Nee Naw

A call which illustrates some of the points made in my previous post perfectly:

Sometimes when the call comes in, the level of background noise is such that I actually recoil and have to move my headphone away from my ear slightly. This was one of those calls. What sounded like fifteen people were shouting and screaming.

“What’s the problem?” I asked.

“Ambulance!” said a foreign male.

“What’s the problem?” I asked.

“It’s an emergency!” screamed a hysterical woman.

“What’s the problem?” I asked.

“Get ‘ere quick!” bellowed a gruff sounding man.

“What’s the problem?” I asked.

“Ambulance, naaaaaah!” said a squeaky teenager.

I tried a difference tack.

“What’s the address of the emergency?”

“Shot!” said yet another voice. “He’s been shot!”

“What’s the address of the emergency?” I asked, feeling nervous and excited at the same time — I’ve never taken a call about a shooting before.

“Sorry, what was that?” said a reasonably sensible sounding young man.

“Okay, okay, PLEASE, don’t give the phone to anyone else. What’s the address?”

“It’s a chicken shop… Bernard’s Fried Chicken in Dicey Broadway in Roughville… I just saw all these people screaming and panicking so I came over to see what was going on… hey, everyone, what is going on?”

“Be careful!” I ordered. “Someone’s been shot. Don’t go in there unless you’re sure it’s safe. Get someone to come out and give you some information if you can?”

It took another couple of minutes before anyone came out of the shop to talk to the man, and getting information out of him was not easy when he did.

“How many people have been hurt?”

“One - a little boy, he’s about one…”

Oh my god, I thought, they’ve shot a baby!

“And the person who shot him? Are they still nearby?”

“Shot?” said the man from the shop. “He ain’t been shot!”

“But someone said there’d been a shooting!” I protested.

“Oh naaah,” said the man, without a hint of shame. “He just said that so you’d get down here quick, like.”

“So, what is wrong?” I asked.

“Well, the baby, it wasn’t breathing like, but now it is, right…” (I suspect the baby had had a fit; people don’t usually just stop and start breathing randomly just like that otherwise.)

By this point, several polices cars, an ambulance and a duty officer were all on way to a meet-up point nearby in order to arrive on scene en masse. Ambulances don’t go into crime scenes until they are given police clearance to do so. (I read somewhere the other day that they didn’t arrive at Russell Square at the July 7th bomb for two hours, which was news to me because as far as I know, they were dispatched straight away - I guess they must have been held back by the police). I had to get a message to the dispatch desk pronto that there was no shooting and that everyone could be stood down, except the ambulance, which needed to get to the sick baby sharpish…

I would have given him a lecture about how lying to the emergency services wastes everyone’s time and would have actually caused a delay in reaching the baby had the lie not been uncovered, but I was too busy banging my head on the desk with exasperation.

The ambulance arrived before I could say anything else, which is probably a good thing, because cracks in my usually serene and unflappable demeanour were starting to show.

There’s a letter in this month’s London Ambulance Service News that has got a lot of control staff up in arms. It’s from a very angry paramedic who has been to one too many “category A” calls on blue lights and sirens only to find a baby who was described as “choking” sitting up and playing with toys on arrival. The child’s parents told the paramedic that they categorically did not state that the child was choking, so the paramedic seems to have concluded that everyone in control is useless and deliberately “sexes up” low priority calls for the sheer hell of it.

I wonder if he’s ever done an observation shift in Control? Mr Angry Paramedic, if you’re reading this, I’d like to invite you to come and listen to some calls, and you’ll see what we’re up against:
a) Callers Lie. You don’t have to be brain of Britain to work out that the worse you make something sound, the quicker you get an ambulance. We have a good idea when they are lying, but what can we do? We’d be hauled into QA faster than you can say “disciplinary” if we accused them of it. Of course when the ambulance turns up, they will say “I never said he was choking!” They are big fat liars.
b) Callers panic. Callers have not been sitting reading medical dictionaries in preparation for dialling 999. “Choking” to us means “has an object lodged in his throat”. “Choking” to a caller can mean “making a choking noise when breathing even though breathing normally”. If the caller says “choking” in the first five seconds, and it takes five minutes to establish what is really happening, then sometimes the ambulance will already be there by the time the ticket is updated.
c) We hate AMPDS as much as you do. See below.

The Angry Paramedic also complains in his letter about AMPDS and the fact that it churns out category A “Severe difficulty in breathing” for a call that is known in the business as “A load of old rubbish”. This is a complaint that I sympathise with entirely and have made myself in the past. Management are always talking about reaching category A calls on target but for some reason have failed to implement the one change which would slash the number of false category A calls and enable them to get to all the proper ones on time and meet their precious target. That change would be to replace the AMPDS question “Is he breathing normally?” with “Is he having difficulty breathing?”

Anyway, calling all London Ambulance Service crews! There’s a form called an LA410 you can fill out every time you get a call that you think was inappropriately categorised. You can download it here (the link will only work if you’re on a London Ambulance Service computer). Print off a bundle, and fill one out EVERY time you go to a “Severe Respiratory Distress” call that turns out to anything but. Several times a shift, if need be. Pop them in the internal post to the QA office, and they’ll soon be drowning in so much paper that they will *have* to do something about it.

Call takers hate, hate, hate making category As out of rubbish calls as much as Angry Paramedics do. Whilst crews are worried about running people down whilst attending these calls on blue lights, call takers tend to focus more on patients who lose out on an ambulance as a result. We’ve all had an experience when we’ve been staying on line with someone who has been pleading for an ambulance for a seriously ill relative, when we know we’ve just sent the last available ambulance to someone round the corner with flu. Stop this nonsense! Fill out your LA410s today!!

It seems I can’t make a post here without someone exclaiming “Oh my god! You published the patient’s address!” For the record, NO I DIDN’T. All the names, addresses and other identifying details on these posts have been changed, and none of the addresses published even exist. Run them through Streetmap if you don’t believe me. My name isn’t really Mark Myers, either.

I would take all the addresses out entirely, but I think it spoils the “flow” of the post, plus the addresses I use are similar to the originals in that they convey what kind of area the call was from. So if a call took place in a council estate in Peckham, I’d move it to a fictitious estate in, say, Hackney, which is a similar kind of area. If it took place in posh Chelsea, I might move it to equally posh Kensington and make the address ’something Mansions’, so everyone could see this is a posh person calling. You get the idea.

So please… no more comments!

So there I was, minding my own business, when the sector controller from the North desk came along and waved an ambulance call receipt in front of my nose.

“Remember this one, Mark?”

I racked my brains. A call I’d taken around an hour ago. 24 Fortress Road, N23. 17 year old female having a panic attack. Bells started ringing somewhere in the back of my mind. Oh yes, I remembered it now.

“Do you remember anything out of the ordinary about it?” asked the sector controller.

“Um,” I said, scratching my head. “Well, the caller was a bit of an idiot, but nothing unusual, no.”

The call had gone something like this:

Me: …
Caller: Yes! Right! We need an ambulance here now!
Me: What’s…
Caller: She’s having one of her attacks!
Patient in background: Aargh, ooh, help me!
Me: What kind of attack?
Caller: It’s a panic attack.
Me: And what’s the address?
Caller: 24 Fortress Road, N23. Look man, never mind all this, just get here quick!
Patient in background: I’m dying, I’m dying!
Me: Okay, I need to ask you a few questions, but…
Caller: I ain’t got time! Just send the ambulance!
Me: If you could let me finish… I was going to say that I need to ask you questions, help will be arranged while I’m talking to you.
Caller: She’s dying, she’s dying.
Me: Please try to calm down. She’s having a panic attack, she isn’t dying.

These were the words that would come back to haunt me.

The rest of the call proceeded in much the same manner. I managed to extract the relevant information: she was seventeen, conscious and breathing, and the call was triaged as a category A because the patient was hyperventilating, in other words, not breathing normally. This is usually the way with panic attacks and I have always thought it was a bit of a waste of an ambulance because there is nothing an ambulance can do to help other than be nice and calm the patient down, which is something anyone can do. Still, off it went and I gave it no further thought. Until…

“So go on…” I asked the sector controller. “What was strange about it?”

“We’ve just blued a fifty-five year old female from that address,” the sector controller explained. “Suspended.”

“Oh my god!” I exclaimed, clapping a hand over my mouth. “I’ve killed her!”

“I’m sure it’s not your fault,” said the sector controller. “What did they say on the phone?”

I told him and he looked as confused as I felt.

I spent an anxious hour watching the movements of the ambulance that conveyed the patient, and as soon as they arrived back on station, I gave them a call.

“You know that suspended you just did…” I ventured.

“Oh god, what now?” said the ambulance man, alarmed.

“No, nothing!” I said. “I took the call and I just wondered how on earth a 17 year old having a panic attack turned into a 55 year old suspended?”

“God knows!” he said. “It was a madhouse in there, and we came in to find her lying in the hallway, looking pretty dead, so we didn’t stop to ask questions. But there were definitely no panicking 17 year olds there. There was just her and a man, they’d both been on the drink and there was evidence of drug taking too, so I think that’s what did it. Her lungs were full of fluid; even with the suction we couldn’t get anywhere.”

“I’m really worried that I messed up the call,” I told him.

“I don’t think it’s your fault; he wasn’t on this planet” he said. “We’ve left him with the police.”

“How is the patient?” I ventured.

“Dead,” said the ambulance man solemnly.

Despite the unfavourable outcome for the patient, I did feel rather better after speaking to the crew. It’s obvious there was a lot more to this call than what met the eye, and nothing which could have been guessed from the call.

I tell you what, though — that’s the last time I tell a patient that they’re not dying!

Three calls after my fourth Born Before Arrival, I was still sitting there with a grin on my face. It’s not often we get a happy call in Nee Naw Control, usually the best we can hope for is improving a bad situation, so when something good happens, we like to savour the moment.

My bubble was, however, quickly broken.

“It’s my flatmate,” said a male voice, with a thick foreign accent. “I think he’s overdosed…”

Because of his accent, it took almost a minute to get the address correctly, with him spelling out every word. C for Charlie, H for Heroin… Eventually I had the address correct and moved on to the questioning.

“How old is he?”

“Twenty-five”

“Is he conscious?”

“No…” Uh oh!

“Is he breathing?”

“Um… no, I don’t think he is…” Aargh!

I can’t quite describe the sinking feeling you get when you have been struggling to get an address from a caller and you realise that the delay may have cost the patient his life. If only I understood foreign accents better, if only callers could brush up on their English… But of course, there is no point in “if only”s at a time like this.

Since the caller wasn’t entirely sure that his flatmate wasn’t breathing, it was time to crank up the “respiration timer”. This is a useful gadget that we use to determine if a patient is still breathing, or merely having agonal respirations (the dying gasps a patient makes immediately prior to death — these aren’t real breaths, so if that is what is happening, resuscitation should be started). The trouble with using the timer is that you need to time four breaths to get an accurate reading, and most callers are in too much of a panic to concentrate. The conversation usually goes like this:

Me: “I want you to tell me every time s/he takes a breath, starting NOW!”
Typical Caller: “Now… now… he’s kind of gasping.. he had diarrhoea last week… and his tonsils out in 1982…”
Me: “I need you to tell me every time s/he takes a breath, and nothing else. Don’t stop until I tell you.”
Typical Caller: “Now… now… look, I can’t do this! Just send the b*****y ambulance and stop wasting time!”

Fortunately, this caller didn’t do that. In fact, he was eerily calm and compliant. I suspect he had been taking some of whatever put his flatmate into his state, although he later informed me that he didn’t know what kind of drug it was and had just stumbled across him in this state. From timing the breaths, it seemed that the breaths were indeed agonal, so I pressed on with resuscitation. Much to my relief, the language barrier didn’t stop the caller understanding the instructions. We do have an interpreter service (Language Line) but trying to use it for resus usually results in chaos, calamity and ultimately death.

The phone was right by the patient, so I could hear the full gamut of gruesome sound effects:

*Puff* *Hisssss* *Puff!* *Hissssssssss*
*Clunk* *Clunk* *Clunk* *Clunk* *Clunk* *Clunk* *Clunk* *Clunk* *Clunk* *Clunk* *Clunk* *Clunk* *Clunk* *Clunk* *Clunk*
*Bluuuuuurgh!!!!* *wipe*
*Puff!* *Hisssss* *Puff!* *Hisssssssss*

When callers are very calm like this one in the face of a “suspended” patient, I am often overcome with a sense of paranoia that the patient isn’t really suspended and that they have misunderstood me, resulting in them leaping up and down on and breaking the ribs of a perfectly well patient. This was particularly strong in this case because the patient was so young, and although the caller’s English seemed perfect except for his accent, maybe he thought I had said something else entirely. Still, I told myself that I had checked several times and that it was much better to break the ribs of a live patient than ignore a dying one.

The ambulance arrived and I proceeded to continually check the log to see what happened next. Eventually, after forty long minutes, the ambulance set off to the nearest hospital on blue lights. He was indeed suspended, and had stayed that way despite the ambulance crew zapping him with the defibrillator, and doing whatever else it is ambulance crews do to prevent suspended patients turning into corpses. Though they were taking him into hospital, his chances were slim, and we later heard that he had been pronounced dead in A+E.

So as the family two miles down the road were cradling their new baby and waiting for the midwife to come and determine its sex once and for all, this young man was saying goodbye to the world forever. He was only the same age as me. What a tragic waste of a life.

I took a call from London Buses earlier. A woman had collapsed on a bus and the bus driver had found she was wearing a medical bracelet. The medical bracelet read “H. C. Elcotropnoresis”. Bear in mind this spelling came from an anxious bus driver across a radio to London Buses’ office to me, and may well be subject to Chinese Whispers. I had no idea what it meant and neither did anyone else in the room. My medical dictionary has not turned up any answers, and neither has Google. Does anyone have any ideas?

It did cross my mind that maybe it wasn’t a medical bracelet at all… maybe she was Greek and that was her name?

Today, I delivered (over the phone) my fourth baby! My first, in a pub toilet, was quite dramatic but the other two were fairly anticlimactic and just consisted of someone shouting “Ambulance quick! The baby is coming NOW!” and then me shouting instructions into an abyss of people panicking and not listening while the baby delivered itself the way nature intended. This time, however, I really felt like I was helping and playing an active part in the baby’s birth.

The call came in around 10am and was made by the baby’s father. The mother was nineteen and it was her first baby, and I guess she thought labour was going to take a lot longer than it did. This makes a change; a lot of first time mothers dial for a “maternataxi” as soon as they miss a period. Still, there was no time to discuss why they weren’t at the hospital yet, as the baby was well on its way. The father-to-be reported that there was “some kind of THING!” appearing “down below” and howled that he needed an ambulance really quickly.

“Sorry, mate,” I said, “but it looks like we’re going to have to deliver this baby now. The ambulance is coming but I doubt it’ll make it in time.”

“But I don’t know what I’m doing! I’ll have to cut the cord and stuff and I don’t know how!!” wailed the man “Please, make them hurry! I need an ambulance”

“Forget the ambulance! And certainly forget cutting the cord! All you need to do is help her get the baby out,” I instructed. “Now do as I say! Are you ready?”

All the maternity instructions are built into the AMPDS software, which is fortunate, as BBAs (Born Before Arrivals) are fairly rare and we don’t get much practice! I brought up the screen and skipped the bit about getting towels and cushions and blankets — there was no time for that.

“With each contraction, place the palm of your hand against the baby’s head,” I read. “As the baby delivers, support its head and shoulder. Remember it will be slippery, do not drop it!”

The father relayed these instructions to the patient’s mother (the baby’s grandmother!) who was also in the room.

“Where is she supposed to put her hand again?”

“Against the baby’s head. I mean, against that thing…”

The mother-to-be screamed in the background.

“Oh my god!” said the father. “I think she’s in serious trouble! I think she’s dying! She’s in so much pain, and there’s blood, and this white stuff, and water and it’s all gone like, oh my god!! HELP! Send the ambulance!!!”

It took me a good couple of minutes to persuade him that nothing was actually going wrong and that this was all normal. With the next contraction, he got it together, and encouraged the mother to “puuuush!” and take deep breaths and do all those things that happen when people give birth on TV. After this contraction, the whole of the head was out.

“Oh my god!” said the father. “It’s the baby’s head!” I think that, up until this point, he had seen the protrusions from his girlfriend’s vagina as something totally alien and forgotten the fact that she was having a baby at all. I was just relieved that it hadn’t been a foot — breech births are far more dangerous and not something that should be dealt with over the phone.

A slight problem then occurred in that, after three more contractions, no more of the baby emerged. It was time to change tack.

“Get the mother sitting on a cushion,” I told him “and tell her to grab her legs and pull them over her shoulders. Then, with the next contraction, tell her to push really hard.”

(There’s an obvious joke here that I’m not going to make…)

The mother did as she was told. Childbirth is indeed not a dignified process. There was a ear-splitting scream, and then a lot of crying. It was hard to pick out the sound of the baby crying, because the father was crying, the mother was crying, and so was the grandmother. I was the only person not crying.

“Is the baby breathing?” I asked, crossing my fingers.

“Yes, it’s crying!” said the father. There was then a short break whilst everyone was sighing and gasping and saying things like “oh my god” and “I can’t believe it”.

“Right,” I said. “Clean the baby’s mouth and nose, wrap it up and give it to the mother. What have you got, a boy or a girl?”

There was a pause while he had a look. Then he came back to the phone. “Um, I can’t tell!”

Kind of worrying that someone who can make a baby doesn’t know the fundamentals of reproductive anatomy!

The ambulance arrived shortly after that — the whole thing had happened in less than five minutes. Mother and baby were well, and were taken to hospital to be checked over. The sex of the baby remains a mystery.

Some address are “flagged” on our computer system because we’ve had problems there (eg. hoax calls, crews being assaulted) in the past. Yesterday, I entered an address which popped up the following information:

James Mason, 31, paranoid schizophrenic, aggressive, carries knives, wears Burberry hat.

Something in the way it was phrased made it sound like the Burberry wearing was as much as of a problem as the knife carrying…

This call was received from a pharmacy on one of the busiest streets in Central London. Bear that in mind as you read on.

“Someone just shouted ‘call an ambulance’” explained the woman. “There’s… someone bleeding in the road, or something.”

“What’s the address?” I ask.

The woman tells me that it’s outside the address she’s ringing from. Checking my “possible duplicates” screen, I see that there’s been a motorcycle accident about fifty metres away. I explain this to her, and ask her to go outside and check the location of the patient and find out what’s happened.

“Oh no!” says the woman. “I can’t do that, I can’t leave my shop. I have customers to serve!”

Nice to see where her priorities lie.

“Okay, can you send someone else?”

“No, there is no-one else here!” she says.

“What about the customers you just mentioned?”

The woman mutters something I can’t hear, and then a young man comes to the phone. I try to ask him to go out and check what is going on, but I don’t get far before he starts shouting and swearing at me.

“Look, you bloody timewaster! Stop f***ing asking me to go outside! She’s dead, okay! Someone is dead! Send the f***ing ambulance and stop asking stupid questions!!!”

And then the line goes dead.

Now, I’ve had the “stupid questions” accusation quite a few times before, and I can understand people getting annoyed with some of the AMPDS triage questions, but this is the first time someone has actually thought that knowing the location and condition of the patient is a “stupid question”. Had he stayed on the line, I would have had another “stupid question” to ask, which would be “how do you know she is dead if you haven’t even seen her?”

As much as I’d like not to, I have to ring the pharmacy back. This time I get a third person, an older man. I explain to him that someone has rather abusively told me that someone is dead, and that two people have refused to go out and investigate. I explain that at the moment we have two ambulances on way (one to the accident round the corner, and one to the pharmacy) and that I need to know if it is the same patient so that we don’t waste an ambulance. I explain that if she is “dead”, we need to start CPR, which I could instruct him on, or else she will die. Do you think I had more luck with this man? No, of course I didn’t.

“I am not going out!” he huffed. “I am working!”

“Send someone else, then!” I implored.

“There is no-one else!”

“I have spoken to three different people in your shop,” I point out. “Surely one of them can be bothered to step outside this shop in order to help this poor lady who might not be breathing!”

“No!” said the man. “That is your job!”

“My job is to instruct you as to how to help her. And you,” I said “are stopping me from doing my job.”

“I am not a doctor!” said the man irrelevantly. “I cannot do anything. Goodbye!”

Now, I don’t know about you, but I think that helping your fellow human beings is everyone’s job, not just that of those who are paid to do it. I hope that tomorrow those three people all get hit by a big red bus and that everyone steps around their bleeding bodies as they lay dying in the street, saying “Sorry, I can’t help you. It’s not my job.”

(Still, you’ll be pleased to know that the outcome could have been a lot worse. It was indeed a second patient, so the decision to send a second ambulance was correct, and it turned out that she was only fitting, and not dead after all.)

These days, it is very rare that I get a call that I haven’t heard before. It seems that there are a finite number of ailments in the world and that the same ones come up again and again. There are some, like chest pains and old people fallen over in the street, that I will without fail take several times per shift. There are some, on the other hand, like the old woman stuck in a dustbin, the rape victim and the young man who dropped dead for no apparent reason during sex with his girlfriend, that I’ve only taken once. I have, so far, never taken a shooting or a complicated birth but I expect I shall at some point. Anyway, yesterday I heard something I’d never heard before. The caller was a young man from south of the river and he sounded panicked and out of breath.

“It’s my girlfriend’s baby, she’s one — I just went to check on her and she was caught up in some trousers — they were caught round her neck. She looked all blue and floppy!”

“Oh, sh*t!” I thought to myself. I didn’t say it out loud, obviously. I clicked the “strangulation” button, which instantly gives the call a Red-1 category, the highest you can get, and then ploughed on, thinking that this poor baby was a goner.

“Is she conscious?” I asked. “Is she breathing?”

“Yes! Yes!” said the man. “It didn’t look like she was at first, but I unwrapped her, and she started gasping, and she’s looking kind of normal now.”

Inwardly, I did a little dance and jumped up and down shouting “hooray”. Dead baby calls tend to spoil my day…

The rest of the triaging part of the call was fairly standard — the man answered all the questions properly and the call went down to a Red-3, which is still a category A, but a lesser kind of category A. Since the man and his girlfriend were in a big panic I offered to stay on line in case there were any changes. I could hear the baby crying in the background, and from their descriptions she was obviously fully alert and breathing normally, so I wasn’t unduly worried. As far as I could tell, the man had averted a tragedy by checking on the baby when he did — they were very lucky.

Glancing at the log to see how far away the ambulance was, I noticed that dispatch had called the police on the request of the ambulance crew. Now, I get a lot of calls where there has been some kind of foul play and usually, they stand out a mile. The general public made very bad liars. They usually try to cover up by going down one of two routes, which are polar opposites. Some turn defensive and give as little information as possible: “It’s a serious head wound! Why are you asking what happened? Just send the ambulance! You’re wasting time by asking for details! You don’t want to help! If she dies it will be your fault!” etc, whereas others will give an improbably detailed account containing details that are utterly irrelevant to an ambulance dispatcher, but make it clear that it wasn’t their fault: “So I was in the bedroom, which was upstairs, talking to my girlfriend on the phone - she can tell you that herself - and I heard a noise from downstairs. The child slipped on a green toy car and banged her head on our Toshiba washing machine, which came from Argos. We got it in 1992 and I don’t think it’s safe because it has very hard edges.” I was quite satisfied the man was telling the truth in this case, and I felt I ought to prepare him for the other kind of emergency service turning up.

Taking a deep breath, I announced “Don’t panic, but the ambulance crew have asked the police to come. It’s just routine — they haven’t heard this call, all they know is that they’re coming to a baby who has been accidentally strangled and they want to check it out.”

The man’s first reaction was to ask if we were still sending the ambulance, to which I replied yes, of course we were. I don’t think that would have been the reaction of an attempted child murderer either. After this he started to worry a bit (”how will they know that I didn’t hurt her?”) and I did my best to reassure him that there were plenty of ways they could find out. I felt dead sorry for him — as if he didn’t have enough to worry about with his stepdaughter having a narrow escape, he would also have to be questioned by the police too. Still, I suppose it is better that innocent people get questioned than guilty people get given the benefit of the doubt. I just hope there is evidence that he was innocent.

… of course, his face may be appearing in next week’s papers with the headline “South London Baby Murder Psychopath Confesses All” and then I may have to eat my words.