Fat people, stairs and backs

The EMS Theory of Weight: The weight of a patient that you are about to transport increases by the square of the sum of the number of floors which must be ascended to reach the patient plus the number of the floors which must be descended while carrying the patient.

• Corollary 1: Very heavy patients tend to gravitate towards locations which are furthest from sea level
• Corollary 2: If the patient is heavy, the elevator will be broken, and the lights in the stairwell are out
• Corollary 3: The further the distance from sea level, the iller the patient will be

"48 year old female, keeps fainting, patient is obese, weighs 35 stone"


On receiving this job, and physically hearing our backs scream 'Nooooooooo!'three things were going to be absolutely certain about what was going to happen.

1. This was going to take ages
2. This was going to hurt
3. She was without doubt, going to be upstairs

As predicted the patient was upstairs, and not just upstairs, up 4 flights of stairs. The corridors in her flat were winding and narrow so extrication as predicted would take ages.  I've never seen someone so large in person. Ive seen people on the usual TV programmes but this was absurd. How can anyone let themselves get like this? She was pale and sweating, and looked ill. She was indeed fainting, every time she sat up in fact. Her list of ailments was as long as my arm and exactly what you'd come to expect from someone that size. Heart failure, diabetes, hypertension, high cholesterol, bed sores, the list goes on and on. It transpired that she hadn't left her bedroom for 4 years. Well, that was about to change!

After giving her the full MOT including ECG (I will be scarred for life) it was clear she had to go to hospital. The problem being was how? She was too big and heavy for our chair (and impossible to lift) and was too heavy for our trolley bed. She also a) couldn't walk and b) fainted when she sat up. We contacted control and arranged for the bariatric ambulance to be dispatched. The bariatric ambulance has special chairs and beds for such situations but cost a lot of money. For the ambulance alone it's about £100,000, special cushions cost about £2,500, stretchers are between £7,000 to £10,000 while reinforcing vehicle tail-lift costs about £800 per time. Heavy duty wheelchairs cost at least £400 and hoists are £4,500 a time, however, all of this was useless as she needed to be kept flat, so there was only one thing for it. The fire brigade and a crane!

This is obviously not our patient!!! That would break the rules!!

In all their glory the fire brigade arrived, kitted up, erected cranes and ladders, removed the double glazed windows and then assisted us to get the patient into a bariatric scoop. Inevitably, by the time she was craned out the window a rather large crowd had gathered. Obviously, I was thriving on this but it was mortifying for the patient. With strict instructions as to how I wanted her removed she was craned down to us, and onto the aforementioned £10,000 bed. To cut a long story short, we got her to hospital, my back still in one piece and the patient still alive, but at what cost? We had been on scene for over 5 hours, as had the FRU. We had the bariatric ambulance and the fire brigade as well of the cost to put her windows back. I'd imagine the fact that she was in a 2nd floor council block and hadn't left the house for so long meant she was on all the benefits available to her. The only cost to her today was her dignity and health. 

At what point did society allow gluttony to become a disability? I am NOT talking about those among us, me included who are overweight or even obese. Those who live to excess, enjoy the nicer things in life and don't care. You can do all that and still be relatively health. You don't need a crane though. When your size means you cannot work THAT is to much. At what point will something be done to stop this growing trend? Do we just throw specialist equipment at the problem? Whatever next? Call in the Army with a Chinook helicopter to replace the inadequate air ambulances? The only way people will learn is in their pockets, if the NHS doesn't fund obesity treatments and stops offering gastric band surgery like paracetomol maybe there will be an incentive to self-help. There is also a financial cost in sick leave to staff. Every single day, ambulance staff go off on long term sick due to back injuries from lifting obese people up and down stairs. This isn't an assault on the overweight. Far from it. People can function being overweight, they can do most jobs and can be self sufficient but it becomes a problem when the ability to do every day functions is compromised. When someone becomes reliant on others due to greed and excess that is where the line has to be drawn. Being classed as disabled, not being able to work, walk, shop or wash because of indulgence is not acceptable, nor is relying on ambulance staff to carry you up and down the stairs.

I'm sure some people will be offended by this stance but quite frankly, I don't care. I know that morbid obesity is an illness, like alcoholism, but they are both avoidable & they are both lifestyle choices. People are born with all sorts of incurable diseases, cancer can grip anyone at anytime but no one is born morbidly obese. It's nature vs nurture where nurture has won. There may well be social and psychological reasons behind peoples obesity and I look at that in 'Obesity: The cause, the cost, the solution'. but that doesn't exempt them from blame or responsibility. I'm not suggesting they don't deserve the same high standard of treatment everyone else gets, I'm saying we must find a prevention rather than a cure. 

A Feline Frenzy

"Sick cat, feeling suicidal, wants to kill herself, caller states she is hitting and trying to hurt / kill the cat"

Where do I start? Obviously, there is an issue as to who the patient is? Is the call taker talking to a cat? If so the the call taker needs to be seen.  Is the cat sick? Is the cat suicidal? If so, how is the cat intending to kill herself? If the cat didn't call then why is the caller trying to hurt / kill the cat who is clearly already sick and suicidal? Or, is this an assisted suicide case? Is the caller trying to help the cat end it's suffering? Or, is the caller suicidal because her cat is sick? But if the cat being sick has made her suicidal then why is she hitting the cat? Are we going to walk into a feline bloodbath? Will the cat have taken an overdose? Will cat and caller both be dead on a bed resembling a scene from Romeo and Juliet? There are so many questions and we haven't even arrived yet.

When we did arrive, full of uncertainty and intrigue, we were met at the door by the caller, not the cat. She was a large lady, with hair resembling 'Doc' Brown from Back to the Future! She was panting and sweaty. It transpires that she is suicidal because she can't catch the cat. The cat was under the bed, hiding from woman who appears to be suffering 'general mentalness'. The cat was sick, the cat isn't sick, but was just sick. On the kitchen floor to be precise. The caller has since been trying to catch the cat, to hurt / kill it for being sick. As she has been unable to catch the cat she is now feeling suicidal. This cat has caused a lot of problems.

So, what do we do? The patient won't be reasoned with. As far as she is concerned the cat needs to die. She doesn't think she is being irrational, in fact she doesn't understand why we won't assist in the 'kitty carnage' she has planned. This my friends, is mental health at its very best. We can't leave her, the cat will die. We can't take her, she has capacity. So all we have left was a sectioning. She has said she intends to kill herself if she can't kill the cat. We have a duty of care to her. And maybe the cat too. I'm not sure on that. Jokes aside, when talking about anything other than the cat, she was rational. In fact, she seemed normal, say the word cat however and all hell broke loose. Images of Tom and Jerry repeatedly sprung to mind. After much faffing and many wasted hours the police eventually managed to convince her to come voluntarily. I'm sure the cat smirked as she was led out of the house. How bizarre!

No excuse

"Emergency Service workers assaulted - Again"

As I grew up, I was led to believe that the emergency services were good people. The police caught the robbers, the firemen dragged people from burning buildings and paramedics helped people who were hurt. The thought of attacking these good people was not a notion that had ever crossed my mind. It wasn't until I was old enough to read or be interested in reading the news that I began to hear of the violence and abuse which emergency services have to deal with on a daily basis. 

Obviously, wrong as it is, the police expect it and are used to it, and therefore are trained to deal with it. Battons, CS gas and Taser guns are but a few of the things at their disposal. The firemen, who do not have such tools nor the training do however have strength in numbers. They generally respond 2-3 engines at a time and lets be honest, 18 fireman isn't an easy target for abuse. We however, travel in pairs at best, often solo in a car with only a 1/2 day course in conflict resolution.

Verbal abuse is a daily occurrence as are threats of violence, but more worryingly acts of violence are becoming common place. In the past year or so, only a handful of high profile incidents are reported on the news, most notably the crew who got shot at. This however is not an isolated incident. I personally have had a knife pulled on me, been punched and kicked, spat at, had bottles thrown at the ambulance and that's just in the last year. I've had friends chased with poles, pushed down stairs, surrounded by youths, had threats to their lives and driven at. These don't make the news, they simply become mess room moans.

We are an ambulance service, we work horrible shifts, long hours, night and day, rain and shine to help people. We shouldn't have to go to work with fear of assault or abuse. The fact that stab vests are standard issue speaks volumes of the state of this country, but what is going to be done about it? The signs in the trucks say how anyone who abuses the staff will be prosecuted blah blah blah but in reality nobody is. Nothing happens. The CPS never have enough to prosecute and the police rarely take it further than diffusing the situation. What will it take for something to be done to solve this problem? Crews to be crippled or killed? Will there be public outcry then? Every one knows the problem exists but no one is willing to make a zero tolerance stand against it and until they do, going to work with the fear of getting sworn at, spat at, punched or kicked will be the norm.

Chasing tails

"55 year old female, Collapsed outside, intoxicated"

The call was nothing special and certainly nothing out of the norm. It was however 3 hours old. We accepted the job are started trundling towards it voicing the usual moans and groans about the LOB we were about to 'help'!

During the moaning our radio rang. The 'all seeing eye' in the Ivory Tower had an update for us:

"Just to advise the patient isn't outside number 49, they are inside number 26. The caller claims we are no longer required as the patient was just drunk and has now gone to bed, however, we can't confirm this as the patient isn't answering her phone so you will have to attend to confirm she is ok"

What are we doing? Is this what the ambulance service is for? We can't even be annoyed with the patient, she got drunk, made here own way home and now some top bods in control want to use an ambulance to check on her! No one checks on me! Do they not know why she isn't answering the phone? I'm assuming they are looking for an answer more complex than BECAUSE SHE IS PISSED!! What a waste of bloody time.

Anyway, back to the matter in hand. We pulled up at the estate entrance, glanced the the map which may as well be in hieroglyphics and tried to navigate a path through the rabbit warren of poorly labeled and numbered flats. Eventually we found it, on foot I may add. We knocked......nothing. We knocked again.....nothing. We informed 'the brain' that there was no answer. After a slight pause we were told the police were on route as it may be a collapsed behind closed doors! Amazing! More resources wasted! After a 40 minute wait for police they arrived. Using their universal key (a big red lump of metal) we were in.

And there she was......in all her glory, naked on her bed. Lush! Fast asleep. Shocker! We woke her, got a torrent of verbal abuse and left. In all, at a cost to the tax payer, an ambulance and 2 police cars were utilised on this and to what end? Who is making these decisions? A member of the public had called it in and subsequently cancelled. When the service is under so much pressure to meet targets and respond to the huge volume of  calls a day, is chasing our tails really the best use of an ambulance? This was quite simply an arse covering exercise but to what extent will we be offering this service! Will every no trace have a full search and rescue, will every non conveyed have routine ambulance follow ups or will someone for once just have the balls to say no!

The Witching Hour

"25 year female, feels a sense of injustice"


Working long shifts is part and parcel of life in the ambulance service. Generally 12 hour shifts are the norm and late finishes are a daily occurrence. The late finishes are accepted as 'thats just how it is' and generally we'd rather finish half an hour late by choice than leave ourselves open to being abused by the system. Sometimes, a late job is inevitable and if its for someone in need we don't care. However, one of the biggest gripes on working hours in the ambulance service occurs over Halloween weekend every year. The clocks go back an hour. This one hour causes more bone of contentions between front line staff, control, and management than any other late finish during the year partly because its compulsory overtime and also that with foresight it could be avoided.

A 13 hour shift isn't rare, in fact it occurs at least once in a run shifts through incidental overtime. However, being forced to do a 13 hour shift + incidental overtime is not accepted by staff. Especially, without a break and when your are due in again 10 hours later to do it all again. This year I was on a 19:00 - 07:00 shift. As I had no break I was due to finish at 06:30. I was due back in in the evening at 18:00. With the ENFORCED overtime this made it a twelve and half hour shift. At 06:14 (1 minute before I was Red 1 only) we were dispatched 8 miles away to a 'fall'. This fall turned out to be a nightmare job, legal gray areas surrounding capacity and consent meant we didn't finish at hospital until 08:40 so didn't sign off until 09:00. That, is 15 hours after we started without a break, due back in in 9 hours -travelling time. Legal? In a word, No.

Below is The Working Time Regulations 1988 No.1833 Part II as set out in European Law.

Maximum weekly working time
4.—(1) Subject to regulation 5, a worker’s working time, including overtime, in any reference period which is applicable in his case shall not exceed an average of 48 hours for each seven days.

Daily rest
10.—(1) An adult worker is entitled to a rest period of not less than eleven consecutive hours in each 24-hour period during which he works for his employer.

Rest breaks
12.—(1) Where an adult worker’s daily working time is more than                six hours, he is entitled to a rest break.


(2) The details of the rest break to which an adult worker is entitled under paragraph (1), including its duration and the terms on which it is granted, shall be in accordance with any provisions for the purposes of this regulation which are contained in a collective agreement or a workforce agreement


(3)Subject to the provisions of any applicable collective agreement or workforce agreement, the rest break provided for in paragraph (1) is an uninterrupted period of not less than 20 minutes, and the worker is entitled to spend it away from his workstation if he has one.

This was a 62 hour week, during the 15 hour shift I received no rest break and only had a 9 hour gap between shift times. In reality that's 7 hours at home in which to wash, sleep and eat. We can have the 11 hour gap as required by law but if so we loose out on an of the enforced overtime that we have earned. At no point do management or control show any remorse for what the front line staff are having to do. Managers (most not all) spend their days hidden in offices, chasing up targets. EOC staff get a 15 minute break for every hour they are sat at a computer and don’t finish late. They kindly sent all crews the following message at midnight:

‘Just a reminder that all crews are required to work the extra hour as per policy’

Gee, thanks! As kind and considerate as we have come to expect. (This is aimed at the OCM's not the dispatchers). Then of course the totally avoidable late job to add to the fatigue and frustration.

For too long now ambulance staff have been abused by the small print and technicalities in the law that the management policy writers use to get as many working hours out of us as possible. They are in constant breach of the law and nothing is done about it. The working conditions are nothing short of archaic and its of no surprise that staff are leaving at an alarming rate. 3 years ago a large amount of new staff were taken on and the fact over 25% have already left speaks volumes about the way we are treated.

The question which should be asked is, if you, your friend or you family were seriously ill and needed an ambulance would you want one, who had been working for 14 hours or more without a break? No is the answer. It isn’t good for patient care and it isn't good for our health. What will be done about it? Nothing. I have no doubt in 12 months time i’ll be whining again but that's my right. Rant over.