Thursday 17 May 2007

Technology

Four emergency calls, all of them requiring an ambulance.

You can probably tell it was a quiet day today. At first I wondered what was going on. Was it the rain? Was it yet another half term for the kids (but then it would be busier, wouldn't it)? Was it that Londoners had finally learned only to call ambulances out when they were dying or very close to dying? I had hours to ponder these questions during my shift.

The amber car is no more - they are sending ambulances to green calls instead of letting me suss them out. I am one of two cars working on all red calls, sometimes amber but mostly red. There are now at least two motorcycle responders, also dealing with red calls and the ambulances are answering these 'Category A' calls too, so it's little wonder that the combination of miserable weather, the drop in numbers of people around and the higher level of emergency cover had contributed to me sitting around doing nothing most of the day.

Not that a rest is as good as...a rest. I'm fine with it but I get bored if I'm not busy. My day goes much quicker when I am running from one call to another. Everything slows down when I sit and read or watch TV.

My first call this morning was to a hotel I didn't even know existed. A very posh entrance led to a very posh room. You can tell five star luxury when you can swing a fat cat on a bungee around the room and still not connect with the walls (not that I would advocate using a cat in such a way - not on a bungee anyway). I was attending a 91 year-old who had fallen and possibly broken a rib. We call this type of fall, where a simple trip is involved, mechanical.

When I went into the room, he was in bed and I asked his name. There were two women in the room with the man and one of them gave me his name and I recognised it immediately. I also looked more closely at the man and realised it was indeed who they said it was. He is a world famous and well respected American TV journalist and anchorman. I grew up knowing the name without knowing who he was and what he did but I know he is synonymous with honesty and truth in the USA. In fact, it is said that more Americans trust him than they do their own Government. I felt honoured to meet him.

Obviously I can't name him but some of you will probably guess. Keep it to yourselves.

He had fallen hard onto the corner of his bedside table and was battered and bruised around his abdomen and ribcage. Otherwise he was stable and in good spirits. I chatted to him until the crew arrived and we carefully moved him onto the chair and out of the hotel to the ambulance. He was still cracking jokes and asking about the possibility of there being pretty nurses at the hospital when I left him. A thoroughly nice man.

There was a lull in my proceedings and then a call for an epileptic at an office had me on my wheels again. An ambulance was already on scene and I went up to the second floor to find the crew attending a young female who was post ictal and recovering from a fit. Nobody in the office knew she was epileptic, it was a revelation for them. It's a good idea, if you are the duty first aider for your company, to find out who suffers from what so that you can report this to us if we are called and so that you know what you are dealing with initially.

I assisted the crew but had nothing to do otherwise - they had it all under control and the hospital was just around the corner. I left them to it and set off on my next call - a 91 year-old female (two 91 year-olds in one day?) with chest pain. When I arrived at the G.P. surgery where she had been attending a routine appointment, the crew were walking her out the door. She didn't have chest pain, she had abdominal pain and it was better now apparently. She seemed like a nice old lady and the EMT attending was getting along well with her.

I think you have done very well in life to reach the age of 91 and still be going to your G.P. for routine appointments! She walked there herself incidentally.

During the rest of my shift I got a large number of cancelled calls. The consequences of living with FRED are beginning to drain me and my colleagues on the other FRU's and bikes (and cycles). One call after another will get you running on blue lights and sirens then they will be cancelled by the system because there is a 'nearer vehicle' or it was 'sent in error'. whoever developed this system had no idea of how it was going to affect the people at the sharp end. It is extremely stressful to start and stop like that throughout the day and, for your information if you are reading this, it slows our response to calls. I have now become so used to being cancelled that I actually wait for a little longer before I set off on the job. Invariably, I will still get cancelled but it has become a stupid lottery. Other road users are being put at considerable inconvenience I think. It got to the point that I was radioing in to ask if they really wanted me to run on this. That's a good 30 seconds wasted if I am required.

Two calls that were cancelled had the additional element of illogical idiocy in the descriptions. One was for a 'sharp leg pain' and was given as a Red3 simply because the patient had answered YES to the question "Do you have difficulty in breathing?". The second call had an address that gave a street name and included, 'London, England'. No postcode. It should be hilarious but it isn't really. Rant over.

Half way through this shift my vehicle's electrical system failed and my MDT gave up on me. All morning I had been getting beeped whenever my speed went over the legal limit for the road I was on. For some reason, the built-in speed warning system had been switched on. Ironic when you consider how many times I was going to break the speed limit today. It became annoying after a few hours and I couldn't work out how to switch it off without a hammer. I took the car back to the station to be fixed - apparently it had the wrong type of battery in it!

I took another car out but it smelled badly of vomit. I scrubbed and scrubbed the inside but I just couldn't get rid of the pong. I kept the windows open for the rest of my shift, rain and all. Later on a colleague explained to me that he had tried for two hours to get rid of that smell after a patient had thrown up without warning.

My final call came in at the end of the day, so I was happy to run on it knowing that I would be back on time. It was for a male suffering chest pains at a petrol station. I sped right past the place. I just didn't see it. What I did see however, was an ambulance coming in the opposite direction. I figured they knew where they were going so I turned around and followed them. They were lost too. Our MDT's were sending us into the wrong street. Luckily, the petrol station was visible around a corner and we both arrived at the same time. Drama.

There was a City of London police officer on scene and he chatted to me as the patient walked himself (chest pain free) to the ambulance with the crew. City of London police carry defibrillators so they can start CPR and give the first set of shocks if required before we arrive on scene to take over. This young officer was telling me all about the new defibrillators that had been issued. He also let me know that he didn't know how to use it. I showed him and he was suitably grateful.

I'm not worried, are you?

Be safe.

6 comments:

Anonymous said...

Worried you bet I am,if those who are going to use defibs are not properly trained to do so then they will end a life instead of saving one do you not agree.

Xf said...

anonymous

Actually, the fully automated defibs that the officers use is perfectly safe. Its a simple task to use them. Listen for instructions and push the button when prompted.

The machine won't shock you if there is no need.

Anonymous said...

We run into drastically over triaged calls as well with the emergency dispatch protocols our service uses.

EMD, the commercial system we use, may very well be the same one you use. It's in us by many major metros across the US.

And what always screws things up is the question, "Is your breathing normal?"

What the hell is normal? People start fretting. Is my breathing normal? Maybe I'm breathing a litter faster than usual. Maybe I'm breathing a little deeper. Oh my god.

Of course their breathing isn't normal. They're calling 911. They're worried.

And so it goes. The slowly oozing surgical suture that started out as a medium priority call is now upgraded to a "life-threatening" call on account of the abnormal breathing.

Unit 934. Your call has been upgraded to code 3, breathing trouble. Then fire rolls (since it's possibly life threatening), so now I have to contend with 5 very cranky and very sleepy firefighters who'd rather not handle medical calls, and a patient with abnormal breathing.

We know it's unlikely to be true respiratory compromise. Dispatchers know this. But we err on the side of over triage. Meanwhile, due to this simple question, my partner and I face increased risk due to red lights and siren use, and motorists face additional risk.

But it's the game we play. We've had some luck downgrading calls to things like police detention centers, certain types of abdominal pain, falls, etc. But it's still a daily thing.

Xf said...

anonymous

We do use the American model too. The problem we have I think, is a nanny state mentality. Too many people who can't take care of themselves and who utilise the 'free' State care system simply because its there.

We are also extremely frightened of litigation. How about handing over some of the responsibility to the person making the call?

I know its what we have to do and its part of the job but its also why so many of us leave. It cant go on like this forever - something will give...

Anonymous said...

The threat of litigation mires every aspect of my work. While we don't have 'free' health care, per se, for many there is no cost simply because they have no money. It is those patients, particularly those who call some 4-8 times a month, that drive up the costs for all others.

As for refusals, those are where we get into the most trouble. I have run afoul of medical control recently for some refusals I did. The patients met the criteria to refuse: competent, oriented adults, who are no threat to themselves or others. But in these few cases, my run reports were scrutinized by medical control as being risky and I had the unpleasant task of explaining the situation with someone who has made up their mind that what I did was wrong.

So herein lies the dilemma: hospitals are overloaded. They routinely close to new patients as their waiting rooms fill with the sick and not so sick. On the one hand I am trusted to administer powerful medications that carry with them significant side effects up to and including death. I am trusted to recognize life threatening illnesses. and threat them appropriately. But I'm not really all that trusted in the case of refusals.

But what it comes down to is the legal liability. We know that a law suit will end up in a cash settlement for the plaintiff. It's cheaper to pay someone off than to defend one's innocence.

In urging transport even in cases where it is clearly not needed, or in cases where the patient vehemently refuses, I contribute to the overloading of hospitals.

But to do anything to the contrary risks my own license and livelihood. I choose myself over others. And in doing so, I become part of the problem not part of the solution.

Something will give, yes. But I wish it could be fixed before it breaks.

Xf said...

anonymous

Thanks. A good argument and I see the problem but I can also see a difficulty in terms of the right to refuse. A patient with capacity can refuse treatment and hospital transfer, after that any move to enforce such a transfer becomes assault and battery (unless there is a legal out, like the Mental Health Act).

As I understand it, the very act of 'persuasion', if pushed too far can be used by a patient against you as coercion. That in itself is an issue for litigation. "I didn't really want to go but he made me".

We, of course, have so called protective mechanisms in place; beneficence and clinical priority.

Its a minefield but it all boils down to society and the ever increasing erosion of trust between us and them.