Now I’ve been qualified to crew an ambulance for more than a year, I’m able to go out and do shifts for the ambulance service. I’ve been hoping to do this for quite a while, but equally been a bit nervous, as I haven’t really got that much experience working in the back of an ambulance.
I’ve managed to get on three shifts so far, and to say they are have been eye-openers would be the understatement of the century. Aside from the tedium of quite a large amount of time waiting for things to do (apparently everyone had q word shifts those days…), I got to see a few things I would have seen as a volunteer at events.
Two particular patients stuck in my mind. I’ll be honest, I can’t remember their names, or their faces, but their stories, as I saw them, will remain with me for a long time.
One old lady. She had a stroke a couple of years ago, leaving her paralysed down one side, weak on the other, unable to speak beyond ‘yes’ and ‘no’, and bed bound. She needed round-the-clock care, had a catheter in-situ and was peg fed. She was going into hospital because she had developed a wheeze (which was not a good sign, as it could potentially be pneumonia).
She was obviously loved and cared for. Her daughters (not young themselves) spent a huge amount of time looking after her and making sure she was as healthy as they could manage.
Still, I can’t shake the feeling that this is no real quality of life. I can’t imagine being stuck in bed for the rest of my life, never to care for myself again, never even to speak properly again. Stuck in my head with no way of getting out. It’s certainly not something I’d wish on anyone.
My other patient was a 90-something year old man, the last job of the day. Living on his own, he had been highly active, right up until the last month or so. He had been experiencing complete lethargy, loss of appetite and a whole host of other generalised symptoms, and his doctor decided that he would need to go in to be checked over in the ward. In the past he had been diagnosed with some cancer or another, and his children feared this was a return of that condition.
Even getting him to the ambulance wore him out, and transferring him to the ward drained him so much he was practically asleep when he hit his bed.
My crew-mate and I made him comfortable, made sure he had everything he needed, handed over to the ward’s nurses, and then walked slowly back to the ambulance. The depression over us was almost palpable, and at almost the same moment we both said, “He’s not coming out again.”
Normally, I meet people who are generally healthy, and just need a little patching up to move on their way. Okay, I’ve seen the odd person with a serious medical condition, and the occasionally seriously injured patient, but almost everyone I had dealt with before had very good prognoses. On these two shifts, I saw what is likely to be the end times of their lives, something I will hopefully never have to see when delivering event cover. I just hope I was able to make what could have been one of their final journeys as comfortable as possible.
You are not well. In fact, it’s safe to say you are very unwell.
We are on both in the road, me sat, you lying, with my bike stood in a fend of position, blue lights beaming out a warning to all around. This is not a fun place to stay, but I’ve got no choice. You have just finished fitting for the second time in ten minutes, and I have no way of getting you somewhere safe without injuring one of us.
The person who flagged me down has wandered off, muttering something about leaving it to the professionals. This is a nuisance, as I could really do with another pair of hands. I have a coat under your head, a blanket draped over the rest of you (now you won’t strangle yourself with it), and my radio microphone in my hand. This is the bit I really want. Two fits in a row is not a great sign, and my instincts say your going to do it again. Somewhere on the way down you seem to have bashed your head, you have road rash on your bare legs and arms (it had been a hot day, a lovely time to go to the beach), and I haven’t even attempted to check you for anything else between fits. I really need help, and I really need it now.
The problem is, there’s nothing available. We have over half our local fleet on the road, and every one of them is busy. It’s so busy I can’t even start talking on the radio to give Control an update (and to try to get an ETA on that vehicle).
A gap forms in the radio chatter, and I draw a breath to start talking. Naturally, this is the moment you begin to fit again. Immediately the mic is dropped, the blanket is whipped away, and I check your head is still safe. Grabbing the mic on its upswing, I cut in on a pause in the current conversation.
“Priority, priority, Control 992.” I release the mic to hear someone talking over me. Blast. Keeping both eyes on my shaking patient, I try again. “Priority, priority, Control 992”
“All stations, wait. Priority call. Go ahead 992.”
“Control, upgrade my ambulance request to emergency. Patient unresponsive, actively convulsing, query status epilepticus.” I technically haven’t been on scene long enough to make that judgement, but every instinct I have says that these fits aren’t going to go away on their own.
“All received 992. Be advised, NHS vehicle en route. Please confirm precise location.” I give a little prayer to any passing deity, thanking them for shared ambulance control rooms.
“Location unchanged. Bike in fend off location, you can’t miss me.”
“All received 992. Control out.”
The radio conversation that had been going on before continued, and I mentally switched off to the radio, listening only for my call-sign. Once more you’ve stopped fitting, and once more I cover you with my blanket, pouring reassurances over you that you are safe and that help is on its way. I don’t know if you can hear me through the chaos the fits have reigned in your brain, but if nothing else it makes me feel better to do something.
In the distance I hear a siren. I’ve heard a few going to and fro, but this one is definitely getting nearer. It is the most welcome noise I’ve heard all evening, well, after the heavy sighs coming from you when I checked your breathing. The junction down the road fills with the glow of blue lights, and an RRV comes around the corner. Getting down close to you, to check your obs one more time, I speak to both myself and you. “This one’s yours, mate. The cavalry’s here.”
A collage of a couple of my recent patients, inspired by the WordPress Weekly Writing Challenge: The Sound of Blogging.
I was cycle responding at a music festival. It’s crowded, there are lots of jobs, and my partner and I are responding right left and centre, 999 calls, shouts for backup, the works.
So after a couple of interesting jobs (which I may or may not post about later), we’re sent on to a 999 call to a collapse. Full emergency conditions, which for us bikes means sirens, whistles (normally get us much more attention than a siren), blue lights if we have them (for all the minimal good they do) and dodging and weaving through people as quickly as we can (without hitting anyone). We’re making good progress, given the crowd density, and most people are fairly willing to get out of our way.
I’m trying to keep an eye on everything around me, hunting out a route that will let me progress, and so not really concentrating on what’s happening behind me. It’s a closed road, and we’re easily the fastest moving objects on it, so I’m not expecting anything that I’ve passed to affect me.
A bunch of people wonder in my way, and I can’t swing around them, so I stop briefly (I can impress one of my friends by briefly holding my bike at a stop without falling off), giving them a blast of my whistle (which is loud enough to make my ears ring) and my siren (which is a little pathetic) and then pulled away as they jumped aside. Almost immediately, I felt my bike swerve out underneath me, and I jumped off, trying to give my bike a graceful landing.
Turning around to get better leverage on the bike, I saw a girl holding on to my panniers, apparently helping me stabilise the bike. With it back upright, I thanked her, turned back around, mounted up and tried to go. And instantly feel my bike try to go out from under me again. This time I jumped off before it went, and swung around to find that girl still holding my panniers, laughing.
“Let go!” She just laughed again. “I said, let go. I’m busy.” She let go, but went to grab it again as I pushed my bike away. “Grab it again and I’ll call the police!” She continued to laugh, not saying anything, until some burly guy came out of the crowd, shouting at her as well. I took that as my cue to move on, fast.
Now I’ve heard stories of people chucking things at ambulances, and prank calls, and all the other things that waste ambulance time, and I’ve had people deliberately get in my way, but this is a new one on me. I still managed to catch up with my partner pretty quickly, the whole incident probably only lasted about a minute or so, but seriously, what the hell… It was fairly obvious I was in a hurry (the blue light and siren was a bit of a hint), and the markings saying ‘Ambulance’ are hardly subtle…
I just don’t understand what would possess someone to do something like that which would knock me off of my bike, particularly when I could have been going to a very unwell person.
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…
- Ambulance Excitement (walkingplasterdispenser.wordpress.com)
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…
- 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)
(Aside: The prose in this is a bit rough, but I can’t quite work out how to fix it so it’ll have to stay that way…)
I have just spent a weekend doing rugby duties. All the players were under 18, Saturday’s lot about 16, Sunday’s between 9 and 12.
The first day was simple enough. One person who had been booted in the chest and was in some pain. He might have broken a rib, we’re not quite sure, but even if he had there was nothing we could do for him. Even if we sent him to hospital, they wouldn’t do a lot (or so a doctor friend tells me). He was otherwise fit and well, so we suggested pain killers (which he declined) and then he wondered off.
Sunday was a bit different. This time there was only two of us (instead of four adults, a youth member and an ambulance). We started the day by getting lost, and heading completely the wrong way. We confused one driver by going around a mini-roundabout multiple times until we got our bearings. Fortunately we still arrived in good time, and settled down on a cold, windy pitch to try to keep an eye on four or five games at once.
The first load of patients were simple enough, standard rugby injuries (bruised hands, heads and the like), though we did get three one after another, keeping us busy for a while.
Then it went dead, we had a very nice burger for lunch, and sat back down outside in what was improving weather. Quietly, knocking on wood the entire time, we thought we’d had our rush and would coast until the end with the odd cut.
Then a boy walked up, saying that his neck hurt and he couldn’t really straighten it. When we took a look at the back of his neck, the pain was mostly near the middle. Possibly muscular, but definitely too near the bone for my liking. I asked my colleague to hold his head (to stop it moving), and I got ready to call an ambulance.
Then another boy turned up with a properly dislocated little finger. I am already on the phone to the ambulance service, so I just mention he’s here, and try to get on with the call.
At this point, someone claiming to be a doctor turned up, and wanted to put the finger back in place. This is against our protocol (we consider that a job for the hospital, in case surgery is needed), and I couldn’t be certain that they were a doctor, so I asked them to wait, as an ambulance is on its way. Naturally they ignore me, then after demanding tape from my kit, and thoroughly disrupting my conversation with the ambulance call-taker, they demand paracetamol (which I refuse to give them without my own assessment, because I have to write-up that it’s given, and I didn’t think the ‘doctor’ would hang around long enough to fill out my paperwork), and promptly vanished (suspicion proven).
I’ll point out now that I put ‘doctor’ in quotes only because I couldn’t prove they were indeed a doctor, I don’t like taking people’s word for it (particularly when they’re a random bystander. What if they were a doctor of physics or something!), and because of the speed with which they disappeared. Not once did they stop to check on the poor boy whose neck we were trying to hold still (a coach did put her two-pennies-worth in by criticising my colleagues method of holding the head, which was correct, but we ignored her). I thought they had a duty of care!
When I was done with the ambulance call, and my colleague’s arms started seizing, it was my turn to hold the head. This also freed him up to placate the other boy, and then deal with the two new patients who chose that moment to turn up with thankfully minor injuries.
The ambulance didn’t take too long to arrive (hurrah!), and when I handed over to the ambulance crew, they agreed that we should be careful and grabbed their long board (aka a spinal board). We now had to put the poor boy through a standing take-down.
For those that haven’t seen or experienced a standing take-down, it is where the long board is placed behind a standing patient, they lean against it, and both are slowly lowered to the vertical. It is a highly unnerving maneuver, requiring quite a bit of trust on the part of the patient, as for the first couple of degrees the patient can feel as if they’re falling with nothing behind them.
My job was to hold his head, and after a bit of shifting to avoid trying to lower him through a tent pole, and to make sure I could keep my hold, we got him to the floor. Now I don’t like this process at all, to the degree that I refuse to have it done to me during training. Needless to say, this brave boy put me completely to shame, taking it in his stride. After a strategic slide up the board, on my command (I had the head, so I was in charge… eek!) and the judicious application of head blocks and straps, he was safe and secure and ready to go.
During this entire process, my colleague had worked through each of the other patients, clearing each one in turn and leaving nothing left for us to do for the rest of the day (thankfully).
I’ve never done anything like this for real before, and it’s taught me a few things about spinal management, including good places to put hands and how to hold the head during a three-man standing take down. While I wouldn’t wish such an injury on anyone, and hopefully the boy wasn’t seriously injured, I am pleased I was able to get involved, and it was definitely good experience. It has also maintained my enthusiasm to finish my ambulance training (whenever the second course comes around), when I can learn to do all of this properly for myself.
Now I just have to write this up for my portfolio…
It has occurred to me that on several occasions now I have responded to emergency 999 calls and dealt with the situation reasonably comfortably. It has also occurred to me that members of The Organisation routinely respond to such jobs, and handle them successfully until the statutory services arrive (if they’re even sent for).
We are, every one of us, volunteers. We don’t get paid. Very few of us are health-care professionals of any kind. While I have every respect for all the ‘real’ ambulance crews out there, I can’t help but to feel proud of this. Proud of what we as an Organisation are capable of, and what I as an individual have done. We’ve come a long way from summer fates and street parties (not that these aren’t just as important).
I can’t wait until my ambulance training starts, in about a month or so.
A quick request to any bystanders who call 999, 911, or 112 or whatever while they’re out and about:
If you are not with the patient, please tell the call-taker precisely where the patient is.
When I’m off hunting for someone who is having difficulty breathing (more on this patient in another post) on a boat, telling them that the patient is by the bar you happen to be in doesn’t help. Not when there’s a tall fence and a stretch of water between them and me, and I have to double back to get down to them.
It doesn’t sound like much, and fortunately in this case it wasn’t a drastic problem, but getting to a patient half a minute sooner can make all the difference.
Oh, and it would have prevented two teams being dispatched to the same incident, each having a different bar as the patient’s location…
This has been a public service announcement from the Walking Plaster Dispenser.