Life on the road

Alex Grant

Faculty: Medical Science
Course: BSc (Hons) - Paramedic Science
Category: Allied and public health

27 April 2016

I am writing this blog post, just as I return from my eighth front line shift on an emergency ambulance with the London Ambulance Service. In other words, our first year placement block has begun! I am at the start of my 10-week block placement, where I have been paired with an operational paramedic who acts as my mentor. As it runs through the block placement system, I have been following the same rota as my mentor, so far I have had a mix of late, day and night shifts.

I can remember my first shift like the back of my hand and it’ll be a memory that sticks with me for a long time. It was an eight hour long late shift (16:00-00:00) where we had four patients to attend to. Of these four, we put in a pre-alert/blue call to the receiving hospital for two of them! A blue call means the patient can be in a time critical or worsening condition and often needs paramedic skilled interventions in the field and needs to be transported to hospital under emergency conditions with blue lights and sirens.

My first blue call was a man who had taken an overdose, which is very common in London. He presented with a reduced Level of Consciousness (LOC) and was changing from a GCS score of 7 to a score of GCS 3. GCS stands for Glasgow Coma Scale, and was originally created for the use of assessing a patient’s conscious level with a head injury, but is now common practice across the board. Later on in my shift we saw our patient in the Resuscitation Room, fully intubated and about to go to a CT scan; the consultant told me he had deteriorated further after we left. My second blue call (and last patient of the shift) was an elderly lady in a hotel room in Central London with difficulty in breathing. Again, another common medical condition but can easily be indicative of something much more severe. We immediately administered  oxygen therapy and decided to take her observations/vital signs in the hotel room. Her blood sugar levels came through as 28.3, way above the normal reading of between 4-8 and a pulse rate of 175! Once in the ambulance I auscultated her chest to assess her breathing, only to discover fluid in the lungs. After doing a full 12-lead Electro Cardiogram (ECG), it came through as showing Left Bundle Branch Block (LBBB). We proceeded to place the blue call in as LBBB and Pulmonary Oedema.

After that first eventful shift, it would seem the rest would suitably follow as being equally as busy! Almost every shift I have had there has been a blue call or two put in place.

I recently went to my first cardiac arrest on a night shift as a crew of 3, and we arrived at the address at the same time as a solo Senior Paramedic responder. The call came through as a respiratory arrest, and we walked into the patient’s room to find he was on a hospital bed and presented with a big airway obstruction. He was foaming at the mouth, and his carer could not lift him onto the ground. Within about 10 seconds of entering the room, we had lifted the patient onto the floor, established 360-degree access, and started basic life support as he was not breathing and did not have a pulse.

Following all the cardiac arrest protocols was relatively easy; as there were four of us it was easy to delegate roles and the Senior Paramedic got on the airway and ascertained leadership of the resuscitation efforts. It was exhausting doing chest compressions, and it can really strain your lumber spine and legs if you do not swap with a colleague frequently. After a ‘down time’ of 38 minutes we eventually achieved ROSC (Return of Spontaneous Circulation). This meant he had a strong pulse (carotid, radial and femoral) however, he was still not making respiratory effort. He was a young man in his 30s with learning difficulties and suffered regular seizures. After stabilising the patient we quickly developed an egress plan and lifted him to the ambulance, down the very tight and narrow flight of stairs. A few days later we asked the nurse at the hospital to check up on his condition, only to learn he did not survive. However, because of the out of hospital interventions we did, his family were able to travel the long distance to see him for one last time in the Intensive Care Unit to say their goodbyes.

As well as the many sepsis calls and the cardiac arrest, I have also attended a firearms incident, a miscarriage and palliative care. It’s not all trauma and death; the vast majority of our calls we attend do not require an emergency ambulance response. In one of my shifts we went to nine people who had all dialled 999 for an ambulance; only three were conveyed to hospital.

I will write another blog post as soon as I can, thank you for reading!
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