Materni-taxis

Ok, this may be a contentious issue and I don't mean to cause offence, but this is not just coming from the 'me' who works on ambulances. My opinion is partly geography biased, being in a city no one is ever more than 3 miles from a hospital, this means no one is ever more than a £6 taxi journey to a hospital, and this is where my frustration comes from. I fully understand that if you live in the middle of the countryside, 45 minutes from the hospital with no means of transport then yes, an ambulance is totally appropriate, but in the city I am sure any pregnant woman could save the cab fare over a 9 month period. By all means, call an ambulance if you need one but a contraction, waters breaking or a 'show' is not, and will not, ever be an 'emergency'! Please read this post in the spirit in which it is meant, an ambulance girl fed up with playing 'taxi' to expectant mothers whose partner follows in the car and lives 400 yards from hospital! If you need us, call us!


“27 year old female. In Labour”

So what! It’s an all too common job. A woman in labour calls an ambulance for a lift to hospital. She isn’t ill, she isn’t dying, she is going to give birth. Giving birth of a function of nature, thats’s what we do. Women have been giving birth since time began and I can assure you, that was long before the invention of the ambulance. Despite our obvious displeasure at being sent we drove there, lights and sirens and ‘save’ another pregnant woman too lazy to arrange her own transport. 

You don’t suddenly give birth. There is a 9 month pregnancy leading up to it. During that time you would have thought a lift could have been arranged. If not, a taxi?! A saving of just 25p a week throughout the pregnancy should be enough to cover it. Failing that, most people know someone or have a neighbor who transports their litter in a Chelsea Tractor. Bug them. Not us! Obviously, if something is wrong, or you have the urge to push, then that is a different matter but don’t take the piss.

We arrived on scene, grabbed all our kit; response bag, oxygen bag, maternity pack, entonox, Paediatric Advanced Life Support kit, inco-pads (yes, it weighs a ton) and headed to the front door. It took some negotiating to get us and our stuff past the 3 cars on the driveway but we made it. Mum-to-be was dressed and ready to go, bags packed and in the hallway, Dad-to-be clearly to excited to drive was fretting about everything, as was various other family and friends who were going to follow in the car. Contractions were coming along nicely, every 6-7 minutes, no show, waters not broken. This really was a life threatening medical emergency. Oh, and they hadn’t phoned the maternity unit or midwife. It’s OK though because we can do that for them too. Anyway, all aboard, boxes ticked, i’s dotted and t’s crossed we drove the 1.6 miles to hospital. Another life saved.

As mind boggling as this is, and as annoying as I find materni-taxis this isn’t why i’m blogging about it. Shortly after the job I tweeted the following on twitter:

“You’ve had 9 months to plan, call a taxi, get a lift from another mum in a Chelsea tractor. It’s labour. You’re not ill. You don’t need 999”

Within 3 minutes of this tweet I received the following message via my Facebook page, which quite frankly, made me seethe. The message was as follows:

“A woman in labour has every right to call an ambulance. The ambulance has all the medical equipment and the paramedics have the medical knowledge to deal with a birth, a taxi does not and neither does a neighbour with a 4x4. Show me where it says a woman in labour cant call an ambulance. Also while you’re at it show me the HPC code of ethics, as i think your statement is way off and to discourage any woman in labour from calling an ambulance is medical negligence. I would invite you to prove me wrong, if you can fine, but bet you cant??? A woman in labour without a way to get to hospital is hardly a sprained wrist and she much more in need for an ambulance than an elderly person who has just fallen over. I suppose you’re going to go onto long term illness and tell me i cant call an ambulance when my daughter is in DKA.”

Are you serious? What a deluded, self-centred fool. It is people like this which cause all the problems in this country. People who think they have the divine right to an ambulance whatever the circumstance, it’s selfish and greedy and exactly what i’d expect if this vulgar human called 999. Yes, you have a right to call an ambulance, if its an emergency, but normal labour is not. You’ll also be reassured to know that the only training a paramedic has on maternity is a 2 day course. We are given a very brief overview on how to deliver a baby in an emergency. Admittedly taxi’s and neighbours haven't had the luxury of a 2 day course but they don’t need it to drive your lazy arse to hospital. They need exactly what we need. Money for petrol. No where does it say a woman in labour can’t call an ambulance, it isn't advised though. The following has been copy and pasted directly off my employers website:

“Please think carefully before calling an ambulance in pregnancy or normal labour. Call your midwife, birth centre or labour ward in the first instance for help and advice. Ambulances are needed for life-threatening emergencies, and normal labour is not an emergency. During your pregnancy, it is important you discuss with your midwife the signs of normal labour and plan your transport to your chosen place for the birth. Initially any pregnancy or labour concerns should be raised with your midwife or birth centre. This includes worries with foetal movements, or if feeling unwell, as they can advise you further.”

To be honest, a) I can’t be arsed b) I don’t have the inclination to and c) I don't care enough to trawl through pages and pages of codes of ethics to find a sentence that will make my point and appease you. Your comment on the elderly speaks volumes about your character too. You are ill informed about the medical needs of pregnant women and to even suggest that a woman in normal labour is more deserving than a 92 year old lying on the floor with a fractured neck of femur is laughable. It’s people like you that cause these genuine patients to be left on the floor for 4 hours +. And as to your snipe about my sick leave, you don’t know me, you’ll never know me and what my sickness has to do with your daughters DKA I don’t know. What chance does she have anyway when your archaic opinions are what she has as an example to follow. No wonder the NHS is in crisis.

Obviously, I wouldn’t want to deter anyone who is in need from calling 999. On the rare occasions where an ambulance is needed for an obstetric emergency I would want someone to call. If:

• You are immediately about to give birth with a strong urge to push.
• If there is fresh bleeding which is more than an egg cupful (or two changes of pads).
• If you have severe abdominal pain that continues and persists after a contraction.
• If the baby’s cord is noticeable.
• If you are suffering from other medical emergencies, such as breathing difficulties or chest pain.

Call 999!!!! If however, you want a free lift to hospital and you are in normal labour, please don’t. It’s an unnecessary drain on resources and is a massively inappropriate use of an emergency ambulance. Rant over. Be safe x

She's gonna blow

"Running call, 17 year old male, unknown problem, ? unconscious"

It's 2am, it's cold, it's busy. We are on route to an assault; the road was empty and dark with only our blue lights to illuminate the high street. Just ahead we see an FRU at the roadside. We pass him giving the obligatory whoop of the sirens. About 30 seconds later we were cancelled for a higher priority. It transpires the FRU has been flagged down and has requested a truck. We swing the truck around and head back. Lying outside a pub in a lifeless lump on the floor is our patient. The FRU wanders over to us and explained that our patient has been drinking all night with friends, came outside the pub and collapsed to the floor. It appears the old 'fresh air' effect had claimed yet another victim.

This kid was seriously drunk; he wasn't unconscious but also couldn't form a sentence. Every question I asked got the same response.

"What's your name?"

"Dinesh"

"And your surname?"

"Dinesh"

"Whereabouts do you live?"

"D-I-N-E-S-H"

"Who's you next of kin?"

"Dineeeeeeeeeesh"

"And who is your GP?"

"Dinesh"

"Are you allergic to anything?"

"Di................nesh"

Well that cleared all that up. Nothing like a clear and concise history! My crew mate who had gone to sit up front was crying with silent laughter! We did all his observations and there was nothing untoward. He was just another alcohol related A & E admission statistic. In our defence we spent a good half an hour trying to sober him up in the hope we could take him home but alas, he was seriously drunk! He was accompanied by 3 friends, all of whom appeared shocked that he could be so drunk when they appeared so sober. We loaded them onto the truck to and headed off to hospital. 

We entered A & E to a sea of green. There were 5 crews with their patients waiting in the corridor to hand over and moments after our arrival a further 2 crews arrived. In one small corridor there were 8 crews, 8 patients and 14 friends and relatives. Our patient was still out of it so his friends were chatting between themselves, sat next to other patients and relatives. We were chatting to another local crew about the night so far, regaling tails of drunkenness and heroism! 

I looked over at the friends and one of them put their hands over their mouth and appeared to hiccup / burp which sounded like the gargle of a drain. I recognised that noise. She was about to blow. A purple liquid seeped between her fingers and a look of horror appeared across her face. It was about to happen and it was about to happen now. Like Mt. Etna erupting in all her glory, our patient's friend exploded. However, she didn't move her hands so the full force of her projectile vomiting came out either side. And boy was it projectile. The problem was she vomited on the guy next to her, and not just a splash, a full facial spray. This poor guy was there because he had been punched in the face and had a broken nose. He now had a regurgitated concoction of Cheeky Vimto and red wine which smelt foul! Everyone in the corridor was gagging. Like Moses and the parting of the waves, an exclusion zone was created around the chucker. Wave after wave of purple, lumpy vomit came. Eventually she got up and went to the toilet. We were left cleaning up the people she had soiled whilst trying to stop crying with laughter. 

I think the reason we were laughing so much was the sense of achievement. None of us had a drop on us, but every patient and relative on the bench was covered, it made a nice change. The whole situation epitomised a weekend in the city; an alcohol fuelled mess. When will these kids learn? I think the difference between them and me when I was that age wasn't the alcohol consumption and getting paralytic, it was the fact that I didn't need an ambulance or a hospital corridor to pepper with vomit.

Zero tolerance? Afraid not.........

"45 year old female, obnoxious asthma sufferer"

It was about 11pm, we had been to a lovely old guy who had had a fall and popped him to the local hospital. We stood patiently in the corridor waiting to hand over to the hospital staff. About 10 ft away was a middle aged woman sitting in a hospital wheel chair. She was obese, not very well dressed, her hair was that of a wild banshee and she had a very large chip on her shoulder. From what I gathered, she had been brought in my ambulance about 20 minutes ago for an apparent asthma attack.

The reason I noticed her was the swearing and shouting.

"Oi, am I booked in? I need a fucking bed, I'm ill"

She repeatedly barked abuse at any staff who walked passed and all that did swerved around her like she was a leper. I'm assuming she was well known to staff and had previous for this behaviour.

"I need a fucking bed, I've got asthma" (pronounced ass-em-eeer)

She was pretty relentless with requests for treatment. A few staff explained that there were many other sicker patients in front of her but she didn't seems to care. To be honest she didn't look or sound like someone suffering an asthma attack so I'm not at all surprised she was sat in a chair.

"Iv'e got asthma, you have to treat me. You're supposed to give me nebuliser (pronounced Nebooo-lizer) within 15 minutes, it said so on the news. I'm iller than all these people, I need a fucking bed"

Everyone appeared more amused than annoyed up until this point but when here abusive requests were ignored she began a torrent of racial abuse at a couple of nurses. Her ignorance was quite horrible to watch. What a sorry state our society is in when people like this are unashamedly able to voice these vile opinions and selfish demands. She wasn't ill, she was simply draining resources. Security arrived to subdue her and she got seen by a doctor in the corridor. What annoys me is nothing will happen, there will be no repercussions, no punishment. She will continue to repeatedly abuse A & E, probably claiming every benefit and disability allowance under the sun. Her racist abuse won't be punished and hospital staff will continue to treat her. And why? Surely when someone abuses staff their right to treatment is relinquished. At what point will the NHS and society as a whole just say No!

No, we won't accept this.

No, we won't treat you.

No, you can't have your benefits.

No, this isn't the end of it.

Yes, you have to leave.

Yes, the police have been called.

Yes, we are pressing charges.

Yes, you are never welcome in this hospital again.

Take this hard line, 0 tolerance approach and maybe just maybe things will slowly begin to change. In reality, she'll be discharged and be back within a few days, dishing out the same abuse as she does every time and as her abuse gets her seen what incentive is there for her to stop. There are similar signs on every ambulance and in every hospital stating:

In order to ensure that all patients attending this department receive the treatment that they need, it is essential that our staff are able to work without fear of attack, abuse or harassment. This Trust views its staff as its most valuable asset and therefore any abuse to those staff is totally unacceptable. Police assistance will always be requested when violent incidents occur and the Trust will support staff that wish to bring private prosecutions against the perpetration of physical abuse. 

In reality this hard line isn't followed. Police, if they turn up, defuse the situation but rarely make arrests. If they do no charges are made once the person has sobered up. Every day staff are subjected to this abuse but no one wants to be the person who refuses treatment, just in case. Again, the fear of backlash and litigation is palpable and while that fear exists nothing will change.

Whilst all this was going on our patient waited quietly and patiently and was thankful to us and all hospital staff for the help he had received. I bed he had to wait longer for his treatment than she did though.

Tis the season to be Jolly!

"26 year old female. Intoxicated. Drink has been spiked"

It's that time of year again, the festive season. A time for family, friends, presents and overindulgence. Oh, and Christmas parties. In the month leading to Christmas every business, every group of friends and every club will hold their annual Christmas bash. This generally means excess alcohol and good time had by all. This good time however is taken a step to far by the folk who can't handle their booze. For the ambulance service this means a massive spike in call volume. In London at the weekend, it isn't uncommon to see the CAD number reach 5500 a day.

Last week we were called to an office party in the city, the usual Christmas bash, a bunch of of well dressed  arrogant city slickers having a good time. Our patient was a 20 something in an absolute mess. She was lying in the corner, semi conscious, surrounded by a load of friends, one of which told us her drink had been spiked. The only thing her drink had been spiked with was alcohol. We established she had been drinking for 4 hours and had consumed red wine, white wine, beer, shots, shooters and shorts. Standard. We scooped her off the floor and walked her to the ambulance. She couldn't walk on her own, her legs were bowing and collapsing under her weight with every step. It resembled the walk of a new born giraffe.  We opened the door to the truck and despite our assistance she unceremoniously fell up the steps. (This was voluntary, she was supported by us but threw herself on the floor) She dragged herself to the bed and climbed up. Skirt rolling up to her hips displaying camel-toe for the world to see. It just screamed class. Her friends handed us her belongings and we started doing the usual checks.

Blood pressure was a low so we put some fluids up. As time went by our patient became more and more delightful. She began to swear and shout, spitting on the floor. She demanded the cannula be removed so we obliged. Despite her kicking off, we began the journey to the Christmas Piss Head Pit Stop. Its basically a hall, with mattresses on the floor manned by a few nurses and paramedics for the patients who are just drunk and need to sleep it off. It helps take the load off the already heaving A & E. 

"I need the toilet"

"We are driving at the moment, i'm afraid you'll have to wait until we stop"

"I need the fucking toilet" (said with much more venom"

"We'll be there in 5 minutes, you'll have to wait"

"I said, I need the fucking toilet"

With that, she got off the bed, the ambulance was stopped,  she staggered to the back corner of the ambulance and leaning against the door crouched slightly.

"Don't you dare piss on the floor"

She just looked at me, slightly cross eyes, pulled her thong to one side and started urinating. I froze for a split second, what now?! And there it was, just looking at me. Her jacket. I grabbed it and slung it between her legs. 

"What the fuck are doing?"

"Cleaning up your mess"

"That's my fucking coat"

"And this is my ambulance. I wouldn't piss in the corner of your office so don't for one minute think you can piss in mine"

This conversation didn't stop her by the way. She continued until she was spent. What a vile, disgusting person. If only here bosses at the bank could see their employee now. She might be well off, normally well spoken, intelligent, good at her job and a lovely person but now she is scum. She has taken getting pissed quite literally! She hurled a torrent of abuse and expletives, at which I opened the back door. She clambered down,  pissy coat in hand and minced off down the street.

"Happy Christmas"

"Fuck off"

Thou shalt not lie........

"43 year old female, chest pains"

Patients lie. It's a fact of life. They don't necessarily do it on purpose but do it all the same. They will tell you one thing, then tell a doctor something else. They will tell you they are in so much paid when they clearly aren't. They will say the have no allergies when they do. They omit crucial parts of their medical history, like have 2 hearts, 1 lung, blindness or extra kidneys. This particular day was your big standard, non cardiac chest pain, no risk factors, right sided and most likely muscular.

We arrived at the house, it was in a nice road, in a nice area and were greeted by a well dressed, well spoken gentleman. He led us through to his wife who was doing her best impression of a dying swan on the sofa. Writhing about, flannel on head, moans and groans galore. From her history I was confident she wasn't seriously ill, her pain score was 10/10 (it wasn't, this was her first lie) but we have to take what a patients says as possibly true. Admittedly, pain is subjective, nether the less, I know a pain score 10 and this wasn't it. Her pain appears to vanish when she was talking but as soon as she stopped it was back. I asked about any allergies and past medical history. No allergies and no previous chest pain (this was her second and third lie). She said the pain came on whist carrying stuff up stair (fourth lie).  She also added she doesn't take any medication and is normally fit and well (fifth and sixth lie). As it was chest pain, as much as I thought it was a LOB we chaired her to the truck. 

On board, we did the usual battery of tests, sitting / standing blood pressure, ECG, cardio assessment, thorough history etc. All was fine, except her pain was worse. She started using buzz words like central and crushing, feeling clammy. *sigh! She wasn't, I knew it, my crew mate knew it and so did her husband. I got the impression she was a huge hypercondriac. Anyway, as I couldn't prove she was lying, so I treated as per guidelines. GTN, Aspirin, Morphine etc. Now the second, fifth and sixth lie became apparent. She DID have allergies. She was allergic to aspirin. It also transpired she was on gastro-restraint tablets due to a stomach ulcer so to say she was on no medication and was normally fit and well was simply not true. Anyway, I gave her the GTN, popped a line in to give some morphine. I flushed the cannula through with 10mg of saline flush. Within about 5 seconds she said:

"Wow, that stuff is amazing, the pain is almost completely gone" (and there is the first lie, 10/10 my arse)

"Really?! What's your pain score now?"

"2/10"

"Excellent, we'll head off to hospital now"

It appears the placebo effect of saline was the miracle cure she needed. Ok, to be fair, she thought she was getting morphine, and she was going to, but the placebo effect did wonders so I didn't tell her the truth until we were at hospital. If they can lie so can I.  Not totally ethical but totally necessary! We trundled off to hospital with our 'cured' patient. We took her into A & E and were greeted by a nurse.

"Hello Jane, back again?!" (me and my crew mate exchanged a look)

"Yes, my chest pain came back again" (Again? and there is the third lie)

"Did it come on while resting again?!" 

"Yes, I was just watching TV" (And there is the fourth)

Apparently Jane has been to A & E 5 times this week. Same complaint. Same discharge summary. Nothing found. This information would have been useful prior to carrying her and treating as a new chest pain. In the 40 minutes with her she told six lies. This isn't uncommon. You learn to take what patients say with a pinch of salt (within reason) and like a episode of CSI, piece together what is actually going from various peoples different stories and their observations. 

I wish there was a way to stop the lies but there isn't. Everyone does it, myself included, however, if you are going to call an ambulance you should expect to be questioned about your medical history. These questions aren't because we are being nosey, it's because a full medical history has a massive baring on diagnosis and treatment. Lie to us, and we pass your lies onto the hospital, and before you know it your symptoms are worse because you've not told us about medication you're on or allergies you have. So, in the words of the lord almighty, "You shall not bear false witness against your neighbour.” Exodus 20:16. In other words don't lie you muppet.