Thursday 29 December 2011

I'm out of here......

"25 year female, jet setting for a wee while"

Right folks, i'm off on my travels, see you on my return. Thanks for the continued positive feedback. It's much appreciated. Having only been blogging for just over two months its really nice to receive support and complimentary messages. Much love. Be safe.

Ella x

Life Goes On

"84 year old male, cardiac arrest, no access available"

It was the night before christmas, families gather for the festivities, last minute wrapping is done and there is a general feeling of good cheer. Our first job came down as a cardiac arrest. Not an ideal start to the shift and certainly not festive, but when it's your time, it's your time. We raced round there, a crowd had gathered in the road outside this guy's house. We screeched to a halt, jumped out and without saying a word to each other grabbed all the kit we might need. Response bag, oxygen bag, paramedic bag, life pack, defibrillator and suction unit. Loaded up like pack horses we did the 'emergency walk' to the front door. It was locked. No one had a key but our patient could be seen in his armchair, motionless, through the window. No time to waste, I entered the porch, dropped my bags, took purchase on the door frame and in a blaze of glory kicked the door in! It was much easier than I thought it would be. In fact, the door came right off its hinges. Aware there was a crowd, and quite proud of myself I felt a shiver run down my spine. I grabbed my bags and in we went.

Sitting in his armchair was our parient. He looked pale. Eyes shut. A small amount of sputum sat on the corner of his mouth. He was in his pyjamas. He'd been dead for some time. His temperature was so low we couldn't get a reading. Surrounded by unopened christmas presents ans cards he'd passed away quietly. He just looked asleep. It was a very surreal moment. It always is when confronted with a dead body. I can't describe that unique feeling. Doing paperwork and trying to piece together some sort of medical history in the presence of the body is a little unsettling to say the least. We cancelled all other resources and requested the police. This is standard procedure in the event of an unexpected death. The guy wasn't terminally ill but had simply died. It happens. It wasn't long and drawn out. Sudden and peaceful. I think that's how i'd like to go. As we were doing our Recognition of Life Extinct paperwork and our report, the family arrived. The eerie silence was broken with that of tears and distress. It's the single hardest thing we have to do. Telling a relative that their loved one is dead. We have no training for it, and nothing really prepares you for having to do it. I found myself fighting back the tears trying to assure them he died peacefully. 

After being left alone for a few minutes, the son and daughter in-law emerged from the sitting room. Their mood was changed. It appeared to some extent, peace had been made. They began sharing stories about the incredible life he had led. They built a fantastic picture of him. The daughter in-law then said:

"Oh my god, we are supposed to be going away tomorrow"

She instantly rebuffed her comment.

"I'm so sorry, that must seem so callous and cold"

Initially I agreed, it did, but the reality is, people do have plans. Death can come at anytime and the world doesn't stop. People have jobs, people have children and continuing with a sense of normality helps the grieving process. They were flying out to see their daughter abroad for christmas and would be gone for two weeks and that is exactly what they were going to do. From what I learnt about our patient, he would insist on it. Today was his day. He's got up for breakfast as he does every day at 9am. He out his teabag in the mug, and boil the kettle. While the kettle boiled he would sit in his armchair and open the post. This he had done. Opening christmas cards from his loved ones was the last thing he did. Still apologetic about her apparent lack of focus on her father in law and his funeral arrangements, her husband and our patient's son said it perfectly.

"It's ok love, he'll keep"

And it's true, he will. They were a nice family, a close family, genuinely kind but realistic people. The funeral can happen after proper planning and when it suits everyone. Making arrangements over the holiday period was always going to be tough so why not wait. No matter what anyone plans for, life throws out it's fair share of curveballs and people deal with them in different ways. There is no right or wrong way. All I know is that our patient will have a great send off and his life will be celebrated. Until then, life goes on.

Wednesday 28 December 2011

Just for the Record

"Response cars causing ambulance delays...Not so sure"

Recently, Channel 4 aired a report entitled Fast Response cars 'causing ambulance delays'. I watched for 9 minutes in amazement as ambulance services were crucified, conditions of effected patients were grossly exaggerated and even paramedics pointed the finger at their own colleagues for causing patients to die. Admittedly over recent years there has been an increase in different types of first responder. There are cars, motorbikes and even cycle response units, all with their own benefits. The motorbikes can weave through traffic, cycles can get through airports, stations and shopping centres and cars are generally faster than ambulances and don't tend to be stock piled at a hospital. All the above add to getting SOMEONE to the patient quickly or as we like to say, in 7 minutes and 59 seconds. That is all that matters. The report harps on about the 8 minute government target being based on sound clinical evidence but as far as i'm concerned it's just like the 'golden hour'. A nice round number to aim for. If a patient is going to die within 4 minutes of calling, they are going to die in 4 minutes. If a patient can survive for 8 minutes then they will. Why not 7 minutes, why not 6? Because it doesn't matter. 8 minutes is the time that was picked so 8 minutes it is.

The report starts with a typical emotional tug. An ill kiddie. We all love a sob story and let's not forget, it's all about the kids. I'm not disputing this child was unwell, i'm sure he was, but to make their point about ambulance delays it's been laid on heavy. Notice that there were no comments from any of the staff involved in that job. Only the mum's word that her child was 'dying'. If the kid was indeed so perilously close to death they wouldn't have waited for 50 minutes, that is for sure. The clinician on scene would have made it perfectly clear to control that the child would die without an ambulance. If it was going to be that long and it was a life or death situation, get the mum, get the kid and drive in your car. As the report said, he'd done all he could and was just watching. It was great opportunity for the journalist to hammer his point home without any clinical evidence whatsoever. 

He goes on to say, with an air of shock, that there is no guarantee that the first responder will even be a paramedic. This is true. There isn't. Quite frankly, you get what your given. There aren't enough paramedics to have on every ambulance and every car. When calls are categorised and a condition flags up as something that may need a paramedic skill ie; a seizure / cardiac arrest, then a paramedic will be dispatched. The paramedic who berated the use of technicians and spoke about them in such low regard clearly has an extremely high opinion of himself. EMT's were basically made out to be glorified first aiders with 2 months training. What he seemed to forget was that every paramedic was a technician in some way, shape or form and it isn't 2 months training. To work on a fast response car as an EMT you need 2 years experience. That includes the 6 month initial training. I'm sure there are bad technicians out there but there are also bad paramedics. If a member of my family was ill i'd much rather have a good technician with 10 years experience than a bad, newly qualified paramedic with no experience. When they neglected to tell you that a Paramedic can qualify from university now who only a few practical placements and minimal patient contact. That means they can be a first responder with only 6 weeks of working on an ambulance under their belt. Feel reassured that your responder is a young paramedic....? Hmmm. What also surprised me was that Jo Webber, Director of the Ambulance Services Network appeared to have no idea that technicians worked cars. So what if they do? If someone is that ill, surely some intervention is better than none. Is a technician on a car arriving before a paramedic on an ambulance any different to a paramedic on a car arriving after 2 technicians on an ambulance? 

Ok, in an ideal world, every first responder would be a paramedic, every ambulance would have a paramedic and a technician on board and every call would be answered within 8 minutes but this isn't an ideal world, far from it. It's a world dictated by money and to get money, targets must be met. Best practice comes at a cost, so the government has a choice. They pay for best practice or pay for targets. They chose the latter.  As briefly eluded to in the programme, ambulances are financially punished for not meeting the 8 minute target. A policy typical of government with no real grasp of what the emergency servies are like. Although, as is often the case high ranking politicians will do a ride-out with an ambulance, with a handpicked crew, given hand picked jobs. It would be interesting if they came anywhere other than headquarters to work with a crew or responder not hand picked by the politically motivated senior management. In an area of health care where cost cutting is dangerous, taking away the little money they have for staff development / training / recruiting is the real reason cars are being used. The only way of protecting the financial budget is to meet the targets as dictated to by policy makers. They take no note of the ever increasing call volume and the ever decreasing staffing. It's no wonder that there are 60,000 missed targets each year. I'm amazed the number is so small. Bear in mind in London alone (I use London as thats the stats the media report) there are over a million calls each year. That 60,000 would only be 6% of the calls in London yet it's a national figure. It was made to sound like a real issue, an issue that is costing lives and an issue the ambulance services are to blame for. In reality it's just a consequence of chasing targets rather than patient care.

The other financial benefit to cars is the obvious material one. It is less than half the price to fully equip and staff a car than it is an ambulance. Sure, scrap all cars, have more ambulances, but in reality, channel 4 would only be doing a documentary about a patient who had no medical response for 50 minutes while she watched her child die. There is no winning. It'll always be a battle. Ambulances have to go to hospital. Once at hospital ambulances have to wait until there is room for a patient, as I discussed at length in 'Hospital Corridors'. If waiting times at hospitals continue to rise, what good would it be to have less cars? Surely having a paramedic or an EMT on scene with a patient within 8 minutes, regardless of ambulance waiting time is a good thing. At the end of the day, if someone desperately needs an ambulance they will get one. That's what triage is for. Prioritising. On a rare occasion, through unforeseen circumstance, someone will have to wait a long time and someone may even die. That's life. It shouldn't be, but it is. Don't sit there and chastise ambulance services and their staff for trying the best they can, with the little money and fewer resources they have. How about do an article praising what they are doing and take the issues to the policy makers, as they are the only ones who can do anything about it?

As for the spineless individual who is ashamed to be a paramedic... shame on you. I'm ashamed to call you a colleague. If the reporter had any sense he would have consulted more than just one paramedic with an inaccurate jilted opinion of the profession for which he works. If he had done,  he may have found a different story. He may have found a story about the frustrations all paramedics, EMT's and ambulance services face, over the contant battle between balancing patient care with available resources and the little money available to them. That wasn't his agenda though. It's always easier to point the finger of blame then help find a solution.

Monday 26 December 2011

It'll be the Vimto that gets ya.......

"28 year old male, overdose, ? paracetomol, ? suicidal"

Drug overdoses are very common, although when the term overdose is used most people think of class A drugs. In actual fact these are quite rare but in recent years there has been a huge increase in over the counter and prescription medication overdoses. Some by mistake but most as a cry for help or an attempted suicide. That said, most we go to are cries for help where there will be little or no long term damage. With the exception of some opioid drugs, there is very little we can do for an overdose other than transport to hospital. 

Going by the details on the screen we weren't excited about the job we were going to. It had been a long night and it certainly wasn't going to wake me up. We drove through the rain and darkness and after much peering, reversing and investigation found the ally-way we were looking for. We climbed the metal staircase to the flats above the shops. A worried looking woman answered the door. 

"Come quickly, he's through here"

Her sense of urgency suggested the patient may be iller than first thought. We entered the living room and our patient, the ladies brother, was sitting on the sofa. He was rather distressed and it took a few minutes to ascertain what exactly had happened. 

"What exactly have you taken?"

"Three paracetomol"

"Is that all? (slight tone of resignation) Did you take anything else with them?"

"Half a pint of Vimto" (Through tears)



"No other medication, just three paracetomol taken with Vimto?"


"OK, you are going to be fine, did you take an extra one by accident?"

"No, I wanted to kill myself"


"My girlfriend has lived in Switzerland for five years and I can't get a visa to go there and tonight my Skype connection has gone down and I can't talk to her and I don't think it's working between us"

"When did you last see her?"

"We've never met"


"No, am I going to die?"

"Yes, but probably not for 50 years or so, all things considered"

"What about tonight?"


"Are you sure?"


Not really sure what else to say about this. He called an ambulance because he'd taken three paracetomol with Vimto. Not a crime but a huge error in judgment and calculations. He wanted to go to hospital to talk to someone about his suicidal feeling. Fair enough. I've come across a lot of people who've wanted to kill themselves for all sorts of different reasons but a lost Skype connection? Really?!

Compu'er says No.......

"104 year old, fallen, no injury, very cold, can't get up"

Working at Christmas is generally a mixed bag. Your'e left feeling frustrated by people's apparent willingness to call an ambulance, when surely the last place in the world anyone would want to be at Christmas would be a hospital. On the other hand, others are reluctant to call 999 because it's Christmas and when they eventually do people are very sick. Most of the jobs we attend have houses full of family and the joy or sadness this brings makes the shift an emotional roller-coaster. At about 10pm a call came in from Gloria. A 104 year old lady who had fallen. It was about 15 miles away but we began. Within a minute or two we were cancelled for a higher priority call.

"21 male, ? # nose, post assault"

We attended this undeserving patient who had misinterpreted 'tis the season to be jolly' and taken it to mean 'let's go kick the crap out of each other'. Nothing spectacular, a quick bandage, a taxi ride to hospital and on to the next. Below are the following jobs I attended:

"47 year old female, SOB, abdo pain"

"14 month old male, not sleeping, feels hot"

"23 year old male, vomiting, has been drinking, collapsed at bus stop"

The 21 year old had been fighting outside a pub, the 47 year old had indigestion, the 14 month old had an ear infection and had seen the GP the day before and got antibiotics. The 23 year old was indeed drunk. None of them seriously ill at all. All could have coped with not going to hospital and all could have made their own way to hospital. Who am I to judge though? I'll just go where I'm sent. After leaving the drunken male at the hospital we greened up.

"104 year old, fallen, no injury, very cold, can't get up"

It was the same job from 10pm. It was now 3am. This job was now over 5 hours old. We called up to see if this was actually the case. Sadly it was. 4 ambulances had been cancelled for higher priority calls. Just like we were, and just like all the jobs we did since were. Apparently Gloria wasn't a priority. Apparently a 104 year old, lying on a cold kitchen floor, on her own on Christmas day wasn't worthy of an ambulance. The drunk people were worthy. Gloria was not. Is this the problem with computers making decisions? Or, is this a matter of ignorance? Who are making these decisions? For her to be left that long, someone consciously decided to send the resources elsewhere. Would they have done so if it was their mother or grandmother? Doubt it. Gloria didn't complain. In fact quite the opposite. She apologised. She explained how she fell over at 6pm, then waited 4 hours to call for help as she didn't want to be a burden. That means at 104, having survived both world wars, having paid tax for 66 years until her retirement at 80 and being self sufficient to the point of needing no benefits or care package she had laid for 9 hours waiting for help. Help she had earned. Help she was basically refused.

She didn't need to spend all of Christmas day in hospital. With the lack of Drs she would probably be in hospital for 3 days over the festive period now. She could have stayed at home. However, after the powers that be decided she didn't need an ambulance sooner than 5 hours, she had pressure sores and hypothermia.  We had to take her. But why wasn't she a priority? No apparent pain but surely a 104 year old won't feel pain like a 70 year old might. Alert. She was able to talk in clear sentences to the call taker and explain exactly what happened. It appears her lack of broken English and good grasp of symptoms had let her down. She denied chest pain and difficulty in breathing. Most people say they have one or the other just so they get an ambulance. In this instance, her willingness to tell the truth had caused her a long wait and a lot of distress. At what point are the fat cats in charge going to show some respect for the people most deserving? None of the jobs I did over the entire weekend were more deserving than her, yet none of them had to wait more than half an hour for an ambulance. I want to know why no one is accountable for this. If it was a member of my family I'd want blood. I have passed my concerns on to the powers that be but i'm sure i'll get a suitably political answer in reply basically saying "tough, get over it", but hey, bet they didn't spend christmas on the floor.

Saturday 24 December 2011

Failed by the system........

"43 year old male, brain injury, feeling suicidal"

I have very little empathy for most of our regular callers, normally it is an attention thing or poor management of a chronic illness. I had similar feelings for Mr Smith but after the first 10 or so meetings I realised he needed empathy, and he needed help. Mr Smith called a lot of ambulances. Sometimes as many as 5 a day. More often than not he went the 600 yards to hospital but sometimes he stayed at home. Mr Smith suffered from schizophrenia which is a mental disorder characterised by a breakdown of thought processes and by poor emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganised speech and thinking, and it is accompanied by significant social or occupational dysfunction. I believe he also had some learning difficulties. His usual complaint was feeling suicidal, stating he wanted to jump in front of a train. He claimed he had had a traumatic brain injury aged 11 but there was never any evidence to suggest this. Every attendance to him followed a similar pattern. We took him to hospital, the nurse sent him to the waiting room and he walked home where he would then call another ambulance. You can see the cycle.

Regular callers are very frustrating. It's a waste of resource and when they are so prolific in their calling the expense is huge. In one calendar year Mr Smith had 478 ambulances at a cost of over £250000 to the ambulance service. Unfortunately this is a bi-product of the system we are in. As previously discussed the care pathways for mental health patients are poor at best. The nearest mental health unit to Mr Smith knew him well but wouldn't allow us to convey him to them without him being assessed in A & E first. On the rare occasions where he did stay in hospital long enough to be assessed, the unit would discharge him to be 'treated at home'. The problem with mental health in A & E is that there are not only very few staff trained to assess him but there is usually a very long wait. Certain nurses knew if they left him for long enough he would just leave. To be honest, myself included, no one really took his threats of suicide seriously. He didn't seem the type. There was no history of self harm and he'd been threatening it for so many years it didn't seem likely. Regardless, he wasn't getting the treatment he desired or needed. He was being let down by the system in a never ending loop of hospital admissions and self discharges and no one who could buck the trend was willing to do so.

It's a far too familiar sight with mental health. No one wants to know. Even the mental health units generally are not interested. They certainly aren't helpful. They make admitting a patient as hard as possible for us and the police. They have so many rules and conditions that must be met before they'll consider even laying eyes on a patient. Because of this the cycle continues. If i'm honest I didn't really know what Mr Smith wanted. He never really said. I tried talking to him, I tried referring him onto every service I could. I filled out frequent caller referrals, vulnerable adult forms and flagged his address. I tried to argue on his behalf to immediate assessment in A & E but everyone has their priorities and he was never going to be one of them. He only ever called from his home. He was never rude, always polite and therefore never had anything to do with the police. The police have more powers than us and can be very useful with mental health and enforcing assessments but this was an avenue which was never open to us. He always agreed to go voluntarily and as such, was never in a position to be held against his will. Unfortunately about 4 months ago a crew not familiar with Mr Smith attended his home. I imagine he told them the usual and he was taken to the hospital. Once at hospital the nurse sent him to the waiting room. 20 minutes later he walked out. 20 minutes after that the following call was sent to a local crew.

"'One under', male jumped in front of Intercity train. ? Life status"

Like he always claimed he would, Mr Smith jumped under a train. From what I have heard he would have died instantly. The train was travelling in excess of 90mph, he didn't stand a chance. Or did he? He had a chance twice on that particular day. Twice he was taken to hospital and twice he was ignored. I suppose it was only a matter of time before he did it. He'd been let down by the system that is there to help him, and he was let down because he was submissive. He didn't complain about lack of treatment. He never raised his voice. He just quietly walked away unnoticed every single time. The cynic in me would say that now he is dead, that is a huge financial burden lifted and it's what he wanted. In reality, I felt crap. He didn't need to die, he needed treatment and help but it was treatment and help I wasn't able to provide. It was treatment and help 'the system' wouldn't allow him to have. I'd like to say that would be little consolation for his family and friends but he didn't have any. All he had was us and we failed him.

Drivers: Take note

"Imbeciles of various ages driving like muppets" 

One of the perks of my job has to be driving. I get to drive a big yellow ambulance through the center of the city at high speed. Well, I say high speed, it's high speed in comparison to the queues of stationary traffic i'm passing but still. To get to jobs quickly and safely it is not about the physical speed you have, but the progress you make. Quick acceleration and rapid breaking doesn't make for a comfortable journey for everyone so anticipation of the road ahead and what other road users will do is  key. But this is where the problem lies. You cannot predict what some of this countries worst and best drivers will do when they see blue!

To get a driving licence one must pass a theory test first where questions are asked on every aspect of the highway code. However, on passing the practical test, it appears all previous knowledge as to what to do regarding Emergency vehicles is forgotten. The highway code states:

'Emergency and Incident Support vehicles. You should look and listen for ambulances, fire engines, police, doctors or other emergency vehicles using flashing blue, red or green lights and sirens or flashing headlights, or Highways Agency Traffic Officer and Incident Support vehicles using flashing amber lights. When one approaches do not panic. Consider the route of such a vehicle and take appropriate action to let it pass, while complying with all traffic signs. If necessary, pull to the side of the road and stop, but try to avoid stopping before the brow of a hill, a bend or narrow section of road. Do not endanger yourself, other road users or pedestrians and avoid mounting the kerb. Do not brake harshly on approach to a junction or roundabout, as a following vehicle may not have the same view as you.'

Every day, on every blue light run, at least one car, van, bus, taxi or pedestrian tries to cause a crash! These near misses are usually just that but sometimes the irratic behaviour of road users causes ambulances to crash, sometimes with a patient on board. I thought i'd compile a 'do not' list just so drivers know what isn't acceptable in the presence of blue lights.
  • Don't stop in the middle of the road
  • Don't put your hazard lights on and continue what you are doing
  • Don't indicate in either direction and continue what you are doing
  • Don't stop in-between a traffic island and the kerb
  • Don't ignore us. We will be overtaking you.
  • Don't speed up and race us. We will be overtaking you.
  • Don't stop in the middle of the road
  • Don't straddle two lanes to block us (it's illegal)
  • Don't swerve left and right
  • Don't continue turning right if we are in the middle of overtaking
  • Don't swear when we overtake you
  • Don't put you arm out the window and wave
  • Don't stop in the middle of the road
  • Don't try and change lane when in stationary traffic
  • Don't stop next to another stopped car
  • Don't block the road
  • Don't tell me to go in the bus lane. I will force you in and make you get a ticket.
  • Don't stop in the middle of the road, indicate left, and move to the right
  • Don't stop in the middle of the road
  • Don't weave through traffic behind us. Ever.
  • Don't run across the road when we are 10ft away. 
  • Don't assume we have time to stop
  • Don't stop across a side road. I may need it.
  • Don't jump a red light and speed off.
  • Don't stop in the middle of the road
  • Don't try and get in front of the buses before moving over.
  • Don't berate me for using the 'wrong' side of the road.
  • Don't 'pretend' to run out in front of me. It's not funny.
  • Don't throw things at the windscreen. Someone will die.
  • Don't push your buggy into the road. I get scared.
  • Don't stop in the middle of the road
  • Don't overtake traffic who have already stopped for me.
  • Don't put your fingers in your ears. Its a pet hate of mine.
  • Don't do anything I deem to be stupid.
  • Don't do anything stupid
  • Don't stop in the middle of the road
  • Don't stop in the middle of the road
  • Don't stop in the middle of the road
  • Don't stop in the middle of the road
I'd also like to put the record straight. We NEVER drive on blue lights unless we are on way to a job that has been categorised as suitable for blue lights or we are transporting a critically ill patient to hospital. That is all. We don't use them to get through traffic for our break. We don't get breaks. We don't use them to get off on time. We never get off on time. We also don't put the sirens on to annoy you. We aren't driving through traffic at speed because we want to piss you off. We are doing it because it is necessary. I can't comment on the Police's use of them but for us it is emergencies only. 

Click the Take Note photo at the top to see the other posts in the series!

Friday 23 December 2011


"40 year old female, abdo pain, in supermarket cafe"

Now the country is in the grips of winter 6am starts seem all the more cruel. We'd done one job but I was still struggling not to yawn and was rocking out a thumping headache. My issues aside, we got another job so fake smile in tow, we headed the 600 yards from the hospital to the job. We made our way through the hordes of christmas shoppers to find our patient, head in hands, staring at her coffee. We introduced ourselves and were met with a voice full of apathy. Her hair was scraggly, she was wearing odd slippers and a Mickey Mouse t-shirt. The combination was a bit bizarre but who am I to judge?! The conversation that ensued epitomised everything wrong with this country.

"Where the hell have you been, i've waited ages"

"You only called 10 minutes ago! Anyway, how can we help you?"

"My tummy hurts, I can't walk"

A brief history told me she was kicked in the stomach with a 'flying ninja kick' by a Philippino nurse. She was discharged from the hospital 45 minutes ago and had a pain score of 3/10. No known mobility problems and denied any leg injury. The described pain raised no red flags so as far as I was concerned she was well enough to walk to the ambulance. Before suggesting that I did a quick battery of tests and they all came back normal.

"Shall we pop you to the ambulance?"

"I might not be going to hospital. I haven't decided where you are taking me yet"

(Brief pause to take in what she had said) "Well, whatever we decide i'd like to check you over fully on the ambulance, it is more private after all"

"Well I can't walk"

"How did you get here, what is stopping you walking?"

"Just get me the supermarket wheelchair. It is by the tills"

(Someone has had one before!) "If you can't walk, we will have to take you to hospital anyway"

"Just get me the chair"

I didn't have the energy to make my point so the chair was fetched and we wheeled her to the ambulance. Once on board it became apparent hospital was the last thing she wanted.

"Right, i've decided I want you to take me home"

"I'm sorry, but we are not a taxi service, if you are unable to walk we will have to take you to hospital"

"Which hospital?"

I gave her a choice of the 3 nearest to us. She refused them without a valid reason other than not wanting to go. I read out the list of the nearest 9 hospitals and their distances away. She refused them all.

"Give me some morphine. It's my right"

"I'm not giving you morphine"

"But i'm in pain and can't walk"

"Then I will try you on Entonox first, and we will take you to hospital"

"Just take me home, what is your problem, the hospital won't provide transport so how am I going to get home?"

"I'm sorry but we aren't a taxi service, you can't just call an ambulance because you want a lift home"

"This is a disgrace, i'm going home"

With that, she got up and walked off to the bus stop and jumped on a bus. That was that. She could walk, and didn't even have a limp! I had consulted our clinical support during the conversation as to her request and was told her only option was the nearest hospital if she couldn't walk. This is why the ambulance service struggles to cope at the best of times. This is why A & E departments are at bursting point. It transpires she was ejected from the hospital for abuse to staff. She had been to hospital 16 times in the last month, always after shopping and every time had requested transport home. Luckily for the tax payer, she had been refused every time. Speechless.

Thursday 22 December 2011

Hospital Corridors.........

"48 year old male, RTC car vs car, neck pain"

A pretty average job on the surface. A low impact collision, two patients with neck pain, no real trauma but all the necessary immobilisation precautions needed to be taken. Our patient was a big lad. We collar and boarded him, gave him a full assessment and took him to hospital. The other crew did the same and we arrived within minutes of each other. It was the arrival at hospital where winter pressures and government cuts were there for the everyone to see. As we entered the corridor leading to the A & E department we were greeted by 4 crews. Each with their patient on a trolley bed. Sitting patients, waiting to hand over to the nurse. With our two patients that made 6 trolly beds, 6 patients and 12 staff. There were long delays to hand over due to a lack of capacity in the hospital.  Within 20 minutes of us arriving another 5 crews arrived with their patients. That is 11 trolly beds, 11 patients and 22 staff. 11 ambulances were sat outside, unmanned and unable to answer calls. Out patient began to get distressed about the delay. Bear in mind lying on a spinal board, with a collar round your neck and strapped down is not comfortable. Add to the the pain you're in, the lack of privacy, the need for the toilet and the view of a dirty, tiled suspended ceiling and no one would be happy. We made a number of attempts to get the spinal patients assessed so we could let them out of their prison but all requests fell in death ears. All in all, we waited just over 3 hours for a handover and we were 5th in the queue. I have no idea how long number 11 had to wait. It's also worth noting that the 4 hours hospitals have to discharge or admit a patient doesn't start until they have been handed over! 

We are not far from this.......
Recently the media has latched onto patients waiting in hospital corridors due to a lack of beds. The problem is, it is a seasonal story, repeated every year. They want to blame. Whether it be through political agenda or personal opinion the same inaccurate stories (usually the Daily Mail) are published. The problem is, it isn't anything new, it happens all year round, every single day, the only difference being, in the winter there are more people waiting than normal. Hospitals are at bursting point and until the 'winter pressures' have passed it won't ease off. And let's make one thing clear, it isn't a physical lack of beds that cause the problem. It is a lack of staff to look after the patients, and a lack of staff caused by a lack of money. That lack of money is a direct result from mindless government cuts. I'm not saying cuts don't need to be made, they do, but cutting hospital staff where they are needed most is crazy. In hospitals all over the country, wards lie empty, in darkness, locked from the world.  That is why ambulance crews line the corridor waiting to offload their patients. There is nowhere to put patients who need admitting. 

It's all well and good though, making us wait in a corridor, but what effect is this having on the public? Call volume for the ambulance service is hugely inflated at this time of year as it is, factor in 11 ambulances waiting at 1 of the 30+ A & E departments and it's easy too see how the precious government targets are being missed. The increase in call volume has a knock on effect for every hospital and with decreasing bed availability the hospital corridor is the only place left to put them. The hospital corridor however loses the monitoring ability and resources a cubicle has, it loses the patient confidentiality the NHS constantly tries to protect and it loses the dignity that our patients are so keen to protect. The media is correct that waiting in corridors is an outrage but they should turn their blame and attentions to the only place which can do something about it. Westminster. Until policy makers wake up and realise their drastic cuts are causing irreversible damage to the health care system which is in turn costing lives, the waits, the queues and the frustrations will continue to grow.

Tube Strikes: The cost of greed........

"25 year old female, palpations, uncontrollable rage"

After hearing about the proposed tube drivers strike on Boxing day I launched an expletive filled rant at my crew mate. I unloaded. It was no holes barred, uncontrolled, unadulterated anger. His about it! So I am. My views on strikes in general are not a secret. I don't agree with them at the best of times. I didn't strike during the public sector strikes last month but despite my opinion on striking, it was a worthy cause. This abomination of a strike is pure greed from the motley crew collection of overweight, miserable, lazy money grabbers that will only effect the poorest people. 

Here are some facts and figures about train drivers and the slave like working conditions they are unfairly forced to endure:

  • Average salary: £45,545
  • Pay rise by 2015: £52,000
  • Average shift length: 9 hours
  • Bonus for working during the Olympics: £1800
  • Yearly Annual Leave: 43 days
  • Time off for a 'One Under': 3 months minimum
  • Rest break guaranteed: 45 minutes 
  • Boxing day compensation: Triple pay, + day off in lieu.

For a job that could be done by a 6 year old, they are pretty damn good conditions. Better wages than a first officer on an aeroplane, better than newly qualified lawyers, better than Doctors and more than double that of a policeman, nurse and paramedic. Yet, like last boxing day they are striking again. And this is despite after their most recent pay deal in October, the PROMISE there would be no further strikes on pay until 2015. It is of no real surprise though. The union representing them is Aslef, a union who has built itself a reputation of being an industrial saboteur. The blackmail tactics, lies and complete disregard for public consequences is a disgusting abuse of striking law. They repeatedly move the goal post to squeeze more and more out of the spineless London Underground management and despite the 1996 agreement where their annual leave was secured with the proviso of some bank holidays being worked, they are again going back on their promises. These are not demands for fair working conditions, they are demands based purely on greed. Like the ambulance service London Underground is classed as an essential service so why their staff should be entitled to special dispensation over the festive period I don't know. Police, Fire, Ambulance, Coastguard, Doctors, Nurses, Carers and every other emergency / essential service have to work over christmas so why shouldn't they?

Maybe they should take a moment to look at the working conditions of that of a Paramedic in London. In reality the disparity in working conditions won't register on the radar of this selfish breed of people but hey, it's an interesting read.

  • Average salary: £21,176 (basic)
  • Pay rise by 2015: Frozen for 2 years then 1% a year thereafter
  • Average shift length: 12 hours
  • Bonus for working during the Olympics: None. 
  • Yearly Annual Leave: 27 days, including bank holidays
  • Time off for a 'One Under': None. Expected to be available within 15 minutes
  • Rest break guaranteed: None
  • Boxing day compensation: 7.5 hours in lieu even if a 12 hour shift was worked

Quite a contrast isn't it. I won't be spending any of Christmas or New Year with my family or friends. It all falls on my work days. I don't get extra pay. I don't get anything extra. It's part of the job. It's when i'm rostered to work. That's life. Perhaps it’s time the government looked again at the union legislation and extended the no strike ban on Police and the Army to all essential services including the London Underground. Better still, in the modern age of technology and industry, and the success of the DLR why don't they scrap tube drivers all together. Automate everything. Chuck em' on the scrap heap to earn an honest salary like the rest of us. No more strikes. No more travel misery. In such frail economic times the capital simply cannot afford the disruption these greedy, self centered, lazy pigs will cause. The truth is the strike will have a devastating effect on the first day of sales at the end of one of the worse trading periods for retailers for 60 years. It will cost millions in lost revenue. And the people who work in the shops are at the lowest end of the income level – the very ones the unions are supposed to support. Disgusting.

Tuesday 20 December 2011

The Cost of Alcohol

"41 year old female, abdo pain, vomiting, alcoholic"

We've all had a drink. We've all got drunk. We've all had weekends where we have drunk to excess, but short of a rotten hangover, that's where it ends. Unfortunately, the culture we live in has drinking woven into the fabric of society and because alcohol is such a common, popular element in many activities, it can be hard to see when drinking has crossed the line from moderate or social use to problem drinking. When drinking to excess becomes the norm and alcohol is used to make you feel better or avoid feeling bad, that's when the reality of alcoholism becomes apparent. Alcohol contributes to 35% of all A & E admissions and that rises to 70% at weekends. Obviously, ambulance staff the world over grumble and sometimes make light of 'scooping up drunks' out of the gutter on a friday night but the problem runs much deeper than a weekend binge.

Alcoholism and alcohol abuse are related to many factors which are more often than not interconnected. These include genetics, upbringing, social environment, and your emotional wellbeing. People who have a family history of alcoholism or who associate closely with heavy drinkers are more likely to develop drinking problems and as eluded to in my last blog (Mental Health), those who suffer from a mental health problems such as anxiety, depression, or bipolar disorder are also particularly at risk, because alcohol is sadly used to self-medicate. It is these patients that we see all day every day, and the cost to maintain their continuing need for medical treatment is what is a putting the health service under a pressure it simply can't cope with. Add to that the cost of the anti-social behaviour and crime that results from alcohol and the cost not only to the NHS but the country as a whole is enormous.

Negating the £3 billion yearly cost of alcohol on the NHS and putting to one side the 33,000 alcohol related deaths in the UK alone last year, the cost to personal health and family life can be catastrophic. Liver cirrhosis, kidney transplants, pancreatitis and cancer, to name but a few are just some of the debilitating illness's that alcoholics suffer with. This particular patient had chronic pancreatitis, which is an inflammation of the pancreas. It causes severe abdominal pain that lasts for days on end. The damage is irreversible. Years of alcohol abuse has caused her body to start shutting down. We arrived at the block of flats and made our way up the outer concrete staircase. When we arrived at the walkway, an elderly lady, head in hands, stood outside the flat. She didn't need to say anything, her look said it all. She was tired, she was hurt and was full of despair. There is only so much a parent can do for their daughter. We made our way up to the room where Sarah lay on the bed wretching and crying in pain. A brief look around the room showed all the tell tell signs of alcohol abuse. Tins, spirits, dirty clothes, no pride in her appearance, a musky haze around the room and the smell was enough to paint a picture. Every minute she would let out a gut-curdling squeel as she vomited the smallest amount of bile into a bucket. She had been doing this every minute for the past 8 hours. She had been in constant pain for 2 days, been to hospital twice, had had 4 ambulances and 1 doctor out to see her. She was red faced, pouring with sweat and covered in vomit and looked exhausted. That was her life. That was her choice. That was alcohol. 

We took her to the ambulance, the retching continuing all the way, the squeals of pain reverberating off the concrete jungle. Wearing a stained white t-shirt, dressing gown and socks she was a sorry figure walking through puddles to the ambulance. A resignation that this was what she could expect from what is likely to be a rather short life. Her mum followed behind, not a word spoken, just a look of solemn exasperation. We did all the necessary checks and left to go to hospital. In between the retching and screaming I tried to talk to her. She had been an alcoholic for 10 years. She wanted to die. She had lost her husband, her kids, her house and her job to alcohol. Her mum had taken her back in to look after her. I genuinely believe she was at rock bottom. We arrived at hospital, and as we lowered the bed on the tail lift I helped her mum down the steps. Our eyes met and a tear trickled down her cheek. In that single moment, the true cost of alcohol became discernibly apparent.

The 12 days of Christmas by Ella Shaw.......

"25 year old female, spreading the christmas joy"

Dear readers,

Despite it being mid-december, Christmas only being a week away, plenty of parties to go to, oodles of festive cheer wherever you look and it supposedly being a joyful time of year, that doesn't appear enough to put people in a good mood.  I sat on a train last week and for an hour I watched throng after throng of commuters get on and off the train. Not a word or smile shared. Just pure misery. And I don't know what they are so glum about, they'll all have Christmas off, be partying on New Years Eve whilst the emergency services are working. As I have done for the past few years, I have edited the 12 days of christmas to put a smile on the faces of any EMS who read it. I hope you enjoy. Merry Christmas to one and all. Be safe out there
Ella x

The 12 Days of Christmas

On the 12th day of Christmas my control gave to me:

12 Cancellations

11 Not a givens

10 Bouts of man flu

9 Not Alerts

8 Pyrexic babies

7 Granny downs

6 Drunken Polish

Off late Again.......

4 Changing colours

3 Pregnant chavs

2 Mental breakdowns

And a cyclist with a grazed knee!


Monday 19 December 2011

Mental Health: No ones responsibility.........

"42 year female, having a breakdown, smashing things, possible mental health issues"

As I have briefly discussed before, the problem with Mental Health in this country is huge. For many years the issue wasn’t really in the public eye, patients were kept in  large hospitals / asylums and forgotten about. This much criticised institutional care of the 1960s and 1970s finally ended in the 1980s when Margaret Thatcher introduced Care in the Community. Its aim was to deinstitutionalise mental health and adopt a new policy of care, whereby patients could receive their treatment in their own home. A great idea in theory, but in practice it has failed on a monumental level. And why? Because communities themselves are scared of mental health. Inaccurate depictions of conditions in the media have fueled stigma and has caused the problem to be feared and ignored. Despite the systems obvious failings the government has no intention of doing anything about it, so for now the vicious circle of hospital admissions, discharges, sectioning and no access to treatment will continue. Come 5pm GP's don't want to know, crisis teams go radio silent and unless patients are willing / able to travel many miles for expensive, private care there is no help available at all. And don't even get me started on weekends!

Like the police, the ambulance service is stuck between a rock and a hard place when it comes to treatment. Although there are various sectioning options to both of us, implementing them is an uphill struggle and more often than not the patient is released by the hospital hours later. In an archaic system, the police have very few powers when a patient is in their own home. The only tool at their disposal is a section 135 of the 1983 Mental Health Act which allows a patient to be taken to a place of safety, but it isn’t a decision they or we can make ourselves. If certain criteria are met, 2 Doctors (one who is section 12 approved, a social worker and an ambulance are required to implement the section. Obviously, thanks to care in the community, the vast majority of patients we see are in their own homes and there lies the problem. Trying to organise all these medical professional at short notice is near impossible, time consuming and costly. It is of no surprise this is normally a last resort.

This particular day, we arrived on scene and waited for police as is customary on apparent violent patients. We entered the building (hovering behind the boys in blue) and headed up to the 8th floor. Our patient was cowering in the corner of the corridor screaming. The police made the first contact and were met with more screaming and swearing. Unfortunately she was Romanian and didn’t speak any English. A glance inside her flat showed extensive damage, everything appeared broken and looking at our patients hands it was clear how. In between the screaming she would mutter words to herself, her manner was very nervous and edgy. I tried talking to her but it enraged her more. She started spitting and trying to bite so was restrained. Not arrested. It was clear she had to go to hospital for a Mental Health assessment. The question was how and under what method. For us, her being under section would be ideal, for the police, her going in voluntarily would be ideal. There was also a grey area as to which section she would come under. Did the corridor outside her flat constitute a public place? If it did, the police could remove her to a place of safety. Or does it come under that of a private dwelling? In that case, a team of Approved Mental Health Professionals (AMPH) would be required for a section 135. Unfortunately for us, the patient, and the hospital, none of the above happened. 

I don’t know police policy, but in this instant, I believe correct procedure wasn’t followed. The patient was handcuffed, brought downstairs to our waiting trolley bed and put on our ambulance. She was neither under section, nor under arrest. Technically, she was being taken to a place of safety ‘voluntarily’ yet her struggle would suggest anything but. We conveyed to hospital and handed over to the nurse. She called the police over and asked if the patient was under section. They told her they couldn’t 136 her because she was at home. 135 wasn’t mentioned!! (To be fair, read my October blog ‘Kum Ba Yah, my Lord’ and you’ll see why!). This is where the problem lies and the never ending circle of mental health begins. Because the patient isn’t under section, the local agreement between the hospital and police is that the police only have to stay there for an obligatory hour. Realistically, with the best will in the world, an hour isn’t enough time to have a mental health assessment in a busy A & E department. Once the hour is up, the police can leave, the hospital don’t have the staff to be able to stay with the patient, nor do the security have the powers to detain. As the patient is there voluntarily, she will be free to leave at any point.

To cut a long story short, we left, an hour later the police left, 20 minutes later the patient left and we are back to square one. A mental health patient, walking the street, striking fear into passers by. And what do passers by do when scared or concerned. Yep, phone 999. And what gets sent to a ‘woman having a breakdown, being violent, bleeding from hands’? An ambulance and the Police. Money, money, money!

While the current laws stay the same and while no alternate care pathways are available, this will be an all to familiar occurrence. No one wants to know.  As the side effects of mental health include unemployment, and a side effect of unemployment is alcoholism and drug abuse, a huge percentage of mental health patients are intoxicated. Mental Health units will not accept any patient showing any signs of intoxication so A & E have to pick up the slack, but A & E department don’t have the specialists to deal with it. The police are reluctant to section because of time, the law and paperwork required so will generally assist in convincing a patient to go voluntarily if they can. This however, will prevent a prolonged stay and full assessment in an appropriate unit. Finally, the ambulance service has limited time, resources and options so will generally have no choice but to convey mental health patients to a hospital where they can walk out at any time. Nobody wants the hassle or the responsibility and its a case of cross ya fingers, stick your head in the sand and hope someone else deals with it.

The lack of mental health training that nurses, police and ambulance staff get is a stark reminder of what little priority is put on their treatment. Patients are pushed from pillar to post, while every service that is there to help, tries its best to pass the buck to someone else. Until the problem is tackled head on, nothing will change. Although mental health in the work place is becoming much more widely accepted, with stress and depression being recognised as common illnesses, patients with conditions that attract a public stigma such as schizophrenia will continue to be social outcasts and while that is the case, mental health will continue to be brushed under the carpet and maybe that is what the government wants. The situation is getting worse at an alarming rate, and with the current government ripping the heart out of the welfare system under the banner of 'reform', even the most basic benefits for the mentally ill are being removed. Britain's mentally ill are being pushed to the edge, evidenced by the 8% increase in suicides this year, but maybe these suicides are the savings in benefits that the government want by reform. It certainly seems that way.