Be Smart?

Two calendars run side-by-side in Israel; one religious, one civil. It means that we celebrate New Year twice a year, just to confuse everyone, including ourselves. The change of year on the civil calendar is still marked, celebrated by many just as it is in many parts of the world, although according to a press release issued by Magen David Adom, the national ambulance service, they were called to only fifty (yes, you read that right) alcohol related incidents on New Year's Eve nationwide. The Israeli population roughly numbers around the same as London, so this is a figure that the LAS could only ever dream of; they were averaging some 400 calls per hour for the first few hours of 2013. Admittedly, not all of them were alcohol related, but I can be fairly certain that a large proportion were. 

The end of the civil year also brings with it various annually-published reports, one of which being the traffic fatality report. The headline is nothing less than staggering: 2012 saw the lowest road-traffic fatality rate in half a century and on top of that, the rate is down 25% on the previous year's figures and some 40% lower than 2005. The UK could only hope for such a drastic change. In fact, the figures from 2010 to 2011 actually climbed by 3%, rather than reduced. It is a truly astonishing figure, but the question has to be raised as to how this has happened. 

As a driver on Israel's roads, I still see the shocking driving for which Israel is infamous. Drivers see keeping a distance from the vehicle in front as a mere nicety, perhaps a minor recommendation, rather than a safety measure; lane discipline is non-existent; indicators appear to be optional extras on most vehicles and road-rage is commonplace. We live in a high-paced, high-energy, live-for-the-moment country, where allowing another driver to overtake is seen as weakness and where allowing another car to slot into your lane makes you appear like a pushover. 

Other figures released today show that police have issued 40% fewer tickets for driving violations in the past year, down to 600,000 from over one million. They have concentrated less on minor offences (although the report does not specify what those are) and more on notorious roads, as well as "life-threatening misdemeanors", including dangerous overtaking, running red lights or stop signs, ignoring pedestrian crossings and, in particular, drink-driving. The police can, and do, when dealing with a driver who breaks one of these so-called "life-threatening" laws, revoke a driver's licence on the spot for up to 30 days. They can also impound their vehicle for the same length of time. 

It all sounds like a plan is coming together. 

However, what the reports barely mention is the number of seriously injured. These numbers still seem to be high, and depending on which report one reads, the numbers may still be climbing. The ambulance services here are becoming increasingly skilled at managing severe trauma patients. The times taken to get to definitive care in hospital is decreasing and the treatment options increasing. Tranexamic acid, a drug commonly used in hospital for surgery associated with a high risk of bleeding, has recently been introduced to front-line crews as a pre-hospital treatment and is having, at least according to initial reports, a serious impact on survival figures. 

All these facts and figures are optimistic, but also leave a little confusion in their wake. Clearly, better infrastructure, more intelligent and robust policing, better skilled pre-hospital providers and the obvious ever-improving safety features of the vehicles themselves are helping to save lives. This is a trend that we can only hope will continue to improve. But the fact that the accident rate is still high, that there are still so many seriously injured, is still a cause for concern. 

The human element is one of the toughest to regulate. Emotion will always play a part in a driving, particularly in light of the descriptions of the Israeli driver that I have already mentioned. Actual attitudes need changing too, but that is hard to do when confronted with a seasoned driver who has years of driving experience and picking up of bad habits. Change needs to begin from the ground up, even before a 17-year-old is allowed to start to hold a steering wheel in their hand. It needs to start with the basics, for example teaching that riding a motorbike whilst wearing almost no protective gear is a path to almost certain disaster. 

Attitudes to alcohol need to change. No more the thought process of one drink will be ok. You want to drive? Don't drink. 

Attitudes to other drivers need to change. Understanding that allowing one driver in ahead of you will not only benefit them, but will help the roads run smoother and reduce the aggression on the roads. 

Attitudes to seat belts and appropriate child restraints must change too. Particularly in certain sectors of society. 

It may take another generation, perhaps less, perhaps more, but if we want to reduce fatalities even further, we need the drivers themselves to cooperate. To understand that sometimes there really is a greater, even if unseen, good. 

Years ago, there was an advertising campaign here that promoted the following philosophy: 

"Don't just be right, be smart." 

A combination of the two would be even better. 

Lost Keys

The door shuts gently behind me, bringing to a close another shift, one that ended at a time normal humans call bedtime. I've left the world of the permanent nights behind, at least for now, choosing instead to pick the shifts I like, while I still can. The times are different, the hours fewer, the system new to me, but the work and the patients remain the same. 

Calls still come in for bad backs, three day old coughs, tight, crushing chest pains and accidents of all types. Cars still fight with each other for a small space on the tarmac, denting bodywork and pride as the space in between goes from narrowed to nothing. Bodies give way to gravity when the ladders beneath them collapse down to earth. Knives and bullets pierce the skin and cause untold, perhaps irreversible damage to the organs hidden from view. 

Here and there a life is saved, a soul is comforted, a child is born. 

Until the door shuts behind me, the shift isn't over and the processing doesn't begin. Most days there is nothing to trouble my thoughts, the patients merging one into the next, each occupying my mind for the duration of our stay with them, or theirs with us. Some leave an impression, a smile, perhaps, maybe a frown. At other times a question mark looms over the lasting imprint of their faces, the tale of their woes, the miracle of their survival. 

Some days, shutting the door behind me, ending the shift with a turn of the key, only signals the start of the process. 

It's bedtime. 

I go in to check on each of my already sleeping children, a habit often repeated several times each night since each was born, thankful that I am able just to stand, and stare, and watch them sleep in peace. I lock the front door, but in so doing, open the door to my own thoughts, trying to process the day. 

That door needs locking too, but all too often I can't find the keys. 

Bad Weather

Heading through the terrible weather towards the scene at right angles to the accident, the level of carnage looks all the more brutal. We're the third ambulance to arrive, adding to the sea of flashing lights. Rain drops look like tiny blue specks of light, reflecting the LEDs from all the emergency vehicles. Police cordon off each end of the street as fire crews start to cut through the mangled remains of what used to be a private car. The two occupants of the first car have managed to escape their wrecked former mode of transport and walked away with nothing but scratched arms and, for the driver at least, a bruised ego.

The other driver wasn't so lucky. Trapped in his seat by the crumpled front of the car, his head pinned back by the first paramedic on scene, all Terry wanted to do was move. One quick glance and I realised that it wasn't going to be a simple question of taking the roof off and dragging him out. There would have to be pieces of metal bent against their natural direction, some cut away all together, before we could even begin to think about getting him out of the car. 

And all the while, the rain continues to fall. 

"You must be getting soaked out there!" said Terry, talking through a misty oxygen mask. 

"Drenched to my core, but I'll worry about that later." 

At least he was in fairly good spirits. 

"Have you got any pain anywhere?" 

"Just my legs, but that's probably because they're wearing part of the engine." 

"No pins and needles, no pain anywhere else?"

"Nope. Nothing at all." 

"That's good. Can you move your toes for me?" 

Terry tells me that he's following my instructions, but his toes don't seem to move. Maybe I just can't see properly, but in any case, there's not much I can do about it.

"OK, we'll check on you a bit more once we've got you out of there." 

It took almost two hours of the fire brigade cutting, stretching and bending metal to get Terry free. In the meantime, we did what we could; gave him fluids and pain relief to keep him stable and comfortable. He finally appeared, borne out of his car on a flat, rigid rescue board. One look at his legs was all it took to see that they were both broken below the knee. 

"Can I just see the car before you take me away?" 

"Well, not really. It's the other side of the ambulance and you're now joining the wet-suit brigade. Besides, I think you need to get to hospital." 

Terry looked disappointed. 

"I'll tell you what - let's get you inside and out of this tropical downpour, and I'll go and take a photo for you on my phone." 

"Sounds like a plan to me!" 

We moved the trolley inside, turn the heating onto the highest level and my crew mate checked him out from top to toe again. I ran outside into the pouring rain, took a photograph as promised, and ran back inside into the dry.

"So, you sure you want to see this?" 

"You bet. Might as well have nightmares about something I've seen, rather than something I've imagined." 

"Alright then, here you go." 

With his head strapped to the board and stuck between two head-blocks, only his eyes moved. 

"Well, it's taken me twenty years!"

"First accident in twenty years?" 

"No. Third actually." 

"So what's taken you twenty years?" 

"Well, I've always wanted a convertible. I just thought I'd pick better weather to put the roof down." 

Eight Miles

The radio vibrates against my shirt, the phone beeps in my pocket and I run back to the car to see the screen flash up a new call. Eight miles isn't all that far, particularly at night, but even at an average of sixty miles an hour, it will take eight minutes to get there. To average sixty, I need to be going ninety for at least some of it. In London, even at night, it's barely possible and for the most part unsafe. Unsafe for me, unsafe for pedestrians, unsafe for other motorists, unsafe for my patient if I never make it to where they are.

Eight minutes is a long time to wait for an ambulance. I know. I've been there. I've had to make that call, had to wait that wait, watching and worrying. I understand. And I want you to know that when I have to travel that far with the screen shouting at me that someone isn't breathing, or someone is seriously injured, I feel the same as you do.

The trepidation that ninety miles an hour just isn't quick enough. The worry that eight miles is just one mile too far. The feeling that each and every speed bump in the road that's meant to slow me down and as I encounter it makes the patient's chance just a little worse. If I could somehow jump over those bumps, skip around the width restrictions, fly over the cars that block my path, I would. But I can't.

The address is eight miles away, 8.2 to be exact. The junction of two suburban streets is also the meeting point for a car and the bicycle carrying Hayley on her early-morning paper round. At six in the morning, traffic is starting to build and people city-wide are starting to consider their commute to work, just as I start to see the light at the end of the shift.

The caller is the car driver, distraught, distressed, disturbed. Scared not so much of the long term consequences, but more of the immediate danger to Hayley as she lies unconscious in the road. The call-taker gives some basic instructions, to check the airway, the breathing. Not to move the patient, but to wait for the crews to turn up.

We arrive on scene together, two of them in the ambulance and me in the car. 

"Six miles we've had to run for this!" says the frustrated attendant as he grabs another bag out of the side cupboard.

"Tell me about it. I ran eight."

One look at Hayley tells us we're going to need some extra help. She's starting to come round, moaning in pain and confusion. A large, dark patch is slowly spreading across her jeans from just above her knee. Her femur, the thigh bone, is clearly broken, the angle of her leg telling us more than we needed to know.

"I'll get HEMS running. I think we're going to need more pain relief than we can give her."

"Good idea. Bet they have further to run than we did."

During the hours of darkness, HEMS teams travel by car, leaving the helicopter to a better night's rest than most of the people who work on it during the day. It takes them some time to get to us, by which time we've tried to stabilise Hayley as much as possible. I give her a strong dose of Morphine, hoping to reduce the pain at least a little, at least enough to let us straighten her leg. It's not enough. Even doubling the dose to the maximum we're allowed to give doesn't allow us to move Hayley's shattered leg at all. HEMS arrive and the doctor on board gives Hayley some ketamine, finally relaxing her into a state where we can pull the jigsaw-puzzle femur straight enough.

We finally settle her on the stretcher, the minimal warmth of the blood-soaked blankets now assisted by the heater in the back of the ambulance. Hayley is well looked after - a couple of paramedics, a doctor, a mother who ran frantically to the scene when she finally heard what had happened. It leaves me with nothing to do but to clear up the scene as much as I can without upsetting the police.

I sit in the car and watch the clock tick over to the end of the shift. The tail-lift is raised and the back door is shut, the blue lights start to flash and the ambulance pulls away with its injured cargo, leaving me to wonder if we had done all we could, if it would be enough. I start the engine and begin my journey back. 

It's a lonely, subdued eight miles. 

Greg

"GREG?" 

The man looks up, raises an eyebrow, shrugs his shoulders and finally shakes his head. 

As for us, there's still a child with an asthma attack waiting for our attention. 

Greg will have to find help elsewhere. 

Thinking back to the crash, maybe he's already receiving it. 

Missing

We spread out and search a room each. The police broke the door down, leaving the splintered remains of the frame lying all over the carpet, like a giant wooden pile of pick-up-sticks. Greg's worried neighbour had called the police having not seen him all day and seeing that his morning newspaper was still sticking half way out of the letter box. 

"He often goes out for the day, but he's never this late back and never leaves before reading the paper first." He stands behind us as we step into the house, brave and afraid in equal measure. "I just hope he's alright." 

Each door is opened slowly as the fear of what may be found behind it gnaws away at the back of all our minds. The kitchen and main dining room are empty, as are the other two downstairs rooms. One of them looks as if it had been locked in a time-warp for fifty years, with piles of newspapers tidily stored all around the room. 

Some houses give more of an eerie feeling than others and this is one of them. Only half the lights seem to be working, the doors creak and floorboards whine as the small army of police, ambulance staff and worried neighbours walks around fearing the worst, but hoping for the best. The search continues upstairs and follows a similar pattern. A gentle opening of the doors, initial relief at finding nothing and then a move to the next room. A more thorough search of each room, behind beds, in hidden corners, in the toilets and bathrooms reveals nothing. Greg isn't at home. 

Initial relief is soon followed by concern. The police start to take a more detailed report from Greg's neighbours, knocking on a few doors up and down the street to see if anyone could remember the last time they'd seen him, the latest time being the previous afternoon. The lady next door tells us that she's known Greg for over twenty years. 

"He has family, but they all live somewhere in the north of England. Come down for Christmas and his birthdays, but that's about it. He's fiercely independent and very stubborn. Never asks for help or anything. Loves his days out, goes everywhere by bus." 

We ask our control to contact the local hospitals, wondering if Greg had been taken ill in the middle of the night or whilst out and about on one of his gallivants. As they contacted each hospital they called us back to let us know the answer. No hospital within a ten-mile radius was looking after Greg and concern for his welfare was building. The police had called his relatives just to make sure that he hadn't headed north without telling anyone, but he hadn't contacted them either. 

As we were about to leave, a white van pulls into the road, the two men on board had come to fix Greg's front door and make sure the house was safe and secure. "We'd have been here sooner," said the driver as he stepped out of the cab, "but we got stuck behind a crash. Some old bloke knocked over about a mile down the road. They've only just let us through!" 

The coincidence isn't lost on anyone and worried looks cross a number of faces. Yet again, one of the officers gets on the radio and tries to find out the name of the victim of the crash. We all hear the reply. 

"No details yet. He didn't have any ID on him." 

We have no choice other than to leave the scene and leave the police and neighbours to deal with the missing Greg. As we drive up the steep hill towards the main road, we're given another call. A child somewhere is having an asthma attack. It puts an end to our mystery call. We turn left at the top just in time to see an older man walking in the opposite direction. Shopping bags in each hand, he strolls without a care in the world. On a whim, I wind down the window and shout. 

"GREG?" 

Silence

Two faces in the dead of night, staring out of the front windscreen of a destroyed car. One's talking to me,  bragging, apologising, part regaling in their achievements, part regretting their actions. He tells me of their drink fuelled night, how they argued over who would drive, how they agreed that they'd have one go each at making the car fly over the bridge. His friend is quiet, eyes staring into the distance.

They succeeded. The police estimated that they must have been driving at over a hundred miles an hour when they hit the brow of the hill. The car's front was unrecognisable, make and model only clear from the back, airbags deployed all around. As we strap him down to a board, hoping to prevent any further injury, he tells us that once they'd left the road, the car just seemed to fly sideways instead of straight, and there was nothing they could do. In the meantime, the police dealt with his friend.

He kept saying that he wasn't brave enough to drive that fast, and when they failed the first time, they turned around, lined up again, changed seats, and had another go. He talked to us all the way to hospital, barely noticing any checks we did, any treatments we provided, just boasting about their tricks, about how impressed he was with his friend, the one we'd left on scene.

"Car's a write-off, isn't it?"

"I'd guess so."

"How come you guys got me out first? Is it because I was making so much noise?"

"Something like that, yeah."

"Well, my leg is smashed, isn't it?" It was. 

"Guess my mate's OK then, he didn't seem too hurt, just sitting back like that in his chair." 

A police officer travelling with us shuffles uncomfortably in his seat, and gives me a quick look. He makes a few more notes in his pocket book, checks once more for our call sign, and asks the passenger again what happened. He goes through the stories again, tells how they took a longer run up the second time round, makes sure that we know that he wasn't driving, that his friend was.

"I was in the driver's seat first time, but we didn't take off. So he took over. Called me all sorts of things for chickening out. But he did it! It was so cool! Shame we hit that fence though, won't be able to do it in that car again!"

It wasn't the fence that was the problem. It was the street light after the fence, the one that had smashed through the roof and the windscreen of the car. On the driver's side. The passenger, our patient, notices the looks, senses the unease. 

"Is my friend OK? Is there another ambulance looking after him? How come you didn't get him out too?" His world crashes in around him as the reality dawns, and he shouts. "I asked you, is he OK?"

I look across at the officer, who gives me an almost imperceptible nod of the head. 

"No. He's not OK. He's dead." 

Suddenly, silence engulfs the ambulance. 

Oil Spill

Monday morning. 

Early. 

As the world begins its weekly ritual, a few tired night workers are preparing for their midweek weekend. Empty milk floats head back to their depots, their early morning rounds completed, many a front doorstep adorned with their goods. Autumnal sunrise greets the early risers, the sun shedding plenty of light but not yet enough warmth to clear the dew from the grass and the roads. 

Mike is one of the masses, joining the rat-race and heading into work. In an effort to make his journey easier and quicker, he abandoned his car in favour of two wheels. For months, he'd enjoyed the fact that he could cut through London's standstill rush hour, leave home a little later, arrive back a little earlier, adding a few precious extra minutes with his family every day. 

The call on the screen brings back memories, ones that I'm not keen to relive. Motorcycle under a van, status of patient unknown. When the call comes in, I'd just finished dealing with an acute case of probable paediatric schoolitis, a common childhood ailment, regularly apparent on Monday mornings. There were twenty minutes left of the shift. The call was some five miles away, and would take me straight past the front door of the station, frustratingly close, yet so desperately far. My relief was probably already there drinking coffee and awaiting my return. A few minutes later, Mike and I meet for the first time. 

Unlike the call I'd feared, Mike's head was visible, and he was actually sitting up, helmet off, and talking quite happily. His right leg, however, is wedged between the two back wheels of the van. His bike is lying on its side in front of the van, smashed shards of shimmering glass mingling on the road and glistening in the sunlight. Just in front of that is a small pile of powder covering what we presume is some oil on the road. 

"I don't really remember what happened, I just lost it on the wet road I think. Next thing I know, there's a van on top of me!" 

A quick conversation with the van driver gives us a few more clues and leads us to believe that Mike's had his leg run over by both the front and the first of the back wheels, with the van coming to a halt before the third wheel added insult to injury. 

Unsure of the exact circumstances, Mike's neck is immobilised in a collar and he's laid flat. The fire brigade, having arrived a few minutes later, have secured the van and lifted it high enough for us to get to see Mike's leg. His leathers are intact with only a few scuff marks, but his foot is lying at an unnatural angle, giving away the secret hidden beneath the leathers. As we cut the trouser leg away, the damage is obvious. Several breaks, the worst at the ankle. 

As usual, several things happen at once. A cannula is placed in Mike's arm, giving easy access for some pain relief. A scoop stretcher is placed under him, ready to move as soon as he is secured. Some bandages and a splint are applied to his leg. All while someone else checks for any other injuries, and luckily, finds none.

In the ambulance, once Mike was settled and his pain controlled enough, there are a few moments for a quick conversation.  

"I think you might have slipped on some oil, or diesel. There's a patch already covered up with some gravel, just by where you came off your bike!" 

"You talking about the white grit-like stuff?" 

"Yeah, that's it. Someone must have put it there not long before, it still looked quite clean." 

"Ah. That's not grit or gravel." 

"How do you know that?"

"Well, I work for a pet shop." 

"And?" 

"Well, I was on my way to work with a big bag of cat litter hanging off the handlebar..." 

Can't Cure Stupid

I think, that rather than preventing my kids from leaving the car at the wrong time, I need to child-lock myself in my car sometimes. 

On route to work, I was followed for almost ten minutes by another car with a small child on the front seat. Then on the back seat. Then back to the front. 

In uniform, out of sorts, and stopped at a set of traffic lights, I could bear it no more. 

I got out of my car, knocked on the window, and was about to suggest to driver that an unrestrained child is not only illegal, but it's damned stupid, and that I didn't much fancy the idea of being the medic at the scene of an accident who had to break the news that her child's dead. Because she's stupid.

Stupid wasn't the half of it. 

On the back seat, secured by not one but two seat belts, was a brand new television. 

"Your TV is strapped in, and your child isn't? What's wrong with you?" I didn't mean to yell, but my red-headed temper got the better of me.

As luck would have it, a passing police car saw the altercation and came to tell me off, assuming another road rage incident (they were only partially wrong), only to see the real problem.

I left them to it. 

Break Up

The car looked as if it had been hit by a tank.

A massive dent in the passenger door.

Every single window smashed.

The boot flipped open.

The hood and the roof scraped.

One of the tyres a hundred yards down the road.

And the driver stood laughing by the side of his car.

The passenger side, the one with the worst damage.

"What are you laughing at?"

"My ex-girlfriend!"

"What has she done that's made you laugh?"

"Broke up with me."

"And that made you laugh? You don't look too broken up!"

"Well, up until ten minutes ago she was my girlfriend. When she broke up with me, parked up outside her house, I threw her out my car. If we'd still have been together, she'd be dead."

Reality suddenly struck and he broke down in tears.

"I've never been so pleased to break up with anyone before."

Provisions

"Education is the best provision for the journey to old age." - Aristotle.

______________________________

Those of you who follow my Twitterings, would have seen that yesterday I was rambling about going to speak to a group of kids, and how nervous I was. Needlessly so, I must add. I shouldn't have a problem talking to kids. I used to be one, I have several of my own, and MrsInsomniac would declare wholeheartedly that I still behave like one. So what made me nervous? Two things.

First - I knew there were going to be adults in the room. Speaking to a roomful of kids is a doddle. They say what they think, ask questions if they don't know, and will always let you know if you're boring them. However, put me in front of a roomful of adults, ask me to give a talk on any given subject, and I fall to pieces.

Secondly - I was going to tell these kids all about the hows, whys and wherefores of the ambulance service.

Now that's something to be nervous about. I've done this sort of thing a couple of times before and found one thing is certain. Whatever you plan will go straight out the window. Go with the basics prepared in your head, and then just flow with whatever happens thereafter.

So I went to work, brought back dozens of items that we use on a daily basis, and laid them out on a table for them all to see.

There were masks, splints, collars, bandages, hi-vis coats, bags, extrication devices, even cannulas. Packaged of course. I had one aim in mind, and didn't really care how we got there. My aim was to ensure that by the end of the session, these kids would know when to call us and what we do, and that there's nothing to be scared of when the green-dressed strangers walk in to their lives.

After a brief introduction, I relinquished (some might say lost) control and let the kids take over, which was fine by me. They wanted to tell stories of when they'd been in an ambulance, they wanted to show that they knew what some of the pieces of kit were for, they wanted to play with the bits that they'd never seen. Not one of them shied away. Even the cannulas didn't scare them off. OK, so I cheated when they asked me why they were different colours and I told them it was pink for girls, blue for boys, and the other ones for adults according to what they were wearing, but then quickly told them the truth.

They were curious, they were interested, they were excited, and not one bit scared.

Part one of my aim successfully achieved.

Part two I thought was going to be somewhat more difficult. When to call us. As they sat in a circle on the floor, I decided it would be easier if they told me when they thought you should or shouldn't call for an ambulance. One child would tell me a good reason to call, the next would tell me a good reason not to.

"A broken leg." Good call.

"A splinter." They all laughed and agreed that was a bad call.

"If you see a car crash!" 

"If you stub your toe." They all laughed again. 

"If someone falls down the stairs and hurts themselves."

"If you fall over and graze your knee."

"If you can't breathe properly."

"If you're hungry!"

"If someone's having a pain in their chest." I thought that was particularly astute for an eight-year-old.

"When you get a paper cut!"

"If someone is bleeding a lot."

"Prank calls." I concentrated on this one a little longer.

On and on we went, until the every child in the circle had had their say. And as I listened to their answers, I was struck by the fact that all the suggestions they had given for when would not be an appropriate time to call an ambulance were situations that I had come across. I'd been called for a paper cut, for someone wanting breakfast, for a stubbed toe and even a grazed knee. It would seem that these kids had a better idea than some adults that I've met over the years.

I wish I could do more of these sessions. Teach the young ones about what we do, when we do it, what we're really there for. Show them the things they may come across if they call us. If the first time you see a collar is after you've just been knocked off your bike, you're bound to be a little more traumatised than if you'd seen one in a classroom, had the chance to play with it, even try it on some time earlier. Maybe, a few years down the line, it would also make the difference between calls waiting for ambulances, and ambulances waiting for calls.

The next generation might have an awful lot to learn, and we can try to hand them these provisions for the future, but it might be worth remembering that all too often they have just as much to teach.

A Sister's Pain

I search for the right words, the strangled words that will express my pain, but they won't come. Nothing is enough to express the anger I feel, the disappointment, the insult and the sadness that now engulfs me. I'm the sister of that thirteen year old, the one who you hit last year.

An accident. That's the technical term, but I refuse to accept it. In the middle of that dreaded afternoon you drove drunk, mounted the pavement on which she stood waiting for the green light that would allow her to cross safely. And you hit her, your impaired judgement showing no mercy. 

She lay in hospital for a week hanging by a thread between life and death, and another month in a coma. That whole time the doctors repeatedly told us that there was no hope.

She wouldn't live.

She wouldn't wake up.

She wouldn't recover.  

Funeral arrangements were prepared, and discussions about organ donation were started.

Then, in defiance, she started to breathe on her own.

This whole time since, she hasn't spoken once. She hasn't stood on her own two feet. She hasn't laughed. I keep waiting. I stand and watch her, and I pray for that one sign that she's coming back to me. But no one can tell me that it's going to happen.

As you stood in court, the judge delivered the verdict. The judge spoke of an accident with devastating consequences, told of your extenuating circumstances, and how difficult your life had become since you hit her.

And for all of that, all that devastation, you got nothing.

A fine and a suspended driver's licence.

Someone who drives whilst talking on the phone gets a fine.

Someone who breaks the speed limit gets a fine. If they do it twice, maybe thrice, they might lose their licence too.

You, you who took my sister's life away and destroyed her future and her family, you get to walk away and live your life as if nothing ever happened.

I wonder if you even gave her a second thought, or if you only ever thought of yourself.

I don't care if you admitted your guilt in court, saving your own skin and supposedly precious time.

Time is something I have plenty of. Over a year of her life has already been taken away. I can wait a little while longer for justice. But it doesn't seem forthcoming.

My heart, already broken, has been ripped out of me and stamped on. My baby sister, my parents' child, is no more than another statistic, another number in the eyes of the courts, and to you she means nothing at all. But to me she's my fun-loving, animal-friendly, bad-taste-in-music, drives-me-crazy sister, and I want her back, body and soul intact.

So whilst you walk the streets in peace, drinking away the days until you can drive again, she lives in a state of constant war. She fights for the tiniest movement, the smallest glimmer of hope, the simplest of signs to show that she's still with us, that she knows us, that she wants to keep up the fight.

As you walk back to your own life, I'll be here fighting her battles with her.
__________________________

The translation and some literary license is mine. The story, however, isn't.

Rag Dolls

So far this weekend, I've seen several vehicles whose wheels have been in a somewhat naturally untennable position. Here's one that I didn't witness, but makes for shocking viewing!

Watch as the bus is hit. From inside the bus involved. Watch how they all stand mortified at the impending crash, and how they're each affected by it. Like rag-dolls in a washing machine. Makes you wonder how there were no serious injuries, and think about what happens in a crash. Especially when there are unrestrained passengers...

Now THAT's what I call Mechanism of Injury.

Remember - wear your anti rag-doll device. Popularly known as seatbelts.

Flowers

Behind the familiar yellow sign stood a tree scarred by violence. The impact had been unforgiving, shattering bones and shredding skin, leaving Yvette barely conscious, moaning in pain. She lay on the ground, her head by the tree and feet stretched out into the road. Her bike a hundred paces further down the tarmac, collapsed on its side like a mortally wounded animal. We treated and packaged her gently, efficiently, whilst at the same time graciously waving off offers of help from well-meaning yet misguided passers by, each with something to say, yet nothing to offer.

I didn't witness the accident, only the aftermath. I had nothing to offer to the phone number on the sign. I was only a witness after the fact, to its immediate repercussions. Behind the sign stood a wall, tall, mercifully untouched by human tragedy, but bearing the weight of so many flowers and cards. The sight of these took me back, and left me reeling. Yvette seemed so alive, fighting so hard when we left her at the hospital. I knew that she'd made it to theatre the very same day, and knew nothing more now that the weeks and months had passed. I didn't expect the tributes to be there, but couldn't stop to read them, and hoped to get back to the distant hospital to find out more.

She had an unusual surname, one that for some reason stuck in my memory, even weeks later. When I finally got to the hospital, I asked the receptionist if she could find out what happened. As she typed in the surname and a range of dates, the sand-clock timer turned slowly on the screen making me even more anxious. I finished the paperwork for the patient I'd just delivered whilst I waited.

"Yvette," said the receptionist, making me look up quickly from what I was doing, "was taken to theatre, and admitted to one of the wards."

"And then what happened?"

"Exactly a month later, to the day, she was discharged home!"

I finally exhaled, the breath I'd been holding flying free as relief washed over me.

Instead of mourning a life lost, I left, celebrating a life saved. 

Yet I still wonder about the sign, the untouched wall, and all those flowers.

Safer

The patient we'd just dropped off at the hospital only became a patient when the police turned up. Far from being police brutality, it seems that they just seem to have an overwhelming effect on some people. Paulo had driven home from the pre-Christmas office drink, a warm up for the main event that was scheduled for mid-December. It was only supposed to be the planning meeting, but he decided to sample some of the drinks to help him decide what to make available for everyone else. Then he drove home. Well, about half way, before he met the kerb, burst a tyre and was stopped by a grass verge. A good Samaritan witnessed the incident, and as he drove past and kept going, he called for an ambulance. Paulo was uninjured, the crash and his escape a dichotomous result of his drunken state. The police turned up a few minutes later, and as soon as they said the magic words informing him of his arrest, Paulo collapsed.

Paulo fell to the ground, making sure he found somewhere soft to drop. His eyelids held tightly shut and hands making tight fists, he failed every test for unconsciousness known to any paramedic worth their salt. However, he still refused to open his eyes or speak, and therefore won the first round. The police had no choice but to send him to hospital, although rather than being let off by them, Paulo was accompanied all the way, and would be watched until he recovered from his mysterious ailment. Round two would be won by the police as soon as he woke up. Far from being sent home, Paulo would spend hours in A&E, and then more hours in a police cell. Round three would be up to the judge.

Having transported an officer and their quarry, we were then free to go back out on the road. We left the hospital, and half way back to station, saw a car veering across lanes, bouncing off the pavement, and showing a general disregard for any rules of the road. We called control and let them know that there was probably another drunk driver on the road and asked for police to attend before anyone was injured or worse. Following the car, we were given permission to use lights and sirens to see if that would help stop the driver, but both were completely ignored.

The car seemed to be accelerating away from us, and was heading directly for a line of traffic waiting at a set of lights. Assuming that our presence might be making the driver act more erratically and dangerously, we turned off the lights and sirens and slowed down. We waited for it to skirt around the line of cars, jump through the red light and across a busy junction. That wasn't even close to what happened.

The car didn't even brake. It slammed into the car at the back of the line and stopped dead, steam pouring out the hood seconds after impact. We pulled up behind the car, radioed in to let control know what had happened and requested another ambulance, as we'd probably have at least two patients. 

The blue van that had been stationary was shunted forwards a good distance right into the middle of the junction. Luckily the lights had changed, so there was no cross traffic and the car in front had already moved off, missing an impact by the thinnest of margins. The driver got out, and looking a little dazed, walked over to us cradling one arm in the other. Even from a distance we could see that he'd fractured his wrist. The police turned up at that point, and were tasked with babysitting him until we could assess the other driver.

The front of her car was half the size it should have been. She hadn't moved since the impact, and as we approached we could see that she was conscious, breathing, and seemingly uninjured. The expected smell of alcohol didn't materialise when we opened the door, although her speech was slurred, she was confused and her behaviour was erratic. Sure drunken signs, but lacking evidence, we carried out further checks. Within under a minute, we had the answer. As a police officer looked for physical clues, we searched for medical ones. A blood sugar check was all it took. Her sugar level had dropped to less than one (or eighteen for you Stateside persons). Most people I've seen with that level have been totally unconscious, and nowhere near a steering wheel. A few hundred drops of sugary water directly into her blood stream were enough to bring her back to reality, although not the one she remembered.

"What happened?"

"Well, you've had a hypo, and crashed your car. It seems that you've come out of it OK."

She took a moment to digest the information. A look of horror suddenly crossed her face. "What about the person I hit? Are they hurt?"

"Don't worry. They're on the way to hospital for a check-up." I didn't have the heart to tell her about the broken arm. "What's the last thing you remember?"

"I was having a meeting with some guy. I run an inn, and we were planning their Christmas do. He had a couple of drinks, maybe more than a couple, and I told him he probably shouldn't drive, but he went anyway. I hope he made it home in one piece! Maybe I should've taken my own advice too..." 

We asked about her medical history, whether she'd been eating regularly, all the other relevant questions for a diabetic whose blood sugar levels have dropped so low. She'd been doing everything right, so the reason remained unclear. There was still one thing we wanted to quiz her about.

"Do you remember the name of the person you met?" I couldn't believe the coincidence, and I didn't expect the answer. 

"Yeah. It was a foreign sounding name. Pablo I think." 

"Pablo? You sure?" 

She sat looking thoughtfully into the distance. "Oh. No it wasn't. It was Paulo. Not Pablo. Definitely Paulo." 

Two ambulance crew stared at each other in total silence, barely accepting the answer we'd just heard.

She broke the silence after a few seconds. 

"Instead of telling him to get a cab, maybe I should have asked him to drive me! It would probably have been much safer..."

You Know You're in EMS When...

So this is the tweet I posted that started it all off: You know you're in EMS when you sit eating breakfast whilst watching amputations and impalements on TV.

After that, I thought it'd be good to hear what some other people think too, and the snowball started it's journey. These are the others that were posted. Read all the way to the end if you want to see my absolute favourite. Actually, there were two that I couldn't choose between. Having said that, I can identify with almost every single one of these!

Enjoy, and feel free to add some more in the comments...

You know you're in EMS when...

... you call a bunch of friends to meet up only to realise that they're all working because it's a weekday. Ah shift work. @flobach

... you're more unconscious than your "unconscious" patient at 3am. @goforfink

... a great sense of humour and no sense of smell are essential. @thesmurse

... you have extra gloves in your car, house, everywhere. @texaschef

... you consider asking your partner to start a line on you after a night at the bar. @texaschef

... you decide which hospital to transport minor calls to based on the food choice in the EMS room. @texaschef

... you somehow you manage to treat the patient with toe pain with the same respect as the patient with the genuine emergency. @justmyblog

... you've had to wait for hours in the emergency department for hours, without being a patient. @goforfink

... bed is a missed friend. @seanhfitz

... you've responded to back pain that's getting better, but they still call at 3am. @texaschef

... you have no shame taking the ambulance through a drive-through, and expect a discount! @justmyblog

... 2 hours sleep is considered a full night. @texaschef

... your crew mate takes the bumpy route when you're in the back. @ambulance_999

... you watch "Trauma" and wonder when your service is going to get stretchers like that. *drool* @goforfink

... you drive up to a width restriction and think "will I fit?" @MadMedic1

... you identify random places around town by the call you attended there. @seanhfitz

... you don't remember working a cardiac arrest at the end of your shift because you were asleep. @seanhfitz

... townspeople and ER nurses only recognize you when you're in uniform. @justmyblog

... you drive by an MVA (RTC) and not look at it, because you've seen worse. @texaschef

... you can eat, use the restroom and sleep, all in 20 minutes. @texaschef

... Friday and Saturday become the worst nights of the week. @goforfink

... you can work a 17 hour shift, running all night, and still find the power to go to the pub. @grindermedic

... you look at a person in the street and think "5 loops and call it!" @MadMedic1

... you can live off two hours sleep per night - as long as you have coffee. @justmyblog

... when you get ideas for your lunch from your patient's vomiting. @seanhfitz

... you tell patients "the gloves are for your protection". @ambulance_999

... you drive a Mercedes all day, then get in your car and try to indicate with the windscreen wipers. @goforfink

... you become a dustbin for everyone's poo. @christopher_mcg

... you've mastered the art of getting dressed whilst still dripping from the shower and still looking somewhat ok. @justmyblog

... you drive home after a night shift and realise you've treated the last three red lights as give-way signs. @999donkey

... you're looking for a friend's house at night and reach for the centre console to turn on the floods. @flobach

... when you use all your sympathy at work, and leave none for your family. @mrsinsomniacmed *ahem*

... when the flight attendant asks if any medical people are on board and you try to become invisible. @seanhfitz

... for you to have a good, challenging day at work, someone has to have a really bad one. @ColdGh0stR1der

... when your house is always an organised mess, and your rig looks like something out of Martha Stewart Home. @justmyblog

... you can judge exactly 350 yards, with or without the satnav. @MrTom_Abbott

... you can smell what's wrong with your patient before you can see them. @ambulance_999

... you eat every meal like it's your last, because you know the alerter will go off any second. @ambulance_999

... hot girls walk past you and you notice they have a curvaceous body, slender arms, and beautiful... veins. @flobach

... you utter the phrase "that's not that much vomit!". @510medic

... you turn off the radio to hear the sirens. @EMTDani

... you never have a wardrobe malfunction at work. @flobach

... you can pick the type of vehicle responding by hearing a far away and faint wail of the siren. @flobach.

... even at home, when the phone rings, without thinking you answer it "Ambulance". @multistar

...you know the streets of your patch like the inside of your pocket, but are hopeless outside. @flobach

... you walk into the messroom at 1900, and bid everyone "Good Morning". @insomniacmedic1

... you're off duty and hear sirens, and for a second think they're your sirens. @texaschef

... you go to grab a pen from your breast pocket... but you're off duty and in a T-shirt. @flobach

... you see a trauma in a movie, and immediately run through your assessment. @texaschef

... your wardrobe has a disproportionate amount of green in it. @saintpara

... you refer to you mirrors as whiskers for judging gaps in traffic. @idle_paramedic

... your life is ruled by three-letter abbreviations and complex terminology. @christopher_mcg

... you categorise people by what you think they'll die from. @saintpara

... you can't watch a medical drama without screaming at the TV every time some actor does something wrong. @multistar

... you've answered your personal mobile phone with your callsign. @thesmurse

... you have to stop yourself waving at ambulances / police cars when not at work. @saintpara

... you're constantly tired, over-worked, and under-paid. @multistar

... you're a passenger in any car and out of habit you say "clear left". @thesmurse

... you look on YouTube for car crash vids, and wonder how you'd extricate them. @yellowspanner

... you discuss decapitated bodies at the dinner table. @UKmedic999

 And my two favourites? These two laugh out loud moments of pure genius:

... you have too much blood in your caffeine stream. @theroaddoctor

and

... when anything over 8 minutes is just too long. @saintpara

For Sale

For Sale: 

Brand new car.

100 miles on the clock.

Good for spare parts and scrap metal,

also some empty beer cans.

One previous owner.

Now deceased.

I tried, didn't I?

A normal residential road, cars parked either side, and a 20 miles per hour speed limit enforced by signs and re-enforced by speed bumps.

I look right and left, see nothing, but hear the screaming engine and decide to wait. The two delicately balanced trays, full of sandwiches, aren't worth risking for the few extra seconds I decide to wait as the car appears round a corner, probably doubling the speed allowed on this road.

No more than ten paces to my right is one of the speed bumps, and the engine is slowed through the gears so that the lowered suspension has every chance of making it over without the raised hump of traffic-calming tarmac causing any damage to the precious undercarriage.

In those seconds, they see me, and the sandwiches.

And as they arrive beside me, they stop.

"Any of those for us?" asks the passenger, a giggly, over made-up and unrestrained girl of probably 18.

"Only if you and your friend buckle up and promise not to drive around like idiots", I reply.

They look at each other, and laugh.

"Nah", says the passenger, "we're not really that hungry!"

Their raucous laughter is soon drowned out by their tyres, as they screech their way down the road.

Fog

I remember the fog as a kid, driving in fog so thick, that we had to pull over and wait for it to clear.

I remember the fog on a school trip, walking in fog so thick, that we had to stop and turn back.

I remember the fog whilst on a recce, lying in fog so thick, not hearing the bullet that left the hole in my collar.

I remember the fog round the ambulance, and being warned of thicker fog lying ahead.

I remember the fog as we crawled through it, finally seeing the lights of those who'd arrived before us.

I remember the fog as we pulled up on scene, and were told there were four confirmed dead.

I remember the fog as we stepped out into it, seeing the dazed driver of the bus as he sat with his head in his hands.

I remember the fog as we treated his passengers, how he swore that next time he'd slow down.

He'll remember the fog and his speed.

He'll remember the fog and his passengers.

He'll remember the fog and the crash.

He'll remember the fog.

The 492

The 492 bus is standing on top of my patient.

It hasn't run over him.

He fell, and landed underneath it.

A feat of luck, judgement and special effects worthy of Hollywood made sure that the actual wheels missed him.

He's a little dazed and confused, and mostly scared. There are no obvious injuries other than a small lump on the front of his head.

We extricate him, and upset the fire-brigade in so doing. I think they felt we stole their thunder. He's moved to the ambulance and reassessed. As we do so, his phone rings, and "The Boss" appears on the screen.

"That's my wife", he says. "Can you answer it, and tell her I'm OK?"

I open the flip-style phone, say hello, and before I can get another word in, she goes into a gush of announcements.

"I'm gonna be late!" She yells.

"I'm on the 492 bus!" She hollers.

"A man's just gone under the bus and we're not allowed off!" She finally stops.

I whisper to our patient, asking his wife's name. "Lisa", he whispers back.

"Er, Lisa", I begin, "I'm from the ambulance service. We're with your husband at the moment. He's OK, but would like to speak to you in person. He can't talk on the phone right now, but if you get off the bus and walk to the ambulance next to you, you can see him for yourself".

The line goes dead, and an instant later, there's a knock on the ambulance door. I open the door for Lisa to jump in.

The babble starts again, a mix of shock, upset, confusion, and relief.

"You IDIOT!" She shouts at him. "You complete and utter MORON! I was phoning to tell you to go a different way home, the whole place is jammed. And then I find out that you're the one jamming it!"

She bursts into tears, looks at her husband, and as we slowly pull away from the scene, she gently kisses his lumpy forehead.

"I'm never getting the 492 again..."