Picked up an assault yesterday - while sitting in the back of the ambulance he told his 2 year old daughter that, "daddy is gonna fucking kill the people who did this to me", then moaned when the nurse at the hospital told him to moderate his language.

I love this job.

We then went to someone who started hitting his own nose in order to prove that it had been bleeding earlier; and then went to a woman who had a bleeding varicose vein that had stopped bleeding, but wanted to pick at it to prove that it had been bleeding.

Then went to a 14 year old girl who was "fitting" but when we got there was confused and combative - as she was a diabetic we checked her blood sugar, which was low. Being confused is one of the symptoms of a low blood sugar and we normally give them an injection that brings them out of it. So we gave the injection and waited for it to work and receive the grateful thanks of the parents.

But it didn't work.

So we checked the blood sugar, and it had come back up to normal levels - yet the girls condition was unchanged.

So we rather quickly took her into hospital - we haven't been back there yet to find out what had caused her confusion, was it drugs, alcohol, psychiatric problems, CVA or even just a bad nightmare? Once we get back to the hospital which we took her to we will no doubt be able to find out. She didn't have a high temperature, didn't have any medical history besides the diabeties, pupils were normal and responsive, all observations were normal, and was otherwise normal.

We spend a lot of time dealing with things that are simple to cope with - you can fix them almost by rote thinking. But every so often you get a job that throws you. Normally you "wake-up" and deal with it by going back to basics, other jobs just completely confuse you, and this was one of those jobs.

Got back from the Isle of Wight - which reminded me why I don't really drink anymore - two beers are guaranteed to give me a hangover the next morning. I'm a lightweight - but I'm also a cheap date...

Doc got a list of questions via e-mail from a student who was doing a report on Paramedics/EMTs for a class.

Here are my answers with minimal joking around.

How did you get started in your career?

Ended up as an A+E nurse after a large number of previous jobs, including a failure to stand teacher training. After 8 years of torturing patients I thought I needed a change.

What are some of the advantages of being a paramedic?

You are your own boss, you get plenty of fresh air, you can get rid of annoying patients in 20 minutes if you want and I get paid more than I did as a senior nurse.

The disadvantages?

Having to lug huge chest pains down narrow/blocked stairs, having to deal with time-wasters who abuse you, not being able to use my nursing skills as much as I'd like, being looked down on by some hospital staff.

What training or education did you need to complete before you were able to apply for the job?

Had to be 21 with a clean driving license, had to pass a basic reading/writing/'arithmetic test as well as carry a dummy up and down stairs. Then it's an intensive 20 week course followed by a years "probation" where you do everything you would be expected to do but only get paid 80%

What enjoyment do you get out of your career?

Fresh air (do not underestimate sunshine and fresh air until you work 12 hour shifts in a windowless box of an A+E)
I also do still enjoy helping people who need help - unfortunately this is a rarity given the "calibre" of most of our jobs.

Did you have any inspirations that helped you decide to be a paramedic?

I always wanted to be Nicolas Cage...

What are some situations you might run into?

Anything and everything, luckily the IRA have stopped bombing us (which is nice) but anything from a stubbed toe or scratched finger to people who have jumped in front of a train. Most day shifts have a mix of Chest Pain, strokes and Abdo pain. Night shifts are more Overdoses, Alcohol related and assaults. We also get to taxi maternities the 800 yards to hospital.

Who drives the ambulance?

Whoever isn't drunk that day (joke). My crewmate and I swap every day.

What are the rules when driving an ambulance?

We have a number of "Exemptions" - we can ignore speed limits, treat red traffic lights as a "Give way" Park wherever we want, drive on the wrong side of the road.
Things we can't claim as an exemption are "Dangerous driving" and "Dangerous parking"
The other main rule is try not to crash into anything...

What tools are stored inside the ambulance?

Basic life support stuff like O2, airways and dressings also more specialised kit like a ventilator, cardiac monitor, heart "shock box", a number of drugs, spinal board and scoop.
We are supposed to be able to undertake "light rescue" but none of the vehicles have the kit to do that.

How long are your daily shifts?

Without "late jobs" normally 12 hours although sometimes we have 8 or 9 hour shifts.

What do you do once you deliver the patient to the ER?

Get a cup of tea...Fill out the PRF (Patient report form) restock and clean the ambo and "green up" for the next call.

Do you have to fill out paper works for each patient?

Yes. An A3 sized sheet.

What is the average amount of calls daily?

In a twelve hour shift between 10-14 calls of varying severity.

How many paramedics travel to an emergency in the ambulance?

Two people in a crew (not counting training crews or people who are "third manning" because they cannot lift due to recovery from sickness) Extra ambos are available for serious calls. Every ambo tries to have one Paramedic but the difference between EMT and Paramedic over here is quite small.

How many people work in one ambulance?

Just two.

...after punishing myself for dealing with a personal problem in a rather poor manner, I thought I'd get back on track and talk about uniforms.
The LAS has got some new uniforms - these include "combat trousers" and a fleece - which is nice seeing as it an get a bit nippy around here. The only problem is that we use Alexandra, who do not have the best reputation for our uniforms. We'll forget that they can't measure you up correctly - I am not a 38" waist no matter how many kebabs I eat. Instead lets consider that the buttons on their shirts tend to fall off at the worse possible moment. Having a button drop in a dead mans mouth when you are trying to resuscitate them is not something that inspires awe in the relatives watching. I was supposed to have 8 shirts - two of them have been cannibalised so that I have 6 shirts with the right number of buttons.
Still the uniform (that was actually trialled by road and office crew) seems quite nice. We have a little "NHS" logo in case the big motor with "Ambulance" written on the side wasn't enough of a clue to our identity, and the shirts have a mesh in the armpits so we can let our sweat out. The combat trousers have "permagard" (their spelling not mine) which are designed to kill bacteria - which is nice considering the state of some of the houses we visit. The high visibility jackets are...well, visible. And we now have a green "beanie hat" - I think it's green so that people won't wear them anywhere except at work.
There is a rumour that we will be getting new boots soon...Magnums. We are a bit like the army in that we buy our own boots because the ones supplied are a bit shoddy.
Anyway the uniform "goes live" on the 12th but those who have uniform that actually fits them have been wearing them early. The bosses are moaning a bit but haven't actually told anyone off about it.

Now I'm off to the Isle of Wight for three days for a drink or two.

Then the wonders of Night Shifts...

Yes I know I thought I'd stop moaning about the psychiatric services (Audience groans) but...

The Newham Mental Health Centre shares the site with Newham General Hospital, in fact the Mental Health centre is 200 yards from the entrance to A+E.
So why did I get two emergency calls following each other to take an in-patient from the mental health center into A+E? Both patients could have walked - or at a pinch got wheeled down the road in a wheelchair. But no, the solution is to call a frontline emergency ambulance. Taking this ambulance off the road deprived other patients, who didn't already have a doctor and nursing staff looking after them. I spoke to the charge nurse in A+E and apparently the same ward had been sending patients down to them all day.
One of the patients claims to have overdosed on his medication, while in the ward. I wonder if anyone will ask how he managed to get enough medication to overdose while in a supposedly safe ward.

So I found myself grinding my teeth, while my crewmate was telling me to take "deep cleansing breaths" and to "go to your happy place"

Now I'm going to wait for that last job before I go home to my nice warm bed at 04:00... Think of that if you had to wake up to a cold grey morning...

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.