The less serious side of emergency care work

There’re a lot of serious issues in the world today, especially in the world of the emergency services so I’ve decided to take a light hearted look at some funny episodes I’ve encountered over the years.  No one was seriously harmed in any of these jobs and everyone involved saw the funny side of the event at the time so I’m not laughing at peoples misfortunes, I’m laughing with people at their own misfortunes, so that’s ok!

  1. At a Halloween party one guest had a nose bleed and another guest fainted at the sight of the blood. You guessed it, the fainter was dressed up as count Dracula.
  2. All the ambulances have fire extinguishers on them, one in the cab and one in the back where the patients are. They are fixed to the wall in a wire frame from which we can quickly remove them if needed.  This particular day, the extinguisher was stored at floor level on the side wall near one of the fold down chairs.  For some reason the safety pin had been knocked clear and a particularly heavy footed colleague accidentally kicked the trigger and discharged all the foam.  The back of the ambulance looked like an Ibiza foam party after a few minutes and he was covered from the waist down in foam.
  3. A young lady had spent ages working on her hair for a party and had used a large amount of hairspray. She was admiring the finished result and stopped to have a cigarette.  As the lighter sparked, her hair on one side of her head ignited due to the hairspray fumes. All that work, not to mention a significant amount of hair disappeared in a flash.  Luckily her skin was not burned.
  4. I was dealing with a hiker who had fallen down a steep, rocky slope. Due to the possibility of spinal injury from the fall we had immobilised him on the scoop stretcher before moving him onto the ambulance.  He was complaining of a lot of pain from his arm.  It was not possible to take his jacket off in the normal way because he was strapped to the scoop stretcher and also his arm was causing too much pain to move and bend.  The only way was to cut it off.  Sometimes people are more worried about us cutting and ruining their clothes than they are about their injuries.  This hiker had a lovely warm duvet jacket, as soon as the scissors cut into it the feathers seemed to explode out of it.  There seemed to be an impossible amount of feathers crammed into that sleeve, we were finding them in the ambulance for days after.
  5. It was ladies night in a club and a troop of male strippers were entertaining the local ladies. As part of his act one stripper picked up a lady to swing her round. Unfortunately the baby oil she had just rubbed into his arms and chest had got onto his hands to and she slipped from his grip onto the floor straining her ankle.
  6. One young man had enjoyed a night at a club with his friends. When he got home he was hungry.  Looking round his kitchen, he fancied a can of beans.  He couldn’t find the tin opener so to save time his drunken brain thought he would stab the tin open with a screw driver.  One slip later and we were called to tend to the self inflicted stab wound in his hand.
  7. A young lady had spent a boring evening with her boyfriend and his best friend. The friend had called round for a quick drink and was still there hours later while she wanted some quality alone time with her boyfriend. Finally the friend left and as the door shut she leapt into her boyfriend’s arms expecting a passionate kiss at last but unfortunately he dropped her and she sprained her ankle.  She spent the next few hours of quality time with her boyfriend in the waiting room of the local Emergency Dept.
  8. A young couple were trying things to spice up their love life. This particular night they were playing with a pair of toy handcuffs.  Unfortunately when they were finished one of the handcuff bracelets jammed on the man’s wrist and wouldn’t unlock.  The more he tried the tighter it got until the circulation was being restricted and his fingers were tingling.  I managed to break them without hurting him by using a pair of pliers and a screwdriver so he didn’t have to face the embarrassment of sitting in a waiting room at the hospital wearing a pair of toy handcuffs.
  9. A woman was in her loft organising the stuff she kept up there. The loft didn’t have floorboards so she was balancing on the rafters.  She misplaced her foot and stood on the plasterboard between the rafters.  It didn’t take her weight and she fell through to the bedroom below.  Luckily she landed well and didn’t hurt herself.  Unluckily she was disorientated and couldn’t see because of lots of plaster dust which had got everywhere and she staggered to the top of the stairs and fell down them too.  Thankfully the xrays showed that there were no broken bones, just bruising and a big job of redecorating her bedroom to look forward to.
  10. One day we were dealing with a fall and had immobilised the patient on the scoop stretcher.  My mate and I went to pick the scoop up and place it on our trolley.  As I bent and squatted to get in position for the lift, with a loud rip my trousers tore from front to back.  Despite it being a warm summer day I had to wear my jacket to cover my embarrassment until I could get back to base to change.

 

My top ten favourite moments at work

I think it’s time for another top ten list.   This is my list of my favourite work related moments.  Not in any particular order.

 

  1. When we’re trying to resuscitate someone who is in cardiac arrest (not breathing and no pulse), it’s a great feeling when we get a pulse back (Return of Spontaneous Circulation (ROSC)). Even better if the person starts to breath for themselves too although this normally happens a bit later when the person is in the resuscitation room and we’ve handed over to the hospital staff.  It’s nice to track the patient’s progress through the hospital to the point where they are discharged home and back to their families.
  2. When a job flows smoothly. There is a certain flow from the point when we are given a job to the point where we hand the patient over in the Emergency Department (ED).  Sometimes the job flows more smoothly than other times.  Things can go wrong, equipment can let us down or the patient may not agree to the recommended care path way.  Sometimes it’s not easy or possible to cannulate the patient if required (insert a small tube (cannula) in the patient’s vein by inserting a needle which is encased in a plastic tube on the outside and then removing the needle leaving the tube in place).  A range of our drugs are given through the cannula (intravenous (IV) so if I can’t cannulate then I can’t give the patient any of the IV drugs or fluids.  It’s great when everything works and flows smoothly.
  3. When pain relief starts to work. Many of our jobs are people who are in pain.  This can range from sudden pain due to an injury or illness or ongoing pain caused by a long term condition which has gradually got worse to the point the patient can’t cope and calls us for help.  We have a range of techniques and drugs (analgesics) we use to relieve pain.  For an injury, eg broken limb, using a splint to immobilise the injury helps to ease the pain.  Reassurance also helps because fear plays a part in making the perception of pain worse, particularly in children.  No one likes to see another human in pain so it’s a great feeling when the patient starts to relax as the pain eases.
  4. When an unwell, scared child relaxes and starts to smile and laugh. When children are unwell or injured they are usually scared too which makes the feelings much worse. As long as the illness or injury is not time critical, we take a while to let the child get used to us.  We involve mum, dad or any other care-giver and encourage the child to show us their favourite toy or book.  It’s a good feeling as the child starts to relax and even laugh.
  5. When we can hear back up crews approaching. When we’re on a big job and have requested back up, it’s a huge relief to hear them approaching in the distance.
  6. When someone says thank you. I know it’s our job to help and it’s what we get paid to do, but we’re human too and it’s fantastic when someone appreciates the help we’ve given them and thanks us.
  7. When we get a free coffee. Very cheeky one this but some places give us free coffees while we’re on duty. Fantastic!
  8. Seeing a student progress. I’m a mentor so I quite often have a student for a year.  In the UK paramedics study at university and have frequent placements with us on the road during their course.  I love to see the student progress over the year from being nervous and confused to become a confident, competent paramedic.
  9. Hearing the relief crew arriving at the end of the shift. If we happen to be on station towards the end of the shift (very rare but it can happen) it’s an unbelievable relief when you hear the relief staff arriving.
  10. End of the shift. Home time!!

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.

Shooting in a nightclub

Many years ago one Friday night shift, Tony and I were directed by our control room to a reported shooting at a night club in our local town.  There were possibly multiple casualties, but the local police were on scene so the scene was ‘safe’.  This was long before our service had response vehicles (ambulance cars with solo clinicians), HART teams (specialist paramedics with extra training in all sorts of hazardous conditions) or a structure of senior clinicians (senior or advanced paramedics with extra education and responsibility) to talk to on the phone or radio.  There was Tony and me.

We arrived to a scene of utter confusion.  The few police officers on scene were trying to organise the large crowd of party goers into some sort of order.  We joined the melee and tried to find the wounded patients.  At this point we did not know how many patients we had or the extent of their injuries.  A hysterical girl grabbed my arm and pointed at a lad who was sitting on the doorstep holding his chest.  He was very calm and didn’t seem drunk.

“I think I’ve been shot” he said, more unbelieving than anything.

A quick look revealed a wound to the back and a wound to the front of his chest.  There was very little external bleeding. He was obviously conscious and his airway was safe, a quick feel of the pulse at his wrist indicated no sign of immediate major bleeding so I left a police officer keeping a very close eye on him while I joined Tony who had found another casualty.  This lad had a single wound in his abdomen with no other obvious wounds; he was also conscious and couldn’t quite believe what had happened.  He was conscious but was quite sweaty and breathing fast.  His airway was safe so an off duty nurse from the crowd who seemed quite sober was left to watch him while we continued to search.

No other casualties were obvious. I couldn’t quite believe I heard myself shouting at one point: “Has anyone else here been shot?”

For now, we were happy that, miraculously, there were only two casualties.  I asked control to ‘make vehicles two’, the concise and unambiguous way we ask to make the total number of vehicles two.  Of course we were told that there would be a delay as there were no available vehicles anywhere in the area.

There began a hectic period of treating the two casualties on the pavement while we waited, oxygen and fluid lines for both and constant monitoring of vital signs.  All the while a large crowd of noisy, drunken partygoers were jostling around us as the police barely managed to impose order and give us space.  As the backup vehicle arrived I handed them the lad with the abdominal wound, his heart rate was increasingly rapid, along with his rate of breathing and his abdomen felt rigid to touch.  These are sure signs that there was significant internal bleeding, for now his body was managing to compensate but it wouldn’t take much longer for his blood pressure to crash.  This was long before we had haemostatic dressings or the drug tranexemic acid to help slow down blood loss.

I was then able to concentrate on my lad with the chest injury.  Once on the ambulance it was possible to listen to his chest to assess the degree of pneumothorax, that’s where air gets into the space between lung and chest wall causing a collapse of the lung, I couldn’t hear a thing outside in the crowd. Incredibly there was still good air entry despite the entry and exit wound in his chest, his vital signs were stable and didn’t indicate much internal blood loss.  There was no respiratory distress and he claimed he was in very little pain.  He said that the most pain came from my cannulation (IV line); obviously a little bravado was coming out to mask his fear.

After a final quick check that no further victims had been found we were able to set off to hospital.  Several people had come forward to say they were “in shock” from seeing the shooting and wanted to be “checked over”.  We gave self care advice to these and managed to not be delayed any further.  It was finally time to set off for the local hospital.  This was before we could go direct to specialist trauma centres, so the ED of the local district general hospital would have to cope.  Our control had already given them a warning that there was a shooting with possible multiple victims in their area as soon as the job came in but now we gave them specific details of our patient.

On the brief trip to hospital, the bravado (and the adrenaline) wore off and he changed from the laughing ‘gangsta’ with his ‘badge of honour’ gunshot wound and he became the scared little boy who was terrified of death. I reassured him as best I could and I was very touched when he said he was glad I was with him as I was a very kind man.  He shook my hand. The gangsta mask went back on at hospital as the nurses were hooking him up to the monitoring gear.

I still have no idea why the two lads were shot, were they just in the wrong place at the wrong time? Were they deliberately targeted?  Rumours were widespread in the following weeks, most seemed to be that they were selling drugs on someone else’s territory.  Sadly the lad shot in the abdomen died in the ED from blood loss, the lad shot through the chest survived.

I think people like to have a reason to justify or explain horrific incidents, if the lads brought it on themselves then it somehow reduces the risk of any of us being shot at random for no reason, although this ignores the fact that opening fire with a handgun in a crowd is as likely to injure/kill the innocent as it is the targets.

As a parent of two children who are now at the age they enjoy a night out at a club with friends, this is one of the reasons I feel such secret dread whenever they are out and feel such relief when I know they are safely home.

This was many years ago before it was routine to offer the crews time out after an intense job and the chance to debrief (talk the job through with a manager or senior colleague, a very therapeutic process).  The next job was waiting for us….

Fifty Shades of Green

There is a common idea out there that uniforms are attractive.  Men are supposed to love certain uniforms and women apparently love a man in uniform too.  A quick survey of the people I know reveals that most women love a man in a fireman’s uniform and men favour a nurse’s uniform.  Not many people of either gender particularly find the ambulance uniform attractive.  It is a shapeless, dull green thing.  It normally comes in 2 sizes:  too-small and too-big.  As long as you avoid the too-small option it is actually quite comfortable to work in, except for the two or three days a year we have a heat wave in the UK, then it is heavy and suffocating.

Years ago, before the dull green uniform we had a more formal uniform:  a blue shirt with clip-on blue tie and blue trousers. Totally impractical for the job we do.  Before my time the outfit was finished off with a tunic style blue jacket complete with shiny buttons and a peaked cap.  Thankfully the hat and jacket had been removed from issue when I started the job.

One night years ago, dressed in the blue shirt-and-tie uniform I was given a job in a night club.  A member of the public had suffered an ankle injury. My mate for that night, Cliff, was excited on the way to the job because he knew that the club regularly hosted strip nights and lap dancing.

We arrived at the club.  Cliff was excited and I was nervous, I was relatively new to the job and still got nervous dealing with jobs in pubs and nightclubs.  We were shown in by the security guy on the door and the look on Cliff’s face was priceless.  It was ladies night.  The place was packed with hundreds of ladies in various states of intoxication, enjoying a night of male strippers.  One unfortunate lady had been lifted by the dancer and slipped due to an excess of baby oil on the dancer’s arms and landed awkwardly, twisting her ankle.

We worked our way through the crowd to the injured patient and some of the more drunk ladies thought we were the next act.  A chant started and was taken up by more and more of the crowd, suggesting we should start dancing and stripping.  It was the single most scary and yet hilarious night of my career, even the confident Cliff was trembling and perspiring.  We couldn’t get the injured lady out of there quickly enough!  Once in the safety of the ambulance Cliff and I laughed hysterically until we were both almost crying.  The lady with the twisted ankle thought it was hilarious too and joined us laughing in between gulps of the pain relieving gas, entonox.

For the rest of the shift Cliff seemed to be seriously considering erotic dancing and stripping as an alternative activity.  I am sure that the ladies of the North West would be very grateful to me for talking him out of it as a career path!

Top 10 things people say to me at work

This is a top ten list of the things people say to us at work. No particular order, just as I thought of them.  In brackets are my normal replies (often unspoken or I’d soon be an ex-paramedic).   A short, light blog as funny top ten lists seem to be the in thing on social media right now.

  1. I couldn’t do your job. (On a good day: awww thanks.  On a bad day: I don’t think I can do my job either any longer)!
  2. How long have you been an ambulance driver? (Driver?? We do a bit more than just drive…).
  3. You must see some sights. (Yeeeeees you could say that!).
  4. What’s the worst thing you’ve ever seen? (My alarm clock flashing at silly o’clock in the morning).
  5. When do you finish your shift? (As soon as possible, normally 12½-13 hours after we started it).
  6. Is it quiet for you today/tonight? (Have to resist the urge to strangle anyone who says this, we don’t say the ‘Q’ word, even if it is. We’re a superstitious lot and believe saying the ‘Q’ word will jinx any nice shift immediately).
  7. Bet you get a good sleep at work on nightshifts. (I wish we did).
  8. Bet you get fed up of the drunken idiots (often said by someone who is drunk and doesn’t realise that they are being an idiot).
  9. It’s like a mini hospital in here. (Yes, a hospital in the midst of an earth quake with some of my colleague’s driving).
  10. Are we there yet? (OK, so this is mainly my kids in my car, not patients at work).