Apr 28 2009

Casting my pearls

Tag: AmbulanceKal @ 8:09 pm

Today was the day that Pig Death Flaming Doom Syndrome struck Scotland.

Pig.
Death.
Flaming.
Doom.

Or Swine Flu. Or Swine Fever, or something. I kinda prefer the term “Swine Fever”, because it makes me think of pigs in white sequinned suits dancing in a 70’s stylee.

All together now…

“Swine fever, swine fever, we know how to do it…”

This morning I listened to the media tell us: “Death! Pig death! Pigs lick you and you die! People in Scotland are dying RIGHT NOW! Don’t eat bacon sandwiches! Or watch Green Acres! Don’t read Charlotte’s Web! Don’t eat Mexican food! Don’t even think Mexican thoughts! Have you ever enjoyed a pinata? You’re gonna dieeeeee”

And then I went into work, where there was a bulletin issued that said “Well…yeah…there might be a wee bit of death. You should all wear sensible PPE, face mask, big white suit that makes you look a bit like a 90’s rave reject and goggles. Oh…and gloves…and totally wear these before you go in - that’s if the patient has been to any of the following places and has flu-like symptoms. We’re not sure how you’re meant to know if the patient is a Swine Fever risk (and thusly, that you should put on your PPE) without talking to them first. Hmmm…that might be an issue…ooh, look, kittens!”

And with that, the bulletin ran out of the room, then came back to shout “Also, don’t take them to A&E! Leave them at home!” before pointing at the kittens again and running away with “Peeeyoing” noises, leaving little clouds of dust.

It’s hard to take an impending pandemic seriously when the radio keeps saying “The people who have been tested positive for this, who we described as “well and stable” this morning have been improving in their condition all day.”

The media is, effectively, saying “You should be really, really scared about this disease, because the people that have got the disease? They’re not very sick at all. Really. They have the sniffles.”

But, you know, we’re professionals, so we assessed each call as it came up, thinking “Does this sound like someone who might have Swine Fever?”

And then we decided that, no, the 92 year old woman who’d fallen out of bed? Probably not just back from Cancun. And the man whose heart was beating a hundred and eighty times a minute? Probably isn’t phoning because he was all shivery and feeling a bit down-in-the-dumps.

The thing that made me laugh most, however, was the big posters on the front door of both the ED and PlayMobil Hospital. The posters on the door of the ED said “If you are the sort of person that the ambulance service might have to wear silly clothes for? Please tell us right now before walking around licking patients or coughing on people. Thanks”

The sign at PlayMobil hospital said “If you have recently returned from Mexico, USA, Canada or New Zealand, please inform reception.”

Which is brilliant, because NOBODY else was saying anything about New Zealand. I think PlayMobil Hospital was just totally against Kiwi people.

They’re just exploiting the medico-political situation, I tell you.*

*Is absolutely not true - I’m sure PlayMobil Hospital are dead nice, non racist people.


Apr 27 2009

What do I do?

Tag: JournalKal @ 2:34 pm

I went through a period, some years ago, of catching hold of older friends, colleagues and family and saying - “What do I do now? You’ve got the experience of life beyond here, I can look at a ten year old kid and smile at his neuroses and fears, I can recognise that he’s probably not going to be an astronaut as he wishes, but I can encourage him to dream it and have a go. You’re twenty, thirty, forty, fifty years older than me. Teach me.”

I got a lot of good advice.

There’s lots more right here - take a look.


Apr 23 2009

Qismet

Tag: Thrilling Installment, AmbulanceKal @ 4:58 pm

I feel a little sorry for Qismet.

He’s new, irritatingly young (”Radio Two?! Fuck’s sake, you’re as bad as my Dad!”) and starving for the next moment of life and death, blue light, screaming siren drama. He’s the newbie of the “Dear Newbie” post a few months ago. With the speed and volume that new staff are coming out of school at the moment, Qismet wears his four months road experience like a veteran’s medal for long service.

All day we shuttle back and forth between nursing homes and hospitals, enjoying the spring sunshine, looming like benevolent crags over our patients. Qismet’s taller and more baby faced than me (and I’m one tall, baby faced muddafugger). Old ladies gush over him, ” such a NICE young man”, young women want to take him home, he smiles shyly at them, shuffles his feet.

In the cab he cracks the filthiest jokes, pointing out legs and bums in short skirts that we pass on the pavement.

“Not my area of expertise, mate.” I remind him and laugh as he feigns exasperation at my inability to lust over the female form.

The shift is winding down for its midnight close when the phone on station rings. Moments later I hear Qismet over the building’s PA system.
“406, triple 9.”

I walk out to the vehicle yard, Qismet is behind the wheel already, engine running, looking as placid as a border collie with ADHD. He winds down his window and yells to me, “Kal! Hurry up! It sounds like a bad one!”

I give him my hundred yard stare.
“Shush! We don’t say stuff like that. What’s the job?”

“Female fallen from a moving taxi.”

I listen to his answer for scary words like “trapped” or “CPR ongoing” or “amputation” or “angry rhino” or “railway enthusiast”. The job sounds an awful lot like some drunk woman has hopped out of her cab before it’s come to a complete stop. I predict a sore ankle and a pissed off cabbie who’ll be complaining about how long we’ve taken to get there.

We head out, Qismet insisting that this is “the one”, me snuggled in my fleece, arms across my chest, watching the time. We finish our shift in twenty minutes…another late finish for us then.

In a small residential street there’s a police car, a couple of cops and a taxi - not a black cab, but a private hire vehicle with its hazards on. Lying in the headlights of the two vehicles in a crumpled heap of party clothes. One of the police officers strolls up to me - I’ve learned to use the police as a decent gauge of how bad a job is, since their level of medical training tends to make things look worse than they are. I once had a WPC tell me there was “pools of blood” on a garage forecourt and, when I went to look, there were three of them. Each about the size of a fifty pence piece.

If the cops aren’t bothered, chances are I’m not bothered. When they ARE bothered, then maybe I’ll listen.

This cop doesn’t look bothered at all.

“She’s been drinking all night, apparently she was steamin’ in the cab, gave the driver a hard time and then jumped out, she’s not making much sense.”

The patient’s lying half-prone on the tarmac, with her right arm trapped underneath her. She is not a small lady. I squeeze her shoulder.

“Hello? Hello my love, my name’s Kal, I’m a paramedic - gonnae open your eyes for me?”

She doesn’t move. I squeeze her harder.

“Open your eyes, love.”

Nothing.

Hmmm.

I stick my finger behind her earlobe and push hard against the top of her jawbone (try it yourself, it’s horrible). She doesn’t flinch.

I look left and right, I’m not keen to appear to be beating this woman up but if she IS just pissed, I’d like to know. Normally drunks can be woken up with some…vigorous stimuli. Rising up, I push my fingers as hard as I can behind her lug, jiggling them back and forth.

Her eyes twitch and she utters an “ugh”.

Her Glasgow Coma Scale is eyes 2, voice 2, motor 1. GCS 5.

7 and below is considered “comatose”.

I’ve had plenty of patients who were COMPLETELY unresponsive through alcohol, but most of them were sleeping on benches and hadn’t fallen/jumped from a moving vehicle. I button-hole the taxi driver.

“How fast were you going?”

She glances between me and the cops and wets her lips before answering.

“Not fast. I wasn’t going fast.”

“How fast?”

“Not fast, honest. You can see the road, it’s a small road, you wouldn’t go fast here.”

“Ok, but how fast?”

“Not fast. Really, not fast. Promise.”

For fuck’s sake. I breathe deeply and try not to shout.

“Look, just give me a ball park. Ten? Twenty? Thirty? Sixty?”

“I was in third gear. Only just in third gear.”

I guesstimate in my head that that’s going to be twenty to thirty miles an hour, the cops pop the driver into their car to take a statement, Qismet runs for the spinal board. With the patient’s dropped level of consciousness, I have to presume she has spinal injuries until we can prove otherwise.

One of the policemen is watching Qismet pull all the gear out of the ambulance and load up the trolley with increasingly worried eyes.

“She’s going to be ok, right?”

“Not sure at the moment, mate, need to have another look at her.”

“But she’s just pissed, isn’t she?”

“Right now? I’m not convinced that this isn’t LTP.”

The cops don’t like it when we suggest that incidents are Likely To Prove (fatal). It leads to a lot of paperwork. His eyes open wide, he looks the patient up and down, I sneak a peek at his badge number to see how new he is.

Pretty new.

He steps away and starts making worried calls into his radio. Qismet arrives with the gear and, with the assistance of the cop and a local resident who’s come out to see what all the fuss is about, we roll the patient onto the spinal board, securing her neck with a collar. She doesn’t move, flinch or groan when we do this, nor when we load her onto the trolley, or hustle her, wheels bumping and jigging over the tarmac, into the back of the vehicle.

This is my first trauma call as a paramedic. It’s feeling an awful lot like the scenarios Uzi and Benito would set us back at school.

Maybe if I pretend this is just a scenario, it’ll all be ok.

“Obs, please, Qis,” I say “BP, four-lead, SpO2 and a BM when you get a minute. I’ll sort some O2 and have a look at her, ok?”

He gets on with it without question, I start at the top, running my protocols through my head like thermal printer rolls gently spewing out onto the floor.

Response: still GCS 5, no change from outside.

Airway: clear in the position she’s currently in, but I wriggle an oro-pharyngeal airway into her mouth anyway, its lurid green flange bobs on her lips.

Breathing: yes, about 25 times a minute, which is a little fast for someone so unconscious. Alarm bells start tinkling in my head, drunk people aren’t normally tachypneic, what’s she wanting all that extra air for? I rip her shirt apart with my shears and sound her chest, top, bottom and sides. Air both sides, equal and loud. I rap on her ribs with my fingers, normal resonance, no trapped air or dulling blood. Good.

Circulation: she’s a bit peaky looking, pale in the face. I stick my fingers against her wrist and feel a rapid pulse, but only just. Its like a whisper against my fingertips, not the solid thump I was waiting for.

“Kal…?”

I look up at the monitor where Qismet’s been working, her heart is way, way too fast, her blood pressure horribly low and narrow. She’s bleeding somewhere, lots and lots. Enough to knock this young, fit woman into a shocked state.

There are five places you can lose enough blood to instigate hypovolaemic shock: “Four plus the floor”, chest, abdomen, pelvis and long bones. There’s no blood coming from her anywhere, so wherever she’s losing it, she’s hiding it inside her. I know her chest isn’t bleeding, so I pull the ripped teeshirt off her belly and take a look.

Her abdomen is ripped and grazed, red bruises rising up from the skin already. I palpate her tummy, she grimaces when I push on her lower abdomen, the tissue below my fingers taut and firmer than it should be. When I push on her liver she gasps, bangs her eyes open, lets out a cry.

When I push on her liver she becomes more awake than when I tried to dislocate her jaw with my fingers.

Push on your jaw again, really dig in behind your ear.

Her liver hurts more than that.

My heart sinks, but I check her pelvis and legs too, muttering hot, sweaty, hard-breathing thanks when they fail to bend under my probing hands

I feel very sick and very scared and very alone.

For years when I’ve felt like this I’ve called on the radio for a paramedic and they’ve come and fixed it all, they’ve taken the jobs where I’m lost and stuck off my hands and gone “Here, Kal. I’m the cavalry, I have all the answers and the skill to act on them. Go drive my car to the hospital, I’ll deal with this.”

It’s been my ace in the hole, my silver bullet - if stuck…call a paramedic.

And now it’s me. But the thing is, my ace in the hole appears to say “Mr Bun the Baker” on it, my silver bullet, on closer inspection, seems to be a rock wrapped in Baco-Foil.

She’s a big, puffy lady with an intra-abdominal bleed who’s dumping her pressure. She needs wide-bore IV access and aggressive fluid therapy to keep her blood pressure high enough to perfuse her brain and kidneys. When you shut those two down? You die.

I really don’t want her to die. She’s younger than me.

I strap a tourniquet around her upper arm and start poking and prodding around the crook of her elbow. I’ve never been able to hit veins in this part of the body, they’ve always evaded me, but aside from driving a needle into her neck, these will be the biggest veins available. I stick a fat spike into the skin roughly where I’d expect to find a blood vessel and come up with nothing. Even when I dig, pointing the needle out in sunbursts under her skin I still fail to see the flash of blood in the cannula that would tell me that I’ve hit gold.

Giving up, I instead push a smaller IV into her wrist, connect a bag of fluid to the port on the needle and squeeze the bag hard , shoving the warm water into her system as fast as I can.

Pish with the cock you’ve got, son.

I rattle my standby to Qis - “21 year old female, ejected from vehicle at speed, abdo trauma, hypotensive, GCS 5″

He nods, committing it to memory.

“ETA?”

I shrug.

“You’re driving, mate, whatever you’re comfy with. But listen, I’m going to be working back here. Get us there, but remember that I’m not strapped in, you can’t be throwing me around.”

He nods, biting his lower lip. He’s a good guy, is Qis, but sometimes he makes me feel old, old, old. Glancing in at the back with the nervous and excited anticipation of a fast crash-in to the ED he looks like a laddie left to tend the farm while the family’s away.

The first bag of fluid runs through as we pull away from the scene and I reassess my patient, stalling once again at “C is for circulation”. Her BP is still shit, her pulse still too fast and absent from her wrist. I wrap a grab handle from the roof around one of my forearms and line up another sack of saline, the bag swinging wildly from its hook in the ceiling. I stand and surf on the moving floor, pushing the fluids through hard, watching the BP constantly as its decline slows, stops and, painfully slowly, starts to improve.

Not out of the woods yet, but we’ve certainly found the footpath.

It strikes me that, while I’m running lines of fluid and obsessively reassessing the patient from top to toe, I’m not falling over. I’m not even holding on at times, Qismet is driving the ambulance like a limo full of Fabergé eggs and set mousetraps. I peek through the bulkhead window, expecting to see us cruising along at a gentle thirty.

Oncoming traffic slams past us at sixty, Qis setting the ambulance’s wheels just so as he corners, flattening out the bends, nipping around lumps in the road. It’s like standing on a gently bobbing boat, rather than the force 9 gale I’d feared.

Whattaguy.

The patient groans and I look back at her, her eyes are open and full of tears.

“Becky?”
“……”
“Becky? Can you hear me?”
“….es….”
“Cool. You’re in an ambulance, Becky. My name’s Kal, I’m a paramedic.”
“…red….”
“Sorry?”
“…’m…..ared….”
“You’re scared?”

She nods as far as the collar and head huggers will let her.

“Don’t be scared, hon. We’ll look after you, ok? Just trust me.”

Her eyes close and she drifts back to where-ever the critically shocked unconscious people go when we’re all fussing around them. The lights of A&E shine through the windscreen and minutes later she’s on a trolley in resus, x-rayed from top to bottom and Qismet is punching me in the shoulder.

“SEE?! It was bad! I told you it was going to be bad. You should listen to me about these things.”

We laugh, I congratulate him on his driving, thank him for his help. He blushes and legs it to the vehicle.

I grab a cup of tea and slurp it outside resus; I’m gearing up to leave when I spot the on-call surgeon, summoned from the wards upstairs to see my patient.

He prods and pokes her belly, makes concerned noises about her blood pressure and expresses a wish to scan her toot-sweet. The A&E consultant and he descend into acronyms and medical speak that far exceeds my understanding. But I’m happy enough with that, I’m not a doctor.

I’m a paramedic.


Apr 22 2009

Oooh - shiny!

Tag: Photography, JournalKal @ 9:40 am

So hey, if you were to wander over to the all new Scottish Ambulance Service website at www.scottishambulance.com, I wonder if while you were perusing its informative and engaging pages you might think “these photos are amazing - so bright and personable, so different from the normal corporate images that people drum out, I’d imagine the photographer is a young and vibrant man with a charming smile and a hyoooge winky.”

And d’you know? You’d be right*.

Always nice to see your work in print :)

*winky statements may not be true….


Apr 21 2009

Go read this stuff.

Tag: AmbulanceKal @ 10:26 pm

Mrs UHDD has emailed me and brought to my attention a campaign into Sudden Arrhythmic Death Syndrome and particular the risks of “Long QT Syndrome” - a potentially fatal and rarely diagnosed genetic condition that is woefully under publicised.

I’m all to pleased to point you guys towards the following article and these two charities:

CRY - Cardiac Risk in the Young

SADS - Sudden Adult Death Trust

Go on ahead and read their material, it’s valuable knowledge and not an issue that is often discussed.


Apr 16 2009

ADDC - Day 7

Tag: Abu-Dhabi DCKal @ 2:00 pm

Before the pirate party last night we had prayers and were assigned our roles for the next day. With Craig incapacitated, Gus relinquished his place in the control room and took a SAR seat on the 212.

I’m sure it was all in the interests of operational efficiency and nothing to do with the fact that he’d spent the entire week so far sitting in a gigantic yellow truck watching the race courtesy of a constantly refreshing satellite feed.

He managed to get out of the control room yesterday and performed the most beautiful maneouvure which was duly reported back to the rest of the team

. Riding out in the back of an aircraft with a pretty young journalist from Scandinavia, he chatted at length about our role and remit as the helo scudded over the sand.
“You’re all so brave…” she gushed, biting her pinky, stroking his chest.

Gus just set his jaw and smiled, the other medics in the helicopter grinned wryly at each other; let the boss have his moment.
Minutes later they were en route to an emergency, a vehicle on fire. The journo fizzed and quivered in her seat, Gus filled her in on the situation - the aircraft would land and he’d get out first, recce the situation and then return for the medics if they were required. It could have been scripted and as the helicopter swooped down onto the dunes, Gus had his hand on the door handle, ready to roll.

No sooner had the skids hit the sand than he had the door open, the howl of the rotors deafening, dust whipped up in storm clouds around them. He swung his feet out of the side door, stepped onto the ground and, head ducked low, began to run from the helicopter towards the crash.

Which should’ve worked well. Should’ve looked amazing. Should’ve sent our blonde pigtailed journalist colleague home with a mental image worthy of any Oliver Stone epic.

Except Gus was still wearing his headset.

And it was still plugged in to the ceiling of the helicopter.

So he only got a few steps away before he ran out of cable, yanking his head and neck back like an errant terrier on a retractable leash.

I’d love to read that journalist’s copy.

At prayers, the story was recounted in detail (with actions!) for the entertainment of the surrounding throng. Gus put his hands up.

“Fair cop. There’s beer in my car for everyone.”

I love working in a team that can laugh at themselves.

Come Thursday morning I was standing on the HLS with Booker and Gus. I wasn’t sure what to make of these two choosing to me to fly with them; either they don’t think I’m a total tool and are happy to work with me, or they’ve heard I’m a screaming incompetent and need to keep an eye on me. Either way, Booker was in a flight suit instead of his normal medics garb.

“I’m working alongisde Gus today, need to learn a bit more about the SAR side of things. So you’re the medic for the helo. If you need anything, tell me and I’ll assist, but other than that, you’re the clinical lead. OK?”

Cool.

Flying along with us is Laurie the cameraman from earlier in the week and a young photographer who we’ll call Nick (principally because I can’t remember his real name, and also because I think a wee bit anonymity might be nice for the laddie).

The two press guys were strapping themselves into “Monkey Harnesses”, essentially a chest and groin harness similar to those bouncey things you hang babies in in doorways, the strapping allowed them to be secured to the aircraft and hang out of the side door to take pictures and film. Once airborne I watched jealously as they sat on the door sill, feet on the skids, the helo swooping along only a few hundred feet above the racing vehicles below. My bench seat and lap belt on the far side of the aircraft leave me a long way from the action.

We chase cars and bikes for a while, then slide the door closed to cover distances faster,closing on the lead racers. Nick the photographer closes his eyes, wipes cold sweat from his forehead and taps my knee. I look up at his pale face and he mimes opening a bag.

No bother, mate. I grabbed a “SicSac” from the aircraft yesterday, just because its name and design made me laugh. The text on it was lovely “Even veteran air travellers are subject to occasional motion sickness.”

DSCF6010

Nick leans over the bag and ralphs his hoop into the bottom of it. The smell is horrendous, I’m not a great one for vomit’s individual bouquet, but here in a hot, vibrating, cramped metal box it’s worse than ever. Booker takes the bag from Nick, ties the top and slings it out of the side window. One advantage of the Empty Quarter is the chances of hitting anyone with puke from above are greatly reduced.

I am deeply, deeply pleased about the fact that I took motion sickness tablets this morning. They mean that I can join in with the “Amused, sympathetic and somewhat world weary” looks and grins that Laurie and Booker are giving Nick. Don’t worry son, happens to everyone, don’t feel bad. Look at me, I’m so at home in this chopper I’m practically in Air Wolf.

We fly some more, Laurie shoots more film, Nick forces himself to take pictures but after twenty or so minutes he scrawls a message on a piece of paper. The resultant conversation was so brilliant, I saved the notes and photographed them once I got home. I share them with you now.

Note one was from Nick to Booker and read:

DSCF6013

That’s “When R we going back bivouac?”, for those of you struggling with the handwriting. Note the desperation in his penmanship. Note the phrasing, not “How long are we out for?” Or “What’s our destination?” but “When R we going back bivouac?” Poor guy wasn’t feeling well and wanted to go hoo-oome.

Sadly, a dose of pukey guts isn’t reason for the helo to turn around and take people back to the camp, so Booker compromised with him.

DSCF6014

For some reason, the word “Check Point” is abbreviated to “PC” out here. I have no idea why. Unless we’re dropping Nick with a police constable, but I can’t see a reason for that. Making the back of the aircraft smell of spew is hardly an arrestable offence.

Nick gives us the thumbs up at Booker’s suggestion and we start making for the nearest checkpoint. He remained pale and sweaty for the journey, burping and repeating his “bag” mime for us.

I pass the following note to Gus, sitting alongside Raph the pilot.

pukebagsv1

He adds a simple answer.

DSCF6012

Shit.

I dig in the medical bag and come up with a ziploc bag full of needles and IV dressings. I pour the contents of the start kit back into the rucksack and Booker glares at me, gesturing towards the mess I’ve made of the kit. I remonstrate with him:

DSCF6011
(note “#/52″ = weeks, A/L, annual leave)

He grins at me behind his shades. Nick fills the bag with vomit.

Touching down at the checkpoint we watch Nick walk off on wobbly legs and Gus, Booker and I stand in a line, pissing into the sand.

I broach a cheeky subject.

“Sooo….Gus?”
“Yes?”
“Strikes me that, with Nick gone, there’s a spare monkey harness and a space on the skids…any chance of a shot?”

Typically Gus, there is no “Yes/No”, but a reserved “I can’t see a problem with that.”

Ya dancer, I’m going to *fly*.

I’m no sooner celebrating being trusted to fly on the skids when we receive a text message - a rider has decked off his bike outside this checkpoint but ridden in regardless. He’s right here, can we check him out?

He’s under a gazebo with his team mates, the same team, as it transpires, as the vocal man who complained so very unpleasantly the night before. The patient is alert and upright, no head or neck pain, but reports coming down hard on his right hand side. I prod and rub his shoulders and collar bones, run my hands down his chest and apologise when he yelps as I push on his ribs. The pain is clearly awful, he grimaces and squints as we walk him towards the helicopter.

Back home I’d shoot him full of morphine to make the journey bearable, but thanks to the UAEs laws regarding benzoes and opiates, we’re stuck with paracetamol and ibuprofen derivatives.

His team mates have already stuck a horse-sized Voltarol down his throat and he’s disappointed to hear that that’s all he’d get from us as well. We sit him on the bench seat, Laurie and Booker sit alongside him and I sandwich myself onto the floor,leaning against the response bag.

No open-door skid riding for Kal today. Can’t help thinking the patient might feel it was a little off that he’s sitting suffering while his medic hangs out in the breeze going “Wheeeeee.”

We all ride in silence, the rotors make conversation near impossible. I write in my note book “Name: DOB: Team: Home Address: Next of kin:” and hand it to the patient to complete. I have no way of gauging his pain other than monitoring his pulse and face. We’re twenty minutes from the hospital.

Ten minutes into the journey I’m aware that Booker, Gus and Raphael are all discussing something in earnest, their hands flying up and down the to “press to talk” buttons in the ceiling that opens comms on their headsets. They’re clearly talking at length, their hands are busier than a group of swotty school children.

I look out the window and realise that while I’ve been focussing on my patient, the conditions outside have deteriorated rapidly. A sandstorm howls along, the wind is high and the loose sand and dust blast against the side of the aircraft. Raphael slows the helicopter down and climbs higher, I assume to avoid the worsening visibility at lower altitudes.

Booker passes me a note:
DSCF6015

I nod and watch as Booker shows the patient the same information. The patient, by the looks of things, couldn’t give a shit where we go, just as long as the pain his ribs abates sometime soon.

I’m settling back down for the long flight to the bivvy when Booker hands me a second note.

DSCF6016

Now I’m listening, a hot off-load is one where you don’t shut the rotors down before disembarking, just dump the passengers as fast as possible. I’ve been warned about them, warned about the risks of low rotors, about flying debris. I pull my Buff up over my mouth and nose and my goggles down over my eyes. We touch down at speed, the skids bumping and banging on the concrete expanse, nothing else to be seen.

I write a note to Booker and he replies.

DSCF6017

The patient doesn’t have a clue what’s going on, we don’t have the time to update him, so the first thing he knows is the aircraft is on the ground and the door is being flung open. I slide out, ducking my head from the blades and reach out for his hand, leading him out onto the tarmac. The briefings are loud in my head and I put my hand on the back of his neck, pushing him into a half stoop and running with him from the aircraft at a ten o’clock angle, just like they said. The noise is deafening, the sandstorm and downwash make visibility almost non-existent. Fifty feet from the heli I turn and look back, expecting to see Booker or Gus following with my kit and jump bag.

I turn in time to see the side door slam and the heli lift off into the sandstorm.

Oh.

Bye then.

With the downwash gone, things are quieter, but the stinging sand blast of the storm continues to scratch our bare arms and my patient’s face. I look around and get my bearings, we’re in what appears to be an abandoned car park, no cover or shelter, save for a small brick wall over the otherside. I lead my patient to it and we hunker down into the lee of the wind. More comfortable now, thanks to the painkillers, he tells me about his family, his history, his racing career. I’m grateful that he’s so well, my kit is still in the aircraft. I’ve got a stethoscope and a tourniquet in my pockets, so I’ll be fine if he suddenly develops an undiagnosed chest infection, or develops a catastrophic bleed from one of his extremities.

Other than that, I’m screwed. I don’t even have a mobile with me to contact Control. I’ve nothing to do but trust Booker and believe that Patch will arrange an ambulance for me.

And, sure enough, ten minutes of anxious waiting later, a red and white ambulance appears over the horizon, lights flashing and siren howling. I walk my patient across the car park to the vehicle and am met by three members of ambulance staff, a driver and attendant, both in natty wee blue waistcoats. They look a lot like they should be standing at the door of a large superstore, greeting people. In the back is a slightly manic nurse, he leaps from the back door as we approach, an unsheathed cannula in one hand. I back away from the open sharp, the nurse grabs the patient and hustles him towards a spinal board on the floor. My patient isn’t keen and, in fairness, I can’t see a reason to lie him down, since I’ve been marching him around and sitting him up without strapping him to a backboard. The patient pops himself down on the bench seat alongside the stretcher, the nurse sits beside him and I squeeze myself down onto the stretcher. The vehicle is small, laid out similar to mine at home, but without the shiny toys. This is a van for driving people to hospital. I can’t imagine trying to run an arrest in here, I can’t stand up, for one thing, plus with the patient on the floor.

The nurse is staring at me quizzically.

“You are a doctor?”

I shake my head.

“Paramedic.”

“Oh. From America?”

“No, from Scotland.”

“How much money do you earn?”

Scuse me?

The patient, a Scotsman now living in UAE is giggling to himself, the nurse persists.

“How much money?”

“Enough.”

“But how much?”

“Its ok, it pays my bills.”

“Oh yes. I see.”

I smile at him, pleased we’ve come to an understanding.

“But how much?”
The patient is still laughing, the nurse continues.

“Two hundred? Four hundred?”

“Dirham, or pounds?”

“Dirham.”

“In a year?”

“In a month. How much dirham in a month?”

I do the maths and tell him. His eyes turn to saucers. He tells me he earns 400 dirham a month. That’s roughly 80 quid.

We’re at the hospital in fifteen minutes, a welcoming committee of nurses and orderlies stand in a polite line outside the entrance to the emergency room. Smiling as they are, my patient seems a little apprehensive and reaches out for my sleeve.

“You’re sticking with me, mate, right?”

In fairness, I don’t know where I am, I have no car, no phone, no money, no contact details for any members of my team and there’s a force 9 sandstorm blowing outside. I couldn’t go anywhere if I tried.

The patient is taken into a room with a smiley wee lady who introduces herself as “Sister Dahlia”. She’s friendly and welcoming, greets me by namem explains that “Mr Sean” (Patch) has phoned ahead and alerted them to our impending arrival.

A group of nurses start to undress the patient and I can feel myself getting sidelined; I remember watching Christina in hospital earlier this week and have my lines all ready.

“Can I speak to a doctor, please?”

Sister Dahlia nods and smiles, shouts down the corridor and a doctor in a white coat strolls into the room. He listens politely to my handover, has a brief chat with the patient and then turns to me.

“I think xrays of wrist, arm, shoulder and chest. Do you agree?”

Uhhh….I drive a van, mate. Sure, why not?

The patient is rolled away to Xray and I take a seat in the corridor, a nurse brings me a glass of iced water and I catch a glimpse of myself in a mirror - goggles and face mask, desert camouflage and huge sand boots, my face still bearing the daft wee pirate moustache and van dyke I shaved into it for last night’s party. I look like an villain from a Biggles novel, or a 1930s boys’ adventure annual.

Sister Dahlia chats to me while we wait for the patient to return with his films, she tells me that the hospital is fully equipped to supply a wide range of services, but the lack of skilled staff means that they’re limited to running a basic A&E and GP service. Upstairs there’s operating theatres, ICUs (adult, paediatric and neo-natal) and rehabilitation wards. All lying empty.

“How come?” I ask “Can’t you afford to staff it?”

“We can afford it, but they’re not interested…this country, they put up buildings, build these hospitals and once they’re done, they don’t want to keep them running. We do what we can, but….”

She flaps her hands in an exasperated gesture, just another health care worker struggling to do the best job with limited resources.

An orderly rolls my patient back down the corridor, an envelope of xrays tucked under his arm. I’m invited into the doctor’s office to review the films.

I’m no radiographer, this isn’t my area at all, but the doctor’s concludes that nothing appears broken, that the chest pain is “probably just cartilage damage” and that his aching shoulder isn’t, as we feared, a sprung AC joint.

The doctor leads me into his office where the patient is sitting fearfully, he listens to the doctor’s diagnosis and, after each statement turns to me with a question on his face. I nod along, reassure him. We come to the end of the consultation, the doctor writes up a prescription and the patient asks me “Is that ok? Will that work?”

The orderly goes to resecure the sling around the patient’s aching shoulder and struggles with the design, unfamiliar with the arrangement of straps and velcro. The patient leans back in the chair, looks over the orderly’s shoulder and catches my eye.

“Kal? Mate? Please?”

I tighten the sling up, support the arm. I’m humbled and flattered by the level of trust he places in me. We walk together back to the waiting room where I bump into Gus, who’s driven up to collect me. I get him up to speed on the patient’s situation and ask if there’s anyway we can give him a lift back to the bivouac.

“There’s only two seats, mate…” he begins, glancing at the patient sitting on the plastic chairs, looking sorry for himself. Sister Dahlia approaches and I break out my “charming young man” role.

“Sister Dahlia, I want to thank you and your staff for looking after me and my patient so well this afternoon. Really, your service has been outstanding.”

I turn to Gus and fix him in the eye.

“I’m assuming we still have emergencies outstanding, boss?”

He looks at me blankly for a moment before my insistently raised eyebrows get the message through.

“Oh. Oh. Yeah, yeah we do…”

I turn back to Dahlia.

“Sister, we have a number of other patients that we need to attend to, but this patient here needs a ride back to our bivouac at Tal Mareeb. Is there anyway you could organise transport back for him?”

“Of course!” she beams “I will arrange an ambulance immediately.”

Gus and I shake hands with Dahlia and our patient and head back out to Gus’ car, he laughs and shakes his head at me as we drive back to the bivi and at prayers that night, after fines, I’m given “kudos to Kal, for blagging an ambulance for his patient.”

There’s worse things to be in this world than a charming young motherfucker, every now and again it pays off in spades.

We wrap up the evening with cold beers, I’m disheartened to hear that I’m back on sweep for the final day; I don’t relish another day baking in those trucks, but the job rolls on. We finish tomorrow in Abu Dhabi and I spend the evening packing my gear, ready to load onto a truck that Baz will drive to the finish line for us. I settle onto my cot for the last time, sleeping soundly through the roaring engines and diesel fumes. I’m woken in the night by a mouse who scampers over my sleeping bag and perches on my legs…and to think I was worried about scorpions and camel spiders.

A mouse? I can handle a mouse.


Apr 13 2009

Any paediatric anaesthetists reading?

Tag: Thrilling InstallmentKal @ 6:39 pm

Edinburgh was hoaching today, the sunshine bringing the holidaying crowds and long-weekenders out.

Lights on, we cruised along the path in the zoo, waved in towards our patient by staff in black fleeces. The guided tour bus was ahead of us and struggled to let us pass, but we weren’t worried- the job wasn’t sounding too serious, a three year old male fallen, with a possible broken arm.

Nobody was dying today.

We attracted interested stares as we passed, but they left us alone as soon as we stepped out of the vehicle. The folk who can afford the forty quid for Mum, Dad and two kids to get into here aren’t likely to be the class of rubber neckers we typically find on the street.

The kid was sitting on his Dad’s knee, the only “query” part of his “query broken arm” being the fact that I couldn’t physically see the snapped ends of his ulna. The banana bend of his forearm made the diagnosis fairly straightforward -that and the fact that he wasn’t for letting anyone- not me, my mate or his parents - anywhere near the warped limb.

I popped the mouthpiece of the Entonox (Nitrous Oxide/Gas & Air) into his mouth and gently pushed the assist valve, releasing him of the odious responsibility of breathing it deepy. Instead I poured a steady dribble of sedative gas into his mouth and let him breathe normally. In a minute or so he grinned at me, giggled and closed his eyes, his head drifting back towards his Dad’s shoulder. His episode of relaxation and painlessness gave me just enough time to pop his jacket off and whip a fast sling around his injured arm.

He was carried to the vehicle and laid out on the bed, monitored and I head-to-toed him for any other injuries, finding nothing.

En route to hospital he dozed, his eyes finally closing firmly shut and sleeping soundly. His Mum was worried - “Should we really let him sleep?”

“Aye, no bother” I reassured her with established knowledge, “It’s perfectly normal for them to have a snooze after they’ve hurt themselves.”

She was happy with that, but as I looked at him I wondered to myself - “WHY do kids fall asleep after they’ve hurt themselves? Is it adrenaline come-down? Are their systems on such a tight-rope of energised vs exhaustion that a relatively minor injury knocks them out? Is it a stress response? Maybe he’s really susceptible to the Nitrous, but it normally burns off from a patient’s system within minutes…and the oxygen I’ve got him on should counter it rapidly.”

It struck me today that my Paramedic course will make me question my Technician skills and knowledge. So I turn to you.

I’d be thrilled to hear from anyone with an opinion on what happened with my patient today, why would a kid with perfect obs, no history of head trauma or KO and an injured extremity be so very drowsy? Be you professional, parent, patient or all three, get in touch.

Answers on a postcard, please.

On the subject of postcards, pictures from the desert will come along at the end of the ADDC journal. There’s a bunch of them to sort out.


Apr 11 2009

ADDC Day 6 - Part II

Tag: Abu-Dhabi DCKal @ 2:52 pm

Back from sweep the team congregates in the clinic to swap stories. There’s a party planned for the evening, a pirates themed fancy dress party. Though the society out here is restrictive when it comes to alcohol, there’s a bar in the bivi. A quick glance at the prices makes me thankful I picked up a bottle of rum at duty free on the flight in.

No mixers, though….

I catch up with Gus - can I borrow your car? I’ll nip into Liwa and buy some cokes.

“Just speak to Baz.”

I sigh inwardly. Baz is a lovely guy, but he drives like a scared pensioner. The 45 minutes to Liwa will stretch out to an hour and a half at his driving speed.

“I really can’t be arsed sitting in Baz’s bus for three hours, mate. Can I not just pinch your motor?”

“What? No, I mean, just SEND Baz.”

The idea of sending a man old enough to be my dad on what will likely turn out to be a two hour round trip just to buy me mixers feels a little uncomfortable.
“Are you SURE, Gus? I mean…”

“That’s what we’re paying him for. That’s his job.”

Fair enough.

Sitting outside the clinic is Craig, one of our SAR guys. He reclines in a plastic garden chair, his foot up on another, wrapped in compression bandages.

Yesterday while we were hanging around upsetting checkpoint staff, Craig and his aircraft were despatched to a rider with an arm injury. They touched down at the incident and Craig turned to the pilot and asked “Are we ok to go?”

“Ok to go.” the pilot apparently replied.

Craig’s role is to get out of the aircraft first and then let the medics out, leading them along a safe path away from the rotors. He’s the first liasion between the medics and the pilot.

He opened the door, put his foot onto the skids and stepped onto the ground.

Except he didn’t.

Somewhere along the way there’d been a miscommunication between the pilot and him. The aircraft wasn’t on the ground, it was still hovering. The down draught and dust and debris that were thrown up left Craig blind as he disembarked.

He describes his gut clenching as he stepped off into oblivion, not knowing how far he was going to fall, not knowing if it was 8 feet or 80. Thankfully it was the former,but when he hit the deck he felt his ankle give way beneath him and commando crawled away from the aircraft. Putting myself in his situation I’d be terrified of those rotors - if the helo isn’t where you thought it was in the air, maybe it’s coming down after you, maybe it’s banking, maybe the blades are turning into the sand.

Lisa and I have a standing joke in the bivi, like Queen Victoria refusing to outlaw lesbianism because the idea was so abhorrent to her it couldn’t exist, we don’t talk about how helicopters are the most dangerous form of air travel. We also don’t talk about scorpions and big spiders. Sorted.

Craig was fortunate, one of the medics working with him was Tom, an orthopaedic surgeon and they got him patched up and xrayed at the nearest hospital quick-smart.

No more flying for him this year. He works in the Control room for the remainder of the week.

Inside the clinic a rider has presented with fatigue and muscle cramps, diarrhoea and vomiting. Classic dehydration, as we’ve seen in dozens of patients all week. Several of the medical team have suffered from the same thing, we’ve nursed each other through it. This rider lies on a cot, a drip in his arm while we encourage him to sip Dioralyte.

Everything goes swimmingly, people slip away to their tents and change into their pirate outfits. I am completely underdressed - I thought I’d been rather inventive with my kilt shirt and sash, but Booker has an entire pirate-in-drag costume. Christina is dressed as a cross between Captain Hook and Peter Pan, all stripey jagged edged knickerbockers and tricorns, Rolf has earrings that would put Pat Butcher to shame, a stripey vest and enormous cutlass. Tom has a blow up parrot on his shoulder that is bigger than his torso. We all look terribly silly, but it’s a good laugh.

Until the dehydrated patient’s friend arrives.

He isn’t happy, wants to know what we’re doing for the patient and why we’re not cas-evaccing him (in the dark!) to the nearest hospital. We explain that there is no need to attend hospital, that we’re treating him as we treated ourselves.

He isn’t interested and starts asking various people “On what basis are you making your decisions?”

Christina quantifies things neatly - “On the basis of my fifteen years experience as a physician.”

He becomes increasingly belligerent, aggressive, shouting and swearing. Honestly, I thought I’d left tossers like this behind when I left Edinburgh.

The medical team are quiet, calming and professional. Patch steps in as our leader and helps sort things out.

It’s distressing and disappointing, but a part of me can’t help giggling at the sight of my colleagues arguing and reasoning with a huge man while they’re all dressed as pirates. Surreal doesn’t come close to it.

Things calm down and we gather around a campfire outside the clinic, people get pissed, the lovely Sarah (one of the race staff) dashes around drawing tattoos on pirates. I get an anchor on one leg with “Marrrrr” and “Parrrr” written beneath it and on the other she’s about to draw a skull and crossbones when I stop her.

“I don’t WANT a skull and crossbones.”

“But I’m really good at them.”

“EVERYONE’S got one. I want something different.”

“I’m quite good at chickens…”

“Nut. I want a tiger, fighting a dragon, on a skyscraper.”

“But…”

“You heard me.”

She gets stuck in. It’s a masterpiece.

I retire to bed with a fuzzy head around 1am, the party runs on while I sleep.


Apr 10 2009

ADDC Interval

Tag: JournalKal @ 12:34 am

I’ll tell you more desert stories soon.

Right now it’s 1am and I just finished my first week at work as a paramedic.

I was kinda thinking I’d be breaking myself in easy, maybe the occasional prophylactic cannula here or there.

Instead my week has run as follows.

Fatal RTA that I can’t talk about, where I utterly failed to perform any useful advanced techniques at all.

Young man with heart rate of 35, IV access and atropine.

Old dude with left bundle branch block and pneumonia, IV access.

Cardiac arrest that we left at home, no paramedic interventions.

Old lady with hiatus hernia, morphine and anti-emetic drugs up the wazoo. This was interesting, as I haven’t been issued with morphine yet, despite being licensed to use it. Had a motorcyle RRU come out with some for me, kind of like the dodgiest pizza delivery ever. “If we don’t bring you your controlled opiates in twenty minutes, you get a free garlic bread!”

Cardiac arrest I totally can’t talk about; getting IVs into dead people is *hard*. Why did nobody mention this? I jagged this patient three times and missed them all. Had to explain on the report form why they appeared to have been stabbed in the neck, elbow and wrist with a fine, sharp implement.

Female ejected from vehicle, sending out worrying “Hmmm…I think I may have ruptured something and be bleeding into my belly…” signs, terrible blood pressure. IV access and aggressive fluid resuscitation.

That’s not to mention the countless other walk on/walk offs, minor bumps and bruises and all the other typical rubbish we deal with on a day to day basis.

Thankfully, on some of these jobs I’ve had back up from other paras or emergency doctors, so where I’ve floundered they’ve helped and supported me. On others, it’s been just me and my partner and I’ve realised “Shit…this is my job now, innit?”

Tonight I’m going to bed feeling like a paramedic.

And it feels fine.


Apr 08 2009

ADDC - Day 6

Tag: Abu-Dhabi DCKal @ 9:54 am

Day 6

My oh-so-clever sleeping arrangements of the previous night fail to take into account the fact that extreme rally drivers probably aren’t all that careful with their vehices and there may be mechanics working on said vehicles for some time after dark.

And by “may be” I clearly mean “are certain to be”. Also, by “some time after dark” I clearly mean “all motherfucking night”.

From sunset until I wake at quarter to five, they hammered and welded, testing their motors, revving engines and hurling bikes and quads up and down the dirt tracks that circle the bivi. I clamber out of bed and dress by the light of a head torch. Rolf will be up in an hour , but I remember how lovely that extra hour was for me the other day when he was getting up early. Breakfast is a hurried affair, I pack sausages, bacon and rolls into a polystyrene box for the sweep drivers who won’t have an opportunity to eat before we set off.

Baz drops me off at the Liwa rest house, a decrepit building with crumbling baroque stone work, populated by hundreds of screaming, yapping finches, their shit dribbling down the flaking plaster facade. There’s a concierge, an eldery man in a stained robe who holds holds the door and points for me when I ask my one piece of pidgin, phonetic arabic. “WC, fen?”

Ablutions complete, I introduce myself to the sweep team, hand over breakfast and am claimed by a driver. We all head out of Liwa in convoy,swinging off the tarmac at an anonymous and apparently unmarked spot and cruising into the sands. The drivers leap out of their trucks and begin letting down their tires, softer wheels have a greater surface area and are less likely to dig themselves into the loose sand. The team is clearly tightly knit, they’ve worked together for years and I struggle to break into their conversation of race and leg leaders, mechanical intricacies and engines.

“Do we follow the riders, then, or what?”

One of the drivers grins at me “Its sort of like running with the bulls, we’ll let most of the pack pass us, then head along the rally route. The remainder of the riders will overtake us as we drive, we normally arrive a checkpoints alongside the slower racers.”

He’s barely finished talking when we hear the distant thumping growl of a quad. It’s amazing how much noise these little things make. When they’re idling it’s easy to mistake them for an approaching helicopter. The red quad comes screaming through the concrete underpass we’re parked beside, spitting sand from it’s back wheels as they dig in to power up the side of the adjacent dune. The noise is awesome, the speed exhilirating and I’ve hardly time to turn to the sweep team and grin when another six bikes and quads hurtle past in quick succession.

The drivers are mildly entertained by my excitement and smile in good humour before tucking back into the cold sausages and flat bread I brought from the bivi. Fully breakfasted we pile back into the vehicles and head into the desert after the racers.

Desert driving is a skill I know nothing about and my driver fills me in briefly on the concepts behind it. Keep the wheels turning, keep the momentum up and pay attenion to the other drivers’ tracks ahead of you. We’re the middle car of our three vehicle sweep convoy, the first seems to have the hardest job, picking a route over and through the dunes for the rest of us.

We start off on small dunes, gently rolling waves of sand but within a few minutes we’re driving up the sides of sheer slopes, swinging the vehicle back and forth as we climb like a shepherd climbing a tough hill. At the top of each one we pause, check our route down and then plunge dizzyingly down slopes several storeys high at angles up 80 degrees. The drop is amazing, the floor comes up to the windscreen fast and I’msure the front of the truck will bury itself and we’ll flip end over end, winding up upside down in the desert. But the driver’s competent and guns the truck hard, spinning the bonnet back up onto the flat.

It strikes me, again, how dangerous the terrain really is, you wouldn’t want to be Joe-Shmoe in a hired 4×4 out on a day’s jolly. These are proficient drivers handling these vehicles, but we still get stuck at times. The trucks ground on the arretes between the dunes when they drivers don’t push them hard enough; huge sand bowls suck us down sideways, the tires drifting laterally away from under the vehicle. At one point the first truck vanishes sharply over the top of a dune and the lead driver’s voice comes back “That’s a bit of a sharp one.”

My driver hits the arrete hard, the bonnet slams down near vertically, an inadvertent “Ohhhh you mother fucker” slips out of my lips, followed by nervous laughter when we make it out the other side.

We follow this pattern hundreds of times through the day, the windscreen shows me sky, then sand, then sky, then sand. I’m tired, very very tired, the car is hot and, as the driver explains, “The AC doesn’t work too well in my truck if the vehicle is working hard.”

“Like, working hard like dune bashing?”

“Yeah, like that.”

I struggle to stay awake, the rocking of the vehicle, my driver’s concentration cuts down on his conversation and the heat (which I later discover tops out at 52 degrees today) is immense. And when he says the air conditioning doesn’t work? He doesn’t mean it doesn’t work. When it stops working, it blows oven-hot air into the car. My head nods up and down as the truck roams over the dunes.

My eyes won’t stay open, the motion of the vehicle rocks me to sleep but my brain is yelling hard that I’m working, with a stranger, that this is my first time working on this event, that I have to make a good impression.

My eyes flip open and closed; I start to micro-sleep, dreaming as soon as my eyes are shut. The images from my dreams are over-laid on top of the view through the windscreen, waking and sleeping merge irretrievably. I am, effectively, hallucinating.

An alligator marches, grinning, down the side of a sand bowl. I see it clear as day.

The lead vehicle transforms into a massive, green John Deere tractor. I mention this to my driver. He glances at me nervously before returning his eyes to the sand.

We do this for hours.

There are no patients.

We recover one motorbike, I stand aside and photograph the team as they load the bike onto the trailer.

By the end of the evening we park up on a ridge, overlooking a fodder farm in the valley below and the lead vehicle breaks open a cooler full of beer.

We sit, six blokes in the desert and drink cold lager, watching the sun begin to set in the distance.

The team chat to me, they ask about my job and I ask about theirs, we understand each other, we natter about home and families.

They drive me back to the bivouac.

Patch seems concerned by my knackered face, he apologises “It’s a part of what we do here…”

I’m not bothered in the slightest.

Sure, I’ve had a long day and it’s not been exciting.

But I’m here to work, to do my job.

Back in Edinburgh I frequently work long days that aren’t exciting.

This is what I do.

It’s just today…I did it in the desert.


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