Thursday, 24 December 2009
Tuesday, 22 December 2009
Thursday, 17 December 2009
I know, it's not all as straightforward and simple as we'd like, but there has to be talk about the system. It isn't some sort of sacred cow that can't be criticised, and should be open to debate, investigation, and change.
Wednesday, 16 December 2009
Tuesday, 15 December 2009
Having never before had the need to break into a house, I found it a difficult decision to make. It had always been the police's job to break doors down. This time they had no units to send, and the report I'd been given was one of a child, possibly a baby, crying continuously. The call had come from a concerned neighbour, who'd heard crying when they went out for the evening, and had returned hours later to still hear the same noise. There were no lights on in the house.
As we arrived (I was in the FRU (fast response unit), but had an observer -a nurse turned medical student- with me for the night), we could hear the whimpers through the letter box. We called, yelled, banged on the door, rang the bell, all to no avail. No lights came on, no curtains twitched, no movement. Throwing caution to the wind and cursing Health and Safety rules, I looked at Beth, my observer, told her she never saw a thing, and broke the door down with two swings of an oxygen cylinder. Note for future reference - they make damned good battering rams.
The first light switch clicked ominously like an empty rifle. No flash of light, just an echoing click. The second did the same. As did the third. I went back to the car and found a torch, and carried that and the newly redefined oxygen cylinder as self-defence. Just in case. I had a quick look up and saw that none of the light fittings had any bulbs in them. We searched every room, and tried to follow the sound of the cries. It was like trying to find the end of a rainbow. Every time we thought we'd pinpointed it, it seemed to move, and we started wondering if we were actually chasing a cat rather than a baby. Ominously, after a few minutes, the noise stopped.
Having found nothing downstairs, other than a framed photograph of a soldier standing proudly in dress uniform, we started up the stairs, a double flight, with a small landing half way up. The darkness seemed even heavier here, the torchlight making minimal difference. In the dull glare of the torch I checked the first set of stairs, skipped the landing, and looked directly upwards. My heart rate doubled and I could feel the sweat starting to build as the adrenaline pumped itself round my slightly terrified system. I still don't know why I kept going, rather than waiting for back up, either in the form of another ambulance or the police. Stupidity rather than bravery, I assure you. Reaching the top of the first flight, and stepping on to the landing, I tripped over a boot, and yelled in fright. The boot was attached to Sim.
Sim looked like a ghost, a pale, almost skeletal ghost, hands nothing but skin and bone, terrified, wild, bloodshot eyes sunk deep into his head. He was cowering in the corner, legs folded up into his chest. Then the tears streamed, and the all-too-familiar cry that we'd heard from outside returned. Sim was no baby, or child. He was a fully grown man, looking decades older than the mid-30s that he was, a shadow of what he probably used to be.
He wouldn't, maybe couldn't, talk for a long while. I'd informed control that we'd found him, that there was no child involved, and they in return told me that they had no ambulance to send, and that the police would be at least an hour as well. Beth and I were ready for a long stay, unsure of what to expect. We asked questions, made statements, promised help, if only he would talk to us. Beth tried to put an arm around his shoulders, a gesture that at first he repelled, horrified, but then accepted with a look of desperation. Sim cried into her shoulder for a full ten minutes, before at last regaining some composure, and whispering a barely audible "Sorry".
We talked some more, Beth and I, while Sim would only answer by nodding or shaking his head. There were intermittent sobs, long silences while we searched for the right questions to give us the answers we needed. The photo downstairs eventually registered in the recesses of my mind, and I realised that this shadow was once that same proud soldier.
"Is that you? In the photo downstairs?"
A nod of the head confirmed my suspicions.
"I was a soldier once. Miss it too! Miss the friends, the closeness, the action. Would go back tomorrow if I could." I told him a little of where I was, what I'd done, what I'd seen, and what it meant to me. Slowly, the tears dried.
For the first time, Sim looked me in the eye. I'd found it. The connection we needed. And then he talked. For the next 20 minutes, uninterrupted, he talked, and we listened. About the Army, about his life without it, about the injury he'd received that meant he could no longer serve his country. He spoke of the nightmares he has, the flashbacks, the friends he'd lost. He told us that the Army was not only his life, but his friends, his family, his support. He cried about being jealous of his friends who were still serving, how they couldn't visit him while they were away on a deployment. How he was left all alone, now that they'd been away for three months. He had no food, no electricity, no money, and not a soul in the world to turn to. He couldn't bring himself to leave the house, the thought of the outside world terrifying him. Tonight was the night he was going to end it all, but he couldn't bring himself to do it. He sat on the landing and cried for hours, until we arrived.
We talked some more about how we could get him some help, and reluctantly he'd agreed to try. He'd come to the hospital, talk to the doctors, the crisis team, the social workers. He made no promises about succeeding, but at least he'd give it a go. "At least I'll try to get to see one more Christmas."
Weeks later, and after a few days off, I returned to station for my next shift to find a card and an almost empty box of chocolates, just sat on the table. I looked in the card, expecting to see another "Merry Christmas" or "Happy New Year" message from a grateful member of the public, or maybe even from our management. Happens sometimes. Instead, it had two sentences inside.
"Thank You for understanding and saving my life. From one ex-soldier to another".
Sim's chocolates were gone.
Sim's card is still safe.
Hopefully, Sim is too.
Sunday, 13 December 2009
Thursday, 10 December 2009
Wednesday, 9 December 2009
Fuel all over the place.
Unconscious, probably drunk driver.
Lots and lots of bystanders who all come rushing out.
I'm always amused by the fact that when attending the scene of a serious RTA, as this one was, there are people who still insist on waving frantically to show the ambulance where to go. I mean, do you really think I can't see the upside down car with the steam pouring out of it? I know, I know they're only trying to help, so I shouldn't really complain, but still. It's weird.
One of the bystanders, we'll call him GD (the reasons will become clear shortly), comes over to tell me proudly that he and one other person dragged / assisted the driver out of the upside-down car, and after a few seconds of drunken yelling and thrashing about, he collapsed into an unconscious heap, where I found him.
Tuesday, 8 December 2009
Sunday, 6 December 2009
The Season has begun.
You know what must be done.
You must go to the office do,
And start off at a run.
To drink all that you can,
Will show you're such a man.
It's just the greatest thing to do,
From pint, to glass to can.
You'll vomit like a tap,
Wake up and feel crap.
Won't remember a single thing,
Was it worth it, dear chap?
No connection - brain to feet,
You'll fall down in the street.
They'll call for you an ambulance,
That has someone else to treat.
You really couldn't care,
Whether it should be there.
The ambulance is there for you,
So your vomit you can share.
We'll cart you in the back,
You'll shower us with flack.
Both words and stomach contents,
A hurtling attack.
You'll wake in A&E,
Desperate for a wee,
And do it in the cubicle,
"The bog's too far for me!"
That's how you'll end your night,
In bright fluorescent light.
A black mark on your record,
And your friends nowhere in sight.
And the crew that you abused?
They're feeling somewhat bruised.
We really have much better things,
For which we should be used.
Thursday, 3 December 2009
Monday, 30 November 2009
Saturday, 28 November 2009
The Close Calls Handover has been posted over at Happy Medic's HQ. As always, the Handover makes for some good reading. There's even an honourable (and I'm duly honoured) mention in dispatches for your local Insomniac.
And, as always,
Wednesday, 25 November 2009
Sunday, 22 November 2009
Saturday, 21 November 2009
Thursday, 19 November 2009
Sunday, 15 November 2009
Tuesday, 10 November 2009
Sunday, 8 November 2009
Friday, 6 November 2009
Thursday, 5 November 2009
At four o'clock in the morning there's very little traffic, very little life about. The world sleeps as I do my small bit to keep it safe and well. The call rate to the ambulance service drops, but so do the number of available ambulances. I know I may be on my own for a while. I stop by the car, take one look at it and its unfortunate occupant, and call for help. I need everyone. Fire Brigade, police, at least one ambulance and a Basics doctor. This patient could need a lot of help, and quickly.
I’m fast asleep, having just finished a late shift in the A&E. How weird, then, that I can hear the drum solo from “In The Air Tonight!” Wait a minute, that’s my ‘phone, Ambulance Control. I blearily answer it, and accept a job nearby – car overturned, entrapment and unconscious.
I climb into the car through the boot, hoping that my assessment of its safety was correct and that the kerb would hold the car from tipping further. The patient was clearly unrestrained, lying with his head on the passenger window against the road, and his legs wrapped around the steering wheel. His breathing is a little slow, which concerns me but just putting an oxygen mask on him is a struggle. He tries to fight me off, making me think that this could be anything from a diabetic coma, to alcohol, to a serious head injury.
The journey is uneventful, and I pass the police barricade a few minutes after leaving home. It usually takes a little while for me to wake up fully, but the sight of the car on its side, facing the wrong way, and the lamp post knocked down, is like a splash of cold water. This doesn’t look good. I jump out of the car and grab my pack – anything else I will come back for. I jog round to the car, and am directed to the rear.
The Fire crews turn up first, and I ask about taking out the windscreen, but that would apparently take some time. I need him out quicker, but have no way to move him and no where to move him to. As I'm still fighting to get a primary set of observations done, three pairs of legs appear at the back of the car, two of them green belonging to the crew, and one of the pairs of legs orange. I recognise the voices and thank everyone who needed thanking for them turning up in a hurry. The orange pair of legs belongs to RRD, and I was fairly certain that when I'd asked for a Basics doctor, it would be him that I woke from his slumbers as I knew I was on his patch. At least now I could share my thoughts and decisions.
I peer in through the hatchback of the car, and see a familiar face – Ben! Excellent! This is going to be entertaining, if nothing else. He quickly appraises me of the situation – an unrestrained driver, was deeply unconscious, now has a GCS of around 8. Difficult to get access to the patient, no obs done. We discuss what options we have; peel the roof down or bring out through the back. I want this man out here, so I suggest to Ben that he tries to wind the seat back down, so that we can bodily drag him out. I wander over to the Fire Chief, and let him know what we are doing. He doesn’t look best pleased – I guess he was looking forward to some cutting, but offers all assistance with lifting etc that we might need. I go back to the boot of the car, to see Ben struggling vainly with the seat controls. “Got a problem?” I ask. He just grimaces, reaches under the patient, and the seat magically drifts back, giving the crew room to get him out. I leave them to it, and go and set up for the inevitable intubation.
We extricated the patient out the car the same way I'd climbed in, through the boot, and onto a rescue board. He was still trying to fight back. By now I could smell the alcohol, but still couldn't rule out that his behaviour was due to a head injury, and we treated as such. RRD knocked him out, intubated him, and made sure that our transfer to the hospital would be as event free as possible.
I watch as, first Ben and then the patient, are born(e) from the back of the car, the patient on a spine board. The crew wheeled him into position, near my kit dump, and we start to cut through all his clothes, so that I can make a formal assessment of his injuries. Ben is set the task of getting iv access. I check him over, head to toe, and find little else wrong with him, apart from the obvious – he is eyes closed, occasional groans and localising to pain. Glasgow Coma Score is therefore… anyone?? 8. of course!! I’ve got the kit ready, the team are ready, Ben gives the drugs, and the tube is in. We get him on to the vehicle, and I ask Ben to travel with us.
I travelled with them, abandoning my car at the scene and remaining in charge of the patient's ventilations as we did the breathing for him.
The journey is uneventful, and the three of us in the rear chat about stuff – other jobs we have done, BASICS, the state of the country, that sort of thing. All the while, we are closely monitoring the patient for signs of deterioration, of which there are none. We get to LocalNeuro, and hand over the patient, with some playful banter about whose IV access is better, Ben’s or mine (mine, of course)
All that remained was the tidy-up, paperwork, NHS tea in paper cups, and to get back to my car and return to base for the end of my shift. Maybe, if I asked really, really nicely, RRD would take me back in his cool car...
And then it’s all done. It’s early in the morning, and there’s a bit of paperwork and a lot of clearing up to do. We stand around, drinking our tea, before I offer Ben a lift back to his car.
Wednesday, 4 November 2009
Tuesday, 3 November 2009
Don't say out loud what you're thinking.
It's damned likely to happen.
So, if you feel the need to say to the The Mrs just before you leave for work that you feel like there's a big job out there tonight, don't. Just don't.
Even if it does mean you get to wake up certain people in the middle of the night.
Thus endeth the Note to Self.
Sunday, 1 November 2009
Saturday, 31 October 2009
Friday, 30 October 2009
Well folks, here it is, the latest monthly Handover Carnival. The theme for this month is all about the small people we deal with, so without further ado, allow me to introduce:
Wednesday, 28 October 2009
Sunday, 25 October 2009
Friday, 23 October 2009
Thursday, 22 October 2009
Wednesday, 21 October 2009
Sunday, 18 October 2009
I think we may have to invite him to join us on the ambulance. Regularly.
Thursday, 15 October 2009
Wednesday, 14 October 2009
Monday, 12 October 2009
Friday, 9 October 2009
Tuesday, 6 October 2009
I know you too haven't much of a break.
But I'm also fairly certain that you haven't been doing a resus for the best part of the last hour, sometimes in the most appalling conditions.
So I ask you, please.
Please don't expect me, after nearly an hour of CPR, to keep going, while you stand by and watch.
Please give me a chance to get my breath back.
Please take over the resus. Please take over the CPR.