In recent nights there is something that I should invent.

An alcohol breathalyzer connected to your computer that you have to blow into before you are allowed to post to your blog.

Could I patent this?

I'm working twelve hour day shifts for the next few days and I've not had a chance to write a load of posts in advance, so if I don't get a chance to moblog (which, given the current push on ORCON is unlikely), the next chance I'll have to post will be about 20:00 tonight.

That is if I'm not completely exhausted...

So I'll take this chance to update you on the progress of 'Da book'...

The meeting with my publishers went well (before the drinking started) and we agreed on a few changes.

Including the title.

It's a good idea, because 'Random Acts Of Reality' won't exactly pull in the bookshop browsers.

While not written in stone, the current title will probably become 'Behind The Ambulance Door'.

I think that browsers will find this much more descriptive.

We also looked at some cover mock-ups, and we all agreed on the same one. Which only goes to prove that great minds think alike. We also agreed that an introduction to the book would weaken it's start, and that the individual posts should have the dates removed.

The (probably) final draft should be finished later this week.

For those that are interested in such things – I’m talking to Brian Hayes on Radio 5 Live later tonight about ‘Employee Blogging’, mainly about how I believe that the management of the Metropolitan Police have made a huge balls-up in scaring off their police bloggers.  I should be on the show just after 11pm.

There is a bigger post about this issue in the pipeline.

Unlike other posts in recent memory, this is a non-drunken post.
The previous post was written under pressure from my publishers. They were most impressed at my ability to post pictures directly from my mobile phone.
At no point was I attempting to impress any attractive young females.
Honest.

Actually, the last sentence or two of my last post were scribbled by my publisher who, by some strange coincidence, was slighty the worse for wear for alcohol.

So I shall blame them...

In other news, the 'book of this blog' may not share this blog's name for purely commercial reasons. I'm also still awaiting numerous young women to start throwing themselves at me due to my recent posts...

I think I wait in vain...

These are my lovely publishers. They have bought me alcohol and given me sexual favours. I like them a lot. I now give you over to these professional writers...



The following is written by my publisher...



As publisher I would like to say That I like the sexual favours bit but will consider anything.

I’m not aiming to annoy GPs, but the day after the “heart attack in the waiting room” I went to another case where the GP had been less than helpful.

It sounded like one of our ‘crap’ calls – “6 year old female, losing weight, tired”, not what you’d mark down as needing an emergency service.

The ill child did look very thin, and her concerned parents told us that she had been losing weight for the past couple of weeks.  She was lethargic, wasn’t eating well (she was mainly drinking a lot of fizzy drinks) and had been having spells of dizziness.  To my eye the child did look rather unwell.

The father had taken her to the GP earlier in the week, and the GP had told him that he was “wasting his time”, and that the child would soon put the weight back on.  The father asked for the child to be sent to the hospital, and the GP refused this.

We got the child into the ambulance and starting running our tests.

Her pulse was normal, as was her blood pressure and oxygen levels.

Her blood sugar was not normal.  It was above 33.0 mmols (which is, I think, around 660 dg/l).  The normal value is around 5 mmols.

The child is (almost certainly) an undiagnosed diabetic.

In my ‘big book of how to tell what might be wrong with someone’ there are six probable causes for severe long-term weight loss.  They are Malignancy,Depression,Thyrotoxicosis,Uncontrolled Diabetes,Infection and Addison’s disease.  Within minutes of meeting this child for the first time, we had a provisional diagnosis.

It’s not hard to do a blood sugar test in a GP surgery, it takes about 30 seconds.

So why did the GP tell the parent to go away?  Was it because the GP was so busy trying to fill the governments targets?  Or was it the case that the GP considers severe weight loss in six year old girls a ‘phase’ that they will grow out of?

However now I realise why the ambulance service is doing diabetes screening.

This is the last moan I’ll have at GPs for a while now – I’ll see if I can balance it out with a tale of a heroic GP at some point in the near future.

We could do with one of these in London.

Maybe next year…

Although I hope, for the love of all that is considered holy (and for the whole idea of decent literature) that Belle de Jour doesn’t win.

This post has been deleted to protect the guilty.

But the short version is that after some alcoholic beverages I bemoaned the fact that my friend had women throwing themselves at him, while I…don’t.

There was a little digression into how wide I cast my net.

First off – I didn’t know that the survey was going to come out that colour – somewhere between previewing the post and it appearing on my blog the colours decided to ‘run’ into one another.  I hate un-accessible web content.

Forgetting to put in a ‘not medically trained’ option in the Medical question was all my fault.  And in answer to one of the comments, I didn’t know that Johnnies got the hump if called ‘St Johns’.

---

I was working on the FRU again for a shift, I’d turned up to work on an ambulance, but there was no-one else to crew up with me.

One of my first calls was to a possible heart attack in a GP surgery.

Once again I found the patient (a very pleasant lady) sitting out in the waiting room.  There are a number of treatments that should happen with someone who is having a heart attack.  First they should have a full set of vitals, then oxygen should be given along with an aspirin and, if the blood pressure is good enough, a squirt of GTN.  It’s pretty standard stuff and does a world of good for the patient (aspirin alone increases your chance of surviving a heart attack by around 25%).

So – how many of these things had the GP done?

Well – he’d taken some vitals, but they were very different to what we got in the back of the ambulance.  However vitals can change and I wouldn’t want to call the GP a liar.

At no point had the GP given aspirin, GTN or even waved some oxygen under the patient’s nose.  The receptionist was helpful, and she led the patient from the waiting room into her office so that I could better assess her without everyone in the waiting room listening in.

I checked the patients blood pressure, gave her some GTN, an aspirin and put her on oxygen.  All things that should have already been done by the GP.

Thankfully the ambulance was pretty quick in turning up, and the patient went off to hospital.

I had a chat with the GP – it’s a chat that I’ve had a couple of times now.  It’s a chat about how possible heart attacks shouldn’t be sat out in the waiting room, about how ISIS-2 and NICE say that an aspirin should be given.  How GTN is a good thing to give such a patient, and that oxygen can really help with the pain and anxiety.

“I don’t care about that”, said the GP, “I just want her to get TROP-I.”

TROP-I is a special blood test to determine a heart attack.

He then didn’t want to hear that perhaps sitting a woman out in the waiting room with a potentially life-threatening condition was, on reflection, a bad idea.  I know GPs are busy, but is a two year old with an ear infection really more important?

I’m left in awe of GPs who don’t seem to want to treat anyone.  Like nursing homes I’m sure I only meet/remember the rubbish ones.  But if my mum was having a heart attack and went to the GP I’d be fuming if they sat her in the waiting room for an ambulance.  It’s not hard to give someone an aspirin, it’s not hard to give them oxygen and it’s definitely not hard to keep an eye on them in your examining room while you wait the (less than) eight minutes it takes for an ambulance to arrive.

I’ve mentioned before how the LAS will visit and help train rubbish care homes – I’m begining to wonder if we should also go to GPs and let them know what the ambulance service (and by extension the local A&E departments) expect.

I often bemoaned the fact that I tend not to get sent to many jobs involving ‘trauma’.  If you’ve been stabbed, I’ll be down the road picking up a maternataxi.  If you’ve fallen out of a second floor window, I’ll be one street over dealing with the sleeping drunk.  And if you’ve thrown yourself under a tube train, I’ll be one stop down dealing with the twisted ankle.

So the smallest little traumatic injury makes me happy.

We were sent to a fifty year old man who had fallen.  We made our way up the stairs to the gentleman’s bedroom and saw him lying on his bed with a woman in a nursing uniform crying her eyes out.  The patient had indeed fallen, his foot was the main injury.

The patient normally wears a caliper on his foot, due to nerve damage from having polio as a child.  He had fallen and the caliper had caused the toes of his right foot to bend upwards.  He had split the skin on the underside of his foot where the toes meet the body of the foot, and he had probably broken something.

The woman in the nursing uniform (who turned out the be the patients wife), told us that at least one toe had been dislocated, and that the patient had twisted it back into shape himself.

He was, unsurprisingly, in a lot of pain.

First, we got the patient some pain relief, some Entonox.  The Paramedic I was with was going to give him something stronger, but the patients pain completely disappeared with the ‘laughing gas’.

We then bandaged his foot, and placed it in a vacuum splint.  This is pretty much a sand filled bag, that becomes rigid when you suck the air out of it.  They are very handy when dealing with injuries in awkward areas.  I don’t get to use them often, but when I’ve needed one, they are perfect.

We then had to, very carefully, carry the patient down the stairs.

All the time the patient was thanking us for looking after his pain, and for helping him get to hospital.  He was a genuinely nice man, and his wife was nice as well.  It was a good job, in that we were able to help someone who needed help and while we needed to put our thinking caps on as to how best to get the patient out of the house the job went smoothly.

I spoke to him later in hospital – he’d managed to break three toes and one of the bones in his foot, his wife was still with him, and once again they thanked us (and let us know that the Entonox was a better pain-killer than anything the hospital gave them).

It put me in a good frame of mind for the rest of the day.

Diamond Geezer had one, and as I'm always stealing ideas from people better than me...

I'm interested in knowing who you are, and the sorts of people who read my stuff, so if you could take a short moment to fill out this survey.

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I can’t remember ever having called a Care home a “Don’t Care home” (It’s too clever for me – I just call them sh*tholes) but NeeNaw has a worrying post.

What is worrying is that it doesn’t surprise me.

The first job of Friday night was to a little old lady (actually, she wasn’t that little).  She had been standing on her bed with her daughter to fix the curtains when she’d felt dizzy and fell down.  She then bounced off the bed and landed on the floor.  Unfortunately for her, she had landed on her neck and head.

One of the first things that I do in a case like this is to make sure that there isn’t an injury to the neck.  I’ll do this by gently feeling the neck while the patient tells me if it is sore.  If there is soreness to one side of the neck then this will normally be a muscular injury while if the pain is in the middle of the neck then there is a chance that the injury is more serious.  Like a broken neck.

This woman nearly leapt from her bed when I gently touched her neck – she had a potentially serious neck injury.

So we needed to be extremely careful in order to make sure that if the patient had broken her neck, we wouldn’t make her injury worse by bouncing her down the stairs from her flat to the ambulance.  Unfortunately everything we had to tell the patient had to be translated by the daughter.  I need to learn Bengali, it’s a real shame I have no head for languages.

The patient had to be moved down the bed so that our scoop stretcher could go under her – then she needed to be securely strapped onto the stretcher ready to be carried downstairs.  In this case, and with shades of the last post, I used a blanket roll to secure her head rather than the more expensive and less effective head blocks.  We called for another crew to give us a hand because in a case like this it is better to be safe than sorry, and you need to be careful carrying a potentially unstable neck fracture down two flights of stairs.

We were all really impressed with the neatness and effectiveness of the strapping.  I wanted to take a photo of it because it doesn’t often look as good as it did with that job.

As mentioned, she wasn’t too light, and it’s really tricky to maneuver a six foot long orthopaedic stretcher out onto a balcony, around half the building and down two flights of stairs.  At one point we had to suspend the poor woman’s head over the balcony in order to get her around the awkward architecture of her building – pretty lucky that she wasn’t looking down at that point…

The job itself went like clockwork.

My back however was starting to hurt from the less-than-safe lifting that we needed to do to get the woman out her flat and into the ambulance.

A couple of ‘nothing’ jobs – coughs, colds and belly-aches.

We got to around midnight when we were sent on a call for a “17 year old male, has a knife, cutting wrist, suicidal”.  As it was in the street I thought that we’d go and have a look – if he was violent then we could soon drive off and await the arrival of the police.

The young man was lying on the floor, his left hand was covered in blood and there were already two policemen there.  They looked happy to see us.

A quick assessment later and it turned out that the patient had nearly severed his left little finger.  He was covered in blood and refusing to say anything except that he wanted to die.  I managed to get a ‘quick and nasty’ bandage on his hand while the police and I wrestled with him.  He wasn’t very happy with being put into the ambulance and once inside fought with us like a man possessed.  Blood was everywhere, he was trying to bite us and the police had to handcuff him (which for some reason, probably paperwork, they really don’t like doing).  It took the three of us struggling with him to get him to hospital and when he reached the department there needed to be six police guarding him in the psychiatric room.

He was, to use an ambulance service technical medical phrase, “Proper mad”.

I felt sorry for the fellow – he didn’t ask to go out of his gourd.

I also felt pain.

Pain in my back.

While fighting with the patient in the back of the ambulance I had somehow wrenched by back and the whole right side of my body was in pain.

So we went back to station, I filled out the required paperwork and went home.  I stayed home for the next two nights, partly due to the pain and partly due to a desire on my part to avoid exacerbating the injury.

I’m better now.

I’m also on a week off work due to my rota.  I may be writing a bit, I may be getting around to answering a load of email.

I may be down the pub.

In my last post I mentioned that the blanket is one of our more important and versatile bits of ‘kit’ that the modern ambulance can have.  In the ‘good old days’ of horse-drawn ambulances the proto-EMT would refer to his equipment as “one and one”, meaning one carry chair and one blanket.

Even today, with our increasingly technologically based health care system, the humble blanket has a multitude of uses.  For those of a ‘hitchhiker’ mindset – think of a blanket as a towel writ large.

• Primarily it is used to stop little old ladies (LOL’s) from getting cold when you drag them out of their nice warm house into the often freezing conditions of the ambulance.
• Said little old ladies don’t like being wheeled around in our carry chair – it has no handrests and feels very unsafe.  LOLs will often try to grab out at things to steady themselves – this is dangerous, especially if we are carrying them down stairs.  So we wrap the patient in a blanket, and make sure that their hands are gently restrained.
• You can use the blanket as a sliding/carry sheet when transferring a patient from a bed to a stretcher, or from the ambulance stretcher to the hospital trolley.  The ambulance blanket is thick and strong with a close weave.  While I wouldn’t like to try using it to lift someone off the floor – I would imagine that it is strong enough to do so.
• When in the ambulance we can use the blanket to protect modesty.  Some of the things we do to people requires them to bare their chest, for females this can be troubling.  We can use the blanket to cover the patient as much as possible.
• If the patient has been incontinent while wrapped in the blanket, we can ‘gift’ the blanket to the hospital – it’s what nurses are for (and we don’t carry warm soapy water and wipes in the back of our ambulances).  Nurses soon learn to ‘unwrap’ carefully the patient who has been left in the ambulance blanket.
• Because of the thickness of the blanket, and the difficulty of carrying vomit bowls into houses, the blanket can catch any vomitus the patient may produce while leaving the house.  Reassuring the patient that it is fine to vomit on the blanket is important in case they become embarrassed.
• When moving a dead body from a location, two blankets in the ‘T-wrap’ will disguise the lack of life from bystanders.  It’s also good for wrapping up very frail LOLs when it is freezing outside.
• With the addition of two triangular bandages the ambulance blanket can be converted into a pelvic splint.  This helps stabilise pelvic fractures which can become life-threatening if allowed to ‘wobble’.  As and aside, the next time I see a ‘trauma surgeon’ flex the pelvis in a suspected fracture, I’m going to find their car and let down their tyres.
• If you don’t have the head blocks that go either side of the head to protect a possibly broken neck, then by the correct folding of the blanket you can form a snug-fitting c-spine restraint.  I prefer the use of blankets to the ‘specialist’ kit here because the blanket is better able to form itself to the patient’s head and neck.
• Our blankets are red – this makes them idea for hiding blood.
• If you have a nasty trauma in a public place the blankets are large enough to be used as screens.  This requires the use of two fire-fighters to hold each end.  Don’t worry, they were probably standing around doing nothing anyway…
• The blanket also works well as an ‘NHS special’ pillow.  We don’t carry pillows on our ambulances and many hospitals are short of pillows.  So roll up your blanket and place between the patient’s head.  LOLs with a curvature of the spine will be especially grateful, as without a pillow their heads tend to roll around like a nodding dog’s.
• If folded correctly, you can put it on your trolley bed and have ‘AMBULANCE’ written down each side.  This not only looks good but also makes it really easy to wrap patients up in it.
• If you have a patient who might become aggressive, then the blanket – if tucked in tightly can provide a mild restraint.
• Doing CPR on the floor for an extended period of time can be wearing on your knees – a folded blanket makes a nice cushion to rest on while pounding away on some dead person’s chest.
• If someone decides to have an epileptic fit in the back of your ambulance, the blanket can be used to protect the head (or other part of the body) from hitting on the wall of the ambulance, or other hard surface.
• Have you had a huge spillage of some noxious fluid?  Are you worried that as you return to your station to mop out the back of the ambulance the fluid will run through the door into the driver’s cab and thus contaminate your packed lunch?  Simply mop it up with a blanket.
• If someone tries to attack you, throw it at them like a net – it may distract them long enough for you to run away.

There are probably a hundred more uses for the ambulance blanket – and no doubt as soon as I publish this I’ll think of another twenty.  Still I think that you will see that the humble blanket has many more uses than our defibrilators and ECG machines.