Image by JackBetty on Flickr

I saw a lovely patient this week, he was a very shy young man who didn’t speak much English but sadly he had just been mugged. There were three of them and only one of him – so violence really wasn’t necessary, but still they punched him in the face a number of times as they ripped his mobile phone from his hand.

Some women were standing at a bus stop nearby and witnessed everything. Immediately one called the police. Additionally, the other woman had the incredible presence of mind to capture the attack on her mobile phones. It was a brave thing to do, had the men seen this they most certainly would have wanted to get the phone containing the evidence from them and I doubt they would have had any qualms about using force to achieve this.

The police arrived very quickly, but the men had already fled the scene. However, the women handed over the footage on the mobile phone and very shortly afterwards the group were spotted and arrested for the crime.

Even though the victim would soon have his mobile phone back, he was in a lot of pain because he had sustained a broken jaw bone and needed to go to a hospital with Facial Maxillary facilities for surgery. But I would like to say well done to those Good Samaritans who can feel very proud of themselves. Without their selfless quick thinking the cowards may have very well got away with it.

I don’t know if I believe in karma but it certainly seemed to come in to play with my patient last week. Although he was seen fairly promptly and spoken to politely, he was an impatient and somewhat objectionable man from the moment we made contact.

As he told me the story of how he obtained his injury, I could just picture the scene! He barely concealed his anger as he recounted the story in great detail, of being ‘cut up’ by a young driver of a tatty Fiesta as he was driving along a local road. He told me that he eventually managed to manoeuvre his car in front of the lad who was forced to come to a halt (and who from his description, sounded terrified).

Our chap then pulled the lad from his car and started telling him what he thought of his driving ability as he jabbed him in the chest repeatedly. And that’s when it happened…

As he jabbed away with his finger at the poor young lad’s chest – the force of the impact caused it to dislocate! This obviously brought a swift end to the situation, it probably also brought a tear to the eye and a few choice expletives. No doubt it also caused a sign of relief from the young driver too – who took the opportunity to make a dash for it!

With no one remaining to take his frustrations out on, Mr Angry then drove himself to the emergency department, still rather cross, to get the finger sorted out.

Even after I had got his finger pointing in the right direction he remained rather grumpy, and left the department muttering under his breath; he didn’t even say ‘Thank you’!  – There’s just no pleasing some people!

I know that this is coming a bit late to some, but if you’re still looking for a gift for the Paramedic in your life, here’s a few ideas:

Streamlight stylus pen torch – £25 – Amazon.co.uk

With a metal casing, this torch eschews quality. Batteries last for ages  and because it’s metal its of a sturdy construction. I’ve been using one for years and think they’re great.

Laser engraved Littman stethoscope – £50 – Medisave.co.uk

Medisave offer FREE engraving on the bell of littman stethoscopes. Really adds a personal quality and should hopefully prevent theft!

Nonin Go2 pulse oximeter – £78 – Amazon.co.uk

I know some people like to own and carry their own pulse oximeter, me included. The Nonin Go2 uses the same technology found in the onyx, but at a reduced price. It’s aimed at the consumer market, hence the slightly larger size and brighter colours on the casing. I’ve been using one for over a year and it’s very reliable.

Blood Bath Shower Gel – £7 – Amazon.co.uk

Excusing the name, i’ve got a penchance for IV bags and blood bags being used for regular things. Couldn’t get hold of this last year (constantly sold out) but has a wider distribution now.

Dr Cool Bag – £7 – Amazon.co.uk

Staying on the IV bag theme, you can get these IV bag shaped cooling gel and also hand warmers.

Giant microbes – now availabe as tree ornaments! – £20 – Amazon.co.uk

These plush versions of disease causing bacteria and viruses are now available as decorations for your Christmas tree, if you so wish!

A Plethora of books worthy of a read

Also be sure to check out my previous post: Medical related items to buy.

Image by aeu04117 on Flickr

It must be something in the air at this time of year. One of my recent shifts was like a groundhog day. It consisted almost entirely of patients who had either vomiting or diarrhoea or vomiting and diarrhoea. These were all otherwise healthy young people; all had a pair of legs in good working order – perfect for walking to the ambulance with. None had had their symptoms for more than about 6 hours and none had considered contacting their GP before calling an ambulance.

Excuses for not contacting the GP were various and included; “I don’t like my GP” (well change your GP then!). “He’d have just sent me to A&E” (most unlikely). “I can’t get to the GP because I have to work from 12.00- 18.00hrs” (Well perhaps you could have gone in the morning). “I couldn’t go to the GP because I can’t walk” (see comment above about patients all being in possession of a pair of fully functioning legs) and my personal favourite “Well I had this once before 5 years ago and now it’s happened again, so I think I should have it checked out properly.”

Similarly, I did a shift in a hospital recently where I saw three patients with minor head injuries. None had been knocked out or had any visible laceration, bump or bruise (well apart from one who had a rapidly fading slightly pinkish patch where where his head knocked on the frame of some gym equipment that he had carelessly walked in to). None had vomited or even felt a bit sick; there were no visual problems, convulsions, loss of memory or co-ordination, headache – no anything in fact between the lot of them. (This list comprises of some of the things that we may worry about in head injuries – see NICE guidance on Head Injury if you want to find out more).

One guy even told me that he had actually bumped his head a whole week before and although he had no symptoms whatsoever, then or now, he decided to come to hospital simply because a bloke down the pub told him he should definitely get a check up and probably needed an X-ray – that ‘bloke down the pub’ has a lot to answer for in my mind – I have seen an awful lot of patients who pitched up following his expert medical advice now I think about it! Forget ‘Street Doctor’ let’s have a TV series called ‘The Bloke Down the Pub who is not a Doctor’ – because that guy really knows what he is talking about – NOT!

Image by fazen on Flickr

It can be a bit hit and miss when you take an observer out for a shift on the ambulance. No self respecting observer arranges an observation shift with the London Ambulance Service hoping for a quite night on station drinking tea and watching Strictly Come X Factor on Ice; and of course we want get a chance to drive fast, show off our skills a bit and generally give them a night to remember.

Clearly there is something of the Munchausen by Proxy personality in the vast majority of us ambulance personnel. On one hand, while not wishing for anyone to befall a dreadful accident, on the other hand we kind of hope that if they do, that it will be our ambulance that gets sent to them – particularly if we have an observer to show off in front of.

Our definition of a ‘good job’ of course, is probably your idea of a ‘nightmare’, one that will undoubtedly become the blood curdling subject of your dinner party conversations for years to come – long after we have forgotten how much we enjoyed bravely wading knee-deep in your body parts while heroically rescuing you from whatever horror you had succumbed (you can be certain that’s how we will retell the story anyway).

Most shifts we are damn busy and we barely pause for breath for the whole 12 hours. We tend to just lurch from one call to the next. Often we are then rewarded for our considerable efforts with a ‘late job’ to ensure we get home absolutely knackered and even later than anticipated.

In fact the chances of getting off on-time are inversely proportionate to how important it is to be heading away from work as the second hand moves into overtime. For example if, as has happened to  me in the past, your child has their first lead role in the school play you know with absolute certainty that you can kiss goodbye to any hopes of seeing their debut; some selfish bugger with an acute case of ‘No Discernible Symptom Syndrome’ (NDSS) will chose precisely those closing moments of your shift to call 999 for a check-up and you can bet your life that your ambulance will be the only available one within a 20 miles radius. You will arrive at the performance, exhausted just as the fat lady sings and your child starts sobbing because you missed her bit.

The moment one puts an observer into the equation things turn on its head. Rather than being run ragged, we instead run the risk of developing pressure sores from complete immobility, only offset by getting up occasionally to source the next round of tea. The deflated observer hears our pitiful plea that ‘it’s not normally like this – honestly – we’re usually really, really busy’ but it sounds hollow and you know they don’t believe you.

I worked a shift on an ambulance recently with an observer Alfonso who had travelled all the way from Italy for the shift – no pressure there then! Thankfully, fate was kind to us, if not to our poor patients. We had a full-on night. As well as the predictable run of unwell folk, including a couple of kids and a couple of ‘blue calls’, we went to a nursing home for the elderly victim of a cardiac arrest. This happened in a room that was not much bigger in dimensions than the bed it contained and it must have appeared like a surreal, uniformed version of Twister (TM) as we clambered and climbed over each other to undertake various aspects of the resuscitation – and why are those places always so uncomfortably hot?

Of course no observational shift would be complete without the obligatory comedy moment. We got a call to a lady who had had rather too much alcohol to drink and had vomited – prompting a a party goer to reach for the phone and call 999.

As soon as we arrived at the private house party where our patient had taken unwell, it was clear that things were going to get interesting. Firstly, our patient had got drunk on mead – who drinks mead these days? I noticed the flower garland in one lady’s hair ….and then her black cape. One man in the group was dressed like a glamorous undertaker, complete with heavy black eyeliner, top hat and tails. It transpired that this was a party for witches and our patient was a real live witch no less! During our assessment of her, she regaled us with a fascinating story; apparently her husband’s nickname for her was ‘Old Trunkard’

‘Do you mean drunkard?’ I asked in a non judgemental sort of way.

‘No, no it’s Trunkard’ She then went on to explain in detail how she earned the moniker after she fell on to an ornamental elephant and the trunk of the ornament ‘accidentally’ entered her body, necessitating a hospital admission to have the offending item removed from the orifice. She had us in hysterics and thanks to the considerate inclusion of many commonly recognised international hand gestures, no detail was lost in translation for Alfonso.

You know what it’s like when you have a new born baby to look after. You would do anything in your power to keep them safe from harm. One new mum took things a little bit far recently when she found a wasp’s nest in the family home.

A scaremongering friend panicked our new mum by saying that if the wasp went near her baby boy it could kill him. The same friend also helpfully offered a strategy for dealing with the creatures – unfortunately this strategy didn’t involve anything as sensible as contacting the local pest control company. No, this plan involved a lighter and can of hairspray!!! This was never going to go well, but thankfully it wasn’t as bad as it could have been – all things considered.

Fearing for her little one’s life when a lazy wasp took flight in the bedroom, our new mum rushed for the hairspray and lighter. Then with her home-made flame thrower directed at the wasp, things quickly took a turn for the worse. The curtains caught alight and smoke rapidly filled the room.

Luckily the baby was in the next room and mum was able to get them both out to safety. When I arrived the pair were seated safely in the fire-engine – mum was sobbing her heart out. Now, with the benefit of hind-sight, she couldn’t believe that she’d followed her friend’s stupid advice.

We took the pair of them to hospital for a check-up and thankfully the only harm done was to the fixtures and fittings so both were discharged home later that day. As for the wasp, well I have no idea how he did in all this!

X-ray of a foot showing Lisfranc fracture

Tom was brought in by a friend who wore a distinctly sheepish expression as he manoeuvred the wheel chair along the corridor. The patient had a particularly swollen and painful right foot; even I didn’t need an x-ray to tell me that something was amiss.

“This chap ran over my foot” he said by way of an explanation when I asked him what had happened. In fact, what he said differed slightly from that but as I am a lady I find I am unable to repeat the colloquial and somewhat colourful words that he actually used.

Tom had managed to bag a lift home after a hard day on the building site. He jumped out of the 4×4 while his mate was stopped at a red light but leant back in the car to retrieve his rucksack just as matey was beginning to pull away. The back wheel drove right over his steel toe capped boot that housed the afore mentioned right foot. Having witnessed Tom’s potty-mouth first-hand I can only imagine what delights must have been emitted as the vehicle lolloped over it – the thought made me blush!

His x-ray was quite spectacular (see below). You can see below that many of the bones in the mid-foot had been pushed outwards to the right (dislocated) and a couple of them were also fractured, the bone leading up to his big toe was also dislocated to the left, this type of fracture called a Lisfranc after Jacques Lisfranc, Napolean’s military surgeon in the early 1800′s. Surgery would be required to return the bones to their natural position and fix them there. I have put two radiographs here to show you how his foot looked and how it should look.

X-ray of a foot showing Lisfranc fracture

X-ray of a foot with no acute injury

Image courtesy megadem on Flickr

I was telling my friends and family about a call I went to recently. It involved a toddler hit by a car with possible life changing or life threatening injuries. My colleagues and I were busy – we had a child screaming with a head injury and the pain of numerous broken bones needing our urgent medical attention, not to mention a traumatised mother and older brother to consider. In the middle of all of this organised chaos I went to retrieve some equipment from my car and as I looked up I noticed that a number of bystanders were holding their phones out in front of them, focussed on the child, filming the incident.

I have to say that I feel considerable disgust at this new social propensity for members of the public to reach for their mobile phone to capture every detail of the suffering of another human being.

When it comes to the media, this is their bread and butter; even the police have no absolute right to stop them from filming. In their guidance it states they have ‘no legal power or moral responsibility to prevent or restrict what they record’. Some matters, arguably, are in the public interest; after all the media are responsible for capturing everyday situations and dramas to inform and record both for contemporaneous and future consumption and that is, perhaps, how it should be. For example, the amateur footage of the tsunami gave an almighty boost to the relief effort; court cases of police brutality have been won and lost on the basis of recorded material – often provided by the public.

However, it surprised me to discover that even if the mother of the child had asked the police to stop people filming him that guidance states ‘If someone distressed or bereaved asks the police to stop the media recording them, the request can be passed on to the media, but not enforced’ – Really? Should that be so?

Am I being a hypocrite? Undeniably.  I too have been ‘guilty’ of watching this stuff on numerous occasions, as has anyone who watches the News at Ten. Perhaps though, there are degrees of hypocrisy. This however, is about the lack of ability in each of us to regulate the setting of our own moral barometer. Have we really become so desensitized to the suffering of others because of the graphic images we are regularly bombarded with in the media that we actually delight in the pain and suffering of a small child to the point where we welcome its presence because it gives us something to share and talk with the family when there’s nothing good on the telly?

What will these non-media people do with their booty?

A) Share it with their children over dinner

B) Commit it to DVD format

C) Send it in to Harry Hill’s TV Burp because one of the paramedics rather hysterically tripped up on some equipment?

A big red helicopter landing on an urban lawn the size of a postage stamp is interesting material, and you can film me doing my job should you wish – I’m doing nothing wrong. Film the blue lights on the brightly coloured ambulance if that’s what you like; but please draw the line at filming a little child lying in the road clearly terrified and suffering during what could be his last moments of life – because next time it could be your child.

I saw a 25 year old man recently in an Urgent Care Centre where I work; he was in an awful state with an infected wound to his hand.

Just over two weeks earlier he had a nasty accident which involved white spirit and a lit cigarette. He sustained terrible, full thickness burns to his dominant right hand – the areas affected worst were his 2nd, 3rd, and 4th fingers and the palm of his hand. Following an initial assessment at a local emergency department he had been transferred to a burns unit some 25+ miles away for definitive care. There his wounds were treated and dressed. He was discharged and expected to return every other day to have his wounds redressed.

And therein lay the problem; this particular young man is homeless and penniless. He had no means to get himself the 25+ miles to the burns unit. But, each time he presented himself to a local emergency department he was turned away and instead advised to go back to the burns unit. Days passed, the dressing remained unchanged and the young man slept rough – perhaps predictably his wounds became infected and painful.

He came to our unit and we didn’t turn him away. Once I called him in he was given some strong painkillers. The filthy blood- and pus-contaminated dressings were by now, firmly adhered to his flesh. I soaked his hand in water to soften them up and eventually I was able to begin to gently remove them from his hand and fingers – the smell was absolutely dreadful and I feared the worst.

Unfortunately, I found that the top of one of his fingers was necrotic (blackened, dead tissue) and another two were practically falling apart as the dressings were lifted off. I put on some temporary dressings and referred him back to the burns unit, where he was taken by hospital transport for surgery. I hope they can save the rest of his fingers – life is already difficult enough for him – but of course I’ll probably never know…

Image Courtesy D. Sharon Pruitt on Flickr

One of the toughest tasks that I’ve ever had to do at work didn’t involve any blood or trauma, but it left me choking back the tears just the same.

We had been called to a young mother found by her husband when he arrived home after work, as he entered the living room he was confronted by the sad scene of his little daughter sitting beside her “Mummy’s asleep” she whispered to him.

It appears that she had unexpectedly collapsed while at home looking after her little girl. He called 999 immediately and we were there within minutes, but unfortunately it was already too late.

Initially the details were unclear due to the confusion that can naturally occur in these situations. However, once we realised that it had been more than an hour since her heart had ceased beating and she no longer breathed for herself we stopped our attempts at resuscitating her.

I broke the dreadful news to her husband that his wife had died. Breaking the news to him it was hard enough, but then he asked me to help tell their four year old daughter.

There was no hurry now; she had been taken upstairs by relatives by the time we had arrived, which gave us a bit of time to organise ourselves. I realised at this point that I had never had to break bad news, in particular the news of the death of a loved one, to a young child before. I felt ill prepared and emotional just thinking about it. I remembered some stuff from way back during my nurse training which I called in to play. It suggested not telling children bad news in their own bedroom, as that should be a sanctuary that they can retreat to in the future. It was also about the importance of using age appropriate language rather than medical jargon and using the term ‘has died’ or ‘is dead’ rather than ‘gone away or ‘gone to sleep’ so there is no room for confusion.

Dad and I talked and we decided that it was best if the news came from him with me there for support. We agreed that if he should feel unable to say it, he would give me a look and I would step in and say what needed to be said on his behalf; and when it came to it, that’s exactly what happened. He was too upset and unable to articulate the words when faced with his daughter’s open expression.

As I said the words ‘Sweetie, I have some very, very sad news for you…I am so sorry but Mummy has died…’ I thought my heart was going to bang out of my chest, and my throat squeezed and burned with raw emotion as she turned her head in to her father’s neck and began sobbing pitifully.

I’m not just a paramedic; I am first and foremost a mother. The pain of their loss touched me deeply, but children are amazingly resilient. She has a loving father and wonderful extended family to care for her so I’m sure that she’ll be fine, but of course the nature of my job means that I will never know for sure.

If you are experiencing a similar tragedy and are looking for support, please visit the Child Bereavement Charity.