Size Matters

"33 year old female, in labour, birth imminent"

Over the past five or so years without meaning to, I seem to have become the ambulance services resident midwife. That isn't an actual, official or even recognised title, it's one I have made up. I have done so because for most ambulance staff, delivering 1 or 2 babies in a 5 year period is about normal. Some have never actually delivered one, other have done more. I however have now delivered 12, including twins, a shoulder dystocia and breech delivery. That in itself is more than the requirement to qualify as a registrar midwife, and was all done without a hospital as backup and using the 'improvise, adapt and overcome' work ethic! (I was told this by the midwife that trains us! Apparently a registrar midwife needs to have done 'X' about of births including twins, shoulder dystocia and breach!)

I think that's what we pride ourselves on in the ambulance service. We have plenty of shortcomings when it comes to clinical knowledge and ability, compared to that of specialist resus teams, midwives, trauma doctors, nurses and GPs but what we do have is an ability to adapt to any situation, be it someone stuck under a train or someone giving birth in the back of a taxi! We generally don't get phased and can make the best of a bad situation.    

Tonight, it became apparent we had logistical problems! We were dispatched to the 'in labour' and after driving for 9 miles we pulled up at the location which had been given with extra details of 'by the park and the school'. We were on the road we were supposed to be on, next to a school and a small park and we were parked at the exact point on the map that the sat nav was saying we should be. The only problem was there was no block of flats or building to match the name we had. 

"Red base, we are at the location but there is no sign of the building, could you call back with some more location information, over"

"Rog, will do, standby, over"

2 or 3 minutes past by so we got all the maternity stuff together waiting for them to call back. Eventually we got a message on our screen.

'UPDATE: Patient states they are in the orange block of flats next to the school'

How helpful.....

"Red base, we are parked by the school, there are no buildings or blocks of flats, let alone an orange one."

"Rog, will give it another ring back"

5 minutes later.....

'UPDATE: Patient states they are in the large orange block of flats.'

Really?!

"Red base, THERE IS NO BLOCK OF FLATS IN SIGHT! We have driven on all the local roads and up and down the length of this road, there are no blocks of flats"

"Rog, standby....."

7 minutes of area searching and frustration followed....

'UPDATE: Patient states they are in the huge orange block of flats next to the school, apparently you can't miss it.'

*counts to 10*

I'm never one for being rude to, or about control staff. They are bound by algorithms when taking a call and cannot deviate. 99% of the time the dispatchers and allocators are polite and helpful. However, I was getting a bit fed up with having the same conversation over and over again.

"Red base, there is no normal size, large or huge orange building, or any other building that could be flats in a half mile radius of our location. I need another road name or the patients partner or someone will have to come to us and direct us, we have been lost here for 20 minutes now!"

"..................Rog, standby......"

STANDBY! WHAT DO YOU THINK WE'VE BEEN DOING?!

*counts to 10 again*

I get it, some patients are bad at giving directions! However, if you have a crew saying there is no block of flats anywhere near, changing the size from normal, to large, to huge isn't going to change anything! What was the next plan?! Ginormous, Mahoosive, Monstrous?! 'Oh sorry, we found it now, we didn't realise you meant the Monstrous Orange building, silly us'. NO! We need a better location, because quite frankly, there could be a baby stuck in our patients vagina and we are STANDING BY!

'UPDATE: Drive down the road you are on, patients husband will meet you outside, hazard lights are flashing on his car"

Off we went, down the road, no hazard lights nearby. We drove, and drove and drove. After just over a mile we saw hazard lights in the distance. Waving frantically was the hubby. There was no school, no park and the block of flats was averagely sized. Oh, and it was yellow, not orange! He rushed inside and we followed. As I turned the corner into the bathroom, I was presented with a crowning vagina! Within 30 seconds I was holding a crying baby boy! Dad cut the cord, everyone was smiles, photos were taken and they were both taken into hospital. 

Another job jobbed.....!

Mike Dangerfield

I'd like to cast your minds back to almost a year ago, back to the day of The Jubilee! That glorious summers day where as a country we united to either a) rejoice in Liz making it to 60 years without becoming a power hungry dictator or b) relished the excuse to have a street party or BBQ in the name of patriotism. Being a day to remember, a bank holiday for all and a time for friends and families to be together, it was obvious that I was working a 12 hour shift. Not only that, but I was a 'relief' which meant that until I arrived I wouldn't know who I'd be working with. It could be absolutely anyone. Someone I like, someone I dislike, a stranger, a bore, a keen student or a manager! Anyway, having seen Liz on a boat and hearing that Phil had a UTI I had to rush off.

Today was a day where I could breathe a sigh of relief. It was someone I liked. 12 hours would be a little more bearable. Not much, but a little. It's worth mentioning, most people on our ambulance station were at a staff members Jubilee BBQ that instantly made me want to sulk. We got our stuff on the vehicle, checked it had everything and booked on. Then my crew mate turned to me....

"Right, no doubt I'll be featuring in your blog in some way, shape or form. Well, I want a cool name  for you to refer to me by."

"Haha, do you have anything in mind?"

"Mike Dangerfield! It's kind of action man like but with some added danger"

"You've thought about this far too much!"

So, as the clock struck 3pm Mr Dangerfield and myself headed off into the unknown. By unknown, I mean the busy city streets, city streets literally brimming with people who had drunk too much 'punch'. House parties and street parties cause 'punch' to be made. 'Punch' is loosely translated to 'every spirit we can find mixed with orange juice and fruit'. Unsurprisingly, it causes most people who drink it to walk like a new born giraffe!

The first couple of hours flew by. Mike Dangerfield was on good form, eternally looking for a road sign with his name on it. Alas, it was not found! Every street we passed seemed to fill our cab with the aroma of a different kind of BBQ. Now THAT is a reason to celebrate multiculturalism right there! Oh how I love GREAT BRITAIN! (UKIP, BNP, EDL, take notes) Despite the great sense of community that we were repeatedly passing, we were not involved. We were isolated from it all, in a bright yellow sweat box, tending to the intoxicated and overwhelmed. Then, from nowhere, a golden egg fell on our laps!

"38 year female, ? Fainted, at a street party"

"It's party time! P.A.R.T why?! Because we gotta!" Mike said proudly.

Oh dear......! Luckily I'd seen The Mask so the joke wasn't lost on me! We may be working, but the idea of being at a street party was pretty exciting! Rule Britannia blasting out of the stereo, we set off. Actually, it was Rule Britannia with a backing track of sirens! Honestly, better than it may sound! After a short drive we were there. Bunting lined the road, flags were raised, music was playing, neighbours who'd probably never spoken were gathered together. People of different ages, sexes, ethnicity's, religions and probably sexual orientation were gathered as one proud community! (UKIP, BNP, EDL, take notes) We stopped at the end of the road. Like an action hero crossed with the Duracell bunny, Mike jumped out of the vehicle (I've been told to make him sound enthusiastic).

Our patient was in good spirits, sitting on a chair in the shade, annoyed that she'd caused a commotion! She instantly said that she didn't want to go to hospital! I don't blame her! She'd basically come over faint and dropped to the floor. We checked her over and found nothing untoward so were happy for her to stay and party!

"Help yourself to some food!"

"No, it's OK!"

"Don't be silly, help yourselves! Sit down and relax for a little bit!"

With that, Mike picked up a leg of Jerk Chicken and sat on one of the many loungers! 

"Never look a gift horse in the mouth!!"

We ate some food, actually, a lot of food, whilst doing our paperwork. Sandwiches, BBQ, crisps, cakes and cuisine from Jamaica to Sri Lanka! It was amazing! I remember sitting back and thinking that this would be one of the moments I'll look back on in years to come with fondness! I also thought that control would have kittens if we didn't stop eating and make ourselves available! It's not often in this job that a golden egg falls on your lap, or so to speak, but at least we'd made the most of it! 

Full up and content Mike and myself headed off. The rest of the shift was uneventful but enjoyable. There were lots of laughs despite never finding Mike Dangerfield Avenue! 

I suppose the point of this post, is that despite the troubles this job throws at you sometimes, it is far from all bad. I get to work with some really great people, meet some amazing characters and there aren't many jobs where you can go to work and laugh all day! No doubt my next post will involve me being on the edge of reason but for now I will enjoy reminiscing! It was also a good opportunity to introduce you all to Mike Dangerfield: A heroic man of mystery. No doubt he will be returning in the future!  

24 - Season 2: Episode 4

continued......

WARNING: Some people may find the following post upsetting 

The following takes place between the hours of 3:50pm and 4:30am

15:50

At last, an opportunity for food. I don't want it now though! Seriously, I don't! I'm not sulking and cutting my nose off to spite my face, but I really don't! I've got dinner at 7pm with my sister so there is no point in eating now! I'm also fully aware that I shouldn't make plans but a casual meal with my sis, at my house doesn't really count! At least not in my book! Typically, now that I no longer require food and have at last made it to a toilet, there was suddenly a lack of jobs! Having not had a break, I was off at 17:15 so I could really do with a job round about now. Obviously, that was never going to happen. Finish on time?! Not a hope in hell!

The minutes ticked by, my finish time loomed closer and closer. I was starting to get a little agitated. After the agitation came the anger about almost certainly being late off. Then came the text to my sister saying it was likely I may be late. Then came making peace and accepting being late off. As the minutes ticked by I was dangerously given hope, could I possibly not get a job?! Nope.....

17:01

"88 year old female, fall, can't get up, ? unconscious"

PANTS! OK, it might not be too bad. Hopefully it will be an assist only fall, I can help her up, check her over, do some paperwork and leave. At worst, it's likely to be a minor injury needing hospital, I'd have to wait an hour for a truck and then can go home! No point in moaning now!

Ten minutes later I was outside. An elderly man was anxiously standing on the pavement and explained he had heard her fall about 10 minutes ago but couldn't get in as the door was double locked and the keys were in the locks. I grabbed some bags and wondered up to the front door. I opened the letter box and peered through. Lying on the floor at the bottom of the stairs in a pool of blood was my patient. Her head was on the floor and her legs up the stairs. She was absolutely motionless. 

I instantly dropped by bags and begun kicking frantically at the door, but to no avail.

"Red base, priority, this is a possible cardiac arrest, police required for access urgently, are other resources on way?"

"Received, police on way, ambulance eta 3 minutes, responder also on route, should be pulling into the road now"

I didn't reply, I just started kicking. Over and over and over again. I must have seemed possessed. On mass everyone arrived together. As the copper came up the path I went for one last kick! Amazingly the door splinter and swung open. We all piled in. I checked her pulse, nothing. 

"Right, lets all grab a limb, support her neck and get her onto her back"

I told whoever was standing next to me to start CPR. Turns out it was one of the coppers. I just started barking orders and everything seemed to happen. From my initial assessment she had a mid shaft of femur fracture, rib injuries, possible collapsed lungs, dislocated shoulder, broken wrist, probably spinal injury and severe head and facial injures. There was so much to do, so little space and so much to think about. I was quite overwhelmed initially, just trying to think about whats what! Trauma though is simple A B C, airway, breathing, circulation. Let's go.

Airway was a mess, mouth full of blood, nose swollen and bleeding, we suctioned and I put in and secured the airway. She was then fitted for a collar. I passed the mask to someone and asked them to ventilate. Hardly any chest rise. Me and the other paramedic who had now arrived decompressed both sides of the chest. A small hiss of air and the lungs were inflating better than they were. That was breathing under control. For now! Circulation was being done with CPR but her femur fracture needed reducing. Pulling a fracture isn't  pleasant job, but it had to be done. Luckily there was someone else on hand to straighten and splint her leg. 

I got some IV access, all the while CPR was being done and rhythm checks at two minute intervals were being called out. Nothing we could shock at the moment. I was still barking out orders, not because I'm a bossy person, but because the first paramedic on scene takes the lead in cardiac arrests. That was me today! Suddenly we had a shockable rhythm, that's something at least. 

"Stand clear, oxygen away, shocking now."

As the electricity surged through her body she jolted. CPR started up again, everyone turned back to the tasks in hand. With trauma it is important to get the patient to definitive treatment ie; hospital,  as soon as possible. It's not a case of 'stay and play', it should be 'scoop and run'. That said, she had to be as stable as possible before we moved her and at the moment she wasn't. In the meantime, I sent someone with a list of things we needed, to get her out. Scoop, straps, head blocks, the bed etc. Minutes past and further shocks were given. She was started on Adrenaline at regular intervals followed by some Amioderone. 

"Right guys, rhythm check please"

"Think we have her back...."

"Pulse check......"

"Strong carotid here."

"Right, I have a thready radial. Well done guys, return of spontaneous circulation (ROSC) at 17:31. We've got 10 minutes or so before we can move her but lets get her packaged and ready to go." 

Like a swarm of worker ants everyone started getting her 'packaged'. By packaged I mean all clothes cut off (skin to scoop), all injuries dressed and splinted, pelvic splint on, put on a spinal board, head blocks on and strapped. While all that was going on, me and the other paramedic were going through the ROSC protocol in a trauma patient. We couldn't get a blood pressure, her pulse was slow and weak so we started giving fluids and Atropine to try and speed her heart up. Before long we were ready to go. She wasn't stable by any stretch of the imagination, but we had to go now. We still had a 30-35 minutes run to the nearest trauma centre. 

Kit chucked on the truck, bags opened and the patient loaded we were just about ready to go. The chest rise on the ventilations was diminishing and her Co2 levels were dropping so whilst the blue call was being put in, we re-decompressed her chest. 

"Ready to go?"

"Yep, shout on the corners please!"

17:43

Off we went, 3 of us in the back! 2 of us were standing up holding on with one hand and trying to snap glass ampules, draw up drugs into syringes and administer them! Do the maths, not enough hands! Forhissy fit!

the most part we were ambulance surfing. Bear in mind it is a legal requirement for motorists to be seated with seat belts on. We were standing up, not holding on, going at speed, into oncoming traffic! The health and safety executive with literally have a

We had only been travelling about 2 minutes when she arrested on us again. CPR was resumed and we started on our cardiac arrest drugs and protocol like before. There was now very little we could do but drive. We couldn't shock her because for all intents and purposes her heart was lifeless, and you can't shock a still heart. 

18:19

Eventually, we pulled into the hospital. Over the last 10 minutes she had deteriorated more and more. Ventilations were poor quality due to the ever decreasing chest rise, Co2 was dropping and her airway was repeatedly filling with blood, despite suction constantly for the last hour. She was in a really bad way. 

With CPR still in progress the back doors swung open. We got her out onto the lift and down the corridor to resus. Waiting, was the biggest trauma team I've ever seen. *gulp* We transferred her to the bed and then the team was silenced for my handover. No HEMS to hide behind, no team leader or clinical lead to do it for me!

"Right, this is an 88 year old lady who has fallen down 15 stairs we believe. On arrival patient was face down on the floor with her legs extended up the stairs. There was no respiratory effort and she was in asystole. After 6 minutes of CPR we were able to shock and did so 3 times whist she was in VF. We received ROSC after the 3rd shock. She has had Amiderone, Adrenaine, Atropine and 1.5 litres of sodium chloride. Her airway is compromised but until 5 minutes ago we maintained a good Co2. She re-arrested on route and has now been down in asystole for 32 minutes. Injuries from head to toe: we have possible fractures to the nose, orbit and mandible with a deep laceration to the occipital area of her skull, possible spinal fracture, possible rib fractures with punctured lungs, 2 sets of bi-lateral decompressions have been performed, she has a dislocated left shoulder, a fractured left radius / ulner, her pelvis is firm but splinted and there is a mid shaft right femur fracture that has been tractioned"

And breathe.....

The trauma team had a brief confab followed by an announcement.

"Time of death, 18:22."

There are no words. Dejected we all went back to the ambulance. 4 of us, covered in blood, sweating and a bit shell shocked. We aren't stupid, we know her chances were next to none by the time we arrived. However, we have just done everything in our power to keep her alive for over an hour in the most difficult of circumstances. We have travelled across the city to get to the hospital where the best people from each speciality are waiting for us. Couldn't they wait until we have left the room?! You sometimes think why do we bother?! Why did we put that poor lady through all that?! We are not after anything from the hospital but for our efforts to be simply dismissed? It's just a bitter pill to swallow. 

We sat there cleaning up and doing the reams of paperwork that was needed. I can assure that it isn't done quickly, nor do we rush. We talked the job through but everyone seemed pretty quiet. It was a horrible job. It was one of the faces that will stick. 

19:31

Now for the drive back to base. The traffic was solid and I just sat there on my own thinking things through. Probably not a good thing to left alone with my thoughts. I sometimes question whether I can carry on with it? Can I keep seeing the things I see? Is there only so much death and destruction that someone can see before they implode? I don't know how people have stuck at it for 30 years. Maybe you just carry one regardless. 

20:48

I finally pulled into the garage. It was empty. I quietly emptied my vehicle and re-stocked it. Then I signed my drugs back in, tipped my stuff into my locker and climbed onto my bike. Over 15 hours after I started, I was finally leaving. 

21:15 

I started my cycle home. Every pedal a struggle. Maybe I should have eaten before that last job. My tank was empty.

21:40

I stepped into my flat, staggered up the stairs and dropped to the sofa. I text my sister 'Really really late, soz x' and dragged myself into the shower. As the water poured down my body it turned pink. The pool of watered down blood appeared at my feet. That's a sign of a bad day at the office if ever I saw one. 

22:30

Cereal. That's all I could muster.

23:05

Set alarm and clambered into bed. Almost 19 hours after I got up! Laters......

04:30

Cue The Buble....

'Oh, the shark has pretty teeth, dear

And it shows them pearly white

Just a jackknife has MacHeath, babe

And it keeps it way out of sight'

*presses snooze*

That was one day shift. Can you recall all 8 of my patients without looking? Had you forgotten about the critically ill 2 year old boy from 21 hours ago? I had. Feels so very wrong doesn't it.

24 - Season 2: Episode 3

continued......

The following takes place between the hours of 12:18pm and 3:50pm

12:19

"56 year old female, back pain, not alert"

Really?! The old 'not alert' has upgraded this job to one suitable for a car apparently! Also, the back pain
in a certain age is interpreted as possible chest pain, but still, I wasn't impressed with having to go. Mainly because I'd just convinced myself I was about to eat! Foolish! The job was just round the corner so I headed round, without even needing to turn the lights on! I pressed 'on scene' just as the call was downgraded to a low priority! Dammit! Had I have been a bit slower I would have been cancelled!

I was met at the door by the patients daughter who beckoned me in. They were a Somali family and only the daughter spoke English, but she spoke very well so there was no problem translating. I assessed the patient, did her ECG and within 20 minutes I'd done everything I could and found that she had a simple case of 'hurty back'. Despite my best efforts to convince them that hospital wasn't necessary, she wanted to go and get checked over. That meant a looooong semi-awkward wait for an ambulance!

I think the difference in cultures means that when a family emigrate from a country like Somalia, where the concept of pre-hospital care doesn't exist, expectations of what to do are different. They have no alternative care pathways, visiting GPs or chemists with drugs to treat most menial problems. In their country, if you are ill, you go to hospital, it's that simple. The idea of being 'ill', being seen by an ambulance and NOT going to hospital seemed foreign to them. I suppose that's where education via the GP would come in handy!

The wait for an ambulance really did become awkward! There were plenty of ominous silences to make me cringe, occasionally interrupted by my apologies for the delay! There is only so much you can talk about, to a group of Somali women who don't speak English! Eventually the crew arrived and I was able to make a quite getaway!

FOOD!!!!!

I made myself available and headed to the shop! I literally went to the first one I came across which happened to be a Wild Bean Cafe at a BP Garage. I grabbed a selection of high calorie, processed rubbish and went to pay.

14:38

"RTC, car vs pedestrian, ? Injuries"

I swear they are watching me! They must me! It's every time I try and eat! EVERY SINGLE TIME! Dammit!

The job was 13 miles away but without even a grumble (that they could hear) I shot off. In reality I was swearing and bitching to myself and moaning out loud the fact that a) I was hungry b) this job is miles away and c) I was hungry. See, I have a food problem! I cant stop thinking about it, yet can't bloody get any! Again, I was weaving in and out of traffic on A roads, B roads, side streets and bits of kerb! I like to mix it up! I was making good progress, and like with all semi-serious / serious jobs I was building a game plan as I went along. 

Left turn, right turn, onto the wrong side of the road and round a traffic island. Through some red lights, back onto the wrong side of the road and lights off, sirens off as I approached a fast duel carriage way! Wouldn't want to be the cause of another crash! Once the lights changed, the noise was restarted and off I went! Left turn, right turn, blah blah blah! It really is good fun at times! Only 4 miles to go!

'CANCELLED: 'Quicker responding unit'

1, 2, 3, 4, 5, 6, 7, 8, 9, 10.......AAAARRRRGGGGHHHH! Right, FOOD! Or not....

15:01

"31 year old female, sickle cell crisis"

OK, this wasn't far, sickle cell is simple, give pain relief until the ambulance arrives, handover, go and get food. That is as simple a battle plan as can be! This time I made it on scene without a cancellation, grabbed my stuff and went over to the patient who was sitting on the back seat of a car, in the grounds of a hospital. I know what you're thinking, but it was a mental health hospital! I started talking to her and became aware of the some ECG electrodes on her hands and ankles! Specifically, ambulance ones!

"Have you had an ambulance today already?!"

"Yes" she said, wincing in pain.

"So what happened?"

Her friend interrupted....

"She was taken to hospital but we waited like, an hour and they didn't do nothing so I brought her here cause I thought this hospital would help, but they won't."

"This is a mental health hospital, she needs to be in A & E. All the hospitals are busy and she will have to wait anywhere she goes, it's just the way it is I'm afraid."

*patients friend kisses her teeth at me*

"Well we ain't going back to dat s**t hole."

"Well that is down to the ambulance crew that arrives. You can discuss it with them."

With that I begun offering Entonox.

"I need morphine, that's all I can have."

"Well lets try this first and see how you go."

"No, just give me morphine."

On cue, the ambulance arrived! And as luck would have it, it was the crew who took her to hospital a few hours earlier. They broke the news that she had self discharged on arrival because the hospital knew her to be a morphine junkie who didn't even have sickle cell! She simply pretended to different ambulance crews and different hospitals across the city! Luckily she had been rumbled and after some foul mouthed expletives and some teeth kissing they drove off! Presumably to go and call another ambulance from somewhere else. 

No wonder the NHS is up shit creek without a paddle! This is what we are up against!

I popped into the hospital to use a loo, it'd been a good 10 hours! My bladder control is good but seriously.....! Inside the building I was greeted by an 'Out of Order' vending machine! FOOD!!!! Oh the torture! Anyway, not wanting to discuss toilets further, I did my paperwork and made myself available for another one! This day was becoming ridiculous! It's never this busy on the car! What next?! 

To be continued.....

24 - Season 2: Episode 2

continued......

The following takes place between the hours of 8:41am and 12:18pm

08:41

"27 year old female, 24/40 pregnant, feeling faint"

So, second breakfast will have to wait! Never mind! It was turning out to be surprisingly busy for the car! Normally there is some down time between jobs because on the car you only go to the higher priority of calls and are generally kept in your area. Today, everyone in my area seemed to be falling ill on an all to regular basis!

Again, I found myself at a supermarket. This time I was on scene within 90 seconds of the call coming in, so when I arrived at the cheese aisle, the patient, surrounded by store staff, was still on the phone to the call taker. I always enjoy the looks of amazement that I'd been able to drive 200 meters so fast! What they don't know, is that the very second they dial 999 the nearest available unit is dispatched by a computer. If its a mobile phone, you are dispatched towards the co-ordinates of the phone mast where the call originated and are then redirected when the address is confirmed. In this case, the mobile phone mast was on top of the supermarket, so when I got the address I simply turned off the engine and got out the car!

The patient was a really sweet young woman who was expecting her first baby. It had been an uneventful pregnancy up until now, but today she was experiencing some profound dizziness in spells. Dizziness in pregnancy isn't uncommon at all and she would need a check up, but really, she was fine. I checked her over, shared my war stories of parenting and generally talked babies, surrounded by cheese, whilst waiting for the ambulance. Mmmm cheese! Those second breakfast gremlins are coming back! 

Eventually the crew arrived, we said our goodbyes and once I'd put by bags back in the car I returned to the cheese aisle with a basket! 

09:35

"General broadcast, all mobile, holding a cardiac arrest, 1 month old baby, limp and floppy, gone blue, please go green or come up on priority if you can assist"

"Red base, I'm green, happy to run on it." I said as I dropped the basket and RAN back to the car." 

As I opened the door the job appeared on my screen. I accepted it, looked at the address and shot off. 6.6 miles to go, through the city, that's 9-10 minutes on a good run. I hope to god another vehicle is coming from closer than me. 

I could feel the adrenaline kicking in, I was driving at mine and the cars limit and fixated on the road ahead of me. I could hear the job updating repeatedly on the screen, but I daren't look at it whilst driving at speed, never worth the risk. As the miles were ticking down, I started to go through a vague plan in my head. I was recalling the resus guidelines for a 1 month old in my head just so I didn't flap when I arrived. I'm not going to lie, I am new to the car, new to this 'lone working' thing, and the thought of being solely responsible for this kids life scared the living daylights out of me. 3.1 miles to go......

I was weaving through the traffic at a rate of knots. Fast acceleration and rapid breaking, to take into account other drivers unpredictable actions. No doubt someone will say I shouldn't need to if I'm driving properly but sod em'. As far as I'm concerned a baby is dead, and they will stay dead until I get there and I will drive as fast as I can do so, safely. The end. 1.8 miles to go.....

I had just over a mile to go, the cars still parting like Moses and the tide, eyes still wide open taking in everything ahe.....

'CANCELLED: No longer required'

WHAT?! Aaaarrrrrrggggghhhhh! Now I'm 6 miles out of area, my heart is pumping stupidly fast, my palms are sweating and I have no frickin' cheese! I pulled over to calm down for a few minutes! I HATE cancellations.....with a passion!

09:47

I sat in car, stereo on (Cheers Mr Buble), seat declined slightly and just laid there. I was hungry but wasn't near any shops and had no real idea where I was so took the opportunity to just chill out! It had been a pretty relentless start to the shift, so until I was told to do otherwise, this is where I would be!

After having my slumber rudely interrupted by a pedestrian wanting directions to a building 25 feet away, I decided that the urge for food was now too strong to ignore! I started heading back towards civilisation in the hope that shops would appear.

10:52

"51 year old male, unconscious, ? Low blood sugars"

And there we have law of the sod! I should have gone as soon as the opportunity presented itself but procrastination has always been my thing! 

I recognised the address when it appeared. If memory served, he wasn't a regular caller per say but someone I've met a few times, controls his diabetes well, but occasionally makes a mistake and has a hypo. It happens! At least it was back in area though, so I wasn't going to moan about the 7 mile run! 

Sure enough, when I pulled up outside, I recognised the house and once inside, recognised the unconscious patient on the bed! He was snoring away, pouring with sweat and showing all the signs that it was indeed a hypo! A quick check of his blood sugar confirmed it. It was 'Low' which means its too low to give a reading on our kit. I set about cannulating him, drew up some glucose fluids and set the drip going. Then it was a case of waiting for him to wake up, act confused for a few minutes and then start apologising for having wasted my time!

10 minutes later, having started a discussion about rabbits playing tennis, he froze, then said:

"I've done it again haven't I?!"

"Indeed you have!"

"I'm so sorry for getting you out, I don't know what happened, I had my insulin this morning!"

"No worries, hospital?!"

"I think you know the answer!" and I did!

"Red Base, cancel the ambulance if you have one assigned, the patient is declining hospital so I will discharge him to his own care, over"

"Rog, thank you."

After checking his sugars, I gave him some more glucose, then while I started on the paperwork, he got changed! During a hypo, people can sweat profusely and his clothes were saturated. Whilst he was upstairs I got his wife to make him some jam sandwiches and a sugary tea. We all sat chatting whilst I dotted the I's and crossed the T's. I even got a coffee for my troubles which was very much needed as I was starting to lag! I'd been up for 7 hours or so and was yet to have more than half a bowl of cereal! 

Have you noticed how much I'm thinking and talking about food! It's a problem. I need help! Anyway, I got him to sign to say he was happy to stay at home, referred him onto his GP and left them to go about their day! I was in my 'break window' now so I made myself available and for once, relished a chance to stop for 45 minutes and eat some hot food! It really is a novelty!

To be continued.....

24 - Season 2: Episode 1

What is an average day? There isn't one. It is as simple as that. Last year I blogged a 24 period, in real time, as it happened on my shift. I felt it would be therapeutic to visit the idea again and share a random day shift as a lone responder. Here goes. Eyes open, to eyes shut, to eyes open again. Sorry about the toilet stops!

The following takes place between the hours of 4:30am and 08:41am

04:30

No one should ever have to wake up at this time. Ever. No one should really have to know what 4:30am looks like! The light from my phone physically hurt my eyes as I turned off the dulcet sounds of Michael Buble's Mack the Knife! (Don't judge me!) Despite the desire and need to snooze, I couldn't. I got dressed, jumped on my bike and cycled the 5 miles to work. The cold air made my eyes stream the entire way and by the time I arrived, it looked like I'd just been to a funeral......in a hurricane! I had a shower at work, got everything ready, uniform on, drugs signed out, me signed in and all my kit on the car and I was ready with about 10 minutes spare to grab some breakfast! 

06:01

"94 year old female, abdo pain, dizzy"

With half of my cereal left behind on the mess room counter, I jumped into my car and shot out the garage. As it was so early, the roads were clear, so I got on scene within a couple of minutes. As it was still dark out, I left the flashing beacon on the roof so the ambulance could find me in the rabbit warren of the estate I was on. I grabbed my stuff and handed on up. I was met at the door by a very anxious, frail looking lady. I helped her back to her armchair and sat her down.

Her symptoms were quite vague and not that severe. So much so, that the illness code I gave her was 'generally unwell'! All her observations were OK, she had a bit of this, a bit of that and could probably have waited for the GP and been treated at home, but at 94 I certainly wasn't going to begrudge her my time or the resources. I made her a tea an some toast whilst we waited for ambulance. 94 is a lot of years and she had plenty of tales to tell me and seemed to enjoy telling them! Back in 1947 she tested racing cars and that was just one of the anecdotes I got from her fascinating life! After about 45 minutes of chatting, the ambulance arrived.

I gave a handover, helped them get her downstairs and on to the ambulance. I got back in my car, appreciative of my second caffeine hit and finished off my paperwork. Job done!

07:03

"2 year old male, fitting"

Yikes! Blue lights on again, yet this time the rush hour was upon me! Being on a car, I can fit through smaller gaps and go faster but that doesn't help being sat stationary in what is effectively a car park! Traffic really does mess with your emotions! On the one hand it makes you livid at the stupidity of some people and their inability to drive. On the other, you have a traffic jam, a potentially very sick patient and no way of moving. You are the person needed to help, yet you can't move faster than the traffic will allow and that can be extremely frustrating and worrying. Luckily, most 'fitters' have generally stopped fitting by the time we arrive and 'most' fitting 2 year olds are actually having a febrile convulsion. Obviously, today was never going to be 'most days'!

As I pulled up on scene a teenager came running outside waving frantically! One word popped into my mind.....'SHIT'! I grabbed everything and hurried into the house, knocking over the clothes horse and a photo off the wall as I bundled up the stairs. In the bedroom, my patient was lying on the bed, fitting. Foaming at the mouth, body shaking and contorted, the mum crying, the other children all crying, it was one of my worst nightmares. I put the oxygen on him and started trying to get a history. From what I could work out he had now been fitting for over 10 minutes. He wasn't a known epileptic but had had a seizure in the past and had been prescribed an emergency dose of buccal Midazolam in case it happened again. Well it was happening again, but in the panic, no one had given it, so I did. Whilst waiting for that to take effect I checked his temperature and blood sugars. All normal. 

There was no sign that the fit was stopping to I decided to give some of my Diazepam rectally. Just as I was administering it the ambulance crew arrived. We were pushing 20 minutes of fitting now, the boy had had the maximum amount of drugs he could, so we needed to run.

"Hello guys, 2 year old male, fitting now for almost 20 minutes, given Midaz and PR Diazepam, let's just go, yeah?!"

Generally speaking, if in an ambulance crew arrive, and the FRU says 'let's go' as they walk through the door, it's a case of no questions asked! Especially in sick kids. We are not equipped or experienced enough to deal with small children. 

No sooner as the boy and his mum were on board, we left for hospital. I put the blue call in on route. You've then got that terrifying 10 minute journey, where you can only watch. Watch a tiny, helpless 2 year old boy violently fit, and there is nothing you can do. You try and reassure the mum, but doing so, without the fear of god in your eyes is near impossible. As a parent I can't imagine the fear I'd be feeling. She held his tiny little hand whilst I held him in position on the bed. It was one of the longest 10 minutes of my life. 

On arrival at hospital, he had been fitting for over half and hour. His condition was critical. We handed over to the paediatric team and they took over his care. We left the mum standing in resus with tears pouring down her face. I did my paperwork with the crew and then got back in my car which had kindly been driven unto hospital by one of them. 

I never found out how the boy got on. I never will.

08:17

"42 year old male, collapsed, fitting, O/S supermarket"

The sex, age and location told me all I needed to know. I knew exactly who it was! It was one of our regular alcoholics and this was his morning fitting hotspot. He'd either have had a fit and now be recovering or will simply be asleep! He would most likely smell and once compos mentis would no doubt hurl abuse and then walk off down the road! I wasn't far away,  so I lit up the roof and off I went. 

As I pulled up outside the caring member of the public who found him waved me over. There, in all his glory was Steve! Lying, asleep, face down in some bushes. And yes, the smell made my nose sore! He was actually a really nice guy when sober, when intoxicated however, he was ghastly! 

"Hello Steve, wakey wakey!"

The onlookers seemed shocked that I wasn't doing CPR and sticking a biro through his neck like they do on casualty. My lack lustre approach was justified when a moment after I told him to wake up he promptly told me to 'f**k off'. 

"I'm afraid not Steve, I can't leave you face down in a bush!"

"F**k off, leave me alone."

"Up we get Steve, you know that I'm not going anywhere until you are standing up!"

"Just f**k off will ya."

The ambulance pulled up and gave me a knowing grin!

"Steve?!"

"Yep! He's not pleased to see me!"

Between the three of us, we pulled him out of the bush. He was looking worse than normal, clearly the 8am Whiskey run had taken its toll.

"How about we pop you up to the hospital Steve? Get you cleaned up and fed."

"Just f**k off will you!"

"At least let us check you over."

"F**k yourself" he said as he wondered off down the road. 

That was Steve! Anyway, just like a Hobbit, it was time for me to have my second breakfast! I think I'd earned it!

To be continued..... 

A Bridge Over Troubled Water

"29 year old male, cardiac arrest"

Even before we got this job I had a strange feeling. I can't describe it, something just didn't seem right! I was on edge like I was waiting for something to happen.  Well,  a 29 year old in cardiac arrest was enough to snap me out of my odd state! Generally the cardiac arrests we do are on the elderly. In fact, I'd say at least 95% are over 65, maybe even higher than that. I'm not saying it's any easier doing a resus on a 80 year old but on some one younger it seems a lot more of a waste. Initially we only had a road to go by, so headed off in the general direction.

"UPDATE: Patient on a boat"

A boat. Of course he's on a boat. It's a big city, where else is he going to be?! The actually location we had been given was to an incredibly narrow, slippery concrete staircase, leading down to an canal footpath. Only problem was there are two sides to a canal and boats lines both sides. There was also two staircases to chose from and we had a lot of kit to carry! Oh, and obviously it was dark.

With all the kit you can envisage for a resus we headed down the stairs that were nearest us and started looking / shouting speculatively for a response. After about 100ft we got on! On the other side of the canal.....

So, about turn, and back we went, up the stairs, across the bridge, down the other stairs and along the footpath to the boat. Now, the boat. The clue is in the name, a 'narrow boat'. There isn't going to be much room to work, nor will there be room to stand or  move around. Once I'd taken a step of faith over the gap to the water I felt a tad safer. My crew mate passed me the kit and then followed me over. Then it was a case of squeeze down a tiny, shallow stair case into the heart of the boat and there was our patient, lying lifeless on the floor.

I quick primary survey showed that luckily he wasn't in cardiac arrest. He was however on the verge of respiratory arrest so I got ventilating him while my crewmate started doing 'other stuff'. His pupils were pinpoint and there was plenty of evidence to suggest a drug overdose to we treated as such. We have a wonderful drug called Narcan that reverses the effect opioid drugs pretty rapidly so we loaded him up with that. After about 8 minutes he started to respond and began breathing effectively himself. 

By now, the FRU had arrived, unfortunately, owing to the fact that it was a narrow boat he was made pretty redundant by the lack of space. He decided to go and fetch our carry chair! Good call! Although the patient wasn't conscious enough to talk in sentences our walk he was opening his eyes and thrashing around slightly which was kind of what we expected. He had already been cannulated by the time the chair arrived back so we got him strapped in and started the the arduous process of extraction! 

Up the stairs we went and on the stern (?) of the boat. Now the plan of how to safety get him, us and our kit across the gap of water to the foot path! Scrap that.....he started fitting. Full blown seizure and pretty violent at that. BALLS! We got him out the chair and onto the deck. This job was really going from bad to worse. We waited a few minutes to see if the seizure would stop. It didn't. We gave Diazepam and waited some more. Still fitting and we are getting pretty desperate now. More Diazepam. Still fitting......aaaaaand stop. A quick ABC check and he was up, on the chair and across the back faster than you can imagine! Sure enough, the second we got him on board the truck the fitting started again and this time it didn't stop. 

You'd think after all of that, the hospital would be appreciative of what we'd been through, but no, the Dr was just plain rude! He interrupted my handover with:

"Well he's probably still fitting because you waited 5 minutes to give him Diazepam"

He then ignored the rest of the handover and talked over me. He looked at us like we'd dropped a baby and spoke to us as if we were naughty children. He criticised and questioned why we waited to give diazepam despite showing him our guidelines. He wasn't interested. Professional courtesy and respect works both ways and today both were distinctly lacking from the doctor. It was a sour end to what had been a challenging and difficult job.

In hospitals you have every level of experienced medical professional at your finger tips. You have every drug, lots of expertise and the patient is on a bed. Pre-hospital you have 3 of us, one of which is a paramedic, one is a student paramedic and the other a technician, a patient not breathing and then seizing uncontrollably, on a narrow boat, in the dark. We are not miracle workers. We are not giving a gold standard of care that the hospitals are capable of. We are simply making the best of a bad situation. And as far as situations go, this was pretty dam bad!

Carry On Stabbing

"34 year old male, stabbed in leg"

Criminal (Crim-in-al)

Noun: A person who has committed a crime.

Synonyms: felon - malefactor - delinquent - offender - culprit

Idiot (Id-i-ot)

Noun: A stupid person.

Synonyms: fool - imbecile - blockhead - dunce - nitwit

Imbecile (Im-be-cile)

Noun: A person who's mental acumen is well below par.

Synonyms: fool - idiot - halfwit - cretin - moron

I am giving you these definitions to bear in mind whilst reading about this job.

Aren't Friday nights wonderful?! If ever you wonder what exactly the tax funded emergency services are doing, specifically police and ambulance (trumpton have their weekly table tennis tournament), then just stand on a street corner and watch the countless number of blue light vehicles career up and down the road! Then, if you get bored of that either go and look inside your local A & E or observe the activity outside your local police station! It is non stop! Most of the things we are dealing with are alcohol related illness or alcohol related crime, both of which stretch our capacity to bursting point. 

Today was no different. I often comment on how busy things are but as far as Friday nights go, tonight was absolute carnage! It really was like a war zone. After having a few drunks we'd scooped up and taken to hospital a stabbing was most welcome! The police were on scene so we headed straight to scene. What we were about to walk into, no amount of description could have prepared us for. You literally couldn't make it up!

Q. Let's say you are a criminal. Where is one place you would NOT want to commit a crime? Outside a police station?

Well, the location of said stabbing was indeed right outside the police station. Not only did it happen outside the main entrance, it was witnessed by 4 burly coppers so the stabber was quickly apprehended. Smooth!

Q. If you had a stubby nature and were....well....a stabber, what would be the goal of stabbing someone? To hurt or kill them perhaps?!

Well, the only person injured in the stabbing, was in fact the stabber. Why? Because he stabbed a man in his prosthetic leg. Yep, not the good leg, the gut, the chest, the back, the neck or the arms, oh no! He managed to stab the one part that was unstabable! The impact of such a solid object caused his hand to slip down the hilt of the blade and slice his own fingers open. Smooth!

Q. When running away from someone (i.e. The police), where do you look whilst running your heart out? Forward or backwards?

Well, in this case, the criminal stabber didn't look forwards. He looked back at the sudden plethora of policeman bearing down on him. Whilst running forward, and looking backwards he was attacked by lamp post and knocked himself unconscious. Smooth!

*cue our arrival of scene* 

Our patient was the smooth criminal who had stabbed himself outside a police station and knocked himself unconscious. He was very much alert when we arrived, saying it was self defence and the war veteran with one leg had been trying to mug him, so he pulled out the kitchen knife he happened to have on him and protected himself. Oh how we all laughed! Perhaps when he had that brainwave it came about in not too dissimilar a fashion to one of Baldrick's cunning plans!

I bandaged his hand, bandaged his head and he was loaded onto the truck, not before he managed to spit at me. That went down well! 

Q. Seriously though, who tries to mug someone outside a police station and then manages to stab himself , cause no injury to their victim and get knocked out in the escape process?! 

A.  A Criminal, An Idiot, An Imbecile

Closed Doors

"83 year old female, collapsed behind closed doors" 

It was a long winter. The dark seemed to last forever, the cold seemed to bite eternally the feeling of being cooped up seemed never ending. But hey, this is England. If we can't bitch about the weather, what can we do. The reason I mention it, is because I feel it may have contributed to the events that followed. 

'Collapsed behind closed doors' is an unnerving situation. A lot of the time you have no idea what lies beyond the door, thus serving its purpose! Still though, day or night, doors must be kicked in to get to someone who may be dead or alive on the other side. Today was the same uncertainty and the same vague details. All we knew was that there was a lady, behind a door, that her daughter couldn't get to. 

We were met at the day by the worried looking daughter. She had been out all afternoon and when she'd got back her was in her room, door locked and not responding to the knocking. She also 'never locked her room'. We went thought the motions of knocking and shouting but to no avail. My crew mate called control and requested the police. Meanwhile I was trying to peer through the key hole but couldn't make anything out. It was an old house and the doors weren't perfectly straight so the was a small gap at the bottom. I laid down and put my cheek to the floor. In that single moment my heart rate doubled and I could feel the adrenaline pouring through my body. About 3 feet from the door, lying facedown on the floor was our patient. 

"We need to get in now!" 

My crewmate took a sizeable shoulder barge at the door but just bounced off it. He the kicked, and kicked, and kicked some more. After about 5 hits the door swung open. I rolled her onto her bad, her eyes were closed, she wasn't breathing, but she was still warm. She was linked up to our machines and there was signs that her heart still had some activity going on. Due to that, and the fact the distraught daughter was screaming for us to do something we started the resus. We called control back and said that this was now a working resus and we needed more resources. 

After 1 shock her started beating again, unfortunately, this was short lived and within a minute or so we were doing CPR again. As the resuscitation moved on it became apparent we weren't going to be successful. The a bin was put next to me by my crew mate. Inside the 100s of tablets she had presumably taken. A glance around the room left reveals a suicide note to her daughter. It was unanimously agreed after we'd exhausted our protocols to cease our efforts and confirm her passing. 

Her daughter was beside herself with grief and guilt. I sat in the kitchen with her whilst she read the letter over and over. I also read it and it really was heart breaking stuff. She had lived a full life, a life of adventure, a life of many tales, but that was a life she had shared with her beloved husband. She explained she simply couldn't live without him anymore. She had her enthusiasm for life had died with him and she could no longer go on being a burden on her daughter. When you read words like 'seeing you grow into the woman you have become fills me with immense pride and joy' was touching to read but little comfort to her daughter. 

I don't know why, but I suppose I associate suicide with younger generations but depression is all to common in the elderly. It's often dismissed as part of being old and the anti depressants are handed out like smarties by GPs. Behind the tablets though the real people. Real people who are not coping with the loss of independence. Not coping with the loss of life long soul mates and not coping with having to impose on their children's lives. As she said, her enthusiasm had gone, and if you take that away from

any of, all that is left behind is apathy. In her mind she wasn't living the life that she had always stood for. The joy and adventure had gone. I suppose she realised that she didn't want to live her final years with apathy and sadness. It did make me think. When the time comes, do I want to go on my own terms when it's right for me. Probably. 

I have no doubt it was a decision that she agonised over for a long time. I'm sure she was well aware of the pain and hurt she'd cause her daughter but it was what she needed to do, for her. At 83, who is to argue when she says 'that's my lot'. 

"Nobody grows old merely by living a number of years. We grow old by deserting our ideals. Years may wrinkle the skin, but to give up enthusiasm wrinkles the soul" 

           - Samuel Ullman