Running On Empty

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

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

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

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

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

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

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

“Can you come and help us?!”

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

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

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

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

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

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

“Sorry, we have no units to send.”

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

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

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

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

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

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

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

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

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

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

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

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

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

Had it been safe for me to do that job? Doubtful! Do you think I was in a good mental place to deal with my patient?! Probably not! Should we carry on being expected to perform under these strains?! I’d say no! A fellow blogger, The Broken Paramedic, recently described what is expected of paramedics and what attributes we must have to do our job at times. 

“These carefully selected individuals are capable of superhuman feats of endurance. They do not require rest or nourishment, they can perform efficiently without sleep and can reabsorb their own excreta so access to toilet facilities is not required. They have cat-like reactions, heightened diagnostic powers and physical strength which only improves with fatigue and they can sustain emotional and psychological extremes far beyond normal humans. They are practically indestructible.

This is of course total rubbish”

I left for home just after 5am. I felt like a broken paramedic. Living the dream eh?! 

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'

I Didn't Think

Welcome to Facepalm Friday! I've decided that each week I will share with you a patient, or a conversation or an encounter that has simply left my head in my hands. Far too often I'm left questioning how some people manage to exist being so moronic! If anyone has their own tails to share, of people they've met or contenders for the Darwin award, I'm happy to have guests posts! Enjoy!

So......

"47 year old female, dizziness, pain in jaw, headache"

10:15am: Patient phones NHS 111 and lists her symptoms. She told them she had chest tightness radiating to her jaw. She said she had severe ear pain. She said she was dizzy. She also had a headache. Despite it's faults, NHS 111 correctly requested an ambulance to be dispatched because of the priority symptoms. 

10:26: Because the patient has told the call taker she has chest tightness it is categorised as a high priority of call. An FRU (Fast Response Unit) and an ambulance were dispatched.

10:32: FRU arrives on scene (me!)

10:33: Ambulance arrives on scene

10:51: After much knocking and shouting and several attempts by control to phone the patient back the door is answered by the patient. 

"Sorry, didn't think you'd be so quick, I normally have to wait ages for my ambulances. I thought I'd have a shower before you arrived."

In my humble opinion, if you are well enough to jump in the shower whilst you are waiting for your emergency response you are a) not that ill and b) not an emergency. Also, the phrase 'my ambulances' grated on me. It means she has us out a lot, probably for similar symptoms. 

"What's the problem today?"

"I already told them on the phone!"

"But that wasn't us was it?!"

"OK, I've got this awful headache and dizziness and this pain in my jaw."

"Do you have any chest pain?"

"Nope."

"Oh, you told the call taker you did! What pain killers have you taken?"

"I haven't taken anything."

"Why not?"

"I didn't think they would work"

*Facepalm*

Seriously! Why do people not take pain killers! The clue is in the name! Time and time and time again it's the same futile conversations! "Are you in pain?", "Yes", "Taken pain killers?", "No". Why?! Why?! Why?! Can someone please suggest an answer to this age old question!

"So what time did the symptoms start?"

"About 2 weeks ago."

*Facepalm*

"Has you seen your GP?!" I asked, fully expecting her to say 'No'!

"Yes."

"And did he diagnose anything or give you any medication?"

"Yeah, these." she said as she passed 2 packets of drugs.

Ah, clarithromycin and prochlorperazine! The former, an antibiotic which she was given to treat an ear infection and the latter is a medication used to treat dizziness caused by inner ear problems. Both should be alleviating her symptoms.

"How long have you been taking these?"

"He gave them to me a week ago but I haven't taken them."

*Facepalm*

"Why not?!"

"Because I thought they'd make me feel sick ."

*Facepalm*

Notice she said 'thought'. She hadn't felt sick because of them. Her, an expert in general practice and pharmacology (not) had opted against the medication given to treat her symptoms. Instead, she called for us! The conversation continued in much the same way whilst we were checking her over. We did her ECG and the full battery of tests we do on most people and found nothing untoward. 

"How about we leave you at home, you take your course of medication and if that doesn't work make another appointment with your GP?"

"Nah, I think I should go to hospital. I know my body, something's not right."

*Facepalm*

Yeah, you have an ear infection and needed clarithromycin and prochlorperazine to cure your symptoms! It's not rocket science! Why do people go to their GP, call 111 or 999 and then ignore all the advice they are given?! Why?! Why?! Why?!

I gave it my best shot at convincing her she didn't need to go to hospital but she was dead set! We walked her out to the ambulance. On board I continued to ask her questions about her symptoms, specifically the jaw pain. 

"So how long have you had this pain in your jaw?"

"About a month, I've seen my dentist about it and he says I have a tooth infection."

"And did he give you anything for it?!"

"Yeah, these." 

She produced a box of Amoxicillin from her hand bag. I don't know why I had to ask, I knew what the answer would be but I was curious!

"And have you been taking them?!"

"No, I don't agree with antibiotics."

*Facepalm*

11:17: I got out of the ambulance to let them get on their way.

11:37: (ish) Patient arrives at A & E and her 4-6 hour journey of waiting, triage, waiting, being told off, waiting and discharge begins. 

There are times when I write my blog and I really really wish that what I was writing about isn't true. Frustratingly, it is painfully true and not uncommon or an isolated incident. It happens every day!

NHS 111 has its faults, the GPs have their faults, hospitals faults are well documented as are those of the ambulance service. As for dentists, again, it isn't perfect, but we know we have to a) wait and b) pay. People have a got over the 1996 semi-privatisation of dentistry so don't moan as much! My point is though, all areas of the NHS have faults, but people like this are not the fault of anyone. The GP and the dentist saw the patient and offered treatment. She didn't take the medication. NHS 111 had to call an ambulance because she lied about her symptoms and we had to take her to hospital because she insisted. The hospital then had to see her, triage her and waste the valuable time of the doctors and nurses; for what?! To give her another prescription that the tax payers are funding and she isn't taking. She can't be charged the £1000s she cost the NHS. She is unemployed. She can go home, not take her medication and then call us back in a few days because she's still ill and the cycle continues until her body heals itself....until the next time anyway. Unfortunately you can't medicate stupid.

*Facepalm*

Playing Cards

"24 year old female, chest pain, DIB"

I tend to be very cynical about young people with chest pain. It is very, very rare that the chest pain is anything sinister at that age. However, I'd reserve judgement until I met the patient and oh what a treat I was in for!

The door was ajar when we arrived, so pushing it tentatively open I shouted a speculative 'Hello?!' as I entered. We were summoned through to the living room where our patient was sitting on the sofa, smoking and watching TV. 

"Hello there, what's the problem today?"

"I got a cough innit."

"OK, how long have you had it for? What has your GP said?"

I always ask that question knowing full well that 99% of people haven't bothered with their GP, but it's my way of subtly making a point!

"Bout 2 days, I ain't bovvered wit ma GP coz they are useless innit." 

She said that while exhaling smoke into my face. 

"Can you put that out please?"

*kisses teeth* "Ya can't tell me what to do in my OWN house, ya get me." 

"Firstly I asked you, I didn't tell you, and secondly can you also refrain from kissing your teeth at me."

*kisses teeth* "Whatevs man."

There is nothing I hate more than teeth kissing. It winds me up something chronic. We don't ask to go to people's houses, they ask us to come to them. Show us some respect and courtesy. In this case, that means no teeth kissing and no smoke in the face. It really isn't asking much!

We checked her over, did an ECG etc and decided that she should go to hospital. The reason for this, she didn't know who her GP was so we couldn't refer her on. She was also complaining of pain in her chest and although it was most likely to be caused by the excess coughing, without a blood test we can't rule out cardiac problems as the cause. As we were getting ready to go to the ambulance she said:

"I can't walk, I feel dizzy."

She wasn't about to be carried. We explained there is no medical reason she can't walk. Her legs are fine all she has is a cough. Cue farther teeth kissing. We assisted her to standing and started walking her to the truck. She then took it upon herself to throw herself on the floor and pretend to faint. I've seen enough people actually faint and plenty that fake it to know the difference. After a few stern words she magically came round, of course, with selected amnesia and no memory of dropping to the ground. Miraculously, she made it to the ambulance. As she climbed up the steps I told her to take the second seat on the left. She laid down on the bed. Brilliant!

The journey to hospital was uneventful and lacking conversation. Her dying swan routine was in full swing and she didn't seem in the mood to answer questions. When we arrived she wouldn't get off the bed, so rather than arguing, we took her in on the bed. I handed her over to the nurse in charge who promptly directed us to 'the lounge! (The waiting room!)

*kisses teeth* "I ain't goin' to da waiting room, truss me bruvs." she said to the nurse.

He looked at her, looked at me and simply said "waiting room"! I love the power nurses have! We started wheeling her back down the corridor as her expletives and mood began to worsen. She had certainly found her voice again! We largely ignored her rant. It was nothing to do with us, it was the hospitals choice where she waited! 

The waiting room was packed. We wheeled the bed up to the chair and asked her take a seat. After a slight delay and a little fuss she clambered onto a chair. My crew mate took the bed back to the ambulance whilst I booked the patient in at reception. Suddenly there was a commotion from the waiting room. I cast my eye over and my beloved patient was lying on the floor, half faking a faint and half faking a seizure. Her movements were not involuntary. It was was one of the worst fakes I'd seen, but the waiting room was in uproar, demanding help and a bed. As people were looking at me to do something, I wandered over. 

"Up we get, sit on the bench, this won't get you seen quicker."

*keeps up charade*

"Come on, you're embarrassing yourself." (and me).

At this point another patient of similar age decided she'd seen enough. Not of the patient faking illness to get seen quicker, oh no. Of me and my failure to treat her!

"You're a disgrace, how can you stand there and not do anything, it's well out of order."

"She is faking it. I know it, and she knows it."

"If she was white she'd have a bed and you wouldn't leave her on the floor."

Ahhhh, the race card. If at first you don't succeed, accuse someone of being racist! At that point, I decided to walk away. I wasn't going to get drawn into a race row in a crowded waiting room.  I never discuss the colour of my patients in my blogs or in real life unless it's relevant. It very rarely is. Today it wasn't. It makes absolutely no difference to me. I don't see a difference, race doesn't even register on my radar. Yet here I am, stood in front of 40 odd people, being publicly labelled a racist. 

I could have informed her that I have siblings that are black. I do. I could have listed to her my Indian, Chinese, Egyptian, Polish, Romanian and Nigerian friends. I could have told her about my black gay friend who I shared a flat with. But I didn't. I don't need to defend myself. I don't need to acknowledge her ignorance. I don't need to feed her desire for an argument. If anything, my being white was an issue to her. I left the department with my patient pretending to fit on the floor and her new found guardian shouting obscenities at me! 

Living the dream.....

Drugs Glorious Drugs

OK kids. Let's talk drugs! I'm not talking about the naughty and highly illegal drugs, I'm talking about the drugs you can buy and the ones doctors can give. The likes of paracetomol, ibruprofen, antibiotics and inhalers. You know, the stuff you take when you're in pain or poorly. Drugs rule! Now, I'm not here to talk about the sensible people who take them. I'm not even going to discuss the idiots that don't take them. (OK, I might!) I am talking about the parents who DON'T give them to their children. The parents who 'don't believe' in paracetomol to bring down their child's temperature, the parents who won't give calpol for pain because 'they don't buy into it' and the parents who refuse their children antibiotics because 'medication isn't healthy. THESE parents. Personally, I think it's criminal and I will always fill out a vulnerable child social services referral if a parent discloses a refusal to medicate their child. I don't get it. Why would anyone want their child to suffer? How can you 'not believe' in them?! They are there to help and a proven to help. That fact is beyond reproach. A child CANNOT control their core temperature. That is what we wrap them up warm and strip them off when hot. That is why we give Calpol when they are ill. 

Drugs are amazing. They make you and your child feel better. It's not something to 'buy in to'. It's something that is there to help. It is one thing to be an adult, and a stupid one at that, to refuse to medicate yourself. I've lost count of the number of people in pain who won't take pain killers for bizarre reasons like 'not wanting to mask their symptoms' but as an adult, they are free to be idiots and face the consequences and discomfort caused by their inaction's. A child is not. A child can only have what they are given, and if they aren't given, then they will suffer. Fact. These happy clappy free spirited parents who go by the ethos that drugs are evil, are quite frankly, mad. Have they never had tramodol?! That shiz is AMAZING! 

"4 year old male, fitting"

Most kiddies 'fitting' turn out to be a simple febrile confusion. As I have said, before the age of 6 a child's brain isn't fully developed, especially the hypothalamus which controls the bodies temperature. Because of this, toddlers, especially males are susceptible to convulsions and seizures when they get a high temperature. This is normally kept in check by good old fashioned Calpol and if there is an infection, some antibiotics will help. 

After fighting my way through the traffic I pulled into the road to be greeted with a familiar sight of frantic waving from the dad. I grabbed my bags, including my DRUGS and headed in. The dad ran up the stairs ahead of me, whilst I navigated the death trap of the stair gate! In the bedroom was the child with the mum. He was having an extremely violent seizure.

I put some oxygen straight on him and took his temperature whilst talking to the mum. 41.4 C. This is one of the highest temperatures I've seen.

"What's the history?"

"He's been unwell for 4-5 days with a temperature and saw the GP a few days ago."

"What did the GP say?"

"That he had an ear infection."

"What medication did he prescribe?"

"We don't believe in antibiotics so we didn't pick up the prescription."

I felt my blood pressure rise immeasurably. Antibiotics are not some mythical being that you 'believe in'. They are not like the tooth fairy or the Easter bunny that you only believe in as a child. They are like Father Frickin Christmas. Real as can be. (don't judge me). You can't 'not believe in them'! Anyway, now was not the time to lecture them. 

"What time was his last Calpol?"

"We don't give our children calpol."

Of course you don't. You enjoy seeing your child's body convulse violently in front of you. You enjoying seeing his brain get so hot that he ends up like this. It is neglect. Plain and simple. What kind of warped principles do these people have? Where does it stem from? It is like not vaccinating your child from killer diseases and not wanting them to have blood transfusions because a book told not to. Inside I was seething. I was also desperate for the ambulance to arrive!

He'd been fitting for pushing 15 minutes now. I ripped open my drug pack and grabbed the diazepam. 

"Is that totally necessary?" the mum said uncomfortably. 

"Yes. 100%. He needs these drugs and he needs them now. It's the only way I may be able to stop him fitting."

She kind of nodded in acceptance, almost annoyed at me for dashing her principles on medication. I gave the diazepam as the ambulance crew walked in. 

"Let's just go!" I said, giving a handover as we walked.

I picked up the still fitting boy and rushed to the ambulance. Mum followed. Without any delay, we left to the hospital. I put in a pre-alert and then just watched, hoping. Eventually the seizure slowed down and stopped. It was certainly a relief but a 20 minute seizure could well have caused real brain damage. Yet this fact seemed to escape the parents. They looked worried, like any parent would but I genuinely think they felt totally justified by their inaction. 

At hospital, I handed over the waiting doctors, making sure to make it clear the parents and refused to give the antibiotics and refused to give any Calpol. Not taking into account the temperature he had, the poor boy must have had the most awful ear ache. No painkillers. It's disgusting. The doctor didn't hold back like I did! She told the mum that her son was in this way because of her. I left promptly because as much as I agreed, I hate watching people getting told off!

Why am I having to write posts like these? Why is this mentality still in existence?! I'm all for free speech and free choice. If people want to do things with their life that is their choice. However, as a parent, you have the responsibility to ensure your child is kept safe and well. They are too young to make ill conceived principled stands on something as amazing medications, and to force these warped ideals on children is just plain wrong. What do you think? Am I being harsh? Should parents be free to choose whether their child gets the medication they need? Or should there be rules in place to stop this harmful way of thinking affecting these poor little kids? You tell me. I just don't understand.

Some People!

"78 year old female, fall, ? Injuries"

Friday night. A & E was an absolute war zone! Nurses were near to running between patients, the resus door were repeatedly swinging open and shut as doctors ran in and out. Porters were going back and forth moving patients from minors to majors, majors to the ward, resus to ITU, and even one, I saw, off to the morgue. Down the corridor from the department was a queue of ambulance trolley beds, at its worst, 8 in total. That's 8 patients, 16+ ambulance staff and 8 ambulances that can't answer calls because there was simply no room at the inn!

Slowly, we crept towards the front of the handover queue. It was simple, if your patient could go to the waiting room, they would, if they could sit in a chair and be observed then they would. If they needed a bed, they'd have to wait. And wait a long time. 

Our patient had been a prat. He was a 17 year old guy who had felt he was more than capable of jumping the gap across a large outdoor staircase. Even I could see that it was a gap that Greg Rutherford would struggle to breach! Unsurprisingly outpatient had fallen woefully short. Even his landing had been found to be wanting! He managed to break his ankle and possibly his wrist in the process. When we arrived on scene, his opening line was...

"Sorry guys, I've been a total idiot, again!"

By again, he was referring to the previous time we went to him after he fell down the stairs and dislocated his shoulder whilst trying to do something fancy with a hand rail! He was indeed an idiot! But a likeable one all the same!

Anyway, despite his injuries, he was more than suitable for a chair. We put him in a wheel chair and my crew mate wheeled him round to the waiting room. No doubt he had a 6 hour wait ahead of him! I then went to hand over to the nurse.

I was half way through explaining what happened when she had to rush off! It's one of the perils of being the Charge Nurse on a Friday night! Lying in the bed in front of me was frail old lady. Her arm was in a soft sling, her head was bandaged and she was looking sorry for herself. We shared a little smile! Then out of no where my arm was grabbed in a manor to turn me around.

"I want a word with you!"

I immediately took huge offence at my arm being grabbed, even more so when relished it was a total stranger doing so! Stood in front of me was a woman, 55ish, hair up in a 60s perm and covered in lavish jewellery. She also had the most bizarre looking drawn on eyebrows and lipstick that appeared to have been applied by a drunken toddler! Before I got a chance to even reply, she launched into one!

"How dare you?! You lot have no consideration for your patients. There was absolutely no need to bring my mum here. You could have picked her up, put her back to bed but Noooo, that wouldn't suit you now, would it? You don't think of the consequences for the family. It's MY sons wedding tomorrow, don't you think I've got better things to be doing than being sat up here because some bloody ambulance driver couldn't be bothered to do their job properly. It's a disgrace. A total abuse of your power. Disgusting."

I starred at her blankly for a few moments to see if her tirade had finished and said:

"Who's your mum?!"

"Who's my mum?! Who's my mum?!" she said, looking around for spectators to be shocked! "The woman you just dragged to hospital!" she said, pointing to the woman with head and arm injuries who only moments before I'd been smiling at!

"I didn't bring her to hospital. I've never met her before. I brought in a 17 year old with a foot injury. Is he your son?"

She starred at me realising what she'd just done, planning her next move.

"I don't care who you brought in. You're all the bloody same. You're just selfish, only thinking about yourselves. People have families you know"

The nurse returned to the desk so I turned around to continue my hand over.

"DON'T turn your back on me." she said grabbing my arm.

"Touch me again and I'll call for the police. I didn't bring your mum here, I don't know you or your mum and I'm handing over MY patient to the nurse."

She stood starring at me for a few moments until the nurse told her to go back into the cubicle. I heard her continue to slag me off as if she were addressing a crowd like Martin Luther King! Sadly for her, her mum was the audience and wasn't big on conversation or applause! 

Some people!

A Bridge Over Troubled Water

"29 year old male, cardiac arrest"

Even before we got this job I had a strange feeling. I can't describe it, something just didn't seem right! I was on edge like I was waiting for something to happen.  Well,  a 29 year old in cardiac arrest was enough to snap me out of my odd state! Generally the cardiac arrests we do are on the elderly. In fact, I'd say at least 95% are over 65, maybe even higher than that. I'm not saying it's any easier doing a resus on a 80 year old but on some one younger it seems a lot more of a waste. Initially we only had a road to go by, so headed off in the general direction.

"UPDATE: Patient on a boat"

A boat. Of course he's on a boat. It's a big city, where else is he going to be?! The actually location we had been given was to an incredibly narrow, slippery concrete staircase, leading down to an canal footpath. Only problem was there are two sides to a canal and boats lines both sides. There was also two staircases to chose from and we had a lot of kit to carry! Oh, and obviously it was dark.

With all the kit you can envisage for a resus we headed down the stairs that were nearest us and started looking / shouting speculatively for a response. After about 100ft we got on! On the other side of the canal.....

So, about turn, and back we went, up the stairs, across the bridge, down the other stairs and along the footpath to the boat. Now, the boat. The clue is in the name, a 'narrow boat'. There isn't going to be much room to work, nor will there be room to stand or  move around. Once I'd taken a step of faith over the gap to the water I felt a tad safer. My crew mate passed me the kit and then followed me over. Then it was a case of squeeze down a tiny, shallow stair case into the heart of the boat and there was our patient, lying lifeless on the floor.

I quick primary survey showed that luckily he wasn't in cardiac arrest. He was however on the verge of respiratory arrest so I got ventilating him while my crewmate started doing 'other stuff'. His pupils were pinpoint and there was plenty of evidence to suggest a drug overdose to we treated as such. We have a wonderful drug called Narcan that reverses the effect opioid drugs pretty rapidly so we loaded him up with that. After about 8 minutes he started to respond and began breathing effectively himself. 

By now, the FRU had arrived, unfortunately, owing to the fact that it was a narrow boat he was made pretty redundant by the lack of space. He decided to go and fetch our carry chair! Good call! Although the patient wasn't conscious enough to talk in sentences our walk he was opening his eyes and thrashing around slightly which was kind of what we expected. He had already been cannulated by the time the chair arrived back so we got him strapped in and started the the arduous process of extraction! 

Up the stairs we went and on the stern (?) of the boat. Now the plan of how to safety get him, us and our kit across the gap of water to the foot path! Scrap that.....he started fitting. Full blown seizure and pretty violent at that. BALLS! We got him out the chair and onto the deck. This job was really going from bad to worse. We waited a few minutes to see if the seizure would stop. It didn't. We gave Diazepam and waited some more. Still fitting and we are getting pretty desperate now. More Diazepam. Still fitting......aaaaaand stop. A quick ABC check and he was up, on the chair and across the back faster than you can imagine! Sure enough, the second we got him on board the truck the fitting started again and this time it didn't stop. 

You'd think after all of that, the hospital would be appreciative of what we'd been through, but no, the Dr was just plain rude! He interrupted my handover with:

"Well he's probably still fitting because you waited 5 minutes to give him Diazepam"

He then ignored the rest of the handover and talked over me. He looked at us like we'd dropped a baby and spoke to us as if we were naughty children. He criticised and questioned why we waited to give diazepam despite showing him our guidelines. He wasn't interested. Professional courtesy and respect works both ways and today both were distinctly lacking from the doctor. It was a sour end to what had been a challenging and difficult job.

In hospitals you have every level of experienced medical professional at your finger tips. You have every drug, lots of expertise and the patient is on a bed. Pre-hospital you have 3 of us, one of which is a paramedic, one is a student paramedic and the other a technician, a patient not breathing and then seizing uncontrollably, on a narrow boat, in the dark. We are not miracle workers. We are not giving a gold standard of care that the hospitals are capable of. We are simply making the best of a bad situation. And as far as situations go, this was pretty dam bad!

Bloody Immigrants

"48 year old male, cardiac arrest in street, CPR in progress"

Our Greatest Ever Team

It is not often that I agree with anything David Cameron has to say, however, when he describes UKIP voters as “fruitcakes, loonies and closet racists” I'm inclined to agree. They seem to be getting carried away with their recent success but the better known they get, the more skeletons from their dirty closets keep appearing. I have every faith that the great British public will see the light and this will be nothing more than a puff of hot hair and a protest vote against austerity.

It's 2013. Any party that expels their members for being pro gay marriage has no place in politics. However, quotes like “I just wish they would keep their homosexual nature and practises to themselves and stop trying to ram it down my throat telling me they are ‘normal’ when they are not.” seem part of the UKIP norm. Then again, that is little surprise when UKIP candidates like Alex Wood are photographed doing neo-nazi salutes. How very British! Last night I was told by someone from UKIP that "people fear the volume of immigrants in the UK" and when pushed he said it was "the fear that the UK they grew up in is changing beyond their control. It's just not England anymore." Ah yes, immigrants making us less English! Sound familiar? Sounds very BNP to me! Personally, I think they put the Great into Great Britain.

The England I grew up in was was a multicultural one. I lived in a nice part of the city and went to a good school. In my primary school class there were two boys from Nigeria, one from Pakistan, a few from India, one from Egypt, one from Ireland and *deep breath* one from Somalia! (UKIP voter shivers!) Some of them were born here, some weren't, to some of them English was their first language, to some it wasn't. Who cares?! Certainly as a 7 year old I didn't, they were just my school friends and still are. Perhaps the innocence of a 7 year old personifies what this country has stood for. It doesn't matter where you are from, what colour your skin is or whether you fancy boys or girls, you can be part of this wonderful country. By the way, forgot to say, there was also an American girl in my class but she doesn't count does she, because she's not considered an 'efnik'.

THIS is the NHS. THIS is Great Britain

This country is held together by 'immigrants'. The NHS alone, would implode without them. They do the jobs that these 'proud to be English' types won't do. Rather than sit there scrounging off the state, never doing a days work in their lives, do you see any of them offering to do a cleaning job? Becoming nurses? Becoming police officers? Doing anything to improve themselves or the country? No! They sit there and bitch about all the 'foreigners' taking their jobs. Well jobs don't fall from the sky, you have to go and earn them. The only reason an 'immigrant' has a job is because they applied for it. They met the criteria, did the training and work bloody hard to keep it, in the face of constant criticism and abuse from the uneducated racists this country harbours. 

This country has done a good job of demonising the BNP over the years and quite rightly so. Sadly UKIP has given these racists a legitimate party to vote for and a forum to start airing their far-right views. As far as I'm concerned, UKIP supporters are a bunch of racists who are pleased that their evil ways are being validated by a political party. 'Oh it MUST be OK, the politicians said so,' Well let me share a little story with you.....

Dear UKIP voter, 

UKIP see a turban. The rest of us see 3 coppers.

Last year I was called to a man who had collapsed in the street. A police officer was on scene and was doing CPR. (This CPR would go on to save the mans life.) The patient was a white man with an English name. Do you think he would have cared that the police officer doing the CPR was wearing a turban? Blooding immigrant eh?  

The guy I was working with that day was gay. Not just a little bit gay, very gay. You know the type, the gay that is proud to say he is. Don't worry, he won't try and turn you with his dirty gay ways, instead he will help try and save a mans life (without ramming his gayness in your face). Amazingly it doesn't effect his job, or prevent him contributing to society. He is also one of my closest friends. He may even want to get married one day! *shock horror face* Bloody homos eh?  

We started the resus and another one of our colleagues arrived. English was his second language. He was born in Kenya. KENYA! Proper immigrant eh? He suctioned the vomit out of the patients mouth and then secured the airway. (This action would contribute to saving the mans life) Can you believe he was allowed a job as a paramedic when English is his second language?! I'm starting to understand the fear. Bloody foreigner not speaking proper English eh?

The 4 of us worked tirelessly. We all communicated well together and were working to one purpose. Eventually we got him back! Wow! The guys heart was beating again! And he was breathing? So, me, the gay, the turban wearer and the immigrant got the guy onto the ambulance and rushed him off to hospital. This guy was a fighter. So bloody English eh?  

We burst through the doors of resus. Well this is awkward, the Consultant in charge was not only a woman, but a Muslim one wearing a Hijab! Surely she shouldn't be allowed to wear that?! Not in THIS country. We handed over anyway and she took charge, continuing the excellent treatment this tax paying Englishman deserves. Still though, bloody Muslims eh?  

As I looked around at the doctors, anaesthetists, nurses and HCAs there was a huge mix of backgrounds. Some born in England, some probably were not. Some were brown, some were black, one was even chinese! One might have even been a lesbian. *shocked face* (She may also want a wedding). My gay crewmates gaydar was working overtime! Anyway UKIP, here is a question for you. If this was your dad, your brother, your uncle or your friend would you care that he was being saved by a bunch of bloody homos and immigrants? Do you think the patient would give a dam? Or the patients family? This man lived and returned to tax paying status. His life was saved by the people of Great Britain. 

You really should have a long hard think about that, because it isn't just a one off. This wasn't a hand picked job to make my point. That is every job I do, that is every hospital in the country, that is every police force that protects you. In fact, that is every school, GP surgery, dentist, supermarket, fire service, coast guard, builder and every other single business, service and institution in this country. England is a multicultural country, always has been and always will be. Your racist policies will not stand up. We pride ourselves on the fact that no matter what the colour of skin, sexual orientation or religious beliefs that someone has they are no less valuable or have any less right to be here than you and me. 

Oh did I mention. I'm a second generation Eastern European. I should probably go back where I came from. Bloody foreigners eh?  

Go on, say it, I know want you, don't be shy, all together now.... 

"We are not racists, we just don't want immigrants in our country." 

Well UKIP, without invoking Godwin's law, your party is starting out in the exact same way as the German Workers Party (Deutsche Arbeiterpartei - DAP) began in 1919. In 1920 Hitler became a member and shortly after that it became the Nazi Party (Nationalsozialistische Deutsche Arbeiterpartei - NSDAP) and we all know how that ended. 

Lots of love 

Ella Shaw (part immigrant, proud brit) x