I love my TomTom Go 740. Really, I do. I buy all the extra live services and map updates for it, I use it every morning on the way to work to route me around the nightmare car park that the M4 in South Wales can be. I use it when I drive to London with business, both to find my destination and to route around traffic. I use it with St John Ambulance and Mountain Rescue to find out where I need to go. I use their route finder on the website. I use it to help me keep to the speed limit. In the year and a bit that I’ve owned it, it’s taken me to Italy and back and to Edinburgh and back, countless trips around south Wales, London, Nottingham and other places. I use the Google search functionality extensively on it (“Where’s my nearest Starbucks?” is a frequent question) and it rocks.

So, why am I so annoyed?

I’ve had a few problems with my TomTom – I’m probably what you’d consider a “power user” – I know what I’m doing when it comes to technology, I have some pretty demanding requirements. I push the limits. I have extra Point of Interest (POI) databases on my satnav showing me things like supermarkets and banks. I store my frequently used locations and I use voice control. So when things go wrong, I’m straight onto their support guys. And this, I find, is where it goes wrong.

The support people I talk to are lovely and polite, but I get a markedly different experience depending on how I raise my issue. The typical experience is this:

I have a problem, I raise a ticket on their website. After browsing the possible answers, it gets submitted. I get a response after 2 days telling me to factory reset my TomTom. This hasn’t, to date, fixed any of my problems. The ticket goes back to TomTom. I wait a while. Eventually, I either get an answer which requires a bit more conversation, or I take the second route – calling them.

I’ve spoke to TomTom on the phone a few times. Almost without fail, the people I speak to are knowledgeable, friendly, competent and are able to resolve my queries there and then. I spend 5 minutes on the phone and my problems are fixed. This morning, one 5 minute call had my issue fixed whilst on the phone when a ticket I’d opened two weeks ago was still languishing in the lost no-man’s-land of “escalation”.

This all begs the question, why should I raise tickets through the web interface? I get a significantly better experience by calling them, yet it’s in their interest to make me use the website because it’s cheaper for them.

From my perspective, this is a failure – it’s a service management failure. My biggest complaint about TomTom is that despite having the best product on the market by a significant factor, their service management lets them down. It has improved – the technical service is a lot better now, but the customer service still appears to be lacking.

So, TomTom, sort your service management out. Customers will only put up with a good product and a poor service for a while…

Originally published at Hypoxic witterings. Please leave any comments there.

Having completely missed the start of the drama that proceeded to unfold in Northumbria due to the lack of updates from the BBC Breaking News twitter feed, Sean and I finally caught up tonight as we heard that there was a “siege” going on. Unfortunately, we’re away from home without our usual Sky TV, so a quick browse on the laptop and I managed to load up the BBC News 24 live coverage. I wish I hadn’t.

Let’s get this straight here, there’s an armed man who’s wanted for murdering a number of people and has made threats against both the police and members of the public in general. He is likely to be highly stressed, emotional, tired and not really thinking clearly. Oh, and he’s got a gun. Police have found him and they’re “negotiating”.

Great, fine, important news. How do you think that should be reported?

How about by broadcasting a live telephone interview with someone who has a line-of-sight view to the proceedings? By having your presenter stood at the edge of the inner cordon after being asked to stay in his vehicle? By trying to catch a glimpse of the gunman through the trees? By intervewing an emotional woman about the fact that her mother was told in no uncertain terms to stay indoors for her own safety and rebroadcasting the clip where she says her mother had a gun shoved in her face?

Am I the only one that believes that those tactics are completely irresponsible?

I see that Northumbria Police have now created a 10 mile exclusion zone.

 

I hope they enforce it. I also hope that the BBC gets a damn good lambasting for its behavour – I’m just as disgusted with Sky who apparently have been doing similar things, but I expect this kind of sensationalist US-style news reporting from Sky. I don’t expect it from the BBC.

Originally published at Hypoxic witterings. Please leave any comments there.

When I was young, I wanted to be a policeman. I had a toy police car, complete with a flashing blue light on it and I pedalled around the garden and neighbour’s houses. I got a toy policeman’s uniform for one birthday, which I was overjoyed with.

I was so convinced that I wanted to be a policeman that one day not long after I’d had the policeman’s uniform, I went missing. My mother was searching the neighbours when she had a phone call from someone who lived in the middle of our village where there’s a crossroads. I was there, in my uniform, about 8 years old, directing traffic. Yup, I wanted to be a policeman.

Skip forward some years later, I’ve not long been in the Mountain Rescue team and I’m studying to be a team medic. I visit one of my closest friends from school and tell him about my recent mountainous antics, and he replied, to utter surprise:

“Yeah, you always were interested in first aid and stuff. I was always surprised you didn’t end up in medicine.”

It was a long drive back home that night and his comment had knocked me for six. I’d never even considered a medical career and I’d long since ruled out the police having decided that I probably couldn’t handle waking a mother up at 3am to tell her that her son had died. My career in computers was taking off, so I discarded the idea of medicine – I’m not sure I fancied 6 or 7 more years of school.

I’d discarded the idea, but James’ comment obviously struck a chord. Mountain Resce helped me find out more about pre-hospital medicine and I found out that, in fact, I was interested. So, after moving to London when my employer was bought out, I decided to try something out. I wrote to the London Ambulance Service and asked if I could go out as an observer on an ambulance for a shift. A few weeks later, it was all arranged – I was to report to Oval and Kennington ambulance station at 7pm for a 12 hour shift. I arrived to a bad start – the person who was supposed to be taking me out had called in sick. I was bundled into the back of an ambulance with a Paramedic and a technician and was told to spend the night with them.

Nothing much happened that Thursday night, it was quiet and by midnight, the technician had to leave to go to headquarters, leaving the Paramedic with no crew. “Never mind,” he said, “come back tomorrow night instead – it’ll be busier on a Friday.”

Luckily the shifts I worked gave me 4 clear days off, so back I went the following evening. I met up with the Paramedic again and took a second attempt. What a night that was – in fact, I spent 3 nights out with Richard Lee, the Paramedic – who turned out to be from a village not 4 miles from where I now sit. More freaky than that was that his wife came from my village. The first night was rounded off in true Welsh colours as we picked up two lads who’d been assaulted outside the Brixton academy. Recognising their accent, Richard and I laughed when they told us they were from Penarth near Cardiff.

Those three nights that I spent learning from Richard and observing the way they work, took the little spark of interest I had and threw it unceremoniously into a huge keg full of dynamite. It ignited a passion in me that’s still going today – brning strongly enough that I’ve committed to giving up a career as a successful communications consultant and instead, to going back to school to become a Paramedic.

It’s been a long road from that innocent comment to where I am now and there are three Paramedics (all called Richard!) who’ve taught me in their own way what being a Paramedic means. For me, it still hasn’t all “come together” yet – I’ve my epiphanies along the way – sudden insights into how the body works, how to look after people and what it’s all about. Jobs that have gone so perfectly, it felt just like another exercise. But for now, the last part of the puzzle is still there, not quite yet within my grasp.

Watch this space.

This blog post was written as a submission to the Handover Carnival, hosted this month by the EMT Spot, on the theme of “…and that’s when it all came together.”

Originally published at Hypoxic witterings. Please leave any comments there.

Yesterday, from a tweet by insomniacmedic, I was linked to a blog post by Buckman. He talks at length about the foolishness of some patients who refuse the care they so desperately need and the knock-on costs of the associated palliative care as they die. It’s a post and a subject that stirs deep emotions and I started writing a reply before realising it was turning into an essay. So, Buckman, here’s my response. Go and read Buckman’s post before you read this though – you need the context!

Coming so soon after the recent episode of the EMS Handover on Respect, this post brought the whole topic back to the forefront of my mind again. I know what it’s like to care for people who are responsible for their condition yet refuse to take responsibility for their actions. I know what it’s like to try and help someone who refuses your help. So I’m not unsympathetic to the plight that Buckman describes – it’s an impossible situation at times, made worse, it seems, by the litigious nature of American society. I’ll try my best to not let this descend into a rant on what’s broken about the US healthcare model in my opinion – I’ll just say that I’m glad that I live in the UK and work within the British healthcare system.

The extreme polarisation of the term “patient care” you write about at the start is something that I haven’t seen in the UK – perhaps I haven’t been working with the system long enough. But I find that extreme views are rarely beneficial to anyone, mainly because they seem to define the issue in a very monochrome way and, as Dr Ben Goldacre says so often “It’s not quite that simple…”. I’m not suggesting that the care that you personally offer is deficient in any way, just that any extreme is bad.

I do think that the concept of patient care is somethign we should hold dear to us and is key to providing effective treatment to our patients. There’s a difference between clinical treatment of a medical condition and actually caring for the patient. I think I’m lucky that coming from a first aid background, there were and still are times when there were no interventions that I could make within my skillset that would help that patient, so caring for them was the only skill I had left.

Having said that, I agree that we shouldn’t mollycoddle patients – some people need some tough lovin’ to get the point across and to help them make the jump across the uncomfortable gap of change. If your description of your medical system is accurate, that it’s a system where you can’t be honest without patients for fear of reprisals when that honesty is truly in their best interest, then I fear for that system. The system is failing to provide the best care for the patients and is crippling your ability to do so. Somethign needs to change.

I don’t think that “Do what I say or else” is an appropriate stance for a medic to take. Yes, let’s move them out of that ICU bed into a ward where they can receive palliative care, but don’t make them pay for it. This gives far too much power for a doctor who is of a bullying nature over the patient’s decisions.

I agree, something needs to be done to curb the growing trend of patients who absolve themeslves of any responsibility over their condition – but this is a problem that we see in society as a whole, not specifically in healthcare. Forcing people to take a specific course of action in their healthcare is like using a sledgehammer to crack a walnut when you’re trying to fell a tree – it’s both overkill and yet far too little at the same time.

We’re facing a growing problem where the lack of personal responsiblity in society is stressing our healthcare systems to the limit and we need to find new solutions to these new problems without compromising the care that we offer patients.

Just my tup’pence.

Originally published at Hypoxic witterings. Please leave any comments there.

@ckemtp has asked for posts this month on the topic of Respect for ‘The Handover’ Blog carnival.

This is a field I occasionally feel like a bit of an impostor in. I’m not a Paramedic. I’m not a Doctor, a nurse or an Ambulance Technician. I am what I would call, an advanced First Aider. Mountain Rescue calls me a Casualty Carer and shows me how to deal with fractures, give drugs, inject people and care for people. St John Ambulance calls me a Patient Transport Attendant and teaches me to use AEDs, gases, use the equipment in an ambulance and care for people. But for all the journals I read and the knowledge that I gain, I’m a first aider.

Over the years, I’ve had respect from patients, health care professionals, members of the public and members of the armed forces. I’ve recently had a number of comments from healthcare professionals that have made me realise that there’s a lot of respect out there for volunteers in this country. Comments from members of the public, from the twitterverse, from friends and even from senior ambulance service officers have all demonstrated that they respect the work that we do. Some of then even respect that while we would like to work for the Ambulance service, some can’t because the NHS isn’t known for the luxurious lifestyles afforded by the salaries and mortgages aren’t known to be cheap things these days.

I’ve also had people treat me with significant amounts of disrespect because I, like thousands of other people in this country, are volunteers. We’re not paid healthcare professionals – but that doesn’t mean we aren’t professional in our work, whether that’s paid or not. I’ve seen Paramedics disrespected by staff in the hospitals, by patients and by their colleagues. Equally I’ve seen patients disrespected by their carers – and of all the disrespect I’ve seen, that one leaves the worst taste in my mouth.

Ingore me because I’m a volunteer. Treat me badly because you’ve had a bad experience with the commercial arm of St John. Swear at your officers. Argue with paramedics in the middle of your A&E department. They all leave a bad taste with the people around. But treat your patients with respect, even when they don’t deserve it. A mentor of mine once pointed out that we’re invited into people’s lives at moments that are significant and horrible for them – for us, it’s just another job, just another DIB, another MI. We’re invited into their lives and they share with us the most intimate details of their personal lives, their troubles, their fears. He taught me to treat my patients like human beings, simple things like asking everyone to leave the room when the paramedic is putting the leads on a woman’s chest because she has to bear her torso to do so.

I’ve learned respect and I’ve learned to earn the respect of my patients. I’ve learned that everyone has a story, even if they seem like assholes and I’ve learned to respect that people can appear like assholes when they’re going through a traumatic time.

Respect. Disrespect. Which will you chose?

Originally published at Hypoxic witterings. Please leave any comments there.

Over the past 6 years we’ve seen technology change our lives. I’m probably an unusually early adopter of a lot of technologies because I work in the field, but I wonder how other people have found technology helping them in a medical aspect.

At home, I’ve used the Internet to learn – googling unknown terms, reading blogs with ECG challenges, learning about the body’s processes and how we affect those. I’ve researched specific conditions or drugs that I’ve come across and am unfamiliar with. I’ve witnessed discussions on blogs and on twitter that have made me think about my treatment, my handling of patients as well as conditions that I come across.

Out in the field, I’ve used my Blackberry to great effect:

• Drugs – I’ve looked up drugs that I’m not familiar with and some that even the paramedic on scene hasn’t seen before. There’s an enormous array of drugs out there and it’s important for us to be able to find out some key information.
• Conditions – we frequently attend to transport patients who have been diagnosed by their GP. Not only are Doctor’s handwriting notoriously bad, but they on occasion use terminology I’m not familiar with. A quick google normally sorts that out and gives me a better understanding of the patient’s condition and how to treat them for the short time they’re with us. I have even, on occasion, passed this information on to the nurse who’s taken our handover.
• Finding a location – ah, the perennial problem of ambulance work: finding the patient. I’ve lost count of the number of times I’ve used Google on my Blackberry to find nursing homes. Google maps has helped us navigate there when TomTom has failed.
• Getting into a house – yeah, not your usual use of a mobile phone this, but I did once make use of the Internet to find the telephone number for a patient’s family to find out where the spare key was kept. 1am, standing outside the patient’s house, freezing cold and stomping around in the snow with no way of getting in, I was very glad I had my mobile with me.

I’m actually considering getting the BNF on my phone at the moment to help us with understanding drugs – the drugs a patient is taking is often helpful in giving us an idea of what the patient is suffering from when the patient can’t or won’t tell us.

I’ve even, on occasion, been known to use my phone to make phone calls.

So, how do you use your phone? How has it changed the way you work?

Originally published at Hypoxic witterings. Please leave any comments there.

Buckman is hosting this month’s edition of The Handover and asked people to write about people who influenced their career.

I have to admit, I’m not short of those. The two Richards, both of whom are accomplished and professional Paramedics in their own rights, each with a very different style. Andrew, Sharon and a whole host of others in Mountain Rescue. The other Richard who introduced me to London’s flavour of EMS work. My grandmother, a Nursing Auxiliary during the war who dispensed her own flavour of rough justice and maldod in my childhood. Malcolm, who got me involved in Mountain Rescue in the first place.

But I was looking for that person. You know, the one that made me stop and think. The one that inspired me to start down this path. And I have to admit that almost everyone in that list helped me get where I am and they may well deserve their own Portrait, but they didn’t give me that first spark.

That accolade goes to someone who didn’t really feature in that list. My grandfather.

Born in 1918 he grew up in the Welsh valleys where coal mining was The Industry. Brighter than the average my grandfather went to nightschool to learn to be a Mining Surveyor and made a career of it. He took a few years out to work for the Royal Engineers in India during the war but came back and worked in the mines in south Wales for most of his career. When I knew him, he was silver-haired and retired, spending much of his time working hard in the garden that was once a coal tip but now bloomed after his hard work. Like a lot of people his age he was a heavy smoker and I distincly remember him suffering from his angina. The little red bottle sprayed under the tongue and the pause while he waited for his heart to catch up.

I have nothing but fond memories of my grandfather. My parents both worked office jobs so when I came home from school, I would spend a few hours with my grandparents just a few hundred yards down the road from our home before my parents picked me up. He gave me my frist car, he taught me to write. He once told me that I could do anything if I worked hard and whatever it was I wanted to do, that he would support me – words that still echo in me today.

It all went wrong one Saturday in May. I remember I called into the house to say hello before I headed out for the day. My grandfather was in bed with my grandmother fussing over him. He just didn’t feel very well, nothing specific, known in the ambulance service as “generally unwell”. He looked pale, enough so that I asked him if he was OK. I asked if they’d rung the doctor but my grandfather insisted he was fine. I was 17 and didn’t really appreciate how people lie, even to their loved ones. I took his word at face value and went out to see my friends figuring it was something minor like it always had been in the past.

It was probably mid afternoon when I had a phone call. My grandfather was ill, the doctor had been called, I should come home, post haste. Grumbling, not realising the severity of the problem, I drove down to my grandparents house where it rapidly became apparent how serious it was. Our local GPs, two brothers, were the sons of the husband-wife pair who’d run the local practice before them. One of them was a cardiac specialist and he’d immediately called 999 for an ambulance, recognising the problem with my grandfather for what it was. I was sent to the bottom of the road to direct the ambulance. I windmilled for my life when I saw it and raced up the road behind it as quick as I could. I have no memory of seeing my grandfather going into the ambulance and my next memory of that day is my grandmother, flustered. My grandmother was never flustered. This was serious.

My father drove us into the local hospital 15 minutes drive away. It was a quiet journey, each of us contemplating the worst. We arrived and headed into A&E where they directed us to the Coronary Care Unit. We walked in and were ushered in quickly to see my grandfather sat up in bed smiling at us, connected up to a hundred cables. We crowded around, holding his hand and chatting quietly. My fears abated, we laughed and joked and said that we’d see him tomorrow.

The next half hour is perfectly clear. I was the last to leave and as I walked out my father was waiting for me. The doctor crossed the room in the corner of my eye and clearly called my granfathers’ name, questioningly. We walked down the corridor and my father met a friend and said he’d meet us in the car. I walked my now-much-releived grandmother out to the car and my father joined us about 10 minutes later – and asked us to come back in. The nurse had asked him to get us. Emotions running wild, we went back to CCU and were ushered into what I now know is the relatives’ room. A nurse came in to say that the Doctor was on his way and my grandmother looked her in the eye.

“He’s gone, hasn’t he?”

She paused. “Yes, i’m afraid he has, love. Doctor will be in to talk to you in a minute.”

The next bit was a blur. I have no idea what the doctor said but I remember going to visit the body, the shell, the sleeping form that was once my grandfather. I remember my grandmother taking his signet ring from his finger and wrapping my hand around it. “It’s yours now.” she said, shakily.

My grandfather had held on until we came to say goodbye to him – at least that’s how I like to think of it. Losing him tore me apart, he was a huge part of my life and I drifted through my A-levels in a daze. To this day, I still miss him sorely.

The signs were all there. When I saw him he was pale enough that an alarm bell rang in my head, but was dismissed when he said he was OK. He was sweaty. He had a feeling of being “just not quite right” and couldn’t shake it all day. He had a history of unstable angina, and was a heavy smoker. If someone described that situation to me now, I’d call an ambulance and give him half an aspirin. I’d ask about chest pain. I’d igore his insistence that he was fine.

My grandfather wasn’t some medical genius, a world-leading surgeon or medical scientist. He was a retired mining surveyor. He didn’t show me any amazing medical procedures. What he made me do was promise to myself that I’d never miss that again. If only we’ve have received some basic lessons in recognising these things at school or anywhere. I didn’t see it. I kicked myself for months that I could have done something but didn’t.

Eventually I accepted the situation, but every decision I’ve made since that saw me doing anything medical stems from that one event. From the knowledge that I could have done more if only I knew. A promise to myself and to him that I will work hard. So that hopefully, one day, I’ll turn up in time to help someone else’s grandfather.

Originally published at Hypoxic witterings. Please leave any comments there.

There’s a big push in the emergency services to get information out to the front line, to the people who really need it. PC Copperfield has emigrated to Canada where the police seem to have a better handle on process and communications to the front line. Access to all kinds of data is useful when you’re on the front line – like when a patient shows you what drugs they’re on but you don’t recognise them, you can look them up in the BNF. When a patient has a rare disease that you’ve not come across but you really need to know what it is, you can look it up in a whole variety of places, like Kal once did. And last week, I used it several times in a shift, twice to satisfy my own thirst for knowlege, a couple of times to find care homes who weren’t well signposted and once to find an important piece of information.

The two not-so-important things were to look up what a bruit was and the second to find out what Tramacet is (a strong painkiller). The second resulted in an interesting conversation with the A&E nurse after we’d booked our patient in.

The other use was a little more…immediate.

A job came through to us around midnight, asking us to go to the local A&E and pick up an elderly lady from a corridor and take her home as she’d been waiting for some time. These kind of jobs are lovely because they’re simple, there’s little or no medical problems to worry about (and while I’m in this for the medicine, it’s occasionally nice to know that your patient isn’t going to die on you. Probably.) and people are supremely grateful. So we tromp into A&E, find our patient and sit her in the ambulance to driver her home. She’s a lovely old lady with a cracking black eye and mild dementia – she’s lucid but isn’t too good at remembering things.

So we get to her address and park up. There’s some talking from the back as I fiddle with the radio for a second to let control know we’ve arrived. A head appears next to me as my attendant sticks her head through the partition. “We can’t find her key.”

We help her look through her pockets. We help her look through her bag. Twice. No key. I run down and check the door, yes it’s locked. Shit. Wait – that’s a keysafe, great. I run back – does she remember the number to her keysafe? No. Shit. Any relatives? No. Son or Daughter? No. Do the neighbours have a key? No. Does she leave one under the mat or a plantpot? No. Carers? Yes, but they’re private and she doesn’t remember the company name.

Right, contact control who have nothing on the incident record. However, she was taken in earlier in the shift so the controller goes to dig around to find the original incident. Right. We empty her bag out. Still no key. Control get back to us saying they’ve spoken to the original crew who mentioned a son. Wait, a son? So I jump in the back and skirted around the earlier questions with a more direct approach.

“What’s you’r son’s name, my love?”

“Chris.”

My colleage stares at me open-mouthed.

“Where does Chris live?”

“In LittleVillage.”

This is bad news – LittleVillage is about 90 minutes West of where we were at best. Still, let’s try for his address to see if I can get his phone number. She remembers the house number and can describe the street where he lives but doesn’t remember the road name. So I get my phone out. Luckily LittleVillage is about 2 miles from where I grew up and her description of the street is one I recognise, so I don’t bother with Google maps.

Onto the BT directory enquiries page. I look up the details. Hrm, nothing in that street. Check google maps – the house number is quite large, almost 200 and there aren’t that many long streets in the village. Try this one instead – aha!

I call the number. “Hi, this is the Ambulance service here…”

“Oh, thank God, you’re taking my mother home?” Right, sounds like we’ve got the right one then.

He knew the keysafe number. And knew where she normally kept her key. So we got her in, put the fire on, made a cup of tea and helped her warm up.

Would we have got her in without the internet? Probably – control could have looked up the number for us, but it could have taken longer. Did the internet help? Yes, without a doubt – I could use the information that I had to find the address quickly and confirm it easily with the patient. Is this the most important use of the internet that we will have? No, without a doubt. I’ve already had twitter increase my knowledge of chest pain in adolescents (thanks Kal!) and teach me about conditions I might come across. We’re humans, not encyclopedias – we will come across things that we don’t know or need reminding of.

I really do think that with the arrival of Airwaves in the Ambulance service we should see smarter devices being rolled out with access to medical databases for looking up medications and conditions or illnesses. I’d like to see medical records being accessible to the front line as well – though I understand the privacy concerns. We have to be careful not to overload the guys on the front line, but access to the information when they need it really can save lives. We need to make sure that we have sources that are definitive and trustworthy and not just wikipedia.

People said that the end of the last century and the start of the new millenium was the information age. Is this the age that we see information being distributed to every person wherever they are, whatever they’re doing?

Originally published at Hypoxic witterings. Please leave any comments there.

A few months ago I walked into my first St John Ambulance evening in Cardiff. Last week I was a member of a 2-man St John crew on an ambulance helping out the Ambulance service on a 12-hour shift on New Year’s Eve. It’s been a very fast and steep learning curve to get here and I loved working the shift.

A number of cases stand out in my mind from a number of the shifts, some of which will make interesting blog posts, some of which will never make my blog for various reasons.

One in particlar sticks out. We’re called to attend a 999 call which has been downgraded to a Green call – an incident that requires a response without blue lights. We turn up and have a chat. The gentleman is in his 40s and has parasthesia from the waist down. He speaks very little English. We ascertain through pidgeon English and gestures that he’s urinating blood.

I’m not attending for this one, but something strikes me as odd. His feet are bandaged neatly – apparently he’s burned them and has been to hospital for his feet already. I look around the room and spot a box of tablets on the windowsill with a hospital pharmacy label. I point to them and he nods. Antibiotics. Paracetamol. There’s a letter with it and again he nods and I read.

His feet are injured from a scald and he spent a few days in hospital. Whilst he was there they noticed the complaint of haematuria and investigated, finding nothing and eventually referring him to a specialist in a nearby hospital. The notes go into more detail – his condition and pain seems unchanged from the time of admission. He’s also seeking asylum in this country but has had his application refused. He has multiple presentations to multiple services over the past 8 months.

On the other hand, he’s complaining of pain and does have some blood in his urine. His obs are fine and he seems comfortable unless we ask him about the pain, whereupon his face screws up. We have a quick chat amongst ourselves and we decide to try and see if we can get the out of hours GP to have a look, and control is informed. We explain to the chap who indicates that he’s happy with this – he doesn’t really want to go to A&E, it’ll be a several hour wait and he can’t afford the taxi journey home.

We hear a knock at the door and in walks a paramedic. We have a brief look between us before enquiring why he’s here. Control sent him. A handover is made and the paramedic asks the chap about his pain, then spends the next 10 minutes or so convincing him he needs to go to A&E, much to our confusion. We look confused but are happy to take him – obviously the paramedic is the senior clinician on scene here.

So we walk the chap out to the truck and drive him up to A&E. The charge nurse gave us a shitty look and we looked suitably apologetic as she tutted over the patient for a few minutes. She comes over to us. We explain what happened.

“Right, I see. Well, being here serves neither his best interests nor ours. I’m referring him to the out of hours GP.”

We left quietly.

Originally published at Hypoxic witterings. Please leave any comments there.

“Dusk is falling and the lamp lighters are at work – it’s Christmas Eve for sure!”

Just finishing off the last few bits of shopping today and my thoughts are with those people who won’t be able to go home to enjoy Christmas with their families. An ambulance just went past on blues. There’s two policemen on duty over there. There’s firemen, doctors, nurses – all who’ll be missing Christmas with the family.

Here’s to you all, wherever you are. Merry Christmas everyone.

Originally published at Hypoxic witterings. Please leave any comments there.

At around 1700 Monday night I had a text message – contingency plans were in place to assist the ambulance service, could I crew a vehicle?

So after work, I grabbed some food and ironed my uniform before de-snowing the car and heading into Llanishen. Once I got out of our village the roads were ok – probably because there was plenty of traffic to keep them clear. Our end of the street was awful, but then we only have about 10 houses there. The trip wasn’t helped by the fact that my car has developed a hole in the exhaust from all the salt. It’s in the garage being fixed today…

So we jumped on the vehicle and completed our inspection very quickly – it’s easier when you have two people doing it, and we had three on the vehicle last night. I decided that I’d had enough time driving and wanted more experience in the back, so arranged to be the attendant for the evening.

We logged on and immediately were asked to hold on for a second while control checked what we should be sent to first. They called back and asked us to back up an RRV for transporting a patient, but when we arrived on scene, the RRV reported that the patient had already made their own way to the hospital. Clearing from that incident, we were dispatched to back up another RRV, about half a mile down the road. There we picked up a woman in her 40’s with “nonspecific abdo pain”. Once I’d coughed my way through the cigarette smoke, we prepared the carry-chair and she stood from her armchair and sat herself down. Mike and I packed her and moved her out to the vehicle with some difficulty – a scenario not covered in training was using our equipment in snow and we found it sinking through the snow and ice.

Mike had already started to attend to her so I took the keys and prepared to drive when whe woman asked for “gas and air”. We looked surprised and asked her, on a scale of 1 to… “It’s 10.” she interrupted us, sitting comfortably and not showing any signs of pain. I blinked and sighed inwardly, leaving Mike to it. Apparently, morphine didn’t touch her pain (hence why she hadn’t asked the paramedic for any), but entonox worked wonders. It was a quick drive to the hospital and we passed her over to the care of the nurses in A&E. There followed a discussion between the three of us on the ethics of witholding pain medication if you believe that there was no clinical need for it.

The next job was for a young woman who really did need us. A transfer into hospital, the GP had diagnosed “?DVT R leg”. Her medical history was long and she was currently just 2 months out of her most recent encounter with chemotherapy. From the way she held herself I could tell she was guarding herself against pain and I asked if we could help, but she politely declined analgesia in stark contrast to our previous patient.

Our last patient was a hospital transfer for another “?DVT” patient. 97 year old lady, she was a real card. I had a great time chatting to her on the long trip to hospital. She reminded me a lot of my own grandmother (who’s 92) except that she got a little repetitive at times. She confided to me that she didn’t mind what we did to her so long as we told her first. She was a little deaf and I found myself being her closest friend as I was the one who got confirmation that she’d heard me before we did anything. We got to the hospital and found that there was no bed for her – a bit shocking as this was a transfer from another hospital. We sat in the corridor for a while, chatting with her until we were given a trolley for her. Her condition needed treatment, but it wasn’t a surgical emergency (according to the Surgeon who reviewed her later as well as the nurses) so there was some confusion as to why she had been transferred at that time of night. The constant bouncing around annoyed me, though not near as much as the paramedic who bumped our stretcher out of the way just to get past us, casuing our patient to call out in pain. We may only be “Jonnies”, we may only be carrying an old lady while you’re dealing with a patient going into resus – that’s no reason to hit our trolley out of the way instead of walking around.

We said our goodbyes and headed off for a break – things seemed to be calming down. We’d not long finished our break when we got our last job of the night – back to the hospital to pick the same old lady up. We looked at each other and shook our heads – this was the second time in two days she’d been passed back and forth from one hospital to another – completely unacceptable. We picked her up again, much to her delight, though this time I drove and passed the responsibility of looking after her to a colleague – I was tired and felt a bit drained from looking after her – she really did remind me a lot of my grandmother. My colleagues said that they’d transferred her less than a week ago as well.

We dropped her off and got her settled before cleaning our kit and checking in with control. They thanked us and sent us home, which was nice since the temperature was dropping fast.

This was the busiest shift I’ve had so far. I really enjoyed it, though it left me feeling drained both physically and emotionally. Looking forward to more shifts now.

Originally published at Hypoxic witterings. Please leave any comments there.

Well, that was a bit quieter than was expected…by ourselves as well as pretty much the entire city.

South Wales police reported that it was quieter last Friday than a normal Friday night. The ambulance crews in the Millenium Staduim drank lots of coffee and dealt with the few incidents we were called to – we only had 3 jobs on our vehicle all night.

I got called last night while in Cardiff to work an ambulance shift for Mid Glam. The highlight of the shift until midnight was the free hot mince pies with cream we were so kindly served by the staff in the canteen at the hospital. Nomnom. We managed to finish them off before we were called onto the one job of the night.

This is of course, a Good Thing. People were sensible and remained uninjured. Hooray.

Let’s see what the rest of my shifts bring this Christmas.

Originally published at Hypoxic witterings. Please leave any comments there.

Today is Black Friday.

Most people won’t know and won’t care what that means, but if you work in or volunteer with the emergency services and you’re on duty tonight – you’re probably either sleeping in preparation or getting your stuff ready.

Black Friday is traditionally the last Friday before Christmas. It’s the day that large numbers of people organise to have a drink together before Christmas…and as a result, Cardiff alone will see 300,000 revellers partying tonight. It’s an incredibly busy night for the emergency services, busier even than New Year’s Eve.

So, what am I doing tonight? After working my day job, I’m on duty (as a volunteer) with St John tonight who have been asked to provide the Welsh Ambulance Service with assistance in Cardiff. We have around 10 extra ambulances on duty; we’re helping to staff the triage centers both in St Mary Street and in the Millenium Stadium. I suspect we’ll see everything from broken nails to alcohol poisoning and assaults, as well as the normal numbers of cardiac arrests and the usual calls because life goes on. I suspect we’ll get more RTC’s tonight because it’s cold and icy and it’s also going to be busy.

And Oh My God but it’ll be cold tonight. The MetOffice is reporting a low of -3 Celsius tonight, down from the dizzy heights of +2 Celsius, with wind speeds dying down from 23mph to 5mph (giving “wind chill” temperatures of around -6 Celsius). That means freezing roads and crashing cars. It means freezing pavements and falling drunk people. It means cold air and hypothermia in partygoers wearing very little. That “beer jacket” that keeps you warm when you’re drunk? It doesn’t – it just stops you from feeling the cold. It could kill you on a night like this.

So tonight we’ll be busy. Tonight we’ll be picking up, helping, trying not to get assaulted and trying to keep warm. I’ll be tweeting and possibly updating the blog where I can, you can follow me on twitter if you’d like: www.twitter.com/thinknuts

Stay safe!

Originally published at Hypoxic witterings. Please leave any comments there.

Back in October of last year, I applied to join South Wales Police as a special constable. Thigns kinda came to a grinding halt over Christmas when the process stopped. It dragged on for a few months and the rumour I had from friends in the force was that all recruitment was on a hold for the time being.

I sat down and re-assesed my options, talking to Sean. I felt as though I was still missing something and Sean was still happy with me doing somethign in addition to Mountain Rescue. I’ve always enjoyed the medical side of Mountain Rescue and I really missed dealing with patients as I used to in the First Responders. So, what could I do?

Enter St John Ambulance. I called national headquarters, based in Cardiff and was referred to Father Andrew, the Divisional Officer In Charge (DOIC) of Cardiff Central. After a long conversation with him, it sounded like I’d hit on the perfect unit – they perform mainly front-line ambulance duties and don’t have a cadet contingent which mean the unit concentrates on training and duties for their adult members.

The first night set the tone really – they’re mostly insane, much like Mountain Rescue. I passed them all the information I could about the training I had complete with Mountain Rescue. Things were looking great…and then a letter came through the door.

South Wales Police had started up its recruitment again. This caused a bit of a dilemma – leave St John and concentrate on the Police? Stop the recruitment process with the police? What to do?

I carried on with both (well, all three including Mountain Rescue) for a while, but this really wasn’t sustainable. Coupled with the fact that I had changed jobs and was considerably busier than I used to be, something had to change. So, after a long conversation with Sean, I decided to withdraw my application to South Wales Police for now. It’s something I’d still like to do, but I’m limited in how much time I have in life – I do like to sleep occasionally!

Last weekend, I passed the 7th course I’d taken in 5 weeks. It’s been a hectic month, but passing my PTA course now means that I can go out with St John Ambulance to do what’s called HDS duties (High Dependency Service) – these are thigns like Doctor’s urgents (when a patient needs to go to hospital urgently but isn’t life-threatening enough to call 999) and hospital transfers. I’m also one of our division’s two drivers currently – so looks like I’m going to be kept busy driving a lot.

On Thursday my uniform arrived – that’s right, look out for me wandering the streets of Cardiff in a natty green uniform. In fact, my first duty is this Saturday, when I’m joining two experienced members for my first HDS duty.

So, er, yeah, that’s where I am, that’s why I haven’t been blogging much of late. Work is taking me to London again this week which means I won’t (again) attend Mountain Rescue on Thursday. Look out for updates on the weekend from the HDS duty, as well as a whole bunch of rants and other stuff I’ve got queued up ready to post.

Tally ho!

Originally published at Hypoxic witterings. Please leave any comments there.

So I forgot I hadn’t posted this. Oops.

We left Todi and had a mammoth drive through Italy, Switzerland and France. It was slated to be 10 hours of driving, but things didn’t go to plan.

Leaving Todi, we hit Italian rush hour which was a bit interesting and I had to concentrate hard to avoid the other cars. It felt like the worst of London driving. We made it to Florence quite quickly though where we’d planned a quick stop to post some postcards that we’d not managed to get stamps for. Well, that was the plan. Our detour into Florence took an hour, going through some beautiful sights and via the main sorting office (that doesn’t sell stamps). Eventually, I dropped Sean off next to the main train station and kept running circles around the block until he came back. Turns out the train station sells stamps…

The weather closed in on us at this point, with heavy rain following us up all the way to Milan. Far from being an interesting and fun drive, this was a hard slog. It wasn’t until we started up into the mountains that the rain eased off a little, but we rapidly hit the clouds and so our progress was slowed down once more. We were aiming for the Gottard tunnel and after weaving my way around queues of lorries, we finally got there.

The tunnel is, I’m sure, a feat of engineering. I certainly appreciated it for that. The drive, though, is boring. It’s a tunnel. Think of the Limehouse link, only 15 miles long and you’re pretty much there. There is, however, a radio station broadcasting inside the tunnel with emergency information, which I thought was quite nifty, though it’s not signposted well enough for someone driving along the motorway.

We came out of the Gottard tunnel and started the journey towards France. It felt like we were past the crux now…which was the wrong feeling, since about 10 minutes north of the tunnel, we hit a traffic jam. There was traffic as far as the eye could see and it was all stationary. After sitting there for a few minutes I turned the engine off, as did everyone else. Within minutes, the road was packed solid in both directions and we settled down for a long wait, with no idea what was going on. Luckily, we’d packed some food for the journey, so we had somethign to eat. It was quite surreal – high in the Swiss mountains, in a picturesque valley with chalets all around us….and cows. Now, I though the Swiss cow bell was a cute little tourist trinket. Turns out, they actually use them. So we’re sat there with a herd of cows next to us, all of which wear bells. Who knew – after a while, that noise gets intensely irritating.

Eventually, after about two hours of delay we got going again – the road narrowed ahead due to roadworks and just at the entrance were some fresh skidmarks and broken glass by the side of the road – which answered the question of what was going on.

By this point the journey wasn’t so much fun as “let’s just get there”. We were both ready to go home and it was only necessity that made us stop in some services just inside Switzerland near the French border. We were starving and needed something, even if it was service-station sandwiches. What we got was just incredible.

We walked in and looked around, getting our bearings. To our right was the restaurant which, at ten o’clock local time, I was expecting to be closed – but it wasn’t. We shrugged and wandered over, before being assaulted by an incredible array of sights and aromas. They had a number of areas, each selling a different kind of freshly cooked food. We looked on in amazement and chose Chicken Cordon Bleu which they cooked in front of us. It wasn’t a five star restaurant, but it was certainly something that Little Chef and Moto could learn from. It sure as hell was not Burger King or McDonalds.

We set off again and got to the hotel just around midnight, having had to call them en route to find out why they weren’t where TomTom said they should be – turns out this is a common problem and her first question was “Do you have satellite navigation?”. She gave us directions from there to a village with the same name as the street we were on about 2 miles away. Reception had closed down for the night when we arrived – this was a small local hotel and our keys were waiting for us on a piece of paper with my name badly mis-spelt.

Thursday morning, a quick breakfast after not enough sleep and we set off again, determined to have a better day. The weather agreed and after some patchy showers, opened up into a beautiful if slightly windy day. We make great progress through the French motorways and hit Calais almost 2 hours earlier than our ferry. A quick stop in a supermarket to take advantage of the cheap diesel and we drove down to the terminal. Without blinking we got put on the next possible ferry leaving in about 30 minutes and we mooched around for a bit admiring the drugs dogs at work. We even managed to get BBC Kent on the radio. We both smiled – I think we were both glad to be going home at this point.

We had a lovely dinner on the ferry – we stood outside Langan’s Brasserie for a bit before threw caution to the wind and decided to end the holiday in style with steaks on the way home. Very nice indeed, as was the creme brulee and, by this time, it was nice to have English accents around us.

It was getting dark by the time we got to Dover and with a reminder from TomTom to drive on the left again, we were back on British soil. Not quite home yet though – we drove to Slough where I met up with some of my work colleagues for a conference the following day. I was far mroe tired than I expected and on Friday, by lunchtime, I was falling asleep in the comfort of the conference and decided that I wasn’t doing any good here. I took off, met up with Sean in Leicester Square for some lunch and we drove home.

We both had an absolutely awesome time and certainly clocked up some miles. I’d like to do something similar again, though in a more comfortable car and with more time to spend in each place. Brussels was lovely and we want to go back there. We never really saw Zurich, and Strasbourg was a lovely surprise. I’m not sure I’d want to drive in Italy again – the other drivers make it very stressful. We’re already putting ideas together as to our next one, suggestions so far include the UK, north or eastern Europe and the USA/Canada.

Originally published at Hypoxic witterings. Please leave any comments there.

I’ve always said that the marque of a good holiday is when, halfway through, you realise that you have no idea what day it is. What the date is, what day of the week it is, how far into your holiday you are. When you’ve reached that point you’ve relaxed completely – you’re no longer tied into the weekly grind.

It’s actually day 12 today – I had to count that on the calendar! Staying in Todi has been fantastic for the both of us. The house we’re staying in is incredibly relaxing with fabulous views and peace and quiet abound. We’ve mostly read books, hung around the house and the swimming pool, had a bit of a walk and driven to town for dinner or grocery shopping once or twice. We’ve slept without alarm clocks waking us up. I feel more alive and refreshed than I have done for a long time. I do feel a little regret for not spending more time exploring the surrounds, but we needed the break to be honest. Besides, we’ve been invited back again next year – I don’t think we’ll drive next time.

We’re staying here with John (Sean’s Dad) and Sophie (his wife). They happened to have two friends staying at the same time (Bill and Sue) which wasn’t a problem – the house is a 3-bed Tuscan villa with a large living and dining room. So evening meals have been a mix – John cooked spaghetti bolognese one night and Bill and Sue cooked another night. So a few days ago, Sean and I announced that we’d cook – spaghetti carbonara. So we prepared, we got a recipe – it didn’t seem too difficult. We then had a bit of a spanner in the works with concerns over the eggs – you mix the spaghetti into the raw eggs and they kinda cook from the heat. So we moved on from carbonara and Sean and I scoured the internet and decided to stick with an Italian staple – Lasagne.

To be fair, I’ve made lasagne before, but only with the help of Mr. Ragu and Mr. Dolmio. This recipe called for making the ragu (the meat/tomato sauce) from fresh as well as the white sauce (actually a bechamel sauce). So, when we got the ingredients, we never realised how much of an epic it would be. We started cooking at just before 7pm and finally served a huge lasagne to serve 6-8 at 9pm – and we cut out quite a lot of the time the ragu is supposed to cook for! It was, however, an absolute resounding success. I served full plates for everyone and had plenty left over…until everyone asked for seconds. I don’t think I’ve ever had a meal go down quite so well. I also learned how to make a bechamel sauce – here’s a hint folks: make sure you have a whisk before you start. Doing it with a fork is bloody hard work.

So today is our last full day in Todi. We’re packing the car tonight for an 8am departure tomorrow. We’ve found a little hotel just south of Strasbourg which means we have some 8 hours of driving to do tomorrow (not including rest stops). Thursday night we have a ferry crossing to Dover and we’ll be in London for Friday where I have a work event. We had plans for the weekend but having experienced a long day’s driving on the way here, we decided to try and leave the weekend to recover and catch up on household chores – we’ve got almost a full suitcase of laundry! I think we’re both actually looking forward to going home now – to more familiar surroundings where shopping isn’t quite so much of an adventure and you can recognise “beef stock” (and not “beef soup”)!

Originally published at Hypoxic witterings. Please leave any comments there.

We woke up fairly early in Grenoble and had some breakfast before heading off – we did find out that she hadn’t waived all the charges, just given us a credit towards our room of the amount we’d already paid – the night we stayed was some €20 more than our original room. Still, better than no credit at all.

It was a pretty long journey down to Marseilles, mostly on motorways. The terrain got progressively more yellow as we went, the trees and buildings becoming more meditaranean and the temperature rising. We found ourselves stopping for water a few times.

Driving in Marseilles was a nightmare and the route in to the city showed it to be a rough, industrial port. I’m sure there are nice areas of the city for tourists to see during the day, but having been through so many beautiful places, we decided to grab a quick sandwich and a drink in a little patisserie before getting back on the road.

It was a few more hours before we finally arrived at Aups having spent the last half hour or so travelling on smaller, provincial roads through some of the stunning Provence countryside. Aups is a beautiful small town which brought to mind memories of French towns from black and white wartime films. I fully expected to see a crowd of French resistance slinking around a corner away from a couple of German generals – my first impression wasn’t helped by the fact that as we got out of the car, an air raid siren sounded. Apparently it’s used to call the local fire brigade out…

We wandered around a little before meeting up with Sean’s cousin and headed over to their house – a beautiful little cottage. We spent a day and two nights here, just chilling out getting to know Eve and Patricio and the kids, Ishmael and Irene. We ate good food, drank good wine and beer and swam in a nearby lake.

Day 7 was yesterday, Thursday 10th, and we woke up early and got ready to leave. We had a long day of driving ahead of us and after saying goodbye to everyone, we packed the car and hit the road. By 10am the overhead signs were telling us it was 27 deg C and we soon stopped for a break on the mountains above Monaco. We hastily grabbed a few photos and took off again. The principle behind building this Italian road seems to have been to pick a point between the bottom of the valleys and the tops of the ridges and build a road along that line, building tunnels and bridges as necessary.

It was a long, long drive down to Todi and the roads got worse and worse as we went before finally ending on the dirt track that served as an access road to the villa. It had been a long day and it wasn’t long before we were crashing out on the sofa watching the sunset.

This morning we woke up to this view (picture to follow) from the balcony of our bedroom. I’m actually sat on the bed taking that one. It’s an incredible place here and we’re loving just chilling out and relaxing and NOT driving. We popped briefly into Todi today to do some shopping and pottered around before heading back and spending a lazy afternoon just chatting. I’m sat on the terrace writing this with the sun slowly falling towards the distant mountains and Sean playing on the guitar behind me. I’ve not had a watch or mobile on me today. It’s been magic. My biggest dilemma is currently whether I pop down to the swimming pool for a quick swim before dinner. I could get used to this.

Miles travelled: 1855

Our route so far (Google maps)

Originally published at Hypoxic witterings. Please leave any comments there.

Waking up on Sunday in Luxembourg, the weather was overcast with low cloud, so we dressed up warm and headed into the center of the old town. Stopping outside the cathedral we took a few pictures but couldn’t head in as it was closing. We pottered around the shops for a bit with the cathedral’s bells ringing across the city and picked up a little breakfast before finally heading south, back on the road again.

It was a long slog down to Strasbourg with both of us quite tired. We pulled in and headed to the tourist inforation center in the main station. The station itself was incredible – they’ve built a glass lozenge over the old station which protects it. Modern meets traditional. From there we walked over to Petit France for lunch. This is the older part of Strasbourg and is absolutely stunning. We walked around, had some lunch and listened to a bagpipe player (he must be very lost) for a bit before getting back on the road again.

Next stop was Zurich although by this time we were exhausted. We looked at our options and realised that with a long day of travelling ahead, exploring the city was likely out of the question. We had a fantastic night in a very upmarket Holiday Inn before getting back on the road in the morning.

As we headed through Switzerland, the terrain changed from the soft undulating hills to steep, craggy mountains with near-vertically sided valleys. The scenery kept surprising us and we climbed up from Martigny and crossed the Swiss/French border somewhere high in the pass before dropping down into Chamonix. We decided to grab some time here and took the Montenvers train to the Mer-de-Glace Glacier. It was an awesome sight and we even got to walk inside the Glacier where they’d dug out a “grotto” and sculpted the ice.

It was probably gone 5pm before we left for the short drive to Grenoble and this is where we got unstuck. In booking all of the hotels before we left, I’d managed to book the Grenoble hotel for the Sunday night instead of the Monday night. Expecting to pay for another night, we dragged ourselves into the hotel and had a wonderful surprise when the woman on reception convinced her manager to waive any charges and just let us have the room tonight. Fab ending to an incredible day.

I’ve uploaded some photos to flickr already – there’s more to come when I have time and a decent Internet connection.

Miles so far: 1,163

Originally published at Hypoxic witterings. Please leave any comments there.

Well, we’re on holiday. Leaving was a bit of a disaster to be honest – when I left the office part of the M4 was closed. I had to work my way home through small lanes and didn’t get back to the house until 1900 – we’d hoped to be on the road by then. A few problems with the alarm were fairly quickly sorted and before 2000 the car was packed and we were off. So far, I don’t think we’ve forgotten anything critical…

We stopped off with a friend in London for the night before getting up for an early start and heading down to Folkestone for our 0950 departure on the Eurotunnel. 35 minutes of train and we were in France – it’s pretty impressive on the convenience front, even if it’s boring: you sit in your car for 35 minutes of tunnel. Still, we were in Calais.

We quickly headed onto the motorway and headed across northern France over to Belgium. Nothing particularly exciting about the drive – it was over land that was quite flat, lots of agriculture. I was munching on a piece of M&S cocktail sausage when it went down the wrong way and spent the next 10 minutes coughing, so we pulled into a service station for a break. No sooner had we stopped than a wasp flew into the car – Sean whacked it with a cloth and flung it straight at me, where it stung me on the neck.

Once I’d finished swearing and Sean had finished apologising, we got ourselves sorted. Apparently, you have to pay 30c to go to the loo in service stations around here. That was a bit of a pain since we hadn’t stopped at a cashpoint yet…

Anyway, we got to Brussels with no idea where we were going and asked TomTom to take us to a car park in the center of town. A nearby Novotel pointed us to the tourist information center in the Grande Place….whereupon we walked into the middle of a huge beer festival. Of course, we were driving, so couldn’t take part much to my disappointment. After pottering around for a bit, we had a Belgian Waffle (what else would you eat in Belgium?) and wandered around taking photos before heading back to the car. We drove around a few of the sights before heading back out on the motorway. I’d love to come back here, it’s a beautiful city with lots to see.

The drive to Luxembourg was more scenic, crossing valleys although by the time we got there we were both exhausted – we’d not had much sleep the night before. So after a bit of food, we headed straight to bed.

Miles so far: 513

Originally published at Hypoxic witterings. Please leave any comments there.

I haven’t been on a decent holiday abroad since…well, since I bought the house. That may be a coincidence…

Anyway, Sean and I have been planning a trip to Italy for a few months now and it’s almost here. Tomorrow afternoon, I leave work and drive to Cardiff to pick Sean up. The next time we’ll see the house, we’ll have drive through Belgium, Luxembourg, France, a bit of Germany, Switzerland and Italy.

I am, understandably, somewhat excited. Internet access has been sorted despite Vodafone being useless – thankfully, 3 are targetting users wanting some decent data rates at the moment, so I have a 3 SIM in my laptop’s built-in 3G card. It’s PAYG so I won’t come home to a £300 phone bill and it means that I can keep a record of the trip on my blog.

I’m just waiting for clothes to dry now and hoping the weather will last…

Update: Track my travels on Dopplr

Originally published at Hypoxic witterings. Please leave any comments there.

I can’t remember my first Mountain Rescue job. I remember a search for a missing person while I was still training, but it’s lost in a blur of memories of trying to work out how to search for a missing person. I remember my first casualty, having chased her over the mountain all night, giving her the attention she so desperately seeked.

What is etched into my memory are two ambulance jobs I did as a first responder – my first red call, and my first cardiac arrest.

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The first red call I had came in the middle of the night. I’d gone to bed, my uniform next to me, the phone on the bedstand and the lava lamp left on, casting a red glow over the bedroom. I jumped out of my skin when the phone rang.</p>

“Hiya, it’s Ambulance control, can you take a red call please?”

I get the address and jump into my clothes, heart pumping, adrenaline rushing around my body. Still half-asleep yet completely awake, I drive off. 30 year old male, difficulty in breathing. Traffic is quiet, I catch the lights on green and I’m driving down the street looking for the address when I see the ambulance. Deflated, I realise I’ve been holding my breath and start breathing normally again.

I pull up and get out, gloves on, ready to assist, just in case – but the crew is stood in the doorway talking to the patient. I walk over and hear the conversation.

“So you’ve had the sore throat for 3 days, and it’s hurting when you swallow…” He turns and glances at me, nodding, acknowledging my presence. “…and the GP says it’s tonsilitis. Does your mother have a car? Right, well she can take you down to A&E if you really want then, but it’s a Friday night, you’re looking at 4 hours of wait. We’re very busy tonight – if you can do that we can get back to helping people who are seriously ill, like heart attacks.”

I catch the undertones, the patient doesn’t. Within minutes I’m filling in my paperwork. The crew watches me, I’m obviously not familiar with the layout.

“First job?” he asks. I nod.

“That was irritating.” I nod towards the house. “Tonsilitis?” I’ve just about managed to get my hand to steady enough to write. I’m not sure anyone’s going to understand what I’ve written.

The technician rolls his eyes. “Get used to it. About one in ten jobs actually need us, five are pissed the other four are hypochondriacs or timewasters.” There’s a shout from the cab interrupting the cynical view of the world I’ve just become privy to. “We’re off. See you later.”

The ambulance rolls away and I’m left in the street dealing with the disappointment, the adrenaline, the futility, the tiredness. I turn around and head back to bed.

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My first cardiac arrest came as a surprise. I’d been responding for months, now used to the dross and inability to actually help a lot of the patients – my Mountain Rescue medical training gave me skills and knowledge that I could not use with the Ambulance service – not in our protocols. I was in the kitchen when the phone rang – around 9am on a Saturday morning. I grabbed a pen as I answered the phone, looking around for a piece of paper and only finding the whiteboard on the wall.</p>

“Hi, got a red call for you.”

I write the address down on the calendar, and write “card arrest” next to it. I blinked. I read the address again. “Er…that’s about 500 yards from where I…from my current location. Show me mobile – count to 10 and show me on scene if you want, I won’t bother calling to report that.” I’m already out the door unlocking the car.

“Oh, ok, thanks.”

Control rings off and I briefly consider running there, but with all the kit….I start the car and drive down the road, turning the corner and pulling up at the pub control had sent me to. The door is closed, I see no way in. I have my kit with me, I’ve not had a chance to calm myself down in the car, my heart is pumping and there’s no way in! I head for the side door and it’s open – I run up the steps, tripping on the top one and almost flying headlong through the door. I blink as I stumble into the gloom, the curtains drawn and I see figures by the bar – the landlord is on the phone.

“Yes, he’s here now…”

I rush over – there’s a woman on the floor, late 50’s I’d say. I rip my kit open, defib out and lid open, get it up and running. Tuffcut shears make short work of the underwire in her bra – I hadn’t intended to cut it, but it’s off now along with her blouse. My mind is racing, and the defib shouts at me in an American voice. “Tear open pads. Remove pads and place on chest.” I’ve already done that and it’s curtly announcing “Analysing rhythm” as I’m getting my Guedel airway out, oxygen fitted with the BVM.

“Start CPR.”

I swear under my breath – it’s not shockable. I don’t even consider whether I should start CPR – I’m already underway now and I have no room in my protocol for recognition of life extinct. The airway is in – easier than the dummies I’ve practiced on. I put my hands on her warm skin and start compressions. As I’m counting my only thought is that the feeling of my hands on her skin reminds me of chicken.  It’s an odd thought and I place it to one side, giving two breaths after 30 compressions. I hear a rib crack and then a second one. I have a rare moment where my brain can catch up and in that moment I get a thought – I can’t hear a siren yet, where’s my backup?

“Do not move patient, analysing rhythm.” The defib interrupts me and I sit back for a moment catching my breath. “Continue CPR.”

My hopes for a succesful rescuscitation are dropping and they hit rock bottom when the landlord opens a curtain to get me more light – I can see what looks like a bruise on part of her body – but at last! I hear a siren approaching. I tell the landlord to go out and windmill for the paramedic, probably an RRV I think.

I look up as he walks in, it’s a friend of mine. He grimaces as he sees her and recognises signs I’ve yet to learn.

“You can stop CPR mate, she’s long gone.” he says quietly, kneeling down and pointing out the purple blotches I’d seen. “Post mortem staining, she’s been down a while.” I sit back on my knees, shaking a little from the adrenaline. He takes over, he’s seen this all before. I can’t stop staring at her, the memory of those two ribs cracking under my hands still vivid.

The police arrive and talk to me and the Paramedic. He asks if I’m OK. I just nod and fill in my paperwork. I pack up my kit – I need a new set of pads and contact an Ambulance officer to get a set and he arranges to meet me that day. I stand outside, packing my car for the moment, stood in the bright sunshine as villagers wander past wondering what’s happening – why all the police and ambulance. I head back inside and take one last look before talking to the Paramedic. No, no chance of reviving her. She’d been down a while. Probably a massive heart attack, probably dead before she hit the floor. How old? 42. Yeah, she looked older. Smoked. He makes sure I’m ok and I head off to get some new defib pads, still shocked by how surreal it all feels. When I finally get back to the house, there’s still a note on the whiteboard with the address and “card arrest” next to it. I wipe it off as I phone control to tell them I’m available for calls again.

Prepared as my introductory post for The EMS Handover Carnival.

Originally published at Hypoxic witterings. Please leave any comments there.

7pm and our incident controller approaches us as we’re taking kit off the Landrover.

“There’s been reports of a casualty across the road. I’m going to be staying here for better comms.”

We all nod and head off. I grab the radio I’ve got and call in to get a radio check and I’ve barely finished when we find our casualty. A 7 year old girl with breathing difficulties. We’re on it like a shot, oxygen and a nebuliser mask out, I’m on to control to get some backup, Mum is upset and panicing. No air ambulance available and the nebulised salbutamol is having little effect. There’s no county ambulance either and our vehicle has a puncture. There’s a quick conversation – I arrived at this incident in my own vehicle, we’ll transport mum and daughter in that. We’re moving, rapidly through the trees whe the radio comes to life – there’s an ambulance en route to us now…

We’re still packing up and debriefing from that job when the radio comes to life again. “We’ve had a call nearby for a young child that’s fallen, no parents, friends have raised the alarm but are not with her.” We look at each other and we’re off again, this time I’ve got the purple gloves on my hands as we head through clouds of gnats. We find her next to a few old logs which she’d been climbing on. She’s 9 years old and looks quite healthy. She’s complaining of a bump on her forehead and a painful ankle. I talk to her, practice my new skill – talking with kids. I’m not good at it and I’ve been practicing. She responds well, I’m on a winner. I check her over carefully and she reports a painful neck. She’s talking to me and I’m adding up her GCS in my head as she tells me she’s feeling sleepy. GCS of 15, she’s alert and responsive…wait what?

She’s feeling sleepy.

Despite the warm summer evening and the gnats crawling all over me, my attention is focused on her as I slip my hands onto her neck and hold her head still. I look at the stump she fell off – 2 feet? 3 feet? A colleague takes over her C-spine management as I get oxygen going – but she doesn’t like the mask on her fact. She’s content to hold it near her mouth and breathe the cold gas though. We package her up and move her down to the road to be met by a county ambulance. I’m all smiles and chatty and she’s responding well.

We haven’t even started the debrief when somone runs up to us. “Come quickly, it’s my friend – he fell off the stile, I think he’s hurt!” We head down, shaking our heads and find a gentleman lying on rocks next to a river. He’s fallen some 2m and is complaining of a lack of sensation in his legs.

Fuck.

I’m running this incident as my colleagues deal with first aid. I request backup from Ambulance control to be told that there’s no land ambulance available. They check on a helicopter for me as we request more people and more equipment. Our landrover pulls up, blue lights flashing and cars slow down on their way past, their occupants staring at a blue-shirted throng of rescuers arranging to move this man onto a stretcher from one of the most awkward positions I’ve ever seen. It’s not long before he’s on a stretcher and moving. We look at the fence – it’s in our way. Bolt croppers are called for and the fence is ready to become a casualty of this incident.

“Ok, hold it there folks.” A voice calls from behind me and the ‘casualty’ pulls his collar and spinal management kit off.

“That collar’s really uncomfortable.” He says, rubbing his neck. I turn around and find ‘mum’ and our two previous casualties grinning behind me. The exercise is over and we’re talking amongst ourselves about how it went. There’s lessons to be learned – there are always lessons to be learned. But we have three people who are alive and kicking (in the scenarios) because of the care we gave them.

As we head back to base I’m thinking that I’m glad I got to practice on children tonight. I’m rusty in dealing with children, but I seem to be getting the hang of it. I shudder as I think of the moment when my casualty told me she was feeling sleepy and know that I’m better prepared for the next one. Chances are, the next one won’t be practice.

Originally published at Hypoxic witterings. Please leave any comments there.

So I’ve had my Go 740 for a few weeks, how’s it going?

Pretty good. It’s re-routed me a few times because of traffic on the M4 – this morning for example, with an accident closing one eastbound lane at J29, it took me an alternate route. Given that my journey is nominally 40 minutes, it was reporting a 30 minute delay and when I passed the traffic on the M4 it was stood still. I got into work 7 minutes late.

It does have limitations though – the M4 Severn Bridge is a bottleneck and if that was closed there’s not much it can do to re-route me. It’s managed to get me to callouts sucessfully, to find locations via Google search results and take me there….all in all, I’m very happy with it. I do think it’s worth paying the £8 per month for the extra services, it turns it from just another navigation tool into somethign quite exceptional.

It has had a few problems though – random crashes from time to time, though it recovers within about 30 seconds and jumps straight back into the thick of it. The latest software won’t let me run the unit from TomTom Home – that’s really frustrating because there was no warning of that on the download and that’s how I add my route corrections. Still, no show-stoppers, a cracking navigation unit.

Originally published at Hypoxic witterings. Please leave any comments there.

I had to do something today that was very difficult for me. I deleted user-contributed content from a site I admin.

I feel very strongly for freedom of speech. I believe everyone has the right to an opinion* and that they also have the right to voice that opinion. Free speech is what a functional society must be based on, the open and frank discussion of ideas, of faults and of mistakes. If one person makes a mistake that harms someone, then everyone should learn from it. I commented on this on Mark Reeves‘ blog this week and I’ve made my position clear before numerous times.

Most importantly, this doesn’t absolve the individual from their responsibility to keep private information that should not be made public. For example, when I attend an incident and want to blog about it, I have to weigh up free speech against an individual’s right to privacy as well as my own professionalism in the approach that I take to whatever topic it is I’m writing about.

This week, a controversial topic has arisen on a website that I’m an admin on. There have been some comments made in public on what is essentially a private matter between two management groups. Although I don’t believe that such comments should be made public since the issue is an internal one and it’s not in the public interest to air it. What’s worse is that the comments that were made were immature, inflammatory and unprofessional. They managed to serve no purpose than to bring their own organisation into disrepute. After a brief conversation with the appropriate managers, a decision was taken to remove them – a decision I did not take lightly.

At the moment I’m furious. Removing those comments left a bad taste in my mouth. However, I cannot condone their behaviour and the comments were harmful to the entire organisation. What disgusts me most is that some of these are people that should know better. They are professionals and they have achieved nothing other than to inflame an already difficult situation and make themselves look like fools.

People should stop and think before putting fingers to keys. As someone once said to me “Don’t ever say anything on the internet that you wouldn’t say in an interview on TV.”

* When I say opinion, I mean just that. Opinions should not be presented as fact, and if you present rumour as fact you should be prepared to stand up and apologise as loudly as you shouted your fact in the first place when you’re proven wrong.

Originally published at Hypoxic witterings. Please leave any comments there.

This time last week, I thought I would be writing a very different post to this one, but TomTom have, after the initial problems, really come through. Not only does the device et a resounding recommendation from me, but their support does as well. So, what happened?

Last week I bought myself a toy that I’d been waiting for some time for – a TomTom Go 740 Live from Amazon.co.uk. I’ve been keeping an eye on the SatNav market for a while, and though the TomTom has a major limitation for me in that you can’t navigate to an OS Grid Reference, the quality of the software, the user interface and the navigation itself have always placed it ahead of its competitors in my book. I will say that I have had a TomTom before – this was TomTom Navigator version 2 on a PDA which I’ve had some 8 years. By now, it’s mostly useless, with major problems with maps and the PDA is obviously creaking at the hinges a bit.

So, when it arrived I was immediately impressed with its size – it’s a lot thinner than the 910 I played with a while ago, much lighter as well. I plugged it in and got the TomTom Home software installed – available for Mac as well as PC – and downloaded all my updates. I used the “Latest map guarantee” to get all the latest map updates, and with the x40 series, you now get 3 months free subscription, so I downloaded all of those updates as well. I was also very impressed with the windscreen mount – it’s rock solid, far better than the old one.

Off I went…and that’s where the problems started. The device simply refused to connect to the mobile network – it has a built-in SIM and ‘mobile data’ connection. Not good, the menu wouldn’t even give me the serial number of the hardware. I raised the issue on Friday with TomTom on their website, and they acknowledged that they were seeing a temporary problem with their servers and suggested a reset process for me to try out once they’d fixed their servers.

Now, being a bit of a geek, I spent a few hours researching this problem (Error 1001). A number of forum users have had the problem – some noted that the excuse given out by TomTom of “server problems” appears to be bogus. I had nothing to compare it against in this case, and those reports were typically US-based, so I gave TomTom the benefit of the doubt.

So roll on Monday morning and lo and behold – the process completes but I still can’t connect. I replied via their online problem system and by mid-morning, I was to impatient so I called them. A very friendly lady led me through a number of procedures, none of which worked and gave me one last one to try at home (I’d forgotten the cradle behind). That also failed, so that night I raised it with Amazon who shipped a new unit out to me.

This morning the replacement arrived. I plugged it in and immediately had some trouble – you can only register one new TomTom device per account every 6 months. This is to stop you from buying one for your friend as well and both having updates – fair enough. So a quick call to TomTom confirmed this and the lovely lady solved that problem within half an hour (Thanks Brandy!).

The new TomTom replaced the old one fine (TomTom gives you several options including backing out of the change – very handy) and off it went to grab updates. Once that completed I immediately checked signal – and yes, it was connecting. Great! But wait, it refused to download my “HD Traffic” updates. Apparently my subscription had expired…and a quick phone call to TomTom (thanks Jade this time!) revealed that with the account reset they’d performed that morning, the 3 month free subscription that had been added was gone. That was quickly resolved and I now have a fully working TomTom.

What about the device itself? Well, navigation is as good as I expected – I have yet to use it in rush hour on a busy route, so I’ve not really used the IQ routes nor the HD traffic functions in anger. But the navigation is good – it takes the routes I know are fastest around here; it updates quickly when I go my own way; the announcements are clear; pronounciation of street and place names is pretty damn impressive, especially for some of the places around here and it even recognises “Senghenydd” when I told it when I was testing the voice recognition.

So, TomTom the device – 9 out of 10. Sorry, but you lose a point for not going OS Grid Reference. TomTom the company – 9 out of 10 – you had some mistakes but you corrected them promptly and politely. Very impressed. Well done, folks.

Originally published at Hypoxic witterings. Please leave any comments there.