Category Archives: Ambulance

Seeing The Future

There is a warden controlled place a little way down from our station and we find ourselves going there a fair bit. Unlike some of the so-called 'care' homes that we go to, this place is really nice, the wardens are great and they call us for all the right reasons.

Our patient was somewhere in her seventies and had just moved into the place, her 'paperwork' was still coming in from the various agencies that had arranged her placement here. She had a 'funny feeling' in her head from the night before and had vomited once in the morning.

As these were unusual symptoms the warden thought that it would be best for her to go to hospital and had called us. I couldn't disagree.

It was hard to get the patient to describe her symptoms to us as she was suffering from the early stages of alzheimers disease.

Her disease showed itself by her constant repeating of a few conversation topics. She kept telling me about the lino that she had jut bought. She told me that she was concerned about the women who keep knocking on her door (the wardens checking that she is alright), and that she sometimes gets panicked during the night.

Yet she was able to recite a long prayer word for word at me.

She was a really pleasant lady, one of the 'old East end' types, littering her talk with gentle, friendly cuss-words. Friendly and polite, telling me about her family that keep visiting her and fitting her new lino. Just the sort of old person that I like, and if you've read this blog for any time you'll know I have a soft spot for the old 'uns.

Normally when we see patients with alzheimers disease they are pretty far gone, often bed-bound, they cannot remember anything, they are incontinent and can spend the whole day crying. It's an awful, awful disease, and this pleasant lady was going to end up like this.

It's hard work to care for someone suffering from dementia, it was hard enough for me to listen to her circling conversation for twenty minutes.

Especially as when I looked at her I could see her future.

Nice

Ah, the joy of Windows computers. My desktop system has gone 'kerblam' and I find myself having to do a complete reinstall of the whole **expletive deleted** system. Which isn't as easy as you would think. Whatever happened to systems being sold with driver disks? It's not like I like to do anything 'fun' with my time off. Why, I haven't looked at my email or twitter alerts for at least two days.

But it's not all bad, I had a shift where everyone was really rather nice.

An elderly woman whose GP had called and decided that she needed hospital treatment. The family were lovely and completely understood why we were a couple of hours late for taking their mum into hospital. They were even nice enough to offer to carry our bags of medical equipment for us while we carried the patient downstairs.

Then there was the mother of a small child which had suffered a febrile fit. The mother was somewhat panicked but our showing up soon calmed her down, especially after we explained what had happened to her child. At the hospital she looked me in the eyes and thanked me, something that is unusual enough that it sticks in my memory.

Then there was the elderly man who was suffering severe back pain, especially when he tried to move. We arrived and the paramedic I was working with gave him some intravenous morphine to try and ease the pain a bit before we tried moving him. While she was doing this I was outside giving the patient's wife a hug as she was crying thinking that she was going to lose her husband. Thankfully the cause of the pain wasn't too serious and the man should make a full recovery.

Our other patients were similarly nice.

No lives saved that day, but everyone got the care they needed and thanked us at the end of it – so one of those days to mark up in the 'win' column.

More Strokes

We had been on a rest-break, but Control had interrupted our break in the last fifteen minutes (which is fine by me as we get financial compensation, and I'd rather not be named as 'Medic on tea-break while my child died' in The Sun)
The call was given as a 'elderly woman collapsed behind locked doors, possibly deceased'.

We got round there as quickly as possible (after taking a detour due to a council rubbish truck sitting in the middle of the road, obviously picking up some cardboard boxes was much more important than whatever we were going to). Our FRU was already there, as was the patient's nephew.

The front door was shut and our FRU pilot was nowhere to be seen. WE knocked on the door and it opened a crack. The familiar face of our FRU appeared in the gap.

“She's laying in front of the door – I climbed in from the neighbour's back garden”.

We made our way through the neighbour's house and stepped over the two foot fence that separated their gardens.

The first thing that I noticed was that the house was spotless, our patient was originally in good health.

Then I saw her laying in the corridor.

She had been there for probably twenty-four hours, there was no carpet so she had been collapsed onto tiles overnight. The entire right side of her body was a huge bruise.

As you get older your skin becomes less resistant to damage, so you bruise easily, tear the skin easily and can get pressure wounds. The weight of a body can cause the flow of blood to become interrupted and unless you move (which is what people normally do) then the skin and underlying tissue can die.

You end up with wounds like this (Warning, you may not want to see this).

The right side of her body was likely going to become like the above picture.

It became obvious that she had suffered a stroke – she wasn't moving the right side of her body. Her left hand kept snaking out and grabbing at us and you could see the fear in her eyes.

She was also as cold as a block of ice. Being unable to eat or move, stuck in the draft from her front door in an unheated house meant that she was suffering from one of the worse cases of hypothermia I'd ever seen.

Her core body temperature was 28 C. (82.4 F)

We carefully removed her to hospital – any sort of physical shock at this temperature can cause the heart to stop. All we could do was to make her as comfortable as possible, wrap her in blankets, hold her hand and talk to her.

With a hypothermia this severe the hospital can rinse warm fluid around your internal organs after making a surgical hole in the abdomen – in this case though the risks to a patient this frail meant that they stuck to the safer warming blankets and warmed fluid into the veins.

It's unlikely that she will survive this episode. I hope that the stroke affected her mind, and that she wasn't aware of what was happening to her. I can't imagine what it must have been like, to lay there for so long, unable to move, gradually getting colder, not knowing if help was ever going to come.

I hope that it affected her mind, but with the look in her eyes I think that she knew exactly what was happening.

It's not a good way to end 80+ years on this planet.


It seems that all I'm writing about at the moment is sad things – hopefully I'll have some happier stories to tell in the near future. At least I have my Mac laptop back and can work on answering some emails.

More Real Work

I have my new permanent crew-mate. This makes me happy and I think that we will work well together. She says that she never gets a serious job, something that I think applies to me as well.

So of course – on our first two days together we end up with some really rather seriously ill patients.

It's been unseasonably hot and we had already been called to an elderly man who had collapsed – we ran our full barrage of tests and it looked like it was due to a few too many layers of clothing. We'd also been to a woman walking around in the middle of the day wearing a puffa jacket who was feeling dizzy. Probably something to do with the high temperature.

So we were called to another collapse, we arrived and thought that he was dead. His whole body was either white or purple and it was only because our first responder was talking to him that we knew he was alive. Gradually a bit of colour came back to him and he told us about the abdominal pain that he had been suffering with from earlier in the day.

As he was laying flat out in the kitchen and we needed to get him to the ambulance we gently sat him up in order to get him into our wheelchair. His eyes rolled back into his head and we quickly lowered him back down to the floor. Again he lost all his colour and I quickly checked that his heart was still beating.

This needed a rethink. A quick examination showed a pulsating lump in his abdomen. This is typically a sign of an Abdominal Aortic Aneurysm (a 'triple-A')which, should it start leaking or burst, will kill you. The only treatment is surgery. Which means getting him to hospital very quickly. So we grabbed our scoop stretcher and carried him out flat. It's a lot more awkward and took more time, but if he was going to collapse every time that we sat him up it was the only way to get him out the house.

A few quick checks on the ambulance to make sure that he wasn't having a heart attack (and would therefore be going to the angioplasty lab) and we 'blued' him into hospital.

As I hopped out of the drivers seat and opened the door I noticed that his colour had improved greatly and he was a lot more talkative. As we wheeled him into the resuscitation bay I said to the doctor, “Well, on scene he looked like a triple-A”.

We left the hospital to it and did a few more jobs.

It was only later that we saw him being wheeled out for a transfer to another hospital – it seems that our initial suspicions were correct and he was indeed having a slow bleed from his triple-A. While he was currently stable (stable enough apparently to transfer him without a nurse or doctor escort), I would guess that he would still be needing surgery.

Once more, a 'good' job, one where we made a difference. I don't know what is going on – all these genuine jobs… Whatever happened to nice simple broken fingernails and watery eyes that walk on and off my ambulance and mean little work on my part.

Mental Services

Mentalnurse tells us about the big headline in community psychiatric services.  I’d say that this post sums up the whole of the NHS…

First off Care coordinators have to look for services that say they will do the work that’s shown on a care plan, then you have to beg for the money to pay for the services, and then you have to monitor the services so that they do what they say they are doing. This last bit is really frustrating, because often they are not, but there are no other services available, so its a bit like being a toothless tiger – and if you want to know what that’s like, just imagine trying to suck an antelope to death.

 

The Standard Weekend Night

After working for two weeks straight I have had a chance to spend two enjoyable days hiding from the world while sitting on my backside reading,watching TV and of course – playing World of Warcraft.

Now I return to work for a Friday, Saturday, Sunday nightshifts.

Deep. Joy.

 

The standard breakdown for a weekend nightshift is as follows.

19:00 – Clock on at the station.

19:01 – First call, normally to someone elderly, probably chest pain

20:00 – Man with ‘man-flu’

21:00 – First assault of the night, outside a pub.

22:00 – ‘Unconscious’ male in street – normally a homeless guy.

23:00 – Another assault.  Fueled by alcohol.

00:00 – ‘Unconscious’ – drunk in street.

01:00 – Child with a high temperature – everyone in the house is awake.

02:00 – Young man with bellyache / young woman with dizziness. (We are now the only ambulance running from West Ham)

03:00 – Nightclubs kick out.  An assault who doesn’t want to go to hospital.

03:30 – Drunk in the street or a drunk who has injured themselves.

04:30 – Get back to station.

04:31 – Maternataxi.

06:00 – Another Maternataxi.

06:30 – Return to station – start watching the clock for sign-off at 07:00.

06:57 – Get a job for a little old lady, miles out of my area with cardiac chest pain.

06:57:01 – Start swearing.

07:25 – After a ‘scoop and run’ return to station to sign off – all ready to repeat the night in just 11 hours and 35 minutes.

Tell you what – I’ll do one of my ‘updated throughout the night’ things.  I can’t guarantee that this is how things will unroll (and this in part is the pleasure of this job), so we can see how far away from my prediction things fall…

Condemned

Back when I was an A&E nurse I would tell people that the job had 'broken me' , that there was no way you could do any other job after working in a busy A&E department. Any other job would be either too boring, or that my own values of what is really important* would make me unsuitable for any work that involves 'profit'.

I'd lose a company millions of pounds and then turn around and, shrugging, say, “at least nobody died”.**

Then I left nursing and joined the ambulance service. While it has it's differences, a sizeable chunk of the work that we do is pretty much the same, make people happier than they were when they first met you, the cause of this unhappiness normally being something to do with their health.

Some months ago I got extremely disillusioned with the job, even my friends outside the service noticed my deep unhappiness and mentioned it to me. I started looking for other jobs, one was for a communications officer for the LAS which I was unsuccessful at getting, others were outside the NHS. I started casting out feelers for other jobs, perhaps from some of the networking that I'd been doing at the conferences I attended or spoke at.

Out of the blue I was offered a consultancy job with a business, just part-time, eight hours or so a week, concentrating on 'internet culture', 'social media', blogging' and all that other non-technical web stuff.

The pay was good, the people at the office were friendly and there was a certain boost to the ego on account of being referred to as the 'internet expert'.

But, what I would almost hope for, as I sat typing away in the office, was that someone would fall sick so that I could spring into action and do something more interesting than compose emails and action plans.

It was hard to generate any excitement for other people's business and to remain enthused in subjects that I had no real interest in.

There was a certain amount of dishonesty on my part which I found very hard to keep up. When I say dishonest I don't mean in the way that fraud or lying is dishonest, but to try and keep the energy up when dealing with something outside my normal sphere of interest was draining me.

I was being dishonest to myself.

So when I had the chance to resign from it as a regular gig, I leapt at it.

As I write this I'm keeping my fingers crossed that I can get back to my 'proper' work soon. Despite it's many flaws, it's still a job that I can get excited about, that I have interest in and that lets me be completely honest with myself, and the people who I work with.

So it looks like I'm condemned to work on the ambulances until I drop dead or retire, whichever comes first.

—–

People often tell me, “I couldn't do what you do”, but I think that the next time I pick someone up from an office environment it might well be me saying that for a change.

—–

*Breathing and having a pulse – money comes pretty much at the bottom of any list I make of 'things that are important'.

**Actually, given the current financial situation across the world, perhaps I would have fitted in perfectly.

Chemical Cosh

My memory is poor, but I'm sure that, when I was a nurse, the NMC had it as a condition of being the sort of nurse who gives drugs to people that the aforementioned nurse understand what a drug does and what it's side effects are.

It's 3am in the morning and I'm miles out of my area on the FRU*. I have been sent, as a blue light response, to a nursing home where one of their 'clients' is sleeping.

Yep – sleeping.

I get there and the patient is in the reception area of the home sitting in a wheelchair. He is… asleep.

The 'nurses' at the home tell me that normally he is very active at night and often comes to see the night nurses and sits chatting with them. He's ninety-eight years old and mildly demented.

I bite my tongue and do all the checks that I can to make sure that there isn't anything obviously medical going on. All his observations are fine and he responds somewhat when I try to wake him. I'm sure that if I provided enough pain stimulus I could fully wake him up, but it would just seem cruel.

I look at the patient's drug chart. Two days ago he was prescribed a rather strong sleeping pill.

I ponder, for about 2 milliseconds, if this might be the cause for his sleeping. At 3am in the morning.

I suggest this to the nurse.

She shrugs.

The staff don't say anything, but I get the distinct impression that they have been getting tired of this patient being awake while they are at work. If all your patients are sleeping then the night shift has little to do. If this patient has been awake, then they actually have to talk to him. In a lot of the nursing homes that I've been to the nursing staff don't like talking to the patients.

In a fair few nursing homes that I've been to the staff and the patients rarely share a language, and so everyone just 'gives up'. As a digression, the good nursing homes that I've been to have been those where the staff and patients do talk to each other, and the care of the patients is considered to be more of a 'partnership'.

The nurses, who I suspect have got exactly what they asked for, aren't happy. They've already rung the elderly relative of our patient (at 3am!) to let her know that he is heading into hospital.

The ambulance crew arrive and I have a real problem explaining to them why we have been called.

“The nurses wanted this patient to sleep at night. They have given him a sleeping pill, and now he's asleep”, doesn't really seem reasonable for a trip to the hospital.

But the 'customer' is always right – and so the patient is driven off to the hospital.

I talk to the crew a few days later and they tell me that the receiving nurse at the hospital was as befuddled as the rest of us.

I don't know, jobs like this make me despair at the general intelligence of people, not less the intelligence of the sorts of people who look after the elderly.

Oh well, at least one of us had a bit of a kip that night.

*I really need to tell you about FREDA one day – perhaps a joint post with Nee Naw.


I'd like to apologise, blogging has been a bit slow of late. Mostly this is due to working on the sequel to 'Blood, Sweat and Tea' – I'm needing to put some concentrated effort into it. this is not easy with twelve hour shifts accompanied by the utter lack of energy I have at this time of the year.

Medgadget are running their annual Medical Blog Awards – you should go over there and have a look at the nominees, there are some really good ones there. Also there is no other motive for suggesting you visit the link. No. None at all…

The Stamford Experiment

I'm watching the TV and a politician has just referred to people who 'binge drink' as 'people who drink to get drunk', a phrase I first used on this blog a year ago. Maybe someone in government is reading this site?
I've written before about how I am a different person when I'm wearing a uniform, how I am more confident, more proactive and sometimes a bit more 'shouty'. The reverse is also true and I think that this is, in some way, due to the way that people treat me when I'm wearing the uniform.

People see me in uniform and permit me to direct them, advise them and do things physically to them. Without the uniform I can't do this.

It all became obvious on the way home from the centre of London one night. I was using the tube and, on coming up an escalator while changing between lines, came across a man who had collapsed.

There were two members of the public with him, a station officer and a station cleaner. As I approached I saw that he was pale and sweaty, he triggered that bit of my brain that says 'this person is properly ill'.

I tried to walk past, I really did. I think I got two steps beyond him before turning around and returning.

“Hi there, I work for London Ambulance, can I help?”

He'd apparently became dizzy and then had collapsed, a little chat with him revealed a significant history of internal bleeding in the past. Feeling for his pulse I couldn't find a pulse in his wrist, this meant that he had a very low blood pressure, this would explain his paleness and sweatiness.

I asked the Station officer if he'd called an ambulance, and he mumbled something in the affirmative. I tried to take control of the situation, but it all came out a bit vague and quiet. I put the cleaning bucket under his feet to try and raise his blood pressure a little and awaited the ambulance.

All the time this was going on I was feeling rather vulnerable, unlike when I am 'on the job', I could also tell that the people I was with weren't taking me as seriously as I would had I been wearing a uniform.

The ambulance crew arrived and I handed the patient over to them. They didn't seem impressed, again probably because I wasn't wearing my uniform.

As I walked away I felt rather bad, If I had turned up in a FRU car, then the job would have felt very different, but without my uniform I wasn't as confident.

It's funny what a green shirt can do for your confidence.

Locus

I’m a scientist at heart, I believe in emperical evidence, research based medicine and the eradication of silly superstitions.

Unfortunately sometimes this job can throw weird things at you.

An example of this happened to me the other day.

Out of eleven jobs I went to three in the same street, lets call it ‘Gray close’.  All the jobs were to diferent houses and all were for diferent illnesses.  The area is not in an especially deprived part of Newham, so there is no real reason why I should have to go there more than usual – and to be honest, I can’t remember the last time I was there.

I was wondering what the chances of this happening were – so bear with me for a bit, and if my maths is a bit screwy then feel free to correct me.

There are roughly 92,382 households in Newham (I worked this out by dividing the population of Newham by the size of the average household 2.64), and while I cover more of an area than Newham, this number will do for the purposes of this example.

All numbers come from the Fire Service.

Gray close has 34 households.

92,382 divided by 34 is 2,717.  So the chances of a specific call being in Gray Close is 1 in 2,717.

I did 11 calls that day, and three of them were in the same close, which has the odds of something like 1 in 20,057,135,813.

At least I think that is right – it has been years since I looked at statistics and probability and to be honest I didn’t understand it then.  But while the maths might be wrong, the effect is still stunning.

An additional thought is that this isn’t that unusual – At least once a week I’ll find myself going to the same street, or streets that are neighbouring each other on the same day for multiple, unconnected calls..

It is this that makes me think that there might just be certain concentrations of some form of ‘bad vibe’ that hit certain areas causing illness, assaults and other ‘emergencies’.  I’m sure there is some clever (and very expensive) clustering software that could work out if this sort of thing was a real effect or just my all too human mind playing pattern recognition tricks with me.

Or am I just going mad?