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!