“The doctors say this is all related to smoking. But still, when you’re in the Burmese jungle, with Japs to the left of you, Japs to the right and they give you forty cigarettes a day, you’re going to smoke them”
I love hearing patient’s war stories…
3 comments March 17th, 2008
We were almost there - a patient with a painful hand. Did it warrant an emergency ambulance? I’ll never know.
Less than two hundred yards away from our destination, we were flagged down by three people at the side of the road. “Metro Control, Alpha Bravo 123, we have a passing call - car vs. lamppost. Will update you when we can.” I climbed out the passenger seat to greet the people milling around the car with no apparent sense of urgency.
“He’s still in there, but the doors are locked so we can’t talk to him” one of the bystanders informed me. I walked around to the driver’s side trying the back door on the way and peered through the window to see the driver.
“Dave,” I shouted to my ECA crew mate, “get on the radio and tell control it’s a cardiac arrest“. I’m not sure if it’s instinctive or not, but you can tell a dead body when you see one.
Just at that moment, a police car that we had passed on the way to the original painful hand stopped and asked us what was going on. I shouted something along the lines of “He’s dead; we need him out quick” and seconds later the police had produced a telescopic baton and were repeatedly striking the back windows of the car in an attempt to gain entry. I had no idea how much effort it takes to smash a car window!
I was surprised to find that the car doors would not open from the inside either, despite the fact that the car engine was still running. The impact against the lamppost was not significant enough to stop the doors opening, so all I could think was that he had a child lock on the back doors. Carefully leaning through, I tried to reach the front door to unlock the rest of the car; tiny pieces of shattered glass were everywhere, and I already had at least one cut finger. Somehow, I managed to find the right button and released the doors. I immediately opened the driver’s door and confirmed my feeling that this patient had no pulse.
Moments later, me and my crew mate dragged the patient unceremoniously out of the car, on to the neatly kept grass verge and started CPR. It didn’t look too good - we had probably spent two or three minutes before we managed to get CPR started, and from what we were hearing from bystanders, it had happened around three minutes before we got there. He was asystolic according to our ECG and looking a little bit blue, but after 2 minutes of resuscitation his appearance started to pick up a bit.
Around a minute later, his heart rhythm was no longer just a flat line, but erratically jumping around. As I was looking around the patient, carrying out my final safety checks before shocking him, I noticed out the corner of my eye someone walking up to a nearby police officer. “Excuse me, can someone move this ambulance - I need to get my car out“. I smiled as the policeman politely explained to the blocked in driver that now probably wasn’t the best time to be moving the ambulance.
Two more minutes of Nellie The Elephant and the inconvenienced driver had disappeared. The ECG still showed VF, so it was time for another shock. The monitor settled and showed a regular rhythm on the screen. I felt for a pulse and there was something there, but it didn’t last. Within 20 seconds it was gone, so it was back to the chest compressions. Help in the form of a second ambulance had arrived now and it was time to get the patient on his way to hospital. Another shock, another fleeting pulse, but within 40 seconds or so it was gone again.
Thankfully we were only minutes away from the nearest hospital, and it wasn’t long before we were sliding our patient over onto the hospital bed with a crash team ready to take over.
It turned out that no 999 call had been made for this incident, and that is more common than you might think. In all the confusion of the bystanders, everyone assumed that someone else had called. We just happened to be in the right place at the right time for this patient, but the outcome of the event was not so fortunate.
We tried our best.
4 comments February 10th, 2008
The AVL said ‘Charlie Code Green’, but it’s still a blue light response. Believe it or not (and I’ve probably mentioned this before), but any 999 call to the ambulance service (in the West Midlands) receives a blue light response - even when it is graded by the electronic triage system (AMPDS) to be non-life threatening such as a cut finger or stubbed toe. This was no different.
We were responding to an 88-year-old female lying on the floor, unable to get up after a fall. On our arrival, we tapped in the six digit Keysafe code and retrieved the keys to the front door. A wall of heat greeted us as we walked in from the cold, dark evening, assuring us we have the home of an elderly person.
“Hello,” I shouted, ‘ambulance service.”
No reply. This isn’t unusual, as the patient more often than not is as deaf as a post, but refuses to wear their hearing aid because they ‘can hear fine without’. As I made my way through the bungalow, I was still not getting a response. This is when you get that niggling feeling at the back of your mind thinking ‘maybe the reason why this old lady fell is more than just a slip’, but that fear was soon resolved when I entered the living room to find a person who matched the description of the patient sat on a sofa.
“Somebody help me,” she screeched. “I need picking up.”
Whilst I was trying to establish what exactly was wrong with the hysterical woman who was now crying, a young woman walked through the door wearing what was obviously a carer’s uniform. It soon transpired that the ‘patient’ simply wanted to be assisted from one chair to another and had pressed her Careline button who had promptly sent for an emergency ambulance.
I usually have all the time in the world for an elderly person who has fallen over at home, but this time, my patience was wearing very thin…
2 comments February 7th, 2008
Okay, I’m back at last. I have just removed 2070 spam comments (as well as 8 genuine ones that slipped in there too - sorry guys!) and now I’m ready to go again (with an updated Wordpress and a spam filter in place, thank you very much WP-HashCash!).
A lot of stuff has been going on at my end, so blogging has been put on the back burner. But once again, I promise to write a lot more often (if only you got a pound for every time I’ve said that…)
Onwards and upwards.
5 comments February 7th, 2008
Read any ambulance worker’s blog and somewhere they will be whinging about ‘maternitaxi‘ cases. For the uninitiated, this is where a woman who has had the past 40 weeks to save for a taxi suddenly decides she requires an emergency ambulance to take her to hospital, saving around £6 in taxi fare (cost to taxpayer for ambulance call out: approximately £300).
Cue one pregnant woman, 5 days overdue (so she had another 5 days to save up). Her waters hadn’t broken, contractions 5 minutes apart, and as this wasn’t her first baby, she knew full well the baby was a while away yet. She had already had a lesson on appropriate use of the ambulance service - well, her husband had, she spoke no English - before she walked onto the ambulance. As she was sitting down, and her husband was with her, the ambulance radio started speaking:
Metro Control to all mobiles, all mobiles, priority call: outstanding cardiac arrest, Smalltown. No vehicle to respond. Any vehicle able to respond or render aid, please call up, Metro Control standing by.
Silence.
The cardiac arrest was within a short distance of where we were before we went on our ‘maternitaxi‘. Frustrating to say the least.
16 comments August 29th, 2007
“It’s okay, he’s stopped breathing now.”
Correct me if I’m wrong, but since when has it been okay that a person has stopped breathing? This is how I was greeted at a nursing home when responding to a ‘severe respiratory distress‘ call.
There was no ‘do not attempt resuscitation’ (DNR) order in place for the patient and from what we could immediately gather, this was not an imminently expected death so after moving the patient from the bed to the floor, we began CPR (you cannot do effective CPR on a bed). The patient was asystolic - had no electrical activity left in his heart whatsoever - but with drugs and good CPR this is occasionally reversible.
It was at this point I noticed that the so-called ‘carers’ had left the room before we moved the patient and had now returned, surprised to find resuscitation in progress (ironically often abbreviated to RIP). One of the biggest difficulties with a resuscitation is deciding whether to actually start CPR or not. We have very specific criteria with which to make our judgement with, but to make this judgement requires obtaining some sort of history and often this is difficult due to relatives/bystanders being understandably distressed. However, the yes or no decision needs to be made in an instant - it’s no point spending 3 minutes obtaining a history and then deciding whether the resuscitation effort is viable or not.
It was at this point we had our first opportunity to get a history. It turns out that the carers had seen the patient in the lounge area ‘breathing funny’. They went to get him a cup of tea and returned to find he had stopped breathing. Not wanting to cause distress to the other residents, they had then left him, found a wheelchair, transferred him from the chair he was in to the wheelchair, took him to his room, transferred him into his bed, tidied the room up and after all that, thought to call for an ambulance. So add this time on to the time it took us to get to him, and we have well over 15 minutes since he was last known to have been breathing.
This is itself is enough criteria to confirm the patient dead immediately, but this information wasn’t readily available to us when we arrived. Add to this that when the nursing home called, they did not tell the call taker that the patient was dead, but merely said he was having breathing difficulties - which implies to us that his breathing has stopped since the call was made, which would have made a resus effort viable.
So yet another tale of gross negligence and lack of care from one of a growing number of these uncaring institutions.
5 comments August 25th, 2007
When a call comes in for a cardiac arrest, control do their best to send two ambulances, or at least one ambulance and a responder if we’re a bit stretched. Extra pairs of hands are very useful!
Everyone pitches in with the resuscitation effort and when it comes to moving the patient to hospital, we load them on to the most appropriate ambulance. Let me explain. All ambulances are, in theory, the same. But it depends on a number of factors as to which one we use. It one is a paramedic crew, and the other isn’t, we’ll probably use the paramedic’s ambulance because he/she will know where everything is, and is the person who’ll be helping the patient the most. Otherwise, it’ll normally be whoever got there first. In the past, I have known these ‘rules’ have been broken for various reasons. Once, the side door broke off and stuck open. Another time, someone (me!) thought they had lost the keys to the ambulance so the second one took the patient. Of course, when I went back to grab equipment, the keys were beneath where I had been kneeling to do CPR!
So once on the back, more hands are still needed, so one person drives, and two people will go in the back with the patient, leaving one person to drive the other, now empty, ambulance to hospital to reunite with the other crew member. This is also a good means of transporting relatives to hospital. They don’t see what’s being done to their loved one, they don’t get caught up in the blue light driving to A&E and hence they arrive after their loved one has been safely transferred to the hospital bed and worked on by the swarm of doctors and nurses waiting.
Quite a few times recently, for no particular reason, I have ended up being the driver of said empty ambulance. The relative will sit in the front passenger seat and is more often than not the husband/wife/partner of the patient. This makes for a difficult conversation on the way in. I always feel obliged to make conversation with these people, as I can only begin to imagine what is going through their mind’s. Often, people want to talk about what they did before we arrived and if it was the right thing. Others will talk about what a surprise this has been to them. Others still will want to talk about something completely different, seemly unaware of what is going on (I realise this is some people’s coping mechanism).
Subjects I have talked about before include the weather, where they have lived, what work they have done and holidays. The latter I once found to be a mistake, so never mention this one now since a woman burst out into tears when telling me she was supposed to be going away the very next week with her husband.
The other difficult situation is the prognosis of the situation. It is hard not to give false hope to the relatives because I know the chance of survival is slim, less than 1%, yet I do not want to tell them their loved one is dead because 1.) the front of an ambulance is not the place to do it, and 2.) as I said before, there is that less than 1% chance that I might be wrong.
Whilst it’s not the nicest of things I have to do at work, I like to think that these conversations make the process just that little bit easier for the relatives. I once had a relative thank me for keeping their mind off what was going on, so now I make an extra special effort.
1 comment July 18th, 2007
“I was stabbed about six months ago” explained the patient.
“Right. So where were you stabbed?” I enquired.
“In the bathroom” replied said patient.
Never mind.
5 comments July 10th, 2007
I didn’t realise it had been so long since I last blogged until I visited to write this entry. I knew it had been a while, but I at least thought it was in June… I could offer tens of reasons for not blogging, all of them trivial, but I knew it was too long when Alexis left a message in the last post checking I’m alright! I shall make posting a bit more regular now, I promise.
It was about 4pm, we were called to a 65 year old woman who was having chest pain, with verified normal breathing. The details we were given were sparse, so as with any chest pain I go to, we took the monitor (portable ECG & defib) and oxygen bag (which also contains some vital drugs) up the stairs to the patient’s flat and range the bell. After about a minute, the patient came to the door. As soon as the door opened, I knew this was the ‘real deal’. She was deathly pale, almost grey in colour, with sweat dripping down her face and breathless. We sat her down on the nearest chair.
“I’m so sorry to have troubled you” she said in an Irish accent.
“Not at all,” I replied, “tell me about this pain.”
By now, the oxygen was flowing, the ECG was connected and her blood pressure was being taken. All of her signs and symptoms were pointing to a ‘heart attack’. Once we knew her blood pressure was fine, we gave her a spray of GTN and an aspirin tablet. She insisted she walked down the stairs, but between us we eventually managed to convince her to be carried by us. We reasoned that because all her life she had paid her taxes, she had already paid to be carried down the stairs. If she walked, she wouldn’t be getting value for money. That was easier than saying “If you walk, it is likely to kill you.”
We were soon alerting the hospital to let them know we were coming so that they could get the cardiologists to A&E before we got there. Within minutes, she was taken down to the catheter lab for PCI.
I actually managed to follow this one up (not very often you manage to get to do this) and found she was discharged three days later and promised to stop smoking. These are the patients who keep me motivated when I am going to one pointless call after another.
4 comments July 9th, 2007
I have blogged before about the strange and not-so-strange things that people have searched for when finding my blog in the past, but these things never fail to amuse me, so I thought I’d post some more. It may even answer some questions!
Everything below is word for word what my hit counter has picked up, and these are genuine search queries that have resulted in a click to this blog. Enjoy!
birmingham red light district 2006
This is a favourite every month. Maybe this visitor was looking for some sort of red light district awards.
placenta curry
Another favourite. Use your imagination on this one, I try not to.
washing up liquid swallowing
Not the brightest of things to do, so don’t do it.
brain evisceration photos
I saw this for real a few weeks ago. Not pleasant.
cpr chest compressions rate 2007
The 2005 guidelines say 30 compressions to every 2 ventilations in adults.
home made curry like mum used to make
Sounds tasty, can I have some?
st john ambulance first responder flashing lights
Don’t get me started on this one…
john robertson
I’m famous! People are Googling me!
what happens in the ambulance on the way to the hospital
Depends what’s up with the patient. Anything from baseline observations, through CPR to a chat about the weather.
alternating flashing headlamps
Yep, we’ve got them.
lucy bus accident
Get well soon, Lucy.
is it legal have blue lights on my car? uk
Well what do you think?
nellie the elephant cpr
Glad it’s not just me!
bright red blood squirting out of wound
You might want to call an ambulance for that… Sounds like an arterial bleed!
elderly women cat urine
Yeah, they smell like that.
what are the step for an emergency call on a women who is going into labor?
Pick up the phone, call a taxi.
resuscitating of a pregnant women
Now you’re testing me! Wedge something under their back so they are at an angle of 30° so that the baby does not occlude the major blood vessels behind it.
an ambulance with lights but no sirens is carrying a dead body
Nope. We just don’t feel the need to use the sirens at that time. This could be because it’s the dead of night and we don’t want to wake people up unnecessarily, there’s no vehicles in the way or pedestrians likely to step out or just we’re going to a load of rubbish but have to put the blue lights on because we’re on the way to a call (very political topic at the moment).
how to commit suicide by carbon monoxide poisining
Make sure the car doesn’t have a catalytic converter.
easiest way to get british nationality for asylum seekers
Re-elect the current government?
what a driver should do when confronted by response vehicle on blue lights
Pull over to the left and STOP! (Don’t just slow down)
singing lessons screaming lessons birmingham
You can get screaming lessons?
what is it like to work in an ambulance
I hope you found the answer in my blog!
stop alzheimer s patients wandering off
Not a bad plan.
why is an ambulance called a bus
Because 70% of our customers could travel by bus.
what is an ambulance like?
Yellow.
do paramedics give injections
They do, and EMTs too.
chavs two fingers
My thoughts exactly.
headlice
Nice.
persons reported fires
Is what a building fire is called when there is reason to believe there is someone inside.
why do people leave a&e without being seen
Because they get there thinking all their problems that they’ve had for 3 years will be solved until they get triaged and find they have to wait for 4 hours. If they were really ill, they’d wait…
amount of elderly patients taking up hospital beds in uk
Do you suggest a cull then? Did you invent MRSA and C. Diff.?
jogging on the motorway illegal
Probably - can you think why?
can paramedics use the siren after 11 pm
Yes. The exemptions state any time.
what do compressions look like on the monitor?
Like a sine wave normally.
mother keeps me still in school uniform
Time to leave home me thinks.
17 comments May 26th, 2007