It Happens To The Best Of Us

"23 year old female, ? drink spiked, vomiting"

It was ridiculous-o-clock in the morning and most of the night's revellers were either a) tucked up in bed b) tucked up in a hospital bed or c) lying in a pile of vomit in a park waiting patiently for a good samaritan to call 999. As far as night shifts go, it had been particularly torrid. Alcohol and drugs had been the stars of the show, with the police and the ambulance service run ragged all night long! Some of my highlights of the proceedings included being spat at and threatened by a crack head, having someones dog 'set on me' (the dog couldn't be arsed) and watching a great episode of domino vomiting (one goes, they all go) outside a club. Oh, spending an hour trying to convince a man in only Thundercat boxer shorts, that lying in the road with his hands in his pants wasn't conducive to good public relations and future job prospects was also one for the out-takes reel. 

It was about 04:30, I was resembling a wild banshee and looking rather dishevelled! My hair really was a thing to marvel at! Being sent to a vomiting drunk person with delusions of drink spiking hardly filled me with warmth, I must say. I was wildly confident that the only thing her drink had been spiked with was alcohol. We headed on up to the 'top floor' flat as instructed. We were met half way up my a drunk, scantily clad girl who was walking like a new-born giraffe. Funny it was, graceful it wasn't. We followed her, and the noise of crying / wrenching into a bedroom. 

There, lying sprawled on the bed, wearing a t-shirt a thong was our patient. Her head was hanging over the edge of the bed and she was indeed vomiting. Her makeup had run somewhat and her hair was....well, matted in vomit. She looked a treat! She was also crying. Stood in the corner of the room as a sheepish looking boyfriend, who wasn't drunk and seemed rather annoyed by the whole situation. 

"Hello my dear, good night was it?!"

"Oh my god, I'm so sorry, I can't stop being sick!" she slurred at me.

Between her and her friend they went on to explain that she hadn't drunk any more than she normally would and drunk the same amount as her friends. They just didn't understand why she was so drunk! Must be a spiked drink eh?! Not the lack of food all day and tiredness combined with any number of other things. Oh, and all the Jaegerbombs. And wine. And other spirits. Definitely, without doubt, a spiked drink! Hmmmmm!

Her boyfriend just rolled his eyes! He looked particularly unimpressed by the whole situation. I made a few jokes about the situation and he chuckled. It was then I noticed his shirt. It was white, with flaps on the shoulders for epaulettes and a velcro patch on the chest. 

"Is that a police shirt?!"

"Yep! I'm a cop, I'm on early turn, start at 7am, then get a call from this muppet!"

"Sleep's overrated anyway buddy!"

The patient started wailing / crying again! She was apologising profusely and stating how ill and drunk she was!

"What do you do for a living?!"

A sorry pout and half grin appeared on her face.

"I'm also in the police! I'm so embarrassed!"

I just laughed, and laughed hard! She started laughing, and her boyfriend was now seeing the funny side of it! 

"And what do you do?!" I said to the friend.

"And what do you do OFFICER!" she said bursting out in laughter!

As far as I was concerned, all her sins were forgiven! Sure, it's favouritism and yes, I have bitched and moaned about drunk people calling ambulances because they are drunk and YES, they should have known better. But, the thin blue line is spread so thin and they do such a great job day in, day out that getting smashed on a Friday night was probably just what the doctor ordered. We spend half an hour talking work, sharing war stories and we left her to wallow in self pity for the entire day before she started night shifts! 

Getting drunk and paralytic happens to the best of us at times, even the police. When not in uniform we are all just normal people making the same stupid mistakes as everyone else! I won't hold it against her when our paths cross professionally. I will however, mock her unreservedly!

Don't forget, nominations are now open for the MAD Blog Awards 2014. Please go and nominate me by clicking HERE. Just add my URL www.tryingmypatients.co.uk to the categories I'm eligible for! (Best Writer & Most Entertaining) Thank you! 

New Years Day

It was New Years Day and the people of our fine city were not feeling well. I spent most of the day observing the pained expressions on people faces as they struggled with the simplest of tasks, like walking. The previous nights celebrations had clearly taken their toll and as per the norm, the ambulance service were left to pick up the pieces! Here is a rundown of what treats the day gave us! Bear in mind, I too was tired. Like everyone else, I had seen the new year in with friends, had a few drinks, mindful I was on an early it was limited to a few! When my alarm went off at 4am I wasn't amused in the slightest but I got on my bike and headed into the night for my 6am start! 

06:05 - '23 year old male, collapsed. He was drunk and asleep.'

Not collapsed. A good Samaritan had called us. They didn't stick around though. Shocker! Taken to A & E to join the heap of drunken delinquents.

07:00 - '21 year old male, collapsed, head injury.' 

He was drunk. In a skate park. He'd fallen over and cut his head. His friends found the whole affair extremely funny and used words like 'wack', 'nang' and 'rad' with worrying frequency. Bandage on head, a large cannula with fluids and trip to A & E.

08:15 - '23 year old female, vomiting blood.' 

She wasn't. She was vomiting red wine. And 'Purple Rain' which I was assured was an 'aggy' cocktail. Her main problem was a hangover. I gave her 2 x Paracetomol, a glass of water, sound medical advise and a few of my best hangover cures. Left in care of friends.

09:06 - '29 year old male, chest pain.'

He did indeed have chest pain. The cause was the copious amount of cocaine, MDMA and skunk that he had taken with alcohol the night before. Due to the fast heart rate and various other things he was given Diazepam to treat his cocaine toxicity. He was promptly taken to the New Years Eve recovery centre for monitoring and further treatment.

10:32 - '30 year old male collapsed.'

He was indeed collapsed. He'd taken an overdose, presumably of heroin.  He was ventilated, filled with Narcan and then once the effects of his high were reversed we were left with an angry, verbally and physically abusive patient who was arrested and conveyed to hospital. 

11:48 - '24 year old male, chest pain.' 

This one was in a police station. He was claiming to pain to avoid being at the police station. Much to his dissatisfaction, once I'd assessed him, done his ECG and spoken to the duty nurse I told him he could stay in the comfort of his room. He called me a cunt. I left.

12:55 - '14 year old female, intoxicated.' 

This one was in a park. She was smashed, well and truly. He blood pressure was in her boots so she got treated to cannula, fluids and a journey to hospital. Because of her age the police had to attend. She vomited all over the ambulance. And my leg.

*change uniform, clean vehicle*

14:10 - '25 year old male, cardiac arrest. '

Sadly, it was as given. He was dead, nothing we could do for him. His friend found him sat on the sofa. He'd been there 2-3 hours. The nights drink and drugs had stolen a young life. A very sobering affair for all involved. Happy New Year eh? 

15:35 - '26 year old male, severe headache, pains in chest.'

He had a hangover. I told him to take his own paracetomol and drink more water. I told him I had just attended a 25 year who had died. I asked him if he felt us being there was a good use of an ambulance. He apologised. We left.

16:20 - '46 year old male, unconscious on bench.' 

He was drunk, on a bench. He told us to fuck off. We did. The caller hadn't stuck around.

16:40 - '19 year old female, feels weak, chest pain, vomiting.' 

She seemed genuinely shocked that her symptoms were caused by lack of sleep, no food, consumption of weed and too much alcohol the night before. I gave her a dose of health promotion and left her with her proud parents. 

17:25 - '40 year old, collapsed in toilet.' 

Clearly the best had been saved until last. We arrived outside a heaving McDonalds and headed inside. A member of staff met us and took us downstairs to the toilets. Hundreds of pairs of eyes stared at us as if they had never seen an ambulance crew, as they chewed their Big Macs. Despite all watching us head into the toilet, within seconds people were trying to come in and seemed utterly shocked that they couldn't use the facilities! Inside was the wonderment that was our patient.

He was a big man, clearly an alcoholic and was locked in the cubicle. His head was slightly protruding from underneath was wall of the cubicle. He was well and truly unconscious. Oh, and his face was lying in a pool of other peoples urine. It appears McDonalds had fallen foul of their hourly toilet cleaning policy, much to the detriment of the patients big ginger beard and open mouth. We requested a chair to look over the top of the cubicle. 

I climbed on top and peered over. There he was in all his glory, trousers around his ankles, and lying in a pool of his own urine and faeces. He had literally keeled over from sitting on the toilet. It really was a wonderful advert for alcohol!

Unfortunately,  despite the treat waiting for us inside, there was the very real problem of how to get him out. I managed to reach down and unlock the door but we could only force the door open slightly, such was his position. My crew mate was slighter than I was so she begrudgingly agreed to be the one to squeeze through the gap and attempt to move him enough to get the door open. Despite her best efforts, the dead weight drunk man could not be moved and in fairness, such was his condition and covering in bodily fluids, she didn't bear hug him with gusto! Luckily for us he started to wake up of his own accord. His personality was every bit as endearing as his appearance. 

"What the fuck are you doing, get out of my cubicle!"

"You collapsed to the floor sir, we are trying to get you out."

"For fucks sake." he mumbled in a thick Scottish accent. 

"Sir, can you move your legs and sit up, we can't get the door open until you do!"

"Yeah.....I know......I'm not fucking stupid you know!"

It's at times like this I like to freeze frame the moment. Ideally I'd like to take a photo on a Polaroid camera and pass it to the patient for them to digest. I was curious as to which part wasn't stupid. Was it the amount he'd drunk? Or the falling off a toilet? Or the double incontinence? Or his face in puddle of strangers urine? All of the above smacked of stupidity, but who am I to judge?! 

Eventually he was up and out. With every passing moment he became more and more abusive and the smell got more and more offencive. After telling us both to, and I paraphrase, 'go away' he headed out back into the restaurant. After attempting to start a number of fights and verbally abusing everyone he passed he staggered up the stairs and out onto the street. During this short journey he only fell over 4 times so that should be looked at as some kind of achievement. He went off into the distance cursing at all he past. I never got his name. What a treat he was!

So, that was New Years Day! Entirely predictable, totally exhausting and all too familiar. Lives wrecked by alcohol and drugs again. When will people learn?! I could sit and reflect on the 25 year old that died but won't. He isn't the first and sadly won't be the last. Perhaps that's cold of me, perhaps it's just self preservation. I'm sure next weekend will bring similar. 

"It's like gambling somehow. You go out for a night of drinking and you don't know where your going to end up the next day. It could work out good or it could be disastrous. It's like the throw of the dice." Jim Morrison

No More, No Less

"RTC, car vs car. Injuries unknown. Police on scene."

We happened to be on the road the RTC was on when we got dispatched to it. It was about two miles away but due to the nature of the relatively narrow and winding road, any RTC always caused absolute chaos in the area. The traffic was already building up, even where we were so it took a little while for us to get there. For every five cars that move out your way, there is one that just sits there and doesn't move. It's most frustrating! Ahead, we could see the blue lights of a police car and after a final push we were there.

As far as RTC's go, this was a minor one. Three car were involved all with relatively minor amounts of damage. There were five patients, all with pretty minor ailments, but all needed assessing and treating. Injuries ranged from minor head injuries to mild chest pain. Once we had parked our 3.5 tonne vehicle traffic was now well and truly blocked in both directions, but whilst the two of us were working our way between the three cars, that was what was happening. The two cops were having to take statements, try and clear the road, act as mediator between the feuding parties as well as making sure everyone was safe until we had arrived. I didn't envy them one bit!

Sat in the traffic, near the front was a brand new white Audi. A guy, mid 20s leaned his head out the window and spoke at one of the coppers.

"Oi, how about you clear the road."

"How about you don't refer to me as 'Oi' for starters."

"How about you just do your job."

"Can you provide me with more officers to assist us, because that is what we need?"

"Ain't my job, I pay my taxes, how about you clear the road like you're paid to do, fucking idiot."

"We can only do so much. There are only two of us. We would love more officers to help but there aren't any. You'll just have to be patient."

"Just move the fucking cars so we can get on our way. It's your job, it's not rocket science. Are you all as incompetent as each other?"

"Stop swearing at me."

"Or what, what you going to do. How about instead of wasting time whining about swearing you do your job and clear the road."

At this point the copper walked away and continued doing the huge list of things that needed doing. I just stood there open mouthed. Had that really happened?! Some people are so unbelievably selfish! And arrogant. And in this case, just a total arse!

"Oi, move your ambulance so we can get past."

Oh, he's talking to me now! I felt that warm feeling inside, one full of joy and excitement! I composed myself for a moment and walked over to his open window.

"You are a rude, nasty, LITTLE man. You will wait like everyone else is waiting. There is nothing you can say, or do to make me move my ambulance any faster. All that you stand to achieve with this attitude is ensuring you wait longer."

With that I begun walking away! 

"Go fuck yourself."

"Very intelligent response. Well done." I said with a smile.

"Fuck off."

Clearly, I don't have the same levels of self restraint that coppers do. I am often found guilty of taking the bait but someone needed to tell him he was being an arse! The police face this abuse on a daily basis and most people get away with it, because there simply aren't enough officers to arrest and process these morons.

I asked the police officers on twitter how many units / officers would be needed in an ideal world to deal with a 3 car RTC with 5 patients on a busy road. These were some of the responses:

"I'd like 6. However I think that 4 is probably all I'd get. And that's on a good day." 

"Ideal world an officer per car, 2 for the road block and 2 for the witnesses so 7. That would almost be my whole team!" 

"6 in an ideal world, but you should be so lucky! 4 would be safe and manageable" 

"Ideally 6, but safe with 4. No less than that." 

"4-6 for scene management, arranging recovery, taking witness statements etc"  

"Depending on the road 6-8 ideally, not less than 4, too much to do." 

"Probably 6 I reckon but that would be most of my team!"

So, I think it's fair to say that the one police car with two officers was not enough to safely deal with the scene. Unfortunately, there was no one spare to send. In previous blogs Please Sir, can I have some more? and A Special Relationship I highlighted what effect the cut of 16,000 front line officers was having. Those two posts highlighted extreme cases which is easy to get outraged about but RTC's like this are part and parcel of every day policing and there simply are not enough to spread around. What you're left with is two officers trying to mange 3 angry families, a blocked road, the irate public, 5 patients, 3 drivers to process and breathalise, vehicles to help arrange recovery for and an ambulance crew to ensure are kept safe! It simply doesn't add up does it?!

As a bonus, as the road was being cleared the chippy chav opened his abusive mouth one to many times! The cop went over to the car and asked him politely to get out the car. The driver don't take kindly to this and his threatening manor and verbal threats landed him in handcuffs. To top it off, due to a faint smell of alcohol he too was breathalised. In what was a beautifully poetic moment, he blew over the limit and was promptly arrested for drink driving. One more scum bag off the road! If only he'd kept his mouth shut!

Despite the pressures, everything got done. The abusive moron was ignored, then arrested! The road got cleared, the patients got treated and discharged and after a good hour or so all that was left was the two cops with an absolute mountain of paper work, an ambulance crew and a clear road. The upshot is though, the public are left blaming the police for not doing enough to ensure their smooth journey! It's not the cars crashing, it's the police not working fast enough to clear the road. That moron happened to voice it but you can be sure others with thinking it. The emergency services shouldn't be left in a situation to just cope and muddle through. These ill conceived cuts to front line services have a huge effect on day to day services and there simply are not enough left to keep the public safe. Then again, lets not forget police should "Cut crime, no more, no less". These non-police matters will sort themselves out, eh Terese May....

Emergency Service

Well, it's that time again. Time to introduce Inspector Michael Brown, author of award winning and acclaimed blog, Mental Health Cop. Normally, I drag him out to discuss all things mental health. However, this time, my narcissistic side, just couldn't resist sharing his words with the masses. Namely, because one of the tails of heroism he refers to is me, and to be brutally honest, I dig that shiz! It's also confirmation that the ambulance service is indeed the BEST emergency service.

So, with all the fanfare it deserves, and a dosage of pomp and circumstance, I present to you, 'Emergency Service'! 

*          *          *          *          *

I sometimes remember to marvel at some of my colleagues and did so again over the Christmas period – ordinary men and women doing an extraordinary job, away from their friends and families whilst we were at home – (it was my turn to be off!) Their pay has been frozen for the last few years with their pensions being eroded compared to those they were promised when they joined up; there is comparatively little or absolutely no training for some of the functions that they are expected to undertake in their role; and sometimes they are patronised and misunderstood by senior members of Government who don’t really get their role at all.

CRIME, SAFEGUARDING AND PERSONAL BRAVERY

A while ago, one of them was at a job where a man had attacked his partner with a knife and the man was known to have a risk history that flags up whenever you attend the address. Back up was a distance away and consumed by an instinct to protect the woman and get to her aid, she went in to that unknowable environment on her own. What she did what she got in there meant the man fled with his knife, the woman was safeguarded from any further threat and it could be declared safe for paramedics to roll the ambulance up to the door. The man was arrested a short-distance away, but that early evidence meant we could prove that he *was* holding a knife during the incident. Crucial evidence, nicely preserved by a brave professional witness who put herself at risk.

You’ll remember this blog was prompted whilst I was off work this Christmas: I remembered what it was like working on the frontline last year – Christmas Eve in particular was a real bender of a shift and resources were so stretched that by about 3am (on Christmas Day!) I was first on the scene of a stabbing. A man so badly injured that his wound was an open chasm in his neck and there were half-pints of blood all over the pavement. I was soon joined by another set of blue flashing lights and before much else could happen, my colleague and I were rolling on the floor with this bloke, fighting him to let us apply pressure to his neck wound so he didn’t bleed to death in the road. We both got knocked about a bit, but nothing serious and wondered afterwards whether this man was as high-as-a-kite on cocaine? But the ambulance crew and more officers turned up and off he went to hospital.

Earlier this year, we had a very mentally distressed lady in police custody – a person in a condition of some particular agitation and obviously very unwell. As various medical professionals have suggested we should, I remember asking the custody nurse whether we could be sure that her basic obs indicated nothing was seriously physically wrong with her – was she actually safe in police custody? The nurse checked the custody record medical forms and admitted she didn’t know. She agreed she should do them again to be certain and saw what I was getting at. Was her heart rate OK, her blood sugar, etc., etc.. The nurse being there with all of her gear, you’d hope and think that a nurse would be able to reassure someone perhaps to a greater degree than someone in uniform that they wanted to check them out, to help make sure they’re OK? This lady couldn’t see that and I patiently watched two of my colleagues spent 90 minutes of constant patient and compassionate conversation turn this into a position whereby the obs could be done and we could relax that she was not potentially seriously medically ill, as well as distressed.

EMERGENCY SERVICE

I could go on and on – the point I want to make here is thatnone of the colleagues I’m referring to above are police officers.

They were all paramedics from our ambulance service. 

It was a paramedic first-responder that intentionally put herself at risk where a man had taken a large blade to his wife, to safeguard her and she unintentionally contrived to be able to provide evidence against him that helped convince the court he was a dangerous liar; it was a paramedic who got physically stuck in to a man who was bleeding heavily but fighting not to be helped; it was two paramedics who came into police custody and spent 90 minutes patiently persuading one of the most vulnerable, psychotic and distressed people I have ever met, to let them care for her.

I could still go on and on – the story of the paramedic in London who continued to provide care for a drunk man just after he’d been hit over the head with a fence post by that man; the paramedic in Suffolk this Christmas who ran into a burning building before the Fire Brigade could arrive to rescue a trapped woman and immediately give her respiratory support; the paramedic who accompanied three officers into a building where there was a risk of a gas explosion in order to assess a man inside – all were hurt when the building exploded, a risk that they knew they were taking.

It is my genuine privilege to work alongside these people – as we do every single day. Despite the very obvious differences between policing and pre-hospital healthcare, there are many overlaps and at the core of it all is dedicated public service at times like Christmas or during family birthdays and other events. It is my view that paramedics are paid peanuts for what they do and they are probably more messed about and taken for granted with the rubbish that is thrown at them, than we realise. The stories of people ringing 999 for an ambulance because they can’t be bothered to walk to hospital or see their GP; the Home Secretary contriving to refer to them as “ambulance drivers” in apparent disregard of the training and qualifications they must have and the media quick to pick up on paramedics not diving into a lake but aren’t mentioning the one who ran into the burning building.

It just beggars all belief that they aren’t considered an emergency service – I have certain views about that!

The practice guidelines for paramedics is a telephone directory sized book and it has four pages of information on about mental health, some of which is wrong! It probably isn’t as widely known as it should be, how many paramedics will say that they want to be able to do more for people in mental distress – they want to access NHS referral pathways, have options for removal to care settings that are more appropriate than A&E and be trusted to take pre-hospital clinical decisions. Let them serve us better, because they want to do it and are currently blocked from trying. We trust these people to get to grips with our heart attacks and strokes and to know what to do when time is of the essence – surely we can open up the mental health pathways and trust their clinical judgements?

So I want to circulate my admiration for my colleagues in green and help build awareness of the stuff they do for you and for all of us each and every day.

We would notice if they weren’t there to do it for us, trust me on that.

A Force To Be Reckoned With

"41 year old male, hit by car, injuries unknown"

The traffic was already at a standstill so it took me a good few minutes to get to the scene of the crash. As I pulled up I could see some colleagues already doing CPR. I did not know it was this bad! I jumped out the car, grabbed some bags and headed over.

"Hello guys, what going on?"

"This guy has been hit by a car, he was unconscious but breathing when we arrived but stopped shortly after. We started CPR and ventilations."

"OK, you OK to carry on CPR?"

"Of course, not a problem."

"What do you want me to do?"

"Can you grab the spinal collars and the suction unit please?"

"Yep, no probs."

I set about attaching the pads to him. He wasn't in a rhythm that can be shocked so we continued working on him, best we could in the circumstances. The rain was absolutely bucketing it down, the three of us soaked through to the skin.

I suctioned his airway which was filling with blood, he wasn't in a good way. I needed to put in an airway but couldn't do it on my own.

"Can you suction here for me?"

"Yep, say when you want me to stop."

"Will do, give me one sec.......OK now."

I pushed the airway into his throat and started ventilating. It was a bubbly initially but air was going in. Unfortunately, the chest wasn't rising properly.

"You got any more gloves on you?! Mine are covered in blood!"

"In my back pocket! Take over CPR will you?!"

"Sure, thanks!"

Once gloved up again I got my cannula roll out and decompressed his chest. I got assistance securing them down and then moved onto the cannula. Amazingly at the next rhythm check we had a very faint pulse. That freed up another pair of hands at least.

"Let's get his legs raised, just use one of those bags. In fact, can you also grab some blankets, try and keep him warm and dry as much as possible. Well done guys, that's great stuff!"

It had only been 10 minutes since I had arrived but it had seemed like an age. Eventually, the ambulance arrived and between the 5 of us we got him onto the bed and rapidly off the to trauma centre. I don't know whether he'll live or not but he'd been given the best possible chance.

That chance came about not because I was there within 8 minutes of him being hit, and not because the ambulance came and we got him to hospital. He has that chance because 2 people had done an incredible job. An incredible job in extremely difficult circumstances. Those two people were police officers. They happened to come across the RTC within minutes of it happening. Not only were they there quickly but they treated him extremely well. They recognised he'd stopped breathing and started CPR early. They didn't have a Bag Valve Mask that we have. They had a micro thin face shield and blew air from their lungs into that of a stranger. They basically kept him alive until I arrived. Once I was there they acted as an ambulance for me. Irrelevant of uniform they did what they had to do to save the life of a member of the public. This is our police force.

This is the same police force facing cuts after cuts. The same police force that has lost tens of thousands of officers. The same police force having their pensions reduced. The same police force who get maligned on a daily basis by all of the gutter press. The same police force who are expected to work in the face of abuse and violence on a daily basis. The same police force we all rely on when the shit hits the fan. The same police force who's morale is at an all time low. 

I for one am fed up of reading the snippets of misinformation reported. We should be proud to have the best police service in the world and I'll be shouting from the rooftops at every given opportunity. We work alongside side them every single day. We rely on them for our safety. We rely on them to investigate crimes. We rely on them to do just about anything to keep the public safe. Well today I relied on them to keep a man alive and they did. We have an amazing police force. Let's not forget that, through all the politically motivated propaganda we are forced to read. 

I wonder of the Daily Mail will report on this. I shall be sending it to them!

The Capacity Games

As I walked into the room he was laying face down on the bed, arm hanging over the side and bleeding heavily. A constant stream of blood was trickling out into the ever increasing pool on the floor. He was seemingly unconscious and very pale. I applied some significant pressure to the wound in the bend of his arm whilst trying to find out what had happened. It turns out that he wasn't unconscious but just playing dead. Within a minute or so he was up and talking, full of bravado and attitude. I applied a pressure dressing to the wound and bound it up relatively tightly. 

In terms of numbers he was OK. His pulse and blood pressure were stable and was showing no signs of shock despite the blood loss. That said, he needed to go to hospital. Clearly this was a cry for help and I wouldn't be happy leaving him on his own. For a suicidal self harmer however, he was surprisingly up beat. Very chatty, very well spoken and extremely knowledgeable about mental health law. He quickly made it very apparent he was not going to be going to hospital under any circumstances and was well aware that currently the ball was in his court. I had hoped some well chosen words and my power of persuasion could have made inroads with him but he was as determined as he was smug. 

Plan B then. If I couldn't force him to go to hospital, then I had to bring the most relevant bits of hospital to him. I discussed options with him and we settled on getting an out-of-hours GP to visit to ensure the wound was clean and appropriately dressed and then contact a mental health crisis team who WILL visit within two hours. Well, that's what they are supposed to do! He was happy with the plan, his dad was happy with the plan and seemed in good spirits. I wasn't happy with the plan but that was probably fed by the compulsion to do something for someone in crisis and not getting my own way. The patient had capacity so this was the best I could do! At a stretch the fact he was drunk could effect his capacity but I was able to have a more than rational conversation with about the pros and cons of staying and going and depute my disagreement with his opinion, it was after all his opinion and ultimately, his choice.

*REMEMBER THIS MOMENT* At this point, no ambulance had arrived, so I phoned control, to tell them that the patient was refusing treatment so no ambulance was required. 

"We also have the police running on this CAD, would you like them cancelled too?"

"Rog, patient is compliant and isn't being aggressive. Cancel police."

"Rog, thank you, red base out."

I explained to the patient and his dad that I needed to go and get my paperwork and phone various people to arrange the referral. I needed to speak to our Clinical Support Desk, the GP and the Mental Health crisis team and that could take a little while to get the ball rolling.  What I did assure them of, was that I wouldn't be leaving until I knew exactly when someone would be coming.

I went down to the car and started my phone calls. Midway through my first conversation there was a knock on the window. It was the dad looking rather panicked.

"He's done it again, I can't wake him, it's bleeding everywhere."

*face palm* 

I hung up the phone and rushed (Ambulance Run - above average walk) into the house and back upstairs. As I got to the landing I could hear the blood pouring onto the wooden floor. He was now lying on his back, other arm hanging over the edge of the bed and blood was literally pouring out of him. He was white as a ghost and unconscious. Again, I applied pressure and held his arm as high as I could. I was now in an extremely awkward situation. *REMEMBER THAT MOMENT* 

I was on my own with a bleed I was struggling to control. I had cancelled the ambulance and considering I had already waited 40 minutes and one never arrived, the chance of getting one instantly was minimal. I had also cancelled the police, who in this situation could be of great use!

"You see the radio on my belt, twist it off, hold down '*' to remove the key lock, then hold down '#' (priority) for me."

His dad followed my instructions and within a couple of seconds the radio started ringing. 

"Hold down the button on the side for me."

"Red base, patient has cut himself again, I need the police and an ambulance as a priority, I'm struggling to control the bleeding." 

"Rog, will do that for you now, nearest ambulance is some distance away, sorry!"

"Right, take the key off my belt loop, in the boot is a big black bag with 'Paramedic' written on it. Bring me that bag please."

Off he ran (Non-ambulance run - Actual running - Weird phenomenon). I managed to apply a pressure dressing to the arm which seemed to do the trick. This time bound even tighter than the first! On his return I got his dad to hold the arm in the air, allowing me to do other stuff. His blood pressure was in his boots so I got a cannula in him (for the medical lot, an orange in the back of the hand, sadistic git that I am) and started running some fluids through. The patient gradually became more coherent and was soon back and telling me to go away and leave him alone. Unfortunately for him and luckily for me, the leaving alone option was no longer viable.

First to my aid was the police. They helped me with everything I was doing and also attempted to convince the patient that now hospital was a must. He was having none of it. 

"You can't section me, I'm old enough to make my decisions and I'm not going to hospital. There is nothing you can do to make me go."

"I think you'll find we can."

"What powers are you going to use to take me from my own home, a place of safety, right here and now. You can't do anything legal and you know it."

The poor copper looked a little stumped and unfortunately had no answer for him which somewhat undermined his authority.

Although the patient had apparent capacity to refuse treatment, on balance I now felt I had reasonable grounds to use the Mental Capacity Act to enforce treatment. As far as I was now concerned he lacked capacity to make an informed decision and didn't appreciate the severity of his injuries. Unfortunately for the patient, he came up against someone with greater knowledge of mental health law than him. I was able to quote section 4(B) of the MCA at him and outline why the deprivation of his liberty was necessary. My rationale was because my proposed treated was wholly or partly for the purpose of giving life saving treatment to him and that, as the medical professional currently in charge of his wellbeing, I was well within my right to ensure he got treatment.

I explained all this in quite a self gratifying speech which left the patient looking rather deflated!

"Aaaaahhh, you just got schooled on the law by a paramedic, aren't the police supposed to know more?! Embarrassing!"

I felt a little awkward but luckily the copper took it on the chin and seemed happy to follow my lead and confirmed to the patient that I could do what I was saying. I also backed that up by telling him that under section 6 of the MCA he could be retrained by the police to ensure said life saving treatment happened and to prevent further harm to himself or us. Faced with three people who were much more well read on mental health law than he was, he quickly got on board with what was going to happen and became compliant. 

When the ambulance arrived he came voluntarily and was most apologetic to all of us. His initial reluctance to go to hospital was easily explained......

5 hours earlier......

A 23 year old guy who suffers from bi-polar and depression, who has a history of self harm and suicide attempts, is feeling particularly low. He is feeling suicidal and wants some help. He tries but fails to get hold of his crisis team. They simply don't answer the phone. Because of these feelings, he has been drinking heavily but being self aware enough to know that he is likely to do something stupid, he self presents and his local A & E. He tells the triage nurse he has been drinking and is feeling very low and suicidal. He said he just wants to die. 

The hospital is very busy, majors and minor are full and the waiting room is at bursting point. The triage nurse listens to a young guy tell her he has been drinking and apparently takes no notice of his medical history and wish to die, so puts him in the waiting room where he waits.....and waits. After 4 hours he got up and left. His cry for help had been ignored by mental health services and his local hospital.  He got on a bus and went home where he carried on drinking. And drinking. 

He then smashed a glass, picked up a shard and rammed it into the crook of his arm. He then called his dad who was downstairs, to tell him what he had done. His dad phoned 999.

"My son has self harmed, he is bleeding from his arm quite heavily."

"OK sir, help is on the way."

"23 year old male, self harm, serious bleeding, access OK"

Luckily I was only round the corner so was on scene within a minute or so. I grabbed all my stuff and headed up the path for my first mental health of the night......

A patients outcome, positive or negative should not be based on luck. Luck that I was close by. Luck that his dad was in the house to find him bleeding when he did. Luck that the bleeding was stopped and he was quickly treated. This should be the basic of mental health care. There are services in place to not only treat this demographic of patients but to safeguard the risks that are associated with their conditions. A patient in crisis and at significant risk of harm should have instant access to their crisis team. Time and time again mental health services are impossible to access outside of 'Mon-Fri 9am-5pm'. It just isn't good enough. With the glaring failings in an understaffed, under trained and underfunded system, the safety net is always A & E. However, combine deep cuts, fed up staff and lack of training with winter pressures and a waiting room full of time wasters and the basics are simply overlooked. 

There was no RAID (Rapid, Assessment, Interface and Discharge) or other liaison service made available or seemingly in place to allow a quick assessment of him. There was also no apparent risk assessment. After only 5 minutes with the guy and a limited knowledge of the Pierce scale of suicidal intent, I had him at a high risk of significant harm. His medical history and presentation alone raised enough Red Flags to warrant a rapid assessment. Instead he was left to his own devices in a waiting room of a busy hospital. Hardly the place for a vulnerable, suicidal young adult to be left. This job highlights the woeful inadequacies of mental health care from top to bottom of the NHS. When will this improve?! 

So, mental health care in the NHS. Discuss.

Can I Go Down There?

It is with great pleasure that I open the floor to my first Facepalm Friday guest post! This week I welcome the award winning, much revered, mental health guru that is @MentalHealthCop from MentalHealthCop! It occurred to me that all the emergency services interact with the public and therefor, we all come across candidates for the Darwin award on a daily basis! This comedy gem from Inspector Michael Brown is from his earlier days as a police officer. At a guess, it was probably in the late 1870's! ;-) 

"Adult male, wanting to go down there" 

I found the Friday Facepalm idea intriguing! - 999 services see human stupidity on an epic scale and we've all got these stories, but my blog doesn't lend itself easily to letting off the necessary steam around them.  Thanks to Ella, I have offloaded some major stress from my early career.

Well over ten years ago, I was a front-line PC in Birmingham.  My partner and I were called to a gas explosion on a very small traffic island where four approach roads intersected.  A engineer for a telecoms company had been working on underground pipes / cables, on the pavement which rounded the corner of two of those approach roads and had managed to ignite gas by cutting electrical wires.  The subsequent blast singed his hair without causing major injury and sent a thirty foot high flame into the sky.

An early Facepalm! for the engineer - but this is merely incidental to the stupidity that followed.

All three 999 services went down there: Ella's lot were helping the engineer change his underwear whilst Simon and Dennis were using their hoses to put out the fires caused to trees and bushes as the gas plume licked back and forth in the wind, torching anything within it's reach.  The only way to stop the plume of burning gas was to get the gas company to dig up the road around fifty metres away and isolate the supply - this would take hours so we were asked to support cordons on the roads and pavements for public safety.

The fire truck blocked one road, the police car another and the two less frequently used approaches were taped off.  There were two cops and a few fire officers to keep saying "No" to the question that always gets asked on these occasions -

It's been the since human pre-history that when you put a cordon on something, some members of the public will still ask "Can I go down there?"  It's important to understand I'd managed nearly two hours of "Can I go down there?" whilst sweating profusely on a what was already a very hot day, underneath a thirty foot plume of burning gas and we'd had to get another patrol to drop cold drinks up to us because it was quite demanding.  So to say I was a bit tetchy about "Can I go down there?" is to understate things.

The clue is:  my police car is across the road with blue lights flashing, we've taped off the road and you can see highly dangerous flames burning brightly and gently toasting us all.  They're licking backwards and forwards fairly unpredictably and there are fire personnel putting out fires as quickly as they can each time one starts.  You've probably seen other people approaching us who ended up heading back the way they came, so what do you think the odds are that you can "just go down there?"

Then happened one of the most unbelievable things I have ever seen - I will remember this until I die:  on the less often used approach, which was taped off and kept in view, but where no-one was permanently standing, a suddenly saw a young boy approach the tape and lift it in the middle. There was a Mercedes in the road, facing me and the boy looked like he was attempting to allow the car underneath the tape. Hang on: that car is slowly moving FORWARD!!

Stop!! 

*Double Facepalm!*

I ran from the opposite, busier cordon shouting "No!"  The vehicle's bonnet was under the tape, the tape stretching across the windscreen and the boy trying to lift it higher as the car inched slowly forward. There was a hairy arm out of the driver's door also attempting to force the tape higher and flick it over the height of the roof.  "Stop!"  The vehicle was approaching the roundabout on the side where the plume of flames was nearest.  Surely he can see it?!  The fire engine was to the right hand side and he could see it from where his car was and both Simon and Dennis were waving frantically in between planning their second jobs and having a snooze.

"What on earth do think you're doing?" I enquired.  "I live up there." he said, implying outrageous unreasonableness on my part.  The wind blew the flames towards us and I felt the temperature really increase before subsiding as the wind dropped.

"Can't you see the tape, the explosion, the blue lights?" 

"But I live up there!"

"It doesn't matter,  Sir - this road is CLOSED!"

"But I live ... just there!!"

"So find another way around, but this road is closed."

"This is ridiculous - I can just drive on the opposite side of the roundabout.  I'll be home in seconds."

"No you won't - because THIS ROAD - IS CLOSED!"

"You're being obtuse, officer."

"If we're offering viewpoints - I have one about using your son to lift police tape without permission and pushing him into demarked areas of extreme danger.  Shall we talk about that?"

"It can't be that dangerous ... they're letting you move about in it."

"They also let me arrest violent criminals, Sir - I'm guessing you don't want your son doing that either?"

"Fair point."

It took the threat of prosecution to get him to reverse and find another way.  I walked up to his house - it was just fifty yards beyond the opposite cordon and gave the appropriate advice.  I think I had hoped he would have realised the main learning opportunities from this encounter.  It amazed me to find he was still furious for the extra five minutes on his journey.  He informed me of that he would be complaining about my attitude and would like to speak to the duty inspector in respect of the complaints procedure.  Fortunately, Carlsberg do make duty inspectors - a man on whom I've modelled my very own approach to that job.

*Triple Faceplam* - the scale of fail.

A Mental Assumption

"28 year old female, sectioning, psych team on scene"

Sectionings are rarely as straightforward as they may initially appear. For starters, rarely are the team of people required actually there and more often than not, we are left waiting hours for people to arrive. Now factor in the fact that by its very nature, a sectioning is removing someones liberty and in this case, removing from their home address. It is of little surprise that most of these patients don't want to go to hospital, let alone go quietly. This is where the police are normally brought in. In fact, realistically, they are brought in when the word 'mental' is used in conjunction with an ambulance. but I'll get back to that. 

In a break from the norm, when we pulled up on scene to find that we were in fact last to the party. The approved mental health professional (AMHP) was there with the police and all the paperwork, signed by two doctors required to make a Section 2 legal was there, I's dotted and T's crossed. The police were there as the patient was being aggressive. The patient was suffering from severe post natal depression, and had been for a perhaps 4 or 5 months since her last baby was born. She had become more and more detached from her family, her moods were changing, she wasn't eating, washing and seemed totally unable to look after herself. When she started being incontinent and being seemingly apathetic about it her husband called in help. The GP (who didn't visit initially) arranged for her to be assessed by the AMHP who wanted her admitted to the mental health ward. The patient refused. The two GPs visited, agreed, left, and here we are.

We entered the house and were led through to the patient. She had an extremely vacant look in her eyes, her lips were pursed and she was acting in a bizarre, almost manic fashion. When she spoke she sounded drunk, but we were assured she doesn't drink. As is required, we checked her over and a few things just didn't seem right. He short term memory seemed to be poor, she was complaining of a headache and her skin was red hot to touch. She didn't have a temperature but I had that feeling that anyone who has worked on an ambulance has had. Something just isn't right. 

"I think she needs to go to A & E."

"No. She's going to the mental health unit for treatment. It's been arranged. You are here for transport." the AMHP snapped.

"And I think she would benefit from an assessment at A & E first."

"No."

Well that told me I'm only an 'ambulance driver' after all. The transport. I shared a look with the two police officers there, which as far as I was concerned gave me carte blanche to do what I wanted! Police and ambulance work together so frequently you just know that they will do anything we say and we would do anything they say. If I say A & E, they will support me! Without any fuss we got her onto the ambulance. She certainly had a decreased Glasgow Coma Score(GCS - a scale used to measure a patients levels of consciousness. A GCS 15 is normal. A GCS of 3 is completely unconscious) and after a quick examination it was clear she was dehydrated. Her blood pressure was also low. The AMHP was still outside the ambulance on the phone, still under the impression we were off to the mental health unit.

"Pass me the cannula roll will you?!" 

"Ha, he's gonna kill you!" (by cannulating and giving treatment she then HAS to go to A & E!)

"He'll need to get over it, she needs fluids and needs to be in A & E, this isn't PND, something is up."

"I agree!"

The police watched on as we cannulated and drew up fluids. 

"A & E then?! Do you want to break the news to him or shall we?!"

Because in a sick way I enjoy some confrontation I offered to break the news and unsurprisingly he was livid! He bleated on about all his wasted time and efforts at which point I interrupted him….

"Surely, what you want, like us and like the police is what is best for the patient?"

*mutter mutter, AMHP goes to his car, head shaking and tutting all the way*

By the time we left, we were that concerned by the patients rapid deterioration that we put in a blue call to the nearest hospital. On arrival I gave a handover to the doctor who promptly bleeped neuro to come and have a look. 

To cut a long story short, this was one of the rare occasions that we found out an outcome. A few days later I was told that the patient had a scan shortly after arrival and was diagnosed with an extremely rare and serious brain tumour. She was transferred to a specialist hospital and had surgery that night. The long term prognosis isn't that great. The problem was, as has happened to me before, it is so easy to get tunnel vision on a medical diagnosis that once set upon a treatment path, it is hard to stop it. In this case the fact she had just had a baby, and had had PND in the past it was assumed it was the same again. The early symptoms fitted with that diagnosis and so did the latter ones. Perhaps when the doctors visited she wasn't as bad as she was with us. Needless to say, there could have been a very different outcome.

Mental Health. Yet again it rears its ugly head again. The elephant in the room of health care and policing if you will. We all know it's there, we all know it's not dealt with properly yet everyone, until recently, has just hoped it will go away! If we bury our head in the sand, perhaps when we re-emerge and one of the other agencies will have dealt with it. Nope! It's still there. In Lord Adebowale's report, published this week, looking into the handling of mental health incidents by the Metropolitan Police, it highlighted a number of key areas for improvement. Most notably to me was the fact that far too many patients were being transported to either police stations or other places of safety without proper medical examination.

This shows why 999 services have to be careful about the risks they can be managing and think for themselves. Lord Adebowale sees a greater role for the ambulance service in responding to mental health emergencies irrespective of whether the police are in attendance. I think this should apply even if mental health services are in attendance, because I know from experience that basic physical health examinations are not as common as they should be.

Parity of esteem is mentioned in the report for physical and mental health - delivery on this is going to have to include not being too quick to assume things about patients with mental health histories to the neglect of their physical health. 

For further reading on the content in Lord Adebowale's report I recommend two posts by Mental Health Cop.  'The Adebowale Report' and 'My Reaction to Adebowale' both give a great insight into the reports contents and its impact and recommendations on police and the NHS. 

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'.