Hitting the Speed Bumps

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As an organisation (or, at least, in my part of the organisation), we are very keen at helping out the local ambulance service. By this I mean we will send out crews on ambulances (and occasionally on bikes) to help the service respond to 999 calls. Understandably, this could only be done by experienced members, and one of the criteria for the ambulance work was a certain number of hours third crewing on those shifts. This means working with two experienced members to build up some experience dealing with patients potentially more serious than anything I’ve ever dealt with before, which I’m strongly in favour of.  I don’t think I’d be happy going out on a shift without doing this first.

Unfortunately, since I qualified, it is no longer possible to third crew on any of our vehicles. Something to do with weight limits on the vehicles (which, given many of them are  transit vans modified into ambulances, not necessarily their original design role). This is very frustrating for me, as it means I can’t gain the experience needed to do NHS support.

To make matters worse, there are very few of us in this position (probably about 3 or 4), and so nobody at county level cares enough to do something about it. As far as they’re concerned, there are enough people to cover the shifts, and so there isn’t a problem.  This leaves me, and those few others, in a catch-22 situation: without having the needed experience, we aren’t able to gain the experience.

Needless to say, this is very frustrating.

A little while back, there was a possible solution. Our CRU lead sent us an email looking for interest in doing NHS cover on the bikes over Christmas. The roads get very busy in BigCity when everyone is doing their Christmas shopping, and the bikes can get around a lot easier than road ambulances. A load of us (apparently) applied, and it looked like it would go ahead. I even delayed heading home for Christmas around this.  A couple of us entertained the thought that this might count towards us getting some experience towards the ambulance work.

Of cause, it never happened. And we only found that out for certain a couple of days before the period was due to end. The reasons given was lack of  interest (yeah right), other duty commitments (*looks at depressingly empty duties book*) and lack of funding (*sigh*). Some of the more cynical amongst us suspect our useless County CRU lead is also to blame, but ho-hum.

All I’ve got to hope, in the nicest possible way to my patients, is that I get something interesting to do on the normal shift. Which, given my track record on a vehicle (nine or ten shifts, one patient transported for a minor injury) seems rather unlikely.  The only time I might have had an interesting job, someone kicked me off my truck (story to follow).

I think, as far as possible, I’ll try to stick with the bikes. At least on them I get something to do (and some useful exercise), giving me some experience treating, even if it’s not transporting someone…

My friend and I are already planning what out of county events we want to do.  Hopefully we’ll have a good yeah helping out our colleagues in the big city. At least there they know how well a bike unit can work…

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• Ambulance Excitement (walkingplasterdispenser.wordpress.com)

Ambulance Excitement

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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…

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…

Unresponsive

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You’ve volunteered to look after freshers this week, and had a good night out with the house you’ve been allocated. In fact, it was such a good night that they didn’t notice that you didn’t come back from the toilets, and went home without you.

I get called to you twenty minutes after the event closes, while we’re packing up. ‘Patient, unresponsive in toilets.’  Perfect. Grabbing a kit from where it had been put away, I walk swiftly out to find you. I have a bit of confusion when I notice that the route to the toilets is far from obvious, but get to you eventually.

You’re sat on the toilet, your boxers around your ankles, body lying on your knees. When I open the toilet door, which opens towards you, it presses against your head, stopping me getting in. It also stops me lifting your head up to properly assess you.

I bend down to speak in your ear, a far from pleasant prospect considering that this is a chemical toilet block, the floor is covered with vomit, and I don’t think you’ve showered in the last couple of days. Yelling loud enough to make security jump, I try and coax a response out of you. Nothing. Hitting you firmly on the shoulders, in fact very nearly slapping you, I try to reach out to a more basic level of your consciousness.  Nope, you are indeed completely unresponsive.

You’re a big lad, and try as I might, I can’t get you sat up, not with the door in the way. With you like this, I can’t open your airway, and I can’t check that you’re breathing.  This is a problem.  I can’t even slip around the door so that I am in the cubicle with you.  I’m just grateful that the door isn’t locked.

I have only one choice.  Turning to the biggest member of security I can see, I ask him to break the door down. Indicating which way I need it to come, I stand back, and he takes great pleasure in forcing the door the wrong way.  Outside I can see campus security eyeing up the door. They’ll be getting your name, assuming you are sensible enough to give it, and I hope you get sent the bill.

The crash of the door seems enough to wake you up, though you aren’t impressed. Twice you try to swat me away, but you’re moving so slow I can easily dodge. Besides, you don’t seem to be seeing straight, and only stay upright while I hold you.  You are definitely in no fit state to go home tonight, and I’m not happy loading you on to the vomit comet for the easy ride to A&E (the vomit comet is an SU run minibus that takes all our minor injuries to hospital, saving on ambulances).

Up comes the local ambulance service, the crew not impressed that they’re having to pick up a drunk. I don’t blame them. I have no sympathy for you either, but we all know that it’s the safest thing to do. The last thing we need is for you to roll over in your sleep, vomit, and then drown in your own stomach contents.  Once we’ve got the basic details out of you, we leave you in the care of the ambulance.

You’ll probably get put on fluids, rehydrated, and have no hangover the next day. You may even go for a repeat tomorrow.  However, tonight at least you and your liver are safe from further harm.  Perhaps you’ll learn. Can’t say I’m too hopeful…