The Complete Blood, Sweat and Tea

There is one problem with the use of cannabis – I’m never sure what to call it in order to sound ‘hip to the kids’, the slang just befuddles me. Is it ‘green’, ‘pot’, ‘hash’, ‘reefer’ or ‘draw’? At least alcohol is just ‘booze’.

And now the government has made it even easier to get hold of alcohol with extended ‘open hours’. Oh well …

Too Quick?

(What I’m going to post about might come across as being heartless, or myself being lazy – I don’t think I’m either of them, but if you disagree with this post, as always, feel free to visit the blog and leave a comment.)

Tonight we got called to a residential home for an 87-year-old female with ‘difficulty in breathing’; once again it was way out of our area of coverage, but we made good time to get there. I’ve been to this home before, and it is one of the better ones I’ve visited; the residents are always clean, and appear well looked after. The care staff know their ‘charges’, and are always friendly, helpful and courteous towards ambulance crews.

I knew there was something wrong from the face of the member of staff who met us. She had a look of total concern, and I don’t like to see that look on someone’s face – it never bodes well. We went through the clean corridors and busy lounge of the home into one of the residents’ rooms. There were three nurses there, one of whom was crying (something I don’t think I’ve ever seen before); lying in the bed was a little old lady who was extremely close to death. Her pulse was weak, and thready, something I could have guessed by the patient’s colour. I very quickly told the staff that, yes, she was extremely ill and that she would have to go to hospital unless she had a ‘Do Not Resuscitate’ order. The staff said that it would be best to take her to hospital. We scooped her up, and her heart and breathing stopped in the lift to the ground floor.

I don’t believe in a ‘slow blue’ (where CPR is performed by ‘going through the motions’ knowing that the patient will not survive and that the CPR is for the benefit of the relatives), so I started active, aggressive treatment while my crewmate drove us the 5 minutes to hospital. The patient remained in asystole (no heart activity at all) and on reaching hospital the doctors there declared her dead.

I may have previously mentioned the study that showed that ‘out of 185 patients presenting with out of hospital asystole arrests, none survived to be discharged’. Both my crewmate and myself – and the hospital staff – knew that this patient had no chance of survival and that the reason we started CPR was because of our policy to commence resuscitation except in certain tightly defined circumstances.

If we had got there a minute later, the patient would already have died – in her bed surrounded by people that cared for her (although not her family) as opposed to being hoisted out onto a chair and then suffering the indignities of CPR in the back of an ambulance. While trying to resuscitate her during the transit to hospital I found myself looking into her dead blue eyes, apologising to her and hoping that she couldn’t feel anything that I was doing to her.

I don’t know if it is because I’ve had one and a half hours’ sleep in the past 38, but it made me feel bad to put her through the indignity of pointless CPR. I know the policies are there to protect us (and members of the public), but sometimes I wish we could use some discretion.

Now I’ll see if I can get some sleep.

I can still remember her sparkling blue eyes looking up at me.

From One Extreme …

So, two nights ago I was dealing with death, people collapsing on the DLR (Docklands Light Railway), young men vomiting blood and looking like death warmed up, and women having miscarriages. Basically everyone I attended to on Wednesday night needed an ambulance.

Last night we had …

One patient with indigestion (for 2 years – FRU on scene when we got there as it was given as a ‘chest pain’).

One ‘gone before arrival’ (a drunk who phoned 999 complaining of a broken arm, but had wandered off before we got there).

One overdose ‘acting violent’, who also had gone before we turned up (driven to hospital by her brother).

One ‘facial injury’ (a woman slapped by her husband: no injury and she didn’t want to go to hospital – her husband was taken away by the police).

One patient with ascites and chronic alcoholism, who was referred to hospital by the GP (could have travelled in her husband’s car).

One call to a police station for an accused who had swallowed some drugs – he denied everything and the police doctor cleared his health.

And one patient with an arthritic knee …

The patient with an arthritic knee was a 70-year-old male who had called out his GP. Said GP had then diagnosed arthritis and decided that the patient needed hospital treatment. We got the call, and had to go out of the area we are supposed to be covering to pick the patient up. The booked hospital was even further out of our area – so much so it was in another sector.

When we got there the patient’s son was present and as we loaded his father into the ambulance we were told that ‘I’ll follow up in the car’.

The look of sheer despair my crewmate gave me had me in fits of laughter; thankfully, I was outside the ambulance so neither the patient, nor his son, who had gone to get the car, could see me.

There was no reason why the patient couldn’t have been driven by his son, yet here we were, out of area, going even further out for someone who didn’t need an ambulance.

Still, after the past few days it was nice to have a shift where no-one was actually ‘ill’, and so we could spend the shift in a fairly relaxed state.

We often get patients in this sort of situation. I’ve given up worrying about it, even if it does mean that an ambulance is tied up doing non-essential work. I just wonder how many people have died because of a delay getting an ambulance because we are forced to do these types of jobs.

Driving for the LAS (For Dummies) Part 1 (Assessment)

When you apply for a job as ambulance personnel for the LAS, one of the things that they look for is that you are a competent driver. Therefore, as part of the interview process they throw you into the most run-down, barely working 14-seater lump of crap they can find, and tell you to drive around Earls Court. For those not from London, Earls Court is a congested area with fairly small streets, constant roadworks and the sort of people who think it is amusing to leap out in front of scared-looking interviewees on their driving assessment.

Before you see a vehicle you are given a piece of paper that tells you what the assessor is looking for, the crossing over of hands when steering is a big no-no, as is over-confidence (along with under-confidence), speeding, going too slow, incorrect use of gears, incorrect use of signalling and a myriad of other things you haven’t worried about since you passed your driving test as a teenager.

When I first went for my driving assessment I noticed the ‘over-confidence’ bit, so I thought I’d be sure not to come across as too aggressive a driver. I was a model gentleman, I let people out of side turnings, allowed pedestrians to cross in front of me and didn’t hassle people who were driving too slow: I failed my assessment for being ‘under-confident’. ‘Come back in 3 months’ I was told.

Three months later and I was determined not to make the same mistake (an additional 3 months stuck in A&E nursing will make you ever so slightly determined). So, I got into the worst piece of crap in the fleet, and off we went. Leaving the yard I hit a kerb and about 200 yards down the road I did the same thing. ‘Turn around and go back’ I was told; I slunk back to the yard and vowed to do better in another 3 months.

Three months later, and I thought ‘Sod it! I’m going to drive how I normally drive’. So I crossed my hands turning the wheel, sped up to stop signals, refused to let anyone out of a side road and drove as if I were driving my 1.0-litre Ford Fiesta.

I passed. Needless to say I was more than happy, and fairly skipped out of the yard that morning.

Of course this double failure didn’t help my confidence when it came to the driving part of my training course.

All I can say is that I haven’t run over any pedestrians, although I have reversed into some stationary objects.

Driving for the LAS (For Dummies) Part 2 (Training)

When you train to be an ambulance technician, you have to do 2 weeks of ‘driving instruction’ where you are split into groups of four, get given a 17-seater van that has been hired for you and you learn how to drive your ambulance using this equipment.

Perhaps the most important differences between an ambulance and the 17-seaters that we are given are that ambulances are automatic, while the 17-seaters are manual (I believe the American term is ‘stick’), and that 17-seaters just don’t ‘feel’ like an ambulance.

The training course consists of 2 days of fun, and the rest is chasing each other around the countryside at high speed.

The two days of fun include driving around a racing track, spinning around a skid-pan and swerving around traffic cones at high speed – both forward and in reverse.

Then, for the next 2 weeks, you learn some theory in the classroom, such as the ‘limit point’ and the forces that act on a vehicle (and why sometimes speeding up when you are losing control is a good thing). The rest of the time is spent driving at high speed around the countryside, making sure that you have the correct gear, speed and suchlike for high-speed cornering.

There are a few things that make this training course less than effective: the first is that as the London Ambulance Service, it is extremely rare that you find yourself driving in the countryside, it is also rare that you drive at any speed above 40 m.p.h. and, as mentioned earlier, ambulances are automatic vehicles and as such don’t have gears.

I drove an actual, real ambulance a grand total of once during training. I sat in the driver’s seat, pointed to the lever in the middle of the floor and said, ‘what’s that, and where is the clutch pedal?’

Luckily for me learning to drive an automatic was pretty easy.

At no point during the driving course did we drive on ‘blue lights and sirens’ – something that may have caused my first RTA.

(Insert wobbly flashback special effect here …)

The first day out on the road out of training school went well. I was attending (A&E nurse for some years) and my crewmate was driving (his previous job? ‘Man and Van’ – driving a removal van around London doing odd jobs). So the driving went well, as did the attending (dealing with sick people). The next day our roles were swapped, I warned our supervisor that I’d never really driven an ambulance before, but he said that we’d be fine if we worked like yesterday.

So, on my first emergency job, blue lights went on, sirens went on and people started moving out the way – it was then that I realised that you can’t fit a 7-foot-2-wide ambulance through a gap made by two cars which is only 6 feet and 6 inches wide. This was the first time (and hopefully the only time) I’ve been sworn at by a boss, although to be fair, the only time I think I’ve deserved it. I learned how to fill in accident forms that day … and how to judge distances a bit better. (An ambulance is wider, longer and taller than a 1.0-litre Ford Fiesta.)