Was it worth it?...

"Running call, male fallen off motorbike"

We had been called to an 1 month old cardiac arrest. After a slightly manic drive and a brisk walk up 3 flights of stairs we were greeted by the FRU with a crying baby in his arms. Clearly not as given! The baby had vomited some milk. Perfectly normal one might think but for the mother, it warranted an ambulance. Despite the apparent well being of our patient due to a service policy of conveying under 2s to hospital, off we went.  Our route to hospital took us on a rather large duel carriage way. It was about 6pm, rush hour, dark and raining. A motorcycle overtook me at about 60mph, then proceeded to swerve in-front of me. His back wheel was all over the place and then he lost it. His bike went over and he was thrown up into the air. Everything seemed to stop and produce clarity, I was watching him fly through the air in slow motion, his arms waving, his body rotating, helpless to stop, bracing for impact. Suddenly, it sped up again. I slammed on my breaks, stopping feet from his bike and he hit the floor. He bounced and rolled. And rolled. And rolled. He came to a stop. He was lying on the bank of grass on side of the road, motionless. 

I jumped out the truck, grabbed some bags and went over too him. Amazingly he was conscious, albeit in pain. My crew mate called control and requested a second ambulance. Due to the winter pressures however, there was no one available. A car was on route but that was all for now. I began assessing the patient, amazingly, he only appeared to have cuts and bruises. A possible fractured leg but nothing serious. No head injury, no apparent spinal injury. Needless to say, we treated for a spinal injury, he was collared and boarded, his leathers were cut off and he was fully immobilised. His voice was a bit slurred and initially I put it down to concussion but the more we spoke the more I wasn't convinced. Eventually the FRU arrived. Due to the lack of second ambulance we decided to put our mother and baby in the car and we'd take the motorcyclist and then we'd all go to the same hospital. We loaded him on to the truck, in the dry and re-assessed. Out of the rain and the wind it became clear exactly why he lost control. He was drunk. And not just a little bit drunk, he was plastered. 

We requested the police and headed off to hospital. He was 18 years old, had just started university and delivered pizzas in the evenings. In fact, he stated he was on his way to work. His boss and rung him to say he was supposed to be there and rather than say he'd been drinking all day, decided to go in. He had had over 3 litres of cider and numerous shots throughout the afternoon and didn't really see the ramifications of what was going on. He was only 18 with his life in front of him, he was going to be arrested, he was going to be charged and going to be convicted of drink driving. He was going to have a criminal record. He would have a fine to pay. He was going to lose his licence, he was going to lose his job. He was going to lose his income, he going to lose his independence and was going to seriously effect his future employability. Despite all of this his main concern was whether or not his bike was OK. I didn't have an ounce of sympathy for him. I tried to explain that the law about drink driving isn't there to be a killjoy. It's there to save lives. He is lucky no other vehicle was involved. He was lucky that the powers that be protect drunk people form serious injury. He was lucky he wasn't killed. He was lucky he didn't kill anyone. He didn't seem to care.

We arrived at the hospital and wheeled him to the corridor where we waited our turn to handover.  Moments later the police arrived. Being strapped down to a board he didn't see them walk in, it wasn't until one of their faces peered over his that he realised just exactly what he'd done and what the consequences were. Que the penny dropping. Que the tears. Que the remorse. Que the request for mum. Que the fear. Que the handcuffs.

Obesity: The cause, the cost, the solution

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

A few months ago I wrote a blog called ‘Fat people, stairs and backs’. This particular post received a lot of praise but also angered a few. It was suggested I criticised without foundation or research and offered no reasoning to may argument. I did a follow up  post  which was a knee-jerk reaction to a rather abusive e-mail but decided I should in fact back up what I was saying with a much more researched piece. So I did! I wanted to look at the social reasons behind obesity and what impact obesity has when not prevented in childhood. I also wanted to highlight the benefits of using prevention rather than cure in tackling such a huge social problem. 

Obesity is a significant societal trend with effects being felt throughout the health care system, economy and society as a whole.  A person is deemed overweight if their body mass index (BMI) is between 25 and 30; a BMI over 30 is classed as obese and a markedly increased health risk. I attended a middle-aged female who had been experiencing DIB for several days as a result of chronic heart failure and episodes of fainting. The patient was of low socioeconomic status, weighed 35 stone and was in her upstairs bedroom.  We began treating her breathing while carrying out a risk assessment of her extrication.  Her condition was deteriorating but due to her size we were unable to safely carry her down the stairs. The decision was made to mobilise the fire brigade to assist us and the bariatric ambulance was called to convey.  The patient was taken out of the house through the window by a crane. This caused considerable delay in her receiving definitive care and despite aggressive management at hospital she died shortly after arrival. What led the patient to be in this position? Why was nothing done to avoid this situation? Why was she allowed to stay like this? How long had she been like this?

The NHS has been forced to focus on treatment of illness rather than prevention due to increasing demands and costs.  This leads one to question, however, where the responsibility for obesity prevention should lie.  Obesity costs the economy not only in health care but also in sick days, workplace injuries and disability pay.  Not only is the prevalence of obesity increasing in the Western community, those who are overweight are also heavier. This paints a bleak picture of a problem which has increased rapidly since the 1970’s; despite being on nearly every major government’s agenda.  The literature is focused towards prevention because ‘cure’ is a nearly impossible ideal and to achieve this we must look at children.

Nearly a quarter (23.1%) of children are overweight or obese by the time they start primary school, this increases to over a third (33.4%) by the time they finish. Health promotion is fraught with difficulties in school aged children as poor management of obesity can result in life-long unhealthy eating habits and avoidance of medical help. Our patient may have had a negative experience with a health care professional and avoidance behaviour is common in obese patients who do not want to be lectured or humiliated. Conversely to the conception that patients will use an illness to seek attention from their doctor, obese patients often avoid this interaction. There is risk of promoting the ‘sick role’ with obese children and all children could benefit from nutritional and physical activity advice. This should not be taught as ‘treatment’ for overweight children who may feel they have an illness as a result.

Obesity is not a disease, however it does appear to spread through social ties. There is literature to support that neighbourhood does increase childhood obesity especially when coupled with a lower socio-economic status. I firmly believe it is time for people to assume personal responsibility for the improvement of society. Although our patient’s obesity is juxtaposed to this ideal her individual community may have made her weight more acceptable. In the school environment however, a lower SES and being overweight are both major factors in teenagers suffering social marginalisation. This leads to emotional distress, low self esteem and lower expectations of their educational future . It is pertinent to note that class position is responsible for health, health does not determine class.

Careful education is imperative for these young people but education needs to be extended to the home. Our patient may have been obese for a number of reasons, however, it is likely she developed obesity from a young age. Poor family functioning, authoritarian parenting styles and single parent families have been cited as factors increasing the risk of childhood obesity . Other factors increasing the risk within the home are stressors; stressors in adults have been linked to obesity, this could be attributed to poor eating habits among stressed individuals and with a huge increase in incidence of stress these days it is of little surprise there is a similar increase in obesity.  This phenomena has been extended to children with specific factors being recognised for younger and older children. A positive association with obesity has been found in younger children who have a lack of cognitive stimulation and emotional support, whereas older children who live in a household with financial strain or members experiencing mental or physical problems (which could be a result of obesity) are at increased risk.

There is a strong correlation between obese parents and obese children and while there is an argument for a genetic predisposition, environmental factors are thought to be the most important. The increase in obesity has occurred among all socioeconomic groups therefore cannot be explained by genetics alone. Genetics can increase ones risk of developing the wide ranging complications of obesity, such as diabetes, high blood pressure and heart disease, some of which were observed in my patient. Obesity is associated with many chronic conditions  the cost of which have a huge impact on the economy. The parliamentary committee omit some of the most expensive areas of the cost of obesity from their calculations  this made it impossible to glean accurate figures for the true cost of obesity. It is estimated obesity costs the economy £4 billion a year and this is expected to rise to £6.3 billion a year by 2015. This kind of required financial support is not sustainable so a way to prevent the need for this financial burden is urgently needed.


Schools are the most appropriate setting for prevention, and therefor there is little we can physically do in the ambulance service other than refer.  The health promotion these kids need should only be undertaken by specialist educators as the message can be distorted.  Poor management can lead to starvation, laxative and slimming pill abuse amongst other drastic measures at a time when nutrition is vital for their developing bodies. If childhood obesity is allowed to progress to adulthood without specialist intervention the individual increases their risk of physical, emotional and social problems in later life.  I do not know the cause of our patient’s obesity or why it was allowed to continue to the situation I met her in.  Unfortunately, my patient did not get the help she desperately needed but hopefully if the right people set up the the right referral process maybe we as a nation can get to a point where prevention is a realistic option.

Chavs and the appendix

Am I a snob? Probably! Am I opinionated? Without a doubt! Do I like chavs? No! I don't care if that offends anyone to the point of leaving! I doubt any would actually read an ambulance blog other than to look up our phone number! The thing that really irks me in general is the calling of ambulances for 'sick' children only to refuse to come to hospital! I reckon any parent who reads this post will do so shaking their head slightly. Then again, that will be of no surprise, as I doubt anyone reading this would actually be so mindless! Kids get ill, adults get ill, it's a fact of life. Ill doesn't necessarily mean ambulance, but if you do need one, you should fully expect to go to hospital as that is where we take ill kiddies! And whatever happens do not, and I mean DO NOT say 'whatevs' man' to me!


"3 year old female, feeling hot, to sleepy to walk to walk in centre"

It'd been a good day. I had good crew mate, a nice lunch, reasonable patients and had stayed in area most of the shift. Obviously, the powers that be were aware there was a crew in high spirits so to restore the equilibrium they sent us to an area that generally makes my stomach turn. It was just wall to wall tools. With all the moans and groans that are associated with going to this area we trundled off, already bitching about what we were on our way to. A quick glance at the map showed us that the address we were going to was less than 200 yards from the walk-in centre. Why on earth did they need an ambulance for a child? Too sleepy to walk? Carry her! 

We arrived at the front door which was hidden down an ally way behind some shops. The rubbish and clutter outside told us exactly what was going to be inside. Our patients mother opened the door, it was a sight I've described a dozen times in my blog. Peroxide hair, multiple piercings, velour tracksuit bottoms, chewing gum and talking like she was from the ghetto. Innit! A chav personified. She took us through the bombsite of a kitchen to the cesspit of a living room where one of her four children were lying asleep on the sofa. 

"So what's the problem today?"

"She 'ad a tummy ache this morning and now I fink she is hot, ja no wot I mean"

"OK, have you taken her temperature?"

"Nah I don't 'ave one"

"Have you given her any calpol?"

"Nah I don't 'ave any"

"Has she seen a GP"

"Nah we ain't been able to do dat"

"How long has she been unwell for? Have you or your other child been unwell recently?"

"Just today, she 'ad a tummy ache, innit"

"And you or your other child?"

"Nah but a lot of my family have pelvic problems, my mum and my sister 'ad theirs removed. They got proper ill first and had proper bad tummy ache so I thought she might have dat"

"Do you mean appendix? Did they have their appendix removed?"

"Yeah, dat one"

Whilst this conversation was going on my crew mate had tapped the girl on her shoulder to wake her up and was talking to her whilst doing her OB's. Normal temperature, normal pulse, normal respiration rate, generalised abdo pain and she had vomited once this morning. She couldn't have calpol because mummy had used it up yesterday when her 5 year old sister wasn't well. Clearly, the 3 year was more articulate and more able to give a clear and concise history than the apparent adult. I say adult, but she she  didn't look a day older than 17 at best.  Meanwhile, my painful conversation was continuing.

"I don't think she has appendicitis. Why didn't you take her to the walk-in centre?"

"Cause she was too sleepy so I called 999. Could it be Mangitus?"

"No, it's not Meningitis, get your stuff together and we'll take you to the walk-in centre so she can see a doctor"

"Wot? You're gonna take us?"

"Well yes, that's the idea!"

"Nah, it's OK, I'll walk her there in a bit"

"So why did you call us, if you didn't want to go to hospital?"

"I just wanted you too check dat she was OK to walk there and needed to go der so I didn't get der and waste my time, innit"

"That's not really what the emergency ambulance service is for"

"Ah whatevs' man, it's OK, you can go now"

Luckily for me, my crew mate had been obtaining all the details I needed for paperwork so as my conversation came to its abrupt conclusion, I was able to disappear to the ambulance without the need to ask inane questions. What a moron! What a waste of time. I dropped the paperwork back in a few minutes later. Strangely though, I wasn't livid. Maybe I'm becoming numb to the nonsense! Pelvic removal......Pah!!

Rock and a Hard Place.......

"74 year old male, DIB, Lung cancer patient"

Every day, there is constant battle between ambulance staff and elderly people. This stems from their need for hospital, our wish to take them and their refusal to go. Sometimes we win, sometimes we loose and visa versa. On the occasions where we loose and they win, invariably we try to refer them on to a GP or another appropriate care pathway so their condition can be assessed / monitored / treated at home. Sometimes this less disruptive option is the most suitable for both parties anyway but sometimes it's the last resort and merely an arse covering exercise. Getting a GP to call is easy, getting a GP to visit.........not so much!

We arrived an Lenny's house mid morning. We were met by the housing warden, who had called us, at the front door. She explained that he didn't trust the NHS as a whole, he hated doctors, despised hospitals, disliked nurses and isn't too keen on ambulances. He had recently been diagnosed with lung cancer but refused to kick his 40 a day habit or take medication. She was concerned he was having breathing problems. I went in with my biggest smile and was met by his biggest scowl. After about 20 seconds I won the battle of wills. I got a smirk out of him. He was a lovely guy. A true cockney, speaking in rhyming slang where he could and was most impressed I replied in kind! The crux of the matter was, he had a chest infection. He had a slight temperature, fast heart rate and a productive cough. He made it perfectly clear, under no circumstances whatsoever was he going to hospital and to be perfectly honest, a GP visit would suffice. I took his GP details from the warden and noticed his GP wasn't anywhere near where he lived. It turns out he had only moved to the area 3 months ago and had been struggling to get registered with the local GP. Let the fun begin......

I called his GP and unsurprisingly they were not interested in travelling the 9 miles to see him. Right, the local GP it is. Apparently, the reason he wasn't registered was that the surgery has a rather archaic system where by the patient has to go to the surgery for a consultation to get registered. As Lenny's mobility was poor and he had no means of transport they were not willing to register him. Surely not. After waiting 8 minutes for a receptionist to answer, I explained who I was and who I was acting on behalf of. She suggested the patient make his way to a walk-in centre. I said he can't walk. She told me he would have to come for a consultation next week. I said he wasn't able to get there. He was elderly and immobile. She said he'll have to make do without a GP. Brilliant! I offered to come and get the registration forms, get them filled out and bring them back. She refused. He has to come in person. I asked to speak to a GP as I wanted one to come and visit him, and while they were here, register him. She refused. I asked for he name. She put me through to the GP. I regaled my whole story AGAIN and was told in broken english he would have to be a registered patient if he wanted a home visit. 

"How is he supposed to register then?"

"He'll have to come here"

"But he can't walk"

"Well he can't register here then"

"Surely, you have procedures in place for immobile elderly patients"

"No, this has never happened before"

"Well what do you suggest, he is ill, he has an infection, his GP won't come, you won't come or register him and your receptionist won't let me come and register him. He is entitled to treatment"

"Well why don't you take him to hospital"

Silly me, why didn't I think of that. Such a simple solution. That's why they are GPs and I'm an 'ambulance driver'. That degree in medicine really does scream true. Prat! Without swearing I explained AGAIN that he was refusing hospital and had capacity to do so. A GP was my only option short of leaving him at home to become septic.

"Well I'll write a prescription of Penicillin for him to pick up, when he's better he can come and register"

"Firstly he's allergic to Penicillin, secondly he's immobile and his osteoporosis and arthritis are not going to get better"

"OK, I'll write a prescription for Amoxicillin and you can pick it up"

"But you haven't seen him, you don't know his observations and won't he also be allergic to Amoxicillin?" (Worrying!)

"I meant Erythromycin, I don't need to see him, they should work"

"Fine, that's your call, not mine but how does he register"

"He'll have to make an appointment and come in"

Aaaaaahhhhhh! I admitted defeat! I couldn't go through it again. I'd got him some medication and hopefully that did its thing. We left Lenny to his busy schedule of chain smoking and NHS hating and to be fair, I see his point. It took me a 27 minute phone conversation to get him nowhere nearer to having a GP. I filled out a vulnerable adult form with my concerns so what will happen I don't know. He appears to be stuck between a rock a hard place, and with no one willing to shout for him I fear he'll just fade away quietly. How can a man who paid tax and national insurance for 50 years not be entitled to a GP because of his inability to physically go to the surgery? Madness! And the government want to put the GP consortium in charge of the NHS? God help us all!

Diminished Responsibility or Bad Policing?

 "18 year old male, going out of his mind"

In my line of work I often get the opportunity to work at various events as a medic with private companies. I mainly work at festivals as it's a good chance to see some good music whilst getting paid. Win win! Last year I worked as a medic at Bestival on the Isle of White. It was a great weekend, I got to work with new people, got to work on an array of different vehicles and although the majority of jobs were drink and drug related it was pretty easy stuff. Pick 'em up and drop 'em off at the field hospital where they were monitored then discharged. It worked pretty well. At about 9pm on the Sunday evening, which was the last night, and while the headlining act was on I was sent to one of the campsite hubs to attend a girl with breathing problems. We jumped in our 4 x 4 buggy and headed over. It was a panic attack. Nothing special. Whilst talking to her however a steward came running over.

"Can you come and help us, there is a guy just up the hill going out of his mind, I think he's on something"

I radioed it in and headed over. I left my cremate who was a first aider to stay with the panic attack and went with the steward in the buggy to the space cadet. It was about 200m from wherer I was and about 20m into the campsite. I clambered over the guide robes and tents and eventually got to the guy. He was about 6ft fall, skinny and clearly wired. His friends were all stoned and laughing at him and said he'd taken a 'molly' of MDMA. MDMA or Methylenedioxymethamphetamine to be flash is basically ecstasy. A 'molly' means that instead of a tablet it's in crystalline or powder form. This was the drug of choice for this years festival. Last year it was Ketamine but MDMA was the order of the day this year and by all accounts it was a pretty potent batch. 

I gathered that the patients name was John. I tried talking to him but he was indeed out of his mind. He was hallucinating and begin to get quite panicked. I wanted to get him out of the campsite and onto the path but when I turned round to get assistance from the steward he had gone. I was on my own. As I turned back to John he punched me in the face which knocked me to the floor and then proceeded to jump on me and try and strangle me. His friends came to my aid and between us we sat on him. I was able to press the emergency button on my radio and after a few minutes stewards came running over and we got him to the buggy. He head butted me and spat in face numerous times until the police arrived and handcuffed him. I had a fat lip, a swollen face, cuts to my neck and general bumps and bruises. He was arrested and taken to the hospital. Once at the hospital the Dr gave him a hefty dose of Midazolam to subdue him. My boss made it clear the company would fully support me to press charges and were absolutely fantastic about the whole thing. I was told  by the police to come back in a few hours to give a statement. 

In the hours that passed, I returned to work and John came to. He was taken to the welfare tent to sleep it off and had been rather apologetic by all accounts. Too little too late! At about midnight, after my 12 hour shift I went to give my statement. It started off as all statements do, blah blah blah but then the following conversation occurred.

"So do you want to press charges?"

"Yes, definitely"

"Why? Don't you think that's a bit selfish?"

"Pardon"

"Well he's only a kid and it will stay on his record, that'll ruin his life, besides he had diminished responsibility because of the drugs"

"So, he assaulted me, drugs or no drugs, it's no excuse"

The other officer in the room then came wondering over and pulled up a chair as if I was being interrogated. I was only a desk light in my face away from a scene from Law and Order!

"I know it's no excuse but be realistic. If you press charges we have to provide officers to take him back to mainland, what a waste of resources, especially when he won't be charged with anything?"

"Why won't he be charged, he assaulted me?"

"Yeah but you've got no lasting injuries and at the end of the day it's your word against his"

"So what!! Look at me"

"Well if you do press charges we won't be recommending it goes any further, you'll just be wasting everyones time for no reason. At the end of the day, it's a festival. Things work differently"

"OK, this statement is ending here, it will be continued after consultation with my bosses and your inspector in control. I have both of your shoulder numbers. Goodbye"

With that, I stormed off to the office. A expletive filled rant ensued and my boss marched me off to see the inspector. A long conversation followed and at 2am the inspector decided to take be back for my statement and to press charges. I waited outside while the inspector had a very heated discussion with the officers. He then came out to me with an awkward look on his face.

"I'm afraid that since you left here earlier your attacker has been released without charge. We have his details but don't know if they are correct. I'm very sorry, we can take your statement and if we make contact with him charges will be pressed."

I just walked away. Since when did the police show such disregard for the law and for procedure. I wrote a 2000 word complaint letter but just received a pathetic standardised response. John wasn't caught, not that I believe any attempt was made to find him. Am I over reacting? Do drugs provide a reasonable defence for violence to emergency services? Was it really diminished responsibility? Or was it just a lack of willingness to do paperwork and put in the time? I hope the latter. If copious amounts of drugs is a reasonable defence then that gives all drug user carte blanche to assault who they like, when they like with no repercussions. Shameful policing.