Tuesday, 2 April 2013

Deja Vu

"12 year old male, rash on body"

My first thought was 'as opposed to the rash not on the body'! Lucky I had arrived to work early as is the norm because even with the best will in the world, I couldn't have signed in, drawn out drug packs, morphine, got my bags from my locker, checked the vehicle over and been ready to go in 17 seconds as they had hoped. That is why we are all compelled to come in half an hour early, unpaid, so we can be ready to go when the first job comes in. 99% of calls that involve a rash are minor, that is, if it is even visible. Very rarely it will an allergic reaction, even rarer it will be anaphylaxis and even rarer than that, it will be meningitis. Due to the latter two, in children especially, most calls with the word 'rash' are given a high priority of call to be on the safe side. I think this is a good thing, especially as even the most calm and reasonable of panicking parents don't want to answer multiple questions about the rash, they just want an ambulance. Also, if it is serious, time really is of the essence. 

Needless to say, we weren't very panicked! We weren't judging the call but the in the information we had there were no priority symptoms like difficulty in breathing or swollen lips etc or anything that would lead us to think the patient was going to be particularly unwell. Oh how wrong you can be! 

We pulled up outside the house to be greeted by 'that frantic wave'. You know, the wave I have mentioned before that tells you something isn't right and you really need to get a wiggle on. I followed the mum through the front door straight in the lounge. The boy was just wearing his underwear which enabled me to see most of his skin. Every part of him was bright red and covered in the worst hives I have ever seen. His face was swollen and he was in untold discomfort. He stood up and rushed to the toilet. It turns out he also had uncontrollable diarrhoea. Although his tongue wasn't swollen and he denied struggling to breathe I felt his condition was bad enough to treat for anaphylaxis and after a brief conversation with our Clinical Support Desk they agreed. 

Once I'd decided what we were going to do, I then had to do it and this is where the second guessing begun! It is very rare to have to cannulate a child and if we had been 5 minutes from hospital we'd have just run but the fact it was longer and the fact his rash was getting worse by the second I wanted to try for a vein before they all completely vanished. The panicked parents didn't help my nerves. I got everything prepared but suddenly became 'a dropper'! More by luck than judgement the cannula was successful. I then checked and double checked dosages for the drugs I was giving. Whilst I was cannulating my crew mate had drawn up and administered the Adrenaline into his muscle and had given full flow oxygen. I then gave some Chlorphenamine (Piriton) and Hydrocortisone  and we left. I felt very conscious that I was shaking slightly, and even managed to drop the radio when putting in the blue call! How embarrassing!

We arrived at the hospital and went straight into resus where the team of paediatricians were waiting. There had been no improvement from any of the drugs we had given and his rash and breathing were now notably worse. At least he was in the right place, and I could breathe! 

This is a weird job, in the sense that you are taught about what to do in a lot of situations for a lot of medical conditions yet you obviously only get to see the conditions you are dispatched to. I can count on one hand the amount of times I have seen anaphylaxis and this was by far the worst I had seen it. It had been maybe two years since the last time I'd seen it too and in all honesty I felt very rusty during the job. Nothing was missed but was I bit slow in treatment? Probably not. Did I do it all correctly? I think so. Did I look or sound confident when doing it? NO! I tend to stay calm in some of the most frantic of situations like most people in the ambulance service but like everyone else, the thought of having a really sick child deteriorate in front of you is by far the worst feeling there can be. At least I will have this memory to draw on the next time I'm faced with it. Anyway, no time to ponder! Time for the next one......

"5 year old female, allergic reaction, known allergy to nuts, has ingested nuts, swollen tongue, DIB"

Are you serious?! I've said before that jobs tent to cluster in a shift and the first generally dictates the rest but really?! Again?! Well, at least I had a clear plan in my head! Off we went and after a short drive it was like deja vu! Out came the waving parent, the only difference was this time, she was followed closely but the father, carrying what looked like a limp child. *cue shiver down spine*

I'm sure I was out of the vehicle before it had stopped moving. The kid was conscious, just, but extremely floppy. We got her straight on to the bed, dad at the head end, mum next to me and crew mate moving around in any space available. The fact she was so compliant said a lot. Hardly any whimpering, all her energy was concentrated on breathing and that was a clear struggle. She got high flow oxygen a nebuliser, IM adrenaline followed by hydrocortisone & chlorphenamine a few minutes later. I didn't even look for a vein, she was so small and we were only a few minutes away from hospital so the latter drugs were given on-route into the muscle. If the last job had scared me, this one terrified me, but in a different way. This time, I knew I'd done everything quickly accept in my head I was planning a resus. She was that bad. 

9 minutes after arriving on scene we were at the hospital again and for the second time in 45 minutes the team of paediatricians had seen me rush in with an extremely ill child! Only difference was this time I was a lot calmer. Amazing what effect the lack of doubt had on my ability to hold things steadily! We weren't even two hours into the shift and I was pretty much out of drugs and totally exhausted! Once the paperwork was done and signed I called up control. 

"Red base, due to the last two jobs we are all out of drugs, can we start heading back to station to re-stock please."

"Rog, no probs, start heading back and we'll try and leave you alone."

We can't be shown unavailable as we can still 'render aid' apparently! What that means is if there is a job we will be sent and they will hope we have enough kit to get by! As long as it's not another allergic reaction we'll be fi....

"10 year old male, allergic reaction, eyes swollen"

Of course it is, what else was it going to be?! The one thing we can't deal with is the one thing we need to find a way to deal with! 

"Red Base, we have no drugs to deal with an allergic reaction. Is there a Hotel car running on this?"

"Rog, they are 3 minutes away."

'Hotel' is ambulance jargon for paramedic and I don't know the origin of it. If there is a paramedic on a vehicle it becomes a Hotel crew. Anyway, we pulled into the road just before the car and I took great pleasure in ticking the 'first on scene' box! Like we had done twice already we jumped out and headed in. This time it was slightly calmer. The boy had a huge swelling under his eyes and a rash over his torso and arms but wasn't too unwell. It was very itchy and causing him a lot of discomfort so thanks to the FRU, we gave him some Chlorphenamine which worked well and within 10 minutes the itching had stopped and the rash was decreasing. By this point we were back at the hospital where we handed him to the waiting paediatrician who looked at me and laughed!


That was it! Not for the shift, but for the allergic reactions and quite frankly, I don't think I could have coped with another! As for the shift, there was still 10 hours to go! *cries* 

As for the patients:

Patient 1: As of 8 hours after we arrived he was still in a very, very bad way. The doctors didn't know the cause and despite a list of drugs and therapies as long as my arm he hadn't improved. The kid was awaiting a transfer to a specialist hospital. I won't find out how he did.

Patient 2: Fine and dandy, sent home 6 hours later and told to stay away from the macaroons.

Patient 3: Discharged 4 hours later with another washing product to add to the list he is allergic to. 

Kids eh! Aren't they fun!


  1. As usual, I salute you!! And Nathan Constable wants to merge you with Fire because you both have time 'waiting for it to happen'. Well, fancy!

    1. Ha! I don't think he accused us of waiting! The fire though, they have all the time in the world!

  2. Wow, they're like buses! Also, FYI, paramedics are called Hotels because the paramedic course used to be residential, and they would stay in a hotel at the service's pleasure. It's amazing what random knowledge you hold in your head...

  3. Hmm... the paramedic course still is residential (in parts) for my Trust. Currently enjoying the full Hotel experience.
    Can't wait to get back to the proper jobs, although sounds like you've been having them all! Children really do make your blood run cold at work but seems as if all the bases got covered. Not looking forward to my first bum-clencher as a Para.


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