Tag Archive | First Aid

The Times They Are a-Changin’

Wow, been a while since I’ve been on here…  Excuse me while I dust of the cobwebs, and begin again with a bit of a rant.

Okay, rapid catch-up:  A few months ago, The Organisation went through a bit of a restructure, from Counties to Regions.  The basic idea (as far as I can see) was to save some money, by cutting back on some of the admin staff and other things that could be merged and getting rid of things we don’t really need, and to help standardise things across the country.  The former is a very laudable goal, if a bit distant from much of the membership, who never really saw the extent of the financial trouble we were in.  The latter I think is almost essential.  As an organisation, we have had one qualification meaning a hundred different things across the county (sometimes from one unit to another), and that’s just not good enough.

As part of the first goal, budgets were centralised and management of money has moved up a level or two in the leadership structure, and this has caused my first rant.  Let me get this clear, I’m not particularly in favour of this change, but I can see how, with a bit of shift in the way we think about things, it could be a good thing.  There is no way we could carry on with people spending more money than they were bringing in, and some people refused to take responsibility for their own budgets.  Now they don’t have to.  The idea is that, if there is a legitimate need for something, and the money to afford it, the Region will pay for it.  I can see how this could go wrong, but properly dealt with (from all levels), this could be a good thing.

Now here’s the bit that bugs me: we have had a rash of people crying ‘they’re taking away our money!’  and ‘now we’ll do all the work and they’ll get all the benefit!’  I could understand it a little from of the members who haven’t had things explained to them very well, but from some of the leaders, who I swear are just refusing to understand, this isn’t good enough.  It was never ‘our money’ or ‘your money’ or ‘my money’.  It is the Organisation’s money.  It is charitable funds that have we have to use to pursue our charitable goals.  End. Of. Story.

Now, foolishly, in the past, I’ve tried to explain to people how the ‘them doing all the work’ business probably won’t happen.  After all, the people doing all the first aid, and bringing in all the money from events, they will be the people who need the uniforms, the consumables and access to vehicles.  If people aren’t going out to events, what are they going to use the money on?  Of cause, they don’t listen, and I’m beginning to think this is because they’ve got their heart set on being annoyed by the changes.

Which brings me on to my next point.  This is a significant change in the way we work and the way we will have to approach practically everything we do.  Change will always meet resistance, and it will always upset people.  This isn’t an excuse to treat people badly, and it’s quite possible that some people have been treated less than ideally.  There have also been some controversial decisions made by many people (past and present), and someone will always take these personally, whatever the intentions behind them.  If you’re unhappy, that’s fine (er… you know what I mean…).  I’ll quite happily sit down with you, let you rant away to a listening ear sympathetic ear if you think it will help you. (I’m getting good at letting such things wash over me…)  I just don’t think that mouthing off about each other in public is helpful.  Especially given that it looks so one-sided (the ‘bad-guys’, so to speak, are being quite reserved in public).  All you’re achieving is winding some people up (which I’m beginning to think is your intention) and alienating others, and the last thing we need right now is division.  It doesn’t seem to have occurred to you that perhaps, if we tried to pull together, to change things and allow ourselves to change, maybe things would start working a little sooner.

Maybe I’m hopelessly idealistic or naïve.  Perhaps this is all a disaster waiting to happen and I just can’t see it.  Or perhaps it’s just another challenge, and we’ll come out stronger on the other side.  More importantly we’re only just three months into this new structure.  We can’t expect everything to fall into place straight away.  And it won’t be perfect, because nothing is, and that doesn’t mean it isn’t worth working for.

Just because there’s no light at the end of the tunnel yet, doesn’t mean it isn’t there.

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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.

Slightly Surreal

It’s the end of the world, the zombie apocalypse.  BigCity is full of zombies and people trying to get past them to safety.  And what am I doing during at the end of the world as we know it? I’m sat astride my response bike, watching it all happen.

This is 2.8 Hours Later, and the aim of the game is to get from check point to check point without being caught by the zombies.  We’re providing first aid cover, ready and waiting for the inevitable slips, trips, falls, and out right head on collisions.  Needless to say, the event is hilarious to watch, and it appears the players are loving it as well.

We get a patient, one of the zombies.  We ask the typical questions, get a medical history (‘so how long have you been dead?’), all while keeping an eye open for the next batch of players to sprint down the high street.  In the corner of the square, a busker is setting up his guitar and amp, another person going about his business while the world ends around him.

We here the next group running, so we cyclists dodge out of sight, while our zombie friend lurches to hide in a phone box.  The running steps slow and stop, and we can just see the group looking down at their map to work out where to go next.  They wonder down the high street, paying far too much attention to the piece of paper in their hands, and not their surroundings.

A groan, a blur of speed from the zombie, and then screams as the group scatters, desperately keeping out of his reach.  The whole group races past where CycleGuy and I are hiding, barely missing the posts we’re propped up behind, intent only on avoiding the zombie on their collective tails.

And in the background, music drifts over from the corner…

Calling in the Cavalry

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.”

Sound effect from Freesound.org, by guitarguy1985, released under the Creative Commons 0 License.


A collage of a couple of my recent patients, inspired by the WordPress Weekly Writing Challenge: The Sound of Blogging.

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.

An Update

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 🙂

Observations Part 1 – Pulses

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:

  1. 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).
  2. 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.
  3. 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.
  4. 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).
  5. 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.

1 – The First Aid Manual, 9th Edition

Well I’ll Go to the Foot of the Stairs

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.

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.

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