Super paramedic? You’re having a laugh!
Having had a day on the ‘bus’ my next shift was 12 hours on the ‘real’ ECP car. The only difference between this and an RRV is that it carries all our ECP drugs and wound care kits. The ECP car is still used as an RRV, so much of the shift is taken up with emergency calls which is the way most of us like it. Just doing ECP jobs all the time would bore me silly.
First job of the day was an emergency call to a 30 year old man who’d collapsed at home. As with so many of these types of calls, by the time muggins here turned up the ‘patient’ was fully alert, feeling fine and wondering what on earth all the fuss was about. A crew had also been dispatched and the poor gentleman was overcome by numbers as we all piled into his lounge. Even if the patient denies any symptoms I always suggest that “as we’re here why don’t we just check things out anyway“. We did all the usual stuff, including a full 12 lead ECG but everything was normal. His wife had already phoned his office and told them he wasn’t coming in today so we agreed all round that he’d stay at home and his wife would keep an eye on him; any further collapses and he was ‘going up the road‘. His wife also rang the GP and booked him an appointment for the afternoon. Job done, another life saved.
Job 2 was to visit an elderly lady who was feeling unwell. As so often, all the symptoms were non-specific. I ran through all the usual tests, including, this time, a urine dip. She came up positive for a UTI (urinary tract infection). Now, on the ECP car we carry trimethoprim for UTIs so I could have gone down the route of ‘leave her at home with medication and let the GP follow up‘. However my gut told me this wouldn’t work. The lady had a couple of friends present. They told me she was a ‘stubborn old bird’; lived on her own, refused to have any social care help and was as independent as they come. Before me though was a frail old lady who couldn’t even get out of her chair and kept dozing off even while I was speaking to her. Chances are she wouldn’t take the medication even if I left it and she certainly wasn’t able to cope alone. I rang the medical assessment unit – they were sympathetic and agreed to see the lady with a view to referring her on to ‘care of the elderly’. I booked an ambulance and then proceeded with the reams of paperwork; cincal report form, referral note for MAU, start of the crf for the crew, ECP outcome form and local admission avoidance form. One of the lady’s friends agreed to stay until the crew turned up so I bid them ‘good morning’.
One of the joys of working around the home counties rather than in ‘the smoke‘ is that we get to do long ‘blue light’ runs around country roads. Whilst I try not to get carried away it certainly gets the adrenaline flowing when you’re zipping around country lanes and along major trunk roads, some good rock music on the juke box, using all the skills from RoadCraft that we learned on the driving course. So, as my next job was for an RTA about 6 miles away on a B road, I set off through the town and then joined the major A road towards Bigtown, having fun overtaking the trucks that clog the route. With about a mile to go I got a call on the bat phone to say that the police were on scene and stated that no ambulance response was required. “Cancel and return to base“.
Next up was a referral from a crew who’d been to a person who’d fallen and managed to sustain two pre-tibial lacerations to her legs. “Would I mind popping round and dealing with the wounds?” Now I enjoy patching up skin tears. They’re easy to do provided you take your time and prepare properly. I toodled on round and did the necessary.
Here’s the result:
I had to soak each skin tear so that I could peel back the skin and clean out the congealed blood that had accumulated underneath. It was then a case of smoothing out the skin so that the edges matched up. A district nurse appeared whilst I was in full flow and agreed to return in a couple of days to ensure that the wounds were healing ok.
The final job of the day was in a town 15 miles away, for an elderly gentleman who’d fallen. Luckily he’d not injured himself so it was a simple matter of picking him up and getting him settled back in his favourite chair. As always with these types of jobs I like to establish why the patient fell, just in case we need to be thinking about further care, assistance, or whatever. On this occasion the patient claimed he’d just tripped over – fair enough. Trouble was, one of his daily carers was there and she said he seemed more confused than normal. Thinking UTI, I went and got the multistix from the car. Interestingly the UTI indicators were all normal but his urine glucose was at the top of the scale and there was a ‘trace‘ of ketones. I’d already taken his blood sugar; 8.5 so that wasn’t exceptionally high. I decided to do it again; 8.2 this time. OK – puzzled expression, start of scratching my head. As we were now into out-of-hours territory I gave the OOH desk a call and asked to speak to one of the doctors on duty. The advice was that the patient might be an undiagnosed diabetic and a fasting blood test was probably in order. This was something that could wait until the morning provided there was nothing else that was of concern. I discussed things with the patient and the carer. They were both happy for him to remain at home. So I spent the usual 3 hours writing out all the clinical reports and forms plus a letter to his GP stating what had happened and asking him to consider whether he felt a follow up investigation was in order. As a ‘mere’ ECP I try and avoid ever telling a GP what I think they should do.
With many elderly people I just get the feeling that they’ll forget to contact their GP when the surgery’s open so, rather than leave my clinical report form with them, I stick it in an envelope with my GP letter and take it round to the surgery myself. This particular establishment was all locked up with none of the gates containing a letterbox. So, torch in hand, I clambered over the fence, found the front door and stuck the letter through the box. Goodness knows what the postman does. Perhaps he only delivers Mon-Fri during opening hours. At any rate, I hope the GP is good enough to follow things up.
By this time it was past ‘finish‘ so I headed back to base, did the official handing over of the bat phone and keys to the ECP on the night shift, and headed home.
Another day on the front line successfully completed.