A Sheet Of A4

I came across a patient yesterday who had a really good idea, it was an idea that helped us, helped her and helped the hospital.

We had been looking for a job to last us until the end of our shift and had thought we had got it with a drunk in the street. It would have been fine if he'd let us take him to hospital, but unfortunately he woke up and wandered off home. So we were stuck with forty minutes until the end of the shift. We would have to hope for a nice quick and easy job – something like a two year old with a head injury.

(Two year olds with head injuries are easy jobs because the injury isn't severe, it's normally stopped bleeding, we don't have to do any serious observation taking and the mum or dad looks after the child while we essentially act like a taxi).

Of course, what we wish for is often very different to reality.

From our 'patch' we were sent to a train station in the middle of London. Miles away.

At least it was Sunday, so the traffic wouldn't be so bad.

Our patient was having an asthma attack, the first responder on the scene was asking for an ambulance as quickly as possible, so it was obviously something a bit serious.

I don't like people having asthma attacks – they can tend to go wrong very quickly. Also the patient is having a very hard time of it and it's never nice to see that. I heard a description of an asthma attack once as, “trying to run a marathon while breathing through a drinking straw”, and that description has stuck with me for years.

So we got there as quickly as we could through unfamiliar streets to find *two* motorcycle responders there. They had been waiting a long twenty minutes for us.

Our patient was still receiving the nebuliser treatment that the two motorcycle responders had started. They told me that the patient's chest had nearly been silent when they had arrived. This is a sign of a very serious attack.

Our patient had obviously been in this situation before as she produced a neatly typed sheet of paper with all her details, her allergies, here previous medical history and the type of treatment options that worked best for her. It told me that she was a 'brittle asthmatic', which always makes me bluelight these patients to hospital when they are having an asthma attack. If you are having an asthma attack it can be difficult to talk – so all our patient had to do was hand over the sheet of paper to whoever was looking after her.

It was a good thing that she had that bit of paper because every time she removed the nebuliser mask from her face to talk her oxygen saturations (a measure of how well she is breathing) dropped rather quickly.

So we loaded her up and sped to the nearest hospital.

I wish that all our patients had such a bit of paper. Where I work there is often a language barrier, even heavy accents can make my life difficult, so a little sheet like that would make my life so much easier. Also I find myself going to patients who don't know what is wrong with them. All they know is that they take a 'little white pill in the morning and two brown pills in the evening”. Of course, this is more a failing of the Primary healthcare provider in not making sure the patient is kept informed about their health.

More importantly imagine going to a 'collapse in the street' only to see a bit of paper stuck to their jacket saying, “I'm OK – I'm just drunk”.

As a question to you all, utterly unrelated to this blogpost. How can I be tired after thirteen hours of sleep?

39 thoughts on “A Sheet Of A4”

  1. The idea is that the local services are given the information about the scheme, the client gets a sticker that's put in a visible location (front door or window). When the relevant people see the sticker they head towards the fridge, it's not so much the location that's important it's the consistency; it won't get dusted around, have something dumped on it, fall on the floor behind the table or suffer from not having a shelf by the front door.Also you have to consider that many people won't be happy displaying all their major conditions and tablets in an easy to read poster…

  2. He's one of the people from dispatch, and a good bloke. Good to see him deal with a tricky question or two.(Although it might not have seemed too tricky from a layperson's point of view)

  3. I've never seen it in my part of town. I just don't think that it is publicised that much to be honest.(And we do look in fridges, because that is where people keep their insulin – and we are a cunning, tricksy type of people.)

  4. I created the same about four years ago, except mine is printed black on yellow, for best visual acutance, and laminated in credit card size so it slips easily into my wallet.It starts: “I'm handing you this because I'm having an asthma attack and I (quite literally) don't want to waste my breath talking.”

    Goes on to name, DOB, address, phone, NOK, GP details, normal drug details, normal PEF/FEV1, says I've never been ventilated or to ITU but have been admitted many times and says I've no known drug allergies. Lists other known medical problems. Adds a quick family medical history and signs off with a suggestion that if I'm having some other emergency to think of this as a steroid card instead.

    It's saved me many valuable litres of O2 when I've needed them most. To any medics, EMTs etc. reading this – PLEASE do not make us poor asthmatics answer any more questions than absolutely necessary and please make as many of them yes/no questions as possible. e.g. NOT “what drugs do you take?” but “Do you use a reliever?”, “Is it salbutamol”, “is it bricanyl?” etc. etc.

    Better still, someone could produce a Q&A sheet that we could just tick boxes on or write the occasional answer – it could even have photos of inhalers for non-english speakers and folks too dumb/disinterested to know/care what they're taking.

  5. “As a question to you all, utterly unrelated to this blogpost. How can I be tired after thirteen hours of sleep?”Too much sleep has the same effect as not enough sleep. Apparently. I wish I got 13 hours sleep last night, I spent the whole night in the toilet throwing up! And no, it wasn't drink-related at all, before you ask. 😛

  6. ooh this is my first comment. i have been reading for ages and ages but only just got round to signing up so i can reply. anyway, i just wanted to say that, like ian who commented above, i also have a similar thing to the astmhatic in the post. mine is also small so it fits in my wallet and has my name, date of birth, that i have epilepsy, what medication i am on, that i am not allergic to anything and my husband's contact details. i think i remember being inspired to make it after reading one of your posts. when i am ill and need an ambulance, i tend to be unconscious and unable to give any of the information myself so i thought it might be useful.and, i also regularly find myself still tired after 13hrs sleep. i too wonder how this is possible.

  7. Note to self. Get magnifying glass out eh route to asthmatics going off on one. Cool idea though. Perhaps someone could get onto the National Asthma Campaign and see if they're intereseted in devising a standard?Sleep tight Tom!!

  8. I too am Brittle Asthmatic and can have real humdingers. I have carried around a 'Treatment Protocol' on an A4 sheet for years. It has been a lifesaver to me. It informs the paramedics and the A&E doctors everything they need to treat me. (including the fact I DO use my epipens ( adrenaline) for my asthma if very splatty!)Very usefull if you are away from your regular paramedics or hospital. No faffing trying to talk though the a& e docs will try and get a complete history out of you the length of a thesis and wonder why you are getting worse!

    I also have a medic- alert with the basics but they do have my protocol on file if you phone the number.

    Though, I have my protocol printed off numerous times and stuffed in all sorts of places.

    AmbuSam

    Asthma UK http://www.asthma.org.uk ( Was NAC!) do have a small card for asthmatics to fill in with their meds, best Peak flows, step up meds etc and what to do when the patient is having an attack ( for the lay person) Hop on to their site to see all the info.

    Kate

  9. I was thinking the same, thats a lot of info on a little card, the crews must have had good light and 20:20 vision.Is a bracelet or necklace more likely to be found quickly than a card in a wallet or purse, on an unconscious casualty? If it were me I'd go for a belt and braces approach and carry both

    As for the sleep question, I am loath to admit that Mr UHDD is right, but yes you can have to much sleep, it also gives me a stonking head ache

  10. i quite often produce similar things for my clients – esp those that have a propensity to take impulsive overdoses. One I did recently has full crisis plan details on and a list of what not to do ie give them lots of painkillers 9maybe i should be more surprised that a&e's would do this to someone with a long history of impulsive overdoses but there you go!)

  11. I disagree with the 'too much sleep' theory. I think you may need a few more 13 hour sleeps as you may still be catching your breath after a very busy month plus jet lag. I have found 2 or 3 nights like that to be necessary sometimes. It restores me and puts me back to my version of normal.

  12. So would it be of value to have a card saying, along with emergency contacts, for example:”I am teetotal and don't have any diagnosed medical condition”

    or

    “I drink heavily but don't have….”

    or

    “I am diabetic and use cocaine, but I don't have…”

    Etc…..

    I know people who fit in all those categories and then some, just asking?

  13. Had a 10 mile 'walkathon' on my patch on wenesday with about 10,000 people taking part. They were all told to write their significant medical history on the backs of their numbers. Shame no one thought to tell the ambulance service about this cunning plan…..

  14. because 13 is the wrong number for your sleep rhythms.you've had a full night's sleep. But you are still tired. So your body tries to have another full night's sleep. 13 hours means you essentially got woken up halfway through session number two.This is also why if you have a nap, it shouldn't be more than an hour – about 20 minutes is best, otherwise your body tries to start “proper” sleep.

  15. That's fairly standard practice for an event like that, so I would have thot the ambo service would know about it. But yeah, woulda bin nice for them to mention it to you.

  16. I had that for when I went in with worse-than-usual migraine – not because of the migraine per se but when the pain made me want to commit suicide rather than put up with any more or I started doing stupid things like putting sharp things up my nose. The constant pain can wear a body down.So all I really want is quiet, dark and a lack of easy access to sharp things and drugs.

    The sheet never stopped me getting a full thesis-length Q&A session, often several timesm from A&E docs. Plus on one occasion, sent home as 'just a migraine' whereupon, sad to say, I shoved a small paintbrush up my nose, got a starburst of pain and a lot of fluid and then slept the rest of the attack out in deep and happy relief. Stop wincing, I'm fine and I know it's not sensible, this is why I went off to A&E in the first place, because I get into states where I know it's not good but it's like cigarettes to a smoker.

    Anyway, back to the point. Ambulance drivers are usually quietly understanding, or at least take the mickey when I am out of hearing. They love the sheet. If I happen to be coherent enough to have details, I'll blame you for the idea.

    What I'm taking, what I am allergic to, that it's probably migraine, chronic, daily, when it began, and I might start adding the suicidal urges to it, but it seems sort of overdramatic. As opposed to asking for an ambulance. Er… anyway. Sheets are good and A&E doctors like to hear patients talk far too much.

  17. I'd never heard of it, but then I've never covered a marathon. Saying that it wouldn't surprise me if no-one knew. I was unaware of some 'big' thing happening in my patch (I *think* it's the arms trade thing, but no-one has let us know).

  18. See, I'm an expert when it comes to the little naps (give me 20 minutes and I'm good to go), never really thought it would 'wrap around' to sleeping too long.But why would I sleep so long in the first place?

    I think this job is killing me.

  19. My best one yet has been flat out for 26 hours after an extremely busy month. Don't stress about it, your body needed the rest.Unrelated, saw the One show last night and surprised you weren't on – is the guy that was media relations or a proper 'ambo'?

    j

  20. After that long comatose, the headache's probably a combination of dehydration and the start of caffeine withdrawal. You're better off getting up for a bit after 9-10 hrs then catching a nap later if you still need it.

  21. Mr UHDD does a lot of fell/mountain races, it is very unusual to be asked to do this, an exception is the Ben Nevis Fell race where the reverse of the runners numbers are preprinted forms that must be filled in. Seeing the high standard of organisation at this race, they would certainly have informed mountain rescue who marshal the event who would most likely be first on scene (the exception being rescue helicopter I suppose)

  22. On a similar note, although aimed more at the elderly, the 'Message in a Bottle' scheme is well worth informing people of, as it's a consistent way to allow easy access to important information that may be needed by emergency responders.

  23. With the best will in the world, how is that going to help? Who on earth is going to look in the fridge for emergency information?Better by far to have it stuck to the OUTSIDE of the fridge or near the front door where it's going to catch the eye. I have an ICE message on the meter cupboard door for that very reason, right where someone who has to come in to deal with an emergency either to me or the house will see it quickly – just contact numbers and where the mains cutoffs can be found.

  24. Going to say a few things, hope I don't offend anyone as its not intended…. firstly not sure about everywhere else, but were not drivers, I know its only a little thing to some, but its a long hard slog to be just a Trainee Tech, let alone an EMT or Para, and although there are lots of different levels, none of us like to be called drivers as we do a lot more than that.Secondly about the A4 sheet, its a cracker of an idea, and it is so very helpful, I have come across a few and it really does make a difference. There was a comment earlier on about us asking questions, I don't know about Tom, but I always start off with just one question…. usually a name and if you can answer that quite clearly then I know how much I can continue questioning. We also look at you, if your struggling and using accessory muscles to get the air in, then someone else can tell me your name, or I will just call you George for the time being.

    We are meant to get a peak flow, I rarely do with someone who is really struggling, I can't think of anything worse to put an asthmatic through, the only exception is those that have a little wheese and can answer questions, I don't mind giving it a go then. If you are really struggling to breathe, I do not know of anyone in the ambo service who would do a peak flow or ask lots of questions. If they are like me, they just get the neb started and worry about the paperwork and other bits later once the drugs start to work and you can breathe again. But then most of the questions would be unnecessary if you had a handy card….

  25. they are very very helpful, a lot of people on my patch have got them, which is a god send when they can only tell us that they take two blue tablets and a brown one.

  26. i produce something similar for my elderly neighbours who see lots of blue lights folk and they have two sheets. one that is medical history and the other with drugs doses and strength of tabs/liquid / spray. they have plenty of copies so that it doesnt matter if the GP / nurse / ambulanceman / social worker keeps one. They are also updated as things change – easy with a PC and, im told, useful too.long time lurker first time commenting

  27. I have one of these as I always have at least one med that the nurse/paramedic/doc hasn't heard of and can't spell. While my asthma is usually not bad enough that I'm not able to talk (I try to get help before it gets quite that far), my brain is usually not in a fit state to spell generic drug names or remember which trade name goes with which generic (I think in generics). It's kept in my purse for convenience and is in a minimum of 12pt type. When I'm on lots of meds, I just do a double-size one and fold it in half rather than reduce the type size.Mind you, my brother comes with a whole folder. But then he usually comes with a (competent) nurse as well…

  28. I have also got my address logged at Ambulance Control so they have some advanced info if I call and can't give them the details.Its says I am Brittle asthmatic etc latex sensitive so they don't come charging in with latex gloves and which neighbours have keys so they don't break the door down.

    Has been very handy.

  29. Cheers mate. Ditto on both your comments. The bottle in the fridge is very handy…….spot the sticker on the front door and straight to the fridge for a comprehensive history. Saves a load of time, especially in cases where the patient is alone and unconscious. Also, no world in which I'd push an asthmatic to talk if they were bad, I'll be the one telling the patient not to try and talk but to concentrate on their breathing, and the peak flow goes out of the window fairly early on.Is this because I am incredibly altruistic and thoughtful……..well……a bit……on a good day……but also because like Tom says, asthmatics have a nasty habit of going wrong……I'm not doing anything to encourage them!!

  30. Good point and I was being offensive, without meaning to. I know full well there's a lot more to the job than driving. I'm sorry for beign thoughtless.

  31. Serious question here. I've never considered I am sick enough to carry my medication list in my handbag. Would it be sensible to put the list with medication, consultant and GP names etc in my handbag as well as keeping it in my desk drawer. It is policy at my workplace to have sealed envelope containing all those things in ones top desk drawer. Thus if you need an ambulance or a&E visit your line manager or the first aider can retrieve it and hand it to teh medical staff without confidentiality ever being breached.I've just never thought rheumatoid arthritis and the attendant mega diclofenac and codeine doses were important enough to record in my handbag. Perhaps I should rethink.

  32. “(And we do look in fridges, because that is where people keep their insulin – and we are a cunning, tricksy type of people.)”And there was me thinking it was cos you hadn't had your meal break yet… 😛

    As an asthmatic myself, that's a brilliant idea. I'm usually a very mild case, don't really need my inhaler and rarely carry it on me. Which didn't help when I had a bad attack miles from home after helping with alpaca shearing (please don't ask). I was grey and “sipping” for air at the doctors (didn't think of calling an ambo, tbh) and he sat there asking question after question. Then the receptionist wouldn't let me have a puff until I'd found my wallet and paid for it. I understand it's probably protocol but that seemed a little mean – I was hardly in a position to run off, was I? 🙂

    About the sleep thing, I do that too. I think it's shift work – when you've been doing random hours with no discernable pattern for a long time, your body just goes “Right, if you're not going to stick to a proper cycle, I'm going to just sleep for a good long time. Then we'll talk”. Sound familiar?

  33. I've taken to carrying around the back of my prescription which lists the medication I'm on. It's in my purse.If I need medical assistance I hand it to the nurse as it saves time, gives the dosage and also has my doctor's details.It also helps when I'm buying over the counter drugs as there are many which can cause an asthmatic reaction.Mind you, with mobile phones getting more techy I'm wondering whether there could be a standard way of accessing such info – rather like ICE

  34. Hello,Thought I would comment to say thanks for this post. Am a non-medical person (just so all know), and a long time asthmatic.

    Having moved to the 'Big Smoke' a year ago my asthma has gone from non exsistant to full force and has scared the bejesus out of myself and the other half on occasion. I have started to get it everytime am travelling back home on the busy DLR and trains, and have started wondering is it enough that I should wave my inhaler at someone and point out my ICE number should it become serious.

    Considering I also have a pretty nasty peanut allergy as well, using this paper method sounds like a pretty damn good idea.

    Even now thinking about it I have been in the situation approx 6 years ago, on a shopping trip in the city. My friend's had rung my mother, who directed them to the nearest A&E. They carried me into the emergency room, in which I was plonked in front of a nurse for assessment. The nurse upon seeing my arm in a cast, made an assumption and said “excuse me love I'll be back in a minute. At this time I was experiencing rather painful excruciating chest pains, and strong efforts in the respiratory department, thereofre rendering me slightly unable to correct her/shout after her.

    Eventually she did return, and asked me what the problem was. The repsonse was an explosion of tears and a rasped “I….*gaaaaassssp*……can't…. *cough* *gaaassssssspp* breeaaaaaaatthheee!!!! *gasp* *splutter* *cough*.

    Would have been alot easier if I has produced a bit of paper methinks.

    So, Mr Reynolds, and the asthmatic lady – thank you for the tip. I shall start typing right now.

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