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.

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.

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!

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.

I’ve had a few people asking me why I want to join the police, and while the answer is complicated and multi-faceted it boils down to one event. A few months ago I was out third manning with a paramedic. We spent the evening on the Rapid Response Vehicle responding to calls around Bargoed. It was a Saturday evening and most of our calls were to drunk people, although a few of the people we saw really did need our help – like the woman with a third-degree heart block who was rushed in. To top it all off, it was the evening after the day that Wales beat England at Rugby in Twickenham – what a day!

It was late, and we were driving up through the center of Bargoed when I spotted around a dozen young men and woman (mostly men) fighting next to a parked car. We came to a halt and Rich flicked the blue lights on. I looked out of the passenger window at the men who were almost lying on top of the car’s boot and for a second, they all stopped and turned to look at the lights…until they realised it was an ambulance car and they went back to their fight. Richard, calling for police backup on the radio, got out of the car and I joined him as we approached the group. The next few minutes passed very quickly as a woman was accidentally knocked over by the fight and when she went down her head hit the kerb. Rich rushed over to help, keeping her still while he assessed her and tried to keep the group at bay. The police arrived and immediately started chasing the ones running away, followed by a second unit which came over and helped us make the scene safe – by this point, Rich had ascertained that the woman wasn’t injured, just very, very drunk.

What really made me concerned was how I reacted – it was an uncomfortable and volatile situation and I shrank back from it. I wasn’t much use to Rich, and I hated that. I hated being that uncomfortable with that situation.

I’ve faced this before. Most relevantly when dealing with casualties in Mountain Rescue – theory and classroom exercises will only take you so far, and when faced with a real, live person, with complex problems that don’t quite fit the textbook…

So, realising that I needed something that I wasn’t getting – experience – I went looking for it. The ambulance service provided the ideal place to get that experience and meet my innate need to help people – the First Responder scheme. In a very short period of time, I got more experience than I had in my entire time in Mountain Rescue. Over two years several things have happened. I’ve had a lot more experience of dealing with people – sufficiently so that I’m comfortable with dealing with casualties now. The second thing is that my role in the team has changed. I’ve still got my qualification with Mountain Rescue, but recently I (along with two others) started training to be Party Leaders – consider it the management track within Mountain Rescue.

Those two things coupled together meant that I needed experience of dealing with situations where I had to establish control and to lead people – something that working with the Police would be great for. Of course, I couldn’t do all of the things that I do – I’d need an extra 8 hours in every day. Conveniently, I’m tired of the politics of the Ambulance service and had decided to leave anyway.

So there it is.

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

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?

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.