Tock (warning, contains scenes of a graphic nature!)

So, when I left you last, I was doing what I definitely don't do best; running! I had picked up my Thomas Pack (25kg) and my patient monitor, and was jogging round a rather obstructive fire appliance to the incident on SmallRoad. I had already been informed that there was one patient, with a severe leg injury. In fact, the actual information was a partial amputation of the foot.

I arrive, only slightly breathless, to see a young girl, already out of the wreck of a car, lying on her left side, screaming in pain. Not a nice sight, but screaming is always better than silence, when you are on the road. She's not all that far from the car. Well, actually, she is lying right next to the car, with a foot that is hanging on by not much, and in a very unanatomical position. Purple isn't a good colour, either.

So, in true ATLS (Advanced Trauma Life Support, the way in which one manages serious trauma) fashion, I ignored the obvious, and went through my ABCD's:

Airway - well, screaming usually means that you haven't got a problem with your airway, so I move on to:

Breathing - again, you need to be able to breathe in to be able to breathe out enough to scream. There is no point in listening to the chest, as there is so much noise around, so on to:

Circulation - a bit of blood on the ground under her head, but no gushing from the foot. No need for my nonexistent tourniquet, then! Phew!! Pulse - 130!! Eeek! Pelvic trauma?? Abdomen?? Let's get a blood pressure while I move on to:

Disability - she's talking, in between screams, even being able to tell me her name, Samantha, and her address. But she is slurring her words, and not terribly coherent. There is a vague smell of alcohol. "Been drinking tonight?" I enquire. "Not much," is her reply. The car accident seems to refute that. She is able to wiggle her toes in the uninjured foot, and is moving her legs, so I am not too worried about a spinal injury, but we would still like to keep things as still as possible - not easy, as she pulls off her cervical collar. Her blood pressure comes back as very high, so I feel that her pulse is due to pain rather than blood loss.

Decision time. She has a severe injury, and is in agony. I have strong painkillers available to me, but they will alter her conscious state. She has drunk a lot of alcohol, despite what she has told me, and so may vomit. Do I intubate her (pass a tube into her windpipe) after giving her anaesthetic agents, or do I give her the pain killers? If I give her the anaesthetic agents and then fail to intubate her, or if she has an as-yet unidentified injury, she may die at the roadside, as a result of my interventions. Also, she is right up close to the car, and on her side; to move her into an easier location will be excruciatingly painful for her. I think about the distance from FarAwayTown to hospital; probably around 20 minutes. Oh, hell, I'm prevaricating, the clock is ticking, and I need action!

I get the painkiller out my pocket, look at it, look at her, and put it away again. "Alright folks, it's a tube and ventilate jobbie." I'll need all hands on deck for this one. Quickly, I draw up the necessary drugs, one to paralyse her so that I will be able to pass the tube easily between her vocal cords into her windpipe, and one to put her to sleep. I gather my equipment, including a long introducer that I keep in the car - bum! another run, back round the fire engine to get it out of my messy boot, and then back to the patient.

I organise the troops. One will need to assist me with the intubation, one will need to be holding the head still, to ensure that the neck is protected, and one will need to press on the front of the neck; to close of the oesophagus to prevent any regurgitation of stomach contents and stop them going into the lungs before I pass the tube. Oh, wait a sec; this one's on her side. I will need to give the drugs and then she will need to be turned on to her back, AND be moved away from the car so that we ll have room to move. And all this needs to happen, and the tube passed, before the patient's oxygen level drops to a dangerous point. Oh well, all in a day's work for the fire and ambulance crews I have around me.

Drugs in, patient rolled, tube passed and secured. Tick! We scoop the patient onto the ambulance trolley and load her in.

Right, monitoring on. Tick! We are almost ready to roll.

One more thing to do before we go. Anyone?? Yep, just the small matter of the foot. We can't wander into a hospital with it looking like that, now can we. So, I look to one of the paramedics. "Want to give that a tug?" I ask. "Me?" I guide her through the very satisfying job of relocating a nasty, open, fracture dislocation of the ankle. Minutes later, the foot is pink, and there are pulses in the foot. Tock! We're off!

Tick

Tick:
Ring, ring; ring, ring; ring, ring. The 'phone's insistant blaring reaches through my sleeping mind and I fumble for the receiver. "Hello, it's Ambulance Control here." Like it's going to be anyone else at... I stare blearily at the hands of my watch ...2am. "We've got a job for you. An RTC on SmallRoad, FarAwayTown." I stumble out of bed

Tick:
I pull on my clothes (despite what my friends might think I don't sleep in my orange jumpsuit) and kiss Mrs RRD goodbye. "Wha'? Where are you going?" I explain quietly, and she clings to me for a moment. "Please be careful," she whispers, but already my mind is shutting down, going into work mode: FarAwayTown will take me quite a while to get to, even at this time of day.

Tick:
Down at my car, and I pop the boot. I stare in dismay at the mess revealed in the boot light. I can see my jumpsuit, buried under my Thomas Pack, but where the hell are my boots? Precious seconds wasted as I rummage to the back and pull out, first one then the other, boot.

Tick:
I'm now in the car. I program the Sat Nav. I know where FarAwayTown is, and I'm pretty sure where SmallRoad is, too, but I can't leave anything to chance. I have to concentrate on the driving, not the directions. I reverse out the drive, switch the Blues and Twos on, and I'm off.

Tick:
The SatNav says it will take over 20 minutes to get to SmallRoad, but I know I should be able to shave at least 5 minutes off that. I get a call through from Control with an update on the patient's condition. He has a serious leg injury. My mind flashes back to yesterday afternoon, when I had attended an ATLS (Advanced Trauma Life Support) Update Day. One of the key changes was
the use of tourniquets for severe limb injury. "I must try and get one of those," was my thought. Was I going to have a problem at this scene, because of lack of equipment? I quickly come back to the job at hand: getting there. I update Control on my estimated travel time. "Ok, drive carefully," was her reply. Drive carefully?? No-one at Control has ever said that to me before...

Tick:
I'm on the motorway. I check the outside temperature with my on-board thermometer: only just above freezing. Oh, oh. No, not that I hadn't dressed warmly enough (I hadn't). I was worried about ice on the road. I slow my speed to a more respectable 110 miles per hour and watch carefully for the tell-tell signs of ice on the road. Two patches reveal themselves as slight changes in the colour and reflectivity of the tarmac, and I adjust my speed accordingly.

Tick::
Off the motorway, and up into FarAway Town. SmalRoad is only minutes away from the slip road, and I phone Control to let them know I am there. As I get out my car I make that last, all important call: "Hi, Mrs RRD. I'm safely here. Go back to sleep. "

Tick:
As I run to the scene (the fire engine had been left right across the road, and I had to park MILES away!) I glance at my watch: 18 minutes have passed since the call.

To be continued...

Result?? Part 2

In Result?? I discussed a Lord's Debate about the provision of pre-hospital care by BASICS doctors last year, and mentioned that there was to be a further debate on 23rd March. Here is the link to the latest debate. So, what news from the Lords? Have we got the Government recognition this time round? Have a guess!

To summarise, it is up to individual Strategic Health Authorities to decide how they provide pre-hospital care. There will be no cenral steer from the Government. There will be no central funding for BASICS. Despite the evidence provided in the debate, including the estimate of numbers of lives that could be saved by having a doctor available to go out 24/7 to the scene of a major accident, the final word was, essentially, "Carry on, lads, you're doing a great job!"

Why on Earth would a SHA put money into setting up a system that is already run on a voluntary basis? Why pay someone when they already do it for free? Please don't get me wrong; I don't want to be paid for what I do. What I do want is the equipment to do the job to the best of my ability, and the ability to equip more doctors in my area, so that I can spend time with Mrs RapidResponseDoc, and with all my little RapidResponseDocs, without having to feel that I am letting anyone down. Alternatively, let my current employer be paid something towards releasing me to go out to scene, so that they can employ other doctors to cover my back when I am not around.

The Government has spoken...

Are You?

What an interesting world I have joined - the world of the underground blogger. I was in the hospital this evening, and a paramedic walked past me, one I have known for a while. He said "Are you, by any chance?" I smiled. "Might be. Are you?" "Possibly", was his reply. We smiled, knowingly, and went our separate ways.

Quick Thinking

Before I start this post proper, may I say a real big thank you to Tom Reynolds, from http://randomreality.blogware.com/, for his commenting on my blog - my hits have gone through the roof since. Just shows how influential the great man is...

My work at the roadside, as anyone who has read the last entry or so would know, requires me to do quite a bit of quick thinking and rapid decision-making. Do I intubate, how much fluid does this patient need, and so on. Whenever I am put in such a situation, there is often a lot of soul-searching afterwards. Did I do the right thing? Today, however, I was in totally different situation where I needed to think quickly, and where, if my choice was wrong, lives would be affected. I will put it to you, my readers, to decide.

Today I was attending a Coroner's Inquest. The specifics are not all that important - maybe I will talk about those at another time. Suffice it to say, when I arrived on scene I was presented with a very unwell man, with severe injuries. He was deeply unconscious, and I treated him rapidly, and got him to the hospital alive. Unfortunately, he died a few hours later.

I was asked to look at the time it took for me to be called by the Ambulance Service and the time it took me to get to the scene. The Coroner then asked me the $1000,000 question: "If you had arrived on scene earlier; if the Ambulance Service or Police had activated you sooner, would he have survived?" I felt I was on safe ground at that stage, and said that, as I was unaware of the post mortem results, I could not answer that question. I was handed the PM report.

As I scanned the report, looking closely at the injuries to various systems; the brain, the heart, the lungs, the spine; I came to an awful conclusion. These were survivable injuries. He had not suffered a massive brain injury. His lungs and heart showed little more than bruising. Sure, he hadn't escaped with minor injuries. But they were survivable.

What to do? I was being asked a question that, in my heart, I knew the answer to. For those who may not know, the Inquest is an open Court, and the family were sitting there, right in front of me. I have sworn, on a Bible, to tell the truth, the whole truth, and nothing but the truth. But, do the family need to know that their son, their brother, could have been alive today, had the speed of response been better?

So, there I am, with seconds to spare, and a decision to make.

My answer: "Yes, if I had been able to get there much earlier, he might have survived." What was initially scheduled as a 15 minute appearence to give a precis of my actions at the scene turned in to a gruelling hour of questionning. How much earlier would I have needed to get there to save his life. 5 minutes? 10 minutes? Would he have survived if you had arrived when he was still conscious and talking? Why didn't the police call you? Should they have that knowledge to be able to determine that he needed more help than a paramedic crew? Could I have driven faster? And so on, and so on. Balance of probabilities, explanation of Revised Trauma Scores (more about them in another post, maybe) and Glasgow Coma Scores (definitely more about them!). I was relieved when the Coroner thanked me for the evidence I had given, and I was allowed to leave the witness stand.

The Court was adjourned after my evidence, but, before he left, the Coroner looked at the family and apologised for the way in which that evidence had been presented to them, how distressing it must have been for them, as he was himself surprised with the answers I had given.

And so I left the Courtroom, hurrying to my car, head down, trying not to catch anyone's eye. As I was getting into my car I felt a tap on my shoulder. I turned, with sinking heart, and found myself face to face with one of the family. He looked at me, with tears in his eyes. "Thank you," he said.

The Worst Job in the World

Tonight was not easy.

I was called to a car which had lost control and flipped off the road, coming to rest on its side. I was informed by Ambulance Control that there was 1 fatal and 2 trapped, so I knew this was a serious accident.

I wasn't too close, so I arrived in about 9 minutes. The crews had already been working on a gentleman on the ground near the car for a short while. He was not breathing, and had quite severe chest and facial injuries. As I approached him, I could see a young lady still in the car, trapped. And now comes the dillema; the difficulty of having multiple casualties, and only one doctor to deal with them all. Do I carry on with the man on the ground, in a vain attepmt to revive him, or do I move on to the one in the car, who is clearly, from a distance, still very much alive? And, how do I make that decision, in full view of the girl in the car? I don't have much time to decide, either - the one in the car may be severely injured, and prevarication could prove fatal for her.

I told the ambulance and fire crews to move the man to an area a little distant from the car, and out of direct vision of who I found out later (and suspected at the time) was his daughter. Meanwhile, and with little time to spare, I made a rapid assessment of the daughter. She had a broken leg and some facial injury, but looked fairly stable. So, giving some quick advice to the paramedics (get an intravenous line sited) I went back to the father.

My assessment of him was unchanged - this man had already died. I pronounced life extinct. I looked at my watch to give an accurate time of death - 3 minutes had passed since I had arrived on scene.

This act of pronouncing life extinct on scene is very important for two reasons. It means that all resources can now be turned to help the person who still has a chance of survival, thereby increasing their chances. It also means that the person who has died is spared any further indignities at the hands of the medical team who would otherwise be receiving him into their A&E department - something that I feel very strongly about.

I then turned my attention to the daughter. It is quite amazing, when I think about it now, how all of us on scene can switch so rapidly from one patient who has not survived to one who needs all our care. Our only access to her was through the front windscreen. She was sitting on the front door - the car had rolled on to its side - with her left leg curled under her in a very un-anatomical way. She had clearly broken her thigh-bone, and was in severe pain. But that was not going to kill her, so I had to check her lungs and pelvis, to make sure she had no life-threatening injuries. I then had a discussion with the fire crew, to ascertain how we were going to get her out. I was all for cutting away part of the roof, so that we could have some more space. The worry was that this was a new car, and there are umpteen airbags and safety curtains built in to the roof fixtures, and these may go off with an ill-placed cut. An airbag is like a controlled explosion, and there were two people in the car - the patient and one of the ambulance crew.

So, back to Plan A - removal through the front windscreen. To do this I had to sort out her pain, as we were going to have to move her leg straight. There are various options, but in this circumstance I always use a drug called ketamine. It's more commonly used as a horse sedative, but, in much smaller doses, is an excellent pain killer for the pre-hospital patient. Within about 30 seconds she was asleep, and we quickly, carefully, pulled her out and on to a spinal board for transfer to the ambulance stretcher.

And then it's all done. Load her on to the ambulance, connect up the monitoring equipment, a quick chat to the fire crew (letting them know how well it went) and the police (she was going to be ok) and then it's a short journey in the back of the ambulance to the local hospital. Collect my thoughts while I sit there, making sure that I have all the information for the receiving Trauma Team.

But what of the third passenger, the one I haven't mentioned yet. She had been in another ambulance by the time I arrived on scene, with only very minor injuries, and I had not seen her. She was, unsurprisingly, the wife of the chap who had died on scene. And there she was, in the hospital, waiting for news of her family. What to do? She needs to know, and soon, it is only fair. So, I have the job, the worst job in the world; to tell someone their loved one is dead. She sat there, quietly, taking it in. No hysteria, just silent tears. Her family, many of them, soon arrived, and sat by her side, supporting her. "Did he suffer?" the only question she and her family wanted answered. I could at least reassure them on that one.

When I left the hospital, about an hour later, I had to pass through about twenty of the man's family. I am now left with the memory of these people, standing or sitting in the entrance to the Department, all quietly grieving, stunned at the devastation of their family.

And as I drive slowly home, I mentally add this man to the list of those who I was unable to save, whose injuries were too great.

Result??

Today I received an email from the Chief Exec of BASICS:

The Lords debate concerning the provision of pre-hospital care by the NHS scheduled for 2nd February was postponed due to the heavy snow fall in London on that day. This has now been rescheduled for Monday 23rd March at 1930 hours for 1 hour. The subject being debated is:

Viscount Falkland to ask Her Majesty's Government why the National Health Service does not provide doctors to treat critically injured and ill patients outside hospital anywhere in the United Kingdom except London.
It is possible to watch the debate live on line by going to:

http://www.parliamentlive.tv/Main/Live.aspx#

Click on the Lords window and scroll down to the debate.

So, suddenly, the difficultlies around funding for prehospital care are going to be raised in the House of Lords!! I should go there, take as many of my fellow BASICS doctors and friends with, show our support for this debate; maybe even get our point of view across to those that can make a difference.

Then I started to wonder, surely this isn't the first time this has been discussed. So I had a little look, and found the following discussion in the House of Lords: http://www.theyworkforyou.com/whall/?id=2008-06-11b.67.0&s=prehospital+segment%3A14025257#g67.2. On June 11th, 2008, the question of Specialist Emergency Trauma Response Teams was raised in the House. Near the end of what appears to be an hour's discussion of pre-hospital care, one of the Lords asked the Minister for Health:

"Just to clarify the Government's position, is the Minister saying that it is not acceptable that critical pre-hospital care should be dependent on volunteers?"

Whoa!! The Government thinks it is wrong for the care of trauma cictims to rely on BASICS doctors?? Result!! Erm, no. The answer, predictably for a Government Minister, was not a short one, but began with the following:

"Critical pre-hospital care is not dependent on volunteers, because any ambulance service or acute service will have a range of reactions to a major incident in its area. ..... Where necessary, teams of doctors will and should be called out to attend an incident to provide such care."

Sorry? Is that a "yes" or a no"? Those teams of doctors are the very volunteers that, according to the Minister for Health, critical pre-hospital care is not dependent upon.

So, I have very little faith that the debate at the end of March will provide any further answers.

A plea to all of you out there: write to your local MP. Get him to ask the question that was posed above. Let's get the Government to accept the fact that there is a problem with the lack of any central funding for doctors to attend critically injured people on the roadside. Thank you.

Rubberneckers

I went to a job today that was a bit different. Different because it was daylight and not down a narrow country road (and it wasn't raining, but that's for another post.) I was very close to my own hospital, and possibly could have walked there faster. I went to assist a man who had driven his car into a bathroom and kitchen showroom. He was unharmed, but the damage to the car and to the shopfront meant that he was well and truly trapped. It took the fire crew about 25 minutes to make the area safe and to remove the roof, so that we could slide him out of the car on a spinal board, just for precaution.

As it was daylight, and on a main thoroughfare, there were an awful lot of bystanders. I'm not used to working for an audience, and it can be quite offputting, looking up and seeing fifty or so people watching your every move. What really surprised me today was the number of people with their mobile 'phones, photographing and videoing the 'action'. This gets me mad! I understand why people slow down to look at accidents. There is something compelling about the misfortunes of others, and we all have a degree of voyerism in us. But, photography and video? No!! I recall one instance when I was being photographed at an accident, and the chap opened the door of the ambulance and started taking photographs of the patient. This is going too far.

What also struck me today, as it does every day, is the teamwork, the slick working together of the ambulance crews, the firemen and police officers, to ensure the safe extrication of the patient. That's one of the reasons I do this; to be a part of this team.

Lost For Words

I was sitting in my wife's car, on the way back from the petrol station, where we had bought some pizzas for supper, when I got a call on my 'phone; was I available for a call? "Give me 3 minutes to swap cars and I will be", was my answer.

I was on my way to a "jumper" - someone who has jumped off somewhere or under something. In this case, off a third storey balcony. Still conscious and breathing normally, but the crew wanted me there for some support and reassurance. This is not an unusual request, and I am more than happy to go along and lend a hand.

I get introduced to "James", a chap in his thirties, who is on antidepressants, and who has decided to end it all by jumping off the balcony of his flat. However, due to the torrential rain we had today, the ground was very soft, and, landing on his feet, he only sustained a fracture of his thigh-bone. Not a pleasant injury, but certainly not life-threatening.

And here I was, lost for words. "Don't worry, it's not serious", didn't seem appropriate to someone trying to end their life. And nor did, "You'll be OK, we'll soon have you sorted." The reassuring words we use, almost as a reflex, to our patients in pain, scared, worried about how seriously injured they might be, just weren't going to do for James. So, instead, the three ambulance guys and I worked on in silence, lost for words of comfort for a man, so unhappy with his lot that he has nothing left to live for.

I finish the job, and drive back to wife, kids and pizza - my life.

Who??

So, there I was, in a ditch with an elderly couple. They had come off the road and flipped their car over, coming to rest upside down in the ditch. Remarkably, apart from a few scratches, they were unharmed, and desperate to self-extricate. I am always keen for patients to do this, as it makes our lives much easier, but we do like them to have something to lie down on. I called up to the paramedic who was with the ambulance; "Steve! Can I have the spine board?" Nothing. "Steve! Can you give me a hand down here?" Still nothing. I turned to my colleague, who was trying gamely to stop the lady falling out of the car. "What's up with Steve? Is he deaf?" "No", came back the answer, "he's Darren!"

Some Thoughts About Being A BASICS Doctor

People often wonder what drives BASICS doctors to spend their spare time racing around the neighbourhood to attend accidents and ill patients. Don't I get enough of that during my day job? I, like many other BASICS docs, am an A&E Consultant. I work all day, and some evenings too (I am at work at the moment), seeing the Great Unwashed of Society. Surely that's enough, isn't it? Well, for many of us, it just isn't enough. We crave the adrenaline rush of the call. We thrive on the tension while we drive on blues and twos to Lord knows what. And, let's be completely honest, we love feeling useful, to know that we have the ability to alter the almost inevitable outcome of a serious trauma.

When I turn up on scene, and am greeted by my colleagues in the Ambulance Service with relief; when the Fire Chief looks to me for guidance, it does give me a sense of purpose, a feeling that I am worth something.

But, all that aside, it is the12 year old lad who survived his cycle-vs-car accident, and the 35 year old lady who survived her microlite crash, and the 17 year old who survived her car-vs-telegraph pole altercation, all because I was called to the scene, and managed the patients in such a way as to optimise their care on the way to the hospital. To know, without a doubt, that these and others like them, are here because you gave up watching Eastenders to go to their aid, is more than enough to offset the sleepless nights and missed suppers.

I still love driving on blues and twos, though!

Friday Night

There I was, just thinking about getting in to bed when my phone rang - unknown number. That is usually my cue to say goodbye to my wife and whichever kids I have at the time (more about that in another post).

"Hello, Ambulance Control Here. Are you available for a job?" I almost always am. This one was about 15 minutes away; a car had spun out of control, left the road and landed upside down in a ditch. 4 teenagers were injured, 2 seriously.

A quick kiss goodbye, out to the car, don the orange jumpsuit (you know when you've been tango'd), and off I go.

I do love driving on "blues & 2's"; there is something quite special about the speed and the need to keep your wits about you. But I was more worried than usual on this trip. 4 teenagers, 1 confirmed unconscious and trapped. It didn't sound good.

15 minutes might not sound far, but, when there has been a major head injury, every second counts. In this instance the ambulance crew felt that 15 minutes was too long, and had already taken the most seriously injured to the local hospital, along with one of the more minor injuries.

I was greeted by a whole flurry of activity: flashing lights by the dozen, and loads of people in reflective jackets. I was directed to a girl, who I will call Samantha (that wasn't her name). She had been a rear seat passenger, and had been cut out of the car. Fortunately she had been wearing a seatbelt. She was confused, and kept asking the same questions over and over - a sign of a head injury. She was pulling at the straps and collar that had been fitted to her to prevent any injury to her neck, and was very difficult to manage. A few choice swear words at me when I put a needle into her vein cheered me up - it's the quiet ones that worry me more. I was thinking about where to take her. I didn't want to overload the local hospital, and my own hospital where I work as my day-job was just 10 minutes away. By this time (only 5 minutes or so after my arrival) Samantha was getting quieter. Oh-oh. The ambulance paramedic was looking anxiously at me. "Ok", I said, "We'll intubate her." I was talking about giving Samantha a general anaesthetic, passing a tube into her windpipe and breathing for her. This is to optimise the amount of oxygen getting in to her system, to make sure that there is no deterioration in her head injury.

In a hospital, when one does this sort of thing, there is lots of space, lots of assistance, and lots of whizzy equipment to help you. I was in the back of a cramped ambulance (fortunately not moving), with 2 ambulance crew, both of whom I know well and have worked with before, and the limited equipment that I carry in my car. Fortunately, this is what I am used to, and we quickly set up the kit, gave her the drugs, and passed the tube. Working as a team, we got her ready to start the journey to the hospital.

This is always the most worrying time for me. I have done what I believe is the right thing for the patient, but what if something goes wrong on the way? It is very difficult to monitor a patient in a moving vehicle, and I have to keep very alert and my wits about me, watching for any signs of deterioration. Lightening the mood, I call to James, who is driving, "Are we there yet? I feel sick! I need the loo!" He just grunts, and concentrates on his driving. I did feel sick; I always do in the back of an ambulance, but I just breathe deeply and concentrate on MY job.

At the hospital the Trauma Team takes over; there's not much left for them to do, except check to make sure I have done everything properly. Some x-rays and a CT scan shows no significant injuries, and I am able to tell Samantha's mum and dad that she is going to be ok. I sit and chat with them for a while. I tell them about my 16 year old, and the father asks how I can cope with what I do, having kids of my own.

The next day (well, later that day; it's already Saturday morning before I leave the hospital) I go back and see her, sitting up and complaining she aches all over. Fortunately, all 4 of the kids had survived with only bruising - a minor miracle, considering the state of the car.

My First Entry

Hi there! This is my first entry in my first Blog. Why am I here? Well, as my "About Me" panel says, I spend much of my spare time being called by the Ambulance Service to attend major accidents and other incidents (shootings, stabbings, falls from height, etc) where the paramedics feel that more medical care is needed for their patient. Who out there has heard of BASICS, the British Association for Immediate Care? Very few, if any. We are a charity, and all the doctors give up their time voluntarily.

I was talking about the work we do at a Women's Club last week, and I got to thinking about all the jobs I do, and the fact that no-one knows about the sterling work the members of BASICS do. There had to be a way to get BASICS more into the public eye.

I am a big fan of Tom Reynolds' blog "Random Acts Of Reality." While I do not profess to be able to write like Tom can, I felt this was the best medium to reach a wide audience. Stick with me; hopefully you will find what I do interesting.