Oh. Is that serious??

Medical terminology has long been a source of entertainment for many ambulance crews. There were the smart dispatchers who would try to use fancy medical words when they sent jobs to the crews, but the majority of patients had no idea what they meant. They did, however, brighten up the crews’ days. Whether laughing at the dispatcher or finding mirth in the words themselves, the effect was usually good.

“Ah yes Stan. You appear to be suffering from an acute case of epistaxis” (aka a nosebleed). It was ok to joke with the regulars, building a rapport with them was like a form of reassurance, and reassurance was one of the best tools we had. But medical terminology also made the mundane jobs more bearable, like the D&Is (Drunk & Incapable). We were often called to the results of drunken brawls and, assisted by the police, we had to decide whether or not the drunken individuals actually required transfer to A&E, or if they could safely be sent on their way. On initial examination, were the brawlers relatively compos mentis, we’d sometimes do some “unorthodox” tests. Nothing nasty or horrible, just silly things, like the straight line walk, the finger to nose test (often resulting in a poked eye!), and the medical terminology test – “I’m afraid you seem to be suffering from a bilateral, periorbital ecchymoses!”. This either resulted in a look of confusion, or a sudden look of horror. “Is that bad? Am I going to die?!” If we provoked the latter we would be quick to explain.

At this point I should probably clarify – we would never encourage fear in a patient, and if extracting a small bit of fun at the patients’ expense would never be taken beyond a simple laugh.

A periorbital ecchymoses means nothing more than a black eye. Bilateral meaning both eyes.

Fun with medical terminology was not restricted to the patients. We sometimes played Word(s) of the Day – a medical word, or expression, would be chosen and the challenge was to use said term in a meaningful patient handover to the staff member at A&E. There will never be a greater triumph in this game than my ex-colleague who managed to seamlessly fit the term “fecal smudging” into their handover. The patient was elderly, a queried hip fracture, and had been lying on the floor of their house for some time. The situation was perfect, the stage was set. On our arrival at A&E the word was spread around crews there, and a few select nurses. Like excited children we sneaked around the other side of the receiving area to watch. The jammy sod got a student nurse! My partner began their handover and the student nurse stood, listening intently and nodding their head in an almost knowledgeable fashion. Then it came – “………..significant fecal smudging up the patient’s back……….”.

My partner continued as if everything was normal, the student nurse continued nodding. That moment cost me coffees for a week! It was never forgotten. Other Words of the Day ranged from” bogey” to “butt plug”. The latter was involved in a failed attempt. Thankfully I was not there to see it!

None of the above involved any harm to anyone, but they were part of the mechanism that helped many ambulance crews cope with the more mundane parts of the job. In some cases they even helped ease the stresses of other jobs.

There has been much criticism of ambulance crews seen laughing on the way to jobs. Never underestimate the professionalism of ambulance crews at a job. But also, never query their coping mechanisms, unless you are willing to get out there and prove you could cope better with what they have to deal with!

It’s based on a true story… Honestly!

Of course I’m talking about the well know UK television show based in the ED of a well known, entirely fictional, English hospital. While I used to watch it purely for the clinical inaccuracies and the abnormally dramatic lives of the staff, now some of the the storylines are close (sometimes very) to jobs and realities I have dealt with. Most recently; Man down, the loss of a colleague. During my career that spanned more than a decade, a number of fellow ambulance colleagues passed away. Some through illness, others in accidents, one more tragic. Most I didn’t know too well, others i knew a bit better, all were sad and their loss was felt across the service. The latter I trained with.

I knew the person closely for 10 weeks, we trained together back at the start of my career. They were a major help towards me passing the exams, a close friend for those weeks away from home, then I never saw them again. but that didn’t ease the impact the news of their passing had. I don’t know the full story, but I know that the job we did had a big involvement in their passing, and that greater support and intervention may have prevented it. I recently met up with a friend who was closer to them. The loss has been very obvious in that friend’s life but, thankfully, support is finally in place for him. But it came from his GP, not from within an Ambulance Service.

The coming episodes of the TV series apparently show the paramedic, and other ED staff left behind after the loss of their colleague, slip into a dark places. I remember the last radio call for paramedic Jeff on the program, my colleague received none of that. Circumstances may be different, but the emotions are the same, as are the questions in peoples’ minds – once again, could more have been done to prevent it?

Ambulance services across the country need to step up care of their staff. I loved my job, but most ambulance crews see and go through things that change the way you view life. “here’s a number you can call….” never has, and never will be enough. I realise this post might ruffle a few feathers in a few ambulance divisions but I hope that, rather than the usual brushing problems under the carpet, they might try to change things if that’s the case. When someone feels unsafe, unsupported by the organisation they work for, something is very wrong!

The TV show may be fictional, but some of the characters and stories are closer to life than you might think. Yes, this post might read like an angry grumble about the lack of support available to ambulance crew members, probably because it is, but I’ve not even brushed the surface of the problem. No one should be abandoned for doing their job, for trying to save lives.

For every “Jeff”, every “Sam” and every “Iain” out there……

RTC? RTA?……….. Crash!

No matter what you want to call it, the coming together of two objects often ends in injury, or worse. I had not long started when I was called to my first fatal RTC (Road Traffic Collision). I think they were still known as RTAs at that point (Accident) but later someone decided “accident” implied that no-one was at fault. I was still working in the big city, it was winter, the roads were icy and there were celebrations going on.

One driver, of a rather large car, had decided one for the road was not enough. Suitably oiled himself, he had taken a large corner too fast and slipped over to the opposite carriageway halfway round, straight into the path of an oncoming 4×4. Not a scrappy German, WAG taxi style 4×4, a real, solid built one. The result of the head on collision was spectacular!

On our arrival, two other crews were working in the rear of the large car in the middle of the road, while the fire brigade were busy dismantling what remained of it. The other vehicle was on the grass verge, looking like it belonged to a passer by who had simply stopped to help. It had a slightly cracked grille, scratched paint…..if you looked closely, and a broken light (not an exaggeration!). The driver was being checked over by a Dr who had come from a house nearby by seemed ok, other than a bit shaken.

There were three people in the large car. All were rather large, none were wearing seat belts. The crews on scene were working hard with the fire crews (aka, with utmost respect, “drip stands”) to extract the two passengers from the rear. Both were in critical condition.

There I was, barely qualified, already a number of RTAs under my belt, but never at night, never in the biting cold, never with so much noise from so many fire engines. I stopped before getting out of the Ambulance and turned to my partner, a veteran of many incidents. My heart was pounding, the noise was mind numbing. “Breathe, then assess the situation” they said in a calming voice. That advice stuck with me throughout my career.

By the time I left my ambulance I knew what my part was and what I had to do. The driver was my patient. Because work was going on in the rear of the car, I had to wait until the passengers were out before I could attempt to deal with the driver. I knew I had to keep his head straight, something important in every impact situation to try to keep the Spinal column straight and prevent any damage to the Spinal chord. I also had to keep them calm while their car was being cut apart around them. I grabbed a fireman and asked them to remove the front windscreen. Once done I was able to talk to them, making sure they were looking straight at me all the time, and not moving their head. Even the length of the bonnet away from them, the alcohol fumes were strong. I asked my partner to put an oxygen mask on the driver, then it was just them and me…..in the middle of a world of organised noise.

I stood in front of that car for, what seemed like an eternity, talking to the driver and finding out all about them. They had been to a party and had decided the roads would be quiet enough to drive home ok. My hands and face were numb with the cold by the time the first passenger was extracted from the rear of the car. I could tell from the looks on the peoples’ faces that it wasn’t going well. They disappeared off to A&E. Then the second passenger was extracted, my partner was helping and they shook their head as the lifeless body was wheeled to the other ambulance. The crew were giving CPR, but I could tell it was hopeless.

As soon as the fire chief gave me a thumbs up I was in the remains of the car, holding the driver’s head from behind their seat. I had already established that the whole front of the car was pushed back, the dashboard and steering wheel pressing against the drivers legs and chest. They had complained about pain in their right hand so I looked from behind them, now I was able to attend to them properly. “it will be ok, well get you sorted” I said, as reassuringly as I could muster. The hand was hanging by nerves and skin at 90 degrees to their arm. The broken ends of the bones were visible at the end of their arm, and sticking up from their hand. Mercifully there was no arterial bleeding!

The fire chief and myself quickly worked out a strategy and explained it to the patient, then they got to work removing the front of the car. The cutters made light work of the metal. Then the whole chassis broke in half, down the length of the car. My left leg was jarred down suddenly and the engine dropped on to the road at the front of the car. The oil sump cracked and oil ran everywhere.

We patched our patient up, extracted them with the help of a spinal board, then into the Ambulance. The journey to A&E was quick and we handed our patient over. As we walked away the patient said something, muffled by the oxygen mask. The nurse lifted it and the patient looked me in the eye and mumbled, still slightly drunkenly, “Thank you. Happy New year, when it comes”. My heart sank! Neither of the two passengers had survived as far as A&E. The driver would never drive again, possibly not even walk. Not a very happy new year.

The moral is simple, obvious, but there will always be those who think they know better. There will always be ambulance crews who will try their best to save them.

“I could never do your job!”

Not true! I went into the Ambulance Service as a non-emergency driver for nearly the first two years of my career. I was squeamish and had no medical background. I couldn’t even watch medical stuff on TV! One night, while working overtime taking discharged patients home, I was confronted by a non-emergency driver from another large organisation. He was grey, could hardly talk, looked terrible and was asking me for help. I had no idea what to do, so I called over to the receptionist who immediately called the crash team. Now I would instantly recognise the symptoms of a heart attack, but that night hit me hard. That was when I knew I could no longer be a bystander, the one who calls for help.

I had no intentions of becoming a hero, and I can honestly say I still don’t. I was trained by road experienced veterans, who drummed any aspirations of herodom out of us very quickly, and were keen to point out that you will never know everything, that your best resources of information are the long serving colleagues you will be working with. It worries me slightly that the current breed of youngsters have a different approach. The current training across many ambulance services is an academic one. The youngsters have no life experience, and leave training (approx. 3 months at a university in most areas) better qualified “on paper” than many older staff with vast experience. Many, not all, of these youngsters seem to believe they know everything they need to, and that they have been adorned with superhero status and the powers associated with that. I still see ambulances flying through traffic with a seemingly banzai attitude, crewed by youngsters who look like they should still be in school. I often joke with ex-colleagues that these young academics could write a patient a good essay, complete with Harvard referencing, but would they be able to spot a TIA or a PE quickly enough? Would they know when it’s more important to make an elderly patient a cup of tea and spend time with them, then refer them for a home visit from their favourite GP, simply because they’re lonely, rather uproot them and take them hospital because they can’t find a problem and don’t know what else to do? Having said all that, there are some who will become fantastic emergency medics.

During my years in the service, I told myself frequently – if one person in every thousand says “thank you”, then my job has been worthwhile. Shortly before I left the service I had the most humbling experience of meeting some who’s life would undoubtably have ended without my intervention. I’ve since heard of others, relatives of friends and, while I still maintain that I was only doing the job I was trained to do, I won’t even try to explain the amazing feeling news like that gives you. Well, not in this post.

Anyway, the point of I’m trying to make, in a very long winded way, is that anyone can be an emergency medic. If you have the urge to make a difference, if you don’t like being a bystander, consider it. Sqeamishness and other such things disappear when you’re doing your job, and your training and experience kicks in. Whether you’re picking up a very large, very drunk person who’s soiled themselves and spread it up their back by rolling around, or directing other emergency services at a bad crash on a busy main road, it’s still the best job in the world

Finally, if you really want to be a hero, I suggest you join the army!

One of those admin posts….

Firstly, thank you to my readers, followers, and likes. I started writing this blog in an attempt to get some things out of my system and to get some things out in the open. I wasn’t sure if anyone was actually going to read any of it, but it appears there are people who do. Some of the issues I post about are still problems within ambulance services up and down the country, most likely in other countries too. In the UK mental health problemi in crew members tend to be swept under the carpet and ignored, but they are becoming more and more of a problem. After all, ambulance staff are only human. A recent episode of the BBC series Ambulance showed a large scale incident in Birmingham last year, with numerous fatalities. Viewers saw a small window of how the medics were affected, then there was the debrief. In all my time as a medic, I was invited to one debrief, and it was by the A&E staff involved in a nasty job we had taken in. My partner and myself had to push our dispatcher hard to be allowed to go, and we were called to a job before the meeting ended.

Please share my blog, tell people about it. Maybe we can help make people aware of how ambulance crews are breaking every day. I mentioned in an earlier blog how I’ve already lost one friend because of the job, I know I’m not alone.

What I would like most though is if you would talk to me, share your own experiences via the contact option. Only I can see your personal details, and I will never share them publicly. If nothing else, it let’s me know what you all think of my posts. Most importantly, it’s good to talk, I know it’s helped me.

Nocturnal Admissions

Night shifts are a whole world of difference. Often, mostly at weekends, we’d be called into the big city to help the busy city crews. This could work well as we’d get the “real” jobs while the city crews dealt with the usual drunks and alcohol fuelled brawling. Sometimes it worked out the other way around. Either way, we all knew that it was going to get busier around closing time. That was when the alcohol seemed to make people braver, and by people I mean every gender. The girls were the worst! Nails, handbags, hair pulling, scratching……The guys just turned into (what their mashed up minds thought were) He-Men, and they felt the urge to attack anyone who dared look in their direction to show their dominance. On that note, I never understood why these males turned into sobbing messes in the back of the ambulance, some even asking to talk to their mothers (yes, seriously!). So, you can picture the scene – Saturday night, drunk people everywhere, you could almost smell the aggression in the air, and us….in a white van with very similar markings to a police van…..and wearing very similar high visibility jackets to the police officers. Police officers who seemed quite sparse on the streets.

We received a call to a regular in the city centre. He was an alcoholic, with a history of violence towards the uniformed personnel of all services, and he had his own area and MO. He used crutches (I never found out why) and used to prey on the soft heartedness of the late night revellers . He would take “fits”, conveniently next to a phone box, and passers by would call for an ambulance when they saw his performances. When the ambulance turned up he’d miraculously recover and swing his crutches at the crew. Our call wasn’t the first one to him that night. When my partner read the job on screen to me we both said his name together. So we rocked up, in our white van, and got out in our high visibility jackets. there he was, lying on the ground. ” He’s having a fit!!” cried the half dressed girl, struggling to stagger in high heels while clutching a bottle of some vile coloured alcopop. My unfortunate first thought was “that will look interesting in a sick bowl later!”, then we approached our patient. To the onlookers he looked pretty much unconscious, but we knew better. We stood either side of him, each with a foot on one of his crutches. “Come on *****. We have sick people to attend to”. One of the onlookers was about to voice their surprise at our approach, but was beaten to it by the “unconscious” patient. His eyes shot open with rage and he shouted/mumbled/sprayed “**** off! The lot of you!!”. He swung his arms at us, realised he had left his, now anchored, crutches behind, then lay back down and swore some more.

Then it all kicked off. There was a small street adjacent to the one we were on, that had a number of nightclubs along it. We heard the noise first, then saw the fighting spill out onto our street. Not drunken brawling, but real viscous fighting. there were around 15 males intent on seriously injuring each other, and it was all moving in our direction! We looked at **** and told him we were retiring to our ambulance , and that he’d be best vacating the area too. Miraculously, he recovered, and rapidly hobbled away. My partner dived into the ambulance as the mob got closer, and locked the doors. I banged on the opposite side window, just as one of the males’ heads sent the large wing mirror on his side squint.

He unlocked the doors and I jumped in. I pressed the Emergency Callback button on the dashboard display, and my partner put in an emergency call via his radio…….. Radio silence! We repeated the actions another time. Eventually, a very bored sounding dispatcher responded. I shouted “We require immediate police assistance at our location!”……….more silence. “6932 to control. Immediate police assistance required! Ambulance under attack!!!”. “Oh, I’ll see if they have any units free” came the reply. “6932 to control. Listen!”. “Oh……. Is that your ambulance making that noise?”. “Negative control. That’s somebody’s head being repeatedly slammed against the side of our vehicle. Get us multiple police units, and any spare ambulances here…..NOW!!!”. ” “Roger 6932. I’ll do that right away”. He’d woken up now. We were in the middle of expressing our views on our controller when the radio sounded again – “Erm….police en route with multiple units………… So.…….erm……..are you guys ok?”. We didn’t reply.

Less than a minute later the police arrived in force! Any of the mob still mobile scattered and we felt safe enough to unlock our vehicle and step outside. It felt like stepping into a war zone. There were bleeding revellers lying around everywhere, so we called it in and began to do our job. We never found out what caused the riot, and we didn’t hear from **** for a good while. Oddly, I felt safe outside the Ambulance at the start of it, before my partner let me in. I felt very unsafe in the city centre most nights, but I was there to do a job. That night, I was in the middle of a riot, but I almost felt like the rioters were avoiding me.

Other vehicles arrived and we dealt with all the wounded. After giving police statements, we cleared.

Perhaps completely unrelated, the next job was to an intoxicated female, who I’m still convinced could not be the one who spoke to us earlier but, just to add to our bizarre night, she managed to fill two sick bowls with half digested kebab……soaked in vile blue alcopop. You have to be careful what you wish for sometimes!!!

You only live…..once

Despite the James bond book/film that claims otherwise, the above is unfortunately very true! When it’s your turn, nothing can change it. Some people, however, choose to bring their time forward. Warning: this post is a blunt one!

Many times we’d be called to an “Overdose”. Sometimes it was a drug user who had overdone it unintentionally, often we could reverse the Overdose with a drug we carried, other times we were too late and the patient had passed away (usually before the 999 call was made). There were also the patients who wanted someone to pay them some attention. These were the ones who took 5 – 10 paracetamol or ibuprofen, thinking that it wouldn’t kill them. Some were spoiled kids who’s parents were too busy, others were so sad and low that you desperately wanted to hug them, but that wasn’t part of the job – all they wanted was someone to listen. None of the patent types I’ve mentioned actually wanted to die.

Then there were the ones who did. The ones who’s lives had gotten into such a state, or who had reached such a low point, that they saw no point continuing with their lives. These patients generally managed to see their wish through, and we were only called when someone found them.

Fatalities were part of the job, and I always managed to treat the majority as just that – jobs. I never knew them, I’d never met them, and I couldn’t tell you what they looked like once we left them. That was the easiest way to deal with death. They were someone else’s loved one, it was their job to grieve. But the ones who took their own lives, they were different. I was called to an unconscious patient, and rolled up to find a very drunk foreign gentleman. He was quite cheery and chatted a lot about how he had come to the UK to work, but he missed his family. Two weeks later, we were called to cut him down from a tree in the middle of nowhere. Another job involved a 15 year old, who was being cut down from a tree in their back garden by the police as we arrived. I remember that one, mostly because there was a strange peace about the scene, and the patient almost looked relieved. Then the mother came out and shattered the peace, understandably hysterical when they saw their dead child.

Then there was the parent who chose to end their life in the stairwell of their home, in full view when their ex when they brought their young children home. I’ll remember that as a job, their children will never forget it for many other reasons.

But we were given the usual 5 minute rest afterwards, then it was on to the next job. No support, no debrief, no health checks. Yes, we chose to do the job. Yes, it was all part of the job. No, no-one is hard or tough enough to deal with situations like that, or worse, and not be affected. The emotions involved in these jobs vary – anger at the selfishness, despair that society has let these people down, sadness for the family and friends.

Then the screen lights up and we go to the next job…..