Don’t Make Me Angry

It’s a schools rugby game.  Not a small one either, the final in the local schools league, which means everyone is taking it that much more seriously.

We’re over by the side, well out-of-the-way, but close enough that we can see and hear what’s happening on the pitch. The windows are all rolled down, and we’re just lounging in the cab of the ambulance, enjoying the sun and chatting about everything and anything.  In short, it’s shaping up as another Q word duty.

A loud yell.  A thud, two bodies against the floor, and a groan from the crowd.  Silence.  Must have been a nasty tackle.  We watch, waiting for the players to get up.  One does.  He’s a little scraped up, but nothing that’ll stop him playing.  He looks down at his dazed  competitor, offering a hand.  And freezing, his face dropping.  The crowd goes silent again, and then, through the breeze, “Medic!”

I slip through into the back of the truck while my crewmate jogs out to the pitch.  Grabbing the gases and the response bag, I scoot out of the back of the vehicle and walk over.  I’ve got all the kit, but there’s no need to rush.  My crewmate is in charge of this one, and he doesn’t look that flustered.  He certainly has yelled anything at me yet.

I can see from two meters off that our rugby player is in pain.  A lot of pain.  From a meter off I can see why.  His shoulder is most definitely out-of-place.  I look to my crewmate as I drop the kit down.  ”What do you need?”

“We’re not going to get anything done here.  I think shuffle to the back of the vehicle and check things out in the peace and quiet.”

“Spinal?”

We both look at him craning around, looking at everything that is going on and the crowd forming around him.

“Probably not.”  We say together, and grin awkwardly.  We’ve been working together a while now, we know each other too well.

“Right, so entonox, scoop, cot?  Nah, scratch that, we can scoop him straight into the back, will be better on his shoulder.”  I eye up the terrain, nothing particularly challenging.  ”So straps, anything else?”

“Sounds good.  Though, perhaps some crowd control?”  The last bit is quiet, for my ears only.

I look around at what looks like  both entire teams craning to see what is going on. “I’ll see what I can do.”  I stand up and start in a reasonable tone: “Alright guys, let’s have some space to work please.”  A couple of people shuffle back, but it appears that a dislocation is just too interesting to leave.  ”Seriously guys, you aren’t helping.  Give us some room.”

Slowly everyone backs off, far enough at least to let me get out and bring the kit back.

Someone who looks distinctly like a coach steps in front of me, deliberately blocking my path.  ”What’s going on?”

I ignore the obvious answer of we’re treating someone, going instead for “I’m just getting some equipment, then we’ll get our friend back there moved into our vehicle.”

“How long’s this going to take?”

“As long as it takes.  We need to be sure we don’t do any more damage.”

“Can’t you just put it back in and walk him off?  We have a game to finish here.”

“Only if you fancy explaining to his parents why he will never use his arm again.  Besides, you have three other pitches you can use, if you’re in a hurry.”  I know that I’m skating the edge of being rude, but you’re annoying me and I have a patient to look after.  He looks grumpy.  ”Look, the sooner you let me get this kit, the sooner we’ll be out of your way.”  I don’t think that’s an appreciated comment, but at least he does move.

A brisk walk to the ambulance, a brief argument with the scoop stretcher, and then I’m on my way back with magic pain killing gas in one hand and jack of all trades lifting equipment in the other.  And yet again I’m facing a crowd, and this time I’ve got minimal patience left.  ”GUYS!”  A single syllable projected across the entire field.  Even I’m a little stunned by the silence that rolls back.  ”Move OUT of my way.  Give us room so that we can do our job.”  Youth Leader training kicks in.  Act assuming compliance.  I step forward purposefully and the crowd spreads out, dispersing before my eyes.  Recognise good behaviour.  ”Thank you guys.”

My crewmate looks at me, eyes wide and jaw lowered.

“Close your mouth, you’ll catch something.”  The residual annoyance makes it a little more of a snap than I intended, but I soften it with a grin.

Our patient manages a strained laugh through the pain as my crewmates’ mouth snaps shut with a click.  He takes the entonox from me, apparently grateful for something to do to cover the confusion, and I start explaining the lift and shift process to our patient.  Once his pain has gone away a little (and he’s high enough not to care about what’s left), we scoop and scoot, and the rest of the job is a fairly routine transport.

As we’re packing up at the hospital, my crewmate looks at me over the cot we’re re-making.  ”Are you okay?  You sounded pretty annoyed back there with the crowd.”

I shrug.  ”That was just lack of patience.  You’ll know when I’m angry.”  He looks at me questioningly, and I just smile.

Pain Scores and Young Children

An important lesson I learned today while on duty.  There is very little point asking a small child for a pain score.

This particular little person had fallen down a couple of steps, and had been brought down to be checked over.  He didn’t have any pain anywhere significant (like the back of the neck), and neither did he seem to be in any particular distress.  Normal practice suggests that I then try and have him quantify his pain level, so that I can work out if there’s something more going on.  I go through the rigmarole of explaining ‘where 1 is next to nothing (as I gently poke him for demonstration) and 10 is the worst thing you have ever felt’, and his first answer “9″.  Now in my experience, people who have 9/10 pain and and show no signs of it have either been really lucky (and so 10/10 is relatively low), have an incredible pain threshold (but even so…) or might possibly be stretching the truth a little.  Looking at this little guy, his mother and I went for the latter.  So I asked him if he was really sure it was 9/10, and stressed how important it is to tell the truth.  So he now says 6, because that’s his age.  Cue much rolling of eyes from me, my crewmate and his mother, and I give up.

The important lesson here, I think, is that I had made the mistake of treating this child like a little adult, and tried to apply a technique aimed at adults to someone who didn’t really understand what I was asking, let alone why.  Children are not little adults, though it can be easy to forget this sometimes, and remembering this is important.

Why I Volunteer

One of the most common questions I am asked (along with ‘Are you paid for this?’ and ‘What’s the worst thing you’ve ever dealt with?’) is ‘How do you do this for free?’ This usually happens about the time when I’m trying to stop a drunk student from drowning in their own vomit, while avoiding getting vomited on myself, and their friend is on the other side trying not to vomit. My stock answer is ‘Because it’s fun!’

Even more often, when I’m knee-deep in the worst of the politics and fighting against the people who are too quick to tell us what we are incapable of doing and the people who don’t care and the people who don’t want to lose their power, I wonder why I do it. I spend hundreds of hours a year doing work for a cause I passionately believe in, and in return I get people try to work against me because I want to improve things and they don’t want to leave the happy little rut that they’ve dug themselves.

A short time ago, I dealt with a patient at a Half Marathon, while working on a bicycle. They weren’t particularly unwell, but they had fainted and were a bit shaken up. They hadn’t run anywhere near that distance before, and weren’t used to all the sensations of their body saying ‘that wasn’t such a good idea, let’s not do that again’. All put together, they got a bit worried, and worked themselves up in to what I’m pretty sure was a full-blown panic attack. And I don’t just mean a bit of hyperventilation that quickly cleared up. They were genuinely terrified, kept fainting from the unbalancing hyperventilation does to your body, which just kept making things worse.

In the end, I called an ambulance for them and got them shipped off to the main treatment center, where someone would have the time to care for them and help them calm down properly. As soon as they were sent off, I was sent to another collapse, and I put the entire incident out of my mind.

After the spending the rest of the day zipping up and down the course, I was stood down and headed to the main First Aid post to grab some personal kit and help pack everything up.

While I was there, I bumped in to my patient from earlier. They had just been discharged and were going home with their mother. They both stopped when they spotted me, and my patient asked if I had been the person with them out on the course.

“Yes, I think so. How are you now?” I replied.

“Much better now, thank you.”

“Do you know what was wrong?” The mother chimed in.

“I can’t say for absolute certain, but I think you had a panic attack.” I went to explain how a panic attack was a scary condition, but usually self-limiting and nothing to be overly concerned about. My patient nodded along with my explanation, and then commented that she couldn’t really remember what happened.

“I just remember being convinced that I was going to die, but I remember you being there, and talking to me, and holding my hand, and I knew that I would be okay.” I didn’t really know how to reply to that.

To me, the treatment didn’t seem that much. A simple, non-life-threatening condition that, even if I did nothing, would most likely pass on its own, which I passed on to someone as soon as it looked like it would take a long time to deal with. Fifteen-ish minutes on scene, before moving on to the next job, patient already out of my mind.

But in those fifteen minutes, I helped out a terrified person, taking away some of their fear just by being there. And to that person, I made all the difference.

This is why I volunteer.

Ambulance Excitement

Image via Wikipedia

Okay, I’m really rather excited again.

First things first, it looks like I’ve passed the last bit of my ambulance crew training.  This means I’m now fully qualified to crew an ambulance (eep!) and transport an emergency patient (ahh!).  I have a year’s probation to complete, but that only limits who I can crew with (which doesn’t change anything, because I can’t drive).  Given the number of sleepless nights the course caused me, as well as how long I spent training, this is really good news.  It might mean I can’t cycle as much as I’d like to (which is sad ) but it will definitely open up a few new opportunities of events I can get to.

Second, I have just heard when I am getting my first duty on an ambulance: at the end of the week…  I qualified on Sunday…  In the upcoming three-day event, I am on an ambulance for two days (during which I’m almost certain to get something…) and am in charge of people on the remaining one.  This is even more scary.  I have never had actual responsibility at a major event. Well nothing more than “Keep an ear on the radio, I’m just going to the loo.”  Being in charge of about one-third of the foot patrols present is not something I’d expected to do, not least because I’d expected to spend most of the days as a foot patrol myself, or in a treatment centre at best.

So yes, life is getting interesting in the Organisation at the moment.

Oh, and try not to get injured if you’re attending a three-day event this weekend.  It might just be me taking you to A&E.

…

Well, try not to get injured anyway…

Cycle Response Run

We’re standing by outside the recruitment post.  Our bikes are attracting a lot of attention: a push bike with Ambulance blazoned across it is an unusual sight.

“992, 992 from Control.”

I turn away from the kids I’ve been explaining the bikes to.  ”Go ahead Control.”

“Respond under emergency conditions to romeo-one-five.  Collapsed child.”

I peer at my map, matching up R15 to where I currently am.  Bloody hell, we’re the other side the city.  I turn to see my partner already mounting up.  To the kids: “Sorry guys, got to go.”  I jump on to my bike, kick the stand away, and push off.

My partner pulls off ahead, and I slip in behind him.  I was good, and left my bike in a low gear when I pulled up.  We accelerate away, shifting up the gears until we’re racing along the road at a respectable rate.

It’s dusk, the perfect time for visibility.  What’s left of the sunlight makes our fluorescent jackets glow, while it’s dark enough for the reflective strips shine in every light.  Nobody should fail to see us as we race past.

We’re in luck.  Most of the route is a closed road. We have the tarmac to ourselves.  We make good time, getting half way to the far side of the event to the other before we know it.

We’re getting to the busy part now.  Slowing down a little, we weave between clumps of people, earning a few glares as we take a turn faster than perhaps people would like.  We shift down, cutting out speed to safely navigate around the dawdling obstacles.

The crowd thickens.  The spaces between the groups narrow.  We start to lose speed, stuck behind people wandering along, not expecting two cyclists to try to barge their way through.

On goes my siren.  They sound a bit weird, too high-pitched, but they certainly grab people’s attention.  People turn and stare.  A path opens up in the crowd, and we regain a little of our lost momentum.

One group turn and stare.  We approach, weaving left and right, trying to find a way past.  My siren is still going full blast, and it’s joined by my partner’s electronic buzzer.  The harsh sound cuts across the sounds of the crowd, making people wince, but still they stand, staring at us like rabbits in our headlights.

We’ve slowed to a crawl, nowhere to go.  Frantically we wave at them. “Make a path!”

Comprehension dawns.  They dawdle out of our way, and we pull off again.  Finally, a clear path opens, the crowd finally getting the hint that the loud, horrible noise means ‘we’re in a hurry, get out of the way’, not ‘everyone stop and stare’.

We career around the last few corners, the road finally clear again. We almost reach a sprint as we close in on our destination. I’ve been listening in to the radio as much as I can, in the hope that we get stood down, or someone got their first. No such luck.

We skid to a halt at the mouth of the road, screeching disc brakes announcing our presence better than any siren. The road is short.  If anyone was collapsed there, we’d be able to see them.

My partner circles up and down the road, scouting the area, while I hold a slightly breathless conversation on the radio, confirming the location of the call. Control tries to call back the original caller, while we lean up against our bikes, catching our breath.

Eventually they stand us down. Apparently our ‘collapse’ had got back up again when his parent’s didn’t give him all the fuss he wanted.  Of cause, they hadn’t thought to stand us down.

We took the slow route back to the first aid post…

Related articles

• Cycle Response (walkingplasterdispenser.wordpress.com)
• Cycle Response Training – Part 2 (walkingplasterdispenser.wordpress.com)
• Cycle Response Training – Part 1 (walkingplasterdispenser.wordpress.com)
• Four new cycle paramedics trained for Great Yarmouth (bbc.co.uk)

Cycle Response

Okay, I’m possibly a little excited.  Actually, scratch that, I’m acting like a kid on Christmas morning.

The last parts of my cycle responder uniform turned up this morning.  This is (and yes, I say it again) extremely exciting.

I’ve wanted to join the cycle responders for years now.  The first time I tried to get on the course, it was cancelled two days before.  The next time, after I’d spent some quality time with the cycle response policy, I didn’t think I had a hope of meeting the fitness requirement. That, and the high price for the uniform, I nearly gave up on it.

Somehow I persuaded myself I could do it.  Somehow, we’d raise the money.  Somehow, I’d pass the fitness test.

And I did it.  I passed the tests.  I am planning fundraising with a fellow responder.

This just left waiting for the uniform.  It’s special purpose uniform, so doesn’t get ordered often, and usually has a long lead time. I fully anticipated having to miss some events because I didn’t have the right uniform.

It’s now here.  All of it, in its hi-visibility yellow glory.  Now I feel like a proper cycle responder.

And just in time.  My first event is in just over a week and a half from now.  I can’t wait!

This sounds a little sad, but it feels like a dream come true.  I never thought I’d get to do this.  This is so much more important to me than the upcoming ambulance aid course I’ve been invited to.  True I might be able to go around in an ambulance soon, but I can go out on a bike now.

So yes.  A little excited, I think.

Bravery

We’re at a street party. Not a lot’s happening, so you’ve come to see the ambulance car. It’s something new, something different, and most importantly has blue lights, bright colours and a siren. In short, it is exciting! You come bounding up, resigned parents in tow.

You go suddenly shy when you reach me, hiding behind your daddy and peering from the side if his legs. He looks at me and shrugs. ‘What can you do?’

I crouch down next to you, and smile, saying “Hello!”. You smile, a little, uncertain. “Do you want to see my ambulance?”

You peer up at Daddy, and he nods, and so you do.

“Come on then.” I put out a hand, flicking a look at Daddy to make sure he doesn’t mind, and you take my fingers. I can feel my partner’s eyes boring me in the back of my neck. I’m closely pushing what I am technically allowed to do under child protection regs, but I have parental permission and you can always leave if you want, so its fine.

We wander around the vehicle, having a peer at everything and anything. I put the lights on. That gets a grin. You have a look in the cab, sit in the driver’s seat. You’re having great fun, and when we’re done you go skipping over to Daddy.

Well, you try to. You get about half way when you trip over your shoe lace. Daddy, my colleague and I all lurch over to catch you, but we’re all too far away. Bump.  You look up and give us all a stunned look, not least because you’ve now got three people, two in bright yellow and green, looming over your head.  There is a bit of a lip wobble, but no tears yet.

Daddy and I crouch down and Daddy asks “Are you okay?”  You give a small nod, still a bit stunned.  He takes your hands and pull your back to your feet.  Your sleeve slips, and I spot an abrasion all along your lower arm.

“Shall I do something about that?”  I nod at the graze, and Daddy replies “Please.”

Together, we lead you back over to the car, and Daddy lifts you in the treatment area (aka the boot…).  As I rummage through my kit, digging out saline, swabs and dressings, you peer over my shoulder, and I talk you through everything I’m doing.  Daddy baulks when I mention the saline I’m going to clean your wound with. “He’ll never let you put that on it.”

Now I know saline is salt water, but the concentration is so low the most people don’t notice.  “I’m afraid I don’t have anything else.  How about we give it a go and see how we get on.”  Daddy shrugs, obviously saying ‘on your head be it’.  To you, “This may hurt a little, so I need you to be really brave.  Can you do that for me?”  You nod, gone all shy again.

Carefully, I clean your grazes.  I’m trying to get clothing fibres out of them, and I know from personal experience that this is most unpleasant.  I have my hand support your arm, and you don’t even flinch.  I see a little grimace from time to time, but otherwise you do really well.  I am definitely impressed.  I’ve had adults fidget and fuss more about this than you.

We’re done in minutes, and your up and about and dashing around as soon as you’ve hopped down from the car.  We spend a few minutes doing paperwork, and then we’re finished and you and your parents are off again.

I do love working with kids.

To Treat, or not to Treat

There is a thing about first aid that some people get straight away, others catch on eventually, and still more never really understand:

You can’t treat everyone.

It is a fact that some people who don’t need treatment will demand it, and others that really need treatment won’t accept it.

The former are very easy to spot, and easy to deal with.  You just have to follow someone like Brian Kellett (né Tom Reynolds) on Twitter (@Reynolds) or read one of his books (which I highly recommend) to get a feel for the number of patients who turn up to A&E or call an ambulance for things that really don’t need emergency care.  I’ve had plenty of this sort of patient, but let’s be honest, these are the people who should be coming to someone like me. I can patch them up and send them on their merry way without consuming the time of a professional who has better things to be dealing with.

The latter group is more difficult.  These are the people who would really benefit from help, but don’t want to be a bother, or don’t want to waste your time.  Their heart is in the right place, but they don’t realise that they are themselves in the group they think we should be spending our time on.  I thankfully don’t see many of these, and the few times I have we’ve managed to reach an agreement that perhaps, may be, it would be worthwhile getting a nice paramedic come out and for them to have a chat.

Finally, there is a third class of person.  I’ve deliberately not called them patients, because most of the time, they’re not.  Often, these are the people who are most likely drunk who stagger past you at a stupid-o’clock in the evening while you’re waiting for a bus.  They are the people determinedly limping past your first aid post on the half marathon.  The might benefit from treatment, but they don’t really need it.

It is tempting to walk over, offer treatment, persuade them to stop.  It’s easy to go charging over, first aid kit in hand, and cure their ills.  Except they won’t appreciate it, and they’ll argue, and to be honest, they’re not interested.  Just because you can fix something, doesn’t mean you have to.  Just because you can act doesn’t mean you should.

You have to be realistic.  That drunk person you want to approach in the street.  Say they actually accept your help and don’t wallop you one for your trouble.  What you are you going to do?  They are conscious, mobile and still with it enough to make their way from A to B.  If you call an ambulance, they’ll take them in (assuming the patient is still around when the ambulance arrives), and they’ll sleep it off in A&E.  What would they do if you weren’t around?  They’d go home, and sleep it off in their own bed.  Yes, in A&E, they will be monitored by the staff and cared for.  But do they need it?  Perhaps it isn’t our call to make, but again, what would happen if you weren’t around?

The same goes for when I’m on duty. You see someone heading towards your post.  You think about going to intercept them.  Except, what if they’re headed past your post?  And even if they are headed your way, what does this gain you? They still need to come to your post if you plan to treat them properly, so you’ve just had to walk too and fro to meet your patient a few seconds earlier, and gained what?

I was the same.  To be honest, I have to watch myself to make sure I don’t revert.  It is very tempting to think that you can go in and solve any problem.  I enjoy looking after people. I think everyone in the Organisation does.  But I think, slowly, I’ve learned when to get involved, and when to just stand back, watch, and wait until I’m needed.

I’m not advocating walking on by every time.  Sometimes you do need to stop and asses.  But you must be reasonable.  Assess the situation from a distance, first. Will you getting involved achieve anything? Are you putting yourself at risk? What are you about to go charging in to?

Sometimes it’s experience.  Sometimes its a judgement call.  It’s not easy, but it is important.  Running in to the rescue may be exciting, but when you get it wrong you just look like an idiot.  And that is not fun…

Memories

Not long after writing about my incident a few days back, I found myself walking up that same hill, past that same step.

Almost as soon as I realised, all my memories of that day came flooding back.  I could still vividly remember the pram and the little girl sat in the middle of that road while her mother and I (also in the road) argued just a couple of meters away.  I could picture that little girls face as she peered suspiciously at me from around the pram, and the younger girls shy smile when I checked up on her before it all kicked off.

I suppose it was probably because it was fresh in my mind, after writing that post, but it still struck me as unusual how detailed my memory of the incident was.  With most of my patients, I can only remember vague details, or specific moments, if that, but almost every minute of this incident.

It must have made more than an impact than I had ever suspected.

Avenue Q and Political Correctness

I had a theatre duty a couple of days back, and I went to see Avenue Q.  Now I’ll be honest, of the shows that I go see for the Organisation, there aren’t that many I would pay to see.  However, some make up for all the duds.

I suspect Avenue Q will make up for every bad show I have to see for at least the next year.  In short, it was awesome!

It was also one of the more surreal shows I’ve seen (and I’ve seen some odd ones).  Watching grown people interact with puppets on stage in a show most definitely targeted at adults is weird at first.  It’s surprising quite expressive they can be (probably helped by how closely the puppeteers match their puppets actions), and you’ll be surprised how quickly puppet and puppeteer merge in to one person in your mind.

And interesting point about Avenue Q is how PC it isn’t.  It makes jokes at a large parts of the population that you’d think they wouldn’t dare to put on stage, and you get everyone laughing along.  Just think how much controversy a  ’Jungle Drums’ comment made (http://bit.ly/gDm4Qf – I dislike linking to the Daily Mail, but it gives you a good idea).  This show includes gay jokes galore (not one that I took offense at, I hasten to add), and an entire song calling everyone racist:

(I’d love to link to a YouTube clip showing a bit of the show, but none of them really do it justice).

At this point, I’d like to put in a quick ‘hear hear’ to this post on The Paramedics Diary, particularly the Speak Up section.  It’s good to see that not everyone is bowing to this Political Correctness madness.

Finally, back to Avenue Q, there is a comment in the reviews for the soundtrack I wanted to quote:

It is inspiring, funny, and at least one song will seem like it is personally written for you

And I’ll leave you with this video: