A Heavy Heart

"31 year old male, chest pain"

I really am bored with chest pain. Historically people ignored it, and as such, people having heart attacks didn't get treatment and subsequently died. Cue the huge, expensive campaign to raise awareness about chest pain. It was hugely successfully and cardiac care in this country is now one of the best in the world. However, the increased awareness about chest pain has inevitably led to chest pain being overused as a symptom. It seems that any pain, anywhere on the torso and for any length of time must be a heart attack, and as such, the amount of people who claim to have just pain when calling an ambulance is huge! Some use it to get a quick ambulance because they know we will come immediately. Some, just can't cope with any pain, anywhere and assume they are dying. 

I would say that as high as 9 out of 10 chest pains that we go to are not genuine chest pains, which is quite remarkable. We go to them every single shift in some form or another, and very rarely is it a heart attack. As a rule of thumb, I find that chest pain in the under 40's is not genuine chest pain. More often than not it is a panic attack, chest pain caused by prolonged coughing, a stitch or any other common day illness which most normal people treat at home. However, 999 seems to be the first port of call! Obviously, there are exceptions to the rule and we wouldn't want to put people off calling if they are having a heart attack, however, what I can assure you of, is sharp chest pain that is only there each time you cough, is not a heart attack.

It was middle of the day and my shift was ticking away nicely when I got sent a job. I shook my head about a 31 year old calling with chest pain and headed off. There is nothing that can be done about filtering these calls. It is very black and white. 'Do you have chest pain?' 'Yes'. They get an ambulance. Find a solution which removes risk and you'd save all ambulance services millions of pounds!

Waiting at the door with almost a proud grin was the patient. I grabbed my bags, trying my best to avoid eye contact for as long as possible, as I'd seen his beckoning eyebrows dancing round all over the shop! Keep them still man! I eventually got to the door and headed in.

"Right sir, what's the problem today?"

"I have pain in my heart."

"Point with one finger where the pain is"

*points to right side of chest*

"Your heart isn't there."

"You sure?"

"Pretty sure."

"Oh, how odd, is that my stomach then?"

*facepalm*

Welcome to my world! Needless to say, he was left at home with advice and 2 Paracetomol! Another life saved!

Utter MADness!

Well, about a month ago a asked you all to nominate me for the MAD Blog Awards 2014! I was a finalist last year which was humbling to say the least, but this year things haven't run as smoothly! For various reasons I haven't been able to blog with the regularity I was last year, so when nominations opened I was asked out of hope more than anything! Since I posted my plea to the masses I didn't think about it again until the finalists were revealed!

In a severe case of Deja Vu, in a carbon copy of last year, I was working a late shift when I got a text message from @BigFashionista saying 'You're a finalist!'. I couldn't believe it! It really was shock! I am a finalist in the Best Writer category and Blog of the Year! I'm still completely speechless about the whole thing, but very much looking forward to it! I met some amazing people last year and can't wait to see everyone again! 

Now, as much as this post is a HUGE thank you to everyone that nominated me, it is also a war cry of sorts! Now I am a finalist I need your votes! I'm up against some seriously stiff competition so PLEASE PLEASE PLEASE take 30 seconds out of your day to vote for me!

Voting can be done on the MAD Blog Awards 2014 website! Select 'Trying My Patients' from the Best Writer category and that's it! 

Thank you all again for your continued support! It really is appreciated! 

Ella x

VOTE NOW!

A Spot Of Bother

It was a rather quiet morning on the car! I'd taken the temporary lull in jobs as an opportunity for coffee with a fellow FRU! It's nice when you get some company on the car as it can me quite a lonely place at time. It's been described as prolonged periods of boredom, occasionally interrupted by moments of sheer terror. I think that is pretty accurate! 

"New Road @ Station Road"

Not two sips into my coffee, a job! A road name @ another road name, usually means an RTC. It could be someone just outside by more often than not it's an RTC. I had no other details yet so just started heading in the right direction. One of the problem with the FRU is when you're driving on blue lights it is very difficult to see any updates that appear on the screen. A buzzer goes of and the message appears in red when the call taker gets more information. The next update was the determinant, which is the main problem, i.e.; Breathing problems, Chest pain, Stroke, RTC etc.

"New Road @ Station Road, Stabbing / Shooting"

Really?! On a tuesday-bloody-morning! Come on! I upped my pace slightly, because despite my shock and horror at a stabbing or a shooting so early in the day, I bloody love stabbing and shootings! I'm not weird, most of us love a juicy trauma really! I started making mental plans of what I might see, what I might need etc. 

"New Road @ Station Road, 17 year old male, impaled on metal fence, report on arrival"

IMPALED?! How did he manage to get impaled?! What is he impaled on?! What is he impaled through?! No time to come up with a plan though, I was arriving on scene!

There was a small crowd beneath the patient, supporting him up in the air. All the heads turned to face me as I got out of the car. That look of expectation mixed with panic on all of their faces! 

*cue emergency face*

They were looking at me as the 'specialist in impaled human removal'. Sadly for them I was far from it! I'd never done an impaling so I was about as experienced as all of them! The patient was panicking atop of his spiked metal fence and to be fair, I would be to! The spikes were about 8-10 inches long and by the look of things he was impaled on two of them, through his inner-thigh. It was hard to tell because he was 8ft in the air! 

His panicking was getting worse. I wanted him to stay still, and wanted everyone to continue helping to support his weight. It really was a logistical nightmare! I radioed into control and requested Fire, Police and HEMS. Fire to chop the fence and bring some ladders, Police to block the road, and HEMS to.....well, just do what HEMS do best! Unfortunately, hearing me ask for the entire world and his wife, the patient panicked further and despite my shouting at him not to, in one big burst of energy he lifted / prized his body off the spikes and fell into our waiting arms.

"Red base, patient is no longer impaled, cancel fire, update HEMS, patient has an arterial bleed from his femoral artery."

There was blood everywhere. The good samaritans moved back, some freaking out at the blood, others just starring. I put all of my weight onto his groin where there blood was coming from. It took an incredible amount of pressure to stem the bleeding. The problem was I now had no hands! I barked order at people to get me things from my car, to press the talk button on my radio so I could get an ETA for my ambulance and to use my scissors to cut up his trouser legs. It was organised chaos! 

Within a couple of minutes the ambulance was with me which was a huge relief. I was getting cramps through my arms, they were literally shaking with the amount of pressure being used. A pressure dressing was prepared, as was an extensive wound dressing. In a fluid movement I swapped places with one of the crew and we got the dressing in place. The patient was white as ghost and sweating profusely. He was in hyopvolemic shock and needed surgery very quickly. 

I set about getting lines in his arms. Luckily for me and the patient he was athletic and had HUGE veins which just popped up nicely for me. As I was setting up the fluids the helicopter appeared above us. What a relief! The bed appeared next to use so whilst waiting for the HEMS team to be driven to us by the police (*cough* not just crime fighters!), we got him loaded onto the bed. Based on where they landed we would have to drive him to the chopper and we didn't want to waste any time. His blood pressure was in his boots, his pulse was racing and he was becoming increasingly groggy. To help stem the bleeding we gave him some Tranexamic Acid which aids clotting. 

With HEMS with us they took over. They started giving him units of blood as we all started loading him onto the ambulance. I felt quite satisfied that that was all they could really do. We'd managed to do everything else before they arrived and that is always a good feeling! Within a minute or so we were next to the chopper and transferring him. Having to keep huge amounts of pressure over his femoral artery made moving him slightly awkward but he was quickly on board and taking off. 

His friend had stayed with him until take off and was awfully worried. 

"How did he get impaled in the first place?!" I asked him.

"He dropped a £10 and it blew under the fence, he tried to run up and volt over, but it went wrong he got stuck on a spike."

"All that for £10?! Couldn't he have just gone through the gate down there?!"

"Oh year, didn't see that."

I had to laugh! Even his friend begun to smile, despite being covered in blood. I was covered to! I looked like Carrie! It was a sight to behold! My arms were literally red! It was time for a shower, uniform change, a re-stock, a fair bit of paperwork and my cold coffee! Just another tuesday!

Obesity, Lies, Burgers & Fries

"30 year old male, vomiting, abdo pain, NHS111"

Another shift, another young person referred by NHS111 and my guess, was another young person who has said the right words to ensure NHS111 send an ambulance. I'm convinced it's a generation thing! In general, you have less ambulances for the 45-65 than for the 25-45. Equally, that 25-45 group, generally have less wrong with them and 99% of the time would have been perfectly able to make their own way to hospital without the need for an ambulance. It also seems a generation that is a lot less equipped with dealing with illness and injury. The elderly don't call ambulances even when they are dying because they don't want to waste our time, whereas the younger ones call us if they cough once, sneeze once, have a headache for 5 minutes, vomit once, or have the shits! It's a generation of pathetic whiners who need to get a grip! AND STOP LYING! They ALL bloody lie! Today, was a case in point.....

30 year old males vomiting are not about to die. OK, one, once, probably vomited and then died but as a rule of thumb, they don't die. His partner was waiting at the door for us in her onsie. Some people don't lend themselves to onsies and this was a prime example but I wisely didn't comment. Or point and laugh. We were led upstairs to our waiting patient. 

We were greeted with a sorry, pained expression of pure suffering and angst. Unfortunately, the 1 hour history of vomiting did not warrant the sympathy he was after. I kept my questions and responses to his whimpering at a professional level without indulging in his drama. It really does infuriate me when people won't talk, use their words and attempt full sentences because they feel unwell! They are grown ups, but it is like trying to communicate with a 3 year old who is mid-tantrum!

The patient was a big guy, a very big guy, 25 stone plus. The irony of really fat people only being able to fit into sports wear was not lost me but he had no pride in anything about him. The flat was a tip, I could smell fried food, there were pizza boxes everywhere and a half drunk 2 litre bottle of coke next to him. Clearly, his extensive medical history had had no effect in kick starting a lifestyle change! I could have guessed he had diabetes, high blood pressure and high cholesterol before he offered up the information, I was hardly bold over with shock! 

My questions regarding his symptoms continued and led to food that could have caused this non-life threatening episode of vomiting. 

"What did you have for lunch today?"

"Just a salad."

Yes, I'm judgemental and when I fatter than I am, I started by eating more salads, but I have met a lot of patients and I can spot the ones trying to lose weight and the ones pretending to be trying. This guy was the latter. The who's who of takeaway boxes and fizzy drinks around the place told me everything I needed to know.

"Just a salad?"

"Yeah, well some crisps and that too."

"And that???"

"You know, yogurt, chocolate and stuff."

Before I could ask about the "and stuff" his girlfriend butted in!

"You bloody liar! What else did you have for lunch?"

"Nothing!" he exclaimed.

"OK, what did you have just before lunch?"

"What do you mean?"

"What do I mean? I mean what about those burgers and chips you were shovelling into your face sat in you car round the corner! I bloody saw you! And I bet there were apple pies too, I know you, don't forget that."

"Oh yeah, sorry."

I stepped in before it turned into a slanging match, or before he died of embarrassment! 

"So, lunch was a few burgers and chips, some apple pies, some crisps, chocolate, yogurt, and a salad?"

"Yeah, I suppose."

Some people are so unlucky to get diabetes! I could have had a health promotion field day with this guy but it was pointless. In 5-10 years he will be having limb amputations, be going blind, having heart attacks and strokes. Maybe then he will buck his ideas up. The one thing I advised him today, was not to lie! There is no need for it. We always know when someone is lying, save yourself the time and embarrassment by just answering all our questions truthfully! And eat less, a lot less! Oh, and don't call an ambulance because you're vomiting. And tidy your flat. And have a shave and a wash! Gahhh, I just wanted to kick him up the backside! 

It's so frustrating to watch someone so young just self destruct! I just don't know how these people can get help or even begin to help themselves. It's a sorry state of affairs when dietary advise is harder to come by than junk food! What has to happen for them to realise that this lifestyle is slowly killing them?! I would suggest it's too late for this generation. On the whole it is too fat, too lazy, expects everything for nothing and has a poor work ethic. The money is better invested in the next lot to come through, hopefully then, we will see the benefits in 20 years or so. Until then, I'll just grumble away!

Fake Smiles

"3 year old female, fallen of swing, cut to head"

We all have things that get under our skin! Chalk on a blackboard & chewing foil etc etc! Everyone has something they hate. Personally, I hate wooden ice cream sticks! Can't touch them! They send shivers down my spine! At work however, as I have discussed many times before, the term 'Ambulance Drivers' really gets my back up, most notably in my post Ambulance Drivers from last year. Police Officers are called Police Officers, not Police Car Drivers, Fireman are called Fireman, not Fire Engine Drivers so we should be no different. It just winds me up! Anyway......

The first sunshine of the year was out, the temperature raised above 12 degrees so understandably, the entire country put on their shorts and rushed to the park. Apparently, our patient had fallen off the swing and cut her head. Because she wasn't 'fully alert' she needed an FRU and an Ambulance. The FRU was already there when we arrived. He headed in past the plethora of cars on the drive way and then followed the sounds of the crying and the panicking. By the way, it wasn't the crying of a child, it was the mother. Combine that, with the father panicking and flapping around and you are left with a very scared child!

"Oh look, more Ambulance Drivers."

*fake smile*

"Hello there."

"Say hello to the nice Ambulance Drivers." he said to his daughter.

*fake smile*

She glared up at us and pouted. She had the smallest of cuts on her forehead, it barely needed a plaster. However, plasters fix a multitude of problems in children, most notably, making the kids feel better!

"Be a good girl and let the nice Ambulance Driver put a plaster on your head."

*fake smile*

She sobbed a little as I put in on the small cut and stopped as I moved my hands away again. 

"There you go, all done!"

"Say thank you to the nice Ambulance Driver."

*fake smile*

"Thank you Ambulance Driver!"

*fake smile*

"You're welcome!"

I gave her a sticker for being so brave. Her face lit up with a smile! We did our paperwork, and as the family didn't want to go to a busy hospital, we left them at home with advice and a GP referral. 

"Say goodbye to the nice Ambulance Drivers!"

*fake smile*

"Bye bye Ambulance Drivers!"

*fake smile*

"Bye bye!"

As we walked down the garden path, my crew mate turned to me and said 'count to 10!'. I got in the truck and exploded in ranting tirade about the phrase Ambulance Drivers! I'll leave what was said to your imagination!