Perspective

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.

Response Cycling Rant

I have worked hard to achieve my role of cycle responder. The course isn’t particularly difficult, but keeping in mind most people have done no training at all, it holds you to a particularly high standard. It also has a particular focus on working in crowds of people safely (you should see some of the maneuvers we’re expected to pull off). Just like anyone else operating an emergency vehicle, we’re supposed to be good at what we do.

Now, I freely admit that there are some idiots on bikes wandering around.  This is an unfortunate side effect of the lack of licensing of bicycles.  Not that I advocate such a license: we need to encourage people to cycle, not make it difficult for them.  (Before anyone interjects that a driving license isn’t difficult to get, I’ll point out that, at 23, I am still unable to drive a car due to the financial investment driving lessons require.)  Proper planning, a bit of common courtesy amongst road users and decent provision of dedicated cycle ways should help keep these few idiots safe and out-of-the-way, keeping all parties safe.

We, on the other hand, are response cyclists.  We are not just cycling as a means to get to work, or to the shops.  Our role has two main parts, in order of importance (in my opinion):

1. Responding to calls for assistance from the public, other first aiders and the ambulance service
2. Patrolling an event, forming a highly visible first aid presence that can be flagged down when needed

To a lesser degree, we also make good a good advert for the Organisation, as we are very visible and something people don’t see every day.  (This is something I think we should capitalise on more…)

Now it is fairly obvious that most of our patients will be found in areas where there are most people, and so it is almost inevitable that we mainly respond to places where there is a crowd.  This isn’t even allowing for the fact that crowds invariably form around patients.  Given that many of our patients are reported as being quite unwell, this means that we will need to respond fast through said crowds.  The most effective way of progressing quickly through a crowd is to make a lot of noise, encourage people to move out of our way (whether with noise makers, voices, “blues and twos” or whatever) and pass through the gaps that naturally form in such groups.  It is exactly the same technique as walking quickly through a crowd (which most people can do without thinking), but at higher speeds and with bigger turning circles.  It’s not perfect (it doesn’t work in very dense crowds) but it still usually gets us on scene faster than a foot patrol (we can take advantage of larger gaps to put on decent bursts of speed) or an ambulance (which can’t exactly dodge and weave in the ways we can).  Sometimes it’s only a minute or so faster, but when someone is very unwell, every minute counts.

Unfortunately, to make it work, sometimes we have to cut things fine.  Sometimes I will pass someone by inches then swerve suddenly in front of them to swing through another gap.  I try to make myself known to everyone, but sometimes I’ll catch people by surprise.  This doesn’t (and I say this with feeling) mean that I’ve nearly hit you.  Believe me, if 45 kg of bike plus 60 kg of rider nearly hit you, you’d know.  In fact, the first thing you’d know of it would be the screech of brakes as I come to a halt behind you.  Because, just like that emergency vehicle going down the road, I never go so fast I can’t stop if I need to.  I have a lot of momentum, but very good brakes and plenty of practice emergency stopping.  I’ll say it again, because I mean it: I am not going to hit you (well unless you decide to jump in front of me at the last-minute, and that, I’m afraid, would be your fault).

On the other hand, when I’m on a patrol, I’m not in a hurry.  In fact, I’m particularly keen to save energy for the times when I really need it.  This means I’m going to move slowly.  Of cause, all velocity is relative, and slow for a cyclists doesn’t always mean the same thing as slow for a pedestrian.  Sometimes the crowd sprawled across my patrol path decides they want to dawdle down the street, taking in the sights.  And why not?  After all, most of the time they are on a day out, and who wants to rush around on a day out.

This makes cycling patrols a very different activity to normal cycling.  On a clear road, we’ll move at roughly normal to slow cycling speeds, stopping sometimes to take in the sights ourselves (everyone loves a bit of people watching).  Then we hit that dense bit of dawdling crowd, and so we slow down, down to the speed of the crowd.  This takes practice; a bike are very difficult to control at such speeds, particularly given the weight of our bikes.  That is precisely why we spend so much time on cone skills and low-speed maneuvering.

Once we’re down to the speed of a dawdle, we can quite happily sit there indefinitely.  We’re happy to wait until the crowd disperses, a gap in the crowd forms naturally, or we have a reason to speed up (usually a job from control).  Of cause, if people move aside to let us through (which happens fairly often once people notice us), we do appreciate it, and we’ll pop through any gap that forms (naturally or otherwise) to move from behind a crowd if the timing is right.  We know that sitting behind people makes them uncomfortable.  That said, if that’s where we have to stay, so be it.  We’ll wait.

Yet again, and I say this with more feeling this time, you are NOT going to get run over.  If we have to stop, we will, no problems, no arguments.

People often mention that we should get off and walk when we’re doing this, often adding that they think we’ll get through faster.  There are a couple of problems with that argument.

First, while we are riding our bikes, they are surprisingly manoeuvrable and easy to handle.  These bikes are HEAVY (have I mentioned this enough yet…) and being able to use your body weight to balance them is extremely useful.  As soon as I get off my bike, I exchange 45 kg of well-balanced bicycle for 45 kg of unstable dead weight.  More than once I have lost my bike when I have had to get off and push, and when those bikes go, they go big style.  I am much more likely to drop that bike on your (and my) shins when I push it than I am to run you over or collide with you while cycling.

Second, these bikes are a real pain to mount and dismount in a crowd.  During these times, that 60 kg of rider that could be used to balance the bike is attempting to swing his leg over the bike and position himself on his saddle, all while trying to keep that 45 kg of bike upright during the inherently unstable procedure.  Having to do this in a hurry, while talking to Control on the radio and keeping an eye on where he is going (not to mention where everything and everyone else is going) is a serious challenge.  We are rapid response vehicles, and like I said before, every minute can count.

In short, constantly getting on and off the bikes is a pain, and staying on is much easier, safer (and highly encouraged by our training).

I appreciate that bikes are unusual, and seeing a fully laden response bike bearing down on you is intimidating.  It is my eternal hope that people will eventually get used to response bikes and begin to understand how they behave.  If nothing else, I hope people start to realise that we are an emergency vehicle, and just like any other emergency vehicle, the operator really does now what they are doing.

I was going to leave you with two things.  The first was a relatively old advert that I really like about how to respond to an oncoming blue light vehicle (in this case, and ambulance).  Unfortunately my Google skills have let me down and I can’t find it…  The second (which I have found) is my customary musical interlude (on both YouTube and Spotify), this time a track from a band I have just started listening to again after having been forgotten for quite some time.  Enjoy.

What the Hell!

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.

Hitting the Speed Bumps

Image via Wikipedia

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…

Related articles

• Ambulance Excitement (walkingplasterdispenser.wordpress.com)

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…

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

Image by gcfairch, on Flickr (see Flickr page for license)

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…