Allergies & Vomiting

“2 year old male, vomiting, ? allergic reaction”

I have my very own 5 year old. In that 5 years he has vomited. In fact, he has vomited on numerous occasions, sometimes on me! Sometimes he has vomited more than once in a day. When he was a baby he would vomit milk all the time. He goes to school, he picks up bugs. He gets coughs and cold and sometimes even an upset stomach. He deals with it all. We deal with it all. Humans get ill from time to time. It’s a fact of life. We certainly never called an ambulance because he had been sick. Just sayin’!

Anyway, it was about 10pm on a bog standard weekday night shift. Me and my crewmate were parked up listening to Frank Sinatra watching the world go by when we were given a job about 100 yards away. We had pulled up, got out, grabbed our bags and rung the door bell before the 999 call had finished! We made our way up to the 3rd floor and knocked on the flat do. 

“In here, come quickly” said a frantic voice.”

We passed two teenage girls in the corridor who pointed us into the bedroom. Sitting on the bed was our patient sitting on his mothers lap. Her knee was bouncing up and down, as was the little kid! Probably not ideal for a vomiting child! I asked what had been going on and despite all the drama that was put into the story the crux of the matter was that the kid had vomited once and was now sleepy. Call me a cynic but is vomiting once a medical emergency and is it any surprise he is sleepy when it’s 3 hours past his bed time?! Despite my best efforts to calm her down, the mother was having none of it. She thought her kid was gravely ill and wanted to go to hospital. This vomiting was an apparent allergic reaction to banana. Trust me, I’ve seen allergic reaction, this wasn’t one. Even her teenage daughters found the whole thing a tad bizarre and chipped in trying to convince her to calm down. No joy!

She was convinced he was riddled with allergies and that was what had made him sick. Asking about allergies is a pretty standard question when determining someones medical history. A lot of what people are convinced they have a penicillin allergy, most don’t. They either had a side effect from taking it or simply don’t like it. The same applies to food people don’t like and in panicking parents, these make believe allergies are passed onto their children. 

“What is he allergic to?”

“Ha, what isn’t he allergic to?!”

“............” I didn’t feel that ridiculous statement warranted a response so just waited.

“Penicillin, wheat intolerant, lactose intolerant, most washing powders and nuts”

“What happens when he takes penicillin?”

“I don’t know, I won’t let him take it?”

“Why not?”

“Because I’m allergic to it.”

“In what way?”

“I feel constantly sick and ache”

“That’s a side effect. I doesn’t mean your son will be allergic.”

“I’m not risking it.”

“Has he been hospitalised or had any severe allergic reactions to anything?”

“No.”

Excellent! No known drug allergies is what I wrote down on the paperwork! This conversation reminded me of an article I read in The Daily Mash that sums up my feeling on the issue!

Your Baby Is Not As Pathetic As You, Say Experts 

WORRIED parents are being urged not to automatically assume that their baby is as pathetic and ill-informed as they are. 

Research has revealed that many parents have already decided their child will suffer from the same made-up food allergies they do.

And a recent study showed 65% of GP visits were the result of parents believing their baby is developing a Coco Pops intolerance because they have a great aunt who is hypoglycaemic.

But now scientists say there are other factors that cause babies to become feverish, develop a rash or shit themselves up to 18 times a day.

Dr Tom Logan, of the Institute for Studies, said: “It’s because they’re babies.”

He added: “If your baby is developing in a perfectly normal way, try to not jump to the conclusion that it must be suffering from that corned beef allergy you read about in Take a Break. 

“Also, if you think that you may have an intolerance to cheese, black pudding and Greggs pasties, don’t assume that your baby is going to be a delusional, self-absorbed halfwit.

“The best thing to do is wait until you have finished breast feeding and then either give the baby to Barnardos or leave it outside a big, posh house.”

We use humor quite a lot to diffuse a variety of situations and as much as i’d like to have read out the above, I used some restraint! Sometimes humor works, sometimes it doesn’t. I consider my crewmate to be very funny! He has good timing and often lightens the mood at the right times. The mother was rushing around like a headless chicken trying to put her entire life in a bag. I tried to tell her that if we are not rushing around there is nothing to worry about! That didn’t help. Maybe a bit of humor to lighten the mood?! The mother had the strongest of Liverpudlian accents. My crewmate went with.....

“That’s an interesting accent, what part of London are you from?!”

The daughters laughed, I chuckled, the mother glared.

“Is that supposed to be funny? Do you really this jokes are appropriate when my child is seriously ill?” 

SHOT DOWN! He sheepishly apologised! Seriously though, lighten up! The joke however, made the whole experience very awkward. Both of us were treated to glares for apparently not taking this life and death emergency seriously enough. What annoys me is that these people call an ambulance and then don’t respect the staff on them. I can only assume she called because she was worried and wanted some medical professionals to help. We arrived, looked, assessed, took a full history and came up with an impression of what we thought was going on, a diagnosis and a list for a differential diagnosis'. We see up to 12 patients a shift, 3-5 shifts a week, 52 weeks of the year. That equates to about 2000 patients a year. We know when a patient is ill, we know when a patient is on death's door and we know when a patient has vomited and wants to go to sleep. Why not call a taxi if you are going to ignore the ambulance crew? They will be able to do exactly what we are doing and probably won’t make any jokes.

People really need to take life less seriously and lighten up. I know that something trivial for one person can be an emergency to someone else but some people really need a reality check! If you call 999 and a paramedic tells you that everything is okay and a 2 year old vomiting once isn’t anything to worry about DON’T tell them they are wrong. Life is too short to be so bloody uptight! Chill your frickin’ beans!

What happens if.....?

“38 year old male, throwing around his job title”

What happens if you park on a double yellow line?

You get a parking fine

What happens if you park in a car park and don’t buy a ticket?

You get a parking fine

What happens if you over-stay in a car park?

You get a parking fine

What happens if you park on or near a crossing?

You get a parking fine

What happens if you park anywhere where it says ‘No Parking’?

You get a parking fine

What happens if you park in an ‘Ambulance only’ bay?

You get a parking fine

Social status or job title does not exclude anyone from having to pay for parking illegally. Typically, at most hositals there are 4-6 ambulance bays outside a hospital marked in yellow or red lines with huge signs on the walls and the ground saying ‘Ambulances only’. It is perfectly clear and there for a reason......so ambulances with ill patients can park outside the A & E and get them into the hospital quickly and easily. Hospital staff, patients, relatives and members of the public have to use the ‘car park’. The clue is in the name! Patients or relatives or members of the public being dropped off or picked up can use the ‘drop off zone’. Again, the clue is in the name. It is very common for all the ambulance bays to be full of ambulances and throughout the day there is always a constant stream of ambulances coming and going. 

This particular day we were sat at our local hospital in one of the 4 ambulance bays. There were 3 ambulances including us, the only one free was the one directly outside of the doors which we typically leave clear if possible, incase a ‘blue call’ (critically ill patient) arrives. We were scoffing down our venting machine food and watery Maxwell House coffees when a brand spanking new, black, Mercedes SLK convertible pulled in and parked in the ambulance bay. A middle aged man in a suit got out, locked it and walked off.

“Excuse me, you can’t park there.”

“Yes I can.”

“No you can’t, it’s an ambulance bay.”

“I’m a consultant, I can park where I like.”

“No you can’t, it’s for ambulances, there is one on route here now.” (massive lie)

“I haven’t got time to talk to you, I have work to do”

With that, the pompous, arrogant, prat, walking into the A & E. Being rather hot headed, I couldn’t let this lie. I stormed into the A & E after him but he’d vanished. So, I took down his registration number and went to the reception.....

*over the tannoy*

“Would the owner of a black Mercedes, registration number LK60 BFU, parked in the ambulance bay please remove it immediately.”

After a few minutes, he had not appeared.

“Would the owner of a black Mercedes, registration number LK60 BFU, parked in the ambulance bay please remove it immediately.”

Still no sign.

With that, the receptionist  picked up the phone and called security. The security at this particular hospital also monitor the car park. He came outside, wrote out a ticket and slapped it on the windscreen. As her did, the alarm started sounding. Within about 30 seconds the self proclaimed consultant appeared. I was sat back in the ambulance by now and watched the argument unfold. He talked to the security guard like he was dirt on his shoe using such phrases as ‘do you know who I am’ and ‘I’ll have your job for this’. In an indignant last ditched attempt to throw his muscle power around he stormed to the front of my ambulance and started writing down the registration number. 

“This won’t be the last you hear about this.”

I wound my window down.

“There is a pay & display car park just over there, that you are welcome to use.”

“You’ve made a huge mistake.”

“Actually it’s you who is parked illegally, I did tell you when you parked it.”

“I’m a consultant here.”

“The sign doesn’t say Ambulance and Consultants only, don’t blame me”

With that, he got in and sped off, revving his engine as he went. What a tool! Funnily enough I never heard any more about it! I truly hate people like that, people who think they are better than others. People who treat people ‘below’ them without respect and with contempt. He may have spent years moving up the ladder and he may be a respected consultant. Unfortunately, that doesn’t give him the right to do what he likes when he likes. I don’t buy into giving respect when it has not been earned. I don’t care what his job title is, I don’t care who he is or how well respected he is professionally, he is still working for the NHS, he is still a colleague and he still has to abide by the same rules as everyone else.  A job title does not give anyone the right to talk down to or dismiss another person. Unfortunately for him, he chose the wrong girl to throw a job title at and despite his best efforts, I was the one who got to sit and watch him huff, puff and speed off in his rear wheel drive penis extension.

What happens if a consultant parks in an ‘Ambulance only’ bay?

He gets a parking fine

*smug face*

21 seconds

“23 year old male, light headed, hasn’t slept”

It was one of those nights! Relentless from start to finish, no down time between jobs, no chance to eat decent food, horrible patients, a mix of alcohol and mental health with the odd contact with bodily fluid. Not pleasant by any stretch of the imagination! I was knackered, it was 6am and after 25 minutes of driving we made it back to station without a job. This was a bad thing in terms of finishing on time. We hadn’t had a break which changes timings slightly. 

Right, for those not in the know on the ins and outs of ambulance services complex rest brake policy let me try and explain. On a 12-hour shift you are entitled to a 45-minute break. Of those 45 minutes, 30 minutes are protected and 15 minutes are interruptible. This means in the last 15 minutes of your break you can be given a cardiac arrest if you are the nearest available crew.  During your shift you can only be given your break during your break window. This runs from 4 hours after your shift start time to 2 hours and 45 minutes before you shift end.  All breaks can only be taken at the ambulance station where you are working from so to get a break you have to be sent by control back to station and once arrived they ring you to give you your break time. Simple! Right?! Now, if you don’t get a break, which is the case 95% of the time, you get your break at the end of the shift. The only difference is that your interruptible part of the break is at the beginning. That means on a 7am finish you can be given a cardiac arrest from 6:15-6:30am. From 6:30 you are finished. Job done!

Now, back to the shift! As I said, it was 6am. If we got a job now, we would be seriously late off. We sat on station begging for 6:15 to come. We waited and waited, seconds past, minutes past. We were almost there! After a night of getting worked to the bone we were going to finish on time. We also had the safety net of a crew that started at 6am who were sat on station so they could take a late job if we were unlucky enough to get one in the next 2 minutes. 

1 minute.

45 seconds.

30 seconds.

25 seconds.

21 seconds…….the radio starts beeping and vibrating. Really?!

I got up off the sofa, headed out of the mess room, down the corridor, into the garage and pressed the button to accept the job. The time stamp on the screen was 06:15:06. The job was a very low category of call, not a cardiac arrest. The other crew had got into their ambulance fully expecting it to be transferred to them. I called up control. 

“Morning red base, just been send CAD 912, just to advise, we are in our interruptible rest break and are Red 1s only now”

“The job was dispatched at 06:14:39, you were not in your interruptible break then”

“OK, then could you send it down to the early turn as they are on station and willing to take it?”

“No, I’ve sent it to you”

“This will make us massively late off, we are currently in our rest break.”

“That isn’t my problem, you weren’t when I dispatched it”

I didn’t bother responding. I was too livid. I can’t ever recall being so angry. So angry in fact I seriously considered quitting there and then. This is no life; enforced overtime when there is no need was not what I signed up to. I’m not evening blaming the system or the management of the system. I don’t for a minute think that this was a managerial decision, it was a decision made by a dispatcher in a bad mood. A dispatcher who is guaranteed to finish their shift on time, regardless of whether the crews they have send off are hours from finishing. A dispatcher who has had a 10-minute break for every hour they have spent in front of their screen. 

We drove the 9 miles to the job through the rush hour traffic. To add insult to injury, our patient was complaining of having not slept. Funny that.....neither had we! 

“What’s the problem this morning?”

“I feel light headed and I’ve been awake all night”

“How long have you felt like this?”

“Since lunch time yesterday”

“Are you fasting at the moment?”

“Yes”

“Have you had this before?”

“Yes, every time I fast”

It was a frustrating conversation. Why if you know the cause would you not do something about it?! What is a hospital going to do? What is an ambulance going to do?! It is personal choice to fast and part of religious beliefs but surely if it causes the need for an ambulance every day something has to give?! Anyway, that aside we headed off to hospital. That was 3 miles in the wrong direction. 

At 7:45am we arrived at hospital. At 8:15 we left hospital. At 09:05 we arrived back on station. At 09:15 we signed out and left station. At 10:10 I arrived home. It was almost 17 hours since I left my house for work. It was just over 6 hours until I would have to leave again. My shift was 14 hours and 15 minutes without a break. Of that, 2 hours and 45 minutes was enforced overtime. What part of any of that is fair? What part of any of it is right? No one is accountable for this, there is no one to complain to and if we did, there would be no outcome that would change a thing. 21 seconds. 21 seconds almost made me quit the job I love. 21 seconds was all that was needed to leave me exhausted for the rest of the run of shifts. 

A Beautiful Death

"97 year old female, DIB, terminally ill"

There is always a sense of appreciation when you are sent to someone so elderly. So many years of experience and knowledge. It's hard to comprehend being alive in 1915. George V was king, Herbert Asquith was Prime Minister and the world was at war. It's an era most of us are lucky not to have been a part of but similarly it's an era and generation where respect is embedded. We arrived relatively quickly, despite the weather and the traffic and were met at the door by the patient's son-in-law. A welcoming smile greeted us and we were thanked for coming. It may sound silly but we a rarely thanked for coming, it's not that I look for thanks or notice when it's not given, but I do notice when it is given and appreciate the gesture. We followed him through the house and up to the bedroom of the annex. 

Our patient was laying in a cot-bed with her daughter at her side. She looked very frail, very pale and exhausted. Her respiratory rate was about 50 and you could hear the bubbling on her lungs as you entered the room. Her oxygen levels were extremely low so we started her on full flow oxygen. She was suffering an acute episode of heart failure. Basically, the heart wasn't pumping properly and fluid was backing up on her lungs. She needed hospital and she needed it quickly. I started to set up the chair in preparation for moving her while my crew mate did her blood pressure.

"We don't want her to go to hospital. She has said she doesn't want to go."

Unfortunately, she was now in such a bad way she was unable to talk, her eyes fixated on the ceiling, breathing was taking every bit of her being. There was no DNR (Do Not Resuscitate) order in place or any palliative care program despite her late stage kidney disease and heart failure. She had been seen by her GP a few weeks previous, who had stopped all of her medication and recommended palliative care but as yet nothing official was in place. This put us in a the very grey area of capacity and our duty of care to act in the patients best interest. We knew that if we left her at home she would die and if we took our oxygen away she would die, but we also knew that with no DNR in place, if she was to die in front of us now, we would have a very difficult job to justify not starting a resus. As horrible and futile that would be on a 97 year old we have to start unless a DNR is in place.

We explained all this and the family were very understanding of our predicament but also quite rightly adamant that they wanted what was best for her and her wishes.

"She wants to die at home, with us and not in a hospital, we are scared that if you take her she won't come home."

She was right, she probably wouldn't. Our thoughts were, that this episode of illness was terminal and it was going to be a matter of hours not days. We needed a plan B and we needed it pretty quickly! We called our local out of hours GP service and explained the situation. After much much debate and various phone calls later, the GP said he'd be with us within the hour and would be able to provide a DNR for us and some medication for the patient. That was a great relief to the family. It was now not about taking her to hospital but about what we could do to make her comfortable. We spent the hour monitoring her and talking to her daughter and son-in-law. Despite the obvious emotion of the situation they showed great interest in us. We talked about the job, what we did before the job, our families and health care. All the while our patient was lying in between us all, fighting hard. Nothing we had done had improved her breathing, it was as bad as it was when we arrived and that was hard to watch. 

Before long the GP arrived. His professionalism and bedside manor was excellent. He engaged with us in everything he was doing and we assisted him drawing up various drugs. He explained everything he was doing to the family and explained he was making her as comfortable as possible. The DNR was openly discussed, written and signed. Everything was in place now for her to die on her own terms. 

We had been on scene for just over two hours before her breathing started to settle down. Her blood pressure was gradually dropping, 102/68, 93/52, 77/44, 63/38. My crew mate was outside the room with the GP and the son-in-law whilst I stood with the daughter, who was holding her mums hand tightly. 

"Is she going to die tonight?"

I knew the answer but didn't know how to respond. Partly because I was choked up and holding back the tears but also because telling someone that their mum is about to die isn't something that is said easily.

"Stay holding her hand, she knows you're there."

She knew what I was saying and asked us to remove all of the monitoring equipment. I left her by the bedside. She told her mum how much she loved her, how much she has inspired her and how much her grandchildren loved her. I ushered the son-in-law back into the room and we stood in the doorway as they said their final goodbyes. The time was now. She wasn't afraid of death and neither was her daughter. Her respiration rate slowly dropped and dropped until she drew her final breath. Very slowly her eyes closed and she let go. There was a peaceful smile on her face It was in that moment her daughter turned to me with a look of fear and desperation and said:

"No, Has she gone?" with tears pouring down her face.

It was as if as much as she knew it, and had made peace with it, but in the moment of death a fear of death had gripped her. I just nodded my head. I walked over and removed the oxygen mask, unable to hold back the tears trickling down my face. We shared a look, one I'll never forget. A look full of appreciation that our inaction had been the greatest gift we could have given their family. It was one of the most heart breaking and distressing things I've ever witnessed yet beautiful at the same time. To be there with someone who isn't afraid of dying and is ready to die, and share that with the family is a humbling experience and one I will never forget. I was so thankful that we avoided a resus because it would have seemed such a tragic way to end what had been a wonderful lifetime.

We went downstairs and in a very British way made them a cup of tea. That is, after all, the done thing in such circumstances. After saying their final goodbyes they came downstairs, teary eyed yet almost relieved. Relieved that they had been able to fulfil her final wish. Death in any circumstances is difficult, but ultimately it's the sacrifice we must all pay for living.

'To die proudly when it is no longer possible to live proudly. Death of ones own free choice, death at the proper time, with a clear head and with joyfulness, consummated in the midst of children and witnesses: so that an actual leave-taking is possible while he who is leaving is still there.'

                Friedrich Nietzsche

Please Please Please

"Signature Needed NOW"

The purpose of this post is simple! I want you and everyone you know, to sign this e-petition as soon as possible. I want the link to it emailed and re-tweeted as much as possible. The e-petition was set up by the Oliver King foundation and was set up after his death at the age of 12. He died from Sudden Arrhythmic Death Syndrome (SADS).

Their aim is to try and raise awareness about the medical condition SADS which commonly affects people aged between 12 and 35 years of age.

By doing this through their fundraising events and major PR drives, their aim is to boost the awareness about SADS enabling them to take the first steps towards preventative steps being made freely available.

They are currently based in Liverpool, UK and are striving to ensure that schools primarily get the equipment they need to help any young people who are affected by this condition. This is namely defibrillators. They need your help to get the government to listen, as until now the only response they have had has been to refuse to help and pass the buck to the ambulance service. 

"From February 2007, responsibility for continuing the legacy of the National Defibrillator Programme was devolved to ambulance trusts. Most of the ambulance trusts across the UK have community resuscitation departments or similar, which work to place defibrillators in the community, and in areas of need."

What they mean is they won't pay for it! What they also don't tell you, is that the ambulance service places defibrillators in places only where the owners pay for them. We do provide HeartStart training in basic life support and defibrillation free of charge to anyone that wants it but this training is provided by willing staff, unpaid, and in their own time. I myself am a trainer. It is something I believe passionately about and it was of such a surprise to me that defibrillators were not in schools by legal requirement. 

The cardiac arrest survival rate in London is around 32%. That figure is much higher than the rest of the country but it also much lower than other cities in the world. Seattle has the highest survival rate in the world at 55%. The reasons for the huge gulf is simple. Basic Life Support is taught as part of the national curriculum from the age of 6. Everyone knows how to use a defibrillator and there is one on every street, in every school and in every public building. That is the survival rate that is possible but that is what the government are unwilling to do. £650 for a defibrillator is more than a 12 year olds life is worth apparently. They even refused to meet The Oliver King Foundation, yet weeks later 16 defibrillators were installing in Westminster and government buildings! If it's good enough for them, it's good enough for you and your children!

Please please please have your say. We have the chance to make a real difference so lets put our weight behind it. 

SIGN THE PETITION NOW!

For more information on the Oliver King foundation please visit  http://www.theoliverkingfoundation.co.uk/ or see them on twitter at @TheOKFoundation.