Tag Archives: ED

The Christmas nightshift

…”should be easy”, I hear you say.

“Pop your feet up and watch some James Bond, maybe nip out to pick up granny who’s fallen after one to many sherries. Or maybe a drink driver crashed into a lamp post.”

Well, yes. It should have been something similar to that, but instead, it was a rather intense shift.

Our first call (admittedly almost an hour after signing onto the Ambulance) was to a lady who has possibly had a stroke. She was 84 years old. Now, we don’t play God. We don’t think “ah well, she’s had a good innings, lets leave her to slip away peacefully.” Especially when this particular 84 year old still cycled everywhere in the village she lived in, and WORKED 2 DAYS A WEEK!!

She was sat on the sofa at her daughters house where she went every year to celebrate Christmas, when suddenly, she listed over to one side. Her daughter asked if she was ok and the mumbled reply confirmed her suspicious; she was having a stroke.

We arrived quite quickly considering the narrow lanes surrounding the village, to be met by her daughter outside in a bit of a panic.

“Through here please!” We just caught what she said as she scurried into the house. We found the living room and saw our patient in quite good spirits, considering. She had a right sided facial droop, slurred speech and was unable to move her right arm – all the classic signs of a stroke.

If caught within a certain time frame, some strokes can be treated and in many cases, the patient will make a good-to-full recovery. But not all the time.

We were well within this window, so basically ‘scooped and ran’ (a term often used to mean just that: scoop the patient up and run to hospital on blues.

I put a needle into a vein in case we needed to give her any drugs and my crew mate blued us to A&E. It was an uneventful journey, but I pre-alerted the hospital staff anyway, as is protocol for stroke patients.  We arrived to be met by a doctor who sent us into ‘Resus” (where the illest patients go) as the CT Scanner was in use – another stroke patient brought in by Ambulance who’d arrived not 5 minutes before us!!

I later found out she was Thrombolised (treatment for a specific type of stroke) and was making a good recovery. Good times!

 

Next patient was a Priority 1 backup request from an RRV Paramedic on scene back in our home town. We darted through the empty city streets and out onto the country road leading to our station, which we sped past on the way to the address.

It was a 44 year old man who was a chronic (and still functioning) alcoholic. He had End Stage Liver Disease and many other health problems. He was completely unconscious, very jaundiced (yellow skin associated with liver failure), and barely breathing. Not a well man.

The RRV Para’ had given oxygen, gained IV access and was giving fluids as we arrived. We lifted him from his bed to the stretcher (thankfully he lived in a bungalow) and wheeled him to the Ambulance. We blued him in as well. On the way to hospital, he developed a dreadful habit of not breathing every now and then, meaning I had to ventilate him with a BVM. He remained unconscious the whole way to hospital.

I handed him over (to the same doctor as earlier) who very quickly set to treating him with the expert nursing team. Once his family arrived, the doctor had the discussion with them that he was unlikely to improve and if his heart stopped, they would not attempt to restart it. The family were in agreement and were in fact relieved that his agony would not be prolonged. He died a few hours later, peacefully and in no pain with his family by his side.

 

We then did a few ‘normal’ jobs – too much sherry etc etc.

Then we got sent to the next town for “18 year old male, stabbed”.

Now, that would fill most people with dread, but I’ve been sent to so many ‘stabbings’ that have in fact turned out to be paper cuts and not much else. One man had a graze on his arm, the sort you get from scratching an itch too hard!

Nonetheless, put down your dinner and pick up the Ambulance keys, blue lights on and off we go.

We arrived to see 2 RRV’s, 3 Police cars and Police dog team on standby. We walked into the house and followed the blood trail…..ah, first clue that this might be serious.

There were our two colleagues dressing wounds, taking vital signs and details while the Police tried to gleam information about his attackers.

We quickly grabbed the stretcher and wheeled him to the vehicle for a proper assessment (cut all his clothes off for a top-to-toe inspection to make sure we haven’t missed any stab wounds) in better light.

He’d taken a fair beating:

Black eye, presumed fractured cheek bone, fractured jaw, laceration to his neck, significant cuts to his hands (typical defensive wounds), cuts to his legs and a pretty nasty stab wound to the knee, of all places. He had lost a pretty decent amount of blood and was an unhealthy shade of white.

Despite his serious condition, he was reluctant, in fact he outright refused to give any details of his attackers to the Police.

We blued him in as well, with a Police escort which was rather exciting (I’ve never had one before). Pulling up at A&E, guess which doctor was waiting for us? “You guys are proper sh*t magnets tonight!”

“You’re telling us?!”

The last I heard, he was OK. It took over an hour to clean all the blood off of him. We hadn’t missed any wounds and he was preparing to go to theatres to have his hands operated on. We spoke with the Police later that night, who told us that when the searched his clothes that we’d cut off, they found a cocktail of drugs. They suspected it was a drug deal that went wrong, which would explain his tight lips!!

 

Even on Christmas Day, you can’t guarantee an easy ride. Still, mostly genuine jobs this time 🙂

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Critical Haemorrhage

I’ve mentioned before that our ‘Primary Survey’ (i.e your initial assessment of a patient to decide if there’s anything immediately life threatening that needs correcting) differs from that of a first aider, who’s primary survey will be:

D – Danger

R – Response

A- Airway

B – Breathing

and maybe C – Circulation

Our primary survey is:

D – Danger

C – Catastrophic Haemorrhage

R – Response

A – Airway

c (deliberately small) – Cervical Spine injury

B – Breathing

C – Circulation

D – Disability or Neurological signs

E – Everything else

F – Family/Friends for history taking

G – Glucose levels.

So, as you’d expect, it’s a bit different.

When it comes to managing Catastrophic/Critical Haemorrhage (by which I mean an arterial bleed which will bleed a patient dry in mere moments), we don’t piss around. As you can see, we control Catastrophic Bleeding before we even try to get a response from our patient, let alone try managing an airway etc etc.

Most if not all of our critical haemorrhage kits have been developed by the Military. Their ‘bread & butter’ work is dealing with traumatic amputations and massive trauma to the abdomen and chest.

They’ve developed very efficient tourniquets and dressings known as ‘blast dressings’, or to give them their proper name, ‘haemostatic dressings’. These have a chemical in them which promotes clotting to stop bleeding quickly. These dressings are idiot proof, very large and very expensive. They save lives.

I’ve never been unfortunate enough to have to apply a tourniquet, though my regular crew mate was – he was sent to a lady who was trapped under the wheel of a bus!

I have, however, applied a blast dressing to a lady with a catastrophic bleed from the chest. It works very well indeed.

We have a special bag which is a cool, special op’s style black bag with red writing which says ‘Critical Haemorrhage Kit, Trained Personnel Only”. In there we carry tourniquets, various sized blast dressings and haemostatatic gauze.

On my last day shift, we answered a 999 call for a man who’d cut himself shaving, so the bag was left on the Ambulance that day……*sigh*.

Needless to say, we recommended some basic first aid and left him to it. Another life saved 🙂

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Mental Health

Mental health can be very difficult to manage. The Mental Health Foundation state that 1 in 4 of us will have some kind of mental health problem in the course of a year. 1 in 4, within the course of a year! That is a huge amount of people! This can range from social anxiety to depression or suicide attempts, and in the Ambulance Service, we see a slice of it all.

People ring 999 in a crisis point 24 hours a day. I’ve calmed people having panic attacks in a restaurant, and talked people out of slitting their wrists with a knife. I’ve transported countless overdose patients to A&E and attended a young lady who’d fatally hanged herself.

My point is, MILLIONS of people suffer with mental health, but it is underfunded, under investigated, and people genuinely don’t know what to do in a crisis, so they call 999.

But then what happens…..?

If someone is having an asthma attack, we give them Oxygen and drugs to open the airways.

If someone has fallen down the stairs, we splint their injuries, protect their spinal cord and ease their pain with powerful pain killers.

If someone is in labour, we can deliver their baby and stop a post-partem haemorrhage.

If someone’s heart stops, we have the training, equipment and skills to restart it.

What we don’t have the training or equipment for, is a mental health crisis.

Last Saturday night, we get a call from a young lady who has been walking the streets of the city crying into a bottle of Vodka and eventually knocked on a stranger’s door to ask for help. The person who owned the house amazingly let her in, then called 999. We arrived and she came and sat in our ambulance and told us her story, which out of respect I won’t repeat. We listened, she cried. Then came the difficult bit – what do we do now?

She was a long way from home, it was nearly 5am, and she was, in our opinion, at risk of harming herself or worse, yet she wasn’t a candidate to be Sectioned under the mental health act.

So we did the only thing we could do, we took her to A&E. Trying to contact a mental health provider is hard enough ‘in hours’, let along at 5am on a Sunday morning, so the only option available to us as the ambulance service was A&E. A busy A&E department that was understaffed with no psychiatrists out of hours.

Every time I attend a patient in that position, I wish there was more we could do, but there isn’t. It’s very frustrating. I’d love there to be a satisfying close to this post, but there isn’t.

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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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