A very short post, just to note a very interesting legal claim, in the civil courts —

Alexander Lewis Ranwell was found not guilty of murder by reason of insanity after three killings in 2019.  Prior to the killings, he had spent time under arrest in police custody for a serious offences and was bailed without charge only travel to Exeter where the tragic killings took place and he was arrested again.  There was discussion at the time of his criminal trial about how the agencies involved had assessed and responded to his mental state whilst in police custody, including reference in a press release by the police after the verdict was returned to issues around the defendant’s mental health.

It now emerges he has brought a civil claim for negligence against Devon and Cornwall Police, Devon Partnership Trust, Devon County Council and G4S (who provided medical services in police custody at the time of his arrests).  A recent legal hearing saw all parties other than Devon and Cornwall Police attempt to have the civil claim...

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There is a ongoing trial in Cambridgeshire at the moment, which is all kinds of tragic:  an elderly lady prosecuted for causing death by careless driving, following a fatal road collision involving five-month old Louis Therold and his mother, Rachael.  I cannot imagine what Mrs Therold and her family must be going through after the loss of an infant in such circumstances.  The legal issue now at stake in this case, shortly to be considered by jury, is whether or not 75yr old Shelagh Robertson was legally insane at the time of the incident.  She has pleaded not guilty by reason of insanity and the jury will shortly consider whether or not that defence succeeds.

The medical case behind that defence is that Mrs Robertson was suffering from undiagnosed dementia at the time of the collision and whether the degree of that condition was sufficient to mean that she “did not know what she was doing or did not know what she was doing was wrong” because of her illness.  Since the incident, she has had medical assessment which confirms...

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Four years ago, when we won the prize of the Commonwealth Games, could anyone have believed what this would actually mean for Birmingham and the West Midlands?

The last few weeks have seen an explosion of colour and culture in the opening ceremony. A mechanical bull that has captured our hearts. Days of sport in spectacular venues, with athletes from across the world and over a million spectators and visitors to this region. Whilst the process of packing up at the conclusion of these events is underway, I think it is worth recognising what remains in our city and for us all to take a moment of reflection to look back on what has been achieved.

Birmingham and the region have changed forever. A city has been reborn in the eyes of the people of Britain and the world, but most importantly those who live and work here. The civic pride that we have all felt that this has happened in our place, will endure. The way visitors have talked about this friendly place; the beautiful squares and the spectacular shops, restaurants and the youth...

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When I was a precepting medic, I had a young boy as a patient.  I heard a rumbling sound and my preceptor said “Look out!”

 Not a second later, the boy vomited all over me.

“You’ll learn to recognize the signs,” my preceptor said, handing me a towel.

The mark of an experienced medic is their ability to avoid vomit, blood and other bodily fluids.

I recently wrote about a bloody call and the coda to the story was that neither my partner not I had a speck of blood on our uniforms, despite the scene and the back of the ambulance looking Mansonesque.  “I’m no rookie” my partner said when another EMT commented on his immaculate appearance.

I ended up cutting that section to keep the focus on the benefits of whole blood administration.  And I didn’t want to appear boastful about the clean uniform.

This week, I had a patient with wheezing without an asthma history, headache, and fever.  For what it was worth she had no COVID contacts that she knew about and she was vaccinated. ...

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The patient had lost nearly two liters of blood and was barely responsive.  I arrived shortly after the primary medic who told me to get the blood set up while he extricated the patient with his partner.  As the rapid response medic, I carry the whole blood (0 negative) in a special cooler.  I check the temperature at the start of the shift, both by inspecting a temperature sticker on the blood and through an app that uses a temperature stick to monitor the internal temperature of the cooler.  I took the 500 cc bag of blood out of the cooler and hung it from a clip on the ambulance wall.  I got out the battery, heating cable and special thermal IV drip set.  The cable plugs into the battery, then the other end of it plugs into the drip set.  I spike the bag just like a bag of saline.  It is strange watching blood flow through the line.  I am used to flushing a line by letting the saline drip into a trash can or on the ambulance floor.  But this blood.  I drip it into a trash can.  Once activated the...

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The patient is lying under the slide at the playground jungle gym.  It is a blistering hot day and this may have been the only shade she could find.  She is unresponsive, cyanotic and breathing agonally.  Her pupils are small.  From the hard lines on her face and poor dentition, I surmise a life outdoors is not new to her.  She takes an oral airway no problem.  As we ventilate her, I try to gather some information from bystanders.  No one knows her.  The kids say she has been under the slide all day.  They thought she was sleeping.  She’d been there at least four hours.

I don’t see any good veins in her arms so I give her 1.2 mg of Narcan IM and take her vitals.  Her pressure is 145/90.  Heart rate is 128.    SAT is only 91%.  Her ETCO2 is 70, but is starting to come down with bagging.  I also check her sugar – 358.

By this time we have her in the ambulance.  A look through her pocketbook finds a recent visit for a broken hand.  No history of diabetes.

Her breathing has...

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I received a book in the mail about a month ago.  I slipped it into my briefcase to read while in between calls in the rapid response vehicle in Hartford.  It sat there in its unopened package for weeks as I was too busy between calls and writing PCRs to take it out.  Yesterday, Saturday, my recovery day, I was cleaning out my briefcase when I rediscovered it.  I brought it down to the bedroom with me to read some before my Saturday afternoon nap where I try to catch up on a week’s worth of toil.  It was not a long book and I read it straight through, unable to put it down despite the incredible sadness it made me feel.

Cody’s Story: A Son’s Death, A Father’s Battle Against Opioids by Richard K. Mogensen tells the story of a man’s son, growing up in a loving family, becoming addicted to opioids, and never being able to shake the addiction until it killed him at the age of 32 after years of struggle. Cody’s introduction to opioids began after a doctor prescribed him oxycodone for his pain...

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