Tag Archives: 111

Blood and bloody idiot

There are a couple of terms used to define bleeding in the medical field;

Capillary – this is when the surface of the skin is scratched, but not deeply, and small spots of blood ooze from the damaged capillaries.

Venous – when a vein is nicked and blood will slowly weep from the wound.

Arterial – Blood will spurt out with every beat of the heart, sometimes spraying large distances depending on the size of the artery.

 

That final one, the arterial bleed, is considered to be a catastrophic haemorrhage. That is, if the bleeding is not quickly stemmed, a person will die within minutes.

 

Today, while working from a different station to normal, we were sent to a 25 year old who had punched through a window in a fit of rage, cutting his forearm. We were told the call had come from Police and they would also be attending.

We arrived after the Police and followed the significant trial of blood to a male laying on the floor, with his girlfriend tightly holding a towel around his arm, blood pouring down through her fingers. Thankfully, we had brought our critical haemorrhage kit in with us, so prepared to uncover, assess and re-dress the wound.

My crew mate wrapped his hands tightly around the arm to slow any bleeding while I prepared some gauze, a trauma dressing (more on that later) and a tourniquet.

*This next section is not for the squeamish!*

I slowly removed the towels to find a large would which was deep enough to nearly see bone through muscle and tendons. He had two large skin flaps where he had effectively de-gloved his arm, he had some blood clots within the wound from a venous bleed, and a quite noticeable spurting bleed from his Ulnar artery (one of two which run down the forearm). He had lost around 500ml of blood. The quick actions of his partner prevented him losing any more than that, which would have lead to shock.

We quickly ‘eyeballed’ the wound for any pieces of glass – there was none – and wrapped our trauma dressing around it. The trauma dressing we used has been developed by the military. It is specially designed to apply pressure directly over a section of injury on a limb, without using a tourniquet, which is always the last line of defence in a catastrophic bleed, as the limb may not survive.

While all this was going on, we obtained a quick history of what had happened. An argument with his ‘missus’ caused a fit of rage and he’d punched a window. He was also intoxicated and had been taking cocaine. He was also a bit of a knob head.

He immediately took a dislike to my crew mate (the person applying pressure to his wound to stop him bleeding to death) because he had “one of them faces innit”, calling him a c*nt and saying he would smash his face in. Delightful. Thankfully, I’ve got a knack of getting on with people like that, a trick I learned from an old crew mate of mine. As such, I quickly built up a rapport with him and persuaded him to come to hospital with us. Yes, I had to actually persuade him!

During this, he continued to be verbally aggressive to all of us and stood unaided to show us how strong he was. Now, he clearly worked out, but also clearly used steroids. We advised he shouldn’t eat or drink in case he needed surgery, so he drank a pint of water. We recommended a wheelchair due to the blood loss, so he walked upstairs to find his phone, all the while, using the C-bomb like it was punctuation and swearing at us all and being generally aggressive and intimidating. The Police said they would travel with us and called for backup from the PC they had dubbed the ‘man-mountain’. And with good reason. At 6’2″ and 18 stone of muscle, he would certainly be able to contain our almost equally sized patient – owing to the advantage of a working arm. And pepper spray. And a taser.

He eventually walked to the ambulance and sat in a chair because we’d suggested he lay on the stretcher (am I building up a picture of what this bloke is like?). I inserted a cannula into his vein to give some pain relief through a drip. All the while he told me how shit I was at my job. We swiftly left the scene on blue lights heading for A&E. After around 6 minutes of travelling, he decided he had become board of wearing a seatbelt and sitting in a chair while in an ambulance travelling at speed through a town centre, so he undid it – against mine and the PC’s insistence – just as my crew mate had to reduce his speed for traffic ahead. As such, the unrestrained man now hurtled towards the bulkhead, stopping himself on a work surface, pulling his IV line out as he did so. This angered him greatly, and clearly it was my fault so he began swearing at me and saying how I wasn’t fit to do the job etc etc. We had to stop the ambulance, causing traffic chaos, to re-restrain him on the stretcher.There was no way I was going back near him with a needle, so I offered him some gas and air for the pain, which he accepted….

 

…for 3 minutes before throwing the mouthpiece at me and calling me a smug c*nt. The Police officer all the while provided suitable dissuasion from him trying anything. I was glad of the PC’s presence!

This pattern of threatening violence, kicking equipment and behaving like a general tit continued for the long 20 minute drive to A&E. It was one of the most stressful journeys I’ve ever had while attending a patient in an ambulance, and I’ve dealt with some stuff in my time! During the whole trip, I had to keep an eye on the wound to make sure it didn’t start bleeding through the dressing, I had to check that it wasn’t so tight it was cutting circulation off to his hand and somehow get some vital signs. He declined any vital signs and wouldn’t let me near him. All I could do was document it and make sure the built-in CCTV was functioning.

We handed him over to the A&E nurse with an apology, as they’d have to deal with his very unpleasant manner. I feel I should add that he hadn’t lost enough blood to cause severe agitation like that, he was just drunk, high and angry.

Afterwards, I was washed out and a bit teary. It’s very hard to provide life saving treatment to someone, only for them to call you a c*nt 27 times and throw things at you. I can scarcely believe there are people like that out there. But there are, and I’m sure I’ll meet many more during my career.

 

So, I guess….don’t do drugs. Or punch windows. Or be a prick to people who save your life 🙂

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Terrified Out of Hours Service

If you need the Police in an emergency, you call 999. If you need to contact the Police for any other business that isn’t life threatening or dangerous, you can call 101.

Similarly, if you need an Ambulance for a medical life or death emergency, you call 999. If you need non-urgent medical advice, you can call 111.

111 is a private contract that is split into dozens of sectors across the county. So the company that answers a 111 call in Devon will be a different company from the one that answers a call in Birmingham.

The tag line for 111 is that you can ring for medical advice……but we few in the Ambulance Service no this is rubbish!

We know this because we have attended people’s addresses, using blue lights and sirens to get there, when they have rang 111 to ask some advice about medication and they have triaged it as appropriate for an ambulance!

Let me explain. When you call the Ambulance Service on 999, you get through to a non-clinical call taker called an Emergency Medical Dispatcher. There medical knowledge is no better than that of a good first aider, but they use a robust triaging system to quickly and effectively decide if the call is immediately life threatening, or can be given a lower priority in order to allow precious ambulance resources to attend the most serious calls first (if you’ve read my blog, you’ll know that people do ring 999 for very un-serious things!).

When you ring 111, you get through to a non-clinical call taker who has in front of them, a screen with a series of questions to ask, your answers to these questions determine what the recommended care pathway is; self care, telephone call with a Nurse, visit and out of hours Doctor, or they can dispatch an ambulance. You don’t get advice when you ring 111, you get triaged!

I should note here, that sometimes, people ring 111 when 999 would have been entirely appropriate – I’ve attended 111 calls where the patient is barely breathing, where a child has a broken leg and a man was having a massive heart attack! My ‘beef’ is when 111 send us to calls that we don’t need to be at:

An elderly man had been suffering a nasty cough for 3 days, his wife thought he had a chest infection, so, one Sunday morning, she rang 111 to speak to a Doctor about getting some antibiotics. She was bombarded with dozens of questions about everything from whether his was bleeding from his anus or if he’d travelled to Africa and may have contracted Ebola. Eventually, 111 told her they would send an Ambulance. This terrified this poor old lady, she thought her husband only had a chest infection, but in fact, he must be seriously ill if they’re sending a blue light ambulance!

-We get the call “85 year old male, Chest Pain and Short of Breath” it’s coded as a Red 2, which is the code for the life threatening calls. So, we do our thing – blue lights, sirens and radio coms – arrive at the address to find our gentleman in bed most definitely not short of breath and not complaining of any chest pain at all .

We get told the story by his wife, and to my ears, it sounds like he has a chest infection and needs to speak to a Doctor about getting some antibiotics. We give him a thorough check over with all the tests to rule out a heart attack, severe infection/blood poisoning, shock or other concerning stuff and it was all fine. So we rang the out of hours Doctors (we have a special number that we can use to directly request a Doctor) to arrange for a home visit.

Time taken for us to drive to the address, assess the patient, complete the paperwork and wait for a callback from a Doctor: 55 minutes.

Time speaking with a Doctor (who agreed with my medical impression): 4 minutes.

That was an hour that an emergency ambulance was unavailable because somehow, that man’s chest infection triaged as an immediate life threat.

This isn’t an isolated incident, sadly. Here’s a list of calls that I’ve been sent on where people have rang 111 and unexpectedly ended up with a blue light ambulance. Ready?

  • Lady wanting to know if she can take Aspirin for a headache
  • Man who hurt his hand three weeks ago and wanted some pain relief
  • Lady with a painful elbow (we were told she was having a stroke)
  • Man who’s back was sore after bending to pick up some laundry (came to us as chest pain)
  • Baby who had a cough and parents wanted some advice
  • Earache

And the absolutely pinnacle in my extensive experience of inappropriate calls:

41 year old man who rang 111 in the middle of the night to see if there was a late night pharmacy anywhere where he could buy some cough syrup. For his cough. This coded as a Red 2 for Chest Pain.

Every single one of those was appropriate for 111. These people did exactly what they should have done, and yet, they each ended up with an ambulance being sent to their houses with blue lights flashing. I didn’t need to take any of these people to hospital,but if you look, that’s at least 7 hours of my time taken up with nonsense. 7 hours during which time someone may be having a stroke, someone may have fallen down the stairs and been found unconscious, there may have been a serious car crash where someone is trapped, someone’s baby may have stopped breathing.

All we can do is report it back, but bare in mind, if you ring the out of hours provider in your area, it may be more than advice that you get!

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