The Complete Blood, Sweat and Tea

Sirens
Tom Reynolds

This book is dedicated to my mum and my brother, who have tolerated me with astonishing patience and love for almost forty years. It is also dedicated to all my work colleagues in the London Ambulance Service who do their best for the people who call them under some very difficult situations.

Finally to anyone and everyone who works for any of the emergency services – those people who bring calm to chaos, peace to despair and aid to the injured and frightened while working under incredible pressure and yet who rarely get the thanks that they deserve.

Contents

Prologue: Too Young

Part 1

Part 2

End Credits

Acknowledgements

About the Author

Copyright

About the Publisher

Sirens is not authorized or endorsed by the London Ambulance Service. The opinions expressed in this book are those of the author alone and do not necessarily reflect those of the London Ambulance Service.

There are a number of terms found in this book that may be unfamiliar; for the assistance of the non-medical reader there is a short glossary at the back.

In the interests of confidentiality patients have been made anonymous and identifying characteristics may have been altered or removed.

Read more at http://randomreality.blogware.com

Prologue: Too Young

Yesterday started well, we had the only new ‘yellow’ vehicle on the complex, and it really is an improvement on the old motors. But then we got a job that should have been routine, but unfortunately was not.

We were given a ‘34-year-old male, seizure’ at a nearby football pitch in the middle of a park. Also leaving from our station was the FRU (a fast car designed to get to a scene before the ambulance). As we had a new motor, we were able to keep up with the FRU.

Arriving at the top of the street, we were met and directed by some of the patient’s football team-mates. Unfortunately, the patient was 200 yards into the park, and there was no way we were going to get the ambulance onto the field – the council had built a little moat around the park to stop joyriders tearing up the grass in their stolen cars.

The FRU paramedic had reached the patient first and I ran across the field to get to the patient as the paramedic looked worried, and this isn’t someone who normally worries.

As I reached the patient, carrying the scoop which we would use to move him, the paramedic asked me if I thought the patient was breathing.

The patient was Nigerian, and it is not racist to say that sometimes detecting signs of life on a black person is harder than if the patient is Caucasian. White people tend to look dead; black people often just look unconscious. Also, a windy playing field at dusk is not the ideal circumstance to assess a patient.

‘He’s not breathing,’ I told the paramedic, just as my crewmate reached us. ‘Shit’ replied the paramedic, ‘I left the FR2^* in my car’.

I had to run 200 yards back to our ambulance to get this, now vital, piece of kit.

On my return my colleagues had started to ‘bag’ the patient (this means using equipment to ‘breathe for’ the patient and performing cardiopulmonary resuscitation, or CPR), which is the procedure to keep blood flowing around the body in the absence of a pulse. Attaching the defib pads I saw that the patient was in ‘fine VF’ (ventricular fibrillation) – this is a heart rhythm which means the heart is ‘quivering’ rather than pumping blood around the body to the brain and other vital organs. Technically, the patient is dead and without immediate treatment, they will remain dead.

We ‘shocked’ the patient once and his heart rhythm changed. It changed to asystole (this means that the heart is not moving at all, and it is much more difficult to restore life to the patient with this form of rhythm). We decided to ‘scoop and run’ to the nearest hospital. The paramedic secured the patient’s airway by passing a tube down the windpipe, and we got the patient onto the scoop, all the time continuing the CPR and giving potentially lifesaving drugs. We then carried him, with the help of his team-mates, to the ambulance and rushed him to hospital.

Unfortunately, the patient never regained consciousness, and died in the resuscitation room.

Thirty-four years old, normally fit and healthy – and he drops dead on a football pitch. Despite our best efforts there was nothing more we could have done for him; the treatment went according to plan and the resuscitation attempt went smoothly. This was a ‘proper’ job, but one job we would have happily done without.

PART 1

Why Won’t They Let Me Do This?

Here is a moan about something that I am not allowed to do. I’m not allowed to run people over in my job. I could really clear the streets of a lot of stupid people if I was able to do that.

Picture the scene: there I am, driving through the streets of London in a big white van, with blue flashing lights, loud sirens running and the word Ambulance written in rather large letters. As a pedestrian, what would you do? Would you think ‘Hmm, being run over by that would really hurt, I think I’ll wait the 12 nanoseconds that it takes him to drive past before I cross the road’. Or would you, as most of the people in my area apparently do, think ‘Hmm, an ambulance on his way to an important job, I bet I can run across the road in front of him before he can hit me’.

During the last job, three people tried to dive under my ambulance. If I was allowed (by government grant or some such) to keep driving and splat them across my windscreen, that would mean three less idiots being allowed to breed tonight.

Oh well, I might get lucky later tonight.

Dear Mr Alcoholic

… Can all alcoholics please just get drunk in their houses and fall asleep there? Why do you insist that you drink your Tennent’s Super in a public place where some do-gooder will think you are ill and call for an ambulance?

… Can you also have a bath once in a while? I know it’s nice to roll around in the road while drunk, but it would be nice if you were at least a bit clean to start with.

… Would you mind awfully not swearing at me, taking a swing at me or exposing yourself to me? I have quite enough abuse from the non-drunks out there … Still at least your fists are easy to dodge, and if I stop holding you up, you fall over.

… If you have a medical condition, please don’t use it as an excuse to get taken into hospital. If you tell me ‘I’m drunk and need to sleep it off’, I have less work to do than if you tell me that you have ‘Chest pain, Angina, Cancer and Difficulty in Breathing’. The more tests I have to do the longer it will be before you get to hospital, and the more I have to come into physical contact with you. If you are just drunk, then I can just be a taxi.

… When you have been sick, at some point in the next week or so could you please change your clothing? Give them to someone who hasn’t knackered their brain on booze to wash. Dry vomit on the clothing, while advertising your love for beer, doesn’t endear you to me thankyouverymuch.

… Please keep your weight down either through diet or through terminal liver failure. I’m the poor bastard that has to lug the dead weight of your unconscious body into the ambulance.

… You don’t have to tell me ‘I’m an alcoholic’, and sound so proud about it. I do have a nose, and can smell for myself.

… Finally, although Tennent’s Super Strong lager, White Lightning, and for the rare rich alcoholic Stella Artois are perfectly acceptable drinks, could you please come up with something less damaging? I think lighter fuel is better for you and contains fewer chemicals.

A Child is Born …

The story of the first baby I delivered – I can still remember it now. I can also remember my feeling of relief when it all went smoothly. Yet still managed to turn it into a rant about midwifery.

Just in from my late-shift and feeling more upbeat than normal. Tonight I delivered my first baby … and yet I can still turn this happy event into a rant.

Picture the scene: you are a midwife (this means you have a chip on your shoulder the size of the African debt), and a lady comes in to your maternity department in the second stage of labour. Do you …

(a) Say hello, take a room and we’ll have that baby out as soon as we can,

or …

(b) Tell them to go home and come back when the pain gets worse.

Guess which answer results in your baby being delivered by an ambulance bloke who has 1 day’s training in maternity (and who, to be honest, slept through most of it)?

Then when I take mother and baby into the same maternity department are you …

(a) Vaguely apologetic, or …

(b) Snotty towards the ambulance crew who did your work for you?

Can you guess that tonight I got (b) for both questions?

Otherwise it was a nice simple delivery, with dad shooting pictures on his mobile phone sending them to all and sundry while his wife was lying, bloodstained and naked on a leather sofa. Blood went all over that sofa, which come summer will start to smell just a little rank. Blood also went all over me (note to self – must remember to pack Wellington boots next time) and my acting skills (‘Don’t worry mum, all normal, I’ve done hundreds of deliveries’) were tested to the limit.

… and I didn’t have to pick up any alcoholics.

Why Would People Even Think It?

I have sometimes been astounded by the bloodymindedness of people, and sometimes by their stupidity. Now I am astonished at their petty nastiness.

I’m driving my ‘big-white-van-with-blue-flashing-lights-and-a-siren’ to a 1-year-old child with difficulty in breathing. While passing a group of youths on the pavement, one of them thinks that it would be a good idea to throw his bottle of coke at the ambulance, thus spraying my screen, obscuring my vision and nearly causing me to swerve into oncoming traffic.

All I can say is that it is lucky for them that I was going to a call, because if I hadn’t I’d have shoved my boot up their arse.

Where in the tiny recesses of their minds does it seem like a good idea to throw something at an ambulance running on lights and sirens?

All I hope is that one day they need me – something likely, given the amount of people like that who get stabbed in my neck of the woods – and I’m just that little too slow to save their worthless skins.

Payment Point

I get called to a lot of RTAs (that is, for the uninformed, ‘Road Traffic Accident’). I’d say that 90% of these are diagnosed as ‘whiplash’ (which is a muscular sprain of the neck – this is a minor injury that is treated with painkillers); I’d suggest that over half of these are an attempt to gain insurance money. In the ambulance trade we call this the ‘Payment Point’, referring to the point in the neck that is painful, and pays out the money.

Tonight I saw the most blatant attempt to get money from an ‘accident’.

I was called to a flyover where two cars had been in a near collision, yes, a near collision. There was no damage to either vehicle, neither were there any skidmarks on the road. The ‘patient’ was the passenger of the car, and complained of pain on the right side of his neck. He was desperate to go to hospital, for what reason I did not know, as there was obviously no injury.

This was made even more evident when he forgot what side of his neck the pain was on. When I called him on this he pretended not to know what I was talking about.

Even the police were not above making fun of this idiot.

It probably didn’t help that he was 10 years younger than me and cruising around in a red sports car.

Of course RTA is now RTC (Road Traffic Collision), because if it’s an ‘accident’ then the police can’t prosecute anyone.

Single

Although I do love my job dearly, there are a number of disadvantages. At the moment I am a ‘relief’ worker, which means although I have a main station, I can be sent anywhere in London to cover absences and holidays in the ‘Core’ staff. I also don’t have a regular crewmate … I am essentially the whore of the London Ambulance Service.

So, at the moment I am sitting on my backside at my main station with no-one to work with, watching daytime TV.

Bored, Bored, Bored, Bored …

Of course, at some point in the next 12 hours I could be rushing off anywhere in London. Being on strange stations is actually quite good fun, as you get to meet new people and, let’s face it, in this job moving around London just means ‘same shit, different scenery’.

… But at the moment I’m bored …

Daytime TV, the ambulance relief’s worst enemy. Thankfully I’m no longer a relief – I’m ‘Core’ staff now, which means I have a regular partner and I work mainly out of one station.

Some People Just Can’t Wait

So, there I am in my ambulance helping a bloke who was actually quite ill, when all of a sudden the back doors fly open and some idiot decides to start berating me because I’m blocking the road. Needless to say I am not pleased at this, not only because it is embarrassing for the patient, but also because of the sheer bloody cheek of this person. When I tell her (very politely mind you) to bugger off, she replies with the old favourite ‘I’m a taxpayer and I pay your wages’. At this I remind her that my patient, my crewmate and I also pay taxes. At this she is a bit nonplussed, yet still she continues to moan that there is no need for me to block the road.

In any event, I did need to block the road, I don’t do it on purpose, but it is more important to get to the patient quickly.

This woman’s moaning then gets other drivers upset and they start honking their horns, and the only way I get rid of the woman who was in such a hurry was to pull the door shut after me and tell her to imagine her relative in the ambulance …

I didn’t hurry treating the patient either.

The same thing has happened on more than one occasion. Now I simply ask the complainer that if it was them rolling around in agony, would they like to have to wait while I find a better place to park?

Maybe it’s Because I’m a Londoner

Research carried out by the London Ambulance Service for our ‘No Send’ policy has shown that 59% of Londoners think that they will get seen quicker in A&E (Accident and Emergency department) if they arrive in an ambulance.

This … Is … Not … True …

In fact, if you come to A&E after calling an ambulance for something minor, the nursing staff will be more inclined to send you out to the waiting room and forget about you.

I was an A&E nurse for a long time – just trust me on this …

Also, Londoners call for three times the number of ambulances for ’flu than in any other English city. Half the time the patient has got a cold and not ’flu at all, and just needs to work it out of their system. Even if they did have ’flu, there is little the hospital could do for them anyway.

Coupled with high population densities, lack of staff and vehicles, speed-bumps everywhere and heavy traffic, is it any wonder we are having trouble hitting the 8-minute deadline we have to make 75% of calls in?

Nice New Motors

The London Ambulance Service is giving us poor ambulance staff shiny new ambos to drive … well, puke yellow rather than shiny … but they are new. These are Mercedes Sprinters outfitted in ‘EURO RAL 1016 Yellow’ which is apparently the most striking colour available and is used throughout the European Union. They have lots of nice new bits for us to play with. Most importantly, they have a tail lift so now we don’t need to break our backs lifting some 20-stone lump into the back of the motor (20 stone is 127 kilograms for those using ‘new money’).

I was asked by a friend what I thought of them, and having just finished my ‘Familiarisation Course’ (4 hours of playing with the new toy) I must say I do like it. Not only is the engine more responsive when moving off, but the brakes also work that bit better than our old LDVs (Leyland Daf vans) and the interior is much more professional looking.

The only real problem I foresee is that the tail lift needs around 4 yards to unload the trolley and around London this means that we will have to park in the middle of the road, blocking off other traffic. So, if you do see one of us blocking your way, please realise that there is no way we can park the things and be sure of being able to load a patient on board as well.

These things also cost £105 000 each and if we get the slightest scratch on them they have to be taken off the road and repaired (unlike the ones we have at the moment where they are beaten up until they stop working). Since our insurance has a £5 000 excess it’ll mean a lot more money going to vehicle maintenance.

Should be fun, but I can’t see management ever letting me drive one … I estimate if I can squeeze through gaps by driving until I hear the crunch …

While I thought that parking to allow the tail lifts space would be a big problem, our biggest problem would turn out to be the regular breaking down of the lifts.

My (So-Called) Exciting Life

I had my hair cut today, which has become a weighty decision in my mind. It goes something like this …

(a) Do I get a crop or not? If I get a crop I’ll look like I’ve just been released from a concentration camp; if I don’t then I’ll look like a paedophile.

(b) Will my mum like it? If not then I’ll have to put up with 3 weeks’ worth of moaning about how terrible I look.

(c) Will this cut enhance my ability to attract members of the opposite sex? To be honest, no haircut has ever done this but I live in hope.

(d) If I go to my local hairdressers will I get the trainee … and if I do will it be possible to get a refund?

Anyway, I went in and got a ‘short-back-and-sides’ and rather unfortunately I’m deaf as a post when I’m not wearing my glasses (for those who have 20/20 vision, you don’t wear your glasses when getting a haircut). So when the whole place erupted in fits of laughter I didn’t know if it was because of a rapidly growing bald-spot.

(Still while I can’t see it, it doesn’t exist.)

The best I can say is that I’m not having to brush my hair out of my eyes with a pair of gloves covered in someone else’s vomit.

Which is nice …

Bloody Cat …

I’m sitting here single on station (you need two people to man an ambulance, and if you haven’t got anyone to work with you are ‘single’ and therefore unable to work. However, you need to stay on station in case they find someone else in London who is single. In that case you find yourself trekking across London to work in a place you’ve only seen on telly). I’m hungry and bored, partly because it’s night-time, and partly because there is no-one else on station.

However I have a plan …

To counter the boredom I have a DVD I can watch on the station’s new DVD player (bought out of staff funds, so no we haven’t been defrauding the NHS). The hunger problem will soon be solved by the microwave curry I have sitting in my car.

Let us now introduce a new member into the cast: when I said I was alone that was a bit of a lie, there is the station cat. Well at least I think it’s a cat as it is so threadbare it could be anything. This cat is so stupid it lies in front of your ambulance just when you need it the most, and refuses to move until you physically have to kick lift it gently out of the way. However, it is intelligent enough to realise that when someone is using the microwave there will be an opportunity to beg for food 5 minutes later (13 minutes if the food is frozen).

I nearly fell over the damn thing stepping away from the microwave, only to spend the next 10 minutes discussing with a mouth full of chicken korma why it wouldn’t like to jump up on my lap and make off with my dinner. It went a little something like this …

Miaow.

‘No you can’t have any.’

Miaow.

‘You wouldn’t like it.’

Miaow.

‘Go eat your own dinner.’

Miaow.

Gets up, plate in hand, to check that the cat does indeed have food/water/toy mouse.

Miaow.

‘Will you bugger off!’

Miaow.

At this point I put the plate (still with some of my food on it) on the floor, which the mangy beast sniffs and turns his nose up at. Said ‘cat’ then goes and hides under a table.

Horrible bloody creature.

It’s now dead; there is only one person on station who misses the bloody thing.

Why This Is a Good Job

My crewmate and I went to a man having a fit on Christmas day; he was a security guard and built like a brick out-house. This fit wasn’t your ‘normal’ epileptic fit, but instead the man was punchy and aggressive. To say it was a struggle to get him on the back of the ambulance is to say that Paris Hilton may have appeared in an Internet video download. Cutting a long story short, the patient is diabetic and his blood sugar has dropped to a dangerously low level. Luckily, we carry an injection to reverse this, and after wrestling with him in order to give him this drug he made a full recovery before we even reached the hospital. This is a nice job because we actually helped someone rather than just drove them to hospital.

Other benefits of the job include (but are not limited to …)

Working outside in the fresh air. I don’t know how office workers put up with air conditioning.

For much of the time you are your own boss – do not underestimate this.

Driving on the wrong side of the road with blue lights and sirens going; it’s not about the speed it’s about the power.

Being able to poke around people’s houses and feel superior even though you haven’t done the washing up in your own house for 2 days.

No matter how annoying the patient is, knowing that within 20 minutes it’ll be the hospital’s problem.

Meeting lots of lovely nurses, and knowing that I get paid more than them.

On the rare occasion, being able to help people who are scared or in pain.

Every time I have a bad day, or feel fed up at work I think back to this list and soon start to feel better – although I no longer get paid more than the nurses I meet.

Death and What Follows

There are some people, who despite being lovely people, you dread working with; one such person is Nobby (not his real name). He is what is known in the trade as a ‘trauma magnet’. He’s one of those people who will get the cardiac arrests, car crashes, shootings and stabbings; by contrast I am a ‘shit magnet’, meaning I only seem to pick up people who don’t need an ambulance. Other than having to do some real work for a change I really enjoy working with him.

I was working with him a little time ago and we got called to a suspended (basically this is someone whose heart isn’t beating and they have stopped breathing). It’s one of those jobs that require us to work hard trying to save the punter’s life. We got to the address and found relatives performing CPR on their granny. You might have seen it on TV as a ‘Cardiac Arrest’.

(Let me correct a few ideas you might have about resuscitation. First, it rarely works; ‘Casualty’ and ‘ER’ have led people to believe that you often save people: I can count on the fingers of one hand the number of people who have survived an arrest and most of them arrested while I was watching them in hospital. Second, it isn’t pretty: when someone arrests there is often vomit, faeces, urine and blood covering them and the area around them. Finally, people never suspend where you can reach them: if there is an awkward hole, or they can find some way to collapse under a wardrobe they will do so.)

This poor woman was covered in body fluids and was properly dead; there was no way we were going to save her. One of our protocols says that we can recognise someone as beyond hope and not even commence a resuscitation attempt. Unfortunately, we couldn’t do it this time as the relatives had been doing CPR (which is the right thing to do) and so we had to make an attempt.

Nobby and I got to work and tried to resuscitate the patient for 30 minutes. Our protocol goes on to say that if we are unsuccessful after attempting a resuscitation for ‘a specified time’ we can end it and recognise death, which is what we did.

However, during our resuscitation attempt it seemed that the entire extended family had arrived and there were well over 20 people in this little terraced house with much wailing and gnashing of teeth. It’s always hard to tell someone that their mother has died, but it has to be done, and if you can manage it well you can answer some of their questions and hopefully provide some healing for them.

The GP (general practitioner) was informed, as were the police (a formality in sudden deaths). The family had called a priest and he was there before the police arrived, while the GP was going to ‘phone the family’; what he expected to be able to do over the phone puzzled me.

We tidied up and went onto another job.

Two weeks later, Nobby was called to a chest pain. He turns up and finds himself in the middle of a wake, surrounded by 20 familiar-looking people.

Can you guess who the wake was for? Its a funny old world …

I worked with Nobby again for the first time in 2 years. He still remembered the job, and what happened after it. I told Nobby that he’d be included in this book but he wasn’t happy with his pseudonym and told me that he would prefer to be referred to as ‘George Clooney’. I refused.

I Do Like Some Drivers …

Although I often moan about the idiocy of other people’s driving when faced with a big white van with blue flashing lights on top, I am sometimes pleasantly surprised at the lengths some people will go to in order to get out of the way. For example, yesterday we had people nearly grounding their cars on roundabouts and roadside verges, squeezing into parking spots I wouldn’t be able to fit a Mini Cooper in and swearing at other drivers who wouldn’t move out of the way. I’ve had workmen stand in the middle of the road and stop traffic, lollipop ladies fence off crossings with their ‘lollipops’, and van drivers who I have clipped while squeezing past them wave me on and tell me, ‘don’t worry about a little damage’.

Yesterday we had all the above on one call (except hitting a van driver), it was like the Red Sea parting before us. It was a beautiful thing to behold; it left us in awe and wonder.

Shame we were going to 2-year-old with a cough.

This is a rare occurrence.

The Dangers of Prostitution

Occasionally you get a job that makes you laugh, normally because the person you are picking up is an idiot. We got called to a chip shop in one of the main roads in Newham – unfortunately there are about 20 chip shops on this road, but we managed to narrow it down by looking for the shiny white police car parked outside. The call had been given as an ‘assault’ which can mean anything from a slap on the face to a fatal stabbing.

In this instance it was a young lad, the spitting image of ‘Ali G’, who was complaining that he had been hit on the nose; needless to say there wasn’t a mark on him, and it turned out that he had been hit by his girlfriend. The police wanted to take statements, but he wasn’t interested and when I tried to assess him he told me that the ambulance wasn’t needed as ‘I’m St Johns innit, and a security guard’. This fella couldn’t scare a toddler, so I suspected he was telling a little bit of a lie. As he wasn’t hurt and ‘refused aid’ my crewmate and I retreated to a safe distance to do our paperwork …

In the course of the night we found ourselves at the local hospital (dropping off yet another ill person) when who should walk in with another crew from my station, but our earlier ‘Ali G’ lookalike. I asked him why he decided to call an ambulance when he’d already sent us packing and it turned out that another woman had hit him … the prostitute he’d hired after his girlfriend had slapped him. Turns out she had hit him and then robbed him of his jewellery. He couldn’t have put up much of a fight because he only had one scratch on him.

It’s pillocks like these we have to put up with … and call ‘sir’ …

However, it is also jobs like this that we can use to have a good laugh with our workmates. So people like him do serve some purpose.

My Night Shift

Much fun and games last night, working in the Poplar/Bow area. Not only did some German bloke graffiti on the back of one of the ambulances, but he also called the crew from a payphone and ran off, repeating it twice.

There are a lot of strange people out there …

MacMedic (an American ambulance blog) gave a rundown of what his shifts are like, so I thought I’d do the same, in honour of our brothers in foreign climes.

All these people called an ambulance last night by dialling ‘999’.

(a) Fractured wrist – young lad at the Boat Show.

(b) An alcoholic ‘frequent flyer’ who has just been released from prison … We thought we’d got rid of him for good.

(c) A 15-year-old with a runny nose.

(d) Very minor RTA.

(e) Domestic Assault, with no actual injury, but police already on scene.

(f) ‘Facial Injury’ which turned out to mean ‘Some bloke kicked my door.’

(g) Assault with a cut hand – actually a decent injury with tendon involvement (which means surgery and physiotherapy).