Nee Naw

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…

Since I posted the BBA Transcript from the Guardian last week, the EMD concerned, Katie Vallis, has shot to fame and appeared on BBC Five Live, BBC News, ITV News, GMTV and in The Sun and The Mail! I think it’s brilliant that the ambulance service, and the control room in particular, are getting some positive recognition for once. Normally, whenever we end up in the papers it’s because someone has made a mistake or had to wait too long for an ambulance and it is somewhat demoralising to have all the good things the service does overlooked to dwell on the rare occasions when things go wrong. Us people in the control room are particularly overlooked. Successful resuses, BBAs, choking toddlers saved, people talked out of suicide… I’ve done all these and never received so much as a thank you letter!

Despite this, I was rather baffled by the amount of media attention this call got. BBAs, you see, are not all that unusual. I’ve been involved in two in the last week, one as a call taker and one as an allocator. (What to do as an allocator when faced with a BBA: Send two ambulances, one of which must contain a paramedic, arrange a midwife, arrange a car to pick the midwife up, cross fingers.) Every single person in the room has done one at some point (except for the newbies, who will be eagerly awaiting their first!) so it seemed odd that it made the international news because being on the news implies to me that the event is unusual and not in the normal line of someone going about their job. Having listened to the recording, it’s clear that Katie is spot on word perfect and should be held up in training school for years to come as a shining example… but she’s still just doing her job. It’s not that I resent her her fifteen minutes of fame, because it’s better one person gets some recognition than no one at all, and I had my own when I (one EMD out of around 100 on duty on July 7th 2005) was invited to 10 Downing Street to meet Tony Blair. It just worries me that the press obviously don’t know we can save lives and deliver babies and the like, and see us as phone gimps who bark out irrelevant questions and stand in the way of people getting ambulances.

Still, more stories like this in the national press, more programmes like the recent London Ambulance series, more people reading Nee Naw, and maybe that will start to change!

Mind you, I wouldn’t like to have the tape of my most recent BBA trotted out in public! It did not exactly go smoothly. The father was driving the mother-to-be to hospital, when he realised he would not make it in time. Unfortunately, this realisation came in the middle of a busy road. Panicking, he stopped the car and dialled 999. I answered. He was obviously causing something of an obstruction. I could hardly hear him over the noise of horns beeping and his wife screaming. After getting the vital details, he pulled the car over to the side of the road. This happened to be next to a busy tube station. It was around 9am, and hundreds of commuters were pouring past, gawping. The husband attempted to get into the back of the car with his wife, who was screaming things in a language I didn’t understand. I could guess what she meant, though - we didn’t have long until the baby came. I got him to instruct her to lie down, stripped below the waist (thank god she wasn’t wearing trousers!) and look for the head. It appeared a few seconds later, and thankfully the rest of the baby followed smoothly. It was particularly difficult for me to follow what was going on because the husband was talking to the wife in Foreign and a million transfixed commuters were shouting in the background and dialling 999 on their mobiles, seemingly just to clog our switchboards as they could see the father was talking to me!

Now, the vital question. “Is the baby crying or breathing?” Fortunately he/she (I never even got to find out which!) was, though I couldn’t hear it all over the pandemonium. It seemed to take forever for the ambulance to turn up - though it was running from nearby, it booked a delay due to traffic - probably the same traffic which had caused this situation in the first place, exacerbated by the growing crowd of rubberneckers! I could hear the wife getting quite distressed and crying and screaming in the background and was worried that something was going wrong. The husband assured me that nothing was wrong except for the fact that she’d just had a baby on the back seat of a car in the middle of London in rush hour in front of hundreds of people. Which, I guess, is a good reason to be crying. I encouraged husband to calm her down and wipe off the baby and give it to her and all that stuff, which kind of kept things under control until the ambulance arrived.

I have never been so glad to hear those nee naw sirens in the distance in all my life! Definitely not one for the BBC!

I’m into my fourth week (or thereabouts) of allocating. I think I’m doing okay. I say this because no one has died as a result of my actions and none of the crews have put in an official complaint about me.

Today something somewhat out of the ordinary happened which tested my fledging allocating skills. If you were travelling by tube today, you might already be aware of it. There was some kind of signal failure on a tube (underground train) line leading to several trains being stuck in tunnels. London tube trains are very cramped and hot and a lot of the passengers are standing up, so when this happens you get a lot of people fainting, having panic attacks, shouting at each other and generally London Underground requested ambulances to four different tube stops, three of which were in my sector. So I had to dispatch three ambulances and two managers all at once, then deal with a constant barrage of reports on the radio from the ambulances, phone calls from the managers and updates from London Underground all whilst still having to give out “ordinary” calls from those inconsiderate members of the public who failed stop getting ill just because I had no vehicles left. I crossed my fingers tightly and prayed this wasn’t going to escalate into a major incident with lots of casualties and even more ambulances being needed… I knew my sector controller (who has been fantastic in helping me with allocating) would help me out, but I’ve reached the stage where I want to be able to do things myself and would feel disappointed if it all got too much for me to deal with.

Strangely, while I was dealing with the train incident, a call came in for a 25-year-old in cardiac arrest (believed to have died due to having an epileptic fit in his sleep). Beyond giving out the call and doing all the routine things to get the crew there, I hardly gave this a second thought. If I’d been call taking, this would a call that I would never forget and that I would be thinking about for weeks afterwards and the trains stuck in the tunnels would be instantly forgotten, but as an allocator, your priorities are different. The dead man was the responsibility of the crew and the call taker once I’d given the call out, but with the train incident I still had to make sure I was keeping abreast of what was going on, making sure my vehicles were in the right place and finding ways to cover my calls despite being three vehicles down.

Fortunately, the incident didn’t escalator. There was a lot of flitting about, but eventually two of the stations were stood down while London Underground evacuated people from one station first, then another. The crews were on hand to check people over but fortunately no one needed taking to hospital and everyone was stood down just as I left for the day. So the whole incident can be chalked up as a good practice for next time I have something big on my sector, when the outcome might be a lot worse…

I live on a busy road in the middle of my sector, so it’s not unusual for calls to the vicinity of my home to pop up on my screen. Today, however, was a little unusual. No sooner than I had sat down the in the allocator’s chair, I had to give out a call to an assault that had happened smack-bang outside my house. That was especially scary considering I had been there on my own in the dark 90 minutes beforehand! Then, a few minutes later, there was a diabetic collapsed in the road just round the corner by my local pub. A spate of calls followed for a drunk lying in the road near the High Street around lunchtime, though this is hardly unusual. A young woman was run over by a car travelling at 40mph a couple of junctions down the road from my house in the early afternoon (I know for a fact that the speed limit on that road is 30mph) and blued into hospital with a nasty head injury. And worst of all, a three month old baby just a few doors away from me was found dead in his cot minutes later. By the end of the shift, the road where I live was dotted with the angry red triangles that denote category A calls on the mapping system.

But it wasn’t over! It took over an hour to get home because someone had decided to jump under a tube train on my route home. He, miraculously, wasn’t killed and it took HEMS and several ambulance crews forever to remove him to hospital, leaving me stuck in a tunnel feeling like I was going to fall asleep on my feet. I finally got home ten minutes ago, and can you guess what was parked in the road opposite my house? Yes, a great big ambulance with its big blue flashing light on! Aargh!

I’ve followed Beaker’s lead and set up a Facebook account for Nee Naw - if anyone would like to add me as a friend, I’m there as Mark Myers or mark [at] neenaw.co.uk. Not quite sure what I am going to do with it yet. Maybe post lots of pretty pictures of ambulances taken with my mobile phone camera. (Yes, I do do that. How sad.)

Psychiatric patients are some of my favourites, just behind deaf old people. I could sit and take calls from them all night. My record spent on the phone with a psychiatric patient was one hour and forty minutes. It was quiet on call taking but there was a shortage of ambulances in her area, and because she was non-violent and non-suicidal — the reason she’d rung was because she was scared there were monsters in her house — she was a low priority call and I offered to stay on the phone until we got there. I had nearly lost my voice by the time we did.

I had the following conversation with a psychiatric patient yesterday:
Me: Emergency ambulance, blah…
Him: (in calm and friendly tone) I think I need to go to A+E. I self harmed yesterday.
(At this point I am thinking “Yesterday? And you want an ambulance *now*? Timewaster!)
Me: How old are you? Are you feeling violent? Do you have any weapons?
Him: (fairly cheerily) Thirty-eight. No, I’m not violent. I just think I need to see a psychiatric and get myself sorted out. Nope, no weapons here.
Me: And when you self-harmed… what did you do?
(I’m expecting him to say “I cut my arms” at this point…)
Him: Well, I tried to cut my penis off! That’s not a good thing, is it? So I think I need to go to hospital to get my penis sorted out. And then some psychiatric help to make sure I don’t do it again. Oh yes! And I tried to burn my house down with me inside it. Then I thought better of it and I managed to put the flames out! That was lucky, wasn’t it? I dread to think what could have happened!
Me: Oh! Um! Er! Yes. I see. Er. Are you burned? How is your penis now?
Him: No, I’m not burned. I managed to put it out in time. And my penis just has superficial cuts on it. It’s harder to cut it off than you think, you know.
(I have to say this isn’t something that I have considered at great length before, but is nice to know.)

The dispatch desk decided that our crew would wait for the police, and a few minutes later we got a message from a rather shocked sounding police person: “Ambulance asap please! Call as given! Male is not very well!” We took him to the hospital and I hope he managed to get himself into a good psych ward somewhere. I still can’t quite get my head around the way he was burning down his house and chopping his bits off one minute, and the next calmly and almost cheerfully describing the events to me as if he were ringing about someone else!

A transcript of a BBA call from Guardian Unlimited - thought this would be of interest to some of you!

On a lighter note, a call one of my colleagues took recently:

Caller: I’ve got a chilli in my vagina!
Call taker: Um. Okay. What’s the address we’re coming to?
Caller: No… I just wanted some advice.
We’re not actually allowed to give advice over the phone but on this occasion my colleague thought this was less like advice and more like Stating The Bleeding Obvious…
Call taker: Well, my advice is to take the chilli out of your vagina. And some more good advice is not to put chillis in your vagina. They are far better in curries.
Caller: Thank you!
Call taker: (firing up the psychiatric card just in case) Are you sure you don’t need an ambulance?

Unless you’ve been living on another planet, you will undoubtedly have heard of Madeleine McCann, the missing child whose parents are now under suspicion of murdering her. I have been rather captivated by the case, but this is a blog about ambulances, not missing children, so I won’t start boring you with my endless opinions and speculation. There is one thing, though, that I think is relevant, and that’s one of the reasons people have for suspecting the McCanns. Apparently, their lack of emotion, the way they have calmly and efficiently gone about setting up a fund and a worldwide publicity campaign to find Madeleine, is an indicator that they are guilty. According to some, any parent faced with the loss of their child should simply fall to pieces and become an ineffectual gibbering wreck. What a load of rubbish. The McCanns are not falling apart because they are treating Madeleine’s disappearance as a surmountable problem. They have barely acknowledged the possibility that she may be dead. This is exactly the attitude we have to adopt as call takers, and if our callers do so too, then they have the greatest chance of saving the patient’s life. Both times I have taken cot death calls, the parents were fantastically strong, and though sadly in those cases the baby couldn’t be saved, I have heard of plenty of cases where their resiliency has paid off.

Which reminds me of a call that came in while I was working some time ago, one which I was glad not to be personally involved in because it was frustrating enough to hear about.

It was the middle of the day and a call came in from a neighbour. The couple from the upstairs flat were running around hysterically shouting that their baby was not breathing. The neighbour had gone straight inside to call the ambulance, and, after giving the details to the call taker, ran back to get them to bring the baby in to start CPR. But when he went back into the corridor, he found that they were gone. He went back and told this to the call taker, who urged him to go and look for them and bring them right back. The ambulance was dispatched, and the neighbour ran off to begin a fruitless search.

The ambulance, which wasn’t far away, was just pulling up at the location when we got another call from a nearby main road.

“Big Long Road, W22. (Caller unable to be more specific.) Couple seen standing by roadside with baby, looking distressed, baby appears unwell. Caller not on scene. Was driving past.”

(You have to love these callers who judge a situation serious enough to call an ambulance but not to actually stop and help these poor people in case it makes them five minutes late for work…)

The ambulance was redirected to the main road and a general broadcast was put out to all vehicles in that area to look out for the family. Whilst the ambulance drove up and down, an eagle eyed FRU spotted the family getting into a black taxi. There was an argument breaking out. The taxi driver, very sensibly, had got out and was calling 999 on his mobile. The mother had climbed into the back of the cab and was hysterically insisting he drive them to the hospital, two miles away. The father was trying to wrestle the phone from the cab driver and shouting “just drive!” The baby was blue, lifeless and unbreathing. No one was doing CPR. The FRU paramedic had to forceably drag the mother and baby out of the car in order to start resuscitation.

By now it had been ten minutes since the initial call from the neighbour. The longest the brain can survive when someone is not breathing and CPR is not being done is three minutes. That’s how long the original ambulance took to arrive on scene.

It would be heartless to blame these parents for the death of their child, and for all I know he may have been beyond help from the start, but no one can say he was given the best possible chance either. The parents, obviously, “lost it”. They panicked. They thought to take the child to hospital, but not much else. They didn’t listen to the neighbour or the cab driver, both of whom knew that an ambulance and CPR would be needed to give him any chance of survival. Their panic and inability to keep it together failed their child.

How anyone can say that a parent should panic, and be contemptuous of one who does not, is beyond me.

My shifts on call taking are generally limited to two every five weeks these days, on the part of my rota called “relief week” which is when we work with other watches. Consequently, I’m a bit rusty with it and tend to forget how exasperating a lot of the calls are and how exhausting a day on call taking is. Thank god I don’t have to do it four days in a row any more.

One call reminded me of just how close to incidents we really do get as call takers. It was a call from an elderly lady who was a carer for her even more elderly friend. Her friend had suddenly started vomiting a lot of bright red blood, which as you can imagine is not a good sign. The call came out as a category A, which would usually have meant an ambulance in about five minutes, but unfortunately, they lived in one of those pesky “rural” places that I talked about before. (Incidentally, some of the commenters had a good laugh at me describing a place 5 miles from the nearest ambulance station as rural. Apparently there are plenty of properly rural places where you are 45 mins or more from the nearest ambulance station and the poor call takers have to stay on line all that time and the callers STILL expect you to be there in five seconds flat! I bet people don’t take this into account when buying big mansions in the countryside…) The nearest ambulance and FRU were sent. They weren’t very near at all - five miles and seven miles respectively.

While I was asking the triage questions, I could hear the patient groaning and vomiting in the background. She sounded in a bad way and I prayed the traffic would be on our side and that the FRU would get there quicker than the computer’s estimate of 10 minutes. Of course, there is one thing worse than a patient sounding really ill in the background, and that’s a patient who you can’t hear at all. And that’s precisely what happened next. Just as I was telling the caller to put her dogs away and open the door, everything went quiet.

“Doris? Doris! She’s gone unconscious! Help!”

My poor caller, who up until this point sounded calm and as if she had been calling ambulances for Doris on a regular basis, totally panicked. After having the usual “where’s the ambulance/hurry up/why’s it taking so long?” conversation, I tried to move on to the instructions for an unconscious person. But it was no good. Doris, who was in her late 80s, had collapsed in an armchair with her head lolling to one side. Joan, the caller, sounded a little younger, but not much and was totally unable to lift her unconscious friend from the chair to the floor. Their nearest neighbour was a few minutes’ walk away and Joan told me she couldn’t walk very fast, so there was no point going for help. It’s always a difficult judgement to make whether you should encourage or even pressurise a caller into moving a patient when they feel unable to do so. On one hand, it might only be fear of making things worse (Joan started off by saying she couldn’t put Doris on the floor, Doris had a bad hip, it could hurt her… but of course alive with a broken hip is better than dead without…) that is stopping them, on the other hand, they really might be physically incapable and could injure themselves trying, and then we’d end up with two patients instead of one! So I didn’t push Joan any further, and instead concentrated on getting her to try to open Doris’s airway whilst she was still in the armchair, clean the blood away from her mouth, talk to her and generally make her comfortable.

I decided to use the “breath timer” gadget on the computer. Normally we use this for a patient with abnormal breathing to determine whether they are going into cardiac arrest and whether CPR needed to be started. On this occasion, I already knew that CPR wouldn’t be possible, but I thought it would do it anyway, partly to give Joan a “job” to make her feel she was doing something, and partly so I could convey this information to the FRU and ambulance to better prepare them if she did stop breathing.

The first time I used the gadget, Doris’s breathing was a nice, regular pattern. A little slow, but acceptable. Joan reassured Doris that she was going to be fine. Doris was silent.

The second time I did it, Doris’s breathing had slowed down a lot. The gagdet told me this was possibly an agonal pattern and to start CPR or recheck. I rechecked. This time, Doris’s breathing was irregular, alternating between shallow and rattling gasps with long gaps in between. I had no doubt that she was arresting.

Just as I was changing the “breathing?” answer from “yes” to “agonal” on the ticket, the FRU burst through the door. I heard him talk to Joan briefly and look at Doris before picking up and speaking to me. I already guessed what he was going to say.

“She’s suspended, can you ask sector for a second vehicle please? Thanks.”

And then they were gone. Sector got the second vehicle there and Doris was blued into hospital in cardiac arrest, but didn’t make it.

You could spend a lot of time worrying about a call like this and how it could have been done differently. If Doris and Joan had lived closer to town, or if we’d had an ambulance on standby in their village, would we have reached them quicker? And would that have made any difference? If I’d sent Joan to fetch the neighbour or been a bit more pushy with her, would they have started CPR earlier and saved her life? Or would Doris have died alone while Joan was fetching the neighbour? Would Joan have hurt her back and been unable to comfort Doris as she took her dying breaths? I’ll never know, but I hope I did the right thing. Sometimes making someone’s death more comfortable is better than trying to save their life.