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Handover Carnival 9

Well folks, here it is, the latest monthly Handover Carnival. The theme for this month is all about the small people we deal with, so without further ado, allow me to introduce:

Kids - Seen and not Hurt

I'm going to start this month's with a post from the Grumpy Dispatcher, who suggests a list of kit that is not part of our emergency stocks, but will probably help even more with our treatment. Remember that you're not only treating a condition. You're treating a person. Read it here.

*****

Read it? Good. Our next post is from Mack505 and tells how calls dealing with kids have the potential of turning a sleepy medic into a sleepless one.

*****

Epijunky, drawing on her experiences as both a mom (or mum in these shores...) and a medic, reminds us that we are all human, with human feelings and emotions, and that it's OK to let them get to us sometimes.

*****

Over at Rescuing Providence, you can read about the way kids capture the hearts and minds of even the toughest EMS and Fire crews, and that even the Bullies on the block are reduced to baby babble.

*****

Back in the UK and up in the Welsh mountains, Hypoxic Witterings gives us two views of the same emergency. One from the rescue team, and one from a bystander who watched helplessly as the drama unfolded.

*****

BasicsDoc, who I've personally had the honour of working alongside, has sent in a post about a call that's both haunting and heartbreaking, showing how families often cling to the smallest details in their despair.

*****

I've also had a couple of entries from blogs that I had not heard of or come across before. This is partly the reason for the Carnival, so I was pleased that it was serving its purpose. The first came from Dispatches From the Street. It shows the internal conflict we often have with a very sick child asking very pertinent questions. Do you lie or do you tell the whole truth?

*****

The next blog I've been introduced to is one called Just My Blog. Here I read about children getting hurt due to the laziness or otherwise of the so-called responsible adults. Sometimes we're no better than the kids.

*****

Lumo tells a story on a similar theme that's not really theirs, and gives an insight into what happens in an A&E department when they don't have the "luxury" of being forewarned of the horrors about to be unleashed, and how it doesn't always have to be personal experience that leaves a lasting impression.

*****

Almost last but most certainly not least, I'd like to give the floor to Mark over at 999Medic, the originator of the Handover Carnival. This is all his fault.

Mark's view is one of mixed memories, from how children leave us all traumatised, to the small people who steal our hearts. From the calls we hope never to attend, to kids who are nothing but sheer inspiration for all the adults around them. We all have much to learn.

*****

The next Handover Carnival is to be held over at The Happy Medic, who whilst planning for his edition, sent in his entry for this one. Sounds like his fire skills as well as EMS ones were going to be required, or maybe not...

The theme for the next Carnival is "Close Call", stories of a time when you or your patient cheated death, which left you with a reinforced idea of how life is precious, just in time for Thanksgiving. Entries by the 23rd of November, to be published on the 27th.

*****

Thus closes this month's Handover Carnival. It has left me with much to think about, a great deal to be inspired by, and a huge amount to be thankful for. I hope you feel the same.

Mother & Baby

Throughout her/our pregnancies, my wife complained on numerous occasions that I had no idea what it's like being pregnant. Now, whilst I can't refute that (and if I could, I'd be earning a fortune), I did constantly remind her that she had no idea of what it's like to be living with someone who's pregnant. The mood swings, the cravings, the going shopping for mango sorbet at 3 in the morning, the vomit all over my clothes on the way to friends' weddings, and a multitude of other sins. Admittedly it's a lame argument, but it's an argument nonetheless. And it's the best I could come up with. All I can say for sure is that babies clearly start causing trouble well before they're even born.

*****

Helene was on her third pregnancy, but she was a little out of practice as her 2 kids were already teenagers. She felt almost like it was the first time all over again. She'd almost forgotten about the twinges, the kicks, the nausea. She'd tried not to remember the sleepless nights, the discomfort and the anxieties that were caused by growing a small person inside you. Over the 38 weeks all her memories flooded back and she knew she could cope with them all.

*****

Until she woke up one morning and thought her world was about to end. The meaning of having your breath taken away had never had such relevance, or filled her with so much fear. Helene had the sensation that she'd been stabbed in the chest and just couldn't take in enough air. She'd had a strange sensation the day before like a muscle cramp in the back of her leg, but put it down to another one of those pregnancy things. "Only 2 weeks to go," she thought, "then it'll all be worth it." At three in the morning she'd woken up and thought she was going to die.

*****

Patients should most definitely not be blue. Unless they're smurfs, and I've never had one of those yet. Helene was blue. Her lips were blue, her finger tips were blue. It was as if she was being lit by an ultraviolet light. No need for an oxygen saturation reading before applying oxygen. It's low. Probably dangerously so. I place a 100% oxygen mask on her and then start checking observations. Pulse rapid, at about 140, oxygen levels unreadable at the moment, air entry greatly reduced, especially on one side. Blood pressure low and dropping. Helene is very poorly. My initial assessment leads me to think that it's a Pulmonary Embolism, or PE, a blood clot in the lungs. Pregnancy is one of the known causes of a PE, where it's either due to the fact that the blood's clotting is increased, or sometimes due to amniotic fluid escaping into the blood stream.

*****

I start to hope that the ambulance is nearby, as there's not much more that can be done pre-hospital for a PE. Luckily they turn up only a few minutes after I complete my set of observations. We wheel Helene into the ambulance and she is whisked to hospital with due haste, while I'm left alone in my car with the paperwork, wondering if I was right or wrong, and what would happen to her now. I have no idea what happened after that. All I know is that, in pregnancy, if the mother's ill, the baby's ill too. So if you treat the mother, you treat the baby. If all's gone well since, the baby should be a few months old by now. I hope that's indeed the case.

Target Practice

Targets. That's what it's all about, at least as far as the Government (and, I could cynically add, The Management, but wouldn't dare) is concerned.

Did the patient receive adequate care? Irrelevant.

Did the patient live or die? Irrelevant.

Just targets.

8 minutes to here.

19 minutes to there.

75% of 8 minutes.

95% for the 19's.

50 minutes per call. Start to finish.

20 minutes at the hospital.

No more than 3 toilet breaks in any 12 hours.

Targets. Just targets.

Well, Dear Government (and see cynical comment above), last night I beat them all. In one hit.

How? Well, my patient was seen, treated, transported and arrived at hospital all before he'd even called the Ambulance Service.

Oh, how I love it when the clocks are turned back...

I bet the number crunchers do too!

Roll Up, Roll Up!

Ladies and Gentlemen,

This is your final call for all submissions for this month's Handover Carnival, entitled:

Kids - Seen and Not Hurt.

Anything related to dealing with those little monsters who instantly take over our emotions, even if we've never met them before.

Don't forget there's still the open section for any other EMS related posts that you may feel appropriate to share with the readers.

All submissions to benyatzbaz999@gmail.com by Monday morning (UK morning...) (26th October), for publication on the 30th.

In the meantime - have a safe weekend, and one piece of advice - Don't put your finger in a baby's mouth...

Insomnia IV

I was going to write something about how this article may go on to help me in future life, but I can't for the life of me remember exactly what it was that I wanted to say... Oh well. Suggestions welcomed...

Piece of Paper

The red and blue lights of the police illuminate the street and point to the house that I've been sent to. I'm not sure how they got there before me, as it took all of 90 seconds for me to arrive, but I'm glad of their presence nonetheless. This doesn't sound like the type of call I'd like to be at on my own for too long.

*****

She sits downstairs, clutching an innocent looking piece of paper as if her life depended on it. The chair squeaks as she rocks backwards and forwards, fighting the rising tide of tears that are about to break the dam. I'm directed upstairs by one of the police officers, whilst another helps carry one of the bags that I've dragged hurriedly out of the car. The initial sight of tears and pale shock tells me that the bags are going to be redundant.

*****

The piece of paper was stuck to the fridge, oblivious to the pain it was about to unleash. She saw it on the fridge door, but didn't register at first that it was a new note amongst all the others stuck there by a multitude of colourful magnets. She'd been in and out of the kitchen a few times before finally taking a proper look. Then her world collapsed around her.

*****

Too afraid to go upstairs herself, she called the police. They had turned up, looked at the piece of paper, and ran around every room in the house. His room was the last they checked. When they found him, one of their number called for the ambulance. He lay there motionless, cold and blue. The blood on the walls and the floor had long since dried and turned from crimson red to dark brown. Next to him lay the weapon that had ended his life, destroyed his future and shattered his parents' world.

*****

She clutched it and begged for answers that she knew would never come. "I'm sorry. There is really no other way."

A silent, innocent, clean piece of paper.

Regularly Irregular

Regular callers come in all shapes, sizes, colours, creeds, regularity, and, most importantly I guess, reasons for calling.

*****

There's the diabetic, who despite her almost religious adherence to meal times, insulin injection times, regular blood sugar tests and the rest, still has repeated hypoglycaemic attacks, where her blood sugar drops dangerously low. In fact, the last time I met Bea, only a few days back, I was being observed for the shift, so there were two of us in the car for a change. It took the strength of two paramedics, neither of us particularly small, to hold Bea down long enough to give her the injection of Glucagon that would release her body's emergency supply of glucose into the blood stream. If anyone was looking in from the street to see what all the screaming and shouting was about, they'd have seen two large green people attacking a seemingly helpless elderly person. Probably would have made great tabloid photos. I don't mind that sort of regular. The ones, where despite their own best efforts, they have the need to call for emergency help.

*****

Then there's the local drunk, Kish. He's not a homeless, penniless drunk. He's a drunk who has a home to go to, and a nice home at that. I know it's nice, because I've been there on countless occasions to take him home. He regularly calls from the same group of phone boxes complaining of whatever he can think of that will get the ambulance to him in the fastest possible time. That's assuming that he's been the one to call, rather than someone else who's found him lying in a heap on the ground after drinking too much (even by his standards). He's nothing but a drunk nuisance. And what's more, he claims not to have had a drink for years. I met him on my first week at work, and have met him literally dozens of times since. He's had over 500 attendances at the local hospital in the last 18 months, each one of them by ambulance. He'll often refuse to go to hospital, and want to be taken home instead, usually a mere 200 metres away.

*****

It's only my professional etiquette that has so far stopped me from telling him what I really think. I'd love to tell him that he's wasting his life, wasting my time, wasting resources. He's delaying ambulances that are needed for real emergencies and delaying treatment for those who desperately require it. I'd love to tell him that he's really just a drunk and unpleasant waste of space. Don't get me wrong, if he was really ill, he would get first class treatment from me, but for now he just makes my blood boil.

*****

The other night, the same night as Bea's call when there were two of us on the car, Kish called again. We were stood, face to face all three of us, trying to ascertain what it was that was supposedly wrong this time. Kish stood there telling us that everything from head to toe was hurting him, his eyes were falling out, that he couldn't stand, couldn't sit and couldn't walk, and swore blind that he has never had a drink in his life. We stood there and listened, unable, and frankly unwilling, to transport him anywhere in the car. We tried to convince him that it would be better for him just to walk the short distance home, but he remained adamant that he wanted to go to hospital. We had no choice but to wait for the "proper" ambulance to come and get him.

*****

Whilst standing there trying to explain the benefits of him just going home, a member of the public walked up to us, tapped me on the shoulder, and said "Excuse me, can I just say something? I work in this shop here". We had no warning for what was about to happen. His next outburst wasn't directed at my colleague or me, but directly at Kish.

"YOU'RE A WASTE OF SPACE! YOU'RE A DRUNK, USELESS EXCUSE FOR A HUMAN BEING! STOP CALLING AMBULANCES, YOU'RE JUST WASTING THEIR TIME! GO GET A PROPER LIFE AND A PROPER JOB AND STOP BEING SUCH A *&%*ING PAIN IN THE $*&^ TO EVERYONE AROUND YOU!!!!"

*****

He started to walk off, turned around briefly, apologised to us for interrupting, and vanished.

Everything I'd had pent up, everything I'd wanted to say, everything I'd been feeling but couldn't express for fear of completely losing my cool (and possibly my job too), had just been blurted out by this well meaning, clearly equally frustrated, passer-by.

I think we may have to invite him to join us on the ambulance. Regularly.

Bigfoot

EMS staff worldwide seem to share a superstition. I'm not normally superstitious, but there are certain laws that govern this insular world of the ambulance. The main rule is check everything, because you can guarantee that the one thing that you don't have, is the one thing that you are definitely going to need. It's almost beyond superstition, it's practically a rule of the natural world.

I'm not afraid to admit that I'm a little nervous at the moment.

A couple of days back, I helped remove all the equipment from one of our trucks. It's affectionately known as Bigfoot. It's a huge, clumsy looking thing, that goes 0-40mph in about ten days. If it's ever to reach any more than 40, we'd need to push it off the edge of a mountain and let gravity take control.

But it's potentially vitally important. Bigfoot is only used under two sets of circumstances. The first is for training, which is in itself rare on this nigh-on-never used piece of equipment. The second is if there is a mass-casualty incident. That's the bit that makes me nervous. This week, Bigfoot has been sent for a bit of R&R. It's been sent for a service and won't be back for a few days.

So I'm nervous. It's the one piece of kit I've never been called on to use, or, thankfully, drive. I've never even seen it used, other than when it's been for training. Normally it just sits, reassuringly still, at the other end of the garage.

Now Bigfoot's missing, I'm hoping that it proves the superstition to be just that.

A Thousand Words

Two people died. Another is critically ill.

All for the sake of a phone call.

Please.

Stay Safe.

Pendant

I took one look at the computer screen, took stock of the fact that it was an elderly person fallen at home. A Green call, the lowest priority possible. Doesn't even require lights and sirens. I muttered unthinkingly and quietly to myself. Or so I thought. "Oh Oh...", I said, for some unknown reason.

*****

The lady who opened the door to Grace Court appeared so old that it seemed that if she was to teach history, then Ancient Rome would be her speciality, due to first-hand experience of the era.

"Yes?" Even the monosyllabic required an immense effort.

"Ambulance Service, madam. We're here for one of your neighbours."

"Do you know who?", she asked, polysyllabalism still elusive.

"Yes madam. Thank you." I smile at her question. Even at an age that would put Methuselah to shame, the sense of curiosity hadn't left her.

The building we enter is a warden-controlled residence. The residents, typically elderly, but largely self sufficient, have the benefit of an on-site manager who can be called on for some basic care and assistance, whilst also maintaining the luxury of independence that they would lose if moved to a nursing home. Most of the residents have emergency call buttons worn as pendants around their necks, so help can be summonsed at a moment's notice. Harold had decided otherwise.

*****

It had taken a concerted effort from Harold's family to get him to agree to move here, away from the home he'd lived in for the past 50 years. Harold was a very proud man, an Army Captain who'd seen and survived so much. He still did his own shopping, cooking and cleaning. Only recently he'd agreed to allow his daughter to do his laundry. The man who had rebuffed so many advances of enemy armies, had to make this one concession to the advancing years.

His family would visit every few days, every weekend without fail, and someone would call every other day. Mondays were a quiet day, time for Harold to recover from the grandchildren running riot around his apartment. He hated to admit it, but these days they seemed to exhaust him a little quicker, tire him out for a little longer. He loved having the family visit, but he also treasured his Sunday evenings and Mondays, knowing that the phone or the doorbell wouldn't ring, and he revelled in the calm after the storm. We were called to Harold on Tuesday morning.

*****

Harold's daughter had called him and unusually received no reply. The phone rang continuously. He hated the idea of an answer-phone, his theory of "If it's important, they'll call back" foremost in his thoughts on the matter. He did, however, unlike many of his generation, carry a mobile phone if he ever went out, but it was switched off when he was at home. "I'm currently probably at home", said the message. "If you know my phone number there, please feel free to use it. If you don't, then I probably don't know you either, so don't bother. Thank you". He must have recorded the message with the family around, as there was a great deal of merriment in the background, but no room for leaving messages here either. Sensing trouble, Harold's daughter made the 25 minute journey to visit him. When she arrived, Harold was on the floor. We arrived no more than five minutes later, despite the fact that the call was the lowest on the priority list.

*****

Harold breathed a shallow breath every ten seconds or so, and seemed to have no pulse that we could feel, he was unconscious, but clearly still alive. Listening to his chest I could hear his rapid heartbeat, feebly trying to keep his body fuelled with the oxygen it craved. It was racing at almost 200 beats a minute. Not enough for the heart to refill and pump the blood around the body. He had no recordable blood pressure. We helped with his breathing, and thought that if we tried to move him with almost no blood pressure, we'd probably kill him. He needed more than just salty water in his veins, but it's the best we had to try to stabilise him enough to be moved. After a litre of fluid, Harold's blood pressure was at least readable. Not good, but better. His breathing had also improved a little, and he was conscious enough to mumble a few unclear words. Time being of the essence, we decided that it was best to move. Once we'd handed Harold over to the hospital team, my crewmate told me off. "Next time you think Oh Oh, will you please keep it to yourself! Bloody Jonah!" Obviously I'd not muttered quite as quietly as I'd thought.

*****

Harold was given a blood transfusion, had surgery on his broken hip, and was kept in for several weeks to recover. I kept track of his progress as best I could, and eventually was told that he'd been discharged home. I'd long forgotten about Harold when, several months later I had a call back to Grace Court. The door was opened by a gentleman who still managed to look several years younger than his real age. He walked with no assistance, spoke clearly, knew who we were and why we were there. "I believe you're here to help Alice. She's fallen again. I've tried to make her comfortable, but I just can't get her up off the floor. Not quite as young as I used to be. Anyway, she's just over there".

We walked over to Alice, who this time had just slipped onto the floor and needed help getting up again. Whilst we were helping her, a voice behind me said: "Apparently your chaps were here helping me a few months ago. I don't remember them or indeed what happened, but if you see them, please tell them that the stubborn old fool from flat 42 is still fighting fit!"

"I'll make sure to do that, sir", I said with a grin, noting that he'd finally agreed to wear the emergency pendant.

Ladies and Gentlemen

Ladies and Gentlemen of Blogsphere...

A short reminder that I'm hosting the Handover Carnival at the end of this month, on the theme "Children - Seen and Not Hurt". I have already received several fantastic entries and look forward to many more. Feel free to make me work for a living (if you can call this blogging a living), and send in entries for the open section too, on anything EMS related. The closing date for entries is October 26th, so time is starting to run short...

Please send your entries to benyatzbaz999@gmail.com .

For now, have a peaceful (or festive, if you prefer!) weekend, and most importantly,

Stay Safe.

TwentyFour/Seven

If you'd have asked me a year ago which my least favourite shift was, the answer would be instant. Nights. I used to dislike them so intensely that I'd quite happily order a government edict that no ambulances are to be sent out at night. If you're ill, wait until daytime. If you can't wait, walk. No mercy. All this was whilst I was on a rotating shift pattern, so I'd go from morning shifts, to afternoon/evening shifts, to the dreaded, loathed and feared nights. But then, just under a year ago, I started working permanent nights.

I had no choice, family came first, and it was the only way I could work and have childcare arrangements that I could cope with. I dreaded the idea of it, and thought that I would never ever get used to nights. Now, I love them. I can't get enough. The peace and quiet of the world at night, no traffic, no mayhem, real patients. The insomnia is still there whether I'm trying to sleep at night or during the day, so no change there. And if I'm already awake at night, while the rest of the world is sleeping, I might as well get paid for it...

However, I had a night off last night, and knew that I could get to bed at the same time as the rest of the normal world. At least in my own time-zone. But I had to remember to set my alarm for seven o'clock to get the kids up for school. It was an optimistic idea, setting an alarm clock. There's no way in the world that I could sleep that late, and my son made sure of it with a bout of croup at 3am. So much for a night off.

Just before seven, I picked up my phone which is also my alarm clock, to turn off the alarm. No need for it now, is there? I took one look at it and had the final proof that I'm now a night-owl. I'd set the alarm to get the kids up for school. Time to get into uniform, have breakfast, clean teeth, brush hair, all in time for the school bus. There was a good chance, had I relied on my alarm clock, that they may have been a little late. I'd set it for 19.00...

A Begging Letter to A&E Staff

Dear A&E Nurses and Doctors,

*****

We have a patient in cardiac arrest.

We have been resuscitating for the past 45 minutes.

We cannulated whilst the patient was collapsed in the toilet, or lying stuck behind the door.

We intubated under a table, in a car, or in the pouring rain at the track-side.

We have distressed members of the family following our every move, shrieking in grief.

We carried the patient in a mess of arms and legs down 3 flights of stairs.

We carried out CPR continuously in nooks, crannies, and at 60 miles per hour down the winding road.

Now we've arrived at your hospital.

Exhausted, sweaty, flustered, sometimes hopeful, sometimes not.

For us, the resus is nearly over.

*****

In the meantime,

You've been told of our imminent arrival.

You've been told that the patient is in cardiac arrest.

You're prepared with all your kit; aprons and gloves donned and at the ready.

You meet us at the entrance to the resus room and direct us to the trolley bed.

You've got the patient 4 foot high, horizontal, in the relative calm of the hospital surrounding. You've got the family safely in the relatives' room.

For you, the resus is only starting.

*****

I know you're also constantly busy.
I know you too haven't much of a break.
But I'm also fairly certain that you haven't been doing a resus for the best part of the last hour, sometimes in the most appalling conditions.
So I ask you, please.
Please don't expect me, after nearly an hour of CPR, to keep going, while you stand by and watch.
Please give me a chance to get my breath back.
Please take over the resus. Please take over the CPR.

*****

Thank you.

Teacher

It's that time of the year again. Our antipodean cousins are anticipating a long, hot summer of cricket (without the Ashes in their back pockets for a change), whilst here we're starting to pile on the layers, preparing for that world-famous phenomenon called The British Winter. The days are growing shorter and the night shifts seem longer than ever. It never seems quite as bad when I have only six hours of darkness on a shift, as opposed to the whole twelve. Give it a couple of months and when I'm on nights I'll see possibly an hour's daylight in every 24 hour period. Very SAD.

Just in case we weren't sure of the imminent arrival of the cold, our airways have a habit of reminding us. Large increases in the cases of asthma, bronchitis, chest infections, croup. Croup is a funny thing. If an ambulance is called to a child aged between 6 months and 4 years (ish), between 11pm and 3am (ish), any time between September and December (ish), because they're having difficulty breathing (not so ish), there's a pretty good chance you're going to meet a croupy kid. The vast majority of the time its bark is much worse than its bite. Literally. The characteristic seal-bark cough is a scary thing for any parent to be woken by. Been there, done it, bought the T-shirt. Scared me half to death the first time I heard it at home, so I fully sympathise with any parent going through it.

*****

Mickey is a normal three-year-old child. He runs around, plays, falls over, scrapes his knee, cries, gets up again and runs around as if nothing's happened. But Mickey's parents weren't sure that he'd ever make it to three. Or two. They weren't certain that he'd make it past the first few weeks. Mickey was born only three-quarters cooked, at 30 weeks instead of the more normal 40 or thereabouts. His lungs were under-developed, his heart wasn't at full capacity, all his internal organs not quite ready for the real world yet. It wasn't Mickey's fault. He was violently evicted, cut away from his mother, just when he was enjoying the comfortable, warm surroundings where he was happily developing. Mum had developed severe pre-eclampsia, causing her to have dangerously high blood pressure, a pre-cursor to eclamptic seizures and all manner of life-threatening problems. In an attempt to save both mother and baby, it was decided that the best option was to deliver Mickey by caesarean-section. Mickey was to be cared for in hospital for the next few weeks, allowing his continued growth, but along the way the medical team discovered that he had several holes in his heart where there shouldn't be any. He had to have several operations, but eventually, after a year or so, Mickey was finally discharged from hospital with an almost clean bill of health. Mum and Dad were told that he might be a little more prone to chest infections than other children his age, but otherwise he should be completely fine.

At the age of two, Mickey had a chest infection. A bad one. So much so that he stopped breathing. Luckily (if it can be termed lucky), he was in hospital when it happened. Mum and Dad had watched him become more and more unwell, and decided it would be best to call an ambulance. Mickey was blue-lighted to hospital where his breathing continued to deteriorate to the point where it stopped. The medical team at the hospital worked tirelessly, and two weeks later Mickey was well enough to go home.

A year after that, for the first time in over three years, Mum and Dad decided it was safe enough to have a night out.

*****

Midnight. The computer rings and tells me of a 3-year-old with difficulty breathing. "Making a funny noise", apparently. Croup. Should be easy enough. Oxygen if necessary, hospital, steroids maybe, back home. Not for Mickey. He's in real trouble. Blue around the lips, the spaces between his ribs noticably sinking with every breath, oxygen levels (Sats) in the high 70s at best. A barking cough that's interrupted only by a horrible screeching stridor. Sounds like he's got a coin stuck in his throat that interrupts the air with every intake of breath. To make matters worse, the babysitter's in hysterics. She's worried that she's done something wrong, when in fact she'd done everything right. She called an ambulance as soon as she heard the noise, and whilst she waited she picked Mickey up and placed him in a steamy bathroom to try and relieve the symptoms.

The babysitter was a family member, so knew all of Mickey's history and retold the tale. His early arrival, his lung problems, his heart problems, his last chest infection, the fact that he'd stopped breathing. The ambulance backing me up arrived only a few minutes after I did, and saw that even though Mickey was on oxygen, his Sats were only in the top 80s now. I retold the story as we walked briskly out to the ambulance, hoping that the cold night air may help as we went. The crew placed a priority call to the hospital, stuck on the lights and took off.

As Mickey was carried in through the doors of the department, he barked. One of the staff was heard to mutter "Oh, it's only croup. What's all the fuss for?" A few raised eyebrows were also spotted. There was a definite atmosphere of "unnecessary ambulance-crew panic" in the resus room. Until, that is, Mickey's story was retold.

The A&E staff had done exactly the same thing I had. Jumped to conclusions before even laying eyes (or ears) on the patient. I'd assumed that it'd be straight-forward. They'd also done the same. I'd assumed that it'd be run of the mill. They'd also done the same. I'd had to switch gears very quickly. They, to their credit, also did the same.

Lesson 1: Don't jump to conclusions.

Lesson 2: Don't jump to conclusions.

Lesson 3: Don't jump to conclusions.

I think Mickey's got a glowing career path ahead of him. I hope he stays well enough to follow it. I reckon he's going to a make a damned good teacher.

Right

So, you had an accident, right?
Right.
You crashed into a lamp-post, right?
Right.
Not a car crash, just you that ran into the lamp-post, right?
Right.
And you have a small cut on your eyebrow, right?
Right.
For which you called an ambulance, right?
Right.
And while you waited for the ambulance, you went to buy some beer, right?
Right.
And the reason you called the ambulance was because you wanted a plaster for your boo-boo, right?
Right.
Right. Right. OK. Right. A plaster. Right.

*One flustered paramedic finds a plaster buried in the car somewhere, and with great self-restraint places plaster on boo-boo*

Thanks. I didn't have enough money for beer and plasters.
Right.
Well, at least he said thanks.