You are going to love this...

I'm at work, it's 7am and I'm checking the ambulance to make sure that all the kit is there and that it is placed where I can find it. As it is 7am and I'm not a morning person I drop the electronic thermometer, part of which falls under the trolleybed. I get down on hands and knees to retrieve it...

...and hear a pop in my right knee.

Lots and lots of excruciating pain follows.

So I collapse onto the floor and scream a bit.

One of my stationmates hears me and comes to investigate, "What the bloody hell* are you doing down there?".

He goes and gets some help. Help to stand there, point and laugh at me. He includes some trainees in the mockery. I think he is getting his revenge because I keep calling him tubby.

I get given some entonox, a painkilling gas better known as 'laughing gas'. For some people this gas does nothing, for me - three puffs in - I'm giggling like a schoolgirl and can feel hardly anything. That which I do feel doesn't seem that important. I laugh a lot, use my good leg to get onto the ambulance trolley, and have some more entonox.

Mobile phone photographs are taken.

The trainees take my blood pressure, pulse and the like. I refuse to take my clothes off as I am a *bad* patient. I am also, as the young people say, 'off my head' on the entonox. It's good stuff, and to think they give us huge bottles of it to play with.

At the hospital, inbetween giggles, I am assessed by my favourite nurse (who, sadly, is escaping that A&E department soon) and I get seen by an Emergency Nurse Practitioner. I know Dr Crippen moans a lot about ENPs and the like, but the one who sees me is a good one - a full exam, a justification for an x-ray and good clinical skills.

The x-ray shows an effusion and maybe some ligament damage. I may get an MRI scan in the near future.

My duty station officer arrives, his first words? "If I'd known it was you I wouldn't have bothered coming, I thought it was one of the trainees".

He is, of course, joking.

So I'm hobbling around on crutches, with painkillers should I need them and an appointment to see the knee surgeon in a little while.

A big thanks to everyone involved, from my stationmates to the folks at the hospital, the care was excellent.

I have a few computery type things to do, but then I'm going to be at a bit of a lose end. I'm pondering learning a computer language, something that I can use in Xcode to knock up a Mac app. I'll search for a book on the Mac API in a bit, I just need to find a good one. It'll give me a chance to write some stuff for Mental Kipple, but I'll have to ration the eight or nine post ideas I have here. No work equals no inspiration.

*He may have used words stronger than 'bloody hell'.

Too damn tired to do anything except sit in a corner and breath quietly to myself, am barely able to string a sentence together - so here is a link to what Ben Hammersley is up to at the moment. I wish I could take photos like this instead of just dealing with the people.

(Favourite trick of the moment when called to an 'unconscious' drunk? Shine a torch in their face and shout 'Go towards the light!' Wakes them up without me having to touch them).

"Patient is suspended"

We rushed to the scene and the FRU arrived seconds before us. The patient, an elderly man, was laying on the floor. He wasn't breathing, he didn't have a pulse and he looked dead.

"He's dead, isn't he?", asked his wife. I could tell by the look on her face that she knew he was dead.

I could only tell her the truth, "He isn't breathing at them moment and his heart isn't beating. We are doing everything that we can for him, but you should expect the worst".

She nodded, she'd seen the colour of him and seemed resigned to his death.

My crewmate put the defib pads to his chest - he was in 'VF', a rhythm that we shock. So we shocked him and did some CPR, all according to our training. Then we shocked him again, gave him some drugs, breathed for him, shocked him again and eventually (and surprisingly) got a pulse back.

We all looked at each other - this sort of thing doesn't happen to us. Normally our dead patients stay dead.

We packaged him up for hospital, three times his pulse stopped but after a couple of minutes of chest compressions he'd get it back. Surely this wouldn't last, eventually he would die.

His wife seemed confused, but happy. Perhaps he wouldn't die after all.

We rushed him to the hospital, I think he lost his pulse twice more, each time we got it back. By the time we reached the hospital he was chewing on the breathing tube.

The hospital worked on him for a long time - still he didn't die. They tried everything, they even gave him a drug that costs more than £600 in the hopes that it would help stabilise him. They did everything, they thought that he may have had a chance as well.

His wife had hope. The last we heard was that he was transferred to another hospital where there was an intensive care bed. I'm guessing that I'll never learn what happened to him in the end.

I wonder if it was for the best that we saved him. My guess would be that, even if he does make a recovery, he will have some form of brain damage - he went without CPR for too long. The alternative is that he never leaves hospital. I wonder if his wife will continue to hope until he fades away in ITU.

From her acceptance that he was dead, to a probably vain hope that she would get him back, I wonder if it was cruel that our resuscitation was 'successful'. At the time we have no chance to make such decisions, we do what we do and get on with it. It's later, as you see the family around the patient, the monitoring machinery showing life but the patient making no movement, only then do you wonder if it is right.

I can't remember many of the people who die despite my best efforts (the cynical would suggest it's the sheer numbers I see that make it hard to remember). But this one will stay with me for some time.

The radio squawked into life, "Can anyone assist with an emergency call in Alice street?"

We were around five miles away and there were three ambulance stations between us and the call, obviously everyone else was further West than us or already busy on their own calls.

"Sod it", I said to my crewmate, "It'll be fun for you to have a decent run on blue lights..."

So we made our way there as quickly as we could in the traffic that seems to come from nowhere at 11pm in East London.

As we approached the scene we saw our FRU already on scene along with a van full of police. My heart sank, I knew that this wasn't going to be a simple job as I could see the police stringing the 'Do Not Cross' tape around where our patient was lying. The locals, as usual, were ignoring the tape, the police were getting exasperated.

Jumping from the ambulance I headed over to the patient. Our FRU paramedic was leaning over the patient's head and as he straightened to greet me I saw that the patient's head was... well... mushed.

He had huge swellings around his eyes and head, he was semi-conscious and covered with blood and vomit.

"Apparently". our FRU told me, "he's been hit once with a lump of wood".

Looking at his head I wondered why, if he'd only been hit once, it was such a strange shape.

"OK", I said, "We aren't going to hang about, lets run him to hospital".

There was some commotion as his drunk friend gave his story, in fractured English, to a police officer while more locals ignored the police tape which was cordoning off the crime scene. I needed to know how many times the patient had been hit, as it would change my treatment of him. His friend was adamant, he was only hit the once and his face normally looked misshapen. It wasn't outside the realms of possibility that our patient was just... ugly.

As we lifted the patient onto the trolley he let forth a long stream of vomit, my boots were merely splashed.

In the light of the rear of the ambulance I could take a closer look at our patient - he did have a very lumpy head along with plenty of 'soft tissue injuries' to the face. One eye was swelling up and he was still leaking blood from a large cut on his scalp. He was still semi-conscious and I made the decision to 'blue' him into hospital.

But which hospital? If I was sure he had a brain injury then I could take him a couple of extra miles to a unit with a neurology unit, but, if his drowsiness was as a result of alcohol (and we had been told that he had been drinking a lot) then the much closer local unit was a better bet. In the end I decided on the closer unit, they would be better able to assess him and if needed could easily transfer him to the hospital with the neurology unit.

So, after making sure that he hadn't been stabbed or shot (not..ahem...unknown in East London), we started towards the hospital.

The police officer who travelled with us asked if our patient's injuries were life threatening, I could only reply that it was a possibility but he'd have to wait until the hospital ran some more tests.

It was only as we were pulling into the hospital that I noticed one of his pupils was getting larger where previously they had been equal - this is not a good sign as it is an indicator of a serious head injury, it's normally quite a late sign though and he didn't look that neurologically impaired. Still it was too late to change our destination. During the transport he had turned his head to vomit on the floor (and this is the picture at the top of this post), and on arriving at the hospital did the same on the lift of the ambulance.

Straight into resus and I gave my handover to the doctor in charge - the team descended on him and, after booking the patient in, we left to begin the long, smelly and mucky task of cleaning out the back of the ambulance (and changing my now spattered uniform).

We went back to the hospital later to find out what had happened to our patient - after exhaustive tests it was found that his facial bones had been broken in
several places and he had a fractured skull - his friend had obviously been lying when he told us that he had been hit only the once. The reason why the patient's pupil had started to change was because the optic nerve had been damaged, there was a strong chance that he would lose the sight in the affected eye.

Thankfully I'd made the right decision, after CT scans it was determined that there had been no brain injury and that the reason he was so 'out of it' was because of the alcohol he had drunk over the night.

It later transpired that the beating was in part due to the 'inter-tribal' warfare that often takes to the street of London. Country 'A' hates Country 'B', and so they decide to beat each other up. The ambulance service and A&E departments along with the police are the lucky souls who get to pick up those pieces.

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OK, I have now run out of stories to write about, so I hope I get something 'interesting' in the next four days... Also I now have an empty Inbox, so if you have sent me an email and expected an answer then it's been lost somewhere.

For the first time *ever*, ambulance crews are going to have rest breaks.

For too long we have been working 12 hours a day without a break.  Sure, we may be able to sneak a cup of tea at hospital, but if you take longer than half an hour to unload patient, handover to nurse, clean and restock the ambulance and finish your paperwork so that the patient can’t sue you, then we often get asked if we could ‘green up’ for another call.  Trust me when I say that it can easily take longer than half an hour to do all the above.

We rarely get to see our station, too many people call us and we simply don’t have enough ambulances to deal with all the drunks, cut fingers and coughs and colds that we get sent to.

European legislation means that we should all get a short ‘rest break’.  If you work for 12 hours, is it really too much to ask for a half hour break at some point?

Apparently it is too much to ask for ‘The Sun’.

Some journalist, who can no doubt have plenty of cups of tea during her day, decides to attack our service for (a) following the law, and (b) treating it’s staff like human beings who need feeding and watering.

It can be hard work on an ambulance, while a lot of our work is fairly simple, there are days when, not only are you run ragged, but you also have a string of tricky jobs.  Why shouldn’t we be like everyone else and get a break.  The police have meal-breaks, nurses have meal-breaks, doctors have meal-breaks and the fire service have meal-breaks (if I were being uncharitable I say that the fire service have occasional breaks in their meals for work).

So why should we be any different?

We make enough sacrifices for this job – shift work knocks years off your life, wrecks your health and social life.  We go into dangerous situations on a daily basis, get beaten up and sit in enclosed spaces with infectious patients.  We also don’t get paid enough considering how the government keeps expecting us to hold together the tatters of the NHS.  Until we got breaks we would also be eating unhealthily, wolfing down fast food between jobs, so physical fitness is a concern for us – gym memberships are a waste of money when you work half the time they are open.

So ‘The Sun’, rag that it is, wants us to work like robots.  Instead they should ask why, despite meeting targets,despite an annual increase in calls, despite being told we should cover the shortfall in GPs and A&Es the government has taken money away from us.  Ask why we can’t have more ambulances?  Ask why we have to go to people who have stubbed their toe, got a wart on their foot or have ‘man-flu’?  Ask why, after dark, it’s us and the A&E departments against the world as all the psychiatric teams, social workers and care home staff vanish along with the sun.

Maybe that would be proper journalism.

I’m already hearing about crews getting abused due to this article, one person reports being shouted at while having a sandwich, while another received abuse from a patient with a cut finger (needing only a plaster) – all because they think we should be running around ‘saving lives’.  It only needs someone to abuse me on this subject and they would get a lecture on how you shouldn't believe everything that you read in your chip wrapper.

In reality meal-breaks won’t make much difference in responding to emergency calls, it just means that the ‘stubbed toe brigade’ will have to wait half an hour for their free taxi to hospital, while true emergency calls will be covered as well as they are at present.  Being able to have a protected break may also mean crews will  be refreshed, meaning that they will ‘green up’ that bit faster, improving our response to those genuine calls.

Everyone was ignoring the patient.

We'd picked her up after an episode of a recurrent illness, she was going to be fine but I felt sorry for her.  Hardly anyone was talking to her, they were all distracted by her partner.  I worried about how safe her partner would be in the back of our ambulance, it turned out that it wouldn’t be a problem.

When we got to the hospital the staff there were more concerned with the patient’s partner although she was a big hit with the department and she did cause a few organisational problems.  A few other patients looked a little worried by her presence.

It made me feel bad, I felt that the patient was being ignored a little with everyone paying full attention to her partner.  So I made sure that I talked to her, I’m guessing that although she was used to such reactions she would still feel upstaged.

“I bet you get ignored a lot when you are with her”, I asked our patient.

“Yes, but you have to get used to it”, she replied.

But why was all this attention being lavished on our patient’s partner?

Because our patient was blind and her partner was a guide dog.

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Sure, it’s an unusual thing to have to deal with a guide dog in an A&E department (although where I worked in A&E we had a ‘regular’), but it still surprised me that playing with the dog or talking about it seemed to be more important than putting the patient’s mind at ease.  Maybe it’s because I’ve got a mate who is registered blind, but it just seems rude to put all your attention on their dog, no matter how cute they are.

 

Blogging is a bit slow at the moment partly because I have nearly run out of interesting ambulance stories to write about.  I’m working on something (when I can motivate myself out of my current ‘funk’), that may mean more posting.  I believe that the best way to get out of a bad spell is to throw yourself into work…

Grief - a Saturday night alone on the FRU makes for a not very happy Tom.

So I'm just snuggling down for a little kip on station, it's about 3am in the morning and all seems quiet, the temperature outside is somewhere around freezing so laying on the sofa wrapped in my fleece is looking like a really good idea.

Obviously the activation phone decides to ring and I soon find myself speeding far out of my area to a 'life status questionable'.

His life status wasn't questionable, his sobriety was. One of our friends from Europe, he had been drinking and decided to have a sleep in the doorway of a shop. Granted if I hadn't gone and woken him up he may had frozen to death, as he was a nice enough bloke I couldn't be too angry. It also put me very close to 'The Log Cabin' which meant I could go and have a hot, filling 'Gob Job' before trying to catch forty winks.

Of course, halfway through the cooking of this gastronomic delight I get another job. I could tell what sort of job it was going to be - someone had dialled '999', said 'Hello', then hung up. For some reason (maybe one to ask Nee Naw), this was coded as another 'Life status questionable'.

"I'll be back in a minute", I said to the domestic goddess cooking my burger.

I dutifully screamed through the streets of Whipps Cross to find, to my utter surprise, an empty phone box.

"Hello Control", I called up on my radio, "I have a lack of any dead or dying people here, please cancel the ambulance, I'm calling it as a hoax".

It was then a quick drive back to collect and eat my burger.

The drive would have been quicker had some drunk not tried to jump into the car so I could, "just take me up the road". When I refused I was sworn at, but that didn't bother me much as I had a nice hot burger waiting for me.

The jobs I did that night were...

2 hoaxes
1 painful knee
1 hot child
1 drunk ...
and an alcoholic with liver failure.

This is not good when you need inspiration.