Five Days

I don't do pets. Never had a pet. Don't understand why you would. Never had to feed a cat, clean out a litter tray, walk a dog, or even open a tin of dog food. Nothing. It's just not me. Don't mind other people having them, but won't ever have one myself. And wouldn't know what to do if I did.

*****

Five days. They didn't know that at the time, but the newspapers on the doorstep gave it away. As did the calendar with the changeable dates that was still showing the date from the weekend before. Gladys had been on the floor for five days. Unable to summon help, she remained trapped between the bed and the chest of drawers where we eventually found her.

"Oh, you found me then", she said. I felt like I'd just closed my eyes, counted to twenty, and started to seek whilst Gladys hid. She was in surprisingly good spirits for someone who'd been stuck on the floor for so long. In a warped sort of way, she'd been lucky. She fell as she was holding a bottle of water, so she had that to keep her going. But still. Five days is a long time on half a litre of fluid.

She was another one of the stubborn generation, but this time, a lonely one. She refused any offers of help, had no carers, no emergency lifeline to call. Most distressingly, she had no family either. Her neighbours did what they could, but she would hardly let them in, either literally or figuratively. It was, eventually, one of these neighbours who noticed the post box was overflowing, and decided to call for help.

These sorts of calls fill me with no small amount of concern. All too often we enter to find that there is nothing left to do. Nobody to help. Only coroners' arrangements to make. This time, there was a yell from upstairs, closely followed by a whimper. Gladys was sat on the floor, where she'd been for the whole five days, unable to lie or stand. Only sit. So she had slept, read, drunk and chatted where she fell. The yell obviously belonged to Gladys.

The whimper belonged to her conversation partner. There he was, laying next to Gladys, guarding over her. "Only ever left me to get some water, he did. Probably drank from the toilet. He's kept my mind busy. Knows a lot about the ancient philosophers he does. He turned on the telly and found out the weather report for me every day too, just to keep me up to speed. Amazing how much you learn from a well-read dog! The conversation's tailed off a bit though. He's probably hungry, he hasn't eaten for five days and can't be bothered any more. Anyway, he probably thinks I'm barking mad."

I can't help but laugh. She fusses his head and then looks back up at us, eyes smiling and full of mischief. "How long have you been down there then?" I finally ask when I'm able to get a word in, both of us aware that I probably know the answer.

"Oh, seen more than a couple of sunrises, missed a couple of loo appointments, must be five days at least. I tried yelling, but no-one hears you round here. Too much traffic. Wasn't like that when I first moved here. No cars then. Only bicycles and the odd milk float. You try being nice to everyone but eventually you just don't know who anyone is any more, so you stop. They're all nice round her, they offer to help. I'm just too head-strong. You know how long I've lived here? 60 years! Can you imagine! That's probably three times your age... Can you understand that? I bet you can't!" I thank her for making me much younger than I really am.

She talks like someone who hasn't spoken to a soul for five days. In the meantime I check her basic observations, which all seem to be healthier than mine. One of the neighbours helps me get her off the floor and we change her out of the clothes she's in, clean her up a little, and get her ready for a dignified journey to the hospital. If for no other reason, it'll give the system time to catch up and find her the necessary help, should she finally choose to accept it.

The ambulance arrives and Gladys is carried down the stairs and gives out orders like a queen sitting on her throne. "Will you make sure the doors are locked?" she asks one neighbour. Another is ordered to turn out the lights, and a third is instructed to tidy the post and the newspapers. "So I can get back in here later", she adds.

"Oh!" she suddenly yells and points at me as we're loading her into the ambulance. "It looks like he likes you. Can you make sure he gets fed some dog food?"

You couldn't pick on someone else? A pet lover maybe?

Oh well. First time for everything I guess. After all, it has been five days.

Close Calls Handover

The Close Calls Handover has been posted over at Happy Medic's HQ. As always, the Handover makes for some good reading. There's even an honourable (and I'm duly honoured) mention in dispatches for your local Insomniac.

Go.

Read.

Be inspired.

And, as always,

Stay Safe.

Armchair

"Oh - it's you again". Sometimes it's a phrase said with genuine affection. Sometimes relief. Sometimes it's just downright disdain.

*****

"Armchair", you grunt, as an afterthought to the opening phrase.

Well, yes. It is me again. And again. And again. I keep coming back here when you've had enough of another one of your clients. But this time, I can bite my tongue no longer.

This time, you left her in the armchair, in front of all the other residents, for a whole day. And night. And most of another day. Almost 36 hours, and none of you thought to check on her.

You just "assumed".

You just thought "she doesn't do much usually".

You just presumed "she was in one of those moods".

None of you thought that it was unusual that she hadn't asked for help to get to meals.

Or back to bed.

Or even to the toilet.

Three shifts went by, and she was still sat in the armchair.

When you finally took a look, you saw she was barely breathing.

You saw she was covered in vomit.

You smelt the strong smell of urine.

So you told her off. Like she was some sort of small child.

Like it was her fault that she'd possibly been unconscious for the best part of two days.

Like it was her fault you ignored her.

Well you know what? It's your fault. Your job is to care, to pay attention, to tend to needs. That's why she was there, so you could look after her. That's what you have chosen to do. That's what you're paid for. So don't tell me that you're "not paid to think, just to clean them". The "them" you refer to are people. Not animals or the cages that they're kept in.

You were charged with her welfare, when she had no where else to look, and no one else to turn to. And you failed.

And I hate to say it - I get the feeling you're almost glad.

Glad that she's taken off your hands.

Glad that you're no longer responsible.

Glad that she'll probably never return to that armchair.

Lifesaver

The darkness is compounded by the cloudy, moonless sky, the heavens showering down their vicious tears with all the contempt they can muster. At least it helps the house stand out like a beacon. It's the only one in the street with all the lights on, shedding some brightness on the otherwise depressing night. As I approach the house through the overgrown jungle that covers the garden path, the door is already open. Standing on the doorstep is Rita, leaning forwards, hands on her knees, struggling for breath. She can barely get one word out at a time.

Rita's man is there, comforting her, encouraging her, keeping her calm. He's doing a good job of it too. It's especially impressive, as Ryan is only 10 years old, and Rita's his mum.

"I'm used to it", he claims. "She sometimes gets very sick and I have to help her".

"Did you call the ambulance?" I ask him.

"Yup. I've done it before. They always ask me the same questions, so I know what to tell them now".

It's about 4 o'clock in the morning. Ryan is wide awake, dressed, has got all of Rita's medications together, and written down the details that we need. It took me less than 5 minutes to get to the call, so he's obviously well trained and very organised. His little sister is half asleep on the couch, still in pyjamas, but with her coat on, ready to go.

While I prepare the nebuliser for Rita, he tells me that his mum has bad asthma attacks sometimes, and that she always has to go to hospital. He was woken up by the sound of a loud wheeze, and knew immediately what he had to do. He'd got everything ready while he was still talking to the call-taker at control, all the while doing his best to calm his mum's anxieties.

Rita's condition and observations mean that she's going to need some aggressive treatment and to be blue-lighted into hospital, and there's no-one else to look after Ryan and his sister, so I'm left with the babysitting duties. The crew and I decide that it's best if they don't travel in the ambulance, as we don't want to distress them any more, so they watch mum being loaded into the back of the ambulance, stare as the blue lights of the ambulance reflect off the vertical sheets of rain, and then climb into the car and out of the deluge. I've got the duty of transporting them to A&E until another responsible adult can be found to look after them.

On the way there, they both remain calm, although Ryan's sister is a little teary. Ryan tells me all about the schools they go to, how he helps at home, how he looks after his mum. More importantly he tells me about the football team he supports, and laughs when I threaten to throw him out of the car for supporting a team that are the sworn enemies of mine. Although, I have to admit it, they're much better than mine. But then, most teams are...

We arrive just after the ambulance, and the kids say a quick hello to mum and see that she's looking a little better and in good hands. They're happy to find the kids' waiting area and go to find some toys. Ryan keeps up his role of babysitter and looks after his younger sibling, finding toys that he knows are her favourites. I watch from outside and am impressed by all I've seen and heard. At just ten years old, this young man is so much already.

Son, big brother, mini-dad, carer. And, of course, whether he realises it or not - a lifesaver.

Mag-num-ificent!

This is my endorsement. Not anybody else's. Not where I work, not who I work with, not who I work for. There. I've said it. Now, for the review.

*****

I, along with several others on blogsphere, was asked to review a pair of boots. A Magnum, Ion Mask, pair. They duly arrived, free and beautifully packaged, a couple of weeks ago, and I decided to take my review very seriously.

First things first, they're huge! They're a much higher (no, I don't mean heels, I can't walk in them) than I'm used to. They also had no steel-toe cap, so I couldn't really test them at work, but I was determined to put them through their paces (sorry).

So I took them with me wherever I went for a few days, through all sorts of weather systems, doing all sorts of DIY, moving boxes, driving, walking miles, dealing with the kids. Whatever and wherever.

The idea of these boots is that they are totally fluid repellent, be that rain, oil or, as is particularly important in my job, bodily fluids. I thought it only fair to try this out too. A bucket of water, some torrential rain, and then a sandstorm later (I was away for a few days where they have sandstorms at this time of year...), and they seemed to be very much up to the task. I liked that. I also liked the fact that they were surprisingly light-weight.

All in all, I would highly recommend them. The only thing that concerns me, is the fact that I have an almost OCDish compulsion to have polished boots, and I wonder what that does to the the special Ion-Mask coating, and whether normal boot polish would ruin it. That's it. That's my only query/concern.

Otherwise, come on Magnum - bring out a pair with a steel toe-cap. I want them for work!

Sleep is Overrated

This is what happens when you sleep.

Admittedly, not when you're in your own bed, but at the wheel of a truck.

Not recommended.

Although, seeing that as we rounded the corner made sure I was wide awake.

Told you sleep is overrated.

Congratulations

You know what? I understand.

I understand that you have strong religious beliefs. And I respect that.

I understand that you have a long list of do's and don't's. And I accept that.

I understand that you'd rather not have a man deliver your baby. And I can deal with that.

But only because there happened to be a female paramedic with me.

What would you have said if there wasn't?

What would you have done?

Would you still have slammed the door in my face?

No. I don't know either.

Oh, and by the way -

Congratulations.

Growing Up

When I was a kid (the Boss will probably argue that I haven't got past that stage yet), I wanted to be all the things a normal boy wants to be when they grow up. A fireman, a policeman, a soldier, even a famous footballer. I have to admit that being a paramedic was no where in the line-up. Probably because I was the most squeamish person you've ever come across.

I did however, strongly consider becoming a train driver. At least I now know why I didn't go with that one.

Close Encounters

It was dark. Probably because it was night.

It was cold. Probably because it was winter.

And I was lost. Probably because I didn't really know where I was.

But I did know that this wasn't an area known for its hospitality.

So far so normal.

*****

I'd been an EMT for about two years at this point, and had faced many fears, many unusual sights, and many challenges. I was still very much on the upward swing of the learning curve, but on this shift I had to learn and teach all at once, as Jill, my crewmate for the evening, had been out of training school for less than 3 months.

A call to an unconscious male on a Saturday night is a fairly normal one, usually leading to us finding someone under the influence of alcohol, drugs, or both. The vast majority of these cases occur in a public place, so getting a call to a private address for a 30 year old unresponsive man was a little strange.

As is the norm when we arrive at high-rise apartment blocks, the lift wasn't working, so it would be a hike up to the 6th floor with all our kit. As we arrived at the apartment, the door was open, so we knocked and walked in. The door shut behind us and made me jump. It was the first sign that something just wasn't right.

Jill and I found him lying on the floor, fully clothed and in a coat, eyes shut, but eyelids flickering. An almost certain sign of pseudo-unconsciousness. A fake. I took a step back and called out to him. Jill was still standing by the front door, uncertain how to proceed. Something still felt wrong, so I asked her to go and call for police back up. With hindsight, I should have gone with.

After a couple of attempts to get him to respond by appealing to his better nature, I approached him and shook his arm. In a blur, he jumped up from the floor, stood up over me, and pulled out a pistol from his coat. His eyes burned with an inexplicable hatred, and I was trapped. The "patient" stood between me and the door. I had no idea if the gun was real or not, and didn't really want to hang around long enough to find out that it was.

Jill came across a couple of officers on the 3rd floor who were there by chance dealing with a domestic incident and asked them to come upstairs. She couldn't explain to them any better than I could explain to her what the problem was, but as she was new, she told the officers that she was effectively just following orders on a hunch. The three of them ran back up the stairs and found the door locked. The police called for urgent back-up.

It felt like a lifetime before I heard the screeching of several sets of tyres outside. In reality it was apparently only 6 or 7 minutes. The gunman kept screaming through the doors for them to stay out or he'd shoot. I believed him. The sound of the army running up the stairs meant they did too. Within seconds of that sound, the door splintered into a million pieces, armed police came charging in, and in a fry of Tasers took hold of the gunman as well as the gun. His flatmates stood no chance either against the 40 or so officers who seemed to pile in from every which way.

Several hours of debrief and multiple cups of coffee later, it was time to go home. Just before I left the police station one of the officers came in and told me that the gun was a real one, and loaded. This had been a close encounter of the worst kind. I kept that night a closely guarded secret for a very long time. I'm still not sure I should have said anything at all.

*****

I gave my daughter an extra-long hug that morning when I got home. It was a very different, much needed, best kind of close encounter.

Under Cover

Many years ago, the ambulance station where I work used to be a fire station, so it has a large garage, a massive front and huge roller doors that let the ambulances in and out. They're made mainly of see-through panels, so as you pull back onto station you can see inside the garage. At night, the lights work on sensors, and only come on if there is someone walking about. The darkness gives the place something of a haunted feeling at times, and arriving back in the dead of night on your own can frequently be a little eerie. It takes the sensors a few seconds to register any movement, but once that happens the station and all the vehicles seem to come back to life. The station doesn't seem quite so spooky then.

Arriving back in the early hours one morning, I find that, as usual, there are no ambulances on the forecourt. The station is in its normal sleepy and abandoned state, and I'm about to step into the deathly quiet station. But sitting outside is a police car.

I notice that it's not one of the local units, but one of the armed response team. (For those of you in the States and elsewhere, not all our police are armed. Something I find weird as I didn't grow up here, and something I'd love to see changed. I think.) I take a slightly better look around and find that in a car park opposite, there are another half-dozen of the armed response units, along with various other police vehicles. Looks interesting. And possibly concerning, as they're parked outside the haunted house that is my station. Has someone broken in? Is someone being held hostage inside? More importantly, has someone raided our supply of coffee?

Before I have the chance to give in to my curious nature, one of the officers approaches me.

"Can we borrow you and your car for a small mission?" Well, now there's an offer! I can't refuse that sort of request, can I? What sort of man would I be if I turned down the opportunity to play at being an under-cover cop?

"Sure", I said, "just let me inform my control that I've been commandeered, and then tell me what you need".

I call control on the radio and try to explain without being too specific, concerned that anyone can listen in and hear about the police being in the area and on the hunt for someone clearly unfriendly. They struggle to understand, and in truth I was probably too excited to explain properly, so I just leave it at being used for police assistance, and that I'd call and let them know what happened when it was all over.

The officer goes on to explain that they'd had dubious reports of a shooting in a local club, and wanted to investigate without arousing too much suspicion of their presence. They wanted to clamber into the back of my car so we could drive past the location and get an idea of what was happening. How they expected a bright yellow car with a light-bar on the roof to look inconspicuous, I'm not entirely certain, but they were convinced it was a good idea.

Cramming a lone patient into the back of my car requires all sorts of manoeuvring of luggage. Getting two fully kitted, heavily armed police officers in, was going to be a small challenge, and not one I was willing to fail.

Eventually, car and kit adjusted, and me in a bullet-proof vest, we drove off. Me driving to the location, the officers in the back telling me to act naturally as we passed slowly past. All was quiet. No screams, no mass exodus from the club, no flagging down of an ambulance car. The police decided it was probably a hoax. I'm still not sure if I was pleased or secretly disappointed. I don't want people to be sick or injured, but I do want to be there if it happens.

We return back to the station, the officers decamp and I offer them a cup of coffee. At least I now know that the supplies are safe. I'm relieved when they decline, as there were more than twenty of them there...

I walk back into the quiet station, call control to tell them of my adventure, and let them know that my police career is over, and that I'm now back to being a paramedic. Back to the next call, back to kids with coughs. Back to normality.

I guess that someone in control decided that that's more than enough excitement for me for one night.

A Tale of Two Bloggers

All I can see in the distance is a set of hazard lights, emitting an intermittent orange glow against the dark background of the night. Maybe this RTC won't be quite as given - trapped and unconscious - but as I approach at a rapid pace I can see that the hazard is not the car with the lights flashing, but a car facing the wrong way, lying on its side, perched up against a street light.
At four o'clock in the morning there's very little traffic, very little life about. The world sleeps as I do my small bit to keep it safe and well. The call rate to the ambulance service drops, but so do the number of available ambulances. I know I may be on my own for a while. I stop by the car, take one look at it and its unfortunate occupant, and call for help. I need everyone. Fire Brigade, police, at least one ambulance and a Basics doctor. This patient could need a lot of help, and quickly.
I’m fast asleep, having just finished a late shift in the A&E. How weird, then, that I can hear the drum solo from “In The Air Tonight!” Wait a minute, that’s my ‘phone, Ambulance Control. I blearily answer it, and accept a job nearby – car overturned, entrapment and unconscious.
I climb into the car through the boot, hoping that my assessment of its safety was correct and that the kerb would hold the car from tipping further. The patient was clearly unrestrained, lying with his head on the passenger window against the road, and his legs wrapped around the steering wheel. His breathing is a little slow, which concerns me but just putting an oxygen mask on him is a struggle. He tries to fight me off, making me think that this could be anything from a diabetic coma, to alcohol, to a serious head injury.
The journey is uneventful, and I pass the police barricade a few minutes after leaving home. It usually takes a little while for me to wake up fully, but the sight of the car on its side, facing the wrong way, and the lamp post knocked down, is like a splash of cold water. This doesn’t look good. I jump out of the car and grab my pack – anything else I will come back for. I jog round to the car, and am directed to the rear.
The Fire crews turn up first, and I ask about taking out the windscreen, but that would apparently take some time. I need him out quicker, but have no way to move him and no where to move him to. As I'm still fighting to get a primary set of observations done, three pairs of legs appear at the back of the car, two of them green belonging to the crew, and one of the pairs of legs orange. I recognise the voices and thank everyone who needed thanking for them turning up in a hurry. The orange pair of legs belongs to RRD, and I was fairly certain that when I'd asked for a Basics doctor, it would be him that I woke from his slumbers as I knew I was on his patch. At least now I could share my thoughts and decisions.
I peer in through the hatchback of the car, and see a familiar face – Ben! Excellent! This is going to be entertaining, if nothing else. He quickly appraises me of the situation – an unrestrained driver, was deeply unconscious, now has a GCS of around 8. Difficult to get access to the patient, no obs done. We discuss what options we have; peel the roof down or bring out through the back. I want this man out here, so I suggest to Ben that he tries to wind the seat back down, so that we can bodily drag him out. I wander over to the Fire Chief, and let him know what we are doing. He doesn’t look best pleased – I guess he was looking forward to some cutting, but offers all assistance with lifting etc that we might need. I go back to the boot of the car, to see Ben struggling vainly with the seat controls. “Got a problem?” I ask. He just grimaces, reaches under the patient, and the seat magically drifts back, giving the crew room to get him out. I leave them to it, and go and set up for the inevitable intubation.
We extricated the patient out the car the same way I'd climbed in, through the boot, and onto a rescue board. He was still trying to fight back. By now I could smell the alcohol, but still couldn't rule out that his behaviour was due to a head injury, and we treated as such. RRD knocked him out, intubated him, and made sure that our transfer to the hospital would be as event free as possible.
I watch as, first Ben and then the patient, are born(e) from the back of the car, the patient on a spine board. The crew wheeled him into position, near my kit dump, and we start to cut through all his clothes, so that I can make a formal assessment of his injuries. Ben is set the task of getting iv access. I check him over, head to toe, and find little else wrong with him, apart from the obvious – he is eyes closed, occasional groans and localising to pain. Glasgow Coma Score is therefore… anyone?? 8. of course!! I’ve got the kit ready, the team are ready, Ben gives the drugs, and the tube is in. We get him on to the vehicle, and I ask Ben to travel with us.
I travelled with them, abandoning my car at the scene and remaining in charge of the patient's ventilations as we did the breathing for him.
The journey is uneventful, and the three of us in the rear chat about stuff – other jobs we have done, BASICS, the state of the country, that sort of thing. All the while, we are closely monitoring the patient for signs of deterioration, of which there are none. We get to LocalNeuro, and hand over the patient, with some playful banter about whose IV access is better, Ben’s or mine (mine, of course)
All that remained was the tidy-up, paperwork, NHS tea in paper cups, and to get back to my car and return to base for the end of my shift. Maybe, if I asked really, really nicely, RRD would take me back in his cool car...
And then it’s all done. It’s early in the morning, and there’s a bit of paperwork and a lot of clearing up to do. We stand around, drinking our tea, before I offer Ben a lift back to his car.

Tweet Tweet

I'm going to give this a go. I've been on Twitter for a little while, keep trying to use it, and I'm slowly getting the hang of it. I've even got a few followers. Which I think is cool. So, if you feel so inclined, and can cope with even more of my ramblings, you can now follow me on Twitter @insomniacmedic. It's going to be a bit of an experiment, and if I seem to get the hang of it, I'll keep it going.

You could always let me know whether you think it's worth it! For now, Tweet Tweet!

Note to Self

You'd think that over the years, and after the previous post, you'd have learnt your lesson.

Don't say out loud what you're thinking.

It's damned likely to happen.

Twice.

So, if you feel the need to say to the The Mrs just before you leave for work that you feel like there's a big job out there tonight, don't. Just don't.

Even if it does mean you get to wake up certain people in the middle of the night.

Thus endeth the Note to Self.

Training School

I was new at the time. Very new. Not even two months out of training school. It was a time when I was keen, eager, and very very scared. I arrived at the station at least half an hour before the shift, which I still do to this day, just to make sure everything that I may need for the shift is available and ready for use on the ambulance. Obviously still keen and eager.

Ten minutes later my crew mate for the day arrived. I introduced myself and told her that I was new, and would need all the help I could get. She asked if there was anything in particular that I was nervous about, anything that I really wanted to see, that she'd see what she could arrange. I didn't really believe it, but I did mention that I'd not yet been to a cardiac arrest call. I'd practised the scenario endlessly in training school. Everyone seemed to die there. All the scenarios seemed to end in cardiac arrest.

Asthma attack scenario? Cardiac arrest.

RTA scenario? Traumatic cardiac arrest.

Pregnancy/Labour scenario? Double cardiac arrest.

Drug overdose scenario? Self inflicted cardiac arrest.

And the scenarios would always be as difficult and unlikely as possible. "Worst Case Scenario" the trainers would call it. We all took it with a pinch of salt, they were just so far-fetched.

In a broken down lift.

A crane at full height.

Stuck behind a toilet.

In the middle of a muddy building site.

On and on it went. Weeks of "people dying". If that was the real world, I wasn't so sure I was ready for it. The real world, however, was anything but constant cardiac arrest calls. Six weeks on the road, and I hadn't seen it or had to deal with it once. So I told Anne about it. She laughed and told me that the chances were slim. It was a day shift, and people tended to die at night.

Those were the days before we had computer dispatch on the ambulances. The calls would come off a printer, and the Control Room would call the station to find out who was to be the next crew out. I can still hear the distinctive whirr of that printer and find that if I ever hear it anywhere else, I instinctively expect to hear a phone ring.

We'd been out on a couple of calls and had managed to get back to station. There was nothing to challenge my knowledge yet. But now, we were the next crew out. I sat anxiously waiting for something to happen. Eventually, the blue piece of paper appeared at the top of the printer, and the phone made me jump half out my skin. This was it. My turn. And for some reason I had butterflies in my stomach. I looked at the piece of paper and saw that we were on our way to a man in his 40s with difficulty breathing. In the special instructions section there was a line about the patient being in a "hard hat" area on a building site. Could be interesting.

Half way there, we get a call on the radio: "ETA request from the scene. Patient deteriorating".

"We're approx 5 minutes away."

"Thanks, we'll let them know."

Anne presses the accelerator a little closer to the floor, the engine screams in response, but the ambulance doesn't seem to move any quicker. Two minutes later, the radio operator calls over the noise of the engine. "Update from the scene. They're on the 3rd floor of a building site. Stairs still unsafe. Ladders in use. Patient turning blue." Leave the important bit until last, why don't you?

"ETA two minutes. Thanks."

Accelerating makes no difference other than the noise, so we will the ambulance to go a little faster.

As we're no more than half a mile away, the radio chirps in once more. "Patient now in cardiac arrest!" I expected panic to set in, for the shakes to take over, for my brain to freeze. None of that happened. It was as if I'd been programmed for just this moment. The adrenaline rush was incredible. In my head I'd made a detailed list of what equipment to take, how we'd get to the patient, how we'd get him down again, and what else needed doing. All this before I'd even got out of the ambulance.

We arrived to find that our patient, had been carried down one floor by the other builders. Now at least we only had stairs to contend with, and no ladders. Two of the builders had started CPR whilst the others looked on anxiously. Anne and I took over and with the oxygen we were giving him his colour started to improve. The defibrillator looked at the chaotic heart rhythm and decided that it needed to be shocked back to life. Shocks, CPR, Shocks, CPR. We were in hard hats, covered up to our knees in mud, on the second floor of a building site, surrounded by exposed beams and electrical cables, with a 100kg patient. A real "worst case scenario".

Moving him to the ambulance was much easier than expected, thanks to several pairs of builders hands helping us carry him. The ambulance visibly sank by several inches and audibly groaned its complaint as the group of 4 ambulance staff, 6 builders and one patient either climbed in or were loaded into the back.

We continued our attempts all the way to hospital where the staff took over. They knew Anne and the other crew, but I was a new face. I overheard one of them ask Anne who the "new guy" was.

"Oh" she said. "He's a bit like this job. Come straight out of Training School."