Tom Reynolds: More Blood, Sweat and Tea
Few jobs are more adrenalin-fuelled than dashing from one medical emergency to another. Ambulance driver and blogger Tom Reynolds tells all
Tuesday 16 June 2009
We get a call to an 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 he needs a lot of ambulances, the fire service and the police. The injuries are all serious.
We crest the hill. With one look at the car and the bus we know he's right. I jump out of the ambulance and head to the car. The officer 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 fast response unit people work on the other people in the car.
He is lying lifeless in my ambulance and the 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.
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. The blood comes off eventually. It's time for our next job.
The Healthcare Commission assesses and rates all NHS trusts. The LAS got a "Quality of Service" of "weak". The reason? We failed "All ambulance trusts to respond to 95 per cent of Category B calls within 14 minutes (urban)". Possibly because we are chasing after Category A calls with not enough ambulances.
We also "underachieved" at "Deliver a 10 percentage point increase per year in the proportion of people suffering from a heart attack who receive thrombolysis within 60 minutes of calling for professional help."
Is this because we don't do thrombolysis (giving a clot buster) in London? Instead, we take the patient to an angioplasty centre, which is much better for the patient.
So, once more we have been punished for not having adequate resources and punished again for providing a service superior to that normally expected.
We are getting used to being underrated by the Government.
Once again this is another example of how the Government completely misses the point of what an ambulance service is for and what it does. We are underfunded and are forced to chase clinically irrelevant targets – it's no wonder we road staff feel rather annoyed.
The thing about wearing a uniform – it really changes your behaviour. I'm guessing that a lot of you are aware of the Milgram experiment, where members of the public more willingly follow instructions if the giver is wearing a uniform or other symbol of authority.
So when I am wearing my uniform I am more confident and can order people around. The police, firefighters and members of the public tend to do what I tell them if there is someone sick around. Obviously I only use these powers for the force of good, but without my uniform I am a much shyer person.
But there is a flip side to wearing an ambulance uniform: you also become more passive. Out of uniform, if I was in the street and some drunk tried to hit me – I'd punch them on the nose. If I was verbally abused, I'd soon be in their face shouting and ranting along with the best of them.
But in uniform I'll gently restrain the drunk trying to hit me and I'll ignore any verbal abuse that is thrown at me. Unfortunately the anger that I feel is then turned inward, which I am guessing is not a healthy thing to do.
I wonder if it is the uniform, or the risk of having a complaint put in about me, that turns me into such a wimp. It might just be that I spend so much time trying to keep patients calm, that I'm feeling very mellow when people abuse me.
Matern-a-taxi! Ten minute contractions! Treated as a large yellow taxi by the whole family! The family never said thank you to their highly- skilled medical crew!
Treated to a free pram, carry cot and car seat by my taxes! (If they have a car seat then they must have a car.) Total distance travelled: 0.8 miles! Unhappiness of this particular ambulance crew for being used as taxi drivers: 7/10!
When the weather is nice, a polite 90-year-old woman who has drunk a bit too much wine and has fallen over can be a very endearing patient.
It's 3am in the lonely hours of the morning and I'm nervous. We are in the bedroom of a six-year-old boy. His mother found him having trouble in breathing half an hour ago. His airways are so tight that every breath he takes turns his chest inside out. He is trying to breathe so hard that I'm waiting for his breastbone to snap under the strain. From across the room I can hear the air whistling through a tiny airway. He has the classic posture of the asthmatic trying to force air into their lungs – he's sitting upright, hands on knees. He can't cry, he hasn't the breath for it. I want him in the ambulance. No, I want him in hospital.
But we can't go just yet. The single mother has two other children, both under the age of five, and they can't be left alone in the house. They need to be woken up and dressed. One needs to be thrown, still sleeping, into a pushchair.
I'm counting the seconds; I'm waiting for the boy to start turning blue. I'm eyeing the kit in our bag. How much experience has my crewmate had in intubating a closed-down airway?
We are already giving him all the drugs that we can. He's so sick that he quietly accepts the noisy nebuliser mask.
I help the mother dress one of her children – socks and shoes slipped onto sleepy feet.
Then it's time to go. Like all parents, she worries about our insistence that we leave the child topless as we walk out into the cold air. It's because of his high temperature, I tell her. I don't tell her that it's also so we can easily see that he's still breathing. For once, my big fear isn't a complaint from the mother – it's that the child will die in the back of our ambulance.
I pass the "blue" call over the radio to pre-alert the hospital; the radio isn't working too well so I have to repeat some of it. I don't think that the radio operator understands one of the medical terms that I use; it's not their fault, as it's pretty obscure. The broken radio means that I can't be sure of the read-back. I don't care – as long as they have the paediatric doctor waiting for us there I'll be happy.
We are 1.9 miles from one hospital, 2.4 from another. I go for the further hospital, as the drive is straighter and I can use the A13 which at this time of the night is clear. The other hospital has too many speed-bumps and side turnings on the route.
I'm listening to what is going on in the back of the ambulance. My crewmate sounds relaxed and over the sound of the engine is the reassuring noise of the child's breathing.
I glance at the speedometer – I'm hitting 80mph; I didn't know that these ambulances reached that kind of speed. I'm thankful that the road is clear and empty and that there are no hazards. I spot the patient's young sister looking at my face in the rear-view mirror, her eyes wide open now.
We pull up to the hospital and I take care of our patient's siblings; I bed them down in the relatives' room while the doctors and nurses and mother look after their brother.
It's only half an hour later that I'm talking with the paediatric nurses. While it looked touch and go for a bit, our patient responded well to the medications that we can't give. His breathing is back to normal. I love the paediatric A&E nurses at this hospital; they are experts at what they do and despite the cynicism that is endemic in the NHS, they really do care for their patients.
We are chatting and laughing at the memory of our fear. We have fought back against death, and this laughter is our victory cheer. The family are reunited.
I still have that memory of fear, though.
The Government hates hoodies, the media lambast hoodies, people in the street are scared of hoodies. Hoodies are urban demons that do nasty things to people and then post them up on YouTube. We were on a nice simple job – a woman had taken her child to the GP; the GP had called us because he thought that the child needed to go to hospital. As we pulled up outside the surgery, a group of hoodies wandered up.
"What's happening?" they asked.
"Plane crash. Didn't you hear it?" My standard answer – anyone would think that children didn't learn about patient confidentiality in schools these days.
We entered the surgery and were directed to the patient. The GP was still with the two-year-old and the mother. It was nice to see a GP who continued to care for the patient while waiting for the ambulance.
The child had had some breathing difficulties during the day and the GP had already started treatment with some salbutamol nebulisers. The mother didn't speak any English so the GP (who was from the same ethnic group) explained what would be happening and we made a move to the ambulance.
Outside the surgery the hoodies were still hanging around. We opened the door to the ambulance to allow the mother and child to get on board but she just stood there saying something to me in some Asian language. We tried to communicate but the woman refused to get onto the ambulance.
"Here, mate," said one of the hoodies, "she says she wants to phone her husband."
"Could you tell her that she can phone him when she gets to the hospital? We haven't got phones on the ambulance."
There was a bit of a dialogue between the two of them. At the original hoodie's direction, one of the others in the group pulled out a phone and handed it to the woman. "She can use my mate's phone if you want, then she'll be happier to get in the ambulance."
There was some attempt to ring her husband, but unfortunately his phone was engaged. The hoodies then spoke to her and she agreed to get onto the ambulance. We tried to assess the child but the mother wouldn't let us take his coat off. Once again, our "street thug" group translated for us. "She says he'll cry if you touch him."
The GP's treatment had obviously worked well so we weren't about to argue the point. We would just take her and her child to hospital and one of the nurses there could translate for her.
I thanked the hoodies for their help before getting into the ambulance and driving off.
"No problem, mate."
So there you have it, these demonised members of society helped us and the woman by translating and offering the use of a phone. Of course, that won't make it to the front page of the newspapers. I'm old enough to have seen the reality of the cycles of media hatred and scapegoating. I remember skinheads being to blame for all society's wrongs, then the punks, then the ravers, now it's hoodies. I'm sure that people older than me can go further back. I'm certain that some will remember everyone blaming the teddy boys in a similar way. Silliness.
'More Blood, More Sweat and Another Cup of Tea' by Tom Reynolds (£12.99)
The pros and cons of driving a ‘van’
When a patient actually needs an ambulance.
People having an acute flare-up of a chronic condition (diabetes, asthma, heart disease)
People who can't walk, but who live on the ground floor.
People who make an effort towards managing their chronic conditions.
Children who don't cry.
Any time a patient, or their relative, says a simple "thank you" at the end of their trip.
Runny noses, coughs and colds. Verrucas.
People who can't walk, but live at the top of a block of flats with no lifts. And are heavy.
People who abuse their bodies with drink or drugs.
Gangsters crying because they have been stabbed for dealing drugs on the wrong street.
Awful nursing homes.
Parents who weep over their child's cut finger causing the patient to have hysterical and utterly unneccesary screaming fits.
Mr "I know my rights".
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