Cue The Madness

"55 year old female, breathing problems"

Community First Responders (CFR), rightly or wrongly are becoming a big part of pre-hospital care up and down the country. I could argue about the ethics of them for days on end. On the one hand, it's great that these people are giving up their own time to help their local community. That should be commended and overlooked. I am not being critical of ANY of the responders themselves, it is more that fact that they are needed and how they are used. The fact that all ambulance services are relying on un-trained volunteers to get to patients first and stop the clock speaks volumes about the shortcoming in budgets and man power. I know that in some areas, especially rural, the CFR scheme is invaluable. In others, like the city, it seems to be more or a PR and clock stopping exercise. Training standards across the country vary but in my area a 3 day St Johns Ambulance course is all they get. Then, they are given a radio, a response bag and mileage form and off they go. This isn't their fault, it is the system. They have little support and really are thrown in at the deep end. 

After 6 months full time training, multiple assessments, months of placements and untold evening hours studying I didn't feel remotely ready to go out as a crew of two and meet patients. THAT was daunting! To do that after 3 days first is simply terrifying! The most important skill we learn as paramedics / EMTs / ECAs etc is talking to people. Making people calm, using tact, employing diplomacy and telling it straight when appropriate. This cannot be taught in a classroom. You learn it from experience and experience only. It cannot be taught on a 3 day course!

We arrived on scene to be greeted in the middle of the road by not one, but two members of the patients family waving their arms and jumping up and down. Clearly, today we would be acting in a calming role! Our patient was lying in bed, coughing and spluttering. To be fair it sounded like a horrible cough but not one that required all the pomp and circumstance that was surrounding her. We checked her over, listened to her breathing, did our usual battery of tests and came to the conclusion that she had pneumonia. Unfortunately, pneumonia is one of those big medical words that very few people have an understanding of and as such, strikes fear into many. Like many conditions, pneumonia can be serious in the very young, the very elderly and people with complex medical needs. She was none of the above so was going to be just fine! convincing her and her family of that was another matter....

As I was explaining what was going to happen and how pneumonia was just a simple chest infection in walked the CFR! Clearly control had forgotten to cancel them! It would normally just be a case of swapping call signs and they would leave but today this young guy decided to stay. Our patient was getting her stuff ready while I told the CFR what had been going on. Everything seemed quite calm, the patient was no longer panicking and her family had stopped hovering and fussing. Bliss! Cue the CFR.....

"My dad had pneumonia." he blurted out.

"Oh, how hold was he?" said the patient inquisitively.

"He was only 53."

"Was he OK, did he recover well?"

"No, he died."

Cue the madness.......

The room became hysterical and I mean seriously hysterical! They were all mourning over her inevitable death like Victorians. They were not far off picking out their black outfits! I tried and tried to resolve the situation but in vain. The CFR backtracked and said that he had had other medical problems too but what had been done, could not be undone. We went out to the ambulance, patient and relative's arms waving like the Harlem Shake and off we went to hospital. The CFR left the scene of the crime with his tail between his legs. Can you imagine the face I had on?!

Chelsea Tractors

"5 year old male hit by car, injuries unknown"

3:30pm. The school run. My money is on a careless driver not watching where they are going and a little kid has paid the price for it. We got about 100 yards from the location given and it clear that it was a school. There was queue of cars obviously stopped because of the incident who were blocking our path to the patient. I'd say at least 50% of said cars were Chelsea Tractors. For those unaware of the term here are some Urban Dictionary ones:

1) Chelsea Tractor 

Any expensive 4x4 that is driven in an urban environment as a status symbol (typically for the school run) and will never be driven off-road.

2) Chelsea Tractor 

An off-road car that never goes off-road

3) Chelsea tractor Noun, a large 4 wheel drive vehicle, driven in cities for ordinary, day to day purposes. eg, Land Rover, BMX X5, etc..

Typically, they are driven by mums for the school run.......because everyone needs a Land Rover Defender to drive half a mile to school to pick up their 1 child. Nothing winds me up more. It's bad enough that they have them, but they can't even drive them! Here we are, blue lights and sirens and they all panic! When faced with an ambulance there are some options available. 

a) Pull over to the left allowing us to pass on the wrong side of the road.

b) Keep going and pull into one of the spaces or the bus stop.

c) Stop diagonally across the entire road preventing any traffic from moving in any direction.

Yes. You guessed it. c) was by far the most appealing option! Though some did try b) but the parking sensors clearly weren't up to scratch. Why have a car you can't drive?! Thanks to one particular owner of a BMW X5 we had to abandon the ambulance and walk with all of the kit we could carry. I glared at the owner and received:

"What do you fuckin' expect me to do?"

Nice, in front of her child too. That kid will have a mouth like a toilet by the age of 7! It'll probably have it's its own petrol guzzler too! 

Eventually we got to our patient. Shock horror, he'd been hit by a 4 x 4. Luckily it was low speed and he had no injuries. The car had reversed and I quote:

"It's not my fault, the reversing alarm didn't go off, they shouldn't have been crossing behind me."

No, you are quite right. It's totally their fault. Crossing at the yellow zig-zags where cars are not allowed to stop, outside a school is just bad parenting. They should be punished for that. The Range Rover Overfinch comes with plausible deniability when it comes to bad driving. I forgot. As for the reversing sensors, right again. Mirrors and awareness of surrounding are so last year! I suppose being so high up in a car means short people should be more vigilant when crossing roads. This child certainly has no right to an apology. Stupid child. Stupid mother for crossing the road at a crossing. I'd call social services if I was you. It's verging on neglect isn't it?! 

ARE       YOU       SERIOUS?!

You are blaming the child for your incompetence?! The child you just reversed into? I really had to bite my tongue! Am I alone in my hatred for these cars in urban areas? Why does everyone flock to them? Why are they so popular? And why are they all driven by women who can't drive? Can I just add, before I get mobbed by feminists for saying 'women can't drive', anyone who relies on parking sensors and reversing alarms / cameras to park a car CANNOT drive. There is absolutely no need to them in built up areas. Fine, if you live in the country and have to drive up steep mud tracks to get to school then fine, but these cars have never seen a mud, let alone a hill. What happened to walking? Most of these people live within a mile of the school! That's how catchment areas work! WALK! No wonder all your kids are fat. Bit harsh. I know. I semi-retract that last comment!

So, here is a car buying guide for anyone considering a 4 x 4 for the school run:

Will you be driving on terrain like this?

Will you be driving up hill like this?

If you answered 'NO' to either of those questions then you DON'T need one of these.....

Will you be driving down roads like this?

Will you be sat in traffic like this?

If you answered 'YES' to either question you don't need one of these......

What you need is a new pair of shoes at best! FACT! 

Seriously, there is no need for them. It is just a status symbol. Nothing more, nothing less. They are bad for the environment, bad for the roads, bad for traffic, bad for people hit by them and badly driven. This child was very lucky. Most kids who are hit by them are not. If you have to drive match the car to your needs, not your wallet. Anyway, got to go, got to walk to the school.....

Please Sir, can I have some more?

Dear David

I'd like to start by wishing you and your family well in these tough economic times. You and Samantha's combined salaries of £400,000 plus shares and bonuses must be really getting spread thin. I empathise, I really do. Like you, I seem to work all the hours god sends yet that £25,000 seems to just disappears! Still waiting for my mileage expenses to come through though, so that will be an extra £42 in the piggy bank! I love expenses! Anyway, the point of this letter is one of a more serious nature. 

I have waited a long time to write this too you. Let me draw your mind back to your first assault on the Police service. In case you'd forgotten you cut 16,000 officers. Less is more! Quality over quantity! Needs must! Look at the bigger picture! We will all feel the pinch! No one is immune from cuts! All very very true. We must indeed all pay the price for the bankers and politicians sticking our country in the economical dark ages. But, there are consequences to your ill advised cuts. Let me share a story. A story that brings back painful memories. A story that still bears real scars. 

As a paramedic, one who has been through years of training and sacrificed friends and family for such a fulfilling salary, I understand that part of my job, in fact, part of my salary is danger money. Well, not officially, but being abused is part of the job, right? As the Right Honourable Ann Widecombe, recently said, "Public servants worry more about their own safety than that of the public, Britain has sunk to a new low". I'm guessing by your lack of condemnation of these comments you must agree wholeheartedly. So, as an 'ambulance driver' (yes, we are that low in the food chain), a bit of danger comes with the territory. One afternoon, I was called to a residential address to a man who had 'passed out'. 

When I arrived that man was lying on the grass. I approached him, on my own, and he appeared drunk. I went about my business, checking him over, when the ambulance crew arrived. We began to get the bed off the ambulance all the while making sure the member of the public was OK. We are public servants after all and serve we shall. Without warning the patient stood up and swayed a little, then staggered into a fence. Poor guy eh?!

He then beat me with a fence post. He also beat the other members of the ambulance service. Three of us in all. Do you know what it feels like to be helpless against a man beating you with a lump of wood? Despite all of our broken bones we managed to press our emergency button. Let me share a conversation with you.

Me: "Red base red base, urgent police, we are being attac......." I stop because the lump of wood has been broken over the back of my head and then broke my hand.

Crew 1: "Red base, my crew mate has been hit over the head, urgent police" he says with 3 broken ribs.

Red Base: "Getting the police for you now, are you all OK, can you get to safety."

Crew 2: "I'm now locked in the car, I think my wrist is broken, he's still attacking us."

Crew 1: "We are away from him but he's coming after us. Are the police on way?"

Red Base: "The police have no units to send, try and maintain a safe distance."

Crew 2: "He's trying to get in the car, he's hitting it with the wood"

Crew 1: "I think he's stopped, he's lying in the road but we can't drive off."

Crazy stuff isn't Dave! No units to send?! But aren't the police supposed to be there to protect us? Surely in a real emergency they have someone to send. Surely you didn't cut too many? It's OK, 9 minutes later two undercover officers arrived. Part of their job is getting abused too. I should probably mention now that in their efforts to protect us from the patient they too both got broken bones. They were struggling to restrain him on their own so much, that we all helped. We all restrained him for 10 more minutes until more help arrived. Guess what we did then Dave? We all took the patient to hospital for treatment. With our broken bones and bleeding wounds, we checked his blood pressure, he even got to travel on the bed. He is of course a member of the public and we are all their servants.

Now, do you still think less police is the right answer? What if you or your beloved family were trapped somewhere in real fear for your life? What if you called for help? What thoughts would go through your mind when you heard those terrifying words "No units to send." The officer who came to my aid told me that it used to be a team of 25 to police the borough on this shift. Today it was a team of 7. No doubt they got complaints from the public for not coming to their aid quick enough whilst 2 of the 7 were sat in A & E with me and my colleagues. Tut tut. We really must all work harder.

The good news from all of this, was our patient was treated professionally by us and the hospital. He was arrested and charged. He was sent to prison. However, because of your cuts to the prison service he has already been released and I could bump into him anytime of any day.  Oh wait....in fact, only last week, I was sent on a job to his house. Can you imagine the fear Dave, can you? Luckily he wasn't there. 

I am proud to say that in this country we have by far the best police service in the world. The things they do and the dangers they face without a gun on their belt. The professionalism they show at all times is nothing short of amazing. That is in the face of your assault on their salary, their pensions and their working conditions. Now you are making a career in the police as unappealing as possible by slashing the starting salary and rushing through the 'Eton Old Boys' to top ranking jobs without ever having to be spat at, kicked, punched, stabbed, shot, sworn at, had missiles through at them and put their lives on the line. It is plain and simple Dave. There are not enough of them any more. Not enough by a long shot. So, in the words of Oliver Twist, 'Please Sir, can I have some more?'

Just a thought, you know that publicly owned bank, RBS? You know, the one we all bailed out with our taxes. Well they are paying their staff £950,000,000 in bonuses this year. As they are PUBLICLY owned, why not use the money to fund the salaries for 38,000 new police officers on £25,000 a year. I think my maths is right. There are other banks to you know. Other ones we all helped fix. How about they now help fix us? I know, I know, I'm probably not looking at the bigger picture, but in that big picture I just see the words 'No Units To Send'. Silly me.

By the way Dave, this wasn't a work of fiction for effect. This actually happened. To me. Have a read. http://www.barnettoday.co.uk/news.cfmid=3449&headline=Man%20in%20court%20for%20paramedic%20assault

Good luck with the economy Dave, there are tough times ahead.

Your Sincerely

Ella Shaw (Public Servant)

Trapped in Darkness - Part 2

continued.....

"Male, U/K age, One Under"

Until now, I had been totally patient focused and hadn't noticed the commotion around me! There were about 6 Fire fighters under the train too with various member of underground staff trying to work out how to lift up the train. I'm guessing by the discussions that it isn't something that is done too often! In most One Unders they are either a) dead, in which case the train is driven off them or b) alive but trapped by a limb, in which case if a quick extraction is needed an amputation and dragging out will happen. Unfortunately, they couldn't drive off as it was his pelvis on the track and you can't amputate a pelvis for obvious reasons!

As minutes ticked by we got drugs flowing! In went morphine and ketamine and fluids. We cut of as much of his clothing as possible to examine what we could get to. There were minor cuts and abrasions but nothing major. All the while, the patient was getting more and more frantic so more and more drugs were given to numb the pain and relax him. Problem was there was no real access to his head. He couldn't see anything but  darkness and could only hear and feel what was going on, and for someone who is claustrophobic I imagine it was torture. I was starting to get very uncomfortable my self, the heat, the smell, the noise, the taste of air, it all made it a very uncomfortable atmosphere. Add to that the fact that realistically the patient could simply die and we would be powerless to do CPR, ventilate and remove quickly. It was a scary thought! 

"Sorry we're all talking about you. How are you doing?"

"Get me out of here"

"We are, it will just take a little while, I'm staying here right by you, if you feel any new pains or anything changes, please tell me."

"Get me out of here"

"We will, we will."

"Please, help me, I don't want to die" he cried.

Talking to someone who can't see you is bizarre. I could only imagine his facial expressions and the fear painted across his soot covered face. I felt totally helpless in all honesty. I tried to keep him positive but as the pain continued and the time went on and on he became more anxious. To be fair, so did I. 

Eventually, after about an hour they were ready to lift. I don't credit the fire service that often but credit where credit is due. They had been fantastic. The were working their nuts off, bringing us more oxygen, providing light and lifting 120 tons of train up! It wasn't a case of 1-2-3 lift! So, in a co-ordinated effort and a very detailed plan, the scoop was lowered down to the tracks and slid along, rope on 1 end. The pelvic splint was positioned and as many hands as could fit were placed on various parts of the patient. We are all told to stay away from the wheels as if the train drops we don't want to get trapped! 'Drops?' 'DROPS?' Encouraging! 

"OK, we are lifting......"

"He's free. Lower him down"

"We got him"

He let out a gut wrenching scream. Once on the scoop he vanished. Pulled the along the suicide pit and out onto the platform where the HEMS paramedic and my crew mate would take over while we crawled out. I shuffled backwards slowly, eventually making it to the platform where the light and underground breeze could be felt. The platform was full. Police everywhere, about 30 fireman, a few ambulance officers, a second crew and of course......HART team huddled together watching! The patient was being strapped up and wrapped in bubble wrap. Blood infusions were being prepared and he was being put to sleep by HEMS. I bet he wished he'd been asleep a long time ago. 

Within only 2-3 minutes we were ready to go. I took over the breathing for the patient and 8 fireman lifted him up and off we went through the maze of tunnels and escalators. FRESH AIR! Oh how I missed it. Behind us was the band of merry men and woman carrying all the kit. Everything was chucked on board, blue call placed and off we went. I was trying to take stock of everything that was going on. Suddenly, the doors swung open, we were at hospital, I hadn't even noticed we'd stopped. Into resus we went, a 30 strong team waiting for us. Luckily for me HEMS did the handover. I'd have probably starred blankly and said 'Hit by a train...erm...'!

We went back to the vehicle which  looked like a bomb had exploded inside. We tidied up and I started on the paperwork. Where the hell did that job come from! It really is true, EMS Rule number 10:

EMS is extended periods of boredom, interrupted by occasional moments of sheer terror.

Nothing can prepare you for things like this. It isn't for everyone. It is one of the few jobs that tests every part of you. The problem is you never find out if you passed the test. As all crews will say, he was alive when we got him to hospital so that's a win for us. It's a cover though. In reality, we are all desperate to know if he survived. We will probably never know. That's the reality of pre-hospital care....once you're at the hospital, your care is supposed to end. 

 My crew mate pointed at my face...

"You got a bit of dirt on your cheek!"

Trapped in Darkness

As far as shifts go, it hadn't been a bad one. I hadn't been spat at, sworn at, I hadn't had to carry anyone and no one had wound me up enough to change my mood! That's not to say that anyone actually needed an ambulance. The mere fact everyone had walked on and walked off meant that in reality, no one actually needed an ambulance but that's by the by! It was late in the evening, we reckoned that we had about two jobs left to do to see us off, so made ourselves available. We were a fair way away from station so we started heading in the right direction as fast as possible (within the legal speed limit of course!). We didn't get very far at all! Within about 5 seconds.....

"Male, U/K age, One Under"

Action stations. We were only 2 miles away so there was a good chance we'd be first there. While my crew mate drove like a bat out of hell I dived into the back to get the hi-vis on and safety helmets out the top locker. Back in the front and...

"UPDATE: Patient is screaming, injuries, unknown"

....we started to get a plan. Once we had confirmation power was of and track protectors were in place, I would get under the train and assess, crew mate pass staff and liaise with fire brigade and train staff. I began stuffing my pockets with stuff I might need; gloves, tape, torch, cannulas, bandages and a tourniquet.

"UPDATE: HEMS on way. Eta 8 minutes"

Right, that should give us just enough time foe me to get under before HEMS take over and we are sidelines! (Trust me, totally happens!). We pulled up at the station to see we'd been beaten by the Fire service and Police.

"UPDATE: HART team on way"

They can bugger right off! HART or Hazardous Area Response Team is by far the biggest waste of money the service has ever had. Always late to any incident in their fancy suits and equipment and they just sit and watch the fire service. They have lots of fancy kit that they never use and it's a classic old boys network full of wannabe firefighters. I predicted they will be stood on the platform on mass.....watching at some point during this job! 

We were indeed the first medical staff to arrive so we needed to carry everything! Luckily some 'water fairies' were on hand to help. We took paramedic bag, response bag, oxygen bag, Life pack, dressings pack. suction, scoop, head blocks, entonox, straps and blankets! The problem with underground stations is some are very very very deep and going back for kit isn't really an option if you need something quickly. We made our way down, and down, and down to the platform. The fire service were on the tracks and doing a good job of talking to the patient. I jumped down to have a look and there he was. In one piece, very much alive and trapped. What was bizarre was that he wasn't trapped or tangled by a limb, which is common. He was trapped by his pelvis between the train and one of the tracks, on his side!

Now, there are no text books telling you what to do, no algorithm, no guidelines, nothing. It was going to be a case of improvise, adapt and overcome. Under I went. Blimey! I forgot how hot it is under trains! And dirty! By the time I got to him my hands were black. He was very much conscious and there was no obvious blood! Always a good sign! He was however in a lot pain from his pelvis and was obviously very panicked. He hadn't jumped. He was drunk and had tripped and was hit trying to clamber out and by all accounts the train had nearly stopped at impact. Via a gap between the platform and train, a hand appeared holding an oxygen mask. I popped it on the patient and then a blood pressure cuff followed. With a bit of a stretch I got it on his arm. All the numbers were relayed back to me. His blood pressure was a little low but if he had a fractured pelvis he could easily bleed out into that and it would only get lower. 

OK, a plan......erm......

"How are we getting him out?" I said hopefully.

"We are going to jack the train up off of him and slide him out." 

No idea who I was talking to!

"How long?"

"Half an hour. 45 minutes maybe."

"Is that the only timescale we have? If he has to come out quick to we have other options?"

"Afraid not"

That's was a long time as far as I was concerned but it wasn't as if he could just be dragged out! He was well and truly wedged! I stuck an orange cannula in the back of his hand as that was the only part of him I could get purchase on. Thank god for big veins! I wanted to give morphine but in the circumstances I felt a grown up should be consulted first. Luckily, as I fixed the cannula down a head torch appeared. It was the HEMS Doctor! 

"You look like a chimney sweep."

Oh goody.....a mascara joke! 

TO BE CONTINUED........