A Day on the Bus
Some time a go, a new EMT with about 3 months experience on the road, was discussing how ‘hard’ he was finding it, working on the bus. There were many reasons but perhaps the most telling was his final comment before heading out on a job, “trouble is, its nothing like it is on the TV!”
Good old Casualty. If we all experienced as many explosions, rail crashes and all the other exciting stuff that Josh and his colleagues get to attend, then I’m sure many ambulance staff would leave after a few years with PTSD.
Yesterday I had a day on the ‘bus’. Just in case there’s anyone who still thinks that ‘real‘ ambulance work is like they show on the TV, yesterday was an example of a typical day around my neck of the woods.
A morning cuppa and vehicle check to start with. I was pleased to see that I was going to be on the ‘pride of the fleet‘ – some clapped out old wreck that came into service 5 or 6 years ago and should really be on the scrap heap (or in a museum). Been round the clock twice, heater belches out clouds of white smoke and it still had an old ‘easy load’ stretcher (no tail lift, but at least it wasn’t an old York 4)
First job was to a 60 year old gentleman who’d had a possible TIA. He was complaining of slurred speech and ‘wobbly’ legs. He’d had a similar episode 4 days earlier but the symptoms had resolved themselves and he’d not thought to see his GP. Today though he was worried. Symptoms would reduce then reappear. Even as he spoke to us his speech improved for a few minutes then started getting all slurred again. No question, he was ‘going in‘. So off we tootled on a 15 mile trip to the hospital.
Now hospitals are always a joy as I usually meet one or two old friends and yesterday was no exception. Dr B, a local GP and trainer on my ECP course was doing his ‘1 day a week‘ in A&E; time to catch up on news. Next it was off round to the local ambulance station and divisional HQ to stock up on some 1:10,000 adrenaline and to refuel (also time for another cuppa and catch up news from the ops manager.)
Next up was a doctor’s ‘urgent’. So it was back to our area to collect an elderly lady with cardiac failure who was experiencing difficulty in breathing. Common problem, so the GP had arranged for her to be seen at the medical assessment unit. Easy enough, she was already walking out the door when we turned up. We got her comfy on the stretcher, put her on O2, and wired her up to the cardiac monitor; got a bit worried as the 3 lead showed ST elevation in lead III on the screen, so a full 12 lead seemed in order. Thankfully nothing sinister showed up, even the ST elevation in lead III wasn’t apparent on the print out. Besides, apart from the difficulty breathing, the lady was not symptomatic in any other way of having a (possibly ‘silent‘ – no pain) MI.
Another trip up to the hospital – given that its 15 miles each way in an old rust-bucket which does 0-60 in 2 weeks, these trips take us an hour or so each time (plus tea and nattering). After that it was back to base for an early lunch-break. There’s nothing more annoying then having lunch around 11 when the shift doesn’t end until 7; makes the afternoon seem really long.
After lunch, the first job was to a possible heroin overdose. I was getting excited as I haven’t given narcan for ages. The gentleman in question had ‘crashed out‘ on a green area of the town. Seemd like an odd place to ‘shot-up’; they normally do it indoors where they feel safer. When I arrived he was spread-eagled on his back, head back with mouth open. Looked like a classic cardiac arrest. As I knelt down I could hear him breathing. I tapped him gently on the cheek, at which he positively leaped up and started jumping up and down. “Wow man what’s happening?” Certainly the liveliest heroin o/d I’ve seen. After much “wow-ing” and “whoa-ing” he sloped off with his friend, who’d been the one to call us and continued to apologise saying “but I thought he’d stopped breathing”. They staggered down the road and off into town. Fair play; another ‘not required‘.
When we ‘greened up‘ Control wanted us to head off to the divisional HQ to swap vehicles. We were hopeful of getting a decent ‘bus’ but no chance. Turns out we were to pick up one of the early ‘tail-lift’ vehicles. A bigger bus than most but with a tail lift that works like something out of Channel 4’s ‘Scrapheap Challenge‘. It was also time for another cuppa.
Having a vehicle with a tail-lift was handy as our next ‘job’ was to ‘post-treat’ two ladies who been seen at the medical assessment unit but were being transferred to one of the community hospitals near our base. Both ladies were in wheel chairs but could walk a couple of steps with assistance, so we wheeled them out to the ambulance and used the lift to get the wheel chairs as near to the seats as possible. It was another uneventful journey until one lady started mouthing something at me. I couldn’t hear because of the noise of the vehicle. I moved nearer but still couldn’t hear as she was talking too quietly. So I got near enough to turn my ear near her mouth. “I feel sick” she whispered. “Oh sh*t!” I’ve obviously lost my touch as she was vomiting before I could get the vomit bowel under her chin. Only a bit splattered down her dressing gown, which I cleared up as best I could. I’d forgotten how much joy can be had from being in a confined space with a couple of bowls of Auntie May’s finest vomit. She felt better by the time we’d got to the hospital and we transferred both ladies to their respective wards. Popped round to minor injuries to say “hello” and bumped into the ECP on duty today – time for another natter.
We were directed back to station afterwards.
Next ‘job’ was to an elderly lady with diarrhoea. The door was locked when we arrived. No answer to the bell so it was back to hollering through the letterbox. I could see the lady kneeling on the floor in the hall and she slowly managed to make her way over to the front door to unlock it for us. Once in she was desperate to get to the loo again. We helped her in and waited outside. A relative turned up and we got details of the lady’s medical history, a list of her medication and were told that she’d had a similar episode a couple of months ago; the GP had prescribed Buccastem and Imodium.
The lady start to feel better but wanted to stay in the toilet, so I sat on the floor outside, the door partially open, and did a consultation with the patient on the loo. (As an aside, the lady had had her gall bladder removed. My colleague told me later that one of the minor functions of the gall bladder is to deodorize faeces – which would explain why the miasma emanating through the gap in the door was turning me green). Eventually the lady emerged and we all went through into her lounge where we did an examination. Nothing sinister found. ECG normal, lungs clear, abdo soft and non-tender, all other obs within normal guidelines. She declined an offer to ‘pop’ up to MAU for assessment (though they’d have just loved having a patient with D&V turn up in the department). I spoke to her GP. He was in agreement that she could stay at home and take the previously prescribed medication, as required. He was happy to see her tomorrow if things hadn’t improved. I wrapped up the paperwork, got the relative to agree to spend the evening with her and then we headed back to station.
With about 10 minutes left before finish another job for a patient with D&V came in, backing up a solo on the RRV. As is normal custom the night crew had arrived and they were happy to ‘jump’ for us; gives them a quarter of an hour overtime and allows us to get off on time.
So that was it, another mundane day on the ‘bus’. Saw lots of colleagues I hadn’t seen for a while (the joys of going to A&E) and drank copious amounts of tea (the ambulance man’s tipple). Next shift is being a ‘real’ ECP for the day.