Thursday, 25 September 2008

Why do we bother!

I'm on yet another RRV shift today. After checking the car and all the kit I get sent out on stand-by. No surprise there then. I'm about half a mile from the station when I hear an all call go out 'Any fast responder available for a Cat A fitting patient in *********** please call for details' and it's repeated again, 'Double EMT crew responding from base' control out. I press the cell call button to call up for this job. The job comes through on the MDT and I'm now mobile, it's to a 17 year old with a cardiac history who has also vomited. Cat A CONTINUOUS FITTING. I arrive within a few minutes and walk into the house, the girl is on the floor unconscious but not fitting. One EMT has started O2 and is checking her sugar level (important in anyone unconscious or who has been/is fitting) and the other EMT on the phone to girl's worried mother. The girl and her friend where at home alone and she started to fit just as her friend's dad had come round to pick her up. We managed to get a bit of sketchy but important history from her friend. There had been a history of unexplained collapses and fits over the past year, she had all the blood tests and ECGs with no real diagnosis given. After getting some more observations I just happened to glance over at the coffee table and saw a letter and an ECG, the ECG showed prolonged QT. Because I'm a bit of an anorak when it comes to prehospital care I have read up on prolonged QT syndrome and know it is related to Sudden Adult Death Syndrome (SADS), this is an adult version of cot death or SIDS, the I meaning infant instead of A for Adult. With this in mind and the fact she wasn't responding to us I decided to put in an IV. This was just in case she started fitting again or if she went into cardiac arrest. There was the possibility of either or both.
The crew pre alerted the hospital and blue lighted her in. Usually when we give a pre alert to the hospital we have at least a Dr & nurse waiting sometimes a whole team, dependent on the condition of the patient. No one was waiting! This does occur at our local A/E from time to time but on the whole they are generally pretty good. A consultant came over with a nurse soon to be joined by one of the staff grade Drs. A little bit whispering went on and the staff grade Dr went off again. They seemed completely uninterested. Having said that they still repeated all the observations and tests that we had carried out and treated her well. It was just the attitude.
In the ambulance service we treat for the worse case that way you can't really go wrong. When you start to become complacent that's when the problems start. I'm sure this girl was o.k and her tests were unremarkable. If we hadn't pre alerted and something had happened I can bet your bottom dollar that we would be the first to know about it!

Why do we bother? Because we care!

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