Jul 12 2012

Whiter than white.

Every year we spend an evening cutting loose, letting our hair down (which is sometimes tricky, when the best haircut for this environment is a half-all-over) and kicking it to some crazy beats.

 

Wednesday night. The fancy dress party. This year's theme?

 

The 80s.

I was born in 1981, so I was kinda tempted to turn up wearing a pair of Osh-Kosh dungarees and eating a Wham bar while inviting people to debate whether Panthra was cooler than Lion-O.

 

Clearly, Panthra, obviously.

But no, instead I did my normal trick of walking into the awesome costume shop near the university in Edinburgh and saying “80's themed party, Need a costume. Less than £40.”

 

The lovely woman behind the counter rummaged around before coming up with satin bloom pants, a shoulder padded jacket, dollar sign medallion and oversized shades.

 

“Wanna be Vanilla Ice?”

 

 

Well…clearly.

 

Come the Wednesday evening, though, my claims to being Vanilla Ice were quickly shot down by everyone walking up to me and saying “Ooooh! MC Hammer.” respect went to Ed, though, who'd spent several days before the event painting squares onto a cardboard packing crate in a Rubiks pattern, then wrapping said crate in brown paper, packing his gear into it and using it at his luggage.

 

His. Luggage.

 

I hate clever people.

 

The evening ran on as it typically does, beer flowed, the music struggled to be heard over the associated hubbub (every year we bring shit speakers, every year they don't work), the police officers stationed at the event sat and glowered at our haram dancing, drinking and canoodling and I was just about to turn into my bunk for my 0430 start the next day (sweep duty after the party…yeuch) when we were all gathered into a huddle by the Clerk of the Course.

“I feel it's only right that we recognise the fantastic work that the SAR/MED crew do, and as such this year we've brought along some prizes to thank you for your excellent outfit efforts.”

 

He worked his way through a number of themes, you know the sort of thing, best male, best female, best dressed, most imaginative deployment of hot pants. People were ushered up to the front where they shook the Clerk's hand and received their prize, a box from a Variety pack of breakfast cereal.

 

“And now we have the glittering grand prize, the prize that will be issued to Mr or Mrs 80s. It's….a box of Coco Pops.”

 

The crowd dutifully oohed.

 

“And the Coco Pops go to…..MC Hammer!”

 

Slaps on my back, cheers around me. I'm trying to tell them “But I'm Vanilla Ice!” when a hand pushes me to the front of the crowd.

 

Fuck it, I'm MC Hammer.

 

 


Jan 07 2012

And so this is Christmas.

I’ve hammered down the road, fast as I dare trust the tires on wet Christmas roads. Control rousing me from a much needed doze with the words I didn’t need to hear.

“Topcat job for you…”

Edinburgh’s Topcat paramedics are a small team who are despatched to cardiac arrests with the sole purpose of managing the scene. We try to ensure high standards of resuscitation and assist crews with decision making, leaving them free to concentrate on the hands-on clinical role.

I shove through the front door and am pointed into a back room by a young, blasé looking woman.

“Twenty eight, twenty nine, thirty. Breathe.”

The patient’s chest flexes and a long, farty exhalation bubbles up out of her throat. The paramedic at the head swears under her breath and readjusts the tube poking out the slack mouth.

“I fucking hate LMAs…”

They tell you that a Laryngeal Mask Airway is the ultimate “fire and forget” for a cardiac arrest, just stuff the tube blindly down the throat and know it’ll end up ventilating the lungs. I’m yet to find a para that likes them, raised as we are on only trusting an airway that you’ve *seen* enter the trachea.

“You need a spot?”

The Community First Responder nods, a ox-bow of sweat spreading across his chest. He was here before us, turning out, unpaid, in the middle of the night when most others in the town have been enjoying the festive festivities.

I step over the patient and bend double from the waist, counting the responder down and taking over the CPR as he straightens up. It’s not the best angle to do compressions from, but it works in a pinch and reduces the time off-chest to an absolute minimum. I press and pound, looking left to right. The para at the head catches my eye and smirks, thinking the same as me.

She calls to her partner, a new technician.

“Are you planning on taking over CPR from Kal at any point? That’s not a comfortable position to work from.”

There’s a wee surprised “oh…right…” and she kneels down alongside us. I regain my feet.

“So what’s the story?”

“Found….about twenty minutes ago now. Asystolic so far.”

“Bystander CPR?”

“Not when we got here.”

Shit. Her chances aren’t good, but…

“She’s *young*, Kal.”

I nod. She is. Barely older than me.

“Ok. So here’s the plan. We stay on the chest, we push adrenaline on time and we rhythm check every two minutes. We concentrate on compression depth and hold out for a reversible rhythm.”

The para nods, bagging gently.

“Do we know anything about her? Drugs? Drink? History?”

There are medicine bags on the bedside table, a quick sift shows nothing more sinister than anti depressants, vitamin b12 and a bottle of methadone. But no incriminating empties to point us down a route.

I shove an IV into one limp arm and brief the First Responder on how to set up a prefilled syringe of adrenalin.

“The paramedic will need one of these every five minutes or so. You can get them ready if you’re not doing compressions, yeah?”

He nods.

“I’ll go and get some history.”

Outside in the corridor I find a young man, skinny and pale. Teary.

“What’s your name, mate?”

“Martin.”

“Alright Martin, I’m Kal. How are you connected to the lady next door?”

“She’s my mum.”

Oh Jesus.

We sit down on the floor. The blasé young woman, Martin’s girlfriend, sits next to him.

“How old are you, mate?”

“Eighteen.”

An adult.

Just.

But an adult nonetheless.

And that makes things, if not easier, then more straight forward.

I write his name on my glove, I’m terrible with names, can’t be forgetting his.

“Martin…your Mum is very ill. Her heart isn’t beating and she isn’t breathing. We’re doing everything we can for her, just the same treatment that she’d receive at the hospital.”

He nods, lifting his face up from his shoes.

“Thankyou.”

“Saying that, Martin…your Mum is really, really sick, ok? Dangerously sick…do you understand what I’m telling you?”

He nods.

“Where’s your dad?”

He mentions a village several miles away.

“And your mum and dad, they get on?”

“Yeah.”

“I think he should be here. Seems like tonight would be a good time to have your dad with you, right?”

He nods, digs in his trackie bottoms for a phone and finds a number, he’s about to dial when I reach my hand out to him.

“Would you like me to…?”

“Please.”

I take the phone from him and I’m about to push the green button when there’s noise from next door.

“Is there someone else in the house?”

“My wee brother,” he nods towards a closed door “in there.”

“How old is he?”

“Fourteen.”

Shit.

I take Martin’s phone from him and stand outside the front door. The man who answers has been drinking, but sharpens up fast when I introduce myself. There’s no time for niceties on the phone, he needs to know exactly what’s going on and I tell him, finishing with.

“Can you come to the house? I need you to look after the boys.”

There’s a woman screaming in the background of the phone call, “Is she dead? Is she fucking dead?” but the man ignores her.

“I’ll get a taxi, pal. Thankyou for phoning.”

He hangs up.

Back in the house Martin is standing in the corridor chewing his thumb bloody.

“What’s your brother’s name?”

“Gerry.”

“I think he should know what’s going on, what do you think?”

He nods sadly.

“I’ll speak to him, but maybe you want to come in and back him up a bit?”

We walk in together, Gerry is playing XBox in his room, there’s lad mag posters on the walls, a smell of socks and dope, a bmx leaned up against one room. Martin sits down next to him on the floor and I sit opposite, using the exact same words as I did with Martin earlier. The lad stares at me like I’ve punched him, nodding when I ask him questions. I’m not convinced he’s taking it in, so I clarify with him.

“Gerry, do you understand that your Mum might not get better?”

He nods again and shuffles under the wing of his brother.

“OK, I’ll go see how we’re getting on.”

Back in the bedroom and the picture is unchanged. Twenty minutes have passed since we arrived on scene.

“What’s the rhythm?”

“Still flatline.”

“Ok. We due another adrenaline?”

“She just had one.”

“So…we give it a few minutes and see if it has any effect?”

“Went in three minutes ago.”

If it was going to do anything, it would have done it by now.

“Blood sugar?”

“Normal.”

“Anything to suggest OD or poisoning?”

“Nothing.”

They’ve thought of all of this, they don’t need me checking, but I’m fucked if I’m giving up without dotting the I’s.

“So to recap, adult female, unwitnessed arrest, no bystander CPR. Airway is secure, we’re getting good chest movement, good CO2 trace on the monitor, high flow o2 throughout, minimal cyanosis with CPR. She’s had maximum time on chest, good quality CPR, she’s got IV access and drugs as indicated. She’s had twenty minutes of ACLS and has shown no signs of responding and is neurologically unresponsive. ”

It’s a comprehensive summary and I’m confident of the answer that I’ll get, but I ask the question anyway, because I don’t like pronouncing people without asking it.

“Can anyone think of anything else we could do for this lady?”

Three heads shake at me.

“Then we stop, all agreed?”

They nod.

I check my watch.

“Zero two thirteen…I’ll go and speak to the family.”

There’s clearly something on my face, because the para frowns at me.

“You ok? You want me to do it?”

“No…it’s ok…I’ve got it.”

I’m in the corridor, calculating. Do I tell the boys what’s happened, or wait for their Dad to get here? He’s miles away, sounded pretty drunk, will need to wait for a taxi, at this time of the year that’ll take a while.

I can’t have them sitting in one room with her growing cold in the next.

I can’t.

I turn the handle, swing the bedroom door open, step into the room again.

They look up at me.

“Guys? I’m afraid I ha…”

My throat closes, the backs of my eyes burn.

Jesus, come on, Kal. Get your shit together.

I swallow.

Look down at my feet and breathe in deep.

Look up.

Breathe out.

“I have some very bad news. When we got here your Mum’s heart wasn’t beating and she wasn’t breathing on her own. We’ve done everything we can, but she hasn’t responded to treatment. I’m afraid she died a few minutes ago.”

They implode into each other, both of them screaming. I stand with my hands folded behind my back, looking at their trainers.

The younger one stops howling, breathes in hard and lifts his head over the parapet of his brother’s shoulder, stares me in the eye.

“Is she dead? Is my Mum dead?”

“Yes mate. I’m sorry, she is.”

The second time he hears it looks like it hits harder than the first.

He shrieks again, they cling to each other, gripping at teeshirts, scrubbing their eyes against each others bony shoulders.

I sit on the edge of the bed with them, as scared of being in this room full of grief as I am of the damage I could do by standing up and leaving them alone.

I need to be here, to stay here, to answer any questions.

And while I’m here, I have to listen to their world fall apart.

Dad arrives and any fantasies I had about his steady parental hands vanish as he crashes about the house like a frightened horse, lost in his own grief and shock. He screams and swears, while his girlfriend sits in a drunken haze on the sofa asking if we’d “done that heart shock thing”.

The boys split like atoms.

Martin sits in the living room with a cop and Gerry curls into a ball in the corner, lit by the screen on his mobile, texting frantically.

I shiver to think of the messages he’s sending.

Their father grumbles and curses, shouting at the police officers, occasionally throwing his arms like a blanket around his face and sobbing from his guts.

I stand on the side and stare and all I can think is:

“This moment. This confusion and grief. This terror and uncertainty about the future. This empty feeling of making adult decisions with absolutely no preparation? This is Christmas now.”

It makes me cold.


Aug 02 2011

International Operations

Tag: Thrilling InstallmentKal @ 8:39 pm

I’m just draining my second espresso and scraping up the remains of the apple kaflouti we shared when there’s a scream from down the street.

We ignore it, concentrating mainly on teachin Louis to play Carcassone on an Ipad (he’s not great at the strategy bit, but rather enjoys making roads and laying little men down on them. He also makes a handy-dandy “semi-smart” random opponent to mix things up. Still, enough about toddlers and their capabilities vis a vis French medieval empires – do you see the ridiculous sideways garden paths we skip down on Trauma Queen?

The screaming continues. It’s interspersed with some yelling as well and as a group we continue to ignore the noise, it sounds good-natured, maybe a group of students horsing around in the evening sunshine. The street we’re sitting on seems a lot like the Grassmarket back home, all pavement pubs and buskers.

A few minutes later when people are starting to stand in the road and look into the distance, Kate casually mentions,

“Is it weird that we’re the only people who don’t seem bothered by the noise?”

“Nah. I’m sure it’s fine…”

But because I’m curious, I hop up from the table and look down the street.

Oh shit.

“Guys? One on the deck. I’m going to go.”

They nod the indulgent nods of friends and families of emergency workers everywhere – yeah, we know you’re going….bye…- and I set off jogging down the pavement, running thoughts through my head.

“The woman on the floor isn’t moving, is flat on her back, one guy standing over her waving a jersey in her face…could be airway problems…could be an arrest…big crowd to the right…lots of shouting still…no actual violence….everyone seems upset rather than angry, but then I can’t understand what they’re saying…no services on scene…”

In reply there’s a wail and a police car swings past me, disgorging its passengers into the melee. I breathe a little easier… things always seems so much better when there are people on your side with guns.

Jog into the middle of the crowd, stay just outside flailing distance of any of the shoutier ones, eyes and ears open.

I approach one of the cops – “Hey, you speak English?”

He’s distracted by the shouting, trying to measure up the situation, waves me away. I’m more insistent.

“I’m a paramedic – can I help?”

That gets his attention; seems like cops in Maastricht are just as keen to pass off the medical aspect of any injury case as the ones back home, he bangs on the shoulder of the guy standing over the patient and speaks to him in Dutch.

They both step back and let me in.

She’s a large woman, lying still but breathing and well perfused, a little blood at her lips and a bruise rising on one cheek. She doesn’t respond when I yell at her, nor when I pinch her shoulder. When I flip her eyelids back her pupils focus briefly then roll upwards into her skull, but her eyelashes flicker when I brush them with my fingers.

Interesting…

I’m not clear where I stand legally using ‘noxious stimuli’ over here, so I hold back from deploying some of the more unpleasant pressure points to assess someone’s neurological status, settling for feeling the weight of her chin, measuring how readily she holds her jaw forwards from the back of her throat.

A cop is standing over me (and I quickly start to think of him as “my cop”).

“Do you know what’s happened to her?”

He shrugs.

“I just arrived.”

I have to stifle explosive laughter, it’s a cliched line from back home. When you rock up at a job on an RRU and haven’t done much in preparation by the time the ambulance arrives it’s traditional to shrug – “I’m just here ahead of you boys…”

It’s also used sarcastically by the ambulance crews – “You just here ahead of us, I take it?”

Anyway, turns out it’s the same across here too.

My cop listens to his colleagues and his eyes widen with alarm.

“They’re saying she’s been stabbed.”

Stabbed?

He hollers something in Dutch to his mate, who runs to their van and brings me a pair of gloves which I gratefully pull over my hands. I hadn’t wanted to body check this woman too thoroughly, since I wasn’t able to communicate my intentions in Dutch, but if she’s got a knife wound somewhere I want to find it.

I plunge my hands under her shirt, rubbing my palms over her skin, feeling for hot blood under my fingers. I cover her belly and chest, her armpits, the parts of her back I can reach, her thighs and buttocks.

Nothing.

Meh.

If she has been stabbed it’s not somewhere that’ll kill her too shortly…

In any case I’m distracted by a gurgling at the back of her throat. Tongue bobbing and spittle and phlegm boiling in her mouth, she chokes and splutters.

I grab her far shoulder and hip and roll her towards me to drain the crap out of her airway.

She fights back, struggling to stay on her back.

Oh-ho. It’s like that, is it?

There’s a hierarchy to nervous responses in your body, with the most vital (thankfully) being some of the last to disappear under the waves of unconsciousness when it washes over you.

Gag and cough responses are tenacious buggers and stick around for ages, even when the rest of your body and brain are effectively turned off.

I’ve never met someone who was unable to spit up phlegm but still sufficiently with it to coordinate their gross motor responses and roll from the recovery position directly back to supine.

She’s at it, perhaps not entirely, but certainly over egging the “unconscious” line
beyond medical authenticity.

I settle for immobiliising her head and holding her airway in a jaw thrust, not because she particularly needs it, but because it’s a neat non-verbal way of saying to arriving back-up that you’re not just some shmuck who read a first aid book once.

An ambulance arrives and two guys in the *brightest* flouroescent poloshirts hop out. Seriously, I thought our uniforms were garish (”Irish” green rather than the “Bottle” green the rest of the UK wears) but these guys look like they’ve just rolled out of a UV disco. They’re friendly and polite, laughing at my question – “Do you speak english?”

“Of course…”

I bring them up to speed quickly, their English being so great that we can communicate just as I would at home, explaining that I’m confident she’s laying it all on a bit thick without letting the patient know we know.

We agree that while she’s probably just fine, we can’t risk not collaring her (it turns out that our Scottish “Bring the lot” translates into Dutch as “somethingsomething planken…alles.”)

Suddenly there’s a cop and the para of the two stands up and walks away into a nearby shop. The technician explains:

“There’s another patient…a woman with her neck cut.”

He draws a finger across his throat.

I nod at our patient – “I’m ok here…you want to go back him up?”

But he’s cool as can be, murmuring into his radio and nodding.

“He says she’s fine.”

We sit with our woman on the floor.

“I think we can’t roll her without my partner.”

“I’d agree.”

“We’ll just wait?”

“Yes…did you have a nice dinner?”

“Yes thanks.”

“What course were you on when this happened”?

“I’d finished my coffee.”

“Ahhh. Not a spoiled evening then?”

“Nope. Good coffee, too.”

“That’s lucky…you shouldn’t spoil dinner for shit like this…how long are you on vacation for?”

“Another week.”

“Nice. “

And then, with just a hint of cynical glare….

“You always carry gloves on vacation?”

“Hah! No, the police officer gave them to me.”

“Thank God for that…”

Check it out – I’ve found Dutch North Cunts :D

The para rejoins us, laughing a little and shaking his head.

“The woman with her throat cut?”

“Yeah?”

“I think she was shaving…I’ve done worse myself.”

We prepare to roll the patient onto the spinal board and realise we need an extra person.

And it’s then that I spot Kate hovering at the police tape that’s been stretched around the whole incident; I wave her over and we all learn something about the Dutch police.

If you LOOK like you know what you’re doing, the Dutch police will let you do whatever you fancy. Kate nonchalantly lifts tape and wanders over to us.

“My colleague, from Scotland…”

They smile at her and gesture towards the patient’s feet – I don’t bother trying to explain the whole Red Cross vs statutory services thing, I just trust Kate to get on with helping us log roll.

The patient firmly on the board and onto a bewildering yellow stretcher we’re left with handshakes and thanks.

We’re about to return to Sean and Louis when a cop stops us –

“Before you go…can I have your names and telephone numbers?”

We comply and he only winces a little when he realises we’re giving him international codes for our mobile phone numbers.

I still haven’t heard from them.

Somethings just don’t change, no matter where you’re working.


Jul 20 2011

Cough Drop VII – finale

Tag: Ambulance,Thrilling InstallmentKal @ 10:32 pm

“Mark, I’m sorry, but I need you to help us.”

He nods, courage and dignity to the last.

I use a sneaky persuasion technique, stating facts in the future tense as though they’re already agreed.
“You’re going to climb into the cage with me and we’re going to get out of here.”

And he does, with a face screwed with effort and agony he hauls himself on all fours into the box.

They slam the gate on the two of us and with a scream of running cables and the creak and ping of chains taking the strain, we climb into the sky with a lurch.

I’m stood over Mark, watching the rock face pass in front of our faces, the lake below us receding away, workmen around it staring up, their hands over their eyes to shield the sunshine makes them look like they’re saluting.

I don’t mind heights. I rather like them in fact, but a coat of cool sweat runs over my back as we climb, I’d been unprepared for the fact that we’re lifted not only out of the quarry, but over the buildings and machinery at the surface.

Fuck me, we’re a long way up in a metal box on the end of a rope.

Mark is still coughing up blood but when I squeeze his wrist his pulse holds up.

“You doing ok?”

He nods, but it’s not very convincing.

“You’re doing great, pal. We’ll get you down to the ambulance and deal with your pain in two minutes, k?”

He nods again, peels the bloody mask from his face, leaving a smeared ring around his mouth and nose.

“Thanks.”

Don’t thank me yet, mate…

On the ground below us I can see my colleagues laying a vaccuum mattress out ready to lift Mark, a fire appliance pulls into the yard and a white-hat jumps out, casting about for something to do.

Too slow, boys…gotta get up faster than that.

The crane operator touches us onto the deck with the gentlest of touches and we’re all focussed on Mark immediately. Later I’m disappointed we didn’t get a chance to thank the guy who ran that crane, without him his colleague would have surely died in that pit.

With his last grains of strength and resolve, Mark hauls himself out of the cage and onto the mattress on the floor, we set to securing him into it with straps and blocks before recruiting a couple of firefighters to help us lift him onto the trolley.

Into the back of the ambulance and the crew’s eyes swing to me – laughable in truth – they were both paras long before I even joined the service.

“Your patient – what do you want?”

Oof…ok…

“Analgesia, please and a proper set of obs. I think we can cancel the trauma team too, since we’re out already.”

They get on with it while I reassess Mark from the head down – things are largely the same, but that right lung simply isn’t shifting air like I want it.

“How’s your breathing feeling, Mark?”

“Not good.”

“Painful? Or hard work?”

He has to breathe in between the words of his answer.

“Just…hard…work.”

I tap his chest with my fingers, listening for the toom-toom-toom that would suggest air trapped in his chest cavity or the fd-fd-fd that would tell us it’s full of blood.

When I was a techy, a colleague once taught me – “If you think it, do it…if you’re questioning in your mind, chances are it’s your gut telling you the right path.”

And then later a doctor in the ED backed that up – “If you suspect pneumo-thorax, just treat it – hell, once it’s in, you’ve caused one anyway.”

Because here’s the thing. Your lungs are two balloons inside their own respective, surrounding balloons. When blood or air gets trapped in the space between a lung and its surrounding tissue, the lungs becomes too compressed and the best treatment is to remove that trapped blood or air.

In the hospital they’d stick in a chest drain, a long plastic tube that’s inserted (with the assistance of a scalpel and your fingers (no, I’m not kidding)) into the patient’s side and stitched in. I’ve discussed emergency chest drains in the desert with senior medical staff (they can be improvised with a scalpel (but any sharp knife will do) and an ET tube) in extremis.

Clearly, that’s not an option here.

In ambulances, we have the option of an “emergency chest decompression” where we insert a needle through both the lung and its surrounding pleura, allowing any trapped air an easy route out into the atmosphere and hopefully reducing the effort required to breathe for the patient.

It’s ultra-low-tech, there is little clever about the procedure.

But I’ve never done it before and, when I turn to my two colleagues and say “I’m considering decompressing this, guys…thoughts?” they both say.

“If you think so.”

I stare at Mark’s chest for a second. That right side is simply not moving as much as his left.

If you think it, do it.

Slight stumbling block, though – how do you explain the procedure to a patient without saying “Dude, I’m going to stab you in the chest now, hold tight.”?

I plump for “Mark, I’m going to give you an injection between your ribs to help your breathing, ok?”

He nods.

I get the feeling I could tell him I was going to remove his liver with a corkscrew and one fist and he’d just go with it.

One of my colleauges calls over my inner monologue.

“How much morphine d’you want, Kal?”

“What’s his BP?”

“140/92”

Mark’s fit and healthy and in horrible pain, I figure he can both handle and probably do with a big bang of opiates right about now.

“Give him the lot for now.”

“You got it.”

I open the drawer and pull a brown cannula from the boxes inside. They’re the biggest we carry, horrible wide ended fuckers, about the same size as the tip of a ball point pen.

“You ready, Mark?”

I wonder if I’m asking him or me.

A quick wipe off of over the site between the ribs high on his chest, place the point on the skin and remember why you’re doing this.

I’m going to stab my patient in the lungs.

And so I do.

There’s a little resistance, a pop and then a series of short ‘gives’ as the needle proceeds through layers of tissue. I whip the sharp out, leaving the plastic tube in place. I’m a little disappointed there’s no dramatic inner-tube hiss, but in a few minutes it’s clear that it’s done its job. Mark’s breathing is easier – still not great, but undoubtedly easier and when I listen with my steth over the stricken lung, I’m encouraged by the extra air I can hear whooshing about in there.

Awesome.

The back doors suddenly whip open and the ED’s trauma team stand silhouetted against the noon sun, their orange jumpsuits gleaming. The consultant hops up into the vehicle with us.

“I know you cancelled us, but we were just round the corner and figured we’d come say hi anyway.”

“No bother, we were calling you for extrication, really.”

“Meh – it’s always nice to keep us running, at the very least we can come in and cheer you on.”

I run her down the patient and she nods along.

“You get much out of that?” she asks, nodding at the needle in his ribs.

“No rush, but he’s improved since.”

She nods thoughtfully before calling for a chest drain set and poking a new hole in Mark’s side. Bright bubbly blood trickles out into the bottle.

“Let’s go.”

Pally drove the trauma team down from the hospital and he’s leaning against The Van with a traffic cop.

“These boys want to know if you want an escort.”

Well…why not?

A parade of emergency vehicles leaves the quarry, traffic car in front, then the ambulance, then Pally in The Van and me behind them in the RRU – passers by stop and stare at the blue-light-flashing convoy that snakes through town. It’s a lot of noise and disruption for one man, but I’m happy when I walk away from resus half an hour later that Mark’s prognosis is good.

Job done.


Jan 03 2011

We stack ‘em high…

Tag: Ambulance,Thrilling InstallmentKal @ 10:21 pm

You guys have heard plenty in the past about the exaggerative abilities of the average 999 caller, so when Scamp and I are called to a local supermarket for “female struck by falling shelf – trapped” we’re dubious.

“You know what this is, don’t you?” Scamp starts as she drives along.

“Uh-huh?”

“This is someone with a shelf on their foot and the shop first aider has been told to never remove a crushing object.”

I’m still laughing at the image when we pull up to the shop, a budget supermarket in a local shopping centre. Outside a man is running up and down the threshold like a dog behind a chainlink fence.

“C’mon! C’mon!” he yells at us “It’s really bad!”

I follow him into the shop, through an excitedly chattering crowd and he directs me to the far right side of the store where a scene of utter retail devastation greets me.

Because when the caller said “a shelf” had fallen, I rather assumed they meant a horizontal plane of metal or wood.

What has happened, in fact, is an entire wall’s worth of shelving units, fully laden with groceries and stretching from the front of the store to the back (and this is not a small store) has come away from the wall and fallen forwards, coming to rest against the upper edge of the facing shelves.

Which, thankfully, have held, excusing us from a domino rally effect that could have landed on every shopper in the place.

As the units stopped falling forwards, the momentum has caused every item of produce to fly forwards, in addition to the broad metal flats of the shelves themselves and the angled steel rods that held them up. Simulataenously, parts of the units have torn themselves apart as they fell. Chunks of metal swing wildly from loose fittings and every few seconds there’s a screeching clang as another section of shelving comes loose.

Peering under this newly built lean-to I see three figures, two men holding the shelves up as best they can and a very large woman sat on the floor, blood squirting from her scalp.

I turn to one of the shop assistants.

“Can you run and tell my colleague we need hard hats, please?”

Because I like my skull without chunks of metal in it, thanks.

Scamp turns up alongside me with the helmets and expresses my thoughts to a tee.

“Oh shit!”

Yeah, that was my thinking.

I strap my hard-hat onto my head, bend double at the waist and creep into the space.

“You guys alright?”

“Getting tired…” warns one of the men holding up the metal hoarding above us.

“You ok for a few more minutes?”

He nods, takes a deep breath and readjusts his shoulders against the weight. I turn my attention to the patient.

“How you doing, my love?”

She’s a large lady, very large indeed and has a personality that’s as jolly as her weight’s stereotype should suggest. She’s smiling, despite the gash on her head which won’t stop bleeding.

“You on Warfarin?”

“How did you guess?” she grins back at me.

“Ok, look. We’ll deal with that in a minute, but we need to get out of here, right? I’m not having this lot coming down on the four of us. Can you walk?”

“I can’t move. I’m trapped….my foot.”

I run my gaze down her leg expecting to find her foot pinioned between two metal beams, or tangled in a mess of fittings. I’m considering calling for a fire crew with cutting gear when I see what’s really going on.

Biscuits.

She’s buried up to her knee in packets of biscuits, packing her foot in so tight she can’t lift it. I start digging her out, throwing bourbons and digestives over my shoulder like a frantic relative at an earthquake site while Scamp runs back to the vehice for a stretcher.

With the patient’s foot free, Scamp is able to slide a scoop stretcher into the gap and we help the woman lie down on it. Her obesity doesn’t make it comfortable and she struggles to breathe, but there’s no other way of getting her out. I loop nylon belts around the handles of the stretcher and throw the loose ends to the waiting crowd at the end of the aisle. Many hands lay on and together we sledge the patient out to safety along a sea of crushed groceries. Cakes, toilet rolls and bread rolls are crushed under her as we pull her free.

I turn to the two guys holding the shelves up.

“You guys ready to get out of here?”

They nod, sweat on their foreheads.”

“Ok, you ready?”

Together they shuffle their hands along until they’re standing by the exit and on the count of three, they run for it. The rest of the shelving comes down with a scream and crash.

The patient by this time is tucked up safely on the trolley, chuckling at the attention and enjoying the tender ministrations of Scamp as she bandages her head.

We roll the trolley into the ambulance and I pull Scamp aside for a second.

“You ok with her?”

“Yeah, of course. Where are you going?”

“I’m going to check there’s noone else in there.”

Back in the store a small crowd of people are starting to gather around the fallen aisle, a few shoppers peering under the collapsed shelving. I corner the manager

“Right, mate, we need everyone at the front of the store, nobody needs to be poking around back there, ok?”

He starts to corral the shoppers back to the entrance and I make my way to the back of the shop, down the neighbouring clear aisle, grabbing a broom handle from a display as I go.

Because I’ve got this idea that I can use the broomstick like a ski-pole, poking it down into the sea of goods and feeling for anybody else stuck under the wreckage. I’m creeping about, my feet sliding and slipping on spilt bottles of oil, smashed jars of gherkins groping at my ankles and rigid, round cans spinning away under my step. It only takes a few minutes of this for me to realise that I’m way out of my depth. I don’t know if anyone’s in there, but I can’t take the risk of assuming that they’re not – “Paramedics leave trapped teen to die in shopping centre horror”.

I make a call for back-up and a fire crew arrive shortly, I walk with the fire officer to the mess.

“There’s someone trapped in there?”

“I don’t know. I don’t think so, but I can’t be sure.”

“And what do you want US to do about it?”

“You’re search and rescue, aren’t you?”

He sighs and waves a team forward to start picking through the crap while I return to Scamp and the patient in the ambulance.

They’re laughing and joking like old buddies, the woman is, astonishingly, effectively uninjured save for the split across her scalp.

We natter all the way to A&E, teasing and joshing each other as we go. Arriving in the ambulance bay we have to ask another crew to help us slide her from our trolley onto the hospital bed, she’s not light.

“It’s just as well I’m just a wee slip of a thing, right?” she asks with a wink.

And then, relaxed into her company as I was, my mouth uttered the career ending line:

“Pffft! Whatever, love. It’s not like we rescued you out of the salad aisle, is it?”

There’s a moment’s silence when my colleagues stare at me, aghast and I desperately try to cram the words back into my mouth.

But she’s chuckling, her shoulders shaking and she regains her composure enough to slap my arm.

“You cheeky little shit!”

Give and take, I suppose.

It’s only later that day that someone points out that the fire brigade will have got to take all the broken packets of biscuits home with them.

Bollocks.


Dec 24 2010

Bringer of dreams

Tag: Ambulance,Thrilling InstallmentKal @ 12:20 pm

Winters grip locks the country down.

I’m running out of morphine and order more – being a controlled drug we can’t just pop down to Opiates R Us and “get some”.

There are procedures.

Processes.

Rules.

The pouch on my belt dwindles.

Four vials.

A heart attack.

Three vials.

An elderly woman with ribs so bust that every breath makes her wish she didn’t.

Two vials.

A guy in his forties slips outside a pub and breaks his shoulder. I pump him full of Entonox instead of morphine. With the alcohol on board it’s enough. Just

Two vials.

She bent over to plug in the hairdryer and her back went. Can’t stand up, can’t sit down.

One vial.

One.

I keep it in my pouch and touch it occasionally, like a lucky rock in your pocket or prayer beads. I save it for someone who really, really needs it. I’ve seen paras do this before “No morphine unless it’s serious”. But what’s serious…and how do you justify denying analgesia or treating below your normal standard “just in case”.

Not to mention that there are double tech crews working who call on Rapid Response Units for intravenous pain relief. It’s not just me who places demands on my morphine stocks.

But this one’s special. My last one.

It’s gotta be right.

And surrounded by christmas shoppers, on a gutter of packed ice, with glittering buses whizzing past us and three off-duty medics at the same bus stop as him, I find him.

A precious “big tooth” smashed from his face, his forehead split and leaking down into his eyes and the anatomy of one leg turned inside out, he’s crying from fear and pain, trying to get up and run away from sensations he’s never felt before and can’t begin to comprehend.

We have a winner.

I pass the vial to one of the crew who back me up – “Draw that up for me, mate?” and then, because I’m paranoid “Don’t drop it, it’s my last one.”

He thrashes when I jag his hand the first time and miss, he lies still when I push another line into the crook of his forearm, a combination of the A&E nurse singing to him as she holds his head and the off duty GP pinning his arm to the floor.

10 millilitres of pain relief and relaxation, I push the plunger hard for the first 5mls, hoping to make his head spin and the drowsiness of the initial hit to cover our rolling him, pulling his twisted shin and ankle back into place and strapping him down onto the board. In the vehicle he blinks slowly and tells me it’s still a bit sore, but not as bad and can he go to sleep, please?

Not yet, pal.

My pouch is empty, I’m declawed and impotent.

But I’m pleased I waited until I found him.


Dec 16 2010

Just Keep Breathing

Tag: Ambulance,Thrilling InstallmentKal @ 5:09 am

He’s gonna go. It’s clear for anyone to see and my first move is to call Control while I assemble an oxygen mask with my other hand.

“Guys, I need a vehicle as soon as, don’t divert it, this job will go purple.”

Because we don’t say “die” in front of the patients or their families.

His face is s chalky grey, his lips blue. I don’t bother to count his respiratory rate since I can tell you it’s “too many breaths a minute”.

Lying flat on the bed wont be helping, so I chivvy him up a little.

“We need to sit you up, pal, c’mon.”

He lifts his shoulders and scooches up the mattress an inch or so.

“No, no, more than that, really sit up.”

I grab his arm and, in a manoeuvre that would have any manual handling instructor shit their pants in horror, I drag him to a sitting position. I’m suspicious that making him push up like this may be just enough to make him arrest, but I’m positive that if he lies flat much longer he’ll give out in minutes.

A heart rate of 140, breathlessness that came from nowhere, his limbs are mottled where his heart cant pump hard enough to circulate blood effectively. His legs and belly look like bruised tortoiseshell and when I push my hands against his skin my fingerprints linger as white spots as sure as if I’d burned him with my touch.

He’s too sweaty to stick ECG pads on properly and denies chest pain anyway, but I hold the errant dots on his chest with myfingers to try and assess his heart rhythm. He’s shaking too hard for it to show me anything useful and I’m pretty certain it wouldn’t show me what I fear is going wrong.

I’d put money on this being a pulmonary embolism and a massive one at that. A fat clot has lodged in the blood supply to his lungs which, while they’re working just fine of themselves, are unable to transmit sufficient oxygen to his heart and brain. I’m basing this not on any solid data, but largely on “Because thats what I think is going on”.

The oxygen has perked him up, now he looks like cold shit, rather than a corpse.

Figure I’ll take what I can get.

My crew arrive and I help them package the patient onto the chair, again worrying that the exertion will prove too muvch for his hypoxic heart. Theres nothing for it, though. He needs to be in hospital, he needs to move now.

I’m sitting in my car when the ambulance leaves for hospital I hope he made the short trip alive. I don’t have his surname…so I guess I’ll never know.


Nov 04 2010

Shitty job…epilogue

Back on station the story has got round faster than cholera in a french public toilet, the LA on duty sniffs the air as I walk past.

“Can anyone smell shite…?”

I laugh.

“I’ll take shite on my shirt over a dead bairn, mate.”

“Wouldn’t we all, pal?”

Twenty hours later I’m driving to work with a blazing hot fizz in my blood, I turn my music up louder as I drive, sing along with the windows open, waving and smiling at folk in traffic who stop to stare.

My arms twitch and effervesce, the grin cracking my face again and again, my soul flooded with a ferocious, victorious joy.

It’s the exact antithesis of this guy. Then I had an ache that chased me for days and drove me to read war poets and write and rewrite until, my thoughts distilled, I sat on my bed and wept.

And the pain came from the denial of future.

“Oh it’s such a waste.” bleat the public flocks, but it’s the absence of chances that cuts me up. Maybe No. 6 was an asshole, maybe he was violent, or a drug dealer. But I’m a Pollyanna and believe that everybody’s generally pretty nice at heart.

When I grieved for No. 6 I was mourning the thought that he’d never marry, that he wouldn’t introduce his parents to their grandchildren, that he’d never retire to a ripple of embarrassed applause from a crowd of colleagues.

He’d never shimmer with the excitement of turning twenty or, ten years later, fret that thirty was closing faster than he realised.

He’d never graduate. Never be struck by that thought that, holy shit, he’s turning into a grown up.

The thickly embellished needlework of scenes that should have hung from the walls in his history remained as empty frames.

And I was witness to the undoing of potential.

And that hurts.

Ten months later. Along comes Emily. Squirming and breathing and squawking on the road to hospital with purple grey fingers and peering at the sweating paramedic over her new born face.

No. 6 is undone. Rebalanced.

Because in Edinburgh there’s a new person.

A whole person who will, hopefully, go on to play Mary in her Nativity play.

Who’ll bring home works of art to stick on the fridge, barely pasted-on pasta and a line of blue for the sky.

I hope she falls and hurts herself and learns to stand up again.

I hope she makes her Mum tear her hair out on occasion.

I hope she rides a bike downhill, fast, with her legs splayed out and her hair running back.

I hope she makes her Mum breakfast in bed, smeary toast and cold tea (because she’s not allowed to work the kettle).

I hope she learns that her siblings love her, even when they’re being dicks.

I hope her Mum tells her the story of how she came into the world, I hope it becomes family folklore.

I hope she wakes up early at Christmas and can’t get back to sleep.

I hope she breaks someone’s heart and has hers broken too.

I hope she finishes education when she wants to, not when she thinks she should.

I hope she creates something one day that makes somebody so happy they cry, be that a work of art, a chocolate cake or a surprise telephone call.

I hope she meets someone lovely and has a family of her own.

I’d love it if she won a Nobel Peace Prize, or a Booker, or Turner, or revolutionised clean water supplies in the third world.

I’d be ecstatic if she cured AIDS, or negotiated peace in Gaza.

She may not, of course, do any of these things.

But here’s what makes the base of my skull shiver, my brain spin and, when I tell Scamp my thoughts in the messroom the night after, what makes her tear up and wave her hands – “Stop…stop…you’ll have me greeting.”

Penfold and I? We’re responsible for restarting a whole lifetime of achievements and failures and dreams and disappointment.

We caught her when she wobbled, set her back on a path and gave her a shove.

I dare say the two of us will ever meet Emily and Beth again.

But meeting them once is enough to ignite another year of drive and passion for what we do and why we do it.

I hope it was enough for them, too.


Nov 03 2010

It’s a shitty job…

Tag: Ambulance,Best Stuff,Thrilling InstallmentKal @ 12:33 pm

Beth can’t stand up.

It hurts too much.

The warm bath helped her contractions, relaxed the ache in her back and fooled her into thinking things were calming down.

Her Mum’s on the landing with us, her kids downstairs in the living room – they waved Penfold and me down as we pulled into the street.

This is baby three, pregnancy three. She’s had no problems before, but her middle one was big and she ripped a little.

Other than that, the pregnancy’s been normal.

And still is.

When she contracts (which she’s doing every couple of minutes) I have a look at the business end. She’s on her hands and knees on the stairs which makes any kind of view tricky, though I’m confident it’s more comfortable for her. Beth is not a small lady and her size isn’t making my exam any more straightforward.

I make a little room with my hands and relax when I see that…nothing is happening. Nothing is stretching or bulging, everything is as it should be and where I’d expect it. The view isn’t great because we’re lit by a single dull bulb above us so I twist my torch on and balance it on a rolled up towel, pointing it where I need it.

“Right Beth, here’s what’s happening, ok? The baby’s not coming any time soon from what I can see, so we’re going to stand up and walk out to the ambulance. I’d sooner you were in the maternity suite than delivering here, right?

She nods, agrees and promises to do her best, but another contraction poleaxes her and has her face down on the stairs, crying. I encourage her to take more gas and air and rub her lower back while she moans, low and mournful. I’m reminded again of how very agricultural this whole delivery affair often is.

I give her a minute.

“After the next one, we’re moving, ok?”

She nods. Penfold picks up the gear and takes it out to the ambulance, main bag, paeds bag, maternity pack, oxygen, suction.

The contraction eases and I pull up Beth’s trackie bottoms, ready to help her to her feet when she screams and slumps back onto the steps.

“It hurts.”

“I know pet, c’mon, let’s go.”

She shakes her head, no.

“Something’s wrong.”

“Nothing’s wrong, it’s just sore. Take the gas. We’ll go after this one.”

She sucks on gas greedily, stopping occasionally to cry. It’s hard to sob and inhale entonox at the same time.

“I need to go to the toilet…”

My heart sinks.

“A poo or a pee?”

“A poo.”

This is never, ever good news for a patient to tell you. Heart attack patients often want a poo and, when they strain to pass the movement, their hearts stop. Women who are about to deliver their babies also feel the same pressure on their bowel. When the expectant mother shits herself? You shit yourself.

“Can you make it?”

She shakes her head and has an accident. Bizarrely, I don’t know what to do because of my training, but because I read “The SAS Survival Handbook” from cover to cover as a very strange and precocious 10 year old.

I grab some baby wipes from the bathroom behind us.

“I’ll just clean you up a bit, love, ok?”

“I’m sorry. That’s really embarassing.”

“This? THIS is embarassing? I’m currently pot-holing in your foof and the fact that you’ve done a poo is what’s embarassing you?”

I don’t say.

Instead I’m reassuring, pleasant, don’t worry love, it happens.

Empty platitudes because my head is shouting.

“She’s pooing! That’s a sign of imminent delivery!”

I take another look betyween her legs. Nothing.

“It’s coming…it’s coming,” she mutters at me.

I’m also remembering the “101 things paramedics have learned before you” jokes I’ve seen online. One of them included “When Mum says the baby is coming, you goddamn believe her.”

I’m an idiot.

“It’s not, Beth. Nothing’s happe……ohhhhhh!”

Because there, suddenly is a head of hair and a crumpled face. I stick my hands beneath the wee one’s shoulders as it delivers and support it down onto the floor.

I could weep.

The kid’s still in the membranes from the inside of the uterus and through the cloudy skin I see a pale, blue ghost of a face staring into the middle distance. At the same time the umbilical cord stretches, catches and rips. Not across itself but longitudinally, the rupture spinning down the length of the cord like an over stretched rope. Shining red arterial blood sprays in a mist from both ends.

Unresponsive baby in an airtight covering with an arterial bleed.

Who have I pissed off?

My left hand grabs the baby’s end of the split cord and I squeeze with my fist as tight as I can while the fingers on my right shred membrane and tissue away from…her…yes…her…congratulations, it’s a girl….away from her face. I grab a towel from the floor and rub her chest and belly with it.

She flexes her arms, opens her mouth and lets out her first utterance.

“….”

Her airway is plugged with fluid still, I can’t let go with one hand for fear she bleeds out through her cord.

“Penfold!”

He hares up the stairs behind me and takes in the scene.

“Oh shit! What do I do?”

I was wondering just that, pal.

“Open the pack and get me a cord clamp.”

He digs it open and snaps two plastic clips over the baby’s end of the cord.

“Now cut that, quick.”

He snips her away from her Mum with a stroke of scissors.

“Now get me the paeds resus bag. Go..GO!”

He legs it while I find an aspirator in the maternity pack and suck gunk and shite out of the back of the baby’s throat.

Rub rub rub.

She flexes, open her eyes and says.

“Uh.”

Before flopping down again.

“C’mon baby…..”

Penfold’s back and hooking an infant bag-valve-mask to an oxygen tank for me. I’m breathing for her in seconds, pushing harder than I normally would to force any excess fluid out of her lungs and into her blood stream.

“Why isn’t she crying?”

I’d completely forgotten about Mum.

“She’s not breathing very well, Beth. But we’ll deal with that.”

“You look after her, right?”

“Will do. Does she have a name yet?”

“Emily.”

“Penfold – can you look after Beth? I’m going to take Emily into the next room.”

I want heat and light, I can’t resus a baby without the two of them but the house is dark and cool. Her heartbeat is audible through my stethofscope but muddled by the rattle of fluid in her lungs and airway.

This isn’t fair. I want her in a SCBU, not on the bedroom floor.

Unless.

“Pen? Get us a second crew, at least one para, please.”

Because Beth is still my patient and there are all sorts of horrible complications that could still occur to her that would need attention.

Penfold, like a multitasking genius, handles making a call to control while catching a placenta in a yellow bucket. Meanwhile Emily has *almost* perked up, she’s still cold and pale on the edges, but at least she’s breathing for herself and when I flick her foot with my finger she grimaces and screams.

Beth at the bedroom door.

“How is she?”

“She’s ok…but she’s had a hard entrance to the world, ya know?”

She nods.

“Can I hold her?”

“Of course you can, I’m going to keep this mask on her while you do?”

She reaches her arms out for her daughter and I tuck the two of them in together, unable to resist dropping an arm around Beth at the same time and giving her a squeeze.

“Good job.”

She’s weeping, tears on Emily’s new face.

Voices and footsteps downstairs and the second crew arrive.

“Guys, this is Beth and Emily. Emily had some problems on arrival and I want to transport her now. I’m going to take her, can you sort Beth out and meet us at the hospital?”

Beth stares at me aghast.

“You’re taking her away?”

“I want her in hospital right now, honey.”

“Can I see her when we get there?”

“I’d hope so, yeah.”

She stares me down.

“You look after her.”

“Like she was my own, Beth, I swear it.”

Right now I feel like I’ve got a major stake in the wee girl anyway.

I snuggle Emily into my shirt where she wriggles once before shitting all over me. As we walk downstairs her brother, sister and granny kiss her in turn as we leave.

Penfold boots the vehicle down the motorway to the hospital while I sit in the back with the mask over Emily’s face, in turns singing to her and swearing at her.

“You made Kal shit himself, didn’t you? Now you just behave yourself, Madam, you hear that? I will be seriously pissed off with you if you try any more of your nonsense….”

It does nothing for her, but makes me feel better.

Half an hour later the four green suits are stood at the foot of the bed in the maternity suite, Beth and Emily cuddled up together.

Beth looks me in the eye.

“Thankyou.”

I smile back and head off to the ambulance to exhale.


Aug 18 2010

Baths

Tag: Ambulance,Thrilling InstallmentKal @ 11:38 am

So I’m standing on a street corner with my bike, giving directions to lost tourists and trying to stop the local kids from switching the lights on. Suddenly, down the hill, two cops come careering past and “dynamically deploy” me to a job.

“Might need you, mate.”

Fair enough, I swing onto the bike and free-wheel down the hill while a police van hammers past me on the right hand side. A total of six cops hair down a wee alleyway between two shops at gather at the foot of a flight of stairs in a small courtyard.

“What’s the issue?”

“Disturbance call…but they say he’s smashed some glass, so there might be an injury too.”

I look up at the building, a traditional Edinburgh tenement. Well kept, clean courtyard, one window smashed out, a black eye in its face.

“You guys crack on. I’ll be here if you need me.”

They gather at the door, ringing the buzzer, shouting at the intercom.

“Police! Open the main door.”

The door buzzes open and they tramp inside, I can hear their footsteps zig-zagging upwards, back and forth on the staircase. Police calls with injured parties are usually a paperwork exercise, they can’t discharge an IP without having them medically assessed.

I casually remove my bike gloves, slide the bags out of the panniers and am gloving up when a lone set of footsteps zig-zags back down the stairs and a police officer arrives, white faced, at the front door.

“Kal!”

He beckons me in and I follow him at a run up the stairs, onto a landing and left into a corridor. The room is about fifteen feet long, five feet across. There isn’t a clean patch of lino to be seen, the entire floor is covered in blood. It spreads a good half foot up the skirting board, splashes on the walls, shards of glass from the broken window float in it.

In the centre of this gory tableau lies a young man who appears to be doing backstroke while his left wrist squirts blood. His right hand is pinned to the floor by a cop, squeezing a tea towel onto his forearm.

I throw my bags beyond the scene into an open doorway (which doesn’t have claret all over the floor) and unzip them, grabbing a couple of large bandages. The patient’s left arm has a wide, triangular hole in the centre of it, blood pours out until I pack the dressing into the wound, wrapping the bandage around it as hard as I can, then tying a second over the top of it. It holds for a moment before a dark red stain blooms through to the surface, spreads and stops, holding its shape as a circle on the dressing.

Fair enough, that’s almost controlled.

I realise, with a fair dose of alarm, that I’ve come running up the stairs without A. an oxygen mask and B. a tourniquet, both of them are in the saddle bag on the bike and not in the main bags. This is a major issue, since I have a tank of oxygen right here, but no way to give it to the man whose entire supply of blood is trying to escape. I’m also keen to get some IV access so that once the crew arrives we can start pushing fluids into him in an attempt to , you know, make him not dead and that.

I improvise.

Looking over at the cop on the patient’s right hand, I see that the pressure he’s pushing on the arm is making the patient’s veins bulge in his lower arm – better than any tourniquet I could put on, it should be a simple matter to slip an IV cannula into that.

“Open that bag and pass me a grey needle, please?”

The police officer by my kit unzips one of my bags and looks in bewilderment at the contents, I try to explain.

“On the IV board?”

He lifts the defib and hands it to me.

“Don’t worry, just pass it over here.”

I expect him to hand me the kit, but instead he slides the entire thing across the floor and into the blood puddle. That’ll take some cleaning up.

Snagging a grey cannula from the board, I move to stick it in the patient but realise I’m going to have to secure his arm somehow before I go waving sharp pointy things about. The traditional method is to shove the patient’s hand between your knees, but I’m crouching, loath to put my bare skin on the filthy floor.

There’s nothing for it.

I splosh my knees down into the bloodbath, wishing I was wearing long trousers and not cycling shorts. The cannula slides easily into his vein and we’re able to move to protecting him against shock, lifting his legs above his head and delivering high flow oxygen therapy via a bag/valve mask, rather than a normal non-rebreather.

The crew arrives, we bundle the patient down into the ambulance and run bags of fluid into him. They take off to hospital in the wake of a traffic car escort, leaving me with a conundrum.

On an ambulance, if you get tagged by body fluids, you’re normally going to the hospital anyway. You can slide your green shirt off, or scrub the worst of it off your trousers with wipes before heading back to station to change clothes. You’re in the vehicle, nobody sees you, it’s all terribly discreet.

Out on the bike, I’ve nowhere to hide. My bare arms and legs are literally dripping with blood and though the police pull a roll of paper towels from their car with which to mop up, I’m still a ghoulish figure that walks back to the Fringe office to clean up.

The next morning I see the cop who deployed me, she laughs when I tell her I’m ignoring her next time. I’m crap with names and I tend to fall back on “Alright, mate?” when I meet the cops who populate the Information Centre on the High St (free coffee, handy loos, my favourite stand-by point!). Regardless of learning names, however, it’s another step to a closer working relationship.


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