One of the bizarre things about the Ambulance Service is that, in the eyes of the government, we are an "essential" service but not an "emergency" service. We are "essential" because the emergency services (Police, Fire Brigade, Coastguard) are run by the Home office - Ambulance services across the country are run by NHS trusts, and as such do not have access to the same resources as the true "emergency" services. The distinction is often slight, but can sometimes have quite important considerations for our safety.

Last night was a case in point - we were called to a patient with abdominal pain, however further information was given that the patient could be violent. There was something in this information that triggered my "spider-sense", so I was happy to wait for police assistance to arrive before approaching the house.
Four police turned up, normally only two are sent to assist us - and they told us that their computer system, and their personal experience with the householder showed him as a nasty piece of work. We followed the police to the patient and they told him that they were going to search him, and that they wanted to put him in handcuffs first. The patient had obviously been involved with the police before, as once he was handcuffed they checked to see if he had any new warrants out for his arrest...

Searching him they found a large stick, and a rather worrying looking (5") knife on his person.

All through this the "lady" of the house was shouting abuse, mainly at the patient, but occasionally at the police officers present. One quick examination later showed nothing life-threatening, so we offered a trip to hospital that the patient accepted. However as we left the house the woman shouted a few final obscenities at the patient and he told us he couldn't be bothered to go to hospital and stalked off into the night. (This was not a problem for either my crewmate or myself).

Police computers had information that he was dangerous (a number of rather vicious assaults) but our computers aren't allowed to have such data. A police dispatcher has told us that they have all sorts of information on addresses, from animal liberation protesters to members of Parliament. Again our computers don't have any information of that sort unless we enter it manually after an ambulance crew has been threatened/assaulted.

Needless to say, one such report has been sent to central office.

Tonight was exceptionally foggy, and while we were kept busy, the only job of any real note was when we stumbled across an RTA, where the driver had swerved into a fence at approx 40mph. He was rummaging in the wreckage when we found him, and refused to be assessed. The last we saw was him rapidly disappearing over the horizon. The police were not amused - but (surprisingly for our area) it looks like the car actually belongs to him. So now he'll be summoned for leaving the scene of an accident, as well as any other driving offences the police decide to throw at him.

No sooner do I hope for a quiet hour or two than the activation phone goes; it's sending us 200 yards up the road to a "Collapsed Male". We are met by two police officers who tell us that the patient was walking along the street, saw the policemen and then collapsed.
We get to the patient and can't smell any alcohol on him, but he is coughing and spluttering like an Oscar winner. He complains of a headache, coughing, leg pain, back pain and an inability to walk. Other than that he is refusing to talk to us. Examination is normal and the patient is obviously play-acting.
He then does one of the things that I really hate (given the prevalance of TB in Newham); he coughs all over us and the vehicle without putting his hand over his mouth. Then he starts to spit on the floor of the ambulance, again something I take a dim view of - but I'm driving so I leave it to my crewmate to sort out.
Forty seconds later and we pull up outside the hospital, and our patient decides to roll around the floor - by now both our patience is wearing thin, so we haul him up and throw him in a wheelchair.
In the hospital he refuses to speak to the nurses, says he cannot stand and doesn't acknowledge any requests.

We leave him there and within thirty seconds are back on station.

While at the hospital I induldged in a little bit of teaching - the nurse who was assessing our patient was trying to check his pupil response (by shining a light in each eye and making sure that it reacts to light) but the eyes don't appear to be reacting. I then suggest turning off the ceiliing light that the patient is laying on his back staring at.

For some reason I don't seem to have much patience tonight, it started with the drunk panic attack and has continued to get worse over the course of the night. A friend of mine would suggest that I am having a "sense of humour failure"; could it be that everyone else is drinking and having a good time tonight while I'm working? Normally I enjoy Friday night shifts, but tonight I'm just grumpy - I'm attending on Sunday, so I better get over it quickly.

I went to occupational health today - it seem that the last time they checked my blood (because of being on PEP) my liver enzymes were a bit elevated. Most significantly my Gamma GT was at 164 (it should be between 0-55). PEP is well known as having effects on the liver, so this isn't completely unexpected.
More blood was taken today to check that the enzymes have returned to normal. The nurse was very concerned that I was alright in having my blood drawn, and that I wouldn't faint. She was asking me this while I'm sitting opposite her in full uniform...
The nurse was also a bit surprised that I'd had the aural hallucinations and looked as me as if she thought I was turning schizophrenic - I assured her that the "voices" were now leaving me alone and that it wasn't a problem. She'd never heard of this symptom before, so at least I entertained someone today.

Coming back from the occupational health department we got a call to a man collapsed in the street - that's right, laying in the rain at 13:00 was someone who was completely drunk. He refused to give us any details, to go with us to hospital or even for us to run him home. I'm not moaning because it gave me a chance to get a saveloy and chips.

Four hours of the shift left to go. Then two days off, after seven days working, this will be bliss.

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.