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Contemplating life.

The other side of the LAS (or: turning night in to day)

The Opera was great. Whilst standing on the escalator getting to the tube platform, the name ‘Berlioz’ caught my eye – the composer of “The Damnation of Faust” – which also caught my eye, right next to his name. What a great idea for a night out, get some culture and some decent classical music in to me. Internet -> tickets -> London Coliseum -> what an experience. If this was an opera blog, I would write more…but it isn’t, so I won’t. I will still thoroughly recommend the performance to anybody even vaguely interested.

I got back to my hostel at a round about midnight. I was dreading having to get up early the next day; I had agreed to pop in to LAS HQ and visit @Melph, who kindly offered to show me around their call taking and dispatching facilities. His shift finished at seven, so I would have to be there at at least half past six, adding time to get there, wake up, eat, shower…ugh. I reluctantly set my alarm for 0530hrs, mildly comforted by the fact that I would be joining some of the guys from the control room at the pub after they had finished for the day (night). Questionable if I would stay awake though I think to myself as my head hits the pillow, desperate to secure as much sleep as possible in the short amount of time remaining.

Jackhammers are tearing through my ears, ripping me from my sleep. I am being bombarded by a choir of snores by the three argentinian blokes that I share the room with, one worse than the other. First they snore in subsequent lines, as if not to disturb the other, politely emphasising the individuals snore-solo with their own silence, but only to kick in once it is their turn in the arrangement. After a couple of minutes, the orchestration calls for harmonised snoring, each taking their own vocal (well, snore) range: bass snore, mid range snore and treble snore. They all have their own individual lines which fit together in perfect harmony and complement each other. The chorus hangs on a little, then slowly builds up in a crescendo to an ear bursting climax; all snores melting together in to one almighty, all frequency encompassing snore – truly breath- and sleep-taking stuff. It is followed by a bass solo, so low that it seems the window panes are reverberating. I can’t stand it any longer; I let out a lard “SSHHH”. Nothing. A second “SSHHH” to no avail. I get up and gently poke our solo artist. Nothing changes. I grab his shoulder, and rock him  sideways. Still nothing, he keeps playing his bass solo, as if he was a world of his own…which he is in, really. I give up, and climb back in to bed, hoping that after the ear-shattering crescendo, I might be able to slip back in to sleep. The occasional mid range or solo snore is still heard, but the bass solo is relentless. But wait, thats more than just a brief pause…has he stopped snoring? Five seconds….ten seconds…snoring again. Then another five…ten…fifteen seconds! My hopes are slowly climbing, I might be able to grab some more sleep, since it is only, erm..my phone says 0300hrs. Bloody hell. If I weren’t so friggin’ tired, I would probably appreciate the impromptu musical performance by these south american nocturnal artists…but I am not amused, as the queen would say. There are still lengthy pauses coming from Mr Bassmann…and then it dawns on me (not literally, daybreak is yet a couple of hours away): This guy is not only stopping his snoring for a good few seconds at a time, he is actually stopping breathing for that period of time as well. Hello sleep apnoea.

Goodbye Flo. I can’t take it any longer. It may be awful o’clock, but there is no rest here to be had. Shower, pull clothes on to body in tired fashion, stumble down stairs, get dumped out on Oxford Street. It’s 0430ish, and there is still mild activity on the streets. Cleaners ridding the pavement of rubbish and other residue, some last drunks still unsteadily staggering around the streets, some climbing on the early morning bus back home. Day is slowly breaking, a beautiful morning indeed. I push my hands further in to my pockets; the day may be a looker, but she is revealing her cold side to start off with. I quicken my pace in an attempt to increase my body temperature, but also to conveniently skip past the dodgy looking fellers zig zagging on the pavement towards me. Despite the cold I feel comfortable, and am surprisingly awake after only three hours of sleep – the two years of shift work training has finally paid off for a good reason, I tell myself. Getting further towards the river, traffic picks up, but the place is devoid of pedestrians – I have the whole sidewalk to myself, and am enjoying the morning immensely. Crossing the road, I dig a banana out of my back pocket, and heartily bite its head off (yes, I did peel the skin off prior to doing this, if you must ask). Bananas have become my staple diet – 90 pence a kg in the UK, 13 AUS$ a kg in Australia this season – I was longing for the sweet yellow fruit that had been taken from me by the evil cyclones in tropical Queensland earlier this year.

Finishing up my banana, I came to Waterloo bridge, and was greeted by a spectacular view of the Thames – completely undisturbed by people, rain or wind. Maybe the early concerto (or snorecerto, to be more precise) had a good side to it after all. Doesn’t everything have a positive touch if you look at it the right way?

After a few more minutes, I arrive at the London Ambulance Services Headquarters – a big concrete block with yellow cars parked on the street next to it. Righty-o, in we go. After a short communication breakdown with the security guard, Melph picked me up from the main entrance and led me in to the beating and buzzing heart of the LAS – admittednly a little bradycardic due to the early hours, but beating steadily nonetheless. A quick guided tour followed, explaining how things work, how calls are handles, dispatches are made – the whole lot. Everyone in the control room that I spoke to was surprised that (at that stage) our service back home did not have any structured calltaking facilities in place. Ironically, while we were about to introduce AMPDS (via ProQA), the NHS was moving away from AMPDS, and implementing their own NHS Pathways protocol instead. This may warrant another blog post all together…

LAS HQ – and neighbouring ambulance station 

Another surprise was myself. I was greeted with a smile by everybody, but that smile came with an additional big questionmark painted all over their faces: What the hell are you doing here at this ungodly hour? True, they were there because it is there job. I was there for the lure of the after-party. And to escape the three tenors…or should I say, tesnores.

I still remained ‘that crazy Aussie’ in most peoples mind. I’m not fussed, they’re not quite off the mark with it either 🙂

I continued poking my nose around the office a little, talking to different people, exchanging stories, listening how calls were taken, watching hows crews were dispatched, learning where some of the stations are, and thinking of the poor souls out there who had been flogged all night treating and driving sick and not so sick people around town (although I couldn’t help a little schadenfreude from creeping up when the button was pushed to wake the crews up for a job).

Relief came in nice and early, so we were off twenty minutes before schedule. It was D-watches end-of-four-night-shifts-in-a-row-let’s-beat-sleep-with-a-pint party, and I was interested how the morning would tootle along; six sleep deprived zombies in green, and myself, a sleep deprived tourist. A glass, a chat, and back to a comfortable bed, maybe.

First of all, time to get some food. Fried breakfast and a pint sounded like a plan, and transport to a pub (that was actually open at 7am) was promptly organised – I had a vague feeling these guys had done this before. As it happens as a foreigner amongst locals, I was attacked with questions from all sides, interspersed with interesting facts from the office, including a “who would you sleep with if you had to” competition between two of the blokes. I don’t know anybody in their office, but I am vaguely familiar with the baboons and the hippos and the London Zoo – and if they are your first choice, I think you might need your head checked. Or your eyesight. Or both.

The animals changed from London Zoo to Australian fauna – the sharks and snakes, wombats, echidnas, kangaroos. Then on to the sparse population of the country, and the vast distances. Then on to Australian Film and Television (nobody really knew of anything except for Crocodile Dundee and Neighbours). Then Australian Music (again, not much was known – but I was more than happy to share some good Aussie stuff with the deprived lads and lasses). By then, the venue had changed, then sun had warmed the senses, and that nice fuzzy and warm feeling had gotten hold of me – they were a great bunch of people I was out with, and I was having a good time. Maybe the fuzziness was also related to some other external liquid factors, but not once did I fall over or anything of sorts. I even managed to sink a ball on the snooker table.

Having said that, I can’t actually remember playing snooker. Well, it was nearly eight weeks ago now.

Anyway,  the day continued, mine having begun abruptly at 3am, theirs having begun at 7pm the previous night. One by one we parted ways to our beloved and comfy beds, and by midnight, I too was horizontal, sound asleep. Thanks to D Watch – What a day!

LASting Impressions

Twenty aspects of the London Ambulance Service

  1. General: The London Ambulance Service (LAS) is the largest free ambulance service in the world – and quite a busy one as well, as you can imagine. Attending over one million calls a year, covering 620 square miles (1600 square kilometres) of Greater London, this is achieved with 900+ ambulances running out of 70 stations, with over 5000 mostly front line staff.
  2. Vehicles: Ambulances are not the only vehicles used to respond to 999 calls (the UK wide emergency number) – the LAS use cars, vehicles and bicycles as well for fast response; allowing paramedics to cut through heavy london traffic a little better, and also spreading resources over more vehicles.
  3. Cleanliness: Being such a busy service, staff don’t have much down time to clean the vehicles – and it showed in some of the cabs: dust, scratches and grit on the dash and instruments. One could see that they are constantly on the run, wear and tear slowly gnawing away at them as they are subjected to the harsh life of emergency response. In response to this, the LAS now have their ambulances cleaned by an external company – not as often as some paramedics would like to see, but a burden off their shoulders nonetheless.
  4. Tiers: Talking of paramedics – not all frontline staff are called so. There are different levels of tiers. Starting at ECA (Emergency Care Assistant, or A&E Support in the LAS), this is the basic level of ambulance training including CPR and Oxygen administration. These crews generally do low acuity jobs, but are also used to back up higher level crews on emergency calls. Next level is the EMT (Emergency Medical Technician, or just ‘Technician’) – a generally dying breed around the country, as not many EMT courses are held anymore. Skill level is intermediate, excluding any invasive skills. Highest level amongst the LAS is Paramedic level. London has (unfortunately) recently stopped employing Emergency Care Practitioners (ECPs) – which were specifically skilled for low acuity calls (such as wound assessment and management, falls with minor injuries), and trying to keep such patients out of hospital, thus saving resources and money. For major trauma cases, paramedics can request HEMS (Helicopter Emergency Medical Services) – the london air ambulance, which is staffed by a doctor and a paramedic, and is based at the Royal London Hospital. Alternatively, a BASICS Doctor (British Association for Immediate Care) can be called if they are available. These are doctors with additional pre-hospital qualifications that volunteer their time (see RRDoc blog). Yes, that’s right, you can call upon a doc if you need them, and they happen to be available. Not my way of organising care, but I’ll leave that for possibly another post.
  5. Clinical Guidelines: As the LAS is a NHS trust, they follow the clinical guidelines of the JRCALC. Generally evidence based, I heard a few disgruntled voices that they are not being updated often enough. Fair enough, the online version does state 2006 (thats five years ago!), but it has had its fair share of individual updates. I personally think it is great that there is a central resource for clinical guidelines in the UK.
  6. Clinical Governance: Didn’t get much exposure to this – they work during the day, and I was on at night. Staff I chatted to hadn’t had much exposure to them either, which didn’t sound too promising I must admit.
  7. Fatigue Management: Generally twelve hour shifts are done in London – working frontline ambulance staff are pretty much on the move for the whole twelve hours. Official rest breaks are given if possible where crews are only to be called on highest priority jobs – but this is not always possible due to lack of resources – instead, they work through the shift, are allowed to knock off 1/2 hour early and receive 10 pounds extra pay that shift.
  8. Occupational Health & Safety: Seems a big thing in the LAS, with all ambulances having pneumatic tail lifts – no lifting necessary! On higher priority calls, a rapid response car and possibly a second crew will be sent, so there are (generally) a multitude of hands at the ready for complicated extrications.
  9. Working Conditions: Mediocre, compared to Australia. Pay is below nursing level, maxing out at roughly 30 000 pounds a year (depending on shift pattern, hours worked, what station etc. Quite complicated). Holidays are 27 days a year (decent IMHO). Rostering is done on a station and individual basis – as you know, InsomniacMedic only does nights on the car, others only do days, some do mixed….
  10. Relationship with other services: Good – similar to other countries I have found. Great working relationship with the police force, somewhat crew and day dependant with the fire brigade. The LFB don’t attend medical calls. Generally great working relationship with the hospitals, both professionally and socially.
  11. Response Times/Distances: Here’s a can of worms that I shouldn’t be touching…so I will just link a website: Clinical Quality Indicators
  12. Cost: Free to the end user, all covered by the NHS.
  13. Station Duties: In theory, keep things tidy. In practice, enjoy the precious few minutes on station with a cup of tea, as crews are out most of the time.
  14. Hospitals: The few bits I saw: Can’t complain. Saw some strange driveway arrangements, but apart from that, it was all friendly, clean, and most fairly modern. Ramping/Bed Block has dramatically decreased over the past few years, it got quite bad 2-4 years back I was told. The staff all seemed professional and caring, the little interaction I had with them
  15. Registration: Is covered by the Health Professions Council (HPC), and only applies to Paramedics. To keep your registration, proof of continuing education via attending courses, reflective practice etc must be documented. Generally Paramedics saw registration as a good thing to keep standards up, even if it was not policed enough.
  16. Equivalency of Qualification: For those of you who want to work in the UK (apart from having to sort out immigration), firstly you will need your HPC registration if you are going to work as a paramedic – then you can apply with one of the 12 ambulance services in the UK. But, as InsomniacMedic points out, getting a job in the LAS may prove difficult in the next few years…
  17. Drivers licence: You’ll need an EU C1 truck licence, as the ambulances weigh more than 3.5 tonnes.
  18. Foreign Paramedics: There are plenty of them around, with London being such a multicultural city you’ll fit right in. I couldn’t even get away from my own brethren – at one scene the paramedic was Australian…
  19. Respect amongst the public: Not as high as in Australia (where we are the most trusted profession seven times in a row!), but people still occasionally give way to ambulances even without their lights and sirens activated (a strange phenomenon)
  20. More DetailsOfficial websiteWikipedia linktwitter account

Any additions, corrections or questions? Feel free to add a comment, or contact me via the ‘Contact!’ link above.

A night out on the town: an observer shift with InsomniacMedic (part II)

…and after a bit of thinking, the memories come flooding back to me – ‘Railway Panic’ and ‘Onion Allergy were the answers I was looking for. I won’t waste too many words on the latter – if you reckon you have an onion allergy, don’t eat onion salad. Quite simple really.

The former though was an interesting job – hyperventilation at the train station, and what a hyperventilation that was! Had never experienced it in such and extreme, even IM admitted that he placed this at the top end of his experienced hyperventilation scale. IM did the whole talking/calming/medical bit while being pawed, then grabbed, and finally hugged by the panicked patient. I diplomatically shifted out of her reach, and moved the partner out of the way to ‘get some details’, which calmed her down a little. The crew arrived, and patients partner and myself went back to the patient for the handover – only for the hyperventilation (and the hugging) to flare up again. I took said partner again to ‘get some more details’, and the situation finally got under control. Panic attack, or possibly a metabolic disorder – or something entirely different? We’ll never know. One of the downsides of working on the car; it makes following up on patients that little bit harder. All in all, an interesting job to attend though!

The next job just reaffirmed that everybody loves IM. After being hugged at the train station, the next patient (an ever so slightly inebriated feller) commented how smart he looked. Unfortunately moods change quickly, and after accusing IM of having connections with the Russian, Israeli and Polish secret police, this newly found friendship ended as abruptly as it had began just three minutes earlier.

Our last job was noteworthy too: Called to an elderly patient, feeling generally unwell over the past few days, deteriorating steadily until the family thought she really needed to be seen. Indeed she did, but more by medical people than the two police cars that came racing to the scene just as we pulled up. Why they had been dispatched? We don’t know, and neither did they. They had just been sent. They marched upstairs with us, and promptly marched back down again when it was clear that they had been sent in error.

We hadn’t though, as our patient wasn’t looking too good at all – awful colour, altered conscious state and all other little signs that send little alarm bells ringing in your head. Rapid extrication down some narrow and steep stairs, and a few minutes later the patient was on the stretcher in the ambulance, getting the full workup – only to go in to cardiac arrest. You know that extra pair of hands you always wished you had on a cardiac arrest? That was me. “You happy staying in the ambulance to do CPR?” I was already getting in to position, and seconds later, was cracking the poor patients ribs. Makes me cringe every time, horrible feeling, those first few compressions. Urgh. Again, never got the final outcome, but an interesting job to be involved in!

Spot the taxi!

Dawn was quickly approaching, and we were sent back to station for the last part of the shift – we were both tired at that stage, and my eyelids were becoming pretty droopy.

Here’s a summary of jobs we did:

  1. ?? (stood down)
  2. OD & ETOH (stood down)
  3. Fainting & ETOH (stood down)
  4. Chest Pain (stood down)
  5. Faint (stood down)
  6. Panic attack
  7. Drunk bloke with a cut to head
  8. Chest Pain
  9. Onion allergy
  10. Abdo Pain (stood down)
  11. Generally unwell turned resuscitation.

 

Back on station for the last hour of the shift, another similarity struck me. IM and myself both have developed the great genius of answering secret telephone calls for other people on station. The difference being that in Perth, they call you  on the defib batteries; in London, they call you on the TV remote.

– ~ –

A big thank-you for everyone I met in the LAS that night for making me feel welcome. Great chatting to you.

And of course a massive thanks to Mr InsomniacMedic for organising the shift and taking me out!

A night out on the town: an observer shift with InsomniacMedic (part I)

The tube is packed, brimming full of commuters who are heading home after a long day at work. I blend in with the masses, the only thing potentially giving me away that I haven’t spent my day at a desk is the stripe of reflective tape on my dark green uniform trousers – people probably think I am a street sweeper. The train snakes its way through the tunnels, passengers swaying gently from its sidewards movements. All doing the standard practice amongst busy public transport worldwide; people keeping to themselves, hiding in their own worlds by means of books, headphones and blank stares. All unaware that instead of coming from work, I am on my way to work. Well, not technically work, as I’m on holiday. Maybe an adventure holiday of sorts?

I’m on holiday for a reason: to relax and recover from the stressors of work, and catch up on some sleep that shift work has robbed me of. What better way to achieve all of the above by going out on a night shift in one of the biggest and busiest cities in the world? See, just my point.

Apparently it was a typical night out, with communication breakdowns being an integral part of the shift as I struggled to exchange words with patients. We were either cancelled (~54% of calls), and didn’t get to see them, or thick foreign accents and a poor grasp of the english language prohibited clear communications (~36% of calls). One the patients was in cardiac arrest (~10%), which didn’t help much either (dead people don’t tend to be too talkative anywhere in the world it seems).

But let’s start from the beginning. I met Mr InsomniacMedic (hereafter known as IM) at his his ambulance station, where he was dutifully checking his bags for the upcoming shift. We jumped right in to it, IM showing me what he carries whilst on shift, whilst I dutifully munched on a banana (he hates the things). After a brief introduction to the station, its surroundings and inhabitants in green, we were ready to go…if the car had have been there. The day shift paramedic was on a late call, and was delayed bringing the vehicle back. Too bad so sad, time for a cup of tea for IM and some answers from me: What the heck is an Ambulance Officer? I had genuinely confused the crews with my uniform and its associated emblems: Officer is a rank that designates a managerial position within the London Ambulance Service (LAS); was I some sort of manager seeing how things were working out on the road? But why is the uniform different, with all that reflective stuff…new uniforms begin introduced? Upon closer inspection: St John Ambulance Shoulder Patches – are you a volunteer? What are you doing in London, how long are you here, is it part of an exchange programme, where are you off to next, how do you like it here, how do you know IM? The last question proved to be tricky on occasion, I reverted to tactical silence and let Mr IM tell his colleagues we were either pen pals, or if they knew about the IM blog, that we were blog buddies. IM isn’t too fussed about secrecy in regards to his online precence – he just doesn’t want people to make a connection between the virtual IM and the real IM.

Educational poster at the station 🙂


The car is still not on station, but there is more to be explored. One of the Hazardous Area Response Teams (HART) are at the station too, and IM organises a quick tour with one of the HART team members. We don’t have anything similar in our service, but had read dribs and drabs about HART – so it was great to see the ins and outs of the trucks, what their area of deployment is et cetera. Basically they are their own self contained medic units wit breathing apparatus, CBRN suits, generators, Geiger counters, life jackets for water rescue, CO detectors. And bulletproof vests – the HART team are the tactical medics amongst the LAS too! Admittedly, they don’t get many call outs, and can get through night shifts without leaving the station, which makes them a great target for collegial jokes of being lazy, but – as a few paramedics point out – when the faecal matter hits the ventilator, the HART team are going to be right in the hot zone earning their money, with the rest of the service looking at them through binoculars from a safe distance. A place preferred by many.

Hart to Hart


The last bit of HART equipment had just been shown and explained to me when, by perfect timing, Mr Dayshift brings in Mr Vauxhall for another 12 hours of punishment, a.k.a. our Rapid Response Vehicle for the night had arrived. IM has been working permanent nights on the ‘car’ as it is known here for many moons now, and loves it. Initially hating the solo response and night shifts, it was the only way of managing family and work comfortably. Out of necessity came toleration, followed by appreciation of this shift pattern – nights bring out special people, roads are generally clear, and the emergency lights make  funky patterns and shadows as they bounce off the surrounding cityscape. We definitely have something in common.

IM and myself got talking about spelling errors. Seems the LAS is not immune either!


We grab the car, have a brief chat to the day shift medic who seems like a thoroughly nice but mad bloke (must be an entry requirement). This is one thing that struck me very positively in the LAS: everyone was really welcoming, chatty, and interested why I was there. Seems everyone knows at least someone in Australia, or has been there on holiday, and was super keen to compare experiences. Professional comparisons were also very interesting, comparing organisational structures, skills, meds and of course my uniform (which was well received!).

Our office for the night. And a shot of IMs leg…pure hawtness!


The car is in a bit of a state – it has seen better days. I am told (and later experience) that everybody is so busy that there is hardly time to give them vehicles a clean – but then again they do get external cleaning agencies to mop their vans which is a nice thing 🙂

IM quickly explains the interior gadgets (SatNav, radios, job screen, procedures) to me, and leaves the best to last: the gloriousness of the electronic air horn!

Yup, his boots are as polished as he claims!

 

As our bags were checked, off to our first standby point it was, which for memory we didn’t reach. Somebody, somewhere had dialled 999 and we had been automatically activated as the closest vehicle. We never found out who called, and why – we just got told an address to go to. No priority, no details, no name, no nothing. Bit dodgy if you ask me, sending a single paramedic to an unknown scene. Violence and knife crime is not unheard of in London, and crews tell me they frequently drive past addresses of calls like these until more details, another ambulance, or the police arrive as well. I should mention that we did ask for some details regarding this job – but whilst waiting for them, we were cancelled. Next job was similar – automatic activation, but this time we actually got some details about the job. Unfortunately the route we were sent on was blocked by a locked gate (two minds, one thought: WTF?!). Whilst finding an alternative route on the map, we were cancelled. In fact we were cancelled on the first five jobs.

Judging by my notes, further jobs included a ‘Railway Pume’ and an ‘Onion altney’. Maybe I should check my handwriting…

 

to be continued, stay tuned!