Tag Archives: Sirens

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…

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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!

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Terrified Out of Hours Service

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Hot Response

‘Hot response’ is a term used to describe a blue light response drive to an emergency. There is a ‘cold response’ which is normal road speed for low priority and urgent cases needing routine admission.

I like the term ‘hot response’, I think it just sounds cool.

The only thing is, we are requested to have a hot response to almost bloody EVERYTHING!!

Lets play a game…

“[callsign] thank you, I have an emergency for you please in the city; 21 year old male hearing voices…”

“Emergency please for an 84 year old male with breathing problems…”

“Thanks [callsign], further emergency for you for a 72 year old female, rolled out of bed and found by carers who got her up and believe she is uninjured…”

Which one of those would you think would require a blue lights and sirens response?

The answer??

All of them. Every single one of those radio transmissions from our control ended with the words “hot response”.

They may be coded at different priorities, but all of those are prime examples of what we blue light to.

I was sent an ’emergency’ yesterday for a lady who’d had shoulder pain for a week and may be aggressive. I don’t understand why that needs me to barge my way through traffic, putting myself and other road users at risk, and making everyone else’s journey more stressful because they need to move out of my way!? What will those extra minutes gain me?

In the case of someone who is not breathing, extra seconds will make the difference between life and death, but when someone has had something for over 24 hours (with some exceptions), what will it achieve?

More ambulance crash when driving under emergency conditions. When driving, we claim exemptions for certain road laws such as speed limits. How could I justify claiming exemption if I crashed and injured someone, for a person who when they phoned 999, said they weren’t hurt?!

Here’s my closing statement in the interest of safety.

If you see an ambulance on blue lights, pull to the left and stop somewhere sensible (not a blind bend if you can help it). Don’t read this post and think “oh, it’s probably just a painful knee they’re off to”, it could be something truly life threatening.

Also, a lot of calls are not as they first appear. If someone rings 999 for an achey arm, it could be a heart attack. If someone calls because they’re dizzy, it may be a brain haemorrhage – we never fully judge a call until we get there!

But, just have a look next time you hear sirens, I bet it’s an Ambulance. Wave if you see me 🙂

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Trauma trauma trauma.

It doesn’t take a genius to figure out that a large van travelling at 30mph making contact with a human male man is going to cause a considerable amount of damage. I can now confirm that it does.

We received an emergency as given above. When we got there, we found a typical RTC (Road Traffic Collision) scene; lots of bystanders, rubbernecking car drivers, a few stopped cars etc etc. This time there was one addition – an unconscious person led on the floor with a rather unhealthy amount of blood on the outside of his body

He was unconscious and his eyes were looking different ways (you don’t need to be medically trained to know that that is not a good sign!). 

He was breathing OK and his chest was a) in one piece with no dents or holes, and b) had good air movement throughout. 

We gave him some oxygen while fitting a hard collar around his neck to protect his spine in the likely event of a fracture. He then woke up, not fully, but enough to start shouting abuse and trying to punch and kick my crew mate and I.

Now occasionally with a head injury, comes something called Cerebral Agitation. This is when the brain has taken a pounding and reacts by causing the person to become violent, even when they could be the most peaceful, calm person normally. 

In this state, he was very difficult to manage. In an ideal world, we would fully immobilise him, fully assess him and convey him to A&E, however, it was taking 4 of us to hold this chap on the stretcher. We don’t normally restrain our patients, but if you feel in danger, or the patient is in danger of further injuring themselves, it’s ok to use reasonable force. 

We requested a Critical Care Doctor to come on the air ambulance and sedate the patient, purely for his safety. The good Doctor (and they are all very good doctors on the air ambulances) flew in and obliged. Once he was sedated, we could secure his airway by passing a tube into his lungs and breathing for him with a ventilator. 

We then had a good top-to-toe assessment for any broken bits, loaded him onto the chopper and they flew him to a major trauma centre. 

Major trauma like that doesn’t come along all that often, but when it does, it’s nice to know that you have additional clinical support where necessary. 

I’m not sure of the condition of the patient now – that’s one of the downsides of the job, you rarely get to find out a final outcome. 

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Lucky!

Our first call last night came from the Fire and Rescue service. They’d received a call for an RTC (Road Traffic Collision) where a car has left the road and come to rest in a wood, with two patients involved, injuries unknown (we rarely receive information on what sort of injuries are involved).

It was fairly close and I got there in 6 minutes on blue lights. The sight we were met with sent shivers down my spine. In amongst some very large trees, about 20 meters away from the road and buried in the woods, was the remains of what used to be a 4 wheel drive performance car. When you see a car that is so badly smashed it’s barely recognisable, you immediately think of the patients involved and my crew mate and I simultaneously said out loud with dread, “they’re gunna be dead”.

The fire service had arrived moments before us and the station chief came up to us and said “Two patients, one male 20 years old an a female 21 years old”

I immediately thought of the waste of life and how on earth the parents of these KIDS would react when they were told of their deaths.

Only then, he pointed to the grass verge and said “They’re over there mate, just cuts and bruises I think”.

To say that we were relieved would be an understatement. We looked once more at the twisted metal that lay buried in the trees and could scarcely believe that anyone could walk away from that in one piece.

We thoroughly assessed them both and found nothing more than a few minor cuts from the broken glass and twigs. In fact, neither of them needed to be transported to hospital! 

The story went that the young male driver was doing 80+ mph, when the back end of the car stepped out on a corner. He over corrected and began to ‘fish-tail’ for over 100 meters until leaving the road, smashing through a dry stone wall and by some sheer miracle, avoided the biggest trees and came to rest against an Oak tree.

This isn’t the first time I’ve arrived to the scene of a crash, looked at the car and assumed a fatality, only to find a patient with minor injuries. Although conversely, I’ve arrived to minor bumps where people are critically injured. 

A police sergeant read the riot act to the young lad, telling him that in the last 2 months, he’s been to 2 RTC’s with 5 fatalities of  young people (I know of one of them – it’ll will go down in history as one of the worst crashes attended by my colleagues for the absolute horror they were met with), and he should take a good hard look at his driving style!

We were very thankful they were both alive and uninjured, it’s not a nice day at work when young people die.

The rest of the shift was fairly uneventful, just lots of tea and chatter. Just the way we like it 🙂

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“Safe to approach”…..

…said our dispatcher over the radio, after sending us an emergency where a patient is cutting his arms.

“Sorry control, repeat your last. Was that safe, or unsafe? Over.”

“Yes, yes safe to approach. Caller states that the patient is ‘not violent’. Over”.

“All received, ummm, what is he cutting himself with? Over.”

“A bread knife. Over”

“Yep, [callsign] requesting police attendance prior to us committing. Over”

A real conversation between our ambulance and our control. 

How could we possibly know that this man was not violent? On the say so of someone with him willing to say anything to get help? How could we possibly know that as soon as we walk into that house, he won’t turn the knife on us and cut my crew mate and I to ribbons. We don’t. 

There was a story in the news recently where a lone, female paramedic refused to enter a property where a 999 call had been placed, as it was a known drug den, the patient had taken drug overdose and she could hear angry shouting and arguing inside. Comments made by the public were most unsavoury about our colleague of another trust, as the patient subsequently died after backup took a while to arrive. 

Ask yourself this question: You arrive, alone, at night to an address where the situation is unknown. You hear angry shouting. You’ve been told that there might be a knife (as in our scenario). Would you, as an unarmed medic, not equipped with pepper spray, a baton, or a stab vest, enter that house without backup?

The start of EVERY primary survey starts with ‘D’ for danger. Simple. If there is danger, do not proceed unless it can be made safe. 

*Hops off of soapbox* 

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