Time off and a thank you

Just thought I’d post a quick update. I’ve been off work for a little while after the arrival of my beautiful baby girl 🙂  – please excuse the poor grammar and lazy prose, I’m very sleep deprived – I’m off for a little while longer, as such there’s no cool exciting jobs for me to tell you about. There is the trauma of dirty nappies but that’s not really the point of this blog!

I also wanted to drop a quick thank you to the team at Parameducate on Facebook for sharing my humble blog and bringing literally hundreds of new visitors to my page; welcome all and hope you enjoy it.

 

While I’m here, I’ll post a quick job that’s popped into my head.

During one night shift, we were in a neighbouring city which is well out of our normal patch. The trouble with big cities is that the are such busy places that resources from further and further afield get dragged into the region to cover the huge volume of 999 calls received.

Thankfully, the ambulances have a pretty decent navigation system (Terrafix, for those that want to know), as long as you apply some common sense, so its not too bad finding addresses in foreign areas.

So, with no chance of escape from the city grasp, we receive details of a Red call across the city for a 27 year old having an allergic reaction. These types of calls are funny ones; people call for a range of severities when it comes to reactions. Some people call for full on anaphylaxis where as others will call 999 for a simple skin rash. This chap’s housemates had called for the former.

An allergy to nuts in some leftover curry was all it took. Nut oil in the sauce, to be precise. He was knelt on the floor with has hands out in front of him propping himself up on the back of a chair, desperately gasping for air through his swollen airway. I grabbed my torch and shone it in his mouth looking for obvious swelling, while my crewmate opened the drugs bag and began drawing up the lifesaving drugs.

I quickly grabbed my stethoscope from my pocket (tearing the fabric in the process!) and listened to his chest: wheeze; wheeze; wheeze; loads of wheezing. I turned to my colleague to report my findings but he handed me a nebuliser before I had a chance to say anything – he’s very experienced and knew he’d need the vapourised drugs which the oxygen mask delivered.

I strapped the mask to his face and shoot my colleague a quick glance. We both know this guy is ‘big sick’, we need to give him more drugs, and quickly! I tell him I need to put a needle into a vein to give him more drugs. He hears me but doesn’t respond, he can’t talk! An enourmous vein jumps out at me and a insert a 16 gauge cannula (it’s a wide-bore IV, incase I need to push IV fluids later). I give a powerful steroid, a strong antihistamine and inject adrenaline into his thigh muscle. Constantly reassessing AB and C. I listen once more to his chest; plenty of air moving now, that wheeze is definitely improved. He starts to utter single words to tell me what’s happened.

5 minutes pass but it feels like a lifetime, we perform blood pressure, ECGs and other observations. He became able to talk in full sentences again.
A short while later, he seems to have made a full recovery. It’s so satisfying being able to bring someone back from the brink!

We conveyed him to A&E for further monitoring after the strong drugs we gave him which could affect his heart. I get the feeling that the A&E team don’t believe how bad he was, but we know. We know.

That newly qualified wobble

I’ve worked on the frontline of the Ambulance service for almost 6 years. I’ve been to my fair share of horrific jobs and in the words of my veteran crew mate, I’ve “got chops” (I smiled and said thanks when he said it, but don’t really know what it means. I assume it means I’ve got bragging rights). 

For the last year prior to qualifying, I’ve been working all but autonomously with my Paramedic crew mates; assessing, making decisions about treatment, administering drugs and handing over to hospital staff. I’ve been confident in my decision making and felt happy to take the lead. Albeit with a safety net of my colleague sat next to me. 

Last month I completed my degree course, qualified and registered as a Paramedic. “Finally” I thought to myself!

So, I’m now in a position to do all of the above; assessing, making decisions about treatment, administering drugs and handing over to hospital staff, BUT it will be on my registration and me signing the paperwork off. I still feel confident and competent and am looking forward to the challenge. 

Imagine my horror then, at the following. 

999 call to a 12 month old little girl who is “hard to wake”. My crew mate and I make good progress through the busy city traffic in our big Mercedes Ambulance, sirens wailing as we speed to the address. 

Upon our arrival the front door is ajar, we grab all of our kit (4 bags, oxygen cylinder, tablet computer and defib) and head in calling “hello, ambulance” as we tentatively enter the house. 

We’re called into the living room by the patient’s dad, who’s holding little one in his arms. She looks round at me as I introduce us which reassures me she’s fully conscious and alert. We take a brief history from dad which includes details of breathlessness for 2 days and a fever. Reduced food intake and being tired and clingy. 

Between my crew mate and I, we take a full set of observations which give us her respiratory rate, heart rate, temperature, blood glucose level and a test to establish how well perfused she is by pinching her finger and seeing how quickly it returns to a normal colour (sometimes the simple tests are the most effective).

We establish that although she seems calm, she’s working hard at breathing with an increased respiratory rate. Her heart rate is also raised. 

6 weeks ago, I would’ve made my decision. Bosh. Sorted. Confident and competent, remember? But I sat there looking at the child, looking at her numbers and I could not for the life of me make a decision about what to do. 

I knew she needed to see a Doctor but couldn’t decide whether to refer her to the out of hours GP or take her directly to A&E.

Her dad was sensible and would’ve known what to look for should we decide to leave her. But what if she deteriorates. Equally I don’t want to fill an A&E bed with a child that could be treated easily in the community. A hundred thoughts whizz through my mind but I could not extract a decision.

After what felt like an age (but was less than 30 seconds) I decided to convey the child to A&E for urgent assessment by a Doctor. 

We took her in, she needed no treatment or drugs so it was an uneventful journey. I had a nice chat to her Dad about this’n’that, and handed her over to the hard working team at the local A&E.
Afterwards I spoke with my Paramedic colleague when we got back to station and confessed that I had struggled to make a decision. 

“It’s completely normal” she reassured me. “You looked at all the facts and made the right decision based on what you had, it was fine.”

Apparently a ‘newly qualified wobble’ is quite normal, and shows that we care about our patients and outcomes. 

My crew mate tonight has been a Paramedic for upwards of 30 years and said he still airs on the side of caution if he’s doubting a decision. That helps 🙂 

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 wound 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 1500ml 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 🙂

Green cross code

The morning had been a busy one.

We’d attended a lady who’d fallen out of bed, was uninjured so we helped her up, checked her over and left her to her breakfast, we’d taken a 57 year old man with chest pain to hospital with a possible heart attack, and rushed a 60 year old man to hospital who was having a bleed on the brain – what we like to call ‘big sick’! 

We were almost back to our station for a much needed restock and cup of tea when we received another call. 

It came through as a road name in the next city. No house number, just a road name. Usually that means someone has fallen in the street, or there’s been a car crash. 

We received a message which said: “14 year old hit by car – unconscious, massive head injury”

Shit! Pedal to the floor and off we go. My colleague driving as I don my hi-vis jacket and think about how I might treat the patient depending on what we’re presented with. 

We receive another message:

“Ambulanc officer is on scene, he states the patient is GCS5 (which means barely conscious!) and has requested priority 1 backup and the air ambulance as a priority.”

Double shit!

We arrive shortly after to exactly the sort of thing you’d expect to see at an incident like this. An ambulance officer’s car straddling the road, a pickup truck parked awkwardly at the curb, a man sat beside it in tears while members of the public console him, a police car screeching to a halt to block traffic and a lifeless child led in the road with a stream of blood trickling down the Tarmac, our officer colleague at her side rapidly assessing her. 

The clinical handover was brief, it didn’t need to be complicated, we could all see what had happened and all knew what we needed to do. 

Her level of consciousness raised after some oxygen. She was in pain and distressed. 

“Quick ABC; airway clear. Breathing adequately and chest clear on auscultation, radial pulses present, she’s tachycardic (fast heart rate) and pale. Let’s get some IV access and get her off the floor.” 

Another paramedic arrives in a car to assist. I look up and see several more police cars now on scene interviewing witnesses. The patient’s mum arrives in a frenzy! Now we have 2 to look after, the paramedic who’d just arrived set to reassuring mum that we were working hard to save her daughter.

With some volunteers holding up a blanket to make a screen for some dignity, we cut her clothes off to assess her fully. She had a large head wound that we had pressure on, a presumed neck injury, large abrasions on her back and shoulders where she’d rolled down the road like a rag doll. She had wounds to her lower legs but as far as we could tell, no broken bones. We gave her some pain relief, a drip, some anti-sickness medicine as she’d vomited profusely (another concerning sign of head/brain injury). She was a little more ‘with it’ now. The helicopter had landed at a nearby school as the road was too narrow for them to safely land. A police car sped off to collect them. A HEMS paramedic and critical care paramedic arrived just as a critical care doctor arrived by road from another base. We told the story and it was agreed we would take her by road to the nearest children’s major trauma centre under blue lights with the doctor on board. 

We scooped her off the floor and onto our stretcher ready to load onto the ambulance. Another quick ABC check and we were ready to leave. The helicopter left having offered their opinions and assistance and we prepared to leave he scene. 

It was around 40 minutes to the trauma unit, with my crew mate driving and me in the back with the doctor and patient. She was fully immobilised and calmed by the pain killers we’d given via the IV. She vomited twice en-route meaning we had to roll her on the spinal stretcher she was on. Not easy with just two of you while doing 70mph through city streets, but this is the career I chose! 

We arrived to a resus room full of doctors, nurses, surgeons, orthopods, paediatric specialists and porters, around 18 people who would now take over her care. 

There was silence as the critical care doctor gave his handover. As soon as he’d finished, the trauma lead set everyone to work. 

Each was allocated a task from airway and breathing to assessing neurological function of her feet. Every inch rapidly assessed for defecit before whisking her away for a CT scan to see what was happening under the skin level.
Absolutely exhausting and emotionally draining, as dealing with children often can be. The police had driven mum to hospital, leaving us space to work in the back of our cramped ambulance. 

Hoping for a good outcome for her thanks to our interventions, we’ll probably never find out though. 

Spice is the spice of life…ish

‘Legal highs’ are becoming a bit of a concern in healthcare circles. They are becoming more and more prevalent, especially among younger children of school/collage age!

For those that don’t know what a legal high is, it is the broad term for a range of drugs that are available legally to purchase over the internet. They pose as a plant fertiliser or similar, and are usually in powder form. They are given unusual names such as ‘whizz’ or ‘spice’, the latter being more popular. Spice is a cannabis derivative mixed with a cocktail of unknown chemicals to bulk it out. It can be smoked with tobacco or sniffed like cocaine.

The trouble with spice is, it kills people. Kills them. It produces a fierce chemical reaction with the bodies own enzymes which increases heart rate, reduces oxygen to the brain which causes respiratory failure, coma and eventually death. But not before a period of psychosis, profuse vomiting, disorientation and symptoms of a heart attack.

Delightful, where can I get some?!

Well, it seems that if you want some spice, all you need to is end up in prison. It is rife!

Cue a flashback to a recent call in the middle of the day to a Category C prison (which is for those who cannot be trusted in an open space) for a 30 year old man who was found unconscious in his cell. He was witnessed to be fitting so the prison nurse was alerted who came and treated him while we were on the way.

Despite there being no packaging for Spice anywhere, the presentation of the man was very similar to someone who had taken it.

When we arrived, we had to pass through 4 double locked gates like a safari park before being signed in to the log in triplicate, then finally being taken to the cell block. After that, we had to grab all our equipment then be escorted into the cell block.

I don’t really get nervous easily with my surroundings. I’m always aware of any danger, but very rarely get scared. I’ve been to drug dens and large fights in small rooms and always managed quite well, but for some reason, I was cacking myself!

As we walked in, every inmate stopped what they were doing and looked at us. The high walls and railings and narrow corridors made it a rather intimidating place to be.

We were shown to the cell to find a male on the floor looking pretty sick. He had a reduced level of consciousness, a racing heart and his colour was pretty poor. We were on the first floor so I needed to get a carry chair, which meant I had to go back to the ambulance and get one! This meant walking along a gangway and down some stairs to the door. Seems simple enough, but I’ve never felt like more of an outsider. Guys stood in the doors of their cells just stared at me as a walked by, people in the gangway didn’t give me much space to pass them and I didn’t really fancy making eye contact.

Anyway, my concerns aside, in the time it had taken me to get the chair and return, my crew mate had got some oxygen on him and gained IV access incase we needed to give him any drugs to stop subsequent seizures. We carried him out to the ambulance, lifted him onto the stretcher and connected our monitoring devizes. By now, he was awake enough to talk to us so we asked if he’d taken any drugs. He denied taking anything so we got driving to hospital.

Back through the security gates to the main gate where they had to find two officers who would escort him to hospital. This meant signing them all out, as well as us and handcuffing them all together. This took quite a while considering he was so unwell, but we didn’t argue – we understood.

So, I got driving to the hospital, which was a good 23 miles away. Nice and steady to start with but then I hear some commotion in the back. There’s only a small hatch between the cab and the back of the ambulance so I couldn’t really see what was happening, but with that, my crew mate popped his head through the hatch and said “keep us moving mate”, which is code for “put the lights and sirens on and don’t stop”. So, I blued the 20 minute drive through the traffic of two small towns and a city until we arrived at the hospital.

It wasn’t until after we’d handed him over to the nurses and doctors I found out what had happened to cause such a stir: He blood pressure and heart rate began rapidly dropping to the point where my colleague believed his heart would stop. He was given various drugs to maintaining a level to keep him alive but he was rapidly deteriorating. He may survive, he may have to be sedated and put into intensive care, he may die, I don’t know. But people take these drugs for a quick ‘high’ and end up critically unwell.

Just to show how commonplace this is in prisons, as we were on the way to hospital, I heard a broadcast over the radio for an emergency in the same prison for another inmate who was fitting after taking Spice…

Ambulance Crew – A Basic Survival Guide

So, you’re thinking of joining the Ambulance Service. Have a seat, make a cuppa, and I’ll tell you what you need to know to survive being an Ambulance Person.

One of the most important things to realise about working for the Ambulance Service, is that it’s not all blood and guts. In fact, it’s been quite a while since I’ve seen any guts, or brains, or body parts that should be inside the body. A large amount of our work is medical complaints; chest pain; shortness of breath; abdominal pain; strokes; headaches etc. There’s also a very large portion of mental health and social concern cases. Because of that, you need my number one rule:

• Be able to talk to anyone.

I once heard a Paramedic of 30 years say he could talk to anyone with an asshole. I thought he was joking, but actually, this is a skill you need to have. As you become more experienced and knowledgable, you’ll be able to talk about more specialist medical things, but first, being able to talk and not being scared of you own shadow is a good start. This brings me to point number two.

• Trust in your training.

You’ll turn up to your first emergency call wearing the uniform of thousands before you and be expected to know what you are doing. Have faith, you won’t be on your own (hopefully) and your basic training will kick in, no matter what the call is. For a newbie, it’s all about A B C and not doing any harm. Increased skills and knowledge will come along in time. You won’t be expected to attend (by which I mean sit in the back of the ambulance and treat on the way to hospital) a very unwell patient, so you’ll be driving the truck more than your crew mate, and so:

• ALWAYS drive to the condition of your patient.

During your driver training, you’re taught to drive as fast as it is safe to go. In reality, when driving a 6 tonne ambulance through narrow city streets with a seriously unwell patient in the back, speed is the last thing you want. Smoothness is the key! I learnt that very early on after a bollocking from my crew mate who nearly fell to the floor while treating an unwell child in the back of the ambulance while I drove on blues to the hospital. These vehicles do not handle well, they wallow around every corner and feel every bump! You’ll be thankful of this advice when the time comes for your crew mate to drive you to A&E with a patient in the back.

• Support your crew mate

You’re with them for 12 hours (or likely more) a day in a very small space, during sometimes some very emotionally charged scenes. Unless the clinical decision is dangerous, always support your crew mate. It looks unprofessional to argue on scene and will create a difficult working environment for the two of you. You can always talk it out after you’ve dropped the patient off at A&E. I’ve done shifts with people I really haven’t liked, I’m talking about proper dicks, but when it came to the clinical stuff, you need to work together, especially when time is critical. Which brings me to point 5:

• Don’t panic!

It will be tempting. You’ll have to stop and take a few deep breaths, you’re ears will be ringing and your vision narrows, you’ll feel your own heart punching you in the chest, your legs will feel weak and your brain will be moving so fast you’ll forget your own name. This will happen the first time you come across something serious like a horrific car crash. And subsequent times after that. Don’t worry about it, but don’t let it affect your care. Even the most experienced medics have that surge of adrenaline during incidents like this. The key is to take your time with things: like a swan – calm and smooth above water, but underneath paddling like fuck!! Your colleagues will be excellent and you’ll fit into the team. You’ll either know what to do, or be told what to do – both are absolutely fine.

• You’ll have memories, good and bad

No need to elaborate too much here. You’ll see some of the funniest, strangest and most heartwarming things doing this job. You’ll also see things that will steal sleep from you, give you flashbacks and haunt you. You need to be ready for that. Take comfort in the fact that you won’t be alone, and there are support networks in place.

 

 

This list isn’t exhaustive, there are hundreds of survival tips I could throw at you, but that would make a very long post indeed.

Now probably the most important rule of all:

• Never, I mean NEVER pass up the opportunity to go to the toilet. You might not see another one for 8 hours! (That ‘drive to the patient’s condition’ rule will soon go out the window when driving to hospital with a bladder the size of a small continent fit to burst!!)

This really is the best job in the world. The government won’t ever appreciate what we do, senior managers will alter your terms to make 12 hours seem harder and harder in the name of ‘efficiency’. You’ll miss your family and friends, spend Christmas Day in the houses of strangers and your body clock won’t know what hour of the day it is. But really, this job is like no other – you’re trusted with people’s lives, you offer relief to those who are anxious and ease the pain of those in need.

It’s not for everyone, but if you can stomach it, do it!

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!

A message to shift workers.

My dear shift working colleagues. As you awake on Christmas day, don your uniforms and head out into the cold for another hard days work, please spare a thought for the poor, poor souls who are forced not to be at work.

Many establishments choose to close over the Christmas period, meaning that workers are not allowed onto the premises, even if they wanted to work.

They will surely awake – not by the usual 0630 alarm, but with calls of “HAPPY CHRISTMAS” from exited children bouncing on their beds, then commence the Christmas routine:

• Drinking alcohol in the morning inducing a hangover by 2pm which can only be cured by more alcohol.
• Eating an enormous meal so large that you simply have no more room for food, apart from the Christmas Pudding, Chocolate, Cheese board, crisps and sweets. You’re so full you feel you may vomit, but have more alcohol instead.
• Giving and receiving gifts aplenty, all the while with festive songs on the radio and blockbuster films on the telly.

Meanwhile, you will be undertaking your usual duties of the day – some may decide to wear a festive santa hat, or some tinsel in their hair, but many will simply wear their own uniforms in the normal manner.

As you maybe able to tell from the tone of this post, I am most certainly the latter. I’m on relief (relief is where they extract you from your rota for 2 consecutive weeks every 10 to work whatever days they have shortages due to sickness/holiday at whatever station they dictate within a 25 mile radius of your base station – it’s a ball ache!) and so working three nights on Christmas Eve’, Christmas Day and Boxing Day. Although all the core rota shifts are covered, my ambulance trust believes that these days are the busiest of the year and so insists on running an extra double crewed ambulance for the period. YES!!

Anyway, my bitterness aside. Have a lovely Christmas and stay safe – I’d like very much not to leave the Ambulance Station all night!!

Ebola…

…is a concern for the health service in England. There’s been lots of planning for the possible/eventual contraction of Ebola by a UK citizen.

It was a very surreal moment when I heard on the news, that if there was any concern about Ebola, and somebody had phoned their doctor or out of hours service, the case would be passed to the emergency services to deal with.

“Good”, I thought, “they’re the kiddies to deal with this”. Then I realised – I’M THE BLOODY EMERGENCY SERVICES!!

But it’s ok; our ambulance trust promptly released instruction on what we are to do when faced with a possible case.

We’ve been provided with Tyvek suits (yes, the ones worn by decorators to protect them from paint, not lethal bloodborne pathogens) and paper masks similar to those worn on a building site to protect one from brick dust.

As you can imagine, ambulance staff were rather worried that if the people in Africa with the pressurised suites and breathing apparatus were still contracting the disease, what protection would a paper suit afford us?!?!

The Trust then upgraded to filtered masks, which is kind. They have also ensured every operational member of staff is trained in the fitting of the mask and an assessment carried out. The rules of the assessment are as follows:

• If you have a beard, it is in automatic fail.
• If you fit the mask incorrectly twice in a row, it is a fail.
• If you fit the mask and can still smell/taste the testing agent in the room, it is a fail.
• If you fail the assessment, it does not exclude you from still being sent to a possible Ebola case.

Let me reiterate that last point – If you fail the mask assessment, for something as simple as having a beard (which many of our male employees do….and some female ones but that’s a different matter), you will still be sent to a potential case. Good.

So, although I’m sure the media are hyping up the disease more than is actually necessary at the moment, I’d like to wish all my fellow, bearded, ambulance colleagues – both male and female – all the very best of luck while holding their breath during the treatment of their patient. Lovely.

(My mum’s going to be furious at reading this!!)

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….”