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", this is someone who is not breathing and their heart isn't beating. 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+ 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 - you can't do anything for the patient, but 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 isn't someone who I would call the most sympathetic person in the world. I spent a little longer at hospital talking to the wife; the only consolation 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 to him.

The next job was a man, who after drinking too much, fell over in the street. He had a greatly altered level of conciousness, 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 as he was laying 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 crewmates 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 conciousness was 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.

Total score for the night..

Death: 1 Us: 7

There has been a discussion over on Doc's forums over which shift we prefer to work. Like many of the others I have a preference for working though the night. The reasons for this are many but include...

1) As I'm single I can lay 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 top people.
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 it's 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 six months before they remembered my name.
9) On a cold winter morning, I'm going to my warm comfortable bed, while everyone else is trudging to work.

It's well described in this page.

Yesterday started well, we had the only new "yellow" vehicle on the complex, and it really is an improvement on the old motors. But then we got a job that should have been routine.
We were given a "34 year old male, seizure" at a nearby football pitch in the middle of a park. Also leaving from our station was the FRU (a fast car, designed to get to a scene before the ambulance). As we had a new motor, we were able to keep up with the FRU.
Arriving at the top of the street, we were met and directed by some of the patients football team-mates. Unfortunately the patient was 200 yards into the park, and there was no way we were going to get the ambulance onto the field - The council had built a little moat around the park to stop joyriders tearing up the grass in their stolen cars.
The FRU paramedic had reached the patient first and I ran across the field to get to the patient as the Paramedic looked worried, and this isn't someone who normally worries. As I reached the patient, carrying the scoop which we would use to move the patient the paramedic asked me if I thought the patient was breathing.
The patient was Nigerian, and it is not racist to say that sometimes detecting signs of life on a black person is harder than if the patient is caucasian. White people look dead, black people often just look unconscious. Also a windy playing field in dusk is not the ideal circumstance to assess a patient.
"He's not breathing" I told the paramedic, just as my crewmate reached us. "Shit" replied the paramedic, "I left the FR2" at my car". So I had to run 200 yards back to our ambulance to get this, now vital, piece of kit.

An FR2 is a defib machine, which is used to shock a heart back into a normal rhythm, in the UK EMT's are allowed to use this piece of equipment, and rapid defib shocks are essential in certain forms of cardiac arrest.

Returning to the patient my colleagues had started to "bag" the patient, which means using equipment to "breathe for" the patient, and to perform CPR, which is the procedure to keep blood flowing around the body in the absence of a pulse. Attaching the defib pads I saw the the patient was in "fine VF"; this is a heart rhythm which means the heart is "quivering" rather than pumping blood around the body to the brain and other vital organs - technically the patient is dead and without immediate treatment, the patient will remain dead.

We "shocked" the patient once and his heart rhythm changed. It changed to Asystole.

This means that the heart is not moving at all, and it is much more difficult to restore life to the patient with this form of rhythm. We decided to "scoop and run" to the nearest hospital. So the paramedic secured the patients airway by passing a tube down the windpipe, and we got the patient onto the scoop, all the time continuing the CPR and giving potentially lifesaving drugs. We then carried him, with the help of his team-mates to the ambulance and rushed him to hospital.

Unfortunately the patient never regained consciousness, and died in the resuscitation room.

34 years old, normally fit and healthy - and he drops dead on a football pitch. Despite our best efforts there was nothing more we could have done for him; the treatment went according to plan, and the resuscitation attempt went smoothly. This was a "proper" job, but one we would have happily done without.

For those who are interested in my ORCON post, which is coming soon I thought you might want to see how the "Advanced Medical Dispatch System" (AMPDS) works.
Each call, when answered is categorised by the call taker using this computer based system. It is supposed to ensure that the most serious calls get an ambulance first. To be honest it doesn't seem to work "on the streets" as we get sent as a "Cat A" to someone who is upset, and yet someone who has had a stroke is only an Amber response. The fact that we use AMPDS is alright, but the Department of Health felt that it needed changing, and so the instruction from them is children under the age of 2 need a "Cat A" response. Which as this forum tells us results in fast cars being sent to children with constipation.

CAT A CALLS :

RED 1 - Actual death imminent (Unconscious not breathing)
RED 2 - Possible death imminent (Unconscious/not alert but breathing, or with other signs like mechanisim of injury)
RED 3 - Risk of imminent death (breathing and conscious but at high risk)

N.B. All calls to children aged 2 and under automatically get a "RED 3" regardless of diagnosis.

CAT B CALLS :

AMBER 1 - Definitely serious (not immediately life threatening ,but requires urgent on scene assessment ,treatment and conveyance)
AMBER 2 - Possibly serious (not immediately life threatening and no specific gain from immediate treatment on scene or in an A&E)

CAT C CALLS :

GREEN 1 - Requiring assessment and or transport (not life threatening or serious, but needs assistance)
GREEN 2 - Suitable for telephone triage and or advice (probably no need for transport telephone consultation can be used to determine the health care needed)

Recent news shows that the UK is the centre of a global asthma crisis. We see a lot of asthma in Newham, it seems that every other person we pick up has the disease and carries around their blue Salbutamol inhaler. You can normally tell when it is going to be "asthma season", either the temperature drops or there is a thunderstorm. On those days you tend to carry the asthma medications in your shirt pocket to save you having to open your response bag every job - and then having to repack it.

I am often heard moaning about the NHS, but compared to the "must make a profit" attitude the Americans have to put up with I guess I'm spoilt. MacMedic is having problems based around his companies need to make a profit.

This is what happens when you swerve to miss some idiot and drive your ambulance into some scaffolding.

Luckily no-one was hurt.

I heard the crew report it over the radio, it went something like...
Crew:"Control, you better send another ambulance on this job, we've had an RTA".
Control:"Anybody hurt?"
Crew:"Nope, we're all alright here".

This happened a little while ago, but I just happened to visit the fitters where it is being stored. Apologies for the big pictures...

Sorry, I know I keep flogging this dead horse...

Yesterday we picked up Phil. Phil has mental health problems in that he his schizophrenic, and sees the Devil and Jimi Hendrix. He is known to be a rent boy and is homeless. It's been a bit cold this week and we found him sheltering in the lea of an office block. Obviously the office workers didn't like seeing Phil so they called us.
Phil is normally very scared and has difficulty determining his hallucinations from reality, so it involves a bit of work on our part in order to make him feel safe enough to travel with us.
Anyway - the hospital discharged him around midnight last night - after psychiatric review. He has nowhere safe to go.
Dropping off another patient we saw him waiting in A+E again today. This is the third time he has attended A+E in as many days. At least it's warm. I doubt that psychiatric services will admit him in order to get the medications that he needs. Instead he will be discharged as part of "Care in the Community". This is the same process I saw when working in A+E, unless he is a specific danger to himself or others, people like Phil just don't get the care they need. Even being a danger to themselves is often not enough; I can count on the fingers of one hand the number of patients attending A+E because of an overdose and then going on to be admitted under the psychiatric services.
Sometimes it feels that no matter how hard you bail out the water the ship is still sinking.

I'll try and post something more upbeat later.