The Complete Blood, Sweat and Tea

Well, apart from the patient, no-one else knew that she was pregnant – she had been hiding the pregnancy from everyone. She hadn’t seen a doctor; neither had she booked into a maternity department. Her family suspected nothing. It’s not as if she were a ‘large’ woman, who could perhaps hide the tell-tale bump under the pretence of fat. She was actually rather slender, which leads me to ask how she could hide her rather obvious pregnancy from everyone.

When my crewmate spoke to her (I was driving), she told him that she had hoped that the pregnancy would ‘go away’.

We tried to prewarn the maternity department that we were coming (because she was quite close to actually delivering the baby), but they hung up the phone twice on our Control. The problem is that the entrance to the maternity department is locked at night, and we need someone to come down and open it for us. So … we were left standing around outside the department waiting for the midwives to phone for a porter to traipse the length of the hospital to come and open the door for us (as opposed to one of the midwives walking down the stairs and opening the door).

By the time we got in the patient was starting to bleed, and we were getting more irate at the apparent ignorance of the midwives.

So, tonight we are going to put in a ‘clinical incident report’ to highlight the danger that standing outside the maternity department for 10 minutes while they arrange a porter puts the patient in.

One of the people on complex has had to deliver a baby in the back of their ambulance while they were waiting for the doors to be opened, so something needs to be done.

Upsetting

Three of our jobs today had the potential to be upsetting, and while they were all sad, only one seriously upset me, and did so in a way I consider rather out of character for myself.

The first job of the day was to an 86-year-old female in a nursing home with a ‘blocked nose’: we raced around there because … well … it was a Category ‘A’ call and those are the top-priority ‘get there in 8 minutes to please the government target’ calls.

Just as we pulled up outside Control let us know that the patient was upgraded to a ‘Suspended’ (no pulse, no breathing), and sure enough we ran into the home to be greeting by a FRU who was doing CPR. I jumped down and did a round of chest compressions, which cracked her ribs (a recognised side-effect of effective CPR), and then noticed that on the cardiac monitoring machine her heart rhythm had changed. She had a pulse! … People don’t normally get a pulse back from cardiac arrests of her particular type. We rushed her to the hospital, where a full cardiac arrest team was assembled. Her pulse was lost, and then returned. Unfortunately, her prognosis was poor, but she stayed alive long enough for her daughter to reach the hospital. She died with her daughter there, which is a small victory, but one that we are getting more used to.

The second potentially upsetting job was to a 1-year-old boy who had pulled some boiling milk on top of him. We turned up to find about 20 police officers on scene, and the HEMS helicopter circling above. The same FRU responder was there and the child had around 10% partial thickness burns to parts of the neck and chest. While nasty, this wasn’t immediately life-threatening, but the HEMS doctor who turned up decided that it would be best to take the patient to the Paediatric Burns Unit at Chelsea and Westminster Hospital by helicopter. As the helicopter could get the child there in under 20 minutes it seemed like the right plan of action. My job during this call was to (1) hold onto the other two toddlers in the house, (2) mix up some paracetamol for the child, and (3) drive child and doctor to the helicopter, which was around 300 yards away. The job was interesting because she was the type of parent who thought it was a good idea to wedge a settee into the hallway to stop her children from falling down the stairs …

The final job was a lot simpler – we were called to an 18-to 22-year-old female who was ‘unresponsive’ in a bus. The bus had reached the end of its route and the driver couldn’t wake up the patient. (Possibly interesting aside – bus drivers cannot touch any of their customers to wake them up.) We turned up and soon managed to wake up the very sleepy girl. She remained drowsy but agreed to let us take her to the place where she lived, but after talking to her a bit, we soon realised that she was homeless. This, coupled with the way she would fall asleep as soon as we stopped talking to her, made us think that it would not be safe to leave her on the street. We decided instead that we would take her to hospital. When we reached the hospital she refused to go in, and instead pulled out a ‘crack’ pipe and started to light up. We told her that she couldn’t do that … So she jumped up, pushed my crewmate and ran off. As there was nothing physically wrong with her we couldn’t chase after her; instead we returned to our station to fill in the necessary paperwork.

So why was it that this last job was the most upsetting, not only for myself but also for my crewmate? Well it wasn’t because she was pretty (she wasn’t, and she had a remarkably nasal voice), and it wasn’t because she was ill, neither was it because my crewmate got shoved.

With our first job, the woman was at the end of her life, and until she died, had enjoyed fairly good health. She didn’t die a painful, protracted death, and she died with her daughter next to her. With the scalded child, he would forget the pain, and will receive excellent care from the hospital he went to, he would return home to his loving (if ever so slightly dense) mother. With this girl, it was as if she were lost; at some point in her life her potential future had unravelled. Instead of getting an education, holding down a job, finding someone special and living a long and happy life, she is homeless, a drug addict, and her future is probably painful and short. What is so depressing is that no-one was able to turn around this descent, and this is perhaps why I despair at society – that so many people are prevented from reaching their full potential. I understand that she has made her own choices, but how much power did she have to make those choices? I wanted to help her, but there was no way I could do this.

And it’s that which annoyed and upset me.

I keep getting upset and annoyed at the same things – the waste of a life is a terrible thing to see. That, and the knowledge that I am helpless to do anything to change it. I imagine that this is why I dislike alcoholics so much.

Therapy?

We got sent to a job of a 6-month-old baby not breathing. While this often means that baby has a cold, it could also be one of the worst jobs you can get. We sped to the address and entered a house where the whole family was distraught. It was an Indian household, so there were a lot of people there, and most of them were crying. Once more, I heard the type of crying that can only mean that something awful has happened – entering the living room I instantly saw a baby lying dead on the settee, father crouched over it crying and the mother standing and wailing, shouting out that her baby was dead.

There is only one thing that you can do in a situation like this, which is to scoop up the baby and run to hospital as quickly as possible. I reached down and picked up the baby; I was shocked to find that it was as stiff as a board and very purple, indicating that it had been dead for some time. It looked more like a doll than anything that had once been alive. We could have recognised the child as dead on the scene, but taking the child to hospital would mean that the parents would see that everything that could be done was being done and, more importantly, they would be in a hospital with all the support that the hospital could provide.

I ran out to the ambulance with mother in tow, and told my crewmate to get us to hospital as quickly as possible. The father and grandmother followed behind us in another ambulance who had heard this call go out and had turned up to see if there was anything that they could do to help. On the way to hospital I did the CPR that I knew was ultimately pointless and spoke to the mother. She had last seen the child alive at 3 a.m., and he had been fine then. It looked like it may have been a case of sudden infant death syndrome, and I did all that I could to prepare the mother for the worst.

We pulled up at hospital and handed the baby into the care of the hospital. I spoke a little more with the mother and grandmother, but there is nothing that you can say to people who have had such a tragedy. Our station officer met us at the hospital and asked us if we were alright, then he booked us off the road so that we could go back to station and have a cup of tea and ‘decompress’. If we needed more support I think it would have been there, but I just wanted to get away from the hospital.

I’m not often affected by jobs, and this isn’t the first dead baby that I’ve had to deal with, but it is the first dead baby I’ve had since joining the ambulance service and it is very different from dealing with them in hospital. Going into someone’s house to take away a dead child is very different from having the child and parents turn up at hospital, which is your safe territory.

At the hospital all the other crews were asking if I was alright and, to be honest, I wasn’t really alright – I was upset that while I was doing CPR on the baby its legs were seesawing into the air, and it looked too much like a doll. There was a point after the job where I thought I was going to start crying, but a moment outside the Resus’ room and I was back to functioning as I normally do. I’m not weak, and when in the midst of something I can deal with anything – it was only after the doctors and nurses at the hospital had taken over that I started to feel anything.

We returned to station, where the therapy of talking about anal surgery with another crew, and a cup of tea, soon had me feeling better. It used to be that you would return to work straight after a job like this, but then I think they realised that if we got our normal inappropriate call (bellyache for 2 weeks sort of thing) we might say something to the patient that we might later regret.

Well, an hour on station later and I feel fully prepared to deal with that sort of thing again – but I think that I’ll be haunted by the image of that child lying dead on my trolley.

I had loads of people commenting on this post, loads of support, which was very much appreciated. The title is a reference to the fact that I have found my blog to be ‘therapy’ for some of the things that I’ve seen and done in the ambulance service … and it’s cheaper than hitting the bottle.

Dog Teams

I’ve often mentioned that the ambulance service and the police tend to get on rather well together; this is at least in part due to us both being called to the same jobs, and probably because we share the same view of the ‘Great British Public’.

An example: we got called to a drunk who was being verbally abusive to a bus driver – we were called because the drunk had fallen over, while the police were called because of the abuse. The drunk man was obnoxious, and well known to both of our services, and because of the lack of an injury was left in the care of the police. If he had been injured then the police would have left the matter in our hands.

So, when we co-respond, the ambulance crew pray that the patient is uninjured, so the police have to deal with them, while I suspect that the police hope that the patient is injured so they don’t have to arrest them.

However, there are a lot of specialist teams in the police service that we tend not to come into contact with that often; we mainly get to meet the normal ‘beat’ coppers. Thankfully, we rarely see the murder, child abuse, drugs or dog teams. This isn’t to say we never see them (and our station did get a Christmas card from the local murder squad telling us to ‘keep up the good work’), it’s just that it is fairly rare.

So, it was rather surprising that I met with the dog-handling team twice last week. On the first occasion, we were called to a known schizophrenic who had threatened to kill herself. The patient herself (a regular attender at the local A&E) was a bit of a pain to deal with, she wanted to stay at home and kill herself and couldn’t see why we wouldn’t let her do that. Her dog, on the other hand, was a real pleasure – happy to see us, interested in smelling all our equipment and extremely friendly. As the police were already there, they got the dog squad to look after the animal until the patient was discharged from hospital.

In case you think I am being harsh on the mentally ill, the patient attends A&E every day with the same complaint of wanting to kill themselves … she hasn’t managed it yet.

The second time I saw the dog-handling team was when we had to gain access to a house where the patient was unable to come to the front door and let us in. The interesting part in this story is that there were five dogs of unknown temperament in the house. For half an hour the police unsuccessfully tried to gain access, mainly by climbing up a ladder and trying to open a bathroom window. We were able to talk to the patient, and so we knew that they were not badly hurt, otherwise we would have had to kick the door down. Then the dog team turned up and, using a top secret criminal technique, managed to get the front door open in about 10 seconds, thus putting to shame the half-hour everyone else had spent trying to gain entry.

All five dogs were really lovely, although energetic, and at the end of the job I had to spend 20 minutes brushing the dog hair off my uniform.

There is a joke we have about dogs. When we ask a patient if the dog is friendly, the patient always answers that they won’t bite; the reply to this from the ambulance crew is to add the unspoken ‘They only bite people dressed all in green.’

I’ve only had one dog take a dislike to me. But I managed to pull my hands away from his gnashing teeth before he could catch me.

Perils of Drinking (Number 1 in a Series of 230)

It was the usual type of busy last night – we heard rumours that there is such a thing as an ‘ambulance station’, a mythical building where one might use the toilet or partake of the life-giving ‘cup of tea’. It must be a myth, as we never saw it at all.

As I have mentioned, we get our calls sent down to a computer screen in the ambulance cab; sometimes you wonder how the Control crew have entered it while keeping from laughing down the phone at the patient. A case in point was one of our calls last night which was given as ‘53-year-old male, taken 3 × crack cocaine, cold and lonely, needs to be put back together’.

Avoiding the rather obvious ‘Humpty Dumpty’ jokes, we soon realised that the complaint, and the location he was calling from, fitted one of our semi-regular callers. By the time we got there he had left the phone box and neither us nor the police could find him after a search of the area. Obviously I was distraught …

Our other stand-out job of the night was a 57-year-old male fitting. We quickly made our way to the location, to be met by a block of low-rise flats that often sneak up on you in our area. These are three or four floors high, and have no lifts. Also there was one of our First Responders. We entered the block, and immediately made our way to the stairs (it is a little known law of physics that in flats with no lifts, people on the ground floor are never ill … only those on the top floor).

Entering the flat, the general state of disrepair, mess and the 3-litre bottle of strong cider I tripped over tended to give the impression that it was owned by an alcoholic. We got into the living room to find a large man lying senseless on the floor, while his daughter was sat over him stroking his hand, trying to reassure him. A quick check over, some oxygen and a chat with his daughter revealed a history of alcoholism (surprise!) and the occasional alcoholic fit. He was a big man, so we packaged him up in our carry-chair and carried him down three flights of stairs. All the time his daughter was saying how strong the nice ambulance men were – which only goes to show that she wasn’t paying attention to my reddening face and struggles for breath …

We got the patient into the back of the ambulance where he started to fit again, this time lasting about 2 minutes. He also decided to bite his tongue and vomit, which meant that the back of the ambulance (and myself in some part) was covered in bloody, cider-smelling vomit. I think I’ve mentioned before how I can’t smell alcohol on someone’s breath, yet I can smell cider when it has been vomited all over my ambulance … and it turns my stomach. We packaged him up and ‘blued’ him into Newham, where he had another two fits (despite some rather strong sedation) and by the end of our shift he was still in Resus’ having infusions of phenytoin and Pabrinex.

So, a busy night without the chance to see our station, with at least one mopping out of the ambulance … pretty standard really.

The vomit in the ambulance took place at the end of our shift, so we couldn’t even get back to station to use the mop. Unfortunately, with the increased number of calls we have, getting back to station is becoming rarer than ever.

Security

Yes, I know I’ve written before about kicking down doors. However, in this post I offer people advice in making the beating down of their door as hard as possible. So please excuse the repetition. Like all good health-care professionals I regularly ignore my own advice.

There is a visceral pleasure in kicking down a door. Once or twice I’ve managed to see someone who is really ill trapped behind a locked door, occasionally there has been someone who has just been unable to open the door. And just the once I have kicked down a door that the patient refused to open because they were schizophrenic and didn’t want to open the door – not that I knew that at the time.

I’ve even been surprised at the ease in which I can kick down the doors of the flats that I live in. Actually, it would be more accurate to say that I am scared with the ease in which the doors can be broken. Oh well, it’s not as if I have a lot to steal anyway …

My experience of kicking down doors has taught me which security features are useful when trying to prevent someone from stealing your TV and video.

If you have a deadlock-type lock, then use it – always. The skill of kicking down a door relies on breaking either the lock, or the wood holding the lock; deadbolt-type locks are a lot more secure than the normal Yale type lock.

If you are in the house and have a bolt on the door, then use it. It takes a lot longer to kick down a door when there is a bolt in the way. Another trick behind kicking down a door relies on applying the force of your kick to the (hopefully) single point of resistance. If there is a bolt at the top or the bottom of the door it makes it a lot trickier to break that door.

Windows in the door are a bad idea – they are a weak point that can be easily broken, and then a skinny hand can reach through and unlock the door.

If you really want to be safe then have a bar across the door. I’ve seen it once or twice, and if someone has a bar across the door then there is no way I’d be able to break that door down. Just make sure you don’t collapse behind it.

Major Incident Cover

One of the perks of this job is the need to cover football games. Well … it’s a perk if you enjoy seeing your local team play. Personally, I can’t stand football but overtime is overtime, and it does make a nice change from the usual jobs I go to. So, this Sunday I got to see West Ham play against Derby.

The LAS provide ‘Major Incident’ cover for these games, we don’t look at sprained ankles or minor injuries (that is the job of the St John’s ambulance). We also don’t look after the players who get hacked down and are unable to walk, only to watch them turning somersaults a scant 5 minutes later when their team scores a goal (that is a job for the private medical firms).

So, unless a stand collapses, there is a major fire, a bomb goes off or someone drops dead in front of us, there is very little we have to do. At the West Ham ground (my local football club), there are four ‘road crew’ present, along with at least one major incident support vehicle, one radio operator and an officer. The road crew sit down near the pitch, while the officer and radio operator sit in a VIP box overlooking the whole ground.

Today I was given the role of ‘safety officer’, which doesn’t mean I’ve been promoted, it just means that in the event of a major incident, I’m supposed to watch out for the safety of the ambulance crews present, liaise with the police and fire service about any hazards that might be a problem, and to make sure that any crews that attend the incident are not getting too stressed. I also have to talk to the person in overall control at the incident about any issues within this sphere that may occur.

We were warned that there was an increased chance of violence at this match because some hooligan ‘supporters’ were appearing before the magistrate tomorrow, and that some of their ‘crew’ might want to cause some trouble. Luckily for us, that did not happen, despite a 2–1 loss.

It was really cold down there in the stands, I had my undershirt, shirt, body armour, fleece and hi-visibility all-weather jacket on, but I was still freezing. Anyone listening carefully as I walked around trying to keep warm would have heard a clink-clink-clink-clink sound as my frozen balls knocked together.

As I’ve mentioned before, I’m not a huge fan of football (overpaid idiots, getting more money in a week than I get paid in a year for booting around a plastic ball), so I spent most of the match listening to music (The Magnetic Fields) on my smart-phone, while stamping around trying to get some sensation back in my toes.

As a quick aside, who needs an iPod Shuffle? My smart-phone can do the same thing and more – it can even make phone calls …

Half-time came and went so we joined the St John’s Ambulance for a cup of tea and a sandwich, rather than watch a bunch of scantily clad young women prance about. Then we were back in the cold, where I tried to stay awake while West Ham, perhaps predictably, lost …

With the exception of someone having a crafty cigarette and setting off a fire alarm, it all went rather smoothly. I did find it funny that the people in the stadium knew what the ‘Inspector Sands’ announcement meant, and did nothing but laugh quietly at it.

At the end of the match we have to stay around until we are ‘stood down’ as the last few supporters leave, so we sat in the ambulance, with the heater going, wrapped in our own blankets (remember, we know what those blankets have been wrapped around, yet we still used them – that is how cold it was).