Wednesday, 22 October 2008

Shocking

Day shift: Seven calls; two assisted-only; the rest went by ambulance.

Stats: 1 Head Injury; 2 Chest pain; 1 EP fit; 1 Anaphylaxis; 1 RTC with minor injury; 1 Electric shock.

I was five minutes ahead of the ambulance when I arrived at my first call of the morning, a 55 year-old man who was unconscious in his hostel bedroom. The staff was waiting and the bed had been lifted up against the wall ‘for his own safety’, bizarrely. Maybe they’ve had a rash of incidents in which beds were used as weapons.

The large, naked man was in the recovery position and not quite unconscious because every time I tried to carry out my obs, he’d move and attempt to stand up, only to fall back into a slump again. His breathing was noisy and he was bleeding from a mouth injury, indicative of a seizure, although the staff stated he wasn’t epileptic and they hadn’t seen him fit. Nevertheless, he was an alcoholic, so fitting would have become part of his medical history sooner or later (or now in fact).

He also had a head injury and that concerned me because, fit or not, the cranial defect would contribute to his behaviour and possibly exacerbate his problem. When the crew arrived I was struggling to keep control of him, even with the help of a large member of the hostel staff. Moving him out of the small room in the chair was going to be highly risky and the thought crossed my mind that it might be easier (and safer) to have him put to sleep by a Delta Alpha. It’s been done before and I’m sure it’ll be done again. He was combative and moved spontaneously, so he would unbalance us on the narrow stairs we had to manoeuvre him down. Oh, and when I say put to sleep I don’t been permanently to sleep…

While we mulled over a plan for his removal to hospital he became less irritated and seemed to be recovering a little, so things were going to be easier for us...well, for the crew – they were the ones who would carry him. We used this window of opportunity and got him out of the building. He was still an awkward, dangerous cargo to take down those stairs but my colleagues did a great job and soon enough he was breathing fresh air – as were we all.


Pharmacists, surprisingly, will not always give drugs in an emergency. My next call to a chemist on Oxford Street was for a 61 year-old man with a history of heart bypass who was complaining of chest pain. The pharmacist was with him and she made a couple of comments to me about how long they’d been waiting for an ambulance. ‘Twenty minutes we’ve been here’ she said, repeatedly. I’d only just received this call (and I try not to stop and do a bit of shopping during my emergency calls as I feel this would be unprofessional and make me rush to buy something on impulse without thinking the cost/quality/value principles through), so I explained that I had only taken five minutes to get to her.

I ventured to ask her if she’d given GTN or aspirin (the patient had forgotten to bring his GTN spray) and she told me she hadn’t. There really is no reason for her not to have done so but I know that a lot of pharmacists are not keen to get involved in case they get sued or struck off. Amendments in the law allow for some drugs, including GTN and Aspirin to be given in emergencies, even by a suitably trained member of the public if the patient agrees and needs it in an emergency.

The crew took the man away (I gave the necessary drugs) and the pharmacist went about her business – I don’t think she was impressed with us.


A 21 year-old epileptic man who had a fit at University was recovering when I arrived, so he declined to go to hospital. Fair enough.


My next chest pain call was for a 48 year-old man who was led from the bus by one of the inspectors at the terminus. Chest pain patients shouldn’t be walked at all if possible and I found the fact that I’d been called to attend the man on a bus, only to find him sitting on a park bench, more than a little disturbing. I asked why he’d been moved and the inspector (who is first aid qualified) told me that he thought it would be good for him to ‘get some air’. Who is teaching these people? I’ve even heard of an organisation that is telling qualified first aiders they cannot give an Epipen to an anaphylactic. This is rubbish. Anyone can give an Epipen in an emergency – if you don’t, someone will die. Maybe these instructors should read the HSE guidelines before they train first aiders.

Anyway, this patient had also forgotten his GTN, so he needed to borrow some of mine. Then he was taken away by the crew and I decided to move away from the terminus to do my paperwork. I was facing the wrong way on a bus lane with nowhere to go but forward to the lights – I couldn’t turn around, so I put my lights on and slowly made my way and was immediately obstructed by a bus coming in to the terminus. I hoped he would let me pass but he didn’t. For some reason, he took umbrage to the fact that I was driving the wrong way so he just sat in front of me and forced me to veer around to his right, further obscuring my vision of the road and making things a lot riskier for me and pedestrians. I have no idea why we get such little respect. If I’d been driving a police car I can almost guarantee his attitude would have been different. For a few seconds it looked like a stand-off between two gunfighters – a large red one and a small, yellow (and therefore less appealing to viewers) one.


An Austrian language student (learning English incidentally) ate a peanut and had a massive allergic reaction. The 12 year-old knew she was anaphylactic but didn’t know she’d eaten the nut. She didn’t have her Epipen and so I gave her an injection of adrenaline as soon as I saw her puffed up face, bulging eyes and scared face. Her wheezy breathing was caused by a ‘fat tongue’ and ongoing occlusion of the pharynx – a recipe for death if not dealt with quickly. A speedy decision to administer adrenaline increases the efficacy of the drug in these circumstances.

By the time the crew took her into the ambulance, she was feeling and looking a lot healthier.


The crew and an off-duty police officer were on scene and dealing with a 24 year-old woman who’d been hit by a motorcycle. She had a minor cut to the chin but was a bit shaken up, as you can imagine. I stuck around to se if I could be of any use and found that I couldn’t, so I left them to it.


If you aren’t an electrician, don’t try to mend live electrical fixtures – you are likely to get a shock. Like the 22 year-old smiley-faced amateur electrician who wanted fix the light switch at work. The live wire gave him a jolt and he was left with a flash burn (not a penetrating burn) on his palm. After an hour, he developed a tachycardia and set off to the nearest walk-in centre for advice. We were called and I found him sitting up, happy as Larry (whoever he is), with a healthy ECG and a settling heart rate. I thought a 12 lead wouldn’t go amiss and advised him to go with the crew anyway. I also advised him not to play with stuff he didn’t understand – wise words from someone who used to install electrical sockets and connect them with a live circuit. Wise words from someone who’d had a few shocks himself. Still, isn’t teaching all about learning in the first place?

Be safe.

15 comments:

Paramedic2be said...

Hello my name is jake im 15 and i want to be a paramedic for the London ambulance service. i have read your book 4 times and i am now reading it for a 5th time. i read all of your blog submitions too. i dont live in london i live in suffolk, sudbury. but i really do look up to you when it comes to working towards becoming a paramedic. i am in my last year at school and iv applied to college to do Health And Care Science. After this i want to apply to train as a EMT but how do you apply? what courses do i have to take and what does the EMT course consist of?
i no i also have to get gcse A-C too. im not the most smartest of people so f i dont get A-C can i still end up becoming a Paramedic.

Thankyou. Your a great Influence.

Jake.

Alice said...

Love your posts, absolutely fascinating! I am in University at the moment, but want to become involved in emergency medicine later in life, inspired by my mum who recently recieved an MBE for her services to healthcare. You and all other hardworking NHS employees should be awarded one too! Keep up the good work.

Hugh said...

From the Royal College of Pharmacists code of Ethics, which can be found here http://www.rpsgb.org/protectingthepublic/ethics/

9. EMERGENCIES
STANDARDS
There may be occasions when you are required to assist members of the
public or patients in an emergency. In such situations you must:
9.1 where appropriate, consider using the exemption in legislation
that allows pharmacists to make an emergency supply of
medicines if a patient has an urgent need for them. You must
consider the medical consequences, if any, of not making the
supply and be satisfied that your decision will not lead to patient
care being compromised.
9.2 advise the patient on how to obtain essential medical care where
you do not consider an emergency supply to be appropriate.
9.3 assist persons in need of emergency first aid or medical
treatment whether by administering first aid within your
competence or by summoning assistance.

If they were that concerned to call an ambulance, why didn't they give GTN or even an over the counter aspirin

Xf said...

Hugh

My point exactly. The public will be VERY confused if a pharmacist does not offer emergency medicine.

I teach all pre-reg pharmacists to follow this code.

Anonymous said...

My partner has just this week done a first aid course for work and has been told never to give epipens. Apparently its because there is too much risk of doing it wrong?

Also, someone in his office has to carry an epipen and has told people how to use it. The first aid instructor said that's not good enough and it should be written down and signed, like a disclaimer if she wanted the first aider to help her.

We're in Scotland.

Hugh said...

in reply to Anonymous (I'm not having a go at you by the way)

this is a sad side effect of the risk averse society we're becoming.

i can't see why it has to be signed, it's unlikely that you'd be successfully sued for doing a "good samaritan" act, especially if the person has instructed you on how to use it.

here is a link to a movie on how to use an epipen. http://www.epipen.com/howtouse.aspx

personally i'd rather be struck off (I"m a Nurse) and sued for administering a life saving drug in an emergency situation, than do nothing and the person potentially die or be severely brain damaged.

Anonymous said...

I did a first aid at work course a few years back (in London) and was told the same as Anon's partner: "under no circumstances administer an epipen" as it could leave the first aider and their employer legally exposed if something went wrong.

In fact, I told my boss the entire course was a waste of time and money as it consisted almost entirely of "don't do this" as you or your employer could get sued. (I've actually done a fair few first aid courses, but this was the first one where the mantra was pretty much "do as little as possible except call 999".)

Xf said...

jake

Thank you. You can apply directly with your local ambulance service. Paramedics tend to be trained the degree route now and your science will have to be fairly strong to make it.

Good luck with your career!

Xf said...

jake

Thank you. You can apply directly with your local ambulance service. Paramedics tend to be trained the degree route now and your science will have to be fairly strong to make it.

Good luck with your career!

Xf said...

jake

Thank you. You can apply directly with your local ambulance service. Paramedics tend to be trained the degree route now and your science will have to be fairly strong to make it.

Good luck with your career!

Xf said...

Hugh

Thanks for your help on this.

To everyone who has commented and emailed about the use of an epipen, let me straighten this out for you. You WILL NOT be sued for helping someone in an emergency situation and giving their epipen is NOT illegal - they need it!

In fact, you can give anyone's epipen in an emergency, even though it is a prescription-only drug. The law allows for some movement here because if it didn't people would die unnecessarily.

Epinephrine is a natural hormone and there are very few contraindications for its use in an emergency.

If your first aid company isn't cutting the mustard on this and other topics, I will teach you myself. These are the same people who go around telling first aiders that its illegal to put a plaster on. This is simply NOT TRUE.

Go to www.paramedicrescue.com. It's a blatant plug for my own company but what the hell :-)

Jo said...

I can ditto what other people have said - my last first aid at work course was more about what we weren't allowed to do than what we could - and one of those was administering the epipen - apparantly, we are allowed to hold it for them, but the patient has to press the button.

Fortunately, the one holder of an epipen in our office, also a first aider, has told us that that is total bull****, and that if she has a problem, to get the adrenaline inside her at once! :-)

It is a very sad state of affairs, but not new - when I was first aiding with the Red Cross (about 10 years ago), we had a directive coming down from on high saying that, we weren't allowed to do first aid unless we were going to or coming from a Red Cross duty, otherwise we wouldn't be covered by their insurance. To which, we all said "Naff off" (or words to that effect...), as none of us could see us refusing to help in an emergency - that is what we had been trained to do!

Anonymous said...

A few more examples from the first aid at work course (run by a very well known organisation) I mentioned in my last comment.

We were to be aware of gender, cultural and religious sensitivities at all times. If the victim was of the opposite sex, the first aider should have a chaperone of that sex present and explain what they were doing and why. Hands should be in sight at all times. Clothing should not be loosened or removed without express permission and at no time should undergarments or "culturally sensitive" areas of the body be visible.

At the time, I was working in an office with just one woman, a Muslim, in it. I asked how I as a male first aider was expected to help her given those strictures (eg don't remove or loosen her hijab) and was told "call an ambulance".

Another point from that course. We were told we were not to give first aid to members of the public as, again, that could expose our employer to legal action. We were told "there is no legal obligation on employers to make first aid provision for non-employees" and while there was a recommendation that employers make provision for non-employees, this was best met by calling an ambulance and remaining with the injured person until ambulance personnel arrived.

There are similar strictures at our local school. The school has first aiders, but parents have to sign a piece of paper each year saying it's okay for their children to receive a very narrow range of first aid provision (basically plasters and ice packs).

If you don't sign or more first aid than that is needed, then parents are phoned on each and every occasion that something happens and asked to come in to do it themselves or collect their child.

The staff are also very twitchy about responsibility should it come to calling an ambulance and are very reluctant to accept the full meaning of "in loco parentis". In other words, they want parents to make the decisions and to be there when ambulance personnel are treating/transporting children.

It's ridiculous and dangerous, but no one wants to take responsibility, make decisions or do anything for fear of being "blamed".

miss emma said...

A few years ago my friend dislocated her finger in PE. The school office said that they could do nothing and she would have to wait until home time to go to A&E. My PE teacher was outraged by this because it was clear that my friend was in a great deal of pain and she had lost the feeling in the tip of her finger. The office also refused to call an ambulance so my PE teacher took it upon herself to sort the finger out (she was a trained first aider). My friend said it was almost pain free the way it was put back into place and her parents even sent the teacher chocolates as a thank you for helping when she had been told not to!

I just couldn't believe that the school were going to make my friend continue for the rest of the day BEFORE allowing her to have a finger sorted!

Anonymous said...

Hi

Just so you know, if you'd been a police car, not only would the bus driver not have moved but he would likely have abused you too. I've experienced this lots of times, including the cabbie who wouldn't pull over the stop line at a red light on an empty junction when we were going to a knife point robbery. He screamed blue murder at us and said "you're not allowed to tell me to do that" (actually we are).

Re the above, my sister carries an Epipen and if she had an anaphylactic reaction and her employer DIDN'T let someone help her, there would be hell to pay for them. Do they ever think about that?

Good luck out there.