Monday, 24 November 2008

A stone's throw

I don't know about places like the USA etc but over here in blighty the majority of opiate overdoses' involve IVDU (IV drug users) and that bag of gear that takes them just over the edge. But occasionally we get called to the intentional/accidental OD on prescription opiates such as co-proxamol/co-dydramol/co-codamol etc etc. A couple of weeks back I was working out of another station with an old colleague from my PTS days. As usual we were having a good old laugh n' a joke and generally catching with all the gossip. We get a call for an OD. It's to a 40 year old female who has taken ? Tramadol (synthetic opiate). We arrive at the location but have a job deciding which gate way to use, the house is that big! Soon we see a man appear on the road who starts to wave to us so we make our way over and park the vehicle in the drive. The house is up for sale and if I had the money I would have snapped it up. It was up for £1.4 million. (Just a few more overtime shifts might do it!). A woman (who also happens to be a nurse, a proper one for a change) obstructs the front door and starts to tell us about our patient.

'She's my sister-in-law and she has taken 60 of these.' as she hands me an empty packet of solpadol.
n.b we were initially informed that the drug was Tramadol although it wasn't

'She is having problems with her husband and I'm really worried about her!'

'OK let's go in and see her shall we.' I say

Inside I'm gobsmacked at the size of it all, beautiful wooden floors and the sweeping stair case and the kitchen, well my wife would have a field day. Inside the open planned kitchen there is a woman lying semi-conscious on the sofa. To cut a long story short she appears to have taken all the solpadol (solpadol is an opiate containing Paracetamol and codeine) and is showing signs of an opiate OD such as pin point pupils, decreased respiration's and reduced conscious level. We treat her with O2 and IV Narcan which does the job and take her to hospital. What we later learned was that at the end of the road and at the exact time of
our job there was a car accident. A local teenager had pulled out of a junction on the busy dual carriage way and had been struck by a van travelling at high speed. She was in cardiac arrest. A couple of crews and the air ambulance attended and despite bi-lateral chest drains and every thing else that goes with a serious trauma job she died.
A sad tragedy had occurred with in a stones throw of where we were. Even if we were there as it happened there would have been nothing that we could have done to save her. It's still horrible to think that someone died right under our noses.

Sunday, 23 November 2008

Another OD

Finally we've just got back to base and had our break. A little while ago as we were approaching town the MDT started to beep and flash, it was a job. Cat A unconscious in the street ? overdose. We were only a couple of minutes away and had no other details. As we pulled into the street there were 2 men standing over another man on the ground. This guy had overdosed on heroin and had done it big time, he was in respiratory arrest.

'Yeah man he's only done 20 quids worth of gear and drank some beers, that's all' said one of his mates.

Out with the BVM and an OPA (oral airway), his pupils were pinpoint (a classic sign of opiate OD) and even in the moonlight he looked pale. As I started to ventilate I asked my crew mate (who is a trainee) to get out the drugs bag and give 800mcg naloxone/narcan via intra-muscular injections, one in each arm. It's funny because only earlier I was talking to him about what skills he has used so far and what did he need to get signed off. Although he had given Glucagen IM in the past he didn't get it signed as this was before the new policy had come into effect. The new policy being that all trainees now need to be signed off (twice) as competent at administering drugs via IM injection, this was his chance.
At this point the police turned up and quickly arrested his mates, why I don't know.
With a good patent airway the next step was to administer the narcan. My crew mate did well and pushed 400 mcg into each arm. I carried on ventilating him for a good few minutes but nothing was happening, he was still not breathing. I opted for a tube and attempted intubation there and then but as I got through the cords he gave a massive cough so I withdrew the tube. I reassessed his airway and breathing but still nothing so I swapped positions with my crew mate so he could practice his BVM technique. Next step was to give more narcan but first I needed to get IV access which can be pretty tricky in IV drug users. Not in this case, the patient had cracking veins so I popped in a 20 g pinky and gave another 800mcg of narcan. Within about 30 seconds he was back in the land of the living. A life saved.
He was no bother on the way to hospital which makes a change! Most of the time when you have ruined a heroin addicts hit/fix they usually moan like hell but not this guy, he was nice as pie and happily came to hospital to be checked over.

It's now 03.30 am and I'm tired. Must try and get some sleep. I'm not holding my breath though!

Friday, 21 November 2008


It's 04.00 am and I feel someone shaking me and soon realise that it's my crew mate.

'Come on we've got a red call!'

Now, I'm not great at waking up at the best of times. The night shift had been pretty quiet and we were lucky enough to have had about 4 hours sleep on base.
I manage to haul myself up and make my way to the vehicle. On the mobile data terminal (MDT) the message reads 'Lights and sirens response, SOB, GP advises patient will need oxygen.' From that I knew that it was a Dr's red call but what I didn't know was whether a DR had actually visited or not. Probably not. We usually get updates of the job en-route but didn't get anything extra.
When we arrive on scene about 5.5 miles away we see that the front door is open so make our way over. Inside there is a lady, about 70, who was really struggling to breath. You didn't need a stethoscope to listen to her chest as the wheezing was so loud. I still had a quick listen so I could detect/rule out a pneumothorax (collapsed lung). Her air entry was equal with a pronounced bilateral expiratory wheeze so straight on with the high flow oxygen while my crew mate was moving the vehicle.
On board I gave her a Salbutamol nebuliser which only provided mild relief so after about 5 mins I gave her another, this time we added Atrovent (Ipratropium Bromide). Her peak flow was only 150 (her normal was around 350 which in itself is pretty poor), O2 saturation's was 90% with a pulse rate initially running at 110 bpm. I decided to cannulate her and administer 200mg of Hydrocortisone. She knew exactly what we were doing as she was an ex nurse and repeatedly kept thanking us for what we were doing even though she wasn't out of the woods yet.
It all started around 2 am when she was woken from her sleep with severe breathing difficulties so she decided to contact the out of hours GP. The GP obviously heard her breathing on the phone and called us.
By the time we reached hospital her O2 saturation's were 98% and her pulse rate had come down to an acceptable 90 bpm although she was still a bit wheezy. We were greeted by a DR and 2 nurses who took my hand over as we transferred the patient to the hospital trolley. As I turned round another nurse came into the cubicle with a tray with 2 vials of hydrocortisone drawn up into syringes and bloods tubes.

'What do you want them for? I've done all that.' I said.

'Have you?' said the nurse.

'Yep, I did say when I gave the pre alert.'

'Oh OK I didn't know. I'll get rid of them them, thanks for that.' she said.

Our patient is now doing much better and after doing an arterial blood gas the DR looks at a loss as to what to do next. He wanders off and starts to write some notes while the nurses get on with repeating some obs. Our patient thanks us and we wearily make our way back to the vehicle hoping to get back to base for a bit more shut eye.

After a week of doing nothing of any significance it was nice to have a proper job just to remind us of why we are here.....................even if it was at 4 am!

Wednesday, 19 November 2008

After reading and the bit about the diabetic, I felt I needed to comment.

We were called to a care home for an unconscious female. She was in bed, unresponsive, malnourished, dehydrated and no heavier than 5 stone in a wet raincoat.

'How long has she been like this then?' I said knowing full well that this wasn't something that had suddenly happened.

'Don't know, I've only just started my shift and I don't know much about this lady.' came the reply.

'Really' I thought to my self.

It amazing how many times we get the same old story, no-one knows anything about the patient, they've just come on shift or 'it isn't me that usually looks after her.'

'Medical history?'

No-one seems to know!

This lady is poorly sick and needs to be in hospital. She is severely dehydrated with barely palpable radial pulses. She is also hypoglycemic (although not diabetic). She needs some fluids and IV glucose. One attempt and that's it. This was before we had the
EZ-IO ( We're in! A 22g bluey in her hand. 50ml of glucose and a bit of fluid en route. She starts to stir.

Overworked, understaffed, don't know this, don't know that. We've heard it all before. There is no excuse to allow patients to get like this.

To the clampers

No hard feelings eh! Ha Ha
Although I had to laugh when I saw this.

Pissed off!

Today my car was clamped at our local hospital, yes I know it was my own fault but I'm still pissed off! I had to take my 9 year old daughter to A/E as she had been suffering severe abdominal pains. We suspected appendicitis as all the signs were there i.e positive Rovsing's sign etc. Anyway we waited for the blood results to come back and thankfully she was suffering from nothing more than severe constipation. We went to the pharmacy to pick up her meds and when we got back to the car we saw 2 car park attendants (I like to call them parking police) walking away from the parking area with a camera, clipboard and clamping gear. I thought nothing of it until I saw my front wheel with it's new yellow friend bolted to it. Of course I got it in the neck from my wife because she had told me to move the car into the staff area but I knew better,'It'll be all right' I said. Famous last bloody words! I paid the £45 release fee and off we went.

OK MY OWN BLOODY FAULT, still pissed off though.

Knowing my little girl is fine and I soon forgot about the slight inconvenience of the clamp and fine.

Monday, 17 November 2008

We offer lots of help and advice to newbies/trainees and this short & sweet gem on ECGs is one of my favourites; 'If there's lots of ink it ain't good!

Oops again

I forgot I took these.
I was working on the RRV when I got a call, 'Rollover, 1 female trapped'. Everything was being sent including the air ambulance, basically every man and his dog.
The accident is on an S bend and road is slippery after some light rain. Within minutes I was there. The usual helpful member of the public was there directing traffic, he gets every where that bloke! Before I pulled up I spotted the windmills, these are those people that think that we are blind and have a need to stand at the scene waving frantically. Perhaps they think we have got multiple incidents along the same stretch of road and need to wave us down in case we drive by. Funny old thing the car on it's side gives it away! Never mind.
I grab my kit, analyse the scene for hazards and quickly check to make sure there aren't any other casualties that have been ejected from the vehicle. There are 4 people gathered at the side of the overturned car and one kneeling by the boot.
'There's some one in the car', says someone. 'We didn't want to move her just in case.'
As I lift up the boot hatch I am confronted with a wriggling mass of coats and bags.
'Can I get out now?' a voice says.
'Hold on.' As I crawl inside. 'Are you hurt?'
'Any neck or back pain, did you hit your head, seat belt worn?'
No, no and yes were the replies.
'Well let's get you out then.' I said.
'Yes please' said the woman.
Before I get her out I call up control and ask for just one vehicle to attend and to cancel the air ambulance and fire & rescue. Although standing down fire & rescue in this country is pretty much impossible.
I have to detach the back seat and slide it out and then remove the coats and bags that are now only partially covering the woman. As I guide her out I am deafened by the sirens of the approaching ambulance. As it pulls up the trainee tech driving turns them off, her crew mate gives her a filthy look and shakes his head. I thought she parked it on my head they were that load! Never mind she'll learn.
The woman is now out and is unharmed so we put her on board the ambulance to have a proper look at her. The crew move the vehicle down the road so it is out of the way. While I'm talking to the Police two fire appliances turn up.
'She's out mate.' I say to the watch commander.
He turns to his colleague from the other fire truck and waves him goodbye. He walks off looking disappointed.
'Right, we'll make the car safe then.' he says.
The woman is being checked over in the ambulance so I pop over to see if the crew need anything. The woman is fine and doesn't need to go to hospital. I then make myself available for calls.
I got another call to the same spot on Thursday this week for a car on it's side, again non-injury. We have been to a lot RTAs on this stretch of road with most incidents thankfully being only minor injuries. Although 4 lads in one car were killed not that long ago at the same spot.

Saturday, 15 November 2008

Richmond Fire dept visit to RAA

Some more pics from my trip to Richmond. The FD dropped in and told us about their role in prehospital care with RAA. One thing I found amazing is this; Like us in the UK, RAA have a response standard, theirs is 8 mins 59 seconds. But the only thing that stops the clock in Richmond is an ALS ambulance, that's a vehicle with at least one crew member who is a Paramedic. If a fire truck or a RAA field supervisor or BLS ambulance turns up first with in this time it doesn't count. Irrespective if they save a life it still doesn't count. Another thing I found astounding is that Richmond's population size is very similar to that of Southampton in the UK but in Richmond they have 20 fire stations and that RAA put out on average 16-18 ambulance crews daily and about 8 crews at night. This doesn't include the rescue volunteer squads dotted about the city. I know for a fact that there aren't that many fire stations in Southampton and that South Central Ambulance probably don't put out that many ambulance crews during the day.

Richmond FD have a few nationally registered paramedics as firefighters and the FD work closely with RAA.

Thursday, 13 November 2008


Anyone seen Michael Moore's documentry 'Sicko'? People have the cheek to moan about the NHS well just watch this and see how lucky we are!

Wednesday, 12 November 2008

Bare with me, I'm tinkering with the layout of me blog.


The little old lady who had been driving this car had just been to the Dr's surgery. I'm sure she was expecting nothing more than an uneventful drive back home. Oops, does help if you stick it into drive and not reverse love! 'Ooh my foot slipped' she said repeatedly.
Once we managed to prize her hands from the steering wheel we checked her over, she was fine. She managed to take out a brand new wooden fence. So new in fact the council workers were just packing away their tools. Didn't they laugh.......................not! Oh well at least I know my £1500 annual council tax money is being put to good use.

Non-injury, sign here!
I've just opened one of my work e-mails and was shocked when I read it.

" There has been a number of incidents nationally involving housing association properties where tenants who are suspected users or suppliers of drugs are secreting DIRTY NEEDLES with in the bottom corner of light switches.
The needle is placed in between the rocker switch and the front plate, meaning that any person attempting to turn the lights on is likely to get a needle stick injury to the finger."

Unbelievable. So to my fellow emergency workers across the land, BEWARE!


Pulling up at the drive way to this £1 million+ house we both look at each other, shaking our heads thinking we are in the wrong business. To make us even more jealous there were two brand new Mercedes Benz sat on the drive. We had been called to a lady who was possibly having a stroke. The vast majority of the properties in this part of town are in excess of £500k which is surprising considering where I work.
After the 'Big Ben' style door bell stopped ringing the door opened and we were face to face with an overweight male in his fifties. 'Quick come this way' he said as he ushered us in. 'Are you all right?' I said to him, he was ever so wheezy and sounded like he was having an asthma attack, In fact I nearly gave him a nebuliser there and then on the spot. 'No I'm fine, it's my wife. Come up here, quickly please.' he replied.
It seemed to take ages to climb the enormous sweeping staircase. The patient was sat on the edge of her bed and was crying. As she looked up we could see the frustration in her eyes. It wasn't the fact that she couldn't speak it was more that what ever she said made no sense. We managed to find out that she suffered from high blood pressure and was taking tablets for it. After doing her temperature and sugar level we moved on to her BP which was 146/78, nothing remarkable there then. As she was symptomatic we popped her on some oxygen.
She still needed to go to A/E and within a few minutes we were on our way. Her husband, whose wheeze had now calmed down, came with us. The patient had been on O2 for around 5 minutes when her speech started to become clearer, it was no longer garbled. A few more minutes and it was getting better, by the time we were at A/E it was back to normal. As we unloaded her on the trolley her husband was leaping around shouting 'Hallelujah, she's cured! You boys are wonderful, you've cured her!' and he was repeating this up and down the corridor. I kept expecting James Brown to pop up and shout 'Can I get a Witness, amen'. With what we were presented with we queried a TIA (transient ischaemic attack, a sort of angina of the brain), did some obs and gave O2. That was it! But the husband thought we were miracle workers. A little while later the grateful husband came up to us and asked if we thought it was definitely a TIA but all we could say was that he should let the Drs run their tests to confirm it. He was more interested in our opinions than those of the Drs.

He was over the moon that his wife was doing well.

A TIA is sometimes called a 'mini stroke' and it is where there is a brief interruption in the blood supply or temporary blockage of a blood vessel in the brain. Patients usually recover within 24 hours but if patients have lots of these it is just a matter of time before they have a full on stroke. Patients with high blood pressure and/or an irregular heart rate (known as AF or atrial fibrillation) are particularly susceptible.

Sunday, 9 November 2008

Just a quick thank you

Every now and then I click on my cluster map to see where some of my visitors are from. Even though I've only had 2000 + visits (that's a lot more than I thought I'd get) it's nice to know some people actually read my blog. I just want to say thanks for reading.