Medic999 CR (Compulsorily Retired)

It is with much regret and not a little anger that I find that Mark Glencourse, aka Medic999, has been forced to choose between his profession and his blog.

Mark’s blog has always been an inspiration. He has put tragic events across very well, walking the tightrope between mawkishness and couldn’t-care-less. He has been really informative and inspirational. As an Amateur, I found his standards were thos to which we should aspire.

In all this time, I cannot recall an incident where a patient could have been identified. I’m sure that sometimes he changed the sex of the patient! Confidentiallity is very important, but if the patient details are hidden as well as Mark did then who loses if he writes about them? Many gain.

His blog was a credit not only to Mark himself, but to the North East Ambulance Service as well. It’s strange to me how the NEAS has decided to threaten their best PR person.

I can’t blame Mark for doing what he did; he has a living to earn, and the people of the North East would lose a great paramedic if he was fired. I can, and do, blame the NEAS management for their short-sighted approach to Mark’s blog. Didn’t they realise what a great PR job he was doing for them?

Thanks Mark. You did a great job on the blog and I’m sure you do an even better one in the real world.

CPR

CPR is something that First Aiders learn and hope never to have to do. It’s also something that CFRs learn, with the likelihood that some day they’ll have to use it for real.

This week was my week when it was real. I’d had to give a few compressions a couple of times before, whilst the paramedic prepared the shock-box. However, I’d never had to do the technique in anger.

I arrived at a “collapse” (can mean anything) to find a paramedic in a fast car had got there before me. I went in.

“CPR please” said the paramedic, leaving that to me as she went to get some different kit. I started with the chest compressions. The paramedic had put in an airway and was using a BVM (bag, valve and mask) so I didn’t need my kit.

This was really different. Sure, I’d done a few compressions before, but there was no way we could shock this patient. The bloke who was down was a fairly big sod, so I didn’t hold back. I gave compressions just like when passing my exam – but with a bit more force as he was a lot bigger than Resusci-Anne!

Doing CPR on a mannikin during training is a lot diffferent to doing it for real. The sensations are quite different but I did everything by the book. The only trouble was that the back-up still hadn’t arrived, so I was pushing for England – and for over 15 minutes.

The crew then arrived and an ECA took over from me. I was dripping sweat, and was rather glad that someone else could get hot instead of me! He carried on for another five minutes, but with no more success than me.

The paramedic called it. This was one we couldn’t save. She went through to the other room to have a word with the patient’s wife, whilst we cleared up.

After we’d done, we made our way out and the paramedic joined us. She turned to me and said “Very good CPR”. Whilst we were all a little down at not being able to save the patient, that comment from a professional lifted me back.

We’d done all we could.

Ambulance Time

Recently, I had the opportunity to spend a shift with one of our local crews. We’re encouragd to do this, as it’s a good way to get more experience. For me, it’s also a way of getting to know colleagues better, and thus to understand how better to help them in an emergency.

Well, it was a busy day! There was a bit of faffing about to start with, to get two (employed) people on the truck, but we then had wall-to-wall jobs.

I was on a double-technician crew and the guys were great. I like to think that my patient skills have developed over the last few years, but these blokes had it sewn up. Both of them had hair that had gone grey (and/or fallen out) in the time they’d been with the Service, and it showed. Their patient care was superb.

I like to think that my own patient skills are better than average, and it’s from watching people like these two that has helped me develop.

We went to some calls that a CFR would never go to. We had two separate calls for “woman in labour” – the first one gave birth to a healthy son. The other was the last job of our shift, so we never found out.

Busy was the operative word. We were covering a larger area than usual (as there was a shortage of trained people in our area and the one next door) so, after starting at 07.00 we managed to get a proper break at 15.00. That, of course, excludes the quick cup of tea at the hospital once or twice.

I’ve been out with crews and on the FRV before, though not for over 12 months. I shan’t leave it so long again, as it was not only thoroughly enjoyable but really instructive.

Mind you, someone else can have the guy vomiting blood next time!

Quick Decision

Quickest call I’ve ever been to tonight.

Got a shout for a “13yo male Difficulty In Breathing”.

I arrived about 30 seconds after the crew. The attendant went straight in and I followed with the driver.

We were met at the door by the patient with the attendant behind him. “Bad asthma – he’s going in!”

I must have been on-scene for 20 seconds, and even the attendant could have been there less than a minute. Mind you, it didn’t take Dr Kildare (anyone remember him?) to make the decision, but the speed with which it was made was fantastic.

Surprising Myself

Got a call to day for “paramedic assist”. He’d be on scene in three minutes – which was just as well, as it was Saturday afternoon and the roads were really busy.

A lady, nearly 100, was unconscious.

As soon as I arrived, the FRV paramedic got me to help move the lady on to the floor. I then did a few obs whilst he set up the 12-lead. He’d already got pulse (68) and sats (99%) – her obs were better than mine!

Whilst the paramedic did paramedicy things, I held the lady’s hand and talked to her. Her eyes had been shut all the time we were there, but one eye opened slightly.

“Freda, can you open your eyes?” I said, more in hope than expectation. I could see her trying to do so – so she could hear me – and then she managed to get both eyes open. I made the paramedic aware, as he was getting details from Freda’s carer. I carried on talking to her, and she managed to keep her eyes open for a while.

Freda tried to talk a little, but all her words were muxed ip. She drifted off again. I carried on talking to her and she appeared to be trying to respond. I asked her to open her eyes again, and she did. This time she was more alert, though still mumbling a bit.

Eventually, she could respond to what I was saying. Not very well, you understand, but she did have dementia and didn’t talk much anyway. She did manage to say she was thirsty and that she wanted water. Unfortunately we had to refuse her, even though she seemed dehydrated.

She said she wanted to get up, but that was going to be a problem. She was incapable of sitting unaided. I just carried on having a “conversation” with her. Her replies were monosyllabic and unclear. I kept chatting away and asking how she felt.

A bit later, she went unconscious again but after a minute or so I managed to get her to open her eyes.

Shortly afterwards, the crew came and we managed to get her into the ambulance. Off she went. I’m hoping she makes 100 not out.

Why the title? Well, the soft skills are not really my strong point but I try. Afterwards, I thought I must be learning something!

Doctor? Why?

At my day job last week, chatting to – sorry, exchanging information with a colleague – and another member of staff came in the room. It doubles as an office and mess room.

This bloke made a cup of tea, sat down and took a bite of his sandwich. The next thing, he’s half rising and obviously cannot breathe. There are some muffled cough-type noises coming from him.

He’d obviously choked on his sarnie. The training kicked in and I immediately bent him over a table and gave him some sound slaps to his back. I repeated this when the first slaps didn’t seem to do anything.

Neither did the second set, so I was positioning myself to give the Heimlich manouvre. Just before I pulled, I noticed a change in breathing – my patient appeared to be getting some air, even though it was whistling a bit. I delayed the Heimlich and waited until I saw what was happening.

My patient sat down and his breathing continued to improve. Eventually he could talk.

“I wasn’t choking. Sometimes my throat just seems to close up.”

I asked him to repeat that, and he did. “This is the first time it’s happened at work.” It seems that, over the last six months, he’s been having these episodes every three weeks or so! His throat goes into spasm and he can’t breathe for about 60-90 seconds.

I asked if he’d seen a doctor about it. Of course he hadn’t!

“Well, this time you damn well will. We’re going to get you checked out now, and you MUST see your own doctor too. You often work alone for a couple of hours and you’re not safe if this is likely to happen.” I know that he could be anywhere in the building, including on ladders.

He went to A&E but was back before long. I don’t know what bullshine he gave them, but I bet he didn’t tell the truth.

I’m not at that site again until Tuesday, but he then gets the third degree on when he saw/is seeing his GP, and what the doc says.

“Errr, I can’t breathe at times, but it’s not worth bothering my doctor.” Should I also suggest psychiatric evaluation?

Dilemma

As you’ll know by now, I believe that CFRs should receive training in a couple of bits & pieces that are currently the preserve of ambulance crews. I had a conversation today that’s made me think a bit deeper.

I was talking with “Jim”, a paramedic on the Fast Response Vehicle (FRV), after a job. I’ve met Jim many times on calls and both like and respect him. We work well together.

Whilst he has nothing against Responders, he’s very cautious about extending our skills. This isn’t because he doesn’t think we’re capable of learning the skills, it’s because of the likely consequences.

In his book, CFRs are useful to the patient and paramedic but are even more useful to HQ. As we carry O2 and a defib, our arrival counts as an ambulance on scene even if we can do nothing to help the patient. It looks SOOO good in the figures.

Jim’s concern is that the brass will be able to say “Not only did we beat the target by three minutes but the patient was given Entonox within six minutes of the call.” It would be just another excuse to reduce the number of vehicles available, particularly at weekends. CFRs are more likely to be around then, and it would reduce the need for premium payments. We’re free; the regulars cost money.

Now, this may seem a little cynical. However, I can understand why he believes this. I’ve waited more times than I’d like to remember for a crew taking over 20 minutes for a Cat A patient. It’s not their fault; they’ve had to come from miles away as the solitary local ambulance was on another call. No, I’m not out in the sticks, I live and respond in part of a large conurbation. My area has about 50,000 people in it.

So, what do we do? Stand with a patient and being able to do nothing except hold their hand, or push the powers that be for further training and more kit and possibly cutting the number of vehicles on the road?

It’s a bit of a dilemma.

Drunk

I’ve had my first!

OK, I’ve been to drunks before but usually they’ve had something else wrong with them. This time the patient’s only “complaint” was essentially inebriation.

Called to a patient, at 12 Acacia Gardens, Control told me he was outside. Chest pains and a known asthmatic. On my way there I was informed that he had drink taken. Was I OK to carry on? Yes, but if he was violent I’d take steps – damn great big uns, and very quick!

On arrival I was faced with a bloke lying on the doorstep of the house, about ¼ inside. He informed me that he had chest pain plus had an aortic valve condition and asthma. “If it’s in the chest, sitting’s best” so I managed to get him to sit up. The crew then arrived.

I’d started to become a little sceptical as he’d sat up a bit easily, and the crew were even more so. They took him on the vehicle for thorough obs.

I’d smelled a little drink on him, but my sense of smell is what experts call “crap”. I thought he’d had 4-5 pints but should still have been OK.

Whilst he was having his obs, I talked to the young lady who’d called us. She didn’t really know him but he was related to someone else who lived at the house (divided into bedsits). His relative wasn’t in.

The paramedic came out of the vehicle and said that all the guy’s obs were normal. Essentially he was soundly drunk.

He’d told me he’d had a couple of pints. He’d told them he’d had 20! Neither was true.

I think he was bored and went to see his relative. On being told the relly wasn’t there, he’d somehow decided to make himself the centre of attention. Drink does funny things to some people!

I left before the final outcome, but I wouldn’t be surprised if it involved our colleagues in dark blue uniforms.

Training

How much would I like further training? THAT much! (Holds hands wide apart.)

Only my opinion, but I reckon that the ambulance services are missing a trick here. Many, but not all, CFRs would like to have extra training to allow us to be more of a help to the patient. Sure, we need to keep up regular training on the basics, as they are life preserving. We need to show a standard of excellence in such matters as CPR, defib and O2 therapy.

However, there’s more we could do. First of all, we’re not supposed to lift or transport patients. I regularly help with both. I know all the principles of lifting properly (I can train people in this) but a bit of extra advice on the best ways to assist would be advantageous. We tend to do it anyway, as usually both we and the professionals regard us as part of the team.

I’d love to be able to do BM (blood sugar) measurements. It would often help in knowing what to do for the patient. Yes, I know it’s invasive but surely, with proper training, it should be possible for us to do it. We can already put an OPA down someone’s throat; isn’t that invasive?

I’m not allowed to carry a thermometer. I accept that there are hygiene issues, but there are such things as disposable thermometers.

We’re not Technicians, let alone Paramedics, but being able to do some of the basics would help us understand what’s going off. At one time, we were forbidden to carry a pulse oximeter – now it’s compulsory. Some of the other gear would be the same.

One final thing. Sometimes we have to deal with rellies and friends. Usually the crew will do this, but at other times they’re too busy. Some advice on what to say (and what not to) would be great. We’re pretty sympathetic types anyway, but a little coaching wouldn’t come amiss.

I accept that we’d need further training, but most CFRs are only too keen to improve their skills, the better to treat the patient.

It’s Happened Again!

I recently posted about a call to “DIB” in a young female (March6th).

I’ve had another one! This time it was to a 14yo male with a CVA (stroke).

Now it’s possible for anyone of any age to have a CVA, given the wrong circumstances. There is, though, a great deal of difference between possible and likely.

On scene, and I found a lithe kid in bed with no signs whatsoever of a stroke. He was obviously feeling very unwell and had been vomiting and had diahorrea, and was so exhausted he could hardly stand. His temperature was well elevated and (surprise) he had a headache. The patient had been feeling alternately hot and cold, with shivering. He was tachycardic, about 145-150.

I’ve got nothing to give in those circumstances, so I made reassuring noises and waited for the crew.

The crew confirmed my observations and checked temperature – well over 40°C. That alone indicated a trip to the Infirmary.

The patient had been unwell for a couple of days, but had come to a crisis, hence mum had called us. The normal antipyretics were not working.

I’m quite OK with going to a patient such as this one, even if I can’t do much. The yellow vest can give reasssurance, making patient and rellies feel better. I can let them know that no, they aren’t dying – or at least no faster than the rest of us. However, I’d like to know what I’m going to.

Most of this type of calls come via NHS Direct. The poor bl***y call-takers have a protocol that they have to abide by. Some of them must know that the advice they are giving is sometimes complete bulls*, but they have their instructions.

NHS Direct is really good when you actually speak to a nurse. It can save a lot of ambulance calls and trips to A&E. Understandably, the call-takers with no medical training obey the protocol. It’s the protocol that’s sometimes NDG.

Surely it’s better to direct a young person’s ailments to a nurse if there is only one symptom of a condition most often seen in the over-70s?