Sunday

After a similar start to Saturday we eventually got our first call. It was passed as a Cat A Stroke, usually they are Cat B so I thought that this must be a bad one.
Our patient was a few weeks post op (total hip replacement) and was in her bed in the front room. Her husband had woken her and discovered she slurred speech with right sided weakness. We quickly assessed her using the FAST exam (Face, Arm, Speech, Time) and confirmed the right side had been affected. Her blood sugar was fine and as her O2 saturations were slightly low I placed her on 2 litres of O2. We reassured her as best as we could and she even managed the odd smile in between the tears. She had expressive dysphasia which meant she couldn't put words together properly but could understand what we were saying. Many stroke patients suffer this and causes them to become frustrated. As a result her husband jotted down the personal details (so I didn't have to ask her and increase her frustration) and said he would follow on.
After pre alerting the hospital I assessed her in more depth using some of the stuff I had learnt on the Advanced Stroke Life Support course. This was the first genuine patient that I could do this to since doing the course. One thing I was stumped by was that her blood pressure was low, usually it is high. She was on meds for arrhythmia but her ECG looked nice and regular so it wasn't that. Oh well, the DRs can look into all that while I do my bit and get her there.
Unfortunately the Stroke team weren't available as it was a weekend so I just hope she is alright or it was just a TIA (transient Ischaemic Attack-temporary blockage). But for a TIA to be diagnosed 24hrs need to pass with the patient being symptom free. I'm in tomorrow so I'll enquire and let you know.

Next call was to 4 month old baby with chickenpox who had vomited. I think the parents panicked and called us. They had taken the baby to hospital twice the previous day and were told the same thing. We reassured the parents and referred them to the OOH GP. They were happy with that.

While we were sorting out the paper work we could hear it all kicking off over the radio. There were Allergic reactions, unconscious diabetics etc and we could hear the sirens of other trucks around us.

We cleared and were given a Cardiac Arrest but it was soon passed as cold and stiff in a warm environment. This meant the patient was obviously deceased. On scene we met the neighbours who had found the unfortunate individual in her own home. They hadn't seen her for 24 hours and decided to see if she was OK. She wasn't. After confirming death and recording a 30 second ECG trace we waited for the Police. They were there within 10 minutes which had to have been a record as they usually take 30 minutes plus. This is not their fault because it's not deemed a priority once death has been confirmed (as long as it's not suspicious). Again we found ourselves clear and ready for the next one.

No sooner had the clear button been pressed another job came through. This was getting silly now, I was getting hungry and desperately needed the toilet. No time, it was another Cardiac Arrest!
It was only round the corner and we were there within 1 minute. A local off duty Paramedic (who also responds as a community first responder) arrived as we did. A lady met us and said that she thought he (her husband) had gone. She showed us into the conservatory where our patient was sat in a chair. He looked asleep but we knew he wasn't. He was a big chap and it took 4 of us to place him on the floor. There wasn't much room to work but we quickly set to work. I placed the defib pads on his chest whilst my crew mate started CPR. The other Paramedic got the BVM out whilst I tried to get a line. He had no veins in one arm and on the other there was a bruise from a recent IV or blood test. I got it in but it wouldn't advance so the other Paramedic managed to get one in the external jugular vein. The rhythm on the defib was PEA (pulseless electrical activity- meaning that there was electrical activity but the mechanics, i.e the pump, wasn't working) so it was CPR for now. Another crew turned up to give us a hand and started sorting the trolley and the drugs. I went to the head and prepared my airway kit. I inserted my laryngoscope and lifted up the tongue but couldn't quite see the vocal cords so asked one of the other EMTs to apply some gentle pressure on the larynx, it worked and quickly placed the breathing tube into the patients windpipe. I connected the catheter mount and BVM then listened to the stomach; No sounds, good. I then ventilated again and heard air entry on both sides of the chest, I was in! Next was some Adrenaline and soon after we had VF on the screen. We were now able to shock. After 15 minutes, 6 shocks, more Adrenaline and some Amiodarone we were now back into PEA so we needed to make a decision about moving. The trolley was set up at the front door so we placed our patient on to the scoop stretcher and carried him out. On board the ambulance I disconnected the BVM and attached the catheter mount to the transport ventilator. I was now hands free to do drugs and fluids en route whilst my crew mate continued CPR. A quick checked of the rhythm showed a slower PEA rate which was turning into an agonal rhythm so I decided to give 3mg of Atropine and a further Adrenaline. No change.
At hospital we were met by the usual resus team who quickly took over but eventually gave up. I wasn't surprised as this is usually the case, if we don't get them back there and then the chances of getting them back at hospital are slim. Sad but true. The A/E consultant said we tried our best and also said well done on a good tube and line. That was nice but in the grand scheme of things not important.
We had the usual tea and a chat and made our way back to base to restock and have something to eat. The ambulance was surprisingly tidy and needed little cleaning. Makes a change!

The last job of the day was passed as a Cat C fall, 17 miles away! it was to an 8 year old female who had a ? fractured arm. Mum met us outside and told us what had happened while we walked through the garden. Her daughter had been climbing a small tree and fell landing on a hammock and then onto her out stretched hand when she hit the ground. Her mum had seen it all and said she immediately knew it was serious by the type of cry her daughter had let out. Our patient was in the front room sat on the sofa sporting a trendy makeshift sling. It was similar to the bandanna worn by Marco Pierre White of Hell's Kitchen. She was very distressed and crying with the pain. After excluding more serious injuries I turned my attention to her arm. Her forearm was deformed and basically looked like a big banana so we started her on Entonox. I checked her pulse and capillary refill on her injured arm which were fine. Because the Entonox wasn't really having the desired effect and the extended travelling time to hospital I opted for some Morphine. I had a look on her hand and found one straight vein. I took my time and it paid off. Straight in and she didn't even flinch, phew! Now with her pain under control we popped a sling on and got her out to the truck and mum came with us. Dad and her sister would be following later. On the way I reassessed her and had to give her some more Morphine. I called ahead to the hospital because I knew it was busy and I didn't want this child to have to wait any longer than she had to. A good job too because as we arrived the trauma team were waiting at the doors for a critical patient from an entrapment RTA coming in by HEMS. It gave mum a fright because she thought they were all for her daughter, we soon put her at ease. We weren't in resus long before being transferred down to the paediatric A/E section. As I booked her in at reception the DR came over and said well done on the line and giving her Morphine. Personally I would have preferred to have given Oramorph but because we haven't got it yet I couldn't. However I have been reliably informed that Oramorph is imminent which will be an important addition to our drugs bags although 3 years late! Better late than never!

Business as usual again

I was on a night shift the day after getting back from Devon and it was uneventful. My trainee crew mate drove all night as none of our patients went to hospital. Even the one and only genuinely ill patient refused! She was short of breath with oxygen saturation's of 87% on room air and her lungs sounded like they were filling with fluid. Her oxygen levels increased with a nebuliser but that was only easing her symptoms and not treating the cause. She said she felt better even though her levels had dropped again but still refused multiple times. She thought she could leave it until the morning but I wasn't happy with this so I referred her to the OOH GP. I also made sure that I noted my concerns on our paperwork and left her a copy. Her daughter was due to visit so hopefully she would have read them. Outcome unknown.

I was on the early day shift over the weekend with a newly qualified EMT and the majority of work was genuine.

Saturday:
Got off to a slow start and after a couple of stints of roadside standby things picked up. We did 6 jobs in total. Here are 2 of them.

We were passed a 'Headache' call 9 miles away. 'Here we go again!' I thought. But when we saw our patient she looked dreadful. She was clutching her head and was very pale and clammy. The light was hurting her eyes and she was vomiting. Her husband said that she never had headaches and wasn't one to complain. I honestly thought we were dealing with some sort of cerebral bleed. The lady said that it was more than a headache and it was really debilitating her. On board we took some obs and because she was in a lot of pain I was going to give her some pain relief. It was going to be a long journey to hospital so I started off by giving her an IV anti emetic. I with held pain relief because after some oxygen the pain was easing slightly. Was this just a migraine or cluster headache or was something more sinister? I don't know but if I treat her for the worst case I should have every thing covered. I called ahead to the hospital to let them know we were coming. By the time we arrived she was so much better. No vomiting and the pain had eased right off, her colour had started to return. She apologised for wasting our time but I told not to be so daft. The main thing was that she was going to be alright. I'd rather treat something like that seriously and it turn out to be nothing than get it wrong.

Another call was to a male with chest pain. He wasn't too clever. He had previously been into hospital with lung problems and was now suffering left sided chest pain. His temperature was 40.9 and he was breathless. His pain was severe enough to impair his breathing so I gave him some Morphine for the journey. I pre alerted the hospital and continued to observe him.
We were met in Resus by a DR and Nurse where I handed him and his blood samples over. Within a few minutes the DR ordered IV Paracetamol and thanked us.

Sunday:
Stroke, sudden death, cardiac arrest, baby with chicken pox and vomiting and a paediatric who fell from a tree and fractured her arm.
I'll post about Sunday soon as I'm now feeling very tired. ALTOGETHER NOW...............AHHHHH!

I'm on base with not much to do, it's been a quiet start. My crewmate has just shown me this picture which made me chuckle. If only all our elderly residents were as fit as this!

I'm Back!

I'm back from Devon and I must say I do miss the place. There's something special about the West Country and that's the reason why we go there as much as possible. It's nice being home but you can't beat getting away from it all and forgetting about the hum drum of everyday life. From the moment we got there it was non stop, swimming, bowling, walking, eating (a favourite pastime of mine!), Zoo, woodland leisure park, more swimming and more food etc etc. It was great!

I'm back to work this weekend on days with a newly qualified EMT. We'll just have to wait and see what happens.

I'm off to Devon for 4 days with the family so I'll resume posting when I get back. I have been working over the last week but haven't had any time to post. Oh well, see ya and stay safe.

Cricothyroidotomy

Sorry another 'What do you use?' post.

In this one I'd like to know what you use for cricothyroidotomy. In the UK Paramedics are taught the traditional and less than ideal 'Get out of jail for 5 minutes' Needle cric using a large bore IV cannula and jet insluffation. Where I work we have the Quicktrach SAD (surgical airway device), pictured above, which I have used in anger and have also assisted in it's use. It's a good bit of kit. I've also found this link to it's new and improved model http://www.vbm-medical.com/cms/97-1-cricothyrotomy.html.

I'm not sure what devices are used by other UK services or in fact across the world. Although I do know that some US/Canadian EMS providers perform open cric with a scalpel.

Capnography: What do you use?

I'm just wondering what sort of kit is used to measure ETCO2 around the world. At the moment we have the disposable detector shown at the top. We're supposed to be getting the EMMA (digital capnography, displayed underneath) soon. Our Critical Care Paramedics already have them and our local BASICS Drs have them. It looks like a cool gadget.

I know London Ambulance Service has capnography and use their Lifepack 12. Not sure about anyone else.

More can be read on this item here http://www.phasein.se/Products/EMMA-Capnometer/. Also click this link to read up on capnography via Peter Canning's blog http://emscapnography.blogspot.com/.

Another life saved cont'd

After the heroin OD I was sent to a Cat A 16 miles away. It was passed as unconscious and then downgraded to a Cat B Not Alert. I arrived at the care home and was shown through to my patient. He was flat on his back and drifting in and out of consciousness. Airway was good and his breathing was adequate so I went on to the other usual checks such as pulse (which was irregular), blood sugar, blood pressure, pulse oximetry (this was a little lower than we liked) and pupils etc. The staff heard an almighty thud and found this chap completely out of it lying flat on his back. Although he was struggling to stay awake I was able to assertain that he had central neck pain. He was in reasonable health and surprisingly not on a great deal of medication. A crew arrived sometime later and I was pleased to see the Paramedic. He was on my Uni course and also on my in-house Paramedic course, a really decent bloke.
I relayed my findings to the crew and we quickly set about immobilising our patient and giving him oxygen. As usual it was a struggle getting him out as there were so many right angles and door ways we had to stand and tip the long board. I helped load the trolley and stayed with crew as they connected him up to all the monitoring equipment. Within 15 minutes of their arrival the crew were off to hospital.

Last night I had a text from the Paramedic on that job, he said that the patient deteriorated en-route so he popped a line in him, he also confirmed that the patient had bad fractures to both C2 and C3 (two of the bones in the neck). Hopefully it's just fractures and no spinal cord damage. There were no signs of SCI (spinal cord injury) on scene so I am hopeful.


Apart from the OD and Neck fracture on Tuesday I also attended:

A collapse: Young male at work recently diagnosed with tonsilitis who collapsed. He had a high temperature and hadn't been eating or drinking properly for the last few days. He went to hospital and was later transferred to a specialist ENT unit. Probably a condition called Quinsey.
Fall: Elderly male who had a live in carer. He bumped his head and was initially going to hospital as he was on the blood thinning drug Warfarin. It turned out his carer got confused between Furosemide and Warfarin and he wasn't taking the latter. He changed his mind and refused to go to hospital so when my back up arrived they just turned around and left. He should of gone really but if they refuse there isn't a lot you can other than refer them to the GP.
RTC: Minor rear end shunt, Police on scene. A male just wanted his neck checked out. He was walking about and complained that the right side of his neck and shoulder was uncomfortable. He declined immobilisation and was happy for me to take him to the hospital in the car. I'm no DR and not at all cynical but I was thinking along the lines of Acute Compensitis.
Fall: A regular faller who had slipped whilst transfering from his wheel chair to another chair. It was passed as an assistance call but on examination I found that he had a temperature of 38.5 (the norm being 36.9-37 depending on which book you read! Like everything else in medicine.) and his heart rate was up. As he had a catheter in situ I figured it was a UTI (Urinary tract infection), he declined hospital as he would prefer to be treated at home. He wasn't that bad so I called the OOH GP service to arrange a visit. A catheter change and some Trimethoprim would probably sort that out.

Finished on time again.

Another life saved

After attending a so called unconscious patient and then a minor injury fall I was sent to another station for a bit of stand by. I wasn't there long before being sent back to base and on the way I decided to stop at the local petrol station to get some munchies. As I got back into the response car I could hear the MDT bleeping and control calling me on the vehicle radio. I had a job. It was an unconscious person in some public toilets. Another message came through to say that the patient was blue and grunting. I knew exactly where it was and made my way over there. An EMT crew were backing me up but managed to go to the wrong location, they were given slightly different directions. As I pulled up on scene I was met by a guy with his 2 daughters. He wasn't best pleased as his kids had wanted to use the toilet but were confronted by a scary looking man, acting strangely and then collapsing to the floor. I did the usual mathematical equation; Unconscious man + In the public toilets + Blue + Not breathing = Heroin overdose! I grabbed my response bag & drugs, approached the door and gently pushed it open. As I peered round the wall I could see the man on the floor, sure he was blue and not breathing. I could hear the sirens of my back up on the other side of the park and within 30 seconds they were pulling up next to my car. I waited for them to turn up before going in and treating this chap because I didn't know if one of his drug crazed mates was hiding in a cubicle waiting to stab me with a dirty needle. Remember people, SAFETY FIRST! There was now three of us in the toilets, no sign of any one else so we set about treating him. After inserting an oral airway one of the crew started ventilating him with a bag & mask (BVM) and high flow oxygen, the other EMT started checking pulse, blood sugar & pupils etc and I sorted drugs. He was a classic text book heroin overdose, blue, not breathing and had pin point pupils. Now, a job like this requires team work and it went very smoothly, everyone getting on with their own thing all the time looking out for each other. You see, where I work it is notorious for heroin addicts/overdoses and there are a lot of us who have encountered situations where things have changed rapidly and found ourselves having to 'Get the F*** Outta Dodge!' pronto. I gave him 2 Narcan injections and while all the time still ventilating him waited for the drug to take effect. 'He's in respiratory arrest, why didn't I go IV?' I hear all you pro's ask. Well he was in a confined space, poor veins and he was a stocky chap who may just 'kick off' if we wake him up too quick. I also have to tell you that this chap was the same guy from a previous post http://streetmedic-coocoocachoo.blogspot.com/2008/09/old-faces.html. Also he overdosed last week and eventually the Paramedic had to use the EZ-IO (his veins kept collapsing after numerous IV attempts) and gave him Narcan through that, 2.4mg in total as he just wouldn't respond to IM Narcan. He wasn't best pleased to have a needle sticking out of his shin bone and it took 4 police officers to hold him down on the way to hospital. Back to the job in hand. We now had to think about moving him as the Narcan wasn't really doing much. One EMT set up the trolley out side and I set up my intubation kit so that I could secure his airway while getting him out. When on the truck I would try diluted IV Narcan if I could get a line and then remove the breathing tube. But as I sorted out my kit he started to breath for himself albeit slowly. We cleared our kit and gave him some room. Eventually he started to wake up and within a few minutes he was upon his feet with our help. A police community support officer turned up to see if we were OK and keep some of the by standers away. Unexpectedly our patient was OK, no kicking off and even agreed to get in the back of the ambulance. The first thing he said was 'I ain't going to hospital', like most of the other heroin OD patients. We weren't going to argue with him. After doing his obs he agreed to having another 2 doses of Narcan to help prevent him relapsing into respiratory arrest again. That's the problem with heroin, it has a far longer half life than Narcan and it has been known for ambulance staff to treat a patient only to find they've walked off and either collapsed or even died somewhere. As everything was fine I left the crew to deal and sort the paperwork while I packed away my kit. Back to base for me for a nice cup of tea. I didn't make it, I got a Cat A fall 16 miles away, the tea would have to wait!

You can read more about some of my dealings with heroin ODs here http://streetmedic-coocoocachoo.blogspot.com/2008/08/od.html

And the rest of last night

6 attended, 1 stand down and still no sleep!

1. Abdo pain. When the details of this job came through I had to do a double take as I thought I had already been to this patient last week http://streetmedic-coocoocachoo.blogspot.com/2009/04/nights-again.html. It was a different address but it was a female the same age who recently had her gall bladder removed.
This lady was doubled up but as soon as we got her on the gas & air she settled. After a set of obs and the pain now under control we started to head off. But a few minutes later she was now in unbearable agony and the gas & air was having little effect, she was in tears. I couldn't sit there and see her suffering like this especially with her husband sat next to her. I put in a 20g cannula and administered an anti sickness drug and then some Morphine. As expected it really hit the spot and made her journey more comfortable. I found out she was a nurse and that she worked at the local hospital, she knew exactly what I was doing and told me so.

Psych/suicide stand down

2. Chapped lip, see last post!
3. Leg pain. A sweet elderly lady, also a regular patient called us because her leg hurt. She has arthritis and the pain came on whilst at rest. After checking her over and reassuring her we give her some of her co-dydramol. She doesn't want to go to hospital anyway so we speak to her family on the phone and offer advice.
4. Breathing difficulties. Passed as a Cat A, it was a teenage girl suffering the mother of all panic attack. She was really going for it and at one point I thought we were going to have to take her in. But just as things looked like they weren't going to get any better we managed to settle her breathing and coach her respirations. We made her hyperventilate again to demonstrate that she was in control of her breathing. After nearly an hour on scene we left her having a smoke in the garden.
5. Psych/suicide attempt. Elderly male who was threatening to pull his catheter out and jump down the stairs . He had a live in carer who had just about had enough and called us as she had reached the end of her limit. we managed to check him over and get him settled into bed. Carer to call GP in the morning.
6. Fall. Irish lady who slipped in the bathroom and banged the back of her head on a tiled wall. Severe head pain and living alone, she was always going to go in. I think my crew mate was especially impressed at my door entry skills. We didn't have a key and there was no answer at any of the other doors so I used one of my ID cards and managed to open the Yale lock.

While at hospital our 2 other crews and the critical care crew were on the way in with a Paediatric cardiac arrest. Although we weren't directly involved in the job we still couldn't escape the sight of the child being vigorously worked on by the crews before handing over to the A/E team. The crews did everything possible, Full ALS inc IO line & drugs etc but unfortunately like most Paediatric arrests it wasn't successful.
We left the hospital hearing the harrowing screams of distraught parents who had just lost their baby.

Real Trauma: NOT FOR THE FAINT HEARTED!

Sat on base, relaxing in our comfy chairs and watching some TV show on special effects. We're like coiled springs, ready to jump into action. Ready to face anything that's thrown to us. Cardiac arrest, anaphylaxis, heroin overdose, catastrophic hemorrhage or RTA entrapment we are ready! Within seconds the station alerters go off and we are soon in our vehicle. It's to a Psych/attempted suicide call just round the corner from base but no sooner are we out of the garage we get a call on the radio 'Stand down, stand down, we have a higher priority coming through to you.' The job comes through and it's a Cat A hemorrhage/lacerations call but it's 5 miles away. 'Better get a wiggle on' I say to my trainee crew mate.

Winding our way through the bends and through a couple of villages we make it to scene. The call is to a pub, to a male bleeding heavily.

We park up and take our kit in with us. As we enter the pub we are greeted by a member of staff with 'Thank god your here!', another says 'Are we glad to see you, you're like gods.' The pub is busy and I can't help thinking that this would somewhere nice to take the wife and kids for Sunday lunch. There are oak beams, nice pictures and a really nice atmosphere as we walk through. There's no time for that, better get on with the job in hand.

'Right, where's our patient' I say looking round.

'Over there by the table' comes the reply.

'Where?' I'm having difficulty spotting anyone who may need our skills.

'Right there!' says a waitress pointing behind us.

'What him!' I'm thinking to my self (and I know my crew mate is thinking the same just by the look he is throwing me).

We turn and move towards the overweight chap sat tucking into Gammon, Egg, Chips & a side of onion rings.

'Thank god you're here lads' he says.

'What's the problem?' says my crew mate.

'Well, it all started about 2 years ago.'

'Let me just stop you there, what's happened tonight?

'Right, it's my lip, it wont stop bleeding! I can't go on like this, look at it, look it! I've been bleeding all afternoon, it's been gushing.'

At this point we have now both completely lost the will to live but being the professionals that we are we remain focused.

'Where are you bleeding exactly?' I say desperately trying to find anything vaguely resembling a laceration.

'Right here.' says our patient pointing to the middle of his lower lip.

We are now both leaning over the table pulling the 'Bulldog chewing a wasp' face trying to find this wound.

We need a torch as we are still struggling to see anything. Now with a bit of light we can see the cause of the problem...........................a split lip! Basically this guy has a problem with his lips getting dry and then they crack and on this occasion started to bleed. He sips his red wine as he talks and starts saying that he wouldn't of called us unless it was an absolute emergency. After spending what seemed like an eternity doing his obs and reassuring him that he wont bleed to death, we give advice and get him to sign our paper work. We brief the staff who at this point are now getting fed up with him being there as he was worrying the customers. Luckily he has a room booked in a hotel next door so persuade him to go to his room and rest. We walk out shaking our heads in disbelief, although we do joke with bar staff about getting 2 pints of Fosters to take away.

We couldn't believe we had been called to a chapped lip. I think alcohol may have played a part in it and the fact a little bit of blood can often look alot.

We drove off into the sunset knowing we had done our bit. I say sunset, it was actually pitch black.

I'm sorry for misleading you with the title of the post (I bet you thought it was something juicy) but I think it is important to highlight that although we have 8 minutes to Cat A calls, not all are Life threatening. In fact a lot don't need an ambulance at all. It's not the call takers fault, they can only go on the information given to them at the time and then input into the AMPDS system.

All done

This weeks shifts are now over with but I lied (unintentionally) that I had 4 days off. I had completely forgotten that I'm doing an overtime night shift on Sunday, Doh!

In the end we only did 4 jobs last night and managed to get some shut eye which is a rare occurrence.



1. Cat A Unconscious. A lady was found on the promenade by some people out walking, she collapsed in front of them and they dialled those 3 magic numbers. We arrived to find a group of people congregating around her. My crew mate took one look at her, looked at me, rolled his eyes and said 'Come on Gill (not her real name) get up. We know you can hear us!' She didn't respond. I touched her eye lash and it started to flicker. She wasn't unconscious at all. After thanking the bystanders they all started to disperse, we could then get on with the task of finding what was wrong this time. Our lady was a regular patient but she was a bit far from home, 7 miles to be precise. I got the trolley out and moved it over to her but as soon as we mentioned moving her and the 'police' she miraculously recovered, got up and walked towards the sea. She told us she wanted to go into the sea and die but because she had informed us of that we couldn't allow that to happen. We called the police and then spent the best part of an hour preventing her from going in the sea. The usual crowd of spectators had gathered and some annoying kids kept getting closer and closer asking all manner of questions. Eventually our friends in blue arrived and we got her up to the patrol car. They arrested her for being drunk & incapable and took her to the local custody suite.

A quality start to the shift, not!

2. Fall. Male fallen in the road. ? dislocated knee. A male in his fifties had been out walking his dogs when one ran off pulling him off balance causing him to fall. It was now dusk and after meandering down what seemed to be a dirt track we found our casualty. He was on the floor and his wife was comforting him. One look at his knee told us all we needed we to know. His knee cap (patella) was sticking out to the side of his knee and he was in immense pain. Out with the Entonox and he was soon away with fairies. Sometimes we can manage to relocate a knee cap just using Entonox, relaxation and gentle pressure with both thumbs, using both forefingers as guides. Not this time, it was stuck fast so we weren't going to mess about. After checking for a pulse in his foot and immobilising his leg we got him onto the trolley using our scoop stretcher. Asked whether the gas and air was working he replied 'I feel pissed as fart, I love it!' No need for anything stronger so off we went to hospital. I felt sorry for him as he was such a nice chap and being self employed he wouldn't be able to work for quite a while. His knee didn't look like all the other knee cap dislocations that we've seen before. It was more deformed and a passing DR took one look at it and said 'We'll need an X-ray of that to rule a tibial plateau fracture.' Oops, that could mean months off as may mean surgery. Poor guy.



In between jobs I had to provide a statement to the police with reference to fatal RTA that I attended where I had to pronounce the driver dead.



3. Fall. A chap with Parkinson's had fallen out of bed and wasn't injured. We helped him back in but discovered he had a high temperature, 38.5. He was also prone to urinary tract infections (UTI) but refused hospital or for us to even get the out of hours (OOH) GP to contact him. He did agree for me to contact the OOH GP to get them to pass on his details to his surgery in the morning.



4. Overdose. Not an overdose at all but a young girl who had been out drinking with friends and couldn't find the entrance to the holiday park she was staying at. A totally inappropriate use of an ambulance. Come to think of it, why were we even dispatched? She was cold and intoxicated so I wrapped a blanket round here and gave her a lift to the main gate. It was far simpler and quicker to do that than try and find security to come and open up the beach gate. The whole call lasted less than 5 minutes and I soon was back on base to continue my power nap.

An easy night shift and finished on time again. Nice.

Nights again

I'm now, thankfully, on my last of 2 night shifts. Last night was steady with us racking up 7 calls.



1. Chest pain. Female in her 30's. It initially came through as a Cat A chest pain but was downgraded to a Cat B. She recently had her gall bladder removed and was now experiencing excruciating epigastric (upper abdominal) pain. This pain was exactly the same type of pain she had before her gall bladder removal. Her surgeon had told her that she may get this if there were some gall stones left in the system. There obviously was. She had taken the usual pain killers but they hadn't touched it and was on all fours on the bed as this was the most comfortable position. The Entonox wasn't doing anything for her so I had no choice but to cannulate her. Her veins were tiny and I failed the first time. To be fair I managed to get it in but it wouldn't advance as there was a valve and a kink in the vein. Another go on the left hand was more successful (should have tried that one first!). It took a while for the Morphine to kick in but when it did, it worked a treat. She was looking forward to going back to work at the Fire & Rescue control room but was now faced with more time off.
2. Chest pain. Another Cat A and this time it was over 30 miles away! It wasn't a Cat A at all. A lady basically getting anxious because she woke up disorientated at the health spa she was staying at.
3. Fall. ? fractured arm. We got this job on the way back from our previous call. A lady had been putting her shopping in her car when she felt her arm 'go'. Someone called NHS Direct aka NHS RE-Direct (standing joke in the ambulance service) and they said call an ambulance! She has a tender bicep and that's it, she can move her arm and there is no bony tenderness or deformity. 'Do I have to go to hospital?' she says.
'You don't have to go anywhere you don't want.' I reply.
She didn't want to go to hospital anyway and said that it was her family fussing about her. I suspect she pulled a muscle so referred her to her GP for the morning. Before leaving we gave her some advice on RICE (Rest, Ice, Compress & Elevation) and to take some simple painkillers.
Why call an ambulance for that? I would be too embarrassed to.
4. Breathing difficulties. On the way to this job we passed one of our other crews who were supposedly on a cardiac arrest so we offered our services. The Paramedic came out to stand us down and said 'It's not a cardiac arrest at all, I don't what the **** is going on!' There were police every where so I suspect that it probably alcohol related or a punch up. We were reassigned our original breathing difficulties and got going. This chap was struggling and had refused to go to hospital a few days before with similar problems. The previous crew had then passed him on to his own GP who diagnosed a chest infection and prescribed antibiotics. This time it had got a lot worse. His Oxygen levels were low, SpO2 of 80% even on O2, his pulse rate was 140 and his blood pressure was very low. A Salbutamol and atrovent nebuliser was having some effect en-route and we also took bloods and set up some IV sodium chloride to keep his vein open. I didn't really need a stethoscope to hear how terrible his chest sounded but did anyway. I had to just to make sure he had air going in and out on both sides. We alerted the hospital and were greeted by a Dr & Nurse on arrival. I was thinking along the lines of Pneumonia.
5. Urgent journey which wasn't, 999 call which wasn't? We had a phone call from control to say that an ex-paramedic who now works for the urgent care team needed us to go out and do an ECG on a chap with chest pain. It was for a cancer patient who this ex-paramedic was looking after over night. The patient had a 20 minute episode of chest pain which was right sided and moved slowly up to his neck and then eased off. We checked all his obs including his 12 lead ECG which looked better than yours or mine. In fact it looked like a text book sinus rhythm. The patient didn't want to go to hospital and the urgent care team were happy with this. After so much chemo he was just fed up and who could blame him.
6. Breathing difficulty. Cat A. A lady with a history of chest infections, heart attacks and fluid on the lungs. She was very breathless, especially on exertion and needed to be in hospital. She had wet sounding lungs and was basically drowning in her own fluid. Her ECG showed a left bundle branch block (LBBB) which was probably from her previous heart attacks so we couldn't do much about that. After some nitrates and a salbutamol nebuliser her breathing eased and she had settled. At hospital she thought she could transfer her self on to one of their trolleys but soon gave up when she became breathless again.

Another pretty standard night shift.

I'm on my last night shift now as I type this and it's nearly over. I'll post about it tomorrow. Then I'll have 4 days off, I wonder how many garden centres and kids clothes shops my wife can drag me round in that time!

Critical Hemorrhage Kit

Here are the items we carry in our critical hemorrhage kits which are on each front line truck.

Photo 1

Kendrick traction splint - This is a compact bit of kit for the use on adults or kids who have snapped their femur aka mid-shaft femur fracture. This is a serious injury and can result in major blood loss especially when there is bilateral open fractures (both bones broken and protruding through the skin). Also bloody painful. Shed loads of Entonox, Morphine and traction. And if you have a handy BASICS Dr, Secamb Critical Care Paramedic or flight paramedic from EEAT available then you might get some Ketamine as well. We also have the sagar traction splint on board which can be used for bilateral fractures where as the kendrick is only suitable for a single fracture.

Photo 2

Military pressure dressings - We have various size dressings including an abdominal one. They do exactly what say on the tin, apply pressure.

Photo 3

CAT or Combat application tourniquet - These are for life threatening hemorrhage from the arms or legs. There has been a lot of debate about the use of the tourniquet in recent years but when used in the right circumstances can and have saved lives. We carry 2 on each truck.

Photo 4

Asherman chest seal -This is for open chest wounds/sucking chest wounds. If someone has this sort of injury then this bit of kit acts as a one way valve. It prevents air from being drawn into the space between the chest wall and the lungs but allows air to escape. If air was allowed to enter it would cause all sorts of problems.

Photo 5

Pelvic splint - If someone has suffered a fractured pelvis we can stabilise it with this device. It helps by reducing the bleeding which can be fatal.