Tag Archives: Doctor

A Typical Day

I wanted this blog to give an insight into daily Ambulance life for an English Ambulance Service, but I’m aware that I tend to concentrate on specific cases of interest. So, I thought I’d write about today – a typical day.

Arrive at work 06:45 to relieve the night crew.

We say hello, ask how their night has been then set to checking the vehicle over for our shift. The night Paramedic signs over the Morphine to the day Paramedic and advises of any issues with the vehicle, any problems at local hospitals or any incidents requiring intervention from an Officer.

We are supposed to have 20 minutes to complete a Vehicle Daily Inspection (VDI), but such is the nature of the beast that if an emergency comes in at 1 minute passed starting time, we have to go.

Today however, we remained undisturbed for 20 minutes. We check that the defibrillator is functioning, that we have full cylinders of oxygen, all of the drugs we need to carry are fully stocked and in date, that our response bag has all of the diagnostic equipment we need, that we have all of the paper work that we need, that the heater works, that all the blue lights work, that all of the vehicle lights (headlights, brake lights etc) are functioning, that we have fuel and lots of other things. Quite a lot to squeeze into 20 minutes.

Anyway, here’s a run down of today’s emergencies:

1st call was to a male who had collapsed in the bathroom after having a shower. He had no recollection of fainting and awoke on the floor covered in blood. He had a nasty cut to the head which had bled heavily – he also took blood thinners which didn’t help! He alerted his wife who had called 999. We dressed the wound, fully assessed him and took him to A&E as he needed stitching and further assessment as to why he collapsed. Also, as he took blood thinners and had suffered a head injury, we wanted to check that he did not have a bleed on the brain as a result of the trauma.

Our second call was while we were heading back to our base station, a lorry driver parked in a lay-by flagged us down as his colleague had hit his head on part of the lorry causing it to bleed. By the way he was frantically waving we thought it was bad, but, it was a small nick the size of the nib of a pencil. We gave him a plaster, completed all of the other checks that we need to do, filled out our paperwork and let him back to work with instructions to see his own Doctor to check his Tetanus status.

As soon as we cleared from that call, we were sent details of a male who was possibly having a heart attack. It was a patient I had seen about 4 months ago when he had his first heart attack. He was at his Doctor’s surgery with atypical pain. His doctor was concerned that the pain he was experiencing in his shoulder was referred pain from his heart. One of our Rapid Response cars arrived shortly before us and conducted an ECG which showed no abnormalities. His Doctor had booked him directly into a medical assessment ward to bypass A&E so the car took him in as it was unlikely he would deteriorate.

We just got back to station for some lunch, and no sooner had I put my baked beans on the hob that we got sent to a nearby town for a male who had fallen more 8 feet from a crane and was unconscious. We were asked to provide an early update of the air ambulance. We arrived to find that the he was in fact fully conscious and alert with no serious injuries, so stood the helicopter down. He had been knocked out for less than a minute and sustained a relatively minor head injury and a probable broken wrist. We took him to A&E giving him some good pain relief on the way.

5th call was an urgent case (normal road speed admission) for a lady with a looooooong medical history of just about every ailment you can imagine. A recent blood test revealed that her kidney function had reduced so she needed to be admitted to a ward for treatment. The Doctor felt it appropriate to book an ambulance to transport her so she could receive a full set of medical observations and and ECG so we might correct any problems we encounter. Everything checked out fine and it was an uneventful transport.

Our final emergency was at a Doctor’s surgery for a lady who possibly had pneumonia. A middle-aged lady who had a 2 day history of a cough with shortness of breath. Her Oxygen levels were reduced below normal limits so she needed admission to A&E. We took a quick hand over from a very busy Doctor and took her to the ambulance. We listened to her chest and heard a pronounced wheeze, so we set up a nebuliser (oxygen mask with a drug to help with the breathing) which worked a treat. We performed an ECG to rule out a cardiac cause of the shortness of breath – it revealed no abnormalities. We did, however, note that she had a temperature and her blood sugars were slightly raised. That along with a fast heart rate (tachycardia) and increased respiratory rate meant it was possible she was septic following a chest infection, so we took her to A&E where they will perform blood tests and chest X-rays to diagnose the problem and treat as appropriate.

120 miles covered, 6 patients and 3 cups of tea. Not a bad day overall, even managed to eat my beans on toast in the end!

Hopefully this highlights how we have to be learned in a wide range of things, from life threatening trauma to routine medical problems. All part of the enjoyment of the job – you really never know what you’ll see next!

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Waiting rooms and Corridors

Now, I am well aware that we only ever see the numerator when it comes to ‘bad practice’, and there are hundreds if not thousands of clinicians who are superb at what they do. Nonetheless, here follows some rather worrying tales.

At least two years ago, while I was stationed in the city, my crew mate and I received details of an emergency at a Doctor’s Surgery, in a small town about 6 miles away. We were informed it was a 7 year old male who was short of breath, possibly with pneumonia.

On go the blue lights and we weave our way through the busy rush hour traffic. I was in the passenger seat, which means that this would be my patient. I begin looking at drug calculations for a child of 7 incase we need to administer anything on the way to the hospital.

We arrive in good time and walk into the heaving surgery. A receptionist spots us over the melee of people cuing and points us to a door the other side of the waiting room.

“Excuse me please”, my crew mate says to the crowd in order to make a path. People stare at us with confused looks on their faces. What are they doing here is what they’re probably thinking.

-Sometimes, people visit their GP with problems that need to be managed in a hospital, not a Doctor’s office, so need admitting to hospital. If it is serious enough, the GP will call for an ambulance.

We are lead through a maze of corridors until we see a lady sat on a chair outside the Doctor’s exam room, holding the greyest, floppiest child I have ever seen. He looked so unwell I genuinely didn’t know what to do first!

With that, the Doctor opened her door, gave us a referral letter and started to tell us what had happened. Before she even finished, my crew mate grabbed the child from the mother’s arms and marched to the ambulance.

As I’m not yet a qualified Paramedic, I am not allowed to give certain drugs, and in cases where someone is VERY unwell or likely to deteriorate, the Paramedic must always attend the patient. As such, I was given the keys, with the command of “GO!”

As I blue lighted this poor child and distraught mother to A&E, my crew mate administers Oxygen and a cocktail of drugs to try to stop his lungs from failing. We arrived in A&E and handed over to a team of waiting Doctors and Consultants (as we had rang ahead) who began treating the child.

The most shocking thing to come out of that story, was that the GP had let the patient sit in a corridor with the door shut while they waited for us. His oxygen levels were in his boots, his respiratory rate was sky high and he was barely conscious. He hadn’t been given any drugs, any oxygen and was not on any sort of monitoring when we arrived. But at least we had a lovely typed referral letter from the Doc. Cheers Doc!

If we were delayed in getting there, for whatever reason, or if we had had to travel from further afield, that child may have stopped breathing in that corridor!

This isn’ the first time I’ve picked up very unwell people from GP surgeries who have been sat in the waiting room or corridor, holding the all important letter. It beggars belief!!

Now, of course, I see plenty of very good Doctors who have given necessary drugs, performed appropriate diagnostic tests and monitored the patient’s vital signs prior to the ambulance arriving, and I am always very thankful to them. But it’s basic stuff surely?

A complaint was made by my crew mate, but the GP registering body is almost bulletproof.

My advice is such – if you go to your Doctor and they decide to call you an ambulance, insist that you stay in their room with them. Don’t be told to wait in the corridor with a possible heart attack or breathing problems (yes, I have seen this).

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ANOTHER public arrest.

Very much on the theme of my post last month, we were sent to another public cardiac arrest.

My crew mate, myself and a University Student on placement had just discharged a patient on scene; a baby who had diarrhoea the day before and her dad called 111. 111 had decided that this was immediately life threatening and actually passed the job to us a an ‘Unresponsive Baby’, which we were very glad to discover she was not.

I digress. We made ourselves available and immediately received details of an emergency in the city about 7 miles away. We were told that an elderly male had collapsed in the street and wasn’t breathing.  This is normally a 20 minute drive with traffic but I got there in 9.

We arrived to find a Rapid Response Vehicle (RRV) Paramedic doing chest compressions and one of our Officers who had also been dispatched, breathing for a patient with a Bag Valve Mask (BVM).

Between the three of us, we had already decided what our plan would be. My crew mate would jump out and help with advanced skills such as IV access or advanced airway management, the Student would take over chest compressions (because he is not allowed to perform any other skills yet, and it’s good experience to do so when the opportunity presents) and I would manage getting the patient off of the pavement and into the relative privacy of our ambulance.

I overheard that they had already delivered 2 defibrillator shocks prior to our arrival, and as I prepared our scoop stretcher, they delivered a third. Between myself and one other, we ‘scooped’ the man onto our stretcher and, while the student continued CPR, wheeled him into the ambulance.

There were Police on scene as well, who had been very proactive and closed the busy road. I was blocking it with my ambulance anyway. Sometimes that’s the only option.

A 4th shock was delivered in the back of the ambulance. For the 4th time, we had been unsuccessful in restarting his heart. But the battle continued.

We were informed that the Air Ambulance had landed in a nearby field and we were to drive round to meet them. I jumped in the front, and with the Police stopping traffic, made my way the half mile or so the the helicopter, where we were met by a Critical Care Doctor and a Critical Care Paramedic.

After a further 25 minutes of quick thinking and hard work, the man regained his pulse – something we call ROSC (Return Of Spontaneous Circulation), however, his heart rhythm was one which would not sustain life and another shock was given to ‘revert’ it back to a normal sinus rhythm. The Doctor, with agreement from all those involved, decided the ‘likely‘ cause – we never really know in these situations – was a Heart Attack which had caused the Cardiac Arrest. There is a specialist hospital that deals with this sort of emergency and it was decided that as the man was too unstable to fly, we would travel by road to this hospital in the next major city.

When everyone was ready, I began the 30 minute blue light drive. It’s a funny feeling up there in the cab on your own. You have a huge responsibility to deliver precious cargo there safely but quickly. The drive must be progressive but smooth. You need to look far into the distance to pick a route through traffic that will cause the least amount of movement in the back of the ambulance and have a 360 degree awareness. It is knackering!

30 minutes later, we arrived and I opened the back doors to lower the tail lift to unload the patient. I’m met by the Doctor who said “that was superb!” High praise indeed! I thanked him and continued to assist with unloading. The patient had maintained ROSC and was making respiratory effort but was unconscious and still very unwell.

We wheeled him in to the resus’ bay and the Doctor handed over to the lead hospital clinician where they set to work attaching leads, taking blood, checking the airway, listening to his chest, arranging scans and a host of other things.

We then were left with the mammoth job of clearing up.

He was alone shopping when he collapsed, but the Officer and I had found his wallet and ID so had his name and address, he also had his next of kin details which we passed to the Police.

I have no idea what happened to the man after we left, but I do hope he survived. If it was not to be, I hope his family were able to come and be by his side before he passed away. Either way, he had been given every chance of survival.

When reflecting on the job, I realised that was the first Cardiac Arrest I had attended where I had not done a single chest compression! Many hands and all that.

The following day, I attended an incident in Bath with my other Crew mate. I don’t like putting city names in my posts but this is important.

We were first on scene at a horrendous incident that made national news on the 9th February 2015 where 4 people were killed in a dreadful accident. I just want you to know that yes, I was there. Yes, it was horrific. And no, I will never be posting it on here.  My trust has been superb in supporting all ambulance staff involved and I have had lots of support from colleagues, friends and of course my beautiful fiancé.

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“Winter pressures”

This could well be the winter that breaks the NHS, or which has come the closest to it.

Every year, there are “winter pressures”, this refers to an expected uplift in work for NHS teams across the country, in particular front line services like Ambulance Services and A&E departments. However, this winter (and we’re not really even at the busiest bit yet), has been borderline ridiculous.

As an Ambulance Trust, we have REAP levels (think of them as Def-Con levels all the American films have). We usually bimble around at REAP 3, this is where everything is at its normal; many many calls, but just about enough resources to cover it, enough vehicles and enough staff.

REAP 4 is slightly more chaotic. The sheer volume of 999 calls puts serious pressure on everyone and there is a really struggle to find resources (by which I mean Ambulances) to answer the calls. Staff sickness/absence means that shifts are dropped as there are no medics to cover them.

We’ve spent a large majority at REAP 5. There are only 6 REAP levels, and at level 6, the trust is in melt down. At REAP 5, there are not enough ambulance, not enough medics, not enough call takes and not enough dispatchers to cope with the huge volume of calls we receive. Calls come in faster than we can triage them and the difficult decision is made not to respond to low priority green calls (such as non-emergency transport to a department, minor cuts to limbs or vomiting).

At this point, our trust was on the verge of declaring a Major Incident. I’m not wholly sure what happens at this point, but as a crew we can only do one emergency at a time, so there’ll probably be little change.

Let me give you some numbers. In our division, we normally receive around 1000 999 calls in a 24 hour period, lately, we’ve received over 1500 calls in the same period. There are no more Ambulance and probable less staff to answer those additional 500 cries for help. This is why we are REAP 5.

Hospitals have it just as bad. There are simply no beds for the patients that need to be admitted. At one point, I counted 17 patients on trolleys and in wheelchairs in the corridor of one A&E department, but let me say that. Every one of those patients was receiving excellent care. They were having medical obs’ done, Doctors were speaking with them, they were taken to a private room for examination. It was a joy to watch this level of organisation.

With all this in mind, I’m worried. January and February are typically our ‘busy’ months, and we’re almost at capacity now!!  Lord help us and all NHS Staff!

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Best job in the world, here’s why:

I feel it’s high time I sing the praises of the Ambulance Service as a career choice. It’s all too easy to moan about this and that but all jobs have their down points. Here are some of my favourite things about working for the Ambulance Service.

  • No matter what sort of day you’ve had, at the end of a shift you can always look back and think that you’ve helped at least one person. Just turning up in your ambulance with your kit makes people really happy, because when you arrive, the pressure’s off them. I’m not sure of any job outside the emergency services where simply arriving makes such an impact.
  • You get to use cool pieces of equipment. As a child I watched ‘Casualty’ (the English equivalent of ER in the USA) and see the Paramedics using spinal boards, stretchers and defibrillators. I NOW USE THESE!!…..ME!!……AS MY JOB!!! Cool!
  • You get to drive with blue lights and sirens. I don’t care what anyone says, even after almost three years doing the job, I still get a buzz from response driving. Sometimes I catch a reflection of my Ambulance in a shop window while on blue lights and can scarcely believe that it’s me driving it! I love the sight of cues of traffic parting like the Red Sea for ME!
  • You get to ease people’s worry. It’s a wonderful feeling being able to tell someone that they, or their loved one will be OK. The relief on their faces would warm even the coldest of souls.
  • You learn so much about such an interesting subject. There’s no doubt that most medical professions are vocational. I don’t think you could just turn around and say “right, today I’m going to become a Nurse/Doctor/Paramedic”, you have to really want it and want it for the right reasons. They say every day is a school day, in this job it is. There are so many unusual medical conditions and clever ways to treat them that in a whole career you won’t see everything. To learn something (almost) every day that truly amazes is magical.
  • You get to work outside. Not so good when it’s -3 and raining sideways, but lovely in the summer. Sat on the grass in the summer waiting for your next shout – it aint a bad life.
  • Once in a while, you actually save someone’s life. Not very often – the job isn’t as glamorous as the media would have you believe – but occasionally, you’ll come across a patient that without your treatment, would surely die. I don’t just mean driving them really fast to a hospital so the A&E Nurses and Doctors can work their magic, I mean the time when you have to give an injection of Adrenaline and Hydrocortisone to the Asthma patient who will stop breathing if you don’t. When you apply a tourniquet to someone with a catastrophic bleed, because they’ll haemorrhage to death if you don’t. When you give CPR and shocks to the patient in Cardiac Arrest because, well, because they’re technically dead and you want to bring them back to life.
  • We’re mostly respected by the public. “You guys do such a good job”, “you’re angels in green”, “I don’t know where we’d be without you” are some of the lovely things people say to us. You need to be modest to do this job 🙂

This isn’t the full list, just a highlight of the best bits of the Ambulance Service.

As I say to most people, “good days and bad days, but it’s the best job in the world”.

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Major Incident.

A few weeks ago, there was a ‘standby’ for a major incident. It came in just after my nightshift finished so I was praying it wouldn’t escalate into a full ‘declared’ major incident – especially after I heard the details of what it was.

This was the recorded phone transmission (minus the exact location, and as best I can remember it):

“Major incident standby, major incident standby. [Location, which was a disused unit in an industrial estate in the city]. Incident type – Illegal Rave. Hazzards include alcohol, drugs, weapons and violence, persons reported in the water. Access via [Roadname]. Between 300 and 800 persons and potential casualties. Currently on scene – Ambulance, Air Ambulance x 2, BASICS Doctors, HART (Hazardous Area Response Team), Fire & Rescue, Police including Riot Police. Details to follow, standby.”

-For those that are interested, this is a METHANE report used to cascade the information of a major incident. If a full incident is declared, then people start to get called back into work.

Although this sounded like a juicy incident to attend, it was most likely just a load of people who’d arranged an illegal rave, it got a bit out of hand, someone phoned the police to complain and all hell broke lose.

It was never declared as a full major incident. Which I was glad about as it meant I could get some post-nightshift sleep before my next 12 hour shift. Nobody died or was injured as far as I know and the ‘persons in water’ was probably someone high on acid who thought taking a swim in the River Avon would give him super powers!!

I’m yet to deal with a ‘proper’ major incident, but I’m sure that they’d see my potential to deal with a serious incident and let me be in charge…..of parking. Yep, there’s a ‘Parking Officer’. You even get a high vis’ tabard and tell crews where to park.

My friends and family would be like “WOAH, we saw that huge incident on the TV, were you there?”

And I’d wryly reply “Oh that? Yeah I was there”, while casually sipping a cup of hot chocolate.

“Bloody hell, it looked bad. Bet you saw some stuff there, mate?!”

“Yes, yes I did; have you ever seen 12 ambulances try to parallel park? Nightmare….”

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Once in a career.

I promised in my last post I would write about the RTC (Road Traffic Collision) I attended last month. This was by far the worst I’ve seen in my short career and also the worst the Officer on scene had seen in his 19 years in the service!

-On a side note, I know I haven’t written for a while, I’ve been on holiday in Italy where I purposed to my girlfriend. So yeah, kinda busy-

Not long after the start of my shift in the city station, we receive an emergency where details state that there are “3 cars, 1 on fire, 2 persons trapped and critical”. This gets the adrenaline pumping let me tell you!

We arrive at the now dark scene which is a fast stretch of country road with no lighting, on a long sweeping bend down a steep hill. We can see that there are two cars (the third I later learned had been driven away as only had minor damage), each on their own side of the road but clearly showing signs of a high speed head on impact. I say high speed because the Traffic Officer estimated that the total impact speed would have been in the region of 130mph.

We were met by our Senior Officer who directed us to one of the patients trapped in his car. With him was a BASICS Doctor (BASICS Doctors are a group of trauma and medical specialists who choose to respond to emergencies in their own time. They are an enormous asset to the service – especially at a time like this).

In training, you’re taught to start assessing the patient ‘from the door’ to quickly ascertain if they are ‘big sick’ – that is to say time critical, or ‘little sick’ – meaning that it is a minor ailment that can probably be dealt with at home.  We’re taught to look at their skin colour (pale, flushed, grey), work of breathing and general appearance. This chaps general appearance was ‘on deaths door’.

So worried was the BASICS Doctor that he had tried to drag the patient from the car to begin treating him, but he was trapped.

I then looked to the car for the mechanism of injuries we were likely to find. I looked down and couldn’t figure out where his legs were.

The driver’s seat had been shoved forward 6″ and the steering wheel pushed back against his chest, so he was slumped over the wheel. The dashboard had been forced back onto his pelvis and the car’s engine block sat where his legs should have been.

We looked at each other and knew we had to get him out as soon as possible or there was a high chance he would die in the car.

We liaised with the Fire and Rescue Service (a separate emergency service here in the UK) who understood that it had to be a rapid extrication.

While the Fire Service cut away various parts of what was left of his car, my colleagues began treating the patient as best we could. We gained IV access in both arms so we could give him strong pain relief and fluids, we gave him oxygen and monitored his heart rate and blood pressure. From these observations, it was obvious he was in shock.

When the public say “he’s in shock”, they mean that they’ve had a nasty surprise and are in a bit shaken. When we say “he’s in shock”, it means the life threatening condition where the body is failing to get oxygenated blood to the brain and tissues of the body. When someone is in shock, they will die if untreated.

For 70 minutes the Fire Service fought to cut him free, and we fought to keep him alive.

Once he was cut free, it was a case of life over limb. That is to say that where we would normally work hard to protect the alignment of the neck by using a hard collar and a series of techniques to get them out while keeping them in a straight line. However, this man was on deaths door, so it was decided that we would drag him from the car and slide him onto our longboard to be carried to our stretcher. I was holding the top of the longboard and so could see down the length of the patient. I could now see where his legs were: broken in several places with open fractures and scissored beneath the car’s pedals.

We got him our and he was losing huge amounts of blood from somewhere internally. I covered the open woulds on his legs through which his broken bones were poking. Then my crew mate and I assisted the Doctor and the Air Ambulance Paramedic in sedating the patient so we could control his airway and breathing. It also meant that he was feeling no pain.

We loaded him onto our ambulance and drove quickly to the air ambulance which would fly him to the regional major trauma centre.

And just like that, my crew mate and I were in a field, in the dark with an ambulance full of broken glass, blood, cut clothes of the patient, used bandages and oxygen hose, empty bags of fluid, and a sense of awe for what we had just witnessed.

We radio’d our control to ask if we were needed back at the scene. They said the scene was in order so we could head to a nearby station to clean up, restock and have a debrief with the Officer.

We all agreed it was a horrendous incident. We spoke about what we felt went well, and what we thought we could have done better. We had a chat and a cup of tea – the ambulance remedy for witnessing something horrific.

It took us over an hour to clean the blood off the kit and restock the mountains of equipment we had used before we were ready to return to duty. I was glad of the extra time to compose my thoughts.

The following day, I received an email from the Officer who was at the scene. He had thanked us all for our hard work and forwarded an email from the BASICS Doctor who praised us for our teamwork and professionalism through what was a very difficult situation. He informed us of the patient’s injuries which included: Bruised Lungs, Bleeding in the abdomen a shattered pelvis and multiple open fractures in both legs. He had lost so much blood internally that they had to replace pints and pints of blood in the hospital before he was stable enough to be taken to the CT scanner. He was still sedated and was in an Intensive Care Unit. I was very pleased, but very surprised to hear that he was still alive.

The second patient in the other car who was also trapped had only minor injures. I didn’t even see him as we were so focused on our patient. But he had another crew, and doctor and another Fire team looking after him.

This was such a horrific incident that I may not see another like it. Then again, I may see one tomorrow – that’s the beauty of this job, it’s like a box of chocolates.

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