Frustration

'111, we have a cardiac arrest for you, you're being backed up by a Paramedic Practitioner.'

'Roger, book us mobile.'

We were 'green' at the hospital when the job came through.

'I know that address, it's only round the corner.' I said to my crew mate. We turned up 60 seconds later.......................................................at the wrong address. I had to recheck the road name and sure enough I got it wrong. The actual address was the other side of the hospital about a mile away so we made our way there. Still got there in under 8 minutes though. The problem was that both road names were very similar and I cocked it up, after all I am human.

I took in the response bag and my airway kit while my crew mate followed with the drugs and suction. As we climbed the stairs we could see a lady attempting CPR while still on the phone to one of our call takers.

The patient was a 70+ year old male whose health had been steadily going downhill for a couple of weeks since changing some medication. The Dr said that there was no link and that it was a coincidence. Any way the gent was in the bathroom, had a episode of diarrhoea and was trying to get in to the shower when he collapsed in front of his wife.

We started CPR and attached the defibrillator, flat line! It's a witnessed arrest which had only happened moments earlier, we had to give him a chance so we pressed on. A few moments later a Paramedic Practitioner (PP) arrived to help. He was on the airway, my crew mate carrying out chest compressions and I was trying to get IV access. As I inserted the cannula I got a flash back but it wouldn't advance so I tried to reposition but to no avail. I could of had another go or tried the external jugular, with the PP at the head end and me at the lower half of the patient I opted for the Intraosseous route (see the picture above). Out came the small battery operated drill, I placed an adult needle on the end and drilled into the patients tibia. Once it was in I flushed it with saline and started to administer adrenaline and atropine. With every adrenaline the ecg rhythm would throw out a few complexes, something which is all too common after adrenaline administration. The problem with resuscitation drugs is that there is no real evidence that they actually work and the key components of a successful resus is good quality CPR and defibrillation. This was not a shockable rhythm so defibrillation was out straight away. All we could do is CPR and use drugs. After about 30 minutes of full Advanced Life Support (ALS) it was agreed to terminate resuscitation. If we weren't going to get him back there then there was probably no chance of getting him back in hospital besides he remained in Asystole throughout. The PP went down stairs and spoke to the patients wife and told her that her husband had passed away, he also explained what would happen next. Once death is confirmed then we contact the police and they attend. They will act on behalf of HM coroner and offer help and support to the relatives. If something is suspicious then they will deal with that as well.

One thing with this job is that out of all the cardiac arrests we attend most will die. It has nothing to do with us, sometimes it is just their time or no one will have been doing any CPR before we get there. I do get frustrated with just 'going through the motions' time and time again only to prolong a death and not save a life! It would be nice to get someone back from time to time but it's beyond our control. May be next time.

More nights!

Again I find myself on more night shifts. This is due to me being on what we call 'relief', we have relief weeks incorporated into our rota which covers annual leave and sickness. Most of the time we are put on night shifts and they never seem to follow any logical pattern, we are just there to fill in the gaps.

The last week hasn't been exactly busy or exciting but at least I have attended a small amount of needy patients. There has been the usual mix of drunk and overdose patients with a sprinkling of regular fallers for good measure.
After attending a couple of patients suffering from MI's (heart attacks) I have become a little fed up, I mean they didn't even have the decency to have an MI that I could Thrombolyse! I don't know, some people eh.

One of the better jobs I went to was a guy in his 30's who thought it might be a good idea to start weight training again...............................at home. The job came in as a GP admission (urgent journey) stating that the patient had back pain. His initially sympathetic partner briefed us about what had happened and showed us the GP's letter. I say initially sympathetic because soon after we arrived and started giving him Entonox she thought he was a bit of a light weight and was playing on his pain. She then started comparing his back pain to 'man flu'. By this point we were all laughing, even the patient. However he was clearly in genuine agony. The GP had queried a prolapsed disc and had refered the patient to the orthopaedic surgeons. His partner said that she had started exercising recently and had joined the local gym, he on the other hand opted for a bit of DIY weight training and put his back out soon after starting. Two Drs had visited over the course of the evening and had given the patient a whole array of pain killers including Diazepam, Paracetamol, Ibuprofen, codeine and even a 100 mg Tramadol injection. In fact the patient was convinced that the Dr must have injected him with water as it had absolutely no effect. He was also surprised that the Dr didn't have any Entonox.
It was time to move him on to the carry chair and get him down stairs. The Entonox was doing the trick up to this point but when he moved, the air turned blue. After a back breaking carry down the stairs we got him on to the vehicle. Back on the Entonox but this time it wasn't as effective so I asked if he wanted anything stronger, I already knew what the reply was going to be. I started with 5mg of Morphine which just started to take the edge off but gave him another 5mg which made him a lot more comfortable. The last thing he needed was to be bounced about in agony on the way into hospital. I think his partner was especially impressed when we, including the patient, said to her that women simply don't understand what us men have to go through. She rolled her eyes and laughed. Good job, nice couple.

Overtime..................and some.

Well I was supposed to be working on the RRV for the day but no sooner had I got to my local station (not where I'm usually based) the red phone rang, it was control asking if I could go to my base station to crew up with a trainee. They were one man down, 'No problem' I said and off I went. The good thing about overtime is that it's paid at time and a half or you can take it as time in lieu. I opt for the money every time as I always seem to end up with loads of annual leave and have to try and take it before the year ends. Because I had started earlier than the person I was due to be working with I thought I'd be able to get away earlier........................................

9 calls today:

1. PR (rectal) bleed, elderly male who happened to be a DR. Lost a considerable amount of blood and was still loosing some. He ended up being infused with blood. Poorly patient. It's not every day you can say you've cannulated a DR!
2. On the way to a standby post we got a Dr's urgent admission into a local community hospital but when we arrived the patient wasn't ready. We passed the call back to control and were told to carry on to the original standby post. Bahh
3. After watching Bondi Rescue on SKY we were given a 999 from the psych unit to the A/E.
4. Before we got on scene we overheard a call for a cardiac arrest so we were passed that call. There was a Technician responder on scene who stood us down as the patient was deceased.
5. Another cardiac arrest call but this was just to lend our ECG monitor to another crew as their machine wouldn't print out a trace. They went and got a spare machine afterwards.
6. Homeless guy with apparent chest pain, more like intoxicated but due to a couple of other contributing factors he needed to go to A/E.
7. Fall in the street, female who was on Warfarin (blood thinning meds) was rushing around town trying to sort out her last minute holiday details when she tripped hitting her head. Patients on Warfarin who hit their head, whether they cut it or not, need to go to hospital due to the internal bleeding risks.
8. Chest pain, young girl at work who became unwell with chest pains but we put it down to one of three things, gastric as bringing her knees to her chest eased the discomfort, possible chest infection brewing as her temp was slightly elevated or anxiety. It was a sharp pain and was causing her a lot of discomfort, enough to make her cry.
9. The Icing on the cake! Transfer up to the big smoke 'London'. A trauma patient needing pelvic surgery and we were the only available vehicle. We had 2 1/2 hours to go and knew we would be late. He was on a morphine PCA pump but had to have it disconnected for some reason. He was ok for pain relief on the journey and didn't need any morphine from me which was surprising. I only finished 3 hours after my shift ended but at least I get paid for 21 3/4 hours! Every cloud and all that. One good thing though, my dinner was in the oven when I got in and it tasted bloody great.

Thank god that's over!

Don't get me wrong I like my job but just lately I feel like I do nothing but work! 4 days off and then back in for an overtime shift on a RRV.



Update on my last 2 night shifts.

Wednesday: 5 patients.

1. Passed as a stroke but was a diabetic having a hypo. We weren't needed as their was a RRV Technician on scene who had given a Glucagen injection. We hung around for a little while just in case the patient needed some IV glucose. She didn't so off we went.
2. Fall, assistance call only.
3. Unconscious, female in a care home. Very pale and blue around the mouth. Her blood pressure was also low and she had a history of chest infections and heart failure
4. Psych/suicide, female who was intoxicated and decided that it might be fun to slash her arm and belly with razor blades. We cleaned her up but she declined hospital. She went off with friends who were going to look after her and take her to the DRs in the morning. They weren't best pleased that she wasn't going to hospital. What can you do? If someone is alert and orientated they have the right to refuse.
5. Chest pain, male in his 30's who had an episode of chest pain. After wasting over 20 minutes deciding whether or niot he wanted to come with us he declined, opting for a lift with a mate. All he was worried about was how he was going to get back from the hospital! I doubt he was having a heart attack, his ECG looked fine and he was too well looking. Anyway he had similar episodes in the past with nothing found and was due a scan.


Thursday: 6 patients.

1. GP admission, suicidal male and at risk of self harm. This was a paranoid schizophrenic that I later learned had a history of violence and assaulting staff! This information wasn't relayed to us with me finding it out by reading the GP letter & notes. I was pissed off to say the least. To top it all the GP failed to refer the patient to the right dept which kept us hanging around at the hospital for ages. The patient was as good as gold and asked me not speak to him on the way in. Fine by me!
2. Fall, elderly female who fell in the morning and now had severe right sided back pain. TLC and a little diesel to get to the hospital.
3. Abdo pain, female with severe abdo pains, occasional chest pain, sob and looking pretty poorly. It all started of with vomiting earlier that evening. Her ECG was horrendous and she was in lots of pain. I managed to get a little bluey into the back of her hand and sort out her pain with some GTN & Morphine. She refused to take any Aspirin. After being seen in resus we moved her down to the coronary care unit where I gave her the rest of the Morphine as her pain started to return. This saved the staff a job as I already had it with me and they didn't need to go to the drugs cupboard and draw it all up. My suspicions of a heart attack were right. Her ECG showed Left bundle branch block (LBBB) and as she had no apparent cardiac history I assumed that this was a new cardiac event. The problem with LBBB is that it basically blocks the view of the left side of the heart making it a bit more tricky to diagnose a heart attack. A proper job!
4. Fall, regular dementia patient with very minor abrasions, the staff admittedly panicked on this one. We left him there.
5. Fall, intoxicated female who fell with someone landing on her arm. This was an obvious dislocated elbow. I screwed my face up like a bull dog chewing a wasp and said to my self 'Shit, that's gotta hurt.' I gave her 10mg of Morphine with gas & air which completely knocked her out for the journey. We have to be extremely careful when administering Morphine to patients that are under the influence of alcohol as they can both depress the central nervous system and lead to a patient who is no longer breathing. We had no problems as I gave it nice and slowly. At A/E resus the DR gave another 10mg of Morphine, I thought I was brave giving 10mg to begin with but she clearly needed it. The nurse said wait till she has some Midazolam then and we'll put it back in. Another proper job.






6. Unconscious, young male who work up suddenly, fell out of bed and bumped his head. He was all panicky that he had a brain abscess, something which he had a few years back. I wasn't convinced with this job but I guess you had to be there. He decided to see his own GP when they opened.

Tuesday: 3 patients.

What a contrast from Monday, only 3 patients! Having said that we had 4 RRVs and an ECP running around taking some of the heat off of us. And only an hour of standby, great!

1. Fits, male with a history of epilepsy who had suffered a small seizure whilst out shopping in town. He was on floor and conscious but a bit dazed. All he wanted to do was go home and sleep it off so after checking him over we took him home, which was only about 500 yards away. We then contacted his GP surgery with a view to them reviewing why he was having more and more seizures.
2. GP 999, male with post operative hernia problems had visited the GP who decided he needed to go to A/E. There was a technician on a RRV on scene who after giving us a handover said that he would of taken the patient to A/E but the Dr thought it would be more comfortable for the patient to lie down. The hospital was half a mile away and it took my crew mate longer to fill out the clinical report form than it did to drive to the hospital and off load the patient!
3. SOB, female with Emphysema who had been seen by a GP an hour earlier at home. As we looked at the GP's note it said in the top left corner 'Advised to dial 999 if gets any worse'. I asked if her breathing was this bad when the Dr was there to which the husband replied 'Oh yes.'
I couldn't believe it so I told them that next time it gets this bad just to call us straight away. The lady was really struggling so we needed to move fast. My crew mate gave her a salbutamol and atrovent nebuliser while I was securing an IV line, the last patient I went to like this ended up having seizures and going into respiratory arrest. I didn't want to take any chances. On the way in to hospital her condition improved with the treatment so we took her down to the medical assessment ward but within a few minutes her breathing started to become worse again. 'Over to you then' I said to the staff. The lady still managed to thank us for what we did and then blow us a kiss and wave us goodbye.

Oh well another couple of night shifts to contend with next. I'm not the biggest fan of night shifts as I personally think that the quality of work isn't the same as during the day. Some may contest that fact but all I can do is go on personal experience.

Oh dear

I don't know what to say really!

Monday: 7 patients.

1. Fall, female who had fallen down the stairs of a double decker bus as it was pulling away. She was conscious and alert with an obvious head injury that had been bleeding briskly. The usual c-spine precautions were taken. When at A/E her head started to bleed again quite heavily and she ended up in Resus.
2. Dr's 999, male in his 40's at a GP surgery. One of our RRVs was on scene first and when we arrived the patient was on O2, had a line in with some fluids running. The Dr queried an upper respiratory tract infection (URTi) and had administered 1200mg of Benzylpenicillin. I couldn't work out whether the GP had used the RRV guy's drugs or his own as the RRV's drug bag was in the treatment room. The patient was in a bad way with a pulse rate of 140 and a temperature of 39.0, he was septic and also in a lot of pain. The DR said asked if we could give him some morphine and another litre of fluid on the way in which is what we did. We have to be particularly mindful of the airway in these types of patients, even the Dr suggested we may have to nebulise him with Adrenaline if he deteriorates. The patient was so poorly he ended up in Resus and then eventually he was intubated and taken to intensive care.
3. Fall, female in a care home. Was is it a simple trip or was it a collapse? No one knew. She had a couple of lacerations to her wrists and a nasty one to her lower leg with her ankle also being considerably swollen. Monitored, wounds dressed and a bit of TLC en route to hospital. She was discharged a couple of hours later.
4. GP Urgent journey, male with a history of recent bladder operation had suffered post op complications. The Dr had seen him at home and deemed it nessecary for him to be admitted.
5. Abdo pain, female college student with what initially sounded like appendicitis. We were only 2 minutes from the hospital so one rounds of base line obs and some gas & air for pain relief.
6. Cat A convulsions, female well known to us standing in her doorway who said she couldn't cope! Inside she had an 8 month old baby which I spent nearly an hour playing with, having a young one myself I was in my element while my crew mate was busy on the phone arranging social services and getting things sorted. She stayed at home and when her mum turned up she gave her daughter a right roasting because she didn't call her first. I would like to know where the Cat A came from seeing as it was the patient who made the call!
7. RTC car into a hedge, a middle aged man was shunted from behind at high speed and ended up being pushed up an embankment into a field which was 8 feet higher than the road. The other driver tried to do a runner but was caught by police. He had been drink driving and had no insurance or MOT, his excuse was that he had an argumant with his girlfriend and was going round to see her as she said she was going to kill herself. Our patient declined transport, against our advice, despite having neck discomfort. 'I feel fine lads, if I'm not good in the morning I'll pop up to A/E myself.'

Bread and butter stuff really, overall not a bad days work.

Business as usual

After last weeks trauma it was business as usual. Here is a round up of my last three day shifts.

Wednesday: 7 patients attended.

1. Unconscious, female in a care home who had been deteriorating over the last few days. Although she was unco she was maintaining her own airway but had very low blood pressure. High flow oxygen, IV fluids and a pre alert call to the hospital.
2. Unwell, male with lots of medical history who had been vomiting blood and passing bloody stools. All obs fine and relatively well looking. Transported to hospital for further tests.
3. Hemorrhage/lacerations, 15 year old female with a cut to her hand. After spending all of 2 minutes on scene dressing her hand and convincing her that she wouldn't loose it we took her to the local Minor injuries unit.
4. Neck pain, 8 year old on holiday who was on a water ride and was shunted by a boat. His pain had just about disappeared by the time we got there. He was more upset than anything. Mum and dad happy to look after him.
5. Deceased, male not seen for two weeks with flies at the windows. Police already on scene and broke in when we arrived. RIP.
6. Fall in the street, elderly female who had slipped on the kerb sustaining a nasty gash to her eye. TLC and taken to hospital for proper wound care.
7. Diabetic , male having a hypo at home. His wife had tried to give him lucozade and milk with sugar but he was getting worse. After popping a 18g IV in the back of his hand and giving him 100ml of Glucose 10% he was right as rain. Although when he came round he looked at our name badges twice and rubbed his eyes 'Oh I haven't had one of them bloody hypos again, have I?'. 'Yes you have!' said his wife, 'He's gets all silly when he goes low and there's nothing I can do!' she added. Nice couple and a nice job to round the day off with.

Thursday: 5 patients attended.

1. Fall, non-injury. Assistance and advice only. Not transported.
2. Chest pain, 999 call from a local DR's surgery. Female who had suffered chest pain for the last couple of days. Already on O2 and had Aspirin and GTN before we arrived. There was nothing on the 12 lead ECG and as she still had some tightness we gave her some more GTN. We took her straight to the medical assessment ward.
3. Headache, male with frontal headache which came on gradually, assessed at home with advice given. His wife had given him 2 paracetamol about an hour earlier which had kicked in while we were there. His wife said she panicked and wasn't sure if he was also suffering from one of his 'panic attacks'. Nice couple and very grateful as well as apologetic.
4. Chest pain, another female who had been having chest pain for several days! Two community responders were on scene when we arrived. We gave her O2, Aspirin and GTN which seemed to help slightly. She said to me that they have terrible trouble with her veins at the hospital. 'Right then, that's a challenge.' I said. I couldn't see any veins or really feel any but I managed to get an 18g in her right ACF and draw off 4 tubes of blood. I was pretty impressed even if I do say so myself. Careful, I may not get through the door if my head gets any bigger. Ha Ha. Knowing me I'll mess up an otherwise easy one next time.
5. Passed as a fall but turned into some thing a bit more interesting. We managed to find the location which was an alley way, after stopping at the wrong one up the road, DOH! Male in his 50's, he was a council worker who had fallen into bushes and thought he had been stung by nettles until he reached down and felt a metal spike sticking out of his leg. When we arrived he was in great pain but in good spirits. His work mates thought it was highly amusing, he was their boss. After putting a built up dressing around the spike to stop it from moving we got him onto the trolley and then onto the vehicle. He drained a bottle of Entonox (gas & air) and received 5mg of IV morphine. When we wheeled him into the A/E dept he became the centre of attention for the afternoon/early evening.

Friday: 5 patients attended.

1. Breathing problems, regular male caller. COPD (chronic obstructive pulmonary disease, such as Bronchitis or Emphysema) who was using his own nebuliser when we arrived. We gave him some salbutamol and atrovent using our nebuliser mask and O2, his mask was pretty naff so we left him one of ours. His breathing had eased after our treatment and he refused to go to hospital so we called his DR's surgery to arrange for a home visit.
2. Fall, male with Parkinson's who had sustained a head injury some time during the night but couldn't remember it. He made a good job of demolishing his sink unit when he fell. Collapse query cause, he had to go in. There was a Community responder on scene before us who had gathered all the patients meds and history for us.
3. Fall, female on a bus who had twisted her hip when the bus started to pull away without warning. She had an obvious NOF (neck of femur fracture/hip fracture). Her leg was shorter and was externally rotated, no need for an X-Ray it was that obvious. She was really calm and kept repeating her self stating that she was so angry with herself. She declined any analgesia.
4. DR's urgent admission, we were sent to another station 30 miles away for a bit of stand-by when we got this urgent job. When we arrived at the address my crew mate opened his door and before he could step out of the truck a male in his late 70's came out of the house with a holdall, strolled over to the truck and asked 'Where do I sit?' TAXI! I thought to my self. We had to take this patient to a hospital that neither of us had ever been to before and after being passed from pillar to post by various staff we finally got him to where he was supposed to be. Just a 40 odd mile drive back to base. Fortunately we didn't get any calls on the way back.
5. DR's 999 from a local surgery. Two Emergency care Practitioners were there and handed the patient over to me. Male in his 70's who was sweating profusely and had a high temperature. All his obs were fine and after an uneventful journey he ended up in A/E.

Weekend off but back in Monday to Thursday for a mixture of day and night shifts.

They say they come in 3's

Over the last week I have attended three horrendous RTCs. The first two happened at the exact same spot but on different days. Both cars were a complete write off with the engines ripped from the cars landing about 50 yards away on each occasion. How on earth anyone got out of the alive is nothing short of a miracle. Neither patients were trapped and both were out of their respective cars on our arrival. The first guy had some chest pain but was said to be fine at hospital. He had been working 7 days a week for the last few weeks and was clearly worn out, he went on to tell us that he feared being fired if he didn't put in the hours! In the UK we have laws that prevent people having to work excessive hours, his boss obviously wasn't up to speed with them. We thought he might have fallen asleep at the wheel.
The next lad, who had only passed his test six weeks ago, was only a teenager and after being questioned by the police officer on scene it was discovered he had been drinking needless to say he failed his road side breath test. Why do they do it? This car was actually slightly worse than the first and it was only due to the car being modern and with lots of airbags etc that he survived. I don't think he'll be driving again for quite a while
The third accident was to a car that had gone side on into a wall, the patient was also a teenager. This was a lot more serious. Fire & Rescue were on scene along with police and another Paramedic crew. No time for the roof to come off, this was a rapid ex job. Rapid ex is a way of extricating someone from a vehicle who has life threatening injuries but using very basic c-spine care. He was on O2, had an oral airway in situ and a c-collar on. With the help of the firefighters we got him out onto a long board and then started assisting his breathing with a BVM while quickly wheeling him to the truck. On board he was hooked up to the monitors, while the other Paramedic was ventilating him, I got a 16g IV in his right arm and started fluids. We had a Basics Dr attending as well who is an anesthetist at the local hospital and as he arrived I put in a 14g IV into the patients chest to decompress it. After explaining what we had he said 'Right, let's RSI him and then I'll do bilateral thoracostomies.' 'OK Doc.' we said and that's what happened. We weren't on scene long and raced this young lad to hospital. Sadly he lost his battle to survive a few hours later in the operating theatre.
Some times people who are badly injured are so far down the dying line that no matter what you do it's just not enough.

A bit of useless information

At the station where I work we have 3 day crews and 3 night crews, we also have a 9 hour response car 7 days a week. If we do roughly 5 calls per vehicle on average, it's actually more, that equates to 12,775 calls per year!

Spooky

I was just sitting at the computer at work and picked up Mosby's Prehospital Trauma Life Support book. Whilst flicking through I started to read about chest trauma and needle decompression, literally about 5 minutes after reading that chapter the phone goes 'can you head out on standby, but just to make you aware you might be needed at an RTC'. So off we go. Sure enough we get the job, we are the second crew. I end up performing a Needle Thoracocentesis ( needle decompression/thoracostomy whatever you wanna call it) on this young lad. What are the chances of that happening?!

Another spooky story from a few years ago, probably a coincidence though. It was a couple of months after moving into our brand new house and the new turf had just settled. I was playing football with the kids in the garden when I tripped on a piece of metal wire sticking out of the ground which I hadn't noticed before. I had cut the lawn earlier and hadn't gone over it with the mower so I was a bit puzzled as to where it had come from anyway After several attempts I managed to pull it out and bin it. I thought nothing of it, like you do. After a good run around with the kids I had to get ready for my night shift. Now here's the spooky bit; the first call of the shift was to a fall with very few details apart from we were backing up another crew. When we arrived there was another crew from the neighbouring county and fire & rescue. It soon became apparent that the patient, a lady in her 30's, had fallen on the pavement and landed on the verge but in the verge was a steel reinforcing rod sticking out of the ground and she had landed on it. In fact it had impaled her underneath her chin and penetrated all the way through her mouth and up into the roof of her mouth. She was still conscious but obviously unable to talk. A couple of lines were inserted, one in her foot! and the other in her hand. This was for fluids and pain relief before the fire fighters cut her free. It was going to be a delicate operation because one false move would of proved disaterous. A few minutes later a Basics Dr turned up to assist and asked if we had given any pain relief yet. The answer was no, it was about to be drawn up but because it was back in the days before we had morphine (we were using Nalbuphine at the time, which is not as good as morphine) and the Dr turned up, we thought he would give something better. One of the Paramedics said 'Are you gonna give Diamorph Dr? of which he replied 'You've got Nalbuphine haven't you?', 'Yeah' replied the Paramedic. 'Well give that then!' 'Err Ok' said a surprised looking Paramedic. So that's what happened, she was given 20mg of Nalbuphine. A short while later the Dr decided to give the patient some Ketamine as well. Once she was cut free she was put on a long board and rapidly taken to hospital. I checked on the tv and heard how the fire fighters had to cut her free, nothing about what we did. Oh well hey ho, the fact that she made a full recovery is all that matters. After all my waffling on, the 'spooky' part was a) me tripping over a piece of metal wire at home and b) the lady falling onto a metal rod. Both on the same day! Maybe it was an omen, I don't know. I don't usually believe in all that premonition stuff, it must have been a coincedence.

Richmond PD

More Richmond Fire Dept

Some good news!

What a coincidence, I was talking with my crew mate tonight about a job we attended together which just so happens to be the one that I wrote about in my last post; the lady with a sub arachnoid hemorrhage. The incident happened about a month ago and I have been wondering how the patient was or if she even lived or died. Well my crew mate happens to live near the address and on his way home from work recently he bumped into the husband. He said that his wife was back home after successful surgery and was now up and about. Everything went well except she has lost the sight in one eye, but she is expected to make a full recovery in due course. Apparently it was a massive bleed and it was touch and go as to whether she would survive or not. He said thanks and was very grateful to us for what we did. To be honest we only played a small part in helping to save her life, OK we were able to stop her seizure, keep her well oxygenated and get her to hospital quickly but we musn't forget the great job that the ED team and the neuro surgeons did. They were the ones who actually diagnosed the problem and repaired it. OK, I queried a bleed but let's be honest that's just a hunch based on experience and nothing else. At the end of the day she is alive and well thanks to a good team effort at all levels. I'm glad those two girls now have their mummy back at home with them.

You know it's bad when..................

You know it's bad when there are kids waiting for you at the front door, crying and pleading for you to do something.

We are called to a hemorrhage/lacerations call near to our station and on our arrival there are two young children waiting on the steps out side the house. As I grabbed the response bag they both came over, sobbing, 'please do something my mummy is bleeding out of her mouth, please, please.' On entering the house we were met by a male in his late forties, whilst ushering us upstairs he explained that his wife was having a shower when he heard a loud thud and when he went up to see what all the noise was he found her on the bed bleeding from her mouth and unresponsive. Now in the bedroom we were confronted with a semi naked female who was face down on the bed, patches of blood on the bed were also visible. I quickly rolled her on to her side and could see she was having some form of seizure. I wanted to put in a nasal airway but she started to flail her arms about so I opted for some O2 instead. Her husband was asking if she was going to be OK but I just had to tell him that I honestly didn't know and that he should go and make sure the two girls were OK. My crew mate went down to get the drugs bag and the carry chair with the husband in tow. This patient had no previous history and was normally fit and well so what was the problem? Was she having a first fit or was she having a cerebral bleed? Whatever it was we needed to stop this fit. As I put in a 20g IV and secured it down my crew mate was entering the room so I got him to draw me up a saline flush and 10mg of diazemuls. After 5mg she stopped fitting and we were now able to get her on the carry chair, down stairs and on to the truck. As her breathing pattern was unpredictable I got out a BVM and assisted her breathing as and when she needed it, my crew mate was attaching all the monitoring equipment. One last thing, the patent's personal details, the husband had gone to write them down. As soon as he returned we were off to the hospital 7 miles away. He and his girls followed on in their car. I did tell him not to try and keep up as we would be going in on blue lights, something that some relatives fail to do! On the way in the patient started to respond and was following simple commands which was encouraging. She even managed to tell me that prior to her collapse she had a bad headache and heard ringing in her ears. Perhaps I was making a fuss over nothing, perhaps this was a first fit and she would go on to be diagnosed with epilepsy where she would receive medication to control her fits, I hope so. On arrival we were greeted by the A/E Doc and a couple of nurses, when I explained to the Doc what had happened he just gave me a wink and said cheers. The husband turned up some time later minus the girls, he had dropped them off with friends and rightly so, no children should ever have to see their loved ones like that if they can help it. I showed him to the relatives room and went back to clean up the truck.
About an hour later we arrived back at the hospital with another patient, some one who most definitely didn't deserve an ambulance trip to hospital I might add! The Doc spotted me and came over, 'Massive sub arachnoid bleed' he said. 'Bloody hell, what's the prognosis?' I replied. 'It's hard to say, she's going to be transferred to the neuro unit soon.' 'Right, thanks for that.' I said, thinking about those poor girls. You can read about SAH here http://www.nlm.nih.gov/medlineplus/ency/article/000701.htm.
Later we were to return and transfer her over to the neuro unit 30 miles away. She had received 4mg of morphine but was still in a lot of pain, I wanted to give her a bit more but the consultant anesthetist preferred that I didn't as it wouldn't completely remove all of the pain. Fair enough. She needed to be where the bright lights and shiny steel was, the operating theatre. A heavy right foot would probably be more useful than another couple of mg of morphine. She was a bit more responsive this time round but not fully with it just saying it hurts, it hurts. We arrived there in one piece and got her up to the neuro ITU ready for surgery.
I've seen the husband out and about but still don't know how the op went or if she even made it. I hope so

Taking our training seriously for a change!

NOT!!!

Does my bum look big in this?

Just a random picture I found. I'm doing a bit of CBRN training. There was point when I thought I was going to die. The battery in the internal fan ran out and I wasn't getting any air to my suit. I quickly started to feel faint and frantically tried to get the suit off but couldn't as my gloves were taped to the arms with duck tape. Everyone thought that I was larking about until I fell to the ground. When some one eventually spotted that I was in trouble I was able to get the hood off. Wow, what a rush of air. The tunnel vision soon went away and I was back to normal. That was scary!

That's my partner!

Our EMT driver for the week, Tom (not his real name), had a heart of gold and was at our beck and call all week with no questions asked. He was totally dedicated to EMS, fire fighting and any thing military and appeared to love every minute of it. One night we were out for dinner with the executive team at RAA and the above clip is of 'Tom', who seemed to accompany us every where in uniform. He provided us with lots of entertainment even though at times he was unaware of this. He couldn't do enough for us.

Full moon

Worked last night, there must have been a full moon because everyone we attended except was as fruity as a nut cake. We went to a young guy who cut himself on purpose with a carving knife. He slashed his forearm and did a good job of it. One of our other crews took him in again because he said the wound was still bleeding even though it had been sutured. I've got a funny feeling that this guy is going to become a regular thorn in our sides. We've been to him three times this week already and he has only been living in the area for two weeks.
Another drug and alcohol fuelled man had stabbed himself in the abdomen and had cut his own throat. That wasn't so bad, the bad bit was that he had hepatitis B and was threatening to spit blood on everyone. No-one could get near him so the police rushed him, bundled him into the police van and took him to hospital them selves.
We are also called to a man threatening to jump off a building and has a machete. His flat is also full of weapons. There were police everywhere all done up in riot control gear ready to take him down. His younger brother turned up and was taunting the police who weren't having any of it. As he walked past us he cracked open another bottle of beer and necked it, smashing the bottle on the ground and doing an about turn ready to confront the police again. He was sent on his way again which really pissed him off, well at least I think he was pissed off due the colourful language he was using. The police said that they would have nicked him if they had more officers available. This time he was lucky. There are more but I've forgotten, we have so many round here!

Grow up!

Working with yet another trainee. We are called to a ? narcotic OD in town and the police are already on scene. Inside I see a familiar face, he is intoxicated and ranting that he just wants to die. I've met this chap before for similar problems and his wife is a known self harmer and we used to go to his mum who's a diabetic. They all used to live together, what a family! A police officer hands me some tramadol tablets, which are a synthetic opiate. I check his pupils which were like dinner plates. He wasn't being very cooperative and was wandering around his flat looking for his rolling tobacco. Eventually he finds it and starts rolling, fumbling with his papers and then dropping it all over the floor.'Come on mate let's get you down to the hospital.' 'Nope, I ain't going, just let me die!' 'Sorry, can't do that.'
And so it goes on like this for around 20 minutes. He starts crying about his son and saying that his life is crap. This time he manages to roll a cigarette but now needs a light. The police officer tells him that he will give him a light if he goes to the hospital with which he agrees. He shakes the police officer's hand. He's finished, 'come on then let's go' I say, 'Nah, can't be bothered just let me die.' And with that he starts ranting that he has asthma and now can't breathe. My crew mate seizes the chance by saying to him that he needs oxygen and therefore we need him to come down to the ambulance ASAP. 'Quick, quick let's get you some O2!' says my crew mate. Surprisingly he follows us down to the truck with the police locking his flat up. They mouth a quick 'Thank you' to us. You see if we had left him there he would carry on drinking and take more pills and we would either be called again that night or called in the morning for a cardiac arrest. Now on board he is given a more than adequate 2 litres of O2 which seems to settle him and off we go to hospital. because I know what this guy is like I flick on the camera so I can keep an eye on him and my trainee. A few minutes into the journey I can see him lying lifeless on the trolley, I start to chuckle to my self, he's putting it on. Sure enough my crew mate comes up to the hatch and asks if we can pull over so I can quickly check him out, she thinks he is putting it on but wants to be certain. I jump in the back and look at him, a pathetic sight, he is staring at the ceiling, not moving. All the monitors are fine, his colour is good but he wont respond so I flick his eye lash and it flutters. Putting it on! Next he grabs himself round the throat, wrapping his fingers completely around his windpipe. He squeezes so hard that his light bulb shaped head is now going purple.
'Right, stop doing that or you'll hurt yourself!' So he squeezes harder.
I start to read him his fortune and grab his hand, 'Let go of your throat and stop acting like a bloody child. GROW UP!' he doesn't listen so I eventually prize his hand away. 'All you are going to do is cause your self a nasty injury, you're not going to kill your self.' I say. 'I just wanna die, let me do it, let me do it.' he replies. 'Sorry, no can do.' so he grabs his throat again. I manage to move his hand again and pin both hands by his side. 'Think about your son, what's he gonna think of you if you act like this?' he then starts to cry. With him a bit more settled we carry on to the hospital. When we get there the nursing staff aren't impressed and don't believe that he has taken 20 x 50mg tramadol tablets, they should have started to take effect by now. He is then put in a cubicle and watched for a few hours.
The next night I ask one of the nurses what happened to him and I'm told that he was earlier that morning to another hospital over 40 miles away as there was no bed spaces left. He was due to start work at 06.30 as refuse collector but was now in another hospital.
I would like to think that he had learnt his lesson but some how I doubt it.