I had a job that required me to undertake an extended role.

The call came down as 'Patient's own hospital bed broken, patient stuck', rather predictably I had visions of some little old lady folded in two by an electric bed.

The 'patient', as it were was sitting in their chair, he husband was running around flapping and the domestic carer was looking confused.

The bed was a type that I had never seen before, it had a hydraulic ram underneath it which tipped the mattress on end by 90 degrees, I suppose so the patient sort of 'slides' into an upright position.

The bed was stuck in this upright position - if the sheets had been black it would have looked like the Monolith from 2001.

After some fiddling around (a technical term) I managed to get it into the horizontal position and checked that it would raise and lower as designed. I'm grateful for my various experiences fixing broken things.

So ten minutes later, after pointing out the rather large print on his bed's instruction folder (Which said 'Emergency out of hours technician ring 0800 xxxx'), and we left another satisfied customer.

I decided to have a joke with Control.

"Control, The patient's bed is fixed, I'll do my paperwork for this job then I'll be ready for any blocked gutters or windows that need fixing".

Funny how people panic and call us...

I have a problem with knees, partly it's because I'm slightly squeamish about them, partly because when they break or dislocate it is incredibly painful for the patient.

Our woman had slipped on a wet floor, she had landed on her knees and, after we drove across most of our patch to get to her, we found her laying on the floor.

Upstairs.

In a narrow corridor.

She wasn't a 'small' person either.

My physical examination led me to believe that she had broken or dislocated her knee - it was a bit tricky to examine her in the enclosed space she found herself, her weight didn't help either.

The patient was lovely, she understood why she had waited so long for an ambulance. She'd also taken some painkillers before we arrived, something that is an absolute rarity. She was nice to talk to and when I explained that we would take things slowly for her benefit she understood.

First thing that I did was to give her some of our painkiller gas entonox. Then I slipped a splint around her injured knee, this combination seemed to help the pain a lot. She proved to be a good patient by immediately understanding my instructions on how to take the entonox - another rarity in our area.

The staircase that we needed to get her down was steep and narrow, there was no way we could use our carry chair. She would have to be strapped to our scoop and carried down the stairs that way. But we would need help.

I'm 6'1", my crewmate is 5' 1 1/2", not the best combination of sizes for getting a large woman downstairs on a scoop (although my crewmate would like you to all note that she (believes) is the strongest one out of the both of us). So we called Control for assistance, namely another crew or an FRU person. We were assured that one would be on their way.

While we were waiting we placed her on the scoop and started the long process of strapping her to it so that, when we tilted it by 80 degrees to get her out of the house, she wouldn't slid out of the scoop like someone being buried at sea.

After some time one of our Emergency Care Practitioners arrived and he gave us some much needed help in man-handling the patient down the stairs and into the ambulance. We took the patient to hospital where x-rays showed a dislocated knee.

This is what I like about my job - This job wasn't about saving someone's life, it was about causing them as little pain as possible while solving the puzzle of how to get the patient out of the house all while keeping them as calm and happy as possible. It's not a 'buzz', but it is the satisfaction of a tricky job well done.

As you may know (if you have ever read this site before), I enjoy a little game called 'World of Warcraft'. For those that don't know about computer games, you take control of a little person, team up with other people and delve into dungeons to kill evil monsters in a fantasy setting¹.

One of the essential things that you need to do before your character enters these large dungeons is to make sure that you are carrying a stock of 'health potions', magical drinks that heal the damage that you character may have taken in the aforementioned fighting of monsters.

I can remember to stock up on these life-saving potions, and this is just a computer game².

So, to translate this into a real world situation if I needed a 'potion' to survive, I'd be damn sure to carry it around with me.

Why then do I find myself going to asthmatics, many of whom are old enough to know better, who let their life-saving inhalers run out? If I were asthmatic I'd make sure that I always had at least two inhalers at all times. Or is there some bizarre flaw in the way these medicines are allocated.

I'm sure that if I were like my last patient (unable to sleep without at least one 'blast' on my inhaler) I'd have one tied around my neck. I could maybe understand it if my patient were a teenager, but this patient is a full grown man.

Oh well, just another mystery for me to ponder.

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¹For those who play, yes I know this is hugely simplistic

²I'm addicted but I can still call it 'just' a game

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.