Just some back from my favourite job of the last four 12 hour shifts...

Patient is 6 months pregnant and she is feeling the baby move. Given to us as "Abdominal pain, pregnant - Category 'A'".

Had to take her out of our area to the maternity unit she is booked under.

Panicking neighbours were telling her it was early labour (Quote I've had three babies)

At least the patient herself was fairly pleasant...

If this format is funny, it's because I'm posting on the move, pocket PC and Smartphone...

Yesterday was the attack of the friendly old women. All of our patients were 85+, and all were really pleasant, normally healthy women who had experienced 'wobbly episodes'. This led to it being a rather pleasant shift.

My crewmate had the first half of the shift off - so, while I was single, I was used to take broken ambulances to the places where they could be fixed, taking fixed ambulances back to their respective station, and dealing with various office related chores. One of the benefits (or drawbacks) of being on a satellite station, is that you rarely see anyone from management. However when they spot you at the main station, they can hit you with all the paperwork that they have been saving up for you...

At the moment everyone is either being congratulated, or warned depending on the amount of sick they have taken. Unfortunately they don't discriminate between 'normal' and 'industrial' sickness, so I fall into the 'warning' category. Not a major problem, it just means that they will keep an eye on my sick, and we will work out how it can be improved. My personal contribution will be trying not to swallow anymore HIV+ vomit during the course of my work, or having epileptics sprain my thumb while I hold them down.

As mentioned, I'm not the only one - but it has been noticed that they are doing this just before Christmas, when (for some reason), the number of people going sick increases...

Of course if they want sickness to improve, they need to stop sending us to people who are ill.

Three of our jobs today had the potential to be upsetting, and while they were all sad, only one seriously upset me, and did so in a way I consider rather out of character for myself.

The first job of the day was to an 86 year old female in a nursing home with a 'blocked nose', we raced around there because...well...it was a Category 'A' call and those are the top priority 'get there in eight minutes to please the government target' calls.
Just as we pulled up outside Control let us know that the patient was upgraded to a 'suspended' (no pulse, no breathing), and sure enough we ran into the home to be greeting by a Fast Response Unit who was doing C.P.R. I jumped down and did a round of chest compressions which cracked her ribs (a recognised side effect of effective C.P.R) and then noticed that on the cardiac monitoring machine her heart rhythm had changed. She had a pulse!
...people don't normally get a pulse back from cardiac arrests of her particular type. We rushed her to the hospital, where a full cardiac arrest team was assembled. Her pulse was lost, and then returned. Unfortunately her prognosis was poor, but she stayed alive long enough for her daughter to reach the hospital. She died with her daughter there, which is a small victory, but one that we are getting more used to.

The second potentially upsetting job was to a one year old boy who had pulled some boiling milk on top of him. We turned up to find about 20 police officers on scene, and the HEMS helicopter circling above. The same FRU responder was there and the child had around 10% partial thickness burns to parts of the neck and chest. While nasty, this wasn't immediately life-threatening, but the HEMS doctor who turned up decided that it would be best to take the patient to the Paediatric Burns Unit at Chelsea and Westminster Hospital by helicopter. As the helicopter could get the child there in under 20 minutes it seemed like the right plan of action. My job during this call was to, (1) hold onto the other two toddlers in the house, (2) mix up some paracetamol for the child, and (3) to drive child and doctor to the helicopter which was around 300 yards away. The job was interesting because she was the type of parent who thought it was a good idea to wedge a settee into the hallway to stop her children from falling down the stairs...

The final job was a lot simpler - we were called to an 18-22 year old female who was 'unresponsive' in a bus. The bus had reached the end of it's route and the driver couldn't wake up the patient. (Possibly interesting aside - Bus drivers cannot touch any of their customers to wake them up). We turned up and soon managed to wake up the very sleepy girl. She remained drowsy but agreed to let us take her to a place where she lived, but after talking to her a bit, we soon realised that she was instead homeless. This, coupled with the way she would fall asleep as soon as we stopped talking to her, made us think that it would not be safe to leave her on the street, so we decided that we would instead take her to hospital. When we reached the hospital she refused to go in, and instead pulled out a 'crack' pipe and started to light up. We told her that she couldn't do that... So she jumped up, pushed my crewmate and ran off. As there was nothing physically wrong with her we couldn't chase after her, so instead returned to our station to fill in the necessary paperwork.

So why was it that this last job was the most upsetting, not only for myself but also for my crewmate? Well it wasn't because she was pretty (she wasn't, and she had a voice like Ken Campbell), and it wasn't because she was ill, nor was it because my crewmate got shoved.

With our first job, the woman was at the end of her life, and until she died, had enjoyed fairly good health - she didn't die a painful, protracted death, and she died with her daughter next to her. With the scalded child, he would forget the pain, and will receive excellent care from the hospital he went to, he would return home to his loving (if ever so slightly dense) mother.

With this girl, it was as if she were lost - at some point in her life her potential future had unravelled. Instead of getting an education, holding down a job, finding someone special and living a long and happy life, she is homeless, a drug addict and her future is probably painful and short. What is so depressing is that no-one was able to turn around this descent, and this is perhaps why I despair at society - that so many people are prevented from reaching their full potential. I understand that she has made her own choices, but how much power did she have to make those choices. I wanted to help her, but there was no way I could do this.

And it's that which annoyed and upset me.

Writing yesterday about having to carry a radiation meter has made me think about all the things I have to/choose to carry in my pockets. I also have a 'bat-belt' which I could wear if I wanted to lose all face in the service, so it stays in the ambulance until I need it.

In my pockets at the moment (and I suspect that this is an echo of some type of meme)

Shirt pocket - right - 4 vials of Salbutamol (asthma medication), half-eaten packet of breath mints (for those post curry/kebab moments), security card for the Royal London Hospital (opens doors for me), work emergency phone

Shirt pocket - left - Black pen, spare black pen, pen torch, small pair of scissors, spare stylus for pocket PC, roll of medical tape, Four sticking plasters (because someone read this, and supplied me with them)

Upper right trouser pocket - Pocket PC

Upper left trouser pocket - wallet (for when I really need that curry/kebab).

Belt - Personal mobile phone, keys to the ambulance if I'm driving that day.

Right trouser pocket - (lower) - Examination gloves - size large (lots of them, never know when you need more than one pair), face mask (because, you never know...yet to be used, so it is looking very grubby), trauma scissors.

Left trouser pocket - (lower) - Key to oxygen cylinders, Number 2 dressing (biggish bandage), guidelines booklet
(huge thing that gives us guidance on all aspects of the job, from drug protocols to hospital specialities)

Right rear trouser pocket - Triangular bandage/sling, spare pair of latex gloves. (I carry a pair of latex gloves outside of work as well, as I told the interview board when I applied for the job "I'll do anything if I have a pair of gloves on").

Left rear trouser pocket - Cheat sheet and ruler for doing things with a 12 lead e.c.g (broken because I sat on it - held together by medical tape), London ambulance service benevolent fund diary.

Stab vest pockets - Spare gloves (can you tell I like having a surfeit of latex gloves).

Is it any wonder I get out of breath when I have to climb a couple of flights of stairs - especially considering the response bag, oxygen, and other medical kit I have to lug around.

The funny thing is that I could do most of this list from memory, sitting in the pub

It seems that the rumors are true, frontline ambulance staff are going to start carrying electronic radiation meters. These 'pager' style devices will sound an alarm when I start getting irradiated. Why will we have to start carrying this additional bit of kit? The answer is of course 'terrorism', but why, when the threat of a 'dirty bomb' is apparently overrated? And should a bomb go off, I'm sure that there will be experts with Geiger counters crawling over the wreckage. I suspect that we are going to be used much as canaries are used in mine-shafts...

While 'Da Firm' do tend to look after it's staff (for instance, our stab vests and emergency phone systems) I would imagine that the real reason that we are going to be carrying them is to expand our role into "mobile dirty bomb detection units". Should we enter a property where the alarm sounds, we will have to tell someone, that message will no doubt travel up the chain of command until it reaches someone who can organise a nice, friendly visit by HM government's finest.

Apparently, (and this is pure rumour) the Metropolitan police are going to have similar devices, and I would imagine for pretty much similar reasons.

It's not that I mind - even if it means carrying even more kit up and down the patient's stairs. Just, wouldn't the money be better spent on equipping our fleet with ambulances that actually work? Or with providing our station with separate male and female changing rooms (which management were going to do, except that we ran out of money)? The chances of us catching a 'dirty bomb' are slim to start with, so wouldn't it be better to deal with the sort of things that kill more people each year, like - for example our crap record of cardiac arrest survival rates.

I wonder which company will get the tender for this job, and what ties they might have with the government?

A week off work has led to a week off from blogging - I took a short holiday to Norrath, went to the Funjunkie christmas Blogmeet, and otherwise generally did very little. I am now refreshed and ready to go.

Normal service will be resumed from tomorrow.

Mark (of Gullible's Travels) asked me to recommend some UK medical blogs. To my shame I could only think of a handful, so I vowed to change this sorry state of affairs and have a look at some other UK medical blogs.

But first, I need your help.

If you own/write a UK medical blog, or if you read one that isn't on my link-list on the right hand side of this page - then please either email me with it, or (even better) pop it in a comment for this post. Then I shall have a look at them all and summarise them in a future post.

Fly my pretties, fly! And bring me interesting links.

It was rather stupidly busy last night, not helped by the fact that there were only four ambulances available on our complex after 3am - instead of the nine we should have running. It also wasn't helped by there being (London-wide) 800 calls between midnight and 7am. You know it's getting bad when a job that has been categorised as a 'Cat A - Choking' isn't sent down to an ambulance for an hour. Not to worry though, it wasn't really a choking, it was a sore throat - and thankfully Control realised this and didn't send us flying down there when there were more serious cases to be dealt with. We personally dealt with 14 calls during our 12 hour shift, and were bleedin' knackered by the end of the shift, but none of our calls were too serious - mainly babies vomiting and maternataxis with an occasional side dish of alcoholics and drunken fights.

We did get the occasional comment that I love, "Don't take me to Newham hospital, it's crap!".

For some reason people only seem to remember the bad stories that they read in the local newspapers (which are, as personal experience can attest to, often wildly inaccurate). Patients (but more often their relatives) also seem to think that they will be waiting longer at Newham than they will at the Royal London. I take great pleasure in telling these people that the government has set a four hour limit from admission to either treatment and discharge, or to being admitted to a hospital bed.

Newham gets more than 96% of patients seen and sorted out by this time limit, and those that go over this limit rarely take longer than an extra hour.

The care for the patient, with the exception of serious head trauma, is essentially the same regardless of which hospital they go to - and should I ever need A&E treatment, I'd be more than happy to attend Newham.

The Royal London is a good hospital, but it's not the be-all and end-all, your local hospitals are also often very good.

And the receptionists at Newham let me give them hugs...