Some people are stupid - really stupid. A case in point was the job I had this morning. We got called to a male with vomiting. When we got there we were given a letter explaining that he has "Idiopathic cyclic vomiting". Which, translated into English, means he has episodes of vomiting which cannot be explained by any other means. When we got there he was doing the "dry heaves", he had a temperature of 38.1C (Normal range is 36.2C-37.2C) so he was hot, and feeling terrible for it.
So obviously his family had wrapped him up in a blanket "to keep him warm". When people get a high temperature they often feel cold. The solution for this is to cool them down, and they will soon feel much better - often the trip in an ambulance will do this nicely.
I explained all this to the patient, and his wife but they insisted on bringing the blanket with them (like we don't have enough blankets in the back of our ambo). I refused to let him wear it, and lo and behold, he began to feel better as he cooled down. I explained all the above to him and his family again - that he was now feeling better because his temperature was lowering, that the blanket is the worst thing you can do, etc, etc...
We booked him in at the hospital, and as I turned around to leave, what do I see but the bloody idiot wrapped in his big thick blanket.
Well, if you are that stupid you deserve to feel like crap, and as I wasn't going to repeat myself again I left him to suffer.

I got home to find a message on my answer machine from Occupational Health asking me to ring them as soon as I can. Unfortunately I'm home too late to ring, and because Monday is a Bank holiday, I suspect that the first time I will be able to ring them is on Tuesday.
I'm hoping that the reason for the call is to remind me to get a blood test over the weekend and nothing more serious.

But I think I'm in for three days of vague worry as various scenarios rattle through my head.

I told you that big things with flashing lights are invisible...

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