Friday, 23 January 2015

Elephants

It has been a long time since my last post but my family and career must come first and if anything I write threatens them, I need to temper my emotions; thus less to say of pertinence.

This week I was invited to sit on a panel during a live national television debate on the 'NHS Crisis' and so, after four busy night shifts in a row, I appeared, bleary-eyed, in front of the nation, along with other healthcare professionals and an assortment of politicians, celebrities and members of the public with a story to tell.

The programme, called 'NHS in crisis - the live debate', which you can see here, discussed the failings of our great healthcare system - the strain it is under and the possible causes. It ran for an hour and I sat, for the most part, in the audience, whilst waiting to take my seat in front of the cameras to say my piece.

I watched the audience and I listened to the panels that came before mine and it became clear that there was an awful lot of hatred for the Government and its policies. Fair enough, there is indeed a major problem with the way the NHS is being run and financed and politicians seem to be avoiding the issues that could break the system. But money gets thrown at it from all angles; every time there is a warning of impending collapse, it seems like a few more hundred million is injected into it. This, to me, is much like injecting antibiotics into the body of someone with a deadly viral condition.

At times I felt overpowered by the feelings of hostility and a few totally irrelevant things were said; things that will go nowhere and do nothing to fix the NHS. One extremely angry woman almost spat venom in her attempt to get a point across but it was anger that would serve to change absolutely nothing about the way the system works and the way I operate within it. It did, however, lend us all a moment of the public's frustration.

I was given a very short time to make a single point - I had many points to make and a lot to debate but I got nowhere near the time I needed to do so. The NHS 'front-line' was heavily represented by doctors and nurses. Apart from myself, there was just one other paramedic present to say something, and he only got seconds to make a statement from the audience.

Now I don't mean to be picky here, but let's define the 'front-line'. A hospital, and therefore its medical staff, is not on the front-line. Patients either present themselves there or are referred there by other healthcare professionals. Doctors and nurses working in hospitals do not go out and get these patients; they do not see them when they are at their worst, or at the moment of their deaths in the streets or at home. They are not subject to the same level of unprotected aggression and violence that ambulance professionals are.

They do an amazing job under very difficult circumstances and they are under extreme pressure, just as we are, but unless they are face-to-face with a patient, away from the protection and backup of a hospital or surgery, they are not truly front-line.

There are very few doctors and nurses working on the front-line as I see it. HEMS teams do and out of hours GPs and nurses do (when they actually go out).

Why does this make a difference? How can you debate the failings of a system like the NHS unless you are at the raw edge of it and can actually see what some (not all) of the problems might be.

The NHS is an old system, designed for a post-war population, when people were generally a lot more responsible for their own health. I find it highly unlikely that as soon as the doors opened to the first Accident and Emergency department, it was inundated with individuals with sore throats, mild back pain and drunkards. I wasn't around then so point me in the direction of a news item or photograph that says otherwise.

A proper debate on the subject needs to be given a balanced representation. Those not on the front-line will see the political problem, whereas we tend to see the root problems.

The cheering and applause was loudest for anyone who said something about Government policy and how they are to blame. Most of the negative responses, especially by some of the doctors and nurses in the audience, were elicited by any comment that appeared to blame the patients themselves.

In the audience sat an obese man who knew he'd brought it upon himself but still felt the NHS should pay for his treatment. And a young man who is suing the NHS because of a nose-job gone wrong. In both cases, when the presenter attempted to shine a light on the possibility that they represented part of the problem, the audience jumped up and down about it. I got a real sense of a massive drop in value of common sense and truth and I have to say, I found it unnerving. We seem to be a nation that defends those who may actually be contributing to the situation because we feel its better to blame a Government rather than an individual.

And of course, no individual is to blame for all of the problems of the NHS but if we don't open our eyes and see the little contributions to impending disaster, we are going to implode.

I spoke about young binge drinkers - those individuals who go out for a night and get so drunk that they end up in hospital. I felt this was a very important point to make but I could feel the audience distancing themselves from the suggestion that those individuals should be fined and that they should pay for their stay in A&E. Its simple; we bring them in because they are not fit and unsafe. A doctor examines them and declares them to be drunk (as if that really needs a medical exam to confirm). They sober up and they get a penalty ticket for £75 or whatever would be seen as suitable.

Drunk people take up a large number of beds in hospitals. In fact, alcohol-related visits to A&E account for most of the violence and wasted time experienced by staff. They are also a major cause of delays when it comes to getting ambulances to truly sick and vulnerable people. We still get calls to elderly people who are on the floor and have been for hours, especially during the weekend. A 19 year-old female who is said to be 'non-responsive' or 'unconscious' or 'not breathing properly' due to drinking, is likely to get a faster response than an 80 year-old on the floor and 'can't get up'. We are all sick of it, and when you look at the descriptions I've given for the young girl, don't they just sound like the sort of things that happen when you are very, very drunk?

How many drunken young people have died in the street or in a club or pub because an ambulance wasn't called or was delayed for hours? How many elderly people have, or could have died waiting for us? To me, the sums are easy.

The debate solved nothing and it created no force for change. Only one of the doctor guests (most of the doctors on the panels were TV celebs), made a statement about people taking responsibility for their own health. She got nothing back from the audience. Obviously, like myself, she was blaming the patient and not the Government. What she was doing was telling it like it is.

On my panel, a doctor stated that there was 'an elephant in the room' but failed to make the point. Funding and Government inadequacies are not elephants in rooms because they are plain and obvious problems and we all shout about them. The elephants are the problems we dare not talk about for fear of ridicule or attack from people who believe everything going wrong is the fault of the ruling party.

Sure, we need a cash injection to help modernise the NHS and bring it up to date. We need to pay doctors, nurses and paramedics what they deserve. We need to change the way the system works to better cope with a larger and more elderly population. But we also need to be honest and stop pretending that it's all about money - it's also about attitude and responsibility.

Demand for emergency services has risen dramatically because we are importing large numbers of people who use them because they are free. More and more tourists are descending on the country each year and they don't know how to use the NHS. Alcohol-related calls are increasing and nothing seems to be slowing the tidal wave of irresponsible youth. The elderly population is on the rise because people are living longer, ironically thanks in part to the NHS - these people fall a lot, they injure themselves and they have chronic or terminal illnesses that require treatment and emergency care.

The social care structure is also failing because emergency ambulances are being asked to go to more and more calls where the problem is social, emotional or mental health related. We can do nothing for these patients, so why are we there?

We bring all of this, and more, into hospital A&E departments, or we use another clinical pathway and we turn a steady flow into a Tsunami. If we just took care of one of these elements, we could start to reduce the flood. I suggested penalising those who get drunk and then expect the tax payer to pick up the bill for their night out. I'm suggesting making them responsible for their actions. That's just one idea and it might, just might, make weekends in A&E that little bit less critical.

I noticed that on New Year's Eve we had fewer drunken patients to deal with. This was the year that Boris Johnson charged an entry fee. If you wanted to get into Central London and watch the fireworks at midnight, you had to pay a tenner. I can't say for sure, but I think that small penalty put a lot of people off and therefore a lot of irresponsible drinkers (who'd rather have the extra money for alcohol) simply didn't show up. Voila!

This is a complex argument, I know and it's almost impossible to debate this subject without provoking anger and upsetting people. We all have different views but I think this live debate was mainly about what doctors, nurses and politicians had to say. The input from paramedics was dilute at best and that's a shame because if you had a room full of us, you'd soon get ideas for solving some of this crisis. Many won't like them and they may not be popular but they'd all make people responsible for their actions and more aware of their own health.

The alternative is to spend billions more and keep throwing money at it until another generation inherits the wreck of it. That's what we seem to do best.

Be safe.




Wednesday, 9 July 2014

Four nights shifts and an egg and spoon race

I'm very tired after this latest run of four. These nights seem to be getting longer and longer as we are continually hammered from the moment we sign on duty until we make our weak attempts to get home on time.

There is virtually no respite now. Everybody and his dog wants (or thinks they need) an ambulance. I'm spending longer periods at scene with patients - some of them very unwell indeed - because there are not enough ambulances to cover the demand.

And this is going to become a not-so-rare event. I already feel like my time is running out and now a colleague has felt the impact of what is one of the most dangerous enterprises in the country; running at high speed to calls that may or may not be life-threatening (but that are very likely NOT to be) in traffic and conditions that are against you all the way. Some motorists simply don't see us, or acknowledge us any more. Do they think that because we are running around on blue lights so often that we're just going on yet another drunk call? Maybe so. Maybe they're right to be so unimpressed.

But every now and then I have to treat a seriously unwell person; someone I want to save. Occasionally I will be thrown into a dramatic and eventful call where it matters what I do and it matters that I do it right. Is the constant pressure we are under, responding under emergency conditions to those who've drunk too much alcohol or who've been nursing a cough for two weeks but now feel they have chest pain or 'DIB' eventually going to cost so many of those genuinely unwell people that the game is no longer safe to play?

I can't say what my heart feels; it would cost me my job and my career no doubt. But I am sick of risking my life for those who need to grow up or get themselves educated. Sometimes a little first aid training will do the trick but even that is flawed. There are first aiders out there who would rather call an ambulance to a sore thumb than risk being sued - or so they would believe. Back-covering is just one aspect of this disease of complete reliance on the emergency services.

I know I speak on behalf of the majority of my colleagues - especially my fellow paramedics. We are expected to help bring life into this world and to ease the pain of those leaving it, as well as everything in-between for not a lot of pay. We stand for everything that is important in pre-hospital medicine - patients tend to trust us more than they do their own GPs. We spend more time with them. We listen to them and we fix them whenever we can. But we are struck off and disabled from our careers in an instant if we make a mistake or say the wrong thing to the wrong person at the the wrong time. Yet here is an example of simplicity in brotherhood. It applies to doctors but doesn't apply to us.

I reserve judgement in this case of course because I don't disagree that the boy may not have been saved and that is not my problem with it (tragic and sad as it was), but I'm pretty certain that if that had been a paramedic, making the same errors in clinical judgement and saying that 'in hindsight' he'd have done something differently, he or she would not have a job the next day and would be off the professional register! He or she would probably have put in a 12 hour shift, without a break and would very likely have been given a late job, forcing him or her into overtime he or she did not request or want - ultimately making safe clinical judgements, never mind the ability to drive at high speed safely, a real problem!

On behalf of all my colleagues, all over the country - I applaud you. God knows, very few others will. And what is it you want? Respect, courtesy and understanding. No amount of extra money is going to make any difference to the way you feel, right? You want people to know that your morale is sinking, if not already in the gutter. No wonder people are leaving the profession almost as quickly as they are joining it!

I love my job; I don't particularly love the way it runs. I want us to be strict about how we send emergency ambulances to calls. I want us to be clever about how we deal with non-emergency patients. Most of all, I want support and empathy when I am out there battling with my brothers and sisters. I want to help sick people; genuinely sick people.

We need our own professional register, run by paramedics for paramedics. We need our practices and disciplinary procedures to mirror those of the other medical professions, without what appears to be an overbearing emphasis on striking us off for much, much less than the example I've given. It's simply unfair that such a drastic mistake in known procedure is apparently just going to 'go away' because it was a doctor involved.

At the end of my tour of nights, I went straight home and straight onto a grassy track where my son's nursery school sports day was being held. I held an egg in a spoon and ran like a tired man to the finish line with four or five other dads. I made it to the line second to last because I believed one of the dads who said 'right chaps, lets not run' and I was far too tired to run anyway!

Be safe.




Monday, 9 June 2014

Human pigeons

THIS sort of thing says an awful lot about humanity. I'm all for protecting the privacy and security of people's homes. I'm sure nobody wants to have a 'rough sleeper' bedding down on their doorstep every night, and I'm almost certain that most of the outraged people petitioning about this would rather not have a homeless person migrating towards their neighbourhood.

However. Installing measures like this to ensure that people cannot lay down is a wee bit over the top in my opinion. We install very similar protrusions to stop pigeons from landing on window ledges and overhung building entrances. Are we now treating human beings like pests?

Over the course of a decade or so,  I have become acquainted with many of London's homeless souls and, apart from the rare exception, drunk or sober - they are just people whose luck has run out. They have nowhere to go and nothing to go to. They depend on charities and pure-hearted volunteers, who often get up at rotten-o'clock in the morning to go and feed them breakfast. That way, they have at least one good meal inside them as they wander the city.

In order to sleep and to stay safe, many of them will bed down in doorways and, believe it or not, even some the most high-brow establishments tolerate it, so long as they move on before the day's trade begins. This seems to me to be a fair and just trade-off, even if, every now and then, a little debris is left behind. Generally, however, rough sleeping individuals get up, pack their things and stroll off for the day. Some return to the same spot night after night, while others migrate around the Capital.

I have spoken to and listened to many of these people. You should know that they all have a story and it doesn't necessarily involve a decline into alcoholism, although even those stories have a relevant background plot. And never forget that we can all end up where they are. It just takes a chain of unfortunate events.

I hope these spikes are removed. I understand the building owner's desire to protect the residents and we don't actually know if there was a critical point at which this decision was made. For example, we don't know that sleeping in that spot was tolerated until it became abused. Or that the area was deliberately soiled with urine or excrement (this can happen unfortunately). But there are other ways of dealing with abusers; there are less inhumane methods of discouraging such behaviour.

We still get calls from premises informing us that there is an 'unconscious' person in the street or near a doorway and when we turn up it can smack of nothing more than the need to have an unsightly thing removed from the area. All we have to do is wake the sleeper up and ask him/her to find somewhere more private and out of the way to rest. Needless to say, this exercise has cost you, the taxpayer, hundreds of pounds and has potentially taken an ambulance away from someone in desperate need of one.

If you own a business or residence in the city and you don't like the look of someone on the ground or in a doorway, try going over to them and asking them to move along. Be nice. Be polite and explain that ambulances may be called for them when they don't really need one. You may be surprised by the reaction.

Unless of course you truly believe that it's too risky and that you may get hurt. In which case I'd ask this question of you. What makes you think it's okay for me or my colleagues to take similar risks? Why didn't you call the police?

No spikes. No pre-judgments. Try kindness.

Be safe.


Monday, 26 May 2014

Abandonment

It's not a word used very often, and when it is, the relevance is rarely on point. But, when you are in a group of mates, out for the night and getting loaded on alcohol (because that's the way its done nowadays), and you dump one of your friends because he or she is too drunk - that's abandonment.

I don't mean dropping them somewhere safe and warm to sleep it off; I'm talking about so-called friends who simply leave their drunken mate on a bus, in a taxi... or even worse, on the street. Shockingly, the vast majority of those I've attended in this situation are female. I'd always considered girls to be more protective about their friends, but suddenly at some point in the night, all of the close-knit, protective posturing goes out of the window because one of the group is too drunk to manage any longer. She can't walk to the next club or bar. She is vomiting too much, or she is practically unconscious and a dead weight on the night's proceedings.

A few years ago I was called to a young teenager who was found by a male passer-by in a doorway in the early hours of the morning during a weekend. She was curled up, half dressed and with vomit in her hair on the step of an office building entrance. When I got her awake and she was able to speak to me, she told me that her friends her left her and she'd tried to get a cab home alone. She'd thrown up in the back of the taxi and the driver had thrown her out. She'd staggered over to the step and curled up to sleep.

This young girl's temperature was hypothermic as I recall. She wouldn't have died but she was extremely vulnerable and at risk. You just have to watch what goes on in Leicester Square every weekend night to realise what a dangerous situation lone young girls are in. Men prey on them openly, pawing at them and trying to get them to go with them to God knows where. This young girl was far enough away from the hub of things to be invisible to those vultures but not necessarily safe from harm.

As it happened a young man called 999 when he saw her lying there. He didn't touch her, and he didn't try to wake her - he didn't want to frighten her.

The most recent call (and there have been dozens prior to this) was for a young woman who'd been left on a bus by her friends. They'd gone off to enjoy themselves without the responsibility she'd burdened them with when she got too drunk to be capable of anything any longer.

She was seen asleep on the bus and taken off by a complete stranger. This man sat her on the bench of a bus shelter and called an ambulance for her. She didn't really need to go to hospital but his reasoning was simple; she was alone and vulnerable.

So, I'm appealing to you if you are someone who'd drop a friend on a night out just because you want to continue and he or she is not fit to do so. Stop and consider what you are risking. Leaving your mate behind, alone and exposed, is not clever. Parts of London are not safe for lone young females (or males for that matter). Please think about the possible consequences of abandoning someone to their fate.

If you prefer to complete your night out and don't want your friend to drag you down, then consider monitoring how much and how quickly they drink. Warn them before they get too far into it that everyone's night will be ruined if they get so drunk that they cannot function.

A lot of our workload is taken up with this, because alcohol is consumed like water and I'm seeing more and more young females 'unconscious' in the street, or in the toilets, or on the floor of a club.

Please look after yourselves. Don't be stupid and stay well away from the drink-fast-drink-lots fad that seems to be sweeping the country. Be sensible with your drinking and keep it paced and measured.

Be safe

Tuesday, 22 April 2014

Wind shift

It has been more than a year since my last post and there have been many changes.

I have changed, my job has changed and the profession has changed. Its simply not what it used to be.

I am reluctant to write in the open and honest way that I used to; there are too many sensitive people out there. It's too easy to offend and bother, either by accident or by being truthful. The design of this blog was deliberate. I set out to let readers know what I experienced and how I experienced it. The result of this, over the years, has been that a number of individuals have become paramedics after reading and following the words I wrote.

A change in my posting methodology is required; I need to write only that which is relevant and neutral while I am professionally bound to one or the other. This is the way of things these days.

The profession is different too. We are answering emergency calls that can, at best, be described as not in the least life-threatening. Insect bites, toilet-tissue incidents and sore thumbs now, apparently, count as worth our lives and the risk of losing them while we run on blue lights and sirens through an ever-obstructive and seemingly non-caring driver world. In the year that has passed, I have had my life threatened directly, been verbally and physically abused by those I tried to help and have had less and less time with my family as the tide changes in favour of the thousands of callers who simply do not need an ambulance, but who call one because they think there is no other option, or they have little or no understanding of their medical or physical problem. All of this is well documented; all of this is on your TV in the shape of fly-on-the-wall entertainment. I am not saying anything here that you do not already know.

My colleagues are tired and depressed. They are leaving the profession, or going to places where there is still hope for pre-hospital care. Paramedics have become nomadic. Almost every ambulance service in the country is experiencing a filter-through of new and experienced personnel. Potentially, if enough of the more experienced paramedics leave their service, the patient knowledge-base will stagnate to only that which is within a few years scope of practice.

Perhaps this is the best way to develop the profession. I haven't met anyone yet who agrees that it is, but nothing here makes me right until it has run its course.

Paramedics are also still extremely vulnerable to losing all that they have worked so hard to achieve because we are still registered with a body that encompasses many other 'peripheral' medical professions. We are not registered alongside nurse or doctors, where I believe we should be. Neither do we have our own professional society - we have a college but its not a 'Royal College'. Not enough paramedics have signed up for it, so it doesn't have the teeth it needs to defend us when the smallest error and sometimes (as recent stories will confirm) doing what we thought was the right thing, can get you sacked and struck off. In comparison to other medical professions, we appear to be the ones set  up to fall the hardest. Where's our protection and assurance?

I still care deeply about my patients and I still love what I do (when I'm doing it properly) but I'm less passionate about my direction of travel. I can't see how on earth we are going to be able to sustain things as they are. Everyone wants an answer; everyone wants to know how we can save money and cut the NHS workload... but nobody is asking us.

What we need is a shift in the wind.

Friday, 29 March 2013

Vulnerable

The last shift of my tour seemed to be nothing more than one alcoholic after another. Individuals with drinking problems that go beyond binging. Emotional and psychological dependence on the stuff is what I'm talking about. This is not the same for me as picking up a gutter-vomiting teenager who needs to be taught when to stop drinking. This tugs on you and reminds you of how vulnerable humans are and where they can end up when things go wrong and they just can't cope with it all.

Before all that, I'd gone through nights and days where aggression and trauma mixed into the scheme of my world so fluently that they became one and the same.

A taxi driver crashed into a lamp-post, flattening it and continued on until he was stopped by a traffic light post, which was bent halfway by the force of the sudden deceleration. We were the second ambulance on scene and it was immediately apparent that it was not safe. The London Fire Brigade (LFB) was called because the engine was still 'live' and there was a spillage of diesel under the cab.

Inside the taxi were a driver (obviously) and a passenger. Both had been thrown forward violently by the crash but only the driver had been wearing a seat belt. However, he seemed in a worse state than his passenger, who was conscious, alert and somewhat annoyed by the situation. His neck was being held stable by a FRU pilot and one of the crew from the first ambulance on scene.

The driver had apparently been unconscious prior to crashing, according to witnesses. An off-duty doctor and paramedic both helped and they informed us that the driver had still been unconscious when they went to his aid immediately after the incident had occurred  This was a worrying bit of information, so I asked for an ECG to be done and a full set of vitals before we moved him.

The LFB had arrived after a few minutes and they were very keen to cut the doors off the cab (this was going to be the extrication method) but I'd asked them to hold fire until I'd seen what was going on with the man's heart.

A few years ago I was called to a crash where the driver had lost consciousness at the wheel and careered into a barrier. His ECG revealed a massive heart attack. I was determined to check this before we did anything else.

The driver's ECG was fairly normal but his blood pressure was consistently high. He had a history of hypertension and a stroke in the past. This seemed to be the only rational medical explanation, so we carefully removed him from the cab first, followed rapidly by his passenger. Both went to the same hospital and both landed in Resus, but the passenger walked out after a short time because he was 'fed up', apparently. The driver was found to have had a stroke and was taken to a specialist unit for treatment.


We were asked to take a 30 year-old male from police custody to hospital because he'd admitted to having swallowed drugs (allegedly). However, when we turned up, he denied it and became extremely verbally aggressive towards us and the officers. In fact, all the way to hospital, even with a police officer in the back with him, he shouted abuse and hatred at me. He made several statements about how we (paramedics) were all 'worthless' and a 'waste of time'. It felt very personal, even though I knew it wasn't but it's extremely hard for someone like me to keep a 'yes sir, no sir' attitude with an individual like this. There are things I want to say but they'd get me sacked. So, I endured and allowed him to berate me, my colleagues and my Service, until he was exhausted by his own venom.


Then a drunken Italian man continued the abuse and added physical aggression to the equation.

We'd picked him off the street after a concerned MOP had called us. Initially he was just annoyingly vociferous but it did't take too long before the drunken stares began... these are usually followed by insults and challenges. I wasn't attending this patient but I got as much of the offensive stuff as my crew mate. The man obviously wasn't fussed.

We tried to put him somewhere quiet to sleep it off because he didn't need to go to hospital. If we'd taken him (even if we'd managed to get that far without him kicking off in the back), he'd have upset every proper patient there and probably caused grief for the staff. I don't like giving hospital staff the same stuff we have to put up with. So, we tried to sit him outside the hostel we thought he stayed at.

He fell over and looked like he was going to keep falling over until someone else called 999 and another crew had to experience his violence. So, we got him back into the ambulance, after a few swipes and punches, and took him to the police station. We asked an officer if he could be arrested for drunk and disorderly behaviour but the cop wasn't having it... they were full up and had many other drunks to deal with.

Suddenly, as if by magic, the man uttered the name of the hostel he was actually staying at. We decided to take him home and leave him with staff who knew him better. The journey wasn't too far but he shouted at and insulted us all the way there.

When we tried to walk him to his hostel, he became very aggressive and his arms swung at us. So, I went to the hostel and got the manager to come and collect him. This worked (eventually) and we finally got rid of our cargo.

Ironically, I was told by the manager that the man didn't usually drink and that he was normally very quiet and gentle as a lamb. Alcohol has a way of stripping away the human side.


I got chatting to a lovely 74 year-old lady who works in the theatre (she still teaches young Thespians) after we'd been asked to take her to hospital following a fall in the street. I suspected she had a broken nose, so an x-ray was needed at the very least. She was quite embarrassed about an ambulance coming for her and said "I thought they'd send a bicycle".

We talked about Groucho Marx and 'The Broons' from our lives in Scotland (she was from Edinburgh). It was refreshing to meet a patient like this after the night we'd had so far.


Our only true emergency of the shift was an 88 year-old female who'd had a recent chest infection and who could barely breathe. We had to take her into Resus on blue lights. Her condition was serious but when I saw her later on she was a completely different person; normal colour and breathing well again.


The first alcoholic we dealt with was a 53 year-old female who was shouting the odds when we arrived. Her carer looked terrified - she'd called 111 and was directed to 999 (this happens a LOT), so we had to attend.

The woman was drunk. She had no immediate medical issues but she had a long history of physical and emotional problems. She'd lost a few important people in her life and everything had spiralled out of control.

She didn't need or want to go to hospital and we could see that she had en extensive history of having ambulances come to her and then leave without taking her in. Dozens of calls like this had resulted in absolutely nothing being done about the problem.

It was very clear that she had mental health problems but that they are not being addressed, simply because she gets drunk and then refuses all help. This cycle has to be broken before she will get any better. Until then, thousands of pounds of tax payers money will be spent allowing her to continue on until she kills herself, dies accidentally or kills others by misadventure. She smokes a lot and it doesn't take a genius to see that if she is drunk enough and drops her cigarette on the floor, among the debris of cooking fat, paper and alcohol, she will burn... and so will her flat, and the flats above hers. It's happened before. It's a fairly reasonable prediction.

In the end we had to leave her, after an hour of chatting and trying to persuade her to go somewhere safe with us. Her sister arrived and sat with her and this woman made me think harder about it all. She was very defensive with me, very agitated and laughed almost manically when she spoke of her sister's condition. It was clear that the poor woman was reaching (if not at) the end of her rope. From what she said to me, nobody had shown any real interest in her sister's problems. I could see the depth of her hopelessness and I wondered how easy it was to get there.

Nobody seems to care. Her GP and the other services are trying everything they can but there seems to be no solution. That just can't be right. At the very least, a Section for her safety should be considered.


Our second alcoholic is someone I know. I've attended to her several times. On each occasion, she leaves hospital without treatment, begs for money on the street and then goes to the nearest shop to buy booze to keep herself drunk. It's not unusual to attend more than two or three times in a single day because  if she doesn't call us, a MOP will. It goes on and on.

She is very well spoken 61 year-old woman and she always says that she knows what a burden she's become and that she wants to end her own life. This is pretty much what they all say but the reality is they want help. REAL help. They don't need us taking them on pointless runs to A&E and they don't want pity or anger or hatred.

Economically, it would be far cheaper to give them the help they need. Take them away from their environment and all alcohol for as long as it takes. Give them new purpose. Instead, we just keep chucking money at the problem without reaching a valid resolution.

I'm not being Utopian, believe me, but up close and personal... these are vulnerable people with nowhere to turn except us. We are NOT Social Services, neither are we the AA or any other agency responsible for this kind of support. It's time we looked at this again.

Be safe.

Friday, 22 March 2013

The happy Space Hopper

Aww, bless her. She went through a lot of pain and yet allowed me to write this story up. This is Laura and she had an accident.

If you look closely at her right elbow you'll see it's not quite the right shape or size. In fact, she's fractured and dislocated her Humerus so badly that the Radius and Ulna (the lower arm bones) have detached completely and slid upwards and behind the upper arm. This photo was taken by her boyfriend 'Brummy' while she was being treated.

We were called to a 'possible dislocated elbow' and managed to get to the address without being cancelled or diverted (which could easily have happened as it was a very busy night for drunks and they, as always, take priority over broken bones).

When we got into the flat, Laura was on the floor and her boyfriend and three others were around her. There was a bit of giggling going on because alcohol had been imbibed (responsibly in this case) and they were all good mates who thought this was awkward and rather amusing, which it was at times. Although having broken a bone myself, I sympathise completely with the general feeling in the room - you know, if we don't laugh, we'll cry... that feeling.

My crew mate and I started putting her at ease and I explained that I'd give her a little pain relief. She was quite drunk - not stupidly so, but enough to keep her grounded while all this was going on and her arm looked pathetically useless to her. So, I gave her a little morphine and a LOT of Entonox. She was perfectly capable of self-administering the gas and it helped her a lot. So much, in fact, that she was positively bursting with happiness at times. She was like a giggling crippled starfish on that floor.

This was going to be an awkward removal because the flat was a couple of flights of steps up and walking her out was our only option. My crew mate, who is a student paramedic, had never seen such a  serious fracture/dislocation, so I spelled out the plan so that we could move her safely and without causing any further harm if possible. It was not going to be easy.

After a bit more gas and a bit more reassurance, and with all her friends settled down to the reality of her condition, we began to move her from the floor to the ambulance. We had no vacuum splints, which would have been ideal, so I made do with a box splint and padding when I got her out of the flat. Holding her arm stable whilst walking with her was the only realistic option we had, given the position she was in, the position her arm remained in and the environment we had to negotiate.

It was a long, slow and careful process. I felt the bones of her arm shift only once during the move; there was a bit of a crunch as they ground together (crepitus) but it wasn't allowed to happen again.

As soon as she was safely in the ambulance, we packed her arm into the splint and positioned Brummy so that he could keep it stable during the slow drive to hospital. He was more than happy to help and assisted with humour and smiles for Laura. That's the way it should be really. She was in pain and she had a fairly serious injury, but it wasn't life-threatening and she needed to be kept up-beat so that she could bear it.

She told me she'd had several fractures in her life; she seemed prone to them when she had the most benign falls. I suggested she may want to investigate the possibility that she had EDS, or another condition that was causing this.

We popped in to see them both in the Resuscitation Room, where they'd been taken so that Laura could have the dislocation reduced. They were in good spirits (well, Laura was mostly off her head on drugs by then).

The arm was reduced but it failed and the plaster had to be cut open and another attempt made. For a good few hours the poor girl went through painful and uncomfortable procedures to make her joint behave. It finally settled into its anatomical position on the second reduction and re-plaster.



The X-ray shows the extent of the dislocation. Laura had to return to hospital to have bone fragments cleaned out and may have to have pins put into the joint.

And how did she manage to do all this? Well, you are already thinking she was hopping about drunk and fell off the big rubber ball... but you're wrong. She was hopping about, as were the others, having a laugh and enjoying a dinner party with friends, but she successfully completed her hopping fun and dismounted. She then took a few steps around it and fell to the floor so awkwardly that she did the damage that now renders her temporarily disabled.

Crazy huh?

They had been drinking, yes... but in the privacy of a friend's home. They had been fooling about on a big inflated ball whilst a little drunk, yes... but they were having a dinner party and it was that or Charades. They called an ambulance, yes... but they needed one. This is a genuine accident and there was a real injury. Not one of these people went out to get so drunk they'd end up in a gutter, vomiting their stomach inside out. They were, in fact, pretty sensible, decent and thankful individuals. Brummy had even been preparing to take his injured girlfriend to hospital in the car, rather than 'waste our time'. I can tell you right now that her injury would have been much worse by the time she'd reached hospital if they hadn't called 999.

My sincere thanks to Laura and Brummy for their permission to highlight this call and for their great sense of humour and common sense. I wish Laura the very best of luck with her recovery, and I'll keep you all posted.

* With respect to recent emails. Can I just clarify once again that Laura gave me express permission to use her name, so she has no objection whatsoever to having her name seen on this x-ray! The photo was taken by Brummy specifically for use here! Thank you.

Be safe.