Dog

I find it fascinating how there are so many dogs in London.  And I find it equally fascinating that the main type of dog appears to be some form of Pit-bull/Mastiff cross breed.  Lots of young people have these types of dogs and they are often used in gangs and/or as a status symbol.

Also, it never ceases to amuse me how, when we arrive at certain jobs there’s always a rabid pit-bull cross-breed going nuts behind a baby cage barrier with foam spewing from its jaws and a hint of recently eaten human flesh hanging from its teeth.  I guess its not so much the cliche of arriving and finding the dog so much as listening to the mum trying to convince us that their little puppy is harmless – all the while smoking away at ten Superking Lights whilst her twenty three kids poke the dog with sticks.

I have a very distinct and healthy fear of dogs that aren’t cared for properly.  And this fear was heightened on one such job.

We were called to a thirty year old male collapse ?cause (query cause).  Upon arrival we were presented with a homeless man asleep in the front alcove entrance of someones flat.  The “someone” turned out to be the epitome of a ‘shoreditch trendie’, who, finding this person asleep in their doorway decided to call an ambulance to ‘sort out his problem’.

To make matters complicated, the homeless gentleman was being stringently guarded by a large white pit-bull/mastiff cross breed.

An approached the homeless man cautiously using newly acquired dog-whispering skills he’d seen from TV.  After some initial growling and potential throat ripping moments (to which the fast gathering crowd of onlookers had their camera phones ready to record) the dog allowed the FRU to touch the patient (there was clear dissapointment from the crowd).  After a few ‘pain responses’ the patient came round and was very apologetic for wasting people’s time.  He admitted being drunk and inevitably said that his dog was “harmless and wouldn’t harm anyone”.

I approached and knelt down beside the FRU and the dog became more submissive.  Relaxing more, we then started giving advice to the homeless man, who did not want to go to Hospital.  I gave him one of the thermal blankets we carry on the truck and started explaining how they work.  Mid sentence, and without warning, the dog lept forward and sunk its teeth into my inner thigh.  Yelping, I lept to my feet.  I confess my initial thought was not of trying to calm the dog but simply one of planting a size 11 steel toe cap boot to the dog’s head.  Thankfully though, the dog had already shrunk back underneath the homeless man’s arm – not for the dog’s health but simply because I would have got it wrong, missed my kick, slipped over and would probably have been mauled to shreds in retaliation.  The homeless man was now desperately trying to convince us not to take his ‘baby’ away and that this wasn’t something it would normally do.

I stormed off to the Ambulance, shut myself in the back, dropped my trousers and inspected my war wounds.  There were two neat vampire like puncture wounds roughly three inches apart and probably two inches from my private parts.  Quickly summising that I wasn’t going to die I relaxed a little.

My crew mate joined me in the back to see if I was ok.

“You see that?”
“Yeh, and I know why it happened too”
“Why?”
“We’d told everyone to keep back but that trendie’s bag was just behind you.  He didn’t pay any attention to us and just jumped forward to grab it.  It must have startled the dog and you being the first thing in its firing line . . .”  She shrugged her shoulders and laughed.

I stayed in the back to calm down – for fear of feeding the trendie to the dog!

The homeless guy was moved on and the trendie, without a word of thanks to anyone, gained access to his flat.  We went off the road to get a quick check at the hospital and then back to station for a cuppa.

Of course, everyone wanted to know what had happened, so, by the time I’d recalled the story a few times it had grown to being a pack of Pit-bulls, a gang of youths – with guns, a small child that I protected in the ensuing battle and eventually me fighting for my life . . . “but I don’t want to talk about it – I’m just doing my job”.

They all listened and when I’d finished, the more experienced medics just looked at me, smiling gently and said, “Bless” before going back to their more interesting conversations.

Binder

“Fast Response Unit”. Single manned cars which speed around the city getting to jobs (generally) faster than the ambulance crews – thus beating ORCON times and being able to treat patients faster. There is something mildly satisfying about reaching the patient before them.

Reaper

Working in the ambulance service you are presented with all manner of problems and conditions.  Some are outright ridiculous (of which I am sure to write about at some point), others are way beyond our meagre training.  And then there’s the ones that fall within our skill range but don’t quite present in a “standard” way.  But, no matter what the job is or how it is presented, we are the front line staff that have to deal with it.  And deal with it we must – and sadly, we can’t always deal with things in a conventional way . . .

I recall one of my first cardiac arrests and remember it falling into the catagory of the latter points above.  I was working off complex and wasn’t long out of training.  To make matters more interesting, we were using an old run down LDV for an ambulance.

We had been called to a seventy year old gentleman who had chest pain.  Arriving at the same time as the FRU (even more satisfying in an LDV) we approached the front door which was being held open by a little old woman on crutches.

“He’s just in the back room – but he’s not talking now”  She told us as we edged passed, kit bags in hands.  I could see the man in the back room sitting with his back to us on the edge of the bed.  The flat was tiny and full of bits and pieces of personal belongings that had been accumulated over the decades.  I could barely move through the hallway so god knows how the little old lady managed on crutches!

We picked our way through to the bedroom where I placed the kit bags down and edged my way round to stand in front of him.  He looked sick.  Big sick.  His eyes were shut, sweat was pouring from him and he had a deathly pallor.

“Hello sir, can you hear me”
Nothing.
I went straight for the carotid pulse on his neck and as I touched him he drew in one last deep breath and released it slowly – almost typically like you’d expect in a film.  And then nothing.  No pulse and no breathing.  I quickly glanced passed the patient to the others and shook my head.
“Is he going to be ok?”  The little old lady asked looking round from behind the FRU.
“Come with me love and lets get some bits and pieces together to go . . . ”  The FRU led  her through into another room and out of the way.

The room was tiny.  There was barely twelve inches between the end of the bed and the wall and the only reason the patient was sitting up was due to the ridiculous softness of the bed. There was no chance of starting CPR here let alone doing advanced life support with three of us round the patient.  In that split second we knew what we had to do . . . we had to get him to the ambulance to work on as quickly as possible!

Moving a patient who weighs over 16 stone with no muscle tone, covered in sweat is no easy task.  Throw into the equation a bed seemingly made from jelly and a home full of clutter and your task becomes bordering hysterical.  With arms and legs trailing we managed to get the patient onto the chair and out of the flat. Racing to the ambulance, one of the patient’s feet slipped off the foot bar and jammed between the pavement and the chair almost catapulting him into the road.  Thankfully, we’d buckled him in and I was able to spin around in one fluid motion and drag him backward to the ambulance.

At the same time, a relative arrived and was able to take over looking after the little old lady.  This was a god send to us because once we got the patient onto our bed things quickly went from bad – to worse.

I yanked the BVM from the the oxygen bag in an attempt to do manual breathing for the patient, but the tubing got caught on the wheel of the bed, ripping the back of the BVM off in one swift motion.  In an instinctive action I reached up above me and opened a cupboard to get another one. My crewmate’s frantic driving had caused everything in the cupboards to pile up against the back of the door so when I did open it everything fell on top of me and the patient.

I connected the new BVM to the mainline oxygen and started “bagging” the patient.  Within seconds the oxygen stopped flowing!  Desperately I looked at the gauge and saw that it was empty.  Ok – all I need to do is switch onto a new bottle by pulling the lever.  I did this so violently the lever broke off in my hand.  Holding it aloft I stared at it, whimpering.
“Get a new bottle!”
“Where?” I sobbed.
“THERE!”
My crew mate pointed to another cupboard and pulling it open I was able to retrieve another bottle.  Whilst I did this my crewmate and the FRU were busy dealing with their own mini disasters.  In his efforts to intubate the patient the FRU had spilled the contents of his bag across the ambulance floor and was frantically trying to organise himself.  My crew mate had started compressions but the de-fib machine had fallen off the patient down behind the bed yanking one of the wires off the pads.  He was now trying to peel off the old pads so he could put new ones on.

Eventually the patient was intubated and we were able to administer oxygen.  And, miraculously, the patient was in VF – a shockable ryhythm.  My crew mate held his hand up to us both.

“Stand clear! Oxygen away, top, middle, bottom, shocking patient”

When my crewmate pressed the “shock” button two things happened at once.  Firstly, the de-fib machine was flipped off the patient dropping behind the bed, again ripping off the leads to one of the pads.  Secondly, the patient’s arm flung upwards knocking the BVM out of my hand and onto the floor.  Instinctively, both the FRU and myself went to pick it up and bashed our heads together.  There was much cursing all round.

“Right!  I’ll drive!”  The FRU jumped out the back and into the drivers seat and got us going.

He didn’t hold back in getting us there quickly either.  By the time we arrived at the hospital, the contents of half our cupboards lay strewn across the floor and the patient.  We rushed him into resuss where the FRU gave the briefest of handovers and then we stood back to catch our breath and let the hospital do their job.

We were knackered!  But stood on to watch for the outcome.  The patient remained in VF for a long while and the consultant ended up recruiting a group of trainee doctors to take turns in doing CPR.  The first did fantastic compressions and appeared really keen.  Sadly, he was wearing a shirt, tie, cardigan and a jacket and within seconds was covered in sweat.  The FRU started chuckling and called over to him.
“Good compressions there son – but I bet you won’t be wearing all that clobber next time you come in eh!”

Next up was a short young round lady who had to stand on bed steps to reach over the patient.  The moment she started her compressions we all cringed.  Three ribs went in one go and it almost appeared as if the patient was folding in half with each compression.  She was practically jumping up and down on the poor man’s chest and the fierce look of determination suggested years of pent up aggression.

The FRU turned to us and whispered, “If he wasn’t dead before – he is now”.

We stayed in resuss to help in anyway we could but sadly the patient was pronounced dead about ten minutes later.  Afterwards we went back to the ambulance to complete our paper work.  Opening the back door an empty oxygen bottle rolled off and onto the ground.  We stared momentarily at the carnage laid before us and as one, burst out laughing.

A little later I handed some sweets round.  They accepted but took them cautiously, being mindful not to come into contact with me.  I looked at them quizzically and the FRU chuckled again.

“We saw what happened when you touched that patient.  You’re the Grim Reaper.  We ain’t touching you.”

Binder

Choking

I am training in South London at the moment.  It’s the last part of my course to become a fully fledged Paramenace and we’re currently learning how to deal with certain emergencies – one of them being choking.

I haven’t dealt with a real choker yet – its either been “not as given” or they’ve managed to stop choking by the time we arrive.  The latter still grants us a thank you from the patient and friends to which I often reply, “I’m just doing my job ma’am”.  I haven’t done anything but its nice to claim attention.

However, it did make me think of one incident that happened to a friend of mine, Mel*, a little while back . . .

They were called to a woman in her mid twenties, choking.  Upon arrival at the restaurant it conspires the woman in question ‘believed’ she was choking . . . her breathing rate was elevated and she was agitated.  However she was able to talk in complete sentences and was able to walk unaided to the ambulance.  At the end of each well articulated sentence she suddenly rememberd to concentrate on her agitation and “enhanced breathing rate”.

The medic attending, after doing all their checks and observations, came to the swift conclusion that this was not ‘time critical’ and, after making the patient comfortable on the bed proceeded with questions.

“So, you’ve got something stuck in your throat?”
“Yes” (puff puff, pant pant)
“Are you sure?”
“Yes” (puff puff, pant pant)
“Really?”
“YES!” (puff puff, pant pant)
“Do you have any medical problems?”
“No” (puff puff, pant pant)
“Are you taking any regular medication?”
“No” (puff puff, pant pant)
“Are you allergic to any medicines?”
“Penicillin” (puff puff, pant pant)
“Penis-all-in?”
“What?” (puff puff, pant pant)
“Penicillin?”
“Yes, Penicillin” (puff puff, pant pant)
“Strap-on!”
“What?!” (puff puff, pant pant)
“You need to put a strap on.  Over your legs.”

The patient did as they were told and then attempted breathing heavier and faster, motioning to their throat, “I think its getting worse” she said, “I can feel it in my throat, its a large lump of some sort – I can’t breath!!!” she pointed at her throat trying to get the medic’s full attention.

The medic, unmoved, stared enigmatically at the patient for a few seconds before turning to Mel, who was sitting in the drivers seat ready to go.

“Ok, ready when you are . . .”  The medic then turned to their paper work, scribbling details and generally using the form as an appropriate excuse not to engage with the patient.  The patient, somewhat perturbed by the disinterest of the medic, upped the ante and started breathing louder and faster, placing their hands on their throat to give the full hint of choking.  They even coughed loudly for effect.

They were in a brand new Mercedes Sprint Ambulance – which is slightly bigger than the older Mercedes Sprint.  And Mel, the driver, hadn’t driven one of the new Ambulances before.  This was a subtle problem that had been casually overlooked by the pair of them when they first started their shift.

Mel cranked the gears and reversed the truck out onto the main road.  Sadly, she missed the road and instead, managed to reverse the truck up and over one of the City’s cast iron bell-shaped bollards.

There was an enormous crash and the effect was sensational.

The patient was flipped out of the bed and onto the ambulance floor landing with a thud.  Their incredulous breathing technique stopped instantly and they sat bolt upright, staring wide eyed toward the back of the ambulance.  The medic, without even looking up from his paperwork, calmly broke the silence.

“Did that dislodge it then?”

The patient was later dismissed from hospital with the conclusion they had suffered a “mild” panic attack.

Binder

*this is clearly not her real name

 

Shot

It doesn’t take much to look an idiot in this job.  And I seem to do it with ease.

There have been times when I have tried to sound more intelligent than I clearly am.  And one such occasion was when we attended a “collapse behind closed doors”.

Each time we attend these jobs they are potentially a deceased purple + patient who could have been dead for any length of time.  We often have to get the police to force an entry as legally, we are not allowed to break in ourselves.  Thankfully, once we do get in the patient is often just wistfully asleep or not even at home!  This bodes well for the patient – as they are not dead.  It also bodes well for us as we don’t have to see them dead.  However, the patient is often not amused by the fact that a policeman is holding their front door in their hands and trying to explain to them that they will be hanging around until they can get their property secured.

So, often the patient is alive in these cases . . . but sadly, sometimes they are not.

We stood outside the flat on the second floor banging on the door.  It was nearing midnight, it was cold and it was our off-job.  Peaking through a side window we could see a light was on in a room at the back but there was no response to our banging and shouts. So, we called Control and asked for the Police.  We were informed they “may be some time”.

Shrugging our shoulders and putting our hands in our pockets we paced up and down trying to keep warm.  We even tried next door neighbours who confessed not to even know the patient.  Eventually, after nearly an hour waiting two squad cars arrived and we managed to open the front door.  Once in the police lead us through to front room which was what we could just see through the window.

The room was clean and relatively bare of furnishings with only a table, sofa and tv in.  Our patient was sat on their knees as if they’d dropped directly downwards and the top half of their body lay on the sofa, head facing us.  Unfortunately for the patient he was dead.  A tiny amount of congealed blood lay around their nose, but apart from that there were no other signs of what could have happened.

One officer couldn’t stop staring, “Are they dead?”.

I say this loosely – but you can eventually tell in most cases, just by looking, that someone is dead.  Often, a glance is all it takes.  But then sometimes you can get it wrong – and by that I mean I’ve checked the odd purple + patient and have almost convinced myself that they are still alive.  One such time I was even trying to convince my crew mate to start CPR.  After staring at me with a look of horrified disbelief they eventually convinced me not to bother and moved the patient’s hand to show me why.  The whole body moved as if made of wood.  They were in rigor mortis.

I checked the patient.  They were as stiff as a board, “I believe they’re dead I’m afraid”.
“How do you think they died?”  The other officer asked, looking through some bits of paper.
My crew mate and I looked at the patient and the surroundings and thought about it for a few moments . . . no signs of any struggle, collapsed directly downward, facing the sofa, the facial expression showed no signs of pain upon death.
“Probably an instant cardiac arrest . . .” I chirped convincingly.
“Yeh?” The officers seemed to be being drawn in by my expertise.
“Yep, yeh, I imagine he had a heart condition of some sort, possibly suffered a massive heart attack.  Seen it lots before . . .”  Damn, I was good.
“What about the blood?”
“Probably a little bit of haemorrhaging from the larynx, . . . or something”  Trailing off I cringed.
“How long do you reckon?”
“Judging by the rigor mortis and temperature, anything between five and eight hours I reckon”  Good recovery.
“You don’t suspect anything untoward do you?
“Nah.  Not a chance I reckon.”
“Do you mind helping us just give the patient a once over?”

On any purple + the police have to briefly check the body for any signs of ‘foul play’.  We managed to move the patient away from the sofa a little.  The patient was ‘stuck’ in places due to the rigor mortis and either the sofa was going to tear away or the patient’s face was.  After checking all we could, the only thing we could see out of the ordinary was the tiniest scratch on the front of their neck.  After much deliberation we convinced the police that the probable cause of death was natural causes.

Just as it seemed we could be wrapping this up and going home, one of the officers stepped on something . . . “Hello, what’s this?”  He stooped down and picked up what appeared to be a spent bullet cartridge.  And then another to his right.  And then another.  Everyone froze.  He slowly looked up at the others.  There was grim silence as they exchanged knowing looks.  My crew mate and I exchanged our own glances – and I could see her slowly screwing her face up and mouthing the words, “oh god no”.

Within seconds we were kicked out of the flat as they turned it into a crime scene.  Within minutes there were four more police cars on scene and eventually, the place was crawling with officers all wanting a piece of the action.

My crew mate and I skulked away in the shadows desperately avoiding the police we’d originally talked to.  After about half an hour an older police man with several important looking pips on his epaulettes approached and asked us several demanding questions.  Like two school children facing the headmaster we stood, staring at our feet and mumbling our responses.

Eventually they let us go, surplus to their requirements and eventually we got back to station two hours past our finish time.  Dejected, we said goodnight to each other and went home.

It wasn’t till a long time after that I had to write a report and have an interview with a DC about that job.  It turns out the patient had not had a “massive heart attack”.  No, it turns out they’d been shot – four times.  Once in the throat and the rest across his body.  The “scratch” on his neck was an entry wound.

Every now and then I bump into the officers from that night when on a job.  I always smile weakly and ask them if they have any jobs going in their CSI division.  The blank looks I get in return usually end the conversation.

Binder

Rest-break

It took me a while to get to grips with break times in the ambulance service.

Basically, if the workload in the service allows it, Control will try and send you back to station for a rest-break.  Now – we work twelve hour shifts and jobs are generally back to back so its fair to say we are busy enough throughout the day.  That aside we manage to get the odd ten minute breather after each job at hospitals etc.  And being busy means the day goes quicker – which everybody likes.

By not getting an “official” break we manage to finish half an hour earlier and get an extra £10 for our troubles.  Most crews like this.  Not so much for the money – that’s trivial – no, its the finishing early that counts.  So, crews will prefer to work flat out for the whole day avoiding an official rest-break and then finish earlier . . . unless of course, your off-job involves something ridiculous – which it always does.  And as has been mentioned before – its always a conspiracy! Staged by Control!!

There is a set time during the shift that you can have your rest-break and this is called the “break window”.  Once you pass the break window (which is usually two and half hours before the end of shift) you can’t be put on rest-break and will then be finishing early.

Now, some crews will go to great lengths to avoid having a rest-break.  Its almost like a personal challenge – with each shift finishing early becoming a tiny victory against oppression (or something).  This can be seen by the outsider as childish in some ways – but rest assured, it is one of many essential processes for maintaining sanity in this job.

A classic way to avoid rest-breaks is to try and find a patient.  This is the only time a crew will rush to pick up a drunk in the street or go steaming into a fight and help.  With some it becomes obsessive.  Sadly, some take it a little too far.

I heard of one crew who had been ordered back for a rest-break with ten minutes still to go in their break window.  On their way back they decided to drive round a large roundabout over seventeen times until it was time to head back – perfectly timing it to arrive on station 2 minutes after break window.  Unfortunately for them, Control had been watching their progress on the map (each truck is fitted with a tracking device) and were well aware of their plan.

So, upon arriving at station the phone started ringing.  This would normally be Control saying the crew are officially on rest-break.  The crew, ready to fight their corner and argue that they were out of the break window, answered the phone . . .

“Hello, Oval Station*?”
“Is that M202**?”
“Yep”
“Control here – you have a choice . . . you can accept your rest-break now, 3 minutes after the break window cut off, or, you can both be suspended for abusing Company time.  Which would you like?”

Unsurprisingly, the crew took their break.

Binder

*Obviously not the real station for this case
**Crews have call signs.  The letter distinguishes the station you work out of and the number represents the shift . . . M202 isn’t a shift that works out of Oval (I think) – I’ve made it up!

Riots

Albeit I want to try and keep everything on here as light hearted as I can (even the times that involve death), this entry is lacking in any mirth – sorry about that.

I am currently training down in South London.  The last part of the paramenace bag stuff.  Apart from the incredible stresses of having to study and recall ridiculous amounts of indications and contra-indications associated with the administration of millions of drugs – it also means that I am off the road and away from the day to day shift work pattern of being on an ambulance.

This means I wasn’t working when the civil unrest hit Tottenham the other day.  I dare say I’m not disappointed about this either.  By the sounds of things there was a lot of anger on the streets – lots of which was aimed at the emergency services, and with no discrepancy on who was targeted!

This saddens me.

I first heard about it when fellow work colleagues were messaging on Facebook, warning  to look out for each other on shift.  Being incredibly naive with the urban disruption I thought this was funny and a tad over reactive of folk.  But then I talked with a friend who was on shift that night who told me of how they had been caught up in the riots and at one point cornered by a large group of “youths” who ended up pelting them with rocks, spitting at them and calling them “scum”.  The crew managed to lock themselves in the ambulance and luckily, within minutes the armed response teams arrived en mass to disperse the crowd.

So, albeit I thought this was funny at first, I had to step back and look at how I was viewing it all.  My friends and colleagues were being assaulted for doing a job whereby they try and help people. And the very people that we go out to help are being the ones who turn on us.  I find this hard to fathom sometimes.  I mean, in the ambulance service we get punched, kicked, spat at – on a regular basis, but most of the time you don’t bat an eye lid and almost accept it as part of day to day business.  But to be attacked en mass by a crowd of delinquents hell bent on taking their wrath out on anyone in a uniform goes beyond what I thought a (supposed) civilised society is about!

And let me get this straight – the official reasons for the unrest were the community believing there was unreasonable behaviour by the police over the shooting dead of a young man.

With the risk of appearing over zealous with my views I have a suggestion for future aspiring “gangstas”.  Next time you are suddenly stopped by armed police and told to put your hands up – do so.  Be nice to the police.  Do as they say.  When they say it – and co-operate at all times.  Don’t, whatever you do, attempt to forcefully negotiate your way out of possible arrest and shoot one of the officers.  This will probably result in instant retaliation and discharge of official weapons in the direction of yourself – the usual outcome of which is termination of your life!  And that’s fatal!

Here’s hoping that all crews are safe on their shifts and are free to do the job they want to do – help people.

Binder