Image by soapylove, on Flickr

This website was launched on Thursday December 4th, 2008, with my initial post, Snapshots.

As a Birthday celebration I asked Jon (my website guy) to pull some facts and figures out of the analytics for the website. Here’s what he came up with.

Aside from the homepage, the most popular page on the site is the gallery. I will definitely try to add more photos to this in 2012!

The three most popular stories (in terms of pageviews) on the site are:

1. June 2010 – where I wrote about how London Ambulance Service decided they would no longer use ECPs as part of their workforce. ECPs were officially redeployed to other roles as of April 2011.
2. August 2009 – where I wrote about the subject of Paramedic Prescribing – which continues to be a hot topic.
3. January 2010 – where Charlotte kindly wrote the first in a short series of articles on Life as a Student Paramedic.

I was back in Italy last week with my friends Carol & Jaqui, and on our first night there we were enchanted as we watched a spectacular performance of Verdi’s ‘La Traviata’ in Verona’s majestic 2,000 year old Roman amphitheatre. Under the inky blue night sky, only the occasional breeze gently reminded us that we were sitting outside.  At the beginning of each interval, as well as the obligatory glass of prosecco, we also rapidly sought out our friends Davide and Alfonso. They are volunteers for the ‘Croce Verde Ambulance Service’ and anyone who has had the pleasure of seeing the opera in Verona will have noticed the ambulance vehicles permanently parked outside the arena during the opera season to provide a medical presence to assist with emergencies during the performance. Luckily as well as being practical, their bright orange attire also made them pretty easy to spot among the rest of the audience (who in general were wearing rather more sober colours). The boys had both kindly reorganised their shifts to ensure that they would be on-duty with their colleagues on the night we were coming. Here are a couple of photographs we took to capture a fabulous evening.

What a spectacular place to work for an ambulance service and I do quite like orange, I wonder if I could get a secondment….

Deciding to challenge my Italian language skills beyond their limits and seeing the opportunity for a little jaunt to my favourite country in with the deal, I signed up to attend a presentation on safety on the road in Italy.

Those who have passed a holiday in a city in Italy will recall the chaos of the busy cobbled roads. The cacophony of car horns, the hot-headed drivers appearing to flaunt the common courtesy of road manners and the plucky teenagers whipping around the traffic on their mopeds without fear or foresight. And anyone who has lived to tell the tale will recall with a pounding heart, the ‘run for your life’ dashes to cross roads even while on the relative safety of a zebra crossing. “Keep moving, they expect to drive around you, if you stop they’re more likely to hit you” I was warned by one wise friend! Bill Bryson tells us that when traversing a road in Italy, we should attempt to take the hand of a passing nun, as no Italian would ever hit a nun, therefore your safe passage would be guaranteed!

Italy has one of the highest densities of car ownership in the world and unfortunately road accident statistics bear out its image as a country of spirited drivers with little regard for the law or the rights of pedestrians. The number of road fatalities per capita is double that of the UK and nearly four times that of the Netherlands, according to figures from the World Health Organisation. In 2009 there were 4,050 road deaths in Italy (DfT). This equates to 6.7 road deaths per 100,000 of population compared to the UK average of 3.8 road deaths per 100,000 of population.

The ‘Educazione Stradale’ type events have been taking shape for the last couple of decades but since 2001 they have taken a more collaborative approach with the traffic police, fire-brigade and ambulance service delivering the lectures together predominantly to young people in schools. The evening event that I attended was hosted by two road traffic police officers Andrea Scamperle & Antonio Benedetti, and my good friend Massimiliano Maculan, an ambulance nurse who works for the S.U.E.M 118 Croce Verde in Verona (see previous post).

There was a good turn out from the people of the small lakeside town of Lazise on Lago di Garda; at a guess I would have said that there were approximately 100 or so who came along. The presentations consist of a series of videos, depicting both real and reconstructed collisions as well as testimonies from the police and ambulance staff. By far the most powerful of the testimonies came from the families of those who have lost loved ones in a Road Traffic Collision (RTC). Although I struggled at times to understand the detail of what was being said, it didn’t stop me feeling the raw emotions of the mother who spoke about her pain at the tragic loss of her teenage child in a RTC. Various videos were used to demonstrate the dangers of poor driving. During one of the videos in particular, a fatal crash caused by texting on a mobile phone while driving was played out, I could see that some of the family members became emotional. It was very graphic and must have taken considerable courage for them to watch it.

Having attended a similar presentation here in London, Safe Drive Stay Alive, it came as no surprise to note that the key messages delivered are the universal ones – all occupants should use a seatbelt, use no drugs or drink alcohol before driving, never use mobile phones to call or text while driving and of course, always drive at a sensible speed.

With each new generation of young drivers bringing up the rear, the need to repeat these events ad infinitum will remain. Sadly it seems that we human beings never have been very good at learning from other peoples mistakes.

Here is a UK video warning of the dangers of texting while driving.  A little warning here if you have any children in the room with you – it’s a graphic reconstruction.

I had a something of a busman’s holiday recently. I went back to Verona for a few days to visit some of my friends Massimilliano and Alfonso who work for the emergency services there (See my previous posts on visiting an Italian ambulance service: Part 1, Part 2, Part 3).

Last time I went to Verona, it was during a very hot summer period so this time was in stark contrast to that visit. In fact, the cold was biting and not unusually for the region at this time of year, a thick fog hung low in the air for most of the week. Alfonso kindly ferried me around, picking me up and dropping me off at the airport. Massimilliano, who also works for the Croce Verde ambulance service, had arranged for me to have a look around various places that I indicated would be of interest to me.

We started with the Vigili del Fuoco ~ Fire Station. As well as a guided tour of all of the usual fire engines and equipment, friendly fireman Paolo took us to see the amphibious vehicle that had proved so helpful rescuing stricken victims during the recent floods in the area. He also treated me to a hair-raising ride as I was elevated 30 metres on the aerial ladder platform where the views of the city were quite stunning. I was somewhat surprised and amused when Paolo then led us to a beautiful fully stocked bar. Looking just like a regular bar you could find on any little Italian side-street, it seemed perfectly incongruous situated in the middle of a utilitarian fire station. We paused briefly to have an espresso break – well it would have been rude not to, ‘when in Rome’ and all that!

The afore mentioned fog was responsible for grounding the emergency medical helicopter for the majority of the week of my visit, except by some amazing stroke of good luck, the day Massimilliano took me to see it. I was delighted by the offer of an impromptu flight over Verona in the yellow EC146 as she flew back to base at the end of the shift. It was just before sunset, and still light enough to see some of my favourite sights from a whole new perspective. The fabulous Arena, home to the opera. Piazza Erbe with it’s bustling bars and market stalls and the Roman Theatre perched on the side of the hill, all twinkled invitingly below in the evening light.

Finally, the next day the capo ~ head of the Verona polizia stradale ~ traffic police gave me a tour of their station where I met a beautiful dog who was the very friendly station mascot! I think Massimilliano may have misrepresented me ‘as someone important from London’ because during the tour his aides were continually taking my photograph as I was shown around the station looking at the different vehicles and equipment!

I was extremely interesting to see how things are done the Italian way, and everyone made me feel so welcome. The thing that remains most in my mind though was the flight over Verona, a very special moment indeed ~ thank you Massimilliano for making it possible.

The Jetty

Well I had an unexpected bit of drama while on my holiday in Sicily. I had been enjoying a spot of sunbathing on a small beach by a jetty when the weather suddenly changed for the worse; apparently this is not an uncommon occurrence on the island. The sunny blue sky was rapidly filling with tumbling gray clouds and to say the sea had become ‘choppy’ would have been a gross understatement.

I prepared to leave the beach. As I pulled on my clothes and rolled up my towel, I noticed a young man running at great speed towards the end of the jetty. Something about his expression made me take an interest and because I am terribly nosey by nature I went from the beach to the jetty and meandered in the direction that he was heading to see what was going on.

Trying to make sense of things, I glanced back towards the beach where I saw a small group of women anxiously pointing out to sea, they appeared to be shouting something at the young man who had ran past me but the noise of the sea and the wind combined made it impossible to hear anything else.

Rescuers

The young man started to point out towards the open sea and I realised that he was shouting to two older men who were being thrown around by the waves. The strong current was preventing them from getting back to shore. I heard someone close to me calling the coast guard on their mobile phone. We were then joined by a man carrying a surf board, he wanted to help but at this point it would have been madness for anyone else to go in the water.

One of the men managed to make it to the jetty but it was too high and he couldn’t climb up. He looked about seventy years old. He tried to cling on but he was being battered against the wall by the waves. One man and I tried to reach down to him but we couldn’t get a proper grip of his wet arms and he kept slipping back in to the water. Then I remembered my towel and so I lay down on my stomach and got it looped around one of his arms and twisted it to form a sort of tourniquet, between us we were then able to drag him up from the sea. He was covered in grazes and bruises with very blood shot eyes but apart from that he appeared in good form. No sooner had I wrapped my towel around his shoulders when a huge wave came over the harbour wall and outright soaked us both!

Rescuers

All our attention then turned to the man who remained in the sea – he was quite far out, perhaps 60 metres at a guess and we watched helplessly from the jetty as he struggled to keep his head above water. I honestly wondered at this point if I was going to have to take part in a resuscitation effort. Presently the life guard appeared with a rope, he looped one end around the man with the surf board who then very bravely jumped in to the turbulent waves. We relaxed the rope as he slowly made his way out to help him. Every now and then a huge wave would sweep over them both and we would lose sight of them; I would hold my breath anxiously until their heads became visible again. At last the surfer reached the man and they both held on to the surf board as we pulled them back towards the beach and to safety. Their wives and daughters had been sobbing as they watched this going on and there were plenty of hugs all around once they were both safely back on land.

I made my way back to our apartment looking like something of a drowned rat. As I told my husband all about my adventure I was still feeling slightly bemused by how events can suddenly take an unexpected turn – although thankfully, on this occasion, with a very happy ending.

Rescue Boat

Image by dno1967 on Flickr

It was the last shift before I was due to go on my holidays. It was also a very hot and sunny day. The last thing that I wanted was any jobs that were going to give me any stress or cause me to break in to a sweat. I was simply intent on winding down in anticipation of my trip to Italy.

Then the first job came down to my screen in the car: ‘Male – Stabbing – please give a report for HEMS’. Oh great – just what I needed! I hurtled down there and arrived at about the same time as an ambulance and the police. We all got out and grouped together before we went in to the house. There was no answer at the front door and the police were weighing up all the options with regard to breaking in to the property when some of the immediate neighbours approached us.

Well, if their stories were to be believed it sounded unnervingly more like an episode of Holby City than downtown suburbia. They told us that one of them had apparently had a heart attack just last week and another had been shot only a few days earlier (although she looked quite well for it), and now a fatal stabbing. I could only guess at what the insurance rates would be in this particular road!

It soon became clear to us all that this was nothing more than a hoax call. Thankfully, no one had actually been stabbed, shot or had a heart attack and in fact it was all down to a single caller who had nothing better to do with their day but waste the time of the emergency services.

Strangely, what first attracted me to The Nicholas Effect was the simple fact that it was predominantly set in Italy, rather than its actual subject matter. However, I have always had an interest in organ donation and regularly give blood when my shifts allow, so this added to my curiosity about the book.

Reg Green, journalist and father of Nicholas, describes the sequence of events that begin with a tragedy during a family holiday to the south of Italy in bitter sweet detail. He describes Nicholas in such graphic and endearing terms that I was actually left with the feeling that I had may have met him somewhere in my distant past. While Nicholas’ death is described early on in the book, his presence continues to be felt as the pages are turned. The huge impact his life and death has made on the promotion of organ donation is largely due to the triumph of the human spirit over adversity, and the remarkable manner in which his family made a conscious decision to embrace the media to produce a positive influence, when other families would no doubt be struggling to come to terms with their grief. When tragedy strikes at the very heart of family life, we have little choice in how we feel about it; but we can choose how we behave subsequently. I have nothing but admiration for the Green family and their drive and determination to make something good come from such a painful loss.

There is little attention paid to the process and procedure of organ donation (which is possibly for the best from the perspective of most readers; although I would have liked to know more about this). However, Reg talks in great detail about the key characters and incidents that came in to play during the aftermath of Nicholas’ killing. Sometimes, if I am honest, I found the comprehensive listing of each and every name and event a little unnecessary and found myself skipping chunks of text. However, as a journalist, Reg is clearly a skilled writer and the book is a profound and interesting read, if for no other reason than it wonderfully illustrates the human ability to forgive and the power of endearing love at its finest.

Last week I wrote an article on organ donation in the UK. If you missed it, please read it now as it was The Nicholas Effect that prompted me to write it.

[Note: This is the final part in a short series about my visit to an Italian Ambulance Service. Click to read: part 1 part 2]

Enrico kindly drove us to the HEMS base where we caught up with the doctor and nurse (Massimiliano) on duty that day. It was a stunning day – very hot and sunny as you can see in the photos. The team – having just returned from a successful resuscitation of a man in cardiac arrest – were very hot from their efforts and I certainly didn’t envy them in their heat-trapping red boiler suits.

I am planning a return visit – after all I simply can’t let an opportunity to fly over Verona and maybe take some incredible pictures pass me by; I wonder if they will let me go out on the winch?!

The ambulance control room

[Note: This is the second part in a short series about my visit to an Italian Ambulance Service. Click to read: part 1]

After we had finished looking around the new ambulance station, Enrico drove us the short distance to the ambulance call-centre; where approximately 300 emergency calls are received each day.

In the London Emergency Operations Centre up to 4,000 calls may be received every day and these are handled by around 25 call takers and around 40 dispatchers and other staff, each covering an area of Greater London. Therefore, we could hardly fail to notice that, in Verona, things were rather different – there were only six desks in the call-centre with just three nurses handling both incoming calls and dispatching vehicles!

The call-centre is staffed by nurses who also rotate through the helicopter emergency medical service (HEMS) along with a doctor and pilot, and a single advance life support car (ALS) also staffed by a doctor.

The HEMS service and ALS car cover the whole province of Verona; approximately 81 square miles / 210 square kilometres, and as they do not use a priority dispatch system, the nurses must judge each call on its merits based on their experience and try to dispatch them wisely to the most critical or deserving patients.

The ambulances are staffed by a small core group of paid staff which include nurses who rotate through the Pronto Soccorso (ED). They are supported by a larger number of volunteers who practise to a level roughly equivalent to our ambulance care assistants or technicians.

Come back next week to read part 3, when Enrico drove us over to the HEMS base.

Enrico, Myself and Alfonso in front of an ambulance

‘Squalls’ – that was exactly what the weather forecast predicted for the week we were due to visit Italy – well they lied! We actually had a practically perfect week during our trip to the Veneto.

Snuggled in a loop of the snaking path of the River Adige, sits the exquisite ancient city of Verona. Designated as a world heritage site because of the value and importance of so many of its beautiful buildings, it is one of my favourite places to be, and I try to get over there as often as work (and the bank manager) permits.

The mostly car free streets and piazzas are lined with pavement cafes and bars punctuated at regular intervals by almost incidental architectural delights. These oases provide the perfect vantage point for a spot of overt people watching while simultaneously enjoying the local apperitivo, ‘un spritz’, a distinctive orange coloured campari based cocktail.

We took the train from Lake Garda in to Verona on one, it has to be said, not particularly ‘squally’ afternoon. While Simon and I left our travelling companions in Piazza delle Erbe, preparing to enjoy a whistle stop tour of some of the wonderful sites of the ancient city, we meandered the short distance to Piazza Bra. There we were met by Enrico, a young volunteer with the SUEM 118 Croce Verde ambulance service. Enrico had kindly agreed to take us for a tour of the local ambulance station and provide the opportunity to take a few photos.

Situated in the far northeast of Italy, the Veneto province has 4.5 million inhabitants and 14 million visitors each year are captivated by its charm and elegance. The Croce Verde respond to all the 118 (emergency calls) in the province. In this sense they do a similar job to our frontline staff here in London. Other private companies deal with all the transfers and appointments. However, the ambulance service is staffed very differently in Italy…

There are no ‘paramedics’ as such, instead the model is one where specialist nurses work alongside doctors and volunteers to provide the service. The ambulance nurses appear to have a much greater restriction on their practise compared to here – but in fairness, it is a difficult comparison to make because nurses do not generally staff ambulances here. Generally the volunteers hold down full-time day jobs as well as fitting in a shift or two a week which include night-shifts. The volunteers operate at roughly the equivalent of our EMT level; I am full of admiration for them.

The ambulance station that we visited is brand spanking new and serves central Verona with its 265,000 inhabitants. The facilities are fantastic. It is incredibly spacious and we were more than a little envious to find that the crews actually have comfy beds to sleep in on quiet nights; my colleagues in London can only dream of the possibility of catching forty-winks in a makeshift bed, so this seems like a real luxury. And here in sunny Italy, the summer uniform consists of a white aertex top and orange hi-visibility trousers – not forgetting the obligatory Gucci sunglasses of course to finish the look off!

We had a nosey look around the ambulances too. Perhaps unsurprisingly most of the kit and medical terms were reassuring familiar to us. I battled to remember my Italian verbs in order to ask questions.

‘Do you have a big problem with alcohol?’ I asked Enrico.

‘No, I don’t drink’ came his polite reply; whoops, I had forgotten to use the plural form; if he was surprised at my question, he hid it well and I quickly rectified the situation before he took offence! He and his colleagues were also very shocked to hear that in London crews wear stab vests and assaults on staff are unfortunately not that uncommon.

Most patients are conveyed to the local ‘policlinico’ at L’ospedale G Rossi di Borgo Roma. On average 1,080 patients pass through their doors each day.

It made me smile when, as we waited for the head nurse to escort us around the department, a disgruntled patient came up to the desk. Even with my poor grasp of the language I could tell he was complaining ‘I have been here for many hours and then you called a woman in before me and she has only just arrived – what is going on?’ he moaned. Miles away from home, I thought, but apparently nothing changes at all!!!