Tag Archive | Treating

Chaos. Complete and Utter Chaos

When I event manage, I like things to go to plan. I have spent ages developing a fairly standard way to run an event that works really nicely for me, and tries to anticipate everything that could happen. And nine times out of ten it works, and everything is nicely relaxed, and it’s all good. And then you get those things you just can’t plan for.

I’m running a student event, the basic night out with loud music and plenty of alcohol. I’ve planned for alcohol intoxication and poisoning, fights, stiletto injuries, even drug overdoses (thankfully rare at this University). I have eight first aiders, so plenty of staff, and so far all we’ve had is the usual run of drunk students who started the night a little too fast. I’ve got two people in the hall, being highly visible in high-viz, two caring for our patients, and four more ready and waiting for the next job.

I get a call from the team in the hall. They’ve been called to a patient in the toilets. I acknowledge, and send a team to cover their spot. Another call comes in from campus security. They’ve had reports of someone whose hurt themselves in the car park. It’s not technically our area, but I want security on side, so dispatch the other team I have with me. I go to peak around the corner at our patients, but draw up short when I hear the distinctive sound of vomiting. They’ll be tied up for a while yet.

The team at the toilets checks in, saying they’ve got to the patient and will advise when they know more. All normal. I try to raise the other team, but they’re not talking to me. Probably out of range, no great stress. They have my mobile number.

The first aid room is still, filled only with the quiet reassurance being poured out by the team with their patients.  I like it when it’s like this.  A gentle busyness that says we’re doing our job properly.

A static filled message fills my ear.  “Control, Control, 412, over.”

“Go ahead, 412”

“Control, we’re on scene at a *fuzz*TC.  We’re *fuzz crackle* a hand, and the *hiss*lice.”

I take a mental double take, looking at my radio in confusion.  “Sorry 412, say again.  Did you say you were at an RTC?”

“*hiss crackle* yes, Control.”

“Do you need an ambulance?”

“No *hiss crackle*nor injuries only, all *crackle*afe.  Need a couple more ha*hiss*s.”

“All received, 921.  Contact the police directly, I’ll warn security, and will send someone your way as soon as I can.”

“*hiss crackle*oger, control.”

I’m still a little confused, but make arrangements for the police to get on campus, and dispatch my team in the hall as backup.  In the back of my mind, I make plans about how I’ll deal with another patient, if they turn up.  In my head I have a wonderful idea of how I’ll pull a team back from the RTC, perhaps send one of my people treating in the room next door to replace them.  Hopefully the toilet call will just be another drunk who can be added to the group to be monitored.

“Priority, priority, control 922.”  My wonderful plans flee my mind.  Bollocks.

“Go ahead 922, you have priority.”

“One patient, male toilets, conscious  breathing, chest…”  The radio cuts off, and I have images of a first aider diving to catch a patient that’s just collapsed.  I’m around the corner to the treatment area in a flash, and grab one of the first aider’s attention.

“922, 922 say again.  Confirm you said chest pains in the male toilets, over.”   My colleague looks at me and I nod and point.  He’s off in a blur, stopping only to grab the O2 and AED bags.  I dive into my pocket for my phone.  “922, 922 from Control, over…  922, 922 from Control. Over.”  Silence.  “Nothing heard, 922.  Backup en-route   Control out.”  I curse under my breath.  This was not the time to lose contact with a team.  I want to phone 921, get them to send a team back to me, but don’t want to risk missing a call from 922.  I curse again.  Of all the things I had considered, the combo of an RTC and a chest pains was not one of them, particularly as I’m now completely out of staff.  Things have now officially gone to pot, and there’s nothing I can do except take a deep breath and roll with it.

“Control, Control, 922.”  This is a new voice, the backup I sent taking charge of the radio.  I grab my mic, other hand poised over the 9 key on my phone.  “Go ahead 922, Control over.”

“Stop. Stop. Stop.  Situation under control.  Returning to your location, over.”

“922, confirm that assistance is not required please, over.”

“That is a yes yes, control.  Mobile to your location.”

“Glad to hear it, 922, I look forward to it.  Control out.”  My sigh of relief is loud enough to get a smile from the last remaining first aider in the treatment area.  She grins at me over the head of a vomiting bloke.  I grin back and then look back at my phone when it buzzes a text.  921 was clear as well, and heading back to the first aid room.  I smile again to myself, everything was going to plan again.

I do like it when things go to plan.


This post was written from a prompt on The Daily PostComfort Zone

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.

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.

Opportunities

I’m about (but not straight away) to say something that probably makes me appear very selfish…

As a rule, I have in the past tended to be quite self-effacing (check definition) when it comes to being given opportunities.  To be more specific, if there are not enough places to get to an event,  I tend to be the sort of person who will offer up his place to another.  I like to do things that help other people out, even if it inconveniences or harms me.  On a number of occasions, this attitude has least that I have missed out on things that I particularly wanted to do, but there weren’t enough places.

We have a major duty coming up, the first of the season. As always, I said that I would prefer to cycle, but would do anything. Others have been less open-minded ( almost demanding that they be allowed to do whatever…)

As is probably to be expected from an organisation like this, we’re short-staffed. This means that people ( myself included) have been given roles that are less than ideal. Admittedly, I’m on a vehicle, which isn’t terrible, but I probably wont get anything, as is normal when I crew an ambulance… Nevertheless, I’m pretty nonplussed. I’ll do whatever is needed. I figure that at some point this might earn me brownie points, and besides, in my opinion it is the right thing to do…

Now it is possible that, at the last-minute, I’ll get reassigned to a bike. Its happened before, and rumor has it that it has been considered. Naturally, this hasn’t gone down well with some of the others. One person has even gone so far as to encourage me not to take my cycle uniform, so someone else can do it instead ( read: him).

Now I’m sorry. I appreciate that people are disappointed with their roles on the day. However, if I am given the opportunity to cycle, I’m jumping at it…  I don’t often get to ride a bike, and I am usually very willing to go wherever I am needed.  I see no reason to go against this, just because I’ve been offered a better position and someone else hasn’t.

Of cause, I’m far too tactful (read: timid) to actually challenge that other member on this.  I just let it lie, and of cause this probably means he’s assumed I’ve agreed with him.  It could be interesting if the situation actually comes up (though I doubt it).

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.

Pain Scores and Young Children

An important lesson I learned today while on duty.  There is very little point asking a small child for a pain score.

This particular little person had fallen down a couple of steps, and had been brought down to be checked over.  He didn’t have any pain anywhere significant (like the back of the neck), and neither did he seem to be in any particular distress.  Normal practice suggests that I then try and have him quantify his pain level, so that I can work out if there’s something more going on.  I go through the rigmarole of explaining ‘where 1 is next to nothing (as I gently poke him for demonstration) and 10 is the worst thing you have ever felt’, and his first answer “9”.  Now in my experience, people who have 9/10 pain and and show no signs of it have either been really lucky (and so 10/10 is relatively low), have an incredible pain threshold (but even so…) or might possibly be stretching the truth a little.  Looking at this little guy, his mother and I went for the latter.  So I asked him if he was really sure it was 9/10, and stressed how important it is to tell the truth.  So he now says 6, because that’s his age.  Cue much rolling of eyes from me, my crewmate and his mother, and I give up.

The important lesson here, I think, is that I had made the mistake of treating this child like a little adult, and tried to apply a technique aimed at adults to someone who didn’t really understand what I was asking, let alone why.  Children are not little adults, though it can be easy to forget this sometimes, and remembering this is important.

CPR Saves Lives

The title says it all, really.

CPR is easy, simple and saves lives.  And that’s all there is to it.  Everyone should feel they can do something if someone stops breathing.

I know I’m late to this particular party, but this is easily one of the best first aid awareness campaigns I have seen in a long time:

Courtesy of the British Heart Foundation.

If you have to do CPR, you can’t really make things any worse.  You won’t get sued.  You won’t get arrested.  Just go for it.

Organ Donation and the Church

If you have been following the news in the UK (specifically, Wales) recently, you’ll know that they are currently considering a bill that will mean that everyone will be assumed to be an organ donor, unless they opt out.  I am in favour of this (and wish the English government would do the same).

I am a registered Organ Donor (and carry a Donor Card), registered with the Anthony Nolan Trust as a potential bone marrow donor and, now that the law has changed, I have been single (and all that entails) for a sufficiently long time and I now have enough weight, I intend to become a blood donor.  I strongly believe that those of us who are lucky enough to be healthy should be doing as much as possible to help those who are not (which in part explains how passionate I am about my volunteering).

Now, I’m not saying that everyone should be forced to donate blood, or bone marrow.  While I’d love it if you did, I know that this can cause (a small amount of) disruption to your life and could make you unwell for a while, and I don’t want people to go into that without being willing.  However, to be blunt, once you are dead, the location of the organs in your body are the least of your worries.  (http://xkcd.com/659/)  If you are unfortunate enough to die at a stage when your organs are useful to others, then using them to allow one or more people to live on seems perfectly logical.

I know that it is scary, considering your own mortality, and that of the people you know.  But this legislation isn’t going to change your chances of dying of something (no matter how many scare stories are bandied around about doctors killing some to save others).  And it will decrease the 1000 people a year (cite) who die while waiting for a transplant.

Many people are thought to be willing to be an organ donor, but just haven’t got around to registering, and I’d wager most of these never will.  This will help those people follow this through without any trouble, and those who are against it will still be able to say no.

This post was prompted by a news article I spotted earlier, about the church speaking out against an opt-out system. This made me grumpy… While I am not religious, I don’t have a real problem with religion. Everyone is entitled to their beliefs, as long as they don’t harm others.

This will harm people. The church has no problem with organ donation (cite). Why are they arguing against something that will save lives?

If you want to find out about blood donation, go here.

More information about bone marrow donation is available from the Anthony Nolan Trust. They are particularly looking for young male donors.

Organ donor registration can be done here.

(All links for England and probably good for the UK in general. Google is your friend if you need the details for elsewhere.)

If you want to sign up, do, and I encourage it. If you don’t, don’t. If that means that you need to opt-out, do so. At least you will have thought about it.

It’s your choice, and always will be. I may not like your decision, but I’ll still fight to ensure you can make it.

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