Thursday, 30 April 2009

21st Century Britain?

I was shocked. I tried not to show it, and hope I did so successfully. But I was still horrified. And the scene? Not one of traumatic injuries, not one of neglect, not one of abuse.
Sitting in front of me was Craig, a gentleman in his late 30's. He'd called the ambulance as he was experiencing chest pain. He'd had a heart attack about a year ago (they seem to be getting younger and younger), and now he had the same pain back again. He's supposed to be on a whole list of medications since his heart attack, but for some reason he's not been taking them recently. I asked him what medications he was supposed to be taking, to which he answered that he was on something for blood pressure, something for cholesterol, something for the heart. But he didn't know what any of them were called.
Craig's pain seemed to be easing with the treatment we were giving him. His pulse and blood pressure were sky-high, but his ECG wasn't too scary. This is 21st century Britain, so we have the technology to assess the patient, the drugs with which to treat him, the NHS to provide it all, so with a little luck (and some self-discipline!) Craig should be OK.
But is this really 21st Century Britain? The reason Craig couldn't tell me what medications wasn't due to a memory lapse or an inability to pronounce the names.
Craig is illiterate. That's what shocked me so much. Maybe I'm naive, but I can't see how someone who grew up in this country in the last 30 years can be in a position where he can't read or write. How can we be proud of all we've achieved when there are still people on our own doorstep who seem to live in the 3rd world?
21st Century? I think we still have some way to go to catch up...

Tuesday, 28 April 2009

Licence to kill?

I must admit that I don't normally read the "red-top" newspapers, but when I heard the discussion on the radio this morning about this article, I had to go straight to the source and read it for myself.
Several thoughts ran through my head as I listened and read. None particularly complimentary.
This girl, who at the age of 24 isn't really a girl any more and should definitely know better, must be either:-
a) naive,
b) uneducated,
c) stupid, or
d) lazy.
The thing that scares me a little more is that there's a fifth possibility. Maybe she doesn't care. Maybe she's using her children and her story for her own personal gain. If that's the case, then I believe her children should be taken into care.
Somebody needs to tell this woman that with her behaviour she's condemning her children to a lifetime of obesity, illness, disease and mental anguish. And all of that probably before they even finish primary school.
As parents we need to take care of our children's present. But paramount in our minds must also be our responsibility to ensure that their futures are the best we can provide too.
This woman seems to think that as they are her children and it's her life, she has a licence to do whatever she pleases. But I, for one, don't believe that she has a licence to kill....

Monday, 27 April 2009

Just a saying?

It's always been the phrase that demonstrated complete disbelief in something. Anything. But apparently this is no longer the case.
As if we didn't have enough to worry about in the ambulance service, the first two cases of Swine Flu have been confirmed in the UK. Allow me to hazard a guess that we'll have a few calls over the coming days and weeks from people who've sneezed once, and now think that they have this disease. It happened with Bird Flu. I had at least three calls to people who thought they had Bird Flu. These people hadn't been anywhere near birds. Or even have flu-like symptoms. But they got so caught up in all the hype, that they were certain their diagnosis was correct.
So just in case you're worried, if you've not been to Mexico or the affected areas in the USA, if you've got a cold but no fever, if you're just feeling a little under the weather, chances are that you don't have Swine Flu...
But apparently, despite history proving otherwise, Pigs CAN fly...

Sunday, 26 April 2009

Fast food?

The scene: My local restaurant / take away
The time : Judging by the noises my stomach's making - Dinner Time
Number of people I recognise: Zero (Not unusual for me to survey the scene. I'm suspicious by nature. Very unusual to spot no-one I know)
"You're a paramedic, aren't you?" says the stranger as he taps me on the shoulder. An ominous question if ever I've heard one. I'm not in uniform either, so there's no clue to my identity. I fear a question on athlete's foot, or tennis elbow, or worse... But I'm certain I don't know this person, so I suspect that it's not something quite that trivial. I risk it. "Yes I am..."
"And you went to a car crash on the North Circular Road didn't you?"
"I'm sorry, sir, but I've been to far too many car crashes on the A406. It's notorious for them". I try to concentrate on my food order. Undeterred, the gentleman, probably in his late 50's, went on to describe an RTA that I'll never forget.
The car was stopped in the inside lane with it's hazard lights on after breaking down. The car that used to be a family-sized car looked like a Smart car. In the boot of the car was a large truck. Not the normal thing you tend to carry around in your boot. By the side of the car was a baby seat, with baby still inside, screaming. In the front passenger seat was the driver, who was completely trapped. The reason she was in the passenger seat was because she'd somehow foreseen the imminent danger and had very quickly unbuckled the car-seat and literally thrown the baby out the car before the impact. (I believe that miracles occur all around us, all the time. We just need to open our eyes more...)
Babies screaming is usually, strangely enough, a good sign for a paramedic. As, sometimes, is a screaming adult. But this time the adult was silent. Becky probably in her mid to late 20's, wasn't moving, wasn't talking, yelling, or doing anything. Other than breathing. Very very quickly, but breathing nonetheless. The extrication was time-consuming and difficult. The Fire Brigade cut the already destroyed car into even smaller chunks, and we were able to eventually move Becky out the car. She was strapped to a back-board to ensure her back was kept straight, and had her head and neck immobilised to prevent any spinal or nerve damage occurring or worsening.
In this sort of condition, there is little time to worry about other injuries, but we noticed that she also had a broken arm, broken leg and we had to worry about internal injuries as well. Once Becky was in the ambulance we took her to the nearest trauma centre, along with the screaming baby. Just before pulling into the hospital Becky opened her eyes. She was completely confused, and her instant reaction was one of horror. She wanted to know where her baby was, and if the baby was ok. We showed her the baby, and the weight of the world seemed to lift off her shoulders. She even managed a smile. We handed over our now-no-longer unconscious patient to the hospital team, and went about the mundane tasks of paperwork and tidying up the ambulance before leaving the hospital.
As the hospital is not one to which I regularly take patients, I had no way of following up her progress.
"Were you one of the paramedics at that crash?"
"Yes, sir, I was. But I don't remember you being there"
"You wouldn't, because I wasn't there. But my daughter Becky was, and she recognised you as soon as you walked in. She's sitting over there at the table. She finally left hospital yesterday, and we're having a family dinner to celebrate! She wants to thank you in person, and wants to know if you'll come over to our table?"
Three months after the crash in which she saved her own baby's life and nearly lost her own, she was able to go out for a family dinner to celebrate her recovery.
We very rarely get to follow up on our patients, and it's even more rare to meet up with them, so it was an exceptional moment for both patient and paramedic. "Thank you. So, so much" said Becky. Her eyes welled up with tears and she gave me a hug that seemed to convey all the anger, confusion, frustration, sadness and eventual joy of the past few months, in just one moment.
And all I wanted was some fast food for dinner...

Saturday, 25 April 2009

On a lighter note...

After the recent "heavy" blogs, thought I needed to lighten the mood a little. Can someone please explain how I managed to miss out on being a part of this research project? Getting paid to eat chocolate? What a great idea...

Thursday, 23 April 2009

The hardest job in the world...


The challenge of working on my own;
the need to think quickly;
the ability to act independently;
the satisfaction of being able to start stabilising the patient before the crew turns up.

Being left on my own when the patient desperately needs to get to hospital;
the associated risks of working on my own.

Being on my own and having to tell someone that their best friend has just been killed in a motorcycle accident when they were both riding home together.
I arrive on scene to see dozens of police officers. Most looking shocked. Some physically shaking. One is clearly in tears. As I'm about 50 metres from the scene of the accident a man runs in front of my car and stops me getting any nearer. He comes to the door of the car, swings it violently open and pulls me out the car. He's shaking, pale, and screaming louder than I've heard anyone scream for a long time. There are a lot of bystanders too. They're also yelling and screaming.


I grab my equipment and run over to the estate car on the side of the road. And there he is. His motorcycle is nowhere to be seen. At first all I see is a leg sticking out from under the car. His other leg is under the wheel. There is so much blood I start to wonder where it's all coming from. I take a proper look under the car, and it takes me very little time to realise that this patient is beyond help. There is nothing I or anyone could do. Apart from the fact that he is under the car and I can't get to him properly. Even if I could get to him, there was nothing left that could be done. It was clear he was not breathing. Cardiac arrest post traumatic injury equals practically no chance of survival.

After a few minutes a crew turns up. I tell them of my findings, and in a last-ditch attempt, maybe a clutching at straws, we remove his boot to check for a pulse in his foot. We find none.

Eventually the Fire Brigade lifted the car and our fears and suspicions were clearly confirmed. The driver had in the meantime run away from the scene. (I hope when they catch him they... actually, I don't know what I hope...)

All the while, the man who pulled me out the car is walking about, clearly distressed. I discover that the man under the car is his friend. They were both on their way home from the office together. Both riding bikes. And his friend was under this car. I'm sure he realised that he was dead. I'm sure that he knew there was nothing I could do. But he clearly couldn't accept it. He must have yelled at me at least a dozen times before the crew turned up that I should be doing something.

I wish there was something I could have done.

I wish I could have found the way to tell him what he already knew in a way that didn't bring both of us to the verge of tears.

Sometimes I hate my job.

Wednesday, 22 April 2009

Not so lucky man...


I'd been busy all shift on the FRU, and it was beginning to look like I wouldn't get my rest-break. That could mean going home a little early for a change. It did, however, mean that I wasn't getting back to station for my food either... Finally, after calls as varied as an RTA with 6 people and only me to send (admittedly, and luckily, only two needed treatment) to an asthma attack, to a man vomiting blood (probably self inflicted due to alcohol abuse) and various others, I was allowed to have a break. I stopped, had something to eat, and waited...

Just when you thought that Jonah had left the building...

2 minutes after the end of my break, my phone goes, as does the station phone activating one of the ambulances. I yell "see you there" and go to see what the call is. The call is given as a stabbing. Police on scene. Maybe. Control calls me to say "hang back a little until we confirm that the police really are there, but just so you know, we've had reports that it's a lunatic with a machete". Nice... I hide around the corner, until the ambulance pulls along side and says that they've had confirmation that police are there. We arrive on scene together.

There are approximately 8 police cars. That's never a good sign. There are some pale looking police officers. Not a good omen either. There are some other officers making frantic windmill impressions. Definitely bad news. We arrive to find a man lying in the street, unresponsive. There's a bandage on his head and one on his arm. Both just placed on top, not tied down, which makes it a little easier for us to take a look.

Lunatic with a machete is long gone, but his "handiwork" is plain for all to see. There's a massive injury to the face, from the cheek to the temple. Sliced clean through to the bone, in the places where there is bone. And an arterial bleed. From the head. As there are three of us on scene things happen in a bit of blur of activity. There's bandaging to be done, we need to immobilise the patient as we have to suspect a spinal injury as well. We need to check for other injuries, especially to the front and back of his torso. We find none. He needs IV fluids, and he needs to be in hospital.

With trauma calls it's especially important to remember to do things in order. There's no point stopping the bleeding, which is what normally jumps out at you, if the patient can't breath. ABC. Airway, Breathing, Circulation. He was maintaining his own airway, and breathing on his own with no problems. So we could deal with the C problems. We had the head injury bandaged and moved to his arm as well. This also had a large laceration. All through all the skin, fat, muscle. The bone was again clearly visible, but at least no arterial bleed this time. We took him to the nearest trauma centre, and left him in the care of the staff there.

This man was clearly not as lucky as the soldier in Afghanistan. It does make me wonder once again though, which is the country with more problems...

Monday, 20 April 2009

Lucky man!

In today's BBC news website is this report on probably the luckiest man in the British Army. I was particularly amused by his description of the Medic looking queasy...
There's only one time I remember feeling queasy and going positively pale "in the line of duty", and that was when I had a call in a dentist's surgery. The call itself was fairly routine, but...
I don't do dentists. I get palpitations at the mere mention of the word, and chest pain every time I walk past a dental surgery. My crewmate at the time never lets me forget it either...

Home Alone

The smell of stale urine hit us as soon as we crossed the threshold. It's a smell that we encounter time and time again, and yet never fails to hit my lungs like a sledgehammer.
We've been called to Dorothy, a lady in her 80's who fell and has since been unable to get up. It's another of our "routine" calls. We expected to see Dorothy on the floor, but she was in her favourite armchair, sitting drinking the tea that her carer had just made for her. A little confused, I begin questioning Dorothy as to what happened.
She had apparently fallen 24 hours earlier, managed to get to her armchair, and has been sat there ever since, unable to get up, despite many attempts. She's not in any pain, doesn't seem to have any injuries, and her basic observations were probably healthier than mine... We helped Dorothy to stand, and with almost no effort she was off walking around the house using her zimmer frame. As if there was nothing wrong at all. She didn't want to go to hospital. She didn't want a doctor. She just wanted to be able to get up and walk around like she normally does. Problem solved? Not quite...
Dorothy lives in a first floor maisonette with no stair-lift and can't manage stairs. She can't cook for herself or bath herself. She can't go shopping. She has no mobility aids at home. No alarm system if she falls. A carer comes in once a day, but that's no where near enough. Her only next-of-kin is her older brother.
Once again, the role of the Paramedic includes social care. We are sometimes exposed to sights that are worse than any traumatic injury. We see abuse. We see neglect. We see heartbreaking loneliness.
There's very little we can do, other than fill out the form that goes to social services, and they can then reassess the patient and hopefully give them the extra care we need. But just like it was with Jim and his mum I can only hope that Dorothy's case won't be left too long. I hope they help her before it's too late.

Monday, 13 April 2009

The 4th Emergency Service???

It's always a little daunting to get a call on the motorway, as more often than not it's an RTA, and invariably it's quite nasty. So when I saw the call on the screen saying M1 motorway northbound, the adrenaline kicked in a little. Then I read the rest of it. No RTA, no carnage. Just a car at the side of the motorway, diabetic driver, feeling unwell. Nevertheless, off I sped to find said car in the hard shoulder.
Anyone in EOC (Emergency Operations Centre or Control in normalspeak) watching me on the map would have been having a good giggle... I started at the bottom end of the motorway, travelled all the way up to where the car was supposed to be, and further until I came off one junction further than I needed to. No car in any hard shoulder. So I turned around and had a look in the other direction. Still no car. Turned back up the motorway and called EOC to see if they could trace our elusive diabetic.
After a few minutes a somewhat confused sounding gentleman from EOC called me back. Apparently the call had come from a neighbouring Ambulance Service who'd got all the details a little confused. The "patient" didn't want an ambulance. He wanted the AA. His car had broken down. Not him. But he did tell the AA he was diabetic, so that they would get a move on and get him home. Someone, somewhere got very confused.
Mr AA Man turned up well before we did, with bar of chocolate in hand for Mr Diabetic. By the time I'd driven up and down the motorway, his car was being towed home, and he was making sure that his blood-sugar levels were still normal...
4th Emergency Service? I guess so after all!

Wednesday, 8 April 2009

Thank You!

Just a very quick post to say thank you.

Unfortunately my Dad had to be on the receiving end of the services of the Ambulance Service, with a nasty LVF. As I can't find the Ambulance paperwork to locate the crew of the FRU and ambulance in order to write you a personal letter, this will have to suffice for now.

So to the Essex Ambulance Service FRU and crew who were called out at about 4.30 yesterday morning - thank you.

And he's doing OK. Just waiting to be evicted from his local hospital...

Sunday, 5 April 2009

Doctor, doctor...

I have had several cases recently where on arrival at the A&E department we are met by members of hospital staff who are, shall we say, less than aware of the Ambulance Service's involvement in a patient's chain of recovery and survival.
I'd like to see a lot more doctors, especially those in A&E, spending more than just a voluntary shift on an ambulance. I think they should have a week as part of their A&E rotation actually on shift with an ambulance crew. Too many of them seem to think either that all their patients appear magically in their resus rooms, or that Paramedics just scoop the patients up and wheel them in to hospital.
I've had too many cases where the doctors simply don't believe that the patient who was at death's door when the ambulance put in the blue-call* could have made any sort of recovery by the time we arrive at hospital.
Calls like:
- the 9-month-old in anaphylactic shock who had practically recovered by the time of arrival.
- the patient who was in cardiac arrest who's now trying to sit up and talk
- the 30 year old who'd had several seizures who then seemed nothing more than a little confused, or
- the elderly lady who was practically breathing her last, but the doctor was too busy to do anything about it and too busy being incensed by the fact that we'd actually treated her, rather than just picking her up, throwing her in the back of the ambulance and dumped her at the door of the A&E department.
These patients don't recover by magic. Ambulance staff may not be doctors, but we are trained and experienced in treating many acute conditions that enable us to get the patient to hospital in a much better condition than they were initially.
Don't get me wrong. You can't tar an entire population of doctors with the same brush. There are plenty who are very pro-ambulance and understand our role. But there seem to be some out there at the moment who, for one reason or another, despise the Ambulance Service. They seem to hold us in contempt and resent the fact that we actually treat patients.
I, for one, do not appreciate a doctor who doesn't have the common courtesy to listen to a handover. I do not appreciate a doctor who takes one look at a patient as we're off-loading and sucks their teeth at me. I do not appreciate the doctor who, in front of a roomful of people says "It's not possible. You must be wrong about what you think you saw". If I'd have been equally as unprofessional, I'd have announced in the same fashion that I have the evidence that proves I'm right.
So, doctor, come and join the Ambulance Service, just for a few days. Try cannulating in a dark alley, try intubating a patient under a dining-room table. Try giving injections whilst moving at 60mph. Come and learn about all the things we can now do. We are no longer the Ambulance Service of 30 years ago. We are highly trained, highly skilled, and very much a part of the same team that you're on. So come on-side again. You may be pleasantly surprised.
*Blue-call: Priority call made to the hospital by radio or phone to pre-alert them that we're coming in with a particularly unwell patient. Gives the hospital time to prepare the basics for immediate treatment.

Saturday, 4 April 2009

Phone Rage Too...

RapidResponseDoc has written a brilliant post on the disease which I think, to some extent, all paramedics suffer from. I know that I do. Phone Rage is a disease, but I think it's one I don't mind having. I also have Child Not Wearing Seatbelt Rage, but more of that another time.
Whilst out walking with my hyperactive kids, waiting to cross a fairly busy, but nevertheless 30mph road, two cars, obviously racing each other, went flying past us. They must have been travelling at least twice the speed limit. One of them was clearly holding his phone to his ear.
Ten seconds later there was the very satisfying sound of a police siren, as a police car that had been well hidden pulled out of a side road, and tugged the two of them. Even more satisfying was walking past the scene again about an hour later (still with same hyperactive, but now somewhat exhausted kids) to see the car belonging to Mr I Own The Road being loaded onto a tow-truck.
I know that it's wrong to gloat, and I know that revenge is a nasty thing, and I know you shouldn't wish ill on people, but.......................
I'd rather there wasn't a need for Phone Rage, but while there are selfish drivers out there willing to (break the law and) put me and other innocent people at risk, I'm not planning on any therapy for my Phone Rage problem.
And by the way - Well done RapidResponseDoc!

Friday, 3 April 2009

A Mother's Love

Working permanent night shifts on an FRU means that I often spend a while with the patients before a crew is available to come to my rescue... Or that of the patient's, depending on which way you look at it. Although sometimes that extra time on scene allows me to make a much fuller assessment of the patient's needs, other than the presenting medical emergency.
Jim is in his sixties, with very bad mobility. I've met him a few times before, usually just to help him up off the floor. He normally walks using a Zimmer frame. Last night his frame let him down, literally, and Jim found his head going through a large glass door. When I arrived he'd managed to get himself propped up on a pile of clean laundry. Now not so clean, due to the blood. He was very much conscious and alert, and although he couldn't even see me as I came in to the house, his first comment was "I see you're back again..." .
The lounge is the first room you come to and it's tidy and clean. At the back of the lounge is what I guess was meant as an extension to the house, but has now become Jim's bedroom. The room's a mess, now even more so with all the blood and glass everywhere. It's a complete contrast to the rest of the house and I find it a little difficult to understand why. In his room he has all sorts odds and ends that he's collected over the years, as well as a painting that's only half way done. This seems to be his pride and joy and he tells me how much he's looking forward to finishing it.
In the meantime I've checked Jim's observations, found them on the whole to be OK, and tried to clean the back of his head where the hair is all matted with blood. I've found that he's still covered in shards of glass, there are about four or five cuts to the back of his head, one of which is still oozing. I'm concerned that the cuts still have glass in them, but it's impossible to see without properly cleaning the whole of his head and that's not really possible, so I place a bandage on his head and wait for the crew to turn up.
All the while, Jim's main carer has been there watching and trying to help where possible. The only problem is that Jim's main carer is his Mum. She walks better than Jim, she does his shopping, his laundry, his cooking. But she's in her 90's. 93 to be exact. She's as fiercely independent as she is deaf. I offer to help clean up the glass. I offer to try to get them some extra help. I offer to get social services more involved by filling in what's known as a Vulnerable Adult form. Both for her and Jim. But she's having none of it. All she's concerned about is how Jim's doing, how long Jim's going to be in hospital for and how he's going to get home. She won't let me back into the house to help clear the mess, and she really doesn't want me to fill in any forms. She just wants to continue to look after her home and her child.
She doesn't need help. She just wants to be his mother.
I hope I did the right thing. I went back to station and filled in the forms...