Tough decisions

I’ve been asked to comment on this article. Of course, being there on the day and having an active role in it, I have been following the enquiry very closely. I am used to hearing that we weren’t there when we were needed or that we were ‘too slow to arrive’ but, like every other mass casualty situation, there are elements in the event of the day that will never be understood by the general public, or in this case, supposedly panicking fire crews.

Now I wasn’t there to witness this particular exchange but if the paramedic has recorded it, then I have to assume it happened as he said. Nevertheless, regardless of the alleged arguments, the medic was correct; the first crew on scene must stay put and report back with casualty estimates, resources required, etc., otherwise, as they spend precious time dealing with injured people, others begin to die for lack of ambulances and paramedics. This a difficult task in the face of such a horrifying incident, so the paramedic who stuck to his guns deserved praise, not abuse. It must have been very hard for him to say no.

The military operate a system in war that saves those that can be saved – we do the same in scenarios like this; patients need to be triaged – sorted out in priority and if one patient is going to die while another could die but can be saved, then the higher priority is the latter, not the former. Otherwise ten dead people arrive at hospital because they could never have been saved, despite the best efforts of the crews, while ten more die needlessly because they lay waiting for immediate life-saving intervention. It’s a harsh reality.

Let me know what you think of the article and please, don’t get offended if you are a fire-fighter; this has nothing to do with the alleged exchange of words – the debate on the table is whether the Incident Officer role is fully understood, now that I’ve outlined it. Do you think the general public should be told all this? Do you think they’d want to know?

Be safe.

Guns and gumption

From a purely ‘dark comedy’ point of view, there are fewer things funnier than hearing that a member of the public who tried to administer an Epipen to a patient having an allergic reaction stabbed himself with it by mistake, or that a guy who was involved in a road traffic collision and whose ‘brains were out of his head’ was reportedly chatting to his rescuer.




Shootings are popular this week; teenagers are killing each other in the name of gang supremacy, pride and God knows what else. A recent news article cited someone as saying ‘why are these young kids out on the streets that late at night anyway?’ The answer is fairly academic – the parents are fundamentally useless and in all probability there is no father-figure in the house. I base this sweeping generality on gut instinct and the current state of our society… nothing more.

Oh, and perhaps I can qualify it with this: I come from a broken home. I had a violently abusive father. I grew up in one of the toughest places in the UK… but to date, I haven’t shot anyone, stabbed anyone or put anyone in hospital. So, no more excuses about ‘disenfranchised youth’ or disaffected teenagers’ because every generation has them but only some of them – the ones with the wrong genes – go around hacking people to death or shooting them with weapons they can afford, thanks to profitable crime or Government handouts.

The bottom line is that young people are dying at the hands of their equals instead of getting on with life and becoming something worthwhile. For that we are all to blame because we don’t get off our backsides and do something about it. Instead we rely on pretty spineless politicians – people who would never make the statements I have just made here, without worrying that their careers would suffer. What the Hell is wrong with the truth and saying it like it is?



Now, a fascinating and unique piece of filming worth commenting on. The BBC’s Helicopter Heroes featured a section in which one of the HEMS Dispatchers had a heart attack and then went into cardiac arrest – on camera. The film crew kept rolling and captured the resuscitation of the man by two paramedics who were with him. Even as a professional paramedic I found this quite incredible and kind of shocking. I don’t think there has been a full-on, as-it-happens, heart attack to cardiac arrest and then CPR filmed like this before. If there has been, it is extremely rare. The man’s identity was never hidden or masked, like they do with other trauma programmes, so he must have consented to the whole thing being transmitted.

It is an important piece of filming because it shows CPR as it really is; violent and disturbing. The man’s arms are still moving as the paramedic pumps down on his chest. You can see agonal breathing; something a lot of people mistake for life and some medical people get confused about at times.

He survives and that’s thanks to the aggressive and effective CPR that was carried out by his colleagues. He would certainly have died otherwise.



This is a bit of film worth watching. I think it deserves an award because it’s bold and brave – both for the poor guy who nearly bought it and the camera crew who had the nerve to keep on filming. I doubt very much they stopped to ask for permission and I’m glad they didn’t.

If the BEEB gives me permission, I will use it when teaching first aid. It’ll be a lot more effective than those dull, old and badly acted things the big first aid companies churn out.

Be safe.

Support

It's different being on the desk as part of the 'core team' rather than as a 'when I want to do overtime' person. It's also good for me; I'm getting to grips with a lot of the stuff my brain should know but my soul had lost the will to help it remember. We don't get challenged out there; not medically anyway. After a while its pretty much all the same and very few jobs throw an unpredictable spanner at you; one in which you are forced to think on your feet. The desk, however, well that's different.

My colleagues dubbed it the 'Google desk' but when a call comes in (and a lot do, 24 hours a day), with a clinical, social or general query, you have to have an answer - the crews and other professionals out there are depending on it, so it's a bit of a mind-number sometimes. We give advice and support on every aspect of the job, we cancel, upgrade and downgrade calls when necessary and we keep track of the elderly and the unwell. I think it serves a purpose and is of great value. Whether I'd like to stay on and do it permanently once my secondment is over, I still don't know. I'm a front-line clinical grunt. I'm happy out there but I need to change my view.

I also get to see and hear every call that comes through the 999 service to us - it's a different perspective and helps me appreciate what they do up there in Control. The two worlds should meet more often; that way there would be less 'them and us' about the system. We all work for the same goal after all.

Be safe.

The final countdown - part 2

My last day on ‘the car’ and it started with a drunken woman who was taken next door to the ambulance station by her son when she came out in a rash that turned into bruising on her arm. She’d never suffered this before and had no allergies or pertinent conditions, so I took her in the car after a request from one of the motorcycle paramedics who was at the station when she was taken in. It was quite surreal to turn up at an ambulance station on blue lights for a call in the station itself. Colleagues were a bit confused - 'you on a job here?' one of them asked.

The son, who was 40 years-old, told me they’d both been out partying all night (who goes partying with their mum at that age... or any age?) and the rash had erupted this morning when they arrived home. The bruising looked like someone had been grabbing her arm but she denied any physical abuse.

I left the pair of them in the waiting room. They spoke to each other like a married couple; very strange.

Yet another case of ‘don’t care’ caring when I was asked to check the condition of a 76 year-old woman who had been found sitting on her doorstep after being out. The carer suspected she’d been out all night and had locked herself out of her own flat but the patient strenuously denied this when I asked her. There were bags strewn around the front door and she told me she’d just come back from the shops. One of the bags contained tins of cat food, so I suppose she may have been shopping but I couldn't find a receipt to verify the date.

Apparently, the woman, who suffers from Alzheimer’s, went out  last night with her dance partner for a bit of Rumba, or whatever it is dancers do, but it was clear that she’d been wandering around and landed back on her doorstep without a key. There was no dance partner - not still alive anyway, and her dancing days were long over.

I took her to hospital, even though she had no medical problem, because her carer was quite bullying towards her and the old lady wasn’t exactly stupid. She treated her like a child, grabbing the bags from her and telling her what to do, rather than asking her. I don’t like this approach to the elderly, regardless of their mental condition, so I got her into the car. She’d soiled herself anyway and I wanted to get her cleaned up – quite frankly, I didn’t trust the carer to do it.

‘Can I go now?’ the carer said impatiently as soon as I’d got the lady comfortable in the car. Obviously the caring business is rushed off its profit-making feet these days.

After dealing with a 19 year-old female who’d got her leg trapped in the doors of a tube train because she’d boarded it and decided it was the wrong one, so tried to abandon ship as the compartment closed, I was off to check the emotional state of a 62 year-old Spanish woman who was allegedly assaulted by drug addicts when she threw a bucket of water out of her front door (she'd been cleaning her stairs). The splash caught one of the loitering druggies as he and his mates huddled in the close stairwell out of the rain. He took offence, swore at her and threw a full bottle of soft drink at her. She then chased them around the block with her broom... and you don’t see that every day!

She took a risk though, you are more likely to get stabbed by one of these cowards if you try to stand up to them, so it was probably not worth the run for her. She suffers from asthma, so the police asked me to make sure she was okay before they left her; which I did... and she was.

She’s been told, sternly by her son and again, just as sternly by me, that she should keep her door shut and call the police if they come back again – she is not to go on a Rambo mission. In any case, the idiot who threw the bottle has very likely left his prints all over them - every thug I know is a complete amateur.

Mr Aneurysm from yesterday was in trouble today. I went back to the address and found him in a chair, with his smoking mate nearby. This time he wasn’t going to refuse to go because he looked like death. I couldn’t get a pulse on his wrist and his BP was too low to read. He was struggling to breathe but still as insulting as ever. I gave him fluids and oxygen until the crew arrived and they got the brunt of his ire – he was like this yesterday, so it was nothing to do with his current condition. And, for the first time, I managed to get the smoking dude to stop as soon as the oxygen came out - he either went outside and smoked or we'd all be blown out of the room. He understood.

Mr Triple A struggled as we got him into the chair and then we struggled to get him down six flights of steps – as usual, no lift was available.

By the time he reached hospital his BP was behaving and he no longer looked like a ghost. We may have saved his life but we won’t be waiting for a medal or a thank you note from him.

A RTC in which a cyclist hit a pedestrian ended the shift and my tour of duty on the car; the woman had a graze to her face and, by all accounts, was hit in slow motion as she crossed the road without looking but she told me she couldn’t remember the incident and when the cycle responder and crew arrived, she told them the same. She did, however, have the presence of mind to make a call to her husband as the police hovered over her, trying to get information out of her. She ignored them and talked to her husband. Then she handed me the phone.

She couldn’t speak English very well, the husband said, and she was ‘a bit upset at the moment’ – meaning she had things on her mind, which might explain her careless trajectory on the road. I wonder if she'd had a domestic - she had that 'I've just had a domestic' glaze over her eyes.

Well, that's it for now folks! I will try to keep the blog-fires burning here as I clear the decks of my million other projects. It's obvious that I will die a busy man but that's okay; it's how I'd want it anyway. I need to finish the books and get on with career stuff but I won't neglect the blog too long - so please check in regularly for new posts! Thanks for reading.

Be safe.

The final countdown - part one

And I thought my job was tricky!

I’ve had a bit of a break so that I can re-charge and write more of the book, which is 4/5ths complete now, thank goodness! Harry’s first birthday and his first toddling steps have also taken up a lot of time as I try to give my family as much attention as I do my work. The Mr Tonsilpus thing is still causing a lot of interest but I’ve been unable to get all of the parts together; website, blog, photo gallery, etc, that I need to make it more than just a fleeting exercise, so I’m trying to get time for that too.

Meanwhile, I am on one of the two last shifts that I will be doing as a frontline paramedic for a while; I’ve applied for, and succeeded in getting, a secondment on the Clinical Support Desk, on which I often do overtime shifts. It’ll be for six months but I will be reviewing my professional situation during this time and may well make a change happen so that I can get back to enjoying my job, instead of, well, whatever it is I’m feeling about it at the moment.

I’ll still be writing but not necessarily reporting the day to day crises of being a solo paramedic; I need a hiatus from that too. Medicine is still my option but I was unsuccessful this year – the graduate course is highly competitive... but there are other branches I can climb along in my academic and professional life – for the moment, its nose to grindstone though.

So, today’s busy set of calls included a 14 year-old girl who fell and said she couldn’t move or feel her leg. She’d slipped on water at home and come crashing down on the kitchen floor. She was a very large young lady and I wasn’t going to attempt to lift her myself, so I asked for a crew. In any case, if she had an injury to look at, it would be better if there were a few of us, including a female member of staff on scene. Mum and step-dad were there but I still wouldn’t feel comfortable prodding her thigh to see if it hurt. Personally, I don’t think she had much wrong with her leg – it was probably just bruised from the impact. She went out in a chair just in case.

An American couple, both retired scientists, sat in my car on the way to hospital after the husband began to feel ill, claiming that his blood pressure was too low. He had a history of Paroxysmal Atrial Fibrillation and a pacemaker had been fitted to solve any erratic heartbeat that was produced as a result. But he’d gone to the trouble of getting a blood pressure meter so that he could check his BP himself. The meter was giving him strangely low readings – so low that he wouldn’t be conscious – and so he dialled 999.

Admittedly, his blood pressure was up and down but I think that had more to do with his pacemaker batteries than anything else; his pulse was very irregular. He was stable, with a normal BP reading when I checked it, so he went by car.

During our conversation, I discovered that they were both genetic engineers and had pioneered a piece of DNA analysis equipment that was used worldwide before new technology changed things and they sold their company off for retirement.

A very bad sprain, possible fracture/dislocation next when a sprightly 84 year-old slipped and fell down steps awkwardly. She sat next to a woman I took to be her sister but it was her daughter – what I mean is, she looked no older than her daughter... hmmm, maybe that’s not right either. Whatever way I say it, it won’t sound like a compliment, right?

Anyway, she was very upbeat about her ankle and laughed with me until the ambulance arrived to take her to hospital. Some people just don’t let things like this get them down and yet we are fighting a tide of timewasters and minor illnesses all the time. It must be in the breeding.

At an underground station, a 69 year-old man stumbled (drunkenly) and fell on the platform, landing on his left arm, breaking the Humerus. This is a painful injury and not without its complications but the man couldn’t feel much, due to the level of alcohol in his bloodstream. ‘I may have a had a little bit to drink, I admit,’ he said to me.

I put his arm in a sling as his two friends watched and laughed. They were all Northerners from ‘oop’ there somewhere (I have a cheek to talk), so nothing was taken seriously. Until, that is, they left to go and see their show on The Strand and I took the injured man to my car. The pain in his arm was increasing, so he got a little entonox but nothing more. Morphine would probably have done a better job but he was getting none of that. Entonox and booze was enough.

In a squalid little flat on the roof of an equally squalid building, I found a crew attending a 74 year-old man whose friend had called them because he was concerned about the man’s condition. He had been diagnosed as having an Abdominal Aortic Aneurysm (AAA) and ‘wasn’t alert’. I was asked to back the crew up in case something drastic happened – a ruptured 'triple A' will kill instantly.

Inside the place, the man was lying on his filthy bed and his smoking mate was fussing about him - he’d locked the door when I got inside and I don’t like it when people do that, so I asked him to go and unlock it again, which he did, but only after accidentally stubbing his lit cigarette into my arm. ‘Oops! Sorry Guv,’ he said. Indeed, I thought as I patted down the pain.

The man on the bed wasn’t interested in getting help and refused again and again to go to hospital. I’d had a very careful feel around his abdomen and found the aneurysm, just under his skinny, neglected frame. According to his notes, it was small and detected by scan – now it was almost visible from outside his body and that wasn’t good. He really had to be in hospital but the best we could do for him was offer him a GP visit if he insisted on refusing our taxi.

This left the crew free to deal with one of two calls that had come in while we were wasting time arguing with the man about his health; both calls were queued and waiting for an ambulance. This is what happens when we are called out to people who don’t want us or waste our time. Somebody else will always suffer.

The novel will be finished soon but ‘101 dumb emergency calls’ should be completed before that – if you want a copy and wish to pre-order it for Christmas, then send me an email and I will get them signed and sent out to you when they are printed. Obviously, if only five of you want one, they’ll never be printed J

Be safe.