what they're talking about!

At hospital, I handed over to the nurse, ensuring she knew that Emma was really scared of hospitals, then booked her in at reception. Just as I was finishing booking her in, mum arrived.
"What's she done now?" she asked irritably, rolling her eyes as if this was most inconvenient for her.
"She's had a bit of an argument with a wall and lost. It looks like she may have broken her arm," I explained, keeping my tone light.
"Was she pushed?!" She was clearly already looking for suspects.
"Yes, but it was accidental, as it was one of her friends who was falling over at the time."
"Oh."

I took her through to where Emma was, expecting her to start having a rant for making her leave work, but she didn't, so I can only assume she didn't mean to sound the way she did.

I don't know whether it was broken or not as it was close to the end of our shift, and our last job took us to another hospital, but I wouldn't be at all surprised if it was. I'll try to find out tomorrow.

Good News & Possibly Bad News

2006-11-13T20:27:00.000Z

It's been a week of mainly good news for me, but there may be a cloud on the horizon.

It's been confirmed that I will be "TSing" a crew when they finish their initial technician training in three weeks time. TS stands for "Training Supervisor", which means I will supervise, guide and debrief them on every call they attend in their first 5 weeks on the road.

This will be my first time TSing, and I'm very much looking forward to this, as I hope to learn lots as well as help the "newbies" to develop their practical skills. I hope they're nice and are willing to learn.

The other bit of "good" news is that I'm going back on the FRU as soon as I finish the TSing. Don't get me wrong, I thoroughly enjoy working with my crewmate and we have a laugh, but the rota is rubbish, and as I've said before, the station is quieter than I'm used to. Going back on the car means I'll be working in the area I'm more familiar with and hopefully a higher rate of calls.

There is potentially bad news though - I've got to go and see the training officer about my latest paramedic application. Apparently there's a problem, and I'm stealing myself to be told that I can't be put forward for the pre-course assessments.

Still, I might be wrong - I'll find out tomorrow.

Running Calls

2006-11-12T08:37:00.000Z

I'm back online now - but on dial-up for now, so it's taking a bloody age to load my web pages.

Running calls are quite rare. This is where we come across an accident or somebody laying in the street etc without being called to them. Sometimes we're already on the way to a call, in which case, we get cancelled down and left to deal with the running call, while another ambulance (probably the one that was coming to the call we've stumbled across) gets sent on our call.

This week, we've done two running calls on two consecutive days, and both were RTAs. The first one happened right next to us. We were on our way back to the ambulance station after dropping a patient off at hospital when a car knocked a motorcyclist off his bike - with an almighty bang. I told control we'd got a running call, and where it was so they could send the police for us. Fortunately, it was right outside the fire station, so we had plenty of extra pairs of hands to help us. Thanks lads.

We were in the middle of dealing with the patient when the MDT (computer) in the ambulance started ringing. At first I assumed control had been trying to get hold of us on the radio, and getting no response (cos we were busy) sent a message down the MDT for us. We ignored it and carried on. We collared and boarded the motorcycle rider, splinted his broken arm, and with the help of the fire boys, lifted him onto our trolley and loaded him onto the ambulance.

It was then we were able to pause for breath and have a look at the MDT. It was a job. Our job. It was given as "RTA motorcyclist lying on floor, LAS on scene". I looked at the time the call had started. We'd been on scene and dealing with the rider for more than 2 minutes before the call started. Why do people do this? Why call the ambulance service to tell them there's an ambulance dealing with an accident? Barmy.

The rider turned out to be very lucky - with just his broken arm. We'd been concerned about his pelvis as he was complaining of pain in the bottom of his back and hips, but the x-ray showed it was all ok.

Our second running call was again on our way back from hospital. It was a 9 year old girl who had been riding her friend's bike, lost control of it, and gone into the road right in front of a lorry travelling at 30mph. Don't ask me how, but she got away with only a few cuts and bruises. Another very very lucky person, and extremely brave. The lorry driver was an emotional wreck, as you might imagine. There'd been absolutely nothing he could do. Even the girl's mum said that and comforted the driver while we looked after her daughter.

I hope we carry on finding the lucky ones....

Observer's Curse Strikes Again

2006-11-05T16:42:00.000Z

Mark Myers came out with us on a late shift earlier this week. He's been out with me a couple of times on the FRU, but this was the first time with us on an ambulance (South of the river anyway).

Unfortunately, the dreaded Observers Curse struck again. A pathetic 2 calls in the whole shift. My new station is quieter than I'm used to, but even that was ridiculously quiet. Even us saying the dreaded phrase "It's a bit quiet tonight" didn't work.

I had a laugh when he panicked when one of our patients said he felt a bit sick. The cupboard door took a bit of a beating, and for both calls, he jumped up and down shouting "Is it a suspended? Is it a suspended?" I worry sometimes!

Still, we've made up for it this weekend. We've been out all day both days, with genuine patients to be fair. I'll write more about them once I've got the broadband connected at the new house - which is wonderful by the way.

Oh well, maybe you'll get a better shift next time Mark.....

A quick post

2006-10-27T14:58:00.000+01:00

This is only going to be a very quick post as I am on holiday, and internet access here costs £1 per 15 mins, and I've used half of that time already checking e-mails and catching up on other blogs.

Next week, I move home, and my ISP says it will take 10 days to move my broadband service. Why I have no idea, but there we are. Hopefully they will provide me with at least a dial-up service while I'm waiting to get connected.

So I return to work on Monday for two shifts, then have the rest of the week off while I move. And at a time when I need to do overtime to get some extra cash, the LAS has £3 million taken off it cos it managed its finances so well last year and finished in the black last year. This now means that overtime is almost non-existant as the service cannot afford to pay us.

Looks like I might have to go back to doing some ad-hoc bus/coach driving to make the extra cash. Good job I've still got my bus licence....

Helpful Passers By

2006-10-20T15:51:00.000+01:00

If you haven't seen the Big White Taxi Service before, please feel free to follow the link, but remember that this is a "Virtual Messroom" for ambulance staff up and down the country - and from abroad too, and as such is filled with the kind of language you might hear in the messroom, and not the polite language we use to our patients. It is our "Sounding Off Board" so is filled with the general moaning about the job etc that we probably wouldn't get away with at work and certainly not in front of patients. It is also filled with "Black Humour". You have been warned!

I found the following on the forum and gave me a good belly laugh. I've reproduced it here for all to see. It will certainly be appreciated by ambulance staff:

HELPFUL PASSERS BY

Would all helpful passers by please note:

If you really must ring for an ambulance for someone you see collapsed/dead/fitting/sat in a shop doorway, please ring then, and not three hours later, by which time – not surprisingly – the deceased has got up and left.

Two adult males sitting outside South Kensington tube station, sharing a bottle of Diamond White cider are NOT collapsed – they are having breakfast/dinner/lunch/a party. Singing, talking, vomiting and belching are all indications that the said males are alive.

Someone who is sitting in a shop doorway when it’s pissing with rain is SHELTERING, not collapsed.

Just because someone with crutches is sitting down, they are not necessarily in need of medical intervention. Having hospital crutches is a clue. They have already been to hospital, and have been discharged.

If you really feel you just have to interfere in the life of a person happily sitting there drinking himself into alcoholic oblivion, when you ask him if he needs an ambulance, please take it as a massive clue when he says “Faaaaaaaaarrrrrrkkkkkk Ovvvvvvvvvvv!!!!!” This is his little way of saying “Thank you for your concern, but I’m fine.”

When someone tells you they are fine, and they do not want an ambulance, please, please, please believe them. They are NOT lying – they know what they are doing.

Someone who is staggering between point A and point B CAN walk. The helpful clue is the movement of the legs and feet. If someone tells you that they cannot walk, but their legs are moving, THEY ARE LYING. Don’t believe them.

Green stuff coming from a drunks’ nose is NOT a reason for an emergency ambulance – it is actually a reason for an emergency hankie. Green stuff emanating from the patient’s nose is very rarely Cerebro-Spinal Fluid, despite what you might have learnt from Casualty, ER and Holby City. It is SNOT.

If you see a pair of legs under a car, and the legs are surrounded by mechanic’s tools, the person under the car has NOT been run over – he is more than likely to be FIXING it. Other clues are the radio playing nearby, and the deceased singing along to the music.

Talking of cars, if you happen to see several cars colliding with each other, and you can’t get through to the ambulance service, have a look around you. Yes, the other twenty people with phones stuck to their ears are ALL calling the ambulance service. That’s why you can’t get through. And please tell us the right location – saying you are on Greenford Broadway when you are on Southall Broadway is less than helpful. And please don’t insist you are right and the other twenty callers are wrong – it is highly unlikely.

Oh – and – please do not call the ambulance service if you see 200 people fighting on Fulham Broadway on Friday night. We are not remotely interested, and will not become interested until the police arrive. The police have guns, batons and CS gas, and can deal with a large fight a lot better than two female LAS personnel who are five feet nothing and jointly weigh 12 stone, and are only armed with rubber gloves and a frothy cappuccino from the Wild Bean Cafe. Please ring the police first – we’ll pop along a bit later. Honestly. We will.

Finally – the dictionary meaning of the phrase “passer by” is “A person who happens to be walking past someone or something.” It does not say “A person who stops and interferes. Don't do it Mate - it's not worth it!!

Originally posted by "The Saint" on the Big White Taxi Service Forum. Link to the original post is here.

Moving

2006-10-19T09:18:00.000+01:00

I'm moving home over the next couple of weeks so there's going to be a bit of a shortage of posts, plus it'll depend how quick I can get broadband connected at the new house.

And in the middle of it all, we're going on holiday for a week. Not entirely sure how that happened, but not the best timing I'll admit. Still, might be good to break up the stress of moving.

I'll post as often as I can.

Hysterical Lodger

2006-10-14T23:38:00.000+01:00

My crewmate has taken this weekend off, so I'm working with reliefs this weekend.

Last night....well, actually early this morning, we were called to an 83 year old lady who'd been found on the floor at the side of her bed by the lodger, a young lady from Wales who is training to be a teacher.

Mary couldn't remember how she had ended up on the floor. She remembered coming upstairs, but nothing after that. She had no pain, and careful prodding didn't reveal any wincing or cries of "Ouch!" so we sat her up.

I was worried that she didn't remember how she ended up on the floor, and suspected she may have blacked-0ut, so I suggested we pop her down to hospital for a check up with a doctor. At that time of the morning, the local A&E shouldn't have been too busy and it was possible she wouldn't be there long, but Mary was adamant that she didn't want to go.

The young lady was quite upset and shocked that she'd found Mary on the floor, and had had a fit of hysterics thinking that Mary might have been dead. Despite the fact we now had Mary sitting up, the hysterics continued, and she spent the next 15 minutes trying to persuade her to go to hospital. Mary was having none of it. I did her pulse which was fine, her blood pressure was a little on the low side but not horrendously, but her blood sugar was quite low. Mary couldn't remember when she'd last eaten, so I asked the lodger to go and make Mary a cup of tea with at least three sugars in it, and some toast with some jam on, and explained that this was to bring Mary's blood sugar back up.

The lodger went off to her task, and Mary told us all about how she enjoyed going on holiday to various places abroad, while the lodger continued her hysterics into a mobile phone while making the toast and tea. Then the smoke alarm went off. The neighbours must have been really impressed. The lodger had burnt the toast due to lack of concentration. Mary told us the lodger was training to be a teacher. "Not a drama teacher by any chance?" asked my crewmate flippantly. "Yes actually," said Mary. Somehow we weren't surprised.

As Mary didn't want to go to hospital, I rang control to arrange the on-call GP to visit. The voice on the other end of the phone sounded rather familiar and I suspected it was Mark from Neenaw, but I wasn't sure so didn't want to ask. I'm sure he'll tell me if it was.

We left with the lodger calmed by the knowledge that a GP was going to visit, and Mary had got herself to bed.

We're not coming!

2006-10-08T14:00:00.000+01:00

It was about 11pm on Thursday night when the activation phone rang and I answered it.

"Hello, do you know Ethel Smith?*" asked the dispatcher.
"Oh God!" I moaned. "What's she rung up for this time? Don't tell me, she's fallen with ?injuries."

My crewmate paused in the act of picking up the ambulance keys. Ethel is one of our regular callers. We're pretty suspicious of her calls on our station. We're usually sent to Ethel for "Fall ? Injury", but when we get there it ends up being something completely different. The last time a crew went to her, the real reason turned out to be because her commode was too far away from her bed and she wanted it moving closer. The time before that was because she thought her house was haunted. Other reasons include a lightbulb had blown and the TV remote didn't work.

"Er nooo, it's because she's too hot and wants her radiator turning off," said the dispatcher.
"You what?! You're not sending us on it are you?"
"No, I went down to the call-taker while the call was still in progress and told her I had no intention of sending an ambulance to turn off a radiator. I wanted to let you know because I gather you're collecting a list of the times she calls and what for."
"That's great, thanks."

When we get persistant regular callers who are blatantly misusing the service, we begin to collate evidence so we can do something about stopping them calling. We get regular callers who have genuine reasons for calling, and we do all we can to help them. It's the time-wasters we want to get rid of for obvious reasons.

On this occasion, she slipped up and told the call taker the real reason for calling, and the allocator refused to send.

If only she'd slip up like that more often....

* Not the patient's real name.

Calling 999

2006-10-06T14:12:00.000+01:00

You know, it's quite bizarre that when I'm planning a post, Mark from Neenaw goes and writes about the same thing. I suppose it saves me some work....

I went to an old chap having a CVA (stroke) a couple of days ago. He had an obvious right sided weakness, with the right side of his mouth drooping down and unable to use his right arm. He'd also lost the use of his speech.
He knew that there was something wrong with him, because he kept picking his right hand up with his left, and dropping it down onto the bed as if to say "Why won't this work?"
We took him to the ambulance, and after doing the necessary obs, we took him to hospital on blue lights.

His wife came with us, and she was understandably quite upset. I reassured her during the journey, and she asked me how it worked when she made the 999 call, as she felt guilty because she'd kept telling the call taker to "hurry up", so I explained the process to her. She asked me to pass on her apologies to the call-taker, which I did through the radio operator.

So I was going to write on here about making a 999 call, but Mark Myers has beaten me to it. I guess he's better qualified to do it than I.

P.S. I know how much you all like to know the outcome of my patients - he's going to be in hospital for at least a few days, but the doctor told me he should make a good recovery.

Nobody Home

2006-10-03T17:52:00.000+01:00

Last night, we were sent to a "collapsed behind locked doors". It's usually an elderly person who's fallen and can't get themselves up again, someone who has passed away, or they've caught their alarm pendant while they've been out and so there's nobody home. The MDT told us that the police were on their way to gain access for us.

We arrived to find the police there, and unable to gain any response from banging on the door - usually, if it's a person who's fallen, they'll call out so we know they're conscious. When this happens, we usually try to find a relative who has a key and wait for them to come and let us in. If we don't get an answer, then the size 9 key is used. If that doesn't work, the police get their "enforcer" out. This is a big heavy metal ram that is used to batter the door open and usually causes lots of mess and broken doors and frames.

The size 9 key didn't work, so one of the officers radioed up for the enforcer to be brought.
"Dave'll be happy," he told me. "This'll be the first time he's had chance to use the enforcer since he did his course last week." While we waited for the enforcer, a few more kicks were aimed at the door, which still refused to give way.

Then a neighbour appeared. "What's going on?"
"The careline alarm has been activated - we think someone's collapsed inside," explained the copper as he got ready to aim his boot at the door again.
"Stop - I've got a key for the back door. And there's nobody there - he's gone on holiday to Portugal," said the neighbour.

She let us in, and sure enough, the flat was empty. We located the careline machine, activated it and spoke to the careline call-centre. We decided there must have been a fault which caused the alarm to activate.

The enforcer was cancelled, and Dave sounded rather disappointed he wouldn't be putting his newly acquired skill of breaking a door down into practice.

At least the owner won't be coming home to find his door smashed....

Technical Question

2006-10-02T14:14:00.000+01:00

I might be reasonably ok at helping to fix people, but I've got a bit of a computer problem I need some help with.....

I have an external hard drive which has got loads of files on that I need, but my computer has stopped recognising it and the device manager reports Error Code 10: Drive unable to start.

Has anyone got any ideas how I can get it working again?

Happy Birthday

2006-09-25T21:02:00.000+01:00

My blog is exactly one year old today. Shame I don't have a cake....

LAS News

2006-09-25T20:48:00.000+01:00

Tom Reynolds, Mark Myers, Beaker and myself have all been mentioned in this months edition of the our internal magazine, "LAS News" which is published every one or two months, although not all of us by name or blog title.

There is a big article about Tom's book, "Blood, Sweat and Tea", and in the article, it mentions that there are other blogs by a couple of control staff (That'll be Neenaw and Not So Newbie at EOC) and a blog written by an Emergency Medical Technician in South West London. That'll be me then.

The encouraging part of it is that the magazine states that the LAS is very pleased with the way the blogs are written to ensure confidentiality of patients is maintained. However, it also says that the LAS is to release guidelines on what bloggers should and shouldn't write about. I'm hoping that they won't try to "censor" us, but we'll all have to wait and see what these guidelines contain...

An Odd Case

2006-09-22T21:34:00.000+01:00

Well, since my last post, we've had one or two "slow" starts, but once we've gone out, we've stayed out. Last Sunday we did ten jobs - one of the busiest days I've had at this station. Still nothing particularly interesting, apart from one job.

We were called to a 24 year old female who was apparently fitting. We found her laying on her back on the narrow landing at the top of the stairs. She was alert, but every so often her muscles went into spasm causing her whole body to jerk involuntarily, looking very much like a seizure. It crossed my mind that she might be "pseudo-fitting"- that is, pretending to fit. This happens more often than you'd think and is often used for attention seeking. It's also a favourite of shoplifters etc who have been caught by the shop's security or the police.

This time though, I didn't think she was faking it. She wasn't exactly fitting, and she wasn't pretending to be unresponsive with it. Between the huge muscle twitches, she outlined her medical history. It could have filled a text book, with a chapter before bed every night for a month, but none of it seemed to have any bearing on the current problem.

The next problem was how to get her down the stairs. We were reluctant to use the carry chair because if she experienced another generalised muscle spasm, we'd be in danger of all three of us ending up in a heap at the bottom of the stairs. The only solution we could think of was for the patient to get herself down the stairs one step at a time on her bottom, with one of us in front of her to stop her falling downstairs if she had a spasm, and one behind her. It was just as well, she had another huge spasm half way down the stairs, and between us, we prevented her sliding down the stairs.

This was the first time I'd seen anything quite like this, and I was a bit baffled by it. I asked the patient if she minded if I followed up on her diagnosis, and she agreed. She spent a few days in hospital, but the doctors hadn't been able to find a cause for the spasms - which she was still having, but had been reduced to head twitches - so they'd decided to put it down to attention seeking.

Maybe it was, but I'm not convinced. If it happens to her again, the family have been told to call an ambulance again, so she may become a regular...

The "Q" Word

2006-09-16T20:04:00.000+01:00

There's been a bit of a lack of posts, because I haven't really been to many blog-worthy jobs.

As has been mentioned before on here and other blogs, there is one word that is usually banned from ambulance messrooms, as it is almost guaranteed to make the phone ring with a job. The word is "quiet", and is often referred to as "The Q word".

The station I work out of now must be one of the quietest in the service (there, I said it), and I prefer to be busier than we often are - after all, there is only so much day time TV a person can take. Having said that, our station does have it's moments. Take today for example.

We started at 7am, checked the equipment on the ambulance and topped up one or two items. Then it was breakfast time - Weetabix and coffee for me, and toast for my crewmate.
Then we sat and watched the news. At 8am, the crew for the second ambulance that runs out of our station came on duty.
Then we watched the history channel.

This sort of thing can go on for hours. I've actually managed to complete a shift at this station without going out at all.

It looked like being another quiet shift and I was wondering how much more sitting around watching TV I could take when the phone finally went with a job just after 10am. As we started first, we were first out. The MDT (computer) screen in the ambulance told us we were going to an 11 year old boy who'd fallen awkwardly while playing football and hurt his back. It also said he couldn't feel his legs.
We arrived to find two first aiders next to the boy, who was sitting up, with one first aider holding a hand to the boy's back, but nobody holding the head to keep it still. It turned out he'd fallen onto his coccyx right at the bottom of his spine, which turned out to be minor bruising, and the boy could feel his legs, move them normally.

I don't know who the first aiders were - they weren't St John or Red Cross, but if any first aiders are reading this - if you suspect a back or neck injury, leave the patient in the position you've found them, but take hold of the head and keep it so that the neck is in a straight line with the back.

After that, another football injury. This time a dislocated shoulder which happened as the patient was taking a throw-in. He'd dislocated it 6 times before, so the joint was already weak, which begged the question why take the throw in knowing it may cause his shoulder to pop out?
We took him to hospital. At the request of the doctor, I took hold of the patient, and lifted him upwards and backwards in his chair, while the doctor tried to manipulate the shoulder back into place. After five minutes of tug-of-war between me and the doctor, with the patient in the middle, I'd felt the shoulder move, but it still hadn't gone back in. The doctor tried another method - she gave him a bottle of water to hold in the hand of the affected side. That did the trick, and the shoulder suddenly just dropped back into place.

Next an unconscious man that wasn't, but he wasn't well, so we took him to hospital.

Then a disabled man who couldn't get himself off the toilet, so we lifted him back into his wheelchair just as his daughter arrived. He wasn't injured so we didn't take him to hospital, leaving him in the care of his daughter.

And finally....

A 62 year old man who'd fallen between eight and ten feet off a ladder. He had a back injury, a large lump on his head, a bit of concussion, but no other obvious injury. We immobilised him on the scoop stretcher, and blued him into hospital. I'll write about this job in a bit more detail at a later date, as I think it deserves a post of its own.

It still counts as a reasonably quiet day, but I'm pleased to have finished and be home, and we'll be back in tomorrow to do it all again...

New Road Layout

2006-09-14T07:03:00.000+01:00

We've got a new road layout near our station. They've moved some of the pedestrian refuges in the middle of the road more to one side, narrowing one side of the road, and put in a bus lane on the wider side. All this so the bus lane can operate for three hours a day in the afternoon.

We'd commented that the road layout looked dodgy to say the least and we're expecting an increase in the number of calls to RTCs on that road. The other day, they'd just finished putting in the red tarmac in the bus lane in the morning. By the afternoon, we'd started to see the first skid marks appearing on the newly laid road.

Then yesterday, our first call. Fortunately it was nothing serious, and to be fair, probably nothing to do with the bus lane at all, but a cyclist had been riding down the bus/cycle lane, passing a line of cars, and someone had opened their car door right in front of him. Luckily, he only had a few bruises and dented pride, his cycle helmet was intact with no marks and his bike was undamaged. We did all our obs, asked the cyclist if he wanted to go to hospital - which he didn't, and waited with him until the police arrived.

I can't help wondering how long it will be before we're called to something more serious along that road.

On another note, it will be my blog's first birthday in just over a week, and I'm coming up on my 100th post. I'll have to see if I can find something "properly" interesting to write about for that one....

Another LAS Blog

2006-09-03T03:46:00.000+01:00

I had a great weekend camping - with only one near emergency with the tent. I'll write about it at a later date.

I was reading through the Big White Taxi Service forums earlier, and came across a post about another LAS blog, this time written by a paramedic who works in central London.

You can find it here.

Camping

2006-08-25T11:37:00.000+01:00

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

2006-08-24T15:25:00.000+01:00

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

2006-08-22T14:33:00.000+01:00

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

2006-08-21T08:04:00.000+01:00

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

2006-08-14T09:31:00.000+01:00

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

2006-08-07T20:23:00.000+01:00

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

2006-08-03T21:00:00.000+01:00

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.

Whatever next

2006-07-20T22:00:00.000+01:00

It's been a bit bleak on the blog front because to be perfectly honest, we've not done any calls worth blogging about as it's all been stuff that could easily have been dealt with by a GP.

I've only ever been in an ambulance as a patient once. It was in Lincolnshire, and I wasn't given the choice by my GP who booked me into hospital on an urgent call. Most of the stuff we've been to this last week or so I wouldn't have dreamed of calling an ambulance for.
For example:

A woman with abdo pain....for 9 months. And no, she wasn't pregnant - not at 68 years old.

A man with penis pain for 3 days and hadn't considered seeing his GP.

Until today, the biggest time-waster of the week was a 23 year old who called because he'd had a cough since the night before. He supposedly had difficulty in breathing. When I suggested he sit up a bit to make his breathing easier if he was finding it difficult, he just curled himself up on the bed and ignored us. We referred him to his GP.

The call that really made me have to bite my lip was a call to a woman who was thirsty!

Still, it goes with the call Mark Myers took for an ingrowing toenail....

One I know the outcome of...

2006-07-10T21:51:00.000+01:00

Until this weekend, it had never crossed my mind that having a dental extraction could lead to a nasty complicated fracture of the ankle.

We were working nights this weekend – at 7pm we’d checked the vehicle over, replaced a couple of items and were ready for our first call. When it came, I went out to the vehicle and looked at the screen.

“Dental extraction this afternoon, passed out, injured broken ankle”

I got the dental extraction bit (I’ve got to have a couple extracted myself – NOT looking forward to it as I have a very real fear of dentists), I got the passed out bit, but I didn’t get the broken ankle bit. Did it mean the broken ankle was an old injury, or did it mean that the act of passing out had caused the broken ankle? I pondered the possibilities as my crewmate Graham drove us to the call.

We were met by the patient’s brother. “He’s in the living room, he passed out upstairs and he’s got a very nasty injury to his ankle.”
“Ok.”
Our patient, Al, was sitting on a chair with his right leg crossed over his left. His right foot dangled uselessly in mid-air, a large lump on his ankle was being held in place by his sock through which blood seeped and dripped steadily onto a towel on the floor underneath.
I turned to Graham.
“Vacuum splint, Entonox, and carry chair please.” Graham left to fetch the necessary equipment.

Al explained he’d had a tooth extracted at lunchtime, and since then, he’d been getting large blood clots forming in his gum which when they came away, he was spitting down the toilet upstairs. On the last trip to expel another clot, he’d passed out in his bathroom, and when he woke up, he was on the floor and his right foot lay at ninety degrees to his leg. He was on his own at this point, but knew he had to get help, so he’d somehow managed to come downstairs on his bottom, and phoned his brother who lived just down the road and had a key to get in. His brother had taken one look at the ankle and called us.

I was amazed at how calmly Al was just sitting there with his clearly badly injured ankle, chatting away as though there was nothing wrong. “Al, out of ten, zero being no pain, and ten being the worst pain you’ve ever experienced, how painful is your ankle?”
“Oh, about three out of ten.” I’d have been screaming.

Graham returned, and after starting Al on Entonox (gas and air), we set about removing the shoe and sock from his right ankle. With a bit of care, we were able to remove his shoe without the need to cut it off, but we had to cut his sock. As we peeled the sock away from his ankle, we saw the bottom of the Tibia (shin bone), known as the Medial Malleolus, poking through the skin on the inside of his ankle. He had not only fractured his ankle, but had dislocated it as well.

A steady stream of blood came from the wound. I felt Al’s foot for temperature and for a pulse, checking that the fracture dislocation hadn’t disrupted the blood supply to the foot. The foot was warm, and I found the pulse on the top of his foot. The pulse can be quite difficult to find, so when we do find it, we put a pen mark at the right point. We then gently put a pad and bandage over the wound, and placed his leg in a vacuum splint. As the name suggests, we wrap the splint around the leg, then using the suction unit, we suck the air out, and the splint moulds itself to the injury and sets hard, preventing movement.

Having his leg straight increased the pain in his ankle, so we gave him some morphine, and took him out to the ambulance.

Due to the nature of the injury, we decided to let the hospital know so they could get an orthopaedic specialist down and we took him in on blue lights.

Later when we went back with another patient, Al had had his leg put in plaster. He told us that he was to have an operation the next day to have his ankle pinned back together. The orthopaedic specialist showed me the x-ray.

This is a normal x-ray of a right ankle. The view is from the front, as though the person was standing facing you.

Al’s x-ray showed the Medial Malleolus had moved sideways – to the right as you look at the x-ray. It also showed that he had a Spiral fracture at the lower end of the shaft of his Fibula – if you were to imagine a spiral staircase going up the outside of the shaft of the bone, that’s what it looked like on the x-ray, but without the steps.

In the operation, the Medial Malleolus would be put back in the correct place, and pinned in place to the Talus. Pins would also be placed along the broken shaft of the Fibula to hold it in place to ensure it repaired correctly.

It was nice to get this feedback from the Dr. All too often we take people to hospital and don't get to know the outcome. It's as frustrating for us as it is for you reading ambulance blogs, because we use this feedback to confirm our own provisional diagnosis, and where that doesn't match, as learning points, to help us to recognise injuries and illnesses and give better treatment in future.

7/7 Remembered

2006-07-07T16:34:00.000+01:00

On July 7th 2005, I was on a rest day.  I woke at around 8.30am, got up, showered, put the radio on, and settled down with a cup of coffee to check my e-mails.  I was listening to the radio station Heart 106.2.  At 9 o’clock, the breakfast show finished and the Time Tunnel began.  I hummed along to an old favourite of mine, and then they went to the newsroom for a news flash.  There were reports coming in of an incident on the underground.

I immediately switched off the radio, and turned the TV on to BBC News 24.  It’s a habit to go to the BBC – I’d worked freelance for them for 7 years as a broadcast assistant in local radio in Lincolnshire, with an occasional shift at Broadcasting House in London.  Work had dried up as they took on more staff positions, causing me to leave and become a bus driver before finally plucking up the courage to leave home and join the world’s busiest ambulance service.  Despite the criticism the BBC receives, and rightly so in some cases, I know the lengths that are gone to try and verify a story before it is broadcast.  But that’s a whole other post.

The newscaster said that London Underground was reporting a huge power surge which had caused a disruption in the power supply for trains.  However, it soon became clear that it was more than just a power surge.  Three stations were reporting problems, and people were appearing with blackened faces and burns.

I immediately picked up the phone and dialled the local resource centre.
“It’s Steve Gibbs here – I’ve seen what’s happening on the news, tell me where I can go to help.”
“What are you working today Steve?”
“I’m on rest day today, but I’m back in on days tomorrow.”
“We’ll keep you in mind Steve, but we can’t guarantee what time you’ll get back home, so we’re currently trying not to use people who are rostered to work tomorrow so that we have fresh staff ready, but please remain ready to come in if we find we need it.”
“Ok.”

And home is where I stayed.  None of the chores got done – I spent the entire day in front of the TV watching my colleagues work their butts off.  Then the news that a bomb had gone off on a bus.  I expected the phone to ring at any moment asking me to go in to work. The call didn’t come.  I was grateful really.  I wasn’t sure I was prepared for what I might see if I was sent to one of the scenes.

Then I felt guilty for thinking that.  My colleagues had been thrown into those scenes.  They’d had no warning.  They hadn’t seen what was being broadcast on the TV.

I recall a posting on the Big White Taxi Service forum from the FRU paramedic who came across the Aldgate bombing as a running call – he was driving past when he saw people, again with blackened faces and burns emerging from the station.

He described being the first paramedic on the train.  The carriage was a mess.  There were people laying everywhere – some with limbs missing, many bleeding.  He recalled having to stack bodies on top of one another just to be able to make progress through the carriage.  He could see a man alive further down, but he couldn’t get to him.  He made his way back down the carriage, got out, stumbled along the outside of the train and climbed in through another door.  When he reached the man who’d been trying to get up, he was dead.

Despite the criticism that the service has received in the last year since that awful day, our staff on the ground did an incredibly good job in the most difficult circumstances you could ever imagine.  It was the first time the LAS had to respond to four major incidents simultaneously, but they went about their duties calmly and effectively.

Yes there were mistakes made.  Some hard lessons have been learned, but the efforts of all our staff that day has made me proud to be able to say that I work for the London Ambulance Service.

Busy Saturday

2006-07-03T15:29:00.000+01:00

I was offered overtime for Saturday on either the day shift or the night shift on the car. I chose the day shift, thinking that I at least wouldn’t get slaughtered running round after people who’d drunk too much and started fighting after the England match.

So I started at 6.30am, trundling around my area for a while, re-fuelling the car and generally enjoying the gentle start to the shift. Due to the heat, I was expecting a busy day of running around to people who’d collapsed with fainting and other heat-related problems. In the end, I did eleven jobs – my busiest shift on the car yet, and conveyed two patients myself as they were minor problems and because the service was so busy, there weren’t ambulances available to attend.

The most serious was a call to a 40 year old male with breathing difficulties. On the way, I considered it could be an asthma attack brought on by the heat. I walked into the house to find most of the family in the lounge calmly watching TV. The patient’s wife lead me through to the bedroom, where I was confronted with a deathly pale man. I immediately started him on 100% oxygen, as I asked him what had happened.
“I’ve been getting pains in my chest on and off for the last couple of days. I’ve also had pain in my stomach, and I can’t keep anything down.”
“Do you have pain at the moment?”
“No.”
I took his pulse – it was racing along far faster than it should be. His blood pressure scared me – 54/35. It was way too low. I laid him flat, and put his feet up on a box.
Then I got on the phone to control.
“Has an ambulance been assigned yet?” I asked the dispatcher.
“Not yet, nothing to send.”
“Can you ask Sector to GB it please – I need an ambulance here urgently, preferably a paramedic crew.” I gave him the obs I’d taken.
“Ooh blimey, yeah I’ll get sector to GB it.” GB stands for General Broadcast, and is a call to all ambulances asking if anyone is available to attend the call. Any crews that are just about to finish completing paperwork, and are reasonably close to the call will come up available and offer to attend it.

A couple of minutes later, control rang back and told me there was an ambulance on the way, but it was running a fair distance. He told me the call-sign and I breathed a sigh of relief. I knew the crew – one was a brand new paramedic who had just started her mentoring period, and the other I knew to be a bloody good paramedic.

I suspected he was bleeding internally somewhere, so while I waited, I felt his abdomen for any signs of bleeding and tenderness. If there’s bleeding in the belly, the abdominal muscles tense up to protect the internal organs. This is known as “boarding”. If there is tenderness, the patient tends to push your hands off his abdomen to stop it hurting. This is known as “guarding”. There was neither. I also felt for a pulsatile mass that could indicate an Abdominal Aortic Aneurysm but didn’t find one. (Click here for more information and a couple of diagrams)

When the crew arrived, I handed over, and stayed to help. This was going to be a difficult removal. The first choice for getting him out was going to be on the carry-chair, but we were worried about his blood pressure bottoming out when we sat him up. We decided we’d give it a go. We lifted him onto the chair, and immediately his eyes rolled and he started fitting.
“Quick, back on the bed,” I said and we dumped him unceremoniously back onto the bed. Almost immediately, he came back round.
Plan B. We got the scoop stretcher – a metal stretcher that we can put under a patient with minimal movement – and strapped him to it. We knew he wasn’t heavy from lifting him onto the chair, so we were satisfied we could get him out without asking for another crew to help – besides, we weren’t sure there would be one available.

We got him out without any further problems, and we got some IV fluid running to help restore his blood pressure. The crew took him to hospital on blue lights.

I don’t know the outcome – I’m hoping to be able to find out from the crew sometime this week. I’ll let you know.

**UPDATE**

Apparently, my suspicions of an internal bleed were confirmed. They found a Gastro-intestinal (G.I.) bleed. He will make a full recovery.

Bipolar Disorder

2006-06-26T09:59:00.000+01:00

It’s been a pretty slow week at work really. The one job that sticks in my mind was a call to a care home for people suffering from mental illnesses. Lisa (not her real name) is young lady with Bipolar Disorder.

Every morning, the home has a “Morning Session” where residents meet and discuss with the group how they’re feeling and what issues are affecting them both positively and negatively. Lisa had woken up feeling more stressed than usual. She usually finds the Morning Session a positive thing, but today it had not been as structured as it normally is and had descended into chaos.

This had upset Lisa, and she was now having a depressive crisis to the point of feeling suicidal.

We couldn’t really do much for her other than take her to hospital who could arrange for a psychiatric assessment, but what struck me was although she was clearly depressive, she was able to hold a reasonable conversation calmly, and to state her needs clearly. What impressed me most was her recognition that she needed help and had to guts to ask for it.

I hope they are able to stabilise her moods, and that she goes on to lead as normal a life as possible.

**UPDATE**

After reading some of the comments on this post, I decided to write to Anna Raeburn on LBC radio and asked her if she'd consider doing a programme about Bipolar. She has replied, and the charity MIND have offered her a guest speaker on the subject, but the programme probably won't be broadcast until October. Anna's promised to keep me updated when a firm date is set so I can let you know.

You can listen to LBC in London on 97.3FM, and elsewhere online or on Sky channel 0177.

Night Shift part 2

2006-06-16T03:14:00.000+01:00

Two more jobs - a search for a non-existant male passed out near an underground station, and the second to the sickest person of the night.

A 91 year old chap who has been unwell all day yesterday with a headache was sprawled across the bed when I entered his basement bedroom. He didn't give any reaction when I spoke to him, and only moved the right side of his body in response to pain.

Noting this, I pinched the back of his left leg, and there was no response. To be sure, I pinched the back of his right leg and he moved it away.

He was making a snoring sound, so I tried to put an oropharyngeal airway (a small curved tube) into his mouth to help him breathe, but as it goes down the back of the throat, it caused him to gag, so instead I put in a nasal airway, and gave him 100% oxygen.

The crew arrived, and we managed to get him onto the chair so the crew could carry him up the stairs. I followed behind weighed down with all my equipment as well as the crew's oxygen bag.

It's now 3.20am, and hopefully I'll be left alone now, but now I've said that I'll probably get another job soon...

Update: That was the last job, so it's nice to have been left alone for he last three hours of the shift. And to correct myself on the number of calls - it was just over 4,200, not just under.

Night Shift part 1

2006-06-16T00:05:00.000+01:00

It's been a busy night so far - I was planning to do a multi-post tonight, but this is the first chance I've had to get near the computer. It's fairly easy to see the effect of the football match on the number of calls. Until the end of the match, the number of calls was ticking along at an average rate.

At the stroke of midnight, our Emergency Operations Centre had taken nearly 4,200 calls - a good 700 more than the average.

My first call was to a stabbing. After donning stab-vest, I made my way to the call, but held off round the corner as it was unclear where the assailant was and the police had nobody to send. I was just about to ask control to ask the police for an ETA when they rang me to tell me the police had updated them that it was a hoax call.

I then went to a bloke who'd fallen off one of those motorised scooters apparently called a "Goped", after losing control on a corner and hitting a parked car. He had a minor knee injury, and as it was what's known as a personal injury RTC, the police attended. Shame the bloke reeked of booze and admitted to having sunk 5 beers. Hope he doesn't have a driving licence - if he did, he doesn't now!

Then it was to a ?stroke. 65 year old man who seemed to fully enjoy the attention he was receiving, and although saying he had lost all movement in his left arm was able to stick his finger out so I could put a probe on his finger and take his blood sugar reading.

Then a woman with "difficulty in breathing". The only difficulty with her breathing was knowing when to stop talking to take a breath in!

And I've just been to a bloke who was assaulted four days ago and now has "pain all over". I'm sure he has, but telling us to "shove your pain-killers up your arse" is not going to help relieve the pain. We eventually got him into the ambulance. It wouldn't surprise me if he self-discharges before being seen.

I'm sure there'll be more - I'll try to update during the night.

Surgical Spirit

2006-06-14T16:43:00.000+01:00

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….

Back On An Ambulance

2006-06-05T09:13:00.000+01:00

So my first week back on an ambulance is over.  The station I now work out of used to be known as the “Olympic flame” because it supposedly never went out, but not anymore.  It has to be said that the vast majority of the jobs were genuine, although I did do three visits to the maternity wing at the local hospital.  One of the reasons for this is if we go to a woman who is more than 20 weeks pregnant, then we take them to their booked maternity unit regardless of what they’ve called us for.

The first one was a blatant maternataxi.  It was the girl’s second baby, she’d had a “show” (which is the plug of bloody mucus that seals the cervix closed during pregnancy coming away) a week before.  Now her waters had broken half an hour ago, but she wasn’t having any contractions. She still had hours if not longer before baby was to be born.  I asked if she had spoken to the hospital – thinking they may have asked her to come in, but no.
The look on her face was brilliant when I told her she’d more than likely be sent home – hopefully with a flea in her ear from the staff for calling an ambulance.

The other two were more genuine.  A lady had fallen downstairs and had pain in her bottom (I resisted the urge to say “Oh, so you’ve got a pain in the bum!”), but although she had no pain in her abdomen and there’d been no bleeding, she hadn’t felt baby move for longer than normal, so she’d rung her GP who’d told her to call an ambulance.

The third was a lady with back pain.  She’d had problems with kidney stones before, and this felt similar.  We did all the usual checks, and I had a listen to her breathing.  The breath sounds on the right were quieter than on the left.  At first, I thought it was just my hearing, so I got my crewmate to have a listen and he agreed.  The levels of oxygen in her blood were good, and she had no chest pain.

So they were our three visits to maternity.  As well as those, we’ve had an old man having a serious stroke – ended up in ITU, a man who decided it would be fun to drink 2 bottles of surgical spirit and was unconscious, a man who was well liked in his community had been found passed away – he was terminally ill, and a woman who threatened to commit suicide because her bank wouldn’t give her any money.

There were a few others as well, but I can’t remember what they were.  So all in all, a reasonable mix of calls.

I’ve taken leave this week, and I’m going home to Lincolnshire to visit family and friends, so there’ll be a lack of posts this week and I may be a little slow approving any comments, but I’ll try to log in once a day.

Have a good week!

What is the FRU?

2006-05-31T20:50:00.000+01:00

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

2006-05-26T16:21:00.000+01:00

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

2006-05-22T19:58:00.000+01:00

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

2006-05-19T06:48:00.000+01:00

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

2006-05-15T10:19:00.000+01:00

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

2006-05-12T19:28:00.000+01:00

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

2006-05-10T22:45:00.000+01:00

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

2006-05-07T21:00:00.000+01:00

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.