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.

“There’s been reports of a casualty across the road. I’m going to be staying here for better comms.”

We all nod and head off. I grab the radio I’ve got and call in to get a radio check and I’ve barely finished when we find our casualty. A 7 year old girl with breathing difficulties. We’re on it like a shot, oxygen and a nebuliser mask out, I’m on to control to get some backup, Mum is upset and panicing. No air ambulance available and the nebulised salbutamol is having little effect. There’s no county ambulance either and our vehicle has a puncture. There’s a quick conversation – I arrived at this incident in my own vehicle, we’ll transport mum and daughter in that. We’re moving, rapidly through the trees whe the radio comes to life – there’s an ambulance en route to us now…

We’re still packing up and debriefing from that job when the radio comes to life again. “We’ve had a call nearby for a young child that’s fallen, no parents, friends have raised the alarm but are not with her.” We look at each other and we’re off again, this time I’ve got the purple gloves on my hands as we head through clouds of gnats. We find her next to a few old logs which she’d been climbing on. She’s 9 years old and looks quite healthy. She’s complaining of a bump on her forehead and a painful ankle. I talk to her, practice my new skill – talking with kids. I’m not good at it and I’ve been practicing. She responds well, I’m on a winner. I check her over carefully and she reports a painful neck. She’s talking to me and I’m adding up her GCS in my head as she tells me she’s feeling sleepy. GCS of 15, she’s alert and responsive…wait what?

She’s feeling sleepy.

Despite the warm summer evening and the gnats crawling all over me, my attention is focused on her as I slip my hands onto her neck and hold her head still. I look at the stump she fell off – 2 feet? 3 feet? A colleague takes over her C-spine management as I get oxygen going – but she doesn’t like the mask on her fact. She’s content to hold it near her mouth and breathe the cold gas though. We package her up and move her down to the road to be met by a county ambulance. I’m all smiles and chatty and she’s responding well.

We haven’t even started the debrief when somone runs up to us. “Come quickly, it’s my friend – he fell off the stile, I think he’s hurt!” We head down, shaking our heads and find a gentleman lying on rocks next to a river. He’s fallen some 2m and is complaining of a lack of sensation in his legs.

Fuck.

I’m running this incident as my colleagues deal with first aid. I request backup from Ambulance control to be told that there’s no land ambulance available. They check on a helicopter for me as we request more people and more equipment. Our landrover pulls up, blue lights flashing and cars slow down on their way past, their occupants staring at a blue-shirted throng of rescuers arranging to move this man onto a stretcher from one of the most awkward positions I’ve ever seen. It’s not long before he’s on a stretcher and moving. We look at the fence – it’s in our way. Bolt croppers are called for and the fence is ready to become a casualty of this incident.

“Ok, hold it there folks.” A voice calls from behind me and the ‘casualty’ pulls his collar and spinal management kit off.

“That collar’s really uncomfortable.” He says, rubbing his neck. I turn around and find ‘mum’ and our two previous casualties grinning behind me. The exercise is over and we’re talking amongst ourselves about how it went. There’s lessons to be learned – there are always lessons to be learned. But we have three people who are alive and kicking (in the scenarios) because of the care we gave them.

As we head back to base I’m thinking that I’m glad I got to practice on children tonight. I’m rusty in dealing with children, but I seem to be getting the hang of it. I shudder as I think of the moment when my casualty told me she was feeling sleepy and know that I’m better prepared for the next one. Chances are, the next one won’t be practice.

Every organisation has its own internal politics – it’s just how life is. Some play power games, some want money, some build empires, and some just want to get on with the job. Politics in voluntary organisations can be particularly bad – it’s not that surprising when you get a bunch of people together who all believe passionately enough in a cause to donate that amount of time and effort. It’s the main reason I stopped my work with the First Responders – between the voluntary side and the involvement with the ambulance service, there was just too much politics. Mountain Rescue in this area has traditionally had some interesting politics, but never let it get in the way of the job.

So when Mountain Rescue politics did kick up last week, it caught me by surprise and annoyed me. More than that, it blindsided Sean. As a result he’s now announced that he’s no longer interested in joining the team, which is a shame – I was really looking forward to working with him on jobs and seeing him do well on the team.

Thing is, it’s got me thinking and has got me pretty angry right now. Do I really want to be part of a wider organisation who can treat people like that? I love the job that we do, I love getting in there and doing the job, and I know that 99% of the people in the organisation are there to do the same as I am – get on with rescuing people. But I find myself questioning my membership over the event. I’m sat here at the moment while there’s a rescue going on a few valleys away thinking about my membership and my commitment and other things – my hayfever, my contribution. Hayfever’s stopped me halway out the door today because I realised that if I wandered up a hill with the pollen this thick, I’d be collapsing in a heap of mucus, sneezes and wheezes before I reached the casualty. No drugs can stop that amount of pollen from affecting me.

So my head’s in a mess with a million different thoughts going through it right now. I’m damn well sure however, that I’m not going to let politics or the team come between Sean and I.

Postscript: I toyed with the thought of posting this for a while. I’m aware that several people will read it and feel like I’m airing the organisations dirty laundry in public. However, I feel strongly that since I started this blog that I would comment on the things that I came across that mattered to me, whether positive or not.

Wherever I go, the pager goes. It goes on vibrate sometimes, other times it even goes on silent. But it stays on, ready to receive its little message.

At night, it sits next to the front door, where it has reception. It’s piercing tone set to beep continuously until I get to it and hit a button – it’s the only way it will wake me up. It’s very loud, especially in the early hours of the morning.

Three nights ago, it went off and interrupted my sleep. Meh, it happens. I can’t respond during nights this week – I’ve got a big project to finish off at work and sadly, Mountain Rescue doesn’t pay the bills. So, when the pager woke me at 0631 on Tuesday morning, I wordlessly padded downstairs, turned it off, set it to silent – because I knew there’d be more messages – and went back to sleep. It was a search in Carmarthenshire – no way I was going to get there and do anything useful before work.

Wednesday morning, it was about 0145 when it went off. This time, it was followed rapidly by a “555″ message – stand down. Fine, back to sleep, grumbling lightly.

This morning it was 0146 when the initial alert came through. Frustrated and tired, I shut it up and went back to sleep. 0200 the message came through – missing person in Caerphilly, all of a 3 minute drive away. Ten minutes later – stand down.

Can I get a decent night’s sleep tonight please?

Our quarry is in this valley somewhere. We start searching – it’s already dark and the snow is falling hard. The snowcover makes it worse as it covers the grass between the tussocks and the tops of the tussocks themselves evenly, meaning that with every step you’ve no idea if you’re going to be standing on a tussock or sinking knee deep in snow. For a moment, the snow slows and I get a view of a line of headtorches and search lamps stretching from ridge to ridge, sweeping down through the valley, a line of searchers led by dogs and handlers searching for the two of them.

Two and a half hours in and I’m tired, wet and steaming lightly in the cold. My skiing jacket isn’t coping with the hard tromping we’re doing and I’m overheating inside it. There’s a call over the radio, one of the dogs has a strike. Adrenaline pumps around my body and as one the line stops, instructed by control to hold position. It’s confirmed, the man and woman we’ve been looking for, alive, cold but very happy to see us. We sweep forward and crowd around, our lights turning that small patch of mountain to daylight. A find! Alive!

We turn and start walking them off, grinning, glad that we’ve found them alive.

A message over the radio: The man’s wife has reported him missing as well, but not to worry, the police told her that we’d found him safe and well.

He blanches.

Did they tell her who I was with, he asks.

A sudden realisation hits us and we try to hide our smiles at his misfortune. We shrug and walk them off.

It’s only later, back in base tucking into tepid pie and chips the police provided that we hear the reaction of his wife to finding out who he’d been with. I left base with visions of his clothes on the snow-covered lawn when he got home.

Truth really is stranger than fiction.

Sorry about the gap recently, I’ve been mad busy sorting Mal’s wedding and other things. This one obviously did not take place recently.

We’d been called at about 1700 to search for a missing person near Swansea. I was at base quickly enough and once I was changed, I got the second vehicle ready to leave and off we went. Blue lighting it out of Dowlais along the A465 to Hirwaun is never fun – it’s a horrible piece of road and with plenty of spray and rain, we held back a bit. Once past Hirwaun, we were on a dual carriageway and then the M4. One last bit of driving through semi-urban areas and we were at the RV.

It was a pretty quick briefing. She’d been missing since the previous night. There was some concern for her safety. There wasn’t much to go on. Here’s your area, do your 300m search. Off you go.

The 300m search area is an interesting statistic. A lot of material has been collated in respect to missing person behaviour and the number of people found within 300m of the point where the missing person was last seen or was last known to be is very high. As a result, we frequently conduct a hasty search of the area immediately surrounding that point.

We’d only been searching for an hour or so – 300m doesn’t sound like much, but a circle of radius 300m is quite large – especially when it’s heavily wooded or scrubland. We’d met up with the second party and were just working out how best to attack the next area when one of the lads who was still walking back to us stopped. It took us a second to realise he was trying to attract our attention, but he’d seen something – and indeed, there she was. In a sleeping back with candles and a magazine, she lay in the forest, cold, wet and by now quite hypothermic.

We wasted no time tending to her and were soon handing her over to the Ambulance service for transport to hospital. The mad rush stopped and we started gathering our equipment – and our thoughts.

I stopped to think. How could she do that? I understand how people can get low enough to feel that there’s nothing left for them – I’ve had some pretty low points in my life and without the presence of good friends I’m not sure I wouldn’t have been in the same boat. But what I couldn’t understand was that she was sat there, under the trees, waiting. Within shouting distance of some houses, she lay there and let the elements take her – and that I couldn’t understand. I can fathom the need to end it all, but to passively lie there and wait…why the torture of waiting?

We’ve searched for a number of “despondent” people over the past few years. Some we’ve found safe and well and helped. Some we’ve been unable to provide anything but comfort for the family with the knowledge that they didn’t suffer. Some we’ve just not found. Each one is unique. You’re never sure if it’s a cry for help or a determined attempt to end it all. I’ve seen all age groups from teenagers to octagenarians, I’ve seen all manner of methods. I’ve accepted each one on it’s characteristics. This search struck a nerve in me, something happened there that I couldn’t understand.

I’m not sure I’ll ever understand how she could wait there, sitting in amongst the trees.

Of course just as I kick my shoes off, the pager goes off. For once it’s a false alarm – random characters, though because I have poor reception here it takes a while to confirm that (thanks Mark!). Either way, it’s been snowing hard and now several of the roads in the area are treacherous to travel. I’m pretty surprised that we haven’t been out tonight at all – although the snow didn’t really hit until quite late giving people the chance to get home and shut the doors and settle down a bit. Speaking with a friend from the ambulance service, he said that the snow’s been keeping people indoors tonight which explains the peace we’re experiencing.

Looking at the snow out there, once the temperature drops overnight I think it’s going to be tough going getting out of here, so unless the snow melts by the morning, I can’t see myself heading into the office. I’ll see how it is in the morning, but at least I can work from home if I need to. I do however wish I was out playing in the snow.

Weather warnings (with thanks to the Met Office)

I’m checking my kit. It’s that time of year where wet thigns don’t dry so well and so I’m making sure that my kit is all set. But I have a reason for it. This is the view of the UK according to the Met Office this evening. Those areas not in green are expected to receive snow tonight – we’ve had the first suggestion of a flurry around here, but the wind is whipping it around, so right now the roads are clear. 

 
In the past when heavy snow has hit the Welsh valleys, it’s made life difficult for a country that doesn’t handle snow well and we’ve been asked to help the other emergency services. We have 4×4 vehicles and clothing suitable for spending periods of time outside not only in snow but in very cold weather – something that’s going to be pretty prevalent for the next few days.

So tonight, just in case, I’m preparing. Fresh water in a clean drinking bottle. Clean and dry clothes. An appropriate selection of clothing. Flask. Fresh batteries. That kind of thing. This is how I’m spending my Sunday night – and I assume there’ll be a few other people across the country doing the same tonight. Preparing for the worst – hoping for the best.

What are you doing tonight?

I’ll be raising my glass to them and hoping they all recover fully.

So what are my views so far? Well, it’s a highly competent CMS for starters - at one point I despaired and started looking at Joomla, but the way it models content disgusted me even more so that Drupal. Now, in this respect, I’ve probably been very lucky. In my last job, I worked for Box UK whose main product is Amaxus, a CMS. Amaxus has been designed from the ground up by some very smart cookies – in fact, mostly by one very smart cookie indeed - Dan Zambonini. The conceptual design for Amaxus is, quite honestly, a work of genius. The model that it uses is simple, easy to grasp and provides incredible flexibility. Of course, it does mean that rolling out a site is quite a lot of work, but with a commercial CMS, that’s where your money comes in – the implementation is the gravy; the professional services part of the contract is normally for this kind of product worth far more than the product itself. So from that perspective, I’ve been spoiled. I’m used to an excellent model to work with…and that’s where I got stuck.

Quite simply, the amaxus model is this: take a navigation tree. Each node is a page made of blocks. Blocks can do anything from picking a single piece of static content, to providing a list of content that’s picked uniquely for each visitor depending on their browsing history through the site. Content is created independently. One piece of content can exist anywhere in the navigation structure more than once. Once you get your head around that lot, you start to see just how powerful this is. Drupal is…well…slightly different. It took me a little time to get my head around it, so here’s a quick run down for anyone currently trying to get theirs around it.

In Drupal, content is the key. The navigation system is only there to provide a convenient way for a user to get to some content. Therefore, the content has to exist before the navigation structure. Now, Drupal makes it easy for you by adding a panel in the content creation page that lets you add a menu item to that content piece, but it’s a paradigm shift for me. The other thing to realise is that blocks are configured on a site-wide basis. So instead of configuring blocks in each node, you configure the blocks once – however, each block has a whole bunch of options you can specify that tells the block when to appear. I’ve used this on our website to provide different kinds of users with different menus – members, non-members, content editors and admins. I have to admit I’ve been frustrated a few times by trying to create a menu before the content, although I think I’m starting to get the hang of it now.

Anyway, I’m impressed. I’ve built a fairly complex site in less than a week and I’ve learned a lot about Drupal in the meantime. Development will probably slow down a little over the next month or so as I learn about the next two things I want to implement – a workflow engine and the associated flows, and a custom content type and associated views for callouts.