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9010

by Reynolds on Thu 19 Oct 2006 08:06 AM BST | Permanent Link | Cosmos

9010 is our code for 'Assist only, not transported'.

It's a grey, horrible day. There is a constant drizzle of rain and when I got in my car to come to work it was so humid everything I touched was sticky.

Our first call of the day was to an elderly female who was believed to have had a CVA, a CVA is another word for a stoke. It's never a nice job, so my heart sank*

We arrived to find the patient sitting in her living room chair, also present were her friends (who have a front door key) and a carer who was preparing breakfast. The patient was *lovely*, she was sorry to have called us out and was, as is common with our older patients, worried that she was wasting our time.

She hadn't had a stroke, instead she had been unable to get out of bed, and so had crawled onto her landing on hands and knees in order to get some help. Her bed had recently been changed after being discharged from hospital a week ago and the rails that she used to get out of bed had been left leaning against the wall.

So my crewmate and I fitted her bedrails. Then we made sure that she could get into and out of bed. I then checked her physically to make sure that she wasn't hurt in any way. We then had a nice little chat, flirted with each other a bit and then, because the patient didn't want to go back to hospital, left her with her carer.

Throughout this call the patient was really worried that she was wasting our time. Personally I think it has the chance of being our most worthwhile call all day - we turned up, fixed her bed (even though that isn't our job) therefore providing her with some more independence. We left her at home feeling happy and more confident about moving around the house. This wasn't a job where we save someone's life - but it was still hugely satisfying to help her out, even if it meant using common sense rather than following any protocol.

*This is also the day that 36% of the world think that torture is acceptable, that America decide that they will annex space and Blair demands more power for control orders and right minded people watch the funeral of 'habeus corpus'...

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Re: 9010

by AFC 30K at 08:37AM (BST) on Oct 19, 2006 | Permanent Link

My wife had an acute CVA when she was 25. Fortunately it was when we were in the states. It seems the here in the UK CVA is not treated as a medical emergency. Anyone who suspects a strocke needs to be in hospital ASAP in if it's appropriate to have TPA within 3 hours of the on set of stroke.

Sorry to stand on my soap box but stroke destroys lives and, just think, it could save the NHS millions in not having to provide such long term care for so many who have been debilitated by stroke.

Re: Re: 9010

by Ratchick at 04:50AM (BST) on Oct 20, 2006 | Permanent Link

I have much sympathy for your wife - and for anyone affected by a CVA directly or indirectly. My father died as a result of a series of haemorrhagic CVAs (so in his case, tPA wouldn't have been relevant) and although his illness was relatively short (10 days) it was harsh enough seeing him reduced to a shadow of himself.

But I would also stress that there is a relatively large proportion of the medical profession who don't regard tPA as being the wonder treatment that it was initially thought to be, and that the risks usually outweigh the benefits. Until the risks are either reduced or specialist stroke teams are developed to monitor and treat any resulting negative responses, then doctors simply aren't going to be comfortable in using tPA on a wide scale, no matter how speedily they arrive in A&E.

Not that I want to argue or anything - but just mentioning it as the other side, playing devil's advocate and all that. From my own experience, and that from those caring for stroke patients long term, I can totally agree that it is definitely something that can destroy lives, and preventing or minimising the resulting debilitation. Similarly, if a CVA is suspected, then the patient definitely needs to be taken to hospital ASAP.

Re: Re: Re: 9010

by AFC 30K at 10:00AM (BST) on Oct 24, 2006 | Permanent Link

Thanks for the information. It made interesting reading. As I said we were fortunate. My wife had a full work up including CT & MRI within 90 minutes of the onset. tPA was administered shortly afterwards. She was cared for at a hospital specialising in stroke rehab and the hospital was listed very highly in the US top 100 hospitals. Her neurologist was also named independently as a leading strole researcher. For me I saw a person struck down by a stroke measuring 3.9CM recover completely within 4 months.

Since returning to the UK all of the 4 neurologists we have seen have repeated stated that for this size of stroke it is very unusual for someone to survive, let alone make such a good recovery.

Whilst I'm here, a big thank you to the Stroke Association. They were so much more home full than anyone we met in the NHS or BUPA...

Re: Re: 9010

by Reynolds at 11:14AM (BST) on Oct 20, 2006 | Permanent Link

The LAS do now treat CVA as a medical emergency - any stroke-like symptoms within four hours gets 'blued' into A&E. We are still waiting for specialist stroke units (as there are specialist heart attack centres), but the LAS con only do so much.

Granted this is a recent change, but it is another example of how we try to do the best by our patients by taking onboard research and best practice.

Re: 9010

by Kittybif at 08:37AM (BST) on Oct 19, 2006 | Permanent Link

You might not have saved her life, Tom.. But you saved her quality of life and dignity. That can, as you say, be just as rewarding. Nice one.

Re: 9010

by Fallen Angel at 08:48AM (BST) on Oct 19, 2006 | Permanent Link

We may be losing all our ancient freedoms and rights and we may be walking straight into a police state but hey, don't forget that Blair (along with his little friend George) doesn't have time to guard democracy in Britain because he's far too busy "introducing" it to the middle east. Happy days.

Re: 9010

by James G at 09:39AM (BST) on Oct 19, 2006 | Permanent Link

I'm currently reading 'Cities in Flight' by James Blish. It was written in the 70's and, like many books of its time, foresaw extended tensions between Russia and the West. However, despite the fact that the 'enemy' has now shifted, Blish still realised how extended 'wars' would lead to sides throwing away some of the fredoms and ideals they supposedly fought for for reasons of 'security.' (Of course, Orwell saw the same thing, although in his case the war was suggested to be largely artificial, invented to allow control of the population.)

Oh, the book itself is fairly heavy going at first, and takes a while to heat up. The first part is initially rather fractionated and can be a bit confusing, as it is a while before any cohesive narative forms. It gets slightly more structure to it later but in my mind fails to achieve anything truely novel. However I'm just over a third the way through it, so it still has time to impress.

Re: 9010

by 24/7 at 09:53AM (BST) on Oct 19, 2006 | Permanent Link

Hello Tom,
Two thoughts here......

1) You mention that fixing her bed is not your job - but in fixing the rails back to her bed (why were they left off in the first place?! To me that's like changing the seat in someone's wheelchair but forgetting to put the wheels back on!), surely you have at least potentially avoided a situation where she might have fallen out of it, or fallen down attempting to get out of it - those rails presumably have a clear purpose....

So wouldn't this come under the category of "preventative care"? *grin* I really do like the way though that you go to lengths to point out that people who genuinely need the attention are often the ones who are most worried about having wasted your time, whereas the other lot, well, nuff said......

2) About the power/control thing, and the US annexing space (presumably so they can construct huge billboards telling us to Buy Coke) - I found a quotation that made me think a lot.

"Any society that would give up a little liberty to gain a little security will deserve neither and lose both."

Who said that? Benjamin Franklin.

Frightening isn't it? It proves that the one thing Americans do not learn from History is that they do not learn from history (in this instance, what one of their own greatest statesmen has said and believed).

Re: Re: 9010

by pete bagnall at 12:23PM (BST) on Oct 19, 2006 | Permanent Link

Another quote that is scarily relevant...

"Voice or no voice, the people can always be brought to the bidding of the leaders. That is easy. All you have to do is tell them they are being attacked, and denounce the peacemakers for lack of patriotism and exposing the country to danger. It works the same in any country."

That was said by Goering, who after all, used that very strategy to get the German people to go along with the Nazi's.

Re: 9010

by rockingk at 12:46PM (BST) on Oct 19, 2006 | Permanent Link

It is ~~funny~~ interesting how good it feels to help someone when it is not your job.

Re: 9010

by Ali at 02:01PM (BST) on Oct 19, 2006 | Permanent Link

Nice one Tom!

I bet you made her day and that she's spent all day telling everyone about 'that nice young man from the ambulance'!! ;o)

If only there was more common sense in the world.....

Thanks for a great blog. Ali x

Re: 9010

by vivdora at 02:19PM (BST) on Oct 19, 2006 | Permanent Link

You would have loved my Mum, Tom. She had a stroke when she was 68 and lasted till she was 89 defying all odds and all sorts of set backs. She had lovely carers and my sister to look after her. Some of her carers used to come round and share a bottle of wine with her before they set off on a night out. My name Vivdora is taken from hers, Vivienne Dora. She was an artist and taught herself to paint again using her non dominant (L) hand .
Anyway one day my sis found a pool of what looked like blood under Mum's chair and she asked her if she was bleeding. Mum denied it so after a quick visual scan my sister began to examine the dog. After a whilde we realised that one of mum's shoes was filling with blood and we found a little gusher.
Obviously we applied pressure but it seem to want to stop bleeding and she was starting to "go off" so we decided it was time to call for help.
Along came a very nice man , as they say,who was very kind to Mum. By this time the bleeding had stopped and he got her into bed , checked her BP and said " you don't want to go to hospital do you?" No thanks! So she was able to stay at home and recover.That's a good job done you know, it's not all ER is it?
About bleeding , I do wonder if the fact that you do not know you are bleeding and can quietly bleed to death is down to a design fault or planned obsolescence? What do you think?

Re: 9010

by Nel at 02:33PM (BST) on Oct 19, 2006 | Permanent Link

We used to take a woman to and from hospital whose failing health meant she had to attend many different outpatient appointments, short stays etc, but she never moaned, was always very appreciative and told fascinating storyies about her life during the journey. Whenever we took her home her husband, of over 50 years, would be waiting at the front door. He always came out to meet her, insisted on helping us with her chair and gave us packets of biscuits for our "trouble", when this was the last thing she was. Their manner always warmed my heart.
In some cultures elderly people are valued for their wisdom and experience i often wish it was a little more like that here.

Re: 9010

by riddick at 03:47PM (BST) on Oct 19, 2006 | Permanent Link

"The patient was *lovely*, she was sorry to have called us out and was, as is common with our older patients, worried that she was wasting our time." - I know exactly what you mean. We had a very similar job a few weeks ago: elderly lady (this time in a care home) with a suspected CVA. She was unresponsive when we arrived; so we gave her some O2, did some obs and took her to get checked out. She recovered nicely with the O2 (I don't think she had had a CVA) and we had a nice chat (and a bit of a flirt) on the way in. As with your patient, she was absolutely lovely and worried about wasting our time (which of course, she wasn't).

Compare and contrast: one night recently we were called to an 18-yr old male with abdo pain, which he had had for four hours (lives with parents, 3 cars on the drive). Granted he may have been in pain but that was no justification for the way he treated us (esp. my crewmate, who was attending). He was a sullen, obnoxious little git who insisted on laying on the trolley with his coat over his head and refused to let us do any checks on him. About 45 minutes after we got to hospital I saw him walking around with a big grin on his face and no sign of any pain. Remarkable recovery, I thought.

Re: 9010

by batsgirl at 07:29PM (BST) on Oct 19, 2006 | Permanent Link

As always with this sort of thing, I'm glad you did it, but concerned that it ended up having to be you that did it.

I wonder if the council or social services would subsidise a "Mr Fixit", basically a subsidised handyman who can be called out by elderly/disabled people in a certain area to come ASAP and do the little DIY things they can't do themselves, like change a lightbulb, replace a fuse, re-fix or tighten up fixings for grab-rails, put the curtains back up when they come down, bleed the radiators, and all those other little bits that don't require a highly trained professional, just need sorting out.

Re: Re: 9010

by OldJewells at 10:22PM (BST) on Oct 19, 2006 | Permanent Link

Some social services do have just what you suggest. It's justified on the grounds that it is preventative and keeps people safe and independent in their own homes for longer. However like many local authority services it's vulnerable to funding cuts. The politicians like to keep the council tax as low as possible in order to win elections.

Re: 9010

by justsue at 12:28AM (BST) on Oct 20, 2006 | Permanent Link

It may not have been "your job"...it may not have involved the adrenalin rush of an emergency run lights and sirens to the hospital...but it was probably the best example of what you got into this game for. To help people. Well done mate!

This Toronto 911 dispatcher salutes you.

Re: 9010

by VTEMT at 02:30AM (BST) on Oct 20, 2006 | Permanent Link

Just curious - if she had a suspected CVA, why wouldn't you transport her for further evaluation ?

Re: Re: 9010

by Ratchick at 04:28AM (BST) on Oct 20, 2006 | Permanent Link

I suspect (though Tom can clarify for sure) that it was simply reported to dispatch as a suspected CVA (because she couldn't get out of bed properly and hence had to crawl) rather than because her symptoms/signs pointed to a potential CVA.

Re: Re: Re: 9010

by Reynolds at 11:17AM (BST) on Oct 20, 2006 | Permanent Link

Ratchick is absolutely right, the neighbours thought that she may have had a stroke, but once we arrived on scene and did our assessment it was obviously not the case.

(The patient had called careline, told them that she was on the floor - careline rang the neighbours and they jumped to the conclusion that she had had another stroke.)

Re: 9010

by vivdora at 12:59PM (BST) on Oct 20, 2006 | Permanent Link

saw a program on tele once,man had a CVA ,taken to hospital, angiogram to check clot not bleed then clot buster drug and then you saw him start to talk and to move his arm and leg normally - amazing! So, Tom, in the future , you will just do a quick angiogram in the back of the ambulance.......

Re: 9010

by robwaha at 10:16PM (BST) on Oct 20, 2006 | Permanent Link

Some people recognise that their relatives who called an ambulance overestimated their bad health...
I always like to tell them that there's no problem, because we get paid for that too!

Re: 9010

by Trixtah at 07:46AM (BST) on Oct 24, 2006 | Permanent Link

What I'm curious about is why the carer didn't refit the rails. It would have made life a lot easier for him/her as well, in terms of managing the patient. Hm.

Welcome to Random Acts Of Reality, a Blog based in London, England, written by an E.M.T working for the London Ambulance Service. Also, number one search result for "Womble porn". All names have be changed to protect the guilty. This Blog was previously known as "Why I Hate Humanity" but the antipsychotic medication seems to have kicked in.
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