Pneumonia or Stroke?

If you have a patient who's presenting with signs and symptoms of both Pneumonia and a Stroke, which condition are you going to be more concerned about?

We were given an A&E Doctor's Urgent as: "Queried Pneumonia / Stroke". We turn up and collect a patient who over the past 48 hours has deteriorated significantly and is presenting as FAST-Test positive. He's unable to hold himself upright in a chair and his speech is abnormal.

As requested by the Doctor (who we never saw and hadn't left us any details), we transferred the patient to the local hospital. Neither me nor my crewmate were too happy about doing this though, as the patient was 'ill'. If it had been anywhere else, I'd have requested further assistance and run the patient into A&E; as it was, we transferred to the local hospital on the belief that they'd been notified, etc, and as they were only a few minutes away. As it turns out, they'd only been told that the patient had "Queried Pneumonia", and were very upset that the Doctor hadn't told them about the signs of a stroke.

As it was, they agreed with our assessment of the patient, and later transferred the patient to a better equipped hospital. So, why dear friends, did the Doctor fail to notify the hospital?!

"The Bruneval Raid", by George Millar

While people may poke fun at "British Boffins", during the early years of the war, it was British Boffins, Dons and Professors who were at the forefront of the war effort. Without them and their intellectual efforts, the outcome of the war could have been very different.

One of the factors in this success was that the British won what is called "The Radar War" - the ongoing struggle between Britain and Germany to achieve radar superiority of the skies. A key factor of that was the British raid on the German radar site at Bruneval, Northern France.

The raid itself was a success, and greatly aided in the war effort. It was lead by Major Frost, who would go on to lead further remarkable operations later in the war. This could be seen as a pre-cursor for what he would later achieve.

This book gives the reader a fascinating insight into both that raid, and the radar war. My main criticism of the book is that there is significantly more focus on the radar war itself, rather than the Commando Raid on Bruneval. There's bits and pieces about the build up to the operation, but there is significantly more about the technicalities themselves. If you want a book looking at raid itself, you’ll need a different book I’m afraid.

Would I recommend this book? Yes, I would. It's more about the technicalities rather than the raid.

Team work

"Isn't it nice, when things just work?"
... was the tag line for a high-profile advertising campaign that Honda aired for the new Honda Accord approximately two years ago. And it's the perfect phrase to express my sentiments of a recent car extraction that I was involved in with St John.

Now, a little bit of background. As a University student, I'm part of St John both at home and at University. Having essentially grown up with St John at home, I find it very easy to work alongside other members there, as they've had a similar set of training, etc to me. Whereas at University, I'm with people who have had a different approach taken to their training, and whilst we're meant to all be equal, we're not. There are skills that these people have that I don't, and likewise, there are skills that I have that they don't.

However, at this particular job, which was not with my home county, it was absolutely brilliant that as a team, we were all on the same wavelength and everything just worked perfectly.

Amongst the other members involved, there has been some speculation that this may be because we're all young (all three ETAs involved are 23), with which I concur - we've all had recent ETA training and we're all young and motivated and willing to learn new things whereas some of the older crews do get a little set in their ways.

The job was quite involved. Car versus a side wall initially, which then hit the back of a stationary car, and was then struck from behind by a second car. As a result, the driver's head would almost certainly have whiplashed, as although he was wearing a crash helmet, we wasn't wearing a shoulder harness for it*. He was complaining of central neck pain on the lumpy bit at the back of the neck (around about C5-C7). We would have no option but to board and collar him.

The collar went on not a problem, and the decision was made to KED^ him. This went straight on, and worked like a charm. The pain in his neck started to subside as soon as his neck was properly secured. This gave us more time to think, and helped to calm the patient down considerably. Next, the car was dismantled around me and the patient, and we were able to slide the patient straight out onto a spinal board.

Like I said, it was nice to see that every part of this scenario worked brilliantly. The use of a KED has been argued against by some, but there was no need for even a discussion in this case. All three of us were in agreement about its use. Oxygen went on at just the right point, although there has been some conjecture about its overuse.

For all of those involved, it just felt like it was a superb job well done.

* Stupid idiot, but that's a rant for some other time.
^ KED, the Kendrick Extrication Device, looks a bit like a straight jacket and can be described as a shortened long board that wraps around a patient's head and torso and holds a patient back and neck steady. Useful for car extrications, as it helps to immobilise the upper body before we start to move the patient out of the vehicle.

Let's all take a moment

In the past few days, three celebrities have passed away. Firstly, Ed McMahon died on June 24th. Farrah Fawcett then passed away June 25th, and Michael Jackson passed away later that same day. Within hours of each of their deaths, it was widespread news. Google even struggled under the strain of large numbers of users searching for news about Michael Jackson's death:

Web slows after Jackson's death

The internet suffered a number of slowdowns as people the world over rushed to verify accounts of Michael Jackson's death.

Search giant Google confirmed to the BBC that when the news first broke it feared it was under attack.

Millions of people who searched for the star's name on Google News were greeted with an error page.

It warned users "your query looks similar to automated requests from a computer virus or spyware application".
Read more...

Yesterday, nickopotamus posted an insightful comment about people losing perspective with regards to the death of Michael Jackson. As he remarks, lots of other things happened on that same day that should have been equally news worthy. I will admit, Michael did a lot for the world of music, racial equality and for charitable causes (apparently he was listed in the 2000 Guinness Book of World Records for breaking the world record for the "Most Charities Supported By a Pop Star"), but I still think the sheer volume of news articles appearing on sites such as BBC News are a tad disproportionate.

My good friend Linda also posted a similar news article on MajorDickWinters.com, about the loss of Shifty Powers and the lack of reporting about it. How many people know the name Shifty Powers? Are there queues of people outside the hospital in which he died, crying over his loss? I doubt it, somehow. The article is thought provoking, and worth reading. I've reproduced it at the end of this post. Please take the time to read it.

Shifty was a good man. A good soldier. And a true American Hero. He served with Easy Company, 506th Parachute Infantry Regiment, 101st Airborne; the company who were immortalised by the HBO mini-series, Band of Brothers. Part of the original company founded at Camp Toccoa, Georgia in 1942, he took part in every action that Easy were involved in. He finished the war with an exemplary record. Yet for the majority of people, none of this shall ever be known. There is just not enough publicity about what this man did for his country.

Amidst The Death Of Celebrities, A True American Hero Passes

Ed McMahon died on Wednesday, June 24th. On the morning of June 25th it was announced that 70’s stunner Farrah Fawcett passed away. Then, before the sun could set on the East coast, pop icon Michael Jackson joined the other two. I was rather quick to report the deaths of Fawcett and Jackson, missed the McMahon death until after Jackson’s. While I was writing about the death of Jackson, I realized that in the overall scheme of things, one of America’s greatest hero’s had passed away last week and he left this world with little fanfare.

His name will only be recognized by a handful, not the masses that come along with the likes of the trio mentioned above. His name was Darrel Powers. To his friends he was called “Shifty“. A simple man from the hills and mountains of Virginia, Shifty Powers never recorded an album, never acted in a movie, and never sat on the “Late Show” or any other late night talk show. Instead, Powers was a part of a dying group of men and women who fought for this nation in World War II.

He will be immortalized however. Featured in the film “Band of Brothers” an epic 10 part mini-series on HBO, Shifty Powers was an “Easy” company man in the 506′th PIR (Parachute Infantry Regimen) “Screaming Eagles“. On a day when Jackson and Fawcett passed away, and McMahon the night before, I find myself not looking at the three of them with sadness but my own regret for not announcing the passing of an American hero last week.

Shifty Powers battled Germans and numerous medical issues in his later years. He was 86 and represents a continual increase in the number of WWII veterans who are leaving our lives. Unlike the above, these are our grandfathers and even our grandmothers. They represent a simpler time and even now, decades later, an era that today is hardly understood by us younger generations.

For those who are familiar with the “Band of Brothers” story, first brought to the public by the late historian Anthony Ambrose, then you too will know that even now, it seems that many of the fallen soldiers of WWII are once again re-uniting with their friends.

It is a sad day when 3 celebrities die, one at least completely unexpected. While we may think we know them through their popularity, it’s often the ones that we don’t know that have done the most for our way of life. It’s because of the sacrifices of those men and women, that I wrote this article. I’m truly glad you found it.

May Shifty Powers and all the men and women who have done so much for our country by putting themselves in harms way find peace in the here after. May they realize their childhoods and young adult lives that were so devastatingly taken away from them.

Perhaps I could have put this on the site as a front page article, honoring all of the American hero’s. Instead, I think much like they lived their lives, it’s a quiet tip of the hat in a way that many of them wanted to live. I put this article where it is at out of complete respect.

Rest in peace Mr. Powers, another Eagle has flown home.
~ Unknown Author, PhinPanatics

Armed Forces Day

Today is Armed Forces Day. Please spend a few moments to appreciate what those in the forces are doing for us. Thanks.

"You’ll need your chair!!"

Medic999 has posted a fascinating post about the number of times that he's encountered patient's relatives who say, "You'll need your chair!!" as a way of a greeting for the Ambulance arriving on scene. I too have encountered this phenomenon.

This is not merely trying to pimp Medic's blog. What I wanted to draw attention to is his remarkable paragraph justifying why he goes into a scene to assess whether the patient needs to be moved via a chair or trolley, or whether the patient can walk to the Ambulance.

This is not uncaring behaviour, it is not neglectful, it does not demonstrate poor standards of care. It does however, show a process of clincal assessment, risk assessment, and maximising the patients independance in a safe and supportive environment
~ Medic999: You'll need your chair!!

I think I'm going to just learn it verbatim for the next time! Especially the last bit - it's genius!

A Conundrum

For those medical people out there who happen to read this blog, I have a discussion question for you.

Within the field of Pre-Hospital Emergency Medicine that I'm involved with, I hear a lot of people claiming that a Long Board and a Scoop Stretcher can be used interchangeably. As you may know these items by different names, these are what I mean:

Long Board and Scoop Stretcher respectively

However, from my experience, they aren't always interchangeable. Now, if we preclude the discussion of which is best for spinal injuries, and we consider both pieces of kit from merely a casualty handling perspective, which would you use to move the patient in the following scenario?

You're at a cycle event in the middle of the Yorkshire Moors. Your nearest help is the Air Ambulance, and you are a twin Ambulance Technician crew with limited kit on your vehicle.

You are called to a job by the organisers, and it's a male cyclist with a mid shaft fractured femur. Mechanism of injury is such that your not concerned with neck or back problems. What you concerned about is that leg. The guy is losing sensation in his foot, he's lost a pedal pulse and there's developing swelling around the fracture site. He's conscious when you arrive on scene (let's say, GCS 14), but his level of consciousness is dropping while your on scene (let's say down to GCS 9, Eyes=1, Verbal=2, Motor=4). Management of the fracture is by whichever means you prefer (and not under discussion for the time being).

You need him out, and for that, you're going to need to get him up off of the floor as you're going to be transporting him a couple of miles to a suitable landing site for the Air Ambulance. And that's where you have to make the decision, scoop or board? Which one, and why?

Demolition Derby

If I said to you that I'd spent a weekend watching very expensive cars having very expensive crashes (and you didn't already know better), then where would you say I'd been? If you're said at a demolition derby, then you are wrong. Wrong, I say!

I was actually at the British Touring Cars Championship last weekend at Croft Race Ciruit, Darlington.

And some of those crashes were spectacular, such as these, taken by nickopotamus during racing on the Sunday. All credit to him for taking them. I love 'em!





Oh, and if you're the owner of that Civic and you want your nearside wing mirror back, talk to Nick about it!

No drivers were hurt in the making of this blog post.