Our second call of the day was to an address where the elderly woman who lived there was believed deceased - the neighbours had called the police, and the police had called us. What this often turns into is us struggling to gain entry to the house, normally resulting in an injury to me, only to find someone who has been dead for sometime.
We rolled up to the house and met with the neighbours who led us around to the back garden where, peering through the rear window, we could see the old woman sitting in her chair looking pale, still and very dead.

Simultaneously my crewmate and I jumped back in shock as we saw her take a breath!

She was breathing about 6 times a minute, and surely didn't have much longer left to live - I rushed around the front and kicked in the front door (in one hit, something I've never managed before) and we got her out to the ambulance in double-time. We quickly decided that it would be wrong to 'stay and play' instead opting to ventilate her via 'ambu-bag' and to monitor her cardiac rhythm and her pulse (which was strong and regular).
The hospital had a team standing by, as we had notified them of the patient on leaving the scene. The transport time to hospital was about two minutes, and on arriving the A&E team leaped into action, intubating and ventilating her, gaining venous access and running the various blood tests - family members were contacted and plans for her treatment were drawn up. At no time did I feel that this 88 year old woman was receiving anything other than the best treatment possible.

We cleaned the ambulance and restocked before going onto our next job; each time we returned to the hospital we popped our head into the Resus room to check how she was doing - there were plans to CT Scan her head, and to move her to ITU. The family arrived and after some discussion it was decided that the best care for her was going to be palliative - that is to make her comfortable, but not to do any invasive procedures and to allow her to die. This was, I feel, the right course of action - lack of oxygen would make any survival both short and would probably result in serious brain damage.

It has been a very long time since I've felt a great deal of sympathy towards someone - but this was one patient that I did actually care about, and not just because I'm soft on 'little old ladies'. She had little chance of recovery, but we hoped for it anyway. She fought for her life, and had probably been doing that for the whole of the night. Because of our actions, and the actions of the hospital team, she wasn't going to die alone, and she wasn't going to die without her family saying a final goodbye to her.

It's a small victory, but sometimes those victories are the only ones you get.

Ergh... Woke up, rolled over and turned off the alarm this morning - very nearly late for my 0700-1800 shift. Being able to drive like an idiot at half six in the morning has saved me from being late...

When I went to the Clap Clinic for my HIV test, I was referred to a 'Health Adviser', which is a new name for Counsellor. I am, as regular readers may appreciate, a fairly simple, pragmatic person - within hours of my HIV exposure I was aware of transmission rates, odds of infection and the rates of death caused by electrocution (1 in 5,000) and shooting in America (1 in 2,500). So to be honest counselling was the last thing I needed.

I did a counselling course when I was a nurse, and it did nothing to abuse me of the notion that all counsellors are hippies who consider themselves 'worthy'. I'll have to tell you about the course sometime.

She asked me a load of questions about how I would cope if I were to be found HIV positive (answer - get over it), and cautioned me not to tell anyone I was testing, unless I was happy for them to know the result (answer - the whole world could know - if they read this site). There was some other stuff that is just too dull for words, and definitely to dull to read.

The thing that amused me the most however was not that the 'Advice Room' had the only comfy chairs in the place - but that the counsellor was wearing a sari (the Indian dress). In and of itself not unusual.

Except that the woman wearing it was 'whiter' than me.

I'm well used to 'white' women wearing various Muslim dresses - it's a religion after all, but as far as I'm aware a Sari is a cultural thing. I'm guessing that in her 'equal-opportunities, worthy, multicultural' world that she is proving how "un-racist" she is. This is handy because to be honest out of the 20+ people at the clinic I was in a race/culture minority of one. Not a problem, I know Newham well - it's very diverse.

But, I'd wonder if Asian people would be impressed or non-plussed by her wearing a traditional Indian dress?

Maybe I should start wearing nothing but a Papuan penis sheath?

HIV Test Result should be received by the 28th...

I've tried as hard as possible to make this sound as non-racist as possible - at no point have I meant to cause offence. I hate no 'race' more than another - I hate them all.

This is a picture of what we get in the vehicle via our computer terminals.

I've blurred the CAD number and address so as to protect patient confidentiality.
The four big buttons (for it is a touch sensitive screen) can show us where we are on a GPS map, the incident details (which you are looking at right now, and a navigation screen so we can be told by the computer how to get to the hospital/nearest petrol garage.
The big red button "At Scene" is what we hit when we reach the address - it then stores this time so we can see if we have hit the governments target of eight minutes for a "Cat A" call. Moving to the right is the Category - this is a RED 3, which is a "Cat A" call - this is someone who is supposed to be seriously ill, and about to lose life or limb if we don't get there quickly. We then have the Map Reference (in-case the navigation goes down) and the times. 'Orcon' is when the telephone dispatchers get an address and provisional diagnosis - this is what the eight minutes deadline is measured from, the RS and RT stand for "Reached Scene by" and "Removing Patient To Hospital" - this tells us when we reached the scene and when we left for the hospital, which all needs to be recorded on our paperwork.
Below this is the address we are going to (blurred out) and other things that are self explanatory (Cons. means 'conscious').
Further down is the complaint the person making the 999 call has described, and the determinant is used by the dispatch system to grade the call - giving us in this case a "Cat A".
Further down are extra details that Control think we may find handy, such as a cardiac history, or if the patient is fitting and is a known epileptic. Under this is where they give further instructions such as "known address - stay back until police arrive" for an address where a crew has been assaulted in the past; or if the job is a transfer, which hospital is receiving.

In this job, there was no difficulty in breathing - instead the patient was hot and had been sick twice...

Oh well.

There is something that I've learnt over many years of health-care work. When you are lifting little old ladies with senile dementia, they will sometimes grab you by the testicles.

And squeeze

This hurts.

I swear, the higher the degree of dementia, the higher the accuracy and the stronger the grip.

And for the love of all that is holy...

Don't drop them.

That hurts even more...

Back to work tomorrow, two twelve hour shifts, a day off then Nights, deep joy - more stabbings/slashings/bottlings/death and destruction. And that's before England are knocked out of Euro 2004.

A lovely quiet night,
1 x matern-a-taxi - baby not due for at least the next 10 hours
1 x crying 1 year old - asleep quite happily when we arrived
1 x headache - who was more concerned about his depression than anything else (I actually had some sympathy for this patient).
1 x 23 year old chickenpox - One of those people who wraps themselves up in a blanket when they get a temperature and wonder why they feel so ill.
1 x panic attack That saw us off shift on time

There were no stabbings, no glassings and no assaults.
Tomorrow is a bit busy, I need to wait for the 'City of Heroes' computer game to arrive from America; visit my mum to convince her that the mark on her face isn't cancer, and attend a small London blogger meetup.

After working twelve shifts on the trot (a mix of 12 and 10 hours) it'll still be relaxing.

For the first night in ages it has been reasonably quiet on the streets of East London - only one stabbing and that was to the patients arse...
However, while adults are no doubt nursing hangovers the children are out causing mischief. The first two calls we got yesterday were to kids (8 and 10 years old) who had been hit by cars. The first was a 'classic' - child running out towards an ice-cream van. He was alright apart from a broken right ankle. No sooner than he is safely ensconced in hospital than we find ourselves dealing with a child who has run out in front of a car (in the absence of an ice-cream van) and has broken his LEFT ankle.
Tie in a hyperventilating adult, a 14 year old with hay-fever and a drunken 'Colles" fracture and you have a pretty good night.

We had one serious job, a CVA on a train. The CVA wasn't so much the problem as the extrication of the patient, who couldn't move, and yet was combative with his unaffected side. To start off the space between the seats on the train weren't large enough to allow our carry chair to pass. The man was large and heavy so we had to basically manhandle him (in a very undignified manner) him through some connecting doors and out onto the platform. The train station has a big flight of stairs towards street-level and only one lift - and the lift wasn't on the platform we were on. It would have been unsafe to carry this man up the stairs due to his weight and combativeness. In a rare spark of genius I realised that if we waited for a district line train we could carry him through the train onto the other platform. We Blued him into hospital as hid pulse-rate was 40 (should be 60-100).
When I went to see the patient later in hospital he had started to regain his speech and wasn't confused - he was about to go for a CT scan so I'll find out what it showed tonight.

On the drive home I saw a water main had broken, and like the loon I am, I thought 'that might make a nice picture'

Well it looks like I was right, the nice weather with people in the pubs from an early hour, coupled with England losing 2-1 in the football has led to what can, in best tabloid fashion, be described as "an orgy of violence".
It started out with a couple of "glassings", which we have been getting over our MDTs as "stabbing to the head" for some reason.
A couple of more assaults including one who was set upon by a number of drunks who were intent on stealing his car - luckily not too badly injured, he was more shook up. Other crews were "blueing" in a number of assaults, including at least one stab victim.
The police were running from call to call, and once more there are not enough ambulances to deal with the large number of calls we have been receiving. Our Duty Officer has been telling crews that we should be wearing our stab-vests constantly - but he isn't the one who has to lug a 20 stone arrest down four flights of stairs in this heat...

Good job I'm not searching for a quiet life.

I am, however, off to bed now.

Some calls are a pain in the arse, not because anyone is particularly ill, but instead because you can see complaints coming in, and there being a high possibility of losing your job.
Tonight was a case in point, we got called to a wedding reception where the bride had collapsed. A quick history revealed Multiple Sclerosis, and that it was likely that this was the cause of the collapse. Unfortunately the patient and the patients new husband were adamant that she wasn't going to go to hospital, particularly the hospital that was nearest. Things weren't helped because they had called an ambulance for an aunt who had collapsed, but had cancelled it before it had arrived because it was "taking too long". Throughout getting a history from the patient, the new husband was generally acting like an arse - he was questioning everything that we did, interfering with our talking to the patient and generally getting in the way. We managed to get rid of him for a short period and the rest of the family came over to us and apologised for his behaviour.
Luckily the patients hotel is next door to the hospital so, after 45 minutes of persuasion, I managed to get the patient to agree for us to take her towards the hotel, and if she felt better then we could, in good conscience leave her there. On route I called up on the radio, and arranged for the duty officer to meet us at the hotel - he did and the responsibility of leaving her without treatment now fell on his shoulders (thus, saving our jobs should anything go horribly wrong).
I know M.S. is a horrible disease, I know it isn't fair that it would strike on your wedding day, and I can understand why you might not want to go to hospital - but if you can't move half of your body, then please understand why the ambulance people might be a bit unhappy to leave you laying in the middle of the street.

It then all 'kicked off' in the Hackney/Homerton area. There was a big fight in a pub, with everything in it being smashed - multiple casualties with various head and facial injuries from flying bottles and broken glass. We were first on scene, and I needed to call up to let control know that at least another three ambulances were needed. At least it gave me a chance to practice my 'five second triage' skills. None of the drunks there were particularly aggressive, but there was a ton of police there pulling me from one casualty to another around the pub, and even 300 yards up the street. This was just a taste of what was to come as another pub was attacked and it basically overloaded our resources. It got so busy our Duty officer was transporting severe asthmatic attacks in his car (and he doesn't carry anything other than a defib and oxygen) and Control was holding 35 calls across the area. That is, 35 calls at three o'clock in the morning. That'll teach me to wonder if it will be busy in a previous post.

Tomorrow England play their first 'Euro 04' match - Alcohol+Patriotism+Recent History (we are playing the French)+Me working=Recipe for disaster.

Watch this space...

The night before last there was twenty people having a fight in Manor Park. Last night there were five stabbings in the area - most of them were Tamil. People were running around the streets with swords, machetes and smaller knives. We got sent as a second crew to one area where one person had had his head opened up by a sword, and another had a seriously sliced knee by the same weapon.
As far as I could tell none of the incidents were alcohol related.

I wonder if there will be more tonight?