Human Rights? Sorry, my bad......

"42 Male, ? Diabetic problems, ? Intoxicated, Police on scene"

In my experience, a ? is usually a fact when alcohol is concerned. This patient was going to be intoxicated. Regarding the diabetic problems I assumed the police had requested us because the patient was a) Diabetic b) They wanted to make sure he was medically fit enough to be arrested. Sceptical, yes, but I was correct on both counts. We drove down the alley way and were met at the bottom of the steel staircase which led to the flats by one of the coppers. He briefly told us the guy was drunk, under arrest but was a diabetic and was screaming stuff about insulin. And we could hear the shouting from the bottom of the 30 or so steps. Joy! We made our way up the stairs and entered the room. There were 7 cops in there and our patient, handcuffed, writhing around on the floor.

"Careful, he's a spitter"

Foul mouthed expletives were free flowing from him, most of which were racist. He himself was of Iraqi origin but that didn't stop the racial slurs towards the Black, White, Asian and Sikh officers standing around him. They were all amazingly calm and professional and were just leaving him to it. A few quick checks and it became clear, medically he was fine. Unfortunately he then did a pseudo fit followed by feigned unconsciousness. Credit where credit due it was a great effort on both counts. To the untrained eye they were convincing. Sadly for us, due to the duration he kept the act up for the police wanted him taking to hospital. They arranged removal to the ambulance which was a joy to watch. 6 cops carrying a large man, pretending to be unconscious down a large metal flight of stairs in the dark. Eventually he was on our taxi and strapped to the bed. Once I was aboard he began hitting himself in the face with his handcuffs making his mouth and gums bleed.  We headed off to the nearest hospital. I'd like to add at this point it was my least favourite hospital. In fact, I detested it.

The patient appeared to have calmed down and I began asking him the basic question need for my paperwork. I asked him if he was registered with a GP. He starred at me blankly and then without warning spat a full mouthful of blood into face. The police pounced on him covering his face with a swine flu mask.  I cut open a bag of saline fluid and began flushing my eye. We arrived at hospital and I went straight to the sink. I ran the tap over my face, cleaned it with soap but I had been exposed. What to? No idea. He wasn't known to the hospital and wouldn't answer any questions about his health. Because he was under arrest he was obliged to provide a blood sample. I provided one and after a lengthy discussion with the consultant of A & E we decided to hold off on prophylactics until the following day pending blood test result. The risk of intra-ocular contamination is very low but the risk is there all the same. The police left with the patient a few hours later and I went back to work. The rest of the shift passed without incident.

The next afternoon I phoned and phoned and phoned the hospital. No answer. That evening I made the 40 mile journey from where I lived back to the A & E to get the results. I waited and waited and waited. I sat there for 4 hours constantly badgering the staff to find out the delay. A sheepish looking Dr eventually came over.

"I'm afraid both blood samples have been lost"

My opinion of the hospital was clearly justified. They had lost the lot. His sample for testing and my serum save. So I said I wanted to go on prophylactics to be safe.

"I'm afraid it's too late to start them now"

Of course it is. I've been here for 6 hours and have been ringing for 6 before that. No wonder it's too late. I said I wanted to get another sample from him to find out what he did or didn't have.

"I'm afraid it's against his human rights to request another blood sample. He's been discharged and is no longer a patient"

Of course it is. Must protect his rights mustn't we. Don't worry about mine. I now have to be jabbed and prodded to 12 months until I can get an all clear. I decided to contact the police and request a blood sample from them. Eventually I got through to one of the arresting officers.

"I'm afraid he was released without charge this morning once he had sobered up, he isn't obliged to provide another sample. We can ask him but if he says no there is nothing we can do"

Guess what? He said no. I asked about pressing charges for assault. I got an all to familiar response when asking about spitters.

"It probably wouldn't go anywhere as there is no physical injury"

Erm, possible blood contamination?!?! It was like talking to a brick wall. No one wanted to know. Too much time had passed and the animal was protected by his human rights bubble. When will assaults on staff be taken seriously? So what if there is a lot of paperwork involved. We have rights too. Surely we have a right to know if we have been infected? Apparently not.

Compensation: £0

Days sick: 0

Apology from patient: Pending....

Apology from hospital: Pending....

By the way, I got the all clear over a year ago but it still irks me. My employer was extremely supportive and provided everything that they could. It's a shame the hospital and police couldn't provide the same.

You just never know

"73 year old male, chest pain"

It was an average weekday morning, bright blue sky, chill in the air, sat outside Starbucks getting the early morning caffeine fix. The MDT made an unwelcome noise. The job was only a few miles away so with the roof lit up, the squeal of the sirens and the groans of a semi-willing crew we headed off. We had no details, just an address but that wasn't unusual. As we pulled up to the house we found out what we were going into to. An old guy with chest pains. Pretty nondescript but it could be a good job. It was a bungalow we had pulled up outside of. Set back from the road it was preceded by a very well kept garden. A small fish pond in the middle of the lawn, flower beds immaculately kept with well pruned roses providing an array of colour. All the lower windows had window boxes of flowers and there was ivy climbing up the exterior walls. A grand oak door with a huge knocker awaited us at the end of the crazy paved pathway. As we approached the door it opened, a well dressed elderly lady greeted us with a smile and invited us it. She directed us to the lounge. As I made my way through the foyer and down the hallway I admired the black and white photos and military memorabilia that lined the walls, it was a real homely home, the smell of freshly baked bread filled the air. I entered the room and our patient was sat in his armchair. He too was well dressed, shirt and tie, trousers and slippers. An equally infectious smile greeted me.

"Good morning sir, what's the problem today?"

"I'm awfully sorry to bother you, I don't want to go to hospital really but I've had this niggling pain all morning ever since I got. It's under my right arm on my ribs and hurts every time I move. I just wanted to ask someone about it so a called NHS Direct and they told me an ambulance was on its way. It seems such a fuss for something so trivial. I'm awfully sorry"

I assured him there was nothing to be sorry for and that I'd give him an MOT and take it from there. I did the full battery of tests on him, every box ticked. He was fit and well, his mobility excellent. His vision spot on, all his observations perfect. His secret was 2 hours gardening a day and it showed. My crew mate had vanished to get the Lifepack 12 to do an ECG. He was telling me about his military career and the amazing life he had led. I was fixated on him. He was such an interesting guy. With every word he muttered his perfectly groomed moustache moved up and down. He was was so well kept and so well spoken. He pointed out his military photos and his medals. He was so animated and enthused to be able to share his experiences. I saw through the window my crew mate returning.

"If it's OK with you sir, we'd like to do a quick ECG and then we can leave you in peace."

"Is that totally necessary?"

"Well, because you had chest pain, albeit, apparently non-cardiac because of your age and the fact you don't want to go to hospital I'd be happier leaving you if we did one."

His wife, Margaret, interjected....

"Harry, you are having one, end of story, either that or you are going to hospital"

Well, that showed him. Clearly the key to their 53 year marriage was a him doing exactly what he was told, when he was told to do so!  The Lifepack arrived and my crew mate began to attach the electrodes to wires. As he did so, I began to unbutton Harry's shirt. Under the shirt was a vest, firmly tucked into the belt. I explained we'd need to un-tuck the vest. At that point Margaret walked out of the room and closed the door. With a sigh he undid his belt and slowly pulled the vest up to his neck. It was in this moment that his reluctance to have an ECG became obvious, it was in this moment I realised why Margaret had left the room and it was in this moment I didn't know where to look, what to do or what to say. He was wearing a black, laced bra. No padding, just the Bra. He was red faced, I was red faced, my crew mate was frozen to the spot and a deftly silence engulfed the room. Never have I wanted the ground to open me up and swallow me whole so much!

I did the ECG in silence, no questions asked, no explanations given, he redressed himself and Margaret returned with a plate of biscuits quizzing us about shift patterns in a vain attempt to restore normality. I certainly wasn't expecting that. A cross dresser! It didn't fit with the man, his life, his home. It's amazing, you really just never know what goes on behind closed doors. Maybe that was the key to a 53 year marriage. A bra!

The Awkward moment when...

On average I do between 230 and 250 shifts a year. During a shift I average 9-10 jobs. Over the year that means I roughly attend to up to 2500 patients. Unfortunately the odds are stacked against me for putting my foot in my mouth, dropping a clanger, being inappropriate and misreading my audience. It's bound to happen and it does. For me however it has seemed to happen an awful lot in recent months. Inspired by the increased incidence of tumbleweed I thought I'd compile a list of 'don'ts' for anyone involved in patient contact. In fact, even if your aren't just follow the rules and you'll save yourself some red faced moments.

DON'T:

1) Ask a patient if their dad will be coming with them when in actual fact it's their boyfriend. (Gross!!)

2) Ask the patients daughter if she is coming with us to hospital when she is in fact the patients wife.

3) Try and take a blood pressure on a prosthetic arm. It makes you look stupid.

4) Ask a Jewish man in severe pain if he has ever had gas before. Refer to it as Entonox. Seriously. (I was mortified)

5) Sit on a patients glass coffee table. It will generally crack.

6) Check for pupil size on a patient with a glass eye.

7) Ask a patient to hold out both arms in front of them when they have already told you they only have one arm.

8) Ask a lady with abdo pain when her baby is due. It's awkward when she tells you she isn't pregnant.

9) Accept a cup of coffee and then proceed to pour it on the cream sofa.

10) Ask how old the patients little boy is when in actual fact it's a girl.

11) Eat a jam doughnut and enter a patients house. When they offer you a tissue for the jam on your chin it's cringy.

12) Repeatedly ring the doorbell for 98a at 3am when you need 98b. It does you no favours.

13) Try and walk through a closed glass door. It doesn't fill the family with confidence and hurts.

14) Laugh when a patient tells you their pathetic ailment. They get offended and sometimes violent.

15) Try to school a patient about chest pain and their ECG. When they tell you they are a cardiologist you feel very small indeed.

16) Say Happy Christmas to relatives of a patient you have just pronounced dead on Christmas day.

17) Laugh out loud when you unbutton a man's shirt for an ECG and he is wearing a bra. The ground won't open up and swallow you.

18) Offer the carry the poorly child then bash their head into the door frame. The crying will not stop.

19) Let the puppy escape through the front door when you have already been warned by the family not to leave the door open. 

20) Ask your 23 year old male patient if their mother is coming to  hospital with them. When he says "She's my fiance" there is nowhere to hide.

Yeah but no but...

"32 year old female, diarrhoea"

Firstly I wondered who calls an ambulance for diarrhoea especially at the healthy age of 32? Secondly, who does this on Christmas day? Surely, hospital is the last place on earth anyone would want to be? To be fair I shouldn't be surprised. Who am I to judge anyway?! We pulled up outside the rather bedraggled looking house in the rather bedraggled looking street in the rather bedraggled looking neighbourhood. A few token Christmas lights hung from windows, the street was covered in litter, bins lay on their sides and as we walked up the path we had to navigate the piles of dog mess. A dead looking Christmas wreath hung from the front door. It was a pretty miserable scene! A little kid opened the door, ran off down the hallway and disappeared into a room on the left. We followed and entered the living / dining room. It was a sight to behold! Imagine the Royle Family. No, not the Queen, Prince Phillip and the Corgis, think Ricky Tomlinson and Sue Johnston from TV series. Add to the mix an offspring of Vicky Pollard and Ali G plus a few scruffy looking children and you'll be close to seeing what I was staring at. All were wearing the obligatory paper Christmas hats, a staffordshire bull terrier was sat expectantly at the side of the table wanting some of the mangy looking turkey. Silence engulfed the room.

"Happy Christmas! Who are we hear to see?"

"Me, innit" 

That "Me, innit" came from the Vicky Pollard of the motley crew sat in front of us. She was of weird proportions, a space-hopper for a body, clad in an ill-fitting t-shirt with 'LUSH' written across it. Her bottom half was 3/4 length joggers, barely big enough to cover her festively large legs and hind. Her hair was pulled back tightly into a pony-tail, her face covered in multiple piercings, a few in the ears, nose, lips and eyebrow. It wasn't a good look. I knew the following conversation would be a struggle at best but unfortunately it was a conversation that had to happen!

"OK, what's your name my love?"

"Chantelle"

"Hi Chantelle, my name's Ella, what's been happening today?"

"So I was sat down having my Christmas dinner right and I farted yeah and it felt squidgy so I went to the toilet and I realised I had shit myself yeah and it smelt fishy so I thought I had C Diff (* see below) innit so I called 999. Is it C Diff? 'Cause I heard that is really dangerous right, I think I need to go again, shall I not flush so you can look in case it's C Diff? I'm not ill but I do need the toilet again"

And breathe! What do you say to that? There was a short pause where me and my crew mate just stared in amazement and then he saved me!

"No, we won't need to see it. Have you been unwell recently or was this the first time you've been ill"

"No, the first time was just when I farted, innit"

"Any other symptoms? Any pain? Any vomiting?"

"Nah"

Thank god he spoke because I was still staring, looking at her, her family, the house, the dog, trying not to laugh. I eventually composed myself.

"It doesn't sound like C Diff but if you....."

"Yeah but how do you know?"

"As I was saying, this was your first episode of diarrhoea, you haven't been unwell and you haven't tried any home remedies such as Imodium. You also have no abdo pain, no fever, no vomiting and you don't appear dehydrated. It seems to just be an upset stomach."

As I was talking and trying explain that all she had was diarrhoea she began to put her coat and shoes on. 

"You don't need to go to hospital, you'd probably be more comfortable to stay at home and see how it goes"

"Yeah but it smelt fishy innit so it might be C Diff"

"I doubt it's C Diff"

"Yeah but it might be right?"

I wasn't going to argue, I'd had enough, it was Christmas day and I was arguing about fishy diarrhoea. Enough was enough. Hospital it was then. Who am I to give a medical opinion? We took Chantelle to the nearest hospital, handed over to the nurse and were redirected to the empty waiting room.

"Right, just wait here until your name is called. See you later, hope you feel better"

I walked away, the automatic doors slid open, I began to step through to the cold Christmas day air when she shouted:

"When will I know if it's C Diff?"

I just kept walking!

* Definition: Clostridium difficile (or C difficile) is a bacteria that normally lives in the large intestine (colon). C difficile may cause inflammation of the colon (colitis) when it becomes too prevalent in the large intestine. This overgrowth of C difficile may take place after a person has taken antibiotics that have killed the helpful bacteria that live in the intestine.

C difficile can be passed from person to person. A person may not have symptoms of having an overgrowth of C difficile, but he may still be able to pass the bacteria on to another person.

C difficile can cause diarrhoea, abdominal pain, vomiting, dehydration and fever.

Success or Failure?

In the 1990's the government introduced the response time targets that all ambulance staff have grown to hate. I'm yet to meet someone who thinks that they work or who thinks the time itself holds any significance to patient care whatsoever. For a patient in cardiac arrest 8 minutes is too long and for a patient with difficulty in breathing from a panic attack the time won't effect the outcome. You can't tell me that if I arrive to a patient in 8 minutes and 1 second from when they rang that their care would be adversely effected had I arrived 2 seconds earlier. Regardless of my opinions the target remains. It's the measure of success we work to and at the end of the day it is what we are judged on. In the vain hope someone in politics reads this I thought I'd offer a comparison about 2 jobs I have done in recent months and how they were effected by the targets.

"69 year old male, not acting normally, breathing problems"

Category: Red 2

Call connect: 20:57

Dispatched: 20:58

Distance: 5.2 miles

On scene: 21:06

Target: Missed

We walked in the front door and were ushered upstairs by the patient's daughter where she gave an excellent handover of his medical history. In all honesty he didn't look well, he was sweating, his pulse was slow and weak and he was wheezing. He also had slurred speech. We treated as we found. We gave Salbutomol for his breathing which had little effect. We gave a second dose with Atrovent. After 10 minutes or so his breathing improved. Whilst the nebuliser was at work we had tested his blood sugar. He was hypoglycaemic (low sugar). We gave glucose IV and he began to come round. He told us he had chest pain too. After a brief assessment and further history we gave him aspirin. His blood pressure was too low to give GTN so fluids were given instead. A 12 lead ECG was done in the house and sure enough, he was having a heart attack. We gave Clopidogrel and once he was on the ambulance and his blood pressure was raised we gave morphine. On way to the ambulance he was given Entonox for the pain. A blue call was put into the local cath lab. It was a 10-12 minute journey on blue lights. On route he went into cardiac arrest. Pads attached and 1 shock given. Airway inserted, oxygen given and CPR started. We gave a second shock. We got him back. Under close monitoring we continued to the cath lab. An update was given on his condition and we arrived with no further problems. He was taken straight into the lab and had an immediate primary angioplasty. The clot was removed, a stent was fitted and a week later he was discharged from hospital. The government deem this job as a failure.

"7 year old female, drowned, CPR in progress"

Category: Red 1

Call connect: 18:09

Dispatched: 18:09

Distance: 1.3 miles

On scene: 18:12

Target: Made

This job is everyones worst nightmare. A paediatric cardiac arrest is by far the hardest thing we have to deal with. No amount of training can prepare you for it. This particular job has affected me more than any other and it still chokes me to write about it. We flew round to the house at god knows what speed. The information on the screen was detailed enough for us to know this was a genuine job. Grabbing every bit of kit we could we ran to the open door (This remains the only time I've ever run at work). We heard a woman screaming for help upstairs so up we went. Lying on the bathroom floor was the lifeless body of the girl. Her mum was doing CPR. I took over. We stayed on scene for less than 5 minutes. The patient was intubated, IV access gained and 2 cycles of CPR completed. Asystole. In layman's terms, there was 0 heart activity. We ran. The hospital was about 2 miles away so we left. The mother went with the second crew that arrived as we were coming out the house. I spent the 4 minute journey doing CPR and ventilating her just staring at her. I didn't need to think about what needed doing. It just came naturally. A member of the second crew was in the back with me. She was also doing everything possible. We ran into the resus. room and gave a handover. They instantly began working on the girl. They did so for over an hour. She was declared dead at 19:31. The government deems this job as a success.

8 minutes. It isn't life or death. It's a number. It's a number that someone or a group of people decided on. I'd like them to tell the mother who lost her child that the ambulance service were successful. I don't feel successful. I'd also like them to tell the guy who walked out of hospital that the ambulance service had failed him. I don't feel like I failed him. But I don't set the targets. Success and failure cannot be measured on a stop watch but it is. Patient care has very little to do with it but I'm sure if the policy maker's family needed an ambulance they would rather the outcome be measured by what I call a success than what they do.