Not Nice Jobs Part 1

Speak to any ambulance crew about what they think is the best thing about the job and a lot of them will say that it's the unpredictabilty of the day ahead. Granted, a lot of our work is routine/unnecessary/mundane or just downright stupid, but you just never know...

One and a half hours into my shift yesterday; we've just cleared at hospital from a job and are free to stop off at the local supermarket for munchies (it goes with the territory when you're on the road for up to 12 hours). I'm just about to pay for my daily intake of carbohydrate/protein and fat cleverly disguised as a Kingsize MarsBar, and the radio bleeps into life. I leave my colleague to pay for the goods while I return to the vehicle to get the details of the job and to book us as 'mobile' to the scene.

I look at the details that have been passed to me from Control: a Purple call to an address where a woman has just found her husband hanging by rope from the loft door. One minute has passed since I was busily foraging in the supermarket, wondering which little choocy delights I was going to invest my hard earned money in and now we are gunning through the streets, lights flashing and horns blaring to somewhere where some people are definately NOT having a good day.

We arrive at scene quickly, even though the Sat Nav has tried to direct us to a street around the corner. We are met at the door by two uniformed policemen, the address is being treated as a possible crime scene until proven otherwise.

I ask a detective where the (ex) patient is, he points up some narrow stairs.

There is something about trauma that takes a bit of getting used to. It's the fact the you see the human body in positions and locations, with injuries that are totally alien to most people's perceptions of injury. An adult male swinging from a length of blue rope tied around his neck, suspended from the floor is a good example.

It's time to put my best Ambulance Technician head on, and time to leave my human head back in the ambulance for re-tuning later.

Being careful not to disturb any possible evidence I attach the limb leads from the ECG to the wrists and ankles of the patient. His limbs are cold, cyanosed and stiff. He's been hanging for some time. The trace on the ECG shows no electrical activity within the heart at all, it's called asytole. I watch the screen for more than thirty seconds and see that there is no change, I print off a hard copy for the records. My colleague busily fills in the 'Recognition of Life Extinct' form, a bit of paperwork that is given to the police to inform them that we have diagnosed death in the home.

Not wanting to make any mistakes where someone's life is concerned I go through a mental checklist to satisfy myself that the patient has indeed expired.

I open his eyes to look at the pupils. Yes, they are fixed and dilated.

I try to move his arms. Yes, they are stiff with the onset of rigormortis.

I look at his ankles. Yes, they are swollen where the blood has pooled at the body's lowest point.

I am now happy that the patient is now officially a body. We hand our paperwork to the police and leave the scene. Carefully.

As we climb back onto the ambulance I glance down the street and catch a glimpse of a woman crying, being comforted by some people and a WPC. I try not to think about the bad day she is having and the bad days that are to follow.

I inform Control that the job is now in the capable hands of the police and that we are now clear. Control very thoughtfully stand us down for the next hour, and tell us to return to base for a cup of tea. We inform them that we are both fine and are more than willing to continue the shift already - we've only been working for two and abit hours.

Ten minutes later, I am sat in front of the telly in the Mess Room, Kingsize MarsBar in hand. The telly is on and tuned into a children's cartoon channel. Sat in the room are a dozen ambulancemen, all eyes transfixed to the screen. Cartoon therapy for us all.

Amongst the living I also start to feel alive again.

A SOB story...

It's 02:30am on Saturday morning. The radio bleeps to tell me and my colleague that we have a job, a priority one emergency.

Looking at the datascreen in the ambulance we are told by control that we are to attend to a male in his fifties who is having trouble breathing, whose speech has become slurred and who is conscious. The software that diagnoses the patient's condition from information given by the caller has classed this job as a CVA - a stroke to you and me. The job has been coded as an amber, meaning that we have 19 minutes to get to the patient to be within the government set time limit. We get to the patient in 11 minutes.

Walking into the lounge of the patient's property we are met by a highly emotional woman who is fretting over her husband who is sat hunched forward on his armchair, gasping for air.

A quick history is gained from the wife. Her husband has a long history of Emphysema and has been getting increasingly short of breath for the last hour. A pulse oximiter is attached to the man's left index finger and shows 80% sats and a pulse of 134. Both are way out of kilter, a normal adults sats are 95% with a pulse of 60-80. I put an oxygen mask on immediately whilst my colleague prepares a nebuliser mask with salbutamol. The rapid pulse and demeamour of the patient rules out a CVA but rules in SOB (shortnesss of breath) brought on by Emphysema.

A minute later and the masks are changed. The patient is now inhaling Salbutamol, a wonderful bronco-dilator which hopefuly will open up the patient's lung tissues to allow better perfusion of oxygen.

Minutes pass and the patient's oxygen sats are not improving. The pulse oximeter still reads 80% and pulse in excess of 130bpm. Not good news. I place the sensor on a different finger just in case the kit is playing up. It isn't.

The job now becomes a 'load and go'. The patient needs immediate help to prevent his condition deteriorating. With the help of a chair the patient is quickly placed on the stretcher in the vehicle. The patient is now no longer struggling to breath and yet his sats are just as bad as before. This is really bad news.

Just before a patient goes into respiratory arrest their breathing and struggling will subside. It's the body's way of resigning itself to arrest.

My colleague quickly prepares a BVM (bag valve mask) and connects it to the vehicle's oxygen supply. As the patient pants for breath, I quickly force air into his lungs by squeezing the bag, in time to each of his inspirations. It's not a pleasent experience to have this done to you but it is the only way to get any meaningful air down into the lungs. I succeed with 10 inflations before the patient gasps at me to stop, it is making him feel sick. His sats have come up to 90% though.

A quick trip to hospital through the deserted streets and we arrive at hospital within 6 minutes. The staff know we are coming and have prepared a team in ER to deal with the patient.

We hand over the patient to the staff, giving them a detailed description of all our observations, and leave him in the more-than-capable hands of two nurses, a doctor and the on-call consultant.

And so ends a SOB story but one with a happy ending. At least for tonight...

A Purple Patch

You'll probably appreciate that not all calls to the ambulance service are treated with the same level of priority. Surprise, surprise, you may well have to wait that little bit longer for an ambulance to arrive if your problem is not immediately life threatening. But we will get to you just as soon as we can. Honest.

The very nice people in Control (sat in their relaxing armchairs being kept at a pleasent room temperature by air conditioning), prioritise calls in to descending order from Purple to Red to Amber to Green. The Purple and Red jobs are the most time critical.

Now, I'm not going to go into how how Control arrive at the required response time (and matching colour) for each job , they have very expensive computer software to do that. One thing I and all my colleagues find though is that the Despatcher's question, "Does the patient have any central chest pain?" is often answered incorrectly by the caller - resulting in numerous Red jobs to folk with mild indigestion in their tummies. A quick hint to all my readers - Central Chest Pain is self explanatory. If you are ever asked by one of our Despatchers if you/the patient has any central chest pain, try to think if there is any pain coming from the middle of the chest, just where the two sides of ribs meet in the middle. Anything else is NOT central chest pain!

Back to the colour coding. Purple calls are the REALLY serious calls. The data screen in our ambulances usually gives a brief description of the job as something like, 'Respiratory/Cardiac Arrest/Death' for example. And we all know that death can be fatal.

In our job we can go through many shifts without any Purple jobs - just loads of Red, Amber and occasional Green ones. Yesterday, we had two Purple jobs back to back.

Arriving at the first job we were greeted by a patient who was looking remarkably alive. The fact that he was busy chatting to his daughter was the giveaway. Somehow the job had been passed to us as one involving respiratory compromise. Point taken that the chap was short of breath and breathing with the aid of oxygen but he was not about to meet his maker. A quick check of his lungs with my stethoscope confirmed that there was no wheezing, rasping or gurgling coming from any of the five lung lobes. He was taken to hospital for further investigations.

The next job was to a drug overdose with Heroin. Now, here's another quick tutorial. Heroin deaths are usually caused by respiratory arrest. The drug affects the nerves that control important bodily functions such as breathing. We were met at the door by a rather hysterical woman who quickly showed me into the lounge whilst my colleague got the necessary drugs from the drawer in the ambulance. Again, I was greeted by a patient who was looking remarkably alive, if not living on the same planet as the rest of us.

The lounge looked like a typical room where the owner had lost the desire/will to maintain what most people would consider reasonable habitation. Clutter and detritus littered the floor and every surface. Even the wall was being used as a giant memo board and had scribbled jottings all over the wallpaper.

The patient was just coming to after a bad fix. Apparently her friend, whose house we were in had been giving her mouth-to-mouth before our arrival. The patient's friend was not happy that she had almost died a few minutes earlier in her lounge. As the patient slowly regained consciousness we could begin to engage in conversation. She did not wish to go to hospital to receive any further treatment. On the way out of the property my colleague accidentally stood on an ashtry overflowing with ash. The owner apologised and said that she'd clean it up after we'd gone. I took one look at the rest of the carpet (what I could actually see of it) and thought that she was being a bit optimistic.

Two purple calls and two live patients at the end of it - not a bad result really, considering that the last purple job I'd done involved a dead child.

The day came to a not altogether unexpected climax when our vehicle broke down at the hospital after clearing from a job. The starter motor had gone. An hour's wait for the recovery vehicle went, followed by a tow around the carpark to jumpstart the ambulance. After a journey back to base praying that the engine didn't stall, we informed Control that there were no spare vehicles in the garage. Forty Five minutes to go until the end of the shift...

Another shift had ended with another broken ambulance. And nobody had died.

Smoke gets in your eyes...

Ambulances have the unfortunate habit of breaking. I say breaking rather than breaking down because it paints a truer picture of the build quality of our wonderful fleet of vehicles. Take last night for instance.

There we are, pootling along to (yet) another 'pick up off the floor' job, sirens blaring, lights flashing - feeling quite content with the state of things in our world. Inadvertantly, I've just driven past the junction for the road I need to turn down. No problems I think, I'm in my shiny, noisy, flashing, bright yellow ambulance - I'll just do a 180 degree turn at the deserted crossroads up ahead. On went the steering, full lock.

Just as I'm coming round to face the direction I'm intending to travel, a strange smell enters our vehicle - the smell of something very hot and oily. Cue the smoke rising from underneath the bonnet. Followed by spitting hot liquid erupting from the grille. Oops.

We're still responding to the emergency call, just round the next corner. The problem is that the ambulance no longer wants to play, the steering has become so heavy that I think I'm suddenly driving through syrup, right up to the wheel arches.

We turn into the street and are met outside the address by a concerned relative of the person we're going to help. As we pull up the ambulance becomes engulfed in acrid grey, smelly smoke. Don't say I never know how to do an impressive 'arrival on scene'! Like a David Copperfield stage act the smoke slowly clears to reveal a sorry looking vehicle - covered in oily power steering fluid from the bonnet to the windscreen.

Casting aside our pitiful vehicle and donning our best paramedic personas, we enter the house to help the patient we've been called to back into her bed (We get a lot of jobs like this).

A quick call is then made to Control to inform them that thankfully the patient will not need to be taken to hospital - now, could we please order a recovery truck to tow us away, and 'No', the RAC won't be able to mend our vehicle at the roadside. Understand, Control?

One hour later, and an RAC van appears round the corner! One look under the bonnet and the man from the RAC calls for a recovery truck. We diagnose patients every day - why doesn't Control let us diagnose a very sick ambulance?

Two hours later on again and a low-loader appears round the corner. 'Now we're cookin!' thinks I. Wrong. Our ambulances weigh 4.5 tonnes and are 21 feet long, give or take a toe nail. As the vehicle is being loaded up the ramp of the low loader the rear end grounds itself into the road. Firmly. The angle of the loading platform is too steep for the length of our vehicle. Any more movement backwards or forwards will cause damage to the rear panels of the ambulance. We (me, my colleague and a swearing mechanic) hold a chinese parliament.

We agree on a collective, 'Sod it, we might as well carry on and to hell with the damage to the ambulance'. The vehicle scrapes itself free of the road, leaving a nice gash in the tarmac surface.

Twenty minutes further down the road and we are safely back at base, ready to swap for another vehicle. Three hours and twenty minutes have been taken up, responding to one call.

And the moral of this story is?

'Don't call an ambulance unless you really need us -

you could be delaying us attending a proper emergency!'

Unequal and Unreactive...

... When your eyes have a torch shone in them and this is the eye pupil reaction, start to worry.

One man who we went to today had the same pupils. He's now on a life support machine in ITU.

During the previous night he'd allegedly been mugged/beaten up in an alley close to his home. At the time his friends called for one of our ambulances to attend. They arrived and duly bandaged his head and inspected his body for other wounds, contusions and lacerations. Now, it's important to state at this juncture that the man was slightly the worse for wear, in terms of sobriety. He refused the crews advice to attend A&E for his wounds and possibly unseen injuries.

Now, as I've stated in previous posts we are not allowed to take patients to hospital against their will. Technically it's called kidnap. The patient was adamant he was not going to hospital.

Fast forward 12 hours and the same man is now lying unconscious on the floor of his friend's living room carpet. Several hours previously he had started to behave erratically, was twitching involuntarily and was being generally 'not himself'.

By the time we arrived he was twiching once every minute or so, he was breathing stertously (snore-like) and was not looking in generally good shape. Our observations of him told us that all was not well.

His pulse was racing at 130 and his blood pressure was falling - signs of possible blood loss somewhere. The clincher was his eyes.

They say that a person's eyes are the window to the soul. It's true in many ways. I've seen people who are just about to do something drastic ie. arrest, faint, collapse or fit, and the eyes always tell you the necessary information seconds before the event.

Our patient's eyes were unequal and unreactive. Even normally unconscious patients have pupil reaction to light and are equally reactive to it. Anything else is a 'big red flag' that all is not well with the neurological balance in the brain.

Coupled with the initial observations and physical appearence of our patient we both decided it was time to get him to hospital. Quick. We have a term for the level of quickness for these jobs, it's called GLF - 'Go Like F**k'.

One minor obstacle lay between our patient and the ambulance - the lounge which he was lying on was located on the fourth floor. And no, there weren't any lifts. Fortunately our patient was not heavy. He was soon in the vehicle.

I sent a quick radio pre-alert to the hospital to tell them a brief history and nature of injuries sustained by the patient, followed by an ETA (estimated Time of Arrival). I told them 8 minutes. I did the journey in 6.

We called in to the Emergency Room later on during the shift, to find out how our patient was. His condition had deteriorated and he was being transferred to a specialist neurology unit at another hospital. A machine was breathing for him.

99 times out of a 100, when we attend a patient who has been mugged/assaulted all that results is a few lumps, bumps and a split head, nothing worse. This was the 100th job. The one where the patient doesn't wake up the next day with a fuzzy head and the UBIs (Unexplained Beer Injuries).

And there's probably someone out there who could now be facing a manslaughter charge...

Fatboy Slim

Another trip to Roddlesworth Reservoir on Friday was rewarded with a solitary Pike of 5lb, caught on a Fox Fatboy lure. The pattern was Storm. The lure now has the battle scars from an encounter with Esox Lucius down its side.

Fatboy lures are like the old S Type lures - but on steroids. Like the S Type, they are reluctant to dive too far and are prone to surfacing if you reel in too slowly. They have a pleasant wobbling action, though.

Friday also gave me the chance to try out some excellent traces that I'd bought on EBay. They are made of Titanium wire and are pretty indestructable, even I couldn't kink them during the session.

The weather was warm again with sun shining striaght into my face off the surface of a mirror flat water, not ideal conditions it must be said. Coupled with the millions of Midges and Gnats that seemed to be strangely attracted to my scalp - the fishing was not the best.

Although I fish for Pike year round, there is a feeling at this time of year that one is starting to approach the pike season proper. When the weather starts to cool and the mornings start later, it is the time when many seasoned pikers consider their first forays to the water's edge since the Spring. October 1st is the traditionalists' start date for the Pike fishing season. 26 days to go.

Soon, the lures will be packed away and out will come the deadbait rods and reels. Time to let the pike come to my bait, rather than me chasing them around the reservoir with a lure. Time to sit still, shivering and huddled over two rods, wishing that the weather was warm again..

Just supposing...

We really need some rain to fill our country's reservoirs, though not anything on the scale that the poor folk in Louisiana have recently endured - let's face it, our generation is buggering up the world's climate with global warming.

Is it a case of 'What goes around, comes around?' - George Bush has blocked legislation for mandatory pollution limits on industry in his own country. He also impeded investment in the upgrading of Louisiana's Levees. Who's crying now?

Sorry to go off on a tangent on this posting but when the world's only superpower can't help its own people in its own backyard, then something is going seriously wrong.

Makes you wonder what would happen if the same thing happened in London or Norwich though, doesn't it? Would the masses loot, rape and pillage within a few days as they have in New Orleans? Or would we form orderly queues, something for which we are world famous (Have you ever seen an orderly queue in Germany/Netherlands/Spain - no, I haven't, either!)

The next few weeks and months will be very interesting, to see how the American people handle another disaster on their own doorstep - this time from Mother Nature.

In the meantime, no jokes about Mississippi Mud Pie, please...!!

A pain in the back and side!

It's been a few days now since I did the heavy lift job with the maggot ridden diabetic collapsee, and my lower back on the left side hasn't been the same since.

When trainees start this job they spend the first few weeks in training school learning all the correct lifting & handling procedures. This is done to prevent staff from damaging their backs but it also is undertaken to minimise the high number of sick days taken by staff suffering from spinal ailments.

The lift undertaken the other day was with my colleague, a Clinical Practice Tutor - someone who knows a thing or two about the challenges of lifting the equivalent of an 18stone lump of jelly. We couldn't have done the lift any more safely. And yet, my back is buggered.

The pain isn't too bad when I'm up and about, moving (Doh, that means I can still work). It's after I've been lying still for four hours that the pain starts. Every night this week I've had little more than four hours sleep. Not good for someone who needs his beauty sleep.

I've tried various pills and lotions including pain relief cream and slow acting Ibuprofen, all to little effect.

As they say, 'Back pain is an occupational hazard, in a hazardous occupation'. Try telling me that 4.00am in the morning...