Posted by: medicblog999 | December 10, 2010

Seeing it first hand..

I was out with the police again recently for another of the trial shifts working alongside the Durham Constabulary in the town centre of Darlington. It was a pretty run of the mill night apart from a little side step visit that we made on our rounds which really made me think about a couple of things….

A few hours into our shift, we came into contact with a crime being flagged up by the CCTV operators. We responded to the ongoing crime and soon after 2 males were in custody in the cage behind where I sit. That in itself was interesting, but what really sparked an interest was when I was taken to the CCTV control room to have a look around and see how the whole thing ran.

First thing I was surprised about was that there was only 2 staff in the main room, watching a bank of over 20 monitors which constantly cycled through a total of 140 CCTV cameras in Darlington and the surrounding areas. I was immediately mesmerized by the feeling of ‘control’, of being able to watch whatever we wanted to and look wherever we wanted to.

People were going on their way, minding their own business and enjoying their night out. I watched people dancing down the street, standing having their cigarettes, huddled together outside of the nightclub front door. I saw a number of the other police officers patrolling around the town centre, constantly aware of where the CCTV cameras are and routinely asking the operators to keep an eye on this group or that as they walk past and spot something a little suspicious, but not illegal.

I am amazed that these two chaps can keep an eye on so many things at once, but I guess that they have a keenly developed peripheral vision and they can spot things out of the corner of their eyes, then bring it up on the main screen on their desk.

After a little while, they pulled up a video that one of the officers I was with was asking about. This was from an assault in an adjacent town centre from a little while ago. As it was replayed, I stood transfixed to the spot as I watched an apparently innocent young man, get assaulted by a group of 4 other males in a quiet, almost deserted town street.

It was truly shocking to see this happen. The violence in the attack was horrific, and to see one human stamp on another humans head is something that I don’t wish to see again.

As the attack finished, the victim lay unconscious on the road while the CCTV operator panned and tracked the camera between trying to keep up with were the assailants were heading, then flicking back to check on the victim. He told me that whilst this was going on, he would have been coordinating the police response and also requesting the ambulance and directing them and the police to the location of the victim.

Over the next 30 seconds to a minute, the victim lay unconscious on the road. I could feel my heart start to race, and I was wondering if he was ok, and where the help was. I was shocked to see two passers by just keep on walking on the other side of the street, even though we could see that they had seen him lying there on the ground.

All of a sudden, he lifted his head then slowly brought himself to his feet. He was obviously dazed and concussed, but he just seemed to dust himself off and start off on his way home again.

Within the next 60 seconds the police arrived and directed him to a seat where they kept him till the ambulance arrived and took over care.

This is the bit that really got me thinking though.

I have arrived on scene to many, many assaults in my ambulance career. One of the first and most routine of questions that they patient and their friends are asked is

“Did you/he loose consciousness at any time? Were you/was he knocked out?”

The answer normally is one of the deciding factors if someone needs to attend an A&E department or not, and to be honest it is usually asked as part of the normal run of questions without much of a thought of the forces that have been involved in the assault itself.

It is very easy to turn up on scene to see someone with some bruising and swelling to their head and face and routinely treat it as a fairly minor injury. Yes, of course they will get the required level of care and treatment, but do we really acknowledge the significance of what has happened to them?

After seeing that CCTV clip, personally, I can say that I have not.

Why did it shock me to see the victim getting assaulted like that? Surely I should be aware of what happens and understand how someone has received their injuries that I am tending too, right?

I have realised that I have become a little too comfortable with looking after the victim of an assault. That’s not to say that I have any areas of my practice to change, as I don’t believe that is the case.

I do however, need to re-acquaint myself with the seriousness of some assaults and remind myself that just because the patient is up and about and orientated when I assess them, that doesn’t necessarily mean that it has been a minor assault.

The human body is an amazing thing……

But it has its limits, and that is where we come in.

Posted by: medicblog999 | December 9, 2010

Working in a Winter Wonderland!

Yet again, I feel the need to apologise for the lack of posts recently, but this time I thought I would share just one of the reasons why I have been away from the computer so much.

The main motorway through the North East- The A1

Yup, its been more than a little bit cold and more than a little bit snowy. I even got to experience a new weather phenomenon for the first time in my life; that of Thunder Snow – A thunder and lightening storm at the same time as a blizzard!

I was at work on the night shift when the snow started to fall. I won’t lie, it was great fun for a while, then a little bit scary, then a lot of fun again.

Our ambulance, ‘Betty’ (she deserved a name after getting us home safely) performed amazingly as we slowly drove past more and more cars and lorries unable to move through the thickly lying snow. We stopped to help those we could when not on the way to emergencies, but our main priority was not to get stuck ourselves. After all what good would we be to our patients if we couldn’t get to them in the first place?

Betty may be getting on a bit, but she was a star!

Over the next few days, the snow kept falling and after the third night, I measured 42 cm of snow at the back of the station, on the road. My service pulled together and I can honestly say that some of our managers went out of their way to help staff get into and out of work as well as helping those of us attending our patients get to and from an accessible road to the patient and then back to the ambulance.

I don’t know how many exactly were hired, but a lot of the senior management team were given short term hired 4 x 4 vehicles so as to support the operational tier do what we needed to do – get to our patients!

My own Manager had only a few hours sleep over the entire weekend due to either helping staff or responding to emergencies himself.

Hmmm...Me thinks Id best not go down there!

The voluntary agencies were also invaluable to the core function of our service. We had St John, The Red Cross, Mountain Rescue and The Coast Guard all available and working alongside us ensuring that where ever possible, our patients were cared for in the manner that they should expect!

Despite our best efforts though, there were many delays. Distances that would normally have been travelled in 7 minutes were taking 20-30 minutes. Instead of pulling up outside of a patient’s house, we frequently had to park on the closest main road and walk in with our equipment. That in itself was not too difficult, but getting the patient back to the ambulance was another matter, and that is where all of the 4×4’s, our managers and voluntary services came to the rescue.

It has been a tough and long week for all of the emergency services, but I feel proud of what we have achieved for our patients. Of course, our ORCON times will have been possibly the worst that we have ever achieved (our response time targets to Cat A and Cat B Emergencies) but I am hoping that whoever audits these takes into account the difficulties that we, and later in the week, the whole country had to contend with.

I am glad that I got to work these shifts, because I feel as though I was part of something that has given a real and palpable feeling of camaraderie.

The medics, management, patients, families, and other services have all pulled together and we have continued to care for our community despite some pretty horrific weather.

And…….I got a little bit of exercise too!

Posted by: medicblog999 | November 29, 2010

Another string to the EMS Bow

We all know how EMS is changing and evolving.

Most of us get excited about the new challenges and possibilities that are opening up to Medics that have never been there before.

I have certainly seen my own role change dramatically in the 11 years I have been in EMS.

Sometimes though, we all still find ourselves in situations that we have not been in before, and sometimes, these can be challenging even to the more experienced of us.

But this isn’t a clinical post as such. Let me set the scene for you…….

Some time ago, I was working on the Rapid Response car and I was dispatched to a cardiac arrest. It wasn’t too far away, and as is usual, I requested more details over the radio prior to me arriving on scene. I was then told that the patient was a 40yr old man who had been sent home from the local hospice to die at home, and he had apparently just died.

Errr, Okay……now not being disrespectful to the dead, why was a paramedic being sent on blue lights to a patient that had died, who was expected to die?

A further update came through telling me that the patient’s wife was now saying that she didn’t think she was dead, and may still be breathing.

“Is there a DNR (do not resuscitate) order in the house?”

“That’s a negative, as far as we are aware, there is no DNR’

Great! Just Great!!

As I was pulling onto the scene, my mind was working through the various scenarios that I was about to have to deal with, but all of those various scenarios ended with me having to very quickly make a decision on whether to do something or not.

As I walked up to the front door, Judy, his wife met me. She had the wide shocked, panicking eyes that usual great me when a patient dies suddenly and without warning. Surely this time, she new that her husband was about to die?

Entering the patient’s bedroom, I could see him (Roger) lying in the bed. He looked comfortable and asleep, but he also looked dead. His skin had that usual white tinge to it, there was no obvious respiratory effort, lack of pulses and his pupils were fixed and dilated. The skin of his legs and abdomen were quickly becoming mottled and taking up the recognisable look of post mortem lividity. There was no question about whether I was going to work this or not, I had made my mind up as I walked in.

I still attached the cardiac monitor and printed of a strip showing continued systole. No CPR had been done prior to my arrival, so the whole DNR worry was now a mute point.

I couldn’t help but still wonder why 999 had been called?

I know that even when a death is expected, there is still obviously the final shock of losing the one that you love, and sometimes people still reach for the phone in a vain attempt to stop the inevitable, but this didn’t seem the case here. Judy appeared calm once I had told her that he was dead. She turned to becoming a host, offering me drinks and something to eat.

I tried to get some history regarding what had happened throughout the day and was told that the doctors in the hospital had told her that it was unlikely that he would last more than a day, and the decision had been made to bring him home to die. He had become agitated once at home, but a couple of hours before I arrived the nursing team had visited to the house and had gave him some sedation to ease his discomfort.

“I didn’t think that he was going to die so quickly……I thought I would have one last night with him”

We discussed what had happened and I tried to support her through the immediate phase of the grieving process. She apologised that she had called but then gave me the reason why I found myself in this house on this night.

“I just want to get him to the chapel of rest. I don’t want him to deteriorate in the house”

And there we have it. Judy had a fear that now that her husband had died, he was going to decompose before her eyes. She was afraid, and this was her emergency now.

Was this the best use of a trained rapid response paramedic? Some may say no, and before I got the whole story, I too thought that I shouldn’t be there.

It transpired that Judy had called the nursing team when she thought that her husband had died. The nurses had told her that they would be coming back out to see him and sort things out, but there was other patients that needed seeing first. Fair enough I guess…..This was an expected death, and is really, in no way, an emergency.

However, there is still a need to care for those left behind, and hearing Judy’s fears, I wanted to help.

I phoned the funeral directors that her and her husband had decided to use and arranged for the undertakers to come and collect him from the house. I contacted the out of hours GP service to inform them of the death, and I completed my paperwork for the recognition of life extinct.

All in all, I spent over an hour with Judy and left just as the undertakers were arriving. I made the usual cup of tea (the all conquering medication for those relatives of the recently deceased) and I had asked her neighbour to come around and sit with her until her family arrived.

So, is this another string to the EMS Bow?….Absolutely, but it is also another example of EMS being the catch all for anything medical in the community that does not fit into a perfectly shaped box.

Whatever it is though, it is also an opportunity to make a difference to another family.

Posted by: medicblog999 | November 22, 2010

Was it really a “Good Catch” ?

Its great when colleagues pat you on the back and give you the whole “great catch” accolade of a rare diagnosis caught early or a potentially life threatening condition that may have been missed being picked up. Its even nicer if the compliments come from the doctors in the Accident & Emergency department.

But, like most things do, this got me to thinking and reminds me of a job I attended a few months back.

I was called to a 50ish year old female (Margaret) who was complaining of left loin pain. She had developed this pain earlier in the day (about 4 hours before calling) whilst moving some furniture in her front room. The pain was starting to become very troublesome for her and despite taking some of her normal analgesia, she eventually decided that she needed to call for help.

I arrived in my Rapid Response car at 04:30 to find her slouched against the fridge in the kitchen. She was conscious alert and orientated, but was pallid and had beads of sweat coming from her forehead.

Her radial pulse was strong and regular at about 80 beats per minute, and whilst she was telling me what was going on, I quickly took a manual blood pressure reading which was 130/75. Her skin was cool and moist and her pain persisted. I knew already that I would be requiring a crew so radioed in my request for a Category B crew to back me up.

She told me that she had come through to the kitchen to get some water when all of a sudden the pain kicked in and the next thing she knew she was waking up on the floor and I was coming into the house.

With her observations within normal limits and her pain where it was I started considering the various causes of loin/kidney pain but I also wanted to do my full abdominal exam. I didn’t want her moving around too much at the moment, and since I was all on my lonesome, I asked Margaret if she would just lie back onto the floor for a moment so that I could feel her abdomen. As is my usual routine, I start on the least painful area and work towards the area of chief complaint, so I started gently palpating the right side of her abdomen which was soft and not particularly tender. As I moved through the various sections of the abdomen, I started to feel a hard structure.

At first, I thought she was tensing her abdominal wall and guarding against my pressure, so I asked her to relax her abdominal muscles which she said she was doing. This time I palpate just a little deeper and felt the curving edge of a large pulsatile mass in the centre of her abdomen. As my finger tips found the edge of it, I moved my thumb across to feel for the other side. I had to stretch my hand as wide as I could to find the other edge.

Margaret had the largest abdominal Aneurysm I have ever felt in 20 years in the health service (including 5 years in the operating room).

I looked over her again, and added this finding to the rest of my assessment. I asked if she was aware of any problems with the “blood vessel ruining through her belly”, to which she replied that she did not. She had no significant medical problems other than a touch of arthritis.

So……My findings now were a 50 year old female with a 4 hour history of left loin pain, a collapse with a loss of consciousness, normal vital signs at the time of assessment and a frankly huge palpable aneurysm.

I decided to go with my gut feeling of a retroperitoneal leaking AAA (abdominal aortic aneurysm) and upgraded the crew to a Category A response. I explained what my concerns were to Margaret and that I may well be over reacting but in my opinion it was better to be safe than sorry. Two 16 gauge cannulas and two 500ml bags of saline later (hung but not running) and the crew arrived on scene.

As they entered the house, I could see the all too familiar look that said ‘ this is a Cat A??? She looks fine!!’, and to be honest, by the time the crew arrived she was actually a good colour and feeling better in herself, but still in pain. I handed over to the crew and told them my provisional diagnosis. Again they look fairly unconvinced until I told the paramedic to have a feel of her abdomen. We made eye contact and i knew that whilst his hands were on her abdomen, he too would understand my rationale.

A couple of minutes later and she was on her way to the hospital with a pre-alert going in for a suspected leaking AAA.

Later on that night, I had the chance to go up to the A&E department and asked how she had gotten on. The Doctors in the office asked if I was the rapid that was on scene, and then proceeded to congratulate me on my quick diagnosis and said that the crew had mentioned that it was me that had ‘caught it’

Now, here is my point… Was it a good catch or was it just a medic doing a full assessment that found a hugely obvious aneurysm and assumed that it had something to do with a patients abdominal pain (although admittedly her pain wasn’t the typically taught location for a AAA)?

I always put my hands onto an abdomen when the patient complains of abdominal pain. If I don’t, I miss a vital part of the assessment process. Any medic who put their hands on Margarets abdomen would have found the AAA too.

Its nice to get the compliments, and it is nice to know that you have made a correct diagnosis, but in this case, it would have been nice to have been wrong – for Margaret.

I was informed that she had gone to theatre for her surgery but was fairly unstable after dropping her blood pressure in the resus room.

I hope she makes it off the table, I really do.

Posted by: medicblog999 | November 21, 2010

Running a little short on time.

I feel as though a little explanation is in order.

As some of you will have noticed, my frequency of blogging has dropped a little bit of lately.

This is simply down to the fact that the Masters Degree I have started is taking a whole lot more of my time up than I expected (maybe I was a tad naive?)

Anyway, just to let you know that I will still be posting whenever I can, but it may be down to once or twice a week. The way I figure it is that with the state of the UK and the university fees at present, then I have to throw myself 100% into this course since I am getting it fully funded with a scholarship for three years instead of it costing me £28,000.

Its a no brainer really.

Thanks for keeping popping by and remember to keep checking in to Ambulance Matters too, which should hopefully be hitting iTunes in the next couple of weeks.

Posted by: medicblog999 | November 20, 2010

Thoughts and Prayers

If you are a regular reader you will know that I have a real struggle with God and faith in general. I still don’t believe and don’t have a faith.

But….

That doesn’t mean I am right, which brings me to the point of this short post.

I have had a patient today who has made more than a small impact on me. She is in trouble, real trouble, and her life is literally hanging in the balance.

She has a family, she has a full life ahead of her and she was talking to me for the majority of the time she was in my care.

No one needs to know what’s wrong with her or what happened. All I am asking is that if you have a faith and if you pray then she and her family could really do with some thoughts and prayers right about now.

I doesn’t matter if I believe or not, I’m not asking for me.

If there is a God, then he will know who I am talking about and you would be doing a great thing by having her in your thoughts whilst you pray to whomever you choose to worship.

Thanks chaps.

Posted by: medicblog999 | November 20, 2010

How Do You Want To Be Seen – Part 2

This is part two of this post – If you havent read part one – click here, then come back to see the flip side.

Ask yourself again, what type of medic do you want to be?

I woke up all of a sudden with a feeling as though someone was plunging a knife deep into my guts and slowly twisting it around and around. At the same time, I knew that if I didn’t manage to get to the bathroom, there was going to be a whole lot of mess in and around my bed.

Sitting on the side of the bed, I flicked on the bedside light and looked into the mirrored doors on the wardrobe at the far side of the room. I looked as white as the sheets on the bottom of the bed. I rubbed my face with my hands which quickly became covered in the cold sweat that was pouring off my forehead. I could feel the bedclothes wet beneath me from the moisture that was coming from the pores all over my body. The room was spinning,

I knew this feeling well, I had been in hospital for this same thing 3 times in the last two months, but was still waiting for someone to tell me what it was. Sure, I had plenty of doctors telling me what it wasn’t, but that didn’t really help the dread I was now feeling, knowing that yet again, I was going to be off to the hospital.

Sarah, my wife, sat up in bed then cuddled into me

“Oh, honey…..Not again!”

“Call me an ambulance Sarah, I need to go back in”

I stood to go through to the bathroom. As my feet touched down onto the carpet and I pushed up off the bed, my world span in circles and I dropped to my knees. Sarah was there in a second, phone to her ear talking to the Ambulance Service.

“No, he has just collapsed, please send an ambulance”

I lay down on the floor placing my head onto the carpet. The pain was intense, I couldn’t remember it ever being this bad.

After what seemed like an age, I heard sirens approaching. I prayed that they were for me.

Sure enough, I glanced towards the curtains and saw the strobing effect of the blue lights as they entered the street. Not long now……..

Sarah ran downstairs to open the door, and shortly after, I could hear the muffled conversation of a male voice in the hallway.

As I lay on the carpet, I opened my eyes and looked up to see an ambulance man standing next to Sarah.

“Hello Sir, my name is Tom and I am from the Ambulance Service. Whats your name Sir?

“Mike”

“Ok Mike, whats going on with you today then”

With that, he knelt down beside me and put his hand around my wrist, I guess to check my pulse. I started to explain what had been happening when all of a sudden another wave of pain came across me and I shouted out again.

“You seem to be in a whole lot of pain there. I need to do a couple of quick observations before I can sort out some pain relief for you ok? I just need to check your blood pressure first so that I know what sort of pain relief I can give you. Can you slip your arm out of your top for me so that I can put the blood pressure cuff on?”

I offered my arm up to Tom and soon, I could feel the band getting tight on my arm.

“So, can you tell me a little more about what happened  last time that you were in hospital?”

Sarah thankfully jumped in to answer. I just couldn’t seem to find the strength to tell him the same story I had told over and over again for the last few weeks. I hope he didn’t think I was being rude? Sarah was telling him all about my visits, what they had tested, what they had done and what they thought.

“They just keep telling us that it is nothing serious. They give him pain killers till the pain goes away and then they send him home. I think he has had most of the tests going, but what would I know anyway? Im not medically trained”

“It must be very frustrating for the both of you. Its always good to be told its not one of the more scary things, but you still need to get to the bottom of it right?”

Another wave of nausea hit me and this time I couldn’t keep it in. Before I knew it, Tom had pulled some sort of plastic bag thing out of his bag and told me to be sick into that.

“You know when you go in to hospital and they give you pain relief…….What do they give you? What works”

“They normally start me on the Morphine, then move me to tablets the next day”

“OK, Champion. Well lets get a needle in your had and sort out this pain, ok?”

Before I knew it, I was being asked questions about my kidneys, if I had bad depression and what I was allergic too. One sharp scratch in the back of my hand, then 5 minutes later, the rush to my head which I get when the morphine starts to work. I could feel the wave pass through my body and stop at my stomach which slowly started to feel a little better.

About 10 minutes later, the proper ambulance arrived and two other ambulance men walked in. Tom stood up from beside me and explained that he had to tell the crew all about what had been going on and what he had done for me. He introduced me to the two lads, Mark and John, and told them all about me. He must have been listening when he was working because thankfully Sarah and I didn’t have to add anything to the story.

“Right Mike, whats that pain like now? Is it any easier?”

“A little bit. Its still there and still hurts but its taken the edge off it”

“Ok mate. What we are going to do is get a chair for you to get you down the stairs and onto the ambulance so we can get you off to hospital ok?’

Some huffing and puffing later (im not the smallest guy in the world) and poor Mark and John had carried me down to the ambulance and got me as comfortable as possible on the stretcher. John took over from Tom to look after me on the way to the hospital, but before he went, Tom popped in to the ambulance to say goodbye and shake my hand.

“Ok Mike, Im away now. Look after yourself and I hope you get some answers this time. John will take good care of you and bore the pants off you with his stories on the way to the hospital!”

“Thanks Tom……Thanks very much”

He closed the door after him as he left the vehicle, I looked over at Sarah who had a little smile on her face. She reached over and held my hand and said

“What a lovely man”

————————————————————————–

In Part 3, I will look into the differences that Mike had with his two paramedics, and look at what makes some paramedics act the way that they do.

Posted by: medicblog999 | November 14, 2010

How do you want to be seen?

This is the first of two posts.

What type of Medic are you?

How do you want to be seen by your patient?

I woke up all of a sudden with a feeling as though someone was plunging a knife deep into my guts and slowly twisting it around and around. At the same time, I knew that if I didn’t manage to get to the bathroom, there was going to be a whole lot of mess in and around my bed.

Sitting on the side of the bed, I flicked on the bedside light and looked into the mirrored doors on the wardrobe at the far side of the room. I looked as white as the sheets on the bottom of the bed. I rubbed my face with my hands which quickly became covered in the cold sweat that was pouring off my forehead. I could feel the bedclothes wet beneath me from the moisture that was coming from the pores all over my body. The room was spinning,

I knew this feeling well, I had been in hospital for this same thing 3 times in the last two months, but was still waiting for someone to tell me what it was. Sure, I had plenty of doctors telling me what it wasn’t, but that didn’t really help the dread I was now feeling, knowing that yet again, I was going to be off to the hospital.

Sarah, my wife, sat up in bed then cuddled into me

“Oh, honey…..Not again!”

“Call me an ambulance Sarah, I need to go back in”

I stood to go through to the bathroom. As my feet touched down onto the carpet and I pushed up off the bed, my world span in circles and I dropped to my knees. Sarah was there in a second, phone to her ear talking to the Ambulance Service.

“No, he has just collapsed, please send an ambulance”

I lay down on the floor placing my head onto the carpet. The pain was intense, I couldn’t remember it ever being this bad.

After what seemed like an age, I heard sirens approaching. I prayed that they were for me.

Sure enough, I glanced towards the curtains and saw the strobing effect of the blue lights as they entered the street. Not long now……..

Sarah ran downstairs to open the door, and shortly after, I could hear the muffled conversation of a male voice in the hallway.

As I lay on the carpet, I opened my eyes and looked up to see an ambulance man standing next to Sarah.

“So whats going on then?”

I explained what was happening as best as I could. I told him about my past hospital visits, how I was going for more tests soon and how poorly I felt. I tried to explain what it was like, but to be honest, I don’t think he was listening to everything I was saying. Every time I had finished telling him something, all I got was a ‘Aha..’. He stood there, at the door way to my bedroom with his hands in his pockets, looking all the world like the last place he wanted to be in this world was in my bedroom.

The pain started to come back again and I cried out..

“Please…..can you just do something for the pain!”

“Alright mate…..in a minute….I just need to see what is going on first”

I could feel myself feeling sickly again and instead of pleading for pain killers, I decided to concentrate on not vomiting again.

Next thing I knew, I had a clip thing on my finger and he was pulling the sleeve of my top up and putting a blood pressure machine on it.

I heard him asking Sarah questions….

“So he has had this pain before?”

“And he was last in the hospital last week?”

“Since this pain is not new, is there a reason why you didn’t call the doctor instead of ringing 999?”

I could feel myself starting to get angry..

“Look, can you please just give me something for the pain. I called 999 because I needed help and I need it now ok??”

“Right mate, just calm down ok! You’re not helping anything by shouting at me ok? I will get you something for the pain in a minute. Just calm down and concentrate on your breathing a bit.”

Calm down and concentrate on my breathing??? Why wont he just do something for my pain? I looked over to Sarah, and I knew that she could tell how sore I was. It was her turn to speak up.

“Im sorry, I don’t know your name, but he really does need some pain killers. Can you just give him something? When he goes to hospital he usually gets some Morphine which really helps his pain”

“I cant give him any Morphine because if I take the pain away, then the doctors wont be able to see how sore he was and where the pain was. The ambulance wont be too long. They will get him up to hospital so the doctors can sort him out ”

After that, he sat down on the end of the bed and just started writing on a clipboard. The pain was unbearable, but as I lay there looking at him, I knew there was no point in trying again to get him to give me something. He didn’t care! Why is he even in this job?

After a little while the nausea returned and I started vomiting, over and over again. I really did think that I was dying. I know people say that men like to exaggerate, but this honestly did feel like It was the end. I started begging the paramedic to help me, but all I got in return was again to be told to ‘calm down’ and ‘stop forcing your vomiting….If you relax, the pain will ease a little’

Eventually, the proper ambulance came and I swear that I saw him roll his eyes a little as he was explaining to the other two ambulance men that I had “some abode pain, but he has had it many times before. He has been back and forth to the hospital but they cant seem to find anything wrong. Oh….and he says that the only thing that helps him is morphine! ”

“Ok matey, lets get you up off the floor”

The two new ambulance drivers came to either side and put thier arms under mine and hoisted me off the floor. The world started to spin again, and the pain came flooding back as I was forced into a standing position. Sarah looked horrified.

“He cant walk, look at him, he is going to pass out”

“He will be fine love, we will help him down the stairs. Sometimes it does them good to get up and about when they have a bit of tummy pain”

With that I was led down the stairs and onto the ambulance. I guess I should be grateful that they let me lie down on the bed.

“So, my mate says that Morphine helps the pain?”

“Yes, it usually takes the pain away..”

“Ok, but this time, I am going to try you on a special gas which will really help”

I was instructed on how to use the gas, which did help the pain, but whenever I stopped breathing it in, the pain came back.

Before I knew it, I was on a stretcher in the corridor of the hospital. The ambulance man came and took the gas away from me and then started talking to the nurse again. I could hear him tell the nurse and everyone else in the corridor what was wrong with me, and again, he seemed to be concentrating on the fact that I keep coming back and asked for Morphine. Does he think that I am making this up?? Does he think that I am a junkie???

But you know what?

I was past caring, I was in hospital now, and maybe some one trained to look after people was going to come and help me know.

A nurse walked up to me..

“Hello Mr Jackson, my name is Sophie and I am going to look after you tonight.”

Posted by: medicblog999 | November 12, 2010

Episode 3 of Ambulance Matters Podcast, now Live!

The latest installment of the UK’s first EMS Podcast is now available to download over at www.ambulancematters.com

In this episode, we discuss the Darlington Police/Paramedic Project.

I am joined by guests from the UK and the US to discuss this innovation in services working together and the potential benefits that it can bring to the emergency care provided to the community of a busy town or city over the usual party hours of a Friday and Saturday night.

I will hopefully be moving the podcast to iTunes over the next couple of weeks, so it wont be long until you will be able to subscribe in iTunes

Posted by: medicblog999 | November 4, 2010

Just Imagine……

This could well be my shortest ever post….

Can you imagine what you would do if you were sent to “Elderly male stuck on floor, cant get up”, and he actually was ‘stuck’ to the floor?????

No, this didnt happen, but it is one of those thoughts that just popped into my mind and made me giggle.

That is all.

Posted by: medicblog999 | November 2, 2010

An AMAZING commercial!

One of my online friends, Nick, sent me a link today.

He volunteers for St John Ambulance, providing first aid and ambulance aid to his local community and asked that I share a link to a video commercial that the organisation has produced about the importance of learning first aid.

I started the video and it wasnt long before the chill went down my spine.

To St John Ambulance – You guys did an amazing job! I wish our services could do something as good as that!

To Nick – Thanks for taking the time to share the video. I am very happy to post it on the blog and I am sure that it will do the rounds around the other blogs too!

[pro-player width=’530′ height=’253′ type=’video’ image=’http://www.youtube.com/watch?v=YiJjkNN3z5M’%5Dhttp://www.youtube.com/watch?v=YiJjkNN3z5M%5B/pro-player%5D

Posted by: medicblog999 | November 1, 2010

Is this an easy way to avoid burnout?

I have a very strict code on how I conduct myself at work.

Im  not talking about my patient care or how I present myself to those who call 999 and get me turning up at their door.

This time, its all about how you can have a positive outlook on your job itself and the stresses that you put yourself under for no reason.

There are some things in our line of work that we cannot avoid, Splashed sadness being the most obvious ( I still think that is one of the best, most descriptive words I have ever heard in EMS – Kudos to Mr Kaiser!), but just for a moment, stop and take a look at yourself and your partner ( or ask yourself the same question even if you are in an entirely different profession) and think of how many times you get angry with control/dispatch or those that manage you?

Sure, I get wound up every now and then when things seem to be going all wrong and you get sent from pillar to post with no obvious reason. Yes, I get frustrated when I am asleep on my feet in the middle of a stint of night shifts and just when I get into the recliner on station I am sent out to go on standby to another station where those staff are resting whilst on their breaks. Sometimes I will grumble on in the vehicle and very very rarely I will question control directly about there decision.

However, 99.9% of the time I will just do as I am told.

I have wrote about this before, but it comes to mind again as the time of year approaches that we in the UK like to call “the winter pressures”.

Calls are already drastically on the increase, there is less and less time to be scraped on station and the late finishes are really starting to mount up. Tempers get frayed and frustrations start to rear their heads and in the vast majority of cases they are directed at those who press the keys and send the jobs from control.

Sometimes when I am on the ambulance its almost like a yin & yang experience in the cab. My mate will be cursing and shouting at the radio as we are turned around and sent in the opposite direction from the job that we were heading too, for the second time in a row, whilst I just sit and say ‘no problem’ on the radio. The discussion follows as he rants about how control dont know what they are talking about and dont have a clue about where we are and how there MUST be a closer vehicle than us.

I say,

“If there was a closer vehicle than us, do you not think that they would be sending them instead?”

We are constantly striving to meet our government response time targets and the computers in control automatically flag up the available crews that are close to an outstanding journey. They will also display the approximate e.t.a for all the vehicles and will suggest the most appropriate response in rank of time to scene. Now, I am not so niaeve that I dont understand that sometimes control may not allocate the closest vehicle every single time. There will be situations where the call is a non life threatening one and we have 18 mins to get to scene. If I am 10 minutes away and there is another crew 8 minutes away, but they havent had a break for the last 6 hours then quite frankly I would hope that the allocator would be willing to send us instead of them.

Thats not to say that control get it right all of the time, after all, no one is perfect right?

What frustrates me more than anything that control can do, is when I see colleagues ‘losing it’ because of how we are dispatched, where we are travelling to, the type of job we are going to, or even the late jobs. Like I said, I get frustrated too. Please dont assume that I dont get annoyed at times, but the big difference is that I dont let it spoil my day.

I dont get angry and I certainly dont take it out on anyone else.

Lets all remember that we knew what we were getting into when we took on this job. If you say that you didnt know, then maybe you should have researched your career choice a little more before you signed on the dotted line.

Sometimes it is our own outlook that makes the day tough for us. If I am on my normal shift, I am at work for 12 hours. 11 of those are paid for. That extra hour is for my breaks (unpaid).

As far as I am concerned, control can do with me what they like. You pay me for 11 hours, I will work for 11 hours, and for the vast majority of the time I will have a big smile on my face and will be happy that I am one of the fortunate ones who are lucky enough to be in this career.

Posted by: medicblog999 | October 31, 2010

My Fan Boy Moment!

Back on the 10th June this year a new podcast started. I found out about it as I was reading Kelly Graysons Blog, thought it sounded like an interesting listen and went off and downloaded it. That was the first step in my addiction to Confessions of an EMS Newbie.

If you haven’t been listening to it, it is about the journey of Ron Davis as he goes from mild mannered computer programmer/photographer, through his EMT Basic course and on to his Paramedic training. The unique thing with this podcast though, is that Kelly accompanies him on his journey and acts as his mentor in the podcast, answering his questions, clarifying his doubts and sharing his experiences from his career in EMS so far.

I now look forward to the download every week and see this as an essential part of my daily dog walking!

As well as following Ron through his training, Ron and Kelly have started to record some special episodes where they interview guests from the field of EMS. Special episode 1 was with Bryan Bledsoe, considered to be one of the most influential educators in EMS in the USA today. Special episode 2? Well that’s where yours truly comes in!

I was extremely flattered to be invited to participate, but a little perturbed that I would be following on from such an eminent and respected person (not much to live up to, eh?).

Anyway, we chatted about UK EMS, training, lessons ive learned during my career and answered a number of listener questions. I had a great time recording it and chatting to Ron, and you can visit the website here to download it directly to your hard drive.

Oh, and while you are there, why not download the other 21 episodes. Even if you are an experienced paramedic you will be amazed and what you will learn.

Posted by: medicblog999 | October 29, 2010

Episode 2 of Ambulance Matters Podcast now live!

In this show my guests and I discuss the frustrations and difficulties the UK Ambulance services seem to have in finding a home and a role for the increasing numbers of paramedics who continue their education to become emergency care practitioners.

Many operational staff see this role as a natural progression in our modern pre-hospital care environment, but the question we need to ask is, how do we actually make it work?

(P.S – make sure you listen after the end music for a bonus little look into the creative processes of Ted Setla!)

CLICK HERE to take you to the Ambulance Matters Website to download the podcast.

Posted by: medicblog999 | October 28, 2010

Proof that hearing is the last to go?

Myself and Mrs999 have been sitting around the breakfast table recounting war stories from our career in the Ambulance service with our friends following on from the London Tweetup last night, which was a fantastic night by the way.

I started telling a story from a good few years ago that I cant believe I havent shared before on the blog. Its a nice and short one, but it was certainly one of those ‘freaky moments’ that happen every now and then.

I was called to the address of an elderly man who was complaining of chest pain. On this day I was working on the ambulance so got the chance to stay with him throughout his time in the ambulance.

His assessment was fairly unremarkable, just another standard, routine cardiac chest pain job. He did have a history of a previous MI and a VF Arrest, but on this occasion his observations were all within normal limits and his 12 lead ECG showed no evidence of ACS at this time. He still got his aspirin, buccal GTN, Morphine and rapid transport to the A&E department though.

What sticks in my mind and what surprised me at the time was what he said when I was looking after him on the way up to the hospital.

As He was lying on the stretcher, he looked over to me and said

“Will you keep talking to me as we drive up to the hospital please?”

“Of course, I will”

“But just keep talking to me though, ok? Just normal talk…..Please?”

When I asked him if there was anything wrong…..

“Its just that the last time that I was in an ambulance, I can remember everything going black and hearing the man sitting where you are sitting shouting through to the driver……’Pull Over!, hes arrested’ “

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