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Holy Joe’s

The London Ambulance Service doesn’t just deal with emergency calls to people’s houses, we also do hospital transfers – patients who go from hospital to hospital because the original hospital hasn’t the expertise to deal with that person’s medical problems. An example of this would be the transfer I recently did from Newham to the Royal London because Newham’s CT scanner was broken, and the patient needed an emergency scan.

One of the regular places that we find ourselves transferring people to is St Joseph’s Hospice, or as we call it Holy Joe’s. Sometimes we will be picking up patients from one of the nearby hospitals, sometimes from the patient’s own home. Its one of those jobs most of us don’t mind doing. The patients are, by definition of needing hospice treatment, actually sick, and we are not so hard-hearted that we would begrudge an ambulance to someone who is ill. Then there is Holy Joe’s itself …

Holy Joe’s is a religious place, it used to be run by nuns, but now they are a bit few and far between. To be honest, I saw my first nun there yesterday, and she was picking her nose … But, you walk into the place and it just seems nice, it is clean, the staff are all friendly, the patients all seem happy and there is a really good social atmosphere there. I don’t know if it is because of its ties to the religious orders (I hate all religions, but the best nursing homes always seem to have nuns running the place), but the hospice just seems to exude calm.

My crewmate and I had just transferred a terminally ill patient into Holy Joe’s and were having a cup of tea in their tea bar (hot drinks are free to the LAS – another reason to love Holy Joe’s). Sitting in this clean, comfortable area, we were watching the patients chat with relatives, staff and other patients, giving the place a real friendly atmosphere quite unlike anywhere in the NHS. It is very rare to see a doctor sitting down with a patient, chatting about nothing in particular and having a cup of tea with them. We both agreed that this has got to be one of the better places to see out the end of your days, and that it is a real shame that there are not more places like this.

It is a shame that in this increasingly ‘technical/evidence-based/audit/professional development/governmental targets’ style of health service, we seem to have forgotten that sometimes we simply, and honestly, need to care.

I went back there for the first time in 18 months. It’s even better now. I’m thinking that the NHS should poach the board of directors and point them at some of our local hospitals.

Assaulted and Happy About It

I got assaulted yesterday, which made me smile …

We got called to ‘Male collapsed outside park’, which immediately set my ‘drunk-o-detector’ bleeping. This is the sort of call that is nine times out of ten a drunk who has decided to have a sleep in a public place as opposed to going home. In a case like this we tend to wake them up, and get them to move on before another ‘good Samaritan’ calls us out again.

We woke him up, so he stood up and started moaning that we had woken him up. Both my crewmate and myself were actually being quite nice towards him – mainly because it was towards the end of our shift and being nasty to people takes energy that we just didn’t have. Then he decided to take a swing at my crewmate, then he decided to have a swing at me … the next thing that I knew I had him in an armlock up against the side of the ambulance. My mate called on the radio for urgent police assistance, and the radio controller asked if we were both alright, to which my crewmate replied ‘I’m alright, but my crewmate is restraining him’.

The police were quick to turn up, and I had just enough time to tell them that he was drunk and had taken a swing at us before he was under arrest and carted off to the local police station. It was then I realised that in the struggle I’d managed to hit myself in the chest, right where I’ve got a broken rib. It was a bit painful. It had already gotten a whack from a heavy trolley yesterday, so I’m wondering if it will ever manage to heal.

I can tell you what went through my mind as I was pinning him to the ambulance: the first thing was ‘Oops, I hope I haven’t over-reacted’, the next thought (about 5 seconds later) was, ‘By the time I return to station and fill in the “incident form” my shift will be over … Result!’ I’d imagined that, going by the speed that the police arrested him, they were close to the end of their shift as well.

I’m just waiting for a Team Leader to read the incident form and call me into the office to ask if I need counselling …

A police friend of mine emailed me a couple of months later telling me that he had been in court providing evidence and the case before his was of a drunk assaulting an ambulance person. After a further description I could tell him that it was me who’d been assaulted. The drunk was found guilty, but had no penalty to pay as he was homeless. It would only have bothered me if he had actually connected with his punch.

Dead Babies

One of the jobs that we find ourselves going on (perhaps once or twice a day) is that of vaginal bleeding, in a woman who is around 8 weeks pregnant. This invariably turns out to be a miscarriage. Unfortunately, it is normal for the body to ‘reject’ a foetus that has no chance of developing into a full-term baby. I would suppose that this stops a woman from carrying to term an infant that would not survive outside the womb.

While dealing with such patients (some of whom have been trying to get pregnant for some time), I always try to be sympathetic, and explain that what is happening is not anyone’s ‘fault’, and that it is a normal happening.

Because of the number of people we have with this problem, and the rate at which hospitals deal with them (when working in A&E we would have about 12–18 cases of this every day), we have all become a little blasé about it. We feel some sympathy, but deep down in our hearts, we know that there is nothing we can do, and that it is a good thing that this is happening now, rather than in 6 months’ time. Nonetheless, we are worn down by the sheer numbers, and at the end of the day, perhaps we stop caring that these women are losing babies.

I have no intention of getting into the whole abortion argument, I’ve seen them done, don’t like them and would rather have the whole thing stay out of my world view.

I first thought that it was just me, and that as a male I was not best placed to pass comment. However, after having a chat with some female colleagues, it seems that they feel the same way I do, that it is natural, and that it is not worth worrying about. But it worries me a little that I seem to have come to care so little for the dead babies.

GCS 3/15 Outside the Door

There were two interesting jobs today, I’ll tell you about one now and let you wait until tomorrow for the other one.

We got called to the very common ‘Male Drunk – Police on scene’. I’ll not moan about how often we get called to this type of job, you’ve heard it all before …

We arrived on scene and were met by a policeman who first apologised before leading us to a man who was approximately 30 years old. The man was obviously drunk, and my crewmate told me that he smelt heavily of alcohol; along his arms were the scars of a ‘cutter’ – something else we are seeing more and more of these days. The policeman told us that the patient was refusing to give his name or medical details, only that he was called ‘John’.

We approached ‘John’ and he agreed to come to hospital with us. I got him into the back of the ambulance and he refused to let me touch him, so I couldn’t do my usual battery of tests. In fact, he didn’t want to talk to me at all, and sat in the back of the ambulance not talking; at one point he threatened to leave the ambulance but I managed to persuade him otherwise. (Don’t ask me why, I normally let drunks go as soon as they say they don’t want to go to hospital.)

All went as normal until we rounded the corner to the hospital, where he got off of the chair and laid on the trolley-bed. One hundred yards later and we pulled up to the hospital and I told him to get up, then I told him louder, then I did a sternal rub to wake him up – and there was no response! I then slipped an oropharyngeal airway into his mouth, this would wake anyone up, but not a flicker … he was deeply unconscious. This meant he was due for the Resus’ room.

We rolled him (rather quickly) into the Resus’ room and were met by a rather angry nurse – she wanted to know why we hadn’t pre-alerted the hospital. I explained that he had just lost consciousness outside the department. She then asked me why he didn’t have oxygen on him. Again, I repeated that he had collapsed when we were outside the hospital. We got him onto one of their Resus’ trolleys while the doctors in the department ran into the room.

For the third time I explained what had happened, and that I had no vital sign observations; this time they paid attention, and accepted what had happened.

To be honest I don’t blame them, the A&E department rarely has any surprises – the hospital is normally forewarned about any ‘nasty job’ we are bringing them, and to suddenly have a seriously sick patient turn up without any warning is always a bit of a jolt.

Now the patient was unconscious the nurses were able to do those vital observations that I was unable to do – and they were all normal. His pulse, blood pressure and blood oxygen levels were all better than mine, his blood sugar was also well within normal limits. There was no obvious reason why he was in such a deep state of unconsciousness.

He was quickly intubated, and we left the department. I’ve spent some time wondering if I missed anything – if there was anything I would have done differently – but to be honest I don’t think there was. Even if I had managed to get a full set of vital sign observations, they would have all been normal and there was nothing that indicated his condition changing so quickly. I can’t ‘assault’ a patient who has refused a procedure (such as observation taking), and all I could do was exactly what I did do – watch him while we took him to hospital.

The current idea is that he had taken an overdose of some sort along with the alcohol, and that it had started to work. Because the patient hadn’t spoken to me, I had no way of knowing if he had taken an overdose.

I never did find out what had happened with the patient – it’s one of the poor things about this job, that you can’t always follow them up.

Protecting Little Old Men from the Police?

We were asked go to the local police station to help with arresting someone. The arrestee (is that a real word?) was an 80 (or more)-year-old male who was accused of recently committing a crime that I would suggest required some amount of physical strength. We were to follow along because the person had heart and breathing problems – so much so that he had bottled oxygen in his house.

We met with the police officers (nine in total, and all rather scary looking plain-clothes types) at the police station, before following them to the address in question.

Once the police had made their entrance we were called forward to give the patient a clean bill of health. We watched as this frail man slowly dressed, needing help from his son to tie his shoelaces; we watched as he struggled around the house and wondered how he could possibly be guilty of any crime that needed any form of physical exertion.

The patient’s son was also a bit put out by the allegations, and promised to have a good laugh at the police’s expense when the truth came out.

Throughout the arrest the police were polite, helpful and behaved in a thoroughly professional manner at all times.

The patient/arrestee was also calm throughout and the whole thing went, as far as I could see, very smoothly, and our ambulance followed the car in which he was taken, until it entered the police station and the FME (Forensic Medical Examiner – a doctor that the police use) took over.

The next job we went to was to outside the same address: a woman had been mugged and the police who were searching the address had called us as she had a rather large bump on her head. Unfortunately, the mugger managed to get away. It surprises me that you can get mugged outside a house full of police and the mugger can still escape.

Victims

Imagine, if you will, getting sent to a job where a 15-year-old boy is threatening suicide. You turn up at the address and discover that it is a care home. Meeting with one of his carers she hands you a list of the boy’s medications and it reads like a ‘Who’s who’ of psychiatric drugs. You talk to the boy, and he seems calm, collected and very polite. He explains that he wants to jump out of a window and kill himself, and agrees that he would like to go to hospital. You take him into the paediatric department of a local hospital. As this does not feel like the normal ‘Teenager wants to kill themselves’ you have a chat with the children’s nurse and you ask them to let you know what happens to the patient. You leave, and continue with your shift. The next day you ask the children’s nurse about the patient and she tells you ‘The boy wanted to die because he wants to have sex with, and kill, small children – and that he knows that it is wrong’.

I hate paedophiles as much as any other member of society, but in front of me that day, I saw a victim.

Behind Locked Doors

One of the jobs that I both enjoy and hate is for a ‘Collapse behind locked doors’. This is when a (normally elderly) patient has not answered the front door or the telephone, and is presumed to be in some trouble. What we often get is someone who has died during the night. Although I hate having people die, the one good thing about this type of job is that I get to use my size 12 boots to kick down a door.

There is a skill to kicking down a door, and I was taught by the best – a policeman. The police also have a huge ram that they can use when their boots aren’t enough. These are very heavy, but also lots of fun to use.

We got called to a house where the daughter could see her elderly mother lying on the floor; shouting through the door and banging on windows didn’t get any response, so we assumed the worst. The daughter was (understandably) crying, so I had an attempt at kicking the door down.

Unfortunately for me, the woman had been burgled earlier in the year, and so had two locks, and a bolt holding the door shut, so it took a couple of minutes of prolonged (and eventually painful) kicking to get the door open. I also managed to wake up all the neighbours, and it’s always fun to be the centre of attention …

Finally, the door gave and we gained access, we were greeted by the elderly woman sitting on the floor smiling at us – earlier in the morning she had fallen and couldn’t get up. When we had tried banging on her windows she had been asleep, and it was only the repeated bashing of my foot against her door that had caused her to wake up.

This was a good job in a number of ways: the lady was happy and healthy, and just needed a hand to get up off of the floor; I got to kick in a door and get away with not causing any serious damage; and finally we looked like heroes to the two daughters of our patient. There were smiles all round and we left the job feeling that we had really been of some use today.

Substitute

I know that the ambulance service is being used as a substitute GP service these days, but it really takes the biscuit sometimes. Take, for example, the job I was sent on last night. It came down to our ambulance as ‘Patient wants to kill his doctor’.

I immediately called up Control on the radio and asked if we were being sent because they couldn’t find the patient’s GP? Although I was half joking, I wondered what good we could do for the patient. Control got back to us, and let us know that they were sending the police, and that we should wait until they turn up. However, when we arrived at the address we knew who the patient was – so we cancelled the police and sorted out the patient’s problem.

I mention this if only because, when I got back on station and read the local newspaper, I found a story about a coroner’s investigation into the death of a 55-year-old female who had taken a fatal overdose of bloodpressure medication. When Control asked if she was violent, they were told that yes, the patient was violent. The police were called and the crew waited at a rendezvous point for half an hour until the police turned up. By then it was too late, and the patient died. Once more, the paper blames the ambulance crew. It doesn’t blame the psychiatric services who discharged her a few weeks earlier after a failed suicide attempt, neither does it blame the person who made the phone call that said that the patient was violent. It blames the crew who, quite rightly, waited for the police. If one of the crew had been stabbed to death, it might be a more sympathetic headline. We are expected to go into people’s houses, where we have been told that the patient is violent, where we could get assaulted or even killed – but as soon as we start thinking about our own safety, we are the ones to blame for anything that goes wrong with that patient.

Violence from the drunks, druggies and criminals doesn’t worry me – the job that worries me is the little old lady who has become confused and is sitting in her living room with her husband’s service revolver, or her favourite kitchen knife, desperate to stop the strange men in green from stealing her away in the night.

As normal the ambulance service has investigated, but in a show of support for its road staff, has stated that the policy of waiting for the police at a rendezvous point is the correct thing to do.

We are not cowards, but neither are we stupid/paid enough to wander into dangerous situations.

Nicked

I’ve just gotten on station for the start of my shift, only to find out that some scrote had broken into the station last night and nicked the video recorder and DVD player.

I mean, it’s not like we are ever on station long enough to use them, but it’s the principle …

These are the sort of people that we serve, these are the sort of people we are polite, professional and caring towards – and this is how we are repaid …

More Nicked

It’s getting so you have to tie things down now …

Yesterday a ‘Decontamination POD’ truck was stolen; this is an unmarked truck that we use to carry around chemical incident equipment. The current word is that this truck was carrying a load of atropine, which is the treatment for nerve agents.

If people were to start injecting this into themselves, they could get serious (as in fatal) effects.

I leave it as an exercise for the reader to decide if this is a good or a bad thing …

You Decide

Still no drunks, but the weekend starts today and my shift ends at 2 a.m. …

I’m going to describe a job I went to last night.

The patient is female and 30 years old. She is married and is attempting to get pregnant. The only medicine she is taking is fertility treatment, and she is (obviously) having unprotected sex; she is normally fit and healthy and has no allergies. Her normal menstrual period is regular, but her period is over 2 weeks late this time around. She has been having nausea and vomiting for the past 3 days. She has no abdominal pain, and is not tender or guarding. She has no pain or increased frequency of passing urine. All vital signs are within normal limits.

So … given this information …

(a) What do you think is ‘wrong’ with her?

(b) Does she need a trip to hospital in an ambulance?

(c) Why do you think she hasn’t done a pregnancy test?

Dragging

Sometimes a day can just drag along. Today, due to rather unusual circumstances, the day really dragged. Here is the time-line of today:

10:00 Turn up for work, brew a cup of tea.

10:01 First job of the day, taking someone from Newham hospital to Barts hospital.

10:02 Cut my finger on my locker door, try to stop bleeding, look for plaster.

10:23 Give up search for a plaster – there are none on the station – leave for Newham hospital.

10:26 Arrive at Newham hospital, ask for plaster; they also don’t have a plaster so I now have a huge dressing on my finger.

10:28 Meet with patient, pleasant woman – meet nurse who will be accompanying patient, barely understand nurse because of her inability to speak English.

10:30 Get patient’s notes and read them – they make more sense.

10:32 Ask nurse in charge why this patient (who is having cardiac monitoring and a blood transfusion) is going to an outpatient department. Get told that the patient ‘just is’.

10:54 After packaging the patient on a stretcher, loading them on the back of the ambulance, we set off for Barts hospital.

10:55 Nurse escort tells me that she gets travel sick.

10:55 and 20 seconds Give nurse a vomit bag.

11:37 Arrive at Barts hospital.

11:38 Enter outpatients’ department. Reception seem rather surprised to see patient on stretcher appear in front of them.

11:40 Problem is referred to the sister in charge, she also looks befuddled.

12:00 We wait while sister in charge phones around the hospital trying to work out why this patient is in her outpatient department.

12:30 Still waiting … We let Control know why we are waiting – there is no stretcher/bed to put the patient on.

13:00 Still waiting.

13:30 Still waiting – we let Control know that we still have the patient on our stretcher while they work out what they are going to do with our patient.

14:00 Still waiting.

14:30 Still waiting – we let Control know that we haven’t gone to sleep, we are told by sister in charge that patient will be admitted soon.

14:45 We place patient on an examination bed so that we can go back to answering emergency calls; patient will hopefully be in a hospital bed soon. We leave the nurse escort with the patient.

14:48 We are finally available for another job.

14:49 We realise we have nearly no fuel, and no fuel card to pay for fuel. We decide to return to station to borrow a fuel card off an unused ambulance.

15:20 We arrive back on station to look for fuel card (and have a cup of tea).

15:30 We leave to get fuel. Take infusion pump back to hospital – the ward seem surprised that the patient has been admitted to Barts.

15:48 We have fuel, we are now ready for another job.

16:00 We get a call, out of area Matern-a-taxi.

16:09 Arrive at Matern-a-taxi, contractions (genuinely) every 2 minutes, previous baby born in 3 hours, drive rather quickly towards her booked hospital.

16:12 Patient’s waters break – start swimming in back of ambulance.

16:20 Arrive at hospital.

16:24 Throw patient at midwife, run back to ambulance.

16:30 Tell Control that we need to return to station to mop out the back of the ambulance.

17:20 Get back to station, mop out.

17:45 Crew to relieve us are already on station; await ambulance to dry out.

18:00 Leave for home.

18:37 Get home, collapse into sofa, start writing this post.

- Fin -

This is how you get to work an 8-hour shift, yet only do two jobs …

After this post I got given a box of plasters by a fellow blogger. No more searching around ambulance stations for sticking plasters.

Sedation

I should be working today, but (and I want loads of sympathy here folks) I’m off sick with a work-related injury. Thankfully, it’s nothing too serious, certainly nothing as serious as last time when I swallowed HIV-positive blood.

On Thursday we got called to a big conference centre in town for a (possibly) suspended/dead/fitting male. We rushed over there and were met by their security who had rather cleverly staked out both entrances to this place so that they could lead us to the patient. Parking up we had to climb a couple of flights of stairs carrying nearly all the equipment from the ambulance. Our first-response bag, oxygen and associated kit, defibrillator, suction and carry-chair are quite heavy and, as we were in a rush to get up the stairs, we were a bit out of breath when we reached the patient.

The first thing that we saw (and were very happy about) was that the patient had not suspended, and was instead thrashing around on the floor with some security guards and the centre’s medic sitting on top of him. Approaching closer we saw that he wasn’t fitting, but was instead very combative, trying to fight off the people who were holding him down in a very confused nature. ‘Aha!’ we thought, ‘he’s post-ictal’.

During the post-ictal phase of a seizure, the fitting has stopped, but the patient is often disorientated, sleepy or aggressive. In this case it appeared that the patient was both confused and aggressive – he was not responding to anyone trying to talk to him to calm him down, and he could only make guttural sounds. Normally, these episodes last less than half an hour, so we stay with the patient until we can get them into the ambulance.

Sometimes the aggression can come from physically being held down – the patient is confused and frightened, and all they can feel is people holding them down, so they struggle. I suggested that the security guards let him go, which resulted in the patient trying to stand up, only to fall over again (don’t worry, we caught him) and unfortunately the centre medic got a head butt for his trouble. I managed to get a blood glucose reading, which was normal, and a work colleague phoned the patient’s mother, so I could get a bit of history. The patient is normally fit and healthy, not diagnosed with epilepsy, but has had 2 fits in the past 2 years. All during this phone conversation the mother could hear her son shouting in the background. He had never been violent before.

We resigned ourselves to a bit of a wait, so we managed to get him over to a leather couch, and held him down there. After 10 minutes there was no change in the patient’s condition – normally they get a bit tired or they start to have a change in their condition. So we started to think about other ways in which we could help the patient at the scene. We couldn’t get him to the ambulance while he was so combative, and so we thought he might need some form of sedation. I ran back to the ambulance and asked Control to get us a BASICS doctor, or at least someone who could give some form of sedation.

Instead after about 10–15 minutes we got the PRU (Physician Response Unit), which is a new service where a doctor from the Royal London Hospital covers medical emergency calls – it’s a bit like HEMS, only without the helicopter, and instead of going to trauma they mainly deal with medical emergencies.

The doctor (who is a very nice man) and paramedic crew with him took one look at the patient, listened to the history and decided that sedation was a very good idea.

Cut forward 40 minutes’ worth of trying to sedate the patient with increasing amounts of medication. For the medically trained out there, the patient needed 10 mg haloperidol and 17 mg of midazolam. At one point the doctor was thinking about knocking the patient completely out and intubating him. Luckily the patient was sedated enough for us to get him out of the conference centre and into out ambulance, where we ‘blued’ him into Newham hospital just in time for him to wake up (the sedation lasting only around 15 minutes) where the doctors there did paralyse and intubate him.

We have few ideas why the patient was so violent and so deeply confused – it’s something that will be investigated in hospital. We were considering epilepsy, head trauma (from when his head hit the floor), meningitis (so antibiotics were given on scene) or some form of brain insult. I’m asking my crewmate to find out what happened to the patient.

The reason why I am off sick? Well after holding the patient down for an hour and 10 minutes, I managed to sprain my thumb. Since I can’t be considered safe to carry a patient downstairs, I’m taking today off (plus 2 days of leave) so that my thumb can heal and I can get back to saving lives picking up drunks again on Monday. Oh, and it’s my birthday tomorrow – 33 is such a young age don’t you think?

I did manage to see the patient again … see the next entry.

Patient Gets Better!!!

I went to visit our patient from the last post. This morning I’d put my hand in my pocket and found that I had £2.66 of his money that had spilled out of his pocket during our struggle and I’d put it in my fleece for safe keeping – given the saga of the job, I’d forgotten to hand it in when we reached the hospital. I thought it would be best if I returned it to him, so I had a chat with the lovely receptionists at the hospital, and they told me what ward he was on.

I went to the ward to find him sitting there, seemingly none the worse for wear. He did have a bit of a black eye (not my fault … honest), and when I spoke to him he told me that the doctors suspected that he had fainted, and when he had hit his head had suffered a form of concussion. His CT scan and blood tests were all normal, although I suspect that they will be running EEGs (electroencephalograms) and other more detailed tests a little later. He told me that he was feeling pretty much normal and I suspect that they are keeping him in hospital to continue to run their tests.

He was very pleased to see me, and we had a little chat. I offered him his money but he refused and suggested that I get myself a pint with it.

It’s the first time I’ve actively gone to look for a patient after bringing them into hospital – and it is a weird experience going into a ward to see a patient whom I last saw trying to fight me. Yet another new thing I’ve done because of writing this blog.

Safety Net

I’ve mentioned before how the ambulance service and the A&E department are often seen as a ‘safety net’ by other health-care providers. Both yesterday and today we had perfect examples of this.

Yesterday we were called by a 70-year-old man with a urinary catheter which had blocked. This is a fairly simple thing to solve as it just needs a flush of water up the catheter to clear the blockage. It’s a 5-minute job that we, as ambulance crews, aren’t allowed to do. However it is the sort of job that district nurses are supposed to do.

So why hadn’t a district nurse been to see the patient so that she could flush the catheter and prevent the patient from having to attend A&E? Why was the patient, who had phoned up the nurse himself, and told her exactly what he needed doing, forced to call an ambulance?

Because the nurse didn’t have any water to actually flush the catheter. It’s a bit like if I turned up to someone having an asthma attack, and didn’t have any oxygen to give them.

So the district nurse told the patient to dial 999 for an ambulance. We arrived and found him with a bladder so full it was causing him severe pain. We took him into Newham hospital, who, within minutes, had cleared his catheter, and eased his pain. They gave him a ‘takeaway’ bottle of water so that the district nurse wouldn’t have an excuse the next time she needed to visit him.

Today, we were called to a patient who needed his anti-Parkinson’s disease medication. He had a carer, who was supposed to visit him once a day to clean and arrange his medication. But for the last 2 days, because the ‘carer’ couldn’t get in touch with the patient’s GP, she’d just left him without his medication. We turned up, not knowing what we could do to help. The flat in which the patient was living is brand new, and yet was already very untidy. The patient told me that he was lucky if the carer spent longer than 5 minutes with him (the carer is contracted to work with him for an hour a day).

This poor man was left, alone and shaking, with a carer who seemed to think that if she ignored this ‘problem’ it would soon go away. So, we did the only thing that we could: we took him to hospital, so that they could sort out his medication for him. Meanwhile I filled in an ‘LA260’ which is a ‘vulnerable adults’ form and allows the LAS to bring situations of abuse, and potential abuse, to the attention of the local social services. They now have the name of the care agency, and this problem can be solved before it repeats itself in a month’s time.

Hopefully, someone will get a bollocking, and our patient will get a carer who actually cares for him.

It often feels that we, and the local A&E departments, are left to do the jobs that other people should be doing, but because we are there, these other agencies don’t seem to care about doing a competent job. I’m aware that there are probably loads of health visitors/social workers/district nurse/CPNs and GPs who do actually give a damn about their patients – it’s just that we never seem to meet them.

I never did get any feedback from the LA260 that I filled in – normally you get a little note sent to you explaining what has been done to resolve the situation.

A Hidden Pregnancy

Our ‘interesting’ call of last night was a Matern-a-taxi. What, I hear you ask could be interesting about taking a pregnant woman 1.2 miles into the local maternity department?

Well, apart from the patient, no-one else knew that she was pregnant – she had been hiding the pregnancy from everyone. She hadn’t seen a doctor; neither had she booked into a maternity department. Her family suspected nothing. It’s not as if she were a ‘large’ woman, who could perhaps hide the tell-tale bump under the pretence of fat. She was actually rather slender, which leads me to ask how she could hide her rather obvious pregnancy from everyone.

When my crewmate spoke to her (I was driving), she told him that she had hoped that the pregnancy would ‘go away’.

We tried to prewarn the maternity department that we were coming (because she was quite close to actually delivering the baby), but they hung up the phone twice on our Control. The problem is that the entrance to the maternity department is locked at night, and we need someone to come down and open it for us. So … we were left standing around outside the department waiting for the midwives to phone for a porter to traipse the length of the hospital to come and open the door for us (as opposed to one of the midwives walking down the stairs and opening the door).

By the time we got in the patient was starting to bleed, and we were getting more irate at the apparent ignorance of the midwives.

So, tonight we are going to put in a ‘clinical incident report’ to highlight the danger that standing outside the maternity department for 10 minutes while they arrange a porter puts the patient in.

One of the people on complex has had to deliver a baby in the back of their ambulance while they were waiting for the doors to be opened, so something needs to be done.

Upsetting

Three of our jobs today had the potential to be upsetting, and while they were all sad, only one seriously upset me, and did so in a way I consider rather out of character for myself.

The first job of the day was to an 86-year-old female in a nursing home with a ‘blocked nose’: we raced around there because … well … it was a Category ‘A’ call and those are the top-priority ‘get there in 8 minutes to please the government target’ calls.

Just as we pulled up outside Control let us know that the patient was upgraded to a ‘Suspended’ (no pulse, no breathing), and sure enough we ran into the home to be greeting by a FRU who was doing CPR. I jumped down and did a round of chest compressions, which cracked her ribs (a recognised side-effect of effective CPR), and then noticed that on the cardiac monitoring machine her heart rhythm had changed. She had a pulse! … People don’t normally get a pulse back from cardiac arrests of her particular type. We rushed her to the hospital, where a full cardiac arrest team was assembled. Her pulse was lost, and then returned. Unfortunately, her prognosis was poor, but she stayed alive long enough for her daughter to reach the hospital. She died with her daughter there, which is a small victory, but one that we are getting more used to.

The second potentially upsetting job was to a 1-year-old boy who had pulled some boiling milk on top of him. We turned up to find about 20 police officers on scene, and the HEMS helicopter circling above. The same FRU responder was there and the child had around 10% partial thickness burns to parts of the neck and chest. While nasty, this wasn’t immediately life-threatening, but the HEMS doctor who turned up decided that it would be best to take the patient to the Paediatric Burns Unit at Chelsea and Westminster Hospital by helicopter. As the helicopter could get the child there in under 20 minutes it seemed like the right plan of action. My job during this call was to (1) hold onto the other two toddlers in the house, (2) mix up some paracetamol for the child, and (3) drive child and doctor to the helicopter, which was around 300 yards away. The job was interesting because she was the type of parent who thought it was a good idea to wedge a settee into the hallway to stop her children from falling down the stairs …

The final job was a lot simpler – we were called to an 18-to 22-year-old female who was ‘unresponsive’ in a bus. The bus had reached the end of its route and the driver couldn’t wake up the patient. (Possibly interesting aside – bus drivers cannot touch any of their customers to wake them up.) We turned up and soon managed to wake up the very sleepy girl. She remained drowsy but agreed to let us take her to the place where she lived, but after talking to her a bit, we soon realised that she was homeless. This, coupled with the way she would fall asleep as soon as we stopped talking to her, made us think that it would not be safe to leave her on the street. We decided instead that we would take her to hospital. When we reached the hospital she refused to go in, and instead pulled out a ‘crack’ pipe and started to light up. We told her that she couldn’t do that … So she jumped up, pushed my crewmate and ran off. As there was nothing physically wrong with her we couldn’t chase after her; instead we returned to our station to fill in the necessary paperwork.

So why was it that this last job was the most upsetting, not only for myself but also for my crewmate? Well it wasn’t because she was pretty (she wasn’t, and she had a remarkably nasal voice), and it wasn’t because she was ill, neither was it because my crewmate got shoved.

With our first job, the woman was at the end of her life, and until she died, had enjoyed fairly good health. She didn’t die a painful, protracted death, and she died with her daughter next to her. With the scalded child, he would forget the pain, and will receive excellent care from the hospital he went to, he would return home to his loving (if ever so slightly dense) mother. With this girl, it was as if she were lost; at some point in her life her potential future had unravelled. Instead of getting an education, holding down a job, finding someone special and living a long and happy life, she is homeless, a drug addict, and her future is probably painful and short. What is so depressing is that no-one was able to turn around this descent, and this is perhaps why I despair at society – that so many people are prevented from reaching their full potential. I understand that she has made her own choices, but how much power did she have to make those choices? I wanted to help her, but there was no way I could do this.

And it’s that which annoyed and upset me.

I keep getting upset and annoyed at the same things – the waste of a life is a terrible thing to see. That, and the knowledge that I am helpless to do anything to change it. I imagine that this is why I dislike alcoholics so much.

Therapy?

We got sent to a job of a 6-month-old baby not breathing. While this often means that baby has a cold, it could also be one of the worst jobs you can get. We sped to the address and entered a house where the whole family was distraught. It was an Indian household, so there were a lot of people there, and most of them were crying. Once more, I heard the type of crying that can only mean that something awful has happened – entering the living room I instantly saw a baby lying dead on the settee, father crouched over it crying and the mother standing and wailing, shouting out that her baby was dead.

There is only one thing that you can do in a situation like this, which is to scoop up the baby and run to hospital as quickly as possible. I reached down and picked up the baby; I was shocked to find that it was as stiff as a board and very purple, indicating that it had been dead for some time. It looked more like a doll than anything that had once been alive. We could have recognised the child as dead on the scene, but taking the child to hospital would mean that the parents would see that everything that could be done was being done and, more importantly, they would be in a hospital with all the support that the hospital could provide.

I ran out to the ambulance with mother in tow, and told my crewmate to get us to hospital as quickly as possible. The father and grandmother followed behind us in another ambulance who had heard this call go out and had turned up to see if there was anything that they could do to help. On the way to hospital I did the CPR that I knew was ultimately pointless and spoke to the mother. She had last seen the child alive at 3 a.m., and he had been fine then. It looked like it may have been a case of sudden infant death syndrome, and I did all that I could to prepare the mother for the worst.

We pulled up at hospital and handed the baby into the care of the hospital. I spoke a little more with the mother and grandmother, but there is nothing that you can say to people who have had such a tragedy. Our station officer met us at the hospital and asked us if we were alright, then he booked us off the road so that we could go back to station and have a cup of tea and ‘decompress’. If we needed more support I think it would have been there, but I just wanted to get away from the hospital.

I’m not often affected by jobs, and this isn’t the first dead baby that I’ve had to deal with, but it is the first dead baby I’ve had since joining the ambulance service and it is very different from dealing with them in hospital. Going into someone’s house to take away a dead child is very different from having the child and parents turn up at hospital, which is your safe territory.

At the hospital all the other crews were asking if I was alright and, to be honest, I wasn’t really alright – I was upset that while I was doing CPR on the baby its legs were seesawing into the air, and it looked too much like a doll. There was a point after the job where I thought I was going to start crying, but a moment outside the Resus’ room and I was back to functioning as I normally do. I’m not weak, and when in the midst of something I can deal with anything – it was only after the doctors and nurses at the hospital had taken over that I started to feel anything.

We returned to station, where the therapy of talking about anal surgery with another crew, and a cup of tea, soon had me feeling better. It used to be that you would return to work straight after a job like this, but then I think they realised that if we got our normal inappropriate call (bellyache for 2 weeks sort of thing) we might say something to the patient that we might later regret.

Well, an hour on station later and I feel fully prepared to deal with that sort of thing again – but I think that I’ll be haunted by the image of that child lying dead on my trolley.

I had loads of people commenting on this post, loads of support, which was very much appreciated. The title is a reference to the fact that I have found my blog to be ‘therapy’ for some of the things that I’ve seen and done in the ambulance service … and it’s cheaper than hitting the bottle.

Dog Teams

I’ve often mentioned that the ambulance service and the police tend to get on rather well together; this is at least in part due to us both being called to the same jobs, and probably because we share the same view of the ‘Great British Public’.

An example: we got called to a drunk who was being verbally abusive to a bus driver – we were called because the drunk had fallen over, while the police were called because of the abuse. The drunk man was obnoxious, and well known to both of our services, and because of the lack of an injury was left in the care of the police. If he had been injured then the police would have left the matter in our hands.

So, when we co-respond, the ambulance crew pray that the patient is uninjured, so the police have to deal with them, while I suspect that the police hope that the patient is injured so they don’t have to arrest them.

However, there are a lot of specialist teams in the police service that we tend not to come into contact with that often; we mainly get to meet the normal ‘beat’ coppers. Thankfully, we rarely see the murder, child abuse, drugs or dog teams. This isn’t to say we never see them (and our station did get a Christmas card from the local murder squad telling us to ‘keep up the good work’), it’s just that it is fairly rare.

So, it was rather surprising that I met with the dog-handling team twice last week. On the first occasion, we were called to a known schizophrenic who had threatened to kill herself. The patient herself (a regular attender at the local A&E) was a bit of a pain to deal with, she wanted to stay at home and kill herself and couldn’t see why we wouldn’t let her do that. Her dog, on the other hand, was a real pleasure – happy to see us, interested in smelling all our equipment and extremely friendly. As the police were already there, they got the dog squad to look after the animal until the patient was discharged from hospital.

In case you think I am being harsh on the mentally ill, the patient attends A&E every day with the same complaint of wanting to kill themselves … she hasn’t managed it yet.

The second time I saw the dog-handling team was when we had to gain access to a house where the patient was unable to come to the front door and let us in. The interesting part in this story is that there were five dogs of unknown temperament in the house. For half an hour the police unsuccessfully tried to gain access, mainly by climbing up a ladder and trying to open a bathroom window. We were able to talk to the patient, and so we knew that they were not badly hurt, otherwise we would have had to kick the door down. Then the dog team turned up and, using a top secret criminal technique, managed to get the front door open in about 10 seconds, thus putting to shame the half-hour everyone else had spent trying to gain entry.

All five dogs were really lovely, although energetic, and at the end of the job I had to spend 20 minutes brushing the dog hair off my uniform.

There is a joke we have about dogs. When we ask a patient if the dog is friendly, the patient always answers that they won’t bite; the reply to this from the ambulance crew is to add the unspoken ‘They only bite people dressed all in green.’

I’ve only had one dog take a dislike to me. But I managed to pull my hands away from his gnashing teeth before he could catch me.

Perils of Drinking (Number 1 in a Series of 230)

It was the usual type of busy last night – we heard rumours that there is such a thing as an ‘ambulance station’, a mythical building where one might use the toilet or partake of the life-giving ‘cup of tea’. It must be a myth, as we never saw it at all.

As I have mentioned, we get our calls sent down to a computer screen in the ambulance cab; sometimes you wonder how the Control crew have entered it while keeping from laughing down the phone at the patient. A case in point was one of our calls last night which was given as ‘53-year-old male, taken 3 × crack cocaine, cold and lonely, needs to be put back together’.

Avoiding the rather obvious ‘Humpty Dumpty’ jokes, we soon realised that the complaint, and the location he was calling from, fitted one of our semi-regular callers. By the time we got there he had left the phone box and neither us nor the police could find him after a search of the area. Obviously I was distraught …

Our other stand-out job of the night was a 57-year-old male fitting. We quickly made our way to the location, to be met by a block of low-rise flats that often sneak up on you in our area. These are three or four floors high, and have no lifts. Also there was one of our First Responders. We entered the block, and immediately made our way to the stairs (it is a little known law of physics that in flats with no lifts, people on the ground floor are never ill … only those on the top floor).

Entering the flat, the general state of disrepair, mess and the 3-litre bottle of strong cider I tripped over tended to give the impression that it was owned by an alcoholic. We got into the living room to find a large man lying senseless on the floor, while his daughter was sat over him stroking his hand, trying to reassure him. A quick check over, some oxygen and a chat with his daughter revealed a history of alcoholism (surprise!) and the occasional alcoholic fit. He was a big man, so we packaged him up in our carry-chair and carried him down three flights of stairs. All the time his daughter was saying how strong the nice ambulance men were – which only goes to show that she wasn’t paying attention to my reddening face and struggles for breath …

We got the patient into the back of the ambulance where he started to fit again, this time lasting about 2 minutes. He also decided to bite his tongue and vomit, which meant that the back of the ambulance (and myself in some part) was covered in bloody, cider-smelling vomit. I think I’ve mentioned before how I can’t smell alcohol on someone’s breath, yet I can smell cider when it has been vomited all over my ambulance … and it turns my stomach. We packaged him up and ‘blued’ him into Newham, where he had another two fits (despite some rather strong sedation) and by the end of our shift he was still in Resus’ having infusions of phenytoin and Pabrinex.

So, a busy night without the chance to see our station, with at least one mopping out of the ambulance … pretty standard really.

The vomit in the ambulance took place at the end of our shift, so we couldn’t even get back to station to use the mop. Unfortunately, with the increased number of calls we have, getting back to station is becoming rarer than ever.

Security

Yes, I know I’ve written before about kicking down doors. However, in this post I offer people advice in making the beating down of their door as hard as possible. So please excuse the repetition. Like all good health-care professionals I regularly ignore my own advice.

There is a visceral pleasure in kicking down a door. Once or twice I’ve managed to see someone who is really ill trapped behind a locked door, occasionally there has been someone who has just been unable to open the door. And just the once I have kicked down a door that the patient refused to open because they were schizophrenic and didn’t want to open the door – not that I knew that at the time.

I’ve even been surprised at the ease in which I can kick down the doors of the flats that I live in. Actually, it would be more accurate to say that I am scared with the ease in which the doors can be broken. Oh well, it’s not as if I have a lot to steal anyway …

My experience of kicking down doors has taught me which security features are useful when trying to prevent someone from stealing your TV and video.

If you have a deadlock-type lock, then use it – always. The skill of kicking down a door relies on breaking either the lock, or the wood holding the lock; deadbolt-type locks are a lot more secure than the normal Yale type lock.

If you are in the house and have a bolt on the door, then use it. It takes a lot longer to kick down a door when there is a bolt in the way. Another trick behind kicking down a door relies on applying the force of your kick to the (hopefully) single point of resistance. If there is a bolt at the top or the bottom of the door it makes it a lot trickier to break that door.

Windows in the door are a bad idea – they are a weak point that can be easily broken, and then a skinny hand can reach through and unlock the door.

If you really want to be safe then have a bar across the door. I’ve seen it once or twice, and if someone has a bar across the door then there is no way I’d be able to break that door down. Just make sure you don’t collapse behind it.

Major Incident Cover

One of the perks of this job is the need to cover football games. Well … it’s a perk if you enjoy seeing your local team play. Personally, I can’t stand football but overtime is overtime, and it does make a nice change from the usual jobs I go to. So, this Sunday I got to see West Ham play against Derby.

The LAS provide ‘Major Incident’ cover for these games, we don’t look at sprained ankles or minor injuries (that is the job of the St John’s ambulance). We also don’t look after the players who get hacked down and are unable to walk, only to watch them turning somersaults a scant 5 minutes later when their team scores a goal (that is a job for the private medical firms).

So, unless a stand collapses, there is a major fire, a bomb goes off or someone drops dead in front of us, there is very little we have to do. At the West Ham ground (my local football club), there are four ‘road crew’ present, along with at least one major incident support vehicle, one radio operator and an officer. The road crew sit down near the pitch, while the officer and radio operator sit in a VIP box overlooking the whole ground.

Today I was given the role of ‘safety officer’, which doesn’t mean I’ve been promoted, it just means that in the event of a major incident, I’m supposed to watch out for the safety of the ambulance crews present, liaise with the police and fire service about any hazards that might be a problem, and to make sure that any crews that attend the incident are not getting too stressed. I also have to talk to the person in overall control at the incident about any issues within this sphere that may occur.

We were warned that there was an increased chance of violence at this match because some hooligan ‘supporters’ were appearing before the magistrate tomorrow, and that some of their ‘crew’ might want to cause some trouble. Luckily for us, that did not happen, despite a 2–1 loss.

It was really cold down there in the stands, I had my undershirt, shirt, body armour, fleece and hi-visibility all-weather jacket on, but I was still freezing. Anyone listening carefully as I walked around trying to keep warm would have heard a clink-clink-clink-clink sound as my frozen balls knocked together.

As I’ve mentioned before, I’m not a huge fan of football (overpaid idiots, getting more money in a week than I get paid in a year for booting around a plastic ball), so I spent most of the match listening to music (The Magnetic Fields) on my smart-phone, while stamping around trying to get some sensation back in my toes.

As a quick aside, who needs an iPod Shuffle? My smart-phone can do the same thing and more – it can even make phone calls …

Half-time came and went so we joined the St John’s Ambulance for a cup of tea and a sandwich, rather than watch a bunch of scantily clad young women prance about. Then we were back in the cold, where I tried to stay awake while West Ham, perhaps predictably, lost …

With the exception of someone having a crafty cigarette and setting off a fire alarm, it all went rather smoothly. I did find it funny that the people in the stadium knew what the ‘Inspector Sands’ announcement meant, and did nothing but laugh quietly at it.

At the end of the match we have to stay around until we are ‘stood down’ as the last few supporters leave, so we sat in the ambulance, with the heater going, wrapped in our own blankets (remember, we know what those blankets have been wrapped around, yet we still used them – that is how cold it was).

We then started making our way back to station …

… to come across a policeman who had tried to stop a car – only to have them speed up (possibly accidentally) and hit him. He wasn’t especially badly hurt, but we took all precautions as we transported him to hospital. He’ll need a few X-rays, but I suspect that he will be fine.

‘Inspector Sands’ is a codeword for use over a public address system. It is used to let the staff know that a fire alarm has gone off without alerting the public and possibly panicking them.

Phonetic