Ben Yatzbaz asks us to think about kids for this months edition of ‘The ‘Handover’, which will be published at his blog ‘The Insomniacs Guide to Ambulances’ on Friday, 30th October

Whenever a new theme comes up, I always find myself stumbling around for a few weeks trying to remember jobs that would fit with what the host for this months edition wants. Sometimes, I write something Im proud of and sometimes I struggle to find inspiration for that particular topic.

If you have been reading this blog for more than the last couple of months, you will know that I have already covered a fair amount of ground on some of the emergencies that I have been to that have involved children. These always tend to be the dramatic ones, the ones that stick in your memory for a loooooooong time to come, and the ones which are usually the most traumatic.

But, there is another side to some of the children that we see day in and day out, whilst going about our daily work, and that is what I want to concentrate on for this post.

Children are truly amazing. They have a tenacity, strength, outlook, and coping mechanism that is just awe inspiring. Sometimes I can be trying to deal with a distraught patient or family member and the child who is in the room is the most sensible and calm one there. Now, this may be down to age and not understanding the full implications of what is going on, but occasionally I think it is as a result of a childs in-built ability to adapt and adjust when things go wrong without having 20/30/40 etc years of conditioning and reliance on others to taint their point of few.

Lets have a look at a couple of examples.

Sam, who is a 16-year-old boy who has to look after his Father at least once or twice a week as he goes into a hypoglycaemic coma. I have known Sam since I started 9 years ago. I have seen him grow from a 7yr old who used to come down early in the morning and let us in the house so that we could look after his Dad, to a 16yr old, who still lets us in early in the morning so that we can reverse his Dads hypo. I feel as though I know him really quite well and I get a running update on what he is up to each time I get to see him. I have heard about his first girlfriend, his first competitive football game, his SAT results and various other benchmarks through his young life. He now has to come to terms with the decision he has to make on whether to go to university somewhere away in the country or if he should just stay in Newcastle so that he can remain at home and look after his Dad.

Julie and Jack 8 yr old siblings, who could only say one thing after my partner for the day, took them into another room to tell them that their Mum had just died (after finding out from neighbours that there was no other family involvement) – “So who is going to look after us now?” (Christ, that was a tough one to deal with)

Conner, the 6 yr old who has been hit by a car and has a horrendous open deformed fracture of his left lower leg. His bottom lip is quivering, but he doesnt cry out as I place a cannula in his arm, and only whimpers when I pull on his leg to bring it back into some sort of normal position. He manages to keep calm right up until the point that Mam arrives on scene.

Joe, the 10-year-old who is suffering with a terminal brain tumour. He is having problems with his last lot of chemotherapy and now has effectively no immune system and currently has a raging temperature and rigors, but still tells mum and dad that “Its OK, dont worry”, and flashes me the most amazing smile that I can still see vividly to this day.

Then there are the countless nameless children that I see on far to a frequent basis who have been unfortunate enough to have been brought into this world by parents who are addicted to various substances which become the priority in their lives, even over their own children. I look on virtually helpless, seeing them living in conditions which I wouldnt dream of letting children be in. But this is the norm for them, they dont have the things that many children of their age will have, but they still run around playing with their friends and wanting to ask questions about whats in my bag, ‘The funny machine’ (my defib) and my ‘ambulance car’ outside. You can see the eagerness to learn and develop in their eyes but you can’t help but walk out of the house wondering what the future holds for them. All I can do is alert the social services department by filling in a ‘vulnerable child’ form and hope that something is done to ensure the child gets the best possible chances out of life……..I can live in hope, cant I?

And then there is the best sound that any paramedic can hear. That of a baby crying loudly!

There have been so many times in my career when I have been sent to a job which sounds like it’s going to be one of those ones that you wish you didnt have to deal with:

“2 year old, going blue. ? Breathing”

“10 month old girl, choking, ? Breathing”

‘3 month old boy, un responsive, pale and floppy”

But when you get on scene and go running into the house you hear a wonderful noise of a screaming or crying baby, which tells you straight away that Airway, Breathing and Circulation are all ok at this precise moment in time.

Unless of course that is the screaming coming from the patients sibling (but thats a whole different story).

Children will always be the ones that can potentially break a paramedic, I have seen children die, I have dealt with two cot deaths, 3 still births, 1 child cardiac arrest and a couple of ‘expected’ children’s deaths. I have, so far, managed to escape from the ‘traumatic child death’. That is the only thing left on my imaginary tick list that has been in my head since I started the job. I have worked through all of the others over the years and know that I can deal with them, but I really dont know how a nasty child death will affect me.

Hopefully, I will go until retirement without ever finding out the answer to that one but until then, I will still get my joy from seeing some truly inspiring children who could teach many an adult a thing or too about coping and dealing with what life throws at you.

Right guys, my new home is now open for visiting…

No further posts will be published on this blogsite. To keep reading my blitherings you will need to go to :

www.999medic.com

For my readers, please update your bookmarks/favourites/rss feeds/bloglines etc etc to point to the new address.

For my blog buddies, please update your blog rolls to link to the new address.

Thank you for making this blog into far more than I could ever have hoped for, over 100,000 hits since January….Now my new site has a count of 0 !!

Please come over and have a look and let me know what you think of it!

See you over on the other side

I have been reading through some of my favourite blogs again tonight (as I do every day!!!), when I came across the latest post from ‘Not Trained but we try Hard’.

In this post, FireCap5 shares with us his experience at this years Memorial Weekend.

Now, I dont know a whole lot of what this is all about, but looking at the National Fallen Firefighters Foundation web site, brings it all home.

What an amazing thing to do for the families of those who have lost loved ones whilst they were performing their duties. I dont know if there is a similar thing for Paramedics and EMTs who are not part of fire departments or if this is just a fire service thing, but either way….Wow!

I have also been speaking to a few of my blogger friends about various ceremonies that they do, one of which is the Wake County Cardiac Arrest Save Ceremony. This is an annual event which follows the following agenda :

The program goes like this:

• An outside reception with snacks and light sodas.
• An opening ceremony involving presentation of the flags by fire/EMS honor guard personnel, accompanied by our Public Safety Pipes and Drums.
• The National Anthem
• A blessing by the chaplain
• Opening remarks by the Chief of EMS, the medical director, and the fire chief
• A speech thanking the medics by one of the elected officials (the Mayor or the Chair of the County Commission)
• A keynote speech, by a survivor or a member of a survivor’s family, usually accompanied by a  slide show.
• Those who have participated in saves are called to the stage by individual save, announced by date, patient age and gender (no names).  They shake hands and get presented with their “save pin” which are a bar worn on the dress uniform.  After the first one, they have numbers to indicate subsequent awards.
• Closing remarks.
• Adjourn

The photos from this years ceremony can be found at http://www.flickr.com/photos/leewilson/sets/72157618513988250/detail/

The more I get to know my American friends and colleagues (dare I say, brothers, or is that too American as well?), I realise more and more that there is so much more that we can do in the UK to value the service that we provide to our communities. I know there are many ambulance staff who will think this is all just ‘American Patriotism’ and Fire Fighter worship, but wouldnt it be amazing to be part of a ceremony like the ones described above.

The closest we have over in the UK is this: http://www.freewebs.com/national-ambulance-memorial/, which pales into significance. This isnt meant to berate what the guys at the National Ambulance Memorial have done, as without them, there would be absolutely nothing! But what it does show, is that there needs  to be some real committment and money put in to getting things like this up and running.

I know that we will never have the same sort of ceremonies as our American brothers and sisters, but we should really strive for more!

I and my steadfast friend Fi, have already started work on something that we will be taking to the ‘powers that be’ sometime in the next few months. Lets see how that works out!

Quick folks, go back to the ‘Blogger Meet up’ Post from yesterday and check out the first comment!

The previously fully annonymous Happy Medic is starting to come out from behind his mask. Read his comment and you can finally know where he is the U.S and where I am going to be working in a little over 3 weeks!

I dont know, next think we all know, he will be putting up a photo of himself and telling us all his real name!!!

Well its really starting to get close to the culmination of 9 months of planning… I will be heading off to Happy Medics neck of the woods in 3.5 weeks to witness first hand, the life of an American Fire Fighter Paramedic. Its going to be an amazing trip which I still can’t really believe that I am going on.

Happy Medic is coming back to wonderful sunny overcast, rainy and cold Newcastle on the 19th November, to see how the NHS Ambulance service differs from his own Service back home in the States.

As part of his time over here, we are organising a night out in Newcastle to have a ‘meet up’ with any of the UK bloggers who know us and would like to meet up and have a chat and put faces to blog names for a change.

The invite also goes out to any readers who would like to come and say hi to Happy Medic and I.

The meet up is going to take place on Wednesday 25th November. If you would like to come and say ‘Hi’ or would like any further information, just leave a comment (an email address) or just send me an email and we will get things organised.

There is a Blogger meet up over in the States as well, to tie in with me being over there (details will be posted over at Happy Medic), so if you fancy??

Sitting in the car on standby, it’s nearly the end of a long and busy shift.

The siren tone on the computer screen alerts me to the likelihood of another late job……Champion!

I look down at the screen:

“34 yr old female, Pregnant, wanting to push”

Oh well, might as well finish the shift on a high! I head off at speed, half excited and half nervous (you can see why in my post ’scary babies’). Ive only travelled a few hundred yards when the radio is activated:

” Medic999, just to let you know this is coming through as a ‘Cat A’, due to the fact that she is only 21 weeks pregnant”

“Yeah, thats received!”

” Unfortunately we dont have anyone to back you up at the moment but we will get a crew on the way as soon as possible”

OH CRAP!!

It had been a really busy day, and I know that everyone had gotten a beasting, and I guess sheer call volume had left me on my lonesome.

I continue on my way going through in my head what I am going to do, and what I might need to do.

I arrive on scene and as I walk in, I hear screaming coming from upstairs.

“Medic999 to Control…..Have I got a crew travelling yet?”

“Thats affirmative, they are coming from quite far away station and should be with you in about 10 minutes”

Phew, thats not too bad!

It turns out that the crew arrived in time, and they even got her to hospital without any baby making an appearance. She did appear in active labour but I sincerely hope that they managed to stop little one coming too soon.

It just goes to show, sometimes the anticipation is sometimes worse than the actual outcome every now and then!

For those EMS types that read this blog, whats the most jaw dropping message you received over the radio from your control?

Since the post I put up the other day about the Camera man and EMT has started off a bit of a ‘legal’ discussion, I thought I would capitalise on the clever folks who read this blog to answer a hypothetical question for me (heres initially looking at you Star of Life Law and TOTWTYTR, but I would love to hear from anyone who has an opinion or any legal know how, especially any UK lawyers, so that we can have a UK law perspective too).

Lets just imagine that 2 bloggers are about to cross the Atlantic ocean to go and work alongside each other for a week (Imagine that??). They are both really excited about it (like kids before Christmas), but at times one of them goes off and thinks about all the various possibilities that could happen whilst he is in the other ones country (Can you think of which one it may be??).

He all of a sudden comes up with a scenario in which he knows what he would do, but doesnt know if it would get him in trouble or not, legally. So here is the scenario…….

Initially, when ‘The Project’ was born, the plan was that when Happy Medic was over here in the UK and when I am over there in the US, we would be actually participating in clinical care (like a student working under a Mentor), that way we could really feel as though we were part of the system for a while. However, back in the real world, the powers that be ran as far away from that idea as possible and the expected instruction of ‘Observation only’ was passed down the chain.

No big surprise there, and to be honest, it is what we had expected all along, and thats fine. But….

What if, for example, I am working along with Happy Medic on a shift, and we are sent to a major incident (or Mass casualty incident)? Highly unlikely I know, but possible. More likely however, would be a multi patient vehicle accident which is well within the realms of possibility. Now, I am there purely in an observation capacity, I must not touch a patient!

I am already wary of the apparent litigious nature of the US health care system and its users, but could I stand by and not intervene clinically if there was a real need?.

Im talking too many patients for the Paramedic or Paramedics on scene (actual poorly/critical patients, not just standing around holding their necks)

I will be standing there in my NHS uniform which states across my chest pocket that I am a paramedic, but I am not providing any assistance.

Whilst I am not breaking the rules by not providing clinical treatment in a country I am not registered to provide care in, could I be held accountable for causing harm by omitting the provision of care, when I am trained and registered to do so (albeit in a different country)

Theres the dilemma!

It’s very easy to say what should be done, but it would be much harder to do that if the situation arose. As I said, I am pretty sure I know what I would do in that circumstance, as would be the same answer for virtually all paramedics out there. But its an interesting thought.

Is there a precedent for this sort of thing, or is it the usual you make your choice and you take your chance?

As any paramedic or EMT will tell you, the opportunities to really make a difference dont come around very often. The times when you can say that you actually did save a life.

There are many times that we can say that we relieve or ease  someones suffering, or help them get to the place they need to be, to continue their care. Even just reassure them and let them know that everything is going to be alright.

These are the reasons why we come to work day after day and night after night. Some would argue that it is self indulgent, but the feeling of actually helping someone or even sometimes saving their life is a wonderful one, not generally experienced by the vast majority of the population on a daily basis!

This was one such time…..

Working with my crew mate Tim, we were dispatched to an elderly male collapsed outside of a local cafe. No further information was immediately available, so this could be one of many different scenarios we were travelling to. During the drive, I had the ’spidey sense’ feeling come over me, and looked over to Tim.

M999: “This is going to be an arrest, I can just feel it”

As we arrive on scene, I glance into the door way and see our patient sitting slumped against the door. His head virtually resting on his knees, obviously unconscious. Even from this distance I can see the all too familiar blue/purple/grey tinge to his lips and face.

M999: “Told you….Lets have the stretcher straight off and we will get him into the back”

As Tim lowers the tail lift and gets the stretcher from the back of the ambulance, I grab the first response kit, Oxygen and defibrillator. As I arrive at the patient, a member of staff (who is just standing over him) says

“He is still breathing isnt he?”

M999: “Er….No, no really. Can I get into him please…..Thanks!”

I get behind him and place my arms under his. I pull his dead weight up and around to the side so that I can manoeuvre him away from the door and onto the path,lying him down in the process. As soon as he is down on the ground, on his back, with his head and neck at the proper angle he takes a couple of agonal gasps. For those that dont know, these are like a last ditch attempt by the brain to try and get some oxygen into the brain and heart to maintain life. They are also the reason why recent CPR guidelines have changed from “is the patient breathing?”, to “is the patient breathing normally?”.

A patient’s heart could have stopped and they could still have a few agonal gasps before they stop as well. Many members of the public understandably assume that an agonal gasp means that the patient is breathing and therefore has a heart beat.

(Just as a side note – here is a video clip from you tube of a successful resus which shows a great view of ‘agonal respirations’ at 3:30 in to the clip)

In this case, it just so happened that my patient did actually still have a heart beat, although going a little slow. Cool, we might get this one back!!

Oro pahryngeal airway in, Bag and Mask on, good seal and good ventilation…..Champion.

Tim brings the stretcher along side and we hoist our patient onto it and move him into the back of the ambulance. Now for the choices, how do I maintain his airway?

He is tolerating the OPA, therefore I consider intubation or LMA. In this case, I opt for one of the iGel LMAs that I have been trialling. It goes in easily but my gentleman decides that he doesnt really like having a big piece of plastic/rubber pushed down his throat and his gag reflex starts to kick in (Great!!, these are all good prognostic indicators). As I was getting good air entry from bag valve mask, then it’s a no brainer to just go back to OPA and BVM which he tolerates well. Tim gets the ECG and monitoring attached, then takes over ‘bagging’ our patient whilst I gain some IV access. I then decide to free up one hand by attaching the face mask to our ventilator instead of manually compressing the bag to ‘breathe for the patient’. I set the ventilator to CMV/Demand, which means that the machine will do the breathing for the patient at a set rate, but if it detects that the patient attempts to take a breath for themself, then it will provide support for that intake of breath also (Clever stuff really!)

Once all thats done, it’s just time for a quick pre-alert radio call to the hospital and off we go, lights and sirens up to the hospital.

On the way, as I test for response to verbal stimulus, his eyes flick open for  a short split second. I try again and the eye’s spring open once more. 5 minutes down the line and I hear the ventilator change its rate in response to a deep breath taken by our patient. His heart rate is back to normal limits now and things are most certainly looking up.

By the time we transfer him to the waiting team in resus, he is now making regular efforts to breath and open his eyes when you verbally prompt him to.

He isnt out of the woods yet, but is certainly on the right path.

I complete my paperwork then pop back behind the curtains to see how he is doing before I leave. I find out that his name is Richard and according to his records is a 74 yr old COPD sufferer. He is now breathing regularly and doesnt need bagging. The doctor in charge of the team gives us a ‘well done lads’, and off we go with a bit more of a spring in our steps than before.

So did we save a life, that day?

5 hours later, we were taking a routine admission patient into the medical admissions unit of the same hospital. Once we had got that patient moved over onto her bed and handed over, we left the ward, moving past the various patients waiting to be seen and moved onto the ward they will be spending their time in. I passed one man happily tucking into his evening meal (which actually looked rather tasty – or maybe that was just because I was starving) and had to stop and take a second look.

M999: “Tim, look!!…Thats Richard!!!”

I decided not to disturb him, It is highly unlikely that he would remember Tim or I, and to be honest, it was enough to see him sitting up eating his food, not even on any oxygen.

As the title to this post states, ‘Simple Actions Save Lives’

The single most important thing that I did in this case was to move Richard from his position we found him in and open his airway. If that had been done earlier by a member of the public, he would never have been so close to death. What the medical team think happened, was that he had difficulty breathing with an exacerbation of his COPD which ultimately made him lose consciousness. Once this happened his position in the door way resulted in his neck flexing forward to the point that he obstructed his airway and effectively asphyxiated himself.

The action of opening an airway and breathing for him for a while was all that was needed to get him back from the precipice.

It may not be much, but it feels good!!

There have been some interesting posts pop up on some of the blogs I read during the last 24hrs. It appears to have started over at Statter 911, where a post was put up describing a video that is now doing the rounds on YouTube, showing a Fire Fighter/EMT from Keene (N.H – Is that new Hampshire?) getting a little upset with a cameraman/photographer who was recording film of him whilst he was performing his duties caring for a patient.

There seems to be a lot more involved in this than initially meets the eye, as you will see from the video produced from the `Free Keene` free rights/anti government group. I can imagine that there may be some history in this town with this group and the various government departments.

The interesting thing from an emergency care perspective though is to watch the video and imagine what you would do in his situation. You are caring for the patient and acting as their advocate. You will obviously be thinking about their confidentiality and may act in the same manner.

You will hear a lot of talk about HIPAA violations. This is the Health Insurance Portability and Accountability Act 1996, which basically covers all patient confidentiality /patient identifiable information issues over in the U.S.

Here are some links about HIPAA if you want to know more (or want to nod off to sleep) Link 1, Link 2, Link 3.

Happy Medic also mentioned HIPAA in a recent blog post which explained things and how they directly relate to patient care in a much simply way. Although this is all American Jargon, what I can tell you from my experience of filming the ‘Emergency’ TV series over here in the UK, is that the law about filming in a public place is the same as in the U.S. Basically once you are out in the open, you lose the right to anonymity as you are in a public place, and therefore you can be filmed/photographed etc without your explicit consent

Anyway, here is the video..Have a watch, spend a little time thinking if you would have acted the same way, then click here to read the legal standpoint from Star of Life (paramedic and attorney!), and also from Steve over at the EMT Spot. Their views certainly opened my mind as to what is the right and wrong way to handle situations like these.

So, would you have done the right thing?

Let me know……..

Well, I am on to day 4 now and am feeling much better. I still feel sniffly and bunged up, my chest hurt likes hell when I cough, but I just feel like I have a cold now, nothing more. My temp is down to the low 37`s and I am hoping to get back to work for the weekend.

Its been interesting going through it though. I have joked on about how I have a new empathy for my patients that I have seen already and that I will care for in the future, now that I have had it too, but it really will make a difference.

It wont change the fact that it will be very unlikely that I will be taking them out of their house and off to hospital (unless something is seriously wrong), but it will increase my understanding of why I will be standing in front of them, with my mask on and apron tied, in the first place.

Once I realised I was in swine flu territory (Day 2 – Pyrexial at 38.4, hot and colt sweats, headache, runny nose, aching arms, sore chest, sneezing all over the shop and generally feeling pretty crap), I decided to phone the national pandemic flu helpline. I wasnt sure if I was going to take the antivirals if offered, but I at least wanted the option.

I eventually got through to a young man who introduced himself and stated that he was going to ask me some questions first to see if I needed immediate medical help.

Operator: “If you answer yes to any of these questions, I will be asking you to put the phone down and dial 999 immediately, okay?”

M999: “Yeah, thats fine, but I am a paramedic and no matter what you tell me, there is no way I am going to dial 999!!”

Operator: “Oh, Ok then…..”

He then proceeded to ask me the usual immediate life threatening triage questions, all of which will be familiar to anyone in the job:

• Are you unconscious?

Ehhh?????? Erm, no Im on the phone to you!

• Are you having difficulty breathing to the extent that you cannot complete a sentence?

To be honest, I had just run upstairs to get the charger for the phone that I was on, and was actually quite breathless, but I knew what he meant and of course said no. However, many members of the general public may well say yes to this question which would then result in a quick hangup and dial 999 instruction.

Some of the other questions were easy enough to rule out :

• Non Blanching rash?
• Inability to touch chin to the chest?
• Severe chest pain? – So subjective and easy to say yes to!
• So drowsy that it is difficult to wake up (??? again, I am on the phone to you!)

And so it continued until we got past those questions and on to the swine flu assessment which I passed with flying colours (Horrayy!!!)

I was given my ’secret code’ to get my tamiflu and was instructed as to where my nearest collection point was, which was now shut until the following morning – champion!

But that gave me time to think about whether I should take it or not.

When I woke up the next morning (Day 3), I decided to let my own defences continue on with what appeared to be a sterling job of doing battle with the dreaded pig virus that was attacking my immune system. Another day in bed thanks to Grandma and Grandad having Alexander again and my decision seemed to be the right one (for me!).

Its now day 4 and as I said, im feeling alot better (enough to get back on the keyboard to you lot anyway!)

Hopefully, as long as the strain doesnt mutate too much before the winter swine flu sets in, I should have some immunity to it now. Who knows, but lets hope so!