Pour some sugar on me

Drunks. Probably the most common job for ambulance crews across the UK. Alcoholics, Saturday night revellers that have had one too many… There are many reasons why a person night be drunk and incapable, but crews must be wary. Not only of the potential for an aggressive but also for misdiagnosis. Not everyone who appears drunk actually is drunk.

There have been jobs I was called to where we turned up and the patient was rolling around, cursing and swearing at onlookers, there was even the strong smell of spirits about them. But they weren’t drunk. The smell? Ketones. The problem? Diabetic Ketoacidosis.

Diabetes affects almost 4 Million people in the UK (approx figures, 2019). Many of those have it under control by their diet or by medication. Occasionally, or in some patients often, their blood sugar rises too high (hyperglycaemia). This can happen for many reasons, but whatever the reason, the results can be fatal. Excess levels of acid build up in the patient’s body and can cause organ failures. To onlookers the patient can seem, and smell, drunk. The only course of action an ambulance crew has in this situation is to take them to hospital where the patient’s blood sugar can be monitored and lowered in a controlled environment.

At the other end of the scale, diabetics can sometimes let their blood sugar drop below safe levels too (hypoglycemia). This too can be dangerous, but ambulance crews can do something more in this case. Initially, if the patient is conscious, there is a disgusting tasting gel that comes in tubes. In my day it was known, cleverly, as Hypostop. It usually did…what it said on the tube. In more severe cases where the patient may not have been quite so conscious, they carry a drug known as Glucagon. I’m not going into the chemistry here, if you want to know more details as to its function, there’s a lot of information on the Internet. Basically, it helps raise blood sugar levels. The only problem with the drug is that it needs to be injected into the patient’s arm or leg. Simple….you might think!

We had a few regulars in our area. People who didn’t control their blood sugar levels very well for various reasons. Two of them became quite aggressive when their blood sugar became low, one in particular. Ambulance crews have no ability to restrain a patient, and usually the police are called for such things if required, but in some circumstances there’s no time for that. We knew the drill, and we usually had the patient’s consent…afterwards, when they were stable. One of us would hold the patient down while the other injected the glucagon. We had a set routine and it worked well. Once the patients blood sugar began to rise, and they became more lucid, we’d give them some of the vile tasting gel and one of the family would make them some toast. They never went to hospital, there was no need, and we left on good terms.

An unwell diabetic incident can have many forms. Sometimes it can even look very much like a stroke. Yes, there are a lot of drunks out there, but I have been to many incidents where people have decided the patient is simply drunk and act in a very quite judgmental fashion. Important lesson No. 1 – never assume that what you see is caused by what you think it is. Ignorance is not an excuse for poor actions. Ambulance crews are trained to use the equipment they carry and diagnose based on their knowledge and experience. Leave them to do the diagnostics and treatment.

Turn to the Dark Side PtII

Angry post warning.

I’ve already spoken about ambulance crews’ dark humour and other coping strategies that they use. I mentioned how “normal” members of the public often don’t get it. Recently I was horrified to read an article relating to this.

It revolved around a message sent to ambulance crews, in their ambulances, telling them to “Please be mindful when outside A+E of how the public view your actions. Eg. Being on mobile phones/Snapchat or taking refreshments.

Firstly, what narrow minded, uninformed person actually sent that message? Any member of any ambulance service should know what their staff go through. To send something like that to crews, while they are still on duty, is utterly thoughtless!

Secondly, the message began “Following a complaint from a member of the public…”. Whoever took that complaint should have put that member of public straight and explained what the crews actually go through on a daily basis and ended things there. It should never have made it past that first person.

There are blinkered people out there who think ambulance crews should go round expressionless and unemotional. Unfortunately robotics hasn’t progressed that far yet so the job is still done by humans, with emotions, and coping strategies.

Sometimes, after certain jobs, they just need to chat with a friend or a loved one, outside A&E, on their phones. Sometimes one of the few chances they get to drink coffee etc is after a job, outside A&E. Normally because they are so busy serving members of the public. They might even have been on their phone to a counsellor after a particularly traumatic incident.

Please don’t ever judge crews for being human. That “member of the public” probably had no idea what the crews they were complaining about had just dealt with. Maybe they actually just needed a break and a brew, perhaps they were taking the chance, between jobs, to check in with their loved ones they’d not seen for a long time because they’d been doing long shifts.

I hope the person who actually sent that message was suitably dealt with.

Finally, if you think I’m wrong, and if you think crews should behave differently, most ambulance services are usually recruiting – why not put yourself in their shoes and see if you are right.

It’s happy (mostly) hour again

Being part of an ambulance crew at a rural station frequently meant long journeys into the main hospital in the city. This often meant spending time in the back of the ambulance with a patient. If it was an emergency you were usually busy, and the patient was most likely unconscious. For a general admissions, the patient was conscious and it was our job to offer reassurance when necessary.

It was like being a barman inost situations – the patient would open up and talk about anything and everything. There was an unexplainable trust, like they knew they could tell you anything. Obviously there was the whole patient confidentiality that meant what was said in the back of the Ambulance went no further, but it was more than that.

I worked in a bar one summer, and I learned things about people because I was somebody they could comfortably share their problems with. Being in the back of an ambulance with a patient was the same.

Sometimes the patient was terminally ill. It was a privilege to be a listening ear to them. To help them by allowing them to get things out of their system to someone who was disconnected from their situation, but could still show sympathy.

Elderly people would talk of the changes the had seen, the difficult times during and after WWII. Some spoke of their experiences of war. Not as innocent victims at home, but as active soldiers involved first hand in the fight. I’ve spoke before of the heroes, not looking for glory.

But being in the back of an ambulance can also be a challenge. There are the aggressive patients – more than once I….”asked” a patient to leave the vehicle. There are some things that won’t be tolerated and, generally, if the patient is able to threaten the ambulance crew then they most likely don’t need their help.

I had many humbling experiences, I have many special memories of patients. It is very like being a barman, but a million times better!

The One and Only

They say everyone in frontline medical care has that one job. The one that sticks with them, sometimes forever.

Mine was an 11 year old, hit by a van while they were actually playing on a dual carriageway. The van driver had no chance of stopping or avoiding them. I often wonder how the driver fared afterwards. For a long time I was angry at the parent that allowed them to be there, but then I realised that they had lost much more than me. I drive past the location sometimes on the way to places, there are still flowers and other tributes tied to a lamp post near to the site.

I know for one colleague it was the 15 year old we cut down from a tree in their garden.

This is not about doom and gloom. It’s about the fact we are all human. No matter how tough the exterior image, we all have the sleepless nights where we wonder “could we have done more”. The answer is always no, but that doesn’t help.

“Stress” was a common ailment in my time. Only now is it being recognised as PTSD. Still the support is not there. Managers still tell you to call a helpline if you’re struggling, rather than recognising the fact that you are not coping and dealing with it themselves.

The title of this post, yes, it’s from the Chesney Hawkes song. It was the theme song of my group during my training. We knew what we were getting in to. Our instructors were veterans and held nothing back.

But still we all went into it. From the first death, the first CPR job – we toughened ourselves and went on to the next job. Most of the public didn’t care, they just wanted what they felt they were entitled to. We did our job, many still do. Not because of the glory, there is none, but because we made a difference. I always said for every hundred patients, if just one says “thank you” then the job was worth it.

It’s New Year and most of us will have made a toast at midnight on the 31st. Something positive and forward looking. I want to end this post with a toast a friend sent me. A friend who still serves with an ambulance service despite a severe period of diagnosed PTSD, after their one job:

“Here’s to getting out of bed when you don’t really want to. Here’s to going to work knowing no one really cares. To doing your bit. To making a difference, to getting by, helping them ambulance types that need it. To making yourself available to the ambulance types that haven’t realised yet that they need some help. Cheers!”

I’ll stand by you.

It’s coming up to that time of year again. The time when all the charities ramp up their appeals on TV and on the streets. All the main organisations have started. In his post, I’m not going to tell you who to give your money to. I just want to mention a few causes that I feel deserve extra support around now, a couple not often thought about. All have already been mentioned in previous posts but they are still important, perhaps more so to me because of my personal experiences with them (that is what this blog is all about after all).

Firstly, elderly people. Winter is a dangerous time for many. With fuel costs rising, hypothermia becomes an actual killer. When you casualty turn up your heating without, think of the older ones who can’t afford to. Loneliness is a huge problem too. Some elderly people may have recently lost their partner of many years, possibly facing their first Christmas alone. More than once I was called to such a person around this time of year, who saw no reason left to live any more and just gave up.

Those are the people who need practical support. Friendship, food, heat, people who show they still care about them.

Secondly, not only the people with terminal illnesses – also the frequently unsung heroes who support them. Family members, who are terrified that this might be their last Christmas with the loved one they are supporting. Also the support charities. The people who try to help it all be that little bit more bearable for everyone, while trying to walk away and hold on to anything they can to keep themselves going.

There are many others but finally, I want to mention one very close to my heart – of course, emergency crews, primarily ambulance crews. I’ve already highlighted PTSD, stress, depression…all the problems brought on by giving everything they have to help other people, while very few people give anything to help them cope. Suicide season is near, it’s a difficult time for ambulance crews. The ones who cut down bodies, who try to save someone after an overdose. Many times the patient doesn’t want to die, their “attempted suicide” is a cry for some attention, someone to show them that they are interested. That’s hard to walk away from at the end of a callout, but ambulance crews have to do it.

This next part is not an appeal, I just want to highlight a few charities that help with the situations I’ve mentioned, a couple I have been involved with personally:

For the elderly –

Help the Aged. Essential work with elderly people, especially at this time of year, with your support.

For victims of cancer, and their families –

Maggie’s cancer support centres. They provided a lot of valuable support to my partner after surgery. The staff are amazing and give more than we could have ever expected.

Two(ish) for the Ambulance crews –

PTSD999. PTSD is starting to be recognised more and more in our emergency crews, it’s not rocket science, but no one thinks about that when they see ambulances around towns and cities. PTSD999 is one of a number of charities highlighting this, and helping emergency crews up and down the country.

Frontline Coffee (https://frontlinecoffee.co.uk). Set up by ex-firemen, they have created a number of different very high quality coffees in various forms (beans, ground…), the profits of which support different emergency services. One of the blends is specifically for Tasc, an ambulance support charity that I know does good work from inside the service. They also give you the opportunity to send a bag of coffee to your favourite emergency services station so you can show practical support. Coffee and emergency services – genius!

And finally, one for all of the above –

You! You can give practical help to them all –

Keep an eye on elderly neighbours, cook something for them, show them you are interested in their welfare.

Ask cancer support groups how you can help, many require volunteers for events etc.

Emergency crews love when someone shows their support by dropping a box of chocolates or biscuits at their local station, or drops by on Christmas Day with a wee gift. I know this because I spent one Christmas Day single crewed, and was visited by a few people who made the shift much more bearable.

I hope this post hasn’t been boring, and that it has made you consider some of the groups I’ve written about. Don’t leave it to “somebody else”, be that somebody. They say Christmas is about sharing, I say it’s about caring too.

Gone, but never forgotten

This post is a tribute to two people, but it also applies to many others around the world. The ones for whom the job becomes too much and they see no alternative. The ones who the system fails to recognise and support.

We trained together, without their help and motivation I might not have been as driven as I was. Then we lost touch. I heard about them through another training friend, the one who found them. It had been thought through, and there was no going back. On reflection, there may have been warning signs, but we deal with death and dying every day. We’re supposed to be immune to it, or so people think. Management don’t care, they are insulated from it in their offices. Forgotten by management, unknown by the public, never forgotten by us. One of us.

A trauma gp, a paediatrician, an anaesthetist… Those were a few of this person’s skills. They were trained to drive with systems by the Ambulance Service and they’d be on call for incidents involving trauma. Because they lived near my station we’d see them often at RTCs. When you felt their hand on your shoulder, and heard their voice, you knew everything would be ok. They didn’t take over, their voice usually said “hey, what can I do to help?”. That’s the kind of person they were. No one guessed there was a problem, until it was too late.

I’ll tell memories of both in later posts, this one is to remember them.

Gone, but never forgotten. To all the emergency workers who have passed away because the job got too much and the support just wasn’t there. Hopefully we learn from the tragic loss before many more die, saving other people’s lives….