Three of our jobs today had the potential to be upsetting, and while they were all sad, only one seriously upset me, and did so in a way I consider rather out of character for myself.

The first job of the day was to an 86 year old female in a nursing home with a 'blocked nose', we raced around there because...well...it was a Category 'A' call and those are the top priority 'get there in eight minutes to please the government target' calls.
Just as we pulled up outside Control let us know that the patient was upgraded to a 'suspended' (no pulse, no breathing), and sure enough we ran into the home to be greeting by a Fast Response Unit who was doing C.P.R. I jumped down and did a round of chest compressions which cracked her ribs (a recognised side effect of effective C.P.R) and then noticed that on the cardiac monitoring machine her heart rhythm had changed. She had a pulse!
...people don't normally get a pulse back from cardiac arrests of her particular type. We rushed her to the hospital, where a full cardiac arrest team was assembled. Her pulse was lost, and then returned. Unfortunately her prognosis was poor, but she stayed alive long enough for her daughter to reach the hospital. She died with her daughter there, which is a small victory, but one that we are getting more used to.

The second potentially upsetting job was to a one year old boy who had pulled some boiling milk on top of him. We turned up to find about 20 police officers on scene, and the HEMS helicopter circling above. The same FRU responder was there and the child had around 10% partial thickness burns to parts of the neck and chest. While nasty, this wasn't immediately life-threatening, but the HEMS doctor who turned up decided that it would be best to take the patient to the Paediatric Burns Unit at Chelsea and Westminster Hospital by helicopter. As the helicopter could get the child there in under 20 minutes it seemed like the right plan of action. My job during this call was to, (1) hold onto the other two toddlers in the house, (2) mix up some paracetamol for the child, and (3) to drive child and doctor to the helicopter which was around 300 yards away. The job was interesting because she was the type of parent who thought it was a good idea to wedge a settee into the hallway to stop her children from falling down the stairs...

The final job was a lot simpler - we were called to an 18-22 year old female who was 'unresponsive' in a bus. The bus had reached the end of it's route and the driver couldn't wake up the patient. (Possibly interesting aside - Bus drivers cannot touch any of their customers to wake them up). We turned up and soon managed to wake up the very sleepy girl. She remained drowsy but agreed to let us take her to a place where she lived, but after talking to her a bit, we soon realised that she was instead homeless. This, coupled with the way she would fall asleep as soon as we stopped talking to her, made us think that it would not be safe to leave her on the street, so we decided that we would instead take her to hospital. When we reached the hospital she refused to go in, and instead pulled out a 'crack' pipe and started to light up. We told her that she couldn't do that... So she jumped up, pushed my crewmate and ran off. As there was nothing physically wrong with her we couldn't chase after her, so instead returned to our station to fill in the necessary paperwork.

So why was it that this last job was the most upsetting, not only for myself but also for my crewmate? Well it wasn't because she was pretty (she wasn't, and she had a voice like Ken Campbell), and it wasn't because she was ill, nor was it because my crewmate got shoved.

With our first job, the woman was at the end of her life, and until she died, had enjoyed fairly good health - she didn't die a painful, protracted death, and she died with her daughter next to her. With the scalded child, he would forget the pain, and will receive excellent care from the hospital he went to, he would return home to his loving (if ever so slightly dense) mother.

With this girl, it was as if she were lost - at some point in her life her potential future had unravelled. Instead of getting an education, holding down a job, finding someone special and living a long and happy life, she is homeless, a drug addict and her future is probably painful and short. What is so depressing is that no-one was able to turn around this descent, and this is perhaps why I despair at society - that so many people are prevented from reaching their full potential. I understand that she has made her own choices, but how much power did she have to make those choices. I wanted to help her, but there was no way I could do this.

And it's that which annoyed and upset me.

Writing yesterday about having to carry a radiation meter has made me think about all the things I have to/choose to carry in my pockets. I also have a 'bat-belt' which I could wear if I wanted to lose all face in the service, so it stays in the ambulance until I need it.

In my pockets at the moment (and I suspect that this is an echo of some type of meme)

Shirt pocket - right - 4 vials of Salbutamol (asthma medication), half-eaten packet of breath mints (for those post curry/kebab moments), security card for the Royal London Hospital (opens doors for me), work emergency phone

Shirt pocket - left - Black pen, spare black pen, pen torch, small pair of scissors, spare stylus for pocket PC, roll of medical tape, Four sticking plasters (because someone read this, and supplied me with them)

Upper right trouser pocket - Pocket PC

Upper left trouser pocket - wallet (for when I really need that curry/kebab).

Belt - Personal mobile phone, keys to the ambulance if I'm driving that day.

Right trouser pocket - (lower) - Examination gloves - size large (lots of them, never know when you need more than one pair), face mask (because, you never know...yet to be used, so it is looking very grubby), trauma scissors.

Left trouser pocket - (lower) - Key to oxygen cylinders, Number 2 dressing (biggish bandage), guidelines booklet
(huge thing that gives us guidance on all aspects of the job, from drug protocols to hospital specialities)

Right rear trouser pocket - Triangular bandage/sling, spare pair of latex gloves. (I carry a pair of latex gloves outside of work as well, as I told the interview board when I applied for the job "I'll do anything if I have a pair of gloves on").

Left rear trouser pocket - Cheat sheet and ruler for doing things with a 12 lead e.c.g (broken because I sat on it - held together by medical tape), London ambulance service benevolent fund diary.

Stab vest pockets - Spare gloves (can you tell I like having a surfeit of latex gloves).

Is it any wonder I get out of breath when I have to climb a couple of flights of stairs - especially considering the response bag, oxygen, and other medical kit I have to lug around.

The funny thing is that I could do most of this list from memory, sitting in the pub

It seems that the rumors are true, frontline ambulance staff are going to start carrying electronic radiation meters. These 'pager' style devices will sound an alarm when I start getting irradiated. Why will we have to start carrying this additional bit of kit? The answer is of course 'terrorism', but why, when the threat of a 'dirty bomb' is apparently overrated? And should a bomb go off, I'm sure that there will be experts with Geiger counters crawling over the wreckage. I suspect that we are going to be used much as canaries are used in mine-shafts...

While 'Da Firm' do tend to look after it's staff (for instance, our stab vests and emergency phone systems) I would imagine that the real reason that we are going to be carrying them is to expand our role into "mobile dirty bomb detection units". Should we enter a property where the alarm sounds, we will have to tell someone, that message will no doubt travel up the chain of command until it reaches someone who can organise a nice, friendly visit by HM government's finest.

Apparently, (and this is pure rumour) the Metropolitan police are going to have similar devices, and I would imagine for pretty much similar reasons.

It's not that I mind - even if it means carrying even more kit up and down the patient's stairs. Just, wouldn't the money be better spent on equipping our fleet with ambulances that actually work? Or with providing our station with separate male and female changing rooms (which management were going to do, except that we ran out of money)? The chances of us catching a 'dirty bomb' are slim to start with, so wouldn't it be better to deal with the sort of things that kill more people each year, like - for example our crap record of cardiac arrest survival rates.

I wonder which company will get the tender for this job, and what ties they might have with the government?

Mark (of Gullible's Travels) asked me to recommend some UK medical blogs. To my shame I could only think of a handful, so I vowed to change this sorry state of affairs and have a look at some other UK medical blogs.

But first, I need your help.

If you own/write a UK medical blog, or if you read one that isn't on my link-list on the right hand side of this page - then please either email me with it, or (even better) pop it in a comment for this post. Then I shall have a look at them all and summarise them in a future post.

Fly my pretties, fly! And bring me interesting links.

It was rather stupidly busy last night, not helped by the fact that there were only four ambulances available on our complex after 3am - instead of the nine we should have running. It also wasn't helped by there being (London-wide) 800 calls between midnight and 7am. You know it's getting bad when a job that has been categorised as a 'Cat A - Choking' isn't sent down to an ambulance for an hour. Not to worry though, it wasn't really a choking, it was a sore throat - and thankfully Control realised this and didn't send us flying down there when there were more serious cases to be dealt with. We personally dealt with 14 calls during our 12 hour shift, and were bleedin' knackered by the end of the shift, but none of our calls were too serious - mainly babies vomiting and maternataxis with an occasional side dish of alcoholics and drunken fights.

We did get the occasional comment that I love, "Don't take me to Newham hospital, it's crap!".

For some reason people only seem to remember the bad stories that they read in the local newspapers (which are, as personal experience can attest to, often wildly inaccurate). Patients (but more often their relatives) also seem to think that they will be waiting longer at Newham than they will at the Royal London. I take great pleasure in telling these people that the government has set a four hour limit from admission to either treatment and discharge, or to being admitted to a hospital bed.

Newham gets more than 96% of patients seen and sorted out by this time limit, and those that go over this limit rarely take longer than an extra hour.

The care for the patient, with the exception of serious head trauma, is essentially the same regardless of which hospital they go to - and should I ever need A&E treatment, I'd be more than happy to attend Newham.

The Royal London is a good hospital, but it's not the be-all and end-all, your local hospitals are also often very good.

And the receptionists at Newham let me give them hugs...

Our 'interesting' call of last night was a maternataxi. What, I hear you ask could be interesting about taking a pregnant woman 1.2 miles into the local maternity department.

Well, apart from the patient, no-one else knew that she was pregnant - she had been hiding the pregnancy from everyone. She hadn't seen a doctor, nor had she booked into a maternity department. Her family suspected nothing. It's not as if she were a 'large' woman, who could perhaps hide the tell-tale bump under the pretense of fat. She was actually rather slender, which leads me to ask how she could hide her rather obvious pregnancy from everyone.

When my crewmate spoke to her (I was driving), she told him that she had hoped that the pregnancy would 'go away'.

We tried to prewarn the maternity department that we were coming (because, she was quite close to actually delivering the baby), but they hung up the phone twice on our Control. The problem is that the entrance to the maternity department is locked at night - and we need someone to come down and open it for us. So - we were left standing around outside the department waiting for the midwives to phone for a porter to traipse the length of the hospital to come and open the door for us (as opposed to one of the midwives walking down the stairs and opening the door).

By the time we got in the patient was starting to bleed, and we were getting more irate at the apparent ignorance of the midwives.

So tonight we are going to put in a 'clinical incident report' to highlight the danger that standing outside the maternity department for 10 minutes while they arrange a porter puts the patient in.

One of the people on complex has had to deliver a baby in the back of their ambulance while they were waiting for the doors to be opened, so something needs to be done.

I'm doing my favourite shifts now - Friday, Saturday and Sunday night shifts. I love them, drunk after drunk after drunk after 22 year old male who gets scared at 3am when his belly starts aching. Coupled with the 5am Maternataxi, what isn't there to like?

7 pm until 7 am - and from 3am we are the only ambulance running out of our station. Which means anyone who is 'ill' or 'injured' between the hours af 3am and 7am will probably end up seeing my wide-awake, cheery face staring down at them.

And I wonder why people keep dying as soon as I walk in the room

I shall, dear reader, endeavour to remain happy, chipper and positive during the next three nights - if only because, starting Monday I have a week off work.

And for anyone in LAS Control, EC sector who is reading this, I'm working on J201 for the next three nights - be kind and try and leave me alone please...

In one of the comments for a previous post, I was asked about paramedics who can arrange drugs. As I thought about answering why paramedics are really not equipped to do this, I realised that for a lot of people there is still some confusion about the ambulance personnel job titles and roles.

I then found out that my job title is no longer EMT, but is now EMT-3, which is a nice Christmas present... So here is a quick rundown of some of the job titles for those of us working on the road.

Note, this may be wrong, and I accept feedback - it's just how I see things, and the roles seem to be changing every day

EMT-1 - Trainee Emergency Medical Technicians, basically while you are still in training school doing your 20 weeks of classroom learning you are an EMT-1. In London they wear attractive blue boiler suits, which make them look like Kwik-fit fitters. They aren't allowed to even touch a patient without an EMT-3 or higher standing behind them.

EMT-2 - '80 percenters', when you come out of training school and go on the road for the first time you used to be known as an 80 percenter, this is because you only get paid 80% of your proper wage - suposedly to pay the firm back for the cost of your training. You are expected to do the same role as an EMT-3, but for this first year on the road you aren't allowed to crew up with another EMT-2, you also can't go on the rapid response car, attend football matches or do any of the juicy training courses like the Decon team. Other than that you are fulfilling the same job role.

EMT-3 - Yours truly. After a year of being an EMT-2, you sit an exam (the 'Millers' exam), and run through a few more assessments - if you pass then you become a fully fledged EMT-3. The biggest change is that you suddenly get a pay rise of 20%. This is really nice. You also then start getting crewed up with EMT-2s who you are supposed to supervise.

EMT-2/EMT-3 have a number of drugs that we can give, these include Aspirin, Salbutamol, Epinephrine (for allergic reactions and severe asthma), Oxygen, Hypo-stop, Glucagon, Paracetamol, Entonox and GTN. Some of these are prescription only drugs, that we give according to our guidelines training. We are also trained to defibulate people in cardiac arrest, perform CPR with adjuncts and mop up vomit from the back of the ambulance. We will also be giving Narcan soon, as soon as we get certified for it.

Paramedic - Paramedics are EMT-3s who have an extra year of experience, then go on a course that is hideously oversubscribed. the course is residential and lasts (I think) 10 weeks. At the end of the course they can cannulate, and intubate people who have no gag reflex (in practice, this means dead people), but they cannot induce unconsciousness to intubate someone (RSI). They have all of the EMT-3 drugs at their disposal and a few extra ones like Narcan, Atropine, Epinephrine (for cardiac arrests), Benzylpenicillin, Diazepam and Tramadol (for pain relief, they used to use Nubain). They can also infuse a limited number of substances like Ringers lactate and Glucose 5%. For this they get paid around an extra £40 a week. One of the better things that they can do is halt a resuscitation attempt, something that EMT-3's can't do.

Paramedic Practitioner - This is a new role that will see highly trained paramedics covering 'green calls' - they will be trained to do such things as stitch wounds, stop ambulances from coming to people who don't need them, arrange social services/district nurses and arrange GPs prescriptions. The training goes on for ages and there are only a few of these service wide at the moment. They have been created so that we can provide cover now that GP's no longer have to attend patients 'out of hours'. They are going to get paid a lot of money when our new pay deal goes through. They work on their own.

Rapid Response Unit - EMT-3s and Paramedics can drive one of these accident magnets - the idea is to get to a patient within 8 minutes, realise that the job is complete crap and then hold the patient's hand until the ambulance gets there. If the job is genuine, then they can start basic treatment early and then wait for the ambulance to turn up. They are brave souls who race around the streets of London alone, in the dark... Or have a sleep on the sofa on station because their dispatch desk has forgotten about them.

Intermediate Tier - These are people who have had some basic first aid training, so that they can do the 'green' calls that some EMT's and above think are beneath them. these would include taking Doris into hospital for her appointment and GP urgent calls. Considering that it is a common occurrence that I end up 'blueing' in a GP 'urgent' case - I feel sorry for these folks. they also get paid a lot less than the rest of us.

HEMS Paramedic - The Helicopter Emergency Service has a Doctor and a Paramedic assistant. The paramedic carries the bag with all the emergency kit in it.

We then go onto management - but to be honest I have no idea what any of them do, and the job titles seem to change every six months - so the less said about them, the better. There are also the support roles, like the blokes who keep the ambulances on the road, admin staff, training staff, etc... And that is without counting the lovely people from Control who send us on jobs, and always seem apologetic when they know a job is a load of crap.