On an uncharacteristically quiet Sunday, the crews at West Ham station have taken some time to relax on the grass outside their station.

We have also just had the four planes for the commemoration ceremony fly past - we then rushed into the station to watch them on the television, just seconds later.

I know you will probably already have seen this but...

This is why Londoners won't be beaten by terrorists.

We have recently updated the AMPDS dispatch system in Control. This piece of software is supposed to categorise all the calls into the three different priorities...

Cat A (Red)- High priority, life threatening injuries and illnesses.

Cat B (Amber)- Medium priority, chance for disability.

Cat C (Green)- Low priority, cut fingers, coughs, colds.

We had been hoping that the new update would cut the number of 'Cat A' calls we would be going to by better triage.

Unfortunately, the opposite seems to be true (for me at least).

For example, Maternataxis, which mainly used to be 'Cat B' and 'C' calls are coming out as 'Cat A' calls because it is often classed as "Bleeding from dangerous location".

"Dangerous area" seems to be a new criteria with this 'upgrade', as it's the discriminating factor on a lot of the calls I go on.

I've just come back from a 'Cat A' call to a 16 year old boy who heard a crack in his neck as he got out of bed. No history of trauma, no neurological deficit, just the normal sound us old people make after waking up.

This was a 'Cat A' because it was a "Dangerous area". I hate to say it, but pretty much every point on the body could be considered a "Dangerous area" depending on what had happened.

I understand that we have to over-triage in order to be safe, but our Call-takers aren't allowed to use any common sense or clinical judgement in deciding the category of a call. It's all very " Computer says 'No'", I'm afraid.

The flipside is that strokes (CVA) tend to be categorised as 'Cat B' calls, which is something that really needs to change if the National Service Framework is to be implemented. Road traffic accidents also tend towards being 'Cat B' calls.

Crazy.

Why am I mentioning this? Well I've just come back from the boy with the neck cracking, and after cracking my knuckles in front of him, the crew took him to hospital and the thing is, after being either cleaning my new flat, decorating it or at work for the past month, I'm starting to have a sense of humour failure.

So I may be a little 'terse' with some of my patients.

Which is good, because if you mollycoddle idiots they'll only think that what they have is serious.

Reynolds is moving on Tuesday, and has a lot of packing to do by then, he is tired, fed up and looking forward to the end of the week when it should all be finished and he can get back to the pursuit of joy...

History’s New First Draft, is a Newsweek piece about how civilians are now reporting the news through Blogs and websites, using mobile phones and cheap cameras.

The writer spoke to me, and so I get a bit of a mention, but it’s a pretty good article in its own right.  For those of us watching the news live, it was obvious that the mainstream media were using a lot of amateur content.

I finish a job, and start to roll back to Station for a nice relaxing cup of tea.  As I pass one of the roads on my route I see a lot of firefighters, loads of police and a Duty officer’s car. 

“Hmmm”, I think, “Something interesting there”.

Then I notice a strong smell of gas.

“A-ha, that’s what they are there for, someone has left the cooker on”.

So I continue on my way, with a bad taste in my mouth and roll up to the Station…

…Only to find a load of Officers, strange ambulance crews (well, I say strange, but what I mean is crews from out of our sector), and some St John’s people.

“Something happening”, I ask.

“Yes”, says one of my friends, “We are roaming London ready to deal with anything out of the usual”.

“In fact”, she continues, “We are here because there might be a Chemical incident in Lucas Avenue”.

“Oh Bugger”, I think.

So I let them know that I drove past it, and they tell me to sit in my car so that I don’t contaminate anyone.  Apparently one of the tests for nasty chemical stuff came back positive.

I’m not too worried, if it was anything that nasty I’d already be dead.

They retest their samples, and it’s actually negative, the team are stood down, and I’m allowed out of the car, and back to work.

 

Still it’s nice to know that our people are still on the ball.

False alarm, more details when I get home this evening.

You may be amused to know that at the moment I am being quarentined as a potential poison gas victim. I do have a funny taste in my mouth. More when I know myself...

It seems that the LAS is back to normal. No hospitals are closed, the Underground is recovering and the buses are pretty much back to normal.

London isn't in fear, and we don't seem to be hanging Muslims from lamposts. Instead we are dealing with it, and getting back to normal. This shows the resiliance of Londoners no matter the faith, ethnicity or class.

I think Mayor Livingstone summed it up best when he said,

"I want to say one thing: This was not a terrorist attack against the mighty or the powerful, it is not aimed at presidents or prime ministers, it was aimed at ordinary working-class Londoners," Livingstone told reporters.

"That isn't an ideology, it isn't even a perverted faith, it's mass murder," Livingstone said. "We know what the objective is. They seek to divide London."


Now it is up to the nurses, physiotherapists, medical applications, therapists and all the other allied services to take over the long term and continuing healing process. These people are often forgotten but have a vital role in saving life and function.

Once more the blogsphere provided up to date news as well as reporting on what the mainstream media was saying.

We have a highly unofficial messageboard, there have been a lot of messages of support. Here are a few excerpts (all unedited).

--------------------------
The LAS and its sister services did a stupendous job today. I doubt if any city in the world could have mounted a similar response. The press talk about heroism. I'd rather talk about professionalism, organisation and effectiveness.

The street level emergency may have wound down, but a lot of our healthcare friends and colleagues are still working hard to save the lives and assure the recovery of the many victims.

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I was involved in the incidents from start to finish and can honestly say no matter how much we moan and whine , it all "came together " today , be it the LAS , the LFB , the Voluntary services , hospitals , the DSO's and AOM's we slag off , the met , the MOD plod , BTP, private amb services helped out, Miat teams , medical teams , HEMS , london buses who conveyed walking wounded , the GP's and district nurses who set up treatement centres in schools, joe public who gave out food to 999 personnel , the outer county services who responded to assist and anyone else i may have missed.

I might regret this , but i can actually say i was proud to work for the LAS today

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I've been on duty all day out in the 'burbs in south london. We've been listening in on ch9 most of the time. To those involved you have my total admiration for a job superbly done, you're all a credit to this service.

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I have to say I have never seen a service as organised as the LAS were today. I offered to go to work and when I arrived there was absolute calm and proffesionalism amongst every rank.

To be honest I thought it would be a nightmare but I was proved wrong. How well everyone did was astounding and a credit to the service.

Well done all involved and especially well done to all in CAC and gold control for organising what can only be described as a massive operation.

Also, well done for all the Tech, para's, ECP's and TQAT's. You can feel very proud all of you.

Thanks also to all the outer counties that assisted. Cheers Boys and girls. Your efforts will not be forgotten.


--------------------------
Just got home. It was a bit of a bugger out there today.
Drink. Shower. Drink. Sleep.
Talk to you all later...

Well done folks - went as well as could be expected.


--------------------------
well done all those who attended today, and well done to CAC on channel 9.

was listening in, and communication was second to none.
fantastic job.

Phone link went down to one of the recieving hospitals,
CAC put out G.B for any crew at hospital to relay blue call info.

Fantastic


--------------------------
I am proud today for the Service I work for.

We all moan, we have grips about what now seem trivial matters.

Many of us came together for what was a horrendous and cowardly act of lunacy.

Everyone deserves a large pat on the back safe in the knowledge you all did a fantastic job.


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(If anyone wants their comment taken down, let me know)

A bit 'stream of consciousness' I'm afraid

I found out about the terrorist bombs in London only because I was told by an electrician who was fitting some new wall sockets in my new flat. I rushed to plug in my small television, and found out about the bombs.

I phoned up our resource centre, as I was on my day off, and they told me that I should come in and go to Newham station.

I then covered the Newham area along with others who had volunteered to come in and cover for the ambulances that were dealing with the aftermath of the attacks.

I think we had a lot less calls than we normally have, I was sitting on station for longer than normal until I, and another manned an ambulance and took a maternataxi to an Essex maternity department.

Once the shock had settled, I started to feel immense pride that the LAS, the other emergency services, the hospitals, and all the other support groups and organisations were all doing such an excellent job. To my eyes it seemed that the Major Incident planning was going smoothly, turning chaos into order.

And what you need to remember is that this wasn't a major incident, but instead four major incidents, all happening at once.

I think everyone involved, from the experts, to the members of public who helped each other, should feel pride that they performed so well in this crisis.

London won't be beaten, we spent 20 years under the shadow of the IRA, and are used to terrorists.

The medical staff at the BMA building did their best to save their 'civilian' staff from looking at the carnage that was left from the bomb on the bus.

The mobile phone networks appeared to be shut down - a good plan for potentially stoppng more bombs from being triggered, but bad if you are trying to get into contact with relatives.

My brother considers himself very lucky, yesterday he took 40 schoolchildren to the science museum - right through the affected area.

I'm back to 'normal' work tomorrow, I wonder what it'll be like.

There are a number of dead bodies from the bus bomb being stored in the BMA building. There is blood up the windows. This comes from a friend who was there when the bomb went off.

via mobile.

More details here

Leave comments if you want.

I’m keeping my fingers crossed for everyone.

Technorati Tags for London explosions.

Right, I’m afraid this site will become rather ‘blogging lite’ for the next few days.  My move from flat ‘A’ to flat ‘B’, while being a huge pain in the arse is soon to be completed (hopefully by the 13th of July).

Unfortunately, this is crunch time, and I may even be without an internet connection for a while (although, for those that are interested, I should have my wireless broadband up and running before the carpets are put in.  How’s that for geek dedication).

My life has so far consisted of work, sleep, wallpaper, chase up council idiots who think that an accessibility bath for an 80 year old is suitable for 6’1” of lanky me, and do other fun stressful things one must do when picking up everything you own in life and move it to another area.

So blog posting will suffer, as will email, blog reading, MMORPGs and all the other little things that stop me from going insane.

So – don’t go away, read some of the archives if you haven’t already, and I’ll try and write something when I’m at work.

See you on the flipside.

Having a vague sense of humour failure towards the end of my fourth night. Not helped by the thought that today I shall be mainly hanging wallpaper, painting walls and trying to buy some carpet.

The stand out silly job of the night was...

40 year old male who'd drank some water and some of the water went down 'the wrong tube', so he coughed and spluttered a bit and his family called an ambulance.

I got it as 'difficulty in breathing'.

Raced, at high speed, across town (with all the dangers that this involves) to find him unsurprisingly fully recovered.

Quick check to make sure he hadn't suffered a stroke (because that can muck up your swallowing function), and then I was on my way.

Back across town at exceedingly high speed for a seven year old asthmatic.

(I do love smelling the burning brake pads when you hop out the car at your destination).

How do you reach the age of 40 without coughing on a drink? I mean, I nearly choked on my tea when I saw this posting., and that was just today.

This post is completely egotistical – but sod it, I can blow my own trumpet sometimes…

I think I’ve just saved someone's life, but only because I’m honest.

It’s 6:20 am, and I had ten minutes to go until the end of the shift.  I’d just finished a maternataxi at the other end of my patch, so I considered sitting there for the ten minutes of my shift before ‘greening up’.  That way I wouldn’t get another job, I could get back to station near enough in time, and by extension be safe and warm in bed before 7am.

“Sod it”, I thought, “what are the chances of me getting a job in these ten minutes”.  So I ‘greened up’, and started heading back to station.

6:28am.  My computer display starts buzzing, “58 year old Male, swollen tongue”.

“Bugger”.

It’s at the other end of my area, on go the lights, on goes the siren, and I key the mike to ask Control if there is anyone nearer, or anyone who finishes at 7am who could take the job.  There isn’t.

The problem with getting a job at 6:30 is that pretty much every other ambulance and RRU in the area finishes their shift at 7am.  So if they have all been on jobs, they’ll sit out the last 20 minutes of the shift at hospital.  Or they could all be genuinely busy.

If Control are holding a job, then they’ll broadcast it over the radio, and hope that someone will take it, which to be honest, someone normally does.

So I race around there, getting there is Nine Minutes.  Damn, the job is a failure…I need to get to every job in under 8 minutes.

The patient has a swollen tongue alright, so much so it’s nearly falling out of his head.  Apparently it started swelling up from last night, and has just been getting worse.

It looks to me that he is suffering an allergic reaction, quite a serious one as well, although he has no idea what he might be allergic to

Ok, I think, if it’s taken that long, he has plenty of breathing time, we can wait for the ambulance, and the hospital can treat him with the nice drugs.  The only drug I have in this situation is adrenaline, which can have some fairly nasty side effects (nothing serious, just it’s not a pleasant drug to have injected into you).

So we wait, have a bit of a chat, and I manage to calm him down.

“It’s still getting bigger”, he says.  So I have a look, and it is indeed getting to a dangerously large size.  If it swells much more his airway will obstruct, and he won’t be able to breathe.

“Alright then”, I say, “Time for that injection I told you about”.

500mcg of Adrenaline, straight in the muscle.

4 minutes later, and he tells me that “It’s getting smaller”.

10 minutes later and it is noticeably smaller, and he is able to talk in a much more normal voice.

His mum, 86 years old, and dressed in a little checked work pinny comes down and offers a cup of tea.

50 minutes after arriving on scene and after having a good chat about the state of English rugby, the weather and the good the NHS does, an ambulance rolls up outside.

The ambulance has also ‘greened up’ with 10 minutes to go on the end of their shift.  Bless them.

I get back to station and finish my paperwork – it’s now 8am, one and a half hours overtime then.  Back in 10 hours to do the same again.

Then I start thinking…  If I hadn’t been honest (read: scared about getting caught and getting the sack), then I wouldn’t have gotten the job, the patient’s tongue would have swollen, and he could have choked to death.

All those little random decisions came together to help this patient.

And I managed to go home with a warm glow inside, rather than the sickness of fatigue, and the dejection of yet another drunk/assault/drunken assault.

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.