I was so convinced that I wanted to be a policeman that one day not long after I’d had the policeman’s uniform, I went missing. My mother was searching the neighbours when she had a phone call from someone who lived in the middle of our village where there’s a crossroads. I was there, in my uniform, about 8 years old, directing traffic. Yup, I wanted to be a policeman.

Skip forward some years later, I’ve not long been in the Mountain Rescue team and I’m studying to be a team medic. I visit one of my closest friends from school and tell him about my recent mountainous antics, and he replied, to utter surprise:

“Yeah, you always were interested in first aid and stuff. I was always surprised you didn’t end up in medicine.”

It was a long drive back home that night and his comment had knocked me for six. I’d never even considered a medical career and I’d long since ruled out the police having decided that I probably couldn’t handle waking a mother up at 3am to tell her that her son had died. My career in computers was taking off, so I discarded the idea of medicine – I’m not sure I fancied 6 or 7 more years of school.

I’d discarded the idea, but James’ comment obviously struck a chord. Mountain Resce helped me find out more about pre-hospital medicine and I found out that, in fact, I was interested. So, after moving to London when my employer was bought out, I decided to try something out. I wrote to the London Ambulance Service and asked if I could go out as an observer on an ambulance for a shift. A few weeks later, it was all arranged – I was to report to Oval and Kennington ambulance station at 7pm for a 12 hour shift. I arrived to a bad start – the person who was supposed to be taking me out had called in sick. I was bundled into the back of an ambulance with a Paramedic and a technician and was told to spend the night with them.

Nothing much happened that Thursday night, it was quiet and by midnight, the technician had to leave to go to headquarters, leaving the Paramedic with no crew. “Never mind,” he said, “come back tomorrow night instead – it’ll be busier on a Friday.”

Luckily the shifts I worked gave me 4 clear days off, so back I went the following evening. I met up with the Paramedic again and took a second attempt. What a night that was – in fact, I spent 3 nights out with Richard Lee, the Paramedic – who turned out to be from a village not 4 miles from where I now sit. More freaky than that was that his wife came from my village. The first night was rounded off in true Welsh colours as we picked up two lads who’d been assaulted outside the Brixton academy. Recognising their accent, Richard and I laughed when they told us they were from Penarth near Cardiff.

Those three nights that I spent learning from Richard and observing the way they work, took the little spark of interest I had and threw it unceremoniously into a huge keg full of dynamite. It ignited a passion in me that’s still going today – brning strongly enough that I’ve committed to giving up a career as a successful communications consultant and instead, to going back to school to become a Paramedic.

It’s been a long road from that innocent comment to where I am now and there are three Paramedics (all called Richard!) who’ve taught me in their own way what being a Paramedic means. For me, it still hasn’t all “come together” yet – I’ve my epiphanies along the way – sudden insights into how the body works, how to look after people and what it’s all about. Jobs that have gone so perfectly, it felt just like another exercise. But for now, the last part of the puzzle is still there, not quite yet within my grasp.

Watch this space.

This blog post was written as a submission to the Handover Carnival, hosted this month by the EMT Spot, on the theme of “…and that’s when it all came together.”

Coming so soon after the recent episode of the EMS Handover on Respect, this post brought the whole topic back to the forefront of my mind again. I know what it’s like to care for people who are responsible for their condition yet refuse to take responsibility for their actions. I know what it’s like to try and help someone who refuses your help. So I’m not unsympathetic to the plight that Buckman describes – it’s an impossible situation at times, made worse, it seems, by the litigious nature of American society. I’ll try my best to not let this descend into a rant on what’s broken about the US healthcare model in my opinion – I’ll just say that I’m glad that I live in the UK and work within the British healthcare system.

The extreme polarisation of the term “patient care” you write about at the start is something that I haven’t seen in the UK – perhaps I haven’t been working with the system long enough. But I find that extreme views are rarely beneficial to anyone, mainly because they seem to define the issue in a very monochrome way and, as Dr Ben Goldacre says so often “It’s not quite that simple…”. I’m not suggesting that the care that you personally offer is deficient in any way, just that any extreme is bad.

I do think that the concept of patient care is somethign we should hold dear to us and is key to providing effective treatment to our patients. There’s a difference between clinical treatment of a medical condition and actually caring for the patient. I think I’m lucky that coming from a first aid background, there were and still are times when there were no interventions that I could make within my skillset that would help that patient, so caring for them was the only skill I had left.

Having said that, I agree that we shouldn’t mollycoddle patients – some people need some tough lovin’ to get the point across and to help them make the jump across the uncomfortable gap of change. If your description of your medical system is accurate, that it’s a system where you can’t be honest without patients for fear of reprisals when that honesty is truly in their best interest, then I fear for that system. The system is failing to provide the best care for the patients and is crippling your ability to do so. Somethign needs to change.

I don’t think that “Do what I say or else” is an appropriate stance for a medic to take. Yes, let’s move them out of that ICU bed into a ward where they can receive palliative care, but don’t make them pay for it. This gives far too much power for a doctor who is of a bullying nature over the patient’s decisions.

I agree, something needs to be done to curb the growing trend of patients who absolve themeslves of any responsibility over their condition – but this is a problem that we see in society as a whole, not specifically in healthcare. Forcing people to take a specific course of action in their healthcare is like using a sledgehammer to crack a walnut when you’re trying to fell a tree – it’s both overkill and yet far too little at the same time.

We’re facing a growing problem where the lack of personal responsiblity in society is stressing our healthcare systems to the limit and we need to find new solutions to these new problems without compromising the care that we offer patients.

Just my tup’pence.

I have to admit, I’m not short of those. The two Richards, both of whom are accomplished and professional Paramedics in their own rights, each with a very different style. Andrew, Sharon and a whole host of others in Mountain Rescue. The other Richard who introduced me to London’s flavour of EMS work. My grandmother, a Nursing Auxiliary during the war who dispensed her own flavour of rough justice and maldod in my childhood. Malcolm, who got me involved in Mountain Rescue in the first place.

But I was looking for that person. You know, the one that made me stop and think. The one that inspired me to start down this path. And I have to admit that almost everyone in that list helped me get where I am and they may well deserve their own Portrait, but they didn’t give me that first spark.

That accolade goes to someone who didn’t really feature in that list. My grandfather.

Born in 1918 he grew up in the Welsh valleys where coal mining was The Industry. Brighter than the average my grandfather went to nightschool to learn to be a Mining Surveyor and made a career of it. He took a few years out to work for the Royal Engineers in India during the war but came back and worked in the mines in south Wales for most of his career. When I knew him, he was silver-haired and retired, spending much of his time working hard in the garden that was once a coal tip but now bloomed after his hard work. Like a lot of people his age he was a heavy smoker and I distincly remember him suffering from his angina. The little red bottle sprayed under the tongue and the pause while he waited for his heart to catch up.

I have nothing but fond memories of my grandfather. My parents both worked office jobs so when I came home from school, I would spend a few hours with my grandparents just a few hundred yards down the road from our home before my parents picked me up. He gave me my frist car, he taught me to write. He once told me that I could do anything if I worked hard and whatever it was I wanted to do, that he would support me – words that still echo in me today.

It all went wrong one Saturday in May. I remember I called into the house to say hello before I headed out for the day. My grandfather was in bed with my grandmother fussing over him. He just didn’t feel very well, nothing specific, known in the ambulance service as “generally unwell”. He looked pale, enough so that I asked him if he was OK. I asked if they’d rung the doctor but my grandfather insisted he was fine. I was 17 and didn’t really appreciate how people lie, even to their loved ones. I took his word at face value and went out to see my friends figuring it was something minor like it always had been in the past.

It was probably mid afternoon when I had a phone call. My grandfather was ill, the doctor had been called, I should come home, post haste. Grumbling, not realising the severity of the problem, I drove down to my grandparents house where it rapidly became apparent how serious it was. Our local GPs, two brothers, were the sons of the husband-wife pair who’d run the local practice before them. One of them was a cardiac specialist and he’d immediately called 999 for an ambulance, recognising the problem with my grandfather for what it was. I was sent to the bottom of the road to direct the ambulance. I windmilled for my life when I saw it and raced up the road behind it as quick as I could. I have no memory of seeing my grandfather going into the ambulance and my next memory of that day is my grandmother, flustered. My grandmother was never flustered. This was serious.

My father drove us into the local hospital 15 minutes drive away. It was a quiet journey, each of us contemplating the worst. We arrived and headed into A&E where they directed us to the Coronary Care Unit. We walked in and were ushered in quickly to see my grandfather sat up in bed smiling at us, connected up to a hundred cables. We crowded around, holding his hand and chatting quietly. My fears abated, we laughed and joked and said that we’d see him tomorrow.

The next half hour is perfectly clear. I was the last to leave and as I walked out my father was waiting for me. The doctor crossed the room in the corner of my eye and clearly called my granfathers’ name, questioningly. We walked down the corridor and my father met a friend and said he’d meet us in the car. I walked my now-much-releived grandmother out to the car and my father joined us about 10 minutes later – and asked us to come back in. The nurse had asked him to get us. Emotions running wild, we went back to CCU and were ushered into what I now know is the relatives’ room. A nurse came in to say that the Doctor was on his way and my grandmother looked her in the eye.

“He’s gone, hasn’t he?”

She paused. “Yes, i’m afraid he has, love. Doctor will be in to talk to you in a minute.”

The next bit was a blur. I have no idea what the doctor said but I remember going to visit the body, the shell, the sleeping form that was once my grandfather. I remember my grandmother taking his signet ring from his finger and wrapping my hand around it. “It’s yours now.” she said, shakily.

My grandfather had held on until we came to say goodbye to him – at least that’s how I like to think of it. Losing him tore me apart, he was a huge part of my life and I drifted through my A-levels in a daze. To this day, I still miss him sorely.

The signs were all there. When I saw him he was pale enough that an alarm bell rang in my head, but was dismissed when he said he was OK. He was sweaty. He had a feeling of being “just not quite right” and couldn’t shake it all day. He had a history of unstable angina, and was a heavy smoker. If someone described that situation to me now, I’d call an ambulance and give him half an aspirin. I’d ask about chest pain. I’d igore his insistence that he was fine.

My grandfather wasn’t some medical genius, a world-leading surgeon or medical scientist. He was a retired mining surveyor. He didn’t show me any amazing medical procedures. What he made me do was promise to myself that I’d never miss that again. If only we’ve have received some basic lessons in recognising these things at school or anywhere. I didn’t see it. I kicked myself for months that I could have done something but didn’t.

Eventually I accepted the situation, but every decision I’ve made since that saw me doing anything medical stems from that one event. From the knowledge that I could have done more if only I knew. A promise to myself and to him that I will work hard. So that hopefully, one day, I’ll turn up in time to help someone else’s grandfather.

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.

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.

It started badly at midnight as I was babysitting the replacement of a switch in our London datacenter and it was running over. I didn’t get to sleep until 0300. I did at least have the presence of mind to turn off the alarm clock before I finally went to sleep.

I got up around 1100 and pottered around the house – I was on duty with the first responders this weekend – which started badly. The first call was to a cardiac arrest in the pub about 300yds away. On scene within minutes, the patient looked bad but since CPR was ongoing I had to carry on. Rich arrived on the RRV shortly afterwards and was able to get a definite reading using his defib – asystole. The blood had started pooling and we stopped resuscitation at that point. Strangely, the overriding memories of that incident are that it felt like I was handling a chicken – loose skin over flesh over bone. The other one was the mistakes I made, but that comes with experience.

So after that I had to get some replacement parts – though the defib itself is fine, the pads are single-use, so I had to get some more. Also the defib stores information about each incident which needs downloading. Fortunately there was a training session on for new recruits so I popped over and had a quick chat with the Ambulance officer running the training. He quickly replaced the pads, but didn’t have a cable to download the information – not a problem, since the defib has sufficient memory for several incidents. More paperwork – and I suddenly found myself in front of the class talking about the incident I’d just been to. Following that, I found myself teaching a session on hypothermia – apparently, I’m the expert on this. News to me.

While we were there, we had a call, but then got stood down with no information. Not uncommon – but a few minutes later, we were called again – the RRV had requested our assistance. As it turned out it was a possible CVA that he wanted a hand with and knew that I was on duty. The call was just down the road from my house…but I was over on the wrong side of Caerphilly, so by the time we got there, the crew was already there and loading the patient on board. Back to pick up my car and then I headed home to meet up with Jon who wanted some driving experience in his new car. Before we could head off, we had a call to a lady feeling dizzy and nauseous. I got back just in time to catch the last 15 minutes of the England – Wales rugby match…and to my amazement saw us beat England in Twickenham. First time in 20 years…

Jon and I headed out for a while and on the way back we decided to grab a takeaway. Just as we got out of the car, the phone went – call to the nursing home not half a mile away. I got there just as the RRV was arriving with the other Richard in it and we got that patient ready for the truck before heading back to the Indian to try again. This time we not only managed to buy food but headed home and almost got in the house before a neighbour asked me for help – there was a child with breathing difficulties. After a quick look at him, I suggested they pop him in to see the GP and headed back to the house to eat. Jon headed off then and I managed a few hours of relaxation before our next call – gentleman with chest pains. We headed down and spent some time looking after this chap until the RRV arrived.

I’ve not long got back from that and it looks as though things have calmed down for now. Five more hours to go….