Nee Naw

The following are some search terms people used to find my blog on Google.
“sounds of agonal breathing” - I can do a good impression; it’s halfway between a wheeze and a rattle.
“999 idiot” - Is this a reference to me or the people I write about?
“london ambulance 0208″ - I hope whoever googled this found my rant about 020/0208 confusion and never made that mistake again!
“london ambulance noise” - Yup, that’d be “nee naw”. Actually, it’s more like woooowooooo these days.
“giving birth sound effects for mobile phones uk” - Why? Why? How sick can you get?
“vibrator ambulance epileptic” - *wince*
“getting to hospital labour” - NOT in our of our ambulances, please!
“how does ambulance control work?” - Good question!
“up his bum nurse” - No comment.
“london ambulance service entry test” - Perhaps I should tell you about this one day. In my case, it involved reelings of long lists of numbers backwards for a while until my head turned to mush and other such mind boggling exercises.
“london ambulance hems operation room telephone number” - Try “999″!
“how long off work due to ingrown toenail” - Erm, none. Get back there now, skiver!
“given enough time most of the conversations you ache to have are with dead people” - Somewhat surreal, but kind of true…
“magic mushrooms and wimbledon common” - Naughty!
“london bombing what did the ambulance service do?” - What it normally does — treated sick people and took them to hospital!
“smashing cot death” - “Smashing” is not an adjective I’ve heard applied to cot death before…
“vibrator supermarket collapsed” - There’s a lesson in that one…
“miscarriage blog uk” - Sounds like cheerful reading!
“my son had his tonsils out and cannot speak” - Unsurprisingly, after having bits chopped out of their throats, children find themselves somewhat less vocal.
“dc42zpswfgmb30lb” - Pass!
“cpr is it good” - You could say that, yes.

This weekend, I took absolutely no genuine calls whatsoever:

• I got told to “suck my c**k” repeatedly by a man I had made irate by not letting him speak to his uncle, who is in “the hospital in Whitechapel”. This was not an enticing offer.
• On Friday night, we kept getting calls from Streatham (makes a change from Romford) from a man who claimed to have been stabbed. We had an ambulance roaming the streets trying to find him with no success. The man kept calling back and giving different locations and sounding generally confused/confusing. We wondered if he might be an escapee from the local psychiatric hospital (one of the locations he gave was in the same road) and spent a good while on the phone to them trying to ascertain if they had lost a patient. He’d called from a phone that wasn’t automatically tracked on the mapping, so we had to get the exchange to trace his location, and when they did, confirming he was indeed in Streatham and narrowing his location down to a few streets, we sent the police around to look since the ambulance had got fed up and gone back to the station. The police turned up, and the man jumped out of a bush brandishing a knife trying to stab them! So they promptly gassed him. They told us that they thought he was trying to lure an ambulance out there and stab the crew, so it looks like one of our crews had a very lucky escape.
• On Saturday night, a man in East Ham called to say his wife had just fallen down the stairs and promptly given birth to their sixth baby. We dispatched a nee naw and a midwife. When the nee naw arrived a large number of Foreign People, but absolutely no sign of any newborn babies, came to the door laughing hysterically because they think it is really funny to call out ambulances for babies that don’t exist. The ambulance people said some bad words and then rang me to cancel the midwife. Midwives, unlike ambulance crews, are not really used to hoax calls and this one hit the roof (at times, I felt a bit as if she was holding me personally responsible for the lack of baby). The police were called at her request, and the naughty people all got arrested. So that will teach them. How stupid do you have to be to make a hoax call and give your real address?!
• On Sunday night I received a call from a man with a squeaky voice in a phone box in Central London who refused to tell me anything other than “I have chest pain” and “I can’t answer any questions because I’M ABOUT TO LOSE MY LUGGAGE”. At the same time, the police rang someone else telling them that a man with a squeaky voice had just been chucked out of one of the local A+E departments for abusing the staff and that we should not send any ambulances to phone boxes in the proximity especially if the caller mentioned luggage at any point. He had also been investigated and his chest pain, if he really did have any, was not indicative of anything serious. So we didn’t send a nee naw. About an hour later (which was about 4am, the time of night when no-one calls and everyone is sitting around chatting), the man rang back (from the same phone box) effing and blinding and accusing the ambulance crew (the one that we didn’t send) of stealing his luggage. As soon as one person got hung up on, he would ring back and speak to someone else. After he had been round the room twice, we called the police. By the time he’d been round four times, the police turned up and carted him away to a cell next to the foreign people without the baby.

I’ve had rather large problems with spam lately and am no longer using the email address mark@neenaw.co.uk. Anything else @neenaw.co.uk will get to me.

More ambulance stuff later…

Over the last couple of weeks, changes have been made at Nee Naw Control. The first of these is that they are knocking down some walls and then renaming it from Central Ambulance Control to Emergency Operations Centre. I think they realised working in a building that had an acronym that was phonetically “cack” was no good for moral. It doesn’t affect me anyway, as I only call it Nee Naw Control.

Secondly, there has been a trial going on about a new way of taking details. Usually, we ask the caller for the address first. This is because once we have the address, the call goes up to dispatch and can be sent to an ambulance. Without a full address, nothing can be sent, however urgent the problem. However, callers never want to give the address first, and often the initial exchange of “Can I tell you what’s happened?” “No! Address first!” sets the scene for the call turning into a battle of wills. So we’ve given in, and in the new trial we ask what is wrong before getting the address, and rely more upon the information passed to us electronically by the telephone exchange (the full address of most landline phones appears on our screens) rather than getting the patient to repeat it back twice. I did a shift working this way last week, and what a difference it made! A couple of seconds were lost at the beginning of the call, and it was a bit awkward moving around the screen entering information in the wrong order, but the callers seemed so much calmer and happier with the way the call was handled, and happy callers make happy call takers.

There were a couple of small hitches in that the new question “What’s the problem?” tends to elicit a long response like “Could you please send an ambulance to my mother, she’s 79, she lives at 6 The Avenue, Bromley, she’s a heart patient and she’s got chest pain and difficulty in breathing and her GP, Dr Myers, said I should call an ambulance and have her taken to Lewisham Hospital, where she sees Dr Humphreys…” and extracting the relevant information makes my head hurt. And of course, all those people who wanted to tell me what the problem was when I asked for the address now want to give me the address when I ask what the problem is…

Less popular is the new rule of No Books or Magazines in the control room. This really hits hard on nightshifts during the week, when there is usually a lul in call rate between 2am and 8am, and a book is an excellent aid in not dozing off in the 5-10 minute gap between calls. (The rest of the time we are too busy for it to matter). But now they are strictly forbidden as they are distracting and make the place look untidy. All we are allowed to read is work related material, and believe me, Ambulance Today got a bit dull after my third read of it. Nee Naw Staff, however, are ingenious creatures, and the following are amongst the games I have seen people playing as an alternative:

• Ambulance Bingo - Write 9 comment ambulance scenarios on a piece of card, eg, “Old woman fallen out of bed” “Caller says ‘I don’t know, I’m not a doctor’” “Hung up on more than three times in one call” “Chest pain” “Flu” “Embarrassing sexual accident” “Caller wants number for pizza hut” “Caller does not understand English but refuses interpreter” “Drunk lying on pavement”. Tick each off as they occur. First person with completed card wins last mess room banana.
• Guess The Ailment - Attempt to work out what is wrong with your next caller before they tell you. I am very good at this and can sometimes guess correctly before the caller even speaks. Stomach aches can be identified by a snivelling tone and the caller telling you “it’s very urgent”. Heart attacks usually begin with the line “I don’t want to bother you, but…”, and if the caller is speaking very fast, it is usually a road traffic accident.
• Ambulance Call My Bluff - Steal the medical dictionary from Telephone Advice and pick obscure words from it. Make colleagues guess what they mean. Extra fun if you choose rude words.

A woman rung from a wine bar in central London to say that another woman had been drinking for about seven hours and now had passed out and soiled herself. This would be bad enough anyway, but it transpired that the defecating lady was the caller’s boss. How the boss will ever manage to look her employee in the face again is beyond me. Time for resignation or relocation, I say.

I was waiting for this one…
Me: Nee Naw Service, what is the add…
Woman: Hello, I want information about Bird Flu!
Me: Pardon?
Woman: Bird Flu! Tell me about Bird Flu!
Me: I’m sorry, this is an ambulance service, we don’t give out information about Bird Flu or anything else.
Woman: Well, do you have the number for Bird Flu Information?
Me: No, I’m afraid I don’t.
Woman: Tsk! *click*

First of the Firework Related Accidents
Yesterday’s calls filled me with a sinking feeling about The State of the World We Live In, etc. Not only did I get a call for a 12 year old girl who had tried to commit suicide and a 80 year old man who had been assaulted by the other geriatrics in his nursing home, I took a call from a British Rail station about an incident which I can only describe as gross and crass stupidity. Apparently, a group of students from the nearby university had gone on to the platform and thrown a lit firework through the doors of a crowded rush hour commuter train. This is one of those pranks that just isn’t funny in any way, shape or form and I was extremely relieved to know that, no thanks to the perpetrators, the injuries were far less serious than they could have been. No-one was actually burned by the firework, but several people were knocked over in the stampede to vacate the train, and one had a sprained ankle.

Little Mo
Life really does imitate soap sometimes. A young woman rang in floods of tears; I had to get her to repeat what had happened several times. “My boyfriend *sob* hit *sob* *sob* iron *sob*.” At first I thought she was saying that her boyfriend had hit her with the iron, but after the third repeat I realised that what she was saying was that her boyfriend had been beating her up and that she had grabbed the iron and smashed him over the head with it, just like Little Mo did to Trevor in Eastenders. He was now prostate on the floor, semi conscious and bleeding, and thankfully unlike Little Mo this girl had done the right thing and dialled 999. I had mixed emotions — on one hand, it is never okay to hit people over the head with heavy objects (or without them), even if they hit you first, but on the other hand, I can understand how someone would be driven to do such a thing and I could hear in her voice that she was horrified and full of remorse at what she had done, and immediately set about getting help. She was also did everything she was told to help him until the ambulance arrived, opening his airway and using a cloth to control the bleeding. Of course, being the face of the non-judgemental impassive Nee Naw Service I wasn’t allowed to express an opinion on the matter anyway, which is good, because I wouldn’t have known which sort of opinion to express.

(NB. I know it’s “prostrate” and not “prostate”, however, the typo amused me sufficiently for it to be left in. Not least coz some might say that guy deserved to have his prostate on the floor as much as an iron in his face.)

After reading Newbie At CAC’s tales of being a freshfaced newcomer at Nee Naw Control, I thought I would dig out some of my old diary entries from a long, long (well, not that long, it just seems it) time ago when I started work there. Here is one from when I was still training with a work based trainer in the room.

First of all, five am starts are not something I would inflict on my worst enemy. At five am it is dark and cold and it feel like the middle of winter or perhaps the middle of a nuclear holocaust because it is that grey and there are that few people around. It took me the full three days to get used to it and reach some semblance of normality (on the second day, I was hearing voices - mainly saying “I need an ambulance NOW” and “Yes, he is still breathing!” and feeling the floor move beneath my feet when it wasn’t) and now I have to adjust myself to going to bed at 8am because come Wednesday, I will be on nights!

I wouldn’t inflict the bloody uniform on to anyone either! Everyone keeps remarking on my too-large jumper but as far as I am concerned it is much too small - it does not even cover my bum and there is nothing worse in this world than too-tight jumpers, except perhaps prawns. My trousers, on the other hand, are definitely too big. They seemed tight when I got them, but I realise now this was the effect of two tonnes of starch keeping them in a pancake-flat shape that it was impossible to fit my legs into. Now this has subsided, they are utterly huge and make me look like a clown.

After a while all the calls start to blur into one. You have a second monitor on your desk which shows the London A-Z zoomed in on wherever the caller is calling from and you start to see these whenever you close your eyes or look at a blank wall. Your head turns into a swarming mass of key questions (”Is he breathing? Is he conscious? Is there any serious bleeding? Is he injured? Where does it hurt? Do you want an ambulance?” etc etc etc etc) and you can’t remember if the person you’re talking to is a diabetic or if the person who told you that was the guy who called ten minutes ago having fallen off a ladder and broken his toe. There are an awful lot of old people fallen out of bed, people with chest pain and tramps passed out in the road for unfeasible lengths of time. These are the “have you tried rebooting?”s of ambulance dispatch, and you forget about them pretty much as soon as you hang up the phone. The calls that do stand out, which I would say is approximately one in five, are the ones where there has been some kind of horrible Accident (as opposed to Illness), the caller is particularly rude or upset, or the ambulance is required for some utterly ridiculous reason and you really, really want to laugh. I could sit here all day and list the calls I’ve received, but here’s some highlights:

• The man who rang me to tell me his son, who has no arms, legs or eyes, had severe pain in one of his toes. I tried to ask how he could possibly have pain in his toe (Phantom Limb Syndrome, I wondered, but the man seemed quite insistent he did actually have a toe) and my work based trainer was in hysterics and I could feel a giggle rising in the back on my throat so thought it best to dispatch the ambulance before it escaped.
• The man (experiencing problems with his catheter, it emerged) who rang to inform me “My penis swollen up like a balloon, and I think it is going to explode!!”
• The man who rang after breaking up with his three months pregnant girlfriend who had promptly punched herself in the stomach “to spite him” and was now bleeding from her vagina.
• The sweet elderly lady who rang me rather worried that her heart might have stopped beating.
• The slightly hysterical woman who thought she had killed her friend — she had slipped and knocked her friend over, knocking the friend unconscious.
• The woman who rang from a hostel to say she had found one of the guests dead an hour ago. She said this in the tone of voice you would expect someone to say “My washing machine is broken”
• The woman who rang screaming that one could die waiting for an ambulance round here and that she was going to sue the ambulance service. The ailment emerged to be a cut finger.
• I didn’t actually get the call about the horrific bus crash in Golders Green (a boy and his father were hit by a bus, the father went under the wheels and was killed, while the boy was dragged along and was seriously injured but survived), which merited getting out the HEMS helicopter (as seen on Trauma), but about twenty calls came in and it was the talk of the room for a while. Apparently the father was seriously mashed in the way you might imagine someone run over by a double decker bus to be, and the first crew on scene included a trainee ambulance technician. Ouch.

On Sunday morning, the call I have both been looking forward to and dreading came - my first “suspended”. In other words, a dead person. We call them this because on some occasions, you can get them back, but it was fairly obvious from the outset that this would not be one of those cases. The caller was a surprisingly calm elderly gentleman who reported “I’ve just gone upstairs to take my wife a cup of tea, and I can’t wake her up. She’s a little blue in the face too. She’s just come out of hospital after having a heart attack”. My first thought was that he was so calm because she was very old and sick and he’d been expecting this, but on further questioning I realised that he actually had no idea what had happened. After reporting that she had no breathing or pulse and that he hadn’t seen her for a few hours, he said “I think she’s had a stroke or something” and kept impressing the fact that she was still warm upon me — I got the impression that he thought dead people would be instantly cold and stiff, but of course it takes a while for these things to set in, and once someone has been without pulse or breath for three minutes, there is almost certainly nothing you can do for them. Of course, we’re not allowed to say over the phone that someone is “dead” or similar, but once we know this, the next step is to give instructions for CPR, which is as good as saying “Oh dear, I think she’s a gonna!” I think at this point, the man began to twig what had happened — he was very old and it was obviously physically difficult for him, but he made a valiant effort with the CPR — because his voice started to break, and I think he was crying a bit, but not in a hysterical way or anything, just in a sad way.

The ambulance crew arrived at that point — it must be so much harder for them, having to look the man in the eye knowing that his wife is dead, and that he doesn’t know, and having to tell him that there’s nothing more they can do…

I felt a bit sad after this, but not in a traumatised way, and I was able to carry on taking calls without having to go and cry in the toilet or anything (they said we were allowed to do that if we wanted to!) even though I did feel a bit like it. This is a good thing; if I can cope with this I can cope with pretty much anything the job throws at me, although I’m still glad I didn’t get the Bus Accident on my first week!

Yesterday afternoon was time for my first assessment, which consisted of the head work-based training guy listening into my calls for an hour and writing a report. As luck would have it, I got lots of really taxing scenarios during this half hour, although this is not all bad, as it gave me a chance to demonstrate my ability to deal with difficult calls. First of all the computer crashed midway through a call, which means I was scribbling all the vital details down with one had, scrabbling for the manual triaging set with the other and still trying to talk - by the end of the call I looked at what I’d written down and it all appeared to be in Greek! Next a doctor rang up and tried to book an ambulance which broke all the rules for Doctors Ordering Ambulances and I had to tell her to sort it out and then ring back (we are allowed to say that to doctors but not the general public). Finally, I got a call from The World’s Rudest Man. It didn’t matter how many times I told him that, through the miracles of modern technologies, I could ask him questions while someone else arranged the ambulance, or that asking him questions would help his poor injured wife and make sure I didn’t miss anything, he just kept bellowing at me “STOP ASKING STUPID QUESTIONS! JUST GET AN AMBULANCE HERE! WHAT DOES IT MATTER HOW OLD SHE IS? IF SHE WAS BLEEDING, I WOULD HAVE SAID SO! YOU *()^*&%*&**S!!!!!!!!!!” I felt a bit like retriaging him to the lowest category out of spite, but you’re not allowed to do that.

My report was much better than it had been at training school: for a start it was very long, most of it was very positive and that which wasn’t was objective and constructive. I meant to write it out but I accidentally left behind. It said things like “Mark has made a very good start to call taking” and that I was more competent than they would expect someone to be at three days, and that my medical terminology and use of the triaging system was very good. The things I need to work on are: talking loudly, taking control of the situation (not letting people babble their life stories at me), remembering to verify addresses and phone numbers and not to fill in postcodes even if I know them, and asking the caller to verify breathing at the end of the call, even if it is only a cut finger, because you can’t be too careful.

I also had a surprise visit from the Quality Assurance Office, who randomly pick on people, listen into their calls and mark their performance out of 100 according to whether they remember to do everything. I got 100% for both my calls so I am therefore brilliant at this.

I would also like to point out that I have not received one single call from the M4 or Heston yet. Every single exercise we did at training school involved a road traffic accident in said place, and every single time I struggled to get a map reference. This is a great relief.

Contrary to what you might think, when a caller announces that they are a first aider, my heart often sinks, the problem being that “first aider” can mean anything from “knows how to put on a plaster” to the members of St John Ambulance and Red Cross who practice first aid all the time, are probably better at it than I am, and could resuscitate a plastic mannequin in their sleep. Since there is no real way of ascertaining the skill level of a first aider quickly, I tend to act as if they don’t know anything and give them all the instructions as I would an untrained person. This is probably very annoying to those first aiders who don’t need to be told and I apologise if you are one of them, but nonetheless it is better to give instructions that aren’t needed than not give those that are. I hope the following call will serve to illustrate this point.

A group of friends are walking along a canal in Islington and find a man (”probably a junkie!”) blue in the face and unconscious on the canal bank. Five of them get on their mobile phones and call ambulances, yelling “GET HERE QUICK! HE’S DEAD!” (because, obviously, the more calls we get, the bigger emergency it is, and the quicker the ambulance will come) while one of them, who did a first aid course when he was sixteen, leaps into action and Does Resuscitation. After getting the vital details, I try to establish that the self nominated First Aider is doing everything right, not an easy task when his five friends are all getting worked up and being asked to do the same thing.

“Listen here” says my caller, pompously “he’s a qualified first aider, you know. Just leave him to it and send the ambulance!”

I explain patiently (I do a lot of this, “patiently” gets harder and harder) that the ambulance is already on its way and my job is to help them look after the patient while they are waiting. After bellowing repeatedly at the caller asking him to tell me exactly what “resuscitation” the friend is doing, he loses his temper and complies.

“He’s got him on his side, he’s thumping him on the chest and another person is pouring water on his face!!”

Not quite what you’re supposed to be doing, you see.

I tell the caller that that is all wrong and finally he takes some notice of me, takes charge of the situation and yells at his friend “OI! YOU’RE DOING IT WRONG! STOP THUMPING HIM!!!”

Suddenly everyone is the picture of compliance and we get the man over on to his back, check in the mouth, open the airway and check for breathing. Much to everyone’s surprise, the man is breathing. I impress that there is to be no more thumping or water over the head until the ambulance arrives and everyone is just to stand back and let one person keep the patient’s airway open and watch his breathing. We get no more trouble until the ambulance arrives, although the caller does start crying into the telephone.

After working here for a while, I’ve seen (well, heard) most things. After a while, I started composing a mental checklist of things I needed to do: deliver baby, cot death, bomb, embarrassing sexual accident, hanging… tick, tick, tick, tick, tick. One thing I hadn’t had until today was a rape. Ambulance crews do deal with people who have been raped reasonably often, but the person who has been raped usually calls the police, who call us, so call takers rarely speak to the victim themselves. However, this woman had also been badly beaten as well as slashed with a knife and was having breathing problems as a result of being punched in the chest, so her priority was to get medical help.

When I first started work here, I always wondered what I would say to someone who had been through such a thing. Sometimes psychiatric patients (the variety who just ring for a chat) mention that they have been raped in the distant past and I never quite know what to say to that. “Oh dear, how awful” is about all one *can* say, but it doesn’t really cut the mustard. In this case, of course, there were practical matters to attend to like finding out where she is, whether it’s safe for her to stay there and if there was anything she could do for her injuries while she was waiting for help. There was also a lot of stuff that I wanted to say but as the professional, impassive face of the Nee Naw Service I couldn’t, like “All men who do things like that should have their balls cut off” and “Give me his address and I’ll go round and do it myself”, nor did I feel it was appropriate to remark that she had the dubious honour of being the first rape victim I had dealt with. Then it was just down to reassuring her that help was on its way and that soon police and ambulances would be descending with their lights flashing and taking charge of the situation with a big wavey magic wand to make it all go away.

I suppose sometimes it’s not just a simple case of fixing the injuries and sending them on their way.

I’m hard at work right now, so here are some links to other LAS blogs.

I’m sure you’ve all read the fantastic mother of all ambulance blogs, Random Acts of Reality — most of you probably found this blog because of it, but I mention it for the sake of completeness and just in case any of you have been in a coma for the last year.

Newbie at CAC is the blog of one of my newly acquired colleagues. Reading her (his?) experiences made me realise I can be a bit of a cynical old git at times, and later on I’m going to try and pull out some of my diary entries from when I started at Nee Naw Control to see if I too was “fresh faced and eager” or if I have always been this jaded.

Finally, The World Through The Eyes of an EMT is another ambulance technician blog, brand new and sparkling, and contains some interesting entries about The Way The Nee Naw Service works.

Any other London Ambulance Service employees out there with blogs? Or how about any emergency operators or dispatchers for police, fire and other ambulance services? If you know of any, please leave a comment!