In my last post, I mentioned that I’d like to be able to show you videos of my daily life.  I can’t do that, but I can do the next best thing…

An ambulance based joke from Channel Four’s “The IT Crowd”.

You can view it by clicking here (WMV file which may not work for some users).

 

“Better looking drivers” – I love it.

An ideal invention for the Blogger in your family would be a pair of video-recording glasses – wear them all day, and should something interesting happen the wearer presses a button to save the last 30 seconds of video to a small storage device.

If that were possible I’d now be showing you a video of a lovely young man.

I was driving along on blue lights and sirens (to an “intoxicated – feeling unwell”) just heading past Plaistow underground station, from the pavement I could hear someone shouting…

…Someone shouting, “Wanker…Wanker…Wanker…”.  He was also making the traditional hand gestures.

A quick look at him lead me to believe that he was either homeless, an alcoholic, or both.  I could see that he had no front teeth.  He only looked around thirty years old.

I slowed the ambulance so that my crewmate and I could loudly laugh in his general direction.

He turned his back on us.

He bent over.

He pulled his trousers down.

Suddenly we were confronted with a skinny white arse, and dangling between his legs were equally white and skinny testicles.

They looked shaved.

Just then a police car came over the hill.

I wound down my window and spoke to the police driver, “See that fellow with no teeth?  He just exposed himself to me”.

“The one calling you a wanker?”, asked the policeman.

“That’s the one…Have fun!”

We continued on the way to the call as best we could between tears of laughter.

It’s strange the things that make your day.

People who abuse or threaten nurses and doctors in England will face fines of up to £1,000.

I just hope that it extends to everyone in the NHS.

Like ambulance workers.

More on a case of ‘abuse’ towards my crewmate and I tomorrow…

The radio sparked into life, “General Broadcast, General Broadcast – are there any crews able to deal with a ceiling collapse on a mother and her two year old child?”

It sounded like an interesting job, so we asked for it to be sent down to us.  I was driving but despite this we were soon at the house.  From the outside everything looked normal.

However, inside the house it was pure chaos.

There were seven children running around the house, all of them under the age of twelve.  A single mother was clutching her two year old to her chest.  At first glance they looked unharmed.  The mother seemed more frightened and angry than injured.

We soon got the full story, the mother and her child were having a nap in the bedroom when the ceiling had fallen on them.  We entered the bedroom expecting a few scraps of plaster.  Instead we were met with the sight of a 1 1/2” ‘plaster and lathe’ ceiling, a huge chunk of this had fallen six foot onto the bed.

This is the hole in the ceiling – it was about five foot in diameter.

This was the rubble left on the floor.

Rather understandably the woman was a bit upset – the pieces of plaster that had dropped on her were about the size of my hand and were over an inch thick.  I couldn’t estimate the total weight of the plaster, but each lump was very heavy.

It was now the headache I’d thought I’d gotten rid of earlier in the evening started to return.

As a single parent who had just moved into the area she had no other relatives to help look after the children – so she was refusing to go to hospital.  My crewmate took her and the toddler into the ambulance so that he could examine her more fully.  If he found nothing too serious then we could leave her at home to look after her children.

So off they went to the ambulance…

Which left me looking after six anklebiters.

I don’t like children.

While he was in the ambulance my crewmate phoned the patient’s GP and arranged for them to come and visit the patient.  He then arranged for the police to turn up and give the patient some legal advice.  Rather obviously the patient was a trifle annoyed at the landlord who had assured her that the house was fit to be lived in.

Meanwhile I was doing my best to entertain the children.  My best wasn’t enough.

I was relieved when the childrens older brother arrived with some takeaway chicken meals.  Yes – there was now eight children in the house of this 36 year old woman.  This older brother was more like a father to the children and he soon had these apparently feral children under control.

Luckily for the woman and her child our initial guess was correct – neither her nor her child were seriously injured.

 

My crewmate and I escaped from the scene as soon as the police arrived.

You’ve got to laugh when an ‘old salt’ police sergeant tells you that he’d like to meet the person who assaulted my patient…

…And shake their hand…

…And you agree with him even though you’ve only known the patient for 20 seconds.

My brother let me know about this story and when I got home Mariamne had emailed me the link (as well as telling me about some awful nursing homes in America).

 Manchester United and Liverpool have issued a joint statement condemning the fans who attacked the ambulance taking Alan Smith to hospital at the weekend. Smith, 25, suffered a broken leg and a dislocated ankle during United's 1-0 FA Cup defeat at Anfield.

Reports in several newspapers on Thursday claimed the ambulance was surrounded by people who threw stones and bottles at it and even tried to rock it from side to side. The two paramedics - both Liverpool fans - were described as being "horrified" by the hostility shown once the culprits realised the occupants of the ambulance were Alan Smith and Manchester United's club doctor Mike Stone.

You can read more about it at the Guardian.

It really beggars all description, attacking an ambulance is just evil – even warring nations tend to not attack Red Cross ambulances, yet these ‘fans’ wanted to do serious harm to the people inside.  I’m just hoping that there is plenty of CCTV footage for the police to look at.

When I saw the picture of the footballer’s injury I instantly recognised it as a fractured dislocation, which is a very nasty injury.  He should be very grateful to the doctor that he was unaware of what was happening to him (I suspect that the doctor gave him some Ketamine).

Just a nasty business all round.

Further to my last post I was sent this link by Lianne (Thanks Lianne)

This article reports on a story in the BMJ, saying that the elderly in NHS nursing homes should not receive CPR.

Writing in the British Medical Journal (BMJ), Simon Conroy, a clinical lecturer in geriatrics, called for a review.
He said: "Given the likely low chance of success, it may be that the institution should not offer resuscitation at all.
"Resources saved by not spending time in training and the subsequent discussions could be better used in improving the quality of care.

(The full article is behind a paywall here)

Please note, I haven't read the full article - I may try to sneak down to Newham Hospital library to have a peek at it.

But I can see a couple of problems with the thinking from just the Daily Mail piece.

First - All NHS nurses are trained in CPR as part of their basic training. It doesn't cost much to keep those skills updated. As I wrote in the previous post, the London Ambulance Service will come out for free and teach you how to perform effective CPR.

70% of cardiac arrests happen outside hospitals, and before the introduction of defibrillators in public places the survival chance was 1%, after the defibs were in place the chance of survival was 3%.

Given the cost of Defibs, was this a worthwhile spending of money? Does the doctor who wrote the article think that putting Defibs in Tesco while removing them from nursing homes is a good idea?

Secondly - Why should we put any money into a treatment that only has a 3-6%(depending on source) success rate? If it is a waste of money to resuscitate the elderly because it has such a low chance of success, then that would apply to any out of hospital arrest.

I'm sorry, but it smacks too much of "let the old ones die" to me - and that is just distasteful. If we start heading down that route, then we may as well stop treating the unemployed or chronically ill because they don't contribute anything to the economy.

My personal view is that CPR is inappropriate in a large number of nursing home cases - but that it should be an individual choice not to be resuscitated and not the default option.

I would have like to have written more, but I'm at work and time/computing resources are limited.

UPDATE: A couple of people have sent me a copy of the article - I'll not mention any names in case it gets them in trouble - but thanks to those who helped. Once I've read it I may post about this subject again.

A couple of posts ago I gave a little rant about how I don't think that 'free market' systems result in a better health service. I have another example.

I was working in another area a little while ago, and while there got sent to a private nursing home. The patient was given to us as '80 year old female with difficulty in breathing'. We arrived and saw what looked to be two nurses having an animated discussion in the main foyer.

Grabbing our equipment we followed one of the nurses into the depths of the home, and were shown to the patient's room.

The patient was very much dead.

Also in the room were four nurses. They were standing around and they weren't doing CPR, they weren't breathing for the patient. They looked at me for guidance.

I immediately switched into commanding mode. "Why isn't anyone doing CPR?", I asked.

"We were", one of the nurses replied, "but I saw you coming in the mirror and stopped".

The mirror was positioned so that if she had been doing CPR, she would have had to have eyes in the back of her head to see me coming.

When someone isn't breathing you have to breathe for them - this is the 'ambu-bag' that TV doctors put over someone's face and operate by squeezing the bag. It forces oxygen into your lungs. Unfortunately the patient had a normal oxygen mask on her, which would bathe her face with oxygen, but wouldn't get the oxygen into the lungs where it needed to be.

The patient was also lying on an air mattress, which would have meant that any CPR which may have been done would have been ineffectual because you need the patient on something hard so you have something to push against.

I felt the jaw of the patient - rigor mortis had already set in, so there was no point in attempting to continue any resuscitation attempt.

Someone had tried to take the patient's blood pressure, as there was still a BP cuff around her arm.

As is usual in these cases where we know or suspect that care has been...shall we say...lacking, we offer the services of the LAS to teach the nursing staff more effective resuscitation skills, they should have these skills anyway as qualified nurses. Talking to one of the people who teaches these courses, it seems that many of these nurses have forgotten how to do this. It's free to them although I don't think we get any extra money from the government to run it.

The nurse in charge (who was busy photocopying in the office while all this was happening) refused.

So, in a world of competition between privately owned care homes, it would seem that the care has not improved. Instead you get poorly skilled nurses, run by staff who don't want their staff to improve. This despite a number of suppliers who are all in competition with each other - it's a lucrative market providing elderly care.

All Hail Minifig.  For he knows the proper way to pay homage to one as wonderous as myself.

He has rendered me in LEGO.

Although good, it is not perfect – why would I be smiling at a drunk in the street?

Superb – and thanks for all the people who emailed me about this.  You can find much more of his work at his Flickr page.

This weeks Grand Rounds are up at Dr. Andy.

It seems that the ‘tagging’ of ambulances isn’t just confined to us in the UK.  Dave (a paramedic from Auckland) sent me this picture of his ambulance after he spent ten minutes inside a patient’s house.

You may notice what a fine example of ‘urban art’ this is…

Imagine that you are 23 years old.

You are also a ‘brittle’ asthmatic.  This means that you can have asthma attacks that can rapidly progress to life-threatening status.  You have been intubated in ITU a couple of times – this is a last ditch treatment to keep you alive.

So why, whenever you get taken to hospital, would you treat your disease as a mere annoyance?

Also – why would you smoke 20–40 cigarettes a day, knowing that it will make your asthma worse?

And why would you self-discharge yourself from the resuscitation room against medical advice only to require a blue-light return straight back to the resuscitation room?

 

It’s just a form of slow suicide…

I was racially abused on Friday night, and it meant I spent the rest of my night gritting my teeth and wanting to punch someone.

We were sent to a ‘standard’ abdominal pain with vomiting.  The patient, a black woman, had vomited ten times that day and had lower abdominal pain.  As always I treated the patient with respect and compassion (as that is my ‘default setting’).  All her observations were within the normal limits.  Talking to the patient was a bit tricky as she insisted on having me ask every question at least twice before answering.

So we took her to hospital, where I handed over the patient to the triage nurse.  She was happy to have another nurse perform a further assessment (for example an analysis of the patient’s urine).  Unfortunately the place for this assessment was physically full, so we were asked to take the patient into the waiting room until some space could be made.  My crewmate did this, while I booked the patient in with the reception staff.

My crewmate told me that when the patient saw she was going to be put in the waiting room, she let out a loud ‘tut!’.

My crewmate then joined me in the reception area which overlooks the waiting room.

The patient then threw herself on the floor and pretended to be unconscious (trust me, when you’ve seen people really pass out in a chair, you can tell when they are faking it).

The waiting room erupted with two people jumping to her aid.  The security guards went to get a nurse.  Then a lot of the people in the room started shouting at us to come and help.  Never mind the half inch thick glass between us and them.

We told them that some nurses were on the way.

“Look at her!  Look what’s happened to her!”, shouted one man.

“Yes mate”, replied my crewmate, “there’s nothing wrong with her – all she’s trying to do is get seen before you”.

The patient was loaded onto a trolley and taken into the main area of the A&E.

The crowd in the waiting room then started moaning at us…

Then both my crewmate and myself heard the comment that would have us angry for the rest of the shift.

“You wouldn’t treat her like that if she were white”.

My crewmate stormed out of the department – he was, quite rightly, fuming.

All I could do was laugh loudly at the black teenager who had said this – “Well, if you are that stupid, you’ve just opted out of talking to me”, I said to her.

I booked in the patient and left the hospital.

Here is the thing that made my crewmate and I so angry.  We like our job – we both like helping people and we’ll help anyone, we don’t care about what colour their skin is, which religion that they believe in, or if they can speak English or not.  I don’t even care if they are an illegal immigrant.  We sure as hell don’t do this work for the pay.  My crewmate is a trained plumber, so he could be earning much more money installing radiators.

We don’t need to work in this area – I could put in for a transfer to a more ‘white’ area tomorrow.  But I enjoy working in East London – it’s a challenge and I enjoy working with all the different cultures that make up our ‘demographic’.  For me, a predominantly white area would be incredibly boring.

But…that comment, “You wouldn’t treat her like that if she were white”.  It made me despair as to how we are seen by the non-white population.  Are we all seen as being racist?  Does the assumption that I would treat a patient better if they were white sit in the minds of the people I treat?  Is this why I get so few “thank you”s?  When I walk into a household, do the people there think “I won’t get good treatment from these two, they are both white”?

I wish I’d gone around to the person who had made the comment and challenged her.  I wish I’d gone into the waiting room and explained exactly what had happened.  But…as I mentioned yesterday, the uniform that I wear makes me more passive than I would normally be.  So I turned the other cheek and walked away.

I’m still fuming.