Those that teach?

Those who can, do; those who can't, teach. (I believe George Bernard Shaw is responsible)

I've mentioned this phrase once before on this blog, on a post for the now sadly defunct Handover Carnival. I despise the phrase. Mostly because I come from a family of teachers. Some of my best friends are teachers. Some of my best teachers are friends. I accidentally came across a teachers' forum where suggested responses to this outrageous phrase ranged from the dirty look to the violent retort. Easily my favourite, however, was one clever comeback: 

Those who can, do; Those who can teach, do wonders. 

As the third in the series of suggestions and advice, particularly to the newer generations of EMS staff, I'd like to focus just a little on the idea of teaching. Personally, I woke up to it a little bit late. I'd always put the training department at the back of my mind as a possible fall-back option for when my time on the road had taken too much of a toll on my back. Planning ahead, I knew I could always rely on experience to teach newer generations of paramedics. But at the start of the career, that fall-back seemed a long way off. 

After a few years, the system changed drastically and meant that students were spending a great deal more time out on the road with experienced staff. This meant that there were now more opportunities to stay on the road and teach at the same time. I jumped at the chance, but no one jumped in the same direction, allegedly because none of the students liked the idea of working only nights. Eventually, one mug fool student picked up the gauntlet and gave it a go. Others followed.

The thing I discovered instantly, was that in order to teach, I needed to be a lot more alert to every single thing I did. The questions could fly thick and fast. What did you just do? How did you do that? And the scariest of the lot: Why did you just do that?

The questions weren't being asked to test me, but it sure felt like it sometimes. My skills had to be razor sharp, as did my knowledge. Most of all, I spent a great deal of time learning as well as teaching. Never being afraid to admit that I don't always have the answers was part of the deal. 

I held a diary in my uniform pocket at all times. At the back, were two sets of notes. One set was a list of calls, brief notes and mini-reminders of people and cases I met that I would then write about. The other set had a title at the top of the page: Homework. My homework, not what I set for my student. When an answer to one of their questions included the phrase I don't know, it was time for another line on the homework page. 

There was also another strand of teaching. Teaching friends, relatives, even the general public. Teaching about the ambulance service itself, teaching the basics of first aid, teaching the skills that could one day make the difference between life and death. Even simpler - teaching when and why to call an ambulance.

Teaching is all about knowledge. It's about having the skills to take that knowledge and impart it to others. It's about having the courage and the awareness to know that you can never know it all. It's about constantly making the effort to bridge those gaps that are missing. 

The thing I discovered about teaching is that it is easily the best learning tool out there. 

So go teach. Find something you're good at and teach it to someone. Or, alternatively, find something that you're not so good at, study it enough so that you'll know that if anyone asks, you can teach that too. 

Those that can't do, teach? Pah. Those who can teach, do wonders. 

Seat belts. Again.

This overnight story from northern Israel is nothing short of horrendous and heartbreaking. Eight members of the same family, parents and six of their children killed in a car accident. A seventh child, a seven-year-old girl, survived after she was thrown clear of the car as it rolled down an embankment before bursting into flames.

The aftermath - the destroyed car and body bags

I've read the story and some of the pseudo-analysis now on several websites, both in English and Hebrew. The thing that has stuck in my throat the most are the "talkbackists", the nickname given to those who comment on news websites, who have commented on the fact that the one person to have survived this awful tragedy, probably did so because she was not wearing a seat belt. The warped logic that flowed was that in order to save lives, the government, the police and whichever other authorities are involved should mind their own business and let people decide for themselves whether to wear seat belts or not.

It may well be true. It may be that in this one horrendous incident a life was saved by not wearing a seat belt. I don't know, nor do I think it should make a difference. I do know that being thrown from a moving vehicle is just as likely to kill, if not more so. 

Twenty or thirty years ago, as the idea of everyone in a vehicle wearing a seat belt was starting to take hold, there were plenty who mocked it. There were cries of government sticking their noses where they weren't wanted, cries of the trampling of freedom of choice, cries that as it was once good enough to drive around without, it should continue to still be allowed.

Times change, technology changes and we must change and adapt with them. Seat belts in the modern car are designed as part of a package of safety features. Crumple zones, airbags, seat belts and a multitude of other features - all work in conjunction to save the lives of the occupants in the case of an accident - and they do work. To claim that this case proves otherwise is nothing short of misleading gobbledygook, or, to avoid putting too fine a point on it, a lie. 

This case, whilst tragic, proves nothing. The only facts we have are that eight people have died, adults, youths, children. The vehicle involved was carrying nine passengers, undoubtedly more than it should have been and possibly being a contributory factor to the initial assessment of brake failure and excessive speed for the road. One child survived. Perhaps she wasn't wearing a seat belt. I'd hazard a guess that more than one person in that vehicle was equally unrestrained. As more facts come to light, we may yet find out that she managed to crawl out, rather than being thrown from the car, further disproving the ridiculous arguments. 

A case such as this is so rare as to be statistically insignificant in the argument for or against seat belts. 

Seat belts save lives. Fact. 

More often than not, it's stupidity that kills. 

Doris

I can't believe I can say this after only a few years in the ambulance service - but - I remember when... 

I remember when the calls were manually dispatched, each call either rolling off a printer followed by a phone call to confirm which crew was going, or given out over the radio requiring details to be taken with pen and paper. 

I remember when the only radios we had were vehicle based, no personal radios at all.

I remember when vehicles weren't tracked, the all-seeing eye up in control flying blind as a bat and relying on the good will and honesty of the crews. 

I remember when you could guarantee that Wednesdays would be the quietest day of the week. To this day I have no idea why. 

I remember when pushing the accelerator pedal on the old ambulances used to make a hell of a lot of noise, but the speed remained exactly the same. 

I remember when the GPS, or sat-nav, or Doris, or whatever else you want to call your guidance system was nothing but a hardcover book called the London A-Z. 

Ten years later, calls are dispatched to a computer screen, each member of a crew has a personal radio on shift and every vehicle is followed to within an inch of the crew's life. 

There's no such thing as a quietest day any more. 

Pushing the noise pedal still makes noise, but there's a little bit of improvement in the speed, and now, the GPS is a GPS. 

Having started when no such thing existed, on ambulances at least, it meant that learning the streets, or at least the general area, was a necessity. Around where I worked it was fairly simple, almost grid like. An area surrounded by four main roads, with another two criss-crossing the centre. However, as the times changed and technology controlled the ambulances more than the humans did, we started to be dispatched further and further afield. In an area the size of London, with it's thousands of miles of streets, hundreds of train, tube and bus stations and almost ten million residents, local knowledge had to spread a little. Eventually, the sat-nav came in and made that job a little easier, but local knowledge was still local knowledge.

Today, however, the newer generation of EMS staff in London rely on Doris from the start. It means that as soon as a call is dispatched, rather than heading in the right direction, there's a need to wait for the technology to kick in, pick a route and suggest turning either right or left out of the station. The skill of map-reading seems almost lost forever. 

Maybe it's because I learnt to read a map early on. Maybe it's because I don't trust technology. Maybe it's because I'm just awkward like that - but if I'm going to rely on the GPS, I'll check the map first, just to give me an idea. Having that vague idea without having to open a map book is all the better. Doris has a habit of not being up to date with new roads, or changes to one-way streets, or even trying to send you to the wrong Station Road. Do you have any idea how many Station Roads there are in London? Me neither, and not for lack of trying. 

My advice, particularly to the new people? Stop relying on Doris. She has her faults. I dare not say anything about asking for directions from a woman at this point. One of these days Doris will fail - either the screen won't work, the roads she's sending you down have been closed, or she's just having one of those days where she seems to be three streets across from where you know you are, and you most certainly know that you aren't driving through that reservoir or along those railway tracks. 

Learn your area - learn the important points - the places that give you your navigating markers, your wayfarers stars. Learn that from your favourite coffee shop to your favourite take away is a rat-run of streets where you'll do fifty percent of your calls. Travel and take notes, be they written notes or mental ones. If you get some down time as you leave the hospital, go for a tour of the area. 

And for the sake of all that is holy, learn to read a map. 

BETS

Having left the LAS for pastures new, I thought I'd look back on various aspects of a decade on the front line in London and suggest ideas or share various experiences for both the old and new crew staff out there as well as give the outsiders an insight into different aspects of ambulance life. This is hopefully the first of a series. 

Six months wasn’t enough – it was really just the beginning, but it was all I had and I hope I made the most of it. My time at the Neonatal Transfer Service, or the Baby Emergency Transfer Service (BETS as it’s affectionately known in the LAS), was easily one of my most enjoyable and rewarding periods in my time as a paramedic in London. It may well have been time away from the front line of A&E work, but there were so many benefits that I took back with me when I headed back to the streets.

It’s true. Normal Paramedic skills on BETS take something of a back seat for a while. However, the time spent learning new skills and gaining new knowledge was totally invaluable. These new skills weren’t just useful for the duration of my time on BETS – they were useful for the years that followed.

Dealing with premature babies, as well as full term but critically ill ones, alongside a team of dedicated, knowledgeable medical staff was not only inspiring, but educational too. Each case was reviewed and followed up, mistakes corrected, and positive action praised. The knowledge that any new skill was taught and supervised by a senior nurse or doctor gave rise to a new level of confidence in dealing with what many, if not most front line paramedics deem as the nightmare scenario.

Sick children, particularly babies, are notoriously frightening for most paramedics – not least of which because of the lack of exposure and training we have in that field. In my six months on BETS I had the opportunity to learn to cannulate the smallest of veins in the most difficult of patients and the chance to intubate the most delicate of patients. These are skills that came in useful on more than one occasion in the years that followed – just by building my confidence and skill enough to know that if I could perform these skills on the tiniest of patients – that back out on the front line, toddlers, children or even difficult adults with the same needs would prove so much less daunting.

I learned about the anatomy of the newborn by learning how to do baby checks, learned what signs to look for in a child that may be ill and how to distinguish them from a critically ill child. I learned how resuscitating a baby is both heart-breaking yet fulfilling at the same time, and more importantly how vital it is that when doing so, keeping a level head and not just rushing the treatment gives that baby the best chances of survival.

Suddenly, blood gases had relevance too, and with that relevance came understanding. You can’t ask a baby what’s wrong – and you can’t ask a ventilator why it isn’t doing what it should be. An understanding of gases helps solve both of those mysteries, whilst an understanding of ventilators and ventilated patients would help on many a critical transfer in the following years.

I learned about the effects that transport has on our patients, whether they are old or young. The benefits of a smooth drive were never more important than when dealing with a patient who had the blood volume of less than a bottle of calpol, but once again it reinforced and improved my driving skills and heightened my awareness.

I can’t recommend a period of time on BETS enough. I can only begin to express in words what it did for my confidence, for my skill levels and for my knowledge base. Any student who has ever asked about secondments, about extending skills and knowledge, or about career pathways in the LAS, has always had the same answer.

Go spend six months, at least, on BETS.

If you want to read about just one of my experiences there - click here for the story on the Baby Bus, and don't forget to click the link at the end for part two of the story. 

Priorities

The lounge echoes, the bare walls bounce back every sound, with no furniture to soak up at least some of the noise. 

The plastic chairs and table carry out their duties effectively, but they sure aren't the normal dining room table and chairs. 

The mobile phones have been good for catching up on snippets of emails or news. 

But now, finally, we have internet too. It's only been a fortnight without it, but it feels like so much more. However, proper communication is now (hopefully) restored, and so, (hopefully again), this blog will be too. Like I said, no furniture yet, but at least I'm getting the priorities in order... 

Thanks for sticking with me as the world around me changes. Normality (whatever that may be), will be restored very soon. 

Globetrotting

I can hear the murmurings clearly. “He goes and wins the award for Blog of the Year and then promptly stops blogging!” I grant you, it’s a fair whinge. But trust me, the reasons are good ones.

I’m sitting in a room surrounded by suitcases, packing my life into bag after bag, ready to fly off in just a few hours. My London adventure ends here, whilst just over the horizon await a whole new set of challenges. Guesses have been made, since I first mentioned the fact that I had left the London Ambulance Service as to where I was going. Guesses ranged from the south coast of England, to the north coast of Scotland, to the west coast of Australia.

The truth is that I’m heading to the east coast of the Mediterranean – to a little country that punches above its weight in almost every aspect of its existence – Israel.

Let’s start at the beginning: My name’s Aryeh – and I’m an Insomniac. So you see, one of the reasons my blog had to remain anonymous was the fact that with an unusual name like mine, unique in the LAS (in more ways than one, I hear my friends cry), there was no hope of hiding behind a smoke-screen of a more common name such as Adam, or Chris, or Dave. At least in Israel, I can hide amongst the masses of others Aryehs.

It’s a funny old place. Laid back yet highly stressed, open-minded but highly suspicious, and people who are exceptionally friendly or incredibly abrupt – sometimes both at once.

The national ambulance service is completely different from the UK based one. There’s no government funding and it’s privately run as a fee-charging charity. The paramedics and EMT’s who work for them are divided between volunteers who live their normal lives around sporadic shifts and actual paid staff whose day to day life is the ambulance service. Working for them, assuming they accept my paramedic skills as good enough for them, will be a very different experience indeed.

In the meantime, I’ve discovered that I really enjoy teaching first aid to the general public and that might become a new string to add to my bow, either in between ambulance shifts, or, at least at the beginning, instead of them.

It’s a new start for my family and me – but it’s a new start that we’ve been planning for some time, so excitement is, at least for now, overruling the sheer terror of such a big move.

As for the blog, well, I’ll definitely keep writing. What started off as a purely cathartic exercise in creative writing has turned into a project of which I’m exceptionally proud. The writing may be a little sporadic over the next few weeks as we settle into a new reality, but stick around.

We may still have a lot to learn together.

Plumbing

The first beads of perspiration appear on his forehead as we attach the monitor leads to his limbs and chest.

"I don't think it's a heart attack," he says, more hopeful than certain, "the pain's in my shoulder, not my chest. It can't be a heart attack, can it?"

As the beats begin to dance across the screen, appearing at regular intervals of just over one per second, the picture begins to emerge. A corner of his heart is screaming for blood, for oxygen, as more cardiac muscle dies every second. The strip of paper that spills out the front of the machine, pink paper with tiny red squares all covered in black lines of the ECG, answers his question and leaves no room for niceties.

"You're having a heart attack. It means that one of the blood vessels in your heart is blocked and we need to get you to hospital so that they can unblock it."

"You make it sound like some sort of plumbing job!"

"Well, in a manner of speaking, it is. They'll plumb their way into your heart, remove the blockage and fix your heart."

He has some medication to relieve the pain, some to prevent the blockage from worsening, some to stop him feeling so sick. His blood pressure is a little low for the first part of the journey to hospital, but his pulse remains steady and constant.

"And you're sure this is a heart attack? I thought you die when you have a heart attack?"

"You can blame the media for that. They need to learn the difference between heart attack and cardiac arrest. One is when your heart is sick, the other is when your heart has stopped."

"So my heart hasn't stopped yet?"

"Thankfully not, otherwise we wouldn't be having this conversation."

The dancing heart beats continue on their way crossing the monitor screen from left to right, looking as though each one is holding hands with a beat either side. Speeding our way down country lanes heading for the hospital, he continues to ask some more questions.

"Is it safe, this angioplasty thing?"

"Of course it's safe. They do hundreds of these every year. You'll even get to stay awake whilst they do it."

"And what if I decide I don't want it?"

"That could be one of the last decisions you ever make." I'm not one for dodging answers to serious questions. 

"Oh."

I look back up at the monitor. Suddenly, one strange-looking beat skipped across, the shape and pace very different from all the others. A messy, irregular beat, it's often the precursor to bad news. Quietly and hidden behind his head, I take the shock pads out of their wrapper and have them ready. Just in case. As the ambulance takes a sharp left turn some seven or eight minutes from hospital, his eyes roll back and the beats on the monitor turn from an organised rhythm into an uncoordinated, mangled mess.

"He's arrested!" I shout through to the front.

"Do you need me to stop?"

"No! Keep going and just get us there in a hurry!"

The pounding on his chest keeps the blood pumping round as much as possible, but it's nothing like it should be. The pads are stuck firmly on his chest and the monitor whines as it charges them ready to deliver a shock. I have one pair of hands where ideally I need two, but the other pair of hands is doing work of equally great importance - getting us to hospital. The orange button lights up, flashing away to tell me that the machine is ready. 

His body jolts up, the useless, erratic beats on the machine register the shock and then proceed to go completely flat, just for a few seconds. More compressions on the chest. Just a few more corners and we'll be there, several pairs of hands will be waiting to help, to take over. 

His body jerks with yet another shock. 

More compressions. 

Suddenly, there's resistance, even a groan as he appears to push my hands away. Not unconscious, but not quite conscious either. Breathing on his own and with heart beats that are once again holding hands. We wheel him off the ambulance and into the lab as he slowly seems to regain his faculties. 

"You're sure this is a heart attack, are you?" Totally unaware of the drama of the last few minutes, he still seems reluctant to accept reality. 

"We're sure." 

One of the lab technicians helps us move him across on to their bed, leaving him surrounded by monitors, machines and staff all dressed in x-ray blocking lead outfits. We move behind the clear, lead-lined screen  as the well-oiled machine of the cardiac team gets to work. One of them introduces himself as the cardiologist and explains once again about the procedure, despite our patient's protestations. 

"It's quite simple," explains the doctor, having tried the softly-softly approach but getting nowhere, "you've already died once. If you wish to do so again, but this time stay that way, then I'll be happy not to operate. However, considering the fact that the ambulance crew have worked hard at getting you here alive, I think it might be worthwhile to try to keep you that way." 

"Yeah," said our patient, "that's basically what he said. Go ahead then. But just one thing." 

"What's that?" 

"I just hope you're as good at plumbing as they say you are." 

Coffee Table

When the package was due to be delivered, Poojah made sure that her grandson was there. After more than half a century of living in the South East of England, having moved in her youth from the South East of Asia, her English was good. She had made the effort over the years, especially in the early days to learn the language by becoming immersed in the mixed community around her. But she always felt that she wanted the added security of having the latest generation, her home-grown family to help her. It wasn't just dealing with the delivery man, it was also the fact that she knew that even without being asked, her grandson would put the package together. 

Poojah's days of youth were long gone and she relied more and more on the wheelchair to get around the house, as well as outside. She would often curse her legs for failing her whilst her arms remained strong and her mind sharp, but she was resigned to the fact that she needed extra help now and then.  

It arrived in a simple cardboard box, flat-packed for easy assembly printed on the side in large black letters. They debated whether to move some of the lounge furniture to accommodate the new arrival, musing as to whether it would be a replacement or an addition. The old coffee table was full of memories, but it was shaky, damaged and splintered, risking injury not only to herself but to her increasingly mobile great-grandchildren. 

As she knew he would, Poojah's grandson got to work straight away. Less than an hour later, the table stood in the middle of the room, coasters from the old table placed on top of the new one, and newspapers and magazines placed in the narrow space between the tabletop and the open shelf below. Thinking ahead to the toddlers who regularly visited, Poojah had ordered some rounded plastic covers for each of its corners.

Minutes later, an ambulance stood outside Poojah's house, the crew who emerged from within barely able to suppress their giggles at the sight that was in front of them.

"If you two laugh at me, there'll be big trouble!" The grandson couldn't help but laugh either. "And you too! I don't care how old I am, or how old you are, I'll beat you all with my walking stick!"

And then it happened. Poojah laughed too. Sometimes, in the face of adversity, even the one directly affected must see the funny side.

"Don't make me laugh! It hurts being stuck here like this!"

All we saw as we stepped in to the room was an upturned wheelchair, newspapers strewn across the floor, and a pair of legs flailing in the air, about a foot off the floor. Poojah, by some miracle of inexplicable science and against all the laws of gravity, had fallen out of her chair and head first onto the lower shelf of the coffee table. She was wedged in the small gap and no amount of manoeuvring by her grandson could release her from her trap.

"As I see it, we have some options. The first one is to get the fire brigade to come and cut through the table. It'll be noisy, messy, but quick."

"Don't you bloody dare call the fire brigade! My neighbours will never let me forget it. It's bad enough your van is here."

"Fine, no fire brigade. The other option is that we all try to pull you by your legs and see what happens."

"You want to do what?"

"Just kidding." I didn't need to see the glare to feel it.

"And your third option?"

"We take the table apart screw by screw. It just might be a bit uncomfortable, because we're going to have to move the table to get to the bits and pieces."

"Do it."

"And it might take time."

"That's fine. I'm not going anywhere." We all laughed again.

As gently as possible, we started to take the table apart. The way it was built meant either just unhitching the shelf, risking Poojah hitting the floor and sustaining injury, or to work our way backwards, remove the tabletop whilst maintaining a steady base. We chose the safer, but more prolonged route and eventually lifted the wood that had become an accidental cage. Poojah was lifted gently off the shelf and helped back into her wheelchair.

She was uninjured in body, although her pride was severely bruised. There was no way she was going to hospital and no convincing her to allow for a doctor to visit, just for a check up.

"We'll just put this back together, then leave you in peace to enjoy your new table."

"Don't bother. I'm sending the damn thing back."

Tammy

A crescent moon hangs in the sky, fighting for supremacy over the scattered clouds. Street lights and unnecessarily illuminated buildings pollute the atmosphere and hide the stars, but the blue lights twinkle in their stead. The night is drawing to an end, the last night. The last shift. As it heads to a close, I think back to my first day, my first call, my first patient and wonder if my last call is going to be quite as bizarre.

The calls all night have been routine. No major trauma, no critically ill patients.

"What would you like your last call to be?" My observer for the shift had been quizzing me all night on all aspects of my years on the front line. What had I seen, what had I missed, how had I coped with the mundane, the bizarre and the upsetting.

"I'd love to deliver a baby. Bring one more life into the world. I think that would round everything off very nicely."

It's a far cry from my early years. Maternity calls used to terrify me, even the simple transports. The thought that a routine call could go so horribly wrong, the thought that I could suddenly be thrown from caring for a straightforward pregnant woman to suddenly fighting for two lives at once, used to scare me more than any other call.

A healthy dose of reality, six months on the Baby Bus and delivering almost a dozen babies in just one year (I wonder if that's some sort of record?) put paid to that fear. In total, over the years, I delivered sixteen, but none in the last year. Just one more would be a nice way to end.

"I guess it'll be nicer than a resus!"

"Pretty much anything would be nicer than a resus."

The address appeared on the screen but there were still no other details. A minute later, an update gave the patient's age and gender. Forty-eight year old female. There was still some hope that it would be what I'd asked for, although the chances were slim. Eventually, the call was completed and categorised. Red 2, Breathing problems. Delay as caller very distressed. Caller is patient's mother.

It could be anything from a panic attack to an asthma attack, from back pain to a head ache. It might, just might, even be the wished for maternity. Approaching the address in the early hours of the morning whilst watching the horizon start to brighten, the two of us travel the last mile in silence, trying to prepare mentally for what we could be about to see and the fact that at least for one of us, it'll be for the last time.

An elderly lady, presumably the caller, stands outside the property, one hand on a walking stick and the other using a car bonnet for balance.

"Quick, quick! She's just in the lounge. She won't talk to me!"

Between the two of us, we grab all the bags we're likely to need, at least to start with, to deal with anything from a simple faint to a cardiac arrest. At least five decades younger than our host, we overtake her on the way to the patient and find Tammy sitting in an armchair, eyes wide open but unable to speak. Her mum had finally caught up with us, automatically accepting the two strangers in her front room as if she had known and trusted them for years.

"There's been nothing wrong with her. She's always in and out of here making sure that I'm alright, but she doesn't even take paracetamol!"

Tammy's blood pressure is high and her pulse slower than normal. Her speech is slurred and confused, and she seems troubled by her lost faculties. One arm is strong, the other has no power at all. She can move her head with no problems, so we ask questions with yes or no answers. She understands some, appears confused by others, but keeps trying to answer.

The ambulance arrives, a crew I recognise and who both immediately understand two things; the seriousness of the patient's condition and the fact that this will be my last patient. One unfolds the carry chair, the safety rings clattering into place as they rattle metal on metal. Tammy is helped into the chair, wrapped in a blanket to keep her warm and secured with a strap to keep her safe.

Loaded once more with the bags on our backs, my observer and I walk out behind Tammy and the crew and watch as she's loaded into the ambulance. The tail-lift shuts into place with a thump, the hydraulic whine easing as the pressure is taken off. Moments later, the back door closes too, the blue lights are switched on and Tammy is rushed to hospital.

The return journey to station is almost silent. Traffic is starting to build as the world begins to go about its daily business. A thousand thoughts run through my head. A thousand faces, a thousand places, a thousand cases. But as we finally pull in, driving into the garage for one final time, only one face remains. Tammy looking back at me through the open ambulance door and nodding a wordless thank you. 

Monologue

An all too familiar scene awaits us as we swing open the door to the doctors' surgery. A waiting room full of coughing, spluttering children, parents losing the battle between enforced immobility and a pile of old toys that have all seen better days. A receptionist pretending to work sits at the front desk playing Spider Solitaire on the computer.

"One of your doctors has called for an ambulance?"

In one swift movement and a click of the mouse the green, card-bearing screen disappears and a computerised table of doctors and appointments appears in its place.

"One of the doctors, eh? The doctors don't do anything here without my say so. Who called you do you think? The doctor, or me? They can't dial anything on their phones without it going through me. First they dial 'zero' to get an outside line and only if I approve it can they make a call."

She barely takes a breath and any attempt to stem the flow is like the little boy with his finger in the dam.

"You know what, they probably don't even need you, they're forever calling ambulances these doctors. They've got no idea what they're doing half the time. Covering their own backsides just to be a pain in mine. I mean, it's not as if they actually make the calls themselves or have to sit watching all these people come in and out, day in - day out, with their coughs and colds and ear aches and ingrowing toe nails. Do you even know what an ingrowing toenail looks like? Have you ever seen one? They're gross, I tell you, but they don't really need a doctor, do they? Just pull it out themselves."

Just for a second, she stops, but before answering the question of where the patient is, the engine starts up again and heads straight into top gear.

"And this one, the one you're here for, do you know what's wrong with them? Nothing! Nothing, I tell you. Came in feeling dizzy, pretending he can't stand up, leaning on their friend, or wife, or girlfriend or whatever that slummy looking woman was. Torn jeans and a see through white t-shirt with a fluorescent pink bra. Who goes out like that? And to a doctor's surgery, no less! I'm surprised she was strong enough to hold him up anyway. He's about six foot, she's only about five. He's probably just faking it for the attention."

She pauses and picks up the phone, pressing just a single button.

"Did you call an ambulance?" From our side, the answer is inaudible, but obvious.

"Well why didn't you tell me? I should have placed the call, not you. How was I supposed to know where to send them?" Yet more one sided silence.

"Next time, make sure you let me do the ambulance arranging." Then, looking back at us, she finally gives us directions.

"Room eight. Down the corridor, second door on the right. It says Dr. Craig on the door, but actually it's Dr. Iain that you're seeing. And don't let the patient give you any sob stories, alright? I know what they're like round here."

We were already half way down the corridor as she finished her last sentence, but still she made sure it was heard. The door opened before we even had the chance to knock and the tall, balding doctor introduced himself and the patient.

"Hi guys, I'm Dr. Iain. This young man is Adam. He came in complaining of severe dizziness. I've called you because he really can't walk unaided, and I've referred him to hospital. It looks like he's got two ruptured ear-drums."

"Both ear-drums?"

"Certainly looks like it. Some accident at work. He's a little bit coy about it all."

"I doubt it was work related. I reckon he must have just been talking to your receptionist."

Five Words

Stepping into the office with an envelope in my hand, I was about to take one of the biggest steps in almost a decade.

"Need my signature on an application form, do you?"

It was an obvious question for my boss to ask considering the fact that once again, the coveted places on the air ambulance had been advertised. That, and the fact that he had no idea of my real motives.

"Not quite!" I answered, handing him one of the copies of the letter. He looked down at the piece of paper, the cheap and nasty stuff that the ambulance service has started to use recently in yet another cost-cutting exercise. The confusion on his face said it all.

"You're sure about this are you?"

"Quite sure."

"Can we do anything to change your mind?"

"Not unless you're packing the LAS into a suitcase and sending it with me."

Handing in my notice was a great deal more traumatic than I had ever anticipated. I have loved my job. If not every minute of it, certainly as a career, as a way of life, I have loved it. But the time had come for a change that MrsInsomniac and I had been planning for some time. I'll write more about the change we're making in another post.

I've already had my final shift. It was initially scheduled to be a lonely solo shift on a rapid response unit, but luck had it that there was a student who needed a few extra hours out and about, so she joined me, hoping that my reputation for attracting "real" jobs would prove itself in reality. It didn't, but it gave us time to talk. Time for me to pass on a little of my questionable wisdom and for her to ask questions, question my answers and answer my challenges too.

Towards the end of the shift, she threw me a curve-ball.

"If you had to sum up your career in four words, how would you do it?"

"Four words? I'm not sure I can. Am I allowed five?"

"You can have five. It's my leaving present."

It took me some time. We attended another call, handed another patient to yet another crew and still my mind's rusty cogs whined and creaked to come up with some cohesive thought. Eventually, in a dull flash of panicked inspiration, I had it.

"Tried to make a difference." It really does some it all up.

It speaks of the patients who had no-one else to care for them, it speaks of the families suddenly bereaved, it speaks of the babies brought into the world.

It speaks of the children who were left battered and bruised by their very own flesh and blood, and others who were nothing if not heroes to their families.

It speaks of the people who just needed to hear a voice tell them that help is at hand, and it speaks of those pleading for help for their loved ones.

I hope it speaks of the students I worked with, studied with, taught and learned from.

I hope it speaks of the people who read this blog, those in the know and those who hope that they will become more in the know by reading it.

I tried. Sometimes I succeeded, sometimes I failed, but I tried. In most cases, I'll never really know.

My move takes me away from the London Ambulance Service, but not away from the world of the ambulance. The blog will continue (considering the accolade it has just received, it couldn't really not). For some time it'll be based on the scribbled notes that already sit in my diary, and soon stories will be told from new notes, new patients, whilst looking out over new horizons.

And if nothing else works out, I'm still proud of who I've become, what I've achieved, and the experience that I've gained. I'm proud of this blog. I'm proud to call some of the best ambulance staff out there my friends. And I'm still proud of those five words.

WINNER!

Maybe I should go away more often. I take some time out, a couple of days away from anything interweb-ish, and lo and behold, the miraculous happens. Whilst I'm away, the results of the EMS Blog of the Year Award are announced.

And there, in black-and-white-and-colours-all-over, is the name of this blog. Winner of the Readers' Choice category.

You're an amazing bunch of people, dear readers, you really are.

Thank you.

Thank you for reading the ramblings of a sleep-deprived paramedic, thank you for joining me for the ride, and thank you for voting too.

Stand by now, for there are exciting developments afoot over the coming days and weeks. You may be in for some surprises...

You've made a simple, if somewhat crazy man very happy.

Jimmy

One two seven High Street, Suburbia.

I know that address. I know that it's not where we're actually needed. It's the centre where emergency calls made by mainly elderly patients hitting a panic button are received. The computer instantly recognises the address from the phone number and dispatches us anyway. Two miles down the road, the address updates and sends us three miles in the other direction.

The call is given as a possible collapse. Someone has pressed the panic button and then contact was lost. All attempts to reach the ninety-four year old, either through the emergency call box or by phone, failed. There was even a mobile phone number on the records, a rarity for someone of that age, but it appeared to be switched off.

With no other options, we were sent. The next of kin, a great niece who lived somewhere in the middle of nowhere, had been woken up and informed of the problem, but even at top speed couldn't get there in under two hours. The police, as is so often the case, had sunk under a tidal wave of their own calls and had no units to send. If there was any need to break in to the house, we'd have to do it ourselves.

As we pull up outside the house, the computer updates with the latest message - there's a key safe hidden behind a pot plant - so no need to break down any doors. As I punch in the four digit code and push open the lock, a bunch of four keys falls onto the floor. There's only one door and one lock, so the need for four keys is unknown, but on the third guess, the key moves the lock and allows us inside.

The house is in total darkness. There's no sound either. Initially I use a torch to find our way round, but feeling too much like a burglar, we opt to switch on the lights. We search the downstairs and find nothing, except for the reason for the other keys. Each door, one to the kitchen, one to the lounge and one into a dining room that looked as if it had been accidentally left behind in the 1800's, was locked. On closer examination of each room, we find them uninhabited.

There were three rooms upstairs too - a bathroom and two bedrooms. In the second bedroom, oblivious to the two strangers wandering around his house calling his name, was Jimmy.

A gentle, almost inaudible snore emanates from the sleeping man and his breathing is calm and restful. Strapped to his wrist, unmoved by the commotion, is his panic button and next to him on a small bedside table is a barrier between between Jimmy and the outside world.

A pair of hearing aids.

We creep back down the stairs, turn off all the lights, lock the door and replace the key in the safe box. As it clicks gently back into place, we both, almost subconsciously, mutter the same three words.

"Good night Jimmy."

Seven Months

We approach only as far as the police tape allows.

"You'll have to wait here with us, just until we know what's going on."

On the screen in front of us, the special instructions fill us in on the latest details as they emerge. Caller states his girlfriend has a gun and is threatening to kill herself. The call is from a mobile phone, the mobile mast locating it two hundred miles from the address we've been given. Instead of playing Chinese whispers, I ask for the mobile number and hand it to one of the police officers. In a swift flip of his radio, he unbuckles it from his bullet-proof vest and with the radio on loud speaker dials the number.

There's no answer the first time and the call rings straight through to the answer phone.

"Hello, you've reached Michael's phone. Please leave a message after the tone, and if I remember, I'll call you back some time."

The officer doesn't leave a message, but tries to call again only a minute later. This time, a sleepy voice answers.

"Hello?"

"Hello Michael. This is PC Ryan from the Met Police. You called to tell us about your girlfriend?"

"Yeah. Natalie! She's at home, she phoned to say she had a gun and she was going to kill herself."

"Has she ever owned a gun?"

"Never. She probably doesn't even know how to use it."

In the distance, we can see other officers dressing as if for battle. Full body armour, helmets, gloves and semi-automatic weapons at the ready give an impression more of a unit preparing for war than a group of people attempting to save a life.

"Has she ever threatened suicide before?"

"Loads of times. She's taken tablets, slashed her wrists, all sorts, but never anything like this!"

"What's her name again?"

"Natalie."

Seconds later, a negotiator calls through a megaphone.

"Natalie - this is the police. Open the door." For some time, nothing happens. No lights are switched on, no curtains move, no doors open. He calls for a second time, but this time, as soon as he calls her name, light suddenly appears through a tiny gap in the curtain of a first floor window.

The face that eventually appears looks confused, perhaps even scared at the sight of a small invading army standing outside the front door. Slowly, reluctantly, she opens a window.

"What's wrong?"

"Put the gun down!" Screams the police team's sergeant.

"Gun? What gun?"

"Put your hands where we can see them!"

Natalie places both her hands very deliberately on the window sill. "I really don't have a gun. What's this all about?"

"Did you tell someone you wanted to hurt yourself tonight?"

Immediately, a note of understanding registers on her face. "You've had a call from Michael, haven't you?"

He puts down the megaphone and the rest of the conversation takes place at a more civilized volume, particularly as it's the middle of the night. Faces appear at various windows and curtains twitch up and down the street.

"We have. He's told us you have a gun and were threatening to kill yourself."

"Wait there. I'm coming to open the door."

Thirty seconds later, Natalie appeared at the front door, adorned in a pair of pink pyjamas for which she apologises.

"It's a hoax. It's the best one he's pulled yet. He can't get over the fact that we split up, seven months ago already."

She goes on to tell the officers about all the other problems he's caused, sending the fire brigade, calling out doctors and mental health teams, even getting the Samaritans to give her a call. Just as a formality, one of the armed response team searched the house and, as expected, found no gun.

"I told you everything was alright. I'm not suicidal, I'm not depressed, I'm just trying to get on with my life." She stared suddenly at the stars, then looked all around her and laughed. "I'll tell you one thing for free; it's been a long seven months." 

The armed response team packed away their kit, other police removed the tape that had cordoned off the street, and we could finally remove the heavy ballistic vests that we'd been asked to wear. As we sit back in the ambulance and watch all the other teams leave, life in the suburban road returns to what should be a normal night, especially in Natalie's life.

Quiet and undisturbed. 

VOTING NOW OPEN!!!

 

Right then, loyal readers, the voting is now open for the EMS Blog of the Year. 

I have, miraculously, been shortlisted. You now have seven days of nagging to look forward to. 

Therefore, GO VOTE! 

Subtle, ain't I? Or maybe, Subtle ain't me. Anyway, I'm up against some serious competition, most of whom I read regularly, and two of them I even nominated in the first place, so I really, REALLY need your votes. You get one vote each - so make 'em count! 

Thanks to all those who nominated me in the first place - I'm honoured to be on a list with some great bloggers. 

Playing Dead

Saturday night. 

In fact, it's worse. 

It's a post pay-day Saturday night. 

The calls are coming in faster than the customers can spend their hard-earned cash. Call after call is alcohol related, leading either to faints or fights, pass-outs or punch-ups. Suddenly, in the middle of it all, a genuine call. 

In fact, it's worse. 

It's a genuine call made by a child. 

The call comes in as a mother who isn't breathing. The child is barely able to contain their emotion as they  follow instructions from the call-taker. Luckily, I'm less than a mile away. Under a minute later, as I step across the threshold, a bag on my back and another two balanced on my arms, a young child grabs me by the hand and practically drags me off my feet. 

I walk into the room to see a sight that worries me even more; it's not just one child who's distraught, but four. The oldest is ten years old. All are crying, worried, scared. One begs me to help their mother. 

"She's not breathing! Do something!" 

Another asks me the awful question. "Is she dead?"

All it takes is one look at the mother. Her eyelids flicker like no dead person's can. As I call her name loudly, she jumps a little, but tries to stifle it to keep up the pretence. As a crew arrives, I usher the children out of the room, asking them to let me treat their mother whilst reassuring them that she'll be absolutely fine in a few minutes. 

"Right," I say, "the kids have gone, and it's just us. Now do you want to tell me what this is all about?" It's  rare for me to lose my temper with patients, but I'm close. She opens one eye, then the other and after a moment or two, decides to pretend that she remembers nothing and that she doesn't know where she is.

Leaving the crew to treat the so-called patient, I go to speak to the children. One of them tells me that the two oldest siblings were fighting, their mum shouted at them to stop and when they didn't, she collapsed and stopped breathing.

"She just dropped to the floor?"

"No. She sat on the couch with a bit of a bump, shouted again, and then fell back with her head on the cushions."

"I understand. Just so you know, your mum's going to be absolutely fine. We'll let you in soon so you can see her and talk to her."

"You mean she isn't dead?"

"No, she's not. She's just a little upset."

Back in the room with our now alert patient, I could bite my tongue no more.

"You realise what you've done to your children, don't you?"

"It's their fault. They know how to behave. I just wanted to show them what it would be like if their mother wasn't here. When they fight, they pretend like I'm not here anyway, so I thought I'd show them what it would be really like."

Speechless and angry, we invite the children back into the room. As the youngest runs into her mother's arms, I leave the house, wondering what would force a parent to be so cruel to their own child. 

Intact

As luck would have it,

we were on the way to a patient and not transporting at the time.

As luck would have it,

they were stood at the side of the road and not above it.

As luck would have it,

the brick shattered the glass in the back, not the front.

As luck would have it,

the trolley caught the brunt of the hit and not us.

Stupid kids.

Stupid games.

Lucky break.

But our patient had to wait for an ambulance that had all of its windows intact.

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." 

AHEM!!!

So, the nominations for the Fire and EMS Blog of the Year have opened.

Know anyone you want to nominate? Well, do you?

Go on. You know you want to. Click here to nominate.

Storyteller

Elaine stood over my shoulder, watching my every move. She'd been there from the second I knelt down beside her husband Carl. She watched every chest compression, heard every rib as it cracked loudly beneath my hands. And as she watched and listened, she told Carl's life story. 

"He lost his leg last year. Diabetes, you know. Awful disease. But he didn't really look after himself. It was probably his own fault in the end." 

She watched as two more crews entered and made a little room for them and their equipment. Then, as we worked in streamlined silence, she continued her story. 

"We're a rare couple we are. Carl from Jamaica and me, a working-class white girl from the East End. When we got married, back in the sixties, my parents swore to write me out of their lives. They never visited, we never visited them, and eventually we didn't even speak. There was no such thing as racism back then. It was just black and white. And no mixing."

She watched as someone stuck a needle in his arm and started to give him fluids and drugs. 

"When the grand-kids came along, suddenly they wanted to visit. But only if Carl wasn't home. So I told them they could choose. They either accepted our family as it was, or they couldn't be a part of it. It was the toughest decision of my life." 

She watched as a tube went down Carl's throat, allowing us to help him breathe a little more. 

"Our friends stopped being our friends. Blacks and whites each going their own separate ways, all of them turning outwards, away from us, instead of rallying around us and learning from each other. We were left with no family, no friends. It was just us. Carl and me and the kids." 

She watched as the first of the shocks jolted Carl's lifeless body off the floor, the unnatural jerk phasing her just a little, throwing her narrative into a brief silence.

"Is he going to be OK?" 

"We're doing everything we can for him, but at the moment the signs aren't good." 

"He's a fighter you know. He'd have to be, putting up with what we have. We've had to fight for everything. Over the last few years, though, we've finally been winning that fight. Mixed couples are all normal now, aren't they?" 

She watched another shock violently wrack his body and begged him to keep fighting.

"I love seeing them. Walking through the park, doing the shopping, wherever. And those beautiful children. Remind me of my own kids when they were little. Not that my kids aren't beautiful any more!" 

She watched as half an hour later, we stopped. Carl lay where he fell and Elaine knelt next to his head, her story told, muttering in silent prayer.

"Maybe," Elaine said after watching us clear up, "I'll write our story one day. Be good to have it written down once I've gone too, then someone else can tell our story."