Safe as Houses

The story of the paramedic who waited outside an address for a considerable amount of time has caused a great deal of outrage amongst the general public. Although the story is a few days old, it has still led to me being asked by several relatives and friends over the weekend what I think about it all. First - three disclaimers:

a) I don't know the whole story, I probably never will.

b) I'm truly sorry for the family of the patient involved, they have lost a loved one, and will never know whether those few minutes made all the difference.

c) The story's not been helped by certain media outlets twisting the facts to suit their own headlines. Truth, apparently, should never be allowed to get in the way of a money making opportunity.

Sometimes, we're stuck between a rock and a hard place. At what point does an open door go from being a welcome sight to being a warning sign? At what point does a normal family home change from a haven of hospitality to a hovel of hostility? At what point does a paramedic say that personal safety comes before patient safety?

The answer to the third question is theoretically easy. Always. Theoretically.

However, we are forever taking calculated risks, especially so, if, like the paramedic in this case (and me), you are a solo responder. We're forever walking into volatile situations. Sometimes with no prior knowledge, sometimes with some sort of forewarning. The mere fact that we are responding to emergency situations means that we're not walking into a normal family surrounding. People react differently when they're under stress, unpredictably so. It's part of our job to accept that, deal with it, and fully expect to be met by a barrage of different emotions. In the vast majority of cases we just get on and do our job, sometimes at great personal risk.

Despite all of the above, if I, or any other paramedic felt that our life was at risk, I would fully expect the patient to take second place. I don't know why the paramedic in our story felt so at risk, but I fully support his decision. After all, if he'd have walked in and disturbed a burglary, then his previous patient may well have been his last one. A life lost is tragic. Two lives lost would have been more so.

Baby Bus II

Driving the Baby Bus is completely different from driving a "normal" ambulance. Every turn, every bump, every acceleration or deceleration has the potential to be catastrophic for a poorly newborn. The little blood they have has a habit of pooling in one area if you brake too sharply, starving the rest of the body of its much needed oxygen. Hit a bump too hard and the jolt can damage their extremely delicate internal organs, not to mention potentially pulling out all the lines and tubes that the team have worked so hard to put in.

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The traffic is appalling, made all the worse by the fact that we're all tired and our nerves are fraught. It's taken almost 5 hours, but finally we're under way with Adam to Bigtown Hospital. Mum and Dad have said goodbye and a few prayers before we set off. Despite the fact we all want to go home, there's no tearing round corners scattering the traffic left and right. The nearly 100 miles have to be driven smoothly, calmly, and with utmost concentration. Not a particularly easy thing to do after what has so far been a 15 hour shift. Adam plays his part nicely, staying calm, sedate, and fighting with all his might to stay alive.

Two hours later, and after stopping twice to resuscitate Adam, we arrive at Bigtown. Adam was the most settled he had been since he'd been born, despite trying to scare us a couple of times. I've never been so relieved to see a hospital before. However, unlike an A&E handover, which only takes a couple of minutes once we're acknowledged, a BETS handover can easily take half an hour. It's not just a question of telling the hospital team what's happened, but the transfer from our incubator to theirs is a delicate procedure. Finally, after what seemed an eternity, we returned back to base, luckily not very far from Bigtown Hospital. I drove home, but to this day I don't remember that journey. It was just before 2pm when I walked into my house, having left home at 5 o'clock the previous evening. Tired just doesn't come close. Probably not as tired as Adam. He had a 50/50 chance now. We'll call back in a week or so to see how he's doing.

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Three days later I'm back on a day shift, just about recovered from the night to end all night shifts, scheduled to work on the Baby Bus that takes the babies back to their local hospital once they're well enough. The advantage of the "Elective" Baby Bus, is that all the journeys are planned, and it is extremely rare to finish late. After the other night, I'm not sure I'm ready to face another late finish. As I walk in, I'm told that we only have one transfer booked for the day, but that it's long-distance. The look of slight despair on my face must have shown, as I was then informed that it's not that far away, that I should be back by just after lunchtime, and that there's nothing else booked. I guess I can cope with that.

I look at the booking sheet, and can barely believe what I'm seeing. The booking is from Bigtown Hospital. Going to Outtatown hospital. 4 day old baby, not ventilated, breathing on his own, conscious, stable. After everything that had happened, after the trauma that his parents faced so bravely, after all the jangled nerves. Having survived a horrible start to life, having been attacked by all sorts of medical teams, having endured my driving, the unbelievable was happening.

Adam was going home.

We arrived at Bigtown, and I spoke with one of the doctors. I needed an explanation, but he had none. Adam had fought and won, and in a very short time, his battle for life. His recovery had been nothing short of miraculous. He was going home, via a couple of days at Outtatown Hospital for observation, with no lasting sign of all he had been through.

The journey back to Outtatown was a gentle one. No lights and sirens, no stops to retrieve signs of life, no fraught nerves.

Mum and Dad were almost unrecognisable as they stood waiting in the same side room where they'd had only a few minutes of troubled sleep just 3 nights ago. Their faces beamed as we wheeled Adam back in, and the tears this time were tears of relief, of happiness, of joy. All the weight of the world seemed to physically lift from their shoulders. I had the chance to talk to them for a short while, and their thoughts now were no longer in the past, barely even in the present. They wanted to think now in terms of the future. Adam's future. The one he very nearly didn't have and which he had fought so hard to hold on to.

Baby Bus

There are several types of ambulances out there, from cars to motorbikes, bicycles to a helicopter, emergency ambulances, as well as all the patient transport vehicles. One of the hidden secrets of the London Ambulance Service is BETS, or Baby Emergency Transport Service. It's an ambulance with a difference. It has a crew of one paramedic, one nurse and one doctor. It does what it says on the tin. This is a team of people who travel round London, the South East, and every so often further afield, in order to treat and transport very sick mainly newborn babies. Some are born very prematurely, with all the complications that it can lead to. Some are born full-term with all sorts of illnesses and diseases. The job that BETS has, in the most simplistic of terms, is to stabilise these babies and transfer them to the most appropriate treatment centre for their condition. Sometimes they also take them back to their local hospital once they are well enough. I had the privilege of spending six months with this team of dedicated people, and would love to go back for more. If only they'd move a little nearer...

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Three in the morning, the only noise in the building is the Batman movie that we're watching, the stirring of the cups of coffee, and the mumbled prayers that the phone stays silent now for the rest of the shift. It had been one of those nights. It took me forever to get to work, we'd been busy from the start up until now, having driven 150 miles already, and finally we could have a sit down and watch the movie that someone had kindly left behind. Ten minutes in, 3 pairs of eyes that were fixed on the TV are starting to droop, but the dream world that slowly envelopes the room is abruptly shattered with a shrill ring. In Outtatown Hospital a hundred miles away is a very poorly newborn, and he needs to get to Bigtown Hospital for treatment. There's a chance that he may not survive long enough for us to get there, there's a chance he won't survive long enough for us to stabilise and transport him, there's a chance he won't survive the journey itself, and if he beats the odds and survives all that time, he only has a 50% chance of survival overall.

Hoping against hope, and knowing that we were going to finish our shift very, very late, we set off for Outtatown.

The doctor on board is given constant updates on baby Adam. He suggests treatments to give him the best possible fighting chance. At about 5 o'clock in the morning we arrive, and are met by the local medical team, as well as Adam's parents. They suggest that as I'm doing all the driving that I go and take a nap. I manage 10 minutes, but the tension is palpable, and I feel that I'd be more use being an extra pair of hands. It was an amazing experience for me as a paramedic to be treated as part of a fully fledged medical team, and is one of the things I miss most about BETS.

The parents are, understandably, distraught. Dad is trying to stay composed, but mostly failing. Mum is in a wheelchair, refusing to give her body the chance to recover from the traumatic birth. They want to see everything, know everything, understand everything. Yet they understand nothing. There was no warning, Adam was born on time, all the scans were clear, no sign of the trauma that was to follow his birth.

It's the wrong side of 7am for a night team. Adam is fighting, but transport is a dangerous business, and he has to be completely stable. It takes time, ingenuity, medication and a lot of patience. The day team calls to see if we want relieving, but we work out that by the time they drive 100 miles in daytime traffic, even on blue lights, we'll hopefully be half way back to Bigtown. Adam permitting.

Mum and Dad finally succumb to a fitful sleep in a side room. The efforts continue, the hospital night staff go home to their Outtatown beds, the day team take over where they left off. Slowly but surely Adam's condition is becoming more manageable and he starts to settle. He has episodes where it seems we'll never be able to move him, but finally, at almost 10 in the morning, Adam's loaded into the incubator and onto the Baby Bus.

CONTINUED...

Aerophobia

I quite like flying. Or at least I'm not particularly bothered by it. I do worry, however, that the famous tannoy announcement of "Is there a doctor on board?" will suddenly break the monotony. What do I do then? I could always hide behind the fact that I'm not a doctor, but that's just being pedantic. I could always pretend that I was asleep, but nobody would believe that one.

Except that I know me, and if it did ever happen, I'd be the first to jump up with an offer of assistance. I can't help a good running call. I'm the sort of person who can't be out and about for more than 10 minutes without coming across some sort trouble, so I'm sure one day when I'm flying, it'll happen.

Having said all of that, I think I'd rather hear the request for a doctor on the plane, than a request for an aircraft mechanic...

Second Chances

"Don't you ever get scared, working on your own at night?", asked Nina, the patient's de-facto carer. Fair question I thought. My initial instinct is to be a typical man and say that I'm never really scared. But that's a lie. I think that anyone in this job, whether working on their own or with a crew-mate, has at least one moment where the Fight or Flight mechanism kicks in. There's a fear of the unknown sometimes, there's fear when someone pulls out a weapon and threatens you with it, there's fear being in a situation where you just can't see your way out.

My biggest fear, at work at least, is none of these. It's a fear of doing the wrong thing. I can't help over-analysing my actions sometimes, just to make sure that if, given another chance, I would do things the same way, because in this line of work, there is, at least sometimes, no way back.

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Alan is at the end of his wits. He sits at home with his 80 year old mum, Eve. He's there, waiting for the inevitable. The monotony is broken only by scheduled visits from the district nurse who gives Eve her pain-relieving injections. There is nothing more that can be done for her, beyond palliative care, ensuring that her last days are at least spent in some degree of comfort. Somewhere, however, the system has let them both down. No nurse has been now for 24 hours, when there should be a 4 hourly visit. Eve is in pain, and Alan can do nothing about it. He's tried the GP's surgery, he's tried Social Services, he's tried phoning the nurse directly, but realised that she must be away as the ring tone sounded foreign. In sheer desperation, he calls for an ambulance.

When we arrive, Alan is on the verge of tears. "I know I shouldn't have called you. I know that this isn't what you're here for. But I just need her to have some pain relief. She doesn't want to go. She wants to die at home. She's been crying for hours and I just can't take it any more!" He crumples to the floor, ashamed at admitting defeat. He had promised himself that he would take care of his mum, whatever it took out of him, but couldn't cope anymore.

Eve lies in her bed, unable to care for herself, unable to sit up on her own, barely able to convey what it is she wants or needs. She's frail, grey, and has a look that is almost begging for the end to come. The expression on her face, along with the agonised moan, screams for mercy. It's heartbreaking.

Technically, administering prescribed drugs is out of our remit. Especially the drugs that Eve was on, so we phoned for advice. We spoke to one of the on-call doctors who allowed us to step outside of our normal rules, and slowly give Eve some pain relief. Under their guidance, we watched how the medication took effect. The look of relief in both faces was remarkable. We stayed a while longer, ensuring that the medication did what it was supposed to, and that Eve was settled. Eventually the expression changed from one of mercy to one of grateful thanks. Then we went outside and completed a pile of paperwork.

10 minutes later, I'm still writing. There's a knock on the ambulance window. Alan stands there with tears streaming down his face again.

In a barely audible whisper, he chokes on the words as he says them "I think she's gone".

We rush back in to see that the inevitable has indeed happened.

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This was a couple of years ago. To this day I wonder if I brought about Eve's death, or whether I just made a sad ending a little more comfortable. That's my biggest fear. No second chances.

Comments

Clearly, judging by the comment, I've upset someone with my previous post. I've tried, in the comments section, to rectify what I hope is a misunderstanding. Nevertheless, is there anyone else out there who agrees either with me or with our anonymous friend? Don't be shy... I'm intrigued to hear!

Public Education Message

Amber emergency calls are those that aren't immediately life threatening, but supposedly have the potential to turn nasty. So says the goddess FREDA.

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The Call: 20 something year old female, severe abdominal pains.

The Category: Amber

The Assessment: 20 something year old female, been sick a couple of times.

The Reason for the call: "Well, if she went to the GP, he'd tell her to drink lots of water, take some paracetamol if she has pain, and give it a day or two."

"And what if YOU took her to A&E yourselves, rather than call out an ambulance?" said I.

"Well, we'd sit there for ages, they'd tell her to drink lots of water, take some paracetamol if she has pain, and give it a day or two."

Slightly exasperated, I ask "And what do you think I'm going to tell you?"

One patient, and three supposedly intelligent adult relatives all look slightly sheepish and as if by magic join in the chorus: "Drink lots of water, take some paracetamol if there's any pain, and give it a day or two..."

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This has been a public education message on behalf of frustrated ambulance staff everywhere. Thank you for taking the time to listen.

Tin Can

It's far too hot to be sitting in the back of an ambulance with no air-conditioning, so of course I decided it was time to do a shift on one, rather than stay in my beautifully chilled car. Well, strictly speaking there is air-con, but as it's summer and hot for a change, it doesn't work. Like the heating that refuses to fire on the coldest day of the year. Every patient we had complained about the temperature both inside and out of the truck. Every patient except one.

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Terry is in floods of tears. His 40+ years on earth have taught him only that he's the Chosen One. Chosen for anguish, chosen for torment, chosen for hardship. He's fought all his adult life against it, but just can't tear away from the reins that constantly pull him back into the abyss. He has good days and bad days, sometimes the good days last for weeks, but sometimes the bad days do too.

Today's a bad day. Terry can't control the sobs, can't shake off the panic. He looks at the ambulance and sees it as a means to enforced incarceration. He's not even sure it's a real ambulance and asks for my ID just to make sure that I really am who I say I am. He is shaking with terror, sobbing uncontrollably. All he wants is to feel that he can cope. To stop the voices and visions that have once again taken over his life. Eventually, Terry is able to calm down a little. Just enough for us to coax him into the back of the ambulance without him feeling as though he's being kidnapped. As the back door of the ambulance is opened at the hospital, all the colour drains from his face, and he is overcome with paralysing fear once again. I have to start the process once more. Allaying his fears, controlling those tears, reducing the trepidation that is his every waking thought. Slowly but surely, Terry starts to come round. He knows he needs the help. He knows he wants the help. Reluctantly he agrees to walk in to the monster that may hold the cure.

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As we enter the hospital building, he stops, turns round, and takes one last look at the ambulance. With a great gush of tears he says, "God, it's hot in that Tin Can".

All Change

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

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

The scream that followed was heard 3 doors away.

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

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

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

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

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

Fightback

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

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

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

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

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

Suggestions Please

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

Gold star award to the winner...

Zero Tolerance

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

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

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

Health and Safety

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

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

Here's hoping for a safe weekend for all!

Burns Night

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

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

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

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

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

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

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

Humble Pie

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

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

"Yes sir. How can I help you?"

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

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

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

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

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

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

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

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

Apology. Ish...

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

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

Rise of the Machines

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

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

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

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

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

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

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

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

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

Show some level of empathy.

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

Dinner Party

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

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

"I think I've broken my arm!"

"I think you have too..."

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

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

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

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

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

Beating the System

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

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

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

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

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

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

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

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

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

Busman's Holiday

Finally, I'm on holiday.

Finally, no night shifts.

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

And still, I'm not safe.

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

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

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

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

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

And now, back to my holiday!