Dr Ben over at Badscience proves why I'll never be out of a job...

I've mentioned before about how we in the ambulance service have procedures in place for the elderly who we suspect of being at risk. If there is a risk of abuse or violence then we can fill in a form, fax it off to Control as soon as we reach a hospital and the team in Control will make sure that Social Services are made aware of our concerns.

It works pretty well to be honest - I've done a couple of these 'vulnerable adult/vulnerable child' referrals and have gotten good feedback on most of them.

Unfortunately there is no easy way to alert social services to a 'non-emergency' cause for referral.

We were called to an elderly lady who had gotten out of bed and had slipped. She had fallen on the floor and couldn't get up. Also in the house was the woman's sister, also in her eighties. Her sister had tried to help, but the patient was heavy and the sister was frail. Our patient was stuck.

I'm more than happy to go to these sorts of calls (a 'Nan down' call) mostly because if the cause of the fall is a simple trip or slip we can pick them up, check them for injuries and more often than not leave them at home. The patient is happy to be off the floor and not being dragged to hospital, and we are happy because we feel that we have done something useful for a change.

In this case it was a simple slip that had caused the patient to fall and she had not hurt herself. We picked her up off the floor and after an examination were more than happy to leave her at home.

I asked the patient and her sister if they had any carers, anyone who came in and helped them with the day to day stuff. She replied that there was a district nurse once, but that she had disappeared without doing anything.

With my inexpert eye I looked around the flat. I could see where some handrails could be useful, where some modifications to the bath could improve safety and where a better bed could prevent a recurrence of the fall. The patients could also do with a community alarm.

(Community alarms are great, the person wears an alarm around their neck and if they fall over or get into trouble they can activate it and we turn up to help them).

So it appeared that someone had been there once, but since then the sisters had dropped off the radar.

There was no way that I could justify filling in a 'vulnerable adults' form for this, they weren't 'vulnerable' they just needed a proper assessment to provide some things that would make their life that little bit easier and safer. If I filled in one of those forms it would take time and resources away from those who really did need immediate action.

Unfortunately I'm stuck - we have no pathway in place to involve social services in any way other than in an emergency fashion. Our Emergency Care Practitioners can refer patients to social services, but only if they live in certain postcodes (where PCTs fund the ECPs - it all gets horribly complicated).

The LAS could do with improving this - we need a way to bring patients to the attention to the social services that doesn't require it being an 'emergency'. Lets face it, we see hundreds of people each day (around 4,300 calls each day at the moment), who better to keep an eye out for people who might be at risk, yet who haven't yet had any social services input?

Maybe the social services don't trust us to to their job for them? Maybe they are so over-stretched that they can't deal with a raft of new referrals that we would make?

Well - in this case I've 'cheated'. I gathered the patient's details, spoke to a friendly receptionist (actually all the receptionists at the hospitals are friendly) so I could get the GP details and I've now written a letter to the GP detailing my concerns. I've done all I can do about this situation which means that I can sleep at night, but wouldn't it be better if we didn't have to 'cheat'.

I hope that the GP/social services doesn't get snotty - I hate having to shout at people...

It's 5am, and we are attending to the now traditional early morning 'maternataxi'.

Two women leave the house, one is obviously pregnant while the other is wheeling the pregnant woman's case.

'Hello', says my crewmate motioning to the pregnant woman, 'You must be our patient'.

The patient nods an affirmative.

'And you', he continues to the woman following, 'you must be her mother'.

'Erm, no', she replies, 'I'm her sister...'

I would like to apologise to all the people in that street for waking them up with my laughter.

My crewmate was a tad embarrassed and of course I didn't let him forget it for the rest of the shift.

"Report on arrival", it's something that Control ask us to do when a call seems serious. It's really a way of reminding us that if we need extra ambulances or the HEMS team to help deal with a difficult call.

This job was to a 'fall from height'. to be honest I was a bit worried about what we would find.

The patient was a ninety-five year old man, he had needed to change a lightbulb on his upstairs landing. He had gotten a stepladder, climbed up it and in the process of undoing the bulb had toppled backwards.

He'd fallen, cracking his head on the lintel of the bathroom door, he'd then rolled down his stairway before coming to rest halfway down the stairs.

When we arrived he had picked himself up and was sitting on the downstairs sofa. His concerned neighbours (who were the ones that called us) had already changed the lightbulb for him.

A quick examination showed exactly two injuries. He had a small bleeding wound on his arm and he also had a bump on the back of his head.

He hadn't hurt his neck, he hadn't been knocked out, he hadn't broken any of his frail looking bones.

He was also a very nice chap.

While I can often examine someone to decide if they have injured their neck, and indeed this patient apparently didn't have any neck injury, in this case I thought that it would be best to err on the side of caution. Ninety-five year olds tend to have crunchy bones.

Half of this job is how you relate to people, so I told the patient that I was going to strap him down to our spinal board so that when he got to hospital he wouldn't be sent out into the waiting room but would instead be seen immediately. It's sometimes better to say this than, 'You may have broken your neck and I don't want you dying as we go over one of the many speedbumps on the way to hospital'.

So we took the patient to hospital - they saw him straight away and it was determined that he had indeed only minor injuries.

A very lucky fellow. And we didn't need the HEMS team, which is good, because when I do need them it means that someone has been seriously injured.

Ergh - I can't type today. I think the heat has made my fingers swell up...

I need to give you a bit of background before I talk about today.

There is a breed of ambulance called the ‘Intermediate Tier’.  Staffed by two crew who have had less training than a regular ambulance they attend to the lowest priority jobs, the so called ‘Green calls’.  Green calls are the sort of calls that, while an ambulance may be required, it is not essential to have them speeding to you with two fully trained staff on blue lights and sirens.  They also deal with ‘GP Urgent’ and ‘Non-Urgent’ calls, those patients that a GP has seen who need treatment at a hospital but again don’t require a full response.

So far it has worked well, some emergency ambulance people loathe doing ‘Green calls’, as they are often not very exciting, (I like them because they are normally simple jobs).

As I am a long term single (without a regular crewmate since she broke her foot), I have been working with lots of different people.  Today I was put onto an Intermediate Tier vehicle with a woman who normally works on it.

I’m always happy for a bit of a change of scenery.  As I have no idea how the paperwork/assessment/handling of these patients differs from my normal emergency work it was suggested that I drove.

The first job was to someone with quite severe back pain.  While not life threatening the patient needed to go to hospital for some really good painkillers and there was no way that they could get there on their own.  Severe back pain is annoying as there is little that we can do to help, the patient often has to walk as the pain gets worse if they sit in our carry chair.  However after some pain relief with ‘laughing gas’, the patient was able to make their way to the ambulance.

At the hospital I bought myself an overpriced hospital sandwich (more on this in a later post) and settled down for breakfast.

Another snippet of background – In my mouth there is a broken tooth, I’ve had it for ages and it seldom bothers me.  I have so far ignored it.

As I bit into the sandwich I felt an incredible shooting pain running from the tooth, under my tongue and jaw and into my feet.  I started to sweat and feel sick.  I couldn’t talk because I had pins and needles in my tongue.

Finally the pain died down into a dull roar and I suggested that we had a drive over to a dentist so I could make an appointment.

I entered the dentists office and found it empty.  The staff were about to start their lunch break.  The nurse behind the counter looked me up and down, asked me a few questions about the pain and disappeared.  She came back moments later and told me that the dentist would fix my tooth for me now.

Fifteen minutes and fifty pounds later I became the proud owner of medical treatment for my tooth and a temporary filling.  I was ecstatic with my treatment – they were very kind seeing me in their lunchbreak, and the dental treatment was first class.  The nurse behind the counter said, ‘We can’t have you saving lives with bad toothache can we?’.  Sometimes the ambulance uniform is an excellent thing to be wearing.  I blessed them all for working during their lunchbreak.  I may have offered one of them a marriage proposal.

It has been more than twenty years since I last visited a dentist (and yes I know that this only promotes the American view of English dental care), not out of fear, but more that if it didn’t hurt me then it wasn’t worth the trouble.

I would recommend the Barking Dental Practice to anyone in the area.  (They should really have their own website…)

I’m also grateful that there were no ‘Green Calls’ that needed our attention at that time.

There were two more calls for us this shift.  Another woman with back pain and a man who was so heavy I worried that he was going to break our carry chair.  Normally you need to tip the patient back on our carry chair.  This is considerably tricky to do when he weighs more than you do and you find your feet lifting off the ground.

A lovely shift, and a nice change of pace.

(I’m not the only Blogware blogger who has had trouble with their teeth).

A friend of mine has just come back from a job as a solo responder.

A small child was choking on a bone, he managed to clear the child's airway so the child didn't choke to death.

I let him know that I was impressed with the way that he saved the child's life, without him being there the child would have died.

"You've worked for your paypacket today", I told him.

He didn't seem too impressed with me noticing this, saying that, "It was nothing".

So - consider this 'being mentioned in Dispatches'.

Top bloke.

The call was for an assault in the street. A nice simple job for a pleasant afternoon in Newham.
We arrived and found six police officers around a Russian man and his girlfriend. There was a lot of shouting and screaming on the behalf of the man, mainly because he'd had his front two teeth knocked out.

Suddenly one of the police turned to me and said, "Quick, we are moving to another area".

"Why is that", I asked.

He pointed to a house window across the road, "Because there is a man there with a gun".

Thirty seconds later my ambulance, my patient, my crewmate and most importantly *myself* were 200 yards down the road behind some houses and a very solid brick wall.

Policemen with big guns appeared from nowhere and they laid plans about what to do about the situation.

To cut a long story short, the police negotiated the release of a child from the house and after around seven hours the siege was ended peacefully.

My patient managed to smoke all of one policeman's cigarettes.

---

Now to reply to two comments that initially don't seem related.

'Let's hope they don't gun down an innocent brown-skinned young man this time.'

A somewhat snide remark. The police don't go around looking to shoot people, despite what the media may lead you to believe. Whenever I've been involved with armed police I've been impressed by the pure professionalism that they show. They are anything but looking for brown-skinned people to shoot.

People who make such pronouncements don't understand how confused a scene can get, with differing intelligence, hearsay, rumour and lines of communication suffering from Chinese whispers.

The second comment is this...

Well now some ten hours after your post, and I can't find anything on the Beeb web site. I'm keeping the conspiracy theories at bay by acknowledging that I'm probably not looking for the right thing...

Related to the above comment, this is an example of how the media works. The operation went off without a hitch - no one was shot, there were no interesting pictures of irate kidnappers. The only injury was someone who had been punched in the mouth.

In 2002 the armed police were called out 2,490 times in London alone.

How many times was this reported in the media?

It's only a story if someone gets shot.

This is why the public have an imbalanced view that the police enjoy shooting people. You never hear of all the lives that have been saved because of their attendance.


The reason why blogs such as mine are so popular is because they tell you the stories that aren't interesting enough for mainstream media to dedicate time to. We humanise the jobs that are often just 'nameless men in uniforms'. Perhaps we need an armed police blog...

...So... there is an armed siege currently underway in my patch. I've been involved in it and once more I'm not sure what would be the right thing to report about it. Lets just say that I was there and it went from a nice easy 'assault' job into a rapid dash for cover...

Something a bit different on a Sunday afternoon. I wonder how the local and national news will cover it. Even for Newham it's a bit out of the usual.

I've got to give the armed police their due - they turned up very quickly once the call went out.