Tuesday, 31 January 2012

Goodbye, Mr. Bond!

"28 year old male. Fainted"

We were called to a very busy high street in the heart of the city. Its a hustling and bustling place, multicultural and diverse, countless bars, restaurants, cafes and eateries. Our patient was a waiter as a very busy Moroccan type restaurant. It appeared packed inside with an outside seating area, equally full, where people were smoking Shisha pipes. We were met at the kerb side by the patient. He stepped straight onto the truck. He appeared well but I wont judge!

He told us he had had a near faint. It transpired that for religious reasons he was fasting so hadn't eaten all day. Working a long shift in a hot restaurant hadn't helped. He was fully recovered but we did a full work up anyway. Everything was normal, he didn't want to go to hospital so we did our paperwork and sent him on his way. We gave him a copy and explained that it forms part of his medical records so he was to give it to his GP at his earliest convenience. He agreed, folded it and placed it in his pocket. He then asked if I could tell his boss that he needs a rest and should go home. I agreed. We followed him into the restaurant.

We hovered around the entrance waiting to talk to someone. Our patient had vanished so we were stood like lemons for what seemed hours just waiting for his manager. After 10 minutes, a very serious looking guy in a suit came over to us.

"The big boss will see you now"

Sounds a bit daunting but OK! He beckoned us to follow and we did. We went up a very large, wide,  winding staircase. It all seemed a bit bizarre but this was just the tip of the iceberg. We reached the top and the guy in front opened these large, high wooden doors. We walked through, the room was huge, yet empty of furniture. A blue sky was painted on the ceiling, where what I assume were paintings on the wall were sheets covering frames. Directly opposite us was a middle aged man, sitting on a chair with a small table in front of him. His legs were crossed and he was only a white cat short of saying 'No Mr Bond, you must die'! There were 2 chairs positioned next to him.

"Come sit"

Alarm bells started ringing in my head. This wasn't normal. We tentatively walked over and as we did I heard the slam of the door behind us. It became all to apparent we were now in a situation which was potentially rather dangerous. We sat down. The 'big boss' removed the PRF form we'd given to our patient out of his top pocket. There goes confidentiality!

"Is he using illicit drugs?"

I wasn't expecting that! Despite not being aloud to discuss our patient, due to the position we were in, I decided to answer.

"Not that I know of"

I explained we were only here to advise he shouldn't work anymore today and that we really needed to get off. On cue the doors swung open and our patient walked over with a tray. We were served mint tea and baklava sweets. I burnt my mouth trying to drink the tea quickly. Me and my crew mate shared repeated looks of angst. My finger was permanently perched on the emergency button of the radio just waiting for something to go horrible wrong. I sensed this guy was sizing us up and trying to work out what our game was, not that we had a game. I just wanted my mummy! I then heard a cough from the other side of the room. As looked up and about 30ft away in a darkened corner was a man in a suit standing next to a door. The way he was standing led me to believe he was guarding said door. And he wasn't just a man. He was a man mountain. At least 30 stone +. What on earth needs a guard above a restaurant? You know what, I don't want to know. I was aware my palms were sweating and all I wanted to do was leave. I knew my crew mate was sharing my sentiments. Whilst we were continued to be questioned about our patient we sipped the tea and ate the sweets as fast as we could. My mouth was hurting but I didn't care.

"Will your bosses be wondering where you are?"


"So why haven't they called......?"

He's made a valid point. EOC are forever sending 'welfare checks' when you've been at hospital too long or you are dragging out your last job on scene. They check on you as guise to tell you to hurry up. Now we needed a welfare check they didn't care! Typical! I took my radio off my belt to look at it while I came up with a reason for their apparent lack of concern. 

"I'm assuming they are busy"

And then it clicked, I held down the button on our radio which shows us 'green mobile' for another job. I just hoped we would get a job quickly so we could run off! To my relief the radios started vibrating and beeping.

"Sorry, gotta go!"

We quickly headed over to the door. It was locked. Enter the pitted feeling of dread in my stomach. I turned round as if to gesture 'what the hell.....' and the lock clicked and the door swung open. We darted out, passed the guard by the door and down the stairs. What the hell was all that about?! Who behaves like that?! What do we do now? Report it? Report what? We were invited inside, given tea and cake and then ran off! Was it all one big overreaction?! If it was, I don't care!

Monday, 30 January 2012

The Wrath of a Lion is the Wisdom of God

"16 year old male, fallen off a Lion"

The cab filled with screams of laughter. We see a lot of funny things show up on the MDT but this was one of the more amusing! Especially as that was the only details we had initially. Not even an address! Fallen off a Lion! What do you say to that?! Would this be a Lion tamer? Would it be a job for the Hazardous Area Response Team (HART)? Would be need the RSPCA or such like? Highly unlikely. If someone has fallen off a Lion it is likely to be a statue and in this case it was. But still, it put us in a good mood so off we went. 

We arrived and were met by a group of teenagers who surprisingly did not appear drunk. They were 'free runners' apparently. Freerunning is another term for Parkour which a relatively new urban sport where by runners known as 'traceurs' move through their environment be it natural or urban as quickly and efficiently as possible. They move around obstacles by vaulting, rolling, running, climbing and jumping and having looked at some YouTube videos it is of no surprise they get injured! To check out what they do take a look at this video. They do indeed jump off Lions! Anyway, we were directed to Cosmo, yes, that was his real name (apparently), who had tried but failed to do a backflip off the Lion and was apparently unconscious. He was indeed unconscious, GCS 3 and snoring. Shit! I was not expecting that. 

We jumped to work, I secured his airway and gave him o2 while my crew mate grabbed collars, a board, straps, blocks and splints. I started to get as much history as I could from his friends. He had landed head first onto the concrete, as they said that my eyes wondered to the small pool of blood and vomit about 3 feet away. He had got up and within about 30 seconds had vomited. After about 2 minutes he was complaining of a headache and began to stagger around. That's when his friends wisely called 999. About a minute before we arrived he lost consciousness. This was serious. I requested HEMS or a BASICS doctor. I was told HEMS were now on route and would be 8 minutes. This was going to be a long 8 minutes!

I assessed the back of his head and it was what we call a 'boggy mess'. No further description is necessary. I applied a large dressing to keep it clean and stop the bleeding. I suspected he had a fractured skull. Between the 2 of us we decided to forget the spinal board until help arrived and concentrate on stabilising and monitoring him as much as we could. A quick pulse check and alarm bells started ringing. It was 36 which in 16 year old with a head injury is a great concern. I did his blood pressure while my crew mate gained IV access and the bells continued to ring. 198/110. For his age he was severely hypertensive. Put those two observations with his head injury and development of irregular respirations and we had what's called Cushing's triad. That told us he had a raised Intracranial Pressure (ICP) which meant he was big big sick. I think his friends started to realise the gravity of the situation but despite this, they were fantastic. They phoned his parents, they got all his details, his allergies and passed us everything we asked for. I lost count of how many times they ran back and forward to the ambulance. We started bagging him as he began having prolonged periods of apnea. I looked up and saw 3 orange jumpsuits walking towards me! And breathe!

HEMS took over which was a relief! He was intubated and immobilised. We get got him onto the truck and after attaching him to monitoring we blued him in to the nearest trauma center. There was a lengthy discussion about whether or not to perform Rapid Sequence Induction (RSI) on him (basically, put in a coma) and breathe for him but the risk of raising his ICP was to high. We just ran! At hospital HEMS gave the handover and although I normally love the drama of a trauma handover to 20+ people, I was glad to pass the buck on this occasion. In vast contrast to the the jovial mood we were in on route to the job we were left in a bit of a daze. You really do never know what you're going to walk into in this job, maybe that's why I like it. I was pleased to find out 2 days later that he was recovering well in ITU. Hopefully in the future he'll give lions the wide berth they deserve. For me though, it was another life saved! Whoop!

The Concrete Jungle

"19 year old male, ? Heroin overdose, history of violence *LOCATION MATCH"

First job of the day, it was early on a sunday morning, we were tired and a tad grouchy. As soon as the job came down our radio started ringing.

"Don't approach, police on route, the patient is violent. Hold for police"

Dur!! As if we were going to be cavalier.  Location match is a red flag. Previous crews have flagged the address as dangerous so either he has been violent or someone in the address has been violent. We would be waiting and then hiding behind lots of police officers! We arrived at the same time so grabbed our stuff and followed them up. It was in the middle of a council estate and one the countries largest. It contains almost 2000 homes and although still popular with the elderly residents, due to schemes like 'care in the community', problems came to fruition when large volumes of vulnerable and disadvantaged people became isolated from society. Concrete jungles like this are vast. This particular one has over 6000 residents and takes 20 minutes to walk from one side to another. The road network through the estate is scattered and complex making navigating for us and patrolling for police extremely difficult. In all seriousness the area is simply too large to police effectively and as such it became a breeding ground for crime, drugs and antisocial behaviour. On an estate where deprivation and violence are commonplace, hopeless life is the norm leaving children without ambition and little prospect of bucking the trend.

As a result, we end up with our patient. A 19 year old male, high on drugs, unemployed with a criminal record longer than the ancient scrolls of Jerusalem. He had no education, his mum was an alcoholic and his dad was in prison. His 3 brothers were all in the same boat as him. We entered the block via the large metal door, a small window hole showed the remnants of the glass that had once been there, bloodied tissues lied in pools of urine and tinfoil stained with crack drifted around the stairwell like autumn leaves. As we climbed the stairs, passing the masses of graffiti we could could hear the commotion. He was smashing up the flat. He was high on MDMA and Trips. He was hallucinating and being violent towards neighbours and his family. We didn't get near him. The police brought him to us already restrained. There wasn't much for us to do other than monitor him. He needed to be sedated at the hospital so for us it was a bit of a non job but it highlighted the problems we, the police, the government and the residents of council estates face.

This job was symptomatic of the problems that are common place all over the country. There are over 6 million people living on council estates in Britain and a large percentage of these people are living in properties that are rundown, isolated and abandoned. In the heart of every thriving city in Britain is a second city. A city hidden from visitors. A city hidden from public view. A city the government would like to forget. A city where more often than not, good people are kept prisoners by the fear of gang rule. And what chance do the police have? A few years ago on this estate, there were 6 officers and a sergeant dedicated to patrolling the area. Admittedly that isn't much for the size of it but dropping it to just 2 beat officers under the Tories has seen a lot of the good work undone. Despite the £12.5 billion flurry of initiative under recent governments promising the 'big society', promising community improvement, promising re-galvanisation, promising criminal justice and promising more policing the mish-mash of projects has produced very few results and have made little to no dent in the growing level of violence and drug abuse in deprived urban areas. Street violence, drug dealing, robbery and burglary have risen and the much vaunted Anti-Social-Behaviour-Orders have become a prize more than punishment.

These estates cause a huge financial burden on the tax payer in both policing costs, medical cost and benefit costs. Unemployment is high, benefit fraud is rife and crime is huge. With unemployment so high it is of little surprise that poor diets and abuse of drugs and alcohol cause a strain on ambulance trusts and local hospitals. This job alone required 12 police officers and an ambulance, let alone the hospital stay and the administration costs of sending him back to prison for breaching his bail. Then there are the costs of keeping him in prison. Multiply this un-isolated job by every estate the country over and it is painfully clear why a decade of broken promises and failed costly initiatives have put the country in a state of economic fragility. Fix housing, fix policing and fix the benefit system and you'll go some way to fix these communities. Or instead we could spend £10 billion on hosting the Olympic, allow bankers multi-million pound bonuses from tax payers profits and fund ailing countries in the Eurozone. The problems faces by communities all over the country can be summed up by one word: Poverty. Poverty of income, poverty of opportunity and poverty of expectation. Poverty is a term we use for 3rd world countries but it is a real problem that exists in our own country. A country billed as 7th richest in the world. Something isn't right is it?

Poverty in the UK

  • Worst in the EU, longest working hours, lowest social spending
  • By EU decency threshold the minimum wage should be £7.87. It's £4.98
  • Three times more UK children fall beneath the poverty threshold than in 1970
  • The base wage for the bottom tenth of the population is worse than 30 years ago (relative)
Crime in the UK
  • 1% of the population suffers 59% of all violent crime
  • 2% of the population suffers 41% of all property crime
  • Most criminals commit crime within 1.8 miles of their home. 92% of these criminals live on council estates consumed by poverty and criminalised by war against drugs
  • A lone 18 year-old woman with a child is five times more likely than average to suffer from crime

Homes in the UK

  • Almost 6 million people - 10% of the population live in Britain's 2.9 million council homes
  • A further 3 million live in homes that have left council control since 1988 through 'Right to buy schemes'
  • Since the public sector reforms in the 70s many traditional jobs done by council tenants have been contracted to private companies making tenants less secure and worse paid. 62% earn less, 73% have fewer holidays, 53% have worse sick pay, 51% have worse pensions and 44% have less security
The longer these council estates are left to rot, the bigger the social disparity will become, the higher the crime rates will be and worse off this country as a whole will be. Lets get our own house in order before we try and fix others.

Friday, 27 January 2012

I smell a rat

"25 year old female, collapsed"

It is extremely rare for a 25 year to collapse from anything other than drink or drugs. If it is genuine there is normally an underlying medical condition like epilepsy or diabetes. Seeing as it was on a weekday morning in a shopping centre and due to the low priority nature of the call it had the billing of complete and utter LOB. Shopping centres are generally pretty dire places to access. It normally involves being met at a service entrance by a security guard with a very poor grasp of the English language and then directed through a maze of corridors and service lifts to the back rooms of whatever shop you're called too. Obviously, all the kit and a chair (just in case) need to be carried all this way too. Massive pain the the proverbial! Today was no different.

'Access vie service gate E, south side, escort to meet crew at gate'

Arse! Just as we feared! We pulled up, grabbed everything we may need, knowing in all likelihood we wouldn't need anything but better to have and not need than need and not have. After what seemed like an age we arrived in the back rooms of Primark. And let me assure you, the back rooms are of similar high quality to their stock! We were directed to a white door. A door without a window and a digital keypad entry system. A small blue sign was screwed to the door. 'Detention Room'. The penny dropped. 'Collapse' was code for 'Caught'. Sure enough, inside was our shoplifter....sorry, patient, feigning unconsciousness on the floor. A few quick checks, some painful stimuli and the audible threat of a nasal airway soon roused her to GCS 15 albeit with chest pain. And may I add, it was GCS 15 with a chip the size of Peru on her shoulder.

Despite my attempts at reasoning with her and laying out in simple English that pretending to be ill would have no positive effect on her wishes not to be arrested, she persisted with her ailments. I explained the waste of resources, the costs she was causing and the possible consequences of wasting an ambulance. Nothing. Whilst I continued to hit my head against a brick wall the police arrived. They had already reviewed the CCTV so when faced with denial they spelt it out plain and simple

"We watched you fill your bag with clothes and then walk out of the shop without paying. You are being arrested. If you continue down the illness route I can assure you I will double the length of time in the cells."

The total value of the goods she had stolen was £13.50. She had also been on the take in Matallan, this time forgetting to pick things without security tags. Hook, line and sinker. If you're going to risk arrest, risk prison and risk a criminal record at least make it worth your while! Strangely, as soon as she was caught by security guards cue the collapse, cue the chest pain, cue the inability to talk, cue the dizziness. Call me a cynic but I smell a rat.......And so did everyone else. Luckily for me the prospect of a prolonged stay in the cells encouraged the thieving little toe rag to make a miraculous full recovery. Despite her now medical well being her unparallelled insistence of innocence was laughable. It never ceases to amaze me the lies and stories people fabricate despite being faced with conclusive undeniable evidence.  Luckily for us we were done and didn't have to listen to her spouting off about the injustices and conspiracies that were being levelled against her. We could leave. Jobs a good'un!

Thursday, 26 January 2012

Fire Brigade: Hands off our service

In the news today were a number of articles regarding the London Fire Brigades audacious bid to take over control of the London Ambulance Service. Their main argument this time is the value of property that the LAS owns and how merging ambulance stations with fire stations would save the £50 million. As the spending of public sector money is at the forefront of the news and political debate it is of no surprise that their proposal has turned all the heads the LFB intended. With apparent backing from the London Assembly and various areas of the Tory government it is perhaps a sign that the latest effort of the LFB to gain control of the LAS may this time be more fruitful. But let's not be fooled. The 'shared station facilities' and 'joint working' are just political jargon for 'land grab' and 'LFB takeover' and if it wasn't for £80 million valuation of LAS property there wouldn't be a peep about it. I'm watching keenly to see who this many effect other services around the country too.

This isn't the first time the LFB have tried to get their hands on the LAS. In recent years they have made moves to try responding to Cat A calls stating their response times are much better so could be on scene quicker. Admittedly, the amount of time LFB spend sitting on station playing pool, basketball, table tennis and hero makes it easier to respond quickly. They don't deal with anything like the call rate the LAS deals with, in fact they only receive 15% of the calls that we do in a 12 month period. Compared to the 1.5 million calls that come through our control room the LFB receive less than 230,000, they mobilise on only 60% of those (138,385) and of those calls only 21% (29,215) were fires. Of the calls the LAS received in 2010/11 1.1 million were activated on an of these 347,675 were deemed immediately life threatening. Until the LFB can show they would cope under such high demand with a much smaller budget maybe they should concentrate on their own budget and their cost to the tax payer.

The power struggle they are seeking smacks of desperation. Desperation to justify their existence and the extensive budget the receive. Maybe it's a convuluted way of staving off the threat of privatisation. Who knows?! Each year they receive roughly £437 million from the government compared to £288 million that the LAS receive. Taken into account call volume it seems a vastly generous and unnecessary figure. Why do they need so much? With less staff and less work load why is there such disparity in the budgets? Maybe they should look at ways to cut their costs rather than ways to cut ours. They cost the London tax payer £60 a head for the service they provide compared to the £30 it cost per head for the ambulance service. In the reports today about how much they could save the tax payer, nothing is mentioned about their recent financial indiscretions. No mention of the £500 million of wasted tax payer money last year with wasted unused vehicles, ill conceived new control rooms and coffee machines! For the full report see http://www.bbc.co.uk/news/uk-14974552. Brian Coleman, chairman of the LFB admitted to a government committee that they had spent £25,000 on a coffee machine at one of their London centres. How frugal of them!

Another point which should be made is that throughout all their latest takeover efforts, there hasn't been a mention of patient care. Just money. At the end of the day, the ambulance service is there to provide care to the people that needed. The LAS is the largest 'free at point of contact' ambulance service in the world. Like every NHS and organisation it has its faults but on the whole an excellent service is provided to our patients. Yes, savings need to be made and yes, there is always room for improvement but those savings and the improvement needed does not come in the form of the Fire Brigade. The arrogance from 'Pet Rescue' that they could swoop in and save Londoners millions is not only unrealistic but would be a huge risk to our patients. Whats next? Will they want to take control of the police, coast guard and RNLI? They could be an all singing all dancing ultimate emergency service with a huge budget to boot! The could be called the 'London Fire Fighting, Crime Stopping, Life Saving Service'. Maybe then and only then would they be happy. 

What I hope is that the LAS continues to rebuff any attempt by the LFB to gain control. The Cheif Exec Peter Bradley has always been outspoken on the issue and today released the following comments:

“While we are happy to discuss opportunities for greater collaboration between emergency services, we believe it is vital that the London Ambulance Service remains part of the NHS."

“We are an integral part of the health service in the capital, delivering world class care to Londoners, day in day out. Our track record shows we are managing increasing numbers of calls while improving our response to the most seriously ill and injured patients."
“The suggestion that savings of £500m could be made by merging stations is completely unrealistic. We respond to around 1.1m incidents a year with a budget of just £288m - providing excellent value for money."
“Our award winning emergency control room is the busiest in the world. We take nearly 1.5m calls a year – more than all 46 English fires services put together. And it costs Londoners just £30 a head for our service compared to £60 per head for the fire service."
“We do want to work more closely with our emergency partners. Where it is operationally practical, we will look at sharing facilities and at joint purchasing arrangements. We are in the process of organising a meeting at a senior level with the Metropolitan Police Service and the London Fire Brigade to improve collaboration between services.

“However, our job is to deliver clinical care to Londoners and, as the London Assembly review concludes, we can do this most effectively if we remain integrated within the health service.”

Well said! The LAS doesn't need help, it has made significant cuts in it's budget quicker than expected and way over and above that of the fire brigade, and the sooner they leave the LAS alone and get their own house in order the sooner they may start to chip away at their exorbitant overspending. 

The Glamour and The Glory...

"38 year old male, abdo pain, feels hot"

It was my first shift for 3 weeks. To say I felt rusty would be an understatement. I arrived at work early, brushed the dust of my kit and loaded it on to the nicest looking truck. Being on a 6am start has its advantages. You get the first pick of vehicle, generally go by the newest registration plate, check its got a Radio / CD player that works and looks generally clean. Today I got a brand new truck. I did the VDI and went to wait for my crew mate. 6am came and went, as did 6:30am. I was single. This meant it was likely a  relief would be sent to work with me from somewhere. At 8:00am my 'carer' for the day arrived. I gave a sob story about being out of practice and lacking confidence and they let me drive. Excellent start to the day!

The morning flew by without event. No one was really ill, a few elderly fallers, a bit of mental health and a no injury RTC. No one had needed carrying and only one had gone to hospital. We had managed to get breakfast, Starbucks and the sun was shining. We were sat with an FRU at a local standby spot sharing war stories, trials and tribulations when we were rudely interrupted by the MDT screaming and radios vibrating. The job was miles away, and despite our polite moans to control we were the nearest ambulance. Apparently! Judging by the details we were given I wasn't excited. In actual fact I was utterly underwhelmed, this guy was more than likely going to be a complete time waster. I predicted to my crew mate that he would have had symptoms for less than 24 hours, he wouldn't have taken any Paracetamol, would be lying on a sofa and there would huge TV, far to big for the living room it was set in. 

I was correct on ALL counts. There he was, a dying swan with nothing more than a mild stomach ache and feeling hot. He didn't even have a temperature. He also didn't want to go to hospital. We decided that as he was staying at home we'd do an ECG just to tick that box. I disappeared off to the ambulance to get the Lifepack 15 and the paperwork. I trundled back to the house, through the lobby, through the carpeted hallway and through the carpeted (cream) living room, across the beige rug and to our patient. I started attaching the leads when suddenly my senses were offended. A foul smell engulfed the room, everyone could smell it, I instantly assumed it was the grotesque moron sitting in front of me. I recoiled back slightly to get away from the source of the smell when something caught my attention in the corner of my eye. A brown smear on the carpet. To my horror, it wasn't alone either. Like a trail of breadcrumbs from Hansel and Gretel my eyes followed patch after patch across the carpet and out of of the room. I stood up revealing a huge trodden in stain where i was crouching. I looked at my left boot. Nothing. I looked at my right. Covered. Covered in dog shit. 

My head sunk. I was mortified. I apologised profusely, promising to clean up. I tip toed out of the room, cleaned my boot as best I could and returned with gloves, spray, wipes and a bin bag. There I was, 3 years training and countless hours on the road and it had come down to this. Me, on my hands and knees, wearing rubber gloves, scrubbing dog shit off a patients carpet. The smell was horrific. I was gagging, sweating and red faced. As the patient and my crew mate watched on in amusement I worked my way across the room scrubbing away, patch after patch. My day had taken a dire turn for the worse. This was as bad as it gets. This was my day. This was my life. This was the glamour of the emergency services. This was the glory which isn't shown on 'emergency bikers'. C'est la vie!

Wednesday, 25 January 2012

Was it worth it?...

"Running call, male fallen off motorbike"

We had been called to an 1 month old cardiac arrest. After a slightly manic drive and a brisk walk up 3 flights of stairs we were greeted by the FRU with a crying baby in his arms. Clearly not as given! The baby had vomited some milk. Perfectly normal one might think but for the mother, it warranted an ambulance. Despite the apparent well being of our patient due to a service policy of conveying under 2s to hospital, off we went.  Our route to hospital took us on a rather large duel carriage way. It was about 6pm, rush hour, dark and raining. A motorcycle overtook me at about 60mph, then proceeded to swerve in-front of me. His back wheel was all over the place and then he lost it. His bike went over and he was thrown up into the air. Everything seemed to stop and produce clarity, I was watching him fly through the air in slow motion, his arms waving, his body rotating, helpless to stop, bracing for impact. Suddenly, it sped up again. I slammed on my breaks, stopping feet from his bike and he hit the floor. He bounced and rolled. And rolled. And rolled. He came to a stop. He was lying on the bank of grass on side of the road, motionless. 

I jumped out the truck, grabbed some bags and went over too him. Amazingly he was conscious, albeit in pain. My crew mate called control and requested a second ambulance. Due to the winter pressures however, there was no one available. A car was on route but that was all for now. I began assessing the patient, amazingly, he only appeared to have cuts and bruises. A possible fractured leg but nothing serious. No head injury, no apparent spinal injury. Needless to say, we treated for a spinal injury, he was collared and boarded, his leathers were cut off and he was fully immobilised. His voice was a bit slurred and initially I put it down to concussion but the more we spoke the more I wasn't convinced. Eventually the FRU arrived. Due to the lack of second ambulance we decided to put our mother and baby in the car and we'd take the motorcyclist and then we'd all go to the same hospital. We loaded him on to the truck, in the dry and re-assessed. Out of the rain and the wind it became clear exactly why he lost control. He was drunk. And not just a little bit drunk, he was plastered. 

We requested the police and headed off to hospital. He was 18 years old, had just started university and delivered pizzas in the evenings. In fact, he stated he was on his way to work. His boss and rung him to say he was supposed to be there and rather than say he'd been drinking all day, decided to go in. He had had over 3 litres of cider and numerous shots throughout the afternoon and didn't really see the ramifications of what was going on. He was only 18 with his life in front of him, he was going to be arrested, he was going to be charged and going to be convicted of drink driving. He was going to have a criminal record. He would have a fine to pay. He was going to lose his licence, he was going to lose his job. He was going to lose his income, he going to lose his independence and was going to seriously effect his future employability. Despite all of this his main concern was whether or not his bike was OK. I didn't have an ounce of sympathy for him. I tried to explain that the law about drink driving isn't there to be a killjoy. It's there to save lives. He is lucky no other vehicle was involved. He was lucky that the powers that be protect drunk people form serious injury. He was lucky he wasn't killed. He was lucky he didn't kill anyone. He didn't seem to care.

We arrived at the hospital and wheeled him to the corridor where we waited our turn to handover.  Moments later the police arrived. Being strapped down to a board he didn't see them walk in, it wasn't until one of their faces peered over his that he realised just exactly what he'd done and what the consequences were. Que the penny dropping. Que the tears. Que the remorse. Que the request for mum. Que the fear. Que the handcuffs.

Saturday, 21 January 2012

Obesity: The cause, the cost, the solution

"48 year old female, keeps fainting, patient is obese, weighs 35 stone"

A few months ago I wrote a blog called ‘Fat people, stairs and backs’. This particular post received a lot of praise but also angered a few. It was suggested I criticised without foundation or research and offered no reasoning to may argument. I did a follow up  post  which was a knee-jerk reaction to a rather abusive e-mail but decided I should in fact back up what I was saying with a much more researched piece. So I did! I wanted to look at the social reasons behind obesity and what impact obesity has when not prevented in childhood. I also wanted to highlight the benefits of using prevention rather than cure in tackling such a huge social problem. 

Obesity is a significant societal trend with effects being felt throughout the health care system, economy and society as a whole.  A person is deemed overweight if their body mass index (BMI) is between 25 and 30; a BMI over 30 is classed as obese and a markedly increased health risk. I attended a middle-aged female who had been experiencing DIB for several days as a result of chronic heart failure and episodes of fainting. The patient was of low socioeconomic status, weighed 35 stone and was in her upstairs bedroom.  We began treating her breathing while carrying out a risk assessment of her extrication.  Her condition was deteriorating but due to her size we were unable to safely carry her down the stairs. The decision was made to mobilise the fire brigade to assist us and the bariatric ambulance was called to convey.  The patient was taken out of the house through the window by a crane. This caused considerable delay in her receiving definitive care and despite aggressive management at hospital she died shortly after arrival. What led the patient to be in this position? Why was nothing done to avoid this situation? Why was she allowed to stay like this? How long had she been like this?

The NHS has been forced to focus on treatment of illness rather than prevention due to increasing demands and costs.  This leads one to question, however, where the responsibility for obesity prevention should lie.  Obesity costs the economy not only in health care but also in sick days, workplace injuries and disability pay.  Not only is the prevalence of obesity increasing in the Western community, those who are overweight are also heavier. This paints a bleak picture of a problem which has increased rapidly since the 1970’s; despite being on nearly every major government’s agenda.  The literature is focused towards prevention because ‘cure’ is a nearly impossible ideal and to achieve this we must look at children.

Nearly a quarter (23.1%) of children are overweight or obese by the time they start primary school, this increases to over a third (33.4%) by the time they finish. Health promotion is fraught with difficulties in school aged children as poor management of obesity can result in life-long unhealthy eating habits and avoidance of medical help. Our patient may have had a negative experience with a health care professional and avoidance behaviour is common in obese patients who do not want to be lectured or humiliated. Conversely to the conception that patients will use an illness to seek attention from their doctor, obese patients often avoid this interaction. There is risk of promoting the ‘sick role’ with obese children and all children could benefit from nutritional and physical activity advice. This should not be taught as ‘treatment’ for overweight children who may feel they have an illness as a result.

Obesity is not a disease, however it does appear to spread through social ties. There is literature to support that neighbourhood does increase childhood obesity especially when coupled with a lower socio-economic status. I firmly believe it is time for people to assume personal responsibility for the improvement of society. Although our patient’s obesity is juxtaposed to this ideal her individual community may have made her weight more acceptable. In the school environment however, a lower SES and being overweight are both major factors in teenagers suffering social marginalisation. This leads to emotional distress, low self esteem and lower expectations of their educational future . It is pertinent to note that class position is responsible for health, health does not determine class.

Careful education is imperative for these young people but education needs to be extended to the home. Our patient may have been obese for a number of reasons, however, it is likely she developed obesity from a young age. Poor family functioning, authoritarian parenting styles and single parent families have been cited as factors increasing the risk of childhood obesity . Other factors increasing the risk within the home are stressors; stressors in adults have been linked to obesity, this could be attributed to poor eating habits among stressed individuals and with a huge increase in incidence of stress these days it is of little surprise there is a similar increase in obesity.  This phenomena has been extended to children with specific factors being recognised for younger and older children. A positive association with obesity has been found in younger children who have a lack of cognitive stimulation and emotional support, whereas older children who live in a household with financial strain or members experiencing mental or physical problems (which could be a result of obesity) are at increased risk.

There is a strong correlation between obese parents and obese children and while there is an argument for a genetic predisposition, environmental factors are thought to be the most important. The increase in obesity has occurred among all socioeconomic groups therefore cannot be explained by genetics alone. Genetics can increase ones risk of developing the wide ranging complications of obesity, such as diabetes, high blood pressure and heart disease, some of which were observed in my patient. Obesity is associated with many chronic conditions  the cost of which have a huge impact on the economy. The parliamentary committee omit some of the most expensive areas of the cost of obesity from their calculations  this made it impossible to glean accurate figures for the true cost of obesity. It is estimated obesity costs the economy £4 billion a year and this is expected to rise to £6.3 billion a year by 2015. This kind of required financial support is not sustainable so a way to prevent the need for this financial burden is urgently needed.

Schools are the most appropriate setting for prevention, and therefor there is little we can physically do in the ambulance service other than refer.  The health promotion these kids need should only be undertaken by specialist educators as the message can be distorted.  Poor management can lead to starvation, laxative and slimming pill abuse amongst other drastic measures at a time when nutrition is vital for their developing bodies. If childhood obesity is allowed to progress to adulthood without specialist intervention the individual increases their risk of physical, emotional and social problems in later life.  I do not know the cause of our patient’s obesity or why it was allowed to continue to the situation I met her in.  Unfortunately, my patient did not get the help she desperately needed but hopefully if the right people set up the the right referral process maybe we as a nation can get to a point where prevention is a realistic option.

Chavs and the appendix

Am I a snob? Probably! Am I opinionated? Without a doubt! Do I like chavs? No! I don't care if that offends anyone to the point of leaving! I doubt any would actually read an ambulance blog other than to look up our phone number! The thing that really irks me in general is the calling of ambulances for 'sick' children only to refuse to come to hospital! I reckon any parent who reads this post will do so shaking their head slightly. Then again, that will be of no surprise, as I doubt anyone reading this would actually be so mindless! Kids get ill, adults get ill, it's a fact of life. Ill doesn't necessarily mean ambulance, but if you do need one, you should fully expect to go to hospital as that is where we take ill kiddies! And whatever happens do not, and I mean DO NOT say 'whatevs' man' to me!

"3 year old female, feeling hot, to sleepy to walk to walk in centre"

It'd been a good day. I had good crew mate, a nice lunch, reasonable patients and had stayed in area most of the shift. Obviously, the powers that be were aware there was a crew in high spirits so to restore the equilibrium they sent us to an area that generally makes my stomach turn. It was just wall to wall tools. With all the moans and groans that are associated with going to this area we trundled off, already bitching about what we were on our way to. A quick glance at the map showed us that the address we were going to was less than 200 yards from the walk-in centre. Why on earth did they need an ambulance for a child? Too sleepy to walk? Carry her! 

We arrived at the front door which was hidden down an ally way behind some shops. The rubbish and clutter outside told us exactly what was going to be inside. Our patients mother opened the door, it was a sight I've described a dozen times in my blog. Peroxide hair, multiple piercings, velour tracksuit bottoms, chewing gum and talking like she was from the ghetto. Innit! A chav personified. She took us through the bombsite of a kitchen to the cesspit of a living room where one of her four children were lying asleep on the sofa. 

"So what's the problem today?"

"She 'ad a tummy ache this morning and now I fink she is hot, ja no wot I mean"

"OK, have you taken her temperature?"

"Nah I don't 'ave one"

"Have you given her any calpol?"

"Nah I don't 'ave any"

"Has she seen a GP"

"Nah we ain't been able to do dat"

"How long has she been unwell for? Have you or your other child been unwell recently?"

"Just today, she 'ad a tummy ache, innit"

"And you or your other child?"

"Nah but a lot of my family have pelvic problems, my mum and my sister 'ad theirs removed. They got proper ill first and had proper bad tummy ache so I thought she might have dat"

"Do you mean appendix? Did they have their appendix removed?"

"Yeah, dat one"

Whilst this conversation was going on my crew mate had tapped the girl on her shoulder to wake her up and was talking to her whilst doing her OB's. Normal temperature, normal pulse, normal respiration rate, generalised abdo pain and she had vomited once this morning. She couldn't have calpol because mummy had used it up yesterday when her 5 year old sister wasn't well. Clearly, the 3 year was more articulate and more able to give a clear and concise history than the apparent adult. I say adult, but she she  didn't look a day older than 17 at best.  Meanwhile, my painful conversation was continuing.

"I don't think she has appendicitis. Why didn't you take her to the walk-in centre?"

"Cause she was too sleepy so I called 999. Could it be Mangitus?"

"No, it's not Meningitis, get your stuff together and we'll take you to the walk-in centre so she can see a doctor"

"Wot? You're gonna take us?"

"Well yes, that's the idea!"

"Nah, it's OK, I'll walk her there in a bit"

"So why did you call us, if you didn't want to go to hospital?"

"I just wanted you too check dat she was OK to walk there and needed to go der so I didn't get der and waste my time, innit"

"That's not really what the emergency ambulance service is for"

"Ah whatevs' man, it's OK, you can go now"

Luckily for me, my crew mate had been obtaining all the details I needed for paperwork so as my conversation came to its abrupt conclusion, I was able to disappear to the ambulance without the need to ask inane questions. What a moron! What a waste of time. I dropped the paperwork back in a few minutes later. Strangely though, I wasn't livid. Maybe I'm becoming numb to the nonsense! Pelvic removal......Pah!!

Friday, 20 January 2012

Rock and a Hard Place.......

"74 year old male, DIB, Lung cancer patient"

Every day, there is constant battle between ambulance staff and elderly people. This stems from their need for hospital, our wish to take them and their refusal to go. Sometimes we win, sometimes we loose and visa versa. On the occasions where we loose and they win, invariably we try to refer them on to a GP or another appropriate care pathway so their condition can be assessed / monitored / treated at home. Sometimes this less disruptive option is the most suitable for both parties anyway but sometimes it's the last resort and merely an arse covering exercise. Getting a GP to call is easy, getting a GP to visit.........not so much!

We arrived an Lenny's house mid morning. We were met by the housing warden, who had called us, at the front door. She explained that he didn't trust the NHS as a whole, he hated doctors, despised hospitals, disliked nurses and isn't too keen on ambulances. He had recently been diagnosed with lung cancer but refused to kick his 40 a day habit or take medication. She was concerned he was having breathing problems. I went in with my biggest smile and was met by his biggest scowl. After about 20 seconds I won the battle of wills. I got a smirk out of him. He was a lovely guy. A true cockney, speaking in rhyming slang where he could and was most impressed I replied in kind! The crux of the matter was, he had a chest infection. He had a slight temperature, fast heart rate and a productive cough. He made it perfectly clear, under no circumstances whatsoever was he going to hospital and to be perfectly honest, a GP visit would suffice. I took his GP details from the warden and noticed his GP wasn't anywhere near where he lived. It turns out he had only moved to the area 3 months ago and had been struggling to get registered with the local GP. Let the fun begin......

I called his GP and unsurprisingly they were not interested in travelling the 9 miles to see him. Right, the local GP it is. Apparently, the reason he wasn't registered was that the surgery has a rather archaic system where by the patient has to go to the surgery for a consultation to get registered. As Lenny's mobility was poor and he had no means of transport they were not willing to register him. Surely not. After waiting 8 minutes for a receptionist to answer, I explained who I was and who I was acting on behalf of. She suggested the patient make his way to a walk-in centre. I said he can't walk. She told me he would have to come for a consultation next week. I said he wasn't able to get there. He was elderly and immobile. She said he'll have to make do without a GP. Brilliant! I offered to come and get the registration forms, get them filled out and bring them back. She refused. He has to come in person. I asked to speak to a GP as I wanted one to come and visit him, and while they were here, register him. She refused. I asked for he name. She put me through to the GP. I regaled my whole story AGAIN and was told in broken english he would have to be a registered patient if he wanted a home visit. 

"How is he supposed to register then?"

"He'll have to come here"

"But he can't walk"

"Well he can't register here then"

"Surely, you have procedures in place for immobile elderly patients"

"No, this has never happened before"

"Well what do you suggest, he is ill, he has an infection, his GP won't come, you won't come or register him and your receptionist won't let me come and register him. He is entitled to treatment"

"Well why don't you take him to hospital"

Silly me, why didn't I think of that. Such a simple solution. That's why they are GPs and I'm an 'ambulance driver'. That degree in medicine really does scream true. Prat! Without swearing I explained AGAIN that he was refusing hospital and had capacity to do so. A GP was my only option short of leaving him at home to become septic.

"Well I'll write a prescription of Penicillin for him to pick up, when he's better he can come and register"

"Firstly he's allergic to Penicillin, secondly he's immobile and his osteoporosis and arthritis are not going to get better"

"OK, I'll write a prescription for Amoxicillin and you can pick it up"

"But you haven't seen him, you don't know his observations and won't he also be allergic to Amoxicillin?" (Worrying!)

"I meant Erythromycin, I don't need to see him, they should work"

"Fine, that's your call, not mine but how does he register"

"He'll have to make an appointment and come in"

Aaaaaahhhhhh! I admitted defeat! I couldn't go through it again. I'd got him some medication and hopefully that did its thing. We left Lenny to his busy schedule of chain smoking and NHS hating and to be fair, I see his point. It took me a 27 minute phone conversation to get him nowhere nearer to having a GP. I filled out a vulnerable adult form with my concerns so what will happen I don't know. He appears to be stuck between a rock a hard place, and with no one willing to shout for him I fear he'll just fade away quietly. How can a man who paid tax and national insurance for 50 years not be entitled to a GP because of his inability to physically go to the surgery? Madness! And the government want to put the GP consortium in charge of the NHS? God help us all!

Tuesday, 17 January 2012

Diminished Responsibility or Bad Policing?

 "18 year old male, going out of his mind"

In my line of work I often get the opportunity to work at various events as a medic with private companies. I mainly work at festivals as it's a good chance to see some good music whilst getting paid. Win win! Last year I worked as a medic at Bestival on the Isle of White. It was a great weekend, I got to work with new people, got to work on an array of different vehicles and although the majority of jobs were drink and drug related it was pretty easy stuff. Pick 'em up and drop 'em off at the field hospital where they were monitored then discharged. It worked pretty well. At about 9pm on the Sunday evening, which was the last night, and while the headlining act was on I was sent to one of the campsite hubs to attend a girl with breathing problems. We jumped in our 4 x 4 buggy and headed over. It was a panic attack. Nothing special. Whilst talking to her however a steward came running over.

"Can you come and help us, there is a guy just up the hill going out of his mind, I think he's on something"

I radioed it in and headed over. I left my cremate who was a first aider to stay with the panic attack and went with the steward in the buggy to the space cadet. It was about 200m from wherer I was and about 20m into the campsite. I clambered over the guide robes and tents and eventually got to the guy. He was about 6ft fall, skinny and clearly wired. His friends were all stoned and laughing at him and said he'd taken a 'molly' of MDMA. MDMA or Methylenedioxymethamphetamine to be flash is basically ecstasy. A 'molly' means that instead of a tablet it's in crystalline or powder form. This was the drug of choice for this years festival. Last year it was Ketamine but MDMA was the order of the day this year and by all accounts it was a pretty potent batch. 

I gathered that the patients name was John. I tried talking to him but he was indeed out of his mind. He was hallucinating and begin to get quite panicked. I wanted to get him out of the campsite and onto the path but when I turned round to get assistance from the steward he had gone. I was on my own. As I turned back to John he punched me in the face which knocked me to the floor and then proceeded to jump on me and try and strangle me. His friends came to my aid and between us we sat on him. I was able to press the emergency button on my radio and after a few minutes stewards came running over and we got him to the buggy. He head butted me and spat in face numerous times until the police arrived and handcuffed him. I had a fat lip, a swollen face, cuts to my neck and general bumps and bruises. He was arrested and taken to the hospital. Once at the hospital the Dr gave him a hefty dose of Midazolam to subdue him. My boss made it clear the company would fully support me to press charges and were absolutely fantastic about the whole thing. I was told  by the police to come back in a few hours to give a statement. 

In the hours that passed, I returned to work and John came to. He was taken to the welfare tent to sleep it off and had been rather apologetic by all accounts. Too little too late! At about midnight, after my 12 hour shift I went to give my statement. It started off as all statements do, blah blah blah but then the following conversation occurred.

"So do you want to press charges?"

"Yes, definitely"

"Why? Don't you think that's a bit selfish?"


"Well he's only a kid and it will stay on his record, that'll ruin his life, besides he had diminished responsibility because of the drugs"

"So, he assaulted me, drugs or no drugs, it's no excuse"

The other officer in the room then came wondering over and pulled up a chair as if I was being interrogated. I was only a desk light in my face away from a scene from Law and Order!

"I know it's no excuse but be realistic. If you press charges we have to provide officers to take him back to mainland, what a waste of resources, especially when he won't be charged with anything?"

"Why won't he be charged, he assaulted me?"

"Yeah but you've got no lasting injuries and at the end of the day it's your word against his"

"So what!! Look at me"

"Well if you do press charges we won't be recommending it goes any further, you'll just be wasting everyones time for no reason. At the end of the day, it's a festival. Things work differently"

"OK, this statement is ending here, it will be continued after consultation with my bosses and your inspector in control. I have both of your shoulder numbers. Goodbye"

With that, I stormed off to the office. A expletive filled rant ensued and my boss marched me off to see the inspector. A long conversation followed and at 2am the inspector decided to take be back for my statement and to press charges. I waited outside while the inspector had a very heated discussion with the officers. He then came out to me with an awkward look on his face.

"I'm afraid that since you left here earlier your attacker has been released without charge. We have his details but don't know if they are correct. I'm very sorry, we can take your statement and if we make contact with him charges will be pressed."

I just walked away. Since when did the police show such disregard for the law and for procedure. I wrote a 2000 word complaint letter but just received a pathetic standardised response. John wasn't caught, not that I believe any attempt was made to find him. Am I over reacting? Do drugs provide a reasonable defence for violence to emergency services? Was it really diminished responsibility? Or was it just a lack of willingness to do paperwork and put in the time? I hope the latter. If copious amounts of drugs is a reasonable defence then that gives all drug user carte blanche to assault who they like, when they like with no repercussions. Shameful policing.

Monday, 16 January 2012

Human Rights? Sorry, my bad......

"42 Male, ? Diabetic problems, ? Intoxicated, Police on scene"

In my experience, a ? is usually a fact when alcohol is concerned. This patient was going to be intoxicated. Regarding the diabetic problems I assumed the police had requested us because the patient was a) Diabetic b) They wanted to make sure he was medically fit enough to be arrested. Sceptical, yes, but I was correct on both counts. We drove down the alley way and were met at the bottom of the steel staircase which led to the flats by one of the coppers. He briefly told us the guy was drunk, under arrest but was a diabetic and was screaming stuff about insulin. And we could hear the shouting from the bottom of the 30 or so steps. Joy! We made our way up the stairs and entered the room. There were 7 cops in there and our patient, handcuffed, writhing around on the floor.

"Careful, he's a spitter"

Foul mouthed expletives were free flowing from him, most of which were racist. He himself was of Iraqi origin but that didn't stop the racial slurs towards the Black, White, Asian and Sikh officers standing around him. They were all amazingly calm and professional and were just leaving him to it. A few quick checks and it became clear, medically he was fine. Unfortunately he then did a pseudo fit followed by feigned unconsciousness. Credit where credit due it was a great effort on both counts. To the untrained eye they were convincing. Sadly for us, due to the duration he kept the act up for the police wanted him taking to hospital. They arranged removal to the ambulance which was a joy to watch. 6 cops carrying a large man, pretending to be unconscious down a large metal flight of stairs in the dark. Eventually he was on our taxi and strapped to the bed. Once I was aboard he began hitting himself in the face with his handcuffs making his mouth and gums bleed.  We headed off to the nearest hospital. I'd like to add at this point it was my least favourite hospital. In fact, I detested it.

The patient appeared to have calmed down and I began asking him the basic question need for my paperwork. I asked him if he was registered with a GP. He starred at me blankly and then without warning spat a full mouthful of blood into face. The police pounced on him covering his face with a swine flu mask.  I cut open a bag of saline fluid and began flushing my eye. We arrived at hospital and I went straight to the sink. I ran the tap over my face, cleaned it with soap but I had been exposed. What to? No idea. He wasn't known to the hospital and wouldn't answer any questions about his health. Because he was under arrest he was obliged to provide a blood sample. I provided one and after a lengthy discussion with the consultant of A & E we decided to hold off on prophylactics until the following day pending blood test result. The risk of intra-ocular contamination is very low but the risk is there all the same. The police left with the patient a few hours later and I went back to work. The rest of the shift passed without incident.

The next afternoon I phoned and phoned and phoned the hospital. No answer. That evening I made the 40 mile journey from where I lived back to the A & E to get the results. I waited and waited and waited. I sat there for 4 hours constantly badgering the staff to find out the delay. A sheepish looking Dr eventually came over.

"I'm afraid both blood samples have been lost"

My opinion of the hospital was clearly justified. They had lost the lot. His sample for testing and my serum save. So I said I wanted to go on prophylactics to be safe.

"I'm afraid it's too late to start them now"

Of course it is. I've been here for 6 hours and have been ringing for 6 before that. No wonder it's too late. I said I wanted to get another sample from him to find out what he did or didn't have.

"I'm afraid it's against his human rights to request another blood sample. He's been discharged and is no longer a patient"

Of course it is. Must protect his rights mustn't we. Don't worry about mine. I now have to be jabbed and prodded to 12 months until I can get an all clear. I decided to contact the police and request a blood sample from them. Eventually I got through to one of the arresting officers.

"I'm afraid he was released without charge this morning once he had sobered up, he isn't obliged to provide another sample. We can ask him but if he says no there is nothing we can do"

Guess what? He said no. I asked about pressing charges for assault. I got an all to familiar response when asking about spitters.

"It probably wouldn't go anywhere as there is no physical injury"

Erm, possible blood contamination?!?! It was like talking to a brick wall. No one wanted to know. Too much time had passed and the animal was protected by his human rights bubble. When will assaults on staff be taken seriously? So what if there is a lot of paperwork involved. We have rights too. Surely we have a right to know if we have been infected? Apparently not.

Compensation: £0
Days sick: 0
Apology from patient: Pending....
Apology from hospital: Pending....

By the way, I got the all clear over a year ago but it still irks me. My employer was extremely supportive and provided everything that they could. It's a shame the hospital and police couldn't provide the same.