A Heavy Heart

"31 year old male, chest pain"

I really am bored with chest pain. Historically people ignored it, and as such, people having heart attacks didn't get treatment and subsequently died. Cue the huge, expensive campaign to raise awareness about chest pain. It was hugely successfully and cardiac care in this country is now one of the best in the world. However, the increased awareness about chest pain has inevitably led to chest pain being overused as a symptom. It seems that any pain, anywhere on the torso and for any length of time must be a heart attack, and as such, the amount of people who claim to have just pain when calling an ambulance is huge! Some use it to get a quick ambulance because they know we will come immediately. Some, just can't cope with any pain, anywhere and assume they are dying. 

I would say that as high as 9 out of 10 chest pains that we go to are not genuine chest pains, which is quite remarkable. We go to them every single shift in some form or another, and very rarely is it a heart attack. As a rule of thumb, I find that chest pain in the under 40's is not genuine chest pain. More often than not it is a panic attack, chest pain caused by prolonged coughing, a stitch or any other common day illness which most normal people treat at home. However, 999 seems to be the first port of call! Obviously, there are exceptions to the rule and we wouldn't want to put people off calling if they are having a heart attack, however, what I can assure you of, is sharp chest pain that is only there each time you cough, is not a heart attack.

It was middle of the day and my shift was ticking away nicely when I got sent a job. I shook my head about a 31 year old calling with chest pain and headed off. There is nothing that can be done about filtering these calls. It is very black and white. 'Do you have chest pain?' 'Yes'. They get an ambulance. Find a solution which removes risk and you'd save all ambulance services millions of pounds!

Waiting at the door with almost a proud grin was the patient. I grabbed my bags, trying my best to avoid eye contact for as long as possible, as I'd seen his beckoning eyebrows dancing round all over the shop! Keep them still man! I eventually got to the door and headed in.

"Right sir, what's the problem today?"

"I have pain in my heart."

"Point with one finger where the pain is"

*points to right side of chest*

"Your heart isn't there."

"You sure?"

"Pretty sure."

"Oh, how odd, is that my stomach then?"

*facepalm*

Welcome to my world! Needless to say, he was left at home with advice and 2 Paracetomol! Another life saved!

Dead Man's Hand

"25 year old male, playing cards, now not talking"

Call me a cynic, but I suspected this was going to be yet another waste of a resource. I may be wrong, he may well be having a stroke like the NHS111 triage system had determined, but at the age of 25, this was highly unlikely. There are always medical phenomenon, where teenagers have strokes, heart attacks and other conditions that are not expected to be a risk for at least 30-40 years. However, they are rare, especially when there are no risk factors. With no other symptoms listed, it was pretty staggering to the me that a) I was even going to it and b) it was such a high category or call! Anyway, who am I to form these opinions and question these decisions?! I'm just the Band 5 warrior who gets to see these people in their own habitat! I'm just the one who treats them. I'm just the ambulance driver who merely takes them to hospital. Questioning NHS111 is way above my pay grade! Anyway, only time would tell if it was NHS111 1 - 0 Me or the other way around. I suspected I would be taking home the points today! 

I pulled up to the house around 1am. It was the only house in the road with lights on so was pretty easy to spot. The door opened as I was walking down the path and a young guy came out to meet me.

"Thanks for coming, you really shouldn't be here."

"No problem, what happened tonight?"

"Between you and me, he's a friend of a friend. We have had a poker night and he has lost money. He kept buying back in over and over and now owes about £70. He collapsed to the floor, we got him up and put him in a chair and he hasn't said a thing since. Every now and again he opens his eyes but just closes them. It's a bit odd, I reckon he's putting it on to avoid paying but a couple of the guys were worried and called that 111 thing."

"OK, thanks for the heads up, let's go and see him."

I was led through to the living room where the perfect 'lads night' was on display. Sky Sports News on the TV, remnants of a curry lying around, poker table set up and a fair few empty cans of lager all over the place. They were actually a really nice group of guys, polite, courteous, offered me tea / coffee etc. 

"Coffee, milk and 2 please!"

Lying in the chair was the patient. I've seen a lot of unconscious people in my time and I've also seen plenty feigning unconsciousness and he was DEFINITELY not unconscious. I don't know what it is exactly, we just know! Unconscious people have a look about them.

"Come on James, open your eyes.......James, open your eyes."

Nothing. I lent forward and gently touched his eyelashes. Sure enough, they twitched. Shocker! 

"James, I know you can here me, stop playing around and talk to me."

Nothing. I pinched the muscle on the top of his shoulder as my 'pain stimulus'. Sure enough, he recoiled from it but still continued the pretence of unconsciousness.

"James, an ambulance is on its why. I'd like to cancel them so they can be used on one of the dozens of seriously sick people who are currently waiting for one. The reason they are coming here is because you are pretending to unconscious. Do me and them a favour and start talking to me, this has gone far enough.........James!"

Nothing. I went for the shoulder again and he slid himself down onto the floor and started 'fitting'. It was one of the worst fake seizures I've ever seen, complete with spitting and drooling. After about 20 seconds he stopped. I picked up his arms, held it over his face and let it go. Sure enough, instead of dropping and hitting him in the face he moved it to one side at the last second. 

"Red Base, this patient is not co-operating, could you request the police to attend this CAD as the patient is preventing the emergency services carrying out their duty." (Forgot to press the transmit button, oops!)

*cue the miraculous spontaneous recovery*

James started moving around slowly and feigning confusion. 

"What happened, what's going on?"

"You pretended to be unconscious and then pretended to have a fit, are you recovered now?"

"What do you mean?"

I could have continued in the same vein but it was easier to just ensure he was fully recovered so I could cancel the ambulance. AMAZINGLY within about a minute he was fully recovered, fully alert, fully cooperative and fully embarrassed. 

"Does he need to go to hospital?" said one of the guys.

"Nope, certainly not, he'll be just fine!"

"Excellent! Pay up bro! Mans have to pay their debts!"

24 - Season 3: Episode 3

continued……

The following takes place between 00:00am and 03:26am

00:00

It was fair to say we had broken the back of the shift! It’s always nice on nights when you consider yourself to be on the home stretch! We tucked into our cold dinner as the clock ticked down to when we had to green up for the next one. Sadly, that time arrived far to quickly and once again we were off. I was also starting to yawn which with 6 hours to go, isn’t ideal! Again, I tentatively suggested we swap round but the only thing I got was laughter in return. Worth a shot! 

“30 year old male, DIB, Asthma. From NHS 111”

You’ll be shocked to hear I was sceptical! As far as I’m concerned, people who have asthma no what an asthma attack feels like and know what to do when they have one. They also know exactly when they need to call 999 so I find it odd for an asthma patient to call 111 for advice. As had been the theme of the evening, my cremate posed me a simple question:

“On a scale of 0-10, 0 being breathing so perfectly it makes me feel positively wheezy and 10 being unable to breathe, requiring ventilations, a silent chest, tracheal and sub-costal tug all needing immediate inspiration and a blue call, how bad is his DIB?”

“I reckon a 2. Possibly a 3. He’s probably got a cough. In fact, change that to a 1. Normal everything, no wheeze but thinks A & E will be some kind of great adventure!”

We pulled up at the block of flats. The address details said ‘4th floor’. There was no lift. Can you imagine the joy that was flowing through my veins?! By the time we got to the top, both of us were breathless and therefore, by my prediction, more in need of an ambulance than the patient. 

BINGO! *takes a bow*

There was our treasure of a patient, sitting on the sofa grinning away. There was no cyanosis, no increased respiratory rate, no obviously distress or difficulty, just a big grin. The grin itself was mildy unsettling! 

“Good evening Sir, what’s the problem tonight?”

“I’ve had this awful cough and cold. I think I’m wheezy with difficulty in breathing.”

“How long has this been going on?”

“Since the afternoon.”

My crewmate, complete with wry smile, did all of his OBs. All normal. Oxygen levels were 100%, there was no temperature, blood pressure and heart rate were normal. I couldn’t find anything wrong with him other than being sniffly. 

Despite my sound medical advice and suggestions of alternatives to accident and emergency he wanted to go and get ‘Antibotics’. I didn’t think he needed Antibiotics but there was definitely no indication for ‘Antibotics’. Rest assure though, he had taken ‘Paretomol’ and ‘Buprofen’. 

*Facepalm*

Anyway, overnight bag packed he headed back down the stairs to the ambulance and headed off. On route I had a fascinating conversation with his wife about diabetes. She had been diagnosed with type 2 diabetes a year ago at the age of 26. I can’t say I was surprised, she must have been in excess of 20 stone and rather short. Diabetes was somewhat inevitable. However, she assured me that she’d ‘caught it’ of her mum. Yep, that nasty contagious strain of diabetes mellitus was at it again, jumping from host to host, catching people unawares. It was just sheer coincidence she happened to be morbidly obese, a smoker and didn’t exercise. But yes, blame the parents! 

What these two need is the health promotion version of the ‘birds and the bees’ chat. An actual in depth conversation about lifestyle, risk factors, causes, what constitutes being ill and PRONUNCIATION of very common medications! Every time someone says ‘Buprofen’ a puppy dies. Spread the message and help cure the madness!

01:15

Thoroughly frustrated and now verging on irritable I no longer felt on the home straight. It felt like there was absolutely years to go until the end of the shift. Urrrrrgggghhhh!!

“23 year old female, tearing abdo pain, From NHS 111”

Really?! ‘Tearing’ seems the new buzzword that NHS 111 seem to be asking patients. Tearing abdo pain is a symptom of a very dangerous, life threatening Abdominal Aortic Aneurysm. (AAA). These patients often die. Unfortunately, if you ask someone who is ringing for advise if the pain is ‘a tearing pain’ it is highly likely a fair few will just say yes. Cue the Red 2 response of FRU and an ambulance. 

“On a scale of 0-10, 0 being calm, relaxed and whistling ‘ Always Look On The Bright Side of Life’, and 10 being the worst abdo pain since records begun, causing eventual loss of consciousness and a necessity to anaesthetise immediately, how bad do you think the pain is?”

“Definitely a 2. No more. But I want a bonus if she says 11 or 12 then laughs.” 

Up ahead of us were blue lights, we slowed down by the police car and saw the wreckage of a car. 

“Evening! Need a hand at all?!” 

“Yes please, we’d just requested you, got 1 trapped”

“RUNNING CALL: RTC, Car vs Tree, 26 year female trapped, injuries unknown.”

Pulled over and the road was subsequently closed. In the passenger seat was a young lady very distress and upset. The wouldn't open and her leg was trapped. A second ambulance was on scene within a minute or so and one of them got into the back, much to his annoyance! Everyone else claimed seniority so it was he who hat to sit in the back, holding her head for probably an hour whilst we got the fire brigade to cut her out. 

As I’ve said before, the fire brigade are great at what they do and we can’t get these patients out of the car without them. They arrived on mass much to the amusement of the police and myself. A sea of daffodils bundled out of all 3, yes 3 fire engines plus a specialist rescue unit. There was at least 24 of them around this tiny Nissan Micra. 

“I can’t stand around here watching them all swinging their bollocks around in some blue light mating ritual. I’m taking the driver to the truck and see how he is!”

Well, that was my cremate gone! And she had a point. Despite explaining that I just wanted the door off they seemed determined to take the roof off! My patient had no neck pain or back pain but was trapped and her leg was hurting. I wanted to get her out with as little faff as possible but that was proving an impossible task. The ‘white helmet’ ( 1 of 3) attempted to patronise me with phrases such as ‘Look here luv…’ which went down a treat. They didn’t need to take the roof off, the door would surface so much to their annoyance I pissed on their parade and stuck to my guns. Rolled eyes and head shakes followed but I didn’t care. It was freezing cold, raining and my patient needed to be in the warm with some decent pain killers. This wasn’t the time of the place for a training exercise. 

With the door off we got her fitted into a KED (fancy extraction devise) and promptly pulled her out of the car sideways onto the bed. She had escaped with minimal injuries so was taken in the other ambulance. We took her husband to the same hospital and left the 24 deflated egos having a collective bitch about that stupid paramedic! Ooops!

This encounter had woken me up somewhat! By the time we were fed and watered and ready to go again it was approaching 03:30 so time for 1, maybe 2 more depending on the customer! Winning!

Time to press the button again…..

To be continued…..

Monkeying Around

"25 year old male,? Fall from height"

Aaahh, the old ? is back! It's like a magical mystery tour! What illness or injury is behind the closed door?! Or in this case, the woods! The ? is kind of important! HAS he fallen from height?! If so, is it extreme height?! I really need to know this stuff, especially as I'm on my own! 

UPDATE: No one available to meet you at the gate. Patient is about half a mile from the entrance near the stream. Caller staying with patient.

"F%#k!!!" (Sometimes you HAVE to swear)

I arrived at the entrance to the park. There was a height restriction on the gate which I could fit under, but the ambulance would not. I drove about 400 yards to the start of the footpath by the woods. Now a long walk.....

UPDATE: Fall from extreme height. ? 40 feet out of tree. Drifting in and out of consciousness.

"F%#k!!!" (Again, this is a 'sometimes' moment)

This job will not allow me the luxury of popping back to the car for kit. I needed to take everything I need or may need. I also have no idea how long I will be there due to the location. It could take a while to get him out! So, paramedic bag on my shoulders, oxygen bag and spare cylinder, dressing pack, Lifepack 15 (weighs a tonne), Entonox, spinal collars and a blanket. I literally couldn't carry any more if I tried. After 15 minutes of walking / shuffling / plodding I heard some shouting coming through the trees. I followed the noise and eventually saw my patient and the caller on the other side of a small stream. I clambered down the bank, tip-toe'd across, up the bank on the other side and go to work!

The guy was in a bad way and was indeed drifting in and out of consciousness. When awake he was in a lot of pain and had various obvious injuries that concerned me. Significantly, a head injury, a possible broken pelvis and a broken neck. That's not to mention the arm and leg injuries he had but I was limited to what I could do on my own. It is these jobs where you learn a lot about yourself and your abilities. The buck stopped with me to a point, I can only do what I can do but lone working means you put an awful lot of pressure on yourself to do a lot.

I requested HEMS due to his injuries and location. HEMS were unavailable. They were my safety net! (Ironic mention of safety net given the circumstances!) In a semi-angry / desperate rant, I basically said, and I paraphrase:

"This guy is literally in (not up) shit creek, I have no means to get him out quickly and safely, I don't care if HEMS are offline, I need someone and quickly. HART, extra crews, anything, but I need it 5 minutes ago. Capisce?!"

I think for poor girl on the radio sensed my stress levels and basically said, and I paraphrase:

"Oi! Chill your beans, leave it with me, I'll get you all the help you need as quickly as I can, we are here if you need us for anything! Comprende?!"

I got it and she got it. Our poor allocators often get the brunt of our heightened stress levels! The good ones understand that and respond with kid gloves and know it's nothing personal. I know it's not their fault HEMS aren't available and I know it's not their fault that I'm in the middle of nowhere, on my own and feeling out of my depth! I know that! Sometimes we all lose our cool! 

The helpful caller continued to be helpful. I got him lying on his front holding the patients head still. It transpires that my patient, James, had decided to climb a tree, on his own, in the middle of woods. About 30-40 feet up, the branch he was standing on snapped. He dropped like a lead balloon. The branch was lying next to him and I could see where it had been, high up in the tree. *shudders* By sheer luck, the caller had been walking his dog and happened to see James lying on the floor. We had no real idea how long ago he had fallen. It was a remote part of the wood and off the beaten track. If he hadn't been found when he had been I wouldn't like to think how long he could have been lying there.

I had oxygen on him and set about cutting off his clothes. I got him linked up to the machine and starting monitoring him. For now, his blood pressure was stable. I fitted a spinal collar and them got IV access in both arms. Still no ambulance!! 

Gradually James became more and more coherent which was a good sign. However, the more alert he became, the more pain he was in. I had Morphine available, but with his injuries I wanted to hold off until it was totally necessary. I began a top to toe survey, to check for all injuries and make sure I hadn't missed anything. I carefully ran my fingers slowly down the small of his back. I felt an ominous ridge in his spine causing him to gasp. As I assessed his legs, it quickly became apparent he wasn't aware of what I was doing, or that I was even touching him. 

After a brief radio conversation with control, I guided the ambulance crew to my location. Eventually they found me and had brought supplies! We now had a spinal board, head blocks and straps. One thing we didn't have was a plan. There was no way we could realistically and safely carry him back to the ambulance. We needed HART team with all their fancy kit and extraction expertise. They, however, were still 20 minutes away because they'd had to get their special off road vehicles ready. All we could do was treat what we could, keep James warm and reduce pain as much as possible. Time really does grind to a halt when you are desperate to fly by. There was a very real possibility that James could be paralysed or even die from his injuries and I think he knew it too. 

It's a horrible situation to be in. As much as you want to talk candidly and be honest, in a patient who must remain completely still, you don't want to cause panic. I made it painfully clear he mustn't move at all but the pain was making him fidgety. I decided that despite the potential risks of morphine, the benefit would outweigh them and with three of us now, any side effects could be managed. So I loaded him up with it and he responded well.

Eventually a guy from the HART team arrived, panting! He'd run! Run! Weirdo! He said they were all here and were trying to get their vehicles inside! Not 1, not 2, not even 3, but 4! The incident response vehicle (big ambulance with tea making facilities), the 4 x 4 jeep thingy which the boss drives and then 'Thunderbird 2'. Well that's what I call it anyway. This....thing has a crane, it lifts off a huge box, and then out the back of said box, comes a special ambulance golf buggy thing with blue lights and stretcher! Anyway, they all arrived and slowly but surely found their way to us. Amusingly, the HART team were stood around in their protective jump suits and hard hats and we were stood next to them in our normal uniform. They didn't get the joke! To be fair though, we couldn't have got him out without them. Today they more than proved their worth!

Once everyone was assembled we got James off the floor and into the vehicle. Whilst he was driven round to the ambulance, we traipsed back with all the kit and met back at our vehicles. James was loaded on board the ambulance and we took him off to the trauma centre. 

I often say that in this job you generally see people when they are having a really bad day. Let's be honest, if you need an ambulance, or think you need an ambulance, clearly things aren't great! That aside though, we are also in the unfortunate position to see people when they are suffering truly life changing events, often with disastrous consequences. People's reactions vary from fear to denial but they all have an unmistakable look in their eyes. Sometimes I think I know the right things to say, sometimes I don't. Today I didn't. James looked at me and said:

'I've really fucked up haven't I?'

Hope can be a dangerous thing and I didn't want to give him any on a false pretence. I suppose my avoidance of the question was very telling. 

'Let's see what the X-rays show.'

A tear trickled down his cheek. I guess the gravity of the situation had hit home. 

I have no idea if James ever walked again. 

Sync Complete

I should probably start this post with an announcement. I HAVE A NEW LAPTOP! How amazing is that! I've been wanting / needing one a long time! My old one was bought in 2007 and can no longer cope with the simplest of tasks! 2007! It's amazing when you think back THAT far! My son hadn't been born, I was married, I was working Monday to Friday in a tragically dead end job! It is amazing what can change in just six years! Anyway, yesterday when I finished work I wandering into the Apple store and bought my new MacBook Air and totally abused my 'old' student card to blag the discount! I was pretty damn chuffed as I walked out, new toy in hand! I drove home, opened the box and started syncing! What a day!

Then I thought, 'yeah, what a day'. My mood descended somewhat into one of reflection. It's easy to get caught up in a moment. Like I said, it is amazing how much can happen in six years. It's also amazing what can happen in 12 hours. It is also amazing what I'd managed to forget over 12 hours. Maybe not forget, but certainly the prospect of indulging in a new laptop had become top priority in recent hours. So much so, that it wasn't until now, starring at the words 'Sync in progress' that I realized that there were other people, people who I had seen today who weren't enjoying their evenings. 

"09:05 - 57 year old female, cardiac arrest"

I shot off up the road, dropped into 'sport' and started tackling the remains of the rush hour. I knew the road well having walked down it twice a day, to and from school for many years. I knew I would be the first to arrive and wanted to get there as quick as I could. 

Four minutes after someone had dialed 999 I pulled into the street. I screeched to a halt, grabbed all my stuff and rushed inside. I was beckoned up the stairs by the distraught looking husband. Lying on the floor of the bedroom was my patient. There was nothing I could do. She was dead and had been dead for quite a while. Rigor mortis had set in and there was post mortem staining present. I exited the room and closed the door behind me. 

"I'm so sorry, but there is nothing I can do. I'm afraid your wife has passed away."

The man fell forward, wrapping his arms around me and began sobbing. As he cried, their son appeared on the landing in his dressing gown, also sobbing. I managed to escape his grasp and let them cry together. I went and put the kettle on to make some tea and I cancelled all other resources. In situations like this, tea always seems sensible. They came downstairs and sat on the sofa crying. They looked totally lost. No idea where to turn, no idea how they will move forward. 

I waited with them, comforted them as best I could until the police arrived. I left them to deal with their unmeasurable loss. A very tragic start to the day for all involved.

"12:09 - 33 year old male, ? slurred speech, ? stroke"

My initial thoughts on being sent this were skeptical. Come on! 33 years old! Having a stroke! Not likely! It only took me 3 minutes to get on scene and my patient was sat at the roadside waiting for me! He staggered towards me like someone who's been drinking! I kept him at arms distance whilst I spoke to him. Within about 10 seconds it was clear he wasn't drunk. He was having a stroke.....

His speech was slurred and he couldn't find his words. He was limping and had very little power on his left side, hardly any grip at all and he was drooling slightly. He had no risk factors which made it all the more bizarre. I called control to tell them it WAS as given and I needed an ambulance ASAP. 

33! Unbelievable. He was a successful guy, had a lovely house in a lovely area. He was very confused and had been found staggering around the front garden by a neighbor. He was due to get married in a few weeks time to the woman pregnant with his child. Surely his life can't be ruined at 33? Surely he will get a chance to do all the little things with his baby? Surely he can still get married to his childhood sweetheart? So much was suddenly unknown. So much had changed. 

The ambulance arrived and rushed him off to the stroke centre. I phoned his fiancée to give her the news......

"16:01 - 26 year old male, RTC, Car Vs Motorbike, ? unconscious"

Again, I knew the road well. It's a busy, fast, duel carriageway. This guy could be in a serious condition. That ominous sense of urgency engulfed me. As I approached the stretch of road, it was clearly serious enough to cause a complete standstill to all lanes of traffic. I managed to get myself into a bus lane and shot down the inside of the traffic to the incident. Lying on the floor, surrounded by people was the motorcyclist. About 100 meters further down the road was his bike. By all accounts he'd been clipped, flown through the air and then hit by a car. 

The guy was unconscious, he had a pulse but his breathing was extremely slow. Under normal circumstances, you need two trained staff to remove a helmet. It was just me and the ambulance would have a nightmare getting through the traffic. Based on my initial findings I immediately called and requested HEMS. Luckily the helicopter was 'on line'. ETA 8 minutes.

I couldn't wait to take his helmet off. I enlisted the help of a by stander and got it off. I got someone to kneel either of his head and hold it still whilst I started cutting of his leathers. His battered, blooded body was fighting to survive but I got the sense he was deteriorating. I attached him up to the machine to get his blood pressure. It was extremely low. I put in an airway and started ventilating him. I was aware of what was being said by people around me but was trying to ignore it. 

"Red base, this patient is about to go into cardiac arrest. Any other resources near by?"

"Rog, we have a car about two minutes away from you."

As she said that, I heard the sirens. What a relief.....

Too late....his pulse had gone and there was now no respiratory effort. I started CPR. The police and FRU arrived together and now the chopper was circling above. We set about running the resus. Airway, chest decompression, IV access and secondary survey. HEMS landed in the road ahead of us and promptly took over. He was given blood infusions, injuries were treated and eventually his heart started beating again. He was taken off in the chopper to the trauma centre by the HEMS team. 

He was pronounced dead shortly after arrival at the hospital......

"20:12 - 28 year old female, starring at new laptop"

Not such a great day after all. Whilst I sit here enjoying my new laptop there are three families who's lives have been destroyed today. Three families where I have been a huge part of their day. Telling them their wife and mother have died, telling them their husband to be and father to their unborn child is having a stroke and trying in vein to save a husband, brother, father and son. Two lives over, one changed forever. It is too easy to forget about these people. They aren't my family or friends and I have no obligation to mourn their losses and in all honesty, after today I'll most likely forget about them. That doesn't mean they didn't have an impact on me though. They did. 

'Sync complete'

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 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.....