Kitabı oxu: «More Blood, More Sweat and Another Cup of Tea»

Prologue: A Good Job

Two a.m. and we are standing on the side of the road waiting for the fire service to take the top off the car in front of us. The wind whistles across the flats making us all shiver despite our fleeces and our jackets.

Two cars have been involved in a high-speed road traffic accident (RTA), the parked car that was hit has been shunted forward leaving ten-yard-long skid marks. The cars aren’t too damaged but the seats inside have shifted around, trapping the occupants.

There are seven ambulances here, four fire trucks, half a dozen police and three ambulance officers with clipboards. There are eight patients, all but one need cutting from the cars and collaring and boarding. The only woman involved is ‘walking wounded’.

The reason that it is taking so long for our car to get its lid removed by the fire service is because of the position of one of the patients inside. He looks rather unwell and the crew looking after him really would like to get to him sooner rather than later.

Our ambulance was fourth on scene. When I arrived I spoke to a stationmate to see what he wanted us to do, who he wanted us to look after. Normally he is the station clown, now he’s all serious and professional, no fake beards or silly glasses.

Everyone gets checked over, all the ambulance crews are calm, it’s serious but it doesn’t look like anyone is about to die; more a case of being careful moving the patients ‘just in case’.

The roof comes off the car and with the help of another crew and some firefighters we get our patient out safely and strapped to a board. He is freezing cold. He is not wearing warm clothing so the delay in getting him out and the terrible weather have us concerned for his body temperature.

We are in a new ambulance so the heater works. Turning it up to full we are soon sweating as we assess the patient and prepare for transport.

I get on the radio to pre-alert the hospital. For some reason the radio isn’t working properly and our Control can’t hear me, so I use my phone instead. Thankfully it works.

I travel a mile over speed-bumps to get to the hospital; there is no other route and every bump makes me aware of my patient in the back being jostled around. It’s not the first time that I curse the council.

After all our patients are safe at the hospital we stand outside and laugh and joke. We reconstruct the accident, we talk about the more injured ones and we mock the driving skills of one of the officers.

We occasionally help people.

It’s a good job sometimes.

Introduction

I’m not special. All I am is one of the faceless people who work for an ambulance service. If you are lucky you’ll never meet me in a professional capacity. Most of the time you won’t even think about us; perhaps only occasionally sparing a thought for our work when an ambulance whizzes past you on the street, lights flashing and sirens sounding.

This book is a series of snapshots from the life of one ambulance worker. For the past few years I have been writing about ambulance work on the internet, regularly updating my website. From around the world people have come to read, and comment on, the sorts of jobs that I go to on a daily basis.

This book is not special—there are no tales of heroics, no exciting derring-do, nothing to compare with what the dramas on TV and film would have us believe. This is what ambulance staff the world over deal with day in and day out.

This is a book that lets you understand some of the situations that ambulance staff encounter every day, some of the pressures, and some of the humour that we use to let off steam.

Every time I talk about a patient in this book that situation has happened for real, to a real person.

Taxi

The staffing of ambulances at the moment is…to put it bluntly…poor.

Working on the fast response unit (FRU—a car that is designed to get to the sickest patients quickly) means that I often get to an emergency call within minutes of it being made. Unfortunately, with so few ambulances on the road, the patient and I are often left staring at each other for long periods of time; in a couple of cases up to an hour.

I was sent to a young man having an asthma attack. It was late at night, and he had been queuing to get into a nightclub when he had started to feel his breathing getting tight, the sign of an asthma attack, so had headed to a taxi office in order to go home. Unfortunatel, his asthma progressed and so an ambulance was called. What he got was me, on my own, in a car.

After dealing with the drunken group of teenage girls that had taken time out of waiting for a cab to start loudly ‘caring’ for my patient, I started my assessment. It was a cold night so I sat the young man in the taxi office and listened to his chest. I could hear a nice loud wheezing from his lungs so I started him on the first dose of our asthma medication. I got his details and checked his vital signs, and waited for the ambulance to turn up.

It takes between five and ten minutes for the asthma medication to finish, and by the end of it there was still no ambulance.

I listened to his chest again, still an audible wheeze, so I gave him a second dose of the medication. So there he was, sitting in a cab office at three in the morning with a mask over his face, ‘smoke’ pouring from it, and all around us were intoxicated people getting cabs home.

It was not very dignified.

We started chatting, and I was impressed by this polite young man with good manners and common sense. The second medication finished and so we continued to wait, and wait, and wait for the ambulance. I phoned up my Control and asked if there was an ambulance assigned.

‘Sorry EC50, we are still holding calls in that area.’

I was on my own with this patient for the foreseeable future.

Sometimes I can transport a patient myself to hospital, it’s not technically allowed. Actually, we’ve been told that we shouldn’t do it at all, but in some cases I think I’m doing the right thing for the patient. So I will load them into the car (which only has the front passenger seat, the rest of the car is taken up by equipment) and nip into the nearest hospital. Control is often happy for me to do this, as it means one less job that it needs to send a proper ambulance to.

I couldn’t transport this patient, though, because he wanted to go to his local hospital, which would mean driving past two other emergency departments and out of my area. I couldn’t see Control, or my bosses, being too happy with that.

So the patient, at his insistence, got a cab to hospital. The double dose of medicine had cleared his lungs up nicely, but he would probably need some short-term steroid treatment. I rechecked my assessment of him, and was happy that his physical condition was good enough for him to get a cab to hospital. I wasn’t happy, though, that there was no ambulance for this patient who actually warranted one.

As I write this I wonder what would have happened if he hadn’t responded to the medication that I gave him.

Leaving My Job

I think I’m going to be leaving my job soon.

I went to a six-month-old baby with possible meningitis. The baby had the right sort of rash (although it was only on the back of the knee and, after checking, nowhere else). It had a temperature, but was one of the happiest, most alert children I’ve ever had the pleasure of meeting. It just didn’t seem as if it had meningitis, and trust me, I’ve seen a fair few children and adults with it so I have a pretty good idea what it looks like.

Then, as in the past, I was left waiting for an ambulance.

For around 45 minutes.

There was no way I was going to be able to transport the patient in my car. It’s just not equipped to carry such a small child. We don’t have baby seats and as the family didn’t have a car they didn’t have one either.

So the family ended up phoning a friend to take them to the hospital. The ambulance turned up just as they were getting into their friend’s car.

All I had going through my head was the potential newspaper headline ‘No Ambulance For Baby Dying Of Killer Bug!’

Later that night I went to a woman who was having an extremely painful miscarriage. There is nothing I can do for that on scene, the patient needs to be in hospital. Thankfully the ambulance wasn’t too far behind me, but if I had been waiting on scene then it would have been a very awkward and distressing wait (again, because of the pain, it would have been impossible to transport her in my car).

More and more I’m looking at my watch as an ambulance fails to arrive. It’s only a matter of time before I have someone die in front of me while waiting for an ambulance.

So, I’m seriously considering leaving the FRU and going back to work on an ambulance. That way I can pick up sick people, and take them to where they need to be: a hospital.

So after the holiday season, I think I’ll be sending a memo up to the office asking to return to my ambulance role.

Zafira

I’m not perfect.

I arrived at work to find that my FRU car was nowhere to be seen. There was no one on the early shift, so where had my car got to?

The week before a friend of mine had had an accident in the Newham FRU car (in front of a load of police officers, which had given them some amusement I would imagine). So the car that I would normally use was being borrowed by Newham station.

So the plan was for me to get picked up at my station by a station officer, go to Newham, get the keys to the brand-new Vauxhall Zafira, return to my station with the car and start working.

The station officer met me and drove me down to Newham station. He asked me, because I was leaving my secondment on the FRU, if I could write up my thoughts on what was good, bad and what could be improved about it.

I told him that I’d be more than happy to point him in the direction of where my thoughts lay.

The brand-new Zafira was parked in the garage at Newham so I hopped behind the wheel and, after some struggling with the new design of handbrake, managed to reverse it out and into the parking area.

Where to the absolute horror of the station officer I drove into another car.

Oops.

Luckily there was no damage to the Zafira (which had less than 600 miles on the clock) and very slight, if any, damage to the other car.

The first accident I had in over 18 months and it was in front of a station officer…

Not a good start to the shift.

My thoughts on the Zafira are these; if you wanted a rapid response vehicle, the Zafira shouldn’t have been chosen. It is too top heavy and wallows like a hippo in thick mud. The acceleration is awful, you hit the pedal and it takes one and a half seconds before the diesel engine gives you any sort of power. It is comfortable to pootle around town in, and the high-up viewing position is quite nice.

But there is no way that it could be considered a ‘Fast’ car.

I think the reason why we have them is because they are able to carry patients, and I imagine that soon FRU drivers will be asked to take the coughs and colds that we see so much of to hospital.

NYE Night

New Year’s night was a busy one for the London Ambulance Service. There were 38 stabbings over the course of the night. I spoke to my workmate who was on the FRU that night; he attended four stabbings one after another.

By 5 a.m. there had been in excess of 2000 calls (we normally do a shade under 4000 calls over 24 hours).

On the television one of our top-ranking management people described the night as ‘horrific’, which I would say is a pretty fair assessment.

I am extremely glad I wasn’t working that shift.

Ten Deep Breaths

The call details appeared on the computer terminal in the FRU:

‘Nineteen-year-old male—Patient has lump on ribs—difficulty in breathing.’

Halfway to the address, a private house, my screen was updated:

‘Patient has taken cocaine.’

I was met at the front door by a young male, stripped to the waist and obviously agitated.

‘Comein, myribsfeelfunny, andmyshoulderbladedon’tfeelright.’

‘Slow down,’ I said, taking his pulse—110, a bit on the high side, but he was bouncing off the walls.

‘My ribs man! They don’t feel right! Have a feel.’ He then started running his hands up and down his chest.

‘Have you fallen over? Been hit? Anything unusual happened?’ I asked.

‘No man—just feel them…FEEL THEM!’

‘Look, you need to calm down,’ I replied. ‘I can’t do anything while you are hopping all over the place.’

He started shouting, ‘FEEL THEM! JUST FUCKIN’ FEEL THEM!’

He turned his back to me, indicating that I should feel his normal-looking ribs.

A sudden wave of anger passed over me—it was all I could do to not punch him in the back. I examined his ribs; they felt perfectly normal to me.

‘There,’ I said, ‘your ribs are fine.’

‘What about my shoulder blades man?’

‘Look, you’ve taken cocaine right? You are feeling paranoid, it’s normal, just try to relax a little.’

‘WHAT…ABOUT…MY…FUCKIN’…SHOULDER BLADES!’

He turned his back on me again. I gritted my teeth and grabbed his shoulder blades. ‘They are fine. Now. Sit. Down.’

He sat down. Then he stood up, then he paced around the kitchen, then he did a few circuits of the sofa, then he sat down again, then he stood up and hopped around a bit. I was getting tired just watching him.

‘Look,’ I said trying to calm him, and me, down, ‘is this the first time you’ve taken cocaine?’

‘No man!’

‘OK, well if you want we can take you to the hospital, get you checked out if you’d like?’

‘NO!’ he shouted. ‘I’m not going to hospital.’

Fine, I thought, not that the hospital will thank me.

‘OK mate, then are you alone in the house?’

‘Nah, my dad’s asleep upstairs.’

‘Well, I’d like to have a chat with him, so he can keep an eye on you.’

‘NO! Get out of my house.’ He started advancing towards me. ‘No hospital, no waking my dad up, just get the fuck out of my house!’

I left the house. While a fight with the patient would have done absolute wonders for my stress levels, it certainly wasn’t worth the hassle, the risk of injury and, most importantly, the paperwork.

But what should I do now? If a patient isn’t transported then we should leave a copy of our patient report form with them. Should I post it through the letterbox? The problem with that was if his father saw the report I’d be breaching patient confidentiality. I guessed that the police wouldn’t be too interested in paying him a visit either. So I left the form sitting in my car—there was little else I could do for him, as he didn’t want help.

I sat in my car, filled out my forms and took a couple of deep breaths. It would be a long Christmas…

Taxi?

I’ve had a couple of people send me a story that appeared in the newspapers.

Nursing staff from a Telford hospital have been accused of using an ambulance as a taxi after a night out.

It was claimed some of the nursing staff got into an ambulance outside The Swan in Ironbridge on Sunday.

The ambulance service has found a crew did provide unauthorised transport to staff but said it was not in operation and returning to base at the time.

To be honest this tends to happen a bit with nurses asking if you can give them a lift to the train station and the like. You tell the nurse ‘Hop in the back, we’ll give you a lift—if we get a call you’ll have to hop out again.’ It helps keep relations good between the hospital staff and ourselves. It doesn’t hurt anyone and it definitely doesn’t remove an ambulance from service.

In fact, it can do good. A crew I know was giving a nurse a lift to the train station after her shift finished when they then got a call to a cardiac arrest and the nurse was able to help out. As long as the crew wasn’t refusing calls then I can’t see the harm in it. In London I’d imagine that our Control would love it as it would mean we are out roaming rather than sitting on station, something our management is eager for us to do.

And if I’m going to spend all shift taxiing drunks around, I don’t see why we can’t sometimes help out the poor buggers who work their fingers to the bone looking after those same drunks.

I wonder if the person who complained is the sort who expects an ambulance to turn up seconds after they’ve cut their finger?

Chickenpox

I went to two cases of adult chickenpox last night. The hospital says that there was another adult with chickenpox the day before that. It seems like we have a little outbreak here.

As both my patients were Nigerian, I have a sneaky feeling that the big (mainly Nigerian) church in Newham may be where the disease was spread and the timing of the symptoms would support this.

As one of the families had school-age children with the disease, I’m going to guess that a lot of children will be ill over the next few days.

Off the top of my head, I can’t remember if I have been vaccinated against chickenpox—but I do know that I had it twice when I was a child, both times at Christmas.

Rough

It was cold, it was dark and it was raining the sort of thin greasy rain that soaks straight through your clothes. I was making my way to one of the Docklands Light Railway stations for a ‘Male—collapsed, caller not willing to approach patient.’ I’d been to this station in the last week for a hoax call and I wasn’t sure if this was a repeat performance.

At the bottom of the stairs just sheltered from the rain was a young man in his twenties, dirty, dressed in filthy clothes and curled up next to a plastic bag. Standing over him was another man, this one dressed in a suit, looking a bit concerned.

(The London borough of Tower Hamlets has both the richest, and the poorest population in London.)

‘He’s just laying there, not talking,’ the smartly dressed man said. ‘I didn’t really know what to do…’

I let him know that I’d take care of the patient, and that he had done the right thing and could go home.

It was just me and the patient. Given the way he looked it was a reasonable assumption that he was homeless. If he was homeless then there was a reasonable assumption that he was drunk and given that he was in such a public place there was a chance that there was something physically wrong with him.

I attempted to wake him up—he was keeping his eyes closed when I tried to open them, so I knew that he wasn’t really unconscious.

‘Look mate,’ I said, ‘if you don’t open your eyes, I’ll have to check your blood sugar, which means poking a needle into your finger. If you open your eyes then I won’t have to do that.’

No response.

So I checked his blood sugar along with the rest of his vital signs; everything was fine.

I crouched down opposite him.

‘Look, you can open your eyes and talk to me you know—we’ll still take you to hospital. To be honest, I can’t blame you, an A&E waiting room has got to be a pretty good option on a crappy night like this.’

Some commuters walked between us; they didn’t look at us. I looked in his plastic bag; there was a sociology textbook.

‘Sociology? I could never enjoy reading that sort of thing.’

He opened his eyes. ‘’S’ all right.’

Excellent. He was talking to me, which meant that the paranoid voice in the back of my head telling me that he might be seriously ill could shut up. It is something that always worries me—that despite my experience I’d miss something serious on a drunk or homeless guy.

We had a little chat while I was waiting for the ambulance to arrive. He’d been a rough sleeper for two years; he admitted to drinking too much. He seemed a nice enough person.

‘Bloody freezing tonight,’ I said to him. ‘I reckon the hospital has got to be a fair bit warmer and drier tonight.’

‘I don’t want to go to hospital,’ he said back to me.

I was surprised. ‘Are you sure mate? It’s no skin off my nose if we take you in.’

‘Yeah, I’m sure. I’ve just had too much to drink.’ He mentioned a hostel nearby. ‘Which way is it from here?’

I pointed him in the direction of the hostel and he wandered off down the road.

I’ve got to admit that I felt sorry for him. I didn’t know why he was homeless, and I’m not a strong believer that all homeless people are victims, but because I’d sat and spoken to him, because he hadn’t tried to hit me and because he seemed like a reasonable person I felt some sympathy for him. He must have made some sort of impression on me as I can still remember the job six weeks after it happened.

Maybe I’m just getting soft in my old age.

The Black Dog Has Been Taken Outside and Shot

I left work this morning with a song in my heart and joy in my step; last night was my final shift on the FRU car.

No longer will I be standing around with my hands in my pockets for 45 minutes while a six-month-old child lies in front of me with possible meningitis. No more will I be told by Control to go and drive around and look busy when there is something good on telly, and no longer will my only conversation with people consist mainly of ‘Where does it hurt?’ for twelve hours straight.

The letter that I wrote my boss telling her that I wanted to come off the FRU takes effect from Friday. I’ll soon be back to working on a ‘truck’, a nice big person-carrying medical-taxi truck.

Lovely!

I was hoping that this last shift would fly by in an exciting cascade of trauma, life-saving and dramatic illness.

Ahem.

It was actually a fairly quiet night. I did seven jobs, four of them being people with coughs (one cough having lasted three weeks before the patient decided to call an ambulance at five in the morning). My last call was to an elderly gentleman with emphysema (and a cough) who actually needed hospital treatment.

However, my first two calls were to drunks.

My second job was a ‘classic’—‘Male collapsed in street, unknown life status—caller refusing to go near patient or answer any questions.’ So I rushed there and found two female police officers standing over a drunk male who was asleep in the street. I did all my normal checks to make sure that he was only drunk (as opposed to being drunk and in a diabetic coma, drunk and has had a stroke, or drunk and has been stabbed). Everything pointed to him being just drunk.

We woke him up and were prepared to send him on his way. He stood up—took one look at me, and smacked me in the mouth.

I ‘assisted’ him onto the floor. The police officers and I then stopped him from injuring himself by sitting on him in a professional manner.

The police have been trained in restraint—they are all careful because they don’t want people dying of positional asphyxia. I haven’t been trained in restraint (well, not in the ambulance service) but I’m guessing that someone isn’t going to die because I’m kneeling over their arm while holding their wrist.

So we carefully restrained him (for around 25 minutes), while he explained how he was either going to kick my head in or sue me. By then the police had tracked down a, now mortified, relative who came and took him away.

No damage done to me, although I would think that as he wakes up this morning he’ll have a number of bruises. I hopped in my car and told Control that I had been assaulted twice in two jobs, so I asked if I could head back to the station for a calming cup of tea, which they allowed. They also made sure that I was all right and didn’t need any other help.

When my mother found out about my being assaulted, did she ask how I was? Did she ask if I had been hurt or damaged?

No.

Her comment was, ‘At least you’ll have something interesting to blog about.’

Bloody lovely that is…

Complaint

It is a constant danger in this job that a patient, or more likely a patient’s relative, will make a complaint against you. While a member of the public can moan about a perceived insult (and half of the complaints against the ambulance service are due to ‘attitude’), there is little that we can do about a patient who is generally acting like a twit.

I have been pretty lucky in my career in that I’ve only had two complaints made against me: once while a nurse and once while working on the ambulances.

The nursing complaint was that I checked the correct dosage of a drug with another nurse before giving it to a child. For some reason this person had decided to complain about me for following the sensible rules laid down by my superiors. My boss at the time called me into the office, patted me on the head and told me I was a good boy and should keep up the excellent work.

The ambulance complaint went to a local investigation.

I was called into the office and asked if I remembered calling a patient a ‘bitch’. As I have a poor memory I didn’t remember until the ambulance officer gave me the paperwork for the job.

We had been called to a patient who had been arguing with his family, he’d drunk a bottle of wine and pretended to be unconscious. As he didn’t want to ‘wake up’, we decided to take him to hospital. While in the back of the ambulance he slapped my leg.

I told him that he ‘slapped like a bitch’ and that he really shouldn’t do it again or I might get upset.

I know, not the best insult in the world. He’d surprised me and I had to come up with something witty on the spur of the moment. If he’d hurt me then I would have thrown him off the ambulance, but as it was such an ineffectual strike I found it more amusing than anything else.

The officer had to investigate the allegation so he interviewed the other staff present and they supported my side of the story. He then had to travel to the patient’s home and interview him there. Luckily the officer saw the character of the patient and convinced him not to go any further with the complaint.

If I’d complained to the police it would no doubt have been considered ‘not worth prosecuting’ by the CPS, but if the patient had continued to complain I could have been seriously disciplined.

All of which only makes me think that I shouldn’t leave any witnesses alive…

Snapshots

…We get the call to the RTA, a car has crashed into a bus; normally these things are ‘nothing’ jobs. We put on the blue lights and head towards the crash…

…The radio bursts into life, there is an officer who ‘lucked’ onto the scene—he tells Control that he needs a lot of ambulances, the fire service and the police. The injuries are all serious. We wonder if he is talking about the same crash we are going to…

…We crest the hill, with one look at the car and the bus we know it’s going to be serious…

…I jump out of the ambulance and head to the car; I ask the officer what he wants us to do. He tells me that we can’t wait for the fire service to arrive to cut out the first patient as his breathing is so ragged. We agree that he needs to be out of the car immediately and that a possible neck injury is a low priority…

…We get him out and I watch as he takes his last breath…

…We work on him; he is so young we have to make the attempt. The DSO (duty station officer) and other FRUs work on the other people in the car…

…He is lying lifeless in my ambulance and the BASICS doctor declares him dead—then we rush off to the next casualty…

…This one gets sedation. I write the dose and time on his chest so that the information doesn’t get lost in the chaos. Another ambulance crew speeds him to hospital…

…The next one is declared dead as the firefighters cut him out…

…The other dead man is left in the car, there is nothing to do for him, it will be some time before the firefighters are able to free him…

…I check on the people in the bus, there are some injuries that will need hospital treatment. I’m trying to keep them calm and relaxed. My crewmate and I move from our ‘all-business’ personalities to our ‘reassurance’ ones in the time it takes us to walk to the bus. I deal with the multiple casualties one at a time, my crewmate helps me out…

…My ambulance becomes a mobile mortuary; the police are checking for identification. The blood is pooling on the floor…

…I’m sitting on the back step of the ambulance, two of the dead are in my ambulance; one, wrapped in a sheet, is at my feet. We are waiting for the undertaker…

…The police investigation team is chalking the outlines of vehicles and taking photographs of the scene…

…My paperwork is done. It seems like such a little bit of writing for such a serious call where three men have been killed…

…Medical equipment and wrappers mix with the debris of the accident. There is the familiar ‘tick-tick-tick’ of our blue lights revolving in their housings…

…Back at the station I have a face mask on as I clean the floor and trolley of the ambulance with the jet spray we normally use on the outside of the vehicles. My crewmate is doing the gentler job of cleaning the equipment. The blood comes off eventually…

…It’s time for our next job.