AMPDS – again!

26 January, 2007

Here we go again.

More 68 buses this morning: the first four jobs of the day were all category A ‘breathing difficulties’. That means a ‘response’ has to arrive at the location within 8 minutes.

As a prologue, let’s just remind ourselves of what a category A call is supposed to be. In a nutshell:

a condition (trauma or medical) which is immediately life-threatening within minutes of recognition and where rapid intervention and effective treatment by front-line ambulance staff will affect the outcome. [my emphasis]- From Review of Ambulance Performance Standards, July 1996

Or to put it another way – if we don’t get there ‘pronto‘ the patient is going to die.

Now that’s serious stuff so, in order to make sure we get it right, Control have the wonderful AMPDS system to triage our calls.

So, having hot-footed it to the addresses, what did I actually respond to this morning?

  • A patient with abdominal discomfort for 5 days. Seen by me on Monday night and his GP on Tuesday. No other symptoms but the ‘ache‘ around his stomach made him feel like he was having to breathe in harder than usual – he stayed at home.
  • A patient with a chest infection for 1 week. Seen by her own GP a few days ago and now on anti-biotics, but the carer thought she ‘seemed a bit worse today’ – she stayed at home too.
  • A young lady with side pain – seen at A&E last night; had a chest X-ray and all that stuff. Nothing too sinister but was discharged with a diagnosis of a chest infection and given antibiotics. She reckoned the pain was worse today and wanted to re-attend. Nothing life threatening but the crew popped her up the road as requested.
  • And finally, a lady having a panic attack. She’d calmed herself down by the time we arrived. We just did the usual checks; everything fine. She stayed at home as well.

There you have it – 4 immediately life-threatening calls – apparently. 3 stayed at home and 1 re-attended ‘just to be sure‘. That’s how ‘good’ AMPDS is (falls off chair laughing), yet on a serious note, ambulance services across the UK are reconfiguring their entire fleets just to make sure they can tick the Nu-Labour box for ‘A’ cat calls like these. What an absolute nonsense and a complete abandonment of patient care.

But hold on to your hats – it will get worse, much worse, next April when the goalposts are moved!

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Booze, Bangs and ODs

25 January, 2007

Watch out, watch out, the nutters are about

Last Friday night there was a new moon and, true to form, the nutters were out in force.

I kicked off with a ‘bottling’ at one of the local nightclubs; usual rubbish “no officer, I’ve no idea who did it” then “I’m gonna get that c*** tomorrow and show him what for”. This particular individual was one of a large family of yobbos who’ve been plaguing us for years – though to be fair I’d not had the pleasure of him before but the surname and the address were all too familiar. He was, as they say these days, ‘giving it large‘ and was having no truck with A&E, effing doctors, or needles. He did however, agree to keep his head still long enough for me to glue up the two lacerations over his eyes, even if he couldn’t keep his mouth shut; trying to impress the two scantily clad females he had in tow I suspect . He was last seen outside the club, waving his arms around and puffing out his chest, vowing to sort out the bastard “wot dun this to me” – what he really meant was “I’ve been in a bit of a scrape and mummy’s coming to pick me up”.

Next call was to an RTA – whoopie, a bit of trauma! Sadly not nearly as exciting as it sounded, but the young man involved was lucky not to have ended up crashing through the railing on the bridge and down on to the motorway below. He’d been drinking and admitted to ‘snorting’ something but wouldn’t say what. Although he appeared to have only minor injuries the bulls-eye on the windscreen (not wearing a seatbelt) suggested a possible head injury so the crew popped him up to A&E with a police officer to keep him company.

Meantime I backed up another crew for a patient with abdo pain, outside one of the local pubs. Sounded a bit like an ECP job so I asked Control if I could assist. What we actually had was a known depressive who’d been out drinking and wanted some attention. The abdo pain was a bit of red herring as she admitted that she was feeling ‘down’ and the pain was making her feel worse, but she couldn’t/wouldn’t take pain killers as she knew she would overdose on them, just as she’d done earlier in the week (and would do again in a couple of days). What she really wanted was to see the mental health team as she felt she couldn’t cope any more. What do you do? It’s Friday night/early Saturday morning and there’s no real help available. It was pass the buck time so the crew took her in and hoped the on-call psychs could help out – (ooh, there goes another pig flying past).

With all the local police gathered outside the town centre night clubs I got a call back to one of the working men’s clubs for an ‘unconscious male‘. He wasn’t when I arrived, though friends claimed he’d collapsed. His main problem was that his brain “was frying” and he had a stonking headache. His wife duly arrived and a more ominous picture emerged. This chap is only in his forties but has a drink problem – which he won’t admit to. He’s prone to ‘abscences’ followed by ‘crushing’ headaches and violent outbursts, which he admitted he can’t control. No, he wouldn’t go and see his doctor. No, the drink wasn’t the cause, it was all stress related. The Missus had had enough and wanted him to see someone. We convinced him that a trip to A&E was probably in order if only to sort out the headache and check that something more sinister wasn’t going on. Hopefully Missus is going to drag him kicking and screaming down to the GP next week in a vain attempt to get him some help for the drinking.

Then it was back to join the police at the night clubs. Two patients this time, both having been swiped around the head with the buckle end of a large, heavy belt. Of course it was all ‘unprovoked’ and they’d no idea who the perpetrator was. One had a nice neat laceration to the top of his head but the other had his top lip nicely bisected for about 1 cm – a job for the max-fax boys. I dropped him off and, as luck would have it, the max-fax doc was down in A&E and agreed to see the guy straight away.

Things quietened down after this – no more lunacy related jobs. Interestingly the following night, Saturday, saw no cases of booze, bangs or overdoses at all.

Roll on that full moon on February 2nd – I’m on nights again!


Spare A Thought For The Dog

23 January, 2007

Both at the mercy of adults

“You were right”, he said, as I unloaded some kit from the car. Being 3 am, cold and miserable I really had no idea what he was talking about. He proudly displayed the ‘moonboot’ splint he had on. “I did break my leg”. Recognition slowly dawned, it was Kevin, who we last met back in mid December. That would explain why the address seemed familiar but the call was for a young child with ‘abdominal pain’ and there were no children at the property when I last called. I followed Kevin as he hobbled up the 5 flights of stairs to the flat. “Hey, look who’s turned up”, he hollered in the front door. I was already bracing myself for the putrid atmosphere and thick smoke and was relieved to find it wasn’t as bad as I feared. They’d had a slight clear up; the mushroom-farm mattress had gone, to be replaced by some rickety Ikea bed and the dog and been booted out of his corner – he was now confined to somewhere behind the television.

The two gorillas, who’d been present when I got called to Kevin, were in attendance but tonight’s call was for Emily. She’s only 3 and looked quite unwell, though she engaged with me happily enough, which was just as well as she was the only one who made any sense; luckily she had an I.Q. that outshone the rest of the them put together; particularly Mum who was struggling to string more than three words together. Mum, too, seemed familiar and it was only later that I discovered that I’d been out to her at her normal abode – the local women’s refuge. Now she was shacked up with the larger of the two gorillas who rents the flat. The place is hardly big enough for one gorilla never mind a vulnerable woman and a young child.

Emily told me her tummy hurt and it was painful when she went to the toilet – to emphasis the point she promptly vomited over the settee, the floor and subsequently Mum’s jacket. To be honest it would hardly be noticed, the floor was still littered with the remains of take-away dinners and fag ends and a set of dog bowls – just like last time. It’s the sort of place where you wipe your feet on the way out.

Now I’m no expert on children but I think it’s fair to say that 3 year olds spend a fair amount of time on the floor and are still at an age where they like investigating their environment by putting things in their mouths. Given the state of the floor goodness knows what Emily had found to sample and no wonder she was ill. I really felt for her – what a start in life. Mum’s already been through the refuge which is hardly conducive to bringing up a young child and now poor Emily finds herself stuck in what can only be described as a “shit-hole”.

I took Emily and Mum up to A&E, if only to get Emily out of there; but what about the dog? At least everyone else had the opportunity to leave if they wanted to but the dog was stuck there and it’s no place for a dog and certainly not for Emily.


Comparing Notes

15 January, 2007

Hey, guess what I did today?

Having done a few years service, I take some pleasure in seeing new recruits, wet behind the ears and fresh out of training school, blossoming into full paramedics. Some take their first steps as nervous, naive EMTs and, after a few years, it’s a joy to see them confidently leading a cardiac arrest or a trauma incident. Others though, start out as arrogant snotty ‘know it alls‘ and progress to bullying, arrogant ‘know it alls‘ (who’ve actually learnt very little). We all know who they are; their idea of mess room conversation consists of regaling everyone with all the tricky jobs they’ve done and how good they are.

Last night I did an overtime shift on the RRV. As most of the service are on 12 hour rotas it normally means that I run with the same crowd every shift and hardly ever see some of my old chums. So, being on o/t meant I bumped into a fair number of colleagues that I hadn’t seen for a while; in particular three who’ve just completed their paramedic training and a couple who’ve been qualified as paramedics for nearly a year. I remember them when they first started and had the honour of working with nearly all of them in their first months on the road. Now they’re fully registered paramedics and out there saving the lives of ‘joe public‘.

It was interesting to hear them comparing notes; how many cannulas have you put in? have you tubed anyone yet? have you given tenecteplase? and so on. Some newbie paras seem to have done an extraordinary amount. One, who’s now been qualified for nearly a year, told me she cannulates 2 to 3 times a shift and has given benzyl penicillin 3 times (I’ve never given it). Another has lead a full cardiac arrest protocol on a trapped patient in an rta within his first fortnight as a paramedic and another gave morphine, metoclopramide, tenecteplase and heparin the first time he had to use his skills!

There’s a touch of envy on my part – I don’t seem to do anything like this. Tom Reynolds wrote in his book, Blood, Sweat and Tea:

I often bemoaned the fact that I tend not to get sent to many jobs involving ‘trauma’. If you’ve been stabbed, I’ll be down the road picking up a maternataxi. If you’ve fallen out of a second floor window, I’ll be one street over dealing with the sleeping drunk. And if you’ve thrown yourself under a tube train, I’ll be one stop down dealing with the twisted ankle.
(I’m sure this is in the book but I couldn’t find it, so here’s the blog link)

I confess that I suffer the same fate. Some people in the service seem to attract any ‘nasty‘ job that’s going; we call them Jonahs; it’s easy to tell who they are as they have nick-names which include adjectives such as deadly, dangerous, Dr Death, trauma Queen/ King, etc. Anyway, if there’s an opposite of a Jonah then I’m it. We don’t have an expression for paramedics like me but statistically speaking, the people in my patch are less likely to suffer major trauma or acute medical conditions when I’m on duty. That’s excellent for my patients but it does mean that I don’t get to use my paramedic and ECP skills very often.

++++++++++

January 2007 marks 10 years since I qualified as a paramedic and I’ve kept a log of every time I’ve used my paramedic skills. So, if you want to compare notes, here are a few of my stats.

I’ve:

  • cannulated 129 times (approximately once per month) Only 1 was a jugular vein cannulation – My success rate is about 92%.
  • successfully intubated 14 patients
  • have only participated in 20 or so full protocol cardiac arrests in my entire career
  • got 2 patients ‘back’ – one lived for a few hours the other for 4 days. Neither lived to be discharged from hospital
  • thrombolysed 3 patients (only the first really made a difference)
  • only attended one fatal rta – and that was an assist for LAS
  • completed one paediatric cardiac arrest – the baby died – had a congenital condition that meant it had a haemoglobin level incompatible with life
  • sutured two patients ‘in the field‘ (one in their bedroom at 3 am, other in the garden)

Jobs I’ve never done:

  • a birth – cross your legs and don’t push
  • a drowning
  • an electrocution
  • a major burn

Skills I’ve never used

  • intraosseous cannulation
  • chest decompression
  • cricothyroid puncture

Loving Our Regulars

11 January, 2007

Can ya give me a lift home guv?

Anyone who’s done this job for a while will have string of ‘regulars‘; those callers who are forever requesting an ambulance for all sorts of ‘spurious’ ailments. They’re mostly a motley crew; alcoholics, druggies, personality disorders, depressives, people with mental health issues, etc. We know them; the hospitals know them; and perhaps, if we’re honest, we don’t treat them as well as we should. Of course some are a right pain-in-the-arse. One of our ‘regulars’ even has an ASBO for calling out the emergency services, particularly the ambulance, and then being verbally and physically abusive when we show up. Can’t say I’m sorry not to have her on the back of the bus any more. We also have another who’s been a ‘regular’ for over 15 years. He’s harmless; he’s an alcoholic, and a right pain-in-the butt to be sure but, when all’s said and done, he’s never been abusive; doesn’t swear, doesn’t lash out and just acts the ‘little lost boy’ when it’s all going wrong. Sometimes we take him in, sometimes we don’t. One thing we never do though is give him a lift home when he been ‘out-on-the-lash’: he’d catch on to that one pretty quickly.

It therefore came as some surprise to all of us on station to find out he was up on a charge of ‘assault’: and not just any old assault, an assault on an ambulance man no less? WTF? Are we talking about the same Harry? Surely not?

Seems we are; though the details are sketchy. A fairly new recruit, from another station – with a reputation for being a bit ‘full of himself’ – attended Harry for the first time. I guess if you don’t know him, Harry can seem a bit ‘odd’. Anyway the story goes that Newbie went into Harry’s house alone and found him sitting on the sofa (as he usually is when he’s at home. Goodness knows if he ever goes to bed). Newbie claims that Harry ‘feigned unconsciousness’ so he decided to stuff an OP airway down Harry’s throat. Next he claims he turned his back to get something out of his para-bag and Harry ‘thumped him one’. No witnesses; just his word against Harry’s. Harry told us later he couldn’t remember the incident. Newbie’s crew mate was out in the ambulance at the time and “knows nuffin’ “ and won’t get involved.

So Harry had to go to court. Whether this was a private prosecution or one ‘sponsored’ by the service we haven’t been able to find out. Newbie clammed up ‘good and proper’ when a colleague confronted him

And the result? Harry pleaded guilty! Why, oh why, oh why, did he have to do that? Just about every member of staff on the station said they’d have given a character reference in Harry’s defence if only they’d been asked. It’s been a real eye opener just how much we ‘love’ Harry. He might be a complete ‘waster’ but he’s our ‘waster’ so you lot leave him alone.

Needless to say Newbie is off everyone’s Christmas card list. We’re just waiting for him to f**k up big time: then we’re gonna take revenge on Harry’s behalf.


Fun With Numbers

6 January, 2007

If only some households knew what these were.

The latest edition of Ambulance UK, the magazine of the ASA, appeared in the mess room the other day. It’s full of the usual boring, out of date articles that epitomise trade journals. I was, however, intrigued that “that old chestnut” of visible house numbers has raised it’s head again; this time from Paul Leaman, Chief Operating Officer for Essex. The article is based on an old press release from October, but reiterates once again the bane of all emergency staff:

With the nights definitely drawing in and the clocks set to go back soon, now is the time for everyone in the county to consider whether the emergency services could find your house in the dark.

There was a national campaign about this some years ago (though I couldn’t find a reference to it during a quick search on google). In any event, the residents of the properties in Scroatsville that we go to struggle with stringing a basic sentence together so the chances of them reading and responding to these types of appeals are, quite frankly, nil. We all know these properties; usually run-down council estates; David Copperfield and colleagues are there every day; and Frank Chalk’s been struggling to teach remedial maths and English to their despicable offspring for years, without much success.

Now it’s fair to say that the introduction of satellite navigation to our ambulance vehicles has improved our ability to find (some) addresses but we are still very much reliant on our own eyes for locating the actual property. The old nightmares we used to have came flooding back the other night when Doris-the-bitch (our sat-nav system) packed up completely and it was back to those tatty, faded, out-of-date map books that we keep stuffed about the cab or in the glove box. It doesn’t help that my present patch is an absolute nightmare; widely accepted as the most diabolical place in the whole county for locating properties.

  • Each road name is actually a whole collection of roads – in fact they’re more mini estates than roads.
  • They’re all a mixture of houses, flats and maisonettes with the occasional tower block plonked down in the middle for good measure.
  • Many properties are only accessible via footpaths.
  • The whole town was designed without even the slightest consideration that people might actually own their own car – or more precisely 3 cars. Consequently the roads are all but impassable with cars strewn on the pavements, across green spaces, blocking ‘turning points’, and dumped on any empty road space not currently occupied by another vehicle. We can only just get the ambulances through so goodness knows what the fire service do. If you make the mistake of turning into the wrong cul-de-sac then you can expect a tight bit of reversing to get out.
  • And then there are the house numbers – or lack of them. We consider it a bonus if the residents actually have a number on their door. But the biggest problem is that when it’s dark, raining, and you’re struggling to get to that ‘A’ cat call as soon as possible and getting all stressed out, there seems to be no rhyme nor reason to the numbering system. And to make matters worse, most of the time the signs showing where properties are located are either missing or heavily vandalised. When all else fails we carry some rather old photocopies showing the layout of these estates which are extremely difficult to read using just the vehicle’s courtesy light. It all adds up to a very harrowing time.

So, as a little challenge for the weekend, I’ve attached examples of the maps we have to rely on, with a test to find a certain property – just to demonstrate the nightmare we’re up against.

Map 1As a first example, this is one of our ‘favourite‘ estates. All the properties to the right of the centre line are only accessible on foot. It’s a mixture of houses, maisonettes and small blocks of flats.

Click on the image to see an enlarged version.

Click here to see the answer.

 

 

 

 

 

 

Map 2This estate is an older one – before planners cottoned on to the concept of flats and tower blocks – so all the properties here are houses (with no numbers on the door). Like in the first example, the houses on the left and at the top are only accessible via footpaths. At first things seem easy. You drive in off the main road and properties numbered in the 140s and 150s are clearly visible. Logic would say that properties in the 130 range should be nearby. Wrong!

Click the image to see an enlarged version.

To discover the whereabouts of number 138 – answer.

 

 

Map 3This is another ‘regular’ on our estate hit list. This place is pretty run down; it houses some of the least desirable elements of the town and has one of our few ‘true’ tower blocks. Once again trying to find a house number or a sign showing the whereabouts of properties is a non-starter.

Click on the image to see an enlarged version.

No surprises really. For the answer.

 

 

 

 

For anyone who’s interested, the numbering systems on these estates were actually set up with some logic. They are designed to assist a very important group of people – Postman Pat and his colleagues.

If you follow the numbers through the footpaths then postie goes round in sequential order.


A Couple of Headaches

3 January, 2007

Enough to blow your mind

The first was ‘legitimate’:

Middle aged female with a 24 hour history of intense headache – and not a known headache or migraine sufferer.
Photophobic
but with no concomitant rash. She had some neck stiffness but was still able to flex her neck.
No nausea or vomiting but felt extremely cold initially and now feeling hot.
Both her pupils were dilated (not surprising as she was lying in a darkened room) but both reacted to light.
She had been seen by a GP earlier in the day; no diagnosis provided but he left a prescription for amoxycillin.

We got called because she had deteriorated over the last couple of hours. She refused, or was unable, to talk; couldn’t stand up, and hubby and sister were now at their wits end. She did manage to ‘grunt’ a confirmation that the headache had come on suddenly. “She was fine yesterday evening and then, all of a sudden, she said she had a blinding headache”, pitched in her sister, helpfully. Not a lot we could do really, so it was a trip up to A&E; trying to be as gentle as possible.

I checked up on her a few hours later: confirmed sub-arachnoid haemorrhage (apparently).

++++++++++

The second was the sort of waste-of-space job that gives you a headache.

A young man with abdominal pain; lying by the shops about a quarter of a mile from the hospital.
“How long have you had this pain?”
“Since I walked down from Tesco.” He pointed back down the road in the direction of the hospital; in fact you can see that particular Tesco from the hospital.
I couldn’t resist a sarcastic comment. “If you were that close to the hospital, why didn’t you pop across to casualty?”
He looked extremely sheepish, and muttered something incoherent to his feet.
“What do you want to do then?”
“I guess I should go to the hospital.”
The options seemed to consist of shaking him warmly by the throat, telling him to piss off and walk back to the hospital, or take him down the road myself. In the early hours of the morning, with a light drizzle starting, I really couldn’t be arsed with either of the first two so I suggested he “hop in”.
“I better call my Mum and Dad and tell them where I’m going.”
Aarrgghh! What’s the matter with this idiot? He walks away from A&E and now decides he needs to go there but can’t be bothered to walk. Has a workable phone (i.e. actually has some credit on it unlike half the local population) but can’t/won’t phone his parents for a lift or call for a taxi; instead he dials 999 for an emergency response.

It only took a couple of minutes to get back to the hospital. I didn’t do a thing for him – didn’t even do any ‘obs’. Couldn’t be bothered to complete yet another ‘totally pointless‘ patient report form so I just dropped him of at the entrance to A&E and told Control it was a ‘not required‘.

I know I wasn’t as professional as I could have been but everyone ended up a winner and I got to head back to station for a cuppa.

Welcome to 2007. Same sh*t – different year.

Picture by Matt Mills