**This is work in progress . . . as in I will be adding to this as I go along.**

Basically, in order to allow the blog to “flow” more easily, I thought I’d write up an A – Z of the slang, para-phrases, acronyms, terminologies and . . . and, um . . . anything else I reckon that needs to be explained . . . to anyone who doesn’t know what the hell I’m talking about.  As I say though . . . this is work in progress.  If there’s anyone who thinks something is missing, wants to put something else in the list or thinks that something I’ve written is wrong – then please, write in and tell me.  I have no pride in correction.

So, here it is . . .

A&E – Accident and Emergency department of the Hospital.  Where patients will end up if conveyed by an ambulance.  This is the part of the Hospital you will possibly wait a long time before being seen – and no, going by ambulance DOESN’T mean you’ll be seen any quicker if you’re injury/illness is NOT life threatening.  In fact, for those who call an ambulance in the vane belief that they will be seen quicker (and are trying to jump the queue) you will more than likely have to wait longer than everyone – probably in thankful payment for costing the British tax payer well over £500 for your efforts.

ALS – Advanced Life Support.  This is recorded as when both an advanced airway is inserted and iv access is gained.

Asystole – A “flat – line” rhythm of the heart.  All electrical output has ceased and the prognosis of the patient is very bleak.  You cannot shock this rhythm as there is nothing to shock.  The sound you hear in films (the long continuous beeeeeeeeep) is best associated with Asystole – but unlike the films you can’t shock the patient.

Attend – There are normally two people on an ambulance and each shift, one drives whilst the other “attends”.  This involves being the first point of call to every patient – talking to them, trying to work out what is wrong, diagnosing, deciding on treatment and of course . . . writing all paper work.

Bagging – This is the term used when you use the BVM on someone.  By “bagging” you are forcing oxygen into the patient’s lungs and therefore breathing for them.

Big sick – This is general term used for patients who are clearly, obviously and with no question of a doubt ill.  They will look like they are on their last legs.  It is something you get to recognise in an instant and know that something has to be done quick.  Once seen its never forgotten.

BLS – Basic Life Support.  This would involve simple airways (NPs, OPs), CPR and BVM and pads and rhythm checks.

BVM – Bag Valve Mask.  This is the device we will use to force Oxygen into a patient when they have stopped breathing.  A mask is held in place over the mouth of the patient with one hand whilst the “bag” (a rugby ball shaped plastic container) is squeezed rhythmically with the other, thus forcing ventilations into the patient.

Blue Call – Once a patient is picked up – if the problem is time critical then we will “blue” the patient into the relevant hospital.  We radio ahead so the hospital can be ready for our arrival and we then drive with the blue lights and sirens.  The slower you see an ambulance driving on blue lights – then probably the worse the patient’s condition is!  Some people don’t understand this – if you had a patient who’d been shot, their bullet was wedged, just touching the main artery from the heart, you would not want to race at 70mph over speed bumps, round corners etc just to arrive and find the patient now bled to death in the back of the truck.  No, you take it very very slow and steady . . . and leave it to the Junior Doctors to kill the patient.

BM – 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.

Board and Collar – When a patient is injured due to trauma we may “board and collar”.  This is when we think there may be risk of damage to the C-Spine.  So…we stick a collar round their neck to secure movement, and then we lie them flat on a board and stick blocks either side of their head and secure their head/neck in place – to reduce movement.

BP – Blood Pressure

Cannulate – When a patient needs to be able to take drugs via their veins (a little like when a drug addict injects heroin into their veins).  We place a “cannula” into one of their veins in their arm (ideally) so that they can recieve either drugs or fluids . . . or both . . . but not heroin – sorry.

CBRN – “Chemical, Biological, Radiological and Nuclear”.  A “specialist” team of folk who will convince you that the terrorist attack (via ‘dirty’ bombs) is “real” (fair play).  And their quote is, “its not if, its when”.

Collar and Board – See “Board and Collar”

Consultant – The man/woman who you want to be treating you in hospital.  A Consultant has the most amount of years experience behind them at hospital and are usually calm, sophisticated (due to general public school up-bringing) and severely lacking in “pride”.  They are the calm ones . . . they are the ones who incorporate all staff into the outcome of the welfare of the patient . . . and thank the Ambulance staff for their work!!!!!!!

Control – or Dispatch if you like.  Control are the bee hive central.  They take the calls and then dispatch the ambulances . . . we are their humble servants.

COPD – “Chronic Obstructive Pulmonary Disease”.  A generic term used for a long term illness associated with the lungs – eg, Asthma, Emphysema, Bronchitis etc.  Patients with COPD usually present with difficulty in breathing (DIB) and are a high percentage of our call-outs.  Smoking is a massive influence to this condition – I reckon if we could take the general public round with us sometimes to visit the folk who are COPD due to smoking, it would probably turn things around.

CPR – “Cardio-pulmonary Resuscitation”.  When a patient is in “cardiac arrest”….ie, heart stopped beating and the patient has stopped breathing…or, they are dead – this is what we  do to ‘try’ and bring them back to life.  CPR is performed on the chest – a person starts “chest compressions” (look it up!) and try’s to operate the heart (in the absence of the heart working) by pumping blood around the patients body.  This is very important should you want to try and survive.

C-Spine – This is the area to do with the patient’s “Cervical Vertebrae”.  Problems with this are usually caused through trauma.  It is the area associated with the vertebrae dealing with C1 – C7.  C7 is the vertebrae that is the most prominent bone sticking out of the top of your back.

CVA – Cerebrovascular 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 death of the brain that is being blocked.  This is where the FAST test is handy.  Having an extremely high blood pressure can be a cause of this.

De-fib – “Defibrillation Machine”.  Its name in the Ambulance Service is the FR2 but always generally known as the “defib”.  It is a small machine that can deliver a “shock” to a patient who’s heart is in a shockable rhythm (see “pulse-less VT”, or “VF”) which could potentially save their life.

Doctor – I refer to a Doctor as the ones you get in the hospitals – not to be confused with a GP.  Usually good albeit sometimes tending to lack in patient care/understanding.

Driver – You usually have two people working on an ambulance and that ‘crew’ will take it in turns each shift to attend or drive.  The driver can still be the lead medic but will generally take the back ground role.  It is a way of taking a break from facing the public.

DIB – “Difficulty in Breathing”.  Term used often for patients with problems such as Asthma, COPD and . . . panic attacks!

DSS – “Dying Swan Syndrome”.  Used to describe patients who’s acting skills are worthy of any “B” rated sitcom.

ECG – “Electrocardiogram”.  This is what we tend to do to most patients these days.  It allows us to take a “snap shot” of the heart to see what is happening.  Very useful for diagnosing heart conditions such as MI’s (heart attacks).  It is done by placing several sticky lead placements across the patient’s chest and on limbs and obtaining a trace via our Lifepak machine.  People with very hairy chests tend to get presented with the razor!

ECP – “Emergency Care Practitioner”.  This was (I thought) a brilliant idea.  Advanced paramedics who were given more specialist skills to be able to diagnose and treat patients at home.  Sadly the scheme has been scrapped (money?) and all ECP’s have now been blended back into the medic world.  Very sad.

EtCO2 – End-Tidal CO2.  This is the reading that tells how much CO2 the patient is blowing out after each breath.  This with other diagnostics is very important in working out what is wrong.

ETOH – In medical terms this means ’Ethanol’.  In Paramedic terms it means ’patient been drinking alcohol’.  So one possible way of saying this is ’Patient PFO, ?ETOH’ (Patient Pissed and Fell Over, query pissed).

Fluids run up – This is a term used when you get a bag of saline fluid, connect it to a giving set (a tube and expansion chamber) and then connect it to the patient via IV access.  But don’t necessarily run the fluids – it is merely run up ready to go.

“Frequent Flyer” – A regular caller of the emergency services.  You would not believe how many times some of these people call the ambulance service each day!  Sadly, most of the time it is all nonsense too.  And yes, we have to attend every time . . . something to do with the “cry wolf” syndrome.

FR2 – Technical name for the de-fib machine.

FRU – “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.

GCS – “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.

GP – “General Practitioner”.  A doctor who’s turned to the dark side.  In my attack of GP’s it should be quickly mentioned there are (clearly) fantastic ones out there – and it should be mentioned that GP’s have done many many years as a Doctor to be able to end up in their GP surgery.  Sadly, some of them have ‘lost touch’ with pre-hospital emergency care – and they know it!

H’s and T’s – Hypoxia, Hypovolaemia, Hyothermia, Hypokalaemia, Toxins, Thrombus, Tension Pneumothorax, Tamponade.  The 8 checks that are covered throughout a cardiac arrest as (other) possible/reversible causes.

HART – “Hazardous Areas Response Team”.  These are like a hybrid of Paramedics/EMTs and the Fire Brigade.  Set up to get life saving medical help to those caught up in areas where normal medics would not be able to access eg, at height, smoky environments, chemicals, etc.  Often a point of contention due to their lack of use in real situations.  Often misused my crews to just help pick up large folk!

HEMS – “Helicopter Emergency Medical Services”.  These guys will get to calls quickly and deal with extreme trauma cases.  Great idea as the team consists of an emergency Doctor and a couple of advanced paramedics so their clinical skills are far superior to those of an ordinary ambulance crew.  They also operate from a fast car – and they all wear bright orange jump suits . . . which don’t always fit properly!

Hospital – The big building with patients in it.

HR – Heart Rate – per minute.

Hypo – Actually means “low” but is quite often used to describe a Hypoglycaemic episode in a Diabetic patient.  When their sugar levels drop below the norm then they have a “hypo” and can present in a number of weird and wonderful ways!  It can also be very life-threatening.

I/M – Intra-muscular.  Route for an injection – usually a quick jab in the upper arm.

Intubate – the process of protecting the Airway and Breathing of a patient who has stopped breathing.  A tube is placed down the trachea to the lungs and ventilations are controlled by the medics around.  The “Gold Standard” of maintaining A&B in the medical world.

iGel – An advanced airway.  Better than the LMA’s as these just need lubing up and are inserted very easily

I/O – When we can’t get I/V access and all other routes are exhausted we will have to go in Intra-Oscula.  This involves using a drill to go into the bone of the patient.  Looks barbaric but bloody quick and effective.  Usually done on cardiac arrests.

I/V – Intra-venous.  Route for fluids and drugs.  A ‘line’ is obtained by placing a cannula in a vein – usually in the arm . . . but can be other places!

Job-about – A more northern ambulance phrase meaning to share the attending from job to job.  That is, one person attends, then the other crew member attends the next job etc.  But . . . only if a patient is dropped off at hospital do you swap.  There are rules!

Junior Doctor – Ah, bless.  Some are nice and eager to learn.  Brilliant I say.  However, most tend to be pride stricken, stubborn grump heads who hate, with a passion, being told they are wrong.  An endless source of amusement.

JRU – Joint Response Unit (JRU) was introduced a few years back to help reduce use of ambulances to police calls as well as help get police back on the beat from medical calls associated with their normal calls. One car plus a medic would assign themself to a police borough in London on Thursday, Friday and Saturday night shifts – they’d have a normal handset radio on open mic as well as a police radio on open mic. There would be a specific desk in Control called MetDG that would specifically sift through the police calls and we, the JRU’s would only answer police medical calls, so that could be drunken fights, domestics, domestic violence, odd in-public weird calls involving health, the odd RTC’s, stabbings and shootings, and multitudes of mental health.

LDV – Leyland Daff Vehicle.  These were the old white ambulances.  Thank goodness they are out of commission now.  Prone to disastrous failure just when you needed them most.  Some crews had carbon monoxide detectors in the front to warn them when they were getting poisoned!

Lifepak – This machine does everything.  BP’s, Sats, EtCO2 and of course ECG’s.  A very valuable piece of kit – but bloody heavy and cumbersome!

LMA – Laryngeal Mask Airway.  The new form of “intubation”.  Not as gold standard as ET but certainly a lot quicker and easier.  There are arguments on both sides regarding its introduction . . . new still is the iGel

LOB – An old, old terminology which means “Load of Bollocks”.

Loc Match – “Location Match”. This means the address we’re going to has a history.  Usually to do with violence but sometimes based around a general clinical history.  It also means that in most cases we need to hold back and wait for the Police to attend – for our safety.  This process of protecting us works for the most part – but on very few occasions we get the ‘Loc Match’ details after we have made contact with the patient!

“Matern-a-taxi” – An old nickname.  Not given to the patient but to us, the crew, when a patient calls for an ambulance because they are feeling a slight pain in the stomach because of being pregnant.  These patients can walk, talk and do everything you tell them and inevitably have their husband follow us in their own car!!!

MDT – “Mobile Data Terminal”. Sounds like it should be something mega technical but it isn’t.  It’s the on board computer screen that keeps us updated with our jobs.  It keeps track of all our times too.  This is important for keeping ORCON and keeping the government happy.

Medic – Term used for a Paramedic

Merc – The newer type of ambulance – bright yellow and packed full of wonderful toys to help everyone.

MI – “Myocardial Infarction”.  Or, heart attack.  With the wonders of modern technologies, ECG’s and our skills – the chances of coming back from an MI are hugely increased now.  Once we diagnose an MI in the truck we bypass all close hospitals and make our way to a Cath-Lab hospital that specialises in dealing with these patients.  It seems a bit bizarre to some people that we do this, but rest assured, it IS in the patients best interests.

Narcan – drug used to bring Opiate type over doses back to the living.  More often than not someone has overdosed on Heroin – we “narcan” them and the effect is almost immediate, one moment they were blue, not breathing . . . and somewhat dead, the next they are up, gasping for air, pink, alive and . . . swinging punches – because we’ve brought them out of their “fix”.  Great job!

NP – A tube stuck through a patient’s nose to secure an airway.

Nurse – I like most nurses.  They tend to be friendly and are the back bone of hospitals.  They get a lot of grief from the public but will still be the ones to clean you, look after you, care for you should you be ill or upset.  But – don’t ever, ever cross one!

Obs – Observations.  These will consist of a BP, Respiratory Rate, Heart Rate, Sats, BM and temperature.  Other Obs might include, EtCO2, ECG and anything else we can throw in for free!

Off-Job – The last job of the shift.  Somehow, this always ends up being the job from hell.  And – as is always the conspiracy theory – its always the fault of Control!

Off the road – This means the truck is faulty for some reason or it needs cleaning.  Whatever the reason, the crew are “off the road” whilst it is getting dealt with.

OP – Little hook shape tube that gets put into the mouth and down the throat of a patient to secure an airway.

ORCON – These are the timelines set out by the government for us to reach patients from the moment the call starts.  8 minutes is our deadline for Cat A Red calls (serious….but strangely aren’t when we arrive).  So, taking into account that the person calling rarely speaks English and this has to be translated, Ambulance crews are already dealing with someone who’s called us for a broken finger nail, the route to the patient is full of pot holes, speed bumps, trendies on single speed bikes, black cab drivers “surfing the blue wave”, general idiots in cars and the en-masse population occupying the road – it is no wonder that these targets are hard to beat!

Pads – Abbreviation to the two pads that are placed on the patient when they are in cardiac arrest.  One on their left mid flank region and the other top right anterior shoulder area

Paramedic – Hero!

Patient – You, me, us, everyone.  The people who call us.  This can be from a fall from a 12 storey flat to a multi car pile up to a person who’s broken their (false) finger nail.  The great British public will call us for anything!  And we will give you our best, undivided attention.

PE – Pulmonary Embolism.  This is a clot or an object that has broken loose in the blood stream, made its way to the heart, come out of the heart and, on its way to the lungs has got stuck.  This causes several problems, one of which can be death – and when it is death, sadly there is not much we can do.

PEA – “Pulseless Electrical Activity”.  This is a rhythm seen on the FR2 or Lifepak machine which resembles the heart beating.  And to an on-looker would look like the person is alive.  Sadly they aren’t at that stage as there is no pulse.  The electrical circuits are firing fine, but the heart isn’t beating.

Priority button – The # key on the radios.  Once pressed, you have priority call clearance to talk with control.

Psych – Mental Health patients.  Since the closure of all institutes several years back, we have seen a huge increase of psych patients.  Some, in interestingly varied degrees of state and composure!

purple + – This is the term used medically for a patient that is dead – and has been a while.  To a point of obviously dead.  The more “+” marks you add, the more “obvious” they are dead.

Reception – The front desk at Hospitals.  They take shit day in, day out and therefore will only ever show an ounce of care for a patient if it is real.  Don’t mess with them, be nice!

Regular – See “Frequent flyer”

Resuss – Resuscitation.  Either the process of trying to bring a patient back to life or the Resuss Room which is by A&E.  This is where we take any patient who’s been blued in.

ROSC – Return of Spontaneous Circulation.  This is the moment when pulses return in a cardiac arrest.  Not necessarily good ones – but pulses none the less.

Sats – Saturation – ie the amount of oxygen saturating in their blood each breath.  A normal level in a normal patient would be between 94-100%.  COPD patients can be expected to be between 88-93%.  If your sats are low, you generally look ill!

Scoop – Orthopaedic Scoop.  A sort of stretcher that splits length ways down the middle to allow attachment underneath a patient with the minimum amount of movement afforded to the patient.

Shit magnet – The crew mate you don’t want.  They are the one that attracts all the rubbish jobs, such as drunks, vomit and urine patients, fighters, or large 20+ stone patients that you have to end up carrying down 10 flights of stairs.

SOB – Shortness of Breath

Technician – A crew normally consists of two technicians or a technician and a medic.  A technician hasn’t got (yet) the skills that the medic has.

Trauma Magnet – A crew mate who somehow attracts all the nasty jobs that involve traumatic injury or death.  If you looked at them through 4th dimension glasses I’m sure you’d see them in a dark hooded cloak with a scythe.

Triage – This is the process of putting into order those patients that need to be seen quick and those that don’t.  At Hospital this is done by the Triage Nurse.  In A&E all patients are triaged.  But some still don’t understand why they are left waiting for hours – whilst holding a saw thumb – whilst at the same time, some poor child is being worked on in the resuss room.

Triage Nurse – Very busy person, who has to make (often) snap decisions on prioritising patients (and not always correctly – but decisions have to be made).  They seem to have the whole A&E department in their palm and, as often is the case, not even Doctors mess with them.

VDI – Vehicle Inspection.  Supposed to be done before every shift.  You are meant to allow for 15 minutes before your shift starts to; check oil, tyres (with no tyre gauge), water, lights and other service abilities, the complete stocking of the ambulance which rarely has what its suppose to.  And guaranteed the moment your shift starts a call is waiting for you and you have drop everything and go to it – half the time, not knowing exactly what you do have or don’t have on board.

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”.

VF – Ventricular Fibrillation.  This is when the heart has gone nuts.  Nothing is firing properly and can be best describes as having an epileptic fit.  Whilst it is like this, it is filling with blood but not pumping anything.  The rhythm is shockable and often, shocking the patient will kick start the heart back into a proper rhythm (of sorts).  Unless there are underlying causes of course.  However, it is important that CPR is performed immediately because the more blood there is swelling the heart, the less likely a shock will work.

VT – Ventricular Tachycardia.  Again this is a shockable rhythm.  Similar to VF but the heart is constant with its contractions – just way too fast.  This will quickly develop into VF if something isn’t done.

12 – Lead – This is the terminology for a complete ECG.  As there will be 12 different views of the heart once completed.