Back in the UK, what now?

So, returning to the UK was quite eventful. I returned a week early and still have heard nothing from the airlines that my flights were cancelled with. 

I have been working shifts in Torbay hospital as a HCA to do my bit in the effort against the coronavirus outbreak. I have worked on a variety of wards, including the Intensive Care Unit, Emergency Admission Unit and also some of the non COVID wards.

One thing I can certainly say is that the NHS is currently coping. However with the peak of the virus due to shortly hit, staff and resources will be stretched to the max and hopefully not to breaking point. Working in the ICU, it is one nurse to one patient, we had 9 patients and 9 staff on, one more patient and we would have been past capacity. The unit holds amazing equipment and the best way to describe it is like working on a spaceship. The only problem, is that it is not designed purposely for a pandemic. Of the 9 patients on the unit, 7 were confirmed COVID-19 and all intubated. The unit was divided in two, one side being "dirty" and the other "clean", and the side rooms in the "clean" side were also in use for covid.

Working in the PPE is hot, exhausting and restricts your communication, it also takes time to don the ppe so nurses working with the patients will stay in the ppe and in the room for periods of up to three hours at a time.

 In the side rooms in the "clean" area, the designated nurses use paper towels to write what is needed on and stick it to the window, so that someone can fetch it for them. (photo below)

As a result of working with confirmed COVID-19 cases myself and my wife Becky have came to the hard decision that she and our six month year old daughter to move out of our home and stay with her parents whilst I am in contact with the virus in order to reduce the chance of me transmitting it to either of them. This has not been easy, after a month of being apart I have returned and only a week later we are apart again. This time with no date set to be back together again.

I have secured a job with a private ambulance company in Peterborough providing front line response over the coming months on a four on four off shift rota. The company have been very accommodating and are happy to sign my hours and competencies off for my FREUC 5 in the process. Obviously the distance from home is an issue, so they are providing accommodation for the time I am working. Due to the fact I will be coming back to an empty home, I am hoping to work as much as I can, a; to complete the remaining 475 hours as fast as I can and b; to increase my wages so that I can fund my further education.

The country is only now realising how amazing our healthcare service is, how dedicated the staff are and how much worse it could be. I dread to think what Mexico would be like if it is hit as hard as we have been.

The End

Yesterday, in the morning we received notice that only essential staff were allowed to work in the hospitals and ambulance services. With ten days left in Guadalajara, the city had finally caught on to the COVID-19, shops were closing, restaurants taking temperatures as people entered and all of a sudden face masks were everywhere. It seems that Mexico had gone from no response, to maximum overnight. The border has been shut to the USA and very soon it is likely they will stop international flights all together.

In a desperate hurry to get home, as I can no longer work and if the borders closed I could be stuck here upwards of a month. Im now sat in Mexico City airport waiting for my flight back to the UK at 23:40.

Day 26 - Day 20 on the Cruz Verde Norte Ambulancia

So today was my twentieth day working on the ambulances in Guadalajara. Much of the day was quiet, however we did respond to three calls in total. The first, an urgent transfer to another hospital for a patient that had a pelvic fracture and fractured femur for surgery.

The second was to three children that had been knocked down by a car in a hit and run. Thankfully on arrival the scene was not as bad as anticipated and only one of the children sustained serious injury. The girl had a fracture to the left tib/fib and was also complaining of back pain. As a precaution we immobilised the child using a device similar to a Kendrick Extrication Device and the smallest leg splint we had on board. I cannulated on route so that pain relief could be given as well as the standard Hartmann Alpha solution.(shown above)

The final call of the day was to a motorcycle accident, however on arrival it was apparent there were no serious injuries and the patient was left on scene.

On another note, I thought I would update you on the COVID-19 situation over here. So far there have been no confirmed cases in Guadalajara, the hospitals have increased the use of basic ppe such as surgical masks and gloves. There also has been an increase in distribution of hand sanitiser and a few more posters have appeared. Business carries on as usual, however I have heard rumors that some schools have closed as a precautionary measure.

Day 24/25 - Day 18/19 on the Cruz Verde Norte Ambulancia

I didn't have a chance to post yesterday. The daytime went very slowly with only three incidents to respond to, all being motor vehicle accidents. At the end of the shift I decided to try a night with the other ambulances that are not based at Cruz Verde Norte. Instead they take up positions far away from the ED so that they can respond to calls in the area quicker. Most the night we spent hopping between petrol station to petrol station waiting for any calls. We had a couple of RTC's but otherwise I spent the night broadening my understanding of the spanish language.

Today I only worked 8 hours, two calls, one to a woman with a minor cut on her chin, she was left on scene. The other was a transfer, we went to pick up the patient and realised that her respiratory effort was increasing majorly. Rather than take her straight away, we took her down to one of the resus cubicles and from there she was RSI'd. When she was stable we then transported her to another hospital, manually ventilating on route. It is unlikely that this woman's condition was as a result of COVID-19 but we took protective measures just in case.

Day 23 - Day 17 on the Cruz Verde Norte Ambulancia

Today was a very slow day, we only responded to one call. 

We responded to a report of a fight with two casualties, both of which only sustained minor injuries and after assessing both at the scene we left them there.

On another note, the travel restrictions due to COVID-19 mean I am now unsure on my position when returning to the UK in two weeks time. The information I can find on the government websites is very vague and does not help in the slightest. The british embassy in Mexico was closed today due to the public holiday and the airlines I am booked with say they can not take any action until 5 days before my flights are due to depart.

Mexico itself is near enough un-touched by the corona virus with little more that 40 cases nation wide and as you can imagine it is business as usual and the only difference is you see the occasional informative poster in the hospitals.

Hopefully tomorrow will bring more work.

Day 22 - Day 16 on the Cruz Verde Norte Ambulancia

(Above, another photo I was sent from yesterday)

Today was pretty average with six calls throughout the day.

The first was outside the city, it was in an area that I could only describe as stereotypical Mexico. Dirt roads, houses made from scrap and horses and donkeys along the street. After about 20 minutes of what can only be described as off road driving, we found the patient at the side of the road, he had pain in the ankle and it was also swollen. We got him on the stretcher and began the long and bumpy journey back to the ED. I cannulated to provide fluids and give some pain relief using the drug "Ketorolaco" (a NSAID and also the primary source of pain relief here) due to the very uncomfortable ride back.

The next call of the day was a RTC, the car (shown in the photo below) hit a concrete barrier at speed, setting the airbags off. Luckily the occupants only sustained minor injuries and were treated and left at the scene.

Soon after arriving back we had a call to a woman experiencing shortness of breath, however on arrival, it was obvious that she was actually experiencing an anxiety attack and hyperventilating. One of the paramedics calmed the woman down before leaving her at the scene. 

In the afternoon we received a call to a seizure. Upon arrival I realised that the patient was a 9 month year old baby, and the parents had covered him in blankets. Realising that the child was very hot and suffering from a febrile convulsion, I removed the blankets and the clothes with the exception of the nappy and directed one of the fans towards the child in order cool him gradually. After about half an hour and checking the obs several times, we left him on scene.

The next call was to another child that had hit their head. Using my amazing skills of creating inflatable elephants out of latex gloves, I managed to calm the girl and she allowed me to inspect the wound and clean it with little fuss before transporting her to hospital for suturing. 

The final call of the day was as usual, to a "enferma" patient, and as I entered I could already see that the woman was deceased. I checked for a carotid pulse and the body was cold, and as I went to move the arm so that I could listen to the chest for heart sounds, I realised that rigor mortis had already set in. As is required I listened for a minute before confirming that the patient was deceased. At this point the patient was handed over to the police to deal with.

On another note, the fundraising has been going well, so far I have raised £375, which is just shy of 10,000 peso's. I have been asking various of the ambulance crews what equipment they would find useful, and one of the notable items, especially now with COVID-19 is contactless thermometers. They do currently have thermometers on the ambulances, however they are the old mercury filled glass ones, that are really not practical for prehospital use. I plan to get a couple of contactless ones as well as more batteries and various other items that will make their life easier and improve patient treatment.

Day 21 - Day 15 on the Cruz Verde Norte Ambulancia

 Today was a very good day, we only had three jobs, but the last one took around four hours.

To start the day we carried out an urgent transfer of a patient that had been stabbed several times in the chest. He had a pneumothorax on the right side and as such I was shown how to create a chest drain. The transfer took around 30 minutes and we delivered him in a stable condition.

The second job of the day was a fall from height at a construction site. The male had fallen approximately four meters and suffered a potential pelvic fracture. We immobilised him on a spinal board, administered fluids and transported him to the emergency department.

The final call of the day was probably the best call I have had since being here. We were called to an elderly male that had been walking in one of the valleys on the outskirts of Guadalajara, after searching the woodland for around twenty minutes a local pointed us in the right direction.

We arrived at the top of the steep valley and the crew I was working with was reluctant to venture down due the terrain. I grabbed the trauma bag and climbed down myself to find I was first on scene. 

The elderly male was complaining of pain in the lower back and pelvis. I completed an assessment and a set of obs, to find that he was hypotensive (86/56) and also hyperglycemic (320mg/dl). Being on my own, I  shouted up to the crew who agreed that I should cannulate and start administering fluids.

About ten minutes after this the Bomberos USAR arrived to help with extrication. They set up the ropes and using a SKED stretcher we formed a litter and carried the patient up the valley, out of the woodland and into the back of the ambulance. 

Completing another set of obs on the way to the ED the patients blood pressure had risen to 103/76 and his glucose levels had dropped to 210mg/dl. In total this call from start to finish lasted around 4 hours.