Our 'interesting' call of last night was a maternataxi. What, I hear you ask could be interesting about taking a pregnant woman 1.2 miles into the local maternity department.

Well, apart from the patient, no-one else knew that she was pregnant - she had been hiding the pregnancy from everyone. She hadn't seen a doctor, nor had she booked into a maternity department. Her family suspected nothing. It's not as if she were a 'large' woman, who could perhaps hide the tell-tale bump under the pretense of fat. She was actually rather slender, which leads me to ask how she could hide her rather obvious pregnancy from everyone.

When my crewmate spoke to her (I was driving), she told him that she had hoped that the pregnancy would 'go away'.

We tried to prewarn the maternity department that we were coming (because, she was quite close to actually delivering the baby), but they hung up the phone twice on our Control. The problem is that the entrance to the maternity department is locked at night - and we need someone to come down and open it for us. So - we were left standing around outside the department waiting for the midwives to phone for a porter to traipse the length of the hospital to come and open the door for us (as opposed to one of the midwives walking down the stairs and opening the door).

By the time we got in the patient was starting to bleed, and we were getting more irate at the apparent ignorance of the midwives.

So tonight we are going to put in a 'clinical incident report' to highlight the danger that standing outside the maternity department for 10 minutes while they arrange a porter puts the patient in.

One of the people on complex has had to deliver a baby in the back of their ambulance while they were waiting for the doors to be opened, so something needs to be done.

I'm doing my favourite shifts now - Friday, Saturday and Sunday night shifts. I love them, drunk after drunk after drunk after 22 year old male who gets scared at 3am when his belly starts aching. Coupled with the 5am Maternataxi, what isn't there to like?

7 pm until 7 am - and from 3am we are the only ambulance running out of our station. Which means anyone who is 'ill' or 'injured' between the hours af 3am and 7am will probably end up seeing my wide-awake, cheery face staring down at them.

And I wonder why people keep dying as soon as I walk in the room

I shall, dear reader, endeavour to remain happy, chipper and positive during the next three nights - if only because, starting Monday I have a week off work.

And for anyone in LAS Control, EC sector who is reading this, I'm working on J201 for the next three nights - be kind and try and leave me alone please...

In one of the comments for a previous post, I was asked about paramedics who can arrange drugs. As I thought about answering why paramedics are really not equipped to do this, I realised that for a lot of people there is still some confusion about the ambulance personnel job titles and roles.

I then found out that my job title is no longer EMT, but is now EMT-3, which is a nice Christmas present... So here is a quick rundown of some of the job titles for those of us working on the road.

Note, this may be wrong, and I accept feedback - it's just how I see things, and the roles seem to be changing every day

EMT-1 - Trainee Emergency Medical Technicians, basically while you are still in training school doing your 20 weeks of classroom learning you are an EMT-1. In London they wear attractive blue boiler suits, which make them look like Kwik-fit fitters. They aren't allowed to even touch a patient without an EMT-3 or higher standing behind them.

EMT-2 - '80 percenters', when you come out of training school and go on the road for the first time you used to be known as an 80 percenter, this is because you only get paid 80% of your proper wage - suposedly to pay the firm back for the cost of your training. You are expected to do the same role as an EMT-3, but for this first year on the road you aren't allowed to crew up with another EMT-2, you also can't go on the rapid response car, attend football matches or do any of the juicy training courses like the Decon team. Other than that you are fulfilling the same job role.

EMT-3 - Yours truly. After a year of being an EMT-2, you sit an exam (the 'Millers' exam), and run through a few more assessments - if you pass then you become a fully fledged EMT-3. The biggest change is that you suddenly get a pay rise of 20%. This is really nice. You also then start getting crewed up with EMT-2s who you are supposed to supervise.

EMT-2/EMT-3 have a number of drugs that we can give, these include Aspirin, Salbutamol, Epinephrine (for allergic reactions and severe asthma), Oxygen, Hypo-stop, Glucagon, Paracetamol, Entonox and GTN. Some of these are prescription only drugs, that we give according to our guidelines training. We are also trained to defibulate people in cardiac arrest, perform CPR with adjuncts and mop up vomit from the back of the ambulance. We will also be giving Narcan soon, as soon as we get certified for it.

Paramedic - Paramedics are EMT-3s who have an extra year of experience, then go on a course that is hideously oversubscribed. the course is residential and lasts (I think) 10 weeks. At the end of the course they can cannulate, and intubate people who have no gag reflex (in practice, this means dead people), but they cannot induce unconsciousness to intubate someone (RSI). They have all of the EMT-3 drugs at their disposal and a few extra ones like Narcan, Atropine, Epinephrine (for cardiac arrests), Benzylpenicillin, Diazepam and Tramadol (for pain relief, they used to use Nubain). They can also infuse a limited number of substances like Ringers lactate and Glucose 5%. For this they get paid around an extra £40 a week. One of the better things that they can do is halt a resuscitation attempt, something that EMT-3's can't do.

Paramedic Practitioner - This is a new role that will see highly trained paramedics covering 'green calls' - they will be trained to do such things as stitch wounds, stop ambulances from coming to people who don't need them, arrange social services/district nurses and arrange GPs prescriptions. The training goes on for ages and there are only a few of these service wide at the moment. They have been created so that we can provide cover now that GP's no longer have to attend patients 'out of hours'. They are going to get paid a lot of money when our new pay deal goes through. They work on their own.

Rapid Response Unit - EMT-3s and Paramedics can drive one of these accident magnets - the idea is to get to a patient within 8 minutes, realise that the job is complete crap and then hold the patient's hand until the ambulance gets there. If the job is genuine, then they can start basic treatment early and then wait for the ambulance to turn up. They are brave souls who race around the streets of London alone, in the dark... Or have a sleep on the sofa on station because their dispatch desk has forgotten about them.

Intermediate Tier - These are people who have had some basic first aid training, so that they can do the 'green' calls that some EMT's and above think are beneath them. these would include taking Doris into hospital for her appointment and GP urgent calls. Considering that it is a common occurrence that I end up 'blueing' in a GP 'urgent' case - I feel sorry for these folks. they also get paid a lot less than the rest of us.

HEMS Paramedic - The Helicopter Emergency Service has a Doctor and a Paramedic assistant. The paramedic carries the bag with all the emergency kit in it.

We then go onto management - but to be honest I have no idea what any of them do, and the job titles seem to change every six months - so the less said about them, the better. There are also the support roles, like the blokes who keep the ambulances on the road, admin staff, training staff, etc... And that is without counting the lovely people from Control who send us on jobs, and always seem apologetic when they know a job is a load of crap.

Just a quick 'thank you' for everyone who sent me a 'Happy birthday' and/or sympathy for the thumb. The thumb is now much better, and the birthday went well because my brother bought me loads of stuff from my Amazon wish list.

Presents are good. A rich brother is also good. Together they are perfect.

Thanks Brett

Now can I get the same response for single, non-smoking females who want to date a shift-worker?

I've mentioned before how the ambulance service and the A&E department is often seen as a "safety net" by other healthcare providers. Both yesterday and today we had perfect examples of this.

Yesterday we were called by a 70 year old man with a urinary catheter which had blocked. This is a fairly simple thing to solve as it just needs a flush of water up the catheter to clear the blockage. It's a five minute job that we, as ambulance crews, aren't allowed to do - however it is the sort of job that District nurses are supposed to do.

So why hadn't a district nurse been to see the patient, so that she could flush the catheter and prevent the patient from having to attend A&E? Why was the patient, who had phoned up the nurse himself, and told her exactly what he needed doing, forced to call an ambulance?

Because the nurse didn't have any water to actually flush the catheter.

It's a bit like if I turned up to someone having an asthma attack, and didn't have any oxygen to give them.

So the district nurse told the patient to dial 999 for an ambulance. We arrived and found him with a bladder so full it was causing him severe pain. We took him into Newham hospital, who, within minutes had cleared his catheter, and eased his pain - then they gave him a 'takeaway' bottle of water so that the district nurse wouldn't have an excuse the next time she needed to visit him.

Today, we were called to a patient who needed his anti-Parkinsons disease medication. He had a carer, who was supposed to visit him once a day to clean, and arrange his medication. But for the last two days, because the 'carer' couldn't get in touch with the patient's GP, had just left him without his medication. We turned up, not knowing what we could do to help. The flat in which the patient was living is brand new, and yet was already very untidy. The patient told me that he was lucky if the carer spent longer than 5 minutes with him (the carer is contracted to work with him for an hour a day).

This poor man was left, alone and shaking, with a carer who seemed to think that if he ignored this 'problem' it would soon go away.

So we did the only thing that we could - we took him to hospital, so that they could sort out his medication for him. Meanwhile I filled in an 'LA260' which is a 'vulnerable adults' form, and allows the LAS to bring situations of abuse, and potential abuse to the attention of the local social services. They now have the name of the care agency, and this problem can solved before it repeats itself in a months time.

Hopefully someone will get a bollocking, and our patient will get a carer that actually cares for him.

It often feels that we, and the local A&E departments, are left to do the jobs that other people should be doing, but because we are there, these other agencies don't seem to care about doing a competent job. I'm aware that there are probably loads of health visitors/social workers/district nurse/CPN's and GPs who do actually give a damn about their patients - it's just that we never seem to meet them.

I went to visit our patient from the last post, this morning I'd put my hand in my pocket and found that I had £2:66 of his money that had spilled out of his pocket during our struggle and I'd put it in my fleece for safe keeping - given the saga of the job, I'd forgotten to hand it in when we reached the hospital. I thought it would be best if I returned it to him, so I had a chat with the lovely receptionists at the hospital, and they told me what ward he was on. I went to the ward to find him sitting there, seemingly none the worse for wear. He did have a bit of a black eye (not my fault - honest), and when I spoke to him he told me that the doctors suspected that he had fainted, and when he had hit his head had suffered a form of concussion. His CT scan and blood tests were all normal, although I suspect that they will be running EEGs and other more detailed tests a little later. He told me that he was feeling pretty much normal, and I suspect that they are keeping him in hospital to continue to run their tests.

He was very grateful to see me, and we had a little chat - I offered him his money back, but he refused and suggested that I get myself a pint with it.

It's the first time I've actively gone to look for a patient after bringing them into hospital - and it is a weird experience going to a ward when I'm not expected to transfer that patient to another hospital. Yet another new thing I've done because of writing this blog.

I should be working today, but (and I want loads of sympathy here folks) I'm off sick with a work related injury. Thankfully it's nothing too serious, certainly nothing as serious as last time.

On Thursday we got called to a big conference centre in town for a (possibly) suspended/dead/fitting male - so we rushed over there and were met by their security who had rather cleverly staked out both entrances to this place so that they could lead us to the patient. Parking up we had to climb a couple of flights of stairs carrying nearly all the equipment from the ambulance. Our first response bag, oxygen and associated kit, defibrillator, suction and carry chair are quite heavy, and as were were in a rush to get up the stairs we were a bit out of breath when we reached the patient.

The first thing that we saw (and were very happy about) was that the patient hadn't suspended, and was instead thrashing around on the floor with some security guards and the centre's medic sitting on top of him. Approaching closer we saw that he wasn't fitting, but was instead very combative, trying to fight off the people who were holding him down in a very confused nature. Aha! we thought, 'he's post-ictal'.

During the post-ictal phase of a seizure, the fitting has stopped, but the patient is often disorientated, sleepy or aggressive. In this case it appeared that the patient was both confused and aggressive - he wasn't responding to anyone trying to talk to him to calm him down, and he could only make guttural sounds. Normally these episodes last less than half an hour, so we stay with the patient until we can get them into the ambulance.

Sometimes the aggression can come from physically being held down, the patient is confused and frightened, and all they can feel is people holding them down - so they struggle. I suggested that the security guards let him go, which only resulted in the patient trying to stand up, only to fall over again (don't worry, we caught him) and unfortunately the centre medic got a head butt for his trouble. I managed to get a blood glucose reading, which was normal, and a work colleague phoned the patients mother, so I could get a bit of history. The patient is normally fit and healthy, not diagnosed with epilepsy, but has had two fits in the past two years. All during this phone conversation the mother could hear her son shouting in the background. He had never been violent before.

We resigned ourselves to a bit of a wait, so we managed to get him over to a leather couch, and held him down there - after ten minutes there was no change in the patients condition, normally they get a bit tired or they start to have a change in their condition. So we started to think about other ways in which we could help the patient at the scene. We couldn't get him to the ambulance while he was so combative, and so we thought he might need some form of sedation. I ran back to the ambulance and asked control to get us a BASICS doctor, or at least someone who could give some form of sedation.

Instead after about 10-15 minutes we got the Physician Response Unit, which is a new service where a doctor from the Royal London Hospital covers medical emergency calls, it's a bit like HEMS only without the helicopter, and instead of going to Trauma, they instead deal with medical emergencies.

The doctor (who is a very nice man) and paramedic crew with him took one look at the patient, listened to the patient's history and decided that sedation was a very good idea.

Cut forward 40 minutes worth of trying to sedate the patient with increasing amounts of medication. For the medically trained out there, the patient needed 10mg Haloperidol and 17mg of Midazolam. At one point the doctor was thinking about knocking the patient completely out and intubating him (something that has it's own risks). But luckily the patient was sedated enough for us to get him out of the conference centre, and into out ambulance, where we 'blued' him into Newham hospital just in time for him to wake up (the sedation lasting only around 15 minutes) where the doctors there did paralyse and intubate him.

We have few ideas why the patient was so violent and so deeply confused - it's something that will be investigated in hospital. We were considering epilepsy, head trauma (from when his head hit the floor), meningitis (so antibiotics were given on scene) or some form of brain insult. I'm asking my crewmate to find out what happened to the patient.

The reason why I am off sick? Well after holding the patient down for an hour and ten minutes, I managed to sprain my thumb. As I can't be considered safe to carry a patient downstairs, I'm taking today off (plus two days of leave) so that my thumb can heal and I can get back to saving lives picking up drunks again on Monday. Oh, and it's my birthday tomorrow - 33 is such a young age don't you think?

This is very interesting, it's a way to embed large videos, photos and pretty much everything else via a blog post.

All I need to do is work out something I can use it for, perhaps a video of driving to a job, complete with maniac idiots walking out in front of me?

Go have a look at some of the other things Downhill Battle do - they are good guys (and gals).

Sometimes a day can just drag along. Today due to rather unusual circumstances , the day really dragged. Here is the time-line of today

10:00 Turn up for work, brew a cup of tea
10:01 First job of the day, taking someone from Newham hospital to Barts.
10:02 Cut finger on my locker door, try to stop bleeding, look for plaster.
10:23 Give up search for a plaster - there are none on the station - leave for Newham hospital.
10:26 Arrive at Newham hospital, ask for plaster, they also don't have a plaster so I now have a huge dressing on my finger.
10:28 Meet with patient, pleasant woman - meet nurse who will be accompanying patient, barely understand nurse due to her inability to speak English.
10:30 Get patient's notes and read them, they make more sense.
10:32 Ask Nurse in charge why this patient (who is having cardiac monitoring and a blood transfusion) is going to an outpatient department. Get told that the patient 'just is'.
10:54 After packaging the patient on a stretcher, loading them on the back of the ambulance, we set of for Barts hospital.
10:55 Nurse escort tells me that she gets travel sick.
10:55:20secs Give nurse a vomit bag.
11:37 Arrive at Barts hospital
11:38 Enter Outpatients department, Reception seem rather surprised to see patient on stretcher appear in front of them.
11:40 Problem is referred to the sister in charge, she also looks befuddled.
12:00 We wait while sister in charge phones around the hospital trying to work out why this patient is in her outpatient department.
12:30 Still waiting...We let Control know why we are waiting - there is no stretcher/bed to put the patient on.
13:00 Still waiting
13:30 Still waiting - we let Control know that we still have the patient on out stretcher while they work out what they are going to do with our patient.
14:00 Still waiting
14:30 Still waiting - we let Control know that we haven't gone to sleep, we are told by sister in charge that patient will be admitted soon.
14:45 We place patient on an examination bed so that we can go back to answering emergency calls, patient will hopefully be in a hospital bed soon. We leave the nurse escort with the patient.
14:48 We are finally available for another job.
14:49 We realise we have nearly no fuel, and no fuel card to pay for fuel. We decide to return to station to borrow a fuel card off an unused ambulance
15:20 We arrive back on station to look for fuel card (and have a cup of tea).
15:30 We leave to get fuel. Take infusion pump back to hospital - the ward seem surprised that the patient has been admitted to Barts.
15:48 We have fuel, we are now ready for another job.
16:00 We get a call, out of area, Maternataxi
16:09 Arrive at Maternataxi, contractions (genuinely) every two minutes, previous baby born in 3 hours, drive rather quickly toward her booked hospital
16:12 Patient's waters break - start swimming in back of ambulance.
16:20 Arrive at hospital
16:24 Throw patient at midwife, run back to ambulance.
16:30 Tell control that we need to return to station to mop out the back of the ambulance.
17:20 Get back to station, mop out.
17:45 Crew to relieve us are already on station, await ambulance to dry out
18:00 Leave for home.
18:37 Get home, collapse into sofa, start writing this post.

-Fin-

This is how you get to work an eight hour shift, yet only do two jobs...

In unrelated news, I had a rather nice time at the London Blogger Meetup, people there included 'Stroppycow', Andrew and Mark, all of which blog for different reasons. After only two pints of John Smiths, I managed to get on a train travelling in the wrong direction... The next meetup will be merged with that of the Funjunkie Christmas meetup, which I am rather looking forward to...