The Complete Blood, Sweat and Tea

I had barely gotten to say hello to ‘Team Leader’ than we got our first call of the day, a ‘Suspended’ (cardiac arrest) a couple of miles from station. Manoeuvring a big yellow taxi through rush-hour traffic is no fun at the best of times, but as I was driving I gave it my best shot – we got to the scene shortly after our First Responder who was already bagging and giving CPR to an obese woman in her eighties. As we were in one of the new yellow ambulances I lowered the tail lift, got the trolley out and nearly ruptured myself lifting the patient onto the trolley bed. Rolling her out to the street, we got her on the tail lift and raising it, rolled her into the back of the ambulance. All that was left was for me to raise the tail lift the rest of the way and rush to hospital.

You may notice that I spent some time discussing the tail lift; this is because as I went to lift it, the hydraulics failed and it was stuck, sticking 7 feet out from the rear of the ambulance at a height of about 4 feet from the floor.

I gave it a kick, a shake and then resigned myself to manually lifting the bloody thing up, all while the crying relatives were watching me pumping the manual handle like an idiot. Finally, it was raised to the closed position, so I made my way rapidly to hospital while ‘Team Leader’ and ‘First Responder’ worked on the patient in the back. I’ll not mention the road closure that forced me to make a painfully wide detour, but otherwise we reached the hospital with some speed where the woman was, unsurprisingly, declared deceased.

After a quick tidy-up of the back of the ambulance (which after a cardiac arrest always looks like a bomb site) we got a job to an ‘unwell child’. The 15-month-old child was indeed unwell, although not life-threateningly so. The assessment was made harder by the mother having very poor English and the child having ‘Development Delay’, which encompasses a multitude of syndromes and genetic/biological causes.

The next job was a transfer from the local maternity department to a maternity department in another county. This is a hospital that I had no idea how to get to (the details of why there was a need for transport are too boring to go into; also, I think I might say something about the mother I’d regret in the morning). I set our travel computer to give me directions to the hospital and we set off. The journey was supposed to be 9.8 miles, but after following the computer’s directions to the letter we had travelled 37 miles along rather crowded motorways.

We had taken 30 minutes longer than we had planned. It’s the last time I trust that bloody machine. ‘Team Leader’ was not happy about the computer but we laughed it off.

The next job was a simple maternity which we drove into the London Hospital. This was fine until I managed to drive into another ambulance when trying to leave the hospital. No damage to my ambulance, and minor damage to the other, but as my first accident in over 18 months, it was obvious that it would happen when ‘Team Leader’ was sitting next to me …

Returning to fill in the accident paperwork, Control asked us to attend to another call – this time it was an obese unconscious 70-year-old female. She was extremely heavy and, because of her ‘floppiness’, was a complete dead weight. Once more I nearly killed myself lifting her. All her body functions and observations were normal so it was a complete mystery why she was unconscious, although I could confirm that she had been incontinent of urine …

… after I put my arm in it.

All these problems throughout the day meant that we worked harder than we needed to – and yet, throughout the day we had a great time as we laughed and joked between patients and vowed never to work together again. I said that I’d take sick leave, saying I was ‘stressed’ and ‘Team Leader’ said she would make sure I got sent to the other side of London before she worked with me again.

And so, at the end of the shift we parted, laughing at the thought that it was possible we could be repeating the experience tomorrow.

I’m looking forward to that possibility.

‘Team Leader’ is still on our complex and is still a good laugh. Thankfully, I haven’t had to work with her again.

Broken Ambulances

One of the main problems with the LAS at the moment is the lack of vehicles. In the past this has come to mean that there are not enough staff to man the vehicles that we have, or fill the rota to maintain safe cover over our area. Lately, however, we haven’t had the vehicles physically present. At the moment, I am typing this from work and looking out the window at the fitters whose job it is to maintain the fleet in our area of London. There are 13 ambulances waiting to be fixed. There are 3 crews sitting on station unable to take any calls because their vehicles have broken down.

Someone has just visited us in the staff car (a nice little Corsa) and, on attempting to leave, its clutch has broken.

Today I took an ambulance from West Ham over to Poplar to replace a vehicle whose steering had broken. Two management brought over a spare vehicle from Newham for me to work on – a vehicle that had just had a broken rear suspension fixed.

Let me tell you, riding on an ambulance with no suspension is an ‘interesting’ experience – you get thrown around and the cupboards fly open spraying bandages and other, less soft, equipment around the cabin.

This ‘fixed’ ambulance lasted three jobs before the suspension died again and I was bouncing around the cabin. It also stalled if you closed the choke.

So now I’m sitting on station twiddling my thumbs, unable to continue my daily grind of saving lives picking up drunks.

The fleet is just falling to bits, the new Mercedes have faults developing around the 5 000 miles mark and the tail lifts are extremely temperamental (like my experience yesterday – they fail at the worst possible moment). The LAS needs a cash injection so that it can have a fleet of basic, but reliable ambulances, fully equipped and fully manned.

Things haven’t changed much since I wrote this, although with a few extra vehicles the turnaround for crews without a vehicle is a bit better.

An Apology to A&E Departments

I would suggest that a lot of the people who read this are doctors and nurses of one persuasion or another. I also guess that many of these readers have some experience of A&E departments.

So, as an EMT I wish to apologise.

I’m sorry that throughout the shift I will continue to bring fresh meat to the grinder, that is, I will be forced to transport patients from ‘outside’ into your department, where they will need to be looked after and assessed by your own good selves.

I’m sorry that I have to sometimes bring their relatives who will harass you about waiting times, the pain their relative is in and about why you are drinking that cup of coffee while their dearly beloved is ‘at death’s door’. I’m also sorry that sometimes I couldn’t bring the only relative who can translate the patient’s moaning and groaning into English, thus making assessment a thousand times easier.

I’m sorry for the dross that I bring to you: the cut fingers, the bellyaches and the spotty backs. I’m sorry that the primary health-care workers (the GPs) are often so useless as to be a liability. I’m sorry that you have to cope with the fallout that occurs because there are so few good GPs and you have to become the first point of call for coughs, colds and diarrhoea

I’m sorry that the schools don’t teach basic health and first aid to their students, preferring to waste time on the history of glaciers or the solving of quadratic equations. This means that the population wouldn’t know the difference between a minor cut and an arterial spurt if it jumped up and hit them over the head with a hammer, neither do they know which of these two injuries warrants a trip to the local Emergency Department.

I’m sorry that our communities where our Elders teach our Youngsters and the Youngsters listen no longer exist, resulting an influx of first-time mothers who think that when a baby vomits it is a precursor of death.

I’m sorry that the protocols and guidelines that we adhere to don’t allow us to leave patients at home. In England at least, we have to transport to hospital. The government thinks that we cannot tell the difference between serious cases and the aforementioned cut finger.

I’m sorry that the police cannot look after drunks on a Friday night; they worry that they will choke to death in the cells, and so we get called. We have nowhere else to take them to but your department. Sorry.

I’m sorry that I bring in those serious cases 5 minutes before your shift finishes. If it’s any consolation it’s probably 5 minutes to the end of our shift that people decide to have their heart attacks, their amputations and their dissecting aortic aneurysms. Like you, this means we get off late as well.

I’m sorry, but it’s not my fault.

I wrote this in part because we do sometimes get dirty looks from A&E staff as we drag in the umpteenth drunkard of the shift. It’s not my fault that the government made 999 so easy to dial.

Knee Trouble

Gillick competency is the ability of youngsters under the age of 16 to give informed consent for medical treatment. Essentially, we have to assess whether a child is competent enough to make decisions about their own body. This is, as you might guess, an ethical minefield.

Back to work with the rather enjoyable 18:00–01:00 shift, where you tend to get lots of drunks, and very few serious cases that require me to do some actual work.

However, you do occasionally come across a job that is tricky, not because I worry about the patient’s illness, but instead for reasons that to the non-ambulance person are hard to understand.

Our first job of the day was one of those very jobs. The call we were given was 13-year-old female with a dislocated knee. Nice and easy I hear you say, but lots of minor problems can build up to make a job less than ideal.

We arrived on scene and found a patient who had a rather obvious dislocated knee – just imagine your kneecap shifted 2 inches to the left, so much so that it casts a shadow on the rest of your leg. Simple enough to deal with: if you are feeling brave you can slide it back into place yourself, or go the more recommended route which is to take the patient into hospital and let the doctors fiddle with it.

Then the problems started piling up. To start with there were no adults present, just another (unrelated) teenager; neither the patient nor this other teenager were what you would exactly call brain surgeons. We are not supposed to deal with children without an adult present, but what else can you do in those circumstances? The father had been called, but he was travelling from another hospital where he had been undergoing outpatient treatment. So we had to decide whether it was ‘safe’ for us to take the patient to hospital – we use ‘Gillick competency’, but it’s always a bit of a gamble on our part.

The patient had fallen from her bunkbed so her friends (who had run off) had lifted her back onto the top bunk. She was screaming in pain (which is fair enough I suppose), and wouldn’t let us near her. This little problem was solved by giving her a lot of Entonox (known to some people as ‘laughing gas’). After enough of this stuff she started laughing and we essentially ‘grabbed’ her off the bed.

Then she refused to sit in the carry-chair, but because we were upstairs she needed to go in it. After a lot of persuasion, and a lot of her screaming very close to our ears, we managed to get her to sit down; this had the rather excellent side-effect of popping the kneecap back in place.

This would normally mean that the amount of pain goes down by a lot, but this girl had a touch of ‘hospital phobia’ so she continued screaming. While screaming she was also arguing with the teenager who was with her, telling him that he needed to come to hospital with her but he was refusing because ‘How am I gonna get back home?’ I must admit I really wanted to tell him to walk it, because the hospital was only about 1 000 yards away. Despite her pleading with him, he wasn’t for budging. He set his Burberry baseball cap square on his head and refused. I don’t think she is going to be too happy at him next time she sees him.

Once that argument had run its course (and my crewmate and I managed to stop laughing), we had to get the patient downstairs – this was made more difficult by a sideboard that was in the upper hallway by the stairs. To counter this problem, we had to lift her completely over the banister. Luckily she was a lightweight, and my crewmate and I are – cough – both strapping, good-looking men.

We saw her later in hospital, having a plaster cast put on her leg, so that the kneecap wouldn’t slip out of place. She was much happier and surrounded by her parents. She even managed to give us a smile, which, in the end, made the job worthwhile.

So, this is what we occasionally have to deal with, not so much the life-threatening stuff, but more the silly little things that can make an ‘easy’ job much trickier.

Drunk and Disorderly

We got called to a pub (which is always promising), to a 24-year-old female who was having ‘difficulty breathing’. When we turned up at the pub, we were met by a man who, after letting us know he was a ‘first aider’, told us that she was fitting and that she had stopped breathing, but that mouth to mouth resuscitation had ‘brought her back’.

Entering the pub we found the woman thrashing around on the floor. She wasn’t having a fit, it was more like a temper tantrum. Throwing himself on top of her was her husband, who was reluctant to let us approach her. People in the pub told us that they had both been drinking heavily.

We near enough had to force the man off of his wife just so we could examine her properly, and it soon became apparent that she was just very, very drunk. Out of the corner of my eye I saw sudden movement and ducked quickly as the husband threw his wife’s shoe at a man standing behind me. We decided that loading her onto the ambulance would be the best thing to do. The husband demanded to be let in, but we told him that we needed room to properly examine his wife. He banged on our windows twice, but then left, apparently running up the road – possibly as a result of him throwing a pint glass at another of the pub’s customers. (This was very unwise of him, because half of Newham police force were 200 yards up the road dealing with an armed incident.)

By this time a second crew had turned up, as someone had called 999 and told our Control that the woman had stopped breathing. We stood them down, although, on reflection, they could have been of help keeping the woman on the trolley because she was still throwing herself around, refusing to lie still, and generally making life difficult. We managed to get a blood sugar, pulse and blood pressure (all of which were normal) but she refused to stay on the trolley and wouldn’t sit on a chair – so we let her lie on the floor.

At times like these, I think I’d give my eye-teeth to be able to put people like her in a 4-point restraint, but it’s something we are not allowed do.

Later, while I was driving to hospital, she made an attempt to leap out the back of the ambulance, and it was only the rugby skills of my crewmate that prevented her escaping under the wheels of a following car. The rugby tackle was all the more impressive given that my crewmate is 5-foot-nothing tall.

We finally managed to get the patient to hospital, where she threw her vomit bowl (with vomit) over the floor and tried to hit a nurse. Luckily I was standing behind her and grabbed her before she could damage any of the staff, or even a patient.

To cut a long story short, the nurses let her phone her sister to come and pick her up, and then kicked her out the department.

Two things about this job that bring a smile to my face: (1) one of her shoes is still lying in the gutter, where we picked her up from, and (2) her husband got out of prison today and, given his attitude and behaviour, he’ll soon be back inside.

So, it’s not just weekend nights we get the violent drunks, it’s every damn night …

We are not taught how to restrain patients who might be violent but sometimes it is essential – for example, in the event of someone having a serious head injury and becoming violent. So, we have to make it up as we go along and hope that it turns out alright.

Favourite Job

The other night I had my favourite type of job, the type of job that meant I wasn’t upset to be late leaving work.

People who are diabetic sometimes have very low blood sugar; this makes them confused, agitated and sleepy, and this can lead to unconsciousness and even death. Their blood sugar can become low for any number of reasons. Most often they have done more exercise than normal and not eaten enough to raise their blood sugar.

The treatment for this condition is to either give them sugar or an injection that ‘frees up’ some sugar that is stored in their liver.

Our patient last night normally controls her diabetes very well; so much so that her family had never seen her with a dangerously low blood sugar (the medical term for this is hypoglycaemia). They called us because she was acting confused and was unable to speak properly or stand upright. We arrived, and found out she was a diabetic; checking her blood sugar we got a reading of 1.6 mmols (the normal range for a diabetic is around 4.5–12.0 mmols) – this is very low and explained why she was losing consciousness.

The family were understandably upset, as they had never seen this before. They saw her slipping into a coma in front of our eyes, so we explained what was going on as I prepared the injection that would raise her blood sugar. I gave the injection (this injection is called glucagon) and waited for it to take effect, all the time reassuring the relatives.

Within 10 minutes she was up and talking, we then gave her some sugar jelly which raises the blood sugar some more. Soon she had made a full recovery, with her blood sugar reading 5.6 mmols. We gave her some carbohydrates (for ‘slow-burn’ energy) and left her in the care of her exceptionally happy family.

The reason why this is such an enjoyable type of job is that we are actually saving a life (for a change) with the treatment that we can give, and that the recovery is normally rapid, and always impressive. From unconsciousness to 100% fitness in the space of about 15 minutes really impresses onlookers … and it does our ego good to be praised every so often.

Notting Hill – Stabby, Stabby

Yesterday was the last day of the Notting Hill Carnival. The police are calling this year’s carnival a success, with little reported crime, but I would tend to disagree: it’s just that the crimes all happened to people as they travelled home.

Our second call of the night started worryingly when Control told us that a male had been stabbed in Stratford shopping centre, and that he could still hear shouting in the background of the call. The stab vest went on and we made our way down there, meeting up with a lot of police officers trying to control a rather large crowd of post-carnival spectators.

We found a 15-year-old male lying on the floor, with a policeman holding some paper tissues over an upper abdominal stab wound. There was no external bleeding, and the patient was alert, calm and talking. He also had a small wound to his right leg, which again was not bleeding significantly. I ran through a primary survey (a very quick examination of the patient to rule out anything that is going to kill him in the next 5 minutes) and then concentrated on making sure his chest and lungs were not damaged. On clearing them I turned my concentration to the belly wound.

We don’t like stab wounds: they can do a lot of damage leaving only a tiny entry wound. One stab wound can easily kill you, whether it is in the leg, the arm, the chest or the belly. After my examination I decided that, although he needed exploratory surgery, he wasn’t critically ill. There was a bit of ‘something’ poking out of the wound, I had no idea what it was (I initially thought it was part of the policeman’s dressing) so I soaked one of our dressings in saline and applied it to the wound. We then got a phone call from what I took to be the HEMS road team (a doctor and paramedic) letting us know that they would be on scene in 12 minutes and that the patient should go to the Royal London Hospital. The problem with this is that the Royal London is some way further away than Newham, and that I knew that if the HEMS crew got on scene they would want to ‘stay and play’ securing IV (intravenous) lines, considering intubation and running a full examination on the roadside. In my opinion, having assessed the patient, his best option would be to go immediately to the nearest hospital and let the surgeons there deal with him.

So, we loaded the patient onto the ambulance and made a run to Newham hospital which took us less than 5 minutes.

The result of which was the patient got to theatre, was ‘packed’ as he had a lacerated liver and gall bladder and is now in ITU for recovery.

I wonder if the HEMS crew will moan. I suspect they won’t because around the corner was another young lad who had been stabbed in what later turned out to be a connected series of battles between two schools. The HEMS crew played around on scene with that patient before taking him to the Royal London Hospital (who really love their trauma jobs). There were then reports throughout the night of other crews picking up more teenagers injured during the fight. The patients were spread fairly evenly between the two hospitals, so no one department became overloaded.

A couple of things struck me as amusing, the first was that when we were about to leave for hospital the patient’s girlfriend and cousin were fighting amongst themselves over who loved him more and should go to hospital with him. The patient’s brother was also there and was fighting with police to get to the patient. He then vanished, and my prior experience would suggest that he was planning revenge and a counterattack.

While going to hospital, the patient’s girlfriend was talking about the other lad who had been stabbed (apparently his name is ‘Biggy G’) and how it seemed that the fight had been planned at the carnival.

As always when I got to the hospital it seemed that the doctors weren’t interested in my handover … on which I will post/moan more later.

As we were going to hospital another crew, this time in North London, were putting in a priority call to their local hospital. They had two young men (aged 19 and 20) who had been stabbed, luckily in a non-serious manner.