Sunday, 20 November 2011

The definition of pain score 10

"12 year old male, bleeding testicle, ? cause, can hear screaming in the background"

Basically, any jobs with the words penis, testicle or vagina written on the screen envoke laughter. Toilet humour is rife in the ambulance service and those words send most of us back to our teens, sniggering like 13 year old boys. We hadn't got many details to go on really so it was going to be a case of rock up and have a look. We pulled up at the council estate, synonimous with local crews for being rough as badgers arse, and got to work trying to find the cul-de-sac in question. After a good 10 minutes we found it. I'm not going to lie to you, it looked grim. The front garden full of rubbish, beer bottles, childrens toys and of course dog shit. Lush. We cleared a path through the minefield of turd and stood at the front door. Before we even knocked we could hear the utter chaos inside. There was the screaming of what I assumed was our patient, a baby crying, a dog barking and two women f'ing and blinding at each other. I knocked on the door. After 30 seconds it swung open. The mother was standing at the door. I picked my bag up as if to enter when she said:

"You can't come in. The little shit will come out to you. Oi, get your arse to the door"

Charming. Obviously alarm bells ring when we are refused entry but looking at her, I wasn't going to argue.  She was vile and looked riddled with STD's. A moment later, squeeling in pain, our patient shuffled to the door. The kid looked in genuine pain, the scream told it all, he was wincing with every movement. Clearly, standing at the front door was not the place to be so with an arm under each shoulder we carried the boy to the truck and onto the bed. As we made our way down the path, what I assume was a sister, hurled an array of foul mouthed abuse at the kid basically saying he deserved it.  Most normal parent's would stay with their child but this one just slammed the door. Due to the location of his injury I wasn't totally comfortable examining him but we didn't really have a choice. I told the kid i'd have to have a look and through the sobbing he agreed. I carefully pulled away his trousers and pants, and there it was.........A de-gloved testicle. I recoiled. My crew mate turned away. It was like a veiny pickled onion dipped in ketchup. It was gross! No wonder this poor kid was in agony. 

"What happened?"

"My sister kicked me"

"How old is your sister?"

"She's 22, she stamped on me"

My eyes were pretty much watering. I couldn't imagine the pain he was in but it appeared my crew-mate could.  He could't look! I didn't need a pain score. This was a 10 every day of the week. I got a wet dressing out and simply laid it across his lap, fed him Entonox and Oramorph and we left. No training prepares you for these situations. The old adage of 'improvise, adapt and overcome' rang true. What was I supposed to do?! He was also covered in scratches and bite marks. They were all over his torso. He said he got in a fight with his sister but that she was much bigger than him. On route I requested the police. This was as much a social and criminal issue as much as it was a medical one. This was a serious injury with the real possibility of huge consequences and social services would have to be involved. I have no doubt, that the kid was a little shit, i'm sure he was rude, nasty and just like the other reprobates on the estate but he was hurt and in serious pain.  As a parent I can't understand that mentality too turn your back on your child when they are hurting but hey, I work and pay taxes so I guess they don't understand mine either. 

During the hand over, nurses and doctors crowded round in amazement and disgust that this had happened from a kick. I had a sick pitted feeling in my stomach for hours afterwards and even now, 2 years on, telling the story makes me feel ill! 

Friday, 18 November 2011

One under

"42 year old male, jumped in front of train"

Alarm bells ring. This is not a job even the most enthusiastic of trauma junkies particularly enjoy. A 'one under' is a term used to describe the rather unfortunate situation of a person under a train. This unfortunate situation occurs through either accident or suicide but more often than not, its sadly the latter. In almost 50% of 'one unders' the result is a fatality. This number is much lower than I had suspected it would be. I was expecting mortality to be in the 90s. After all, the human body is not designed to cope with the trauma, of the best part of two hundred tons of train, hitting it at a speed of 30mph. Over the past 10 years in the city there have been 568 'one unders' of which 261 have been fatal. That's over 1 a week. 

Today we had about 2.5 miles to drive. Just enough time to get a game plan and remember what we need to do. Hi-vis's donned, safety helmet on and as much kit as we could carry including all our response bags, paramedic bag, rescue board, collars and pockets stuffed full of everything we might need under a train. We were met at the RVP by the Rail Incident Officer (RIO) and confirmed we had 'power off, trains stopped'. Short circuit devises were in place on the tracks and it was a confirmed 'one under' suicide attempt. 

This was a deep station, a very long way underground, therefore it took a good few minutes to get down there along the maze of corridors and plethora of escalators. It also meant there was a high chance we would be incommunicado and would have to rely on station staff relaying messages to our control. We got to the platform, the train was three carriages out of the tunnel.  There was an ominous spreading of blood on the front of the train. The 'jumper' had jumped when the train entered the station. Doing so at this end of the platform signifies much more intent on suicide and a decreased chance of survival. We climbed down onto the tracks and into a 'suicide pit'. These pits were introduced in the 1930's during the depression when suicide rates were extremely high. With the use of emergency lighting and torches we were able to see the motionless body, the length of a carriage away. He was just a silhouette against a back drop of track and train. 

I made my way towards him, staying as close to the floor as I could. The heat under the train was like nothing I have ever experienced. So intense. The sweat was dripping of my brow with every movement I made. I could here the commotion on the platform, I could hear creaking from the train as the cooling metal constricted but more than anything I could hear my own breath. It was an aery experience. I was also all too aware that I may come face to face with rats but I tried not to think about that! The closer I got to this guy the more evident it was that this was futile. I could see the pool of blood he was in, I could see he was missing a shoulder and arm and I could smell burnt flesh. I finally reached him. He was lifeless. There was massive cranial and thoracic destruction. He was partially entangled between the wheel and the track. His torso contorted to the point where I didn't really know what part was what. This guy had been successful in his suicide attempt. There was nothing anyone could do. I laid there, on my front, under a hot train, filthy, covered in blood, just staring. I wasn't upset, to be honest I don't know what I was but I just starred. What could possibly have happened in this guys life to lead him to such desperation? I just don't  understand the thought of killing oneself, and especially in such a public place in such a unreliable and disruptive way.  I can’t help thinking that if I was at the point of taking my own life I would not go and buy a ticket at a station and stand amongst the silent commuting throng waiting for the next southbound train to greet me.

I climbed back on to the platform. Removing him wasn't our job. We spent a little while with the driver. Luckily it appeared not to affect him. He had an air of apathy about the whole thing. If anything he saw it as a bonus. He'd get a few months off work so was perfectly happen with the outcome. Morbid? Heartless? Maybe its just a coping mechanism. Maybe he just doesn't care. By this time, the platform was swarming with masses of people. HEMS had arrived, the British Transport Police were there in large numbers as were the Fire Brigade. We made all the relevant smalltalk, regaling the crawl, taking the jokes about looking like a chimney sweep and grabbing call signs for our paperwork. We collected our kit and made an attempt to remove ourselves from the circus. As we got to the top of the first escalator a smartly dressed man approached us, 

“Did someone jump under the train?” 

I looked at the blood on trousers and hi-vis momentarily before assuring him that, yes, they have. He paused for a moment, looked at his watch and said, 

“So, how long before we get on the move again?”

I was to look back on this exchange with amusement and also, strangely, comfort: in the midst of the horror, normality was briefly restored by a commuter asking for alternative travel arrangements. 

It's a Tuesday

"25 year old female, suffering despair, resentment, anger and fatigue"

The first job of the shift, more often than not, sets the tone. It generally dictates the calibre of patient you are likely to expect during the shift. For some bizarre reason shifts often tend to take on a theme. You have maternity nights where everyone is either pregnant with some kind of pain / bleed, in labour and needing a lift or about to give birth on their cream carpet. Other nights you may go to numerous RTC's or loads of pyrexic babies. Jobs come in clusters. Its just the way of the EMS world. This particular night was alcohol. Admittedly its common to have a lot of alcohol related calls but this many? On a Tuesday? I could rant for hours and no doubt I will but I thought I'd share my call log, as they were dispatched to me, to highlight what a massive problem alcohol is and what a huge drain on resources its causing.

19:01 "54 year old male. Intoxicated - unresponsive, been drinking for 8 days solid, patient has had 5 l of scotch, 1 l of brandy, bottles of wine and possibly more, been diagnosed as a functioning alcoholic"

20:13  "36 year old female. High blood pressure, drinking alcohol for 2 weeks non stop / not eating"

21:03  "Female. Potentially collapsed behind closed doors, female is an alcoholic. UPDATE: Patient has answered door but can't stand. Claims to have drunk 18 cans of special brew"

22:21  "Female has knife. Threatening suicide. Patient has been drinking a lot"

23:59  "20 year old male. Intoxicated - states cant move arms, legs or hands. Heart beating fast"

01:17  "30 year old male. ? Overdose, disorientated, agitated, packets of A.M.P. States harmful, not for human consumption"

02:28  "21 year old female. Vomiting. Lying in phone box. Friend states patient has consumed 2 bottles of vodka"

03:36  "46 year old male. Collapsed. ? Ethonolic. Upstairs of bus. Driver won't approach patient"

04:51 "18 year old male. Assault. Head injury. Patient has been drinking. "

05:55  "U/K female. Lying in bush, Shopping trolley on head, making funny noises. Patient has urinated herself"

07:50  "25 year old female, one and a half hours late off, suffering despair, resentment, anger and fatigue"

That was my night. That is why I was suffering despair. That is why I resented all of my patients. That is why I'm angry. And that is why I am tired. How can you stay enthused? How can you remain professional? How can you maintain a high standard of patient care? You can but try but I'd be lying if I said that at 03:36 in the morning I was polite, courteous and full of the joys of spring.

Sunday, 13 November 2011

Dulce et Decorum Est

Race, religion, sex, sexuality, political standing, student protests, strikes, football, road rage, and arguments. All pail into insignificance at 11am on the 11th November every year. It's the one time, the one day where people stop and think. People's squabbles and petty differences are temporarily forgotten to show in one voice, that we will 'Never Forget'. 93 years on from the end of World War 1 the same respect and thanks is still shown. Admittedly the younger generations don't necessarily understand the significance of the sacrifice given by those men and women, but they wear a poppy, the observe the silence and think about the fallen. 

Remembrance day in modern climes stands for more than remembering the first world war. And even the second world war. It's a day to simply remember, to thank and to honour the fallen. The fallen from every generation. From every battle, past and present. The sacrifice made to protect our country and our way of life. While we stand still for two minutes there are men and women facing fire from foe the world over. They are putting their lives on the line in the name of their country, our country,  and the very least we can do is put our lives on hold every year to remember that. 

As we stand and observe the silence, the famous words of war poet Wilfred Owen ring true:

"Dolce et Decorum Est, Pro papria mori"

It's a sweet and proper thing to die for ones country. This is the sentiment of war. The sentiment of our troops. Though many fear death, they are more than willing to risk it for the honour and privilege to serve their country. And, in turn, we honour it, we respect it and we will never forget it. 

Remember our fallen and donate:

Saturday, 12 November 2011

Time of death

"89 year old male, cardiac arrest"

There is no other job like. In essence this is what we are there for. This is what people associate with ambulances, the blue lights and sirens. It is life or death. Make no bones about it. If we don't get there quick enough, if we don't work as a team and if we don't do everything correctly the slim chance of survival is gone. Personally there is no adrenaline rush like it. Nor is there a greater sense of achievement following a positive outcome. Similarly there is no greater feeling of disappointment when your best efforts are not good enough. Guidelines are constantly changing to reflect a constant change in opinion on what is the best way to achieve a positive outcome.

In recent years the compression to breathe rate has changed from 15:2 to 30:2, drugs have come and gone and most notably the idea to 'stay and play' rather than 'scoop and run' has become more popular. It is thought, in certain rhythms, staying on scene and running a full Advanced Life Support (ALS) protocol until the patient is in a 'transportable' rhythm is the best way forward. A few years back it was decided that a patient in Ventricular Fibrillation (VF) was to be treated for as long as necessary on scene. Although it lead to better outcomes it resulted in some pretty lengthy and often futile resus attempts.

This particular day, it was our 'off job'. The last one of the day. We were due to finish our shift in 10 minutes but that wasn't to be. And none of us cared. It's life or death. It's our job and finishing on time is not the priority. We raced to the address. The FRU was already there. We grabbed extra kit and headed to the second floor of this mansion. We entered the tiny loft bathroom to find the FRU delivering CPR. Auto pilot was engaged. We knew our jobs, we knew what had to be done and got to it. Within minutes the patient was intubated, intra-venous access gained, shock pads applied and drugs were being administered. The patient was in VF, a cardiac rhythm that we shock. It's basically a spasm of the heart, and needs stopping in the hope it returns to a regular beat. We administer shock after shock but the patient remained in VF. After 40 minutes and 18 shocks we called the clinical support team for advise. We were told to change the pad placement and up the voltage of the shocks. We did. We also had to request a 3rd crew as we had used 2 drug packs worth of drugs and urgently needed more. After 32 shocks the patient was still in VF. At this point we were told to transport the patient to the nearest A & E.

We put the patient on a carry sheet and began the task of getting him down the huge winding stair cases, which had stair lifts running up the middle, whilst still doing CPR, shocks every 2 minutes and delivering oxygen and drugs as necessary. Eventually, once on the ambulance we headed to hospital. By the time we arrived we had delivered 39 shocks. We had been doing CPR for close to 2 hours and it showed. We burst through the doors into resus and whilst transferring to their bed I gave a handover. The Dr then addressed the resus team:

"Right, due to the history, the age, the amount of shocks and the length of time he's been down, we are going to call it. Any objections?..........No? OK.....time of death......."

"Wait!! " shouted one of the nurses.

"I have a pulse.....and respiratory effort......he's breathing......we've got him back"

We've?!?!?! The guy survived for an hour, long enough for his family to arrive and say their goodbyes. And that counts for a lot. The frustration for us, isn't being 3 hours late off, or him not surviving to discharge, it's that for too often hospitals don't appreciate the sheer effort we have put it. There were 7 of us stood open mouthed, sweating and exhausted in the resus room, as the Dr called time of death without trying anything. Maybe I'm selfish but at least do something. Even if it is wait until we have left the room! What was the point in us trying and transporting if they won't? For those who have administered CPR you'll appreciate how we were feeling after 2 hours and to have that simply ignored was horrible. I like to think that that is why the patient started breathing again. He died on his terms, with a little help from us, and with his loved ones at his bedside. That is job satisfaction. That is why we go to work and that is why I love my job.

Thursday, 10 November 2011

Seat belt, Seat belt, Seat belt

"27 year old male, great friend, great husband, great father to 3 young boys, great son, great guy, didn't wear his seat belt. RIP my friend"

It has only been 3 days since my friend died. It's still very raw.  It's perhaps too soon to blog but it's my way of dealing with it and a tribute to a good man. A good man who paid the ultimate price. If one person who reads this blog puts on their seat belt who wouldn't have otherwise then it's worthwhile. 

It was just another morning, another day, another dollar. As he had done every day he stood at the end of his road, waiting to be picked up. Waiting to do an honest days work. Waiting to support his young family.  It was an overcast morning, the road was wet. From what I know they stopped for breakfast before the 45 minute drive to work. Somewhere along their route something happened. What, I don't know. I may never know. The vehicle careered off the road. As is a natural human reaction the driver instinctively swerved himself away from the lamp post. He succeeded. The impact  was on the front near side. The passenger side. The driver had his seat belt on. My friend didn't. He was ejected from the car through the windscreen. His life, in that instant was over. I shiver with sorrow as I try to imagine the final thoughts that went through his mind. The faces of his beautiful family, the life he could have led.

He was declared dead at 08:27 on the 7th November 2011. From that moment his wife was a widow. His three young boys were without a father. His parents had lost a son. His brother had lost a brother. I had lost a friend. I have asked myself the same question over and over again since I received the news. Why didn't he wear a seat belt? And that cannot be answered. He normally does. A moment of madness, a lapse in judgment, distraction by conversation. I don't know. We have all done something stupid whilst driving. Changed the CD, turned to your passenger, lit a fag, driven when tired. It happens. All that means is we got away with it. He didn't. I'm not going to berate him, he's learned his lesson and paid the ultimate price. As have his loved ones. 

I'm writing this, with the full consent of his family. A family consumed with grief but a family wanting his short life not to be in vein. The reality is, everyone knows they should wear a seat belt. Everyone knows the consequences of not wearing one. Hopefully this tragedy will stand as reminder that no one is invincible. That one time you don't wear one could be the last. Please please please wear your seat belt. Don't run the risk. Life is precious, hold on too it with both hands.

Goodbye my friend, you will always be loved and never forgotten. Please rest in peace. See you around xxx

Wednesday, 9 November 2011

What a waste

"Wife and children were in property, now not picking up phone or answering door, ? collapsed behind closed doors, caller unable to gain access"

It's 1am. It's raining. I'm in a bad mood. The above, tarnishes the MDT screen causing the usual moans and groans, expletives and rants. Nevertheless, off we go. We arrived on scene to a plethora of blue lights. It was a tiny cul-de-sac, barely big enough for car to get through yet somehow there was a fire engine, the police and us in all our glory. It transpires that this 40 year prat has been drinking. He has lost his keys and there is no answer. As he can't get in so he calls the fire brigade. They in turn call us as it may be a 'collapse behind closed doors'. We in turn call the police to force entry in case it is a 'collapse behind closed doors'. Curtains were twitching, people were looking out their windows but there was a distinct sense of apathy amongst the emergency services.

The police go up to the door and knock. No answer. They knock again. No answer. And again. No answer. They shout through the letter box. No answer. Finally on the fifth time of knocking the door opens. A middle aged, very tired looking woman answers the door. She's alive then. Admittedly, the concept that a full time working mum of two could be asleep at 1am hadn't crossed her drunk husband's mind. In he staggered. No apology, no shame and at no cost to him. Everyone was stood down. The shared annoyance and frustrations of all services were apparent. It was an all to familiar scene which we were all powerless to do anything about.

When on earth are events like this going to stop? The fact is they probably won't. Not only is it a complete waste of time and resources but it is pulling the resources away from places they are really needed. I can only speak for the ambulance service but it is a well documented fact that there are not enough ambulances for the number of calls in the city. Waiting times are increasing, government targets for response times are not being met and financial penalties are being imposed on a service already struggling to meet demand. This type of call is not an isolated incident by any stretch of the imagination. Every day the emergency services responds to 100's of calls which require nothing more than common sense but there is no deterrent for abusing any of the services. None whatsoever. I don't know exactly what this call cost the tax payer financially, though it is into the £1000's, but the cost to the people who need us most could be far greater.

Whilst this country and it's policy makers remain gripped by the fear of litigation and public opinion nothing will change. No government wants to risk public objection so the topic is rarely brought to the forefront and tackled. The topic of charges for emergency services has been discussed at length and admittedly there are no obvious solutions. The risk of deterring the genuine callers from dialling 999 is a risk that is not acceptable and to be honest I don't know the answer.  All I know, is if the call rate continues to rise at the rate it is and resources are continually wasted on idiots like this, then the shortfall in vehicles where they are actually needed will increase with grave consequences.

Shiver me timbers

"35 year old male, wielding a mallet and a sword, threatening self harm, police on scene"

Standard. Nice bit of mental health to get the ball rolling and there is nothing quite like the threat of a sword wielding maniac to motivate you to save lives and make a difference. We pulled up to the street and headed in the direction of the police cars. Usually a safe bet! It was a terraced town house, no easy rear access and the front was covered in scaffolding. We wondered over to the coppers who looked rather amused. They hadn't been able to gain access to the property as he was barricaded in, possibly armed and had possibly doused the barricade in petrol. Oh, and he was dressed as a Pirate, complete with eye patch, telescope and tricorn captains hat. In fact not too dissimilar to Captain Jack Sparrow! The sword in question was indeed a cutlas. We put on our stab vests and watched the action unfold.

Our patient, the pirate, kept appearing at the upstairs window and climbing out onto the scaffolding. He looked very unstable and twitchy! He was shouting at every one below in particular the police officer trying his best to reason with him!

"Be gone you lily-livered son of a biscuit eater. And take your hoard of sqiffys with you"

You can't help but laugh! I genuinely believe he thought he was a pirate. We were sat a way back as every now and again, he would disappear back inside and an array of household items would fly out the window. You could hear Captain Prat shouting:

"Clear the decks me hearty's, we are over run with scurvy dogs"

This was surreal, I've seen my fair share of mental health patients but I've never been so fixated on one's behaviour. He was frantic! It transpires he was being evicted and clearly did not want to leave. The poor guy given the arduous task of talking him down made it clear an enforcement team was on the way but alas. He would not be reasoned with!

"If you bilge-sucking scallywags enter I'll make sure ye dead men tell no tales. I'll hang ya from the yardarm"

As it was apparent from arrival that this would be an extremely blogable event I was writing down as much of what he was saying as I could. Not many people get the opportunity to go to work and get front row seats to watch the public meltdown of a pirate. 

"You can't make me leave, I have letters of Marque to occupy this vessel. Stop trying to hornswaggle me debloons"

On cue, a police van pulled up and out bundled 12 officers in riot gear. For want of a better phrase they were going to storm the ship. On seeing this development the pirate let out a very loud 'Aaaaarrrrggggghh' and he vanished back inside.

"Batton down the hatches me hearty's, the pillage is upon us"

I for one, was crying with laughter. The police were taking it all rather seriously, the odd smirk but generally stony faced. I however was gone. Every time I looked at him or he spoke I was shaking like a tonic clonic seizure. The police eventually ruined my fun. They smashed their way in and after plenty of screaming and shouting the pirate was brought outside, and what a disappointment. I was hoping to see the pirate in full costume but this long haired, bare footed man came out with jeans and a black t-shirt. Distinctly average and he didn't even growl at me! What an anti climax it was, though it still stands alone as the funniest day of my career so far. I literally just met Steve the Pirate!!


I took the liberty of googling some of his phrases and below are their translations!

Aaaarrrrgggghhhh! - exhortation of discontent or disgust
Batten down the hatches - put everything away on the ship and tie everything down because a storm is brewing
Bilge-sucking - insult
Cutlass - short heavy curved bladed sword used by pirates
Dead men tell no tales - phrase indicating to leave no survivors
Doubloons - other coins or found in pirate hoards and stashes
Hang 'im from the yardarm - punishment of those captured in battle
Hornswaggle - to defraud or cheat out of money or belongings
Letters of Marque - letters issue from governments during wartime to privateers endorsing the piracy of another vessel
Me - my
Pillage - rob, sack or plunder
Scallywag - mild insult akin to rapscallion or rogue
Scurvy dog - the pirate is talking directly to you with mild insult
Shiver me timbers! - comparable to "Holy Crap!"
Son of a Biscuit Eater - insult directed towards someone you don't like

Tuesday, 8 November 2011

Gangs, Knifes and Amnesia

"19 year old male, stabbed in back"

Working in a city, we see our fair share of knife crime. It happens much more regularly than the media report. In reality you only hear about it on the news if its a teenager who has been stabbed or rich white man was stabbed by a black man. In practice, stabbings occur every single day and 99% of it is young males in gangs. The dispiriting truth about the cities gang culture is that it is not only large, with at least 100 gangs, but it attracts ever younger children. There must be worthwhile alternatives for young people to gang membership, not just limited to sports centers. Education is the most powerful force for change: government-driven improvements in schools in deprived areas will, it is hoped, offer teenagers more fundamental alternatives to the gangs, by providing them with the skills and discipline to aspire to employment and further education rather than an existence as drug-pushers.

The London riots showcased to the world the gang culture that exists and the roots of these appalling events are many and complex but none more so than the way Britain's educational establishment has cringed helplessly in the face of ever increasing gang culture; a culture that rejects every tenet of liberal society. It's violent, it's sexist, it's homophobic and it's racist. Unfortunately,  it is broadly tolerated by many people in the poorer communities, which has lost control of its teenage youths. Those youths scare the wits out of teachers and social workers, the public and police officers. Knife crime is rife and not enough is being done to stop it. There is no parity in sentencing for offenders, not enough police resources available to tackle the issue head on and not enough incentives for these young people to buck the trend. In London alone (I choose London because they are the easiest statistics to find!), there were 7,231 knife crimes in 2010/2011, a 29% increase on 2008. There sits evidence enough that the issue is not being tackled and whilst there are Conservative promises of more cuts to front line police the numbers will simply increase.

We were called to an address in rough part of town. Music was blaring, there were scores of people loitering with intent outside the address, buzz words such as 'retribution' and 'revenge' were being branded about. This was clearly gang related but for us, the problem with gang related stabbing is the clear and concise history! Our guy was stood in the living room, tempers were high, testosterone at critical levels and don't even get me started on their dress sense! He however was topless, bleeding from a rather large stab would in his back. I was concerned about the levels of air entry in his left lung and was keen to treat as I found, however, he didn't want treatment, he wanted to go out, I assume, tooled up looking to hit back at the rival gang. Nether the less, the police assured him he would be going to hospital. Now the history.

"So what exactly happened?"

"I don't know"

"What were you stabbed with?"

"I don't know"

"Who stabbed you? Was there a gang of them?"

"Can't remember"

"Did you get in a confrontation?"


"Where did this happen?"

"Cant remember"

"So you were just walking alone, realised you had been stabbed, but didn't see anyone, hear anything or feel anything?"

"Nah, I got back to yard yeah and my home boy told me I was bleeding, innit"

Wow! Amnesia is so frustrating. To loose the memory of such a memorable event must be a nightmare. How on earth will the police catch the bad guy? In a word, they won't. They will continue to chase their under-resources tails until they come across another teen. Dead. Stabbed by the guy with amnesia. And why? I can't remember!

This guy didn't die but also didn't appreciate the significance of what had happened. It was just another day. Gang life. It comes with the territory. For too long, the less affluent areas of society have been left to breed this hatred and it is now endemic. The softly softly approach clearly doesn't work, job and financial incentives are futile because more money can be eared in pushing drugs. What is needed is 0 tolerance, long prison sentences, removal of benefits, confiscation of property. What the government needs to do is give the police the powers to stop this mindless violence and criminality in its tracks but instead, they have a different solution. 16000 less officers! Genius! That'll fix the problem!


Above my pay grade

"71 year old male, shortness of breath"

I don't profess to be a GP, nor do I wish to be or act like one. Like nurses GP's range in quality from helpful and polite, to rude, obnoxious and verging on negligent. Many wasted ambulance hours are spent picking up the slack for GP's not willing to do their bit and simply taking the easy option and clogging up a hospital. This is party due to a lack of GP's available during out-of-office hours and partly, in my opinion due to laziness. One consequence of the opt-out policy, which was part of the new GP contracts which came into effect in April 2004, is that the overwhelming majority of England's 298 primary care trusts were left with a huge gap in their budgets as they take on the burden of the out-of-hour service. A burden that has not been dealt with correctly and one which is causing unnecessary strain on hospitals and the ambulance service. Ask any member of the ambulance service, or any nurses if they wanted to 'opt out' of working crap hours and you'd get a resounding yes. There are 24 hours in a day and unsurprisingly, people are in fact ill, between 5pm and 9am. Shocker! 

In recent years ambulance services have begun to move away from just taking everyone to hospital. In fact, if a patient can be referred and left at home that is preferred. One of the alternate care pathways (ACP) is a GP referral. We assess the patient, if they don't need to go, or refuse to go, we arrange a GP to call or visit. This applies to the out-of-hours GP service too. And in general it works quite well, a GP will ring, talk to the patient and either make an appointment or come and visit. On occasions where we have concerns for the patient we will speak to the GP and politely request / insist they do visit. Like with everything, you get good and bad GP's. Some will come out at any hour, will do the right thing, go the extra mile and be polite and courteous whereas others, won't come out for love nor money, will be dismissive rude and lazy. I mean, it's not as if we should expect them to see ill people at night on a meagre £100,000+ salary. Absurd!

This particular job, was very common. An elderly guy, having trouble breathing, but despite all the advise in the world refuses hospital. I'd imagine it's partly from pride and wanting to not be a burden and partly fear, not wanting to die in hospital. Either way, he wasn't going. We did all of our checks, the full work up, sitting and standing blood pressures, ECG and a advanced respiratory assessment. We arranged a GP referral and said to our control it was imperative that a GP visited this guy. We completed the necessary paperwork and went back to the truck! Not 3 minutes later, and our patient appeared at the door, beckoning us to return. He told us the GP had just phoned, didn't ask any questions about how he was etc and told the patient to make his own way to the local hospital and see a Doctor there. Needless to say, our patient told us he wouldn't be going to hospital.

Steam pouring out of my ears I phoned control and asked that the GP phone me directly on my mobile. I was livid. What is the point? What chance do we have of unclogging emergency departments when the ACP's in place can be abused by the unwilling and lazy. After 15 minutes my phone rang. It was the GP.

"Hello there, I was informed you wanted to talk to me"

"We requested a GP visit for this patient as he has poor mobility and would benefit from seeing someone with the ability to prescribe medication, the patient isn't well but is too scared of hospitals to go. He says he was told to make his own way to hospital"

"That's correct, I assessed him over the phone"

"You didn't ask him any questions about his health, his mobility or reasons for refusing hospital, he uses a frame, has no family and is scared"

"Well if you're that concerned you should have taken him in"

"We can't kidnap him, he has capacity and has refused admission. That's why we referred to you"

"In all honesty love, you are talking above your pay grade, I've made my decision, and you aren't qualified to question me"

Wow! He picked the wrong girl to mess with tonight. Needless to say, an argument in sued. It wasn't an argument I was ever going to win but one that made me feel better. I was able to rant about all the above. I told him exactly what I thought of him and I didn't hold back either! I went to town on him. We exchanged names for counter complaints, I even offered my call sign and personnel number. Pay grade, really? He went there? The arrogance and self proclaimed greatness was enough to make me seethe for hours and I did. It was like a red flag to a bull. My crew mate looked on in fear as I screamed and shouted (off the phone by now) at him about bloody GP's. When will they realise that we are no longer stretcher monkeys. Many have degrees in paramedic science, some have masters, there are Emergency Care Practitioners and in general, we are good at determining if someone is ill. When will we get the respect we deserve? We all work for the same team and the sooner the other medical professionals stop treating us like the kid that was never picked for anything, the better state the NHS will be in. By 'better state the NHS will be in' I mean the happier I will be! Lets be honest, being nice won't make a blind bit of difference to the NHS as a whole other than remove animosity and ill feeling between two bodies of people who are essentially working for the same team!

Clean up on aisle 3

"72 year old female, generally unwell, at GP surgery, chair required"

A pretty standard job for a Monday morning. Mondays are a funny day. GP's tend not to work weekends,  so on a Monday morning everyone who is everyone flocks to the GP surgery like migrating buffalo and sits there waiting for their various ailments to be examined. As a result GP's phone a lot of ambulance to alleviate their strain. This particular patient was sitting in the waiting room with a wicked grin on her face. She was basically doing a stand up routine to all the ill and needy that Al Murray would have been proud of! Every one around her was smiling!

"Last time I was here I went up to the receptionist and said there's something wrong with my vagina"

"You shouldn't come into a crowded waiting room and say things like that." 

"Why not? You asked me what was wrong and I told you," 

"Now you've caused some embarrassment in this room full of people. You should have said there is something wrong with your ear or something"

"I walked out the door and came straight back in and said I've got something wrong with my ear. The receptionist nodded approvingly"

"And what is wrong with your ear, madam?" 

"I can't piss out of it,"  

The waiting room erupted in laughter. What a character! I'd heard the joke before but she delivered it so well. We explained we had a chair for her. As we assisted her to standing she let rip! And I mean with gusto!

"Sorry about that, had egg and beans for breakfast"

Whilst trying to maintain some form of professionalism my crew mate managed to do the British thing of 'Keep Calm and Carry On'! Me? Not a chance, I couldn't stop laughing. She just farted! It's funny! Fact! We wheeled her to the ambulance, transferred her to bed but in doing so, she let rip again but this time we were in a metal tin.

"Sorry, how un-ladylike, that's not going to be pleasant"

I was beyond help, I was supposed to be treating her but I couldn't control the laughter. I was shaking! Verging on a seizure. With a raised eyebrow the keys were past to me and my pen confiscated. It was a sign I was to remove myself from the situation. As I stepped over my crew mates legs to get out, in the most ungainly of fashions, she did it again. This time though her tone changed, she had 'that look' on her face and the sudden smell told us all we needed to know, but she put it so well.

"Oh dear, clean up on aisle 3"

This is the kind of humour you'd expect from a drunk 20 year old but a sober 72 year old who is apparently ill? Amazing! It made our day to meet such a lovely, funny, albeit smelly woman. This is why our job is the best job in the world! You'd pay good money for that calibre of entertainment yet we get paid to watch it first hand! I didn't stop laughing for a very long time. Even writing this blog I can't help but giggle! Everyone hates monday mornings, that will never change but a little laughter goes a long way to improving ones mood!

Monday, 7 November 2011

To Blue or Not to Blue?

"30 year old male, unconscious"

Can I just say, before I rant, I like nurses. Most, who I come into contact with are very nice indeed. Some are a bit moody, some are a bit snappish, some epitomise the 'matron' we all fear but generally I won't have a bad word to say about them. Generally.

We arrived on scene and soon realised it was the same guy we picked up yesterday. An alcoholic. He was a young guy, about 30, well dressed, but clearly fallen on bad times. He was lying at the bus stop, on the floor, empty bottle of vodka next to him. A picture paints 1000 words. Attending so many alcohol related calls can and does become frustrating and it's easy to become complacent and lazy. I try not too. You never know when complacency will bite you in the arse. Due to my over caution and paranoia this 'drunk' got assessed and treated the same as everyone else.

A quick primary survey told me his airway was slightly compromised, his respiratory rate was low, around 8 breaths a minute, and he a weak radial pulse, probably due to low blood pressure. We loaded him on to the bed, I inserted an oropharangeal (OP) airway and my cremate 'bagged' him while I put some fluids up. We also raised his legs to try and raise the profound hypotension. At the end of the day, this guy may be drunk, but left to his own devices, was in real risk of dying through positional asphyxia or aspiration, not to mention the long term effects of alcohol abuse. Alcohol damages almost every organ in the body, including the brain. The cumulative toxic effects of chronic alcohol abuse can cause both medical and psychiatric problems.

I only ever pre-alert the hospital if I genuinely believe the patient is severely ill, at risk of rapid deterioration or there is airway compromise. The fact this guy was tolerating an airway, was unresponsive to fluids or any pain stimulus I deemed that he warranted a blue call. The fact his condition is self inflicted has no bearing on the clinical decision making process.

We arrived at our local hospital. Every crew likes their local. They know the staff, the staff know them and it generally makes for a more pleasant experience. We went straight into resus, transferred patient to bed and began a handover to the waiting Dr. During my handover, the nurse in charge came marching over.

"I knew it would be him, he certainly doesn't warrant a blue call, you should know better"

"He's GCS 3, tolerating an airway and not responding to treatment, that's airway compromise. Blue call"

"No, it's a waste of my bloody time. I'm just gonna stick in 2 grey cannula's, give him a litre of fluids until he wakes up then let him stagger out"

"And there lies the problem"

"What would you know, I spend all day every day in this department and you clogging up my resus with pissheads doesn't help"

On that note, I walked out rather than get embroiled in an argument I wasn't going to win. She had a chip on her shoulder the size of Peru and views ambulance staff as untrained stretcher monkeys who bring her work. She was rude, dismissive and in many ways, adding to the problem. Professional courtesy is a big thing for us. We are treated like the pond life of the NHS food chain by GP's, some nurses and our own management and without good cause. They may not have faith in our abilities and that's fine, but there is no need to be rude and condescending. Like nurses, we work long hours, are treated like crap by peers and patients alike but at the end of the day we are doing a job. We are working for the same team. If someone phones an ambulance, they get one. If that person wants to go to hospital, we have to take them, and if that person is unconscious we will take them. That's how it works. What does she want us to do? Leave him in the street? Dump him in the waiting room? Has she not heard of the duty of care or is it only something that applies if she deems the patient to be deserving enough of her oh so valuable time. I for one will continue to do what I do, treat how I treat and 'Blue in' who the hell I want to regardless of her issues and PMT. The funny thing is, if we hadn't blued him in and gone to triage with a patient with an OP airway being bagged not only would we have been sent to resus but would have more than likely got a complaint!

This job also highlighted one of the major problems with the NHS. As the nurse said, she was basically going to wake him up and push him out the door. Yet she seems surprised that he is back the next day. And the next and the day after. What he needed was help. I spoke to his family. He is a good guy. He had a good job and wife he adored. She died. And so will he unless he gets help. For too long the NHS has been throwing money at 'cure'. Perhaps if that same money was thrown at 'prevention'  in the long term maybe those cut backs may not need to be so severe. 

Saturday, 5 November 2011

Unions, Strikes and Scabs

I ummed and arred over writing this blog but like most things I ponder over, I end up doing them anyway. I pondered because as is often the case my views are not popular but hey ho, they are my views and I don't try and encourage anyone to agree!

The ambulance service is a very unionised institution. Staff are actively encouraged to join one during their training or once they are posted to a station. I am with Unison. I am with them because they are the only union represented at my station and because unions in general are very good if you need representation with any issues at work. They also try to act in the best interest of their members when it comes to government policy and changes to working conditions. They are however biased and i believe anti-democratic. They are very closely aligned to one political party and dictate everything from policy to leaders. That is where a high percentage of our monthly fees go. As their affiliated party is not currently the party chosen by the people, I think its fair to say, that that is their motivation behind persistent strike threats. 

As most of you are aware, the government have been making some very radical and drastic cut backs to reduce the national deficit. One of the main things to effect us and all public sector workers is changes to our pensions. They want us to pay more, work longer and receive less. Obviously, we don't want this. Why would we? We work hard enough and long enough as it is and quite frankly, we feel we are being treated like crap. After much deliberation, Unison decided to ballot its 1.1 million member on strike action. The result was a 78 per cent majority, with 245,358 in favour and 70,253 against, on a turnout of only 29 per cent of the members balloted. Whilst I don’t agree with the length to which the government are going I also don’t believe the unions are being realistic in their demands. This country and Europe in general are financially up shit creek, and without drastic measures, further financial misery is inevitable. Yes, it wasn’t our doing, it was the greedy bankers but everyone has too pay the price. It’s just how it is.

I for one won't be striking for a number of reasons, and its not because I'm happy with what is happening, I'm not. Firstly, I don't agree with striking. I don't believe that what is essentially blackmail, is the correct way to make a case for what you want. Secondly, I joined the job to help people. It wouldn't sit well with me to stand on the picket line knowing that people would die or suffer because of our action, and they would. I assure you of that. There may well be a skeleton staff running but not all the holes will be plugged. People wont phone 999 because we are on strike and that is not what the ambulance service stands for. Finally, from a selfish point of view, I can't afford to lose a days pay! If I have to work on the 30th November, I will. I will make no apologies for it  and if that means I have to relinquish my union membership, get called a scab and take flack in the mess room then so be it. I've never been one to suffer fools gladly and I wont start now. Everyone has the right to do what they believe in, but I feel union culture removes that. The 'us vs them' attitude puts walls up with can't be easily removed. 

As well as my personal reasons for not striking I believe there will be much greater consequences should the strike go ahead. Public opinion and trust in the ambulance service will be damaged and it's not David Cameron or Nick Clegg who will bare the brunt of that, it's us. As per the riots, public frustrations against the government will be aimed directly and the people on the front line. The strikes of 1989 had great public support but today, the public are in the same boat as us. Everyone is being pinched financially and I don't think they will accept us putting lives at risk for money at a time where they are become increasingly sympathetic towards the governments cause. The government itself wont tolerate it either. Striking is becoming more and more frequent and at such unstable economic times, the government will not be held to ransom. As unions repeatedly push with strikes and threats of strikes based on low turnout they are making the case for legislative reform even more compelling and much harder to resist. Having striking made unlawful will mean the end of any positive dialogue and that will not be in the best interest of its members. 

For what has been billed as 'the strike of the century' turn out was poor, very poor indeed! It doesn't convey the showing of strength that was promised nor does it show that members have any confidence in their unions.  If the strike goes ahead, it will do so on the say so of less than 25% of it's members and although it may be enough to legally go on strike I don't think that it conveys the right message. It smacks of desperation, a final roll of the dice that if unsuccessful may end any hope of protecting our pensions and working conditions. It also poses the question of whether we need unions any more. Unions were founded when workers had no rights but times have changed. All workers are protected by law to such a great extent now that the need for union representation could just as easily be filled by any solicitor, most of which can be obtained free of charge. The unions clearly don’t have a majority of support from their members, through either frustration, disillusionment or apathy, and without full backing and confident of it's members the once booming voice of strength is now nothing more than a polite whisper.

I'm all for taking the fight to the government, whether it be pensions, working conditions or wages but it needs to be done in the right way without compromising what the ambulance service stands for and without bias from political agenda. We are there to help the public at their greatest times of need (yes we moan about the drunks etc but still....) and that principle must not be lost in the fight for our working rights.

Thursday, 3 November 2011

Dr Shaw: Open all hours?

What do you do when your kid is ill? We all have different approaches, some of us are lenient, some of us are strict. Me? I'm strict, I can see through the 'I have a tummy ache' and 'I don't feel well' and have no doubt that as he gets older his fake illnesses to avoid school will be common place. On the occasions where he is sick I used to do what everyone does! Freak out! What if it's something really bad?! I would give Calpol and cuddles, it cures most things after all! Failing that, i'd call NHS direct or call the GP and make an appointment. One thing I didn't do this......

"35 year old female, her daughter doesn't feel well"

I recently moved house. After a prolonged absence I came back to my home town. It was a stressful yet exciting time. I moved in on a Friday and was unpacking solidly until work on Sunday afternoon. I finished this particular shift at 3am. I crawled into my bed, knowing that there was no need to set an alarm. I had 4 days off so catching up on sleep was top of my priority list! Therefore, you can imagine my displeasure at being woken at 7:30 by a ring on my doorbell. Who in god's name is that? The postman? I don't care, it can't be that important. Apparently it was, the bell rang again. Begrudgingly I got up, chucked some clothes on and staggered down stairs. Looking like a wild banshee I opened the door. A 35 ish year old woman was standing there, well dressed, well kept, with a 6-7 year old girl standing by her side looking miserable. That makes two of us.....

"Hello there, my name is Joanne, I live a few doors up"

Failing to see her point I croaked a vaguely audible hello back, making my displeasure at being woken perfectly clear with the cunning use facial disgust and body language!

"I saw you leave for work yesterday and couldn't help but notice you were a paramedic"

I knew where this conversation was heading. Things started to make sense now, she was being strangely friendly because she wanted something and the child was looking suitably unhappy to suggest she wasn't well. Begrudgingly I replied 'yes, I am' in a tone that conveyed annoyance, displeasure, frustration and anger all at the same time.

"I was wondering if you could help me, Chloe here isn't feeling well, she is really hot and flushed as you can see and says her throat is very sore. She has hardly slept all night and has a terrible cough. I didn't want to go through the palaver of dragging her up to the GP, you know how it is. Would you be able to check her over?"

Firstly, I had to check over my shoulder to see if there was anyone behind me who gave a crap. Nope, no one there, she is actually talking to me. Secondly, I had to decide how to play this one. Do I......

a) assess the child like the consummate professional and provide the necessary health advise to appease this anxious mother.

b) rant, tell her exactly what I'm currently thinking, tell her what I'd really like to do with people like her.

c) stare blankly for 3 seconds, turn slowly and slam the door as i staggered back up the stairs.

Well, A was never going to happen, I was too annoyed and too tired. B, tempting, do I risk upsetting a neighbour after 2 days and C, again, bit risky. After a brief moment of consideration, I went with B. A rant. 

"I don't mean to be rude, but I didn't get home until gone 3am. This is my rest day and now I'm up. I'm not a GP, I can't prescribe medication, I can't even take her temperature. I'm not telling you how to suck eggs but surely, if a kid is hot and coughing, they have a cold. Calpol will probably do the trick but what you expect me to be able to do I don't know. And, to be perfectly honest I think it's a bit off for you to come here, first thing in the morning based on seeing me leave in my uniform yesterday. If you are worried take her to the GP."

"Sorry, I should have thought, I'll let you get back to sleep, sorry"

Admittedly, I got a card through the door to apologise again which I appreciated but still! What a bloody cheek! The audacity, to knock on my door because she couldn't be arsed to go to the GP.  Is she for real? And, someone she has never met before! I was speechless! It doesn't say 'Dr Shaw: Open all hours' above my door. In fact, if I did have a sign above my door it would say 'Jog on!' I get it, people worry about their kids, but a kid with a cold? She is 6 years old. That means she has had 6 years at managing and treating a cold! Surely, knocking on a strangers door isn't top of her list of things to do? How dare she?! Needless to say, I vented, ranted, stomped and shouted for the rest of the morning.  

I'm not a miserable git, honest, and if someone was in need I'd always be there and have been. I've helped out with cardiac arrests and RTC's when off duty but interrupting my sleep for a cold is not, and will not, ever be acceptable. Ever.