Closed Doors

"83 year old female, collapsed behind closed doors" 

It was a long winter. The dark seemed to last forever, the cold seemed to bite eternally the feeling of being cooped up seemed never ending. But hey, this is England. If we can't bitch about the weather, what can we do. The reason I mention it, is because I feel it may have contributed to the events that followed. 

'Collapsed behind closed doors' is an unnerving situation. A lot of the time you have no idea what lies beyond the door, thus serving its purpose! Still though, day or night, doors must be kicked in to get to someone who may be dead or alive on the other side. Today was the same uncertainty and the same vague details. All we knew was that there was a lady, behind a door, that her daughter couldn't get to. 

We were met at the day by the worried looking daughter. She had been out all afternoon and when she'd got back her was in her room, door locked and not responding to the knocking. She also 'never locked her room'. We went thought the motions of knocking and shouting but to no avail. My crew mate called control and requested the police. Meanwhile I was trying to peer through the key hole but couldn't make anything out. It was an old house and the doors weren't perfectly straight so the was a small gap at the bottom. I laid down and put my cheek to the floor. In that single moment my heart rate doubled and I could feel the adrenaline pouring through my body. About 3 feet from the door, lying facedown on the floor was our patient. 

"We need to get in now!" 

My crewmate took a sizeable shoulder barge at the door but just bounced off it. He the kicked, and kicked, and kicked some more. After about 5 hits the door swung open. I rolled her onto her bad, her eyes were closed, she wasn't breathing, but she was still warm. She was linked up to our machines and there was signs that her heart still had some activity going on. Due to that, and the fact the distraught daughter was screaming for us to do something we started the resus. We called control back and said that this was now a working resus and we needed more resources. 

After 1 shock her started beating again, unfortunately, this was short lived and within a minute or so we were doing CPR again. As the resuscitation moved on it became apparent we weren't going to be successful. The a bin was put next to me by my crew mate. Inside the 100s of tablets she had presumably taken. A glance around the room left reveals a suicide note to her daughter. It was unanimously agreed after we'd exhausted our protocols to cease our efforts and confirm her passing. 

Her daughter was beside herself with grief and guilt. I sat in the kitchen with her whilst she read the letter over and over. I also read it and it really was heart breaking stuff. She had lived a full life, a life of adventure, a life of many tales, but that was a life she had shared with her beloved husband. She explained she simply couldn't live without him anymore. She had her enthusiasm for life had died with him and she could no longer go on being a burden on her daughter. When you read words like 'seeing you grow into the woman you have become fills me with immense pride and joy' was touching to read but little comfort to her daughter. 

I don't know why, but I suppose I associate suicide with younger generations but depression is all to common in the elderly. It's often dismissed as part of being old and the anti depressants are handed out like smarties by GPs. Behind the tablets though the real people. Real people who are not coping with the loss of independence. Not coping with the loss of life long soul mates and not coping with having to impose on their children's lives. As she said, her enthusiasm had gone, and if you take that away from

any of, all that is left behind is apathy. In her mind she wasn't living the life that she had always stood for. The joy and adventure had gone. I suppose she realised that she didn't want to live her final years with apathy and sadness. It did make me think. When the time comes, do I want to go on my own terms when it's right for me. Probably. 

I have no doubt it was a decision that she agonised over for a long time. I'm sure she was well aware of the pain and hurt she'd cause her daughter but it was what she needed to do, for her. At 83, who is to argue when she says 'that's my lot'. 

"Nobody grows old merely by living a number of years. We grow old by deserting our ideals. Years may wrinkle the skin, but to give up enthusiasm wrinkles the soul" 

           - Samuel Ullman

Keeping Up Appearances

"48 year old female, (ironic) chip on her shoulder"

Q. What do cars need to run on?

A. Fuel & Water. Right?! Run out of fuel and they stop. Run out of water and they overheat and eventually stop.

Q. What do humans need to run on?

A. Fuel & Water. Right? Run out of fuel and they stop. Run out of water and they overheat and eventually stop?

Q. What do you do if the petrol light appears on your dash board?

A. Refuel right?

Q. What do you do if you're hungry?

A. Refuel right?

OK, science lesson over kids! Our petrol light was on. We didn't have enough fuel in the tank to safely do another job so were shown 'unavailable' to go an refuel. It was 5:30pm. I'd been at work since 6:30am. I had not had a break. I had not had a hot meal for almost 24 hours. The venting machine at the local hospital was out of order. Petrol stations sell sandwiches. I needed a sandwich. My headache also told me I probably needed something to drink too! As gin is frowned upon whilst on duty some Ribena would have to do! As luck would have it, in the petrol station they do a meal deal where I can get a sandwich, crisps and a drink and save 19p off the total price! Win! 

I parked up on the forecourt and stuck £101.01 in the tank. Wow, we were low! I headed into the shop, grabbed my BLT, a pack of steak McCoy's and my Ribena light (yes, I'm watching my weight and 'light' makes all the difference). I joined the queue. Eventually I got to the front and first of all paid for the fuel with my fuel card. I then started to pay for my lunch / dinner combo when I was interrupted by a woman behind me.

She was late 40s early 50s, wearing some kind of ill fitting business suit and blouse. It looked like she'd had a team of 10 people shoe horn her into it. One of her chins hung well below the neck line of the blouse and she was wearing a grotesque broach. Her hair was a big curly think, clearly dyed and badly. There was a tell tell stain across her hair line. She also looked and spoke like she was sucking a lemon.

"Ha, so this is where the tax payers money is going then?!" she said with an arrogant smirk.

"I'm paying for this myself, is that OK with you?"

"I'm not talking about WHAT you are buying, it's the fact there are people out there waiting for an ambulance and you're in here only concerned with feeding yourself."

"I beg your pardon?!" I said in utter disbelief.

"See, that's the best you can say while you think of a way to justify yourself."

"The ambulance needs petrol and we are entitled to eat you know!"

"Don't waste your breathe, I know your type, carry on, stomachs to feed."

Was this really happening?! Is this what people think?! Was getting a sandwich really that unreasonable?!

"Do you not eat whilst you're at work?"

"Of course I do, but I don't risk lives in the process, I don't know how your lot sleep at night. No wonder the NHS is in crisis. To think my tax is being wasted on you."

"I also pay tax."

"Hurry up, you're boring me now, run along with your lunch."

Discuss.......

Welcome To The Jungle

Generally, despite it being a weekend, I like working on Sunday mornings. The roads are quiet, people don't tend to be drunk and more often then not, people don't swear as much. Unfortunately, it was raining and cold! By raining, I mean absolutely pissing it down and by cold, I mean absolutely, unequivocally, smuggling peanuts weather! It was just after 6am, still pitch black outside and no where was open that sold decent coffee. My usual Sunday optimism was waining somewhat! We drove out of station into the downpour and started heading for the nearest Wild Bean Cafe. I'm assured that it's 'gourmet on the go' but it really isn't. It's tepid pond water at best, but beggars can't be choosers! In this kind of weather there is one job you don't want to get and that's.....

"RTC, car on roof, patient trapped, injuries unknown"

Uuurrrggghh! We lit the roof up and off we went. As we approached the traffic lights ahead, the fire brigade came swinging round the corner. At this time of the morning, I couldn't deal with them trying to take over so I accelerated somewhat! Luckily for us, about a mile up the road was a width restriction that they had to open a gate for. We however were able to squeeze through the normal restriction so off we went, waving at them as we did. The guys in the back laughed, the driver looked positively livid! Build a bridge.....and get over it! 

We were greeted on the road in question by the frantic wave of a man standing IN the road. He continued to wave even as we were slowing down to stop. He then came running to the door, trying to talk to me before I could get out! When I could eventually get out he was more intent on telling me it wasn't his fault than what happened! Over 30 feet from the kerb, deeply embedded in one of the biggest bramble bushes I've ever seen was a car, upside down with the wriggling arms of our patient waving around. 

We headed over to the car, our patient was alive, not complaining of any pain, but was well and truly stuck....upside down and seat belted in! By all accounts the car had rolled 2-3 times before settling in the bush! As Gun'n'Roses once said 'Welcome to the jungle, we've got fun and games'. Well quite, although it was more of a rain forest than jungle and getting her out would be no fun at all! It was a 3 seater and her door was jammed. Due to the bramble bush she was in, the passenger side wasn't accessible so the boot was the only option!

Due to the foliage and the fact the car was on its roof, the boot would only partially open, just enough for me to ungainfully squeeze in. As I did so the fire brigade came over on mass! I wriggled my way through to the front of the car! It is very disorientation, crawling on a roof with the steering wheel above you! I hit my head on the gear stick! The patient was in good spirits but now complaining of some neck pain. I got the collars passed through the broken window and muddled my way through sizing and fitting it! That WASN'T easy! I positioned myself in such a way that I could hold her head still. It involved lying on my back, legs outstretched the length of the roof and holding her head from the front! Not ideal, but as the saying goes, improvise, adapt and overcome.

Once I had her head, I could do nothing else! My crew mate and the fire brigade came up with a plan and implemented it! It involved a lot of cutting equipment, a lot of noise and the kind of lifting manoeuvre the the Health & Safety executive would break into a sweat over! It took almost an hour of the door and boot to be cut off, the back seats to be removed and enough shrubbery to be cleared to make extraction possible! An hour is a long time to sit in the same uncomfortable position with your arms outstretched!

During the hour though I got to know my patient very well! I learnt about her life, her children, her taste in music and her hobbies! She also learnt about mine! She was referring to my son by name and I hers. An audio recording of our conversation couple have been mistaken for one between friends in a pub despite there being absolutely carnage going on around us! It was one of those moments in my career I will look back on fondly, not because I saved a life or did anything particularly special, but because I had a laugh with someone who was upside down, whilst I was laying on my back, in a bramble bush, in the rain, surrounded by fireman! Wait.....am I dreaming?! 

Eventually, we were ready to more her! Somehow, 3 fireman managed to squeeze in the car with me, a spinal board was slid in, her legs were support with straps and she was slowly lowered onto her front on the board. She was then slid out the boot, then log rolled onto her back onto another spinal board that had materialised! I clambered out after her and we got her into the warm! It was only then that I was told my arms and face were bleeding! Clearly I caught then on the brambles and/or broken glass somewhere along the way! Oops! 

I met her again 4 hours later when she was being discharged! It was nice to there was no injuries and nice to say goodbye properly! It seems weird never seeing someone again that knows you so well! 

NB: Trumpton banter aside, the fire service do a bloody good job, for crap money, and were fantastic on this job. I may give the daffodils a hard time but we are all the same team and I couldn't do what they do! (hate sitting around!!) Sorry, couldn't help it!

A Mental Assumption

"28 year old female, sectioning, psych team on scene"

Sectionings are rarely as straightforward as they may initially appear. For starters, rarely are the team of people required actually there and more often than not, we are left waiting hours for people to arrive. Now factor in the fact that by its very nature, a sectioning is removing someones liberty and in this case, removing from their home address. It is of little surprise that most of these patients don't want to go to hospital, let alone go quietly. This is where the police are normally brought in. In fact, realistically, they are brought in when the word 'mental' is used in conjunction with an ambulance. but I'll get back to that. 

In a break from the norm, when we pulled up on scene to find that we were in fact last to the party. The approved mental health professional (AMHP) was there with the police and all the paperwork, signed by two doctors required to make a Section 2 legal was there, I's dotted and T's crossed. The police were there as the patient was being aggressive. The patient was suffering from severe post natal depression, and had been for a perhaps 4 or 5 months since her last baby was born. She had become more and more detached from her family, her moods were changing, she wasn't eating, washing and seemed totally unable to look after herself. When she started being incontinent and being seemingly apathetic about it her husband called in help. The GP (who didn't visit initially) arranged for her to be assessed by the AMHP who wanted her admitted to the mental health ward. The patient refused. The two GPs visited, agreed, left, and here we are.

We entered the house and were led through to the patient. She had an extremely vacant look in her eyes, her lips were pursed and she was acting in a bizarre, almost manic fashion. When she spoke she sounded drunk, but we were assured she doesn't drink. As is required, we checked her over and a few things just didn't seem right. He short term memory seemed to be poor, she was complaining of a headache and her skin was red hot to touch. She didn't have a temperature but I had that feeling that anyone who has worked on an ambulance has had. Something just isn't right. 

"I think she needs to go to A & E."

"No. She's going to the mental health unit for treatment. It's been arranged. You are here for transport." the AMHP snapped.

"And I think she would benefit from an assessment at A & E first."

"No."

Well that told me I'm only an 'ambulance driver' after all. The transport. I shared a look with the two police officers there, which as far as I was concerned gave me carte blanche to do what I wanted! Police and ambulance work together so frequently you just know that they will do anything we say and we would do anything they say. If I say A & E, they will support me! Without any fuss we got her onto the ambulance. She certainly had a decreased Glasgow Coma Score(GCS - a scale used to measure a patients levels of consciousness. A GCS 15 is normal. A GCS of 3 is completely unconscious) and after a quick examination it was clear she was dehydrated. Her blood pressure was also low. The AMHP was still outside the ambulance on the phone, still under the impression we were off to the mental health unit.

"Pass me the cannula roll will you?!" 

"Ha, he's gonna kill you!" (by cannulating and giving treatment she then HAS to go to A & E!)

"He'll need to get over it, she needs fluids and needs to be in A & E, this isn't PND, something is up."

"I agree!"

The police watched on as we cannulated and drew up fluids. 

"A & E then?! Do you want to break the news to him or shall we?!"

Because in a sick way I enjoy some confrontation I offered to break the news and unsurprisingly he was livid! He bleated on about all his wasted time and efforts at which point I interrupted him….

"Surely, what you want, like us and like the police is what is best for the patient?"

*mutter mutter, AMHP goes to his car, head shaking and tutting all the way*

By the time we left, we were that concerned by the patients rapid deterioration that we put in a blue call to the nearest hospital. On arrival I gave a handover to the doctor who promptly bleeped neuro to come and have a look. 

To cut a long story short, this was one of the rare occasions that we found out an outcome. A few days later I was told that the patient had a scan shortly after arrival and was diagnosed with an extremely rare and serious brain tumour. She was transferred to a specialist hospital and had surgery that night. The long term prognosis isn't that great. The problem was, as has happened to me before, it is so easy to get tunnel vision on a medical diagnosis that once set upon a treatment path, it is hard to stop it. In this case the fact she had just had a baby, and had had PND in the past it was assumed it was the same again. The early symptoms fitted with that diagnosis and so did the latter ones. Perhaps when the doctors visited she wasn't as bad as she was with us. Needless to say, there could have been a very different outcome.

Mental Health. Yet again it rears its ugly head again. The elephant in the room of health care and policing if you will. We all know it's there, we all know it's not dealt with properly yet everyone, until recently, has just hoped it will go away! If we bury our head in the sand, perhaps when we re-emerge and one of the other agencies will have dealt with it. Nope! It's still there. In Lord Adebowale's report, published this week, looking into the handling of mental health incidents by the Metropolitan Police, it highlighted a number of key areas for improvement. Most notably to me was the fact that far too many patients were being transported to either police stations or other places of safety without proper medical examination.

This shows why 999 services have to be careful about the risks they can be managing and think for themselves. Lord Adebowale sees a greater role for the ambulance service in responding to mental health emergencies irrespective of whether the police are in attendance. I think this should apply even if mental health services are in attendance, because I know from experience that basic physical health examinations are not as common as they should be.

Parity of esteem is mentioned in the report for physical and mental health - delivery on this is going to have to include not being too quick to assume things about patients with mental health histories to the neglect of their physical health. 

For further reading on the content in Lord Adebowale's report I recommend two posts by Mental Health Cop.  'The Adebowale Report' and 'My Reaction to Adebowale' both give a great insight into the reports contents and its impact and recommendations on police and the NHS. 

Ambulance Drivers

"Bunch of ambulance drivers, disrespected......again"

If you read my blog regularly, you will know my hatred for the term 'ambulance driver'. To me, it shows a total lack of respect for what we do and paints a picture of us as taxi drivers with a first aid kit. This is NOT what we are. Today, at the Police Federation of England and Wales' annual conference, Theresa May, whilst talking about the police's resourcing to mental health patients said:

'Police officers have many skills, but they are not in a position to be psychiatrists diagnosing and treating mental illness - nor are you meant to be social workers or ambulance drivers'.

This made my blood boil! Rather than the usual rant, laced with sarcasm, I decided to take a more pro-active approach. Here is my letter to the Right Honourable Theresa May, Member of Parliament for Maidenhead, Home Secretary and Minister for Women and Equalities.

Dear Theresa May, MP 

I am a front line Paramedic working in the UK and am writing to you in response to your comments at the Police Federation of England and Wales' annual conference. I'm confident in saying that what I'm about to say represents the feelings of my profession and the professional body that represents us.  

In your address to the conference you said: 

'Police officers have many skills, but they are not in a position to be psychiatrists diagnosing and treating mental illness - nor are you meant to be social workers or ambulance drivers.' 

Your comments are extremely dismissive of our profession and suggests we are not skilled clinicians, but just mere drivers. You wouldn't address, or refer to police officers as police car drivers, and you wouldn't refer to fireman as fire engine drivers because that is not what their professions are. Similarly, you didn't happen by the position you find yourself in. No doubt you got there through years of education, campaigning and hard work. You are given a title and are addressed as such by the public and your peers. We expect the same courtesy.

Since 2005, qualified paramedics have had to complete a degree course at university or study to an equivalent level within an ambulance service. There are many exams, high pressured assessments and numerous clinical hospital placements. On top of this there is a significant amount of patient contact time and many hours of studying prior to qualifying. To gain the protected title of Paramedic we then have to register with the Health & Care Professionals Council (HCPC), to whom all of our actions are scrutinised. We are held accountable for all of our actions whilst at work and when off duty.  

Not only are there paramedics on ambulances, but there are Emergency Medical Technician (EMT) and Emergency Care Assistants (ECAs) all of whom have undergone significant training. We may all drive ambulances, but we are much more than 'ambulance drivers'. Just like there are many roles within the police force, in the ambulance service we have Emergency Care Practitioners, Critical Care Paramedics, Paramedic Practitioners and Consultant Paramedics. To bunch as all under the umbrella the generic term 'driver' is extremely insulting to say the least. 

Our professional body, The College of Paramedics, has been working tirelessly to get our profession the recognition it deserves, and I feel that your flippant words undermine our credibility, not only in the media who report and quote the words you say, but to the country as whole. We have long been fighting the stigma of being labeled 'little more than professional drivers' by Kenneth Clark in 1990 and yet 23 years on, it seems the governments view of us has changed very little.  

I would appreciate it, if you would recognise that we are infact medical professionals, in the same you you would credit doctors, nurses, psychiatrists, surgeons, radiographers by their profession.  

Yours sincerely, 

Ella Shaw
(Paramedic)

Thoughts on a postcard please peeps! Am I over reacting? Do I need to just get over it? Do we deserve more respect from people like Theresa May? Will I get a decent reply? So many questions, answer what you can!

My good friend Inspector Michael Brown, author of Mental Health Cop (@MentalHealthCop) has also shared his thoughts on the same subject. Interesting to see some parity across the 999 family. Go and have a read of his 'Ambulance Drivers'.