You should be doing my job!!

Called to a 16yo who was short of breath and vomiting.

On arriving to find this rather healthy looking chap in bed at his parents house, with Mum fussing around him, I proceeded to ask my questions to get to the bottom of his problem.

After a few choice questions, his Mum pipes up "It's almost like he has the flu! What do you think?"

Guess what?

He has the flu! Bye!

Fatal. Car vs Shopping Trolley

Standing outside on a nice sunny day in town, there's a tap at the window.



"We have a job!" shout my crew mate through the patio window glass.



I empty the mostly full cup of tea onto the grass and head indoors to the garage to see what we have been called to.



It's a Road Traffic Collision (RTC) and the detail states that it is a fatal accident, car vs shopping trolley, Police are on scene. My crew mate and I look at each other and both the question at the same time, "how do you kill yourself colliding with a shopping trolley?"



Lights on, off we go it's only 3 miles away, the other side of town so should be quick to get to.



I am driving and we make good progress through what little traffic there is in town in the mid afternoon. As we arrive at the scene, I look through the sea of flashing blue lights from the numerous Police cars and spot the casualty lying in the street with a Policeman leaning over her, his head is rhythmically bobbing up and down, which means only one thing - active CPR!



The scene looks like typical chaos, a busy road in a residential neighbourhood, with lots of daytime onlookers, Police cars and Officers milling around. The casualty is about 80 yards away with the car between us and her. The shopping trolley in question, is actually a mobility scooter, the one's you see ridden by the elderly all the time. It has not come off well in the collision and is scattered in pieces all over the road.



My crew mate grabs the response bag and O2 from the back of the vehicle and I grab the Paramedic bag and we sprint to the scene, well I try and half run and half limbo dance under the Police scene tape which leads me to almost fall over backwards, not an auspicious start to the job.



On arrival we find a young Police Officer doing an excellent job of CPR, I ask him if he is still comfortable to continue and he says that he is, so I leave him to it as my crew mate starts ventilating the patient. There's alot of blockage to the airway, so I run back to the vehicle for the portable suction unit and start suctioning the patients airway to allow my crew mate to gain access for intubation.



Whilst he is doing this I can hear Helimed circling overhead, looking for a suitable landing site, a Police Officer comes over to enquire where the helicopter will land. "As close as possible" is my reply to which he goes a slight shade paler and I see his mind contemplating the logistics of trying to organise a landing site in the middle of the housing estate.



I don't have time to explain the procedure to him and he'll soon realise that the pilot will land the thing in an area that seems impossibly small, which he duly does.



I open the cannulation equipment bag and start to apply the tourniquet to the patients arm to enable IV access for the round of drugs we will be giving her, at this point the Flight Paramedic arrives and starts the IV access.



We apply the pads from the AED machine and start to get a basic rhythm from the patient, Pulse less Electrical Activity, keep the CPR going. I start preparing the round of cardiac arrest drugs that we will need to administer to the patient, we are creating quite a mess with all the equipment that is scattered around but that can be cleared later.



The Police Officer is now looking tired so I relieve him and start continuous CPR myself, the Flight Paramedic puts in two chest tubes to decompress any chest injury and the trauma team arrive from the hospital. I notice that as I push down on the chest, the chest tubes are slowly being pushed out of the chest wall, I have to put in a one handed compression occasionally to push them back in. Shouldn't these be taped down??

By this point, there are 5 people working on this patient and I am starting to think that we will have to think about moving her soon. One of the trauma team starts a top to toe summary of the care so far;
Intubation tube in
Ventilation's effective
Needle chest decompression in
Active CPR ongoing
Wide bore lines in each arm
Fluid bags hung up
Cardiac drugs administered in 3min intervals

then he starts to work his way down

Abdomen distended
Unknown pelvic injury
Obvious blood loss from the lower extremities
Obvious deformity from the lower extremities

He pulls up her trouser leg and the left leg is mostly amputated and just hanging on via fatty tissue, I look but am thankful to have my mind on other matters as I count the rounds of CPR we are giving.

Just as the verbal summary of care finishes, he looks at the flight doctor and asks the question!

Do we feel that we have done everything possible? Are we ready to declare?

The Doctor confirms the comments.

He looks at the flight paramedic, same question. "Yes"

As he moves around the circle of people who are all now still, each answers positively in turn, he can't be about to ask me! I'm a trainee, what do I know? Besides, by now, I am the only one doing anything as I continue to pump her chest to try and maintain some semblance of circulation................

"Are you happy we have done everything we could, is there anything else you want to do?"

I answer as everyone else has done, without thinking, I wonder what else he had expected me to say? With all these highly trained trauma personnel here, what marvel of modern medicine would he expect me to come up with that they had not thought about?

It's an odd feeling, but as I tentatively stop the CPR and sit back, I feel that, as the last one asked, I have decided we give up trying to save this woman's life, it was my choice. I know logically that this is not the case but as I sit there in the road, listening to the Doctor declare time of death, I find myself only now thinking about his question. Was there more I could have done?

My crew mate hands me a waste bag and it's time to start packing up the mountains of kit and rubbish and sorting out who's is who's. We book clear and advise control that we need to restock the vehicle and I need a cup of tea!!

I'm Back!!

Well it's been a hectic 6 months, hence no posts to the blog.

Lots happened, too much to go into at the mo.

Work has been cool and have been accepted onto the Paramedic degree programme, which involves 3yrs of study!! Oh my god, how much do I regret posting that application now!

Will keep you posted on developments on that one.

Plan to be back to normal postings about jobs from now on, so keep an eye out.

Thank you (2)

When I got up this morning, I checked the post that had arrived the day before and found a note from HQ.

Always impending sense of doom when you get written to directly by HQ at your home address.

This was the best thing to wake up to though, as it was a copy of a card sent in by a patient, thanking us for our efforts a few weeks ago.

I have attached a picture, but in case you can't read it, the text is as follows;

"Thank you does not seem anywhere near the gratitude I have for the 2 gentleman who came to me two weeks ago.

I was rushed in for emergency surgery following a ruptured ectopic pregnancy (unknown to me at the time).

Your men saved my life and as I was unaware of the danger I was in, kept me reassured and as comfortable as possible.

Please ensure you pass my thanks to the 2 Paramedics who's skill, compassion and professionalism, helped to save my life and the same time keep me calm"

My first thank you card. I was touched beyond belief and now know I have the best job in the world!

Thank you (1)

Has been a great day for thank yous today.

We took a very nice lady into hospital today who had fallen in a shopping centre and dislocated her hip.

My crew mate had been out to her before and treated her for the same problem.

We loaded her into the Ambulance and arranged for her daughter to meet us at A&E.

When we got there, we got presented with a box of chocolates from the daughter stating how grateful she was and that we were 'Heroes'

Left that job on a high!! We don't do this for thanks, as we very rarely get any, but when you do, boy is it nice!

101

Met my first patient over 100 years yesterday!!

Grand old chap who just had a touch of pneumonia.

On gaining his history we asked him what medication he was on and he produced this small packet of pills and said he has recently had to start taking these for his blood pressure!!

That was it!! Fab

He also seemed to smile at everything, despite the obvious effort he had to put into breathing, I wonder if that had something to do with his longevity?

The only disappointment was as he was quite poorly with the pneumonia, we had to rush him in to hospital quickly and I did not get chance to see his telegram from the Queen.

Blackeye! Sorry

Call was to a young diabetic patient that was non responsive.

It was 2am and the traffic was non existent so the journey time was short. I pulled up outside the block of council flats and made a mental note to ensure that I locked the Ambulance whilst we were at the address. It looked the kind of place where there would be a local market stall selling medical equipment the following day if I did not.

I didn't bother to turn the vehicle around for ease of egress as with this type of patient the treatment at home is usually exactly what the patient having a hypo needs and they often do not want to go to hospital. This would prove not to be the case! Me and my assumptions!!

On entering the flat we found a young woman on the floor surrounded by a group of her mates, all stating that she was a known diabetic and they had been trying to force feed her sugary drinks.

A quick check of the BM levels revealed that her blood sugar levels were fine, so it's not a diabetic coma. Given the state of the flat and assurances that she had only smoked a little weed! we assumed drugs and started our treatment protocol based on that.

The Paramedic I was with gained IV access for the Narcan drug to reverse any opiate effects, whilst I secured her airway. Now on checking for a response, I tried the never fails sternal rub with the full force..........nothing! She must be out or have a seriously high pain threshold.

Next thing was to ensure the airway was maintained. In comes the Nasal Airway. Now, unless you are unconscious, you don't really want to have one of these put in. They are measured against the size of your little finger. So I duly opened the airway bag and pulled out a medium and large size.

The problem seemed to stem from the fact that this girl had very chubby fingers combined with a small nose. Despite a fair bit of KY and a lot of twisting and pushing the number 7 would not go in. It did however wake her up slightly for a limited period, now starts the doubt as to her true consciousness levels. Needing the skill signed off anyway, I aired on the side of caution and went for a No6. Given the pathfinder route ploughed through her nasal cavities by me using the No7 initially, this slightly smaller one went in without fuss.

We carted her down the stairs and off to A&E where they managed to finally wake her up. Appeared she was faking it and did seem to have some serious pain threshold!!

She was also sporting a rapidly developing black eye on the same side the nasal airway was inserted, a good demonstration of the close relationship that exist between the sinuses and the eyes.

Ooops Sorry!

Here 10 mins and it feels like a lifetime!

And can you believe they have not even got around to naming me.

Damn Them!

I am suing McDonald's for future obesity and heart disease.

Have just been into the local McD's on the way to shift and ordered my meal. When I came to pay the guy undercharged me!

Being the honest sort of chap I am, I queried this only to be told that they now offer Emergency Services a huge discount!!

How am I going to kick my junk food habit with that kind of bribery? I have only so much willpower!

Seriously - Thanks Ronald x

Friday night is abuse night!

This entire shift consisted of people putting their bodies through the usual Friday night round of abuse.

The first job was a little different, he did not willing abuse his body, although it did go through a little trauma. 18 month old baby fitting. Gone from being freaked by this event to now being the voice of calm. They are very rarely still fitting when we get there and the scene resembles the usual pub on a weekend night.

A young female in hysterics and vomit everywhere!

We did the usual and calmed Mum down and assured her the little chap would be fine. Checked the baby over, who was now coming round from being post ictal, administered 100% oxygen and whisked them both off to A&E for a quick check up.

Then we got called to a pub fight, where a chap had been hit over the head with a car jack. Got there to find a young lad, pissed and a little hyper active????? took his pulse and he was tachycardic at around 135bpm and talking at 100mph!

On enquiring what he had taken, he quietly told us he had been doing a little cocaine, all this while keeping his finger over his mouth as if it were a secret! He had a nasty gash to the back of his head which needed stitches and I finally persuaded him to go to hospital to have it seen to, although his main concern was would he be let out before the pubs closed.

He got a wake up call at hospital, when he kicked off after being told he would have to wait 2hrs to be seen. The nurse proceeded to explain the effects of cocaine on the coronary arteries and the likelihood that he would be about to have a heart attack. This seemed to scare the crap out of him and kept him compliant for the ECG.

Then got called to the 'rough' end of town with the Police for a violent patient who had taken a methadone overdose, along with diazepam. Not sure why we needed the Police as with that many chemicals on board the guy was hardly rousable, yet alone a problem.

And finally the drunk and 'unconscious' 15 year old girl at a party! Do I need to add anything to that one?

Mobile healthcare

On standby in the market square, don't think my crewmate really expected the market to be on! Feel we should make use of our time and offer a discounted BUPA medical to local shoppers. Community service and fundraising, perfect!

Fixed!

Just had a text from a mate at work. M&S takeaway cappucino machine is fixed. It's been ages!

Normality has been restored to standby's in the town centre. All is well with the world!

Female fallen

We often get called to the elderly who have fallen, either getting in or out of bed. Limited mobility often results in difficulty getting back up after slipping to the floor. Most warden controlled flats, residential homes and nursing home have a no lift policy and this results in a call to the service for our assistance.

The other frequent call is to the drunk who has also fallen but their limited mobility comes from an excess of alcohol.

Tonight was my first combination job.

It came through as female fallen and the address was a block of warden controlled flats. So we expected a sweet little old lady who had slipped getting into bed, they always seem to have nylon duvet covers and nylon type nighties, not a good combination when you really want to avoid the slippiest material on earth!

On arrival, we did find a sweet old lady on the floor, but on bending down to examine her, I got this strong whiff of spirits!

When we enquired whether she had been drinking, she looked all innocent and stated she had no idea what we were talking about!

A quick look around her flat uncovered 2 bottles of brandy beside her tv chair, a brandy glass on the coffee table and an empty hip flask at her bedside!

Brilliant, 96 years old and drunk as a skunk!

We advised a glass for medicinal purposes was fine but could she try and keep it to one glass a night! Not sure she cared.

A good start to the day

You know when you have had a good job to start the day, by the mess left in the ambulance after dropping the patient off at hospital. This little disaster was created by treating a woman with chronic abdo pain, which turned out to be a ruptured ectopic pregnancy. We cannulated her, have met for nausea, morphine for pain, fluids for her low BP and several flushes. She went to theatres later that day.

Teenagers!

I have now reached that point in life when all the Police Officers look far too young, not only do I not know the lyrics to the songs being played on radio 1 but now have not heard of any of the artists.

It was bound to happen eventually and I accept it in good grace. Despite the signs of advancing years, I still do consider myself hip and trendy, able to relate and communicate with the modern youth. Had that one shattered last night.

Called to a 16 year old who had slit her writsts. Now I do actually have a vague idea about what is going through the mind of teenagers, I was one once. Do appreciate the whole, the world hates me thing and life is too much to cope with thoughts that rattle around your head at that age.

This call was beyond my undertanding though. On arrival at the address we were met by a young girl who was the patients friend. She informed us that her mate was getting ready upstairs and would be down shortly. We were not allowed in as her parents were asleep and they would go mad if we woke them up.

I pointed out that as she had seen fit to call an emergency vehicle at 3am, they would understand, also I had no intention of examining her mate in the front garden! This prompted the usual teenage response 'Fine then, you don't care that I am going to get into trouble, I hate you!'
When her friend finally came downstairs, I found her to have hesitation cuts to both wrists and the right one was still bleeding slightly. I patched this up and then told her she needed to go to hospital, more to understand why she did this in the first place. I then got the whole story, I won't bore you with the details but it seemed to boil down to the fact that her neighbour had accused her of having a party whilst her parents where away and it's so unfair!

As we were leaving, she asked her friend to come with her, at this her mate launched into this stream of abuse about how as she is into self harm and this suicide attempt is only a way of pinching her thing! 'you only did this because I do it and you want to copy me, it's my thing to cut myself and you are just a copycat!'

They then proceeded to have this huge row about it. Aaaargh! Teenagers!

Welfare Check

Continuation from previous post.

As I walk into station, exhausted and looking forward to a cuppa, the phone rings in the office.

It's my first welfare check.

Control want to know, given the last job, am I OK?

I am reassured that with only 15mins left of our shift, we will not be sent out again and can grab a cup of tea without being interrupted.

How very kind of them!

As the kettle goes on the crew taking over from us arrive and that's when we have chance to deal with the feelings from the RTA in the usual Ambulance way. We tell them all that has happened and start complaining about everyone else who was at the scene, taking the piss out of anyone who remotely deserved it.

The saddest story so far

John and Rita have been to Las Vagas to celebrate John's 70th birthday.


They have always wanted to travel abroad and never ventured further than the occasional trip to France on the ferry. John is particularly excited to go as he always wanted to try the slots in the famous casinos.


Their children are now grown and left home and they finally have the funds and more importantly, the excuse to go on the trip of a lifetime.


On their return journey the long flight is uneventful, Rita and John even manage to grab a few hours sleep, even with the cramped seats on modern aircraft.


At the airport, the usual hanging around takes it's course, as they wait for the baggage to be unloaded and then the somber walk back to the car and reality. It has been a long journey and they are both looking forward to getting home to tell friends and family about the trip and share the photo's.


Rita gets behind the wheel to drive the 2 hr journey home, she is tired after their long flight but they will be home soon, with suitcases of washing and fond memories to look back on. John puts the radio on to catch up on what has been happening while they have been away. As they pull out of the terminal car park into the traffic flow, the end of their holiday is now a reality.

The journey down the motorway is typically monotonous, the dual carriageway they turn onto does not offer any additional stimulation, John is dozing in the passenger seat as the countryside passes by at a steady 70mph.

The road is straight and the traffic is light, the radio continues to repeat the same headlines every half an hour, it has not taken long for Rita to be up to date with going's on at home and she is no longer really listening to the commentary from the presenter, the songs are becoming more like background music she is vaguely aware of. She is feeling tired now but not long to go and they will be home with a nice cup of tea. Rita is not aware how her concentration levels are falling, how her eyelids are becoming more heavy and how more frequently she is yawning. With each yawn she closes her eyes briefly, it's a nice feeling, The day is sunny and the car interior is nice and warm, it's a familiar environment as the car speeds down the dual carriageway without effort, it does not take long for sleep to catch up with Rita.

It takes some time for their car to come to a stop after leaving the dual carriageway at 70mph and hitting the bridge support head on. The impact sends the car into a violent spin which causes the drivers front wheel and suspension to collapse, it has not been designed to take this lateral force. With all the rain we have had the ground has become softened and as the wheel collapses the front of the car digs into the ground causing it to flip end over end, finally coming to rest on it's roof.

We have been on scene for 50 mins now and I am aware of the 'Golden Hour' which is critical for trauma victims to stand the best chance of survival. I need to get her to hospital. Rita is shocked and does not seem to know what has happened, I keep busy reassuring her and attending to her injuries all the while silently praying she does not come to enough to ask about her husband's condition.

John is still in his seat, hanging from his seat belt. We have already declared him life extinct as soon as we arrived on scene. Other emergency services will deal with his body.

I block from my mind the horror of what she surely must feel when she is finally told of her husband's condition. Traffic is getting heavy as we approach rush hour and I need to concentrate on getting this patient to hospital as quick as possible. Feelings are to be put into the box and filed, I have a job to do.

I want to be a paramedic

Had a couple of shifts now with a para and we have some really interesting medical jobs to contend with.

This has meant we have been able to treat the patients with the right drugs before we have taken them to hospital.

It is the first time i have really seen the scope of the skills a Paramedic has to use and how much more they can do for the patient than the EMTs.

Ambulance crew found dead in vehicle of over eating

The state of our cab after trip to shops and kebab van! Very professional. Good job we have a door between it and the patient.

Lucky, lucky, lucky

• Head on collision with another car.
• Closing speed of 90mph
• Front wheel and suspension sheared off and 200yrds up the road
• Other car 300yrds away in the ditch
• Engine taken off it's mountings and entered the cabin, trapping the Husband by the legs
• Wife in the passenger seat, no air bags on this age of car
• 3 kids in the back seat.
• Helicopter scrambled to scene.
• 2 Ambulances on scene
• 4 Police cars in attendance.
• Injuries: 1 x Broken wrist, 1 x Bruised knee - all for the driver.
• Everyone else walked away!

Combative

Called to 80yr old lady who was fitting.

On arrival at the scene we found the patient on the floor, blood smeared across the kitchen floor from a small head wound sustained from the fall.

She was fitting and this was common with this patient, due to her current medication, explained her husband.

We got her into the back of the Ambulance as quick as possible and the Paramedic put a cannula in her hand, no mean feat as she was very combative and post ictal. She then promptly pulled this out before we could secure it in place. Time to try and stop huge haemotoma developing on the back of her hand then.

Cannulation attempt number 2.

Hand is now useless as a potential site, so the Paramedic tries for the arm but she will not hold still. In steps the local naive Technician and I clamp her hand between my legs, support her elbow with one hand to enable the Para to put the needle in and hold her down with my other hand.

That was, in hindsight a mistake.

I have her wrist clamped between my legs and when the needle is inserted, she grapples with her hand for anything she can grab hold of.

This leads to a few sharp intakes of breath and a huge effort to keep the tears at bay!

Thank Christ for the boxers I have on today, which keep everything mostly out of the way!!

No surfing with the horses

After trudging across a boggy field I spy what must be our patient standing with a small group of people, I can tell it's our patient as this gent in his later years has a mass of white hair, all apart from the rather large red patch occupying the back of his head. Ouch!

If he's up and about, he can't be that bad, can he?

On reaching the patient, we find one very jolly Irishman who can only be politely described as 'In Drink' more precisely, s**t faced on 8 pints of Guinness. He is also sporting a rather gooey mess to the back of his head, where he lost the fight with gravity and the pavement.

He is insistent that he is fine and wants to go home for his dinner. This is really not an option, as he is covered in blood over his head, face, chest and back and the wound to the back of his head is still bleeding.

We have a sensible chat with him about the fact that he needs to go into hospital to be checked over. This rapidly deteriorates into a stern telling that he needs to go to hospital, combined with a half walking, half dragging tactic, towards the Ambulance.

Half way there, he collapses to the floor, sobbing that the IRA had killed both his parents during the troubles, this then manifests itself into leaping up, banging his head on the nearby wall in the process, shouting and being quite aggressive about how the terrorists were then dealt with, or not, which appeared to be his point. Don't have an issue with this as long as he does not go down the path of 'transfer of aggression' and we become the focus for his anger.

We finally get him into the Ambulance and secured on the stretcher, when he turns into hug mode, now would not normally mind this but he is covered in blood and now so am I. Gloves only cover so much of you.

Spend the trip into hospital trying to bandage his head, all the while trying to avoid him putting both his bloody hands on my face.

When we unload at A&E he then decides that he is fine and wants to go home, trying to climb off the stretcher. This takes 10min more persuasion to keep him from falling off and banging his head again.

We go through to Minor's and attempt to get him into a chair in the cubicle, this takes another 10mins of shouting and 'gentle' prompting from us.

The nurse examines his head and cannot see anything due to the amount of blood and matted hair, so a trip to the nearby sink to wash him is planned. You can guess this took a good 20mins.

He insists on walking back to the cubicle, shrugging us off on the way and promptly misses the chair and lands on the floor...................banging his head! The staff decide he should stay there as less likely to anymore damage if he is already down on the floor, so a mattress is brought in for him to lie on. This he takes offense to and leaps up shouting and swearing, where he then lands a punch on my crew mates chin, who promptly grabs him and secures his arms. I get spat on and told in no uncertain terms what he will do to us once he gets free.

We hatch a plan. Let's just take him down face first onto the floor and hold his head while 1 porter and 2 Ambulance crew sit on him and the nurse can staple his head closed. Despite the small bang to the front of his head he received on reaching the floor (Ooops - he did miss the mattress on the way down due to his struggles) this plan worked like a dream. 2 quick staples later and he had been treated. We left him in the company of several less than amused Police Officers.

I pondered after that unlike the advert, serious quantities of Guinness do not make you think you can surf the big waves with the white horses, it just makes you a complete and utter, obnoxious twat!

Update: Hanging

Arrived on scene 22mins later to find a paramedic from the RRV already there. He had secured a nasal airway to improve her perfusion as, although she was breathing on her own, the snoring meant that her airway was compromised.

She was GCS3 which is as unconscious as it gets and posturing, which is holding your clench fists to your chest, indicating a spinal or brain trauma. We needed to get her down the stairs and into the truck to start the journey in. This was going to be a little tricky as the top of the stairs was occupied by a large fake marble mermaid outside the bathroom door, very random!

Also the Police had parked two cars outside the house, plus the two cars the residents had plus the RRV plus our truck. We were almost parked in another postcode!

Stretcher into the neighbours drive and then use the large sling for rescuing trapped dock workers for the trip down the stairs seemed to be the best plan of action.

After securely strapping the patient into our contraption, we man handled her down the stairs and into the Ambulance, where we could monitor her a little more closely.

The run into hospital took another 20 mins and we 'unpacked' her in resus for the team to start work on her. I have to say the marvels of Oxygen never cease to amaze me.

On arrival at hospital, she would open her eyes in response to her name, which was a marked improvement. Not sure what the overall prognosis would be for her as she had sustained some neck damage from the hanging, severity of this is unknown.

I will try and get an update on this one for you.

Fashionable

Someone told me the other day that hanging is on the increase as a suicide method. Apparently it is quite fashionable!

How do you find this out when contemplating killing yourself?

Currently on my way to a female who has hanged herself and her husband has cut her down and is doing CPR.

I can only say, I hope he is really good at it as we are 25 miles away! There are no crews nearer.

I struggle to understand that must be going through your mind to choose to do that. I hope when we get there we can do all we can to give this lady a chance to get the help she obviously deserves.

Mummy's boy!

A night of young drunks.

Two memorable one's where the 16yr old who drank 3/4 of a bottle of vodka in an hour and then promptly fell over! No surprise there then!

So called mates (who let him down the stuff in the first place) got concerned and called us as he had blood coming from this nose. That'll be the nose he fell on when he hit the ground?

I would love mates like that, their main concern was if we were going to call the Police! Quality!

At least this one was pretty much unconscious and co-operative for the journey.

The next one was a real Mummy's boy.

He had downed 3ltrs of alcohol (mainly alco pops from the sound of it) and was throwing up like a trooper when we got there. With a large haematoma on the front of his head, he needed to go into hospital.

At this point he developed a pathological fear of needles and hospitals. This did not bode well for a peaceful journey! He then burst into hysterical sobbing begging this girl to come with him in the Ambulance. She looked less than impressed about the whole affair and did not seem keen to leave the party and I don't blame her. I did try to point out that this kind of sobbing and hysteria is seriously not attractive to a more than sober female. Reckon his relationship with that one will be short lived.

Finally got him into hospital, after he repeatedly begged us not to inject him with anything as this would kill him!!

When his parents arrived, he launched himself at his Mum and spent the next 20mins that we were there sobbing into her shoulder. Dad looked a little embarrassed and non too pleased.

Winter wonderland

Woke up this morning, just about still this morning after night shift, to find myself expecting Christmas presents when i looked outside. Do we have wierd weather or what? Should make tonights shift interesting if it keeps up! Marley enjoyed his first snow experience.

A test of willpower

It's now 4.5hrs into my shift and not one sick person!

We have been sent out on standby 3 times now to sit outside McDonald's!

Talk about a hurculean show of willpower to have only eaten two hashbrowns so far this morning.

Where are all the sick people?

TV!

Sitting on standby- parked outside a garden centre,bored. After playing with the satnav buttons, I have discovered we have tv in the cab! How cool is that! Just need to work out how to power a kettle and would be happy to stay here all day!

Healthy eating plan foiled!

Why do they send us on standby to an area occupied by a McDonald's and a KFC!

Had great plans to eat more healthy from now on. Even to the point of being organised and doing some forward planning. Braved the supermarket the other day to buy pitta bread, dips, fruit and some cereal. All with the grand plan of eating this on shift.

First hiccup came when feeling peckish yesterday, I resorted to eating all the pitta bread and dips, followed by half the fruit.

So on shift today I had the grand total of 2 bananas, 1 plum and a box of Ricicles as available sustenance. Therefore sending me under duress to park outside the two temples of the fast food religion I worship, did not end in a good cholesterol outcome!

Must try harder tomorrow.

If they are dead, please tell us

The weather is dire, it has been raining constantly all morning and now the roads are perilous. There are huge puddles of standing water and visibility is poor.

Not great conditions for a 4.5t vehicle, being driven on the edge.

I am driving on the edge to get to a 60 year old man, who is lying face down in a pool of vomit, 15 miles away. The caller is unwilling to move the patient, despite requests from our control. Whatever the circumstances, this guy deserves the best help we can give him, as quickly as I can get to him.

To say the drive is a challenge is an understatement! The truck skips across the road markings, planes through the standing water and with this much water on the brakes, needs the same distance to stop as the average Royal Navy frigate.

We finally arrive at the address to be met by the Police.

'hope you got the message not to rush boys as he has been gone for a while, we told our control.'

Thank the stars for effective inter service communication!

Where are all our shiny new Ambulances?

Just had a text from a mate with the attached picture!

A nice row of 'old' white vehicles!

What has happened to all our new shiny yellow ambulances?

It will be my first shift at my base station tomorrow morning, since nearly two weeks off.

They better find them before then, I have only just managed to remember where everything is in the new vehicles, let alone trying to work it out in the old one's.

Impending sense of being the 'new guy' coming on, as I will end up opening every cupboard in the truck to find the first piece of equipment I need!

Unconcas: A few rules

If you are going to pretend to be an unconcas (unconscious casualty) then I feel a few rules would be of some use, as most of you are crap at it;

1. Unconscious does not mean, when I bend down and put my hand on your shoulder to 'shake & shout' at you, you moan and groan for effect!

2. Unconscious does not mean, when we are questioning your family and mates, you move position as your arm has gone to sleep, you should have picked a comfy bit of floor to 'collapse' on in the first place.

3. Unconscious does not mean opening one eye to check we are still there when you think we are not watching.

4. Unconscious does not mean letting the ambulance crew see you through the glass door, running down the stairs into the lounge, as we arrive.

5. Unconscious does not mean that you will be let off being nicked, the Police may be fooled but will only call us and we have to check for a pain response at some point, this we are well practised at and depending on how long you try and be 'unconscious' the more it's going to hurt!

6. Unconscious does not mean squinting at the vehicle headlights when we show up to find you on the pavement outside the pub, with lots of concerned people around you.

7. Unconscious does not mean that when you think the game is up and you have been found out, pretending to fit will add anything to your situation, especially when you look like my Dad trying to dance at a wedding on speed.

8. Unconscious does not mean the laws of physics do not apply, when we hold you limp hand over your face and let go, it miraculously falls uphill, away from your face.

9. Unconscious does not mean you flinch, bite down or gag when we try and put the inevitable oral and/or nasal airways.

10. Unconscious does mean you will get the best pre hospital care around for those who need it.

The Worst Feeling

0650am and moving well through the lines of traffic, with the sirens wailing, the lights flashing and all other road users jumping out of the way, might be viewed as a good feeling.

It is, however, the worst feeling that accompanies it is we are on our way to hospital 25 mins away and we should be finishing in at 0700am.

I do not mind the overrun, it's the fact we have to sit in the traffic back to base under normal driving conditions and then I have to drive back through the jams in my own, non blue light equipped car for the 65 mile drive home.

After a busy 12 hour night shift, I am not looking forward to the prospect. I may resort to a few hours kip on the crew room sofa to let the commuting hoards dissipate.

Problems, Problems

I cut through the jeans leg, trying not to actually cut the patient. It should be easy as she is lying on the resus table in A&E and not in the back of a moving Ambulance but this is the first patient I have seen deteriorate during our care and my hands are shaking. I am helping the resus team strip the patient so that they can work on her.

I watch as the anaesthetist waits for the paralytic and anaesthetic to take effect so he can intubate her and take over her breathing, he removes the airway I inserted in the Ambulance for a more secure alternative.

A nurse attaches ECG dots to her body, ours have come off when she started fitting on the way into the hospital, the ECG will tell them the damage the overdose is doing to her heart. It's not good news when the print off comes chattering out of the machine. Atrial fibrillation with rapid ventricular responses. There is no recognisable QRS complex and the heart rhythm is in disarray.

A Doctor is inserting a nasal gastric tube to enable the litre of concentrated charcoal solution to be pumped into her stomach, to absorb any remaining medications.

Two nurses work on gaining additional intra venous lines in her hands and arms to administer the Sodium Bicarbonate solution, which will try and arrest the toxic acidosis caused by the 23 anti depressants reeking havoc to her body systems.

The Consultant of A&E medicine calmly directs the nurse as she draws up the additional syringes of drugs that will be required to stabilise the patient to ensure she makes it through the next hours.

Bloods are taken for sugar levels, post fitting this can cause it's own problems, also a screen for any other additional medications in her system. We need to know what she has taken. My crew mate and I gathered 2 different meds that were evident on the scene and the Police have returned to the address to search for others.

I stand back as the team of 10 people work busily trying to keep this girl alive, when she so obviously did not want to be.

I watch for 30 mins hoping to see some sign of improvement, silly really with her anaesthetised, I look for a more relaxed manner in the A&E resus team, showing she is making some effort on her own to live but they are just as efficient and non emotional as they have been from the start.

Finally my crew mates comes and gets me. We need to book clear and be ready for the next job. I leave and clear my head ready for the next call to a girl with a belly ache!

I thought about her throughout the shift that night and what must have been going through her head, at 20 yrs of age to do this, I do not understand it and struggle to see this as a solution. This was not a cry for help, have seen a few of those and they are almost laughable compared to this.

Can the system offer her the support she needs? If she lives to accept it.

Bad Shift

Been on an 11's today. That is 11.00 to 23.00hrs.

Really naff shift, as you cannot do anything in the morning before leaving for work and it is a quarter to 12 when you get home.

No pubs open and the only socialising to be done at this hour is with the kebab van cronies, having already consumed own weight in mulched lamb earlier tonight as it is, that option seems a little dull and poor for the waist line.

My usual night time cohort seems to have fallen asleep on me an hour early, so no texts from her then and all my other mates are on days!

May end up revising trauma skills and watch an episode of ER then.

RTC with no 'C'

We are ruining on blues down the motorway, the traffic is thankfully not too bad, even though it is around 5pm on a weekday.

My crew mate pushes the Ambulance to it's limit and we manage a 'sensible' 85mph with the wind behind us! The 4.5t vehicle does not have the performance of a saloon car, so once we get it up to speed, it is all about maintaining the momentum. What we do not need is a brain dead company car driver, not looking in their mirrors and pulling in front of us..........on go the brakes, out into our lane comes the 3 Series!. Every one is moving into the two left hand lanes and Mr Unaware has found his lane a little crowded, so why not use the bizarrely empty fast lane?

I hit the bullhorn repeatedly and he jumps back into the middle lane, we have now lost 15mph and have no hope of gaining the momentum back for the next few miles as the motorway climbs a hill.

I know the Road Traffic Collision (not allowed to say Road Traffic Accident anymore, as this implies no blame) is coming up soon and I keep an eye out for the tell tale line of brake lights in the distance that signal everyone is trying to get a look at what is happening, to break the monotony of their everyday, commute home.

The Traffic Officer is flagging us down to the hard shoulder, we are the first crew on scene, with just 3 police cars also in attendance.

After the usual round of hello's and 'what have we got 'ere' jokes with the Police, I look down the embankment to see the car 40 feet down, lying at about 45 degrees on the drivers side. Time to put into practice the one of the many skills, again they did not get around to teaching us at school, mountaineering with 30lb ruck sac and oxygen cylinder.

On reaching the vehicle, I find one patient, awake and chatting to a Police Officer and looking a little pale, understandable I suppose, considering the shock of the accident. Yes I called it an 'accident' as he did not appear to have had a collision with anything! Just left the motorway at 70mph and dropped 40ft off a bank.

Quick trauma assessment;

A - Airway good, he is a little white but does have good colour
B - Breathing, seems to be doing that OK
C - Circulation, no obvious blood loss or bleeding
D - Disability - where's the pain? and what are your injuries?

As soon as he says the magical words 'my neck hurts' he has to be immobilised, completely and the car has to be effectively taken away from around him, so he can be extracted without actually moving his head or back in any way. This is where the Fire Brigade bring in all the cool toys and we stay and play.

Do you have any pain?

My neck hurts!

Bloody marvelous, let the games begin!

My crew mate clambers into the back to take hold of his head from behind, to start the process of making sure he is immobilised. I am the attendant for this job but she is far more experienced that me but that does not matter, I need to learn and she gets in the car and lets me run the scene and coordinate impending extraction from the car, up the embankment to the Ambulance.

Love her, she's great.

We then conduct a full secondary survey on the patient and conclude, tenderness and pain in C3 and C4 vertebrae, potentially 1 broken rib and a right side tenderness to the thoracic region, probably from the airbag impact. Not life threatening but the spinal pain means our job is to ensure this guy can walk at the end of this ordeal.

The Fire Brigade arrive on scene and we have ladders and ropes placed down the embankment to ease access and I talk to the Fire commander to brief him on what we have and what I want to happen.

'1 casualty, male in his 30's left the motorway at 70mph and ended up here, no impact with stationary object evident, air bags deployed, vitals stable, broken rib left side, no respiratory impairment, ?C3 & C4 spinal damage, no other injuries present. I need the vehicle stabilised, the roof removed for access and an extraction plan to get him up that embankment once we have him immobilised him on a spinal board. He is not time critical.'

I love this job! Where else to do get to say that in everyday life!

The commander gets the crews to work and comes back to me with 2 options. I go tell the patient what will happen and inform my crew mate.

Right mate, this is what is going to happen. We are going to get you out of this vehicle, keeping you as still as possible to minimise any damage to your spine. It is going to take a while so just relax and let us work. Fire crews have arrived and will be working on the vehicle to help get you out. We will be placing you on a board and strapping you down to ensure you do not move then we have 2 options to get you up to the Ambulance. One is hand to hand up the embankment, the other is a large platform gets lowered to the car and we strap you underneath and hoist you up to the motorway.

'You are joking about option 2?' he asks

No and it sounds like fun, so that will be my choice! Do you have any questions?

'Is my car a right off?'

Well it does not look too bad from here but the Fire Brigade are about to turn it into a convertible for you, so that we can get you out. It will be pretty much knackered from there I am afraid.

The job went great and the huge crane platform was cool to see in action, the communication between the services was good and the patient was safely delivered to hospital 2 hrs later.

Dead....and for a while!

Walked into the house and the aroma hit me straight away.

Had been advised to make sure you try and breathe through your mouth at all times, but this seems really bad advice, as can now taste it and we left the scene hours ago!

I have drunk gallons of tea to try and rid me of the odour and finally just about there.

Pleased that even though our uniforms are green, standing next to the Police Officer who attended to take over from us at the scene, I looked a lot less nauseous than him!

He looked particularly ill on enquiring if it was blood coming out of the mouth, my crew mate launched into a full and graphic explanation of the decomposition process and how various body fluids will leak out of the various orifices, which is what he was seeing.

I have to say, I would not want my family to see me after a few days into the afterlife, the pooling which goes on in the body (where the blood pools to the lowest points due to gravity) does not tend to make for a pleasant sight.

It was lucky he was discovered by the care home manager and we had the opportunity to manage the families exposure to the corpse to minimise any unnecessary distress.

Sugar Rush!

Continuation from previous post.

Thanks mate, those sweets work great, eat 3 on way to the job. Done in 45mins.

Back at base at 3.50am and wide awake!!

Pants!

Chalk and Cheese

Fast asleep on the rather comfy sofa at base, when roused by my crew mate at 3am!

I am on night shift so don't be too horrified. My body however, is disgusted and rebels instantly with that, got up too quick, swaying thing that happens. It's is a very good job I am not driving this round and have 8 mins to wake up enough to be able to speak coherently to the patient. Run to job with head out of the window, slapping myself vigorously around the face, hunting in my pockets for the Dextrose sweets a mate gave me and swore by.

Arrive at the address, slightly wind swept and munching a mouthful of high energy sweeties to find the patient outside his flat awaiting our arrival. He wants to go to hospital then.

Have a quick chat and discover he is sporting a dislocated shoulder. he is supporting the afflicted arm OK and will not need a sling.

I ask him to get onto the Ambulance so that I can have a look in the light and he turns around pointing to his front door, which is slightly ajar, telling me to go and close it before we leave!!

I point out that he is only 30 years of age, standing, otherwise fit and well, has the use of the other arm and only 8 feet away!

"Oh but can you do it, as my shoulder really hurts?"

If it helps, I will walk the 8 feet to your front door with you, in case you slump to the ground, unconscious from the pain and the effort.

Cheeky bugger! Some people are not just ill or injured but at death's door, no matter what is wrong with them.

Previously popped around to a nursing home and picked up a 95 year old, who has slipped out of bed, belly crawled to the bathroom to try and use the bath as a prop to get up and after 2 hours, had finally given up and called us. She was most apologetic. We tried to point out that this is what we were here for and were proud to be on call for her.

I hope to

a. Get to 95
b. have her attitude to self reliance and Independence

We did also give her a bit of a telling off for not calling us straight away.

Chalk and Cheese tonight!

What is the Point?

Having been on the road now for a few weeks, I am starting to come across things, which I have seen and experienced before.

So now, when the circumstances are right, I am trying to improve my performance. Commendable, I hear you shout.

Well is there any bloody point?

We fill a standard set of paperwork in for every patient we see and having done this a good few times now, I wish to improve the way I fill in the forms. 90% of the form is tick type boxes or boxes to put in patient observations; i.e Pulse, Oxygen saturation, Blood Pressure etc.

This means that it does not require a great deal of free thinking, just accurate observations.

There is however, one blank, free text space. (the size of three 1st class stamps by the way!) to write the history and what you discovered, in your own words. There is also a method of taking patient history and observations, called the Medical Model. This is similar to Doctor's notes in hospital and ensures that we are all speaking the same language. This is made up of the following sections and abbreviations;

PC = Presenting Complaint (why we are there)
HxPC = History of Presenting Complaint (what let up to them calling us - symptoms etc)
PMH = Previous Medical History
Allergies
DH = Drug History
SocHX - Social History (Their living circumstances)
FamHX - Family History (genetic predispositions to disease etc)
O/E = On Examination (what I found when I examined the patient)
Plan = Treatment plan

Now all that information above cannot be squeezed into the little free text box we get, so there is a nice A4 continuation sheet available to record all that valuable information and patient history on.

I completed this in detail for a patient yesterday and after completing a comprehensive verbal handover to the A&E staff, I duly gave a copy of the paperwork to them.

Imagine my surprise, when on being called today to move the same patient from the hospital to the hospice and being given a copy of his notes from his 1 day hospital stay, I could not find any record or copy of anything I had written on the 30min journey to hospital, when he was at his most ill.

I am not even sure if any of the Doctor's or Nurses had even referred to it during his treatment and probably asked the poor Gent all the same questions I had.

Why bother??

Arrogant

Don't get me wrong.

A&E Doctors are great, they know a huge amount more about clinical matters than me. It's just nice not to have your face rubbed in it and when they do, it's nice to see them be taken down a peg or two!

Picked up this rather ill patient with heart failure today and as we were a double Technician crew, we arranged to meet a Paramedic on route to the hospital so they could give some additional drugs to help the patient during the transfer.

Once the Paramedic was on board, we drove under blue light conditions, to the hospital. Now a drive on blue lights to hospital is rare and is only used for really ill people. It is also a real challenge for the driver, as your crew mate (or in this case, crew mates) are trying to work on the patient, so throwing them around in the back is not going to help, especially when the Paramedic is trying to get a line into them (needle in the back of the hand for drugs).

Anyway, we got to hospital in good time but the Paramedic had not been able to get the line in during the journey, knowing he was a little nervous about his current run of luck, having only just qualified, I could see the disappointment in his eyes as we unloaded the patient.

Arriving in Resus, we handed over to the Doctor, who asked if we had cannulated? No we had not been able to, on the run in. Then came the dismissive, disapproving look!!

We all stood there for 10mins as three Doctors tried to get a line into this poor woman, who now resembled a pin cushion, without success. I turned to the Paramedic and in a rather louder than appropriate voice, enquired if they could not do it here in this well lit, calm and flat room, I wonder how well they would do in the back of a van at 60mph through town?

Another disapproving but slightly more humble lookthis time!

It's a Girl!

Just seen my first baby being born, a hugely messy experience from what I could tell.

Did not actually mind all the goop though, as we had been called to the birthing centre because the the labour had developed complications.

Basically there was muconium in the amniotic space, which means that the fetus has been in some distress and has a reduced oxygen level, this causes the fetus to relax it's bowls and quite simply has a poo whilst still in the uterus. This can cause complications in it's self let alone the primary reason that it was in distress in the first place.

This would have meant a rapid transfer from the birthing centre to the hospital, with mother 7cm dilated and delivery imminent! Oh and me in the back attending!!!!

Luckily the Mother delivered the baby fine on her own and with some vigorous rubbing and oxygenation, we got our first cry. Smiles all round.

Just about to pack up and leave, when they noticed the Mother was still bleeding heavily. Now not sure from the cuts they had to make or from the Uterine wall (Post partum hemorrhage).

Could we hang around and cannulate the Mother to hang some fluids?

Neither of us could, so we called for another crew who had a Paramedic on board. They arrived and we all waited nervously as the senior midwife, stitched the Mother back up and gave her some drugs to make the uterus contract one final time, thus hopefully stopping the bleeding.

Did not really want to drag a new Mum away from the new baby to rush her, hemorrhaging to the hospital if we could help it!

Sweating enough that morning and we had only just started. Those birthing centres are seriously warm. I know you come into this world with no clothes and it may need to be warm for that reason but surely they could have some ready for baby, as the rest of us are dressed for a winters day!!

Great start to the day to see a new life come into this world, will make up for the fact we may see an old one go out, later this afternoon.

Wise words - Yawn!!

Worked a night shift yesterday, finishing at 6am this morning. Off tomorrow, so taking the advice of my course guru about coping with the whole body clock issues and not planning to go to bed till tonight.

Sequence so far is; up Tuesday at 7am (thank the dogs for that one), at work for 6pm Tues till 6am Weds with 2 hours kip on shift, now Weds night 7.30pm!

Now feel slightly woosey, fluffy around the edges and objects appear to have a slight glow around them when viewed under artificial lights.

I have yet to be convinced about this plan, may have to avoid operating heavy machinery just in case!

Yawn!

Bark worse than his bite!

Back on front line shifts again last night. Fab! Have missed them.

Can you tell? Still at the keen and eager stage!!

Got called to a young man 30's with altered level of conciousness last night. We were lucky as we were just finishing a job around the corner, so the call came at 07mins past the hour, we went mobile at 08mins and were there by 09mins past the hour. Not a bad response time I feel.

Walked into the house, having locked the truck, yes that part of town! Met by Mum and a neighbour, who explained that they had found their son dazed and confused when they returned from a shopping trip. He had shown no signs of improvement in the hour prior to them calling us and was now talking complete rubbish. Also he was a known diabetic.

At this point the neighbour sparks up "Don't worry, his bark is worse than his bite." This is often a good clue to leave, lock one's self in the cab and call the Police, several of them.

On describing our preferred plan of action, we were quite bluntly told that if the Police show, he will really kick off and that could be bad for all concerned. This little insight sort of confirmed our previous choice of action but being a bit of an eager newbie at the moment, I offered to talk to him, to assess the level of threat Also confident in the knowledge that if his LOC (Level of Conciousness) was that altered, I could probably out run him.

I stuck my head around the door of his bedroom to find the pt. lying in bed looking fast asleep, I gave him a precautionary nudge and called his name, at which point his Mum came in and started giving him a round of verbal abuse (after shutting the door behind her! Great trapped with psyco 4ft 2in Mum and 6ft 6" nutter), this woke him up smartly and off he went shouting at her in some strange 'soup dragon from the Clangers' dialect (for those old enough to appreciate quality kids telly).

I obviously left.

After a minute of shouting, the pt. came out and staggered into the other bedroom and turned the telly on, that's handy, primary survey done then, not about to die on me.

A short chat with Mum about how it is not easy to assess her nearest and dearest, whilst she is winding him up and in I go again. Got agreement for a pulse check but got something that sounded like f*** off when I asked for a blood sugar test and BP. He has every right to decline me sticking a very small needle into his finger for that test and I was not about to push it.

I did manage to get him to open his eyes enough to check the pupils and they were seriously constricted. At that point my crewmate came in (wearing his high viz jacket) and this set him off again (assumed he thought he was a Police Officer) Up he got shouting 'soup dragonese' at us and back into his room again, slamming the door. Crew mate looses high viz jacket for fear of being beaten up and calls the Police anyway.

The pupils and his manner told us everything, opiate drug use. Despite the family denials, we proceeded to try and chat with the pt. to confirm this.

We moved rooms again! The Police had turned up at this point and we briefed them on the less than happy reception they would get if the pt. saw them, so everytime he stormed from one room the another, the coppers all ran outside to hide. Did not fill me with confidence.

Finally agreed to give the pt. a drug called Narcan, which is an inhibitor for the opiate family of drugs and would reverse the symptoms. I got to draw up the drug under the supervision of the Paramedic and armed with a 5ml syringe and needle, we discussed the problem of getting close enough to inject this guy without bodily harm.

Both agreed that we should have access to an out of hours big game vet service, as darting him from outside the room with a gun was the best option available, as the NHS in their wisdom have not yet invested in this scheme, plan B would come into force and newly qualifed trainee would have to go in and stick him with something much bigger than a blood sugar needle!

Decided the best course of action would be bribary, he seemed really pissed we were there waking him up all the time and asking loads of questions, I offered a solution. Let me give you this small injection and I will piss off and leave you alone. Agreement !!

Administered the Narcan and legged it. We waited 15 mins and went back in. No real change.

"Did you give him the whole dose?" the Paramedic asked.

"Yes"

"Half in each arm?"

"Er No, jabbed him, hit the plunger and legged it"

Right then, another dose, in the other arm then. Off you go.

Successfully administered another 4 shots before he started to come around, he then jumped up, walked into the kitchen and started making a sandwich?!?!

The munchies!! A sure clinical sign of recovery. We left, finally, two hours after getting there.

Standy

Have just been on standby. Parked up at a very empty industrial estate for an hour, wishing someone was ill nearby.

How horrible am I?

Did get the chance to read the Sunday papers though and have a catch up with mate coming off nights.

Back at base now, tea and toast is the plan to kill the next hour or so.

PCSO's

Got called last night to a job described as young male lying outside house, phoned in by old male living at house. Police to attend also.

Arrived to find a 20yr old lad lying on the pavement, feining unconciuosness and not doing a very good job of it.

This would normally warrant the usual Ambulance response of an unsympathetic primary survey, which consists of standing on their hand until they stop feining unconciousness, sit bolt upright and start complaining, thus proving they are alert and have a viable airway.

Last night however, having not had the opportunity to complete a full head to toe secondary survey on an unconcas (unconcious casualty), this lad was going to get a full MOT, unconcious or not.

After finding him.......... surprise, surprise, ...........well but pissed, I completed the paperwork and asked the two PCSO's (Police Community Support Officers) to sign for his custody. They both looked a little surprised and queried why we would not be taking him to hospital?

Well I felt this deserved a chat about the role of A&E in caring for 'sick' people and in my view, the role of the Police in dealing with pissed people, who were not sick. The problem came, they explained that as he has not committed a crime, they had no reason to hold him. So why does this make him our problem and the only place he can go is to occupy a valuable bed in A&E so he can sleep it off!

Finally pursuaded them to arrange for a car to collect him and take him home. I am all for increasing the Police presence on the streets to deal with criminals, but in my humble view they also have a duty to serve the public, both the old man who has a drunk lying outside his house and the young man who has had too much to drink to be left alone at 01:30 in the morning, even if no crime has been committed by either party.

Grand Mal

Picked up a young patient today from the local hospital to transfer her to a specialist neurological unit, as she suffered from uncontrolable Epilepsy.

The good news was, I was due to attend and have not met an epileptic patient yet and also we were due to have a nurse travel with us.

Now nurses always seem to be impressed about travelling in the Ambulance as they think we rush everywhere on blue lights! and there is nothing wrong with impressing the odd nurse here and there. This particular nurse was going to be very disappointed as we were going to be travelling the whole under 'normal' driving conditions.

Even the odd flurtatious request to turn the lights and sirens on from her did not get the required result from my crew mate who was driving. If we use the lights and sirens whilst not on an emergency call, then this can be a sackable offence.

The patient seemed happy and relaxed, mind you I would be given the quantity of sedative they had pumped into her to control the fits.

Patient was secured on the stretcher and the nurse was strapped into her seat, while we set off and I hooked the patient up to the array of monitoring equipment we have in the back and settled in for a leisurely trip down the motorway with ample time for once to do all the paperwork and fill every single box in!!

After about 20mins, the nurse got her wish! I was chatting with her, telling the usual war stories (those I have after two weeks in the job!) keeping an eye on the monitor to check the patients vitals, I leaned forward to ask if she was Ok and got no response and she looked all blank.

The nurse also picked up on this and got out of her seat to try and rouse the patient, after a few seconds, it was quite obvious she was having an absence episode and this would more than likely lead to a full Grand Mal fit soon, and soon came 15secs later!

I moved to the chair at the patients head and ensured her airway was open while the nurse put the O2 mask on her. I leaned back to my crewmate and said the fateful words 'progress please mate' I then turned to the nurse, who was now standing over the patient and advised her she may want to hang on and get used to treating someone, one handed (one hand being used to hang onto the grab rails). We lit up like a Christmas tree and off we shot, off shot the nurse to the back of the truck and landed on her butt!

We then came into the centre of town, with all the roundabouts and traffic lights and it became like those fair grounds rides where you have to try and stand in a padded room whilst it moves in all directions, only without the padding.

I got the odd evil stare, quickly superimposed by a look of terror, quickly distorting into a look of pain as I advised that the nurse that she should really hold onto something secure!

We arrived 8 minutes later at A&E with the patient post ictal but recovering nicely and the nurse on the floor, also recovering nicely!

Despite the bruises and mishapen hair do, the nurse emerged from the Ambulance with a big grin on her face and a little more respect for the Ambulance service.

A little more respect was more than welcome last night, as the staff in MAU had been downright rude that evening, I know they were busy but we get enough crap from the public without getting it from our fellow healthcare workers.

Lost

Lost a patient today.........well did not actually loose per se, more got away from me. All 28st of her was firmly strapped into the stretcher as we were wheeling her to the truck for a routine transfer to hospital, when the left rear wheel dropped into a small, completely unnoticed pot hole.

This small change in angle of the stretcher, combined with the weight of the patient meant that both ended up spilled onto the road!

Thankfully the patient was fine and did not fall that far and was good natured about it. Myself and my crewmate were horrified and hugely embarrassed.

On checking what has caused us to tip, I found half a cobble stone missing from the drive, it was this, one of the wheels dipped down.

It was actually quite fortuetous that the stretcher tipped so readily as neither of us had chance to try and stop it. With 28st on board, plus the 10st for the stretcher, it would have been goodbye inter vertebral discs!

Query Dead

Had my first dead body today.

70yr old lady with lung cancer, called in by a family member.

We found her in bed, under the covers, looking very peaceful.

Whatever pain and anguish she went through with this horrible disease and any subsequent brutal treatment, her end looked very peaceful.

Glad to have helped your family, in a small way, say goodbye to you.

What no waffles!

Today had a call to collect a patient from the Coastguard rescue helicopter.

He was a Belgian fisherman with a 25cm laceration to his inner thigh.

I was driving when the call came in and with a 10min ETA for the helicopter, I put my foot down to get to the helipad, as a wound that large may have compromised his femoral artery and he could be bleeding badly from a life threatening wound.

I rushed through the traffic on blue lights and turned into the road for helipad, which was a mass of speed humps!! After launching my crewmate from his seat on the first and nearly loosing the back axle on the second, I made an exectuive decision to take the other 17 at a more sedate pace and hoped the council loons who had put that many on this road would not have the death of a fellow EU member on their conscience.

As with most of our jobs, the information was a little misleading and when we arrived at the helipad we were met by the Coastguard mobile ground unit, who informed us that the helicopter was 10mins away from meeting the fishing vessel in the English Channel!

So insued the 1hour wait for the helicopter. We amused ourselves, watching the sailors on exercise, launching themselves into the freezing water nearby and attemting to scramble into their liferafts.

Finally the helicopter arrived (much pleased with my photo by the way) and we were waved in by the crew, I reversed the Ambulance gingerly towards the helicopter, wondering exactly how far off the ground the rota blades were spinning? Could just imagine the incident report I would have file if the rota's took the light bar off the roof!

I jumped out the cab, only to be nearly blown off my feet by the wash created by the rota's and almost loosing the door to the Ambulance in the process as it swung widly on it's hinges.

We transfered the patient from the helicopter to our stretcher on the wire basket they use for rescues and wheeled him into the Ambulance for some much need peace and quiet. On examination, he appeared to be no where near a recent encounter with the grim reaper and other than some mild pain, quite chatty. Pity none of us spoke Flemish!

The helicopter medic came aboard and handed over the patient and kindly asked for his rescue stretcher back, this presented a small problem as we had already buckled the poor lad up ready for transport.

I had one of those few and rare sparks of imagination and suggested we get the scoop stretcher to lift him up so they could remove the rescue stretcher. Great idea shouted my crew mate through the noise, as the heli medic had left the door open.

Outside I go to open the equipment locker to get the scoop, which is on the equipment locker door behind the long board (we use this for spinal patients and it looks like a surf board with handles). seems logical to have remove the long board first, which I do and it catches in the rota wash, flips in my hand and smacks me in the face! Ouch!

Finally get all the relevent equipment into the back of the truck and manage to perform the swap with minimal discomfort to the patient. The run into hospital is routine thankfully as a blue light run would have been a challenge with both eyes watering from the smack on the nose.

To top an eventful afternoon, the guy failed to bring any waffles or even a nice piece of Cod with him, some people are just so thoughtless!

Treated and happy

Its nice to be able to get back in the truck and rather than writing the hospital in the destination box on the vehicle log, we write treated. Nebulised an asthmatic and all went fine. Her dog was also in labour but we could not hang around long enough for me to get my canine maternity signed off. :-(

In my opinion

In my aspiration to be the leading authority on ready meals in the South Central area, I can confirm Tesco's Finest beef stroganoff is well worth the 6min wait!

Blood, Sweat & Tea

There is a great book called Blood, Sweat & Tea by Tom Reynolds, which is his account of life as in the London Ambulance Service.

I read this on my course and found it excellent, I always thought the title inventive, until Tuesday night, when I experienced all three on one job!

We were called to a nursing home on the seafront, this was an AS3 call, which is about as low a priority as we get. The call time from the Doctor was around 4.15pm, we got the call at around 9pm to collect this patient with suspected GI bleed and transfer at a leisurely pace to hospital. To say we took our time getting there would be an understatement as we were hoping that they would task us with something more interesting on route, they didn't.

Pulling up outside the nursing home, we jumped out and walked in without any response gear to find our patient, hopefully walking and escort them to the Ambulance for the trip to hospital.

When we got inside one of the carers asked if we could have a look at another gent who had fallen 10mins ago, to save calling another crew. Dick asked me to have a look and he would check out our original patient. I ran to the Ambulance to get the response bag and headed inside, only to find they had not held the lift for me and gone ahead, asking another care assistant where the fall patient was, I was told to make my way to the top floor - Pants!

After four flights of stairs, carrying a rather large response bag, I arrived in the hotest room in the place to find a gent of about 90 sitting in a chair in his underpants, covered in blood!

"Blimey, what happened to you?"

A very attractive care assistant stated that he had fallen by the bathroom door. Standing straighter and holding my stomach in for the maximum I am not a junk food addict look, I check over the patient.

5cm laceration to the top of his head, 3cm laceration to his forehead, broken nose, ?dislocated shoulder, most of the skin missing from left elbow, cuts on his hand, both knees scuffed and a cut on his left foot!

"Did you hit everything in the room on the way down?" I ask

I question him further and find out that there has been no loss of conciousness and he remembers stumbling, no faint or dizziness. Good news, just a patch and run job then.

Pulling out the dressing kit from the reponse bag, I now get the opportunity to 'stay and play' with the patient. Should be able to use most of the kit in here on this one guy.

Just then Dick comes in and after a few expletives about the state of my patient, tells me his is quite ill, GP is a moron and he has hung a bag of fluid and needs to transport now, no other crews free, so we are taking everyone, including next of kin.

I quickly finish patching my patient up, into a chair and down the lift thank god, to be met by Dick with his patient in a stretcher, looking quite unwell with his wife in attendance.

Everyone on the truck and off we go. Dick leans back and tells me to keep an eye on his patient, asks me to check the BP and tells me we will be going in under blue lights, this does not happen that often.

The wife complains about the cold, so I turn the heater on in the back for her and run the machine to get the stretcher patient's BP......... it comes on the screen 60/33 - oh shit !! not good.

Normal is 120/80 so this was seriously low, complications include kidney damage as the pressure is too low to push the blood through the dense kidney tissue for cleaning resulting in damage to the kidneys and a build up of toxins elsewhere in the body, damaging other organs.

I open the tap and run the fluids through as fast as possible, while wiring him up to the SPO2 meter to measure his oxygen concentration, I put a mask on him and plug this into the vehicle O2 supply, all while hanging on one handed, as Dick negotiates the trip to hospital as rapidly as possible.

Not forgetting my other patient, I attempt to brace myself on the floor between his chair and the stretcher to do a manual BP on him, no way and I going to be able to hear with the sirens going, so I put the cuff on and feel for the radial pulse, pumping the cuff up until I cannot feel it will at least give the systolic blood pressure. I start pumping up the cuff, and pumping and still feel the pulse. At 200mmhg it stops!! I ask the patient, if he has blood pressure problems, oh yes, but they stopped my tablets due to my age. Great!! Sit still and don't move please.

I check the stretcher patient, his SPO2 levels are at 75% (should be 100%) I look down at the mask and the oxygen resevior is empty! The O2 bottle has run out! I switch over supply and see the bag inflate, I run another BP on the machine, check he is still concious, reassure the wife about the sirens and ditch my jacket as it is getting hotter.

I sit down to at least start the paperwork, and glance up at the SPO2 monitor, no change, look at the bag and again it's deflated!! Check the O2 bottle and it is full, something wrong with the line then.

Dick leans back and tells me 3min ETA, great, I throw the clipboard on the floor and open the repsonse portable O2, spilling the contents on the floor, and change supply for a third time, all whilst trying to look calm.

I feel us reversing into the bay at A&E and as the door's open I am standing there with 2 patients, kit everywhere, sweating like mad and trying to find my pen, which I dropped. Outside is the Tech I was with the night before, he takes one look at the carnage, and exclaims to Dick "Working him hard then tonight?"

Into hospital for handover, and a well earned quick cup of tea!