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.

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.

A Bit of Excitement

Image by Márcio Cabral de Moura, on Flickr (see Flickr page for license)

(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…

You Can’t Make It Up

There are some stories that you just can’t make up.

This week, I was on duty at the UniTown theatre. This time it was a show I wanted to watch, which is almost as bad as using the q word.

My partner and my house-mate sit down, and the music starts. Almost immediately, we are approached by a member of theatre of staff.

“You’re needed downstairs.”

Brilliant. We have brought a kit and an AED to the theatre, and grab the kit as we head in the direction we are pointed. Sure enough, we find an old woman sitting on a chair, looking unwell, accompanied by her daughter.

Daughter tells us that she was complaining that her chest hurt, she is having a little difficulty breathing and is feeling tired. I have a quick look at our patient. She is old and rather a bit overweight, so there is a good chance this is the serious kind of chest pain.

Our patient refuses to answer most of my questions chosen to confirm this, becoming very snappy when I try to get a history. My house-mate wasn’t able to get her pulse, and she wouldn’t stop talking long enough to get her breathing rate.

Then comes the comment from our patient that I can’t believe:

“I’m probably just having another heart attack.”

!

My house-mate gives me a look that makes it clear she’s just taken a mental double-take. It is a challenge for me to stop my jaw from dropping. Our patient’s tone had been so matter-of-fact, she might as well have been talking about the weather. There was none of the panic normally associated with a heart attack. None of the ‘impending sense of doom’ we joke about in training sessions. I didn’t think anyone could be so blasé about the real possibility of a potentially fatal condition.

Oh yeah, and she refuses to take aspirin and won’t tell me why… It just get’s better.

I skip immediately from ‘trying to work out what’s happening, possibly need an ambulance’ to ‘I want an ambulance yesterday’! I tell Daughter’s son to go grab the bag with our AED in, and the theatre’s duty manager to get me an ambulance.

During my conversation with the ambulance call taker, our patient finally decides to tell me that she’s on Warfarin.  This explains why she doesn’t want to take aspirin. Via me, the call taker tries to overrule this instruction, but we both get ignored.

In no time, the RRV is with us, swiftly followed by the full ambulance. Some oxygen, a GTN spray and an ECG later, and our patient is off.

It takes another hour until my house-mate and I get our heads around what we’ve just seen.

Bad Day

This has not been my most productive day. I have spent almost all my time at work playing with a computer, trying to work out why the damn thing doesn’t work.

It was typical. I had nothing to do, and made the mistake of asking my supervisor for something new. Cue MechEnger, the mechanical engineering student from my university, to sit down to test the computer I’d been working with before, and have it break on him.

Bother…

This rendered the entire system useless until it’s fixed.

Bother…

And it still isn’t fixed. I have to try some new things tomorrow, in the desperate hope I’ll sort it out.

Oh yeah, and my cold, which I thought I’d got rid of a week ago, seems to have come back with a vengeance.

Yay…

It’s like the dreaded ‘q’ word. Anyone medical out there will have heard of it. As soon as anyone says that word, you can guarantee all hell will break loose.

I know what I won’t be saying any time soon.