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The Complete Blood, Sweat and Tea
If we had got there a minute later, the patient would already have died – in her bed surrounded by people that cared for her (although not her family) as opposed to being hoisted out onto a chair and then suffering the indignities of CPR in the back of an ambulance. While trying to resuscitate her during the transit to hospital I found myself looking into her dead blue eyes, apologising to her and hoping that she couldn’t feel anything that I was doing to her.
I don’t know if it is because I’ve had one and a half hours’ sleep in the past 38, but it made me feel bad to put her through the indignity of pointless CPR. I know the policies are there to protect us (and members of the public), but sometimes I wish we could use some discretion.
Now I’ll see if I can get some sleep.
I can still remember her sparkling blue eyes looking up at me.
So, two nights ago I was dealing with death, people collapsing on the DLR (Docklands Light Railway), young men vomiting blood and looking like death warmed up, and women having miscarriages. Basically everyone I attended to on Wednesday night needed an ambulance.
Last night we had …
One patient with indigestion (for 2 years – FRU on scene when we got there as it was given as a ‘chest pain’).
One ‘gone before arrival’ (a drunk who phoned 999 complaining of a broken arm, but had wandered off before we got there).
One overdose ‘acting violent’, who also had gone before we turned up (driven to hospital by her brother).
One ‘facial injury’ (a woman slapped by her husband: no injury and she didn’t want to go to hospital – her husband was taken away by the police).
One patient with ascites and chronic alcoholism, who was referred to hospital by the GP (could have travelled in her husband’s car).
One call to a police station for an accused who had swallowed some drugs – he denied everything and the police doctor cleared his health.
And one patient with an arthritic knee …
The patient with an arthritic knee was a 70-year-old male who had called out his GP. Said GP had then diagnosed arthritis and decided that the patient needed hospital treatment. We got the call, and had to go out of the area we are supposed to be covering to pick the patient up. The booked hospital was even further out of our area – so much so it was in another sector.
When we got there the patient’s son was present and as we loaded his father into the ambulance we were told that ‘I’ll follow up in the car’.
The look of sheer despair my crewmate gave me had me in fits of laughter; thankfully, I was outside the ambulance so neither the patient, nor his son, who had gone to get the car, could see me.
There was no reason why the patient couldn’t have been driven by his son, yet here we were, out of area, going even further out for someone who didn’t need an ambulance.
Still, after the past few days it was nice to have a shift where no-one was actually ‘ill’, and so we could spend the shift in a fairly relaxed state.
We often get patients in this sort of situation. I’ve given up worrying about it, even if it does mean that an ambulance is tied up doing non-essential work. I just wonder how many people have died because of a delay getting an ambulance because we are forced to do these types of jobs.
When you apply for a job as ambulance personnel for the LAS, one of the things that they look for is that you are a competent driver. Therefore, as part of the interview process they throw you into the most run-down, barely working 14-seater lump of crap they can find, and tell you to drive around Earls Court. For those not from London, Earls Court is a congested area with fairly small streets, constant roadworks and the sort of people who think it is amusing to leap out in front of scared-looking interviewees on their driving assessment.
Before you see a vehicle you are given a piece of paper that tells you what the assessor is looking for, the crossing over of hands when steering is a big no-no, as is over-confidence (along with under-confidence), speeding, going too slow, incorrect use of gears, incorrect use of signalling and a myriad of other things you haven’t worried about since you passed your driving test as a teenager.
When I first went for my driving assessment I noticed the ‘over-confidence’ bit, so I thought I’d be sure not to come across as too aggressive a driver. I was a model gentleman, I let people out of side turnings, allowed pedestrians to cross in front of me and didn’t hassle people who were driving too slow: I failed my assessment for being ‘under-confident’. ‘Come back in 3 months’ I was told.
Three months later and I was determined not to make the same mistake (an additional 3 months stuck in A&E nursing will make you ever so slightly determined). So, I got into the worst piece of crap in the fleet, and off we went. Leaving the yard I hit a kerb and about 200 yards down the road I did the same thing. ‘Turn around and go back’ I was told; I slunk back to the yard and vowed to do better in another 3 months.
Three months later, and I thought ‘Sod it! I’m going to drive how I normally drive’. So I crossed my hands turning the wheel, sped up to stop signals, refused to let anyone out of a side road and drove as if I were driving my 1.0-litre Ford Fiesta.
I passed. Needless to say I was more than happy, and fairly skipped out of the yard that morning.
Of course this double failure didn’t help my confidence when it came to the driving part of my training course.
All I can say is that I haven’t run over any pedestrians, although I have reversed into some stationary objects.
When you train to be an ambulance technician, you have to do 2 weeks of ‘driving instruction’ where you are split into groups of four, get given a 17-seater van that has been hired for you and you learn how to drive your ambulance using this equipment.
Perhaps the most important differences between an ambulance and the 17-seaters that we are given are that ambulances are automatic, while the 17-seaters are manual (I believe the American term is ‘stick’), and that 17-seaters just don’t ‘feel’ like an ambulance.
The training course consists of 2 days of fun, and the rest is chasing each other around the countryside at high speed.
The two days of fun include driving around a racing track, spinning around a skid-pan and swerving around traffic cones at high speed – both forward and in reverse.
Then, for the next 2 weeks, you learn some theory in the classroom, such as the ‘limit point’ and the forces that act on a vehicle (and why sometimes speeding up when you are losing control is a good thing). The rest of the time is spent driving at high speed around the countryside, making sure that you have the correct gear, speed and suchlike for high-speed cornering.
There are a few things that make this training course less than effective: the first is that as the London Ambulance Service, it is extremely rare that you find yourself driving in the countryside, it is also rare that you drive at any speed above 40 m.p.h. and, as mentioned earlier, ambulances are automatic vehicles and as such don’t have gears.
I drove an actual, real ambulance a grand total of once during training. I sat in the driver’s seat, pointed to the lever in the middle of the floor and said, ‘what’s that, and where is the clutch pedal?’
Luckily for me learning to drive an automatic was pretty easy.
At no point during the driving course did we drive on ‘blue lights and sirens’ – something that may have caused my first RTA.
(Insert wobbly flashback special effect here …)
The first day out on the road out of training school went well. I was attending (A&E nurse for some years) and my crewmate was driving (his previous job? ‘Man and Van’ – driving a removal van around London doing odd jobs). So the driving went well, as did the attending (dealing with sick people). The next day our roles were swapped, I warned our supervisor that I’d never really driven an ambulance before, but he said that we’d be fine if we worked like yesterday.
So, on my first emergency job, blue lights went on, sirens went on and people started moving out the way – it was then that I realised that you can’t fit a 7-foot-2-wide ambulance through a gap made by two cars which is only 6 feet and 6 inches wide. This was the first time (and hopefully the only time) I’ve been sworn at by a boss, although to be fair, the only time I think I’ve deserved it. I learned how to fill in accident forms that day … and how to judge distances a bit better. (An ambulance is wider, longer and taller than a 1.0-litre Ford Fiesta.)
Soon my training came to an end and I was thrown into the world of emergency driving in Newham …
(End wobbly flashback sequence, cue end title ‘To Be Continued …’)
The boss who swore at me was right though. Even now I think that this is why I like the ambulance service over nursing. With nursing the boss would call you into the office to discuss your ‘problem’, and how I might ‘reflect on what happened’. So for me, being sworn at was a breath of fresh air.
After the assessment, the training and the first time racing around the streets of London being sworn at, you finally end up on your own, in a new part of town where you are expected to get to emergency calls in 8 minutes.
I got posted to Newham, which is a 10-minute drive from where I live; unfortunately, I’d never driven there and my navigation was awful. When I told my new workmates where I lived they thought, ‘Good someone who knows the area’ (and just after that they probably thought, ‘If he lives there I wonder if he’ll steal my car?’). This was before the days of satellite tracking where you just have to follow the dulcet tones of the computer (sometimes in Danish if some bright spark has reprogrammed the computer); in those days you had a mapbook and were expected to get on with it.
Gradually, you get to know the streets, where the regulars live, the pubs that are ‘trouble’ and where the 6-feet-6-inch width restrictions are. You then have to counter every threat the ‘natives’ throw at you.
For example, I might be driving a big white (or bright yellow) van, covered with flashing lights and ‘ambulance’ written on the side, occasionally – if I feel like pushing out the boat – I’ll even have the sirens going. You might expect people to get out of the way; instead, pedestrians will be drawn to run out in front of you, like particularly dim-witted moths to aflame. People in cars will suddenly develop selective blindness, and idiots with Drum ’n ’Bass pounding out from stereos worth more than their car will argue that I should make way for them.
Drivers will pull out from side streets in front of you, and as for the bizarre ideas some people have as to the best way to clear a path for us (jump on the brakes, swerve in front of us, sit there and panic), well, it’s a good job we often don’t have far to travel.
However, there are benefits to driving an ambulance: driving on the wrong side of the road (at a top speed of 20 m.p.h. mind you) still makes me happy, driving over kerbs is often a giggle, and let’s face it, who wouldn’t like to treat red lights as a ‘Give Way’?
Despite popular belief, we don’t actually go that fast – we can’t, we never know when some young mother is going to push her baby buggy out in front of us. At best I think we have a maximum speed of 40 m.p.h., not only for our safety and the safety of other people, but purely because the worn-out ambulances that we drive have an acceleration that would embarrass a milk float, and a top speed of … oh … about 42 m.p.h.
I once got on a motorway and ‘opened her up’, we got up to 70 m.p.h. (downhill naturally) before the front of the ambulance started lifting up and the steering became a trifle ‘unresponsive’. Luckily I managed to stop screaming in sheer terror for long enough to regain control.
Most of our accidents (as a firm) come from reversing, I’ve – cough – occasionally reversed into pillars and lampposts; one person I worked with managed to reverse into a low-flying balcony. I have on at least two occasions got stuck in a width restriction (I swear, one day I’ll get our 7-foot-2 ambulance through a 6-foot-6 restriction – I just need to get up to a decent speed before tackling it). Thankfully, our ambulances are so old and battered that small amounts of damage just add to the character of the vehicle.
Of course all that has changed with the new yellow Mercedes Sprinters. Or at least it would if they haven’t all started getting faults around the 5 000 mile mark. Our station had three of the new ambulances, now we have none. They are all either being patched up, or shipped back to Germany to have major repairs done. Current reports are that the fibreglass back is splitting from the metal chassis – possibly because of the number of speed-bumps we have to contend with.
Speed-bumps – a good idea in theory, but in practice they slow us down by a hell of a lot, wreck the ambulances, and in 5 years’ time I intend to go on permanent sick leave because my kidneys have been shaken out through my mouth. My plan to get local councillors thinking a little more sensibly about speed-bumps would be to strap them down on a spinal board and drive them through the streets – I think they would be begging for mercy after 5 minutes.
Parking is a nightmare in Newham as well. We often have a line of traffic parked on either side of the road, making side streets effectively single track routes. When we get a call for a ‘chest pain’ (you know, the sort of thing that could be a heart attack), then we have no choice but to park in the middle of the road, blocking any other traffic. At no point do we engage in the ‘how much traffic can I stop’ game. We don’t like confrontation at all, we like a nice quiet life, so we are not trying to wind people up on purpose.
Unfortunately some people don’t see it like that and will sit there honking their horn at us to get a hurry on. To be fair, I tend to spend a maximum of 10 minutes on scene, and if you honk your horn at me, I’ll then change my working speed to ‘go slow’ (assuming that this won’t affect the patient’s condition).
I think it’s incredibly rude to think that your journey is more important than that of an emergency ambulance.
Don’t you?
I’m off to work now to drive around those selfsame streets … wish me luck, and if you see me in your rear view mirror, please get out of the way by pulling over and stopping on the left of the road.
Some unusual jobs today, the first call was to a concrete company (which will remain nameless – no doubt they have better lawyers than I). We were told to meet with the Police and Fire Service at an RVP (meeting point). It turns out that some animal liberation types have taken offence to this company (rumour being they are supplying concrete to a new animal testing laboratory) and have sent some deactivated incendiary devices to various branches in order to scare them. Today, in three of the offices across London, some ‘suspicious packages’ had turned up and we were being sent to cover the defusing of one of these devices. Two ambulances, one Duty Officer, three fire engines and countless police were there, standing around the now evacuated offices.
Our Duty Officer started allocating ‘Major Incident’ roles to everyone. I don’t think he was best pleased when I asked him why, when major incidents are designed to deal with multiple casualties, we needed to play that game when the only person in any danger in the now deserted office was the bomb disposal officer.
He sent me to arrange the parking of the emergency vehicles. We were soon stood down, however, when it was discovered that the ‘device’ was actually a packet of envelopes.
The next call was to two brothers who had fought over possession of a bong, with one brother trying to sell it to a third brother. Both we and the police were sent; when we got there both brothers had calmed down and there were no serious injuries. One policeman was confused about what a bong was used for, until I explained that it was ‘drug paraphernalia’. One of the brothers told the policeman that he was selling it because he didn’t use it – he much preferred smoking his cannabis in a spliff.
Luckily for him the policeman ignored this massive blunder (and me collapsing in tears of laughter at this idiot essentially confessing his drug habits).
Our next interesting job was to a man in Docklands who had a head injury caused by trying to avoid an attacking seagull. It turns out that there is a seagull living there who likes to dive-bomb people passing by. This man had ducked the avian attack, then tripped and fell flat on his face, knocking himself out. He had only minor facial injuries, but the loss of consciousness will mean a short stay in hospital being watched. My old crewmate suggested that he sell his story to the newspapers.
The rest of our jobs were rather boring after this early excitement.
One of the things that will constantly amaze me is that some people will drop dead at the drop of a hat (so to speak), while others will survive injuries that would kill us mere mortals.
Today was a case in point: we got called to a 39-year-old female who’d been hit on the head by a brick that had fallen seven floors. We turned up at the location fully expecting to see someone with less of their brains inside their head than would be considered healthy. Instead, the woman was sitting in a chair (having had a C-spine collar applied) with her head supported by a BASICS doctor (a doctor who volunteers to respond to calls in the community).
This woman, who should have been dead, had a 1-inch cut on the top of her head.
… And that was it.
The brick had hit her on the head, then had hit the floor with such force that it had shattered. Yet, here she was with no injury other than complaining of the cut being painful. There was no loss of consciousness, but we treated her as if she had a neck injury, purely because of the ‘mechanism of injury’. It’s been a while since I’ve had to do a ‘standing take-down’ (where you get a standing patient onto a spinal board by placing it against their back and laying it flat with them on it) but it all went smoothly, the doctor travelled with us and was a pleasure to work with.
Although she was 39 the woman actually looked like she was in her early twenties – perhaps she has some witchy super powers? Either way she was discharged later in the day.
She was exceptionally lucky – if you can call getting beaned by a brick ‘lucky’.
I discovered yet another reason to avoid alcohol, namely that it can mask the symptoms of otherwise obvious illnesses and injuries.
We got called to a 60-year-old man who had fallen in the street: as it was 2 a.m. we could guess that alcohol was involved. When we arrived on scene the patient was standing against a wall very much the worse for drink. Admitting he was an alcoholic he told us that he had tripped over and now his right leg hurt. While he was standing there I gave him a quick examination, he had no bony tenderness and was able to bear his weight on his leg. He could feel his toes wriggling in his shoe and there was no obvious deformity to the leg. We helped him walk the few steps to the ambulance, but he was unable to manage the stairs at the back of the ambulance so we put him in our carry-chair and lifted him into the ambulance. Further examination showed little else of note; his pulse was a tad on the high side but otherwise his blood pressure and other observations were well within normal limits.
We transported him to hospital, where the nurse gave him a quick examination, essentially repeating the examination I’d given him in the field, and she sent him out to the waiting room.
When we returned to the hospital a little later we were told that he had a fractured neck of femur – essentially he’d broken his hip.
He was so drunk that he felt little pain, and for various reasons none of the normal signs of a broken hip were present. Luckily, I’d documented that I’d examined for the possibility of this type of fracture and found negative signs all the way along, so should he complain (which I doubt he would do) both I and the admitting nurse would be covered.
So … don’t drink, or you may find yourself walking around on a broken leg.
Now I’m off to sleep. Two very long night shifts and I’m ready to collapse.
It’s one of the main differences between A&E nursing and ambulance work – in an A&E department you have good lights, can undress the patient and can put them on an examination table. In ambulance work you can find yourself down dark, unlit streets, in the rain and with the patient lodged under a car. I did feel a little bad about this patient, mind you …
Have you noticed how much I talk about being tired or needing sleep? The benefits of shift work …
First off, I’m bloody knackered, frazzled, chin-strapped, and generally tired. If I ramble just poke me in the ribs with a stick.
Today was both bloody awful and rather good fun, which despite sounding like the ramblings of a madman is a perfectly sane way to describe today, although I’ll be glad for it to be over.
The day started badly: I woke 3 minutes before my alarm was due to go off so I turned it off and woke for the second time 10 minutes before my shift was about to begin. I didn’t get much sleep last night so I suspect my body overruled my brain to give me an extra 50 minutes of sleep.
Luckily, when I wake up with an adrenaline jolt like that I can get washed, dressed and speed through the streets of Newham like an Olympic sprinter on methamphetamine.
Turning up at the station I found out that my regular crewmate was ill, and instead a ‘Team Leader’ was being sent to work with me. Team Leaders are on the lowest rung of management: they are the people who are supposed to keep the troops in trim, and so spend considerable time moaning about the speed at which we get to jobs, and the poor quality of our paperwork. I’m of the belief that if management don’t know about me, I can’t get in any trouble, so working with a new Team Leader was something I was less than happy with.
