A charity is calling for the Scottish Ambulance Service (SAS) to be prosecuted after a damning report from safety inspectors.

I'm off to bed - early start in the morning *gaah*, so no comment. Anyone from the SAS fancy commenting?

FOR SALE:

X hundred words on various health related stories currently in the news (Binge drinking, 24 hour drinking, MRSA in ambulances, etc).

Normal rates apply.

(Why?  Well, I’d love to put ‘professional writer’ on my CV.  Don’t worry, I’ll write about it here as well)

Thanks folks you have successfully bullied my mum into going to the doctor.  She’s going to use Cheryl’s suggestion of blaming it all on me, and I’m currently educating her into not accepting ‘no’ for an answer from the doctor.

Gotta love the power of the internet…

Seriously – thanks.

Normal service is now resumed

Last night was a pretty strange one, in that I wasn’t massively busy – I only had eight jobs, but instead I spent most of my time standing around in patient’s houses waiting for an ambulance.

For various reasons, the manning of the ambulances last night was particularly poor – there was no night ambulances out of my station, and across the sector I heard the rumour that there was only ten ambulances running.

So the pattern for the night was that I would turn up to a patient, and then spend 30–45 minutes waiting for a crew to take the patient to hospital.  This isn’t a problem when dealing with a maternataxi ( patient’s first baby, pains started two hours ago, contraction pains of about 20 seconds every 15 minutes with membranes intact) who when I told them how long they would be waiting for an ambulance decided that driving themselves would be a better plan.

But with someone who is ill, those 50 minutes (I know, I timed it) seem to stretch.

In this case it was an elderly man with lung cancer who was having real difficulty in breathing.  his oxygen levels were 75% (they should be 95% or higher) and he was struggling to get oxygen to his brain.  Unfortunately there was nothing that I could do for him treatment wise apart from give him oxygen, and try to reassure him and his family.

It’s a bit hard to reassure a patient when the only word you understand is ‘bish’, which means ‘pain’, and he is using that word a lot.

Thankfully his family were on hand to translate, and they were incredibly patient and understanding about the long wait to get their father to hospital.  The oxygen that I was giving him seemed to help settle him a bit, but at one point he emptied my oxygen cylinder, so I had to nip back down to the car for a replacement.

So, not a busy night, just a bit of a hard one in places.

 The first sign of melanoma is often a change in the size, shape, color or feel of a mole. Most have a black or blue-black area. In watching for changes in your moles, remember the following "ABCD" signs:

1. Asymmetry: The shape of one half of the mole does not match the other.
2. Border: The mole's edges are ragged, notched, or irregular. The pigment, or color, may spread to the surrounding skin.
3. Color: The color is uneven. Shades of black, brown, tan, white, gray, red, pink or blue may be seen.
4. Diameter: There is a change in size, usually an increase. Melanomas are usually larger than a pencil eraser.

Mothers.

Annoying sods the whole world over.

She has a mole that has changed shape, and has an irregular border.  I happen to think that she should get it checked out by a doctor, because it might be the early stages of a melanoma (and remember, we have free health care in the UK, so it won’t cost her anything).

But of course – she doesn’t want to go, despite me shouting at her in person and down the phone.

Why? Well, she is either scared, doesn’t want to ‘bother’ the GP or thinks that the GP will ‘strike her off the register’ for wasting the GP’s time.

And of course she won’t let me come along to persuade the GP to refer to a dermatologist at the local hospital.

What she doesn’t realise is that I see people who I think are ‘undeserving’ of medical attention getting hospital treatment, and to see her refuse to be examined makes me angry that these other people get seen, but that my mother might die because of some stupid idea she has in her head.

I see it a lot, when I turn up at some little old lady, hovering around death’s door, and the first thing they say is “I didn’t want to bother you”, and it always makes me angry.

So the purpose of this post is to remind you to look after your own health (and that means checking for skin cancer – 7,000 people are diagnosed every year in th UK, and 1,700 die from it).

And also to see if this will change my mothers mind about seeing her GP. 

Feel free to berate her in the comments…

Can I have one of these please boss?

It is designed to plug into an oxygen cylinder and will automatically perform effective CPR (they tested it on pigs, which I can't really support - I like pigs, and I have friends who love pigs.)

I mean, not only will it mean that I can be lazy and not actually have to jump up and down on someone's chest, but if I'm the sole responder I can then concentrate on breathing for the patient.

Also it is more effective than manual CPR, and unlike me it doesn't get tired.

Only £6,000 - we can't let Staffordshire ambulance service beats us now, can we?

Note - photograph from the Daily Mail website, copyright does not belong to me.

I’ve not posted anything about hurricane Katrina, mainly because I have to say that hasn’t already been said by better people than me.

Instead, here is some haunting writing by two Paramedics caught up in the middle of it.

“Unfortunately, our sinking feeling (along with the sinking City) was correct. Just as dusk set in, a Gretna Sheriff showed up, jumped out of his patrol vehicle, aimed his gun at our faces, screaming, "Get off the fucking freeway". A helicopter arrived and used the wind from its blades to blow away our flimsy structures. As we retreated, the sheriff loaded up his truck with our food and water.”

“In the pandemonium of having our camp raided and destroyed, we scattered once again. Reduced to a small group of 8 people, in the dark, we sought refuge in an abandoned school bus, under the freeway on Cilo Street. We were hiding from possible criminal elements but equally and definitely, we were hiding from the police and sheriffs with their martial law, curfew and shoot-to-kill policies.”

I’ve been reading this post on being poor.  It’s partly an explanation as to why a lot of people couldn’t evacuate from the path of hurricane Katrina.

It’s strange, but there were bits in it that brought tears to my eyes, because my family had been in that situation in the past and it brought back some memories that I thought I had forgotten.

I thank my luck that I’m no longer in that situation, but tonight, when I’m at work, I know that I’ll see signs of poverty at some of the houses that I go to – and that this post will make me think about it a lot more than I normally would.

An excerpt,

Being poor is hoping the toothache goes away.

Being poor is knowing your kid goes to friends' houses but never has friends over to yours.

Being poor is going to the restroom before you get in the school lunch line so your friends will be ahead of you and won't hear you say "I get free lunch" when you get to the cashier.

Being poor is crying when you drop the mac and cheese on the floor.

Being poor is stealing meat from the store, frying it up before your mom gets home and then telling her she doesn't have make dinner tonight because you're not hungry anyway.

I know it’s a rare thing, but we actually managed to save the life of someone!  It was bloody hard work mind you, so I wouldn’t want to do it too often…

I got sent on a job with very few details , all I got was “Male, Unknown age, Unconscious, Unknown cause”. I knew roughly where the address was so I rushed around there, and saw the ambulance pulling up at the same time.

I quickly checked my computer screen and saw that I had gotten to the location in under eight minutes.  Whatever happened now the government would consider this job a success.

There was something about the family member who let us through the security doors that set my ‘spider sense’ tingling.  That ‘something’ was confirmed when the ambulance crew and myself walked into a bedroom and saw a rather dead looking 30 year old male lying on the lower part of a bunk bed.

I must admit that my first thought was ‘I wonder how long he has been dead?’, because if he had been dead for a while, we wouldn’t have to attempt a resuscitation.  We quickly pulled him from the bed and laid him on the hard wooden floor.

“Grrrooooooollll” was the noise he made.

I’m very used to dead people making unusual noises, it’s normally as a result of their last breath leaving their body.

We quickly hooked up our heart monitor and checked for a pulse.

His heart was beating!

He took a shuddering breath.

The patient wasn’t breathing often enough to maintain life, so we would have to take over breathing for him, which we did using a bag and mask.

One of the crew lay on the floor and peered down his throat.  Would we be able to intubate him? (intubate = stick a breathing tube down the patient’s throat in order to protect their airway)

“Nope”, she told me, “his airway is too tight”.

We picked up the (heavy) patient and wheeled him out of the house and into the ambulance.

Another attempt at securing his airway…

“No chance”, she said, “His airway is the size of a pencil”.

This explained why I was finding it hard work to force air into his lungs.

“Perhaps it’s his asthma”, I suggested, “shall we get some Salbutamol into him?”

Salbutamol is an asthma medicine that is inhaled – we can use various complicated connecting tubes to give this drug while I continue to ‘bag’ him.

“Lets give some adrenaline as well”, I said, seconds later it had been drawn up and given.

Giving adrenaline is another treatment for asthma.

(Why was I the one making all the suggestions?  Well the crew were busy connecting monitoring equipment, gaining intravenous access and doing other tricky things – I had the simple job of breathing for him, so I had plenty of time to think about our next step of treatment).

Then it was time for the run to hospital.  By now the patient’s chest was getting harder and harder to inflate.  His levels of oxygen in his blood were lower than I would have liked, but it was pretty understandable considering how incredibly close he was to death.

His chest got so tight that it ended up with two of us ‘bagging’ him – I would hold the mask to his face, while one of the crew was using both hands to squeeze the breathing bag.  I can still feel the pain in my arms where I was using all my strength to squeeze the bag in order to force air down his tiny airway and into his spasming lungs.

Then he vomited blood – well, ‘vomit’ is an understatement, he actually went off like a geyser – bloody vomit flew up to the ceiling of the ambulance, on the walls, over my arms, onto my trousers and covered my face and glasses.

I have learned however to keep my mouth closed when this happens…

We got to hospital, and as we were entering the resus bay the patient was starting to breath for himself – and by the time we had cleaned up the ambulance (and my face) the patient was sitting upright and was talking.

He had made such a recovery that the staff at the hospital had trouble believing that he was as ill as we told them he had been.

(Until they checked his blood levels, and on getting the results ended up sending him to intensive care).

A quick round of pats on our collective backs, and it was back to work.

Where my next job was a 30 year old with a painful foot for the past week.

I love reading peoples comments, not only are they often interesting, but they also serve to swell my ego.  This is a good thing.

This seems to be a popular blog, which is a good thing, but with that popularity comes a price.

Comment and Trackback spam.

I’ve been coming back from work and finding 20–30 bits of comment spam, and often half a dozen bits of Trackback spam.  After twelve hours of work, the last thing that I want to do is sit down and clear out the clutter.

As one of those people who hates registering for anything, especially reading/commenting on blogs I’ve always left open the possibility to comment anonymously without having to sign in.

Unfortunately I think that this is going to have to change.

So in the next couple of days, unless I receive another idea on how to stop the spam, I’ll be turning off anonymous commenting.  The problem is that I’m kind of tied to the Blogware commenting system, so switching to a slightly less spam-friendly is as far as I’m concerned out of the question.

Obviously I’d like everyone to register a commenting identity, as it makes it easier to follow what people are saying to me, but if you want to remain anonymous then you can use the following details.

Username: guest

Password: guest

Comments?

Dear patient,

I'm sorry.

I know you thought that you were going to die peacefully, but we have to try and save lives, even though you were terminally ill. Your husband didn't want you to die yet, neither did your daughter.

I'm sorry that when I reached you, you were breathing your last. It meant that I had to lift you off your bed onto the hard floor.

I'm sorry I had to do that, but it is the only way I could do effective chest compressions. I'm sorry I had to do the chest compressions, I know I broke some of your ribs, but please understand that it is a known side effect of trying to keep your heart pumping.

I'm sorry that we had to put those needles in your veins, but you needed the fluid. You also needed the drugs that helped your heart beat - but it was probably painful.

I'm sorry that we had to pump air into your lungs, it can't have been nice for you, but we needed to keep your vital organs supplied with oxygen.

I'm sorry that because of the air in your pleural space we had to push two large needles into your chest. I don't know if you felt it, but it did help reinflate your lungs.

I'm sorry that your husband didn't quite understand what was going on - we tried to explain, and I think that at the end he did realise that you probably weren't going to wake up.

I hope you didn't mind when we had to keep passing a couple of hundred joules through your body - it made your body jump, but it's not your fault. I don't know if it hurts. I hope it didn't.

I know that the journey into hospital wasn't the smoothest ride, and the sirens were loud - but we did need to get you into hospital quickly.

I did remember to wrap the blanket around you so that anyone standing outside the hospital doors wouldn't see that you were naked.

But...

...I'm not sorry that we, and the hospital were able to keep you alive long enough for your family to arrive and gather around you.

I hope that there was a part of you that was still aware of what was happening, and was able to hear their words of love.

I hope that it was worth the pain so that you could hear those words, and feel their presence.

I left you at the hospital, your heart was beating and you were breathing. I hope that your end was without pain.