A routine call on a Friday night to a pub. Not an unpleasant pub, just to a twenty-something year old guy who happened to get in the way of the bouncers while they they ‘ejecting’ someone. His slightly unbalanced, slightly intoxicated gait resulted in a rather hard landing on the corner of a wooden box causing an unexpectedly large wound to his lower back.
Injuries aside, the amusement came from the journey into hospital:
Me: So, are you working at the moment?
Patient: Yeah.
Me: What do you do?
Patient: I’m a groundsman.
Me: Ah right.
Patient: Do you work?
Me: Umm, yeah, I’m a paramedic…
Patient: Ah right.
Yet again, I make a promise to blog more. Yet again, I’ll probably disappoint…
March 24th, 2010
I knew there would be something that would make me return to this thing. Something big, that I’d want to vent about. Or perhaps something reflecting on a past post.
You see, when I come across something I want to blog about, I always think to myself I’ll write about that in a few months or so in an aim to retain a little anonymity (I have read the Tom Reynold’s ‘How To Blog And Not Lose Your Job‘ - several times). But of course, a few months later they have passed into the depths of my mind and any inclination I had to write about them originally has long since departed.
But swine flu would appear to be the impetus I needed to log back in to Wordpress and actually write something. Of course, the piggy flu pandemic seems to have made every other blogger appear from the woodwork and write too.
Most people in this job get annoyed with the time wasters. The people who call an ambulance when there really isn’t anything wrong with them. In all honesty, I’m really not that bothered by them. I see them as job security - my ambulance trust is recruiting several hundred people this year, and there’s unlimited amounts of overtime available. Just the other night I spoke to someone who has worked every single day for the past three weeks.
Despite all this, people who are calling about swine flu are getting to me now. At first, I admit it was quite fun to dress up in all the protective gear, but now it’s really starting to become a nuisance. I am probably seeing between 4 and 8 people a day with flu-like symptoms. Most of them don’t actually want to go to hospital, they just want to know if they’ve got it or not. I must admit that I do find this quite puzzling. What’s the big deal if you have swine flu or not? Just because it has a fancy name, hyped by the media, doesn’t make it any different to normal flu. In fact, from all the people I have seen with it, swine flu is nowhere near as bad as normal flu.
Entire families are calling with identical symptoms, and the first question out of their mouths is ‘have I got swine flu?’ Based on the fact that your six-year-old child’s school has been closed because there has been an outbreak there, said child is showing symptoms and now you are, what do you think? The HPA (in Birmingham anyway) are no longer swabbing suspected patients, so all I am going to do is take a guess based on your symptoms and the contact you’ve had - all things that you already know… because you told me them. So now I have to fill out an A3 size form for each member of your family, while taking a full set of baseline observations (blood pressure, temperature etc.) and passing the details on the ‘flu cell’. After that, all the equipment we took in has to be thoroughly cleaned, so one family of people sniffing and coughing has taken a frontline ambulance off the road for a minimum of 2 hours, as well as exposing both crew members to the virus.
At one house I went to, no sooner had I uttered the words “based on what you have told me, the likelihood is that you have swine flu“, but someone behind me grabbed their mobile phone and excitedly informed someone else that Dave has got ‘The Swine Flu’.
In all honesty, I don’t know where I am going with this blog entry. I’m not going to lecture you what to do about Swine Flu as you are all educated enough to know better. This is probably a good place to stop…
July 8th, 2009
There’s rarely a week that passes without going to a ‘nan down’. An elderly person, normally female, who more often than not lives alone and has fallen over at home. In recent weeks, I’ve been going to 3 or 4 or these a day for some reason.
Some people hate them, but I’ve got all the time in the world to go and pick someone off the floor, make them a cup of tea and listen to their life story. In the past week alone, I’ve heard tales of late husbands who were on the beaches of Dunkirk, gentlemen who were sent to Berlin on D-Day and so on. I consider it such a priviledge to be regaled with these stories of first and second hand living memory, which won’t be around for much longer.
But not all falls are straightforward. Sometimes there’s no way in and it’s the crowbar’s time to shine. Others, the victim of the fall has sustained sometimes serious injuries, such as a fractured neck of femur. Occasionally, you get patients who for very different reasons are unable to get up.
Cue one elderly lady and the church warden. The church warden hadn’t seen Daisy for several days and when she arrived, she thought Daisy didn’t look too well. ‘I know what Daisy needs, a good bath’, so the kind church warden set about running a nice warm bath for her and Daisy willingly obliges, getting in with a little bit of assistance.
Once Daisy had had a good soak, out comes the plug and it’s time for Daisy to get out. This is the time at which me and my observer arrive to find Daisy stuck in the bath.
“How do you normally get out of the bath?” I asked, hoping for some insight into how we’re going to get this poor 80-something out of the bath.
“I don’t normally have baths because I can’t get out of them. I only normally have showers.” Daisy replied.
Until you have tried to get a fully grown adult out of the bath yourself, you will never appreciate how slippery they are (baths and wet people). Whilst my observer set about making the patient comfortable using her wealth of nursing skills, I arranged for an ambulance crew to come along with a special lifting device. A short while later, and after a lot of wriggling to get the cushion under her, Daisy was finally out of the bath.
Once she was all dried off and dressed, thanks to the church warden, we ensured Daisy had a nice cup of tea and a sandwich after some basic checks. I drive past Daisy’s house quite often and always wonder what she’s up to now.
December 29th, 2008
Every month I get several people coming to my blog after searching for something like “what does it mean when ambulances have flashing lights but no siren?” or “ambulance lights flashing no siren dead?” - these are actual searches that pointed to this blog in the past three weeks.
I have never actually heard anyone say this, but there is obviously a misconception that ambulances which are driving with blue lights on and no sirens are transporting a dead body. There are a number of reasons why this would never be the case, let me explain as many as I can think of:
1.) First we need to define dead. Medically, a person is dead when their heart is not producing a perfusing rhythm. In other words, if it’s not pumping (enough) blood to sustain life, the person is dead.
2.) But death isn’t as easy as that. Death has to be confirmed or pronounced (there’s a difference) by a medical practitioner qualified to do so. Ambulance service clinical staff can confirm death (recognition of life extinct) in specific circumstances. If we believe there is a chance that a recently deceased person could possibly be ‘brought back to life’ (or resuscitated), this person is medically dead, but not legally dead. This is when we start doing CPR, and alert the receiving hospital with ‘cardiac arrest, resus in progress’ - ironically, the abbreviation used by ambulance control for ‘resus in progress’ is often RIP. In these circumstances, we will use blue lights and sirens to get to the hospital and won’t be sparing the horses.
3.) Persons who have been confirmed dead by the ambulance service are not routinely transported. The only place we would take them would be to the public mortuary (not a hospital mortuary). We do this following a death in a public place (e.g. a shopping centre), or from a private home when there is noone present who is able to take charge of the body and arrange a funeral.
4.) When we use blue lights and sirens, we have to be able to justify any traffic laws we claim exemption from. These are covered by the Road Traffic Act, and include such rules as:
“No statutory provision imposing a speed limit on motor vehicles shall apply to any vehicle on an occasion when it is being used for fire brigade, ambulance or police purposes, if the observance of that provision would be likely to hinder the use of the vehicle for the purpose for which it is being used on that occasion.”
Similar rules exist for red traffic lights etc., however, if we are transporting a body that we have confirmed dead to a mortuary, in what way would - for example - observing statutory speed limits hinder our journey? So why use blue lights?
5.) There is nothing in law that says sirens must be used at all times when blue lights are on. In fact, I do not believe there is anything in law that states blue lights must be used at all, as long as you can justify the exemption you were claimed. But you’d be ill advised to drive through red lights without blue lights on - all emergency drivers can still be prosecuted for Dangerous Driving, irrespective of the emergency.
6.) Attitudes towards sirens appear to vary between services. The police generally use sirens constantly throughout their journey. Our training officers encourage sirens to be used only when necessary. My emergency driving instructor would wind the window down if you left the sirens on for longer than required.
7.) Certain medical emergencies may require a quiet journey. A pregnant woman suffering from severe pre-eclampsia/eclamptic fits should be exposed to as little noise and flashing light as possible, but the condition is a serious medical emergency. Therefore, we close the blinds to ensure she doesn’t see any flashing blue lights and use the sirens as little as possible - but never to the point where we could compromise the safety of ourselves and other road users. Personally, my approach would be brief ‘beeps’ of the horn to alert a driver who hasn’t seen us behind them, resorting to siren use if they still don’t see us.
8.) Most people drive proportionally to the speed of response necessary. So if we’re responding to a 25 year old who has had belly ache for three weeks, we won’t be driving particularly fast - but current ambulance service policy states we must have blue lights on. A policy which only came about in 2006 and is a bit of a contentious issue.
So there you go. Ambulances driving around with lights but no sirens could be doing so for many different reasons, but you can be fairly certain there is no dead body on board!
August 25th, 2008
This post contains language which may offend some readers. It has been quoted directly from the aggressor and its absence would detract from the scene which the incident occured in.
The abuse of NHS staff has been quite widely publicised recently. You don’t have to look hard to find stories like this, though it is unusual for anyone to receive a sentence for it. It nearly every case where I have been threatened, verbally abused or otherwise, it has not be by the patient, but a relative, friend or somebody completely unrelated.
The most common trigger point for threats and abuse seems to be caused by simply blocking the road with the ambulance. In some areas, it is impossible to park in a proper parking area so sometimes we have to seemingly abandon the vehicle in the street. If only people would understand that we only block the road because we have to (and legally we can). I know of crews who have been physically assaulted by upset drivers who have something far more important to do than us; I have been threatened with assault several times, including this week.
Whilst attending to a 2 year old child who was fitting, the front door of the house burst open and in the doorway appeared a driver whose route was being blocked by our ambulance. “Move your fucking van before I move it for you” he balled, staring aggressively at the crew member nearest the door. “There’ll be a fucking emergency out here if you don’t shift it, prick“.
He stormed out of the house, and we simply closed the door behind him and locked it. I took no notice, having heard it all before. Walking out of the house, I openly wrote his number plate on my glove while the crew loaded the patient on to the back of the ambulance and went about my business as if nothing had happened. The driver kept sounding his horn, but apparently felt enough restraint to stay in his car.
I expect no different any more.
August 19th, 2008
I appear to have written a grand total of seven posts in the past twelve months. I will write more, it stops Merys Jones bugging me to post anyway!
August 16th, 2008
I make no secret of the fact that I have a very short attention span. I get bored of things very quickly (interruptions in blog posts?!), and this is why I love the job that I do. No two days are the same, and it is unusual for me to be with the same patient for more than an hour. The other day, the entire spectrum of the job becomes apparent.
9pm on a very hot summer evening. The phone rings and I hot foot it to a cardiac arrest just down the road. There I find a 95 year old woman who hasn’t been seen for the past 5 hours. She was found collapsed on the floor, and the family put her back into bed - please don’t put dead people back into bed when you call us, we only have to put them back on the floor for resuscitation and that wastes time. This lady was beyond our help though, leaving me to sit in her bedroom in the sweltering heat filling out the paperwork. To top things off, she also had the heating on, leaving the room well in excess of 30°C.
Back into the night and after a few more jobs, I went back to station for my break. I am yet to find an ambulance station that has a cool mess room, so sitting on the step down the side of the station I tucked into my multitude of sandwiches and fruit, enjoying the refreshing 2am breeze.
A little while later, the phone rang again and I was off to a pregnant woman having contractions every two minutes. I did all the normal checks for a woman in labour, and the called control to find out if there was an ambulance crew on the way to me. Standing in the sweltering heat, I looked out the open window when I heard the familiar sound of an ambulance engine stopping outside. Ambulances have a very characteristic noise - think of a diesel engine, then think of one that has done over 100,000 miles and has spent a considerable number of those being driven like it was stolen and you’re coming close. I saw the shadows of the crew climbing out and heard the doors close, only to look back at mum-to-be and notice something wasn’t quite right. A lump had appeared in her pyjama pants, yet the patient appeared to be in no more pain than she had been five minutes ago. I decided I better take a look at what was going on, something I prefer not to do - especially when I’m on my own - for fear of getting wet let alone anything else!
As I feared, the back of a baby’s head was pretty much delivered and I was just in time to see the restitution of it, something I have previously heard described as something out of Alien. ‘Okay, so restitution is a good sign’, I thought to myself. I clearly remembered my obstetrics and gynaecology training that said failure of the baby’s head to restitute was a sign of forthcoming shoulder dystocia - and that was a bad thing! The rest of the baby quickly plopped out in the usual less-than-dignified manner and started crying. Moments later, the crew were with my clutching a maternity pack (cord clamps, scissors, towels etc) and went about drying the baby off and handing him over to mum.
It’s not very often you see such extremes as that, but occasionally you do have to be a Jack of all trades…
August 13th, 2008
“I woke up and I was too hot” said the 70 year old woman stood in front of me.
It was 3am on a warm July evening. She told me that she didn’t normally feel the heat and had never woken up hot before. Looking at her bed, there was a winter duvet pulled back from when she got up.
I checked everything I could, and found nothing wrong with her. Even her temperature was normal, yet she still insisted on going to the hospital “just to be on the safe side“.
She could be sure of a long wait in A&E…
July 7th, 2008
“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…
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.
February 10th, 2008
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