Nee Naw

… I will update my blog more often!

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

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

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

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

Hooray for Christmas miracles!

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

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

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

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

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

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

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

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

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

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

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

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

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

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