Decisions

I've been a bit busy lately, so slow on the pick up for this and also slow on its significance.

The Times has dealt a blow to bloggers everywhere by outing Nightjack. There was no reasoning behind it other than they could. I truly hope it comes back and bites them in the arse very hard.

I enjoyed reading Nightjack's blog immensely and miss it.

Since this ruling another two of my favourite blogs have decided that the writing they love doing is not worth the risk of being outed by the next morons who choose to have a go.

Like Nightjack, PCSO Bloggs and MetCountyMounty tell it like it is. They tell the blog reading public about the reality behind modern police work.

Their contributions being lost is a huge dent to free speech and stopping the powers that be from spinning us the lies they weave to tell us everything is ok with the country.

Its not.

And so its leads me to a decision. Do I carry on? Is it worth the risk?

So far I have been lucky. There are people in my work environment who know I am Ambulance Nut. Their are others that suspect it is me. No one has complained about it or made any noises indicating what I have been writing should cause me a problem.

But will that continue?

What will happen the next time someone takes offense at something I write? Will they decide that my personal opinions make me unable to do my job and try to 'out' me?

I have always tried to make the posts about MY opinions and MY reflections on the jobs I have done, the people I have met and the actions I have taken.

I have pissed off a few people in the process. I've been called judgemental, accused of 'bashing' the other professions I come into contact with and once I was even accused of assault when I had to act to stop a difficult patient grabbing out at equipment and possibly causing me danger.

My next post was going to be about a job where I became very angry with the actions a GP took (or more to the point didn't take).......

.........Should I now be scared of writing these experiences, MY PERSONAL experiences, for fear of reprisal from a disgruntled reader?

These are the decisions I am currently weighing up and would appreciate your thoughts..............

Is the world of blogging as we know it now a dying breed...............? and should I carry on, with more care and censorship to what I write and how I write it? And if I were to do this would it be the same?

Thank you
Louise

Light Entertainment

On the day when a court ruling may have buggered all anon. bloggers everywhere I've decided to do a blog with no real meaning or story as a little light entertainment!

What would be your favourite piece of music to blue light drive to?

A current favourite for me is Warriors Dance by the Prodigy and old favourite is Slam by Pendulum (the video to this is also brilliant!) ..................... just love it when the bass kicks in!

A classic favourite which has been used before is Danger Zone by Kenny Loggins from the Top Gun Soundtrack................... Genius!!!!

Disclaimer:
Of course I am not condoning the act of not concentrating fully on the job in hand but I'm sure there are several of us who have been caught dancing in the driving seat and really feeling that drive!

A Good Job

The patient is in an awkward position. I have to step over him and watch my footing on the stairs to get into his eye line.

The stairs are in two parts separated but a long thin landing. Our patient appears to have fallen someway down the first set to land with his head and body on the landing and his legs up the stairs.

He's at least 6 foot tall.

When I speak to the patient he appears confused. I run a battery of tests and questions. My brain is thinking Stroke, although not the worst I've seen.

The next trick is find out if he has any injuries, neck and back first. The patient complains of pain across his shoulders and upper back. Its unknown how long he has been in this position, a neighbour noticed he hadn't opened his curtains this morning and came to check on him. A quick head to toe reveals this as the only problem and all limbs are where they should be, with no extra joints.

Is his pain due to an injury caused by the fall? Or by having been in this position for a long tim?

One of his slippers is 4 steps up from the landing caught on a snag in the carpet. I try to assess how far the fall was. The steps are shallow, putting the fourth step approx 2 foot off the ground, add in the patients height and there is fall of 8ft.

I decide the mechanism of injury means the patient will need boarding. But with the space we have and the manoeuvres we have to do to get him out, it will require an extra set of hands.

While we wait to be joined by the cavalry we talk to the patient, obtain a set of observations and gain information from the neighbour and the daughter who has hurriedly arrived on scene. Our patient is an independent man with no previous history of serious illness or injury.

Our findings show a mild weakness on his right side but his pupils are equal and with the magic of oxygen helps break through some of his confusion.

The second crew arrives, I take over from my colleague who has been holding the patients head in one position after we had applied the cervical collar. A scoop stretcher appears with some straps, I'm informed our trolley has been prepared with the long board in place to complete the immobilisation.

It was suggested the trolley be bought into the house, I point out the driveway made of 'chuckies' that would make this very difficult. Whatever happened to tarmac or block paving?

The move goes well, the patient still complains of central pain in his upper back but is otherwise doing ok. We strap him into the scoop stretcher. I'm volunteered to do the strapping, I was last out of the training school, so in theory should remember how to do this better than the others. There are some things we just don't do that often but, when needed, its amazing the things you can pull from the back of your memory.

Getting him off the thin landing means tipping him at an angle, with his head going down, not ideal but luckily there are only a few steps before we can straighten him out again.

We transfer our patient onto the long board. I apologise for having to put the patient on it as it is not the most comfortable thing. I've found I do this for most patients I need to board, having been strapped to one before myself I know its not the nicest experience. The cavalry leave us to clear for another job, or a cup of tea at station which ever comes first.

A short drive to hospital and patient is handed over. The family and neighbour have followed up. As we leave the hospital they are coming through the doors. A quick exchange that never fails to make me feel like I'm doing something right.

"Thank you"
"Anytime"

We check the ambulance to see that all our kit has been replaced and we are ready for the next job. I look at the times on our incident screen, we were on scene for over an hour.

Sometimes you have to go slow to do a good job.

He Said She Said

'2 Year old. Head Injury. Police on scene'

There are some texts on the screen that start ringing alarm bells the moment you see them. This wouldn't have been one of them had it not been for the last statement.

We pull up outside the address and find a police officer talking to a man outside the front door.

"Upstairs" is the simple instruction we receive as we enter.

The house looks relatively well kept. Its obvious a child lives here but the living conditions do not cause any immediate concern.

I follow SoItIs* upstairs and we're met by a female officer, she points in the directions of the main bedroom where the mother has the patient sat on her knee holding a towel to her head.

SoItIs approaches the child and starts to take the towel off. Inevitably this leads to much screaming and distress from the child.

We can see why.

She has a cut approximately 4 inches long on the top if her head. Not a simple laceration as the skin has been pushed back causing a wide bloody scar in the thin hair. The skin has become degloved from the skull which is clearly visible.

I hand SoItIs a clean dressing for the mother to apply and then try to calm the patient and get the story of what has happened.

"He says she fell out the cot"

She reports being in bed and hearing the patient crying. She reports him bringing her to the main bedroom stating "She's ok, just needs a cuddle to settle her". She reports this as being in the dark and not realising the child had a cut. She reports it was only when the police entered the bedroom and turned the light on that she found she was covered in blood and the child was injured.

While listening to this I stand just outside the room and take it at face value. Without any thought or investigation the story doesn't sound hugely far fetched.

One thing doesn't make sense. Why are the police here? With the patient and mother in easy ear shot I'm reluctant to get their take on things. I'm soon forced to.

We get ready to leave the room and head for the ambulance. The female officer is on the landing

"Does the mother have to travel with you? We're going to detain them both. The stories don't match and theres no way the child fell out that crib and got that kind of injury"

I look into the child's bedroom and see what she means. The gate of the cot is up, its low to the floor and there is nothing close enough to it that could have caused the head injury. The sides are padded or rounded. There is, however, blood around a toy set. This is no where near the reported injury site.

"We need a guardian of some sort with us, I don't think we'd be comfortable taking her on her own. Shes calmer with people she knows"

"Ok. I'll need to travel with you"

We leave the house and get everyone settled for the journey to the paediatric hospital in the city.

After handing over the patient to staff SoItIs and I return to the ambulance.

"Did you find out why the police were there?"

"Neighbours reported a disturbance, breaking glass and such. They arrived and found him drunk with blood on his shirt so they went in. Found her hiding the child under the duvet with her. It actually sounds like an innocent accident but because they keep changing their stories, that don't match its become suspect."

If they had just rang us when the accident happened.

If they had told us when we arrived that she had fallen or been dropped hitting her head on the toys.

If they had seemed genuinely distressed and concerned about their actions

If.............

None of this would have happened and there wouldn't be a child stuck in the middle of an adult argument of he said she said.

Solid Silence

The tower block looms up out of the night lit by the orange of the street lights that surprisingly still work in this part of town.

We pull up to the doorway to find 3 police with a solidly build man in the shelter of the the door way. The wind whips around the courtyard bouncing off the building and hitting us from all directions. I have to hold on to the ambulance door to stop it being retched back and breaking.

The patient has huge blood stain on his t-shirt and is holding a towel to his top lip. The police informs us he isn't very talkative and just need seeing to.

We get the patient into the back of the motor and have a look at the offending wound. A small puncture wound to his top lip oozes claret freely. I ask him to open his mouth so I can see if the wound penetrates through the lip and for any other damage. No other injuries appear to have contributed to the large red circle on his shirt.

Throughout he remains silently co-operative. The police leave us to it and I try to engage him in conversation to enable me to fill of the PRF. I get the bare minimum, name, age, date of birth.

As for details of how he came about his injury he remains defiantly silent. I explain I'm not the police and if I know how it happened it may help the treatment. This doesn't work.

I supply him with more gauze to hold firmly to his lip and we proceed to hospital.

My handover is brief and concise.

"Pretty much as you see it"

We transfer the patient to a trolley in a cubicle and he reclines with the same obeying silence that has been with us from the start.

The nurse lifts the gauze away from the patients lip and we both move rapidly to avoid being hit with the arterial spurt that greets us.

"Well that explains why there's so much blood"

Because the patient had been upright throughout his time with us the arterial spurt had appeared as a steady ooze helped by gravity to simply dribble down his chin. Now free of gravities immediate influence the blood was free to pump out of the wound in its colourful pulse.

As I move away I hear the nurse ask the series of questions I had used to try and gauge the reason for the injury.

The department is quiet and the silence becomes oppressive with the patients silent reaction. The atmosphere feels chill and the hairs stand on the back of my neck as I move away.

I'm glad the address was close to the hospital, that feeling in the confines of the ambulance is not nice for long periods of time.

You Opinion Please?

In reference to responding to emergency calls

Quote:

"You don't need to know what your going to, just where your going"

Your thoughts?

Thats Gonna Sting!

I shimmy passed the offending ladder on the landing and head into the bedroom as directed.


The patient is laying on her back on the bed with her leg up in the air supported by her husband. He is holding a towel firmly onto her shin. There are several other bloody towels strewn around the room.


"What happened?"


The patient lifts her head and looks at me, she is pale but seems quite calm through the grimace of pain.


"I was getting Christmas* decorations out of the loft and slipped on a step. I hit my leg on the ladder as I was sliding down. Seems to have skinned part of my shin"


"Ok, lets have a look"


The husband gingerly lifts the towel from the patients leg while still supporting it. There is gash about 4 inches wide on her lower leg. As she has slid down the skin has been pulled back (de-gloved) to reveal the bone underneath.


"Ok, I'll get a proper dressing on it. I'll state the obvious, you need stitches! Also need to check that you haven't caused a fracture with hitting the leg, the bone looks like its in tact but will need to make sure. Seems to have stopped bleeding, you've done a good job. Although I think you might need some new towels!"



"Never know I might get some for Christmas!" The patient manages to make this joke through a tight giggle of pain.


I ask Impressionist* to grab a chair but not before I let him get a good look at the cut. He's been out of the school a couple if months now and starting to find his feet.



"So did you get the decorations down?"



"Yeah. The kids better have them up by the time I get home. I don't want to see the boxes again!"



Its always nice to have a patient who keeps a sense of humour through the pain. I wonder how she'll get on with the Gas 'n' Air?! This could be one of those fun journeys to hospital!

Health and safety gone mad?

* It was near Christmas, don't panic it is only May still!

"Why Have You Brought Her Here?!"

The women looks terrified.

She is crunched up in agony on the sofa.

Tears stain her pale face as she holds on to her belly.

She is 19 weeks pregnant.

Her eyes plead with me to do something.

All I can do is take her from the comfort of her house to people who know better than me about this.

The entonox doesn't touch her distress.

She is before the 24 week deadline for us to take her to the Obstetric hospital. The protocol says nearest A&E.

Holy Hospital in almost in the next street.

We're a double technician crew. We can't give adequate pain relief or fluids.

The obstretic unit is almost 30 minutes away, on Blues.

I call it in.

We swing into the ambulance bay and the doors are flung open by one of the nurses.

"Why have you brought her here?"

In full ear shot and view of the patients distress and pain

"Because I'm not transporting her in this state when I can do very little for her. Because our protocol says nearest A&E before 24 weeks. Because you guys can stabilse her for a more comfortable transport

We transfer the patient into the care of the resus team and give a handover.

Again the question comes "Why did you bring her here?"

"Because, that was clinical decision made based on our protocols and what I thought was best for the patient. Ok?"

They carry on treating the patient whose distress isn't being relieved by the discussion about her immediate transport to the Obstetric unit. I suggest to the nurse that if they called it into ambulance control now, chances are we could get it when we clear, its all about the timing.

10 minutes later our screen lights up with a message to transfer a patient from Holy Hospital.

Funny that.

The women is calmer, in less pain and stablised.

As we make our way towards the recieving hospital she is quiet. Sobbing silently while clutching her belly, hoping to hold on to the package inside.

All I can do is offer a tissue and a reassuring presence.

Its not enough but its all I can do.

Do You Want a Tissue?

"What's a club doing open at 6.30 in the evening on a Wednesday?"

This is the first question that pop into my head as we head for the front door. We walk up the stairs looking for the familiar green suit of the paramedic who is ahead of us in the RRU.

I open the heavy door leading to the main floor of the club. Its where the music is coming from so I assume its where the people are.

I pause briefly to take in the scene. There are a serious of silver poles around the room. Milling around the room are mixture of women dressed mainly in shorts, t-shirts and high heels. Some ridiculously high heels. Out of the corner of my eye I see a lady launch herself onto the pole and begin 'dancing'. I use the term loosely as these girls are not by any stretch of the imagination professional pole dancers.

The only lady in the room who could possibly pass as a dancer approaches us. She has legs that go on forever accentuated by the high heels (I wouldn't even be able to walk in them, never mind dance in them!). She is beautiful in a very striking way with her perfectly curly hair cascading around her shoulders.

I hate her already.

"Hello, your mate is over there with the girl"

"Thank you"

The RRU paramedic is setting up a nebuliser for the patient. She appears calm although one side of her face is puffy and swollen. She's had a reaction to something. After some questions and set of observations we get a chair in to take her to the ambulance. Insisting she is ok to walk we persuade her otherwise, anaphylaxis has a nasty habit of escalating and we didn't want to exacerbate the problem. I decide I'll give her a shot of adrenaline in the ambulance, she's stable enough to move at the moment. Our paramedic friend is obviously ready to hand over all responsibility as he is packing up.

For all the questions we can think of there appears to be no cause for the reaction. We can not work out what she has been exposed to. When her friend comes up with a suggestion

"What about the wax?"

This gets a raised eyebrow from the boys and a confused look from me

"We use wax on the poles so its lubricated without making you move too fast"

As we move away from the room I catch a quick word in the ear of my colleague

"You want a tissue?"

"Huh?"

"Your dribbling"

I get a playful punch on the shoulder for my cheek before I notice him checking in the mirror that this isn't the case.

Just another day at the office

First Timer

I closed the door and started the engine to pull away from the forecourt. The screen suddenly lights up and starts screaming at us to pay attention.

'O/D, unconscious, blue, not breathing'

The address is well known hostel in Jacketsville. The blues and twos light our way down the road and through the traffic. Its amazing how invisible we feel as people pull out in front of us and refuse to get out of the way.

On arrival at the hostel we're met by one of the wardens and ushered quickly towards the stairs.

"One of the residents came and got us. He had been in the room with the guy when he collapsed. They say he snorted a bag of heroin."

"Snorted it? How much?"

"Don't know but apparently its his first time and took the lot."

I enter the room which is dominated by the huge sofa. The patient is lay out on the laminate floor looking very pale and not at all well. A quick check puts his respiration's at approximately 4 a minute. Not adequate if you want to stay alive very long.

I quickly hook up the oxygen and start 'bagging' him, forcing air into his lungs via the airway he has gratefully accepted into his mouth. Gutbucket* is unzipping the drugs pouch and retrieving the Narcan, our wonder drug for reversing the effects of opiate overdose.

All the while I'm asking the gathered bystanders a series of questions to work out how he got to this point. Working out if its a simple case of opiate overdose as it appears or if there could be another underlying problem. His pupils are pinpoint and everything is headed towards the suspected cause, but you can never be too careful.

The patients respiration's begin to increase with the first dose of Narcan but he still isn't quite supporting himself yet so he gets a second shot as the rapid response paramedic arrives with the police. Unfortunately its not one of the most pro-active paramedic we have on the team so I'm met with a shrug when I ask if he's going to cannulate the patient. The shrug says "are you really going to make me? God, I hate young technicians"

His respiration's improve enough for me to stop ventilating him and put a trauma mask on to keep the oxygen blasting in his face. He is responding more and his colour now looks like he isn't about shake hands with the grim reaper.

The paramedic reluctantly gets a cannula in and gives another dose of Narcan. The drug is fairly fast acting but doesn't last very long. Its a consistent battle against the amount of opiate he has taken to bring him round. He gets to the point where we can assist him into a chair and have a wee chat about what has happened and see how much sense we can get out of him for a proper assessment.

All the while there is more chatter and conversation in the room as the police question the warden and the patients friends. They are sat sheepishly on the end of the sofa, looking guilty for all the denial that is coming from their mouths.

We begin to haul the patient out to the ambulance. He has agreed to come to hospital and isn't spouting the usual annoyance at his hit has been ruined. He tells us it was his first time and he had indeed snorted the whole bag, £20 worth, of heroin. The amount means nothing to me, I'm not familiar with the street value of heroin. He needs to go to Holy Hospital to get stabilised, chances are if we left him we'd be back in 10 minutes. I also get the feeling the wardens are keen to have him out, apparently he's not a resident but a guest of one of the other men in the room.

I honestly don't understand or comprehend addiction of this kind. You hear of so many intelligent, bright, talented people succumbing to heroin. Its not like we don't know the risks. Its highly addictive, messes with your health in a big way, can lead to a life only focused on getting money for the next fix which leads down other dangerous roads.

We know this. We understand this. Yet we still have people choosing to take it. As far as I understand that is what it comes down to, a choice.

A very famous film once said Choose Life. Yet there are many people who choose that something different.

And so we come running with the narcan and oxygen to stop them from killing themselves with their choice.

I just don't get it.