CraigP asked me about the recent Cardiac arrest I dealt with

Just intrigued about the whole transport thing for an asystolic patient. With a response time of 8 minutes, comms processing time realistically 1-2 minutes, and recognition time of at least 1 minute by the family this patient was a no go from the outset I would suggest. Is it LAS's policy to transport in this circumstance? I know that in our service, this patient would not normally have been transported - certainly age would not have been a valid reason.

Personally I prefer to transport sudden deaths - it means that the family don't have to stare at their dad laying on the floor until the police/GP turn up (which can be a couple of hours). You've got to remember that in London we are never more than 10 minutes from a hospital, where there are doctors, and more importantly nurses who can look after the relatives.
If they are beyond hope, then I'll often leave them with the family (maybe after putting them in bed). It all depends on the situation in which you find yourself.
It ties in with our protocols, which I'll answer next.

Our protocols state: if the initial rhythm in an unwitnessed cardiac arrest is Asystole or PEA the survival rate approaches zero and it is usually inappropriate to begin resuscitation. If there has been no restoration of a palpable pulse after 20 minutes, then it is appropriate to stop resuscitation. If a patient has not been successfully resuscitated it is inappropriate to routinely transport them to hospital.

Our protocol is that if the person has been collapsed for 20 minutes, without bystander CPR then we don't have to start resus.

You can have a look at our flowchart here, but just don't tell the copyright police...

If we have started a resus then if there is Asystole after 5 cycles of CPR/Meds then we can discontinue and "recognise" death, otherwise we have to transport. (Our Extended Training Order 11)

At all points we should "consider" transport - again, not necessarily for the benefit of the patient (who is dead) but more for the family/members of the public.
If we haven't even started resus, then they'll often get left.

I hate having to say to someone that x person is dead, when within reason in the sub 50 age group (and more so in the sub 30 group) they should have stood a better chance, but ultimately someone has to make that decision. We all know the 10% rule for each minute of a cardiac arrest rule, so realistically a large number of patients we respond to will never survive their cardiac event (etiology dependent). It makes you wonder if a) our medical director is cavalier or b) is he realistic. More food for thought anyway.

I'm of a slightly different tact in that, possibly due to my years of nursing and the number of people that died in my care (hold on - that doesn't sound right...), I'll avoid resus if at all possible - it's not pleasant, it's undignified and it seldom does any good in a pre-hospital setting.
But when there is a chance - no matter how slight, then I'll go all out. I don't believe in a "Slow Blue". If there has been bystander CPR, or the durations are right then we'll give it our best. I've never worked with anyone who goes at a resus half-heartedly.

It all boils down to doing the best in the situation you find yourself in - every situation is different and your approach is often different - something I suspect we all know and practice.

I often carry a camera around with me. I was talking to some kids recently - they were happy little buggers, enjoying the sunshine on a lazy Sunday.



It's not all bad this job.

Yesterday was a bad day, it started badly and just got worse - but not as bad as one of my patients.

I was sure I was working my overtime shift from 6pm - so I was a bit surprised when I got a call from my old crewmate at 4pm asking where I was.

I was in the bath.

Completely my fault - I had some form of brainfart, instead of a 6pm start it was a 4pm start. So I rushed out of my bath got dressed (leaving half my kit behind - I never need it) and dashed into work. Luckily, and unusually, there hadn't been a call in the 45 minutes it took me to get into work. I was starving, I hadn't had anything to eat since the day before, and I could feel my blood sugar crashing.

No sooner had I arrived than a call came in - Car vs Pedestrian, so we saddled up and rushed to the scene. The pedestrian had "bullseyed" the windscreen of the car, hair was embedded in the glass, yet the patient was up and walking around with no apparent injuries. I managed to assess him, but only after knocking his sunglasses out of his hands and breaking them (accidentally I'll have you know). He was adamant that he wasn't going to hospital, and the police couldn't persuade him either. So he left and walked home.

The next job was a LOL (little old lady) who had a urine infection, but who looked as if she were going to die within the hour - luckily the hospital was 3 minutes away, so we had little to do on that job.

I still hadn't had anything to eat, when we got a "Chest Pain", way out of our area - so we rushed out to it only to find two "management types" had just beaten us there. I didn't recognise them, so we searched for the address, only managing to find it after some searching. We came across a 50 year old man who had cut his foot on a piece of glass, and who wasn't having chest pain at all. This tiny puncture wound was barely visible, yet he was writhing around the floor as if his foot had been cut off.
The two management types left, so I dressed his foot and took him into the local hospital. I finally managed to get a McDonald's large meal, and was thus sated.
I asked my crewmate if she knew who the two management types were, and she spent the next ten minutes laughing at me. Apparently one of them was our new Station Officer, and the other was the Complex Manager.
I think I've mentioned before how I like to avoid management - so I'm a bit annoyed their first sight of me was unshaven with an un-ironed uniform, wandering around an estate looking for an address...

We had started to return and had reached Stratford when we got a "suspended" in Hackney. We made it in eight minutes, although I have no idea how we got there that quickly.

We deal with a lot of crap on a day to day basis, but there are certain sounds that will send a chill up your spine. As we rushed toward the address I heard a woman wailing - just from this sound I knew that the "suspended" wasn't a "faint", or an "unwell" - but was instead a dead person.
A 39 year old male had been working in the garden, had come into the house and collapsed dead in front of his partner and four children.
There was no electrical activity in his heart, so we started CPR until a second crew turned up which was about 30 seconds later. He was intubated, cannulated and the full works given - we rushed him to hospital where they worked on him, finally declaring him dead half hour later.

The partner was screaming thoughout the resus, although the children had been taken in by neighbours. As I'm typing this I'm thinking of how that womans life has changed completely. She has lost her partner and is now a single parent family with four young children. All in the space of an hour.

For us, the rest of the shift went fine.

First off OUCH! (From Warren Ellis)

There is a Transit of Venus today - all these special astronomical phenomenon remind me of the eclipse we had in the summer of 1999...

(Cue wobbly flashback video effects)

I was working in A&E at the time of the eclipse and thought that there would be no way I'd get to see it. Like all A&E departments this place had no windows and could be perhaps best described as a "bunker". Today however the department was empty for the first time in living memory - normally by that time of the day we would be packed full, but today - not a soul. One person had been in earlier with a painful foot, but there wasn't the normal "trolleys in the corridor" effect that was normal for that time of day.

We learnt that day that CT films make excellent sunglasses.

So the whole department stood outside on the "smoker green" staring at the sun slowly disappearing - very spooky, and one of the few strong memories I have from that long ago. I suspect that many of the wards were empty as well; there was a procession of people wearing dressing gowns and holding tight to IV drip stands wandering around the hospital grounds.

As soon as the eclipse finished we immediately had two cardiac arrests brought in by ambulance, it was as if they had waited until after the eclipse before deciding to keel over dead...

Apparently I'm the love child of Johnny Depp, Jim Carey and Quentin Tarrantino.

(And no, I'm not naked in that picture).

There are eleven radio channels for communicating across London that the ambulance service uses, we in EC sector uses channel 11 while NE uses channel 9. I think that almost all radios were tuned to channel 9, that of the major incident to listen in to what was happening.
It has since become clear that it was a fairground ride that collapsed - sixteen people were transported to hospital after being cleared by HEMS (the helicopter service). From the radio chatter it appears that the most serious injury was a broken leg, most other injuries were fairly minor. Camden ambulance station was commandeered as a refreshment and "debriefing" centre. All injured were out of the scene by five minutes past six.
In London this seems to be fairly minor news, securing just a 20 second spot on the local news.

Today my patients included a baby who decided to catapult itself out of it's mother's birth canal - "bungee-jumping" using the umbilical cord and landing on the floor.
Luckily mother and baby were both fine.
I missed Notcon due to work, so I'm hopeful that they will make good their threat so release MP3s and video of the various talks. I did manage to catch some of the IRC via my sexy new Smartphone.
Tomorrow I start working some 1800-0100 shifts (nine of hem to be exact) which is basically a series of "drunk runs".
I love it...

We've just heard on the radio that a stand has collapsed at Alexandra Palace. Loads of ambulances are on the way there, and it's been declared a Major Incident. It's on the other side of London from where I am at the moment. So far the numbers of injured are unknown.
More on this when I find out about it.

This was posted by a Dorset Ambulance bod. It was written after a talk about the need to remain politically correct about the language in the Messroom.


"Throughout the land, corporates, businesses, conglomerates, in fact, just about every work place is being subjected to changes in language, speech and behaviour.
This thing we call political Correctness has crept in like an unperfumed gas, and I think most of us acknowledge that certain things should not be said for fear of offending other individuals- human beings.
This seems fair enough, and most of us, before uttering something potentially inappropriate, automatically consider whether or not we ourselves would be offended by it.
Generally, most people I know regard others the way they themselves would hope to be regarded by others. It all comes down to a fundamental respect for each other. We, as a human race expect it, and demand it.

And what of this job, this workplace that is the Ambulance Service? A whole chunk of business, finance, training services, and then come the pockets of people going out day and night, rain or sun, snow or gale, meeting with a whole rainbow of people, patients, situations involving treatments, protocols, clinical decisions, life and death, trauma to make your hair curl, which can easily "tap" in to a depth far beneath the veneer of a paramedic, technician, duty officer, in fact any human being who may be faced with some or all of the above.
Our job reminds us on almost an hourly basis that we are not made of stone: we are mortal beings, and somewhere deep inside us, there is not only a quick thinking clinical mind, but a conscience - a brain that can go to pieces at any given moment, and a heart, that most passionate of organs, which can bleed and break very easily at any given moment.
Consider:
The parents you left when their child had been taken away from them forever. The children you left when their parents had been taken away from them forever. The good looking young man who would now never walk again, or marry, or have children. And all the other situations too numerous to labour upon, but we know, don't we? Because we, as bizarre as it may seem, live "this life", where all these tragedies are a part of "this life".
More often than not, if something tragic happens to a patient, we take that tragedy on board; for as long as it's will, we have that tragedy in our lives.
This is where I think that some aspects of "P.C." have become stationary of "olde", insignificant.
We have "levellers" on every single station here in Dorset, and no doubt on every Ambulance Station in the land. Our unofficial station de-briefs (which involves offloading to colleagues) demands that our feelings are heard, they demand that someone, somewhere on station will level out our tragic train of thought. It may seem "sick" to those who are unattached from this psyche, but believe me, when we get back to the station from tragedy, a really bad joke in the worst possible (unintended) taste, is usually the very thing that will mend us, and prepare us for the next call.
There is a danger that political Correctness does not acknowledge grey areas; it has become silly and often practically unworkable. Some of us just don't fit in to the 'shirt and tie' loop, where a definitive politically correct protocol is easy to follow.
We are thinking, hurting, laughing human beings, who, whilst being constantly aware that we should not hurt the feelings of others, need to somehow find the common ground, where the cloudy burdens of this jos, this life, are lifted from our shoulders.
We are the grey area."

Busy day today, but not because of a lack of ambos, instead all trucks were manned but the population of London decided to spend today either crashing their cars into each other, or having a fit.

The first call of the day was to a R.T.A which left one car looking like this...

The driver was fine, and we took him to Newham solely because we wanted breakfast...

Our next job was to an epileptic who had just finished having a fit in the local post office. He started out by looking rather ill, but by the time we reached A&E he was much better. The only thing that worried us was his temperature was 38.5C which is a shade high, even for someone who has been fitting.

No sooner than he had been dealt with, than we were back to another R.T.A - this one involved much less damage; we took the family into A&E because the youngest daughter had gotten a friction burn from the seatbelt. We'd much rather deal with that than a 4 year old flung out a windscreen onto a dual carriageway. The moral of this story? Seatbelts=GOOD

We then had a short break for a cup of tea before being called to a ?meningitis. As soon as I walked in the room I knew that the four year old child wasn't ill. The spots that had appeared were more like a Measles spot - something we are seeing more and more of since the brouhaha in the media about the MMR vaccination and it's supposed link with Autism.
If there are any parents reading this - GET THE VACCINE! The link is far from proven, and yet Measles, Mumps and Rubella are all child killers. I've seen more children killed by measles than I have children who are Autistic. We left the child at home, as the father just wanted reassurance that his child didn't have Meningitis. I gave him a health promotion talk, made him promise to take the child to the GP, and left for our next job, which was a walk in the park.

We were called to Poplar Park, where there was a 25 year old male, supposedly unconscious. Seeing as the last call of this type I'd gone to had been a fatal cardiac arrest I traipsed into the park carrying my full load of kit. Only to find out that it was two lads who had smoked a bit too much of the "wacky baccy" and were incapable of moving. They told us to "fuck off", so we did - but only after calling the police.

Later in the day we drove past a Rapid Response Car at the fitters - another example of the fine L.A.S driving technique...


Then it was a long run to a pub where the Irish, alcoholic publican had had an alcoholic seizure with some minor facial injuries. We bundled him up and ran him into A&E where he soon perked up. I swear, every publican I know is an alcoholic, and most of the alcoholics I know are Irish. So an Irish publican is just asking for trouble.

Our supposedly last job of the day was a 62 year old female who had fainted on the London Underground. When we got to her she was still looking ghastly, so after lugging her up a load of stairs (it's not just the disabled who want lifts in all underground stations you know) we got her onto the back of the motor, did a quick 12 lead ECG (which was normal) and took her to the Royal London Hospital.

Unfortunately Control had a different idea than us about it being our last job, so we got sent to a 1 month old child who had vomited. This was as exciting as you can imagine - although I'm rather sanguine about the whole thing as it gave me an hours worth of overtime.

Low point of the day for me was learning that my annual leave for Sunday couldn't be granted. I'm annoyed because I really wanted to got to Notcon.
So instead I've put myself down for some overtime, which brings my current workload up to a 12 day stretch. I may go for longer, just to see how long I can work before I break.

I'll see if the overtime dries up before I do...

I haven't written for a bit as I've hit a patch of "lack of enthusiasm", most of the time I'm running around doing *stuff* - but every so often I just want to lay in bed and do nothing.

Some things that I have been enjoying recently-
Rodeohead
Eric Idle - FCC Song
Beatles - Come Together

I managed to delete 9Gb of data from my hard disc this morning, all because the new Nvidia drivers decided that my monitor could be driven at 97Hz (which it can't). Trying to make the driver "stick" to 70Hz was an exercise in frustration so I used "system restore", which has worked, but it also tricked me into deleting a hell of a load of downloads. Can you guess how I feel?

At work, you can sign up for text messages offering overtime shifts. The phone has just buzzed, and out of the four ambulances that are supposed to run out of my station tomorrow, it looks like I'll be the only one working. I suspect that I'll be just a tad busy. My fingers are crossed for for someone needing some extra money and therefore a bit of overtime.

Talking about money - It's a "five week" month for me, a big wait until my next pay-packet. My current pay is the lowest it can go, as I was sick on PEP for that time, and have no overtime/subs pay to bolster the amount. I also have to pay my rent three times before I get paid again.

Oh well, back to work tomorrow, where I can forget all that crap for twelve hours.