A Cut Above the Rest?

November 30, 2006

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Yesterday was my first day shift after nights. It all seems to blur into one long stint.

Our first job was right at the start of the shift….called to someone in the river! Blues & Twos on and off we go. It was a really icey cold morning too so I thought whoever was in the river will be probaly hypothermic.

On arrival scene we are directed to the foreshore and liase with our police colleagues who have managed to coax the person out of the river.

On approaching our new found patient I instantly recognise him. He is becoming a real regular, a rising star in the Hall of Fame for frequent flyers. Within the past three weeks, to my own personal knowledge, he has cut his wrists, tried to hacksaw through his head (down to the bone, so good effort), and tried to drown himself.

He stands in front of us, dripping wet (understandably) and freezing cold and shivering (again very understandable). He wants to end it all, but first he wants to go to hospital to see the Crisis Team (local mental health unit). So off we pop to the A/E where the crisis team refuse to see him…”he has a personality disorder!” they say.

So this guy is going to keep on slashing, hacking, jumping, getting wet and generally making a nuisance of himself. It just amazes me that he cant get help from mental health services. The times I,ve convinced someone with first time suicidal tendencies to come with me to A/E to get the ball rolling in the hope of someone giving professional help, and they,ve been sent away without even seeing anyone. The crisis team are getting paid for what???

Later on in the day this guy discharged himself when no-one would see him and walked back into the river!!!


Sunday…a day of rest or a day of arrest?

November 27, 2006

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Still hacked off at the last job we did on the Saturday night shift at approx. 0600hrs. We were called to an assault which seemed strange with it being almost dawn. We thought it was probaly someone who had been smacked the night before and was now realising they were in pain with the alcohol wearing off. (We are so cynical!).

Enroute to the address we were advised via the terrafix data terminal to make a “silent approach” (no sirens/lights). This was from the police. We asked control if the police were on scene and they said no. We asked for a police ETA. Shortly we arrived near the address and still no sign of police. Again we asked control for an ETA. Control radioed us back and said that the police had no-one to spare!

Heres the problem, we are going to a domestic, female assaulted (updated at scene), and we normally stand off until the arrival of the police. They were not coming out to play! After about ten minutes I wander over to the address (she had taken refuge in a neighbours house) and seeing that it was all quiet I knocked on the door. I was shown in to the house where I found our patient. She had been beaten about the head and her hand repeatedly crushed in a door frame! She was understanderbly upset and very afraid.

After eventually coaxing her out of the house and making a dash for the ambulance, we took her to A/E. Her husband was asleep next door in her house and did not know that she had called for the police.

We have an excellent working relationship with the police in our area, but just lately we are getting sent to jobs where the police should be attending also. Then later they ask us for details for their crime log. The only reason they did not attend is that they were due to change over at 0700hrs. (This is my considered and cynical opinion).

Police resources are stretched, but so are ours yet we will still respond to an injured officer within minutes of the call being made. I just think that sometimes they are treating us with indifference to our safety. Our service is aware of this growing problem and is putting together a report to put to the senior police officers in charge.

Right thats off my chest….the shift for Sunday has mainly consisted of breathing diffs for every single patient! We,ve used up a whole sh*t load of oxygen. Oh and the odd drunk…cant do a shift without a alcohol related incident!

On my days off I,m going out to the pub on the night and getting totally pissed and cause a fight in a kebab shop, then get punched and go to A/E and cause mayhem. All in the cause of research to see what its like from the other side. 

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Saturday Night & Wide Belts….

November 26, 2006

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So far most jobs have been to do with poor medication advice

First off was the 82 year old lady with asthma who was using her preventer inhaler when having an asthma attack! Spent the best part of an hour on scene nebulising her and showing her how to use her reliever inhaler.

Same as the angina sufferers who are told to use their GTN spray before exertion. Went to a gent who told us he keeps collapsing in the shower after taking his spray. Educated him as to the vasodilatory effects of his medication and also that of warm water which kept dropping his blood pressure! He also commented that he uses his spray before going shopping around the supermarket aisles and he always felt dizzy!

Whilst out and about the city we,ve noticed a lot of women (young and not so young) wearing inappropriate clothing for the inclement weather we are having! I mean “thats not a skirt!…thats a wide belt!”

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I think we should conduct a campaign of preventative medicine and hand out leaflets to these “nearly in the niff” women advocating the wearing of duffle coats, scarf, mittens (on string), woolly tights and a stout pair of brogues. But then again that would take all the fun out of “ogling” some pretty fit women!


Trial & Error….

November 25, 2006

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I,m still getting my head round this blog. I have had a go at trying to get pics into the sidebar thingies and played around with different settings and stuff.

It brings to mind my family motto:

“Semper in faciebus

Sumus sole

Profundum variat!”

We are always in the sh*t, its just the depth that varies!

Normal service will be continued soon I think!!


Friday Night…so far!

November 25, 2006

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The shift started as it meant to go on…two minutes after “booking” on over the vehicle radio we got our first job. Called to a 28 female with “Severe Respiratory Distress” code Red cat A (this is according to the AMPDS system in our ambulance control which prioritises calls). Turns out she had a chest infection. Advice was given and she continued with the anti-biotics.

Next job was to a 84 year old female who was having a stroke. This turned out to be a T.I.A. (transient ischaemic attack – mini stroke or CVA – usually resolves itself quite quickly). The lady refused point blank to go to hospital. Her condition was complicated by her having diabetes (insulin dependant), hypertension (high blood pressure), previous mastectomy (breast removal – or part removal) and a colostomy (bowels evacuate, or open, via a stoma or opening in the abdominal wall into a special bag. During our checks with monitor, B.P., blood sugars etc and whilst questioning her it was revealed that she had not taken her blood pressure pills due to an upset stomach. We arranged for a doctors home visit and left her in the care of her daughter.

Next up was a gentleman who had been found at the bottom of his stairs by a carer. We was given the job as a fall….but where from we did not know yet. Arriving scene we found him on the floor at the foot of the stairs, not injured, having NOT fallen down the stairs but incredibly drunk. Again this chap refused hospital treatment. So we patched him up and left the carer to get him settled in bed.

We then got a call to another fall…again this was an elderly gentleman who was rat arsed!!! He had slipped onto the floor and his wife could not get him back on the chair. Again he did not want, or require, treatment at hospital.

Shortley after we attended a very large house with electric gates, gravel drive, numerous cars and a stunning garden (what we could see of it in the dark). The patient was a 38 year old with upper back pain, stabbing in nature. Once again we monitored and did all the normal observations. Whilst doing this he became pain free and declined to go to hospital.

Called to back up a crew with 2 patients from a street fight. One was reported unconscious. We got “stood down” before we arrived at scene.

By now me and my mate are thinking that we wont have to go to A/E at all tonight at this rate! Back at station and once the kettle boils….the alerter goes off!

Tasked to an elderly gent in a care home vomitting blood. On closer inspection the blood appears to be like “coffe grounds” (indicative of a possible ulcer). This chap is taken in to the A/E for assessment.

Then its back to base for a cup of tea and something to eat. Strange shift so far, just hope we dont get a late job!


The Dark Side….

November 24, 2006

 night

Getting ready for another funfilled shift of night time shenanigans with the public.

I wonder….how many will be drink related?  What ever happened to being arrested for being “Drunk & Disorderly” or “Drunk & Incapable”?

Will I be able to use my Paramedic training in Advanced Trauma Life Support, pre-hospital thrombolysis, paediatrics, gynae, obstectrics and all the other advanced techniques/procedures that I have learnt?

Or will I be sorting out drug/alcohol fuelled night people who have drunk far too much (and now say their drinks been spiked) or the ones who are vomitting all over the place, or the unfortunate ones who get the “big hello” from someones size 9 boots or a knife?

We will see……..


Pre-Hospital Care-Pathways…

November 22, 2006

 

 ambo

It still amazes me how many calls we get which do not require an ambulance yet the crew will still take the patient to A/E.

Now this can be due to many things:

  • the crew is erring on the side of caution.
  • easy way to get back to station (vehicle needs restocking/cleaning etc.)
  • crew are knackered from job overload and it takes time to arrange other agency response.
  • crew (or member of crew) has been bollocked for previous job where patient complained about been left.
  • easier to shift the responsibility to someone else ie A/E
  • RRV/RFU has told patient that the crew will take them to A/E. (even if patient does not need to go.)

These reasons are of an historical nature. In years gone by we were always expected to convey the casualty to A/E.

If anything went wrong during the pre-hospital phase (bag goes missing/meds get misplaced/patient is sick/relatives go to wrong A/E  /Doctors letter is lost on the ward!) then normally the blame was levelled at the crew (ambulance drivers!).

If for some reason a patient was left at home due to not been ill/injured, and then later does fall or become ill (which was totally unconnected to the original 999 call) then again the crew would cop it!

With the introduction of extended skills with Paramedic training and better education for all Ambulance Service staff, we have a better understanding of things and can make reasoned decisions based on patients presentation, the history, our experience or in easy cases according to a guideline/protocol.

The NHS is battling to balance the books. Measures are being taken to redirect people away from hospitals via other care pathways. For example NHS Direct, General Practioners, Emergency Care Practioners, Social Services, Community Nurses and so forth.

But on the front line we, the ambulance service, are still responding to many jobs where the caller/patient/casualty could be redirected to a more appropriate form of treatment. I, like most of my colleagues up and down the country, have been trained to treat major wounds/massive chest injuries/fractures of long bones/unconscious patients/heart attacks etc. etc. What we need is further training in minor injuries and how to deal with them on scene. This would free up A/E and release crews for the more serious calls.

I feel quite confident in dealing with minor wounds/illnesses and so I will stand a crew down if I can manage on my own (whilst on RRV/RFU). I just wish everyone else was.

I write this post because I am fed up with the different levels of response from crews/RRV/RFUs. We all know that certain people will transport or wait for crew backup regardless of the patients needs. We need to sing from the same hymn sheet. My most recent experience of this was last night….called 999s to an out of town job (14 miles away) to an elderly lady who had fallen in a care home. Blues & Twos go on and off we go in the dark through the late rush hour traffic. On arriving at the scene we are greeted by the sight of the RRV car. (was not aware RRV was attending also). We were met by a member of staff and shown to the lady…who is sat in a wheelchair, nice warm coat on, handbag on her lap, and a nice smile for us. Sat next to her is the RRV paramedic who states that she fell about half an hour ago and is complaining of a slight pain in her side.

I asked if the Doctor has been called…”yes but he said ring 999.” The lady appeared to be quite comfortable and the pain was fairly insignificant. Her breathing was fine and only complained of a twinge when taking a deep breath in. This was a very simple straight forward job which could have been referred back to the GP. Unfortunately the RRV paramedic had stated right from the outset that she would be taken to A/E.

If I had any suspicion of serious underlying injury or illness then I would not have questioned this job….but there are some of us who are confident to make a decision based on assessment/examination/history/experience etc. and some of us who are not!

I have never had any problems in referring to other agencies /care pathways. All it takes is a bit more time and making sure that you are doing the best for the patient. Also the paperwork must be completed and comprehensive in detail.

It is unfortunate that in the past crews have been hauled over the coals by management over petty things involving patients when the crew RRV/RFU have tried to redirect to another agency and something has cropped up. I have personally been bollocked for not taking a patient to hospital (when they did not need to go) because the ladys son was a doctor who was more than 150 miles away and thought she was having a heart attack on the phone!

Turns out she was very anxious and highly strung, a fact borne out when I spoke to the ladys own GP over the phone from her address! He was quite happy for us to leave her at home. (Obviously I had done all the tests as a precaution, monitor, blood pressure, blood sugar etc.) But its easier to bollock us than to say to the son, who was after all a doctor, you are a pillock and should retake your exams! 


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.

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Why then have these bits of kit disappeared?  


Blood, Sick & Tears…..

November 18, 2006

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 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. 


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