Ambulance Stories (50)

Nothing To See Here

When I started this blog, I used to post a lot of factual stories about events that occurred during my long time working on emergency ambulances in London. But over the years, other categories took precedence, and I began to wonder if there was much more to tell. After all, you can only relate so many tales; some tragic, others amusing, before it all starts to sound like more of the same. But I was thinking back to those days this morning, and this memory popped into my head.

A warm summer evening in west London, probably around 1995, maybe 1996, I don’t remember the exact date. I was on the late shift, starting at 3 pm, and finishing at 11. My regular partner was on holiday, and I arrived for work wondering who I would be crewed with that day. An awkward-looking young man appeared, tall and gangly, with an edgy and nervous demeanour. He asked if I was Pete, and told me he was working that shift with me. I hadn’t seen him before, and it transpired that he was a new guy, recently out of training school, and assigned to the divisional relief rota. He had what sounded like an Australian accent, but when I asked, he told me he was from New Zealand.

As we checked over the vehicle, he was keen to let me know that he was a very experienced first-aider in his home country. He had helped out in the voluntary services there for five years, before coming to live in England. He was quite scornful of our training and equipment, gabbling on about how much better things were in New Zealand, and how the volunteers there were more professional than the staff he had met in London. I could have taken him to task of course, but I had heard all that stuff before, and it was like water off a duck’s back to me. He asked to drive, so he could get to know the area. That meant I would have to spend all my time shouting directions to him, whilst looking after the patients in the back. But I said OK, telling myself that it was only one shift, and it would soon be over.

On the first couple of jobs that afternoon, he drove the ambulance like a maniac, at breakneck speed, stamping on the brakes, and shouting obscenities at drivers who were slow to move out of our way. I sat relaxed in the passenger seat. I had already decided that I was not going to like this bloke, and I wouldn’t give him the satisfaction of arguing with him about his driving. As the evening rush hour began, he hadn’t calmed down, and seemed to be trying to prove a point. I gazed out of the window, seemingly oblivious. Just before 6 pm, we received a call to attend a road traffic accident, not far from the base we operated out of. The radio operator added the words “Believed serious, possibly fatal” after giving us the location. That got him really fired up, and we arrived in record time.

The scene was one of carnage indeed. A woman and female child had been struck by a car as they ran across the road. The child wasn’t moving, and her mother was obviously badly injured too. To make matters worse the car had swerved after the accident and hit a traffic island. The driver wasn’t wearing a seat belt, and had impacted the window, and steering wheel. I jumped out, shouting to the New Zealander to call for another two ambulances, and to request the police and fire service too, all usual in such accidents. At the busy junction, and the height of the rush hour on a hot summer evening, there was naturally a large crowd of onlookers. Traffic was stopped, drivers out of their cars, and people hanging out of nearby windows to see what was going on.

The child, a girl of around ten, was fatally injured, with no vital signs. As well as a massive head injury, her neck appeared to be broken. Her mother had one badly fractured leg, with bones protruding, and she was also bleeding profusely from a head injury sustained when dragged along by the car. Fortunately, she was barely conscious, so unaware of what had happened to her daughter. A witness was telling me that the car hit the girl at some speed, and then ran over her mother, dragging her under the car until smashing into the concrete base of the traffic island below the sign. I put a blanket over the dead child, and proceeded to treat the head and leg injuries on her mother. I shouted to the new guy to check the driver of the car, who appeared to be a teenage boy. An overview of the scene would have looked dramatic indeed. A dead child, lying in a pool of blood, covered by a blanket. A badly injured woman, with a trail of blood, tyre marks, and road dirt leading to where she was lying, as well as a car crashed into a traffic sign, windscreen smashed, and the driver’s face covered in blood.

As I struggled with the woman’s injuries, I listened out for the sirens that would announce the arrival of some help. But there was a delay getting another ambulance, due to a shortage of crews, and the fire engine was having to come from some distance too, which I obviously didn’t know. A young police woman arrived, and I sent her to check the driver of the car, as I couldn’t see my colleague anywhere nearby.
Then, above the noise of the crowd, the passing trains, and the sounds of traffic I heard someone shouting. “NOTHING TO SEE HERE, MOVE AWAY NOW, NOTHING TO SEE HERE”. Recognising the accent, I twisted round, spotting the other ambulance man some fifty yards away, arms outstretched, and gesturing to the crowd gathered on the road. I heard him shout again, “NOTHING TO SEE HERE”, before yelling at him to get his arse back to the scene, and get on with looking after the driver.

Fortunately, two more ambulances arrived, along with the fire service. One crew dealt with taking the child away, and another stood by as the firemen cut the roof off the car, ready to extricate the driver. We could now leave, taking the mother to the nearby casualty department. As we were cleaning up later, I explained to my temporary partner that he should pay less attention to the crowds in future, and concentrate on looking after the patients who have a chance of surviving.

As we got back into the vehicle, I added, “And by the way, you were wrong. There was plenty to see”.

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Ambulance Stories (49)

Saving Lives.

On another blog, I was asked a question by the lovely Kim. That post told the story of how I drowned as a child, and how I was saved by a brave angler standing nearby. She commented there, and went on to see the connection, that my life was saved, and I later went on to work as an EMT, intent on saving lives myself.  It’s a reasonably straightforward question, “How many lives did you save?” It got me thinking, and led me to write this post, which I am including in my category of ‘Ambulance Stories’.

Most people presume that ambulance crews save lives. It’s a fair presumption, and reinforced by scenes on the news media, documentaries on TV, and scenes in films and dramas. The reality of working in emergency ambulances in a big city like London is very different though. Much of the day to day work is dealing with old people who have chronic conditions like Asthma, Heart Disease, Diabetes, and Circulatory Disease. Some have suffered strokes, others have Dementia, or one of the many other debilitating conditions that affect us all eventually. Constant calls are made to the 999 (911) service to attend to these old people, and they live their lives on a merry go round of hospital attendance, admission, discharge home, and back again.

Then there are the inter-hospital transfers. Taking a patient from one hospital to another can take up a lot of your time. These Emergency Transfers are usually accompanied by medical teams, and may be necessary for brain scans, severe burns, or premature babies. Given the distances involved, the preparation of the huge amounts of equipment needed, and delays at each hospital, a job like that could well take up half of an eight-hour shift.

Mental illness is also a huge part of working in emergency ambulances. Persistent callers, disturbed people who cannot cope alone, or are having a crisis. People with suicidal tendencies, or those who self-harm, suffer with Anorexia, or perhaps wish harm to others. With more and more of these patients discharged into the ‘Community’ to fend for themselves, their care has been transferred to calling for an ambulance, at least in the first instance. It is easily possible to do a run of shifts without ever attending what most people would consider to be an actual ’emergency’.

So, almost 22 years, and thousands of emergency calls later, did I actually ever save anyone’s life? Strange that you have to think about it, given the nature of the job. The main remit of the emergency ambulance when I joined was to get people into hospital alive if possible, to be handed over to expert nurses and doctors who then treated them. We had few drugs, and defibrillators were only ‘on trial’ back then. Most of our training was a legacy from the 1950s; bandages, splints, and the administration of oxygen, and nitrous oxide. The accepted practice was known as ‘swoop and scoop’. Arrive as soon as possible, and get the patient into the vehicle as painlessly as we could. Scoop them off the street, and get them to a hospital that was close by.

Over the years, that changed a great deal. New drugs, better diagnostic equipment, and the ability to treat more conditions on scene led to taking more time with the patients, and administering more treatment before leaving for a hospital. Those hospitals changed too. Certain areas developed specialist centres, and we could no longer just go to the one that happened to be the nearest to the job. Protocols and training updated all the time, and the technical aspects of being an ambulance worker became more complicated too, with the crews becoming more accountable for their actions. Today’s emergency ambulances are a world away from those I started on, and the job itself is very different too.

After all that, I have to answer Kim’s question. Did I actually save any lives?

Some, for sure. Recognising a problem that I might have overlooked was definitely a way of saving lives. Placenta previa can be fatal if not spotted and properly treated, so I do recall at least three occasions where that saved someone’s life. Correct diagnosis of a Diabetic coma, often mistaken for someone being drunk and aggressive, that can definitely save a life and was something I managed a few times. Something as simple as getting someone off of their back, so they do not inhale fluid or vomit; this can also save a life, and was something we did all the time. Delivering a baby at home, with all the potential complications for mother and baby. I recall fourteen occasions where I did this, though mostly I just ‘caught’ the baby as it slid out!

On a few occasions, I kept people with serious burns alive, at least long enough to get into hospital for specialist treatment. But whether or not that saved their life, I never found out. Then there is the difficult subject of CPR, which is very often shown as incredibly effective on TV shows and films. In truth, it rarely works, and depends how long the person has been left like that before we arrived. On one occasion, just the one, in all those years, we attended a lady who had suffered a cardiac arrest on an underground train. We just happened to be outside the station at the time, and a fellow passenger who was a doctor had already started CPR. We got the lady into hospital with an output, and she went for emergency heart surgery that morning. She later sent us a letter of thanks, so I can say that we all definitely saved her life.

One evening, I spent a long time sitting on the balcony of a flat at the top of a tower block. The female resident was perched on the ledge, intending to jump. I managed to talk her out of it by telling her how awful her body would look, once it had made contact with the street below. Perhaps vanity saved her life, along with my rather brutal description.

But most of the time, we just did our best. We did what we could, faced with the conditions we found, and using the equipment available. As they say in medicine, “First, do no harm.”

Ambulance Stories (48)

Nostalgia

I have just seen a link posted by a good friend who still works in the London Ambulance Service. It is to a You Tube film, a documentary from 1974. It is a serious current affairs programme from the time, probably from the BBC. I don’t recall seeing it back then, but it was broadcast five years before I applied to join. Despite that, it is incredibly familiar. Many of those featured were well-known to me later on, and I worked with some of them on occasion. It was filmed in London and Yorkshire, but predominantly set in and around North Kensington Ambulance Station, where I worked for over twenty years.

By the time I was there, nothing had changed from how it is shown in the film. I wore the same uniform, used the same equipment, and probably even drove some of the same vehicles. The emergency calls shown in the film are all genuine, and the way they are dealt with is exactly as I would have dealt with them at the start of my career. The interior of the Ambulance station was the same, and the descriptions of laundering the blankets, washing the vehicles, and even cleaning the toilets, all too familiar.

Much of the film deals with the period of transition that the Ambulance Service was going through during the mid-1970s. Where the crews had once been competent drivers, trained only in basic First Aid, they were starting to get the first items of real life-saving equipment, and beginning to be trained to become the professional service we would soon see. They still had employment issues and were receiving pitifully low pay, and these problems were causing dissent, which resulted in strike action. The film is very much on their side, showing them as ordinary people; caring individuals doing their best in the situations they encountered. It is also a wonderful fifty-minute snapshot of England in the 1970s, and makes forty-one years ago seem more like seventy. Hard to believe now, but wonderful to behold.

The uniforms have changed, the vehicles and equipment are different, and the training is in another league. But the job is still the job, and that Ambulance Station is still there, as busy as ever.

Here’s the link. If you know anyone who ever worked in any Ambulance Service, or if they are just interested in fascinating social history, please share it.

Ambulance Stories (47)

PTSD

Post Traumatic Stress Disorder is a subject much in the news these days. It can affect anyone, in a variety of situations; from a soldier returning from a combat zone, to someone who witnessed a bad traffic accident. I found this recent definition of the condition on the NHS website.

The type of events that can cause PTSD include:
serious road accidents
violent personal assaults, such as sexual assault, mugging or robbery
prolonged sexual abuse, violence or severe neglect
witnessing violent deaths
military combat
being held hostage
terrorist attacks
natural disasters, such as severe floods, earthquakes or tsunamis
PTSD can develop immediately after someone experiences a disturbing event or it can occur weeks, months or even years later.
PTSD is estimated to affect about 1 in every 3 people who have a traumatic experience, but it’s not clear exactly why some people develop the condition and others don’t.’

You notice that there is nothing in that list specifically about working for the Emergency Services. I suppose that if you choose to embark on a career in the Ambulance Service, or the Fire Service, and The Police, you should anticipate the likelihood of having to deal with a lot of unpleasant things, and that you will be witnessing things that others never see. The same applies to those who choose a career in the Armed Forces, but they are on the list, given the extreme nature of their role I presume. It would appear that being the victim of something, rather than just witnessing it, or dealing with the outcome as part of your job, is the defining factor here. So how does this manifest itself, what are the tell-tale signs? This is again from the NHS website.

Signs and symptoms
‘Someone with PTSD will often relive the traumatic event through nightmares and flashbacks, and may experience feelings of isolation, irritability and guilt.
They may also have problems sleeping, such as insomnia, and find concentrating difficult.
These symptoms are often severe and persistent enough to have a significant impact on the person’s day-to-day life.’

For more than twenty years, I witnessed all sorts of unspeakable things working on an Ambulance in Central London. Countless dead bodies, attempted resuscitation of people of all ages, including babies. Finding corpses that had been neglected and were decaying, traumatic limb amputations, decapitations, murders, sexual assaults, and violent crimes. Sufferers of terminal illnesses, people who had jumped from a great height to their deaths, or under trains, or sometimes into water. Suicide by drug overdose, death from drug addiction, victims of shootings and stabbings, others seriously injured in road accidents. I saw them all, and dealt with them accordingly. There was a lighter side. Delivering babies, chatting to interesting elderly people, the banter with colleagues and hospital staff. But generally, it was mostly unpleasant, and often downright nasty.

We were threatened and attacked too. I was physically assaulted a few times, and verbally abused daily. I have been threatened with violence, had knives waved at me, and on two occasions, even a gun was brandished. We were fair game, and enjoyed little respect. Writing the stories about my experiences on this blog has brought back many recollections of my time there; and as memories, they are mostly good ones, surprisingly. When you are dealing with the victims of terrorist bombings for example, you don’t really have time to think about stress, or trauma to the mind. You just do the job you signed up for, and move on to the next one. The day after that, you turn up for work, and deal with whatever is thrown at you, starting all over again, from scratch.

I did my last shift in an Ambulance in November 2001, before moving on to pastures new, as a Communications Officer with the Metropolitan Police. I can honestly say that I didn’t miss the job at all, just some of the people. I joined at the right time for me, and left when it no longer felt right. Since retiring in 2012, I often have vivid dreams. About 70% of those dreams happen to be related to working in an ambulance. Two nights ago, I woke from one such dream at around 3AM. I had been driving an ambulance, and I had got lost, unable to find the location of the job I was required to go to. Rather than being in London, I was on the coast somewhere, driving near the edge of a cliff. The person beside me was unfamiliar, not one of my old crew-mates at all. This is a recurring dream, though often the person with me is someone I know well, or a person that I could never have known at the time, but have met since. They are not unpleasant dreams, but they usually concern lots of driving, and getting nowhere fast. Perhaps someone skilled in interpretation of dreams can explain them, I know that I cannot.

I suppose I always suspected that PTSD might be the legacy of a third of my life spent attending 999 calls. But it wasn’t. I didn’t get it, though some others surely did. I was one of the lucky ones.

Ambulance Stories (46)

Clean up after your dog

As a responsible dog owner, I always clean up after my dog. There are plenty of dog-poo bins in areas where dog-walking is popular, so no excuse to leave anything unhygienic around. It may not be one of the best things about owning a dog, but it just has to be done. Sadly, in many parts of London, there is little evidence that the dog owners of that city follow suit. This story is as much about the bystander involved, as the victim. It is not a pleasant tale, but then many aspects of life and death are far from pleasant.

One morning, we were called to a main road nearby. The job was given as, ‘man fallen, not moving.’ At the end of the rush hour, Holland Park Avenue in west London is still a busy thoroughfare. You will encounter heavy traffic, late commuters still hurrying to the underground station, and morning shoppers waiting for shops to open. When we arrived on scene, we were met by a middle-aged lady. In that area, eccentric people are common, so her appearance was not that unusual. She was dressed in a style that you might describe as ‘retro-sixties’, except that her hippy clothing was almost certainly original. She was short, and overweight, and despite the cold morning, large hairy toes protruded from the sandals she wore. She carried a substantial handbag, and I could see the head of a cat sticking out from one end. The zip was fastened sufficiently far along to prevent the feline escaping, though it was obvious from its wriggling, that this was just what the unfortunate animal was attempting to do. In looks, she resembled the genetically-engineered outcome of a cross between Catweazle, and Miriam Margolyes. (See links)

She told us that she had been waiting for the nearby grocery shop to open, so that she could buy some milk. A well-dressed man had been walking towards her, heading in the direction of the underground station. She related how he had suddenly stopped still, and had then fallen straight down, with no attempt to break his fall. She said that it was, “as if an unseen cable had suddenly pulled him forwards, into the pavement.” I thought this was a very good description of someone collapsing after they were already dead; possibly from a brain haemorrhage, or something similar, giving them no time to contemplate their demise. My colleague walked over to the prone figure of a tall man. His head was covered by a plastic carrier bag, draped across the rear of his neck. The lady offered an explanation. “I did that, it’s not very nice under there, poor man.” My partner recoiled as he removed the bag. All around the dead man’s face was a foul substance, giving off a terrible smell. The lady nodded. “I told you, it’s dog shit,” she loudly exclaimed.

We got the man into the vehicle. He appeared to be in his sixties, and was dressed in smart business clothes. We tried as best as we could to carry out our normal resuscitation procedures. This meant cleaning the excrement from his mouth and nose, before using suction to remove what we could not get out from the inside of those orifices. He was obviously ‘well-dead’, a phrase we used often; but as he was in a public place, and the incident was not that old, we were naturally compelled to try as hard as possible to revive him. Continuing with all of our usual protocols, we took him off to the nearby casualty department, alerting them of our arrival. Despite the presence of the dog muck all over his head, hospital staff continued the attempt at resuscitation for some time, but could get no output. Without the benefit of knowing the results of a post-mortem, we could only conclude that something had killed him instantly, as he walked briskly to the station. He had been doubly unfortunate, as he had fallen face first into a very large pile of dog poo, left on that street by an inconsiderate dog owner. We threw away much of the equipment used, in case of any infection, and had to spend ages deep-cleaning the larger items, before returning to disinfect the whole vehicle on the inside. Dog waste can carry a disease called Toxocariasis, and this can cause blindness, particularly in children.

I often think of this poor man. Not only did he die in public, he died with a lack of dignity, caused by a thoughtless individual, who could have cleaned this up in a moment. At least the strange lady tried to spare him some of that.

https://www.google.co.uk/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=miriam%20margolyes
https://www.google.co.uk/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=catweazle
http://en.wikipedia.org/wiki/Toxocariasis

Ambulance Stories (45)

Drunk, or Diabetic?

At the time I joined the Ambulance Service in London, equipment and diagnostics were still fairly basic. We didn’t have defibrillators until later, and blood pressure had to be taken manually, with a stethoscope and wrap-around cuff. There was nothing to take a temperature with, and drug administration was restricted to the gases Oxygen and Entonox. It was to be some years before we progressed to things like blood sugar testing kits, pulse oximeters, and intravenous drugs. As as consequence, I once made a major mistake, and this the first time I have ‘gone public’ with it. Fortunately, it did not have any serious effects on the patient, or on my reputation.

When a person is affected by low blood sugar, the symptoms can vary, depending on the severity, or the individual. Some patients can quickly realise that they are about to experience problems, and can counter this by eating or drinking something sweet. This will give them a temporary respite, and allow them to seek medical help, or manage the problem themselves. Our main treatment of known Diabetics back then was to get some sugary fluid, or even powdered sugar, into their system as soon as possible, to help them recover enough to take them to hospital. If this failed, we had to move them on stretchers, unconscious, or semi-conscious, and convey them to the nearest casualty department. This worked reasonably well, if you knew the medical history of the person concerned. In their home, or perhaps that of a friend or relative, there was normally someone else to give you the patient’s history of Diabetes. On the street, or in public places like stations, you might discover a ‘medic-alert’ bracelet or neck-chain being worn. This distinctive item of jewellery opens up to give you the necessary information to confirm a diagnosis, and you can act accordingly. There are other situations where none of this information is available, and where the patient is not necessarily presenting with recognisable symptoms.

On one occasion, we had started a night shift at 22.00. After going straight out to do a transfer from one hospital to another, the next job was given as ‘a male in a collapsed state’. The address was outside a pub, and it was almost an hour after closing time. It is fair to say that we went off to this job expecting to find a drunk lying in the street, having had too much to drink in that very pub. As we arrived, we were directed by bystanders to a man rolling around the pavement, in an alleyway beside the building. He was shouting incoherently, and he appeared to have urinated in his trousers. When we approached him, he swung his arms at us, and kicked out violently. He continued to shout and swear, though it was hard to make out anything he was saying. Trying to make some examination of him was difficult. He looked to be in his early forties, and although he was reasonably smartly dressed, his clothes were filthy, from contact with the ground. He stared at us aggressively, and opened his eyes wide. He was spitting and slurring, and kept lashing out at us with his feet. We decided that it wasn’t worth the trouble of getting too close, and having to end up in a fight with this man. So we called the Police.

At that time, it was perfectly acceptable for the Police to remove someone who was being violent to an ambulance crew. Anyone refusing to cooperate with us was fair game, and very likely to be arrested. When the local van turned up some ten minutes later, the two officers tried to reason with the man, and to get him to stand up. He refused to assist them, and eventually managed to kick one of them in the leg. He was arrested for being drunk and disorderly, and for assaulting a Police Officer. They dragged him into the back of their van, and handcuffed him. We considered ourselves lucky to have passed him onto them, and continued with our shift. After a busy night of constant calls, we finally managed to get back to the base at about 04.30. I was just about to make some coffee, when the emergency phone went, and we received another job. This time, it was to the cells at Notting Hill Police Station. Apparently, they had an ‘unrousable male’ detained there, and they had called out the Police Surgeon (an on-call doctor) to examine him.

Of course, it was the man from earlier on, the aggressive drunken male, who had been collapsed outside the pub. The Police Doctor had determined that he was almost certainly in a diabetic coma, having been able to take a reading of his blood sugar. Occasionally, the symptoms of  diabetic coma are very similar to drunkenness. Slurred speech, incoherent phrases, disorientation, and violent behaviour. This man was very unwell. He had not been drinking at all, and it turned out that he had been on his way to work on a night shift in a local factory, when he happened to collapse outside the pub. The doctor had no idea that we had previously attended him. The Police had said nothing, save the fact that he had been arrested as a suspected drunk. We took him off to hospital in Paddington, where he was given glucose via an intravenous drip, and soon made a full recovery. He remembered nothing of the original incident, or of being detained in a police cell. Chatting to staff in the early hours, we managed to get the full history of his case.

Nobody had mentioned us, or what served as our neglect of this diabetic patient. Some time after, Police would no longer take drunks in charge, in case underlying causes of illness surfaced later. We also received instructions to treat all ‘drunks’ as potentially unwell from other causes, and the hospitals had to cope with a sudden influx of drink-related problems. I learned a valuable lesson. Look beyond what you perceive to be obvious. Diabetes was and still is a massive problem, and the symptoms of coma are so easily confused with other problems, like being drunk, or a stroke. I escaped serious consequences that night, and fortunately, so did our unlucky patient. I didn’t repeat that mistake, during my remaining years in the job.

Blatant Advertising

I am unusually puffed up once again today. For the third time, I have had an article published on a film website. These small things may seem unimportant, and carry an element of ‘so what’? To me, it is very exciting, to see my name in print, somewhere else, under a piece of writing.

As this is not a re-blog, and was written specifically for the other site, I will not publish it on beetleypete. What I will do though, is post a link here, and hope that any readers who are interested in film, and my writing, will go over and have a look at it.

The rest of the site is well worth a visit, with interesting, intelligent, and well-written reviews of films, cinema articles, and everything connected to both. (And that’s just my stuff! Only joking)

Thanks in advance for looking at it. Pete.

http://curnblog.com/2014/01/23/blood-bandages-paramedics-film/