Not The Time Or The Place

In recent years the concept of the e-petition has got a lot bigger and in many cases has been used effectively. Like anything that can be created by anyone online it is left open to misuse. In America a similar principle led to a petition to get the US government to build the Death Star as seen Star Wars! The point of the e-petition as set out on the government website is 'If you have a strong opinion about an issue relating to our policies which you’d like to raise you can register it as an e-petition'. Recently The Oliver King Foundation petitioned for defibrillators to be installed in all schools and wanted legislation to back that up. Sadly the House of Commons debate didn't get the result we all wanted but it showed the power of the e-petition.

My issue, is with the misuse of e-petitions for personal gain. I'm sure I'll get a lot of complaints and abuse from my fellow professionals for this, but I am totally against a recent e-petition for more money for paramedics. Let me explain why!

Entitled 'Increase UK Paramedic Pay to NHS Agenda for Change pay Band 6' the title cuts to point but is this a) appropriate and b) how we want our profession to be portrayed? 

Paramedic training requires them to undertake Advanced Driving qualifications and attend an approved Paramedic Course via an Ambulance Service or University to register as a Paramedic. Many Paramedics go on to complete Bachelors and Masters Degrees and even Doctorates. As the Senior Ambulance Service healthcare professional the Paramedic takes complete clinical responsibility at accidents or medical emergencies. Paramedics assess patient's using and interpreting high-tech equipment, such as defibrillators, monitoring equipment, ECG’s, and spinal and traction splints. As autonomous clinicians they have over 40 drugs at their disposal and the ability to perform life saving procedures. Add to that the injuries caused by constantly carrying heavy equipment, manual handling of patients, abuse, assaults, ever increasing demand, cuts in Ambulance Service funding and public sector pensions, we ask you, the government, to pay Paramedics what they deserve.

Don't get me wrong, it is a challenging job and there are a lot of areas that need improving but asking for more money in this way is not the way to go about it. For starters, if an e-petition is being set up it needs to be done so by a body representative of the profession, not an individual. We are represented by the College of Paramedics but the fact they havn't even obtained a royal status due to lack of member speaks volumes about the lack of voice we have in the medical community. If we want a voice, we need to speak together. Add to that, the fact that the petition itself is badly written and reads like Oliver Twist asking for more gruel, it can give little confidence in the cause. It hardly paints us in a good image where we can be taken seriously when the petition a) refers to 'patient's' not 'patients' and b) is asking for money despite highlighting the ambulance service is facing a funding cut!

Sure, we have to do a driving course and yes, some have degrees. We do make clinical decisions and use the equipment we are trained to. It's true, we give lots of drugs and carry heavy patients and yes, the carrying of bags is a pain but that is the job we applied to do. We knew the salary when we applied, we knew patients and bags need carrying and we are compensated for it. Obviously, I would like more money, who wouldn't, but compared to the national average salary we are paid well. We are all in relatively secure jobs with sick pay, annual leave and a pension. In the economic climate where there are 1000's of people queuing for jobs when a new supermarket opens and 100,000s are facing the very real threat of unemployment, asking for a pay rise is hugely inappropriate. It is not the time, nor the place. 

The question of banding of salaries came about in the now outdated Agenda for Change and our job role has change a lot since then. Our skill-set has expanded and we now have a lot more clinical responsibility than we did. A registered paramedic is no longer a Band 5 job and I do think that the salary bands need modernising but an e-petition is not the way to do it. E-petitions should be left to things that benefit society as whole and will make a real difference to the country, not a small body of people.

We all know there is salary disparity across the country and it is wrong that a manager in McDonalds earns more than a paramedic but salaries cannot be quantified across the public and the private sector. If there is an e-petition for paramedics to get more money, there could be just as many reasons for a nurse to get more. And an HCA, an EMT, an ECA, an ECP, a junior doctor, the list is endless. There is no more money. The reason every department in the NHS is facing cuts is testament to this. Do we really think the government and even the general public are interested in increasing the wage bill when everyone else is feeling the pinch? We could debate for days and days the rights and wrongs of NHS cuts and the real cause of the economic climate we are facing but the fact is, as a country, we are in the shit. Now is the time to be securing people's jobs and securing the delivery of free health care to the masses, not lining our own pockets.

So, without further ado, I now open this post to debate and abuse. I'm expecting the same backlash as when I criticised the unions! Bring it! 

Invisible Wounds

"Female u/k age, tired, mental health problems"

"What's been going on?"

"About a year or so ago I witnessed something horrible. The death of a young man. I suppose, in the days / weeks that followed I expected to see his face in my thoughts. On the night itself I think the adrenaline kept me going until I got home. I just laid there on my bed and absorbed it all. I'd just watched someone die in the most horrific of circumstances and was helpless to stop it. Could I have done more? It was a helpless feeling that I just couldn't shift. His face. It was there all night. As the days past I thought about him less and less. I don't remember when his blood stained face stopped appearing in my dreams but within a month I'd say he was gone."

"So what's changed?"

"I found out his name. I was shown an online article about his death. I suddenly felt I knew who he was, what he was meant to be, what he had lost. His blood stained face came back. I'm plagued by flashbacks on an almost daily basis. I can't get his face to stop invading my dreams. It's weird though, now I almost take comfort in his presence. I can't imagine a day where he isn't present."

"And have you talked about this to anyone?"

"Sure, I've spoken to the people that were there and others. I feel like I'm the only one bothered by this. It's an overwhelming isolation which is eating away. Maybe it's just sleep I need. I can't remember the last good nights sleep I had. I've always had a problem sleeping but now it seems worse. After hours of trying I eventually get to sleep but once drifted off I'm awake again with an alarmingly predictability and the circle starts again. And again. Sometimes I just wake. Sometimes it's a nightmare. I picture his last moments again and again. Not from where I was though. It is as if I was watching it on TV. And I'm not looking at him really. I'm looking at me. It always ends the same though. His bloodied face, distorted, mutilated and swollen, lifeless. It's just......there."

I was clear just from looking at her eyes that this was taking it's toll. She looked drained.

"I have seen things that should upset me since but they don't. Maybe I'm hardened to it. I just feel numb. I try and keep busy to take my mind off it. The more tired I am the more I try and avoid thinking about how tired I am. I know if I think about sleep I'll think about him."

"What about your friends and family? Do they know?"

They do and they don't. They say they do yet I feel vilified for being irritable. Despite how I'm feeling they always have something trivial which is much much worse. Either that or I'm given happy clappy cliche advise about 'staying strong' etc. My mood swings back and forth and I try to only interact with them when I in a good place. It's just easier that way. I'll be fine, I'll get over it, I'm just tired."

"There is help available." 

A smile appeared on her face. Clearly I wasn't in on the joke.

"Yes I know, therapy, drugs, a sick note etc. No thanks. Can't be dealing with a disciplinary and P45 too! Work is a good distraction but they don't take kindly to mental frailties! Honestly, I'll be fine! Just venting!"

*          *          *          *          *

The 'patient' was me. The 'guy' was patient from '3am' (read). Post Traumatic Stress Disorder (PTSD) is very very real. It's often associated with the military due to the sights they see and the environment they are in. However, it is becoming more and more common, or more and more freely admitted in the Police and the Ambulance services. I have it, or had it, I'm not really sure. I'm also not really sure if it is ever something that goes. Maybe it is and it just hasn't gone yet. Maybe it is gone and what is left will stay. I don't really know. I wrote this post because of one I read on the One Police UK Facebook Page. It really hits hope what PTSD is all about. 

Despite what the PR department will say, there really is no provision within the emergency services for dealing with it. I tried accessing the 'free counselling' service that is offered and if anything just trying to make an appointment made me worse. Actually saying  'I have PTSD' was of huge importance, as cliche as it is. Not in the sense of standing in a circle and saying 'My name is....... and I have.....' but to admit that your mental health is affected is quite a big thing. Especially when until that point, you only ever had to deal with other people's mental health. In the ambulance service, the closest you come to your employers knowing something is wrong is going off sick with stress. And lets be honest, that only stands to give you a reputation for 'someone who goes off sick with stress'. i.e. chancer, faker, pulling a fast one, playing the game, abusing the system. It's true. That is how you will viewed by management. 

Admitting weaknesses isn't something that is done much in an environment full of black humour and bravado. Mess room banter probably wouldn't cope with someone saying 'actually no, I see his face in my sleep every night'. You just play the game. Put on the brave face and only confide in the ones you think won't judge your weakness. Let's be honest, it doesn't give much confidence in a new crew mate when a simple head injury causes you a panic attack. There a triggers everywhere, it's about learning to spot them and avoid them. Sadly, this job doesn't let you avoid seeing words like 'fall from height'. These are the invisible wounds that PTSD leaves behind.

The problem we and police have is it doesn't stop. There is always a new memory around the corner. '3am' has effected me. It was the last job of the shift, the last shift in a run and I had seven days off to dwell on it. Maybe PTSD in the emergency services is more about timing rather that the event. I have seen things that a more tragic and more disturbing since but they don't effect me. Part of me wishes that they did. 

Another traumatic death or a dead child. Maybe the one memory that stays is protecting us. If every traumatic sight we saw effected us in the same way we simply wouldn't function. There is very little time to process information. Very often I have written about seeing something which most people would see as probably the most traumatic event in their lifetime, only to go to another call five minutes later. Maybe this is why

PTSD isn't going away, it is a fact of life and although some efforts are being made to treat it and make it more accepted, until it is fully embraced and tolerated by employers little will change. Let's be honest though, the reason why it isn't widely tolerated as a genuine reason for sickness is money. We can't have our police officers and ambulance staff on long term sick can we! There are targets to be met.....

Don't forget to vote in the MAD Blog Awards 2013. I'm a finalist in the Best Writer category and all votes will be appreciated! VOTE NOW! Voting closes midnight tonight!

Experience

"28 year old female, lacking experience....."

Right! Rant time! This post was inspired by a twitter conversation with @butwhymummywhy about being judged as being too young! (see her musing on the same subject here) Tell me, who here has been told they were too young to do something? Which mothers have faced criticism for being to young to have a baby? I'm not talking the 13 and 14 year olds, they ARE too young. I'm not even talking about the '16 and pregnant' ones. I'm talking those in the low 20's. At what age is the 'right age'? Who has not been trusted at work because of their age? Who's opinions have been discounted because they were 'too young' or 'inexperienced'? Personally, I've been on the receiving end of a number of comments about being 'too young' throughout my relatively short life. Being a parent at 23?! What was I thinking! Far too young! Right?! Let me put this too you....

Let's say I went to university, graduated at 21, got a job, worked for 4 years, had a committed relationship and then had a baby at 27. Is that acceptable? Yes it is! How about leaving school at 16, working for 3 years, buying my own house, had a committed relationship, worked for another 4 years and had a baby at 23. I was earning more than most of the 23 year olds with degrees. I owned a house and had 7 years working and living as an adult under my belt. Am I any less qualified? Apparently so! Surely my degree from the University of Life counts for something?! It really pisses me off when age is used to undermine, with nothing to back it up other than a date of birth. 

Now take the work place. My work place. The ambulance service is a very strange working environment. There is a bizarre mentality amongst many that the more years of service you have done, the better you are. There is a culture of looking after the 'long timers' and the 'newbies' can deal with it. The relief rota is a case in point. Working 7/10 weekends indefinitely just because you are new if fine for a few years but 3? 4? 5? 6 years? When are you experienced enough to not have to do the shifts that the experienced staff don't want to?!

"68 year old female, chest pain"

I was working with a guy who had done 25 years on ambulances. The shift had been painful. He didn't have the time of day for me because I was a student. At no point did he bother to ask where in my training I was. He opened the days conversation with 'are you one of jumped up Uni medics or one of the Playmobil Paras?'. There is a lot of ambiguity in the service about university students. They are seen as stuck up 'know it alls'. OK, some are but similarly there are 'old hands' or 'dinosaurs' who swagger around with just as much self importance. It's not the training, it's the personality. Difference is I wouldn't call them a derogatory name to their face! This guy was giving me one of two labels regardless of what kind of clinician I was. For the record I was a 'Playmobil Para'. I get this label because my route to becoming a paramedic had a different name for the final exam than what used to be done. Therefor it stands to reason that I will be incompetent, useless, untrustworthy, unknowledgeable and a clinical liability. Right?

The hours past with stories about 'back in the day' and instructions not to do too many jobs in the shift etc. I was mocked for being thorough and told my extensive paperwork was a waste of time. I ignored it. It was the expected treatment for a relatively new student. By relatively new, I mean only 2 years. At 4 shifts a week, 10 jobs a shift, that equates to roughly 4,160 patients. In that time I had done 2 ECG recognition courses, a course in Trauma, plenty of home study, clinical updates, reflective practice and some other work related stuff. Yes I was new, yes I was still keen (still am) and no I didn't tell him what I'd done in my spare time.

We arrived on scene at the patients house and as the 'newbie' I carried all the bags while he followed with his hands in his pockets. The patient looked like crap. Pale, sweating and complaining of central chest pain radiating to her jaw. I did the ECG, looked at it and KNEW it was heart attack. I passed it to my crew mate of 25 years experience.

"Nah, it's just high take off."

A) Normal B) Heart Attack (NOT High Take Off!)

For those not down with ECG terminology, we look for ST segment elevation. I know that means nothing to most of you but all you need to know is high take off and elevation can look similar but are not the same. I explained my reasons why it wasn't high take off and the response I got was:

"You can use all the long words you like, that's high take off."

The reason this was a sticking point was, if it WAS a heart attack, we would be travelling a long way to a Heart Attack Centre and would be late off. It is wasn't, and was just high take off, we'd be going to the nearest A & E and would be off on time. 

"I've been doing this job for 25 years, you're a student, trust me, it's high take off."

"It's elevation, we are going to the HAC, you can call clinical support if you like. The history matches the ECG."

He muttered something under his breath about 'know it alls' with 'no experience' and stomped off to the cab. We drove to the HAC, the waiting cardiologist looked at the ECG and confirmed it was indeed ST elevation and she was indeed having a heart attack. 

Student 1 - 0 25 Years Experience

It made for an awkward journey home. I didn't gloat. I didn't say 'I told you so' but I didn't need to. He just ignored me. The silence was golden. My point isn't that I was great. On a day to day basic his wealth of experience would help him and me in many ways but just because I'm young and new doesn't mean I don't know what I'm doing. He hadn't done any training for years, no continual professional development. Therefor, is 25 years experience just 1 years experience repeated 25 times? I have uppermost respect for people who have done the job for so long but respect still has to be earned. Treating my like an idiot only earned my crewmate disdain. I don't know everything, far far far from it. I'm still learning. I'll always still be learning. The time I don't feel the need to learn more is the time I stop gaining experience.

People should be judged on ability not experience. People should be judged on how how well their children are brought up, not how old the parents are. Experience is relative. It's well known that discriminating against sex, race, religion and sexuality is not acceptable in today's society. Well, age isn't a reason to belittle / dismiss / ignore someone either. To label someone as too young to do something or to have done something, smacks to me as criticism to justify their own choices in life. There is no point in having experience if you've done sod all with it.

Rant over! 

Do I have enough experience ranting to call myself a well rounded ranter or am I too young?

Zig-Zags

"Bunch of parents being dangerous and selfish"

Being on a rest day I actually got to do the school run for a change. I took the car because a) the weather was grim and b) I had somewhere to be after I dropped the boy off at school. I turned up, parked about 50 meters down the road and walked him into school. As I passed the yellow Zig-Zags with huge KEEP CLEAR letters written on the road a car pulled in and parked. The mother got out, got her child out and walked in to school. 

"You can't park there." I said.

"Well I have." she said as she started walking off.

"Not only is it illegal, it's incredibly dangerous and selfish. Read the sign."

"How about you mind your own fucking business."

"How about you mind your language."

With that, she raised her chubby middle finger at me and walked off. Parenting at its best! Why is it so hard to NOT park on the 20 meter stretch of road?! 

It really really winds me up and there is sod all I can do about it. There are no teachers or school staff outside stopping it, there are no police or PCSO's outside stopping it so it just continues. Obviously, I don't expect the police to waste resources on it but surely something can be done. Why do these parents show such disregard for a) the law and b) the safety of children. They are there for a reason and I have been to several children injured because of it. 

To make my point I busted out the camera and took 3 photos while arriving and leaving:

This is the woman with the mouth like a toilet.

Culprit number two as I was leaving. Why walk when you can park?!

There was a legal space opposite but it needed parallel parking. Long!

All it is, is selfish laziness. Nothing more, nothing less. Pig headed ignorance. If all other parents who drive can park legally, a little further down the road why can't these morons do the same?!

I've written a letter to the school about it and hope something will be done. Do you have a similar problem at your school? Please share you thoughts! Am I over reacting?! Personally, I'd like to see zero tolerance. Park on school zig zags and if there is evidence of it, your car is crushed and you get 6 points on your licence. That'll soon stop it!

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When God Made Paramedics

I found this randomly on the internet. It is written by an unknown author but it sums up well the job we all do. The text refers to paramedics but it applies to anyone who works in any ambulance service the world over! Enjoy!

NB: After posting this, I received the following message:

"Ella, When God created paramedics is not anonymous. It is plagerized almost word for word from a mother's day column by Erma Bombeck. Google "When God Created Mothers." This version has been making the rounds for over a year. The person who originally posted obviously did not understand that writing is a labor of love and that publishing another's work as a whole or with a little tweaking, is stealing."

I did google it and the original poem was written by Erma Bombeck. Writing is a labour of love and I wouldn't want anyone to tweak my writing and claim it as their own. This 'version' of the poem does convey the message about EMS but shouldn't be credited to anonymous. Thank you Erma Bombeck.

*          *          *          *          *

When God made paramedics, He was into His sixth day of overtime. An angel appeared and said, 

“You’re doing a lot of fiddling around on this one.” 

God said, 

“Have you read the specs on this order? A Paramedic has to be able to carry an injured person up a wet, grassy hill in the dark, dodge stray bullets to reach a dying child unarmed, enter homes the health inspector wouldn’t touch, and not wrinkle his uniform.”

“He has to be able to lift three times his own weight. Crawl into wrecked cars with barely enough room to move, and console a grieving mother as he is doing CPR on a baby he knows will never breathe again.”“He has to be in top mental condition at all times, running on no sleep, black coffee and half-eaten meals, and he has to have six pairs of hands.”The angel shook her head slowly and said, 

“Six pairs of hands…no way.” 

“It’s not the hands that are causing me problems,” God replied. 

“It’s the three pairs of eyes a medic has to have.” 

“That’s on the standard model?” asked the angel.

God nodded. 

“One pair that sees open sores as he’s drawing blood, always wondering if the patient is HIV positive.” (When he already knows and wishes he’d taken that accounting job) “Another pair here in the side of his head for his partner’s safety. And another pair of eyes here in front that can look reassuringly at a bleeding victim and say, “You’ll be alright ma’am when he knows it isn’t so.”

“Lord,” said the angel, touching His sleeve, “rest and work on this tomorrow.” 

“I can’t,” God replied. “I already have a model that can talk a 250 pound drunk out from behind a steering wheel without incident and feed a family of five on a public sector paycheck.” 

The angel circled the model of the Paramedic very slowly. “Can it think?” she asked.

“You bet”, God said. “It can tell you the symptoms of 100 illnesses; recite drug calculations in it’s sleep; intubate, defibrillate, medicate, and continue CPR nonstop over terrain that any doctor would fear… and it still keeps it’s sense of humour.”

“This medic also has phenomenal personal control. He can deal with a multi-victim trauma, coax a frightened elderly person to unlock their door, comfort a murder victim’s family, and then read in the daily paper how Paramedics were unable to locate a house quickly enough, allowing the person to die. A house that had no street sign, no house numbers, no phone to call back.”Finally, the angel bent over and ran her finger across the cheek of the Paramedic.“There’s a leak,” she pronounced. “I told You that You were trying to put too much into this model.” 

“That’s not a leak,” God replied, “It’s a tear.” 

“What’s the tear for?” asked the angel.

“It’s for bottled up emotions, for patients they’ve tried in vain to save, for commitment to that hope that they will make a difference in a person’s chance to survive, for life.”

“You’re a genius!” said the angel.

God looked somber.

“I didn't put it in there” He said.

–Editor unknown

Original poem 'When God Made Mothers' by Erma Bombeck

Flowers

"Am I going to die?" she said softly. 

How do you answer that? I'm a terrible liar at the best of times but in situations like this I can be read like a book. That said, as much as I am able to tell someone that their loved one has died, I couldn't bring myself to tell someone they are going to die. Maybe my eyes told the whole story but my words didn't. They simply didn't answer the question.

"Stay calm, we are going to get you out of here and off to hospital."

With that, I rested the blood stained oxygen mask back over her face knowing all too well this would be her last few minutes. She closed her eyes. It was chaos around me. Every emergency service, a sea of blue flashing lights and rain. Heavy rain. I was in the car with Claire. I had climbed in through the boot, clambered to the back seats and then through the front of the car. Claire was trapped in the mangled wreckage of her car. There was no quick exit, the oak tree was where the drivers seat should be. Claire was where the gear stick should be, I was in the gap that was left. I followed health and safety procedures in that I had a high-vis jacket on and a helmet. The visor quickly steamed up and due to it's size I couldn't move. The helmet came off. It was just me and Claire in the car. Getting her out wouldn't be down to me, I'd just be the passenger in all this.

9 minutes earlier......

"RTC Car vs Tree, 54 year old female, trapped"

It was about 10pm and the weather was grim. I didn't relish this job at all but off we went. Strangely, we were first on scene. The second we turned the bend I could see the headlights through the mist of the rain pounding on the floor. That one image was all I needed....

"Red base, can we have Fire, Police and HEMS please."

"Roger, on way"

It's not often I request everything without assessing the patient but the car was on a blind bend, the car was quite literally wrapped around the tree and from the damage I could see from 10ft this patient would not have escaped serious injury. Within seconds the police and fire rounded the corner blocking road in both directions and I headed over to the car. The passenger door wouldn't open, nor would the back door but the boot was open so in I went. I got oxygen on her but she panicked with the mask. I tried to fit a collar on her but she panicked. I held her hand and assured her we would help her. She was pale, blood was pouring out of a wound of her head, her arm and leg were clearly broken and she couldn't breathe. I managed to get a cannula in her hand but she ripped it out. Bugger. She squeezed my hand tightly and starred at me. It's a look I will never forget and one that will stay with me for my entire life. That I am sure of.

"Am I going to die?" she said softly. 

"Stay calm, we are going to get you out of here and off to hospital."

As we were........

The fire brigade were working tirelessly around the car to get her out. The sawing, the banging, smashing and shouting drowned out my voice. 

"Claire, Claire, open your eyes!" I shouted. 

Another face appeared in the back of the car. It was my crew mate. 

"Claire, open your eyes!"

I felt for a radial pulse. Nothing. I felt for a carotid pulse. Nothing. It was the first time in my career I didn't know what to do. I felt helpless. Do I start CPR? I'm just going to pump the little blood that's left in her body out. I turned to my crew mate, we had a brief discussion of her injuries and decided any resus attempt was pointless. The fire brigade were about 15 minutes away from freeing her, that was too long to make any resus worthwhile. I started CPR though, I felt I had to. My crew mate spoke to our clinical support who agreed that we could stop. Then I stopped. Stopping is strange feeling. In my heart I knew she was gone but it's against our instincts to stop and walk away. I wish i'd known when she closed her eyes, eyes full of fear and pain, that it would be the last time. 

I clambered out backwards. Numb about what had happened. Claire. That's all I knew about her and in reality, all I will ever know. 

The other cold, harsh reality is that now I had to do paperwork for us and the police. Then, without much further ado and moping around I'd have to press that magic green button and go and do another 5 or 6 jobs before bed time. And that is what we did. It doesn't mean Claire wouldn't enter my thoughts but realistically it wouldn't be until I'm lying in the dark, staring at my ceiling, that I will have a chance to spare her a proper thought.

"22 year old female, headache, nauseous, states has run out of paracetamol"

C'est la vie.

1 week later......

You know when people die at the road side, tributes are left by friends and family to mark the spot where a tragedy occurred? Be it someone run over or victims of a crash there are always tributes left behind. I often see them at places where me or my colleagues have been or what is reported in the paper. It's a constant reminder of what happened, it triggers memories, evokes emotions and shows what someone has left behind. 

We were driving along the very road where Claire's time had come to an end. I slowed down as I rounded the corner and the tree came into view. The tree stood proud and tall. If you didn't know any better you wouldn't know that a Ford Focus had been wrapped around it 8 days previous. There was no debris, no fragments of glass, no nothing. 

No flowers. No memory. 

The MADS

So, a month or so ago marked the start of the 2013 MAD Blog Awards. I knew that as a parent I kind of qualified but as my blog is hardly a parenting blog I didn't think too much of it. Then, I got a few tweets saying people had nominated me. Then, a few more, and more, and more! I was amazed! So I posted a little blog telling my readers how to nominate and left it that. On miserable night shift last week I got a text message from a fellow blogger. It simply read "You're a finalist bitch!". I replied "Shut up.....". It turns out she was right! Of the 100,000 nominations received you lot had given me enough nominations to be one of the top five finalists in the Best Writer category. I am not only truly amazed but totally and utterly humbled! Thank you so so much. It really does mean so much to me. 

When I started blogging I received a fare amount of hostility from other bloggers and ex-bloggers in the  EMS world and I almost stopped blogging. That was until I discovered the mum and dad blogs. What a welcoming community they were. Full of support, tips and ideas and since then I haven't looked back. That is what the MADS are about. Community. We all blog for different reasons and take different things from blogging but being even just a small part of such a friendly bunch of people has been great. 

I'm up against so top top blogs and as nice an accolade as it would be to win it is highly unlikely. However, you got to be in it to win it as they say so now I'm a finalist, please vote for me in the Best Writer Category! 

You can do so by following the link below! Once again, many many thanks to one and all who nominated me. It means so much.

Ella x

VOTE NOW

The Thin Green Line

This is a post written by @FatManonaBike on his blog 'Fat Man on a Bike'. I felt it wonderfully sums up the struggle and reality that the NHS is facing and well worth sharing with one and all! Enjoy!

"The Thin Green Line"

There are few things in life about which I can speak (or write) with any kind of authority, and cycling certainly isn’t one of them. Neither, for that matter is politics, nor the subject of this post: the current failings of the National Health Service.

To be fair, that’s a little bit unfair. The NHS is not failing. Given the kicking the NHS receives on a almost daily basis by the men in suits that control the money, it’s an absolute miracle that the UK has a health service at all. Despite terrible funding cuts (or, no less difficult to manage, insufficient funding increases), inappropriate decisions made by people that have little idea what planet they’re on, and the ridiculous notion that healthcare is a profit-making scheme, the NHS still makes sick people well, and does so with dignity, professionalism and compassion. I work for the NHS. I’m one of those chaps in green outfits, as seen on Casualty. No…not Jimmy the Porter…more like Josh Griffiths, but good-looking and with hair. I’m frequently told, “Oh, I couldn’t do your job”, which clearly means I’m made of tougher stuff than some of you. This, in turn, means that I could duff you up in a fight and, therefore, unless you wish to find your nose bloodied you should stop what you’re doing and pay attention. This is your NHS, and like the punch-drunk boxer struggling to stay standing, it’ll only be a matter of time before a suited politician comes along to put it out of its misery.

Earlier in this post, I told a lie. It was unintentional, but a lie nevertheless. This isn’t about the failings of the NHS per se, but a small part of it. In fact, that’s probably a little inaccurate, too. This post is about inadequacies, not failings, yet such inadequacy will invariably lead to failure for the unfortunate minority. Sadly, such failure doesn’t mean that a business folds, a shop closes, or someone has to go back to working on the bins. Without being even slightly melodramatic, it means people die. Actual proper death. Gone. Brown bread. It could be you, your mum or dad, your wife or husband, brother, sister, girlfriend, boyfriend, etc. I think you probably get the picture without me listing all possible relationship statuses. Dead. To your terrible sorrow is now added bucketsful of anger. You watch, helpless to save your loved one dying, still waiting for the ambulance three hours after you called.

Ambulance delays are now an everyday occurrence. Fact. Lengthy delays. Life-threatening delays. 

There are always occasions when delays are inevitable. Ambulance services are not immune to bad weather, heavy traffic, or the overwhelming desire of the general public to get pissed, then have a fight on New Year’s Eve. Heavy snow can turn a six-mile journey into a three-hour affair, but this isn’t the shit I’m talking about. I’m talking about your average day. A Tuesday, perhaps, because nothing of note ever happens on Tuesday. On every single average day, many lengthy delays can and do occur.

By now, an Ambulance Service manager, hot under the collar and fuming at my words, may be preparing to lynch me. That’s fine, but I suggest that he or she reads on first. I have a point to make before I swing. The point is that such terrible delays are not our fault. On paper, provision of ambulance cover is just about adequate. In practice, it would be equally be just about adequate were it not for closing Accident and Emergency departments, false or shelved promises of new super-hospitals, reductions in hospital beds, forced redundancies of hospital staff, and a whole host of other problems created purely by penny-pinching, blinkered civil servants, keen to make a saving that ultimately ensures their job security in the next reshuffle. The city in which I work does not have an A&E department, and hasn’t had one for over ten years. In the last two years, the towns on either side have also lost their A&E departments. The super-hospital that was promised prior to closing those A&E departments is invisible or, more probably, unbuilt. So where do ambulance patients go now? Very simply, they go to an Accident & Emergency department. An Accident & Emergency department that can not, for very obviously-logical reasons, cope with the additional influx of the sick, dying and dead. An Accident and Emergency department in a hospital that has had the number of beds, nurses and doctors reduced. An Accident & Emergency department that has ambulances queuing for hours outside it’s doors. The ambulance simply pushes the first domino, and they just keep on falling.

If you’re expecting me to have the answers to all these problems, you’ll be disappointed. Clearly, running the NHS as if it were a business, rather than as a publicly-funded healthcare-providing service, doesn’t work. Beyond massive cash injections, restoration (or an increase) of the pre-existing healthcare provision, u-turns in political policy, careful and considered spending, and people having the balls to admit that not all the implemented changes work, I fail to see how or when the NHS can pull itself away from the ropes and come out fighting.

Cue The Madness

"55 year old female, breathing problems"

Community First Responders (CFR), rightly or wrongly are becoming a big part of pre-hospital care up and down the country. I could argue about the ethics of them for days on end. On the one hand, it's great that these people are giving up their own time to help their local community. That should be commended and overlooked. I am not being critical of ANY of the responders themselves, it is more that fact that they are needed and how they are used. The fact that all ambulance services are relying on un-trained volunteers to get to patients first and stop the clock speaks volumes about the shortcoming in budgets and man power. I know that in some areas, especially rural, the CFR scheme is invaluable. In others, like the city, it seems to be more or a PR and clock stopping exercise. Training standards across the country vary but in my area a 3 day St Johns Ambulance course is all they get. Then, they are given a radio, a response bag and mileage form and off they go. This isn't their fault, it is the system. They have little support and really are thrown in at the deep end. 

After 6 months full time training, multiple assessments, months of placements and untold evening hours studying I didn't feel remotely ready to go out as a crew of two and meet patients. THAT was daunting! To do that after 3 days first is simply terrifying! The most important skill we learn as paramedics / EMTs / ECAs etc is talking to people. Making people calm, using tact, employing diplomacy and telling it straight when appropriate. This cannot be taught in a classroom. You learn it from experience and experience only. It cannot be taught on a 3 day course!

We arrived on scene to be greeted in the middle of the road by not one, but two members of the patients family waving their arms and jumping up and down. Clearly, today we would be acting in a calming role! Our patient was lying in bed, coughing and spluttering. To be fair it sounded like a horrible cough but not one that required all the pomp and circumstance that was surrounding her. We checked her over, listened to her breathing, did our usual battery of tests and came to the conclusion that she had pneumonia. Unfortunately, pneumonia is one of those big medical words that very few people have an understanding of and as such, strikes fear into many. Like many conditions, pneumonia can be serious in the very young, the very elderly and people with complex medical needs. She was none of the above so was going to be just fine! convincing her and her family of that was another matter....

As I was explaining what was going to happen and how pneumonia was just a simple chest infection in walked the CFR! Clearly control had forgotten to cancel them! It would normally just be a case of swapping call signs and they would leave but today this young guy decided to stay. Our patient was getting her stuff ready while I told the CFR what had been going on. Everything seemed quite calm, the patient was no longer panicking and her family had stopped hovering and fussing. Bliss! Cue the CFR.....

"My dad had pneumonia." he blurted out.

"Oh, how hold was he?" said the patient inquisitively.

"He was only 53."

"Was he OK, did he recover well?"

"No, he died."

Cue the madness.......

The room became hysterical and I mean seriously hysterical! They were all mourning over her inevitable death like Victorians. They were not far off picking out their black outfits! I tried and tried to resolve the situation but in vain. The CFR backtracked and said that he had had other medical problems too but what had been done, could not be undone. We went out to the ambulance, patient and relative's arms waving like the Harlem Shake and off we went to hospital. The CFR left the scene of the crime with his tail between his legs. Can you imagine the face I had on?!

Chelsea Tractors

"5 year old male hit by car, injuries unknown"

3:30pm. The school run. My money is on a careless driver not watching where they are going and a little kid has paid the price for it. We got about 100 yards from the location given and it clear that it was a school. There was queue of cars obviously stopped because of the incident who were blocking our path to the patient. I'd say at least 50% of said cars were Chelsea Tractors. For those unaware of the term here are some Urban Dictionary ones:

1) Chelsea Tractor 

Any expensive 4x4 that is driven in an urban environment as a status symbol (typically for the school run) and will never be driven off-road.

2) Chelsea Tractor 

An off-road car that never goes off-road

3) Chelsea tractor Noun, a large 4 wheel drive vehicle, driven in cities for ordinary, day to day purposes. eg, Land Rover, BMX X5, etc..

Typically, they are driven by mums for the school run.......because everyone needs a Land Rover Defender to drive half a mile to school to pick up their 1 child. Nothing winds me up more. It's bad enough that they have them, but they can't even drive them! Here we are, blue lights and sirens and they all panic! When faced with an ambulance there are some options available. 

a) Pull over to the left allowing us to pass on the wrong side of the road.

b) Keep going and pull into one of the spaces or the bus stop.

c) Stop diagonally across the entire road preventing any traffic from moving in any direction.

Yes. You guessed it. c) was by far the most appealing option! Though some did try b) but the parking sensors clearly weren't up to scratch. Why have a car you can't drive?! Thanks to one particular owner of a BMW X5 we had to abandon the ambulance and walk with all of the kit we could carry. I glared at the owner and received:

"What do you fuckin' expect me to do?"

Nice, in front of her child too. That kid will have a mouth like a toilet by the age of 7! It'll probably have it's its own petrol guzzler too! 

Eventually we got to our patient. Shock horror, he'd been hit by a 4 x 4. Luckily it was low speed and he had no injuries. The car had reversed and I quote:

"It's not my fault, the reversing alarm didn't go off, they shouldn't have been crossing behind me."

No, you are quite right. It's totally their fault. Crossing at the yellow zig-zags where cars are not allowed to stop, outside a school is just bad parenting. They should be punished for that. The Range Rover Overfinch comes with plausible deniability when it comes to bad driving. I forgot. As for the reversing sensors, right again. Mirrors and awareness of surrounding are so last year! I suppose being so high up in a car means short people should be more vigilant when crossing roads. This child certainly has no right to an apology. Stupid child. Stupid mother for crossing the road at a crossing. I'd call social services if I was you. It's verging on neglect isn't it?! 

ARE       YOU       SERIOUS?!

You are blaming the child for your incompetence?! The child you just reversed into? I really had to bite my tongue! Am I alone in my hatred for these cars in urban areas? Why does everyone flock to them? Why are they so popular? And why are they all driven by women who can't drive? Can I just add, before I get mobbed by feminists for saying 'women can't drive', anyone who relies on parking sensors and reversing alarms / cameras to park a car CANNOT drive. There is absolutely no need to them in built up areas. Fine, if you live in the country and have to drive up steep mud tracks to get to school then fine, but these cars have never seen a mud, let alone a hill. What happened to walking? Most of these people live within a mile of the school! That's how catchment areas work! WALK! No wonder all your kids are fat. Bit harsh. I know. I semi-retract that last comment!

So, here is a car buying guide for anyone considering a 4 x 4 for the school run:

Will you be driving on terrain like this?

Will you be driving up hill like this?

If you answered 'NO' to either of those questions then you DON'T need one of these.....

Will you be driving down roads like this?

Will you be sat in traffic like this?

If you answered 'YES' to either question you don't need one of these......

What you need is a new pair of shoes at best! FACT! 

Seriously, there is no need for them. It is just a status symbol. Nothing more, nothing less. They are bad for the environment, bad for the roads, bad for traffic, bad for people hit by them and badly driven. This child was very lucky. Most kids who are hit by them are not. If you have to drive match the car to your needs, not your wallet. Anyway, got to go, got to walk to the school.....

Please Sir, can I have some more?

Dear David

I'd like to start by wishing you and your family well in these tough economic times. You and Samantha's combined salaries of £400,000 plus shares and bonuses must be really getting spread thin. I empathise, I really do. Like you, I seem to work all the hours god sends yet that £25,000 seems to just disappears! Still waiting for my mileage expenses to come through though, so that will be an extra £42 in the piggy bank! I love expenses! Anyway, the point of this letter is one of a more serious nature. 

I have waited a long time to write this too you. Let me draw your mind back to your first assault on the Police service. In case you'd forgotten you cut 16,000 officers. Less is more! Quality over quantity! Needs must! Look at the bigger picture! We will all feel the pinch! No one is immune from cuts! All very very true. We must indeed all pay the price for the bankers and politicians sticking our country in the economical dark ages. But, there are consequences to your ill advised cuts. Let me share a story. A story that brings back painful memories. A story that still bears real scars. 

As a paramedic, one who has been through years of training and sacrificed friends and family for such a fulfilling salary, I understand that part of my job, in fact, part of my salary is danger money. Well, not officially, but being abused is part of the job, right? As the Right Honourable Ann Widecombe, recently said, "Public servants worry more about their own safety than that of the public, Britain has sunk to a new low". I'm guessing by your lack of condemnation of these comments you must agree wholeheartedly. So, as an 'ambulance driver' (yes, we are that low in the food chain), a bit of danger comes with the territory. One afternoon, I was called to a residential address to a man who had 'passed out'. 

When I arrived that man was lying on the grass. I approached him, on my own, and he appeared drunk. I went about my business, checking him over, when the ambulance crew arrived. We began to get the bed off the ambulance all the while making sure the member of the public was OK. We are public servants after all and serve we shall. Without warning the patient stood up and swayed a little, then staggered into a fence. Poor guy eh?!

He then beat me with a fence post. He also beat the other members of the ambulance service. Three of us in all. Do you know what it feels like to be helpless against a man beating you with a lump of wood? Despite all of our broken bones we managed to press our emergency button. Let me share a conversation with you.

Me: "Red base red base, urgent police, we are being attac......." I stop because the lump of wood has been broken over the back of my head and then broke my hand.

Crew 1: "Red base, my crew mate has been hit over the head, urgent police" he says with 3 broken ribs.

Red Base: "Getting the police for you now, are you all OK, can you get to safety."

Crew 2: "I'm now locked in the car, I think my wrist is broken, he's still attacking us."

Crew 1: "We are away from him but he's coming after us. Are the police on way?"

Red Base: "The police have no units to send, try and maintain a safe distance."

Crew 2: "He's trying to get in the car, he's hitting it with the wood"

Crew 1: "I think he's stopped, he's lying in the road but we can't drive off."

Crazy stuff isn't Dave! No units to send?! But aren't the police supposed to be there to protect us? Surely in a real emergency they have someone to send. Surely you didn't cut too many? It's OK, 9 minutes later two undercover officers arrived. Part of their job is getting abused too. I should probably mention now that in their efforts to protect us from the patient they too both got broken bones. They were struggling to restrain him on their own so much, that we all helped. We all restrained him for 10 more minutes until more help arrived. Guess what we did then Dave? We all took the patient to hospital for treatment. With our broken bones and bleeding wounds, we checked his blood pressure, he even got to travel on the bed. He is of course a member of the public and we are all their servants.

Now, do you still think less police is the right answer? What if you or your beloved family were trapped somewhere in real fear for your life? What if you called for help? What thoughts would go through your mind when you heard those terrifying words "No units to send." The officer who came to my aid told me that it used to be a team of 25 to police the borough on this shift. Today it was a team of 7. No doubt they got complaints from the public for not coming to their aid quick enough whilst 2 of the 7 were sat in A & E with me and my colleagues. Tut tut. We really must all work harder.

The good news from all of this, was our patient was treated professionally by us and the hospital. He was arrested and charged. He was sent to prison. However, because of your cuts to the prison service he has already been released and I could bump into him anytime of any day.  Oh wait....in fact, only last week, I was sent on a job to his house. Can you imagine the fear Dave, can you? Luckily he wasn't there. 

I am proud to say that in this country we have by far the best police service in the world. The things they do and the dangers they face without a gun on their belt. The professionalism they show at all times is nothing short of amazing. That is in the face of your assault on their salary, their pensions and their working conditions. Now you are making a career in the police as unappealing as possible by slashing the starting salary and rushing through the 'Eton Old Boys' to top ranking jobs without ever having to be spat at, kicked, punched, stabbed, shot, sworn at, had missiles through at them and put their lives on the line. It is plain and simple Dave. There are not enough of them any more. Not enough by a long shot. So, in the words of Oliver Twist, 'Please Sir, can I have some more?'

Just a thought, you know that publicly owned bank, RBS? You know, the one we all bailed out with our taxes. Well they are paying their staff £950,000,000 in bonuses this year. As they are PUBLICLY owned, why not use the money to fund the salaries for 38,000 new police officers on £25,000 a year. I think my maths is right. There are other banks to you know. Other ones we all helped fix. How about they now help fix us? I know, I know, I'm probably not looking at the bigger picture, but in that big picture I just see the words 'No Units To Send'. Silly me.

By the way Dave, this wasn't a work of fiction for effect. This actually happened. To me. Have a read. http://www.barnettoday.co.uk/news.cfmid=3449&headline=Man%20in%20court%20for%20paramedic%20assault

Good luck with the economy Dave, there are tough times ahead.

Your Sincerely

Ella Shaw (Public Servant)

Trapped in Darkness - Part 2

continued.....

"Male, U/K age, One Under"

Until now, I had been totally patient focused and hadn't noticed the commotion around me! There were about 6 Fire fighters under the train too with various member of underground staff trying to work out how to lift up the train. I'm guessing by the discussions that it isn't something that is done too often! In most One Unders they are either a) dead, in which case the train is driven off them or b) alive but trapped by a limb, in which case if a quick extraction is needed an amputation and dragging out will happen. Unfortunately, they couldn't drive off as it was his pelvis on the track and you can't amputate a pelvis for obvious reasons!

As minutes ticked by we got drugs flowing! In went morphine and ketamine and fluids. We cut of as much of his clothing as possible to examine what we could get to. There were minor cuts and abrasions but nothing major. All the while, the patient was getting more and more frantic so more and more drugs were given to numb the pain and relax him. Problem was there was no real access to his head. He couldn't see anything but  darkness and could only hear and feel what was going on, and for someone who is claustrophobic I imagine it was torture. I was starting to get very uncomfortable my self, the heat, the smell, the noise, the taste of air, it all made it a very uncomfortable atmosphere. Add to that the fact that realistically the patient could simply die and we would be powerless to do CPR, ventilate and remove quickly. It was a scary thought! 

"Sorry we're all talking about you. How are you doing?"

"Get me out of here"

"We are, it will just take a little while, I'm staying here right by you, if you feel any new pains or anything changes, please tell me."

"Get me out of here"

"We will, we will."

"Please, help me, I don't want to die" he cried.

Talking to someone who can't see you is bizarre. I could only imagine his facial expressions and the fear painted across his soot covered face. I felt totally helpless in all honesty. I tried to keep him positive but as the pain continued and the time went on and on he became more anxious. To be fair, so did I. 

Eventually, after about an hour they were ready to lift. I don't credit the fire service that often but credit where credit is due. They had been fantastic. The were working their nuts off, bringing us more oxygen, providing light and lifting 120 tons of train up! It wasn't a case of 1-2-3 lift! So, in a co-ordinated effort and a very detailed plan, the scoop was lowered down to the tracks and slid along, rope on 1 end. The pelvic splint was positioned and as many hands as could fit were placed on various parts of the patient. We are all told to stay away from the wheels as if the train drops we don't want to get trapped! 'Drops?' 'DROPS?' Encouraging! 

"OK, we are lifting......"

"He's free. Lower him down"

"We got him"

He let out a gut wrenching scream. Once on the scoop he vanished. Pulled the along the suicide pit and out onto the platform where the HEMS paramedic and my crew mate would take over while we crawled out. I shuffled backwards slowly, eventually making it to the platform where the light and underground breeze could be felt. The platform was full. Police everywhere, about 30 fireman, a few ambulance officers, a second crew and of course......HART team huddled together watching! The patient was being strapped up and wrapped in bubble wrap. Blood infusions were being prepared and he was being put to sleep by HEMS. I bet he wished he'd been asleep a long time ago. 

Within only 2-3 minutes we were ready to go. I took over the breathing for the patient and 8 fireman lifted him up and off we went through the maze of tunnels and escalators. FRESH AIR! Oh how I missed it. Behind us was the band of merry men and woman carrying all the kit. Everything was chucked on board, blue call placed and off we went. I was trying to take stock of everything that was going on. Suddenly, the doors swung open, we were at hospital, I hadn't even noticed we'd stopped. Into resus we went, a 30 strong team waiting for us. Luckily for me HEMS did the handover. I'd have probably starred blankly and said 'Hit by a train...erm...'!

We went back to the vehicle which  looked like a bomb had exploded inside. We tidied up and I started on the paperwork. Where the hell did that job come from! It really is true, EMS Rule number 10:

EMS is extended periods of boredom, interrupted by occasional moments of sheer terror.

Nothing can prepare you for things like this. It isn't for everyone. It is one of the few jobs that tests every part of you. The problem is you never find out if you passed the test. As all crews will say, he was alive when we got him to hospital so that's a win for us. It's a cover though. In reality, we are all desperate to know if he survived. We will probably never know. That's the reality of pre-hospital care....once you're at the hospital, your care is supposed to end. 

 My crew mate pointed at my face...

"You got a bit of dirt on your cheek!"

Trapped in Darkness

As far as shifts go, it hadn't been a bad one. I hadn't been spat at, sworn at, I hadn't had to carry anyone and no one had wound me up enough to change my mood! That's not to say that anyone actually needed an ambulance. The mere fact everyone had walked on and walked off meant that in reality, no one actually needed an ambulance but that's by the by! It was late in the evening, we reckoned that we had about two jobs left to do to see us off, so made ourselves available. We were a fair way away from station so we started heading in the right direction as fast as possible (within the legal speed limit of course!). We didn't get very far at all! Within about 5 seconds.....

"Male, U/K age, One Under"

Action stations. We were only 2 miles away so there was a good chance we'd be first there. While my crew mate drove like a bat out of hell I dived into the back to get the hi-vis on and safety helmets out the top locker. Back in the front and...

"UPDATE: Patient is screaming, injuries, unknown"

....we started to get a plan. Once we had confirmation power was of and track protectors were in place, I would get under the train and assess, crew mate pass staff and liaise with fire brigade and train staff. I began stuffing my pockets with stuff I might need; gloves, tape, torch, cannulas, bandages and a tourniquet.

"UPDATE: HEMS on way. Eta 8 minutes"

Right, that should give us just enough time foe me to get under before HEMS take over and we are sidelines! (Trust me, totally happens!). We pulled up at the station to see we'd been beaten by the Fire service and Police.

"UPDATE: HART team on way"

They can bugger right off! HART or Hazardous Area Response Team is by far the biggest waste of money the service has ever had. Always late to any incident in their fancy suits and equipment and they just sit and watch the fire service. They have lots of fancy kit that they never use and it's a classic old boys network full of wannabe firefighters. I predicted they will be stood on the platform on mass.....watching at some point during this job! 

We were indeed the first medical staff to arrive so we needed to carry everything! Luckily some 'water fairies' were on hand to help. We took paramedic bag, response bag, oxygen bag, Life pack, dressings pack. suction, scoop, head blocks, entonox, straps and blankets! The problem with underground stations is some are very very very deep and going back for kit isn't really an option if you need something quickly. We made our way down, and down, and down to the platform. The fire service were on the tracks and doing a good job of talking to the patient. I jumped down to have a look and there he was. In one piece, very much alive and trapped. What was bizarre was that he wasn't trapped or tangled by a limb, which is common. He was trapped by his pelvis between the train and one of the tracks, on his side!

Now, there are no text books telling you what to do, no algorithm, no guidelines, nothing. It was going to be a case of improvise, adapt and overcome. Under I went. Blimey! I forgot how hot it is under trains! And dirty! By the time I got to him my hands were black. He was very much conscious and there was no obvious blood! Always a good sign! He was however in a lot pain from his pelvis and was obviously very panicked. He hadn't jumped. He was drunk and had tripped and was hit trying to clamber out and by all accounts the train had nearly stopped at impact. Via a gap between the platform and train, a hand appeared holding an oxygen mask. I popped it on the patient and then a blood pressure cuff followed. With a bit of a stretch I got it on his arm. All the numbers were relayed back to me. His blood pressure was a little low but if he had a fractured pelvis he could easily bleed out into that and it would only get lower. 

OK, a plan......erm......

"How are we getting him out?" I said hopefully.

"We are going to jack the train up off of him and slide him out." 

No idea who I was talking to!

"How long?"

"Half an hour. 45 minutes maybe."

"Is that the only timescale we have? If he has to come out quick to we have other options?"

"Afraid not"

That's was a long time as far as I was concerned but it wasn't as if he could just be dragged out! He was well and truly wedged! I stuck an orange cannula in the back of his hand as that was the only part of him I could get purchase on. Thank god for big veins! I wanted to give morphine but in the circumstances I felt a grown up should be consulted first. Luckily, as I fixed the cannula down a head torch appeared. It was the HEMS Doctor! 

"You look like a chimney sweep."

Oh goody.....a mascara joke! 

TO BE CONTINUED........