Friday, 20 January 2012

For what it's worth

It was only a matter of time....

This happened to a friend of mine and I've been saying for a while now that, sooner or later, one of us is going to pay the ultimate price. I for one do not want to be killed racing to an emergency toothache. In this case, the call was a genuine 999, and I think if I get taken out on the way to a life-or-death situation, then it will have been worth the risk.

Now people who call ambulances for nonsense might see what actually happens when one of us runs out of luck.

Get well soon Jim.


Tuesday, 17 January 2012

To beat or not to beat

I had compiled a few news stories that I found either relevant to my profession, worth talking about or just plain daft but I never got around to posting them, so now I'm making up for it, starting with this:

I grew up in the 60's and 70's, and corporal punishment was legal and quite routine. Teachers in my day used a leather strap; a thick brown or black thing that, when brought down hard on the palm of your hand, delivered a long-lasting stinging-numbing sensation that made you feel like your hand would drop off. I can actually remember the pain to this day. You had to stand outside the school office, or the head's office... or even in the middle of the classroom, with your friends watching, as you waited for the 'belt' to be brought out of the teacher's desk. The anticipation alone was punishment enough.

Then you'd be asked to stand straight, with one hand one top of the other, outstretched, as if begging for money. Every kid I saw getting hit with this thing bent their little elbows in to try and avoid getting hurt too badly as it flew down onto them. However, if you were seen doing this, you'd be told to behave and you'd get another, extra lash for your trouble. Trying to pull your hands away was futile because it often ended in farce, as the belt missed and instead, hit the teacher on the knees.. or worse, the groin. You'd get hit much harder for that. And if this didn't happen, you'd end up getting hit so hard on the tips of your fingers that you'd wish your hands had remained still. But, it's hard to stand there and watch as it comes down, without wanting to run away from it.

Sometimes the evil thing crossed the border of hand and wrist and you'd get a lot more pain than you deserved, as it burned into the softer, more vascular area of your lower arm. No matter where you got hit, you'd be left with a red mark that told of your evil character. One hand, then the other would be battered. Usually one or two blows were enough but some kids got hit four to six times. By the time that ordeal ended, they'd be crying or screaming in pain and would have to go and see the school nurse!

Every teacher could give out this punishment, and there were no rules or guidelines as far as I'm aware, for the meting out of it. I was once given a few lashes just for playing the school piano without permission. I had done no real harm and I was showing off. There was no damage done, except to the ears of those with a love for good piano playing. It was harsh and extreme. I got punished like this for going into the staff ladies' loo, just to see what it looked like. Mrs Cuthbertson, a very large teacher, caught me as I made my escape and I got a few lashes for trespassing... or curiosity as we call it nowadays.

But in those days something else was pretty endemic; physical abuse at home. It was almost normal for parents to beat their children with belts, fists and God knows what else, as a means of 'disciplining' them. Well, I can tell you, it didn't work. It made us fear adults but not respect them. It taught us that the only way to get someone to do what you want them to do is to hit them. Bullying was rife in my day.

I am all for discipline and I am passionately against this 'new wave' stupidity that came along in the 1980's, where children were told they had rights (yes they do but please, just stop telling them!) and that everything could be sorted out by letting them grow 'naturally'; in other words, they could do and say whatever they liked. It was their right to behave like that. Small children calling their parents by their first names is a dead giveaway for this relaxed attitude. Imagine soldiers calling their superiors by their first names.

"Corporal, take your men over that hill and kill the enemy immediately!"
"Yeah, righto Simon. I don't bloody think so!"

Rubbish! They are children; they need to be told what to do and to be guided in the right direction, otherwise they become feral little gits, with no sense of value or truth. Children are all inherently selfish, for good survival reasons, but they should eventually learn that others have rights too and that others have frank opinions. They should also learn that for every bad deed there is a punishment; a consequence for their actions. That punishment does not have to be physical. At least, not to the point of brutality, which is what I described from my school days and home life.

I have never hit my children and never will. I would spank Harry on the backside if he ever went beyond ridiculous but I've never had to. Physically, they need no more than that. I have the right to bring my child into line and to teach him that he just can't misbehave without consequence. More effective, however, is the naughty step. Harry puts me on it if he thinks I've done something wrong! That's how well it works. He believes in the concept and therefore understands that he is sitting on it because he's been naughty. He will learn the difference between good and bad.

Does beating a child make them better behaved? No, it doesn't. It provides shock and awe for school staff, so that they can get a moment of power back for themselves. It teaches the child nothing about leniency, respect, appropriate repercussions or love.

I have an idea. Why don't we just tell the parents of every child in school in the UK to stop bullying the school staff? Why don't parents, who think they know better than the teachers at their child's school, shut up and let these people get on with their jobs? After all, if it wasn't for them, none of us would be able to work because we'd be too busy taking care of and educating our little ones. They are doing us a favour and they are inspiring our children.

Stop going down to school and 'having a go' at some defenceless member of staff just because you don't agree with their policies. The old 'it's my child, so don't you be telling him/her/it what to do' BS has got to end.

When Harry goes to school, I want the staff to treat him with love and respect. I want them to hold his hand if he allows it and needs it. I want them to hug him if he's down or has fallen over and is sobbing. I want them to punish him, using the clever tools of psychology, if he has been bad. If he, for example, pushes another child in the playground, I expect a member of staff to stop him in his tracks, using a firm no-nonsense voice and to instill in him a sense of fear that what he did was so wrong there will be consequences if he ever does it again.

I will NOT march my prissy self down to the school, get in the face of one of the teachers or the admin staff, and bellow 'how dare you shout at my child? Who the f**k do you think you are?!' That, my friends, is bullying. That is someone with no sense of the scale of things and the possibility that their little cherub deserved it and is a little shit at times.

So, no to hitting our kids but a big fat YES to giving school staff the power back they need in order to stop the rot that is festering in our children.


Sunday, 15 January 2012


I've dealt with a spate of cardiac arrest calls recently, where the patient has been in a state known as PEA - Pulseless Electrical Activity; in other words, there's little or no output, but there is still electrical activity within the myocardium. PEA produces waveforms that are similar to normal electrical impulses when the heart is beating, except they tend to be slower than normal because the heart muscle is struggling to cope with a lack of blood and oxygen, as is the brain and so there is much less electrical activity than normal.

However, in at least six cases over the past few days, where elderly patients have been in slow PEA for quite some time (up to an hour), with CPR ongoing and Adrenaline being given by extremely competent crews, and where the teams in question requested permission to terminate the resus on the basis of futility - not long after it was 'called' and given a time for Recognition of Life Extinct (ROLE), the crews reported a return of spontaneous circulation (ROSC). In other words, shortly after compressions ceased, the patient's heart began to beat. This occurred in every one of those patients despite every causative avenue having been explored prior to cessation of resus and a call, in conference to the Clinical Support Adviser and a senior doctor.

Adrenaline, of course, is a major factor here. This hormone can 'make a stone beat', according to one of my doctor colleagues, and I've seen this on many occasions myself (the effect of adrenaline that is), but what I'm thinking about is the possibility that something is happening that could be relevant to the difference between a loved-one dying on the carpet in the front room, or in a hospital bed, with enough time given to say goodbye.

Are we inadvertently creating a ROSC by NOT continuing CPR, or was there a pulse there at the time, during compressions? We continually compress the chest now; there are few pauses and rests, so could there be a reason so many PEA-ROSC outcomes are being recorded?

To be honest, I don't know and I'm hoping that someone out there has had more experience of this and can give me something more to go on than 'it's just one of those things'.

Be safe.

Thursday, 5 January 2012

Naughty nurses

Nurses are getting a rough ride from this report, which concludes that some nurses are poorly trained and ill-equipped emotionally to care for patients who are sick and dying.

I'm afraid I agree with it to some extent (and to a much greater extent on the basis of aspects that I simply cannot air because we don't live in a society where blank truth is acceptable), because I have seen, first hand, on many occasions, so-called registered health care professionals, treating patients with a complete lack of care or compassion. But you have to remember that many 'nurses' are not registered and only carry the title very loosely to describe their line of work in the 'caring' professions. Many Care Home 'nurses' are nothing of the kind and give real nurses a very bad name indeed.

Neither should we let newspaper stories, based on such reports, runaway with reality; there are still a large number of nurses out there who care very much about what they do and that is why they do it. It's still a minority of bad eggs... but it seems to be a growing minority. If the Government hadn't been so desperate to recruit more nurses rapidly, back in the early 90's, using so-called fast-track training programmes, we might not have this mess.

A 2006 report into nurse shortages and the consequent importation of international nurses into the UK argues that the way they were recruited, and the methods used to train them, caused bigotry and created a disingenuous system of patient care.

As with all professions with shortages at a time of general unemployment, as soon as an opportunity becomes available for those seeking any form of work that is less handsomely paid against their usual occupations in descending fields of endeavour, they flock to it. This may actually be happening with my own profession; there was a sudden shortage of paramedics and a coincidental shedding of jobs in the City and elsewhere, attributable to the market slump, and a popular diversion towards ambulance work from individuals more used to calculators than ECGs. This, of course, does not necessarily mean they will become bad paramedics but I wonder at the reasoning behind some choices. Sure enough, people move into the NHS from all sorts of disciplines because they want to make a difference but how many paramedics, nurses... indeed future doctors, are simply in it for other, less humanitarian reasons?

I remember driving to a Nursing Home in the worst of the snow a few years ago. An elderly woman had gone into cardiac arrest and was lying on the floor of the place, with five or six 'nurses' standing over her. It had taken me and my crew mate longer than normal to get there due to the severe weather, and we'd skidded on the road several times, even at low speed. It was essential that somebody took control form the outset and did the right thing. They would have been asked by the 999 call taker to start CPR; they would have been given the option to do it but would have been allowed to decline if they so wished.

Unfortunately for someone's sister, mother and grandmother, every single health care professional in that place declined to do anything to help her, and I was left with the task of calling it before I'd even given it a chance, because there wasn't one.

The bottom line here is, why would you do a job that involves high tolerance and an understanding of human nature if you don't really want to?

Meanwhile... you don't hear of THIS sort of thing every day, do you? What a very lucky lady!

Be safe.