Wow!
If this is what it’s like in America – when can I move out there?
(Maybe the LAS could make our own version of this recruitment video – mind you, it might be a little bit different…)

I went to two cases of adult chickenpox last night, the hospital says that there was another adult with chickenpox the day before that. It seems like we have a little outbreak here.

As both my patients were Nigerian, I have a sneaky feeling that the big (mainly Nigerian) church in Newham may be where the disease was spread and the timing of the symptoms would support this.

As one of the families had school-age children with the disease, I'm going to guess that a lot of children will be ill over the next few days.

Off the top of my head, I can't remember if I have been vaccinated against chickenpox - but I do know that I had it twice when I was a child, both times at Christmas.

I'm writing this at 3:20am, and I'm stuck on station because my fast response car seems to have gone into 'safe mode', and I can't drive faster than 25mph.

Which is a bit slow for a 'Fast' car.

The book is going pretty well at the moment (although as I'm working for the next two nights, I'll be taking a break from it)

Finally - these three shifts, Friday, Saturday and Sunday night will be the last I spend on the FRU. From Monday (well... my first shift is actually on Friday) I shall be back to working on an ambulance.

Joy!

UPDATE: For some reason (writing at half past three in the morning with no food or rest perhaps?) I wrote 'measles' instead of 'chickenpox'. Post has been updated to correct this.

I’ve had a couple of people send me this.

 “Nursing staff from a Telford hospital have been accused of using an ambulance as a taxi after a night out.

 It was claimed some of the nursing staff got into an ambulance outside The Swan in Ironbridge on Sunday.

The ambulance service has found a crew did provide unauthorised transport to staff but said it was not in operation and returning to base at the time.”

To be honest this tends to happen a bit.  You tell the nurse “hop in the back, we’ll give you a lift – if we get a call you’ll have to hop out again”.  It helps keep relations good between the hospitals and ourselves, and it doesn’t hurt anyone.  It definitely doesn’t remove an ambulance from service.

In fact it can do good – a crew I know was giving a nurse a life to the train station after her shift finished, they then got a call to a cardiac arrest and the nurse was able to help out.  As long as the crew weren’t refusing calls, then I can’t see the harm in it.  In London I’d imagine that our Control would love it – as it would mean we are out ‘roaming’ rather than sitting on station, something Control management are eager for us to do.

And if I’m going to spend all shift taxiing drunks around, I don’t see why we can’t sometimes help out the poor buggers who work their fingers to the bone looking after those same drunks.

I wonder if the person that complained is the sort of person who expects an ambulance to turn up seconds after they’ve cut their finger?

So… What is the new and expanded role of the ambulance service?  It’s actually one of the better ideas, but why it can’t be done by the hospitals mystifies me.  I’ll let the memo tell you.  (PRF= Patient Report Form)

Routine screening for early diagnosis of diabetes

There are over two million people in the UK who have been diagnosed as diabetic. Because of modern diet, lifestyle and the way populations are changing diabetes has become one of the UK’s fastest growing diseases – the number of diabetics is likely to double over the next five years (it is already estimated that there are about one million undiagnosed diabetics in the UK).

The majority of people with diabetes have Type 2 diabetes, which usually occurs in people over the age of 40. The older a person is, the greater their risk of developing Type 2 diabetes. Due to a complex range of factors including genetics, cultural and lifestyle differences, people from a black or minority ethnic group are at increased risk over the age of 25 and are four to five times more likely to develop Type 2 diabetes than people from white ethnic groups.

The longer diagnosis is delayed, the more chance there is that people with diabetes will go on to develop serious and life-threatening complications – kidney failure, blindness, lower limb amputation and increased risk of coronary artery disease and stroke are all potential results from undiagnosed, and therefore untreated, diabetes. Once diagnosed, diabetes is a manageable condition, and diabetics who manage their condition are better able to lead full, healthy lives.

In view of the above facts, the Department of Health’s National Service Framework for Diabetes sets out a vision for ‘fewer people developing [Type 2] diabetes.’ Part of the approach for realising this vision includes increasing the number of people who are screened for diabetes, particularly those who are more at risk.

To contribute towards this goal, whilst continuing to test the blood-glucose of patients who are known diabetics, EMTs, paramedics and ECPs should routinely test the blood-glucose levels of all patients who are:

1. • 40 years of age or over
2. • 25 to 40 years of age with one or more of the following pre-disposing factors:

1. o from a black or minority ethnic group
2. o a history of diabetes in close family (mother, father, brothers and sisters)
3. o overweight (BMI of 25-30 kg/m2 or above) with a sedentary lifestyle
4. o ischaemic heart disease, cerebro-vascular disease, other circulatory problems or hypertension

Where blood-glucose testing would not normally form part of their assessment and treatment, the patient’s consent should be sought before the test is carried out, explaining why the test is being done.

If a patient declines to consent to the test this should be recorded on the PRF. The results of the test should be recorded in the usual way on the PRF.

If the blood glucose reading is outside normal limits (above 5.6 mmol/l or below 3.0 mmol/l) in a non-diabetic patient, this information should also be passed to the receiving staff upon handover at the receiving hospital unit.

If the patient isn’t conveyed, the pink copy of the PRF should be left with them, and they should be advised to see their GP to discuss the test results. Generally, the hospital or GP will diagnose diabetes when two separate blood tests reveal blood glucose levels above 7.8 mmol/l before eating or above 10.0 mmol/l after eating.

The screening for diabetes should not take priority over assessment and treatment pertinent to the patient’s presenting condition, nor should it contribute to unnecessarily extended times on scene.

So, during our roaming around we are to check the blood sugar of pretty much all out patients to screen for diabetes.  Got a twisted ankle?  Get a free trip to hospital with added diabetes check.

It’s not a bad idea to be honest, if we can detect diabetes earlier, then we can better treat it.  But, I’m betting that we aren’t getting any extra money for this new role…  Also, given the make up of Newhams population, I’m going to be checking the blood sugar of pretty much everyone over the age of 25 I go to.  I wonder if this is why we currently have a shortage of the blood sampling needles?

As for the person who suggested that we are about to be asked to work twelve hours without a break – we already are expected to do this, we get £7.10 paid to us because we don’t get any breaks.

Later I’ll tell you about another role that we seem to have taken upon ourselves.

I’ve had cause to realise another reason why I enjoy working for the ambulance service as opposed to working as an A&E nurse.

I was woken from my sleep at eleven in the morning by a phone call from my mum.

“I’m really ill, I can’t stand up – please come over”, she sounded really scared.

I rushed over to my mum’s house, as I walked in the door, and saw her sitting in her armchair I thought she was dead, she was pale, and didn’t answer when I called out her name.  Thankfully she wasn’t dead, just a bit deaf.

She had been doing the laundry when she suddenly became dizzy, she’d vomited once, and now was so dizzy that she couldn’t stand up.  Her pulse was slow, and she looked ‘shocked’.

So against her protests I called for an ambulance.

“Look”, I told her, “I get called to people with cut fingers, you are my mum, and you are properly sick – you’re getting an ambulance”.

The calltaker was quick and professional, which is what I would expect and the ambulance was there very quickly.

The ambulance crew were friendly, understanding and professional.  They used the carry chair to get her out to the ambulance, did all the tests that they could do and when she started vomiting again they stuck the blue lights on to get us through heavy traffic.  The attendant spoke to her like a human being, and I could see that she was putting my mum at ease.

We reached the hospital, and this is when I saw the real difference.

The nurse who took handover didn’t even look at my mum, “take her out to the waiting room”, the crew were told.

The ambulance attendant tried to persuade the nurse otherwise, but the nurse was adamant.

So we ended up out in the waiting room, with my mum unable to move.  All the time the ambulance crew were apologetic.

It took three hours before she was treated, and to be fair the doctor was excellent.

But…

As an ambulance crew, with one patient, you can give your full attention to that one person.  You can care for the patient, and if you are ill and scared that is often the best thing that you can do for them.  You have that chance to do a bit of hand-holding, which can often be a great treatment.

As a nurse in an A&E department, all you seem to have time for is moving ‘patient X’ through the system before your four hour time limit is up.  You don’t have the time to care for the patient, only to give them drug X, treatment Y, and get them out as soon as possible.

So this is why I like ambulance work – it gives me the chance to act like a nurse.  Something I never had the chance to do when I was employed as a nurse.

Mum was fine after treatment – It turned out to be her arthritic neck, coupled with muscle spasms causing spinal nerve stimulation, an uncommon complaint but the doctor recognised it pretty much straight away.  She’s fine now.

I’ll answer the previous post (about our new role) tomorrow.

 

Blogging is continuing to be a bit light as I’m making a bit of a push on getting the book done.

So I’ll ask you a question.

As an ambulance service our main role is to quickly get to sick people, stop them from dying and take them to hospital.

But it’s not that all we do, we help plan for major incidents, do school visits, run CPR courses and the like.

So…what do you think is the latest thing us frontline ambulance staff are expected to do?

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