Child RTC – unknown if breathing

(SPOILER ALERT: To avoid undue distress this anecdote ends happily)

 

One Saturday afternoon Tony and I were passed details of a job: it was a reported child RTC (Road Traffic Collision – in other words the child had been hit by a vehicle).  Due to the panic of the caller and language differences, our call taker was unable to establish if the child was breathing, responding or conscious.  All we had was the street name and possible age, 7.  The street was not far away and we were there in minutes.  On the way we were both apprehensive and anxious.  There’s something about an unwell or injured child that that I dread. I think that every emergency worker feels the same – it’s just so heartbreaking when a child is harmed or killed and even after 20 years I feel very scared when a child’s well being and even life is in my hands.

I turned the ambulance onto the street, blue lights still flashing, and the sense of dread increased.  A large crowd of people were standing in the street and on the pavement.  As soon as we arrived members of the crowd started waving and shouting at us.  At this point we couldn’t see the child through the crowd.  We got out of the cab and the shouting got more frenzied as people tried to rush us.  Tony got the response bag (a large rucksack which contains most of the equipment needed to start treating almost every conceivable emergency) out of the side door and we started to walk toward the area of the crowd that we were being jostled towards.  People sometimes think that ambulance staff are too casual and slow when approaching an emergency, they expect us to run.  During training it is emphasized that you should never run – that’s when mistakes are made and injuries happen.  We are trained to take a calm, measured approach and observe as much of the scene as we approach to evaluate and minimise any dangers to us, the patient and any bystanders.

We pushed through the crowd and finally got to the young boy, Bilal, who was lying on the street on his side with his mum cradling his head and sobbing and praying.  A multi-person-vehicle (MPV) was parked a short distance away with a large, obvious dent in the front where it had collided with Bilal.  We had to gently get Bilal’s mum to let go of him so we could roll him onto his back so we could protect his neck and assess his breathing and circulation.  Tony gently held Bilal’s head in neutral alignment so his spine was in its natural position and to our relief we saw that he was breathing and had a pulse, both were in the normal range for his age and there was no obvious difficulty with breathing.  His blood pressure was normal for his age. A man came forward and introduced himself as Bilal’s uncle, Ash, who offered to interpret for us as Bilal’s parents spoke very little English.  Tony knelt on the floor holding Bilal’s head in neutral alignment, also protecting his airway and explained to Bilal’s parents, via Ash, what we were doing and what we needed to do.  I tried to clear some space around us by shepherding some of the crowd away onto the opposite pavement.  I went to the ambulance to get the equipment we needed: a rigid collar to help immobilise Bilal’s neck, scoop stretcher plus padding to fully immobilise and various straps and a blanket.  As soon as I started back to Tony and Bilal the crowd had resumed their position in a tight circle around them.  I forced my way in with the equipment and Tony and I began the delicate task of immobilising Bilal so we could safely move him from the floor to the ambulance and then on to the Emergency Department.

Bilal had a large swelling above his right eye from his collision with the MPV and a swelling to the back of his head which had a small laceration on it: as with all scalp wounds this had bled profusely.  His level of consciousness was reduced from normal and was constantly changing.  He would be restless and agitated crying in pain then lapse into a quiet phase then return to the restless phase. We tried to apply the rigid collar but he became very agitated, fighting us off.  We made the decision to compromise and leave the collar off.  Although this was reducing the immobilisation of his spine this was one of those cases where it’s better to leave the collar off and keep the patient calm than try to keep the collar on and have the patient agitated and restless – probably doing more damage to a potentially damaged spinal cord.  We managed to get Bilal on the scoop and place the padded head blocks and body straps on without disturbing him too much, and moved to the ambulance.

In the ambulance we settled Bilal’s mum and uncle Ash and closed the doors so we could work in relative quiet.  We rechecked all Bilal’s vital signs and checked him thoroughly from head to toe.  His main injuries were the swelling above his eye and the laceration to the back of his head.  There were several other superficial cuts and abrasions on his elbows and his back.   His pupils were equal size and both reacted when a light was shone into them.  If one or both pupils became dilated and stopped responding to light that would be a sign that there was internal swelling in the brain.

Before we left the scene we had a quick word with the driver of the MPV and some of the witnesses, they all said that he had been driving along the street at about 25 mph when Bilal had run out in front of him giving him no chance to stop.  Bilal had been knocked to the floor and had been completely unresponsive for a few minutes before recovering to the agitated state he was in now.

We set off to the ED of the local hospital with no further delay (this was before we had specialist trauma centres).  As we set off we asked the control centre to pre alert the hospital so they were waiting for us as we arrived.

The rest of the shift carried on as normal but both Tony and I kept dwelling on the job, analysing everything we did and wondering if we should have done things differently, if there was a better way to have handled the job.  As always, I had a vague sense of guilt that I had not done enough for Bilal, although I couldn’t put my finger on anything specific.

A few days later we checked and were relieved to hear that Bilal had made a full recovery and was discharged home.  A happy ending this time, hopefully in future he’ll be more careful on the roads!

Mental well being

Hello.  It’s a lovely, sunny, Friday morning – just before a bank holiday weekend.  The sort of day that has us all feeling great, full of energy and excited and glad to be alive.  Right?

Unfortunately for many people, even a lovely Friday morning does not bring with it feelings of well being.  The Rusty Siren Statistics Department has researched a few unsettling facts and figures:

7.8% of the UK population satisfy the criteria for diagnosis of depression and/or anxiety.  That’s approximately 468,000,066 people in the UK who won’t be enjoying this lovely exhilarating Friday feeling.

In 2015 (most recent stats I could find) in the UK, 6188 people took the irreversible step of death by suicide.

Specifically to the UK Ambulance service, 91% of staff has admitted to experiencing stress and low mood.  91% of us. That’s such a high number it surprised me so I had to say it twice,   and that is just the ones who admit to it, the true percentage is probably even higher.

The effects fan out through the population, every ‘statistic’ above is a person.  People have families, friends and people who love and care about them (I hope!).  Obviously all these people also will experience a lowering of mood and increase of anxiety as they see the ones they love suffering.

What’s the answer?   There’s no simple, straightforward answer, I wish there was.

If you or someone you know is thinking about suicide then immediately go to your local hospital Emergency Department for an emergency assessment by the mental health team.

If depressed or anxious but not thinking of suicide then get an appointment with your GP as soon as possible to discuss a plan.  Meanwhile find the people you can trust and have a good talk with them about what is bothering you.  If you find it hard to talk to people (I know what that’s like, I find it nearly impossible!) then a good first step is to write it all down in a private journal.  Writing it down is an excellent way of clearing your mind and sorting your feelings out, then if you still find it hard to talk to your trusted friend you could start by getting them to read what you’ve written to start the conversation.

In an ideal world, once you’ve seen your GP you will be on a tailored plan to help you deal with your feelings and find a way to process them to get you back to a state where you can enjoy life and function once more.  Unfortunately we’re not there yet so it may be necessary to take steps yourself to get help.  Lots of resources are available on-line, two good sites to start off with are:

www.mind.org.uk

www.samaritans.org

Specifically for emergency service workers:

www.mind.org.uk/bluelight

These sites and the resources they link to suggest ways to improve mental well being and provide mental well being tips.

The most important thing is to be able to talk about mental health, and to finally obliterate the residual stigma associated with mental health.  Mental health problems are NOT A SIGN OF WEAKNESS!  The help is available we must all be willing to ask for it when we need it.

I wish you all a happy and safe weekend.

 

PTSD in the ex-serviceman.

Late one evening on a night shift I was called to a report of a male who was ‘feeling suicidal and unable to cope’.  We were also told that the man was known to the police for violent outbursts.  The police were not attending unless we asked them to after assessing the patient as they felt that their presence provoked him.

These jobs still make me apprehensive, who’s to say that the gent would not be equally provoked by my mate and me?  To some people a uniform is a uniform whether police, ambulance, fire, prison service, all symbols of a despised authority.  Let’s hope he wasn’t like that.

I approach all threats carefully, that is drummed into us from day 1 at training school: be aware of the surroundings, possible escape routes and hope that my calm friendly nature will diffuse any tense situation.  When all else fails, drop the gear and run! As I say to my mate, you don’t need to outrun the aggressor, just your crew mate!  Unfortunately he is younger and quicker than me.

We arrived and I knocked on the door, heavy response bag on my shoulder.  There was no answer.  My mate quickly asked for an address check to confirm we were at the right place as I knocked some more.  Once we knew we were at the right place I tried the handle, it was unlocked.  In these situations where there is a reasonable suspicion that a person is in danger or come to harm we are allowed to enter without a specific invitation.

I walked along the short hall, shouting ‘hello, ambulance’ over and over as I went and generally making noise so I didn’t accidentally sneak up on and make a volatile person jump.  As we went past the kitchen and a bedroom we put the lights on and checked each room.  All the horror films I have ever watched seemed to flood my mind with images of killers jumping out on the heroes from a darkened room.  This is definitely not the time to have a vivid imagination.

I went into the last room off the hall and saw the man, Alan (name changed for confidentiality), sitting on the sofa with his head down on his chest.  From the door I could see he was breathing, the rate was normal and his complexion had a normal, healthy appearance.  From a physical point of view I could relax a little, he didn’t appear immediately at risk.  I shouted ‘hello’ again and his head snapped up.  He looked startled but didn’t make any immediate moves so I introduced myself and my mate.

“What the **** are you doing in my flat?”  He shouted.  I explained we had been asked to come see him as the police were concerned for his welfare.  He admitted he had spoken to the police on the phone about a long running problem with his neighbours, he couldn’t remember but thought he probably had said if they (the police) didn’t ‘get off his back’ he would kill himself.  He seemed to calm down a little so I asked if we could talk and see if there was anything we could do to help.  As I glanced round his room I saw empty lager cans on the floor but no obvious weapons within easy reach.  On the shelf were a photo of him in an army uniform and several items of military memorabilia.

He started to tell me that he was alcohol dependant (must have seen me look at the empties) and that it was the only thing helped him damp the horror of some of his memories from the army.  We discussed counselling and Alan said he had some and it was good but after 5 sessions he had been told that was all the funding would allow and could have no more.  His GP’s answer was to give him medication to damp his emotions, presumably for the rest of his life as there didn’t seem to be a plan to get at the root cause and help him deal with it.

I would like to be able to say that we had a calm talk and I came up with a care plan which would lead to a happy ending.  I would really like to be able to say that.  However…back to the real world…at several points during the chat Alan became very aggressive and threatening to me.  Alternating between tearful remorse and shouting threats “Who the **** are you to judge me? What do you ******* know?”  I find this hard to deal with.  For one thing I never judge anyone, I’ve lived long enough to realize you can never tell what another person has been through and just accept that they are as they are.  It was quite scary too, thought I might have to run for it a few times, luckily for me at the height of the aggression the tearful recrimination phase took over.  I have a great deal of respect for anyone who serves in the armed forces, I’m aware that I’m able to sit here typing my opinions because people in the armed forces have suffered and sacrificed to protect this lifestyle.  I’ve never been in the armed forces so in that respect Alan is right: what the **** do I know?  This is a kind of dilemma for us: if a drunk assaults an emergency worker who is trying to help him then he is quite rightly reviled and we feel justified, obliged even, to press charges.  If, however, an ex military person assaulted me I would feel guilty about pressing charges, after all he acquired the PTSD serving his country.  Thankfully it has never come to that yet.

The best we could do for Alan that night was refer him to the out-of-hours GP service and ask them to refer to his own GP and ask for a review of his needs.  Far from ideal but the best plan we could come up with due to the late hour and his refusal to come to hospital for an emergency review.  Hope things work out for him but the chances aren’t good.

There was no time to dwell; the next job was waiting for us as we cleared….

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.

All in the mind????

 

Quite a common job to respond to is ‘suicidal person’ or ‘person threatening suicide’.  What these jobs boil down to is a person who is struggling to cope with their life and have reached a point where the pain is so bad they need to escape it.  The situation can be anything.  To a person not involved in that person’s life may not seem that serious or it may be so bad it leaves you thinking ‘how the hell have they survived so long’.

Our training as ambulance people in mental health is limited and the only options we have to help them is either take to a local hospital Emergency Department for review by the mental health team or in some cases, in some areas we can refer directly to mental health teams.

Often the ambulance person can feel a little awkward, displays of raw emotion by a stranger are a little daunting and a lot of us feel embarrassed and unsure how to respond.  I’m always scared of saying the wrong thing and making an uncomfortable situation even worse.  It may be that I’m a middle aged male, brought up in the 60s and macho 70s but I definitely feel awkward.  I’m glad that times seem a little more enlightened now and high profile celebrities, even the younger members of the royal family have made it ok to be emotional and talk about negative feelings.

It seems to me that one thing that all these people have in common is that their minds are trapped in a negative loop or set of thoughts.  Mine used to be very negative; I’d often be set off down a negative, bitter chain of thought and would get really down and anxious.  Then the anxiety and low mood would feed the thoughts and a vicious circle was set up.  I’ve been through normal, modern life experiences, divorce, young children and death of loved ones.  I’ve never been for formal counselling, I think with hindsight I should have, it may have speeded up the journey to where I am now, relaxed, grateful and content with life.

Instead of professional counselling I have spent a lot of time reading and researching the self help field.  The things which have helped me most are:  Cognitive Behavioural Therapy (CBT).  The main things I’ve got from this are that the thoughts you are thinking may not necessarily be true or accurate.  I have got myself into the habit of questioning my own thoughts if I find them negative.  Mindfullness.  This is something I am very much still getting to grips with.  Observing my thoughts as they occur and not getting bogged down with them.  I practice staying in the present moment as much as possible.  The past is gone now and can’t be changed.  Mistakes can be learned from but best not dwelt on.  The future can be planned for but the only place we can do things is now.  Here.  I find I can always cope with what is happening now; I only get overwhelmed or stressed if I try to think too much about what will happen in the future.  Gratitude.  There’s a horrible phrase: ‘attitude of gratitude’ which sounds awful but does make a lot of sense.  I find it helps me by regularly thinking about things I’m grateful for, it helps me put things in perspective and actually spending time thinking about things and people I love really puts me in a happy mood.  Exercise. The benefits of exercise are well established in the field of mental health and it really works for me.  I’m not a fan of gyms; I love to get my exercise in the fresh air.  As well as the benefits of endorphin release with exercise I find that walking or running also has an extra benefit, the rhythmic slap of my feet on the floor is soothing and slows my mind down.  Fun with Friends.  Another no brainer.  Making time to have fun with a few good friends really has got me through some hard times in life and is something I thoroughly recommend.

Being told to ‘cheer up’, ‘get a grip’ and ‘it’s all in your mind’ definitely do not help!

Back to our patient who is feeling suicidal.  All I can do for him/her is talk to them and encourage them to accept the help that is on offer.  This can take a long time as quite often the last thing the patient wants is to sit for ages in a busy emergency department.   I find it frustrating at how limited my own personal scope is to help them, for these jobs I’m just a friendly taxi driver.