More Blood, More Sweat and Another Cup of Tea

The thing about wearing a uniform—it really changes your behaviour.

I’m guessing that a lot of you are aware of the Milgram experiment, where members of the public more willingly follow instructions if the giver is wearing a uniform or other symbol of authority. (Go to the internet for a more complete explanation. If you’ve never heard of this experiment, it and the Stanford prison experiment make scary reading.)

So when I am wearing my uniform I am more confident and can order people around. The police, firefighters and members of the public tend to do what I tell them if there is someone sick around. Obviously I only use these powers for the force of good, but without my uniform I am a much shyer person.

I noticed this when I went to a recent gathering of internet people. When I arrived I knew one person there, and once I’d stopped talking to her I became an instant wallflower.

But there is a flip side to wearing an ambulance uniform, you also become more passive.

Out of uniform, if I was in the street and some drunk tried to hit me—I’d punch them on the nose. If I was verbally abused—I’d soon be in their face shouting and ranting along with the best of them.

Yes, I know three paragraphs before I said I was a wallflower, but this is in a social situation. When my temper is roused it is a terrible thing to behold.

But in uniform I’ll gently restrain the drunk trying to hit me and I’ll ignore any verbal abuse that is thrown at me. Unfortunately the anger that I feel is then turned inward, which I am guessing is not a healthy thing to do.

I wonder if it is the uniform, or the risk of having a complaint put in about me, that turns me into such a wimp. It might just be that I spend so much time trying to keep patients calm, that I’m feeling very mellow when people abuse me.

Abuse Your Ambulance Crew

I was racially abused on Friday night, and it meant I spent the rest of my shift gritting my teeth and wanting to punch someone.

We were sent to a ‘standard’ abdominal pain with vomiting. The patient, a black woman, had vomited ten times that day and had lower abdominal pain. As always I treated the patient with respect and compassion (as that is my ‘default setting’). All her observations were within the normal limits. Talking to the patient was a bit tricky as she insisted on having me ask every question at least twice before answering.

So we took her to hospital, where I handed over the patient to the triage nurse. She was happy to have another nurse perform a further assessment (for example, an analysis of the patient’s urine). Unfortunately the place for this assessment was physically full, so we were asked to take the patient into the waiting room until some space could be made. My crewmate did this, while I booked the patient in with the reception staff.

My crewmate told me that when the patient saw she was going to be put in the waiting room, she let out a loud ‘Tut!’

My crewmate then joined me in the reception area which overlooks the waiting room.

The patient then threw herself on the floor and pretended to be unconscious (trust me, when you’ve seen people really pass out in a chair, you can tell when they are faking it).

The waiting room erupted with two people jumping to her aid. The security guards went to get a nurse. Then a lot of the people in the room started shouting at us to come and help. Never mind the half-inch-thick glass between us and them.

We told them that a nurse was on the way.

‘Look at her! Look what’s happened to her!’ shouted one man.

‘Yes mate,’ replied my colleague, ‘there’s nothing wrong with her—all she’s trying to do is get seen before you.’

The patient was loaded onto a trolley and taken into the main area of the A&E.

The crowd in the waiting room then started moaning at us.

Then both my crewmate and I heard the comment that would have us angry for the rest of the shift.

‘You wouldn’t treat her like that if she were white.’

My crewmate stormed out of the department—he was, quite rightly, fuming.

All I could do was laugh loudly at the black teenager who had said this. ‘Well, if you are that stupid, you’ve just opted out of talking to me,’ I said to her.

I left the hospital.

Here is the thing that made my crewmate and me so angry. We like our job—we both like helping people and we’ll help anyone, we don’t care what colour their skin is, which religion they believe in, or if they can speak English or not. I don’t even care if they are an illegal immigrant. We sure as hell don’t do this work for the pay. My crewmate is a trained plumber so he could be earning much more money installing radiators.

We don’t need to work in this area—I could put in for a transfer to a more ‘white’ area tomorrow. But I enjoy working in east London—it’s a challenge—and I enjoy working with all the different cultures that make up our ‘demographic’. For me, a predominantly white area would be incredibly boring.

But that comment: ‘You wouldn’t treat her like that if she were white.’ It made me despair as to how we are seen by the non-white population. Are we all seen as being racist? Does the assumption that I would treat a patient better if they were white sit in the minds of the people I treat? Is this why I get so few thank yous? When I walk into a household, do the people there think ‘I won’t get good treatment from these two, they are both white’?

I wish I’d gone around to the person who had made the comment and challenged her. I wish I’d gone into the waiting room and explained exactly what had happened. But as I’ve mentioned earlier, the uniform that I wear makes me more passive than I would normally be. So I turned the other cheek and walked away.

I’m still fuming.

Slow Suicide

Imagine that you are 23 years old.

You are also a ‘brittle’ asthmatic. This means that you can have asthma attacks that can rapidly progress to life-threatening status. You have been intubated in ITU a couple of times—this is a last ditch treatment to keep you alive.

So why, whenever you get taken to hospital, would you treat your disease as a mere annoyance?

Also, why would you smoke 20-40 cigarettes a day, knowing that it will make your asthma worse?

And why would you self-discharge yourself from the resuscitation room against medical advice only to require a blue light return straight back to the resuscitation room?

It’s just a form of slow suicide.

I Wouldn’t Trust Them with My Dog

I have another example of why I don’t think that the free-market system is particularly good for the health service, or at least not good for the patients who use it.

I was working in another area a little while ago, and while there got sent to a private nursing home. The patient was given to us as ‘80-year-old female with difficulty in breathing’. We arrived and saw what looked to be two nurses having an animated discussion in the main foyer.

Grabbing our equipment we followed one of the nurses into the depths of the home, and were shown to the patient’s room.

The patient was very much dead.

Also in the room were four nurses. They were standing around and they weren’t doing CPR, they weren’t breathing for the patient. They looked at me for guidance.

I immediately switched into commanding mode. ‘Why isn’t anyone doing CPR?’ I asked.

‘We were,’ one of the nurses replied, ‘but I saw you coming in the mirror and stopped.’

The mirror was positioned so that if she had been doing CPR, she would have had to have eyes in the back of her head to see me coming.

When someone isn’t breathing you have to breathe for them—this is the ‘ambu-bag’ that TV doctors put over someone’s face and operate by squeezing it. It forces oxygen into your lungs. Unfortunately the patient had a normal oxygen mask on her, which would just bathe her face with oxygen, but it wouldn’t get it into the lungs where it needed to be.

The patient was also lying on an air mattress, which would have meant that any CPR which may have been done would have been ineffectual because you need the patient on something hard so you have something to push against.

I felt the jaw of the patient—rigor mortis had already set in, so there was no point in attempting to continue any resuscitation attempt.

Someone had tried to take the patient’s blood pressure, as there was still a BP cuff around her arm.

As is usual in these cases where we know or suspect that care has been—shall we say—lacking, we offer the services of the London Ambulance Service (LAS) to teach the nursing staff more effective resuscitation skills. However, they should have these skills anyway as qualified nurses. Talking to one of the people who teaches these courses, it seems that many of these nurses have forgotten how to do this. It’s free to them although I don’t think we get any extra money from the government to run it.

The nurse in charge, who was busy photocopying in the office while all this was happening, refused.

So, in a world of competition between privately owned care homes, it would seem that the care has not improved. Instead you get poorly skilled nurses, managed by staff who don’t want them to improve. This despite a number of suppliers who are all in competition with each other—it’s a lucrative market providing elderly care.

Laughing Policeman

You’ve got to laugh when an ‘old salt’ police sergeant tells you that he’d like to meet the person who assaulted my patient…

…And shake their hand…

…And you agree with him even though you’ve only known the patient for 20 seconds.

Structural Collapse

The radio sparked into life, ‘General Broadcast, General Broadcast—are there any crews able to deal with a ceiling collapsed on a mother and her two-year-old child?’

We were just finishing up the paperwork on our previous job so we asked for it to be sent down to us. I was driving and we were soon at the house. From the outside everything looked normal.

However, inside the house it was pure chaos.

There were seven children running around the house, all of them under the age of twelve. A single mother was clutching her two-year-old to her chest. At first glance they looked unharmed. The mother seemed more frightened and angry than injured.

We soon got the full story: the mother and her child were having a nap in the bedroom when the ceiling had fallen on them. We entered the bedroom expecting a few scraps of plaster. Instead we were met with the sight of one-and-a-half-foot plaster and lath ceiling, a huge chunk of which had fallen six foot onto the bed.

The hole in the ceiling was about five feet in diameter; there was a lot of heavy debris spread across the bed and floor.

Rather understandably the woman was a bit upset—the individual pieces of plaster that had dropped on her were about the size of my hand and were over an inch thick. I couldn’t estimate the total weight of the plaster, but each lump was very heavy.

It was about now that the headache I’d thought I’d got rid of earlier in the evening started to return.

As a single parent who had just moved into the area she had no other relatives to help look after the children so she was refusing to go to hospital. My crewmate took her and the toddler into the ambulance so that he could examine her more fully. If he found nothing too serious then we could leave her at home to look after her children.

So off they went to the ambulance.

Which left me looking after six anklebiters.

I don’t like children.

While he was in the ambulance my crewmate phoned the patient’s GP and arranged for them to come and visit the patient. He then arranged for the police to turn up and give the patient some legal advice. Rather obviously the patient was a trifle annoyed at the landlord who had assured her that the house was fit to be lived in.

Meanwhile I was doing my best to entertain the children. My best wasn’t enough.

I was relieved when the children’s older brother arrived with some takeaway chicken meals. Yes—there were now eight children in the house of this 36-year-old woman. This older brother was more like a father to the others and he soon had these apparently feral children under control.

Luckily for the woman and her child our initial guess was correct—neither she nor her child was seriously injured.

My crewmate and I escaped from the scene as soon as the police arrived.

Shorn

An ideal invention for the blogger in your family would be a pair of video-recording glasses—wear them all day, and should something interesting happen the wearer presses a button to save the last 30 seconds of video to a small storage device.

If that were possible I’d now be showing you a video of a lovely young man.

I was driving along on blue lights and sirens (to an ‘intoxicated—feeling unwell’) just heading past the Underground station when from the pavement I could hear someone shouting: ‘Wanker…Wanker…Wanker.’ He was also making the traditional hand gestures.

A quick look at him led me to believe that he was either homeless or an alcoholic, or both. I could see that he had no front teeth and he only looked around 30 years old.

I slowed the ambulance so that my crewmate and I could laugh loudly in his general direction.

He turned his back on us.

He bent over.

He pulled his trousers down.

Suddenly we were confronted with a skinny white arse, and dangling between his legs were equally white and skinny testicles.

They looked shaved.

Just then a police car came over the hill.

I wound down my window and spoke to the police driver, ‘See that fellow with no teeth? He just exposed himself to me.’

‘The one calling you a wanker?’ asked the policeman.

‘That’s the one…Have fun!’

We continued on the way to the call as best we could between tears of laughter.

It’s strange the things that make your day.

12th November 2046

The young man breathed a sigh of relief as he finally sighted his quarry of the past four days. The old man was sitting on the park bench enjoying the sun and feeding the ducks.

‘Hello fella,’ the young man said as he sat down on the bench. ‘You said that you’d be able to tell me about the old days? About 2006? About the blankets?’

The old man tore off another piece of bread and threw it in the pond and watched a small crowd of ducks hungrily fight over it. ‘Sure, if you want to hear about that sort of stuff.’

The young man started a mini-recorder and placed it on the bench between them while the old man continued to talk.

‘It was back in o-six, about the middle of February, and if you believe the reports it was the first winter of the “big freeze”. I remember the years that followed, OAPs dropping dead in the road, cats frozen stiff in the streets…Happy days.’

Before continuing the old man took a swig from a bottle of something, probably illegal, which he’d concealed in a brown paper bag.

‘As you know I was working in London for the ambulance service, it was a pretty good job, but back then the health service was run and funded by the government. So a lot of things went wrong.’

The young man interrupted, ‘That was when Blair the Deceiver was in power? Just before the Party started to dissolve parliament?’

The old man looked sullen. ‘That’s right, bad days, very bad days.’

Sensing that the old man was about to enter a fit of depression, the young man decided to prompt him, ‘But about the blankets…?’

‘Yes,’ replied the old man, eyes suddenly snapping into focus, ‘we used to say back then that the only equipment we really needed was a chair and a blanket, but on that day there were no blankets to be found. We searched the stores, we even tried ransacking disused ambulances in case they had some—but there were none to be found.’

‘What did you do?’ asked the young man.

‘Well, we got onto our Control—they tried to contact someone in management, but no one seemed to be around. So Control spoke to their overseers—the people who had the job to look after these emergencies. They were no help.’

‘Was the management ever any good?’ the young man asked.

The old man was quiet for a moment before continuing, ‘In this case it turned out that there were no blankets at our central stores. Normally the blankets would be stored there before being delivered to individual stations by a tender driver. But the warehouse that washed and packed the blankets hadn’t delivered any to the stores.’

‘With no blankets, how could you help patients?’

‘Well, after talking with Control they suggested that we “liberate” some blankets from the hospitals in the area—so some of us went on stealth missions. We’d take in a drunk and while the nurses’ backs were turned your crewmate would sneak out with an armful of blankets.’

The old man threw another chunk of bread to the anxiously waiting ducks. ‘We didn’t call it stealing. Besides, the hospitals had more than enough.

‘Of course,’ the old man continued, ‘back then we’d share a blanket among a couple of patients—there wasn’t enough for one blanket each. This was before the H5N1-MRSA cross-breed became epidemic. You’d never get away with it these days. But back then if there wasn’t filth on the blanket, you would use it again. We had to or there would have been blanket shortages every day of the year.

‘In this case the shortage lasted for a couple of days. It turned out that nearly everyone in the blanket warehouse had applied for annual leave at once, so there was hardly any staff working. In those days you had to use up most of your annual leave before April. That year they prevented the ambulances from collapsing by letting us carry over more leave to the next financial year than normal, but they forgot about some of the support workers.

‘We were lucky that year…we didn’t know it was about to get worse—’

The youngster clicked off his recorder before the old man could continue. ‘Yes, but we all know what happened in twenty-o-nine. I’m just researching the precursors to the health collapse and I was thinking that this might be of some use.’

‘Well, I hope I was of some help,’ the old man said standing up from the bench with a groan. ‘I’m off to stretch these worn bones. If I can be of any more help, just let me know.’

‘Will do Mr Reynolds,’ said the young man, ‘will do.’

Yes, we did have a shortage absence of blankets a couple of days ago. So far there is no official reason, but the tender driver told me the theory that I used in this story. It’s also true that we have to reuse blankets for different patients. There was a manager around, but he was in a meeting. I don’t know what the ‘overseers’ suggested.

There is no H5N1-MRSA cross-breed. I’m keeping my fingers crossed that I’m still alive in 2046.

Yes, I wrote this because I have too much time on my hands.

Sorry.

On the Power of Blankets

I have mentioned that the blanket is one of the more important and versatile bits of kit that the modern ambulance can have. In the good old days of horse-drawn ambulances the proto-EMT would refer to his equipment as ‘one and one’, meaning one carry chair and one blanket.

Even today, with our increasingly technologically based healthcare system, the humble blanket has a multitude of uses. For those of a ‘hitchhiker’ mindset think of a blanket as a towel writ large.

Primarily it is used to stop little old ladies (LOLs) from getting cold when you drag them out of their nice warm house into the often freezing conditions of the ambulance.

Said little old ladies don’t like being wheeled around in our carry chair—it has no handrests and feels very unsafe. LOLs will often try to grab out at things to steady themselves—this is dangerous, especially if we are carrying them down stairs. So we wrap the patient in a blanket, and make sure that their hands are gently restrained.

You can use the blanket as a sliding/carry sheet when transferring a patient from a bed to a stretcher, or from the ambulance stretcher to the hospital trolley. The ambulance blanket is thick and strong with a close weave. While I wouldn’t like to try using it to lift someone off the floor, I would imagine that it is strong enough to do so.

When in the ambulance we can use the blanket to protect modesty. Some of the things we do to people require them to bare their chest, for females this can be troubling. We can use the blanket to cover the patient as much as possible.

If the patient has been incontinent while wrapped in the blanket, we can ‘gift’ the blanket to the hospital—it’s what nurses are for (and we don’t carry warm soapy water and wipes in the back of our ambulances). Nurses soon learn to unwrap carefully the patient who has been left in the ambulance blanket.

Because of the thickness of the blanket, and the difficulty of carrying vomit bowls into houses, the blanket can catch any vomitus the patient may produce while leaving the house. Reassuring the patient that it is fine to vomit on the blanket is important in case they become embarrassed.

When moving a dead body from a location, two blankets in the ‘T-wrap’ will disguise the lack of life from bystanders. It’s also good for wrapping up very frail LOLs when it is freezing outside.

With the addition of two triangular bandages the ambulance blanket can be converted into a pelvic splint. This helps stabilise pelvic fractures which can become life threatening if allowed to wobble. As an aside, the next time I see a trauma surgeon flex the pelvis in a suspected fracture, I’m going to find their car and let down their tyres.

If you don’t have the head blocks that go either side of the head to protect a possibly broken neck, then by the correct folding of the blanket you can form a snug-fitting c-spine restraint. I prefer the use of blankets to the specialist kit here because the blanket is better able to form itself to the patient’s head and neck.

Our blankets are red—this makes them ideal for hiding blood.

If you have a nasty trauma in a public place the blankets are large enough to be used as screens. This requires the use of two firefighters to hold each end. Don’t worry, they were probably standing around doing nothing anyway.

The blanket also works well as an ‘NHS special’ pillow. We don’t carry pillows on our ambulances and many hospitals are short of them. So roll up your blanket and place under the patient’s head. LOLs with a curvature of the spine will be especially grateful, as in a moving ambulance without a pillow their heads tend to roll around like a nodding dog.

If folded correctly, you can put it on your trolley bed and have ‘AMBULANCE’ written down each side. This not only looks good but also makes it really easy to wrap patients up in it.

If you have a patient who might become aggressive then the blanket—if tucked in tightly—can provide a mild restraint.

Doing CPR on the floor for an extended period of time can be wearing on your knees—a folded blanket makes a nice cushion to rest on while pounding away on some dead person’s chest.

If someone decides to have an epileptic fit in the back of your ambulance, the blanket can be used to protect the head (or other part of the body) from hitting the ambulance wall or other hard surface.