tag:blogger.com,1999:blog-54981941826292042712024-03-14T18:49:48.756+00:00The Paramedic's DiaryA record of the working life of a London Paramedic.
All in-confidence.
All real.Xfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.comBlogger683125tag:blogger.com,1999:blog-5498194182629204271.post-43535409869986099992015-11-29T15:32:00.000+00:002015-11-29T15:32:38.864+00:00Goodbye to a good man<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZExLigtsHxTYoquzCoSZw6EV2KzO7iZYMdjhcXZobXSvlkf9JeAwHas806vVB80FoDLXdT5wLr1_eueAOdUgqj076o84A3xq7gi9U9mQFL46gIc3UInuMkPyp123s-Kx9SvLwXt3Upgc/s1600/Sahib+Lalli.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="238" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZExLigtsHxTYoquzCoSZw6EV2KzO7iZYMdjhcXZobXSvlkf9JeAwHas806vVB80FoDLXdT5wLr1_eueAOdUgqj076o84A3xq7gi9U9mQFL46gIc3UInuMkPyp123s-Kx9SvLwXt3Upgc/s320/Sahib+Lalli.jpg" width="320" /></a>I've had plenty to write about but have lost the heart to write it in the past year. You know how much we are being crushed under the weight of it all. Too many people need (or think they need) an ambulance and there's far too few of us to help them.<br />
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This post isn't about all that and I may just possibly find the impulse to post regularly again next year, we'll see.<br />
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I'm posting to say thank you to Sahib Lalli, the police officer who died last week at a young age. My colleagues were unable to save him and I guess that's where our territories divide; greater powers than us decide the outcome, especially for the best of us.<br />
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I knew this officer, as I do many of the men and women who work the West End of London. I have spent many hours over the years chatting to the people of the Met and finding out just how human they are... and how vulnerable at times.<br />
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Of course, opinions vary when it comes to what we think of our police officers but, as a front line professional, I've needed them and they've needed me on so many occasions that you simply cannot distinguish some of them from your own family.<br />
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So, here's to you PC Sab Lal; rest in peace.<br />
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XfXfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com4tag:blogger.com,1999:blog-5498194182629204271.post-88379196196317066832015-04-16T18:36:00.001+00:002015-04-16T18:36:31.448+00:00Devolution<a href="http://www.itv.com/news/london/2015-04-13/paramedic-who-rushed-to-help-collapsed-woman-finds-a-dying-pigeon/" target="_blank">What's to be done</a>? I'm actually starting to feel some despair about the situation.<br />
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I was sitting in my response car at the scene of a call. There was an ambulance behind me - the crew was in the back treating the patient, who'd felt faint but hadn't actually passed out. I was on the phone to a fellow paramedic when a man approached me and asked me to wind down my window, which I duly did (although these days I'm a little bit more cautious about doing so).<br />
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The following exchange then took place.<br />
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Man: "Sorry for interrupting but I pay for the NHS too, so can you tell me why there are so many ambulances parked on this road?" (I should remind you that there were two!)<br />
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He went on to ask, "Are you waiting for something?" to which I replied, "We are dealing with an emergency call"<br />
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Man: "Are you on stand-by?"<br />
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Me: "No sir, we are dealing with a patient. The crew in the ambulance is treating her right now".<br />
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Man: "And you are doing what?"<br />
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I have to admit I was mildly shocked at this question. I suppose being on the phone and not doing anything relevant to my role must have irked him in some way. I'm not really sure.<br />
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So I replied, "I am talking to a colleague on the phone while I wait for my colleagues to tell me what the results of their tests are".<br />
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I was waiting, as I normally do, for my colleagues to pass me the ECG. They were treating a young woman for near-faint, so an ECG is in order. However, I usually leave the ambulance to reduce the number of males present for this check. That way the young lady's dignity is preserved.<br />
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Man: "Oh, I apologise profusely".<br />
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He then staggered down the road. He had been drinking but he was not completely wasted on alcohol.<br />
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One of the crew from the ambulance appeared a few minutes later and I told her what had happened and she told me that a man had opened the back door of the ambulance just as they were covering the patient up. He looked in and asked them if they could spare a pound!<br />
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This stuff may seem funny but its not. The pigeon story says a lot about where we are heading and what is going wrong but nobody dares say it or hint at it for fear of being punished.<br />
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I had a conversation recently with someone about my own views on certain incidents that have taken place in the world and I got an extremely incendiary response. I found myself backing away from the subject simply because the other person couldn't hold another view or entertain the possibility that the 'popular' truth was not so. This is denial and it stems from fear.<br />
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We should be talking openly and honestly - as brutally as required - so that we can get to the bottom of our problems and solve them. We need not scapegoat people or organisations but we must dismantle this multi-layered approach to system preservation at all costs. If it doesn't work, own up and take it apart.<br />
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I am reminded so often of our condition when I watch Gordon Ramsay go head-to-head with a stubborn restaurant owner who is convinced his food is great when every single customer he has is telling him otherwise!<br />
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We have a problem and it is bigger than the NHS and the Government. It is human and it is devolving.<br />
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Be safe.<br />
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Xfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com4tag:blogger.com,1999:blog-5498194182629204271.post-79615294055657043972015-01-23T03:34:00.002+00:002015-01-23T03:34:56.132+00:00ElephantsIt 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.<br />
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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.<br />
<br />
The programme, called 'NHS in crisis - the live debate', which you can see <a href="http://www.channel5.com/shows/nhs-crisis-the-live-debate/episodes/nhs-crisis-the-live-debate" target="_blank">here</a>, 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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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).<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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?<br />
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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 <i>could have</i> died waiting for us? To me, the sums are easy.<br />
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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.<br />
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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.<br />
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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.<br />
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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 <i>how </i>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.<br />
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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?<br />
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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.<br />
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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!<br />
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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.<br />
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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.<br />
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Be safe.<br />
<br />
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<br />Xfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com5tag:blogger.com,1999:blog-5498194182629204271.post-63394063915329740692014-07-09T00:38:00.000+00:002014-07-09T00:38:08.457+00:00Four nights shifts and an egg and spoon raceI'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.<br />
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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.<br />
<br />
And <a href="http://www.dailymail.co.uk/news/article-2684488/There-goes-no-claims-bonus-Ambulance-crashes-insurance-brokers-office-way-emergency.html?ITO=1490&ns_mchannel=rss&ns_campaign=1490" target="_blank">this</a> 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.<br />
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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?<br />
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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.<br />
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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 <a href="http://www.bbc.co.uk/news/uk-wales-south-east-wales-28093679" target="_blank">here</a> is an example of simplicity in brotherhood. It applies to doctors but doesn't apply to us.<br />
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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!<o:p></o:p></div>
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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!<o:p></o:p></div>
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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.</div>
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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.</div>
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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!</div>
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Be safe.</div>
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Xfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com1tag:blogger.com,1999:blog-5498194182629204271.post-82568031006704587382014-06-09T13:28:00.002+00:002014-06-09T13:29:38.761+00:00Human pigeons<a href="http://www.aol.co.uk/video/critics-disgusted-at-antihomeless-spikes-in-london-alcove/518260991/?icid=maing-grid7%7Cuk%7Cdl3%7Csec1_lnk1%26pLid%3D270355" target="_blank">THIS</a> 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 <i>their</i> neighbourhood.<br />
<br />
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?<br />
<br />
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.<br />
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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.<br />
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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 <i>all</i> end up where they are. It just takes a chain of unfortunate events.<br />
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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.<br />
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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.<br />
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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.<br />
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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?<br />
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No spikes. No pre-judgments. Try kindness.<br />
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Be safe.<br />
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<br />Xfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com1tag:blogger.com,1999:blog-5498194182629204271.post-69773218363791463562014-05-26T08:00:00.003+00:002014-05-26T08:00:55.585+00:00AbandonmentIt'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.<br />
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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.<br />
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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.<br />
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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.<br />
<br />
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.<br />
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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.<br />
<br />
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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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Be safe<br />
<br />Xfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com2tag:blogger.com,1999:blog-5498194182629204271.post-82922300667569198222014-04-22T09:23:00.000+00:002014-04-22T09:23:01.960+00:00Wind shiftIt has been more than a year since my last post and there have been many changes.<br />
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I have changed, my job has changed and the profession has changed. Its simply not what it used to be.<br />
<br />
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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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?<br />
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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<i> us</i>.<br />
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What we need is a shift in the wind.Xfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com6tag:blogger.com,1999:blog-5498194182629204271.post-76997923227052020272013-03-29T19:05:00.000+00:002013-03-29T19:05:23.981+00:00VulnerableThe 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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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Then a drunken Italian man continued the abuse and added physical aggression to the equation.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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".<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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 <i>at</i>) 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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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Be safe.Xfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com10tag:blogger.com,1999:blog-5498194182629204271.post-70332435741593407932013-03-22T22:19:00.001+00:002013-03-30T18:33:44.242+00:00The happy Space Hopper<div class="separator" style="clear: both; text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi35B4worPt1S6U9SkEh9xPkODNx3Ea9O2YxnDnLWz4g6KMQggT3L53Oc-Y60t_MLwCHZeMOU90Sg8AQ62ScbWenT_B8ncZ0BdmVpqluo11a66SKw7ji0FufhEuxhW2IbFDGloa6pC66ec/s1600/Wine+and+space+hoppers+dont+mix.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi35B4worPt1S6U9SkEh9xPkODNx3Ea9O2YxnDnLWz4g6KMQggT3L53Oc-Y60t_MLwCHZeMOU90Sg8AQ62ScbWenT_B8ncZ0BdmVpqluo11a66SKw7ji0FufhEuxhW2IbFDGloa6pC66ec/s320/Wine+and+space+hoppers+dont+mix.png" width="320" /></a>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.<br />
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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.<br />
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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).<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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 <a href="http://emedicine.medscape.com/article/1114004-overview" target="_blank">EDS</a>, or another condition that was causing this.<br />
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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).<br />
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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.<br />
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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.<br />
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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 <i>was</i> 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.<br />
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Crazy huh?<br />
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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.<br />
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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.<br />
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<i>* 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.</i><br />
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Be safe.<br />
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<br />Xfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com8tag:blogger.com,1999:blog-5498194182629204271.post-61270356948408687672013-03-21T01:02:00.002+00:002013-03-21T01:02:18.749+00:00Major trauma<div class="separator" style="clear: both; text-align: center;">
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My friend got a delivery of heavy shelving recently. This is where the delivery guy decided to leave it when she didn't answer the door. She was in at the time of the delivery but she just didn't hear him. Her door opens outwards....<br />
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Two patients at once after a fight broke out in Covent Garden. Both men had been beaten up quite severely and one had been left unconscious. Both had head injuries but I was more concerned about the man who'd been KO'd than the other one, because, although he had a fractured nose and cheek bone, he was alert, orientated and responding appropriately. The other man began a slow decline from the same state to somewhere relevant to the severity of his injuries.<br />
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His skull appeared depressed where he'd been kicked or punched - probably whilst on the ground - and that gave me all I needed to divert him (and his mate) to a Major Trauma Centre (MTC), rather than Accident and Emergency.<br />
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We can take serious trauma patients to specific hospitals, where specialist treatment is immediately available. It has to be done with caution, however, using good clinical judgement or, as in the case of this man, instinct. I don't mind getting it wrong if the alternative is that I could take someone to an inappropriate treatment centre and there's a delay in their care. I think that applies to most of my colleagues too.<br />
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En route, the man with the broken nose bled all over the ambulance floor; it was difficult to stop the flow until I wrapped a dressing around his head. The other man began vomiting. I'm sure we made the right call.<br />
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I'm known for my opinion on binge drinking, especially with young people and I still believe our NHS ambulance services should not be tasked to recovering people who deliberately go out and poison themselves with alcohol. However, there isn't much option and no resolution of the problem is in sight. So, we take them off the streets and to places of safety (usually hospitals) and that's that. But everyone has a duty of care for young drunks when they are in their professional arena. So it was disturbing to hear that a bus driver allegedly told a semi-conscious 17 year-old and his friends to leave the vehicle when he became sick.<br />
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Taxi drivers have little tolerance for this either, and I completely understand - they will spend a good few hours cleaning up the mess and will earn nothing while they do it. Bus drivers will have to get their vehicles cleaned too and they will be off the road.<br />
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The problem is that throwing a young person off public transport and leaving them in the street might just put them at risk. Years ago, I posted an incident where a taxi driver had taken a teenage female off his vehicle because she'd started vomiting. He left her in a doorway, in the small hours of the morning, in the freezing cold, with very little in the way of clothing to keep her warm. She was left exposed and dangerously vulnerable until someone called 999 and we picked her up. It happens almost every weekend.<br />
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In this case, the young man had friends with him but he was still left in the street, surrounded by people waiting for buses. He was almost unconscious when we arrived to take him to hospital. He was very cold and had been sick all over himself.<br />
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It may not be appropriate or convenient when a drunken person starts vomiting and messing up your clean vehicle, but it is a simple matter of judgement for anyone to assume that, if they are in such a state, then maybe they should be going to hospital - but not via the street.<br />
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Our last job of the night was another head injury but this time it was much more serious. The man had been hit by a taxi and had almost gone through the windscreen and into the cab, such was the force of the impact.<br />
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We arrived after the FRU and there was a paramedic and student paramedic dealing with him as he lay motionless on the ground. A small crowd had gathered and were watching and filming, so I asked them to leave the area. I've never understood why people would want to film someone's personal horror. It's not illegal because it's in the public domain but it tasteless and pointless.<br />
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There was a lot of blood around and it made the scene hazardous for everyone working there. The four of us managed his airway, started getting IV access and assessed his injuries, which were multiple and major. He was still breathing and still had a pulse, so there was still hope.<br />
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HEMS arrived and soon we had blood being transfused and more advanced intervention going on to save the man's life. It took almost 30 minutes to stabilise him and get a decent pulse so that he could be moved. He'd been RSI'd and immobilised fully for the journey to MTC and when we got there he was still breathing and had a better BP than we'd measured whilst treating him in the road.<br />
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Heading home after a shift like this invokes two things; a feeling that something worthwhile had been done and a life might be recovered from tragedy, and reflection on the skills and procedures carried out, so that they can be honed further.<br />
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Be safe.Xfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com3tag:blogger.com,1999:blog-5498194182629204271.post-53850676865394732292013-03-19T13:31:00.000+00:002013-03-21T01:02:50.726+00:00Back to the nightsI completed my first tour of night shifts since my unfortunate period of illness and trauma last year. It took me a few shifts to get into it again, and my sleep pattern was erratic at best to begin with. Nevertheless, I enjoyed the run and actually dealt with some genuine (and genuinely nice) patients.<br />
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However, my first night kicked off with a call I'd rather not have gone to. A 1 month old baby with respiratory failure. She'd stopped breathing due to a genetic condition, and her mother and sister were taking care of her when we arrived. There was a motorcycle paramedic (MRU) on scene and we got the story from him when we entered the little flat.<br />
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The baby was breathing again (albeit inefficiently) but had stopped several times prior to the 999 call. She is in such poor shape that it is unlikely she will have much of a future, if any at all. This type of call always makes me feel very down, especially as I am a parent myself. I have a lot of admiration for people who struggle through with very unwell children and still manage to keep a smile on their faces.<br />
<br />
We took her to hospital while supporting her breathing all the way. We had been diverted to this from a nonsense call way out in the opposite direction; if it hadn't been for the common sense and good judgement of whoever was despatching us at the time, we'd have been attending a fully grown up woman who was 'not talking' instead.<br />
<br />
<br />
Tonight was all about alcohol for a good few hours. In fact, our next patient - a drunken female at an underground station, had such strong alcoholic breath that I could still smell it on my uniform hours after we'd taken her to hospital for her own good. This was swiftly followed by a 40 year-old man, found lying among the rubbish bags in the street. A MOP had called us because he was worried about him and he was right - the guy would have been left all night and ignored for the most part, until he was finally taken in unconscious with hypothermia.<br />
<br />
He was drunk of course, but he was a gentle drunk. A man with a learning disability and no clue where he was or how he ended up on the pavement. This made him vulnerable but he knew that and when I spoke to him later, when he was in his hospital cubicle and sobering up, he agreed.<br />
<br />
<br />
It was almost certain that I would get assaulted at some point during this weekend; the number of aggressive drunks and angry people around made it inevitable if we were to get involved with them at any point. So I wasn't really shocked when I was punched a few times by a fist-swinging patient who'd allegedly taken 60 codeine in an attempt to kill herself. I got hit on the way down the stairs of the hostel, as police officers attempted to keep her off me, and hit again in the ambulance as a reward for trying to sit her down safely.<br />
<br />
It was the first time I'd ever been assaulted by a six-foot transgender patient.<br />
<br />
<br />
In the early hours of the morning we set off, on blue lights and sirens (because it was an emergency call) for a 90 year-old bed-bound man who woke up and realised he hadn't switched his TV off! Incredibly, we were allowed to go all the way there before it became clear (even though it was to us) to everyone else, that the call was about switching off his TV for him and no more. To add insult to injury, there was a 24-hour concierge on the front desk of the apartment block when we arrived. So he was tasked with the job and we returned to whatever normality we'd be allowed to resume...<br />
<br />
<br />
...Until a drunken 25 year-old female fell down steps in a night club and split her eyelid open, deep enough to reveal the bone of the orbit. She wasn't knocked out and she was lucid enough, so she went for cleaning and closure.<br />
<br />
<br />
The last call took us a long way out to tend the needs of an old woman who was 'vomiting'. She lived with a strange man in a strange, unkempt house. In front of a fully-functioning three-bar electric fire, she retched her way through explanations of illness as the man stood over her, patting her on the back in that 'I really don't want to touch you' way that you sometimes see when people are trying to be sympathetic but either don't have the practice or don't know what else to do.<br />
<br />
She continued to retch and cough, but never vomited. And when she was preparing to come to hospital with us, she requested her teeth, and the strange man duly obliged, fishing them out of a cup with his fingers. Then he lost them on the grubby carpet for a time and they had to be retrieved by the FRU paramedic who had arrived ahead of us. He gingerly picked them up and handed them to the woman. Now she could smile if she wished, and her carpet debris could smile with her.<br />
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She retched all the way to hospital and stopped as soon as we arrived.<br />
<br />
More to come from this tour...<br />
<br />
Be safe.<br />
<br />
<br />
<br />Xfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com8tag:blogger.com,1999:blog-5498194182629204271.post-91316904104107064562013-03-14T13:42:00.000+00:002013-03-14T13:42:07.445+00:00The Royal cushionEvery now and again in this business, we treat individuals of high stature or fame, or both. A call to an 81 year-old woman who'd fallen in the street didn't allude to anything more than an average call to an average person. However, when we arrived, we saw that armed police had settled and comforted the lady and that a decoratively dressed man was also in attendance. It was clear from a distance that they were helping someone who was regarded as a little more than ordinary.<br />
<br />
The woman had stumbled over her walking stick and fallen hard onto her arm and hip. Her upper arm was giving her a lot of pain and we controlled this with Entonox, whilst establishing what had happened. The lady's husband is an employee of the Queen, and she was on her way to Sunday church service near the Palace, when she misjudged her step and fell onto the pavement.<br />
<br />
She was helped to a sitting position by the cops, who'd been close by, and the decorated man, who is also in the employ of the Royal Household, appeared shortly afterwards, to render moral support and to provide a beautifully embroidered cushion that belonged to the Queen Mother.<br />
<br />
Every patient is an individual, regardless of their status in society. Every patient feels pain and deals with it in their own way. But it is nice to treat people that you know, with absolute confidence, will not abuse you. They won't swear at you, spit at you, or cause you discomfort whilst carrying out your job.<br />
<br />
I will probably never meet the Queen (I'm sure my medal for contributions to blogging is in the post however), but it was a pleasure to come into contact with people who work closely with her. I was expecting to be commanded, rather than allowed to do my job. I was expecting to be excluded from the conversations the patient and the decorated man would have in the ambulance. Neither happened. The decorated man praised the LAS in fact, citing how wonderful the service was and how well we all did our jobs.<br />
<br />
The patient, although in a lot of pain, was animated and humorous in conversation. It was an unexpected pleasure to be with them. So many high-ranking people forget to consider who we are and what we do, day after day. It was refreshing to be reminded that, when it comes to the crunch, they are just people, like everyone else.<br />
<br />
I don't know what the outcome for this lady was - I suspect she had a broken Humerus - but it made me smile to think that my handover was initially rejected.<br />
<br />
"I have two VIPs with me", I said to the nurse. "Members of the Queen's staff".<br />
<br />
"Yeah, in your dreams", said the nurse with a grin.<br />
<br />
<br />
On the other hand...a call to a 32 year-old man who'd had a witnessed seizure in the street, jolted me back to reality. A cycle response (CRU) paramedic was on scene and the man was still dazed and confused after his 5 minute fit, during which he'd bumped his head and cut his hands.<br />
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There was a single can of extra-strength lager in a carrier bag next to him. It was safe to assume it belonged to him, that being the nature of many of these calls. Nevertheless, we took him into the back of the ambulance, where he was initially calm and fairly compliant. The police accompanied us. They had been called to help and had decided to stick around.<br />
<br />
It took a long time to get the man's first name and no other details were forthcoming. Post-seizure patients can be very vague and seemingly uncooperative, but that's part of the recovery process, as the brain resets itself. It can take an hour for a patient to fully recover and start talking sense.<br />
<br />
As this man began to recover, he became extremely aggressive and abusive towards me. In fact, he made it very personal with me, which angered me. I am not a diplomatic person. I will not allow anyone to abuse me or insult me without a response, but while on duty and representing my profession and my employer, I simply cannot indulge in my instinctive reactions, so I had to sit there while he dealt me one threatening insult after another. He was no longer post-ictal and seemed lucid enough to know better.<br />
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I, like many of my colleagues, have had years of this type of abuse. Somehow people think it is acceptable. People think its just 'part of my job'. Well, it is NOT part of my job. It isn't in my contract and it isn't in my professional guidelines.<br />
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Unfortunately, there is very little or nothing we can do about this, so it really comes down to how long you are willing to accept it yourself (as part of the job). For me, time is running out. After a decade of abuse and insults and physical assault, I'm seriously thinking of a better life.<br />
<br />
This guy was eventually taken off the ambulance and allowed to walk away. The police could do nothing (well, they could but it'd change nothing), so he staggered off, with his can of lager and his hateful soul.<br />
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I had to consider the huge contrast between this job and the last one, and it depressed me somewhat. The first call had lifted my spirits and made me feel like the job was worthwhile. This call had reversed all of that in an instant.<br />
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I analysed his anger and hatred towards me, simply because I was trying to help him as he bled onto the floor of my ambulance. I analysed my own anger, as I sat there wanting to lash out verbally at him in response, or simply ask him who the hell he thought he was talking to. But most of all, I had to analyse the possibility that he'd cracked his head hard enough on the pavement to cause a brain injury and that his response to me was the result of his slow post-seizure recovery, his alcoholism, or a bleed inside his head.<br />
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I could forgive only two out of three of those possibilities.<br />
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Be safe.<br />
<br />
<br />Xfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com3tag:blogger.com,1999:blog-5498194182629204271.post-56139825576001113322013-03-08T11:44:00.002+00:002013-03-08T11:52:34.220+00:00The root of all queues<a href="http://www.bbc.co.uk/news/uk-wales-21674044" target="_blank">THIS</a> news story relays the current problems we are<i> all </i>facing but I have heard many times that this is fairly common with WAS. However, look at the story and read it carefully. The problem was caused, in my opinion, by the GP and the structure of the pathways set in place for such ambulatory patients.<br />
<br />
How did the GP diagnose a fractured spine? He clearly wasn't absolutely sure but had suspicions, so he arranged for an ortho bed and an MRI to be carried out, to see exactly what the extent of the damage was to this lady's back. That is all fair enough. The GP has to act on his experience and knowledge and the given set of signs and symptoms surrounding his patient. But it sounds like he either used an emergency ambulance service, (which is solely for immediately life-threatening illness and injury), just to expedite his patient's journey to hospital, where other means of transport, such as A&E support or Patient Transport Services, were available (in other words he dialled 999 for a patient who was <i>not</i> being admitted for immediate life-saving intervention)... OR, as I suspect, there is simply no option available to him. There are no other transport pathways and so everyone ends up dialling 999.<br />
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The woman's daughter even stated to the Press <span style="font-family: inherit;">"<span style="background-color: white; color: #333333; font-size: 14px; line-height: 18px;">Admittedly, my mother was not an emergency case, but nevertheless during her long wait she was unable to go to the toilet and was getting increasingly tired and fed-up", </span></span>before going on to describe the intolerable wait her mum had to endure, and the obvious frustration of the crews, even though they were professional and patient.<br />
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The irony is that if she hadn't been sent to hospital, essentially for a scan, by emergency ambulance via the 999 system by a health care professional, the queue would not have been quite so long, because they would not have been in it. The patient coming in behind them would not have had to wait even longer than they did, due to their presence, and the crew may have been saving the life of a seriously ill patient elsewhere.<br />
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Without alternative pathways; other means of taking patients to various different departments in hospitals without the need to call 999 and have them go through our already stretched Emergency Departments, this problem is only set to get much, much worse, until, soon I suspect, someone will die in the back of an ambulance because their undiagnosed <a href="http://www.nhs.uk/conditions/repairofabdominalaneurysm/Pages/Introduction.aspx" target="_blank">triple A</a> ruptures, while various GP referrals and District Nurse referrals - Health Care Professionals (HCP) using 999 as a means of transporting non-emergency patients - are brought in by exhausted and frustrated crews who will wait for hours outside hospitals with patients on-board who remain stable for hours. It's madness.<br />
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In my opinion, the problem is one of two things when it comes to HCP referrals. They either don't realise what they are doing when they take an emergency vehicle away from genuine emergency calls to transport stable, non-emergency patients. Or they don't have a choice, because there is no alternative.<br />
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This lady couldn't get herself to hospital and a car or taxi would have been a non-starter, due to her condition. A fractured spine is serious but it is not necessarily immediately life-threatening. A critical asthma attack, a serious head injury, unconsciousness, neck fractures, vomiting blood, central chest pain, cardiac arrest.... these are all 999 calls. But how do you get this patient to hospital for a scan if you have no safe means of transport? She needs an ambulance with a trolley bed (and a spinal board) and a crew that knows what to do.<br />
<br />
The voluntary services offer non-emergency transport services, so what about them? Or private ambulance services... or the NHS Trust Patient Transport Services.<br />
<br />
Here's the rub. Many hospitals have contracts with private or voluntary ambulance services but, when it comes right down to it, the HCPs who want their patients taken care of simply don't seem to trust these services and prefer to call 999 instead, knowing that they are going to get a professional front-line crew. I've even heard preferences for paramedics to take care of patients, even though there is no need because the patient did not require paramedic intervention of any kind. The transport services used by hospitals are usually the cheapest quoted and the contracts are decided by management, not necessarily clinicians.<br />
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We have a major problem. If this continues, not only will our system fail and patients start to suffer, but ambulance crews will begin to lose heart. They will also become unwell due to exhaustion, stress and frustration. This will have a knock-on effect and before you know it, we will be struggling to cope with the system as it stands.<br />
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HCPs aren't the major culprits though. The general public still attend Emergency Departments for the most insignificant problems. Everyone's emergency is personal, I know that, but when are we going to start educating people properly? First aid should be taught in every school - to school students, not just staff. And it should be taught by professionals who have actually done the things they are teaching you to learn. That way, a more realistic perspective is taught and kids might just start growing up taking ownership of their minor injuries and illnesses, instead of assuming that the health system is there to solve every little problem.<br />
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If you want an example of how bad things are getting, consider the 14 mile journey I undertook - on blue lights at a doctor's request, so that a patient could have a tooth replaced.<br />
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XfXfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com6tag:blogger.com,1999:blog-5498194182629204271.post-23795334628229698842013-03-03T19:21:00.001+00:002013-03-03T19:21:39.342+00:00Dogs have feelings too...Another cardiac arrest dragged me and my crew mate miles from base. An 83 year-old man had collapsed in front of his family. He was a known diabetic but had been speaking to his son earlier, with no problems reported at that time.<br />
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When we arrived, a FRU and another ambulance, crewed by an Accident and Emergency Support crew was on scene. We were told that a Physician's Response Unit (PRU) was also on the way.<br />
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The man was stuck in a tight space and the FRU Paramedic was in the process of resuscitating him, with the help of the A&E Support crew. It was clear that this was a messy and complicated job, and the presence of his family, in various rooms of the house, didn't help the situation. Emotional energy like that can hamper a resuscitation attempt - the task calls for an almost cold but certainly calculated demeanour; having family and loved ones out of sight is important whenever it can be achieved.<br />
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Before too long, there were too many cooks in that space. The PRU team had arrived, consisting of a HEMS paramedic and two doctors, so when they joined in to help, there were eight of us working on and around the poor man. However, once a few necessary skills had been carried out and we'd finally managed to get <a href="http://en.wikipedia.org/wiki/Intraosseous_infusion" target="_blank">Intraosseous access</a> (IV access proved to be impossible), only those directly involved with the resuscitation attempt were left with him. The A&E Support crew got busy with supplying and tidying away equipment, passing drugs and keeping the man's son, who was in a room opening directly onto the small landing area where his father lay, occupied and out of sight.<br />
<br />
One of the doctors dealt with other aspects of the attempt, including communicating the process with the other family members upstairs.<br />
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Once again, despite what is said about the job and what we do, when it comes to this stuff, we all know it well. Teamwork and communication is vital during a life-saving attempt. Keeping calm and responding to the situation without allowing it to affect you personally, is what makes the difference, if there is to be one, between death and life. I'm still proud to work alongside my colleagues in situations like this.<br />
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Unfortunately, despite our best efforts over a long period of time, the doctor discussed termination of the resuscitation with us and we all agreed. There had been no change in the man's condition for almost an hour. It was futile to continue; the effect on the family was bad enough - to draw things out would have been cruel and unnecessary.<br />
<br />
The man's body was left at home, appropriately covered and cleaned up as much as possible. The police were called (standard procedure) and the family was left to grieve in peace, with all of us waiting outside in our vehicles until the police arrived to take over the scene.<br />
<br />
When we were tidying up, I walked into the small room that the son had been in, until he went upstairs at the end of the attempt. Inside, lying on the sofa, was a Boxer dog. He had his head on his paws and his eyes told me everything about how he felt. This was the dead man's dog and the animal was clearly upset and depressed about what had gone on around him. His eyes followed me without his head lifting, and this just made him look ever more sad.<br />
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I tried to persuade him to move into the little kitchen area, away from the sight of his master laying on the floor of the landing, and, at first he followed, tail wagging at the sound of a kind voice (up til then all he'd been hearing were the voices of control and procedure and they are not kind voices). But he turned and went into the landing area, where he bowed his head close to his master's face, before running up the stairs.<br />
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I love animals. I love dogs especially; they can be extremely intelligent and are famously loyal, and I believe that what I witnessed at that moment, was a dog saying goodbye to his master.<br />
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Be safe.Xfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com6tag:blogger.com,1999:blog-5498194182629204271.post-71138590982092540732013-02-19T18:28:00.001+00:002013-02-19T18:28:56.417+00:00Getting back on the horseI'm going to ease myself back into writing this blog; it's been a long time since I recorded patient-related events in detail, so forgive me if things start off a little slow.<br /><br />I've been 'third-manning' for the first few shifts on my return to work. I need to be assessed as fit for practice, so I am duty-bound to sit in an ambulance with a crew and 'learn' my trade again. This is standard procedure for any frontline staff member who has been away from patient-care for a length of time.<br /><br />So, initially I was taking obs and re-learning the layout of an ambulance (not that you forget it but I've been on a car and a desk for a few years now and things change). After the first shift of lifting and listening, I started attending again. I felt as though I'd never left.<br /><br /><br />My first patient, an 80 year-old lady with a Urinary Tract Infection (UTI), asked me when I was going back to Scotland. She didn't ask me in a 'I am interested in whether you will be returning to your roots at some time in the future' kind of way, but more in a 'why don't you bugger off back to where you came from' kind of way. UTIs have a lot to answer for!<div>
<br />As we drove her to hospital, she chatted and argued with the Hi-Vis jacket that was hanging on a hook in front of her.<br /><br /><br />A 2 year-old boy was fitting continuously in a non-emergency hospital and we arrived to help. He'd been convulsing for 20 minutes and had already been given Diazepam, with no effect. The nurses were suctioning his airway to keep it clear and he was twitching and arching on a small couch when I first saw him. I can't help thinking of my own little boy when I see things like this now.</div>
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<br />It took another dose of Diazepam and a further ten minutes to get him to settle down, but he wasn't breathing for himself and so his ventilations were assisted all the way to hospital. He began to recover and stabilise but he still required support for his breathing, even when we arrived at the Resuscitation room.<br /><br /><br />An 87 year-old lady fell at home and was found face-down on her kitchen floor by her carer. When we examined her, it was clear she'd fallen many times. She had a fractured wrist as a result of this latest event. A look around her small house gave all the clues needed to suggest this lady needs to live somewhere else; her stairs (which she still used) were extremely steep and the carpeting was worn and sagging, making any ascent or descent a hazardous journey. If she fell from the top of those stairs, she'd be found seriously injured, or dead, next time.</div>
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<br />We recorded and reported this, as required, in the hope that something would be done for her.<br />Unfortunately, jobs like these can come back and haunt you. You can ignore what you see and find yourself on scene again, treating a major head injury, or attempting to resuscitate an avoidable lost cause.<br /><br /><br />Speaking of head injuries. A 45 year-old female was found laying in the middle of the road by plain-clothes police officers who just happened to drive past. They'd seen a small gathering of people around her and thought, like everyone else, that she'd been hit by a car.</div>
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<br />When we arrived, she was sitting with the cops, smoking a cigarette. She'd also obviously been drinking, but when asked how many, she stated 'two glasses of red wine'. She'd also had a free Valium, (courtesy of her friend whom she'd apparently visited prior to her fall), to 'take the edge off'.</div>
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<br />She had a nasty cut to her head but no other injury. She denied the possibility of unconsciousness but was vague about certain things… like the date and time of day. She kept telling us that she had a dentist appointment and that she was on her way. She seemed very concerned about her teeth. She'd told us that she'd visited her friend, had a couple of drinks and a Valium, then started making her way to her appointment. As she crossed the road, she tripped and hit her head.</div>
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<br />The story was fine but there were a few anomalies. The blood stain in the road was quite far from where she claimed to have tripped, so she either staggered and fell or she flew into the air. She was also hypothermic - something that doesn't just happen rapidly in a mild environment, so she must have been somewhere cold for a while… or she'd been on that road longer than she thought - possibly overnight.</div>
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<br />By the time she'd reached hospital with us, she was warmer but still confused, although adamant about the events that led to her being lifted from the road by the police.<br /><br /><br />Part of the process of a return to practice is re-training in the core skills that are necessary for all frontline personnel, such as advanced life support resuscitation. After covering skills and knowledge in these areas again, one hopes to get straight back into the thick of it as soon as possible, so that rust doesn't settle and spoil the art. My last job gave me the opportunity to save a life, using a lot of the stuff I'd only just revised.</div>
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<br />We'd been called to an elderly woman who'd fallen from a wheelchair and was not responding. Initially, this seemed like a perfectly straight-forward call, because 'not responding' can mean anything these days. However, as we pulled up on scene, we were up-dated and informed that it was now a cardiac arrest, so the tone changed and the pace accelerated.</div>
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<br />There was already a motorcycle paramedic on scene, carrying out CPR with the help of an off-duty nurse, so I got beside him and asked what he needed. My two colleagues followed immediately with the rest of the necessary equipment.</div>
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<br />No matter what you think of us (ambulance drivers, taxis, servants for drunks), we are extremely well drilled in cardiac arrest procedures and within seconds, we will have a team around you, working efficiently and carefully until we stabilise you or lose you, depending on what God decides.</div>
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<br />From the outset, there were problems with this patient. She was elderly, she had a recent medical history that gave her less of a chance for survival, and, as we later discovered during the process of resuscitating her, she had leaking lungs. Air was gathering around her lungs so that it caused pressure to build up, thus restricting our ability to help her breathe. It's very likely she had a herniated lung (or lungs) and <a href="http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001151/" target="_blank">pneumothoraces</a> caused by her predisposing medical condition... or our chest compressions. We know that this is a possible complication of aggressive CPR - which is the only way to achieve a positive outcome, if there is going to be one at all.</div>
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<br />We worked hard for 20 minutes or so before deciding to take her rapidly to hospital. It is quite normal for us to stay and attempt to stabilise a patient before conveying - they have a better chance of survival if we can get the heart to work before moving them. Unfortunately for this lady, despite our very best efforts, we could not stabilise her long enough to justify remaining on scene any longer, and so we continued CPR out to the ambulance and all the way to hospital.</div>
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<br /></div>
<div>
To relieve the pressure building up around her lungs, we inserted two large cannulae into her chest, one either side. This worked, but only very temporarily, as expected.</div>
<div>
<br />The hospital team continued to work on her for a little while longer but eventually called it and she was left in peace. I wish it had gone the other way but, as I said, not long into the attempt, it was clear she was in trouble. Still, we get to see some miraculous recoveries, so every mission to save someone is worth the sweat.</div>
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And, as I also stated earlier (and please do not think I feel this poor lady was good for practice and no more), her fate allowed me to get back into my skill-set.... inevitably, she will have helped me save a life further on down the line. In all aspects of emergency medicine, this is often the way of it. Someone slips away and exchanges life for life by allowing medics to get better at what they do.</div>
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Be safe.</div>
Xfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com3tag:blogger.com,1999:blog-5498194182629204271.post-24419558367139039752013-01-30T08:13:00.001+00:002013-01-30T08:13:22.982+00:00Acute deathSo.... I'm just about ready to get back on the road. I just need to prove I'm fit enough again (mainly to lift drunks and heavy patients). It'll be a couple of weeks but I'm returning to patient-care based stuff. I've had my fill of sitting in front of a bank of monitors.<br />
<br />
I should explain what's been going on because many of you have been asking me why I haven't been posting and where I'd disappeared to.<br />
<br />
I developed a very painful and persistent earache which turned out to be caused by a large 'mass' in my middle ear. My family and I endured a couple of weeks of waiting while they checked to see if it was malignant, post-biopsy. During that time I became much sicker and I think it convinced my loved ones that I wasn't going to be around much longer. It certainly felt that way!<br />
<br />
I was finally told that it was benign but that it was destructive; eroding bone at the base of my skull and into the semi-circular canals. There was another wait to see if it was operable or not.<br />
<br />
All of the problems I've faced in the last none months have been the result of this Cholestaetoma - the constant feeling that something was not quite right, the dizziness and nausea (which caused the fall that broke my collar bone) and eventually, the pain.<br />
<br />
The potential for death had crept up on me without warning and I don't think I had much time left to stop it... but I did.<br />
<br />
I've recently had the thing removed and I am recovering well. It hasn't made me deaf, as expected, despite the enormous damage it has done inside my ear, and I will be monitored for the rest of my life, to ensure that it doesn't recur and that I don't develop other problems associated with the internal structural damage. And it hasn't affected my brain; I'm still mad.<br />
<br />
So, there it is. My excuse for not being around in the past nine months. Sorry.<br />
<br />
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I have been 'third-manning' an ambulance while I have my return to work managed and there have been no surprises. The world is still the same and people are still demanding emergency medical care for non-emergency problems. We are still social-working the population and we are still being run ragged and to the point of exhaustion.<br />
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I have been given a fresh opportunity to appreciate how hard my colleagues work, especially on the ambulances. One call after another. Relentless.<br />
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I'll be back and posting on as regular a basis as I can just as soon as I am fully able to.<br />
<br />
Thanks for checking in and thanks for all your emails and messages of concern.<br />
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XfXfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com17tag:blogger.com,1999:blog-5498194182629204271.post-48176605434436940262012-12-17T16:54:00.000+00:002013-01-30T07:49:48.469+00:00Tinsel and stuffThe Season's upon us again. This year, for various reasons, it will be especially nice to be celebrating Christmas with my family. I think I lost sight of the worth of things you never have to buy in life, while a tidal wave of bad luck and bad consequences swept over my head.<br />
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I've missed writing regularly of course, but I need the time to completely heal and get things done that must be done if I am to return to the front-line battle that is paramedicine. I've not lost my opinions nor has my attitude evaporated; I'm re-charging my batteries and re-focussing my lenses, that's all.<br />
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So, have a lovely Christmas when it comes. I wish you all good health and a happy time over the period. Please don't drink yourselves stupid if you can avoid it and please remember to say something nice to an ambulance crew - even if they aren't actually treating you!<br />
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I'm not involved in this year's battle against Festive alcohol-fuelled stupidity and violence. I won't be mopping out a vehicle floor covered in someone's vomit. I won't be assaulted, shouted at, insulted or thrown around London like a caricature of a medical person.... but my colleagues will; my friends will. So I want to take this opportunity to wish them all the best for the season too and to ask them all to be safe and get through it unscathed, so that they can join their families at some point during Christmas and New Year.<br />
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I'll speak to you all again in 2013.<br />
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Be safe.Xfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com0tag:blogger.com,1999:blog-5498194182629204271.post-75024475938951965902012-11-03T21:00:00.000+00:002012-11-03T21:00:03.061+00:00Stalking postersDuring the years I have been writing this blog, I have been asked to add links so that others can advertise their services and products. I have also been sent hundreds of comments that look as if they are genuine but often contain links to commercial websites or products.<br />
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I don't mind this because it is part of the downside to blogging, but I would respectfully ask those who have attempted to post comments, tagged with links to their businesses, to stop doing this on the one post that I feel deserves to be left alone... 'Goodbye JT'.<br />
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This post was written as a heart-felt farewell to my dead son, so I find it a little insensitive that those of you with no more than a commercial interest in posting on my blog would choose <em>that</em> particular post to comment on.<br />
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I have thousands of legitimate readers and they visit because they want to learn, engage, discuss and argue with me. Please don't bother if all you want to do is sell viagra, or skin lotions, or pay-day loans. I have allowed Google ads to transmit selected items here and that is all I am permitting, so give it up.<br />
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Thank you!<br />
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XfXfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com7tag:blogger.com,1999:blog-5498194182629204271.post-70203665807142636862012-10-27T21:00:00.000+00:002012-10-27T21:00:00.204+00:00Gassy booze<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKVWRReYfb1FtF78hn_r13i2lLbNLbZ5QPldjprXajonJUzZdKdcXTWUbEfOY2Dnpie47c6402q-cWaKnNUk3K4ZJdNhn_vHYQnV7zF-XG-iXCloUzSjcxWy9l9hO-95mfmkVB_uf1YqI/s1600/liquid+nitrogen+cocktails.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="209" oea="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKVWRReYfb1FtF78hn_r13i2lLbNLbZ5QPldjprXajonJUzZdKdcXTWUbEfOY2Dnpie47c6402q-cWaKnNUk3K4ZJdNhn_vHYQnV7zF-XG-iXCloUzSjcxWy9l9hO-95mfmkVB_uf1YqI/s320/liquid+nitrogen+cocktails.jpg" width="320" /></a></div>
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Isn't it bad enough that we are dealing with more and more young drunkenness, with the prospect of alcoholism and liver failure creeping into those in their early teens, without the additional alcohol-industry-induced trauma that drinks like <a href="http://www.huffingtonpost.co.uk/2012/10/27/gaby-scanlon-speaks-liquid-nitrogen_n_2028750.html?ncid=webmail1" target="_blank">this</a> can cause? <br />
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Gaby Scanlon, an 18-year-old who was given one of these cocktails, endured agonising pain and was rushed to hospital by her friends. A CT scan revealed a large hole in her stomach.<br />
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Surgeons found that the extremely low temperature of the liquid nitrogen had not only burned a hole in her stomach but had completely destroyed her stomach lining. Her whole stomach had to be removed and surgeons connected her oesophagus, which takes food from the mouth to her stomach, directly to her bowel.<br />
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Now her diet is restricted for the rest of her life.<br />
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Proponents of these 'theatrical' cocktails will say they are perfectly safe to drink and that Gaby was an unfortunate 'one-off', but is it really worth even one young person's health (and she could have died if this hadn't been dealt with quickly) for the sake of selling more booze to inexperienced drinkers? I mean, what's the point of having smoke billowing from your glass as you drink? It has no effect on the alcohol or its taste, so clearly it's a gimmick to push booze down the throats of the young and vulnerable.<br />
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If liquid nitrogen does not completely evaporate, it will instantly freeze living tissue and destroy it. You can lose fingers by just touching it. So why is it clever to add it to a drink and then hand it over to someone without controlling the situation by ensuring the evaporation process is complete? It's exactly the same as removing something from the microwave and allowing someone to eat it immediately before the cooking process has stopped.<br />
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There's too much emphasis on creative boozing these days. Educating our young about the dangers of overdoing it is hard enough but dragging them away from an attractive smoking liqueur on their rite-of-passage birthdays is going to be impossible: they drink it, they enjoy it; or they drink it and the live the rest of their lives with the consequences.<br />
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I don't want to be a kill-joy here; life is all about risk but we should not be <em>creating and introducing</em> those risks to our children.<br />
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Be safe.<br />
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Xfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com8tag:blogger.com,1999:blog-5498194182629204271.post-55914901622892028182012-10-18T14:11:00.002+00:002012-10-18T14:11:57.180+00:00Shut your mouth<a href="http://www.huffingtonpost.co.uk/2012/10/18/rowan-atkinson-launches-westminster-free-speech-campaign-insult-law_n_1977488.html?icid=maing-grid7%7Cuk%7Cdl1%7Csec1_lnk1%26pLid%3D132807">THIS</a> has to be one of the scariest pieces of legislation that has ever been created.<br />
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I've often ranted on the rights of everyone to say what they mean and for those who feel 'insulted' or 'offended' to deal with it because such things are emotive and personal and there is no way of measuring them fairly. <i>In fact, this post will be offensive to some, simply because I have stated that!</i><br />
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The law is pushing us all into an abyss of fear, where only those who believe themselves righteous will have a say and those of us with an alternative viewpoint or a different opinion, will be arrested for speaking out.<br />
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Does this law extend to MP's? Aren't they forever insulting each other? Aren't they always causing some form of offence in order to make clear their opposition to a rival's opinion?<br />
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This is very, very dangerous indeed. It will spell the end of this blog and the very freedom of speech that we all have a right to practise. It will insult the memories of all those who gave their lives in order to protect us from losing our born rights, including the tyranny of a minority, hell-bent on being 'offended', whatever you say to them!<br />
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Please join me and get on board with Rowan Atkinson and Stephen Fry - two very outspoken individuals who've become famous for insulting others in the name of comedy. Go <a href="http://api.viglink.com/api/click?format=go&key=479001a47b532f95d19b8db2a7d169be&loc=http%3A%2F%2Fwww.huffingtonpost.co.uk%2F2012%2F10%2F18%2Frowan-atkinson-launches-westminster-free-speech-campaign-insult-law_n_1977488.html%3Ficid%3Dmaing-grid7%257Cuk%257Cdl1%257Csec1_lnk1%2526pLid%253D132807&v=1&libid=1350568623918&out=http%3A%2F%2Ft.co%2FpTWP7y5O&ref=http%3A%2F%2Fwww.aol.co.uk%2F&title=Rowan%20Atkinson%20Launches%20Westminster%20Free%20Speech%20Campaign%20Against%20Insult%20Law&txt=http%3A%2F%2Ft.co%2FpTWP7y5O&jsonp=vglnk_jsonp_13505693844921">HERE</a> and vote for this rubbish law to be repealed before you say something to the neighbour's cat and find yourself arrested as a result.<br />
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***</div>
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I am back at work but not quite fit for duty as yet... that'll take a few more months I suspect. Residual pain and limited strength has rendered me useless in the real world. But I'll be back. You know I will ;-)<br />
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XfXfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com5tag:blogger.com,1999:blog-5498194182629204271.post-72309488443314699272012-09-09T18:23:00.000+00:002012-09-09T18:23:12.699+00:00Calling itThey have power to make this decision on the basis of knowledge and experience but I'd argue we are using a lot more knowledge and experience out there in the world because we keep going for as long as possible.<br />
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<a href="http://news.bbc.co.uk/today/hi/today/newsid_9749000/9749017.stm">http://news.bbc.co.uk/today/hi/today/newsid_9749000/9749017.stm</a>
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<br />
However, we are pre-hospital and doctors factor in the time we've been working on a patient before calling it.<br />
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Good quality CPR over a long period if necessary is in everyone's best interests but there has to be a time limit, so doctors will need to be given guidelines for ending the attempt, just as we are.<br />
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XfXfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com5tag:blogger.com,1999:blog-5498194182629204271.post-17183984462763187142012-08-09T19:14:00.000+00:002012-08-09T19:14:15.975+00:00BrokenFalling hard can have many consequences for the body but I really wasn't expecting to end up like this. It's going to take me another two months to get back to normal, so please bear with me.<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhN1i7PjuMeYq6pd6PJNtzHygcdWPmdPbt-fV8S_PYhOctKrJEOPgMtIww4GGCOiJTgUvQJ7XFkuZJPjJESiSSbCiIynRTY37_keP-znsTIyePokkG1ghUNktFXxGNmuPlwnTxEoFJapnY/s1600/4th+August2.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhN1i7PjuMeYq6pd6PJNtzHygcdWPmdPbt-fV8S_PYhOctKrJEOPgMtIww4GGCOiJTgUvQJ7XFkuZJPjJESiSSbCiIynRTY37_keP-znsTIyePokkG1ghUNktFXxGNmuPlwnTxEoFJapnY/s320/4th+August2.JPG" width="262" /></a></div>
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I'm also being told that, unless you have a Google account, you won't be able to read my blog any more. Obviously this is not good, so I will have to consider moving this to my own website. I'll keep you posted once I'm repaired!</div>
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Xf</div>Xfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com22tag:blogger.com,1999:blog-5498194182629204271.post-71295922906845675942012-05-19T17:54:00.002+00:002012-05-19T17:54:16.874+00:00MIAWell, kind of. I do apologise to all of you for the dearth of writing but I am on long-term sick leave and need to rest. I will be back as soon as possible and when I know I am ready for it again!<br />
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XfXfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com32tag:blogger.com,1999:blog-5498194182629204271.post-30869769393648717102012-03-09T00:20:00.004+00:002012-03-27T00:27:23.005+00:00The shopping trip<div class="MsoNormal">The second night shift with the Welsh one....</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">A call to an 82 year-old female who is reported to have a fractured ‘P12’ (soon to be reasoned out as a misheard T12, unless there are new vertebrae I’m unaware of), starts us off. We arrive to find the lady in a lot of pain and a crew on scene. Our task is simply to assist with the transfer of the patient from her sofa to the ambulance down a few flights of stairs.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The poor old lady is unable to move or be moved without a good deal of discomfort and her anxious family stand around us, no doubt wondering how we are going to get her out of there. She’s been given 5mg of morphine but it’s nowhere near enough. The paramedic on scene is balancing the analgesic dose with the lady’s vital signs, but she gets another 5mg because pain is the greatest enemy of sustainable vitals, and the removal, or at least easing, of it can make everything much better; respiration rate, pulse rate, blood pressure.<o:p></o:p></div><div class="MsoNormal">Once she’s settled, we decide to transfer her onto a scoop stretcher by sliding it underneath her and pulling her gently onto it. Then we place her on the floor, wrap her up to secure her, and lift her all the way down to the ground floor and onto the trolley bed, which has been parked outside the uselessly small lift.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">As soon as the lady was inside the ambulance, Naomi and I set off on the next call. The idea for these two shifts, is to clear as many of the waiting and minor calls as quickly as possible by running on them and either transporting the patient ourselves or deciding on an alternative pathway. Additionally, the options for most of the calls we receive are pretty straight-forward. We can leave the patient at home, treated and safe, or we can leave them at home awaiting a GP visit. Our aim is to hit and run, as it were, to reduce the number of calls that are clogging up the system and slowing down an ambulance for those who really need it.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">A 49 year-old woman with chest pain in a train station next. She was a known asthmatic and she had a slight wheeze, but you can never tell with chest pain and so it was prudent to have a look at her ECG before making decisions in the direction of a cardiac origin. A crew turned up within minutes of our arrival and so they took this patient for further investigation.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Then a call to a 23 month-old child who’d ingested incense somehow was cancelled, so I did a quick U-turn. The call was reinstated and I did another U-turn.... then it was cancelled again. My U-turns are getting very good.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">An aggressive 56 year-old male, with a special liking for harassing female crews, called for an ambulance but we were sent to suss it out because he rarely needs to go to hospital. When we arrived, I knocked on the back door of his house and he shouted for us to go in. I was a bit wary because the little room he stayed in was gloomy and unlit.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">He was lying in bed; his island in a sea of debris and rubbish strewn all over the floor and around him. He told me he had high blood sugar and needed a nurse to come and give him insulin. Naomi checked his BM and it was normal – so he didn’t need anything.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">He accepted that all his obs were normal and he asked if we could go and buy him some bottled water and a pay-as-you-go card for his mobile phone. He asked politely but routinely. He had clearly done this many times before.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I spotted about a dozen bottles of liquid on the floor and I drew his attention to them. <o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">“What about this water? Why don’t you drink this?” I asked.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">“That’s piss”, he answered.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">He wasn’t insulting the water per se, he meant what he said. He urinated into bottles and just left them in the middle of his floor. A simple and efficient system I thought.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Naomi did his shopping (the local shop was only about 50 metres away) and returned to report that the shop keeper knew who she was buying the water for. This, indeed, was a regular habit of his.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I accepted the shopping trip this once but when he asked me if I could pop over to the GP surgery, which was in the same location as the shop, to check when the nurse could visit, I told him he’d reached his limit as far as goody-tokens were concerned. We bid our farewells and left before he asked us to spring clean his flat for him.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">In an office more centrally located than the last call, a 28 year-old female had a faint, a fit or a panic attack – nobody seemed to know which. The evidence pointed in the direction of a panic attack because she admitted to having them and seemed poised for another if she didn’t get out of her environment quickly. Her colleagues were concerned and this was creating tension, especially when they spoke of her being unconscious and having seizures, none of which she could recall.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">So, an ambulance crew took her off to hospital and by the time she’d reached the steps going in to the vehicle, she seemed much better. She’ll have tests done but I doubt they’ll find much wrong with her.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">A drunken 70 year-old staggered into a bar, sat down, wet himself and then proceeded to annoy the customers, according to the manager when we met him. This call was literally around the corner from the last one and so we were on scene very quickly. But even our rapid response couldn’t beat the speed at which the tall manager had removed the drunk from his premises.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">He was sitting on a chair outside the front door as people came and went and the street began to get busy with nightlife. He was a typical amusing drunk. That is to say, he was harmless but more than a wee bit annoying and clawing. He wouldn’t tell us where he lived or where he was heading. Neither would he admit to drinking much. We’d considered and abandoned a stroke possibility because he reeked of alcohol and his demeanour was of one who’d practised this art of boozy-clowning over the years.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Naomi went to get something she needed and I was left for a few minutes with the man. He pawed at me, grinned at me and then warned me that he was going to wet himself. Then he fulfilled his promise and a stream of urine trickled out from his trouser leg and onto the pavement. The local smoking women standing outside the bar were not impressed.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Luckily the ambulance arrived and I was able, with Naomi’s help, to get the man to his feet and away from the area before his dignity went the way of the meandering liquid he’d deposited. When I informed the manager of the bar that there was a pool of urine just outside the entrance, he was not pleased with me at all. “Stuart, I can’t believe you let him do that”, he chastised.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">So, two lessons here: number one; paramedics cannot prevent nature from taking its course when it comes to drunks peeing. Number two; be careful who you give your name to.<o:p></o:p></div><div class="MsoNormal"><br />
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</div><div class="MsoNormal">The next call initially looked like it would need the assistance of the Fire Service. We arrived to find a 45 year-old man semi-conscious, with his arm trapped in between a railing and a wall, near the top of a flight of steps. It looked tightly stuck. Passers-by had noticed the man behaving strangely and had reported him being unconscious at times. Now he was semi-conscious, semi-standing and possibly risking the loss of a limb.<o:p></o:p></div><div class="MsoNormal">We carefully bore his weight and attempted to free him by sliding his body up towards the top end of the steps. It looked possible but was very tricky because his arm was being squeezed even tighter at times. Suddenly, however, the man woke up. He reeled around and seemed momentarily confused. He fought against us as we tried to keep him still, then he yanked his arm out of the space. If he’d done that before we’d taken his weight, he’d have ripped it off at the elbow.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Then things became very strange indeed. He didn’t want to go to hospital. He didn’t want to be examined and he denied being drunk. He did admit to smoking a little weed though, but he was very embarrassed. I can’t tell you what he did for a living for obvious reasons, but it’s not the sort of thing you do very long in your life after being caught under the influence of drugs.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">An ambulance arrived and I explained the situation. The crew insisted on taking the man inside the vehicle for a chat about what to do next. He couldn’t go directly back into the hotel where he was staying (the hotel that the stairs and railing belonged to) because he’d almost certainly start to behave erratically and things would go bad for him. The idea was to persuade him to go to hospital and ‘dry out’ before going back. A fair proposition I think, don’t you?<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">A bit of a selfish one next. An encounter with an HiV positive patient who walked out to the car and demanded to be taken to a specific hospital because he’d been banned by the nearest one for ‘aggressive behaviour’. He then demonstrated this by getting angry when I told him we’d be taking him to the nearest. He stormed off but came back and relented.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I looked at the miles between one hospital and the other, and decided to give him a break. I’d take him to the next nearest and hope that would appease him.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">He had bleeding open sores on his head and had been picking at them. He put blood on his hands and purposefully wiped them all over the back seat and head rest. I had warned him on several occasions to consider where his blood was going but he didn’t seem to care at all. I could have sat there and dressed each and every separate wound he had but it would have been pointless because he was determined to mess with them.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Eventually, he behaved and allowed me to take him where he needed to go, without further fuss.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Later on, after coffee and a bit of a break, we went to see a 63 year-old man with back pain. His front door was open and after announcing our arrival with a knock and a shout, we entered his flat. It was in darkness, so we tread carefully.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The patient shuffled out from his bedroom to greet us. He was naked except for his underpants, which were worn and freshly soiled. He was clearly not being taken care of and his first complaint was that his door was unlocked. Apparently his carers had been earlier but they’d left his door unsecured – allegedly anyway.<o:p></o:p></div><div class="MsoNormal">“That door is always locked when they leave”, he told us.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">He had chronic back pain and was prone to falls. All he needed was his medication, which had not been given to him by his visiting carers, again allegedly.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">I checked his blister pack, called his care team and then, after clarifying that he had been visited but nothing had been done, gave him his Tramadol. I made sure the care team knew that this man had been left exposed, in more ways than one, and that his meds had not been given, as prescribed.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">He didn’t want, or need, to go to hospital but he was genuinely upset that he’d been neglected like that. I sympathised with him, as did the red-haired Welsh one. We’ve both seen this time and time again in our business. It’s sickening.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Finally, we get a call to a man who is inside a pink taxi. He’s either drunk or under the influence of drugs. Police are on scene and they want us to check him out because they’ve found a large number of tablets and paraphernalia on him when he was searched.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">We arrive to see the pink cab driving away with a furious looking female cabbie behind the wheel. The man is being spoken to by the cops and his tablets – some prescribed, some illicit, are on the roof of the police car.<o:p></o:p></div><div class="MsoNormal">“He made the cab drive around for a while and he jumped in and out of several clubs, pretending he had business in them”, explained one of the cops. “But he was getting drugs or messing about. We found a crack pipe on him.”<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">They didn’t find any evidence of hard drugs on him, however. Most of the stuff they asked me to identify was his own or somebody else’s, but nevertheless harmless.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">The man himself was unusual. I mean, he didn’t come across as a typical drug addict. Instead, he looked like a lost lamb; somebody with no purpose and the need to find one. He may have had (and I suspect he did) mental health issues.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">He had no need of hospital and the police weren’t going to arrest him, so he was told to walk home. He pleaded for a lift but the cop’s order was quite clear.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">“You aren’t wasting our time or the LAS’s time tonight. You are going to walk home.”<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">He only lived around the corner anyway, so it was no big deal.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">This man had spent a few hours in that cab apparently. He had the driver take him from place to place in a circle until he’d run up a £100 fare, which he didn’t pay. I’m truly surprised that any cab driver would have allowed that to happen. I would have thought he’d be asked for at least some of it when he stopped for the first time and got out!<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Be safe</div>Xfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com8tag:blogger.com,1999:blog-5498194182629204271.post-30183309505672055322012-03-08T00:27:00.004+00:002012-03-27T01:11:47.369+00:00How to step from the pavement and surviveNaomi the Welsh visited for more punishment, London-style, and helped me on two shifts on the car. I’m in Wales next month to attend a CPD day and I’m due to ride out with her and her colleague whenever I get the time to do so. I’m hoping to learn why our system is so different from everyone else’s in the UK. Meanwhile, however, Naomi continues to learn why we are so fast and efficient when it comes to patient obs and pathway choices.<br />
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We start the shift with a call to a 64 year-old female with exacerbated <a href="http://en.wikipedia.org/wiki/Chronic_obstructive_pulmonary_disease">COPD</a> and a history of two <a href="http://www.patient.co.uk/health/Myocardial-Infarction-(Heart-Attack).htm">MI</a>s. We don't have to do much for her because an ambulance is on scene fairly quickly.<br />
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We left the scene of that call to attend a held call for the police. They have a 28 year old female who has accidentally overdosed on her antidepressant medicine. The call has been held for a while, and I guess the cops got fed up waiting, because as we arrived, the patient was being walked out with them - they were going to take her to hospital in their own car.<br />
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I had a quick chat with her and decided to take her in my car instead, with the police vehicle following, less one officer, who was now sitting in the back seat with the patient... just in case.<br />
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A 39 year-old man was allegedly assaulted outside a pub. He had a lacerated nose, so he wasn't in dire need of a grown-up ambulance. Instead he got us and the FRU, in which he was conveyed to hospital.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaEsOV2sF8i8Sg1mFAEn9rqLQfGNW5IKhGUKD5GXVBmtfhBgfCweez7z_arlZv4Ljs2B-3z9RdttsZsbl-PST3yVGsoEYdA3VTMtFMWjayyZGkWmNceBG6ShNpzQKM7ZBUOPj-tW0pavM/s1600/Fell+from+kerb+drunk+(2).JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="239" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaEsOV2sF8i8Sg1mFAEn9rqLQfGNW5IKhGUKD5GXVBmtfhBgfCweez7z_arlZv4Ljs2B-3z9RdttsZsbl-PST3yVGsoEYdA3VTMtFMWjayyZGkWmNceBG6ShNpzQKM7ZBUOPj-tW0pavM/s320/Fell+from+kerb+drunk+(2).JPG" width="320" /></a>This x-ray (permission given to show it) belongs to our next patient. She was drunk, as were her friends, and she managed to step off the shallow kerb in a drunken, uncoordinated way. She basically tried to take a big step forward where there was none to be had. She landed awkwardly and tumbled, tackling her own leg on a twisted descent, into the road... and that's where we found her.<br />
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Her friends were all around her but, as is the norm for drunken 'sensible' people, they became a bit of a nuisance, so I asked them to step away and keep away. I'm pretty sure they'd have hauled her to her feet and got her into a cab if one of them hadn't retained a sense of propriety about the situation. He seemed to know, outside the alcohol, that his female friend had a significant injury.<br />
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On inspection it was very clear from the start that she'd broken her leg. In how many places and just how badly would not be known until my attention was drawn to that x-ray when we got to hospital with a later patient. What was obvious, however, was the lump of bone protruding under the skin of her shin.<br />
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She was in pain but I think the smog of alcohol was taking the edge off it. She still had enough marbles to use entonox to good effect and that's all she was getting until the ambulance arrived and took her away.<br />
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I don't doubt that this 25 year-old lady will reconsider her booze intake the next time she's out with the lads.<br />
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We were met by a security guard and an angry girlfriend (soon to be ex I should think) when we got on scene to help a flat-out drunken 22 year-old who'd downed a full bottle of whisky after a tiff with his boss. This seems ludicrous but people do the most idiotic things when they get upset.<br />
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"He's normally a light drinker", his girlfriend tells me. "But tonight he drank a whole bottle then called me up to get me to collect him. I had to get out of bed to come down here".<br />
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The young man was semi-conscious, so I taught Naomi a trick that is not often used in Wales (as I understand); she put a line in and fluids were given in a bolus. Within a few short minutes, the man was awake and fully aware.<br />
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Now, there is no clear scientific evidence that IV fluids clear ethanol rapidly, but the studies that have been carried out tend to be weak and suffer from small sample sizes and questionable methodology and I'd argue that, in my experience and probably that of hundreds of London paramedics, giving fluids to unconscious and semi-conscious drunks who are saturated in ethanol, will flush and dilute the problem, leading to a fairly rapid recovery... at least to consciousness if not sobriety. I've done this dozens of times, and even multiple times in one place with two or more patients on the street. To me, there is enough evidence to propose that IV fluids help. At the very least, it's worth a try.<br />
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Naomi doesn't get to see enough stupidly drunk people, so she has never witnessed the miracle of a needle, some tubing and a bag of salt water.<br />
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At a police station, a 27 year-old man was giving a statement about his recent assault, in which he'd been grabbed and beaten about the face as his iPhone was ripped from his hand, causing another injury on that part of his body. The poor guy was shocked, as you would be. He wasn't seriously hurt, so we took him in the car to hospital. If I were to give advice about this, it would be <i>don't walk around with your iPhone out in the open, especially at night</i>. Mobile phones are the new wallet and some thieves will stop at nothing to get you to relinquish it - some thieves carry knives to ensure that happens. It's simply not worth it.<br />
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Our last job was for an 82 year-old man who had leg pain after falling. He'd waited 4 hours for an ambulance. His GP had asked for one and said it needn't hurry. There were no ambulances to send, so we went and got him. He could walk, so we carefully assisted him down his stairs and out to the car. It was a painfully (more for him than us) slow journey but it was our going home job, so we took our time with him. He was rather tall and getting him into the car felt like a folding job.<br />
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That was that for the night. No mishaps and only one error. Naomi thinks there is a time called 22:60. She must do because she wrote that on the PRF. It's probably the tea-time hour in the valleys.<br />
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Be safeXfhttp://www.blogger.com/profile/08189044083128101123noreply@blogger.com1