This is a field I occasionally feel like a bit of an impostor in. I’m not a Paramedic. I’m not a Doctor, a nurse or an Ambulance Technician. I am what I would call, an advanced First Aider. Mountain Rescue calls me a Casualty Carer and shows me how to deal with fractures, give drugs, inject people and care for people. St John Ambulance calls me a Patient Transport Attendant and teaches me to use AEDs, gases, use the equipment in an ambulance and care for people. But for all the journals I read and the knowledge that I gain, I’m a first aider.

Over the years, I’ve had respect from patients, health care professionals, members of the public and members of the armed forces. I’ve recently had a number of comments from healthcare professionals that have made me realise that there’s a lot of respect out there for volunteers in this country. Comments from members of the public, from the twitterverse, from friends and even from senior ambulance service officers have all demonstrated that they respect the work that we do. Some of then even respect that while we would like to work for the Ambulance service, some can’t because the NHS isn’t known for the luxurious lifestyles afforded by the salaries and mortgages aren’t known to be cheap things these days.

I’ve also had people treat me with significant amounts of disrespect because I, like thousands of other people in this country, are volunteers. We’re not paid healthcare professionals – but that doesn’t mean we aren’t professional in our work, whether that’s paid or not. I’ve seen Paramedics disrespected by staff in the hospitals, by patients and by their colleagues. Equally I’ve seen patients disrespected by their carers – and of all the disrespect I’ve seen, that one leaves the worst taste in my mouth.

Ingore me because I’m a volunteer. Treat me badly because you’ve had a bad experience with the commercial arm of St John. Swear at your officers. Argue with paramedics in the middle of your A&E department. They all leave a bad taste with the people around. But treat your patients with respect, even when they don’t deserve it. A mentor of mine once pointed out that we’re invited into people’s lives at moments that are significant and horrible for them – for us, it’s just another job, just another DIB, another MI. We’re invited into their lives and they share with us the most intimate details of their personal lives, their troubles, their fears. He taught me to treat my patients like human beings, simple things like asking everyone to leave the room when the paramedic is putting the leads on a woman’s chest because she has to bear her torso to do so.

I’ve learned respect and I’ve learned to earn the respect of my patients. I’ve learned that everyone has a story, even if they seem like assholes and I’ve learned to respect that people can appear like assholes when they’re going through a traumatic time.

Respect. Disrespect. Which will you chose?

At home, I’ve used the Internet to learn – googling unknown terms, reading blogs with ECG challenges, learning about the body’s processes and how we affect those. I’ve researched specific conditions or drugs that I’ve come across and am unfamiliar with. I’ve witnessed discussions on blogs and on twitter that have made me think about my treatment, my handling of patients as well as conditions that I come across.

Out in the field, I’ve used my Blackberry to great effect:

• Drugs – I’ve looked up drugs that I’m not familiar with and some that even the paramedic on scene hasn’t seen before. There’s an enormous array of drugs out there and it’s important for us to be able to find out some key information.
• Conditions – we frequently attend to transport patients who have been diagnosed by their GP. Not only are Doctor’s handwriting notoriously bad, but they on occasion use terminology I’m not familiar with. A quick google normally sorts that out and gives me a better understanding of the patient’s condition and how to treat them for the short time they’re with us. I have even, on occasion, passed this information on to the nurse who’s taken our handover.
• Finding a location – ah, the perennial problem of ambulance work: finding the patient. I’ve lost count of the number of times I’ve used Google on my Blackberry to find nursing homes. Google maps has helped us navigate there when TomTom has failed.
• Getting into a house – yeah, not your usual use of a mobile phone this, but I did once make use of the Internet to find the telephone number for a patient’s family to find out where the spare key was kept. 1am, standing outside the patient’s house, freezing cold and stomping around in the snow with no way of getting in, I was very glad I had my mobile with me.

I’m actually considering getting the BNF on my phone at the moment to help us with understanding drugs – the drugs a patient is taking is often helpful in giving us an idea of what the patient is suffering from when the patient can’t or won’t tell us.

I’ve even, on occasion, been known to use my phone to make phone calls.

So, how do you use your phone? How has it changed the way you work?

The two not-so-important things were to look up what a bruit was and the second to find out what Tramacet is (a strong painkiller). The second resulted in an interesting conversation with the A&E nurse after we’d booked our patient in.

The other use was a little more…immediate.

A job came through to us around midnight, asking us to go to the local A&E and pick up an elderly lady from a corridor and take her home as she’d been waiting for some time. These kind of jobs are lovely because they’re simple, there’s little or no medical problems to worry about (and while I’m in this for the medicine, it’s occasionally nice to know that your patient isn’t going to die on you. Probably.) and people are supremely grateful. So we tromp into A&E, find our patient and sit her in the ambulance to driver her home. She’s a lovely old lady with a cracking black eye and mild dementia – she’s lucid but isn’t too good at remembering things.

So we get to her address and park up. There’s some talking from the back as I fiddle with the radio for a second to let control know we’ve arrived. A head appears next to me as my attendant sticks her head through the partition. “We can’t find her key.”

We help her look through her pockets. We help her look through her bag. Twice. No key. I run down and check the door, yes it’s locked. Shit. Wait – that’s a keysafe, great. I run back – does she remember the number to her keysafe? No. Shit. Any relatives? No. Son or Daughter? No. Do the neighbours have a key? No. Does she leave one under the mat or a plantpot? No. Carers? Yes, but they’re private and she doesn’t remember the company name.

Right, contact control who have nothing on the incident record. However, she was taken in earlier in the shift so the controller goes to dig around to find the original incident. Right. We empty her bag out. Still no key. Control get back to us saying they’ve spoken to the original crew who mentioned a son. Wait, a son? So I jump in the back and skirted around the earlier questions with a more direct approach.

“What’s you’r son’s name, my love?”

“Chris.”

My colleage stares at me open-mouthed.

“Where does Chris live?”

“In LittleVillage.”

This is bad news – LittleVillage is about 90 minutes West of where we were at best. Still, let’s try for his address to see if I can get his phone number. She remembers the house number and can describe the street where he lives but doesn’t remember the road name. So I get my phone out. Luckily LittleVillage is about 2 miles from where I grew up and her description of the street is one I recognise, so I don’t bother with Google maps.

Onto the BT directory enquiries page. I look up the details. Hrm, nothing in that street. Check google maps – the house number is quite large, almost 200 and there aren’t that many long streets in the village. Try this one instead – aha!

I call the number. “Hi, this is the Ambulance service here…”

“Oh, thank God, you’re taking my mother home?” Right, sounds like we’ve got the right one then.

He knew the keysafe number. And knew where she normally kept her key. So we got her in, put the fire on, made a cup of tea and helped her warm up.

Would we have got her in without the internet? Probably – control could have looked up the number for us, but it could have taken longer. Did the internet help? Yes, without a doubt – I could use the information that I had to find the address quickly and confirm it easily with the patient. Is this the most important use of the internet that we will have? No, without a doubt. I’ve already had twitter increase my knowledge of chest pain in adolescents (thanks Kal!) and teach me about conditions I might come across. We’re humans, not encyclopedias – we will come across things that we don’t know or need reminding of.

I really do think that with the arrival of Airwaves in the Ambulance service we should see smarter devices being rolled out with access to medical databases for looking up medications and conditions or illnesses. I’d like to see medical records being accessible to the front line as well – though I understand the privacy concerns. We have to be careful not to overload the guys on the front line, but access to the information when they need it really can save lives. We need to make sure that we have sources that are definitive and trustworthy and not just wikipedia.

People said that the end of the last century and the start of the new millenium was the information age. Is this the age that we see information being distributed to every person wherever they are, whatever they’re doing?

A number of cases stand out in my mind from a number of the shifts, some of which will make interesting blog posts, some of which will never make my blog for various reasons.

One in particlar sticks out. We’re called to attend a 999 call which has been downgraded to a Green call – an incident that requires a response without blue lights. We turn up and have a chat. The gentleman is in his 40s and has parasthesia from the waist down. He speaks very little English. We ascertain through pidgeon English and gestures that he’s urinating blood.

I’m not attending for this one, but something strikes me as odd. His feet are bandaged neatly – apparently he’s burned them and has been to hospital for his feet already. I look around the room and spot a box of tablets on the windowsill with a hospital pharmacy label. I point to them and he nods. Antibiotics. Paracetamol. There’s a letter with it and again he nods and I read.

His feet are injured from a scald and he spent a few days in hospital. Whilst he was there they noticed the complaint of haematuria and investigated, finding nothing and eventually referring him to a specialist in a nearby hospital. The notes go into more detail – his condition and pain seems unchanged from the time of admission. He’s also seeking asylum in this country but has had his application refused. He has multiple presentations to multiple services over the past 8 months.

On the other hand, he’s complaining of pain and does have some blood in his urine. His obs are fine and he seems comfortable unless we ask him about the pain, whereupon his face screws up. We have a quick chat amongst ourselves and we decide to try and see if we can get the out of hours GP to have a look, and control is informed. We explain to the chap who indicates that he’s happy with this – he doesn’t really want to go to A&E, it’ll be a several hour wait and he can’t afford the taxi journey home.

We hear a knock at the door and in walks a paramedic. We have a brief look between us before enquiring why he’s here. Control sent him. A handover is made and the paramedic asks the chap about his pain, then spends the next 10 minutes or so convincing him he needs to go to A&E, much to our confusion. We look confused but are happy to take him – obviously the paramedic is the senior clinician on scene here.

So we walk the chap out to the truck and drive him up to A&E. The charge nurse gave us a shitty look and we looked suitably apologetic as she tutted over the patient for a few minutes. She comes over to us. We explain what happened.

“Right, I see. Well, being here serves neither his best interests nor ours. I’m referring him to the out of hours GP.”

We left quietly.

So after work, I grabbed some food and ironed my uniform before de-snowing the car and heading into Llanishen. Once I got out of our village the roads were ok – probably because there was plenty of traffic to keep them clear. Our end of the street was awful, but then we only have about 10 houses there. The trip wasn’t helped by the fact that my car has developed a hole in the exhaust from all the salt. It’s in the garage being fixed today…

So we jumped on the vehicle and completed our inspection very quickly – it’s easier when you have two people doing it, and we had three on the vehicle last night. I decided that I’d had enough time driving and wanted more experience in the back, so arranged to be the attendant for the evening.

We logged on and immediately were asked to hold on for a second while control checked what we should be sent to first. They called back and asked us to back up an RRV for transporting a patient, but when we arrived on scene, the RRV reported that the patient had already made their own way to the hospital. Clearing from that incident, we were dispatched to back up another RRV, about half a mile down the road. There we picked up a woman in her 40’s with “nonspecific abdo pain”. Once I’d coughed my way through the cigarette smoke, we prepared the carry-chair and she stood from her armchair and sat herself down. Mike and I packed her and moved her out to the vehicle with some difficulty – a scenario not covered in training was using our equipment in snow and we found it sinking through the snow and ice.

Mike had already started to attend to her so I took the keys and prepared to drive when whe woman asked for “gas and air”. We looked surprised and asked her, on a scale of 1 to… “It’s 10.” she interrupted us, sitting comfortably and not showing any signs of pain. I blinked and sighed inwardly, leaving Mike to it. Apparently, morphine didn’t touch her pain (hence why she hadn’t asked the paramedic for any), but entonox worked wonders. It was a quick drive to the hospital and we passed her over to the care of the nurses in A&E. There followed a discussion between the three of us on the ethics of witholding pain medication if you believe that there was no clinical need for it.

The next job was for a young woman who really did need us. A transfer into hospital, the GP had diagnosed “?DVT R leg”. Her medical history was long and she was currently just 2 months out of her most recent encounter with chemotherapy. From the way she held herself I could tell she was guarding herself against pain and I asked if we could help, but she politely declined analgesia in stark contrast to our previous patient.

Our last patient was a hospital transfer for another “?DVT” patient. 97 year old lady, she was a real card. I had a great time chatting to her on the long trip to hospital. She reminded me a lot of my own grandmother (who’s 92) except that she got a little repetitive at times. She confided to me that she didn’t mind what we did to her so long as we told her first. She was a little deaf and I found myself being her closest friend as I was the one who got confirmation that she’d heard me before we did anything. We got to the hospital and found that there was no bed for her – a bit shocking as this was a transfer from another hospital. We sat in the corridor for a while, chatting with her until we were given a trolley for her. Her condition needed treatment, but it wasn’t a surgical emergency (according to the Surgeon who reviewed her later as well as the nurses) so there was some confusion as to why she had been transferred at that time of night. The constant bouncing around annoyed me, though not near as much as the paramedic who bumped our stretcher out of the way just to get past us, casuing our patient to call out in pain. We may only be “Jonnies”, we may only be carrying an old lady while you’re dealing with a patient going into resus – that’s no reason to hit our trolley out of the way instead of walking around.

We said our goodbyes and headed off for a break – things seemed to be calming down. We’d not long finished our break when we got our last job of the night – back to the hospital to pick the same old lady up. We looked at each other and shook our heads – this was the second time in two days she’d been passed back and forth from one hospital to another – completely unacceptable. We picked her up again, much to her delight, though this time I drove and passed the responsibility of looking after her to a colleague – I was tired and felt a bit drained from looking after her – she really did remind me a lot of my grandmother. My colleagues said that they’d transferred her less than a week ago as well.

We dropped her off and got her settled before cleaning our kit and checking in with control. They thanked us and sent us home, which was nice since the temperature was dropping fast.

This was the busiest shift I’ve had so far. I really enjoyed it, though it left me feeling drained both physically and emotionally. Looking forward to more shifts now.

South Wales police reported that it was quieter last Friday than a normal Friday night. The ambulance crews in the Millenium Staduim drank lots of coffee and dealt with the few incidents we were called to – we only had 3 jobs on our vehicle all night.

I got called last night while in Cardiff to work an ambulance shift for Mid Glam. The highlight of the shift until midnight was the free hot mince pies with cream we were so kindly served by the staff in the canteen at the hospital. Nomnom. We managed to finish them off before we were called onto the one job of the night.

This is of course, a Good Thing. People were sensible and remained uninjured. Hooray.

Let’s see what the rest of my shifts bring this Christmas.

Most people won’t know and won’t care what that means, but if you work in or volunteer with the emergency services and you’re on duty tonight – you’re probably either sleeping in preparation or getting your stuff ready.

Black Friday is traditionally the last Friday before Christmas. It’s the day that large numbers of people organise to have a drink together before Christmas…and as a result, Cardiff alone will see 300,000 revellers partying tonight. It’s an incredibly busy night for the emergency services, busier even than New Year’s Eve.

So, what am I doing tonight? After working my day job, I’m on duty (as a volunteer) with St John tonight who have been asked to provide the Welsh Ambulance Service with assistance in Cardiff. We have around 10 extra ambulances on duty; we’re helping to staff the triage centers both in St Mary Street and in the Millenium Stadium. I suspect we’ll see everything from broken nails to alcohol poisoning and assaults, as well as the normal numbers of cardiac arrests and the usual calls because life goes on. I suspect we’ll get more RTC’s tonight because it’s cold and icy and it’s also going to be busy.

And Oh My God but it’ll be cold tonight. The MetOffice is reporting a low of -3 Celsius tonight, down from the dizzy heights of +2 Celsius, with wind speeds dying down from 23mph to 5mph (giving “wind chill” temperatures of around -6 Celsius). That means freezing roads and crashing cars. It means freezing pavements and falling drunk people. It means cold air and hypothermia in partygoers wearing very little. That “beer jacket” that keeps you warm when you’re drunk? It doesn’t – it just stops you from feeling the cold. It could kill you on a night like this.

So tonight we’ll be busy. Tonight we’ll be picking up, helping, trying not to get assaulted and trying to keep warm. I’ll be tweeting and possibly updating the blog where I can, you can follow me on twitter if you’d like: www.twitter.com/thinknuts

Stay safe!

I sat down and re-assesed my options, talking to Sean. I felt as though I was still missing something and Sean was still happy with me doing somethign in addition to Mountain Rescue. I’ve always enjoyed the medical side of Mountain Rescue and I really missed dealing with patients as I used to in the First Responders. So, what could I do?

Enter St John Ambulance. I called national headquarters, based in Cardiff and was referred to Father Andrew, the Divisional Officer In Charge (DOIC) of Cardiff Central. After a long conversation with him, it sounded like I’d hit on the perfect unit – they perform mainly front-line ambulance duties and don’t have a cadet contingent which mean the unit concentrates on training and duties for their adult members.

The first night set the tone really – they’re mostly insane, much like Mountain Rescue. I passed them all the information I could about the training I had complete with Mountain Rescue. Things were looking great…and then a letter came through the door.

South Wales Police had started up its recruitment again. This caused a bit of a dilemma – leave St John and concentrate on the Police? Stop the recruitment process with the police? What to do?

I carried on with both (well, all three including Mountain Rescue) for a while, but this really wasn’t sustainable. Coupled with the fact that I had changed jobs and was considerably busier than I used to be, something had to change. So, after a long conversation with Sean, I decided to withdraw my application to South Wales Police for now. It’s something I’d still like to do, but I’m limited in how much time I have in life – I do like to sleep occasionally!

Last weekend, I passed the 7th course I’d taken in 5 weeks. It’s been a hectic month, but passing my PTA course now means that I can go out with St John Ambulance to do what’s called HDS duties (High Dependency Service) – these are thigns like Doctor’s urgents (when a patient needs to go to hospital urgently but isn’t life-threatening enough to call 999) and hospital transfers. I’m also one of our division’s two drivers currently – so looks like I’m going to be kept busy driving a lot.

On Thursday my uniform arrived – that’s right, look out for me wandering the streets of Cardiff in a natty green uniform. In fact, my first duty is this Saturday, when I’m joining two experienced members for my first HDS duty.

So, er, yeah, that’s where I am, that’s why I haven’t been blogging much of late. Work is taking me to London again this week which means I won’t (again) attend Mountain Rescue on Thursday. Look out for updates on the weekend from the HDS duty, as well as a whole bunch of rants and other stuff I’ve got queued up ready to post.

Tally ho!