A broken arm and some wonderful colleagues

It’s 6.52 am on a Saturday, and we’re ready for home time when the radio starts up.  Male of 65 fallen out of bed with a ?broken arm.  Patient initially spoke to son (who is on scene with him) but is now unconscious.

The call is to one of the nicer areas of Flagmarsh.  Here, most of the houses are owner-occupied, have at least four bedrooms and are spread over three separate floors.  All, without exception, have well-kempt gardens front and back.

This house does not disappoint.  The sweeping driveway is covered in those annoying little stones that get into your tyre tread and irritate you all the way to hospital.  The lawn and driveway still have a spattering of leaves from the copper beech hedge.

We park on the driveway, ring the bell, and are met by the son.  He’s staying over for a few days, whilst he attends some interviews in the area.

This morning, Son took a cuppa in for his Dad.  As he was leaving the room, Dad started to get up, then fell forward, away from the bed.

Son asked if he was all right, and Dad said, “My arm!”  A quick visual tells us that both bones of the forearm are quite clearly broken.

Son went to call an ambulance, then came back.  Dad was no longer talking to him, so Son updated us.  [Well done that man!]

All of which was fine; right up to the point when we found that he also wasn’t breathing and had no heartbeat.

So at 7:01 am I commence CPR whilst Supermedic heads back down to the vehicle for his drug bag and the defib.  The gentleman is large.  We request extra pairs of hands; it’s unlikely for us to get anyone this close to shift change, and this is borne out by the response: no vehicles to send.  So we work as best we can.

After a few minutes, we get a heartbeat, although Dad is not yet breathing for himself.

We prepare to take him out to the vehicle ourselves.  It may be an unsafe lift (he looks to be about 20 stone), but this man needs more care than we can give him here; he needs to be in a hospital where they can stabilise him and deal with the underlying issues affecting his heart.  It’ll be undignified, but we can use Son and the furniture to help get him onto our chair and out to the vehicle.

Then we hear sirens.  Supermedic and I exchange a glance.  If that’s for us, we’ll wait before moving him; if it’s not, we’ll only be wasting time.

I call control on the radio.  It is indeed our back-up.  It arrives, and Mustard and Thunderbird 3 climb out of the cab.  It’s now 7:15, and they should have finished their shift at 6:30.

They shrug it off.  “It’s on our way back to station.  Besides, no-one else offered and we knew you wouldn’t ask unless you really needed it.”  I brief them and we head back upstairs to find Supermedic pounding away on Dad’s chest again.  Two shocks later, and his pulse is back.

The four of us quickly manoeuvure Dad onto the chair, down the stairs and into the vehicle.  It is so well coordinated that Son compares us to a well-oiled machine.

Son decides to get dressed and then follow us up to the Crown Jewels in Crown City.  Mustard and Thunderbird 3 bring down our equipment whilst I call in a pre-alert; Supermedic is busy in the back.

As they bring our equipment onto the vehicle, the patient starts to vomit.  Thunderbird 3 steps back sharply, so it only hits the drug bag and the floor; Mustard reaches into the locker and grabs our last bowl.

And when we eventually get back to station, Twix and Cuthbert are standing there with mugs of tea.  And a mop and bucket, so we can clean the back of the ambulance whilst we hand over…

All in all a great end to a particularly bad Friday night shift.  I’ll blog about the rest of it presently.  In the meantime, I owe Mustard and Thunderbird 3 a favour, and Twix and Cuthbert a nice cup of tea.

Keep safe,
TGG

Vehicle update

I have been reminded that our not-so-happy ambulance was last seen being loaded onto the back of a low-loader outside TBCP A&E.

As a result, we’ve been driving round in a different vehicle for the last few shifts.  Having switched between different vehicles a bit in the past, the different lay-out hasn’t taken that much getting used to – vomit bowls are in the same place as this vehicle and blankets and inco pads the same as that vehicle, etc.  The thing that has got me confused is that the third siren is totally different.  We’re borrowing it from over the border, from a different old Ambulance Service, and their sirens are different to ours.

Happily, we have been promised our own vehicle back towards the end of the week.  Being cynical old ambo bods, we expect it back sometime towards the end of May…  [That said, Tyres and his colleagues are usually good at getting our vehicles back to us in a timely fashion.  Obviously, unless there's a fault, or no part arrives, or another problem crops up, or...]

Keep safe,
TGG

Swine ‘flu

So I thought I’d be highly original and comment on the latest thing to hit the news.  [Note the sarcasm.]

The WHO pandemic alert phase is now at level 5 because there has been human-to-human transmission in more than one WHO country, and some people have died from Swine ‘flu.

The messages that are being given out via the media seem a little confusing.  On the one hand, they’re telling us that we’re all going to die from it.  In the next item, they are then reporting that the people who have been confirmed as having Swine ‘flu (as opposed to any other variety of ‘flu or ‘flu-like illness) are recovering very nicely – thankyousomuchforasking – not that they were particularly ill to start with.  And yet, other people have died (unconfirmed numbers in Mexico and at least one in the USA).

A similar thing seems to be happening within the NHS.  I think that Kal describes it quite nicely.  In one sentence, we’re being told to don PPE and wash obsessively.  In the next, we’re being told that patients with a high index of suspicion will be advised to call their GP (instead of sending in the green-clad cavalry).  At one hospital, we simply need to pre-alert for any patient with a high-index of suspicion.  At the next, the patient will be assessed on board the ambulance and dealt with appropriately.  At still another, patients with a high index of suspicion will not be accepted unless the problem is immediately or potentially life-threatening.  [Note: these aren't all necessarily in my patch, or even in 4CAST.]

And there are large numbers of people calling the emergency services who think they may have Swine ‘flu.  Instead, they could try calling the Swine Influenza National Helpline (0800 1 513 513).  They could follow the advice which the media has been giving out – to call their GP during surgery hours, and to self-treat where possible.  If it’s outside surgery hours, they could try NHS Direct (0845 46 47) or their local on-call GP.  If the GP suspects that it’s Swine ‘flu - and determines that the patient needs to be in hospital – they refer them to the ambulance service, who then get some warning about the index of suspicion.  Which beats being greeted at the door by someone coughing in your face.  [Before you get unduly worried for me, the last time that happened, I'd already caught it and fully recovered.]

In general, I don’t know what to think.  Should I be concerned?  Afterall, it seems to have swept through Mexico - infecting nearly everyone who has come into contact with it - and even killing some people.  Or is this just misinformation and media-hype?  Of the thousands who seem to have contracted it in Mexico, less than a hundred (last time I heard the figures) had died.  And no-one has died in the UK – but then only a handful of cases have been confirmed.  Only time will tell.

I guess I’ll be using common sense and my best judgement.  And keeping a mask in my pocket beside the spare pair of gloves, just in case.  After all, the patient with the broken leg may have neglected to mention their ‘flu-like symptoms when they called us.  But they probably don’t have any.

Keep safe,
TGG

TBCP and The Crown Jewels

These are the two hospitals in Crown City.

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TBCPWNSFBBTRFMSMALTH stands for The Big Concrete Plus With Nesting Site For Big Bird, Tyre Repair Facilities, Mini Shopping Mall And Local Trauma Hospital.  It also has quite a nice restaurant canteen.  It is a tower block in the shape of a very large plus sign, as viewed from the air, and consequently has North, South, East and West Wings.

The main reception and canteen are below the mini-mall in the East Wing.  Patients who look too much like patients are not allowed in through this door; see below for further details.

Outpatients is on the ground floor of the South Wing, and has a very pleasant coffee shop; although it should be noted that this has two main states – Heaving or Closed.  It also does take-away hot drinks and lets nurses and ambulance crews who want these skip the queue if we’re in uniform (who says there are no perks to the job?).

The North Wing has a small extension which houses the Paediatric A&E and doubles as the Helipad (the NSFBB).  The main A&E and the Emergency Medical Unit (EMU) are in the North Wing itself.  This is also the only entrance through which you can take patients on trolleys, or patients in wheelchairs with drips, or patients in wheelchairs in their nightwear, or patients who need to go to a ward for some other reason, or patients who look too ill for the mafia boss lady site manager to allow in through the main entrance.  [I have argued the toss on a few occasions, particularly when the door to Maternity has got stuck on closed again - pregnant women are not generically ill.]  This wing also houses HDU, ICU and the Trauma Unit (this being the Local Trauma Hospital).

Maternity is in the West Wing.  The door has a complicated locking mechanism and gets stuck sometimes frequently.  When it gets stuck on open, Security set up camp there (the SCBU and NICU are in the same area of TBCP).  When it gets stuck on closed, we have to find another entrance.  The best second entrance is through outpatients (which involves trekking the whole way round the hospital because someone has put a great big wall between the South and West Wings).  If that’s shut (ie it’s not between 8am and 7pm on a working day), we have to go up to the Service floor, cross the plus and then return to the ground floor at the edge of the wing, ending up beside the entrance we should have used in the first place.  No other floors have access to both the central lifts and the maternity lifts, except via locked doors.

The other main department in the West Wing is the Mortuary.  Presumably this was either a rather sad attempt at humour (when you ‘go west’, you go west), or not very well thought through (for the same reason).

In order to access the central lifts (the only ones into which our trolleys will fit), first we have to find a porter.  Then we have to deflect the objection ‘but the ambulance service should have their own card.’  [To my knowledge there is one card at the nearest ambulance station, which is stored in a locked cabinet in the staion manager's office, a post which is currently vacant - making it Political for anyone else to enter the office to search for said access card.]  Having persuaded the porter to allow us to use the central lifts, we must ascertain which floor we require.  What is generally referred to as the Ground floor is, infact, level 3.  The next floor up is level 5.  Level 4 only exists in Maternity, as a mezzanine, and at the NSFBB.  There is another jump between levels 6 and 9 – levels 7 (N&W) and 8 (S&E) being theatres and therefore having their own lifts; also each is only half a floor, as there are aproximately 18 inches between the two ‘levels’.  From there up, floors are numbered continously, although the top four floors don’t have numbers: Service, Offices, Staff Only and Maintenance being the labels.  All the hospital literature states only the floors visitors will see in the other lifts (accessible via the main entrance, and labelled from Ground up only mentioning the floors they can access), so a certain amount of mental gymnastics is necessary to work out what floor you actually require.  Whilst you’re working this out, you should already be calling the lift, because it’s geriatric and takes a while to answer the door bell call button.  Usually the staff are very good at opening the doors to the wards when we get out of the lift at the other end.  Which is a blessing.

~~~~~~~~~~~~~~~

By contrast, Crown Jewels is a haven of peace and calm.  It was founded by nuns (the Sisters of Mercy), who still run the hospice next door.  The original four doctors at the hospital had names related to precious stones, hence the locals’ name for the place. 

It is the local cardiac centre, a unit tacked onto the end of one of the corridors which has its own road entrance for ambulances.  Outpatients and the renal unit also have their own road entrance and car park, although this is on the opposite side of the hospital from the cardiac centre and A&E/EMU entrances.

The A&E staff at the Crown Jewels let ambulance staff use their facilities (tea, coffee, toilets) for a small donation to ‘the pot’.  They treat us as colleagues, and there is no feeling of ‘them and us’ – we are simply a large team with different jobs to do, and differing areas of expertise.  The canteen also does a very reasonably priced sausage-chips-n-beans and vegetable-chilli-n-rice.

The hospital as a whole sprawls either side of the central corridor, with lifts between every cross-corridor and easy-to-understand signage.  There are even maps.  With colour-coding.  And clearly labelled ambulance access points.  In fact, the only improvement that could be made from and accessability point of view would be to add bus stops inside the grounds.  Otherwise, it’s complete.

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As with everything else in the blog, these hospitals are based on my experiences at several different hospitals, and may or may not bear resemblances to any or all of these.  If you recognise something good about your local hospital in what I’ve said here, tell someone about it – praise the hospital for getting it right.  If you notice something bad about your local hospital in what I’ve said here, tell them about it nicely - after all, if you don’t tell them there’s a problem, how will they know?  And how can they find a solution?

Keep safe,
TGG

Tyres

Today, we’ve on the vehicle that’s been giving everyone problems recently.  But, apparently, it’s been fixed.  So it should be alright, right?

The first two jobs are cancelled before we leave the yard.  It’s turning into a bit of a slow day.  Not that that’s a problem – it gives crews time to catch up and learn from each other.  Some of the conversations on station can be quite refreshingly odd.

Eventually, we get a job and make it out of the yard.  In fact, we make it to the patient’s house.  We check the patient, load the patient and leave the scene.

Halfway to hospital – Crown Jewels  is the closest – the engine starts making some very odd noises.  I slow the vehicle and change down a gear.  The noise stops.  For a time.  Then it starts again.

“Your vehicle doesn’t sound too healthy.”  The patient’s relative is a mechanic.  We tell him it’s just been fixed.  He suggests we try to get our money back.

I see the patient, the relative and my colleague safely into the hospital, and leave them in the queue.  [They're doing some variety of building/decorating/etc to A&E at the moment, so half of it seems to be shut off.]  Then I turn my attention to the vehicle.

At first, there’s no reply from Control.  Knowing what was wrong last time, and having heard the mechanic’s warnings, I quickly try the ignition.  Nothing.  I isolate and restart, then try again.  Nothing.

Control call back.  It’s just as well this is a slow day.  “You need to go and make yourselves/the vehicle/the problem known to Tyres.  He’s just round by Cardiac.”

A quick check shows that the queue is still looming large in front of our posse.  I let my colleague know where I’m going.  He’s obviously explained my absence to the crew in front, because they volunteer to assist him if (against all reason) the queue suddenly starts moving.

As I head round to Cardiac, I hear the Voice of Authority on all things vehicle.  “Right.  That’s all done and ready to go.”  He shuts the bonnet with a quiet slam.  “But before you go, I’m just going to check your tyres…”  It’s a bit of a ritual; each time he works on one of our vehicles, Tyres makes sure the pressures are correct.  It’s nice to know that someone cares about our safety.

I explain briefly what’s wrong with our vehicle and head back round to A&E.  The patient’s still waiting.

By the time we get out, Tyres is working on our vehicle.  He shakes his head sadly.  No tyre check today.  Just a lift back to the nearest station to pick up a spare vehicle.  We start to gather up our belongings.  This will be my fourth vehicle in less than 24 hours.  And that’s not including my POV.

Keep safe,
TGG

Dancing on…

…ice the ceiling the roof.  You’ve heard of tap dancing, but this was a different s-tile of dancing…

So the patient’s sense of humour (or, quite possibly, lack of it) was still intact.  Which is more than can be said for his knee – it looks very dislocated (note it was the knee, not the knee-cap – quite unusual).

He’s only fallen from around 8 foot, but he can’t remember landing, so we treat it as a spinal/head injury just incase.  As he’s sat up, we do a sitting take-down onto the spinal board, strap his leg up as best we can, and transport him to *TBCP in Crown City.

On the way there, I ask casually what he was doing on the shed roof.  He confesses that he wasn’t infact dancing.  He was trying to rescue the cat.  And where is the cat now?  When he screamed, it jumped down and ran into the house.  He smiles sheepishly, and says that next time he’ll just try screaming…

Keep safe,
TGG

*TBCP, or to give it its full title TBCPWNSFBBTRFMSMALTH, stands for The Big Concrete Plus With Nesting Site For Big Bird, Tyre Repair Facilities, Mini Shopping Mall And Local Trauma Hospital.  I shall blog about it presently.

Fractured hip, fractured English, fractured lives

She tells us in somewhat broken English that she fell around two weeks ago.  And now she has pain.  Everytime she moves, when she tries to use the toilet, when she sits, when she stands up – or does pretty much anything except lying down, infact.

And may we examine her?  Not my crewmate.  Okay, fair enough – Beanpole is definitely male, all 6′4″ of him.  So off he goes to ask for some assistance to get this lady down the twisty, turny staircase.

And I look at her hip.  She has all the classic signs/symptoms of a #NOF – rotation, shortening, exquisite pain just there.  She also has another one I’ve only seen once before.  Just here (right by where the pain is), there’s a hollow at the back of her hip which isn’t there on the other side.  The only other time I’ve found that, the patient turned out to have a fractured pelvis as well as hip.  I’d like to treat it as both, just in case, but I’m not sure how to explain this to the lady.  Explaining the nitrous oxide was hard enough - and I don’t know whether she actually understood me, because she refused to use it.  And I’m still not sure how we’re going to get her downstairs.

Once I’ve covered the lady up again, I call Beanpole back in again.  He stoops to hear my mumbled message - mumbled because I don’t want to scare the lady, and just the fact that she seems unable to speak English doesn’t guarantee that she can’t understand us, regardless of her reaction to my offer of ‘gas and air’.  He nods sagely, and looks at the staircase and the patient.  “Solo’s on the way; maybe they’ll have some ideas.”

“My son…”  The patient is suddenly crying.  “My son…”  I perch on the edge of a seat and hold her hand.  “…he was … you know – him fight…”

Evidently Beanpole reminds her of her son.  She points to a picture; I can see the resemblance.  From his uniform, I can see he’s a soldier; from his beret, a Marine.  The picture looks some ten years old from the decor behind him.  He is relaxed, sitting with two other boys, younger, presumably his brothers.

“…like his father…”  I ask about the other boys – his brothers.  “They go – they all go.  Him -” she points at the youngest boy “- he fly.  Not like others – they fight.”  She smiles slightly – a proud Soldier’s wife, a proud Forces mother.  But then her sadness returns.  “Him not come home…  …my son…”  She turns the picture frame over.  On the back, the names of the boys are written with their dates of birth.  Beside one name, the oldest, is written another date – six years ago today – and the name of a place in Afghanistan.  There are no words to say; I hold the lady’s hand and sit with her while she collects her thoughts.

I hear the solo pull up outside.  I offer the lady nitrous oxide once more – explaining that we will have to move her around a lot to get her out to the ambulance.  She looks uncertain, and flashes a glance at the picture of her sons.  “Your son wouldn’t want you to have that much pain, would he?”  I gently ask.  She nods and takes the pain relief.  What’s changed?  Just that the person who’s offering has taken the time to understand her.

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It strikes me once again that we are privileged to be taken into people’s homes and lives as part of our job.  Often we see the start and end of life, and the bits people will remember (whether they want to do so or not) in between.  People let us into parts of their lives which they wouldn’t consider sharing with their families, just because we’re professional outsiders.  And sometimes talking helps, even if it’s just for five minutes in the back of an ambulance speeding you to hospital.

Keep safe,
TGG

Top reason for not starting CPR?

The head being about twenty feet beyond the feet.  Yes, I was working with Twix.  It was the second job of my second day working with her…

Keep safe,
TGG

Working with Twix

Twix and I worked together, very briefly, back when I started working for MiCATT.  She’s one of those lovely people who are completely unflappable in the face of extreme provocation, and she’s genuinely nice to everyone.  Even some patients that I lose patience with…

She’s also a bit older, and has the benefit of a number of years in the job as well as more life experience generally, so Sauron puts all the newbies with her for their first couple of weeks out of training school.  She generally eases them in to the real life on the road.  You could say that she’s the mother-figure at Flagmarsh.  Nothing goes wrong when Twix is shepherding the newbies.

Except when I was the newbie.  From the first job of my first shift, we had chaos.  After three shifts, Sauron decided that I needed to see the gentler side of the job, and switched me and Gingerbread for the next week.  After a few more-normal shifts, Sauron tried Twix and me together again; all hell broke loose once more.

So we were separated indefinitely.  My gentle easing into the job was done by Thunderbird 3, KitKat, Mustard and Supermedic.  I never got to benefit from Twix’s wisdom and street-smarts.  I never got her gentle coaching on how to do the job for real.  Or the Twix method for filling in the paperwork.  Or the CPD write-up method.  Don’t get me wrong – the others did a fantastic job – but I felt like I had missed out on something that was ‘normal’.

So I spoke to Sauron about it.  [I am truly blessed to have a line manager who is so approachable and friendly.]

And now Twix and I do the odd shift together about once every three or four months.

And that shift is coming up next week. 

Keep safe,
TGG

Public service advertising campaigns

There have been a number of public service advertising campaigns recently. And some of the messages seem to be sinking in.

For example, the woman in her early-fifties with chest pain who called us out one morning last November. A life saved because she’d seen the advert and recognised what was happening to her.
[A chest pain is your body saying call 999]
[The man with a belt around his chest]

Now we can add a man who had the classic triad of symptoms for CVA, and whose daughter had seen the new advert about strokes. Within an hour and a half of first symptom, he had had a CT scan, and the damage was being assessed and limited.
[The faster you act, the more of the person you save]
[When Stroke strikes, think and act FAST]

Hopefully, this trend will spread, and people will start to take note of the campaign about coughs and sneezes…
[Catch it, bin it, kill it]

Keep safe,
TGG