Lets imagine that you are old and need a bit of care in your home – simple stuff, nothing too taxing, just a bit of a hand to help you wash when you wake up.  Maybe you need help with some of the fiddly little tablets you have to take.  Perhaps you just need someone who’ll help you keep your flat tidy.

Then, for the sake of argument, lets say you’ve had a bit of a fall – nothing too serious, it’s just that your legs are starting to get a bit weak, and you don’t want to use the walking frame the hospital has given you.  You are lying by your front door – so when you use your community alarm you are able to let your carer in and then the ambulance people.

The ambulance people quickly check you over while you are on the floor – they let you know that they don’t want to pick you up if you’ve broken your leg.  So you let them examine you, and finding nothing, you ask them if they can just put you in your normal chair by the television.  You wonder why the ambulance crew are tutting at your carer for not at least putting a pillow behind your head while you were stuck on the floor.

The ambulance crew help you up and put you into your favourite chair.  As you aren’t hurt by the fall you don’t want to go to the hospital – you’ll only sit in the department for several hours before some young doctor tells you that you should be using your walking frame.  It’s easier to sit in your own flat.  The ambulance people seem pretty nice though, and they want to give you a full physical check up to make sure that there is nothing obvious that would cause you to fall.

You tell the ambulance people that you’ve been having a few falls, as your legs have been getting a bit weaker recently, but that you get around alright and that you have the community alarm button around your neck should you get into any trouble.  The ambulance people try to persuade you to goto hospital, but you refuse again.  One of the ambulance people checks various pulses and pressures and sugars and heart tracings before agreeing that you can refuse to go with them.

The ambulance person is looking around your flat and tutting at the carer again.  He doesn’t like it that as he walks around he is making a crunching noise as he crushes your tablets which are strewn all over the carpet.  It’s not your fault that you sometimes drop them, I mean, it’s not the carers job to make sure that you can take your pills.

The ambulance man then tells you that as you don’t want to go to hospital, would you mind if we got your GP out to see you.  You agree and the ambulance man says that your GP might be able to arrange to have handrails put on your walls – it sounds like a good idea as you really don’t like using the walking frame.  You tell the ambulance man your GP’s phone number but he doesn’t want to borrow your phone.  He tells you that if his Controller phones the GP then the call is recorded so if the GP promises to come out then they darn well better.  You wonder why the ambulance man is so distrusting of GPs.

The ambulance man then disappears for a bit into the kitchen, he’s talking to the carer before she leaves.  You can’t hear what he says, but his voice seems a little forceful.

The ambulance man comes back and asks you one last time if you’d like to go to hospital, you refuse and the ambulance man reminds you to use the walking frame for getting around – and also to make sure that you have your emergency button on you at all times.  He tells you that he is only a phone call away.  He picks up his equipment and prepares to leave.

You’ve enjoyed chatting to him and his partner, so you try to keep up a conversation – the only person you regularly see is your carer, and she doesn’t talk to you much – she hasn’t said a word to you while the ambulance people have been here.  The ambulance people stay and have a chat with you, but they can only stay ten minutes.  But at least those ten minutes is ten minutes of conversation you wouldn’t have had otherwise.

The ambulance people wave goodbye to your carer as she walks out the door without saying a word.

Ten minutes later you wave goodbye to the ambulance people, and you are left on your own until the evening carer comes.

 

Downstairs in the ambulance, an EMT’s heart breaks just a little.

 

Here is the thing – I’m a pretty poor liar.  I don’t get much practice, I don’t like doing it and as part of my personality flaws I love sharing things that I know with anyone that’ll listen.  Unfortunately in this business you need to try and keep some things to yourself.

I was called to a place of work where a fifty-five year old woman was complaining of constant headaches.  When I arrived on the scene she was being comforted by a work colleague as she had obviously just been crying.  Now – some people would be wondering why an ambulance would be called for a headache, and why I’m not moaning about the waste of resources.

The reasoning behind my not moaning are simple…

• The woman was terribly upset.  This indicated fear, and I’m very forgiving if people call an ambulance because they are scared.
• You are fifty-five years old.  you know all about headaches.  This is different, very different, to the headaches you’ve had in the past.
• I’m getting soft in my old age.

I got a verbal history from the patient – the headache had been coming and going for two weeks and normal painkillers weren’t touching the pain.  there was no other history of ill health, she hadn’t been to the doctor for years and she had no allergies.  She told me that on that morning she had woken up with the headache and also a feeling of “not being connected to the world”.  Once more, her painkillers hadn’t even touched the pain.

A quick ‘n’ dirty neurological examination didn’t reveal anything particularly scary and her observations were all normal apart from a moderately raised blood pressure.  I discounted the blood pressure as her being scared and sitting in the back of an ambulance looking at my ugly mug.

So we had a drive over to the hospital.

All through the trip I could see that her main fear was that she had grown a brain tumour.  The words were never mentioned – but her fear was of such intensity and direction that I knew that this is what she was thinking.  I would have loved to have lied to her.  I would have given a lot to be able to put my arm around her and tell her that there was no chance of the headaches being caused by a brain tumour. 

But I couldn’t.

I had to sit there and explain about all my ‘negative findings’, I could tell her that her pulse was fine, that she hadn’t had a stroke, that her blood sugar was better than mine and that her short neurological exam didn’t show anything unusual.

But I couldn’t tell her what she wanted to hear.

We reached the hospital, and while I handed over to the nurse one side of her face started to become numb…

---

A little later, while returning to the hospital with another patient, I saw our woman in the resuscitation room.  She was sitting up and talking to her work colleague who had accompanied her in the ambulance.  I wondered why she was in there – but was too busy to ask the resus nurse.

---

Towards the end of my shift I saw our patient walking back from the toilet (with colleague still in tow).  I asked her what the doctors had found.

“They are keeping me in”, she told me, my heart sank.  “Apparently I have a really high blood pressure, and that’s what’s been causing it”.

“Oh superb!”, I said, “they can cure that!”.

You could see that she was a lot more relaxed, and that her main concern was that she was now going to be in hospital while the doctors treated her blood pressure. 

Hardly a concern at all.

 

Her blood pressure had been so high, our machine for recording it hadn’t been able to measure it correctly.  Which is a little troubling. 

 

After two days of struggling with people, it was nice to go back to the simple jobs that are a joy to do, it's also nice to see a sense of community.

In this case it was a little old lady who had tripped over a wobbly pavement in one of our local markets. She was surrounded by people of all backgrounds - there was a black market warden who had put cones over the offending paving stones. A Bangladeshi man was chatting to her and two Greek looking men met me at the ambulance and led me to the patient. A Sikh stall keeper also pointed me in the direction of the patient.

The patient herself was one of the dying breed of 'traditional' English East Londoner. Normally an extremely healthy eighty year old, she had a graze to her nose that refused to stop oozing blood. A real pleasure to talk to, we chatted about how the East of London has changed in her lifetime - and how she still enjoyed living here.

"I'm an ethnic minority now", she told me, "but there are still a lot of people around who'll help you out".

And she was right - as an ambulance person I tend only to see the worst of people. I go to the assaults and the arguments. I hear about the murders and the abuse, the neglect and the trouble. Just as this woman was, for me, an unusual patient in that she was a healthy eighty year old, so it was that I saw the 'unusual' event of people helping someone in distress.

One of those jobs that leaves you with a smile on your face for the rest of the day.

After two days of struggling with people, it was nice to go back to the simple jobs that are a joy to do, it's also nice to see a sense of community.

In this case it was a little old lady who had tripped over a wobbly pavement in one of our local markets. She was surrounded by people of all backgrounds - there was a black market warden who had put cones over the offending paving stones. A Bangladeshi man was chatting to her and two Greek looking men met me at the ambulance and led me to the patient. A Sikh stall keeper also pointed me in the direction of the patient.

The patient herself was one of the dying breed of 'traditional' English East Londoner. Normally an extremely healthy eighty year old, she had a graze to her nose that refused to stop oozing blood. A real pleasure to talk to, we chatted about how the East of London has changed in her lifetime - and how she still enjoyed living here.

"I'm an ethnic minority now", she told me, "but there are still a lot of people around who'll help you out".

And she was right - as an ambulance person I tend only to see the worst of people. I go to the assaults and the arguments. I hear about the murders and the abuse, the neglect and the trouble. Just as this woman was, for me, an unusual patient in that she was a healthy eighty year old, so it was that I saw the 'unusual' event of people helping someone in distress.

One of those jobs that leaves you with a smile on your face for the rest of the day.

Yesterday I mentioned having a similar job to the early morning 'madness' of my 68 year old man. It's partly why I asked you to keep in mind that opposites attract...

We were called to a fourth floor flat in one of the many housing blocks in the East of London where we found an unkempt man in his forties pacing back and forth along the access balcony to his flat.

He wasn't wearing any shoes, socks or a shirt, and his trousers and pants were falling off him.

While pacing he was muttering about God and the Devil. Next to him was another man and the next door neighbour of the patient.

The other man disappeared as soon as we arrived.

The patient obviously had mental health issues, but we also suspected something else was causing this change in behaviour. At one point he made to throw himself over the balcony - we stood in his way to prevent him doing this, and more importantly to stop him making us go through the, frankly hard, work of trying to save his life in the face of major trauma.

As we led him back into his flat to get some shoes/clothes we realised that the reason why he was behaving so strangely might have been exacerbated by drug use. We nearly tripped over an empty bottle of methadone.

The flat was - as I've mentioned before, exactly how you would expect a drug den to look. There was drug paraphenalia strewn around the place, mattresses on the floor and the heavy curtains looked like they had never been drawn.

The patient continued to pace around while occasionally becoming quite agitated. While we didn't think that he would become violent we were still rather wary of getting too close to him or letting our guard down.

After half an hour we had managed to get him dressed and were able to lead him downstairs where we *ahem* 'gently' got him into the ambulance.

While I drove us to the hospital my crewmate did his best to keep the patient calm. We pre-warned the hospital that they would need security and the secure room ready for us. Unfortunately the hospital switchboard wasn't picking up the phone so there was no-one there to meet us when we rolled up outside the A&E doors.

At one point he exposed his genitals to my crewmate - something that the patient I wrote about yesterday did to me.

A bit of a struggle began where the patient wanted to jump off the ambulance and run away, so my crewmate and I ended up restraining the patient until security arrived to help drag the patient into the department's 'padded room'.

So for two days on the trot I've been wrestling with patients in the back of the vehicle.

Once more (and this is with a different crewmate) we felt that it was this sort of job that you have to enjoy in order to remain as ambulance staff. While we like the little old ladies, and the two year olds wth runny noses, there is nothing quite like struggling with a 'mad' person in order to get them the care that they need.

What sturck me as amusing was that on consecutive days the first job of the shift was to someone with an altered mental state who was blaming their God and the Devil, and who would later go on to show us their genitals.

I wonder if it's something in the water?

I've been told by those 'in the know' that people with mental illness now prefer to be called 'mad', I think it's to do with reclaiming the term, much as homosexuals have with the word 'gay'.

I’d just like to say that opposites attract.  Just bear this in mind when you read this entry.

Picture the scene – our first call of a beautiful sunny Sunday morning.  Most folks were in bed, so the ambulance station had been particularly quiet, it was 8:30 and no ambulances had gone out.  Then we got a call, it came down to our ambulance as “68 year old man, clammy, possible stroke or heart attack”, so we got to the address as quickly as possible.

The gentleman was lying on the floor, he was a short Indian man and he was swearing at three younger Indian lads.  I learned that they were his next door neighbours and had heard him shouting.  When he didn’t answer his door they had kicked it down and found him…

…acting strangely.

The first thing that I thought was that the patient was a diabetic with a low blood sugar.  He was shouting and screaming about Allah and the Devil, telling us that we were all going to die.  He also told me that he was thirsty, but when I gave him some water he told me, “Allah won’t let me drink it”.

He then slapped me in the face.

My crewmate and I leapt on him and restrained him as gently as possible.  I had three times his body mass, my crewmate is a dedicated martial artist and a wall of muscle.

We managed to get enough blood to check his sugar levels – they were fine.

Getting what little history that we could it seemed that the patient had suddenly ‘gone mad’.

He was swinging between being calm, talkative and fairly pleasant and being a little hellion of violence.  There was no hints as to when he would change his attitude.

We were getting a bit concerned, we were trying to work out how to get this aggressive, violent and delusional patient out of his house and into the ambulance.  His neighbours tried talking to him, and they got slapped for their trouble.

My crewmate went down to the ambulance and radioed Control to ask for police assistance.  He let them know that they weren’t needed ‘mob handed’ as the patient was pretty small and frail.

While he was doing this I managed to get slapped again.  I was also called a ‘pharoah’ and was told that I would drop dead in the next five minutes so that I could be sent to Hell.

While he was annoying I was feeling sorry for this man, as he was obviously ‘mad’ and not ‘bad’.

My crewmate returned and the patient indicated that he wanted to spit on him – but his mouth was so dry he could summon up the liquid required.

Somehow we managed to get the patient to go down the stairs (after slapping my mate on the arm) and as we made it to the front door the police turned up.  They did act in a very ‘softly softly’ manner, but as we crossed the pavement the closest policeman was called a “bastard” and got a hell of a slap on the face.

The patient ended up on the floor – and then got manhandled into the back of the ambulance.  He was handcuffed and we made our way to the nearest hospital with one of the police aiding me in restraining the patient in the back of the ambulance.

The policeman nearly got a punch in the testicles.

All throughout the transport the patient was shouting about how we were all going to be ‘blown up’, and that Allah would alternately love us, or damn us.  It was an interesting five minutes.  He nearly managed to kick me once or twice.

We reached the hospital, and were met by one of the Sisters.  She didn’t seem too impressed with the two brawny men sitting on a little old man.  So she tried to be nice to him.

Until he called her a “cow” and tried to kick her.

We left the patient in the tender mercies of the hospital.  I love my job and I especially love it when I can leave patients like this with someone else looking after them.

Control contacted us to ask if we were alright.

“Fine”, I replied, “apart from us both being bitchslapped by a 68 year old man”.

---

My crewmate and I had a cup of tea and returned to the station to fill in our paperwork.  I know it might sound strange (and I’m guessing it’s one of those things where you really had to be there), but we were laughing all the way back.  It just struck us as amusing that this little man was so aggressive, and that he managed to strike everyone that he met.  Obviously no-one was hurt, even the patient.  We agreed that if it had been a drunk thirty year old then it may have ended differently – but we really didn’t want this patient to get hurt.

We took great pleasure in telling this story to every workmate who would listen.

I hope that the patient had nothing wrong with him that couldn’t be cured.

 

Today my first job was to a near repeat of this patient, except in this case the cause was drugs, and he wasn’t as aggressive, just annoying with a vague undercurrent of threat.

There is a bit of a kerfuffle in London at the moment about the failure of communication during the July 7th bombings.  In November one of our top management people told the review committee that our radios “worked well”.  This is being reported on as a misrepresentation.  While I don’t have any ‘inside information’ I can tell you that the communication gear supplied to us is inadequate.

And it’s the government’s fault.

Currently our communication equipment is -

a) A VHF radio installed in each ambulance/RRU

b) An ‘emergency’ mobile phone.

c) Managers and other important people have pagers.

The pagers are, as I understand it, in direct response to the July bombings – our managers became unreachable after the mobile phone networks were ‘switched off’.  We were quite lucky that a whole bunch of our managers were at a meeting in Milwall – and so large numbers of them could be contacted.

We used to have hand-held radios, but almost all of them have disappeared.  They were seldom in a good working order, the reception was awful, the battery life was crap and they weighed a ton.  They were so heavy that, should I be assaulted, I’d be better off using it as a weapon rather than trying to call for help.

Our mobile phones are also fairly useless – they are locked so you can only call certain numbers and because of the lack of staff up in Control you can be waiting a long time for the phone to be answered.  They are also pretty poor at getting a signal – they don’t like tunnels.  Or walls.

So – quite rightly – we will be getting a brand new system that will be integrated with other emergency services.  It is spanking new and apparently much better (although there have been some concerns about possible health risks, although others play such risks down.)

The problem (besides the chance of getting tumours) is that we will only be getting this system in 2008, this is of course, hoping that a government I.T. plan goes to plan – which, given recent schemes which have gone five times over budget, is highly unlikely.

I’m guessing that effective radios for ambulances is a pretty low priority given the financial state of a lot of NHS trusts.  Most of this problem is due to the unexpectedly high cost of Agenda for Change (40% of the extra money earmarked for the NHS) - it has gotten so bad that at least one hospital is making 1 in 7 staff redundant (because we obviously need less nurses, not more).  Although, at the risk of sounding like NHSblogdoc, the blessed Patricia Hewitt is blaming ‘bad management’.

We can only work with the money that the government gives us - there is no way we can ‘turn a profit’ on ambulance work – especially as we seem to be doing more and more community work for no additional funds.

So – communication failure has little to do with the LAS, and all to do with the money the government gives us.

(And this is after the government screwed EMTs over Agenda for Change bandings in order to give us as little money as possible)

While the colour scheme is horrendous, the text is actually quite funny.

EMS STUPID Frequently Asked Questions -- With answers!

Found while doing research for my next post.  Yes I do research on my posts.