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?

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….

The one job that still gives me flashbacks.

That one job…

Everyone who works in the emergency business has at least ‘one’ job.  You know the one.  The one which keeps coming back in your mind, even years after.  The one that can keep you awake at night and make you question every step of the job and every decision you made.

Mine was several years ago.

It was an ordinary Saturday afternoon.  Myself and my crewmate, Tony, had just cleared from a job.  We were at a hospital not on our usual patch.  To make the eventual comparisons more extreme we had just finished a job which had gone very well.  An elderly male had collapsed.  When we arrived we found he had collapsed due to a low heart rate.  We were able to quickly resolve this with a drug (Atropine) to the point where he looked 100% better, no longer pale and drenched with sweat, and was happily talking to us and his relieved family.  It was a happy family in the ambulance as we took him to the Emergency Department for follow up treatment.

We cleared the job and were passed ‘that’ job.

It was a report of a teenage boy who had crashed a quad bike on farmland.  This was before sat-nav or Google maps and was an area Tony and I were totally lost in.  I contacted the control room and explained we were unfamiliar with the area and asked for backup from any available local crews.  We were told there was no one else.  By now Tony had plotted the best possible route on the A to Z map book and I set off, blue lights and sirens on.  The farm was about 12 miles from where we were.

Soon after setting off we received an update from the control room:  The boy was in cardiac arrest (no heartbeat, no breathing).  His friend, who had called 999, was too distraught to attempt CPR by instruction from the call taker.  We were still about 10 miles away, relying totally on Tony’s map reading ability.  Any light-hearted banter immediately stopped and I started to feel that sinking feeling.

Miles passed and we were heading even further into the wilds toward the farm.  The roads were becoming narrower and bendier so against my desire to get us there I had to slow down – we needed to get there in one piece to be any possible use.  I made a turn as directed by Tony, concentrating on driving yet still mentally preparing for the job ahead, what equipment in what order to get from the ambulance.  The road became narrower; trees were closing in on us on both sides.  I started to doubt Tony’s choice of route, but then a police car closed in behind us, also with blue lights on, obviously heading to the same job, this reassured us both.  Not for long though.  The tarmac finally gave way to compressed mud, a steel bollard in the middle stopping any thoughts of pushing through.

A quick conference with the police officers and they managed to turn in the road and hurtle off to find another route.  I wasn’t so lucky, had to reverse until I found a spot I could turn round in then set off again with Tony sweating once more over the A to Z.  By this time control had found a local crew but asked us to carry on and back them up.

When we arrived the local crew were there and we could tell from their body language and lack of resuscitation activity it was not good news.

The boy had un-survivable injuries from his collision with a stone wall and was dead.  It would have been futile attempting to resuscitate.  By now his parents were there along with the parents of his friend.  Our job now was to try and support the families.  How exactly do you help someone who has just heard out of the blue that their child had been killed in an accident?  That area of our training was and is a bit sketchy.

Later on that day and following days my mind was flooded with the ‘what ifs?’  What if we had known the area and got straight there? What if we had picked a better route and got there earlier?  It goes on…

There was an internal enquiry, Tony and I were found to be totally blameless, anyone who didn’t know the area would have picked the same route we did and met the same steel bollard.  That reassured me a bit but still couldn’t stop thinking that would in no way help the family of the boy.  How does any parent get over the death of their child?

I was offered counselling by the service but foolishly declined – thought the best way to deal was to try and forget by just carrying on.  We even carried on working that day without taking any time out.

A depression settled on me which affected my whole family but still I refused counselling and any professional help.  Instead, once I actually realised there was a problem, I began a long process of self study and read many self-help books.

Many years have passed since that Saturday afternoon and I would say I have learned to deal with it.  It is still etched in my memory in a way that very few jobs are  (I normally can’t even remember details of jobs I did last week) but there is no sinking feeling or feeling of despair and guilt associated with the memory any more, just some residual guilt about the effect on my family.  Maybe the healing process would have been quicker with professional help; probably would have been less damaging to my family.  Maybe it was more thorough thanks to my long process of self helping, maybe all healing has to be done by yourself. Who knows?  I certainly don’t.  I feel strong now and able to cope with whatever the job throws at me, also able to help my colleagues by encouraging them to talk, talk and talk some more.  Talking bad jobs over with your work mates really helps you to put things in perspective and reassures you that your decisions and treatments were sound and that you did the best you could.  I would also strongly recommend anyone accepts the professional help offered.

I still wonder how the family are coping after all this time.