A second public service announcement....

I was going to write a long spiel for this post about the 999 triage system, but I have since come to realise that there are several different one in operation, from AMPDS, to NHSPathways and others.  These are clever (if not computer orientated) triage systems and have changed "since my day".  This is however not a cop out and I feel the need to delve deeper.  What I can say for now is this...

The questions the call handler asks are relevant.  

The questions do not delay your care, but are aimed at enhancing it.  

If a call is identified as life threatening, which happens at the beginning an ambulance is immediately dispatched.

Call prior it can go up as well a down.

Please help the call handler, which in turn helps us, by answering truthfully and politely.  Rudeness towards staff is never acceptable.

It's short I know and hardly informative, but hopefully more to follow at a later date!

A public service announcement...

In recent weeks I have come across some confused and frustrated patient who didn't know which telephone number to call for medical assistance, resulting in apologetic 999 calls.

There are a few numbers to call for help and below should help to clarify that, so first, 999.

The 999 emergency number, launched in 1937 was the worlds first specific emergency only telephone number and reportedly recieved under 1400 calls (Holland 2010). Now ambulance services alone recieve more calls daily.  This is the number to call to contact the emergency services, Police, Fire, Ambulance, Coastguard and Mountain/Cave rescue.  Examples of appropriate calls include a crime in progress, a fire or road traffic collision, a patient not breathing or someone in trouble in the sea.  

From an ambulance point of view 999 should be used for :

Cardiac Arrest (patient unconscious and not breathing properly),

Unconscious Casualty,

Chest Pains,

Supspected Stroke,

Severe Asthma and breathing difficulties,

Anaphylaxis (severe allergic reaction)

Convulsions,

Traumatic injuries and Road Traffic Collisions,

Other medical emergencies requiring immediate assistance.

There is now another number to call for medical advice.  That is 111.  This system was introduced to replace the variety of different numbers for advice, GP services and other medical needs.  If you need medical advice or out of hours wish to reach a GP this is the number to use.  You will speak to a call handler who will screen your call to identify any immediatley life threatening problems before being contacted by a clinician who will determine the best course of action for you call, be it advice, a GP appointment or an ambulance attendance.  This number should not be confused with 101...

More and more patients are confusing 111 with 101, the national police non-emergency number and 112, the European Standard Emergency Number.  Whilst 112 will get you an ambulance, it may not get you the most appropriate care and could result in an ambulance attending unessasarily.  101 will allow you to speak a police call handler, who if identified that you need medical assistance will pass you to the ambulance service, but ultimately will delay your care.

The next post will bust some myths around what happens to your 999 call! Watch this space!

The first hurdle

So I did it.  I actually went for a run.  The wife even laughed when I said I was going, but go I did.  

I found a park at the top of town that has a nice circuited path, that is about half a mile long.  It's also far enough away from my house that the neighbours won't see me!

Anyway, I decided in order to break myself in, so to speak, to do a mix of walking and running (I've heard that's a good way to warm up and get started...)  Last thing I need is to collapse with chest pains and have to explain to my colleagues! So off I went, five minutes of walking then five of running etc etc.  Forty minutes later, quite frankly I'd had enough.  I was hot, thirsty and my legs hurt....I had though, run about 1.5miles in total! Yay me! Feeling rather chuffed I went home in a sickeningly good mood and had a cold shower (I've heard that's good for recovery?!).

In order to track my progress I thought I'd share with you some vital stats.  When you read the following, imagine it's being displayed with a rotating photo of myself, NFL Style...

So, I currently weigh, if I'm being kind to myself, 85kg., I'm 5'5 (and a half) and have a 36" waist, which means I have a BMI of 31.  So I'm overweight. This I knew. I eat too much.  I like food!

My Resting heart rate rate is 78 and my last blood pressure was 131/78. I "ran" a mile in 14 minutes (this isn't wholly accurate 'cos I like totally walked some of it!). I'm hoping that all these figure are going to drop.  Obviously not my height.  There is nothing I can do about that, I've made my peace there...

So, on Monday morning I'm going out again.  This time, I'm going to see how far I can run before I have to stop, just to set a bench mark there!  I'm hoping I can manage at least a mile.  I have some learning points from this week though.

1. Take water

2. Cycling to and from work the same day, means the next day I will hurt!

3. Cold showers are horrible!

Onwards and upwards!

Big ideas, small begginings

I have decided to do something daft.  Allow me to explain...

Earlier in September I watched my Sister and three our friends, Martha, Sophy and Lucy run the Bristol Half marathon.

This has inspired me to do the same.  Now, naturally, in my line of work I'm not unfit.  I mean, I'm not at a peak level of fitness by any stretch, but with regular cycling to work and the demands of the job I'm no couch potato.  However I detest running. I'm not a runner.  At school, I cam last in any event that required running and I have been frequently heard to complain that running should only be used to get away from fire and lions...

So why have I decided to do something that I hate so much?

Well, my sister and our friends managed the half, some with minimal training and really enjoyed themselves. They also raised £1000 for BIBIC, the charity for brain injured children.  They also have a memory to look back on and say, 'I did that...'

There's also the charity element.  It's a great way to raise money.  I have a charity in mind, I've not told them yet, but in my mind it's the perfect one.

So, here's my plan...

I have 50 weeks until Bristol Half Marathon 2014. I am going to blog, weekly about my progress, the pain and the fundraising.  All I need you to do is keep reading, supporting and donating money.

Am I crazy? Yes!

Am I motivated to do this? Yes

Is it going to hurt? Absolutely!

Wish me luck

Next blog to follow...

Advice, Tips and Guidance for (new) Student Paramedics

There are an increasing number of universities now offering Paramedic courses and therefore that means more student paramedics.  I thought it may be helpful to pen a 'tongue-in-cheek-with-a-element-of-truth' piece for our newbies.  I have has the privilege of mentoring a student through the last 3 years and also can remember what it was like for me starting out as a trainee Technician all those years ago.  Setting the record straight, I'm not against the student paramedic route, nor am I solely in favour of the 'old way', both have pros and cons.  Anyway, here goes, Ambulancemandans' Advice, Tips and Guidance for student Paramedics:

1. Firstly, congratulations on achieving your place at University, you've already gotten through the first hurdle. You've entered into a highly competitive market now though, so the hard work has just begun...

2.  Ask yourself, "Why do I want to be a Paramedic?" 

If your answer is "So I can drive around really fast on blue lights and go to lots of car crashes and stuff" Stop now.  You have picked the wrong job. Perhaps Firefighting is more your calling?

However if you answered along the lines of "to care for mine and the wider community, day or night, dealing with a variety of people with sometimes complex medical, social and psychological needs as well as being equipped, trained and ready to save the lives of those afflicted with the most serious medical and traumatic injuries often at the expense of my own personal well being, social and family life" then proceed to the next point.

3. This isn't your usual University course.  You will have placements all over the area. You will spend time in operating theatres, GP surgeries, psychiatric wards and in ambulances.  You will "work" shifts 24hrs a day, on birthdays and bank holidays.  Come rain or shine.  On top of that you will need to study, write essays, reflective practices and attend lectures.  It is going to be hard work.

4. In light of 3, take the chance to rest.  You will be tired and stressed.  Join a Uni social club, a choir, sports society somewhere you can de-stress and talk about something other than Paramedicine.

5.  On placement you may come across people who expect you to know everything from day one.  They may be short with you or treat you like a fool.  This is not your fault.  Do not take it personally.

6. On placement you will come across people who are excellent with students, who will teach you, encourage you and challenge you.  Learn from these people.

7.  Be nice to your paramedic mentor.  They do a lot of work for you for nothing extra from the service or Uni.  Sometimes, donuts, cake or Thank you is appreciated.

8.  If you do not understand something ask.  If you're not sure on a procedure, ask.  We have all been in that position.

9.  If you're stressed, scared, tired, nervous, or struggling, tell someone.  We've all been in that position.

10.  Don't try to pass your course by sleeping with people.  It is frowned upon.

11.  Don't try to pass your course by cheating.  It is frowned upon.

12. When on ambulance placements, pee at every available opportunity. It could be a while between stops!

13. Be proactive and engaging.  Be prepared to learn from all staff.  Each has something valuable to teach you.

14. It takes time to settle into an ambulance station. You won't be able to step straight into the banter, it will take time for people to get to know you and trust you.  Don't take it personally.

15. Pee at every opportunity!

So, take these words with a pinch of salt, an element of reality and with the humour intended and may I wish you the best of luck!

Team Work

Cardiac Arrest.

The words strike fear and excitement into the core of any medic. The adrenaline courses through the veins, the heart quickens, breaths deepen, this is it. This is what you've trained for. The chance to save a life and of all our life saving skills, this one probably gets used the most. You are the only thing standing between a patient and the coroner. The important thing to remember is, to reverse a cardiac arrest, teamwork. Obviously there are the underlying medical causes to address, but none of it makes a difference if the rescuers can't work together.

I'm going to tell a tale of teamwork, hard work and good work.

David is a businessman. An important man? I don't know, perhaps we will never know, all I do know is he is about to experience Team NHS at its best. David has just arrived at work. He walks into the office, a little sweaty, quite breathless, a lot pale. He looks up at his colleague and tries to speak as he collapses to the floor. A hush fills the room and after what feels like a eternity the cries of "Call an Ambulance!!" break the silence.

"Ambulance Emergency..." The call taker answers "What's the problem."
"He's not Breathing!!" stutters the secretary, her voice quivering...
"OK, I'll tell you what to do, the Ambulance is on its way..."

The call handler talks David's colleagues through CPR. It's 2 minutes since he collapsed, already bystanders are forcing blood around David's body, keeping his brain oxygenated, giving him every chance.

Simultaneously a First Responder, seconds from David's office is dispatched, as is my ambulance, a second from the next town and our HEMS team.

4 minutes, the responder is by David's side.
Defibrillator on.
One shock
CPR

12 minutes after his collapse we arrive. Grabbing all the kit we can can my crew mate and I run to David. We arrive at a scene of utter calm and disbelief. The responder has everything under control and a good history ready. He carries on with CPR, whilst with a glance and a nod my crew mate and I assume our roles, one on Airway and Breathing, the other on IV access and drugs.

15 minutes after his collapse David is Intubated, ventilated, has patent IV access and begins to receive life saving drugs. We swap. I take the CPR, the responder squeezes the bag, delivering oxygen to David and my colleague looks at the reversible causes.

20 minutes Post arrest - we pause...."rhythm check"

David's got a pulse, it weak, but its there. The second crew arrive with stretcher and scoop. David is stabilised, fluids to correct low blood pressure, cooling packs to reduce brain injury, he is carefully lifted onto the stretcher and carried out to the ambulance.

35 minutes.

Our HEMS service has landed a short distance away. It's too far to walk, so he is driven to the waiting helicopter. As we pull up next to it, his heart stops again.
More drugs, more CPR. A needle is inserted into David's bone, it's brutal, but stronger, the intravenous access already damaged from all the movements.

45 minutes after his collapse, David is now in the Helicopter. The noise of the engines and smell of aviation fuel fills the air. The downdraft throws up leaves and mud as the small aircraft lifts off and disappears over the houses. The hospital know he is coming, they are waiting.

60 minutes. 1hour later. David is now in the Emergency Department Resuscitation room. He is surrounded by Doctors, Nurses, Anaesthetists, all trying to keep him alive. His heart started to beat again in the helicopter, so now the team had to keep it that way. Bloods were taken, scans done all trying to piece together what had happened...
Meanwhile, my crew mate and I are staring at the devastation that is our ambulance. It was like someone had turned it upside down. We simply close the doors and drive back to the ambulance station and only there do we sit back and reflect.

We managed to find out what happened to David. Sadly, despite everyone's valiant efforts, the damage to his heart was too great and it finally stopped. It's a sad outcome, but I know that the whole NHS team did everything possible to try and save him. I'm proud to work for such a team, in such a team and with such a team.

Regulars...

We all have regulars. Pubs have regulars, hairdressers have regulars, hell I'm sure even the coffee shop has them and the ambulance service is no different.
Regulars are all varied. Some are just plain annoying, calling because they're bored/lonely/can't find their back door key. Some are just victims of their circumstances, alcoholics, chronic respiratory problems or regular fallers. Some aren't regarded highly due to they're persistent aggressive and generally unpleasant demeanour, whereas some are adorable, kind, grateful and you may find yourself accidentally spending an hour there.
And then there are the special ones, regulars who out live many ambulance crews, who are known not just to the station, but to the sector and beyond.
In the years I've been doing this job I've come across many regulars, some spanning the length of my career, some very nice, unfortunate people and some nasty pieces of work.
I knew a particular one, who ticked all the boxes...At times a nasty person, with a horrendous addiction who was troubled by their past, or so it was to be believed and as, over the years the substance abuse took hold, they became more, contrite, to the point of grateful, no longer using us but relying on us. Maybe just because we were sympathetic, maybe deep down we understand or perhaps we had no choice, we would help where we could and leave when we couldn't. Recently I met this regular again and for the last time. The years of battering had ruined the organs and left them a shell, a shadow of their former selves.
As we delivered this barely conscious, dying patient to the hospice we said our goodbyes, so longs, in the cheery fashion we always do, like nothing is wrong.
The patient, for pretty much the first time since we arrived opened their eyes and looked straight at us.
"Thank you"
It was barely a whisper followed by a slow, tired smile
"Thank you, boys"
The room fell silent again
We turned and closed the door to the room, knowing that the years of trouble, strife, aggression, even violence were repented and admonished in just two little words.
The journey back was silent until my colleague wryly says, without eyes off the road
"The thing with regulars, one goes, another fills their place, just a gamble who it's going to be..."