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The Complete Blood, Sweat and Tea
Working outside in the fresh air. I don’t know how office workers put up with air conditioning.
For much of the time you are your own boss – do not underestimate this.
Driving on the wrong side of the road with blue lights and sirens going; it’s not about the speed it’s about the power.
Being able to poke around people’s houses and feel superior even though you haven’t done the washing up in your own house for 2 days.
No matter how annoying the patient is, knowing that within 20 minutes it’ll be the hospital’s problem.
Meeting lots of lovely nurses, and knowing that I get paid more than them.
On the rare occasion, being able to help people who are scared or in pain.
Every time I have a bad day, or feel fed up at work I think back to this list and soon start to feel better – although I no longer get paid more than the nurses I meet.
There are some people, who despite being lovely people, you dread working with; one such person is Nobby (not his real name). He is what is known in the trade as a ‘trauma magnet’. He’s one of those people who will get the cardiac arrests, car crashes, shootings and stabbings; by contrast I am a ‘shit magnet’, meaning I only seem to pick up people who don’t need an ambulance. Other than having to do some real work for a change I really enjoy working with him.
I was working with him a little time ago and we got called to a suspended (basically this is someone whose heart isn’t beating and they have stopped breathing). It’s one of those jobs that require us to work hard trying to save the punter’s life. We got to the address and found relatives performing CPR on their granny. You might have seen it on TV as a ‘Cardiac Arrest’.
(Let me correct a few ideas you might have about resuscitation. First, it rarely works; ‘Casualty’ and ‘ER’ have led people to believe that you often save people: I can count on the fingers of one hand the number of people who have survived an arrest and most of them arrested while I was watching them in hospital. Second, it isn’t pretty: when someone arrests there is often vomit, faeces, urine and blood covering them and the area around them. Finally, people never suspend where you can reach them: if there is an awkward hole, or they can find some way to collapse under a wardrobe they will do so.)
This poor woman was covered in body fluids and was properly dead; there was no way we were going to save her. One of our protocols says that we can recognise someone as beyond hope and not even commence a resuscitation attempt. Unfortunately, we couldn’t do it this time as the relatives had been doing CPR (which is the right thing to do) and so we had to make an attempt.
Nobby and I got to work and tried to resuscitate the patient for 30 minutes. Our protocol goes on to say that if we are unsuccessful after attempting a resuscitation for ‘a specified time’ we can end it and recognise death, which is what we did.
However, during our resuscitation attempt it seemed that the entire extended family had arrived and there were well over 20 people in this little terraced house with much wailing and gnashing of teeth. It’s always hard to tell someone that their mother has died, but it has to be done, and if you can manage it well you can answer some of their questions and hopefully provide some healing for them.
The GP (general practitioner) was informed, as were the police (a formality in sudden deaths). The family had called a priest and he was there before the police arrived, while the GP was going to ‘phone the family’; what he expected to be able to do over the phone puzzled me.
We tidied up and went onto another job.
Two weeks later, Nobby was called to a chest pain. He turns up and finds himself in the middle of a wake, surrounded by 20 familiar-looking people.
Can you guess who the wake was for? Its a funny old world …
I worked with Nobby again for the first time in 2 years. He still remembered the job, and what happened after it. I told Nobby that he’d be included in this book but he wasn’t happy with his pseudonym and told me that he would prefer to be referred to as ‘George Clooney’. I refused.
Although I often moan about the idiocy of other people’s driving when faced with a big white van with blue flashing lights on top, I am sometimes pleasantly surprised at the lengths some people will go to in order to get out of the way. For example, yesterday we had people nearly grounding their cars on roundabouts and roadside verges, squeezing into parking spots I wouldn’t be able to fit a Mini Cooper in and swearing at other drivers who wouldn’t move out of the way. I’ve had workmen stand in the middle of the road and stop traffic, lollipop ladies fence off crossings with their ‘lollipops’, and van drivers who I have clipped while squeezing past them wave me on and tell me, ‘don’t worry about a little damage’.
Yesterday we had all the above on one call (except hitting a van driver), it was like the Red Sea parting before us. It was a beautiful thing to behold; it left us in awe and wonder.
Shame we were going to 2-year-old with a cough.
This is a rare occurrence.
Occasionally you get a job that makes you laugh, normally because the person you are picking up is an idiot. We got called to a chip shop in one of the main roads in Newham – unfortunately there are about 20 chip shops on this road, but we managed to narrow it down by looking for the shiny white police car parked outside. The call had been given as an ‘assault’ which can mean anything from a slap on the face to a fatal stabbing.
In this instance it was a young lad, the spitting image of ‘Ali G’, who was complaining that he had been hit on the nose; needless to say there wasn’t a mark on him, and it turned out that he had been hit by his girlfriend. The police wanted to take statements, but he wasn’t interested and when I tried to assess him he told me that the ambulance wasn’t needed as ‘I’m St Johns innit, and a security guard’. This fella couldn’t scare a toddler, so I suspected he was telling a little bit of a lie. As he wasn’t hurt and ‘refused aid’ my crewmate and I retreated to a safe distance to do our paperwork …
In the course of the night we found ourselves at the local hospital (dropping off yet another ill person) when who should walk in with another crew from my station, but our earlier ‘Ali G’ lookalike. I asked him why he decided to call an ambulance when he’d already sent us packing and it turned out that another woman had hit him … the prostitute he’d hired after his girlfriend had slapped him. Turns out she had hit him and then robbed him of his jewellery. He couldn’t have put up much of a fight because he only had one scratch on him.
It’s pillocks like these we have to put up with … and call ‘sir’ …
However, it is also jobs like this that we can use to have a good laugh with our workmates. So people like him do serve some purpose.
Much fun and games last night, working in the Poplar/Bow area. Not only did some German bloke graffiti on the back of one of the ambulances, but he also called the crew from a payphone and ran off, repeating it twice.
There are a lot of strange people out there …
MacMedic (an American ambulance blog) gave a rundown of what his shifts are like, so I thought I’d do the same, in honour of our brothers in foreign climes.
All these people called an ambulance last night by dialling ‘999’.
(a) Fractured wrist – young lad at the Boat Show.
(b) An alcoholic ‘frequent flyer’ who has just been released from prison … We thought we’d got rid of him for good.
(c) A 15-year-old with a runny nose.
(d) Very minor RTA.
(e) Domestic Assault, with no actual injury, but police already on scene.
(f) ‘Facial Injury’ which turned out to mean ‘Some bloke kicked my door.’
(g) Assault with a cut hand – actually a decent injury with tendon involvement (which means surgery and physiotherapy).
(h) Varicose Vein that had burst – plenty of blood everywhere.
(i) A 29-year-old with chest pain, hyperventilating, with very upset relatives.
(j) A suicidal overdose in a house filled with young men with short hair and tight T-shirts (ifyouknowwhatImean).
(k) RTA with a traffic light pole coming off the worse in a two-car collision.
(l) An 8-month pregnant female who had fallen earlier that day.
and …
(m) A fitting 9-year-old; only one parent spoke English, and they decided to stay at home and send the father who doesn’t speak English with us, because ‘The hospital has interpreters …’
Now, out of these thirteen jobs, only five actually went to hospital …
This counts as a ‘good shift’, reasonably interesting jobs, and no-one tried to hit me.
Sorry folks, bit of a rant here … but I last slept 22 hours ago …
We got a call to a patient who was ‘Depressed – not moving’: normally with this type of call it’s some teenager having a strop, but this time it was a little different. Basically, the patient, who suffers from depression, was discharged from the local psychiatric unit 3 weeks ago and recently had her dose of antidepressants reduced. Yesterday, she was crying all night, and tonight she was just sitting staring into space, refusing to make eye contact and not talking at all.
One of the things that we as an ambulance crew cannot do is physically remove someone to hospital if they don’t want to go – that would be kidnapping and is frowned upon by the law. This young girl was not going anywhere despite my best attempts to persuade her – she just wasn’t communicating.
The solution would be simple: call the Community Psychiatric Nursing (CPN) team to come and assess her and, if needed, arrange her compulsory removal to the psychiatric unit (called a ‘Section’ under the Mental Health Act). The problem? It was 10 p.m. …
First off I phoned the psychiatric unit that she had received treatment under. After talking to two idiots who had trouble understanding plain English, I finally managed to get the number of the CPN team. Now, the London Ambulance Service (LAS) is quite smart: when we want to arrange an outside agency we go through our Control because all the telephone conversations are recorded … so if someone says they are going to attend they damn well better. I got onto Control, passed the details to them and waited for them to get back to us.
I’d just like to say that in all my years of medical experience I have never had a simple referral to a psychiatric service: they always seem to try shirking any form of work by ‘forgetting’ you or by being just plain obstructive. Maybe I’m just unlucky and get the idiots every time.
Needless to say we waited … and waited … and waited … from 22:20 until 23:00 we waited; then at 23:02 Control got back to us. Apparently the CPN team all goes home at 23:00 and hadn’t answered the phone until 23:00 on the dot. So they refused to visit the patient. The moral so far is if you are going to have a psychiatric breakdown in Newham don’t do it after 22:00.
So we switched to plan ‘B’, which is to arrange the out-of-hours social worker to come and visit, as they double as Psychiatric Liaison. Again we went through Control and waited … and waited … and waited … Finally we heard back that the social worker would ring the family and would like to talk to me. (Outside agencies try this trick, as they know the patient’s phone isn’t being recorded, and so can say whatever they want, with any disagreement being my word against theirs.) The social worker explained that she was very busy and so would prefer not to come to see the patient and have I tried the out-of-hours GP?
Back to Control I went and got them to try and contact the out-of-hours GP (a GP, for those not in the UK, is the patient’s family doctor). Can you guess what we then did? We waited … and waited … and waited … Finally, Control got back to us and informed us that the out-of-hours GP hadn’t arrived for work yet and that when they did, they would have to see two other patients first.
All through this time the family of the patient were very understanding and were happy when I explained that the GP would call at some point in the night. All I could do was advise them to remove anything that the patient could use to hurt herself, and keep an eye on her, calling us back if they felt the need.
Total amount of time an ambulance was tied up trying to get outside agencies to DO THEIR DAMN JOB – 2 hours and 19 minutes … and not the world’s most satisfactory outcome.
As I mentioned to our Control, sometimes you feel very lonely out there on the mean streets of Newham.
It is still the case that as soon as the sun goes down, various community services disappear and people in trouble need to rely on the ambulance service and the A&E department, even if it isn’t the best place for them.
There is something deeply disturbing about walking on a sticky carpet – especially when the flat is in a complete mess and the punter has called an ambulance 4 times in the last 2 days for a pain in the chest that has lasted 2 years. I’d like the jury to note that the pain hasn’t changed in any way, it’s not worse, or moved around the body, he has no other symptoms. But the patient just seems to like calling ambulances. I wanted to wipe my feet on the way out of the flat.
It also doesn’t help when the patient smells so bad that I want to leap out the side window. We didn’t have any air freshener (and apparently, neither does the hospital).
When we got to the hospital the triage nurse took one look at the patient, muttered ‘Not him again’ and sent him out to the waiting room. I suspect that it may just be a ploy to use biological warfare to empty the waiting room.
I still keep getting called back to him for the exact same ‘problem’.
Once again I know a lot of visitors here are from America, so I’m going to explain how the LAS works on a day-to-day basis. This will either be very boring or immensely interesting – your choice.
Ambulances run out of dedicated stations, we don’t share stations with the Fire Service. In fact, some years ago, when it was suggested the idea was shot down as we would be disturbing the firecrews’ sleep throughout the night. Each station has its own call-sign ‘K1’, ‘J2’, ‘G4’ for example, then each ambo has a suffix that is attached to this, so one ambulance running out of station J2 would be called J201, while another would be J207.
The stations are spaced approximately 5–6 miles apart, and you mainly service the area surrounding the station; however, with interhospital transfers and other irregularities you can quite easily find yourself across the other side of London.
It’s an old joke that when asking if we need to travel so far the dispatcher will ask us if it still says London on the side of the ambulance.
There is a main station, and two or three ‘satellite’ stations; the main station will normally have between three and six ambulances running from it, while the smaller stations have between one and four. There is less cover at night, and you can easily find yourself being the only ambulance running from a given station.
Across London we deal with more than 3 500 calls per day, and with a fleet of 400 ambulances of which perhaps only three-quarters are manned, we seldom get a rest. Where I work we average 1 job an hour, and are supposed to transport every one of those patients to hospital.
The longest shift we officially do is 12 hours, in which we can expect 10–13 jobs, which doesn’t sound like a lot but is enough to keep us busy … We spend 97% of our time away from station (compared with 3% for the fire service).
However, it is a fun job.
There has been a discussion over on another medical blog’s forums over which shift we prefer to work. Like many of the others I have a preference for working through the night. The reasons for this are many but include:
(1) I’m single, I can lie in bed as long as I want. And breakfast is dinner … and kebabs are lunch … and an icecream is supper.
(2) You get empty streets, and so can drive like someone out of ‘The Fast and the Furious’.
(3) You also get the strange jobs: ‘sex-toy accidents’, criminal behaviour, stabbings … (4) It feels as if you ‘own’ the world: there is no-one else around, and anyone you do meet is normally shocked to be awake at night.
(5) You get to work a lot of jobs with the police, who are generally excellent people to work with.
(6) I get to sleep through early morning television – I’m sorry but I can’t see the attraction of ‘Trisha’ or ‘This Morning’.
(7) I don’t have to go into a school, and be surrounded by 400 screaming children just because a kid has sprained their ankle.
(8) There is less management around – actually there is no management around (always a good thing); I like to avoid management as much as I can: I worked this job for 6 months before they remembered my name.
(9) On a cold winter morning, I’m going home to my warm comfortable bed, while everyone else is trudging to work.
I still like nights, which makes me a rarity in the LAS. Most of my most interesting jobs occur at night.
No sooner do I post why I like night shifts than I get two ‘proper’ emergency calls, one after another. The first was a 76-year-old Male ‘Suspended’. Unfortunately, despite our best efforts there was little hope for him, and he died later in hospital without his heart ever restarting. His wife of 50 or more years was disbelieving of the whole situation, and I was too busy doing CPR to be able to comfort her much. It is one of the few things that I miss about nursing – sometimes you want to spend time with a relative. If you can’t do anything for the patient, the relatives then become your concern. For the first time in 50 years she was going to sleep alone and the nurse who would be looking after her is not someone that I would call the most sympathetic person in the world. I spent a little longer at hospital talking to the wife. The only consolation that I could give her was something that I’ve practised many times over the years – that her husband never suffered, and that he wouldn’t have felt anything that we did.
The next job was a man who, after drinking too much, fell over in the street. He had a greatly altered level of consciousness, possibly due to the alcohol but also possibly due to the large head injury which was leaking a frankly excessive amount of blood over the tarmac.
He could have been worse – he was lying in the middle of the road and could have easily been run over. It is important in such a job that you should ‘collar and board’ them. This is a way of immobilising someone in order to prevent any damage to the spinal cord. Unfortunately the patient was quite combative and so the only safe way to secure his head was for me to hold it during the transport – all the time blood was leaking through the dressing we had put on him, all over us, the trolley bed and the floor of the ambulance. Some managed to flick up onto my crewmate’s face, which is something you don’t really want happening to you.
I’ve just come back from the hospital (after dropping off yet another assault) and our patient is doing fine – seems that his altered consciousness was indeed as a result of the alcohol. He still isn’t sober enough to have a meaningful conversation, but he is looking a lot better than when we picked him up.
I still like wrestling with drunks, and writing about blood being flicked up into your face set the stage for a future set of posts.
The LAS has got some new uniforms. These include ‘combat trousers’ and a fleece, which is nice seeing as it can get a bit nippy around here. The only problem is that we use ‘Alexandra’, who doesn’t have the best reputation, for our uniforms. We’ll forget that they can’t measure you up correctly – I am not a 38-inch waist no matter how many kebabs I eat. Instead, let us consider that the buttons on their shirts tend to fall off at the worst possible moment. Having a button drop in a dead man’s mouth when you are trying to resuscitate him is not something that inspires confidence in the relatives watching. I was supposed to have eight shirts; two of them have been cannibalised, so that I have six shirts with the right number of buttons.
The new uniform actually seems quite nice. We have a little NHS logo in case the big motor with ‘Ambulance’ written on the side is not enough of a clue to our identity, and the shirts have a mesh in the armpits so we can let our sweat out. The combat trousers have ‘Permagard’ (their spelling, not mine) which is designed to kill bacteria, which is nice considering the state of some of the houses we visit. The high-visibility jackets are … well … visible and we now have a green ‘beanie hat’ (I think it’s green so that people won’t wear them anywhere except at work).
There is a rumour that we will be getting new boots soon … ‘Magnums’. We are a bit like the army in that we buy our own boots because the ones supplied are a bit shoddy.
Anyway the uniform ‘goes live’ on the 12th but those who have uniform that actually fits have been wearing them early. The bosses are moaning a bit but haven’t actually told anyone off about it.
I now have five shirts with the right number of buttons. People are still buying their own boots.
Picked up an assault yesterday. While sitting in the back of the ambulance he told his 2-year-old daughter that ‘daddy is gonna fucking kill the people who did this to me’, then complained when the nurse at the hospital told him to moderate his language.
I love this job.
We then went to someone who started hitting his own nose in order to prove that it had been bleeding earlier, and then went to a woman who had a bleeding varicose vein that had stopped bleeding, but wanted to pick at it to prove that it had been bleeding.
Then we went to a 14-year-old girl who was ‘fitting’ but when we got there was confused and combative – she was a diabetic so we checked her blood sugar, which was low. Being confused is one of the symptoms of a low blood sugar and we normally give them an injection that brings them out of it. We gave the injection and waited for it to work and receive the grateful thanks of the parents.
