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

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

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

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

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

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

“First job?” he asks. I nod.

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

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

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

“Hi, got a red call for you.”

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

“Oh, ok, thanks.”

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

“Yes, he’s here now…”

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

“Start CPR.”

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

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

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

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

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

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

Prepared as my introductory post for The EMS Handover Carnival.

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

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

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

Anyway, more office to clean…

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

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

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

Right, time to wash the car I think.

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

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

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

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

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

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

How was your weekend?

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.