Friday, 16 November 2007

Right said FRED

Nine calls – three false alarms, one refused and five genuinely in need.

The one aspect of FRED, our automatic despatch system, that riles me most, is its ability to run you off your feet without actually having you do any work. I received at least a dozen calls from FRED on this shift, all of which were cancelled at the station. All I had to do was go outside, open the car and press the button to reset the system. Back and forth I went for the best part of an hour. Its most damaging effect is psychological. There is no way you can settle down to rest after a heavy shift when you are constantly waiting for the next call from FRED. I think we are all entitled to unwind a little between jobs, especially when it is busy but this system sends calls to your MDT regardless of your state of mind. It’s a computer and it doesn’t give a toss about how wrecked you feel.

FRED is like a shark to me (it’s a loose analogy but it fits with my way of thinking). It hunts for the nearest available FRU to the call and sends the job down to its MDT. When it locates an even nearer vehicle, it cancels the first FRU and sends the job to the new FRU and so on. I believe it can continue doing this until it has literally ‘relayed’ the call from one FRU to another all the way down the line. All those other units have been cancelled at station (so the poor sod has to go outside and press the button) or in the middle of the journey (so traffic and pedestrians have been inconvenienced for nothing – not to mention the potential risk that the driver undertook when he started running on blue lights and at speed to get there).

So, my shift was busy and frustrating at the same time. Thanks FRED.

Having said all that, I did have a busy night. An 80 year-old woman with DIB and psychiatric problems was having a panic attack when I arrived (thus the ‘breathing problems’).

‘Please don’t take me away!’ she begged.

I don’t know what the last visit to hospital cost her but she wasn’t prepared to pay the price again. It took me a while to calm her down. I was sure she was much younger than the age I was given but I didn’t like to ask at this stage, so I waited for a crew to take her to hospital. She had settled down a little by the time they arrived and lots of reassurances from the crew persuaded her to go.

Then a 19 year-old female with DIB and chest pain. I was sent 3 miles for this one, only to find a crew already on scene and dealing with her. I was, of course, not required. I was also, of course, out of my own area and thus no cover was available from me.

Another DIB and chest pain combination. This time it was a 72 year-old female. She had emphysema and a history of MI, angina and chest infections. She had taken her own GTN for the pain and it had brought some relief, which is a good sign. Her angina was probably playing up. Her DIB persisted, however, so the crew treated her and took her to hospital.

A 30 year-old ‘collapsed in street’ got up and walked off when he saw the police coming towards him. I arrived just as he left. I wonder what his plan was?

I was no sooner back at station when I received another call for yet another 3 mile hike. This time I was going to see a 45 year-old man who had collapsed in the street. When I got on scene he was lying very still in the middle of the road. A number of people were standing over him, not doing much. He looked dead. I thought I was heading towards a suspended patient.

In fact, he turned out to be the first of what will be many ( as soon as Christmas gets close) of my decently dressed, well fed, well paid, drunk and extremely rude patients. He opened his eyes when I spoke to him and he stared at me with the glassy eyes of a middle-aged doll on crack. He was a suit-wearing drunkard and they are the worst kind in my book. They have an arrogance that comes with being a tax-payer who is utilising the services at his or her convenience, without actually needing to. They have that 'I pay your wages' attitude about them.

‘Why are you lying in the middle of the road?’ I asked him.

‘I dunno. I’ve had a few drinks. What are you anyway?’

I would have preferred him to ask ‘who are you?’ It would have been a friendlier start. Should I reply with ‘I am a London Ambulance Service Paramedic. Highly trained and professional and your willing servant, master.’ Or would that have seemed childish and disrespectful? I wasn’t sure.

‘I’m with the ambulance service. These people called us because they were concerned about you’.

‘What people?’

I asked the little crowd to go back to wherever they came from and thanked them for their help. I could hear no sirens and I didn’t expect to hear any soon. It was a busy night and this man wouldn’t be a priority.

Eventually, I managed to persuade him to stand up and I examined him properly. The light in the street was bad, so I took him to the car and sat him in the back seat. He had a nasty bump to his head, probably caused when he fell to the ground as he staggered about. He had no medical history and complained only of the pain in his head. I advised him to go to hospital and even gave him the option of going in the car to save waiting (it was cold out here) but he refused, while at the same time moaning about his head.

‘Can’t you just check me out and tell me it’s ok?’ he said.

‘Well, I can only see a bump and you don’t know if you were unconscious or not, so I can only advise you to go to hospital’, I told him.

Then he sat in the car and made me stand around like a lemon while he got on his mobile phone to his mate. He spent ten minutes talking to him and describing his ordeal as I stood there in front of him, trying my best to look like I had much better things to do. He ignored my obvious annoyance and continued to chat about his head, the fall, the ‘ambulance bloke’ and what he should do about it. Obviously his friend’s advice was much more relevant than mine.

‘Is that a friend on the phone?’ I asked.

‘Yes’.

‘Can I speak to him?’

‘No’.

I was hoping to get my point across to a sober person on the phone but the man was rude and there was no way of curing him of it. So I continued to stand in the street waiting for him to make a decision or have one made for him by his buddy on the line. I was getting really annoyed with him now.

After a twenty minute wait, his friend arrived, girlfriend in tow, and asked me what was happening. I explained the situation, including the advice I had given to go to hospital but it was decided that he would go home with them instead. I was glad because I didn’t want to spend another minute with this arrogant guy anyway. I got him to sign my PRF – he was reluctant at first. I honestly think he wanted to have my career as a failsafe should anything go wrong.

‘So if I sign this, you can’t be blamed if I get worse later on?’ He asked.

Mister, you couldn’t get any worse than you are now, I thought.

Sometimes a little threat can produce results when you know you are dealing with a timewaster. I was called to a cell at a police station for a 25 year-old who was ‘unconscious’ on the floor. The police had tried to get him to respond but he was completely out. He had been fine when they arrested him but he suddenly collapsed and hadn’t moved for fifteen minutes now.

The first test I tried was his eyelashes. A gentle brush across them with my finger produced an immediate response. He wasn’t unconscious. He didn’t respond to painful stimulus (a shoulder pinch) so I needed a plan B. I looked at his pupils – they were pin point. He was a known drug user, so I told the police officers (and him) that I would give him some Narcan, just in case he had taken Heroin. I opened my bag but then a mumbling voice sounded in the cell.

‘I haven’t had H, I’ve had MDMA’.

We all looked down at him. His eyes were open and he was, surprise, surprise – conscious.

‘Sorry, what was that? I asked.

'I’ve had MDMA and my head’s f**kin rushing'

The crew arrived at this point and, after a little more coaxing, he came out of his ‘coma’ completely and walked to the ambulance. None of us believed he needed medical attention but we had a duty of care and off he went, moaning all the while about his rushing head. Don’t take drugs then, I thought.

My second false alarm was for an ‘unknown male, lying on ground with feet sticking into road’. I hoped his feet were still attached as I drove to the scene. Of course, when I arrived I couldn’t find his feet. Or his body. He wasn’t there. An ambulance joined me for the area search (just to make sure) and we still couldn’t find him. Someone who is lying in the street with errant feet is more than likely drunk, so it was no surprise to me when I noticed a tall unkempt man staggering around in the bus terminus. I approached him.

‘Were you lying in the street a minute ago?’

He nodded but only because I used my hands to gesture sleeping. He was foreign and made that clear in his first reply to me; ‘No english’.

At least we had found our sleeping feet. He wandered off into the sunrise.

Placenta Praevia is a complication of pregnancy. It’s a common complication I should add but the fact that it presents a potentially problematic delivery is always worth bearing in mind when you go to a ‘birth-imminent’ call. In the early hours of the morning I was sent, with a crew not far behind me, to a 33 year-old pregnant female with a low-lying placenta. She had bled whilst on the loo and her waters had gone. She had no pain and no desire to push but that means little at this stage of pregnancy and it was important to ensure that there was no obstruction to the baby’s passage from the Uterus. She was lying on her bathroom floor but was able to get herself up and out to the ambulance. The crew took her swiftly to hospital where, hopefully, she had a trouble-free delivery. Incidentally, I’d be interested to hear from any women out there who have experienced Praevia.

Just as I was about to pack up for the night, FRED sent me on an errand. I had to go and rescue a 19 year-old who was drunk and who had DIB. Hmmm.

I found her lying on the grass with her friends, outside a club that was chucking out for the night. She had no DIB - of course she didn’t - she was drunk. They were all drunk. She didn’t even want to go to hospital in fact, so I had wasted my time coming to rescue her. I told her friends to take her home and they sheepishly agreed that it would be the right thing to do.

This call had been made by the security guy at the door. I know exactly why he had made it and he should be fined for wasting our time and resources. He had seen her lolling about on the grass with her inebriated mates and wanted her gone from the premises. Part of his job is to ensure that everyone leaves...completely. So he called an ambulance and told us she was drunk. When he was asked by the call-taker if she had problems with her breathing, his answer was easy...YES! He wanted an ambulance to take her away, so of course she had difficulty breathing. This is what we have allowed our service to be reduced to. We are the refuse collectors of society and we are at the beck and call of everyone with a forefinger and a disdain for truth.

Be safe.

5 comments:

Anonymous said...

Out of Interest have you worked any where else other than the LAS ? In your personal opinion who would you regard as some of the best paramedics in the world ?

Robin said...

I was one of the 15-20% diagnosed with a low-lying placenta at the 20 week scan and was told to come back for a scan at 36 weeks. Fortunately, by that time the placenta had grown well out of the way and I was given the all clear for a vaginal delivery. I was told that if it had become placenta praevia I would have automatically had an early c-section, any other option being too dangerous for baby and me. You didn't say how many weeks the woman was but I would be surprised if she had been allowed to go full term with such a condition. (I'm not a midwife though and am only speaking from my own experience!)

Xf said...

anon

I worked in Surrey and have done some work as an army medic.

I can't really answer your second question because I am biased but I will say that all ambulance staff are worthy of accolade, regardless of the service they work for.

Xf said...

robin

You're quite right, low lying placenta is dealt with before the woman is full term but in this lady's case, her LLP was reported on the system as if it was an immediately critical thing to deal with. She had bled and this was worthy of investigation. Sometimes, just a small part of the placenta can obstruct the baby's passage through the vagina. Its possible the structure slipped or the last scan was misread.

To be honest, she was taken away too quickly for me to verify one way or the other.

Anonymous said...

I had PP, complicated further by a breach and a very large baby. Needless to say a C-section was ordered.