Sink or Swim

"RTC, Car in Lake, Fire and HART on way, injuries unknown"

I moan. Yes, I know, you can all hide the shock on your faces but I do. I moan more than I realised! I was moaning to my crewmate about how I never get the good jobs and its just the same drivel every day! The funny thing about this job is you do so much in a week, it can appear a lifetime ago that you did something worth while. In actual fact it's more than likely you did something worth while less than a week ago, you've just forgotten! I suppose it doesn't help that I can't remembers a job from 7 hours ago, let alone 7 days. You're enthusiasm for this job is only ever as good as your last patient!

He stopped me in my tracks and said:

"In the last month you've had 4 cardiac arrest, a shooting, a stabbing and at least 3 serious RTCs! What are you moaning about?!"

Good point. I'll shut up! Seriously though, the day was dragging and the last patient had been rude and obnoxious so my enthusiasm was particularly low!

Car in Lake?! Yes please!! Like Sonic the Hedgehog in Red Boots we sped off to the lake in question. I say lake in the loosest sense. Pond would be a better description! Actually fish pond to be precise! It would also be worth noting that the title to this blog is also a bit dramatic! The car had sunk to the bottom but had barely covered the wheels with water and it would be a case of wading more than swimming but still, the headline in my head was "Paramedic swims across shark infested lake to save drowning granny from sinking car".

Our patient was sitting in the car looking rather bashful! She wasn't injured or trapped, just scared. My crewmate looked at me with a grin and said "off you go!". Clearly chivalry is dead! I heard the sirens in the distance, no doubt from the fire brigade, police and HART team and I wasn't going to have them massage their inflated egos (police excluded) by diving into the rescue, so in I waded! All 3 steps worth! The back of the car was only 2 feet from the edge of the bank!

I checked her over, was happy there were no injuries and told her to wait until we could get her back to land.

"Nonsense, I just need someones hand to hold onto, my feet are already wet! I'm certainly not having someone carry me, how embarrassing."

She was so defiant and I certainly wasn't going to cross her, so at her request, I took her hand and stepped her onto the bank, just as the fire brigade came rushing over!

"It's OK guys, you just leave all the rescuing to us little ladies, you take it easy!"

They laughed but you see it had killed them not to be able to wade into the water! I hope the Daily Mail tell the public how we did indeed risk shark infested ponds to save people! Can't have health and safety getting in the way of good care now can we?! We sat in the ambulance for a few minutes checking her over and doing paperwork when there was a knock on the door from the Hazardous Area Response Team (HART). They had turned up late to the party as per usual despite me cancelling them once we had our patient on board. No doubt they hung around the fire brigade for a little while cursing about how irresponsible we had been! If you want to play in hazardous areas, get to the hazardous areas before anyone else!

Not the actual car or pond before some of you have kittens!

We took her to hospital for a check up and a cuppa! That's all she really wanted! In fact, she was quite put aback by the lack of biscuits in A & E! See, cut backs are not only causing ambulance delays, there are very real biscuit shortages too! It's an outrage!

"So, you gonna moan about never doing anything interesting or you gonna have a few hours off?"

"Touché!"

B.O.G.O.F

"88 year old female, DIB"

For those that read my blog regularly, you will be able to tell the mood I was in by the following three pieces on information:

1) It was 06:55

2) I'd had no coffee

3) It was raining

Not a good day thus far! I was tired, grouchy and awful company. Luckily for me, the crew mate is also not a morning person and we know each other well enough, not to have to make small talk. We communicated with nods and grunts until such a time we are awake enough to function! Getting a job tends to wake us up so being sent to a local care home woke us slightly.

If we were still struggling with being alert, the update we received to say the patient was now in cardiac arrest snapped us out of it. We made our battle plan, we knew who was doing what, so when we arrived we each grabbed our designated kit and went in. As the driver, I was about 20 seconds behind my crew mate as I had to get some of the heavier stuff out the back of the ambulance. As I entered the room, he was starting CPR.

We started going through the routine, I took over compressions while he attached the pads, checked the rhythm and began to secure an airway. Once that was done, he took over compressions whilst I started to look for IV access. Still no second crew or FRU but it was shift change over time to that was little surprise! Then 7 words were spoken by one of the careers....

"We have another patient in cardiac arrest."

This wasn't part of our battle plan! We starred at each other for a few seconds then my crew mate just said "GO!". I pressed 'priority' on my radio, I grabbed the spare defibrillator, ran (yes, I actually ran) to the ambulance, grabbed more oxygen and ventilating bag, more drugs and the spare paramedic bag and ran (ambulance walk now) back inside and up the stairs!

Sure enough, lying on the floor was another patient with a carer doing CPR! My radio started ringing whilst I was asking the carer to continue!

"Red base, we now have 2 patients in cardiac arrest, we require at least 3 more resources on scene."

"Rog, understood, you have an FRU about 3 minutes away."

I attached the pads whilst the carer continued compressions then I started oxygenating the patient. I couldn't think straight! I couldn't really comprehend what was going on! I hadn't a clue what was going on downstairs! How was my crews mate doing? How was our patient?! You need more hands than what we had available too us. There is something very unnerving about being put in situations you are not prepared for. I've often spoken about how the journey to a job is crucial for gathering thought and getting mentally prepared for the worst case scenario you may walk into. THIS, neither of us were prepared for. I couldn't help my mind wondering to the patient down stairs.

The history of my current patient was vague, she had been seen this morning but then found not to be breathing. CPR was being done so I carried it on until I had some help and a chance to step back and think! Within 5 minutes the cavalry arrived, a total of 3 ambulance and 3 FRUs all descended on the care home! As it was student season most of them had a student too! The 12 of us got split between the two rooms and eventually I was able to return to my original patient!

Unfortunately, despite our best efforts, we terminated the resus of patient 1 after 20 minutes of advanced life support. We cleared up our kit and headed out to the ambulance car park to request the police for an unexpected death. 5 minutes later everyone else from upstairs appeared. Patient 2 had also passed away despite being given the best chance. All that was left was a mass of paperwork.

This job will always throw curveballs at you, generally when you least expect them. Today the grim reaper won, tomorrow we will win. It was going to be one of those days.

Handle With Care

"34 year old male, chest pain"

As far as night shifts go, this was a particularly gruelling one. No break, no food, crap weather, extra tired, rude patients and a headache! It was time for the last job and for once we got it relatively quickly! To me, a 34 year old male with chest pain is a simple job (in general). He's unlikely to be ill and will probably go to hospital and probably won't need carrying. It had all the makings of the perfect off job!

We were due to finish at 06:15 so arriving on scene at 05:30 gave us 45
minutes to do our thing! Bags in hand I mustered my energy to drag myself down the path and up to the front door. I rang the bell and gave a loud knock on the door.......

Nothing!

I knock again, this time louder and held the bell on for an irritating length of time.

Nothing!

I shouted through the letter box, knocked on the door, windows and rang the bell repeatedly.

Nothing!

"Red base, can you give this patient a ring back, there is no answer at the door."

"Rog, stand by."

A few seconds later we could hear the phone ring.....and ring.....and ring.....and ring some more!

Nothing!

"No answer so we are treating this a collapsed behind closed doors, have requested police to force entry."

There goes finishing on time! When the police eventually arrive (I'm not complaining!) it was 06:30! We exchanged some banter about delays and how tired we all looked and wondered up to the front door. One of the coppers came with us while the other was getting the Big Red Key from the boot. The copper gave the door a knock.....

Nothing!

He then tried the handle and door swung open to reveal our patient lying on the sofa snoring. I wanted the ground to open up and swallow me whole! I was mortified! I tried to lie and say I'd tried the handle but was quickly told to stop lying and admit that I was a numpty! Everyone had a laugh at my expense, jokes were made and re-enactments were done! My face was redder than the Enforcer!

We may have been late off by every embarrassing cloud has a silver lining. Our patient woke up or was woken up, and decided to become abusive! He called us c**ts for taking so long that he fell asleep and then told us to 'get the f**king pigs' out of his house. Obviously the police didn't appreciate this, so when he got up off his sofa and squared up to one of them it ended with him being bundled to the floor, put in handcuffs and taken away in a van!

For me, I needed to clean the egg of my face, cover up the rosie cheeks and find away to a) restore my pride and b) convince my crew mate not to tell anyone else! I failed miserably on both counts! The banter continues......

Hob Nobs

"38 year old male, choking"

Ooohhh, a choking! Haven't done a proper one for absolutely yonks! My slumber on standby in the car didn't last long! That piercing noise filled my cab, drowning out Elvis on the stereo and off I went! The anticipation of a) an actual choking and b) arriving on my own and having to deal with it was a tad overwhelming!

EMS Rule 10: EMS is extended periods of intense boredom, interrupted by occasional moments of sheer terror.

My god that is true! As I flew through the traffic, going through the choking algorithm in my head, I built myself a game plan. I knew exactly what I was going to do on arrival in a variety of different scenarios. i.e: Airway slightly occluded, airway completely occluded, Unconscious etc!

I pulled up with a screech, engine ticking and breaks burning! I grabbed my stuff and rushed to the front door. A guy opened the door, fag in hand, sun glasses on and a bottle of Corona in his hand. It's alright for some!

"Come in, we're just through here."

He seemed perfectly calm and not at all worried about the patient. In the garden was a group of adults all relaxing in the sun with a BBQ. I must have looked like I'd seen a ghost, desperately looking for the choking patient.

"Where is the patient?!" I exclaimed.

EMS Rule 26: Algorithms never survive the first thirty seconds of patient contact.

"I'm the patient" said a voice behind me.

I swung round and the only person standing there was the guy who let me into the house.

"You're the patient?! I was told someone was choking and turning blue."

He laughed. Yes, laughed. I didn't. I looked seriously miffed.

"Haha, it was funny really, I was eating a Hob Nob and started choking, It was like when food goes down the wrong way!"

L O L. So funny my side was literally splitting.

"So who phoned the ambulance?"

"I did" he said whilst chuckling.

"But you weren't choking anymore."

"Yeah but thought it best to get an ambulance driver to check me over."

Ambulance driver....ambulance frickin' driver. I could feel that vein on the side of my forehead starting to pulsate in rage! Luckily for him the ambulance crew walked in because I was probably about to say something I would regret! I gave my most sarcastic of Hob Nob related hand overs to the crew and stomped off.

"It was funny really....."

NO IT WASN'T. Douche bag.

EMS Rule 71: You can't cure stupid

Making Plans

There is an unwritten rule in all ambulance services. It is a rule we all know well. It is a rule that our friends and families know. It is a simple rule.

"THOU SHALT NOT MAKE PLANS ON A WORK DAY"

Simple. Why? Because if you make plans you WILL finish late and you WILL let people down. Again and again. Do we all follow this rule? In general, yes! Do we ever disregard the rule and think that just this once it will be OK?! Yes! 

On this particular Saturday I had a short shift. I was due to finish at 3pm so despite the obvious rule, I felt it was pretty safe to make some plans. My reason for this was a friend was visiting. A friend I haven't seen for a very very long time. They don't live anywhere near me but on this particular day they were free to see me for a few hours. In fact, they were free from 3pm until 8:30pm to see me! I was pretty dam excited, just a little shift to get through first!

12:03:  I got a text. "I'M HERE!"

The shift was ticking along nicely, I hadn't had a break so at 14:30 I was off into town for some catch up, coffee, cocktails and cake! Winning! I even gloated about it on a number of occasions!

13:35: "Hurry up! I'm bored!"

We finished up with our patient at hospital and made ourselves available for our last job. It was busy on the road, we had been going from job to job to job all day as per usual. I pressed the 'Green' button and waited for the job to appear......

And I waited......

And waited some more......

Nothing! As the minutes ticked by I began to get more and more annoyed! 13:45 came and went as did 14:00. 

14:10.....

14:20.....

14:25..... *crosses fingers*

14:28.....

14:29.....

"RTC Car vs Ped, 34 year old female unconscious"

ARE.....YOU.....SERIOUS?! Off we went, I had just enough time to send a message saying 'Late job, sorry!" We made our way through the now solid traffic. After about 5 minutes we arrived on scene. A crowd had already formed in a well formed semi-circle, 3 people deep all staring in fear and anticipation. Lying in the road surrounded, by a group of 5-6 people rendering aid was our patient. She wasn't unconscious but she wasn't far off it. Just a quick look at her told me that we needed HEMS and we needed them 5 minutes ago. 

The three of us on scene went about the routine. We utilised the public to fetch stuff while clothes were being cut off, primary survey was being completed and an assessment of her injuries was being done. This lady was big big sick. Major head injury, long bone fractures, likely spinal injury and who knows what internally. She had a collapsed lung and based on her blood pressure she was losing a lot of blood from somewhere. I decompressed her chest while my crew mate got IV access. So much was happening, it all seems a bit of a blur even now. Her leg fracture was pulled straight, to which she let out a gut wrenching moan. The police were had arrived and were doing everything that we couldn't manage with the 6 hands we had! 

I couldn't tell you how much time had elapsed but just as the patient started to have a convulsion there noise of the helicopter could be heard. Now there's a sound that filled me with joy! By now the patient was on a scoop, the injuries were being dealt with and the student was ventilating her. His eyes were so wide open, concentrating so hard on his task and he was doing it bloody well. This was his first trauma, first HEMS job and first really sick patient. I remember what an adrenaline filled gibbering wreck I was after my first! 

With HEMS on scene we got the patient onto the bed, still in the road, still with somewhat of a crowd! They decided to RSI (Rapid Sequence Induction) her which means to put her to sleep and take over her breathing. This was done, blood transfusions were given and we were off to hospital. The decision was made to convey the patient in our ambulance with HEMS on board. Off we went! Through the traffic, complete with police escort. We burst through the door of the resus and HEMS handed over to the waiting trauma team. The patient was transferred and we returned to the vehicle.

It looked like a bomb had gone off. The student was like a 5 year old on Christmas day, bouncing off walls with excitement! The truck took a while to clean and then there was a HEMS debrief and then all the paperwork!

16:39: Left hospital. 

Being a trauma centre, we were now no where near our station and had to sit on the Saturday afternoon traffic to go 13 miles across the city. I had a plethora of messages on my phone asking what was going on! Awkward......

18:03: Arrived back on station

18:20: Signed out and left work to cycle the fastest I could to get to the station to make the 18:44 train.

18:43: Arrive at train station. Lock up bike. Watch train pull out of station.

The next train was at 19:14. I was a 1 hour journey to get to the part of the city where my friend was waiting for me. Time for a phone call.

"I'm so sorry, I won't get there until about 20:15."

"Not much point is there!"

"I guess not."

It happens every single time. It has led to many an argument and many a tear. I'm still waiting to see my friend!

That'll teach me to think I can defy the ambulance gods. Gutted! Thou shalt not make plans on a work day. I won't be making that mistake again......until the next time anyway. :-(