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!

Stand Back! Ambulance Service

I have just finished a run of two night shifts at the coast, what a hectic place in the winter. I always imagined these places to be busy during the summer with the tourists etc but this time of year?

So much happened over the two nights I will break it down into a few postings, apologies that they may not be in chronological order.

This particular evening, I was working with an experienced Paramedic, we had already had a hectic night and it was around 00:30, just got back to base and half way through my cup of tea when the radio starts bleeping, Emergency appears on the tiny screen. Just as we are about to leave, the phone rings, it's control, 'Don't go to the job till the Police arrive.'

We jump in the truck and it is my turn to attend. I look at the screen and hit the send button to accept the job, without really reading the description properly.

I then re-read the description: 'Caller is mad, threatening suicide' - hum, this one is going to be fun. For those of you who are into your political correctness, mad may seem a less than acceptable term to use but it actually used to mean Mental Affected Disorder, which was used to describe all manner of mental illness. I will let you be the judge of whether you thought control were using it in this context.

We run to the job and as we turn into the road, we see a Police BMW area car parked on the left, curious as the address given is not at this end of the street, maybe he is attending another call?

Dick turns all the lights off, including the headlights and we cruise upto the block of flats in darkness, no sign of the Police here. We call up control to check if the Police are on scene and wait. As they come back to us to confirm, a rather large 'doorman' looking copper comes around the corner.

"Your guy is fine, just seen him come out of his flat, he is on the first floor but cannot get in as there is an electronic lobby door to the flats, which he refuses to open. Going to get my crowbar, back in a sec, parked at the wrong end of the bloody street"

Feeling slightly more safe, I let go of the central locking button and climb out of the cab and go around to the block entrance.

Dick tries to jimmy the lock with his Gerber tool, yet another skill training school seemed to have missed off the syllabus! no joy, until Mr Policeman turns up and gets us in, in under 3 secs with very large crowbar.

We head upto the flat and find the patient ranting and raving, hitting himself on the head and generally looking like someone not in control of all his emotions. He does however, look surprisingly heathly, again a 'why are we here?' moment for me.

We go into the flat with the Police and try and find out what is going on. Apparently, everyone is out to get him and we are all f*****g bastards involved in the consipracy, never actually been involved in a conspiracy before, so feel quite proud at this point.

I gather up his medications, while Dick talks to the patient. He is very aggressive, particularly to the copper. "I will only talk to the Ambulance, not the f*****g Police, he justs wants to section me." I couldn't really disagree with his logic, he had a point and it was highly probable he was about to be proved right. The copper says he will stand outside to make things easier, not sure I wanted to be left alone with this guy and the range of kitchen utentials he had out on the side, being assulted with an egg whisk on my first week would not do much for street cred, was trying not think about the large bread knife I could see in arms reach.

After a rather heated 10min debate, we finally establish that he wants to go to hospital before he kills himself, I have to agree, from a medical point, this would be the best way around too.

Finally get the patient outside the flat, after a long debate as to why he can't make himself a sandwich before we go to hospital, when he kicks off again about leaving his key behind. The copper, generous to a fault, says he will go and get the keys and heads into the flat.........

At this point the patient, slams the door, produces the so called keys and deadlocks the door, before running off shouting something about, I sectioned him before he could section me!.

This called for a brief explaination through the letterbox about what had happened and some additional skills that training school kindly deem inapproriate to teach us.

'Stand Back' as Dick gives the door several kicks, unfortunately it's not moving. Another chat through the letterbox and out comes the crowbar, through the slot. Dick levers the door, while I give it several good kicks, no joy again but at least it has moved slightly.

A short note to the people who make council fire doors, well done lads!

We change over and I jimmy the door and with a final kick from Dick, it gives way and we release one very pissed off and ever so slightly embarrassed Police Officer. "Where the f**k is he?"

My guess, as we did not lock the truck, is he will be in the back. sure enough, we get downstairs, open the side door and there he is sitting in the dark!

After a brief chat about the facts of life from the police we sit him down at the back of the truck for the run into hospital. Dick asks if I am OK in the back with him and some reflex goes off in my head and I say yes, without really thinking. I now develop a pathological obsession with passenger safety and insist the patient wears his seat belt, thinking it would give me a few secs if he kicked off before he could get it undone, Dick is one step ahead and straps him to the chair with the longboard straps, with the buckle behind the seat! Now feel safe to move.

The run into hospital consisted of me trying to question the patient for details about the patient report form, while he ranted about his front door being off it's hinges. "Bloody coppers, kicked my door in, they can't do that!"

Well actually, that was us.

On arrival at hospital, Dick had phoned for security and when we opened the back doors, we were surrounded by three rather large blokes, who were surprisingly polite.

As we ran into hospital throughout the night with various other patients, I could hear this guy still ranting from the examination room and occassionally see a security guy in the corridor rolling his eyes and sighing.

Funny thing is that throughout the whole episode, I never did see a mental health professional attend the patient, it was all left to the A&E team and the emergency services to deal with. I guess care in the community has more emphasis on the community bit than the care bit.

My Skin

Have just completed my first 'live' shift as an Ambulance crew!!

Went really well actually, I attended for the first 6 hours. We had no major jobs on but dealt with some very sweet people who were gald we came and some very 'quite well' people, who were equally amazed as us as to why the GP had called for an Ambulance in the first place.

With nothing clinical to throw at you today, my thoughts turn to other more mundane matters, like how much crap I have eaten in the last 24hrs!!

Brief summary below;

• 16.00hrs Takeaway pizza & cajun chicken wings - yummy


• 19.00hrs Waiting for vehicle - Tea & chocolate bar


• 19.30hrs Still waiting for vehicle - more tea


• 21.30hrs Finished standby - Back to base - More Tea & microwave chips


• 23.00hrs Standby at base - Tea & biscuits


• 01.00hrs Meal Break - Cheap Tesco sweet & sour chicken


• 01.30hrs Nap - belly full of cheap Tesco sweet & sour chicken


• 04.30hrs Feel sick, as try and digest previous rubbish - solution, Tea


• 05.30hrs More tea


• 07.30hrs Finished shift - Tea


• 08.15hrs Stopped at American Diner for full pancakes & bacon brekkie!

If this keeps up, I will be mahousive and have really bad skin. Really need to sort out night shift grazing patterns to encompass some real food.

Quick question, to anyone who may be responsible for stocking the freezers at the station, why are 90% of the meals, oven cook only and require at least 45mins in the oven??

Curious, considering we only get 30mins meal break!!

Going nocturnal

Just got up 13.30!! After multiple attempts to get some sleep.

No, not being a lazy git. Have a run of 3 nights shifts coming up and trying to go nocturnal.

Plan is less than successful so far.

Stayed up as late as possible last night, started watching a film at about 2ish and did not make it through to the end.

So rather than going to bed around 4am and sleeping as long as I felt, I ended up nodding off on the sofa at 4am and being woken by a spaniel jumping on me a 07.45 wanting his breakfast!

Back hurts, neck hurts, knackered and covered in spaniel fluff!! A good way to start my first night shift this evening!!

We don't just treat the patient

I was half asleep on the sofa watching some random program, I was not paying attention to, when I was brought back to conciousness by the radio bleeping loudly. 'Emergency' is all the small screen read.

My crew mates (still 3rd manning today) rushed to the vehicle to accept the job, we have 30secs to do this. The computer screen in the vehicle would give a brief description of what the job was. I jumped into the front passenger seat, as the attendant and looked at the screen

19MTH OLD FITTING - (Oh Shit! - in my head, not on the screen)

Laura, the Paramedic I was working with jumped in the back of the vehicle and Carl, the other Paramedic, fired up the engine.

The station doors were open, that would save a few seconds, as we exited the station, I hit the '999' button on the dash, which puts all the lights and siren on, Carl hits the horn to start the sirens and we are off with 4.2miles left to run to scene.

As we run the red lights at the roundabout and take the exit with the wheels somehow holding ground still, I have to try and complete the paperwork. I check the address, check the sat nav is working, write the times on my glove for reference later and copy the address onto the job sheet.

I look around at Laura who is frantically scribbling weights, breathing rate, pulse rates and drug doses on her glove as an adie memoir. Very good idea, I do the same. It crosses my mind that two days with these guys is no where near enough to learn all I need to handle my first real job.

The SatNav directs us off the main road, into the housing estate. The car in front, slams to a halt, we slam to a halt as we cannot see around the corner. Laura leans through from the rear and hits the bullhorn and I see the guy in front actually jump but it does the trick and he moves to one side.

Carl turns to me and asks what I am thinking about this job,

"Infantile Fibrile Convulsions" is my guess

We turn left into the road we need, looking for No21, No7 on the left, it's going to be on the left, we see it and pull up. I hit the 'At Scene' button and the time comes up - 7 mins from the call being answered in control, not bad.

I have my left glove on already, full of notes and times scribbled on the back of my hand, I jump out the vehicle and open the side door, almost making Laura fall out as she is also opening it from the inside. We grab the response bag and oxygen and head for the house.

I am due to attend this one and now my mind goes blank, the training in school seems too long ago and too rushed. I have done so much since then and cannot recall what I would do with a fitting baby.

I knock on the door and ring the doorbell at the same time, the noise that comes from behind the door when it opens makes me breathe a big sigh of relief. Crying, lots of it, a very unhappy baby, but one with good lungs that are working fine. Phew!!

Baby is lying on the floor, with a puddle of vomit to one side and not happy, I kneel down carefully (already knelt down in one house without looking, regretted that one) I put my hand on her head and she is roasting.

'Hello little one'

Both eyes spring open and look at me, take in the huge man leaning over her dressed in green and off she goes again at an octave higher. I don't care, she heard me and responded to my voice, opened her eyes and was co-ordinated, that will do fine. I look at the chest and see both sides rising and falling as she breathes, good, no vomit aspirated by the look of it, I could try and listen for crackles and wheezes but with her in this mood all I would get would be stereo cying through the stethoscope.

I ask Laura for the Oxygen mask to give the baby, she already has it ready and hissing away.

I look up at the mother to get some history and see what has happened and I am faced with this young woman, in abject terror. Her eyes appear wider than the glasses she is wearing and she seems to dancing on the spot.

'What's her name?' I ask

I get a mumbled 'Milly' in response.

Then it all leaves me, my mind goes blank and I do not know what to say next, the baby seems fine, the mother looks like she is holding on by thread and I do not know what to say.

Without a pause Laura takes over the questioning, and I see two well experienced Paramedics do their job calmly and without fuss.

I have so much to learn.

They treated the patient, and spent as much time talking to and calming the Mum, which helped the patient calm down.

I popped into their room on our next trip to A&E to find Milly still screaming the place down still and Mum in tears of relief.

Mum looked up at me with very red and swollen eyes and mouthed 'Thank You' as I shut the door, smiling to myself.

A good day at work.