Thursday, 24 December 2009

Holiday Handover


Due to an incapacitated MrsInsomniac, and an overworked and ever more underslept Insomniac, I have been extremely lax in promoting the latest Handover Carnival. It has been expertly and brilliantly hosted over at Ambulance Driver's site, and I thank him for including one of my posts along with so many other terrific pieces. In the spirit of AD's musings, I wish you all a happy, healthy and peaceful holiday season.

Tuesday, 22 December 2009

Prayers Answered?

Conversations with patients and their relatives often turn to the weird and wonderful whilst waiting, ever longer, on scene for an ambulance. Ambulances are scarce at the best of times, but especially at this time of the year.

There's an absurd fascination in this wintry weather with attempting to stand on that frozen stuff on the ground and see if it really is slippery, and really does make you fall over, and really makes you break your arm/leg/hip. Let me help. It is. It does. It will do. So unless you absolutely have to - don't. Enjoy the view from the window, hot chocolate in hand, heating all around. Don't get me wrong - I fully understand, appreciate and endorse the need for building snowmen. And snowwomen, if you prefer. But stay off the ice! (The publication of this blog has been delayed due to MrsInsomniac doing precisely the opposite...)

Anyway - I digress.

Marik was one of those I'd term the "Worried well". He bought himself a blood pressure machine, just in case. And he had an hour-long head-ache, so he checked his blood pressure, which was fine.

Which worried him. So he took it again. And it went up.

Which worried him more.

So he took it again, and up it went, and he panicked. A little.

He spoke to the doctor on the phone who told him he was having a CVA, or stroke. Thanks Doc.

Well, that was it. Full scale panic. The FRU (aka clock-stopper), was sent, with the promise of an ambulance as soon as one became available. It may be a while. A history was taken, observations checked and found to be in perfect order, advice was given, and a request to be taken to hospital made. For various reasons I was unhappy about taking him in the FRU, so we'd have to wait for the snow/ice/leaves-on-the-track delayed ambulance to arrive and convey.
Whilst passing the time of day, I have a good look around the room and check out all the books. I have a bad habit of doing that, as it gives me a very good clue as to who the people in front of me are. I find that you can learn a lot from books, and not necessarily just by reading them. I see books on all the sciences, especially physics and maths. Books about stars, planets, discovery, the world, and its place in the universe.
Then I see bibles. Dozens of them, in a dozen languages. Shelves of them, 3 books deep, each shelf holding one of the languages. I'm a little surprised. Not at the fact that there is a bible in the house, but at the sheer volume and variety. I'm forced into a corner. I try not to show my curiosity/nosiness or whatever you want to call it, but on the other hand, I have to ask.
"Do you sell bibles for a living?"
"Well, in a way, I guess you could call it that."
"OK. What do you mean?"
"As you ask, I have to be honest. I don't like to tell everyone, but I'm a Prophet of the Lord!"
Now, how do you respond to such a statement? I want to say "A What???" or "Are you sure???" or, probably less appropriately, I want to shout "What the hell are you on about???" I didn't say any of them. I was much more profound.
"Oh", I said. For good measure, I think I even added an "I see".
Then he went on to talk about how he uses his knowledge of science to help him spread the word of God, help him understand, help him make the world a better place. He told me how he received his information, how he knew what to teach. He told me about the messages he received. They were the equivalent of the Twitter Direct Messages. @Prophet. @God. Cool. Wish I had that sort of inside information.
I also wondered if he'd been sent to help out an old friend of mine. I wonder if his prayers have finally been answered.

Thursday, 17 December 2009

Someone, Somewhere...

...has been paying attention to what the workforce on the frontline has been saying for ages. You never know, we may actually have been right!

I know, it's not all as straightforward and simple as we'd like, but there has to be talk about the system. It isn't some sort of sacred cow that can't be criticised, and should be open to debate, investigation, and change.

Here's hoping.

Shock Tactics

It's a change in behaviour that we need to aim at the younger, grass-roots members of society.

Before they start exhibiting that behaviour.

Maybe, just maybe, this is one way of doing it.

Good Luck.

Wednesday, 16 December 2009

Anonymous

Dear All,
I have been toying for some time with the idea of blocking anonymous comments on the blog. Whilst I want to encourage conversation, I find it difficult to respond when, for example on the last post, there are FIVE anonymous comments. And then debate begins between them. So, in order to not turn away those who wish to hide, I haven't blocked them. Yet. But...
I'm now starting to moderate every comment that comes in, and every comment that doesn't arrive with at least initials at the bottom of it, be they real or even fake initials, will be rejected. You can use nicknames, daft names, real names, whatever (within reason please), but you must use at least some form of identification.
In the meantime, please keep reading, commenting, and debating.
Thank you!

Tuesday, 15 December 2009

Sim's Card

All around, festive lights are flickering. On trees, in windows, in truck cabs and shops. Some windows have candles alight. It seems that everyone needs some extra light at such a dark time of the year. The short days bring only temporary respite from the long nights. Even then they're merely a dim glimmer of hope, the cloudy skies preventing the sun from breaking through and showering some of its warmth. For so many, this time of year, far from being a time of joy and family gatherings, is a time of loneliness, fear, and heartbreak.

Having never before had the need to break into a house, I found it a difficult decision to make. It had always been the police's job to break doors down. This time they had no units to send, and the report I'd been given was one of a child, possibly a baby, crying continuously. The call had come from a concerned neighbour, who'd heard crying when they went out for the evening, and had returned hours later to still hear the same noise. There were no lights on in the house.

As we arrived (I was in the FRU (fast response unit), but had an observer -a nurse turned medical student- with me for the night), we could hear the whimpers through the letter box. We called, yelled, banged on the door, rang the bell, all to no avail. No lights came on, no curtains twitched, no movement. Throwing caution to the wind and cursing Health and Safety rules, I looked at Beth, my observer, told her she never saw a thing, and broke the door down with two swings of an oxygen cylinder. Note for future reference - they make damned good battering rams.

The first light switch clicked ominously like an empty rifle. No flash of light, just an echoing click. The second did the same. As did the third. I went back to the car and found a torch, and carried that and the newly redefined oxygen cylinder as self-defence. Just in case. I had a quick look up and saw that none of the light fittings had any bulbs in them. We searched every room, and tried to follow the sound of the cries. It was like trying to find the end of a rainbow. Every time we thought we'd pinpointed it, it seemed to move, and we started wondering if we were actually chasing a cat rather than a baby. Ominously, after a few minutes, the noise stopped.

Having found nothing downstairs, other than a framed photograph of a soldier standing proudly in dress uniform, we started up the stairs, a double flight, with a small landing half way up. The darkness seemed even heavier here, the torchlight making minimal difference. In the dull glare of the torch I checked the first set of stairs, skipped the landing, and looked directly upwards. My heart rate doubled and I could feel the sweat starting to build as the adrenaline pumped itself round my slightly terrified system. I still don't know why I kept going, rather than waiting for back up, either in the form of another ambulance or the police. Stupidity rather than bravery, I assure you. Reaching the top of the first flight, and stepping on to the landing, I tripped over a boot, and yelled in fright. The boot was attached to Sim.

Sim looked like a ghost, a pale, almost skeletal ghost, hands nothing but skin and bone, terrified, wild, bloodshot eyes sunk deep into his head. He was cowering in the corner, legs folded up into his chest. Then the tears streamed, and the all-too-familiar cry that we'd heard from outside returned. Sim was no baby, or child. He was a fully grown man, looking decades older than the mid-30s that he was, a shadow of what he probably used to be.

He wouldn't, maybe couldn't, talk for a long while. I'd informed control that we'd found him, that there was no child involved, and they in return told me that they had no ambulance to send, and that the police would be at least an hour as well. Beth and I were ready for a long stay, unsure of what to expect. We asked questions, made statements, promised help, if only he would talk to us. Beth tried to put an arm around his shoulders, a gesture that at first he repelled, horrified, but then accepted with a look of desperation. Sim cried into her shoulder for a full ten minutes, before at last regaining some composure, and whispering a barely audible "Sorry".

We talked some more, Beth and I, while Sim would only answer by nodding or shaking his head. There were intermittent sobs, long silences while we searched for the right questions to give us the answers we needed. The photo downstairs eventually registered in the recesses of my mind, and I realised that this shadow was once that same proud soldier.

"Is that you? In the photo downstairs?"

A nod of the head confirmed my suspicions.

"I was a soldier once. Miss it too! Miss the friends, the closeness, the action. Would go back tomorrow if I could." I told him a little of where I was, what I'd done, what I'd seen, and what it meant to me. Slowly, the tears dried.

For the first time, Sim looked me in the eye. I'd found it. The connection we needed. And then he talked. For the next 20 minutes, uninterrupted, he talked, and we listened. About the Army, about his life without it, about the injury he'd received that meant he could no longer serve his country. He spoke of the nightmares he has, the flashbacks, the friends he'd lost. He told us that the Army was not only his life, but his friends, his family, his support. He cried about being jealous of his friends who were still serving, how they couldn't visit him while they were away on a deployment. How he was left all alone, now that they'd been away for three months. He had no food, no electricity, no money, and not a soul in the world to turn to. He couldn't bring himself to leave the house, the thought of the outside world terrifying him. Tonight was the night he was going to end it all, but he couldn't bring himself to do it. He sat on the landing and cried for hours, until we arrived.

We talked some more about how we could get him some help, and reluctantly he'd agreed to try. He'd come to the hospital, talk to the doctors, the crisis team, the social workers. He made no promises about succeeding, but at least he'd give it a go. "At least I'll try to get to see one more Christmas."

Weeks later, and after a few days off, I returned to station for my next shift to find a card and an almost empty box of chocolates, just sat on the table. I looked in the card, expecting to see another "Merry Christmas" or "Happy New Year" message from a grateful member of the public, or maybe even from our management. Happens sometimes. Instead, it had two sentences inside.

"Thank You for understanding and saving my life. From one ex-soldier to another".

Sim's chocolates were gone.

Sim's card is still safe.

Hopefully, Sim is too.

Sunday, 13 December 2009

Wednesday, 9 December 2009

GD

Chaos.
Smashed glass.
Fuel all over the place.
Unconscious, probably drunk driver.
Lots and lots of bystanders who all come rushing out.
*****
I'm always amused by the fact that when attending the scene of a serious RTA, as this one was, there are people who still insist on waving frantically to show the ambulance where to go. I mean, do you really think I can't see the upside down car with the steam pouring out of it? I know, I know they're only trying to help, so I shouldn't really complain, but still. It's weird.
One of the bystanders, we'll call him GD (the reasons will become clear shortly), comes over to tell me proudly that he and one other person dragged / assisted the driver out of the upside-down car, and after a few seconds of drunken yelling and thrashing about, he collapsed into an unconscious heap, where I found him.
GD then stands watching me and talking to me as if I'm his best friend. I complete an initial assessment, sort out a collar, some oxygen, do some basic obs, and assess for any immediately life-threatening injuries. None are apparent. Had he not have been drunk, this would never have happened, but the fact that he was, probably saved his life. Ironic really.
The whole of the local fire department turn up, and look sorely disappointed when the car wasn't on fire as had been originally reported. Apparently. They're closely followed by the ambulance. We package our drunk friend, who's starting to come round a little. Frankly, it was easier when he was unconscious and wasn't claiming to be one of several Hollywood heroes whilst fighting everybody off.
The ambulance leaves, and as I start my paperwork, I'm left watching the fire brigade turn the car back onto its wheels and then sweep up the mess. A voice behind me startles me a little, and I turn round to see GD standing there, proud as a peacock. "You don't remember me, do you?," he says. "You were at my house six weeks ago!"
I search the recesses of my brain but in the chaos can't place him at all. He must have seen the blank look on my face. "You were at my house", he adds, "for something completely different. Just as messy, though. Don't you remember? You delivered my... "
"Grandson!" we both said, simultaneously.
I'd delivered his grandson not two months previous, in the house right by the scene of the crash. I knew the house looked familiar.
"Don't you remember? I floated round the house yelling to everyone on the street: I'm a GrandDad! I'm a GrandDad!"
Cue huge grin.
Oh yes, GD. I do remember.

Tuesday, 8 December 2009

Ever Before


She holds her eldest child close.

Closer than ever before.

Her sobs are pained and silent.

Quieter than ever before.

She needs him as he needs her.

More than ever before.

They've said goodbye to the baby.

They'd not said it ever before.

Sunday, 6 December 2009

Used and Abused

With apologies to, well, everyone. You really probably shouldn't read this either on a full stomach or an empty one. It's 3 in the morning, and I can't sleep. Again. And I can't use work as my excuse this time. The news is showing endless loops of drunks in public places, private parties, and excruciatingly humiliating themselves. It's led to some sort of worrying muse. However - I have to say, hats off to the boys and girls who man (sorry) the Booze Bus. I don't know how you do it.
*****

The Season has begun.
You know what must be done.
You must go to the office do,
And start off at a run.

To drink all that you can,
Will show you're such a man.
It's just the greatest thing to do,
From pint, to glass to can.

You'll vomit like a tap,
Wake up and feel crap.
Won't remember a single thing,
Was it worth it, dear chap?


No connection - brain to feet,
You'll fall down in the street.
They'll call for you an ambulance,
That has someone else to treat.

You really couldn't care,
Whether it should be there.
The ambulance is there for you,
So your vomit you can share.

We'll cart you in the back,
You'll shower us with flack.
Both words and stomach contents,
A hurtling attack.

You'll wake in A&E,
Desperate for a wee,
And do it in the cubicle,
"The bog's too far for me!"

That's how you'll end your night,
In bright fluorescent light.
A black mark on your record,
And your friends nowhere in sight.

And the crew that you abused?
They're feeling somewhat bruised.
We really have much better things,
For which we should be used.

Thursday, 3 December 2009

Swings

I like swings.

And roundabouts.

And slides.

But I don't like swings.

So please don't take one at me. I won't take to it kindly.

Thank you.

Monday, 30 November 2009

Five Days

I don't do pets. Never had a pet. Don't understand why you would. Never had to feed a cat, clean out a litter tray, walk a dog, or even open a tin of dog food. Nothing. It's just not me. Don't mind other people having them, but won't ever have one myself. And wouldn't know what to do if I did.
*****
Five days. They didn't know that at the time, but the newspapers on the doorstep gave it away. As did the calendar with the changeable dates that was still showing the date from the weekend before. Gladys had been on the floor for five days. Unable to summon help, she remained trapped between the bed and the chest of drawers where we eventually found her.
"Oh, you found me then", she said. I felt like I'd just closed my eyes, counted to twenty, and started to seek whilst Gladys hid. She was in surprisingly good spirits for someone who'd been stuck on the floor for so long. In a warped sort of way, she'd been lucky. She fell as she was holding a bottle of water, so she had that to keep her going. But still. Five days is a long time on half a litre of fluid.
She was another one of the stubborn generation, but this time, a lonely one. She refused any offers of help, had no carers, no emergency lifeline to call. Most distressingly, she had no family either. Her neighbours did what they could, but she would hardly let them in, either literally or figuratively. It was, eventually, one of these neighbours who noticed the post box was overflowing, and decided to call for help.
These sorts of calls fill me with no small amount of concern. All too often we enter to find that there is nothing left to do. Nobody to help. Only coroners' arrangements to make. This time, there was a yell from upstairs, closely followed by a whimper. Gladys was sat on the floor, where she'd been for the whole five days, unable to lie or stand. Only sit. So she had slept, read, drunk and chatted where she fell. The yell obviously belonged to Gladys.
The whimper belonged to her conversation partner. There he was, laying next to Gladys, guarding over her. "Only ever left me to get some water, he did. Probably drank from the toilet. He's kept my mind busy. Knows a lot about the ancient philosophers he does. He turned on the telly and found out the weather report for me every day too, just to keep me up to speed. Amazing how much you learn from a well-read dog! The conversation's tailed off a bit though. He's probably hungry, he hasn't eaten for five days and can't be bothered any more. Anyway, he probably thinks I'm barking mad."
I can't help but laugh. She fusses his head and then looks back up at us, eyes smiling and full of mischief. "How long have you been down there then?" I finally ask when I'm able to get a word in, both of us aware that I probably know the answer.
"Oh, seen more than a couple of sunrises, missed a couple of loo appointments, must be five days at least. I tried yelling, but no-one hears you round here. Too much traffic. Wasn't like that when I first moved here. No cars then. Only bicycles and the odd milk float. You try being nice to everyone but eventually you just don't know who anyone is any more, so you stop. They're all nice round her, they offer to help. I'm just too head-strong. You know how long I've lived here? 60 years! Can you imagine! That's probably three times your age... Can you understand that? I bet you can't!" I thank her for making me much younger than I really am.
She talks like someone who hasn't spoken to a soul for five days. In the meantime I check her basic observations, which all seem to be healthier than mine. One of the neighbours helps me get her off the floor and we change her out of the clothes she's in, clean her up a little, and get her ready for a dignified journey to the hospital. If for no other reason, it'll give the system time to catch up and find her the necessary help, should she finally choose to accept it.
The ambulance arrives and Gladys is carried down the stairs and gives out orders like a queen sitting on her throne. "Will you make sure the doors are locked?" she asks one neighbour. Another is ordered to turn out the lights, and a third is instructed to tidy the post and the newspapers. "So I can get back in here later", she adds.
"Oh!" she suddenly yells and points at me as we're loading her into the ambulance. "It looks like he likes you. Can you make sure he gets fed some dog food?"
You couldn't pick on someone else? A pet lover maybe?
Oh well. First time for everything I guess. After all, it has been five days.

Saturday, 28 November 2009

Close Calls Handover


The Close Calls Handover has been posted over at Happy Medic's HQ. As always, the Handover makes for some good reading. There's even an honourable (and I'm duly honoured) mention in dispatches for your local Insomniac.

Go.

Read.

Be inspired.

And, as always,

Stay Safe.

Wednesday, 25 November 2009

Armchair

"Oh - it's you again". Sometimes it's a phrase said with genuine affection. Sometimes relief. Sometimes it's just downright disdain.
*****
"Armchair", you grunt, as an afterthought to the opening phrase.
Well, yes. It is me again. And again. And again. I keep coming back here when you've had enough of another one of your clients. But this time, I can bite my tongue no longer.
This time, you left her in the armchair, in front of all the other residents, for a whole day. And night. And most of another day. Almost 36 hours, and none of you thought to check on her.
You just "assumed".
You just thought "she doesn't do much usually".
You just presumed "she was in one of those moods".
None of you thought that it was unusual that she hadn't asked for help to get to meals.
Or back to bed.
Or even to the toilet.
Three shifts went by, and she was still sat in the armchair.
When you finally took a look, you saw she was barely breathing.
You saw she was covered in vomit.
You smelt the strong smell of urine.
So you told her off. Like she was some sort of small child.
Like it was her fault that she'd possibly been unconscious for the best part of two days.
Like it was her fault you ignored her.
Well you know what? It's your fault. Your job is to care, to pay attention, to tend to needs. That's why she was there, so you could look after her. That's what you have chosen to do. That's what you're paid for. So don't tell me that you're "not paid to think, just to clean them". The "them" you refer to are people. Not animals or the cages that they're kept in.
You were charged with her welfare, when she had no where else to look, and no one else to turn to. And you failed.
And I hate to say it - I get the feeling you're almost glad.
Glad that she's taken off your hands.
Glad that you're no longer responsible.
Glad that she'll probably never return to that armchair.

Sunday, 22 November 2009

Lifesaver

The darkness is compounded by the cloudy, moonless sky, the heavens showering down their vicious tears with all the contempt they can muster. At least it helps the house stand out like a beacon. It's the only one in the street with all the lights on, shedding some brightness on the otherwise depressing night. As I approach the house through the overgrown jungle that covers the garden path, the door is already open. Standing on the doorstep is Rita, leaning forwards, hands on her knees, struggling for breath. She can barely get one word out at a time.
Rita's man is there, comforting her, encouraging her, keeping her calm. He's doing a good job of it too. It's especially impressive, as Ryan is only 10 years old, and Rita's his mum.
"I'm used to it", he claims. "She sometimes gets very sick and I have to help her".
"Did you call the ambulance?" I ask him.
"Yup. I've done it before. They always ask me the same questions, so I know what to tell them now".
It's about 4 o'clock in the morning. Ryan is wide awake, dressed, has got all of Rita's medications together, and written down the details that we need. It took me less than 5 minutes to get to the call, so he's obviously well trained and very organised. His little sister is half asleep on the couch, still in pyjamas, but with her coat on, ready to go.
While I prepare the nebuliser for Rita, he tells me that his mum has bad asthma attacks sometimes, and that she always has to go to hospital. He was woken up by the sound of a loud wheeze, and knew immediately what he had to do. He'd got everything ready while he was still talking to the call-taker at control, all the while doing his best to calm his mum's anxieties.
Rita's condition and observations mean that she's going to need some aggressive treatment and to be blue-lighted into hospital, and there's no-one else to look after Ryan and his sister, so I'm left with the babysitting duties. The crew and I decide that it's best if they don't travel in the ambulance, as we don't want to distress them any more, so they watch mum being loaded into the back of the ambulance, stare as the blue lights of the ambulance reflect off the vertical sheets of rain, and then climb into the car and out of the deluge. I've got the duty of transporting them to A&E until another responsible adult can be found to look after them.
On the way there, they both remain calm, although Ryan's sister is a little teary. Ryan tells me all about the schools they go to, how he helps at home, how he looks after his mum. More importantly he tells me about the football team he supports, and laughs when I threaten to throw him out of the car for supporting a team that are the sworn enemies of mine. Although, I have to admit it, they're much better than mine. But then, most teams are...
We arrive just after the ambulance, and the kids say a quick hello to mum and see that she's looking a little better and in good hands. They're happy to find the kids' waiting area and go to find some toys. Ryan keeps up his role of babysitter and looks after his younger sibling, finding toys that he knows are her favourites. I watch from outside and am impressed by all I've seen and heard. At just ten years old, this young man is so much already.
Son, big brother, mini-dad, carer. And, of course, whether he realises it or not - a lifesaver.

Saturday, 21 November 2009

Mag-num-ificent!


This is my endorsement. Not anybody else's. Not where I work, not who I work with, not who I work for. There. I've said it. Now, for the review.

*****


I, along with several others on blogsphere, was asked to review a pair of boots. A Magnum, Ion Mask, pair. They duly arrived, free and beautifully packaged, a couple of weeks ago, and I decided to take my review very seriously.

First things first, they're huge! They're a much higher (no, I don't mean heels, I can't walk in them) than I'm used to. They also had no steel-toe cap, so I couldn't really test them at work, but I was determined to put them through their paces (sorry).

So I took them with me wherever I went for a few days, through all sorts of weather systems, doing all sorts of DIY, moving boxes, driving, walking miles, dealing with the kids. Whatever and wherever.

The idea of these boots is that they are totally fluid repellent, be that rain, oil or, as is particularly important in my job, bodily fluids. I thought it only fair to try this out too. A bucket of water, some torrential rain, and then a sandstorm later (I was away for a few days where they have sandstorms at this time of year...), and they seemed to be very much up to the task. I liked that. I also liked the fact that they were surprisingly light-weight.

All in all, I would highly recommend them. The only thing that concerns me, is the fact that I have an almost OCDish compulsion to have polished boots, and I wonder what that does to the the special Ion-Mask coating, and whether normal boot polish would ruin it. That's it. That's my only query/concern.

Otherwise, come on Magnum - bring out a pair with a steel toe-cap. I want them for work!

Thursday, 19 November 2009

Sleep is Overrated

This is what happens when you sleep.
Admittedly, not when you're in your own bed, but at the wheel of a truck.
Not recommended.
Although, seeing that as we rounded the corner made sure I was wide awake.
Told you sleep is overrated.

Sunday, 15 November 2009

Congratulations

You know what? I understand.
I understand that you have strong religious beliefs. And I respect that.
I understand that you have a long list of do's and don't's. And I accept that.
I understand that you'd rather not have a man deliver your baby. And I can deal with that.
But only because there happened to be a female paramedic with me.
What would you have said if there wasn't?
What would you have done?
Would you still have slammed the door in my face?
No. I don't know either.
Oh, and by the way -
Congratulations.

Tuesday, 10 November 2009

Growing Up

When I was a kid (the Boss will probably argue that I haven't got past that stage yet), I wanted to be all the things a normal boy wants to be when they grow up. A fireman, a policeman, a soldier, even a famous footballer. I have to admit that being a paramedic was no where in the line-up. Probably because I was the most squeamish person you've ever come across.
I did however, strongly consider becoming a train driver. At least I now know why I didn't go with that one.

Sunday, 8 November 2009

Close Encounters

It was dark. Probably because it was night.
It was cold. Probably because it was winter.
And I was lost. Probably because I didn't really know where I was.
But I did know that this wasn't an area known for its hospitality.
So far so normal.
*****
I'd been an EMT for about two years at this point, and had faced many fears, many unusual sights, and many challenges. I was still very much on the upward swing of the learning curve, but on this shift I had to learn and teach all at once, as Jill, my crewmate for the evening, had been out of training school for less than 3 months.
A call to an unconscious male on a Saturday night is a fairly normal one, usually leading to us finding someone under the influence of alcohol, drugs, or both. The vast majority of these cases occur in a public place, so getting a call to a private address for a 30 year old unresponsive man was a little strange.
As is the norm when we arrive at high-rise apartment blocks, the lift wasn't working, so it would be a hike up to the 6th floor with all our kit. As we arrived at the apartment, the door was open, so we knocked and walked in. The door shut behind us and made me jump. It was the first sign that something just wasn't right.
Jill and I found him lying on the floor, fully clothed and in a coat, eyes shut, but eyelids flickering. An almost certain sign of pseudo-unconsciousness. A fake. I took a step back and called out to him. Jill was still standing by the front door, uncertain how to proceed. Something still felt wrong, so I asked her to go and call for police back up. With hindsight, I should have gone with.
After a couple of attempts to get him to respond by appealing to his better nature, I approached him and shook his arm. In a blur, he jumped up from the floor, stood up over me, and pulled out a pistol from his coat. His eyes burned with an inexplicable hatred, and I was trapped. The "patient" stood between me and the door. I had no idea if the gun was real or not, and didn't really want to hang around long enough to find out that it was.
Jill came across a couple of officers on the 3rd floor who were there by chance dealing with a domestic incident and asked them to come upstairs. She couldn't explain to them any better than I could explain to her what the problem was, but as she was new, she told the officers that she was effectively just following orders on a hunch. The three of them ran back up the stairs and found the door locked. The police called for urgent back-up.
It felt like a lifetime before I heard the screeching of several sets of tyres outside. In reality it was apparently only 6 or 7 minutes. The gunman kept screaming through the doors for them to stay out or he'd shoot. I believed him. The sound of the army running up the stairs meant they did too. Within seconds of that sound, the door splintered into a million pieces, armed police came charging in, and in a fry of Tasers took hold of the gunman as well as the gun. His flatmates stood no chance either against the 40 or so officers who seemed to pile in from every which way.
Several hours of debrief and multiple cups of coffee later, it was time to go home. Just before I left the police station one of the officers came in and told me that the gun was a real one, and loaded. This had been a close encounter of the worst kind. I kept that night a closely guarded secret for a very long time. I'm still not sure I should have said anything at all.
*****
I gave my daughter an extra-long hug that morning when I got home. It was a very different, much needed, best kind of close encounter.

Friday, 6 November 2009

Under Cover

Many years ago, the ambulance station where I work used to be a fire station, so it has a large garage, a massive front and huge roller doors that let the ambulances in and out. They're made mainly of see-through panels, so as you pull back onto station you can see inside the garage. At night, the lights work on sensors, and only come on if there is someone walking about. The darkness gives the place something of a haunted feeling at times, and arriving back in the dead of night on your own can frequently be a little eerie. It takes the sensors a few seconds to register any movement, but once that happens the station and all the vehicles seem to come back to life. The station doesn't seem quite so spooky then.
Arriving back in the early hours one morning, I find that, as usual, there are no ambulances on the forecourt. The station is in its normal sleepy and abandoned state, and I'm about to step into the deathly quiet station. But sitting outside is a police car.
I notice that it's not one of the local units, but one of the armed response team. (For those of you in the States and elsewhere, not all our police are armed. Something I find weird as I didn't grow up here, and something I'd love to see changed. I think.) I take a slightly better look around and find that in a car park opposite, there are another half-dozen of the armed response units, along with various other police vehicles. Looks interesting. And possibly concerning, as they're parked outside the haunted house that is my station. Has someone broken in? Is someone being held hostage inside? More importantly, has someone raided our supply of coffee?
Before I have the chance to give in to my curious nature, one of the officers approaches me.
"Can we borrow you and your car for a small mission?" Well, now there's an offer! I can't refuse that sort of request, can I? What sort of man would I be if I turned down the opportunity to play at being an under-cover cop?
"Sure", I said, "just let me inform my control that I've been commandeered, and then tell me what you need".
I call control on the radio and try to explain without being too specific, concerned that anyone can listen in and hear about the police being in the area and on the hunt for someone clearly unfriendly. They struggle to understand, and in truth I was probably too excited to explain properly, so I just leave it at being used for police assistance, and that I'd call and let them know what happened when it was all over.
The officer goes on to explain that they'd had dubious reports of a shooting in a local club, and wanted to investigate without arousing too much suspicion of their presence. They wanted to clamber into the back of my car so we could drive past the location and get an idea of what was happening. How they expected a bright yellow car with a light-bar on the roof to look inconspicuous, I'm not entirely certain, but they were convinced it was a good idea.
Cramming a lone patient into the back of my car requires all sorts of manoeuvring of luggage. Getting two fully kitted, heavily armed police officers in, was going to be a small challenge, and not one I was willing to fail.
Eventually, car and kit adjusted, and me in a bullet-proof vest, we drove off. Me driving to the location, the officers in the back telling me to act naturally as we passed slowly past. All was quiet. No screams, no mass exodus from the club, no flagging down of an ambulance car. The police decided it was probably a hoax. I'm still not sure if I was pleased or secretly disappointed. I don't want people to be sick or injured, but I do want to be there if it happens.
We return back to the station, the officers decamp and I offer them a cup of coffee. At least I now know that the supplies are safe. I'm relieved when they decline, as there were more than twenty of them there...
I walk back into the quiet station, call control to tell them of my adventure, and let them know that my police career is over, and that I'm now back to being a paramedic. Back to the next call, back to kids with coughs. Back to normality.
I guess that someone in control decided that that's more than enough excitement for me for one night.

Thursday, 5 November 2009

A Tale of Two Bloggers

All I can see in the distance is a set of hazard lights, emitting an intermittent orange glow against the dark background of the night. Maybe this RTC won't be quite as given - trapped and unconscious - but as I approach at a rapid pace I can see that the hazard is not the car with the lights flashing, but a car facing the wrong way, lying on its side, perched up against a street light.
At four o'clock in the morning there's very little traffic, very little life about. The world sleeps as I do my small bit to keep it safe and well. The call rate to the ambulance service drops, but so do the number of available ambulances. I know I may be on my own for a while. I stop by the car, take one look at it and its unfortunate occupant, and call for help. I need everyone. Fire Brigade, police, at least one ambulance and a Basics doctor. This patient could need a lot of help, and quickly.
I’m fast asleep, having just finished a late shift in the A&E. How weird, then, that I can hear the drum solo from “In The Air Tonight!” Wait a minute, that’s my ‘phone, Ambulance Control. I blearily answer it, and accept a job nearby – car overturned, entrapment and unconscious.
I climb into the car through the boot, hoping that my assessment of its safety was correct and that the kerb would hold the car from tipping further. The patient was clearly unrestrained, lying with his head on the passenger window against the road, and his legs wrapped around the steering wheel. His breathing is a little slow, which concerns me but just putting an oxygen mask on him is a struggle. He tries to fight me off, making me think that this could be anything from a diabetic coma, to alcohol, to a serious head injury.
The journey is uneventful, and I pass the police barricade a few minutes after leaving home. It usually takes a little while for me to wake up fully, but the sight of the car on its side, facing the wrong way, and the lamp post knocked down, is like a splash of cold water. This doesn’t look good. I jump out of the car and grab my pack – anything else I will come back for. I jog round to the car, and am directed to the rear.
The Fire crews turn up first, and I ask about taking out the windscreen, but that would apparently take some time. I need him out quicker, but have no way to move him and no where to move him to. As I'm still fighting to get a primary set of observations done, three pairs of legs appear at the back of the car, two of them green belonging to the crew, and one of the pairs of legs orange. I recognise the voices and thank everyone who needed thanking for them turning up in a hurry. The orange pair of legs belongs to RRD, and I was fairly certain that when I'd asked for a Basics doctor, it would be him that I woke from his slumbers as I knew I was on his patch. At least now I could share my thoughts and decisions.
I peer in through the hatchback of the car, and see a familiar face – Ben! Excellent! This is going to be entertaining, if nothing else. He quickly appraises me of the situation – an unrestrained driver, was deeply unconscious, now has a GCS of around 8. Difficult to get access to the patient, no obs done. We discuss what options we have; peel the roof down or bring out through the back. I want this man out here, so I suggest to Ben that he tries to wind the seat back down, so that we can bodily drag him out. I wander over to the Fire Chief, and let him know what we are doing. He doesn’t look best pleased – I guess he was looking forward to some cutting, but offers all assistance with lifting etc that we might need. I go back to the boot of the car, to see Ben struggling vainly with the seat controls. “Got a problem?” I ask. He just grimaces, reaches under the patient, and the seat magically drifts back, giving the crew room to get him out. I leave them to it, and go and set up for the inevitable intubation.
We extricated the patient out the car the same way I'd climbed in, through the boot, and onto a rescue board. He was still trying to fight back. By now I could smell the alcohol, but still couldn't rule out that his behaviour was due to a head injury, and we treated as such. RRD knocked him out, intubated him, and made sure that our transfer to the hospital would be as event free as possible.
I watch as, first Ben and then the patient, are born(e) from the back of the car, the patient on a spine board. The crew wheeled him into position, near my kit dump, and we start to cut through all his clothes, so that I can make a formal assessment of his injuries. Ben is set the task of getting iv access. I check him over, head to toe, and find little else wrong with him, apart from the obvious – he is eyes closed, occasional groans and localising to pain. Glasgow Coma Score is therefore… anyone?? 8. of course!! I’ve got the kit ready, the team are ready, Ben gives the drugs, and the tube is in. We get him on to the vehicle, and I ask Ben to travel with us.
I travelled with them, abandoning my car at the scene and remaining in charge of the patient's ventilations as we did the breathing for him.
The journey is uneventful, and the three of us in the rear chat about stuff – other jobs we have done, BASICS, the state of the country, that sort of thing. All the while, we are closely monitoring the patient for signs of deterioration, of which there are none. We get to LocalNeuro, and hand over the patient, with some playful banter about whose IV access is better, Ben’s or mine (mine, of course)
All that remained was the tidy-up, paperwork, NHS tea in paper cups, and to get back to my car and return to base for the end of my shift. Maybe, if I asked really, really nicely, RRD would take me back in his cool car...
And then it’s all done. It’s early in the morning, and there’s a bit of paperwork and a lot of clearing up to do. We stand around, drinking our tea, before I offer Ben a lift back to his car.

Wednesday, 4 November 2009

Tweet Tweet

I'm going to give this a go. I've been on Twitter for a little while, keep trying to use it, and I'm slowly getting the hang of it. I've even got a few followers. Which I think is cool. So, if you feel so inclined, and can cope with even more of my ramblings, you can now follow me on Twitter @insomniacmedic. It's going to be a bit of an experiment, and if I seem to get the hang of it, I'll keep it going.
You could always let me know whether you think it's worth it! For now, Tweet Tweet!

Tuesday, 3 November 2009

Note to Self

You'd think that over the years, and after the previous post, you'd have learnt your lesson.

Don't say out loud what you're thinking.

It's damned likely to happen.

Twice.

So, if you feel the need to say to the The Mrs just before you leave for work that you feel like there's a big job out there tonight, don't. Just don't.

Even if it does mean you get to wake up certain people in the middle of the night.

Thus endeth the Note to Self.

Sunday, 1 November 2009

Training School

I was new at the time. Very new. Not even two months out of training school. It was a time when I was keen, eager, and very very scared. I arrived at the station at least half an hour before the shift, which I still do to this day, just to make sure everything that I may need for the shift is available and ready for use on the ambulance. Obviously still keen and eager.

Ten minutes later my crew mate for the day arrived. I introduced myself and told her that I was new, and would need all the help I could get. She asked if there was anything in particular that I was nervous about, anything that I really wanted to see, that she'd see what she could arrange. I didn't really believe it, but I did mention that I'd not yet been to a cardiac arrest call. I'd practised the scenario endlessly in training school. Everyone seemed to die there. All the scenarios seemed to end in cardiac arrest.

Asthma attack scenario? Cardiac arrest.
RTA scenario? Traumatic cardiac arrest.
Pregnancy/Labour scenario? Double cardiac arrest.
Drug overdose scenario? Self inflicted cardiac arrest.

And the scenarios would always be as difficult and unlikely as possible. "Worst Case Scenario" the trainers would call it. We all took it with a pinch of salt, they were just so far-fetched.

In a broken down lift.

A crane at full height.

Stuck behind a toilet.

In the middle of a muddy building site.

On and on it went. Weeks of "people dying". If that was the real world, I wasn't so sure I was ready for it. The real world, however, was anything but constant cardiac arrest calls. Six weeks on the road, and I hadn't seen it or had to deal with it once. So I told Anne about it. She laughed and told me that the chances were slim. It was a day shift, and people tended to die at night.

Those were the days before we had computer dispatch on the ambulances. The calls would come off a printer, and the Control Room would call the station to find out who was to be the next crew out. I can still hear the distinctive whirr of that printer and find that if I ever hear it anywhere else, I instinctively expect to hear a phone ring.

We'd been out on a couple of calls and had managed to get back to station. There was nothing to challenge my knowledge yet. But now, we were the next crew out. I sat anxiously waiting for something to happen. Eventually, the blue piece of paper appeared at the top of the printer, and the phone made me jump half out my skin. This was it. My turn. And for some reason I had butterflies in my stomach. I looked at the piece of paper and saw that we were on our way to a man in his 40s with difficulty breathing. In the special instructions section there was a line about the patient being in a "hard hat" area on a building site. Could be interesting.

Half way there, we get a call on the radio: "ETA request from the scene. Patient deteriorating".

"We're approx 5 minutes away."

"Thanks, we'll let them know."

Anne presses the accelerator a little closer to the floor, the engine screams in response, but the ambulance doesn't seem to move any quicker. Two minutes later, the radio operator calls over the noise of the engine. "Update from the scene. They're on the 3rd floor of a building site. Stairs still unsafe. Ladders in use. Patient turning blue." Leave the important bit until last, why don't you?

"ETA two minutes. Thanks."

Accelerating makes no difference other than the noise, so we will the ambulance to go a little faster.

As we're no more than half a mile away, the radio chirps in once more. "Patient now in cardiac arrest!" I expected panic to set in, for the shakes to take over, for my brain to freeze. None of that happened. It was as if I'd been programmed for just this moment. The adrenaline rush was incredible. In my head I'd made a detailed list of what equipment to take, how we'd get to the patient, how we'd get him down again, and what else needed doing. All this before I'd even got out of the ambulance.

We arrived to find that our patient, had been carried down one floor by the other builders. Now at least we only had stairs to contend with, and no ladders. Two of the builders had started CPR whilst the others looked on anxiously. Anne and I took over and with the oxygen we were giving him his colour started to improve. The defibrillator looked at the chaotic heart rhythm and decided that it needed to be shocked back to life. Shocks, CPR, Shocks, CPR. We were in hard hats, covered up to our knees in mud, on the second floor of a building site, surrounded by exposed beams and electrical cables, with a 100kg patient. A real "worst case scenario".

Moving him to the ambulance was much easier than expected, thanks to several pairs of builders hands helping us carry him. The ambulance visibly sank by several inches and audibly groaned its complaint as the group of 4 ambulance staff, 6 builders and one patient either climbed in or were loaded into the back.

We continued our attempts all the way to hospital where the staff took over. They knew Anne and the other crew, but I was a new face. I overheard one of them ask Anne who the "new guy" was.

"Oh" she said. "He's a bit like this job. Come straight out of Training School."

Friday, 30 October 2009

Handover Carnival 9


Well folks, here it is, the latest monthly Handover Carnival. The theme for this month is all about the small people we deal with, so without further ado, allow me to introduce:


Kids - Seen and not Hurt

I'm going to start this month's with a post from the Grumpy Dispatcher, who suggests a list of kit that is not part of our emergency stocks, but will probably help even more with our treatment. Remember that you're not only treating a condition. You're treating a person. Read it here.






*****
Read it? Good. Our next post is from Mack505 and tells how calls dealing with kids have the potential of turning a sleepy medic into a sleepless one.

*****
Epijunky, drawing on her experiences as both a mom (or mum in these shores...) and a medic, reminds us that we are all human, with human feelings and emotions, and that it's OK to let them get to us sometimes.


*****
Over at Rescuing Providence, you can read about the way kids capture the hearts and minds of even the toughest EMS and Fire crews, and that even the Bullies on the block are reduced to baby babble.

*****
Back in the UK and up in the Welsh mountains, Hypoxic Witterings gives us two views of the same emergency. One from the rescue team, and one from a bystander who watched helplessly as the drama unfolded.

*****
BasicsDoc, who I've personally had the honour of working alongside, has sent in a post about a call that's both haunting and heartbreaking, showing how families often cling to the smallest details in their despair.







*****

I've also had a couple of entries from blogs that I had not heard of or come across before. This is partly the reason for the Carnival, so I was pleased that it was serving its purpose. The first came from Dispatches From the Street. It shows the internal conflict we often have with a very sick child asking very pertinent questions. Do you lie or do you tell the whole truth?

*****
The next blog I've been introduced to is one called Just My Blog. Here I read about children getting hurt due to the laziness or otherwise of the so-called responsible adults. Sometimes we're no better than the kids.

*****


Lumo tells a story on a similar theme that's not really theirs, and gives an insight into what happens in an A&E department when they don't have the "luxury" of being forewarned of the horrors about to be unleashed, and how it doesn't always have to be personal experience that leaves a lasting impression.

*****
Almost last but most certainly not least, I'd like to give the floor to Mark over at 999Medic, the originator of the Handover Carnival. This is all his fault.
Mark's view is one of mixed memories, from how children leave us all traumatised, to the small people who steal our hearts. From the calls we hope never to attend, to kids who are nothing but sheer inspiration for all the adults around them. We all have much to learn.





*****
The next Handover Carnival is to be held over at The Happy Medic, who whilst planning for his edition, sent in his entry for this one. Sounds like his fire skills as well as EMS ones were going to be required, or maybe not...
The theme for the next Carnival is "Close Call", stories of a time when you or your patient cheated death, which left you with a reinforced idea of how life is precious, just in time for Thanksgiving. Entries by the 23rd of November, to be published on the 27th.
*****
Thus closes this month's Handover Carnival. It has left me with much to think about, a great deal to be inspired by, and a huge amount to be thankful for. I hope you feel the same.

Wednesday, 28 October 2009

Mother & Baby

Throughout her/our pregnancies, my wife complained on numerous occasions that I had no idea what it's like being pregnant. Now, whilst I can't refute that (and if I could, I'd be earning a fortune), I did constantly remind her that she had no idea of what it's like to be living with someone who's pregnant. The mood swings, the cravings, the going shopping for mango sorbet at 3 in the morning, the vomit all over my clothes on the way to friends' weddings, and a multitude of other sins. Admittedly it's a lame argument, but it's an argument nonetheless. And it's the best I could come up with. All I can say for sure is that babies clearly start causing trouble well before they're even born.
*****
Helene was on her third pregnancy, but she was a little out of practice as her 2 kids were already teenagers. She felt almost like it was the first time all over again. She'd almost forgotten about the twinges, the kicks, the nausea. She'd tried not to remember the sleepless nights, the discomfort and the anxieties that were caused by growing a small person inside you. Over the 38 weeks all her memories flooded back and she knew she could cope with them all.
*****
Until she woke up one morning and thought her world was about to end. The meaning of having your breath taken away had never had such relevance, or filled her with so much fear. Helene had the sensation that she'd been stabbed in the chest and just couldn't take in enough air. She'd had a strange sensation the day before like a muscle cramp in the back of her leg, but put it down to another one of those pregnancy things. "Only 2 weeks to go," she thought, "then it'll all be worth it." At three in the morning she'd woken up and thought she was going to die.
*****
Patients should most definitely not be blue. Unless they're smurfs, and I've never had one of those yet. Helene was blue. Her lips were blue, her finger tips were blue. It was as if she was being lit by an ultraviolet light. No need for an oxygen saturation reading before applying oxygen. It's low. Probably dangerously so. I place a 100% oxygen mask on her and then start checking observations. Pulse rapid, at about 140, oxygen levels unreadable at the moment, air entry greatly reduced, especially on one side. Blood pressure low and dropping. Helene is very poorly. My initial assessment leads me to think that it's a Pulmonary Embolism, or PE, a blood clot in the lungs. Pregnancy is one of the known causes of a PE, where it's either due to the fact that the blood's clotting is increased, or sometimes due to amniotic fluid escaping into the blood stream.
*****
I start to hope that the ambulance is nearby, as there's not much more that can be done pre-hospital for a PE. Luckily they turn up only a few minutes after I complete my set of observations. We wheel Helene into the ambulance and she is whisked to hospital with due haste, while I'm left alone in my car with the paperwork, wondering if I was right or wrong, and what would happen to her now. I have no idea what happened after that. All I know is that, in pregnancy, if the mother's ill, the baby's ill too. So if you treat the mother, you treat the baby. If all's gone well since, the baby should be a few months old by now. I hope that's indeed the case.

Sunday, 25 October 2009

Target Practice

Targets. That's what it's all about, at least as far as the Government (and, I could cynically add, The Management, but wouldn't dare) is concerned.
Did the patient receive adequate care? Irrelevant.
Did the patient live or die? Irrelevant.
Just targets.
8 minutes to here.
19 minutes to there.
75% of 8 minutes.
95% for the 19's.
50 minutes per call. Start to finish.
20 minutes at the hospital.
No more than 3 toilet breaks in any 12 hours.
Targets. Just targets.
Well, Dear Government (and see cynical comment above), last night I beat them all. In one hit.
How? Well, my patient was seen, treated, transported and arrived at hospital all before he'd even called the Ambulance Service.
Oh, how I love it when the clocks are turned back...
I bet the number crunchers do too!

Friday, 23 October 2009

Roll Up, Roll Up!


Ladies and Gentlemen,

This is your final call for all submissions for this month's Handover Carnival, entitled:

Kids - Seen and Not Hurt.

Anything related to dealing with those little monsters who instantly take over our emotions, even if we've never met them before.

Don't forget there's still the open section for any other EMS related posts that you may feel appropriate to share with the readers.

All submissions to benyatzbaz999@gmail.com by Monday morning (UK morning...) (26th October), for publication on the 30th.
In the meantime - have a safe weekend, and one piece of advice - Don't put your finger in a baby's mouth...

Thursday, 22 October 2009

Insomnia IV

I was going to write something about how this article may go on to help me in future life, but I can't for the life of me remember exactly what it was that I wanted to say... Oh well. Suggestions welcomed...

Wednesday, 21 October 2009

Piece of Paper

The red and blue lights of the police illuminate the street and point to the house that I've been sent to. I'm not sure how they got there before me, as it took all of 90 seconds for me to arrive, but I'm glad of their presence nonetheless. This doesn't sound like the type of call I'd like to be at on my own for too long.
*****
She sits downstairs, clutching an innocent looking piece of paper as if her life depended on it. The chair squeaks as she rocks backwards and forwards, fighting the rising tide of tears that are about to break the dam. I'm directed upstairs by one of the police officers, whilst another helps carry one of the bags that I've dragged hurriedly out of the car. The initial sight of tears and pale shock tells me that the bags are going to be redundant.
*****
The piece of paper was stuck to the fridge, oblivious to the pain it was about to unleash. She saw it on the fridge door, but didn't register at first that it was a new note amongst all the others stuck there by a multitude of colourful magnets. She'd been in and out of the kitchen a few times before finally taking a proper look. Then her world collapsed around her.
*****
Too afraid to go upstairs herself, she called the police. They had turned up, looked at the piece of paper, and ran around every room in the house. His room was the last they checked. When they found him, one of their number called for the ambulance. He lay there motionless, cold and blue. The blood on the walls and the floor had long since dried and turned from crimson red to dark brown. Next to him lay the weapon that had ended his life, destroyed his future and shattered his parents' world.
*****
She clutched it and begged for answers that she knew would never come. "I'm sorry. There is really no other way."
A silent, innocent, clean piece of paper.

Sunday, 18 October 2009

Regularly Irregular

Regular callers come in all shapes, sizes, colours, creeds, regularity, and, most importantly I guess, reasons for calling.
*****
There's the diabetic, who despite her almost religious adherence to meal times, insulin injection times, regular blood sugar tests and the rest, still has repeated hypoglycaemic attacks, where her blood sugar drops dangerously low. In fact, the last time I met Bea, only a few days back, I was being observed for the shift, so there were two of us in the car for a change. It took the strength of two paramedics, neither of us particularly small, to hold Bea down long enough to give her the injection of Glucagon that would release her body's emergency supply of glucose into the blood stream. If anyone was looking in from the street to see what all the screaming and shouting was about, they'd have seen two large green people attacking a seemingly helpless elderly person. Probably would have made great tabloid photos. I don't mind that sort of regular. The ones, where despite their own best efforts, they have the need to call for emergency help.

*****

Then there's the local drunk, Kish. He's not a homeless, penniless drunk. He's a drunk who has a home to go to, and a nice home at that. I know it's nice, because I've been there on countless occasions to take him home. He regularly calls from the same group of phone boxes complaining of whatever he can think of that will get the ambulance to him in the fastest possible time. That's assuming that he's been the one to call, rather than someone else who's found him lying in a heap on the ground after drinking too much (even by his standards). He's nothing but a drunk nuisance. And what's more, he claims not to have had a drink for years. I met him on my first week at work, and have met him literally dozens of times since. He's had over 500 attendances at the local hospital in the last 18 months, each one of them by ambulance. He'll often refuse to go to hospital, and want to be taken home instead, usually a mere 200 metres away.
*****
It's only my professional etiquette that has so far stopped me from telling him what I really think. I'd love to tell him that he's wasting his life, wasting my time, wasting resources. He's delaying ambulances that are needed for real emergencies and delaying treatment for those who desperately require it. I'd love to tell him that he's really just a drunk and unpleasant waste of space. Don't get me wrong, if he was really ill, he would get first class treatment from me, but for now he just makes my blood boil.
*****
The other night, the same night as Bea's call when there were two of us on the car, Kish called again. We were stood, face to face all three of us, trying to ascertain what it was that was supposedly wrong this time. Kish stood there telling us that everything from head to toe was hurting him, his eyes were falling out, that he couldn't stand, couldn't sit and couldn't walk, and swore blind that he has never had a drink in his life. We stood there and listened, unable, and frankly unwilling, to transport him anywhere in the car. We tried to convince him that it would be better for him just to walk the short distance home, but he remained adamant that he wanted to go to hospital. We had no choice but to wait for the "proper" ambulance to come and get him.
*****
Whilst standing there trying to explain the benefits of him just going home, a member of the public walked up to us, tapped me on the shoulder, and said "Excuse me, can I just say something? I work in this shop here". We had no warning for what was about to happen. His next outburst wasn't directed at my colleague or me, but directly at Kish.
"YOU'RE A WASTE OF SPACE! YOU'RE A DRUNK, USELESS EXCUSE FOR A HUMAN BEING! STOP CALLING AMBULANCES, YOU'RE JUST WASTING THEIR TIME! GO GET A PROPER LIFE AND A PROPER JOB AND STOP BEING SUCH A *&%*ING PAIN IN THE $*&^ TO EVERYONE AROUND YOU!!!!"
*****
He started to walk off, turned around briefly, apologised to us for interrupting, and vanished.

Everything I'd had pent up, everything I'd wanted to say, everything I'd been feeling but couldn't express for fear of completely losing my cool (and possibly my job too), had just been blurted out by this well meaning, clearly equally frustrated, passer-by.

I think we may have to invite him to join us on the ambulance. Regularly.

Thursday, 15 October 2009

Bigfoot


EMS staff worldwide seem to share a superstition. I'm not normally superstitious, but there are certain laws that govern this insular world of the ambulance. The main rule is check everything, because you can guarantee that the one thing that you don't have, is the one thing that you are definitely going to need. It's almost beyond superstition, it's practically a rule of the natural world.

I'm not afraid to admit that I'm a little nervous at the moment.

A couple of days back, I helped remove all the equipment from one of our trucks. It's affectionately known as Bigfoot. It's a huge, clumsy looking thing, that goes 0-40mph in about ten days. If it's ever to reach any more than 40, we'd need to push it off the edge of a mountain and let gravity take control.
But it's potentially vitally important. Bigfoot is only used under two sets of circumstances. The first is for training, which is in itself rare on this nigh-on-never used piece of equipment. The second is if there is a mass-casualty incident. That's the bit that makes me nervous. This week, Bigfoot has been sent for a bit of R&R. It's been sent for a service and won't be back for a few days.

So I'm nervous. It's the one piece of kit I've never been called on to use, or, thankfully, drive. I've never even seen it used, other than when it's been for training. Normally it just sits, reassuringly still, at the other end of the garage.

Now Bigfoot's missing, I'm hoping that it proves the superstition to be just that.

Wednesday, 14 October 2009

A Thousand Words

Two people died. Another is critically ill.
All for the sake of a phone call.
Please.
Stay Safe.

Monday, 12 October 2009

Pendant

I took one look at the computer screen, took stock of the fact that it was an elderly person fallen at home. A Green call, the lowest priority possible. Doesn't even require lights and sirens. I muttered unthinkingly and quietly to myself. Or so I thought. "Oh Oh...", I said, for some unknown reason.
*****
The lady who opened the door to Grace Court appeared so old that it seemed that if she was to teach history, then Ancient Rome would be her speciality, due to first-hand experience of the era.
"Yes?" Even the monosyllabic required an immense effort.
"Ambulance Service, madam. We're here for one of your neighbours."
"Do you know who?", she asked, polysyllabalism still elusive.
"Yes madam. Thank you." I smile at her question. Even at an age that would put Methuselah to shame, the sense of curiosity hadn't left her.
The building we enter is a warden-controlled residence. The residents, typically elderly, but largely self sufficient, have the benefit of an on-site manager who can be called on for some basic care and assistance, whilst also maintaining the luxury of independence that they would lose if moved to a nursing home. Most of the residents have emergency call buttons worn as pendants around their necks, so help can be summonsed at a moment's notice. Harold had decided otherwise.
*****
It had taken a concerted effort from Harold's family to get him to agree to move here, away from the home he'd lived in for the past 50 years. Harold was a very proud man, an Army Captain who'd seen and survived so much. He still did his own shopping, cooking and cleaning. Only recently he'd agreed to allow his daughter to do his laundry. The man who had rebuffed so many advances of enemy armies, had to make this one concession to the advancing years.
His family would visit every few days, every weekend without fail, and someone would call every other day. Mondays were a quiet day, time for Harold to recover from the grandchildren running riot around his apartment. He hated to admit it, but these days they seemed to exhaust him a little quicker, tire him out for a little longer. He loved having the family visit, but he also treasured his Sunday evenings and Mondays, knowing that the phone or the doorbell wouldn't ring, and he revelled in the calm after the storm. We were called to Harold on Tuesday morning.
*****
Harold's daughter had called him and unusually received no reply. The phone rang continuously. He hated the idea of an answer-phone, his theory of "If it's important, they'll call back" foremost in his thoughts on the matter. He did, however, unlike many of his generation, carry a mobile phone if he ever went out, but it was switched off when he was at home. "I'm currently probably at home", said the message. "If you know my phone number there, please feel free to use it. If you don't, then I probably don't know you either, so don't bother. Thank you". He must have recorded the message with the family around, as there was a great deal of merriment in the background, but no room for leaving messages here either. Sensing trouble, Harold's daughter made the 25 minute journey to visit him. When she arrived, Harold was on the floor. We arrived no more than five minutes later, despite the fact that the call was the lowest on the priority list.
*****
Harold breathed a shallow breath every ten seconds or so, and seemed to have no pulse that we could feel, he was unconscious, but clearly still alive. Listening to his chest I could hear his rapid heartbeat, feebly trying to keep his body fuelled with the oxygen it craved. It was racing at almost 200 beats a minute. Not enough for the heart to refill and pump the blood around the body. He had no recordable blood pressure. We helped with his breathing, and thought that if we tried to move him with almost no blood pressure, we'd probably kill him. He needed more than just salty water in his veins, but it's the best we had to try to stabilise him enough to be moved. After a litre of fluid, Harold's blood pressure was at least readable. Not good, but better. His breathing had also improved a little, and he was conscious enough to mumble a few unclear words. Time being of the essence, we decided that it was best to move. Once we'd handed Harold over to the hospital team, my crewmate told me off. "Next time you think Oh Oh, will you please keep it to yourself! Bloody Jonah!" Obviously I'd not muttered quite as quietly as I'd thought.
*****
Harold was given a blood transfusion, had surgery on his broken hip, and was kept in for several weeks to recover. I kept track of his progress as best I could, and eventually was told that he'd been discharged home. I'd long forgotten about Harold when, several months later I had a call back to Grace Court. The door was opened by a gentleman who still managed to look several years younger than his real age. He walked with no assistance, spoke clearly, knew who we were and why we were there. "I believe you're here to help Alice. She's fallen again. I've tried to make her comfortable, but I just can't get her up off the floor. Not quite as young as I used to be. Anyway, she's just over there".
We walked over to Alice, who this time had just slipped onto the floor and needed help getting up again. Whilst we were helping her, a voice behind me said: "Apparently your chaps were here helping me a few months ago. I don't remember them or indeed what happened, but if you see them, please tell them that the stubborn old fool from flat 42 is still fighting fit!"
"I'll make sure to do that, sir", I said with a grin, noting that he'd finally agreed to wear the emergency pendant.

Friday, 9 October 2009

Ladies and Gentlemen

Ladies and Gentlemen of Blogsphere...
A short reminder that I'm hosting the Handover Carnival at the end of this month, on the theme "Children - Seen and Not Hurt". I have already received several fantastic entries and look forward to many more. Feel free to make me work for a living (if you can call this blogging a living), and send in entries for the open section too, on anything EMS related. The closing date for entries is October 26th, so time is starting to run short...
Please send your entries to benyatzbaz999@gmail.com .
For now, have a peaceful (or festive, if you prefer!) weekend, and most importantly,

Stay Safe.

TwentyFour/Seven


If you'd have asked me a year ago which my least favourite shift was, the answer would be instant. Nights. I used to dislike them so intensely that I'd quite happily order a government edict that no ambulances are to be sent out at night. If you're ill, wait until daytime. If you can't wait, walk. No mercy. All this was whilst I was on a rotating shift pattern, so I'd go from morning shifts, to afternoon/evening shifts, to the dreaded, loathed and feared nights. But then, just under a year ago, I started working permanent nights.

I had no choice, family came first, and it was the only way I could work and have childcare arrangements that I could cope with. I dreaded the idea of it, and thought that I would never ever get used to nights. Now, I love them. I can't get enough. The peace and quiet of the world at night, no traffic, no mayhem, real patients. The insomnia is still there whether I'm trying to sleep at night or during the day, so no change there. And if I'm already awake at night, while the rest of the world is sleeping, I might as well get paid for it...

However, I had a night off last night, and knew that I could get to bed at the same time as the rest of the normal world. At least in my own time-zone. But I had to remember to set my alarm for seven o'clock to get the kids up for school. It was an optimistic idea, setting an alarm clock. There's no way in the world that I could sleep that late, and my son made sure of it with a bout of croup at 3am. So much for a night off.

Just before seven, I picked up my phone which is also my alarm clock, to turn off the alarm. No need for it now, is there? I took one look at it and had the final proof that I'm now a night-owl. I'd set the alarm to get the kids up for school. Time to get into uniform, have breakfast, clean teeth, brush hair, all in time for the school bus. There was a good chance, had I relied on my alarm clock, that they may have been a little late. I'd set it for 19.00...

Tuesday, 6 October 2009

A Begging Letter to A&E Staff


Dear A&E Nurses and Doctors,
*****
We have a patient in cardiac arrest.
We have been resuscitating for the past 45 minutes.
We cannulated whilst the patient was collapsed in the toilet, or lying stuck behind the door.
We intubated under a table, in a car, or in the pouring rain at the track-side.
We have distressed members of the family following our every move, shrieking in grief.
We carried the patient in a mess of arms and legs down 3 flights of stairs.
We carried out CPR continuously in nooks, crannies, and at 60 miles per hour down the winding road.
Now we've arrived at your hospital.
Exhausted, sweaty, flustered, sometimes hopeful, sometimes not.
For us, the resus is nearly over.

*****
In the meantime,
You've been told of our imminent arrival.
You've been told that the patient is in cardiac arrest.
You're prepared with all your kit; aprons and gloves donned and at the ready.
You meet us at the entrance to the resus room and direct us to the trolley bed.
You've got the patient 4 foot high, horizontal, in the relative calm of the hospital surrounding. You've got the family safely in the relatives' room.
For you, the resus is only starting.

*****
I know you're also constantly busy.
I know you too haven't much of a break.
But I'm also fairly certain that you haven't been doing a resus for the best part of the last hour, sometimes in the most appalling conditions.
So I ask you, please.
Please don't expect me, after nearly an hour of CPR, to keep going, while you stand by and watch.
Please give me a chance to get my breath back.
Please take over the resus. Please take over the CPR.

*****
Thank you.