Every Day's a School Day

One of the things I love about my job is the chance to learn something new every day.

A few months ago we were given a new drug protocol which included administering hydrocortisone to patients in Addison's Crisis. To be perfectly honest, not only did I not know what it was, I'd never even heard of it until a few months ago. At the time I did a little bit of homework to find out a little bit more, but it was all a little bit theoretical as I'd never seen a patient with this condition. The condition itself is called Addison's Disease and you can read all about it here.

There's never an opportunity in the life of a paramedic to say "I've seen it all", as any time you even contemplate the thought, something new gets thrown in your direction. Having never met a patient with Addison's before we were allowed, or even knew how to treat it, I was pleased that we were able to help Gillian last night. She's spent the last few months having test after test with no answers until very recently when Addison's was diagnosed, and last night she had another crisis.

One of the problems with Addison's is that it presents differently with every patient so can be difficult to spot early. The symptoms vary greatly, but on the balance of probabilities Gillian was mid-crisis, so we checked our guidelines and administered the hydrocortisone. The effect was almost like magic. Within a very short space of time the patient's observations began to stabilise, she began to feel much better, and was much calmer in herself at the thought of being on her way to hospital for further treatment.

To top it all off, it was nice to hear Gillian's mum say that after several months of losing all hope, the Ambulance Service restored her faith in the NHS. I hope she manages to find a treatment plan that suits her and allows her to carry on with as normal a life as possible.

For Insomniacs Everywhere

I don't often have much to thank the BBC for, but today's different. They've led me to this blog, all in praise of a good night's sleep....

Is there a cure after all?

Sixth Sense

On our local high street there are several pubs, one of which used to have a somewhat unfavourable reputation, but has totally cleaned up its act and is now even family-friendly.

It's about 9 in the evening and I'm just driving home (stupidly in uniform, as I've just come off shift) past said pub, when out the corner of my eye I see a figure lying on the pavement, just between a bus shelter and the pub. My instant, work-experienced reaction is one of "another binge-drinking session gone wrong". So I drive on.

However, something tells me to turn round and go back again. Some sixth sense kicks in and my professional instincts take over. I get to a mini-roundabout and do an about-face, park in the bus-stop, put on my hazards, and grab my little bag-of-tricks out the boot. There's not a great deal in it, but just enough to be a helpful first-aider.

I crouch down to find a 20ish year old young lady, the smell of alcohol on her breath almost overwhelming, but something isn't right. I've seen enough drunk people to last me a lifetime, and this lady wasn't just drunk. The pub's landlady comes over to me and says that she's already called an ambulance, and that they were on their way. I thanked her, and she left to go back to her customers.

The patient didn't respond to any voice, and only made a vague noise when I applied some pain to her nail-bed, a tried and tested method to elicit a response from those who are pseudo-unconscious. Her GCS was probably about 8/15. In the distance I can hear a siren. I can also hear the paramedics muttering to themselves the same thing I was thinking when I first drove past. The siren that I could hear turned out to be an FRU who I think was pleased to see that there was another green person there. As she got out of the car, I gave a brief handover of the patient's observations, told her about my sixth sense which she instantly accepted.

It was at that exact point that the patient stopped breathing. She still had a pulse, but was in respiratory arrest. Although I had never met this paramedic before, there was an instant co-operation and we worked together as if we'd been crew mates for years. We were able to resuscitate this patient to the stage that when the ambulance turned up she was regaining some level of consciousness and by the time she was actually in the ambulance she was even telling us her name.

Just before I left the crew, Ellen, the FRU lady, turned to me and with a wry smile thanked me and said "Next time you have another Sixth Sense moment, please check that I'm off duty..."

Underground, Overground

One of the advantages of wearing a uniform for work is that you become instantly recognisable for the job you do. You also then become totally anonymous when you take it off and become a civilian again. A little bit like this blog where I can hide behind my pseudonym. Apparently not totally though...

There I was, visiting a relative in a hospital not far from home, when I came across a doctor who I suspected of being RapidResponseDoc . You can see the conversation we had by following the link.

His is another one of the blogs that I'll be following closely....

Booze Bus

I'm still undecided whether the Booze Bus is a good idea or not. On the one hand, should we really be pandering to the needs of a self-harming group of individuals, who have no-one else to blame but themselves? Do we really need to cater for those with self-inflicted "My drink's been spiked", "I usually handle more than this" and other such ailments? Is it really a problem that society as a whole should be paying for?

On the other hand, I guess the Booze Bus does save sending an A&E ambulance to every irresponsible drunk...

One thing's for sure. I do think that anyone who does (ab)use the Ambulance Service in this way, should get charged at least double the cab fare to the nearest A&E department...

The "Jonah" effect

Apparently, my reputation precedes me. I have a habit of attracting very poorly people to my ambulance. It's known as the Jonah effect. For some reason, last night Jonah went from being my middle name to become my first name...

Many outside of the Ambulance Service will be reading this and thinking that surely that's exactly what should be happening, but let me tell you that it's just not the case. I would hazard a guess that the vast majority of calls that are received by the LAS are calls which could be dealt with in other ways.

But back to the point at hand. When I informed the person who was to be my crew mate for last night's shift that we would be working together, his instant reaction was something along the lines of "Oh oh...I'll make sure everything's properly stocked!" Nice, huh? But evidently wise thinking.

To have the reputation of a Jonah at work is not a good thing. It means that everyone's a little scared of catching the disease with which it seems I've been smitten. I like to look at it another way. I like to think that at least I get to put all my training, experience and expertise to good use.

So to my patients from last night, from the gentleman (and that's not sarcasm) who'd been shot, to the two patients with heart problems, to the lady who ended up in theatre last night, to the ambulance crew involved in the RTA, to the poorly (and sometimes drunk) diabetics, I'm sorry for being such a Jonah. But I hope that you're all the better for the experience...

Nights

Accidentally came across this article. The more I read, the more worried I get...

Drunk again?

On top of having a very busy shift with proper poorly people (again... my reputation as a jinx continued, more of that at a later date), I also had a very religious experience at work last night. We were called to an alcoholic to start off the shift who kept stressing to me the importance of believing in God. It was God who had got him where he is today. Lying in the street after collapsing.

I was a little confused to say the least... Do you mean that it's God who's made your liver and kidneys start to fail? Or make you drink at least 10 cans of cider a day? Or that gave you all those self-harm marks on your arms, most of which have required stitches or worse? It would seem, however, that I even had a lesson to learn from Mr Drunk.

It was God who had let him choose his path, and he had chosen badly. Or so he said. Now he wants God's help to lead him back to the rehab clinic so he can start again. I did advise that his GP could probably help him out by being God's messenger in referring him to rehab. But this gentleman was having none of it. He was waiting for God to deliver His message to him personally...

I await to see whether this GFA* remains on our regular callers' list or whether he receives his calling...

*God Fearing Alcoholic

Little People

Probably the nightmare of every paramedic worldwide is a sick child. It's the time where we all struggle to cope with our emotions at the same time as coping with the situation itself.

Ambulances are forever being called for children with temperatures and the fits that they can sometimes cause (called febrile convulsions, see earlier post), as well as children with just run-of-the-mill coughs, colds, won't stop crying type things.

Recently, however, I've been called to some very poorly children. If there's any call I'm likely to "take home" with me, it's these. These are the emotional ones. Even if I don't always realise it at the time. Maybe I'm more sensitive as I have Little People of my own.

Yesterday's shift brought us an 8-year-old boy who has severe learning difficulties and epilepsy. He usually has 2 or 3 seizures a month, but this time, he'd had six in the space of 24 hours. When we arrived we were met at the door by Dad who told us that Amir was no longer fitting, which is always a relief to hear. Mum was by the bedside keeping an eye on the little man. Both parents were very calm, obviously used to their son's condition, and despite their anxieties were able to put my crew mate and me at ease with the situation. I was sure it should be the other way round, but having parents who know about, understand, can explain about and cope so admirably with their child's condition just made the call that much easier to deal with.

So thank you to those parents who understand that the ambulance crews are human too, that we appreciate your help sometimes as much as you appreciate ours.

Weighty problem

This article, from today's BBC News, offers the view of the Fire Brigade on a problem which Ambulance Services are facing on a daily basis, with ever increasing frequency. Locally, the general rule is that the Brigade will only come to help us out if the patient is in a life-threatening condition.

The fact that we sometimes need to call on their assistance is a necessary evil. They have more equipment than we can carry, and generally have 6 personnel on their vehicle to our 2. It's a simple question of maths. Either we need 4 ambulances for one patient, or 1 ambulance and 1 fire appliance. I fully understand their frustration at the situation, but surely even the Brigade can see the logic of not taking 4 ambulances away from public service.

Insomnia

I wonder what these researchers have to say about people like me who only work nights... Is sleeping until lunchtime the same as having a lunchtime siesta? Doesn't bode well, does it...?

To call or not to call, that is the question...

Just as a quick suggestion, I thought I'd send the non-medically minded here for some advice on when it IS a good idea to call an ambulance.

After you've had a good read, allow me to give you a few ideas of when not to. These are calls that I have personally been sent to, so are not made up...

Please don't call if:

1) you have a paper cut.
2) you have been prescribed antibiotics for an ear infection, and 10 minutes after taking the first tablet your ear still hurts.
3) your mobile phone battery has nearly run out and your charger is not working.
4) you are a GP whose surgery is about to close and you don't know what else to do with your regular patient who's back again complaining of a sore throat.

There are many many more that I could think of, and if you're an ambulance person reading this, feel free to add some of your own. A prize of kudos goes to the most bizarre reason for a call out.

When you read you begin with ABC...

As it happens, tonight (for it is now 05.30 and I'm towards the end of another night shift) is a good time to start composing. I've had a fairly busy night, and for a change most of the people who called for an ambulance tonight, at least those who I was called to, genuinely needed the help.

Admittedly I'm working on a First Response Unit (FRU for future reference) so I'm supposedly called to the most genuine and serious calls, but that logic doesn't always work. A call to someone having a panic attack can easily be categorised as highly as someone having a heart attack. More of this at a later date.

There's been a range of breathing problems, chest pains, poorly children, allergic reactions and one RTC (or RTA or car crash...).

On the subject of poorly children, I'd like to offer some advice. If your child has a fever, please, PLEASE don't put 15 layers of clothing on them. Yes, they will complain it's cold. Yes, they will shiver lots and lots. But at least you'll be helping bring down the temperature and hopefully stop them from having a fit.

Oh, and another thing... Can someone please explain the logic of people putting toothpaste on burns??? Water? Yes! Burns dressings? Yes! Toothpaste? WHY???

Late starter...

So here it begins. After requests for suggestions for a name for this new blog, it has been chosen. The subject matter should be clear, but there'll be a random mix of lots of things. I know it seems that I'm just following the trend of ambulance blogs, and I'll shamelessly admit that it's true. I'm a sheep. But writing is good therapy, so I hope you enjoy it.

The name I use is obviously a pseudonym, but it won't take a genius for many people to work out who I am. I've only changed it on here to protect the guilty...

Having been a reader of Blogs for a long while, especially anything connected to the ambulance service, I realised (very slowly) that it was a great way to achieve several things. First of all, to get things off my chest. Despite the fact that most paramedics and EMTs (emergency medical technicians who are basically the same thing as a paramedic but get paid less money) will tell you that you can't take your job home with you or it'll drive you mad, but sometimes this job does just that.

Second, a little public education. Whether it'll be successful is open to much debate, but at least I'll feel like I've tried.

Otherwise, it'll hopefully be another insight into the world of a London paramedic. I'm aware that several of these already exist, but maybe I'll be able to give you a slightly different angle. I was an EMT for almost four years and have been a paramedic now for nearly three.

For the sake of ease of use, any time I refer to paramedics in general, I'm referring to EMTs as well.

Enjoy, feel free to comment, abuse or otherwise interact....