Guess where I’m going to be on Friday?

Come and join us if you want.

The first job of the morning has stayed with me for the rest of the day

*Warning: not for the faint of heart* Herein lays a tale of Scaryduck stylings.

I was sent to a 'Male, 59, fitting - locked in empty bathroom'. I got there quickly, within eight minutes, so already it was a 'successful' job.

As the person who met me opened the door to the flat I was overwhelmed with an intense, and incredibly disgusting smell. At first I thought that it was the person opening the door (he was rather dishevelled, and I've smelt breath that bad before), but no, the smell got stronger as I entered the flat.

There were four people there, all of them looked like the man who opened the door, and the state of the flat made me think that everyone in there was an alcoholic.

Sitting, or rather, propped up on the sofa was the man who had been fitting. His friends had managed to undo the door to the bathroom, and had manhandled him into the living room.

"He's been drinking, we were both drinking heavily yesterday", I was told.

"Fair enough", I said, "Is he epileptic, or does he have alcoholic fits?"

"Both, I think", replied his friend.

Then I looked down.

Something the size of a snooker ball had rolled down the inside of his jeans and was sitting in front of him. It was brown, it was wet, and was rather horrible looking.

A pile of poo. His poo. A poo done after a night of heavy drinking.

Suddenly I realised where the smell was coming from.

I'm sure that most people realise that after a night on the town, the first poo you do can stink to high heaven. This was that epic a poo. I imagine that there was a lot more of it smeared over the inside of his jeans. This is the sort of poo that would issue forth from the arse of Satan himself. It was the sort of poo that shouldn't be flushed away, but instead sealing in a barrel and buried in a place that has lots of warning signs pinned to the barbed wire fence surrounding it.

It really did smell that bad.

His friend (who actually didn't know him that well), picked up the poo with a bit of newspaper and ran it into the toilet.

I could hear him gagging from his new-found proximity to the toxic poo. When he came back into the room his face was an interesting shade of pale green, and there was a thin film of sweat upon his brow.

I treated the patient, actually quite a simple job. Then the ambulance crew turned up, and I pointed out that the patient's shoe was covered in his own sticky poo.

Carrying the patient down the stairs, the poo managed to get transferred from the shoe onto the shirt of one of the crew. He wasn't happy.

I stopped myself from laughing.

...almost.

The only problem is that I can still, several hours later, smell the rank stench of that demonic poo from hell. Actually, I can still taste the poo in the air.

I almost feel sorry for the nurses at the hospital...

The first of my two nights, wasn’t too bad, as I mentioned, I didn’t have to wait too long for an ambulance to turn up. 

Shame about the second night…

My first call was to a 71 year old female with ‘Difficulty in breathing’.  

I turned up, and was met by loads of small children.  Making my way to the patient, she was using her own home medication to try and ease her asthma.

It wasn’t working.

A quick check of her oxygen levels showed 71%.  It should be above 95%, below 85% makes me rather worried.  You might guess that 71% really put the wind up me.

I spoke to the son while preparing my treatment.  He’d obviously seen this before, as he gave as good a description of the patient and her problems as I would have expected from a medical professional.  The patient had been in intensive care twice for her asthma.  If an asthmatic ever ends up in ITU, then it shows how rapidly the patient’s condition can deteriorate.  At the very least, it makes me rather nervous that the patient will ‘go off on me’, and it suddenly turns into a respiratory arrest.

The medication was given to the patient, Salbutamol – a nebulized drug administered straight into the lungs in the form of a gas.  I was also giving her a large amount of pure oxygen in an effort to raise her blood oxygen levels.

Then I turned around and nearly fell over three rows of eight children, quietly sitting cross legged and staring up at me with big brown eyes.

“Don’t mind them”, said the patient’s son, “It’s Eid, so the whole family are celebrating”. 

“She”, he said indicating the patient, “has twenty one grandchildren”.

I nearly suggested that this might be why she was breathless…

So now it was time to wait for the ambulance to take this very sick patient out of my responsibility and off to the hospital.  I could see her getting more and more tired, although her oxygen levels were more normal (if only because I was blasting plenty of oxygen down her face-mask).

“Would you please leave the room”, asked her son after talking to the patient, “she needs to use the commode”.

Now, ask any medical professional when is the most dangerous time for your patient, and I would think that 99% of them would say that it’s when they go to the toilet.

“Hmmm… alright”, I said, “but someone stays with her”.

I was standing right outside the room, waiting for a shout for help and then for me to bound into the room to resuscitate her in front of twenty-one small children.

Luckily for all involved, she survived her encounter with the commode, and we settled down to wait again.

While I was waiting, I was constantly reassessing the patient.  I really wasn’t happy to have her waiting so long because while my treatment was improving her condition somewhat, she needed better care than I could give.

The son offered me a cup of tea.

He knew how serious it was, he knew that the ambulances in the area were probably picking up drunks, and yet he understood my apologies, and offered me a cup of tea.

Thankfully the ambulance arrived, and because of my earlier treatment, the patient had become a little more stable.  She still needed urgent hospital care, but I wasn’t worried that she would die on the back of the ambulance.

It had taken forty-five minutes to get an ambulance to the patient.  Sometimes I like that I’m on the RRU when I can get to a patient in time to actually make a difference.

I also love the drugs I carry, I don’t use them much, but when I need them, they really do come in handy.

I hope everything turned out alright, because as I followed the crew and the patient out to the ambulance, the son shook my hand and said, “Thank you”.

Waiting 45 minutes for his critically ill mum to get a proper ambulance, and still he thanked me.

It’s a Wednesday night shift, which means that hopefully there won’t be too many drunks roaming the streets.  It doesn’t hurt that the weather is, to put it politely, occasionally raining.  I shall be writing what I have been doing every time I get back to station – so if this post seems a little disjointed, it’s because it’s been written over twelve hours.

The first job of the night was just on the edge of my ‘patch’, a woman in her thirties suffering from chest pain.  In people of this age it’s often related to some form of chest infection.  However, when I reached there, the first words out of the relatives mouth was, “She has a heart condition”.

The patient, and her relatives were pleasant to me, but for a person with a serious long-term illness, she didn’t really know a great deal about it.  I asked her what sort of problem she had with her heart, and she couldn’t name it, I asked her about the operation that she was waiting for, and again she didn’t know what it was, or what it was for.  I had to use my knowledge of hospital treatment (“Did they massage your neck the last time you were in hospital?”) in order to work out her previous medical history.

A shame really, patients should be a bit better clued up on what ails them..

My next call was to a location around 200 yards from my first job, unfortunately I’d managed to get back to the station, so I felt like I was on a rubber band.  I was beaten there by the ambulance, so I had little to do apart from making sure that the crew didn’t need my help.  The patient had a pretty standard bellyache coupled with a panic attack.  I did however manage to practice my reading of Polish drug names, translating them into English.

I got back to station, and while writing the first part of this post started shaking uncontrollably.  My legs were weak, and my head was spinning.  What was going on?

I checked my blood sugar…

3.6 mmols!

This is a low blood sugar, our guidelines say that we should give sugar treatment if the blood sugar drops below 4.0 mmols.

I have no idea why my blood sugar was so low – I’d had a big dinner around my mum’s house just four hours earlier.

So I sucked on some sugar, and then got Control to take me off the road for a bit so that a station mate could drive me to the nearest take away shop so I could ‘fill up’ on some longer term sugars.  Chicken chop suey and curry and chips should see me through the night…

I was soon feeling better, so I made myself available for calls.  A few minutes later I got sent to one of our regulars, an alcoholic who had been locked out of his hostel for the night, so he claimed to have chest pain and called for an ambulance.  As this is my first nightshift, I’m fairly ‘chill’ about this sort of job.  There was nothing for me to do apart from chat to him until the ambulance arrived.  It wasn’t raining, and he has always been pleasant towards me, so it was an easy job.

My next job was…Trauma!  A stabbing to be precise.  A young man who had been mugged and stabbed in the leg. Luckily it was a fairly minor wound, and apart from putting a bandage on him, there was little that I could do.  The HEMS doctors turned up in their car, and they were quite happy to leave him in my *cough* capable *cough* hands.  I only had to wait around 15 minutes for the ambulance.

Then I was sent on a ‘chest pain’ job,  but another RRU was there, so it was what we call a ‘duplicate job’, maybe someone up in Control needed a coffee…

A Maternataxi next, she had contractions every 10 or more minutes (and very weak contractions at that) and her membranes were intact.  I was on scene for 50 minutes waiting for an ambulance to turn up.  I was getting so bored that I actually considered reading my ‘Agenda for Change’ booklet.  Apparently there were eight calls in the area waiting for ambulances.

On the way back to station (for a well deserved emptying of my bladder…) I came across one of our ‘make-ready’ people driving an ambulance to the nearby petrol station.

He didn’t realise that he was driving along with both of the back doors open.

As I write this line it is 2am, and I’m conscious that I have 4 and a half hours left to the rest of this shift.  I also fancy a cup of tea…

Forty-five minutes later and I’m racing through the streets to an ‘elderly man, unconscious’.  He is indeed unconscious when I reach him.  Apparently he was asleep with his wife, when he shouted out and became unrousable.  This is the sixth, or seventh time that he has done this, and the hospital are supposedly baffled.  Observing his recovery (looking scared and confused, ‘plucking’ at his clothes), to me he looks like an epileptic who is in the ‘post-ictal’, after-fit state.  The ambulance are thankfully quick to arrive, and he starts to recover as we lift his heavy body down the narrowest flight of stairs I’ve ever seen.

I’m then granted nearly two hours on station, where I have a little doze before being sent out to another elderly man who has been bleeding from his penis for the last 24 hours.  A classic example of the ‘I didn’t want to bother you’ brigade, his house is spotless and he has been married to his wife for nearly 60 years.  It’s nearly 5am and his wife is dressed as if she were going to a Womens Foundation cake sale.  Both are polite and helpful, and more importantly – they laugh at my jokes.

It’s now an hour to go before the end of my shift, and I’m wonder whether to have a cup of tea or not.  I don’t want the caffeine keeping me awake when I go home to sleep, but I am rather thirsty.

Perhaps a glass of water?

It has now reached that time in my shift where the next (hopefully last) job is either going to be someone waking up to their elderly, yet very dead, husband – or another maternataxi…

And as if by magic – 12 minutes after writing that line…

Another bloody maternataxi!  And this one didn’t want to talk to me, refusing to answer any of my questions.  Well, that’s fine, at this time in the morning I don’t particularly want to talk to her…

This time however, the ambulance is a lot quicker to arrive, and I’m left with half an hour until the end of my shift.

Will I get another call?…

The short answer is….No.  Instead the day relief came in quarter of an hour early, and has sent me home.  By the time this has been posted off, I shall be slumbering peacefully in my bed.

Last night is what I would consider a fairly ‘good’ night, a couple of jobs where people were actually ill, a stabbing (although a rather minor one, needing only assessment and a bandage) and with the exception of waiting fifty minutes on the maternataxi, I wasn’t left high and dry by the lack of ‘proper’ ambulances.

And later tonight, I do it all over again.

And while it will be completely different, it will also be the same.

I try to go to conferences about things that interest me, but work (or money) sometimes gets in the way of that.  So I find myself downloading video, or more often audio from various sites like IT Conversations.  Unfortunately, for a bunch of audio/video geeks, the video presentations are often lacking.  I’m guessing that it’s hard to video stuff in a lecture hall, or up on a stage without spending megabucks on equipment.

Also, the presentation when it comes to actual putting it on the internet is also often lacking.

But I do still have a massive amount of respect for the people who do record and upload stuff – this is just a call for a fresh idea (nicked from an EMD site…)

But – I have found (via our unofficial ambulance forum) the following way of doing it right.

It’s a very interesting talk about Advanced Cardiac Life Support, and the speaker is incredibly interesting (and he does indeed ‘tell it how it is’).  The smart thing about this presentation is that the slides are on the right of the screen, while the video of him talking is tightly focused on the left of screen.  You can also directly select where in the talk you want to start.

The only thing that I don’t like is that there isn’t a way to download it to your own computer to view offline.  Any Open source geeks fancy creating an open source version of this software?

Take a look at the presentation, it’s half an hour and the speaker talks a lot of sense.

It would appear that the LAS is starting to recruit a few more people.  How do I know this?  Well a couple of people have emailed me for tips on how to get into this job/pass the interview/pass the driving test etc...

So in an effort to increase my laziness efficiency I am writing this post just so I can point it out to people who email me asking for advice, and this will hopefully answer all their questions...

First off - there are two routes into working for the LAS.  the 'traditional' route is to apply for a place on one of our training courses, after which you are offered a place at one of the stations around London.  This is the route that I took, and at the end of 20 weeks training you are an EMT-2, or as they used to be known 'Trainee Qualified Ambulance Technician'.

The other route is via the University of Hertford (and now also Kingston University, but I think you have to get on the course via the LAS), who do a degree course - It takes 3 years and when you finish the course you are a State Registered Paramedic.  You are not guaranteed a job though.

More information is available via the links.

To apply for the traditional route you must…

• Be aged between 21 and 45
• Have a stable employment or education record.
• Be able to communicate effectively with people from different backgrounds.
• Be physically fit with good eyesight.
• Have held a full, manual British driving license (with no more than 3 points) for at least for two years.
• Be resident in or near the Greater London area or prepared to relocate.

You should also have at least a little bit of common sense.  Previous medical knowledge is not required, although obviously it's an advantage.  Reading this blog should give you an idea about the work, and whether you are emotionally/psychologically suited for it.

I don't know what being in the St John's ambulance would do for your chances of getting in.  While the training would be useful a fair few people still hold a grudge over the dispute in the late 1980's.  It shouldn’t have a negative effect on your application, but you never know.

For more details, and to apply the important address is…

London Ambulance Service NHS Trust
Recruitment centre
St Andrews House
St Andrews Way
Devons Road
London E3 3PA
Tel: 020 7887 6638
e-mail: recruitment@lond-amb.nhs.uk

Once you apply, expect to wait.  Expect to wait a long, long time.  I had to wait over a year to be interviewed, as it all depends on when the LAS are able to run the courses due to either manning or financial pressures.

The interview is to see what sort of person you are (duh), and to see if you will fit in with the ethos of the LAS.  The questions that I was asked included 'Do you mind taking orders from a woman?' (which we all found hilarious considering that I was coming from such a female dominated profession), 'Do you have any problem with blood and guts?' and then they gave me a scenario dealing with a stroppy relative.  I think there was also some of the standard questions you get in any interview, 'What qualities do you think you will bring to the job?', 'You do know that you will be working shifts?' and 'Are you a racist?'

My interview was a fairly friendly affair, but then I think I have that effect on people.

Then on another day, comes the physical/mental assessment.  This involved carrying a weighted dummy up and down some stairs (with another applicant), so make sure you wear decent shoes, I was wearing my best high heels, so I had a fair bit of trouble...

Then they test your dictation/English skills, which involved copying down a text from a tape.  They play the tape twice, and it's not too fast.  As long as your handwriting is legible, you should get through this bit.  If you think you'll have trouble, practice with a friend reading a paragraph from a book.

You also get sent a piece of paper teaching you how to put an Entonox cylinder together.  You have to learn it and then physically do it.  It isn’t hard to do, and they give you plenty of practice.

The maths test starts off easy, but then progresses to questions like, 'Your ambulance goes 5 miles to the gallon in town, and 7 miles to the gallon on the motorway.  You travel 4 miles in town, then 7 miles on the motorway followed by another 3 miles in town.  What colour is your ambulance? How much petrol have you used?

Calculators are not allowed.  Nor are mobile phones with calculator functions.

I don’t know if there are sample question sheets, but if you are not too happy with maths, then warm up your brain by doing some arithmetic before going on the assessment day.

Then comes the driving test.  Essentially you are expected to drive a 14 seater van around the streets of Fulham.  Qualities that the tester is looking for are - safe driving, following the highway code, and the thing that stuffed me on two occasions…”underconfidence/overconfidence”.

Oh, and not to hit any kerbs…

If you are not used to driving vans, then I highly recommend that you hire a van and drive it around for a bit.  It did wonders for me.  I’d also suggest that you drive it like you would drive your own car.  I failed first time on the ‘underconfidence’ thing, as I was driving like a 90 year old granny with poor eyesight.  I’d suggest driving as if you are driving your own car.

They do give you a couple of attempts on separate days to pass.  I think there is 6 weeks between attempts though.

 Hopefully, this will help you join the wonderous organisation known as the LAS.

Good Luck!

…sucker…

I get sent to a job “Female 14, collapse in back of police van”.  Nothing suspicious about that, we often get people collapsing when they are being arrested/evicted/give final notice/have the repossession people around.

So there they are, in the say in a side turning just off a main road.  I park up and can tell from the relaxed attitude of the police that it’s probably nothing too serious.  One look at the patient confirms this – she’ll have to go to hospital (to protect everyone against being sued), but she is fine.  I examine her vital signs and everything seems to be normal.

The ambulance turn up and I’m just handing over the information about the patient when a woman in a SUV decides to turn down the now blocked side turning.  Realising that she isn’t going to fit between ambulance and police van, she starts to reverse.

The ambulance crew, the four police officers, the patient and myself can all see what is going to happen next.

“STOP!”, shouts the policeman

“Stop!”, shouts (slightly less loud) one of the ambulance crew.

“Oh dear…”, I whisper under my breath.

*CRUNCH* goes the (slightly battered) SUV against an absolutely pristine vintage Jaguar.

“FUCK!”, goes the driver of the Jaguar, quite understandably I feel.

“You muppet”, mutters the police officer.

If you listen carefully you might hear a little snigger from someone on the ambulance side of the seven witnesses of this act of ‘Driving without due care and attention’.

Not from me…obviously.

The patient goes into the back of the ambulance, and I’m left chatting to one of the policemen.

“I bet”, I say, “She doesn’t have any insurance…”.

“Well”, he replies, “It seems that half the people around here seem to think it’s optional”. (Point 4 on the link – Although it wouldn’t surprise me to think that 50% of all car stops have no insurance).

So I have a little eavesdrop, and sure enough, she has no insurance.  The driver tries to get angry at the police, but this soon vanishes when she realises exactly how much trouble she is in.

(In the great scheme of things, not *that* much, but enough to cause her some serious anguish).

The police officer spends the next ten minutes rolling his eyes as he contemplates the paperwork he will have to do.

I try to cheer him up by telling him that he has personally successfully detected two crimes.

I don’t think it worked…

From Diamond Geezer. 

Hi Mum. Hi Dad.

Sorry, but for the first time in my life I'm not able to be with you this Christmas. At least it's not my fault, it's that damned bird flu. Even if I was allowed to leave London, which I'm not, I don't think I'd ever be able to get round the Felixstowe Exclusion Zone. I've heard they shoot people who try to cross the M25 now…

A really powerful read, more of it on his Blog.

(WARNING:  It has been a while since I was in education, so I don’t know the current ideas on political correctness, so if the post below is insulting, I’m sorry.  You should know by now that I treat everyone the same.  If you think I’m racist, then check out my archives.  However, it’s not against the law (yet) for me to say that I think religion is a generally silly idea).

Written by the Ambulance Service Association, the Community Handbook (Pocket edition) is an easy reference guide to many of the ethnic groups that we may come across.

Of course, in London there are around 200 different ethnic groups, so any ‘comprehensive’ handbook would weigh a ton.

So we get a two page spread of some of the commoner ethnic groups in the UK.

You can take a look at a sample of the book.

It’s very pretty, and I can imagine it possible being useful for ambulance trusts who do not have a large ‘ethnic’ population.  But I work in Newham, where the ‘ethnics’ outnumber the WASPs, and I’ve found that you tend to pick up on other peoples culture pretty quickly, as in a week or two on the job.

One amusing point of the book is that for a lot of cultures, it says that you should remove your shoes on entering the house.  Yet one of the main things we were told in ambulance school, was that you never take your boots off, as it’s just too dangerous.  I’ve only been asked to remove my boots once before, when I was entering a Mosque.  I explained that I couldn’t and the head bloke there told me not to worry, as the sick person was more important (he was as well, he was having a heart attack).

For a number of cultures, the book tells us that we should speak via the head male family member.  Again, in practice I’ve never come across this.  What I do tend to come across is a seven year old girl doing the translating for the whole family, which is why I think you have a lot of very ‘grown-up’ Asian girls.  Language is always a problem, but I’ve found that although people tell me that they can’t speak English, it is more probable that they don’t have the confidence to try.  So I always try to talk to the patient, and then the relatives will translate the odd tricky word.

Various cultures also apparently have a taboo about men dealing with women.  Again, something I have very little trouble with, as I’m not about to perform gynecological examinations on my patients.  The only time I’ve found that it might be an issue is with delivering babies, but if there isn’t a woman around then I’ve found that people are just plain happy that there is someone around who knows what to do.

Although, having seen some of the ethnic grannies, and their attitudes to their granddaughter having a baby (something along the lines of, ‘Stop being a wimp, and push it out’), I suspect they have as much an idea about delivering babies as I do.

And I can’t see any culture being happy about having their women undress alone in front of strange men.

The book also has little sections on ‘Customs around Death’.  I’d like to think that we are so successful at treating people that we don’t have to deal with it that often…

To be honest, a lot of the book is trying to teach us to suck eggs.  As long as you have some semblance of common sense, and are polite and respectful to everyone (except maybe drunks…), then you shouldn’t have any problems.  If in doubt ask is my motto, and I’ve learned quite a bit about other cultures just by asking the patient.  I’m guessing that a lot of ethnic people have come across a fair bit of unconscious culture clash, and have developed their own strategies for dealing with it.

Please note how Reynolds has made special effort to make everything positive in the above post.  Note how he hasn’t mentioned that some people have a huge chip on their shoulder about their culture, or how one culture seeks to emulate the worst qualities of another culture, or how a lot of non-drunken violence seems to be ‘ethnic’ vs ‘ethnic’ violence.  Just remember, I dislike everyone equally, I’m an equal opportunities cynic.

At Ikea. Will to live fading. Name of computer desk only bearable thing. Send help now - need easy way to commit suicide...

UPDATE: So, the reason why I was in Ikea was purely because my mother can’t stand driving on the A13 (one of our more dangerous roads).  So as the good son who can drive, I was designated to take mother and brother to that Hell of furniture.  Why furniture?  Well they have decided to redecorate their house.

I only did this because Mum brought me some flat coke when I was too poorly to set foot outside my flat, so I kinda owed her a favour.

Obviously my diarrhea and vomiting are much better, thanks for all the advice, and I do wish I’d saved a stool sample to send off to an enviromental health lab – but my mind had been on other things.

I also got lumbered with cutting of the excess wallpaper at their place.  My mum doesn’t trust my brother with anything sharp – that’s why he marks all his school books in crayon.

Now I have an hour to get ready for my Tuesday night meet-up with my friends around my place.  At least I don’t have to make myself look beautiful…