While we deal with a lot of crap jobs on a day to day basis, but when we are really needed I think we do a bloody good job.

One of the people injured in the London bombings is getting married this weekend.

The thing that gets me is this quote.

“As well as losing both feet in the bombing, Ms Hicks lost 75 per cent of her blood and her heart stopped twice on the way to the hospital.”

That means that an ambulance crew successfully resuscitated her twice, long enough to get her to hospital and that because of that unnamed crew, she is now alive and getting married.  It’s stories like that which makes me happy to do the work that I do, that sometimes we can make a difference.

(Via: Going Underground)

Did you know that the Meteorological Office offers ‘health forecasts’?  We got a memo from them (via our office) about a predicted increase in paediatric respiratory infections.

No kidding!  For two days all I attended were patients with chest infections.

Then on Friday all but two of my thirteen calls were faints, or epileptic fits.  I’m left wondering if it is something in the weather that caused that little spike.

Oh, I also attended three schools on Friday (one epileptic and two fainters), while normally I wouldn’t see that many schools in on month.

A strange day.

I’ve checked with my sources, and the story is true.

At Poplar ambulance station there is no room to park.  The station itself is tiny, barely bigger than a portacabin.  There is a big metal fence and electric gate around it.  There is minimal parking.

So the ambulances park out on the street – if they didn’t then every emergency call would be delayed by minutes as the crews wait for the gate to open and then maneuver the ambulances out.  This would be very bad for the patients (and more importantly, extremely bad for our ORCON times).

There is nowhere else to park.

So…a couple of days ago the ambulances all got parking tickets.

Apparently there is a man who lives in one of the nearby tower blocks who keeps complaining because his daughter nearly had an accident pulling out of the turning.

So a nice man from the council (or a parking warden) came around and put tickets on the ambulances.  In his defence he did try to not ticket them by telling the crews to drive around the block…

The ambulance crews find this all very amusing.

(We are, by our driving exemptions allowed to park where we like as long as it’s not ‘dangerous’, we are guessing that this man has complained so much the council has been spurred into action).

It was as if my prayers had been answered, a GP who today managed to balance the poor skills of yesterdays doctor.

I was sent to a 74 year old male with difficulty in breathing and chest pain. My computer display told me that the GP was going to remain with the patient.

I got there and was met by an apologetic GP who thought that the patient just had a chest infection, but while she was talking to him, the patient developed a possibly heart related pain. She had tried treating him herself, but thought that the best thing was for him to have some further tests in hospital.

My assessment and treatment of the patient went without a hitch, and I agreed that although I also thought the pain was as a consequence of his chest infection, it would be best for the patient to be assessed in the local A&E department.

As was the case yesterday the ambulance was 40+ minutes in arriving, so I had a bit of a chat with the GP (who was rather pretty...) and the patient (not so pretty). As there was nothing else the doctor could do with this patient, I let her leave the house to see her other patients.

A nice job, made easier by another health care professional.

Just how it should be.

I’ve had some good comments from the Morphine post, it’s very interesting to hear about the different dosages and protocols that various ambulance organisations use.

This post is one that I’ve been thinking about writing for at least a year, but I’ve always been a bit shy of writing it because it touches on possible racism.  Just remember, I hate everyone, not just one type of person.

Sickle Cell disease is a horrible illness, it results in massive pain, and due to the blood cells ‘clumping’ it can cause stroke, blindness, kidney failure, heart attacks and numerous other complications.  The pain these patients feel is unbelievable.

The thing is, most of these patients are black.

Here is the problem that I have.  There are a number of sufferers who are banned from certain emergency departments, there have been legal orders that say a patient should not got to a specific A&E when they get a crisis.  It’s normally because the patient has caused trouble while waiting to be treated, I was an A&E nurse in North London for long enough to realise that some Sickle Cell Disease patients aren’t saints, but…

In my personal experience, Sickle Cell Disease patients are the only patients who get banned from departments.  Drunks can be much more violent, yet they never seem to get banned.  ‘Frequent flyers’, patients who attend every day, use up more time and resources than those with Sickle Cell Disease, yet they never seem to get banned.  I’ve also personally witnessed nurses being hit, yet the patient still receives treatment, and isn’t banned.

Why I understand that Sickle Cell Disease patients can be demanding, they are in a huge amount of pain.  Some of them are indeed opioid addicts, but my thought on the matter is that it isn’t hurting me to give them painkillers, and that the stresses of withdrawal can cause a sickling crisis.  But it does seem that Sickle Cell Patients are being discriminated against.

This affects the ambulance service in the following way – we might pick up a patient 200 yards from the local hospital, he has chest pain, and is in a lot of general all-over pain.  If he is banned from that local hospital, we might have to travel miles to get him to a hospital that will accept him.  If he has a heart attack or stroke on the back of the ambulance, is it our fault for bypassing a nearby hospital?

These patients often have a ‘treatment protocol’ at their hospital – this states the type of pain relief that they get, and who should be contacted to continue their treatment.  These patients are often concerned that if they are not taken to their specialist centre (always miles away…) then the hospital that we do take them to won’t have their treatment protocol.

Also, will we be called more because we are now carrying morphine, and will maybe give it to patients, when their personalised treatment protocol states that they shouldn’t have morphine at all?

 In my opinion, Sickle Cell Disease patients are treated poorly in A&E departments, and I don’t think that it can be just that they are ‘demanding’ for their pain relief, or that they are personally ‘annoying’.  While a lot of these patients can be annoying, I think it’s only because they are treated poorly to start with.

Disclaimer: I used to work in an A&E department with a huge patient population of Sickle Cell Disease patients.

And don’t forget, it’s World Aids Day today.

I was going to post about how much I hate Christmas, but Bill Sticker (an always readable and enjoyable blog) has beaten me to it.

We in the LAS will soon have a new drug to play with.

Morphine.

Morphine is an excellent painkiller, in our case it will be given through an injection straight into a vein causing nearly instant relief of pain. It's a pretty safe drug in that few people are allergic to it, and even if we make a huge mistake and overdose someone, it is really easy to reverse using another drug (Narcan) that we have been using for years.

But all is not perfect with this drug. It's potency, and the ability to get people 'high' means that it is a 'Controlled Drug', with whole books of legislation covering it. It should be stored in a double locked wall safe, every usage must be well recorded and every use should be witnessed by two professionals.

This is a bit of a problem for the ambulance service. While we have double locked wall safes on station to keep the stock on, the ambulances are a bit short on these. Instead we have come up with a plan, that for reasons that will are obvious, I won't be mentioning here.

Why won't I mention where we are keeping it? Let me put it this way, junkies love morphine, especially the nice pure, safe stuff that we will be carrying. Junkies also have a habit of turning to crime to get their 'fix'. We don't want junkies stealing our Morphine, if only because it will mean filling in a tree-load of paperwork.

So the Morphine is safely padlocked and hidden away. Although to be honest, the security is all in the hiding, rather than in the padlock...

Even though Morphine is a paramedic only drug, meaning us poor lowly EMTs can't give it, we all have to undergo the additional training. The reasoning behind this isn't because we can't trust the Paramedics not to muck it all up and give the wrong dose, but because we have to sign our name to a bit of paperwork every time Morphine is given to say that the patient got the right dose, and that our Paramedic crewmate isn't shooting up in the carpark/selling it on the street.

So we have all had a look at the drug information sheet, we had a laugh at one of the contraindications (reasons when not to give the drug) as being described as 'rare as rocking horse shite'. You wouldn't get that in a nursing memo.

The issue I have with the use of this drug is in its dosage and administration. For the medical people out there, the dosage is 2.5mg over two minutes, repeated every 5 minutes (I may have to amend this later, I've left the information chart at home). For the non-medical people, this is a dosage that seems almost homeopathic in nature. It is a tiny dose. I'm considering all the times in hospital we'd give 8mg immediately, and another 2mg to 'top up'. While I understand that too much can cause you to stop breathing, we do have the 'antidote' sitting right next to it.

While I understand the concerns of our Clinical director, I hope that this will get reviewed at some point in the near future.

What has been done right is that the drug comes in pre-filled syringes. We won't have to faff around with needles, bottles of water, and shaking up bottles of powder. Instead it is a simple process to pull out a syringe, flip off the top and give the patient some pain relief.

So we are moving forward with our pain relief treatments, which can only be a good thing.

Although I don't think we will be getting paid any more for our new skills...

Well, extended licensing laws are in, which I’m afraid will mean more disorder on the streets, couple that with the seasonal increase in illness, and the ice on the roads that means I can’t drive as fast as I normally can and what you get is an increasing failure to reach our government’s benchmark time.

Remember the Great and Powerful God ORCON?  Where we have to reach most high priority calls within 8 minutes?

We aren’t on target for it this year, and unlike other years I don’t think that “extra effort”, as our management call it, will save us.  There is a shortage of ‘flu vaccinations, so more at risk people will get ill, we’ll be going to more alcohol fueled violence because of the new licensing laws.  It is thought that there will be a colder than average winter, so, because of ice, our vehicles won’t be able to drive as quickly and as safely as normal.  And Agenda for Change has hit morale hard especially given the uncertainty of payment for overtime shifts (which are needed to cover staff shortfalls).  Oh and more people are calling us for more crap reasons every day.

We are doomed.

But worry not, patients won’t be doomed, remember, this eight minute ORCON time has absolutely no basis in health, or prevention of death.  If your heart stops then you have, at best, five minutes to get it going again, after eight minutes, I’m afraid you are more than likely dead, and are going to stay that way.  Most calls clinically either need a “faster than five minutes”, “faster than half an hour” or “Sometime in the next couple of hours” response.  Eight minutes is some figure plucked out the air.

So don’t worry, all it means is that the best Chief Executive the LAS has ever had will lose his job, and we won’t get given as much money to fund the service.  After all you wouldn’t want to fund a failing service would you?

Stupid $&%*£^&*!!! government.

All I can do?  Get there as quickly and safely as possible, and make sure the patient doesn’t get any worse.  I can only do what I can do…

Absolutely nothing of interest last night, the most interesting job being someone with a two month history of muscular back pain that had been getting worse that day.

“So”, I asked all innocently, knowing full well the answer I would get, “Have you taken any painkillers as the pain got worse?”

I wasn’t surprised by the answer she gave.

Then two calls to two regulars, one of which had only been discharged from hospital three hours previously.  Then finally to a patient who was actually sick, but that would only be because he earlier discharged himself from hospital against medical advice.

There is nothing more disheartening than to attend to a patient, and to see them clutching a little pink slip of paper.  “Why so?”, I hear you ask.

When you visit the local hospital, and the doctors and nurses are finished poking and prodding you they decide if you need to be admitted to hospital, or if you can safely be sent home with treatment.  If you are to be sent home they give you one or two bottles of pills, explain how the pills work, and then write a letter to give to your GP (family doctor).  The letter tells your GP exactly what tests they have done, and the treatment that they have prescribed.

This letter is on a pink bit of paper.

All too often I get called to a patient who has been seen with a minor condition earlier in the day, but after one dose the medicine hasn’t cured them, this is most common in the case of antibiotics, but you will also find people who tell me that the pain has gotten worse, and that they don’t like to take the painkillers the doctor has prescribed.

Inevitably they still have the discharge letter with them.

In these cases all we can do is take them back to the hospital they were seen in just hours ago, so that the doctors and nurses can repeat all the tests they ran the first time.

Sometimes this happens three of four times.  And each time they call an ambulance.

Don’t get me wrong, sometimes things do indeed get worse, and in that case a return trip to hospital is warranted.  But in most cases I come across it is simply the inability of a single dose of a tablet to make your symptoms disappear instantly and permanently.  Still on the up side, it makes diagnosis really easy, all you have to do is determine if the symptoms are the same as the last time they were in hospital, or if they have gotten worse or changed in any way.  If the symptoms are the same, then they are unlikely to drop dead in the back of the ambulance (thus causing a lot of unnecessary paperwork).

I have two or three days off now (don’t ask me how many, I need sleep before doing any serious thinking), so I may raid my ‘Ideas File’.

It is, to put it bluntly, cold enough to freeze the balls off a brass monkey, which is really cold. No matter, it keeps the drunks off the street...well, mainly it keeps the drunks off the street...

I got sent to a '50 year old man, fallen in street. blood from ear'. The location was given as 'Outside Red Lion Public House'. I could guess what had happened.

I pulled up, leaving the headlights pointed at the patient who was laying on the ground covered by a blanket borrowed from the pub. surrounding him were:

A lot of police (about five or six officers).
Two sons, both of which were crying and worrying about their dad dying.
Some bystanders, most of them had come from the pub, and...
One off duty fireman, who was clutching the patient's hand.

"Fair enough", I thought, "best get to work".

The lighting in the street was bad, but my headlights, and some police torches made that a little better. The patient had been celebrating in the pub and had tripped over a kerb while trying to walk home. He had possibly been knocked out, and there was some blood coming out of his left ear.

The first thing that you think of when someone who has fallen has blood coming out their ear is that they may have fractured their skull. With a fractured skull you will sometimes get cerebro-spinal fluid coming from their ear. Cerebro-spinal fluid is the liquid that your brain and spinal column float in, and should not be outside the body at all.

The standard test is that blood and C.S. fluid don't mix, so you'll see yellow streaks in the blood. Given the poor light it was hard to see, so I fell back on an old trick. You stick your (gloved) finger in the blood and if there is C.S fluid in it, the blood will feel 'slick'.

The side effect is that your gloves get covered in blood. It was cold. I wanted to wipe my nose. My gloves were right out, and I wouldn't like to wipe my nose on the cuff of my jacket because it's a disgusting thing to do, and also (mainly) because my jacket is horribly unclean.

The patient also had a large swelling to the back of his head, and because of the way that he had fallen, I couldn't rule out an injury to his neck. In a perfect world I would have liked to have put a cervical collar on him to immobilise his neck, but this is far from a perfect world. A cervical collar only really immobilises a patient if they want to be immobilised, in a drunken or combative patient this will often make them thrash around trying to get it off. So often a better course of action is to tell them to lay nice and still and leave the collar until you need to move them.

The off duty fireman had obviously had a bit of first aid training, because he was keeping the patient constantly talking. This was fine, as it meant I didn't have to talk to the patient too much, apart from assessing him, and getting his details.

The crowd were pretty well behaved, I kept hearing one of them moaning that the disabled ramp to the kerb was the reason behind the fall, and that they were 'bloody dangerous'. I didn't want to mention that walking while drunk was perhaps more of a contributing factor...

I threw another blanket over the patient because there was little else I could do until the ambulance turned up. Unfortunately I'd been waiting a long time for ambulances all night, and I suspected that this would be the same.

My nose still threatened to drip on the patient.

Suddenly behind me was a flash of a high-visibility jacket, "Excellent", I thought, "the ambulance has turned up".

But, no, it was one of our duty managers come to see how I was doing. They knew the ambulance would be some time, and wanted to make sure I was alright.

"Ah", he said, "I can see you have everything under control", and left.

He could have wiped my nose for me...

By now I was losing sensation in various small, but important bit of my anatomy. I looked at my watch and saw that I'd been with the patient for over thirty minutes, I was cold, but at least I wasn't laying on the cold wet floor.

Finally the ambulance arrived, they had travelled from out of their area to attend this call, and I was very grateful for them turning up when they did. We put the collar on the patient, strapped him to a stretcher and loaded him into the back of the ambulance where it was much warmer, and I could remove my gloves and wipe my nose.

Can you see what was uppermost on my mind?

The patient was swiftly taken to hospital, and as I prepared to face the crowd of people and explain exactly why the ambulance took so long to arrive, I was instead mobbed by people who wanted to shake my hand and thank me. None of them were bothered by the forty minutes it had taken the ambulance took to arrive, and they were actually happy that we had done our jobs, accepting that as it was a Friday night we might be a bit busy.

It was only later that I found out that there had been another shooting in the area (some drunk men had been apparently been thrown out of a pub, they then returned and fired a pistol through the pub windows, hitting a barman).