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Someone had tried to take the patient’s blood pressure, as there was still a BP cuff around her arm.
As is usual in these cases where we know or suspect that care has been—shall we say—lacking, we offer the services of the London Ambulance Service (LAS) to teach the nursing staff more effective resuscitation skills. However, they should have these skills anyway as qualified nurses. Talking to one of the people who teaches these courses, it seems that many of these nurses have forgotten how to do this. It’s free to them although I don’t think we get any extra money from the government to run it.
The nurse in charge, who was busy photocopying in the office while all this was happening, refused.
So, in a world of competition between privately owned care homes, it would seem that the care has not improved. Instead you get poorly skilled nurses, managed by staff who don’t want them to improve. This despite a number of suppliers who are all in competition with each other—it’s a lucrative market providing elderly care.
Laughing Policeman (#ulink_79bd2aef-a99f-5e31-9864-576705e9dee8)
You’ve got to laugh when an ‘old salt’ police sergeant tells you that he’d like to meet the person who assaulted my patient…
…And shake their hand…
…And you agree with him even though you’ve only known the patient for 20 seconds.
Structural Collapse (#ulink_cd30937b-e449-5bd6-90e8-a77d3c4f4081)
The radio sparked into life, ‘General Broadcast, General Broadcast—are there any crews able to deal with a ceiling collapsed on a mother and her two-year-old child?’
We were just finishing up the paperwork on our previous job so we asked for it to be sent down to us. I was driving and we were soon at the house. From the outside everything looked normal.
However, inside the house it was pure chaos.
There were seven children running around the house, all of them under the age of twelve. A single mother was clutching her two-year-old to her chest. At first glance they looked unharmed. The mother seemed more frightened and angry than injured.
We soon got the full story: the mother and her child were having a nap in the bedroom when the ceiling had fallen on them. We entered the bedroom expecting a few scraps of plaster. Instead we were met with the sight of one-and-a-half-foot plaster and lath ceiling, a huge chunk of which had fallen six foot onto the bed.
The hole in the ceiling was about five feet in diameter; there was a lot of heavy debris spread across the bed and floor.
Rather understandably the woman was a bit upset—the individual pieces of plaster that had dropped on her were about the size of my hand and were over an inch thick. I couldn’t estimate the total weight of the plaster, but each lump was very heavy.
It was about now that the headache I’d thought I’d got rid of earlier in the evening started to return.
As a single parent who had just moved into the area she had no other relatives to help look after the children so she was refusing to go to hospital. My crewmate took her and the toddler into the ambulance so that he could examine her more fully. If he found nothing too serious then we could leave her at home to look after her children.
So off they went to the ambulance.
Which left me looking after six anklebiters.
I don’t like children.
While he was in the ambulance my crewmate phoned the patient’s GP and arranged for them to come and visit the patient. He then arranged for the police to turn up and give the patient some legal advice. Rather obviously the patient was a trifle annoyed at the landlord who had assured her that the house was fit to be lived in.
Meanwhile I was doing my best to entertain the children. My best wasn’t enough.
I was relieved when the children’s older brother arrived with some takeaway chicken meals. Yes—there were now eight children in the house of this 36-year-old woman. This older brother was more like a father to the others and he soon had these apparently feral children under control.
Luckily for the woman and her child our initial guess was correct—neither she nor her child was seriously injured.
My crewmate and I escaped from the scene as soon as the police arrived.
Shorn (#ulink_1d23a0f7-2714-5883-9e3d-215260ba4a58)
An ideal invention for the blogger in your family would be a pair of video-recording glasses—wear them all day, and should something interesting happen the wearer presses a button to save the last 30 seconds of video to a small storage device.
If that were possible I’d now be showing you a video of a lovely young man.
I was driving along on blue lights and sirens (to an ‘intoxicated—feeling unwell’) just heading past the Underground station when from the pavement I could hear someone shouting: ‘Wanker…Wanker…Wanker.’ He was also making the traditional hand gestures.
A quick look at him led me to believe that he was either homeless or an alcoholic, or both. I could see that he had no front teeth and he only looked around 30 years old.
I slowed the ambulance so that my crewmate and I could laugh loudly in his general direction.
He turned his back on us.
He bent over.
He pulled his trousers down.
Suddenly we were confronted with a skinny white arse, and dangling between his legs were equally white and skinny testicles.
They looked shaved.
Just then a police car came over the hill.
I wound down my window and spoke to the police driver, ‘See that fellow with no teeth? He just exposed himself to me.’
‘The one calling you a wanker?’ asked the policeman.
‘That’s the one…Have fun!’
We continued on the way to the call as best we could between tears of laughter.
It’s strange the things that make your day.
12th November 2046 (#ulink_76fa5272-1e93-5d69-943f-6eed9deea013)
The young man breathed a sigh of relief as he finally sighted his quarry of the past four days. The old man was sitting on the park bench enjoying the sun and feeding the ducks.
‘Hello fella,’ the young man said as he sat down on the bench. ‘You said that you’d be able to tell me about the old days? About 2006? About the blankets?’
The old man tore off another piece of bread and threw it in the pond and watched a small crowd of ducks hungrily fight over it. ‘Sure, if you want to hear about that sort of stuff.’
The young man started a mini-recorder and placed it on the bench between them while the old man continued to talk.
‘It was back in o-six, about the middle of February, and if you believe the reports it was the first winter of the “big freeze”. I remember the years that followed, OAPs dropping dead in the road, cats frozen stiff in the streets…Happy days.’
Before continuing the old man took a swig from a bottle of something, probably illegal, which he’d concealed in a brown paper bag.
‘As you know I was working in London for the ambulance service, it was a pretty good job, but back then the health service was run and funded by the government. So a lot of things went wrong.’
The young man interrupted, ‘That was when Blair the Deceiver was in power? Just before the Party started to dissolve parliament?’
The old man looked sullen. ‘That’s right, bad days, very bad days.’
Sensing that the old man was about to enter a fit of depression, the young man decided to prompt him, ‘But about the blankets…?’
‘Yes,’ replied the old man, eyes suddenly snapping into focus, ‘we used to say back then that the only equipment we really needed was a chair and a blanket, but on that day there were no blankets to be found. We searched the stores, we even tried ransacking disused ambulances in case they had some—but there were none to be found.’
‘What did you do?’ asked the young man.
‘Well, we got onto our Control—they tried to contact someone in management, but no one seemed to be around. So Control spoke to their overseers—the people who had the job to look after these emergencies. They were no help.’
‘Was the management ever any good?’ the young man asked.
The old man was quiet for a moment before continuing, ‘In this case it turned out that there were no blankets at our central stores. Normally the blankets would be stored there before being delivered to individual stations by a tender driver. But the warehouse that washed and packed the blankets hadn’t delivered any to the stores.’
‘With no blankets, how could you help patients?’
‘Well, after talking with Control they suggested that we “liberate” some blankets from the hospitals in the area—so some of us went on stealth missions. We’d take in a drunk and while the nurses’ backs were turned your crewmate would sneak out with an armful of blankets.’
The old man threw another chunk of bread to the anxiously waiting ducks. ‘We didn’t call it stealing. Besides, the hospitals had more than enough.
‘Of course,’ the old man continued, ‘back then we’d share a blanket among a couple of patients—there wasn’t enough for one blanket each. This was before the H5N1-MRSA cross-breed became epidemic. You’d never get away with it these days. But back then if there wasn’t filth on the blanket, you would use it again. We had to or there would have been blanket shortages every day of the year.
‘In this case the shortage lasted for a couple of days. It turned out that nearly everyone in the blanket warehouse had applied for annual leave at once, so there was hardly any staff working. In those days you had to use up most of your annual leave before April. That year they prevented the ambulances from collapsing by letting us carry over more leave to the next financial year than normal, but they forgot about some of the support workers.
‘We were lucky that year…we didn’t know it was about to get worse—’
The youngster clicked off his recorder before the old man could continue. ‘Yes, but we all know what happened in twenty-o-nine. I’m just researching the precursors to the health collapse and I was thinking that this might be of some use.’
‘Well, I hope I was of some help,’ the old man said standing up from the bench with a groan. ‘I’m off to stretch these worn bones. If I can be of any more help, just let me know.’
‘Will do Mr Reynolds,’ said the young man, ‘will do.’
Yes, we did have a shortage absence of blankets a couple of days ago. So far there is no official reason, but the tender driver told me the theory that I used in this story. It’s also true that we have to reuse blankets for different patients. There was a manager around, but he was in a meeting. I don’t know what the ‘overseers’ suggested.
There is no H5N1-MRSA cross-breed. I’m keeping my fingers crossed that I’m still alive in 2046.
Yes, I wrote this because I have too much time on my hands.
Sorry.
On the Power of Blankets (#ulink_60f9df7d-4313-55de-ba98-2ba3a6da0ee8)
I have mentioned that the blanket is one of the more important and versatile bits of kit that the modern ambulance can have. In the good old days of horse-drawn ambulances the proto-EMT would refer to his equipment as ‘one and one’, meaning one carry chair and one blanket.
Even today, with our increasingly technologically based healthcare system, the humble blanket has a multitude of uses. For those of a ‘hitchhiker’ mindset think of a blanket as a towel writ large.
Primarily it is used to stop little old ladies (LOLs) from getting cold when you drag them out of their nice warm house into the often freezing conditions of the ambulance.
Said little old ladies don’t like being wheeled around in our carry chair—it has no handrests and feels very unsafe. LOLs will often try to grab out at things to steady themselves—this is dangerous, especially if we are carrying them down stairs. So we wrap the patient in a blanket, and make sure that their hands are gently restrained.
You can use the blanket as a sliding/carry sheet when transferring a patient from a bed to a stretcher, or from the ambulance stretcher to the hospital trolley. The ambulance blanket is thick and strong with a close weave. While I wouldn’t like to try using it to lift someone off the floor, I would imagine that it is strong enough to do so.
When in the ambulance we can use the blanket to protect modesty. Some of the things we do to people require them to bare their chest, for females this can be troubling. We can use the blanket to cover the patient as much as possible.
If the patient has been incontinent while wrapped in the blanket, we can ‘gift’ the blanket to the hospital—it’s what nurses are for (and we don’t carry warm soapy water and wipes in the back of our ambulances). Nurses soon learn to unwrap carefully the patient who has been left in the ambulance blanket.
Because of the thickness of the blanket, and the difficulty of carrying vomit bowls into houses, the blanket can catch any vomitus the patient may produce while leaving the house. Reassuring the patient that it is fine to vomit on the blanket is important in case they become embarrassed.
When moving a dead body from a location, two blankets in the ‘T-wrap’ will disguise the lack of life from bystanders. It’s also good for wrapping up very frail LOLs when it is freezing outside.
With the addition of two triangular bandages the ambulance blanket can be converted into a pelvic splint. This helps stabilise pelvic fractures which can become life threatening if allowed to wobble. As an aside, the next time I see a trauma surgeon flex the pelvis in a suspected fracture, I’m going to find their car and let down their tyres.
If you don’t have the head blocks that go either side of the head to protect a possibly broken neck, then by the correct folding of the blanket you can form a snug-fitting c-spine restraint. I prefer the use of blankets to the specialist kit here because the blanket is better able to form itself to the patient’s head and neck.
Our blankets are red—this makes them ideal for hiding blood.
If you have a nasty trauma in a public place the blankets are large enough to be used as screens. This requires the use of two firefighters to hold each end. Don’t worry, they were probably standing around doing nothing anyway.
The blanket also works well as an ‘NHS special’ pillow. We don’t carry pillows on our ambulances and many hospitals are short of them. So roll up your blanket and place under the patient’s head. LOLs with a curvature of the spine will be especially grateful, as in a moving ambulance without a pillow their heads tend to roll around like a nodding dog.
If folded correctly, you can put it on your trolley bed and have ‘AMBULANCE’ written down each side. This not only looks good but also makes it really easy to wrap patients up in it.
If you have a patient who might become aggressive then the blanket—if tucked in tightly—can provide a mild restraint.
Doing CPR on the floor for an extended period of time can be wearing on your knees—a folded blanket makes a nice cushion to rest on while pounding away on some dead person’s chest.
If someone decides to have an epileptic fit in the back of your ambulance, the blanket can be used to protect the head (or other part of the body) from hitting the ambulance wall or other hard surface.
Have you had a huge spillage of some noxious fluid? Are you worried that as you return to your station to mop out the back of the ambulance the fluid will run through the door into the driver’s cab and thus contaminate your packed lunch? Simply mop it up with a blanket.
If someone tries to attack you, throw it at them like a net—it may distract them long enough for you to run away.
There are probably a hundred more uses for the ambulance blanket—and no doubt as soon as I publish this I’ll think of another 20. Still, I think that you will see that the humble blanket has many more uses than our defibrillators and ECG machines.
Friday Night’s All Right for Fighting (#ulink_45ff1d45-c3be-5877-be5d-2945ab9873d2)
The first job of our Friday night was to a little old lady (actually, she wasn’t that little). She had been standing on her bed with her daughter to fix the curtains when she’d felt dizzy and fell down. She then bounced off the bed and landed on the floor. Unfortunately for her, she had landed on her neck and head.
One of the first things that I do in a case like this is to make sure that there isn’t an injury to the neck. I’ll do this by gently feeling the neck while the patient tells me if it is sore. If there is soreness to one side of the neck then this will normally be a muscular injury while if the pain is in the middle of the neck then there is a chance that the injury is more serious. Like a broken neck.
This woman nearly leapt from her bed when I gently touched her neck—she had a potentially serious neck injury.
So we needed to be extremely careful in order to make sure that if the patient had broken her neck, we wouldn’t make her injury worse by bouncing her down the stairs from her flat to the ambulance. Unfortunately, everything we had to tell the patient had to be translated by the daughter. I need to learn Bengali; it’s a real shame I have no head for languages.
The patient had to be moved down the bed so that our scoop stretcher could go under her then she needed to be securely strapped onto it ready to be carried downstairs. In this case I used a blanket roll to secure her head rather than the more expensive and less effective head blocks. We called for another crew to give us a hand because in a case like this it is better to be safe than sorry, and you need to be careful carrying a potentially unstable neck fracture down two flights of stairs.
