Friday 27 September 2013

Hot Stuff

"38 year old female, feeling hot"

Now, the question is, was she feeling hot because she was unwell and her core temperature has risen slightly? Or was she simply hot because it was a hot day? Or maybe she just had too many layers on? OR she was wearing little black dress and killer heels and as such, simply felt HOT and wanted to share this?! Hmmmm, the former was most likely but the latter would amuse me greatly! I headed round to the address anticipating this medical emergency with baited breath!

'Good morning my dear, what's the problem today?'

'I feel really hot'

'In what way?'

'I just feeling really hot'

'Any other symptoms at all?'



'And what did your GP say?'

'That it wasn't an emergency so I couldn't have an appointment until Thursday.'

'I see, did they advise calling an Emergency Ambulance?'

'No, but I didn't know what else to do'


'OK, let me just take your temperature............36.7, it's fine'

'Yeah I know, I already took it.'

'Well I'll check you over but without any symptoms there's not much I can treat.'

'I reckon it's because I'm due on my period. I normally get hot flushes before it starts.'


And that is how my week started! Wearing green, living the dream, saving lives and making a difference. 
"Nothing in the world is more dangerous than sincere ignorance and conscientious stupidity." Martin Luther King

Thursday 26 September 2013

Running On Empty

“33 year male, RTC, Bike vs metal fence”

Let me start off by telling you how frightfully tired I am at this point in time and how desperate I was for the toilet! I was also thirsty and starving hungry but the last 4 patients hadn’t gone to hospital so for 6 hours I’d been without any of the essentials that human beings require to function! To be fair, it was kind of my own fault. (Totally my fault!) I had volunteered to do overtime without checking my rota. I knew I was on a rest day do just booked it! What I neglected to check, which subsequently caused said tiredness, was that I was on a night shift the night before. I was supposed to finish at 7am. I didn’t. I finished at 8:30am so was in bed by 9am. My overtime shift started at 3pm. Now do you see my problem?! Ooops! The rest of my needs ie: food, drink, rest and a toilet, were not my fault. That’s just what we do! 

Anyway, the reason why I am so frightfully tired now, is that it is 2:30am. I’d was at the end of my 12 hour shift and due to a lack of a rest break we were heading back to station to go home. We were done, finished, finito, terminé, fertig, terminado, call it what you will, we were offski! 

“General broadcast, all mobiles, any unit available for an RTC, motorbike crash, please press priority or go green mobile” 

That wasn’t meant for us, we were no longer on duty and as much as I felt for the motorcyclist, at some point we have to stop! Besides, I literally couldn’t keep my eyes open! I’d be useless in a trauma situation right now! We carried on back to station which was only a 4 mile drive. Oh god I needed the toilet! 

“General broadcast, all mobiles, we are still holding an RTC, motorbike crash, please press priority or go green mobile” 

Not a chance! Sorry! Nature calls! We pulled onto the road where our station was, all our bags were by the back door, paperwork was done with the I’s dotted and the T’s crossed. The station was visible now, 400 meters up the road. 300 meters......200 meters......100 meters......50 meters...... Ahead, blue lights. An ambulance, thank god! I need my bed! I need the toilet! Just as we approached the entrance to our station we were stopped in our tracks by a frantic policeman. 

“Can you come and help us?!”

I’m guessing I had a tired and confused look! There were two ambulances with blue lights on about 30ft away, why are we needed?! We are finished! And I need the toilet! 

“Apparently the men on those ambulances are “fleet support” and have no medical training. They just came across the crash! We have a motorcyclist who’s come off, I think he’s in a pretty bad way.” 

The penny dropped. My heart sunk. This was the job they’d been broadcasting. This is why they need an ambulance. We now had no choice but to help. The toilet was so close! 

We drove over, I jumped out, grabbed a few bags and the collars and went to assess the damage. Well, a motorbike helmet embedded in a metal fence is never a good sign! What was a good sign was the guy was conscious and talking, although he was trying to get up which obviously I didn’t want him to do! Despite my sternest voice and soft use of force and stood up. Unfortunately, the second he put weight onto his foot he dropped to the floor (into my arms) in a heap. 

Due to blood on his shoe, I decided my first port of call would be his ankle. As I rolled his trouser leg up my stomach turned. His foot was facing the wrong way and both bones of his lower leg were protruding from where you’d expect his shin to be. It was gross. By now my crew mate had come over with other bags and was trying to hold his head still. Unfortunately because of how drunk he was, and the fact he had a head injury he wasn’t willing to let is go near his head. 

“Red base, we had a male with a serious open fracture to his left leg, a potentially serious head injury and a very high mechanism impact. We are x-ray (ambo lingo for FINISHED) so could you send a unit to us urgently.” 

“Sorry, we have no units to send.”

Now, the sceptic in me says that even if they had a unit to send, there would be no intention to send it! Why?! Because we were there and would have to convey ourselves due to the condition of the patient! Due to his injuries we would also have to take him to a trauma centre, the nearest being a 25 minute blue light run away. Humpffffff!! 

We got the bed next to him and with the help of the police removed his clothes, got his leg bandaged and immobilised, head injury dressed, cervical collar fitted, pelvic splint applied, got him onto an orthopedic scoop, strapped up and onto the bed. That all took about 10 minutes. We were ready(ish) to go. Until now he had removed the oxygen mask every time it was put on. Just as we were about to roll the bed to the ambulance he went floppy for a split second and then begun fitting. 

It wasn’t just any kind of seizure, it was one of the most violent seizures I’d ever seen. 

“Chuck me my cannula roll” I said as I put a tourniquet round his arm. 

“Red base, our patient is now fitting, we have a long run to the trauma centre, are HEMS available?” 

“Negative, HEMS are busy on another job at the moment.” 

“Rog, this patient may need sedating, what about a Delta Alpha?” (Doctor in a fast car) 

“Standby................ negative, your nearest DA is 25 minutes away, coming from their home. The HEMS desk recommend you just leave now.” 

Thanks for the recommendation! Not sure what we would have done without it! My issue is I had a trauma patient fitting violently on the back of my ambulance with multiple fractures and probably spinal and internal injuries. I didn’t consider him to be stable enough to transport but hey, improvise, adapt and overcome eh?! 

I got a cannula in him and we got him loaded on board the truck. Although the fit hadn’t lasted long enough to give drugs according to the guidelines and although he hadn’t had repeated seizures which the guidelines also say you can give drugs for I decided not to wait. They are guidelines after all and I was happy to justify my actions should they be questioned. Five minutes of an extremely violent seizure post a traumatic head injury was enough for me to try it! And guess what?! It didn’t work. By the time I had decided it hadn’t worked we were well on our way to the hospital. The copper in the back of the ambulance was god send, I needed the extra hands! 

After 27 minutes we arrived at the trauma centre. That was 31 minutes after he had started fitting and I had given all the drugs I could. He was handed over to the waiting trauma team and we went to clear up the bomb site of the ambulance! And what a mess! Now for the paperwork! I hadn’t even started one because all my paperwork was put away at the END OF MY SHIFT! 

So, 45 minutes after arriving we were ready to go. We checked in on our patient who had stopped fitting and was being treated for his multitude of injuries. Maybe he’ll survive, maybe he won’t. It's not that I don't care, it's just I won't find out so I try to move on from it. It's easier that way. Let's call it self preservation! 

We now had a 35 minute drive home! Luckily I wasn’t driving! My adrenaline surge had well and truly ended, my second wind had gone, I was a wreck! 

Had it been safe for me to do that job? Doubtful! Do you think I was in a good mental place to deal with my patient?! Probably not! Should we carry on being expected to perform under these strains?! I’d say no! A fellow blogger, The Broken Paramedic, recently described what is expected of paramedics and what attributes we must have to do our job at times. 
“These carefully selected individuals are capable of superhuman feats of endurance. They do not require rest or nourishment, they can perform efficiently without sleep and can reabsorb their own excreta so access to toilet facilities is not required. They have cat-like reactions, heightened diagnostic powers and physical strength which only improves with fatigue and they can sustain emotional and psychological extremes far beyond normal humans. They are practically indestructible.
This is of course total rubbish”
I left for home just after 5am. I felt like a broken paramedic. Living the dream eh?! 

Tuesday 24 September 2013

A Life Of Grime

"59 year old female, collapsed behind closed doors."

There is that ominous feeling again! The one I get when those words appear on the screen. The apprehension that goes with the territory of entering someone's house, not knowing what you will find. Will the house be empty? Will you go from room to room hoping not to find a body? Will you find someone hanging? It's a horrible feeling and a job I never relish doing. 

We headed round to the house. It was an old Georgian terraced property in quite considerably disrepair. Flaking paint, rotten sash windows, dirty net curtains, ivy growing up the wall, an over grown garden, a boarded up window and a broken letter box. If I didn't know any better I'd have said the house wasn't occupied but we had it on good authority that someone was indeed inside. Two days worth of milk was in the porch which suggested that normally someone was there. I knocked and shouted through the letter box. To my surprise I heard a faint 'Help me' in reply. 

We couldn't get in and no one had a key so I requested police. While we were waiting a neighbour offered us access to her back garden. She also told us that the lady inside never goes out the house. We squeezed through a gap in the fence and peered through the window. Darkness! Luckily the old sash window wasn't locked and lifted up with relative  ease. I immediately wished it hadn't. The smell that hit!

This job in general challenges your senses and often offends them. It is true that there are smells you can taste and this smell instantly made me gag. Covering my mouth and nose 
I pulled the curtain across and was met with literally a wall of rubbish. There was no way in, I couldn't see any part of the room. Back to the front!

By the time I'd clambered through the fence and got to the front door the police were on scene. After my explanation of the smell, we all donned masks and police forced the door in. I can't begin to describe the state of the house or convey the smell in words. It was beyond grim! As we made our way down the hallway, shuffling past the stacks of rubbish, I could feel the soles of my boots sticking to the floor. We followed the faint voice from the back of the house, all the while, the smell getting more intense. Maybe it's like touching something with a 'wet paint' sign on it, but despite knowing how vile the smell is I still found myself checking! 

My heart sank as I turned the corner at the end of the hallway. The piles of boxes and rubbish continued, making it almost impossible to get to her but my main concern was her! She was lying face down in the doorway of what I assume was her bedroom. When I say 'in the doorway', I mean literally wedged. She must have been 30-35 stone. There was no way to even roll her onto her back. She had also been there two days so was saturated in urine and faeces. For the first time in a long time, I didn't have a clue what to do, or where to start. How do we move her?! How do we get her up?! How do we get her out?! My crewmate checked her over and medically she was OK, apart from some dehydration. Clearly we couldn't manage on our own and our equipment wasn't large enough or strong enough to cope with her size. 

I phoned up control and had a discussion with our clinical support team. They decided to send HART (Hazardous Area Response Team) and an officer for starters. The benefit of HART, is like firemen, they tend to come on mass! There is normally six of them on their big truck so at least we'd have hands! Ideally we needed a removal company, pest control and a deep cleaning company but we don't always get what we want! Within 20 minutes or so the troops had arrived and like us, were perplexed as to what to do. 

The officer, rightly said we needed the bariatric ambulance to convey her, so he arranged that. Due to the lack of bariatric ambulances and the ever increasing number of obese people who need them they can only be requested by an ambulance officer, so they are not used inappropriately. Meanwhile, the head scratching continued. Eventually a plan was made!

It involved clearing the hallways for starters! Unfortunately, there was no space to put any of it! We ended up having to line the pavement with it all. Almost an hour later, the bariatric ambulance had arrived, a path was cleared, dead rats had been found amongst other unidentified dead creatures and we were all filthy. As for the smell, what smell?! We'd been around it for so long, I was over it! 

With a configuration of straps, sheets and a hoist we managed to get her onto her back, then to sitting, then onto a chair, out the house, onto the bed and off to hospital. We all then went for showers and a uniform change.

I've blogged about obesity at length and apart from saying how much this has cost the NHS in resources, I won't discuss the obesity issues. They are obvious enough. However, there are huge social issues and obvious failings in a flawed system. How can anyone be allowed to end up in a state like this? The council WERE aware of the situation and had done nothing. It was a council property and there was a resident clearly not able to cope. Why had social services not intervened? Time and time again we see people that have 'fallen through the cracks' in the system. I'm not being funny, but this isn't falling through a crack, this is simply not caring for people who need it. This hasn't happened overnight. This is the result of a lifetime of self neglect and being overlooked by the services that are in place to help. No one will be answerable for this situation. It's been left for the emergency services to sort out, again. No one should be allowed to live in such squalor, regardless of how obese they are, regardless of whether or not they are a hoarder and regardless of whether or not they can afford or want the help they need. Allowing anyone to 'fall through the cracks' is neglect. End of. 

Monday 23 September 2013

Into The Mixing Pot

WARNING: If you are squeamish, read no further. You won't like it!

"32 year old male, arm stuck in mixer, bleeding"

Oooohhh, bit of trauma! Love it! Yes, I'm morbid but I can't help it. I don't want anyone to be shot, stabbed, run over, have limbs cut off or fall from buildings, BUT, if people do, then I want to be the first there and I will quietly revel in the glory of it to myself whilst sporting my very serious 'emergency face'. Anyway, surely if you were seriously injured you'd want a paramedic who loves trauma and doesn't flap?! That's sound logic in my head anyway!

So, the patient. I was on the FRU and pulled up outside the building site in question. I was greeted by a large group of men frantically waving. I put on my hi-vis, my hard hat (yes, we have hard hats and yes, they look ridiculous) and followed them in. A couple of them  looked rather pale. 

"I hope you've got a strong stomach, his arm is fucked."

Well, at least he's not beating around the bush. They led me up some scaffolding stairs and carried all my bags for me. Makes a nice change! On the second floor was a man with his arm in a machine. He was surprisingly calm. The machine was some kind of mixer with blades in, what for exactly I'm still not sure. What I was sure about was a) his arm was inside it, b) there was a worrying amount of blood and c) despite his calm demeanour, he was white as a sheep. I asked for torches inside the machine to have a close look. He'd managed to pull most of his arm out and from what I could see, he was only trapped by his sleeve. I tentatively cut bits of his sleeve until suddenly his arm became free. I then told him to look away as I cut his sleeve off. 

As I did, one of his mates vomited. Not the most comforting thing for him to see, or me! I insisted he did NOT look at his arm. I wanted him conscious if at all possible! Now, his arm...... The guy's original description was pretty accurate. This was the first time I'd seen a completely de-gloved forearm and it wasn't pleasant. Flesh, muscle, fat all mangled and twisted. Large areas of bone exposed and his hand was a total mess. (I called for HEMS immediately and said I needed the ambulance NOW!) Blood was coming from what appeared to be everywhere so I applied a tourniquet. Until now he hadn't been in much pain. It was all numb. Well, the scream he let out as I tightened, and tightened and tightened the tourniquet was gut wrenching. I won't repeat the words he called me. I let it slide! Just as the bleeding stopped he passed out. 

We got him on the floor and I arranged his arm to be supported upright while I dressed what I could. Apart from the guy who was recovering from his vomiting incident, the rest were amazing. They couldn't do enough to help me and that makes jobs like this infinitely easier. The extensive wound dressing and non-adhesive dressings were placed over his arm and I bound it all together. I then remembered to write the '15:37 T' on his forehead in black pen. We were told to do this if you put a tourniquet on so it is never overlooked at hospital. His arm is now dying and that tourniquet needs to come off at the earliest opportunity. 

I managed to get a line in him and starting giving him fluids as the noise of the chopper blared out above us. The patient was awake again and talking. Turns out his wedding ring fell off and as he tried to grab it his hand went in too far. He kept asking how his arm was and I kept ignoring him. I didn't know what to say. His mate answered for me.

"Seriously buddy, you may have to start wanking with your other hand!"

Everyone laughed. It is amazing what a soothing effect humour can have on a situation. Through all the chaos and horror that was around, a joke can still be made and that probably helped more than any of the drugs we could give. Everyone knew his arm was bad, he knew his arm was bad, but the people who knew him best, knew he didn't need to be told that.

Within minutes the orange jumpsuits appeared! I love it when the grown ups arrive. I couldn't give anything as his blood pressure was too low and as the adrenaline started wearing off and the pain was getting worse he needed proper drugs! Cue the Ketamine! Still without an ambulance we used the HEMS scoop, strapped him in and carried him down. He was being given units of blood on the way. 

We loaded him on to the chopper and off they flew. I was left, covered in blood, and dust, to do the paperwork. I trundled back to my car and on cue the ambulance arrived. I didn't know  whether to laugh or cry! I did know I needed a shower! 

De-gloved forearm! Awesome! One for the scrap book!

Thursday 19 September 2013

You've Been Framed

"34 year old male, head injury"

In general, I'd say most people take at least some degree of pleasure out of other people's misfortune. I'm not suggesting we are all sick and twisted or even nasty, but who can honestly say that they don't?! You see someone stumble or trip over, you smile! You see someone spill a drink on their crotch, you smile! Almost everyone has at some time or another,  watched 'You've Been Framed' and laughed at the misfortune and calamities that strangers experience! It's great! What's not to enjoy about seeing someone stand on a chair, the chair collapse and the person falling and stumbling and knocking over the TV! Maybe we are a sick and twisted bunch after all! Needless to say, I am blessed to see the results of said mishaps and occasionally I allow myself to laugh! Sue me!

The job appeared on the screen and off we went. It was a gorgeous day and we were heading to a golf course. The exact location was the 1st Tee! We pulled up to the club house and were met by a groundsman who kindly drove us, and our bags, to the patient on a golf buggy! At the 1st Tee was a large group of people and sitting on the floor amongst them was our patient. 

I could see immediately the HUGE lump on his forehead, it was like an orange! The patient was very well dressed, covered in designer labels, fake tan and expensive looking jewellery. I introduced myself and he immediately tried to cover up his obvious concussion with bravado! I'm assuming he didn't want to lose face with the crowd! He was an Essex boy and I'm guessing from the way he was talking, he was one of the alpha males!

"So what happened?!"

"It's nothing guv, I was just hit with a ball."

"Did you lose consciousness?"

"No, don't think so."

"He did." said one of the guys in the group.

"How long for?"

"About a minute, maybe two."

He then went on to explain EXACTLY what happened!

It turns out that Mr Essex was on a business trip and was taking a number of his clients on a corporate golf day. According to his colleague he also fancies himself as a bit of a golfer. He certainly had all the gear and some very expensive looking clubs! Anyway, being the host he decided to tee off first. He put the ball down, did a few practice swings, addressed the ball and 'shanked' it! The ball flew off towards the trees about 10 metres away to the left, hit a tree and came straight back him. It hit him between the eyes, after smashing his Dolce & Gabbana sunglasses on the way through! Amazing!

I laughed. Out loud. So did everyone else!

 "Aren't you paramedics supposed to be sympathetic?!" he said, as I laughed!

"We are, but you've knocked yourself out by hitting yourself in the face with your own golf ball! That's made my day!"


I let him have that one! 

There was a small cut on the top of the bump so we put a dressing on it. Despite his resisting, we convinced him to come to hospital. I continued to mock him mercilessly which he took in good spirit! 

I'm sure some people will tell me it's morally wrong to laugh at a patients misfortune. I'm sure I'll get a comment about being unprofessional, blah blah blah! It was funny! We laughed. He laughed. He got good treatment. The end!