Thursday, 25 December 2008

Merry Christmas!

Merry Christmas, dear readers!!!!!! That is if there's anybody left still reading this blog...I'm hoping to be back at work next month, so keep stopping by.

I hope you and your loved ones all have a fantastic Christmas. Remember not to get TOO drunk, because nobody wants to call an ambulance on Christmas Day! :P

Go on - eat, drink and be merry!

Petrolhead

Thursday, 11 December 2008

999 transcripts

A few weeks ago, the Guardian Weekend magazine had a very interesting piece about 999 calls. It features several transcripts of calls to the ambulance service, and shows readers what it's really like when you pick up the phone and request an ambulance.

Personally, I'm fed up with the way that TV programmes such as Eastenders and even Casualty portray the initial contact. OK, I understand that having a five minute scene where the person reels off information such as the patient's address and level of consciousness may not make enthralling viewing, but the number of times I've seen Peggy Mitchell bark "Yeah, I need an ambulance now! My son's been assaulted!" and then slam the phone down is infuriating!

Friends of mine outside the emergency services have commented that the feature is a fascinating insight into how things work 'behind the scenes', and how important it is for callers to remain calm in what are obviously very distressing situations.

Here's a link in case you haven't read it yet. http://www.guardian.co.uk/society/2008/nov/29/unpublished-999-call-transcripts

Wednesday, 20 August 2008

I'm still here!!

Sorry for the distinct lack of posting over the last 3 months! I am still here, but things are very busy in the world of Petrolhead right now. I'll update you when I can, but don't give up on me, I'm still here!

Monday, 26 May 2008

Out of Area

Occasionally, we get calls for other parts of the UK. Usually this happens if somebody – from Cardiff for example – phones a relative in Sussex, and they suddenly collapse. The person in Sussex will phone 999, and we process the call as usual. When the call is finished, we’ll look up the ambulance service for that county and pass it to them to deal with. Yesterday, I took a call for a patient in High Wycombe, a 73 year old female who had collapsed in her utility room. Her son, who had special needs, panicked and called his uncle who lives in Brighton. He phoned 999 himself, and automatically got through to the Sussex control room. I took the call as usual, but then there was some confusion over which service actually covered High Wycombe! It’s East Midlands Ambulance Service, if you’re interested. Altogether that call took 11 minutes from the initial beep in my ear to completing passing the call to EMAS. Not bad!

Sometimes, we have to use our powers of persuasion with patients. I got a call from a very sheepish 57 year old man who was stuck on the toilet. He was disabled, and couldn’t transfer himself from the toilet to his wheelchair. He was also pretty certain that something was going on ‘down there’ so that was causing him a bit of pain. He wasn’t sure he needed an ambulance, and asked me if I thought he did. “How will you get off if we don’t come out to you?” I asked. He couldn’t think of an answer, so agreed to let me send a crew to him.
“I feel such a fool!” he told me. “Stuck on the toilet at my age! Will the crew mind? It seems such a stupid reason to have an ambulance.”
“That’s what we’re here for, to help people. People call ambulances for far more trivial reasons.”
I felt pleased with the way I handled this call. I made this man feel slightly better about calling us out, and even though we could have refused to send one because he wasn’t in a life threatening situation, how else would he have got off the toilet? If he’d called the out of hours GP, I’m sure they’d have referred him straight to us anyway!

Full Moon

I always thought it was a myth when my colleagues told me that the strangest calls seem to happen when there’s a full moon in the sky. I was on a 12-hour night shift recently, and it was all going OK until about 1.30am when Dave – a regular caller – phoned us, saying he’d passed out 3 times in as many hours. I went through my questions as usual, but he kept saying he couldn’t understand me, like I was speaking a foreign language. As I was trying to ask the rest of my questions, he told me the doorbell was ringing (at that time in the morning??) and insisted on answering it. It was clear he wasn’t going to give up, so I let him go and answer it. He came back to the phone a few seconds later, saying the taxi driver was there. “So you’re getting a taxi to the hospital?” I asked. “Shall I cancel the ambulance?”
“No,” Dave sounded exasperated, “The taxi is here so I can get food! You speak to him, I haven’t got time for your stupid questions!” so he passed me to a very confused sounding Italian man, who got very impatient when I asked to be put back on to Dave and slammed the phone down. Agitated, I phoned back and the taxi driver picked up. “Does Dave still need an ambulance? Is he going to make his own way?”
“You’re making me late for work, go away and leave us alone!” was the reply I got. Dave grabbed the phone from the taxi driver, so I asked him. “No,” came the grumpy reply “I just want some food, so go away!” We got a further 4 calls from Dave that night – the saga only ended when I got one of his calls at 4.45am and passed it straight to my DDM (duty dispatch manager) who managed to persuade him that maybe it would be a good idea to go to bed.

At 2.30am I got a call from a woman who said he partner was hitting himself over the head with a deodorant can. She sounded exasperated, and explained that he had a history of mental health problems for the past 3 weeks. No matter how many times she asked him, he simply refused to give her the deodorant can. I wonder what happened to make him go crazy like that?

My final call of the night came via NHS Direct, for a female with a headache and confusion. The twist was, she was Arabic and neither she nor her husband – the caller – spoke English. NHS Direct had got a translator from Language Line, so we knew what we were dealing with but this made the call much longer and drawn out than usual. I had to ask my question which was translated, then the answer was also translated, a bit like you see on TV sometimes. It was very interesting though, and fitting that it should be the first Language Line call I get, exactly six months into the job!

Sunday, 18 May 2008

A Mother's Instinct

Not being a mother, I can't say I really understand, but it seems to me that a mother's instinct is an incredible asset. My mum can almost always tell when I'm lying!!
When it comes to life-threatening emergencies, this instinct is amazing. I answered a call for a one year old little boy, who had spots and was vomiting. The call came from the child's mother, who had phoned NHS Direct earlier that evening. They put the boy's symptoms down to chickenpox and recommended the usual plenty of rest and calamine lotion to soothe the itching. But the mother's instincts told her this was not just a case of chickenpox. She was convinced it was something worse, as the baby was now quite floppy and unresponsive. When the crew got to the house, they were equally as concerned for the baby and rushed him into hospital on blue lights and sirens. I later found out that he had been diagnosed with meningitis. If she hadn't phoned 999, his condition would have deteriorated rapidly and he could have died.
Sometimes, the instincts of a parent - more often than not it's the mother, for some reason - can be rather annoying for the child (offspring, I should say, I'm not a child!) but on other occasions, such as this, it can save lives.

Saturday, 10 May 2008

Number one rule..

...Windows are not designed to be jumped through, especially when they're closed!!

Of course, most people know that already, and would think I'm pretty stupid for mentioning it in this blog. But one of the most interesting (and major, it turns out) calls on Friday night turned out to be just that. A very drunk, and very upset, 19 year old decided to throw herself through the window of the local post office just to show her (now extremely embarrassed) boyfriend how much she loved him. Being quite a warm Friday night, the town centre was milling with people, so we got several calls about this particular incident. There were 7 call-takers on duty that evening, and I think we all got at least one call relating to it!

We had a paramedic manning the clinical advice desk that night, so he drove the 300 metres to the scene. The patient's leg was bleeding severely when he arrived, and apparently her nerves and muscles were there for all to see. Her right thumb was completely degloved (the skin was torn off the thumb tissue - not pretty!) and she was taken straight to A&E when the ambulance arrived. We later heard that she'd been taken for extensive surgery soon after her arrival at A&E. Because of the damage she's done to her thumb, she won't be able to return to her job as a hairdresser for a long, long time. That was certainly a night for her to remember, although I'm sure she'd love to forget it.

Sunday, 4 May 2008

The Joys of a Saturday Night!

I hope you've enjoyed my last couple of posts, they explain more about the technicalities of my job, because I haven't really had many interesting calls!

This week is my relief week, so I did a 10-hour night shift last night -I worked from 8.30pm to 6.30am. It started off well enough, the 'usual' chest pains and falls, as well as drunk people and overdoses. It got interesting when a call dropped into my ear and the first thing I heard was shrieking teenage girls. The alleged problem was that one of the girls - 18 years old, apparently - had taken an overdose of ecstacy tablets. They seemed rather proud of the fact they were experimenting with drugs, despite the fact that the tablets seemed to be having a detrimental effect on the patient's health. When I asked exactly where they were, they said they were by the side of the road next to a well known local park. I took the call as usual, then went on to take a couple more calls.

After about 15 minutes, the girls phoned back and the call came through to me again. The patient was now deteriorating, losing consciousness. They were louder and more giggly than before, and one girl in particular seemed quite mouthy, yelling in the background "Where the hell's this f***ing ambulance? Hurry up, you f**ing c***s!" I don't have time for people who shout abuse at the people who are trying to help them, so I asked the caller to get her mate to calm down. The girls kept passing the phone from one person to the other, including the patient, who seemed really drugged up and out of it. Several minutes after the ambulance had booked on scene, there was still no sign of the crew so I asked for better location details. The whole time, the swearing girl was getting more agitated, so I instructed the caller to send her to check the road sign. She came back, and what do you know? The whole time she'd been screaming abuse about the ambulance service, I'd sent our ambulance to completely the wrong side of the park! I entered the correct location details, and sent one of the girls to flag down the ambulance.

So that's that. An ambulance, in the busiest town in the county on the busiest night of the week, driving round and round in circles because a bunch of kids were too high on drugs to give me the correct location in the first place! Oh yes, it's the joys of a Saturday night!

Tuesday, 29 April 2008

Chief Complaints

Depending on the symptoms that the caller gives, each call is put as a 'chief complaint'. For example, if you say 'my daughter's fallen out of a tree', that would go under number 30: Traumatic Injuries.

The 'public' chief complaints go from number 1 to 32.

1. Abdominal pain
2. Allergies/Envenomations
3. Animal bites/attacks
4. Assault/Sexual Assault
5. Back pain
6. Breathing problems
7. Burns, Scalds and Explosions
8. Carbon Monoxide/Hazchem (Hazardous Chemicals)
9. Cardiac or Respiratory Arrest/Death
10. Chest Pain
11. Choking
12. Convulsions/Fitting
13. Diabetic Problems
14. Drowning/Diving/SCUBA accident
15. Electrocution/Lightning
16. Eye Problems
17. Falls
18. Headache
19. Heart Problems/AICD (internal defibrillators)
20.Heat/Cold Exposure
21. Haemorrhage/Laceration
22. Inaccessible/Other Entrapment
23. Overdose/Poisoning/Ingestion
24. Pregnancy/Childbirth/Miscarriage
25. Psychiatric/Suicide attempt
26. Sick person
27. Stabbing/Gunshot/Penetrating Trauma
28. Stroke (CVA)
29. Traffic & Transportation Accidents
30. Traumatic Injuries
31. Unconscious/Fainting
32. Unknown Problem (3rd party) This is mainly used when a careline calls us because a client of theirs has pressed their emergency button but not made verbal contact. We also use it when a caller isn't actually with the patient, for example if they drive past a person who is lying face down. We don't know whether it should be 31 (unconscious), 23 (overdose), 17 (falls), 12 (convulsions) or 9 (cardiac/respiratory arrest)

I have been working for the ambulance service for nearly six months now, and have used every single chief complaint at least once. Some complaints are more common than others: breathing problems and chest pain being among them. But ask any EMD and they will tell you without fail that the most common chief complaint is 17 - FALLS!!!

A guide to the 999 system

Statistically, the average UK resident will phone for an ambulance every 14 and a half years, so it's quite likely that the majority of our callers will be doing so for the first time.

I'm going to guide you through an average 999 call.

Me: Ambulance emergency, what's the address of the emergency?
Caller: 23 Random House, Average Road, Boringsville, Sussex, AB12 3CD
Me: Thanks. What's the problem, tell me exactly what's happened?
Caller: My dad's got chest pain.

I will then find 'chest pain' on the ProQA system and get the screen up.

Me: I'm organising help for you now, I just have to ask a few questions but it's not delaying any assistance to you.

Then I will ask the caller some questions relating to their father's chest pain, such as whether or not he is breathing normally. This determines the severity of the problem at that time, and the call is triaged.

Me: I'm arranging help for you now, stay on the line and I'll tell you exactly what to do next.

I will give some general instructions - called PDIs, or Post Dispatch Instructions - such as asking the caller to gather the patient's medications and writing down the name of their GP, and sending somebody outside to meet the ambulance crew. Usually, that is where the call will end, but if the chest pain is severe enough to pose an immediate risk (such as the patient losing consciousness or going into cardiac arrest) I will stay on the line in case further instructions are required. These are called Pre Arrival Instructions.

I hope you've found this interesting! If you want to know any more about the ProQA system, there is some information at http://www.prioritydispatch.net/index.php?a=products&b=policeproqa_more

Friday, 25 April 2008

Child Callers

Today, I had my first (genuine) call from a child. I say 'genuine', because I have had several calls from kids, but up until now they've all been hoaxes.

I was connected to the operator as soon as the call dropped into my ear, and he read out the phone number the child was calling from, before adding that the caller sounded like a child. I'm ashamed to say that as soon as he said this, I was already to prepare myself for explaining to the dispatcher that the call was a hoax. But when the child gave me the address and I asked what the problem was, it sounded pretty genuine.

The child's mother had fallen and hurt her back, she was unable to move properly. While I arranged help, I notified the crew that the caller was a child, and was 7 years old. The child was very calm, and as well as phoning 999 for help, he calmed his little sister down who was a little upset at the commotion. The child's mother was Indian, so he translated my questions into Indian for his mother, and back to English. I was thoroughly impressed, and that call made me change my views on child callers completely. I vowed to initially take all calls like this seriously, unless they seem blatantly obvious that they're hoax. I got a call 3 weeks ago from a couple of kids who claimed that a factory in Barnsley was on fire - "That's strange, how do you know about what's going on in Barnsley when you're calling from a phone box 250 miles away?" I asked. They hung up, horrified that I'd seen through their stupidity.

Sunday, 10 February 2008

Two extremes

It's 2.30am, the control room is quiet, just the low hum of the air-conditioning unit can be heard. Then I hear a 'bleep' as a call drops into my ear. "Ambulance emergency, what's the..." I'm interrupted by a panicking woman, who tells me that there's been a crash outside her house down a dark lane. After I manage to get the address, I inform her that we have dispatched an ambulance, and she explains all she knows. Given that she was woken up by a huge crash and dialled 999 immediately, she doesn't know much. Looking out of her bedroom window, all she can see is a single light shining up to the sky. She thinks it's a motorcycle, so I update the crew. It's very important that the crew know as much as possible before they get to the scene, so I ask the caller to go outside and tell me what she can see. She's phoning from the landline so I call her back on her mobile. Frustratingly, it cuts out as she's running down the lane so I phone back. When she answers, she sounds very distressed. There is a car, upside down, and she can hear screaming. This is good, because if you're screaming, you're conscious and breathing. I'd be very worried if there was nothing but silence coming from the car. All the while, I updated the crew of everything the caller was telling me. About 30 seconds later, I heard the lovely sound of sirens. The caller confirmed that this was the ambulance, so she hung up.

The dispatchers kept receiving updates from the crew, as well as the fire brigade and police. I was also keeping tabs on the job, and it transpired that the car was a Ford Fiesta, driven by a 36 year old male, who tragically died on the scene. There were 3 passengers, all of whom were taken by ambulance to the nearest A&E department.

This call didn't 'get to me' like I thought it would. I was saddened by the fact that a life was lost, but I didn't let it affect me. That's a good thing, because the very next call really shouldn't have needed a 999 response. It was an elderly gentleman with earache! That's what NHS Direct is for, or the out of hours GP services - to prevent ambulances being dispatched for very minor problems, which then clog up the A&E departments. Of course I sympathised with the patient, because he must have been in an awful lot of pain - I've experienced more than my fair share of ear infections - but what could an ambulance crew honestly do for him? I transferred his call to our Clinical Advice Desk, who advised him to call his out of hours GP.

Wednesday, 6 February 2008

Directions

Last night was a 2230-0630 shift, which went annoyingly slowly. The majority of the calls were fairly 'routine', such as chest pain, falls etc. but I did get quite an interesting one - an assault.



It took several minutes to ascertain that a 37 year old female had been beaten up by her partner and left in her car by the side of the road. Unfortunately, she was in a very minor B-road in a small village somewhere in the county. I had no idea where she was, and she could not see any specific landmarks, so it took about 10 minutes to get a good enough location to send the ambulance crew. If the incident had taken place in the day, or before 1am, we could have dispatched the helicopter to locate the patient, but unfortunately the incident occured at 3.30am so the 'copter was tucked up in its hanger - fat lot of good it was in there! Eventually I managed to work out that she was in a dark blue Peugeot estate, and I instructed her to switch on the hazard lights so her car was visible to the crew.



The patient was very distressed, her partner had punched her in the face and she had a possible head injury so I stayed on the line with her until the crew got to her.



My friends stayed the night in my room last night, I had to turf them out of my bed when I got back at 7.30am! I felt guilty for about the 3 seconds I was conscious after my head hit the pillow. When I woke up at 1pm, I was greeted with the news that I dont snore in my sleep, but I actually sleep-talk!! Apparently, I was saying "I'll get that to you as soon as possible, sir." I can only imagine that I was dreaming about work, and 'that' was in fact an ambulance. I was so embarrassed!

Monday, 21 January 2008

Third Manning

Ever since I was a kid I wanted to be a paramedic, and today I got my first taste of what it's like 'on the road', when I went third-manning (observing) with a local crew.

I arrived at the ambulance station at 6.30am, and met the people I'd be crewing with. At 6.35am we got a red call so I jumped into the back of the vehicle and we zoomed off on blue lights and sirens. It was very exciting! We got to our destination, and helped to pick an elderly lady up off the floor, where she'd fallen out of bed. She had a severe laceration to her forehead, and was quite confused. One of the crew was an ECP (emergency care practitioner) and could have stitched the patient's forehead himself without the need for her to attend A&E, but because she was confused, it was best that she was given a full check-up, so we took her down to the local hospital. Unfortunately, when the crew was lifting the patient from the floor, the paramedic felt his back 'go', so he got checked out in A&E too (five star treatment all the way!) and was deemed unfit to work, so he did paperwork all day, poor thing.

I teamed up with another crew, and our first call was at about 9.30am, to a 50 year-old-male with chest pain. When we arrived he seemed fine, but there's no knowing with chest pain so we took him to A&E anyway. It was probably just a touch of angina, but it's always better to be safe than sorry. And how right we were! When we dropped off another patient later on in the shift, the A&E staff told us that the patient had suffered a massive MI (myocardial infarction - aka heart attack) and had to have a stent inserted into an artery in his heart. When you have an MI, there's a blockage in the artery, so a special drug (thrombolysis) is given to get rid of the blockage and then you have a stent inserted to keep the artery from narrowing. (If any paramedics/technicians read this and want to correct me or add to that, please feel free!) So, if we hadn't taken our patient in as a precaution, he would almost certainly be dead right now. As it is, he's in CCU (Coronary Care Unit) and is being discharged tomorrow! We also had a patient who phoned 999 because he had a locked jaw, but when he was sitting in the back of the ambulance he forgot he couldn't talk and was chatting away 19-to-the-dozen until we reminded him and he went bright red! I could have given him the number for a cheap taxi service if all he needed was a ride to the hospital, but as it is he could have taken a front-line ambulance away from a patient who really needed it. I hate time-wasters so much!

Wow, it's been a long time!!

Oops! It's been over a month since I last posted.

Well, we're nearly a whole month into 2008, and I hope it's going well for you! It's certainly going well for me. I finished my training, and I went solo on 30th December 2007. My final training shift couldn't have gone better, if I'm honest. I took a call from a young mother whose 2-year-old son was having a fit. He'd been fitting for 5 minutes straight, which was incredibly worrying. I arranged the ambulance and stayed on the line with the mother until help arrived. I tried to keep her calm, because needless to say she was a bit panicky. The paramedics arrived, I left her with them and got on with the rest of my shift, which went fairly uneventfully. Later on, however, my DDM (Duty Dispatch Manager - my boss) sat me down and told me to get the job back on the screen. I was a bit confused, until he showed me the comments section. The mother had been so impressed with the way that I'd kept her calm and focusing on her son that when they arrived in A&E she asked the crew to thank me! I felt really proud of myself, because I hadn't tried any harder than I usually did, but that in itself must be a good thing because I must just be a calming influence on callers! It was certainly a very positive way to end my training, and also to end 2007.

So, I've now been solo for 3 weeks, and it's great. I'm trusted to take 999 calls, and I'm so proud of myself. This time in 2007 I was a kitchen assistant in a care home, doing 12 and a half hours a week - and in 2008 I'm a full-time EMD doing 12 hours in a day!

I hope you all had a peaceful Christmas and New Year, and that 2008 has started as well as mine has!