You cannot be serious!

“66 year old female, diarrhoea“

It was a weird morning; weird because it was very quiet. Obviously we never say the "Q word" whilst at work, we just ignore the elephant in the room. We chat away, drinking coffee, eating crap; all the while thinking ‘blimey it’s quiet'. We managed a nice breakfast in peace, a hot coffee and a newspaper. After 2 hours of relaxing we were finally sent a job! The cheek of it! There was only an address to go on so started trundling in the right direction: 

“Diarrhea, really?! I’ve just eaten! Surely we will be cancelled?!”

Sure enough we were. Result! We pulled over and got back to the arduous task of doing nothing; sadly, this was short lived:

“66 year old female, diarrhoea & chest pain”

This stank to high heaven; not of diarrhoea, but of ‘been told you’re not having an ambulance quickly so ring back with chest pain-itis’. It’s a very common condition, and is a bi-product of a campaign telling people to call an ambulance if they get chest pain. It didn’t take long for people to realise that by saying those two magic words they would get an ambulance every time; quickly & regardless of age, sex, medical history. I believed the chest pain we were en-route to would be just that; a load of tosh (but I’ll stay open minded, ish!)

We pulled up outside of the block of flats; there was a huge grassed area, so we parked in the bus stop on the road and walked over. Because we were told chest pain and she was semi-elderly we took the chair with us, just in case. We made our way across the grass and up the stairs to the first floor. The door was ajar so we made our way in giving the obligatory ‘Hello, ambulance’.

To our surprise, there was a first responder on scene. His car wasn’t parked out the front so I assumed it was just us. He had a fed up, angry, dejected look on his face. He was kneeling on the floor in front of our patient who was sitting up in the chair.

“Hello guys, it’s not as given. This is Cheryl; she doesn’t have any chest pain or any diarrhoea for that matter. She has an appointment at the hospital for her eyes in 45 minutes and doesn’t fancy getting the bus. I was just explaining how this is an inappropriate use of the ambulance”

I think I still have a bruise on my chin from where my open mouth hit the floor. In the words of John McEnroe ‘YOU CANNOT BE SERIOUS?!’ Obviously I didn’t say that, but my jaw hitting the floor with a thud said it all!

“So can you take me to the hospital for my appointment then?”

“I’m afraid that isn’t what we do. We take patients with a medical need to accident and emergency and you have said you are not ill.”

There was a brief pause……

“I have some chest pain”

“You have chest pain?”

“Yes”

“OK, we’ll have to do an ECG etc here and then take you to accident and emergency where you will be booked in as a patient with chest pain”

“I don’t want an ECG but I do want to go to A & E”

We were powerless to do anything about it. She was playing the system and intending to self-discharge and get to her appointment.  We are not allowed to refuse hospital to someone, let alone someone saying they have chest pain. She declined the offer of a chair and walked off to the ambulance. Oh, incidentally, the bus stop we had parked in was the stop for a direct route to the hospital main entrance. Oh, and she has a freedom pass. 

“Couldn’t you have got the bus?”

“I didn’t fancy it”

“...Or a taxi?”

“That costs £16”

We drove to hospital in silence while I wrote the most sarcastically professional paperwork I could muster. As we arrived, I said:

“How’s the chest pain now?”

“It’s gone”

Hmmm, funny that! We took her into A & E, her appointment now 15 minutes away. I could sense she was waiting for an opportune moment to leave, luckily for us A & E is nowhere near the eye clinic and she needed directions. I gave a full handover to the nurse in charge. The whole time I was talking she was glaring at the patient.

“Where is your appointment?”

“At the eye clinic”

The nurse walked over the phone, looked at the list of phone extensions, picked up the handset and dialled. 

“Hi there, we have Cheryl Smith (not her real name) in A & E with chest pain, can you cancel her appointment please………thank you”

She came back over to us:

“Right, your appointment has been cancelled, you can wait in the waiting room until your name is called, just be aware, it’s a 4-6 hour wait.”

With that, she signed my paperwork and walked off.

VICTORY!! Now why can’t we get away with stuff like that?! Her face was a picture, she whined and moaned, swore and shouted but it all fell on many sets of deaf ears. 

Age is no excuse for bad behaviour and this is all this job was; bad behaviour. She simply called 999 to use us as a taxi. Seriously though, what can you do when someone plays the system like that? As a service, or as individual clinicians, we are in a very grey area when it comes to refusal of an ambulance or refusal of conveyance. We end up playing another game of ass -covering and passing the buck simply because that is what we are told to do, or realistically, not doing so is more than our job is worth. Until decisions are made at a high level, and I don’t mean ambulance management, I mean government level, nothing will change. This is a national policy problem and not something we can fix with well-placed lectures. Needless to say, I had an epic rant afterwards and spent the rest of the shift well and truly riled by the whole thing!

Happy Blog-iversary

"27 year old female, celebrating a paper anniversary"

Hello one and all.

I know it's been a while since I posted a blog, but I haven't stopped! I've had a lot on personally and professionally and, although I have still been writing away, I haven't been posting because I haven't had the time to commit to tweet them or reply to comments and emails. One of the main reasons I write is because of the dialogue and debate I get from doing it, and without being present to do that part of it I didn't really see the point in posting whilst I was busy.

Anyway, why today of all days to check in and say Hi?! Well, today marks a kind of special occasion; an anniversary of sorts! Today it is a year since I started my blog Diagnosis: LOB. I remember the night vividly. My life had been turned upside down; I was living out of bin bags and staying between my Mum's house and on the floor at the foot of a friend's bed. This particular night I was at Mum's. I'd just gone out and splashed the last money I had in the world on a brand spanking new iMac. Well, what do I do with it now?! I didn't really need it, I had no real use for it, but it was very pretty and shiny so I bought it on a whim. My crew mate @secondonscene had told me to write my rants down for a long time so he didn't have to listen to them! So I did.

I set up a blog. I designed a pretty poor looking page on blogger, wrote a bio, said a few words to introduce the blog and that was it! 

'New Post'...

Now what?! I starred at the blank screen not having a clue what to say! I didn't know a thing about blogging. All I knew was that I had read a blog called 'Insomniac Medic' which was a bloody good read. The thought of actually writing my thoughts down was quite daunting. I just went for it and after 3 hours I had a badly written, error-filled blog about a frantic impatient parent. 

'Post'...

Now what? How do people read it? Isn't there something called Twitter?! So I gave that a go! I set up an account and started tweeting. Then I got 'mentioned'! Weird! I didn't have a clue what I was doing but a few kind folk gave me some pointers. At the end of the first month I'd written 15 posts or so and had amassed 375 blog hits! Most of which were probably me. I had the bug! I started to love writing and as the weeks and months ticked by the popularity of my blog got more and more. It really was humbling to see my blog being read over 50,000 times a month.

As Peter Parker was once told, 'with great power comes great responsibility'. The more I wrote, the more likely I was to cause upset, and upset I did. I never set out to be controversial or upset people but I suppose being a stubborn, opinionated hot head who wears her heart on her sleeve it was always going to happen. I received words of warning about the appropriateness of what I was writing from time to time; some constructive, some not so much. I suppose we all learn somewhere, no one is perfect, and I like to think I don't make the same mistake twice.

What the blog has given me this last year is great enjoyment and some real pride in what I was doing. Being a finalist for the EMS Blog of the Year was a highlight, as was being nominated for various digital media awards and being contacted by a publisher! Despite all of that though what I wouldn't swap for anything is the friends and amazing people I've met along the way. I've had people guest blog for me, I've guest blogged for some real knockout bloggers, and had my writing published in places like the Guardian. None of these things would have happened if it wasn't for my fabulous readers and followers and for that I thank each and every one of you.

I love blogging and I will be back soon but today I just wanted to thank you all for your continued support. 

See you all soon.

Ella xx

Dial 999... & wait?

"A country in apparent shock at having to wait for an ambulance"

On Monday 3rd September the BBC aired a programme called 'Dial 999...& wait?' detailing the failings of the emergency services in this country. It's shocking isn't it; having to wait for something? Just terrible. Like with most documentaries, articles and reports about the emergency services, we all come under attack. I say all, as per usual the PR department for the Fire service has been working overtime so they came away unscathed. There was no such escape for the Police and Ambulance services. The culture of targets and response times was what the programme was about and, rather than talk about the real causes, it just highlighted the failings of the services using some well-placed stories about people suffering due to waiting times. 

First in the firing line was the police; the shocking statistic that out of 1 in 5 calls made, the police take more than 15 minutes to arrive. Outrageous. We surely expect more from our police?! I wonder what the government had to say about it... oh yeah, they declined an interview. Obviously the cuts are to blame, there is no denying that; a 20% budget cut is huge, but instead of doing a programme blaming the government they blame the police for basically being greedy. The short interview with Andrew Haldenby from the "think-tank" Reform showed only the attitudes of those not directly involved in working with or in the police. The police have 'never had more money than they have now' and 'for far to long, forces have rested on their laurels'. If cuts are being made, services will be affected. The reason the police have more money now than ever before is because year-on-year the call volume goes up. Don't for one minute believe isolated statistics of a decrease in crime; it is simply that the type of crime is changing. The police still require resources to deal with the 100's of 1000's of daily calls. This call volume will not change, yet somehow, on skeleton staff, they are expected to arrive anywhere within minutes of a call.

The example they used of peoples' suffering was a shop owner who had been burgled. She was 'shocked' at the police not arriving for 20 minutes. How many shop alarms are triggered each night? How many violent assaults are there? How many domestics? How many hoaxes? How many RTCs? How many requests from the ambulance service? How many raids are being done? How many criminals are being hunted? That is just a fraction of the work our police force is doing. In the London borough where I live there are about 330,000 residents. The borough covers 87 square kilometers and is the second largest in London. While chatting to an officer a few weeks ago on a Sunday morning, he told me there were only 13 front line officers responding to calls. He also told me he remembers when there were 30+. It's no surprise that with such huge cuts low priority calls like a shop alarm are getting a delayed response. To be perfectly honest I'm 'shocked' that the police got there so quickly.

Avoiding the fire, ironically, was the Fire Service; no shock there. No talk of missed targets, only that they arrived at a fire within 6 minutes. To be fair, it is easy to arrive anywhere in 6 minutes if you are sitting and waiting for that call to come in and get to spend all day perfecting the art of getting into your vehicle quickly. Last year the London Fire Brigade had a budget of around £437 million compared to £288 million the Ambulance Service got. They received 230,000 calls compared to the 1.6 million the London Ambulance Service received. They attended only 138,385 calls compared to 1.2 million that LAS did. They did so with their 5800 operational staff (almost double that of the ambulance service) from their 112 fire stations (compared to the ambulance service's 70), and of their calls attended, only 29,215 were fires. That is about 80 a day across London. Considerably less than 1 per fire station. Is it any wonder that they are able to respond quickly?! What was highlighted by the programme though was the crippling cuts that they are now facing. A whopping 3% in their budget! Wow! How will they cope?! Maybe they will have to send less than 25 fire-fighters to rescue a seagull from a 3ft pond. Oh wait... they refused to go in; they just sat around and watched a member of the public go in. Yes, THIS happened. Click here. It's weird how all of these facts and figures were omitted from the programme, hmm?

Saving the best until last, the Ambulance Service came under attack for people having to wait. They opened with a tale of an elderly lady waiting on the floor for hours, with the addition of an interview from her daughter about how terrible this was. I agree. In an ideal world no one would have to wait for an ambulance, least of all our elderly population. Unfortunately, the medical world uses a triage system based on what the caller tells the call-taker. As horrible and uncomfortable as it is, an elderly lady with a knee injury is not a high priority and when there are only a handful of ambulances covering a large area priorities have to be made. In this instance it wasn't life or death. Who knows what other calls were in progress. Long have I banged on about the fact that time wasters and nonsense calls just need to be told 'NO'. Sadly, Panorama decided to interview Tony Hughes for the GMB union who decided to highlight the few calls that slip through the net and are wrongly triaged. SO WHAT?! Out of the millions of calls the services receive that is bound to happen every now and again. There are not enough ambulances and staff to send one to every single 999 call that comes in.  Fact.

What annoyed me most about the programme was the failure to highlight the cause of these delays and lack of ambulances. Yes, we have faced cuts like everyone else but as of yet it hasn't had a huge impact in the amount of ambulances working on the front-line. The problem is that the call volume is going up year on year. This wasn't mentioned once. Nor was the massively high proportion of calls that we go to that are a complete waste of time and resources. No mention of the alcohol related calls we go to, the hoaxes, the split nails, the stubbed toes, the headaches, the colds, the can't sleeps, the noise in ear, the finger injuries, the needing a lifts to hospitals; basically 80% of the work we do. No mention at all that the delays people are facing are caused by the public's misuse of its ambulance service. Despite all of that though, for the first time all of the services met the category A target of reaching 75% of life threatening calls within 8 minutes. Instead of leaving it there and heaping praise on the service they interview people to highlight the apparent cheating that is going on. Calls being downgraded to meet the target? Calls being upgraded to meet the target? Is there any proof that this goes on? All ambulance staff, myself included, moan about the conspiracies, the stitch ups and mis-categorising of calls, but personally I don't think this is done to meet targets. The categories of calls change as new information comes in and I think it's highly irresponsible of Panorama to throw out accusations without a scrap of evidence. Then again, who ever said investigative journalists were supposed to research...?!

In the presenter's introduction he said 'What happens when the ambulance service decides you're not sick enough to get an ambulance?' Well as far as I'm concerned the answer is pretty simple; you don't get an ambulance because you are not sick enough. If the public and the media want an ambulance immediately then give us a budget proportional to the calls we attend. Based on the London Fire Brigade's budget per calls they receive, the London Ambulance Service's budget should be around £3 billion a year. Now mirror that across the across the country and you'll see the shortfall we face. Just imagine how quickly we would arrive with that budget at our disposal! We could probably all sit around waiting for calls, practicing getting into our ambulance really quickly, sending 5 ambulances to an elderly faller and do countless public demonstrations of our equipment... ring any bells? People expect miracles and in this economic climate miracles are not going to happen. 

So, you dial 999....& wait?! Yes. That's life. Build a bridge and get over it.

The Pursuit of Happiness

"32 year old male, fainted, DIB"

This was the first job of the day and amazingly we had been at work for a good two hours by the time we got it! We'd managed a relaxing Costa and a non-rushed breakfast so we were in high spirits. The address given was a gym so we were fully expecting a non-complicated faint in someone who had not eaten and been pushing themselves too hard. We pulled up outside and it was obvious from the name what kind of gym it was. There would be no treadmills, no cross-trainers and no pool. There would also be no middle-aged slightly tubby woman, or any women for that matter. It was a weights-only gym and appeared to be aimed at bodybuilders only. We walked in and were met by the manager; arms bulging, veins in neck pulsating and wearing a vest meant for a 10 year old. With his chest puffed out and his arms resembling a two-handled mug he led us up the stairs and to the patient.

Our guy was lying on the floor, unconscious, sweating and snoring. He was squashed up against some dumbbells so we pulled him into some open space. He was showing all the signs and symptoms of being hypoglycaemic (low blood sugar) but having no working kit to test it, we had to guess! We treated it as such and gave him an injection to raise his sugar levels. While waiting for him to regain consciousness I looked around; it was such a bizarre place. There were a good 25 or so blokes pumping iron, growling, grimacing and then starring at themselves in the mirror! The mirrors stretched around most of the walls allowing them to stare to their hearts content. Scattered around the place were hundreds of photos and posters, some signed, of male body builders all who looked like they'd been tango'd! In a setting where people are trying to act as manly as possible it all seemed very homoerotic! There was a long oak bar, about 25ft long like in old social clubs, the difference being no pint of lager and some pork scratchings; just protein shakes! I found the whole ethos of it bizarre!

Anyway, back the patient! He started coming round after about 3-4 minutes. He was very groggy and confused. Confused in his vocal response but also in his eyes! He clearly didn't have a clue where he was or what was going on! We gave him a Lucozade to up his sugars as when he came round he said 'yes' when I asked if he was a diabetic. It became apparent pretty quickly by the odour in the air that he had been incontinent, and not just a No. 1! We led him to the toilet and as every minute went by became more and more coercive. We got him a change of clothes while he cleaned himself up in the cubicle. I went back in and he was by the sink.

"Any chance you could give me some privacy while I wash at the sink."

"Of course, we'll be just outside."

We waited and chatted, and sniggered at some of the characters we could see in this testosterone filled cauldron of vanity. The FRU arrived with the kit needed to test his blood sugar and we explained what was going on. We asked the manager if there was any chance he'd been taking any under-the-counter steroids or anything like that.

"No, definitely not, he's not the type."

To be fair, he didn't look the type. He wasn't that well-built and didn't seem to have the obsession many of the others appeared to. After a few minutes of waiting I heard a bang. We burst into the toilet to find our patient naked and in a cubicle, upright and fitting. We got him on to the floor, got the oxygen on him and let him fit. We took his blood sugar and to our surprise it was relatively high. Clearly our initial diagnosis was wrong and he had been unconscious post a seizure. After a few minutes he stopped but then vomited; we rolled him into the recovery position whilst this was going on. Unfortunately, the use of all the muscles needed for the body to vomit had another undesirable effect. Like the eruption of Mount Vesuvius out came an explosion of poo. I've never been so close to vomiting. It went everywhere, and as he came round he rolled in it. It got on his hands which he then kindly transfered to us in the post-ictal melee. We eventually got him wrapped in a blanket, into a chair and down to the ambulance. I should have been concentrating more on what was causing his fits but all I would think of was:

"I have sh*t in my hair"

"I have sh*t in my fuc*ing"

"I have sh*t in my mother fuc*ing hair"

"I have fuc*ing shit in my mother fuc*ing hair"

It really is a panic stricken moment when you get bodily fluids on you. You want it off but often you don't get a chance. Often you know it's there but try and ignore it but once it starts seeping through your uniform you feel the damp on your skin. Sometimes it's spit in your face or blood all over you. It is just an unnerving experience and one I will never get used to. Surely I should get paid more than £9 an hour to get sh*t in my hair?!

Once on the ambulance our patient came round again. This time he said he wasn't diabetic! In fact, he said he had no medical problems at all. No history of seizures and on no medication.

"Have you taken any illegal, under-the-counter drugs to help you bulk up? You won't be in any trouble, we are not the police, but we need to know. It's really important."

After a brief pause he nodded. "Yes"

"Are they amphetamine based?"

"Yes"

"How long have you been using them for?"

"2 days. I bought them off the gym manager, he said I'd lose weight and bulk up quicker."

I couldn't be bothered to go back in to give the lying rat a dressing down. We needed to get our patient to hospital, ideally before another seizure. My crewmate got some IV access, I did an ECG and we left on blue lights. On route he had another seizure. He was still seizing when we arrived. He was still seizing when we left resus. It did eventually stop, we checked in on him a few hours later. He had been for brain scans and we were told by the doctor that the drugs he'd been given had raised his blood pressure significantly. This had caused the seizures and had probably triggered epilepsy. All for what?

This guy felt the need to take drugs to improve himself. He wasn't happy with the body he was in. Who really is though? Models often have eating disorders in their pursuit of a size 0. I don't think anyone is ever really content. The skinny amongst us often wish they could bulk out a bit or get even slimmer and the fat want to be skinny. People complain about needing to lose weight and I often look at them and think 'No you don't!' but it's personal. The people who are physically fit want to be fitter and the dedicated athletes want to get better. Will a body builder ever think they have reached perfection? Will a diet ever get anyone to where they want to be? I don't think so. If I set myself an ideal weight to get to, I am pretty sure that if I got there I wouldn't be happy. There would still be a bit that needs improvement. It's not just about weight, I know plenty of people who are happy with their size but there is always something. There would still be something to strive for, but for the vast majority of people the need for improvement is balanced with the enjoyment of the nicer things in life and we tend to find a middle ground. We want to improve and will occasionally do something about it, but deep down we want that Chinese takeaway and binge at the weekend. Basically, we don't care enough to do something about it. The other side of the coin is people who care too much; they will do anything to reach a goal that cannot be reached, and as I saw today that often comes at a cost. It is amazing the lengths people will go to in the pursuit of happiness that I don't think is ever truly obtainable. You tell me, is it?

Gü on then

“33 year old female, electrocution” 

Some things are just meant to be. Sometimes you are just destined to be in a certain place at a certain time. Today was one of those days. The sun was shining on the righteous, the righteous being moi!

We were sat outside Subway, which happened to be next door to Greggs... and opposite a milkshake shop... we were feasting like kings! Then, out of the blue to ruin the moment, we got a job. Typical! It was 7 miles away which for the time of day was a long old stretch! The address was an industrial area so it took a while to find the entrance to the correct unit. We parked up, grabbed our stuff and headed in. It seemed like we were walking for an age; turn after turn, corridor after corridor, stair case after stair case, it was ridiculous! Eventually we arrived at the first aid room. 

Lying on the bed was our patient. As we entered she sat up and smiled:

“So sorry you had to come, I told them I didn’t need an ambulance but they said I had to get checked out.”

She seemed fine; her hair wasn’t up on end, no smell of burning and no smoke rising from her head. She worked on the packing line of the factory and one of the machines had given her an electric shock. She wasn’t knocked to the floor, it was just a zap. She said she didn’t want to go to hospital and just wanted to get back to work. We explained we would have to do an ECG etc and get her to sign our paperwork if everything was OK. As the ambulance was a good half marathon away, we suggested we do all that on the ambulance to save bringing all the kit up to the first aid room. She agreed! *happy dance*

The ECG was normal, as were all her obs and she was still declining the offer of hospital so she signed our paperwork and left. As we let her out the back door her manager, the factory manager, was standing there with a large cardboard box.

Right, now I shall digress slightly. Gifts. The official line is we are not allowed to accept gifts from patients. Obviously there is common sense involved and often refusing a small token of appreciation can be insulting, especially to some cultures. I have a personal rule and that is not to accept money. I’ve been offered £5, £10, £20, £50 and £100 in the past and each time I have respectfully declined despite my own financial need for it! If something then went wrong and it turns out I had been given cash I would be the shit hitting the fan. I also turn down alcohol. A bottle of whiskey in the cab of an ambulance wouldn’t look so good if we crashed. Then there is food; this, I tend to allow! If someone wants to give us a box of chocolates or a cake despite always saying ‘no, don’t be silly’ I invariably say ‘oh go on then, if you insist’! So, rules explained, that brings us back to the large cardboard box...

All I knew is that we were in some kind of factory. I didn’t know what they were producing nor had it really crossed my mind. 

“Here is a mix of things for you and your colleagues to share”

As he said it he lifted up the flap of the box. 

Gü

Yes Gü!!

It was a whole box of frickin’ Gü!

Not just one product, a vast selection of the most scrumptious Gü desserts you were ever likely to see. My tongue rolled out of my mouth, across the floor, up his leg and into the box. There were ‘hot chocolate melting middles’, ‘After dark morello cherry bakewell puds’, ‘chocolate tiramisus’, ‘key lime pies’, ‘chocolate and vanilla cheesecakes’, ‘chocolate mousses’, ‘After dark black forest gateaux’ and ‘white chocolate mousses’. And that was just the first few layers! There was one of each of their products in there! 

“No, don’t be silly, we can’t take that”

“It’s our pleasure, nice to give something back to our emergency services”

...”Oh go on then, if you insist” 

I literally couldn’t grab the box quick enough! I know the old adage of ‘with great power comes great responsibility’ but I did not have enough willpower to show such responsibility... or restraint. This was my payment for years of crap. All the late finishes, no rest breaks, the sickness policy, the punches, the kicks, the spitting, being vommed on, pissed on, and shat on, by all and sundry! All that was temporarily forgiven and forgotten while I was staring at my very own box of diabetes! 

I ate to excess for the rest of the shift. My crewmate and I went home with bags full of cake feeling extremely sick. We also left a couple of cakes in the mess room for everyone else to share.

Don’t judge me. Today was my day. Tomorrow someone will piss on me. C’est la vie!

PS: I take back everything I have ever said about obesity. I am currently 3 mouthfuls away from this...

...and I don't care! Nom nom nom!