Medical stuff is easy, I know exactly what to do when someone is having a heart attack, has a broken leg, or has driven their car at speed into a wall.

It's the 'social' stuff that is really tricky.

3am in the morning, and I find myself going to a call, "Female, fell down stairs". On arriving outside the flats I heard two people arguing, and initially the female wouldn't let me into the flat. Then a young looking boy (he looked and sounded about 13 to me), 'buzzed' me into the flat.

The patient had a black eye, and a possible broken nose. She was covered in blood and was extremely upset.

She also refused to go to hospital, because she had her young daughter asleep upstairs.

The patient maintained that she had been out drinking, while the young looking lad had been looking after her daughter - she didn't want to go to hospital because she didn't want to leave her daughter with the lad anymore.

I did confront her over being happy leaving her daughter to go drinking, but not to go to the hospital - she was still determined not to go to hospital

I also asked her if she was telling the truth, and that she hadn't been assaulted. She stuck to her story that she had simply fallen down the stairs.

Unfortunately, I can't drag people off to hospital, and even if I could, I'd have to arrange care for the young daughter.

I asked the young man how old he was, and he told me he was 22.

If he is 22 then he has some serious hormone imbalance problems, as his voice hadn't broken.

So, I had a woman who looked to me as if she had been punched, refusing to go to hospital. I had a 13 year old boy (or thereabouts) looking after her and her daughter. And I had heard them both arguing loudly from the street about something.

I couldn't just leave them like that. But what to do?

At 3am, there is only really one thing to do - although I hated doing it.

Call the police.

Contacting Social Services would have taken weeks to sort out the problem, and there was nothing us ambulance folk could do - so that left the police.

I know that they are busy, I know that they don't like attending this sort of thing, and I know that their hands are tied as much as mine. But I live in hope that they could do something about this situation - at the very least get it calmed down.

I'm still not 100% sure that I did the right thing, but compared to ignoring the problem I think that getting the police involved is 'the path of least evil'.

For all I know they have a huge file on this woman.

So, to all the police who read this blog - Sorry.

I am so unbelievably busy at the moment, mainly because of my impending move (and the fact that the place I’m moving into was left in a barely habitable state), couple that with some nightshifts, and a few other things that are going on, and you have a very tired, busy and generally worn out EMT.

I apologise if I need to email you, phone you or generally do something for/with you at the moment, and haven’t gotten around to doing it.  I will do it in the near future.

However the last nightshift did throw up a few possibly interesting stories – so I won’t need to search for inspiration for the next couple of posts.

Night buses are wonderful things, they allow nightclubbers in London the opportunity to find their way back home after the tube network has closed down for the night.  They also seem to collect people with *ahem* ‘colourful’ personalities.

The only problem is that they tend to rock you to sleep.

Bus drivers aren’t allowed to touch their passengers.

So when a driver reaches the end of his route, and there is someone still asleep on the bus, then the driver can shout, bang on the handrail, and stamp their feet.  But they can’t shake the person awake.

So they call the police, and the ambulance service to wake the person up.  The police in case they are violent, and the ambulance service in case they are ill.

The details are often sent as ‘person unconscious’.  Which makes it a high category call…

Can you see where I come into the situation?

As it is a high category call, myself, or someone like me is often sent along, on blue lights and sirens, to well…

…give someone a shake, and wake them up.

This is how our resources seem to be allocated these days.  Waking people up who have fallen asleep on the bus.

I don’t mind the patient, because who hasn’t fallen asleep on the train or bus?  But I do dislike the need for us to turn up to a call where there is no injury or illness because bus station staff are too scared/not allowed to gently shake someone awake.

 

I am part way through reading the Ambulance Report, and have already thought of a few comments for it.  Stay tuned.

On the way back from London I met Lee*. 

Lee thought that it was ‘cool’ to…

     …Get drunk on Strongbow and White Lightning.

     …Overdose on Heroin.

      …Fixate on Kurt Cobain.

     …and stick silly, and unattractive, amounts of metal through his face.

In fact Lee actually wanted to die young.  Preferably of a heroin overdose.

I spent a very enjoyable tube journey telling him exactly what us LAS do to twits like him.

I even demonstrated a proper sternal rub.  He couldn’t stand five seconds of it…

With idiot kids like him, is it any wonder we are fighting a losing battle?

Well, at least he and his friends, did entertain me on the tube back from the centre of town.

And he did promise to phone me when he was drunk…

I suspect he might reconsider if he reads the rest of this blog….

 

*Lee is his real name – I wasn’t on duty, so who cares about confidentiality and anonymity.

Not in the pub at all. Honest.

It started off as “hit with a broomstick”, but ended up resembling a cross between a riot and a carnival.

A small road, perhaps 20 households, down on the isle of dogs.  A family feud had finally spilled over into violence, one woman had been hit with a plastic broom, another had hurt her leg, a 10 year old had brandished a knife.

One of the injured parties had knocked on every front door in sight looking for witnesses, so there were around 50 people (mainly children) milling around.  It was a beautiful day, and people were enjoying the spectacle in the afternoon sun.  Children were running around, ice creams were being sold, and teenagers were staring at the scene, smoking and snogging and getting in the way.

The police had come in a van, and no-one was listening to what they said.  They couldn’t arrest the 10 year old, there were no witnesses, the child was under age, and yes, if he had stabbed someone then they could arrest him.

There were half a dozen languages being spoken, and people were angry that the police and I aren’t fluent in Urdu, Hindi, Somali, Turkish and Twi.  they didn’t realise that running up to a policeman, waving their hands around and shouting what sounded to me like gibberish, when there is someone who can translate standing next to you isn’t the best way to go about things.

“She hit me”, “All three of them hit me”, “I was kicked”, “I have a broken leg” (No…you don’t), “My mum is going to have a heart attack”, “I want them arrested”, “I want this written down”, “It’s been going on for ages, why haven’t you done something?”, “Why are we waiting so long for the ambulance?”, “What are you going to do about them?”, “My mother has fainted”, “My leg is still broken”.

I suggested that the police get the riot squad down.  A good idea, but they were all on day release having a picnic.

The police were starting to lose their temper, no-one was listening, no-one cared for what the police could or couldn’t do, they just wanted the attackers punished, locked up, or evicted.

People started to filter away when they realised that no-one was going to get handcuffed and thrown in the police van.

I finally managed to get to one of the ‘patients’.  Her family were pouring water over her head.  There is a ‘section of the community that believes that water being poured over the afflicted area will help, so I get sent to people with difficulty in breathing who are being soaked with flannels, and chest pains that are dripping wet.

I’m used to strange beliefs, my mother thinks inanimate objects have feelings…

The water was running clear from her head, no blood.  No loss of consciousness either.  Looking at the ‘broomstick’, a light plastic pole, I’d be surprised if it even left a bruise.

The ambulances came, crews looking confused as I gave them the shortest version of the respective stories I could come up with.

The other ‘patient’ was complaining of a broken leg.  She was still convinced she had a broken leg as she climbed up the steps into the ambulance.

Two patients, two different hospitals (we like to keep people separated in cases like this), and half a dozen police officers.

Slowly the street returned to normal and I settled down next to the Thames to do double the normal paperwork.

“No obvious serious injury”.

Fuck.

Stupid, stupid, stupid judges.You have just made any form of information transfer potentially illegal.

Just wait for some other countries to take advantage and economically crush the US tech business.

If not the next war, but the war after it will be fought because the US doesn’t like their enemy’s ‘lapse’ copyright laws.

Now watch the entertainment companies persuade British companies that the American route is the way to go.

Other things that could be rendered illegal?  TCP/IP, Video recorders, Camcorders, Tape recorders, Ethernet, WiFi, Pen and paper…

Lets see how many lawsuits the RIAA throws around.

See you all in the dark ages.

Got interviewed by the BBC today (Health online website).  At the end of the phonecall I was asked if I had a photo of myself I could send.

Well bugger me if I don’t look like a complete pillock in all the photographs of me I own.

And everything on Flickr that is tagged with my name has me looking drunk.

Perhaps I should get a cool photographer to take some portrait shots?  After all, I’ll need one for the back cover of my first book.

In different topic, tomorrow I shall be at the NMK seminar – if you are there, feel free to wave at me.  I’m still tryng to work out why I’m going, I suppose that it seemed like a good idea at the time.

So…

“Da Boss”, Peter Bradley CBE, Chief Executive of the London Ambulance Service also moonlights as the governments ambulance advisor.  As part of this new role he has created a report on the future of the ambulance service.  This report will be published on Thursday, although a couple of his ideas have already been released to the public (the use of ECPs and the changing balance of vehicles).

ECPs are ‘Emergency Care Practitioners’, paramedics specially trained in treating minor injuries.

Mr Bradley is strangely respected by the road crews of the LAS – and I say ‘strangely’ because we tend to be dismissive of anyone who works in an office.  Middle management tends to be disliked by everyone, and upper management is seen as having lost touch with the job as it is today.  But Mr Bradley commands a great deal of respect amongst the troops.  From people who have spoken to him I hear that he is indeed a fair, and forward thinking boss, something that I think we need.

Once I get my hands on the report I’ll do a full breakdown of it, but until then, here are my thoughts on what the media has been reporting.

First off, there is no way the ambulance service can continue in the current way of working.  The number of people using the service are rising, and while the ambulance service was originally for emergency calls, our area of expertise has had to be expanded in order to fulfil the wishes of our clients.

In plain language, we deal with a lot more ‘crap’ jobs.  Because of all these crap jobs, we soon won’t be able to cope.

We have tried to educate the public about the correct use of ambulances, and the NHS has provided other sources of patient information and treatment, like pushing for pharmacists to provide more advice, the creation of NHS Direct, and more ‘Walk-in centres’.  Unfortunately, this hasn’t helped much, and the change in the working hours of GPs has only increased the workload for ambulance services countrywide.

In other words, no matter how many times we tell people we aren’t a taxi service, and give them other ways to get treatment, they still want a ride to A&E in a big white taxi.  GPs refusing to work during the hours of darkness (or hours when the golf course is open) hasn’t helped us much either.

So, the ambulance service needs to think smarter, rather than throw resources at the problem.

We surrender.  The public are too daft to be told.

The plan is simple, we bring treatment to the patient, rather than bringing the patient to the treatment.  A&Es are busy places, and there are a lot of patients who can safely and effectively be treated at home.  Other patients will be advised of other, more appropriate, avenues of treatment.

Taking everyone to A&E only increases hospital waiting times, which are no good for anyone (let alone government targets), so why can’t we treat things like minor wounds at home?  We should also be able to tell people with a runny nose that they need tissues, not an A&E department. (We do at the moment, but the service doesn’t currently support us doing this).

The ambulance personnel that will undertake these roles will have to have extra training.

Here is the problem, it’s all good until someone gets left at home and then dies.  Training will have to be pretty intense, and that will cost money, and take time – there will also have to be some serious support for people acting in this extended role.  When every job could ‘go bent’, I imagine the stress will be pretty big.

The salaries of those trained will have to increase.

Because a majority of calls to ambulance services are not life-threatening emergencies (my opinion only), the balance of solo responders (like myself) will increase, while the number of ‘proper’ double crewed ambulances will drop.  Of course, if these extended role practitioners feel the need for a patient to go to hospital, if appropriate they may transport the patient themselves.  (This is why all new ‘Rapid Response Units’ are going to be people carriers).

This is really brave.  With enough ECPs I think that this will work.  But I wouldn’t like to work in the PR department the first time the Daily Mail has the headline “Ambulance chiefs send car to dying wife”.  Also with more people turning up alone to calls, I suspect that there will be more and more risk of ambulance personnel being assaulted.

The plan is to send these rapid responders to more calls, so as to filter out and treat those people who do not warrent an ambulance.  Then ‘proper’ ambulances will be reserved for the most serious cases.

My personal opinion of what I’ve heard?  I think it’s a bold, yet very clever idea – and I hope that it will work.  I think that success will depend on the details, like what the training is like, and I hope that the government doesn’t water down the ideas.  We will also need some serious thought going into treatment guidelines and protocols in order to protect the registration of paramedics.

At the end of the day – we are cheaper than GPs, we work 24/7, unlike district nurses, community psychiatric nurses and GPs.  It is up to the ambulance service to pick up the shortfall in care that this leads to, and ‘Da Boss’ is thinking ‘outside the box’ to solve this situation.

I’ll write more once I’ve read the report.

One of these is a London Ambulance.  One is Thunderbird 4.

So, I was at the RRU meeting yesterday, where we talked about response times, the future of the ambulance service and the new piece of equipment us RRU people are getting.

I'm not working for the next couple of days, so I'll spread these subjects out over the next few posts.

(It'll give me something to do in between wallpapering my new place).

The RRU cars are all getting a new piece of equipment, a propaq monitoring device.

They measure blood pressure, oxygen saturation, pulse, respiration, ECG, and end-tidal CO2.

They weigh a lot. They also come in their own shoulder-strap bag.

At the moment we can measure blood pressure, oxygen saturation, pulse, respiration and ECG. We can't measure end-tidal CO2, but it is incredibly rare that we would need to. Ambulances, as opposed to RRUs can monitor end-tidal CO2.

The equipment we are using at the moment is lightweight, and fits in one hand (or our primary response pack).

Cost per unit for the Propaq? £9,000 each. (That is a discount because we are buying in bulk)

Cost for the kit we are using now? £320 (roughly).

Number of RRUs in service? 60.

Total cost for this new equipment that we really don't need? £540,000

Yes. Over half a million pounds for a bit of kit that is heavier, more fragile, more expensive to replace and does essentially what we can do right now.

I suspect that there is someone high up in management who. much like the Blair government, thinks that throwing I.T. at things will make life better.

I think I'll stick to manual blood pressure measurement, and an oxygen monitor that is the size of a box of matches.

Oh, and some bright spark has made them cut off the carrying handle, so that it wouldn't be so heavy...