Category Archives: Emergency Vehicle Operation

Ambulance Specs

A facebook follower recently posted the following on the Happy Medic Page:

“I recently got involved in specifications for 2 new ambulances…any suggestions out there?”

Well, are there?

This is what social media is about folks, being able to spread an idea, issue or question far and wide quickly to get a wide variety of responses.

If I was on the committee to spec new rigs I’d have a few requests for sure.

  1. Larger area behind the front seats so night crews could recline a bit and have room to store their coolers and jackets, and packpacks etc.
  2. Plugs in said larger area for crew to run laptops and plug in other peripherals
  3. A compartmentalization layout designed by actual practitioners so that I don’t have to stand up from the airway chair to reach my airway supplies for example.
  4. Suspensions that last more than 6 months.
  5. Warning lights that can be seen when the back doors are open.
  6. GPS
  7. Because my system is limited by height since 2 of our ER entrances are underground, I can’t get a taller rig, but it’d be nice.
  8. If you’re a rural FD EMS, what about extra room for turnouts and airpacks, perhaps even a CAFS?

What are you looking for in a new ambulance?

Calculated Risk and Letters in the Files

Before you get too excited to hear what I think about the politician and the ambulance company at the shooting scene, close the door and take a seat.
Before you go ripping into scene safety and how this guy has no idea what it is we do, take a deep breath.

Because half of you are hypocrites.

How many of you race lights and sirens without wearing your seat belts? According to NIOSH studies and reviews of fatal and non fatal ambulance accidents…HALF. Yes, half.
Half of you are not wearing your seat belts in your ambulance.

So when you complain that some politician thinks you are invincible and should go racing into an unsafe scene, I almost gag knowing full well HALF of you already do that on a daily basis. And for even more minor incidents than the one in the press.

Yes, this is a letter in YOUR file. Those of you not wearing your seat belts in the cab of the ambulance. Patient care in the back does not even enter into this or the data I’m finding, this is only about in the cab.

So many were so fast to jump on the politician, yet how many of you really pay attention to yourselves on a daily basis?
Worried about a wrinkled shirt? Can’t reach the radio? Go ahead, try to give an excuse for not wearing your seat belt, the same thing you preach about to unrestrained drivers at wreck scenes. You can’t. There is no excuse for not wearing your seat belt in the cab of the ambulance. None.

Then why is not wearing one killing so many EMS responders?

We’re not a stupid group, stubborn perhaps, but we seem to understand kinematics and mechanism of injury, at least to the point it guides our treatment, but to not apply those standards to our own flesh and blood is insane.

Stop shaking your head and muttering that you already do wear it. Half of you are lying. Lying to yourselves.

I’ve had enough. You have made me unHappy.

Buckle up. I’m getting annoyed reading these studies about line of duty deaths and the lack of a simple click that could have made a difference. And if you are a LODD from not wearing a seat belt, should it really be a Line of Duty Death or should it be renamed Lack of Due Diligence?

The Crossover LIVE

My brother from another mother Motorcop and I continue our back and forth between the boys in blue and the heroes in a segment he dubbed The Crossover.

In this most recent installment we knew the back and forth would be great, so I fired up the ambulance, hit the lights and ran a red light on the way for a coffee so we’d run into him.

Topics covered include continuing education for motors and medics, why he can let law breakers go with a warning and how I’m bound to take every Tom, Dick and Harry to the ER no matter what and the burning question: Why don’t motor officers wear chaps?

Episode 1

Thank for listening, more to come!

A Letter in the File of Kenneth Montgomery

As reported by WPTY in Memphis, Memphis Fire EMT Kenneth Montgomery was assigned to a unit transporting a patient.  Instead of completing the transport he steered the unit to Firehouse 16, parked and went looking for a relief to take the rest of the job.

Kind of a no brainer to me and I hope to you too.

Finish the job you’re sent on.  That’s a letter in your file and in case you thought this would get you off the ambulance, think again.  Unlike many folks on Facebook, I’m not asking for your resignation, your EMT card, or anything else.

Why not?

The video posted at the news website includes certain “details” that got my memory spinning.

You see, I’ve been on this call 100 times.  I’ve even been on the call that is the 1 in a million like this, but I know that wasn’t an actual emergency and I’ll tell you why in a moment.

Using my amazing holistic detective skills I can tell you this was a morning run to a rehab center for chest pains.  I would honestly be surprised if they had to look at the map book for this one.  999 out of 1000 times the chief complaint does not match the signs and symptoms, someone will start to hospital shop, refuse a 12 lead ECG etc.  Treat every job like that 1 in a million until proven false.

I have no details as to the patient care or condition in this circumstance so don’t even comment that I’m not being compassionate.

I do have one set of details that, had it been happening, the press would have mentioned it for sure:

No lights and sirens to the hospital.

We can debate the benefits of playing Paramedic Pinball code 3 to the hospital, but it can tell us a lot about what may or may not have been happening in the back of that ambulance.

Had this been a code 3 return Mr Montgomery would indeed be facing harsher punishment from the likes of me, but having recently taken a promotional exam that dealt with similar situations there are a number of statements I need to gather before passing on a recommendation for disciplinary action:

1. Interview the call taker and pull the E911 tape to confirm the call.

2. Interview persons at the scene as to the disposition of the crew.

3. Obtain admission condition and discharge condition of the patient.

4. Interview Paramedic in charge of patient care.

5. Interview Mr Montgomery as to his thought process and justifications, if any.

and most importantly,

6. Were there actually any rules or regulations broken?

Is there a rule in your system that mentions being required to go straight from the scene to the hospital?  Even something as vague as “Timely Discharge of Orders” might stick to the wall, but my guess is Memphis is about to get one of those rules that can be traced to a name.

Mr Montgomery, what you did may not have been right, but it brings us into focus in a way we don’t need.  I’m sure private ambulance companies will be mentioning this event at the next system bid for sure.

Can you see me now?

Have we all gone Hi-Vis insane?

Forget about a nanny culture or statistics about it making us safer.  Last I heard it was the flashing lights that attracted sleepy and inebriated drivers so turning me and my crew into passive crappy driver attractant is not my idea of a good time.

I wear my vest most times, really I do.  Mainly on account of my uniform is all navy blue and at night I disappear.  Perhaps the slight chance I get seen at the last minute is the point, but I have a big coat with reflective that could do the same thing.

“What the heck, Hap?  What got you all fired up?”

This photo from Ray Kemp at 911Imaging.

You saw this series on the cover of JEMS magazine a little while back.  The first thing that will catch your eye is the sea of reflective vests, running about $100 a piece on the rescuers, covering the reflective on their turnouts.  The ambulance folks have them on as well, well done, folks.

But look IN THE STREET!

In the one place those vests can actually be useful and you’ll see two fellows wearing what I wear, all dark colors.

Well, I wasn’t there so I can’t blah, blah, blah.  No, I’m jumping in here and pointing out that perhaps we have our priorities a bit out of whack.  We go racing to jump on the Hi-Vis bandwagon without looking at what our people already have and using it to our advantage.  Hidden in all the stories of people getting hit and killed in the streets are the facts adding up that vests don’t stop cars, trucks and SUVs from killing you.

If you stand in the road covered in day glow paint carrying flares you will still die.  If we trained our drivers to block the road with the giant reflective rigs, perhaps the vests could go to those who have no giant truck to protect them.

Better yet, where is the increased driver’s education to stop the poor drivers from trying to kill us in the first place?  Rhetorical for sure, but I can see at least $1000 in this photo that could go a long way.

My own service is not immune to the allure of the shiny, reflective vests.  We have some that say Incident Commander, others say Triage.  Mine on the engine says SFFD in black on a field of bright yellow and silver.

Here’s a picture from one of our new engines under construction (Thanks Crimson-Fire):

That is where the reflective belongs!  And while we’re at it, can we get some more warning on the sides of these giant road blocks?  How nifty if we could get an arrow stick on the sides AND the back, since if we park to block the scene the rear mounted one is hard to spot.

Some Departments deploy street signs out ahead of the scene, cones, flares, all those kinds of nifty, expensive street decorations aren’t stopping the drivers who are going to hit us anyway.

Even on a simple vehicle fire on the highway, we need to focus on parking and awareness rather than throwing money into reflective to cover up reflective just to check a box on a state form.

If you have a vest wear it, but use common sense first.  Use that giant thing that drove you there to protect the scene and stay out of traffic.  Leaving the scene unprotected and going in and out of moving cars will get you killed, no matter how much shiny suit we plaster on you.

Be safe people,

HM

“RTB for a cuppa” I’m allocating in the UK

chroniclesblogRTB means Return to Base.  A cuppa is slang for a cup of tea.  Allocating is something I very much wanted to see first hand.

On this morning in Newcastle, my second to last, Mark has arranged for me to meet with the executive staff of the NEAS at their headquarters.

Before meeting with them, however, I’m downstairs in the bullpens.  I’ve got 2 hours to sit in the dispatch center and do a “Sit-along.”

When you tell a guy who loves talking theory on systems allocation he gets to see the system work from the nerve center, he gets a touch giddy.

My first chair was at a call taker’s desk and I got plugged in.

BANG, less than 10 seconds, not even a chance to introduce myself to the call taker I’m with the first tone is in my right ear.

Before she can answer the call a timer has popped up on her screen 8:00, 7:59… the clock is running.

“Ambulance Service” she answers and begins reading from the screen the pre-ordained triage system called Pathways.  As I’ve mentioned before, this dispatch system makes no attempt to diagnose the problem, but the physician designed questions can dial up or down the response in real time as the call taker asks the questions.

While she is asking and answering, a small red circle has appeared on the screen, then, a bit away, a purple one.  Later I would learn that one is the location of the caller and the other the closest vehicle assigned to the call.  When that vehicle arrives on scene, the timer now passing 6:15 will stop.  This is their target and they take it very seriously.  As I’m listening to the call, it is a very straight forward sick call and the caller is honest about it.  It is then I see the benefits of the flexible front loaded system.  The rapid response car, the closest resource to the caller, has been stood down since there is not an emergency at the caller’s location.

The vehicle, or cot transport capable ambulance, is continuing, however, and the target is no longer 8 minutes, but now 16 from the time the call was answered.

As more questions are answered and the system confirms the lack of life threats, a simple screen gives instructions for the caller until the crew arrives.  The call taker then scrolls around her GPS monitor and finds the vehicle, then advises the caller about how far out they are.  The caller thanked her and the call was terminated.  Less than 3 minutes passed from the answering of the call to the triaging and confirmation of appropriate response.

At no time did a supervisor step in to augment the call taker’s classification, nor did the system err on the side of caution by upgrading the response, putting rescuers’ lives at risk, “Just in case.”

In the hour we were together I learned more about the desk I was at and the number of calls she answers in an average shift.  We took mostly non-emergent calls, details of which would obviously violate privacy, but I can share with you the CALLERS.

When I explained how folks abuse our service by calling from a cell phone miles away about a person they think might have been either unconscious or sleeping, she smiled.  Then, I went on, our criteria based dispatch system considers the caller’s inability to confirm consciousness to be unconscious and their inability to confirm breathing to be apnea, and 7 people are now responding code 3 for nothing.

It was just when the call taker was explaining some of the loop holes used that a care facility called to request an ambulance.

They were not with the patient so unable to observe their mental status, efficiency of breathing or if there was any bleeding.  The system took this information and kept the RRC responding.  Each time the call taker asked a question, the caller was already answering, knowing exactly which question comes next.

She later explained that folks have learned that if they take a cordless phone around the corner and call an ambulance, the crew arrives faster than if they honestly answer the triage questions.

“Same callers, different country.”

It was later in the morning across the room with the allocators that I saw the strength and weakness of the NEAS.

Mark and I spoke at great length about being honest but respectful when offering our observations and suggestions to improve each other’s systems.  Mark was an example of this when he met with SFFD Chief of EMS Pete Howes for a kind of exit interview before leaving.  I hope I can meet that example with the following paragraphs, but each time I write it it comes off preachy, so here goes.

Sitting between the allocators I watched them constantly on the radio with numerous vehicles and cars in various states of service.  Each color on their screens meant something different, from enroute, on scene, RRC, vehicle, on post etc, but it was the clipboard they were passing back and forth that caused them the most frustration and, more than once, delayed allocation.

Not by a definitive amount, we’re talking 3-5 seconds, but it was the constant flipping of pages and radio traffic related to the one thing that I think the NEAS needs to change for the betterment of the system.

No more breaks.

I can hear the UK medics now “Hell no.”

Let me elaborate for my work straight through the shift American friends.

The NEAS, as a portion of their labor agreement, provides their crews with certain breaks depending on their daily activities.  When they have been on post for an hour away from station, they get rotated back to the station.  This was commonly referred to on the radio as “Return for a cuppa.”  The basic premise is simple enough, really.  People need clean bathrooms and a chance to eat since eating is not allowed in the cars or vehicles, nor are they allowed to sit down and eat in an establishment while on duty.  This was evident when Mark was nervous enjoying some Pho in San Francisco.

In the car and vehicle this didn’t seem to be a big deal, we’d get a message to return to base, or that we were clear for meal break.  The meal break can be interrupted, should the allocators need the resources, but they avoid it since the crew interrupted gets paid quite a bit for it and the allocators, although they wouldn’t elaborate, appear to be held accountable.

Sitting between the two allocators on the desk that morning, 50%-75% of their time was arranging rotation station breaks or ensuring crews got their meal breaks.  These variables also added more color codes to the dispatch screen.  This car is on dinner, this vehicle is on base rotation…etc, etc.

When a call came in they shot a quick look to the clipboard showing who gets a break when and dispatch decisions are based off of that.  I did not witness it make a difference in response times, since that information is streaming in real time on giant monitors overhead, but these folks are scrambling to keep everything running smoothly.

With my limited dispatch experience it seemed like a simple change, since on the days I was on rotation in Newcastle we never had a point in the day where we were unable to reach a bathroom or food.

My head was trying to process all the information these women were basing their allocations on and one of them turned to ask me, inbetween moving a car back to base “for a cuppa,” “How do your dispatchers handle your breaks?”

When I explained we (listen to me, like I’m still in a rig), THEY are gone for 10 hours, no breaks, they froze.

It was passing the clipboard back and forth that I saw the only 2 seconds they both held still: glaring at me.  It was clear I was not to repeat that statement for the rest of my time with them.

“That would make, ‘Go ahead 405′ this so much ‘thanks and to base if you please’ easier.”

Yeah, 2 conversations at once.  I have trouble typing and listening to music or TV at the same time.

Mark had some family business to attend to while I was meeting the voice on the other end of the radio and he returned just before dinner time to collect me.  It was an eye and ear opening experience to see the chaos that a simple concept like breaks caused the folks moving units around.

Something I completely neglected to mention over lunch with the executive team.

Told you I couldn’t screw that up.  My conversation with the folks hopefully getting Mark cardioversion and CPAP, and where to put your coffee when the table is literally covered in signs that say “DO NOT PUT CUPS ON TABLE, USE SAUCER” soon.

Yeah I did.

On the Ambo in the UK

Subtitle for this post: Can you reach that for me?

Coming off a superb time on the Rapid Response Car, nappy time aside, we’re on the vehicle today.  The vehicle is what you and I would call an ambulance, but since anything that can take people to the hospital is an ambulance, it needs to be narrowed down a bit.

The car is certified as an ambulance since it can take people.

The vehicle can, as that is the main purpose of it.

But hiding around town, and just out of camera range as we drove by were swarms of non emergency ambulances, almost buses in their capacity.  When asked their function, Mark and our ECSW Becky (more on her later) informed me they take folks to their appointments, get tests and from one facility to another.

Collecting my jaw from the floor I explained to them and reminded Mark how many times we activated 6 people to do just that.  Becky shot me a look from the driver’s seat of the vehicle and asked a great question I still can’t answer.

“Why not just give them a ride in a van or bus?  Why send the ambulance?’

Why indeed Becky, why indeed.

I could try to explain to her how, in America, people have become so expectant of lights and sirens whenever they want them that they’re willing to sue if they don’t get them.  Regardless of the condition, reason or outcome, folks will threaten a lawsuit and managers will blink and change protocol. Why inconvenience the few when we can just take them and inconvenience the many, right?

That was the start of my shift on the vehicle.  I’d love to tell you that life on a UK ambulance is so much different than in the US.  But when it finally gets to comparing apples to apples in these systems, having someone in the back is it.

Previous posts have covered my impressions of the ambulance layout and ways I think they can be improved to benefit patient care and provider comfort and safety.

Mark had difficulty accessing most of his equipment from the cabinets.  Everything he needed he got to, but not without ducking around the patient, around the family member, then leaning over.  The trash was also oddly placed, lying directly behind the family member so that to dispose of bloody mess you have to ask them to lean aside.

But that being said, with the current layout based on “safety” there is no other place to put these things.

Mark described to me the regulations in place to protect the persons traveling in the back of the vehicles and it makes perfect sense.  Until we have to actually do patient care.

After my description of the ambulances in a previous post I was contacted by an ambulance manufacturer who wishes to remain anonymous, I’ll call them Box inc.  Box inc wanted my thoughts on what makes the perfect ambulance and I told them I have yet to see it.  But, Box inc had some new ideas about making your ambulance more versatile when on post, more on that another day.  But Box inc will still take a van or pickup truck, rip off the back, slap on a place for a cot and make it flash, there really isn’t another option at this point.

But back to Newcastle and the McDonald’s parking lot.

Yes, we’ve found our way to the parking lot at the McDonald’s, on post if you can believe that, so I snuck in for a coffee.  It’s an addiction, I know.  We had a chance to talk on camera about Becky’s role in the NHS and what an ECSW is.  But as we talk about it, a few points to look for first.

I am sitting on the cot and Mark in the chair for family members.  The pass through to the cab behind him has a small door on the top that leads to the trash bin behind that seat he’s in.

The cabinets behind us and between as as we talk contain all of Mark’s equipment.  Just from the layout you can see how challenging it could be to access them with a poorly patient in the back.

When I said that Becky was above an EMT, the comments section at youtube went insane.  What I meant was that she can give pain relief without medical direction.  She can do something I can’t do, mainly because I’m told I need more education and training to deliver pain gas to those in need.  Becky is proof I do not.  So when I said she is above an EMT, I was referring to her ability to medicate them in that manner.  An EMT can transport, Becky can not.  Apples and Oranges folks.

Our jobs on the vehicle were similar to what Mark and I saw on Medic 99 in the City, moving folks with this complaint over there and that complaint over here.

It was on the vehicle that we encountered the only person, out of dozens, who demanded transport.

As you all plainly know, my clients demand transport 90% of the time and need it 5% of the time.  Newcastle respects their Paramedic’s opinions, likely because they can get in and get seen outside the A&E in a reasonable amount of time compared to here in the US.

This person activated 999 to report an assault and we entered the house cautiously.  It was quite a bit reassuring knowing that the occupant was most likely not carrying a weapon that could mow us down from 40 feet away.  I’m no ninja but I’ll take a clipboard to a knife fight over a knife to a gun fight any day.

The local police were close on our heels, again, without firearms (hard to get used to) and the scene was more than secure.  Very secure the police confirmed, poking holes in our patient’s story.  Then there was the recounting and description of the event given and none of that matched what we were looking at.

Clearly there were behavioral issues in play and the decision was made to transport based on the inability to confirm normal mental status.  We’ve all been there and trying to communicate with eye movements and physical gestures must have appeared as though Becky and I were flirting.

My eyes said “Look at the door, the things piled in front of it, it opens inward, no one broke in there.”

Her eyes said “What?”

My body, arms crossed, said ‘Over there, look, the door!”

Her body, arms raised to the side and shoulders up said, “Huh?”

Mark’s eyes said “Stop it!”

Mark does not ring down, or pre-alert, the hospital himself, but relays it through his control center.  When I saw what the control center did the next day, I decided that was unnecessary.  If your service relays patient reports trough a third person you are introducing another player in the telephone game and just another chance for pertinent information to get lost.  I would love to be able to forward my report to that point to the hospital and they can move that information to a bed and await our arrival.

Oh, did I nod off?

Right now my service gives audio radio reports to whichever nurse lost the coin toss that day and has to answer the radio.  I tell them what I have and why, vitals and hang up.

 

Many Americans may shudder at the idea of waiting 2 hours for an ambulance but I met a woman who disagrees.

Mary, I’ll call her, fell down on a friday afternoon and injured her hip. Being of a stoic generation, she didn’t want to bother anyone with her trouble, so she hobbles through the weekend until her doctor’s office opened monday morning. She called the office and spoke to her doctor who advised her to go into the A&E to be evaluated since his office had no x-ray capabilities.

The doctor called the ambulance and the call was classified as an €œurgent€ meaning there was no life threat, but still a need for a transport. This call is then put in hold in the system with a maximum wait time and an ambulance is assigned as soon as the system has the available resources.

Mary met us at the front door and walked us in with a slight limp, dressed and ready for her trip to the A&E like many of my lights and sirens patients. We took our time making sure her medications were gathered and the stove turned off, then into the chair and down to the ambulance.

Because this trip was arranged her medical records were waiting at the hospital, as was a bed reserved for her and she was seen as soon as she arrived. I asked her if the 2 hour wait was too long and she looked at me as if I asked her what color the sky was.

€œI waited all weekend to call, another few hours wasn’t going to kill me, son.€

I wanted to hug Mary right then and there.

After a day of back and forths on the vehicle and torturing Becky with the American and the camera duties, we were close to finishing our shift when that dreaded job came in.

The late job.

We were planning on meeting some of the rank and file for a social evening and this job would put us over our shift and we’d be late.

We screamed through the streets of Newcastle, pushing old women off the road and opposing traffic wherever we could.  OK, not really, we were sent on a common case that would later bring out our common response “Same patient, different country.”

With the patient on board and her friend safely secured we made our way through the evening traffic to St Farthest, all the while talking and keeping our patient in good spirits.

The day went fast in retrospect.  Traffic still doesn’t get out of the way when you’re rolling lights and sirens, you still have to go hunting for the extra blanket at the hospital and the nursing staff is still often glad to see you when it counts.

The evening was a night out with some of Mark and Sandra’s co-workers, we were fashionably late after some creative dropping off and ride sharing.  I got to talk to them about Mark without him listening and their opinions were high and genuine.  Mark is a respected and admired Team Leader in his station and his system.

The Good and the Bad – Continuing Day 2

I left off soon after our first job on the car which had me wanting to see the versatility of Swalwell 405, our Rapid Response Car.   I was beginning to wonder if I had built it up into more than it was when the universe stepped in and answered my questions, as always.

A school child was ill with a unique condition that was familiar to the child’s brother at the school as well as the mother who had arrived on the scene before us in the car.   When Mark had determined the non-emergent condition of the 10-18 year old (not a little one is the point) the ambulance was canceled.   There it was, the front loaded model in action.   A trained set of eyes able to determine no need for a two person gurney transport, so the unit is canceled ASAP.   Should transport be needed or requested (which it never was, save once over there) the patient was appropriate to sit in a car, seat belted, and driven to the A&E or clinic.

Through the course of the evaluation Mark and I both asked a variety of questions trying to get to the center of what the unique condition was doing to our patient.   In the end, Mom decided she would follow up with their Doctor later that day and she will let the child rest at home, something that usually helps when the child feels this way.   Mark offered to follow Mom back to their house just 5 minutes away just in case something happened.   Not sure exactly what that might be I was even more excited when he said, “Or I can just take her in the car and follow you home.   Would that make you feel better?”

The mother smiled, blushed and sighed. “Would you?”   Mark smiled and assured her it was no problem at all and we escorted our patient to the car and drove her home.   There was never a point where this patient needed a hospital, let alone an ambulance based on the mother’s description of the unique condition and other factors revealed at the scene.   In San Francisco I would have had to transport the child or send them home with Mom.   In my experience both parents are often working and unavailable to respond to the school, and that’s IF they even answer the phone number given on the emergency contact card.

5 minutes and a car made a huge difference for resources in the area.   I was sold on it right there and then and a number of other calls re-enforced the benefits of the RRC.   The old man with the hurt wrist who we gave a ride to the clinic, leaving the ambulance available.   The baby with a cough who we gave a ride, strapped in her seat with Mom along for the ride.   None of them needed an ambulance but had no other way of getting evaluated for their chief complaint.   In San Francisco a 4 person ALS engine and 2 person ALS ambulance, 6 people and$600,000 worth of apparatus to do the job of 1 man and a ford station wagon.   It was reading through the real estate section looking for a house to buy that a call came in that would change my mind about the current NEAS system.   A certain resource issue that is.

This is the section Mark has been waiting for.   All through our experiences he has been wondering what my real opinions were/are/will be and I kept telling him, “I already told you.”   But I have to share with all of you or else this is all for nothing, right?

The ambulances currently used by the NEAS are inefficient when it comes to treating a patient enroute or dealing with more than 1 patient.   I use the term carefully since when a rider is placed in Mark’s ambulance and a patient is in the cot, half of his kit is inaccessible.   The large gurneys load into the open space in the rear of the ambulance and latch into a sliding platform that can move the gurney from the wall to the center of the floor for the simple reason of accessing the patient’s left side.   This removes space for a bench seat and moves the patient a good deal away from a practitioner in the back.   I had difficulty imagining Mark working a proper patient, rolling blues to the hospital and being able to access anything quickly and safely.   This photo is from Swalwell Vehicle 214, which we worked on later in the week, but show the head of the cot and the fold down seat for a family member or rider.   the cabinets slide out of the wall so when they are closed they are secure and not accessible.   More on that when I discuss working in these Vehicles.

That being said, I did like being able to almost stand up completely and have all the light and vent controls in an overhead consul instead of buried back in the corner near the shelf near the captain’s chair like in many type IIIs here in the US.

Working a motor vehicle collision with more than one patient opened my eyes to the benefit of multiple hands on the scene.   We arrived soon after the police and began assessment.   An ambulance had already been dispatched and when they arrived I had my first glance into one.   Whoa.

The crew opened the doors and a large lift was raised and the gurney loaded onto it.   Then it was lowered to the ground and removed to our location.   In all less than 2 minutes, but still seemed like a long time.   I’m an immediate satisfaction type of guy.

When the first patient had been boarded and was being loaded I saw Mark reach to his radio and request another ambulance.   I stopped, looked around the crew loading the first patient in and that is when I saw there is no bench.   No place to put a second patient on a board.   Neither of the patients needed critical care interventions, just C-spine precaution, routine medical care and assessment, something I’ve done to 2 LSB folks often.

It was an awkward wait in the middle of the highway for that second ambulance.   During that wait, on the other side of the highway went a fire engine.   In service, staffed, yet not dispatched to the motor vehicle accident on the highway.   The first emotion was confusion as in, “Why can’t they respond to assist?” which gave way to frustration, “Lazy brigade won’t even hang a u-turn and check on us?” then reality sank in, “They couldn’t help right now if they wanted to.”   No fluid leaks, no fire hazard, the road was already safely blocked by the highway department and all we needed was a place to put a patient on a backboard.

My plans to move over were put on hold.   For all the benefits there were indeed drawbacks.   Of course there would be.   But so far, the only thing missing was that ability to take a second backboarded patient and have access to all the equipment in case of a proper patient.   Especially since Mark spoke of having to do CPR and push drugs alone in some cases.

But what is the answer?   The NEAS used a Chevy type III years ago and it didn’t work out.   From what I’ve been told I think it was a combination of politics and underpowered motors, not necessarily the patient care compartment.   That conclusion is drawn from a number of conversations with a number of NEAS folks.

It was made clear to me when I brought up my observations to Mark that the governing bodies mandate the secured nature of all the equipment in the ambulance and that repositioning it would not only take a completely new vehicle, but changes in rules and regulations country wide.   So the work is cut out there. However, to be fair, Mark took one look into the back of medic 99 and nearly passed out.   Nothing secured, supplies behind flimsy plastic doors, no cot lift, it was a recipe for injury in his mind and the mind of his regulators.

Is there a middle ground?   Wheeled Coach, Medstar, there are so many different manufacturers just here in the US, what are they using as the basis for their designs?   And what about Mark’s ambulance manufacturer?   Are they deciding what is best for us or are we?   I have yet to work in an ambulance where I thought to myself, “This is perfect!”

See Mark, all things I told you when I was there.   We even discussed it in a video report later in the trip.

A few more jobs and we were back to the station for end of shift.

The spot on swooning British nurse impression Mark does was not actually spoken, but he was told repeatedly that I looked “nice” in my station uniform.   Funniest thing was, I was cold and wearing my coat most of the time and he had me remove it before going in.   I think he’s angling for a different style of uniform.

The end of my first day on the RRC brought smiles from me and from Mark and a look forward to another wonderful evening with my extended UK family.   Tea with Margaret, Sandra and the Boys was my family time.   Had I had the time to bring Mark the hour home with me each night here in SF, I think he would have had a much better experience and I now regret not being able to share that time with him.

Back to the hotel and a warm shower and inviting bed.   Tomorrow would be another big day on the car and an afternoon of local heritage, discussing Event EMS and an explanation of this photo:

Steph Frolin? Is that you?

Swalwell 405 – Day 2 in Newcastle

 

This is a continued retelling of my adventures on Part 2 of the Chronicles of EMS, the one we weren’t allowed to film.

Day 2 in Newcastle, Day 1 on the car.

The iphone rang so early I thought I was still dreaming.  Sure it said 5:15 AM and Mark would be along to pick me up in 30 minutes time, but I felt destroyed.  My body still thought it was 10 PM and was gearing down for night.

NO! I yelled to myself and turned the lights on.

This was going to suck.

I got cleaned up and dressed, then went to make a cup of coffee.  Coffee in England is different than in America.  In America you get a nice drip brewed cup of joe from perhaps a Peet’s, or even a Starbucks or gas station.  In room 501 of the hotel, my HMHQ for the week, there was a water kettle and a baggie of freeze dried coffee.  A taste I choked down at first and then missed as soon as I was on the plane ride home.  I had come prepared for the coffee situation, however, as you may recall from this video I posted later in the day:

Mark took me over to his station, the sun yet to rise.  Inside I met a few of the night shift going off duty in the ambulance room of the Fire and Ambulance Station.  It immediately took me back to microwaving 25 cent burritos and drinking tap water during my internships.  There was a TV in the corner, 4 very nice green chairs (green is the color for EMS there) a couple of side tables, small kitchenette with sink and a microwave.  We really are the same.

Craving more coffee I went to fire up the kettle and prepared another cup of the freeze dried goodness as Mark took me out to the floor and to Swalwell 405, our Rapid Response Car for the day.

It was exactly as I had imagined.  A ford station wagon, appointed with safety markings, emergency lights and the ever important aspect to the RRC, the label “Ambulance.”

The RRC with the Appliances at Swalwell Station
The RRC with the Appliances at Swalwell Station

Mark led me on a quick overview of the equipment kept inside and what I could carry on a job and what I should stay away from.  We talked about interventions I could perform, such as assisting persons to stand or to walk, the basic stuff we all do, but at no time was I to use his giant Lifepack 12 to cardiovert someone in unstable SVT.

As soon as we were checked out we were sent on a system status post in a nearby neighborhood.  Not to get Mark in trouble, but I needed more coffee (some have cocaine, others a hobby or “life”, I have coffee, let it go) and the only place that pours a cup is a place I hadn’t been in over two decades, the McDonald’s.

We were on post for an hour when we were called back to the station.  You see, Mark and his co-workers are given a rotation back to the station each hour for bathroom trips, food and what not.  When we left our area, another vehicle or car would fill in.  This seemed simple enough at first, but a few days later, while watching the allocators try to juggle all the breaks and rotations, I wondered just how important that 1 hour mark was.

At the station Mark’s point to point radio came alive.  I had trouble understanding the accents at first to decipher our assignment and there was no station alarm or alert system.  Perhaps it would have awakened the firefighters upstairs?  We climbed in the car and away we went, blue lights flashing to a reported fall victim.  Specifics aside this was the perfect first call for me to see the NHS in action.

I in my station duty uniform with badge of office and Mark in his now famous green jumpsuit made our way in and found a run we EMT and Paramedics handle all the time, a minor muscular injury.  Mark went into his comfort zone, patient care, and I handed him the BP cuff and placed the stethoscope across his shoulders to have it in reach.  That got me a look I often saw as a small child when I would break something expensive.  No one over there stores their stethoscope around their neck.  I only do it on scene, mainly so I don’t lose it, but throughout my trip I never saw one ‘scope around one neck.

As I recovered from that faux pas a walking Saturday Night Live memory came through the door.  The patient’s neighbor was a Scotsman, a true Scotsman, and when he found out I was American he began to tell me a story about an American he knew back in the 60s.  I know this because Mark translated for me later.  I could only make out a few words here and there, no unlike watching TV in a foreign country.

The Scotsman was ignored when I heard Mark tell the woman she should take some Peracetamol and the ambulance will be along in a moment.  He is allowed to let his patients medicate themselves for new conditions.  Now, I can create a gray area and make it work, but imagine telling the receiving facility that you let your patient dose up on Tylenol (paracetamol) for a new injury.  The ambulance crew arrived and away the patient went and we were back in service.  Nothing extraordinary, a simple run of the mill job we both encounter all the time.  The only difference was arriving at the scene in a car, and alone (without me) would be challenging at first, but some days, with some crews, I am kind of am responding alone.

In my next post I’ll describe the odd moment when we were waiting in the middle of the highway for a second ambulance as a fire engine drove by, not assigned to the accident and something I think the NEAS needs to change immediately to better serve their citizens.