Things you see at a Taxi rank

Working in an urban setting you get used to the nightlife. With various pubs, clubs, casinos and gentleman’s clubs on the patch; dealing with alcohol fuelled injuries and situations was not uncommon.

That’s why; when the next job came in whilst working the night shift on a pay day weekend in July, my crew mate and I were not shocked.

The first year student we working with – was.

The student – a very well spoken young man called Tom was on his first placement with the ambulance service having embarked on his degree in Paramedic Science. He had moved around 200 miles to study. His parents were both solicitors. He had; up until now, led quite a sheltered life.

We were being sent to a busy taxi office in the city centre for a “concern for welfare”. The patient was a 33 year old man. No more details had come in so far.

We headed towards the incident. The Emergency Care Assistant was driving, and the student was going to attend with me for support if he needed.

“What does concern for welfare mean?” Tom shouted through the hatch in the back.

“It means that there is some suspicion the patient has come to some harm. Usually the caller is not with the patient so the call handlers struggle to categorise the call” I replied.

We pulled up in the road, it looked like something out of a cheap zombie movie. There were people staggering in the road everywhere as they went from one bar to the next.

As we drove down the road towards the location that had been given to us I could see a crowd building. This normally meant one of two things; a fight, or a patient.

I quickly explained to the student that we would make a quick assessment. If it was a fight we would hold back and await the police. It soon became clear however, that they would not be needed.

There in the middle of the crowd. Sat on a bench. Was a man; crouched down, head in hands. Completely naked.

“Tom, I think your going to need to grab a blanket” I called through the gap separating the back of the ambulance from the front.

I watched through the divider as the student fumbled with the locker, attempting to get a blanket out, clearly embarrassed.

“It’s ok, we only need one”. I gently called through.

Eventually, the student managed to grab one. I opened my door and stepped out. The warm air immediately striking us. I opened the side door and took the blanket from Tom.

“I’m sorry we didn’t know what to do, so we had to call”. A voice from behind me said.

I turned around and was met by a couple of young ladies; dressed for a night out – looking concerned. The taller of the two had spoken, and was looking bemused.

After a brief discussion I found out that the man on the bench was unknown to the group and had been found by them being kicked out of the taxi office. According to the group, the patient had been trying to get the taxi rank to let him use the phone. However, they had been adamant that he could not and had forced him to leave. That is where the group had found him.

We approached the patient. As we approached he looked up. You could see from the immediate flushing in his face and his widening eyes that he was embarrassed.

“Give him the blanket Tom” I quickly said to the student.

Tom shuffled from side to side. For a minute I could not tell who was finding this more awkward; Tom or the patient. Tom extended his arm and the patient gratefully took the blanket and wrapped it around himself. A sort of NHS toga.

Sheepishly, the patient headed toward the ambulance. The plan being to get him inside and try and recover some dignity while we established what had happened.

The patient sat on one of our seats, wrapped in his thin NHS issue blanket. “My name is Matthew, I live on the street behind and managed to lock myself out my house. My dog was chasing something in the garden and the door closed behind me. I can’t get back in” He quietly said.

“So you went to the taxi office?” My ECA said, bemused.

Yeah it was all I could think to do – I needed to use a phone. They wouldn’t even let me in!” His eyes scanned the ambulance and all three of us. “I’m sorry I called. I don’t need an ambulance” He added.

We drove around to his street. Astonishingly he must have walked past a couple of pubs and betting shops on his way to the taxi rank. I wondered why he hadn’t gone in any of them to get help. When we pulled up outside his house he asked us to go and knock on the door. No answer.

We tried the windows. Locked.

The ECA tried the back – met a friendly and excited little dog and then found that door to be locked too.

Matthew stared at the floor the whole time. We asked him if there was anyone he could call to let him back in. Turned out his wife was deployed abroad with the armed forces and his family were a couple of hours away with no key.

20 Minutes Later…..

I watched as the fire service got to work. Unscrewing the locks to Matthews front door. We had come to the decision that we would have to call them to help him into his property. They usually are good at opening doors that need opening and can get into most places somehow. They were very careful to ensure that the door was able to be secured again.

Of course, there was the banter. Then we had the conversation about things we had seen before in taxi ranks. We were all in agreement that this was probably the strangest.

Never Off Duty

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As a Paramedic, when your off duty – your never off duty.

It was around midday. The heat of the sun was beating down as I drove through some country lanes on the way to meet some family for a barbecue. I was driving along enjoying the weather with the radio far too loud. It was the first day off after a run of gruelling shifts and I had just woke up from a post-nights sleep. Usually, I would be struggling through the post-nights haze. With a headache or jet lag type feeling. Today was different. I was feeling awake and alert – and looking forward to some days off.

My immediate family were already there – waiting for me to turn up, they had been picked up earlier by the in-laws and I was the lift home at the end of the night.

As I drove around the corner I got stuck behind a queue of cars. I slowed down and waited my turn to overtake whatever obstacle was ahead. As each car had its turn and we edged closer I could see what was ahead – a group of runners.

The car in front was preparing to overtake the runners. Suddenly, it swerved. I had just enough time to slam on the brakes and my car came to a sudden halt. There – on the road, laid a runner. I sat for what felt like a couple of minutes and took in the scene.

The runners had stopped and were looking down. The runners foot was in a pothole and he was sprawled out in front of it – in the same position as a crime scene chalk man.

He wasn’t moving. From where I was sitting, I wasn’t even sure he was breathing. Pressing the button for my hazards I swore under my breath. I reached down, unclipped my seatbelt and got out of my car. Walking to the boot of my car I could overhear the runners agitated tones as they were all talking amongst themselves.

“Call an ambulance” “Can we move him?” “Did anyone see what happened”

I placed on my ambulance high vis in order to identify myself and pulled a pair of gloves out of the pocket. I approached the gentlemen and introduced myself as a paramedic. I asked someone to call 999 and put it on loudspeaker for me when they got through to the ambulance service and knelt down next to the man.

I was acutely aware that we were in a dangerous area. It was a country lane – and although there was traffic the road was still live. I asked some more of the runners to stand further up and down the road to control the traffic. D is for danger – this was now sorted.

I could hear the call handler over the phone asking if the patient was conscious and breathing. The patient was breathing – and was not conscious. I quickly relayed this back and told the call handler I was a paramedic and needed P1 (Immediate) backup.

I then started my assessment. I needed to move the man but was aware that there was potentially reason to suspect an injury to his neck. I got some more of his friends to help me and we log-rolled the patient. This was a very controlled manoeuvre that allowed me to get the patient onto his back to manage him better.

As we rolled the patient we could see that he had quite a large head injury. He was also completely unconscious. His breathing was irregular and he was loudly snoring. His airway was obstructed. I relayed this back to the call taker as I placed my thumbs on his cheek bones and fingers under the back of his jaw. I pulled with my fingers and his jaw moved up – with it the patients tongue. Straight away the breathing normalised.

Once in this position I was stuck. If I let go the patients tongue could fall back. I instructed someone to pat the man down to see if they could feel any other injuries and updated the ambulance service on what was happening.

Around 10 minutes later – my hands hurt.

In the distance I could hear a siren. I looked up to see an ambulance pulling up. As the crew jumped out I recognised them. I gave a quick handover and let them take over the care of the patient – assisting them to get him into the back of the ambulance.

“Never off duty, eh” The Paramedic said.

Rubbing my hands, I agreed.

Incarceritis

Urban Dictionary,2021

We watched from the warmth of the cab; sipping our hot drinks, as the drama unfolded.

“Do you know what would go great with this?” My crewmate said.

“What’s that?” I asked, intrigued.

He switched to Classic FM.

We surveyed the scene unfolding in front of us. There; in time with the dramatic chorus of string instruments on the radio, was a hail of bricks coming down from above onto the street below.

It was around 2 in the morning. We had been sent to support the police with one of their customers. A 19 year old male who was currently involved in a stand off with them. He wasn’t pleased that he had breached a restraining order by visiting his girlfriend; whom, he had recently placed into surgery for facial reconstruction.

When the police arrived they had been spotted quickly. The patient had then chosen to climb out on some scaffolding and unleash all sorts of building materials down on anyone; or anything, that was close enough to be within firing range.

We watched; as the orchestra reached its crescendo, the patient flung more rubble at the officers underneath. It struck one of the shields as the officer underneath braced himself.

Two hours later, we were still there. It was now beginning to turn into dawn.

“This has to be over soon” My crewmate sighed. An hour and a half before that we had turned Classic FM off. It wasn’t helping us stay awake.

We both watched as the police seemed to be moving around a lot more. I thought that they were probably getting into position.

Suddenly there seemed to be a bit more action. I could see a group of officers on the roof with the gentleman. Slowly, they moved in formation. Shield raised. I could see one of the officers arms sticking out of the side with a yellow object in hand. A taser. The patient was stood in the middle of the roof, no where near any danger if they decided to taser him. I saw him reach for a slate to throw.

“TASER, TASER, TASER” I heard.

I watched as the male stiffened. Body rigid, he fell forward.

“Kind of like a tree in a forest” My crewmate remarked. I had to agree.

There was a knock on the window on my crewmates side. He wound it down. A police officer stood there.

“Any chance you can take the probes out please?” He said, grinning. We agreed. We both got out of the cab and into the back – getting the equipment ready for this task – some gauze, a dressing pad and some micropore tape.

We could hear the patient before we could see him.

“I cant believe you tasered me!” He was shouting. I could believe it.

He walked towards us. Arms behind his back, cuffed. On his rubble covered t-shirt there were two probes. Towards the end of them was some blood where they were embedded.

“You can cut it off mate” The patient grumbled, he was talking about his t-shirt.

I grabbed my shears and made light work of it. Exposing the patients chest I could see the barb embedded just below his left nipple and slightly above his belly button. I quickly explained that the tasers had barbed ends. The only way to get this out was a quick pull – and that it may hurt but I would be as quick as I can. The patient nodded and clenched his teeth.

A taser barb.

I went for the one near the nipple first. Taking my left hand I made a V around the barb to anchor the patient down. Grabbed it with my right – the patient flinched.

“Ok, on the count of three..” I said.

“One” and I pulled. There was an audible pop as the barb came out intact. The patient squealed. I dressed the wound, and then moved onto the next.

“Two” I said, and did the same again.

We then thoroughly assessed the patient. He had fallen hard so had some bruising and abrasions. However, otherwise had got off lightly. The patient and police left and we started to tidy the back of the ambulance.

Just as we were about to leave there was another knock on my crewmates window. It was the same officer who had knocked the first time. This time, he was stony faced.

“He has got chest pain” He said and pointed to his body worn camera – which was flashing. Recording. He then mouthed “Incarceritis”

Incarceritis is a term used by police and some medical staff. Essentially it means a condition that has suddenly started when the patient is presented with the prospect of time in a police or prison cell. Usually, their symptoms would spontaneously resolve just before a blood test or diagnostic procedure was carried out.

The patient was brought back in. We reassessed him. When we got to the stage where we wanted to do an ECG he refused.

“No way mate, not after pulling those out my chest. Those sticky dots are going nowhere near me” He barked at me.

I explained that we needed to do an ECG to see if there was anything going on with his heart. Again, he refused.

I treated him for cardiac chest pain. Gave him Aspirin, GTN spray and paracetamol to relieve the pain. We all sat in silence the rest of the way.

When we arrived at the hospital I handed over to the doctor in charge of ambulance streaming – the triage area where ambulance crews hand over. I explained the situation. The doctor looked less than impressed.

The last I heard the patient had managed to spend the night in hospital under “observation” as he was refusing to allow an ECG or repeat bloods to be done. He was discharged the next day after his pain resolved.

I couldn’t help but think that the police that initially tasered him were probably now regretting this, as they had spent the night with the patient as he was still in custody. In essence, the patient had won.

Visiting Times

It was around 10:30 in the morning as I pulled up outside the patients address. I was working on a car and had been dispatched to reports of an elderly lady who had a fall. She had managed to get up with the help of her husband. However, now had considerable hip pain.

I got out of the car and put on my Level 2 PPE – a mask, goggles, apron and gloves. Although necessary during the COVID pandemic this feels as though you are placing more than just a barrier to infection on – there is an element of removing the element of humanity and ridding the patient of the ability to read expression; a vital part in communication.

I walked to the boot of the car and collected my equipment: Monitor, primary response bag and oxygen as well as my tablet computer. I ensured I was well balanced as I carried the equipment to the front door. As I approached it swung open. Stood in the doorway was an elderly gentlemen. His aged face wrought with worry. I quickly introduced myself and he told me his name was Stan.

Stan wobbled back through the hallway – grabbing onto anything he could find as he showed me the way to his wife. He introduced me to her on the way. Her name was Betty, like him she was 86 and had tripped on a piece of post that had been dropped on the floor by a carer causing her to fall backwards onto her bottom.

I walked into their living room – and there on a bed was Betty. Betty looked a little less frail than Stan. Although, was obviously in pain. I quickly gained her details and past medical history while I obtained a quick set of observations. Betty explained that she had osteoporosis and felt as though she may have broken something.

Betty was describing groin pain and inability to lift her right leg. She was in severe pain and given her medical history and the mechanism of injury I was suspecting that she had a fractured neck of femur. This type of fracture is relatively common in our frailer patients. It is the bone that connects the femur to the ball joint that sits in the hip. In my experience of seeing many of these – they are extremely painful.

With this in mind I called for backup on a priority 2 – I wanted an ambulance to run on emergency conditions (lights and sirens) to back me up.

While we waited for my backup to arrive I got Betty ready for her trip to hospital. I put a cannula in and gave her some pain relief – which made her a lot more comfortable and in turn, more chatty.

Betty told me how she met Stan. It was at a train station. He was the guard and she was travelling to London to meet family. This was 10 years after the end of World War 2, and travelling to London was quite a depressing task. Betty said that the evidence of bombing remained in the landscape as the train approached the city.

Stan came and sat with Betty for the last half an hour of the journey. He admitted then that he couldn’t take his eyes off of her. However, at the time he told her he was due a break and didn’t want to sit in the smoking car.

For the next month or so, Betty would be on that train on a weekly basis – and every time she travelled Stan took his break with her. Eventually, she started bringing him bacon sandwiches. Which; he says, won him over.

For the last 50 years, they had been inseparable. Stan loved her. Really loved her. You could sense it, from the way he spoke about her and also the way he spoke to her.

Eventually, talk turned to the pandemic. Betty explained that she was worried about this – and that she had been isolating away from it all with Stan. They had only had carers in and they had been in full PPE. Something that stood in the way of Betty communicating with them as she felt it made them less human – I agreed that the masks were a bit of a barrier.

I explained that currently, the hospital was not allowed visitors. There was silence apart from Stan shuffling from side to side nervously.

“I have to go love, this needs sorting. I will be back before you know it and causing you all sorts of mischief” Betty said to Stan.

I couldn’t help but notice the wobble in her voice. Stan noticed too. He came over and sat on the bed next to her. I moved my monitor to give him some room. For the next couple of minutes nothing was said as he held her hand and mopped her hair out of her eyes.

Nothing was said, but at the same time. In that moment, Stan said so much.

I excused my self to give them some time together. As I started getting my things packed up in the hallway the ambulance arrived. I led the crew into the room and handed over. The crew were tender and caring and had Betty smiling in no time.

I watched with Stan as Betty was wheeled out on a stretcher to the ambulance. I saw a familiar look on Stan’s face. It was the same worried expression I had seen as I approached the front door.

“They will look after her” I said out loud. I’m not sure if it was for me or for Stan.

As the crew were loading Betty on board she stopped them. She wanted to give Stan a kiss.

“Ill be back soon, make sure you eat properly” Betty said to Stan, and they shared a kiss.

“Love you”

With that, the doors to the ambulance closed and Stan shuffled towards the front door. I helped him into the house and watched to make sure he got in okay.

He walked to the window – and watched for a while before the crew left. With that, he pulled the curtains across and disappeared into the house.

It is widely known that patients who suffer from Neck of Femur fractures who are elderly spend longer in hospital. They also have a higher risk of death whilst there. During the COVID-19 pandemic Betty would not have been allowed visitors at all.

I do not know the outcome for Betty, but I hope she was reunited with Stan again and they got the chance to spend longer together. While I stood watching Betty tenderly kiss her husband, I couldn’t help but think this was more than just a quick goodbye.

Hitting the Wall

It was the middle of a night shift, around 3am. The time I usually struggle. I was sat on standby with my crew-mate; he was driving and I was in the attendants seat. I could feel my eyes beginning to close.

“DMA001, please respond to 1 Night Street, Nosleep village”

The radio sprang to life. I jumped and the sudden surge of adrenaline brought me to my senses. I leant forward and pressed the button to say that we had received the job and were mobile.

This job was a category 1 job – the highest category. Usually reserved for potential cardiac arrests, major haemorrhage or unconscious patients. The MDT showed that the patient was unconscious.

As we headed toward the job more information was coming through as the call taker was receiving it. We now knew that this was a 52 year old male who had been unconscious and now was conscious but very confused.

Night shift fatigue is a very real thing. Most ambulance staff work off of coffee and sweets, riding a sugary caffeinated high throughout the shift – not particularly healthy, but effective. However, regardless of my sleep pattern or diet; I always hit “the wall” at around 3am.

Luckily, it would seem that between the adrenaline from the initial jolt that the radio gave me plus the fact that this job sounded serious woke me up and would provide the boost I needed for the rest of the shift.

We arrived outside the house. Upstairs, one of the lights was on and we could hear shouting as we approached.

“Calm down!” a woman’s voice cried.

We approached the door, and knocked.

“We’re upstairs!” The voice cried “The doors open, I can’t hold him much longer!” A voice cried.

My crewmate and I looked at each other, eyebrows raised. We stepped forward and opened the door.

The house we stepped into was nice, the hallway lined with photos and the air perfumed with the smell of the air freshener that was on a table by the front door. We shut the door behind us and head upstairs, wandering towards the light that had been left on in one of the bedrooms.

We walked in to the strangest sight.

On the bed was a pair of legs, flailing around as the person face down underneath tried to get free of the thing pinning them down. That thing…..was the patients wife.

“Oh I’m so glad your here” the middle aged wrestler said to us.

“It’s my husband Don, he’s having a hypo” She quickly explained

“Geerrrrroooffff me!” The man under her screamed and bucked, in a scene that can only be described as the same way a bucking broncho would. The patients wife holding on for dear life.

I walked round the other side of the bed so I could get a look at the patient, watching out for the flailing arms and legs as I went.

Hypoglaecemia is a condition where the patients blood sugars can fall to low. It leads to agitation, confusion and ultimately a coma. If untreated it is fatal. Usually diabetics have these episodes, which are referred to as “hypos”.

The wife quickly explained that the patient has recently been having hypos as his insulin dose had been increased. She went on to tell us that each time he has one he becomes confused, agitated and wanting to fight everyone and anything.

The patient was naked, extremely sweaty and fighting hard. I quickly restrained a hand and took a blood sugar reading – finding it to be 1.2mmols (the normal range is 4.0-8.0). The patient was definately having a hypo.

As a paramedic, there are four treatment options available to me in order to manage a patient suffering from a hypoglaecemic episode:

1. If the patient is able to, encourage them to eat something sugary and follow it with some carbohydrates (the short term boost from the sugar is then reinforced by the carbohydrate)

2. Administer a tube of Glucogel. This is a sweet smelling paste that the patient absorbs into their gums when it is squeezed into their mouth. It gives enough of a boost of glucose to allow further treatments to be used.

3. Intramuscular Glucagon – this is a vial of powder that is mixed with fluid and injected into the arm. It is good as a last ditch attempt as it stops the liver from storing glucose – if it is given the patient must be taken to hospital

4. Intravenous glucose. IV glucose is given through a cannula in the vein. It allows the body a supply of glucose to then regulate the blood sugars. It is fast acting and effective.

The fact that this patient was so combative meant that getting a cannula in would be difficult. However, I quickly explained to the wife that this would be the fastest course of action in order to boost the patients sugars. She agreed and said that this was what had been done before.

We started planning what we were going to do in order to make this safe for everyone. Luckily for us, the patient was pinned down in a sort of star fish type shape. This meant that it was easy to get to an arm in order to put in a cannula.

Between us all we managed to get the patient into a position where movement was difficult and limited. As I placed the cannula in the patient started fighting more intently. I thought to myself about how well this wife was managing to restrain her husband considering the force he was fighting with.

Cannula in and secured, I started pushing through some IV glucose. The first 50ml went in with no change. However, by around 70mls the patient had started to relax and the wife managed to get up off the patient. This was the first time we had managed to get a good look at the both of them. The wife left the room for us to carry on our assessment.

The patients wife was around 5’10, and of a slight build. She looked flushed and was out of breath. Looking at the patient it was amazing that she had managed to hold on so long and stop him from either hurting himself or from her.

The patient was a little larger, he was around 6’2 and probably weight 20 stone. He was dripping in sweat and looking around extremely disorientated.

Luckily for us, the glucose was working and the patient was slowly returning to normal. I quickly covered him up with a blanket that was on the end of the bed for his dignity as we set about assessing him fully. As we were doing so he was becoming more co-operative, apologetic and starting to ache all over.

The patients wife returned carrying a plate full of jam and toast. She explained that she knew we would ask for it next as it is what normally happens. She obviously knew exactly what to do.

For the next twenty minutes we sat with the patient and his wife. The angry man that was fighting on the bed was gone, and the patient was now extremely apologetic.

After we referred the patient onto the diabetic team at the hospital and printed out our notes for the patient we left. Stepping out into the sunrise.

“I’m glad she was there” Said my crewmate, referring to the patients wife.

“I couldn’t think of anything worse than having to pin him down at 3 am” he continued.

The adrenaline from the job fuelled us, as it did her. We were lucky it was there. It helped us break down what felt like a very big wall.

Break a Leg

“DMA 123, you are being dispatched to a 24 year old male with a leg injury at Nicehotel”

The radio came alive. It was 2am on a weekend night. My crew mate (an experienced ECA) and I were just tucking into some chips. We looked at each other, put the food down and drove towards the job.

The hotel we were headed to was one that neither of us had been too before – which usually was a good thing.

As we pulled up outside the lobby we noticed a lot of people hanging around outside in little groups. All were dressed up; jackets, heels and dress clothes. A bell boy waited for us. As we pulled up he stood outside – a human windmill waving us down.

“This looks posh” My crewmate muttered as we got out of the cab and grabbed all of the kit we would need – response bags, monitors, oxygen and the tablet computer that our paperwork was completed on.

The bell-boy asked us to follow him – we walked into the grand hotel lobby. As we walked people stopped and turned – looking to see what was going on. We headed towards the ball room – and on the way I asked what had happened.

“I’m not sure, there is a wedding on tonight and I think one of the guests has hurt his leg” answered the bell boy. We went into a grand looking ball room – lights on bright, disco tidying away and tables littered with alcohol and fancy looking centrepieces all around.

We headed to what was the dance floor – where I quickly noted the bride was sitting on the floor – with a man leaning on her lap. Her dress making a great place for him to rest his head. He looked to be in considerable pain. As we got closer, I could see why.

Where his foot should have been facing straight, it was off at an ankle with a deformity just below his knee – it looked a bit like a banana. No X-ray needed to diagnose this fracture. We placed our kit down next to the gentleman and asked what had happened.

“They told me to break a leg – so I did” answered the man. Voice trembling, his attempt at humour masked behind the obvious pain he was in. The bride answered:

“This is my new husband. He was showing off on the dancefloor when he got his leg caught in my dress – he fell over and we heard the crack over the music. The worst part is – I think he has ripped my dress!” She half shouted.

I quickly explained the plan to the patient – I would quickly assess his vitals – and check for any other injuries and then we would sort out his pain relief. My ECA was tasked with getting the Entonox (Gas and Air) a vacuum splint and the stretcher. I roped in the bar staff to assist with this too.

While they were gone I did my assessment – found that the patient had no other injuries and that his foot had good circulation to it. I explained that I needed to put a cannula in – a plastic tube into the vein in order to give him some good pain relief.

Where the patient was leaning on his new bride; the top half of his body was against her dress. Sometimes – putting a cannula in can be messy. There can be a little bit of bleeding. I was aware that this dress was already ripped. However, thought that the bride would not appreciate the blood that could potentially end up on her dress.

During my assessment I had already cut the grooms trousers after a bit of an argument as they had been hired – and there was quite a big deposit on the suits (In the end I cut up the seams and the new mother in law was going to try and sew it all back together).

I managed to get the cannula in with no mess – thankfully. By this point the ECA had come back with the equipment and the groom was taking deep inhalations of the gas and air. He found it worked very well, a bit too well as he told everyone who was listening how much he loved his new family and started serenading his bride.

We splinted his leg and got him on the trolley – as we walked towards the lobby the bell-boy from earlier told us that the wedding party had formed a guard of honour and that the photographer was waiting to take some photos of the bride and groom leaving to start their life together.

What a way to start it.

Masks, Aprons, Goggles and Gloves

Photo by Griffin Wooldridge on Pexels.com

Working during a Pandemic is hard. There is a lot of anxiety as well as poorly people and difficult decisions. When this all started I was working extra hours in a busy emergency department. I worked in Majors, Resus and Rapid assessment and triage. The role for me was new. I had not worked in a busy emergency department before.

On this day I was working in Majors, cubicles 16-22. These cubicles were side rooms and were for patients who needed isolating. The work was full on. I was responsible for these 6 patients. At the beginning of the shift the consultant in charge of the department gathered us all together.

“As you are all aware – we are seeing cases of COVID-19 within this hospital. We do not have the swabs to test everyone, and our intensive care is nearing capacity. Any patient with respiratory symptoms will be isolated in side rooms – this is including those that would normally be seen in resus”

I already had one patient in a side room who I took handover for. She was a lady with cancer who had an infection. She did not have coronavirus and was being isolated to protect her as her immune system was so low. I went in, placed an IV line in her arm and took some blood. I then went to the drugs room where I got her antibiotics ready. While I was in there two of the health care assistants came in and were talking amongst themselves.

“We dont have enough PPE. We are low on masks and aprons.”

Hearing this made me anxious. I was working in isolation bays where I would need to change my PPE every time I went in and out of a room to see a patient. I went to the trolley where my PPE was laid out and made sure I had enough stock for the day.

My next patient was a lady in her forties. She had called an ambulance that morning as she was coughing and having difficulty in breathing. The ambulance crew had pre-alerted her to hospital and instead of going into the resuscitation room she was coming into one of my side rooms. I watched as she was wheeled in. She was on high flow oxygen and looked agitated. I asked the crew to take her into the isolation room while I put on my PPE.

Once all my PPE was on I entered the room. I introduced myself and the patient was only able to grunt in response. Her breathing was so bad. Her shoulders heaved, wide eyed she looked at me. She was obviously very scared. I set about taking an initial set of vital signs. I took her pulse, it was quick. Her breathing was also very fast. Her oxygen levels were low (despite having the oxygen on full) and her temperature was high. The only positive was her blood pressure was spot on.

I went to escalate this – I needed a doctor to come and see this patient. I stepped out, removed my PPE and went to find one. I felt she needed ventilating as well as some sedation. I was aware that she was panicked and that her oxygen levels would affect her level of conciousness. I found a doctor and told him. He came and looked through the slats in the door. This struck me. Was he also scared to enter the room?

He agreed. I was to take the blood from the patient and pop a cannula in to start some antibiotics and give the patient some medication to lower her fever in the hopes that she would start to feel better. The doctor would speak to his senior to see what the plan would be moving forward.

I obtained all the pieces I would need to set up an IV and prepared the drugs that would be needed. I placed on my PPE and entered the room. The patient was trying to pull her mask off. She was claustrophobic and struggling to breathe. This for her was fight or flight. I wasn’t sure which one it was yet.

I tried to reason with her, but she was so confused. I placed the mask back on and this helped a little. I then told her I would have to place a cannula in her arm. This was when she panicked. Unfortunately, she did not have capacity. Her oxygen levels were so low that she could not make a decision. I placed the cannula anyway. As I was holding the cannula to secure it – her other arm came around in a fist and punched me square in the face.

I was torn. On the one hand – she was not fully aware of her actions. She was fighting for her life. On the other hand, she had just punched me. Somehow I managed to bandage that cannula, and start her treatment. With the medication the doctor had prescribed she calmed down.

I went to report back what had happened. I was asked if I would continue and I did. About half an hour later the patient had a chest x-ray. They were planning on placing her on ventilation and needed to make sure one of her lungs had not collapsed. The bloods I had taken had come back unfavourably and showed that the patient was extremely unwell.

The chest X-Ray came back and the patient was classically showing signs of COVID-19. Unfortunately, we were unable to swab her. I managed her until she was ready to move up to a high care respiratory ward. At one point we used the ipad her family had given her to facetime them. She wanted to talk to them before she was potentially intubated. She managed a few words, they said a few back.

She was one of 20 patients I saw that day. All with varying levels of respiratory distress. When these patients are escalated and need ventilation we up our PPE to match the level of care. However, I did not feel protected. It is a vulnerable feeling working in a pandemic.

Unfortunately, more recently I am seeing more of this again. The cases have increased and the government has announced a month long lockdown. I want to see my family at Christmas. So I welcome this.

Stay Safe.

Tricks of the trade: from emergency ambulance to emergency room and everywhere in between.

I’ve been quite lucky in my career so far. I have worked on traditional ambulances, I have worked on rapid response cars. I’ve struggled to treat patients in fields in the middle of the night and I’ve treated them in field hospitals behind the main stage of a festival.

I’ve commenced treatment on VVIP in secure areas. I’ve worked on high profile sports events and in busy emergency departments. I’ve triaged over the phone and via video link.

There were many things I have picked up on the way from patients, situations and the people I have met along the way. I thought I’d share these with you.

1. Always arrive a few minutes early. Check your equipment. You never know what the day will bring and knowing your equipped for anything will make you feel a little more prepared.

2. Never run to anything. Running increases your heart rate, your gloves are harder to get on and your out of breath. Walking buys you headspace to make a plan.

3. Never underestimate a mother’s intuition. Ask them what they think is wrong with their child if you are treating them 9/10 times – they already know.

4. Oxygen tubing cut into pieces makes a great straw if a patient needs a drink.

5. If a patient says they feel like they’re dying – take them seriously. They probably are.

6. Create time for silence – a well timed pause can create opportunity. Wether it be a patient asking a question in this gap or the family seeking reassurance.

7. Holding someone’s hand is one of the best treatments you can give.

8. If it’s wet and sticky – don’t touch it.

9. If you get stuck – take the patients pulse. It buys time to create a plan.

10. Offer to clean. If you have just been to something traumatic then cleaning up after can be therapeutic. It buys time to reflect.

The fight for a father.

Any healthcare professional will tell you the value of your gut feeling in the assessment of a patient. The British Medical Journal published an article citing it as:

“clinician’s intuitive feeling that something is wrong, even after examination that suggests otherwise, appears to have diagnostic value, even greater diagnostic value than most symptoms and signs”

In this case, stood looking at the patient in front of me. I knew something was wrong. We were in the living room of a family home – children’s toys were strewn across the floor and we were surrounded by pictures, ornaments and children’s pieces of art.

I was working with a student paramedic and an emergency care assistant. It was the early hours of the morning after a busy night shift. The patients wife had phoned 999 – she did not speak any English and gaining a history from her was proving to be difficult.

The patient – a tall man in his 40s was sat on the chair on the sofa. He was leaning slightly forward. He was pale, clutching his head and vomiting.

The student was doing the initial observations – the patients blood pressure was extremely high and his pulse low. He had slurred speech. I asked the ECA to get us a chair.

In the ambulance service this is a code phrase – it means we need to get moving quickly. Whilst the ECA was doing this the patients daughter came downstairs.

The daughter was around 10, she was young. However, she was the only person there at the time that was able to tell us what had happened. Her dad was struggling to speak, her mum spoke very little English.

She told us that her dad had been working that night on the late night bus. She then started translating for her mum – she told us that the patient had come in and complained of a sudden, severe headache.

This was all I needed, I knew what this looked like. The patient was presenting with a subarachnoid haemorrhage – a dangerous bleed in the brain. He was very unwell.

We managed to get him onto the chair, our sense of urgency reflected by the flashing blue lights on the windows around us. We carried the patient out of his front door and down the steps outside.

At this point we noticed a change. The patient slumped to the side. His eyes fixed and glazed to the right. His arms were trying to draw up to his body – a position called decorticate posturing. The brain was injured and was pulling the limbs in to protect the bodies core and central organs.

We managed to get the patient onto the trolley. As we did so the patients wife was getting more upset. There, stood next to her. The patients daughter. She was silent.

I had to get my student to help me hold a limb straight. I needed to get a cannula in. The patient needed medication to stop him vomiting and protect his airway. We managed it between us.

I was acutely aware that the patient was possibly still aware. His eyes were open and fixed to the side, I was trying to reassure him as tears rolled down his cheek.

At this point – the patient started fitting. I quickly got my ECA to close up the ambulance and instructed the student to get the oxygen on the patient. I drew up the diazepam and administered it. The seizure stopped.

There was a gentle tap on the door. I opened it and found the daughter stood at the bottom. She asked me what had happened. I was honest. I told her that her dad was unwell, it was critical that we got him to hospital quickly.

She translated this to the patients wife, her mother. This 10 year old was having to deal with something that she would be dealing with for years to come. The mother vomitted. We got her a bowl.

“She wants to come with you”. The girl said.

We only had the seat in the front spare and one seat in the back. The daughter was doing a great job of remaining calm and collected as well as translating for me.

I kept her in the back. Wether or not this was the right thing to do, I am still unsure. I needed a translator. I also needed calm. She was both. She was amazing.

The patient remained stable the whole way to hospital. The daughter held his hand tight the whole way. The mother sat in the front.

Sadly, I don’t know the outcome of this job. I watched in the resuscitation room as the patient was put to sleep and prepared for transfer to a neurological unit.

I like to think the patient survived. The resolve in the face of the ten year old girl as she gripped her fathers hand as we raced towards hospital will forever be with me. Our treatment did half the job – she did the rest.

Sometimes holding a hand is the most important treatment you can give. It encourages hope, gives purpose; and sometimes – can make someone fight.

The woman in the middle of the road.

Working on your own on the rapid response car can be very rewarding. It forces you to make your own decisions about how you manage your patient based on your own assessment. However, at times it can make you very vulnerable.

On the night shift that this incident happened. I was working on my own on a rapid response vehicle. It was mid winter, so it was cold. However, it was a clear evening.

I was travelling to a job I had been dispatched to. On the way the mobile data terminal (MDT) blared to life.

STAND DOWN” The electronic voice blared at me.

I pressed the button acknowledging the stand down, and with that another job flashed up. The radio started ringing.

“TGM1 this is control, we are dispatching you to a 55 Year Old Female. Difficulty in breathing”.

The address was in a rural part of the patch, where there are lots of farm houses and the distance to hospital can be quite far. I knew I had to decide what I was going to do early, in order to get back up running as soon as possible if the patient needed to attend a hospital.

As I drove down the country lane I turned the full beams on and the headlights lit up the road, allowing me to see clearly what was coming up. The reflection of the blue lights flashing bouncing off of the puddles on the road and lighting up the eyes of the odd dear or owl.

I started to approach the address on the sat nav so I started to slow ready to look for the house. Lucky really. There in the middle of the road, was a figure. I slammed on the breaks.

I took a deep a few seconds to steady myself. I was unnerved. It was the middle of a night, in the middle of nowhere and this woman was just stood in the middle of the road. Facing me. I changed the blue lights on the car to only flash from the rear of the vehicle as I did not want to dazzle her and left the headlights on.

I quickly activated the run-lock feature on the car, a feature that allows the engine to run with no key in the ignition. However, would cut the engine if any pressure was applied to the accelerator. That way I knew the lights would stay on and the car would stay warm.

I took ahold of my torch and stepped onto the road. I pulled on my hi-viz jacket and approached the figure.

Ambulance Service, are you OK?” I called out.

“Yes, I called you. I couldn’t breathe.” Came the reply.

I was suddenly very aware of how alone I was. I ran the torch up and down the patient. She was a lady in her 40’s wearing jeans and a hoody.

“Do you live nearby?” I asked, slowly stepping towards her. I could see from the way she was standing that she was not struggling to breathe. Her shoulders weren’t moving, and there was no difficulty in taking a breath that I could see.

“No, I don’t. I didn’t want to die at home. So I went for a walk” she calmly replied.

“Ok, tell me what’s been happening and Ill see how we can help” I said.

The patient then went on to tell me how she had been under the mental health team for a while but thought they weren’t helping any more so cut all ties and stopped her medication. I enquired what medication she was on and she replied with the name of a potent anti-psychotic. She then said that she believed that she had been poisoned by her family; became short of breath whilst walking and so called 999.

I invited the patient to come and sit on the edge of the boot at the rear of the car, that way she would be partially sheltered and I could give her a blanket to stay warm.

“No thank you, its time for you to follow me” She stated.

“Follow you where?” I enquired

“Back to my house, its warm there and I can tell you more about what is happening” She suggested.

At this point. I definitely was not comfortable. I explained that an ambulance would be on the way and it would be warm and comfortable in the back of that.

By now my assessment was complete. Medically she was well, she had a fast heart rate (tachycardic) but this was due to her mental state. I told her I was going to ring the mental health crisis team for the area and walked to the front of my car.

As I discussed the patient to the crisis team I found out a few facts that put me more on edge. This patient was known to become aggressive – and was normally accompanied to appointments by a security guard. The nurse on the phone said that there was room in the 136 suite (a secure room that mental health patients can be kept in whilst being assessed).

Luckily, at this moment the trees in the distance started pulsing the familiar blue of my colleagues approaching with their lights on. I felt a wave of relief wash over me.

10 minutes later. The patient was handed over and on her way. I had to sit in the nearest fuel station forecourt to calm my nerves.

I took a deep breath. Pressed the “clear” button and watched the screen light up with the next job – an 85 year old male had fallen. Perfect. I fired up the lights and headed towards the patient.