The Students Guide To Blogging

This post is the result of various requests and emails I have had over the last few months, mainly from student paramedics. Being 2014 and very much an online world, prospective students and current students, and indeed anyone else, turns to the Internet to find out what the job is like from the people doing the jobs. Many, it appears have stumbled across my blog as a point of reference! In a number of cases, it has led them to want to start their own blog of their experiences from training, all the way through to qualifying! I've been asked the same questions on a number of occasions so thought I'd stick my answers into a post for them, and anyone else, whatever level, who was considering starting an ambulance blog or similar. These are my views from my experiences and by no means are a strict set of rules! However, they have kept me out of trouble and generally well received! 

For The Love Of God, Why?!

Why are you blogging? Seems a stupid question to ask, but the answer will impact on how successful you are and how much you enjoy writing it. My only advise on this matter, is to write it for you and you alone. If you start writing what you think other people want you to write or hear, invariably it won't work. Don't try and be something you're not and don't lie. By lying, I mean to embellish to point it's unbelievable. Don't pretend you are doing things way outside you clinical scope of practise. By all means you can and should use poetic license but do so for the right reasons. Also, don't write wanted fame, fortune, awards and a book deal! If you deserve any of the above, it will come to you because of your writing, not because you want it to happen! Trust me, I'm still waiting patiently for all of the above! ;)

To Be (Anonymous) or Not To Be?

This is one of the biggest decisions when you start out. Do you write anonymously, or as yourself. There are advantages to both and don't rush the decision. Personally, I decided to write under a pseudonym. I felt I had more freedom of expression anonymously and I wouldn't get personally judged face to face. That said, being anonymous also has it's drawbacks and frustrations. Do whatever is right for you. What I would say, is try to avoid being anonymous because you think you can get away with saying what you want. You really can't and if you overstep the line, you'll quickly find your anonymity isn't as sacred as you may like.

Do You Want The Sack?

Will you get in trouble? You might. Firstly it depends on your employer and their social media policy and secondly, it depends what you write! Although I write anonymously, I have been made aware that my employer is aware of who I am! Why am I still writing? Because I haven't crossed a line. At no point in any of my posts have I ever mentioned the name of who employs me, nor have I ever criticised them. Sure, like all organisations, the one I work for has its faults, but by openly criticising them I'm simply putting a target on me! It is also not why I started a blog. I started to share my experiences, good and bad, in my life as a paramedic. I didn't do it to moan about policy and procedure and personally, I don't think that content has any place in a blog of this kind. Be all means ignore me, but I know of plenty who have fallen foul of this and paid the price. Be wise!

Confidentiality 101

As a healthcare professional you have a duty to protect the anonymity and confidentiality of your patients. As a paramedic, you not only have to respect this on behalf of your employer, but also the HCPC. Follow the codes of conduct and don't write anything that could be linked back to a specific patient. No names, no addresses, no nothing that could lead anyone back to them! And no bloody photos! How you do this is down to you, but there are plenty of jobs I would love to write about, but they are just too high profile. I change the ages, the sexes, the circumstances and everything else I can to protect the identity of my patients. Sure, what is left is as much a work of fiction as it is reality, but I get my point across. I also don't publish posts immediately after the event. Always leave it as long as you can. If you think 'I might get in trouble for this post' then you probably will!

Don't Be An Idiot!

It goes without saying, that if you are writing about your treatment of a patient, don't write things which are clinically wrong or incompetent. Don't write about giving Diazepam to someone with back pain, when you know it isn't indicated! At work, you always act within your guidelines and scope of practise, don't change that when you write! You need to think about each post and stand by it. If you can justify everything you did and everything you have written then the chances are it's fine. If you have doubts about part of it, get rid of them!

Haters gonna Hate!

If you are publishing a blog it is in the public domain. If you allow comments, anyone can comment. Remember that. Also remember that no matter how hard you try and no matter how well you think you did something, there will always be someone who thinks different, and they will tell you. There will be people who hate you! I used to let it bother me but try not to let it! You'll find some bloggers will be supportive of you, some will be negative. Some think they are wildly superior and will get their cronies to say the same as them. Ignore it all! Two years ago I was told I was unprofessional and no place in the blogging community. Well, jump forward two year, 1,000,000 blog hits later and finalist in various blog competitions, those words and threats mean nothing. Remember, write for you and only you! Also, you write about a controversial subject you are guaranteeing negativity. Personally, I enjoy being the fox in the hen house. I'm an opinionated know it all and will say what I think! That may not be your style, but if it is, expect the agro that can and will follow!

Share Share Share

USE SOCIAL MEDIA! People won't happen across your blog and become an avid reader. You need to put it out there. Get on Twitter, Facebook, Bloglovin etc and talk to people! Invite bloggers to guest blog on your page to get people reading! When you start out you want to post regularly so people have stuff to read! However, if you have nothing to write about, don't force the issue! Talk to people, start conversations, engage in conversations. Just get out there! Have your own opinions and share them! No one wants to read about someone sitting on the fence! If you don't want it 'out there' then write each post in a book instead and start it off with 'Dear Diary'. 

Jerry's Final Thought

Finally, enjoy it! I write because I enjoy writing! Plain and simple. I stop blogging from time to time and take a long break, mainly because I lose enjoyment. When you aren't enjoying writing, it shows. The social media and blogging community can be such a welcoming place. There are great people out there, some of who are now my closest friends. Just because yours is an ambulance blog, that doesn't mean you can only interact with similar! I hardly talk to any ambulance bloggers (Apart from Binder, his antics amuse me). There are police bloggers (MentalHealthCop), family bloggers (MamaOwl), parenting bloggers (MyTwoMums), fashion bloggers (BigFashionista - bitchy opinions for free) and many many more to enjoy! So go and enjoy them! You'll get much more out of blogging if you don't seclude yourself to one small group of people!

Get involved and don't be an idiot! 

PS: You know what I said about haters? If I see any of you hating on me, I'm gonna hunt you down!

The X Factor

“45 year old male, bleeding penis”

Yes, I’m a 6 year old. When the word ‘penis’ appears on the screen in front of me I laugh, every time! Actually it’s more of a snigger, but still, I’ll admit I’m a child! Unsurprisingly, neither my crew mate or myself wanted to have to examine a bleeding penis. We don’t even need to see it. There is nothing we are likely to do other than get the patient to apply pressure themselves. I certainly won’t be applying any direct or indirect pressure to a strangers penis (unless utterly necessary) ! The amazing thing about a bleeding penis, or any penis injury for that matter is the fact that the patients are always desperate to show us! FYI, unless it’s been cut off, or severed, we don’t want to see it! We have absolutely no training on penis injuries and therefor all we would be doing is looking and agreeing with you that it is indeed bleeding / weeping / swollen or erect, none of which I want to see! 

Anyway, what made this particular bleeding penis all the more ridiculous was the other information we got on route.

UPDATE: “45 year old male, bleeding penis, had circumcision today, now swollen and bleeding”

You don’t say! Surely, if you’ve had part of your old fella' chopped off, it would a) have a wound which may bleed and b) swell up! Unfortunately for me, I was on the board and my crew mate made it perfectly clear that if said penis made an appearance, I would have to look at it! Dammit! 

We pulled up to the house and were met at the door by the patient's girlfriend. She led us into the lounge where our patient was sat on a chair, holding a tea towel down his pants. I introduced myself and started my questions about what happened, why he was concerned and how much it was bleeding. Without warning he was suddenly standing up, trousers round his ankles and his swollen, bleeding penis was presented to me like an Amuse Bouche. I gave it cursory glance and suggested he could re-dress himself! I also agreed with him that it appeared to be bleeding slightly. I told him that as I wasn’t familiar with his penis I couldn’t comment on the swelling situation! 

As the surgery was today, we decided to pop him back up to the hospital as it would be seen as a failed discharge, and hopefully he could get his little major looked at by a penis specialist! We got him and his girlfriend onto the ambulance and headed off.

It was at this point, that what was already a rather awkward situation became a lot worse! His girlfriend was very chatty and talked constantly about how talented her daughter was. I smiled and nodded and feigned interest, which backfired somewhat. Apparently she was an extremely talented singer and was going to be on the X Factor. Again, I did a good job of showing surprise and interest. This only encouraged her more and before I knew it, I was presented with a phone. A video of her daughter on YouTube began to play…..

Just so you know, I HATE the X Factor. I think it’s atrocious! I hate how talentless people have been convinced or convinced themselves that they have talent, and then they are paraded on TV like a performing chimpanzee, much to the amusement of the audience! Well, in horror, I sat through this girls video of her destroying Celine Dion's My Heart Will Go On! Without going into detail, she also didn’t have a pop-star look! It was awful! Her voice was painful to listen to, but what could I do! I smiled and had to agree that she was really good, only fuelling the false hope! I could envisage the conversation…. “Even the paramedic who came to us thought you were brilliant.” Gaaaahhh! Three minutes later, the torture ended and I passed the phone back. I hoped that starring intently at my paperwork with a furrowed brow would keep the talent sharing at bay!

I continued to ask penis related questions to the patient when suddenly the phone appeared in front me again. This time, Avril Lavigne's Skater Boy was getting massacred. I sat in stunned silence unsure of how to proceed or where to look. Do I listen and compliment, while ignoring the patient and his bleeding penis or do I concentrate on a bleeding penis and pass the phone back, possibly insulting the girlfriend? I didn’t even have the luxury of a red buzzer to end the madness! Being in my ambulance it was like the NHS version of Judges Houses! My crew mate was well aware of the torture I was enduring and found the whole thing hilarious. It was the longest journey to hospital I have experienced. It turns out this was because my crew mate took a scenic route and drove as slowly as possible. He did so under the guise of ensuring a smooth and comfortable journey to ensure excellent patient comfort was maintained. There will be revenge, that I can assure you!
continued to ask p, Avril Lavigne's

Eventually we got to hospital and I was able to escape! As I left the department I heard a nurse bringing told all about the talented family they had! I'm sure she neither wanted to hear about it, or see a swollen bleeding penis. Unfortunately for her, she was about to get an earful and eyeful both! 

The Generation Gap

"28 year old male, fall, hip injury"

One of my greatest frustrations about this job is how the elderly don't want to be a burden on us when they need us most, mirrored by young people seemingly being unable to cope without us. The sheer volume of people aged between 16 - 40 who call 999 with a worrying frequency is putting a huge strain on the NHS. People in this age group with coughs and colds, minor injuries and other such benign ailments seem intent to call us out as a first port of call. On the other side of the coin, you have an 80 year old woman who has been lying on the floor, unable to get up for two hours but didn't ask for help through fear of causing us too much work. The amount of young people who spend their days lounging on the sofa is really quite startling. People really need to get a grip! 

This job was a case in point. The location was at the gym, in the shower rooms. I refused to believe that a 28 year old could have broken his hip and if I was correct, there was absolutely no reason an ambulance was needed. We were met by staff at the door who informed me that against advice he had been helped up, got dressed and was sitting on a chair waiting for us. Really?! I was all ready for one of my 'why can't you make your own way?' lectures when a break down in communication became apparent! 

"Hello sir! Forgive me, but you are not 28 are you?!"

"I'm afraid not! I can't even remember being 28!"

"How old are you?!"

"I'm 98 but today is the first time I felt it!"

He was sat there in a wheelchair, in a suit and flat cap and didn't look a day over 70!

"Well you don't look it! What's happened today Sir?"

"Well I came for my yoga class and slipped over in the shower afterwards, now everyone is making a bloody fuss."

"Wow! Yoga at 98, that's amazing! More importantly, I was told you'd hurt your hip? Have you got pain anywhere?"

"Well my hip is a bit sore. But nothing too bad I don't think."

"OK, well I'll check you over, give you a quick MOT and see if you need anything. Sound like a plan?!"

"You just do what you've got to do duck!"

It turned out that this lovely old man comes to the gym three times a week for different classes! He does yoga, water aerobics and a seniors spin class! I did ask if he did Body Pump, but he just laughed and said that was a young'uns game!

Unfortunately, I quickly established that he had indeed broken his hip. How he had got himself up and dressed I don't know! I broke the news to him and his was viably frustrated and rather upset. Clearly a man of routine and activity, the thought and prospect of resting was not one that sat well with him. 

He declined all pain relief and was content to just sit in the chair until the ambulance arrived to take him off to hospital. What a guy! 98!!

The rest of the shift continued to pass without incident, although it also passed without any characters quit like my elderly fitness fanatic! I had time for one more job......

"23 year old male, abdo pain"

I suspected this was going to be one of those 'bite lip and count to ten' type jobs. As the CAD updated on route, the more information I got, the more frustrated I became! 'Feels nauseous, has a headache, feeling dizzy, already seen GP, now feeling worse'. Oh please! For the love of god, people need to just cope! Unless he had a ruptured appendix or a diagnosed chronic condition he was making a mountain out of a mole hill! I was desperately trying to reserve judgement until I arrived, but it's a hard thing to do!

I was met at the front door by his girlfriend who looked wholly unimpressed by the entire situation. I'm not surprised! I could see him lying on the floor in the background, writhing around and groaning. 

"What's the problem today?"

"Aaarrrgghhuuurrrghhg."

"What's the problem today?"

"Aaarrrgghhuuurrrghhg. My stomach."

"What about your stomach?"

"............................"

"What about your stomach?!" my voice now sounded more and more frustrated.

"Aaarrrgghhuuurrrghhg."

I looked at his girlfriend in frustration! 

"He's got a stomach ache and heart burn. He saw the doctor who said it was reflux and gave him these." (Omperazole, Paracetomol & Gaviscon Advance)

"Thank you, are you going to talk to me?!" I said as I took a seat.

"Aaarrrgghhuuurrrghhg. it hurts."

"Have you taken your pain killers or the Gaviscon because it doesn't look opened."

"Aaarrrgghhuuurrrghhg. Not yet. I can't just be reflux so I haven't bothered."

This was a red flag to a bull! I gave him a rare telling off and told him he needed to buck his ideas up. I assured him I wouldn't be crawling on the floor to examine him and if he wanted my help after calling 999 then he would need to get up off the floor, sit down and start answering my questions with answers, as opposed to groans. I also let him know the cost to the NHS for an FRU and an ambulance  and that so far, he was just abusive the privilege of having one.

I think he was a little stunned that he had called 999 and was getting told off, not mothered, but it had the desired effect. After a minute of over-acting in getting up he was sat upright in his chair and I gave him a full examination. His abdomen was fine, all his OBs were fine, there was no signs of an infection and the history he eventually gave, combined with the description of pain led me to agree with the GP. Reflux. 

I told him he didn't need to go to hospital but he felt he did. His reasoning behind this was that tomorrow was his first day in his new job and he wouldn't be well enough to go so therefore going to hospital would mean he could get a letter etc etc. I told him that's not how it works and that I would be cancelling the ambulance. I don't think I was his favourite person! 

To be honest though, sometimes we have to be strict! There are finite resources available and when people are using them incorrectly they need to be told! These two jobs highlighted the huge generation gap that exists in the tolerance of illness and injury. Unfortunately, the elderly will continue to see themselves as a burden and the young ones will continue to see all treatment and resources as their divine right. The knock on effect will be, in 20 years when our current elderly generation are gone, we will be left with the next generation of people who have been brought up thinking that you dial 999 when you don't feel well, not just in emergencies! I suppose the problem lies in the perception of what an emergency is. Clearly the advertising campaigns to date need some work!

Hakuna Matata

"2 year old male, vomiting"

Blue lights, fast cars, sirens, life threatening emergencies, death, destruction, trauma, helicopters, police cars, fire engines and hi-vis jackets. This is what the ambulance service is often seen to be. On rare occasions it is. The reality however, is much closer to this job! A vomiting child! 

In almost 7 years, I have never called an ambulance because my child is vomiting. In fact, I have never called an ambulance for him, despite the temperatures, tantrums, chicken pox and uncoordinated dancing. It's never crossed my mind! That said, this might be a real emergency, you never know! What I do know, is that if it this was a life threatening emergency, I would be incredibly surprised!

We arrived at the mansion in question, and carefully made our way past the 7 cars on the driveway. Yes, 7! We were greeted at the door and ushered inside where my eyes were drawn to the huge split staircase. Up we went, following the sound of the crying child! Some of the artwork en route was quite amazing! Inside the 'nursery' (bigger than my entire flat!) we were introduced to our patient who was less than impressed with his life on this particular day! Vomiting has that effect on children! Let's be honest, who likes to vomit!

The family was lovely, offering us food and coffee. I respectfully declined until I saw the cakes and quickly changed my mind, as did my student! Whilst eating and listening to the dulcet tones of the crying child, we explained that due to his age, a trip to hospital was required. It turns out that giving me cake seems to prevent my 'inappropriate use of the ambulance service' chat that I occasionally find myself giving out! In fact, with cake like that, they can call an ambulance daily if I'm going to be on the receiving end of it! 

On board the ambulance my student sat on the bed, opposite mum and baby, whilst doing his paperwork. I sat in the jump seat 'observing'. For those of you with children, you generally know when your child is about to throw up. They have a face. The 'I'm about to chunder' face if you will. When this face appears, we take evasive action wherever possible. On an ambulance your options are limited. 

Without warning, in a scene reminiscent of Rafiki holding up Simba over Pride Rock in the Lion King, the mum held up the child. He volcanic explosion erupted from him and whilst at arms length, showered my student. And I mean covered in the stuff! It was wonderful!

I for one, found the whole situation hilarious! The mother was mortified, the student was livid! It was an ambulance life 101 lesson for him. Always look at your patient! With his head buried in his paperwork he was caught off guard! The mother was deeply apologetic but I told her not to worry! 

As Timon and Pumbaa would say, 'Hakuna Matata'! 

Choices

There is a recurring conversation that I have with people when talking about my job. It normally starts with a "I couldn't do your job..." with infills of "I don't know how you do it..." and "don't you get scared..." or "how do you sleep at night?" etc etc. My stock answer is something like "Ha! It's fine, things don't really effect me..." with side notes of "I disassociate myself from the patients..." and "I get into a zone and don't really think about it..." etc etc. You see the pattern!

The fact is, most of what I say is true. At the end of most shifts I've completely forgotten about the patients at the start. If someone has a horrific injury, a do what I have to do to it, cover it and move on. If I'm faced with a combustible situation where I might be vulnerable I tend not to think about the what ifs. Instead I focus keeping everything calm. These situations are no place for fear. That said I am by no means immune to feelings of fear, dread, guilt and nausea! We all are, everyone who works for the ambulance service has those jobs which have effected them, or those situations they fear being part of. They differ from person to person and we each react differently when faced with them.

For me, I don't like to see sick, dying or dead children, and it's fair to say that that is across the board, the same for everyone. My greatest is fear in this job is watching someone die and being powerless to stop it. I know it happens but it is an isolated, helpless feeling, especially when you're on your own. Finally, a situation I would have been happy to avoid my entire career, was being the person who has to make a decision between who lives and who dies, when faced with that choice. You can imagine what kind of day I was having, when all three of my fears came to fruition in one job.

"30 year old female, in labour, contractions 1 minute apart."

Not an ideal start to the shift if I'm honest. Early jobs tend to have longer waits for ambulances due to shift change over time, and the prospect of having to deliver a baby on my own is not one I cherish If I'm honest! It is what it is though, I'd have to suck it up and see! 

I grabbed EVERYTHING I could possibly need and headed in through the open door. The patient was on all fours, mid contraction. I started with some history taking and started making a note of times. With women in labour you have to work out if it will be a home birth or hospital birth. At all costs, you want to avoid delivering on an ambulance! They are cold, impractical and dirty! It became apparent pretty quickly, that without an ambulance and the quick fire contractions, that I would be taking on the role of midwife imminently. Balls!!!

I quickly set up a baby resuscitation area just in case! It's something I was taught by a very wise paramedic a long time ago, and I have stuck with it. If things go south, I don't want to be scrambling to find kit, so everything that I would possibly be needed was laid out, opened and ready! Then there was mum! I made a snap decision to cannulate her prior to delivery. I don't know why, it's not something I normally do, but again, with no ambulance I wanted to cover all bases, just in case! 

Anyway, cannula in, everything set up, examination complete and we were ready. She started crowning about five minutes later! I just about had time to update control that birth was imminent and I would require an ambulance as quick as possible, before the head appeared. My relief at seeing the head was short lived. It quickly became apparent that something was wrong. Very bloody wrong. The cord was wrapped around the babies neck. Shivers ran down my spine and I'm sure that all the blood trained from my face. Inside I was panicking. I had never delivered a baby with a cord around it's neck and I wasn't entirely convinced I knew what to do. Well, I knew I had to get cord off the neck, but we were limited in what we were taught on our two days maternity training! She carried on pushing during contractions and after what seemed like an eternity (probably 1 minute) we made enough progress that I could loosen the cord and finish the delivery. 

With baby out and mum overjoyed I started drying and rubbing the little boy. I just wanted him to make that first cry. The first 10 seconds or so are pretty relaxed, the next 10 are a little anxious and by 30 seconds I'm starting to get a little desperate.

"Why isn't he crying, is something wrong?"

Her joy quickly led to desperation. I clamped and cut the cord and moved him over to where all the equipment was waiting. I laid him down on blanket and started ventilating him. This was my worst nightmare. Or so I thought....

"Some thing's wrong, I'm bleeding." she said.

I turned my head slightly and my heart sank. She was having a huge post-partum hemorrhage. It was literally like a bucket of blood had just been poured on the floor and it just kept coming. If I didn't stop the bleeding, she would die, plain and simple. If I didn't work on the baby and get him breathing, he would die, plain and simple. How do you make the choice? It's one I had to make on my own and I could see no way out of this mess. 

I tried to advise mum of what she could do whilst I ventilated the baby. She wouldn't listen, her only concern was why her baby wasn't crying and that kind of made my decision for me. I started listening to heart sounds and when I heard them it was a huge weight off my shoulder. In my head I was screaming 'breathe' over and over again. I managed to hold down the button on my radio long enough to shout exactly what was happening. I couldn't begin to tell you what the reply was because after a slight wriggle, this tiny little boy let out the most amazing cry! 

I turned to the mum, and saw the relief of her pale face, just as she begun to lose consciousness. I wrapped the baby in a towel, left him on the blanket and started a uterine massage on mum. Again, i'd been told what to do years ago but I'd never actually done it! I was kneeling in what felt like a swimming pool of blood. I grabbed my drugs and started drawing up the Syntometrine to stop the bleeding when I heard the door go and a 'Hello?!' in the corridor.

"In here!" I shouted.

Just like London Buses, two crews arrived at once! Thank god! The face of them when they walked in was an absolute treat. Then again, I'm sure my face told a fairly good story. A crying baby on a towel next to resus equipment, an unconscious naked woman in a huge pool of blood and me on my knees amongst it all presumably looking like crap. A hive of activity ensued, fluids were drawn up, drugs given, baby cleaned, wrapped and looked after and we got mum out to the ambulance. 

There was no time to take stock of what the hell was going on. We put in our pre-alert and all headed off in convoy to the nearest maternity unit. The bleeding had stopped but she had lost A LOT of blood. In truth the second I heard the crying of the baby it didn't really get another thought from me. It's easy to compartmentalise patients into fixed and not fixed. Through jobs like this, priorities change. I couldn't stop thinking about whether the mum would ever get to hold her baby. I found myself daydreaming about the 'what ifs' that I don't normally entertain. I also, quite predictably started asking myself if I had made the correct decision. Did I ignore the bleeding too long? Did I chose right? Only time would tell. In situations like this are there ever correct decisions? 

We got to the hospital and handed over. The midwife looked me up and down. 

"Well done, now go get yourself a tea!"

I don't even really like tea, but it's the done thing when chaos ensues. I sat in the blood bath of that ambulance and just starred at the wall. I could feel my hands shaking as the adrenaline continued to rush through my body. What a start to the day! Only 10 hours to go until home time.....

"It's fine, things don't really effect me, I disassociate myself from the patients and I get into a zone and don't really think about it."

Well, we all have very effective barriers we use from time to time.

*                   *                    *

Two days later I found out that despite losing half of her blood volume, mum survived and baby was absolutely fine. And THAT is how I can do my job. There is no better feeling than finding out news like that. At least now I 'know' what to do! Ish!