Never look back, except to learn from your mistakes.  Your road is in front of you so take joy in travelling it.

Happy New Year folks – May your plans be fruitful, and your problems solvable.

From my nursing days – a reason why I hate people who smoke around children

Eight year old girls don’t look like they are sleeping when they are dead.  At least not after over an hour of trying to save her life from an ultimately fatal asthma attack.

We were all distressed, she had been gasping for breath when the ambulance crew had ‘blued’ her straight into resus.  Asthma nebulisers hadn’t worked, and all you could fixate on was her chest desperately trying to pull air into her lungs.

So she died, a frightening and painful death.

The doctor and I went to tell her parents.  They were in the relatives room, I could barely see them as I walked in, the clouds of smoke filled the air.

They cried, of course they cried.

Then they went outside and have a cigarette.

Then they came back inside the resus room and sat with her body.

The father lit up another cigarette.

 

This is why I hate asthma, this is why I hate people who smoke when they are pregnant, this is why I hate people who smoke around children.  Kill yourself if you want to, but don’t kill your kids.

This is why I hate people who smoke around their asthmatic children or, if I mention that smoking aggravates asthma, they send them in their nightclothes to stand in sub-zero temperatures.

There are jobs that haunt you.  This was one of them.  Try calming down an eight year old girl who is dying in front of you because they can’t breathe.  Then try and forget about it.  I did a cot death once, beside the cot was a full ashtray.  Sure the parents are punished by the death of their child.  But it doesn’t help the child…

As I typed this I realised that I was clenching my teeth.

I found myself standing in a house, sometime in the small hours. In front of me was a women who was just starting to go into the early stages of labour. Also in the sparse sitting room were four small children, a husband and a grandmother.

"Do you mind if I have a fag?", the woman asked, peering over her baby carrying belly.

"Been smoking a lot?", I asked while eyeing an asthma inhaler.

"Yeah", she replied, "they won't let me smoke in the hospital, will they?"

"No, they tend to frown on people smoking around newborns - not good for their health you know".

I looked at the children again.

"Hi kids", I said, "who here has asthma?"

Two of the children put their hands up.

"You know of course", I said turning to the mother lighting up her cigarette, "that your smoking has probably given them asthma".

"Yeah", she replied, "Kids - go stand outside while your mum has her fag".

The two children, one four years old, one perhaps seven, both dressed in their night clothes went out through the front door into the freezing air of the night.

I don't think the mother quite understood what I was trying to tell her.

Luckily the ambulance crew turned up before I could tell her that the best thing she could do was die quickly of lung cancer so her kids might get adopted into a family that may have the slightest concern for their health.

Yes - I am an anti-smoking nazi, especially when you are fucking up the lives of children who have no say in the matter.

I'm sitting on station at the moment, unable to go anywhere because I don't have an FRU car.

The reason for this is that my mate working the day shift has crashed it into another car. I'm not too sure on the details, as he's currently in the hospital being checked over for injuries but the word so far is that it's minor injuries only all round.

Add in the FRU that I mentioned yesterday which was crashed last week, and there is a distinct lack of motors to go round.

(Also I think that the fancy new Zafira I had yesterday is having an engine repair done on it).

I'm sure that it's nothing to do with this spate of crashes, but because of our ORCON times, we did all get a memo a week or so ago telling us to try and drive to calls a bit faster...



I think I'm getting a station officer's car after 10pm, I'll try to be careful.

I'm not perfect.

I arrived at work to find that my FRU car was nowhere to be seen. There was no-one on the early shift, so where had my car gotten too?

Last week a friend of mine had an accident in the Newham FRU car (in front of a load of police officers, which gave them some amusement I would imagine). So the car that I would normally use was being borrowed by Poplar station.

So the plan was for me to get picked up at my station by a station officer, then I would get the keys to the brand new Vauxhall Zafira. I'd thgen return to my station and start working.

The station officer met me and drove me down to Newham station. He asked me that, because I was leaving my secondment on the FRU, if I could write up my thoughts on what was good, bad and what could be improved about it.

I told him that this blog would answer most of those questions.

The brand new Zafira was parked in the garage at Newham, so I hopped behind the wheel and after some struggling with the new design of handbrake, managed to reverse it out of the garage and into the parking area.

Where to the absolute horror of the Station officer I drove into another car.

Oops.

Luckily there was no damamge to the Zafira (which has less than 600 miles on the clock) and very slight, if any, damage to the private car.

The first accident I've had in over 18 months and it's in front of a station officer...

Not a good start to the shift.

My thoughts on the Zafira are this - if you wanted a rapid response vehicle, the Zafira shouldn't have been chosen. It's top heavy and wallows like a hippo in thick mud. The acceleration is awful, you hit the pedal and it takes one and a half seconds before the diesel engine gives you any sort of power. It is comfortable to pootle around town in, and the high up viewing position is quite nice.

But there is no way that it could be considered a 'Fast' car.

I think the reason why we have them, is because they are able to carry patients, and I imagine that soon FRU drivers will be asked to take the coughs and colds that we see so much of of to hospital.

I am tired, and in an incredibly bad mood after this shift. I'll explain more when I can motivate myself to write about it.

‘Grand Rounds’ will be stopping here next week.  If you don’t know what it is then you can have a look at this weeks edition.  Essentially it is a round-up of medical blog posts.  If you want to contribute then please feel free to email me your articles for inclusion.  My email address is hidden behind sneaky anti-spam technology.  I was involved in the first couple of these, but then got too lazy to send in articles, so now I just read it.

 

Of course, there may be potential hazards with working in an ambulance.

Hey, just because I’m leaving the FRU doesn’t mean that there is a lack of people willing to take my place.  All they have to do is listen to our management as they insist we spend more time sitting in the car (which is bad for my back) and that we faster to jobs (which is bad for my safety), and maybe spend time on standby on night shifts (which unions successfully stopped double crewed ambulances from doing, because it’s just not safe).

At the end of the day, sick people need to be in hospital, not in their own home, or on the side of the road with me standing over them watching as they get sicker and sicker.  Sure, I can give some lifesaving treatment, but this is only for a few specific illnesses.

What we need on the road are not more FRUs, which exist mainly to get our ORCON times up, what we need is less people calling ambulances more ambulances on the road.  We need more ambulances than we have at the moment, as total numbers of ambulances have hardly increased in the past ten years, while our workload has soared.

This really needs to be a subject of a long post all of it’s own.

As an example – consider Christmas Eve night.  After 1am, there were no ambulances from the busiest complex in London.  Other complexes had to cover Newham, Poplar and West Ham.

There was one FRU.

At the end of the day I believe that I will be providing better help, to more people, working on an ambulance rather than a FRU.

I think I’m going to be leaving my job soon.

I went to a six month old baby, possible meningitis.  The baby had the right sort of rash (although it was only on the back of the knee, and nowhere else.  I checked).  It had a temperature, but was one of the happiest, most alert children I’ve ever had the pleasure of meeting.  It just didn’t seem as if it had meningitis, and trust me, I’ve seen a fair bit of children and adults with meningitis to have a pretty good idea.

Then, like my previous post, I was left waiting for an ambulance.

I think it was around 45 minutes.

There was no way I was going to be able to transport the patient in my car.  It’s just not equipped to carry such a small child.

So the family ended up phoning a friend to take them to the hospital.  The ambulance turned up just as they were getting into their friend’s car.

All I had going through my head was “No Ambulance For Baby Dying Of Killer Bug!”.

Later that night I went to a woman who was having an extremely painful miscarriage.  There is nothing I can do for that, the patient needs to be in hospital.  Thankfully the ambulance wasn’t too far behind me, but if I had been waiting on scene, then it would have been a very awkward and distressing wait (again, because of the pain, it would have been impossible to transport her in my car).

More and more I’m looking at my watch as an ambulance fails to arrive.  It’s only a matter of time before I have someone die in front of me while waiting for an ambulance.

So, I’m seriously considering leaving the FRU/RRU and going back to work on an ambulance.  That way I can pick up sick people, and take them to where they need to be.  A hospital.

So after the holiday season, I think I’ll be sending a memo up to the office asking to return to my ambulance role.

The reason why there is a shortage of ambulances?  Partly the season and the increased number of calls, partly because while the population of our area has increased the number of ambulances haven’t, and partly because of a lack of manning.  Oh and that we have to go to crap jobs.

For your enjoyment – another strange eBay auction.

A big thanks to all the people who sought out their local ambulance stations and similar to feed them.  A personal extra big thanks to *version 3.1 who, besides having the best fancy dress costume ever, left a lovely package full of sugary goodness at my station.

Also, thanks to everyone who wished me and my fellow workers a merry Christmas.  It’s all appreciated.

Big news tomorrow…

The staffing of ambulances at the moment is…to put it bluntly… poor.

Working on the FRU/RRU means that I often get to a call within minutes (yes, within 8 minutes) of that emergency call being made.  Unfortunately with so few ambulances on the road, the patient and I are often left staring at each other for long periods of time.  Up to an hour in a couple of cases.

I was sent to a young man having an asthma attack.  It was late at night, and he had been queuing to get into a nightclub, had started to feel his breathing getting tight, so had headed to a taxi office in order to go home.  Unfortunately his asthma progressed and so an ambulance was called.  What he got was me.

After dealing with the drunk group of teenage girls that were waiting for a cab, loudly ’caring’ for my patient, I started my assessment.  It was a cold night so I sat the young man in the taxi office, and listened to his chest.  I could hear a nice loud wheezing from his lungs, so I started him on the first dose of our asthma medication.  I got his details and vital signs, and waited for the ambulance to turn up.

It takes between five and ten minutes for the asthma medication to finish, and by the end of it there was still no ambulance.

I listened to his chest again, still an audible wheeze, so I gave him a second dose of the medicine.  So there he was, sitting in a cab office at three in the morning with a mask over his face, ‘smoke’ pouring from it, and all around us were intoxicated people getting cabs home.

Not very dignified.

We started chatting, and I was impressed by this polite young man with manners and common sense.  The second medication finished and so we continued to wait, and wait, and wait for the ambulance.  I phoned up my Control and asked them if there was an ambulance assigned.

“Sorry EC50, we are still holding calls in that area”.

So I was on my own with this patient for the foreseeable future.

Sometimes I can transport a patient myself to hospital, it’s not technically allowed.  Actually we’ve been told that we shouldn’t do it at all, but in some cases I think I’m doing the right thing for the patient.  So I will load them into the car (which only has the front passenger seat, the rest of the car is taken up by equipment) and nip into the nearest hospital.  Control are often happy for me to do this, as it means one less job that they need to send a proper ambulance to.

I couldn’t transport this patient though, he wanted to go to his local hospital, which would mean driving past two other emergency departments and out of my area.  I couldn’t see Control, or my bosses being to happy with that.

So the patient got a cab to hospital.  At his insistence.  The double dose of medicine had cleared his lungs up nicely, but he would probably need some short-term steroid treatment.  I rechecked my assessment of him, and was happy that his physical condition was well enough to get a cab to hospital.  But I wasn’t happy that there was no ambulance for this patient who actually warranted an ambulance.

As I write this I wonder what would have happened if he hadn’t responded to the medicine that I gave him.

17:49 - 18 year old female, fainted.

A new experience for me as it all took part in a Shiska bar. Strange to have 30 young Muslim males, smoking shiska, wishing me a happy Christmas and astounded that I have to work today.

The patient was fine, and didn't want to go to hospital. As her examination was fine, I left her with her friends.

Hopefully the last job of the shift for me.

Merry Christmas.

17:06 - 23 year old female, 22 weeks pregnant, possible miscarriage, maybe 'just' an early rupture of membranes.

What a cheery day I'm having this shift.

Still, I'm doing better than a lot of my patients.

I just want to sleep now...

14:26 - 26 year old male with chest pain and hyperventilating. Probably nothing serious, but as he has had the chest pain since 4am, its wise to treat it as cardiac.

12:17 51 year old alcoholic with difficulty in breathing.

I entered the room and he had vomited blood everywhere.

Then he stopped breathing.

Then his heart stopped.

I could only find one glove, so my left hand became covered in blood and vomit.

We got him into hospital, before we got there we had restarted his heart. It probably won't last for long, but you can always hope...

11:28 - Little old lady in sheltered housing. Bit of a chest infection with some upper abdominal pain, probably through coughing too much.

An easy job, with a carer who actually seemed to care.

10:38 Set to a Bupa nursing home for a little old lady with a grotty chest infection. Quite seriously ill, and as is common in nursing homes 'it happened suddenly'.

After taking the patient away they asked for the oxygen mask back as it was the only one they had...

...why aren't we winning the fight against MRSA?

(For those that don't know, oxygen masks are one use items, otherwise illness, for example a CHEST INFECTION may be spread between two people).

Time to return to station to fill in a 'dangerous occurance' form...

First job at 6:33 - Maternataxi.

We came close to deciding to deliver at the home.

Spilt my cup of tea getting to the call, which is the real tragedy..

So it's Christmas. I'm probably sitting in my car, all alone and hungry outside Stratford town centre. Feel pity for me.

Further on in the article it talks to a homeless fellow. Seems that he is getting a full Christmas dinner in one of the homeless hostels. That is better than us poor bloody ambulance workers. Not that I begrudge them a good meal mind you, just that us in the LAS find it funny. I'd bet that prisoners will be eating better than me today as well.

I wonder how many drunks I'll pick up today.