Nee Naw

Just as everyone is whinging about going back to work, I am finally getting four whole days to myself. I only managed two complete days off between December 21st and today… so I was looking enviously on at everyone else enjoying the post-Christmas and New Year Festivities (more on the latter later) and eagerly looking forward to joining in… only to find it’s too late and everyone is busy taking their trees down! Damnit. Who’d be a shift worker?!

I was hoping for a q-u-i-e-t shift yesterday. It was my last one, and having changed from days to nights and back again in the space of four days, my body clock had packed up and I was half asleep. Still, a chilly Wednesday at the beginning of January - there wouldn’t be much going on, would there?

Wrong.

“Hello, it’s the fire brigade here. We’ve got an eight pump fire going on.”

“Okay. What’s the address?”

“It’s the Royal Marsden Hospital…”

Well, that woke me up.

“The fire’s in the roof. At the moment there’s no casualties, but we’re going to need an ambulance on standby…”

Funnily enough, these words didn’t make me feel any better. It was the exact phrase the fire brigade had used to me at 8.53am on July 7th, 2005, two minutes after bombs killed 52 people and injured 700 others. Don’t ask me why I always get these calls! Perhaps the powers that be should stop putting me on call taking if they want to avoid major incidents.

The Royal Marsden is a medium sized hospital in Fulham, which specialises in cancer treatment. There is no A+E there, but there are operating theatres, wards and outpatient clinics. At the time of the fire, there were around 900 people in the hospital - including around 40 bedridden inpatients and two under general anaesthetic.

The dispatch desk sent the requested ambulance, along with a manager and the HART (Hazardous Area Response Team) vehicles. The manager was quick to report back with what was both good and bad news. The hospital had quickly been evacuated and no one had been hurt. This meant there were now 900 people standing outside on the icy streets, many of whom were seriously ill cancer patients. The doctors and nurses - some just in their surgical scrubs - were busily ferrying them into a nearby church to protect them from the cold. The manager requested another nine ambulances while beds in nearby hospitals were found for the patients. Those patients that could be were sent home, but many were far too ill for that. The ten ambulances spent the afternoon going back and forth, taking patients all over London.

Call taking became a bit hectic after that. Of course, we weren’t getting calls about the fire itself, but being ten ambulances short for an entire afternoon lead to delays, particularly in the west and central areas. As vehicles moved out of their areas to cover, the shortfall was felt all over London. It wasn’t so bad that we had to refuse any calls like we did on 7/7, but response times were definitely slower than you’d expect.

The response of callers was an interesting insight into human nature. I must admit I quite liked having a ‘proper’ answer to the ‘why isn’t the ambulance here NOW?’ type questions. Terribly sorry, but we’re having difficulty finding someone to deal with your bellyache because there’s a hospital full of critically ill cancer patients on fire and we’re out SAVING LIVES like we’re meant to. Not everyone knew about the fire, and some people were incredibly apologetic. One woman, a perpetually drunk regular caller, seemed absolutely mortified when I told her, and was silenced for the first time in her entire life. Others were understanding and offered to make their own way to free up ambulances for the fire. Others, on the other hand, made me sick to the core with their selfishness. “I don’t care about the fire, what about me? You have to get here NOW.” If there was an award for selfishness, there’d be two callers fighting for it. A nurse at another hospital, who was waiting for an ambulance for a routine transfer, so she could go home. And a first aider in a well-known department store, who rang because a child had cut his foot and couldn’t walk properly. Sometimes I feel I am going to lose my temper with these kinds of people. I’m glad I don’t have to do call taking so often these days as I definitely feel I had done my time listening to the stupid and selfish.

Griping about The Public aside, though, I went home with a general sense of relief. It may have been a hectic afternoon but it could have been so much worse. The incident was winding down and all the patients were safe in their new hospitals. The outcome could have been so different.

… I will update my blog more often!

Sorry. I’ve been so busy! At the moment I am in the middle of a hellish block of shifts: Friday, Saturday and Sunday days, Monday night, then Wednesday day! By the end of it I won’t know if I am coming or going. I am gritting my teeth and thinking of the Christmas Attendance Bonus…

A little piece of Christmas cheer for you. Two days before Christmas, we had a call in to a man in his early fifties who, by the sounds of it, was having a heart attack. Just as the crew arrived, he stopped breathing and went into cardiac arrest.

The crew got out their drugs and zappers and whatever else they use on the euphemistically “suspended”, and thirty minutes later, we got the following blue call (well, not quite, I’ve substituted the medical terms for ones everyone can understand!):

“H701, blue to Chase Farm, with a fifty-something year old male, post cardiac arrest. Now has pulse of Very Good, oxygen saturation of Perfect, blood pressure of Not Bad and a GCS of Fully Conscious and Having A Chat With My Crewmate In The Back”.

Hooray for Christmas miracles!

The title of this post is probably number one on the list of “things call takers don’t want to hear”. Unfortunately, it was exactly how the call began.

“My baby’s not breathing,” said the panicked mother. “He’s blue and his face is covered in vomit… I think he’s choked on it!”

I asked for the address immediately. I wouldn’t have understood what she’d said but fortunately she was calling from a landline, so I could see her address. She lived on a dual carriageway. When you get a call to a dual carriageway, it’s important to find which carriageway the address is on, otherwise the ambulance may be sent from the wrong direction, meaning it has to go all the way up to the next junction, go round a roundabout and come back. Not a delay you want when you have a non-breathing baby.

The caller lost it. She couldn’t remember whether it was eastbound or westbound and quite frankly she didn’t care! “Just send the ambulance! Hurry up! My baby’s not breathing. It’s an emergency!” I could see it from her point of view - her baby wasn’t breathing, and there I was asking stupid questions like “what side of the road do you live on?” But of course, from my point of view, the question was vitally important… but there was no time to explain why. I got the baby’s age - one-and-a-bit - then asked her what had happened. She’d heard a strange noise on the monitor and come in and found the baby like this. Straight on to the CPR instructions. Clean the vomit out of baby’s mouth - there was plenty so it took a while - then tilted the baby’s head back and listened for breathing.

I already had the “Start Compressions” card fired up when the mother told me that actually, yes, the baby was taking shallow breaths. He was twitching a little bit too, she noticed, but otherwise unresponsive. I let out an audible sigh of relief and gave the mother the instructions for maintaining the airway, whilst using the breath timer gadget to make sure the baby was breathing regularly. He was. Now there was nothing to do but wait for the ambulance, I decided to ask the mother a few more questions about what had happened (the purpose of these is usually more to distract the caller and make her feel she is doing something than to find out anything important). The baby had been ill with a cold, but didn’t have a temperature. She’d heard choking noises on the baby monitor, which is why she’d assumed he’d choked on vomit. When she cleared the vomit from the baby’s mouth, his teeth had been clenched and he nipped her finger. It was sounding more and more like he’d had a fit, so I marked the ticket “? fitting” so sector could make sure they had dispatched a paramedic crew.

Just before the first ambulance crew arrived (two had been sent, as is protocol with any “working” cardiac arrest - though I had confirmed the baby was breathing, no one wanted to take any chances!) I heard a very welcome sound. The baby started to cry! Ambulance call takers are the only people in the whole who like the sound of a crying baby! (I only wish this were still true when one sits next to me on the bus.) I bet the crew were relieved to find the baby was alive too. I listened in for a couple of minutes (since I have been unable to find any protocol prohibiting is and there weren’t any calls waiting) and what I heard the crew saying confirmed that they also thought the baby had just had a fit. The mother was asked which of the two nearby hospitals she’d prefer to go to, and at this point I’d heard enough and hung up, relieved. They wouldn’t be letting her pick and choose hospitals if the baby was in a life threatening condition. I think he was probably breathing all along and the mother mistook the tail end of a fit for a cardiac arrest. It’s also possible that the vomit was blocking his airway and clearing the airway saved his life - in which case the mother must be thinking that baby monitor was the best investment she ever made! Whatever the case, it definitely felt to me that the baby had come back from the dead. I’m glad to not be bringing you a post about cot death today!

On the subject of babies fitting, I do think that parents should receive more education about febrile convulsions (fits which happen in babies only due to a high temperature - they are nothing to do with having epilepsy and while you should definitely call an ambulance if your baby has one, they are not usually life threatening). It’s obvious that a lot of parents have never heard of them and think their baby is dying when they happen, which must be really traumatic for them.

While offices all over the world are steady winding down for Christmas, Nee Naw Control just gets busier and busier. The cold weather has a negative effect on the elderly and festive drinking does little for the young. Staffing levels are not great, because everyone’s off with the flu, and the overall result is one of Too Many Calls, Not Enough Ambulances. I was just about managing to keep on top of it by getting the poor radio op to lose her voice broadcasting the calls we were holding and cajoling the long suffering ambulances turn around a little bit quicker at hospital.

Then the call which was to be the final straw came in. A car hit a motorcyclist on a busy, fast road right in the middle of my patch. The car actually drove over the top of the motorcyclist before it managed to stop. He had serious head and chest injuries. About twenty calls came in at once from panicked bystanders, and as is the way with bystanders, only about half of them had the address right and only half of them knew what had happened (some said a pedestrian had been hit by a car, some said someone had fallen off his bike, some just knew a man was lying in the middle of the road), resulting in a spattering of similar sounding calls around the area. The danger in situations like these is that one might assume they are all the same call, when really there have been two similar incidents in the area, so three ambulances were started whilst the call takers managed to ascertain that there really only was one incident. One ambulance was then cancelled. I kept two running because the general consensus was that the person was unconscious, and two callers seemed to think he was also not breathing. Unfortunately, HEMS could not be dispatched because it was co-incidentally dealing with another call on my patch (a child who’d fallen down concrete steps and sustained a serious head injury with a GCS of 3 - ie. completely unconscious) but the HEMS team in the control room spoke to the crew on the phone to give them advice.

The advice of the HEMS team was to get the patient to the Royal London Hospital as quickly as possible. This is the hospital the helicopter operates from and it has advanced trauma care and a neuro department. The crew were just heading off when they hit a stumbling block - the patient had come round and was what we call ‘cerebrally irritated’ - in other words, his head injury made him confused and violent and he was lashing out at the crew that were trying to help him. There were already three paramedics/technicians on the back of the ambulance but they were unable to restrain him. They radioed for urgent police and another crew. These were all sent straight away, along with the duty manager. So there was now:

Five paramedics/technicians in the back of the ambulance treating the patient.
One driving the ambulance.
An unknown number of police restraining the patient.
A manager making sure the crew are okay.
An FRU still at the scene of the accident checking over the bystanders and the car driver and babysitting all the empty vehicles.

I am not even sure how all those people managed to fit in the back of the ambulance. They decided to take him to the local A+E to get his condition stabilised, rather than make the long trip to the Royal London. The local A+E most probably organised another ambulance transfer to the Royal London for specialist care later.

So that was it for the ambulance cover on my patch. Three ambulances down is a whole stations worth and my calls were mounting up. I had a call in to a 33 year old male in cardiac arrest and had absolutely nothing to send to it. My neck was saved by a very kind offer from a crew who had actually finished their shift and were taking the vehicle back to station who offered up for some impromptu overtime. In the end, the patient was beyond any help, but it’s not a chance you want to be taking. I was so stressed when I left the building I thought my head was going to explode! I was really grateful that I’d taken today off to attend the most important football match of the season (Leyton Orient vs Millwall).

Fortunately, this situation is unlikely to arise over the festive period as management have got wise and offered us (control and road staff) a £750 bonus on the condition we work 72 hours over Christmas including two bank holidays and aren’t late or sick at all in that time. As you can imagine, everyone has suddenly put their name down for overtime and manning is going to be at full whack!

Sorry I haven’t posted lately! I have been dead busy but I promise to provide you with some new ambulance tales soon - but not right now as I am supposed to be working on a presentation about the 999 system for some St John Ambulance cadets!

To give me some inspiration for new posts, I’m throwing this one over to you lot: ask me a question or give me a topic and I promise to write a blog post about it. (Er, assuming it’s on topic and not breaking the law or the bounds of decency.)

I hope you’re not all sick to death of reading posts about babies making unexpected appearances! I’ve gone for a different angle on this one and brought home a copy of the log, so you can see exactly what was going on behind the scenes while I was helping a new grandfather deliver his daughter’s baby.

13.41:49 Call comes in. I give the standard opening line - “Ambulance service, what’s the problem? Tell me exactly what’s happened?”* Middle-aged gentleman explains: “My daughter is pregnant! And she’s having a baby! Like, now! On the bathroom floor!” I condense this to three letters - BBA - which is a clear message to sector to GO GO GO. By the time I have typed BBA and pressed return, the allocator on the sector desk can see the call, but he has to wait until I’ve confirmed the address (which is already on the ticket, because the call is from a BT landline) before he can send.

13.42:09 The address is confirmed. Allocator pulls up a list of available vehicles and decides which one to send. Because the caller has been calm and co-operative, we’ve reached this stage in 20 seconds. My personal record is 23 minutes**.

13.42:15 The first vehicle is sent, from 1.6 miles away. They are currently driving back from hospital, so can make their way straight to the call.

13.42:16 The legendary ORCON time, ie, the point at which I have entered a diagnosis, address, age, status of breathing and consciousness and selected a “chief complaint” card to go through. As you can see, ORCON time has very little to do with the time ambulances are actually sent.

13.42:28 A second vehicle is sent, also from 1.6 miles away, but this one is at an ambulance station so will take a little longer to get moving. If possible, we always send two vehicles to BBAs - one for the baby and one for the mother. We make sure that at least one of them contains a paramedic, or if that’s not possible, send a paramedic in an FRU (car).

13.42:30 First vehicle pushes “amber to scene” to confirm that they’ve got the call and are on the way.

13.43:47 Second vehicle pushes amber to scene.

Meanwhile, I’m still on the phone. I’ve determined that the mother-to-be is full term (phew) and the grandfather to be is checking how close the baby is to being born. The phone is at a distance from the bathroom and the cord won’t reach, so there’s a lot of running around.

“Can you see any… oh! I can see the head!” I hear in the background. “HEAD OUT” I enter on the ticket, to let the crew know what’s happening. Granddad runs back to the phone to tell me. I give him the next set of instructions: “Tell your wife to place the palm of her hand against the vagina to stop the baby’s head delivering too quickly. As the baby comes out, support its head and shoulders and hold the hips and legs firmly. The baby will be slippery so try not to drop it.” I tell him to go back to the bathroom and impart this information and to come back as soon as the baby is delivered, or after three contractions if only the head is out.

After three contractions, he is back. I tell him to reposition the patient in an ungainly way with her bottom raised and legs hooked up to her shoulders.

13.46:50 Five minutes and one second after the call began, the first ambulance crew book red at scene. It takes them a minute or so to unload their equipment from the vehicle and make their way to the front door, so I’m still on the line.

13.47:00 The baby is born! Baby is, thankfully, well and crying so loudly that even I can hear it. I instruct granddad to get towels to clean and wrap the baby and give them to grandma. Then he comes back to the phone. I take the mother’s name and the hospital is under so we can notify the midwives (though ambulance crews are fully trained in childbirth, a midwife has far more training and experience and is still needed) and congratulate granddad on his sterling performance and new addition to the family.

There’s a knock at the door and granddad lets the ambulance crew in, thanks me for my help and says goodbye.

13:48:55 Second crew arrive. Crew report mother and baby well, but placenta not yet delivered, and request midwife to scene.

13:50:00 Midwife is requested. No idea what happens for the next hour. We need a spyhole into people’s houses…

14:47:21 One crew takes mother and baby to hospital for a routine check up. Other crew “greens up”, ie, makes themselves available for another call.

15:21:00 Second ambulance greens up, ready for another job.

I think this is a pretty good example of when everything runs smoothly, except of course for the baby being born on the bathroom floor in the first place! I never got to find out the sex of the baby, but whichever it was, I’m thinking “Lou” might be a good name for it…

* I hate this line. It is far too long and it is impossible to say without a) being interrupted b) sounding like an automated answering service.

** For a foreign man who could neither pronounce nor spell his address, even with the help of an interpreter, could only give the area as “London” and was calling from an untraceable mobile. He did not seem to think this was a problem and kept shouting “Never mind the address, just send the ambulance” in Tamil.

Last weekend, at about 4am, I took a call from a middle aged man. He’d apparently been cooking his dinner and spilled some oil on the floor, slipped in it and banged his head, knocking himself out. When he’d come round, he’d called 999. There was nothing really unusual about the call, except the fact that the man had been cooking at 4am in the first place, so I didn’t really give it a second thought, until half an hour later another call came in from the same place. The same man was ranting and raving and calling the poor ambulance crew that had attended him all sorts of unpleasant words. I now realised that his slightly slurred speech that I had previously attributed to his knock on the head was actually due to drunkenness. Looking back, drunkenness was probably the reason that he had been cooking at 4am, and the reason he had spilled the oil and subsequently fallen in it. I checked the log and found the ambulance crew had left the scene because the patient had been “extremely abusive and threatening towards them”.

Trying to maintain a neutral approach (despite the fact that anyone who is inconsiderate enough to call 999 to make a complaint, potentially blocking an emergency call from getting through, is almost always in the wrong), I asked what had happened (I got no coherent answer), and explained that if he wanted another crew to attend we would have to sent a police escort because of the report from the first crew, but if that he felt that the first crew were at fault, I could provide him with the complaints department phone number. At this point, the caller (who had been nice as pie during the first call) turned on me and started calling me all sorts of names not suitable for publication on this blog. He demanded to be put through to my supervisor, and, when I explained my supervisor did not deal with complaints and was tied up trying to locate a RTA call from a person who didn’t know where he was, he demanded to be put through to Gordon Brown, as apparently Gordon Brown is my Big Boss. I explained that we weren’t actually located in Downing Street and that Gordon Brown was asleep. I offered the complaints department number once again. The caller refused to take it, and demanded to be put through. Why should he pay for the phone call to make a complaint? I pointed out that they were closed, and I could put him through if he liked, but he’d just get the answerphone. “PUT ME THROUGH NOW!” he bellowed, and not one to refuse a caller’s request, I did.

“This is the complaints department of the LAS. The department is open 9-5, Monday to Friday. Please leave your name and number after the tone.”

I decided to stay on the line message the caller left, partly in case he started issuing death threats or anything else we should be aware of, and partly out of sheer nosiness. It was 4am on Sunday so there weren’t any calls waiting. It went something like this:

“I’ve just had one of your crews round and they were ***** and ***** and *********! They didn’t know what they were doing. They were just jealous because I live in one of the best houses in [an unglamorous, suburban part of London]! I pay my taxes! I demand Gordon Brown does something about this service! And that ********* person I just spoke to has put me through to the wrong number. I wanted the boss, not an answerphone! ****** and ********! You’re all useless!”

And it went on for another five minutes or so, until the automated voice cut in and said “Thank you. Your message has been recorded. Goodbye”.

In all that time, he still hadn’t given his name or contact details. Oh dear.

Ian Beale calling for an ambulance:
“Ambulance. We’re on the top floor. It’s a block of flats. A big block of flats. I don’t know what it’s called. ” [Lucy shouts something that sounds like “Rsomethingside House”] “Rsomethingside House! My wife’s been SHOT! Just come quick! What? Yeah. Police.”

That’s ALL he said, and yet somehow the ambulance managed to get there within ORCON and whisk poor Jane to hospital. Now, I know it would probably spoil the flow of the storyline for Ian to spend too much time talking to 999, but he could at least have given an intelligible address with some kind of indication of which area he was in and answered a couple of questions (as another character, Garry, did in a recent storyline when he saw a child get run over). It’s no wonder callers ring 999 and shout things like “I’m in a big block of flats on the main road!” and expect us to know exactly where they mean. Please Mr BBC, don’t make our jobs even harder with these poor examples!

Occasionally, we get wildly inappropriate calls which are not your usual brand of timewaster but people who do not know where to turn and are using 999 as a kind of general helpline. I often wonder what makes them request ‘ambulance’ instead of ‘police’ or ‘fire’ - I guess it’s just that they see police as scary law enforcers and don’t want an entire engine full of firemen turning up, so ambulance is the only option left.

One such call came in this week, at around 8pm. It was from a woman in her 80s who was a carer for her disabled, bedbound sister, who was even older. The little old lady was very upset because the lightbulb in her sister’s bedroom had broken. Apparently, her sister was scared of the dark, never switched the light out and suffered from panic attacks. The caller wanted to know if we could arrange someone to come round and change the lightbulb. She’d pay, if necessary, she just couldn’t find anyone to do it. She had no nearby relatives, no carers, her neighbours were all equally elderly and she didn’t know what to do because her sister was getting more and more distressed by the minute. The call taker, quite rightly, told the caller that she was sorry but that she couldn’t help because we only deal in ambulances and not lightbulb changing people. She recorded all the details, including the address, on a ticket, which duly popped up on our screen as an “enquiry only”.

“Hmm,” said the allocator. “How many ambulances have we got sitting on station at the moment?”

“Three,” I counted. “One at Edmonton, one at Tottenham and one at Bounds Green.” (This is very unusual for 8pm; for some reason no one in North London fancied a trip to hospital that night.)

“And look,” said the allocator. “There’s H702 on their way back from hospital. They’re going to have to drive right past this lady’s house to get back to station. Mark, could you please call them up on the radio and ask them for a mobile number so I can speak to them in private?”

I got H702’s mobile number and the allocator rang the crew, who no doubt thought they were in trouble.

“Bit of an odd request here,” she began. “How are you at changing lightbulbs? Yes, lightbulbs. See, we’ve had this call… [she explained the call] and it’s just up the road. There’s a couple of vehicles on station so I doubt you are about to get a call, but if you do I’ll call you on this mobile number and you’ll have to drop the lightbulb and run.”

The allocator then rang back the old lady to tell her we had managed to find someone after all, but in future she would have to sort out a regular lightbulb changer as we wouldn’t do it again. Fortunately, no calls came in in that area and ten minutes later, H702 were back in their vehicle, leaving behind two very satisfied customers.

“After all,” said the allocator, “if I hadn’t sent them, she would be phoning in three hours later when her sister was in the midst of a panic attack. And that would take far longer to sort out. Prevention is better than cure, that’s what I say.”

If I’d been on night shifts this week, I’d have David Beckham’s dad to add to my list of celebrity patients (along with David Hasselhoff and Brian Harvey). But as I was on days, I found myself dealing with what must be one of the most horrible calls ever. I was on the radio at the time and I don’t envy the call taker who took this one bit.

It came in from man who was doing building work on a house. He heard a commotion coming from the house opposite and went to see if everyone was okay. Everyone was not okay; everyone was screaming because someone was not breathing. Since everyone was panicking, the workman dialled 999. Before starting CPR, the call taker quickly asked what had happened, in case this was a dangerous situation for our crew. The workman didn’t know. All he could see was a young woman lying on the floor, not breathing and her hysterical family around her - and that the young woman was clearly pregnant. Not wanting to waste any more time, the call taker started CPR.

Meanwhile, upstairs, we’d sent two crews, an FRU, a manager and the police. The FRU was a paramedic, the first crew were the usual technicians, but the second crew were what is informally known as a “green truck” - lesser qualified technicians who usually spend all day taking old people with minor injuries to hospital. Since the second crew on a suspended is primarily there just to assist with fetching equipment, lifting the patient, looking after distraught relatives and keeping in touch with control, and the “green truck” was far closer than the next regular ambulance, it made sense to send them. I bet they weren’t expecting to see something like that when they got up for work that morning.

The FRU arrived on scene first, took one look at the patient and asked the workman for the phone.

“Send HEMS, please, it’s a hanging!” he said.

HEMS was sent and then we didn’t hear anything from any of the crews for quite some time. Our sector control, concerned for their safety, decided to call the manager, who told her that everyone was still working on the patient. It had been over an hour and we wondered what was going on - had they managed to save her? Someone pointed out that if a woman dies when she is nearing full term, sometimes her baby can be saved if it is delivered by caesarian quickly. Were they doing that?

Then the HEMS desk got a call from their doctor to say that the resus attempt had failed and that they had pronounced life extinct. The woman was too early on in pregnancy for the baby to have any chance either. One by one, the crews withdrew from the scene, going off the road for that infamous cup of tea that makes everything better and them ready to face another call, which they did, an hour later. We made sure we gave them nice calls to little old ladies for the rest of the day.

We all felt quite despondent in the control room after we’d heard from HEMS - I guess we’d all been hoping for a happy ending against the odds. We all wondered what could be so awful in that young woman’s life that she had to destroy it, and her unborn child too. But perhaps the circumstances of her pregnancy were what was too dreadful to bear, and she felt it better that her child didn’t have to deal with them. Or perhaps she was suffering from a psychotic illness, not thinking straight, not realising what she was doing. You just don’t know, do you? It was too horrible for words. We didn’t want to think about it any more. We just pressed on, more calls, more ambulances… think about something else…