This is the sort of thing I get called to, given as "Male, Possibly Dead, Caller Unable To Remain On Scene".

I mean…really…does he look dead to you?

“19 year old male – Patient has lump on ribs – difficulty in breathing”.

I’d just been to the Christmas Crisis run homeless shelter at the London Arena three times on the trot (I’d be back there once more later that night).  I’d never seen so many alcoholics in one place.  The people running the shelter were all nice in a worthy sort of way.  This is good, we need more people like this, and less people like me…

But I digress.

Halfway to the address, a private house, my screen was updated.

“Patient has taken cocaine”.

I was met at the front door by a young male, stripped to the waist and obviously agitated.

“Comein, myribsfeelfunny, andmyshoulderbladeedon’tfeelright”.

“Slow down”, I said, taking his pulse – 110, a bit on the high side, but he was bouncing off the walls.

“My ribs man!  They don’t feel right!  Have a feel”, he then started running his hands up and down his chest.

“Have you fallen over?  Been hit?  Anything unusual happened?”, I asked.

“No man – just feel them…FEEL THEM!”

“Look you need to calm down”, I replied, “I can’t do anything while you are hopping all over the place”.

He started shouting, “FEEL THEM!  JUST FUCKIN’ FEEL THEM!”

He turned his back to me, indicating that I should feel his normal looking ribs.

I sudden wave of anger passed over me – it was all I could do to not punch him in the back.

“There”, I said, “Your ribs are fine”.

“What about my shoulderblades man!?”

“Look, you’ve taken cocaine right?  You are feeling paranoid, it’s normal, just try to relax a little”

“WHAT…ABOUT…MY…FUCKIN’…SHOULDERBLADES!”.

He turned his back on me again.  I grit my teeth and grabbed his shoulderblades, “They are fine, Now. Sit. Down.”.

He sat down.  Then he stood up, then he paced around the kitchen.  I noted that there were no knives on the washtop, but even so I kept close to the door. (Mum didn’t raise me to be a fool).

“Look”, I said trying to calm him, and me, down, “Is this the first time you’ve taken cocaine?”

“No man!”

“OK, well if you want we can take you to the hospital, get you checked out if you’d like?”

“NO!”, he shouted, “I’m not going to hospital”.

Fine, I thought, not that the hospital will thank me…

“Ok mate, then are you alone in the house?”

“Nah, my dads asleep upstairs”

“Well I’d like to have a chat with him, so he can keep an eye on you”.

“NO!  Get out of my house”, he started advancing towards me, “No hospital, no waking my dad up, just get the fuck out of my house!”.

I left the house, while a fight with the patient would have done absolute wonders for my stress levels, it wasn’t worth the hassle.

But what now?  Should I post my patient report through the letterbox (if the patient isn’t transported then we should leave a copy with them).  The problem being, that if his father saw the report I’d be breaching patient confidentiality.  I’m guessing that they police wouldn’t be too interested in paying him a visit either.  So I left it – there was little else I could do for him, as he didn’t want help.

I sat in my car, filled out my forms and took a couple of deep breaths.  It would be a long Christmas…

 

The honour of hosting the first Grand Rounds of 2006 has fallen to me.  Well…. actually the evil minds behind it got me drunk first.  When I said ‘yes’ I thought I was agreeing to another round of drinks.
Grand Rounds consists of mainly medical bloggers sending the links of their best post of the week to some poor sucker who has to collate them all and post them on their own blog.  It’s a great way to be introduced to some of the excellent blogs out there.  Unfortunately in this case you are going to be directed to much more interesting people than me – so please promise to come back here when you are finished…
Reading through these posts has meant I'm adding yet more blogs to my already overflowing Bloglines subscription.

Next weeks sucker host of Grand Rounds will be Clinical Cases Blog

In no particular order (and please note, some descriptions may be slightly tongue in cheek) I present this week's Grand Rounds...

Dr Charles has hallucinations while treating a patient!

Sumer asks “It can be tough being married to a doctor, but if they are a radiologist, is it tougher?”

Red State Moron comments on how difficult it must be to announce the birth of a child with a disability.

Orac has a very personal post touching on how hard it is to be medically trained, and to have a family member critically ill.

GeekNurse talks us through an unusual x-ray (and yes, I jumped to the obvious conclusion as well).

HealthConcerns has one of those interesting thoughts that comes to you at three in the morning. Her thought could also apply to medical Blogs.

Was there really a malpractice crisis?  Medpundit disagrees with the local media.

Doc around the clock plays guitar and sings then points to an article on physician musicians.

Medical Connectivity Consulting reports on GE Healthcare staking a claim on wireless networks in hospitals.

KidneyNotes expresses concern about recent news that bowel cleansing preps may cause kidney damage.  (And provides further references).

Anonymous rating of doctors, is it a good thing?  MSSP Nexus blog investigates.

Joan H. over at Oasis of Sanity tells us about the peculiar body image issues that female cancer patients should deal with, but often don’t.

Jim Hu notes an interesting idea that Proton Pump Inhibitors may aid Clostridium Difficile.

In a very scary report, Clinical Cases notes that for Doctors, speed can kill.

The Daily Rhino presents a clinical case that every medical professional must have thought about at one time or another. Vroom, vroom!

I read Medviews’ post, but being in the land of milk, honey and socialised medicine I have no idea what they are talking about.  I think it’s something about Doctors and pay.

Fixin’ Healthcare looks back on 46 years of medicine, and points out a possible future path.

The UK has just started allowing patients a choice of hospitals, Insureblog points out a problem with this ‘consumer driven healthcare’ in America.

Genetics Health points out that there are plenty of jobs in clinical genetics.

Healthcare.wurk.net meanwhile tells us about a simple way of getting the message across – comics.

Health Business Blog comments on ideas to prevent runaway spending on biotech.

This ain’t livin’ has a funny post that makes me glad that I have ‘man bits’ for my own personal undercarriage.

The pleasures of the internet include seeing how other countries deal with healthcare.  Mexico Medical Student tells us (in four posts) about Mexican community medicine (you can read the other posts easily as they are linked in his sidebar).

Diabetes Mine has good news for type 1 diabetics, it seems that all the hard work of controlling your blood sugar is well worth the effort.  She also reports on a potential new way of measuring blood sugar.

NHSBlogDoc (who seems to be turning into my nemesis, although for that to work he’ll need more flying attack robots with death-rays), well…he has a crap in his office, and it’s still there.

Dr Tony examines some testimony from a doctor who has…erm…strange views of medical practice.

Steve, over at The Eyes of an EMT, writes about the thing all us ambulance people dread – the complicated ‘late job’.

nbm at DSPS – the sleep disorder, has got me as a new regular reader – because this post rings very true to my sleep patterns.

UPDATE: You know, there are always a few people who leave it to the last minute.  Some people also forget that due to timezones and other arcane things I’m a couple of hours into their future.

So here are some late Grand Rounds submissions.

The Medical Blog Network has had a site redesign.

From Manila in the Philippines we have a detailed post on fireworks injuries.

GruntDoc has a scary report on how to spread measles to as many people as possible.

DB’s Medical Rants shows us the importance of clinical judgement.

Herbicide as cancer cure?  Interested-Participant thinks not (and so do all right-minded people).

Some stories on how to make a Christmas in hospital as special as possible from Hospital Impact.

Biotech Weblog reports on a phase one study on using stem cells for child brain injury.

Remember, next week Grand Rounds will be hosted by Clinical Cases Blog

From my nursing days – a reason why I hate people who smoke around children

Eight year old girls don’t look like they are sleeping when they are dead.  At least not after over an hour of trying to save her life from an ultimately fatal asthma attack.

We were all distressed, she had been gasping for breath when the ambulance crew had ‘blued’ her straight into resus.  Asthma nebulisers hadn’t worked, and all you could fixate on was her chest desperately trying to pull air into her lungs.

So she died, a frightening and painful death.

The doctor and I went to tell her parents.  They were in the relatives room, I could barely see them as I walked in, the clouds of smoke filled the air.

They cried, of course they cried.

Then they went outside and have a cigarette.

Then they came back inside the resus room and sat with her body.

The father lit up another cigarette.

 

This is why I hate asthma, this is why I hate people who smoke when they are pregnant, this is why I hate people who smoke around children.  Kill yourself if you want to, but don’t kill your kids.

This is why I hate people who smoke around their asthmatic children or, if I mention that smoking aggravates asthma, they send them in their nightclothes to stand in sub-zero temperatures.

There are jobs that haunt you.  This was one of them.  Try calming down an eight year old girl who is dying in front of you because they can’t breathe.  Then try and forget about it.  I did a cot death once, beside the cot was a full ashtray.  Sure the parents are punished by the death of their child.  But it doesn’t help the child…

As I typed this I realised that I was clenching my teeth.

I'm sitting on station at the moment, unable to go anywhere because I don't have an FRU car.

The reason for this is that my mate working the day shift has crashed it into another car. I'm not too sure on the details, as he's currently in the hospital being checked over for injuries but the word so far is that it's minor injuries only all round.

Add in the FRU that I mentioned yesterday which was crashed last week, and there is a distinct lack of motors to go round.

(Also I think that the fancy new Zafira I had yesterday is having an engine repair done on it).

I'm sure that it's nothing to do with this spate of crashes, but because of our ORCON times, we did all get a memo a week or so ago telling us to try and drive to calls a bit faster...



I think I'm getting a station officer's car after 10pm, I'll try to be careful.

I'm not perfect.

I arrived at work to find that my FRU car was nowhere to be seen. There was no-one on the early shift, so where had my car gotten too?

Last week a friend of mine had an accident in the Newham FRU car (in front of a load of police officers, which gave them some amusement I would imagine). So the car that I would normally use was being borrowed by Poplar station.

So the plan was for me to get picked up at my station by a station officer, then I would get the keys to the brand new Vauxhall Zafira. I'd thgen return to my station and start working.

The station officer met me and drove me down to Newham station. He asked me that, because I was leaving my secondment on the FRU, if I could write up my thoughts on what was good, bad and what could be improved about it.

I told him that this blog would answer most of those questions.

The brand new Zafira was parked in the garage at Newham, so I hopped behind the wheel and after some struggling with the new design of handbrake, managed to reverse it out of the garage and into the parking area.

Where to the absolute horror of the Station officer I drove into another car.

Oops.

Luckily there was no damamge to the Zafira (which has less than 600 miles on the clock) and very slight, if any, damage to the private car.

The first accident I've had in over 18 months and it's in front of a station officer...

Not a good start to the shift.

My thoughts on the Zafira are this - if you wanted a rapid response vehicle, the Zafira shouldn't have been chosen. It's top heavy and wallows like a hippo in thick mud. The acceleration is awful, you hit the pedal and it takes one and a half seconds before the diesel engine gives you any sort of power. It is comfortable to pootle around town in, and the high up viewing position is quite nice.

But there is no way that it could be considered a 'Fast' car.

I think the reason why we have them, is because they are able to carry patients, and I imagine that soon FRU drivers will be asked to take the coughs and colds that we see so much of of to hospital.

I am tired, and in an incredibly bad mood after this shift. I'll explain more when I can motivate myself to write about it.

Of course, there may be potential hazards with working in an ambulance.

Hey, just because I’m leaving the FRU doesn’t mean that there is a lack of people willing to take my place.  All they have to do is listen to our management as they insist we spend more time sitting in the car (which is bad for my back) and that we faster to jobs (which is bad for my safety), and maybe spend time on standby on night shifts (which unions successfully stopped double crewed ambulances from doing, because it’s just not safe).

At the end of the day, sick people need to be in hospital, not in their own home, or on the side of the road with me standing over them watching as they get sicker and sicker.  Sure, I can give some lifesaving treatment, but this is only for a few specific illnesses.

What we need on the road are not more FRUs, which exist mainly to get our ORCON times up, what we need is less people calling ambulances more ambulances on the road.  We need more ambulances than we have at the moment, as total numbers of ambulances have hardly increased in the past ten years, while our workload has soared.

This really needs to be a subject of a long post all of it’s own.

As an example – consider Christmas Eve night.  After 1am, there were no ambulances from the busiest complex in London.  Other complexes had to cover Newham, Poplar and West Ham.

There was one FRU.

At the end of the day I believe that I will be providing better help, to more people, working on an ambulance rather than a FRU.

I think I’m going to be leaving my job soon.

I went to a six month old baby, possible meningitis.  The baby had the right sort of rash (although it was only on the back of the knee, and nowhere else.  I checked).  It had a temperature, but was one of the happiest, most alert children I’ve ever had the pleasure of meeting.  It just didn’t seem as if it had meningitis, and trust me, I’ve seen a fair bit of children and adults with meningitis to have a pretty good idea.

Then, like my previous post, I was left waiting for an ambulance.

I think it was around 45 minutes.

There was no way I was going to be able to transport the patient in my car.  It’s just not equipped to carry such a small child.

So the family ended up phoning a friend to take them to the hospital.  The ambulance turned up just as they were getting into their friend’s car.

All I had going through my head was “No Ambulance For Baby Dying Of Killer Bug!”.

Later that night I went to a woman who was having an extremely painful miscarriage.  There is nothing I can do for that, the patient needs to be in hospital.  Thankfully the ambulance wasn’t too far behind me, but if I had been waiting on scene, then it would have been a very awkward and distressing wait (again, because of the pain, it would have been impossible to transport her in my car).

More and more I’m looking at my watch as an ambulance fails to arrive.  It’s only a matter of time before I have someone die in front of me while waiting for an ambulance.

So, I’m seriously considering leaving the FRU/RRU and going back to work on an ambulance.  That way I can pick up sick people, and take them to where they need to be.  A hospital.

So after the holiday season, I think I’ll be sending a memo up to the office asking to return to my ambulance role.

The reason why there is a shortage of ambulances?  Partly the season and the increased number of calls, partly because while the population of our area has increased the number of ambulances haven’t, and partly because of a lack of manning.  Oh and that we have to go to crap jobs.

A big thanks to all the people who sought out their local ambulance stations and similar to feed them.  A personal extra big thanks to *version 3.1 who, besides having the best fancy dress costume ever, left a lovely package full of sugary goodness at my station.

Also, thanks to everyone who wished me and my fellow workers a merry Christmas.  It’s all appreciated.

Big news tomorrow…

The staffing of ambulances at the moment is…to put it bluntly… poor.

Working on the FRU/RRU means that I often get to a call within minutes (yes, within 8 minutes) of that emergency call being made.  Unfortunately with so few ambulances on the road, the patient and I are often left staring at each other for long periods of time.  Up to an hour in a couple of cases.

I was sent to a young man having an asthma attack.  It was late at night, and he had been queuing to get into a nightclub, had started to feel his breathing getting tight, so had headed to a taxi office in order to go home.  Unfortunately his asthma progressed and so an ambulance was called.  What he got was me.

After dealing with the drunk group of teenage girls that were waiting for a cab, loudly ’caring’ for my patient, I started my assessment.  It was a cold night so I sat the young man in the taxi office, and listened to his chest.  I could hear a nice loud wheezing from his lungs, so I started him on the first dose of our asthma medication.  I got his details and vital signs, and waited for the ambulance to turn up.

It takes between five and ten minutes for the asthma medication to finish, and by the end of it there was still no ambulance.

I listened to his chest again, still an audible wheeze, so I gave him a second dose of the medicine.  So there he was, sitting in a cab office at three in the morning with a mask over his face, ‘smoke’ pouring from it, and all around us were intoxicated people getting cabs home.

Not very dignified.

We started chatting, and I was impressed by this polite young man with manners and common sense.  The second medication finished and so we continued to wait, and wait, and wait for the ambulance.  I phoned up my Control and asked them if there was an ambulance assigned.

“Sorry EC50, we are still holding calls in that area”.

So I was on my own with this patient for the foreseeable future.

Sometimes I can transport a patient myself to hospital, it’s not technically allowed.  Actually we’ve been told that we shouldn’t do it at all, but in some cases I think I’m doing the right thing for the patient.  So I will load them into the car (which only has the front passenger seat, the rest of the car is taken up by equipment) and nip into the nearest hospital.  Control are often happy for me to do this, as it means one less job that they need to send a proper ambulance to.

I couldn’t transport this patient though, he wanted to go to his local hospital, which would mean driving past two other emergency departments and out of my area.  I couldn’t see Control, or my bosses being to happy with that.

So the patient got a cab to hospital.  At his insistence.  The double dose of medicine had cleared his lungs up nicely, but he would probably need some short-term steroid treatment.  I rechecked my assessment of him, and was happy that his physical condition was well enough to get a cab to hospital.  But I wasn’t happy that there was no ambulance for this patient who actually warranted an ambulance.

As I write this I wonder what would have happened if he hadn’t responded to the medicine that I gave him.