Carry on Carrying…

November 21, 2006

 stretcher

Reading a post from ECParamedic recently, or was it NFI ? reminded me of a job I did last week on nights.

Called to a house to back up a crew….no details given as to why. Could be a hand with a heavy patient, could be a difficult resus, or a multiple casualty situation, it could be anything!

As it turned out the crew had been called 999s to a house to a renal dialysis patient who had necked a full bottle of Jack Daniels whiskey. Patient had gone into a sudden hypo (massive blood sugar reduction). The patient was fitting and was also quite heavy. It was impossible to get a line in and he appeared to be extending mostly. (Rigid extension of arms and legs due to a central nervous system reaction).

In short, he needed to be in hospital asap. There was no way we could have safely carried him on our carry chair so we decided to use the scoop stretcher. (special metal or plastic stretcher which splits in two and enables us to “scoop” the patient in the postion found.)

With the patient strapped securely to the scoop we started to carry him out, negotiating the narrow door way into the even more narrow hallway. It was at this point that we had to tipp the scoop sideways to edge through the door. (Bearing in mind that the patient was 16 stone plus.)

Eventually we get the patient onto the vehicle stretcher placed outside the front door and then onto the vehicle. From there he was transported to the hospital.

All of this could have been made much easier if we had a simple piece of equipment called the “carry sheet”. Basically a very strong sheet with grab handles at regular intervals. I,ve used this in the past on difficult extrications from houses, down stairs, from under vehicles and other situations where the space has been limited.

sheet

Why then have these bits of kit disappeared?  


Blood, Sick & Tears…..

November 18, 2006

tank

 Well I,ve just got up after having about 5 hours kip. Got back home in the very early hours of the morning after a shift on the Foxtrot Oscar response car. A fairly busy shift but not as busy as I expected although the calls lived upto their expectations.

Went to the Ambulance Station and picked up the response vehicle. Checked all the equipment in the back: oxygen, entonox, defibrillator/monitor, dressings/bandages bag, main green bag with all the medicinal drugs and intervention kit and made sure there was plenty of spare stuff to replace items when used.

Picked up hand held radio and mobile phone and placed on vehicle along with maglite torch, personal helmet,  sandwichs and flask of tea. (Last two items most important).

Next was a short drive to pick up the Police officer who I was crewing up with for the next eight hours.  Picked up “Mike” and called my Ambulance control to inform them that we were operational. Tasked by control to patrol the city centre. The shift covers the main part of the night when it usually gets busy with drink related incidents…the idea being that we can assess the assault/collapse/”spiked drink”/unconscious calls and hopefully treat on scene thereby freeing up the crews for real emergencies.

Two minutes into the shift and our first call is to a stabbing just within the city centre area. Blues & Twos on and we,re on scene within 3 minutes at a block of flats. People are screaming at us to help, my police colleague is calling for extra police backup (already called enroute). Making sure that the scene is safe we enter the property and find a late 30ish male doing the backstroke in pools of his own blood!

It soon becomes obvious that he is in drink and drugs (no shit Sherlock!) but there is confusion as to what has happened and people are calling him by different names. A friend/neighbour/passerby had a blood soaked towel pressed firmly on the patients leg over his mid thigh. Whilst trying to calm him down I cut his trousers and take a look at the wound and find a 2 inch long stab wound which appears to have stopped bleeding….for the moment.

The friends/neighbours/passerby state that it was spurting but I think its more of a venous bleed. This is where the fun starts. The patient in his drug/alcohol fuelled state stands up and opens the tap wide for his leg to start gushing blood all   over the floor. Trying to get him back on the floor and raise his leg is nigh on impossible, so I attempt to put a pressure bandage on his wound whilst he is trying to get away. (My police colleague believes he is wanted on warrant).

Eventually as he tires and his blood pressure lowers more, we get him on the deck and get his leg raised up and put more pressure bandages on. The crew turn up and with alot of cajoaling and straight talking he is taken to the ambulance. Turns out he had an argument with his girlfriend and stabbed himself in the leg (as you do….) and thought he was going to get nicked. An easy job from an ambulance point of view but awkward for the police due to the mis-information and drugs aspect etc. Also messy from my point of view as my hi-vis jacket got covered in claret!

The rest of the shift consisted mainly of drunk women collapsed on pavements or in pub toilets. Each one said their drink had been spiked which I know does happen from time to time but the signs & symptoms are different from massive amounts of alcohol on an empty stomach. Others included people falling over and sustaining minor injuries to a few who who were training for the world vomitting championshps!

Towards the end of the shift we are tasked to an unconscious male after an assault outside the city centre. Again Blues & Twos on and we arrive at scene in about 5 minutes. There is already a police unit on scene and a couple of public first aiders have put the casualty in the recovery position and watching his airway. A quick assessment shows that he has a fractured jaw at least, he is unconscious and his airway is in jeopardy. A quick call to ambulance control for a crew asap. His mouth is full of blood so before I attempt to insert an o/p airway I sweep the bulk of the fluid away with the o/p tip.

At this he starts to come round a bit and proceeds to spit blood and vomit onto the floor….followed by partially digested pizza and copious amounts of what appears to be…mmmhm let me think, aaahhh yes alcohol! All over my boots!

The cause of this 17 year olds injuries are as the result of a massive beating and kicking by multiple assailents. The crew turn up and we place him on the stretcher as he is still very disorientated and off he goes to the A/E.    

A rather busyish shift and I did,nt get to eat my sandwichs or drink my tea….unheard of for me! This shift was different to regular ambulance work as we got sent to police related incidents too. All in all its a good scheme and I look forward to my next shift. And so to breakfast….!!!


Pudsey Bear goes to Town…

November 17, 2006

 Pudsey Bear

Tonight I,m working on Papa-Charlie 1. Combined Paramedic/Police response car. Its main function is to attend all the drink related incidents that normally someone would call an ambulance for. If we can treat on scene…clean, bandage or give advice then that saves the A/E department filling up with alcohol fuelled people who can cause bother.

Someone pointed out today that its “Children in Need” night. So that might just mean that the city centre is going to be even more full of fancy dress people! I shudder to think what we are going to find…….

Will let you know tomorrow as this tends to be a night shift. 


Chain of Survival…who looks after the links?

November 15, 2006

 Chain of Survival

A couple of busy shifts on the RRV doing 12 hour stints. Most jobs were very minor with the occasional chest pain and a few kiddies with infections leading to febrile convulsions.

Towards the back end of the second shift I was tasked to respond to a “cardiac arrest in the street outside a health centre…”.  I arrived almost the same time as the crew and I saw that CPR was being carried out by two members of the public. With my defib and resus bag I approached the scene and saw that the patient was attached to an automatic advisory defibrillator (basically a shock box which delivers electric shocks to the patients heart via adhesive pads on the chest with assessment of the underlying heart rhythm done by computer). 

It was then that I noticed that they were nurses from the health centre and a G.P. The pads had been taken off the patients chest and I was told that he had been shocked twice….CPR was still been carried out (mouth to mouth and chest compressions). The G.P. was after “calling it” (ceasing the resus). But in a quick conflab with the crew we took over and started “bagging” using a bag and mask with O2 attached, and took over chest compressions. This was due to the fact that it was a witnessed arrest and that good CPR had been initiated with initial defibrillation all within about the last 10 minutes.

I intubated the patient on the ground while my colleague gained venous access and started administrating cardiac drugs. Checking our monitor showed that the patient was displaying a rhythm. A regular pulse could be seen on the screen but on checking the patient at carotid and femoral arteries we knew that he was in PEA (pulseless electrical activity…meaning that the electrical stimulus was firing in the heart but the actual heart muscle was not responding). We then moved the patient to the stretcher and onto the vehicle continuing CPR all the way. Further cardiac drugs were given and the crew set off for the resus room at the local A/E putting in a pre-alert for the hospital via control.

I stayed behind to sort out my kit and clear up the normal rubbish left after a resus (syringes, paper, wrappers etc.). I spoke to the health centre staff and thanked them for their efforts and they appeared pleased to have been of some help.

It was then that I noticed a young man stood at the side of the road visibly upset. He was close to tears and shaking. (For members of the public to witness us carrying out a full resus in the street is not that common and it can be distressing to watch).

I asked him if he was okay and he asked if the gentleman who had collapsed was going to be alright? This is where you need to be careful as I thought the young man may have been a relative…turned out that he was not. So I said that everything was been done to help the chap, to which the young man replied that he had witnessed the patient walking along and then he saw him suddenly grasp his chest and then collapse to the floor! 

The young man had rushed over and realised that he had arrested and started CPR straight away, sending someone in to the health centre to get help. It was then that the young man explained to me that no-one would come out of the health centre to help as they believed that he may be drunk (the collapsed gent) and that they were not covered for insurance purposes off the premises. (This is what the young man told me).

As he was still quite shaken up and upset I told him that he had done a terrific job and that he should not feel downhearted. It was reassuring for me that this lad had helped rather than walk on by. But I felt that it was a shame that no one had bothered to talk to him during our resus efforts. It then became obvious that he was stuck in a loop. He seemed to be venting his anger or frustration towards the health centre for not coming out sooner. Again I tried to explain the reasoning/rationale behind their initial reluctance to attend. Before I left scene to follow the crew to hospital to retrieve some of my kit, I again thanked him for his efforts.

At the hospital I collected my kit and was talking to the crew at the reception area when I overheard the receptionist talking on the phone trying to calm someone down who was after info on the chap that had been brought in. It was the young man….one of the crew took the call and again reassured him and thanked him.

For us it was part of our job. We attended the patient, treated and transported to the hospital and filled in the relevant paperwork. Re-kitted our vehicles and called clear for the next job. We had spoken briefly about the arrest knowing that the patients prognosis was poor. We also talked about the next staff night out and the local football club.

Its difficult at times to put peoples minds at rest especially after they have been involved in a traumatic event, but usually we are long gone either with the patient to hospital or onto the next job. I just hope that the young man who helped out will see the positive aspects of what he did and not dwell on the circumstances that he found himself in before we arrived.

For us closure is simple (apart from the real bad jobs involving kids or multiple fatalities).  And if we should need help we can always talk to each other using dark humour etc. Members of the public dont.

I just hope that the young man is okay……


T.A.R.D.I.S.

November 13, 2006

TARDIS….Time And Relative Distance In Sandwiches!

sandwich

Today was busy on the RRV. Three jobs almost on the bounce in the first hour or so. Only problem was that by 0930 hrs. I,d eaten all my food! (2 x ham and pickle sandwiches/2 x choccie biscuits/1 x blackcurrant cheesecake - small,  and a couple of mini scotch eggs) . Bearing in mind that I,d had breakfast at 0530 hrs before setting off for work.

I must pace myself more. By the end of the shift I could have eaten a scabby horse!

For tomorrows shift I,ve made extra sarnies and included more goodies…just hope the wife has been to the supermarket. I now need a bigger “bait box” or pack-up container….in fact I might have to take some kit off the RRV in the morning so I can fit my lunch in!


Overtime on the old RRV ……

November 12, 2006

RRV

Getting my kit sorted for two days overtime on the RRV. Looking forward to the shifts as hopefully in between jobs I can catch up on some admin.

Working in a different patch as well which should prove interesting so I hope I can meet interesting people in interesting places and stick big sharp pointy needles in them….if needs be of course!


If only we had Scum Nav….!

November 12, 2006

Last nights shift was fairly busy to start with….chest pains, fitter and the proverbial drunk. Later on we went to another fitter and whilst dealing with the patient in his house…some scumbags broke into our ambulance and stole the sat nav screen!!!

We did,nt realise until we got back in the vehicle after clearing at the aforementioned patients house (fits due to alcohol withdrawal and he did,nt want to go to A/E.) It was only when we pushed “Not required” on the Terrafix and we got sent a job for a Cat A Red Call on the other side of the city did we notice ….no sat nav screen! Bugger!

So off we went to the job as luckily I knew where I was going. It was one of those working jobs where we needed back up and a bit of ingenuity to extricate the patient from the up stairs of the house.

After clearing at the A/E we were then sent back to station to do the police statements and swop vehicles (which meant swopping the entire kit from one to the other!) We were off line for more than 2 hours….all due to some thieving scumbags!!!

I wish the police had “scum nav” then once they were caught we could strap their legs down to a table with barbed wire and then using a hand drill with a broken rusty drill bit covered in dog shit we would drill into their tibia and extract the bonemarrow replacing it with hydrochloric acid….or we could cheese grate their finger ends off with a very rusty cheese grater covered in tramps diahorrea.

Just a thought….a passing thought…thats all….but what a thought!!!


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