It was cold, it was dark and it was occasionally raining the sort of thin greasy rain that soaks straight through your clothes.  I was making my way to one of the Docklands Light Railway stations for a ‘Male – collapsed, caller not willing to approach patient’.  I’d been to this station in the last week for a hoax call and I wasn’t sure if this was a repeat performance.

At the bottom of the stairs just sheltered from the rain was a young man in his twenties, dirty, dressed in filthy clothes and curled up next to a plastic bag.  Standing over him was another man, this one dressed in a suit, he was looking a bit concerned.

The London borough of Tower Hamlets has both the richest, and the poorest population in London

“He’s just laying there, not talking”, the smartly dressed man said, “I didn’t really know what to do…”.

I let him know that I’d take care of the patient, and that he had done the right thing and could go home.

It was just me and the patient.  Given the way he looked it was a reasonable assumption that he was homeless.  If he was homeless then there was a reasonable assumption that he was drunk and given that he was in such a public place there was a chance that there was something physically wrong with him.

I tried to wake him up – he was holding his eyes closed when I tried to open them, so I knew that he wasn’t really unconscious.

“Look mate”, I said, “If you don’t open your eyes, I’ll have to check your blood sugar, which means poking a needle into your finger.  If you open your eyes then I won’t have to do that”.

No response.

So I checked his blood sugar along with the rest of his vital signs, everything was fine.

I crouched down opposite him.

“Look, you can open your eyes and talk to me you know – we’ll still take you to hospital.  To be honest, I can’t blame you, an A&E waiting room has got to be an option on a crappy night like this”.

Some commuters walked between us, they didn’t look at us.  I looked in his plastic bag, there was a sociology textbook.

“Sociology?  I could never enjoy reading that sort of thing”.

He opened his eyes, “S’all right”.

Excellent.  He was talking to me, which meant that the paranoid voice in the back of my head telling me that he might be seriously ill could shut up.  It’s something that always worries me – that despite my experience I’d miss something serious on a drunk or homeless guy.

We had a little chat while I was waiting for the ambulance to arrive.  He’d been a rough sleeper for two years, he admitted to drinking too much.  He seemed like an alright kind of person.

“Bloody freezing tonight”, I said to him, “I reckon the hospital has got to be a fair bit warmer and drier tonight”.

“I don’t want to go to hospital”, he said back to me.

I was surprised, “Are you sure mate?  It’s no skin off my nose if we take you in”.

“Yeah, I’m sure.  I’ve just had too much to drink”. He mentioned a hostel nearby, “Which way is it from here?”

So I pointed him in the direction of the hostel and he wandered off down the road.

I’ve got to admit that I felt sorry for him – I didn’t know why he was homeless, and I’m not a strong believer that all homeless people are victims, but because I’d sat and spoke to him, because he hadn’t tried to hit me and because he seemed like a reasonable person I felt some sympathy for him.  He must have made some sort of impression on me as I can still remember the job six weeks after it happened.

Maybe I’m just getting soft in my old age.

Remember when I asked you to go vote for me for the Medgadget awards?  Well I won…twice, both best Medblog, and best Literary Medblog.  Nee Naw (also London Ambulance Service) won the Best Newcomer award.  A bit of a full sweep for us London ambulance people then.  You can read about it here.

So thanks for voting for me, it’s very much appreciated.

I left work this morning with a song in my heart and joy in my step, last night was my last shift on the FRU car.

No longer will I be standing around with my hands in my pockets for 45 minutes while a six month old child lays in front of me with possible meningitis.  No more will I be told by Control to go and drive around and look busy when there is something good on telly, and no longer will my only conversation with people consist mainly of “where does it hurt?” for twelve hours straight.

I have four days off, and then from Friday I’m back to working on a ‘truck’, a nice big person carrying medical-taxi truck.

Lovely!

The Driving Instructor (frequent commenter and jolly good read) asked if I would miss the FRU.  Does this answer your question?

I was hoping that this last shift would fly by in an exciting cascade of trauma, life-saving and dramatic illness.

*ahem*

It was actually a fairly quiet night, I did seven jobs, four of them being people with coughs (one cough having lasted three weeks before he decided to call an ambulance at 5am in the morning), my last call was to an elderly gentleman with emphysema (and a cough) who actually needed hospital treatment.

However – my first two calls were to drunks.

The first call was a young man, who after having an argument with his family drank a bottle of wine and pretended to be unconscious.  We loaded him into the ambulance, and as I had a ‘funny feeling’ about the job I traveled in the ambulance with the patient and the ambulance crew.  During the transport it seemed that he took a dislike to me and opened his eyes just enough to plant a heavy slap to the inside of my leg.

I may have swore at him.

My second job was a ‘classic’ – ‘Male collapsed in street, unknown life status – caller refusing to go near patient or answer any questions’.  So I rushed round there and found two female police officers standing over a drunk male who was asleep in the street.  I did all my normal checks to makes sure that he was only drunk (as opposed to being drunk and in a diabetic coma, drunk and has had a stroke, or drunk and has been stabbed).  Everything pointed to him being just drunk.

We woke him up and were prepared to send him on his way.  He stood up – took one look at me, and smacked me in the mouth.

I ‘assisted’ him onto the floor.  The police officers and I then stopped him from injuring himself by sitting on him in a professional manner.

The police have been trained in restraint – they are all careful because they don’t want people dying of positional asphyxia.  I haven’t been trained in restraint (well not in the ambulance service) but I’m guessing that someone isn’t going to die because I’m kneeling over their arm while holding their wrist.

So we carefully restrained him (for around twenty five minutes), while he explained how he was either going to kick my head in, or sue me.  By then the police had tracked down a, now mortified, relative who came and took him away.

No damage done to me, although I would think that as he wakes up this morning he’ll have a number of bruises.  I hopped in my car, told Control that I had been assaulted twice in two jobs, so I asked if I could head back to station for a calming cup of tea – which they let me.  They also made sure that I was alright and didn’t need any other help.

As a question to any police officers reading this.  The man was drunk and had (in a minor fashion) assaulted me, and attempted to assault two police officers, yet there was a real reluctance to arrest him.  I’m wondering if this is because there would be little or no chance of there being a prosecution?  Or is there some other reason?  I’m not moaning, just curious…

When my mother found out about my being assaulted, did she ask how I was?  Did she ask if I had been hurt, or damaged?

No. 

Her comment was “At least you’ll have something interesting to blog about”.

Bloody lovely that is…

 

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?