It's not all bad

"16 year old female, self harming, using glass, ? violent"

I'm often very critical of mental health services. That criticism is based on personal experience in dealing with staff at mental health units, crisis teams and AMPHs. In rather heated exchanges I have been told by mental health professionals that it isn't all bad and there are good staff out there. My response has always been that I can only write about what I come into contact with. If it's bad, then I will say just how bad it is but if and when I get a positive experience I will also share that. Well last night I had one. Not only with a mental health unit, but also a crisis team and the staff I met. 

We were called to a private address to a young girl who was self harming. It is always sad to see someone so young suffering as they are and they are often very difficult to interact with, especially with the limited training we have. When we arrived we were pointed in the direction of an upstairs bedroom by an apparently unbothered mother. Perhaps here is one of the reasons she is was self harming in the first place. That aside we went upstairs to meet Amy. She was in her room and having some kind of manic episode. She was very twitchy, on edge and was acting rather frantically. She had the most captivating eyes, and despite her behaviour a really gentle manner about her. She was smiling and talking to herself and sadly, bleeding from her arms. I began talking to her, keeping my distance as I didn't want her to think what we were encroaching on her space. Gradually, as the conversation went on I edged in and sat down. We discussed her recent treatment and then I asked if she had a crisis team. She did. Going by past experience, the prospect of having to go through the uphill, hapless task of getting them out was something I was dreading. 

To my pleasant surprise I had a very fruitful conversation with her case worker. I got a full history, a list or do's and don'ts and a promise that she would be with us shortly. And she was. By the time she arrived we had dressed and cleaned the wounds so I stepped out while they spoke. I few minutes later she emerged and said she was going to call her unit to see if she could be admitted there. I was happy with the cuts so if we were able to bypass A & E that would be better for everyone. I overheard an extremely heated conversation between the case worker and the unit.

"I don't care, I am bringing her in, make space"

No idea what they replied!

"Fine, I'll stay with her but I'm not having her sit in A & E for hours on end. The ambulance have said she if fine to come with me, we'll be there shortly"

Boom! So refreshing to see someone go that extra mile and be in a position to insist on an admission to the correct facility. We took them both and left the unit very pleased with the outcome. Normally, that would be the end of that patient for the day but clearly this was no normal day!

About 9 hours later we got a call to the same mental health unit. We started heading round and the screen updated with more details.

"16 year old female, cut to arms"

It was the same girl and amazingly we had got the job. Shortly after her arrival in the afternoon, she had cut herself again with a broken glass. Staff had cleaned and dressed it but when a doctor visited in the evening, he wanted it closed properly at a hospital. We arrived at the unit to be met by waiting, friendly staff. On the walk to their medical room the nurse gave us a full history, one we already knew but useful all the same. Amy seemed relaxed to see me. She also seemed in a much much better state of mind than before. She skipped to the ambulance and was very chatty. The case worker who had stayed with her came with us. It was so nice to see. The staff were very compassionate towards the patients that we saw. 

Amy had had a troubled upbringing with huge attachment issues. Her manic depression, low self esteem and history of abuse and neglect were horrible to hear and read, but seeing respond so well to people who clearly cared about her mental well being was great to see. I was a prime example of the what benefits there can be when an ambulance looks for other options other than A & E, when a crisis teams comes out on request, when a mental health patient is taken to the most appropriate place and when staff are attentive and willing to go the extra mile for the right outcome. It also showed the results that can come from continuity of care. Far too often, people complain that they never see the same staff and information isn't passed on. It can feel like starting over, every meeting they have. Clearly, if all areas within the NHS work together, have transparency and support each other the patients will only benefit. I live in hope that these types of jobs will become common place and not a rarity. 

One Night

"82 year old male, fall"

This job throws up surprises all the time. You meet some horrible people, some lovely people and some strange people. You see the best in people and the worst. You see greed, compassion, anger and happiness. You see life end and life begin. Every shift is different and offers something new. Most days, I don't remember most of the people I see but sometimes there is the odd person who sticks with you. There are jobs you will always remember. Your first job, your first cardiac arrest, you first trauma, your first HEMS job and your first baby delivery. They are jobs that mean something to you, that in a way define your career and define who you are as a clinician. It is important to learn from the good and the bad that any job has to offer. 

We were sent to a warden controlled housing block for a regular faller. He was a lovely guy. He was already up off the floor by the time we arrived and not injured but as he was having spells of dizziness we thought it best to pop him up to hospital. We did all our checks and loaded him into the ambulance. He was a Jamaican man with a fantastic accent and a huge personality. He was a real gent, desperate to pay us for helping him but obviously we refused. We chatted for a while whilst I did my paperwork, him telling me about his 40 years in England working for the NHS. In the background was a compilation CD we had been playing. 'One Night' by Elvis started playing and he got so animated!

"Turn it up, turn it up, me loves this song"

He started singing in a tone very similar to that off Louis Armstrong! He had a lovely voice. There was a real sense of joviality in the back of the truck. I joined in with the singing as did my crew mate! It was like Ambulance Karaoke without a microphone. God knows what anyone standing outside must have thought! Everyone was smiling, me and my crew mate were in stitches! The song ended and we left for hospital, serenaded all the way to the likes of Elvis and Sinatra. I just sat there watching him take so much joy in singing along. Here was a lonely man with no family who spends day after day sitting at home with only himself for company. Anyone could be forgiven for being miserable but he wasn't. He was having the time of his life. Maybe it was proof that he didn't need hospital but I didn't care. Surely this is what it is all about. Making a real difference in someones day. It is one of the magic moments I will look back on as a highlight of my career. Priceless!

Elvis Presley - 'One Night'

The Late Job

"82 year old male, fall, no injuries"

It is 4:45am that I'm writing this post. I should have been asleep for almost two hours by now, instead, I was two hours late off from work. Again. In my last post 'Fed Up'  I listed at length the annoyances ambulance crews face on a daily basis. If there was one we could fix, one that winds us up more than anything it is finishing late every single day. More often than not it's only half an hour or an hour but sometimes a lot more. And like I said, it is EVERY day, bar none. If you ask any crew, no one minds being late off the a genuine job and no one minds being a little late off for a job that over ran. What we all take umbrage to is being late off because the powers that be abuse the system. I know the term stitch-up is often used and probably sometimes unfairly but there are times when it seems that is exactly what has happened.

It had been a normal, very busy 12 hour shift. In fact, it was the busiest day of the year so far. Well over 5000 calls and that is on a Tuesday. During the shift we left a bag on scene at a job. Obviously we needed to pick it up and as luck would have it we were able to do so with minimal time off the road. My crew mate joked:

"I bet we'll pay for that later!"

Like every day, we had gone from job to job to job, no rest break and a distinct lack of ambulances at hospitals. At times it had felt like we were the only ones working. As we hadn't had a break we were supposed to finish at 02:15. At about 00:45 we were at hospital having just dropped our patient off and 'greened up' looking for our 'off job'. I'll now list what happened for the next hour and a half.

00:47. Dispatched 6 miles away. 22 year old male, nausea & vomiting. 

00:59. 0.2 miles from the location. 'Cancelled. Call downgraded'.

01:04. Dispatched 8 miles away. 77 year old female, fall.

01:19. After arriving at scene. 'Cancelled call downgraded'

01:28. Dispatched 4 miles away. 25 year old female, DIB.

01:32. 0.5 miles from location. 'Cancelled, quicker responding unit'

01:50. Arrive back at ambulance station.

This is when we realised why we had been run ragged all night. The garage was full. 7 ambulances and 5 cars. All unmanned. No night crews on. No other late turns. No FRU's. None of these were offered on overtime. All the staff from our station who were at work had been sent to 'priority complexes' leaving our area uncovered. Why? Because targets are easier to meet on ambulance stations where the call volume is closely populated. Less distance to travel, higher call volume and more ambulances means in that area a greater percentage of targets will be hit. It is so frustrating seeing so many vehicles unmanned, not only because it is highly likely we will get a late job so they have an extra ambulance for an hour but also because I know there are calls waiting for an ambulance. Some for hours. All night EOC were putting out waiting calls on a general broadcast basically begging for any ambulance to offer up for them. Maybe, instead of constantly fixing short term goals they look at long term. Maybe instead of 5 yearly hire and fire exercises they improve staff morale so 25-30 people don't quit every month. Instead of wasting money on media friendly exercises and initiatives how about fund proper ambulance cover in an ambulance service. Yeah right! 

02:13. Dispatched 11 miles away. 77 year old female, fall. Yes, the one we were cancelled off 54 minutes ago. Yes, we are supposed to finish in 2 minutes.

02:30. The computerised voice on the MDT says, "Callsign, Echo Three One Five, Not on shift" How ironic. We clearly are.

02:31. Arrived on scene.

03:14. Leave scene to hospital.

03:32. Arrive at hospital.

04:06. Leave hospital.

04:18. Arrive back at station. 

04:30. Sign off and go home.

Not only was this totally unavoidable it was totally typical and unsurprising. We could have been on scene well over an hour sooner, in fact we were. There is not a credible reason I can be given for what happened. There is no credible reason why they waited until 2 minutes before we were off to re-send us, other than it would be an extra resource on the road for another hour. But at the end the day, that is all we are. A resource. Not people with homes to go to, with families to see, with lives out of work, with kids to put to bed. None of that even registers on their radar. Let us not forget, they are never 2 hours late off. This constant abuse of the system is what angers road staff so much and is one of the main reasons for morale to be so low. If this was an isolated incident then maybe it wouldn't matter but it isn't. It has happened time and time again and will continue to do so. All we can do is grumble!

Get your house in order

"79 year old female, constipated "

Ok, not the most glamorous of jobs, but lets be honest, four days without a crap is not gonna be comfortable! We'd spent the previous six hours rolling our eyes at various 20 year olds with headaches, back pain and man flu so an old dear was just what the doctor ordered. We pulled up outside a large block of flats knowing full well there would be stairs to climb and not a lift in sight. We traipsed up the stairs to the third floor and entered the rather lavish apartment. The live-in carer met us at the door and took us to Edna. Edna was bed bound from a stroke a number of years ago. She was paralysed on the left side and had very little cognitive function which required 24/7 care.

In all fairness, her carer was excellent, she'd done everything she could to prevent an ambulance being called but she had been let down by the service she relies on. A GP had been out the previous morning for the constipation and had prescribed an enema. Not being a nurse she asked the GP what to do. The GP told her to arrange a community nurse so she did. After hours of trying to get through one was arranged for the evening. Unfortunately they didn't turn up and by the time the carer called to see what was happening the office was closed. In the morning, another visit was arranged for lunchtime. Again, they didn't turn up but this time they wouldn't answer the phone. This is common practise, if the phone isn't answered they don't have to commit to jobs, similar to crisis teams and various other NHS services. It had now been four days since Edna had opened her bowels and appearing in real discomfort her carer, quite rightly, called us. We will always turn up regardless of day, time or call rate. If only other services would do the same. 

We started assessing her and within just a few seconds it was clear this was now beyond constipation. Her skin was clammy, her face was pale and the pulse was racing. Her breathing was very fast, her blood pressure was low, as were her oxygen and carbon dioxide levels. She had a huge temperature and was hyperglycaemic and was without any doubt, septic. Her abdomen was also distended and extremely rigid. We blued her into hospital and left her in the care of the doctors. She probably won't have died but it is more than possible. How can something as simple as constipation get so out of control? The elderly totally rely on the services that the NHS provide and there really is no excuse for these failings. It happens time and time again where the ambulance service and the A & E departments are left to pick up the slack for poor practise. I put in a futile complaint but in all honesty it was to make myself feel better, rather than the possibility it will actually do anything. 

Giving a patient full time care in their own home requires services to work together and deliver the care they are there to provide. Prescriptions need delivering, GPs need to visit, carers are required throughout the day, nurses are needed for catheters etc, meals need delivering, ambulances are needed for hospital admissions and appointments and social services are needed for facility provisions. These patients often need all of the above simply to exist. All it takes is one not to pull their weight and you end up in a situation where a simple home visit being missed, costs a life. There are also financial implications too. The conveying to hospital and an extended stay costs £1000s upon £1000s. Money the NHS can ill afford whilst trying to stave off privatisation, especially when it could have been avoided. I am totally opposed to the NHS reforms, I think it will be bad for patient care, bad for the country and people will get left behind. Sadly though, there are areas of the NHS which are not doing their job and are providing the policy makers with all the excuses they need to out-source services. If people are serious about keeping the NHS as a non-private, non-profit, free for all organisation, then all areas within the NHS need to get their house in order and prove they are fit for purpose. 

Blog of the year?!

"25 year old female, pretty bloody chuffed"


I have only been blogging for about 5 months or so but I have thoroughly enjoyed every minute of it! I have never written before so it is all very new to me even now. One of the things that has amazed me so much is the positive reaction I have had from people who have read it. I never thought for a moment I would a) stick with it or b) people would like it but I appears I was wrong on both counts. Today I received a direct message via Twitter from someone saying they had nominated me for the Fire & EMS blog of the year competition. That really did mean a lot especially as even I didn't know that the competition existed! Well I do now and the fact 1 has voted for me why not more eh?! If you like what you read then any nominations would be absolutely fantastic!

To do so just click on the link below:

Fire & EMS Blog of the Year 2012


and fill the form in with the following details:


Title: Diagnosis: LOB


URL: www.diagnosislob.com

Thanks again for all the comments and positive support!

Ella x