Wednesday 28 March 2012

That's a Wrap

"26 year old male, stabbed in the stomach"

When you first come out on the road, it's quite daunting working with lots of different people; people with different experiences, different personalities, different genders, different ages, different attitudes and different ways of doing things. I've probably worked with at least 300 different people over a 4 year period, most have been great, some haven't been, but on the whole it's been good. 12 hours is a long time to spend with someone in a confined, high stress environment and getting on makes it a whole lot easier. As I've said before, working the relief rota is tough. You don't know who you will be working with, your shift patterns and shift times change daily and you could be working anywhere. The long term goal of all staff is to be given a permanent line on a rota with a permanent crew mate. Sadly, I am not there yet and probably have a number of years until I am, but in the meantime there are occasional opportunities to ghost a line. For the best part of a year that is what I've been doing. 

Due to the fact that you are with that person day in day out, 12 hours a day & up to 5 times a week you have to be able to get on. You spend more time with them than your friends and family. As such, as much as I get on with near enough everyone I work with, there are not many I would be happy to work with all the time. I was lucky enough to get the opportunity to work with one of the few and what a blast it has been. It has by far been the best months of my career; not just because I was at my local station, on a regular pattern, with plenty of weekends off and fewer nights; but because I had such a good time doing it. I learned a lot from him and take a lot away from the experience. Obviously I had to put up with his verbal abuse and constant stream of insults, but that's him! What he also did was get me blogging. It was his idea. Maybe he suggested it in the hope that I'd moan somewhere else! Well that didn't happen! We work in a very similar way, we have the same ethos and the same views on health care. A large proportion of my posts have been inspired by his rants so it'll be interesting to see if the tone changes after we are finished! We often moan about the stuff we go to. The 'good jobs' seemed very few and far between yet the LOB seemed to be constant. It seemed to be a running theme!

After months of laughs, good music, crap food and smutty jokes, the dream team drew to a close. @diagnosisLOB & @secondonscene were no more! We have shared a lot together and as a crew have been in some pretty hairy situations. Coming into work knowing that I can rely on him to have my back in the face of violence and abuse is comforting. I trust him implicitly and that makes the rest of the job easy. Although he was the paramedic, all decisions were discussed as a crew. He respected my opinion as I did his. There was no rank pulling or worry about the level of patient care being given. The most important thing with a crew mate is having someone who is not going to lose you your job. That's what it comes down to. That is a security you don't have as a relief.

We arrived at work for our last shift together in what was a rather sombre affair. We are not the types to cry and hug, but we both knew there would not be as many laughs in the months to come. We managed to get a vehicle with a CD player and off we went. It was  a hugely uneventful shift, the dream of a traumatic cardiac arrest to sign off on was fading fast. We managed our statutory McDonalds dinner at about midnight and then the dross continued. We finished up at hospital, cleared down the back of the truck and started heading back to station. We were reminiscing about the good times, the bad times and some of the utter crap we had been to. We debated what had been the best job, the worst job and the best shift. There were a lot, but what sticks in my mind was a job from a previous blog 'She's Gonna Blow'. We still laugh about it 6 months on! Half way through our nostalgic 'remember when' conversation the radio went off.

"General Broadcast, all units, ambulance required for 26 year old male, stabbed once in stomach, please press green mobile or priority to assist"

We had finished work but no discussion was needed. We were 1/2 mile away from the job, we would be the first there, HEMS were on route, as were police, this was our time to shine. This was the one we wanted.

"Red base, we'll take that, we are just round the corner"

Details were given, stab vests donned and we headed round. We were first on scene, shortly followed by an officer and 3 police cars. We knocked on the door. No answer. We knocked again. No answer. On the third knock the door opened. An angry looking middle aged woman was stood in her dressing gown. Clearly the address was wrong. We made our apologies and scuttled off. We called in for a location update. As we did the HEMS car arrived, as did 3 more police cars and another ambulance. They were all on another job; a bottling further up the high street. A bit of investigation from the police showed it was the same phone number that had called them in. They got an updated address further up the road so the 5 police cars, the HEMS car, the officer and the 2 ambulances drove to the new location. The house was in darkness; again there was no answer. This was just another Saturday night hoax. The caller was probably watching us all chasing our tales and laughing. We had to laugh! Not because a hoax is funny but it summed up our time together. We got back in the truck and let Frank Sinatra's That's Life blare out one last time. We sat and listened as we drove back to station enjoying the moment. That was our theme song and its sentiment is mirrored in our outlook on the job. 

We put our crap in our lockers, signed all the drugs back in and signed out. We touched fists and walked to our cars. He turned to me and said:

"It's been emotional"

And it has been. Without wanting to give him a big head, I've enjoyed every minute we've been together and I will miss working with him. This is the point he'd normally look me up and down, snarl slightly and call me pathetic! That's a wrap! 

Nice Try

"25 year old female, a tad disillusioned but fighting back and feeling generous"

It's been the best part of a week since I last blogged, which as my regular readers will know, is a long time. This isn't because I have nothing to say or write about, I do, but a few things happened which led me to step back and ponder. When I started blogging, I did so as an outlet; an outlet for pent up feelings which I wanted to get out. Some were frustrations, some celebrations and some simply anecdotal but most importantly it was for me. I said from the outset that I have always been the type of person that questions right and wrong. Be it politics at local level to government policy, or patient behaviour to staff attitudes I will always ask questions. That is just my nature. I don't care if people don't agree and I don't care if people don't like what I have to say, or how I say it.  All I wanted to do was vent frustrations, share experiences, provoke debate, and educate people as to what life is really like on the road AS I SEE IT. That is what a blog is. It's personal.

As far as I was concerned, and to a point still am, the blog is going well. A lot of posts have indeed created debate, shown some home truths and rubbed a few up the wrong way. Last month, in what was the highlight of my newly found world of blogging; I received nominations for EMS Blog of the Year. For the first time in a long time I was proud of myself. I felt I had achieved something from nothing. Not an accolade but recognition from people who read my ramblings and it was touching to say the least. I had no expectations to be shortlisted and no expectations whatsoever to win. It was just nice to have my blog mentioned with some very well known, established blogs. Unfortunately, this public recognition brought the detractors out of the woodwork. I received nasty messages about my blog and was basically told I have no place in the 'blogging community'. As the competition went on I began hearing whispers via Twitter that a number of people were talking about me behind by back. As childish and playground like this may seem it was true. I was sent copies of messages, screen shots of conversations, the content of which was bringing my professionalism into dispute. Accusations of breaching patient confidentiality were mentioned, and as untrue as it was, it had the desired effect. 

I spent a number of days trying to write posts, but as I did, rather than writing for myself like I had always done, I found myself writing to please others. I started second guessing everything I wrote and my posts felt forced. I began to resent my blog. It was doing the complete opposite of what I had intended it to be. The added anxiety I was feeling about possible repercussions of these accusations caused my already sleepless nights to become pure insomnia. For that reason I closed my laptop and gave twitter a wide birth. I always said I'd blog for as long as I enjoy it. Well, certain people took that enjoyment away. I didn't know if I would come back to it. It kind of felt a bit tarnished. That was until a very close friend gave me a good old fashioned telling off. She told me in no uncertain terms that I cannot let these idiots win. I cannot walk away from something I've worked so hard at and what means so much to me. 

There will always be bullies; there will always be people who don't like me, no matter what I do. I can't change that, but so what? If you don't like my blog, don't read it; if you don't like me, unfollow/block me; if you have an issue with what I have said then say it to my face. Failing all that; be a coward, bitch about me to others, leave anonymous comments and messages, I don't care. I'm going to carry on writing for me and anyone who wants to read it. Don't like it, jog on!

I think this is also a great opportunity to thank all my readers for the support you have shown me over the past 6 months. It's so nice to hear the positive feedback I get and this compels me to do more. As a token of my appreciation I'm giving away 5 x Diagnosis: LOB mugs.

To enter the competition all you have to do is:
  1. Click the 'Join this site' button on the right of this page and do just that.
  2. 'Like' my Facebook page (if you have Facebook)
  3. Tweet the following if you have Twitter. 
'I've just entered @diagnosislob March competition. Have you?! If not, get involved. You've got to be in it to win it!'

Once you've done the above, leave a comment on this post to tell me you've done so with your name, email address or twitter name. Each entry will be given a number and then the winners will be picked out by a random number generator on 4th April.

Thanks again for all the kind messages of support, all the nominations I received and all the votes I was given. It meant a lot. Good luck and happy hunting!

Ella x

Thursday 22 March 2012

Lost in Translation

"69 year old male, chest pain"

There is a lot of inter-service banter between ambulance and police. We mock them for repeatedly asking us for our call sign and they mock us for requesting police back up because in 1974 someone at the address swore at a crew! We roll our eyes when they call us for the most pathetic of injuries and likewise, they get fed up at our constant requests for help the second the words mental health or assault are mentioned. It is a constant source of amusement and one which will not go away. The problem is, we will never stop asking for help if an address is flagged or there is a hint of danger and similarly, the police will never stop asking for an ambulance when someone is ill or injured. This is simply because no one wants to take the risk! The one time they don't call us, there will be an unexpected death in custody and the time we don't call them, we will get a beating. Things will continue to frustrate and amuse, but what can you do?! This job today had a lot to do with the flagging of addresses. When ambulance or police go to a property if the occupant is violent, abusive, used weapons etc. that information is linked to that address. Through CADLink the information is shared between the services so when either of us are called to an address we know what we could potentially be walking into. 

It was about 11pm when we got the job. On the CAD information was *LOCALITY MATCH*. We phoned in for further details and were told not to approach. This address is known for firearms and we were to wait at the RVP for police. This is was exactly what we did! We waited, and waited, and waited some more. An hour went by and nothing. The police and no units to send. Unless we are in imminent danger police response can be varied. Waiting 2 hours a few hundred yards from a patients address isn't uncommon. I think a lot of it has to do with the amount of time we have to call them. Just like Peter crying Wolf so many times, the response to ambulance requests can often become diluted. I'm not saying we are calling them unnecessarily but we are not a priority if we are sat safely on the side of the road eating a cold McDonalds! After about an hour and a half a car turned. The two officers called in to get more information on the address and the occupant was known to be violent and have a string of firearm offences. I don't blame them for requesting SO19 back up! Eventually one of our officers arrived with ballistic vests. We shoehorned ourselves into them and continued to wait.

"What's your call sign?" one of the coppers asked!

After a little while the whole team was assembled. 2 x cars of firearms officers, 1 x car of police officers, 1 x incident officer, 1 x DSO and 1 x Ambulance. In a glorious convoy of blue lights we headed round to the address. I love moments like this, this is what I live for! We pulled up and the police sprang into action. I was unable to see the entrance to the property but I could here lots of shouting. After about a minute a copper came wondering over. 

"All clear" he said with a look of amusement and dejection.

Loaded up like pack-horses we bundled into the house. Sat in the living was a rather bemused, shocked looking elderly couple. Audrey and William had been enjoying their evening when William got chest pain. 2 hours after calling an ambulance the armed police burst in. Not exactly what they ordered! Luckily he wasn't having a heart attack either. We took him to hospital as a precaution apologising profusely for the mix-up. Needless to say it was our turn to gloat today. There was some head scratching going on amongst the 5-0! Something, somewhere had got lost in translation and never in their 50 years of marriage had either of them been gun toting reprobates! They saw the funny side! We all did!

Wednesday 21 March 2012

Baby Blues?

"4 month old baby, crying, mother not on scene"

To be honest, it seemed like a rather bizarre call to get. A crying baby is hardly a medical emergency now is it! We had no other information other than that to go by so mind open we headed round. We arrived at a block of flats and waited an eternity to be let in. Eventually, as someone was leaving we bundled in and headed up the stairwell. I could hear the babies crying as we entered the corridor, so just followed the noise. The door to the apartment was ajar so we knocked and entered. Standing in the living room was a guy with his hands in his pockets. On the floor, in a car seat, was the baby crying.

"What's the problem today?"

"The mum gave me the baby and said she can't do it anymore"

"How do you know her?"

"She's my neighbour, she hasn't been right"

I started checking over the baby, he seemed well. I opened that bag that he was left with and found some milk. It worked a treat, we could now start to try and unravel what has happened. 

We called the police and requested social services. While waiting we managed to track down a friend on the phone. It turns out that the baby's mother may have been suffering Postnatal Depression. She had been crying a lot, been very irritable and had been losing her temper with the baby. Apparently there had been weight loss through not eating and a distinct lack of sleep. She hadn't received any help either which I found strange. PND can often bring feelings of denial to services because new mums fear their child may be taken away, but in this case it appears she had fallen through the cracks in the system. Not speaking fluent English maybe she didn't know what services she was entitled to or maybe her symptoms had simple gone unnoticed by those she came into contact with. What we did know was there was a vulnerable adult missing and no one seemed to know where she might be.

Postnatal depression is very common, yet too often new mothers are left to suffer in silence, struggling alone with the pressures of parenthood without any diagnosis. Giving birth brings with it a range of emotions from pure happiness to anxiety and mild depression. The mixed emotions and tearfulness are often put down to 'baby blues' by GPs and other services alike and are fully expected to clear up on their own.  When it doesn't and the depression gets worse the PND occurs. It usually happens when the child is between 4 and 6 months old and effects 1 on 10 new mothers. It can be a gradual or sudden onset and can be mild to extremely hard hitting. Clearly in this case it reached the extreme of abandonment. With no father around and an apparent lack of access to services she had left the baby and run; that to her seemed the only logical option. Obviously for an outsider looking in it isn't a rational thing to do but not being in the mindset of a mother in such difficulty it's hard to comprehend what she is going through.

The signs and symptoms of PND are extensive and varied and I think it's important that anyone close to a new mother is aware of them. New mothers may go through one or more of the following experiences, although it's extremely unlikely that they will go through all of them:
  • feeling very low or despondent, thinking that nothing is any good
  • feeling tired and very lethargic, or even quite numb
  • not wanting to do anything or take an interest in the outside world
  • a sense of inadequacy; feeling unable to cope
  • feeling guilty about not coping, or about not loving the baby enough
  • being unusually irritable, which makes the guilt worse
  • wanting to cry
  • losing your appetite, which may go with feeling hungry all the time, but being unable to eat
  • difficulty sleeping: either not getting to sleep, waking early, or having vivid nightmares
  • being hostile or indifferent to your husband or partner
  • being hostile or indifferent to your baby
  • losing interest in sex
  • having panic attacks
  • an overpowering anxiety
  • difficulty in concentrating or making decisions
  • physical symptoms, such as stomach pains, headaches and blurred vision
  • obsessive fears about the baby's health or well being
  • thoughts about death
It is the latter that was concerning us today. Intrusive thoughts about death can be frightening and make the person fell they are losing control. Clearly it had got to the point where the mother could no longer cope alone and desertion seemed the best thing to do. It was imperative she was found for her own well being so she could receive treatment and prevent her son going into the care system.

Under normal circumstances PND is assessed by health visitors who use a tool called the Edinburgh Postnatal Depression Scale. When originally designed it was meant for British women and its usefulness and effectiveness on women from ethnic minority communities has been brought into question. Perhaps this job was a case in point. Maybe her poor grasp of the English language had caused her to continue without diagnosis. Like with most things with the ambulance service, we are limited to what we can do. We have an hour window to diagnose, treat, refer or convey so even if she had been in contact it isn't necessarily likely that we could have helped. New mothers need to rely on friends and family and the health care professionals they come into contact with to get a diagnosis. 

Clearly the system failed on this occasion. We were left with an innocent baby whose mother was missing. It was impossible to imagine her mindset and frustratingly we never find out the outcomes. It's one of the most annoying parts of the job we do. All we can do is try and understand the causes and symptoms in the hope we are able to spot and prevent similar in the future. What this job highlights is the fragility many new mothers face despite apparent well being. If they become isolated a vicious cycle of denial can occur leading us to the situation we found ourselves in. It was this point that gave me the idea of combining my thoughts on the issue with that of someone who has suffered from postnatal depression. It is with great pleasure I introduce a fellow blogger and friend BookwormMummy. Gem shares her thoughts and personal experience with PND in an attempt to show the vicious circle and mindset of the patients we often come into contact with and how their feelings are often marginalised as 'Baby Blues'.

"Perhaps the majority of you reading the above felt a mixture of concern and disgust. I read it and felt a mixture of relief and hopefulness. Relief that the mother had walked away leaving her baby safe with someone who did the right thing, and hopefulness that by doing so it allowed her to find the help she desperately needed. I hope that she was found to be well and reunited with her baby with the proper support in place, which is the outcome everyone would hope for. I also secretly wish I had done something so bold to indicate that everything actually wasn’t OK. 

I have never been medically diagnosed with postnatal depression; I am not truly sure what my medical records must say about the three visits I made over a 3 year period to discuss my mood swings, irritability, anger, anxiety, night terrors, exhaustion and tearfulness. I do know that I have a phone number somewhere from my first GP for a local counselling group I could never get an answer from. I know the same GP told me on my second visit that I was perfectly normal and would be fine, that perhaps a diary where I recorded all my feelings and moments that made me happy each day would help give me a boost. I have that diary still; the few entries I made do not make happy reading. I know that from the third visit, to a different GP (that I burst in to tears in front of which rarely happens!) I have a leaflet about contraception. I know from the list above I had almost all of the experiences listed. I know no one ever really asked me the right questions, probably falsely assuming the smile I painted on my face every day meant everything was OK, and that joking about sleep deprivation and comparing myself to a milk machine at the baby clinic meant I was fine. I wasn’t fine, I was unable to make any decision or even speak properly when my baby would cry, my skin would itch with tension and my heart would race. I know I gave up on explaining myself properly to a GP and decided it was probably ordinary and I was just tired. I know that I felt isolated, alone and inadequate, even when surrounded by family, friends and my children that were hard work yes but thriving. I know that I am lucky to have made my way through it. I’m not entirely sure I am through it.

What probably made a huge difference to me was having good friends and a supportive family around me who picked up the slack on days I ran away, who helped the best they could to get me to rest, and who provided me with enough encouragement and reassurance I was doing OK that I believed them. Another godsend was having somewhere I could feel in touch with people also having a bad time. The Internet makes it easier to seek solace and support even when you’re too anxious or exhausted to leave your front door; it is also fairly anonymous or at least I don’t have to look someone in the eye when I type “I am struggling” or “I’m not sure I can do this anymore”. I wasn’t really aware of any support groups or charities that I could approach; I felt they were for the really ill ones, or people that didn’t have anyone there helping them, I didn’t think I deserved to be a bother or would get treated with the same vague shrug and a hug I got from my GP. I should really have realised I needed to reach out, but until I emerged from the really ugly fog I didn’t actually realise how immersed I was. That is the difficulty with depression, it isn’t a choice or a state you trip up in to suddenly; it creeps up, masked usually by other events like illness, or sleep deprivation, or a bad turn of events; then before you comprehend it you’re stuck in the fog unable to think clearly or find your way home."

This was a very valuable exercise from a patient care point of view and one I intend to use more often. As health care professionals we are often far too focused on our own job and those of the services we interact with. The patients voice is often lost amongst all the hypocrisy but if we can start to understand the mindset of the people we are trying to help then perhaps the level of care they receive will be greatly improved. 

If you are suffering with PND, or know someone who is or might be, then contact Mind
for advice. Don't allow it to go unchecked.

Mind infoline 0300 123 3393
or email to

Tuesday 20 March 2012

I'm Lovin' it!

"41 year old female, collapsed"

Sometimes there are those days where everything goes wrong. Sometimes there are those days where everything goes right. Sometimes there are days where everyone is rude. Sometimes there are days where everyone is bizarre! Today was one of those days. I can't quite put my finger on what it was about most people I saw, but it was just odd. The locations were all weird, the circumstances for illness or injury were abnormal to say the least, the dress sense of people were extrovert and the patient's behaviour in general was well.....just bizarre!

We headed through the lunchtime traffic and pulled up outside McDonald's. This is where our patient was supposed to have collapsed. This is where she was supposed to be unconscious. We headed in with all our kit to be greeted by a member of staff. 

"She's over there" he pointed rather sheepishly....

"There?! The one sitting at the table eating?!"


We wandered over slightly bemused as to why we were there and why she was showing no signs of collapse or indeed any signs of illness.

"Hello there, did you phone for an ambulance?"

"Do you mind? I'm eating"

"OK but you have phoned for an ambulance so we want to make sure you're OK."

With that she took another bite out of her Fillet-O-Fish and began chewing whilst starring directly at me.

"Can you stop eating please so we can find out what the problem is?"

(Whilst chewing) "I'm not going to ask you again, I'm having my lunch, I'll come out and talk to you when I've finished, now stop pestering me"

I made another few attempts to reason with her but, alas, they were in vane. We took the kit back to the truck and waited, watching her through the window. I wasn't happy leaving until we had checked her over in case she had been unwell. After watching her eat her second Fillet-O-Fish she got up and walked over to the ambulance. I went and met her at the side door and she climbed on board.

"So what is the problem today, why have you called an ambulance?"

"I'm feeling better now, can you just drop me off at my hairdressers, I have an appointment at 2pm"

Now it was my turn to stare. My jaw dropped to the floor and I'm sure one eyebrow raised itself independently to my hairline. 


"The hairdressers. I have an appointment."

"I'm afraid we don't offer that. If you are ill we can take you too hospital. If you don't want to go to hospital I can refer you on to your GP, but if you are not ill I am certainly not taking you to your hairdressers. That is a totally inappropriate use of an ambulance."

She just looked at me, nostrils flared and a real look of disgust on her face. She picked up her bag, swung the door open and walked out. It took a moment to take stock of what had happened. I wasn't even angry! I just shook my head and laughed! What can you do?! Like I said, it was one of those days!

Sunday 18 March 2012

That's Life

"19 year old female, vomiting"

The ambulance service is no different to the police when it comes to 'one of those shifts'. No matter what you do, no matter what attitude you start the shift with, it is just a bad day at the office. Its non stop; everyone you meet is rude to you. People spit, people are violent, people piss and vomit over everything. Everyone needs carrying; no one needs hospital but want to go all the same. The shift drags and drags, when you look at the clock, already exhausted, there is another 7 hours to go. Passers-by are rude, hospital staff are dismissive, it feels like everything and everyone is against you, and no matter what you do or say it's wrong. Hitting your head against a brick wall is simply not satisfying enough. You find yourself accusing Murphy of being an optimist, whatever can go wrong, will go wrong, and then some! Only when the shift is over can you draw a line under it, it was just one of those shifts. 

  • First job was a 22 year old with a headache; she wouldn't listen to our advice, refused to walk and threw herself on the floor so we ended up carrying her. She then complained because we had taken too long to arrive. The hospital staff asked why we had brought her in. BECAUSE SHE WANTED TO COME. That set the tone. 
  • We moved off to a grim part of town to a 32 year old with a twisted knee. He was an alcoholic. He was lying on the floor. He was 25 stone+. He wouldn't help with getting him up. He refused to try and move his knee. We carried him. At hospital he simply got up, and walked, without limp, to the toilet. 
  • Our next contestant was a MH patient. Suicidal and then obstructive. After 2 hours of coaxing we got her on board. A regular caller, known to us, the hospital and police. She had just been discharged. On arrival at the hospital the nurse in charge refused to accept her. The police had no units to send. The patient refused to get off our bed. We can't force her off. So we waited in the corridor for 2 hours. The hospital staff were extremely rude. What are we to do? Leave a suicidal woman who won't tell us her address, alone at night, in the street, screaming?! 
  • Now we went 10 miles further out of area to a 19 year old, unconscious. He was drunk. Lying on the floor. The FRU had been waiting for us for an hour. We got the guy on our bed and in the warm. He promptly vomited everywhere.
  • In unfamiliar surrounding we went to a 1 year old, unwell. The parents were obnoxious. They had called because the kid had a blocked nose. As if that wasn't ridiculous enough, they had already been to hospital and were discharged 3 hours previous with a prescription. As it was the middle of the night, no chemist was open so they called another ambulance to take them back. The mind boggles!
  • Now to a police job. It was literally 20 feet from one of our trauma centres. Our patient was under arrest and unconscious for assault. His victim had already gone to hospital. We were not allowed to take him to the same one but as he had head injuries and was still unconscious we had to take him to a trauma centre. That meant a long blue light run across London. I say unconscious loosely. We thought he was but he wasn't. No response to pain, took an OP airway, didn't respond to all the other little tricks we do. On arrival at the hospital when the arresting officer came into view our GCS 3 patient jumped up and started fighting everyone. We got spat on. 
We had had enough. There was only time for one more job. We had cleaned the ambulance again. All I wanted to do was go home to bed. 
  • 19 year old female, vomiting, intoxicated
My crew mate and I just looked at each other; Of course, what else would it be? A polite, little old lady fallen on the floor? Not a chance! Me and my crew mate have a great working relationship and have similar likes and dislikes. We also have little rituals we go through each day, music being one. We have various compilation CD's for different moods. As soon as this job came down, he shook his head and changed the CD. The song we played whilst driving through the empty streets is one we always play after or before a load of tosh. When things get too much it makes us feel better. It really does! Try it. Police, ambulance staff, nurses, Drs, in fact anyone having a bad day, sit down, turn up the volume, lay back, press play, and close your eyes. Just do exactly what the song says. Every time you find yourself flat on your face, pick yourself up and get back in the race. That's Life.

Frank Sinatra - That's Life

Saturday 17 March 2012

Silence Hides Violence

"33 year old female, chest pain"

NB: This post is about Domestic Abuse, so for anyone who has been a victim or knows someone who has, reading may cause distress and provoke painful memories.

We were trundling back to station towards the end of our shift when we got sent the job. We were only a couple of minutes away so were on scene quickly. The address was given as 'above the shops'. Flats above shops can often be very difficult to access, mainly because the entrance is nowhere near the corresponding shop number. This particular flat was accessed via the rear of the shop from an alley way. After a few minutes of looking we found it, but had walked a considerable distance from where we had left the truck. I went in to see our patient whilst my crew mate went to move the vehicle closer. I was greeted at the door by our patient's husband. He was a polite guy and gave me a very full handover of what had occurred. She suffers with anxiety and had a panic attack, but had some residual chest pain. Which seemed reasonable. I entered the bedroom and Claire was sitting on the bed. It was obvious she had been crying and appeared very timid. Her voice was quiet and shaky. I started asking my usual questions about the chest pain whilst trying to get her to slow her breathing down. She said the same as what I had already been told but wasn't giving me very clear answers about her symptoms or cause of her anxiety. I became aware that before and after everything she said she was looking over my shoulder. Her husband was standing in the door way and it was obvious to me she was holding back. 

A couple of moments later there was a knock on the door. My crew mate had returned. Claire's husband went to let him in and I turned to her and said:

"Do you want me to get you out of here?"

She simply nodded and the expression on her face said it all. She was desperate to get out of the flat. She was terrified. I offered to take her to hospital and her husband was very quick to interject.

"She doesn't want to go to hospital, it was just a panic attack"

"That may be but she still has some chest pain and at the very least we need to do an ECG"

"Then do it here, she doesn't need to go to hospital, she needs to rest. The last crew did the ECG here"

(Lying through my teeth) "I'm afraid we can't do it in here, we have no batteries so it needs to remained plugged into the ambulance"

His tone had changed, it was rather intimidating. He was a big guy and clearly objected to my suggestions and started acting in a very aggressive manner saying she didn't need to go anywhere, and that we were no longer needed.

"Look, she has chest pain, she needs an ECG, and that's what we are going to do. One of the best cures for a panic attack is leaving the environment in which it occurred. In this case, stepping outside for 10 minutes could do her the world of good."

With that, I basically ushered her out of the room and out of the flat. He began acting rather frantically and marched out after us.  We got Claire on board and he tried to push his way on. We managed to close the door on him and lock the truck. My crew mate clambered through to the front and started driving off out of the alley way. Her husband was screaming and shouting, punching the back door. I called for urgent police and we drove off down the road and out of harm's way.

Claire burst into tears. While we waited for police she disclosed years of abuse. She showed me the bruises, strangulation marks & scratches. She had suffered since the day after their wedding 6 years previous. He was controlling, possessive, she had no freedom at all. He used to take her to work and pick her up afterwards but had stopped her working 2 years ago. If she did anything he didn't like he would beat her. If he got drunk, he would beat her. If she answered back he would beat her. She feared for her life but was too scared to walk away. He had threatened to kill her should she leave him. She had no friends and no family in the country and not a single soul knew of her suffering. She wasn't allowed to socialise, she wasn't allowed any money. She was basically his prisoner. She had suffered physical, emotional and sexual abuse on a daily basis for her entire marriage. It was gut wrenching to hear. How can anyone cause so much pain and suffering to another? How can anyone be that cowardly to torment and abuse someone who is so powerless to stop them? How can a man do that to his wife? She had attempted suicide on a number of occasions as it seemed the only way out. Each failed attempt came with it a beating and more threats. As she sat there pouring out everything she had been bottling up, I could see what a relief being able to do so was. She was still terrified but had finally found the strength to put an end to it. Her suffering would end here, although it would be a long journey of psychological recovery ahead. 

Domestic abuse is far too common. I see it on a number of different levels at work, be it emotional, physical, economical or sexual abuse. It is horrible to see and often very challenging to deal with. That said, the emotions I feel when seeing the consequences of it, pale in significance when I think about what the victim has suffered. So often the abuse is painfully obvious but denied by the victim through love or a continuing sense of loyalty. This particular job was some time ago. It was one of the first instances of abuse I had seen and it wasn't until I decided to write about this topic that I found out exactly how common it is and what effects it has, not only on the victims, but also on the NHS too: 
  • Domestic violence accounts for between 16% and one quarter of all recorded violent crime. 
  • One incident is reported to the police every minute. 
  • In any one year there are 13 million separate incidents of physical violence or threats of violence against women from partners or former partners. 
  • Women are much more likely than men to be the victim of multiple incidents of abuse, and of sexual violence.
  • 54% of UK rapes are committed by a woman’s current or former partner. 
  • On average 2 women a week are killed by a male partner or former partner: this constitutes around one-third of all female homicide victims. 
  • The cost of treating physical health of victims of domestic violence, (including hospital, GP, ambulance, prescriptions) is £1.2 billion, 3% of the total NHS budget. 
  • Between 50% and 60% of female mental health service users have experienced domestic violence, and up to 20% will be experiencing current abuse.
  • Domestic violence and other abuse is the most prevalent cause of depression and other mental health difficulties in women.
  • Domestic violence commonly results in self-harm and attempted suicide: one-third of women attending emergency departments for self-harm were domestic violence survivors; abused women are five times more likely to attempt suicide; and one third of all female suicide attempts can be attributed to current or past experience of domestic violence.

The statistics alone speak volumes but seeing it first-hand makes me extremely angry. Any kind of bullying is disgusting and seeing someone so gripped by fear emotes all sorts of feelings. Sadly, it is prevalent in all walks of life, across all age groups, and can take a number of different forms including emotional, verbal and physical abuse. As the world develops so does bullying and with the ever growing world of social media it is becoming more and more prevalent; be it subtle digs and intimidation online or physical violence in person, the lasting effect on the victims are the same and domestic abuse is merely bullying within an intimate relationship. It is picking on someone and making their life a misery for personal satisfaction. Intimidating someone to the point where they put up with it, through fear of repercussions, is what these thugs rely on. I don't know the outcome of his arrest, but the police were confident that he wouldn't get away with it. What also concerns me is the reliance these women (and men) have on the NHS, especially that of the already under resourced mental health services. I shudder to think what effect the inevitable NHS Bill and subsequent privatisation will have on the accessibility and affordability to these services. Only time will tell. There was an interesting article in the Guardian regarding the impact the government cuts will have on the help that is available to victims (click to view). The suffering of many will not stop though. It will continue behind closed doors and will continue to go unreported, often until it is too late. That is the tragic reality of the world we live in. All I can do, and all anyone can do, is encourage victims to come forward as and when we become aware of it.

If you, or anyone you know, is suffering or has suffered domestic violence or abuse please please please contact the 24 National Domestic Violence Helpline either by phone or on line.

0808 2000 247

Thursday 15 March 2012

What is Experience?!

I have a list as long as my arm of blogs I want to write. I can assure you that this wasn't one of them but needs must. Before I started my blog, I had never written a thing. One day I had a rant at my crew mate and he said;
"Seriously, you should write a blog, seeing you that angry was funny as fuck"
So I did! I haven't looked back since. I thoroughly enjoy it and that is why I do it. It's a forum where I can share my feelings openly and that was an outlet I'd never had. I read various blogs beforehand, some of which inspired me to write mine. They can be found in the 'Top Blogs' page on my website. I never thought my blog would become popular and from the outset I said very clearly the purpose of my writing;
"I’m writing this blog to vent frustrations, share experiences, provoke debate and educate people as to what life on the road is like. I don't have the wealth of experience that many do but I don't think you need that much to form opinions. I may have only been on the road for 3 years but in that time I've seen and learnt more than my entire life before that."
I also stated that they were my opinions and didn't represent anyone else. A few weeks ago someone sent me a message on twitter telling me they had just nominated me for the EMS Blog of the Year 2012! I had never even heard about it so it was especially nice to be considered for someone's nomination. Someone liked my ramblings enough to recommend me! After an amazing week of support I got an email from EMS1 to say that I had been shortlisted to the top 10 EMS blogs and voting had now begun. I was honestly gobsmacked and so grateful to everyone who nominated me. I really do feel it is one of my best achievements to date. Today however, I got a rather nasty email from 'Anonymous' which took the edge off what had been an enjoyable couple of days.
"You might be under some illusion that by getting yourself nominated you've earned the right to call yourself a blogger. Let me tell you, you have not. You don't belong in the blogging community, your lack of clinical experience alone makes you ill placed to share your views. You have no place in the EMS blogger of the year competition and I can assure you that you will not win. I don't like your blog, I'll make no secret of that but what I don't like is seeing the writing of others overlooked because you managed to hoodwink your way onto the short list. Just think about that."
OK. I will indeed think about that. I don't care if 'anonymous' doesn't like my blog. As much as it annoyed me, I didn't really care about apparently not being part of the blogging community or having "no place" in the competition. If that's the case then I won't win. I probably won't! I am up against 9 other great blogs; blogs that I myself read and recommend to others. As for this 'blogging community'; I have had guest bloggers, I've written guest blogs, I share other peoples work and have had many discussions with other bloggers on a variety of topics. What one has to do to be accepted I don't know and frankly don't care. If people do like me then great, if not so what. I can't please everyone. I also didn't put myself on the shortlist, others did; that to me is enough to nullify that ill -conceived comment. What did get me really riled was the suggestion that I wasn't experienced enough to write about what I do for a living. It got me thinking a lot about experience and what counts as experience.

I've made it no secret that I'm a student paramedic. I've also made it no secret I've only been on the road 3 years, but does that make me any less qualified to talk about a job that I have done; a job that affected me physically or emotionally, or a patient that I interacted with? Opinions can only ever be based on personal experience and personal feelings. I know for a fact that mine differ from others, that is the point, surely?! That is how a debate occurs. That is how democracy works. That's life! Because I've only worked on ambulances for 3 years can I not talk about the politics of the NHS? I'm not a politician but I have opinions. Experience is relative and constantly evolving. Yes, there are people with 20 years' experience but what if that person stayed in the same role for 20 years; what if they never tried to better themselves, never learned new skills, never moved with the times? In effect their 20 years' experience is just 1 year's experience, repeated 20 times. That's not me. It may be only 3 years but it's been a great 3 years. 3 years where I have learned a lot about myself. I'm not satisfied with the amount I have learnt, nor will I  ever be. If you don't strive to better yourself you'll never gain new experience. That is part of what my blog is about. It is somewhere to reflect; look at the good, look at the bad, look at what can be learnt, and try and dissect what the hell just happened. Yes I'm new to blogging and have a lot to learn. I look back at the first few posts I did and they are in a completely different style to what they are now. I'm learning from my experience. 

As for 'anonymous' whoever you may be:
 "I don't want to talk to you no more, you empty headed animal food trough wiper. I fart in your general direction. Your mother was a hamster and your father smelt of elderberries." (Monty Python)
 I raise two fingers and blow a raspberry!

I'll make no apologies for my opinions, they are mine and mine alone. Whilst ever I still enjoy it I will keep writing. If you agree with what I write about, leave a comment. If you don't agree, leave a comment. I welcome all opinions, for and against. If you feel like you have no choice but to insult me, please leave a name, even if it's a fake one, so I can give as good as I get! As for the EMS Blog of the Year 2012, you decide. There are 10 great blogs to choose from each with their own unique identities and their own great writers. Whichever one does win will be a more than worthy winner. Obviously, if I don't win, I'd like to see the title come to the UK! Have a read:

Insomniac Medic

Pick your favourite! 

EMS Blog of the Year 2012 - VOTE NOW! 

Wednesday 14 March 2012

Walk-in, Drive-through or Both?

"46 year old male, cuts from broken window"

It was a busy Saturday night like every other Saturday night. We'd had a steady flow of the usual when this popped up on our screen. The location was at a drinking hot spot in the centre of town. We headed over, slurping down the last few dregs of our luke warm hospital coffee, and were greeted by a scene of absolute carnage. It turns out that the location was a kebab shop & it was full of late night revellers queuing up for their post beer Doner kebabs. There was a large crowd gathered outside, about 50 strong, most of which flagged us down as we came into view. Oh yeah, there was also the rear end a car hanging out the front of the shop!

We stopped in the middle of the road, partly because there was nowhere else to park and partly because so many people were stood in the road flapping their arms around. With the adrenaline was pumping and a suitable adjusted emergency face we power walked over, expecting to find multiple injuries on multiple people. Everyone was shouting at us and I couldn't make head nor tail out of anything I was hearing. It was crazy!

"Right, if you are not injured or not directly involved with whatever has happened, please move away and wait for the police"

Nothing! No one budged, and with the considerable amount of alcohol running through most of their veins, no one shut up either. Luckily the boys (and girls) in blue came screeching to a halt outside and dispersed most of the onlookers swiftly. Now it was triage time. My crew mate was already dealing with one of the kebab shop staff, treating him for some small cuts to the hand. 

"Right, who else needs medical attention?"

I looked round at the 15 or so people who were left in and outside. Nothing! Not a twitch! No one had a scratch on them, despite the car completely demolishing the shop front, the glass counters, the grills and burners. Incredible! We finished up with our 1 patient and left him at scene. What made this job all the more amusing was the circumstances surrounding the car ending up using the kebab shop as a drive through!

A family of 3 had parked on the opposite side of the road, the mother and daughter and gone in to get their food whilst the dad waited in the car. In a moment of sheer brilliance he had decided to turn the car around and park outside the shop. Mid-manoeuvre he had tried to brake but in his haste his foot had slipped off the break pedal and on to the accelerator. From that point he simply ploughed across the pavement and parked the front of his car in the salad bar. There's being impatient for your food and then there is taking matters into your own hands! I'd love to know how long he spent in the doghouse after that little stunt! Massively awkward!

While you are here, can I please remind you to vote for me in the EMS Blog of the Year 2012 competition! If you have already then thank you ever so much! 

Voting Now Open

Dear all,

I’ve just found out that after a week of nominations my blog has been shortlisted for the Fire and EMS blog of the year 2012. To say i’m surprised is an understatement! There are some excellent blogs out there which all have their own identities and to be included in such a list is humbling. Like I said, this whole blogging thing is very new to me and i’m ecstatic that my ramblings have become so popular in such a short space of time. Never in my wildest dreams did I think it would take off like it has. I’m so grateful to everyone for the positive comments and support i’ve been given. 

Obviously, now that i’ve been shortlisted winning would be awesome. It’s a long shot I know, as i’m up against some fantastic, well established blogs but if you think i’m worthy then vote for me. 

Voting is open until 21st March and can be done by following the link below. It's just a couple of clicks!

Thanks again for everything. I really do mean that. I’m seriously bloody chuffed!

Ella xx

Monday 12 March 2012

Suffering in Silence

"30 year old male, suicidal, depressed"

These types of jobs are quite tough to deal with. They don't require any treatment that we can give. All we can really do is take to A & E with is as much use as a chocolate teapot or refer onto a GP. What we can do is talk to them, but often they are in that position because they are not good at opening up. Least of all a complete stranger. We arrived at the flat and our patient, James, cut a sorry looking figure. He looked scruffy, unshaven, bags under his eyes and his clothes appeared dirty. He invited us in and sat on the sofa. It was a friends flat. He was just staying as he'd just come out of a long term relationship and had no where else to go. I sat there while he told me about the past year of his life and to be fair, it sounded pretty shit. His marriage had broken down, he was struggling with only seeing his children weekly, his new relationship had also ended badly and a number of relatives had died. He'd lost everything as far as he was concerned. 

He went onto tell me that three nights previous, while drunk and feeling particularly low he had tried to kill himself by means of an overdose. Obviously, it was a cry for help and he was feeling ashamed of doing it but it happened all the same. Tonight he was having the same feelings and was scared of what he might do. I'm not ashamed to admit that i've suffered anxiety and depression and you do feel very alone. Being consumed by unfamiliar feelings can be suffocating to say the least. It is no wonder the people who are most fragile are left with thinking being gone would be the simplest fix. Suicide is often spoken about as being a cowards way out. It's considered selfish for the family and friends that are left behind and something I have rarely spoken in depth about, with a patient. I asked him straight up.

"What about your kids, your family, you friends?"

He agreed. He said he had a loving family and good circle of friends. He also had a good job, but what he did say, was that when you are depressed none of that seems to matter. He admitted he was wallowing in self pity but at the same time he could not face the prospect of having to start a life all over again, and from personel experience, that prospect is a daunting one. It all got too much for him. Maybe he felt ashamed, embarrassed, I don't know, the fact was the feelings he was having were real. He had taken an overdose of Amitripyline after seeing his GP for sleeping problems. It's an anti-depressant often used to help mild sleeping disorders and is often prescribed without looking at the core problem. James was depressed, he needed to talk to someone, not be drugged into a fake sleep. When he wakes, the problems will still be there and they were. He wasn't keen on being prescribed the drug either but with the targets and time constraints GPs face a quick prescription is more practical than a heart to heart. His objection to the drug stemmed from the fact he didn't want to admit he was depressed and because he knew drugs were not going to fix anything. He was a very level headed guy and I admired his honesty. He was being completely frank about his feelings especially as we had never met before. I think that is what he needed.

I explained our problem in terms of options too him and he agreed A & E wasn't the place for him. I offered a GP referral but he didn't want that either. He was all to aware of the social stigma around mental health disorders and didn't want it on his medical records. He feared it would effect his future employment and to be fair, I spoke about similar fears in 'Mental Health in an Ambulance'. The funny thing was that James knew exactly what he had to do. It was a lifestyle change that was needed and all he had to do was buck the trend he was in. Calling an ambulance was his way of admitting what had happened and I was more than happy to be that person he needed to talk to. It did get me thinking though, about how intricately balanced peoples lives are. We are creatures of habit and if that is disrupted it can easily seem that the world is ending. The old adage of 'what doesn't kill you makes you stronger' was very true in this case. We left James at home with a plan on how to move forward. I was confident he would turn things around and perfectly happy that he wouldn't do something stupid. 

This job raised a lot of questions around mental health. People who have never suffered with mental health problems or don't know they have, have no idea where to go for help or even what to say when they do. All they have is the social stereotyping, perpetuated by the media and employers alike which make the idea of asking for help an unattractive one. Stress, depression and anxiety are becoming so common place, yet in many areas of employment, admitting to one, can halt your career in an instant. Feelings are pushed under the carpet and bottled up until drastic actions are taken as the only conceivable way out. Things are getting better, but for some it's not quick enough. Help needs to be readily available, confidential and easy to access and this can only be done with the full support of the government and NHS. Yes, it will cost money but like everything, in the long term it will save. It's just a shame there is such short sightedness when it comes to Mental Health.