Dear ‘Opiate Addict’,

     Just a quick letter to give you a warning – especially if you are in the East London area (although I do not know how far the distribution of drugs stretches).

     It appears that there is a batch of illegal opiates on the streets of East London, what is unusual about this particular batch is that I believe it to be cut with a little less chalk/rat poison/talc powder than usual.  I can tell you this because my friends and I have come across a number of regular users of these substances who have overdosed.

     Signs of an overdose include a reduced desire to breathe, purplish lips and ending up being buried in a cemetery in a wooden box called a coffin.

     As a suggestion – if you desire to inject/smoke opiate based drugs, try a little less than you normally use, and make sure that there is someone ‘straight’ to watch over you.  If your rate of breathing drops below ten breaths a minute they should call for an ambulance.  Tell the caller not to worry, the ambulance service and the hospitals don’t involve the police.  If they wish, just ask them to leave the door open before they run away.  A note pinned to your chest may also be useful.

     Try not to vomit.  It just makes a mess.

     I would also ask that when we revive you, try not to attack the ambulance crew for ‘ruining the buzz’ – trust me, we only do this if we think that you are about to die – at least you know that the rest of the batch you have may last you a little longer than expected.

     Keep safe out there!

 

          Yours,

               A friendly ambulance person.

Blogging may be a bit light over the next few days - The proofs of "Da Book" are in, so I have to carefully check them. As I'm working 12 hour shifts, and it has to be done by Thursday, I've got to concentrate n that rather than my blog.

The post before last, concerning the boy with the broken toe - I thought I'd leave it up to you, dear commenter, to decide why I posted it. The main reason was to highlight the attitude that the media often show towards us, and the way that the LAS can only respond with a 'no comment', or 'an investigation is taking place', something I've touched on in previous posts.

The first patient of our shift this morning was a classic example of how patients can often forget a potentially useful part of their medical history. The patient was an elderly man with a general sort of abdominal ache. We quizzed him about his history (nothing especially relevant apart from some possibly constipating drugs), our initial idea was that the patient had constipation.

It was only as we were wheeling him out of his front door that he mentioned that he had diverticulitis - a medical condition that can cause exactly the type of pain he was describing...

At least he mentioned it to us rather than waiting and telling the nurses, making us look like fools, something that happens with some regularity (they'll then go on to tell the doctors something additional, thereby making the nurses look bad).

Right - time tp start the proofreading...

-=-=-=-=-
Sent from a mobile phone, probably from the cab of an ambulance.
-=-=-=-=-

To answer a comment…

Yes I will be doing my traditional ‘sit around my mum’s place to watch and laugh at the Eurovision song contest’ – It’ll be a bit different for me this year as I won’t have access to alcohol in order to numb the pain.

I shall also be at a Eurovision party in Second Life.  I may be wearing something UK based…

…

A Schoolgirl uniform in honour of our entry?

 No ambulance for agony boy

A boy was left crying in agony at his New Addington home after waiting in vain for more than an hour for an ambulance to arrive. Scott Thorpe broke his toe when a concrete bollard collapsed on his foot - but when his dad called 999 for help the response was painfully slow.

In the end parents Anthony Bailey and Maureen Thorpe, both 50, were forced to beg a neighbour to come to the rescue and drive the 10-year-old to hospital.

Furious Anthony has complained to the London Ambulance Service (LAS) about the poor response - but has been told paramedics had to give priority to more serious calls.

The dad-of-two said: "I think it's disgusting. For a boy that age to be distressed and in pain like he was is disgusting.

"I waited and waited. I waited an hour and ten minutes and nothing arrived. He was crying and shouting out, rolling around in the chair saying: 'Help me dad'."

The youngster was hurting so much, that when his dad finally did manage to get him to hospital he was plied with morphine to ease the pain.

Anthony said: "The toe was swollen up and had gone blue. The person on the phone said it was the wrong time of day to have an accident.

"They asked: 'Can you get a cab?' I said: 'No I can't afford it'. I couldn't do anything."

With neither of Scott's parents able to drive and no neighbours initially on hand to help he was left stranded.

And the family insist they are too cash strapped, with Anthony being on sickness benefit, to pay the expensive fare to Mayday Hospital.

The accident happened at about 5.30pm on May 2 near tower blocks at the top of Lodge Lane where Scott and his friends were playing.

His dad persuaded a neighbour to drive him to the minor injuries unit at Parkway Medical Centre.

There Anthony was told the injury was so serious his son needed to go to hospital.

But once home the neighbour who had helped could not take them because she had to look after her own children. So Anthony called an ambulance at 5.50pm - and more than an hour later they were still waiting for help at their home in North Downs Crescent.

Eventually, another neighbour came home from work and took the Wolsey Juniors pupil to hospital.

But his dad is fuming at the response.

A spokesman for the LAS confirmed an ambulance would have reached Scott, but that there were other people in more urgent need of help.

He said: "Our records show that we were unable to send an ambulance immediately because all of the crews in the area were already responding to other 999 calls.

"Having established that the injury was definitely not life threatening, one of our clinical advisers contacted the family and suggested that the boy could be given painkillers before the ambulance arrived.

"However, we were subsequently advised that they would make their own way to hospital.

"His family have been in touch with us and we will be providing them with a full response in due course."

 Please feel free to discuss the difference between an ambulance going to someone with a heart attack, and someone with a broken toe.  Consider the limited resources that prevent an ambulance on every street corner.  You may be amazed to hear that our Priority dispatch system does sometimes work…

 

(Cheers BWTS and ParamedicUK)

It seems that this week is turning into a bit of a ‘confession’ about how I sometimes deal with patients.

I was sent to a twelve year old whose hand had been burnt.  The address that we were given was in the street, so we could expect anything.

Outside the local newsagents was a group of ‘feral children’ eight or nine of them aged 10–13 I’d say – I told my crewmate who was driving that we would ‘scoop and run’, as it was near the end of our shift and there was no way that I wanted to try and control a bunch of little thugs.

“Who’s the patient”, I asked as I jumped out the ambulance – I’d already spotted one lad holding his thumb, sure enough he identified himself as the patient.

“Ok then, on the ambulance”, I opened the door and bundled him in.

About six of the other children all wanted to come with him – I wasn’t going to hang about to argue so, after discovering that there was no relative or adult present, we made our way to the hospital.

The child had decided to spray some deodorant into a glass jar, then drop a match in it.  As the fumes caught light his hand had received a minor, but painful searing.  The skin wasn’t even red.

Still – we have a nice burns dressing that smells lovely and can ease the pain so I wrapped his hand in one and asked him why he had done such a daft thing.

“Dunno”, was this particular scientists answer.

I told him, in no uncertain terms that playing silly buggers with chemicals and fire would only lead to him getting even more hurt – would it do any good?  Well I doubt it, but surely it’s worth a try.

Here comes the confession – I was a little ‘short’ with him.  Not only do I think that a “there, there, everything will be alright” approach would have been wasted on him, but I also wanted to make sure that he knew exactly what an idiot he’d been.  I wanted to embarrass him, I wanted him to pay attention and most of all I didn’t want him doing similar things in the future.  There may have been some sarcasm, hopefully he’ll remember that more than if I’d been all motherly towards him.

My brother is a teacher – he uses sarcasm when needed to control his classes, he can be nice and he can be a right evil sod, it all depends on the child and on the situation.  So on that day I took a leaf out of his book.

I just hope that I don’t end up returning to that child after he’s torched his parents house.

On Monday I posted about what was apparently ‘bullying’ behaviour on my part in order to get a patient the best care that I could give.  As I was writing this post I realised that I’ve done it again.

I used to swim.  I used to swim alot and so it was a nice surprise to be called back to one of the swimming pools that I used to spend so much time in.  Unfortunately it was for a drowning.

Rather obviously we raced around to the pool.  A member of staff kindly ran us to the first aid room where we would find our patient.  During this run, carrying pretty much the entire contents of our ambulance with us, I was going through my mind about everything I knew about drowning – I was expecting a lot of work on this job.

We entered the first aid room, and the patient, a young lad, was wrapped in a space blanket, sitting up chatting with his friends.  My crewmate and I both breathed a sigh of relief.

We spoke to the patient, his friends and the two lifeguards who’d pulled him out of the water.  The patient had been unconscious on the bottom of the pool for around 30 seconds, after the lifeguards had pulled him out the patient had started breathing on his own.  A short period of time after looking ‘shocked’, and ‘shaking’ the patient had made an apparent full recovery.

“I don’t want to go to hospital”, he told me, “I’m alright”.

My crewmate and I looked at each other.

I turned back to the patient, “You haven’t got a choice mate – you are going to hospital”.

As I looked at the patient the thing that was foremost in my mind (and the mind of my crewmate) was ‘Secondary Drowning’.  In secondary drowning there can be damage to the lungs caused by the inhalation of a fluid.  The patient will then die a couple of hours after being pulled from the water.

He was going to hospital.  I just had to persuade him.  So I tried all the nice ways, the ways that won’t worry the patient, the ways that maintain respect and autonomy and all those other hippy words that are apparently so important even if the patient is bleeding to death in front of you.

None of it worked.

Time for the big guns.

“Ok mate”, I said, “the reason why we are taking you to hospital is because of a thing called secondary drowning – you are alright now, but it can cause you to drop dead in a couple of hours, and there would be nothing we could do about it.  So you are coming to the hospital with us – you have no choice in the matter”.

He agreed to come to hospital with us.  He was a pleasant young man, and he was given the all clear a bit later that day.

My point is – despite the cries of the ‘respect brigade’ (and I don’t mean any of you dear readers – all the comments in the previous post were good points), sometimes you have to become a patriarchal bully in the best interests of the patient.  Sometime it’s the only way to get the patient the care that you know they need.  I don’t like bullying people, but sometimes it’s the only way to protect both the patient – and my job.

So, sod it, sometimes I’m a bully.

Yes – I am posting today.  No – I haven’t been in World of Warcraft.  I’ve just been busy catching up on some of those bits of business that accrue during night-shifts.

My crewmate sent me a message today – she has actually managed to break her 4th metatarsal.  I think she did it to show solidarity with Wayne Rooney.  This means that she will be off work longer than expected.  Lets all send her healing thoughts.

---

The picture is of the floor of the reception area in the local hospital.  Look at how expertly the lino has been laid, see if you can spot the subtle repair-work with masking tape.  The patient area is little better, except that it has transparent tape sticking it down.

Why am I posting a picture of a hospital floor?

It’s because our station’s kitchen boiler is broken. 

It’s also because of the debt the NHS is in.

It’s actually been broken for nearly three months.  Initially the company ‘didn’t have the part’, after a number of emails from one of our station officers that ended up verging on the rude the company managed to get the required part.  It hasn’t been fixed though – instead it’s been condemned.  We are still waiting for a new one. 

We ordered new chairs for our station through a certain ‘high street catalogue shop’, our old ones were falling apart.

They sent us the wrong chairs, then took another three weeks to deliver five correct chairs.

But this isn’t about our boiler, or our chairs – it’s about how contractors deal with the NHS.

Everything is overpriced and shoddily done – because the NHS doesn’t complain, and it’s so large that any company ‘blacklisted’ by one part will still be able to get business from other trusts.

I have a friend who is a carpenter, he told me that his company adored getting contracts from the NHS.

“You can charge them twice as much, take twice as long, do half a job, and yet they never complain – it’s money for old rope”.

 It’s not just small things either for individual trusts, I’m worried about the upcoming NHS national procurement for IT.  It’s been renamed ‘Connecting for Health’ presumably in an effort to rid itself of some bad press.  The IPPR has already suggested that it will fail (for them it is the lack of consultation and and skills that is their predictor of failure).  The Register tells us about the upcoming National Audit Office report.

Remember – it is costing £6.1 Billion.

When we are sacking nurses and closing beds is this money well spent?

 

£250 million (the total NHS debt) is 1/244th of the cost of the NHS-NfpIT programme. 

UPDATE:  Thanks to commentors and emailers who have told me the the UK uses two definitions of ‘billion’, a scientific and an economic.  No wonder I’m confused…

---

My legal advisor has suggested that I state that all the bad things I’ve heard from friends placed in NHS-NpfIT and any other company are hearsay.  I am not suggesting that the various companies involved in the NHS are anything other than fine and upstanding.

Please don’t sue me – you won’t get much.

I’ve been thinking of writing something about Lord Joffe’s bill to allow doctors to kill patients assist the terminally ill to end their life.  However Dr. Crippen’s excellent post has pretty much summed up my feelings on the matter.

Except for one further point – while I would trust myself to take my own life, given the standard of many of the GPs in my area I wouldn’t like to trust them to help me do myself in.

Besides, (and I think Dr. Crippen missed a trick on this one) how long would it be until the government introduced targets for doctors to hit in the amount of people they snuff assist to die?

Still – I find that the Bill does have an important use - it is causing us to discuss such issues as palliative care and suicide in the public arena, where such things are normally whispered behind closed doors.

There is a big difference in allowing someone to die with as much dignity as possible (Do Not Resuscitate orders) and polishing them off by injecting them with drugs designed and dosed to end a life.

More excellent discussion on this at Black Triangle and Norman Geras.  While Secondhand Smoke is a blog centred around euthanasia.

 

While pointing you to Dr. Crippen, I’d like you to note that I worked for a short time at the Mental Health Unit mentioned in this post – and there was indeed a thriving drug use culture amongst the patients there.  The sleeping areas stuck to high heaven of cannabis, and those areas seemed to be ‘no go’ areas for the staff.  As an excuse for my complicity, I was a mere student nurse at the time.

I’m fully accepting of the need for some people to make suicide attempts and I’ll treat them with the same respect that I treat all my patients.  However, I’m only human and sometimes those people really annoy me.

We were called to a 25 year old woman living in a shared flat in a nice part of town – she had taken an overdose three hours earlier, it was now 2am in the morning so we were at the location very quickly.

We were met by a housemate who told us that she had taken some Ibuprofen tablets earlier – she had then sent text messages to her friends telling them that she had overdosed.  Then she refused to answer the phone when her concerned friends had tried to contact her.

As we walked in the door the patient told us, “I’m not going to hospital, I’ve taken 20 Ibuprofen before, so I know I’m safe”.  The patient had taken around eight of the tablets which, while an overdose, isn’t life-threatening.  This meant that the patient knew what she was doing, and I considered her actions to be manipulative rather than a serious attempt on her life or even a parasuicidal action.

Still, it didn’t matter, we still treated her with professional care – we advised she should come to hospital so that we could be sure that what she was saying was the truth, and so she could receive a psychiatric assessment.

But she was adamant that she wasn’t going to go to hospital – we tried to convince her, her friends (some of whom had driven for three hours to reach her) tried to convince her, but she wasn’t going to come with us.

The way she was talking and acting – laughing and joking, not in a “parasuicide has been cathartic” manner, but instead a more, “I’m the centre of attention” fashion – coupled with her history led me to believe that she wouldn’t be in serious danger if she were left in the care of her friends.  While I knew that the overdose probably wouldn’t harm her, our protocol and a wise protocol at that because I can always be wrong (IANAD*), dictated that we talk to our Control, and that they contact the poisons unit for the all clear.

While waiting for Control to get back to us, another of her housemates arrived at the scene – he was obviously a very sensible chap, a drug counsellor he told us some more about her history and agreed that while hospital would be the best place for her, we very well couldn’t kidnap her.  He told us that he was more than happy to take responsibility for her and would keep an eye out for her.

Just as we got the response from our Control one of the patient’s other friends came running out and told us that she had started to cut herself.

So…we went back inside and found her with some very minor cuts to her arm.

That was the final straw – she had undertaken self harm while her friends were present and while she knew an ambulance was sitting outside the house.  There was no way that we were going to leave her at home.

But still she refused.

I’m still not allowed to kidnap her.

I went back outside and told Control what had happened and that they should get the police to come to this address as in cases like this the sight of some ‘boys in blue’ often changes the patient’s mind.

Returning to the house I tried a little trick that has come in useful in situations like this – I offered her a choice.

Choice (a) was to come to the hospital with us under her own power.

Choice (b) was to wait for the police to arrive, we would then arrange for a social worker and two doctors to attend in order to have her ‘sectioned’ under Section 2 of the Mental Health Act 1983.  She could then be handcuffed and dragged from the flat kicking and screaming, ending up in the padded room at the local hospital.

With some help from her friends she chose Choice (a)

This is good, because Choice (b) is a royal pain in the rear to arrange, especially at 2am.

So the patient ended up at the hospital where her wounds were dressed and was left waiting for a psychiatrist to see her.

But, as I may have mentioned before, referral to psychiatric services never go smoothly – so when, after three hours, no psychiatrist had arrived (it is after all a long 200 yards to walk from the psychiatric unit to the A&E) she took her own discharge.

Another job well done…

 

A round of applause though for her friends who were absolute diamonds throughout this whole saga – supportive, sensible and caring – everyone should have friends like them.

*IANAD – I am not a doctor (nor do I want to be one)

For some reason the post that I tried sending from my mobile phone has disappeared into the ether – so should a post titled ‘Foamy’ turn up at some inopportune time in the future, just blame the time warp that is Newham.

I have a week off work.  I shall be mostly doing very little.

Sunday, however, is taken as I shall be in Covent Garden for the Britblog meetup.  Meetups are generally good fun and it’ll be good to meet some people from outside the ‘normal suspects’ of the London blogging ‘scene’.  Please do turn up to say hello and to make sure that I keep my vow of not drinking any booze.

I’ve got plenty to write about over this coming week, so any lack of updates is purely because I am being lazy.

You may take the silence of the rest of the night in one of two ways...

1) I was asked to move to a station so far out of my area that no mobile phone signals reached me so I couldn't post. Also I did jobs so interesting that I didn't have any time to write stuff.

...or...

2) There wasn't another 'single' ambulance staff anywhere in London so I was able to have a nice sleep on West Ham's sofa.

Hint: I'm rubbing sleep from my eyes.

There are a couple of options tonight, all of them involve me working - so I shan't be getting paid to sleep anymore.

I'm not really looking forward to tonight because of what is happening later today and because of where I work.

I work at 'West Ham'.

Later today the football team 'West Ham' are in the FA cup final (sort of like the UK version of the Superbowl for any Americans).

It looks like it will be a warm day. The pubs will be open - and showing the Cup Final Match. I suspect that there will be (as a friend of mine would put it) plenty of chance for police overtime.

In addition ambulance manning isn't at it's best.

Oh well...


Of course - now I'll probably get nothing but babies with runny noses while two streets away there will be running battles between two groups of drunk football hooligans - something that we have a long and valued history of in this part of town.

Well... That's the last time that I try and predict what will happen in a night.

For a change it's not me that is injured, but instead my crewmate.

We had just returned to station and as she climbed out of the ambulance her foot caught in a hole between the kerb and a dip in the grass, I looked over and saw her rapidly disappearing from view.

To be brutally honest, both myself and the FRU driver's first action were to... *ahem*... 'make fun' of my crewmate - that was until she told us how badly her ankle hurt. A quick examination under the darkness of night told me that the best place for her would be the A&E department.

So I drove her, in her own ambulance, back to the A&E we had just left.

Our Duty Station Officer met us there, discovered what had happened and left her in my capable hands as he drove off to deal with a crew that had been assaulted.

My crewmate was seen quickly in the A&E (perks of the job you see) and x-rays were taken of her badly swollen ankle - thankfully nothing was broken, although the prognosis is that her recovery will take 2-6 weeks.

I'm going to drive her home, then come back to station and see if Control has found someone to replace her.

Oh well - it was nice having a regular crewmate - if only for a little while...