Brand New Babies!

If there’s one type of job most ambulance people, especially male ambulance people, are apprehensive about it’s maternity jobs.  For me they’re the scariest type of job.  Part of our job is to deal with obstetric emergencies (emergencies in pregnancy), delivering babies and life support/resuscitation, and general newborn baby care.  I’m always reassured by the thought that Homo sapiens have successfully been giving birth to their off springs for about 200,000 years.  It’s only in the last 100 years or so that birth has moved into the domain of the medical profession.  Still scares me though.

Most of our maternity cases are in early stages of labour.  Birth is not imminent.  These types of jobs get called ‘maternitaxi’.  This isn’t really an appropriate case for an emergency ambulance, if we politely question why the ambulance was called, normally we are told that the potential mum has rung the Maternity Unit (MU) and “they told me to ring 999”.  When we arrive and hand the patient over, normally the midwife scolds them and says that they said to get a taxi not and ambulance!

Maternity cases differ from other emergencies in many ways; one major difference is the destination.  When we deal with most non-maternity jobs the destination will usually be the emergency department (ED) of the local hospital.  Certain conditions are taken to specialist units but generally for a given emergency in a given region the destination is determined by location and condition.  Maternity cases however the potential parents choose in advance which hospital MU they want to go to.  Obviously this has to be within reason – if a mum-to-be is hundreds of miles from home and labour starts an ambulance can’t travel hundreds of miles we have to settle for one of the local units.  The other main difference is that we can’t just turn up at a MU unannounced.  If the mum or dad hasn’t rung the MU then we have to get our dispatcher to ring and we can’t set off until the MU agrees to accept.  It can and sometimes does happen that a particular MU is full, in which case we are told to go elsewhere.  This is stressful for the prospective parents because they will have had lots of visits to the MU they chose during the pregnancy and to be told at the big moment that they have to go to an unfamiliar unit must be scary.  It’s scary for us too because it normally means longer before we can hand over to the midwife!

When we arrive and birth is imminent we don’t transport, we deliver the baby at home.  One of the first tasks is to request a community midwife to come to the address.  If he or she arrives before the baby then that is fantastic, midwifes are the experts in assisting birth.  If not it’s down to us.  The area where I work is covered by several MU’s.  One is a specialist MU where it is recommended all high risk pregnancies in the area book into.  Ironically, that one MU does not send midwifes into the community so the higher risk home births are left to us.  Another benefit of a midwife attending is that if all has gone normally and mum and baby are well we don’t need to transport anywhere and the new family can stay at home.  If we deliver with no midwife present then mum and baby have to go to the MU.  We then have 2 patients: mum and baby (possibly 3 if dad has fainted during the birth!).

The biggest risk to a new born is the cold.  A baby comes into the world naked and very wet.  They have very little body fat at that stage so lose heat quickly.  A priority once we know the baby is alive and breathing is to dry baby off and get them in skin-to-skin contact with mum to warm up, then wrap both up and make sure the room is warm.  A hat is an excellent idea for baby.  My regular mate Tony is a big fan of baby hats and it has become a bit of a catch phrase for him once baby is dried off: “get a hat on that baby!”

I have assisted with many births over the years, some stick in my mind:

One dad tried to drive his wife to the MU but had just left it a bit too late (or baby was impatient) and mum started to deliver in the car.  Luckily we were driving past and he was able to flag us down.  I opened the passenger door of the car to find mum with one foot on the dash board and baby’s head just visible.  I assisted the birth in the car foot well then quickly got mum and baby into the ambulance.  I asked if mum and dad had a name for their new daughter and dad joked that he would call her Corsa after the car.  I asked if he was glad he didn’t drive a Skoda…It seemed funny at the time.

Another time we were on the way to an imminent birth and we were told that the baby was breech.  The normal position for a baby about to be born is head down in the uterus so the baby comes out head first.  Breech means the baby is bottom first.  This is a complication because the head may get stuck after the body has been born.  This is a very scary situation.  As we arrived the response car was already there.  To our great relief Stella, on the car was assisting the delivery and thankfully baby came out with no complications.  Stella said that when she got there baby’s foot was visible and that was all.  She had a very anxious wait for the next contraction when mum managed to push the rest of the baby to the world.  Since no midwifes had been available to attend we had to transport mum, dad and baby to the MU.

One final birth which sticks in my mind is a 17 year old girl who lives with her parents.  She was 36 weeks pregnant and hadn’t yet figured out how to break it to her parents – she had spent the last few months wearing baggy clothes.  One Sunday morning she thought she needed the loo and baby decided to make his appearance.  Mum and baby were fine the new grandparents were shell-shocked, they had no idea when they went to bed the night before that they would be grandparents in the morning.

Mental Wellbeing in the build up to Christmas

This is the Rusty Siren guide to keeping your spirits up in the build up to Christmas with some mental health tips.  I don’t personally like to think about Christmas before the middle of December but these days I’ve found it is in our faces as soon as Halloween is over.  Evidence suggests that mental illness may increase at Christmas, this is my personal guide to dealing with the whole Christmas thing with minimal stress.

The challenges of this time of year are obvious and well known:

Money.  This has become an expensive festival and the pressure is on to spend more and more.  When we feel obliged to spend more than we have this is a huge source of stress.  Several years ago I had a chat with my family.  We decided to cut back on presents.  We all know we love each other so we don’t unconsciously try to measure love by present monetary value.  Family policy now is children get bigger presents adults get a token present.  Homemade presents are very welcome. We’re all relieved and happy with this.

Time.  Lots of us find ourselves working extra hours to get the extra money we need which then obviously leaves us less time to do the Christmas shopping.  My answer is to start the planning and organising early (hence why I’m writing this now).  I know this will annoy some people; I used to get irritated by the organised types who had Christmas all sewn up when I was just starting to panic around the 20th of December!   I’ve now joined their ranks.  I’ve also caught up with the rest of you in the 21st century and do some of my shopping on-line.  The earlier start leaves longer for the gifts to arrive.  For the shopping I can’t get on-line I plan shopping expeditions in the local towns.  I start early and generally have a loose plan of what I will get and where I will get it.  When it goes well I reward myself with a gift too!  There have been times when I’ve not managed to get a single present but still got myself a gift.

Also, about now is when I start to think about posting any cards which need to go overseas.

Perfect-family-syndrome.  The television is full of adverts for Christmas now.  Often a perfect family is shown; the beautiful couple with the happy children whose life is made even happier by the perfect Christmas they are having.  If that’s you then you have my best wishes and I am truly glad for you and hope you have a fantastic time.  Most of us at some point fall short of that ideal scene. As a divorced dad my Christmases have been a little different.  When my children were younger I used to feel guilty that I had deprived them of this perfect Christmas.   Often my shift pattern has meant that I have been working on Christmas day or Christmas night.  The way we got round this was to plan a day near Christmas when we had our own Christmas.  I came to love our alternative Christmas days.  The kids are adult now but we still enjoy our custom.

Through working the Christmas period I know that a lot of people feel increasingly lonely and depressed at this time – I think this is made worse by the Perfect-family-syndrome pushed by the advertisers.  It’s important to remember that a lot of people also feel lonely and low at this time of year and that it isn’t unusual.  Times when I’ve been alone on the day itself I’ve still planned treats for myself – nice food and tried to have a relaxing day and included a nice walk in the fresh air.

The years where Tony and I are working Christmas day we each bring a microwave Christmas dinner so when we get our 30 minutes on station we can still feel quite festive.  I generally eat all the mince pies, Tony doesn’t really like them!

Extended time with family. During the holiday period we tend to spend more time than we are used to with our families.  Much as we love them, this may also cause increased stress.  Then as the anxiety rises and patience levels drop we feel guilty for feeling like this when we’ve probably been looking forward to spending this time with our loved ones and feel that we shouldn’t feel like this.  It’s good to take a realistic view at times like this. It’s natural that there will be tension when spending more time than we usually do with our families, especially if staying at their house and adapting to their routines.  This is part of being a human.  When this has happened to me I just accept that this is natural and I rely on my go-to remedy for everything: I go for a walk and practice my relaxation techniques.

Despite what it might look like from above I do love Christmas.  I’m a big kid at heart and love all the shiny lights and decorations.  I do think people are kinder and more loving to each other for a brief period of the year.  Regardless of spiritual or religious views I think we all think more about loving and giving at this time of year.

I hope you all have a relaxed and stress free build up to Christmas (It’s way too early to wish Merry Christmas yet!).

Typical day at the office

This is a timeline of a typical dayshift I worked last week.  It developed into a longer blog than normal for me.

06:40  

I arrived at work.  My mate, Tony arrived pretty much at the same time.  The station we are based at is in a pretty rough area.  We are allowed to put our cars in the garage as there is a high risk of them being vandalised while we are out and about on emergencies if left out on the street.  We walked into the mess room and I made straight for the kitchen to put my food in the fridge and more importantly make coffee!  The night shift had already arrived back on station and were pleased to see us.  They handed over the radios and Pat, the paramedic I was taking over from gave me the key to the safe in which the controlled drugs are stored.  We chatted about their night shift and they started to get their belongings together to get home to bed and a well earned sleep.  Tony and I drank our coffee while we contemplated the 12 hours ahead of us.

07:00

Time to sign on.  We carried our personal equipment onto the ambulance.  We take it in turns to drive – Tony and I usually swap half way through the shift.  This morning Tony was driving first.  I got into my side of the ambulance and put our staff numbers in the data pad in the cab.  When I pressed ‘send’ this told our dispatcher who we were and that we had signed on for the shift.   Our dispatcher called us up on the radio to say good morning and check we had all our equipment and were ready to go.  While I had a brief chat Tony had started the engine, put all the lights on and was walking around the vehicle making sure that they were all working and that the tyres all looked ok.  In an ideal world we would be given time to check equipment in the back of the ambulance, restock any consumable equipment we were running low on and check and sign for the drugs and the controlled drugs.  However….

07:04

The first job of the day was passed.  An 86 year old lady had fallen in her bedroom; her elderly husband had made the call because she was unable to get herself up.  It was fairly local so we were there in minutes.  I got the First Response Bag from the side door of the ambulance.  This is a (heavy!) rucksack which has all the equipment we need to assess and start treating just about any emergency.  Mr J was waiting at the door for us and he pointed up the stairs.  “She’s up there lads, don’t think she’s hurt, but I can’t lift her.”  We found Mrs J lying on the floor next to her bed; Mr J had covered her with the quilt to keep her warm while she was on the floor.  After checking her, there was no sign of injury and from her baseline observations no sign of illness.  She said that she had not fainted or felt unwell, just lost her balance while getting up from bed. We helped her up and she was able to walk down the stairs as normal.  There was no need to take Mrs J to hospital or arrange a doctor’s appointment.  I rang her son to let him know what had happened and then, with Mrs J’s permission I passed her details onto the local falls team, a multi-disciplinary team who would visit Mr and Mrs J with a view to giving advice to prevent further falls.

09:30   I cleared the job, making us available again for the next emergency.

09:30

We were passed details of a 13 year old boy who was unwell with stomach pains.  We arrived and were shown into the front room where Toby was curled up on the sofa hugging a bowl.  He had vomited twice while waiting for us.  From the history and his presentation the most likely diagnosis was appendicitis.  We needed to take him the hospital for assessment and possible operation.  Appendicitis is difficult to diagnose with absolute certainty.  Toby would be seen by the Emergency Department (ED) doctor and referred on to a surgical specialist.  Even the surgeon would not know for certain, they operate if the “index of suspicion” is high that it is appendicitis.  We dropped Toby and his mum off at the ED and took the chance to make a cheeky coffee to take out to the ambulance while we checked and signed the drugs check sheet.

10:30   I cleared the job.

10:30

The next job was passed, a 93 year old gent who had fallen in the night and his carer called us because he “wasn’t himself”.  We arrived to find Albert sitting in his chair.  His morning carer had visited and was about to leave as we arrived.  He was annoyed that his carer had called us, he didn’t like fuss.  There was no sign of injury from his fall and he was able to walk with no problem since his fall, which he said was just down to being half asleep when he got up in the night to go to the bathroom.  His baseline observations were all normal.  There was no need to go to the ED.  Once we told him this he brightened up and started to talk.  He was feeling low because he didn’t want to leave the house he had lived in for 50 years and was scared that we would take him away and that would be it.  I reassured him that we were all there to help him and to keep him well so he could carry on living in his own house.  He agreed that I could phone his grandson who he was close to and Tony made him a cup of tea while I did this.  His grandson agreed to call round with fish and chips after he had finished at work.  I suggested that Albert made an appointment with his GP (GP = General Practitioner: the doctor who looks after us in the community and co-ordinates our health care) for a general check up and review of his medication, which they agreed to do.  I also passed his details to the falls team – we were keeping them busy this morning!

11:58   I cleared the job.

11:58   We were told to Return to Base (RTB) for meal.

We set off back to station but two minutes later…

12:00

We were passed another job (dinner would just have to wait!).  This was in the next town, a 27 year old female who was 30 weeks pregnant and was passing blood with abdominal pain.  We arrived and the family met us at the door.  They had phoned the local maternity unit (MU) and they had said to come in.  We helped Safira onto the ambulance and her mum then after quickly assessing her baseline observations set off to the MU.  They were obviously subdued on the journey in and didn’t want to chat so after getting the essential details I needed I let them have peace.  We cleared at the MU and this time we would have to be allowed back for a break because we had been out more than 6 hours.  Sometimes ‘Health and Safety’ works in our favor.

13:20   RTB for meal.

13:35   Arrived on station and demolished our packed lunches.  Sometimes I pick up a take away but generally prefer to bring a packed meal.  Meal break is 30 minutes long and when we have been out longer than 6 hours cannot be disturbed by control.

14:05

Right on cue, the next job was passed to us.  It was my turn to drive.  We were given a 55 year old man who was in severe abdominal pain. We walked into his flat to meet Joe.  Joe admitted he was alcohol dependant (we guessed by the empty cider bottles next to the sofa).  He suffered with chronic pancreatitis as a result, and the pain had flared up this morning.  This is a long term condition where the pancreas is damaged, in Joe’s case by many years of daily drinking cider.  Joe had taken his usual amount of cider this morning (it can be dangerous for an alcohol dependant to suddenly stop drinking) but the pain was not subsiding.  We helped him onto the ambulance, checked his observations and I cannulated him and gave some morphine.  This dulled his pain and we took him to the local ED.  We raided the ED staffroom for a cheeky coffee and a few biscuits.

15:20   Tony cleared the job.

1520

The next job was waiting for us, the jobs were stacking up in control now and this had waited 50 minutes before an ambulance was available to allocate.  It was a 25 year old male who had cerebral palsy, development problems and epilepsy.  He lived in an adapted house with 24 hour care support to enable him to live as independently as possible.   Jamey had had a seizure.  The care staff were concerned that the seizure had been triggered because Jamie had an underlying chest infection and had contacted Jamie’s GP to arrange a check up.  The GP had insisted an ambulance was needed.  We checked Jamie’s observations.  We worked slowly and got the carer to help keep Jamie calm as we explained each test as we did it.  Jamie had fully recovered from his seizure by now and was back to his normal self.  There was no need to take Jamie from his secure, familiar house to a noisy, busy ED, so Tony convinced the GP service that Jamie was safe to stay home and wait for a doctor to start treatment for a chest infection.  (This sounds straightforward but actually is frustratingly time consuming: we make a phone call to one of the GP services we use and give the basic details to a call taker.  We then wait for A GP to ring us back to discuss the case.  This can be up to an hour later.  Then, during the daytime office hours the GP will often ring the patient’s own GP (we’re not supposed to do this directly ourselves – don’t ask!)  Then our GP will ring us back with a decision).

17:10   We cleared the job.  We were over due our second rest break of the shift, 20 minutes this time, but control asked if we would take a look at a child involved in an RTC they had no ambulances available to cover.

17:10

We were passed the job, a 14 year old girl who had been struck by a car.  The girl’s friends had made the call and were hysterical so our call taker had no idea of any injuries.  We arrived at the scene and were relieved to see everyone was on their feet – no one was lying on the road – a good start to the job!  Chelsea had been checking Facebook on her phone and had stepped out into the road. A car had managed to almost stop in time but had connected at low speed with Chelsea’s right leg, knocking her to the ground.  She had managed to avoid banging her head and jumped up immediately.  She was more upset that she had dropped her phone and the screen was smashed.   We got her onto the ambulance and checked her over.  We were happy from the mechanism and from the examination that there was no spinal injury.  She had some bruising to her right thigh and bruising and a cut to her left elbow where it had hit the road.  As we were checking Chelsea we heard raised, worried voices approaching – mum was here. Chelsea’s friends had rung her mum as well as phoning for the ambulance.  With a loud hammering on the ambulance door mum arrived.  I opened the door to let her in and calm her down as Tony was getting some details from Chelsea.  When mum saw that Chelsea was basically ok she burst into tears of relief then started shouting at her and threatened to kill her for the worry she had caused.  I asked her to wait until after 7 o’clock before she killed her because that was when we went off duty.  That lightened the mood.  We took Chelsea and her mum to the ED to get her elbow x-rayed and the cut closed.

18:35   We cleared the job and were RTB’d for our belated rest break.  At least it meant we would finish on time.

18:45   We arrived back on station, for the second time since we left at 07:04 this morning.  We took our gear off and I grabbed a mop to give the floor a clean as Tony got a few things from stores that needed restocking.

The night crew arrived and we handed the vehicle, radios and controlled drugs keys over to them.

1900    Time to go home.  Quite rare to finish on time, normally we are still on a job when finish time comes around and we obviously have to finish the job before we can go home.

Time now to relax until 07:00 tomorrow when we get to do it all again.

Keeping my mind tuned up.

This blog is about my mind and what I do to keep it healthy and to expand my brain. I like to read other blogs about how people manage to keep their minds healthy and active.  If we all share tips like this we can all maybe help each other a bit. I want to stress that this describes things which work for me.  I’m fortunate that I’m basically healthy mentally; all I suffer is the occasional low mood and some social anxiety.  If you suffer with the more serious conditions then I’m sure you realise that it’s expert professional help you need.

I’m not a mental health professional.  I want to stress that.  As a paramedic I’ve very little training in mental health, surprising when you consider how many cases we go to where mental health is the chief complaint.  I am however becoming an expert on me and my mind.  I’ve utmost respect for mental health professionals and always stress that if you have problems you shouldn’t hesitate to get professional help but one thing I’ve learned is that you don’t have to be a professional to help someone.  Just by being there and being prepared to listen and support someone can help a great deal.  Just listen without judging and without even trying to ‘fix’ things.  That may be enough to help a person through a crisis.  Encourage them and support them if necessary to go for professional help.

Talk about things on your mind.  We all know this one but don’t all do it.  I’m as bad as anyone at bottling things up but it really helps to have a few trusted friends in your circle who you feel comfortable talking to.  This next bit probably sounds a bit wrong but I think there comes a point where you have talked about some troubling event and continuing to go round in circles talking or thinking about it will make things worse.  There comes a point when you’ve analysed the event, learned from it, when you have to accept that you can’t change it or make it ‘un-happen’ by continuing to ruminate on it.  This is the point where you have to accept that it happened (I’m not saying that the event is acceptable.  It may be totally unacceptable and terrible but the fact is it has happened and you can’t change that, so it helps to accept that it happened).  This can be the difficult bit and where professional help may be needed. Once you’ve accepted it, maybe you can come up with a plan to improve things.  I found this the hard way: I had a particular problem I kept alive for 6 months by constant rumination and trying to analyse it.  Eventually I got so sick of it I just accepted it.  That was a huge weight off for me and I actually started to move on then.

It’s important not to ignore uncomfortable feelings and emotions.  In the past I’ve done this.  I’ve used distraction to take my mind off feelings it would have been better to face.  Thankfully my coping mechanisms weren’t too destructive.  I’ve avoided excessive alcohol and drugs but have watched many hours of mindless TV and read countless novels just to distract myself.  The thing is these feelings don’t just go away.  Experts tell us they hang around just out of sight (repressed), possibly building strength and cause problems from behind the scenes later (unexplained low moods or bursts of emotion at random triggers).  Now when faced with an uncomfortable or painful emotion I make a bit of time for myself and just feel it. It’s ok to cry at this point if you feel like it (I find this hard but they say it’s healthy and can be a relief). I concentrate on nice slow, deep, abdominal breathing and feel the feeling.  I try not to think about it or describe it to myself, just concentrate on feeling it and breathing.  If I find my mind starting to think about it, judge it or describe the feeling I focus once more on my breathing. I find that it passes after a while and doesn’t seem to cause problems later.  Sometimes the feeling may come back again but I just feel it again – it seems to be less intense and unpleasant the second and any subsequent times.  To date this had been successful for me.

This is the time of year when Seasonal Affective Disorder (SAD (isn’t that an appropriate acronym?)) may start to take effect (here in the UK).  It causes the typical symptoms of depression and is associated with the shorter, darker days of autumn (fall) and winter.  The exact cause of SAD is not fully understood but it is thought that reduced exposure to light affects the way part of the brain (hypothalamus) works.  It may cause: over production of melatonin, the hormone which makes you feel sleepy and tired; under production of serotonin, the chemical which provides a feeling of well being.  The lower exposure to light is also thought to affect the natural sleep cycle (circadian rhythm) leading to symptoms of depression.  The self help methods for tackling SAD are quite logical.  Try to make the most of what natural daylight there is.  Spend time outside when you can, couple this with exercise – a nice long walk – and you increase the benefits.  Exercise on its own should help with the symptoms of low mood, even if it’s not outside.  Make sure you have a healthy diet.  Some people find artificial light helps; there are ‘natural light’ bulbs you can get for lamps which are said to help.  You can get special ‘light boxes’ which are very bright lights, I’ve never tried these.

Music always helps me.  Most of the time at home I have the radio on rather than the TV (I’m listening to ‘princess of the night’ by Saxon at the moment).  My taste in music isn’t to everyone’s taste but it really helps me.  I have various playlists on my phone of specific, upbeat rock songs guaranteed to help lift me in just about any situation.

To finish, I feel incredibly grateful for my life, I’m very lucky to be healthy, have a wonderful family and partner and feel I’m generally blessed.  My Grandma always told me to ‘count my blessings’ and I think that old advice about focussing on what is going right in your life and being thankful for it really helps to keep positive.

I wish you all health, relaxation, peace of mind and contentment.

Why I wear a Remembrance Day poppy

This blog post has no ambulance anecdotes in it; this is what the symbolic meaning of the remembrance poppy is to me.

The poppy was first used in 1921 as a symbol to commemorate the fallen military in the First World War. It was inspired by the war poem ‘In Flanders Field” by Lt Col John McCrae.  Since then it has come to be a symbol of remembrance of military fallen in every conflict including and since the First World War.

Some see it as a political statement and a measure of patriotism, some as a glorification of war and others even as a racist slur.  To me it’s none of these.  I certainly don’t glorify war – I wish we as a species could at long last ‘grow up’ and accept differences, tolerate other viewpoints and all get on and love and help each other.  John Lennon summed it up for me in his masterpiece ‘imagine’.  End of rant.

I wear a poppy to remember and honour my great uncle Saville.

Saville was born in 1899 in a small Yorkshire town, Northowram.  He joined the army in 1915, joining the Royal Army Medical Corps as a stretcher bearer.  Some stories have been passed down through the family and one of my favourites is about how Saville and his colleagues dealt with wounds.  If a wound was bleeding and they were struggling to stop the bleeding one trick they found to increase the pressure was to place a dressing on the wound then place a small stone, or even once a potato on the wound then strap a bandage around it – the stone would increase the pressure to stop the bleeding.  Coming back to the 21st century, one type of trauma dressing we use has a plastic pressure bar insert (with a projection shaped like a small potato!) to be strapped over a wound to increase pressure and help stop bleeding.  It always makes me smile to myself because I think that my uncle and his friends invented this gadget!

Saville was awarded the Military Medal for bravery during a particularly fierce battle making several sorties out into no-man’s land to fetch wounded soldiers back to safety.  Tragically he was killed on the first of October 1918 – just weeks before the end of the war.  A shell exploded above him while he was on his way to pick up some wounded soldiers and a fragment of shell casing struck him in the chest, killing him instantly.  His mother, my great grandmother, never got over her grief at losing her son.

This is just one tragic story out of the hundreds of millions of casualties in the 20th century wars but it is very personal to me.  I obviously never met my great uncle but I would love to talk to him and hope that he would be pleased I’m a modern day stretcher bearer.

That’s what the poppy means to me and that’s why I wear it.

When a summer swim turned to tragedy.

Today this is a guest author spot.  It is written by my long term, long suffering workmate Tony and describes an incident he dealt with one day while not working with me.  I leave him alone for one day and see the trouble he gets into… Over to you Tony…

Thanks.  It was a sunny day.  I was working with Rachel, an experienced paramedic on an overtime shift.  Overtime always seems like a good idea when you book it, never seems quite so good when you actually come to start the shift, especially on a sunny day.  The day started pretty uneventfully – A steady stream of routine jobs, nothing too taxing.  Everyone was enjoying the sunny Saturday afternoon, the parks and pub beer gardens were all full of happy people.

We were driving back to base after a job when we were passed the next job.  It was a possible drowning at one of the local reservoirs.  We live about 50 miles from the nearest coast and on hot, sunny days we often see groups of children and teenagers climbing over the gates and fences into the reservoirs and dive and swim around.  The water authorities issue warnings every year about the dangers of swimming in reservoirs yet every year people ignore them and carry on swimming.  The problem with any body of water in the UK is that it tends to be cold.  Even on a run of hot weather it rarely warms the water below the surface layer; experts say the water below the surface doesn’t rise above a breathtaking 10˚C.  Reservoirs have the additional problem that there can be unexpected strong currents due to underwater valves and suction pumps.

We arrived at the reservoir to a crowd of bystanders all frantically waving us forward.  We had to climb over a fence to get to the edge of the water.  Two teenage lads were treading water a distance out from the edge.  They were shouting for help saying that they had hold of their mate but couldn’t get him out of the water.  They had been jumping from the edge of a building into the water on the opposite side of the reservoir all afternoon with no problems but on the last occasion their mate just never surfaced again – maybe he had banged his head on the paved floor and become unconscious, maybe the cold had made his muscles cramp, maybe the diving reflex kicked in – a reflex which all mammals have where the body responds to sudden immersion of the face in cold water by slowing the heart rate and diverting blood flow from the outer parts of the body, possibly leading to a faint.  Whatever the reason was, he never surfaced again.  Two of them tried to find him and drag him out while the rest called for help.

I shouted to the lads and asked if they could drag him to us.  They replied that they were struggling and couldn’t keep hold of him much longer.  The lad on the left was starting to have problems keeping his head above the water.

With some trepidation I took off my heavy work boots, emptied my pockets and waded out into the water.  It was cold! The deeper I waded the colder it got. The stone floor of the reservoir sloped steeply and the water quickly became deeper and colder.  The lads were still some distance out so I had to swim a short distance.  The lads by now had to let go of their friend to stop themselves from going under, one of them swam himself to the shore and I helped the lad who was struggling.  By now an ambulance response car and the police had arrived.  Stuart on the response car was taking his boots and tunic top off and one of the police officers was taking off his boots and body armour.  Rachel dished out blankets to the two friends and was preparing the resuscitation equipment on the shore.  After a quick conference we decided that since we knew pretty much where the lad had last been seen we would swim back in and have a look.  The fire service had mobilised the specialist water rescue unit but that would be ages before it arrived.

Back into the cold water we went.  The second time was no better; it still took my breath away.  We swam to where the lads had had to let go of their friend and looked around.  The police officer spotted him under water and we dived and managed to get a hold. We made our way slowly to the shore, Stuart joined us and we managed to get him back to the shore where we quickly dried off as Rachel started to dry him off and assess him.  He was in cardiac arrest: no pulse and not breathing.  We started to resuscitate and as we did his heart started to beat again.  He still wasn’t breathing for himself and was completely unresponsive.  We headed off to the local hospital after pre-alerting them that we were on our way, me driving (still damp and shivering) and Rachel in the back still ventilating the patient (using a machine to mechanically push air into his lungs and then allow the lungs to breathe out relying on the ribs and chest wall muscles to relax and force the air out).

He was kept alive for a few days on Intensive care but sadly was only alive because of the drugs and machines, the decision was made to turn off the machines and allow him to die.  I like to think that at least his family had time to see him before the machine was turned off and hope they got some slight comfort from that to help them through the grief.

That’s it really, all I’ve got to say.

Thanks for that Tony.  Just one point I’d like to add:  Tony and Stuart got a bollocking from the service for the risk to their lives they took that day, apparently there are rules somewhere which forbid us from doing stuff like that. However, they and the police officer got a very well deserved commendation from the Royal Humane Society for their bravery that day!

Halloween (true) anecdote

This is a true anecdote and seems appropriate for Halloween time.  Here goes…

One morning Tony and I had signed on for our 0700-1900 shift and we were given a job straight away.  It was a reported elderly male who had collapsed and was unresponsive to his family.  A suspected cardiac arrest.  The family had declined to attempt CPR.  On the way to the job, we didn’t speak much – neither of us are morning people.  I was mentally preparing what equipment to take in – all the gear we would need to attempt resuscitation.  I would grab the first response bag and drugs bag and go straight in, Tony following shortly behind me after gathering the monitor/defibrillator, suction gear and advanced airway bag.

We arrived outside the address, a terraced house.  The front door was open so I went straight in.  I walked through the front room into the kitchen dining room where several family members were gathered: an elderly gent was sitting next to a low table looking at his cup of tea and toasted tea cake, an elderly female was standing, in tears with a middle aged man holding her.  As I walked in, the lady pointed to the stairs in the corner and sobbed “He’s up there…”  As I walked across the room to the stairs I asked what had happened.  The Lady said her husband had collapsed on the way to the bathroom and she had been unable to wake him.  She called her son who came straight round and then rang the ambulance.  By now the gentleman had been down about 30 minutes.  I always feel that on jobs like this I must seem very abrupt and almost rude, but at this point of the job we quickly need some basic information as we are assessing the patient to make the big decision whether to attempt resuscitation or not.  I walked quickly up the stairs, Tony behind me with the rest of the resuscitation gear and found the gentleman collapsed on the hallway.  After assessing him we decided that it would be pointless to attempt to resuscitate – we would have had no chance of success and would have only prolonged the pain of false hope for the family.  As Tony started to pack the equipment away, I went back down the stairs to break the news to the 3 family members in the kitchen.  I was quite struck by the resemblance the patient had to the elderly gent sat down by the table, I presumed they must be brothers, maybe even twins.

I walked into the dining room and now there were only 2 people there, the patient’s wife and middle aged man who was his son.  The elderly ‘twin’ was not there.  I broke the news as gently as I could that the patient had died and we would not be able to resuscitate.  I gave his wife and son chance to comfort each other as the terrible news sank in.  As I got the paperwork ready to get some details, I wondered where the patient’s twin had gone, I assumed he must live very near; I made a mental note that we would have to make sure he was also offered support along with the family before we left.  I started to get the gentleman’s details from his wife and son and generally chatted about his life as I was explaining to them what would be happening over the next few hours and advising of the various means of support available to them.  As part of our conversation I asked about the gentleman’s brother and if he had any other brothers or sisters.  His wife looked puzzled and said that he had no brothers, sisters or any other family than her and their son.  She saw me looking at the small table with a cup of tea and toasted tea cake on a small plate and started sobbing again – that was the table he always sat at for his breakfast, she had prepared it and put it there just before he collapsed – he never got chance to have it.

Later in the ambulance talking to Tony, I decided to risk his derision and told him what I had seen; normally very skeptical of anything supernatural he said that he had goose bumps because he had seen him too.

Heroin Overdose.

One autumn afternoon, Tony and I had just cleared at a local hospital and were hoping to be RTB’d (Returned to Base) for meal.  Instead, with its usual irritating bleep, the data terminal announced another job for us.  It was a few streets away and was a reported heroin overdose, possibly more than one patient; the caller was too agitated and panicking for our call taker to clearly get all the details, but possibly the patient was not breathing.  This is the thing with heroin, as with all opiates such as morphine, as well as being excellent pain relievers they act on the cardiac and respiratory systems to reduce the respiratory effort, ultimately causing respiratory arrest which if left untreated rapidly leads to cardiac arrest – death.

We were on the street within minutes. Unfortunately we weren’t 100% sure which house number we were going to.  The caller had been hysterical and shouting making it hard for our call taker to understand clearly what he was saying.  Our call taker said to try number 51, that’s what it sounded like.  The caller had ended the call and wasn’t answering when our call taker tried to ring back.  We knocked at number 51 – no reply. By now we were joined by Stuart, a paramedic on the response car.  We waited for control to listen to the tape recording of the call to have another attempt at interpreting the address (all calls to the service are recorded and it has often been proved useful to get vital information on a second or third listen).

As we waited, a man further down the street popped out of the door and started waving and shouting frantically.  It was number 31.  We quickly moved the vehicles and Tony and I grabbed the equipment we needed for resuscitation.  Stuart followed us in.

As always seems to be the case when you need to act quickly, the house was cramped and the room we needed was hidden by the open front door so we had to enter one at a time and close the front door behind us to get in the bedroom before the next one could open the front door get in.

I was in now. Instantly I had a flash back to training school where as part of the training for resuscitation we set up scenarios for each other and as we got the hang of the resuscitation procedure we would make the scenarios more ‘interesting’ with multiple casualties and confined spaces.

One patient, a lad in his mid twenties was asleep on a single bed near a window.  He was breathing but only occasionally and his lips were blue.  A male aged approximately 50 was on the floor next to the bed and was in cardiac arrest.  The man who had called us down the street was doing chest compressions on him.  A third patient was in the doorway, also in cardiac arrest.  There were needles and syringes scattered over the floor.

Stuart updated control and requested two more ambulances as I managed to shake the patient who was breathing occasionally and wake him up enough to breathe normally.  Then I took over the resuscitation of the 50 year old, with assistance from the man doing chest compressions.  Tony and Stuart started to work on the third patient.  I also had to keep an eye on the sleepy lad, make sure he didn’t fall back asleep unnoticed and stop breathing.  I could reach him with my outstretched leg as I was resuscitating my patient so every so often I had to kick him to wake him up. All the while we were working we had to be very careful not to injure ourselves on any of the discarded needles scattered around the room. Luckily the service wasn’t too busy that afternoon and the backup crews arrived quickly.

The first crew took over the resuscitation of the patient in the doorway and moved him out of the door.  The next crew took the sleepy patient so then Tony and I could concentrate on my 50 year old patient.

Despite the initial chaos, the job flowed smoothly.  We had all three patients out of the house and in hospital within about 20 minutes from first arriving on scene.  The sleepy patient survived and was discharged from hospital that afternoon.  Sadly the two cardiac arrest patients died.  What made the job more poignant was that the 50 year old patient was not a regular heroin user – today on a whim he’d decided to try it for the first time because his friend was a user – first and last time.  The man who had tried to help with the resuscitation had supplied the sample for the three of them.  Because our patient had never used before, his ‘friend’ the supplier had actually injected it for him.  The last I heard he was arrested and being tried for manslaughter.

After this we did eventually get RTB’d for meal break – a somber and reflective meal break.

Suicide on the canal tow path

SPOILER ALERT:  Some readers may find the content of this post distressing.

 

It was early one spring morning.  Tony and I had been working the night shift, starting at 7pm the previous night.  It was 5 o’clock in the morning and we were looking forward to the end of the shift.  It was starting to become daylight and there was a mist: the sort of morning that usually precedes a pleasant sunny day.  Not that I was planning to see much of the day, I was planning on a nice long sleep today.

We had just finished our break on station and were wondering what our last job of the shift would be.  The phone in the mess room rang right on cue (this was the old days where control rang the mess room and a dispatcher spoke to us.  Now it’s much more impersonal/’efficient’ with a bleeping of our airwaves handsets).  The dispatcher said that she had a report of someone who had hanged himself from a tree on a remote path by the side of a canal.  The call may be a hoax, the caller said he was a cyclist who had run into the hanging body and then ended the call.  When the call taker tried to ring back for more information the number was unavailable. “Could you go and check it out please?”

We set off, Tony driving and me studying the map book trying to work out the most likely bit of the path to check and the best access point for us.  I decided on a car park where a road crossed the canal and the path was accessible.  The roads were still fairly quiet and we were there in good time.  As we pulled up there was a man sitting on a wall smoking a cigarette, his bike propped next to him.  He jumped from the wall and started talking as soon as I opened the ambulance door.

“He’s about half a mile up there. Just hanging from a tree.  I didn’t see him, had my head down.  I bumped into him, nearly fell into canal. It’s horrible.”

He was obviously distressed and I tried my best to be reassuring as I was getting equipment from the back with Tony to deal with a possible resuscitation.  I asked why he had not answered when control rang him back; I said it might have helped him by talking to our call taker as we were on our way.  He said he didn’t have a phone and had to flag down a car with a phone (hard to remember the days when we didn’t all have our own mobile phone).  The car driver had then driven off once the call had been made.

Tony and I gathered the three bags, cardiac monitor and suction equipment we would need if we were going to start resuscitation.  If it came to that, we would then have to figure out how to get the patient back to the ambulance – the tow path we could see was bumpy and narrow – probably too narrow for the stretcher.  However, one thing at a time.  We set off along the tow path.  The mist was quite thick here in the valley by the canal and we couldn’t see very far ahead.  The gear was becoming quite difficult to carry now, along the bumpy path and both Tony and my patience were wearing thin, made worse because we didn’t know how far we had to walk.

It seemed very quiet walking in the early morning mist; it would have been a pleasant walk if it wasn’t for what was waiting for us.  Eventually, slowly out of the mist a figure hanging from a tree materialised as we approached.  It was the most haunting and sad sight I’ve ever seen, still can clearly see it in my mind after all this time.  We found a male, in his forties or fifties hanging by a rope from a branch of a tree.  It was obvious on examination that we could do nothing for him – he was beyond resuscitation.  Once we had made that decision our priority is to shield the patient from public view as much as practical to preserve his dignity and to preserve the scene as much as possible.  Until proven otherwise we assume that this is a crime scene and it is important that crime scene investigators can gather all the available evidence with as little contamination by us as possible. We updated control and confirmed the patient was dead and we needed the police to attend as soon as possible.  People were walking past occasionally, we did our best to reassure and move them along, we couldn’t do much to shield the patient from view he was right next to the path.  About five went past before the police managed to seal that section of footpath.  Eventually a police officer arrived and we updated him as he quietly took in the grim view.

A small patch of grass had been trampled flat near the foot of the tree and a collection of cigarette ends was scattered around along with a few empty beer cans.  I couldn’t help wondering if the man had sat there smoking and drinking as he contemplated his life.  In my vivid imagination I could picture him there.  My heart went out to how dejected and desperate he must have felt.  Did he come there with the rope intending to end his life or was he just trying to walk off his depression and the rope was already there?  An innocent children’s swing which he had decided to use to end his life on a desperate impulse?

When the officer had spoken on the radio with his sergeant we were released from scene after giving him our details.  In cases like this crime scene officers would need to see the scene before the patient was moved to ensure there were no signs of foul play; the ambulance service would not be needed to move the patient, the local undertakers would do the job when the police had finished investigating.

I never heard any more about our patient, never got to find out his circumstances.  As I write this it is Mental Health Day.  I wonder if our patient was getting any support or help with his mental health? How long had things been building up for him? Had he tried to reach out and talk? Had he asked for help? Was there anyone in his life he could talk to?

I sincerely hope that eventually the stigma attached to mental health will be lifted and patients like this one will get help and support to help prevent such a lonely, desperate end to a life.

My blogging journey so far.

I’ve been blogging now for 5 months.  Here is a short blog with some thoughts about my experience so far.  There are no ambulance anecdotes in this one.

The first point is that I love the process of writing. For years I have been a fan of keeping a journal.  I agree with the experts that writing things down is a great way to get things straight in your mind and help you get things in perspective. I even love daily to-do lists – I find these a good way of de-cluttering my mind and ensuring I don’t forget things.  I love the feeling when a new idea pops into my mind for a blog article – I generally do a mind-map type sketch to get down the points I want to include and get a rough idea of the order to get them in.  Then I sit down to write – often the blog takes off in its own direction and doesn’t follow the plan.  I did wonder at first if I would dry up and run out of ideas to write about, hopefully that won’t happen.

At first I was very nervous when it came to pushing the publish button.  What if people hated what I wrote or thought it was boring? Worse still, what if nobody read it?  Thankfully I have found that the WordPress community seem very friendly and supportive.

I love the stats function on WordPress.  The day I publish a blog and a couple of days after I love to see that it has been viewed.  It’s fascinating to see that people have viewed my writing from faraway places around the world.  The ‘likes’ and comments are also very exciting to receive.

It’s very interesting to read other people’s blogs – I’m getting a great insight into lots of different subjects.  Mental health is a particular interest of mine, the open and honest accounts written by WordPress bloggers are very brave and insightful.  In my daily practice as a paramedic these insights help me to help my patients more effectively and also be a better mental health advocate for my colleagues.

I write with the pen name (should that be keyboard name in this digital age?) of RustySiren, Rusty for short.  A few but not many people know who I am.  This may come across as a bit cowardly and maybe it is but there are several reasons I decided to do it this way:

  • If I wrote with my real name it would be obvious to my colleagues who some of the colleagues mentioned in some of my anecdotes are and I want to avoid embarrassment for them.
  • My employer has a very strict view on social media and any form of publication. I always maintain patient confidentiality and always talk about patients with compassion and respect but my employer would probably disapprove of some of the anecdotes being made public and would probably want to edit and approve them before publication.
  • Although I respect my colleagues and patients I don’t always respect some of the direction and decisions of my employer and I want to feel free to express my opinions.
  • I am learning to become a mental health advocate for my colleagues (This is the excellent charity enabling me: mind.org.uk/bluelight). I would never ever blog about any colleague who is struggling with mental health but would not want to compromise my ability to help by a workmate by them fearing that they may be the subject of my blogs.
  • I find it easier to express my feelings by using a keyboard name (okay, this one is a bit cowardly I know but I’m still working on being able to talk freely about feelings). This includes me being able to talk about the job which caused me to become depressed and my journey out of depression (that job is described here – if I can get the link to work).

 

 

Lastly, did I mention that I love to write?