In light of my recent incidents involving Facebook, I recently got very worried about posting about, well, anything. When I looked at my incoming referer logs, it was clear that people had come this way from my Facebook page. Potentially a lot of people, based on the number of hits, though most likely only a couple who just browsed most of my blog. For a brief while, I was paranoid that all of my friends (at least, those who can see my Facebook timeline) would be heading this way to see what I’d written. Of cause, I clamped down on what could be seen very fast, and I think I limited the ‘damage’ (the only confirmed person who saw the blog I can cope with), but that didn’t make me feel that much better. Suddenly, the perceived safety of a pseudo-anonymous blog had vanished. Perhaps it was time to jack it all in.
Except, I then remembered why I set up this blog. I write here to express myself, to vent, and because I enjoy writing for its own sake. Sure, I might have blown my ‘cover’. Sure, someone I know may actually read this. I’ve realised it doesn’t matter. Because this blog is mine, not yours. I’m not breaking the law (as far as I know), so I can say what I like. You may not like it, but that’s tough. I still have enough shreds of plausible deniability left to protect me from other members of the Organisation, and ultimately, it’s a free country. As long as I’m not hurting someone, I can say what I like.
Of cause, this may not make me popular, but if I let that stop me, I’ve lost out, not them.
When I was thinking about all of this (and pondering over a few posts that I could write), an xkcd post comes to mind. I think it covers quite well my final conclusion. I think I’ll leave you with that, and, real-life permitting, normal service will resume shortly…
I’ve decided I fancy a change around on this blog. I’ve played with some themes, and settled on a new one I like, and I’ll be wondering through my posts to make them fit in with the new style.
Things could get interesting over the next couple of hours/days/weeks…
This is aimed at everyone who has come this way via a recent post that appeared on my personal Facebook timeline. If you didn’t come here from there, you can ignore this if you wish.
My previous post from this evening showed up in my personal Facebook timeline instead of the blog’s Facebook page. This was an accident.
As I hope you have guessed, as at least one of you has wandered around this website, this blog is intended to be a semi-anonymous place for me to write whatever I feel like. I have posted things on here that I do not wish to be made public knowledge just yet. I would also draw your attention to page where it points out that half the stuff on here is made up. Stories that you think you might recognise may not tally with what we may have discussed while sharing our ‘war stories’.
I have changed my settings so that this won’t happen again, and completely removed the post from Facebook. I’m not going to ask you to forget what you’ve read. You can keep reading if you want (though, keep in mind I tend to be very honest, and so may say things you won’t like to read). Alternatively, you can put it all out of your mind.
What I will ask is that you please respect my desire for anonymity, and keep whatever you read to yourself. If you try to discuss this in front of other people, I will deny that I have any idea what you are going on about. This isn’t because I’m ashamed of what I’ve written, or because I don’t believe in what I write or do. It’s because I genuinely believe this is the best way for me to operate this blog, to avoid getting myself into trouble, to protect my friends and my patients, and to ensure I don’t unintentionally the organisation I volunteer for into disrepute.
I hope you understand this.
I don’t often write about gay things (well beyond the odd side-comment). Occasionally I’ll post something on Twitter, if I spot a tweet worth an RT, but I can count the number of these occasions on the fingers on one hand. If you’re interested, my favourite would have to be:
Gay Star News (@gaystarnews) February 27, 2012
Which is probably because I’m an old romantic at heart.
To get back to the point, last night I watched the film Beautiful Thing for the first time. I’d heard of it before (I’d imagine most people in the LGBT community probably have), but have only just got around to actually seeing it.
Now, I’m not normally a fan of such films. Give me an action/adventure or sci-fi any day. That said, I found it really enjoyable, and a far cry from many gay movies that pander to every single gay stereotype going.
The best bit is definitely the final scene. It is really simple (like all of the film, in fairness), but really moving, and the perfect happy ending.
Sorry that this is a bit of an aimless post, I just wanted to share. I definitely suggest everyone goes out to see this, even if just for the feel-good-factor of a genuinely happy ending.
As I have mentioned a few times now, I am currently the leader of the local Organisation unit for young people. This means I am in charge of two other adults and twenty 10-18 year-olds, and am somehow responsible for making sure they become disciplined, confident and well-rounded individuals (which most of them are).
Now, I have been a member of this organisation for just under five years. The first three-ish years were spent in the university unit, which was fun at first, but in the end I had a falling out with two of the more influential members, and it became more trouble than it was worth to stay put. Somehow, I convinced myself (and was convinced) that it would be a good idea to work with young people, and I transferred to, and eventually ended up leading, the my current unit. In short, this was the best thing I could ever have done. While trying not to be over-dramatic, I am convinced that, had I stayed at the University unit, I would since have left the organisation, or at the very least be very fed up. Instead, I have had two of the most enjoyable years of my life, and I have grown very attached to all of the young people I work with.
Unfortunately, now that I am graduating, life gets more interesting. With my upcoming graduate program, I could end up changing where I am working every three months. I could end up spending three months working in the US, or Germany, or anywhere else that my company operates in. Add on to the fact that I won’t know where my first placement is until after my housing contract has ended, and this level of uncertainty is not really conducive to being a good leader.
I don’t want to leave my unit. I feel like I have really achieved something here, and without all the hassle of the politics involved in working with adults, and I also feel really guilty about being the fourth leader to leave them in as many years.
That said, I am about to embark on what could be a really exciting start to my career, and I am worried that if I feel tied down to a specific location, I am going to be unwilling to take up some of the opportunities I could get. I would love to go work in the US, even for a little bit. While part of me is keen to stay in the UK, I think I would be doing myself a disservice if I let these chances pass me be. It’s not as if I wouldn’t be able to volunteer in EMS elsewhere (even if I ultimately end up living outside the UK).
I think I’m going to have to have a long hard think about this, when all my university stuff is done, and I have a feeling I know what the answer will be.
It totally sucks, but I have a feeling I won’t be a youth leader for much longer.
I know I said I would do a series of posts on observations, and I still intend to, but at the moment real life is just getting in the way. This is just a quick update of what’s happening, and the next post will be about something I really need to get off of my chest.
So, I am rapidly approaching the end of my degree. My final report is due next Tuesday, and after the Thursday after that, I am done. Finished. Leaving my university and likely not coming back (except for graduation based stuff).
I’m not going to lie, it’s a scary prospect. Not accounting for my work placement, I’ve been in full-time education for 19 years. It is literally the only thing I can remember doing. As of September, I start on the beginning of what (at the moment, at least) will be a career in Engineering. Real engineering (it doesn’t get any more real than jet engines…), where the work I do actually has a real purpose.
I will be leaving behind what I know and am comfortable with, a huge number of my friends, and all the other benefits of student life. This is scary beyond belief…
In other news, I am currently bike-less again, as some idiot drove over the front wheel of my bike (fortunately while I wasn’t on it). Needless to say, this is very annoying, not least because I am currently sat on a bus that takes the most roundabout route home possible.
This year I am not going to the graduation ball. In fact, this is the first time since starting university that I’ve not been there in some kind of first aid capacity, and I have zero interest in going as a punter. I had intended to go as first aid, but I haven’t been asked yet, and the unit has upset one of my good friends, so we’ve decided to go on duty the next morning instead. The person who did the upsetting is now also not going, but I have managed to persuade my friend that it isn’t her problem any more (and so she doesn’t need to pick up the pieces after the very likely meltdown).
Speaking of meltdowns, the local adult division is currently having a very slow one. Three of the more progressive members have been made to feel very unwelcome, and so have walked away. As a result, their training program is steadily going down the pan, morale is going to drop (as people realise what they’ve lost), and its all going to go to hell. Of the units six-ish active ambulance qualified volunteers, they now have two actively refusing to do events, two prioritising county level events (me and CycleGuy), leaving two to (fail to) meet the units commitments (meaning other units have to help out).
On the bright side, my unit of young people is going strong. We have just had a very successful sponsored walk (where I got to legitimately play tag for the first time since I left junior school), and have half a dozen things planned for the near future.
Work is still being its normal irritating self (but that’s retail for you), and I’m doing far too many hours for the Organisation (no change there, then), and for the most part I’m enjoying myself.
When things start settling down, I will try to post more frequency. For now, I will get on when I can, and I’m still on Twitter (my lifeline when drowning in my project).
Now, to finish, another musical interlude. Enjoy 🙂
This was prompted by a duty a while back where I and another person ended up doing an impromptu lesson in patient monitoring to half a first aid post. Not a promising start to the duty, but we were told afterwards by quite a few of the members that they appreciated the help.
Observations. Obs. Pulse and Resps. Vital Signs.
Whatever you call them, they’re important. And too many of us (myself included) are really bad at remembering to do them.
I was checking over a report for a patient I had treated, where I had come cycling down to back someone up. Something simple, but significant enough to require a reasonable amount of writing to prove we’d tried to think of everything. As I scanned through the notes, I noted that they’d put down: “patient apparently stable”. I glanced over at the observations box: empty. Now I agreed that the patient was stable (they wouldn’t have wondered off five minutes ago if they weren’t), but if you look at that form there was nothing to back us up. Nothing showing that the patient’s obs were normal, or at least returning to normal, and not shooting off somewhere unpleasant.
Repeat after me: if it isn’t written down, it didn’t happen.
To prove that something isn’t changing significantly, you need at least two data points. One tells you nothing. And they need to be reasonably spaced out. Two sets of obs done in two minutes tells us nothing. A lot of things that could go very wrong happen over a relatively long period of time (at least at first). Getting two sets of obs should be simple: one when they arrive, and one when they leave. Obs every ten minutes or so works well, if you can (obviously life-saving stuff needs to come first). It should only take a minute or so to do, and we don’t have to be getting precise numbers every time. We just need to know what’s going on, and then use that information to help us make decisions (such as, do I take my time and finish tidying this bandage, or do I want to have a paramedic with me yesterday…)
Taking a pulse is a simple technique, anyone with a couple of fingers on one hand should be able to do it, but it does takes practice. However, in my experience, it doesn’t seem to be covered as much as it should by our training. Everyone just assumes that everyone else knows what they’re doing. I’ve been caught out a number of times in training where someone has told me they don’t know what they’re doing. And I’ve caught out a number of people trying to cheat in an assessment by making things up (and holding the wrong part of my wrist…)
This is the method I use on a conscious patient:
- Decide which wrist you’re going to use. Make sure it’s comfortable for the patient, and the arm isn’t squashed beneath them or against something (and cutting off the blood supply).
- Make sure your patient knows you’re going to do a pulse. Like with any technique, if you do this without consent you could technically be assaulting your patient.
- Take the hand as if you are going to shake hands, and gently rotate it around so that their palm is up. Don’t let go, but consider resting it on a hard surface (a leg works well if it isn’t shivering). This means you have control of the arm, and you can keep it still.
- Using the first three fingers on your other hand (never your thumb, which has its own pulse), place your fingers on their wrist, beneath their thumb, next to their radius. You are trying to (gently!) press their radial artery against a bone. Hopefully you should feel their pulse. Don’t push to hard (you may cut of the blood supply, or your patient may just hit you because it hurts), and be prepared to hunt for it. It’ll always be on the thumb side of the arm, but sometimes you’ll have to search (and sometimes it is quite hard to find).
- Count the pulse for 15, 20 or 30 seconds, and then multiply it up. You don’t need to count for an entire minute, we’re not after exact numbers here, this should give you an acceptably accurate number. A normal pulse in an adult is about 60-80 bpm1 (though remember this depends on the patient’s fitness and what they’ve just been doing), and expect a child’s to be faster (and a baby’s faster still). Also pay attention to the quality and regularity of the pulse. Are they strong or weak? Are they skipping beats? Is it a regular pulse (or regularly irregular, or just plain irregular)? All things that are important.
If you can’t find the radial pulse, try the brachial. This one is on the inside of the elbow. It can be quite challenging to find, so practicing this one is a very good idea. If you ever learn to do manual blood pressures (which I hate doing, but we can’t use automatic BP cuffs) you’ll need to know about this one, as this is the one you listen to. As a last resort you can use the carotid (in the neck, next to the trachea on both sides), but this is not very comfortable for a conscious patient (take it from someone who has played at casualty as many times as I have: it is NOT fun). The First Aid Manual has some good pictures on where you can find pulses (page 53).
Keep in mind that if you expect your patient’s blood pressure to be very low (for example when shock is starting to get bad), pulses do start to disappear (radial first). It is worth noting if you can’t find a pulse (don’t be embarrassed or afraid to say you can’t do something), and it is very important to note if a pulse disappears.
Get used to making this one of the first things you do for a patient (after your primary survey, of cause). Not only does it give you a baseline to work from later, but it starts to tell you something of what is going on, and it makes you look like you know what you’re doing (and you have a plan). Finally, if you’re patient is distressed, the act of taking their hand can be very reassuring (I know this one from experience).
Naturally, be alert for people who aren’t comfortable with you touching them (holding hands can be seen as being quite personal) and be prepared to alter your technique to fit. If they won’t let you take a pulse, note that down and move on. It’s not worth alienating someone over. First aid is all about taking the perfect solution and the real world injury and making the two fit.
And don’t do what someone did in an assessment, and move a ‘broken’ arm to take a pulse. Needless to say, they got an earful from their casualty.
The most important things are, in my humble opinion, practice, practice and more practice. Every time you get a patient who’s with you for any length of time (we’re not talking the plaster dispenser ones here), take a pulse. Every time you do a scenario in training, take a pulse. Pester your friends to let you practice on them. Develop your own method of taking a pulse, one that works for you (or pinch mine, that’s what I did). Whatever it takes to get yourself confident in taking pulses.
I’ll cover respiration rates in my next post. These are more difficult to get, but form the other part of the most basic observations we can all do as first aiders.
Yesterday, after a rather dull afternoon on duty, I went out to a meal with a group of my Organisation friends. Amongst them was one of the most senior uniformed members in the area. Now, normally I get on very well with this person (who I will christen TopBoss, because the people above her don’t count…), but everything I have been hearing has suggested that she has been getting in the way of us taking the bikes and making them better.
Needless to say, bikes came up at the meal (as they do…), but, unexpectedly, it was TopBoss who brought them up. By saying that she was getting us some shiny new equipment. To be precise, a set of miniaturised medical gas bottles and a lightweight, compact defibrillator that’ll actually fit in the panniers properly. This is kit we’ve wanted for a long time, as it makes our lives so much easier on duty. It’s only enough for one pair of bikes, but that’s a lot better than the nothing we expected to get.
It turns out, despite what we’ve thought, TopBoss is very much in favour of the bikes, but normally has too many other things she needs to buy to spare any money on a set of bikes that rarely get used. Which is really good (and a great relief).
Of cause, this means we now have only one person to blame for the state of the bikes, but he’s someone we can’t do anything about until the restructuring happens.
I’m about (but not straight away) to say something that probably makes me appear very selfish…
As a rule, I have in the past tended to be quite self-effacing (check definition) when it comes to being given opportunities. To be more specific, if there are not enough places to get to an event, I tend to be the sort of person who will offer up his place to another. I like to do things that help other people out, even if it inconveniences or harms me. On a number of occasions, this attitude has least that I have missed out on things that I particularly wanted to do, but there weren’t enough places.
We have a major duty coming up, the first of the season. As always, I said that I would prefer to cycle, but would do anything. Others have been less open-minded ( almost demanding that they be allowed to do whatever…)
As is probably to be expected from an organisation like this, we’re short-staffed. This means that people ( myself included) have been given roles that are less than ideal. Admittedly, I’m on a vehicle, which isn’t terrible, but I probably wont get anything, as is normal when I crew an ambulance… Nevertheless, I’m pretty nonplussed. I’ll do whatever is needed. I figure that at some point this might earn me brownie points, and besides, in my opinion it is the right thing to do…
Now it is possible that, at the last-minute, I’ll get reassigned to a bike. Its happened before, and rumor has it that it has been considered. Naturally, this hasn’t gone down well with some of the others. One person has even gone so far as to encourage me not to take my cycle uniform, so someone else can do it instead ( read: him).
Now I’m sorry. I appreciate that people are disappointed with their roles on the day. However, if I am given the opportunity to cycle, I’m jumping at it… I don’t often get to ride a bike, and I am usually very willing to go wherever I am needed. I see no reason to go against this, just because I’ve been offered a better position and someone else hasn’t.
Of cause, I’m far too tactful (read: timid) to actually challenge that other member on this. I just let it lie, and of cause this probably means he’s assumed I’ve agreed with him. It could be interesting if the situation actually comes up (though I doubt it).