Car driven into a crowd

It’s been a while since my last post, family things have taken over my life recently but all’s well again so I can get back into my writing.

Tension relief alert:  No one was seriously injured in this job.

This is about an incident which happened recently.  I’ll write it to show that the way we receive details about an emergency is not always straightforward: sometimes information is drip-fed to us piece by piece as we approach and can be quite misleading and even dangerous.

It was late one evening; I was working a nightshift with my longstanding, faithful colleague Tony.  We were sitting at a local hospital outside the Emergency Department after dropping a patient off.  We had just finished our obligatory coffee when Tony tapped the keys on the vehicle data pad telling our dispatcher that we were available for the next emergency.

A job came through immediately.  It was a category 1 (the highest priority) and the computer dispatch system automatically sent the address to us so we could set off while the  call taker was still getting details of what was in store for us.  The address was about 4 miles away from us.  I switched on the emergency lights (blue lights) and set off.  Our dispatcher opened up the radio to say that the details were still coming through but it appeared that we were going to an RTC – a car had hit a pedestrian. These jobs are unfortunately quite common on our busy roads.

Less than a minute later she voiced us again to say that multiple calls were coming in about this job.  This is a sign that it was going to be chaotic on scene – when an accident in public happens, normally bystanders help the casualties until we arrive and are organised enough such that only one person rings for the ambulance.  The bigger the emergency, the more chaos on scene and usually this means we get more than one call for the same job.

As she was speaking to us more information was arriving on her screen from the call taker: the scene was becoming ‘volatile’.  A volatile scene is one where emotions are running high and can be quite dangerous for the ambulance staff as people’s fear, stress and frustration can boil over into violence against us.  She suggested that we pull over and wait until the police arrived (who were also attending on a high priority) if we wanted.  It still seemed to be a pedestrian RTC at this point.

We still had no idea of the severity of the casualty’s injuries so Tony and I decided to go straight to scene, normally we can tell the mood as we approach and we can usually diffuse a volatile situation by dealing promptly with the patient.

Just as we decided this radio bleeped again and she told us that the accident was outside a mosque and that the car had been driven deliberately into a crowd of pedestrians – potentially a terrorist attack. Possibly also weapons involved, armed police units were being mobilised.  The decision was made for us: we were not to go to scene, we were to wait at a nearby area (Rendezvous point – RVP). We were told a second ambulance was also attending and a manager to oversee things.  I parked at the RVP and Tony and I waited.  All sorts of scenarios were going through my mind, thinking about similar recent types of jobs.  A ‘major incident standby’ was declared,   not actually a major incident but everyone was preparing for one if it was declared.

The second ambulance arrived shortly after this and parked next to me.  Matt, a senior paramedic and the EMT he was crewed with got out to compare information with us.

We still had no idea of the number of casualties and severity of any injuries.  As we were talking lots of police cars and vans were passing us, blue lights and sirens disrupting the evening, heading in the direction of the incident.  It was frustrating beyond belief wanting to get there and assess and treat the casualties.  We were told that the HAR Team (Hazardous Area Rescue Team – a section of ambulance staff with extra equipment for managing hazardous situations) would be joining us.

The first HART ambulance arrived at the RVP with us and parked next to us.  People were starting to wonder what was happening at the RVP – 3 ambulances parked up and a constant flow of police vehicles streaming past us.

Finally a police car pulled up next to us and told us we were to go to scene, it was declared safe.  Matt set off in the lead with us close behind.  Our manager was still en-route to the RVP, he would have to follow on.

Within minutes, Matt and I arrived on scene and parked our ambulances as directed by the police officer in charge.  Although there was a large police presence the scene was still chaotic.  Emotions were understandably running high although thankfully no aggression was directed towards us. Luckily there were no serious injuries.  We were directed to an elderly gentleman who had been caught on the leg as he jumped out of the way of the car.  Matt was assessing him as I searched for any other injured parties.  This can be surprisingly difficult, in the chaos injured people sometimes are hard to find, they don’t always make themselves known to us.  The only other casualty was a young male who had punched through the side window of the car to try and stop the driver; he had several superficial cuts to his arm.  The driver had driven away after running into the crowd.

It turned out that the incident had been caused by a family feud.  Two children had earlier in the day had a disagreement while playing which ended in a fight.  The older cousin of one of the fighters had driven the car to attack the family of the other as they were leaving the mosque after prayers.  Although it was a terrible, irresponsible act it was not classed as a religiously motivated hate crime.  Thankfully it was down to the police not us to resolve that one; I’ve no idea if they caught the driver.  Hopefully the family feud ended there.

Instruction Manual For Dating Ambulance Staff

This is a jokey look at the trials, tribulations and rewards of dating or being in a relationship with a member of an Ambulance service.  It is written in the style of an instruction manual.  Boom – think I’ve just lost most of my male readers!

It applies equally to male or female and in the absence of any universally recognised gender-neutral pronouns I will use he, she, him and her at random (I’m not going to use the clumsy “he or she” every time), just assume that each applies equally in all cases.

I’m going to use the term ‘ambo’ in the interest of fluidity and shorthand to mean all ambulance staff whatever grade or job title.

 

Introduction

Congratulations on choosing to date or relate with an ambo.  You are guaranteed an interesting, possibly turbulent but hopefully never boring time.  By following a few simple guidelines and considering a few simple insights which follow you should get years of enjoyment out of your ambo.

 

First Meeting

You may meet on-line, in a bar or just out and about.  The fact that he’s an ambo will probably crop up early on in proceedings. It’s something that’s a fundamental part of her life, as the saying goes, it’s not just a job; it’s a way of life.  It’s a career choice that most ambos identify strongly with and define themselves by.  If they don’t mention it here are a few clues that may suggest your new friend may be an ambo:

  • Permanently tired. This comes from the long shifts and rapid changes from day to night shift and vice versa.
  • Slightly confused. Particularly noticeable after the ambo has worked a series of night shifts.  Your ambo may ring you mid morning for example, after having woken in a panic after night shifts convinced he has overslept and missed your date scheduled for that later that evening, or even the next day – it can be that confusing.
  • Strange meal choices: admitting to a whisky or beer for breakfast may not necessarily mean a serious addiction problem it may simply signal the end of a run of nights.
  • Eating or drinking very quickly. This is a very bad habit picked up at work trying to eat or drink between emergencies.

 

Uniform

Particularly for customers involved with a male ambo there can be a certain mystique or glamour about a ‘man in uniform’.  Sadly not the ambulance uniform.  It tends to be a shapeless green outfit (UK model).  Even if you find your ambo quite appealing in green polyester, you may be disappointed that he changes out of it at work before meeting you, or if he has no changing facilities at his particular place of work, the minute he gets home, probably before allowing you a hug.  The reason is that most ambos due to the nature of work develop a healthy level of germ-o-phobia.  In his mind’s eye it will be a stinking rag crawling with thriving communities of bacteria and viruses. Not to mention the occasional fungus or crawling things.  Ewwww.

 

In the relationship.

You’ve had a few dates and somehow that mystical change happens and you’re in a relationship with your ambo.

You may find the constant tiredness and occasional exhaustion-fuelled confusion initially quite cute.  As the relationship progresses it may become a bit tiresome.  It’s worth bearing in mind at this point that your ambo usually has no choice about the range of shifts she has to work.  Ambulance work is 24 hours a day, 7 days a week, 365 days a year.  Different areas will operate different systems but all involve taking your ambo away to work nights weekends and public holidays at some point.  Given enough notice, your ambo will usually be able to get a specific day or night off but short notice changes are usually quite hard to achieve.  Partners of ambos become used to attending family events alone and having to explain to family and friends that “..he’s working! Again!”

Some newer models of ambo may have very irregular shifts patterns, there is often an initial period of ‘reserve’ or ‘relief’ working where the ambo has to fill in for sick leave or holidays.  Usually only a few weeks’ notice of shifts is possible. This can last months or years depending on the employer.  Eventually this period ends and a position on a regular shift pattern becomes available.  This still means shift working but at least the ambo (and you) knows what he will be working at on a particular day in the future allowing for better planning.

 

Pregnancy

Either planned or unplanned, you may find you are pregnant.  This is a huge subject and is beyond the scope of this manual, but here are a few guidelines.

Your ambo is trained in obstetrics and has probably delivered many babies while at work.  While this may be reassuring, it’s probably for the best to rely on the professional services available in your area.  On the big day when baby is about to make an appearance, keep him at your head end, not the baby end – leave that to the midwife.  This will probably be what he wants also.  Besides, you need him to hold your hand as you squeeze and break his fingers during the contractions and swear at him for putting you through this.

 

Parenthood

Your ambo will generally make a good parent.  As the child grows, during the early years at least, being an ambo will be ‘cool’ and she will be proud of him.  Shift working will often mean that the ambo parent will be able to do school runs and get to events during the school day.  On open days at the school (fairs and fetes for example) you will probably be able to persuade your ambo to bring an ambulance for a couple of hours for the children to look at and sit in.  Obviously it won’t be an active operational one but he will probably be able to get hold of a ‘spare’ one for a couple of hours.  Most ambulance services love their staff to engage with the community.  Don’t listen to any complaints that she doesn’t want to, ambos love doing school visits, and they love the attention!

 

Breakdown

You may sometimes experience episodes of your ambo seeming withdrawn and quiet.  Records show this This may be more than just tiredness.  It may be due to a particularly unpleasant job he has done.  He may find it hard to talk to you about it.  This is not because she doesn’t trust or respect you it’s more likely that he wants to spare you the horrible details.  Evidence shows that male ambos are more prone to bottling things up and not talking about feelings than female ones.  Work is ongoing to try and overcome this design defect but it may take time.

Hopefully the occasional episode of low mood will pass as the ambo processes and comes to terms with the event and will return to his usual bright and responsive normal self.

Sometimes however the problem will not easily resolve and specialist assessment and repair may be required.  Watch out for the following signs that your ambo needs help:

  • A low mood which does not pass quickly.
  • A low mood that seems more serious than usual everyday low moods.
  • Your ambo becoming withdrawn and not talking to you.
  • Your ambo no longer wanting to be physically intimate with you.
  • Your ambo become irritable and unusually bad tempered.
  • Your ambo using unhealthy coping mechanisms: drinking alcohol more often or heavily than usual, using drugs.
  • Your ambo losing interest in the things she used to enjoy doing.
  • Your ambo no longer making the effort to keep in contact with friends and family.

The best thing to do is to keep encouraging her to talk but meanwhile encourage her to engage with professional services to help.  He may find he can open up to total strangers who are professionally detached.  For UK models the charity ‘mind blue light’ is an excellent start point, or their own doctor.

 

Final words

So there you have it.  A brief guide to the workings of an ambo and suggestions which hopefully help you understand and get the best out of your ambo.

GOOD LUCK!!

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.

 

Surviving Storm Emma

That’s a very dramatic title.  Sorry.  Here in the UK we now seem to love dramatic titles and headlines.  According to the press we are currently in the grip of ‘the beast from the East’ (a weather system blowing from the East) and ‘Storm Emma’.   A few years ago we would have called it ‘a spell of winter weather’ but I suppose that wouldn’t sell as many newspapers or get as much internet traffic as ‘the beast from the East’ ravaging us.  To put it in perspective, where I live, we’ve had approx 2 inches of snow with drifts of approx 4 feet in places, blown around by a 40mph breeze.   It’s lasted 3 days so far and caused widespread travel disruption closing roads and forcing train and bus operators to cancel services.  We don’t cope well with the winter weather; I get a bit embarrassed when I think about how some countries cope with months of ‘proper’ snow and drifts without a single sensational headline.

Sadly however there have been a few deaths caused by the winter weather so here is my guide to coping and maybe even thriving.

  1. Keep warm. Very obvious one to start with.  If you have to go out, spend a few minutes preparing what to wear.  To stay warm in this weather you need to keep dry, nothing cools you down like being wet (just think how lovely it is to jump into the pool on a scorching holiday in the sun and how effectively it cools you).  A suitable layer next to skin can help to move any sweat caused by exertion away from your skin so it stays dry.  Nothing feels more uncomfortable than a cold, damp tee-shirt against your skin.  A few layers then to keep hold of layers of warm air near your body and stop your heat from convecting away into the winter’s day. On the outside, a good waterproof layer.  If possible, a modern, breathable waterproof is best, lets the aforementioned sweat get out while still keeping the rain or snow out. Top the outfit off with a hat.   It used to be thought that 40-45% of body heat is lost from the head.  Modern sport science experiments have disproved this but you still lose approx 7% so a hat will make a difference.
  2. Check the news reports for advice on what the roads you’re planning to use are like. If the police are saying not to risk them then it’s probably best not to.  They’re not being spoilsports but are trying to prevent you from being yet another car they have to get towed from a ditch or snowdrift.
  3. If you do have to drive anywhere, prepare. Assume you will be delayed, possibly for a few hours.  Take spare warm clothes, even in your car it can get very cold out there if you’re not moving.  Make sure your mobile (cell) phone is charged or that you have a charger for it in the car.  Take a snack or a drink.
  4. If you’re on regular medication, consider taking it with you then in the worst case if you are delayed by several hours you won’t miss a scheduled dose.
  5. You don’t need to panic buy. In the UK bad weather only normally disrupts things for a couple of days at most.  If snow storms are predicted (and we do normally get a couple of days notice) then just make sure you’ve enough of the basics to last (don’t forget the wine and chocolate!).
  6. Make sure your neighbours are ok, especially the elderly. It may not be as easy for them to get to the shops in foul weather.

 

The local police have found the snow helpful.  One burglar was caught when the officers followed his footprints from the crime scene to where he was hiding.  A cannabis ‘grow house’ was found when it was noticed that it was the only house with no snow on its roof at the height of the storm.  The heat required to grow the plants in the loft had melted it as it landed.

So there you have it.  As always, though, at times of adversity, human goodness tends to shine through.  There are lots of stories of people volunteering to help stranded people providing food warmth and shelter.  Farmers and 4 wheel drive owners have been helping to tow stuck cars.

Keep warm and safe.

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!!

Collapse in the street

I’ve just noticed that most of my anecdotal blogs seem to end in tragedy.  Just so people don’t get the wrong idea about me and my paramedic skills I thought I’d include this one which has a HAPPY ENDING!

It was a Saturday afternoon, Tony and I were just over half way through our day shift.  Through the morning we had drifted further away from our normal area and were in a neighbouring town.  We were on our way to the next emergency when a category 1 emergency jumped the queue and was passed to us – a 45 year old female had collapsed on a street and was in cardiac arrest.  Luckily a bystander who saw her collapse was first aid trained and recognised cardiac arrest and started CPR immediately while other bystanders called 999.

It didn’t take long to get to the general area, a pedestrianised street of shops on the edge of the town centre.  We were lucky; the lady had collapsed conveniently near an access road so we could get the ambulance near.  As we arrived a response car arrived too, a local paramedic, Steve got out joining us.  We took a mixture of our and Steve’s equipment to the pavement where the lady, Amy, was lying on the pavement with a first aider, Carol, doing CPR.  A local shop keeper had thoughtfully brought some screens out and arranged them round Amy to give some privacy.  I asked Carol to continue with chest compressions while we prepared our equipment.  Tony connected the Bag-Valve-Mask (BVM) device to an oxygen cylinder. A BVM is a rugby ball shaped rubber reservoir connected to a face mask.  The mask can be placed over the patient’s mouth and nose, then the reservoir is squeezed and this forces a lungful of oxygen-enriched air into the patient’s lungs.  He inserted a basic airway into Amy’s mouth, a small plastic tube which prevents the tongue from blocking the airway and took over the job of breathing for Amy as carol continued chest compressions to keep the blood circulating.  Steve and I were preparing the defibrillator – we placed 2 large, sticky gel covered electrodes to Amy’s chest.  We could monitor Amy’s heart through these and, if needed, deliver electric shocks.  In the old days we had 2 manual paddles which we had to coat with gel and hold against the chest while we analysed the rhythm and delivered the shocks. The stick-on pads are much more efficient and safer to use.  Amy’s heart rhythm was not one which would benefit from an electric shock (she was in Pulseless Electrical Activity (PEA)).

At this point we decided to move Amy to the ambulance.  We used a ‘scoop’ stretcher (a long board which splits long-wise in half so can be fed under the patient from each side and clipped together with minimal movement of the patient) to pick Amy up from the floor onto our stretcher (gurney) and then onto the ambulance, all the while continuing with chest compressions and breathing for Amy.

On the ambulance Tony took over the chest compressions (Carol the first aider was exhausted by now).  I moved to the head end of the stretcher to monitor Amy’s airway.  She had a basic airway protector in but I intubated her to fully protect her airway.  This involves putting a tube (Endotracheal tube (ET)) into the top of the wind pipe (trachea). The ET has a small balloon around the outside which once in situ in the trachea this is inflated to seal the airway and prevent vomit or other secretions getting into the airway and lungs.  Once this was in place we attached a mechanical ventilator to the projecting end of the ET.  The machine now takes over the breathing for Amy. While I was intubating, Steve was finding a vein in Amy’s arm and had cannulated.  We could now give drugs directly into Amy’s blood stream.  During resuscitation we give the drug adrenaline (also known as epinephrine) every 3 to 5 minutes.  This circulates round the body and causes surface blood vessels to constrict so all the blood is concentrated to the major organs.  We also give fluid, water with salt dissolved in to the same concentration as in the body.

During this activity I thought I noticed a slight flicker of movement on Amy’s face.  This can be a normal part of CPR, we compress the chest quite vigorously and this tends to move the whole body but as I did a pulse check I was excited to feel a pulse on the side of Amy’s neck.  We stopped the chest compressions immediately and checked Amy’s baseline observations.  Now the heart had resumed its duties in driving the blood around Amy’s circulation her baseline observations were surprisingly normal.  Her heart was beating at a normal rate, her ECG (trace of her newly started heart) looked surprisingly normal too. Amy’s blood pressure was good, she was still unresponsive and not breathing for herself but things were looking good.

This was the time to get to the local hospital.  Tony gave the hospital a pre-alert call via our control room so the staff would be ready for us and have time to prepare for us.  During the short drive to hospital I sat with one hand on Amy’s neck feeling the pulse.  She still wasn’t breathing for herself but the ventilator was breathing for her.  We transferred Amy to the care of the Emergency Department staff and then began to tidy up and make a list of the equipment we needed to restock (over a well earned cup of coffee).

Over the next few weeks we were happy to hear that Amy progressed from Intensive care to a general medical ward and was finally discharged to home having made a complete neurological recovery.   The key to Amy’s survival was the immediate good quality CPR provided by Carol, the first aider.  No amount of work by us will resuscitate a person who has been down with no CPR for the 5 minutes or more that it takes us to get to the collapse.  I can’t stress enough the respect I have for first aiders and feel that everyone should learn basic CPR – it really can make the difference between life and death.

Male on the road – no sign of life.

Warning:  contains material some might find distressing.  No happy ending.

It was a cold and rainy early morning in winter.  Tony and I were looking forward to the end of our night shift.  The shift had been busy with the usual routine type of emergencies – nothing too taxing for us.  We were on our way to the last job of the shift, a category 2 emergency – an 83 year old male who had fallen while making an early morning visit to the bathroom.  With a bleep on the data pad our plans were changed.  We were passed a category 1 emergency – immediately life threatening.

It was a report of a male lying in the road outside a bar; the caller didn’t want to get too close but was unsure if the male was alive.  It was about 6am, most bars in this area had closed hours ago so it was unlikely to be a drunk sleeping it off.  We were only a few minutes away so we would know soon.  We arrived at the bar and stopped.  We looked around but could find no trace of any male lying in the road.  Two police cars arrived shortly after us and started to look around the immediate area as Tony contacted our control room (EOC) to ask for any further details about the location.  We were both thinking that this was after all a case of a drunk male who had miraculously come back to life and wandered off before we arrived.  The message came back from EOC that the man was a few hundred yards further along the road, hidden from our view by a hill.  We jumped back in the ambulance and set off.  As we got to the crest of the hill we saw our patient.  He was lying on his back in the road with just his feet on the pavement.

We didn’t know his name, I still don’t know what his name is as I write this but I’m going to call him Jack.  This is to make the account personal and to honour the human being.  In the medical reports and police statements I referred to him as ‘the patient’ or ‘the male’.  This feels horribly impersonal and makes us forget that this is a person with a life history who has family and friends who love him.  This is for Jack.

We parked near Jack, using the headlights to provide as much light as possible on this dark rainy morning.  The police had already blocked the road in front of and behind us so at least we didn’t have to look out for cars speeding past inches from us.

I grabbed the first response bag and walked to Jack.  We rarely run, that’s when you miss things and risk having an accident yourself or further hurting the patient.  As I approached I was taking in the scene, trying to get an idea of what had happened. It was hard to see in the dark but I could see a quite large amount of blood on the downhill side of Jack’s head – obviously a head injury which was bleeding profusely.  He was fully clothed against the winter weather so it was hard to assess any other injuries.  He looked about 45 years old.  I knelt by his head to quickly assess.  Jack’s mouth was open and was full of blood so his airway was totally blocked, he was obviously not breathing and I couldn’t feel a pulse in his neck.  He was in cardiac arrest (No heartbeat and not breathing).  As I was assessing him I noticed that Jack was still quite warm.  Since he was lying on the road in the rain I knew he hadn’t been down very long.

This was decision time.

We don’t automatically try to resuscitate every cardiac arrest we attend.  Some are beyond all hope of help.  Medical cardiac arrests (caused by medical emergencies such as heart attack, stroke etc) have a slightly better chance of survival.  Studies indicate that recovery rates range from approximately 36% to 3% depending on the presenting heart rhythm, assuming immediate resuscitation attempts are made at the time of collapse.  This was a Trauma cardiac arrest (caused by trauma = physical injury).  Studies show that survival rates from traumatic cardiac arrests are 6% at best.  Certain injuries are deemed to be unsurvivable and if a patient has an unsurvivable injury we don’t attempt to resuscitate. If we decide resuscitation is viable and we start, trauma resuscitation guidelines advise that the resuscitation attempts should continue as the patient is transported to a specialist trauma centre.

The decision we had to make was: did Jack have a survivable or unsurvivable injury?  We couldn’t take long over this decision – if, after a prolonged examination we decided his injuries were survivable we would have killed him by delaying resuscitation attempts.

I decided we couldn’t say his injuries were unsurvivable here in the dark and rain on the floor so I decided to start working on Jack while we moved him into the ambulance for a closer look.  A police officer was ‘volunteered’ to do chest compressions then my next priority was to clear his airway.  Tony had brought the suction unit so I could use a tube to suck the blood from his mouth.  As soon as I cleared his airway it refilled with blood.  I decided to intubate as soon as possible.  I do this by kneeling above his head and use a laryngoscope.  This has a blunt blade at right angles to a handle with a bulb on it.  By using it to lift the tongue and lower jaw gently up I can then see the vocal chords – the structure at the top of the trachea – the windpipe.  After a last attempt to suction the blood out of the way I inserted an endotracheal tube (ET) through the vocal chords and into the top part of the trachea.  The ET is about 10 inches long and the end of the ET which sits in the trachea has a balloon on the outside, I inflate this and this seals the trachea, blood in the mouth can no longer block the airway.  The other end of the ET is projecting out of Jack’s mouth and by connecting to a ventilator we can breathe for Jack.

By this time a second ambulance, an off-duty paramedic on his way to work and a senior paramedic in a response car had arrived.  Tony was organising them to get the equipment we needed to immobilise Jack and move him to the ambulance.  Under Tony’s supervision as I concentrated on protecting the airway and neck, a police officer continued chest compressions we immobilised and moved Jack into the ambulance.

In the ambulance where it was brightly lit (and warm and dry) we could fully assess Jack.  While still carrying on the resuscitation attempt, we cut all Jacks clothes off.  It was obvious that Jack’s injuries were severe; this wasn’t just a case of falling over and banging his head on the kerb.  Multiple fractures were now obvious throughout Jack’s body and his head injury was substantial.  As a team we sadly decided that continued resuscitation would be unsuccessful so we stopped.

This was a breach of our guideline.  If we decide not to attempt or to terminate resuscitation we’re not supposed to put the patient on the ambulance. Legally speaking, the site of a traumatic death is a crime scene until the police have ruled out foul play.  By moving the patient to the ambulance the ambulance becomes the crime scene.  Our managers frown on this.  In the debrief, the senior staff agreed that this was an exceptional case and I couldn’t have done anything else.  I couldn’t have said that Jack’s injuries were unsurvivable without a proper examination and I couldn’t do that in the dark on the road.  They all reluctantly agreed that they would have done the same.

I still don’t know what happened to Jack that morning.  His injuries suggested high energy impact, not just falling over.  One possibility was a hit and run RTC – the injuries weren’t typical of impact with a vehicle though.  The road where Jack died passes through a cutting in the hill with steep embankments about 60 feet high on both sides.  The most likely explanation was that he fell or jumped from the top of one of the embankment walls.

It was a sad, late and wet finish to our night shift.

Blogger recognition award

bogger-recognition-award

I’m thrilled and very grateful for being nominated for the Blogger Recognition Award.  I would like to thank Noel Hartem who blogs at https://noelliesplace.com, with views on life expressed in powerful poetry and prose.  I’m relatively new to the blogging community and it’s fantastic that a fellow blogger thinks enough of my writing to nominate me.

The suggestions for nominees are:

  1. Thank the blogger who nominated you, include a link to their blog.
  2. Give a brief description of your blog site.
  3. Share 2 or more pieces of information for new bloggers
  4. Nominate 10 other bloggers
  5. Comment on each blog telling them you have nominated them with a link back to your award post.

My blog, rustysiren, is a mixture of my experiences from 21 years working as a paramedic in a big UK city and random views on life.  My passion is mental health; that of the patients I meet and try to help and also the work-related mental health of my colleagues.

Advice for new bloggers

  1. Work on your writing to make your content readable, interesting and compelling.
  2. Blog about the things you are passionate about. Your passion and excitement will show through your writing.
  3. Enjoy your writing.
  4. Read and comment constructively on other blogs, enjoy the comments you get in return, it’s great fun!

Nominations

  1. Dr Perry at Make It Ultra.
  2. Rough Bandit.
  3. Elsie LMC.
  4. Damn Girl Get Your Shit Together.
  5. Merbears World
  6. Combat Medic
  7. On the couch
  8. Love,Nourish.Enjoy
  9. Brobeck at Homeless: Life on the Streets
  10. Emmanuel Rockan.

 

Gravity always wins!

It’s no secret and no big surprise but all aspects of the NHS in the UK are overstretched now.  The pressure is felt as much in the Ambulance service as anywhere.  The impression given by the media is that drunk and drug related incidents are the main cause.  We do get these jobs, of course, but in my experience these are not the most time consuming of our jobs.

My experience is that most of our jobs are elderly people unwell or falling.  NHS (in the UK) stats tell us that 1 in 3 people over the age of 65 will have at least 1 fall per year, about half of these fallers will have more than 1 fall.  At the end of the 20th century and start of the 21st we are living longer than our ancestors.  This means that the age range of the population is increasing and the proportion of elderly in the population is increasing.

With age can come weakness, balance problems and reduced co-ordination – these all contribute to the increased risk of falling.  The highest risk times for falling seem to be late at night and early morning.  Many of our elderly population seem to be prescribed medication to help them sleep at night this obviously leads to drowsiness and increased risk of falling when getting out of bed to visit the bathroom.

The consequences of falls in the elderly can be severe.  A common injury is a fractured ‘neck of femur’ (#nof (the hash symbol in this case is not a hashtag, it’s medical shorthand for fracture)).  The femur is the thighbone, the longest bone in the body.  At the top of the femur there is a ball shape which projects at an angle and fits in a socket in the pelvis forming the hip joint.  The portion of bone between the main shaft of the femur and the ball joint is called the ‘neck of the femur’ and is the weakest part of the whole bone.  With increasing age the bones can become less dense and more brittle.  If a person then falls and lands on his or her hip then this easily causes a #nof.  This requires surgery to repair with all the associated risks of surgery in the elderly and then a period of immobilisation in hospital (typically 6 weeks) followed by a period of physiotherapy.  Another common problem is a head injury – many elderly people are on ‘blood thinning’ medication (anticoagulotherapy).  In this case a trip to the Emergency Department is needed for a CT scan to rule out a bleed on the brain.

What do we do when we get to a fall?

First thing, as always, is to quickly assess airway, breathing, circulation and responsiveness.  Once we’re happy that the patient is alive and breathing we make them as comfortable and warm as possible on the floor while we assess their baseline observations and examine for injuries.  If there are no injuries and the patient is medically stable the next step is to get up from the floor.  If the patient is unable to get up themselves with instruction and assistance from us we use an inflatable cushion to lift.  When deflated, the cushion is flat and can be slid under the patient’s bottom (with some shuffling, leaning, sliding and under-the breath-swearing!).  Once in position we connect a series of pipes to a compressor and inflate the cushion.  The patient can then simply stand from sitting and we can assess his/her mobility.  If all is well, we can safely leave the patient at home (after we have completed the mountain of associated paperwork).  One further service we perform is to refer the patient on to a falls prevention team.  This is a multi-disciplinary team of people who visit the patient and get involved to try and prevent further falls.  This may involve physiotherapy to improve strength and balance, it may involve a review of possible walking aids with training in how to use them and it usually involves advice on lifestyle and adapting the home to remove or minimise trip hazards.

I’m not for one second suggesting that falls are not a genuine part of our job but falls do take up a lot of ambulance time.  What’s the answer?  I don’t know if there is an answer.  We are always going to be needed when elderly and vulnerable people fall.  I believe falls prevention plays a huge part in preventing repeated falling.  It’s a pity that you have to have a fall before the falls prevention team get involved; it would be good to see the falls prevention team’s roles increased so they could get involved with everyone as a certain age is reached to prevent even the first fall.

2018

It’s been a hectic couple of weeks so I haven’t had much time to blog.  I would just like to thank everyone who has read my stuff so far and everyone who follows me.  Things will get back to normal now and I aim to carry on publishing once a week.  I have a feeling that 2018 is going to be fantastic, let’s all make it great!

Best wishes to you all for a healthy, happy and content time.

Rusty.