Blah...blah, ORCON...blah...lack of patient care...blah...blah...stupid government target...blah...blah...no rhyme or reason...blah...blah...

You have heard me ranting about ORCON many times in the past, about how it causes a reduction in patient care, how it isn't a good reflection on an ambulance service and how there seems to be no evidence as to why eight minutes is so important. Whenever I've asked about the magical eight minute figure no-one has been able to give me a straight answer.

The (excellent) Magwitch has taken on this mystery that no ambulance person has been able to answer and has detailed his findings here. It's a superb read and I suggest you all take a look at it, and the comments, and decide for yourself why the reasons for this target seem to be hidden.

I think some further investigation is needed. Anyone an expert on the British Library?

There is a road on our patch that I'd never been to before, there are only thirty or so houses in it. However, in the past two weeks I've been there on four occasions.

Last night I was there because someone had slipped and fallen on the floor. Last week I was there for an ill child, but it was the first two times I went there that will stick in my mind. They were both on the same day.

It was the first call of the evening, a 'difficulty in breathing' for an elderly woman. We entered the house to be surrounded by a large number of relatives, this isn't unusual it was an Indian family and they tend to be large. The patient herself was a very frail and bedbound elderly woman, she had had many strokes in the past and was dependant on her family for her care.. It didn't need the FRU paramedic to tell us that she was extremely unwell. The patient was unresponsive and had laboured breathing. She had a sheen of sweat on her, a sign that her body was struggling and she was completely unresponsive.

It soon became obvious that the patient had pneumonia and wasn't shifting enough air to keep alive. We loaded her and one of her relatives onto our ambulance and 'blued' her into hospital. The relative seemed resigned to our patient dying, we couldn't disagree with them.

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By the time we took our next patient into the same hospital, all the relatives had arrived. They had spoken with the doctors and it was decided that it was in the best interests of the patient to not pursue any active treatment, and instead to let her die. The relatives had asked if they could take her home, and the hospital was in the process of arranging transport for her.

It must have been a hard decision to make - having seen many, many futile attempts to save someone's life, it always seems to involve pain and suffering as needles are pushed through skin, drugs with nasty side effects are given and breathing tubes are inserted. It was brave of the patient's relatives to make that choice that this moment was the end of their loved one's life and that it should be as undistressing for the patient as possible.

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It was less than an hour later that we were called back to the same address, the job was given as 'patient deceased'.

What had happened was that the hospital transport had taken the patient home and, before they left, the patient died. They then advised the relatives to call for an ambulance.

So we arrived and everyone decided that it was for the best not to resuscitate her. We offered our sympathies and arranged for a GP to come out to certify the death.

The family were lovely, they offered us tea and thanked both us and the hospital for what we had done. We hadn't saved her life, but we had allowed her to die with some dignity at home, rather than being treated futilely on a hospital trolley.

When I went back to the same address a couple of days later (for the sick child), I saw the funeral notice on their front door. Last night when I went back to the same street for the woman who'd fallen over, one of the family came out and thanked us again.

Four times to one small street, and with a family and a 'job' that I'll remember for a very long time.

Lots of anger tonight.

The local A&E departments are full, the nurses in charge are doing juggling acts in order to try and get patients in a position to be examined by the doctors. Waiting rooms are full and in at least one case there are no beds left in the hospital while plenty of patients needing admitting.

I explained to one patient we brought in that this is why she had to go to the waiting room - there just wasn't room for her and her two-day old headache to lay on a trolley...

"Fucking hospital, always some excuse!".

It took some restraint on my part to not shout at her to open her eyes and take a look at the crowded department she was standing in, to look at the staff charging around doing a dozen things at once, and to consider that this headache perhaps wasn't the highest priority illness that night.

The expectation of patients is much higher than that which can be provided. Even when it is obvious that the department is being overloaded, the desire to get their 'serious' problem cured immediately leads to anger.

Patient tempers were flaring, likewise the doctors and nurses were run ragged. Multitasking is an important nursing skill, especially when, not only do you have to do all your normal nursing duties, but you have to run crowd control on angry relatives and the normal cast of drunks.

I'm writing this post in the middle of my shift and it wouldn't surprise me if there is violence in the department before the sun comes up.

So please explain to me why those complete *expletive deleted* morons in the Ministry of Health are going to be closing two of our local A&E departments? When the current A&E capacity isn't enough, and there is a year on year increase in attendance, shouldn't these people be supporting the A&E departments rather than cutting capacity even more?

Sorry, I forgot - we are supposed to be more 'efficient', people are going to be treated in the community (by ambulance staff at some point in the indeterminate future), they won't need to go to hospital. Remember that 60% of our calls don't need an ambulance. But, and it's a big but, they might need an ambulance, x-rays, blood tests and the like to come to the conclusion that they didn't actually need that ambulance.

Of course, people will still want to go to hospital, and we are unable to refuse. Then when they get there and see queues running out the door they'll complain and make life awful for the folks who work there.

This overloading of A&E departments is one of the things that led me to leave nursing - and I haven't haven't missed the hassle, nor the inability to properly care for terminally ill patients because there were no pillows or blankets in the hospital.

It's sad, but one of my favourite nurses is in the process of moving career because she's getting fed up of trying to bail out a sinking ship. I suppose that this is a governmental success, less departments and less nurses means fewer wages which saves money.

I don't know what they plan to do with the patients though.

This was written when most newspapers had the death of a race horse as the front page news.

I've been a bit lapse in blogging of late, partly because it's been one of the few occasions when I could spend time with Laura (and it will be weeks before I can see her properly again, something that I'm not happy about), and partly I've just been completely overflowing with procrastination. Never mind - I'm looking to blog every day until the new year. Plus do 'other stuff'.

Now to ambulance things.

I love Google, I really do. It does a wonderful job and helps me out in nearly endless ways.

But.

It seems that more and more calls that I go to have a computer running in the background. These computers are often displaying a 'health information' webpage. While I think that having readily available information is a good thing, it is important to be able to interpret that information. It is not enough to read and understand the words that are shown on screen, it needs to be filtered through some form of expert knowledge, even if it is just the skill to use a bit of common sense.

Take for instance a job I went to recently. The patient is a fit and healthy 25 year old. He works on a building site and this involves plenty of heavy lifting. For the last two weeks he has had pain in his left arm. He'd already been to A&E because he was afraid that it was something serious. The hospital did plenty of medical tests, all of which came back normal.

So, why was he calling for an ambulance when the illness was so old? He'd looked on a web-site and it had mentioned that left arm pain can be caused by having a heart attack. He'd read this, then started to have a minor panic attack, as he continued reading it also told him that difficulty in breathing is also a symptom of a heart attack.

Now - most people would realise that, given his history, it would be very unlikely that he would be having a heart attack lasting two weeks. But this patient read the webpage uncritically and so convinced himself that the cause of his pain was cardiac in nature.

Obviously this was one of our high priority calls, so the FRU car was already there although we weren't too far behind. All I could really do for the patient was to reassure him, check his vital signs and symptoms, and then drive him to hospital so that he could be 'checked out'. He was a nice enough bloke and he accepted that some of his symptoms were caused by his fear, so for me it is an easy job and one that got me off shift on time.

I think that you need to develop an easy-going attitude to these sorts of calls, you can get very annoyed by these calls that seem like a waste of time. I just put it down to fear and lack of knowledge, not something a lot of people can do much about.

however with that lack of knowledge rather unfortunately often comes a lack of critical thinking about what turns up on an internet search. While Google can be helpful, it isn't the be all and end all, you still need people who can interpret it, after all 15 out of 26 diagnosis isn't that good a hit rate.

It was supposed to be a simple job, pick the little old lady up off the floor and either take her to hospital, or leave her at home. Unfortunately there were a number of complications.

The first complication was that there wa a powercut in the area. As it is the middle of the night the whole place was pitch black. We have lovely torches in our ambulances. Well... It turned out that we had 'A' torch. It wasn't working.

Brilliant, all our actions would be under the light of our pentorches.

We managed to find the house quite easily, there were two candles in the window. The paitnet herself doesn't open the door, she's too scared. Instead one of her neighbours has a key and lets people in. He wasn't much younger than the patient herself and had been drinking a little.

We arrived and, under feeble torchlight, managed to determine that she had a black eye, a cut on her shin and a small cut on her face. She refused to go to hospital. All she wanted to happen was to be put back to bed.

I looked around, I couldn't see a bed.

The patient sleeps on the sofa because she is too frail to climb the stairs to her bedroom. So she puts lots of pillows on the sofa and throws a blanket over herself. Because of the powercut she didn't have any heating either.

Like Ms Nightingale before me, this (ex)nurse was forced to clean and dress the patient's wounds under candlelight - my crewmate did a good job of holding the candle only dropping it the once.

Still the patient refused to come to hospital.

I asked her if she had any carers, she told me that her son comes every couple of weeks to stock her cupboard with food, but other than that she has no social services/care input at all. This is partly why she was sleeping downstairs on the sofa, she hadn't been offered to have a stairlift put in.

I wasn't very happy to leave the patient at home, but she had the capacity to refuse treatment so I had no choice. In a case like this I like to have a GP come to visit to make sure that I haven't missed anything important (I know my limits). Unfortunately the emergency GP couldn't give us a time when he would be able to visit - as the keyholder was going to be going to bed (it was edging on to 11pm), there would be no-one to open the door for them.

So with some regret I arranged to have the patient's own GP come out to visit them in the morning. It was basically the best I could do for the immediate future.

Then the patient needed to use the toilet, my (female) crewmate took care of this for me (for which I'm very thankful). It was about now that I realised that the light on my pocket pc/camera made a really good torch.

For a longer term look at her care I filled in a 'vulnerable adult' form. This got faxed off to our Control who then deal with any concerns that we raise. In this case they will speak directly to the local social services and hopefully they will provide some help to enable this patient to live safely in her own home.

I have to do all this, it's how I get to sleep at night. If I'd just left her and crossed my fingers then I'd be worrying for days about her. By doing all the above I've done all that I can, and it is now up to the GP and Social Services to do their job.

A conscience is a terrible burden sometimes.

Of course it would have all been a lot easier if there hadn't been a powercut, if it wasn't during the hours of darkness (when the regular services all vanish) and if she opened her own door.

Actually it would have been much easier if I'd been able to persuade her to go to hospital.

A tricky job to write up as it touches on a ‘thing’ that has squatted in the back of my head for some time.  Something I thought I dealt with years ago, but obviously haven’t.  My mum will read this and I don’t think it’s something I’ve ever really talked to her about, but I asked her if I could write this, and she agreed.

We were stuck in traffic on our way to someone with a headache.  It was a ‘Green’ call so we didn’t need lights and sirens, we just had to trundle there, pick up the twenty year old and trundle into hospital.  It’s a nice easy job and gets us a bit closer to the end of the shift.

Then we heard Control asking if there were any free ambulances to attend to a female who was giving birth, the nasty bit was that the woman was only 26 weeks pregnant.  Control told everyone that the babies head was visible.  We called up and mentioned that we were on a low priority job and if they wanted to send us we would quite happily go.

A crew was already on their way and as the information came in that the woman has just given birth we were dispatched as a second crew to help out.  If she has given birth to such a premature baby, then every hand can help.

We were on the other end of our patch and the daytime traffic was hectic, but I drove like a demon and we were soon there.  The job was at the top of a block of flats so we grabbed our kit, jumped in the lift and made our way to the right floor.

The doors of the lift opened and standing there was one of my mates with a tiny baby in his hands.  It wasn’t breathing.

“Do you want the baby or the mother?”, he asked.

“Give us the baby, we’ll run with it”, I answered.  With that he handed us the baby and the lift doors closed.

We were met downstairs by the father who had ran down the stairs, so we rushed out to the ambulance to ‘scoop and run’, to get this baby to the hospital as quickly as possible.  All I could look at was how tiny the baby was, it looked like the baby birds that you sometimes find fallen from the nest.  It’s arms were like matchsticks, it was covered with blood and there were no signs of life.  My mate was in the back doing trying to resuscitate the baby while I drove us the, thankfully short, distance to the hospital.

We got to the hospital and the doctors there tried their best, but inevitably the baby was declared dead soon after we got there.

It turned out that the woman, while believing that she was 26 weeks pregnant, was only 20 weeks pregnant, so the baby didn’t stand any chance at all.

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This job shook me up because I believed that it had a chance.

I was less than a year old when my mother gave birth to my brother Mark, he was premature at 23 weeks gestation.  Survival rates for child at that age today are around 17%, back then in the 1970’s it was much lower.  After a few days of life my brother died.

I thought that it was something that I had put behind me many years ago, that I had a brother I’d never met, who’s grave I’ve never seen.  It’s not something that we talked about much as it still pains my mum to think about it.  Some years ago, for no reason, I started wondering what he would have been like if he had survived.  I long thought I’d put those thoughts behind me, but looking at a child that I thought was 26 weeks gestation brought those memories flooding back.  I wondered if that had been what Mark had looked like.

At the hospital there was an officer – he told us to return to station to have a cup of tea and a ‘de-stress’ and to return to work when we felt able, also that if we wanted to talk, he’d be around to listen.

A cup of tea helped, and I felt able to keep working after a little sit-down.  But now, as I write this, I can feel the sadness in my chest – not for the child that never had a chance at life, but for the brother that I never met.

Once more this blog turns into therapy.

Four jobs into the shift and none had wanted to go to hospital, it was a mix of the uninjured and the ‘can’t be bothered’.  This is not normally a problem, but in this case my crewmate really wanted to use the toilet.

“Two people stuck in a lift for two hours, one has collapsed.  Fire service on scene”.

Great…this could take hours.

So we dutifully made our way to the train-station when the lift was stuck and, after traipsing around a bit carrying our kit, managed to find the affected lift.  There were a couple of firefighters, some station staff and three lift engineers.  It turned out that two teenage boys had been jumping around in the lift causing the emergency locks to jam, they had been stuck for two hours and were making a lot of noise.  From the shouts of both of them it was obvious that neither of them had ‘collapsed’.

There was little for us to do while waiting for the engineers to free the lift apart from chat to the firefighters and watch a fireworks display going on across the river.

Twenty minutes later and the lift was freed and the two little hooligans rolled out.

“Who’s gonna take us to get McDonalds?”, were the first words out of one of the boy’s mouth.

No, “Thank you”, no, “Cheers for getting us out”, and definitely no, “Sorry to waste all your time”.

We told the boys to…ahem… ‘Go home’ and set about packing our gear away.

One of the firefighters turned to us, “Fancy a cup of tea back at our station?”.

My crewmate still needed to use the toilet so we agreed.  A quick drive to their station to ‘use their facilities’ and a nice cup of warm tea.  Excellent company as we put the world to rights and five minutes later we were back on the road ready to continue.  It was handy of them to offer us the use of their station as it was a lot closer than our ambulance station, so we were back on the road quicker than we could have been otherwise.

I’m occasionally dismissive of the fire service (mainly because they don’t wave when we drive past each other), so it was really nice to be human to each other.  And while I do take people as I find them, a simple cup of tea has meant that I can look at some of them in a much different light.

We should do it more often.

 

Actually I think that we should have rideouts between us, the fire service and the police – it’d only help to improve our working relationships (although us ambulance people and the police tend to get on well anyway due to us often attending the same sorts of jobs).

The has been some really interesting conversation over in the comments thread for the post 'Beaten', while I don't have a lot of time to reply to comments I do read each and every one.

The very next day we were called to a woman who had been assaulted. We arrived to find her talking to two police officers in her house, she had been punched in the face and would have a black eye coming up soon. They were getting details on the male who had assaulted her.

The story was fairly simple. The male was her ex-boyfriend but she had stopped seeing him some weeks ago, however he kept coming to her place to persuade her that he still wanted to date her. This time though he had seen fit to break into the house and then to punch her in the face.

The police knew of the male and were trying to get the woman to press charges.

For some reason she didn't want to.

Was it because she knew him and worried that he would come back and kill her if the police were involved? Was it because she didn't want to go through the trouble of the courts? Or was it some other reason? I couldn't understand it myself, but then, having never been beaten, I don't expect I would.

So the police could only refer her to the domestic violence team and leave the patient in our care.

Sometimes I'd like more 'closure' in my work.

For some reason Amazon has reverted to an old draft cover for my book. It makes me glad that we went for the one we did. Amazon should be changing it back soon, so hurry if you are interested. Also, can I take this time to mention that 'Blood, Sweat and Tea' would make a wonderful Christmas present for the whole family (that's one for each family member, not one per family...) Also be prepared for strange posting times as I'm on late shifts this week, which means I can lay in bed as long as I like...