NOT AGAIN!

Last night I was driving, we take alternate shifts at this, if that's what you could call it. We were at a job in the middle of a park for a kid with a sore back.

I managed to reverse into the fence around the play area resulting in minor damage. As a result of this, however, I was feeling particularly stupid so headed away from the offending post - into mud.

We waited two and a half hours for the rescue truck who took a further hour, and 3 broken tow ropes, to get us out. So a quiet night work wise as a result. Luckily I'm off over the new year week and the copious alcohol consumption should clear my head. No doubt I'll return to a disciplinary hearing and a retraining course which, in all honesty, may not be a bad thing.

I'm off to a whisky soaked Scottish island tomorrow for a few days but will let you know how bad I was feeling on the 1st when I get back. Happy new year to one and all.

NURSING HOME; WHAT NURSING, WHAT HOME?

Was trying to think of a good work related thing from last night, and there was a couple but I kept thinking about the call to a nursing home. Now there is no accuracy in either part of this title. There was no discernible nursing and it certainly was not home to anyone there.

I find it really sad when I enter one of these places and see two or three elderly people crammed into what would be called a double bedroom. These people worked, saved and had their dignity only to have it rot away when they are least able to do anything about it.

Tonight's job was to an 85 year old man who was apparently "powerfully" cyanosed. Not knowing this particular medical term we got there pretty quick and rang the bell. A couple of minutes later a care assistant type person answered the door and pointed us down the corridor. Getting to the end of this corridor we discovered that we were alone so headed back to find someone who could show us a powerfully cyanosed man.

Up the lift, along the corridor and into the room. There was this frail, skeletal man with blue lips struggling for breath lying on the bed, in his curtained off quarter of the room.The "nurse" started to tell me some history but, and hopefully she thought I was impolite, I ignored her; sat the man up, which is basic stuff for people who are short of breath, and got on the O2.

Keeping an eye on the patient and knowing my mate was busy with sats readings, BP's etc I got the story. Mr Powerful had been a resident for some months, he had breathing problems but they were not sure what and were unclear about any other medical conditions. He had been discharged from hospital earlier today, as he had been in with a chest infection, with steroids and antibiotics.

Now, I didn't even know his name at this point but would bet all of my mates monthly salary that the man had emphysema and dementia. You could hear the gurgling in his lungs and sitting him up should be the first thing anyone does, even a nurse in home. I would of also thought that a little bit of knowledge of what the medical history of a resident is would go a long way to helping formulate any care plan.

What really disappointed me though was the fact that they had not given this poor man any of the domiciliary oxygen that had so thoughtfully been provided for his benefit. A huge black and white bottle of the good stuff was sitting next to a powerfully cyanosed, emphysemic with a chest infection and the nursing staff in a nursing home did nothing but provide us with a print out of his next of kin and GP's address.

We took him back to hospital as much to keep him out of harms way as anything else. Hopefully they will keep him in until he's well enough to survive the neglect that his family probably pay £400 a week for and know nothing about.

It sickens me and makes me angry. This is negligent: but it happens at every home I go to.

NICE THINGS.

There are nice things that happen. One thing I think is nice is a good scratch.

A new nice thing is getting comments on this blog. I'm fully aware that most of what I blether on about is largely for my own benefit. A cathartic rambling of disjointed, half thoughts. It has also meant that I have found new blogs to wile away the hours, I need to update my list.

Thanks everyone. I appreciate it.

WHAT??? I MEAN WHAT!!!!

I was driving home after last nights shift and heard on the radio that the government is to plough millions in to Britain's most antisocial areas. These areas are to be called "RESPECT AREAS".

You will never teach these Burbery clad scrotum's respect. You can't even teach them English. Still, nice to see yet another well thought out project from the government. Just as well we have all those policemen on the streets or that could of been where the money went. Thank God that long term solutions to a problem don't win votes or who knows where we would be.

I CAN ADMIT WHEN I'M WRONG.

Well, I was wrong! Christmas eve was quieter than I anticipated without the run on drink related issues that I was expecting. Last night was also unexpectedly free of family boxing. Not that we were not kept going just that we were not chasing our tails as much as I expected. Quite good nights for us with most jobs being "proper" jobs where an ambulance was required for whatever reason.

The biggest thing I was wrong about though was our last job on Christmas eave. The call came through as "21 year old male fallen in stairwell". Now, I'm a cynic by nature and experience so heading en-route there was a pretty high expectation that we'd be attending someone full of Christmas spirit who had fallen asleep in a stairwell.

Well; as we walked up I did a quick assessment of the scene and thought to myself "bugger, that's got to hurt"! It did. There was this young chap sitting on the bottom stair clutching his thigh. The complete leg was rotated through about 100 deg. and there was another knee up by the top of the femur (long thick leg bone between knee and hip).

In situations like this really anything we do is going to hurt. I gave him some morphine, actually quite a lot of morphine, and we immobilise as best we could the injured leg, this hurt. We then had to get him on to the stretcher. As mentioned he was sitting on some stairs and this is never an easy maneuver. Getting him on to the scoop from this position really hurt. It involved quite a lot of sudden movements as he made the sitting on a stair in pain to lying on a stretcher in even more pain transition.

Once on the trolley we further immobilised the leg trying to make him as comfortable as we could. There was good distal (below the fracture) sensation and piedal pulse. The fluids were up and running and his blood pressure was stable at about 115/70. The swelling was massive, you can bleed up to about half your body's blood into the thigh when there is a nasty break of this bone.

Really that's about all we could do other than get him to A&E as smoothly as possible.

Talking to him through all of this it transpired that he had a prosthetic knee following bone cancer. He'd got the all clear 3 months ago. Despite the pain and us having to lug him around, making everything worse, he didn't even swear. Brave, brave man to my mind.

I apologised to him for the things we had to do and the pain we inflicted. I think he understood but I still feel bad. Sometimes no matter what - you just have to get on with it, even when you know it's going to hurt and sometimes make things a little worse.

I know that this man is waiting on the consultant to make a decision. A big decision. The replacement knee was quite extensive and where the break has occurred means there is not a lot of bone left for them to do anything with. He may loose his leg. He's 21, f***k I hope not.

SEASON OF GOOD WILL

Well, here we go. I'm just back from a couple of days away -- ah relaxation -- and am back for a string of five twelve hour night shifts. Don't mind this really but hope that people behave better than I expect them to. Including my self.

Anyway, happy Christmas to everyone and I will let you know about any interesting Christmas frolic's that I happen across. Enjoy!!

A LITTLE KNOWLEDGE....

It's a sad admission but I can't remember if this job was from today or yesterday. Everything just becomes a blur after a while, merging into the mulch that is my brain.

A call came through as an "alcoholic feeling unwell", now this has all the hallmarks of a job that is a load of pish and, well, I'll let you decide...

The patient had been known to be an alcoholic for the past 18 years. 7 weeks ago he had what sounded like a severe gastric bleed, although his wife said it was ruptured osophogeal Varese's. These Varese's can burst like a balloon and spurt like a fountain. I've never been to anyone, and that's only 2 people, who has survived this. Usually there is more blood on the walls than in them; although caught in time they can be banded. It may of been osophogeal varisees - I don't know, I'm no doctor.

Following this admission to hospital he stopped drinking and was discharged 3 weeks ago. He was given medication including Diazapam, which is to help manage the withdrawal. The other medication was for his (mild) dementia.

Three days ago he came up to his sons for Christmas. Here his son was concerned that his dad was a bit drowsy and not as coherent as he expected, so he phoned his sister. His sister is a policewoman and as explained by him "she knows all about this sort of stuff". (now i have the greatest respect for the police so don't think that this is a jab at anyone/any organisation). I have no doubt that she has encountered Diazapam in OD's or with our Jakie friends and this exposure enabled her to form the opinion that the Diazapam should be stopped immediately.

Roll on the next day and dad suddenly starts to shake and becomes unsteady on his feet. He manages to soil himself, but this is not an uncommon thing according to his wife. He also kept falling asleep.

We turned up and helped him to the bus and to A&E, where they prescribed ......... Diazapam.

I thought everyone knew not to suddenly stop a prescribed medication. Knowing of a drug in a particular set of circumstances does not lead to a knowledge of it in all. I know very little about some drugs and nothing about most. There are the ones you come across all the time but then why some patients are prescribed a particular eg. antidepressant than another is well beyond my ken.

A little knowledge is a dangerous thing. The decision to withdraw their fathers medication could of led to seizures/stroke many things. Leave these decisions to those who are supposed to know.

THERE THERE.

Not a particularly busy day today. Elderly people only and only urgent cases. Not one of them needed an ambulance and only one of the seven wasn't followed to hospital by a relative in a car. They all walked, only 3 with a helping hand.

Still all very nice people, and it gives us something to do when there are no ill people.

JOB DONE!

At the moment it's -4c here in the wopwops. I've bought, wrapped and delivered all the x-mas presents I need to.

Job done!

REQUESTING INFO.

Puke, vomit, shit, alcoholics, Ferrel people. I'm use to the smell.

I'm lucky enough to have never been called to a two week old corpse. BUT, Is there a remedy to the smell of some body who has been burnt to death?

It kind of lingers.

EMOTIONALLY

I sometimes wonder about how my description of my job comes across. I cant stress enough how much I love my job. I've done many things before finding this including (mostly as a student)
1. Bar man
2. Door man
3. Bank Clark
4. School janitor
5. Ski instructor
6. Furniture manufacturer
7. Locations assistant manager in Film/TV

For most of my working life I was a Chartered Surveyor. A job I think I liked in essence but honestly didn't like the people I worked for. I never had that greed for money or the inherent desire to be a businessman. I left surveying to join the police but due to a home office directive at the time, they did not employ asthmatics. What would I do?

It took a bit of time and a spell building database driven intranets to find my calling. It was a bit of a fluke really. A girl I have known since I was 3 has parents that go to church with my mum. She's a paramedic. I met her for a drink and had a chat. 4 years later I too am a Paramedic.

I love my job and will always be involved with this work. There is no greater reward than helping someone who is in trouble or seriously unwell. We are limited in what we can do, our remit is to get people to hospital, but we can and do make a serious difference to those in need. We save lives or at the least give people a chance that they would not otherwise have. We reassure, console, relax and sometimes make people laugh. Despite the fact we give morphine, fluids, adrenalin, oxygen etc. 80% of what we do is make people feel that they are getting the best care possible, and they do.

There is a bit of political piss with the "technician/Paramedic" thing but I would rather have a good Technician turn up to one of my parents than a burnt out Paramedic.

I once thought I was worldly wise. As a surveyor you go into houses all over the city; good neighbourhoods and bad. I also thought I knew people. I knew people from my background and speculated about the rest. My eyes have been opened. In a country where 1 in 5 people leave school unable to read/write or do "sums" I shouldn't be surprised with what I come across.

As far as I am concerned the welfare state has destroyed this country. We are now into 3 or 4 generations of people who have no intention of working. It is more beneficial to have a few kids and live of the state. This is the education they get from their parents so why bother at school. And, lets face it, their right. I'd be better off having another 2 kids than working and having to pay child support at the same time.

The biggest thing though is that people, the general, undereducated people have no idea about self responsibility these days. We live in a Nanny state so I shouldn't be surprised when they expect an ambulance for something trivial. There are two factors in this:-
1. Age
2. Education

Age. Well, the number of people over 70 that don't call an ambulance when they should is amazing. I spend a lot of time telling them that that's what were here for, if they have chest pain etc. it's my job and I enjoy helping them. The NHS was established for these people but they seem reluctant to bother anyone. I get a great deal of reward from helping and reassuring these people. People under 50 think of us as a taxi. Screw those people who are ill/dieing, we want a lift; no really that's their attitude.

Education. Well I'm biased. I had a good education and so did all my friends. We lived it large in our day but never sought trouble and always looked after our friends. We still do. We always knew we'd work for a living and that there was a point where we would have to be responsible for ourselves. This just don't happen in chavsville.

I love my job. I hate the state of the country. It started with the Tory Thatcher and is going on with the Tory Blair.

God help the emergency services.

Sorry, ran out of steam on this. could of gone on for ever.

BUSY, BUSY.

As mentioned I've been on nights Friday and Saturday. I'm still recovering and trying to re-set the clock for day shift on Tuesday. Never easy.

Friday night was mad. I think it was the busiest night of the year so far. normally it's the Friday before Christmas so next week could be worse.

What did we do? Well we did:-
3 chest pains
2 difficulty in breathing
5 assaults
2 D&I
2 urgent cases (where a GP has seen the patient and booked transport)

I was quite impressed with one of the D&I's. I've seen it before, but was breath taken by the achievement of the individual involved. This 19 year old student had got so incredibly drunk that not only had he passed out, GCS 9 (Below 9 is a coma) he had filled his breaks. The stench was terrible. Clouds of shit guff hovering in the air, mustard gas would be less toxic. The volume passed also exceeded anything I have previously encountered, so I obviously managed to get some on my trousers. Luckily for me he diluted this with vomit en route so off I was to get changed.

The second urgent case is still irritating me. 48 year old Mrs Y had to wait 4.25 hours for a lift to the hospital. Her GP suspected a UTI ( Urinary Tract Infection) and in an open letter, which she had red, suggested that she be monitored and on fluids for 4 hours, unusual for a GP to be this specific but there you go. When we turned up she was waiting and walked out to the bus with her husband saying, as expected, I'll follow in the car. FU**ERS. She would of been getting ready to go home if she'd jumped in her husbands car as suggested by the Doctor. People really have no concept about what we do and the limited resources available, even on "quiet" days. Hope her piss burns for weeks.

Saturday was unnaturally quiet. Not to say we were not on the move all the time just not under the same pressure to clear at hospital for the next job.

4 assaults
4 chest pains
2 DIB's

Normal stuff really.

One of the assaults could of potentially been vary serious. A 23 year old male had got into a fight at a club and he Had been "glassed". Why someone would glass this 5'3" Gent was beyond me. He walked like a Paratrooper with the jaw on his shaved head thrust out and was kind enough to ask everybody to fu*c off before he bumped into them. Anyway, the glass shattered cutting deeply into his neck. It had sliced through the skin and partly severed the thick corded muscle that runs down the neck. In hospital they could see the carotid artery through the wound. Another couple of mm and he'd of bled out before we arrived. His cousin was with him. A very pleasant woman who would not stop shouting about the revenge that the family would take on the culprit and refused to do anything asked of her because everybody in the police and ambulance service is " f***ing stupid". Last I herd they had both been nicked for breach while in the hospital. Such a shame, such nice people.

I actually like being this busy. Time rattles in and before you know it your asleep on the station couch after finishing time because your to tired to drive home. They were good nights and the people who needed help got it despite the mayhem.

UTTER, UTTER RUBBISH!

My attention was brought to a particular toilet paper article by the most excellent blog "Random Acts".

There is not much more to say other than read the comments. And the article in question, below.

http://www.thesun.co.uk

My twenty cents are that there is a difference between rural crews and town crews in this regard.

I sit somewhere in the middle. We're supposed to be a ruralish crew but spend most of our time in Northtown as there are not enough crews there to cover the workload.

I know that in more rural stations they accepted the derisory offer from the ambulance service of £250 a year to "buy back" the meal break time we no longer get paid for. To make it clear when we are on our break we are not working. We could go home, shopping --- if there was time. A call during these welcome breaks is the same as calling you in to work from home, in effect.

The acceptance of this miserly sum, in ruralshire, was largely because the workload is not at saturation point. Crews are more likely to get time to have a meal during their shift without having to set aside a special "window" for this. Also there is additional social responsibility within smaller communities where you may be the only crew serving the community in which you live.

In larger cities or towns the £250 was stuffed up the services arse. This equates to an offer of approx. £2 an hour for overtime. It is not that crews do not care, of course we do. It would be a pretty thankless job if it was not for the reward of helping people who really need help. Rather the refusal is because 1. The offer was an insult 2. We need a break.

45 minutes away from work in 12 hours is not bad. If lives are lost it is because there are not enough crews around to meet demand under normal circumstances; not because humans need to eat to survive.

Eating aside, the 20 or 25 minutes you get off the clock makes a heck of a difference to your mental state over the 12 hours. Never getting fed was always a main complaint. Now its not. I wouldn't go as far as to say moral was better, just that we cant moan about being starved any more.

As for people being "forced" to finish a break, well - their not at work, not getting paid for it. The problem is more of finding the time to eat/rest rather than being made to. If there is an issue with a shortage of ambulances then there are things that could be done.
1. A reasonable offer to buy back the 45mins a day could be made. Although this would have to be "healthy" for me to consider having experienced the luxury of undisturbed breaks.
2. Additional crews could be put on the road to meet the underlying demand.
3. The "right" to transport by ambulance could be varied. It's never the ones who need/deserve an ambulance that complain. It's the bleeding warts and drunks that take exception to waiting. We should be able to refuse to transport such people where transport by emergency ambulance is not "appropriate or necessary". How many crews would this free up? I guess between 50% and 60%.

WEEKEND

On the coalface for Friday and Saturday night. I don't actually mind working these nights as you tend to know what your up against. D&I's and the regular PFO's (pissed fell over). Given the amount of office parties it will be busier than usual but I guess you can only do one job at a time.

We will see.

Chinese Whispers

I was reminded of a job I did some time ago. It was a strange thing but, I guess, not that uncommon.

A 999 call came through for a man knocked off his bike by a car. Now, this has the potential to be a "good job" as there may be some good trauma, which means that we get to use our toys and skills. Obviously its better if there is no injury but if there is we can help; do our job.

The lights and sirens were doing their thing as we battered through Northtown towards the scene. On arriving there was no car nor any obvious patient. There was a small group of people near a bin on the side of the road 100m up. We trundled along and asked if they had seen anything. Sure enough they had the "patient" pinned against the large bin and were asking him various things - no idea what. He was obviously agitated and was shouting at these well doers to leave him alone.

I took him to the side and managed to get out from him the information I needed. He was homeless and had been raking in the bins for clothes. He had about 15 bags of clothing on his bike and couldn't balance it as he pushed it along the road. Hence the RTC - man in road off his bike, obviously a hit and run.

Despite my concern that there may be some mental health issues there was nothing wrong with him physically and just wanted to be left alone. The caring members of the public became abusive when they heard we were not taking him to A&E. Words like heartless, bastard and uncaring were banded around. Nothing new but usually it's drunks swearing at me.

(I can imagine the handover - "was pushing his bike along the road and it fell over. He was GCS 15 on arival with no injuries. We've placed him in a collar and on a spinal board as a precaution and he's had 20mg of morphine because, despite the fact he was in no pain, the bystanders thought I was a c**t for not bringing him to A&E resulting in all his worldly goods getting nicked".)

We contacted Control and started away from the scene. Five minutes later another 999 to where we had just been. Same man, same do gooders. This time however the poor man was angry that they would not just piss off and let him live his life. When he saw us again he started shouting even more and thankfully the well meaning passers by got the message and left. Good.

Informed control and headed off..... 999 to man fallen of bike in Same Street.

Back on scene more pesky Samaritans being yelled at by this poor man. The thing was that he was getting a bit pushy at this stage so my colleague contacted control and informed them that the patient was in an aggressive state. We talked to the concerned citizens and to the "patient" and made the peace. The public went on their way and the bag covered bike was trundled off into the dark by a very frustrated homeless person.

He had gone no more than 50 metres when all hell seemed to break loose. Control had informed the police about the aggression and they had sent the armed response unit.

It's good to know that the police are there like that for us, I know that the other emergency services get extra special care from me, but really. I don't know what message was passed on and how it was distorted but the look on this poor mans face was a picture.

I have never seen someone crumble so efficiently in my life. The World landed on his shoulder in the space of 1 second. His shoulder sagged, his eyes lost their shine, his mouth drooped and I'm sure I heard the words "what the f***". I'm sure if I was close enough I would of heard his heart break.

Fortunately the police used the common sense required to do their job and the man was last seen heading to his favourite bench. Don't know what he thought he'd done to deserve this night, but don't think he'll forget it soon. I'll never forget the speed at which someone can suddenly look so completely dejected and set upon.

The thing is that he was set upon. I think it is highly commendable that people take responsibility for their fellow human beings and feel that they are able to call on emergency services when their required. Sometimes though they can do more harm than good. This poor man was looking for a new pair of shoes and ended up surrounded by half a dozen cops in Kevlar and ceramic plate. If people would use their ears and common sense things, sometimes, would be better all round.

Poor bugger.

NO LAUGHING

One of the things I like to do is catch a wave whenever I can. Don't get out much these days and may never go again after seeing this. Still trying to get the stains out ... and its only a photo.

MORE LAUGHING

I'LL DECIDE

Something people should not do, when an ambulance turns up, is to greet us with "they'll need a chair". Sometimes they will but let us assess this. The fact that you have declared the appropriate means of removal makes it more likely that we will get them to walk. Because someone is more comfortable lying in bed does not mean they cant walk. If they can make it to the toilet they can walk. Remember this you divot!

I have a bad back anyway so am not inclined to increase my pain and shorten my working life just to keep you happy. The chances are that you have little idea about whats going on and what our job is, so bugger off and let us get on with it.

Just something that pisses me of.

CATCHING UP

Having a couple of days off, and given that Christmas is coming, I went out with one of my mates for a couple of beers on Wednesday night. It was good fun and great to catch up as I'd not seen him for a while, ages actually, and it's been my fault. Much ale was consumed and feeling a bit green around the gills at the moment.

While we were out we also ran in to some of the nursing staff from A&E. I've never met any of these folk socially before. It was good to meet them and get to know them just a little bit better.It's strange how you can see someone almost every day at work and not really know anything about them.

A TRADITIONAL FAMILY X-MAS

Dear Sir/Madam,

I am writing on behalf of the people who gave birth to you, raised you and, in most instances, nurtured, loved and worried about you.

As you may be aware Christmas/the winter festival, call it what you may, is only two weeks away. This is generally regarded as a time of good cheer where friends and family get together to celebrate a christian festival or simply to wish each other well. Traditionally there will be a meal for the whole family and the exchange of presents, large or small, and an expression of love and good wishes to those present or, indeed, mankind in general.

It may, therefor, be regarded as an unseasonable gesture to contact the accident & emergency arm of the ambulance service requesting the removal of an elderly parent immediately before or on Christmas day. I understand that they may be incontinent, have very poor mobility or even Alzheimer's but, believe me, the hospital is no place for them to celebrate. They are crowded with ill people who would love to be with their family, if only this was an option. Our staff members are experienced and professional and will generally know within a minute what a heartless shit head you are. Irrespective of the accurate description of the symptoms you found on Google for bird flu the physiological elements will not be present; no matter how much you tell us you think they are.

Additionally, the likelihood of other members of the public becoming genuinely ill over this period are the same as on any other day. There will be as may cardiac arrests, strokes, chest pains etc as at any other time of year. Consequently the crews who are on shift will be quite busy enough without trying to provide respite care for your unwanted parent/relative. May I respectfully request that you enter into the spirit of the season and take some responsibility and show goodwill to those that love you.

Failing this please try and refrain from hitting relatives, that are able bodied enough to attend your shindig, with anything too hard or sharp. Despite the effects of Stella and vodka this may cause harm. Even the application of a fist at speed may be detrimental to the well being of both your brother/father/uncle/wife and yourself.

Should you choose to have your traditional gathering and party games it would be of benefit to remember that there are limits to how much alcohol you can have before driving. Your 3 year old daughter will not understand that you are putting her life at risk, even when you hit the wall and she hears her neck break.

Wishing you the best of the season,



Iain MacBain

I MAY NEED TO APOLOGISE

I may need to apologise, at least a little.

It's very easy just to let rip at some anonymous, faceless, cretin when you know not much about what they get up to. I do this lots - to our control, to traffic wardens, to most drivers, to most things that make absolutely no sense in anybodies world.

This is NHS world so, and it's the same in any public service, there is no reason. No rational with dealing with the great unwashed. It's a bit like trying to have a sensible conversation with spinach, you just don't seem to get the answers you expect.

I know this. I know it's not easy and I know the systems in place suck. I give NHS Direct/24 a hard time. They know as well as I do that they take the piss a bit and while I do get frustrated, and hate them at times, I guess that I'm spared the agony of working in a call centre.

I found TALES FROM TRAGEDY TOWER through NHS BLOGDOCTOR. I now understand a little better, sorry. Love the blog; keep it up,( I know that none of you are really cretins).

HMMMMM!

I think I probably started smoking because I thought it was cool. And who wouldn't with Audrey babes doing her nicotine thing. Stupidest thing I ever did though. Don't even like it.

I recently stopped for nine weeks. Fantastic!! Then I got a bit drunk two weeks ago. Back to 20 a day.

BATTENS DISEASE

Today was not to busy really. Very quiet early on with the afternoon picking up.

One of the calls was to a patient with Battens Disease. I had no idea what this was so looked it up a minute ago. Apparently only about 500 people in the world have this particular genetic disorder. A gene has to be inherited from BOTH parents and then there's a 25% chance of developing the disease.

Basically the body can't absorb certain enzymes/fats leading to various symptoms including seizures, blindness and it destroys the cells in the brain. The patient was having a seizure. This seizure lasted 30 minutes before we arrived, despite medication. Prolonged seizures like this is called status epilepticus.

We gave her some Diazamuls to try and stop the seizure then grabbed her and ran. You don't hang around in this situation. Her airway was secured with a small oropharangeal airway (a small tube to hold the tongue away from the wind pipe) and an oxygen mask was put on. The seizure continued the whole journey in. There was saliva in her mouth so suction was necessary at times during the very fast trip. By the time we arrived at the pre-alerted hospital the seizure had been ongoing for an hour.

The doctors were intubating her when we left and giving other medication to try and stop the fit.

She was only four years old. I hope that she's OK. I'll think about this wee girl for a long time.

HE'S GOT THE LOOK!

During Ambulance Technician training you learn lots of stuff in a short period. It messes with your head at the time and you forget most of it. It's not until your on the road that it all starts to fall into place and the signs and symptoms can be related to what you see. Soon you can walk into a room and tell when someone is really sick, even if they don't have all the signs and symptoms that are in the text books. You also learn to spot someone who's swinging the lead pretty quickly.

Long before any of this sinks in however you learn what an alcoholic usually looks and smells like. The smell thing is good because it gives you a warning, on entering a house, what you will probably be dealing with before you find the "patient". Usually it is crap generated by loneliness or a rotting mind, sometimes our friends just like phoning because their drinking buddies find it amusing.

I have to admit that I have little patience with this now. I accept that it is an illness etc. but I long to hear a new story. It always takes the line of "my dad/sister/best friends brother/dog died and I started drinking ... blah, blah, blah. Only so much sympathy to go around and that's generally reserved for the bereaved and/or elderly.

Sometimes they are nice alcoholics, sometimes they spit and swear, sometimes they puke on the floor or hit you. I have not met many of the first type. They all bore me though and, other than the rare occasion when they are ill, A&E is no place for them to be.

The usual routine is that you get the call, turn up, spend half an hour waiting for them to decide if they actually want to go to hospital (sometimes when they hear that we have the audacity not to wait on them and provide a lift home they swear at us and we can leave), get them there, book them in - then watch as they stagger of down the road 5 minutes later. Heading home while you mop the phlegm up of the truck floor. If they're not seen immediately the nurses and doctors can go "do" themselves.

What a waste of time and money.

Despite all this I treat them with the same respect as anyone else I encounter, which is quite a lot, BUT --- I'll be buggered if they get to hear any of my jokes!!

Small victories.

THE SCEPTIC

THINK THAT'S SUPPOSED TO BE A THERMOMETER IN THE KIDS MOUTH - ALTHOUGH CERTAIN PARENTS AROUND HERE.......

Why would a GP call an emergency ambulance to a 3 year old, with a chest infection, at five to five? Nothing other than this wrong with the child.

Could it be that his dinner would get cold if he took the time to treat the patient, or did the child need to go to the children's hospital for specialist treatment?

Am I missing something?

THINGS TO COME

So,you're waiting on cataract operations - sorry to hear that but guess that explains why you tripped on the step. Thank you for laughing at my joke about causing trouble; I can see that your in pain and that your shoulder is dislocated.

What!! It happened 5 hour ago, I'd be crying like a baby and shouting for my mum. Really it's not bothering us. That's what were here for, it's my job and at 78 you've got every right to phone us.

Hopefully the morphine I give you will help with the pain on the journey in.

Is there anyone we can let know what happened? No, no family and most of the people you know are dead. Don't know what to say to this, but know that an extra bar on the fire would warm the flat up a bit and that there has not been anyone able to look after the flat for a while. It's clean but there are things, I guess, you cant do anymore.

You laugh at my jokes and I like you for it. These are the jokes I tell all the time to try and put people at ease but they are new to you and you seem to like them. Your pulse is slowing down a bit as you relax, but I can still see the pain in your eyes.

Really, its not a problem. You are a pleasure to deal with. Is the morphine working? I can give some more, I don't like seeing you in pain when there's something I can do for it.

Thank you for thanking me and my colleague. Lots of people don't. It actually means a lot.

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I hope that you're not as lonely as I have presumed you are. I have no right to do this. I hope that you have good neighbours and that there are friends out there to check up on you or go for a pint with. I liked you and don't know why there is no next of kin to share your life with. It could be for any reason.

I hope that you are happy and that your shoulder is reduced without too much pain and that your cataract operation goes well. Take care.

X-MAS CHEER

I've been feeling a bit guilty today. I have done nothing at all apart from play with this new blog thing.

I should of been doing some Christmas shopping. The thing is that I'm a real Christmas humbug. I don't know where this comes from but it's the same with my birthday, which is, lets face it, more important to me. There just other days in the year.

Maybe its because I don't have kids of my own to get overexcited on the 25th and maybe it's because this drives home the reality of being single. It can be very lonely at any time but I guess that at this time of year this is exacerbated. Maybe I just need to get out there and get laid. It would help.

Anyway I've done some online shopping for my friends kids so will need to wrap and deliver these. I have also got stuff for my folks and my sister who kind of like x-mas. In fact there's not much left to do, but I should of done it today. Get it over with.

Fortunately work commitments mean that I'll be on shift for x-mas itself for the 4th year in a row. This is good from a Scrooge perspective, means I don't have to make excuses up for not going to the cousins or wherever. Also a good thing is that for the first time in 4 years I'm off for new year. I intend to spend it with friends getting very drunk indeed and feeling crap for days after.

FOR HOW LONG

Just heard on the news that campaigners have managed to keep open the Inverclyde Royal Infirmary (not a PFI). Congratulations.

Being a sceptic I can't but wonder how they'll make you pay. There is always a price.

WORKLOAD - JAKIES, GP's AND NHS REDIRECT

The work load of ambulance services is growing and growing. It's got to saturation point in most regions. There are a number of reasons for this.

First there is yet another generation of people who think that we're here to attend their every whim. People who have probably never worked, had homes, tv's, washing machines and taxis provided for them at our expense. People who don't think that they should be responsible for themselves and are brought up to expect everything on a plate. People who think ear ache, bleeding warts, boils etc. warrant an emergency response because, well, that's our job. Why bother to drive your husband/son to hospital with a broken finger when there are special buses that come to your door. It's also fun to call an ambulance when your drunk and/or lonely, we have loads of time to sit around.

Secondly, GP's. Now there are loads of good GP's but I guess that we hear more often from the not so good ones. There is a thing called "continuity of care" that is banded around as a reason for doctors calling an ambulance for otherwise capable people. I will never understand why a GP will let a patient sit at home for a couple of hours waiting on us to turn up when the have someone that could drive them to hospital in 20 minutes. If mobility is not an issue and transport is available they will be seen by a doctor before we even get round to picking them up. Common sense will never prevail. Where is the care in being left with a letter? If this is appropriate an ambulance usually is not.

NHS Direct. The best way to explain this is probably to give a couple of examples of jobs that they send emergency response to.

Turn up at Mr D's home to find him amazed that were there. Totally unexpected and the flashing lights and sirens didn't make him to happy. Talk of the street I'm sure. He had phoned these idiots an hour before because the dressing on his bedsore needed changing. This had been explained to NHS Direct and a district nurse was requested, as normal. 999 to us?? What could we do? He did not need nor want to go to A&E.

Mrs P has chronic back pain which has been playing up for two weeks. She runs out of painkillers and, unable to bare the pain at 0400 hrs calls NHS 24. She explains that it's a pain management issue and that she is a single mum with 2 kids to look after. NHS 24 say that they will have a doctor attend within a couple of hours. She lies in bed trying to avoid crying with the pain. 0630hrs 999 call from NHS 24 to ambulance control, emergency response requested for 36 YOF with lower back pain. We turn up to a women who once again did not want nor expect an ambulance. As she said "what can we do for her"? Nothing; except call back NHS 24 on her behalf and start the thing all over again. This woman was in severe pain but knew what was required to manage it. We responded on lights and sirens for a sore back!!

I can only guess that NHS Direct/24 have about 2 hours to complete a "case", from a call being made to them receiving the appropriate care/outcome. Where they can't do this an emergency response from the Ambos is requested, clearing this from their books and no doubt meeting some government target. While driving fast is fun it is a dangerous thing for all road users, including us. I resent us being used to meet another organisations targets when we struggle to meet our own ORCON times.

TICKLED ME

I could just be a bit weird, but these made me laugh.

ELEPHANTS IN THE GARDEN

Nothing to do with work but I found this in my house this summer. Aparently it's an Elephant Hawk Moth. Quite something. It woke me up rusteling away in a plastic carrier bag - thought it was a rat.

JOINED UP THINKING

I have been thinking, in a rather small way, about the NHS. Given that I work for them I do a bit of this.

The NHS is run, now, by PFI's. They build smaller hospitals and charge us a fortune for running them resulting in NHS owned hospitals being closed down. Smaller hospitals are justified on the basis that more people will be treated at home, ignoring an ageing population that results in larger numbers of people needing hospitalisation.

This done the government removes the requirement for GP's to provide out of hours cover. Now, I could be wrong, but this must significantly reduce the man hours that doctors provide. Who is there to treat patients at home given that the hospitals are shrinking in both size and number?

NHS Direct/24. You cant diagnose people over the phone, at least NHS direct cant. I would not like to say that there incompitent - because they wont be, but my god!! I guess that they have a time limit for keeping jobs "live" because they pass cases on to us Ambos that we should never be going near, never mind on lights and sirens. More on this later.

Paramedic Practitioners. Good men and women but the ambulance services dont know what to do with them and, afterall, while doing the Practitioner stuff their not even working for the service but rather the Hospital trust. This training is, in my opinion the way forward for paramedics, but we are not doctors. Knowing that management will hang you out to dry should a mistake happen, and they do, is no position to be in.

I dont know what the solution is. Possibly if the NHS built its own suitable hospitals and provided the appropriate medical professionals to treat people at home, should that be appropriate, things would work. But maybe thats taking a step back in time to when things worked. The Government must know that their killing the NHS off in a deliberate way. I know they are and that when i retire I'll need private health care.

What a mess!

WEEK OFF

Been off work for the last few days. The way it works is that we do 5 twelve hour night shifts, then get a week off. Huraaaaa.

Back to work tomorrow though so I'll need to try and reset the old body clock. The 5 nights we do really messes with me. Although we get a week off afterwords its not until Monday, at the earliest, that I begin to feel human. This week hasn't been a good one sleep wise. Haven't had more than 5 hours sleep at a stretch - I like my sleep so have been a bit grumpy.

Will see what the next four day shifts bring. I actually prefer night shift and would like to think that I'd be able to work only these. In reality though I see little enough of my friends and parents so becoming a full time owl would not be a good thing.

Also at this time of year I miss the daylight, think there may be an element of SAD in my make up. This might explain why my sleep has been mixed up more than usual.

ANGRY

Where do I start?

Most pissing of job - women in her late 40's with something? doctor didn't specify but did arange an ambulance for her. Turned out she had a hospital apointment and her husband did not like driving in northtown. Ahhhhhhh!!

Most agrivating contact - 36 year old woman with cellulitis requires transport to hospital, despite having 2 (yes two) people carriers and a "capable" husband. very obise with 7 children, the oldest two have kids of their own. Getting a brand new 6 bedroom house built for her, despite no-one in the family ever having had a job. I've worked since I left uni.

Job i took home 1 - 18 year old OD. friends killed him. No doubt about that. ran away when they thought he was not breathing. denied drugs involved. C***s!!

Job I took home 2 - Amasing in a way. On a coal bing in the middle of nowhare two kids, 17 & 22, had a head on collision on their trail/trial bikes. Older kid very dead but had to work on him, had to despite knowing that there was no point. I cried for two days after this job. Good boys in a friek situation, hope to never see this again.

SETTING UP

Well, I'm a bit drunk while I'm doing this so probably shouldn't.

I'm a regular reader of random acts of reality. Probably the best post and best written post on the web. I'm a paramedic in northtown and dangerously close to 40.

I think this post is probably going to be more of a rant than something constructive. While I dont really believe most of what I may rave about certain things, as you will gather, piss me off.

There is a common theam.