I was just looking at the journal entry that I started in the UK. It discusses the first half or so of the trip, so here I’ll discuss the second half.

I had been planning to go stay in London over the weekend. Mr. Ermine (a coworker) had rented a Cessna 182 for Friday afternoon and Sunday, so I finally decided to change my reservation and stay in Reading for the entire time.

I took a day trip into London with two coworkers who were visiting from India. My team is globally distributed; UK, India, California, and Vermont.

I had a great time in London. The two indians were a hoot; they had a very different perspective on many things. As an example, the Red Menace (my employer) had loaned them a VW Passat from the motor pool; I would have considered the car to be nothing special but these guys were really taken with it. We did have things in common other than our employer; early on, one of them reminded me of the scene from ‘The Matrix’ where Neo goes into non-space to outfit himself with ‘guns, lots of guns’. Bala had changed this quote to one he found more appropriate; ‘Beer, lots of beer’. We took the train into London and spent the day as tourists, misquoting ‘The Matrix’ as we went and stopping in pubs every hour or so to top off. Bipin, the other coworker, had to stop us every hundred yards or so to take three or four group photos, so it was a fairly slow process. We went on a boat ride on the Thames and went for a ‘flight’ in the London Eye at dusk.

Sunday, Mr. Ermine, Bipin, and I went for a flight in the Cessna 182. This was the flight previously noted with the glider near miss.

Sunday night, I went out to the pubs. England was playing France in the world cup. It was a big deal, and many cars and businesses had been flying the cross of St. George in anticipation, much as sports fans over here advertise their team loyalties. I got to the pub latish, just as the game was ending. It was very close, with France scoring the winning two goals in the last minute and a half of the game. The previously high-spirited crowd became very quiet, so much so that it took me a while to realize the game was over and lost. I left the pub to walk back to my hotel through the city centre and witnessed rioting and hooliganism, with windows being broken and signs and equipment being ripped out of the pavement. I made my way safely back to the hotel. The cops were out in force and looked uniformly terrified. I guess I would have been pretty scared too, tasked with control of the unruly crowds and with no effective means of force for self-defense.

On Monday, I took a half day off of work and went to the Reading Ambulance Resource Centre. I was met by the centre menager who took me straight off (after a cup of tea, of course) to the 999 call centre, across town. The 999 call centre is the equivalent of the 911 centers here in the states. I sat between two dispatchers for about forty minutes and watched them take and dispatch calls. It was amazingly interesting, and I got to see a lot of things that the public doesn’t even think of.

After some time (and another spot of tea), the resource centre manager collected me to return to the ambulance resource centre. On the way there, we received a call for a car versus motorcycle. The centre manager is a practicing paramedic and we were the closest unit to the call, so off we went. The ride to the accident scene was the second most tense moment of the trip; we drove at breakneck speeds through the thin medieval windy urban roads on the wrong side (as far as I was concerned). But we made it.

It was a hit and run, but the cyclist was okay. In the states, we would have boarded and collared him, but in the UK, they have much more liberal standards towards spinal precautions. I later asked about this, and I was told that the chances of being sued are much less, so they can be more selective about who they board.  Here, of course, we board everyone with a mechanism regardless of symptoms in most cases.

We returned to the centre, and the manager set me up with a paramedic team for the five pm to one am shift. We saw a few interesting things over the course of the evening; a juvenile with a febrile seizure, a juvenile with a possible head injury from a bike accident, a routine transport to the hospital on doctor’s orders, another car versus motorcycle. We did board and collar the second cyclist, leading to perhaps the highlight of the evening; I assisted the nursing staff at the hospital in deboarding the patient. This was very cool in that I got to ‘practice medicine’ in an NHS facility; now I’m the only US EMT I know who has provided care in a nationalizedhealth care system (okay, I know a guy who was a paramedic in Toronto. I mean in the hospital).

Along the way I got to talk to the paramedics a lot about differences in care. I felt that they provided quite competent care, but I like it better here. One practice I absolutely disagreed with was the linens policy; they changed the cot linens once, at the end of the shift, where here we change them on every call. By the end of the evening, the cot linens had seen five sweaty bodies; I wouldn’t have wanted to be on them.

One clear advantage of the UK EMS protocols is in the area of pain control. In the states, a paramedic can start certain meds for pain control in limited cases. As a basic, if I feel my patient needs pain control, I can request a paramedic intercept. I might or might not get a paramedic depending on time of day and other factors.  In the UK, each ambulance carries nitrous oxide set up just like oxygen, and the basic practitioner can administer it if pain control is dictated.

I resisted the urge to ask if they had an N2O port in the front of the rig for the driver. Every single American EMT I have discussed this with, though, has immediately asked if they had a line up front.

Here’s what UK and American EMT’s have in common; most of them smoke cigarettes. Here’s what they don’t; tea, versus coffee.

Another interesting difference is in transport standards. On the UK, a rig can only transport one patient. In the states, a rig will carry two in a pinch. In the UK, everyone wears a seatbelt. In the US, the working technicians in the back do not (I think I’ve mentioned before in this forum the excitement when a rig with unbelted techs in the back stops suddenly for deer in the road).

The evening passed pretty quickly, and without a serious call. I did see a pair of drunken idiots delivered to the emergency department by a different ambulance, providing a bit of humor to the evening.

The following day was spent totally at work, and Wednesday I worked a half day then was driven to the airport by a coworker. The coworker is a peer of my boss and is what would be called a technical evangelist. He’s a very interesting person, and we had a very interesting conversation on the way regarding the current state of morale and progress in the UK office.

Here comes a big thunderstorm; I’d best shut down my gear before it gets zapped.

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