Friday, 18 March 2011

Who cares?

My heart sank as the familiar vibrating sensation got me and my crewmate out of our seats. Our radios had buzzed indicating we had a job.

"This one will be sick" I said to my fairly new crew mate.
"How can you tell?" they asked.
"Simple. We have less than 30 minutes of our shift left!"

We climb into the vehicle and my fears mount.

"Yep, gonna be a sick one. Just look at that address..."

Any job at a care home / nursing home tends to fill me with dread. And this one was no exception. Sure enough, more information buzzes down to our computer as we start to roll out the garage.

"Looks like you might be right" my crew mate says to me. I take one look, press the "999" button turning my big yellow custard box into a flashing yellow custard box and do my best to personally destroy the ozone layer as I make significant haste towards this job.

What had made me go like a rocket was a few notes in the description box "BP 66/33. Oxygen levels low". For anyone non-medical reading this, your Blood Pressure (BP) really should have the top number (the systolic) above 90. If it is not, then vital organs, such as kidneys and the brain, start having issues getting blood to them. This is bad.

As we pull up and get out, met by an aroma of rather hot breaks, I suggest we take the bed and all the trimmings in. Normally I take in my medic bag, O2 and a defibrillator anyway, but for this job I actually thought I was going to need them.

We start rolling the loaded bed towards the entrance when a lady appeared to show us in. I'll admit this did surprise me as I am more than used to having to wait for 5 or so minutes to get in / find someone who knows what is going on. Perhaps this was one of the better care homes in the area. How wrong was I.

We squeeze our trolley bed into the room that clearly had not been designed with getting patients in/out in mind, and are met by a nurse.

"Hello there. What's happened?"
"This is Edna" I look over and see this elderly bag of skin and bones sat up in bed looking not well. "Edna's had diarrhoea for the last 3 days. Now her blood pressure is low. So are her oxygen levels. And she's not really responding that well either"
"Ok, what are her obs?" I ask as I start trying to find a radial pulse, pop my sats probe (a device that measures the oxygen content of your blood) on her finger and indicate to my crew mate to do a temperature and check the ladies sugar levels.
"The last BP was 66/33 and her sats were 83%"

I look at the ladies badge. Yep, it does say nurse.

"So, why is she still sat up?" I ask. A blank look is my reply. "And do you have oxygen in this place?"
"Oh yes" the nurse replies.
"Any reason it is not on this patient then?" I ask.
"Er.... I don't know" they sheepishly reply,
"Well may I suggest that if a patient has a low blood pressure you lie them flat at least, and perhaps raise their legs if you can. And if they have low oxygen levels you actually give them oxygen?" There is a distinct bitterness in my voice at this point. Not entirely sure she realised how annoyed I was at her. "Do we have any notes for this patient? Any sort of medical history?"
"There should be some notes in her file".
"Then may I suggest you go and get us a copy of these notes as this would actually be useful". I may have over stressed the word actually, but I think she got the message as she left.

The radial pulse was all but non existent. A manual BP showed about 75/40. Better than what we had been told, but not by much. This still was a very sick patient. Temperature was slightly raised, so perhaps there was an infection on board. A quick listen to the lungs; nothing significant in there. Sugar levels fine. Pulse slightly quick. Oxygen levels initially a bit low had now come up since we had actually put oxygen on this poor lady.

I look at my crew mate. "Trolley, ambulance, scarper me thinks".
"I agree!" they reply. Considering they had been on the road less than 6 months, they certainly had more of a grasp of the severity of the situation than the "Nurse" did.

We move her over carefully. It wasn't hard, to be honest I could have blown her over. There literally was nothing over her. I turn around to put some bits back in my bag...

"I don't think she's breathing"

In the immortal words of James May, Cock.

I turn round. No obvious chest movement. Quick listen.... a beating heart but no sounds of breathing. I dive in the oxygen bag and pull out a bag valve mask (BVM) used to ventilate people, plug in the oxygen and pass it to my crewmate who was already at the head. As she starts to ventilate the patient, I grab the defibrillator and start sticking on the pads - once breathing stops, the heart often isn't far behind!

"She's breathing again". Sure enough, there was clear chest rise, not being caused by my crewmate.

"Let’s move before she goes again" I suggest, with which we grab all our bits (no staff around to help of course) and start rolling towards our ambulance. On route we bump into the nurse.

"One of our colleagues is coming with you. He has all the notes". Nice to be asked if this is ok! But at least we will get the notes.

On board the ambulance I pop a needle into the lady, which I must be honest I didn't expect to work as old people have veins that like going POP when they even see a needle. But, having not cannulated a patient for well over a month, first go and in it went. I connected up a bag of fluids, raised the patients legs, both in the hope of getting her blood pressure up a bit so that her brain and other vital organs would get a better blood supply. We shot to hospital, handed over to the staff in resus and left her there. I have no idea if she made it through the night, but I have my suspicions.

The thing that struck me about this job was the nursing home. Now, before I continue I should point out that, as a paramedic, tend to only see the less good nursing / care homes. The ones that are not looking after their patients. This is why we keep getting called. The better ones look after their patients and so we don't see them much. This may have warped my view slightly....

When we get older and frailer, we may end up in a state where we struggle to care for ourselves (there are some that think I can't do that now!). At this point we may well end up in a care home or, if we need extra looking after and have more medical needs, a nursing home. In these supposed sanctuaries we should be properly looked after until the day we pass away. However what I saw with Edna was a poor little old lady, suffering, skin and bones, not well cared for at all. And she is not alone. The number of homes I go into where patients all look so uncared for is scary. And it breaks my heart every time. Many of these patients are paying very good money for these places and they are being totally let down. Yet nothing seems to be done.

Not wishing to start a euthanasia debate, but we do appear to look after our beloved pets better than our elderly. They are either nursed back to health or, should they be suffering, put down. Yet our elderly are stuffed into these homes, with staff that are highly questionable and only care about their pay cheque and going home, and are left to suffer, usually prolonged by modern medicine trying to keep them alive, until they finally pass on.

I don't want to moan, I really don't. But this issue really gets to me every time I enter one of these "pre-mortuaries" (I did not make this phrase up but I do find it scarily accurate). We should be honouring our elderly. They should have prize place in our society. We should be ensuring their care is above reproach, top class, never faltering. So I ask anyone who has actually stopped to read this to do one thing:

Never be afraid to highlight a problem in one of these places. Be you a visitor to your relative or a visitor in green coming to take another poor person to hospital. If you have even the slightest doubt that the care may not be up to scratch, tell someone. If you are working, there should be reporting mechanisms. If you are a visitor either talk to the management, or if you are worried your relative's care may suffer because of it, go through your local social services and they should be able to help. Only by highlighting your concerns every single time can a body of evidence be put together to make changes happen. It may not be easy. It may make you late off work occasionally. But these people often can't stick up for themselves. We must be their advocates. We must be their voice.

Thanks for reading



  1. I was wondering myself why registered Nurses at nursing homes don't follow guidelines for O2 administration and/or auto-transfusion. We've been to nursing homes before and have found similar cases, I don't understand it myself. Whether it's laziness, being busy, or just a plain lack of care or competence. I agree that the relevant services should be contacted when we step into these situations and find quite poorly people not receiving the care they should be receiving. We have an MDT office at hospital and various vulnerable adult forms to complete. I usually try to tell the receiving staff at A+E of all of my findings. Do you do the same? Do you document it on your paperwork? (This is something I'm a little wary about doing, as all my paperwork is countersigned by my mentor and is under his name).

    Great blog anyway, really good for new Para's.

  2. We have vulnerable adult (and child) forms which we fill in and they get sent to a central unit who deal with all the referrals. I have found out that they are indeed acted on and have been several cases where our services referrals have been key in getting certain "care" homes to start caring! I generally document my findings on the PRF but as that is more about what we did, the concerns and other issues I generally expand on the referral form. But however you do it, I feel it is vital we document AND PASS ON this information. Only by sharing and highlighting will these vulnerable people be looked after!

    Thanks for reading :-)


  3. Well this gonna be awesome informative topic. It'll surely very helpful to others.

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