Love My Job!

Feeling better now thank you people........ it's amazing what a good day at work can do! Lots to blog about so watch this space!

Feeling Blue

Ok, so I'm having a crap week and feeling pretty shit about certain situations of my own naive making. But I'm not made for being in a bad or sad mood and will snap out of it soon I'm sure.

My current feeling though has got me thinking about some of the patients I have attended. As I have mentioned before we get a lot mental health calls, usually people who have taken an overdose, self harmed or are threatening suicide.

Also as I have said before I try not to make a judgement about the job and treat what I see as it appears to me. I would like to use some examples to show the diversity of jobs like this we can get.

Example 1

I attended a patient recently who is known to the service and the police, he has suffered depression and alcoholism since the death of his wife and self harms. He has been known to go into significant shock through this as he does a 'proper' job of it, on this occasion the sheath containing the muscles of the forearm were clearly visible. He has had several stays in the local hospital MH unit but can get aggressive if he feels he is not being helped. The following night we were called to him again as he was feeling suicidal, on arrival he told me the on call psychiatrist had been dismissive and he felt no-one cared or wanted to help him. He was picking out the stitches in his arm from the night before and threatening to kill himself as soon as we got out the hospital again.

This is difficult, as I have said before people who are truly set on suicide don't tend wait for a audience or announce it. I believe those who do, such as this patient, are really crying for help.

Example 2

I have been to several patients who have taken a tablet overdose as a result of a fight or argument. They have wanted to get back at the other party in some way and this seemed like a good idea at the time.

Example 3

I go to a lot of patients who have a history of depression, usually in varying degrees. Every so often they appear to get to a point where they feel they can't cope anymore and take an overdose of their anti-depressants to try and combat this. Many haven't asked for help from their GP and this appears to be an 'end of the line' cry for help. Another instance was a lady I attended who was wailing and crying inconsolably, she had been sticking to her normal medication but had been in this state for 3 days and just needed help.

Examples 4

Then there are the scary ones. The ones where you know you could have been coming to a very different call.
I arrived at a 3rd floor flat to find a young man holding his baby while quietly weeping on the sofa. His wife, who let us in, gently takes the child from him so we can find out what has happened. He tells us about a family dispute a few weeks previous that left him injured and in hospital and disowned by his family. He had been fighting the creeping depression since then and it came to a head that night. Without any warning he had got up from the sofa and attempted to jump off the balcony outside his flat's front door. His wife had caught him before he could do it. I asked him on route to the hospital if he intended to kill himself.............. he replied "I don't know, but I could have done".

Now please note I use the phrase 'cry for help' and not 'attention seeking'. As I have mentioned before many 'old bears' in the service are insensitive towards MH patient and use attention seeking a negative term basically meaning 'their faking it'.

I honestly do not understand the true feeling behind extreme depression and MH, I only think people who have experienced it do. I find it very difficult to empathise with these patients but I at least try to sympathise with them.

I am just as guilty as the 'old bears' of going into a job and feeling frustrated that we have been sent to it as the person is not as 'ill' as has been reported. But I get much more frustrated when I get a genuine patient in genuine need and the only thing I can do is take them to A&E. A&E is not the place for many these patients but it is the only access we have to try and get them appropriate help.

I don't know enough about mental health services available so I am not going to pass comment on the lack of or inefficiency of them............. I can only tell you what I see.

Please go to 'Purpleplus's' latest blog for another A&E view and to 'There and back to see how far it is' for a MH patient view (find them on my tool bar!)

Have just read this through and realised it doesn't seem to have a point or a conclusion and sounds like a bit of a ramble............. let me know what you think.

Just the one

I've had several patients this week who have found themselves unexpectedly in contact with the pavement.

After assessing for injuries and getting them to sit up or getting them into the back of the ambulance we get down to why they decided the pavement would be a good place to stop.

The standard answer: "I don't remember/know"

Now, even outside the confines of the ambulance I could detect a particularly strong whiff of alcohol, it is unmistakable and when you add it to the behaviour, speech patterns and co-ordination skills of the patient............... the conclusion is simple........... their pished (Scottish accent coming on well)

The next obvious question is "How much have you had to drink today?" (I would also like to point out that these calls happened well in advance of 'closing time'...................... some were in advance of opening time!)

Standard answer: "Just one or two"

Now forgive my ignorance as to the affect of alcohol on people I don't know, but even 'one or two' of Absinthe would have difficulty in bringing on the 'symptoms' we found our patients with.

"One or two. Is that glasses or bottles?"

______________________________________________________________

On the skint/overtime front............ there is select O/T available (which a few stations have boycotted on principle.......... fair enough for the non-skint workers........... not me!).

I have been given an event cover shift this week.......... have just been informed I will be working for 8 Hours with my Area Service Manager........................ Ergh!!!

Update: I have ended up bowing to peer pressure with regards to overtime............ very upset by tactics used. Will blog about it when blown over.

New Carpet

Man Alive! My first thoughts as I walk into what can only be described as a scene from CSI (without the dead body). There is blood on the walls, doorhandles, fireplace, carpet, sofa................. its everywhere.

The lady it has come from is in her late 70's and is lying on the floor near the front door.

"Hello, whats happened here then?"

"Hello dear, thank goodness, I tripped while carrying my dinner through"

There was a tray of food lay on the carpet as well, but I still couldn't work out how the blood had got everywhere.

"Where are you hurt sweetheart?"

"I hit my head"

I can see this, her hair is completely matted with it all, in clumps of red clots, and getting any kind of assessement of the wound is impossible The good thing was that it didn't appear to be bleeding anymore, but it must have been a spurter when she did it!

All her vital signs appear normal, even her blood pressure is nice and healthy. She tells me she doesn't have any medical problems and isn't on any blood thinning drugs (which could have been another explanation!).

We lift her off the floor and on to our chair, her clothes are completely covered in blood as well, all the way down to her bra. We give her a hand to take these off and put something clean on before transporting her

"Oh dear.......... I'm going to have to get this carpet cleaned"

I squat down in front of her and look her in the eye with a slight smile...........

........................."Sweetheart........... I think your going to need a new carpet!"

Question?

I have a question as a result of a job I went to a while ago.........

......... How often are GP's and Locum's required to update their CPR skills and training? and are they assessed as part of continuing professional development or ongoing monitoring of their skills?

Ok so that was 2 questions but I'll tell you why.

Smiler* and I got the job through as 'Female collapse, GP on scene'

We arrived and were presented a lady on the very small bathroom floor looking very blue and not very well at all............... the GP (locum) was sat on the side of the bath looking at her. Even in my relative inexperience I could see this lady was in cardiac arrest, or if not serious trouble.

Smiler: "What was her respiration rate?"
GP: "Er............ 2 or 3"
Smiler: "and what was her pulse?"
GP: "Er......."
Smiler: "Because I can't find a pulse can you?"

At this point I am throwing a bag-valve and mask at Smiler to start bagging the patient (assist her breathing), setting up the defib, and organising cannulation and intubation equipment for Smiler to do her stuff.

Smiler: (to the GP) "Do you want to start compressions?"
GP: "Oh! Er........... ok"

The GP proceeded to do ineffective compressions (bent elbows not actually depressing the rib cage) on the upper part of the sternum (CPR is supposed to be performed over the heart, between the central and lower part of the breastbone).

By this point I have cut the patients clothes and applied the defib pads. The patient was in VF (Ventricular Fibrilation, chaotic ineffective heart beat and a shockable rhythm). This was the first time I've shocked a patient and its not pleasant. During this time we also tried to established what had happened to her.

Smiler: "When did she collapse?"
GP: "When I got here.......... about 15 minutes ago"
Smiler: "What is her medical history? Any cardiac history?"
GP: "I don't know I'm a locum she's not my patient"
Smiler: "Why were you called out?"
GP: "I don't know, was just told the lady was unwell"

Smiler asked the GP if he would go and find out from the assembled family about her history. I then took over CPR, my first set of compressions I broke several ribs (a necessary side effect of effective CPR) further proving the GP's CPR was not great.

Smiler tried to intubate and cannulate but the patient's neck veins were distended and any veins for cannulating had shut down.

The lady had been 'down' for 15 minutes before any work was begun on her, we managed one shock and for the next 10 minutes of CPR and trying to secure the airway and get drugs in, she was in Asystole (flat line).

The GP came back in with little information for us other that she had been suffering from indigestion for a couple of days (alarm bells anyone?)

Smiler: "Ok, we've been working on her in Asystole for 15 minutes, making total collapse time with no response 30 minutes, we can't cannulate or intubate............. (to the GP) Do you want us to load and go? Or do you want to call it here?"
GP: (Looking a little shocked) Erm....... well........ what do you think?"

During all this I'm absolutely knackered still doing CPR

Smiler: "You are the doctor, if you say load and go we will............. but remember..... 33 minutes, no output and no possibility of drugs.......... Up to you"
GP: "Well, er........ we'll just call it then shall we?"
Smiler: "Your decision doctor........... If you say call it we'll stop"
GP: "Er.... what are her pupils like?"
Me: (Wiping sweat from my brow) Fix and dilated"
GP: (Deep breath) "Right....... We'll call it then......er...... Time of death _:_"

The GP went through to tell the family while we cleaned up the mess that happens with an arrest. We cleaned up the patient and moved her into the bedroom so the family could see her away from the mess. There were no suspicious circumstances and the GP was on scene to certify death the police were not involved.

And so I refer you back to my original questions........... Are GP's required to update their resuscitation skills? and are their skills monitored through assessment?

Now I would like to point out I am not having a go at GP's or locum's, they have a greater knowledge base than me and lots more training and experience. I also appreciate that they do not have to deal with these situations as much as Paramedic's, Technician's and A&E medical staff.

But surely they are required by the British Medical Council (BMC) to update their knowledge and skills in this area and if they are not.............. why not?

I'm not saying this patient would have survived if the Locum had better CPR knowledge and skills but 15 minutes went by, a medical professional was with the patient, and nothing was done........

..........Is this really acceptable?

Update on Skint

The ban is to last 3 months apparently................... senior officers have tried telling the Chief Exec that it won't work and been told to 'conform or go'.

It is now affecting normal scheduling. As a relief worker I have to ring the planning office (at my own expense if I'm not in the station) to receive my shifts for the following week.

I rang today, to be told that I had to ring back 11am Friday as the managers hadn't checked (and changed) everything............. this was all due to the overtime ban. The managers have to make sure that the right shifts are covered. They were supposed to do it today but were busy else where. This means I could have just over 48 hours notice of starting a night shift on Sunday (this is counted as Monday's shift....... don't ask!)

RUBBISH!

Skint!

We currently have a blanket ban on all 'none essential' over time, this means that there are day shifts being single crewed as the planning department deem the night shifts more essential and are directing staff onto those.

This apparently is a nationwide thing, now whether they mean Scotland or the UK you guys in the service in other areas will have to let me know.

And it is because there is apparently not budget for it.

1 month into the financial year.

Single crews being sent to Urgent jobs where the patient has been reported as mobile by a GP or other health professional.

Now I have been to Urgent's before that have turned into emergency stand by's (blue light into hospital, with medical team ready), and I personally am not happy with the idea of something happening while the patient is with me........ where is my back up, my second pair of eyes? Will the service take any responsibility for sending a single crew if the person is actually gravely ill?

Secondary to this the fact the wage of a probationary ambulance technician isn't brilliant, in fact I think Joe public would be quite shocked to hear what Technician's are paid. I live alone and have rent, council tax, house hold bills, a student loan, bank loan, credit cards and a car to pay for out of this small wage (no it doesn't help that I'm rubbish with money either!)

I can clear an extra £300 a month without killing myself with a few 'time and a half' extra duties. Without these I will struggle, I have already had to cancel a planned trip to Wales in July as I can't afford the flight, this was to see people I haven't seen for up to 4 years and I was really looking forward to it. However, for once in my life I need to be sensible and not bankrupt myself for a cracking piss up!

But the only reason I need to do this is because of this ban. Bugger!

Oh Baby!!

Hello! Hope your all enjoying this lovely bank holiday. Since its lovely I thought I'd blog about something good that happened to me!

As I walked blurry eyed at 'stupid o'clock in the morning' towards the sound of the phone Stickler* my work partner, for what had been an 'interesting' week, asks "You done a maternity yet?"..................... perfect!

We arrived at the address and Mum knew what she wanted............. "GAS AND AIR!!". We established that she'd woken just an hour and a half earlier with pains, this was her 3rd child, with no complictions in pregnancy and she was now having contractions about 5 minutes apart.................. Uh oh!

We gave her Entonox and managed to get her into the vehicle, now I'm no expert but just the way she positioned herself on stretcher told me we weren't going to make it to the hospital.

Now we had a day (about 5 hours) at college with a midwife. Basically the general idea is to 'catch'. But then you start learning about everything that goes wrong in labour.............. so in my general state of inner panic I'm thinking, what if its breech? What if the cord is around the neck? What if it doesn't cry straight away? What if Mum starts to haemorrhage? AAAAAAHHHHHHH!!!!!!!!

Apparently on the outside I looked the picture of a calm professional and was saying all the right things like I'd done it before (God bless TV!)

I needn't have worried, Mum knew exactly what she was doing and it was indeed just a case of playing catch!

A shout of "Pull over I can see the head!!!" (after a futile attempt to do what the technician manual tells you 'call for assistance from a midwife' HA!!!) and we're parked up not 10 minutes from the patients home.

In the early hours of the morning we delivered a healthy baby in the back of the ambulance!!!! Cried as soon as it came out and hand all the bits in all the right places! Dad cut the cord, Mum was fine!!

Amazing!! Stickler and I had huge cheesy grins! I was bouncing off the walls for a couple of hours before I could even think about going to bed!

It wasn't until the midwife asked us at the hospital that the parents found out neither Stickler or I had had a delivery before! Que Handshakes and Well Done's all around!

Love My Job!!!

Tag! Your It!!

Er.......... I've been tagged by Uphilldowndale................ I'm not exactly sure what a Tagger is but I'll give it a go!

Here are the rules, for those who decide to play along:

1) Link to your tagger and post these rules on your blog.
2) Share 7 facts about yourself on your blog, some random, some weird.
3) Tag 7 people at the end of your post by leaving their names as well as links to their blogs.
4) Let them know they are tagged by leaving a comment on their blog.


Facts about me then............................

1. I'm a stubbornly independent, career driven cow, who hasn't had a proper relationship............. ever!

2. I'm a complete technophobe, the fact I'm doing this is amazing, I don't even own an MP3 player as I don't know how to download music onto it.

3. I love CSI, and I am slowly getting all the box sets........... easy to buy for at Christmas!

4. I did gymnastics as a kid and Trampolining at Uni and can still do the splits

5. My family is so spread out that if one of my step brothers goes to live in Ireland my Dad will have the Home Nations set!

6. I am obsessed with Rugby. Follow Sale Sharks and Glasgow, my mixed blood (Dad is Scottish) makes me an oddity in that I will support both England and Scotland. England always come first though (Sorry Scottish readers) as I was born in Manchester.

7. I am an experimental baker much to the delight of my test subjects at station.......... next I am going to attempt Carrot Cake!



Right now this is really sad, but please refer to number 2, I don't know how to make peoples names link from the blog! I can link from the title............ but not worked out how to link from text yet!

So I will list 7 people who are on my 'Blogs I Read' section:

Area Trace No Search
Nightjack
I am not a drain on society
Fat Lazy Male Nurse
Purpleplus
MetCountyMounty
Trauma Queen

Chair Lifts

Thought I'd get an opinion on this...................Chair lifts............. a useful tool or a pain in the arse!

Example of the 'Pain in the Arse' Argument:

The patient is upstairs, she isn't a large lady but she isn't a frail waif either, she can't walk but she has chair lift........................ its broken. Hmmm, the stairwell is tight anyway, never mind the tracks and the chair blocking access to the top. I'm working with Smiler* and in normal circumstances we could manage quite easily, however this time we have to call out a second crew to help us lift her over the offending piece of equipment.

Example of the 'Useful Tool' Argument:


The patient is at the wrong end of the BMI scale and having difficulty walking since she dislocated her hip. The stair lift (working) helps us to transport her practically to the front door where we can easily transfer her without any back ache.

These are just 2 examples of my encounters with this piece of technology and no matter how many times they have been useful I always seem to think 'bollocks! Bloody stair lift!' when I walk into a house and see one.

Opinions anyone??