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. 

A Life Of Grime

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

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

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

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

This job in general challenges your senses and often offends them. It is true that there are smells you can taste and this smell instantly made me gag. Covering my mouth and nose 

I pulled the curtain across and was met with literally a wall of rubbish. There was no way in, I couldn't see any part of the room. Back to the front!

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

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

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

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

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

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

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

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!

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!"