Time Out

Dear Blog,

I promise I haven't forgotten you. I'm on holiday. A real, proper, time off work, away from it all, sunshine and beaches, holiday. But don't worry. I'll be back in a few days when normal service will be resumed.

Yours sincerely,

Ben the Insomniac

School's (knocked) out!

It was a grey and overcast day, which was normal.

It was cold, which was normal.

I was waiting to pick up my kids from school, which was normal.

I was asked by one of the mums if I was the paramedic, which was, surprisingly, normal.

She told me that the school had just called an ambulance. This was definitely not normal.

After initially being told by the school admin staff to mind my own business, they did eventually let me in to go and help. Apparently a 10-year-old child was knocked out in the playground. Having been called more times than I can remember to schools to an unconscious child who wasn't, I was a little skeptical. However, as I got to the playground, I saw that this time was different. The child was unconscious. She'd been knocked over by another child as they ran in different directions, and a teacher who saw it happen described how her head hit the floor and nothing happened after that. Slowly she started coming round, and seemed to be in a post-fit daze. She'd been incontinent, which often happens when someone fits. A fit after a head injury can sometimes indicate a serious injury, so I was a little concerned.

With very little kit I felt kind of useless, but luckily I didn't really have to do very much other than to keep her airway clear, keep her calm, and keep her still. I once again had in my mind "So this is what it feels like to wait for an ambulance"... The crew turned up a few minutes later, and I was pleased to see that I knew one of them. It made the hand-over easier, as I didn't have to explain who I was and what I was doing there. They immobilised the patient, and by the time they were ready to go, her mum had turned up as well, so she went with them too. Job done, I went back to picking up my own children.

Kids. Who'd have 'em???

I really shouldn't be let out in public any more. I just seem to attract trouble. Or maybe it just attracts me...

Chauffeur driven...

In my introduction to this blog, I wrote that for ease of use, whenever I talk about Paramedics, I'll be referring to EMT's as well. In a large number of our cases it makes no difference whether the crew are made up of either. However, every so often, the advanced skills that the Paramedic has been trained in are required. If that Paramedic happens to be a single responder in a car, and the crew that turn up are EMT's, then the Paramedic might end up travelling with the crew to hospital.

Richard was, according to the call we'd been given, nearly 80 years old and having an allergic reaction. I pull up on scene only seconds ahead of the crew, and we're met by a relative looking frantic.

"How bad is he?"

"Not sure, but I don't think his breathing's very good. He looks blue!" At that, I pull all my bags out the car and get moving. We walk in to the room, and at first glance we all thought that we had a resus on our hands. Richard was very blue, unresponsive, and for the first few seconds he didn't take a breath. A few seconds longer and the first breath was drawn. He was breathing at around six times a minute. We instantly put him on oxygen and his breathing picked up with little further intervention. In fact, by the time we arrived at hospital, he was at 40 times a minute. One extreme to the other.

With a very poorly patient, like with the trauma patient, it's vital to remember ABC's. So we started at the beginning. A - airway - clear. B - breathing - better than it was, air going in and out of both lungs. C - circulation - ah. No bleeding anywhere that we can see, but a blood pressure so low (about 50/30) that it's almost unreadable. We decide that Richard needs to be a little more stable before we even think of moving him. Gone are the days in the Ambulance Service of "scoop and run".

This is where the Paramedic bit comes in, and the reason I would have to travel with the crew. We decide that it would be a good idea to give Richard some fluids before we transfer him to the ambulance. A needle in the arm and 500 mls of fluid later and Richard's BP is still not great, but a little better, so it's time to move. Ideally we'd like to keep him flat, but that's just impossible in this house or on the route out of it, so stick to using our carry chair and regularly assess him on the way to the ambulance. We reassess Richard in the Ambulance, his BP is still low, so as we start moving (fairly rapidly, having put in a priority call to the hospital), I decide to put another IV line in his other arm and give him some extra fluids. Just as well, as he decided to pull the first one out as we were travelling.

As we arrive at the hospital there is an improvement in Richard's condition. He's responding to some questions, his vital signs were better, and we're quite proud of our efforts.

Time to get back to my car. The crew who have kidnapped me ask control to return me to the scene of the call, but are given job after job, and I end up staying with them for several hours, unable to get back to my car. To be honest, I was pleased of the company, and it helped pass the night even quicker. Eventually I was abandoned at the hospital when another FRU came to my rescue.

In fact, I enjoyed being driven around so much that night, that I came back the following night and worked on a "proper" ambulance... Chauffeur driven again!

Losing Trach...

2am, Tuesday: "97 Local Close, Nearbury. ?75 year old female, Breathing problems, unable to hear patient properly".

Could be anything really, especially at 2 in the morning. I park the FRU outside the address and remember to leave a space for the ambulance. They're going to be doing the carrying after all... I find the front door open, so knock and walk in. I find Gillian sitting at a table, breathing about 60 times a minute, and a great rasping noise coming from her neck.

Gillian has a surgical tracheostomy. You can read about these here. At least I now know why control couldn't hear her. She's grey, clearly distressed, and tries but fails to tell me what's happened. Her oxygen levels are very low, so I attach an oxygen mask to the trachy site as best I can. Within a minute or so Gillian's oxygen levels begin to improve, and she's breathing a little slower, but she is still very much struggling to breath. Her chest sounds like there's an army marching through it. Her other observations are ok, other than a slight fever. She tells me in two-word sentences that the last time she felt like this she had pneumonia, but it took 3 visits to hospital until it was discovered.

The ambulance arrives after a few minutes, Gillian is feeling a little better, but nevertheless we take the decision that she should be "blued" into hospital. I suspect that she has a chest infection that's turned nasty, and promise her that the hospital will look after her.

2 am, Wednesday: "97 Local Close, Nearbury. ?75 year old female, Breathing problems, unable to hear patient properly". What? What?? I was there 24 hours ago! But back I went, knocked on the door and walked in again. Gillian looked, and smiled as if to say "Oh no! Not you again...!". This time she wasn't quite as grey, but still finding breathing difficult.

"They cleared my trachy site, and sent me home. But I just don't feel right."

We started everything all over again. The observations, the oxygen, the words of comfort. I remember telling Gillian that the hospital would look after her, but I'm not sure they were able to back up my confidence in them, and feel bad for promising something I couldn't really deliver. A different crew turn up this time, I lock up the house, and say goodbye to Gillian.

"See you later" she says back to me.

"I mean this in the nicest possible way, but I hope not..."

Guess I'll have to wait and see.

No More Mr Nice Guy!

There's an almost 100% chance that if you're nice to me, that I'll be nice to you.

I don't care if you're male or female.

I don't care if you're black, white or anything in between.

I don't care if you're Christian, Hindu, Jewish, Muslim or Zoroastrian.

I don't care if you're old or young.

I do care if you're ill, and even if you really didn't need to call an ambulance, I'll still be polite. Even if you're drunk. And I hate drunks...

But.... If you feel it necessary to threaten me with a gun, a knife or a golf-club, if you feel it necessary to say you're going to kill me (even if it's in a foreign language which I may or may not understand), if you fancy throwing a punch at me, then that almost 100% chance of me being nice, drops instantly to almost 0%.

Yes, I will walk away from your friend or relative. Yes, I will refuse to treat them. And, Yes, I will make sure that your address has a red-flag attached to it on the computer system, so that you can never again have an ambulance to your address without the police turning up too.

I am fed up at having to wait for police to turn up for these calls, but that's your fault. Once you realise that you are responsible and accountable for your behaviour, once you realise that your actions have reactions, and once you realise that I deserve to do my job without being threatened, I'll come back to your home and try to be nice again.

Insomnia II

Although this guy isn't me, it might as well be.... Makes for interesting viewing! Would love to be able to try his cure, but shift work isn't exactly conducive to routine... Oh well, back to the drawing board.

A Different Thank You

For the first time in a very long time I had an FRU shift with long lulls interrupted by short working episodes. Normally it's very much the other way round. So I had some time to read, study, think and generally laze about. I was driving randomly around the area I cover to stave off the boredom when the on-board computer rings and jolts me out of my thoughts. Half way through the shift and only my second call.

70 year old female, unconscious, breathing. Head back where I've just come from... Typical. Whilst on route, I hear control call over the radio to ask if there are any ambulances available to help cover my call, which means I could well be on my own for a while. Something tells me to prepare for the worst, so when I arrive on scene I take all my luggage with me, not just the bare essentials.

I arrive to find the front door open, and call in to find out where the patient was. The strangled, distressed cry from upstairs tells me what I already feared. Not the words, just the voice. Upstairs, lying on the bed, cyanosed, not breathing at all, is Grace. "She's been like that for about 10 minutes now. She hasn't been right all day, but she just decided to sleep it off!" Grace's husband is beside himself with anguish. We move Grace onto the floor and I begin CPR. It's too difficult for him to watch and he tries to cope by calling members of his family.

In the meantime another FRU and a crew turn up and the resuscitation attempts are in full swing. More and more members of family turn up, adding to the emotion of the situation. We shepherd the family into one of the rooms downstairs while we carry Grace downstairs. It's not a very dignified process. It's a mess of arms and legs, squeezing round corners, over banisters and other obstacles. Despite the fact I have no problem with family members watching a resus (for some it's therapeutic), I think that the one thing they don't need to see is carrying their loved one down the stairs.

Grace kept fighting all the way to hospital, and we kept fighting for her. One of her relatives came with us in the ambulance. We arrived and handed over to the hospital team, who continued our efforts. After a while, when it became apparent that there was no more that could be done, the team stopped the resuscitation and went to talk to the family. By this time there were quite a few members of the family at the hospital, hoping for the best, and at the same time fearing the worst. The doctor explained all that had happened, and that despite our best efforts, Grace had died.

We were sitting filling in our paperwork when the family filed past on a sombre walk to see Grace for the last time. The lady who came with us in the ambulance stopped and told the rest of the family that we were the ambulance crew who'd tried to save Grace.

One by one they walked up to us, shook our hands, and said thank you. It was probably the most moving thank you I'd ever received.

Then they went on to say their final goodbyes.

Babysitting

As I work mostly on the FRU (First/Fast Response Unit) at the moment, I am supposedly tasked to the calls that are graded as either Red or Amber, so they are either immediately or potentially life-threatening. Supposedly, both because the system doesn't always get it right and because a call to someone having breathing problems from asthma and breathing problems from a cold are graded the same. A great deal depends on what Ambulance Control gets told on the phone. Anyway, I digress slightly...

A call to a 9-month-old choking is definitely worthy of being a Red call, the highest priority. I'm about 4 miles away, and if they're sending me, I must be the nearest. There's nothing quite like a call to a poorly child to get the adrenaline going, and I often find that I drive a little quicker to these calls. After driving 3.9 miles, the call is updated, the baby has stopped choking and is now breathing properly. The call is regraded to Green, the lowest priority, to which FRU's aren't sent. Nevertheless, as I'm within sight of the house, I call control and offer to go in anyway, just to make sure that all's well. As they have no other ambulance to send within a 15 mile radius, I think they were grateful of the offer.

I'm greeted downstairs by dad. He's looking a little pale, but clearly on the recovery stage from whatever the shock was.

"Thanks for coming so quick. Come and meet them".

"Them? There's more than one patient?"

"Well, there's only one patient, but there's more than one baby..."

Ah. Well that I can cope with. I go upstairs to meet these babies, only to find that they aren't 9 months old, but 9 WEEKS old. And they've only recently come out of hospital after being born very prematurely. One of them choked on their milk, couldn't breath and went very blue, but dad had managed to remedy the situation just before I turned up, so all was well. It's fairly common in newborns, especially if they were born prematurely, to struggle a little with feeding, but this was about the fifth time that it had happened, so we decided that it would be best to send baby back to hospital for a check up.

Except that, if you remember, there was no ambulance to send. So I'd have to wait. One dad equals one pair of hands. So where's mum? She's out with another one of the babies... Yup - triplets!! And there's lots of things to get ready if you're going to take multiple babies out. A friend was looking after the "patient" who was completely unharmed by the ordeal and was slowly dropping off to sleep, dad was getting organised and eating something on the move, and I got to look after the other baby. My kids are somewhat past the stage of being bottle fed and rocked to sleep. So getting the chance again, and especially with such a tiny baby, was a really nice change of pace. Waiting an hour on scene on my own for an ambulance doesn't usually fill me with glee, but this time I wasn't in such a rush...

Not exactly ambulance work, but all part of the service.

Traumatic Racism

What's going on? I'm not used to this sort of behaviour... I don't attract trauma calls! My colleagues might disagree, but I'm sure I never used to get called to so many people with traumatic injuries. Another day, another stabbing. The area where I work has its fair share of anti-social behaviour, but there seems to have been an upsurge in the more serious type, including shootings and stabbings.

This time it was a male in his 30's. The call came in as stabbed in the face, and I was told to hide somewhere away from the scene to ensure that police turned up. As I was just about to hide, a stream of police cars, marked and unmarked, went flying past me on blue lights. I had no doubt that they were going to the same place I was, so joined the convoy. It must have looked to the general public that war must have broken out somewhere.

The man is standing in the street, looking a little pale, and covered from head to toe in blood. He was with a group of friends who were totally intent on keeping the police out of the property where they all lived. The patient had a very deep slash mark on his face and a stab wound in his shoulder. He was, unsurprisingly, a little agitated and kept trying to walk off the back of the ambulance. Eventually it seemed that the reality of the situation hit him, and he fell onto the trolley bed in the ambulance and allowed us to treat him.

When his friends were asked what had happened, they claimed that he was approached in the street by a group of 4 or 5 people of another ethnic group to their own, and just randomly slashed across the face. The police seemed to think that the attack happened in the property, and was an altercation between the "friends". In an effort to cover this up, they had to find a scapegoat. So they blamed an unseen, but clearly identifiable group who looked completely different from them.

Now, the word ALLEGEDLY should be plastered all across this post, because it's all pending an investigation by police, and probably go to court. Still, I couldn't help but feel that the reason behind their story was not just one of hiding the truth, but had a nasty element of racism behind it. It was almost a case of finding an easy target to blame, one that was easy to believe. One that the police, at least initially, wouldn't question and that the ambulance staff wouldn't bat an eyelid at.

Which made me think that maybe I was guilty of it too.

A Fighting Chance

Having read the guest post written on Medic999's blog, it made sense to talk about the good that bystanders CAN do. The call I'd been given was to a 60 year old male unconscious but breathing. In the special instructions box it said that a neighbour was on scene, had done CPR and the patient was now breathing again. A hunch told me otherwise.

When I turned up the patient wasn't breathing and didn't have a pulse, so I started CPR again, while the neighbour told me about the patient collapsing, him doing CPR and the patient suddenly taking a deep breath, so he stopped. As he'd had lots of training, I asked him to help me while I waited for a crew to arrive, which he did very ably. Having an extra pair of trained hands when trying to resuscitate a patient is always helpful. It means that I can continue with further skills, such as securing the airway and giving drugs, while they keep going with the vital basics.

He continued to help us throughout, either with CPR, with equipment, with anything that he could, even once the crew had turned up. We spent about 45 minutes on scene with this resus attempt, as the patient kept showing signs that he was fighting back. He was shocked with a defibrilator, given drugs, had continuous care and resuscitation, and eventually his pulse and breathing returned. We blue-lighted the patient to hospital, where he was still, literally, fighting for his life.

CPR doesn't usually restart a heart, but it does keep the heart "alive" for longer so that we can shock it back to life. This man was given the best fighting chance by a bystander who didn't just stand by.

Trapped Victim!

RTC, hit-and-run, 20 year old female trapped, unable to move legs. All conjures up images of a bad accident, and I was on my way to it in the FRU. As I was nearing the site of the accident the screen updates with further information, but I can't take it all in as I need to watch where I'm going. Out of the corner of my eye all I see are the words Police, Pick-up-truck, conscious. I guess the last one is a good sign. I arrive at the location, expecting to see some other blue lights at this serious accident, but there are none. The location is a junction of a busy road and a small side road. There's nothing there. I take a proper look at the screen and the update, and now see that the patient is "waiting in the car on the side street". Well, I kind of expected her to wait if she was trapped...

I turn into the side road and find said car. It has a minor scrape down the drivers side, that looks more like it's been keyed than hit in a major RTC. There's also a dent to the front wing. And the driver's just sitting there as if nothing's happened. Confused, I approach the driver and ask what's happened.

"This truck just hit me and drove away. I waited ages for the police to come but they didn't and then I got tired of waiting and I was causing a traffic jam so I drove home!"

"Where and when did this happen?"

"In town, about an hour ago."

I'm sure you can hear the incredulous look on my face at this point.

"You drove all the way home from town, got into your own street, stopped the car, and then called an ambulance? Why???"

"Because the police were ages..."

"Do you need to go to hospital?"

"No, but I want paperwork to say that I'm injured."

Except that she wasn't injured. She had a slight bruise on her knee, but could walk with no problems. I'm not even convinced that the bruise wasn't an old one. In the meantime the police have arrived on scene, on blue lights and at a rate of knots, and did exactly the same double take as I did. I explained the situation. I also cancelled the other ambulance that was on its way to back me up. The officers looked equally as incredulous as I felt. I explained that I was just completing paperwork and that they could speak to the driver.

One officer's look changed to a knowing look. He muttered something about "wasting police and ambulance time" and "she can't think she's gonna get away with this". I hope he stuck to his guns, but I'd left them dealing with it and didn't hang around to find out.

Trapped victim? Trapped in her own selfishness and stupidity if you ask me...

Bread and Butter

There's no such thing in the Ambulance world as a routine call. Every time you dare to entertain the thought of "I've seen it all", something will jump up and bite you.

This time it was a Green call. No lights and sirens. No dire emergency. Just a 90-something year old who's "On the floor, unable to get up. No apparent injuries. Grandson on scene for access". These calls are our bread-and-butter jobs. Something we do, on average, at least once a shift. Normally, we turn up, make sure the patient is uninjured, help them back into either their favourite chair, the loo or into bed. Sometimes we'll make sure they have a cup of tea and a natter before we leave. Maybe check their fridge and ensure they have some food. They may not see anyone again for a day or two. And then we leave. Easy. Straightforward. Uncomplicated. So without putting my brain into gear, we trundle off to see the young man on the floor.

The first knock at the door yields no response. Neither does ringing the doorbell. Quick look through the windows and a knock on them too. Finally, just as I'm about to go and ask control to phone back, the door opens.

As promised, the grandson opens the door, and in an instant my brain jumps into gear.

The grandson is standing at the door with a clean 10" knife pressed against his own neck. If it's clean, he hasn't used it yet, so Grandpa is probably safe. He's probably in his late 20's, shaking like a leaf and has a terrified look in his bloodshot eyes.

"They've done it to me again!" he screams. "This time I've had enough! I'm gonna do it!!"

My crewmate backs away very slowly to the ambulance to summon urgent police help. I (probably stupidly) stand and try to talk to him. His name's Mike. He's always being left to look after his grandfather who's asleep upstairs. And he doesn't want to do it anymore. But nobody listens, so this time he has to do it.

"I'm not allowed to work, I'm not allowed to go out, I'm not allowed to do anything!" By now the neighbours are twitching their curtains to see what all the shouting's about. Some are even brave enough to come out of their front doors. Mike looks serious, but he also looks scared. I get the feeling that this isn't really a suicide attempt, but just a cry for help. A man at the end of his wits who has no idea what else to do.

Slowly, Mike tells me that he has the job of looking after his grandfather, and has done for years, because his parents work and there are no other family members to help. I also observe, and have confirmation from one of the neighbours, that Mike has learning difficulties. He still has a knife to his own neck, which has already made a mark. Somehow I eventually gain his trust, and at about the fourth time of asking he throws the knife into the garden, far enough away from both of us. 30 seconds later the police arrive.

I ask the police to talk to Mike, to keep him calm, while my crewmate and I go to check on his grandfather. He's fast asleep in bed, unaware of the drama that was unfolding on his own doorstep. One of the officers calls Mike's dad and asks him to come home.

Mike is no longer left in charge. He's now finally getting the care that he needs too.

Bread-and-butter calls? Only if you expect the unexpected...

Time for a new job?

Just for laughs...
I get the feeling that this paramedic has probably found a new job... Wonder if he suffers with insomnia too, because I think that can be the only explanation for his bizarre behaviour!

Another Epidemic...

There seems to be an epidemic in the country at the moment, and I don't mean any type of flu. It seems that there has been a spate of hit-and-run accidents in the news recently. It may be that after my recent call I have become a little more sensitised to seeing these things in the news, or it may be that there really has been a sudden increase.

There are, on average, ten people killed every day on Britain's roads. And nothing seems to be bringing down that number. But more worryingly, those involved seem to be becoming more callous. I don't profess for one moment that I have the answers to either of these problems. Some suggestions maybe. Having lived in various different countries over the years, I've seen how different places try to deal with the same problem, with varying degrees of success. One of the ideas I've seen, rather than using shock tactics, is using reality.

At the end of every day a list is released. It includes the number of accidents that have occurred, the number of people injured (including degree of injury), and most importantly the number of those killed. This list is then published in the national press. Every day. It appears on TV news. On the internet. On the radio. Every day. Slowly but surely the tide seems to be turning. There seems to be a shift in public awareness.

Here, the fatalities make the local news at best. RTA's with major injuries don't even do that unless the Motorway's been shut for several hours, and then it only makes the traffic reports. We need to do something to drag ourselves out of our apathy and callousness.

Send those who are responsible for serious RTA's for a week's work and observation to a rehabilitation centre where the victims of their actions are trying to piece their lives back together. Show them the reality of their crimes.

Reality is often scarier than fiction. Maybe we all need a dose of reality to help rid us of another epidemic.

Swine Flu (Or H1N1)

The item below is not of my authorship, but I think it's a very useful piece of information. I was called twice yesterday to people who probably had no more than a throat infection but called ambulances because they were worried about Swine Flu. Remember that the chance of catching it without having been to the affected areas, or in close contact with someone who has, is negligible.... So try not to panic. You'll note that nowhere in the advice given below is it suggested to call an ambulance, and in any case, the advice we've received as Ambulance Staff is that even if we suspect H1N1, unless the patient is critically ill, we should leave them at home!

Happy reading!

Public Health Message

A National Flu line was launched by Health Minister Michael McGimpsey to provide information and support for concerned individuals. It is still strongly recommended that anyone who has recently visited one of the countries or areas where human cases of swine flu has been identified, to closely monitor their health. It is advised they do this for seven days after their visit to the affected area. However there is no need for them to isolate themselves from other people as long as they remain well.

If during this period they have a temperature of 38°C / 100.4°F and over and develop a feverish illness accompanied by one or more of cough, sore throat, headache and muscle aches, they should stay at home and seek advice from NHS Direct on 0845 4647 or contact their GP by phone immediately. If anyone is worried, we would encourage them to call the swine flu information line on 0800 1 513 513.

Good hand hygiene can help to reduce transmission of all viruses, including the human swine influenza. Other prevention tips include:

• Covering your nose and mouth when coughing or sneezing, using a tissue when possible

• Disposing of dirty tissues promptly and carefully

• Maintaining good basic hygiene, for example washing hands frequently with soap and water to reduce the spread of the virus from your hands to face or to other people

• Cleaning hard surfaces (e.g. door handles) frequently using a normal cleaning product

• Making sure your children follow this advice