Lives in the day of...

Weight of the world

2007-03-07T04:13:00.000-08:00

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

2007-03-06T01:21:00.000-08:00

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

2007-02-21T23:51:00.000-08:00

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

2007-02-21T23:28:00.000-08:00

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

2007-01-28T00:15:00.000-08:00

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

2007-01-14T12:48:00.000-08:00

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

2007-01-10T13:26:00.000-08:00

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...

Chest Pain

2007-01-09T00:39:00.000-08:00

There is, at the moment, a campaign by the British Heart Foundation, backed by the LAS, to make more people call an ambulance if they experience chest pain. So far so good. Sounds sensible, since chest pain is probably the most common indicator of a heart attack. It can, of course, be an indicator of many other ailments, so not every chest pain is a heart attack. So that's why you need to call in the professionals. Which is just what happened. We had a call from a care home to an elderly lady with chest pain, shortness of breath and vomiting. A common type of call, especially in the part of the world where I work. On arrival the patient really did have all three symptoms, as opposed to the call taking system just making them up. (I know that it's not always the call-takers fault, and that AMPDS has much to answer for). The bit that confused us was this. The care home decided to call the GP first, rather than call an ambulance. They should know better, but it gets worse. The GP heard all the symptoms, couldn't be bothered to come and assess the patient, so prescribed over the phone. The prescription? Glass of WARM MILK! Oh, and if she doesn't get better, call an ambulance. Warm milk?!?!? For chest pain that you haven't assessed? And vomiting on top of it? Sometimes I despair. If the professionals don't follow sound advice, what hope for the general public?
The outcome for this lady was good. She had a bad chest infection, and with some IV paracetamol and antibiotics was already much better when we went back to see how she was doing in A&E.

Breaks again

2007-01-08T15:33:00.000-08:00

So the LAS has hit the newspapers. Several articles were published this weekend about patients dying due to the fact that crews were on their uninterruptable breaks. Especially about a patient in Edmonton. The Sunday Express and the Sun amongst others have led an attack on the Service as a whole. I'm fairly sure that all frontline staff would agree on a couple of things. First, we deserve a break. Hungry crews make for grumpy and sometimes careless crews. Second, and just as important, if any crew was to find out that there was a cardiac arrest call round the corner, they would get in their vehicle and go to the call. Break or no break. Rules or no rules. The problem is not necessarily with the breaks, but the way they are being allocated. It has almost instantly become a cost-cutting exercise, rather than a sensible way to ensure crews get the rest that they deserve, and at a time that is logical. The fact that more than one crew on a station are being put on breaks at the same time is crazy. Patient care still has to come first. However, it seems that more and more like this is going to the bottom of the list of priorities. Times and rules come first. Common sense has gone out the window.

Fooled again

2007-01-02T14:48:00.000-08:00

I can't honestly say that I've seen everything. There are plenty of things in life in general and as a paramedic in particular that I've not seen (some that I hope never to see!). This week was another one of them. We were called to a male in his late 20's with chest pain. As many paramedics will tell you a call like that tends not to be life threatening. It might be a cold, chest infection, muscle pain. But very VERY rarely does it tend to be anything heart related. The call was in the early hours of the morning, the patient had been out drinking all night, was very vague when asked about any drugs taken. All pointing away from cardiac problems. He then went to give all the symptoms that kept leading us away from a cardiac diagnosis. Even his ECG was near on perfect. Then we got to hospital. And his ECG changed dramatically! What was even stranger was that it was different depending on whether he was sitting or lying. Again leading away from a diagnosis of an MI (heart attack). But just in case we were asked to convey him to our nearest Cath Lab. This is where an angiogram (which gives you a look at the blood vessels of the heart) can be performed and if necessary angioplasty. This is where a blocked coronary artery (the basic definition of a heart attack) is opened with a balloon and a stent left in place to keep it open. Even the doctors at the Cath Lab were fairly dubious that this patient was having an MI, but nevertheless performed the angiogram. Which is when you saw about a dozen jaws hit the floor. There on the screen appeared the largest blood clot I have ever seen in a coronary artery. This 20 something year old was having a heart attack. He was going to spend the rest of his life on medication. He would probably not be allowed ever to go on a rollercoaster. I know that sounds like a ridiculous thing to say. But it's always the little things that are the most missed. Remided me of just how mortal we all are. And also how I ain't seen nothing yet.

Doctors and nurses

2007-01-02T01:00:00.000-08:00

Sometimes you'll hear ambulance staff complaining about other health care "professionals". Sometimes for no reason other than the fact that we like a good whinge now and again. Sometimes there are grounds for these complaints. We were called to a gentleman who was seen earlier by a district nurse who came in to administer his medication. Somehow, she decided that the gentleman needed an insulin injection. Which is fair enough as the patient was a diabetic and normally does require his insulin. The catch was that prior to this she checked his blood sugar and found that it was quite low. Yet she STILL managed to think that it would be a good idea to give him the insulin, which brings the blood sugar level even lower. Strangely enough, the patient was not particularly well by the time we got there... I think that this is one that we're going to try to follow up.

Where have you been?

2006-12-28T02:18:00.000-08:00

So I set this thing up, then never did anything with it. Useless. I told you I was new at this... My excuse is that I actually had a few days off so actually had to pay a little more attention to my kids and ignore the computer. Since I started my blog, rest breaks have been introduced and then revoked. There is some warped logic up in senior management that says "lets reduce the overtime, expect the same service, but still tell our crews that on their busiest shifts they don't need a break". I know that the whole rest break thing has caused some controversy (as per The Sun "news" paper), but working the night shift on Christmas eve (see also NeeNaw) which was one of the busiest shifts I have ever done, with no break at all, was a disaster.
In fact, nights over this whole period have been nightmarish. There are as many calls from drunks (or usually for them) as there are from lonely elderly types who just want to spend Christmas with someone, and equally from happy families who just want to get rid of nuisance granny so that they get drunk enough not to even remember they have a granny in the first place. How sad.
At least I've actually seen some genuine patients over the past couple of days. Did two shifts on the FRU (managed to actually get some O/T!) which vaguely restored my faith in humanity, if not in the overall use of FRUs.
Well, I'd like this to be your blog as much as it is mine, so if you wish to raise topics for discussion, please do so! I promise to post messages a little more frequently.
Wishing you all well into the new year! Hope it's a happy one for us all.

Late developer

2006-12-16T18:47:00.000-08:00

Having been a reader of Blogs for a while, especially anything connected to the ambulance service, I realised (very slowly) that it was a great way to achieve several things. First of all, to get things off my chest. Despite the fact that most paramedics and EMTs (emergency medical technicians who are basically the same thing as a paramedic but get paid less money) will tell you that you can't take your job home with you or it'll drive you mad, but sometimes this job does just that.
Second, a little public education. Whether it'll be successful is open to much debate, but at least I'll feel like I've tried.
Otherwise, it'll hopefully be another insight into the world of a London paramedic. I'm aware that several of these already exist, but maybe I'll be able to give you a slightly different angle.
I was and EMT for almost four years and recently became a paramedic. For the sake of ease of use, any time I refer to paramedics in general, I'm referring to EMTs as well.
Enjoy.