The Complete Blood, Sweat and Tea

Last night was a case in point. We were called to a patient with abdominal pain; however, further information was given that the patient could be violent. There was something in this information that triggered my ‘danger-sense’, so I was happy to wait for police assistance to arrive before approaching the house.

Four police officers turned up – normally only two are sent to assist us – and they told us that their computer system, and their personal experience with the householder, showed him as a nasty piece of work. We followed the police to the patient and they told him that they were going to search him, and that they wanted to put him in handcuffs first. The patient had obviously been involved with the police before, as once he was handcuffed they checked to see if he had any new warrants out for his arrest …

Searching him they found a large stick, and a rather worrying-looking (5-inch) knife on his person.

All through this the ‘lady’ of the house was shouting abuse, mainly at the patient, but occasionally at the police officers present. One quick examination showed nothing life-threatening, so we offered a trip to hospital, which the patient accepted. However, as we left the house the woman shouted a few final obscenities at the patient and he then told us he couldn’t be bothered to go to hospital and stalked off into the night. (This was not a problem for either my crewmate or myself.)

Police computers had information that he was dangerous (a number of rather vicious assaults) but our computers are not allowed to have such data. A police dispatcher has told us that they have all sorts of information on addresses, from animal liberation protesters to Members of Parliament. Again, our computers don’t have any information of that sort unless we enter it manually after an ambulance crew has been threatened assaulted.

Needless to say, one such report has been sent to central office.

I later found out that the patient was addicted to crack cocaine – which explains a lot.

Return of Pavlov’s EMT

Last night we picked up an alcoholic who is HIV positive. I (still) have no real fear of HIV patients, even when they are bleeding a bit and this patient was not (although they had wet themselves). The only problem is that I seem to have turned into one of Pavlov’s dogs. When we found out the patient was HIV positive my stomach churned as if I were back on the PEP. It was really rather strange because it wasn’t fear (I’ll only have that when I’m due for my HIV test) but instead something more … biological.

The son of the patient was extremely embarrassed at the antics of his parent, and my crewmate spent some time making sure that he was alright.

Naughty?

Is it naughty to take someone to hospital, who doesn’t really need to go, just in order to get a fry-up breakfast there?

It’s a lot simpler to take everyone to hospital whether they need it or not. It means that I have to do less paperwork, the patient feels validated and it means that if I’m missing something nasty (which is likely to happen at 6 a.m.) then the hospital has a chance to catch it.

Too Darn Busy

I am extremely busy at the moment; I’m often posting from my PDA (Personal Digital Assistant) and mobile phone. I should be catching up with stuff on Friday (including answering all those comments people have left).

Got some blood results (post PEP stuff), seems my white cell count is still going down. I think they have a life-span of 120 days, so it might get lower before it gets better. Still, it gives me an excuse to see the rather pretty occupational health nurse.

Today we did the usual of little old ladies who feel unwell calling their GP and the GP calling us to take them to hospital because they are too busy to drag their arses out of their office to visit sick people. On the radio it seems that lots of people are dropping dead – the weather is quite a bit warmer (24°C) so the old are placed under a bit more physiological stress.

I have a 101 things to do, and no time to do it – simple stuff like paying bills can be incredibly hard when you are single and a shift worker.

And I think I’m moaning too much …

I’m off to bed now. Goodnight all.

How Not to Stop a Stolen Car

So damn tired …

I’m currently at that point where I wonder whether I am hungry enough to cook dinner before I go to sleep. Which biological urge will win out?

Today, our Control wanted us to go to an emergency call when we were the other side of the Thames – I rather politely asked them if we were the nearest motor as we weren’t actually a boat, the reply was, ‘Yes, do you have your water wings?’ So we ended up going a couple of miles out of our way to cross the river.

The call was a faint, probably from the heat that is roasting London at the moment – at least the women are wearing revealing clothes, which makes our job of cruising through the streets a bit more enjoyable.

Picked up two psychiatric drug-using patients in a row who were drunk and lying in the road perhaps 500 yards away from each other. Some children were poking one with a stick …

Then there was the 51-year-old 4-foot-4 Asian grandmother who, upon seeing her husband’s car being stolen, jumped on the back and hung onto the rear windscreen wiper. She was flung off and, thankfully, not seriously hurt – mainly bruising and gravel rash. Unfortunately, the car that was stolen also contained her house keys and bank books. The A&E was so busy they had to put her out in the waiting room – something that annoyed me no end, especially as the nurse that put her out there had annoyed me earlier in the day by suggesting that I didn’t know what the symptoms of bulimia were.

Now to eat/sleep … then lather/rinse/repeat tomorrow.

Sunday

Sunday alone in my flat, no work, no stress, some decent stuff on telly = Good.

No chocolate in the fridge, uniform to be ironed, work tomorrow = Bad.

Phone call from Occupational Health telling me my blood values are back to normal = Excellent (only HIV/hep test to go now).

Eight … Nine Down

Our complex is EIGHT ambulances short today, so it comes as no surprise that we are running around like the proverbial blue-arsed fly. Control keeps broadcasting jobs for which they have no ambulances, this means that a lot of crews are more unhappy than usual, as Control hassles us about ‘greening up’ quicker. It doesn’t bother me, if I’m busy doing jobs it makes the shift go quicker.

As I’m typing this an ambulance has had a blow-out on the fast lane of the A102 – a very busy road. The crew are alright, but it means we are now nine ambulances down for the next 2 hours at least.

The jobs I’ve been doing are the usual Monday morning sort of stuff: 97-year-old women having heart attacks, 10-year-old boys with cut heads (a rather impressive 3-inch cut, mind you) and 88-year-old men from nursing homes who have ‘high blood pressure’ (they invariably have a better blood pressure than I do).

Now some silly sod has stabbed himself in the stomach with a pair of scissors.

Health Copyright

I’ve been on a ‘Guidelines’ course. Essentially, this is a course that tells us that we are already doing the right thing; it also introduces us to a book with our new treatment guidelines. It takes 2 days and tomorrow will include learning about child abuse (do we have to bring our own child?). So far the course has been a trainer telling us that this course changes nothing, and we are to continue doing what we are doing at the moment. At least the days are short, 8 a.m. until 2 p.m. At the start of every Powerpoint presentation is the same definition of ‘Clinical Governance’.

We had to write our own scenarios then swapped them around to other groups (this is a really easy teaching technique, since you don’t have to plan anything). There was also a chat about how our complaints to compliments ratio is about 50/50, and that most of the complaints are because of ‘staff attitude’. So far I have had no complaints, and no compliments – I’m a strong believer of flying under the radar.

However there is a problem – the Guidelines book we should be getting is version 3.0, but the book we are actually getting is version 2.2.

The reason for this?

Copyright!

It seems that the LAS wants to change a few bits to make it more relevant to London. But because the organisation that wrote it maintains the copyright it can’t be changed for us. Lawrence Lessig’s Free Culture states that you get value added when others can build on your work. This is a perfect example of this principle.

So, the people of London are not getting the best clinical care because of copyright.

Clinical Governance is about getting the best care to the public, so it’s a bit of a mixed message.

Venus Transit

There is a Transit of Venus today – all these special astronomical phenomena remind me of the eclipse we had in the summer of 1999 …

(Cue wobbly flashback video effects)

I was working in A&E at the time of the eclipse and thought that there would be no way I’d get to see it. Like all A&E departments this place had no windows and could be perhaps best described as a bunker. Today, however, the department was empty for the first time in living memory. Normally by that time of the day we would be packed full, but today … not a soul. One person had been in earlier with a painful foot, but there wasn’t the normal ‘trolleys in the corridor’ effect that was normal for that time of day.