The Temperature

Temperatures. We all have them, we all deal with them, kids especially. Until the age of 5 children cannot control their core temperature as well as adults so are prone to high temperatures when fighting any major or minor infections. To that end, we give Calpol and do so because it contains Paracetamol. Paracetamol is an 'anti-pyretic' and will bring the temperature down. If the temperature isn't controlled there is a risk of a febrile convulsion which can be scary to see for a new parent. Generally, it is common sense though. Before I started this job and had any medical training I was a parent. I didn't have a clue what I was doing but I knew when my son was ill and knew that when he had a temperature I was to keep him cool and give Calpol &/or Nurofen. Apparently, I was one of the lucky ones though! Lucky because I was given this closely guarded secret and extremely useful knowledge.

"2 year old male, fever"

Wednesday lunch time. We had done the usual mix of slips, trips, falls and chest pains when this job came down. My first thought was 'So?!' That was the only information we had to go on which was reflected in its low priority category. We arrived at the tower block and rung on the bell. The piercing buzz of the locking mechanism echoed down the corridor towards the 'not so welcoming' looking lift. We risked it anyway as 16 floors was not about to be walked! The smell of urine and graffiti on the wall told us all we needed to know really. We arrived at the flat, the door was open, so we wondered in. Sitting in the living room were both parents and the child. Our patient was lying on the sofa, dummy in mouth, looking around inquisitively whilst wrapped in about 20 layers of clothes and various blankets!

"What's the problem today?"

"He's gotta tempricher"

"OK, how long for?"

"I reckon bout an hour ago or summit"

"And have you given any Calpol?"

"Nah"

"Have you got any?"

"Nah"

I got out our Calpol whilst shaking my head a tad. He did have a temperature but not that high. I removed most of the clothing whilst reminding them that dressing a hot baby as an eskimo will not lower the temperature! 

"Has he been unwell at all? Any cough or cold symptoms?"

"Nah"

"Any vomiting or diarrhoea or pain you are aware of?"

"Nah"

"So what made you worried enough to call an ambulance?"

"He's gotta tempricher"

SO WHAT?! She didn't get where I was trying to go with this conversation. I tried my best to explain that kids get temperatures and that doesn't mean they necessarily need an ambulance. The kid was happy as anything! Perhaps if the temperature lasted a number of days and he wasn't well and didn't respond to treatment, then perhaps a GP would be a good idea, but a 1 hour history?! Hmmmm. Sadly my words of wisdom were lost on her! Hospital it was!

2 hours later.........

"4 year old female, fever and shaking"

It was clearly going to be one of those days. We'd spend half the shift picking people up off the floor and now the latter was being spent taking temperatures and administering Calpol! In stark contract to the first job we were now driving towards a very affluent road. We pulled up outside this grand detached house with a huge double garage as separate outhouse. Parked outside the garage was a Porsche 4 x 4 and a branch new Range Rover. I couldn't help a sarcastic 'Oh...so they do have cars' comment as I ventured up the path to the huge front door. As I learnt towards the doorbell, the door opened. A very well spoken woman in her 30's opened the door. As we walked towards one of the living roomS I couldn't help but think that given a house like this I'd do a better job! Sitting in a high chair was the kid. He had a flushed face and looked tired and grumpy. I'm not surprised. He had a whopping temperature! 40.9 to be precise! I'd be grumpy if I was that hot!

"What's the history? What's been going on?"

"Well, it started about 3 or 4 days ago. He's generally been under the weather and not himself but I thought it would pass but it hasn't"

"So what has changed today?"

"He had a convulsion about an hour ago and has since been really groggy, I'm getting a bit worried now"

"And have you spoken to his GP at all?"

"Oh no, I didn't think of that!" she said with a jovial tone. Haha.....

"What time did he last have Calpol?"

"He hasn't, we don't do Calpol, we don't agree with it"

"Well it's what is going to bring his temperature down. That's what the hospital will most likely want to give"

"Well as parents we decided not to use unnecessary drugs"

I skipped on. I was never going to win. I wasn't educated. She was. I have no money. She was rich. She was talking down to me. I wanted to be done with this job. We took her and her kid to hospital & I left the department grinning, as the nurse schooled her on the benefits of temperature control, whilst sad next to our previous patient! I wear smug very well indeed!

Seriously though, when did the concept of giving kids Calpol get forgotten. These are by no means isolated jobs. Most kids we see with temperatures have not had Calpol. That is probably partly because the ones who have had Calpol don't need an ambulance. See, there is a clue! Temperatures need treating, they don't need ambulances. Kids with temperates also still fit into their own car seats......just a thought! A temperature on its own is also not a medical emergency. It is simply the bodies way of fighting off an infection. Let it do it's thing! Also, please please please don't wrap them up in every piece of fabric you can find. I really did think that people knew this when I started the job. It's just common sense. As for wanting to go to hospital, 4-6 hours sat on a metal chair in a waiting room will probably make things worse for all involved. Giving your child Calpol when they are unwell is basic parenting and personally, refusing to give it 'on principle' is negligent. If the kid grows up and decides he or she doesn't want to take it then fine, but to risk a child's health and comfort because of a warped principle is wrong. 


I'm not saying don't call an ambulance, I'm simply saying do the basic things to reduce a temperature first. If they are unwell and showing signs of serious illness, have a rash or go floppy the do not hesitate but a one hour history of a moderate temperature is not an emergency. That is all!




For tips on treating a fever see the NHS Choices website. 

A Calling

"26 year old female, made a change, found her calling"

On the 22nd of May EMS Week 2012 begins and EMS1.com is running another competition. It is all about informing people of why we do the job we do. They ask the simple question: 'When did you know EMS was your calling?' It's a very good question and one that I'm sat here thinking about at 4am on a rather horrendous night shift. Here I am, exhausted, standing in the back of a cold ambulance, listening to rain crash onto the windscreen whilst I clean vomit off the floor. Is this what I had chosen to be? Is this what I had chosen to do? Yes it was! And I would do it over and over again. Some will raise an eyebrow and say...'really?!' Let me explain why...

About 5 years ago I came home from another day at work. It was 'just a job'. It paid the bills but it wasn't fulfilling at all; I had ended up doing it through a number of poor choices and various inactions. Today was no different to the end of any other day. I  sat down on the sofa, puffed my cheeks out and exhaled deliberately. There was nothing to say really. It was just... just the way it was. Was this really what I would do forever? I hoped not but I couldn't see any way out of it; my training and qualifications only really allowed me to do work in a very particular area, and it wasn't one I savoured. That night, things changed. I flicked through the newspaper's job pages with the usual air of resignation and chanced upon an advert; 'Student Paramedic'. Hmmmm! I read on. It described a great opportunity where I could become a paramedic in just 3 years. All the training would be provided, I would be paid whilst training and it was a career that offered progression and a pension which was something my current job lacked. I applied on a whim not expecting to get an interview. To my surprise 4 months later I received a letter inviting me to an assessment day. To cut a long story short I was assessed, I went for an interview, I had a driving assessment and a medical, and got offered the job. I was made up! Could this be the job, the career, the life I had been looking for?!

Training began. It was a tough six months, a lot of home study, multiple exams and assessments and a large proportion of it was done without any knowledge of what it was like to work on an ambulance. It was a little scary to be honest; I was putting in all of this work with no real idea if I would truly like the job. Then I had my first placement. It was the first time I indeed entered the world of EMS. Dressed in my brand new uniform, polished boots, company branded rucksack and a hi-vis jacket you could eat your dinner off, I arrived for my first ever shift. Due to the fact I was at training school I was 'third manning'; there were three of us on the vehicle: a paramedic, a technician and me. It being my first day I was observing and helping out with obs etc. It was the first time I had done a 12 hour shift and 6am is not a good look on me. At 6:01am we got our first job. Sat in the back, looking through the bulkhead door as we drove through the dark streets, blue lights flickering off every window and road sign, sirens blaring, I was so excited! What a rush! I soon got to see what a Materni-taxi was but I didn't care! When you're new every job is a good job. I suppose I was just so happy to be there. The shift passed by very quickly. We saw a variety of patients; chest pains, drunks, an overdose, an elderly faller, a pyrexic baby. I remember every job from that day, none more so than our off job:

"64 year old male. DIB. COPD patient. On home o2"

It was about 4pm and already dark, it was raining and we were flying through the city streets with all the drama I had imagined; I was loving it! My neck was hurting from peering through to the front for the last 10 hours but I wasn't going to miss a second! We arrived at the address and all piled in. 


The first thing that hit me was the smell of stale smoke. Our patient was sat in his armchair, clearly in trouble. To this day I still haven't seen anyone so blue; not alive anyway. He was surrounded by empty bottles of vodka and it was a sad case of a life of excess laid out in front of me. He was given oxygen and my mentor's sense of urgency was evident. We got him onto the chair and out to the truck. We didn't hang around and before I knew it we were driving; and then I saw why we had been rushing. My mentor said, 'Shit, he's gone on us, start CPR', and so I did. I was very task focused and did what I was told. Whilst the ambulance was swinging from left to right I was doing a concoction of CPR and bagging. It was a surreal out of body experience. I remember it as if I am some fourth person, looking on at me working; I don't see it from my eyes. We arrived at hospital and wheeled the bed out onto the tail lift. There I was bouncing up and down on this guy's chest, being lowered on to the tarmac. We entered the hospital through its double doors. About 100ft away, at the end of the corridor, was resus. The doors to resus were open and inside were the awaiting crash team. We sped down the corridor towards them, continuing CPR as we went. My heart was pounding, shivers ran the length of my spine and I could feel the hairs on the back of my neck stand up. This moment was when I knew that EMS was my calling. This was what I had chosen to be. This was what I had chosen to do. This, I will remember for the rest of my life.

I soon found out that it isn't all like that, far from it. I quickly learnt that there are time-wasters, hoaxes, violence, vomit and abuse. Many of the people we go to don't need a hospital. We work long, arduous, unsociable hours, and get little or no thanks, and little or no breaks, but we take the bad with the good. There will always be that one job which makes everything worth it. 

I am left now cleaning vomit off a floor. Vomit from someone who drank too much. Vomit from someone who was rude to me. This is my calling and I love it!