28 June 2005

Wait. There's more in England than London?

I'll apologize in advance for my spelling and the length of this entry. And, for the record, I knew there was more to see than London. (the outskirts have ambulances too!) We have been to several places outside of London. After my last entry we visited Westminster Abbey so that we could catch up with all of our friends: Chaucer, Darwin, Newton, Oliver Cromwell, and some kings and queens. Now, unless you’re very unorthodox, you’re sitting down already, but Mom, Dad, and I flew the eye. Unbelievable, yes. (well, only if you really know us, actually) It’s quite a feat, believe me. This was awesome to say the least, ‘Flying’ above London at about 500 feet. Then we visited the British Museum. This is a vast and frustrating place. They have 5 million objects to see, and we had about 2 hours to do it. Impossible. But, we saw the Rosetta Stone, The Marbles ‘acquired’ from the Parthenon in Greece, a statue from Easter Island, plus a ton of other stuff.

We also visited Shakespeare’s birthplace and burial place. Look at any sidewalk. That could be where he is buried. But it was worth the trip just for the charming town and church.

Today we visited Bath. They said it would take an hour to get through the actual Roman baths; it took us a predictable 2 (and could have been more!) This is a beautiful and charming town. Then we had lunch on the go and headed to Stonehenge. This was totally cool! I got almost giddy walking towards it. (almost) It is quite mysterious, but dates to almost 5000 years ago! We hung out here for a bit, and took way to many pictures, but hey. The largest stones weigh 40 tonnes and were apparently brought there from 20 miles away. The smaller stones came from southwest Wales, almost 240 miles away, amazing!
On the way there we saw a huge horse carved into the hillside that was put there by Alfred the Great to commemorate their victory over the Vikings. This is visible because of chalk in the soil that is the remnants of sea creatures decaying skeletons. These mountains area the ‘youngest’ in Britain, and grow at a rate of 1cm every 50 years!
It’s cool to be here with the ‘rents, Weird to visit my ‘old haunts’ with them. It seems I went on a lot of calls, and luckily my memory is not gone so I can remember to point out “I had a call there!” I still get excited every time an ambulance goes by. I’ve even cut out an article about the Emergency Care Practitioners. Apparently, they’re just now telling the public what that’s all about.

Tomorrow is our last official day in London; we’ll be visiting the National Gallery. If we can get Dad out by midnight, it will be quite a feat.

25 June 2005

Ah, London

Just as I left you. We are here after one of the longest days of my life. There could have been 10 rapid response units outside our window last night and I would have slept through it. Half of the battle was over when we survived getting to our layover in the smallest plane I had ever been on (I think it was produced by Matchbox). Our hotel is lovely except for the minor a/c problem (actually it's not a problem, it just doesn't exist). But, we can have a full English for breakfast, included! (hurrah, as they say.)
Today we had a nice bus tour of the city and visited St. Paul's cathedral built by Sir Christopher Wren exactly 295 years ago (after the 'great' fire of London destroyed the city of London in 1666). Turns out that I didn't remember a thing about this place from out last trip. We also saw the building that served as the backdrop for Gringotts Bank in Harry Potter. Our tour guide today was hilarious and told us to 'chillax' a combo of chill and relax, I love that!
Later we went to Windsor Castle. Started as a wooden building on a hill by William the conqueror, this is now a very impressive structure. The queen stays here on the weekends, and was in residence today. Unfortunately, we didn't have time to join her for tea. But we did have time to play with her dollhouse, slightly nicer than the Barbie version.
We had dinner at an Indian restaurant, mom just loved it!
So, (sister, et al) put your minds at ease as we are having a great time (and arrived safely, of course). There may not be another opportunity to blog, so enjoy this one and tell your friends. Tomorrow we're off to Oxford and Stratford (the birthplace of Shakespeare).

21 June 2005

Bits and Pieces

Here are a few left over things from London and an update on the rest of my summer. I have fixed my questionable spelling and grammar in the London entries. Now you sticklers can breathe easier (mom). Hey, mannequin and souvenir are hard to spell!
In London, they call a cardiac arrest a ‘suspended.’ They never clarified to me if this meant functioning has suspended or if the patient was ‘suspended’ between heaven and wherever. Paramedics in certain areas carry a set of large and unhandy keys for unlocking exclusive gated communities. Every paramedic in London is issued their own paramedic bag. They can take it to and from work, the grocery store, library, or pool. They are responsible for its contents and also get to organize it in any way they want, pretty cool.

For the next two weeks I’ll be on vacation. I’ll paraphrase a conversation I had this morning:
“Where are you going?”
“Um. London and Paris.”
“Weren’t you just there?”
“Er, Sort of……yes.”
The original plan was for my parents to meet me in London and then we could tour the country from there. That evolved into a trip to London (and the surrounding area) and Paris (and the surrounding area) which couldn’t take place until now. This trip is purely ‘camera around your neck’ touring. We’re seeing all of the ‘classic sites’ plus a little extra. I’m excited if only because my parents are going somewhere that isn’t Colonial Williamsburg (their favorite holiday spot). I have been there personally about 3 million times, and they’ve gone there way more than that. (Come to think of it, if you ever need a personal tour guide there, just let me know; lovely place.) But that’s a wholly different subject…
I’ll be taking my ACLS cards and studying for national regi……wait. Who am I kidding?!
I’m going to try to blog a bit, but we’ll see how that works out.
As for the rest of the summer; volunteering and test-taking are in order it seems. There has to be something else too. Oh yeah, a job! What a crazy concept. You can do stuff…for money? Awesome! Sign me up!

18 June 2005

Cures

There is nothing a good cup of tea and some gratuitous violence can't fix. I drove home this morning feeling better purely because it was a new day. I got back, made some tea and decided to sit and watch one of my favorites, Kill Bill. From the first punch I felt better, what a satisfying movie!
I decided (well, faced actually) that there's nothing I can do about registry and I'm going to have to use this as a learning opportunity. Maybe (once I pass) I'll join the registry's governing body and change all of their moronic policies. (I think that a stamp on your forehead the reads "Loser" is preferable to retaking the whole test.)
I must take this space to apologize to my fantastic friends for being a bit 'down in the mouth' yesterday and not feeling too festive. You all did great!
I'll see you on the 15th for Charlie and Harry!

17 June 2005

TKO...ouch

Yeah, I'm down for the count. And the day started out so nicely. Wait, no it didn't. The 5 o'clock hour and I rarely meet, and never under good terms. It was nice to see everybody today and help to calm their nerves by sharing my NREMT practical experience.
I was (and always have been) dead confident in the skills for this test. I had no reason to think that I wouldn't pass one station, again. In fact, failing today completely caught me by surprise. I'm fairly certain that I uttered some unfriendly words under my breath in front of the registry rep. I didn't really care. I feel hurt, let down by my supposed confidence. I also feel let down by the national registry and its ability to "assess the knowledge and skills necessary for competent practice." It's so helpful when they refuse to tell you why you fail a specific station. That really aids in the learning process.
In failing this station today I am not alone. In failing to this extent, I am alone. Because I have failed one station an unfathomable three times I must receive remedial training and retake the entire practical. That makes so much sense. It's like a bizarre punishment for screwing up. It's irritating because I passed all off the difficult stations no problem, and now I get to do it all again. Thrilling. I feel ill.
I consider myself an even-tempered person. That's probably why it's harder for me to cope when I feel such strong emotions. Frustration is the worst.
Sorry for this downer of an update, I don't even feel better after having ranted a bit.

But, as a good friend says: I have a pulse, I'm breathing, and I have friends to take care of me, which makes me a profoundly lucky person.

16 June 2005

Ellie v. NREMT (round 2)

"I want a good clean fight!"
Ah, we meet again national registry practical, for the last time! I hope your conscience is clear, trauma assessment!
In all of the excitement of leaving for London, I cleverly neglected to inform you kind readers of my national registry practical/written exams. What a fun task this test is! I liked the practical so much that I decided to take the trauma assessment station again, I just can't get enough! Long and boring story short I failed the trauma and have to take it again tomorrow. But that was the only one!
The story of my classes' practical is a long and sad one. Our practical was originally scheduled for the middle of May. Then, something retarded happened (it is a mystery that will go down in history) and the practical was cancelled the night before. (gasp! horror! shock!) I'm fairly certain that a few members of my class had to be resuscitated before deciding to stay up late and maybe have a few drinks.
Fast forward to the next morning at 7:30 when I get a call telling me to hurry up because Jon and I will be taking the practical. (gasp! horror! shock!) A worthy way to test how fast I can prepare myself. Jon picked me up and once the day got started, it was okay. The rest is history. Which leads me to my present position of taking trauma assessment again (the reasons for failure are....um...well, I'm not sure considering almost every person there failed that station as well.) Either way, here I am, spending the night at a friend’s house so I don't have to get up at such an unholy hour and make the drive from home.
As for the written, everyone in class has their results online except for me, I think. (what joy.)
Wish me luck tomorrow, again...

09 June 2005

Home again, home again.

Well, almost. I'm here at school, a logical rest stop between Newark and home. We arrived yesterday around 7:00 here time (midnight our time).
Getting back was a trial at times. It started out with our airline weighing our carry-on bags and saying that they couldn't be more than 6kg. We were kind of freaked out about this; I knew mine was way more than that. I was carrying a grocery bag with orange kit-kats in it (yes, for you) so I decided to throw stuff from my bookbag into that bag. Working the system, I guess, but they didn't care. This was so ridiculous because you could have bought a million kilos worth of stuff at the duty free shop. I guess that my extra few kg didn't affect the plane too much. Maybe they should weigh each passenger as well. Or, put a huge scale on the runway to measure before planes take off. Then they can stop the plane and announce that they can't go until they jettison some cargo, guilting you into throwing your duty-free vodka, souvenir shot glasses, or small child overboard.
Then, when we got here I was grilled at customs/immigration. The dude was treating me like a criminal (and the bright light in my face didn't help much). "We're you on payroll? Who were you with? What is his relation to you?! What university? We're you paid?" Dude, simmer down. I'm sure an internship with an ambulance service sounds really suspicious, but really! At least I didn't get stopped and interrogated about whether or not I was carrying dairy products. "Yes, here is the cheese I brought over! I confess!" The last time I came back from the UK it seemed that having a carton of milk was as punishable as having a suitcase full of blow.
Well, it's fantastic to be back. It's nice to take a shower in an area that is larger than a shoebox. Soon, I'm going to collect my things and head home.

07 June 2005

The parting glass

Our last official day in London was just as fantastic as the others. We visited the LAS museum located in Ilford. This is probably about 10 miles away as the crow flies, but in London it takes about an hour to travel it. We ended up in an ambulance station with a section dedicated to the 'museum.' They have old British ambulances parked outside. Inside they have stuff everywhere. There was a section with ancient training devices including the mask of a woman who we know as "Anne" (the CPR mannequin).
Interesting story that I never knew before: In the late 1890s, this young woman was pulled from the river Seine in Paris. It was assumed that she committed suicide and because she was unknown, a death mask was made of her face. The story was romanticized throughout Europe and years later Asmund Laerdal decided to use the death mask to produce a resuscitation mannequin in order for more people to learn live-saving skills. And, the rest is history; we all use Laerdal products almost every day.
I digress. This place was also filled with memorabilia/equipment/kits collected throughout the years. I've never seen such a collection. It's like some nutter decided to steal stuff as it went out of use. What they ended up with is a fantastic collection of London and English EMS. The vehicles they have range from the horse cart, to the current Mercedes truck.
After this we went back to Waterloo HQ for a 'debriefing.' They basically wanted our opinions of the system and how the LAS works. It was really nice to have a wrap-up and to touch base with everyone who set this up for us. We came back and had a nice dinner out and a pint. Now, I'm supposed to be packing (actually, it'll probably turn into stuffing before it's all said and done). It may be a while before I get a chance to update again, but we'll see.

Yesterday

Quick note on yesterday's activities. I rode out in Wimbledon with a First Response Unit. We had a fun day. The best call was for a diabetic with a blood sugar of 1.7 (gasp! horror!). Pretty bad yes, but we gave glucagon while waiting for the transporting unit to arrive. Glucagon, you ask? Their EMTs can give glucagon. In fact, speaking of gasps and horror. The guy I was riding with was shocked at the lack of skill out EMT-Bs have. Really couldn't believe it, I had to slap him around a bit; he just glazed over when I told him we couldn't give any drugs with needles (save epi), do 12 leads, do 3 leads (for that matter), check glucose levels, manage intraortic balloon pumps, or perform thoracotomies, and I agree, it's just terrible! Practically skilless, our EMTs. I need to get a more powerful job and get EMTs some fun skills.
We also got to see the All England Lawn Tennis Club Wimbledon (that must be said with a posh English accent). This is where the Wimbledon championships are held and, in 2 weeks time the pristine streets will be lined with people camping out to get tickets.
It was a good day. Update for today will be up shortly as well.

05 June 2005

Language barriers

Combined update tonight of yesterday and today. This may be kind of long and boring, but...
Yesterday we visited what is basically a haz-mat team that is comprised of personnel from LAS, the fire brigade, and the metropolitan police. They call it CBRN (chemical, biological, radiological, and nuclear). They took us out on the Thames on the LFB (London fire brigade) boat. This was awesome; we went all the way up (or down, depending) to Tower Bridge. I felt very touristy, taking a million pictures, but it was something that very few people get to experience.
After this we visited the EXPO, the explosives office. London is the only city in the UK that has a civilian bomb team. They respond to any suspicious thing and neutralize or minimize it. They have a museum of sorts filled with explosive devices; military, commercial, or homemade. All of these had been found in London which is pretty amazing. It was a little freaky when the guy was holding a hand grenade (with his index finger in the pin) and then began listing things using his fingers. (well, we respond to this, this, and oops!). The team mostly responds when people find old hand grenades that they don't know what to do with and also to incendiary devices left over from the last war. (a reminder of a history that Americans could never really understand) During WWII Germany dropped about 80 million incendiary devices on London. Luckily 1/4 were faulty (due to purposeful poor production by oppressed laborers). People are still finding them in gardens because they got imbedded in the dirt and forgotten for 60 years. Anyway...
We also saw their bomb robot which can neutralize bombs with other explosives (somehow that works). It is a really cool 'piece of kit' as they say. We also saw a video of it blowing up a lorry, (who doesn't love to watch things get blown up?).
Today I rode with an Emergency care practitioner (EPC). This is, in effect, an extended care paramedic who responds in a car. The theory is that they can provide more definitive care and either eliminate the need for ambulance transport, or get the patient directly to a general practitioner (GP). They don't have a real scope of practice yet, but it is in development. They will have prescription power, the ability to do more extensive diagnostic testing, stitching, and the like. It's a great idea, I think. More proof that LAS is better at recognizing problems and doing something about them.
I was talking to the EPC I was riding with about how sometimes I feel that I don't speak English here. It's not the accents, but the colloquial sayings that have no meaning to us. (but, at least I knew what the loo meant before I came here) Medical terms especially are challenging. Today we had a diabetic with a blood sugar of 24. Critically low, you may think, but here they measure it in millimoles or something bizarre like that so normal is 5-7. On my first call here the blood sugar check was 6.2. I thought they were nuts when no one seemed concerned about this.
When we returned tonight we were greeted by three new roommates. French guys who are here to find jobs and an apartment eventually. We've spent the last couple of hours talking to them using dictionaries, the google translator, and our other roommate who speaks French (how handy). It's been really cool. We were talking about French stereotypes, and as we mentioned baguettes and wine they all groaned. Funny.

03 June 2005

Full English Breakfast

We started today visiting the LAS press office. Got a feel for what they do pretty quickly: deal with the press, make up ad campaigns. These campaigns are extremely clever and deal with issues that the providers see out in the field. The national health system started this a few years ago with posters concerning house numbers and the difficulty in finding houses. The catch phrases were "999 where are you" and "Is your number up?" a hilarious play on words. The LAS has done a few since then. One concerns abuse toward ambulance personnel. This "No excuse" poster features and actual LAS paramedic who was assaulted while on the job. Another features a London taxi cab and a London ambulance. It reads "Only one of these is a taxi service." Hilarious! These posters mostly improved employee moral rather than discouraged Londoners from calling 999 needlessly. Their current one is advertising their free bystander CPR training. It has an actual cardiac arrest survivor on it and has been endorsed by local celebrities. This aspect of LAS is really cool. They recognize problems and actually try to do something about them, (unlike many US services).
We then went to a cafe where I got a 'full English breakfast.' This involves bacon, bangers, eggs over easy, baked beans, and toast....hmm....oh! sorry, I got distracted by thinking about my breakfast, so good!
After this we visited their emergency planning unit. Their disaster management is almost identical to ours. One exception is that they put little cards on each unit to remind you what to do in a mass casualty incident. This is very nice; especially when you have a CRAFT moment (can't remember a flipping thing).
We just experienced a bizarre, random London rain storm, and now that's over, it's dinner time!

02 June 2005

Governance Day!

Today we attended the HEMS governance day. This is a day once a month where HEMS docs and paramedics get together to do QI on calls and their system in general. This was set in a building that was very modernly decorated. The lecture hall we were in was completely green, I mean green. From carpet to ceiling, crayola green, with the exception of 10 completely random red chairs.
They started out reviewing articles from various medical journals, and then reviewed several cases that HEMS took where the patient died (overviewing what happened to the patient, what care was given, and what could have been better). The calls involved a hanging, car v. pedestrian, car v. cyclist, and a 'one under' (someone under a train). After this they reviewed two calls from start to finish, from the 999 call, dispatch and response, right down to the data recording. Then for lunch Jon and I ate at the café there (completely red) and split a lemonade shandy. This is a drink half lemonade and half beer (surprisingly good and refreshing). We also had tea and biscuits (cookies) in the ante-room (completely orange). Then we listened to a lecture on chest trauma, a bit over our heads for a bit, but some interesting concepts. The last bit was a lecture given by a policeman about ballistics. They are quite fascinated with the subject here because all guns are outlawed, so they have limited experience with them.
When we were finished we had a pint with some of the people there. They gave us a bitter which is literally pumped out of the bar (not CO2 powered like regular taps.) These apparently are local beers which are more alcoholic than regular ones, so true! We both felt like lightweights when this one pint made us 'fuzzy' as I like to call it.

01 June 2005

How much do you weigh in stones?

"We'll just pop 'round to the 'ospital and get you looked over, love, a'right?"
Today we visited an LAS training center and met an upcoming class of EMT-3s. I should take this time to explain the certification levels here in the UK. There are three levels of EMT in London only. EMT-1 is BLS capable, can administer oxygen therapy, and use an automatic defibrillator (AED). EMT-2 is an interim EMT-3 (for 12 months). EMT-3s can do everything a 1 can plus a few interesting skills. They are 3 lead and 12 lead capable. They can recognize ST elevation and basic heart rhythms. They can also administer nitroglycerin, aspirin, glucagon, entonox (nitrous oxide, believe it!), adrenaline (epi), parasetamol (pain reliever/fever reducer for children), and glucose paste. These drugs are all given subcutaneously, orally, or IM. Paramedics have a whole host of other drugs they can administer very similar to our drug scheme. They also perform decompression, intubation, and various other skills.
So where was I? We visited a class of students training to be EMT-3s. We walked in and one exclaimed “You’re from Baltimore!” (The blue uniform must be a dead give away). Everyone we meet has a copy of our schedule, and some people know it better than we do, which is really cool.
Anyway, this was their first day doing scenarios after all of their initial training. I could barely believe it was their first time putting it all together, they were very good. They have a great review system, getting the opinions from everyone in the room (including us). I joked that instead of taking pictures we could just photoshop green uniforms on our students and no one would know the difference. Everything is different and everything is the same.
Some fun facts about LAS: average 4.5 thousand calls per day (about 1 million per year.) Last Friday they had 4,996 calls, that’s crazy! New Year's Eve, 2000 they logged 1390 calls from midnight to 3 am. There are 73 stations in a 620 square mile area. During the working week, the London population swells to almost 8 million people. England has socialized medicine and the EMS system is paid for entirely by the government. (from the Mercedes ambulances, right to the socks that go with their smart green uniforms.)
Briticism of the day: Busking- apparently refers to performing music (original or not quite original) in the underground. There are specific places set up where this is accepted in the tubes. I also learned that one stone equals 14 pounds, what a handy fact!