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.