Wednesday, November 11, 2009

Tuesday, September 22, 2009

A disappointment

I know that first and foremost, I'm a software engineer. It's something that I'm good at, and that I do on a day-to-day basis. But I'm also an Emergency Transport Attendant (ETA) with St John Ambulance. That is something I don't do on a day-to-day basis, but which I do as a hobby. Consequently, it's something that I work incredibly hard to keep my skills up to date, and my knowledge moving forwards. I take this role seriously. And I work hard to ensure that I'm good at what I do.

That is why it annoys me whenever I hear of tales of others in the organisation who are clearly not up to scratch, and who show us up. We want to be taken seriously as a professional organisation, but we can not be taken as such if we're being let down by others.

Take for example, the following situation:

30 year old female, early stages of pregnancy, suffering contraction-like severe abdo pain which are getting worse, with PV bleeding. This patient was transported to hospital, but not with the same sense of urgency or severity that it should have attracted:

  • Taken in under normal road conditions (20-25 minutes through heavy traffic)
  • No pain relief given, despite the pain getting worse
  • Obs taken before transport was pulse, resps, BP and GCS. One set taken in transport, consisting of only a pulse. Yes, one set during the entire 25 minute run

When myself and a couple of other ETAs found out, we were shocked and appalled. There is the time and the place for going slow with jobs, but this was not one of those circumstances. And our ETA training teaches us to consider carefully what is best - to scoop and run, or to wait for a Paramedic. It often depends on how close we are to A&E, and how close the nearest Para is. In this case, A&E would have been obtainable in less than 6 minutes.

Unfortunately, cases like this do a great deal of damage to our reputation. So why have I spoken publicly about it? Mainly because this sort of thing winds me up so much, and because I feel that if just one person can take this tale and use it to help somebody else not make the mistake again, it will have been to our benefit.

There has been active drives within the organisation to improve the quality of our members, and this needs to keep happening. We have to do this, if we are to be taken seriously by others, and to stop the more offensive and derogatory comments being levelled as us.

Thursday, September 10, 2009

"A Drop Too Many" by Major-General John Frost

Major General John Frost's autobiography, "A Drop Too Many" was first published nearly 30 years ago. It tells the story of birth of the Second Battalion, The Parachute Regiment, which was formed September 30, 1941 as the Second Battalion, 1st Parachute Brigade.

Born in 1912, Major General John Dutton Frost had an illustrious career in the British Army, earning "the Military Cross, the Distinguished Service Order and Bar, and was a Companion of the Bath and a Grand Officer of the Sovereign Military Order of Malta." This book, his memoirs, was first started while he was a POW and was eventually published in 1980 following the success of Cornelius Ryan's, A bridge too far. Frost is best known for the action that he led at Arnhem, where less than 800 lightly armed paratroopers held the north end of a key road bridge over the Rhine for 3 days and 4 nights against repeated counterattacks by German forces. However, the story doesn't start there.

It starts with his time with the Iraq Levies, an aspect of World War II that I know nothing about, and yet I probably should. It describes his transfer into the 1st Airborne Division, and of how he came to command 'C' Company, 2nd Battalion, whose first active operation was Operation Biting (sometimes known as the Bruneval Raid), which greatly aided Britain's involvement in the radar war.

It goes on to tell about their involvement in Tunisia, Sicily and Italy. By the time of Tunisia, Frost was in command of the entire of 2nd Battalion, and he lead them against a series of airstrips near Depienne as part of Operation Torch. This plan went disastriously wrong, and the battalion was left 50 miles behind enemy lines. They eventually fought their way out, and took part in the rest of the campaign, proving themselves to be worthy adversaries during the Battle of Tamera. They were pulled out of action March 29, 1943.

However, nobody at home knew of their involvement in Africa,as the press were not allowed to report on their presence. Their involvement was kept strictly secret, and nobody, not even their friends and family knew.

On July 12, 1943, after rest and refit, 2PARA was dropped into Sicily as part of Operation Fustian with orders to form a defensive perimeter whilst the remainder of the 1st Parachute Brigade had orders to capture and hold onto a road bridge called Ponte di Primosole. The operation did not go as planned, and the 1st and 3rd Battalion were eventually forced by counterattacks to retreat to 2nd's positions overlooking the bridge. However, a combined attack by tanks and elements of the Durham Light Infantry retook the bridge on July 16. However, Sicily had cost the battalion dearly.

After a short stint in Italy during which time they did very little, the battalion were recalled to the UK. They were not involved in the D-Day landings, and it was only after a significant period of rest and refit that they were involved in Operation Market-Garden; and given the important task of holding the bridges at Arnhem. Much has already been written about this operation, and its failings. The failings were with the original plan, a plan that Frost appears sceptical of right from the start.

The last chapters outline Frost's time as a POW, and describes in brief the reformation of the battalion after the war.

Sadly, Frost died in 1993 at the bag of 80, as he would probably have some interesting political views on the current situation regarding Iraq and Afghanistan.

The book is very well written, and well worth reading, although the later chapters are a bit short. The description of the Arnhem operation is incredibly short, which is a tragedy. Frost's thoughts on the operation should by rights be truly illuminating, and while they are, the reader is left craving more!

Tuesday, August 25, 2009

"The Dam Busters", by Paul Brickhill

Originally published in 1951, this is the story of 617 Squadron. Yet it is more than just the story of the raid on the Möhne Reservoir, which earnt the squadron its nickname. It is the story of the formation and operations of the squadron, right up to the end of the war, during which time the squadron earnt itself a reputation as being a truly remarkable fighting force.

The book starts with the history of Barnes Wallis, and his quite novel ideas for a new range of weapons - the bouncing bomb, the Tallboy and the ten ton Grand Slam. Development of each of these are described in some depth by the author, Paul Brickhill, who also served in the British Army during World War II. This makes it a fascinating look at how the squadron and its weapons and tactics all matured together. Few books are as well rounded as this, tending to consider just one aspect at a time.

What the men of 617 squadron achieved is just incredible. And what they endured is also remarkable. They were bombing targets with very rudimentary equipment and achieving bombing accuracies that are still remarkable even in the of laser guided smart bombs, etc. No wonder then that they had to make their story into a movie - it has all of the necessary elements! The near-suicide mission (low level approach over heavily-defended enemy terrority at night), the characters (Barnes Wallis, numerous charismatic squadron leaders, Bomber Harris, Winston Churchill and a dog) and the gut wrenching plot.

It is definitely a very good book, and well worth reading.

Sunday, August 23, 2009

"D&V"

The job was given as a 'simple' "Diarrhoea and Vomiting" run. A GP had been out to the lady and had requested that a non-emergency ambulance take her into hospital.

We turn up at the address, and I start talking to the patient. Firstly, turns out there's absolutely no history of diarrhoea. So where that came from, I just don't know. Secondly, it's been over 10 hours since the GP was on scene, even though they only booked the ambulance transfer 2 hours ago. Why it took them 8 hours to book the transfer, I don't know.

But the fun doesn't stop there.

I'm talking to the patient, and thinking to myself, "God this lady looks pale."

I ask where the pain is.

"In my chest. Right in the middle."

On further questioning, it turns out to be a central crushing chest pain, radiating into the back, rated 8/10. There's no history of cardiac problems in the lady's family, but rather upsettingly, it turns out she was a grey/blue colour this morning while the GP was on scene. She's now either pale or starting to turn jaundiced (it's hard to tell in the poor light!)

Maybe that prognosis should have been, "? cardiac problems which I'm going to leave at home for 10 hours so she can slowly die whilst in pain." That would have been more accurate.

We scoop and run with the patient, and the nurse at hospital looks appalled when we turn up with the patient at A&E. I think the sanitised version of he said goes something like: "That's no £$%^&*@ GI tract problem! £$%^&*@ GP!"

Tuesday, August 18, 2009

Private Ambulance Service

So a while back, I encountered a Private Ambulance Service whose staff were fantastic. In contrast to the post about that, I thought I'd describe one of the horror stories that I have about other Private Ambulance Services.

St John had been contracted to provide First Aid and 2 Ambulances at a Motocross, but about a week before it, we'd been contacted and told that our services were no longer required. They'd organised a Private Ambulance Service, who were apparently a lot better than us. It was a bit of a blow to us, but never mind.

Instead of being on duty at the Motocross, the road crew ended up doing A&E Support. And in the earlier afternoon, they were passed an Emergency at that very same Motocross. A teenage rider had caught his thumb in the sprocket of his bike, and had amputated it. The Private Ambulance Service Paramedic and other staff were dealing on scene, but they required somebody to transport the casualty to hospital...

Good start, right?

So the crew turn up at the event. The patient is ready to travel, and his thumb has been dealt with. It's in a bag, ready to be transported along with the casualty. The crew are then handed the patient report form. It was the size of an A5 piece of paper, and was lacking in all but the most basic details. The reason the Private Ambulance Service aren't transporting? Because they're not insured to do so. They've not got insurance to transport patients on the Public Highway.

Tell me you're impressed, now.

The crew transport the patient, and are met at the receiving hospital by a surgical trauma team. Who open the package containing the thumb (which was not touched by our crew at all), to find a single disposable ice pack wrapped around the thumb. Which is now entirely blue.

So, let's recap. These "Paramedics" failed to treat even a simple amputated thumb, causing a 14-year old boy to lose his thumb. His right thumb. And he was right-handed. I'd say that's pretty bad, wouldn't you?

Friday, August 14, 2009

When God Made Paramedics

Dedicated to the Paramedic (and those like him) who helped us out the other day:

When God made paramedics, He was into His sixth day of overtime. An angel appeared and said, “You’re doing a lot of fiddling around on this one.” God said, “Have you read the specs on this order?

A Paramedic has to be able to carry an injured person up a wet, grassy hill in the dark, dodge stray bullets to reach a dying child unarmed, enter homes the health inspector wouldn’t touch, and not wrinkle his uniform.”

“He has to be able to lift three times his own weight. Crawl into wrecked cars with barely enough room to move, and console a grieving mother as he is doing CPR on a baby he knows will never breathe again.”

“He has to be in top mental condition at all times, running on no sleep, black coffee and half-eaten meals, and he has to have six pairs of hands.”

The angel shook her head slowly and said, “Six pairs of hands…no way.” “It’s not the hands that are causing me problems,” God replied. “It’s the three pairs of eyes a medic has to have.” “That’s on the standard model?” asked the angel.

God nodded. “One pair that sees open sores as he’s drawing blood, always wondering if the patient is HIV positive.” (When he already knows and wishes he’d taken that accounting job) “Another pair here in the side of his head for his partner’s safety. And another pair of eyes here in front that can look reassuringly at a bleeding victim and say, “You’ll be alright ma’am when he knows it isn’t so.”

“Lord,” said the angel, touching His sleeve, “rest and work on this tomorrow.” “I can’t,” God replied. “I already have a model that can talk a 250 pound drunk out from behind a steering wheel without incident and feed a family of five on a private service paycheck.” The angel circled the model of the Paramedic very slowly. “Can it think?” she asked.

“You bet”, God said. “It can tell you the symptoms of 100 illnesses; recite drug calculations in it’s sleep; intubate, defibrillate, medicate, and continue CPR nonstop over terrain that any doctor would fear… and it still keeps it’s sense of humor.”

“This medic also has phenomenal personal control. He can deal with a multi-victim trauma, coax a frightened elderly person to unlock their door, comfort a murder victim’s family, and then read in the daily paper how Paramedics were unable to locate a house quickly enough, allowing the person to die. A house that had no street sign, no house numbers, no phone to call back.”

Finally, the angel bent over and ran her finger across the cheek of the Paramedic.

“There’s a leak,” she pronounced. “I told You that You were trying to put too much into this model.” “That’s not a leak,” God replied, “It’s a tear.” “What’s the tear for?” asked the angel.

“It’s for bottled up emotions, for patients they’ve tried in vain to save, for commitment to that hope that they will make a difference in a person’s chance to survive, for life.” “You’re a genius!” said the angel.

God looked somber.

“I DIDN’T PUT IT THERE” He said.

-- Author unknown.

Stolen from Medic999.