Nee Naw

I’m off South of the river for an observation shift with Steve later on today (on a proper full sized Nee Naw this time, as opposed to a FRU), so if you live down that way, please try and have some interesting accidents for me to blog about! Thanks!

I just saw on the news that they are stopping free English lessons for asylum seekers.

My first thought was, they have free English lessons for asylum seekers? They don’t seem to have done much good if the calls I take are anything to go by.

A man came on the line sounding as if someone had died.

“You need to send someone. We need someone here!”

“What’s the problem…” I began.

“She’s BROKEN HER TOE!”

I sighed inwardly. As you know, we’re not allowed to comment on the appropriateness of a call, so I ploughed through the questions in a monotone, being careful to emphasise words like “conscious” and “breathing” in an attempt to bring home the point that ambulances are generally for people who have problems in one of these areas, not those who have BROKEN THEIR TOE.

This didn’t faze our lovely caller, who answered every question with “No, but she’s in pain!” Well, yes, it generally is painful when you’ve broken your toe. The call, unsurprisingly, came out as a Green 2, the lowest of the low.

His piece de resistance was his answer to “And when did this happen?” The toe had been broken yesterday, when the patient had stubbed it against the door.

I tried to bring the call to a close, but the caller was going on and on: “Are you sending someone? Are they on their way? She is in pain!” and wouldn’t take the stock ambulance service fob-off of “help will be with you as soon as possible” as an answer. I was going to just say goodbye and hung up, but felt this man would be ringing up every five seconds if I didn’t say something to him. If the QA office are reading this, please accept my apologies.

“The 999 service is for serious and life threatening emergencies,” I said. “We prioritise all our calls, and yours is the lowest priority. Do you really consider this to be a life threatening emergency?”

“Yes!” said the caller. “She’s in pain!”

Well, I tried.

I checked on the call a bit later and there was a message from the Telephone Advice people upstairs: “Already spoken to this patient - no send policy invoked - self care advice was given, patient to make own way to hospital if needed. Will ring back and advise.”

I thought that was the last of it. But it wasn’t.

Five minutes later the caller was back on the phone, and this time, he had the bright idea of answering every question with the opposite of what he’d said earlier. Is she conscious? No. Breathing? Struggling! Quick, quick, send us an ambulance. Didn’t you call earlier for a patient with a broken toe? No, no, that wasn’t me. Just send the ambulance.

As it was now a category A emergency, we not only had to send an ambulance, but a FRU (first response car) as well. The FRU was a lot closer to the call than the ambulance, and the FRU desk asked the FRU to report on arrival due to the nature of the earlier calls to this address.

FRU arrives, finds a fully conscious and well patient with a broken toe. He rings us straight away and tells us to cancel the ambulance. I don’t know what he said to them, but he was on scene for a grand total of six minutes, including doing his paperwork.

It’s a shame there isn’t a law against wasting ambulance time like there is for the police.

Up on the dispatch desks, it’s the allocator’s job to decide which ambulance gets which call. This becomes partly tricky when we have more calls than ambulances, as is often the case. There are three main factors we use to decide:

• Most importantly, the priority of the call as determined by the AMPDS questions, and also from looking at the diagnosis.
• The distance the ambulance is from a call. For instance, do you send the last available ambulance to the broken leg call it’s right next to, or make it drive five miles to a heart attack call?
• The length of time a call has been waiting.

The other day, we had one call and one ambulance nearby - simple! The call was a Doctor’s Urgent, which is a journey booked by a doctor which needs to be done fairly quickly (between one to three hours) but not with lights or sirens. These calls are supposed to be less serious than 999 calls, but of course with large numbers of people abusing the 999 system, it doesn’t work out that way. The Doctors’ Urgents are the people who really suffer from ambulance shortages, and they are usually old and frail people with things like pneumonia, mild strokes, broken hips etc. If it were up to me I’d give them top priority and let all the 999 callers wait! But it isn’t up to me, of course.

The diagnosis on this call was “89 year old male, end stage COPD, high potassium level”. COPD stands for Chronic Obstructive Pulmonary Disease and causes nasty breathing problems. A high potassium level means you are at substantially increased risk of a heart attack. In other words, this guy sounded quite sick to us, so we dispatched the ambulance immediately, even though it was our last one. (Sometimes if we have one ambulance and one not-very-serious call we wait for another ambulance to become available so we always have one spare for a serious call).

The ambulance was halfway to its call when another call came in - a Category A (Red) 999 call. “25 year old female, suffers from depression, on slimming tablets, palpitations, hyperventilating”. The ambulance was not far from this call, but we didn’t really want to take it off the Doctor’s Urgent, so I did what is known as a General Broadcast on the radio:

“This is a general broadcast all mobiles on Channel 18. We are currently holding a Category A call in Some Road, Somewhere, for a 25 year old female hyperventilating and having palpitations. Anyone able to deal with this call, please go Green Mobile and press your Priority Button. General Broadcast at 0909, Mike Mike, red base out”.

The crew on way to the Doctor’s Urgent pressed their priority button. “We’ll do that one, over!” (For some reason that I don’t get, crews don’t like doing Doctors’ Urgents).

The allocator thought it over for a few seconds. “The Cat A *could* be cardiac, what with the slimming pills, but it also sounds awfully like a panic attack. And there’s a response car on way, and that crew at the hospital nearby look like they’re about to become available. This crew are nearly at the Doctor’s Urgent, too. Tell them thank you, but please continue on the Doctor’s Urgent”.

A few minutes later, we got a call from the crew on their way to hospital.

“Just for your information, this old boy is fine, if a bit wheezy. I think you really should have taken us off this call for that category A.”

I cursed inwardly. “Thanks for letting us know. From the look of the diagnosis, we didn’t want him to wait, but I guess we were wrong.”

Then the FRU who had been sent to the Category A call rang up. Oh no, I thought, he’s going to say she’s suspended and we still haven’t got the ambulance there and now we’re going to have to explain why we kept that crew on that Doctor’s Urgent.

“Cancel the ambulance,” said the FRU. “She’s having a panic attack - I’m able to deal with it and she won’t need to go to hospital.”

Phew. Looks like we made the right decision after all.

When a “suspended” call pops up on our screen on the dispatch desks, there’s always a quick rumble of activity. There’s no “Hello Greenwich, how are you this morning? Got a call for you… little old lady hurt her hip… in Eltham… L202 having a cup of tea, are they? Shall I send it down to L203? Okay, have a nice day.” Instead it’s “Greenwich, it’s a suspended.. L203? Thanks.” And the crew rush out to the vehicle just like they do on Casualty (so I’m told) and put their foot down just that little bit extra, because in this situation more than any other, every second counts.

So what’s worse than a suspended call? A suspended call that involves a young person. These are far less common than you’d think. As far as I can recall, I have taken eleven such calls in two years:

• Two people who’d been hit by cars. One was trying to cross the North Circular, which is like a motorway.
• A motorcyclist decapitated by a pillar whilst driving in an underpass.
• One person who’d jumped in front of a train.
• A fatal stabbing.
• A twenty-something year old man who mysteriously dropped dead whilst having sex with his girlfriend.
• A young man who’d died of a drug overdose.
• A teenager who, I think, vomited in his sleep due to a stomach bug and choked to death on it.
• A 37 year old woman with a brain tumour who just didn’t wake up one morning.
• A severely disabled ten year old boy who’d stopped breathing. His parents were very calm, apparently it wasn’t the first time this had happened.
• Two cot deaths.

The call which popped on our screen on Wednesday morning was another. It simply read “21 year old male suspended”. Not wanting to send the two crews we’d immediately dispatched into a dangerous situation, our sector controller lifted the receiver and listened into the call. She could hear a hysterical woman describing a horrible scene.

The patient was her flatmate. She’d got up that morning to go to University, knowing he had to be up at that time too. When she’d finished her breakfast and he still wasn’t up, she went and knocked on his door. He hadn’t answered. She’d peeked her head around the door to see if he was there. He was. Lying in the bed, eyes open, his face purple, stiff, cold, obviously dead. The caller had screamed her head off, then grabbed the phone and continued to scream down it. The call taker was gently trying to persuade her to take a closer look and start CPR, but the caller was having none of it. She wouldn’t even touch him. I couldn’t blame her - I wasn’t even *there* and I could tell this patient was beyond any help.

At this point, a man - another flatmate, I think - took the phone. He was calmer, but confirmed what I suspected: when the call taker asked him to start CPR he said there was no point, the patient was clearly dead. The call taker asked him if he knew what had happened, and the caller said he had no idea. The patient was epileptic, but he hadn’t had a fit in ages, and otherwise he was perfectly healthy. He just couldn’t believe what had happened…

The crew arrived at this point. It was less than ten minutes before they called back to say yes, the patient was “purple plus” (ambulance speak for “dead beyond any possible doubt with no chance of resuscitation whatsoever”) and could we arrange for the police to attend due to the patient’s young age. There were no obvious suspicious circumstances, he said, in fact there was no obvious cause at all, and it seemed likely the patient had simply had a fit in his sleep, causing his tongue to block his airway rendering him unable to breathe.

I could still hear the patient’s flatmate wailing in the background.

This incident was a wake up call to all of us about how deadly fits can be. We get hundreds of fit calls every day, and 99% of the time, these are routine - the patient starts to recover before we’ve even got off the phone and doesn’t always need to go to hospital. This was a reminder to us that if the patient doesn’t have someone to turn them on their side and check their breathing afterwards, a fit can be anything but routine.

Miranda asked:

What advice would you give to us, as members of the public, on how to be the best possible 999-callers?

I’ve come up with a list of “commandments” for you. These come with the caveat that we know that when you’re calling 999, it’s an emergency and you’re going to be distressed and unprepared, so we don’t expect you to be perfect. But, y’know, it helps if you try!

1. Know Thy Address. When you call, make sure you have a full street name, house number, area name and postal district, and any important information and landmarks which might help us find it. If this isn’t possible (for instance, if you have just witnessed a traffic accident, you might not know the name of the road you are on), call from a telephone box or other landline (ask in a shop or knock on someone’s door) — we can trace the call. We can’t trace the exact location of a mobile phone.

2. Know Thy Problem. We get loads of from receptionists and security guards who have been asked to get an ambulance for someone else without being told what is happening. An ambulance is unlikely to be dispatched until they’ve told us what the problem is. This is because a) we triage calls according to importance, and we don’t know how important it is if we don’t know what is happening b) we don’t just have ambulances, we have helicopters and cars and bicycles and Emergency Care Practictioners (and telephone advisors!) which we might dispatch depending on what has happened c) ambulance crews don’t like entering dangerous situations, and like to know what they are going to before they go blazing in.

3. Stay With Thy Patient. You’ll need to answer a few questions about the patient and possibly perform a bit of first aid, so it really helps if the person who is calling is sitting right next to the patient.

4. Thou Shalt Not Waffle. Give clear, concise answers to questions and don’t be scared to say “I don’t know” if you don’t know! Now is not the time to give the patient’s entire life story.

5. Thou Shalt Not Hang Up Until Thou Is Told. On TV 999 calls are over in seconds. In real life, you will be on the phone for approximately 2-3 minutes or until the ambulance arrives. Don’t hang up until the call taker says you can. Remember that the length of the call has absolutely no bearing on how long the ambulance will take to arrive, and that what the call taker is telling you is important.

6. Trust Thy Call Taker. I reckon I spend about half an hour a day listening to callers “helpfully” telling me things like: It’s an emergency! You’d better get here fast! Stop asking questions and just send the ambulance. You could send one from Woolwich Ambulance Station, it’s just around the corner. I think you’re going to need the fire brigade too. Tell them to drive fast! Hurry up! Etc. Remember that we have been taking these calls day in, day out, for years. We don’t need you to tell us how to do our jobs.

7. Meet Thy Ambulance. If you have a spare person at the scene, get them to stand in the middle of the road and do an impression of a windmill. The location may be obvious to you, but it is not always obvious to the ambulance crew, and while ambulance crews are usually local, they’re not always.

8. Keep Thy Phone Switched On. Or give an alternative number. We often need to call people back for more information.

9. Thou Shalt Keep A Civil Tongue In Thy Head. Yes, we know you’re panicking, but really, there’s no need to be rude. Call the call taker an effing moron once too often and the blue flashing lights you see next will be attached to a police car!

10. Know Thy First Aid. We can give you instructions over the phone, but don’t wait until you are kneeling over a comatose relative to learn CPR. Ask your employer or St John Ambulance about going on a First Aid course.

Okay, back to answering Readers’ Questions!

aendr asked:

I have a couple of questions given a situation where a person sees an accident/incident) which is obviously going to need more than one service - for example collision where someone’s going to need cutting out, or a crime where someone ends up injured and the perpetrator is still around. First, what service should be asked for; second, how are the other services contacted - is the person passed around so each operator gets first hand details (subsidiary to that - what if continuing first aid information is needed to be fed to the ambulance service operator especially if there’s something meaning there will be a delay till the arrival of assistance from the ambulance service)?

There’s two answers to this, a short answer and a long answer. The short answer is, it doesn’t matter which service you ask for or who you speak to, everyone who needs to be there will turn up so long as you give one of the services the necessary information.

The long answer is as follows! Imagine you have seen a road traffic accident where someone is going to need cutting out of the car. You’ll need all three services. The service you need most urgently is the Fire Brigade, because the priority is to get the patient out of the car. When you ring 999, you can either ask for “fire” or “all three, starting with fire”. Now imagine the person trapped in the car is conscious and not badly hurt, but another has been ejected from the car and isn’t breathing. In this case, you’d ask for ambulance first, so that the call taker can give you CPR instructions and an ambulance can get to the scene first.

If you have only asked for an ambulance, but actually need other services, when the dispatch desks see the call they will contact the other services (whether you have asked for them or not). We have an electronic link to the police so by pressing a button we can make our calls pop up on their screens and send messages back and forth. If we need the fire brigade, we ring them up and give them the details of the call. This only takes a few seconds and will probably be done while you are on the phone to us. The advantage of staying on the line and talking to all the services is that you can give everyone all the information you require (as you can imagine , all the services ask different questions, for instance if someone is assaulted the ambulance service want to know how badly they are hurt, while the police want a description of the assailant…) and they can all give you instructions. The disadvantage of talking to all the services is that you will be on the phone for quite some time which might impede you helping out at the scene (or running away from the scene very fast, which you might need to do if it’s a fight or a fire or something!) One thing, though - make sure you speak to every service you request, because the telephone operator has to try to connect you to everyone you’ve asked for, and we waste a lot of valuable time calling back people who have asked for police and ambulance and then hung up after talking to the police.

Did my first call taking shift in god knows how long today. It’s a bit like riding a bike. I spent the first hour thinking “Were they (the public) always this rude/stupid/loud? Did they always contradict themselves like this? Oh my god, it’s an actual serious life threatening call, shock, horror!” but after that it was back to triaging heart attacks in my sleep like I’d never been away.

For part of the shift, I had an observer — a young doctor from the Occupational Health Department. (Perhaps they made her do an observation day in Control so she could understand why so many EMDs rock up in Occupational Health with stress related ailments?) As any of the crews who have ever had an observer will know, once you have an observer on board, you are guaranteed not to get any interesting or remotely worthy calls. I spent a good half an hour arguing with an angry midwife who wanted a particular ambulance which was currently outside her hospital to do a non-urgent transfer from her ward. Sector were saying NO because they had several higher priority 999 calls waiting for that ambulance. Midwife was not taking NO for an answer. It went on and on. God knows what the doctor though - she had probably thought she was going to hear me doing CPR and delivering babies, but instead here I was arguing red tape with midwives…

The most “interesting” call of the day came around lunchtime from an extremely drunk sounding male. He didn’t want an ambulance, he told me, but he had no credit on his phone and didn’t know what else to do. I expected he was going to ask me to contact his GP or social worker as people sometimes do, but no.

“I hear Richard Branson is making a space rocket,” he told me. “And I need to tell him how to do it.”

I was, for once, lost for words.

“Um,” I said. “We don’t have any dealings with Richard Branson. Are you sure you don’t need an ambulance?”

“I told you I didn’t!” said the man (as if I was the one saying the stupid things). “Richard Branson is sending a rocket into space, and he needs my help.”

“Well, this is an ambulance service,” I said. “What makes you think we have anything to do with Richard Branson?”

“You’re all British, aren’t you?” said the man, and promptly hung up.

Got home and googled for “Richard Branson space rocket” and found that Richard Branson *is* actually sending a rocket into space. This was news to me. You learn something new every day in this job…

Has anyone else noticed how the sizing of LAS uniform is totally haywire? I just ordered some new trousers as mine were looking a bit knackered, and as I’ve put on a few pounds (as one does working in that room) since joined I decided to go for the next size up.

So while my original trousers were a bit snug, my bigger trousers are so tight I can’t even fasten the button. Same make, same style, two inches “bigger”. They aren’t even made of a stretchy material so it can’t be that. I’m sure I have heard other people in the room saying similar. What on earth is going on?