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!

Time Out

Dear Blog,

I promise I haven't forgotten you. I'm on holiday. A real, proper, time off work, away from it all, sunshine and beaches, holiday. But don't worry. I'll be back in a few days when normal service will be resumed.

Yours sincerely,

Ben the Insomniac

School's (knocked) out!

It was a grey and overcast day, which was normal.

It was cold, which was normal.

I was waiting to pick up my kids from school, which was normal.

I was asked by one of the mums if I was the paramedic, which was, surprisingly, normal.

She told me that the school had just called an ambulance. This was definitely not normal.

After initially being told by the school admin staff to mind my own business, they did eventually let me in to go and help. Apparently a 10-year-old child was knocked out in the playground. Having been called more times than I can remember to schools to an unconscious child who wasn't, I was a little skeptical. However, as I got to the playground, I saw that this time was different. The child was unconscious. She'd been knocked over by another child as they ran in different directions, and a teacher who saw it happen described how her head hit the floor and nothing happened after that. Slowly she started coming round, and seemed to be in a post-fit daze. She'd been incontinent, which often happens when someone fits. A fit after a head injury can sometimes indicate a serious injury, so I was a little concerned.

With very little kit I felt kind of useless, but luckily I didn't really have to do very much other than to keep her airway clear, keep her calm, and keep her still. I once again had in my mind "So this is what it feels like to wait for an ambulance"... The crew turned up a few minutes later, and I was pleased to see that I knew one of them. It made the hand-over easier, as I didn't have to explain who I was and what I was doing there. They immobilised the patient, and by the time they were ready to go, her mum had turned up as well, so she went with them too. Job done, I went back to picking up my own children.

Kids. Who'd have 'em???

I really shouldn't be let out in public any more. I just seem to attract trouble. Or maybe it just attracts me...

Chauffeur driven...

In my introduction to this blog, I wrote that for ease of use, whenever I talk about Paramedics, I'll be referring to EMT's as well. In a large number of our cases it makes no difference whether the crew are made up of either. However, every so often, the advanced skills that the Paramedic has been trained in are required. If that Paramedic happens to be a single responder in a car, and the crew that turn up are EMT's, then the Paramedic might end up travelling with the crew to hospital.

Richard was, according to the call we'd been given, nearly 80 years old and having an allergic reaction. I pull up on scene only seconds ahead of the crew, and we're met by a relative looking frantic.

"How bad is he?"

"Not sure, but I don't think his breathing's very good. He looks blue!" At that, I pull all my bags out the car and get moving. We walk in to the room, and at first glance we all thought that we had a resus on our hands. Richard was very blue, unresponsive, and for the first few seconds he didn't take a breath. A few seconds longer and the first breath was drawn. He was breathing at around six times a minute. We instantly put him on oxygen and his breathing picked up with little further intervention. In fact, by the time we arrived at hospital, he was at 40 times a minute. One extreme to the other.

With a very poorly patient, like with the trauma patient, it's vital to remember ABC's. So we started at the beginning. A - airway - clear. B - breathing - better than it was, air going in and out of both lungs. C - circulation - ah. No bleeding anywhere that we can see, but a blood pressure so low (about 50/30) that it's almost unreadable. We decide that Richard needs to be a little more stable before we even think of moving him. Gone are the days in the Ambulance Service of "scoop and run".

This is where the Paramedic bit comes in, and the reason I would have to travel with the crew. We decide that it would be a good idea to give Richard some fluids before we transfer him to the ambulance. A needle in the arm and 500 mls of fluid later and Richard's BP is still not great, but a little better, so it's time to move. Ideally we'd like to keep him flat, but that's just impossible in this house or on the route out of it, so stick to using our carry chair and regularly assess him on the way to the ambulance. We reassess Richard in the Ambulance, his BP is still low, so as we start moving (fairly rapidly, having put in a priority call to the hospital), I decide to put another IV line in his other arm and give him some extra fluids. Just as well, as he decided to pull the first one out as we were travelling.

As we arrive at the hospital there is an improvement in Richard's condition. He's responding to some questions, his vital signs were better, and we're quite proud of our efforts.

Time to get back to my car. The crew who have kidnapped me ask control to return me to the scene of the call, but are given job after job, and I end up staying with them for several hours, unable to get back to my car. To be honest, I was pleased of the company, and it helped pass the night even quicker. Eventually I was abandoned at the hospital when another FRU came to my rescue.

In fact, I enjoyed being driven around so much that night, that I came back the following night and worked on a "proper" ambulance... Chauffeur driven again!

Losing Trach...

2am, Tuesday: "97 Local Close, Nearbury. ?75 year old female, Breathing problems, unable to hear patient properly".

Could be anything really, especially at 2 in the morning. I park the FRU outside the address and remember to leave a space for the ambulance. They're going to be doing the carrying after all... I find the front door open, so knock and walk in. I find Gillian sitting at a table, breathing about 60 times a minute, and a great rasping noise coming from her neck.

Gillian has a surgical tracheostomy. You can read about these here. At least I now know why control couldn't hear her. She's grey, clearly distressed, and tries but fails to tell me what's happened. Her oxygen levels are very low, so I attach an oxygen mask to the trachy site as best I can. Within a minute or so Gillian's oxygen levels begin to improve, and she's breathing a little slower, but she is still very much struggling to breath. Her chest sounds like there's an army marching through it. Her other observations are ok, other than a slight fever. She tells me in two-word sentences that the last time she felt like this she had pneumonia, but it took 3 visits to hospital until it was discovered.

The ambulance arrives after a few minutes, Gillian is feeling a little better, but nevertheless we take the decision that she should be "blued" into hospital. I suspect that she has a chest infection that's turned nasty, and promise her that the hospital will look after her.

2 am, Wednesday: "97 Local Close, Nearbury. ?75 year old female, Breathing problems, unable to hear patient properly". What? What?? I was there 24 hours ago! But back I went, knocked on the door and walked in again. Gillian looked, and smiled as if to say "Oh no! Not you again...!". This time she wasn't quite as grey, but still finding breathing difficult.

"They cleared my trachy site, and sent me home. But I just don't feel right."

We started everything all over again. The observations, the oxygen, the words of comfort. I remember telling Gillian that the hospital would look after her, but I'm not sure they were able to back up my confidence in them, and feel bad for promising something I couldn't really deliver. A different crew turn up this time, I lock up the house, and say goodbye to Gillian.

"See you later" she says back to me.

"I mean this in the nicest possible way, but I hope not..."

Guess I'll have to wait and see.

No More Mr Nice Guy!

There's an almost 100% chance that if you're nice to me, that I'll be nice to you.

I don't care if you're male or female.

I don't care if you're black, white or anything in between.

I don't care if you're Christian, Hindu, Jewish, Muslim or Zoroastrian.

I don't care if you're old or young.

I do care if you're ill, and even if you really didn't need to call an ambulance, I'll still be polite. Even if you're drunk. And I hate drunks...

But.... If you feel it necessary to threaten me with a gun, a knife or a golf-club, if you feel it necessary to say you're going to kill me (even if it's in a foreign language which I may or may not understand), if you fancy throwing a punch at me, then that almost 100% chance of me being nice, drops instantly to almost 0%.

Yes, I will walk away from your friend or relative. Yes, I will refuse to treat them. And, Yes, I will make sure that your address has a red-flag attached to it on the computer system, so that you can never again have an ambulance to your address without the police turning up too.

I am fed up at having to wait for police to turn up for these calls, but that's your fault. Once you realise that you are responsible and accountable for your behaviour, once you realise that your actions have reactions, and once you realise that I deserve to do my job without being threatened, I'll come back to your home and try to be nice again.

Insomnia II

Although this guy isn't me, it might as well be.... Makes for interesting viewing! Would love to be able to try his cure, but shift work isn't exactly conducive to routine... Oh well, back to the drawing board.

A Different Thank You

For the first time in a very long time I had an FRU shift with long lulls interrupted by short working episodes. Normally it's very much the other way round. So I had some time to read, study, think and generally laze about. I was driving randomly around the area I cover to stave off the boredom when the on-board computer rings and jolts me out of my thoughts. Half way through the shift and only my second call.

70 year old female, unconscious, breathing. Head back where I've just come from... Typical. Whilst on route, I hear control call over the radio to ask if there are any ambulances available to help cover my call, which means I could well be on my own for a while. Something tells me to prepare for the worst, so when I arrive on scene I take all my luggage with me, not just the bare essentials.

I arrive to find the front door open, and call in to find out where the patient was. The strangled, distressed cry from upstairs tells me what I already feared. Not the words, just the voice. Upstairs, lying on the bed, cyanosed, not breathing at all, is Grace. "She's been like that for about 10 minutes now. She hasn't been right all day, but she just decided to sleep it off!" Grace's husband is beside himself with anguish. We move Grace onto the floor and I begin CPR. It's too difficult for him to watch and he tries to cope by calling members of his family.

In the meantime another FRU and a crew turn up and the resuscitation attempts are in full swing. More and more members of family turn up, adding to the emotion of the situation. We shepherd the family into one of the rooms downstairs while we carry Grace downstairs. It's not a very dignified process. It's a mess of arms and legs, squeezing round corners, over banisters and other obstacles. Despite the fact I have no problem with family members watching a resus (for some it's therapeutic), I think that the one thing they don't need to see is carrying their loved one down the stairs.

Grace kept fighting all the way to hospital, and we kept fighting for her. One of her relatives came with us in the ambulance. We arrived and handed over to the hospital team, who continued our efforts. After a while, when it became apparent that there was no more that could be done, the team stopped the resuscitation and went to talk to the family. By this time there were quite a few members of the family at the hospital, hoping for the best, and at the same time fearing the worst. The doctor explained all that had happened, and that despite our best efforts, Grace had died.

We were sitting filling in our paperwork when the family filed past on a sombre walk to see Grace for the last time. The lady who came with us in the ambulance stopped and told the rest of the family that we were the ambulance crew who'd tried to save Grace.

One by one they walked up to us, shook our hands, and said thank you. It was probably the most moving thank you I'd ever received.

Then they went on to say their final goodbyes.

Babysitting

As I work mostly on the FRU (First/Fast Response Unit) at the moment, I am supposedly tasked to the calls that are graded as either Red or Amber, so they are either immediately or potentially life-threatening. Supposedly, both because the system doesn't always get it right and because a call to someone having breathing problems from asthma and breathing problems from a cold are graded the same. A great deal depends on what Ambulance Control gets told on the phone. Anyway, I digress slightly...

A call to a 9-month-old choking is definitely worthy of being a Red call, the highest priority. I'm about 4 miles away, and if they're sending me, I must be the nearest. There's nothing quite like a call to a poorly child to get the adrenaline going, and I often find that I drive a little quicker to these calls. After driving 3.9 miles, the call is updated, the baby has stopped choking and is now breathing properly. The call is regraded to Green, the lowest priority, to which FRU's aren't sent. Nevertheless, as I'm within sight of the house, I call control and offer to go in anyway, just to make sure that all's well. As they have no other ambulance to send within a 15 mile radius, I think they were grateful of the offer.

I'm greeted downstairs by dad. He's looking a little pale, but clearly on the recovery stage from whatever the shock was.

"Thanks for coming so quick. Come and meet them".

"Them? There's more than one patient?"

"Well, there's only one patient, but there's more than one baby..."

Ah. Well that I can cope with. I go upstairs to meet these babies, only to find that they aren't 9 months old, but 9 WEEKS old. And they've only recently come out of hospital after being born very prematurely. One of them choked on their milk, couldn't breath and went very blue, but dad had managed to remedy the situation just before I turned up, so all was well. It's fairly common in newborns, especially if they were born prematurely, to struggle a little with feeding, but this was about the fifth time that it had happened, so we decided that it would be best to send baby back to hospital for a check up.

Except that, if you remember, there was no ambulance to send. So I'd have to wait. One dad equals one pair of hands. So where's mum? She's out with another one of the babies... Yup - triplets!! And there's lots of things to get ready if you're going to take multiple babies out. A friend was looking after the "patient" who was completely unharmed by the ordeal and was slowly dropping off to sleep, dad was getting organised and eating something on the move, and I got to look after the other baby. My kids are somewhat past the stage of being bottle fed and rocked to sleep. So getting the chance again, and especially with such a tiny baby, was a really nice change of pace. Waiting an hour on scene on my own for an ambulance doesn't usually fill me with glee, but this time I wasn't in such a rush...

Not exactly ambulance work, but all part of the service.