In reference to responding to emergency calls
Quote:
"You don't need to know what your going to, just where your going"
Your thoughts?
Thursday, 28 May 2009
Friday, 22 May 2009
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!
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!
Tuesday, 19 May 2009
"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.
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.
Thursday, 14 May 2009
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
Saturday, 9 May 2009
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.
Monday, 4 May 2009
Double Take
I concentrate on not looking at how close we are getting to the cars while they part to let us through. The main road into the Big City is always bumper to bumper at this time of day. But we know the road and we know how people react when they see us so we make good progress towards the call.
'RTC , One car, one injured male. Police on scene'
This is all the information we're privy to. Usually if the police are on scene we get an update if its serious so we know what to expect.
As we approach the blue lights indicate the scene, I take in the positions of the vehicles involved. Nothing looks like it has rolled or been crushed in the process of coming to an abrupt stop. It just looks like the small car has shunted into the barrier clipping a van on his way towards it.
"Hello guys whats the story?" I say breezily as I approach the policemen coming towards me. He is radiating calm so I'm not immediately concerned that I'm going to be faced with a grizzly scene.
"Hi. We have a young man who was in the car. Witness reports he swerved into his path for no apparent reason and he bumped the van while he was at it. He seems pretty out of it, the van driver reports they weren't going over 30mph. The guy had his seat belt on and was still sat in the car when we got here. The car smells heavily of cannabis and he's not talking. We did a search and found a substantial bag of weed on him. A search of the car found us a spliff on the go. Negative breath test for alcohol though"
"Right. Well shall we get him in the back of the motor and see how he's doing? Any evidence of him hitting the windscreen or being injured?"
"Like I say he's not talking. But he doesn't appear to be in pain, but I'm no expert on that"
An officer gets out of the car and takes the patient by the arm to guide him to the ambulance. He is walking like a toddler just learning to walk and has his eyes half shut.
We place him in the hot seat and ask the police officer if he'd be willing to wait by the door. The patient may be more willing to talk without them around.
"Ok, first things first, Whats your name?"
Nothing
"Ok, do you have any pain anywhere?"
Nothing
"Right. Listen, we're not the police we're only interested in making sure your ok and finding out if you need to go to hospital and it would be really helpful if you talked to us."
Nothing, he is starring ahead through slits for eyes and ignoring us. In a world of his own.
"Can we do some tests to check you out since your not willing to chat. Blood pressure? Blood sugar? Your eyes?"
He rolls up his sleeve, holds his arm out and makes an effort to hold his eyes open wider. This is good enough for me as an informed consent. At least he's with us in some way.
So I carry out the battery of tests available.
ECG is normal, oxygen Saturation are 99% on air and his blood pressure is better than mine. Blood sugar is within normal limits as is his temperature. His pupils are equal and reactive.
"Ok, I need to do a top to toe to check you out for any injuries..............it would be easier if you just told me."
He nods in agreement but doesn't talk. So I start at his head and work my way down. Palpating a little harder than usual to try and illicit a response which might indicate an injury. Nothing, not a scratch on him. No medi-alert bracelet.
"Do you want to go to hospital for a full check up?"
Nothing
"I can't take you against your will so I need to know your decision. Would you like to go to hospital?"
Nothing, not even a nod. I head out to see the police officer.
"He's not talking and everything is checking out fine. He has responded by giving permission to carry out checks so as far as I can tell he understands and is fully aware of what is going on. My problem is he isn't consenting or not consenting to go to hospital. If I take him and he claims he refused I get it in the neck. What were you guys planning to do with him?"
"He's getting lifted for driving under the influence. We'll take him for now since he's checking out medically. We'll probably take him for a full check once we've booked him."
"That sounds good to me. I'll report our findings and the situation, any problems just give us a call back. Can I take your name just to put as reference?"
I get the information and explain to the patient what is happening. I'm met with the same blank response.
15 minutes later
We settle down with a brew hoping that we'll be able to finish it. Signs are looking good as the other crew is on the bell.
As if on cue the phone shrieks into life. Cynic* rises from the chair with a sigh that contradicts his speed to answer.
"Concrete Jungle 2. Yes. Uh huh. Right. Ok. Thanks."
He puts the phone down and throws on his jacket
"You guys just do a refusal on an RTA? The guy went with the police?"
"Yeah, why?"
"He's having a seizure"
Shit.
My head starts over drive. Questioning the tests we did, his reactions, his manner. Was I wrong to assume he was with it and understanding everything? Was there a test I missed? Had he hit is head? Did I miss an injury that triggered a seizure? What would have happened if I'd taken him and not the police? Would I have noticed anything on the journey that would have changed my mind about his neurological state?
SoItIs* looks at me. "Bloody hell, you've gone pale! Don't worry. You did everything, its all documented. What were you going to do when he wouldn't talk? There is nothing you missed."
"Suppose. I'll still feel better when I know whats happened though"
A few calls later and we return to station to see Cynic* and Glasses* sat calmly with a brew. The wind up starts immediately but I'm not interested.
"Just tell me what they said about it at the hospital. I'm not in the mood. Was it something I missed?"
"No. He's epileptic. It was in his records once they found out his name"
The relief was palpable and his words instantly lifted my mood.
In some jobs if you drop the ball a quick wrist slap off the boss is probably expected, maybe a proper telling off or a disciplinary.
In our job if you drop the ball it can mean someones life. No matter how much you tell yourself that you did everything right and didn't miss anything, its scary shit when a job comes back a bites you.
'RTC , One car, one injured male. Police on scene'
This is all the information we're privy to. Usually if the police are on scene we get an update if its serious so we know what to expect.
As we approach the blue lights indicate the scene, I take in the positions of the vehicles involved. Nothing looks like it has rolled or been crushed in the process of coming to an abrupt stop. It just looks like the small car has shunted into the barrier clipping a van on his way towards it.
"Hello guys whats the story?" I say breezily as I approach the policemen coming towards me. He is radiating calm so I'm not immediately concerned that I'm going to be faced with a grizzly scene.
"Hi. We have a young man who was in the car. Witness reports he swerved into his path for no apparent reason and he bumped the van while he was at it. He seems pretty out of it, the van driver reports they weren't going over 30mph. The guy had his seat belt on and was still sat in the car when we got here. The car smells heavily of cannabis and he's not talking. We did a search and found a substantial bag of weed on him. A search of the car found us a spliff on the go. Negative breath test for alcohol though"
"Right. Well shall we get him in the back of the motor and see how he's doing? Any evidence of him hitting the windscreen or being injured?"
"Like I say he's not talking. But he doesn't appear to be in pain, but I'm no expert on that"
An officer gets out of the car and takes the patient by the arm to guide him to the ambulance. He is walking like a toddler just learning to walk and has his eyes half shut.
We place him in the hot seat and ask the police officer if he'd be willing to wait by the door. The patient may be more willing to talk without them around.
"Ok, first things first, Whats your name?"
Nothing
"Ok, do you have any pain anywhere?"
Nothing
"Right. Listen, we're not the police we're only interested in making sure your ok and finding out if you need to go to hospital and it would be really helpful if you talked to us."
Nothing, he is starring ahead through slits for eyes and ignoring us. In a world of his own.
"Can we do some tests to check you out since your not willing to chat. Blood pressure? Blood sugar? Your eyes?"
He rolls up his sleeve, holds his arm out and makes an effort to hold his eyes open wider. This is good enough for me as an informed consent. At least he's with us in some way.
So I carry out the battery of tests available.
ECG is normal, oxygen Saturation are 99% on air and his blood pressure is better than mine. Blood sugar is within normal limits as is his temperature. His pupils are equal and reactive.
"Ok, I need to do a top to toe to check you out for any injuries..............it would be easier if you just told me."
He nods in agreement but doesn't talk. So I start at his head and work my way down. Palpating a little harder than usual to try and illicit a response which might indicate an injury. Nothing, not a scratch on him. No medi-alert bracelet.
"Do you want to go to hospital for a full check up?"
Nothing
"I can't take you against your will so I need to know your decision. Would you like to go to hospital?"
Nothing, not even a nod. I head out to see the police officer.
"He's not talking and everything is checking out fine. He has responded by giving permission to carry out checks so as far as I can tell he understands and is fully aware of what is going on. My problem is he isn't consenting or not consenting to go to hospital. If I take him and he claims he refused I get it in the neck. What were you guys planning to do with him?"
"He's getting lifted for driving under the influence. We'll take him for now since he's checking out medically. We'll probably take him for a full check once we've booked him."
"That sounds good to me. I'll report our findings and the situation, any problems just give us a call back. Can I take your name just to put as reference?"
I get the information and explain to the patient what is happening. I'm met with the same blank response.
15 minutes later
We settle down with a brew hoping that we'll be able to finish it. Signs are looking good as the other crew is on the bell.
As if on cue the phone shrieks into life. Cynic* rises from the chair with a sigh that contradicts his speed to answer.
"Concrete Jungle 2. Yes. Uh huh. Right. Ok. Thanks."
He puts the phone down and throws on his jacket
"You guys just do a refusal on an RTA? The guy went with the police?"
"Yeah, why?"
"He's having a seizure"
Shit.
My head starts over drive. Questioning the tests we did, his reactions, his manner. Was I wrong to assume he was with it and understanding everything? Was there a test I missed? Had he hit is head? Did I miss an injury that triggered a seizure? What would have happened if I'd taken him and not the police? Would I have noticed anything on the journey that would have changed my mind about his neurological state?
SoItIs* looks at me. "Bloody hell, you've gone pale! Don't worry. You did everything, its all documented. What were you going to do when he wouldn't talk? There is nothing you missed."
"Suppose. I'll still feel better when I know whats happened though"
A few calls later and we return to station to see Cynic* and Glasses* sat calmly with a brew. The wind up starts immediately but I'm not interested.
"Just tell me what they said about it at the hospital. I'm not in the mood. Was it something I missed?"
"No. He's epileptic. It was in his records once they found out his name"
The relief was palpable and his words instantly lifted my mood.
In some jobs if you drop the ball a quick wrist slap off the boss is probably expected, maybe a proper telling off or a disciplinary.
In our job if you drop the ball it can mean someones life. No matter how much you tell yourself that you did everything right and didn't miss anything, its scary shit when a job comes back a bites you.
Subscribe to:
Posts (Atom)
