Thursday, 21 August 2008


Naloxone hydrochloride, better known as Narcan is a drug carried by paramedics the world over. The UK is no exception. It is a drug used to treat opiate overdose and/or accidental/intentional opiate poisoning. Opiates are drugs/medicines derived from the opium poppy and the most common one you would have heard of is Heroin. There are quite a few others both legal and illegal, some of the most common being Morphine, Diamorphine (medical heroin) and codeine. Narcan is an opiate antagonist which basically means; A substance that tends to nullify the action of another, as a drug that binds to a cell receptor without eliciting a biological response. In other words it blocks the effects of opiates. The reason why it is so important to treat this form of OD is because opiates when taken/given in large quantities can depress the central nervous system (CNS) which in turn will potentially lead to respiratory arrest and soon after, death.

We have quite a big problem in the south with opiate OD's, the vast majority being IV drug users (IVDU). With the recent influx of eastern europeans to our shores overdoses seem to be on the up, that's just my take and not going on statistics. There has been a fair few in our area and I've recently dealt with three which includes one today.

One on the beach and two on the street.

We were called to the beach near town to an unconscious male ? breathing. When we got there it was a classic heroin OD, blue in the face, barely breathing with pinpoint pupils. After oxygen and 800 micrograms (mcg) of narcan via intramuscular injection he started to respond. I thought he was a drunk scotsman but it turned out he was latvian, not a word of English. We managed to get him off the pebbles and up onto the seafront. As he was staggering along he shrugged us off so he could walk himself. In a split second he stood bolt up right and proceeded to fall backwards. We realised he was'nt going to crumple and therefore stay in his assumed position. With lightning reflexes we just caught him inches from the ground and prevented him from smacking the back of his head on solid concrete. He was still dead straight and rigid when we got him up. I swear if we hadn't of caught him he would have cracked his skull wide open or even killed himself. On board he started to drift off again so I put an IV in, took some bloods and gave him some more narcan, 400 mcg IV this time. We let the hospital know we were coming. On arrival he was now awake again but still drowsy, next thing we knew he hurled himself off the trolley and fell on the floor. Long story short: He kicked off in resus, bent one of the nurses wrist and fingers back and had to be restrained by police. He also ripped his IV, at least I got some bloods so they could test for any other nasties in the system. I think he got booted out later. The nurse's wrist and fingers were ok, no lasting damage, but that's not the point!

Next OD was in the street, not far from base. On scene we were confronted with a male on his back on the pavement opposite town hall. There were two elderly standing over him, one of which was holding his wrist. 'He's tachycardic, that's it!' one of them said and then proceeded to bugger off a bit sharpish. He was like the first, unresponsive and barely breathing with pinpoint pupils. Same again, O2, 800mcg of narcan IM and soon was recovering. I was working with a Technician and we had an arm each, sharing the narcan, giving him 400mcg in each arm. We went either side and got him to his feet, I loked straight at my crew mate and there's something missing, it was the patient. I looked down and saw him, he was tiny. A little scotsman in his late forties early fifties absolutely pie eyed. He stank of booze and remained addament that he hadn't done any drugs. Yeah Yeah sunshine whatever! It's funny how his breathing picked up and his pupils were now a respectable size 3 and what a suprise his conscious level increased. We left him at hospital later to find out that he started to expose himself to all the staff and patients. The police then had to have the pleasure of his company.

Today I'm working on the RRV and my first job was to a heroin OD, in a beach hut on the sea front. I got there first, he was staggering over the road with his junkie mates and was off his face. IVDU, on methadone and had been drinking heavily and had a fix on top of all that. Soon a vehicle turned up and we persuaded him to get in so we could check him over. Sat on a seat he drifted off to what looked like a deep sleep. I placed my hand on his chest and watched, his breathing was 4 per minute, not adequate to him alive for much longer. He had 800mcg narcan IM and was left with the crew to deal with. He was really pissed that we ruined his fix but given the other options of Police or hospital, he agreed to narcan. He refused hospital treatment and said that he would just go and score another fix later and do it agin. Fair enough we'll come and pick up the again next time.

There are other types of opiate OD's but they aren't as common as heroin. Co-proxamol, co-dydramol and co-codamol all have codeine and therefore have the potential to stop someone breathing. There are so many others, too many to list. You can get called to anyone from the depressed who just wants end it all or the person whose just split up from their partner or even an old granny who has been taking too many tablets without realising. There have also been cases when IVDU's have put methadone in their babies milk to quieten them down only to find them dead in the morning. It's a harsh world.

Another situation we could encounter would be a home delivery where the midwife has given mum-to-be some pethidine for pain relief and this has then passed over to the unborn baby. Very rarely the baby might be born a bit floppy and not responding to the usual tactile stimulation and may need a 200mcg IM jab just to perk things up.
I must stress this very rare.
My second eldest daughter was born a bit floppy after my wife had some pethidine but she didn't need any thing as she was responding although a bit sluggish. She was just observed for a while.


I was born in an ambulance. Back in those days, the 70's, ambulance crews did both forms of work, PTS and A/E. PTS or Patient transport = taking patients to & from hospital appointments and non-emergency work. On this occasion it was no different, the local ambulance crew had a few patients on board that needed to be returned home when they got a 999 call. It was to my parents house. My dad was a village policeman and lived at the local police house which was located on the old A3 and was one of the busiest roads in the south. He knew the local crews well, working with them frequently at the many horrendous RTAs occuring on that stretch of road.
The call was to my mum who went into labour, the crew turned up and reassured my dad that everything would be fine and that he was not a polieman now and that he was a panicky father to be. They said they had a few drop offs before getting my mum down to St Mary's in Portsmouth. They never made it, the crew had to pull over outside a town hall in Petersfield when my mum suddenly had the urge to push. Next thing you know out I pop. All was well, a healthy bouncing baby boy!
A few days later there was a small write up and a picture of me & mum in the local paper. My first taste of fame!
Funnily enough about 2 years later I tripped over one of my brothers legs and hit my forehead on the wooden arm of a chair, I actually remember this vaguely. Crying and holding my forehead I ran to my parents and told them I hit my head, as I moved my hands the blood started to flow. The next thing I remember was lying on my bed with a cold flannel on my forehead. The same ambulance crew that delivered me also took me to hospital to have my head stappled.
It's weird but I've worked out of the same ambulance station (only on overtime) where this crew were based.
Prehaps I was destined to do this job!

Wednesday, 20 August 2008

Nearly there

Well no more jobs on the 17th, fortunately there were 2 crews in before us and we were safe until the 3 night crews took over. However they both got jobs and we left for 45 mins waiting to see if we got a job that would make us late, it never came. Finished on time. Yippee.

Started my night on Monday only to find out my crew mate went sick so I ended up working on a RRV. It didn't bother me as I enjoy the odd shift on the car. Did 6 jobs in all with a couple of stints of standby. Did a SOB call to a guy with Emphysema (Chronic obstructive airways disease/COPD), he recieved some nebulised salbutamol and ipratropium bromide which did the trick, 2 non--injury falls, a chest pain, 10 year old abdo pain and a 28 year old female with abdo pain, turned out she had just been diagnosed with an ovarian cyst and had recently been discharged from hospital. She still had a niggling pain since her discharge and had developed severe pain. She was sweaty, pale and in excrutiating pain. After 10mg IV of maxalon and 5mg of morphine she was a lot more comfortable. When I looked at her hand for vein to cannulate she said that she didn't have very good viens and that the hospital took a while to get one. That was a challenge in my eyes if ever there was one. The first vein I saw was a small straight one on the back of her hand. I opted for the smallest cannula, a blue 22g, and got it in straight away. Job done!

I'm now well into my final shift of 4, pretty quiet, a bit of standby early on and during that a bit of education with crew mate who is a trainee Technician. Going through all the drugs and kit in the back of the truck. Only one job so far and that was to a lady who fell off the last fews steps of a ladder whilst going into her cellar. She had fractured her forearm and had done a proper job of it. A complete break midway between her elbow and wrist. When we examined her it was floppy and looked like she had another elbow. Both bones, the radius and ulnar, were broken completely in two. You could feel the crepitus (bone ends grated). She had a couple of glasses of scotch prior to our arrival to help numb the pain. The important thing to assess in an injury like that is to evaluate whether there is any nervous or vascular compramise such as loss of feeling, pulse and capillary refill and temperature of the limb. She hadn't lost any feeling but there was a very faint radial pulse and she had an extended cap refill time, her fingers were going cold as well. With that we applied some gentle traction and immobilised her arm in a vacuum splint, that restored some circulation. Watch and rings removed from her left hand as well in case of swelling. Now she said it was getting more painful but had to contact neighbours about looking after her dog, she also wanted to contact her daughters, both were DRs. This was wasting time and she needed to be in hospital. I don't think she realised the severity of the break even though I pointed out to her that she might need an operation in the morning. I was imagining her arm having to be amputated if we didn't hurry up. After a neighbour arrived we managed to get her on to the ambulance, get an IV and did some observations. Her BP was low which apparently was normal for her, her other observations were fine. The pain was now getting worse so I asked her if she'd like some pain relief, she said no and that she would only have some when the pain got unbearable. All I could think of was the crepitus, that makes me shudder just thinking about it.

Just got back from taking a gent in with a possible stroke (CVA). Also checked up on our lady from earlier with the fractured arm, yes it was a bad break and yes she will be having an operation on it tomorrow.

Oh well better have some kip, day off tomorrow and only 2 and a half hours of this shift to go.

Sunday, 17 August 2008

Today so far

5 jobs so far;

A fall - left at home.

A collapse at a church - all obs ok but still taken in for re assessment & obs due to the lady being unconscious for a brief period and her age.

20 year old collapse with chestpain and pain in left arm. patient was polish and spoke very little english. he looked quite pale, his pulse kept fluctuating, one minute it was 100 beats the next it was 160. His 12 lead ECG was abnormal as well. He had O2 & Aspirin, IV access for his trouble and we took some bloods for the hospital for good measure.

A diabetic hypo. Backing up a RRV Technician already on scene. I thought I'd be giving some IV glucose, because usually the only reason why a tech would ask for paramedic back up at a hypo would be because the IM glucagen had failed and the patient wasn't improving. Nope, we were called because her BP was only 82/56. We waited for a couple of minutes and the lady started coming round, funnily enough her BP also came up as well, 126/74. Oh well nothing for us here. The RRV tech stayed and re assessed her, gave advice and completed his paperwork.

RTC (Road traffic collision) or RTA or whatever it's called this week. Car lost control on a bend and slid sideways into a tree. 4 patients, one of which was trapped. 4 ambulances, 1 response car and 2 officers + fire & rescue & police. HEMS was mobile but stood down as not required. the usual chaos ensued and we were off to the hospital with our patient within 15 of arrival on scene. at hospital within 6 minutes.

Still got 1 hour and 45 minutes of the shift to go!

While I'm thinking about it.

Thinking back to the diabetic lady on my last shift got me thinking of one of my first hypoglcaemic (low blood sugar) patients. When we get a call stating diabetic problems it's usually for a 'hypo' obviously the last patient wasn't the case. Anyway I was a trainee technician and working with a clinical team leader, we also had a trainee paeds nurse observing for the shift as well. We get a call to a diabetic. Arrive on scene to be greeted by a frantic 10 year old shouting and screaming from her front room window, I later learned that she was hard of hearing. I grab the response bag & drugs and run over to the window, the girl beckons me in and with out stopping I jump onto the window ledge and step into the front room. I'm confronted with a heap on the floor, it's our patient, the young girl's mum. She's unconscious and snoring. Now at this point I turn left to see my crew mate and the nurse. They are looking at me rather blankly. 'Didn't fancy the door then?' said my crew mate. DOH!, a vision of homer simpson pops up in my head. It was a real casualty moment, Josh would have been so proud!!! Anyway I sorted her airway with a basic chin lift which sorted out the snoring, gave some oxygen and then gave her an intramuscular injection of glucagen which worked a treat, after some oral carbohydrates she was left in the care of a friend. This would turn out to be a regular patient in the years to come. I made a mental note to myself - always try the door first.

We also had a heroin overdose that day. It was in a part of town that was notorious for ODs. Young lads from up north would descend on the south and get mixed up with drugs and we would frequently be called to pick up the pieces. 'Er it's me mate like, he's gone an stopped breathin ain't he like.' was the usual greeting. It was no different on this call. We pull up outside, grab our kit and make our way to side door of this 3 storey town house. The door is rotten and the inside isn't much better, no lighting and a horrible stale smell. We were shouting out but heard nothing, we carried on to the stair well and heard a faint voice. Up on the next floor in the hall was a young chap who stated that his mate had just had a £10 fix and was behind the bathroom door, he didn't think he was breathing and couldn't get in. Before I knew what was happening my crewmate had managed to squeeze his way behind the door, taking with him an OPA (oral airway) and a cannula. 'Chuck us some Narcan (naloxone-antidote for opiate OD/poisoning) and a flush!', 'It's here I say, passing it behind the door.' I was also getting the BVM & O2 out to pass to him but by that time I could hear a wretch as the patient gagged on the OPA. 'Bloody hell he's got the IV in and given the Narcan before I could even blink and the patients breathing & upright!' I said to the observer. This was my first heroin OD and couldn't believe how quickly this stuff works. If anyone has seen that Nicolas Cage movie - Bringing out the dead then you'll know what I mean. This was several years ago, these days we don't rush to give Narcan IV as it can wake people up so rapidly they can become aggressive. We usually sort airway and breathing out, get a line and give it diluted and maybe give a prophylactic Intramuscular injection to help prevent relapse, which can happen as heroin stays in the system a lot longer than Narcan.
Another thing to avoid initially is rushing in to secure the airway by intubation, yes the airway & breathing is extremely important but is usually managed with basic oral/nasal airways, BVM and O2. There was a paramedic locally who intubated a heroin OD patient, administered Narcan, the guy woke up rapidly and legged it off down the street. Trouble was he still had the endotracheal tube in his throat, tied in, most amusing watching him running down the road whistling like a kettle every time he took a breath.
No one saw him again, a lesson had been learn't.

Saturday, 16 August 2008

1st of 4

Well I've just done my first shift of 4 after several days off. Not a particularly busy shift. Only 5 jobs and 3 lots of standby ( sat at response posts awaiting the next job).

1. Chest pain, male 60's with history of lymphoma. 5 mins of sharp chest pain resolved on our arrival. He has a hickman line in situ (this for withdrawl of blood samples and administration of chemotherapy). We do the usual 12 lead ECG & other monitoring which is unremarkable. No other symptoms and as advised by the oncology dept he is taken in to hospital for re-assessment and observation. I feel sorry for this guy, not only is he in the throws of cancer, his house was flooded and he is in temporary acommodation. His wife also had a stroke earlier in the year but fortunately has made a full recovery.
2. 2 year old fitting. RRV (Rapid response vehicle-lone responder) Technician is already on scene. The child has had oxygen and has come round from the fit. The child is an Epileptic and mum has already given rectal diazepam to terminate the fit. No need for us to intervene. After a discussion with the mum she is happy to look after her daughter as she has come round quicker than normal. The RRV Tech is left at scene to do the paperwork.
3. Elderly lady walking on some pebbles has slipped and caught her shin. Her daughter is worried as it has bled? Would have helped if she took the stocking off to have a look. Tiny wound the size of a 1 pence piece if that. Advise given. She didn't want or even need to attend the hospital.
4. Diabetic problems. Elderly lady with dementia in a care home. Had been up & about earlier but had a high blood sugar reading (hyperglycaemia), it was 30 mmol/l (the norm being between around 5 - 8, depending on what book you read.) When we arrive we see the Out of Hours DRs car at the end of the road, I know where they're going! When we told the carer she said that she called the DR hours ago but because the lady had deteriorated, she called for us. Good job too, the lady was unconscious with no radial pulses. High flow O2 and I put my tourniquet on early. At this point the DR turned up and stood in the door way. I basically told him what we were going to do, I simply said ' She's hyperglycaemic, unconscious with no radial pulses, she's going in (to hospital). She's already on O2 as you can see, I'll pop a line in, take some bloods and set up some saline.' 'Looks like you've got it all under control, I'll leave it with you.' He stayed 5 minutes to complete his notes and left. When we got her onto the vehicle her BP was 72/46, pulse 115 and still barely responsive. Because I put the tourniquet on early she had a great vein in the crook of her elbow (ACF) that was visible. I managed to get a 16g (grey) cannula but was unnable to get any blood as her BP was so low. She had a total of 600ml of fluid on the way in, her BP came up to 114/75. The DR in resus seemed impressed that I got a grey in, he was strugling like hell to get a line in on the other side. We all had a chuckle about it. We're fortunate to have a really good relationship with the A/E staff. Nether the less he got his line. I'll check up on her tomorrow, oops that'll be today then.
5. Breathing difficulties. Male in his 70's, only medical history was high blood pressure. Been short of breath (SOB) for 2 weeks! Seen by his GP several times and prescribed 2 lots of different antibiotics, obviousley not working then. His oxygen saturations were 91% on room air. Oxygen on and his sats were up to 98%. He was mildly pyrexic aswell (high temperature). We took him in and that rounded us up nicely. Finished on time for a change and ready to do it all again.
Apart from the diabetic lady, a pretty slow & routine day, not what I'm used to, I usually attract every one elses share of decent jobs.

Friday, 15 August 2008

New bit of Kit?

This is a new piece of kit that is supposed to make intubation easier. Intubation for dummies spring to mind!

Thursday, 14 August 2008

Trainee cont'd

About an hour to go until the end of the shift and we're sitting on standby not far from our station. The radio pipes up, 'we've got a category C fall for you', this should see us out nicely til the end of the shift. The location wasn't far away and we were soon on scene. It took ages for someone to open the door. It was eventually answered by a man in his early fifties who seemed anxious and said his mother had fallen in the bathroom. He'd been out most of the day and came back to find his mother on the floor. How long she'd been there no-one knew. Making our way through the house we arrived at the bathroom. There on the floor was the lady. She hadn't fallen, she had collapsed. There was vomit all around her neck and she was barely responding. With virtually no room to work we managed to get into the bathroom, I was in the empty bath! Her airway needed suctioning so I got on and did that, my crew mate then started to apply some oxygen. She was a horrible grey colour and very clammy. Drifting in and out of consciousness we managed to get out of her that she had experienced lower back and abdominal pain. I was struggling to find a radial pulse at this time, it was really thready and rapid at 120 beats per minute. Her BP was about 70 systolic, that's low! The average adult needs their systolic pressure to be above or around 90 systolic in order to maintain adequate oxygenation of all the organs & tissues.
While my crew mate was securing IV access I started to feel her abdomen, it was distended and it was also pulsating. This is a result of blood being pumped in the abdominal cavity. You've got to remember that the heart is a powerful muscle and pumps blood with some considerable force to enable it to get right round the body and that the aorta (which branches directly from the heart) is the largest vessel in the body, the abdominal aorta is not far down from the heart. The next thing I know is I've got a blue glove in my face, my crew mate had written 'AAA' on his glove. I had only ever read about abdominal aortic anyeursm or AAA in books and never seen a patient with one. AAA is basically a swelling that has occured on the abdominal aorta. Some times they are picked up on scans or are undetected until it ruptures (usually fatal) or starts to leak. If they are detected early enough they can be repaired by surgery and we are talking M A J O R surgery. This lady had no history of this and apart from high blood pressure was relatively healthy. Prehaps her BP had been high for a while despite her medication and it caused her AAA to start leaking, who knows!
We tried to reassure her son who was quite shaken and suprised as he thought she had just fallen and didn't realise the severity of the situation. The next thing was to get her out, she wasn't the smallest of people and it was going to be a struggle to get her out. The carry chair was not an option because if we sat her up almost certainly there would be a significant drop in her BP and put her into cardiac arrest. Some thing we were trying to avoid, we're there to help save her or at least prevent deterioration until she was in the land of bright lights and shiny steel AKA the operating theatre.
Another crew was needed so while waiting for them I gathered some IV fluids and the scoop stretcher and brought them into the house. Eight minutes later they turned up and come into the bathroom, ask us what we need and set about helping get the lady out. One of the crew got in the bath and bent over to get hold of the scoop stretcher when rrrrrrrrrRIP, his trousers split. From arsehole to breakfast time and his spotty boxers were exposed to one and all. Given the seriousness of this job it was a real struggle to keep a straight face, but being the professionals that we are, we managed it. Now finally secured on the vehicle and properly monitored we were on our way. I passed a pre alert call to the hospital while my crew mate was putting up some more IV fluids to help maintain her BP. She was now responding a lot more and aware of her surroundings.
At the resus room we were met by the team who quickly set about their tasks. Bloods, x-ray and a ultrasound scan soon confirmed it was a AAA. Meantime her son arrived and we took him to the relatives room and explained that a Dr or nurse would be out to give him a better idea of what was happening. He thanked us and we made our way back to the vehicle and then base to clean and restock it, finishing on time.
Next day we enquired about our patient and soon learn that she suffered a cardiac arrest on the way to the operating theatre. They tried to stabilise her BP in resus, managing to for a short while and decided to race her to theatres. She was pronounced dead at 22.00.

Wednesday, 13 August 2008


After completing my technician course I was sent to my old station and had a week of working with a training officer. This was to get us newbies some experience prior to be let loose on the public with another crew member. In our area it would be 2 trainees with a training officer but because I was the only one in my area there was just the 2 of us.

I remember my first 'Red' drive (blue lights & sirens), it was to a chest pain about half a mile away. Before we even got out of the garage I had everything going, everyone in the crew was looking out of the window probably thinking 'what a twat, there goes another trainee on a red call!' Anyway within 60 seconds or so we were on scene. The house was a small end of terrace and had an immaculate garden, there was a neighbour waiting outside and showed us the way in. We were presented with an elderly lady, probably mid 80's, sitting in an armchair. She was complaining of shortness of breath (sob) and chest pain. She was pale, clammy and had an irregular pulse. With that I popped on some oxygen (O2). We gathered her meds and got out onto the vehicle where we assessed her vital signs and applied a 12 lead ECG, there was no sign of a heart attack on the reading (this doesn't mean that someone isn't having a heart attack!). However it did show AF (atrial fibrillation) which is basically an irregularly irregular rhythm. She had no history of this so the training officer decided it was an acute episode and that we needed to get going asap. He popped in a IV and gave some pain relief, I gave her some aspirin and GTN spray and then drove on 'Red' to the hospital. I didn't really think about what happened to this lady...................................... until several years later.

I was now a seasoned technician and working with Rob, a paramedic, one of the larger than life characters we have on base. We got a job in town, the address sounded familiar, we approached the house and I realised it was probably the same patient that I had attended on my first red drive. What are the chances of that happening! We were greeted by the gardener and this time led into the bedroom. We were confronted by a lady, this time in her nineties. She was lying on the bed wailing in pain and throwing her arms up in the air. Rob and I looked at each other and shook our heads. She was complaining of chest pain but every time someone else came into the room she would become almost normal again and start barking orders like don't forget the grass cuttings or remember the papers. She seemed to over exaggerate her symptoms. Anyway Oxygen on and onto the carry chair. Whilst wheeling her out, we agreed quietly 'It's all in her head'...........................until we looked at her ECG, it was showing massive ST elevation, a sign of a heart attack! Rob wanted to put an IV into her hand, easier said than done, no veins! I looked down and saw what resembled a blue biro mark on the back of her left hand. It was a vein. Yippee!! Out came a selection of cannulae, all went back in the drawer except one, a bluey. This is smallest we carry, I mean they're tiny. It was nail biting stuff, the sweat was building up on Rob's brow, I almost felt sorry for him. One vein, one shot and then we go is what he said, he punctured the skin, 'it's in!' he yelled, 'it's in!' Neither of us could believe it, now he could give some pain relief. It was quite comical because we forgot about the patient for a split second as we were so impressed at this quite remarkable or should I say lucky cannulation.
You had to be there, we still talk about it now.
At the hospital and after a repeat ECG in the A/E dept we wheeled the patient into the coronary care unit (CCU). The patient was having a big heart attack and needed clotbusting meds, she was too old for us to do it (our limit was 75 back then). The CCU nurse was drawing up the drugs while the DR was doing something else. She said to Rob 'have you given this yet out on the road?', 'nope, not yet' he replied. 'Well here you go then' said the nurse passing him the syringe. He administered the relevant doseage and shortly after, the ECG started to resolve it's self. It was working.
We sorted out the trolley and packed up our defib and other kit then had a nice cuppa joking that it was all in her head, how wrong we were!
Unfortunately the patient died a week later following complications, namely heart failure.

Tuesday, 12 August 2008


Back again, now for the drugs bit. There are quite a few drugs so bare with me.

Let's see, ok Heart attacks (myocardial infarction/MI). The majority of ambulance services are providing what is known as 'Prehospital thrombolysis', you may have read in the press about clotbusting drugs. Thrombolysis is the process when 3 drugs are given, they are aspirin, heparin and tenecteplase. A heart attack is when a coronary artery is blocked by a clot. The heart muscle below the clot doesn't get enough or any oxygen. These drugs act in different ways by stopping the red blood cells sticking to the original clot and preventing it getting any bigger, breaking down the clot and the prevention of it forming again. Therefore once the clot is broken down, oxygenated blood can get back to the heart muscle again. we use a saying 'Time is heart muscle'. Once heart muscle dies that is it!
Staying on the cardiac side of things we can give nitrate spray or tablets for angina/MI or heart failure. For slow heart rate we can give Atropine, we also use this in cardiac arrest and organophosphate poisoning.
Adrenaline 1:10,000 in cardiac arrest, the other strength of adrenaline is used for anaphylaxis/allergies/asthma.
Amiodarone is used in cardiac arrest when shocks are not working (basically).
Nebuliser therapy, 2 drugs salbutamol and ipratropium bromide which help widen the airways.
Antibiotic therapy for the potentially deadly meningococcal septicaemia (bacterial meningitis).
Anticonvulsant medication to treat seizures and also drug toxicity.
Glucose drip, glucagen injection and gel for low blood sugar (hypoglycaemia)
Various fluids for dehydration, fluid loss and maintenance of blood pressure.
Antihistamines/steroids IV/IO and injection for anaphylaxis/allergies.
We also use steroids in asthma and adrenal crisis.
Naloxone for OD/poisoning with opiates.
Morphine for pain relief.
Metoclopramide for anti sickness.
Syntometrine for severe haemorrhage up until 24hrs after birth.
Furosemide for heart failure, although I am trained/educated to give it we don't have it where I am.
There's a few to be getting on with. I hope the last couple of posts have helped give you a slight insight into our skills. I'll sign off now and return with something a little more interesting...............................................I hope.
Here endeth the lesson.


As a paramedic I have all the skills of an EMT and some. I'll split it up into Airway, Breathing, Circulation and Drugs, Here goes.
Airway mangement, as well as the basic oral and nasal airways we can insert a laryngeal mask airway (fanny on a stick, pardon the expression!) or an endotracheal tube which offers better airway security. Trainee paramedics need to go into the operating theatres to perform these under supervision of an anesthetist and get 'signed off ' by the consultant before being allowed to use them on the street. Cricothyroidotomy (Cric), 2 types, needle and the use of a SAD (surgical airway device). Most other trusts train their paramedics in the needle version. This is a procedure where we put either the needle or SAD through the wall of the windpipe in order to get oxygen into the lungs where all other methods have failed such as in the patient with a blocked airway or severe facial trauma. This is a last resort airway rarely needed. I have performed this and will tell the story at a later time.
Breathing, in severe chest trauma or rarely asthma I can decompress the chest by inserting a needle into the chest. This is to relieve the pressure that can build up in the chest cavity after a lung has collapsed. The condition is known as 'Tension Pnuemothorax' and is life threatening.
Circulation, Ican insert intravenous cannulae (I.Vs, drips), these vary in size and go into the veins - used for the admistration of drugs, fluids and for taking blood samples. If I can't get an IV in I have the option of being able to go IO (intraosseous access) which involes putting a needle into the centre of the bone using an IO drill. Again this is reserved for seriously ill patients both adult & children. Apparently it is no more painful than a standard IV! I wont be volunteering to see if it is or not! The painful bit is the drugs or fluids going in, we can administer local anesthetic to minimise the pain.

Oooops, gotta go, just got a job will carry on with this soon.

For those of you that don't know

And another thing, I appreciate that it could be anyone reading this so I will try and enlighten you to what us EMT's & Paramedics can actually do for you in your moment in need.

For starters:
Emergency medical Technician (posh name for Ambulance Technician)
The back bone of any ambulance service, a Paramedic shouldn't leave home without one! A decent EMT is worth their weight in gold and even though slightly less skilled, will be there to keep you on track, support and assist you when you need it most.
Skills include (for the majority of UK EMTs): Defribrillation (applying a shock to the heart in shockable cardiac arrest and yes there is non-shockable cardiac arrest aswell), CPR, suctioning of the airway, ventilation using a bag valve mask, oral & nasal airways, traction splintage (special splinting of fractured (#) femurs (thigh bone), 12 lead ECG application, monitoring of vital signs such as blood sugar (BM), pulse oximetry (basically the oxygen% in the arterial blood supply, the best being 100%) and blood pressure (BP). EMTs can administer a limited amount of medications and medical gases such as Oxygen, Entonox (analgesic gas), Aspirin, nitrates, nebuliser therapy, glucose gel, paracetamol oral suspension, Ibuprofen. Also some some life saving injections such as Adrenaline for Anaphylaxis/Severe allergic reactions and life threatening asthma. Others are Glucagen for low blood sugar and Naloxone which is for certain overdose (OD) patients, usually heroin but can be used to treat accidental OD or poisoning of other opiate based medications. There's a lot of other things I'm sure I've missed but because we do it everyday it is sometimes easily forgotten. Some services vary slightly in what there EMTs can do either slightly less or slightly more skilled, this is just a basic overview. I'm sure I'll be put right about the stuff I've missed
One thing that does bug me is that UK EMTs can't administer anti-convulsant meds to stop patients fitting. It's to do with the law which i think needs to be changed! Yeah yeah I know there is supposed to be a Paramedic on every vehicle but this is the real world and it takes longer to train Paramedics.
EMTs work on ambulances, rapid response vehicles (RRV), push bikes and work alone or with another EMT or Paramedic. I'm not even going to mention ECAs (Emergency care Assistants) it will just open up a whole can of worms:>

Next, what Paramedics do.

Monday, 11 August 2008

Just getting started

Well it's 23.52 (11.52pm in old money) and I'm on yet another night shift! Just been reading through a couple of blogs, not that I read blogs that often, just like to be nosey. I thought to myself 'Hey I could probably do that' , so here we are. Let me introduce myself, I'm a Paramedic working on the south coast of England and love my job. I'm happily married with hundreds of kids (well it seems like hundreds:) ). I hope to give you a glimpse into what it's like to be a Paramedic................................from my perspective. It will be sort of a diary but also stories of old, battles won and lost. Happy reading.