Diagnosis: “Ate tuna and pickle sandwich. Now feels sick.”
What did he expect? Tuna and pickle has got to be one of the most vile fillings ever to grace a sandwich. I felt sick just thinking about it.
The call taker had typed “CHOPPED FINGER OFF” as the diagnosis, which seemed like more than enough reason for me to send an ambulance. Off one sped. The problem was that the call taker then didn’t type anything else, which made me suspicious. Why wasn’t she triaging the call and what had happened at midnight at a residential address to cause an amputated finger?
Picking up the phone to listen in, I soon discovered why the call wasn’t progressing. The poor call taker couldn’t get a word in edgeways as the injured man ranted and raved. For a change, he wasn’t ranting and raving about the ambulance service, he was ranting and raving about his girlfriend and how awful she was. Now, we are taught various techniques for taking control of the call and getting information out of a caller, and I happen to know the call taker in question is usually very good at that, but on this occasion even she was having no luck whatsoever.
I asked the radio operator to warn the ambulance crew not to enter until we said so as there seemed to be a little more to this call than met the eye.
Some minutes later, I pieced together the rants and worked it out. Finger Man had come home from the pub and his girlfriend had (his words) “started give him lip” and “getting on his nerves”. So he had picked up her widescreen TV in an attempt to throw it out the window to teach her a lesson. Unfortunately, widescreen TVs are rather too cumbersome to be easily thrown out of windows by one person and he’d dropped it squarely on his finger. It wasn’t amputated at all but it did sound rather broken. Broken fingers are of course not a good reason for having an ambulance, sent the crew to someone else and left CTA to deal. CTA no doubt recommended a taxi to the hospital and a session of marriage counselling.
I’ve completed two weeks as an Allocator on the East Central! I’ve also managed not to fall out with any crews or colleagues or cause a significant drop in those all-important performance figures. I haven’t yet worked out which ambulance belongs to Mr Reynolds but I’m working on it. So I can tentatively consider myself a success in my new role. So far.
The hardest part so far is getting used to regularly working on a different sector. I was on the North East for three years and only worked other sectors on overtime or relief shifts, allocating with the help of someone who usually works that desk. I knew all the crews’ shift times off by heart and all the little idiosyncrasies of the sector, like the way Tottenham crews gravitate to Edmonton ambulance station and Whipps Cross 29 starts and finishes at Walthamstow for no apparent reason. I got to recognise some of the crews by voice (“Bonjour Romford” brightened many a shift – we took to sending messages down his MDT in French) and became quite fond of the regular callers – Jimmy the surprisingly nice throat slitting alcoholic, George Michaels the fit-prone alcoholic who frequently offers to marry me, Mrs Haddock who wants us to change the TV channel and make her a cup of tea… I miss them all, and when I see someone else sitting with my former deskmates in “my” chair it’s a bit like seeing your ex boyfriend out with a new girlfriend.
But the East Central is great, and I’m learning my way around it. The first thing I had to get my head around is the fact that all the ambulance stations are very close together, and while 5 miles is a perfectly acceptable distance to send a Romford (London/Essex borders) crew, you’ll be pushing it to send a Smithfield (central London, in the City/financial district) more than two. The roads are narrow and there is so much traffic that two miles can take 10 minutes, even on blue lights.
The other shock has been the contrast between night and day. During the day, the East Central is one of the busiest sectors. At night, it practically shuts down. This is because a large part of the sector is taken up with the City and Docklands, areas where a lot of people work, but not many people live. Those who do live in the East Central are mainly young, well off people, who are less likely to get ill in the first place and more likely to take taxis to hospital. The exception to this is the Newham/West Ham area, which generates a steady stream of pointless green calls throughout the night. By 2am, it is perfectly possible to run the entire sector with five ambulances, three of which are based at Newham. Of course, when you have a small number of ambulances and a small number of calls, it only takes one large incident – a car accident with multiple patients, for example – to throw the whole thing out of kilter and the only way to deal with this is to steal ambulances from the North East and the South East. I have become a master at eyelash fluttering and bargaining with other allocators. For example: “I have a really nice little old lady on the floor. She’s been waiting AAAGES! Can I have your Bloomsbury? If you give me your Bloomsbury, you can have my 6am Smithfield!”
I’m getting to know the crews too: the friendly green truck who really will go anywhere and do anything, the world’s most cheerful DSO (manager) and Barney, so called because he likes to have one. And where would we be without the regulars? There’s Harriet, who calls with chest pain but really wants us to tuck her into bed, Derek, the self harmer who wants us to call his mum, Adrian, the nasty lunatic just out of prison who “knows where we live” (we know where he lives too) and currently Horace Halfpenny is hanging around our sector and giving all the crews earache. His 50% burns are all but forgotten.
Another advantage of the East Central desk is that you have a really clear view of the control room TV, so I get to watch Takeshi’s Castle and World’s Most Amazing Videos every night.
I had a novel experience this weekend: allocating on the South East on a Friday night. “South East” is a rather misleading name because the sector actually covers the whole of the West End and related area but doesn’t cover Bromley and Orpington (the far south east point of London) – those are part of the South West. Confused already? Good. It’s fair to say I haven’t had such a busy night since New Year’s Eve. In the space of about four hours, we had: (in approximate chronological order, though to be perfectly honest it is all a bit mixed up in my head now)
* One “man lying unconscious in the road” who actually turned out to have a life threatening head injury. (And about fifty who were just drunk or asleep.)
* One man hit by a fast moving bus. Would only have needed one ambulance if it were not for the two idiot callers who rang in about the incident giving the COMPLETELY WRONG location.
* One massive fight in a nightclub, requiring three ambulances.
* One massive fight in the street, with seven patients, needing two ambulances.
* (At exactly the same time as the last call, about 2 miles away) A shooting with three patients, requiring three ambulances.
* One BBA where the baby had some problems after birth, needing two ambulances and a midwife.
* One man randomly dropping dead in the street, needing two ambulances.
* One man randomly dropping dead in a community hall, needing two ambulances.
* One great big humungous fight on a fight involving forty people. Fortunately, the “patients” did us all a big favour by running away from the scene as soon as the police turned up, meaning we didn’t have to send any ambulances. Which was good, because we didn’t have any left.
* One fight with two people unconscious right at the wrong end of the sector.
* About twenty rubbish little fights.
* Five hundred bazillion million people who had drunk too much and passed out in the road. A lot of these were dealt with by the Booze Bus – an ambulance dedicated to picking up drunk people and ferrying them to hospital, thus freeing up the “real” ambulances for people who are actually ill – who must have the least enviable job in the whole of the service and deserve everyone’s heartfelt thanks for actively volunteering to deal with impolite drunks and pools of vomit.
* A selection of people inconsiderately having medical emergencies like heart attacks and strokes at the worse possible time. Couldn’t they wait until morning, eh?
I asked the other allocator, who regularly works on the South East, if it was like this EVERY weekend.
“No,” he said. “This is a quiet one. Next weekend it’s payday, so it’ll be much busier. It gets like Beirut out there. You can have five calls in Leicester Square, which all sound the same, but not quite, and when you ring them back the callers are too drunk to speak, so you don’t know if you have one patient or five. The only way you can deal with it is to send an ambulance in, wait till it finds someone, then ring everyone back and ask if they have an ambulance there.”
What a nightmare! And I thought Romford on a Friday night was bad!
I start with my new watch on the East Central desk tomorrow.
“25 year old female – Drank a mixture of bleach and aftershave. Caller states he was using it to clean his shirt and patient mistook it for a drink.”
If this wasn’t ridiculous enough, the call was received at 2.30am! Who on earth cleans their shirt with a mixture of bleach and aftershave in the middle of the night? Presumably this was a tall tale designed to cover up a self harm attempt, but really, could they not have come up with something SLIGHTLY more believable? I almost wanted to withhold the ambulance on grounds of Unconvincing Lying!
A couple of weeks ago, the QA (Quality Assurance) man brought round a copy of the new AMPDS (that is, the system call takers use for triage) protocols. It got a hearty thumbs up from just about everyone. AMPDS’s biggest problem is the inclusion of the question “Is s/he breathing normally?” in just about every protocol. If the caller answers no, it tends to decide that the patient has “severe respiratory distress” and churn out a Cat A response. The trouble with this is that if the patient is puffing with pain, or upset and crying, of course their breathing is going to be difficult from normal – but not in a medically relevant way. Yet AMPDS treats someone who is hyperventilating at the pain of their papercut the same as someone with a life threatening asthma attack.
Well, not any more! The infamous “are you breathing normally” question is completely gone from a lot of protocols, and when it IS there, a “yes” only results in an amber response, not a red. The rationale, which I totally agree with, is that if the breathing was that much of a problem, they’d have told us at the beginning of the call!
I can’t wait for this new protocol to come in. It is going to decrease frustration levels in call takers, allocators and ambulances crews no end, and more importantly, we won’t end up having to waste ambulances on rubbish when people who are really sick are still waiting.
Unfortunately, the new protocols weren’t in in time for the delightful young man who called last week to say he had a cotton bud stuck in his ear. Was he breathing normally? Apparently he wasn’t. Category A call. FRU despatched.
The FRU in question called us on the radio.
“Cotton bud in ear?!” he said incredulously. “How on earth is this a category A life threatening emergency? Do you really want me to run on this?”
“It’s the old ‘Are you breathing normally chestnut’,” I said apologetically. “Severe difficulty breathing… from a cotton bud in the ear. Perhaps this guy breaths through his ears? Sorry about this, but I’m going to have to ask you to continue…”
“But…” said the FRU. “I had a cotton bud stuck in my ear this morning! I got it out myself!”
“You should be an expert in the field then!” I said. “Clearly the most appropriate resource for the job!”
“I walked right into that one,” grumbled the FRU good naturedly, and continued on to the call.
Allocators do have some leeway in using their common sense, so, for instance, if there had been another more serious call for the FRU to go to, I would have been able to cancel him from Cotton Bud Man and send him to that. Unfortunately, refusing to send at all is not permitted. Even though the REAL purpose of FRUs is to get to the life threatening calls quicker than an ambulance can, it is sometimes helpful to send them to the “rubbish” calls that have come up as a high priority. That way, the FRU can ring control and tell us that the patient doesn’t have any difficult breathing, and that an ambulance isn’t needed, or that it is needed but not in any great hurry (for example, if the patient had perforated his eardrum with the cotton bud.) If an ambulance arrives straight away, they tend to take the patient to hospital (they are not allowed to refuse) so the patient gets their big white taxi and doesn’t learn their lesson.
You will be pleased to know that our brave FRU managed to deal singlehandedly with the offending cotton bud, and no further resources were required.
When I was promoted to Allocator, I was told there was a chance I’d have to change desks and even teams, but I rather brushed it to the back of my mind, thinking that as there was a vacancy on my current desk (the North East), I’d get to stay there. Well, management seem to have had other ideas, because I was told this week I am moving teams (so a whole new rota, and new colleagues) AND desks (so a whole new area to get to know). It really feels like a whole new job now! I’m going to miss my old deskmates – we had a really good team there and I expect they will fall apart without me to keep them in check, hahaha. But I’m quite looking forward to my new desk too – I’ve worked with my new deskmates before and they all seem really nice. And it’s nice to get to know a new area – I’ve been on the North East for about three years now and I know it inside out.
My new area is the East Central which means I’m covering places like Newham, Docklands, Shoreditch, Islington and the now-dreaded City Airport. It’s quite a small area geographically (so no running ambulances five miles) but very busy. There’s some very poor areas in it, which means a lot of timewasters and low priority calls, and also a lot of bars and clubs, which means fights and stabbings and drama. On the whole I think it’ll be an interesting sector to work on! It also means I’ll be in charge of Tom Reynolds’ ambulance so he’d better be nice to me
The reason most Emergency Medical Dispatchers fear the West Desk is because it contains London Heathrow Airport. And London Heathrow Airport contains the possibility of plane crashes. A plane crash is the ultimate major incident of major incidents which would entail us using all our training – and not just the bits we use every day and know off by heart. Some of the procedures are things we have only learned theoretically, and if the worst happens, we have to remember them and get them right because with something like a plane crash, there’s no room for error or slowness.
Since my promotion to Allocator, I’ve been slightly nervous that I might have to move to the West Desk, so it was therefore ironic that on my last weekend on the North East Desk, there was a plane crash at London City Airport. London City actually comes under the East Central, not my sector, but several of the nearest ambulances and officers came from the North East. The call we’d received from the airport just said “Aircraft Accident” so we had no idea if we were going to be facing hundreds of casualties, hundreds of deaths even. Our hearts were in our mouths as we waited for the report from the first ambulance on scene. Just how awful was it going to be?
“EC60 reporting. We’ve got four casualties, all minor injuries. The plane has skidded whilst taxiing and the passengers had to evacuate by emergency chute, which is what caused the injuries.”
The immediate reaction was a huge PHEW all round. We’d already sent more than enough ambulances to cover the four casualties, so our work was done. There would be no donning of luminous jackets and running out to the Major Incident room, no frantic dispatch of ambulances from all over London, no deaths, no horror, no headlines dominating the news for the next month.
The second reaction was one of anticlimax. This always brings up the question – by feeling a sense of anticlimax, was it that I wanted people to die? Am I a horrible, mercenary gore hunter who wishes tragedy on others to brighten up my shifts? My answer to this is no, of course I’m not. I wish we could somehow rid the world of plane crashes and other disasters and that everyone would die peacefully at home in bed at the age of 90, if they have to die at all. I wish no one would ever get hurt. But they do, and the fact that this plane crash turned out not to be a major disaster does not mean there will be no major disaster today, tomorrow, or next week. Sooner or later, we’ll be sitting there again waiting for that report, and this time, it’ll be worse than we all imagined. And when that day comes, I don’t want to be tucked up in bed or watching it on the news – I want to be at work, dealing with it, using my training, doing something to help. That is, after all, one of the reasons why I do this job.
The ambulance crews were stood down a few hours after this incident and carried on with their everyday work of heart attacks and broken legs. But for one, there was one last job at City Airport. A woman, not involved in the crash, having a panic attack. Well, quite frankly, I don’t blame her!
Another message from the police:
Address: OUTSIDE 45 HIGH ROAD, N28
Diagnosis: PERSON ? FALLEN FROM SCAFFOLDING
Special Instructions: POLICE HELICOPTER HAS IDENTIFIED BODY LYING AT BOTTOM OF SCAFFOLDING
Of course, we sprang into action for that one! The radio operator broadcasted the call, and H609, who were on their way to one of our regulars who’d fallen in his living room yet again, leapt at the opportunity to go to something a bit more exciting. There were no other takers, so I cancelled them from the regular and sent them to the police job. I let HEMS know, and I was just in the process of ringing a manager when…
From: METROPOLITAN POLICE SERVICE
To: LONDON AMBULANCE SERVICE
CANCELLATION. BODY IS ACTUALLY A LARGE PUDDLE.
Hang up on manager. Cancel HEMS. Send H609 back to the regular. You can’t beat a good false alarm…
I can guarantee that the above phrase will ring a bell with pretty much every crew from Tolworth to Chase Farm. And probably many crews from Essex Ambulance Service, South East Coast, possibly even Yorkshire and Scottish Highlands. I wouldn’t even be surprised if some crews from Australia and Timbuktu are nodding knowingly. You see, this is the catchphrase of one of our most prolific regulars. Horace Halfpenny is a homeless, alcoholic gentleman with no affiliation to any particular area. He drifts around London, occasionally stopping off at payphones to call 999. Sometimes he asks a member of the public to call for him. But the problem is always the same. Horace’s bowels are hanging out. I’m led to believe that Horace’s bowels are indeed hanging out – but this is an ongoing problem and not an acute emergency. It has never quite been explained to me quite where they are hanging out from, what happened to cause this affliction or why the problem hasn’t been fixed. What I do know is that Horace has a reputation as an exceedingly impolite person, who has a tendency to swear at ambulance crews and fling his colostomy bag at them. He’s been taken to hospital countless times but nothing ever seems to get fixed and the next day he’s calling us again from the other side of London because his bowels are, once again, hanging out. He has no real need for an ambulance, what he really needs to do is stay put in his care home (he had one, but went AWOL from it, and every crew in London was under instruction to bring him back if they found him) and wait for an operation. The despair is tangible in crew’s voices when they get the call down their MDT – “Bowels hanging out? It’s going to be Horace Halfpenny, isn’t it? I’ll let you know now, we’ll be off the road after this call. Dirty vehicle and uniform. Possible stress break too.” Legend has it that one crew got so fed up with going to Horace that they took him to a hospital fifty miles outside London. He was back in our area within the week.
A few weeks ago, we received a call from the Fire Brigade from a blaze in a council tower block. The report came in from the first paramedic on scene: “We need HEMS – we’ve an adult male with 50% burns. He’s close to cardiac arrest.”
The DSO gave Control a call to let us know what had happened. The patient was still alive, but they weren’t optimistic about his chances. He’d been taken straight to hospital by helicopter – meaning that the priority was to save his life, rather than get him to a burns unit to treat the burns. He also let us know the patient’s name. You’ve probably already guessed it – it was Horace Halfpenny. It turned out that he’d just been housed by the council after years of homelessness. And somehow, he’d managed to set fire to that home.
So in the weeks that followed, the phone booths of London were quiet. There were no more calls to people whose bowels were hanging out. Colostomy bags remained unflung. Ambulances crews everywhere breathed a sad sigh of relief. In Control, we asked around to see if anyone had seen a call transferring Horace to a burns unit. But no one had. Horace must have died. Although no one liked Horace and everyone thought he was a thorough pain in the neck, we did feel sad. Like all our regulars, he was an institution. And how tragic it was that he’d died just as he’d finally got somewhere to live.
Then, last week, we had a call from a phone box.
“My bowels are hanging out!” exclaimed Horace. “AND I’ve got fifty percent burns!”
So, yesterday I left for work an hour early… and arrived an hour early! The tube was running absolutely fine; the only thing that took longer than usual was buying my dinner because half the shops at Waterloo were closed and there were only three tills open at Marks and Spencer.
I got to work just as the “extreme over capacity plan” (which, incidentally, I think should be renamed the “getting rid of rubbish calls” plan and used every single day) was winding down. Apparently, for most of the day, anyone ringing with a non life threatening problem (that is, green and some amber calls) were told they needed to make their own way hospital, unless it was blindingly obvious that they couldn’t, in which case sector were allowed to use their common sense and send an ambulance. CTA (telephone advice) were ringing back all the calls that hadn’t been refused but hadn’t received an ambulance yet either and some of the callers were being referred to NHS Direct, GPs, etc, and some were being upgraded. At the point when I took over, there were a few calls waiting, but everyone I rang back was very understanding about the delays, and we soon cleared them off when the night crews started at 7pm. Even though we took over 5000 calls yesterday (nearly as many as New Year’s Eve), it wasn’t a lot busier than an ordinary busy evening. I was surprised that there were no serious RTAs, but perhaps people had the sense not to drive. There were a lot of people falling over in the road and breaking bones, but considerably less drunks, so it evened out.
Unfortunately at this point the rules went back to normal and there were clearly several callers who hadn’t been watching the “life threatening emergencies only” coverage on the TV because we got the following calls:
* Child fallen in snow, very minor cut on head. Crew arrived, parents wanted them to stitch wound. Crew did not think wound needed stitching and are not able to do it anyway. Crew told parents child would have to go to hospital. Family became abusive and said they didn’t want to go to hospital in this weather and that ambulance crew were useless for not being able to do it at home. Family then said they were going to follow ambulance in their car as they wanted ambulance crew to insist patient was seen immediately in A+E. Ambulance crew said patient would not be seen any quicker if they took him. Family put patient in car and drove off. Ambulance crew and North East Allocator agreed wholeheartedly that they hoped family had a long, cold wait in A+E.
* 20 year old female, suffering from period pains.
* 29 year old male, has a funny lump on his tongue.
* 16 year old male, fainted during snowball fight.
* 32 year old female, spot on back for two days.
Fortunately, none of the last three got an ambulance as CTA were able to point them in a more suitable direction (perhaps a bottle of Clearasil in the case of the last one.) The snow seems to have melted a bit now, so I expect everything will be back to normal all night.
I’m watching the TV before my nightshift tonight. They keep saying “the ambulance service is under severe pressure and will only respond to life threatening calls”. Surely we should only be responding to life threatening calls anyway?
I’ve had the resource centre ring up and ask if I’m going to be able to get in to work tonight. I answered truthfully that I haven’t a clue! I should be okay, because I live near a tube station on an unaffected line, but I won’t know until I try. I think I’ll leave an hour earlier than normal!
Tonight will be… interesting.
Address: PIZZA WORLD TAKEAWAY, 200 HIGH STREET, NE20
Diagnosis: CALLER STATES HE IS THE KING OF ENGLAND AND WISHES TO GO TO PSYCHIATRIC HOSPITAL.
Special Instructions: CALLER WILL WAIT INSIDE PIZZA SHOP AS HAS ORDERED A PIZZA.
From: LONDON AMBULANCE SERVICE
To: METROPOLITAN POLICE SERVICE
Message: PLEASE CAN WE HAVE YOUR ASSISTANCE WITH MALE PSYCHIATRIC PATIENT, POSSIBLY VIOLENT, STATING HE IS KING OF ENGLAND AND WISHING TO BE TRANSPORTED TO PSYCH UNIT.
Message: SORRY, NO POLICE AVAILABLE AT PRESENT. WE ARE ON CHANGEOVER.
Message: NO WORRIES – APPARENTLY PATIENT HAS ORDERED PIZZA WHILE HE WAITS.
Message: NO ANCHOVIES FOR US PLEASE.
Twenty minutes later.
Message: PLEASE CANCEL. PATIENT HAS RUNG BACK STATING PIZZA NOW READY. IS TAKING BUS TO LOCAL HOSPITAL.
Message: WE ARE VERY DISAPPOINTED. OFFICERS WERE HUNGRY AND LOOKING FORWARD TO MEETING KING OF ENGLAND.
My second piece of good news is that this week, I accepted a book deal with Penguin. A book based on Nee Naw is planned for publication in January 2010. At the moment, the format of the book is still being decided, but it’s likely to contain a selection of my favourite posts from the blog with lots of new and exciting previously unseen stories.
Here is the announcement on Book Brunch.
Penguin have bought the UK and Commonwealth rights for the book, for enquiries about other rights, please contact my agent, Isabel White.
As for my real identity, the book is being published under my real name, so it’s time to come out. Most of you already know that Mark Myers is a pseudonym, but what you may not have realised it that I’m not actually a bloke. I am girl and my real name is Suzi Brent.
Needless to say, this week has been something of a whirlwind for me. I’m expecting to wake up any second now and find out I’ve fallen asleep in the middle of a nightshift and dreamed the lot…
Yesterday, after slaving over a hot application form for weeks and passing an assessment despite not knowing the callsign of the CCV at Waterloo (neither did any one else, including several senior managers), I had an interview for an Allocator position, something I have been after for a long, long time. It’s basically what I am doing now, but with more responsibility (and more money!) It’s still in the thick of the action but higher up the career ladder.
It all went reasonably well except for one question. Imagine the easiest, most basic question you could be asked. Something you probably learned on the first day in training school. I will not print this question as management probably do not want their interview questions published, so let’s pretend for the sake of this entry that it was “What noise does an ambulance siren make?”
“Naw Nee” I said.
“Are you sure?” said Mr Important Boss.
“Absolutely certain,” I said. “Naw Nee”.
“Are you sure? Do you want to that a think about that?” he urged.
Aha, I thought, they are trying to catch me out here, they are testing my confidence in my answer. Well, I will not be fooled. It’s NAW NEE.
Of course once they said “No, it’s not, it’s Nee Naw,” I realised what I’d said and that of course it wasn’t Naw Nee and that I’d even answered the very same question correctly in the assessment. I went back to the control room kicking myself and telling everyone who’d listen what a total moron I was.
This afternoon, one of the managers came to the control room and summoned us out one by one like the grim reaper. Some hopeful faces returned crestfallen. Then it was my turn. I was taken to the major incident room and sat down. I grimaced and prepared myself for the bad news.
“Well done, Mark. You have been successful!” he said.
My jaw actually dropped. My face went like Alexandra Burke’s when she won the X Factor.
“Are you sure?” I said.
I cannot remember what happened next so I hope it was not important. The next thing I knew I was back in the control room, sitting at my desk, trying not to jump up and down with excitement, and suddenly there was a call to a person under a train. Oh my god, I thought, I can’t handle this right now. And then. of course, I did. Because I am an allocator now!
At risk of making this sound like an Oscar speech, I would just like to thank everyone on my sector for their support over the last few weeks, their patience in listening to me recite the Visions and Values of the LAS and for not getting me sectioned when I was running around shouting “I’m an idiot” yesterday.
There is EVEN MORE good news to follow, but I will leave that for my next entry as I do not wish to overload you with good news. Let’s just say something very big has happened with this blog, and you’re all about to find out who I really am!
Until this week, it’d been a long time since I’d had a real, full on, this-is-what-we’re-here-for cardiac arrest call. In the last four days, I’ve had three. The worst came early this morning. There was nothing unusual about what had happened – an elderly female had passed away unexpectedly in her sleep and been discovered by her daughter. What was more unusual was the daughter’s reaction – she was utterly hysterical. All I could hear was “dead, dead, dead”.
After discovering – eventually – who was dead and why, I offered the resuscitation instructions. The caller didn’t do them and she didn’t reject them. Instead, she described her mother’s appearance – stiff, freezing cold, mauve. It was like she was telling me this so that *I* would say she was beyond help, so she wouldn’t have to make that call herself. But of course, I couldn’t say that. I ploughed on with the instructions, but as it turned out, the caller bottled it when she felt her mother’s icy skin. She couldn’t go on. She knew her mother was gone. The minutes between this decision and the ambulance arriving were long for both of us. There was nothing left to do or say, no way I could make things better. Usually I would ask for irrelevant details like medical history and postcodes to fill this gap and make the caller feel like she was doing something, but she was too upset so I just tried to calm her down and reassure her that the ambulance was coming – as if the ambulance was going to change the situation somehow.
As I mentioned above, this situation isn’t rare. It’s probably one per call taker per shift and while the callers are, of course, upset, it’s rare to find one who is hysterical like this. The difference, I think, was that this lady did not expect her mother to die. She kept telling me how she’d been fine earlier, she was in good health, she couldn’t be dead! Some people just block out the fact that everyone they love will inevitably die. Of course, I’m the opposite. I know that one day it’ll be me finding the lifeless shell of a loved one. This job gives me a falsely inflated impression of the likelihood of the worst happening. I see people and see what could go wrong. My elderly relatives are heart attacks and strokes waiting to happen. Old age can result in your languishing forgotten in a “don’t care home”, lying for hours in your own excrement until your legs rot away or stumbling around in a dazed state swearing at your family because you don’t even recognise them. I don’t wish that the people I love will never die. I pray they will never break their legs or have strokes or lose their minds. I hope that when they die it will be quick, painless and at the right time.
I told her I was sorry, but was I really? I was sorry she was so distressed. I was sorry for her loss. Was I sorry that her mother had died peacefully and painlessly in her sleep at a good old age? No, I wasn’t. Death is the one thing you can be certain of, and as deaths go, this is about as good as they get.
Call taking the other night, I took a call from one of the rudest, most unpleasant, man I have ever encountered. It went something like this:
Me: Emergency ambulance, what’s -
Him: Are you just going to ask stupid ****ing questions or are you going to send me an ambulance?
Me: Um, I’m going to ask questions and I am going to send you the ambulance. Talking to me will not delay help coming. What’s the problem?
Him: Listen here, you ****. I don’t have time for this. My wife could be dying and you just want to sit here and ask me questions.
Me: We need to ask questions so we can send you the right help. While I am talking to you, someone else is arranging help.
Him: I demand you stop asking me questions and ring the ambulance crew up and tell them to come now.
Me: That isn’t how it works. My job is to get information from you, someone else’s job is to arrange the ambulance. Now please tell me what the problem is.
Him: My wife is 37 weeks pregnant and there is water coming from her ****ing vagina! Oh my god! What more do you want?
Me: The address of the emergency, please.
He gives me the address – in the sort of tone of voice that implied that I should already know, and anyway, never mind the address, just send an ambulance – and I find that he has already called. I read the original ticket, which informs me that this is a green call, to his pregnant wife, whose waters have broken. She is not unwell and is not even in labour. The original call taker has valiantly battled to get those details from him, but he has hung up before telling us his wife’s name and hospital, essential information for any maternity related call. “Very abusive caller”, the call taker has written. Dispatch have sent the police and the ambulance crew are not going anywhere near until the police arrive.
Me: I see you’ve called already. Help has been arranged. Has there been any change in the patient’s condition?
Him: NO! There is WATER coming between her legs! She is dying, I tell you!
Me: Why do you think she is dying? What is wrong?
Him: I told you, you moron! There is WATER coming from between her legs.
Me: Nothing else? She’s not ill or in pain at all?
Him: THERE IS WATER! WHAT MORE DO YOU WANT?
Me: Her name and hospital, please.
Him: You send the ambulance and I will tell them!
Me: It doesn’t work like that. The ambulance crew need to know where they are taking the patient to, and if there is a problem we need to contact her midwife, and the midwife will need to know who she is.
Him: So what, the midwife will get in her car and come over??!! (He says this as if I have suggested something utterly ridiculous).
Me: Yes, exactly.
Him: So have you rung the ****ing midwife yet???
Me: No – we will ring the midwife if there is a problem. From the information you have given me, there isn’t a problem. Your wife’s waters appear to have broken, which is a normal thing that happens before a woman gives birth. When the ambulance crew arrive, they will check her over, and if there is a problem, then they will contact a midwife.
Him: Oh lord! I don’t know what I have to do to get an ambulance from you!
There were so many answers I could have given to this last question, none of which would have been compliant with London Ambulance Service protocol, but fortunately I didn’t have time to say anything before he hung up.
I think it was not so much his rudeness that annoyed me – rude callers are ten a penny in this job – but the fact that despite having a heavily pregnant wife, he totally failed to realise that there was absolutely nothing wrong with his wife and that waters are supposed to break when you are about to have a baby! If he didn’t know this fundamental fact about childbirth, one wonders how much he knows about looking after an actual baby. I can’t help wishing that idiots like this weren’t contributing to the gene pool!
Tragedies are common in this job. Ambulances aren’t supposed to go to happy events. But usually, in every call, there’s a glimmer of hope, a small positive that we can take home from the situation. Occasionally, this is not so. Occasionally a job is just horror from beginning to end and makes you shudder and feel cold inside.
To begin with, there was no indication that the call was anything out of the ordinary. A few days before Christmas, a thirty-nine year old female, in labour. Waters broken. Baby due on Christmas day. How sweet. Sixteen year old daughter making the call. Panicking a bit. As we sent the ambulance, we rolled our eyes and made the usual comments about maternataxis and how after sixteen years as a mother one should know how to get to hospital by taxi and…
The ticket updated to indicate that the pregnant woman was having a fit. Okay, we ate our words and realised this was a medical emergency. We made sure the crew knew that – although of course that wouldn’t make them drive there any faster, would it? An emergency call is an emergency call!
Just as the ambulance was pulling up, the ticket updated again. It now read as follows:
“39YOF IN LABOUR, WATERS BROKEN. EDD 25/12/09. NOW ? FITTING NOW ? CARDIAC ARREST”
We weren’t sure what was going on and there was a suspicion amongst us that the teenage daughter was either giving the wrong answers to questions as a result of panicking or a language barrier, or, as sometimes happens, she was deliberately making the situation sound worse than it was to get an ambulance quicker. After all, it’s quite a leap from being in labour to being dead, and the two states are not easily confused. While we naturally have these thoughts, we never act on them. Never doubt the integrity of the caller, as they taught us in training school. A second ambulance was sent to assist straight away.
Half an hour later, the blue call came. “It’s H702, blue to hospital, with a 39 year old female, full term pregnancy, in cardiac arrest. We’ll be five minutes.”
So it WAS as given. The desk went very quiet, wondering what on earth had happened.
An hour or so later, we spoke to the crew, who were having a cure-all cup of tea back at station.
“They delivered the baby by emergency caesarian,” one of them told us, “but he was already dead. They managed to get an output from the mother, but as they were taking her up to Intensive Care, she arrested again, and this time they couldn’t get her back.”
“How awful,” I said. “What happened?”
I thought he’d say that she’d suffered from eclampsia or a pulmonary embolism, something big and deadly that no one could have prevented.
“She choked,” said H702. “On a chicken bone. She was in early labour and she was having something to eat with her kids before she went to hospital. As she ate, she collapsed. Her daughter who made the call didn’t realise what was wrong. We only found out as we tried to intubate her. There it was, blocking her airway. We got it out, but by that time, she’d already been down too long.”
So that was it. Something as simple as a chicken bone had ended two lives, robbed a family of their mother and the baby brother due to be born on Christmas Day. Instead of welcoming the new arrival, they’d be planning a double funeral. It’s calls like this that make you appreciate the fragility of life and the knife edge that we all live upon.
After complaining in my last post about the numerous calls we get to “man lying in the road”, what did I happen to find on my way to work yesterday? Yes, that’s right, a man lying in the road. Flat on his face, outside the tube station, in a pool of what looked like urine, a man in his 40s wearing ordinary clothes and carrying a rucksack full of books.
I pretended I was in some kind of first aid training exercise and did the whole routine. Check for danger (no knife wielding maniacs or runaway steamrollers in vicinity… good), check for response (unlike in any first aid exercise I have ever done, the response was “mnurgh”, whatever question I asked or instruction I gave), do secondary survey to determine if patient has anything horrible like a broken leg or a medical bracelet on (nothing apparent).
A gaggle of bystanders appeared, apparently encouraged by the fact I’d started prodding the patient. I was very glad that I was wearing a long coat which concealed my greens, otherwise they might have had me down as a competent professional or something.
“What shall we do?” said one passerby. “Is he drunk or is he sick?”
“WHAT’S WRONG?” I asked.
“DO YOU NEED AN AMBULANCE?”
“DO YOU WANT US TO CALL SOMEONE?”
I knew there was a good chance of the patient just being drunk, although I couldn’t smell any alcohol on him, and thought that maybe he’d had a fit or a diabetic problem or something horrible like that, and anyway, as the other passerby said, even if he was just drunk, we couldn’t just leave him there because he would freeze to death, and as he wasn’t able to speak except for “mnurgh” we weren’t going to have any luck getting a friend or relative to come and look after him either.
So very reluctantly, I pulled out my mobile and became that person who calls 999 for the “man lying in the road”. This felt like a training exercise too, and I could have parroted off exactly what the call taker said to me. I was tempted to add, “and by the way, this is Mark Myers from the North East Desk. I am due in at 7pm so if you make this one a priority I won’t be late!” but I didn’t. I didn’t say who I was at all because in my experience there is nothing worse than taking a 999 call from a fellow professional and reeling off instructions that you already know they know, but you have to say because you will get marked down otherwise. It makes you feel like a right tit.
I spent the next five minutes monitoring the patient like I tell callers to do every day. It felt rather odd being on the other side of the fence and I must have done too many first aid scenarios with St John because I was totally convinced he was going to stop breathing or have a fit or something dramatic, which of course he didn’t.
NEE NAW NEE NAW! The FRU came steaming along the road (beating ORCON by three minutes, I was pleased to note. There I was, bolstering the North East’s stats before I was even in work). Of course, those blue lights and nee naw sirens worked a miracle that my repeated efforts had failed to. My patient raised his head and made an abortive attempt to get up.
“He was completely out of it when we got here!” I said apologetically, imagining the FRU paramedic with a little thought bubble coming out of his head saying “Oh great, another pisshead. Nothing wrong with him at all. Call this a Cat A?” I rearranged my coat, praying he wouldn’t see that beneath it, I was wearing an LAS uniform just like his.
“What’s your name?” said FRU Paramedic to the patient.
“My name is Sergei. I am Russian!” said the patient and then fell over again.
“Well, thanks for your help!” said the FRU Paramedic to us, and that was my cue to leave. I shuffled off to work feeling very sheepish, but you will be glad to know that due to the fast response of the North East desk and Mr FRU Paramedic, I was not even late for work and got there about the same time as Sergei got to the local hospital. I never did find out whether he was just drunk or if there was anything really wrong with him. At least I know that when faced with a “man lying in the road” I do not turn into one of those people who call 999 from a hundred yards away, shout at the call taker, then go on my merry way leaving the patient either to die or recover and walk off so the ambulance crew have to spend an hour searching for him.