I was being sent to one of our regular nursing homes - I'd been to 'Rose Cottage'* a few days earlier for a patient who 'wasn't eating' and had a low blood sugar. This time it was for a patient with chest pain.

It's not the worst nursing home that I go to - the place is clean and tidy, some of the nurses speak good English and the patients aren't beaten. But it's still not as good as it should be; the normal problems of the staff not knowing about their patients, and the usual cold cups of tea siting just outside of the patient's grasp render it an impersonal and borderline neglectful place.

We arrived to find that our patient was a 93 year old female, bedbound and only recently discharged from hospital. She also had dementia although more of the 'pleasantly confused' type. I have found that there are two main ways that dementia manifests itself in nursing homes, the 'constant screaming, scratching and crying' type, and the 'pleasantly stoned' type where the patient is dotty but fairly happy.

This tiny little bird was of the second type, she looked at me as I walked in the room and gave a big toothless smile.

Our patient had been discharged from a good hospital less than 24 hours ago. She had been in hospital because, even though she is bedbound, she managed to break her hip. While in there she caught a chest infection but had since recovered enough to go home where she would continue to be nursed.

Fat chance of that.

The nursing home staff had called the GP who had decided that the patient should go to the hospital. Like most out of hours GPs he saw us arrive, threw a letter at me and ran off.

For some reason they don't like talking to other medical people they can't bamboozle in person.

The doctor had decided that the patient needed to return to hospital - Fair enough, at the end of the day it's what I'm here for.

"She has chest pain", the nurse told me.

I asked the patient if this was true.

"Only when I cough", she was just finishing her course of antibiotics and this was to be expected.

It was obvious that the patient was dehydrated, the heating in the room was high and a full cup of water sat out of reach.

"She hasn't been eating or drinking", the nurse told me.

"Would you like a drink?", I asked the patient.

"Yes please", she replied.

So I did what nurses are supposed to do with patients like this - I helped her have a drink of water. At this point the nurse scuttled out of the room to 'photocopy the notes'.

I noticed that she had a recent cut and some bruises to her arm that were undressed - probably nothing as she does have frail skin, but I made note of it anyway. I lifted her to the trolley and, wrapping her up, took her back to the hospital.

"It's a Rose cottage special", I said to one of the doctors. She replied that she could tell that from a distance without needing to speak to me. The charge nurse who I handed over to spotted the cut to her arm before I had chance to mention it, which puts me in a good mind about the sort of care she'll get at the hospital.

So she returns to hospital where he will probably get another chest infection, and this one might kill her.

Even while the patient is in hospital the care home will be charging in the region of £500 a week for the empty bed. Is it any wonder they call for an ambulance at the drop of a hat? I would imagine that a care home with all it's patients in hospital would be very good for the shareholders.

At the moment I'm looking very seriously at the Commission for Social Care Inspection and their Expert by Experience as I'm getting fed up of tackling things on a case by case basis - I want to change things for the better permanently, something I just can't do in my current job.

*Not it's real name, although some people may well get the reference.

Over at Mental Kipple I have my review of Sunshine - I think it's the last time I'll be invited to a press screening...

It's just over a week til the Open Rights Group's Support ORG (and Party!) event, at which there will be public domain DJs, free culture goodie bags and the chance to win some really cool schwag. Our special guest speaker is the wonderful Danny O'Brien, who is always fantastic value for money and well worth coming along to see. So, if that sounds like fun, come along - it's free! Well... it's sort of free - we just ask that you bring someone who might like to become a new ORG supporter.

If you can't make it, then you can still support ORG by buying a raffle ticket for just £2.50 (link to PayPal is at the bottom of that page). Prizes up for grabs include:

* a signed copy of Code 2.0 from Lawrence Lessig
* £150 in O’Reilly book vouchers
* a signed copy of the Gowers Review of Intellectual Property from Andrew Gowers
* a signed copy of Bruce Schneier's Beyond Fear
* a set of a dozen Beatpick compilations
* a signed author's galley of Cory Doctorow's next novel, Little Brother and the opportunity to be written into it
* ... and the pièce de résistance, as far as I am concerned - a 'very battered keyboard with a key missing and everything!', signed by our Patron, Neil Gaiman.

Many thanks to everyone who has donated! Buy your tickets on the night, or online via PayPal. At £2.50 each, they're a snip!

(Nicked from Suw's Blog)

Technorati Tags: blogging

So yesterday's shift was on the FRU (If you read my twitter updates in the sidebar, you may well get previews of upcoming posts).

Remember - the FRU is only sent to the most serious calls.

So on this shift going to serious calls I went to...

Two panic attacks.
One urinary infection.
One earache.

And that's it.

Nice to know I'm back to normal.

For the second time in two weeks I did a job where we did some actual good. To be completely honest it put my crewmate and I on a bit of a buzz for the rest of the day.

The job stated out as a bog standard chest pain; 41 year old male, pain in the chest radiating down his left arm. He is originally from the Indian sub-continent and people from this part of the world tend to have a lot of heart problems.

It didn't seem like a big job to be honest, he didn't look like he was having a heart attack - he wasn't sweaty, the pain got worse when he breathed in (often a sign of non-cardiac chest pain), he didn't have the 'feeling of impending doom' that is described daily in ambulance training schools across the world.

But he just didn't look right. I have no idea what it was about him, but there was something about him that set alarm bells ringing.

So we popped him onto our carry chair and wheeled him out to the ambulance in order to do a few checks before taking him to hospital.

His blood pressure was high, but everything else seemed fine. As we were preparing to do an ECG (a tracing of what is going on in the heart) my crewmate and I agreed that no matter what it showed we would be 'blueing' him into the local hospital, just based on the feeling we had about the patient.

His ECG printed out and we realised that we wouldn't be going to the nearest hospital around 400 yards away.

There is something that the LAS do exceptionally well, and that is to diagnose heart attacks (properly called Myocardial Infarctions, or MI's). We have good experience of spotting ST segment elevation MI's and dealing with them accordingly. Not so long ago the treatment for an MI was to have a 'clotbusting' drug which worked most of the time and has the possibility of some serious side effects (like bleeding onto the brain and death). Recently, in London at least, some specialist hospitals have been offering 'primary angioplasty' which is a surgical proceedure where a wire is threaded from your groin into your heart and the blockage is cleared manually. It's done under a local anaesthetic and is the gold standard treatment.

So now the LAS will diagnose a heart attack and instead of taking you to the nearest hospital for sub-standard treatment, will take you to the specialist unit for the best treatment possible.

This patient was having a massive MI. Absolutely life-threatening.

He had been waiting for a same day appointment to see his GP about the pain, but as the pain got worse he'd wisely called for an ambulance.

We gave him aspirin, morphine and GTN - good, immediate treatment for his MI, and blued him to the specialist unit.

As we arrived we showed the receiving doctor the ECG heart trace. He told us that, "That's all I need to see, bring him straight through". We moved him onto the hospital's trolley and left him in the care of the doctors while they assessed him for surgery.

Then his heart stopped pumping blood.

He was dead.

Rapid, effective treatment by the doctors restarted his heart within a minute and he was soon asking them if he had just fainted. During this I was explaining to the wife what was happening. English wasn't her first language so she was confused by what was going on.

He was rushed into the surgery room and the doctors asked if we would like to see the proceedure - as we were doing our paperwork we agreed.

An x-ray image of his heart came on the screen as they pumped a contrast agent into his blood to show where the blockage was.

There are two main arteries feeding blood to the heart, one branch of these was completely blocked. The doctor described it as 'The widowmaker'; a severe blockage in exactly the wrong place. This was almost certainly why his heart had stopped beating effectively while they were preparing him for surgery.

We watched as they did a bit of delicate plumbing work to remove the blockage and restored the flow of blood to his heart.

While he will almost certainly survive this episode, I wonder what damage has been done to his heart; the MI causes part of the heart to become starved of oxygen and this can reduce it's function.

If he'd waited the hour to go and see the GP, he would be dead.

If he hadn't called for an ambulance, he'd be dead.

If we weren't routinely trained to recognise MI's and take them to the right place, he'd be dead.

If the primary angioplasty wasn't available, he'd probably be dead.

Everything went right on this call, we felt that we had saved his life (a rarity in this job), and it let us feel that we had earned our pay today.

Another 'good' job.

And our next two jobs were picking up unkempt homeless drunks from the street. It doesn't do to get an ego in this job...

For the medically minded, he had a VF/VT arrest, corrected after two shocks and a complete blockage of the LAD about 3mm from the base.

I'm too tired to post about the good job of today, so instead a short post on our last job.

I called up Control on the radio after dropping our patient off at the hospital.

"Control, I need to return to station to clean out the back of our motor - we've just transported one of our 'local legends'. Is there any infection control policy for patients who are infested with insects?".

"Erm...", came the reply, "Just scrub everything really well".

So we returned, used every cleaning product that we have and then used the ambulance jetwash to hose out the interior.

But I still feel itchy typing this.

UPDATE: I woke up this morning and found myself covered in insect bites. So the itchyness yesterday wasn't imagined. I am f*&%king fuming... And wondering what diseases I can catch.

Two am in the morning and we are standing on the side of the road waiting for the fire service to take the top off the car in front of us. The wind whistles across the flats making us all shiver despite our fleeces and our jackets.

Two cars have been involved in a high speed RTA, the parked car that was hit has been shunted forward leaving ten metres long skid marks. The cars aren't too damaged but the seats inside have shifted around, trapping the occupants.

There are seven ambulances here, four fire trucks, half a dozen police and three ambulance officers with clipboards. There are eight patients, all but one need cutting from the cars and collaring and boarding. The only woman involved is 'walking wounded'.

The reason that it is taking so long for our car to get it's lid removed by the fire service is because of the position of one of the patients inside. He looks rather unwell and the crew looking after him really would like to get to him.

Our ambulance was fourth on scene. When I arrived I spoke to a station-mate to see what he wanted us to do, who he wanted us to look after. Normally he is the station clown, now he's all serious and professional, no fake beards or silly glasses now.

Everyone gets checked over, all the ambulance crews are calm, it's serious but it doesn't look like anyone is about to die; more a case of being careful moving the patients 'just in case'.

The roof comes off the car and with the help of another crew and some firefighters we get our patient out safely and strapped to a board. He is freezing cold. Not wearing warm clothing, the delay in getting him out and the terrible weather has us concerned for his body temperature.

We are in a new ambulance, so the heater works and turning it up to full we are soon sweating ourselves as we assess the patient and prepare for transport.

I get on the radio to pre-alert the hospital - For some reason the radio isn't working properly and our Control can't hear me, so I use my emergency phone instead. Thankfully it works.

I travel a mile over high speedbumps to get to the hospital, there is no other route and every bump makes me aware of my patient in the back being jostled around. It's not the first time that I curse the council.

After all our patients are safe at the hospital we stand outside and laugh and joke. We reconstruct the accident, we talk about the more injured ones and we mock the driving skills of one of the officers.

We occasionally help people.

It's a good job sometimes.

I haven't blogged for a bit so that the last post of mine would be at the top of the page for a while; I think it's an important issue that needs to be discussed in public.

I'm not as thin as I used to be. Come the end of April and I shall be engaging in that thing called 'exercise', my belly is resembling a pot and I get out of puff walking up two flights of stairs. This is not good for a youngish man such as myself.

It's good to see that my own mental image of my body is current though, otherwise I may well have got myself in some serious trouble.

We were called to a 'trapped behind locked doors', we arrived and the police were waiting for the 'enforcer', a ram that they use to knock down doors. Given that she was a little old lady, and that they could see her lying on the floor through an open window they didn't fancy smashing her door to pieces.

"Open window".

I looked at it, it was a very narrow opening but I thought that I would be able to make it.

The thing is; I'm a big kid at heart - give me a door to break down or a window to climb through and I'm a happy soul. It's not so much for the patient's benefit (although obviously I am thinking about the patient) it's more for the fun of the experience.

One of the police found a garden chair that I could stand on, and they eyed me suspiciously as I tried to slide through the window.

The fleece that I was wearing was padding me out too much, so I took it off.

I tried again, this time in was my pen, pen-torch and scissors in my shirt pocket that got in the way. I moved them into my trouser pocket.

One of the police asked if it would help if I were buttered up.

I pretended not to listen to him.

I managed to get my head and chest through the window, then my gut got in the way and there was a momentary fear that I would get stuck in this position, half in, half out the window. I sucked in my stomach and thought 'thin thoughts'. I managed to slip through the window only nearly killing myself in the sink.

I had a little ego boost as, panting heavily, I opened the door so that my crewmate could get in and we could look after the patient who was actually rather ill.

So yes... I need to lose some weight and get fitter than I am at the moment.

Tomorrow I shall be spending the day with Laura, the first chance to see her in a month as our shifts have been opposite each other. A nice trip to the museum I think.