All Change

Five o'clock in the morning. A call to a cardiac arrest is not unusual at this hour. It's relatively common for carers, spouses and other family members to find elderly people seemingly asleep in bed, only to discover that they are more than just asleep. This time however, it wasn't an elderly person. It was Jean, a woman in her mid 40's.

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Clare came home from a night out to find that, strangely, all the lights were still on at home. Normally, Jean would see her off and go to bed shortly after, trusting that her daughter would come home eventually, safe in the knowledge that she was always with the same group of friends. Normally Clare came home to a quiet, dark house, with just the porch light on to help guide her in. This time it was still quiet, but all the lights were on. An uncomfortable feeling crept over her, and she refused to go in without one of her friends. They both entered cautiously, found no-one downstairs, no signs of a disturbance, so Clare decided it was just a one-off. Mum must have forgotten to turn the lounge lights off. She decided that it was safe for her friend to go, said good-night, turned off the lights, and went upstairs.

The scream that followed was heard 3 doors away.

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The call came in as 40 year old female, Cardiac Arrest. Disturbance in the background, police requested. As we pull up outside, in the squalling wind and rain, we find that we are next door to an underground station. A train's just pulled in, and the tannoy announcement can be heard from the street. "All change please, all change. This train terminates here".

We enter the house to find Clare still screaming, lying across Jean's body. "DO SOMETHING, HELP HER!" Jean is beyond any help that we can provide. She's been dead probably for hours. There's no hope at all. However, one of the rules of resuscitation is that if the family request, we have to continue efforts, even if they are clearly pointless. By this point, we're treating the family, not the patient. With no questions asked, the two crews start the resus protocol.

The boxes of anti-depressants lying next to Jean tell a story of their own, as do the bottles of vodka. A quick search of the surroundings shows up one more horrifying fact. There are another 3 children in the house. Clare is the oldest, in her late teens, and the youngest is just 3 or 4 years old.

The resus continues all the way to hospital, and is tragically, but understandably, terminated after only a few minutes by the team in A&E. It's at this point that we fully comprehend the circumstances. Clare has gone from being a full-time teenager to full-time mum. She has three little siblings to worry about now. Her whole life has been turned upside-down in one horrible moment.

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The world around carries on as normal, the wind keeps blowing, the rain keeps falling, the trains keep running. But for Clare, the tannoy announcement says it all. All Change.

Fightback

It's around 1 in the morning, the shift has been non-stop. Not even the chance to use the "facilities". Red call - "80 year old, Chest Pain" reads the call that's come down the MDT, cruelly dashing my hopes for a return to station. As well as the computer screen shouting at me, the phone's ringing too. "Hi, it's John at control. On this job, for Chest Pain, read Cardiac Arrest... There's already another FRU on scene, but the nearest ambulance might as well be in Scotland." My right foot gains a little bit of weight and the engine grumbles it's response. Guess I'm not the only tired one.

Sam is lying on the floor, looking like he's fallen asleep with his eyes open. Alex, on the first FRU, is in full swing of a resus attempt in the tropical heat that is, for some reason, an elderly person's apartment. As I join the resuscitation, the warden starts telling us Sam's story. Sam's just come out of a long stay in hospital and has been moved into this apartment as a kind of test to see how it feels to be out of hospital, and still have the safety-net of a warden on site 24 hours a day. Sam's family had only left shortly before we were called, having made sure that Sam was well settled for the night.

It seems cruel. Now we've got to phone the family and ask them to meet us at the hospital as Sam was now very ill. It was part practicality and part cowardice that meant that we asked the warden to make that call.

The crew arrived, and the resuscitation attempts were continued all the way to hospital. We all knew that the chances of success were slim, but there seemed to be a common thought that if Sam's made it out of hospital once, maybe, just maybe, there's enough fight left for a second time...

As we're sitting outside the A&E, the family start to arrive. Through the window I see a doctor talking to the family. I see the tears start to flow. I see the scene that conveys it all. The fightback is over.

Suggestions Please

In the LAS we have an automatic dispatch system called FREDA, which apparently stands for "Fast Response Electronic Dispatch for Ambulances". It's supposed to be brilliant at locating the nearest resource and sending it to wherever it's needed, and on the whole, it does the job. However, Miss Freda drove me nuts last night. Again. Sent me to cover areas where there were already three ambulances, sent me to a station for area cover and then 5 minutes later sent me back to my base station, sent me on a call three times and cancelled it three times, and various other misdemeanors. She drove me so mad, that I spent some of the time thinking up other things that FREDA could stand for. I couldn't come up with any sparks of brilliance, so was hoping that some of you might. Friggin' Ridiculous Extra Distance Allocator was about the best I could do... (At least it gave me something to think about while I was dealing with the lady who called an ambulance because she and her teenage son both had a cold).

Gold star award to the winner...

Zero Tolerance

I've been marvelling at the courage and patience shown by Nick Horobin, an EMT who was seriously injured in an attack on the ambulance he was driving back in 2001. If you go to the link you'll see that he's now chosen to go into nursing, after his career in the Ambulance Service was cut cruelly short by thugs. Or in this case potential murderers. Good luck to you Nick.

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The thing is, these attacks still go on. Eight years after Nick's attack. Despite threats of "zero tolerance" there seems to be no stopping them. A few months ago when I was the target of some verbal, physical and racist abuse I actually went to the police. It didn't help that the "patient" was also threatening to kill me. I went because it was "that bad", not the "normal" sort of abuse we encounter on a regular basis. More often than not we ignore the vile creatures who feel it within their rights to say what they like or do as they wish. The "I've paid my taxes" brigade. We don't report it, not internally and not to the police, despite the fact that it goes on all the time. Or maybe because it does. I wonder what the answer really is. I wonder if we're ever likely to stop it happening, or whether we're just resigned to it happening.

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Just as an aside, my complaint to the police got as far as the CPS and was then dropped. Apparently it was "Not in the Public interest". Zero Tolerance? Don't think so.

Health and Safety

Came across this article, and as much as I dislike smoking at the best of times, I'm struggling to decide if it's a good idea or not. How far can you legislate for parents' behaviour and level of responsibility? More to the point, is there any way for the already stretched police force to have the time to enforce it?

I for one would rather we concentrate more on parents who put on their own seat belts (or not), but don't bother to strap the kids in. Seems to me like child neglect at the very least.

Here's hoping for a safe weekend for all!

Burns Night

It's just gone midnight, I'm listening to the calls on the radio of several people being "blued" into hospital after a bad RTC (or car-crash in normal-speak) that happened not far from me. I can't help but think that this time I'd got away with it. I still seem to be attracting all the big jobs, and somehow instead of dealing with this one, I'd been to an 80 year old with breathing problems. Safe in the knowledge that the RTC was cleared, I headed back to station to grab some much needed coffee. As usual, Control had different ideas. One of these days I'm going to find the hidden cameras that show Control just when we're making a drink...

I took one look at the call and instinct told me to ask for police to attend before I'd even set off. Three men with burns outside a local health centre. A closed health centre, of course, as it was the middle of the night, so no help from them. My sixth sense tells me this isn't some sort of hoax or just minor burns, and I can't work out why they'd be outside in a public place with such injuries.

As I approach, I can hear the screams before I can even see the patients. I pull up outside the health centre to find a shocking scene. The men were clothed in either underwear or nothing at all. They were burnt almost from head to toe. Their skin was peeling, blistered, bleeding, disfigured, and in some places just plain black. They had blackened mouths and noses, an indication that their airways could become a problem. They looked as though they had just walked out of a bombing. Not just the injuries, but the clear state of shock and fear in their faces.

They spoke no English. There were a few others about who spoke their language, but were giving me different stories as to what happened, and I decided that at this point it was fairly irrelevant. I called for back-up and said that I needed 3 ambulances, and needed them in a hurry. I knew that 8 or so had been dealing with the earlier RTC and feared that I'd be stuck for a while with no help. Luckily, there was an Urgent Care ambulance nearby. These ambulances are meant for our Green calls. The calls that don't necessarily need a full A&E emergency ambulance. The people on these are not trained to the same extent as front-line ambulances, but are nevertheless a great asset to the Ambulance Service. I'd started to put burns dressings on the patients, but outnumbered three seriously ill people to one Paramedic, I was struggling. They had a patient on board, yet one of the staff on the UC ambulance came over and offered to help, an offer that was gratefully accepted and that I once again thank them for.

Police arrived and stood there shocked. After a few minutes another FRU and two ambulances arrived. I sent the most seriously injured of the three in the first ambulance, and they headed directly for a specialist burns unit. The other two were taken to nearer hospitals after the third ambulance had arrived a few minutes later still, and then transferred out later to burns units as well. The extra pairs of hands were able to do things like sort out pain relief and fluids which I could never had done on my own. Being a single responder means dealing with the most immediate needs and then working down from there.

It also meant that once the ambulances had left I was left to assess what was almost a surreal scene. The chaos and carnage had been replaced by calm and police questions. There was no evidence of the dozens of burns dressings that I'd used. No sign of the horrific injuries that I'd just witnessed. No reminder of the initial feeling of concern that I'd be unable to cope.

Just time for a quick reflection that, clearly, I'd missed out on the RTC for a reason...

Humble Pie

I'm in the FRU, on standby, happily reading a book that I've been trying to read for ages, when a knock on the window almost makes me jump out of my skin.

"You're an ambulance, right?", asks the middle-aged gentleman. Clearly the bright yellow, the blue lights and reflective writing all over the car needs some explaining to some people.

"Yes sir. How can I help you?"

"I always see you guys parked up just reading or sleeping. What do you actually do?"

I'm slightly disgruntled, as these days I rarely get to just sit around reading my book, hence the fact that 2 months on and I'm still much nearer the beginning than the end, and I certainly never sleep in the car. Wish I could sometimes, but insomnia and some sense of moral responsibility prevent me from doing so. Not to mention it's too bloody uncomfortable.

"Well, we are sent to areas where the computer system thinks we're going to get our next call. It's almost never right, but we go anyway. Then we wait for the calls to come in."

"Oh. I see. Well that's OK then. BUT F*** OFF AND DON'T DO IT OUTSIDE MY HOUSE!"

Seeing as there was clearly no need for that sort of behaviour, and that there was going to be no reasoning with said gentleman, I close the window, put my book down, and without another word, drive off.

I stop about half a mile away, and pick up the book. As I open up at the bookmark, the computer rings and I'm sent on a call. 80 year old female, collapsed.

Address? next door, literally, to middle-aged gentleman. Ironically, he was the one who called the ambulance. As we were loading the dying patient into the ambulance, he came over, managed a sheepish "I'm sorry", and walked off...

I'd just about calmed down by the time the crew took me back to my car.

Apology. Ish...

I've been told off. Muchly. Apparently I shouldn't have criticised a colleague in my blog. Refer to the "Rise of the Machines" below to see where I supposedly levelled my criticism. I didn't see it as such, and if that's how it was perceived, then I'm sorry. I'm almost 100% certain that the person I was referring to won't read either the original or this post, but still.

However, I stand by what I wrote. We're all guilty of the same thing sometimes, and I was just commenting on it, not having a go.

Rise of the Machines

With all the technological advances in Emergency Medicine that have happened over the last few years, especially with regards to ambulances, sometimes it's easy to forget that we're treating the patient and not the machine.

Alex is a 55 year old man. Asthmatic since childhood. Heavy smoker since not long after that. Not a good combination.

His breathing today is the worst it's been for a very long time. He's tried all his normal remedies, including oxygen that he now has at home, but has realised that this time he's going to need an ambulance.

I'm back on the FRU again, and turn up first. The smell of smoke hangs heavily in the air, and there's a light fog to go with it. As I walk through the mist, Alex's friend calls through to say that it's OK, he's put out all the cigarettes, and it's safe for me to enter. I don't need to listen to his chest, I can hear the wheeze from the hallway. He's struggling to put 3 words together, and looks very flushed. "I.... Can't.... Breath...."

I put Alex on a nebuliser, and check his observations. His oxygen levels are a little low, his breathing rapid and noisy, and his pulse escalated. After a few minutes on the nebuliser his breathing eases a little, and the oxygen levels begin to improve. The crew turns up as well.

"I still.... Can't breath...."

"Don't worry", says one of the crew, "the machine says you're doing fine, and the machine's never wrong."

"But I can't..... Breath...."

I can't imagine what it must feel like to struggle for breath, but then to be told that the machine says that everything's ok, must just add to the anxiety. Alex's breathing was getting better. Slowly, but definitely improving. Except that he still didn't feel like it, and that needs to be our main concern.

Show some level of empathy.

Treat the patient. Don't just treat the machine.

Dinner Party

"If we'd have known how nice real ambulance people were, we'd have invited you earlier"!

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I was working away from my normal part of London, and was beginning to think that the only thing that happens around here was 50+ women falling over. I think in total we had 5 of them in the shift. Faller number 1 (I'm going to call her Hyacinth because, well... just because) was at the dinner party, and luckily for her, was a little drunk. She'd been helping her friend, the hostess of the party, to carry food to the masses upstairs, and had slipped in the kitchen whilst holding a tray. There was blood mixed with salad all over the floor. Hyacinth had landed face down in the mess, was talking to us, could move, but yelled every time she did.

"I think I've broken my arm!"

"I think you have too..."

Hyacinth's arm just looked wrong. The angles were wrong. The shape was wrong. It was almost back to front. She seemed to have two elbows. One of them was nearer her shoulder. Told you it was wrong. We were going to have immobilise the arm before moving her. I checked her pulse in the broken arm to make sure that there was still blood supply past the break in the bone. We decided the best course of action would be Entonox, or Gas and Air. The sort of stuff they give to women in labour for pain relief. Also known as laughing gas. And for good reason.

Hyacinth took deep breaths on the Entonox, and, combined with the alcohol, was soon carefree and giggling enough to allow us to move her arm, put it in a splint and carry her back up a flight of stairs to street level and into the ambulance. Hyacinth's friend came with us.

Once in the ambulance we rechecked that Hyacinth still had a pulse in the broken arm, readjusted her arm in the splint, tried to put some traction on it to reduce pain, and travelled to hospital.

Hyacinth kept asking if I thought it might just be dislocated. I was brutally honest. The X-ray showed 3 fractures of the humerus. And they call it the funny bone...

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"Even though you're just ambulance people, you can come to my dinner party anytime, daaahling..."

Beating the System

Well, it didn't take long. Back to earth and back to reality after the holiday. And in order to ease myself back in, I chose to work on an ambulance for the night, and not the car. That way there are two brains trying to think if necessary.

Except, that on the whole, it wasn't. I spent most of the shift thinking, again, that it's high time we introduced some type of fine system for abusing ambulance resources. One call in particular, amongst the overdoses, multiple ambulance-calling people and drunks of last night, boiled my blood. Not only because it was absurd, but because the system put in place to try and avoid such things just turned the other cheek and continued to allow the abuse.

At first, the call came in as a Green call. Lowest priority. No lights and sirens, no drama. To a man in his 30's with...... Earache! I was incredulous. I didn't know whether to laugh or cry. After several years in this job, I'm still surprised sometimes by the crazy calls we respond to. Then the system kicked in, and the call was referred to Telephone Advice, set up to deal with the calls that are, let's say, not in dire need of an ambulance. They are supposed to help find alternative care pathways, or at least different methods of attending hospital when an emergency ambulance is not the most suitable. They then referred the call to NHS Direct.

Once again, this was set up to try to reduce the number of A&E attendances, and ensure adequate ambulance cover for real emergencies. They have nurses and doctors at the other end of a phone line who are able to dispense sensible advice to the masses. In theory, this should have been the end of Earache Man. But No.

Two hours after the initial call was cancelled, we were on station, and the phone rings. The dispatcher at the other end starts the conversation with "I'm really, really sorry to do this to you"... Sounds ominous. For some reason though, I instantly reply with "Let me guess. He's 30 years old, has an earache and lives round the corner from the local hospital". The dispatcher is shocked by my sixth sense, but laughs. He explains that the call has been returned to the Ambulance Service from NHS Direct, and is now an Amber call. Lights and sirens. Possibly life threatening. FOR AN EARACHE!

The fact that this man had played the system and won, the fact that when we arrived he looked more like he was in labour than having an earache, the fact that he'd seen his GP and had just started antibiotics for an ear infection, and the fact that he refused to walk by repeatedly throwing himself to the floor, all added to my anger and frustration.

He amazingly felt much better once he was in A&E, and as I was finishing my paperwork, I saw him walk, perfectly steady and unaided, to the toilet.

I'm sure that many of my colleagues will laugh at my frustration. They'll say that it's just how it is and there's no point fighting. I guess that I'm still an idealist.

This man beat the system. I just wish there was a way for the system to beat him back. Just a little.

Busman's Holiday

Finally, I'm on holiday.

Finally, no night shifts.

Finally, no knocks on the front door asking for help.

And still, I'm not safe.

There I am, walking around the city centre in our holiday destination, when I spot a very familiar looking gathering of general public all looking at the pavement. I get a little closer and see a lady on the ground, with blood around her. Thankfully conscious after falling in the street, but very tearful. She's uncomplicatedly young, about 30 years old, but complicatedly pregnant, about 38 weeks... She has a large hole in her chin which had caused the blood loss, and has abdo pain which could be anything from simple post-fall pain to the baby being in distress, which was obviously her main concern.

There were two police officers on scene and they had called an ambulance. Whilst I undertook an initial assessment of the lady, someone else pushed their way through the crowd. "I'm a paramedic, Holidaysville Ambulance Service".

"Nice to meet you", I replied, "I'm also a paramedic. Although my ambulance is 3,500 km from here". As I speak the local language, he really wasn't sure whether to believe me or not, but accepted my help anyway.

We sent the young lady to get her chin stuck back together and make sure that her baby was ok too.

Think I'm gonna need some kind of ASBO to keep me away from Running Calls...

And now, back to my holiday!