Weight of the world

It would seem that weight issues are never far from the news headlines. If it isn't because of the Size 0 debate, it's because of NHS Trusts refusing to treat morbidly obese people until they at least start to help themselves. But at the front line, as always, are ambulance crews. A call came in to a 50ish year-old gentleman, who was having "breathing difficulties". As is often the case, the breathing difficulties were nothing more than stomach ache and constipation. Easy. Patient walks on the ambulance, has his BP checked, walks off the other end, and then becomes the hospital's problem. But half way to the call an update comes down the MDT and says "PATIENT WEIGHS 22 STONE". In the grand scheme of things, 22 stone isn't terrible, so we thought we would cope. Especially as it was a Category A call, and assumed that there would be an FRU (which there was) on scene. All good, except for one slight problem. Patients, with all the best intentions in the world, lie. 22 stone was what this patient may have weighed once. Not today, though. It was probably nearer 30. And his mobility, as you can imagine, with that weight, wasn't great. We managed to get him onto his feet, but after a few steps, he threw himself down on the ground and refused to try to get up. Or maybe he couldn't. Don't know. But, we had to work out how to get this gentleman out the house and into hospital, which is where he kept saying he wanted to be.
We asked for the fire brigade to come out, but apparently they're not allowed to help us carry patient unless it involves an immediately life threatening problem. This is just in case they hurt themselves. Health and safety. Apparently. So at 1:30 in the morning, when ambulances are scarce as it is, we had to get another ambulance and an officer down with specialist equipment to help lift the patient onto our trolley bed.
All in all, this call took over 90 minutes. Can't help wondering if we wouldn't have been better use to someone who actually wanted help, but more than that. Someone who actually wanted to help themselves, too.

Slow news week

Not a great deal to report. Just thought that in the meantime I'd share with you the hazards of driving when you're tired. Red truck driver fell asleep at the wheel. More by luck than judgement - 3 injured, none too serious. As we came round the bend (we were, as usual, given the wrong location by the police...) looking for this crash, the first thing we saw was the red truck. To say that we were slightly concerned for the welfare of the occupant is a slight understatement.

Gallows Humour

Now that I've got the rant out the way, back to the real business of ambulance work. For some reason (ahem), I seem to have a bit of a reputation as a "Jonah". Those of you outside of the world of the ambulance service, it just means that I attract trouble. Not necessarily in the form of violence or such like, but just "real" jobs. Very sick people. Now, having said that, I don't seem to get many trauma related calls, but usually a lot of medically ill people. My second day back at work, 10 minutes into the shift, we were given a call to a male fallen from a bridge. Normally that tends to mean dead. We arrived on scene (which was literally 50 metres from the nearest ambulance station - but there was no-one there), looked over the bridge, saw the 12-15metre drop onto tarmac and assumed that our first thought was correct. The patient was dead. Except that on an immediate second look we saw that the two (yes, two) first responders were actually working. And not doing CPR. That means the patient was alive. So I ran (doesn't often happen) down the flight of about 50 stairs while my crew mate found a route round into this car park to get the ambulance as near as possible. The patient was obviously badly injured, unconscious, but very much alive. All that had to be done was done, patient intubated, fluids, defib pads attached in case, packaged, in the back of the back of the ambulance, applied lots of diesel and blued to hospital. In the meantime we requested HEMS (the helicopter that's supposed to be for just such calls) but as usual when I ask for it, it was unavailable. A policewoman came with us in the back to the hospital and kept repeating "I could never do your job". Ditto. Couldn't do hers either. She just couldn't understand how we could deal with our job day in, day out. Far from there being a sombre mood on route to hospital, it was almost jovial. Gallows humour. That sense of "if you don't laugh, you cry, and you can't keep crying in this job". Finally a job I could get my teeth into. A job where I could use some of the skills that I was trained for. For the general public I guess it would be better if I never had to use these skills, but for me it's just a good day at the office.
It was one of those days. Lots of running around for genuinely ill patients. Jonah. My crew mate threatened not to come back again. He did.

Back to work

Once again, it's been a fair old while since I posted anything. I've had a couple of weeks off work, which I thought would be a good break, even though I didn't go anywhere. The fact that the kids saw this as a sign of weakness and decided to make sure they were sick for the whole of the first week, is besides the point. Good thing that we had the snow to cheer everyone up...
While I was off, politics at work continued, moans continued, ORCON continued to plummet, overtime was still discontinued, and in general the state of the LAS seemed to be in disarray. Part of the solution was to man more cars. Not actual (patient transporting) ambulances. This way the ORCON targets will be met, if not the needs of the patients. Apparently there was a survey done amongst the general London public, in which the top of their wish list when it came to ambulances was that there was a VEHICLE on scene quickly. Not an ambulance. I get the feeling that this is a slight deviation from the actual point. Joe Public doesn't want a vehicle. He would never even use the term vehicle. He wants an AMBULANCE. The thing that takes him to hospital because he/she/nan/kiddy is sick. He doesn't want a car. How many times have I been asked "How are you going to put the stretcher in the back of that?", only to have to explain that I'm only the initial responder. The cavalry is on it's way. Cars are NOT the answer.
Nevertheless, the day I came back was the day that some bright spark with lots of things on their shoulders finally realised the fact that the service, as has been the case probably forever, can't run without overtime. So they brought it back. Albeit limited. I wonder if this will work. They took the overtime away at a time where not only was it critical for the performance figures of the LAS, but also for many of the staff. The Christmas/New Year time of the year is usually the most expensive and many staff rely on this overtime. So many of them were, to say the least, upset. I wonder just how many people have realised that they can actually function without the overtime, leaving the firm short anyway. I wonder how many bullet holes there are in the feet of senior management. Glad I don't have to do their job, that's for sure. Roll on the new financial year...

Licensing laws

Once again, it's been a while since I last posted anything. Don't think that I've quite got the hang of this thing yet, but getting there slowly. Since my last entry, I have started a new "ghosting", which is basically covering somebody else's line while they are off doing other things, such as racing around in fast cars or having babies or anything in between. Hopefully that means I get some sort of stability for a few months. This is my third ghosting since qualifying as a paramedic, but the first one where my crewmate is a technician and not a paramedic as yet. Up until now, I've been working with a medic who's had at least a year or two more experience with that big green bag, but now I've got to think on my own and remember all the extra drugs and procedures that I'm allowed to do. Crazy ambulance service, letting me run around with lots of sharp and shiny toys to play with...
As usual, though, it's not been the big jobs that have caught the headlines in my day to day activities. It's the one's that just niggle at the back of the brain. Having read the title of this post you probably assumed I was going to whinge about the extended alcohol selling hours. But no, this is about a license that no-body has, but I think sometimes would be a pretty good idea. I'm not talking about owners of dangerous dogs, off-licenses, pubs, or anything of the like. I'm talking about PARENTS. Some parents need to go back to parenting school. Now, I realise that not everyone has an ideal upbringing and that all parents make things up as they go along. I know that I do. BUT. All prospective parents should know the basics. I don't mean treatment, although that would be good too. I mean accident and illness prevention. The 18 month old baby who we went to last week had me jumping up and down on the spot with steam coming out of my ears. Baby has only been walking for a month or two, so is still a little doddery on feet. But parents have had a while to get used to baby becoming toddler. Never occurred to them though, that stairs are not quite within baby's ability yet. However, the flight of 13 concrete steps was unguarded. No gate, no door, nothing to stop baby from trying to climb down them. Or tumble, as the case was. So down baby went, ended up with a broken leg, and the walking that she's only been doing for a few weeks now gets put back by a few months again.
Sometimes I just give up...

Tough day at the office

Rarely, very rarely, do I take a job home with me. But today one of the calls got to me. We were given a call that I looked at the screen and said to my crewmate "this has got grief written all over it". We were called to a terminally ill patient who had been discharged from hospital so that she could die at home. Her son was there and called the LAS as his mother was very distressed, breathing very rapidly and in a great deal of pain. He had the right medications at home, but just needed someone to administer it. The district nurse who was supposed to do it hadn't shown up, the GP was unavailable as it's Sunday, and NHS Direct had suggested to call an ambulance. In itself that's a fairly logical conclusion, except that the drugs that she needed are ones that we are not licenced to give. So we called for back up. We spoke to EOC (control room) who put us in touch with one of the top doctors who help the LAS with real-time medical support. We were authorised to give the medications, with some time intervals and see how they helped the patient. The idea was not to prolong the patient's life, but to make their last few hours or days as comfortable as possible.
So this is what we did. Over the next two hours we monitored the patient, administered medication, tried to arrange for palliative care, ensured the district nurse was going to attend and generally attempted to make the patient as comfortable as possible. Finally the patient seemed to be a little more comfortable and much less distressed. Certainly she was in no pain. We explained to the son that there was nothing further that we could do, advised him as to what could follow withing the next few hours and left the premises.
We were in the vehicle completing paperwork, ensuring that if any further crews were called that they knew what had been going on, that they did not convey the patient to hospital, and that, if events presented, she was not to be resuscitated. Her son had accepted the situation and was fully aware that his mother was dying.
While we were still finishing the paperwork, he came outside and said that he thinks that his mother had died. We rushed back in only to confirm that his fears were indeed correct. She had, in the 10 minutes that we had been sitting outside, died. She was pain free, less distressed and with her son, when she quietly passed away. He seemed to be comforted by these facts.
Sometimes our job isn't about just saving lives. It's about ensuring that the lives we live, even if they are nearing the end, are lived with dignity and comfort. It's about looking after the relatives best interests as well as the patient's.
And sometimes, just sometimes it's about working out how not to take another job home.

Petition

You may have already seen this elsewhere, as I have stolen it from another blog. One of our biggest bugbears is that of inappropriate calls. A great deal of education is needed, so someone has decided to start a petition on the Number 10 website. So have a look and if the mood takes you (please), then sign up. Who knows, it could be the start of something beautiful...