The Complete Blood, Sweat and Tea

As I mentioned to our Control, sometimes you feel very lonely out there on the mean streets of Newham.

It is still the case that as soon as the sun goes down, various community services disappear and people in trouble need to rely on the ambulance service and the A&E department, even if it isn’t the best place for them.

Sticky Feet

There is something deeply disturbing about walking on a sticky carpet – especially when the flat is in a complete mess and the punter has called an ambulance 4 times in the last 2 days for a pain in the chest that has lasted 2 years. I’d like the jury to note that the pain hasn’t changed in any way, it’s not worse, or moved around the body, he has no other symptoms. But the patient just seems to like calling ambulances. I wanted to wipe my feet on the way out of the flat.

It also doesn’t help when the patient smells so bad that I want to leap out the side window. We didn’t have any air freshener (and apparently, neither does the hospital).

When we got to the hospital the triage nurse took one look at the patient, muttered ‘Not him again’ and sent him out to the waiting room. I suspect that it may just be a ploy to use biological warfare to empty the waiting room.

I still keep getting called back to him for the exact same ‘problem’.

Workload

Once again I know a lot of visitors here are from America, so I’m going to explain how the LAS works on a day-to-day basis. This will either be very boring or immensely interesting – your choice.

Ambulances run out of dedicated stations, we don’t share stations with the Fire Service. In fact, some years ago, when it was suggested the idea was shot down as we would be disturbing the firecrews’ sleep throughout the night. Each station has its own call-sign ‘K1’, ‘J2’, ‘G4’ for example, then each ambo has a suffix that is attached to this, so one ambulance running out of station J2 would be called J201, while another would be J207.

The stations are spaced approximately 5–6 miles apart, and you mainly service the area surrounding the station; however, with interhospital transfers and other irregularities you can quite easily find yourself across the other side of London.

It’s an old joke that when asking if we need to travel so far the dispatcher will ask us if it still says London on the side of the ambulance.

There is a main station, and two or three ‘satellite’ stations; the main station will normally have between three and six ambulances running from it, while the smaller stations have between one and four. There is less cover at night, and you can easily find yourself being the only ambulance running from a given station.

Across London we deal with more than 3 500 calls per day, and with a fleet of 400 ambulances of which perhaps only three-quarters are manned, we seldom get a rest. Where I work we average 1 job an hour, and are supposed to transport every one of those patients to hospital.

The longest shift we officially do is 12 hours, in which we can expect 10–13 jobs, which doesn’t sound like a lot but is enough to keep us busy … We spend 97% of our time away from station (compared with 3% for the fire service).

However, it is a fun job.

Night Shifts

There has been a discussion over on another medical blog’s forums over which shift we prefer to work. Like many of the others I have a preference for working through the night. The reasons for this are many but include:

(1) I’m single, I can lie in bed as long as I want. And breakfast is dinner … and kebabs are lunch … and an icecream is supper.

(2) You get empty streets, and so can drive like someone out of ‘The Fast and the Furious’.

(3) You also get the strange jobs: ‘sex-toy accidents’, criminal behaviour, stabbings … (4) It feels as if you ‘own’ the world: there is no-one else around, and anyone you do meet is normally shocked to be awake at night.

(5) You get to work a lot of jobs with the police, who are generally excellent people to work with.

(6) I get to sleep through early morning television – I’m sorry but I can’t see the attraction of ‘Trisha’ or ‘This Morning’.

(7) I don’t have to go into a school, and be surrounded by 400 screaming children just because a kid has sprained their ankle.

(8) There is less management around – actually there is no management around (always a good thing); I like to avoid management as much as I can: I worked this job for 6 months before they remembered my name.

(9) On a cold winter morning, I’m going home to my warm comfortable bed, while everyone else is trudging to work.

I still like nights, which makes me a rarity in the LAS. Most of my most interesting jobs occur at night.

Busy, Busy, Busy

No sooner do I post why I like night shifts than I get two ‘proper’ emergency calls, one after another. The first was a 76-year-old Male ‘Suspended’. Unfortunately, despite our best efforts there was little hope for him, and he died later in hospital without his heart ever restarting. His wife of 50 or more years was disbelieving of the whole situation, and I was too busy doing CPR to be able to comfort her much. It is one of the few things that I miss about nursing – sometimes you want to spend time with a relative. If you can’t do anything for the patient, the relatives then become your concern. For the first time in 50 years she was going to sleep alone and the nurse who would be looking after her is not someone that I would call the most sympathetic person in the world. I spent a little longer at hospital talking to the wife. The only consolation that I could give her was something that I’ve practised many times over the years – that her husband never suffered, and that he wouldn’t have felt anything that we did.

The next job was a man who, after drinking too much, fell over in the street. He had a greatly altered level of consciousness, possibly due to the alcohol but also possibly due to the large head injury which was leaking a frankly excessive amount of blood over the tarmac.

He could have been worse – he was lying in the middle of the road and could have easily been run over. It is important in such a job that you should ‘collar and board’ them. This is a way of immobilising someone in order to prevent any damage to the spinal cord. Unfortunately the patient was quite combative and so the only safe way to secure his head was for me to hold it during the transport – all the time blood was leaking through the dressing we had put on him, all over us, the trolley bed and the floor of the ambulance. Some managed to flick up onto my crewmate’s face, which is something you don’t really want happening to you.

I’ve just come back from the hospital (after dropping off yet another assault) and our patient is doing fine – seems that his altered consciousness was indeed as a result of the alcohol. He still isn’t sober enough to have a meaningful conversation, but he is looking a lot better than when we picked him up.

I still like wrestling with drunks, and writing about blood being flicked up into your face set the stage for a future set of posts.

New Uniforms (But Still Green)

The LAS has got some new uniforms. These include ‘combat trousers’ and a fleece, which is nice seeing as it can get a bit nippy around here. The only problem is that we use ‘Alexandra’, who doesn’t have the best reputation, for our uniforms. We’ll forget that they can’t measure you up correctly – I am not a 38-inch waist no matter how many kebabs I eat. Instead, let us consider that the buttons on their shirts tend to fall off at the worst possible moment. Having a button drop in a dead man’s mouth when you are trying to resuscitate him is not something that inspires confidence in the relatives watching. I was supposed to have eight shirts; two of them have been cannibalised, so that I have six shirts with the right number of buttons.

The new uniform actually seems quite nice. We have a little NHS logo in case the big motor with ‘Ambulance’ written on the side is not enough of a clue to our identity, and the shirts have a mesh in the armpits so we can let our sweat out. The combat trousers have ‘Permagard’ (their spelling, not mine) which is designed to kill bacteria, which is nice considering the state of some of the houses we visit. The high-visibility jackets are … well … visible and we now have a green ‘beanie hat’ (I think it’s green so that people won’t wear them anywhere except at work).

There is a rumour that we will be getting new boots soon … ‘Magnums’. We are a bit like the army in that we buy our own boots because the ones supplied are a bit shoddy.

Anyway the uniform ‘goes live’ on the 12th but those who have uniform that actually fits have been wearing them early. The bosses are moaning a bit but haven’t actually told anyone off about it.

I now have five shirts with the right number of buttons. People are still buying their own boots.

Daddy, Daughter, Kill

Picked up an assault yesterday. While sitting in the back of the ambulance he told his 2-year-old daughter that ‘daddy is gonna fucking kill the people who did this to me’, then complained when the nurse at the hospital told him to moderate his language.

I love this job.

We then went to someone who started hitting his own nose in order to prove that it had been bleeding earlier, and then went to a woman who had a bleeding varicose vein that had stopped bleeding, but wanted to pick at it to prove that it had been bleeding.

Then we went to a 14-year-old girl who was ‘fitting’ but when we got there was confused and combative – she was a diabetic so we checked her blood sugar, which was low. Being confused is one of the symptoms of a low blood sugar and we normally give them an injection that brings them out of it. We gave the injection and waited for it to work and receive the grateful thanks of the parents.

But it didn’t work.

We checked the blood sugar again, and it had come back up to normal levels, yet the condition of the girl was unchanged.

So we (rather quickly) took her into hospital – we haven’t been back there yet to find out what had caused her confusion. Was it drugs, alcohol, psychiatric problems, CVA (cerebrovascular accident) or even just a bad nightmare? Once we get back to the hospital which we took her to we will no doubt be able to find out. She didn’t have a high temperature, didn’t have any medical history besides the diabetes, her pupils were normal and responsive; all observations were normal.

We spend a lot of time dealing with things that are simple to cope with. You can fix them almost by rote thinking, but every so often you get a job that throws you off balance. Normally you ‘wake up’ and deal with it by going back to basics, but other jobs just completely confuse you, and this was one of those jobs.

This post got me a large number of people coming to my site looking for the search term ‘Daddy fucking daughter’. Sometimes the Internet is a scary place. It turned out that the girl had been drinking vodka, and that this was the reason behind her confused and combative state.

ORCON!