Following our lunch, which was another example of how working in an American Fire House is so much more different to on a UK ambulance station, i.e. everyone sitting down together and enjoying a wonderful home cooked meal (with HUGE portions!). It really did feel like sitting down for lunch with a big family. Conversation was flowing, music was coming in from the TV in the lounge area when all of a sudden everything stopped and we all looked over at the screen…..What’s this? Was Justin on the TV already??

No, but it was one hell of a likeness. Whatever music channel was on, there was some 70’s style music on. Willa noticed that one of the singers on screen had a startling resemblance to Justin, which just had to be recorded for Prosperity. Justin and Willa jumped into action, and I got the shot! What do you think?

Can it get any weirder?

The only thing that would complete the picture was if Justin only had blonde hair. In comes Janet to the rescue to lend Justin some of her luscious long blond hair. And…….Hey Presto!!

The laughter died down and everyone moved on to washing dishes and cleaning up. I wasn’t allowed to help with the washing so busied myself with wiping down the table. Once that was done, I popped out to the garage to see Ted and Chris who were busy editing, emailing, tweeting and uploading videos. Those two guys really didn’t stop during the whole time we were out!

It wasn’t long before the tones went off again, and everyone stops to listen to hear if it is the Engine or the Ladder going out. This time it was neither, instead it was for the Rescue Captain to go and assist with an unconscious patient.

Off he went in his SUV. I hadn’t really had much of a chance to see what his role was and how he fitted into this whole Fire Fighter/Paramedic thing so far, but I would change that before I went home from the Shift.

A couple more Fire Calls came in, all of which were false alarms or malfunctions in the alarm systems, but at least I got another ride out in Engine 13!

Then we had another medical call. This time to a collapse in the foyer of an office building just around the corner. We all took our seats again, Chris joining us to film the action whilst Ted stayed behind to get some shots of Engine 13 leaving the Station. As we arrived, Justin and I got out first whilst the other members of the crew followed behind. I made it my goal to actually have some part of these calls so I ensured that I at least grabbed the defib to carry in (there, you see, I was actually useful to have around). As we approached the patient, who was still sitting in a chair, you could tell that it wasn’t just another ‘nuisance call’. The lady, in her early 50’s, was pale and looked like she was just staring out into space. Justin quickly checked her radial pulse and called out

“No radial”

With that he, grabbed the patient’s upper body and I grabbed her legs, thighs and waistband.

“1, 2, 3 Lift!”

As soon as she was on the floor, I just grabbed hold of her feet and hoisted them into the air so that they were resting on my waist whilst I was standing up. To be honest, I didn’t know if that was what I should have been doing, but sometimes you can’t help but go into automatic pilot. If someone is so hypotensive that they lose their radial pulse, then those legs just need to go up!

Whether I should have done it or not, Justin seemed happy with what I was doing. She came round after about 20 seconds and tried to get back up. Everyone around her, Justin, I and the other 3 crew members of Engine 13 all tried to get her down on the ground. She was confused and obviously in need of hospital. After maybe 2 minutes the SFFD Ambulance arrived and took over care of the patient. Justin tidied up and stowed everything away back on the Engine and went to finish off his handover to the Ambulance Crew, and I got the opportunity to get one of my favourite pictures of my trip :

The SFFD in action!

I don’t know if he realised it then, but I’m sure he did after he came over to the UK. The job he is doing on Engine 13 as the Paramedic is exactly the same as I do on my Rapid Response Car. Go out, get there first, stabilise the patient and have a good assessment ready where possible for the arrival of the crew. Obviously the only default is to transport to hospital or get a refusal form signed, but the basic role of the Engine Paramedic is not too different from mine on the car.

It wasn’t until afterwards when we were discussing the case with Ted and Chris that Justin said how weird it was that I did that with the legs, as he was just about to ask someone to do it, but I had already done it by the time he looked up. Proof yet again….Same patient, different country, and remember the basics!

The afternoon was interspersed with various other medical and alarm calls, but also a fair amount of down time where we did some filming and discussion pieces. I had the opportunity to discuss my thoughts on Engine responses with Justin also.

My thoughts, after going out on a few medical calls, where based solely on what I had witnessed, and may not have been the norm. Maybe I was just lucky that it was a fairly quiet day and the SFFD and other agencies ambulances weren’t being stretched too much, but all I could think was that if there was already an ambulance in that response area that will meet whatever response time target is already there, and there is no expected need to have a large volume of staff on scene, then why does the engine have to respond at the same time as the Ambulance?

Surely that is putting a lot of people at risk, both SFFD staff and the public who are either on the roads or pavements (sorry, sidewalks!) for a negligible benefit. Now, I would understand completely when there is not an ambulance close by to respond, and in fact, that is what I would love to see brought in to my own area.

As if to bring this point home, just before the evening meal at Station 13, the tones went off and again, it was for the Rescue Captain. This time however, it came through as resuscitation so Justin quickly asked the Captain, if I could come along with him, to which he replied that I could.

So I squeezed into the back of his SUV and off we went. It was a much farther distance than the engine would cover as there are far less of the Rescue Captains than there are ambulances or Engines. They are Paramedics who do not work on the Fire Engines at all. Their purpose it to arrive on scene and act in a supervisory capacity to ensure that everything is being done correctly and to provide assistance if required with some interventions that only they are allowed to perform, such as I.O cannulation. As we were travelling to this scene, he informed me that there would be two engines and an Ambulance on scene, as the first engine had only an EMT on board and not a paramedic, therefore a second engine was dispatched which had a paramedic as part of the crew.

We arrived on scene and were quickly informed that it was actually a heroin overdose pt that had gone into respiratory arrest. Naloxone had already been given before we got there and the patient was starting to come round.

I took a moment and stepped back a couple of paces and just counted … 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11!!  11 Members of the San Francisco Fire Department for 1 Patient !!!! 4 from each Engine, 2 from the Ambulance and 1 rescue Captain (oh and one UK paramedic in a green uniform standing there with his mouth hanging open!)

I understand the need to get a paramedic on scene for a life threatening emergency, I really do, but do you really need that many people on scene? This seems like the perfect type of job for Justin to trial his Rapid Response Model…Same call comes in. Justin responds as a lone paramedic in a fast response car with an ambulance following close by. 2 Vehicles, 3 members of staff.

Now I know what you are thinking – if the patient is in arrest, we would need more people in the back. Yes I completely agree, and that is where the benefit lies with having so many staff on scene – you can always pinch one to come in the back. However, if Justin was there in his RR Car, then he could travel in the back of the vehicle and lock his vehicle until the crew can drop him off afterwards. To be truthful, I think we have just gotten used to being alone in the back of an ambulance and trying to do the best CPR that you can whilst giving repeated doses of cardiac drugs etc! That doesn’t make it right though. I can’t think of a single medic who would not want at least two people in the back of an ambulance for a serious ‘working job’

Anyway, it’s something to think about. How many staff is too many on scene?

Once the patient had been transferred to hospital from the scene (in restraints, which is another thing that could never happen in the UK, The Rescue Captain drove me back to the Station 13, just in time to have me evening meal.

Yet again, another fantastic meal. Which reminds me that I never did get hold of one of the ‘San Francisco Fire Departments Fire House Cook Books’ to bring home!

I filled my belly, offered to do the dishes again, but again to no avail, then pinched a lift back to my hotel from Ted.

It had been a great day. I had a lot of thoughts whizzing around in my head and had thoroughly enjoyed seeing the dual role that Justin delivers day in and day out of his working career.

I seemed to be getting a little bit starry eyed about life in San Francisco, you always think the grass is greener over on the other side, but in reality, I know that there are all of the frustrations I have over in the UK, over in San Francisco too.

We were meant to be doing another ambulance shift in the morning, but that had been lost due to some miscommunication down the line. We could have still worked a shift, but it would have been some ungodly hours which would have impacted hugely on our following day and also the one chance that Justin may get to actually get home early and spend some time with his good lady and his beautiful children.

It gave us the chance to meet up a little later than normal the next day (yeah, a little sleep in), and to go and get some filming done in some of the more scenic places around the bay, then actually have a little free time in the afternoon.

Sounded good to me………

As we moved on to the next post of the day we sat and chatted about this and that.  Justin told me some of the history surrounding the merger of the Fire and Ambulance service which was surprisingly recent, but more about that later in the story.

The radios went off and we were sent to another location for an elderly female who was allegedly “deteriorating” in her general health and seemed confused.

Jim drove lights and sirens for a fairly short distance until we arrived at the patient’s house. Again, the engine crew was already there and had made contact with the patient. Another quick handover and a universal look between two paramedics when you just cannot say the words out loud:

” there is something a bit odd about this one ”

The patient, Joan, was assisted to the Ambulance and placed on the stretcher for a full assessment by Justin and Jim. Justin starred off with his History taking whilst Jim pottered around and helped with getting a set of observations before he sat down in the captain’s chair and started taking some notes on the electronic care record.

The history taking revealed that the call had come in via Adult Services (like our social services) after they had received a call from the patients landlord stating that she was ‘acting a little odd and seemed confused’ Someone on scene, from adult services I think, stated that she felt the call was more to do with the fact that Joan had missed her rent a couple of times and in reality, the landlord probably just wanted her out of the house so that he could evict her and change the locks.

Just looking at Joan, you could see all of the classical signs of chronic illnesses left untreated. She obviously had an element of COPD, her legs were very oedematous and one had an obvious cellulitis. She seemed unkempt and quite lethargic, but was a very sweet lady who was very personable and quickly wangled her way into the ‘what a lovely patient category’

As Justin asked about her medical history she stated that she had never been in hospital and had never been to see a primary care physician. Apparently this was due to a lack of insurance and the lack of money to pay for any treatment! What hit me like a brick to the chest though was when she was laying on the stretcher and she looked at Justin and said:

“Oh dear, how much is this going to cost me?”

Now, whenever someone says that to me in the UK (which they do sometimes for some reason) I always enjoy being able to say

“oh don’t worry about that, it’s free, let’s just get you sorted and you can repay me with a bacon buttie when you feel better!”

But in this case that wasn’t true, however Justin still went down the route of

“let’s worry about that later Joan, we just need to get you some help to get you on your feet again don’t we?. We are going run you up to hospital to get you feeling better ok?”

Joan agreed but you could see the concern on her face about it all. From that moment on, during this patient care episode, I hardly heard anything else in the back of the ambulance. My mind was just wandering around trying to rationalize what I had just heard.

Over in the UK, this is the kind of thing we assume happens all the time in America. A patient unwell and not treated because they can’t afford health Insurance, surely that’s the whole problem with the system right?

Maybe that is part of it, but what I saw during my time there was the rampant abuse of the system by those without adequate health care insurance who use 911 as their access for primary health care issues and minor illness and injury, as they know they can access that service and virtually have nothing to pay for it due to their own personal circumstances.

That wasn’t the case for Joan though; she was just a lady who couldn’t afford health care, so she didn’t get any!

As we drove to the hospital, I was surprised to feel myself getting a little upset. Here was a woman who would not be in this situation if she was in the UK, unless she chooses not to access health care. If she wanted it, she would be having regular checkups for her COPD, she would most likely have a specialist respiratory nurse reviewing her periodically in her own home, she would have all the medication she needed delivered to her door and she would have been given a nebuliser machine too. And that’s just for her breathing problems!

All I kept thinking over and over again was just how wrong it seemed. I looked over at Justin and can remember feeling a little odd that he didn’t seem to be too bothered about the whole thing, then I put myself in his shoes and realised that this must be something that he sees day in, day out for the entirety of his EMS career so far, so maybe this was just routine run of the mill stuff after all.

However, when we discussed it later, it was obvious that this is as frustrating and maddening to most all of the Paramedics and EMTs of the SFFD, and they will go as far as they can within the realms of their remit and professional obligations to ensure that the patient gets the care they need. It is a problem with the system that, at this moment in time, no one can do anything about. But as I was told by some of the men and women that I had the fortune to talk with during my time in San Francisco, there is always something someone can do to make it easier for the genuine patient who just cant afford healthcare, and it was heartwarming and reassuring to realise that there are professionals out there who will do all they can for their patients, more than just caring about their physical needs.

We arrived at a different hospital and handed over our patient in the same fashion as in the other hospital. I wonder if it is a legal thing or a trust/professionalism thing that requires the nursing staff to repeat all of the observations that Justin had taken mere minutes before in the back of the ambulance, before they actually accept the patient.

As soon as we got outside, Ted and Chris were waiting to pounce.

“How did that make feel?”
“You look a little upset, are you upset by that?”
“Tell us your thoughts?”

I know he was looking for TV gold and hoping for a tear to be trickling down my cheek, but there was no way that was going to happen.

It did however, leave a certain mark on me and it did confirm my continued belief in the NHS and the system that I work for.

The NHS is not perfect; there can be mistakes and inefficiencies. Some may not have the best service ALL of the time, but it is there for EVERYONE regardless of their personal circumstances and that is something that I will cherish and believe in for the rest of my career.

Time for lunch now though…….

Jim and his amazing knowledge of all things food related around the city came to the rescue. No matter which intersection we were passing, I would hear him say from the front seat

“Oh there is a great Chinese/Indian/Vietnamese/Italian/Steak house restaurant down there”

I’m sure he must spend his entire free time going around different places to eat and learning where all the best spots are. I really think he has missed an opportunity to be the first EMS celebrity restaurant reviewer.

Anyway, this day, he decided to take us to a local authentic Vietnamese restaurant.

Jim and Justin tucking into our Vietnamese lunch

As we arrived, I asked what we would do if a job came in and we were sitting at the table, to which I got the obvious answer, “we just go!”

It seemed a little risky to go for a sit down meal, but what I hadn’t counted on was the speed that the meal arrived at the table. Justin and Jim told me that there are many restaurants around the city which become regular stops for many of the SFFD Ambulance crews, even to the point that some just start cooking the house specials or a selection of dishes as soon as an ambulance pulls up outside and the food is virtually at the table as the crew sits down.

I glanced at the menu and realised that I didn’t have a clue what I was going to order, so I am afraid that I bottled it and went for a safe bet of an omlette of sorts, can’t go wrong with that right?

The food arrived in quick order and we tucked in. Justin, Jim, Ted and Chris all had some sort of soup with varying degrees of heat and spiciness. It was fun to watch Ted starting to sweat after a couple of minutes and I am sure that he paid for that some time in the near future!

We finished our food without getting a job, and moved back to the vehicle.

We were then sent on another couple of calls, the last one of which was a pedestrian V Car RTC. It was obviously a Code 3 call, so Jim drove us the few minutes to the job and we arrived on scene shortly after the engine company. They had already immobilized her and had started to log roll her onto the spinal board when Justin and Jim moved in to offer assistance and to get another quick handover. I had a quick glance over the scene and noticed the car with a bulls eye to the windscreen (always a worrying sign), however from what I could see of the patient between the 6 qualified ambulance staff on scene (FOR 1 PATIENT!! – that is something that you would never ever get in the UK, but something which obviously has great benefit when the situation calls for it!), she seemed to be alert, conscious and orientated, with no obvious traumatic injuries. However, the team clicked together and moved into action. Before I knew it she was in the back of the ambulance with Justin, Jim and I.

Justin did his quick head to toe whilst Jim did some quick basic obs and started the patient care record on the computer. Shortly after it was off on the Code 3 run to the hospital, which was about 15 minutes away.

Our patient was very distressed and really getting herself anxious and upset, I could see Justin was busy trying to do what he needed to do, and I knew I wasn’t meant to have any physical patient contact, but surely I could help out with one of the best tools we have as paramedics and EMTs?

I moved over into the captain’s chair at the head of the spinal board and reached forward and held her hand. I introduced myself as the funny talking one from the UK, which lightened the mood for a couple of moments, then spent the rest of the journey trying to distract her, reassure her that everything seemed fine and calm her down.

It worked to a point, but it was really good to feel that I was actually being part of the team rather than just standing on the edge and looking in.

In the end, she apparently suffered no significant injury, and that was to be the only real potentially traumatic job that I would see in my time there, but it was enough to see what I had expected from American EMS, rapid trauma care in a very methodical and structured way. Although I still didn’t get to hear Justin should ‘STAT’ to anyone, or pound on someone’s chest whilst looking to the heavens and shouting ‘IM NOT GOING TO LET YOU DIE, NOT ON MY WATCH!!!”

The Medic99 Crew - Jim, Justin and I

In total we did 6 jobs in the 10 hours that we were on shift. Quite a quiet day according to Justin, but it was a great introduction to SFFD. It was a shorter shift than I work back home and it was quieter, but it felt longer and more tiring, due to not being able to get any rest in a station and not having any period of the day when you know that you are not going to be called out, even if it is only for 30 mins.

Justin dropped me off at my hotel as I was moving to a different hotel that night as I was getting sick of not being able to use the Wi-Fi that I had paid for. I quickly packed my stuff and Justin kindly came back after dropping the Ambulance back at the depot so that he could move me over to my new hotel.

I was shattered, and after posting a couple of videos up on the Chronicles of EMS web site, I collapsed into my new bed and went straight off to sleep, wondering what day 2 of my Ambulance shifts would bring………

So I guess this is the bit you are waiting for eh? Well get comfy, because this is the longest one so far!

Justin picked me up from the hotel to take me down to the depot for my first shift on a San Francisco Fire department Ambulance. I spent a little bit of time earlier in the morning deciding whether to go with the green jumpsuit or the polo shirt and trousers…..It just had to be the ‘jolly green giant jumpsuit’

As we travelled through the early morning city to the Ambulance depot, I really didn’t know what to expect. I was excited about seeing everything first hand and witnessing up close and personal the way that pre-hospital care is delivered in a private healthcare environment, but I also felt very weird about being an ‘observer’

As most of you know, on my station I either work alone in the rapid response car or on an ambulance with an Emergency Care Support Worker. Either way, I am always the lead clinician on scene with my patient. I decide what happens to them, what treatment I give, how they will be managed and ultimately where I will send them for definitive care (if that is so required). This was going to be the first time in a looooong time that I didn’t have any say or any influence. Maybe it’s just a control thing, but I wondered if I would find it hard to not ‘much in’ and lend a hand!

We arrived at the depot nice and early. After finding a parking spot, we walked through the ranks of ambulances and went inside to meet the supervisors who would allocate us a vehicle and tell us who we would be working with for the shift.

The Ambulance Depot

Justin had already requested a certain vehicle, one which had some relevance to previous blog posts and one which uncannily was called Medic99 (If only there was one more nine on there!)

It turns out that we would be working with Jim for the 10 hour shift. Jim was an EMT, who had absolutely no idea that he was about to be an intimate part of some filming for a ‘groundbreaking new programme, soon to be known as the Chronicles of EMS’. With all due credit to him, once we were introduced and he realised what he had unwittingly stumbled into, he just took it all in his stride and said

“Ok, no problems”

We went out to look for Medic99 in amongst all of the vehicles. When we eventually found it, Justin opened the back doors and I jumped in.

I’m trying to think of a nice way to put it, but I can’t think of a better way than saying

“It was like going back in time 10 years”.

Now, please don’t hate me. Let me justify that, then read on to see how my opinion changed over the remainder of the trip and after my return back to the UK

When I started in the Ambulance service 10 years ago, for some reason, the North East Ambulance Service were running Chevy G30 ambulances and Chevy Suburban Ambulances. The back of Medic99 was identical to the back of the vehicles that I had worked in up until about 7 years ago. It was like taking a small step back in time.

The back of Medic99

All of the cupboards were in the same place, the stretcher (manual lift!!) was similar to the one that I had used (though with a very cool trick up its sleeve) and all of the bags and equipment were pushed into the various nooks and cranny’s that I had remembered. It seemed to be an ’older’ ambulance, but I am not sure of how old as I didn’t get to figure the number plates out or ask Justin or Jim. There was a walkthrough to the cab, which we never had on our vehicles, and a couple of benches with a large and varied amount of soft items stored on.

The ’Captains’ chair was in the same spot and there was a long bench seat sitting opposite to the stretcher. I had forgotten how low the stretcher was once it was on the floor of the saloon. Everything just seemed out dated and old.

Maybe it is because we have been spoilt, or maybe it is because the European Union has dictated so much about how our Ambulances are designed and laid out, but our ambulances, even the older ones, seem to be better laid out and ‘nicer’ to work in. But most importantly……NO TAIL LIFT on Medic99!

I had a quick peek in the cab to see that it was also very similar to what I was used to. There was a large computer in the centre of the dashboard for getting emergency details and a large cardboard box in the centre of the two chairs with a bin bag inside of it for the rubbish throughout the shift. (Again, that would never happen in the UK – Health and Safety Rules over here!)

So was it really that bad?  I thought so at that moment in time……..But more on that later.

What was interesting to me were the two sets of very large headphones, with Mic, hanging from the roof of the cab. Justin explained that when they were on the way to a job, they put these on to protect their ears, and also so they could talk to each other easily and also with control. That was handy to see, especially after I got home and a memo came out telling us that we have to use our sirens constantly, day or night, whenever we have our blue lights on.

Justin and Jim checked the vehicle, and then made us available to control, and we were sent to our first ‘post’ of the day (or Standby, as I know it as)

Sitting on post

As we headed off I asked about their breaks and how often they get back to station.

“We don’t come back until the end of the shift, and we don’t get any breaks, we just eat whilst we are out and about”

M999: “What??, how does that work then. Can you not request to go back to a station once you have been on standby for more than an hour?”

Justin “Why, what for?”

M999: “A comfort break! If I have been on standby for an hour, I can radio control and they have to send me back to a station so that I can use the facilities and get out of the car/ambulance for a while. They can also only send me on six periods of standby in a 12 hour shift if I am working on the Ambulance”

Justin: “What happens if you have done your six standbys then?”

M999: “Well then they have to return me to a station after I have finished the job I am on, and they have to keep me at the station unless a job comes in”

The look of surprise on Justin’s and Jims face was a picture! And that was before I told them that we HAVE to be stood down for two 30 minute meal breaks on our own station in a 12 hour shift and within certain time bandings. Once we are stood down, we cannot be disturbed from our meal break, unless there is a Major Incident.

COMPLETELY different from that of the SFFD medic! However, I am not sure that I would mind that much if I had the amazing choice of places to eat in such a small geographical area that I found in San Francisco.

Anyway, off we went.

It wasn’t long before we had our first call of the day, to a Chest pain patient in the street. Code 3 (i.e. lights and sirens), so off we went. We didn’t have far to travel from out post, so we were there well within the required time. As we approached the scene, I got to see the Fire Engine in the distance with its lights flashing. The crew were gathered around the back of the vehicle as the patient was sitting on the back step of the appliance. One of the crew (I guess an EMT or a Paramedic) had done a very quick once over and handed over what he had gleamed to Justin. Justin quickly took over the care of the patient and moved him to the back of the Ambulance, thereby allowing the engine crew to clear and hopefully get back to their Fire House.

Once in the back of the ambulance, Justin gave the patient another quick once over then told Jim to just head off to the hospital. The full assessment was done on the move, including the cannulation and ECG. It was all very slick and very efficient, but I did ask Justin afterwards why the need to do everything on the go. I would usually have stayed on scene for a bit longer and done everything whilst stationary, rather than risk it in the back of a moving vehicle. Obviously things change for a time critical job, but at the time, I would have taken more time to get the full assessment done before deciding on what I was going to do with the patient (including if he needed to go to the A&E) It could well just be a preference in the way we work, but I was curious to find out more.

On reflection though, I think alot of it has to do with the fact that the only end disposition that Justin has is for a trip to hospital for the patient or a refusal of treatment. Once the patient shows the intent that they want to go to a hospital, then Justin is legally bound to take the patient to the hospital. In my case, where I have so many other options available to me, including ‘you are fine, you don’t need to go’, then what would be the point of doing everything en route to a hospital.

I guess if you are going to be travelling to hospital, no matter what you think, then why not just do everything on the go?

What also become very evident over the next few days is that I obviously stay on scene a little more because I am by myself in the back of the ambulance the VAST majority of time, so I like to get things done with the assistance of the member of staff driving the vehicle. In Justin’s case, he has so many different people he can utilise when on scene, especially when an engine crew is there, that the vast majority of things are already done or in the process of being done, and the focus then seems to be on a swift on scene time. Not necessarily a bad thing, just a different way of working.

When I read what Justin has to say about his time over here (which will follow on from my series about SF), I wonder if he will state that he felt as though I was too slow or ’stayed and played’ too long?

Our patient was the classical ‘regular caller’. He appeared to know his condition intimately well and gave a full cardiac history, with every magic word used. He was obviously a member of the transient population and Justin has a bank of questions that he slips in to see if his patients are from the city originally or if they have travelled there from elsewhere in the State or Country.

The interventions and the treatment options were very much the same as I have available to me in the UK; in that respect nothing was different. In the majority of the cases that I was able to observe the phrase ‘same patient, different country’ kept on cropping up.

Justin captured all of the data from the job onto his electronic patient record (a tough book computer) en route to the A&E department which was then attached to the printer at the hospital and a paper record printed off to keep with the patients’ notes.

We have been waiting for the electronic patient report form, for the last 5 years in NEAS. Some Ambulance Trusts in the country have them already, but we want them to integrate with out Pathways triage and treatment tool that is used in our control room. Hopefully we will get them sometime in the next couple of years, as what I saw, seemed to be pretty good and fairly quick to complete.

On the way to the hospital Justin radioed ahead to the ER to tell them about his patient and gave a handover which had me giggling away to myself. I realised there and then why he had got the nickname of The Happy Medic. n fact I was so impressed I wanted a record of it, so I waited until Justin was over here, and a little tipsy after a night out, then pulled out the video camera :

In The UK, we only radio ahead if we are taking in a critical patient to the A&E department, or a patient that we feel requires the services of the Trauma team. Even then, we can only radio our control room, and then they contact the hospital on the red ‘bat phone’.

I would love to be able to radio directly to the A&E, so that they can ask us any questions that they may need to know to ensure an appropriate response. That won’t happen here though, as once we radio through our control, there is a record of the message so that if anything happens after the fact, then we can access the radio (and phone call) message and see exactly what was said.

Once we got to the hospital we waited in a queue of 3 patients to handover to the hospital nurse and the Ambulance Triage station.

Outside of San Francisco General Hospital

A quick handover was given, where it became apparent that our patient was a very well known gentleman by both the other Ambulance crews waiting as well as the nurses and doctors in the department. The nurse took a full set of observations again, before pointing Justin in the direction of the treatment area that he was going to.

The nurse was very pleasant and professional. There was no query as to why he was at the hospital again, no remarks about ‘time wasting’ and ‘abuse of the system’. She was generally really quite friendly with him.

I said to Justin afterwards:

“She was lovely; I can believe how nice she was to him. He may well have got a bit of a telling off for presenting again at one of my hospitals without an actual medical reason to be there”

Justin then replied that it was more likely to do with the fact that the nurse was probably just burned out after years of abuse and has probably realised that it is less hard work to fight the system abusers than try to change their perceptions of their entitlements for health care, whether insured on not. It’s often easier to just smile!!

I said hello to various members of staff, and one of the Attendings came over to say hello, as he had read about our trip and had been looking out for me, which was really nice!

We went outside to have a chat with some of the other guys, before we jumped into the Ambulance again and headed off to another standby point somewhere in the wonderful city of San Francisco.

We sat in the Ambulance chatting and doing a little bit of filming and taking pictures, whilst we were waiting for the next job.

We didn’t have to wait long, and this time it was going to be a job that really surprised me with the impact it had on me……….

The meeting with the Chief was a great success and we were all on a high following the best possible start to the U.S part of the trip.

The plan for the rest of the day was to go for some lunch at a local bar that Justin wanted to show me, then it would be time for me to have my ‘walking tour of the city’ , then pop down to Engine 13 where I would be doing my 2 shifts on the fire engine later in the week.

As I said in the last post, Justin LOVES his history. If there is something about the city that he doesn’t know (as far as historically facts), I guess it isn’t worth knowing! I could tell he was dying to share some of his hard remembered facts with me, and to be honest, I love having little factoids to share with people too. We headed off into one of the districts of the city to get some lunch when we were rudely interrupted by an email coming through on Justin’s phone. To cut it short, it was from a member of staff from the Mayor’s office and just said…

“Ok, that’s fine, whenever you want”

WHAT!! Justin looked at Ted, Ted looked at Chris, Chris looked at me…..

“Really?? Are we going then?”

“Right guys back to the car, we are going to see ‘THE GAV”!” Justin said, smiling from ear to ear.

We were buzzing with excitement. For all my British readers, the Mayor of a major US City is a hella (like it?) more important than a UK Mayor. This would be a scoop and a half and would more than likely give the Chronicles of EMS a huge boost. Justin joked on and said

“Hey if we can get the Mayor, let’s keep going and go and meet President Obama!”

We piled into the car and headed off towards the centre of town. We decided it was best that Justin should ring ahead and speak to the person who had sent the email, so that she could let the Mayor know that we were coming and should be there soon.

As he dialed the number, we were all straining to listen to the conversation. I looked at Justin’s face as he introduced himself and told the lady that we were on our way and should be there within 15 minutes…………Then I watched the smile drop from his face, and the twinkle go from his eye….

“Oh Okay, right…..I`ll do that now then……Thanks very much……..Goodbye….”

“Well, what’s happening?”  asked Ted…

“Errr, she meant ‘OK, that’s fine, we can send details in an email requesting a meeting’

Well, if ever you wanted to know what it feels like to be a balloon deflating rather quickly, you would have seen it in all of our faces as we stood there in the middle of the street. The enthusiasm drained for a couple of minutes before we realised that we were onto something special anyway and it was still Awesome! PLUS, it wasn’t a NO and we still had time to try and get this thing sorted out.

We headed off for our lunch in a wonderful small pub which I can’t remember the name of (EDIT – The Old Ship), but it used to be right on docks before the great fire & earthquake but is now nearly 2 miles 200 metres inland due to the all the rubble and debris from the earthquake being pushed into the bay (see Justin, some facts I will remember for life now – Thanks for that !). I had a burger and some of the apparently always required Garlic Fries as I sat and watched Ted start his hunt for a plug to charge his  iPhone from. He eventually found one half ways up a wall and managed to balance his phone on a small outcrop of metal. Result, one happy Ted!!

As we were sitting eating, Justin kept popping out to make phone calls to the Mayor’s office and then spent the rest of his time penning his email reply to try and get us in. It was looking less likely, but still possible.

After we finished eating and Teds phone dropped from a height onto the floor (DOH!!!) we headed off again. This time we went down to Engine 13 so Justin could check that everything was in order before he arrived there in a couple of days with a strange guy, in a green jumpsuit with a strange accent.

Station 13

As he went in to talk with the Captain, Ted, Chris and I stayed outside and chatted.

Engine 13

I took a couple of cool touristy photographs of the beautiful fire engine that I would be riding in and also the magnificent Bank of America building Trans America Pyramid which the station was located at the base off.

The great thing now is that whenever I see a skyline picture of the City Scape of San Francisco, as soon as I see the pyramid, I can say, “Yeah, that’s where I worked!”

Justin came out and introduced us to a couple of the guys on shift, and we had a great chat about what we were doing, what it was like where I worked and what we hoped to do with the Chronicles of EMS. There is still a general negativity to the ‘TRAUMA’ TV show from the medics in the department and what we hoped to do was show the public what it was really like to be a Medic in San Francisco.

Many times Justin explained what we were doing by saying:

“We want to show the regular patients, the abuse of the system, the things that don’t work and what it’s really like to do what we do. All of the time on post, and the less glamorous side of the job”

Unanimously, this always got a great response from the Men and Women of the SFFD.

The view from Station 13

At one point, Ted seemed to be getting into a particularly heated discussion with one of the guys from the Station, but once he heard exactly what we were trying to do and how we were trying to change things for the better of everyone, he was sold and by the time we left, he was wishing us all the best and telling us that he couldn’t wait to see what the finished programme was like.

Then came the opportunity for Justin and me to show the true skill, professionalism and street wise ways that we have developed over the years…

Along the street came a gentleman who appeared a little ‘worse for wear’. He stood back and watched whilst Ted and Chris did a bit of filming, then he made his move!

He stood alongside Ted and one of the guys from the station and started asking questions about this and that, telling them what he thinks of the SFFD (which was actually quite nice and positive) and generally becoming quite vocal.

As we saw him move in, Justin and I said our hellos to him and had a quick chat, but once we recognised that it was a situation that there may be no quick way out from (i.e. one of those guys who just like to talk and it becomes difficult to find a break to be able to say ‘goodbye’, we quickly maneuvered to a point where Ted and the chap from the station were in line to provide conversation to our new found friend! Success!!!

After about 20-30 minutes he was still going strong. I knew that he and Ted were becoming close when he offered to swap his T-Shirt with Ted!! Ted then took the opportunity to ask him if he wanted to say anything for all of our viewers:

A ‘one of a kind guy’, but also one of the true reasons for the trip – To see the ‘real San Francisco’ not just the lovely tourist brochure!

We finally managed an exit strategy, and by this time, I had managed to say hello to most of the chaps on duty that day. They all seemed really friendly and welcoming and it put some nerves to rest about going to work there later in the week. I know it wouldn’t be the same guys, but if these were so welcoming, surely all of the crews must be?

We left Engine 13 and headed back to the hotel to get changed. By now it was getting to late afternoon and I was keen to let Justin get away and back home to his family. Kim, Justin’s wife, had different ideas though. She phoned late on in the afternoon and I got the chance to say a quick hello to her. She spoke with Justin and then he asked me if I would like to have dinner with Kim and his kids?

The plan was that they would drive into the city and meet up with us, and then we would go to the cheesecake factory, which is a restaurant on the top floor of Macys overlooking Union Square. Sounded like a plan to me!!!

However, it was getting late and I was concerned that it may be too much for Kim and the kids coming out fairly late, but Kim wanted to meet me, and to be honest I was really looking forward to finally meeting her and the kids. It was only the second day, but I was already missing my family, and this would be nice!

Shortly after 6.30 Kim arrived in Union Square and met up with us. The children came out and Morgan, the eldest, seemed especially excited to meet me….until she actually got close. She quickly clung on to daddy and wouldn’t come anywhere near me (which is understandable and quite good considering I was a stranger at that point). I gave them a small present I had brought over, two teddy bears with the Union Jacks on, which seemed to go down well. Kim came over and said hello and we gave each other a hug. It was nice to be part of a family unit again, even if it was ‘borrowed’ for a while.

We went up for dinner and ordered our food. My highlight of the meal was the moment when Kim was struggling with Morgan and Eliza (both were obviously very tired and starting to get a little ratty) whilst trying to have her food, whilst Justin was on his iPhone. The look she gave him made me feel so at home, as it was the one that Sandra throws me when she finds herself in similar circumstances!!

It was at that moment that I knew that if Sandra and Kim do get to meet in the future, they will get on just fine!!

Once the meal was over, we said our goodbyes and went our separate ways. Justin took me back to my hotel where yet again, the Wi-Fi was not working and I ended up blogging, uploading photos and videos in the back office of the reception. Not good, and my complaints were starting to mount. I would try and move hotels the following day, as this just wasn’t good enough. I had now been up for approximately 40 hours with just 3 hours sleep in the middle of it.

I was at work on the Ambulance in the morning and I was absolutely knackered. Time to go to bed.

It was another big day tomorrow!!

It’s been more than a week now since I said goodbye to Justin at his hotel. Things have been getting back to normal over here and the routine of work and home life has quickly jumped back into place.

The whole experience still seems a little unreal to me at the moment. Many people have come up to me at work and have asked what it was like over there and how Justin found it over here, but the truth is, I find it really hard to explain. How can I portray what 21 days of sharing practices, our lives and our homes was like in a quick conversation?

It just can’t be done…..which brings me to my next challenge.

How can I share everything that I have learned and the experiences that I had with all of you?

I was going to go down the route of picking specific jobs and discussing them, or sharing the meeting I had with Chief Hayes-White, Chief Howe and Chief Wong, but then that would miss so much more of what it was really like. I know that Justins posts over at ‘The Happy Medic’ will be much more structured into sections that he wishes to discuss, but that isn’t the way I write, as you will know if you have been reading my blog for a while.

I mean, what about how I felt when I walked back to the hotel from work after being told by Justin and his workmates that I should just hunch my shoulders, keep my head down and pretend I knew where I was going!! (Hey, I didn’t know what the good or bad bits were of the city when I booked my hotel!!)

So, I have decided to go down the day by day route and share my thoughts on things as they happened. I hope this is the sort of thing that want to hear, if not, just post a comment and tell me how you would rather I share my story. I will cover all of the comparison bits when they crop up as I go through my week, so you will get the juicy bits in chronological order!

As much as anything, I want to write a comprehensive record of the trip for me to look back on over the years. So, don’t worry, you will get ALL of my thoughts eventually, but hopefully this will satisfy all needs, including those of you who want the ‘whole’ story and those who just want the clinical and organizational comparisons.

Between Justin’s Blog and my own, you should be sorted!

Well, here goes:

DAY 1

On the 8^th November, I finally left on a once in a lifetime trip to go to work as part of the San Francisco Fire Department for 8 days. It had been planned over the last 9 months and now here I was about to get on the plane and actually get to experience all that San Francisco and the SFFD had to offer. I was both incredibly excited but also very nervous.

What if Justin and I didn’t get along?

Sure, we had emailed many times and spoken on Skype more than a few times, but that was all the ‘courting’ phase. After we had lived in each other’s pockets for a few days, what if he decided I was a bit of a jerk, or I thought he was the same?

I could just cross my fingers and hope for the friendship that had started by a fluke decision to pick ‘The Happy Medic’ out of all the blogs I read to send the email to asking if he would consider doing a trip together, to continue on in person.

Coming in to land

After a 14 hour trip I arrived in San Francisco International airport, not really knowing what to expect from Justin. I had seen one photograph of him, but I wasn’t sure if I would recognise him. I also had the pressure of knowing that we would be filmed throughout the San Francisco portion of the exchange for an EMS documentary called ‘The Chronicles of EMS’, and the camera crew was going to be waiting for me at the airport. Sandra, my beautiful, had insisted that I take a nice shirt in my hand luggage, so that I could get changed whilst my cases were coming through, so that I didn’t look a scruff for my arrival on camera. So of I dutifully went to get changed in the toilets. I took my shirt out and it amazingly wasn’t creased to hell! It was one of my better ones, one that I hadn’t worn for some time, but I knew it would look smart.

Off with the T-Shirt and on with the crisp clean shirt……..Bollocks!!!

TO SMALL!! When did I put all of that weight on??

Oh, well back to the T-Shirt and out into the arrivals.

As I walked through the international arrivals door, I immediately noticed Justin, given away by the San Francisco Fire Department (SFFD) Helmet that he was holding up in the air that has now become so well known within the Chronicles of EMS crowd:

This quickly became and will always be my most treasured physical item brought back from the trip. How many UK paramedics have a ‘genuine’ SFFD helmet’ and individual front plate?  I couldn’t keep that exact one as Justin needed it back as it was his own personal issue helmet, however, on my final day in San Francisco, the wonderful Dorothy at the SFFD Training centre managed to find me an old ‘antique’ SF Fire Marshalls helmet which now has pride of place in my living room. How cool is that!

My best present!

I didn’t even get a chance to say hello to Ted as he was already filming and starting to “Change the World!!’ with his wonderful vision of moving our Project into the Chronicles of EMS.

After Justin and I had walked off into the distance, we risked a glance around to check that Ted had finished, then we turned round and got to say hello properly. It sound cliché but it really was like three old friends meeting up after a short time apart, not three strangers meeting properly for the first time. The excitement was palpable and we knew that we were about to embark on something special.

Once I walked around to the wrong side of Justin’s car (Doh!), I finally got in the right side and off we went into the City. It was less than 5 minutes before Justin and I started quizzing each other ab0ut the differences in our systems. As we headed towards the downtown area, I was firing questions at him left right and centre…

“Does your service reach the airport?”

“Which ambulance service covers this area?”

“How many hospitals do you serve?”

“What happens if you want to see a GP (primary care physician)?”

This last one was the one that sparked a good little conversation. Justin informed me that if they wanted to see their doctor for a routine appointment, they would have to wait approximately 3-4 weeks. Their home doctor was not even in the area that they live in and was not very accessible. I then told him about how it works for me…

“If I call my GP, whose surgery is about 1 mile from my home, before 8.30 in the morning, I will be seen that day and usually before 12pm. I have never not been able to get an appointment on the same day”

I think this took Justin by surprise, and the conversation that followed was quickly stopped in its tracks by Ted, who was sitting in the back seat.

“Hey Guys, let’s leave that sort of things for when the cameras are on!”

That was us told!!

The rest of the 20 minute trip to my hotel consisted of me smiling and looking out of the windows, saying over and over again…

“I can’t believe that I am actually here and we are actually doing this!”

We got to the hotel and it was a quick unpack whilst Ted and Justin twittered and updated face book and tried to gain a decent Wi-Fi signal (there’s a WHOLE other story!) A quick change and it was off into the city for a drink and to plan the week.

I can remember listening to Ted and just thinking ‘what a great guy, but a bit over the top!’

Now, hopefully Ted won’t take offence at that, but the amount of times on the first night that he said:

“Hey man, we are going to change the world”, or ‘This is going to be huge”, or he told us of some other plans he has for the filming , I just kept thinking that it would be great if this happened, but how likely is that?

Little did I know the power of Ted and the soon to be growing Chronicles of EMS Team!!

We got to Gordon Birsch Brewery just after dark. If you don’t know it or didn’t see it on the live Tweet up, it’s situated just below the Bay Bridge and just opposite the home of the SFFD Fire Boat. It was a beautiful evening, the bridge was lit up, I was with two of my new friends and life was really great. Now came my big test though…

“What do you want to drink Mark?”

Why is it that I can’t just order a pint of lager in San Francisco? Do you want a pale, or a red, or this, or that????

I don’t know, I just want a lager!!

The choice was made for me, we sat down to the first of quite a few beautiful burgers and even nicer Garlic fries!!

The conversation continued on with the plans for the week.

I was going to meet the other camera man, Chris, the following day when we get to the Headquarters building of the SFFD for our meeting with the Chief of Department and Chief of EMS and it quickly became apparent that virtually the whole time I was going to be there was to be planned out and organised like a slick military machine. Ted had his priorities of what he wanted to catch on film and Justin had his plans for what he wanted me to see and experience. I on the other hand, was just happy to go along for the ride and soak it all in.

This was going to be a once in a lifetime journey for me, and I didn’t want to miss a thing.

After a couple of hours in the bar and a couple of pints (I was really starting to feel the jet lag then), Justin and I said our goodbyes to Ted and headed back to Justin’s car so that he could give me a lift back to the hotel so that I could get some rest before ‘The Project’ started in earnest the next day.

However, my mind had other ideas for the night!

If you have read my blog for a while you will know that I have had problems with OCD some time back, well it decided to rear its ugly little head again for one night only!!

I suddenly felt very isolated from my family. Why was I all the way across the Atlantic? I didn’t have to be here, this was all my own doing? What if something happened to my family when I was over here and I couldn’t get back in time? What if something happened to me and I didn’t get to see them again? I am a simple paramedic from the UK, what the Hell am I doing in America??

I spoke to Sandra on the phone for a few minutes (very expensive!!) and she tried to put everything into perspective for me, which helped, but in the end I didn’t get to sleep until about 4am.

Maybe the jet lag had something to do with it, but it wasn’t the start to trip that I had hoped for!

BUT…I quickly got myself sorted out. How many people around the world would love to have an experience like this one? I am doing myself, my family and my readers and followers no good, by being stressed about things. I decided there and then that I was going to embrace this trip with everything that I have. I was going to be a SFFD Paramedic for a week and I wasn’t going to let anything get in my way, most of all my own hang ups!!

This was going to be a truly AWESOME trip!

Coming in the next post –

Day 2 – The Meeting with The Chiefs and my thoughts and impressions of the hierarchy of the SFFD

My First trip to an Engine Company and meeting some of the Fire Fighters

A meeting with the Major??

Justins walking tour of the City.

Thoughts and preparations for my first Ambulance shift.