Pass The Donkey - Part 1

"46 year old female, suicidal"

We pulled up outside a busy pub; our patient was sat in a wheelchair arguing with a member of the public. We knew her very well, she was a very regular caller and was always a difficult patient to deal with. The normally phoned police or ambulance daily for anything from being suicidal or simply being locked out. It transpires she had been discharged from hospital only an hour previous, she had been given transport in a private ambulance home but had kicked off in the vehicle and been kicked out by the private ambulance driver. They had then called us because she said she was going to kill herself; and she had tried several times in the past. This was going to take ages! We approached her which immediately got her back up as she hates the ambulance, police and hospitals (begs the question why does she normally call!). She wheeled off towards the entrance to the pub and in a scene reminiscent of Little Britain she just got up and walked inside. Obviously, we followed. The pub was packed and she was drinking strangers' drinks at every opportunity. After half an hour of coaxing, and the landlord asking her to leave, we got her outside. She refused to come to hospital and said she just wanted to go and kill herself. Knowing all too well we couldn't physically force her onto the ambulance we requested police. 

What happened next I will explain, but I thought this post would be the perfect opportunity to get the views from a number of different perspectives. With only the above information I've invited guest blogs from a police officer and a police inspector to offer feelings on mental health patients and what they would have done in the same situation and to provide where the job stands legally within the mental health act. From a hospital point of view there is a guest post from a charge nurse and finally the thoughts and feelings of patient. Obviously, I'm the voice of the ambulance but this is a kind of experiment to see how all five opinions tally up.

Firstly I'd like to introduce fellow blogger Laptop Cop who is a service police officer on the front line in a busy city. I asked him how he felt about mental health jobs and what he would do in this situation:

"Dealing with people who suffer with mental health conditions can be very challenging; the biggest tool we carry in our kitbags is communication. I would genuinely say a lot of the calls involving mental health can be dealt with by talking. This isn’t always the case though, sometimes force has to be used. 

The police and ambulance are emergency services, so we should only be called when there is an immediate threat to life or someone is in danger. This is often not the case, far too often we are receiving calls where a community team or local MH practitioner could attend and deal but they don’t, I guess it’s a lot easier to pass the buck and shift the ‘problem’ onto someone else rather than take responsibility for something. From our point of view, we can turn up, if someone is in a public place and is posing a danger to themselves or an other we can section them under 136 of the Mental Health Act and take them to hospital. If they’re in no immediate danger, and they don’t want to go to hospital all the police can do is take a report that gets forwarded on to our Mental Health Liaison Officer.

Unfortunately the culture we live in today is something that I’ve referred to as CYA, which means Cover Your Arse and I hate it with a passion. I will do everything in my power to help someone, it’s in my nature and it’s why I joined the service but the problem is that this culture is all about making sure you’re covered incase the brown stuff ever hits the fan. So, in the job that Ella dealt with I am quite sure that even though this patient had the capacity to refuse treatment, the fact that she had made threats to hurt herself I would without doubt had to section her using 136 powers. This is so we can take her to a place of safety and get her help but I make no bones about the fact that this is partly down to covering myself. If I did nothing, even though she is a regular caller and probably won’t carry out the threat; IF she did, it would be me ‘gripping the rails’ at a coroner's inquest with the potential for losing my job." 

I would now like to welcome back Mental Health Cop to Trying My Patients. Although he is more than qualified to offer much more, I simply asked him to tell me the police powers and procedure for dealing with the patient as she presented to us:

"If the police are called to support the ambulance service where they are dealing with a non cooperative mental health patient who is making threats of suicide or self-harm, thoughts should turn to whether there are any criminal offences being committed and / or whether or not the criteria for detention under s136 Mental Health Act are satisfied. Although resolving a situation without resort to legal coercion is far preferable, it may well be thought unlikely to succeed if the Ambulance Service have called for police support, having already tried and failed to persuade.

Threatening or attempting suicide is not a criminal offence, so in the circumstances outlined it appears to be s136 or persuasion. Officers have tried to persuade - actually, sometimes a police uniform is persuasive as it also implies 'or else' - but that having failed, it looks like detention under s136 is the only viable option to consider. In so doing, thought should pass to what the consequences would be of not implementing s136? Amidst known mental health problems and threats of suicide, were these to be realised after such contact with NHS and police professionals, it is reasonable to assume difficult questions would be asked. The patient would have the right to walk away from any healthcare offered, as the paramedics concerned have stated that a decision to decline treatment could not set aside by virtue of the Mental Capacity Act.

So on the circumstances as presented, I'd have been implementing s136 MHA and doing so in knowledge that this may then mean a wait within A&E or at a place of safety, pending assessment."

Sadly it didn't quite work out how a) I wanted and b) how both Laptop Cop and Mental Health Cop would have wanted. The police did come. They implied they were going to section and forcefully assisted the patient onto the ambulance but then left. I assume this was partly due to the fact that they had spent most of the previous night with her and were extremely busy again tonight but I wasn't at all happy with the situation we were left with. As Laptop Cop says, the 'cover your arse' attitude dictates most of what we all do everyday, in this case the police had got the patient off the street and into the safety of our ambulance. It was now no longer a public issue and although, like Mental Health Cop confirms a Section 136 would have been the appropriate action, the fact of the matter was the patient was now being taken to a 'place of safety' without any further strain on police resources.

As much as I disagreed with the methods used as I could see no legal right to take her off the street without arrest or section, I'm not one to look a gift-horse in the mouth, so we took her to hospital. Bear in mind she didn't want to be in the ambulance, she certainly didn't want to go to hospital, but she made no attempt to leave so I didn't push the subject. It was a short journey but long enough for us to be called every name under the sun.


To be continued.............


Part 2 - Click here

I want, does get

"21 year old female, vomiting"

This was the second time in as many hours we were sent to the same job; an 82 year old on the floor, post falling, and unable to get up. The call was now almost 3 hours old and considering we had previously been cancelled to go to a 40 year old bloke with a 2 week history of tummy ache we were looking forward to picking up an old dear off the floor. She was bound to be grateful and polite at the very least! Alas, that not meant to be: 

"Cancelled for higher priority event"

Again!! What really annoyed me was that the so called higher priority was a 21 year old vomiting. What do I know though? I'm just a bum on a seat. We trundled round to the address and looked in amazement at the size of the place. It was obscene. We grabbed our stuff and edged up the driveway, being careful not to hit our bags onto 1 of the 2 Porches, the Land Rover and the Mini Cooper convertible. The door was ajar so we entered into the marble floored foyer. Oh how the other half live! We were ushered into the living room where our patient was sat with a plastic bowl in front of her. The mother gave us a handover of recent events:

"She woke up this morning and didn't fell well. She started vomiting about 3 hours ago and is now feeling very weak. I want her taken to hospital to have a full work up"

Without being rude I tried to explain that perhaps hospital wasn't the best place for her. Having only a 3 hour history of vomiting, she may be best suited to being treated at home with water and rest. I also offered to refer her on to the out of hours GP so that they could call back and give some further advise:

"That won't be necessary, I'm a GP and I want her to go to hospital"

Well that told us. We finished checking her over, everything was absolutely fine, she didn't even have a temperature. We walked her outside, past the 4 cars and onto the ambulance. I sat her on one seat and offered the other one to her mother. 

"Oh, I'm not coming in the ambulance, I'll follow in the car, it'll be a pain to get home otherwise won't it?"

With that, she got in the Land Rover and left her not so ill daughter with an irate ambulance crew. Seriously, what chance do we have when the ambulance service is abused by the very people the government are putting in charge. What chance does the ambulance service have of meeting needless targets when people who know what to say to get a quick response, cause the people who need us most to be stuck on the floor for hours? What chance do the hospitals have of meeting their patients needs, when they have to waste valuable time assessing and discharging the daughter of GP who probably ate some dodgy Fois Gras.

As frustrating as this job was, there is nothing we can do about it. Until we are able to make decisions for ourselves, until we have the right to refuse transportation to hospital, until we can refuse to send an ambulance or until there is a suitable deterrent for abusing the service nothing will change at all. We are of course, bottom of the food chain. I was also always told as a kid 'I want, doesn't get'. It's a good ideal, you can't go through life thinking you can have everything you want. Well, that isn't entirely true. If you have money are a complete ass you can do anything you want to. This was a case in point. I want does indeed get. Gotta love the patient charter! And GPs.......

And The Winners Are.....

The March competition has come to a close and it's time to make the draw! Every entrant was assigned a number and 5 numbers were picked by a random number generator. I've added the screen shot of the results in the interest of fairness! The numbers were assigned by the order in which they tweeted their entry. 

01 @art_of_serenity

02 @DitchDocRN14

03 @Yellow_Van_Man

04 @wilkotwig

05 @oldburymrso

06 @p_a_r_a_medic

07 @ChippyLyn

08 @pheonix_rising_
09 @deefer_dog
10 @HelmutGrein
11 @Mrs_Lifesaver
12 @clc2304
13 @halloikbenwill
14 @paramedicSA
15 @TomDimmock
16 @Martin_Papworth
17 @reckydecky1989

18 @colette_powell

19 @URCherry

20 @999TraumaAngel

21 @Petrolhead999

22 @LilPingu999

23 @RosemaryJCherry

24 @pixie_toes

25 @KatieMagnet

26 @Colinp02

27 @ali_bumgo

28 @BookwormMummy

29 @PJ_and_Doo

30 @StairliftWit

31 @Beanstalktam

32 @da_big_fish

33 @marksonofwil

34 @@gaz140987

35 @drew_DH1

36 @justinthetree

37 @yvon_gib

38 @Dizzy_LJ

39 @sneakysquirrel

40 @chocolatewig

41 @bendyben88 

Thanks to all that entered! If you are one of the lucky winners please email where you would like it sent to diagnosislob@gmail.com and your mug will be sent out ASAP! 

Sacrifice

"Who wants to be married to a shift worker?"

Doing this job can be tough. The long shifts, the ever changing shift pattern and the stressful nature of what we do and often see can take its toll. Most front line staff at one time or another will have suffered some form of Post Traumatic Stress Disorder, be it intrusive thoughts, flash backs and harrowing sights in their dreams. We all have coping mechanisms to deal with it but a lot of the effects spill over into our personal lives and can have a damaging effect on personal relationships. The fact that the 'relief' rota is known as the divorce rota speaks volumes. I can testify to it! My marriage suffered as a result, to the point where it was beyond repair. I was always tired, moody, didn't feel like talking about what was troubling me and generally became crap company. I pushed away the person I was closest to, the person who had supported my career change and for what?! There is a general feeling that if you don't do the job, you don't understand. You spend so long at work and form close relationships with people that they become the ones you confide in; that in itself can cause a strain. Add to that the fact that your colleagues are the only people off work when you are & you end up socialising with them too. It is therefore no surprise that it is a very incestual service. A large percentage of people are married to or partners with someone else in the job. Let's be honest, with a 7/10 weekend rota your chances of meeting someone outside of work is seriously limited. Obviously, there is no fuel without fire, my marriage break-up cannot be souly blamed on my work, but if I hadn't changed careers I do often wonder, what if?

As tough as it is on the ones doing to the long hours and varied shifts it is equally hard, if not harder, for the spouses who suffer the company of a miserable shift worker. It's a perspective that I can't give, as I haven't been on the receiving end of it, but it's a perspective I think is well worth hearing. Every argument has two sides, every divorce has two people hurting, so I thought it would be worth hearing it from the other side. Seeing what it's like to have someone who has a normal job and then dons the green and changes. Someone who saw their marriage fail, in no small part to being married to a shift worker. It is with great pleasure that I introduce Michelle, a friend who suffered the effects of the 'relief rota' from the other side of the fence: 

'My name is Michelle, and I was a shift widow.'

"I wonder if there is a support group for the shift widow? If there is, I never found it. He wasn't a paramedic when we got married, in fact he became one after I saw an advert in the Metro on my daily commute. He applied, he got in. I was happy for him, he’d been looking for a decent career for years. Would I still have shown him that advert if I'd known what would come next? Possibly not...

To give you an understanding of our situation, you should know that we have a small child and that I have a full time (9-5 office) job. So as well as navigating the shifts, we had to deal with childcare, my occasional evening and weekend work and sporadic train- related lateness as well as the odd attempt to see each other/have a life.

I'm not going to lie, living with a shift worker was a nightmare. Especially a disorganised one. Let's just say he wasn't exactly reliable when it came to sharing his shift pattern and the infamous 'Relief rota' seemed to be completely random. So I spent half the time not knowing when he was working. Cue lots of confusion over who was supposed to pick up our child. Or my mum letting herself into our house at random when he was in bed after a night shift and him going nuts at me about it (there's a whole other post on interfering mothers there... Maybe another time).

The side effect of a lack of information meant that I basically turned into a massive nag. Whenever we were both at home, all I did was to badger him for his rota so that I could sort out childcare and moan at him for never being around. He would snap at me, I got no information and on numerous occasions I couldn't attend work events or social gatherings. On top of that, apparently the housework was all my responsibility. Even though he seemed to sit around doing nothing and making a mess on his days off, my evenings and weekends comprised of looking after our child, cooking, cleaning and sleeping. I lost me and I lost my social life. It didn't take long for me to begin to resent it. And it wasn't much later that he started spending all his non-working time with his new paramedic mates, who I hated (despite never having met them) because as far as I was concerned they were the reason he wasn't spending any time with his family. Especially when I found out he’d told me he was working when he was actually out with them... Probably to avoid the inevitable fight if I found out.

It was less than a year after he started the job that he left. There were other things going on at the time that contributed to the split, but if I had to list the top three reasons for the end of our marriage, the job would be right up there. At the time, I didn’t see it as being the job and blamed him - which on reflection was unfair. But I didn’t understand the pressures of his job... and he didn’t have any idea of the impact of it on me either."

I think it's fair to say that there will always be two very contrasting opinions and versions of events. I think the point that there is a lack of understanding between the impact on each others lives is very poignant. So much can and could have been fixed with communication. It's all too easy to run away from the root of the problem and find alternatives to facing up to what is essentially staring you right in the face. Sacrifices are made for this job and there are times those sacrifices seem worthwhile. But it is important not to lose sight of the fact that we are not the only ones making that sacrifice.

The 5 Stages

"32 year old male, head injury post RTC, Car vs Lamppost"

First job of the shift; one minute in, typical start to the day. We put on our hi-vis jackets, threw our stuff on the truck and headed out for the day. The location was a residential road but quite a high speed one. It was just after 7am so the traffic was starting to pick up. When we arrived on scene, at the same time as the police, our patient was still in the car, the bonnet of which was wrapped around a lamp post. The airbags had been deployed and he had a nasty looking gash on his head. We fully assessed him and after the wound was cleaned slightly it wasn't as bad as it first looked. He had no neck pain at all so we slowly helped him out of the car, onto the trolley bed and onto the truck. He said he'd been driving to work and a cat had run out in front of him. He'd swerved to miss it, lost control and ended up well acquainted with the lamp post. As is standard practise the police came on board to take a statement and breathalyse him. Up to this point he had been very chatty but failing the breathalyser changed that. 

Although guilty of drink driving, I believed he had done so without intention. It is all too common to still be over the legal limit following a night's sleep and a breakfast. Regardless of his intentions though, the law is there for a reason. That reason is to stop people getting killed; simple as that. The costs to our patient, of not baring that in mind were huge. What made this job interesting though was watching how he dealt with being arrested. There was a striking similarity to that of the 5 stages of grief and mourning. Obviously, he wasn't suffering grief or mourning in the traditional sense but he did follow the pattern first described in Elsabeth Kubler-Ross' 1969 book 'On
Death and Dying' that says a distinct pattern of emotions is followed.

1. Denial

His first reaction to learning of being arrested was to deny the reality of the situation. He simply would not accept what was happening or what the officer was saying to him.

"Are you serious? No way. This is not happening, you're kidding right?"

"I don't kid about drink driving"

"But I stopped drinking last night... I didn't have that much, it can't be right"

Explaining that it was indeed correct and he would now be arrested changed his mood somewhat.

2. Anger

As the masking effects of denial began to wear thin the reality and severity of the situation re-emerged. His intense emotion was deflected from his apparent vulnerability and was redirected and expressed instead as anger. He started shouting abuse at the cops and us for that matter.

"You lot should be out catching real criminals" Blah Blah Blah....

"What the f@$k are you looking at?"

He then proceeded to jump off of the bed and make a bee line for the back door, kicking out and swinging wildly. Needless to say, he was promptly subdued and put in the back on the bed, this time in handcuffs. He continued his abuse for a few minutes until he realised it was getting him nowhere.

3. Bargaining

It didn't take him long to realise that anger was not working so he tried begging and pleading to not be arrested.

"Please mate, come on, you don't have to do this. There must be something I can do. Please. I'll do anything, honest"

"Sorry fella, you've been drink driving, there's no excuse and nothing you can say to change the facts"

"Seriously, I'll do anything, I'll pay a fine, community service, whatever you want"

Like the anger, this went on for a while. My crew mate was dressing the cut on his head while I did paperwork and he just continued to beg and plead for redemption.

4. Depression

Two types of depression are associated with mourning. Obviously he wasn't mourning in the traditional sense but he was certainly realising the gravity of the situation. The first one was the reaction to practical implications relating his arrest. His sadness and regret were obvious and as he spoke I kind of felt sorry for him. I'm passionate about my hatred for drink drivers, but when you hear someone list the implications of the careless mistake they have made made, it's hard not to feel for them a bit. 

"I'm gonna lose my licence and my job aren't I?" 

It was a rhetorical question; he knew the answer as did we.

"What am I gonna tell my wife? She can't drive, how am I gonna pay the bills? Oh my god, what have I done?"

He had a point but as the old adage goes, if you can't do the time, don't do the crime. The second type of depression was more subtle and, in a sense, perhaps more private. He just lay their on our bed, staring at the ceiling. He then put his head in his hands and cried. It was an awkward moment really. What do you say? You can't really say 'serves you right', although it does, but it's human nature to have compassion. Then again, if his drink driving had killed a little kid there would be no questions that he should get everything that's coming to him. The fact that he got lucky doesn't negate that.

5. Acceptance

By the time we got to hospital he had a quiet acceptance about what was going to happen. He was apologetic to everyone for what he had done and how he behaved. I'm sure in the coming days he will be dipping back into anger and depression, and only once he's had his day in court and learns to live with the consequences of his actions, will he truly accept what has happened. It's easy to point the finger and equally easy to find compassion for the guilty, but there are people who may never find the acceptance they need. These people are the victims of drink driving; the people behind the statistics, the people who will never forget the consequences of someone's stupidity.

• On average 3,000 people are killed or seriously injured each year in drink drive collisions. 

• Nearly one in six of all deaths on the road involve drivers who are over the legal alcohol limit. 

• The latest figures show that some 590 people were killed in crashes in which a driver was over the legal limit; 2,350 were seriously injured and 14,050 were slightly injured in the last year.

• Car crashes are the leading cause of death for teens and one out of three of those are alcohol related.

It doesn't matter if you have had one drink too many or 10. The results can be catastrophic. It doesn't matter if you drive whilst drinking or the morning after; the same risks apply and if you think you won't get caught, more than half a million breath tests are carried out each year and on average 100,000 are found to be positive. Don't take the risk. Don't drink. Don't become a statistic. That is all.