MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'ambulance'. Sat, 03 Sep 2011 01:47:46 +0100 http://www.medworm.com/index.php?rid=5181839&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1843 I am writing to alert you to a dangerous new phenomenon called JFA that is sweeping the nation, requiring several 999 emergency ambulance calls every week. This frightening condition causes patients to suffer an acute reduction in consciousness and, if an attack takes place while driving, swimming, operating heavy machinery or handling dangerous animals, may result in serious injury or death. Patients who are JFA can be recognised by its distinctive presentation: Decreased neurological status. Closed eyes (often with flickering of the eyeball and lids) Hypotonia. Bradycardia. Deep, slow breathing (often with sonorous upper airway noises). Sufferers report intense visual and auditory hallucinations, often with associated uncoordinated thrashing movements. Patients’ family members states ... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=5181839 Thu, 01 Sep 2011 10:51:00 +0100 5181839 http://www.medworm.com/index.php?rid=5130654&cid=t_92383_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2011%2F08%2F15%2Fthe-queen%25e2%2580%2599s-ambulance-service-medal-qam%2F Scan or Click to Download 'The Queen’s Ambulance Service Medal (QAM)' Title: The Queen’s Ambulance Service Medal (QAM) The Skinny: Details the issue of a Queen’s Ambulance Service Medal (QAM) to recognise distinguished service by the ambulance service. The Command Paper [Cm 8140] was laid before Parliament on 11 July 2011 instituting the QAM. A copy of the Command Paper is available with further information on the criteria for eligibility, along with details on how to nominate individuals for the Medal. Publisher: DH Published: 11/07/11 Size: 5p. Additional Documents: The Queen’s Ambulance Service Medal (QAM) Guidance Filed under: Ooops Missed Category! Tagged: Ambulance care assistants, Ambulance Services, Ambulance staff, Ambulance technicians, Awards, Control assistant... Fade Library blogs http://www.medworm.com/rss/comments.php?id=5130654 Mon, 15 Aug 2011 14:21:38 +0100 5130654 http://www.medworm.com/index.php?rid=5050642&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1835 “Mark, I’m sorry, but I need you to help us.” He nods, courage and dignity to the last. I use a sneaky persuasion technique, stating facts in the future tense as though they’re already agreed. “You’re going to climb into the cage with me and we’re going to get out of here.” And he does, with a face screwed with effort and agony he hauls himself on all fours into the box. They slam the gate on the two of us and with a scream of running cables and the creak and ping of chains taking the strain, we climb into the sky with a lurch. I’m stood over Mark, watching the rock face pass in front of our faces, the lake below us receding away, workmen around it staring up, their hands over their eyes to shield the sunshine makes them look like they’re s... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=5050642 Wed, 20 Jul 2011 22:32:29 +0100 5050642 http://www.medworm.com/index.php?rid=5050643&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1825 From above us a crane’s jib swings into view and a large metal box is lowered down, the worker by my side guiding the cage down by radio. It’s then that I realise the crane operator can’t see where he’s lowering this thing. It’s about the size of a Mini Cooper and probably weighs the same but between the two of them they touch it down delicately next to us, resting two corners on the terrace while the other two hang in the air. “Hold tension…” says the guy on the radio. It reminds me of the pictures online of Chinook helicopters landing with their tail lifts on mountainsides while the front two thirds are suspended in nothing by the rotors. The cage is slightly too small to lie down in, and access is gained by crawling in a hatch through th... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=5050643 Tue, 19 Jul 2011 22:15:00 +0100 5050643 http://www.medworm.com/index.php?rid=5050644&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1823 An ambulance arrives and two brilliantly experienced paramedics jog down the steps towards me. I’m feeling better already and shoving a giant IV into that elbow when Mark barks out horrible, deep coughs that seem to come from somewhere behind his navel. Still gasping for breath, he chokes and hacks until without warning his mask suddenly fills with bright red bloody foam. People talk about colours that “don’t exist in nature” and had I not seen it come from a man’s body, I’d say it was OTT, but the blood that sprays from his mouth is so vibrant and vivid that it can only be highly oxygenated stuff directly from his lungs. Your lungs aren’t meant to bleed, they’re delicate structures and easily ripped, but don’t respond well to blood ... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=5050644 Mon, 18 Jul 2011 22:12:01 +0100 5050644 http://www.medworm.com/index.php?rid=5036259&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1821 While this is going on I’ve hit the Priority button on my radio, I’m going to need specialist help to get Mark out of here. I’d love to put him on a spinal board and hoist him out of here on helpful shoulders but with the hypoxia his breathing problems will surely give him I’m not sure he’ll be cooperative enough to lie still while we lift him out. I’m also unhappy with the idea of him squirming or seizing halfway up those bloody steps. We’ll need a high line team to get him out of here…and probably a flying squad medical team to anaesthetise him first. My radio bleeps and I call my order in. Medic One trauma team, please, and a rope rescue crew – either the fire brigade or our SORT crew, whoever can get here first. I’m hauling e... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=5036259 Sun, 17 Jul 2011 21:59:31 +0100 5036259 http://www.medworm.com/index.php?rid=5036260&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1818 I count, rapidly. The terrace beside me is about four feet tall and there are ….. sixteen of them from surface to floor….sixtyfour feet…shit. “He hit some of them on the way down, smacked his head proper on one…” he gestures to the colossal lump thats bursting from the back of the patient’s head, “and then he hit the floor flat on his chest.” I peer down at the floor, shallow water over rough stone with little stubs of metal rebar protruding. “I know you’re not meant to shift folk, I’m first aid, eh? But he was out cold.” “He was unconscious when he hit the water?” “Aye…and face down…we had to pull him out.” And here his voice cracks as he justifies his instinct against his tr... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=5036260 Sat, 16 Jul 2011 21:56:27 +0100 5036260 http://www.medworm.com/index.php?rid=5036261&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1815 ‘Down there’ is at the bottom of a frightening set of slippery crude steps where I can see a little huddle of men crouching on the floor. Scummy water lapping at their boots. I’m not a strong swimmer, water freaks me out in honesty, but nobody seems to be wearing flotation devices. The foreman sees me hesitate. “The water’s only about a foot deep, you want a hand with your gear?” “That would be great, thanks.” Everyone else is hi vis and helmets, so I grab my PPE from my turn-out bag, and unshackle the defib from its cradle, passing it to a worker and pulling the response bag tight across my shoulders. And down we go into the shadows cast by the stone walls and machinery. The steps are lethal and I’m pleased to have both my hands free... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=5036261 Fri, 15 Jul 2011 21:51:25 +0100 5036261 http://www.medworm.com/index.php?rid=5028342&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1812 Male fallen into water” is what they send me at first and I’m on the radio as I drive, asking if we’ve scrambled the coastguard or lifeboat or a towel. I ain’t going swimming. I don’t have my trunks. “Reports coming in say its a quarry, calls coming from the firm’s office.” Well now, that changes things. Jobs in heavy industrial areas are never good news, they’re always difficult to find, and if they don’t involve trying to extricate someone from the belly of a ship, or up a ladder or in the mechanics of some horrible machine, they’re at the least places where very bad things can happen to the staff. Some years ago I went to a construction worker who’d seen a concrete pipe rolling off a stack and towards him. Without th... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=5028342 Thu, 14 Jul 2011 21:47:16 +0100 5028342 http://www.medworm.com/index.php?rid=5028343&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1808 Last week I took part in a study for a research medic in which I was asked to cannulate a plastic arm while completing mental arithmetic sequences. I dreaded it and felt no better when my dry run of the maths problems fell flat, even without the distraction of placing the IV. When it came to doing things properly, however, it was easier. I felt my brain split into two, one running the cannulation procedure, the other listening, remembering and calculating. Practice until it’s instinct, they say and it’s clear looking back that while maths problems dont come up so often with me, what I’m very used to is performing important tasks (like cannulating) while thinking about something else and talking about another. “Draw me up some morphine, please, mate? And officer? We need to leave&#... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=5028343 Tue, 12 Jul 2011 21:07:06 +0100 5028343 http://www.medworm.com/index.php?rid=5008242&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1810 A long time ago, dearly beloved, I worked at the Edinburgh Dungeon, a horror themed tourist attraction with live actors. If you’re from the US or Canada, it’s a haunted house. It”s a bit of a hokey old place, lots of cheeky innuendo and RockyHorror jokes. Because the performances were, for a large part, improvised and based on whatever the audience was doing at the time, you had an awful lot of free rein to say, pretty much, whatever you fancied. The great thing about this is that, should you find yourself in a bit of a bad mood in the morning, you could make yourself feel better by being vile to the public. Keep it funny, but make it vicious and they’d be rolling in their seats while you money-shot buckets of sizzling spleen over their faces. I particulary enjoyed telling ... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=5008242 Wed, 06 Jul 2011 21:10:44 +0100 5008242 http://www.medworm.com/index.php?rid=4800872&cid=t_92383_46_f&fid=38787&url=http%3A%2F%2Fmsf.ca%2Fblogs%2Fphotos%2F2011%2F05%2F09%2Fcongo-15%2F Lubutu, DR Congo – February 2011 Nurse Innocent Cigangu caring for a patient on the way back to Lubutu hospital in the MSF ambulance. MSF took over the running of Lubutu General Reference Hospital in Maniema Province, DRC in 2006. The aims were to reduce the extremely high mortality levels in this remote rural area and to share with the Ministry of Health and other interested parties MSF’s experiences of how best to reduce mortality in DRC when in full control of a hospital. The hospital is due to be handed back to the Ministry of Health in December 2011 after 5 years of MSF management. (Source: MSF Blogs) MSF Blogs blogs http://www.medworm.com/rss/comments.php?id=4800872 Mon, 09 May 2011 12:08:25 +0100 4800872 http://www.medworm.com/index.php?rid=4670367&cid=t_92383_82_f&fid=34667&url=http%3A%2F%2Flaryngoscope.blogspot.com%2F2011%2F04%2Fheart-troublecar-trouble.html Sorry ma'am, the ambulance that your new heart was travelling in has broken down(it's going to be a long day) (Source: i'm so sleepy) i'm so sleepy blogs http://www.medworm.com/rss/comments.php?id=4670367 Sat, 02 Apr 2011 15:57:00 +0100 4670367 http://www.medworm.com/index.php?rid=4605853&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1525 He cries when I put the tourniquet on, its elastic grasp nipping his skin as I tighten it. Turns his head into waiting arms and weeps piteously, shaking his head at me as I puncture a vein with the tiniest, gentlest needle I have. “Sorry, buddy…” A string of drool runs a steady drip-fed stain on his chest, I wipe a bib across his chin when I get a second. My colleague lifts his hips while a nurse and I pull up the soft, grey joggers. His hands play absent mindedly with the cotton cord tie at his waist while we slide velcroed shoes onto his obedient feet. In the ambulance I swaddle him in blankets, tucking them under his feet, under his armpits and around his tummy. He stares into the gloom, the lights dimmed to encourage sleep and slowly, precisely, steeples his fingers... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4605853 Thu, 17 Mar 2011 18:28:06 +0100 4605853 http://www.medworm.com/index.php?rid=4580938&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1535 So I’m standing at reception, booking in my patient when I become aware of a presence to my right hand side. There, standing waaaay inside my personal space is a man in his forties. “I need to speak to you…” I have a strategy for dealing with rudeness or just plain bad manners, I like to correct them in a matter of fact way, as though explaining the faux pas to a child who doesn’t know better. It’s intensely patronising, I realise, but makes me feel better and pretty much forces people to remember their manners. “I’m talking to this lady at the moment, sir. I’ll be with you as soon as we’ve finished our conversation.” I wrap up with the receptionist while the man stands a few feet away, clenching and unclenching his fists, l... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4580938 Mon, 14 Mar 2011 09:00:37 +0100 4580938 http://www.medworm.com/index.php?rid=4527749&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1451 It’s nightshift, a snowy, slushy nightshift where every sensible member of society is tucked up in their beds, warm under their duvets, resting their cold feet against the heated flank of an uncomplaining partner. Me? I’m in my car. Nothing’s going on, no jobs, no calls, just foxes digging in the rubbish for discarded KFC wrappers and the occasional drunk weaving along the pavement. I pull up behind the zoo, in a dark car park with no cameras and fewer light. Recline the seat, zip my fleece shut to my chin, fold my arms across my chest and snooze. Hours pass. Hours. I’m woken by the CBT bingbonging, a text message – “RTB EDC MB, thanks.” Return to base, Edinburgh City for meal break, for those of you playing along at home. Shaking my head to clear... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4527749 Sun, 27 Feb 2011 22:58:19 +0100 4527749 http://www.medworm.com/index.php?rid=4445820&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1473 The locus is weird, not somewhere you’d find yourself as a pedestrian and the story is so over the top that we’re convinced it’ll be exaggerated by the caller. But when we arrive, we realise that we’re wrong. When…I hesitate to use the phrase ‘bad people’…but let’s go for “society’s fringes” find themselves with a disagreement they tend not to go for sensible discussion, the small claims court or the Citizens’ Advice Bureau. They grab you off the street, take you somewhere far away and do beastly things to you. And then dump you, brutalised and far from home. Now, I’ve had my share of people being unpleasant to me, but I like to think that by not subscribing to the class of “I shall further myself b... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4445820 Mon, 07 Feb 2011 22:25:59 +0100 4445820 http://www.medworm.com/index.php?rid=4445818&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2011%2F2%2F7%2F4742586.html It's been two months since I last blogged, and I think that this is nature's way of telling me that this blog is finished. When I started writing this I never thought that it would take off in the way that it did - two books, a radio play, opportunities to speak to lots of people at once and of course the upcoming TV series. But all good things come to an end and, since leaving the London Ambulance Service, my life has settled down somewhat. Which means that I have far less to write about the ambulance service, which is what this blog very quickly became about. So I've decided to put this blog into a 'Deep Freeze'. So the links, posts and everything else will remain here, but I won't be updating it any more. In a fortnight I'll close down the commenting system so that I don't have to spend... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=4445818 Mon, 07 Feb 2011 10:00:00 +0100 4445818 http://www.medworm.com/index.php?rid=4414534&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1469 He probably wouldn’t think so. But he’s lucky. He’s lucky we were seconds behind them. That we pulled across the junction and ran the roof lights, secured the scene. He’s lucky we’re there to take the phone from the woman’s hands and speak directly to police control. “I’m a paramedic, we’ve been flagged down – can we have a traffic set for a two car VA, no apparent injuries, no entrapment, no fire?” He’s lucky he hit them straight on, while they waited at the lights. That they had their wheels straight and simply rolled forwards, instead of looping off the road and into a tree, or a lamp-post. He’s lucky the pedestrian crossing was clear and that there was no traffic coming through the opposing green light. A broadside at that speed would lift most anything, ... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4414534 Sat, 29 Jan 2011 23:45:28 +0100 4414534 http://www.medworm.com/index.php?rid=4386286&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1444 So I got a letter from Beth. It was a lovely note, it said thankyou for our help and explained how she’d felt sure things would be alright, despite the problems that Emily faced at birth. It’s always nice to hear from patients, commendations go into your personal file and “thankyou” is a word that’s rarely heard, people being understandably preoccupied. But at the bottom of the letter? “PS – Emily is a happy, healthy little girl.” Scuse me. Something in my eye. (Source: Trauma Queen) Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4386286 Sun, 23 Jan 2011 00:42:28 +0100 4386286 http://www.medworm.com/index.php?rid=4322534&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1441 She stood beside me at the desk, arguing about the wait, tears, snot and saliva pouring from her red, swollen face. A bottle of bleach, apparently. She’s drunk it before, for reasons best known to herself. Last time it didn’t kill her. If she walks out today? Who knows? - He gets frustrated when his medication doesn’t work. Rolls his chair into the hall. And beats his head against the corner of the doorframe. Over and over. Five vertical lacerations on his forehead. His eyes stare through me as I clean and dress the cuts. - We’re en route when the radio calls. “Be aware this patient has a warning on his address…last time a crew was there he pulled a knife on his mother.” We slow down until the police get there before us. (Source: Trauma Queen) Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4322534 Fri, 07 Jan 2011 18:39:28 +0100 4322534 http://www.medworm.com/index.php?rid=4309642&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1433 You guys have heard plenty in the past about the exaggerative abilities of the average 999 caller, so when Scamp and I are called to a local supermarket for “female struck by falling shelf – trapped” we’re dubious. “You know what this is, don’t you?” Scamp starts as she drives along. “Uh-huh?” “This is someone with a shelf on their foot and the shop first aider has been told to never remove a crushing object.” I’m still laughing at the image when we pull up to the shop, a budget supermarket in a local shopping centre. Outside a man is running up and down the threshold like a dog behind a chainlink fence. “C’mon! C’mon!” he yells at us “It’s really bad!” I follow him into the sh... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4309642 Mon, 03 Jan 2011 22:21:39 +0100 4309642 http://www.medworm.com/index.php?rid=4287432&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1427 Winters grip locks the country down. I’m running out of morphine and order more – being a controlled drug we can’t just pop down to Opiates R Us and “get some”. There are procedures. Processes. Rules. The pouch on my belt dwindles. Four vials. A heart attack. Three vials. An elderly woman with ribs so bust that every breath makes her wish she didn’t. Two vials. A guy in his forties slips outside a pub and breaks his shoulder. I pump him full of Entonox instead of morphine. With the alcohol on board it’s enough. Just Two vials. She bent over to plug in the hairdryer and her back went. Can’t stand up, can’t sit down. One vial. One. I keep it in my pouch and touch it occasionally, like a lucky rock in your pocket or prayer beads. I sav... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4287432 Fri, 24 Dec 2010 12:20:04 +0100 4287432 http://www.medworm.com/index.php?rid=4265797&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1421 He’s gonna go. It’s clear for anyone to see and my first move is to call Control while I assemble an oxygen mask with my other hand. “Guys, I need a vehicle as soon as, don’t divert it, this job will go purple.” Because we don’t say “die” in front of the patients or their families. His face is s chalky grey, his lips blue. I don’t bother to count his respiratory rate since I can tell you it’s “too many breaths a minute”. Lying flat on the bed wont be helping, so I chivvy him up a little. “We need to sit you up, pal, c’mon.” He lifts his shoulders and scooches up the mattress an inch or so. “No, no, more than that, really sit up.” I grab his arm and, in a manoeuvre that would have any man... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4265797 Thu, 16 Dec 2010 05:09:42 +0100 4265797 http://www.medworm.com/index.php?rid=4253145&cid=t_92383_88_f&fid=38129&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Flifeinthefastlane%2FWZHV%2F%7E3%2F-yuBTYrkPas%2F Today working at triage there was a buzz about our paramedics, with there service announcing that from next year it will be rolling out iPads to all on road paramedics and transport officers to use as a patient care record system. (Source: Life in the Fast Lane) Life in the Fast Lane blogs http://www.medworm.com/rss/comments.php?id=4253145 Mon, 13 Dec 2010 08:58:24 +0100 4253145 http://www.medworm.com/index.php?rid=4253178&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1369 “Male, seizure, local church.” I shake him awake, the whisky fumes barrelling off him like stampeding cattle. Seizure my arse. “Hello, Willy.” “Hello, sir.” “You pissed, Willy?” “Yes, sir.” “Can you walk?” ” I think so.” “Off you pop, then.” - Male, CVA, bus stop outside local church. I shake him awake. “Morning, Willy.” “Morning, sir.” “You pissed, Willy?” “I’ve had a seizure.” “Really?” No facial, oral or extremity trauma, no post ictal stage, no incontinence. “You sure about that? Because last time I found you like this, you were pissed.” “Fair enough.” “Can you walk?” “No.” We pi... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4253178 Sun, 12 Dec 2010 16:30:10 +0100 4253178 http://www.medworm.com/index.php?rid=4249073&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1392 Snow on the ground and rimming the edges of the road like an expensive martini, we”re running wihtout systems to a simple fall when Qismet slows. “RTA, mate…” I look up from my paper and reach for the radio. Two cars stopped in the carriageway, their hazards flashing. Between them a small, organic crumple in the road. “The f. is that…?” Too small to be an adult, but the wrong shape to be a kid, we approach. One of the drivers is pulling a tarp from his boot while the other starts explaining. “It just ran out, I skidded a bit…” Long golden coat, full tail and lips pulled up from his teeth in more of a grin than a grimace. But crimson blood pools in his mouth and his vermillion lips are torn and bruised. “I think he’s de... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4249073 Thu, 09 Dec 2010 01:22:36 +0100 4249073 http://www.medworm.com/index.php?rid=4237916&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1368 Did you notice that it snowed a little? It may have passed you by, if you’ve been living in a cupboard for a week. Its been challenging, I’ll give you that. On the first day it dumped on us, the carpark at station was effectively impassable. Patient Transport vehicles were snowed into their spaces and the paths in between were thick with the stuff. We’re supposed to be on the councils ploughing list, but something went wrong and they missed us, concentrating on keeping “the arterial routes to schools and hospitals open” without apparently working out that ambulances still need to get to those arterial routes in the first place. In the absence of a plough, we instead jumped into ambulances and drove around and around and around, smashing the snow banks up a... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4237916 Sun, 05 Dec 2010 17:29:58 +0100 4237916 http://www.medworm.com/index.php?rid=4151826&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1359 I’m off to Abu Dhabi this morning to cover the F1 Grand Prix on Sunday, you can keep up with what we’re doing at www.twitter.com/kalshassan - in the meantime, here’s a guest post from an old friend, Reemie. Confusion or Catharsis? I am sitting in Kal’s flat drinking beer, not long after his return from ADDC 2010, when I jokingly say “I had my ‘first time in an Ambulance’ piece all written – and did I get the nod? No, you just went and did it all yourself, didn’t you. Git.” And now, about a week later, here I am, sitting with the lap-top, actually writing it. Why am I writing it? To be perfectly honest, I don’t know; it’s not something that I’ve ever told anyone and there’s no obvious reason why I should possibly start ... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4151826 Wed, 10 Nov 2010 06:54:56 +0100 4151826 http://www.medworm.com/index.php?rid=4133760&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1357 Back on station the story has got round faster than cholera in a french public toilet, the LA on duty sniffs the air as I walk past. “Can anyone smell shite…?” I laugh. “I’ll take shite on my shirt over a dead bairn, mate.” “Wouldn’t we all, pal?” Twenty hours later I’m driving to work with a blazing hot fizz in my blood, I turn my music up louder as I drive, sing along with the windows open, waving and smiling at folk in traffic who stop to stare. My arms twitch and effervesce, the grin cracking my face again and again, my soul flooded with a ferocious, victorious joy. It’s the exact antithesis of this guy. Then I had an ache that chased me for days and drove me to read war poets and write and rewrite until, my thoughts distilled, I sat on my bed and wept. And t... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4133760 Thu, 04 Nov 2010 21:47:47 +0100 4133760 http://www.medworm.com/index.php?rid=4133761&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1356 Beth can’t stand up. It hurts too much. The warm bath helped her contractions, relaxed the ache in her back and fooled her into thinking things were calming down. Her Mum’s on the landing with us, her kids downstairs in the living room - they waved Penfold and me down as we pulled into the street. This is baby three, pregnancy three. She’s had no problems before, but her middle one was big and she ripped a little. Other than that, the pregnancy’s been normal. And still is. When she contracts (which she’s doing every couple of minutes) I have a look at the business end. She’s on her hands and knees on the stairs which makes any kind of view tricky, though I’m confident it’s more comfortable for her. Beth is not a small lady and her size isn’t making my exam any more str... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4133761 Wed, 03 Nov 2010 12:33:46 +0100 4133761 http://www.medworm.com/index.php?rid=4121891&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1354 I’ve already rung the bell a number of times - it’s not a normal bell, but one of those computerised systems whereby only the flat that has been dialled can open the door. It’s a heavy, metal door with double glazing set in. I’ve seen one of these smashed in once, it stayed intact and the entire frame fell in with it. Bubble and Poppet pull up in a double crewed ambulance and watch me ringing the bell with amusement. “No answer?” “Nothing.” “Control just sent us a message, she’s deaf, we’ll need to phone them to get her to let us in.” Bubbles sinks, her shoulders slumped. “This is going to be a nightmare.” But Poppet has a plan. “Kal can do sign language.” He knows this because I was telling hi... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4121891 Sun, 31 Oct 2010 22:27:10 +0100 4121891 http://www.medworm.com/index.php?rid=4105715&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1353 He was crossing the room and fell. Just fell to the floor and lay there. She tried to pull him up. He was heavy, fat. Not many tatties rolled off his plate. She sat and fretted. What to do? Twenty minutes passed. She phoned her brother. He came and together they pulled at his arms. Pulled him up to sitting. He fell back each time. Didn’t even try. Always was a lazy f.er. Even when he was young, he’d never help himself. Her brother phoned for an ambulance and the three of them came in. Two men and a woman. A laugh. One man and a laddie and wee girl. Not old enough to button their breeks. They shook their heads at him on the floor. The granular black vomit on his face like overboiled jam. Or crumbling bitumen in a roadside summer. The laddie sat down on the pouffe and folded hi... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4105715 Sun, 24 Oct 2010 21:00:50 +0100 4105715 http://www.medworm.com/index.php?rid=4097996&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1352 Early morning is a good time to drive fast, like that anonymous driver who hoored it through Paris streets one sabbath, scattering croissant shoppers left and right and alarming passing street cleaning machines. He had the right idea. And I’m thinking of him as I drive to the job, my speedo nudging nearly three times the limit on the streets. I’m also wondering if I can second guess the satnav, it seems to want to take me a route around the houses, while I’m sure there’s a road running north/south that would take me off the main drag and into the estate directly. I’m fortunate that I remember the small matter of the canal and how I need to be on the other side of it before I let my oh-so-cleverness screw up my day. I’m thinking about all these things. But mostly I’m thi... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4097996 Fri, 22 Oct 2010 18:26:41 +0100 4097996 http://www.medworm.com/index.php?rid=4077285&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1351 He came to the door when we called his name. Dezzy lifting the letterbox gingerly with a pen, holding his face away from the hole. Pally taught me to handle a dangerous front door, the Ambassador taught him, now I’m standing on the landing behind Dezzy, passing on the skills. “Kal, he’s got a knife….” The burred edge of my shears are sweaty against my fingers, heavy and reassuring. Dezzy backs up to stand beside me as the door opens. Ever the gentleman, Dezzy is polite - “Can you show me your hands, please?” He lifts both hands away, a short vegetable knife in one of them. I’m too antsy around knives for manners - “Drop it. Now.” He does so. “Now kick it in the corner.” He complies, shrugging. “Ah’m no causing any hassle….” - Later, sat in the li... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4077285 Mon, 18 Oct 2010 12:10:23 +0100 4077285 http://www.medworm.com/index.php?rid=4077286&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1350 The conversation continues in the comments with vigor, so I think it might be time for facts. The job occured in a church, during a mass and we assessed the patient in the pews before removing him to the ambulance. The priest was not requested by the patient or his family. He decided that he should be in the back of the vehicle. As far as “dying” is concerned - if we take 0% to be perfectly healthy and well and 100% to be sign-the-form-and-call-for-the morgue-truck then this patient was at 75&. He was very unwell, but relatively stable with it. I was confident our treatment would reverse his condition, assuming there were no delays in delivering that treatment. If I was preparing to declare him dead, I would have welcomed the priest in to deliver the last rites, recognis... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4077286 Sun, 17 Oct 2010 11:56:06 +0100 4077286 http://www.medworm.com/index.php?rid=4065385&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1347 A man sat on the roof of his house as flood waters rose around him. A local man in a dinghy rowed past and offered to rescue him. “No, no,” said the stricken man “God will save me.” The flood waters rose higher and a larger boat from the Fire Service sailed past, neighbours crammed onto its benches. “Room for one more, sir.” offered the firefighters. “Not at all…God will save me.” And still the flood waters rose. Eventually the man was perched on top of his chimney pot, the waves lapping at his feet. He was freezing, soaked to the skin and feeling very sorry for himself when a helicopter hovered overhead and lowered a ladder to him. He waved them away, shouting over the thud of the blades. “I’m fine…God’s going t... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4065385 Wed, 13 Oct 2010 14:28:06 +0100 4065385 http://www.medworm.com/index.php?rid=4060629&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1346 “No contact 48/24” tells me this is a death, the family haven’t seen him for a few days and came to the door this afternoon to check that he was ok. He wasn’t. The name and date of birth are all we’ll need to declare him “life extinct” on the form. A conversation with a stoic sibling - “We all knew this was coming…” - paints a rough watercolour background of his medical past, the images slopped haphazardly, pushed for time. A history of alcohol and its ugly sisters, seizures and DTs. An entire life and death reduced to six lines of administrative detail. (Source: Trauma Queen) Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4060629 Tue, 12 Oct 2010 16:30:13 +0100 4060629 http://www.medworm.com/index.php?rid=4040585&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1336 Adopt a “kit dump” attitude. My military colleagues have check lists for dealing with ambush and IEDs. Their protocol is somewhat similar to ours, it includes things like “ensure comms” and “Make sure no c.’s shooting at you while you’re trying to bandage up the leaking people.” But last year I spotted Booker’s protocol included “establish kit dump”. The idea being that whenever you’ve finished using something, you throw it towards one designated place. I first used it for this kid when I knew I wouldn’t have time to concentrate on counting gear back into the vehicle. I subsequently did the same thing here when I was scared we’d leave vital equipment in the dark. And latterly I’ve started doing it at ... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4040585 Thu, 07 Oct 2010 22:43:16 +0100 4040585 http://www.medworm.com/index.php?rid=4013214&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1337 Drawing up a syringe of dextrose straight out of the bag is a nightmare with a blunt-fill needle - once you put the bag down it flops over and pisses sticky syrup over everything. Next time, cannulate the IV port on the bag with the biggest cannula you’ve got, remove the sharp and leave the plastic tubing in place, with the cap on the drug port. Hey presto, easy access dextrose that won’t dribble everywhere and leave you with that feeling of “my boots won’t unstick from the patient and also, is he now hyperglycaemic or did we just take a finger prick through a layer of pure candy floss?” (Source: Trauma Queen) Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4013214 Tue, 28 Sep 2010 14:20:48 +0100 4013214 http://www.medworm.com/index.php?rid=4002902&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1342 “D/C A/E 4/7 prev, penicillin and flucoxacillin…since then failure to comply with meds. Genital abscess not improving.” Well, no shit. His excuse was genius - “I can’t take the tablets.” “Why not?” “Because I’m meant to take them four times a day, starting in the morning.” “And….” “And I don’t get up until twelve o’clock. I can’t take the tablets while I’m asleep, can I?” “Have you considered waking up earlier?” “Nut.” “Why not?” He adopts the mannerisms of someone explaining something very simple to an even simpler child. “Because I don’t get up until twelve o’clock.” I’m halfway through counting to ten when his mobile rings; failing to excuse himself, he answers it with a grunt. “Aye…the ambulance guy’s here ... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=4002902 Sun, 26 Sep 2010 13:42:50 +0100 4002902 http://www.medworm.com/index.php?rid=3999014&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1341 Sunday morning. “Male collapsed in park” Early enough to be still drunk from last night, one of the city’s most popular nightspots shining at the top of the road like a quest’s end in a stella fuelled fairytale. Barbour jackets, the three of them, husband, wife and some breed of complex gun down, though I’d bet this one’s never tasted feathers in its life. “He was over there…but he’s gone now.” Well, yes, because sure as shit the man’s drunk and has woken up and gone somewhere more appropriate….like, you know, bed? “I’d imagine he’s moved on, sir.” He sucks air through his whiskers. “He looked very ill.” My scale of “very ill” is rather different from most. When I describe people as “very ill”, they’re unlikely to have the faculties or ... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3999014 Fri, 24 Sep 2010 19:07:40 +0100 3999014 http://www.medworm.com/index.php?rid=3983411&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1339 In my breast pocket I carry a Moleskine reporters notebook. Black covered and austere, it’s corset of elastic black strap holds it shut or at a particular page. I use it for work, flipping it open to record patient details. Currying information from people is important and during your technician course you’re taught to collate a full medical history from someone while holding a pleasant conversation. This way, patients don’t feel interrogated and you wind up with the information you need. On the Response car, however, one doesn’t always have the luxury of such time and you need to log those details at speed in order to handover to your supporting crew. Alternatively, if there’s a delay in getting transport to you, an awkward silence can be avoided by studiousl... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3983411 Sun, 19 Sep 2010 10:33:13 +0100 3983411 http://www.medworm.com/index.php?rid=3976512&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1334 “So what’s the problem with the kid?” We’re horsing up the road in the Neonatal Transfer vehicle, a transfer team riding with me. An hour’s drive away a tiny person needs moving from one hospital to another. “Six weeks prem, born five days ago and hasn’t pooed since. He’s vomiting bile and we’re worried he’s malrotated.” “Surgery?” “Probably. We need to CT him first. Once we get him in the scanner the surgeons’ll make their mind up.” “What does he weigh?” She shuffles papers on her lap. “950 grammes.” I blow my cheeks out. “Can they operate on someone so small?” “Can do. It’s not without risk. He’ll probably end up with short gut syndrome.&#8... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3976512 Fri, 17 Sep 2010 06:59:45 +0100 3976512 http://www.medworm.com/index.php?rid=3957929&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1335 A cute trick I learned today. Need a sheet of sterile plastic for, say, sucking chest wound or to cover exposed entrails? Slice open a bag of fluid and apply the interior face of the plastic to the wound. Clean, sterile and already wet and non-adherent. Dingledy-damn, that’s smart. (Source: Trauma Queen) Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3957929 Fri, 10 Sep 2010 16:02:44 +0100 3957929 http://www.medworm.com/index.php?rid=3935811&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1327 I’ve mentioned that we’re running on electric bikes this year, they’re a God-send when you hit a hill, or find that every junction you have to inch through is on red, knocking off your momentum everytime you stop. They’re lovely and tasty. But next year, I want one of these. They’re only $78,000. Anyone? (Source: Trauma Queen) Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3935811 Mon, 06 Sep 2010 08:51:33 +0100 3935811 http://www.medworm.com/index.php?rid=3929251&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1332 An ambulance passes, rolling to the hospital. Shall we sneak inside and see what’s going on? In the vehicle a heavily intoxicated woman lies on the trolley while a paramedic sits opposite her. Their conversation runs thus: “D’you love me?” “I don’t love you, no. I’m your paramedic.” “Stop! Stop the car! I wanna get oot!” “I know, we’re nearly there. Don’t touch your seatbelt.” “I’m starving.” “What do you want to eat?” “Coffee.” “How’s about steak and chips?” “Nawwww! Radge…” “Ok. What then?” “Yerra f.in’ radge…..gizza kiss?” “Away!” “Ah’m gorgeous! Will you love me in th... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3929251 Fri, 03 Sep 2010 09:56:10 +0100 3929251 http://www.medworm.com/index.php?rid=3924921&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1293 I’ve just collected my dinner, salad and fruit, my sessions at BMF encouraging me to eat a little healthier - not through some holistic weight loss plan, more that I resent paying someone to beast me and I’m not prepared to piss the sweat, pain and cash away by eating crap. The car’s indicator ticks patiently while I wait to turn right across traffic when the phone rings, I extend a finger from where my left hand rests on the gear knob and press the green button - the despatcher’s voice comes through the speakers. “Kal? I need you on a cardiac arrest in PalaceHill, double Tech crew making from the ED.” “Got it.” I pull the RRU back into traffic, pushing the “999″ button on the dash that makes the Carnation system light up - halo... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3924921 Wed, 01 Sep 2010 19:56:27 +0100 3924921 http://www.medworm.com/index.php?rid=3891691&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F8%2F22%2F4611219.html I would like to start with an apology. A little while ago, I asked the question 'What is it that makes an ambulance'. I then went on to inform you that the only equipment that an ambulance requires is a defibrillator and a bag-valve-mask. I may have made the suggestion that this shows the priority that the LAS has on patient care. But I must apologise, for I made a mistake. You don't need the defibrillator. ----- Yes, on my final shift I found myself on an ambulance without a defibrillator, going to calls of elderly patients with chest pain. Then our tail lift stopped working, so there was no way to use the stretcher. We we refused our request to go 'unavailable' in order to return to station in order to get replacement kit. So the last shift continued my tradition of trying to give good h... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3891691 Sun, 22 Aug 2010 19:01:07 +0100 3891691 http://www.medworm.com/index.php?rid=3889104&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1328 Late last week I was crouching by a young woman by the side of the road, wiping blood from scrapes and grazes. She’s wiped her bike out against another and come off the loser. The other bike had taken off, having confirmed that she wasn’t going to call the police. Chivalry is not dead. While we were sitting there waiting for the ambulance a young man in a pink teeshirt walked past, stopped, looked and approached my patient. “Excuse me? Would a puppet cheer you up?” And from his bag he produced a kick-ass, foam headed muppet with googly eyes and waggly ears. It was (and bear in mind, I used to operate some cool puppets) a f.ing awesome puppet. My patient was extremely cheered up by this, not only the puppet itself, but by the sheer loveliness of this stranger. So it ... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3889104 Fri, 20 Aug 2010 20:53:33 +0100 3889104 http://www.medworm.com/index.php?rid=3880889&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1326 So I’m standing on a street corner with my bike, giving directions to lost tourists and trying to stop the local kids from switching the lights on. Suddenly, down the hill, two cops come careering past and “dynamically deploy” me to a job. “Might need you, mate.” Fair enough, I swing onto the bike and free-wheel down the hill while a police van hammers past me on the right hand side. A total of six cops hair down a wee alleyway between two shops at gather at the foot of a flight of stairs in a small courtyard. “What’s the issue?” “Disturbance call…but they say he’s smashed some glass, so there might be an injury too.” I look up at the building, a traditional Edinburgh tenement. Well kept, clean courtyard, one window sm... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3880889 Wed, 18 Aug 2010 11:38:59 +0100 3880889 http://www.medworm.com/index.php?rid=3868759&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F8%2F16%2F4605964.html I've not been writing because I've been incredibly busy of late, working my normal LAS shifts (my last shift is on Friday, three more to go and, yes, I'm counting the hours), plus the paperwork for my new job (currently filling out the second Criminal Records Check form because I was sent an out of date one earlier), as well as all the normal stuff that keeps us busy, like laundry and shopping and making sure my Sky+ box doesn't get filled up with too many programmes. Hopefully this will all soon change, giving me more time to put finger to keyboard. ----- I've been talking to a lot of people about my upcoming change in jobs to the local hospital - both ambulance and nursing staff, and the thing I've noticed is that sometimes people just don't get on. For example - I explain to one of my a... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3868759 Mon, 16 Aug 2010 10:53:53 +0100 3868759 http://www.medworm.com/index.php?rid=3848893&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1325 There aren’t many stories to tell you, on account of how I’ve seen few patients of note. My days are full, currently, of organising the Parabike and its coverage for the city centre. Last year we ran a bike through the crowds of the Fringe and Edinburgh Festival and it worked in a big way - this year we’re pushing it a little further. There’s awesome new equipment like electric bikes that pull you up the hills, pocket GPS transmitters that tell Control exactly where we are and a lights/siren system that parts crowds like a shit covered tramp with poor personal space awareness. Sinky, another paramedic, is working alongside me so I get to share the shifts this year. The city centre bike has always been my baby and now that it’s growing up, I have a whole rang... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3848893 Tue, 10 Aug 2010 10:16:43 +0100 3848893 http://www.medworm.com/index.php?rid=3848889&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F8%2F9%2F4600273.html 'Male, collapsed in street - cannot see if he is breathing'.Once more I found myself speeding towards a drunk in the street. It's *always* a drunk in the street, except of course on the one occasion when we don't whizz to scene - then they will be dead.The Sod's Law of collapsed or deceased patients.Like many of the drunk calls, we also had the information that 'caller will not approach patient', of course not, because the 'possibly dead' person is drunk, smelly, and possibly violent. That, after all, is why we are called to wake them up and move them on.In this case however, it was much more reasonable, the caller was a CCTV operator.So we rolled up and found our man snoring gently in the middle of the pavement. Hopping over the fence between us and the patient I went up to him and woke h... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3848889 Mon, 09 Aug 2010 14:32:52 +0100 3848889 http://www.medworm.com/index.php?rid=3822947&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1324 A night out with friends, including dinner suspended from a crane in the middle of Princes Street Gardens, cocktails afterwards and a giggly ride home on the bus. Then flip open the headlines to catch up and feel my stomach shiver. “Three children found dead in Edinburgh blast.” The crack and whine of the job flying over my head is nearly audible, while I sat in my living room playing video games and drinking tea, my friends and colleagues from all three emergency services were handling something unspeakable. Raise your glass, or mug, to families of those lost and the others who pick up the pieces. (Source: Trauma Queen) Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3822947 Wed, 04 Aug 2010 21:03:13 +0100 3822947 http://www.medworm.com/index.php?rid=3816430&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F8%2F3%2F4595465.html I recently had my last ever night shift, I would have written abut it earlier but the effects of the shift work had basically knocked me on my arse and made me incapable of doing anything except sleeping and dozing on the sofa. It was, ultimately, a not unusual shift - no jobs that leapt out as being anything out of the ordinary. My first job was to a woman who was intensely isolated because of her being unable to speak English, the only person she knew was her daughter who has a full time job. We were called because the woman was 'behaving strangely'. We arrived with the police to find her crying on the floor. We did the only thing that we could do, take her to hospital to see a psychiatrist. It was handy to have the police there, because initially the woman wanted to refuse to come, but ... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3816430 Tue, 03 Aug 2010 19:46:00 +0100 3816430 http://www.medworm.com/index.php?rid=3794817&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1323 Off the back of my recent post about stress responses, I found myself the only HCP amongst a host of volunteer first aiders recently. As a team we’d managed and packaged the sort of patient that gave me the shivers, the type of patient who clearly thinks that they’re dying, asks if they’re dying and I am unable to answer honestly. Volunteer first aiders train for this sort of thing to an extent and I have to say that the group I found myself inadvertently leading were slick and proficient. They did exactly what I said when I said it and stopped when instructed to do so. They performed tasks that were far beyond what they anticipated on their first aid duty. One held a young man’s head in her lap and told him he’d be fine, to just keep breathing and try to relax. Another was imp... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3794817 Tue, 27 Jul 2010 22:30:41 +0100 3794817 http://www.medworm.com/index.php?rid=3790727&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F7%2F26%2F4588466.html To whom it may concern, I wish to resign from my post as an EMT-3 in the London Ambulance Service. If possible I would like to go onto a bank contract so that I may work the occasional shift. I would appreciate it if you could tell me my last working day as soon as possible as I am moving elsewhere in the NHS and they would like to know the earliest date that I can start. Many thanks in advance. Brian Kellett ----- I handed this letter to my immediate boss today. People who follow me on Twitter will have already heard that I have a new job, one that I'm due to start in approximately one month. In one month's time I shall be going back to nursing where I am taking a post as an Urgent Care Nurse Practitioner at Newham hospital. I've been led to this by a number of factors, a majority of thin... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3790727 Mon, 26 Jul 2010 13:41:00 +0100 3790727 http://www.medworm.com/index.php?rid=3772250&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F7%2F20%2F4582872.html The NHS White Paper is out and I've read pages and pages of analysis, although I'm yet to read the White Paper myself. It's sitting in my reading queue waiting to be read. The big change is the PCTs who currently 'purchase' healthcare will go the way of the dodo to be replaced by 'consortia' of GPs. The thought being that GPs know better the needs of their community. While I am sure that there are plenty of conscientious, well trained, thoughtful and management minded GPs out there, certainly in my part of London they seem a bit few and far between. As an example, my crewmate and I were sent to a patient who had seen the GP who had thought that she might need hospital treatment. The patient was described as 'ambulant'. She was 'ambulant', in that she had walked to the GP surgery - at least... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3772250 Tue, 20 Jul 2010 09:08:10 +0100 3772250 http://www.medworm.com/index.php?rid=3762926&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F7%2F17%2F4580786.html You would think that it is pretty obvious what us ambulance people do; pick up sick people, treat them and then take them to hospital.If you've read this blog over the last few years you will have realised that we do much more than that.It's why I carry a Swiss army knife, because more than once I've been called to fix something.The other day I had one of the weirder calls, it was sent to us as 'Having heart attack because of two boxes'.Needless to say this piqued our interest.We arrived as scene quickly, after all it was a 'Cat A' call and so be there in eight minutes or be a failure - but we were also the quickly as the address was just around the corner to the station.Once the patient opened the door we recognised her, I'd say all LAS and half of the Police force in the area would have ... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3762926 Sat, 17 Jul 2010 15:54:00 +0100 3762926 http://www.medworm.com/index.php?rid=3753849&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F7%2F14%2F4578080.html It would appear that the radio system that the LAS uses has been in the news of late - claims that it doesn't work in the rain, or that vehicles are without radios. Or vehicles use the 'Airwave' standard, a digital network shared by, amongst others, the police. We have a main set that is fixed to the ambulance and should have two handsets that we carry everywhere with us. I can only talk personally, but in my experience the radios are often a bit flaky (but remember that this is a system that was forced on us by the government), but not any flakier than any digital phone network. The problem is that they are digital, if they have a poor signal then they just refuse to work, unlike the old VHF analogue radios that would transmit, although over a load of static. With analogue though the huma... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3753849 Wed, 14 Jul 2010 11:01:15 +0100 3753849 http://www.medworm.com/index.php?rid=3750073&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1320 We held a blanket around her like parents at the beach while she shook and shimmied her soaking jeans and knickers to her ankles. A twist she never thought she’d dance You hit the floor with a thud and while I dropped a towel over you to protect your young Dad’s shining eyes, I was praying you were a clot like that one time. But I knew you weren’t. I knew what you were. Experience does nothing to soften these. No dark red, sharp edged flesh. No slices and angles. Your surfaces smooth and soft like a sea-pebble in my pocket. You are entirely contained within your form. You’re a shining, translucent red, bright and vigorous as a childhood jelly. We’d giggle as it slurped and farted lusciously from its mould onto good china, off-white with pale yellow flowers painted on the ed... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3750073 Tue, 13 Jul 2010 20:57:09 +0100 3750073 http://www.medworm.com/index.php?rid=3737059&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1319 Business over, standing about like the father of the bride at the wedding - we’ve handed over our charge.  We were *it* for an hour, everything that the weeping parents in the room held dear rested in our hands and now we’re extra baggage.  We confirm with the team in resus that there’s nothing further we can do, I apologise to one nurse for snapping at her.   We sidestep the parents for now.   As we walk back to the ambulance there’s a lot of physical contact, shoulders punched and clapped.  We make a laughing show of wiping our damp palms before shaking hands and nodding - “Good job, thankyou.”    The contact unifies us, reinforces the “us-ness” of the team.    We are three, we dealt with something horrible.    It’s still... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3737059 Fri, 09 Jul 2010 03:52:54 +0100 3737059 http://www.medworm.com/index.php?rid=3729892&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1315 This is the fourth time I’ve met you and, if I’m right in my estimations, the fourth “fee-yoncy”. I doubt you remember me. I recall the first lassie, sixteen and ODing on paracetamol. She avoided eye contact with everyone in the room while you pulled your arm tighter around her shoulders and chided her for being “shy”. The second was blonde, I think. I forget her details, but remember the black eye how you smeared her nose into her upper lip. Number three was hanging off your arm at the ED while you shouted at the staff because they wouldn’t pay for a taxi home. And this one, dumpy and brunette, skipping about you in her panties while I try and take an ECG, pulling football socks onto your stinking feet, kissing your belly while she recites your date of birth like a nurser... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3729892 Tue, 06 Jul 2010 13:05:10 +0100 3729892 http://www.medworm.com/index.php?rid=3724455&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F7%2F4%2F4570607.html So... What is it that makes an ambulance? What sort of equipment do you think needs to be on a vehicle for it to be classed as an 'ambulance'. You'd probably think that it would need a stretcher, a carry chair and some sort of medical equipment. Perhaps something to take blood sugars, blood pressures and tracings of your heart. Maybe it would need something to deal with broken limbs, a board to strap you to if the crew thought that you had a broken neck and maybe even some drugs to treat conditions such as asthma, heart problems and allergic reactions. You might also expect bandages. You would, of course, be wrong. We have had the official memo from one of our Assistant Director of Operations. To be a working ambulance you need... 1) A vehicle which passes the legal requirement of basic ... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3724455 Mon, 05 Jul 2010 01:56:18 +0100 3724455 http://www.medworm.com/index.php?rid=3724457&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1317 The fireys have folded away their cutting gear, the traffic cops have swept up the glass and I’m standing in A&E writing in my notebook, taking notes of names and ages. Dezzy and I were first on scene, before the call even came in, the car smashing head first into a victorian stone wall. Three patients, two trapped, one critically injured. The untrapped girl screamed at me to give her “a f.ing painkiller” to address her broken foot. The rear seat passenger was blacked out and gurgling. The driver pinned to her seat by the steering wheel folded against her pelvis. By the end of the incident I was swapping numbers and details with police and fire chiefs. The driver four times the limit, I dropped into resus to confirm her address and was about to leave when she calle... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3724457 Sun, 04 Jul 2010 15:24:45 +0100 3724457 http://www.medworm.com/index.php?rid=3718421&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1318 Mako and I worked together on an ambulance for the past few days, both of us laughing like school kids when we saw our names together and realised that we wouldn’t be split up to “share the paramedics around”. Everyone else on shift had at least one para on their vehicle, no double tech crews on at all. There’s a fantastic symbiosis that comes about when neither crew member is watching the other one. Things just….happen. Examinations and investigations get done without you asking, you think to yourself “I wish I had a…” and it appears, magically, in your colleague’s hand - he having thought the same thing and jogged to the vehicle. And when we had jobs that needed both of us to muck in and Get It Done, whoever was occupying the attendan... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3718421 Thu, 01 Jul 2010 21:01:03 +0100 3718421 http://www.medworm.com/index.php?rid=3714218&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1314 Back in January I wrote for the BMJ about the phrase “trust me” and this afternoon I found myself using it in an unfamiliar way. With most patients I use “trust me” as, in honesty, a pacifier/dummy. Here, take this and suck on it for a bit while I get on with fixing you. Your panic and stress are getting in the way, your endless questions and frantic messing about your keys, your jacket, how you’ll get home, whether we’ll drop you. I’m pretty good at what I do. We’re all pretty good at what we do. But I’m not allowed to say “wheesht, you, I’m busy saving your life”. So instead we say “Trust me”. And they do. That’s not entirely true. They pretend to. That’s their part of the bargain. I say &#... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3714218 Wed, 30 Jun 2010 20:13:30 +0100 3714218 http://www.medworm.com/index.php?rid=3710582&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1313 The downside of the RRU is that you can find yourself in a situation that sounded quite benign over the phone, but on arrival is far from it. I’m here for a male with chest pain, but as soon as I’m in the house I realise that the caller, as one might, has failed to mention that he and his housemate live in a smack den. The floor is thick with rubbish, a TV blares in the corner between two corpulent sofas, both with putrid sleeping bags on them, crawling and shivering over their sweaty plasticky skins like kicked dogs. The table in the centre of the room is scattered with candles, tin foil, blackened tea spoons and the wrappers from syringes. I’m cautious, placing my feet and gear only where I can see it’s safe and reassured by the solid bump in the small of my back as my Magli... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3710582 Tue, 29 Jun 2010 23:15:46 +0100 3710582 http://www.medworm.com/index.php?rid=3702958&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F6%2F28%2F4564678.html It's never a good sign when your patient has her knickers around her knees. ----- 'Woman in Labour - outside newsagent shop'. So far, so boring - another maternataxi job, walk on walk off, baby arrives a few hours after the end of our shift. No sweat. My crewmate is driving, blue lights to do a job of a taxi, when a minicab swerves across the road and pulls in front of us. "Oi! Can't you see the lights!?", shouts my crewmate - we are used to the crazy drivers of Newham (especially the minicab drivers) but this one really takes the biscuit. "Erm... That's our patient", I say. In the rear of the minicab that is parked across our nose is our patient, her husband and her two other children, both under the age of six. I hop out of the ambulance and walk to the back of the cab. Inside our patien... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3702958 Mon, 28 Jun 2010 04:48:30 +0100 3702958 http://www.medworm.com/index.php?rid=3690857&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1312 “Four year old male, fallen from bike, smashed head open.” I power up and down the road looking for the little body on the floor, the blood on bystanders’ hands, the frantic waving. They’re standing on the kerb, the wee boy rubbing his leg. Nettle stings. He fell from his bike into a patch of nettles. They stung his legs and face. “Which hospital will you take him to?” asks his Dad. I suggest a trip to the chemist, a tube of anti-histamine cream and maybe an ice creamto make things better. He phones his wife, already driving at speed to Paeds A&E. I’m writing in my notebook, take his son’s name, his age, his address. “What’s his date of birth?” He smiles at me, sideways. “Ummm…” I give him a minute before running out of patience. “Ok. What MONTH was... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3690857 Thu, 24 Jun 2010 07:26:27 +0100 3690857 http://www.medworm.com/index.php?rid=3690853&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F6%2F23%2F4560831.html Role Models In the final part of my series of whinging, moaning and general grumpiness I'd like to look at the one thing that road staff truely have no-one to blame except themselves. Where are our role models? It took Mary Seacole, Florence Nightingale and others like them to start to drag nursing up from it's roots as a 'Doctor's Handmaiden' into a profession of it's own. Likewise you have Sir Robert Peel and his effect on policing, Elizabeth Fry and her prison reforms and countless scientists from Gallelio up to Prof. Brian Cox and Dr. Ben Goldacre. So, who is the role model, the innovator, the spiritual leader of the ambulance services? Josh from Casualty - a fictional character? What name do we think of when we, as a profession, ask ourselves - who is the paragon of ambulance work, wh... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3690853 Wed, 23 Jun 2010 12:48:00 +0100 3690853 http://www.medworm.com/index.php?rid=3683639&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1310 Win-Stone raises an interesting question in the comments below. “While I understand that you sometimes have to see and do horrible things - and you know that you have every sympathy, I would be intrigued to know what your readers regard as the worst job………. The poor, oft derided and underpaid Emergency Services Worker who has to deal with things like PLE (shovels optional) - or - The poor, oft derided and underpaid Emergency Services Worker who has to go and tell Mammy/Wife/Children that Daddy/Hubby is not coming home again - ever.” Thoughts, folks? (Source: Trauma Queen) Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3683639 Mon, 21 Jun 2010 16:25:17 +0100 3683639 http://www.medworm.com/index.php?rid=3683638&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F6%2F21%2F4558740.html Continuing training Medicine and the paramedical sciences are constantly developing, there is new research and new products that we need to learn about. We also need to refresh skills that we might not have used in some time. For example, I don't believe many babies, other crews deliver loads. I don't have many calls that could be classed as 'trauma' other crews are 'trauma magnets'. Meanwhile there are crews that perhaps don't have the same number of 'social care' issues that I do. So it is essential that we have continuing training in order to learn new stuff, and refresh ourselves on the stuff we don't do that often. Until very recently there were essentially no continuing training courses for road staff, at least none that I have ever been made aware of (and in this instance, not knowi... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3683638 Mon, 21 Jun 2010 11:02:00 +0100 3683638 http://www.medworm.com/index.php?rid=3679770&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1309 He came in as “Male on ground, query dead” and I floored it, the heavy back wheels of the car swinging around corners behind me as I screamed into the rural outskirts of the city. The road surrounded by looming shrubs and trees, the occasional dog walker stepping sideways onto the verge, pulling the leash tighter to the hip as I fly past. En route the phone rings and the controller updates me - “Kal, I’ve got a crew making too, they’re going get there before you, we’ll keep you going just in case. Police update says they think he’s fallen.” I’m on scene shortly afterwards, a police van closing the road I’m aiming for, the cop waving me along, pointing me down into the dark. Two traffic cars and a panda, plus the ambulance parked up, lights blinking in the darkness. I ... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3679770 Sun, 20 Jun 2010 20:42:24 +0100 3679770 http://www.medworm.com/index.php?rid=3676662&cid=t_92383_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fmedication-safety-and-ambulance-chasing-lawyers%2F2010.06.18 I don’t know about the rest of you medical bloggers, but I’ve been getting emails from folks who run a website called DrugWatch.com asking for reciprocal links and promoting themselves as the go-to place for patients to get up-to-date information on medication safety. Tucked into the website is this promise: “We will never accept advertising from the pharmaceutical industry.” Right. Because the whole site is a front for a bunch of Orlando lawyers trying to sniff out potential clients for medication-related lawsuits against the pharmaceutical industry. (more…) *This blog post was originally published at The Blog that Ate Manhattan* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3676662 Sat, 19 Jun 2010 01:14:18 +0100 3676662 http://www.medworm.com/index.php?rid=3662690&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F6%2F15%2F4553886.html There are two important parts of training, that of the initial training that you have to do and the other being the continual development, refreshment and assessment of our skills that should be constant through our career. Initial Training The LAS is a place where you never quite know the skill level of the person that you find yourself at the scene of an accident with. In part this is due to the varied training programmes that you have in order to be employed by the service. For instance, I was trained in sixteen weeks. I was sat down in front of a Powerpoint presentation while a trainer read out what was on the screen. We also had to practice some physical skills - the use of a carry chair and CPR were just two of those skills. There was very much a 'systems' approach to my EMT educatio... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3662690 Tue, 15 Jun 2010 12:25:03 +0100 3662690 http://www.medworm.com/index.php?rid=3658974&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F6%2F14%2F4553039.html On this blog I've often moaned about things that the government does that makes our job more difficult, less effective and worse for patients. A large part of this being the clinically irrelevant Orcon target of reaching a large number of our patients within eight minutes. This target chasing has led to what I consider to be a number of very bad decisions from our upper management which has resulted in low staff morale. However, I've endlessly banged on about these problems and I'm yet to see any change. What I haven't done is look at the role that us road staff have to play in this situation. Our own personal morale is crucial in our own development, without some 'get up and go' we are happy to remain where we are. Turning up at the start of the shift, doing twelve hours work, and then at... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3658974 Mon, 14 Jun 2010 11:54:00 +0100 3658974 http://www.medworm.com/index.php?rid=3655615&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1308 I look up at Turismo and mouth the word “thrombolyse!!!!” at him (my facial expression adding the exclamation marks) and his eyes widen with mine. We draw masks over our faces, calm and professional, friendly and reassuring as we load the patient onto the chair and begin to roll him down the stairs. Dezzy has the handle at the back, I’m lifting the front wheels, Turismo following behind with the oxygen bottle and tubing snaking over the patient’s shoulder and into his non-rebreather. Turismo tells me later that he only hears what happens next, that he sees nothing, but hears me shout: “Pete?” Then, anxious. “Aww, f.!” Followed by a thick, fleshy thud as I punch the patient hard in the chest. Pete’s head swings uselessly at the end of his neck while his limbs stutter fo... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3655615 Fri, 11 Jun 2010 15:57:32 +0100 3655615 http://www.medworm.com/index.php?rid=3648528&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F6%2F10%2F4549502.html As I was reading my Twitter feed before my shift started I noticed something. Loads of my fellow London Ambulance people were talking about intubation. I had no idea why. It only took me a while to hear the rumour, then manage to get back onto station, then find on the internal website the bulletin that they were all talking about. ----- Since the start of Paramedic training, one of the things that has been a main thrust of their qualification is the skill of intubation. Intubation is the passing of a plastic tube into a patient’s airway in order to breathe for them. This protects the airway from becoming blocked and, more importantly in CPR, prevents vomit from entering the lungs thereby buggering any chance of successful resuscitation. The bulletin is entitled ‘The future direction o... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3648528 Thu, 10 Jun 2010 10:46:00 +0100 3648528 http://www.medworm.com/index.php?rid=3644785&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1307 Spring sunshine pulls families from their houses - on a scabby corner of grass at the end of a terrace an extended family flip fatty burgers on a barbecue, smoke spitting in the air, pasty white chests flexing in the sun for the first time in months. Our patient is round the corner. Turismo has arrived already, his motorcycle at the kerb on its sidestand. We grab our defib before heading up the stairs, the motorcycle (like my parabike) doesn’t carry a full cardiac monitor. The patient’s called for chest pain, so we’ll need the extra kit to take an ECG The door carries scrawls of magic marker graffiti and the stairs are dirty, the paint flaking and tired, shreds of carpet clinging to old nails. Dezzy is a few paces ahead of me as we walk into a living room, the curtains drawn ... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3644785 Tue, 08 Jun 2010 18:32:36 +0100 3644785 http://www.medworm.com/index.php?rid=3635825&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F6%2F7%2F4546937.html What do you mean you aren't watching 'Chronicles of EMS'? It's a show about EMS, and it's by EMS people and it is really rather splendid. And now there is a competition! For they are very close to being picked up by 'proper' TV. (I'd enter but I haven't had an original thought in years... Also I don't like flying and I already have an iPad) ----- So here is the big news! We need your help. Over the past few months our esteemed creator/director/producer and all round good guy, Mr Thaddeous Setla, has been meeting and pitching to TV Executives across many of the networks in America, and whilst they all really like what we are doing, they want to see a change to the name ‘Chronicles of EMS – The Reality Series’ What we need from you is your creative thoughts on a new name for the show. ... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3635825 Mon, 07 Jun 2010 11:02:00 +0100 3635825 http://www.medworm.com/index.php?rid=3635828&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1306 I’m checking in at reception, delivering my lines - I’ve never seen the screen that the receptionists use to check patients in, but I’ve learned the order in which I get asked the questions - Surname, date of birth, gender, first name, address, GP, next of kin, complaint”. The order of business is so ingrained in my head that, several months ago when I took Amber’s kid Dan to A&E (and swore I wouldn’t let on what I do for a living) I blew my cover in the first moment by asking first to “check in, please” and then rattling through his details without being asked. Silly Kal. Today, however, I’m checking in a middle aged woman with a whole bunch of diffuse (and frankly, not very interesting) symptoms, none of which is sufficiently a... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3635828 Sun, 06 Jun 2010 19:59:41 +0100 3635828 http://www.medworm.com/index.php?rid=3625468&cid=t_92383_87_f&fid=36050&url=http%3A%2F%2Fblisstree.com%2Flive%2Fer-congestion-new-program-may-reduce-hospital-wait-times%2F photo: Thinkstock Waiting in the ER is the worst. Whether you’ve sprained an ankle or just feel under the weather and don’t have insurance, if you’re a low-priority case, you could wait all day (or night). So Louisville Metro Emergency Medical Services has launched a program aimed at eliminating unnecessarily long waits in its ER waiting room. When patients call 911, the dispatcher directs the lowest-risk cases to a nurse. The nurse evaluates the person’s symptoms and determines if they need a trip to the ER, or a different course of treatment. The goal of the program is to reduce costs and provide better patient care. While we’re all for initiatives to reduce wait times in ERs, we can’t help but wonder what would happen if someone doesn’t adequate... Breastfeeding 1-2-3 blogs http://www.medworm.com/rss/comments.php?id=3625468 Wed, 02 Jun 2010 21:27:10 +0100 3625468 http://www.medworm.com/index.php?rid=3617835&cid=t_92383_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fdo-speeding-ambulances-save-more-lives%2F2010.06.01 How fast should an ambulance go? The stereotypical speeding ambulance with lights flashing and sirens blaring is the image that most conjure up. But recent data suggests that transport speed may be overstated. In a fascinating piece from Slate, emergency physicians Zachary F. Meisel and Jesse M. Pines examine that very question. They cite a recent study from the Annals of Emergency Medicine, which concluded that a fast transport speed didn’t necessarily save lives. (more…) *This blog post was originally published at KevinMD.com* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=3617835 Tue, 01 Jun 2010 14:00:49 +0100 3617835 http://www.medworm.com/index.php?rid=3617850&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1281 The radio rings and I slide it from its metal clasp on the dash. “303?” “303 go ahead.” “Got a job for you, CCTV report a male lying on the grass outside the cathedral in The Neighbourhood.” I cast my eyes over the heaving crowds outside my windows. Shorts, ice-creams, RayBans. “On a day like today? Never!” There’s a robotic chuckle over the speaker. “You want to make cold?” “Ta.” Eschewing lights and sirens I filter into traffic, slide down the Bridges and find my way to the cathedral. There’s a coffee booth here that Turismo often parks his motorcycle at, large stone sculptures sit heavy and squat on the paving slabs. I hop out of the car and peek over the flower beds at the man. “You alright buddy... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3617850 Tue, 01 Jun 2010 02:16:36 +0100 3617850 http://www.medworm.com/index.php?rid=3617848&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F5%2F31%2F4541858.html For the past four or five months I have been coasting at work. It's not really my fault, it's just that none of my patients have been... challenging. I've been going to a seemingly endless supply of patients who either do not need an ambulance because their 'illness' is so minor, or have had such simple problems that helping them doesn't require much in the way of thought. I haven't had to 'blue light' a patient into hospital for this period. And so I find myself settling into a fug of relaxed 'easy jobs'. Nothing much requires thought and, for many of my calls all I need to do is a set of basic observations and write down a name and date of birth. It seems to last forever, being able to walk through my workday without having to think, without having any worry. It makes the days go very sl... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3617848 Mon, 31 May 2010 21:05:00 +0100 3617848 http://www.medworm.com/index.php?rid=3603624&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F5%2F27%2F4538541.html Someone tried to assault me on Sunday - an alcoholic who was brought into hospital drunk, then sat outside to continue her drinking. She then decided to wander off home while still attached to and IV, IV bag and drip stand. Another crew came across her and were trying to deal with her but already had a patient in the back of their ambulance, so we decided to help out and take the 'patient' back to the A&E department to have the IV removed. As I was waiting to chat to the nurses about her she because louder and aggressive and I told her to behave - she then threw her mobile phone at me. I call that 'refusing treatment', so I removed the IV and, in an armlock, marched her out of the department and told her to 'go away'. There is paperwork to be filled in, but honestly - what is the point... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3603624 Thu, 27 May 2010 10:34:46 +0100 3603624 http://www.medworm.com/index.php?rid=3592241&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F5%2F24%2F4536102.html As is my wont, I often find myself moaning about social care, or rather the lack thereof. We were sent to an elderly man who had fallen over, the police had already arrived and had gained entry to the address and by the time we go there they had already picked him up and sat him on the end of the bed. We did our usual checks, and a few things were a little 'off'. For example his ECG showed a chronic heart condition that may have been the cause for him to collapse. The patient didn't want to go to hospital, he'd only recently returned home after an extended stay there. As I've mentioned in the past, I'm not actually allowed to kidnap people against their will. So, I made sure he understood the risks of remaining at home - "You could die", I told him. "That's fine by me", he replied. But we ... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3592241 Mon, 24 May 2010 08:52:00 +0100 3592241 http://www.medworm.com/index.php?rid=3581556&cid=t_92383_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2010%2F05%2F20%2Fheatwave-plan-for-england-protecting-health-and-reducing-harm-from-extreme-heat-and-heatwaves%2F Title: Heatwave plan for England: protecting health and reducing harm from extreme heat and heatwaves Skinny: Aims to enhance resilience in the event of a heatwave. It is an important component of overall emergency planning. Publisher: DH Size of Publication: 47p. Published: 23/03/2010 Filed under: Ambulance Services, Emergency Planning, Grey Literature, Hospitals, NHS, Primary Care, Strategic Health Authorities, Strategic Planning Tagged: Climate, Disaster Planning, Emergency Planning, Environement, Grey Literature, Heatwave, NHS, Strategic Planning (Source: Fade Library) Fade Library blogs http://www.medworm.com/rss/comments.php?id=3581556 Thu, 20 May 2010 04:01:57 +0100 3581556 http://www.medworm.com/index.php?rid=3581557&cid=t_92383_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2010%2F05%2F20%2Fnhs-emergency-planning-guidance-the-ambulance-service-guidance-on-dealing-with-radiological-incidents-and-emergencies%2F Title: NHS emergency planning guidance: the ambulance service guidance on dealing with radiological incidents and emergencies Skinny: Describes the role of NHS ambulance trusts in planning, preparing and responding to radiation incidents and emergencies involving irradiated and contaminated people. It provides a strategic framework for local planning and links to resources that ambulance services may find useful. Individual services will need to draw up plans appropriate to their locality. Publisher: DH Size of Publication: 48p. Published: 23/03/2010 Filed under: Ambulance Services, Emergency Planning, Grey Literature, NHS Tagged: Ambulance Services, Contanimation, Decontanimation, Disaster Planning, Emergency Planning, Grey Literature, Radiation, Strategic Planning (Source: Fade Library) Fade Library blogs http://www.medworm.com/rss/comments.php?id=3581557 Thu, 20 May 2010 03:57:34 +0100 3581557 http://www.medworm.com/index.php?rid=3581558&cid=t_92383_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2010%2F05%2F20%2Fnhs-emergency-planning-guidance-planning-for-the-development-and-deployment-of-medical-emergency-response-incident-teams-in-the-provision-of-advanced-medical-care-at-the-scene-of-an-incident%2F Title: NHS emergency planning guidance: planning for the development and deployment of Medical Emergency Response Incident Teams in the provision of advanced medical care at the scene of an incident Skinny: Best practice guidance to National Health Service (NHS) organisations in developing and deploying Medical Emergency Response Incident Teams (MERITs). It builds on the guidance given in the underpinning section of the NHS Emergency Planning Guidance: immediate medical care at the scene. The purpose of a MERIT response is to provide advanced medical care on scene at a range of emergency incidents, up to and including major and mass casualty incidents. Publisher: DH Size of Publication: 12p. Published: 23/03/2010 Filed under: Acute Services, Ambulance Services, Emergency Planning, Grey Li... Fade Library blogs http://www.medworm.com/rss/comments.php?id=3581558 Thu, 20 May 2010 03:52:41 +0100 3581558 http://www.medworm.com/index.php?rid=3581561&cid=t_92383_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2010%2F05%2F19%2Fproposals-to-introduce-prescribing-responsibilities-for-paramedics-stakeholder-engagement%2F Title: Proposals to introduce prescribing responsibilities for paramedics: stakeholder engagement Skinny: This stakeholder engagement exercise invites thoughts and opinions on proposals to extend non-medical prescribing responsibilities to paramedic practitioners. The exercise will help to shape a formal consultation later in the year, which will ultimately inform recommendations to Government Ministers on whether to extend prescribing to paramedics. Publisher: DH Size of Publication: 36p. Published: 22/03/2010 Filed under: Ambulance Services, Grey Literature, NHS Tagged: Ambulance Services, Grey Literature, Non-Medical Prescribing, Prescribing, Stakeholder Engagement (Source: Fade Library) Fade Library blogs http://www.medworm.com/rss/comments.php?id=3581561 Wed, 19 May 2010 19:07:15 +0100 3581561 http://www.medworm.com/index.php?rid=3573713&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F5%2F18%2F4531524.html I've been doing a fair amount of transfers between hospitals of late. Which is why this article on the BBC news site struck me a particularly timely. Unnecessary risks are being taken when transferring seriously ill people from hospital to hospital, doctors say. But British Medical Association doctors said medics often had to rely on batteries to power vital equipment - and these were prone to failing. Most ambulances do not have sockets for standard three-pin plugs. Instead, they have cigarette lighter-style sockets, which means hospital equipment such as ventilators, blood pressure monitoring and intravenous drug equipment cannot be plugged into the vehicle's power supply. Doctors transferring patients are therefore required to connect the equipment to batteries. Newer ambulance... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3573713 Tue, 18 May 2010 08:30:00 +0100 3573713 http://www.medworm.com/index.php?rid=3560258&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F5%2F13%2F4527735.html Two police officers had to be cut free from a police car that was involved in an accident on its way to a 999 call this morning. The car was going to an emergency call when it was involved in an accident with another vehicle at shortly after 5.05am. The accident happened at the junction of New City Road and Barking Road. Police, fire and ambulance officers attended. The two officers in the police vehicle received leg injuries in the accident and were taken to Newham General Hospital. The driver of the other car was unhurt, said a Scotland Yard spokesman. I hope that every involved makes a full and fast recovery. I would wager that I've been on more than one job with the officers involved. We've had two FRU's have similar accidents at that corner, it's a blind junction with one stop li... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3560258 Thu, 13 May 2010 07:26:39 +0100 3560258 http://www.medworm.com/index.php?rid=3552271&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F5%2F11%2F4526389.html Nice - Can me and my crewmate have a £10,000 budget please? I could do a study into why our ambulances rarely have a complete set of equipment on them. Or, you know, I could just spend the £10,000 on buying the kit. An ambulance service has apologised after staff were asked to rate how "cool" Adolf Hitler was in a questionnaire. The survey was sent out to 4,000 employees at West Midlands Ambulance Service (WMAS) as part of a £10,000 study to identify what made good leadership. Respondents were asked to rate how "cool" 10 famous leaders were on a scale of one to five. Besides Hitler, the list included Gordon Brown, Richard Branson, Winston Churchill and Fabio Capello. A WMAS spokesman apologised for any offence caused. He said: "At the end of the day, Hitler galvanised a nat... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3552271 Tue, 11 May 2010 13:45:00 +0100 3552271 http://www.medworm.com/index.php?rid=3549335&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F5%2F10%2F4525379.html It's night and myself and a policeman are leaning against a front garden wall, my crewmate is in the ambulance cab doing some paperwork. If this were a TV drama one of us would be casually smoking a cigarette in order to show the audience how cynical and hardened we are. We are outside a squat, opposite a school. The windows are boarded up and so was the door, but the people living inside managed to pry them off and sneak some mattresses into the building. There were two people living inside, now there is only one. He was found on the floor, laying on his mattress, nothing else in the room apart from a small vial of what appeared to be drugs. The room is freezing and there is no electricity for lights. The other man who lives in the house called us because he found his friend unconscious a... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3549335 Mon, 10 May 2010 10:19:47 +0100 3549335 http://www.medworm.com/index.php?rid=3529810&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F5%2F4%2F4520660.html It's a simple little rule really, one that I learnt in training school. 'If they are drunk and have fallen a long way, collar and board them'. It sounds simple, but there is a world of difference between what should be done and what can be done. My current chappie was drunk which, to be honest, was probably a normal state of affairs for him. He'd taken some imagined offence at the person living upstairs from him (for this was the classic Newham housing scheme where a landowner converts a perfectly nice house into eight or nine one bedroom flats). He'd staggered upstairs and been banging on the other person's door - then when the door was answered had become aggressive. The flat owner had given him a push and our drunken patient had stumbled backwards and fallen down the stairs. The person ... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3529810 Tue, 04 May 2010 10:06:00 +0100 3529810 http://www.medworm.com/index.php?rid=3508207&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F4%2F27%2F4515130.html The two women sit in the pub drinking heavily. One of them puts down the phone having called for her husband to come and walk her home. She turns to the other woman and says, "I've going to have a laugh on the way home". "How's that", the other replies. "Well, I'm going to get halfway home and then 'discover' that I can't walk. So I'm going to throw myself on the floor and roll around like a two-year old having a temper tantrum". "Won't that get you dirty?", the other woman says. "Well, yeah, but that doesn't matter. I'm then going to wail at the top of my lungs - I won't be talking, just grunting groaning and making a noise." "Sounds like fun", says her friend. "That's not the best bit, because then someone is going to call for an ambulance, but not until after I've dug my fingernails int... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3508207 Tue, 27 Apr 2010 08:14:25 +0100 3508207 http://www.medworm.com/index.php?rid=3499093&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F4%2F22%2F4511807.html Sometimes the eyes are blue, sometimes brown, sometimes green. But almost always the eyes are reddened and damp with tears. Sometimes they are male, sometimes female, sometimes old and sometimes a child. But they've always been hurt. Sometimes it's bruises, sometimes it's cuts, sometimes a broken bone, sometimes something much worse. Sometimes I talk to them, my crewmate hovering outside the door, police in the house talking on the radio. Sometimes I'm the one standing in the doorway, teeth clenched and hands balled into fists as I listen to the tale being told. The police collect statements, photograph injuries, protect evidence. They provide support and safety, they listen to the litany. I hear them on their radios, this is the third time they have been here, the fourth, the fifth. Somet... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3499093 Thu, 22 Apr 2010 21:17:00 +0100 3499093 http://www.medworm.com/index.php?rid=3494322&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F4%2F21%2F4510942.html I'm often sent to a patient who has 'collapsed', sometimes this is due to a genuine medical condition - something like a heart attack, a stroke or diabetic problems. Often this is due to alcohol - the location and calltaker details often gives it away - the patient is in the street and the person who phoned for the ambulance cannot give us any details because they 'don't want to go near the patient', that or they are phoning for us from a bus or car. 'Drive-by calls' are normally for drunks in the street. Often homeless drunks who speak very little English. The final sort of 'collapse' that we are often sent on is the pseudo-collapse. This is a person who has not actually collapsed per se, but instead is pretending to be unconscious. Sometimes they will also pretend to have a seizure. As A... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3494322 Wed, 21 Apr 2010 20:39:00 +0100 3494322 http://www.medworm.com/index.php?rid=3463622&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1242 Trauma Queen serves a number of purposes. Primarily it is here to entertain, inform and educate. It keeps me writing, has me flexing creative muscles from time to time. And occasionally it serves as my personal catharsis. When I come home from a shift and have images in my head that I need to expunge and file away somewhere else. When I’ve witnessed violence, depravity and deprivation. When I need a beer and a mate. Sometimes I pour it out here and share it. Your comments do me wonders. Sometimes, though, I write about events that happened months ago. Privacy dictates that a certain amount of time must pass before I report events that could otherwise be identified through the media. These events are often traumatic, unpleasant. But they don’t upset me. They may have done at... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3463622 Tue, 13 Apr 2010 08:33:14 +0100 3463622 http://www.medworm.com/index.php?rid=3460183&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F4%2F12%2F4503463.html I've just spent longer than I'd like to think in deleting spam from this blog. While I do like the simplicity of the Blogware system, it isn't the world's best at filtering out spam. I wish there were a way of turning off the comments to an article automatically after a month or so. As it is I've turned on moderation for comments that the Blogware system thinks is spam and decided to not allow HTML in comments any more. Sorry if this annoys you but I have better things to be doing with my time than clicking through and deleting spam. ----- I've been utterly fed up for the past week or so - I shouldn't have, because I've been busy for much of my five days off work. I took my mum to see 'Priscilla - the musical' for her birthday, and it was superb. The day day we dragged her around London Zo... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3460183 Mon, 12 Apr 2010 14:38:42 +0100 3460183 http://www.medworm.com/index.php?rid=3436275&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1240 We’re hardly in the living room before his mother tries the magic words. “I want him sectioned.” My colleagues in the police complain about “I want him charged.” The public struggle with understanding that these are not processes that they can order like pizza. The police can’t just turn up and charge somebody. We can’t just show up and section somebody. But we don’t have to. Because the nineteen year old guy in the armchair is begging us for help. He tells us that his mother pulled him out of rush hour traffic, that she won’t let him home to his high-rise flat, that he’s not allowed in the kitchen because of the knives. He tells us about his daughter’s funeral the week before. He shows us and the police the text messages... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3436275 Sun, 04 Apr 2010 01:19:07 +0100 3436275 http://www.medworm.com/index.php?rid=3424881&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F3%2F31%2F4493995.html Comrades! Feel glory in the wonderful opportunity that central government has given you. Your inability to reach the required number of 'Amber' calls in the mandatory time has resulted in a new and innovative plan to allow intellectuals to shine. We are to cut your budget by £1.6 million, thus allowing you to 'think smarter' in order to reach these same goals in time for next year's auditing. As that cute white kitty says 'hang in there baby' for while some of the proletariat may see this as a 'punishment' rest assured that this is no such thing. By cutting your budget we will enable innovative practice to flourish. By placing this obstacle in the path of providing world class healthcare we will be 'evolutioning out' poor ideas and this burning of the forest of old ideas will enable new s... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3424881 Wed, 31 Mar 2010 11:35:13 +0100 3424881 http://www.medworm.com/index.php?rid=3424883&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1241 Sitting in the RRU base just up the road from my flat and things have been steady all night. A glassing that occured yards from my door, a collapse or two. Nothing to weigh on my mind. I’m sufficiently chilled that I’ve taken some time to break out my Open University stuff and am sat at a table, coffee to one side of me, making models of esters and amides and pretending I’m an evil scientist in an underground lair. This is easier than it sounds. The lighting in the RRU base is crap. The phone rings and a colleague answers it, hanging his head back around the partition. “OD/Cardiac arrest round the corner, Kal. I’ll go if you’re studying?” I sweep the balls and sticks and textbooks into my jump bag, I’m reaching the point of educational saturation anyway. “I’ve got it.... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3424883 Wed, 31 Mar 2010 05:11:00 +0100 3424883 http://www.medworm.com/index.php?rid=3416058&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F3%2F29%2F4492495.html Here we go... Ambulance service gets £38 for every patient they don't take to hospital Patients' groups expressed horror at the "sick experiment" in which NHS managers have agreed to pay £38 for every casualty that ambulance staff "keep out of Accident and Emergency" (A&E) departments after a 999 call has been made. The tactic is part of an attempt to manage increasing demand for emergency care amid failings in the GP out-of-hours system. Documents seen by The Sunday Telegraph disclose that staff at Britain's largest ambulance service have been encouraged to maximise the organisation's income, by securing payments for diverting patients to telephone helplines. The bonuses are among dozens of schemes being tried out by ambulance trusts across the country as they attempt to impro... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3416058 Mon, 29 Mar 2010 14:43:00 +0100 3416058 http://www.medworm.com/index.php?rid=3390781&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F3%2F22%2F4486284.html 'More Blood, More Sweat and Another Cup of Tea', is about to be released in what is called 'Mass Market' edition. This is a cheaper and smaller format of the book - hopefully it'll mean a bump in sales, and therefore a bump in royalties coming to me. It's the same book, just a handier size. It is released on April the first (yes, yes, I know...) and if I may dare to be so bold, would make a lovely gift for your loved ones, neighbours, acquaintances and random people in the street. It's being stocked by Waterstones and Smiths and I'm keeping my fingers crossed that a supermarket or two might pick it up. The last time I pimped my book here it shot to the #1 slot in the pre-order charts and it gave my ego a much needed massage, as well as giving my publisher a smile (which I think he needed, ... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3390781 Mon, 22 Mar 2010 10:00:00 +0100 3390781 http://www.medworm.com/index.php?rid=3390782&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F3%2F22%2F4486267.html When we are called to a drunk in the street we have a number of options open to us. Well, we have four options, but realistically we only have two. Option One Leave them where they are - either they aren't that drunk, or they have friends who will look after them. We don't do this that often as it will only take one of them to then waltz out into traffic and get their fool arse killed to lose you your job. Option Two Call the police. If there is nothing wrong with them then surely we should call the police, after all it's not a medical problem really is it? Realistically, it's the police who call us to get rid of the drunks and one too many death in custody cases means that custody sergeants are loathe to have drunk in their cells. I can't really blame them. Option Three The commonest one ... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3390782 Mon, 22 Mar 2010 09:00:00 +0100 3390782 http://www.medworm.com/index.php?rid=3382776&cid=t_92383_87_f&fid=34935&url=http%3A%2F%2Fmedicine.com.my%2Fwp%2F%3Fp%3D8424 We should not make fun of other’s misfortunes but some misfortunes are just avoidable. This one certainly is! From the FailBlog (via DrAnony) from the Malaysian Medical Resources Ambulance FAIL (Source: Malaysian Medical Resources) Malaysian Medical Resources blogs http://www.medworm.com/rss/comments.php?id=3382776 Thu, 18 Mar 2010 00:00:00 +0100 3382776 http://www.medworm.com/index.php?rid=3374154&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F3%2F17%2F4482633.html It's getting harder for me to blog because I'm trying to not lose my sanity. You see, this blog has been a place for me to tell stories but it has also been a place for me to get angry - to shout about crappy social care, uncaring and criminal nursing homes, the misuse of our service and, indeed, the mistakes that I think the government and our own management have made. But of late I've come to realise that getting angry about things doesn't matter, not really. I can shout all I like, rant and rave, fill in paperwork and publicise things on this blog - and the net result of all that energy, strain and anger is precisely nil. So I've been working on not getting angry anymore about things that I cannot change. No blankets on my ambulance - not my fault. No essential medical kit on my ambulan... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3374154 Wed, 17 Mar 2010 11:35:41 +0100 3374154 http://www.medworm.com/index.php?rid=3350295&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F3%2F10%2F4476539.html The first job of the day was to 'female slipped on ice - police on scene'. I'll admit that, at half past six in the morning my thoughts towards people, actually towards anything, are often less than charitable. 'It's not that cold', I said to my crewmate - although years of working in all weathers mean that I'm perhaps not best placed to judge, 'I bet she's found the one tiny patch of ice in Newham and fell on that'. It's the end of the financial year, and so there are roadworks and temporary traffic lights everywhere, unbeknownst to us there was also a 'fun run' in the area - no-one had told us road staff about it. So it took a fair bit longer than normal to get to the patient. She was stretched out on the pavement and there were four police officers standing around her. As she was partwa... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3350295 Wed, 10 Mar 2010 11:42:00 +0100 3350295 http://www.medworm.com/index.php?rid=3350300&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1232 I’m walking to reception in A&E when a little white coat walks past me at somewhere between elbow and shoulder height. The badge of the medical students, it’s ironic that nowadays the “doctor’s white coat” is only worn by people who are doctors to be, they shed it once they pupate into qualified staff. I say hello as I pass and he squeaks back at me. “Morning.” I laugh and shake my head. “You guys make me feel older every day, Jesus…what year are you in?” “Fourth year.” So he’s twenty-two, but looks younger. Wait. Looks much younger. And short, too. No facial hair, not even stubble. Hang on. “How old are you?” He laughs. “Sixteen.” “SIXTEE…..Oh….hang on….you&#8... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3350300 Wed, 10 Mar 2010 08:55:46 +0100 3350300 http://www.medworm.com/index.php?rid=3342669&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F3%2F8%2F4474750.html I really like I.T - Information Technology, after all I've been using it since I was around eight years old. However, in those thirty years of using computers I'm also fully aware of some of the problems that I.T can make manifest. Especially when you bring in the cheapest contractors, don't supervise them properly, don't consult properly with the people to be using the system and then start cutting budgets halfway through the project. *cough* NHS *cough* I mean, if you can't get contractors who are skilled enough to stick linoleum to the floor, how can you trust your commissioning people to find someone good enough to do invisible and arcane things with computers. Therefore you end up doing daft things like sending letters with confidential information to the wrong people - as, despite wh... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3342669 Mon, 08 Mar 2010 09:39:29 +0100 3342669 http://www.medworm.com/index.php?rid=3342672&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1237 I’m outside the house, juggling defib and response bag onto their respective shoulders when I realise I’ve failed to lock the car. Never mind the morphine…my laptop’s in the front seat. Pulling the key from my pocket it snags on the tourniquet that’s also in there, I tug harder to free it and it leaps, like a beatific tree frog, into the air. Spins, twinkles in the street lights and lands with a “chink” onto the cover of the storm drain by my right foot. Balances. Stays. I’m reaching down to retrieve it, encumbered by the heavy plastic defib on my shoulder, when the key smiles up at me, winks once and arabesques sweetly into watery oblivion. Shit. I grab the drain cover and haul it out of the house, hoping that the key fob has enough plastic... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3342672 Mon, 08 Mar 2010 05:48:44 +0100 3342672 http://www.medworm.com/index.php?rid=3338235&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1236 “30 YOF cardiac arrest” and I’m running fast, the rear of the car stuttering and shimmying through the lights at Tollcross as I push the accelerator a little too hard. One day I’ll find out what happens when I actually floor the gas pedal in this thing. So far I’ve been too scared of it. Thirty year old women shouldn’t arrest, but if they do, we stand a good chance of reversing it. If I get there fast enough. Driving the RRU is, it has transpired, very different from driving an ambulance. A larger vehicle uses its lights to invite other users to make way, to pulll in and allow forward progress. The car has lights too, sure, but its advantage comes mainly from its acceleration and speed to get it through gaps that you’d never consider trying in a ... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3338235 Sat, 06 Mar 2010 16:20:48 +0100 3338235 http://www.medworm.com/index.php?rid=3322379&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F3%2F1%2F4469637.html As I am a complete nerd, I have email alerts set up for various topics spoken about in government. Often I don't have the chance to read them but, being stuck alone on station last night, I had the time and the good luck to read on such discussion. This was a discussion about encouraging people to 'self care' their minor ailments. There was no mention of ambulances, the discussion centred mostly on the role that Pharmacists, GPs and Practice Nurses have to play. After all the government has no idea what us ambulance people do - I'm sure they think we only go to car crashes, heart attacks and the sort of thing you see on 'Casualty'*. ----- Never mind, although I do have one comment to make on the discussion. 'It is worth listing the minor ailments that I mean. They are generally part of e... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3322379 Tue, 02 Mar 2010 02:29:04 +0100 3322379 http://www.medworm.com/index.php?rid=3318403&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1231 Sixteen years old, just round the corner from these clowns a month ago. I shivered when the name of the district came up on my screen - working alone in a Rapid Response Unit I’m supposed to think a little harder before storming into less desirable areas. No mate behind you to watch your back or second set of six senses letting you know that things have turned south. I park up at a six-in-a-block, this corner of the estate small and clear enough for my back-up crew to see the vehicle from the passing road, no need to leave the roof lights and red strobes to guide them in. From the boot I swing the response bag over my shoulders, hopping in place as I tighten the straps to suck the weight into the small of my back. The defib comes next, lifted from its housing on the left hand side. W... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3318403 Sun, 28 Feb 2010 21:11:52 +0100 3318403 http://www.medworm.com/index.php?rid=3294613&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F2%2F21%2F4462361.html It's not May yet, but I'm starting to feel some energy returning to me from over the winter. It's only a little and it's not being directed towards anything useful, but at least it means that the worst of winter is over. Why do I say May? Well it's when there is a spike in suicides from all those winter depressives finally having enough energy to do something stupid. ----- You may ask yourself why I'm thinking about suicide, well it's because of something rather stupid that I did during a recent shift. We'd been to this house before a week or two earlier - the sole male occupant said that he was depressed and that he wanted to kill himself. We'd gone along and had been sent some police assistance in case the patient felt violent. We knocked on the door and the young man eventually opened i... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3294613 Mon, 22 Feb 2010 00:42:00 +0100 3294613 http://www.medworm.com/index.php?rid=3283489&cid=t_92383_87_f&fid=34595&url=http%3A%2F%2Fnhsblogdoc.blogspot.com%2F2010%2F02%2Fdealing-with-meningitis-risk-management.html It was a very busy morning surgery. I was already running forty minutes behind. The second patient I had seen had had an acute psychiatric crisis, was suicidal, and needed a detailed assessment and immediate referral. Getting through to the hospital psychiatric services is never easy. One is usually fobbed off by some junior, medically unqualified, member of the CMHT (see Shocking Psychiatry) who will ask you to fax a referral through and mark it urgent.  This patient was so disturbed that I was determined to speak with the duty psychiatrist which, finally, I did. The fifth patient in, who was three weeks post-heart attack, was short of breath and clearly going into heart failure. Whilst I was examining him, the receptionist phoned to say that there was a couple at the desk who had ju... NHS Blog Doctor blogs http://www.medworm.com/rss/comments.php?id=3283489 Thu, 18 Feb 2010 09:56:00 +0100 3283489 http://www.medworm.com/index.php?rid=3279995&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1229 “Fallen from window” should tingle my spidey-sense, but a second look at the location calms the hairs on my neck. A favoured night-spot in the centre of town, the Mecca for stag nights and hen parties, I imagine a sozzled backwards lean into a ground-floor window seat. Maybe even a drop from the first floor, God’s benevolent palm cradling idiots, drunks and bairns safely to the ground. The falls from height I’ve attended before have snapped ankles, broken wrists, maybe even clattered their heads against the wall on the way down. A collar and board for show, really, until a radiologist can confirm their linguine like spines are intact and here’s-some-Ibuprofen-and-don’t-do-that-again. The message ends with “conscious and breathing”, which stamps it firmly as originating from... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3279995 Wed, 17 Feb 2010 16:18:30 +0100 3279995 http://www.medworm.com/index.php?rid=3271038&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1201 Recent job despatched to my screen. And for those of you who would try, that image is triple protected against you peeking under the blackness to find patient details. Nae chance. (Source: Trauma Queen) Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3271038 Sun, 14 Feb 2010 11:32:20 +0100 3271038 http://www.medworm.com/index.php?rid=3258998&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1228 Nothing to write home, or anywhere else, about. Just an old feller with some indistinct shoulder pain that might, or might not indicate some sort of cardiac origin. Dezzie is running through the standard questions. “Any medical problems in the past?” “No, none.” “And do you take any medication?” Because they ALWAYS say that they’ve never had anything wrong with them and then they ALWAYS have a list of medications that you can reverse engineer a medical history from. You don’t get taught about common medicines on your Technician course. You should do, it wouldn’t be a hard module to drop in, just an afternoon of “Here are a couple of dozen very common drugs that lots of people take, remember them.” It comes with time. Because we’re ignorant about medicines, most of... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3258998 Wed, 10 Feb 2010 12:31:59 +0100 3258998 http://www.medworm.com/index.php?rid=3258996&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F2%2F10%2F4452012.html "I know you like doing that sort of thing", my crewmate said, "but I can do it this time seeing as you are getting old and fat". ----- It was 3am in the morning (as it always seems to be) and we were being sent out of our area, although quite close to where I live, to go and see an elderly woman who had called for an ambulance and seemed a bit confused. Knocking on the front door I could see a hunched shape moving around in the hallway. It came to the door, fiddled around a bit and then wandered away. It's more normal that when people call for an ambulance they open the front door for us.* I tried knocking again - this time the living room window opened and I was suddenly face to face with a little old lady. "I can't let you in, the door is locked and I can't find a key", she waved her arm... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3258996 Wed, 10 Feb 2010 08:19:15 +0100 3258996 http://www.medworm.com/index.php?rid=3251220&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F2%2F7%2F4449955.html A lack of energy from these winter hours, night shifts and a feeling that no matter how hard I shout about things nothing is going to change has meant that I've been lacking the will to write. I keep thinking 'no-one listens', or at least nobody who has any power to change anything.* What I should be writing about is the private ambulance companies that are being contracted to do our A&E emergency work, which is an incredibly bad idea. I should be writing about the utter tosh calls I've been going on of late. I could even be moaning about how our training day was 'postponed' because there is no-one to train us, and even if there was they have no idea how to train us, or what to train us in. I'm sure it's just the season and that, come spring and a bit more energy, I will once more be w... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3251220 Mon, 08 Feb 2010 02:00:30 +0100 3251220 http://www.medworm.com/index.php?rid=3235855&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1226 He lies to the police, claims it was a bar fight. They explain that they’re usually in plain clothes, detectives back in uniform for a busy Saturday night. Where’s the blood on the pavement? On the stair? If you’d walked back from the pub, there’d be blood on the stair. She did it, didn’t she? He sighs, shoulders forward, a crescent slash from his hairline to the top of his eyelid, another pound of force behind it and we’d be packing his ruptured eyeball back into his head and running for the hospital. Instead he nods, apologises for lying, expains he doesn’t want his partner charged. The younger detective fumes and fizzes while the older gives him a gentle talking to about wasting police time. They shut the door and we nash him up to A&E, allowing him a fly fag o... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3235855 Tue, 02 Feb 2010 22:57:02 +0100 3235855 http://www.medworm.com/index.php?rid=3224843&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1225 “So if she can tell the call-handler that her spare key is at number thirty-four, how come she can’t just phone number thirty four and get her neighbour to let us in?” “Maybe the call’s from Careline?” Careline are a faceless entity, a telephone service accessible by pulling a cord, or pressing a panic button. Their voices come, mechanical and shouty, preceded by a squawking tone, through speakers in the corner of bedrooms, halls, kitchens. We shout at the plaques on the wall when our patients contact them, a remote and sterile system for caring for the elderly. I leave Milhouse standing in the street while I nip over to the front door of 34. Her neighbour across the road at 31 is, apparently, in some distress, having phoned three nines. Before we can treat her, we need to ... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3224843 Sat, 30 Jan 2010 20:51:48 +0100 3224843 http://www.medworm.com/index.php?rid=3208411&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F1%2F25%2F4437984.html We had a student with us for the past two weeks. It was her first ever time on a real working ambulance so she had a more than a few 'firsts'. She saw her first dead body. She drove for the first time with the blue lights and sirens. She used the radio for the first time, talking to Control. She spoke to her first patient, calmed her first scared patient. She met her first alcoholic (who was nice) and her second alcoholic (who wasn't). She got cut out of her first car, holding the neck of the driver who'd crashed it. She filled in her first accident report form (neither her fault, nor connected with the previous point). She took her first 'real' blood pressure, her first blood sugar reading, her first pulse and listened to her first chest. She carried her first patient down a couple of fli... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3208411 Mon, 25 Jan 2010 23:39:00 +0100 3208411 http://www.medworm.com/index.php?rid=3201743&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1221 A cutting from my Mum that she found in the Guardian some time ago. I knew some of these, but a number of them were new and made me laugh. Most medical readers will recognise some or all, but for the rest of you: Doctors’ Notes Translated: UBI: Unexplained Beer Injury CTD: Circling The Drain NFN: Normal For Norfolk LOBNH: Lights On But Nobody Home GPO: Good for Parts Only GLM: Good-Looking Mum TFTB: Too Fat To Breathe GOK: God Only Knows TEETH: Tried Everything Else, Try Homeopathy TLR: Two Legged Rat (a patient undergoing extreme or experimental treatment) DBI: DirtBag Index (number of tattoos x number of missing teeth = estimated period in days since patient’s last shower) FLK: Funny Looking Kid NQR: Not Quite Right TUBE: Totally Unnecessary Breast Exam Freud Squad: Psychiatr... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3201743 Sat, 23 Jan 2010 16:43:58 +0100 3201743 http://www.medworm.com/index.php?rid=3185278&cid=t_92383_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2010%2F01%2F19%2Fthe-standard-nhs-contracts-for-acute-hospital-mental-health-community-and-ambulance-services-and-supporting-guidance%2F Title: NHS Standard Contract Acute Services 2010-2011 multilateral (NHS Standard Contract – Activity Plan 2010-11) Skinny: NHS standard contracts for Mental Health and Learning Disability and Ambulance Services.  The contracts support the  NHS Operating Framework for 2010-2011: The contracts should be read in conjunction with the  Principles and Rules for Co-operation and Competition and the PCT Procurement Guide.  The NHS standard contracts cover agreements between PCTs and all types of provider delivering  NHS funded services.  The contract will apply to agreements from 2009-10 for: NHS trusts NHS Foundation Trusts New agreements between PCTs and independent sector providers New agreements between PCTs and third sector providers Publisher: DH Size of Publication: 26p. Pub... Fade Library blogs http://www.medworm.com/rss/comments.php?id=3185278 Tue, 19 Jan 2010 13:13:59 +0100 3185278 http://www.medworm.com/index.php?rid=3185382&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1218 The call had originally listed “17 YOM, allegedly unconscious after drinking alcohol.” En route it updated to “CPR in progress.” We chuckled, picturing the scene vividly. 17 year old laddie gets pissed, falls over. His friends call an ambulance and when the call handler asks if he’s breathing they lean over his face for a whole half second before, panicking, inform them that no, he is not. CPR instructions follow, we arrive and find a very alive patient with sore ribs. Same old story. The job is a long way away, the roads are icy, it’s risky to push the vehicle much faster than 40, however much I’d want to, the back wheels step out on the tighter bends anyway. Kahuna in the attendant’s seat is leaning back against his headrest. “I was j... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3185382 Mon, 18 Jan 2010 23:05:10 +0100 3185382 http://www.medworm.com/index.php?rid=3175890&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F1%2F15%2F4429135.html She's in her late eighties, she has arthritis, sores covering her body and brain cancer. Every movement causes her pain. She's been moved from one hospital to another - all for her own benefit, but she only seems to stay in one place for a few weeks before going to somewhere more suitable. She's getting good care, people are looking out for her, the place where we pick her up from is a nice unit - she's going back to the local hospital because of a new symptom that is causing her pain. We put her on our trolley and wrap her up in our one remaining blanket, I 'borrow' a pillow from the unit. We don't have pillows, neither does A&E. She worries that she has left something in one of the cupboards so, before we go, I make a point of opening all the doors and showing her that they are ... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3175890 Fri, 15 Jan 2010 14:07:00 +0100 3175890 http://www.medworm.com/index.php?rid=3171924&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1219 I’ve mentioned before about stock phrases, little bits of script that we roll out in recurrent circumstances.  The framework of the job (person nae weil, we come along, male them a wee bit better, take them to hospital) means the same issues come up repeatedly.  The experienced ambulance crew will see te same patterns emerging at jobs and second guess them, allaying a patient’s fears before they’re voiced. “We’ll lock up.” “Your neighbour will look in on the dog later.” “You’re not wasting our time at all.” This week I saw a colleague trying to persuade a reluctant gentleman to travel to hospital with us.   BP on the floor, he we struggling to stay awake, let alone stand up.  He was adamant, however, that hospital was an... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3171924 Thu, 14 Jan 2010 00:48:30 +0100 3171924 http://www.medworm.com/index.php?rid=3167061&cid=t_92383_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2010%2F01%2F13%2Fpandemic-influenza-summary-infection-control-guidance-for-ambulance-services-during-an-influenza-pandemic%2F Title: Summary infection control guidance for ambulance services during an influenza pandemic Skinny: Concise summary guidance for infection control for the ambulance services and it is intended for use during the pandemic. The guidance in this document is equally applicable to lay responders, who should adopt the same infection control and hygiene measures.  This guidance document includes sections on patient management, infection control precautions, use of personal protective equipment (PPE) and environmental infection control, as well as occupational health. Publisher: DH Size of Publication: 25p. Published: 08/01/2010 Posted in Ambulance Services, Grey Literature, Infection Control, Influenza, Pandemic Tagged: Ambulance Services, Grey, H1N1, Infection Control, Influenza, Pandemic (So... Fade Library blogs http://www.medworm.com/rss/comments.php?id=3167061 Wed, 13 Jan 2010 10:44:21 +0100 3167061 http://www.medworm.com/index.php?rid=3167145&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F1%2F12%2F4426886.html Queen's Hospital in Romford is closed King Georges Hospital, a bit closer to my station is closed. Whipps Cross hospital remains open for more of the day, but then closes. Newham, Homerton and the Royal London are now the only hospitals in East London accepting patients. ----- Queen's and King Georges being closed in the east means that ambulances local to them are bringing patients to Newham. Crews local to Newham (i.e. me) are being told to take patients to either the Homerton or to the Royal London. I don't know what crews local to the Homerton or Royal London are being to to do. ----- I pick up a patient a stone's throw from Newham hospital, he has chest pain that could be cardiac in nature. I have a bit of job persuading him to come to hospital, but he finally agrees that the... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3167145 Tue, 12 Jan 2010 21:47:00 +0100 3167145 http://www.medworm.com/index.php?rid=3159757&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F1%2F10%2F4425134.html Good News Patients suffering an out of hospital cardiac arrest in London now have more chance than ever before of being resuscitated by staff, according the latest Service figures. The report, published by the Clinical Audit & Research Unit (CARU), also shows the Utstein* survival rate is up to 15.2 per cent from 12 per cent the previous year. So, if you have a cardiac arrest in London (for certain values of cardiac arrest), you have a 15.2% chance of survival. Which is great but won't result in us getting any more funding. Well done everyone involved, and well done to the new CPR protocols - I've personally noticed a difference with the 30:2 compressions. ----- Bad News For the first time in its history the Service has responded to one million incidents in a single calendar year... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3159757 Sun, 10 Jan 2010 18:30:00 +0100 3159757 http://www.medworm.com/index.php?rid=3153398&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2010%2F1%2F8%2F4423475.html We get another one of our bog standard 'nan down' calls. An elderly person, not too spry on their feet has fallen over and needs us to come and pick them up again. The door is opened by her son, two eyes stare at us suspiciously from over a foot long beard. A half smoked cigarette is dangling between his fingers. 'Come in then', he says gruffly then, indicating his mother's bedroom, he disappears into the living room to continue smoking. His mother is on the floor in an awkward position. She's wearing a filthy dressing gown, she obviously hasn't washed in some time and her toenails have grown so long that they have curled under her feet. I'm later told that she also smells. She is in quite some state of neglect. We check her over while she remains on the floor, she's not confused, jus... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3153398 Fri, 08 Jan 2010 15:21:25 +0100 3153398 http://www.medworm.com/index.php?rid=3145999&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1216 One of those nights between Christmas and Hogmanay, nothing much to celebrate but no framework of work and routine to hang oneself from, she swallows pills and vodka. We puzzle over foreign medications, pharmacological mysteries tangled up in Ks and Zs, Ws and Js, a family friend is called to translate, the phone shuttled back and forth between us. I crouch before her and break out my one line of Polish - “What’s your name?” She responds, with a faint smile. Her husband laughs, clapping my shoulder. “You speak Polish!” No, no. Just a few phrases, “What’s your name? Please. Thankyou. Hospital. Pain. Police. Stand up, please. Get up!” They laugh, the police arrive and I become Polish consultant. Spelling names is difficult when your letters ... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3145999 Wed, 06 Jan 2010 08:44:45 +0100 3145999 http://www.medworm.com/index.php?rid=3137512&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1213 We’re already rolling fast when the CBT boops at us, a text message from Control - “Police called back requesting hurry-up.” The original call was for a male fitting, with blood coming from his ear. We’d rolled our eyes at each other; most of these calls come about when someone hits their head and lies on the floor. Wounds bleed downwards and blood frequently settles in the ear canal. There’s a difference between “Bleeding from your ear” and “Bleeding into your ear”. Of course, on the other hand, if you ARE bleeding from your ear canal, that’s a Very Bad Thing Indeed. In what passes for a shopping centre in this concrete corner of the city a crowd have gathered around three police officers and a man on the ground. Standing in th... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3137512 Sat, 02 Jan 2010 21:15:33 +0100 3137512 http://www.medworm.com/index.php?rid=3129515&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2009%2F12%2F30%2F4415939.html With New year's eve night approaching the LAS has put out it's usual call for people to be sensible. Our head of Emergency Preparedness says this, “Alcohol-related calls put extra pressure on the Service, so I’d ask people to be sensible. Every minute that we spend looking after somebody who is simply drunk, is a minute that could have been spent helping a patient who is seriously ill or injured. We want people to enjoy themselves, but they should think carefully before dialling 999. It should only be used for emergencies.” Because. for us - New year's eve is an emergency. Note that he does say what I'd like us to do - "If you call an ambulance for someone who is drunk, or has had their drink 'spiked' (normally their tenth or eleventh pint), don't expect an ambulance, instead e... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3129515 Wed, 30 Dec 2009 12:11:15 +0100 3129515 http://www.medworm.com/index.php?rid=3115109&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1212 We send the cops in first. Any caller who gives our call handlers grief gets police onscene with us. Mako, the two cops and I ride the lift up the eighth floor. I step to the side and let them enter first. One constable shuffles himself to the back of the car. “So you’re by the doors if he’s standing there with a chainsaw…” I flick his vest with a finger. “Isnt that why you’re here?” Joking aside, they take the lead on the landing. The front door is open, Talking Heads’ “Life During Wartime” screaming from a stereo somewhere in the house. There’s a golf club in the hall and he lifts it, I assume to put it somewhere safely out of radge’s reach, but he cunningky uses it to swing the doors open as we stalk through ... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3115109 Tue, 22 Dec 2009 20:41:15 +0100 3115109 http://www.medworm.com/index.php?rid=3111369&cid=t_92383_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2009%2F12%2F22%2Fusing-the-cquin-payment-framework-an-addendum-to-the-policy-guidance-for-201011%2F Title: Using the CQUIN payment framework – an addendum to the policy guidance for 2010/11 Skinny: The Commissioning for Quality and Innovation (CQUIN) payment framework makes a proportion of providers’ income conditional on quality and innovation.   This is an addendum to the Using the Commissioning for Quality and Innovation (CQUIN) payment framework – 2008 guidance that should be read in the context of the NHS operating framework for England for 2010/11 and the national standard contracts for acute, ambulance, community, mental health and learning disability services. These contracts require commissioners to make 1.5% of contract value available for providers to earn if they achieve locally agreed quality improvement and innovation goals and, for acute providers, two nati... Fade Library blogs http://www.medworm.com/rss/comments.php?id=3111369 Tue, 22 Dec 2009 06:51:40 +0100 3111369 http://www.medworm.com/index.php?rid=3108368&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2009%2F12%2F20%2F4408859.html He's ninety years old, ex-army. He's slipped on the ice coming out of his house, we are sent to the call as 'Fallen over, leg is at a funny angle'. We get there, he's broken his leg all right. He's lovely, the family are lovely. He has waited one and a half hours for an ambulance. I am furious. He has been laying on the ice for that long without an ambulance. I've just come from the hospital - the police have been bringing in patients with possibly broken ankles because there are not enough ambulances. ----- Apparently it doesn't matter, as the 'public perception' of the service is high. That doesn't mean we provide a good service - it just means that our PR department is good at making us look good. ----- It's not a hard problem to solve, I can see what it is and I'm on the bottom rung of... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3108368 Mon, 21 Dec 2009 00:46:17 +0100 3108368 http://www.medworm.com/index.php?rid=3100821&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2009%2F12%2F18%2F4407284.html I've not died - my plan was to blog at least every second day, but that has gone for a burton as my internet connection is up and down more times than a *insert metaphor*. I'm trying to get it fixed, but of course that means some time after the bloody waste of time that is Christmas. ----- I must admit that I saw this on the BBC, and thought it sounded somewhat familiar. The government has been urged to review its targets for ambulances responding to 999 calls, following claims that patient care is being affected. The NHS Confederation, which acts for ambulance trusts, said that targets can produce "unintended consequences" and "may not be benefitting patients." Ahem . However Mr Edwards added: "Any narrow target which focuses on one measure does have the potential for producing uni... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3100821 Fri, 18 Dec 2009 16:01:00 +0100 3100821 http://www.medworm.com/index.php?rid=3096796&cid=t_92383_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2009%2F12%2F17%2Fnhs-operating-framework-for-201011-letter-to-social-partnership-forum-and-national-stakeholder-forum%2F Title: NHS operating framework for 2010/11 (letter to Social Partnership Forum and National Stakeholder Forum) Skinny: Letter introducing the NHS operating framework 2010/11 to the Social Partnership Forum and National Stakeholder Forum Publisher: DH Size of Publication: 3p. Published: 16/12/2009 Posted in Acute Services, Ambulance Services, Decision Making, Demand, Equity, Financial Management, Governance, Grey Literature, Health Economics, Hospitals, Inequalities in Health, Management, NHS, Poverty, Primary Care, Quality, Social Exclusion, Social Inclusion Tagged: Access, Deprivation, Equity, Grey Literature, H1N1, Hospitals, Inequalities, Infection Control, Influenza, NHS, Pandemic, Patient Experience, Poverty, Primary Care, Priorities, Quality, Staff Satisfaction, Stakeholder Engagemen... Fade Library blogs http://www.medworm.com/rss/comments.php?id=3096796 Thu, 17 Dec 2009 08:30:38 +0100 3096796 http://www.medworm.com/index.php?rid=3084801&cid=t_92383_101_f&fid=38982&url=http%3A%2F%2Ftraumaqueen.net%2F%3Fp%3D1211 Short handed in resus, I stick around and lend a hand where I can. The charge nurse and I each grab a side of his waistband and tug the patients jeans down. A combination of tight jeans, dodgy knicker elastic and slightly over zealous staff results in the gentleman…falling out of himself. “Oh!” blurts the nurse, “Santa hat.” I laugh.  An odd, but festive and fitting euphemism for the male phallus, I think.  Floppy, red and white, bobble on the end and fluffy bits at the base. Never thought of it in such terms, but, yes, I suppose it fits. She pulls a red and white fluffy hat from a jeans pocket and I point, open mouthed. “Oh!  Santa hat!” She looks at me strangely. “Yeee-eees?” “Nothing.” Exit Kal, resus left, blushing. ... Trauma Queen blogs http://www.medworm.com/rss/comments.php?id=3084801 Mon, 14 Dec 2009 10:10:32 +0100 3084801 http://www.medworm.com/index.php?rid=3084737&cid=t_92383_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2009%2F12%2F14%2Fnhs-ambulance-services-more-than-just-patient-transport%2F This report outlines key examples of how the ambulance service is directly improving patient care through health education, clinical development, delivering care at home and many other initiatives and schemes. Publisher: NHS Confederation Size of Publication: 16p Published: 02/10/2006 Posted in Ambulance Services, Grey Literature, NHS Tagged: Ambulance Services, Domiciliary Care, Grey Literature, Health Education, NHS (Source: Fade Library) Fade Library blogs http://www.medworm.com/rss/comments.php?id=3084737 Mon, 14 Dec 2009 07:30:19 +0100 3084737 http://www.medworm.com/index.php?rid=3084799&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2009%2F12%2F14%2F4403564.html I've mentioned before in passing my call where I was told that 'Patient wants a cup of tea'. An 'amber' call - lights and sirens if you please. Drive down the wrong side of the road as well. Our 'patient' was an eighty year old woman who got up and opened the front door when we arrived. Trying to be as polite as possible I asked her what the problem was. 'My carer hasn't arrived, I need a cup of tea'. My immediate thought was that this patient wouldn't have much problem making her own cup of tea, but I'm not paid to be an occupational therapist, so I kept my opinion to myself. I tried to feel as much sympathy towards this patient as possible. I enquired as to how many times a day she would have a carer, what they did for her, and when the carer was expected. All in all it seemed like a pre... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3084799 Mon, 14 Dec 2009 07:00:00 +0100 3084799 http://www.medworm.com/index.php?rid=3075520&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2009%2F12%2F10%2F4401293.html I find myself going to a lot of 'victims of crime' that are nothing of the sort - people who have been assaulted by 'some bloke', often 'some big black bloke' who has beaten them up for no reason whatsoever. Now, while there is random violence and muggings on the streets of Newham and Tower Hamlets, I rarely see it - often the causes of the injury are blatantly obvious. Normally it's gang activity, or rival drug dealers, or more often X's girlfriend has got off with Y, while X was shagging Z at W's house all because V is T's baby daddy. Or some such. Sure, not everyone is some sort of criminal, but it's so common that Im surprised when I see someone that is genuinely innocent. But, you ask yourself, how do I know who is innocent? Well dear reader, allow me to give you a generic example how... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3075520 Thu, 10 Dec 2009 10:32:00 +0100 3075520 http://www.medworm.com/index.php?rid=3063272&cid=t_92383_101_f&fid=34592&url=http%3A%2F%2Frandomreality.blogware.com%2Fblog%2F_archives%2F2009%2F12%2F7%2F4398994.html Once more I find myself concerned with Capacity and Consent. Capacity and Consent are two linked words that govern how I can treat patients and it always needs to be at the forefront of my mind. Capacity Is the ability for someone to understand what I am telling them and to be able to make a decision based on being able to understand the risks of choices that they make now. Consent is my patient allowing me to do things to them, be that blood pressure measurements, giving them medicine or taking them to hospital. For most of my jobs both capacity and consent are implied - someone calls an ambulance, I arrive, I do certain medical things to them and they do not complain and then I take them to hospital - the patient, for their part goes along with this and everyone is happy. ----- In short,... Random Acts Of Reality blogs http://www.medworm.com/rss/comments.php?id=3063272 Mon, 07 Dec 2009 12:15:00 +0100 3063272