A Work in Progress

It will come of no surprise to you dear readers that I spent the morning relishing in lectures concerning all things London Ambulance Service. It's been a busy two years since I've been there and by the end of the week I'll have heard lectures that touch on the Diamond Jubilee, Royal Wedding, 7/7, 2011 Riots, and the Olympic Games. So many special events, so little time. I believe that many of our heavily populated cities can learn a lot from the LAS model. I believe it to be a simpler version of the incident command system that we use. It's flaws were pointed out though in my favorite part of the lectures so far. The Lecturer said that on 7/7, the London Fire Brigade were confused over the triage process and concerned that patients were being overlooked. (take this 3rd hand info with a grain of salt)  But, this reiterated that communication and knowledge of operations for all agencies is paramount for a successful response. I also thought it was pretty funny as...

Because they can get away with this kind of advertising. LOVE it. (no this isn't the picture of the day. that would be cheating.)

London, it’s people, it’s workers, LAS, LFB, MET, and LU have been in my thoughts today. I proudly wore my LAS pin to work, but I’m not sure anyone noticed. I remember watching as the day's events unfolded last year, jetlagged, shocked, helpless, and feeling it was personal. Feelings not quite resolved.

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 ...

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...

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 produc...

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 champions...

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 ...

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 arre...

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...

"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 variou...

We started today with a nice chat with the senior clinical advisor (or, assistant medical director, if you will). He was quite fascinated with the intricate idiocy that American EMS can sometimes resemble. He had a hard time getting his head around the fact that there is no national system, only national curricula. Their system is so simplistic (and smart) here now, (it became really organized in 2000) that it’s hard to believe that the US doesn’t operate in the same way. It was nice to have an opportunity to talk to him and further learn about their system. Their national registry is called the British Paramedic Association and the Health Professions Council is who registers qualified paramedics. Once you have an HPC number, you can take it anywhere in the UK and get a job as a paramedic. We also learned that it would be almost ridiculously easy to transfer national registry to here. (probably easier than transferring to Virginia (but don’t tell my parents)). I’ve also learned that I ...

Today we hung out at the central ambulance control (CAC) or dispatch and listened in on 999 calls. Some pretty cool stuff, a cardiac arrest, a lightning strike, lots of little trauma, and various medical calls, all not requiring real care. They're dispatch system is very similar to ours. We met a doctor who runs with the physician response unit. This is a very clever idea where a doc responds to lower priority calls and diagnoses and treats people without the need for ambulance. My Briticism of the day is the phrase 'went wobbly' which means fainted. We also hung out the HEMS or helicopter EMS desk and figured out how they decide which calls they go on. That consists of a paramedic and doc who respond to trauma only, land in places like Piccadilly Circus, and render care like thoracostomy tubes and chest cracking (apparently with good outcomes). That would be cool to witness. The helicopter says Virgin on it, but that is mostly for advertising purposes. They pay £450,000 pe...

Here's another micro update. I'm here at Waterloo, the LAS HQ. I've been riding another rapid response unit tonight, mostly north of the river in the heart of London. We've had some good calls: a cardiac arrest, a stabbing, and various other drunk-related incidents. I learned that English AEDs speak to you in British accents (useless fact). I know I look quite fetching in my LAS ballistic vest (stab vest) and I feel pretty damn cool too (haha). Some of the most fun of the night has been racing past Buckingham Palace (waking up the Queen), Trafalgar square, and St. Paul's, hanging out in Soho, and watching the sun rise over Waterloo Bridge. The sun rises quite early here, by 4:00 it is already bright. I also got to go fetch a patient off of the top floor of a double decker bus (first time on one of the busses here). I also got to go in an exclusive London club near Piccadilly Circus (a guy had been assaulted and cut in the face) so, another life goal fulfilled. (I ho...

Two posts in one day; well, sort of. It still counts as the same day if you never go to bed, right? This update is free. I'm here at the Oval Ambulance Station utilizing their computer. I've been doing a night shift with a 'Rapid Response Unit.' I'm with a paramedic and we respond to category 'A' calls or priority '1' as we say in the states. It's been awesome and I feel great even though it's almost 6 am here. I'm all hyped up on caffeine at the moment. Maybe I'll go straight to Portobello road from here. We've had a lot of calls, (17) and I got to draw up 'Daizamuls' aka Diazepam. Pretty cool. I've learned a lot about LAS and England in general. All different, but the same. Just with British accents and phrases like 'When did the poly start?' 'Shock box' and 'Sharp Scratch.' The people here are awesome, I can still barely believe it. They were worried I'd be bored because we've mostly ...

Welcome to the most expensive and fast blog update ever! I'm here in London with Jon, things are going great! Living at a hostel is a new experience for me, but this one is really nice (as are our roommates). We arrived on Wednesday around 10, checked in, and found the closest pub for a pint. Expensive here, but Jon has learned that Guinness from the tap rocks his world. Yesterday we visited a station of the London Fire Brigade. We saw all of their equipment, and it was so cool, even my squirrel tail went up! Then, we found our way to LAS headquarters and met with the kind people who have planned this for us. There is much in store, and just thinking of it makes me giggle. Tonight we are doing a night shift until 7am. That should be interesting. The LAS people have treated us extremely well, gave us a nice LAS pen, disposable camera, and other goodies. They also drove us around to see the sights in one of their haz-mat units. Being on the 'wrong' side made me a little nervo...

All the IV flashes in the world could not yield the volume of happy dancing that I would like to do now. My classmate Jon and I have successfully coordinated a visit to London to ride with the London Ambulance Service (LAS) for two weeks. We’re also going to visit their university, helicopter EMS, communications center, and boat team, among other things. I am currently reading the indemnity form I have to fill out. My favorite part so far states that I cannot offer treatment to a patient unless asked to do so by the crew members: “Sure, I’ll drop that tube, no problem.” hehehe! I’ve known for a bit, but because of my mild superstition I had to wait for the plane tickets to be purchased and the hostel booked to make it “official” (because blogging makes everything official.) I am beyond excited about this, I can barely describe it. I try not to think about it too much or I may break out into song and dance at inappropriate times (at church, during NREMT exams, in class, et...