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.