What is etched into my memory are two ambulance jobs I did as a first responder – my first red call, and my first cardiac arrest.

“Hiya, it’s Ambulance control, can you take a red call please?”

I get the address and jump into my clothes, heart pumping, adrenaline rushing around my body. Still half-asleep yet completely awake, I drive off. 30 year old male, difficulty in breathing. Traffic is quiet, I catch the lights on green and I’m driving down the street looking for the address when I see the ambulance. Deflated, I realise I’ve been holding my breath and start breathing normally again.

I pull up and get out, gloves on, ready to assist, just in case – but the crew is stood in the doorway talking to the patient. I walk over and hear the conversation.

“So you’ve had the sore throat for 3 days, and it’s hurting when you swallow…” He turns and glances at me, nodding, acknowledging my presence. “…and the GP says it’s tonsilitis. Does your mother have a car? Right, well she can take you down to A&E if you really want then, but it’s a Friday night, you’re looking at 4 hours of wait. We’re very busy tonight – if you can do that we can get back to helping people who are seriously ill, like heart attacks.”

I catch the undertones, the patient doesn’t. Within minutes I’m filling in my paperwork. The crew watches me, I’m obviously not familiar with the layout.

“First job?” he asks. I nod.

“That was irritating.” I nod towards the house. “Tonsilitis?” I’ve just about managed to get my hand to steady enough to write. I’m not sure anyone’s going to understand what I’ve written.

The technician rolls his eyes. “Get used to it. About one in ten jobs actually need us, five are pissed the other four are hypochondriacs or timewasters.” There’s a shout from the cab interrupting the cynical view of the world I’ve just become privy to. “We’re off. See you later.”

The ambulance rolls away and I’m left in the street dealing with the disappointment, the adrenaline, the futility, the tiredness. I turn around and head back to bed.

“Hi, got a red call for you.”

I write the address down on the calendar, and write “card arrest” next to it. I blinked. I read the address again. “Er…that’s about 500 yards from where I…from my current location. Show me mobile – count to 10 and show me on scene if you want, I won’t bother calling to report that.” I’m already out the door unlocking the car.

“Oh, ok, thanks.”

Control rings off and I briefly consider running there, but with all the kit….I start the car and drive down the road, turning the corner and pulling up at the pub control had sent me to. The door is closed, I see no way in. I have my kit with me, I’ve not had a chance to calm myself down in the car, my heart is pumping and there’s no way in! I head for the side door and it’s open – I run up the steps, tripping on the top one and almost flying headlong through the door. I blink as I stumble into the gloom, the curtains drawn and I see figures by the bar – the landlord is on the phone.

“Yes, he’s here now…”

I rush over – there’s a woman on the floor, late 50’s I’d say. I rip my kit open, defib out and lid open, get it up and running. Tuffcut shears make short work of the underwire in her bra – I hadn’t intended to cut it, but it’s off now along with her blouse. My mind is racing, and the defib shouts at me in an American voice. “Tear open pads. Remove pads and place on chest.” I’ve already done that and it’s curtly announcing “Analysing rhythm” as I’m getting my Guedel airway out, oxygen fitted with the BVM.

“Start CPR.”

I swear under my breath – it’s not shockable. I don’t even consider whether I should start CPR – I’m already underway now and I have no room in my protocol for recognition of life extinct. The airway is in – easier than the dummies I’ve practiced on. I put my hands on her warm skin and start compressions. As I’m counting my only thought is that the feeling of my hands on her skin reminds me of chicken.  It’s an odd thought and I place it to one side, giving two breaths after 30 compressions. I hear a rib crack and then a second one. I have a rare moment where my brain can catch up and in that moment I get a thought – I can’t hear a siren yet, where’s my backup?

“Do not move patient, analysing rhythm.” The defib interrupts me and I sit back for a moment catching my breath. “Continue CPR.”

My hopes for a succesful rescuscitation are dropping and they hit rock bottom when the landlord opens a curtain to get me more light – I can see what looks like a bruise on part of her body – but at last! I hear a siren approaching. I tell the landlord to go out and windmill for the paramedic, probably an RRV I think.

I look up as he walks in, it’s a friend of mine. He grimaces as he sees her and recognises signs I’ve yet to learn.

“You can stop CPR mate, she’s long gone.” he says quietly, kneeling down and pointing out the purple blotches I’d seen. “Post mortem staining, she’s been down a while.” I sit back on my knees, shaking a little from the adrenaline. He takes over, he’s seen this all before. I can’t stop staring at her, the memory of those two ribs cracking under my hands still vivid.

The police arrive and talk to me and the Paramedic. He asks if I’m OK. I just nod and fill in my paperwork. I pack up my kit – I need a new set of pads and contact an Ambulance officer to get a set and he arranges to meet me that day. I stand outside, packing my car for the moment, stood in the bright sunshine as villagers wander past wondering what’s happening – why all the police and ambulance. I head back inside and take one last look before talking to the Paramedic. No, no chance of reviving her. She’d been down a while. Probably a massive heart attack, probably dead before she hit the floor. How old? 42. Yeah, she looked older. Smoked. He makes sure I’m ok and I head off to get some new defib pads, still shocked by how surreal it all feels. When I finally get back to the house, there’s still a note on the whiteboard with the address and “card arrest” next to it. I wipe it off as I phone control to tell them I’m available for calls again.

Prepared as my introductory post for The EMS Handover Carnival.

We’re up to our forty-something-th callout already this year – we’re well on track to be amongst the busiest teams in the country and this weekend’s contributing heavily to that number. Last night, just after midnight, while Sean and I were just winding up a long-needed clearout of the enormous piles of crap I have in my office the pager went off. With my hayfever going mad this year it’s triggering asthma which isn’t a good thing – especially when I’m going to be heading out with the team!

On the way to base we heard the details – we had a search for a misper down on the Gower – an elderly gentleman with dementia. He’d gone wandering and though we spent quite some time searching, we couldn’t find a trace. With the sun rising, the police stood down for a few hours for a shift handover and we headed back to base with the pagers announcing that the search was continuing. I was heading for bed.

This afternoon we’ve had a request from South Wales police to help recover a body. That’s going on at the moment and on top of that the search is continuing in the Gower. Another busy weekend for us. I’ve been catching up on sleep and preparing for tonight – a first responder meeting to go over any clinical issues we’ve had recently.

Anyway, more office to clean…

After doing my Ambulance shift on Saturday, I headed up to Aberystwyth. Sean and I headed out to a Greek restaurant in town, where I think I surprised the waitress by actually knowing what I was ordering and pronouncing it fairly accurately too. It was a cracking meal and as Sean and I were relaxing in his room later on, the pager went off for the first time in a while. This one was for a search in Penarth for a missing elderly gentleman. Weighing up the options, I decided to not attend – it would be a 100-mile journey to base, 2 hours minimum. Not really worth it – a decision that’s becoming harder to make with rising fuel prices, since I have to pay for my own diesel for going to callouts.

The search continued into the early hours when it was stood down – the team had an ex on Sunday which was supposed to go ahead until the pager went off again at 1000 – a continuation of the previous nights’ callout. Whilst my colleagues were scouring scrubland in South Wales, I was eating ice cream and relaxing on the beach in Mid Wales (sorry guys!). The afternoon peace was broken by another pager message – this time for an area call in the waterfalls which finished fairly quickly. With the afternoon dying away, the search was finally stood down and I enjoyed a peaceful night.

Until last night when, as I was pulling away from Tesco’s, the pager went off. I headed up to base, vaguely concerned about my frozen pizza in the boot. Once there, I found that we had a sighting of a flare in or around the Ystradfellte Reservoir and so we headed up to Storey Arms to meet the Brecon team. With people approaching the valley from all directions, it wasn’t long before we stumbled across some people who had been setting off flares for no good reason and should have known better. I can’t go into detail, but suffice to say, they’re probably not having a good day today.

As I was about to pull out of the layby after packing up, the pager went off again, this time for a possible downed hanglider north of Cardiff. By the time I got to base, we’d been stood down since no actual evidence of the crash had been found. We packed up and headed home where, at 2300, I finally managed to cook my now-deformed and defrosted pizza. I finally collapsed into bed around 0100 and fell deep asleep…

…until about 0145 when the pager woke me – search for a misper in Porth. With feet of lead, I dragged my reluctant self downstairs and headed off to base again. Not much to say about this one, there wasn’t a huge amount of information, it was a horrendously shitty area to search and he was found outside of our search area. By the time I’d packed up the vehicle in base and reached home it was 0600 and I managed a few hours’ sleep before I had to get up for work.

I just hope that this isn’t the trend for the week.

Technorati Tags: callout

I’ve not really been responding with the First Responders recently because of something that happened to me that has caused huge repercussions through my whole life – my car died. Now, I believe in Bangernomics – running cheap cars with higher maintenance costs instead of newer more expensive cars who depreciate quickly. However, I was expecting my little Rover to last another year or two, so it was a little bit of a shock when the head gasket blew and I had to get towed back from halfway to London. I have a temporary fix and I have someone looking for a more permanent fix for me, so I’m not too bad for now but it does mean that I’m not really able to respond for now.

We have had a job with Mountain Rescue – apart from a standdown after a request for assistance for a search in Redditch that is. It was a call to New Tredegar to assist the fire service with two youths stuck on a rock face. They were in a pretty nasty little gully, lots of loose rock, very unstable and we had a bit of a job getting them down. It was nice to be at the sharp end of a fairly technical job for a change, so I was happy with that.

Right now, I’m sat in a fantastic flat in Battersea in London getting Sean and his Dad ready for his Dad’s wedding. It’s going to be fun event I think, I’ve even got a reading to give and I’m taking the groom to the wedding in a rental car. The first of four wedding-type events of this year so far, Sean and I are going to be all weddinged-out by the end of the year I think.

Right, time to wash the car I think.

The shift started off quiet with no calls from Ambulance control until Saturday morning, meaning that I could get a decent night’s sleep. Of course, a lie in was out of the question as the phone rang at just before 0900 for a call to an elderly lady with a PR bleed. I headed off to the home – it’s a fairly decent place, but it’s more of a sheltered home than a nursing home offering full medical care. Apparently, the lady had been sent home from hospital the week before with a perforated bowel, though that seemed unlikely. Either way, she was in pain and so after only a few minutes of getting her details the crew arrived and she was rapidly taken out to the ambulance. I headed back for some breakfast and a cup of coffee.

Off into Caerphilly at lunchtime to meet an old friend. We managed a decent meal without interruption and I started thinking that I might even be able to get some DIY done today. Of course, on the way back from Asda I had a call, so seeing as I was 20 yards from the house I dropped Sean off, he grabbed the shopping and off I went. The call was for a 54 year old female who’d fallen and had a back and shoulder injury. I found the house OK and headed in – the husband pointed me upstairs where I found the lady bent double over the bed. She’d slipped while showering in the bath and fell backwards onto the taps. She was fairly comfortable so long as she maintained that position and just as I started getting some basic obs the crew turned up. They listened to her chest and suspecting a pneumothorax caused by a broken rib, we got her out to the ambulance quickly and she was blued into A&E.

On the back from that call, I had another, this one to a 98 year old female who’d fallen. Off I went across Caerphilly to find the lady had fallen coming out of the kitchen and had bruised her knees. I took some basic obs, reassured myself that she was ok – the walking around the house proved that. Control called to get an update while I was there which is unusual – they asked if I could clear and since there was a crew pulling up and I said yes. Things had suddenly kicked off with an RTC, a collapse, chest pains, several Difficulty In Breathing calls and a “?CVA – unresponsive”. So I got the CVA. When I got there, the “unresponsive” part was true – he was sitting up and breathing fine but wasn’t responding to us. The crew was coming down the road as I walked into the house, so I gave the chap some oxygen and let the daughter bring the crew up to speed. I assisted in getting him out to the truck and headed back to the car. There was an RRV on as well and I heard him heading off to another job as I packed the car up.

Hoping to go home to get a cuppa, I was still a mile away when the phone rang again – 41 year old female, ankle injury. Ok, no worries I said, where? The answer – “The burger van, Caerphilly Mountain.” “Excuse me?” I queried how far from the road she was and was told that the caller said that she was near the road. I asked to put Mountain Rescue on standby, just in case. I got there quickly – it’s an easy run from where I was and traffic was light – the rain however, wasn’t. I got to the top and there was no sign of anyone with a broken ankle. Back to control who called the reporter, asking me to keep a look out for a woman with a dog. Spotting her across the car park, I asked her for some details. Apparently the lady was some distance from the road. I headed back to the car – by now the rain was heavy and the sky gray – or was it the other way around? Either way, it was cold and wet and getting wetter. I called control back and asked them to arrange for Mountain Rescue – I’d need some backup on this one especially if she was any serious distance from the road. I slung a decent coat on, grabbed my MR kit and my Ambulance bag and off we went.

She was some 500m from the road on a muddy and slippery path. The ankle in question was swollen and slightly deformed and moving it was causing some pain, so I got my KISU tent out (naturally, it was the first thing I thought about this time) and insulated her from the ground. There were 3 other family members and her son, so I put them under the KISU tent too. Meanwhile, I had Mountain Rescue and Ambulance control to coordinate. The ambulance arrived and held at the RV which was the burger van. Police arrived soon after with 2 WPCs slipping and sliding their way up. Helimed – the air ambulance – was rejected due to the fact that the casualty was in trees and Gwent’s helicopter couldn’t fly in this weather. Rescue 169 was an option and after a discussion between myself and one of our MR Incident controller’s, was stood to and asked to make their way to us. The police were happy to leave things to us – the terrain wasn’t good and although they offered the fire service, we really needed MR. Our stretchers are designed to have people strapped into them instead of balanced on top and on this kind of terrain I wasn’t happy with anything else. I had a few conversations people and I think it did show a little of the fact that people aren’t that aware of our capabilities as mountain rescue.

Pretty soon we had plenty of people there and with a blast of entonox, we packaged the lady’s ankle in a vacuum splint and stretchered her off. The team had assessed the path on the way in and stood down 169. Within half an hour she was in the back of the ambulance on the way to Cardiff. I called Ambulance control and advised them that I was going off-service for a while – I had to follow the vacuum splint to Cardiff to retrieve it and then head home to get changed out of my soaking wet clothes. I had a thanks from control and from the police Sargent whom I’ve now seen on a few incidents in the area. I had a chance to chat with the lady in A&E and found that she had indeed fractured her fibula right on the ankle. I wished her well and picking up the splint headed home for chips and a shower and some dry clothes. Despite going back on service the rest of the night was nice and quiet as was the rest of the weekend – I’ve even managed to (finally) finish painting the bathroom.

How was your weekend?

Jamming my shoes and jacket on quickly, Sean and I ran out and drove off. Arriving on scene, I texted one of our senior guys who I knew was en route and quickly changed into my boots and a hi-viz. I could see someone standing up by a small quarry uphill from us and Sean and I headed up the scene. A young lad had broken his leg and the ambulance crew were already on scene. We had a few interesting moments but apparently they’d already called 169 to come and assist and apart from covering them in a KISU tent and trying to organise a winching location for the helo, there wasn’t much for us to do. I had the amusing moment of clearing the scene of helmet-less people (mainly police) but other than that it was a fairly rapid and uneventful callout. 7 mins from pager to being on-scene and I think we were stood down within about an hour.

Couple of things come to mind though as I look back and analyse my own actions. I was very aware that although I’d joined First Responders to get some experience of dealing with scenes, this one threw me because I’d concentrated so much on the medical and there was nothing for me to do here – there was a paramedic on scene. I did have concerns about their health at one point since it was damnably cold up there, but 169 shocked us all as it suddenly appeared from over the hill and we were gone before it became an issue.

So, in retrospect, and knowing that hindsight is 20:20, what I could have done better:

• Got a better handover from the ambulance crew. To be fair, the paramedic was being a little brusque and somewhat territorial with his casualty, and while I could have been more assertive, it wouldn’t have benefited the casualty any unless 169 would have taken another hour or so.
• Got my KISU tent out. It was cold up there, but I was mainly trying to get a handle on the scene and get in contact with the rest of the team whilst Mike (who arrived a few minutes after I did) got his KISU tent out.

I think I did OK, certainly room for improvement, something I suspect will come with experience. I certainly think that had we remained there for any length of time I would have chosen a number of actions – got the ambulance crew out before they got hypothermic; got the casualty in a cas bag; moved him onto our stretcher off of the ambulance’s scoop stretcher; certainly I would have offered the casualty some Entonox I think - the Paramedic was sure that the kid was OK with his pain (until he nudged his leg), but I’m not sure how much of that was bravado on the young lad’s part. He refused my offer of Entonox since the casualty was hypothermic – it’s a controversial subject since it’s not technically contraindicated for hypothermic casualties and so long as the cylinder is above -4 celsius it should be ok (you have to shake it first when it’s cold just to make sure it’s mixed). My biggest concern would be monitoring his consciousness levels given that both hypothermia and Entonox can in extreme cases affect it.

Anyway, some food for thought. Good result and the young man seemed to be happy as he got his first helicopter flight, his leg momentarily forgotten as 6.5 tons of noisy, yellow helicopter thundered overhead.

Tonight was agaKin out with the ambulance service – something I’m really enjoying though it is frustrating at times. It’s frustrating because the knowledge that I have in terms of diagnosing and treating some conditions through mountain rescue could be applied here – giving Hypostop to diabetic patients having a hypo; giving Entonox to patients suffering from painful trauma; giving aspirin to a patient suffering from a possible heart attack - just three examples where we could make even more of a difference to the community.

Take the last few calls for example. We had a two hour battle with a lovely old guy who was having a very bad hypo – only the second of his life and he’d had diabetes for some 20 years. When we turned up, the wife was able to take a blood glucose measurement for us and between us we managed to get him to take some sugar and some jam. We can’t perform blood glucose measurements ourselves and we don’t carry Hypostop (actually I do for mountain rescue but can’t use it for ambulance service calls). I’ve had a call to an elderly lady who fell – a “nan down”. She’d broken her femur, that much was obvious from the swelling and deformity, but she might also have done some damage to her knee. I had no analgesia – we don’t carry Entonox – and so I could do nothing for her other than monitor her and keep her company. The last 20 minutes of the hour-and-a-bit I spent with here were very worrying – she was starting to deteriorate and I had nothing I could do or give her to treat her. If the crew hadn’t arrived as I was getting my phone out, I would have been on the phone to control to ask for an RRV to back me up – I was concerned at that point about her slipping into hypovolaemic shock. Finally, a few weeks ago, I saw a gent who was complaining of classic heart attack symptoms, and all we could do was watch and wait. I did call for an RRV on that one because I was worried, possibly not necessary, but I’d rather be dragging an ambulance officer out of bed to come and slap on a 12-lead ECG for nothing than having my patient die.

So a frustrating time at the moment. If the ambulance service insist on sending us to these calls where we are currently achieving nothing but stopping the clock, then at least give us that tiny bit more in terms of skills and equipment that could make such a huge difference to someone’s life.

It’s quiet at the nursing home. We’re led to a room somewhere in the building- the place is a rabbit warren. “She’s very violent.” someone says. Joy. I head in and start talking to her. She looks confused and doesn’t register my questions. I’m just starting to gather the details when the crew arrive. Her right leg is obviously shorter than the left and rotated outwards – classic symptoms of a broken femur.

While we’re helping, the phone rings. It’s control – are we available? We take the details of another call - 6 year old child with breathing difficulties.

I’m more awake for this one and head across town. I get there as the ambulance is pulling up and jump out to assist. When we get inside it’s painfully obvious that this poor boy is having a severe asthma attack. The crew get some Salbutamol going with a nebuliser mask with oxygen. His respiratory rate is at 32 breaths per minute, and his oxygen saturation is down to 83% – both indicators that this kid is very ill. Packing their kit up quickly, the boy is swept up into the arms of a paramedic and taken out to the ambulance. Minutes later, we watch as the ambulance heads off to hospital, blue lights flashing.

I head back to my car and toddle off home, knowing that by the morning, these calls will seem like dreams to me. I just hope I get a decent lie in after this.

Wow.

On Saturday I was prepared. Not wanting to get caught out again, I got all my kit ready, ironed my uniform and got everything ready for my ambulance shift which started back up at 08hrs. I started pottering around the house and everything was going to plan until the pager went off. So I logged off, jumped in the car and headed up to base. As it turns out it was a dog rescue, which we completed quickly enough with the fire service before heading back to base. I headed back home and settled down for the afternoon to clean up the house a bit and watch the rugby. A great game, I was most surprised to be able to watch it all when the phone rang – red call to a gentleman with difficulty breathing. So I headed off across Caerphilly to find this poor gentleman in the later stages of heart failure, with COPD, multiple pulmonary embolisms – he was already very ill, and an illness in the family was not helping. A little confusion and once the crew arrived, a few things became clearer – this was actually a blue call – a scheduled ambulance pick up into hospital. However, it transpires that in the discussions between the doctor and the control room, it had been categorised as a red call – effectively a 999 emergency call. Given his condition, this wasn’t surprising and we were just saying goodbye to the crew when my phone rang.

I’d left my pager at home and this was Les, one of our team members who was coming with me on Sunday to a Scenes of Crime training course at Police HQ. As we were on the phone, he said to me “Get up to base quick then. Gwent police have just called.” So I headed back to the car, handed the shift over to Linda and headed up the A470 sharpish. Straight back to New Tredegar where we’d rescued the dog, this time we had an 11 year old girl with a broken leg. We turned up and once again the fire service were there. After a brief assist, we happily headed home for some food.

I was enjoying the rest of my night and determined to go to bed early when the phone rang. Red call to a patient complaining of chest pains in Penyrheol. We took ages to find it – if you’re anything to do with the layout of roads and names of roads, please think about the poor people trying to find houses in an emergency. Equally, folks, please put your house number clearly on the outside. Anyway, we headed in to find a middle aged chap gripping his chest and groaning with pain every time he breathed. He described the pain as a crushing, gripping pain that spread from his chest to his back and up into his jaw. We couldn’t get a pulse – his arms were so tense from the pain. Linda and I shared a glance and suddenly the chap stopped breathing. He pitched forwards and I threw my hands up to catch him, and as he hit my hands, he drew a breath and carried on. I was worried.

I called control – we had nothing en route to back us up. No RRVs in the area and there wasn’t anything available. I gave them an update and an enormous thanks to the controller for his efforts. He found us an ambulance and gave me an ETA of 30 minutes. He then found me a paramedic in an RRV who turned up very quickly. In the meantime, some more history came out – the gentleman had fallen twice that day, once on his back and once on his front. I considered that his pain was related to the injury for a moment, but even if it was, the pain spreading into his jaw was inconsistent with the injury he described, so we carried on assuming it was cardiac-related. When we finally got the RRV’s ECG out and got a 12-lead readout, his heart looked fine, though because of his pain, it was difficult to tell. A quick shot of morphine and his pain was history. We then had another readout which didn’t concern the paramedic – a good thing. We could finally talk to this chap properly and it transpired that the pain in his back was worst. The crew quickly turned up after that and they took him in to get checked out. Were we right? Well, tough call – the paramedic on the RRV acknowledged that the back and chest pain was most likely related to his injury, but his neck pain was inconsistent. It’s possible he’d had a cardiac incident as well.

We headed home and as I was getting into the house the phone rang again – head injury. Off we went, this time it was an elderly lady. She was on Wharfarin and had a nose bleed – a potentially dangerous condition for someone whose on drugs to stop the blood from clotting. We sat with her until the ambulance came to take her in. I then stood down from my shift and went home to get a much needed 3 hours’ sleep.

The course on Sunday was cracking – very valuable and while it didn’t teach us everything about scenes of crime (or as someone kept saying – signs of cream), it gave us a basic introduction to the concepts. Certainly useful when we come across cases where it’s too dangerous for a SOCO to get to the scene and we have to collect evidence on their behalf. I was home by 17hrs and I lay down for a nap at 18hrs, sleeping most of the way through the night.

Time for a break.

Leaving work, I headed off to base where I jumped in the first response Landrover and headed off. We’d been requested by the Cave Rescue team who had been rescuing a young woman with a dislocated knee from Porth yr Ogof. Fearing a carry out from the cave entrance and having been involved in a rescue for several hours already, they wanted some assistance to carry the lady out. As it turned out, she was of a strong mettle and hobbled herself out with some assistance. With that done, we packed our kit away and headed back.

By the time I’d gone home to change it was gone 2000 and I headed out to pick up the first responder kit. Meeting up with Nigel and Alison we chatted for a while before suddenly the phone rang – we had a red call in Abertridwr. Off we went to a lady with breathing difficulties. As we turned up it was apparent that she had chronic emphysema and as I was getting out a 100% mask to replace the 28% one she was wearing, the crew arrived. Alison and Nigel had accompanied me and I’d called Dilwyn and Rachel who were on shift with me. As the crew came in, things kicked off – a member of the public approached from outside saying that someone had been knocked down. Leaving the crew to the lady, we headed outside to check him out.

A young man was lying on the floor apparently unconscious. Eliciting a response from him wasn’t too difficult though he vaguely mumbled. It transpired he’d drunk half a litre of vodka and had been assaulted. I’d asked for a police presence and a second truck. There was no ambulance available so we kept an eye on the casualty while the police worked out what had happened. Eventually we managed to get him to respond – fairly explosively as it turns out and we backed off suddenly as the police stepped in. Dad was there by that point and as I pointed out to the police that now he was walking around there was nothing wrong with Dad taking him down to A&E as he was more drunk than anything else. The police agreed and Dad gladly put him in the back of the car as I stood down the ambulance.

Rachel and I went to fill in our paperwork and just as we were finishing my phone rang. Looking confused I answered to hear the dulcet tones of Gav, manning the RRV desk in Control. But I’d diverted the phone already…? He gave me the details of a call with a suspended patient.

Rachel and I headed off and got to Bedwas where we rushed in to help. The crew wasn’t far behind us and together we worked on the man for some time before the crew finally called a stop. Sadly we’d not been able to revive the man and a large family came to grieve for his loss. After our work we cleared up and gently moved the man onto the bed where we covered him in a blanket – he’d vomited quite a lot and we had a fair amount of cleaning up to do. Eventually, with the police on scene, we headed off home. For me, to wash my jacket and trousers which both had vomitus on them…and I’m on duty tomorrow again. For now, I need something to eat, put my clothes to dry and some sleep.