Tinsel and stuff

The 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.

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.

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!

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.

I'll speak to you all again in 2013.

Be safe.

Stalking posters

During 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.

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'.

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 that particular post to comment on.

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.

Thank you!

Xf

Gassy booze

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 this can cause?

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.

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.

Now her diet is restricted for the rest of her life.

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.

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.

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.

I don't want to be a kill-joy here; life is all about risk but we should not be creating and introducing those risks to our children.

Be safe.

Shut your mouth

THIS has to be one of the scariest pieces of legislation that has ever been created.

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. In fact, this post will be offensive to some, simply because I have stated that!

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.

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?

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!

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 HERE 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.

***

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 ;-)

Xf

Calling it

They 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.

http://news.bbc.co.uk/today/hi/today/newsid_9749000/9749017.stm

However, we are pre-hospital and doctors factor in the time we've been working on a patient before calling it.

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.

Xf

Broken

Falling 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.

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!

Xf

MIA

Well, 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!

Xf

The shopping trip

The second night shift with the Welsh one....

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.

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.

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.

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.

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.

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.

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.

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.

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.

I spotted about a dozen bottles of liquid on the floor and I drew his attention to them.

“What about this water? Why don’t you drink this?” I asked.

“That’s piss”, he answered.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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?

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.

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.

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.

Eventually, he behaved and allowed me to take him where he needed to go, without further fuss.

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.

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.

“That door is always locked when they leave”, he told us.

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.

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.

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.

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.

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.

“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.”

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.

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.

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.

“You aren’t wasting our time or the LAS’s time tonight. You are going to walk home.”

He only lived around the corner anyway, so it was no big deal.

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!

Be safe

How to step from the pavement and survive

Naomi 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.


We start the shift with a call to a 64 year-old female with exacerbated COPD and a history of two MIs. We don't have to do much for her because an ambulance is on scene fairly quickly.


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.

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.


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.


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.

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.

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.

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.

I don't doubt that this 25 year-old lady will reconsider her booze intake the next time she's out with the lads.


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.

"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".

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.

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.

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.


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 don't walk around with your iPhone out in the open, especially at night. 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.


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.

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.

Be safe

Answers to the BIG post

I ruffled a few feathers with my post on obesity. I knew I would; I expected it. I want to respond to everyone who has commented and emailed to support, criticise or threaten me (yes, there are still a few idiots out there), just because my professional viewpoint doesn't suit them.

First of all, as I clearly stated in that post, I understand that not all obesity is the result of self-abuse and excess. I have crossed comments with individuals who have taken drugs that have fat-gaining side-effects, or those with other significant issues. But I have to stress that gaining weight is a physical thing. Those who pile it on surely know they are getting far too big for their own good. Too may calories and not enough burning.

I watched an episode of Supersize vs Superskinny, in which doctor Jessen exposes some horrific facts when he visits the USA. Statistically, a third of this nation's population is now obese. Click on this link and look at the map as it shows trends for obesity across every state. It is truly shocking.

One woman, weighing 50 stone, that's over 300Kg, complained about how unwell she was and how she hated the way she looked. She bemoaned the fact that her son's life was ruined by her excesses because he now had to take care of her. He fed her, bathed her and helped her get dressed.

This lady was so heavy that she often damaged the lift system on the bus she needed to travel in to get places.

But while she did all this complaining, she still took herself down to the local restaurant, in her over-sized mobility chair, and she still shovelled in more food than most of us could possibly eat in a day, never mind one sitting. She did that and then went home to lie down. She loaded on calories and spent very little energy getting rid of them.

When Dr Jessen exposed her on TV, showing us the crammed contents of her fridge and the snacks and unhealthy food she had been eating, the lady giggled and rolled her eyes like a naughty child. She had just been told that she would die if she did not stop, yet there she was, mocking the very serious nature of what she herself talked about and agreed upon, moments before.

Getting too fat to live is more than just about eating, whatever the excuse. It is about other issues; emotional, psychological, self-esteem, lack of confidence. Sometimes it's about greed and mostly I believe, sheer laziness. It's just too easy to eat rubbish and do no exercsie these days.

We must address this now. We must be frank, open and honest. We need to face the problem and deal with it, without judgment or criticism where possible. But if those who need help simply don't want it, then there is no solution and things will become steadily worse as time goes on.

Go back to the CDC link and look at their map again... and again. Tell yourself I'm a liar and that it isn't happening. Convince yourself that you are different and that it's everyone else who's to blame. And while you watch the map staining red across those states, copy the pattern in your mind and transpose it for the UK and Europe... and in time, the rest of the world.

If a third of the entire adult population of a continent is obese and cannot function fully as a result, what becomes of a nation trying to defend it's borders when, as time goes by and we ignore the problem, more than half of it is populated by fat soldiers?

Xf

Fat future

Why are we even talking about this? The Government thinks it's a great idea and an 'innovation' to make special ambulances and resources available for drunk people. Getting specialist ambulances in for the grossly obese should be no biggie.

I've noticed the rise in larger patients among the elderly and this is quite shocking, because it indicates a generation of obesity that is about to slam into our NHS budget, causing a crisis like no other. It is already a fairly regular occurrence for crews to call in and request a bariatric vehicle for a patient they simply cannot carry, even on the newest ambulances with the wider beds. Private ambulance companies, like the one shown, are investing millions because they can see the future.... and the future is FAT.

The whole concept of spending millions of public pounds at a time when we are all being told to 'tighten our belts', is laughable and crudely paradoxical. I know that many obese patients got where they are because it is not as simple as not eating as much, but it is still due to excess that most of them are in that position. why are we paying for it? Why, in fact, are we paying to help out drunkards by giving them special vehicles and facilities too?

The bottom line is this: we haven't got the money for this nonsense. It would be cheaper to have everyone with a serious weight problem banded without fee if they reach a certain weight. Many obese people want this done because it can save their lives. However, it costs the NHS and there is a bit of moaning about that. How ironic then that we send that money (the same money that would be spent on banding) into the private sector so they can be trundled to and from hospital many times before they succumb to their disease.

I can see another future. Those binge-drinking kids that think it's so cool. A proportion of them (not all of them) will continue to drink like that and they will become alcoholics. We will see that generation filter into the NHS purse as a direct result of their ignorance within the next decade or so. Check back here in 2022 and see if I'm wrong.

Oh, and I'm not having a go at the obese; I'm having a go at our complacency to deal head-on with our problems. It's ridiculous. There are plenty of people out there who were once obese but got their act together and stopped bemoaning their condition as if it was someone else's fault. They lost weight and saved themselves. Even those who elected to get a gastric band fixed have acted to stop the rot.

So, instead of supplying indefinite funding, why don't we just educate people properly? Spend the money teaching people how to eat and drink wisely. Poor old Jamie Oliver tried to do this and got slated in the USA because they didn't like being told what to do! I expect my views on this subject will get me a similar reaction from some of you. That's a shame because I'm simply saying what everyone else is thinking.

Xf

Radio Gaga

      

This is the interview from the beginning of the week. Even the Beau, who came with me (cos it was Daddy day), enjoyed himself and sat in with the DJ, although he doesn't look too impressed!

If anyone out there has software to record this as it streams, can you do it for me and send me a Wav or MP3 file of it? Thanks!

I'm still battling for the return of Mr Tonsilpus but I think I'm losing. Some people just have no soul.

I may send the original Mr Tonsilpus (the first one ever made of two) with a new passport, off to the remaining locations; Australia, New Zealand and Lebanon, if I don't get the little guy back from his last host by the end of March.

If you were a member of the old Mr Tonsilpus Facebook group, you'll need to apply for membership of his new group because FB has migrated the whole thing and now there are only two members! There were almost 300 members in the last     one. Type in 'Mr Tonsilpus' on the search bar and you should find the group.

Xf

Man in pants skates for dog

Now this is just plain stupid. I'd do pretty much anything for Scruffs the cat but I don't think it would include leaving my family without a husband and father. There have been a number of recorded deaths as the result of humans putting their own lives before that of animals and it all seems poetic on the outside and, I suppose, should you successfully negotiate thin ice in your underwear and bring 'Tappy' the dog back from the brink, then you would feel proud, but very few dogs have actually drowned in these circumstances - many of them scrambled to safety by themselves... usually after the human drowned trying to get to them. Maybe the animals saw what was going on, realised that if they stayed much longer they'd end up just like the daft two-legged rescuer, and made a proper bid for freedom.... with their four able legs.

It's been very cold recently, so not only are the dog-rescuers coming to the fore, but the elderly are suffering as usual. Among those are individuals who fought in a war to entitle us to charge them exorbitant sums for the privilege of switching on the gas. I heard one old lady say she had a simple choice, 'eat or heat'. I feel a lot of shame for our society.

BBC Three Counties Radio have asked me to say a few words on the Jonathan Vernon-Smith show from about 9.45am on Monday, 20th February. Listen in if you can; I might say something pithy :-)


Be safe.

What NOT to die for...

http://www.huffingtonpost.co.uk/2011/12/25/ambulance-service-condemn-call_n_1169199.html

Nuff said.

Xf

For what it's worth

It was only a matter of time....

http://www.camdennewjournal.com/news/2012/jan/paramedic-biker-%E2%80%98fireball%E2%80%99-euston-road

This happened to a friend of mine and I've been saying for a while now that, sooner or later, one of us is going to pay the ultimate price. I for one do not want to be killed racing to an emergency toothache. In this case, the call was a genuine 999, and I think if I get taken out on the way to a life-or-death situation, then it will have been worth the risk.

Now people who call ambulances for nonsense might see what actually happens when one of us runs out of luck.

Get well soon Jim.

Xf

To beat or not to beat

I had compiled a few news stories that I found either relevant to my profession, worth talking about or just plain daft but I never got around to posting them, so now I'm making up for it, starting with this:

http://www.tes.co.uk/article.aspx?storycode=6003543

I grew up in the 60's and 70's, and corporal punishment was legal and quite routine. Teachers in my day used a leather strap; a thick brown or black thing that, when brought down hard on the palm of your hand, delivered a long-lasting stinging-numbing sensation that made you feel like your hand would drop off. I can actually remember the pain to this day. You had to stand outside the school office, or the head's office... or even in the middle of the classroom, with your friends watching, as you waited for the 'belt' to be brought out of the teacher's desk. The anticipation alone was punishment enough.

Then you'd be asked to stand straight, with one hand one top of the other, outstretched, as if begging for money. Every kid I saw getting hit with this thing bent their little elbows in to try and avoid getting hurt too badly as it flew down onto them. However, if you were seen doing this, you'd be told to behave and you'd get another, extra lash for your trouble. Trying to pull your hands away was futile because it often ended in farce, as the belt missed and instead, hit the teacher on the knees.. or worse, the groin. You'd get hit much harder for that. And if this didn't happen, you'd end up getting hit so hard on the tips of your fingers that you'd wish your hands had remained still. But, it's hard to stand there and watch as it comes down, without wanting to run away from it.

Sometimes the evil thing crossed the border of hand and wrist and you'd get a lot more pain than you deserved, as it burned into the softer, more vascular area of your lower arm. No matter where you got hit, you'd be left with a red mark that told of your evil character. One hand, then the other would be battered. Usually one or two blows were enough but some kids got hit four to six times. By the time that ordeal ended, they'd be crying or screaming in pain and would have to go and see the school nurse!

Every teacher could give out this punishment, and there were no rules or guidelines as far as I'm aware, for the meting out of it. I was once given a few lashes just for playing the school piano without permission. I had done no real harm and I was showing off. There was no damage done, except to the ears of those with a love for good piano playing. It was harsh and extreme. I got punished like this for going into the staff ladies' loo, just to see what it looked like. Mrs Cuthbertson, a very large teacher, caught me as I made my escape and I got a few lashes for trespassing... or curiosity as we call it nowadays.

But in those days something else was pretty endemic; physical abuse at home. It was almost normal for parents to beat their children with belts, fists and God knows what else, as a means of 'disciplining' them. Well, I can tell you, it didn't work. It made us fear adults but not respect them. It taught us that the only way to get someone to do what you want them to do is to hit them. Bullying was rife in my day.

I am all for discipline and I am passionately against this 'new wave' stupidity that came along in the 1980's, where children were told they had rights (yes they do but please, just stop telling them!) and that everything could be sorted out by letting them grow 'naturally'; in other words, they could do and say whatever they liked. It was their right to behave like that. Small children calling their parents by their first names is a dead giveaway for this relaxed attitude. Imagine soldiers calling their superiors by their first names.

"Corporal, take your men over that hill and kill the enemy immediately!"
"Yeah, righto Simon. I don't bloody think so!"

Rubbish! They are children; they need to be told what to do and to be guided in the right direction, otherwise they become feral little gits, with no sense of value or truth. Children are all inherently selfish, for good survival reasons, but they should eventually learn that others have rights too and that others have frank opinions. They should also learn that for every bad deed there is a punishment; a consequence for their actions. That punishment does not have to be physical. At least, not to the point of brutality, which is what I described from my school days and home life.

I have never hit my children and never will. I would spank Harry on the backside if he ever went beyond ridiculous but I've never had to. Physically, they need no more than that. I have the right to bring my child into line and to teach him that he just can't misbehave without consequence. More effective, however, is the naughty step. Harry puts me on it if he thinks I've done something wrong! That's how well it works. He believes in the concept and therefore understands that he is sitting on it because he's been naughty. He will learn the difference between good and bad.

Does beating a child make them better behaved? No, it doesn't. It provides shock and awe for school staff, so that they can get a moment of power back for themselves. It teaches the child nothing about leniency, respect, appropriate repercussions or love.

I have an idea. Why don't we just tell the parents of every child in school in the UK to stop bullying the school staff? Why don't parents, who think they know better than the teachers at their child's school, shut up and let these people get on with their jobs? After all, if it wasn't for them, none of us would be able to work because we'd be too busy taking care of and educating our little ones. They are doing us a favour and they are inspiring our children.

Stop going down to school and 'having a go' at some defenceless member of staff just because you don't agree with their policies. The old 'it's my child, so don't you be telling him/her/it what to do' BS has got to end.

When Harry goes to school, I want the staff to treat him with love and respect. I want them to hold his hand if he allows it and needs it. I want them to hug him if he's down or has fallen over and is sobbing. I want them to punish him, using the clever tools of psychology, if he has been bad. If he, for example, pushes another child in the playground, I expect a member of staff to stop him in his tracks, using a firm no-nonsense voice and to instill in him a sense of fear that what he did was so wrong there will be consequences if he ever does it again.

I will NOT march my prissy self down to the school, get in the face of one of the teachers or the admin staff, and bellow 'how dare you shout at my child? Who the f**k do you think you are?!' That, my friends, is bullying. That is someone with no sense of the scale of things and the possibility that their little cherub deserved it and is a little shit at times.

So, no to hitting our kids but a big fat YES to giving school staff the power back they need in order to stop the rot that is festering in our children.

Xf

ROSC and ROLE

I've dealt with a spate of cardiac arrest calls recently, where the patient has been in a state known as PEA - Pulseless Electrical Activity; in other words, there's little or no output, but there is still electrical activity within the myocardium. PEA produces waveforms that are similar to normal electrical impulses when the heart is beating, except they tend to be slower than normal because the heart muscle is struggling to cope with a lack of blood and oxygen, as is the brain and so there is much less electrical activity than normal.

However, in at least six cases over the past few days, where elderly patients have been in slow PEA for quite some time (up to an hour), with CPR ongoing and Adrenaline being given by extremely competent crews, and where the teams in question requested permission to terminate the resus on the basis of futility - not long after it was 'called' and given a time for Recognition of Life Extinct (ROLE), the crews reported a return of spontaneous circulation (ROSC). In other words, shortly after compressions ceased, the patient's heart began to beat. This occurred in every one of those patients despite every causative avenue having been explored prior to cessation of resus and a call, in conference to the Clinical Support Adviser and a senior doctor.

Adrenaline, of course, is a major factor here. This hormone can 'make a stone beat', according to one of my doctor colleagues, and I've seen this on many occasions myself (the effect of adrenaline that is), but what I'm thinking about is the possibility that something is happening that could be relevant to the difference between a loved-one dying on the carpet in the front room, or in a hospital bed, with enough time given to say goodbye.

Are we inadvertently creating a ROSC by NOT continuing CPR, or was there a pulse there at the time, during compressions? We continually compress the chest now; there are few pauses and rests, so could there be a reason so many PEA-ROSC outcomes are being recorded?

To be honest, I don't know and I'm hoping that someone out there has had more experience of this and can give me something more to go on than 'it's just one of those things'.

Be safe.

Naughty nurses

Nurses are getting a rough ride from this report, which concludes that some nurses are poorly trained and ill-equipped emotionally to care for patients who are sick and dying.

I'm afraid I agree with it to some extent (and to a much greater extent on the basis of aspects that I simply cannot air because we don't live in a society where blank truth is acceptable), because I have seen, first hand, on many occasions, so-called registered health care professionals, treating patients with a complete lack of care or compassion. But you have to remember that many 'nurses' are not registered and only carry the title very loosely to describe their line of work in the 'caring' professions. Many Care Home 'nurses' are nothing of the kind and give real nurses a very bad name indeed.

Neither should we let newspaper stories, based on such reports, runaway with reality; there are still a large number of nurses out there who care very much about what they do and that is why they do it. It's still a minority of bad eggs... but it seems to be a growing minority. If the Government hadn't been so desperate to recruit more nurses rapidly, back in the early 90's, using so-called fast-track training programmes, we might not have this mess.

A 2006 report into nurse shortages and the consequent importation of international nurses into the UK argues that the way they were recruited, and the methods used to train them, caused bigotry and created a disingenuous system of patient care.

As with all professions with shortages at a time of general unemployment, as soon as an opportunity becomes available for those seeking any form of work that is less handsomely paid against their usual occupations in descending fields of endeavour, they flock to it. This may actually be happening with my own profession; there was a sudden shortage of paramedics and a coincidental shedding of jobs in the City and elsewhere, attributable to the market slump, and a popular diversion towards ambulance work from individuals more used to calculators than ECGs. This, of course, does not necessarily mean they will become bad paramedics but I wonder at the reasoning behind some choices. Sure enough, people move into the NHS from all sorts of disciplines because they want to make a difference but how many paramedics, nurses... indeed future doctors, are simply in it for other, less humanitarian reasons?

I remember driving to a Nursing Home in the worst of the snow a few years ago. An elderly woman had gone into cardiac arrest and was lying on the floor of the place, with five or six 'nurses' standing over her. It had taken me and my crew mate longer than normal to get there due to the severe weather, and we'd skidded on the road several times, even at low speed. It was essential that somebody took control form the outset and did the right thing. They would have been asked by the 999 call taker to start CPR; they would have been given the option to do it but would have been allowed to decline if they so wished.

Unfortunately for someone's sister, mother and grandmother, every single health care professional in that place declined to do anything to help her, and I was left with the task of calling it before I'd even given it a chance, because there wasn't one.

The bottom line here is, why would you do a job that involves high tolerance and an understanding of human nature if you don't really want to?


Meanwhile... you don't hear of THIS sort of thing every day, do you? What a very lucky lady!

Be safe.