A day of “proper” jobs

Proper jobs come round once in a blue moon.  But when they do, its a bit like the buses – they all come at once.

We only had four jobs the other day.  This was because we had to spend two seperate occasions at the dreaded  and eventually had to swap onto another truck.

First job, a hypoglycaemic patient with a  of 1.7.  He was hiding under his bed sheets and peering out at us with a look of terror and anguish.  Sweat was pouring from him and his sheets were drenched.

After the initial pleasantries it was clear to us that we’d have to hold him down to give treatment.  There’s nothing satisfying about doing this but sometimes it just has to be done.  And, after one Glucagon injection(IM), several sandwiches and a sweet cup of tea later we were able to leave the patient at home fully back to normal and with our closing words of “just doing my job man”.

After changing vehicles at the fitters it was onto our next job – a  patient with a BM measuring “High” on the monitor (this means its through the roof and at a minimum of 30mmol/L).  The patient looked unwell, very obviously dehydrated, poor mobility and kept drifting off to sleep.  We gathered them onto the ambulance where I was told to get I/V access to give fluids!

Right.  Access.  I/V access.  Ok.  Um . . . right, I needed a cannula.  What else?  Erm . . . er . . .

Whilst I struggled remembering what basic bits and pieces I needed to gather together, I smiled at the patient and reassured them that we were going to look after them.  I made sure not a single one of my frayed nerves showed externally and took my time as best I could, under the circumstances.  I was about to insert the cannula when my Mentor touched my arm and whispered to me, “take a deep breath and let it out slowly”.  She must have noticed the tiniest beads of sweat starting to form on my brow – or probably that I was gibbering like a pathetic child and frothing at the mouth.  Either way, it helped and the cannula went into the tiny vein first time.

I secretly “high-fived” myself – but not before letting the patient bleed onto the ambulance floor as I failed to place pressure on the vein to put the cap on the end of the cannula . . . but these “little” faults can be excused.

After about 200ml of fluids the patient had perked up lots and even managed a smile.  And we felt that we’d managed to do something good and worthwhile when we handed them over to the hospital staff.

The next two jobs were “blued” into the hospitals.  The first was a poor woman with suspected haematemesis (vomiting blood) and melaena (gastrointestinal hemorrhage coming out as black tarry poo – not good).  Again, she looked very sick.  This was pretty much a “scoop and run”.  Because of excessive hyperventilation we found it hard to obtain an accurate blood pressure but later the hospital told us it was 63/33!

The last job was a suspected .  Upon arrival it was clear the patient was reduced  as they were confused and struggling with articulation.  The more the patient tried to speak the more incoherent they were and it appeared that this was distressing the patient as they knew something wasn’t right.  It was also clear from the history that only an hour before, this person had been up and moving and talking normally.

We attempted a FAST test but the patient was frightened and combative.  Therefore, it was a “load and go” situation again.  The carers on scene contacted the patient’s family as we started moving her to the ambulance and we got ready head off sharpish – as this was now time critical for the patient.  Cannulation and an ECG were also ruled out as the patient withdrew from all efforts to do so.

It took us twenty five minutes of aggressive (but safe!  Honest!) driving for us to travel the 7 miles to the Royal London Hospital.  And after rushing the patient into resuss we handed over to the Stroke Doctors.

As I sat in the ambulance afterwards, sipping a cup of tea, my Mentor approached and informed me that the doctors had decided they would not be  the patient as she was over the cut off age of 80.  Apparently it is not considered to be in the government’s best interests to treat patients over this age.  Not viable I guess.

The patient was 81.

This means there will be no treatment for her other than palliative like care.  It did nothing less than boil our blood and break our hearts.  And as this was our off job it left a bitter taste in our mouths.

Weekend off now and back on Tuesday.  I will now attempt to keep these posts regular.

Binder

“Vehicle Fitters”. Seasoned East-Enders genetically evolved to be the epitome of the British car mechanic.  Always with a look of utter contempt, no matter what the occasion or whoever is the happless individual unlucky enough to bring a truck to them for repair.  Always to be found with a cup of tea fossilised to one hand and forever starting any contemptuous diagnosis by sucking in air through their teeth and stating, “not till Tuesday mate”.
“Blood Sugar”. A terminology used for measuring someone’s blood sugar count in their blood. Usually done for Diabetics but in the emergency services, done to . . . . um, anyone really. Very useful for diagnosing certain problems – like Hypoglycaemia (low blood sugar – indicative of an Insulin Dependant Diabetic) . . . or ruling out diabetic problems with someone who is suffering a CVA.  A normal reading will be between 4mmol/L to 8mmol/L.
“Hyperglycaemia”. This is where your blood sugar levels are high.  Technically, anything above a reading of 8mmol/L is considered not normal.  However, hyperglycaemia is generally recognised at 13mmol/L onwards and signs and symptoms can start at as little as 15mmol/L onwards.  Some signs and symptoms can be; weight loss, excessive thirst, dehydration, excessive urination, excessive hunger, extreme tiredness and deep laboured breathing (Kussmauls Breathing).  If left unchecked the person will most likely slip into a coma and die.
“Cerebral Vascular Accident” Or, “stroke”.  This is when a clot of some sort enters the circulatory system of the brain and gets stuck – thus causing a blockage and subsequent possible necrosis of the brain that is being blocked.  This is where the FAST test is useful.  Having an extremely high blood pressure can be a cause of this. Once the diagnosis is made it is best for the patient to be transferred to a Stroke Unit – and this can sometimes mean bypassing several hospitals en route to do so.
“Glasgow Coma Scale”.  The GCS of a patient determines how “with it” they are.  Obviously a Doctor wouldn’t be saying “this patient has a reduced GCS as they’re not with it” but would justify their statement with a score.  It is scored out of 15 taking into account reaction of eyes, verbal and motor skills.  If the patient scores 1 in each they are GCS 3 – this is very bad and would suggest a coma of some sort . . . or at least very drunk! If they are GCS 15 then this is good.
“Thrombolysis” is the breakdown of blood clots.  Specific “clot busting” drugs will be introduced into the patient’s system as part of the therapy to treat disorders like CVA’s.

Oh, I’ll take her alright

Its unbelievably refreshing to be back on the road after so much time spent in the classroom.

The eight weeks of the paramenace course crams so much information and learning into your mind that you feel sure every cell in your body will implode or that your bones will liquefy.  And all the while your soul is perpetually crushed by the imperialist yoke of oppression as the Service threatens suspension to all those who dare fail any exam en route.

So, to be back dodging fists, catching vomit, wiping urine and faeces from clothes and taking a constant barrage of abuse is actually – a relief.

The first set of shifts have been relatively uneventful – as they normally are.  The jobs were various, to which some included . . .

– Period pains (“worse ever!”)
– Self harm
– Overdose (15 year old – 5x Paracetamol!)
– Old woman – “Generally Unwell” – don’t think there was anything wrong with the poor lady, I reckon the family just wanted her out of their house for a while.
– ?broken arm on a teenager.
– baby won’t stop crying after an hour

And then there was one that made me giggle.  It came down as  – 16 year old with a “hurt foot” in a car park.  Now, we only got this because we happened to be driving past as it was called.  Otherwise it would normally have been down graded to another part of the Service.

It turns out mum had collected daughter from school because daughter had hurt her foot in netball.
Mum had stopped to get something from a shop.
Mum had left her mobile phone in the car.
With daughter.
Daughter phones 999 because “foot is hurting”.
We arrive within a minute.
So does Mum.
Mum looks at daughter holding her phone.
Mum looks at us.
Mum looks back at daughter.
Mum grows the most fearsomely angry image across her face.

After pre-empting a blood bath we calmed mum down and quickly deduced that the foot injury was not life threatening.  There was no swelling, no bruising, no cuts, full movement and generally nothing to suggest that this was nothing more than a case of Extremis-Patheticitis (a common ailment amongst young adults).

“Um . . . are you happy to take your daughter to A&E in your car – seeing as she’s already in the seat?”  We tentatively asked.
“Oh, I’ll take her all right!”  Mum’s eyes hadn’t moved from burrowing into the back of her daughter’s head and started to bulge with a hunger that suggested her daughter might be about to taste her last breath of fresh air.
“Right . . . erm, we’ll leave her with you then”.

As we drove away I’m sure I saw, out the corner of my eye, a large stick baring down toward the young teenager.  And I think I heard the muffled sounds of “thuds” followed by screams of pain.  But then I think it was just a fly on the windscreen and probably just the fan belt slipping.

Binder

’tis but a scratch

Before I start to write about day to day events I wanted to write about my first shooting I went to.  Basically, in between day to day events (which won’t be that interesting I’m afraid) I want to write about other stories/jobs.  Not just mine but other peoples too.  Personally, I love listening to people’s anecdotes and already have a plethora of stories to write.  Its just about getting the right inspiration I guess.

Shootings happen all the time in London.  Sometimes every day I reckon.  And I really don’t know why we don’t hear about it on the news as much as we should.  Maybe some are too uninteresting to report.  Maybe the press don’t get hold of some of the info so don’t know.  Maybe its part of an elaborate plan to keep everyone knowing.  Who knows.

My first shooting was shortly after being out of training school.  We were called to a 20 something male who’d managed to drive their van to a police station after being shot in the shoulder.  It appeared he was ambushed whilst driving down a quiet lane and the police believed it was a case of miss identification, ie the wrong guy in the wrong place at the wrong time.

The patient walked onto our truck and we attended to his injuries.  This consisted of one “hollywood” type graze to his left shoulder.  A flesh wound.  And, after cleaning, it needed nothing more than a small dressing.  Throughout treatment the patient had remained calm and polite, albeit a little shook up at what had happened.  It was then I took it upon myself to lighten the situation by taking the mick out of his wound.

“Ah, bless,” I said mockingly, “is Sammy shoulder seeming a bit sorry for himself”.  The patient laughed politely, taking my attempts at humour as what they were – attempts.  He looked down at his shoulder as if for the first time.
“Its ok then yeh?”
“tis but a scratch”  I mocked.  One of the police officers standing by lent down and whispered in my ear.
“I reckon you should come and see this”  He motioned for me to follow him and we stepped out of the Ambulance and walked over to his van parked behind us.  He mentioned that I couldn’t touch anything as it was going to be impounded for criminal evidence.  But as we approached my jaw dropped.  The front bonnet, windscreen, seats and panelling were all littered with bullet holes – 20 to 30 holes everywhere.  The officer quietly explained that a couple of people had jumped out in front of the patient and opened fire with fully automatic machine guns, strafing the front of the van.  The patient had dived down to one side as they did and thankfully only one bullet glanced past his shoulder.
“if he’d ducked down a fraction of a second faster it would’ve gone through his head”
” . . . bloody hell.”
“yeh, lucky man eh.  Just thought you should know the full story before giving him a hard time”
” . . . yeh.  Good point.  Thanks”  I couldn’t take my eyes off the mess.  After all that, he’d still managed to drive off and get to a police station to report it.  And he wasn’t even the intended target.

I walked back to the patient who was giving my crew mate details for the paperwork.
“um, you need anything from me?” I asked my crew mate.
“No, all good here, cheers”
“How you feeling now?”  I asked the patient.  He smiled brightly.
“Ok thanks.  Bit shakey – but ok.”
I retired to the drivers seat and remained silent until the patient left to continue statements with the police.  I continued to ponder over my naivety and vowed never to be that insolent toward a person’s near death experience again.

But as I say – this sort of thing happens all the time in London.  Do we hear about it?  Of course we don’t.

Binder

Bag Day

After all the hospital placements are done there is “bag day”.  This is your last day back at training school to complete admin and receive your Paramedic bag.

The day was rather uneventful but it was good to catch up with classmates and relive tales of disastrous moments in different hospital departments.  I mainly got quizzical looks when I asked other folk to tell me about thier awkward moments.  And after several embarrassing pauses I tended to move the conversation on to other things.

After the day was done we all gathered in the local pub where many drinks and mirth was had to celebrate completion of our course.  I had promised I would not drink that night but that lasted less than 30 minutes when I bought the first round of (many) Jägerbombs.

The evening went on and recollection became dimmer and dimmer until I decided to staggered home.  In two days time I would be starting my mentoring period where I would be putting my newly aquired paramenace skills into practice whilst my registration was being sorted.

For now though, I needed my bed.  Or the big white microphone – I hadn’t quite decided at that point.

Binder

HEMS Governance day

HEMS or the “Helicopter Emergency Medical Service” is a trust run on donations from the public.  It has been proven to be an effective emergency service that compliments the Ambulance Service and personally I reckon it is essential to have in modern times.

They run both a helicopter (a bright red one with Richard Branson’s branded “Virgin” written on it) and also a couple of vamped up cars in which land-teams race around.  The teams mainly consist of an Emergency Doctor and an advanced Paramedic – and sometimes observers.

Why am I mentioning this?  Well, I arranged to go to one of their Governance days at the end of my placements and went along with a couple of friends.

The HEMS Governance Day is held only once a month and is an audit of sorts.  They publicly take apart various “jobs” done previously and “review” them.  I say review, but for entertainment value it is sometimes not to be missed.  And when I say taken apart, what I mean to say is they are occasionally ripped apart – nothing short of the Spanish Inquisition.  Stepping away from the humour of seeing highly respected consultant doctors torn apart for various mishaps, it is a brilliant method of consistently improving a vital service.  And I only wish we could do the same in the Ambulance Service!  Our only “reviewing/improving” tends to be peer related and at the expense of a few laughs.

I enjoy the HEMS Governance days as not only are there the audits but also interesting lectures in between.  So, all in all, a good day is had . . . if you’re happy to use up one of your vital days off that is.  Oh, and most times there’s free lunch!

Afterwards, there’s usually a mass gathering in the local pub where you can get to know the various doctors and HEMS paramedics better.  Networking I think its called.  Sadly my attempts at “networking” invariably end in disaster, usually with me causing insult to someone somehow.  On one occasion many years back, I remember being at an important dinner party and standing in a small circle of people whilst the host boasted about buying new wheels for his Maserati.  I had drifted off into a thousand yard stare and wasn’t paying full attention.  But somehow I felt the urge to pipe up . . .

” . . . must’ve cost a fortune to have them done eh”  I sighed, not even breaking from my distant gaze.  But a few seconds later and I suddenly became aware of the pause in conversation and felt the hairs on the back of my neck start to prickle.  It was then I broke out of my day dream and realised that my “stare” had been aimed directly at the cleavage of the host’s wife.  Everyone was looking at me horrified.

” ah . . . ”  I smiled weakly and seem to recall being asked to leave shortly afterwards.

Albeit the HEMS days wasn’t any exception, it was perhaps a little less disastrous.  And this time I had a partner in crime – a friend from my class.  We’d both had backgrounds that involved working in the mountains and seeing the Lead HEMS Doctor wearing a Jack Wolfskin jacket that attempted to be outdoorsy we took it upon ourselves to gently berate him on his choice of outdoor clothing.  To us we thought we were being brilliantly amusing.  Unfortunately it wasn’t until the next day when another friend of mine pointed out, by text, what we’d done and how the Doctor had taken great exception to our comments.

Needless to say, I’m looking forward to the next time I can attend a Governance Day – but I might perhaps sit at the back of the lecture room.  Out of the way.

Binder