A Spot Of Bother

It was a rather quiet morning on the car! I'd taken the temporary lull in jobs as an opportunity for coffee with a fellow FRU! It's nice when you get some company on the car as it can me quite a lonely place at time. It's been described as prolonged periods of boredom, occasionally interrupted by moments of sheer terror. I think that is pretty accurate! 

"New Road @ Station Road"

Not two sips into my coffee, a job! A road name @ another road name, usually means an RTC. It could be someone just outside by more often than not it's an RTC. I had no other details yet so just started heading in the right direction. One of the problem with the FRU is when you're driving on blue lights it is very difficult to see any updates that appear on the screen. A buzzer goes of and the message appears in red when the call taker gets more information. The next update was the determinant, which is the main problem, i.e.; Breathing problems, Chest pain, Stroke, RTC etc.

"New Road @ Station Road, Stabbing / Shooting"

Really?! On a tuesday-bloody-morning! Come on! I upped my pace slightly, because despite my shock and horror at a stabbing or a shooting so early in the day, I bloody love stabbing and shootings! I'm not weird, most of us love a juicy trauma really! I started making mental plans of what I might see, what I might need etc. 

"New Road @ Station Road, 17 year old male, impaled on metal fence, report on arrival"

IMPALED?! How did he manage to get impaled?! What is he impaled on?! What is he impaled through?! No time to come up with a plan though, I was arriving on scene!

There was a small crowd beneath the patient, supporting him up in the air. All the heads turned to face me as I got out of the car. That look of expectation mixed with panic on all of their faces! 

*cue emergency face*

They were looking at me as the 'specialist in impaled human removal'. Sadly for them I was far from it! I'd never done an impaling so I was about as experienced as all of them! The patient was panicking atop of his spiked metal fence and to be fair, I would be to! The spikes were about 8-10 inches long and by the look of things he was impaled on two of them, through his inner-thigh. It was hard to tell because he was 8ft in the air! 

His panicking was getting worse. I wanted him to stay still, and wanted everyone to continue helping to support his weight. It really was a logistical nightmare! I radioed into control and requested Fire, Police and HEMS. Fire to chop the fence and bring some ladders, Police to block the road, and HEMS to.....well, just do what HEMS do best! Unfortunately, hearing me ask for the entire world and his wife, the patient panicked further and despite my shouting at him not to, in one big burst of energy he lifted / prized his body off the spikes and fell into our waiting arms.

"Red base, patient is no longer impaled, cancel fire, update HEMS, patient has an arterial bleed from his femoral artery."

There was blood everywhere. The good samaritans moved back, some freaking out at the blood, others just starring. I put all of my weight onto his groin where there blood was coming from. It took an incredible amount of pressure to stem the bleeding. The problem was I now had no hands! I barked order at people to get me things from my car, to press the talk button on my radio so I could get an ETA for my ambulance and to use my scissors to cut up his trouser legs. It was organised chaos! 

Within a couple of minutes the ambulance was with me which was a huge relief. I was getting cramps through my arms, they were literally shaking with the amount of pressure being used. A pressure dressing was prepared, as was an extensive wound dressing. In a fluid movement I swapped places with one of the crew and we got the dressing in place. The patient was white as ghost and sweating profusely. He was in hyopvolemic shock and needed surgery very quickly. 

I set about getting lines in his arms. Luckily for me and the patient he was athletic and had HUGE veins which just popped up nicely for me. As I was setting up the fluids the helicopter appeared above us. What a relief! The bed appeared next to use so whilst waiting for the HEMS team to be driven to us by the police (*cough* not just crime fighters!), we got him loaded onto the bed. Based on where they landed we would have to drive him to the chopper and we didn't want to waste any time. His blood pressure was in his boots, his pulse was racing and he was becoming increasingly groggy. To help stem the bleeding we gave him some Tranexamic Acid which aids clotting. 

With HEMS with us they took over. They started giving him units of blood as we all started loading him onto the ambulance. I felt quite satisfied that that was all they could really do. We'd managed to do everything else before they arrived and that is always a good feeling! Within a minute or so we were next to the chopper and transferring him. Having to keep huge amounts of pressure over his femoral artery made moving him slightly awkward but he was quickly on board and taking off. 

His friend had stayed with him until take off and was awfully worried. 

"How did he get impaled in the first place?!" I asked him.

"He dropped a £10 and it blew under the fence, he tried to run up and volt over, but it went wrong he got stuck on a spike."

"All that for £10?! Couldn't he have just gone through the gate down there?!"

"Oh year, didn't see that."

I had to laugh! Even his friend begun to smile, despite being covered in blood. I was covered to! I looked like Carrie! It was a sight to behold! My arms were literally red! It was time for a shower, uniform change, a re-stock, a fair bit of paperwork and my cold coffee! Just another tuesday!

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…..

51 minutes earlier

"You ready? 1...2...3...lift."

"Get me out of here!"

"Stay there, we'll be with you in a minute, OK?"

"Right, I'm on airway, I need some suction. Get the clothes cut off, start a top to toe."

"Have EOC come back to us yet?"

"Not yet.......excuse me, can you help us?"

"Sure."

"Can you go to other the guy in the back, talk to him, reassure him, find out where he is hurt, tell him we'll be with him in a minute."

*radio rings*

"HEMS on way, eta 12 minutes."

"Rog, we need another crew and the fire brigade. We have 3 casualties, 1 deceased, 1 peri-arrest and 1 trapped."

"Received, police and fire on way. Your second crew is 3 minutes away"

"Rog"

"I've got no respiratory effort now, pulse check?"

"Nope, no carotid."

"Time of arrest, 21:42, start CPR."

*police and fire brigade arrive*

"Hi guys, only 1 car involved, 3 occupants, driver is deceased, rear passenger is trapped but no obvious serious injuries and this guy, front passenger has just arrested on us."

"What do you need from us?"

"Can you take over CPR from my colleague......and can you guys deal with the guy in the back please. The other ambulance should be here in a minute."

"Right, let's get this airway sorted, chuck me a size 4."

"There you go, we are in asystole, I'll get a line in."

"Any long bone fractures?"

"Maybe foot, looks like it's just the head injury and anything we can't see."

"Stop CPR for a moment........I haven't got much air entry at all, let's decompress the chest. Carry on CPR, thanks."

"Here you go, I'll get the right side."

*second ambulance arrives* 

"Hi guys, what needs doing?" 

"If one of you could help here, and one of you help the fire brigade with the guy in the back, I have no idea what's going on there."

"What about the guy in the front?"

"Massive cranial destruction, in cardiac arrest on arrival and trapped. This guy was unconscious but breathing and the guy in the back was talking."

"F#%ing hell!"

"Yep........right where are we at?"

"Airway is being managed, chest is decompressed, CPR is constant, just getting fluids up now, he's getting dressings on the head.....want me to take over for a few minutes?"

"Yeah cheers fella, I'll stop after the next cycle."

"Does anyone know what happened?"

"That guy standing over there saw it, apparently they lost control, swerved around the road, flipped over and finished in this tree."

"Still in asystole."

"Carry on. Let's get stuff ready to move if we have to, can you get bed, scoop, blocks and straps. To be honest, I doubt we'll be going anywhere but you never know."

"Chuck me another cannula, I'll get a second one in."

"I'm all out of orange. Grey?"

"Yeah that'll do......how's the guy in the back?"

"Nothing major at the moment, seems stable, distressed obviously, having to cut him out"

"HEMS are here."

"Hi guys, where are we?"

"This guy was front seat passenger, on arrival he was unconscious, irregular respirations and some airway compromise. We pulled him out the car and he arrested a couple of minutes later. He's bleeding into his airway but it's being maintained with an iGel and suction. We've got bi-lateral IV access and bi-lateral chest decompression. He's been in asystole throughout. There was nothing we could do for the driver and the rear passenger is walking wounded by all accounts."

"OK guys, great stuff, let's move him a few feet so we get good 360 access."

HEMS took over and went about their business. We held units of blood and did what we were told! The scalpels appeared and they cut holes in his chest to assess his lungs properly.  It was at this point the police officer who had been helping us decided to go and stand somewhere else! 

After about 5 minutes the resus was terminated.

"Are we all in agreement?......*head nods all round*......time of death 22:03."

A blanket was places over the guy and everyone turned their attention to the one in the back of the car. The fire brigade were cutting the car away and one of them was holding his head still through the boot. There was a mass of bodies all working towards one common goal. I remember looking through the mass of people and seeing the lifeless dead body of the driver just sitting there. It was first time I'd been involved in a job where I've had to ignore the dead. It was an uneasy feeling, I have to admit. 

After about 20 minutes the patient in the back was freed from the wreckage. He was place onto a spinal board and loaded onto the ambulance. HEMS travelled with the patient and the other ambulance crew to the hospital. We picked up all our kit and followed, leaving the carnage behind for the police to deal with.

51 minutes earlier......

Three 18 year olds were driving along. Where they were going I don't know. Where they had come from I don't know. What they were talking about I don't know. I'm sure there was laughter and banter. There always is when friends are together. I'm sure they were enjoying the freedom that a car gives you. They had their lives laid out in front of them with endless possibilities. I don't know exactly what happened next, I only know what we were told.

"RTC Car vs Tree, 3 patients, 2 unconscious and trapped."

We weren't far away, I knew the road and knew it had potential to be serious. Nothing, however, could prepare me for what lied waiting for us. Within a few minutes of the call coming in we were on scene. A number of cars had stopped and blocked the road in doing do. The car itself was utterly destroyed. I was surprised to find anyone conscious to be honest. It was truly horrendous.

It was a 3 door car and due to the way it had impacted the tree I go only get to the passenger door. The driver was dead. I don't need to expand further than I have but there was nothing that could be done for him. The passenger in the back was dazed but talking. He was complaining of pain in various places but being behind the driver there was no way we could get him out without the fire brigade. The only person we could meaningfully help right now was the front seat passenger. 

He was unconscious, covered in blood and breathing very slowly. He had a pretty awful head injury and needed to be out of the car very quickly. The door wouldn't open fully but after some gentle persuasion it was bent out the way. I lent in and grabbed him under his arms. My crew mate grabbed the legs.

"You ready? 1...2...3...lift."

*          *          *          *          *

No matter how hardened we all are to this job, these events do effect us. Whether or not we lie awake thinking about it, day dream about it or just think long and hard about what has been lost, it effects us all. Three young men had their lives destroyed. One may have survived but you can rest assured that his life won't be the same again. Neither will that of their families. All I can think about and keep revisiting is how much fun me and my friends used to have whilst driving along in a car. Perhaps the only difference between a great time and a life changing tragedy is a mis-timed glance over the shoulder  and some bad luck. Who knows. Life is so fragile.

“To die is poignantly bitter, but the idea of having to die without having lived is unbearable” Erich Fromm

Bridging The Gap

"18 year old male, on railway tracks, multiple injuries"

I'm assuming most of you have heard of The Darwin Awards?! If you haven't, they are basically a fictitious award that recognise individuals who have contributed to human evolution by self-selecting themselves out of the gene pool via death due to their own unnecessarily foolish actions. The awards are now more official after a serious of books and the criterion for the awards states, "in the spirit of Charles Darwin, the Darwin Awards commemorate individuals who protect our gene pool by making the ultimate sacrifice of their own lives. Darwin Award winners eliminate themselves in an extraordinary idiotic manner, thereby improving our species chances of long-term survival". Now, this nominee didn't die, somehow, but his actions and the similar actions of others is what provides us with job security! 

There he was, lying on the tracks, about 2 foot from the train. He was covered in blood. He had head injuries, broken teeth, a broken ankle and a dislocated shoulder. He found it all very amusing, due to the fact he was totally plastered. We found the general situation less amusing. I'm sure the 1000s of passengers at this busy station during the rush hour were also not amused.  Neither did the police, the fire brigade, the station staff, HEMS and the rest of the gang who'd arrived. That is A LOT of resources! Anyway, we treated all of his injuries, packaged him up, lifted him off the tracks and got him off to hospital.

"I don't know what all the fuss is about." he said. 

*Facepalm*

45 minutes earlier......

He had been drinking with friends all day whilst watching the cricket. He was well dressed and frightfully well spoken. He went to a very expensive, private school and made sure we all knew about it. Anyway, the cricket had finished and it was time to get home 'in time for supper'. He arrived at the station with friends and they were cutting it fine to get their train. If they'd have missed it, they would have had to wait a whole 15 minutes until the next one. They rushed up the platform in a loud and garish rabble. They had come up to the wrong platform and their train was approached. They were faced with a choice. Do they a) cut their losses and wait for the next one or b) run back down the stairs, along the corridor and back up to train. It appears our patient had a better idea. He had option c)!

*Facepalm*

Option c) involved a leap of faith. A jump of at least 16 feet, across two train tracks and onto the concrete platform on the other side. 16 feet is a long way, especially with a small run up and especially when landing on concrete!

With the train approaching, and to the horror of onlookers, he went for it. He ran, he jumped, and about 8 ft short, he landed. And landed badly. Despite breaking his ankle he managed to scramble, fuelled by adrenaline to the far platform edge and climb up. Somehow, he made it! In what was a pure act of bravado and showmanship, he stood up, and like Rocky Balboa, raised his arms above his head in celebration. 

FACT: Standing up straight when drunk can be a challenge. Standing up straight when drunk, with a badly broken ankle is never going to end well. 

Sure enough, with the train now 20 ft away he fell backwards. 

*Faceplam*

He again, land on the tracks with a thud. The train slammed on the brakes but not quite soon enough. By all accounts the patient somehow managed to stand before the impact and was then bounced backwards before the train came to an abrupt halt. 

He was alive and not critically injured. He had multiple broken bones, delayed 1000s of people getting home and needed the assistance of every emergency service. And all because he didn't want to be late for supper! Genius! One thing is for sure. There will always be candidates for The Darwin Awards and there will always be people intent on providing us with job security. I suppose that in itself is a blessing. 

Prat.

Access OK

"68 year old male, ? Stroke, slurred speech, access OK"

You will see shortly why the words 'access OK' was the least of our worries! Generally, access is always OK. If it isn't, it's made OK via a well placed boot or the police's universal red key! Normally it's the exit which is troublesome! Never more so than today! 

I...pulled...up to the house around 7 or 8 and I yelled to the patient 'Yo homes what's the problem?!'.... only kidding! We pulled up, grabbed our stuff and knocked on the door. The patients wife came to the door looking extremely worried. 

"He's been up there for ages and isn't making any sense, something's not right."

"OK my love, where is he?!" 

"Upstairs, in the loft"

THE LOFT! Obviously! Where else would he be?! The MOST inaccessible part of any house! Sure enough, at the top of the stairs was a rickety old ladder, leading up to a hatch in the ceiling. Being an old Edwardian terraced house they were high ceilings too. I poked my head up into the darkness and shone my torch around. The loft had no lighting, no proper boarding and insulation everywhere that made my skin itch just by looking at it! Oh how I was cursing the 'bare below the elbows' uniform policy now. Sitting about 20 feet away from me, against the water tank was our patient. I pulled myself up and using the rafters as support carefully traversed the floor beams to him.

Within about 3 seconds I was aware of two things:

1. He was having a massive stroke.
2. Getting him out was going to me HELL.

There isn't much we can do for strokes other than get them to hospital quickly. There is a 4 hour window in which the hospital will be able to give a stroke patient treatment. We were possibly two and a half hours into that window. I clambered back to the hatch where my crew mate (who was conveniently terrified of heights) was waiting at the bottom.

"FAST positive CVA (stroke), no way we can get him down safely as he is."

"HART (Hazardous Area Response Team)?"

"Yeah, it'll have to be. Can you grab me the Lifepack too please."

Crewmate vanished and returned a minute later with all the monitoring equipment! She tentatively climbed a few rungs of the ladder until I could reach her.

"HART not available! Fire Brigade on way!"

The ONE time they are needed! No wonder road staff see them as a joke! Aarrrgghh! I won't waste my breath on ranting about them again. The sensitive souls will only moan about me being mean! Anyway, the fire brigade are better equipped and much more experienced at this kind of thing, probably for the best! 

Within minutes they were on scene. One of them appeared through the hatch and promptly provided the whole loft with light! He asked me what I wanted, and I just said I wanted the patient down to the ambulance quickly! Kit and more fireman gradually started appearing the loft. I stepped back and let them get on with it! They quickly got him into their deep scoop and strapped him in. The scoop was attached to some ropes and eventually, with a combination of make shift pulleys and man power he was lowered down the ladder and promptly carried down the stairs to the waiting bed! 

My eyes took a moment to adjust to the light and by the time I'd passed my stuff down and clambered out my crewmate, the patient and wife were on board! Groups of neighbours were out on the street watching the drama unfold. We didn't stick around, the clock was still ticking and we had a 30 minute blue light run to the nearest stroke centre. I thanked Trumpton and off we went. We arrived at the hospital with 25 minutes of 'X time' remaining. A job well done!

'Access OK'! Pah!

Welcome To The Jungle

Generally, despite it being a weekend, I like working on Sunday mornings. The roads are quiet, people don't tend to be drunk and more often then not, people don't swear as much. Unfortunately, it was raining and cold! By raining, I mean absolutely pissing it down and by cold, I mean absolutely, unequivocally, smuggling peanuts weather! It was just after 6am, still pitch black outside and no where was open that sold decent coffee. My usual Sunday optimism was waining somewhat! We drove out of station into the downpour and started heading for the nearest Wild Bean Cafe. I'm assured that it's 'gourmet on the go' but it really isn't. It's tepid pond water at best, but beggars can't be choosers! In this kind of weather there is one job you don't want to get and that's.....

"RTC, car on roof, patient trapped, injuries unknown"

Uuurrrggghh! We lit the roof up and off we went. As we approached the traffic lights ahead, the fire brigade came swinging round the corner. At this time of the morning, I couldn't deal with them trying to take over so I accelerated somewhat! Luckily for us, about a mile up the road was a width restriction that they had to open a gate for. We however were able to squeeze through the normal restriction so off we went, waving at them as we did. The guys in the back laughed, the driver looked positively livid! Build a bridge.....and get over it! 

We were greeted on the road in question by the frantic wave of a man standing IN the road. He continued to wave even as we were slowing down to stop. He then came running to the door, trying to talk to me before I could get out! When I could eventually get out he was more intent on telling me it wasn't his fault than what happened! Over 30 feet from the kerb, deeply embedded in one of the biggest bramble bushes I've ever seen was a car, upside down with the wriggling arms of our patient waving around. 

We headed over to the car, our patient was alive, not complaining of any pain, but was well and truly stuck....upside down and seat belted in! By all accounts the car had rolled 2-3 times before settling in the bush! As Gun'n'Roses once said 'Welcome to the jungle, we've got fun and games'. Well quite, although it was more of a rain forest than jungle and getting her out would be no fun at all! It was a 3 seater and her door was jammed. Due to the bramble bush she was in, the passenger side wasn't accessible so the boot was the only option!

Due to the foliage and the fact the car was on its roof, the boot would only partially open, just enough for me to ungainfully squeeze in. As I did so the fire brigade came over on mass! I wriggled my way through to the front of the car! It is very disorientation, crawling on a roof with the steering wheel above you! I hit my head on the gear stick! The patient was in good spirits but now complaining of some neck pain. I got the collars passed through the broken window and muddled my way through sizing and fitting it! That WASN'T easy! I positioned myself in such a way that I could hold her head still. It involved lying on my back, legs outstretched the length of the roof and holding her head from the front! Not ideal, but as the saying goes, improvise, adapt and overcome.

Once I had her head, I could do nothing else! My crew mate and the fire brigade came up with a plan and implemented it! It involved a lot of cutting equipment, a lot of noise and the kind of lifting manoeuvre the the Health & Safety executive would break into a sweat over! It took almost an hour of the door and boot to be cut off, the back seats to be removed and enough shrubbery to be cleared to make extraction possible! An hour is a long time to sit in the same uncomfortable position with your arms outstretched!

During the hour though I got to know my patient very well! I learnt about her life, her children, her taste in music and her hobbies! She also learnt about mine! She was referring to my son by name and I hers. An audio recording of our conversation couple have been mistaken for one between friends in a pub despite there being absolutely carnage going on around us! It was one of those moments in my career I will look back on fondly, not because I saved a life or did anything particularly special, but because I had a laugh with someone who was upside down, whilst I was laying on my back, in a bramble bush, in the rain, surrounded by fireman! Wait.....am I dreaming?! 

Eventually, we were ready to more her! Somehow, 3 fireman managed to squeeze in the car with me, a spinal board was slid in, her legs were support with straps and she was slowly lowered onto her front on the board. She was then slid out the boot, then log rolled onto her back onto another spinal board that had materialised! I clambered out after her and we got her into the warm! It was only then that I was told my arms and face were bleeding! Clearly I caught then on the brambles and/or broken glass somewhere along the way! Oops! 

I met her again 4 hours later when she was being discharged! It was nice to there was no injuries and nice to say goodbye properly! It seems weird never seeing someone again that knows you so well! 

NB: Trumpton banter aside, the fire service do a bloody good job, for crap money, and were fantastic on this job. I may give the daffodils a hard time but we are all the same team and I couldn't do what they do! (hate sitting around!!) Sorry, couldn't help it!

Ambulance Drivers

"Bunch of ambulance drivers, disrespected......again"

If you read my blog regularly, you will know my hatred for the term 'ambulance driver'. To me, it shows a total lack of respect for what we do and paints a picture of us as taxi drivers with a first aid kit. This is NOT what we are. Today, at the Police Federation of England and Wales' annual conference, Theresa May, whilst talking about the police's resourcing to mental health patients said:

'Police officers have many skills, but they are not in a position to be psychiatrists diagnosing and treating mental illness - nor are you meant to be social workers or ambulance drivers'.

This made my blood boil! Rather than the usual rant, laced with sarcasm, I decided to take a more pro-active approach. Here is my letter to the Right Honourable Theresa May, Member of Parliament for Maidenhead, Home Secretary and Minister for Women and Equalities.

Dear Theresa May, MP 

I am a front line Paramedic working in the UK and am writing to you in response to your comments at the Police Federation of England and Wales' annual conference. I'm confident in saying that what I'm about to say represents the feelings of my profession and the professional body that represents us.  

In your address to the conference you said: 

'Police officers have many skills, but they are not in a position to be psychiatrists diagnosing and treating mental illness - nor are you meant to be social workers or ambulance drivers.' 

Your comments are extremely dismissive of our profession and suggests we are not skilled clinicians, but just mere drivers. You wouldn't address, or refer to police officers as police car drivers, and you wouldn't refer to fireman as fire engine drivers because that is not what their professions are. Similarly, you didn't happen by the position you find yourself in. No doubt you got there through years of education, campaigning and hard work. You are given a title and are addressed as such by the public and your peers. We expect the same courtesy.

Since 2005, qualified paramedics have had to complete a degree course at university or study to an equivalent level within an ambulance service. There are many exams, high pressured assessments and numerous clinical hospital placements. On top of this there is a significant amount of patient contact time and many hours of studying prior to qualifying. To gain the protected title of Paramedic we then have to register with the Health & Care Professionals Council (HCPC), to whom all of our actions are scrutinised. We are held accountable for all of our actions whilst at work and when off duty.  

Not only are there paramedics on ambulances, but there are Emergency Medical Technician (EMT) and Emergency Care Assistants (ECAs) all of whom have undergone significant training. We may all drive ambulances, but we are much more than 'ambulance drivers'. Just like there are many roles within the police force, in the ambulance service we have Emergency Care Practitioners, Critical Care Paramedics, Paramedic Practitioners and Consultant Paramedics. To bunch as all under the umbrella the generic term 'driver' is extremely insulting to say the least. 

Our professional body, The College of Paramedics, has been working tirelessly to get our profession the recognition it deserves, and I feel that your flippant words undermine our credibility, not only in the media who report and quote the words you say, but to the country as whole. We have long been fighting the stigma of being labeled 'little more than professional drivers' by Kenneth Clark in 1990 and yet 23 years on, it seems the governments view of us has changed very little.  

I would appreciate it, if you would recognise that we are infact medical professionals, in the same you you would credit doctors, nurses, psychiatrists, surgeons, radiographers by their profession.  

Yours sincerely, 

Ella Shaw
(Paramedic)

Thoughts on a postcard please peeps! Am I over reacting? Do I need to just get over it? Do we deserve more respect from people like Theresa May? Will I get a decent reply? So many questions, answer what you can!

My good friend Inspector Michael Brown, author of Mental Health Cop (@MentalHealthCop) has also shared his thoughts on the same subject. Interesting to see some parity across the 999 family. Go and have a read of his 'Ambulance Drivers'.

Sink or Swim

"RTC, Car in Lake, Fire and HART on way, injuries unknown"

I moan. Yes, I know, you can all hide the shock on your faces but I do. I moan more than I realised! I was moaning to my crewmate about how I never get the good jobs and its just the same drivel every day! The funny thing about this job is you do so much in a week, it can appear a lifetime ago that you did something worth while. In actual fact it's more than likely you did something worth while less than a week ago, you've just forgotten! I suppose it doesn't help that I can't remembers a job from 7 hours ago, let alone 7 days. You're enthusiasm for this job is only ever as good as your last patient!

He stopped me in my tracks and said:

"In the last month you've had 4 cardiac arrest, a shooting, a stabbing and at least 3 serious RTCs! What are you moaning about?!"

Good point. I'll shut up! Seriously though, the day was dragging and the last patient had been rude and obnoxious so my enthusiasm was particularly low!

Car in Lake?! Yes please!! Like Sonic the Hedgehog in Red Boots we sped off to the lake in question. I say lake in the loosest sense. Pond would be a better description! Actually fish pond to be precise! It would also be worth noting that the title to this blog is also a bit dramatic! The car had sunk to the bottom but had barely covered the wheels with water and it would be a case of wading more than swimming but still, the headline in my head was "Paramedic swims across shark infested lake to save drowning granny from sinking car".

Our patient was sitting in the car looking rather bashful! She wasn't injured or trapped, just scared. My crewmate looked at me with a grin and said "off you go!". Clearly chivalry is dead! I heard the sirens in the distance, no doubt from the fire brigade, police and HART team and I wasn't going to have them massage their inflated egos (police excluded) by diving into the rescue, so in I waded! All 3 steps worth! The back of the car was only 2 feet from the edge of the bank!

I checked her over, was happy there were no injuries and told her to wait until we could get her back to land.

"Nonsense, I just need someones hand to hold onto, my feet are already wet! I'm certainly not having someone carry me, how embarrassing."

She was so defiant and I certainly wasn't going to cross her, so at her request, I took her hand and stepped her onto the bank, just as the fire brigade came rushing over!

"It's OK guys, you just leave all the rescuing to us little ladies, you take it easy!"

They laughed but you see it had killed them not to be able to wade into the water! I hope the Daily Mail tell the public how we did indeed risk shark infested ponds to save people! Can't have health and safety getting in the way of good care now can we?! We sat in the ambulance for a few minutes checking her over and doing paperwork when there was a knock on the door from the Hazardous Area Response Team (HART). They had turned up late to the party as per usual despite me cancelling them once we had our patient on board. No doubt they hung around the fire brigade for a little while cursing about how irresponsible we had been! If you want to play in hazardous areas, get to the hazardous areas before anyone else!

Not the actual car or pond before some of you have kittens!

We took her to hospital for a check up and a cuppa! That's all she really wanted! In fact, she was quite put aback by the lack of biscuits in A & E! See, cut backs are not only causing ambulance delays, there are very real biscuit shortages too! It's an outrage!

"So, you gonna moan about never doing anything interesting or you gonna have a few hours off?"

"Touché!"

We Need to Talk About The Ambulance Service

"An emergency service in crisis?"

Yesterday, I read a brilliantly written blog by @NathanConstable entitled We Need to Talk About The Ambulance Service. If you haven't read it yet, please do so now, otherwise this post won't make much sense! He speaks about a lot of issues that surround the ambulance services in general and what knock on effects that has on the police. Rather than leave a long rambling comment providing my thoughts on things, I thought it would be better explained in a post of my own.

I didn't take anything that @NathanConstable wrote as a dig. It is a discussion that needs to happen, but realistically, it needs to be happening between senior figures in the police, the ambulance service, the NHS and the government. I just wish they'd listen to what we are all saying, where we are not ruled by the politics of a situation! Like Nathan says, for all the inter-service teasing and banter that goes on (and before you ask, my call sign is Whiskey Delta 4-0. Oh, and fireman, hold these fluids, good dog!) there is a mutual respect and a fantastic front line working relationship between all emergency services. We do many jobs with the fire service, some are the most traumatic of jobs we will every see. I do have a huge amount of respect for the job they do. The relationship between ambulance and police is a stronger bond, born from the huge amounts of jobs that we do together. As detailed in 'A Special Relationship' I, along with the rest of the profession, hold the police in the highest regard.

My first thoughts when I read 'The Ambulance Service is broken' was agreement. I nodded my head as I thought about what was wrong with the ambulance service. However, the more I read on, I came to a very different conclusion. Despite its failings with the relatively small things we moan about on a day to day basis (missing kit, hours, breaks, working conditions, pay bands etc), on the whole, I think the Ambulance Service is far from broken and I'll do my best to explain why.

I can't argue with the fact that police are having to wait longer and longer for us. They do. Nathan gave 4 examples of waits he's encountered, but I'm sure he could list another 20 or so without any trouble. And that is probably only the last month or so! I also wouldn't struggle to list the police jobs that I have been cancelled on! THAT frustrates me. I know if I ask for the police, if there is a unit available, they will come. Far too often, we are cancelled for a 'higher priority' knowing full well that police will have to start the wait again. The problem however, I don't believe is caused by the ambulance service alone. It's caused by triage, call rate and hospitals. I'm not saying the ambulance service is totally blameless but it does feel from a front line perspective, that we are being pulled from all sorts of different places, meaning we can no longer function as an emergency ambulance service. Whilst police wait and wait and wait for us, on thing is for sure. Someone else is waiting to!

So, hospitals. Nathan documented seeing 5 ambulances sat at the hospital due to lack of capacity. Well from experience, I'd say he caught them on a good night! Only last week I was stuck at a hospital with 13 waiting ambulances due to a lack of capacity inside. There were patients who could walk and who eventually went to the waiting room but the nurse in charge wouldn't take the hand over, so therefor we couldn't leave. This BBC article - http://www.bbc.co.uk/news/uk-england-norfolk-21999859 documents the problem well. No ambulance service could cope with all 17 of their emergency vehicles being stuck at 1 hospital. Due to huge fines for going on divert, hospitals don't. They just make us wait in corridors. Until the patient is off our bed, they don't become the hospitals patient so departments are in no rush to take the handovers, off a huge queue of ambulances. What's the result? The police are still waiting for an ambulance. It isn't just the police though. Whilst they are waiting, so are dozens of other people who have phoned 999. Is the ambulance service to blame for these delays?

Call rate is another big problem. Year on year the call rate is increasing at an alarming rate. My service alone received over 1.7 million calls last year. Calls are coming not only from the public, but also from GPs, hospitals transfers, the police, the fire service and now the new 111 service, which has seen a huge spike in the need for resources. With government cuts to the budget, there simply isn't the money to replace the 25+ staff who are leaving each month. The crews on the ground are working harder and harder. We are being forced (with financial penalty) to turn jobs around quicker and quicker to try and match demand for the service. Our control room has just started a pilot, of refusing to send ambulances to some calls, in an attempt to ease the pressure. We simply don't have the budget or the resources that the police and fire service have and us such, the service is struggling to cope. 

Despite the calls volume and despite the delays at hospital, there will always be the eternal problem of triage. How does one call get priority over another? Why are the police told an ambulance is on route and then one never materialises? Triage! Calls are categorised, then re-catagorised. Crews are sent, then cancelled for a higher priority, then cancelled for another higher priority, as 200+ calls an hour continue to roll in! The issue is priority symptoms and the police are victims of their own common sense.

When the police call and ask for ambulance back up they say exactly what they see and exactly what is happening and therfore a '20 something year old male with a head injury' which has had a dressing put on it by a police first aider will get trumped every time by a 35 year old female with a cough. Why? Because the general public know what buzz words to use. A cough is cough, but when they call, they say they have difficulty in breathing and when asked if they have chest pain, they say yes, because there is pain in their chest from coughing. Now, you have a situation where an ambulance and a car are sent to a '35 year old female, DIB and Chest pain' because those are the priority symptoms she flagged up. The same problem happens with 111. A simple headache becomes meningitis, prickly heat become anaphylaxis and so on. It is a world wide problem. People lie to get what they want and no ambulance service will ever risk NOT sending an emergency response to a DIB or Chest pain. That is, if all their ambulances are not sat at a hospital or busy doing critical transfers and the plethora of other things we are being called to. And who has to wait? Whoever told the truth!

Again, I don't think this is the failing of a particular service, triage is there to get resources to the highest priority of calls the quickest. You rarely hear of there being absolutely no resource to send to a cardiac arrest. All it means is someone else is left waiting. The AMPDS triage system that is used, is modified world wide and if used correctly works well. Unfortunately, until a cure is found for liars, time wasters and hypochondriacs triage will remain an issue. 

One thing that Nathan spoke at length about was the amount of calls they attend to back us up. It's true. They do, and this is a failing of the service and of individuals. I have worked with a number of people who see the words 'mental health' and call the police. If the word 'assault' appears, the police are called and there is a case to answer for us never going to scene until police are there. Records of flagged addresses are woefully out of date, hence why I've been sent to an 80 year old with chest pain accompanied with armed police and ballistic vest! This needs to change but requesting back up at the first sign of trouble is often too late! As I detailed in 'Please Sir, Can I Have Some More' we are not even remotely equipped to deal with violence against us. The half day conflict management course really doesn't cut it. That job also highlighted how the police are stretched so thin that they also 'have no units to send'. Is the police service broken? I'd say no, but I would say, like us, they also struggle to deal with the demand placed on them by all and sundry! The public, the fire service, the ambulance service, mental health services and hospitals all call on the police and there will always be someone, somewhere, who is left waiting. And who is that? Probably the low priority who told the truth, the whole truth and nothing but the truth!

Finally, there is the issue of the merger! Now, this was like a red flag to a bull and the only part of the blog I 100% disagreed with. I've made no secret of my distain for this idea in 'Fire Brigade: Hands off our service' and 'Unhappy Trumpton.....Bless!' . It is something that the fire service is keen on, but they are keen on taking on us rather than the other way round. If the fire brigade became part of our HART team then perhaps that would work but that would never happen. They are far too powerful an organisation to lose their identity for starters. You only have to look at the obscene budget they manage to repeatedly procure to see this! £50,000 on a coffee machine at HQ says it all! They have been after part of the ambulance service for some time, namely, to justify their resources. Their cuts under this government regime have been minimal in comparison to ours and the police. I can see no benefit in merging the police and fire and just as little in merging ambulance and fire. I does work across the pond but a) that's how it has always been so the infrastructure is there and b) with the ability to charge for all emergency calls, you can pay for the resources to cover call volume! The more calls, the more money. Over here, with the ambulance service deeply embedded within the NHS and with the lack of emergency service status, I can't see it ever happening. 

This has been a great opportunity to discuss the failings and trials this countries emergency services are facing and I'd like to thank Nathan Constable for writing such a great post. I don't see them as failings. They merely highlight the detrimental effect this government regime is having. I don't think the ambulance service or the police service in this country are broken. Not by a long shot. I  think they both perform admirably and perform over and above what their resources, diminishing budgets and demoralised work forces probably should. And THAT is a testament to individuals who turn up when someone phones 999. It's an honour to be part of the team.

Flowers

"Am I going to die?" she said softly. 

How do you answer that? I'm a terrible liar at the best of times but in situations like this I can be read like a book. That said, as much as I am able to tell someone that their loved one has died, I couldn't bring myself to tell someone they are going to die. Maybe my eyes told the whole story but my words didn't. They simply didn't answer the question.

"Stay calm, we are going to get you out of here and off to hospital."

With that, I rested the blood stained oxygen mask back over her face knowing all too well this would be her last few minutes. She closed her eyes. It was chaos around me. Every emergency service, a sea of blue flashing lights and rain. Heavy rain. I was in the car with Claire. I had climbed in through the boot, clambered to the back seats and then through the front of the car. Claire was trapped in the mangled wreckage of her car. There was no quick exit, the oak tree was where the drivers seat should be. Claire was where the gear stick should be, I was in the gap that was left. I followed health and safety procedures in that I had a high-vis jacket on and a helmet. The visor quickly steamed up and due to it's size I couldn't move. The helmet came off. It was just me and Claire in the car. Getting her out wouldn't be down to me, I'd just be the passenger in all this.

9 minutes earlier......

"RTC Car vs Tree, 54 year old female, trapped"

It was about 10pm and the weather was grim. I didn't relish this job at all but off we went. Strangely, we were first on scene. The second we turned the bend I could see the headlights through the mist of the rain pounding on the floor. That one image was all I needed....

"Red base, can we have Fire, Police and HEMS please."

"Roger, on way"

It's not often I request everything without assessing the patient but the car was on a blind bend, the car was quite literally wrapped around the tree and from the damage I could see from 10ft this patient would not have escaped serious injury. Within seconds the police and fire rounded the corner blocking road in both directions and I headed over to the car. The passenger door wouldn't open, nor would the back door but the boot was open so in I went. I got oxygen on her but she panicked with the mask. I tried to fit a collar on her but she panicked. I held her hand and assured her we would help her. She was pale, blood was pouring out of a wound of her head, her arm and leg were clearly broken and she couldn't breathe. I managed to get a cannula in her hand but she ripped it out. Bugger. She squeezed my hand tightly and starred at me. It's a look I will never forget and one that will stay with me for my entire life. That I am sure of.

"Am I going to die?" she said softly. 

"Stay calm, we are going to get you out of here and off to hospital."

As we were........

The fire brigade were working tirelessly around the car to get her out. The sawing, the banging, smashing and shouting drowned out my voice. 

"Claire, Claire, open your eyes!" I shouted. 

Another face appeared in the back of the car. It was my crew mate. 

"Claire, open your eyes!"

I felt for a radial pulse. Nothing. I felt for a carotid pulse. Nothing. It was the first time in my career I didn't know what to do. I felt helpless. Do I start CPR? I'm just going to pump the little blood that's left in her body out. I turned to my crew mate, we had a brief discussion of her injuries and decided any resus attempt was pointless. The fire brigade were about 15 minutes away from freeing her, that was too long to make any resus worthwhile. I started CPR though, I felt I had to. My crew mate spoke to our clinical support who agreed that we could stop. Then I stopped. Stopping is strange feeling. In my heart I knew she was gone but it's against our instincts to stop and walk away. I wish i'd known when she closed her eyes, eyes full of fear and pain, that it would be the last time. 

I clambered out backwards. Numb about what had happened. Claire. That's all I knew about her and in reality, all I will ever know. 

The other cold, harsh reality is that now I had to do paperwork for us and the police. Then, without much further ado and moping around I'd have to press that magic green button and go and do another 5 or 6 jobs before bed time. And that is what we did. It doesn't mean Claire wouldn't enter my thoughts but realistically it wouldn't be until I'm lying in the dark, staring at my ceiling, that I will have a chance to spare her a proper thought.

"22 year old female, headache, nauseous, states has run out of paracetamol"

C'est la vie.

1 week later......

You know when people die at the road side, tributes are left by friends and family to mark the spot where a tragedy occurred? Be it someone run over or victims of a crash there are always tributes left behind. I often see them at places where me or my colleagues have been or what is reported in the paper. It's a constant reminder of what happened, it triggers memories, evokes emotions and shows what someone has left behind. 

We were driving along the very road where Claire's time had come to an end. I slowed down as I rounded the corner and the tree came into view. The tree stood proud and tall. If you didn't know any better you wouldn't know that a Ford Focus had been wrapped around it 8 days previous. There was no debris, no fragments of glass, no nothing. 

No flowers. No memory.