24 - Season 3: Episode 3

continued……

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

00:00

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

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

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

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

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

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

BINGO! *takes a bow*

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

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

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

“How long has this been going on?”

“Since the afternoon.”

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

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

*Facepalm*

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

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

01:15

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

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

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

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

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

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

“Evening! Need a hand at all?!” 

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

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

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

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

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

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

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

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

Time to press the button again…..

To be continued…..

Iron Man

"RTC, Car vs Ped, 8 year old male, injuries unknown"

Do you remember the energy you had a child?! You could effortless run and run and run! Especially in the sun! It was amazing! I remember playing on the pavement in my road all summer long! Kicking a ball against a wall, playing hide and seek, having water balloon fights with other kids across the road, it was amazing! It is probably the most memorable part of my childhood, and the kids I played with then are still my best friends today, 20 years on. I remember kicking a ball across the road causing a driver to slam his brakes on.  I ran into my house, through to my garden and hid! A minute later my dad appeared, red faced and telling me how stupid and dangerous I had been. It was a quiet road but cars still came down, in hindsight and with what I now know it was incredibly stupid but hey, I was 9! 

Today was a particularly hot summers day. A glorious Saturday, not a cloud in sight. Everyone was in their summer clothing, parks were bustling, kids were everywhere having fun, there was a smell of BBQ in the air and I was.....well I was wearing thick green trousers, heavy boots, a heavy green shirt and was sat in a car with no air conditioning! Living the dream! It had been a quiet day, I was looking forward to my own BBQ in the evening with friends so was heavily clock watching!

My peace and quiet was interrupted by noise of my MDT giving me a job! And it was outside in the scorching heat! Typical! The age of the patient worried me and continued to worry me as I raced round to the address. As I pulled into the road I saw the huge crowd of people and the blue lights of a police car. That would certainly make things easier! I grabbed my stuff and rushed over.

Lying in the middle of the road was a little boy. He looked absolutely terrified. There were tears rolling down his face and all the adults seemed more concerned with vilifying the driver of the car than tending to their son. Holding the boy's head still and talking to him was one of the coppers and he was doing a great job. I set about fitting a collar and assessing his injuries. It quickly became apparent the despite his crying and talking he was in a very bad way indeed. A life threatening kind of bad way. I had no ambulance and no idea how long one would be, so called for HEMS straight away. Luckily I was near a wide stretch of road so there would be plenty of room for the Helicopter to land. 

The little boy kept asking me questions and crying out in pain. I gave him Entonox to try and distract him from the impending needle that was about to enter his arm. He promised to be brave like Iron Man would be. We talked about Iron Man the whole time I was with him, only occasionally did we digress to other, lesser superheroes. I tried to keep him alert and talking but it was becoming harder and harder. I could see the bruising on his flanks getting worse and knew it was likely a ruptured spleen. His leg was also broken. I told him I had to move his leg and it would hurt. He nodded and starred intently into my eyes. While taking about who would win in a fight between Iron Man and Batman I straightened his leg.  He yelped.

By now the chopper was overhead. The police blocked the roads and it landed about 30ft from us. The Dr's and Paramedics came over to me. I handed over and they did their thing. They gave the boy a soft toy helicopter which lit his face up. The decision was quickly made to sedate him and get going. Only now did his parents start to realise the gravity of the situation. Because he was going in the chopper they couldn't go with him. As a parent I can imagine the pain that not being with him would cause. It was a highly emotional situation. To see your little baby, be loaded into a helicopter, unconscious, with tubes sticking out of him must be absolute torture. 

I watched as they took off and disappeared into the blue sky. The parents left in a police car and as usual I was left to clear up. For a child to survive an impact like that and to survive the injuries he had received would take a miracle as far as I was concerned. What a tragic way for such a beautiful day to end up. I could imagine the joy he was feeling, the fun he was having as he ran out between the cars on his quiet road. I spared a thought for the driver of the car. I couldn't live with killing a child, albeit accidentally. Just a tragic, tragic day. 

*Two weeks later*

I was in the thick of more trauma and again I had HEMS come to me! Same crew as before and I asked them about the boy. He was alive and well and is expected to make a full recovery. There are miracles.

Iron Man lives on.

51 minutes earlier

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

"Get me out of here!"

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

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

"Have EOC come back to us yet?"

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

"Sure."

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

*radio rings*

"HEMS on way, eta 12 minutes."

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

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

"Rog"

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

"Nope, no carotid."

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

*police and fire brigade arrive*

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

"What do you need from us?"

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

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

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

"Any long bone fractures?"

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

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

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

*second ambulance arrives* 

"Hi guys, what needs doing?" 

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

"What about the guy in the front?"

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

"F#%ing hell!"

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

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

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

"Does anyone know what happened?"

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

"Still in asystole."

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

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

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

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

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

"HEMS are here."

"Hi guys, where are we?"

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

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

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

After about 5 minutes the resus was terminated.

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

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

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

51 minutes earlier......

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

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

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

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

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

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

*          *          *          *          *

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

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

Sync Complete

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

'Sync complete'

24 - Season 2: Episode 3

continued......

The following takes place between the hours of 12:18pm and 3:50pm

12:19

"56 year old female, back pain, not alert"

Really?! The old 'not alert' has upgraded this job to one suitable for a car apparently! Also, the back pain
in a certain age is interpreted as possible chest pain, but still, I wasn't impressed with having to go. Mainly because I'd just convinced myself I was about to eat! Foolish! The job was just round the corner so I headed round, without even needing to turn the lights on! I pressed 'on scene' just as the call was downgraded to a low priority! Dammit! Had I have been a bit slower I would have been cancelled!

I was met at the door by the patients daughter who beckoned me in. They were a Somali family and only the daughter spoke English, but she spoke very well so there was no problem translating. I assessed the patient, did her ECG and within 20 minutes I'd done everything I could and found that she had a simple case of 'hurty back'. Despite my best efforts to convince them that hospital wasn't necessary, she wanted to go and get checked over. That meant a looooong semi-awkward wait for an ambulance!

I think the difference in cultures means that when a family emigrate from a country like Somalia, where the concept of pre-hospital care doesn't exist, expectations of what to do are different. They have no alternative care pathways, visiting GPs or chemists with drugs to treat most menial problems. In their country, if you are ill, you go to hospital, it's that simple. The idea of being 'ill', being seen by an ambulance and NOT going to hospital seemed foreign to them. I suppose that's where education via the GP would come in handy!

The wait for an ambulance really did become awkward! There were plenty of ominous silences to make me cringe, occasionally interrupted by my apologies for the delay! There is only so much you can talk about, to a group of Somali women who don't speak English! Eventually the crew arrived and I was able to make a quite getaway!

FOOD!!!!!

I made myself available and headed to the shop! I literally went to the first one I came across which happened to be a Wild Bean Cafe at a BP Garage. I grabbed a selection of high calorie, processed rubbish and went to pay.

14:38

"RTC, car vs pedestrian, ? Injuries"

I swear they are watching me! They must me! It's every time I try and eat! EVERY SINGLE TIME! Dammit!

The job was 13 miles away but without even a grumble (that they could hear) I shot off. In reality I was swearing and bitching to myself and moaning out loud the fact that a) I was hungry b) this job is miles away and c) I was hungry. See, I have a food problem! I cant stop thinking about it, yet can't bloody get any! Again, I was weaving in and out of traffic on A roads, B roads, side streets and bits of kerb! I like to mix it up! I was making good progress, and like with all semi-serious / serious jobs I was building a game plan as I went along. 

Left turn, right turn, onto the wrong side of the road and round a traffic island. Through some red lights, back onto the wrong side of the road and lights off, sirens off as I approached a fast duel carriage way! Wouldn't want to be the cause of another crash! Once the lights changed, the noise was restarted and off I went! Left turn, right turn, blah blah blah! It really is good fun at times! Only 4 miles to go!

'CANCELLED: 'Quicker responding unit'

1, 2, 3, 4, 5, 6, 7, 8, 9, 10.......AAAARRRRGGGGHHHH! Right, FOOD! Or not....

15:01

"31 year old female, sickle cell crisis"

OK, this wasn't far, sickle cell is simple, give pain relief until the ambulance arrives, handover, go and get food. That is as simple a battle plan as can be! This time I made it on scene without a cancellation, grabbed my stuff and went over to the patient who was sitting on the back seat of a car, in the grounds of a hospital. I know what you're thinking, but it was a mental health hospital! I started talking to her and became aware of the some ECG electrodes on her hands and ankles! Specifically, ambulance ones!

"Have you had an ambulance today already?!"

"Yes" she said, wincing in pain.

"So what happened?"

Her friend interrupted....

"She was taken to hospital but we waited like, an hour and they didn't do nothing so I brought her here cause I thought this hospital would help, but they won't."

"This is a mental health hospital, she needs to be in A & E. All the hospitals are busy and she will have to wait anywhere she goes, it's just the way it is I'm afraid."

*patients friend kisses her teeth at me*

"Well we ain't going back to dat s**t hole."

"Well that is down to the ambulance crew that arrives. You can discuss it with them."

With that I begun offering Entonox.

"I need morphine, that's all I can have."

"Well lets try this first and see how you go."

"No, just give me morphine."

On cue, the ambulance arrived! And as luck would have it, it was the crew who took her to hospital a few hours earlier. They broke the news that she had self discharged on arrival because the hospital knew her to be a morphine junkie who didn't even have sickle cell! She simply pretended to different ambulance crews and different hospitals across the city! Luckily she had been rumbled and after some foul mouthed expletives and some teeth kissing they drove off! Presumably to go and call another ambulance from somewhere else. 

No wonder the NHS is up shit creek without a paddle! This is what we are up against!

I popped into the hospital to use a loo, it'd been a good 10 hours! My bladder control is good but seriously.....! Inside the building I was greeted by an 'Out of Order' vending machine! FOOD!!!! Oh the torture! Anyway, not wanting to discuss toilets further, I did my paperwork and made myself available for another one! This day was becoming ridiculous! It's never this busy on the car! What next?! 

To be continued.....

Welcome To The Jungle

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

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

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

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

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

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

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

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

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

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

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

Sink or Swim

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

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

He stopped me in my tracks and said:

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

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

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

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

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

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

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

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

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

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

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

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

"Touché!"

Making Plans

There is an unwritten rule in all ambulance services. It is a rule we all know well. It is a rule that our friends and families know. It is a simple rule.

"THOU SHALT NOT MAKE PLANS ON A WORK DAY"

Simple. Why? Because if you make plans you WILL finish late and you WILL let people down. Again and again. Do we all follow this rule? In general, yes! Do we ever disregard the rule and think that just this once it will be OK?! Yes! 

On this particular Saturday I had a short shift. I was due to finish at 3pm so despite the obvious rule, I felt it was pretty safe to make some plans. My reason for this was a friend was visiting. A friend I haven't seen for a very very long time. They don't live anywhere near me but on this particular day they were free to see me for a few hours. In fact, they were free from 3pm until 8:30pm to see me! I was pretty dam excited, just a little shift to get through first!

12:03:  I got a text. "I'M HERE!"

The shift was ticking along nicely, I hadn't had a break so at 14:30 I was off into town for some catch up, coffee, cocktails and cake! Winning! I even gloated about it on a number of occasions!

13:35: "Hurry up! I'm bored!"

We finished up with our patient at hospital and made ourselves available for our last job. It was busy on the road, we had been going from job to job to job all day as per usual. I pressed the 'Green' button and waited for the job to appear......

And I waited......

And waited some more......

Nothing! As the minutes ticked by I began to get more and more annoyed! 13:45 came and went as did 14:00. 

14:10.....

14:20.....

14:25..... *crosses fingers*

14:28.....

14:29.....

"RTC Car vs Ped, 34 year old female unconscious"

ARE.....YOU.....SERIOUS?! Off we went, I had just enough time to send a message saying 'Late job, sorry!" We made our way through the now solid traffic. After about 5 minutes we arrived on scene. A crowd had already formed in a well formed semi-circle, 3 people deep all staring in fear and anticipation. Lying in the road surrounded, by a group of 5-6 people rendering aid was our patient. She wasn't unconscious but she wasn't far off it. Just a quick look at her told me that we needed HEMS and we needed them 5 minutes ago. 

The three of us on scene went about the routine. We utilised the public to fetch stuff while clothes were being cut off, primary survey was being completed and an assessment of her injuries was being done. This lady was big big sick. Major head injury, long bone fractures, likely spinal injury and who knows what internally. She had a collapsed lung and based on her blood pressure she was losing a lot of blood from somewhere. I decompressed her chest while my crew mate got IV access. So much was happening, it all seems a bit of a blur even now. Her leg fracture was pulled straight, to which she let out a gut wrenching moan. The police were had arrived and were doing everything that we couldn't manage with the 6 hands we had! 

I couldn't tell you how much time had elapsed but just as the patient started to have a convulsion there noise of the helicopter could be heard. Now there's a sound that filled me with joy! By now the patient was on a scoop, the injuries were being dealt with and the student was ventilating her. His eyes were so wide open, concentrating so hard on his task and he was doing it bloody well. This was his first trauma, first HEMS job and first really sick patient. I remember what an adrenaline filled gibbering wreck I was after my first! 

With HEMS on scene we got the patient onto the bed, still in the road, still with somewhat of a crowd! They decided to RSI (Rapid Sequence Induction) her which means to put her to sleep and take over her breathing. This was done, blood transfusions were given and we were off to hospital. The decision was made to convey the patient in our ambulance with HEMS on board. Off we went! Through the traffic, complete with police escort. We burst through the door of the resus and HEMS handed over to the waiting trauma team. The patient was transferred and we returned to the vehicle.

It looked like a bomb had gone off. The student was like a 5 year old on Christmas day, bouncing off walls with excitement! The truck took a while to clean and then there was a HEMS debrief and then all the paperwork!

16:39: Left hospital. 

Being a trauma centre, we were now no where near our station and had to sit on the Saturday afternoon traffic to go 13 miles across the city. I had a plethora of messages on my phone asking what was going on! Awkward......

18:03: Arrived back on station

18:20: Signed out and left work to cycle the fastest I could to get to the station to make the 18:44 train.

18:43: Arrive at train station. Lock up bike. Watch train pull out of station.

The next train was at 19:14. I was a 1 hour journey to get to the part of the city where my friend was waiting for me. Time for a phone call.

"I'm so sorry, I won't get there until about 20:15."

"Not much point is there!"

"I guess not."

It happens every single time. It has led to many an argument and many a tear. I'm still waiting to see my friend!

That'll teach me to think I can defy the ambulance gods. Gutted! Thou shalt not make plans on a work day. I won't be making that mistake again......until the next time anyway. :-(

Flowers

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

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

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

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

9 minutes earlier......

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

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

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

"Roger, on way"

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

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

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

As we were........

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

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

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

"Claire, open your eyes!"

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

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

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

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

C'est la vie.

1 week later......

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

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

No flowers. No memory.