Tag Archives: NHS

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.

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The first Paramedic shift…

…was actually what it was supposed to be this time; This was my first shift working as a registered Paramedic. I’d been given my shiny new ‘Paramedic’ epaulettes, a personal issue Morphine log book and Morphine pouch and was ready to take the lead on the Ambulance for 12 hours.

My first shift as a Para was with my old mentor. We agreed to meet on station early to go through the daily drug audit process – a lengthy but legally necessary process where the first Paramedic to book in/out controlled drugs after midnight that day, has to perform a full controlled drug count and note it in the log book.

Once that was complete, we grabbed the keys ready to check the vehicle before the start of our shift. Suddenly, somewhere between putting the kettle on and grabbing my hi-vis kit, the station phone rang:

“I’m really sorry to call you early, guys, but I’ve got a Red Call that’s just come in in the next village and the nearest crew is 20 minutes away, can you book on early for me??”

The voice was that of one of our Dispatchers, a particularly efficient and trustworthy Dispatcher who happens to be a close personal friend of mine. I knew she wouldn’t ask us to book on early unless she had to.

“Yeah of course, whats the details?”

“It’s a 19 month old who’s been scalded by boiling water”

An immediate rush of adrenaline rushes across me, along with 100 questions about what had happened; how much water; where are they burnt; was this non-accidental; where were the parents; how in the name of all that is Holy do I manage this patient?!

“Right, send it down, mark us as Mobile to Scene.”

“Will do, thank you so much.”

 

I holler through the garage to my crew mate who responded by firing up the truck, which revved to life after rare 12 hour break. We both jumped in the cab and rushed the 8 or so minutes to the address. The whole way there I was thinking how that after months and months of having nothing but non-injury falls and drunk students, my first shift as a Paramedic commenced with what would be considered a nightmare job! I had to consider assessment strategies, treatment plans, drug protocols, the availability of the air ambulance, our proximity to hospital compared to the regional burns centre, how I would calm the child, how I would calm the parents – all this while my crew mate drove at 60mph through the town centre.

 

We arrived at the three-story Georgian-style new-build to find a very anxious looking Mum at the door. As I jumped out, she said “I’m a Police officer, please don’t report me!” This eased tension quite quickly. Even in dire circumstances, the blue-light team always have a warped sense of humour.

“Where are we going?” I replied while smiling calmly but secretly shitting myself.

Mum pointed upstairs. She needn’t have bothered, I simply followed the screams until I found the bathroom where a stripped naked boy lay in his fully-clothed dad’s arms, both sat in the bath tub, dad spraying him with a cool shower – the absolute best thing to do initially for any burn.

I took a quick history while I opened the burns kit. My crew mate, instinctively knowing that we would be ‘scooping and running’, began preparing the ambulance to transport the patient and parents.

The child had severe scald burns to his lower face, lips, neck, chest, shoulders, arms and back. It was a full, fresh made coffee that he’d grabbed from the kitchen worktop while his mum turned her back for a second that had caused the damage. There were several large blisters that had already burst, and several more forming.

It’s very important that we (pre-hospital clinicians) estimate the total body surface area that has been burned. There are several quick-and-dirty methods to do this, my favourite at the moment is to treat the patient’s whole palm and fingers as 1% and work it from that. I estimated that in this case, the lad had approximately 10% superficial and partial-thickness burns. This is a significant burn % area for a child and it confirmed my suspicions that we would be bypassing the nearest A&E and heading for the regional burns centre.

We gave him some Calpol (liquid paracetamol/Tylenol for those abroad), strong oral pain relief (liquid morphine) and turned off the shower. We placed cling-film over his burns* and placed cooling burns dressings over the top. Mum carried him to the ambulance while dad changed into some dry clothes.

Once aboard, I completed as many clinical observations as you can on a highly distressed 19 month old, then blue-lighted him to the burns centre. I phoned ahead on the red-phone (the priority line) to prepare the team for my patient.

It was an uneventful journey. The pain relief kicked in quite quickly, and cartoons on Dad’s iPhone were a hit, too! At the hospital I handed over to the Consultant Paediatrician who praised the parents for their quick actions in administering first aid. I sensed he could see the guilt in their eyes of having left a hot drink in reach of their child and wanted to try to pacify them. It was clearly an accident and an easy mistake to make. They weren’t the first and certainly won’t be the last parents to do this! The hospital team thanked us and set to work on the boy.

 

It was a very satisfying job. Our total ‘on scene’ time was 11 minutes. And 4 of that was waiting for Dad to get changed. I felt very proud of my actions as lead clinician, and my crew mate and ex-mentor high-fived me and bought me a coffee – the equivalent of a medal in the Ambulance Service 🙂

 

Our very next job was a drunk man on a park bench who said he couldn’t stand up, then, when we wheeled the stretcher to the park bench, promptly stood up and walked to it…….normal service resumed then.

 

 

*Cling film, believe it or not, is excellent for all burns: not only does it reduce infection, it prevents air getting to the exposed nerve endings and actually reduces pain! Definitely don’t be using butter/moisturiser/ice/anything else!

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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 🙂

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Alcohol

it’s no secret that in the UK ambulance service, we deal with a lot of alcohol induced incidents. If we get to a call where the patient feels they’ve been waiting too long, they’ll usually say something like “Oh, I suppose you’ve been busy picking up drunks!” Not far wrong, sadly. But it’s not always that simple.

I would say that a decent percentage of our calls are for something linked with alcohol. For example, chronic liver failure caused by alcoholism causing pain, pancreatitis pain caused by the same, people vomiting blood as the lining of their stomach has been worn away by cider and other alcoholic drinks, a large number of medical issues secondary to complications in drinkers. Not to mention car crashes caused by drink drivers, people falling down stairs because they’re drunk or getting into fights because they’re, you guessed it, drunk.

My last two shifts contained enough calls where alcohol was the catalyst to warrant be posting about it. Here they are:

1) Priority 1 backup for a Rapid Response Vehicle Paramedic who has been called to a man in his 50’s who is led on his bed with a heavily reduced level on consciousness. He hadn’t been seen or spoken to in 2 days and his son has come in and found him like this. We had no medical history and there were tablets scattered around the house, but the packets were full so we weren’t convinced of an overdose. We lifted him onto our carry char, carried him down the stairs and out to our ambulance where we conducted a few other tests, then blue’d him into A&E with a  pre-alert for the resus team. We handed over to the waiting Doctor, cleaned our stretcher and kit, then headed off for another emergency.

When we returned later on, I asked the nurse how he was (thinking they would’ve scanned his head for evidence of a stroke), she told me he was drunk. Drunk. My crew mate had a cold and I can’t really smell alcohol, so we didn’t pick up on it. All of that fuss and bother for a man who was simply drunk. He was discharged later that day with a monster hang-over.

2) 999 call to an RTC. Motorcycle vs. Car. The motorcycle had turned off a fast roundabout at speed while overtaking another car. He had drifted across the white lines and scuffed the side of a car coming the other way. He was thrown from his bike and slid 100 meters down the tarmac. He had a broken finger, a nasty open-fracture (bone sticking outside of the skin) to his lower leg and, as he had a leather jacket but only jeans below, a nasty friction burn to his thigh. We gave him Morphine for his pain, stabilised the fracture and took him to A&E. On the way, he told us he was an alcoholic and had been drinking all day then went for a ride on his bike. Thankfully, the car driver wasn’t hurt and thankfully, he didn’t slide under the wheels of the lorry that was also passing by!

3) In the early hours of the morning we received an emergency. “Male with serious arm injuries and heavy bleeding after going through a window”. It turns out this man (who had been drinking heavily all night) had gotten into an argument in a pub. He shoved a man over and was evicted by the landlord who had apparently given him some verbal abuse as he did so. Once outside, he took his anger out on the pub’s window, punching it hard enough to break the glass. When pulling his arm back through, he gave himself a very deep and long laceration to his arm causing a considerable amount of bleeding. There was around 8 of his drunk friends all in the street shouting and screaming, so we got him aboard the ambulance hastily drove to the hospital.

4) About an hour after the above case, we were called to a male in a bus shelter, unresponsive and vomiting. We arrived, blue lights flashing, to find a student who was celebrating finishing his exams and had drank his weight in whisky and beer. He was very very drunk and his friend whom he lived with was equally drunk, so we couldn’t take him home as there’d be nobody to look after him. So, that left us with no choice but to take him to A&E, where he took up a valuable bed which an elderly patient may have needed. He also vomited on my ambulance floor which upset me greatly as I had to mop it out and sanitise everything after dealing with him.

5) This was the absolute pinnacle. The same night as the above two examples, called to another student who had apparently fallen with a head injury and was unconscious. He had indeed fallen, but had sustained no head injury and was actually conscious, albeit incredibly drunk. We picked him up out of the puddle of his own vomit and walked him to our ambulance. We checked him over and found that he was indeed just drunk. He lived locally so we offered to take him and his equally drunk friend home. I built up a good rapport with him and felt comfortable to give this as my final statement as I handed him a copy of our paperwork. “Take this as a reminder never to get so drunk that you need an ambulance, as it’s a horrendous waste of our time.” He nodded, took the paperwork and stumbled through his front door.

We cleared at his address and were instructed to head back to our station for a well earned break. About 20 minutes later, we were radio’d by our control to ask the address that we’d taken the last young man to. We gave it and were told that there was a young man, the same young man that we’d just taken home, had GONE BACK OUT INTO TOWN and collapsed in his own vomit again. Another 999 call was made for an ‘unresponsive male’ and another ambulance, this time a Rapid Response Vehicle, picked him up, checked him over and took him home, unaware that just 20 minutes before hand, we had just done the very same!!!!

Yep, alcohol plays a large part in emergency medicine and an even larger part in chronic treatment in hospitals for outpatients etc. I wonder when the government start fining alcohol companies for every A&E admission caused by alcohol??

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