Wednesday, 12 September 2012

Dial 999... & wait?

"A country in apparent shock at having to wait for an ambulance"

On Monday 3rd September the BBC aired a programme called 'Dial 999...& wait?' detailing the failings of the emergency services in this country. It's shocking isn't it; having to wait for something? Just terrible. Like with most documentaries, articles and reports about the emergency services, we all come under attack. I say all, as per usual the PR department for the Fire service has been working overtime so they came away unscathed. There was no such escape for the Police and Ambulance services. The culture of targets and response times was what the programme was about and, rather than talk about the real causes, it just highlighted the failings of the services using some well-placed stories about people suffering due to waiting times. 

First in the firing line was the police; the shocking statistic that out of 1 in 5 calls made, the police take more than 15 minutes to arrive. Outrageous. We surely expect more from our police?! I wonder what the government had to say about it... oh yeah, they declined an interview. Obviously the cuts are to blame, there is no denying that; a 20% budget cut is huge, but instead of doing a programme blaming the government they blame the police for basically being greedy. The short interview with Andrew Haldenby from the "think-tank" Reform showed only the attitudes of those not directly involved in working with or in the police. The police have 'never had more money than they have now' and 'for far to long, forces have rested on their laurels'. If cuts are being made, services will be affected. The reason the police have more money now than ever before is because year-on-year the call volume goes up. Don't for one minute believe isolated statistics of a decrease in crime; it is simply that the type of crime is changing. The police still require resources to deal with the 100's of 1000's of daily calls. This call volume will not change, yet somehow, on skeleton staff, they are expected to arrive anywhere within minutes of a call.

The example they used of peoples' suffering was a shop owner who had been burgled. She was 'shocked' at the police not arriving for 20 minutes. How many shop alarms are triggered each night? How many violent assaults are there? How many domestics? How many hoaxes? How many RTCs? How many requests from the ambulance service? How many raids are being done? How many criminals are being hunted? That is just a fraction of the work our police force is doing. In the London borough where I live there are about 330,000 residents. The borough covers 87 square kilometers and is the second largest in London. While chatting to an officer a few weeks ago on a Sunday morning, he told me there were only 13 front line officers responding to calls. He also told me he remembers when there were 30+. It's no surprise that with such huge cuts low priority calls like a shop alarm are getting a delayed response. To be perfectly honest I'm 'shocked' that the police got there so quickly.

Avoiding the fire, ironically, was the Fire Service; no shock there. No talk of missed targets, only that they arrived at a fire within 6 minutes. To be fair, it is easy to arrive anywhere in 6 minutes if you are sitting and waiting for that call to come in and get to spend all day perfecting the art of getting into your vehicle quickly. Last year the London Fire Brigade had a budget of around £437 million compared to £288 million the Ambulance Service got. They received 230,000 calls compared to the 1.6 million the London Ambulance Service received. They attended only 138,385 calls compared to 1.2 million that LAS did. They did so with their 5800 operational staff (almost double that of the ambulance service) from their 112 fire stations (compared to the ambulance service's 70), and of their calls attended, only 29,215 were fires. That is about 80 a day across London. Considerably less than 1 per fire station. Is it any wonder that they are able to respond quickly?! What was highlighted by the programme though was the crippling cuts that they are now facing. A whopping 3% in their budget! Wow! How will they cope?! Maybe they will have to send less than 25 fire-fighters to rescue a seagull from a 3ft pond. Oh wait... they refused to go in; they just sat around and watched a member of the public go in. Yes, THIS happened. Click here. It's weird how all of these facts and figures were omitted from the programme, hmm?

Saving the best until last, the Ambulance Service came under attack for people having to wait. They opened with a tale of an elderly lady waiting on the floor for hours, with the addition of an interview from her daughter about how terrible this was. I agree. In an ideal world no one would have to wait for an ambulance, least of all our elderly population. Unfortunately, the medical world uses a triage system based on what the caller tells the call-taker. As horrible and uncomfortable as it is, an elderly lady with a knee injury is not a high priority and when there are only a handful of ambulances covering a large area priorities have to be made. In this instance it wasn't life or death. Who knows what other calls were in progress. Long have I banged on about the fact that time wasters and nonsense calls just need to be told 'NO'. Sadly, Panorama decided to interview Tony Hughes for the GMB union who decided to highlight the few calls that slip through the net and are wrongly triaged. SO WHAT?! Out of the millions of calls the services receive that is bound to happen every now and again. There are not enough ambulances and staff to send one to every single 999 call that comes in.  Fact.

What annoyed me most about the programme was the failure to highlight the cause of these delays and lack of ambulances. Yes, we have faced cuts like everyone else but as of yet it hasn't had a huge impact in the amount of ambulances working on the front-line. The problem is that the call volume is going up year on year. This wasn't mentioned once. Nor was the massively high proportion of calls that we go to that are a complete waste of time and resources. No mention of the alcohol related calls we go to, the hoaxes, the split nails, the stubbed toes, the headaches, the colds, the can't sleeps, the noise in ear, the finger injuries, the needing a lifts to hospitals; basically 80% of the work we do. No mention at all that the delays people are facing are caused by the public's misuse of its ambulance service. Despite all of that though, for the first time all of the services met the category A target of reaching 75% of life threatening calls within 8 minutes. Instead of leaving it there and heaping praise on the service they interview people to highlight the apparent cheating that is going on. Calls being downgraded to meet the target? Calls being upgraded to meet the target? Is there any proof that this goes on? All ambulance staff, myself included, moan about the conspiracies, the stitch ups and mis-categorising of calls, but personally I don't think this is done to meet targets. The categories of calls change as new information comes in and I think it's highly irresponsible of Panorama to throw out accusations without a scrap of evidence. Then again, who ever said investigative journalists were supposed to research...?!

In the presenter's introduction he said 'What happens when the ambulance service decides you're not sick enough to get an ambulance?' Well as far as I'm concerned the answer is pretty simple; you don't get an ambulance because you are not sick enough. If the public and the media want an ambulance immediately then give us a budget proportional to the calls we attend. Based on the London Fire Brigade's budget per calls they receive, the London Ambulance Service's budget should be around £3 billion a year. Now mirror that across the across the country and you'll see the shortfall we face. Just imagine how quickly we would arrive with that budget at our disposal! We could probably all sit around waiting for calls, practicing getting into our ambulance really quickly, sending 5 ambulances to an elderly faller and do countless public demonstrations of our equipment... ring any bells? People expect miracles and in this economic climate miracles are not going to happen. 

So, you dial 999....& wait?! Yes. That's life. Build a bridge and get over it.

Thursday, 6 September 2012

The Pursuit of Happiness

"32 year old male, fainted, DIB"

This was the first job of the day and amazingly we had been at work for a good two hours by the time we got it! We'd managed a relaxing Costa and a non-rushed breakfast so we were in high spirits. The address given was a gym so we were fully expecting a non-complicated faint in someone who had not eaten and been pushing themselves too hard. We pulled up outside and it was obvious from the name what kind of gym it was. There would be no treadmills, no cross-trainers and no pool. There would also be no middle-aged slightly tubby woman, or any women for that matter. It was a weights-only gym and appeared to be aimed at bodybuilders only. We walked in and were met by the manager; arms bulging, veins in neck pulsating and wearing a vest meant for a 10 year old. With his chest puffed out and his arms resembling a two-handled mug he led us up the stairs and to the patient.

Our guy was lying on the floor, unconscious, sweating and snoring. He was squashed up against some dumbbells so we pulled him into some open space. He was showing all the signs and symptoms of being hypoglycaemic (low blood sugar) but having no working kit to test it, we had to guess! We treated it as such and gave him an injection to raise his sugar levels. While waiting for him to regain consciousness I looked around; it was such a bizarre place. There were a good 25 or so blokes pumping iron, growling, grimacing and then starring at themselves in the mirror! The mirrors stretched around most of the walls allowing them to stare to their hearts content. Scattered around the place were hundreds of photos and posters, some signed, of male body builders all who looked like they'd been tango'd! In a setting where people are trying to act as manly as possible it all seemed very homoerotic! There was a long oak bar, about 25ft long like in old social clubs, the difference being no pint of lager and some pork scratchings; just protein shakes! I found the whole ethos of it bizarre!

Anyway, back the patient! He started coming round after about 3-4 minutes. He was very groggy and confused. Confused in his vocal response but also in his eyes! He clearly didn't have a clue where he was or what was going on! We gave him a Lucozade to up his sugars as when he came round he said 'yes' when I asked if he was a diabetic. It became apparent pretty quickly by the odour in the air that he had been incontinent, and not just a No. 1! We led him to the toilet and as every minute went by became more and more coercive. We got him a change of clothes while he cleaned himself up in the cubicle. I went back in and he was by the sink.

"Any chance you could give me some privacy while I wash at the sink."

"Of course, we'll be just outside."

We waited and chatted, and sniggered at some of the characters we could see in this testosterone filled cauldron of vanity. The FRU arrived with the kit needed to test his blood sugar and we explained what was going on. We asked the manager if there was any chance he'd been taking any under-the-counter steroids or anything like that.

"No, definitely not, he's not the type."

To be fair, he didn't look the type. He wasn't that well-built and didn't seem to have the obsession many of the others appeared to. After a few minutes of waiting I heard a bang. We burst into the toilet to find our patient naked and in a cubicle, upright and fitting. We got him on to the floor, got the oxygen on him and let him fit. We took his blood sugar and to our surprise it was relatively high. Clearly our initial diagnosis was wrong and he had been unconscious post a seizure. After a few minutes he stopped but then vomited; we rolled him into the recovery position whilst this was going on. Unfortunately, the use of all the muscles needed for the body to vomit had another undesirable effect. Like the eruption of Mount Vesuvius out came an explosion of poo. I've never been so close to vomiting. It went everywhere, and as he came round he rolled in it. It got on his hands which he then kindly transfered to us in the post-ictal melee. We eventually got him wrapped in a blanket, into a chair and down to the ambulance. I should have been concentrating more on what was causing his fits but all I would think of was:

"I have sh*t in my hair"

"I have sh*t in my fuc*ing"

"I have sh*t in my mother fuc*ing hair"

"I have fuc*ing shit in my mother fuc*ing hair"

It really is a panic stricken moment when you get bodily fluids on you. You want it off but often you don't get a chance. Often you know it's there but try and ignore it but once it starts seeping through your uniform you feel the damp on your skin. Sometimes it's spit in your face or blood all over you. It is just an unnerving experience and one I will never get used to. Surely I should get paid more than £9 an hour to get sh*t in my hair?!

Once on the ambulance our patient came round again. This time he said he wasn't diabetic! In fact, he said he had no medical problems at all. No history of seizures and on no medication.

"Have you taken any illegal, under-the-counter drugs to help you bulk up? You won't be in any trouble, we are not the police, but we need to know. It's really important."

After a brief pause he nodded. "Yes"

"Are they amphetamine based?"


"How long have you been using them for?"

"2 days. I bought them off the gym manager, he said I'd lose weight and bulk up quicker."

I couldn't be bothered to go back in to give the lying rat a dressing down. We needed to get our patient to hospital, ideally before another seizure. My crewmate got some IV access, I did an ECG and we left on blue lights. On route he had another seizure. He was still seizing when we arrived. He was still seizing when we left resus. It did eventually stop, we checked in on him a few hours later. He had been for brain scans and we were told by the doctor that the drugs he'd been given had raised his blood pressure significantly. This had caused the seizures and had probably triggered epilepsy. All for what?

This guy felt the need to take drugs to improve himself. He wasn't happy with the body he was in. Who really is though? Models often have eating disorders in their pursuit of a size 0. I don't think anyone is ever really content. The skinny amongst us often wish they could bulk out a bit or get even slimmer and the fat want to be skinny. People complain about needing to lose weight and I often look at them and think 'No you don't!' but it's personal. The people who are physically fit want to be fitter and the dedicated athletes want to get better. Will a body builder ever think they have reached perfection? Will a diet ever get anyone to where they want to be? I don't think so. If I set myself an ideal weight to get to, I am pretty sure that if I got there I wouldn't be happy. There would still be a bit that needs improvement. It's not just about weight, I know plenty of people who are happy with their size but there is always something. There would still be something to strive for, but for the vast majority of people the need for improvement is balanced with the enjoyment of the nicer things in life and we tend to find a middle ground. We want to improve and will occasionally do something about it, but deep down we want that Chinese takeaway and binge at the weekend. Basically, we don't care enough to do something about it. The other side of the coin is people who care too much; they will do anything to reach a goal that cannot be reached, and as I saw today that often comes at a cost. It is amazing the lengths people will go to in the pursuit of happiness that I don't think is ever truly obtainable. You tell me, is it?

Monday, 3 September 2012

Gü on then

“33 year old female, electrocution” 

Some things are just meant to be. Sometimes you are just destined to be in a certain place at a certain time. Today was one of those days. The sun was shining on the righteous, the righteous being moi!

We were sat outside Subway, which happened to be next door to Greggs... and opposite a milkshake shop... we were feasting like kings! Then, out of the blue to ruin the moment, we got a job. Typical! It was 7 miles away which for the time of day was a long old stretch! The address was an industrial area so it took a while to find the entrance to the correct unit. We parked up, grabbed our stuff and headed in. It seemed like we were walking for an age; turn after turn, corridor after corridor, stair case after stair case, it was ridiculous! Eventually we arrived at the first aid room. 

Lying on the bed was our patient. As we entered she sat up and smiled:

“So sorry you had to come, I told them I didn’t need an ambulance but they said I had to get checked out.”

She seemed fine; her hair wasn’t up on end, no smell of burning and no smoke rising from her head. She worked on the packing line of the factory and one of the machines had given her an electric shock. She wasn’t knocked to the floor, it was just a zap. She said she didn’t want to go to hospital and just wanted to get back to work. We explained we would have to do an ECG etc and get her to sign our paperwork if everything was OK. As the ambulance was a good half marathon away, we suggested we do all that on the ambulance to save bringing all the kit up to the first aid room. She agreed! *happy dance*

The ECG was normal, as were all her obs and she was still declining the offer of hospital so she signed our paperwork and left. As we let her out the back door her manager, the factory manager, was standing there with a large cardboard box.

Right, now I shall digress slightly. Gifts. The official line is we are not allowed to accept gifts from patients. Obviously there is common sense involved and often refusing a small token of appreciation can be insulting, especially to some cultures. I have a personal rule and that is not to accept money. I’ve been offered £5, £10, £20, £50 and £100 in the past and each time I have respectfully declined despite my own financial need for it! If something then went wrong and it turns out I had been given cash I would be the shit hitting the fan. I also turn down alcohol. A bottle of whiskey in the cab of an ambulance wouldn’t look so good if we crashed. Then there is food; this, I tend to allow! If someone wants to give us a box of chocolates or a cake despite always saying ‘no, don’t be silly’ I invariably say ‘oh go on then, if you insist’! So, rules explained, that brings us back to the large cardboard box...

All I knew is that we were in some kind of factory. I didn’t know what they were producing nor had it really crossed my mind. 

“Here is a mix of things for you and your colleagues to share”

As he said it he lifted up the flap of the box. 

Yes Gü!!

It was a whole box of frickin’ Gü!

Not just one product, a vast selection of the most scrumptious Gü desserts you were ever likely to see. My tongue rolled out of my mouth, across the floor, up his leg and into the box. There were ‘hot chocolate melting middles’, ‘After dark morello cherry bakewell puds’, ‘chocolate tiramisus’, ‘key lime pies’, ‘chocolate and vanilla cheesecakes’, ‘chocolate mousses’, ‘After dark black forest gateaux’ and ‘white chocolate mousses’. And that was just the first few layers! There was one of each of their products in there! 

“No, don’t be silly, we can’t take that”

“It’s our pleasure, nice to give something back to our emergency services”

...”Oh go on then, if you insist” 

I literally couldn’t grab the box quick enough! I know the old adage of ‘with great power comes great responsibility’ but I did not have enough willpower to show such responsibility... or restraint. This was my payment for years of crap. All the late finishes, no rest breaks, the sickness policy, the punches, the kicks, the spitting, being vommed on, pissed on, and shat on, by all and sundry! All that was temporarily forgiven and forgotten while I was staring at my very own box of diabetes! 

I ate to excess for the rest of the shift. My crewmate and I went home with bags full of cake feeling extremely sick. We also left a couple of cakes in the mess room for everyone else to share.

Don’t judge me. Today was my day. Tomorrow someone will piss on me. C’est la vie!

PS: I take back everything I have ever said about obesity. I am currently 3 mouthfuls away from this...

...and I don't care! Nom nom nom!

Saturday, 1 September 2012

You Tell Me

“19 year old, assault, head injury”

There are times in your life where you just have to say ‘whatever’ and move on. Be it with family relationships, spouses, work or whilst trying to argue your point to an Indian call centre; sometimes the point comes in any uphill battle where you just give up and walk away. Today was one of those moments.

We were called to a park by the police for a guy who had been in a fight. We arrived to a sea of blue lights, lots of coppers and various chavs scattered around. As we got out the cab a couple of cops came wandering towards us with our patient. ‘Patient’ is probably too kind... specimen is more appropriate. 

He was wearing some beige chinos which were elasticated around the ankles, some navy blue Toms with no socks and the most garish of Ralph Lauren polo shirts in the most ghastly mustard yellow colour. To go with this rotten ensemble he had a huge diamond (fake) stud in each ear, a gold cross round his neck (he so isn’t religious), an Omega watch (fake) too big for his skinny wrist and various tacky sovereign rings on his fingers. To top it off he went with one of these new types of baseball caps, I think they are called ‘Lidz’ and was wearing it to one side. He walked with what looked like a limp but I am reliable informed this is called a ‘bop’, he had lines shaved into his eyebrows and when he spoke he sounded like a cartoon character with something sticky stuck in his larynx with an awful grasp of the English language. Anyhoo, he ‘bopped’ past us in his handcuffs, up the steps and into the ambulance. 

The copper told us he had been punched, hence the cut above his eye but that was all they knew. He also told us that he had a chip on his shoulder and a hatred for all uniforms.

“Good luck!”

Well, this should be fun! 

“Right, what’s happened this evening?”

“You tell me, innit”

“Well I don’t know, I just arrived, that’s why I am asking you.”

“You’re the doctor.” he said in a very cocky tone.

“No I’m not, just tell me what’s happened.”

“You tell me.”

“Have you been punched?”

“You tell me.”

“Did you lose consciousness?”

“You tell me.”

“Why won’t you answer any of my questions?”

“You tell me”

“You’re acting like a child, just answer my questions and you can leave.”

“What did you say to me bruvs? WHAT...DID...YOU...SAY?”

“I said you’re acting like a child.”

“Don’t test me bruvs, I will cut you.”

I looked up at the copper and raised an eyebrow. He laughed!

“Firstly, I’m not your ‘bruvs’, secondly, you’re not going to do anything, now just tell me what’s happened.”

“You tell me” he chuckled to himself.

“Do you want us to treat you or not?”

“You tell me BRUVS.”

“We are done here.” I said to the copper, “He’s acting like a child.”

“Don’t step to me bruvs, I’ll end you, you fucked with da wrong nigga innit (he was white), you bes watch your back, I’ll be der waiting, do you know me, do you KNOW me?”

“You tell me...”

With that, he was grabbed by the handcuffs and dragged off the ambulance, staring at me the entire time. As he reached the bottom step he spat towards me and kissed his teeth. All that did was get him bundled to the floor. What a foul little animal. 

When did our youth end up like this? Why is there such little respect for any uniform? The Nanny-state we live in has allowed this Chav culture to breed and fester. They have quickly become well regarded as the rednecks of Britain. They have far too many rights; they know the law and the police can do very little. Parents do nothing to stop it and even schools allow it to continue. There is no discipline anymore; back chatting is tolerated and every figure of authority faces a struggle to impose themselves on these thugs. It makes me so angry looking at them, listening to them and being around them. Watching the death of the English language is horrible to see and a stand needs to be made before it becomes irreversible. Can you imagine these cretins working in the media; presenting TV programs & writing articles?! 

“Yes bruvs, welcome to the News at 10. Safe.” 

Their intimidation and aggression strikes fear amongst many and their threats of violence means they mostly go unchallenged and avoided. They hang around street corners drinking and smoking; generally causing a nuisance to all that go near them. They are parasites and should be treated as such. This ‘culture’ needs stopping in its tracks. 

Now, where do we start? You tell me...