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View Article  Fallen

'Male 56, fallen'

I turn around to the student who is working with us for this month and tell her that it's probably some bloke who is drunk - after all, that is the sort of job that I tend to get sent to.

As is traditional the call is on the other side of our patch to where we currently are, but thankfully we can whizz along the A13 to get there that much quicker. It's not even rush hour.

As we pull up outside the house my subconscious starts shouting at me, I don't know if it's the behaviour of the relatives or something else, but I yell to my crewmate that she should bring her big bag of paramedic tricks with her - I grab the oxygen bag and the defibrillator and make my way into the house.

I follow someone who I understand is the wife into the house, she leads me along the corridor telling me that she was making a cup of tea and when she came back from the kitchen her husband had fallen over.

Before I enter the living room all the alarm bells in the back of my head are ringing - I couldn't tell you why I had that feeling, but I've learnt to listen to my inner voice when it is screaming at me, it doesn't send me wrong.

Sure enough our patient is face down on the carpet, not breathing and his skin is that deeply unhealthy bluish-purple that tells me that he hasn't got a pulse.

Over my shoulder I hear the wife ask if he will be alright, another woman ask if he'll be alright for the disco tonight and a boy wailing.

I'm on my own for the minute, my crewmate and student are still gathering the kit from the ambulance. I have long legs and I tend not to hang about getting to the patient, especially when I'm getting the 'bad vibes'. Unfortunately this can put me some way ahead of my shorter-legged colleagues.

I roll the patient over and start the CPR - he looks pretty far gone to me, but you never know. The training takes over, I haven't been flustered at a cardiac arrest for years and I settle into the familiar patterns.

Crack, crack, crack, crack go four of his ribs. I always wince when I break someone's ribs, sadly it's pretty much unavoidable if you are doing CPR properly - it's worse when you feel the ribs go on the little old ladies that have bird-like bones.

I pump away and can hear my crewmate asking where I am. I think for a moment, trying to remember my route into the flat.

"Down the end of the corridor, and it's a suspended!", I shout.

My crewmate and the student arrive, I tell the student to place the defib pads on the patient's chest which she does perfectly. Someone gets out the ambu-bag and I suggest that I 'bag' the patient (breathe for him), while our student can do the CPR and my paramedic crewmate can do all the other things like popping a needle in his veins and preparing to intubate him.

At some point I send our student back to the ambulance to call for another crew - with a cardiac arrest it's always handy to have a second ambulance to help out.

The defib tells us to stand back as it wants to analyse the heart rhythm to see if we should 'shock' the patient - I look at the screen, it's a pretty obvious case of VF, something that we do shock. For some reason the machine isn't completing it's analysis, it keeps telling us to move away from the patient even though we aren't touching him.

Just as I'm about to put the defib in manual mode and do it my own damn self it decides that yes, perhaps a shock is advisable.

Our student gets the honour of hitting the button. She checks that we aren't touching the patient, presses the button to shock him and our his body gives a shudder.

The relatives keep asking if he will be alright, one of them mentions a disco again and I think then leaves the house. I have my mind on other things, but find the time to tell them that because our patient is very sick we are pumping his heart for him and breathing for him.

I ask my crewmate if she wants to secure his airway by intubating him, she's been trying to get a line in because she knows that I can handle airway management pretty well. She throws me a cannula in it's packet and tells me to get venous access, while she starts lays out the kit she needs to pass the breathing tube.

Our student keeps up the CPR, and it's good CPR at that - training school seem to have been doing a good job in teaching CPR.

I insert the cannula and secure it while my crewmate gets the breathing tube down in one swift, smooth movement. At the hospital the anaesthetist will compliment my crewmate on her intubation skills. She won't tell the doctor that she had to tube the patient while half curled up in a tiny space half under the TV.

One lot of drugs go in through the cannula, the patient gets shocked again and would you believe it, he gets his pulse back and starts breathing.

The trolley is fetched and we continue to stabilise the patient. It's looking pretty good, he's got nice strong breathing and a very strong and regular pulse. He could be sleeping were it not for all the bits of medical kit sticking out of him.

We lift him onto the trolley and are loading him on the ambulance when two FRUs and another ambulance turn up.

"You're too late", I tell them, "we've got it sorted - look he's even breathing for himself".

"Sweet", comes the reply from a FRU responder.

We plug him in to our ambulance equipment - his vital signs are all exceptionally good, better than mine at that moment I would guess.

We pre-alert the hospital and make a run for it, our student is driving while me and my crewmate monitor our patient - it's looking pretty good for him.

At the hospital our patient starts to wake up, so the doctors knock him out so that he can rest and so they can do some more diagnostic tests without him fighting them. There is no obvious reason for his cardiac arrest and some of the other tests performed are pretty hopeful for his recovery.

We later find that he was moved to another hospital as that is the nearest with an empty ITU bed. It's a bit of a shame as it means I won't be able to follow him up to see if he survives to discharge. It's a shame, I'd really like to know how it works out.

To see if he survives his 'fall'.

-----

On May the first I'll be at this event - Cory Doctorow and Charlie Stross (two of my favourite authors) will be talking about how to escape the surveillance society. Proceeds go towards the excellent Open Rights Group. Doctorow is an annoyingly effective and engaging talker and, while I've never heard Stross talk in public, I would imagine that it will be an very entertaining and educational evening.

You can register for tickets at eventbrite. Well worth £10 of anyone's money, or if you are feeling particularly wonderful, for the cost of a subscription to the ORG. If you come along do say hello.

View Article  Shaved

It is traditional, when removing a beard, to take off portions at a time and admire the result. I have removed my beard.

Shaved

It is a legal requirement that during this process you need to do your best impression of Ron Mael. Sadly my bathroom now looks like I've been holding badger baiting contests in it. And can I just say that, unlike Mr Matthew 'rough and tough' Fox, no shaving or skin care products were used apart from a razor, some water and a pair of scissors.

View Article  Bollocks II (The best and the worst)

'The patient is a 37 year old male, he initially had groin pain for the last five weeks which he thought was muscle strain. However two days ago in the process of self examining his testicles he discovered acute tenderness and swelling in the area of the head of the epididymis. He is normally fit and healthy, although he is a shift worker. He takes no medicine and is not allergic to anything. He has not been sexually active for the last two years and has no urinary symptoms or symptoms of any sexually transmitted disease.'

I'm sitting in my GP office, the GP himself looking rather bored. The patient is myself and I'm a little concerned. I discovered the tenderness last night and while I treat myself for most injuries and illnesses, this is a bit outside of my sphere of knowledge. The GP surgery sees me ten minutes after I phone for an appointment - so full marks there.

The GP examines me, and hands me a prescription for Flucloxicillin, an antibiotic that on getting home and doing some research seems to be not ideally suited for my problem. Still, what the Hell, it's a week course and if it hasn't resolved I'll see him again.

A week later I'm back sitting before the same GP, the pain has got worse and spread into the other side of my groin. I'm a little more forceful.

He examines me. Well, he examines my healthy testicle and completely ignores my left one, the one that is paining me.

"Are you going to refer me to a urologist?", I ask, "maybe under the two week rule?"

He smirks. 'That's not very helpful' I think.

"Go to Queen's A&E", he tells me quite sharply, "Maybe they will scan you, if not phone me and let me know".

It's not really an A&E job, but he can refer me through A&E - I just need a referral letter.

"Are you going to write me a referral letter?"

"No, just turn up", he tells me.

This is naughty, the GP should write the letter and talk to the speciality - I try telling him this but he isn't listening.

"Just go to A&E", he says, "Let me know if you are lucky", and he motions me towards the door.

I leave thinking that I need a new GP. However I consider myself honoured, I've never heard him say more than four sentences during a consultation.

I hop on the bus to Queen's hospital already rehearsing the apologies that I'm going to make. I'm taking the bus because I suspect that the cost to park will be greater than the cost to getting two buses.

I reach Queen's, grab something to eat from the canteen and head to the A&E. I chat to the greeting nurse, starting with an apology, but he apologises to me.

"We don't have urology specialists at this hospital".

I grit my teeth and think about strangling my GP.

"Your best bet is to go to King George's hospital, they have urologists there - sorry".

I let him know that it's not his fault that my GP is an idiot and hop back on a bus to get home.

The bus breaks down and I walk the rest of the way. It's not been a fun day so far.

I decide to drive to King George's hospital and damn the cost - in reality driving and parking saves me £2.40. I head into the A&E to book in, the first thing I do is chat to a doctor at the reception. He listens to me and asks for the GP referral letter - I tell him that the GP told me that I didn't need one and that I apologise for the (lack of) actions of my GP.

The doctor calls over someone who I assume is one of the admin managers and asks her to ring the surgery.

With professionalism and grace she phones the surgery, explains to the GP that he's done the wrong thing and asks him to fax over a referral letter, the GP agrees to do this.

During the rest of my stay at the hospital no such fax appears. Sadly I'm not surprised.

I wait ten minutes before I'm seen by the triage nurse, considering I feeling rather relaxed my observations are a bit worrying (SpO2 of 95%, BP of 141/92 Pulse of 99), I think I need to take up some sort of exercise once this is over.

Once more I apologise to the triage nurse, she's very nice and tells me that she'll have a chat with the urologist as she is in the department at the moment.

I wait for about an hour, I'm not too sure how long exactly because I've got my nose buried in a Rick Dakan e-book. A young lady doctor appears and calls my name. We find a consultation room and she examines me and takes my history. She's got a very pleasant manner to her even if she does tell me that these things take longer to get better in the 'older man'. I splutter somewhat until she looks at my notes and, somewhat confused, notices that I'm only 37.

I think it's time to lose my grey beard.

She gives me two different courses of antibiotics better suited to fight any infection of the epididymus and books me in for a scan next week. I'm impressed with the speed of the scan and with the bedside manner of this doctor, the antibiotics will fight any infection (which is what I think I have) while the scan will rule out anything more malign like cancer or testicular torsion.

I head home happy that I'm being well looked after.

In one day I saw both the best, and the worst, of the NHS - I'm so unimpressed with my GP (I dread to think what my GP would have suggested if I hadn't pushed for being referred - would he have referred me or tried a different, equally ineffective, antibiotic), and yet I'm incredibly impressed with King George's hospital and the urologist and nursing staff there.

I have my scan on Monday - hopefully it'll show everything normal. Fingers crossed.

-----

For those that saw the last episode of Battlestar Galactica - did anyone notice that when Lee Adama took his helmet off he had a hairstyle reminiscent of a certain 'Ace' Rimmer?

View Article  From The LAS News Site
Copied from the LAS News website.

A paramedic has been attacked after he disturbed thieves trying to steal drugs from an ambulance station.

The paramedic was hit over the head with a fire extinguisher, punched and kicked during the burglary at Pinner Ambulance Station, Harrow.

Police are now searching for four men in connection with the assault which happened at approximately 1:30am on Saturday (14 March).

The staff member, who is a team leader at the station, does not wish to be named. He said: “I was on my break at the station and as I walked into the garage four men sprung up from behind one of the cars and just came at me.

“They ran straight at me, throwing punches and kicking me as I tried to fend them off. Then I felt an almighty thump on the back of my head from a fire extinguisher. I was dazed and was stumbling around which gave the men the chance to run away.

“The whole thing lasted not more than two minutes, it was all over before I knew it.

“Afterwards, I was fuming. Then I found a slash on my forearm and saw the slit through my shirt with a wound on my stomach – it transpired later that a knife with blood on it was found outside the station – I realised then how lucky I had been.

“When you are at your ambulance station you just don’t expect anything like this to happen. I’ve been doing this job for 19 years and have never been assaulted like this.”

Following the attack the paramedic was taken to Northwick Park hospital for a check-up.

Ambulance Operations Manager for Pinner Sean Brinicombe said: “We are doing everything we can to support him through this and to aid the police in pursuing a prosecution.

“I am shocked that people would sink so low as to steal from an ambulance station and attack a paramedic in the process.

“Thankfully he is okay, but this incident could have been a lot worse. Our staff shouldn’t have to work in fear of attack, especially from the very community they are trying to serve.”


No comment needed beyond hoping that he gets well soon.

View Article  An Example Of Social Media

Yesterday Google released it's 'Streetview' service in the UK. This allows people who use Google's mapping website to look at panoramic photographs of the areas covered.

The first place that I looked was for my house, sadly the Google camera car stopped one street away. I looked for my Mum's house, and again the photographs stopped one street away.

Then I looked for my ambulance station.

View Larger Map
All very clever, and as the streets are public, not a problem. Anyone with nefarious purposes are better served by actually visiting the place in question. For example, in these pictures of our station, you can't see the security cameras...
But then I thought about the road outside Newham hospital, had the camera car been down there?

Sure enough they had, and what was shown was a patient being unloaded from an ambulance.

Now, I'm not too sure if the road that the hospital on is public property or not, but ethically there is surely an expectation of privacy when you are on an ambulance or being wheeled into A&E? It is this expectation of privacy which is important1.
Being a bit busy I just twittered about it and thought nothing more about it.

Twitter


However it would seem that someone with a bit more energy behind their ethical standing took notice of it and reported the image to Google, and being generally good guys, they quickly removed it.
Then today I saw exactly the same picture printed in The Metro, with a screaming headline about privacy concerns. Really, if they were that concerned about privacy, they shouldn't have printed the picture along with the story...
I suspect that someone on the Metro reads my twitter feed (actually, I personally know someone who does, but they are quite smart and are unlikely to have been involved in printing the picture). But what it does show is the surprising speed of information via various 'social media' networks.
-----

For those that listen along, the next Podcast thing is up where I apologise for the delay between 'casts and read the next half an hour of my first book. You can find it here.


1Here is an excellent guide for UK Photographers and the law.
View Article  On Scene?

A quick recap for those who haven't yet seen me write about ORCON. ORCON is the government target that tells all ambulance services that they have to keep the time between the phone ringing up in Control and the ambulance arriving on scene to under eight minutes for our highest priority calls. There is also a nineteen minute target for not-so-serious calls. For the low priority calls, like grannies with broken hips, we can leave them on the floor for up to four hours.

This eight-minute target is based around outdated research and has little clinical significance for the majority of our patients, something admitted by our own chief executive as 90% of our calls come from people who do not need an emergency ambulance. This 90% figure is based on the London Ambulance Service's own research1.

It's easy to tell when to 'start the clock', as soon as the BT operator connects the 999 call to our Control, but when do you 'stop the clock'?

The target states that the ambulance should be on scene. Does this mean when the ambulance pulls up outside your house and I hit the big 'At Scene' button? Does it mean when the keys are out of the ignition of the ambulance (because we track that)? Does it mean when I poke my ugly mug around the bedroom door to find you on your bed with bellyache (and if you live in a block of flats with no working lift it might take me over a minute to actually reach you)?

All these are reasonable ways of measuring the time. When we pull up, or when the keys are out the ignition are easily measured due to the tracking devices in our ambulances. Being face-to-face with a patient would need us to have an accurate watch and to note the time ourselves, so accuracy would be a problem but it would better match the 'patient experience'.

How about marking us as 'on scene' when we are within 200 meters of the address? This is what many of us on the road suspect of happening - when we get within 200 meters or so of the address our MDT 'updates'.

It doesn't matter if you have crashed your car on one side of the dual carriageway and we have to drive an extra five miles to get on the correct side. It doesn't matter if we have to creep around tiny winding estate roads, wary of knocking off the wing mirrors of parked cars. It doesn't matter if the address is a bit wrong, if we are where the computer says we should be then we are 'on scene'.

As the time arrives when we have to finally collate our ORCON success rate approaches (appropriately enough April the 1st), so we find the percentage of calls that we make on target start creeping up towards the magic 75% mark.

Why is this? Well, in the words of our own Chief Executive,

"...our Management Information team check all our records to ensure we capture everything correctly. [The] team are checking every missed call, and with over one million calls, inevitably they are finding some that can be legitimately included."

Which makes me think that they go over every call, and if we were within 200 meters of the address when the eight minutes are up, they then count us as being 'On scene' and therefore the job can be seen as a 'success', regardless of patient outcome.

As always, the LAS and LAS management have the full right to reply to anything that I write here. It would be nice if they could confirm, or deny, us being within 200 meters as being part of hitting our targets, and to what 'legitimately included' means.

1Taking healthcare to the patient: Transforming NHS ambulance services (Page 8)

View Article  Clearing Out Some Links

Good news on the kidnapped MSF workers front - they were released on Saturday. If I didn't have things like rent and bills keeping me here I'd love to join MSF.

-----

Time until appropriation by a marketing company for a TV ad? Probably less than three months.

Thru-you.

-----

De-Baptism.

Sticking your tongue out at Pascal's Wager.

-----

While pondering 'what next' for my literary career (such as it is) Suw's thoughts on cliffhangers dropped into my RSS reader. Made me reconsider the structure of the fiction that I want to write.

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Dementia with Lewy bodies - tagged as 'research'.

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Welcome please 'A life in the day of a BASICS Doctor', they've just started blogging, but it looks like one to watch.

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GREG RUTTER'S DEFINITIVE LIST OF THE 99 THINGS YOU SHOULD HAVE ALREADY EXPERIENCED ON THE INTERNET UNLESS YOU'RE A LOSER OR OLD OR SOMETHING - A fairly comprehensive list of things that make up the internet's subconscious. Trust me and avoid the NSFW 'bonus' links at the bottom. Some things cannot be unseen...

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You are reading Freakangels, right? How about the forum where I tend to only lurk because everyone else there is smarter than me?

-----

When they start talking about the credit crunch and start throwing about those huge numbers, remember that

A million seconds is 11 days
A billion seconds is 32 years.
A trillion seconds is 32,000 years.

(From William Gibson's blog)

-----

Why, as a shift worker, I'm fcuked. It's why I get annoyed at obnoxious patients - those of us who work shifts give up our health for the ungrateful swines.

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The Danish government seems to be doing something helpful for it's sick shift workers, somehow I can't see the British government paying compensation to our shift-workers. They'd rather spend their money bailing out the banks. Sadly this would not be without precedence.

-----

Attack of the badly photoshopped mutants soon to be invading the telly.

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.

All opinions on this website are mine alone, and may not reflect those of the L.A.S or other ambulance crews

Find out more about me here.

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