Hospital Corridors.........

"48 year old male, RTC car vs car, neck pain"

A pretty average job on the surface. A low impact collision, two patients with neck pain, no real trauma but all the necessary immobilisation precautions needed to be taken. Our patient was a big lad. We collar and boarded him, gave him a full assessment and took him to hospital. The other crew did the same and we arrived within minutes of each other. It was the arrival at hospital where winter pressures and government cuts were there for the everyone to see. As we entered the corridor leading to the A & E department we were greeted by 4 crews. Each with their patient on a trolley bed. Sitting patients, waiting to hand over to the nurse. With our two patients that made 6 trolly beds, 6 patients and 12 staff. There were long delays to hand over due to a lack of capacity in the hospital.  Within 20 minutes of us arriving another 5 crews arrived with their patients. That is 11 trolly beds, 11 patients and 22 staff. 11 ambulances were sat outside, unmanned and unable to answer calls. Out patient began to get distressed about the delay. Bear in mind lying on a spinal board, with a collar round your neck and strapped down is not comfortable. Add to the the pain you're in, the lack of privacy, the need for the toilet and the view of a dirty, tiled suspended ceiling and no one would be happy. We made a number of attempts to get the spinal patients assessed so we could let them out of their prison but all requests fell in death ears. All in all, we waited just over 3 hours for a handover and we were 5th in the queue. I have no idea how long number 11 had to wait. It's also worth noting that the 4 hours hospitals have to discharge or admit a patient doesn't start until they have been handed over! 

We are not far from this.......

Recently the media has latched onto patients waiting in hospital corridors due to a lack of beds. The problem is, it is a seasonal story, repeated every year. They want to blame. Whether it be through political agenda or personal opinion the same inaccurate stories (usually the Daily Mail) are published. The problem is, it isn't anything new, it happens all year round, every single day, the only difference being, in the winter there are more people waiting than normal. Hospitals are at bursting point and until the 'winter pressures' have passed it won't ease off. And let's make one thing clear, it isn't a physical lack of beds that cause the problem. It is a lack of staff to look after the patients, and a lack of staff caused by a lack of money. That lack of money is a direct result from mindless government cuts. I'm not saying cuts don't need to be made, they do, but cutting hospital staff where they are needed most is crazy. In hospitals all over the country, wards lie empty, in darkness, locked from the world.  That is why ambulance crews line the corridor waiting to offload their patients. There is nowhere to put patients who need admitting. 

It's all well and good though, making us wait in a corridor, but what effect is this having on the public? Call volume for the ambulance service is hugely inflated at this time of year as it is, factor in 11 ambulances waiting at 1 of the 30+ A & E departments and it's easy too see how the precious government targets are being missed. The increase in call volume has a knock on effect for every hospital and with decreasing bed availability the hospital corridor is the only place left to put them. The hospital corridor however loses the monitoring ability and resources a cubicle has, it loses the patient confidentiality the NHS constantly tries to protect and it loses the dignity that our patients are so keen to protect. The media is correct that waiting in corridors is an outrage but they should turn their blame and attentions to the only place which can do something about it. Westminster. Until policy makers wake up and realise their drastic cuts are causing irreversible damage to the health care system which is in turn costing lives, the waits, the queues and the frustrations will continue to grow.

Tube Strikes: The cost of greed........

"25 year old female, palpations, uncontrollable rage"

After hearing about the proposed tube drivers strike on Boxing day I launched an expletive filled rant at my crew mate. I unloaded. It was no holes barred, uncontrolled, unadulterated anger. His response.....blog about it! So I am. My views on strikes in general are not a secret. I don't agree with them at the best of times. I didn't strike during the public sector strikes last month but despite my opinion on striking, it was a worthy cause. This abomination of a strike is pure greed from the motley crew collection of overweight, miserable, lazy money grabbers that will only effect the poorest people. 

Here are some facts and figures about train drivers and the slave like working conditions they are unfairly forced to endure:

• Average salary: £45,545
• Pay rise by 2015: £52,000
• Average shift length: 9 hours
• Bonus for working during the Olympics: £1800
• Yearly Annual Leave: 43 days
• Time off for a 'One Under': 3 months minimum
• Rest break guaranteed: 45 minutes 
• Boxing day compensation: Triple pay, + day off in lieu.

For a job that could be done by a 6 year old, they are pretty damn good conditions. Better wages than a first officer on an aeroplane, better than newly qualified lawyers, better than Doctors and more than double that of a policeman, nurse and paramedic. Yet, like last boxing day they are striking again. And this is despite after their most recent pay deal in October, the PROMISE there would be no further strikes on pay until 2015. It is of no real surprise though. The union representing them is Aslef, a union who has built itself a reputation of being an industrial saboteur. The blackmail tactics, lies and complete disregard for public consequences is a disgusting abuse of striking law. They repeatedly move the goal post to squeeze more and more out of the spineless London Underground management and despite the 1996 agreement where their annual leave was secured with the proviso of some bank holidays being worked, they are again going back on their promises. These are not demands for fair working conditions, they are demands based purely on greed. Like the ambulance service London Underground is classed as an essential service so why their staff should be entitled to special dispensation over the festive period I don't know. Police, Fire, Ambulance, Coastguard, Doctors, Nurses, Carers and every other emergency / essential service have to work over christmas so why shouldn't they?

Maybe they should take a moment to look at the working conditions of that of a Paramedic in London. In reality the disparity in working conditions won't register on the radar of this selfish breed of people but hey, it's an interesting read.

• Average salary: £21,176 (basic)
• Pay rise by 2015: Frozen for 2 years then 1% a year thereafter
• Average shift length: 12 hours
• Bonus for working during the Olympics: None. 
• Yearly Annual Leave: 27 days, including bank holidays
• Time off for a 'One Under': None. Expected to be available within 15 minutes
• Rest break guaranteed: None
• Boxing day compensation: 7.5 hours in lieu even if a 12 hour shift was worked

Quite a contrast isn't it. I won't be spending any of Christmas or New Year with my family or friends. It all falls on my work days. I don't get extra pay. I don't get anything extra. It's part of the job. It's when i'm rostered to work. That's life. Perhaps it’s time the government looked again at the union legislation and extended the no strike ban on Police and the Army to all essential services including the London Underground. Better still, in the modern age of technology and industry, and the success of the DLR why don't they scrap tube drivers all together. Automate everything. Chuck em' on the scrap heap to earn an honest salary like the rest of us. No more strikes. No more travel misery. In such frail economic times the capital simply cannot afford the disruption these greedy, self centered, lazy pigs will cause. The truth is the strike will have a devastating effect on the first day of sales at the end of one of the worse trading periods for retailers for 60 years. It will cost millions in lost revenue. And the people who work in the shops are at the lowest end of the income level – the very ones the unions are supposed to support. Disgusting.

The Cost of Alcohol

"41 year old female, abdo pain, vomiting, alcoholic"

We've all had a drink. We've all got drunk. We've all had weekends where we have drunk to excess, but short of a rotten hangover, that's where it ends. Unfortunately, the culture we live in has drinking woven into the fabric of society and because alcohol is such a common, popular element in many activities, it can be hard to see when drinking has crossed the line from moderate or social use to problem drinking. When drinking to excess becomes the norm and alcohol is used to make you feel better or avoid feeling bad, that's when the reality of alcoholism becomes apparent. Alcohol contributes to 35% of all A & E admissions and that rises to 70% at weekends. Obviously, ambulance staff the world over grumble and sometimes make light of 'scooping up drunks' out of the gutter on a friday night but the problem runs much deeper than a weekend binge.

Alcoholism and alcohol abuse are related to many factors which are more often than not interconnected. These include genetics, upbringing, social environment, and your emotional wellbeing. People who have a family history of alcoholism or who associate closely with heavy drinkers are more likely to develop drinking problems and as eluded to in my last blog (Mental Health), those who suffer from a mental health problems such as anxiety, depression, or bipolar disorder are also particularly at risk, because alcohol is sadly used to self-medicate. It is these patients that we see all day every day, and the cost to maintain their continuing need for medical treatment is what is a putting the health service under a pressure it simply can't cope with. Add to that the cost of the anti-social behaviour and crime that results from alcohol and the cost not only to the NHS but the country as a whole is enormous.

Negating the £3 billion yearly cost of alcohol on the NHS and putting to one side the 33,000 alcohol related deaths in the UK alone last year, the cost to personal health and family life can be catastrophic. Liver cirrhosis, kidney transplants, pancreatitis and cancer, to name but a few are just some of the debilitating illness's that alcoholics suffer with. This particular patient had chronic pancreatitis, which is an inflammation of the pancreas. It causes severe abdominal pain that lasts for days on end. The damage is irreversible. Years of alcohol abuse has caused her body to start shutting down. We arrived at the block of flats and made our way up the outer concrete staircase. When we arrived at the walkway, an elderly lady, head in hands, stood outside the flat. She didn't need to say anything, her look said it all. She was tired, she was hurt and was full of despair. There is only so much a parent can do for their daughter. We made our way up to the room where Sarah lay on the bed wretching and crying in pain. A brief look around the room showed all the tell tell signs of alcohol abuse. Tins, spirits, dirty clothes, no pride in her appearance, a musky haze around the room and the smell was enough to paint a picture. Every minute she would let out a gut-curdling squeel as she vomited the smallest amount of bile into a bucket. She had been doing this every minute for the past 8 hours. She had been in constant pain for 2 days, been to hospital twice, had had 4 ambulances and 1 doctor out to see her. She was red faced, pouring with sweat and covered in vomit and looked exhausted. That was her life. That was her choice. That was alcohol. 

We took her to the ambulance, the retching continuing all the way, the squeals of pain reverberating off the concrete jungle. Wearing a stained white t-shirt, dressing gown and socks she was a sorry figure walking through puddles to the ambulance. A resignation that this was what she could expect from what is likely to be a rather short life. Her mum followed behind, not a word spoken, just a look of solemn exasperation. We did all the necessary checks and left to go to hospital. In between the retching and screaming I tried to talk to her. She had been an alcoholic for 10 years. She wanted to die. She had lost her husband, her kids, her house and her job to alcohol. Her mum had taken her back in to look after her. I genuinely believe she was at rock bottom. We arrived at hospital, and as we lowered the bed on the tail lift I helped her mum down the steps. Our eyes met and a tear trickled down her cheek. In that single moment, the true cost of alcohol became discernibly apparent.

The 12 days of Christmas by Ella Shaw.......

"25 year old female, spreading the christmas joy"

Dear readers,

Despite it being mid-december, Christmas only being a week away, plenty of parties to go to, oodles of festive cheer wherever you look and it supposedly being a joyful time of year, that doesn't appear enough to put people in a good mood.  I sat on a train last week and for an hour I watched throng after throng of commuters get on and off the train. Not a word or smile shared. Just pure misery. And I don't know what they are so glum about, they'll all have Christmas off, be partying on New Years Eve whilst the emergency services are working. As I have done for the past few years, I have edited the 12 days of christmas to put a smile on the faces of any EMS who read it. I hope you enjoy. Merry Christmas to one and all. Be safe out there

Ella x

The 12 Days of Christmas

On the 12th day of Christmas my control gave to me:

12 Cancellations

11 Not a givens

10 Bouts of man flu

9 Not Alerts

8 Pyrexic babies

7 Granny downs

6 Drunken Polish

Off late Again.......

4 Changing colours

3 Pregnant chavs

2 Mental breakdowns

And a cyclist with a grazed knee!

MERRY CHRISTMAS AND A HAPPY NEW YEAR!

Mental Health: No ones responsibility.........

"42 year female, having a breakdown, smashing things, possible mental health issues"

As I have briefly discussed before, the problem with Mental Health in this country is huge. For many years the issue wasn’t really in the public eye, patients were kept in  large hospitals / asylums and forgotten about. This much criticised institutional care of the 1960s and 1970s finally ended in the 1980s when Margaret Thatcher introduced Care in the Community. Its aim was to deinstitutionalise mental health and adopt a new policy of care, whereby patients could receive their treatment in their own home. A great idea in theory, but in practice it has failed on a monumental level. And why? Because communities themselves are scared of mental health. Inaccurate depictions of conditions in the media have fueled stigma and has caused the problem to be feared and ignored. Despite the systems obvious failings the government has no intention of doing anything about it, so for now the vicious circle of hospital admissions, discharges, sectioning and no access to treatment will continue. Come 5pm GP's don't want to know, crisis teams go radio silent and unless patients are willing / able to travel many miles for expensive, private care there is no help available at all. And don't even get me started on weekends!

Like the police, the ambulance service is stuck between a rock and a hard place when it comes to treatment. Although there are various sectioning options to both of us, implementing them is an uphill struggle and more often than not the patient is released by the hospital hours later. In an archaic system, the police have very few powers when a patient is in their own home. The only tool at their disposal is a section 135 of the 1983 Mental Health Act which allows a patient to be taken to a place of safety, but it isn’t a decision they or we can make ourselves. If certain criteria are met, 2 Doctors (one who is section 12 approved, a social worker and an ambulance are required to implement the section. Obviously, thanks to care in the community, the vast majority of patients we see are in their own homes and there lies the problem. Trying to organise all these medical professional at short notice is near impossible, time consuming and costly. It is of no surprise this is normally a last resort.

This particular day, we arrived on scene and waited for police as is customary on apparent violent patients. We entered the building (hovering behind the boys in blue) and headed up to the 8th floor. Our patient was cowering in the corner of the corridor screaming. The police made the first contact and were met with more screaming and swearing. Unfortunately she was Romanian and didn’t speak any English. A glance inside her flat showed extensive damage, everything appeared broken and looking at our patients hands it was clear how. In between the screaming she would mutter words to herself, her manner was very nervous and edgy. I tried talking to her but it enraged her more. She started spitting and trying to bite so was restrained. Not arrested. It was clear she had to go to hospital for a Mental Health assessment. The question was how and under what method. For us, her being under section would be ideal, for the police, her going in voluntarily would be ideal. There was also a grey area as to which section she would come under. Did the corridor outside her flat constitute a public place? If it did, the police could remove her to a place of safety. Or does it come under that of a private dwelling? In that case, a team of Approved Mental Health Professionals (AMPH) would be required for a section 135. Unfortunately for us, the patient, and the hospital, none of the above happened. 

I don’t know police policy, but in this instant, I believe correct procedure wasn’t followed. The patient was handcuffed, brought downstairs to our waiting trolley bed and put on our ambulance. She was neither under section, nor under arrest. Technically, she was being taken to a place of safety ‘voluntarily’ yet her struggle would suggest anything but. We conveyed to hospital and handed over to the nurse. She called the police over and asked if the patient was under section. They told her they couldn’t 136 her because she was at home. 135 wasn’t mentioned!! (To be fair, read my October blog ‘Kum Ba Yah, my Lord’ and you’ll see why!). This is where the problem lies and the never ending circle of mental health begins. Because the patient isn’t under section, the local agreement between the hospital and police is that the police only have to stay there for an obligatory hour. Realistically, with the best will in the world, an hour isn’t enough time to have a mental health assessment in a busy A & E department. Once the hour is up, the police can leave, the hospital don’t have the staff to be able to stay with the patient, nor do the security have the powers to detain. As the patient is there voluntarily, she will be free to leave at any point.

To cut a long story short, we left, an hour later the police left, 20 minutes later the patient left and we are back to square one. A mental health patient, walking the street, striking fear into passers by. And what do passers by do when scared or concerned. Yep, phone 999. And what gets sent to a ‘woman having a breakdown, being violent, bleeding from hands’? An ambulance and the Police. Money, money, money!

While the current laws stay the same and while no alternate care pathways are available, this will be an all to familiar occurrence. No one wants to know.  As the side effects of mental health include unemployment, and a side effect of unemployment is alcoholism and drug abuse, a huge percentage of mental health patients are intoxicated. Mental Health units will not accept any patient showing any signs of intoxication so A & E have to pick up the slack, but A & E department don’t have the specialists to deal with it. The police are reluctant to section because of time, the law and paperwork required so will generally assist in convincing a patient to go voluntarily if they can. This however, will prevent a prolonged stay and full assessment in an appropriate unit. Finally, the ambulance service has limited time, resources and options so will generally have no choice but to convey mental health patients to a hospital where they can walk out at any time. Nobody wants the hassle or the responsibility and its a case of cross ya fingers, stick your head in the sand and hope someone else deals with it.

The lack of mental health training that nurses, police and ambulance staff get is a stark reminder of what little priority is put on their treatment. Patients are pushed from pillar to post, while every service that is there to help, tries its best to pass the buck to someone else. Until the problem is tackled head on, nothing will change. Although mental health in the work place is becoming much more widely accepted, with stress and depression being recognised as common illnesses, patients with conditions that attract a public stigma such as schizophrenia will continue to be social outcasts and while that is the case, mental health will continue to be brushed under the carpet and maybe that is what the government wants. The situation is getting worse at an alarming rate, and with the current government ripping the heart out of the welfare system under the banner of 'reform', even the most basic benefits for the mentally ill are being removed. Britain's mentally ill are being pushed to the edge, evidenced by the 8% increase in suicides this year, but maybe these suicides are the savings in benefits that the government want by reform. It certainly seems that way.