Taxi........

"40 year old female, abdo pain, in supermarket cafe"

Now the country is in the grips of winter 6am starts seem all the more cruel. We'd done one job but I was still struggling not to yawn and was rocking out a thumping headache. My issues aside, we got another job so fake smile in tow, we headed the 600 yards from the hospital to the job. We made our way through the hordes of christmas shoppers to find our patient, head in hands, staring at her coffee. We introduced ourselves and were met with a voice full of apathy. Her hair was scraggly, she was wearing odd slippers and a Mickey Mouse t-shirt. The combination was a bit bizarre but who am I to judge?! The conversation that ensued epitomised everything wrong with this country.

"Where the hell have you been, i've waited ages"

"You only called 10 minutes ago! Anyway, how can we help you?"

"My tummy hurts, I can't walk"

A brief history told me she was kicked in the stomach with a 'flying ninja kick' by a Philippino nurse. She was discharged from the hospital 45 minutes ago and had a pain score of 3/10. No known mobility problems and denied any leg injury. The described pain raised no red flags so as far as I was concerned she was well enough to walk to the ambulance. Before suggesting that I did a quick battery of tests and they all came back normal.

"Shall we pop you to the ambulance?"

"I might not be going to hospital. I haven't decided where you are taking me yet"

(Brief pause to take in what she had said) "Well, whatever we decide i'd like to check you over fully on the ambulance, it is more private after all"

"Well I can't walk"

"How did you get here, what is stopping you walking?"

"Just get me the supermarket wheelchair. It is by the tills"

(Someone has had one before!) "If you can't walk, we will have to take you to hospital anyway"

"Just get me the chair"

I didn't have the energy to make my point so the chair was fetched and we wheeled her to the ambulance. Once on board it became apparent hospital was the last thing she wanted.

"Right, i've decided I want you to take me home"

"I'm sorry, but we are not a taxi service, if you are unable to walk we will have to take you to hospital"

"Which hospital?"

I gave her a choice of the 3 nearest to us. She refused them without a valid reason other than not wanting to go. I read out the list of the nearest 9 hospitals and their distances away. She refused them all.

"Give me some morphine. It's my right"

"I'm not giving you morphine"

"But i'm in pain and can't walk"

"Then I will try you on Entonox first, and we will take you to hospital"

"Just take me home, what is your problem, the hospital won't provide transport so how am I going to get home?"

"I'm sorry but we aren't a taxi service, you can't just call an ambulance because you want a lift home"

"This is a disgrace, i'm going home"

With that, she got up and walked off to the bus stop and jumped on a bus. That was that. She could walk, and didn't even have a limp! I had consulted our clinical support during the conversation as to her request and was told her only option was the nearest hospital if she couldn't walk. This is why the ambulance service struggles to cope at the best of times. This is why A & E departments are at bursting point. It transpires she was ejected from the hospital for abuse to staff. She had been to hospital 16 times in the last month, always after shopping and every time had requested transport home. Luckily for the tax payer, she had been refused every time. Speechless.

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!