The Complete Blood, Sweat and Tea
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We met with the police officers (nine in total, and all rather scary looking plain-clothes types) at the police station, before following them to the address in question.
Once the police had made their entrance we were called forward to give the patient a clean bill of health. We watched as this frail man slowly dressed, needing help from his son to tie his shoelaces; we watched as he struggled around the house and wondered how he could possibly be guilty of any crime that needed any form of physical exertion.
The patient’s son was also a bit put out by the allegations, and promised to have a good laugh at the police’s expense when the truth came out.
Throughout the arrest the police were polite, helpful and behaved in a thoroughly professional manner at all times.
The patient/arrestee was also calm throughout and the whole thing went, as far as I could see, very smoothly, and our ambulance followed the car in which he was taken, until it entered the police station and the FME (Forensic Medical Examiner – a doctor that the police use) took over.
The next job we went to was to outside the same address: a woman had been mugged and the police who were searching the address had called us as she had a rather large bump on her head. Unfortunately, the mugger managed to get away. It surprises me that you can get mugged outside a house full of police and the mugger can still escape.
Imagine, if you will, getting sent to a job where a 15-year-old boy is threatening suicide. You turn up at the address and discover that it is a care home. Meeting with one of his carers she hands you a list of the boy’s medications and it reads like a ‘Who’s who’ of psychiatric drugs. You talk to the boy, and he seems calm, collected and very polite. He explains that he wants to jump out of a window and kill himself, and agrees that he would like to go to hospital. You take him into the paediatric department of a local hospital. As this does not feel like the normal ‘Teenager wants to kill themselves’ you have a chat with the children’s nurse and you ask them to let you know what happens to the patient. You leave, and continue with your shift. The next day you ask the children’s nurse about the patient and she tells you ‘The boy wanted to die because he wants to have sex with, and kill, small children – and that he knows that it is wrong’.
I hate paedophiles as much as any other member of society, but in front of me that day, I saw a victim.
One of the jobs that I both enjoy and hate is for a ‘Collapse behind locked doors’. This is when a (normally elderly) patient has not answered the front door or the telephone, and is presumed to be in some trouble. What we often get is someone who has died during the night. Although I hate having people die, the one good thing about this type of job is that I get to use my size 12 boots to kick down a door.
There is a skill to kicking down a door, and I was taught by the best – a policeman. The police also have a huge ram that they can use when their boots aren’t enough. These are very heavy, but also lots of fun to use.
We got called to a house where the daughter could see her elderly mother lying on the floor; shouting through the door and banging on windows didn’t get any response, so we assumed the worst. The daughter was (understandably) crying, so I had an attempt at kicking the door down.
Unfortunately for me, the woman had been burgled earlier in the year, and so had two locks, and a bolt holding the door shut, so it took a couple of minutes of prolonged (and eventually painful) kicking to get the door open. I also managed to wake up all the neighbours, and it’s always fun to be the centre of attention …
Finally, the door gave and we gained access, we were greeted by the elderly woman sitting on the floor smiling at us – earlier in the morning she had fallen and couldn’t get up. When we had tried banging on her windows she had been asleep, and it was only the repeated bashing of my foot against her door that had caused her to wake up.
This was a good job in a number of ways: the lady was happy and healthy, and just needed a hand to get up off of the floor; I got to kick in a door and get away with not causing any serious damage; and finally we looked like heroes to the two daughters of our patient. There were smiles all round and we left the job feeling that we had really been of some use today.
I know that the ambulance service is being used as a substitute GP service these days, but it really takes the biscuit sometimes. Take, for example, the job I was sent on last night. It came down to our ambulance as ‘Patient wants to kill his doctor’.
I immediately called up Control on the radio and asked if we were being sent because they couldn’t find the patient’s GP? Although I was half joking, I wondered what good we could do for the patient. Control got back to us, and let us know that they were sending the police, and that we should wait until they turn up. However, when we arrived at the address we knew who the patient was – so we cancelled the police and sorted out the patient’s problem.
I mention this if only because, when I got back on station and read the local newspaper, I found a story about a coroner’s investigation into the death of a 55-year-old female who had taken a fatal overdose of bloodpressure medication. When Control asked if she was violent, they were told that yes, the patient was violent. The police were called and the crew waited at a rendezvous point for half an hour until the police turned up. By then it was too late, and the patient died. Once more, the paper blames the ambulance crew. It doesn’t blame the psychiatric services who discharged her a few weeks earlier after a failed suicide attempt, neither does it blame the person who made the phone call that said that the patient was violent. It blames the crew who, quite rightly, waited for the police. If one of the crew had been stabbed to death, it might be a more sympathetic headline. We are expected to go into people’s houses, where we have been told that the patient is violent, where we could get assaulted or even killed – but as soon as we start thinking about our own safety, we are the ones to blame for anything that goes wrong with that patient.
Violence from the drunks, druggies and criminals doesn’t worry me – the job that worries me is the little old lady who has become confused and is sitting in her living room with her husband’s service revolver, or her favourite kitchen knife, desperate to stop the strange men in green from stealing her away in the night.
As normal the ambulance service has investigated, but in a show of support for its road staff, has stated that the policy of waiting for the police at a rendezvous point is the correct thing to do.
We are not cowards, but neither are we stupid/paid enough to wander into dangerous situations.
I’ve just gotten on station for the start of my shift, only to find out that some scrote had broken into the station last night and nicked the video recorder and DVD player.
I mean, it’s not like we are ever on station long enough to use them, but it’s the principle …
These are the sort of people that we serve, these are the sort of people we are polite, professional and caring towards – and this is how we are repaid …
It’s getting so you have to tie things down now …
Yesterday a ‘Decontamination POD’ truck was stolen; this is an unmarked truck that we use to carry around chemical incident equipment. The current word is that this truck was carrying a load of atropine, which is the treatment for nerve agents.
If people were to start injecting this into themselves, they could get serious (as in fatal) effects.
I leave it as an exercise for the reader to decide if this is a good or a bad thing …
Still no drunks, but the weekend starts today and my shift ends at 2 a.m. …
I’m going to describe a job I went to last night.
The patient is female and 30 years old. She is married and is attempting to get pregnant. The only medicine she is taking is fertility treatment, and she is (obviously) having unprotected sex; she is normally fit and healthy and has no allergies. Her normal menstrual period is regular, but her period is over 2 weeks late this time around. She has been having nausea and vomiting for the past 3 days. She has no abdominal pain, and is not tender or guarding. She has no pain or increased frequency of passing urine. All vital signs are within normal limits.
So … given this information …
(a) What do you think is ‘wrong’ with her?
(b) Does she need a trip to hospital in an ambulance?
(c) Why do you think she hasn’t done a pregnancy test?
Sometimes a day can just drag along. Today, due to rather unusual circumstances, the day really dragged. Here is the time-line of today:
10:00 Turn up for work, brew a cup of tea.
10:01 First job of the day, taking someone from Newham hospital to Barts hospital.
10:02 Cut my finger on my locker door, try to stop bleeding, look for plaster.
10:23 Give up search for a plaster – there are none on the station – leave for Newham hospital.
10:26 Arrive at Newham hospital, ask for plaster; they also don’t have a plaster so I now have a huge dressing on my finger.
10:28 Meet with patient, pleasant woman – meet nurse who will be accompanying patient, barely understand nurse because of her inability to speak English.
10:30 Get patient’s notes and read them – they make more sense.
10:32 Ask nurse in charge why this patient (who is having cardiac monitoring and a blood transfusion) is going to an outpatient department. Get told that the patient ‘just is’.
10:54 After packaging the patient on a stretcher, loading them on the back of the ambulance, we set off for Barts hospital.
10:55 Nurse escort tells me that she gets travel sick.
10:55 and 20 seconds Give nurse a vomit bag.
11:37 Arrive at Barts hospital.
11:38 Enter outpatients’ department. Reception seem rather surprised to see patient on stretcher appear in front of them.
11:40 Problem is referred to the sister in charge, she also looks befuddled.
12:00 We wait while sister in charge phones around the hospital trying to work out why this patient is in her outpatient department.
12:30 Still waiting … We let Control know why we are waiting – there is no stretcher/bed to put the patient on.
13:00 Still waiting.
13:30 Still waiting – we let Control know that we still have the patient on our stretcher while they work out what they are going to do with our patient.
14:00 Still waiting.
14:30 Still waiting – we let Control know that we haven’t gone to sleep, we are told by sister in charge that patient will be admitted soon.
14:45 We place patient on an examination bed so that we can go back to answering emergency calls; patient will hopefully be in a hospital bed soon. We leave the nurse escort with the patient.
14:48 We are finally available for another job.
14:49 We realise we have nearly no fuel, and no fuel card to pay for fuel. We decide to return to station to borrow a fuel card off an unused ambulance.
15:20 We arrive back on station to look for fuel card (and have a cup of tea).
15:30 We leave to get fuel. Take infusion pump back to hospital – the ward seem surprised that the patient has been admitted to Barts.
15:48 We have fuel, we are now ready for another job.
16:00 We get a call, out of area Matern-a-taxi.
16:09 Arrive at Matern-a-taxi, contractions (genuinely) every 2 minutes, previous baby born in 3 hours, drive rather quickly towards her booked hospital.
16:12 Patient’s waters break – start swimming in back of ambulance.
16:20 Arrive at hospital.
16:24 Throw patient at midwife, run back to ambulance.
16:30 Tell Control that we need to return to station to mop out the back of the ambulance.
17:20 Get back to station, mop out.
17:45 Crew to relieve us are already on station; await ambulance to dry out.
18:00 Leave for home.
18:37 Get home, collapse into sofa, start writing this post.
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This is how you get to work an 8-hour shift, yet only do two jobs …
After this post I got given a box of plasters by a fellow blogger. No more searching around ambulance stations for sticking plasters.
I should be working today, but (and I want loads of sympathy here folks) I’m off sick with a work-related injury. Thankfully, it’s nothing too serious, certainly nothing as serious as last time when I swallowed HIV-positive blood.
On Thursday we got called to a big conference centre in town for a (possibly) suspended/dead/fitting male. We rushed over there and were met by their security who had rather cleverly staked out both entrances to this place so that they could lead us to the patient. Parking up we had to climb a couple of flights of stairs carrying nearly all the equipment from the ambulance. Our first-response bag, oxygen and associated kit, defibrillator, suction and carry-chair are quite heavy and, as we were in a rush to get up the stairs, we were a bit out of breath when we reached the patient.
The first thing that we saw (and were very happy about) was that the patient had not suspended, and was instead thrashing around on the floor with some security guards and the centre’s medic sitting on top of him. Approaching closer we saw that he wasn’t fitting, but was instead very combative, trying to fight off the people who were holding him down in a very confused nature. ‘Aha!’ we thought, ‘he’s post-ictal’.
During the post-ictal phase of a seizure, the fitting has stopped, but the patient is often disorientated, sleepy or aggressive. In this case it appeared that the patient was both confused and aggressive – he was not responding to anyone trying to talk to him to calm him down, and he could only make guttural sounds. Normally, these episodes last less than half an hour, so we stay with the patient until we can get them into the ambulance.
Sometimes the aggression can come from physically being held down – the patient is confused and frightened, and all they can feel is people holding them down, so they struggle. I suggested that the security guards let him go, which resulted in the patient trying to stand up, only to fall over again (don’t worry, we caught him) and unfortunately the centre medic got a head butt for his trouble. I managed to get a blood glucose reading, which was normal, and a work colleague phoned the patient’s mother, so I could get a bit of history. The patient is normally fit and healthy, not diagnosed with epilepsy, but has had 2 fits in the past 2 years. All during this phone conversation the mother could hear her son shouting in the background. He had never been violent before.
We resigned ourselves to a bit of a wait, so we managed to get him over to a leather couch, and held him down there. After 10 minutes there was no change in the patient’s condition – normally they get a bit tired or they start to have a change in their condition. So we started to think about other ways in which we could help the patient at the scene. We couldn’t get him to the ambulance while he was so combative, and so we thought he might need some form of sedation. I ran back to the ambulance and asked Control to get us a BASICS doctor, or at least someone who could give some form of sedation.
Instead after about 10–15 minutes we got the PRU (Physician Response Unit), which is a new service where a doctor from the Royal London Hospital covers medical emergency calls – it’s a bit like HEMS, only without the helicopter, and instead of going to trauma they mainly deal with medical emergencies.
The doctor (who is a very nice man) and paramedic crew with him took one look at the patient, listened to the history and decided that sedation was a very good idea.
Cut forward 40 minutes’ worth of trying to sedate the patient with increasing amounts of medication. For the medically trained out there, the patient needed 10 mg haloperidol and 17 mg of midazolam. At one point the doctor was thinking about knocking the patient completely out and intubating him. Luckily the patient was sedated enough for us to get him out of the conference centre and into out ambulance, where we ‘blued’ him into Newham hospital just in time for him to wake up (the sedation lasting only around 15 minutes) where the doctors there did paralyse and intubate him.
We have few ideas why the patient was so violent and so deeply confused – it’s something that will be investigated in hospital. We were considering epilepsy, head trauma (from when his head hit the floor), meningitis (so antibiotics were given on scene) or some form of brain insult. I’m asking my crewmate to find out what happened to the patient.
The reason why I am off sick? Well after holding the patient down for an hour and 10 minutes, I managed to sprain my thumb. Since I can’t be considered safe to carry a patient downstairs, I’m taking today off (plus 2 days of leave) so that my thumb can heal and I can get back to saving lives picking up drunks again on Monday. Oh, and it’s my birthday tomorrow – 33 is such a young age don’t you think?
I did manage to see the patient again … see the next entry.
I went to visit our patient from the last post. This morning I’d put my hand in my pocket and found that I had £2.66 of his money that had spilled out of his pocket during our struggle and I’d put it in my fleece for safe keeping – given the saga of the job, I’d forgotten to hand it in when we reached the hospital. I thought it would be best if I returned it to him, so I had a chat with the lovely receptionists at the hospital, and they told me what ward he was on.
I went to the ward to find him sitting there, seemingly none the worse for wear. He did have a bit of a black eye (not my fault … honest), and when I spoke to him he told me that the doctors suspected that he had fainted, and when he had hit his head had suffered a form of concussion. His CT scan and blood tests were all normal, although I suspect that they will be running EEGs (electroencephalograms) and other more detailed tests a little later. He told me that he was feeling pretty much normal and I suspect that they are keeping him in hospital to continue to run their tests.
He was very pleased to see me, and we had a little chat. I offered him his money but he refused and suggested that I get myself a pint with it.
It’s the first time I’ve actively gone to look for a patient after bringing them into hospital – and it is a weird experience going into a ward to see a patient whom I last saw trying to fight me. Yet another new thing I’ve done because of writing this blog.
I’ve mentioned before how the ambulance service and the A&E department are often seen as a ‘safety net’ by other health-care providers. Both yesterday and today we had perfect examples of this.
Yesterday we were called by a 70-year-old man with a urinary catheter which had blocked. This is a fairly simple thing to solve as it just needs a flush of water up the catheter to clear the blockage. It’s a 5-minute job that we, as ambulance crews, aren’t allowed to do. However it is the sort of job that district nurses are supposed to do.
So why hadn’t a district nurse been to see the patient so that she could flush the catheter and prevent the patient from having to attend A&E? Why was the patient, who had phoned up the nurse himself, and told her exactly what he needed doing, forced to call an ambulance?
Because the nurse didn’t have any water to actually flush the catheter. It’s a bit like if I turned up to someone having an asthma attack, and didn’t have any oxygen to give them.
So the district nurse told the patient to dial 999 for an ambulance. We arrived and found him with a bladder so full it was causing him severe pain. We took him into Newham hospital, who, within minutes, had cleared his catheter, and eased his pain. They gave him a ‘takeaway’ bottle of water so that the district nurse wouldn’t have an excuse the next time she needed to visit him.
Today, we were called to a patient who needed his anti-Parkinson’s disease medication. He had a carer, who was supposed to visit him once a day to clean and arrange his medication. But for the last 2 days, because the ‘carer’ couldn’t get in touch with the patient’s GP, she’d just left him without his medication. We turned up, not knowing what we could do to help. The flat in which the patient was living is brand new, and yet was already very untidy. The patient told me that he was lucky if the carer spent longer than 5 minutes with him (the carer is contracted to work with him for an hour a day).
This poor man was left, alone and shaking, with a carer who seemed to think that if she ignored this ‘problem’ it would soon go away. So, we did the only thing that we could: we took him to hospital, so that they could sort out his medication for him. Meanwhile I filled in an ‘LA260’ which is a ‘vulnerable adults’ form and allows the LAS to bring situations of abuse, and potential abuse, to the attention of the local social services. They now have the name of the care agency, and this problem can be solved before it repeats itself in a month’s time.
Hopefully, someone will get a bollocking, and our patient will get a carer who actually cares for him.
It often feels that we, and the local A&E departments, are left to do the jobs that other people should be doing, but because we are there, these other agencies don’t seem to care about doing a competent job. I’m aware that there are probably loads of health visitors/social workers/district nurse/CPNs and GPs who do actually give a damn about their patients – it’s just that we never seem to meet them.
I never did get any feedback from the LA260 that I filled in – normally you get a little note sent to you explaining what has been done to resolve the situation.
Our ‘interesting’ call of last night was a Matern-a-taxi. What, I hear you ask could be interesting about taking a pregnant woman 1.2 miles into the local maternity department?