Saturday, 12 September 2009

Another day in paradise

See? The shadows on the wall are more interesting than the people on the plinth!

Day shift: Five calls; one NPC; three by car and only one by ambulance.

Stats: 2 eTOH; 1 ? fracture; 1 Abdo pain; 1 Eye injury.


Ahhh, the old Red1, ‘life status questionable calls’ – they never cease to wake me up and make me smell the roses. I didn’t even make contact with this one (who was, of course too drunk to look alive). The police had found him lying on the pavement, where nobody in their right mind was going to touch him to see if he was alright, so they called us. The cops hadn’t over-reacted and screamed cardiac arrest down the phone but someone else button-pushed their way through a load of stupid questions, designed by and for robots, until the only conclusion they could come to (automatically, remotely and whether they liked it or not) was that the person on the pavement must be dead. A ‘life status questionable’ that actually produces a corpse is as rare as an ‘unconscious on a bus’ being something more than just another sleeping drunk.

‘Where’s my mates?’ asked the drunken fool, according to the police officers who flagged me down and stopped me from becoming part of the circus. I’m also told he then attempted to get up and fell back down, stating ‘I’m so drunk I can’t even stand up’. Honestly, he knew what was happening before we did. I would want to produce a little book of receipts and swipe his credit card for the couple of hundred quid that he had just cost me and my fellow tax-payers; Ka-ching.

Bear in mind folks, that it was still early in the day – morning time in fact.


Moving home for the new University Semester can be stressful. Moreso when, not only have you barely seen your new pad but your parents are visiting to help you settle in and your sister, who is also at uni, is at hand to comfort you during the move. Then you trip and fall off a high kerb outside your new digs, badly spraining your ankle in the process.

I was called to the aid of this 19 year-old woman who now lay in the road with her family around her. She still had her sense of humour and she still had her dignity (wasn’t wailing and crying all over the place) and she did have a possible broken ankle. Moving would have to wait and I took her and her mother up to A&E in the car.


The voluntary services arrived on scene when I was dealing with my next patient, a 33 year-old pregnant woman at 22 weeks who had abdominal pain and the worries of the world about losing her child. I had expected my colleagues to show and was quite prepared to take the lady and her husband to hospital if they didn’t, so I stuck to my guns because (1) I had no idea why the volunteers were there on blue lights and neither did my Control desk, (2) I would have to ride along with my patient in their ambulance because I had no idea what their skill levels were and I was responsible for her and (3) well, let’s just say I didn’t like the look of them to be honest.

I know I will get the usual flak for that comment but even my patient was concerned about being left in their care – one looked far too old to be doing the job and the other may still have been at school; the image was bad and the poor lady in pain had no confidence in them from the start.

She wasn’t bleeding and the pain came and went. Her last scan, which was the day before, was fine, so she was absolutely stable for travelling in the car. In fact, she insisted, so I cancelled the crew down right there, even though I didn’t know in what capacity they had even arrived here and drove the patient and her husband to hospital myself, delivering them to the Obstetric Day Unit within 20 minutes.

I must point out that, regardless of my personal opinion of the crew that arrived, the patient was given the option of travelling in their ambulance because I wanted to make sure I wasn’t the only one with an uncomfortable feeling about it. This is not an attack on the voluntary services, which generally do a great job and without which we’d struggle at times; it is a statement about the image given by certain individuals in their uniforms.


The stupid call of the day was for a 27 year-old man with a 2-week old eye injury (he poked it with his finger) who called an ambulance from a phone box when he got lost on his way to the eye hospital – apparently, he couldn’t see where he was!

He had been attended to at his local hospital but they had referred him to a specialist unit and now he was in Regent Street, nowhere near his destination. His eye couldn’t be to blame for that confusion and misinterpretation; his brain must have played a part.

I found out just how devious (or thick) he was when, after the fuss of myself and an ambulance showing up for him and me offering to drive him almost 4 miles to his destination, he not only asked me to stop at a shop so he could top up his mobile credit but to wait for him so that when he was finished at the hospital, I could take him home... to Acton! I clenched the wheel as I drove, I can tell you.

I deposited him in the waiting area of the eye hospital, where the triage nurse listened to my story and tutted sympathetically for me. Then I drove off in a puff of irate blue smoke and sped into the distance as the mad blind man came running after me, waving his mobile phone in the air with the words on its screen reading ‘battery lo’.

That last bit didn’t actually happen but it could have. I just drove off and left him there. The words ‘battery lo’ were probably flashing in his brain.

We end as we begin, right? As in life, the drunks and wasters get all the duvet, so I was given my last life-saving assignment for the shift at a train station where a Polish man lay ‘unconscious’ on the floor, directly below a little food stand. Police were on scene and by the time I got there, he was awake. He’d never actually been unconscious and he proved his worth by vomiting, without much warning or the good manners to catch it, copiously onto the cleanish, tiled floor underneath that little food stand (which was currently doing no business).

His foul vomiting went on and on. He became aggressive and nasty when the cops held him down for his own sake. He had no medical need of me or anyone in green but we had to do something about him – he was putting the Burger King customers off their meals. So, I asked for an ambulance and hated myself for doing it. The poor crew were dragged, near the end of their shift, all the way from the north to here in the south, just so they could continue the game we had started – ‘babysitting the foreign drunk man’; a game played by thousands of healthcare professionals and police officers around the country and a game which can be variously titled ‘foreign’ or ‘home-grown’, depending on your town and its national diversity.

This game, incidentally, if you are still chortling away, is costing us all money every day. It appeases no-one who pays to suggest that alcoholism is a disease, so ‘leave them alone and don’t be judgmental’. When we run out of money and have to face it all, what will we do with those hard-core individuals then? It would be cheaper to buy an island, drop them off and let them drink as much as they want until they die of it, or sober up and come home to rejoin society. We could use the savings to buy hospital beds for children with cancer or other genuinely ill people.
That would be nice.

This ‘patient’ was the only person I had to call an ambulance for. That says it all I think.

Be safe.

13 comments:

Fee said...

And yet every time the government (I'm no great supporter of theirs, either) try to suggest a way to lower our alcohol consumption rates, there are howls of protest from all sides. The Scottish government has proposed a minimum price per unit, and the publicans, supermarkets and manufacturers are all screaming "no, no, no". I'm not saying this would end all the problems, but we have to start somewhere. Yes, I know, the responsible drinkers shoudn't be punished, etc, etc, but you can't make an omelette without breaking eggs.

Viking83 said...

No flak needed Stu, I'm a volunteer ambulance dork in my spare time and I've seen some of the crews on the road and I wouldn't let them touch me even if I was dead and in need of a go with the AED.
Its nice you don't mention them by name!
Just I'm wondering how did they arrive on blues if they weren't called, unless they where passing and got flagged?
Anyway its not important, whats important is that (hopefully) they didn't argue when you said I'll help out back, and if they did you obviously forced them to take you!

Tom said...

In fairness to the volunteers, we would hear them calling to our control, as supplemental 1 etc, and yes they could be helpful, but my first experience with our volunteers, was less than productive.

As the local lot were trained by one of our oppos they could be relied upon to care for the patient, but if I had a choice, I would prefer a professional crew turn in for my family.

I mean no offence Viking83. I do not have the commitment or guts to do the volutary sector thing, which makes me somewhat ashamed..

b said...

It's an (albeit unfortunate) reality that volunteer services, by their nature, may not always live up to the standards we would hope that they do.

Those of us who serve as members of the voluntary ambulance services all know the crews who we wouldn't want to see turning up on blue lights at our doors; in some cases we'd rather hop to hospital with dis-membered leg in hand.

What I would say in this case, however, is that you've prevented a single potentially worrying trip to hospital for this patient, but that crew will probably have gone on their merry way to another patient who might not have been as lucky as yours.

I'm not suggesting name-and-shame for volunteer crews, but if you've encountered a crew who worried you enough that would keep a patient on-scene rather than send her with them then I'd hope (maybe you already have) that you would find a way to feed this back.

Standards won't improve unless this happens, and unfortunately it doesn't happen at all in most cases.

DH said...

Hi - I've been reading your blog for some time, but haven't felt compelled to post until now. I'm a university student and a member of one of said voluntary services (I'm currently halfway through my ambulance aid training), and thought I'd throw in my 2p in response to your comments about the volunteer crew you dealt with.

First of all, you said you and your control didn't know why the crew were there; as far as I know (meaning this could be completely different in the LAS), ambulance control aren't generally aware that a given crew are volunteers; volunteer ambulances are listed on their system as a normal double technician crew and are allocated jobs accordingly. So, the crew that turned up were probably just allocated the job and control were unaware that the crew they'd sent was voluntary.

Secondly, as I said, I'm halfway through my ambulance aid training, and some of the people on my course (and some people I've worked with who are already qualified as ambulance attendants) are absolutely not fit for the role, so I understand your concerns about the types of people to whom you would be handing over your patient. However, the concerns you had (apparently) were about the attendants' ages - 'one looked far too old to be doing the job and the other may still have been at school.' Their apparent age should have no bearing on their clinical abilities nor on your treatment of them as individuals; ambulance services hire paramedics as young as 19, and I'm sure you would have had no qualms about handing over to a young-looking person in LAS uniform. Similarly, I am aware of no voluntary service which allows people older than a reasonable age limit to crew ambulances, so the older attendant's age should also have no bearing on your assessment of his skills. However, like I said, I have worked with individuals in voluntary organisations who I would not trust to treat my mother, so if it was the attendants' behaviour or overall demeanour rather than their age that caused you concern, I would probably be more sympathetic with your position.

Thirdly, you were particularly concerned about their skill level. Anyone crewing a blue-light ambulance - voluntary or otherwise - will have had the training necessary to perform the job. Just because we're volunteers doesn't mean we're incompetent or untrained. The patient you describe does not sound as if she needed paramedic intervention - if she was stable enough to ride in your single-crewed car, she was almost certainly stable enough to ride in the ambulance.

Essentially, what I'm saying is, if you do have a voluntary crew turn up to assist you on a call, don't assume immediately that they're unskilled and unprofessional until they demonstrate otherwise. Treat them as you would any other health care professional unless you are given a compelling reason not to; the fact that their uniform says Red Cross or St John instead of LAS should not immediately give you reason to treat them differently. The vast majority of voluntary ambulance crew I've had dealings with are upstanding, intelligent, capable, and, above all, well-trained individuals. It's a minority which are unfit for the role.

If you have concerns about the level of training that voluntary crews have, I'd suggest you do a bit of digging on the internet to see what's covered in a typical ambulance aid course, or give your local BRC or SJA unit a ring, I'm sure they'd be more than happy to fill you in.

Deborah said...

I'm a member of a volunteer agency and yes, for many of my colleagues I would be glad to see them and welcome - for others, I would be better walking across broken glass to A&E myself. Perhaps they are jsut not confident in their own abilities and you picked that up?

Xf said...

DH

That was a very long and (unfortunately) misinterpreted response to my comments. Whilst I fully appreciate that not all volunteers are ill-equipped to do the job, I was commenting specifically on the image of the two people that turned up. True, age has nothing to do with it BUT you have to consider the effect a certain look and overall image has on patients.

This lady may or may not have required paramedic help but that is my decision and clinically things can change. Even in the car, she had the benefit of my help if required. On that ambulance she would not and I would still be responsible for her.

LAS control ALWAYS know who they are despatching and we do NOT just send any callsign without them being assigned to us. This crew, as I found out, were sent because someone from LAS was covering an event down the road and they were given the task.

You cannot be a paramedic at age 19. Sorry but it takes three years at least to become one and you certainly cannot begin your training at age 16. You need to be able to drive for a start.

As for the level of training, thank you but I am fully aware of what ambulance aid training is! We all do it. What I worry about is the lack of definitive qualifications by means of uniform ID. Red cross badges and SJA ranks mean nothing to me, Im afrtaid. I need to know what these individuals are skilled to do.

As I said, my post wasn't a go at the services but I am entitled to give my opinion about how I see things...and most of my commenters totally agree.

DH said...

Hello again - I think I may have come across rather more angry than I intended to in my comment. I wasn't trying to have a go at you personally, trying to imply that you made the wrong decision in taking the patient to hospital yourself, or that I wouldn't have reached the same conclusion as you, were I in the same situation. As Deborah comments, 'I would be better walking across broken glass to A&E myself' rather than going in an ambulance with certain voluntary crews (those of us who work alongside such people probably know this better than anyone). So, I wasn't saying you were wrong or that you aren't entitled to your opinion - you were there, so you obviously know what happened in this particular situation better than I. What I was commenting on more was that it sounded like your only problem with the crew was their age - if that was not the case, then I will gladly eat my words, I wouldn't want to get in the back of an ambulance with an unprofessional or dodgy-looking attendant either.

With regards to age, a foundation degree in paramedic science is 2 years, meaning that if you enter university at age 18, you can graduate whilst still 19 and be qualified as a paramedic; whether you are hired at this age is another matter, but there are fully qualified paramedics in this country who are 19 years old. For an example, check the following: http://courses.uwe.ac.uk/b780/2009.

In terms of ambulance control allocating jobs, what I meant was that if a voluntary crew are providing routine support for the ambulance service, as far as I know (in my area, at least), that crew are not necessarily displayed to the allocators as a voluntary crew. As I said, and as seems to be the case, this could be completely different in the LAS - I'm not at all familiar with the way that system works.

As you say above, 'What I worry about is the lack of definitive qualifications by means of uniform ID.... I need to know what these individuals are skilled to do.' My goal was to encourage you to do a bit of research so that next time you find yourself working alongside such a crew, you are more aware of what they can and can't do. I don't particularly want to go into details in this comment about protocols and levels of training specific to the organisation I work with, as this could identify both myself and the organisation, but as I said, a quick call to your local SJA or BRC unit would give you an idea of what 'Red Cross badges and SJA ranks' are so that you may be more (or less, as the case may be!) comfortable handing a patient over to one of their crews.

Hopefully that clarifies my meaning and intentions a bit more. If you'd like, I'd be happy to carry on this conversation via email, just say the word.

Anonymous said...

Hmmm, Booze Island, add some CCTV and we've got the next Endemol reality tv show on Five :) The problem is that raising the price of booze taxes everybody twice, once when we fancy a sensibly consumed pint, and again when the wasters still need picking up. We need to either stop trying to solve every problem (and just drop them on the island, or at least allow a medical professional, like a paramedic, decide that the drunk should suffer in place rather than cost the taxpayers) or find the narcan alcohol equivalent that'd sober them into the mother of all hangovers and give that every time you get a drunk customer.

Xf said...

DH

Trust me, I have no emotion about commenters that have their own opinions. You simply stated your case.

As for 19 year-old paramedics; surely you would have to begin your foundation course at age 17? All other courses are of three year duration anyway and you missed my point. You had stated that I seemed to be having a go on the basis of age but I wasn't. I had mentioned the extreme of one age and the other in the crew as a means of demonstrating something about them that I could not go into in detail without identifying them. They were probably perfectly good people with good hearts but neither me nor the patient had any faith in them.

Xf said...

anonymous

Punishing grown-up society for the misdeeds of others is totally wrong. The answer may be to fine these people after they have recieved costly NHS treatment if it is proven, beyond doubt, that they were simply drunk and had abused themselves with alcohol.

Ana said...

Stu,

Rank has got nothing to do with the skill levels of ambulance crew. It works in the same way everywhere, the higher you go up in rank, the more admin work you do. You may well be a doctor, on the other hand you may be a first aider. Badges may be able to tell you what they are qualified to do. Patient Transport Attendant is Tech 1, Emergency Transport Attendant is Tech 2 If a crew has arrived on blue lights, they have done so because they are qualified to do so. Ambulance crew with the voluntary sector are there to support the LAS, not replace them. They will work only within their skill levels, and will not hesitate to request for a more qualified crew if they feel the need to do so.
I am just clarifying a few things here, not questioning your decision. At the end of the day, you are responsible for your casualty and if both you and your patient were not comfortable, fair enough.

Lottie said...

DH

I was with Stu for this shift and he wasn't the only one who had concerns about them.

I've been a member of the voluntary services before and while there are some very skilled people, they're in the minority. A significant number of members do not possess enough skill to treat people safely and effectively, even as first aiders.

A big issue I have with the voluntary services is that their members are not subject to fitness to practice rules in the same way that healthcare professionals are by their registering bodies (GMC, HPC and NMC etc...). These are the fitness to practice rules that I am subject to as a medical student and you'll see that it covers a number of things over and above clinical skill like professionalism and health.

I remain unconvinced that the crew we met would be allowed to continue working were they subject to those rules. I felt they were unprofessional and had questions about their health, especially the older member of the crew who appeared very frail... and it wasn't just our perception of the situation - the patient was uncomfortable at the thought of being asked to go with them too.

I wouldn't have a problem handing a patient over to a young person in an LAS uniform because the LAS have a good reputation and people well aware of that - to join the LAS you must reach a minimum professional standard as well as a clinical one, not just pass a CRB check and a couple of first aid courses like some voluntary services.

Honestly, if you called an ambulance and the crew that arrived were disheveled, frail and fumbling with their bags like Basil Fawlty, would that inspire your confidence? Would you let your mum go with them? I certainly wouldn't.

It isn't the colour of the uniform that makes us cautious, it is the behaviour and well being of the person wearing it... and how can you blame someone for a lack of faith in an organisation where their members won't even own up to their skill levels?

There are plenty of volunteers who will say they can do something then demonstrate that they've no idea when they're asked to do it. A key thing about being professional is owning up and saying "No, actually I don't know how to do that" (or even better "No I don't know how to do that but, if you show me, I will know for next time) rather than doing something with the potential to harm the patient (and make a tit out of yourself).