24 - Season 2: Episode 3

continued......

The following takes place between the hours of 12:18pm and 3:50pm

12:19

"56 year old female, back pain, not alert"

Really?! The old 'not alert' has upgraded this job to one suitable for a car apparently! Also, the back pain
in a certain age is interpreted as possible chest pain, but still, I wasn't impressed with having to go. Mainly because I'd just convinced myself I was about to eat! Foolish! The job was just round the corner so I headed round, without even needing to turn the lights on! I pressed 'on scene' just as the call was downgraded to a low priority! Dammit! Had I have been a bit slower I would have been cancelled!

I was met at the door by the patients daughter who beckoned me in. They were a Somali family and only the daughter spoke English, but she spoke very well so there was no problem translating. I assessed the patient, did her ECG and within 20 minutes I'd done everything I could and found that she had a simple case of 'hurty back'. Despite my best efforts to convince them that hospital wasn't necessary, she wanted to go and get checked over. That meant a looooong semi-awkward wait for an ambulance!

I think the difference in cultures means that when a family emigrate from a country like Somalia, where the concept of pre-hospital care doesn't exist, expectations of what to do are different. They have no alternative care pathways, visiting GPs or chemists with drugs to treat most menial problems. In their country, if you are ill, you go to hospital, it's that simple. The idea of being 'ill', being seen by an ambulance and NOT going to hospital seemed foreign to them. I suppose that's where education via the GP would come in handy!

The wait for an ambulance really did become awkward! There were plenty of ominous silences to make me cringe, occasionally interrupted by my apologies for the delay! There is only so much you can talk about, to a group of Somali women who don't speak English! Eventually the crew arrived and I was able to make a quite getaway!

FOOD!!!!!

I made myself available and headed to the shop! I literally went to the first one I came across which happened to be a Wild Bean Cafe at a BP Garage. I grabbed a selection of high calorie, processed rubbish and went to pay.

14:38

"RTC, car vs pedestrian, ? Injuries"

I swear they are watching me! They must me! It's every time I try and eat! EVERY SINGLE TIME! Dammit!

The job was 13 miles away but without even a grumble (that they could hear) I shot off. In reality I was swearing and bitching to myself and moaning out loud the fact that a) I was hungry b) this job is miles away and c) I was hungry. See, I have a food problem! I cant stop thinking about it, yet can't bloody get any! Again, I was weaving in and out of traffic on A roads, B roads, side streets and bits of kerb! I like to mix it up! I was making good progress, and like with all semi-serious / serious jobs I was building a game plan as I went along. 

Left turn, right turn, onto the wrong side of the road and round a traffic island. Through some red lights, back onto the wrong side of the road and lights off, sirens off as I approached a fast duel carriage way! Wouldn't want to be the cause of another crash! Once the lights changed, the noise was restarted and off I went! Left turn, right turn, blah blah blah! It really is good fun at times! Only 4 miles to go!

'CANCELLED: 'Quicker responding unit'

1, 2, 3, 4, 5, 6, 7, 8, 9, 10.......AAAARRRRGGGGHHHH! Right, FOOD! Or not....

15:01

"31 year old female, sickle cell crisis"

OK, this wasn't far, sickle cell is simple, give pain relief until the ambulance arrives, handover, go and get food. That is as simple a battle plan as can be! This time I made it on scene without a cancellation, grabbed my stuff and went over to the patient who was sitting on the back seat of a car, in the grounds of a hospital. I know what you're thinking, but it was a mental health hospital! I started talking to her and became aware of the some ECG electrodes on her hands and ankles! Specifically, ambulance ones!

"Have you had an ambulance today already?!"

"Yes" she said, wincing in pain.

"So what happened?"

Her friend interrupted....

"She was taken to hospital but we waited like, an hour and they didn't do nothing so I brought her here cause I thought this hospital would help, but they won't."

"This is a mental health hospital, she needs to be in A & E. All the hospitals are busy and she will have to wait anywhere she goes, it's just the way it is I'm afraid."

*patients friend kisses her teeth at me*

"Well we ain't going back to dat s**t hole."

"Well that is down to the ambulance crew that arrives. You can discuss it with them."

With that I begun offering Entonox.

"I need morphine, that's all I can have."

"Well lets try this first and see how you go."

"No, just give me morphine."

On cue, the ambulance arrived! And as luck would have it, it was the crew who took her to hospital a few hours earlier. They broke the news that she had self discharged on arrival because the hospital knew her to be a morphine junkie who didn't even have sickle cell! She simply pretended to different ambulance crews and different hospitals across the city! Luckily she had been rumbled and after some foul mouthed expletives and some teeth kissing they drove off! Presumably to go and call another ambulance from somewhere else. 

No wonder the NHS is up shit creek without a paddle! This is what we are up against!

I popped into the hospital to use a loo, it'd been a good 10 hours! My bladder control is good but seriously.....! Inside the building I was greeted by an 'Out of Order' vending machine! FOOD!!!! Oh the torture! Anyway, not wanting to discuss toilets further, I did my paperwork and made myself available for another one! This day was becoming ridiculous! It's never this busy on the car! What next?! 

To be continued.....

24 - Season 2: Episode 2

continued......

The following takes place between the hours of 8:41am and 12:18pm

08:41

"27 year old female, 24/40 pregnant, feeling faint"

So, second breakfast will have to wait! Never mind! It was turning out to be surprisingly busy for the car! Normally there is some down time between jobs because on the car you only go to the higher priority of calls and are generally kept in your area. Today, everyone in my area seemed to be falling ill on an all to regular basis!

Again, I found myself at a supermarket. This time I was on scene within 90 seconds of the call coming in, so when I arrived at the cheese aisle, the patient, surrounded by store staff, was still on the phone to the call taker. I always enjoy the looks of amazement that I'd been able to drive 200 meters so fast! What they don't know, is that the very second they dial 999 the nearest available unit is dispatched by a computer. If its a mobile phone, you are dispatched towards the co-ordinates of the phone mast where the call originated and are then redirected when the address is confirmed. In this case, the mobile phone mast was on top of the supermarket, so when I got the address I simply turned off the engine and got out the car!

The patient was a really sweet young woman who was expecting her first baby. It had been an uneventful pregnancy up until now, but today she was experiencing some profound dizziness in spells. Dizziness in pregnancy isn't uncommon at all and she would need a check up, but really, she was fine. I checked her over, shared my war stories of parenting and generally talked babies, surrounded by cheese, whilst waiting for the ambulance. Mmmm cheese! Those second breakfast gremlins are coming back! 

Eventually the crew arrived, we said our goodbyes and once I'd put by bags back in the car I returned to the cheese aisle with a basket! 

09:35

"General broadcast, all mobile, holding a cardiac arrest, 1 month old baby, limp and floppy, gone blue, please go green or come up on priority if you can assist"

"Red base, I'm green, happy to run on it." I said as I dropped the basket and RAN back to the car." 

As I opened the door the job appeared on my screen. I accepted it, looked at the address and shot off. 6.6 miles to go, through the city, that's 9-10 minutes on a good run. I hope to god another vehicle is coming from closer than me. 

I could feel the adrenaline kicking in, I was driving at mine and the cars limit and fixated on the road ahead of me. I could hear the job updating repeatedly on the screen, but I daren't look at it whilst driving at speed, never worth the risk. As the miles were ticking down, I started to go through a vague plan in my head. I was recalling the resus guidelines for a 1 month old in my head just so I didn't flap when I arrived. I'm not going to lie, I am new to the car, new to this 'lone working' thing, and the thought of being solely responsible for this kids life scared the living daylights out of me. 3.1 miles to go......

I was weaving through the traffic at a rate of knots. Fast acceleration and rapid breaking, to take into account other drivers unpredictable actions. No doubt someone will say I shouldn't need to if I'm driving properly but sod em'. As far as I'm concerned a baby is dead, and they will stay dead until I get there and I will drive as fast as I can do so, safely. The end. 1.8 miles to go.....

I had just over a mile to go, the cars still parting like Moses and the tide, eyes still wide open taking in everything ahe.....

'CANCELLED: No longer required'

WHAT?! Aaaarrrrrrggggghhhhh! Now I'm 6 miles out of area, my heart is pumping stupidly fast, my palms are sweating and I have no frickin' cheese! I pulled over to calm down for a few minutes! I HATE cancellations.....with a passion!

09:47

I sat in car, stereo on (Cheers Mr Buble), seat declined slightly and just laid there. I was hungry but wasn't near any shops and had no real idea where I was so took the opportunity to just chill out! It had been a pretty relentless start to the shift, so until I was told to do otherwise, this is where I would be!

After having my slumber rudely interrupted by a pedestrian wanting directions to a building 25 feet away, I decided that the urge for food was now too strong to ignore! I started heading back towards civilisation in the hope that shops would appear.

10:52

"51 year old male, unconscious, ? Low blood sugars"

And there we have law of the sod! I should have gone as soon as the opportunity presented itself but procrastination has always been my thing! 

I recognised the address when it appeared. If memory served, he wasn't a regular caller per say but someone I've met a few times, controls his diabetes well, but occasionally makes a mistake and has a hypo. It happens! At least it was back in area though, so I wasn't going to moan about the 7 mile run! 

Sure enough, when I pulled up outside, I recognised the house and once inside, recognised the unconscious patient on the bed! He was snoring away, pouring with sweat and showing all the signs that it was indeed a hypo! A quick check of his blood sugar confirmed it. It was 'Low' which means its too low to give a reading on our kit. I set about cannulating him, drew up some glucose fluids and set the drip going. Then it was a case of waiting for him to wake up, act confused for a few minutes and then start apologising for having wasted my time!

10 minutes later, having started a discussion about rabbits playing tennis, he froze, then said:

"I've done it again haven't I?!"

"Indeed you have!"

"I'm so sorry for getting you out, I don't know what happened, I had my insulin this morning!"

"No worries, hospital?!"

"I think you know the answer!" and I did!

"Red Base, cancel the ambulance if you have one assigned, the patient is declining hospital so I will discharge him to his own care, over"

"Rog, thank you."

After checking his sugars, I gave him some more glucose, then while I started on the paperwork, he got changed! During a hypo, people can sweat profusely and his clothes were saturated. Whilst he was upstairs I got his wife to make him some jam sandwiches and a sugary tea. We all sat chatting whilst I dotted the I's and crossed the T's. I even got a coffee for my troubles which was very much needed as I was starting to lag! I'd been up for 7 hours or so and was yet to have more than half a bowl of cereal! 

Have you noticed how much I'm thinking and talking about food! It's a problem. I need help! Anyway, I got him to sign to say he was happy to stay at home, referred him onto his GP and left them to go about their day! I was in my 'break window' now so I made myself available and for once, relished a chance to stop for 45 minutes and eat some hot food! It really is a novelty!

To be continued.....

24 - Season 2: Episode 1

What is an average day? There isn't one. It is as simple as that. Last year I blogged a 24 period, in real time, as it happened on my shift. I felt it would be therapeutic to visit the idea again and share a random day shift as a lone responder. Here goes. Eyes open, to eyes shut, to eyes open again. Sorry about the toilet stops!

The following takes place between the hours of 4:30am and 08:41am

04:30

No one should ever have to wake up at this time. Ever. No one should really have to know what 4:30am looks like! The light from my phone physically hurt my eyes as I turned off the dulcet sounds of Michael Buble's Mack the Knife! (Don't judge me!) Despite the desire and need to snooze, I couldn't. I got dressed, jumped on my bike and cycled the 5 miles to work. The cold air made my eyes stream the entire way and by the time I arrived, it looked like I'd just been to a funeral......in a hurricane! I had a shower at work, got everything ready, uniform on, drugs signed out, me signed in and all my kit on the car and I was ready with about 10 minutes spare to grab some breakfast! 

06:01

"94 year old female, abdo pain, dizzy"

With half of my cereal left behind on the mess room counter, I jumped into my car and shot out the garage. As it was so early, the roads were clear, so I got on scene within a couple of minutes. As it was still dark out, I left the flashing beacon on the roof so the ambulance could find me in the rabbit warren of the estate I was on. I grabbed my stuff and handed on up. I was met at the door by a very anxious, frail looking lady. I helped her back to her armchair and sat her down.

Her symptoms were quite vague and not that severe. So much so, that the illness code I gave her was 'generally unwell'! All her observations were OK, she had a bit of this, a bit of that and could probably have waited for the GP and been treated at home, but at 94 I certainly wasn't going to begrudge her my time or the resources. I made her a tea an some toast whilst we waited for ambulance. 94 is a lot of years and she had plenty of tales to tell me and seemed to enjoy telling them! Back in 1947 she tested racing cars and that was just one of the anecdotes I got from her fascinating life! After about 45 minutes of chatting, the ambulance arrived.

I gave a handover, helped them get her downstairs and on to the ambulance. I got back in my car, appreciative of my second caffeine hit and finished off my paperwork. Job done!

07:03

"2 year old male, fitting"

Yikes! Blue lights on again, yet this time the rush hour was upon me! Being on a car, I can fit through smaller gaps and go faster but that doesn't help being sat stationary in what is effectively a car park! Traffic really does mess with your emotions! On the one hand it makes you livid at the stupidity of some people and their inability to drive. On the other, you have a traffic jam, a potentially very sick patient and no way of moving. You are the person needed to help, yet you can't move faster than the traffic will allow and that can be extremely frustrating and worrying. Luckily, most 'fitters' have generally stopped fitting by the time we arrive and 'most' fitting 2 year olds are actually having a febrile convulsion. Obviously, today was never going to be 'most days'!

As I pulled up on scene a teenager came running outside waving frantically! One word popped into my mind.....'SHIT'! I grabbed everything and hurried into the house, knocking over the clothes horse and a photo off the wall as I bundled up the stairs. In the bedroom, my patient was lying on the bed, fitting. Foaming at the mouth, body shaking and contorted, the mum crying, the other children all crying, it was one of my worst nightmares. I put the oxygen on him and started trying to get a history. From what I could work out he had now been fitting for over 10 minutes. He wasn't a known epileptic but had had a seizure in the past and had been prescribed an emergency dose of buccal Midazolam in case it happened again. Well it was happening again, but in the panic, no one had given it, so I did. Whilst waiting for that to take effect I checked his temperature and blood sugars. All normal. 

There was no sign that the fit was stopping to I decided to give some of my Diazepam rectally. Just as I was administering it the ambulance crew arrived. We were pushing 20 minutes of fitting now, the boy had had the maximum amount of drugs he could, so we needed to run.

"Hello guys, 2 year old male, fitting now for almost 20 minutes, given Midaz and PR Diazepam, let's just go, yeah?!"

Generally speaking, if in an ambulance crew arrive, and the FRU says 'let's go' as they walk through the door, it's a case of no questions asked! Especially in sick kids. We are not equipped or experienced enough to deal with small children. 

No sooner as the boy and his mum were on board, we left for hospital. I put the blue call in on route. You've then got that terrifying 10 minute journey, where you can only watch. Watch a tiny, helpless 2 year old boy violently fit, and there is nothing you can do. You try and reassure the mum, but doing so, without the fear of god in your eyes is near impossible. As a parent I can't imagine the fear I'd be feeling. She held his tiny little hand whilst I held him in position on the bed. It was one of the longest 10 minutes of my life. 

On arrival at hospital, he had been fitting for over half and hour. His condition was critical. We handed over to the paediatric team and they took over his care. We left the mum standing in resus with tears pouring down her face. I did my paperwork with the crew and then got back in my car which had kindly been driven unto hospital by one of them. 

I never found out how the boy got on. I never will.

08:17

"42 year old male, collapsed, fitting, O/S supermarket"

The sex, age and location told me all I needed to know. I knew exactly who it was! It was one of our regular alcoholics and this was his morning fitting hotspot. He'd either have had a fit and now be recovering or will simply be asleep! He would most likely smell and once compos mentis would no doubt hurl abuse and then walk off down the road! I wasn't far away,  so I lit up the roof and off I went. 

As I pulled up outside the caring member of the public who found him waved me over. There, in all his glory was Steve! Lying, asleep, face down in some bushes. And yes, the smell made my nose sore! He was actually a really nice guy when sober, when intoxicated however, he was ghastly! 

"Hello Steve, wakey wakey!"

The onlookers seemed shocked that I wasn't doing CPR and sticking a biro through his neck like they do on casualty. My lack lustre approach was justified when a moment after I told him to wake up he promptly told me to 'f**k off'. 

"I'm afraid not Steve, I can't leave you face down in a bush!"

"F**k off, leave me alone."

"Up we get Steve, you know that I'm not going anywhere until you are standing up!"

"Just f**k off will ya."

The ambulance pulled up and gave me a knowing grin!

"Steve?!"

"Yep! He's not pleased to see me!"

Between the three of us, we pulled him out of the bush. He was looking worse than normal, clearly the 8am Whiskey run had taken its toll.

"How about we pop you up to the hospital Steve? Get you cleaned up and fed."

"Just f**k off will you!"

"At least let us check you over."

"F**k yourself" he said as he wondered off down the road. 

That was Steve! Anyway, just like a Hobbit, it was time for me to have my second breakfast! I think I'd earned it!

To be continued..... 

A Bridge Over Troubled Water

"29 year old male, cardiac arrest"

Even before we got this job I had a strange feeling. I can't describe it, something just didn't seem right! I was on edge like I was waiting for something to happen.  Well,  a 29 year old in cardiac arrest was enough to snap me out of my odd state! Generally the cardiac arrests we do are on the elderly. In fact, I'd say at least 95% are over 65, maybe even higher than that. I'm not saying it's any easier doing a resus on a 80 year old but on some one younger it seems a lot more of a waste. Initially we only had a road to go by, so headed off in the general direction.

"UPDATE: Patient on a boat"

A boat. Of course he's on a boat. It's a big city, where else is he going to be?! The actually location we had been given was to an incredibly narrow, slippery concrete staircase, leading down to an canal footpath. Only problem was there are two sides to a canal and boats lines both sides. There was also two staircases to chose from and we had a lot of kit to carry! Oh, and obviously it was dark.

With all the kit you can envisage for a resus we headed down the stairs that were nearest us and started looking / shouting speculatively for a response. After about 100ft we got on! On the other side of the canal.....

So, about turn, and back we went, up the stairs, across the bridge, down the other stairs and along the footpath to the boat. Now, the boat. The clue is in the name, a 'narrow boat'. There isn't going to be much room to work, nor will there be room to stand or  move around. Once I'd taken a step of faith over the gap to the water I felt a tad safer. My crew mate passed me the kit and then followed me over. Then it was a case of squeeze down a tiny, shallow stair case into the heart of the boat and there was our patient, lying lifeless on the floor.

I quick primary survey showed that luckily he wasn't in cardiac arrest. He was however on the verge of respiratory arrest so I got ventilating him while my crewmate started doing 'other stuff'. His pupils were pinpoint and there was plenty of evidence to suggest a drug overdose to we treated as such. We have a wonderful drug called Narcan that reverses the effect opioid drugs pretty rapidly so we loaded him up with that. After about 8 minutes he started to respond and began breathing effectively himself. 

By now, the FRU had arrived, unfortunately, owing to the fact that it was a narrow boat he was made pretty redundant by the lack of space. He decided to go and fetch our carry chair! Good call! Although the patient wasn't conscious enough to talk in sentences our walk he was opening his eyes and thrashing around slightly which was kind of what we expected. He had already been cannulated by the time the chair arrived back so we got him strapped in and started the the arduous process of extraction! 

Up the stairs we went and on the stern (?) of the boat. Now the plan of how to safety get him, us and our kit across the gap of water to the foot path! Scrap that.....he started fitting. Full blown seizure and pretty violent at that. BALLS! We got him out the chair and onto the deck. This job was really going from bad to worse. We waited a few minutes to see if the seizure would stop. It didn't. We gave Diazepam and waited some more. Still fitting and we are getting pretty desperate now. More Diazepam. Still fitting......aaaaaand stop. A quick ABC check and he was up, on the chair and across the back faster than you can imagine! Sure enough, the second we got him on board the truck the fitting started again and this time it didn't stop. 

You'd think after all of that, the hospital would be appreciative of what we'd been through, but no, the Dr was just plain rude! He interrupted my handover with:

"Well he's probably still fitting because you waited 5 minutes to give him Diazepam"

He then ignored the rest of the handover and talked over me. He looked at us like we'd dropped a baby and spoke to us as if we were naughty children. He criticised and questioned why we waited to give diazepam despite showing him our guidelines. He wasn't interested. Professional courtesy and respect works both ways and today both were distinctly lacking from the doctor. It was a sour end to what had been a challenging and difficult job.

In hospitals you have every level of experienced medical professional at your finger tips. You have every drug, lots of expertise and the patient is on a bed. Pre-hospital you have 3 of us, one of which is a paramedic, one is a student paramedic and the other a technician, a patient not breathing and then seizing uncontrollably, on a narrow boat, in the dark. We are not miracle workers. We are not giving a gold standard of care that the hospitals are capable of. We are simply making the best of a bad situation. And as far as situations go, this was pretty dam bad!

Carry On Stabbing

"34 year old male, stabbed in leg"

Criminal (Crim-in-al)

Noun: A person who has committed a crime.

Synonyms: felon - malefactor - delinquent - offender - culprit

Idiot (Id-i-ot)

Noun: A stupid person.

Synonyms: fool - imbecile - blockhead - dunce - nitwit

Imbecile (Im-be-cile)

Noun: A person who's mental acumen is well below par.

Synonyms: fool - idiot - halfwit - cretin - moron

I am giving you these definitions to bear in mind whilst reading about this job.

Aren't Friday nights wonderful?! If ever you wonder what exactly the tax funded emergency services are doing, specifically police and ambulance (trumpton have their weekly table tennis tournament), then just stand on a street corner and watch the countless number of blue light vehicles career up and down the road! Then, if you get bored of that either go and look inside your local A & E or observe the activity outside your local police station! It is non stop! Most of the things we are dealing with are alcohol related illness or alcohol related crime, both of which stretch our capacity to bursting point. 

Today was no different. I often comment on how busy things are but as far as Friday nights go, tonight was absolute carnage! It really was like a war zone. After having a few drunks we'd scooped up and taken to hospital a stabbing was most welcome! The police were on scene so we headed straight to scene. What we were about to walk into, no amount of description could have prepared us for. You literally couldn't make it up!

Q. Let's say you are a criminal. Where is one place you would NOT want to commit a crime? Outside a police station?

Well, the location of said stabbing was indeed right outside the police station. Not only did it happen outside the main entrance, it was witnessed by 4 burly coppers so the stabber was quickly apprehended. Smooth!

Q. If you had a stubby nature and were....well....a stabber, what would be the goal of stabbing someone? To hurt or kill them perhaps?!

Well, the only person injured in the stabbing, was in fact the stabber. Why? Because he stabbed a man in his prosthetic leg. Yep, not the good leg, the gut, the chest, the back, the neck or the arms, oh no! He managed to stab the one part that was unstabable! The impact of such a solid object caused his hand to slip down the hilt of the blade and slice his own fingers open. Smooth!

Q. When running away from someone (i.e. The police), where do you look whilst running your heart out? Forward or backwards?

Well, in this case, the criminal stabber didn't look forwards. He looked back at the sudden plethora of policeman bearing down on him. Whilst running forward, and looking backwards he was attacked by lamp post and knocked himself unconscious. Smooth!

*cue our arrival of scene* 

Our patient was the smooth criminal who had stabbed himself outside a police station and knocked himself unconscious. He was very much alert when we arrived, saying it was self defence and the war veteran with one leg had been trying to mug him, so he pulled out the kitchen knife he happened to have on him and protected himself. Oh how we all laughed! Perhaps when he had that brainwave it came about in not too dissimilar a fashion to one of Baldrick's cunning plans!

I bandaged his hand, bandaged his head and he was loaded onto the truck, not before he managed to spit at me. That went down well! 

Q. Seriously though, who tries to mug someone outside a police station and then manages to stab himself , cause no injury to their victim and get knocked out in the escape process?! 

A.  A Criminal, An Idiot, An Imbecile