Tuesday, 31 March 2009

The observer rides again

As I said in my last post we would be having an observer coming out with us again. He was a medical student in his 5Th and final year and had been doing a GP placement locally.
I recently had a phone call from an Emergency Care Practitioner who works at the same surgery, he asked if I minded if a med student came out with us for a shift. No problem. So today was the day that he experienced first hand exactly what we get up to at the sharp end. Or something like that. First we went through all the kit. I think he was impressed with the EZ-IO http://www.vidacare.com/ez-io/index.html and the amount of drugs we carry. It's surprising just how many Drs and other health care professionals don't know just what we carry.
After a brew I had him sign some paperwork, gave him the observer PPE kit (personal protective equipment) and adopted the usual morning pose....................................in other words we took up positions on some comfy chairs and waited for the first job to come in.
It wasn't long before we were out, not a job but out on standby at a local GP surgery. We weren't there long before being sent back to base. We didn't make it and were soon on our first call.

1. ? CVA/stroke. Female collapsed. We checked her over and found no real signs of a stroke. The only abnormality was that her blood pressure was elevated and she was a bit vague. She perked up with a bit of Oxygen and we decided to her take to A/E for further assessment. Whilst on scene a gardener ran over shouting that there was a man in a door way feeling unwell. I went over and saw that he was conscious and that there was no life threatening problems. I reassured the gardener and said that another vehicle would be on it's way soon.

2. GP 999 chest pain. This was a guy with obstructive airways disease who the GP thought was having a PE (pulmonary embolus-blood clot on the lung). He was having problems breathing, severe chest pain and was coughing up blood (also known as haemoptysis. Some Oxygen, IV Morphine and some bloods before heading off to the hospital. His breathing and chest pain was now bearable after the pain relief.

3. GP Urgent renal problems. According to the GP this guy was nephrotic and had current renal problems. After getting some blood results the GP decided that it was best to organise an ambulance for this chap. He was waiting at his door with his bag packed, walked onto the ambulance and walked off again at the hospital.

4. Cat A Fall. Life status questionable. We thought it was going to be a cardiac arrest in the street but it turned out that a passing motorist saw an old man fall over, rang 999 and carried on going. We spent 10 minutes driving around looking for our patient but found nothing. Control called us back and said that the motorist saw someone fall, get up and walk off. How this came in as a
Cat A I'll never know! Stood down and back to base..........................................and more tea!

5. RTA/RTC/MVA (whatever it's called this week!) Car vs Cyclist. A lady was cycling when a car (just pulling out of a junction) clipped her back wheel. Nothing serious, only some abrasions to her knees. What we call a brush and dust off job. We checked her over and offered her a trip to A/E but she declined. I quizzed her why she wasn't wearing a cycle helmet and her reply was that she read some research that stated that their was no real evidence to support wearing them. 'I only wear them on serious rides, I didn't expect this' she said. Unbelievable. We dropped her and the bike back at her house which was just around the corner.

6. Fall. Lady who twisted her foot on the way out of a dentist surgery. Slight discomfort on the instep and little toe. An ice pack was all that was needed. Her husband picked her up and took her to the minor injuries unit as she had declined A/E. I doubt she broke any thing.

7. Cat A fall. Male in his 70's who had collapsed/fallen, we really didn't know. His head was covered in blood and he had a nasty laceration to the back of his head. He appeared dehydrated, short of breath and was very repetitive and confused. He wasn't well at all and was covered in vomit and faeces. Oxygen and an IV as his blood pressure was initially low and off to the hospital.

We also finished on time for a change. I think the med student enjoyed himself and after thanking me and shaking my hand he said that it was nice to see what we got up to. I just said that that was a typical day. Not like casualty where there is major incident every shift!

Monday, 30 March 2009

Welcome to the ambulance service!

I turned up at work this morning expecting yet another manic Monday only to find out that we were having yet another observer out with us for the day. Well that was it, cursed again!
We had an A/E nurse with us, in fact she was due to start in A/E today but was told to come the ambulance station instead.
We did 6 jobs in total and it was pretty much bread and butter work.

1. Diabetic/Vomiting. Regular caller (alcoholic & ex IVDU) who had D&V all night. 'I can't breath, I can't breath, I can't breath!' she kept saying (SPo2 98% on air & would give any one a run for their money at the world fastest talking person championships). She had vomit on her night dress and wanted us to get her changed. Begrudgingly we obliged. She had a broken shoulder from a previous fall and was playing on this, her care package had now run out and wanted us to get her up. I knew the moment we got her changed that she would refuse hospital. We spent 40 minutes on scene waiting for her to make her mind up. 'Wait a minute, wait a minute, wait a minute, I can't breath, oh I'm panicking now!
'Naaaah, I fell a lot better now.' she replied
AAAAARRRRRGGGGGHHHHHH! I thought to myself. So after checking her observations (which were unremarkable-surprise, surprise) and completing the paperwork we left her to it. My first words to our nurse observer were 'Welcome to the ambulance service'.
Back on base and I called up the patients GP and referred her to them.

2. Fall. Elderly lady who fell in the bathroom and was wedged behind the toilet. A local DR was already on scene and gave us the low down before leaving. 'Your the experts at this, if you don't need me I'll leave you to it.' were his departing words. She was riddled with arthritis and had a recent knee replacement which was now hot and inflamed. She was in a lot of pain. It wasn't long before we were on the road to hospital and her concious level had decreased. I popped her on some oxygen and tried to get a line for pain relief but as soon as I touched her wrist with the cannula, she flinched.
'Stop hurting me you're hurting me! she said.
' You're not sorry at all!' was her reply.
I wasn't going to persist so we just got her to hospital, moaning in agony all the way. I thought it was me but as we wheeled her through the ambulance bay doors she took one look at the floor and started moaning about the type of floor it was. I put her comments down to an infection originating in her knee which was making her delirious.

3. Fall from a height. We were backing up an EMT on a response car who was on scene with a guy who had fallen backwards off a ladder.
'You'll need a collar and backboard lads!' shouted the EMT as we approached. Our man had a large laceration (approx cm) to the top of his head, complaining of pain in his arm and lower back. After immobilising him and getting him on the truck I set about giving him some Morphine. His head wound started to bleed profusely, he had an obvious fractured arm and considerable back pain. With the Morphine now kicking in and my crew mate controlling the bleeding we rushed him in. We called ahead and were greeted by a full trauma team who set about repeating the Primary survey and then on to the secondary survey and scans, X-rays etc.
It took us an hour to clean out the back of the truck; head wounds bleed alot!
We later found out he had fractured his spine but will hopefully, in time, make a good recovery.

4. Overdose. Young female who took 30+ paracetamol last night and now had abdominal pain. Less than 2 minutes on scene and we were on our way to hospital. She had been waiting outside her parent's house and had called the hospital for advice, apparently they said dial 999. I doubt it, it was probably more along the lines of 'Get yourself to hospital and we'll see you'

5. Mental health patient under section. On scene were 3 police officers, a Psychiatrist and 2 social workers. We were called to transport this lady to a mental health unit. She remained silent so the police had no other option but to force her to come. They kept apologising as one of the officers carried her down the stairs into the ambulance. She remained silent all the way there. As I opened the side door to let her out I said 'Come on then we're here, don't worry there's no police about. Let's get you inside.' and with that she got up and walked into the unit.

6. Fit. Known epileptic lady who had recently undergone shoulder surgery. She had a small fit, nothing out of the ordinary but was now complaining of severe pain in her bad shoulder. In the past she had dislocated it (13 times this year!) during her seizures and needed it repaired in surgery. She now feared it dislocated again and was in agony. I started her off on Entonox but en-route I had to give her some Morphine as the Entonox wasn't really doing it's thing. She threw the old IV challenge thing at me.
'You'll never get one on this arm, all the veins here have been scarred and used up by the Paramedics and DRs when I've been status (Status Epilepticus-continuous seizures which is potentially life threatening) and when I've dislocated my shoulder before. The only good ones are on this hand!' She said wiggling her fingers on her bad arm. I couldn't see a vein but could feel one so I went for it........................................and got it in..............................albeit a small blue 22g cannula. It didn't matter, a line is a line and it was only for analgesia. At hospital she said thanks and we bid her farewell.

And that was Monday, the usual bread and butter work and finished an hour late!
Tomorrow we have a med student coming out with us. I wonder whether it will be the curse of the observer on that shift?

Sunday, 29 March 2009

Breaking bad news

Here is some great advice from an experienced DR. I'm sure he wont mind me posting a link to his blog. Click here http://basicsdoc.blogspot.com/2009/03/worst-job-in-world.html and look at the 5th comment.
To some our job looks easy but breaking bad news never is.

Leaving people at home

For those of us that work in a prehospital system that on occaision leave people at home click this link for some excellent advice http://medicblog999.wordpress.com/2009/03/28/leaving-patients-at-home/. It also is useful info for our prehospital friends around the globe, gives a bit of an insight.

Saturday, 28 March 2009

The end of another week

A weekend off at last! Well not quite. I spent all day today finishing off my daughter's bedroom.
I had to take the day off on Wednesday to look after my family as they all, in turn, were suffering from a horrible bug. I rarely have time off but in this instance it was justified. Family first! I on the other hand have seemed to escaped the wrath of the D&V bug, touch wood. Must be that good old ambulance immune system kicking in!

Back to work on Thursday and to be honest it I can't really remember what calls I went to. All I know is there was nothing of any real interest. We did have an army medic come out with us. We have a lot of these at our hospital and they frequently ride out with us to get an insight as to what we do. Trouble is, like any observer, they bring with them the dreaded observer's curse. It's well known that when ever an observer comes out with us nothing interesting ever happens.
We did do a transfer from a private ward at our local hospital to a private hospital 30 miles away. It really annoyed me because it didn't warrant an A&E ambulance at all. The patient was a pleasant man who was going for an operation. He was having a CABG, pronounced cabbage; CABG stands for coronary artery bypass graft. We took the stretcher up to the private ward but as soon as one of the nurses saw it she said ' He won't go on that, he'll probably walk down'. I couldn't believe it. 'Does he not need to be monitored?' I asked. 'No, he's been in all week and is not having the op til tomorrow, he's OK.' He didn't even have a line in.
Control told us that we had to do the job as the patient needed monitoring and that the urgent journey vehicle couldn't do the job as it didn't have the required kit. Oh well. He was fully clothed and looked a picture of good health (and if you didn't know what he'd been in hospital for you would have thought he was a perfectly fit & healthy man ). He walked down to the vehicle and sat on one of the seats and we chatted on the journey. He couldn't have a stent fitted as the narrowing of his arteries were on a junction and a by pass was the only option. Naturally he seemed a little nervous and so would I if that was me. When we got there we had to wait while he filled out a registration form and then escorted him to his room. In the lift he apologised and said that he felt embarrassed that we had to bring him over and that he thought it was an inappropriate use of an A&E ambulance. Although I completely agreed I just made up some excuse about the other vehicle not being available. He was a really nice chap and I hope everything went according to plan. But I can't help thinking that these sort of jobs don't help when the government are putting increasing pressure on ambulance trusts to get to people in 8 minutes. When a transfer is booked with ambulance control I think more questions need to be asked as there are more appropriate resources available and they need to be used properly.

Friday and I was working with my old school mate. No matter what jobs we go to we always have a good shift, he is a top bloke! And true to form it was a pretty unremarkable shift. We did have one patient who was in an awful lot of pain. He was only in his 40's and suffered IBS (Irritable bowel syndrome) but for some reason he was experiencing severe abdominal pain. The pain was the worst pain he had ever experienced and was also vomiting. Another problem was that he had difficulty in breathing (DIB) and he said that he felt like his whole chest was in spasm. His wife was really concerned and said that this is so out of character for him as he usually has a very high pain threshold. Because off the spasm in his chest it was actually impeding his breathing and as a result had actually caused his oxygen saturations (SPo2) to drop, they were in the low 90's. On board the vehicle I gave him some IV Maxalon and 5mg of Morphine, this wasn't doing much so I gave 1mg every minute until his pain was controlled, he had 8 mg in total. It took the edge off the pain and also helped his breathing. He was now able to take a deep breath and his SPo2 was now a more acceptable 98%. I probably would have started with Entonox but due to his DIB I was doubtful that he would have inhaled it effectively.
As with all the other patients I'll probably never get to find out what was wrong with him. All I know is that we delivered him to hospital in a better condition than when we first saw him.

Everyone says that I get all the decent jobs but it's just not true. Yes I do usually get a lot of unwell patients and regularly get to use my skills but I too get days when not much happens.

Back Monday for 2 days and 2 nights. We'll see what that brings.

Wednesday, 25 March 2009

What a difference

What a contrast between Monday & Tuesday. Yesterday I turned up for my car shift as per usual and started to check the equipment on the car. I was just about finished when I saw an off the road notice, it needed a securing bolt for the Lifepack. So I started to check another car but found that the lock on the boot was faulty, so off to find another car. I started checking the ECP car but was told not to use it for some reason; even though there were no ECPs on duty. There was another car at the other end of the garage but that too was off the road, blue lights faulty and a flat battery! Now there were only two more to choose from, a ropey old car and a 4x4. I opted for the 4x4 as there was someone from my base station coming over to use a car for a course. Finally an hour and a half into my shift I was ready to go. What a joke!
After that charade I was sent to a station on standby in the north of the county and spent 3-4 hours sat there twiddling my thumbs hoping for a decent RTA to come in, if you are going to get one then this is usually a good area for those. But no, nothing. I was sent back to base for my break. By this time on Monday I had already done 5 jobs.
Later on I got sent for standby at a Dr's surgery near my base station. First I must explain that where I have been working for the past two shifts is in my home town but not my base station. I sat there for a while reading and about 45 minutes later I heard an all call go out, 'Any fast responder available for a Cat A fitting please call, responding a Technician crew from ***** base.'
The call wasn't far from base and I knew a local car was starting at 15.00, I hadn't done anything all day so I decided to call up for it. And sure enough I got the job. It was a regular patient who had a history of epilepsy, he had a couple of seizures earlier and was now vomiting. Initially I was going to let the double EMT crew deal but the patient started fitting so I stayed in case he needed some IV Diazemuls. It was a nightmare getting him out as there was no real room to manoeuvre and he was a big lad as well. He kept having lots of short seizures with little recovery time in between so I put a line in him and gave him 5mg of Diazemuls. Sorted. I got the usual from his partner 'They have a hell of a job getting a drip into him usually.' Right, that's a challenge I thought to myself. No problem, straight in. I left the response car where it was and accompanied the crew in just in case I needed to give some more drugs or in case he lost his airway. If he lost his airway I may have needed to intubate him. I didn't need to do either.
Into resus he went and for some reason they weren't that interested so after a quick look they said he was alright to go into majors so off they went. Within 10 minutes he was back in resus. The problem is we have a brand new box of junior Drs so things don't always go to plan. Bless them, they are still finding their feet.
We cleared at the hospital and the crew were taking me back to my car. We nearly made it when we got a Cat A chest pain back near the hospital. So we turned round and blue lighted 7 miles back to the location. It was a Patient transport (PTS) ambulance who called us, they had a lady complaining of chest pain and they had her on Oxygen when we arrived. Funnily enough the crew I was with had taken her in earlier and the PTS crew were taking her home. I had also taken this lady in recently with the same problem. She worries alot and pretty much suffers chest pain on a daily basis. This time she just happened to mention that her chest was tight and she didn't have her nitrate spray with her so the PTS crew called for back up. We caused chaos as it was rush hour but we had a job to do so everyone would just have to put up with it. To cut a long story short she point blank refused hospital and wouldn't let us do a 12 lead ECG, she just about let us do her blood pressure! She said it was just like her normal angina and that she panicked as she didn't have her spray with her. All we could do was let her carry on back to the home and for the PTS crew to advise them of what had happened. Anyway she was pain free after the Oxygen. If they refuse then there's nothing we can do.
We cleared from that and were given a RTA back in the other direction, it was a Cat C female cyclist had collided with another cyclist. I called up and asked if the crew could drop me off back at my car (seeing as it was a Cat C and an officer had already booked on scene). That was fine with control and I was finally back at the car. I did a little bit of standby at my base station before returning back to end my shift on time. Now there's a first.

I'm supposed to be working today but my baby daughter has been ill all week with vomiting and now my youngest son, wife and now my oldest daughter are all sick. I've been up all night with them and will now have to run the show at home today. That'll be fun. I just hope I don't catch what ever they've got. I hate having time off sick especially when I'm not even ill!

Tuesday, 24 March 2009

Virginia USA

I will post some more on my trip to Richmond VA, when I get round to it. So much overtime and not enough free time! Hey ho

A busy start

Mondays are the new Friday & Saturday nights, well that's what I think anyway. It seems to me that nowadays Monday is one of the busiest days of the week. People always say to me 'Cor, I bet you're busy at the weekends aren't you?'. In fact everyday is busy in this day and age.

And it was no different yesterday. I was supposed to be on a RRV but crewed up on a vehicle as someone was sick. AGAIN! It was non stop. 8 jobs in total (and an assist) and the other crews were exactly the same.

1. Dr's 999, GI bleed. This guy wasn't very well at all. White as a ghost, tachycardic, hypotensive and had high blood sugar. He was also in a lot of pain. After some fluids and pain relief from us he stayed in resus while he had a blood transfusion.

2. Chest pain. Female with severe chest pain. The usual Aspirin & nitrates, took some bloods and gave her some pain relief which worked well. Unable to thrombolyse though. AGAIN! Story of my life.

3. Head injury. Male who had sustained a head injury before the weekend and wasn't feeling right. He had a bruise on the brain and some slight bleeding.

4. Unconscious. Male who found at the front on the street with vomit by his mouth. We backed up a car but when we got there he was insistent on walking to the photographic shop. We managed to check his pulse, blood sugar and temperature but nothing else as he kept walking off. I suspected he had a seizure. We cleared from that job but the car went off looking for him. Another crew brought him in later.

5. Seizure with hip pain. A young epileptic girl had a seizure in the street and developed hip pain. She had a previous problem with her hip as a child so we took her in to get it checked out.

6. Chest pain. Elderly lady with chest pain on and off for 2 days. Her blood pressure was 71/45! Aspirin, IV & bloods and also some sodium chloride just to keep the vein open. She was blue lighted in and stayed in resus for a while. Not very well at all.

7.Dr's 999 Bowel obstruction. Lady with terminal cancer of the brain, as you can imagine she wasn't very well at all. All we could do was make her as comfortable as possible. This was the same lady I went out to before who was having seizures while still conscious. I was toying with the idea of cannulating her in case I needed to give her diazemuls (She is prone to recurrent seizures which has needed our intervention in the past) but decided not to. The last thing she wanted was for me to be poking her around and anyway she had good veins so if she started fitting I would get one in when I needed to.

8. Back pain. A lady with arthritis had developed central lumbar back pain and couldn't get up. We managed her pain with good old gas and air. We used a scoop/orthopedic stretcher to get her out and took her in to get checked out.

We also stopped to assist an officer who was dealing with a regular patient who was on the side of the road. He had taken an overdose of paracetamol & alcohol and was not really with it. We stayed with the officer until a volunteer crew turned up (we were off the road and heading back to base for our 1st break). The patients face was a picture when he was being loaded into the ambulance, it was right in the centre of town and everyone was staring at him. That will teach him although I doubt it will be the last time we see him!

Saturday, 21 March 2009

Money Grabbing Again!

I know I know, I said I was having 7 days off but on Wednesday night a mate from my station phoned me and asked for a favour. Could I cover his late car shift (on overtime of course!) as he couldn't do it. To be honest I wasn't that keen on doing it but as I had nothing planned for the next day I said yes. After all, the way the current economy is I'd be a fool not to. This constant stream of overtime wont last, I just know it. Grab it while you can I say!
It was a quiet shift, for me it was anyway. All the day crews had been rushed of their feet, by the time I started things were calming down. I did an hours standby at a local DR's surgery where I started to read my book by Stuart Gray http://www.mondaybooks.com/Life_And_Death/lifeanddeath.html, he's another Paramedic with a bloghttp://theparamedicsdiary.blogspot.com/ . I thought I was going to get a call to back up a crew at an RTA but I wasn't needed. Next thing I heard on the radio was the crew calling up for Fire & Rescue as they couldn't free the patient. Well they knew where I was if they needed me.
I got my first job, it was Cat C non-traumatic back pain (Cat C meaning low priority call). I t was to a young guy who for no obvious reason developed severe lumber pain. When I got there he was in absolute agony. I have never seen anyone with this sort of problem in so much pain. Usually it's a bit of gas & air and then off to the hospital. Not this time. I ended up giving him 10mg of Morphine. Eventually after a combo of Morphine and 2 bottles of gas & air he started to fell slightly more comfortable, the exception being when his back went into spasm. Although after the drugs he did say at one point that he felt completely pissed! It turns out that he is best friends with one of the guys at work and also knows several members of my family who do a specific job. I'm not going to say too much about that. I went with the double EMT crew (as I had given Morphine) to hospital. On arrival at hospital it was absolutely heaving, ambulances everywhere with crews queuing to handover their patients. We left him in good spirits albeit still suffering the odd agonising spasm.

My 2ND and final job was a chest pain about 2 miles from base. I received no updates on the way so naturally assumed that I was going to male/female of mature years. Actually it was to an 11 year old. She had recently been diagnosed with chrons disease and was still being fed via a nasal tube. After doing my obs the crew turned up and got her on to the ambulance. She had left sided chest pain and it radiated into her left arm. Her 12 lead ECG showed no acute changes. So after discussing the various pain relief options with her and her mum, the patient declined pain relief. All we could do was transport her to hospital.

I still have 3 days off........................................filled with all sorts of things such as taking the kids to the cinema (movies), swimming, and laying wooden flooring.
Definitely no more shifts until Monday!!!!!!

Tuesday, 17 March 2009

Time off

I've now got 7 days off! I could do some more overtime but I'm not going to, there is enough of it going around afterall. I think I've done more than my fair share and it's not like I haven't got any more shifts lined up!
I've already plumbed in the new washing machine that arrived this morning and cleared the garden of the old furniture that we've been slowly replacing. I'm sure the wife has got more jobs lined up for me. Ha Ha.

So just to conclude my shifts.

Wednesday night:

our first call was passed as a cat A Asthma, 3 year old. When given a potentially serious job, especially a child, I usually look up the possible drug dosages and jot them on my glove. This saves time when initiating treatment. So there we are racing to this child with 'Severe Respiratory Distress', I've written down the hydrocortisone dose on my glove, 57mg. I knew the salbutamol and atrovent neb dosages and was thinking to myself 'If it's bad we'll just load and go and I'll treat on route'. If I have to give hydrocortisone I'll probably give it via intramuscular (IM) injection into the thigh. I could give it IV but in a child with severe breathing problems trying to cannulate will be far more distressing for the child and that's the last thing we need. If the child needs assistance with their breathing then hydrocortisone will be the last thing on my mind as supporting breathing will be the main priority. Even more so if working solo or part of a crew. To provide effective ALS in kids you need more than 2 crew in order to maintain good uninterrupted basic care.
With all this in mind we arrive on scene only to find a response car already on scene. Nobody told us, no change there then. Inside we see a senior officer chatting to the mum and I start to scan the room for this apparently really poorly kid. I do however find a cheeky 3 year old sat on the sofa cuddling a teddy bear, grinning at me. No breathing problems. The child has been ill for 3 weeks, has a temperature and not drinking much water. The GP has already prescribed antibiotics but the mum wants him checked out at hospital as he can't keep any meds or fluids down. So after deciding which toy he wanted to take we got him & his mum on board. On the way he said he was a bit breathless so we gave him some oxygen which made him feel a little better. At hospital we handed over to the nurse and sat them in the paediatric waiting area. Personally I would of just rung the out of hours GP or popped in to my own DR in the morning but there are some people who think hospital will be the best option for every thing. Oh well it makes no difference to me as I get paid the same whatever calls I go to.

The rest of the jobs are just routine falls and drunks.

Thursday night:

We did have what was initially a serious job. An unconscious female who had recently been discharged from hospital earlier that day. Carers couldn't wake her and she was foaming at the mouth. We sorted her out after plying her with oxygen and got her to hospital in a better shape than when we first arrived on scene.

Another child, this time a 7 month old with a fever of 40.2. When going to a child that is potentially seriously ill I want to rule out certain things, hypoxia (lack of oxygen), menningococcal septacaemia (by searching for a rash amongst other things & then rapidly treating with antibiotics), seizures (terminating them with anti convulsants if needed) and hypoglycemia (which can be common in ill kids, not just diabetics either, and treating appropriately with IV glucose etc).
As we pull up I recognise the house. A very nice house in a nice part of town and after seeing the mum I knew why I recognised the place. Just before Christmas I took her husband into hospital with pneumonia and he was really poorly. I remember that he had severe chest pain and was hypotensive (low blood pressure).
The young mum burst into tears when we arrived and told us that she was awaken by her baby's erratic breathing. She been off her food for 2 days and then later that evening started getting irritable and developed a fever. Thankfully there was no sign of a rash and her sugar level was fine too. We had to wait a while for the grandmother to arrive to look after the 2 other sleeping children. Prior to our arrival the mum gave the child 2.5ml of ibuprofen. With a temperature so high the child risked having a febrile seizure so all we could do was watch as we took them both to hospital.
After we handed over, my crew mate made a remark which annoyed me.
'What was her problem? Is she spoilt or what!' I couldn't bite my tongue so I told him what I thought. Not in a nasty way but I just said that this woman was scared shit less about her baby and was probably panicking. I wasn't going to lose my temper as we actually get on really well but as my crew mate doesn't have kids and I have 4 I think I have a right to share the benefit of my past experiences.

More routine calls.

Overtime Sunday:

On the response car yesterday for a couple of jobs and then on a vehicle for the remainder to cover sickness, AGAIN!

Another child, Allergic reaction. It was a mild reaction to penicillin but didn't warrant any treatment by us. Some liquid piriton would have done the trick but we only have IV/IO/IM piriton and she wasn't going to get any of that as her symptoms weren't causing her any discomfort or distress. There was a long history of penicillin reactions in the family so the crew took her in for a check up. It didn't help that she had chicken pox as well and had been put on antibiotics as 2 of her blisters had become infected. You could see a fine rash developing on her skin, completely different from her chicken pox.

More falls, one which took us over 9 minutes just to get into the building thanks to all the key safes and care line buttons etc. Good job it wasn't an emergency!
We also went to a diabetic lady who was discovered by her friends. Her sugar level was low and she refused to eat any thing. After giving her 100ml of IV glucose she was wide awake again. This wasn't the first episode this week and she refused hospital so we referred her to her diabetic nurse in the morning. I also contacted the out of hours GP so the incident would be recorded and left the lady in the care of her neighbour.

I was due to finish at midnight but got caught with a late job, a chest pain. 69 year old male and there I was rubbing my hands thinking I may get to thrombolyse. I wouldn't have minded being late if that was the case but no such luck!!!

Back next Monday when I'm on a response car....................................................on overtime!

Thursday, 12 March 2009

This week so far


Crew mate sick. 9 jobs, 7 on the response car, all before 13.00! 3 chest pains and 3 falls with varying injuries and 1 woman whose carer couldn't wake her up. When I woke the lady she shouted 'I'M NOT GOING TO HOSPITAL!, she was fine and after examining her & doing her obs stayed at home. I then jumped on a truck with a Paramedic who was due on the car. We did 2 more jobs before I went home. He then went on the car til midnight.


Crew mate still sick. Back on the car but a much quieter morning. Only 4 jobs. Then the same as Monday back on a truck for the remainder of the shift with the same Paramedic. We again did 2 jobs but these were proper jobs. The first was to a 12 year old who was playing football at school and someone went to clear the ball and kicked it at full pelt. Problem was that it connected with this young lad's hand and bent his wrist back. When we get there we are confronted with a sobbing boy with a grossly deformed wrist. It looked like his radius & ulnar were about to pop out of the skin. He was in agony so my crew mate plied him with Entonox while put in a 22g IV and gave him 2.5mg of Morphine. It did the trick. After a brief examination by the DR he went straight to the operating theatre to have it straightened and put back in alignment.

Half an hour til the end of my shift and a cardiac arrest call came in. We thought it was to a 19 year old but it turned out to be an elderly lady. A double EMT crew had just arrived moments before us and starting Basic life support. I cannulated the external jugular vein and started drug therapy while my crew mate intubated. But despite our efforts the lady didn't respond to our treatment so we decided to terminate resuscitation as she was asystolic (flat line on the monitor).

That brings my total of 3 cardiac arrests in as many days!
I did, however, find out that the lady from the second cardiac arrest on Sunday is still on ITU and the staff were thinking about bringing her round to see if she could breathe for herself. I'm doubtful but you never know.

Sunday, 8 March 2009

Another 5 shifts!

Well I've had 3 days off and I'm back for another 5 shifts. Today I did an overtime shift on a response car at my local station (not my base station). There were some good people on today and it started off well with one of the guys cooking bacon baguettes. They were delicious. It was a quiet start for me while all the crews were either given calls or tasked to standby somewhere. I got a call later in the morning to go to one of the sub stations in the north of our area, I didn't mind. I had a good book and my sunglasses and the sun was shining, what more could I ask for on a Sunday morning. I had to get some fuel for the car and before I left the service station I was asked to go the hospital for standby. I remember thinking that this was going to be a cushy shift and being paid at time and a half aswell. I was only there a short while before being given a cat A chest pain in the next town. A young lady with a recent NSTEMI (as some would say-a minor heart attack) and a recent stent experienced chest pains. I and another officer got there first soon followed by a crew who took her into hospital. I cleared up and was sent back to base.
Back on base a call came in for one of the crews, I volunteered as one of the crew was talking to a police officer. It came in as a fall, no big deal. I'll be done and dusted in no time I thought. I find out that it's a 6 year old who has fallen from some playground apparatus. She's in agony, pale and has a deformed right arm. It looks blue and mottled from the elbow and her hand is cold compared to the other one. While I'm there she nearly drains a CD size Entonox bottle and I manage to get a small 22g IV into her left hand and give her 2mg of some much needed Morphine. She was in that much pain that she offered me her hand for me to pop the cannula in. A crew eventually turned up to take her in to hospital but before we moved her we splinted her arm with a vacuum splint. This is a slpint that has all the air sucked out and becomes rigid, this will keep her hand nice and still. At the time I suspected that she fractured her humerous and possibly dislocated her elbow. I later learned that she had in fact dislocated her shoulder and elbow and also completely snapped the end off of her humerous. The DRs also think she may have fractured her wrist. En route the paramedic gave her another 2mg of Morphine which made her high as a kite......................again! The combination of Entonox and Morphine really did the job. The last time I asked about her she was in having emergency surgery.
It's not often we have to stick an IV in a child but sometimes it's needed. All I did was treat her as if she was my own. I couldn't believe how brave she was compared to some adults that we go to. You know the ones when you take a sugar sample from their finger and there they are wailing about on the floor, GET UP!!! Well that's what I feel like saying to them sometimes.
I'll pop in to the children's ward and check on her tomorrow.

No sooner have I cleared up from that job I get a call to back up a double EMT crew at a cardiac arrest. Elderly lady, witnessed collapse. To cut a long story short there are 2 community first responders and an EMT crew on scene doing basic life support. I get there and intubate and put an IV in so I can give some resus drugs. We work her for 20 minjutes and after that I halt resus. There is no sign of improvement and the monitor is showing a flat line.

I had to get back to base to swap cars as I couldn't get into the boot, the lock was jammed. On base I restocked my kit and checked another response car.
A short while later another cat A call came in, it was another cardiac arrest. I got there to find one of our staff responders already doin CPR. She was showing Asystole (flat line) on the monitor. Her airway was a problem as it was filling with vomit. I managed to get a tube in and secure her airway. Next I got an IV into her left arm. A crew from a station 35 miles away backed us up and helped with the resus drugs and fluids. After a short while we got a pulse back. I hooked her up to the ventilator on board the ambulance and travelled in with the patient. She held her own all the way into A/E and at around 22.40 this p.m I was told that she was in ITU. Unfortunately she may die but never say never in this game. We did our best.
I get a lift back to my locked and abandoned response car with a local crew.

I then get another job but soon come to the conclusion that it's a GP 999 so query why I'm backing up a more than competent Paramedic crew. I then get stood down only to be given yet another cat A. This time an asian shopkeeper has fallen from his shop counter and landed on his head. His daughter stated that he collapsed in to her arms. A crew turn up so I assist them with a collar and full immobilisation. The patient smells like he has been drinking and is confused and lethargic. The crew take him in and I clear up.
6 six calls in all, not a bad day at all. Most importantly they were all genuine incidents.

Back tomorrow to do it all over again.

Thursday, 5 March 2009

Finally I have 3 days off. I feel knackered after 5 days on the trot.

Chest pain from a DRs surgery. There was one of our Paramedics already in the surgery, he was on a placement for his Paramedic Practitioner training and he handed me a 12 lead ECG. It showed flipped T-waves which is an indicator of ischaemia. On board we connected him up to our monitor and started treating him. He had chest pain for 24 hours which wouldn't go away and had difficulty breathing when lying flat through the night. I suspected that he had a heart attack the previous day. He had probably had a sub-endocardial infarct which basically means that it hasn't affected the full thickness of the heart muscle. Never the less it is still serious and needs prompt treatment. When transferring him from the carry chair to the trolley he became very breathless but as soon as the oxygen was on it eased off. He still had pain which wasn't relieved by nitrates so I put a line in to give him some morphine but he declined this.
At hospital he was told off by one of the CCU nurses for not having pain relief even more so because his heart rhythm was now in fast AF and the ST segments were now starting to elevate. The team then started to fuss about him with some urgency. By giving pain relief to cardiac chest pain patients not only does it take the pain away it also takes the strain off the heart and reduces the risk of nasty heart rhythms which can be fatal.
Our next call was to a COPD patient who was staying at his holiday home with his wife. He also had a double colostomy and abdominal fistula. The call was a possible bladder infection. He had an infection alright, probably septic. He was more breathless than usual, had a temperature of 39.9 and was also tachycardic & hypotensive. He had a total of 1000mls of IV fluids en-route and a 500ml bag connected as we arrived at hospital to keep the vein open. His blood pressure was still only 83/40 when we got there. I saw his wife the next and found out that he had a serious chest infection amongst other things and would be in for a few days.

The rest of Monday and the following day were pretty unremarkable with the usual routine jobs.


I was on overtime again. I know what your are thinking, MONEY GRABBER! Too bloody right, take it while you can. It won't last forever.

I was on the new response car and was soon on my first job. It came through as a penetrating injury. A 12 year old managed to get a knitting needle stuck in her thigh. When I arrived I was shown up to the bedroom where the young girl was being comforted by her dad. There was a wooden knitting needle sticking out of her thigh. Compared to the other one I could tell that it had gone in approximately 4 inches and it taken some of her pyjamas in with it . I cut up the leg to get a better look. Being in a lot of pain I started her off on some Entonox which really hit the spot. She was out of it at times. I did say that I may need to put a drip in her hand and give her something stronger if when we come to move her it starts to really hurt. She didn't need it, the Entonox was more than effective. I was backed up by a critical care ambulance who then took over care and transported her to A/E.

A collapsed female who kept passing out while sitting/standing. She was taken in by a crew.

My third and final job was to a lady in her 40's who had a stroke a year ago and had only just started to recover. She phoned her friend in a distressed state who then called 999. Her friend recognised that she may be having another stroke and went straight round there. I used the FAST and Miami emergency neurological deficit exam and quickly concluded that she was indeed suffering a stroke. I checked her other observations and got on the radio to see where my back up was. The crew arrived about 60 seconds later and our patient was quickly on board and en-route to A/E. The stroke team were ready and waiting and according to the crew the DRs think that she may have suffered a sub-arachnoid haemorrhage. I was thinking of a clot at the time and thought that she may have been a candidate for stroke thrombolysis, sadly it wasn't to be.
I'm not sure what happened to her maybe she got transfered out to the neuro centre for an operation.

Monday, 2 March 2009


1. 101 year old chest pain. Yes you saw it right, 101 year old! This chap was a surprisingly young looking 101, still self sufficient and lived alone. Complaining of chest pain through the night, worse than his usual angina pain, he didn't want to bother any one. He called his daughter who popped round to see him and had obviously took one look at him and decided to dial 999. He had a non-stemi late last year and apart from that he hadn't been too bad. We soon sorted him out and after some aspirin, GTN, O2 and morphine he was looking a far better colour on arrival at hospital. He even managed a cheeky smile, something he didn't feel like doing when we first arrived on scene. Just imagine what he has seen in his life, all the changes, war and hardship. Bless him. I hope he has many more years ahead

2. Paediatric burns. 18 month old who had tipped hot coffee over himself. Mum was cooling his burns as we arrived. All we could do was apply water gel dressings and give ibuprofen & paracetamol oral suspension for the pain. This job pissed me off because what I really wanted to give him was oramorph (oral morphine) which is a drug we are supposed to have. We are still waiting to get it. He was too young to understand Entonox and there was no clinical justification to give IV/IO morphine due to the size of burns. The A/E staff completely agreed with my annoyance. Don't worry I'm on a mission to get this sorted and wont stop until until we get the extra drug.

3. RTA, 2 cars and 5 patients. Every man and his dog was there including the neighbouring air ambulance. See above photo. The rear of the car shown was pushed right under the back seat. The other car had relatively minor frontal damage, it was a brand new Audi. A case of new versus old.
4. We cleared from that incident and within 60 seconds were given a breathing difficulty in the next county. It was lucky we were so close because the other county would of taken ages to get there. It was a lady with COPD/asthma who was really struggling. She had a high temperature aswell so she needed to go in. We treated her with salbutamol and atrovent nebulisers which helped considerably, bringing her O2 saturations up from 85% to an exceptable 92%. We try and maintain COPD patients at around 90-93% so as not to mess there blood gases up. They rely on low levels of oxygen in the blood to stimulate their breathing where as us healthy types rely on low levels of carbon dioxide. This basically means that if we increase their oxygen levels we might remove the stimulus to breathe and cause them to go into respiratory arrest. This is rare and only happens in a few cases where the disease is advanced.
The hospital was over 20 miles away but by the time we got there her breathing was now fine. She still needed her underlying infection treated otherwise if we treated her at home with nebulisers and left her there another crew would be out later. In these patients with COPD or asthma who have an underlying infection a nebuliser is only a tempoary fix and sometimes can fool the patient and even the crew that they are cured.
5. Non-injury fall, left at home.
6. Paediatric head injury. A baby had fallen off a chest of drawers face first while having his nappy/dyper changed. Cryed straight away and alert. Small bruise appearing on the forehead. Mum and dad concerned so we popped them in to hospital just for their piece of mind.
Again 6 jobs, only one of any real note.
Elderly male with a history of Myasthenia Gravis who collapsed at the dinner table. He started having mini seizures and was a bit agitated. I popped in an IV because I thought I was going to have to give some Diazemuls to stop the siezures but after some O2 he recovered on the way in to hospital. His wife and daughter were in tears before we left because they thought he was going to die. They were relieved when they saw him smiling at hospital.