Where's my Oxygen?

"56 year old female, DIB, Asthma patient"

It had been a pretty miserable night shift, a constant drizzle of rain, non descript jobs one after another and we were miles out of area. The job was sent to us and we headed off towards the address. About 5 minutes before we arrived we got a message telling as an FRU had arrived on scene. We pulled up on your typical Edwardian terraced road with nice big houses. We entered the address through the ajar door and made our way down the dark corridor. There were no bulbs in any of the light fittings so we used a torch to follow the sound of voices. The property had been turned into a bed sit of sorts. Each room was locked with hand written numbers on the doors. What a waste of a lovely building. We entered the room at the end of the hall way which would have once been a living or dining room in its hay day. Inside was our patient, sitting on her bed. The room resembled that of student accommodation, a self contained pod with a mish-mash of paintings, posters, books, magazines, junk, a TV and mess all over the floor. Our patient was sat next to her Pomeranian dog which to be honest, was better presented than she was. Her hair was wild and greasy, she was in pyjamas, faded and smeared make up on her face and plenty of evidence suggesting she was alcohol dependant. A haze of stale smoke engulfed the room and a stain of ochre covered the ceilings. It wasn't pleasant. The FRU gave us a half smile of frustration (LOB) and a brief handover.

She was complaining of DIB for the last hour. She was an asthmatic and proudly showed us an array of inhalers. She also produced a stack of Patient Report Forms (PRF) indicating a large number of ambulance attendances in recent months. She always refused hospital and they all painted a similar story. Called with DIB, all OBs normal, no wheeze, refused hospital and GP referral. Sure enough, all her OBs were normal. 99% oxygen saturation, a normal respiration rate, good chest rise, no cough and no wheeze. Her pulse, temperature, blood pressure, blood sugar and ECG were also normal. She wasn't ill and unsurprisingly she declined hospital and refused a GP referral. 

"Gimme one of those neblizers"

"You don't need an NEBULISER. You haven't got a wheeze"

"So, the other crew gave me one"

"Well I'm assuming you had a wheeze then. Today you don't and as thus, you don't need a nebuliser"

"Gimme some oxygen then"

"You don't need oxygen, your saturation is excellent"

"I don't care, it's my choice"

"I'm afraid it's not. We only give drugs if it is clinically indicated. In your case it isn't. If you are concerned you should come to hospital with us"

"Oxygen ain't a drug"

"Yes it is"

"How dare you come into my house and refuse me oxygen. It's my right. I pay your wages"

"You called us. We assessed you, advised you to come to hospital, you declined, don't shout at us for refusing to give you a drug you don't need"

"It isn't a drug"

"OK, we'll have to agree to disagree, and for the record, the taxes I pay also pay my wages. What do you do for a living?"

"I can't work, I'm disabled, I got Ostoritus (i'm assuming Osteoarthritus but it wasn't evident in her medication) but I USED to pay your wages"

"I never said you didn't...."

"You implied it"

"Are you coming to hospital or not?"

"No, get out of my house seening as you have refused to treat me"

"I haven't refused, I have offered you 2 care pathways, both of which you have refused. I have refused to give you drugs you don't need"

"Get out of my house"

"OK, good night, nice to meet you"

"Get out"

Not much else to say really. These are the people ambulances are wasted on. This is why elderly fallers have to wait hours on the floor. This is why the service and the NHS is under constant pressure. But it's OK. She pays our wages!

A Life Lost, A Finger Pointed

“17 year old female, vomiting, ? been drinking”

This week there were a number of articles in the media about the tragic loss of a 22 year old man named Daniel Cripps (click link to read article) most notably in the Daily Mail. Daniel died after getting involved in a drinking game and consuming in excess of 14 shots of vodka. His friends phoned an ambulance and the crew that attended assessed him and deemed him safe to stay at home and ‘sleep it off’ in care of friends. Unfortunately, shorty after the crew left Daniel aspirated on his own vomit and choked to death. The case was heard at the coroners court this week and binge drinking was given as the reason that led to Daniels death. A narrative verdict was given, basically meaning no one was personally to blame. The coroner did say however that:

“With the benefit of hindsight he should have been transferred to hospital”

Whilst I believe this verdict was correct it concerns me that the crew in attendance have come under so much criticism. The Daily Mail led with "Paramedics left aspiring model to die at party after he downed 14 shots of vodka telling him to 'sleep it off'". Legal proceedings are now being brought against the ambulance service involved by Daniels family and although it is their right to do so I think apportioning blame to an ambulance service where no neglect has been found is dangerous. Ambulance staff go to work each day and face all sorts of situations. We see the best and the worst life throws at people and everything else in the middle. If law suits are brought every time someone dies you’ll not only cause people to question the career they are in but the NHS will be inundated with patients who are being brought to hospital because no crew are willing to risk leaving someone at home. It's another prime example of irresponsible journalism where the facts are completely distorted. 

A few months back we were called to a 17 year old, vomiting. We pulled up outside a huge property. Inside there was a house party in full swing. Most of the guests were underage bar a few 18 year olds and our patient was paralytic. We sat with her while she spewed her guts up and although we would rather she had gone to hospital she refused. Unfortunately, she had capacity to refuse and as there were ‘adults’ present we had no choice but to leave her at home. Like in Daniel's case, we left her in the recovery position, we gave her friends advise on how to care for her. We also left voice messages on her parents phone telling them what was happening and why. Fortunately for our patient and us she lived to do the walk of shame the next morning. This outcome would be the case more than 99% of the time but for Daniel, he was one of the unlucky ones and paid the ultimate price. There is always a risk leaving someone at home but that risk cannot become a deterrent. It frightens me to think that I could be in court and facing a law suit because someone I leave at home dies, but generally, I leave them at home because clinically and socially it is the right thing to do. Alcohol always poses a risk but now more than ever it is at the forefront of public agenda and something has to give. If we are to do our job properly, we need to do so without the fear that an unforeseen accident could end up with headlines implying malpractice. If our patient had aspirated and died the head line would probably have read "Ambulance crew left a child to die".

The problem begins with the culture of binge drinking. Night on night thousands of people, especially youngsters drink themselves into oblivion. They chose to do it despite the advise of medics, media, police, parents and the government. Daniel was an adult, he knew what he was doing and knew the risks. Admittedly, we have all had a binge, myself included, and more than likely to the same level of excess as Daniel. All that means is we got away with it. Last year there were over a million alcohol related admissions to hospitals in England at a cost of over £3.6 billion and these figures are rising year on year. Hospitals are at breaking point and ambulance service demand is constantly on the increase, in no small part because of alcohol. If every intoxicated person is taken to hospital the NHS would collapse. It is not logistically possible to do so. The other difficulty ambulance staff face is that of hospital staff. When we take in someone who is intoxicated we aren't greeted with open arms. Far from it. They don’t want the patients taking up a bed especially if they have come from somewhere where they could just ‘sleep it off’. Obviously, the suggestion to sleep it off in this case has become a headline and a criticism. Daniel was left in the care of friends in a position that would have kept his airway open and clear. It is easy to blame the ambulance crew but where were his friends? 


I have the deepest sympathy for Daniels family but has horrible as it is to say,  he is to blame for his own passing. Of course, our ‘blame culture’ today cannot accept this. It is always someone else's fault. It can’t be nice to hear that if Daniel had been taken to hospital he would have lived but he wasn’t. And he wasn’t because he was a young, fit 22 year old who had been drinking. He was in a place of safety, not the street. It wasn’t a medical emergency and as such no blame should be apportioned to medical practitioners. Hospitals cannot ‘cure’ drunkenness and all they would have done would be to monitor him and the crew left him in an environment where this was more than possible. Yes as the Daily Mail so kindly pointed out, he would be alive if he was taken to hospital. Yes, the hospital was only 5 minutes away and yes, he died after being told to sleep it off but that is not the point. That is like saying that if everyone who has a heart attack was in a catheter lab, surrounded by cardiologists when it happens they would survive. Sure they would but life isn't like that. 

I don’t want to sit here preaching about how wonderful all ambulance crews are. Crews make mistakes as does everyone, but what I will say is that the media and relatives are far to quick to apportion blame on a crew rather than look at the cold hard reality of a given situation. Hindsight is a wonderful tool but it isn’t one we have at our disposal. We have our experience and our judgement. In this case experience said a 22 year old was safe to leave at home and judgement said he was being left in a safe environment with responsible adults. As far as i’m concerned that is enough for me and I would have made the same decision. I hope Daniel's death will be a stark reminder of the risks of binge drinking and hopefully it will go some way to influence the behaviour of our drunken teen generation. That is what the article should be about. If only a handful of people take note and act in a more responsible way he won’t have died in vein. We can but hope.


Rest in Peace x

Slow motion

"RTC Car vs Pedestrian 'Running Call'"

The 8 minute target is much talked about and discussed at length. The government require us to be on scene within 7 minutes and 59 seconds of a 999 call being connected should it be categorised as a Cat A call. Cat A basically means immediately life threatening and as thus Cat A calls are generally cardiac arrests, unconscious, chest pain, seizure, major trauma and any medical condition where death is a possibility. Obviously, this is open to interpretation and based entirely on the information given by the caller. Regardless of what the job is we try to get there as quick as possible. During the drive to any job, the attendant in particular goes through in their mind what exactly what they will possibly be walking into, what kit they will need and what the protocols and guidelines are if the job is 'as given'. These few minutes of composure are extremely important for the jobs where a life hangs in a balance but more often than not it's all a worry about nothing. That's the job. For me, doing without those few minutes is where I'm taken out of my comfort zone. You learn very quickly what is and what isn't second nature and as a crew you have to rely on each other to do the right thing.

As per usual, as is customary on a relatively quiet weekday morning, we were sat outside Costa coffee getting our caffeine fix. The day had been pretty uneventful and we were just watching the world go by waiting for a job. We were at the far end of the high street, the road clear of shops ahead of us and clear of traffic. The next 10 seconds occurred in slow motion. A woman, on her own, came into my view running / jogging up the side road about 20 meters away. As she approached the main road she appeared to look diagonally across in our direction to check for cars and continued into the road. Everything slowed down even further, as each step she made went by a maroon Ford escort inched closer and closer to her. We were the only ones who knew what was about to happen and we were powerless to stop it. The car struck her, she went no higher than 6 feet in the air and span like a Catherine wheel. She landed on the bonnet to a screech of brakes. The car ground to a halt and she was catapulted forward off the car about 30 feet and lay motionless on the floor. Still in slow motion we watched the car door open, out stepped the driver, 3-4 pedestrians from both sides of the road ran to her aid. Forget 8 minutes, we had 8 seconds until we'd be on scene. 

The passers by started to place her in the recovery position, my crew mate sounded the horn and I waved frantically for them to stop. They did. I jumped out and went straight to her head. Her face was covered in blood and grazes. To my surprise she opened her eyes and started crying. That's a good sign! My crew mate came over loaded up like a pack horse. He didn't know she was alive and talking so had unloaded everything he could carry, all the bags, the collars, the suction and the paramedic bag. While he was staggering over I pressed 'priority' on the radio on my belt. I just shouted 'Running Call, RTC Car vs Ped, HEMS required'. I knew we'd need HEMS because both of the legs were pointing in the wrong direction. We began assessing her, albeit in the wrong order. Witnessing it had taken our composure away! Despite her obvious leg injury and a nasty gash on her forehead she appeared stable. We gave her Morphine which didn't really help but it was a start. We wanted something inside her as  the fractures would need reducing. We cut off her clothes keeping her as covered as possible. Her left leg was broken and were unable to late a pedal pulse in her left foot. We needed to pull the fracture so after explaining what was going to happen and some lugs of Entonox my crew mate straightened her left leg. She screamed but after a few seconds felt more comfortable. We put both her legs in splints and started patching up her head injuries.

Twenty minutes after calling HEMS arrived. To be fair we had done everything. All her injuries had been assessed, treated, dressed and splinted. The passers by had been a great help and all we needed HEMS for was more pain relief and someone to pass the responsibility on to. They obliged and drugged her up ready for transport. Strangely, if we had had the 8 minute drive to scene I doubt we would have requested them but we panicked. Having to deal with trauma when you've seen it happen puts a different slant on it and you approach it with more frantic severity than you would otherwise. If we'd arrived and a witness told us the lady had been hit at 40mph, spun at least 3 times in the air, landed on the bonnet and then shot forward 20ft and rolled on the floor, we would hear it as 20mph, spun once and fell to the floor. Generally people embellish, not through malice or a need to lie but because everything is exaggerated when a monumental event occurs before your eyes. I'm sure it wasn't as bad as I remember it but we are only human. 

This lady was lucky, a broken leg, a dislocated knee, 6 stitches in her forehead and a fair bit of bruising.  It could have been so much worse. This all occurred though through a moment of stupidity. A moment where she didn't think, and we all do it. We all forget to put our seat belt on at some point, answer our phone when driving, look at something on the pavement, cross the road 20ft from a crossing, run into a road because when you looked 5 seconds ago it was clear. We just do stupid things we know we shouldn't. From when we learn to walk and talk we are constantly told to Stop, Look and Listen or Look Left, Look Right, Look Left again. Our patient knew that. Why didn't she? Because she didn't! Has she learnt her lesson? Yes! Will she do it again? More than likely.......

More Musings from Another Waiting Room

"25 year old female, waiting for an X-Ray in a waiting room"

A few months back when I started blogging I wrote one entitled 'Musings from a waiting room.....'. It was inspired by an unfortunate A & E admission by myself where I was forced to sit in waiting room for almost 6 hours with a bunch of morons. I threatened that I may take up this subject again and now due to recent events I got the chance to spend another prolonged stretch of time in one of the most depressing places one can be. Like before I sat there patiently waiting my turn watching hordes of people come and go. To be honest I was disgusted with what I was seeing. The pathetic reasons people were there, the shameless dress sense, the poor parenting, the immigration problem laid bare and just generally the lower echelons of society amalgamating in waiting room during the middle of a weekday. My opinions may make me a snob, in fact, they probably do but I don't care. I was there by appointment, I was reasonably well dressed, I sat on only one chair and sat quietly until my name was called. That is what waiting room etiquette dictates, that is what is courteous to do. Apparently the general public think otherwise. This is what the NHS is up against.

The Divas and their sprogs:           They were about 25 years old. She was a gobby diva and talked loudly like she was from the Bronx, he was a poser and sat sulking on the bench. Their twins were about 18 months old and screamed constantly. Their solution was to give them a Nintendo DS each, with the volume on full. Selfish much? Oh, when the crying started again, 3 packs of sweets were the order of the day. Not ideal for a toddler but what do I know?

The English language:          Her nor the children could speak a word of English. From the sign language to the receptionist the boy had a sore throat. They were told that they should go and see a GP. This was A & E for accidents and emergencies. They nodded and sat in the waiting room and as there was no way to communicate with them they were booked in despite it not being appropriate.

The Mobile Phone:             Like I said in my last waiting room rant, phones have a silent function. Silent should be enabled when at work, in meetings, on buses, trains and hospitals. Why? Because it's the courteous thing to do. When in a crowded public place having you phone repeatedly play Betty Everitt's Shoop Shoop song is more than a tad irritating. In fact having a conversation about the fact you're sat in a waiting room so everyone can hear is also infuriating. 


The Hot Baby:            In comes a frantic looking mother clutching her offspring tightly! I can overhear her telling the receptionist she has a temperature that won't go away with Calpol. Erm......doy! See the hot baby? Yes, the one you are holding. The one wrapped in a vest, 3 baby grows, a sleep suit, 3 blankets, a duvet, a space blanket, a sheep skin, a bobble hat and gloves. Yes, that one. That is why she still has a temperature. If you wrapped me in that I would sweat like a weight watcher in a cake shop! 

The Hypercondriac:           The was a large lady sat on the front row. She had one leg up on the seats next to her occasionally looking around the waiting room seeking apparent approval and sympathy for her injury. The funny thing was her 'severe' injury gradually improved with each stage of the triage process. When her name was called she hopped into the assessment room. She hobbled out.....! She hobbled off to xray. She limped back.....! She limped into the Doctor. She walked out........

The Drama Queen:             The generations of a family all equally as melodramatic. They were on my bench. The 9 year old had apparently broken her wrist. She clearly hadn't. After triage she wasn't put in a sling. After xray she was sent back to the waiting room yet even then the mother was on the phone to all and sundry saying how she may have a 'severe break' and may need surgery! I sense some Munchausen syndrome by proxi!

The Chav Family:         I want to vomit. The was apparent ill though you wouldn't have guess. Glammed up, peroxide hair in a council face lift, chewing gum with a mouth like a toilet. He was dressed Ali G with bum fluff, the 3 year old boy was dressed like a mini Ali G with his ear pierced and drinking a can of coke. The 5 year old girl was a mirror image of her 18 year old mum but with cornrows for a haircut. The worst behaved kids I've ever seen, running around, shouting and swearing which the parents repeatedly went outside to smoke.

The School Boy:          This insolent little punk had a constant smirk etched across his face. I never worked out what was wrong with him. His fat obnoxious parents were both there which to me meant neither of them worked. No surprise there. They also felt it appropriate to verbally abuse reception staff because they had been waiting for 2 hours. So what! So has every other prat in the place. And I told them so! When his name was called his parents were outside having a fag and he was in the toilet. I said nothing, just smiled. Poetry!

The Teenage Lesbians:             I have nothing against lesbians. Some of my best friends are lesbians. I do however have issues with unnecessary public displays of affection. And I mean full on groping, not just a kiss. You're supposed to be ill for starters, let alone being surrounded by children! The first one was a goth, with ears, eyebrow, lips, nose and cheeks pierced. She was also sporting a ridiculous haircut but hey, each to their own. The other one, the 'ill' one was obese, had achne, was wearing a 'rainbow' striped hoodie was the Hindu Aum symbol on the back. This was accompanied by pyjama bottoms and Ugg boots. This isn't and never has been a look. You are in public. Make a bloody effort or failing that, at least get dressed!

All of these people could and should have been treated by their GP by appointment but why bother? Why wait? Why not clog up a hospital? And why not make it a family outing. I mean it's like going to the zoo but instead of animals there are ill people and instead of the gift shop there is a vending machine and pharmacy giving out free medication. After an initial triage if they should have gone to the GP just say"Go away"! If it isn't suitable for A & E don't treat it. No wonder the NHS is always under pressure, these people who pay tax and don't pay national insurance abuse it with no deterrent. Set some rules for the waiting room about noise, mobile phones, attitude and having takeaways delivered and enforce them. Hospitals have security, use them! I you don't obey the rules you don't get treated. 

Why the long face?

"15 year old female, fallen off horse, still on floor, to be met at gate"

Certain jobs are like London buses. You wait ages for and 3 come along at once. I had never done a 'fallen off horse' since I started the job. I chuckled with disbelief when this job appeared on the MDT as this was the second horse related job in the shift and the third in two day! We headed to the location but had huge problems finding it. Our Sat Nav takes us to a finishing post, normally within a few meters of an address. The problem today was that the location needed was the entrance to a bridle path yet the location we were taken to was the middle of a village. A number of calls went back and forth between us and control, and control and the caller. Eventually we were painstakingly navigated by radio to the location (a mile away)!

A woman met us at the gate, but the gate was locked. Apparently the key holder was being tracked down. The problem was the patient was at least a mile down the 5 miles path. I got out, grabbed all the kit I could carry and began walking, leaving my crew mate behind to wait for the key. About 20 minutes later and absolutely caked in mud I got to the patient albeit panting, hot, sweaty and aching! She was lying on her back also caked in mud and in good spirits, the horse had bolted when the farmers gun had gone off and she'd landed head first. She was complaining of neck pain and tingling in her legs. I knelt down and placed a knee either side of her head to immobilise her spine until my crew mate arrived. I fitted a collar to her and took what basic OBs I could from where I was kneeling. Other than the pain, she was stable. After about 10 minutes my crew mate arrived with the truck. Thank god! Carrying her out would be a nightmare! 

We went through the immobilisation procedure, carefully log-rolling her onto the scoop, securing her head with head blocks and fully strapping her to the board. We got her loaded onto the truck and her friend headed back where we had come from with the two horses. She had obviously phoned our patients mother as moments later she arrived having run a mile along the path. My crew mate warned that the path was extremely uneven and difficult to drive along. There wasn't anywhere to turn the truck around so rather than reverse a mile we decided to drive forward 4. There were lots of overhanging trees so going backwards could have been problem. The patients mother assured us there wasn't a gate at the other end and in actual fact it brought us out on the road we needed for the hospital. Win win! Of we went!

Due to the nature of the possible injuries we had to take it very slowly due to the state of the path. In the back of the ambulance every bump, dip and undulation is exaggerated which make even the smoothest of rides potentially uncomfortable in the back. We went round every bend,  up and down every slope, through every puddle and successfully avoided every over hanging tree. It took us about 35 minutes to get to the exit, and like the mother had said the was indeed no gate..........however, there was a width restriction! There were no signs at the start warning of this potential problem or if there were we didn't see them! We were driving one of the new vehicles which are wider than the old ones. We inched up to the restriction, each with our heads out the window shouting the clearance. It wasn't going to happen. We were 2 inches too wide. F%@k s%&t bol&!cks! 

We called up control to see if there were any cunning suggestions we hadn't thought of like the HEMS helicopter. Nope! HEMS was offline! Reverse it was. It's ok, there is a reversing camera on ambulances so you can see what is right behind you. Nope! It wasn't working! So, with the back door open, some shouting and a mish-mash of hand signals we began painstakingly reversing along the 5 miles of bridle path with me walking behind the ambulance pointing out potholes and trees. Almost 2 hours later in near darkness, we reached the gate and were able to head off to hospital. I was filthy, covered head to toe in mud, my uniform brown, face spattered and chilled to the bone. 4 hours after dispatch we were on our way to the hospital on an actual road. It is now I will tell you we were sent this job at 14:45. We were suposed to finish work at 15:00. We got back on station at 19:35. Cest la vie!