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Big Yellow Taxi


15 Storeys High

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Big Yellow Taxi is a song title......the song is originally by Joni Mitchell...but loads of people have covered it....and really...the song has absolutely nothing to do with the way I present the title here.....for me, the words "Big Yellow Taxi" have very different connotations. In the UK, the majority of our ambulances are now yellow...there are still a few rubbish old white ones running around but most have died and been replaced with the bright yellow. Many U.K. Paramedics, Emergency Care Practicioners (ECP's), Ambulance Technicians and Emergency Care Assistants (ECA's) refer to their ambulances as "Big Yellow Taxis", or "Buses"....It's supposed to be a sarcastic reference to the 80% of people that phone for an ambulance for one of three reasons.

 

1) They still mistakenly believe they'll get seen quicker at A&E

 

2) They actually think we're a taxi service

 

3) They have no common sense and are unable to deal with minor injuries/illness by themselves.

 

There's a further term......."materni-taxi"......for those expectant mums and their friends and family that have nine months to plan a birth and and how they might get to the hospital but don't bother because an ambulance is "free" and they don't have to wait.

 

You may or may not already know that I work for the ambulance service. I'm an ECP...i.e. a Paramedic with a few extra skills. I work both on a Rapid Response Vehicle (RRV) and a Double Manned Ambulance (DMA).....On the car I'm on my own, on the ambulance I have a crewmate, usually a care assistant.

 

I've been in the service for several years now and I've seen a lot, experienced a lot and know pretty much all the tricks on the book. There are two sides to my job. One good, one bad.....the good involves helping people, caring for them, improving their lives and sometimes saving their life. The bad involves being assaulted, spat at, sworn at, urinated on, ordered about, never having enough vehicles, not having enough staff, the politics and having to deal with the same old time wasters day in, day out. The bad can certainly outweigh the good but then you get that one job where you really make a difference, you save someone's life and the crappy bits just sort of get forgotton.

 

I'm about to embark on a training for a different tier of the ambulance service called the Hazardous Area Response Team (HART). It involves several weeks of intense training in various dangerous rescues and will go live in January 2011. To get this position I had to complete an application form, an interview, a medical assessment and a physical assessment. The physical assessment involved 3 tests.

 

1) A ladder climb of around 13 metres to a 3rd floor storey, and then being lowered down to ground on a rope. This is designed to test your ability to work at height.

 

2) A tunnel test. Consisting of a crawl through a tunnel with three constricting obstacles and two "bridges". The way back is done in complete darkness. This is designed to test your ability to work in confined spaces.

 

3) A weighted carry test. Consisting of wearing a 35kg weighted vest whilst performing nine laps of an obstacle course (involving step overs, duck unders, stair climbs and zig zags) finished with a dummy drag (75kg) and a manual dexterity test (3 tests - unscrewing screws, clipping belts together ect).

 

The position will still involve dealing with normal 999 calls but will also involve dealing with rescues in hazardous areas......before this we had to wait for firefighters to bring patients out of dangerous areas before we could begin treating them. Now, I'll be able to enter the "hot zones" and begin treatment right away.....This new team has been developed partly as a result of the 7/7 attacks on London (which occurred 3 years ago today) and will mean better care for patients that find themselves injured or ill in dangerous and hazardous environments.

 

I thought I'd document how my training goes and how/when developments occur, as well as my daily, "normal" work....which I'll still be doing for a while yet.

 

Last night I went to a motorcyclist......at around 3:30am. His back wheels had locked whilst going around a corner and he'd clipped a car, come off his bike and skidded along th eground for about 30 metres, hitting a wall. He was wearing a crash helmet, a t-shirt and cotton trousers. Hardly the best gear. He had severe gravel rash all over his back and shoulders, a nice, deep hole in his right elbow down to the bone, neck pain, lower back pain and hip/pelvic pain. He was lucky to be alive. I gave him oxygen, morphine and fluids. We triple immobilised him and rushed him into resus. If he ever rides again I hope he reconsiders what he wears. It may be hot and uncomfortable to wear full leathers in the summer but it will save your life or your limbs or stop you from suffering longterm problems. Protective gear is not a gimmick.

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Great read 15S - I hope you will continue with this. in the 1970's my cousin used to be an ambulance attendant/driver as they were called then in Croydon and some of his stories were very interesting.

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Ahhhh...the profession has come a LONG way since then...or so I'm led to believe....back then it really was a case of pick you up and drive you in regardless. Nowadays, our job is to keep people out of hospital.

 

Among many other skills I've been taught to clear a C-Spine, do a cranial nerve test, prescribe antibiotics, suture people, catheterise men, refer to GP's, refer to falls teams, refer to police...blah blah blah.....all that can keep a patient at home. Taking someone to hospital is supposed to be a lsat resort nowadays. Gone are the days when we were actually there for life threatening emergencies only. Those jobs make up only 5-8% of our daily work. Nowadays I don't even go on lights and sirens to jobs even though "technically" we're supposed to be at supposed life threatening incidents within 8 minutes. 8 times of ten it is so far from life threatening I could have more breathing difficulties than the patient. When you've been in the job for a few years you can tell by the one sentence description what the job will be.....

 

For instance....

 

"Male, lying on pavement" - is almost always some drunk bloke.

 

Added to this is the description of "being unconscious but complaining of chest pain".....there are several tests one can do to determine if a patient is actually unconscious or just pissing around.....one is to lift their arm, hold it over their face and drop it. If their arm "miraculously" falls down by their side inside of hitting them in the face they're most definitely awake. Others involve checking for a pain response and checking their eyelids. A competent Paramedic will know straight away if a person is truly unconscious and begin treatment straight away. If we know you're wasting our time (which we will) we will make you look like an idiot, because someone out there somewhere is dying and doesn't have an ambulance because of you.

 

"Female, difficulty breathing, breathing quickly, age 20" - is almost always a panic attack

 

"Male/female, cut leg/arm/finger -lots of blood = is almost always a tiny scratch that has stopped bleeding by the time we get there.

 

"Male/female - fallen -care line calling" - almost always because the carers can't be arsed to pick the patient up because they have a "no lifting policy". There's no such thing. They just can't be arsed and will happily let their patient lay on the floor for hours while waiting for us to get there. They're a low priority you see....because they're inside, conscious and not injured. I'll get sent to a drunk bloke laying on a wall before I get sent to a little old lady that's fallen and can't get up "in case he's unconcious".

 

Male/Female - Shaking a lot. - Almost always a drunk person being a muppet.

 

Concern for welfare - Almost always someone that has gone to bed and refused to answer a persons annoying phonecalls. Moreso on night shifts.

 

I think we can see we're hitting a pattern here.....Can anyone see why we might get just a tad cycnical?....Some might say I'm mean and heartless.....but I don't care.

The people that are genuinely ill/injured and require an emergency ambulance I will give everything I possibly can to, regardless of their age, gender, enthnicity, sexuality, lifestyle and so on. People who are unable to take care of their own minor injuries/illnesses annoy me because there are so many resources out there.

 

I have countless stories of inappropriate calls. Some sad, some just plain bloody annoying and some from people sho should know better. It's annoying because however much you try to educate people another one just takes their place. I can go an entire run of five shifts without peroforming a single Paramedic skill. Which is good in a way....because it means I'm not dealing with poorly people but in that time I'm dealing with people that don't really need me.....when I could be available for someone who does. It's not unheard of to have a person having a heart attack to wait 30 minutes for an ambulance. It's not unheard of for a person hit by a car and is peri-arrest to have to wait for a DMA for 45 minutes because the clock has already stopped because I got there in the car within 6 minutes. That did happen by the way....he arrested and died on me while I was waiting for backup. There's only so much one person can do.

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Some of that stuff will come in useful for me.

 

It's not dissimilar to 'homeless' people 'shelter-shopping' for a bed and food when they don't need it. Or trying to get into a six month stay in rehab to avoid looking after themselves when they aren't really addicts at all.

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Watch out for the "fits" too. That's a common one with homeless people and also people that are in the cells that have just been arrested or awaiting trial.

 

Fits and Chest Pains are very, very common complaints amongst the homeless, addicted and incarcerated. You'll get to learn what a real fit looks like though. If they're smart they'll feign chest pain because 9 times out of 10 a person needs to go hospital for blood tests and observations, even if I've done an ECG and can clearly see theres no abnormalities. They know the system better than we do. We just can't take the risk.

 

I remember last year...being called to "Male, 22, cardiac arrest in the holding cells at the crown court". Even in the crown court they couldn't see this bloke was faking it and were in a huge panic. On my arrival they screamed at me "he's not breathing" (he was), "he's been fitting for ten minutes!" (he wasn't). My treatment? A quick dig in the ribs and a whisper in the ear to stop being a muppet. He soon "came around".

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Not really....is it just another term for being addicted? There are thousands of them out there......that along with the "gang" speak is a nightmare.....

 

"blud I've bin shanked at the hands of a bruv" - What?

 

apparently that means "Paramedic, I've been stabbed in the side by a bloke I thought was my mate" or something similar. I didn't like to tell him he hadn't been stabbed but had merely fallen over and knocked himself out.

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Not really....is it just another term for being addicted? There are thousands of them out there......that along with the "gang" speak is a nightmare.....

 

"blud I've bin shanked at the hands of a bruv" - What?

 

apparently that means "Paramedic, I've been stabbed in the side by a bloke I thought was my mate" or something similar. I didn't like to tell him he hadn't been stabbed but had merely fallen over and knocked himself out.

Shanked or shank is a word use here as well, especially about home-made knives in prisons.
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Good luck with your HART training.

 

there are several tests one can do to determine if a patient is actually unconscious or just pissing around.....one is to lift their arm, hold it over their face and drop it. If their arm "miraculously" falls down by their side inside of hitting them in the face they're most definitely awake

 

That's good to know. I hope I never need to test it out but I'll certainly keep it in mind because it may come in handy one day.

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Early shift today. 11 jobs.

 

1. "M, done back in. Gone into spasm" - Started running and got stood down enroute

2. "F, 82yrs. Panic Attack. Very bad breathing" - Not conveyed

3. "Child on board plane with breathing difficulties, landing shortly" - Not conveyed

4. "M, collapsed. Cardiac problems, unconscious" - Stood down enroute

5. "F, 46yrs, taken OD" - Stood down enroute

6. "M, fallen off pushbike ?#arm" - Conveyed to A&E, minors

7. "M, fallen. Now sitting on stool but can't get up due to leg pain" - Diverted

8. "M, ankle is bleeding because ?vein popped" - Not conveyed, aranged GP appointment

9. F, ?# humerus - Diverted

10. "M. Choking, unconscious, cyanosed on floor. 96yrs" - Got him back to his normal self. Living Will in place, not for resus/active treatment. Not conveyed. GP informed.

11. "F, fitting, 45yrs - Recovered well. Not conveyed.

 

So....out of 11 jobs...I took one to hospital. To the minors area. I used no Paramedic skills at all. The only drugs I gave were Oxygen and Entonox. Kind of a boring day really. I was half expecting the choking job to be a full cardiac arrest by the time we got there but he still had a pulse. After some abdominal thrusts and clearing of his mouth/airway plus oxygen we got him breathing again and he recovered pretty well. Unfortunately he probably aspirated on the food he was eating and will more than likely get a nasty pneumonia, which is then pretty likely to kill him without I.V. antibiotics, which he won't have because of his living will and daughter having power of attorney.

 

The guy that fell off his pushbike had a very nice fracture-dislocation of his elbow. A dog ran out in front of him causing him to fall off. His arm probably won't ever be the same.....he'll probably never be able to straighten it completely.

 

I found out I have my Breathing Apparatus (BA) course in the middle of August. Not sure when the rest are yet. Each member of the team is going to receive around 40 thousand pounds worth of PPE (personal protective equipment). Amazing.

 

I'm glad to be home and out of my uniform......it's been so hot today. I'm lucky that our vehicle had air con.

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It was boring in the sense I didn't get to use any skills, give any drugs.....none of it was that taxing.....But I met 11 new people......plus all their relatives, carers, friends and randoms....and everybody was nice...and nobody died.......so that makes it a good day all in all.......you just feel more satisified if you've had to perform some procedures and use your skills to save a life in a shift.....you go home with more of a sense of achievement when that happens. Obviously I don't wish ill health and injury on people but it happens and when it does I want to be the one that goes to them......so I can use the skills I spent a long time learning....

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I am just starting to catch up here a bit...slowly.

 

This is a wonderful journal -- I love reading about these experiences you are having and will be very interested once your HART training starts to hear all about it, here.

 

I didn't know about the origin of the word "jonesing", but I think it's sunk into the common vernacular, too, to mean just "hankering" for something -- "I'm jonesing for something sweet".

 

I'll have to remember about that trick of dropping the arm to see if someone is really unconscious -- because all this time, I've been doing just what you said: letting it fall to my side. What a terrible faker, how come I didn't think of that! Heh heh heh....just teasing.

 

I know it must be very frustrating that you get so many jobs that seem so trivial, and about how the waste of resources is very unideal, but on the other hand, there's a certain "better safe than sorry" mandate there that I almost wish we had. I don't know what paramedics deal with here in the majority of the cases, but I have a strong feeling that there aren't things going on like attending to people who are concerned about unanswered phone calls. I think in a case like that, they would be directed to the police instead, first. (Which brings me to the thought that the police must really get a load of trivial stuff, too.)

 

I've actually found where I live that there is more hesitancy to use resources than abuse of the system, especially among the elderly. I don't know if that's your experience at all, or it can go equally either way; but I've seen more people in these parts refuse help or resist it even when it's appropriate. Of course, there are people who go in for every little thing, but it's more common that someone doesn't want to "bother"...and this could be a personality thing (lots of pride), or a cultural thing. I live in a building which houses nearly all disabled and elderly, many of them who don't know English, or barely. The fire/ambulance team is here REGULARLY. And it seems to me that much of the time, it's neighbors who are concerned and over-rule the injured party.

 

Like one day I walked into my front door into the lobby, and an elderly woman was just sitting on the floor, back against the wall, in front of the elevators. I thought she was just dazed and confused at first, but as I came up to her, I saw I streak of blood on the wall, behind her head, and I immediately looked around me to find someone to help her up (I hate that I can't lift a little old lady to her feet myself, that I'm not strong enough) and since no other residents were about, I told her to stay put where she was and told management (I didn't have my cell on me at the time.) I stayed there and a couple of other residents eventually showed up, and by the time the ambulance arrived (4 minutes, I'd guess), she was trying to fight people off, meekly. It was a real struggle for them to convince her she needed to be taken in to have a look at her head.

 

Another time, my neighbor (a retiring, quiet Korean woman -- we've found a way to communicate and mostly understand eachother, somehow, even so, with pared down language) stopped me as when I was outside on the porch to show me one of her lower legs, which was splotchy and red, and swollen. She said, "Hot. Hot." And I said, "Yes. You need doctor."

"Later."

"No, not later. Bad. Bad problem, you get sicker. I call doctor."

"No, friend will call, take me later."

"Who friend? Bible study friend?"

"Yes."

"When? When they come? Do not wait with this. More pain, worse later, need help NOW."

"They come later on."

"I go in house now and call 911. Okay?" (I happen to know that she'll say anything to get me off her back. But she showed me, didn't she, her leg?)

 

And so it goes.

 

She was actually gone a day or two.

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I should probably clarify that the paramedics here are not qualified to prescribe antibiotics or do many of the things you do (like suturing). Only M.D.'s (or some N.P.'s/P.A.'s -- Nurse Practitioners, and Physician's Assistants, respectively) here are licensed to do such things, and it's done in a facility.

 

Which makes me wonder...which is more wasteful: overuse of the ER (being sent to hospital every time, rather than being treated in the home), or overuse of the kind you experience. Seems like either way, people are going to end up using these resources for non-emergency situations because they don't have other providers (or don't bother to go).

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^^ don't forget about urgent care. I try to go there instead of the ER. The urgent care in many US hospitals is for issues that need to be seen that day, but aren't as serious as requiring the ER. Like if you have a UTI or I thought I had strep throat, so I went there. I like urgent care a lot, and I've never had to wait more than 10 minutes to be seen by a PA.

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Another early shift today....Just 5 jobs because a couple took a few hours to deal with.

 

1. "F, PR Bleed + passed out a couple of times"

2. "F, fallen out of bed, speech slurred, can't move her right side"

3. "F, fallen and hit head"

4. "F, ?collapsed or passed away, no reply at address. Police en route"

5. "F, Can't get up"

 

All ladies today for some reason.....sometimes it goes like that....Again...another day where I didn't need to use any paramedic skills. Drugs I gave were oxygen, entonox and glucogel. We had a student paramedic out with us today so I got my crewmate (who is also a student paramedic) and her to act as a crew with me observing....pretty easy day for me really because they're both very good.

 

Job 4 was a collapse/fall, not a death btw.

 

One thing I absolutely love in my job is being able to go into other peoples houses and have a little nose around.....I've seen so many amazing houses, gardens and pieces of furniture....it's really interesting what you find in peoples houses.....today we ended up in a huge house with a full size snooker table, swimming pool and wall shelves full of boxed Match cars. Not long ago I went to a lady who painted....and her stuff was really quite good....she mostly did paintings of animals but there a few others with broken dolls and scary faces and so on.....those, she told me, she did whilst going through her divorce....Another guy was in a wheelchair because of M.S. and he spent an hour showing us all the different gadgets and techniques he'd come up with to make his life easier.....they were really ingeniuous.....he's a very clever man. And I'd never have met any of these people sitting in an office.....

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Was #2 a likely stroke?

 

Possibly. Several of the signs and symptoms pointed to that......but she'd also stopped long term steroids suddenly in the few days prior, which can cause an adrenal crisis.....which has some similar symptoms.

 

Today was another early shift....6 jobs

 

1. "M, Cramp in top of thigh. Can't get off toilet. Carer can't lift him."

2. "Carer on scene. F. Breathing erratic. Mouth dropped"

3. "F, Chest Infection, collapsed in Dr surgery"

4. "M, Had MI 2 weeks ago. Now has chest pain"

5. "M, severe headache, coughing up clood"

6. "RTA 2 cars. Driver trapped in car - totally smashed up"

 

The first job.....jesus...what a horrible old man...rude, obnoxious and just generally a horrible old git....He actually had abdominal/back pain which disappeared after I cannulated and gave a small dose of morphine.

 

Job 2. Her breathing was fine. Her mouth was fine. She was perfectly alert and with it. Told us to go away because she was tired and wanted to sleep. We got her GP to do a home visit.

 

Job 3. The GP had decided it would be ok to admit straight to the medical admissions unit. I, on the other hand, decided that she needed to go into the resus room at A&E. The patients heart rate was 176, she was in fast AF and her blood pressure was 99/40. Cannulated her as a precaution.

 

Job 6. Poor lady.....trapped in her car for 65 minutes while it was cut away. We had to get the roof off, then the drivers side and the dashboard had to be lifted up away from her. She'd slid halfway down into the footwell, her knees were trapped by the dashboard and somehow her seat had bent forward. She was in an extremely awkward position. She suffered internal abdominal injuries, an open, compound fracture of the patella, fractures to her lower leg and lacerations and grazes to her arms, chest and neck. We tripled immobilised her, gave her high flow oxygen, cannulated her and gave her morphine and fluids. This job caused me to finish an hour late but I don't mind because it was a genuine job and she needed us. I hate finishing late for timewasters.

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Job 6. Poor lady.....trapped in her car for 65 minutes while it was cut away. We had to get the roof off, then the drivers side and the dashboard had to be lifted up away from her. She'd slid halfway down into the footwell, her knees were trapped by the dashboard and somehow her seat had bent forward. She was in an extremely awkward position. She suffered internal abdominal injuries, an open, compound fracture of the patella, fractures to her lower leg and lacerations and grazes to her arms, chest and neck. We tripled immobilised her, gave her high flow oxygen, cannulated her and gave her morphine and fluids. This job caused me to finish an hour late but I don't mind because it was a genuine job and she needed us. I hate finishing late for timewasters.

 

That sounds like Hell on Earth. Thank goodness you all got her out. Was she conscious ?

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Yeah....conscious throughout. That's why we get in the car with them...not only to provide the medical care and immobilise the head/neck but also for reassurance and to explain exactly what's happening. It's quite a scary experience if you've never been through it.....it's very loud with grinding/crunching/smashing/almost road drill type noises and you get covered by sheets so no dust/glass shards fall on you so it can also be a little claustrophobic at times too. Add all that to the pain and anxiety caused by injuries, throw in a bit of shock and you certainly have a "situation".

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My in-laws were nearly killed by a drunk driver several years ago. One of them died on the table (pupils dilated) but was revived. The jaws of life had to get them out and I don't think they have ever been the same psychologically since.

 

One of them has no memory of the accident but the other one does and it really sounded horrifying. Thank goodness there were people working quickly to save them.

 

It's very important work for sure!

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