Big Yellow Taxi

[15 Storeys High]

Late shift tonight......with another hour long over run. I'm knackered after todays shift.....we had bang on 30 minutes break and that was it.

 

1. "Been unwell for 3 days. Unsteady on feet, mouth drooped"

2. "GP admission - Fall related"

3. "F. SOB. 94yrs. Unconscious"

4. "F, taken OD, Unconscious"

5. "Assault. M been punched in face, eye bleeding"

6. "M, Nosebleed. On warfarin. Blood running down throat"

7. "M, Accidental OD fast acting insulin"

 

Job 1 - I think his wife had accidently OD'd him on his epilepsy medication. Filled out a vulnerable adult form as a precaution.

Job 3 - In a nursing home. A lady with dementia. Not SOB, nor unconscious. There was, in fact, nothing wrong with her. Stayed with her for a little while because she was great.

Job 4 - Absolutely hate getting this type of job through.....given my history....especially when it's a female and they're allegedly unconscious.....I always feel like there's a lump of lead in my stomach on the way to the job. This particular time, she wasn't unconscious.....just pretending to be. They must think we're bloody stupid....do they think we've never seen it before?

Job 6 - Lovely man.....nose had been bleeding for over an hour and just wasn't stopping....that's what being on warfarin does....he was hypertensive, which is probably why the bleed started in the first place. Took him into resus.

 

Got my contract for my new position through today. Need to sign it and get it sent off....my "official" start date is going to be the 19th July but nothing much will change until the end of the year.....except for the few courses I'll be going on between now and then.

 

And now, it's off to bed. Got to fit in a session at the gym tomorrow morning and a few chores to do before work in the PM.

[tiredofvampires]

 

 

Ughghghghgh.....

 

Why do people pretend to be unconscious, really? Maybe a dumb question, but still...do they think it'll get them more pampering or something? I'm not clear on the motive....

[15 Storeys High]

^ It's usually one of a few things....

 

1. To save face/garner attention from bystanders/friends/families

2. They want a bed for the night or they live near the hospital and want a cheap taxi home

3. Because they think they're outsmarting us/that we're stupid and have never seen it before.

 

Night shift last night and Twilight shift night before.....I can barely remember the jobs....

 

Last night....

1. F, chest pain, SOB - 12 Lead ECG showed left bundle branch block, probably old but can't tell unless you have a previous ECG. Gave aspirin & GTN, cannulated and pre-alerted A&E.

2. Can't for the life of me remember what this one was...

3. F, 89, Fall, no injuries. Daughter can't lift her.

4. F, 18, vomited blood - This is a typical complaint from young people that have gone out, got drunk, gone home, thrown up and decided what they've thrown up is actually blood. 99.9% of the time it isn't. This one wasn't either.

5. M, 27yrs. Playing football earlier, now has neck pain, can't move - This guy had played football 8 hours earlier, headed the ball and felt pain in his neck. He then woke up in the night with more neck pain. Because he claimed he had central neck pain (i.e. bony tenderness) on palpation we had to collar and board him. We all knew it was muscular but you have to play the game and cover yourself.

6. F, 24 wks pregnant, shaking, can't breathe properly - panic attack.

 

Night before...

1. M, fall ?NOF - Had severe pain right hip/groin/midshaft - Gave entonox, cannulated and gave 10mg metoclopramide and 10mg of morphine, which didn't touch the pain, very surprising since he was 96. It did however make him throw up and feel like crap so I couldn't give him anymore. Had to rely on entonox. Probable fractured neck of femur.

2. M, assault, injured eye - this guy had learning difficulties. Some little pikey demanded a cigarette from him and when he said they smacked him in the face.

3. M, abdo pain for last 3 days - Hadn't bothered going to his GP in the last 3 days or taken any painkillers. Thought he'd wait until 2300 and then call an ambulance. Walked out to the ambulance, walked into A&E.

4. F, 18. Took speed. Feels like she's dying - Took an unknown quantity of speed orally 3 hours prior, went home, started to come down and feel like rubbish, threw up, had a panic attack. Moral of the story - Don't take speed.

 

I think there was one more but can't remember

 

They've decided, in their infinite wisdom, that it'll be a good idea to reduce the kit we carry in our response bags. apparently I now only get one of each cannula in my cannulation pouch, which is not adequate at all. If I'm with a patient at the bottom of a cliff and my vehicle is at the top and they need bilateral wide bore cannulas for fluids and drugs what am I supposed to do? Just say..."hang on a minute while I pop back to the vehicle to get some more kit".....yeah....that'll work. What if I have two patients that both need the same size cannula? What if I have a patient who I've intubated on scene and something goes wrong with the tube? Am I supposed to leave it in and hope for the best because we're only allowed to use one on each patient now? It frustrates me that these people in their cushy little offices implement these things with no consultation with the people that will be using or not using the kit. It makes my job far more complicated and stressful.....it's almost like they want to suck any enjoyment out of the job by pissing you off as much as they can. All I want to do is to be left alone to do my job and be provided with the kit I need to do that job properly. That's all. It's not asking much.

[annie24]

 

Ughghghghgh.....

 

Why do people pretend to be unconscious, really? Maybe a dumb question, but still...do they think it'll get them more pampering or something? I'm not clear on the motive....

 

i was wondering the same thing....

[15 Storeys High]

Went to a stabbing today....in broad daylight.....busy part of town....multiple stab wounds....claret everywhere.....meal break 7.5 hours into shift......hour over run.....

 

I'm playing in a charity football tournament tomorrow.....it'll be a welcome relief from work....sometimes a run of shifts can completely drain you......sometimes you can finish your run as fresh as you started it.....it all depends on the jobs you get, how many late breaks you get, how many over runs you get.....and so on.....this week has been pretty draining. Tomorrow will give me a chance to burn off some of the stress. I'm looking forward to it.

[15 Storeys High]

I had to force my way into a bathroom this morning. An elderly man with dementia had barricaded himself in there and refused to open the door to his wife, who was beside herself with worry. He was pretty strong....took all of my weight to force the door open. Once we'd got in and said hello he was the most polite, dignified man ever.

 

Also had to give a dose of atropine for a bradycardia of 38. He was so difficult to cannulate but I knew I had to get a line in to give the drug. Then he dropped his BP so I had to put up some fluid. Still alive on arrival to hospital so I've done my job.

[15 Storeys High]

A lady in septic shock today.....very very poorly.....heart rate of 192, BP of 82/40, Temp of 42 C, SPO2 of 92%, confusion.....Got I.V. access.....squeezed a litre of fluid through and got her BP up to 120/62......High flow O2 and a pre alert.....she's in intensive care now. She's only 37. Think I'm gonna check on her tomorrow.

 

Oh, and I went on a boat, delivered a baby and got punched in the face too (not all on the same job, obviously). Pretty hectic day really. My bed is calling me.....

[annie24]

wow, crazy day!!!

 

how did the lady get septic shock?

 

hope your face is ok.

[tiredofvampires]

I really shouldn't laugh, nor jest about this, but I admit it's a little disconcerting to think of delivering a baby, only for it to punch you in the face.

 

 

 

Not that it isn't disconcerting how it really went!

[15 Storeys High]

wow, crazy day!!!

 

how did the lady get septic shock?

 

hope your face is ok.

 

She had a major operation, with lots of complications at the end of June. It's more than likely arisen from that. I checked on her last night. She's still with us. 50% of people with septic shock will die. I hope she isn't one of them.

 

Face is ok thanks....only a little bruise.

 

I really shouldn't laugh, nor jest about this, but I admit it's a little disconcerting to think of delivering a baby, only for it to punch you in the face.

 

 

 

Not that it isn't disconcerting how it really went!

 

That would definitely be one for the news....haha....

 

Trying to remember the jobs I went to last night....

 

One was a 2 year old girl fitting - febrile convulsion......pyrexic at 39 C. Once we stripped her off and gave her some calpol she perked right up.

 

Another was a man with a severe PR bleed who collapsed at the GP surgery. He was poorly.....and for the third shift in a row I had to give some fluid.

 

Another man put his hand through a window, someone fell through a table, another guy had abdominal pain (think he probably had kidney stones), a chest pain, a geri down and some drunk woman made up a load of symptoms, demanded we take her to hospital then promptly got up and walked out as soon as we handed her over. Cheeky cow.

 

Drugs I gave = Entonox, Morphine I.V., Sodium Chloride I.V., Metoclopramide I.V., Calpol, GTN, Aspirin and Oxygen.

 

On a night shift tonight. On a Saturday......with what looks suspiciously like a full moon.....Marvellous.

[DN]

with what looks suspiciously like a full moon

It's amazing that effect does seem to exist - same as 'sundowners'.

[15 Storeys High]

^ It really does.....on a full moon night shift there are always far more assaults/fights and acute mental health problems/overdoses as well as the just plain strange.

 

Last night was go go go......all night long. We went to our first job 2 minutes after we logged on, had our 30 minute meal break 7 hours in and finished an hour late this morning.

 

Jobs included.....

A man hit around the head with a brick - lots and lots of blood - took a while to clean everything up afterwards.

 

A teenage girl punched to the ground and kicked/stamped on and around the head by a group of 6 people, 4 of which were men.

 

A teenage girl who we found lying on the forecourt of a garage, drunk and asleep.....alone, no money, no I.D. and no idea where she'd been, what she'd done or who she'd been with.....Luckily it was me that spotted her as we drove past and not someone that might have harmed her. We woke her up, checked her over, helped her up and took her to hospital, which acts as a "place of safety".

 

A drunk man feigning chest pain and unconsciousness. apparently he was "unconscious" for 5 minutes......not just drunk and asleep like he was when we got there. His friend wanted us to lift him...and when I said no he started to get a bit annoyed. This bloke was massive and there was no way I was lifting him when we knew he was perfectly capable of getting himself up. There was a time when I would have but I'm a lot more savvy now and know when someone is taking the piss.

 

A man that took an overdose and then later ran away from A&E - the police had to be called to go out, find him and bring him back to hospital.

 

An older man who had fallen yesterday, injured his shoulder and was having a lot of trouble mobilising/completing daily activities because of his arm being slinged and pain. His flat was an absolute state. His family lived nearby and supposedly visited daily. Doubtful. I referred him to the Falls Team and Rapid Response who will be visiting him today and hopefully he'll now get the social care/input he needs......this was the job that made me finish an hour late.....but I didn't want to just pick him up and leave him with nothing put in place so I spent a while sorting out the referrals.

 

There were a couple more......which I can't remember.....Just minor stuff...nothing interesting....otherwise I'd have remembered.

 

I have six weeks of training for my new position coming up in August. It involves training in gas masks, gas chambers, breathing apparatus, working in burning buildings, working in CBRN incidents and training on the different protective "suits" and masks we'll be getting. I'm really looking forward to it.

[SWEET_J]

Good thread..thanks for starting it...we don't always appreciate what you guys have to deal with day to day!!

[15 Storeys High]

Horrible day today. Probably one of the worst I've had in a long time. It always hits you hard when it's someone you know.

 

Other than that, I had an argument with a doctor over the phone, delivered a baby, went to an elderly lady who fell down her stairs from top to bottom and a chest pain - non cardiac.

 

Bring on tomorrow.

[sidehop]

Some stories there; my friend is an EMT in Boston; they're so underrated and underpaid. Often time it seems like they are the ones saving a life or plugging in extra 10 minutes so they have a chance to live.

 

Looking forward to hear more

[15 Storeys High]

I forgot to say that I found out today that the lady that was in the car accident the other week died in hospital. The investigating officers want us to do a statement.

[BellaDonna]

I forgot to say that I found out today that the lady that was in the car accident the other week died in hospital. The investigating officers want us to do a statement.

 

Oh no. That is very sad.

[DN]

It can be hard to deal with - a lady I was talking to on Monday died suddenly on Tuesday - she was 104.

 

It must be harder to deal with sudden death with much younger people with so much of their natural life left.

[metrogirl]

Can I ask you a question 15 Storeys? Have you ever worked as a nurse in a hospital setting or have you only been an EMT? Do you prefer one over the other?

[15 Storeys High]

I was a nursing assistant on a ward for about a year and a half when I was trying to get some experience in care/medical work to help my ambulance application. I much prefer being out and about on the road. I'm my own boss and I make all of the clinical decisions. I get to see sunlight everyday. Most of the time I only have one patient at a time and I can take as long it takes to get them sorted and I don't have to worry about what jobs I have to do next because I don't know what it is or even if there are any more.....And having only one patient at a time means I can give them my full attention and not be distracted by Mrs Miggins in the next bed.....Although being out on the road has it's stressors I find them easier to deal with than the stress of being cooped up and running around like a headless chicken on a ward. I found the ward too routine and kind of boring really. We did this then and then that at that time...every single day....I like that there is no real routine in a day for us out on the road....I like the spontanous nature of my job, the unexpected and the expected all rolled into one. And plus....when you've taken part in a dangerous/precarious rescue and saved a life you get to feel a bit like a hero for a little while, which is always pretty nice. I don't think you can get that same feeling being in a hospital, with all the tools and perfect setting you need. I'd never go back to working on a ward now I've tasted what I've got.

 

Today for instance....

Young guy, walking in the woods at 5am (who knows why?), claimed someone started chasing him so he ran through a thorn bush, fell in a river, dragged himself out of river, fell in another thorn bush and lay there for 2 hours until he thought it was safe. When we got to him his clothes were torn to shreds and he had superficial wounds from the thorns all over his body and he was hypothermic.

 

Brilliant old lady who fell over and probably fractured her leg but was absolutely determined that we weren't going to lift her onto the stretcher. She did it herself. She was pretty awesome.

 

A couple that decided on a suicide pact and took a bunch of tablets.

 

A young women who took an overdose.

 

A man who fell from his loft down into his hallway and suffered a head injury.

 

A lady having a TIA.

 

Complete mixture there....old, young, medical, trauma, mental health......Makes the day go quicker.

 

Plus, if you have a horrible patient you only need to get them to hospital and then you never see them again!

[BellaDonna]

I don't have to worry about what jobs I have to do next because I don't know what it is or even if there are any more.....

 

Really good point. Makes a lot of sense.

[metrogirl]

Thank you for responding and to be honest, the way you talk about your days I kind of already knew what your answer would be.

[DN]

link removed

[15 Storeys High]

Ahhh yes.....the target times.....Well....firstly, there are no "clinicians" in control....the person that takes your 999 call is not clinically/medically trained so they don't have the knowledge to decide what's wrong with you when you call. They ask you questions and based on your answers you are triaged by a computer system. Until this system is improved the target times are useless. Currently, the system doesn't recognise a stroke as a life threatening incident, thus a patient having a stroke is deemed able to wait longer than the target of 8 minutes.

 

Add to that, 8 times of 10 an "8 minute response call" is not at all life threatening. The minute you say you can't breathe properly it becomes an LTI (life threatening incident) - This can range from actual LTI's (i.e. COPD exacerbation, Asthma attack, Anaphylaxis, Heart attack ect to panic attacks, chest infections and exercise induced shortness of breath.

 

If you say you have chest pain you get an 8 minute response yet this could range from an actual heart attack all the way down to a muscular injury.

 

If you say the person is not awake this can range to actual unconsciousness to being drunk to being asleep.

 

Take, for example last night - 19 year old, apparently passed out through drink. He was categorised as an LTI because he was apparently unconscious. He wasn't. In fact, he got up and walked to the ambulance because I told him to. He also didn't throw up on the ambulance floor because I told him if he did he would be cleaning it up himself.

 

The computer system is flawed. And currently the people in control aren't allowed to over ride and say....well...no, you don't need an ambulance or ask them to get themselves to hospital. If you phone you get a response and that's not how it should be.

 

However, I would welcome some different targets that focus more on patient outcome. Like I've said before.....I can get to a patient in 6 minutes and they die but it's considered a success because I met the response target. I can get to a patient in 8 minutes and 45 seconds and they live yet it's a failure because I missed the response target.

 

Yesterday I was called to a man who claimed he'd taken an overdose. He was threatening violence (to fill bottles with lighter fluid, light them and throw them at us all - Keep in mind HE called US) so the police were asked to attend. They wanted to meet at an RVP a little way away so we went and sat there for two and a half hours waiting for the police to show, only to find they'd gone in without us, detained him and not bothered to tell us. Now, I'm wasn't complaining because I needed a quiet shift and it did me good not to be so busy but that was an ambulance off the road for over two hours......there aren't enough as it is.

 

The bottom line is if that people didn't abuse the ambulance service with inappropriate calls, violence and just plain stupidity there would be enough of us to reach people in need in a decent time. The number of 999 calls has more than doubled in the last 10 years, yet the number of staff and ambulances hasn't changed. There are a lot of things wrong with the service and the way it's treated and that's what is the most stressful about the job.

[15 Storeys High]

Last night I got sent to a cardiac arrest half an hour before I was due to finish....which meant I finished 2 hours late.

 

When I got there he wasn't breathing and had no heartbeat. Basic life support was already in progress and his heart rythym was asystole, which is non shockable. I intubated him and secured his airway first, then cannulated his external jugular vein (EJV) and started administering adrenaline 1:10,000. I gave 6 doses of adrenaline in total, a dose of atropine and squeezed in a litre of fluid.

 

The home had no lift so we had to carry him down two flights of stairs whilst still trying to continue with life support. It's a tricky process but we had secured his airway, cannulated him, started advanced life support, taken him downstairs and into the vehicle and were on our way within 40 minutes. On the way in he flipped into VF, which is one of two shockable rhythms, so I shocked him. Unfortunately he flipped back into asystole and remained there until our arrival at hospital. When we left him in resus he had cardiac output with full pulses felt, but was making no respiratory effort. I'm about 99% certain he won't have made it to this morning but at least we gave him a chance.