Emotional content

Again, its been a while and again, I apologise.  I guess I can’t be inspired to write things all the time.  I really don’t know how columnists do it!

And its not as if there’s nothing to write about either.  Every day brings something different in this job.  We still hold a belief that a good 80% of calls don’t need an ambulance and some would argue that this figure is being conservative.  However, every call brings something different and a chance to have a brief look into someone else’s life.  Therefore, there will always be a plethora of things to write about.

Its just sometimes I can’t find the ‘oomph’ to get it down.  And then there’s my thoughts of what direction I want this blog to be going . . . do I want to keep it as light hearted anecdotes?  Or more a chronological collection of events?  Do I get deep and meaningful?  Or do I just down right take the piss all the time.

I’ve always felt uneasy about being deep and meaningful and am possibly the last to sit and feed on sympathy over sad events.  In fact, I’d probably be the first to burst out laughing at a funeral.  I remember years back, when my father had just died I showed some colleagues a copy of his death certificate . . . Continue reading

Pain Scoring

When dealing with patients who are in pain, we are told we need to obtain a “pain score” from them.  This is so we can monitor the progress of their pain throughout our treatment. We use a simple method by scoring the pain out of ten.  Ten being the highest and most painful and one meaning no pain.  Simple.

Or so you’d think.  But sadly its not really that simple.  Pain scoring is very subjective and relative to that one person’s definition of pain.  We therefore, as clinicians, have to use a little ‘creative common sense’ when dealing with some people’s definition of pain.

Here are three good examples of why this is so.

Patient 1
An elderly lady from somewhere in India sits in front of me complaining of global-everything pain.  She leans forward and strains to listen.

Binder:          So, on a scale of one to ten, ten being the worse pain imaginable and one being nothing, what number would you give?

As if on cue the lady throws her arms to her head and she starts wailing.

Lady:               Too much pain!
(arms wave and holds head)
(Lady stops to listen)
Binder:           No, I need a number between . . .
Lady:               Too much pain!
(arms wave and holds head)
(Lady stops to listen)
Binder:           Yes, fine, but can you just give me a number . . .
Lady:               Too much pain!
(arms wave and holds head)
(Lady stops to listen)
Binder:           No, a number.  Between . . .
Lady:               Too much pain!
(arms wave and holds head)
(Lady stops to listen)
Binder:           Any number . . .
Lady:               Too much pain!
(arms wave and holds head)
(Lady stops to listen)
Binder:           Right.  I’ll um . . . make it a three then shall I?

Patient 2
A thirty year old male sits before me complaining of chest pain after being in a police cell for a few hours.  He looks ahead nonchalantly.  Two police officers are standing beside him.

Binder:          So, on a scale of one to ten, ten being the worse pain imaginable and one being . . .
Patient:           Ten
(patient looks nonchalant)
Binder:            Ten?
Patient:           Ten
(patient looks nonchalant)
Binder:            Really?
Patient:           Yep
(patient looks nonchalant)
Binder:            Honestly?
Patient:           Yep
(patient looks nonchalant)
Binder:            So this pain couldn’t get any worse
Patient:            Nope
(patient looks nonchalant)
Binder:            . . . . !
Patient:           . . . . .
(patient looks nonchalant)
Binder:            Even if I dropped a large piano on your head this is still a . . .
Patient:           Ten.  Yes.
(patient yawns)
Binder:            . . . . . . . wow.

As I look at the patient I write a three.

Patient 3
I kneel in front of a tiny eighty eight year old lady who’s been lying in an awkward position at the bottom of her stairs for nearly four hours.  One of her legs is shorter than the other by half a foot and her pelvis looks clearly deformed.  Her wrist is bent in the wrong direction and a large gash on her forehead has left her hair and face matted with blood.

After all the obvious primary checks I stumble my next words.

Binder:          So, on a scale of one to ten, ten being the worse pain imaginable and one being nothing, what number would you give?
Old Lady:        Well, it does smart a little.  So, I’d probably give it a four or a five.  But I don’t want to make a fuss.
(patient tries to smile)

My jaw drops and tears well up.  I stare at the patient dumb founded and as one hand scribbles “100” in the scoring box my other reaches for the morphine in my pocket.

Binder

Day dreaming . . .

I often day dream.  Always about stupendously impossible things.  Like beating Chuck Norris in a martial arts tournament whilst my eight pack abs glisten in the setting sun.  Or abseiling into the set of Countdown and rescuing a buxom Carol Vorderman from the evil clutches of Richard Whiteley whilst he sits in his evil chair stroking an evil white cat.

I remember, not so long ago, day dreaming about being a Super Paramedic . . . Continue reading

Rest-break

It took me a while to get to grips with break times in the ambulance service.

Basically, if the workload in the service allows it, Control will try and send you back to station for a rest-break.  Now – we work twelve hour shifts and jobs are generally back to back so its fair to say we are busy enough throughout the day.  That aside we manage to get the odd ten minute breather after each job at hospitals etc.  And being busy means the day goes quicker – which everybody likes.

By not getting an “official” break we manage to finish half an hour earlier and get an extra £10 for our troubles.  Most crews like this.  Not so much for the money – that’s trivial – no, its the finishing early that counts.  So, crews will prefer to work flat out for the whole day avoiding an official rest-break and then finish earlier . . . unless of course, your off-job involves something ridiculous – which it always does.  And as has been mentioned before – its always a conspiracy! Staged by Control!!

There is a set time during the shift that you can have your rest-break and this is called the “break window”.  Once you pass the break window (which is usually two and half hours before the end of shift) you can’t be put on rest-break and will then be finishing early.

Now, some crews will go to great lengths to avoid having a rest-break.  Its almost like a personal challenge – with each shift finishing early becoming a tiny victory against oppression (or something).  This can be seen by the outsider as childish in some ways – but rest assured, it is one of many essential processes for maintaining sanity in this job.

A classic way to avoid rest-breaks is to try and find a patient.  This is the only time a crew will rush to pick up a drunk in the street or go steaming into a fight and help.  With some it becomes obsessive.  Sadly, some take it a little too far.

I heard of one crew who had been ordered back for a rest-break with ten minutes still to go in their break window.  On their way back they decided to drive round a large roundabout over seventeen times until it was time to head back – perfectly timing it to arrive on station 2 minutes after break window.  Unfortunately for them, Control had been watching their progress on the map (each truck is fitted with a tracking device) and were well aware of their plan.

So, upon arriving at station the phone started ringing.  This would normally be Control saying the crew are officially on rest-break.  The crew, ready to fight their corner and argue that they were out of the break window, answered the phone . . .

“Hello, Oval Station*?”
“Is that M202**?”
“Yep”
“Control here – you have a choice . . . you can accept your rest-break now, 3 minutes after the break window cut off, or, you can both be suspended for abusing Company time.  Which would you like?”

Unsurprisingly, the crew took their break.

Binder

*Obviously not the real station for this case
**Crews have call signs.  The letter distinguishes the station you work out of and the number represents the shift . . . M202 isn’t a shift that works out of Oval (I think) – I’ve made it up!

Update

I have updated the page “Ambulance Lingo”.

This has an A – Z of specific lingo, phrases and meanings to common day to day medical terms.

When I write future entries I hope this can be used to reference bits that some of you might not understand.  For those who do, please feel free to “edit” anything you reckon isn’t quite right.

Other than that  – there’s a couple of blogs on their way tonight.

Binder

Costume

Someone asked me the other day whether ambulance crews are allowed to “dress up” during certain holiday periods such as Christmas.

“Dress up?”  I asked.

“Yeh, you know, like a bit of a hat, or tinsel or something – you know, bring a bit of festive cheer into peoples’ lives . . .”

“hmmmmm”  my mind drifted to the possibilities . . .

. . . I could picture the scene – called to a crowded flat on Christmas day.  Someone’s nan has just suspended (gone into cardiac arrest) due to choking on a piece of chicken.  As my crew mate is getting the defib ready his santa’s hat keeps falling forward over his face allowing the bell to continuously get caught in his false beard.  Whilst my crew mate is struggling with that I would be performing CPR on the patient and with each chest compression the Jester bells of my hat would tinkle causing my clown’s nose to flash.

Other than the rhythmic tinkling of my jester bells – there is complete silence.  I look up and around at the horrified family, their eyes wide and jaws dropped.  I look away toward the curtains and notice the dark crimson paisley effect of the material.  I feel I must say something . . .

“. . . I like what you’ve done with the curtains, heh – “

There is the sudden unmistakeable sound of a rib cracking, followed by the sound of someone dropping a plate behind me.

I drift back to reality and answer my friend, “you know – its probably best that we don’t wear fancy dress”

Binder