Exercise time...

One of the things that we do on a regularish basis is to take part in training exercises designed to either test people, train people in new skills or to assess the competency of a team of people working together.

I used to be an associate member of a mountain rescue team and as such became used as a body during a part of an exercise. It was during one of these exercises that I was promised a winching into the coast guard helicopter taking part in the exercise once it was completed. over 100 members of Mountain Rescue were gathered at the briefing point for the exercise while myself, two other "victims" and our escort left early to get into position.

Arriving at the foot of the hill we decided to cross the river at the base of the hill before walking up on the slightly steeper path on the opposite side from the trail as it was easier to cross the river there than at the top. On reaching the top of the hill we scouted around for a suitable site to bed ourselves for a while and found two nice hollows to put our three casualties.

We sat down and proceeded to have a chat for about half an hour and admired the scenery at the same time while waiting for the sound of the helicopter to herald the approach of the search teams. It had been decided that for this exercise that the search teams were going to be positioned by the helicopter which is why we waited for the helicopter to come. We eventually heard the hum of the approaching helicopter and watched as it flew below us in the valley until it started rising to fly directly over us.

Luckily for us the helicopter crew did not give away our location as it would have been easy for them to find us with their infa-red camera. Unfortunately for me the position I had selected was not ideal although it had been selected for the right reasons. I had picked a hollow to lie down in so that it would take the teams time to find me but little did I realise that the hollow was also a channel for a breeze leading down into the valley.

I was stuck in this position for nearly 90 minutes before I heard a team walking up the path on the far side of the river. We could hear them talking as they debated the best way to cross the river that was blocking their way across. The inevitable happened and we heard a loud splash as some of the search team fell into the river. We were able to hear them laughing at their missfortune so we knew there was no need for us to reveal our location and go to their assistance.

They quickly extricated themselves from the cold water and dragged themselves back onto dry land and continued the search for us. Without realising it they almost walked right on top of me such was my hidden position. Luckily they saw me just in time to avoid giving me some genuine injuries to cope with.

They quickly got into action to assess our simulated injuries and recognised that I had a serious injury (fractured femur but should actually have been a fractured pelvis!). After a while of assessments by them of my "health" I advised them of the real simulated injury at which stage they changed tack and realised that my condition was more serious than initially expected.

Unfortunately for them my injuries were severe enough that I was loosing vast quantities of blood into my pelvic area (simulated of course!) and eventually I went into cardiac arrest and "died". Unfortunately this ment that I did not get my helicopter ride out and had to walk back down to the start point!

We tried to put it back in...

Many years ago on a Scout Jamboree I was just preparing to head off to breakfast with a few of my fellow medics before starting my shifts for the day. As we were walking away from the medical center I noticed a scout walking towards us with one of his arms being held up by his good arm and his leader supporting him. The look of pain on his face made me realise that he was not having a good time.

On seeing this I grabbed a chair and walked towards the scout and had him sit down where I met him. The leader advised us that the scout had a history of dislocated shoulders and that he had suffered another one on waking up.

Unfortunately for the scout we are not trained to reduce dislocations outside of the hospital so we gave him some pain relief and organised for him to be transferred to the hospital with one of his leaders. The leader and scout later came back to us to tell us that they got on fine in the hospital and that his shoulder was back in place. We wished them well and sent them off to get their dinner and to enjoy the rest of the camp.

The next morning I was again just about to head off to get breakfast when I saw the scout coming towards me with his leader, I recognised the same look on his face and knew straight away that he had dislocated his shoulder again. Once again we gave him some pain relief and sent him off to hospital with one of his leaders. This time a second leader had come with him and remained behind with us. I pulled them aside and asked them for more information about what had happened.

He started by telling me the exact same things as we had been told the day before before saying "Oh and we did try to put it back in". It turned out they had been told by the parents to try to put the dislocated shoulder back in if it happened but the parents never told them how to put it back in. The end result was they tried to get him to put it back in Mel Gibson style (see video below)! Needless to say this is not a recommended method and for his sins the poor scout ended up with a broken arm as well going from his shoulder to his elbow!

This weekend..

Hi guys

No updates for this weekend as I am working and Im not sure if I will be able to get online at any stage as I dont know if the hotel I am staying in has an internet connection. Normal service will resume on Monday.

Shane

Doctors...

Over the years I have worked with many individuals and have seen some excellent people but at the same time I have come across individuals who are dangerous.

I was on duty with a crew of two others covering a rugby match on a fine sunny day. During the match one of the players was observed by us to have taken a bad kick to the head who then walked over to us at the ambulance stumbling a fair bit.

We quickly examined him and it was very obvious that he had a head injury and we were preparing to place him onto a spinal board with a standing take down when the club doctor waddled out and ordered us to stop what we were doing. He then proceeded to do his own "examination" of the patient which amounted to feeling his neck for any spinal tenderness etc. After this 10 second check he says to the player, "your fine, on you go and play". All three of us looked at each other in surprise and the player looks at me and asks me what I thought. I simply said to the player "Its up to you what happens, we cannot force you to go to hospital however we strongly recommend you do go based on what we saw". At this stage the doctor interrupted me and told the player not to mind us and to go back on and play.

The player reluctantly walked back towards the lines man and from there onto the pitch. To our horror he started vomiting onto the pitch however the doctor refused to allow us to take the player off the pitch and take him to hospital for the assessment he genuinely needed.

Eventually after another 25 minutes of playing the match finally ended. All through the 25 minutes we could see that the player was struggling and quite slow to follow the ball around the pitch. As soon as the final whistle went we went straight over to them and asked them how they felt. He confirmed that he felt 10 times worse than he had felt when he was with us earlier and agreed to go to hospital with us there and then.

As quickly and safely as we could we brought him over to the ambulance and placed him onto a spinal board and onto the stretcher. As I closed the ambulance door I saw the doctor waddling as fast as he could towards us, seeing this I slammed the door shut and shouted through to the driver to drive. He quickly realised why I wanted us moving and drive off leaving the doctor behind us in the gathering dust.

We repeated the patients vital signs on the ambulance while taking him to the hospital to find that he had a very high blood pressure and a very slow pulse indicating a potentially serious head injury based on what we had seen happen to him. We were very surprised that he had managed to last until the end of the match.

On arrival at the hospital he was quickly rushed into the resusitation room and very quickly they organised various tests for him praising us for recognising the potential seriousness of the situation and under their breaths muttering about useless GPs who forced players to play on.

The good news is the player suffered no long lasting effects from the delay in getting treatment but things could have been a lot worse....

EDSFAT Videos

No actual blog entry tonight but some videos for you to look at: (nb you may need a facebook account to view these)

Video 1

And

Video 2

And finally:

Video 3

A little scratch

It all started with a little scratch...

An emergency call to an unconscious patient at a train station had us rushing through the streets. On arrival there was a First Responder on scene gave us a brief run down indicating that the patient had complained of a scratch to the lower leg some two hours previously. By now the scratch was an angry looking yellow rash that may or may not explain the patients current unconsciousness.

We quickly transferred the patient to an Ambulance and completed a more detailed assessment including a 12 lead ECG. We did not find anything remarkable on the ECG but did notice that his blood pressure was on the low side and his heart rate and breathing rate were on the fast side indicating that the patient was suffering from shock.

With no obvious explanation for the scratch which his friends said had not been yellow until an hour previously we took the decision to rush him into hospital in order to get an explanation for the causes of his unconsciousnes.

Along the way the patient had brief moments of lucidity when they woke up and tried lashing out at the crew. Unfortunately we are not allowed to restrain a patient so we have to make do with deflecting their half hearted attempts to hit us which for the most part they do not realise they are doing in the first place.

Luckily for us we were only a few minutes drive from the hospital and we were able to get him transferred to a resuscitation trolley where they quickly got to work assessing the patient and finding out what was wrong with him.

Sadly for us we never got a chance to find out what was causing his unconsciousness but we suspect it was as a result of the scratch that he obtained some hours earlier.

It just goes to show the need to ensure that you keep covered up in areas that your not normally in to prevent any bites or scratchs causing problems at a later stage.

Scout First Aid Teams the return

Many of you will remember my earlier mention of Scout First Aid teams in this blog ( here ) a few weeks back.

I received this email in my inbox and I just thought I would share with you what one of the teams has been getting up to lately...

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As you may have noticed there has been heavy snow fall and icy conditions which has lead South East Coast Ambulance Service to declare a “business continuity incident” which is basically a major incident which lasts a long time.

EDSFAT have been providing support by using the land rover ambulance for several shifts which unfortunately developed a mechanical fault which is being fixed by secamb and will be back on the road tomorrow, extra thanks to Mick and Brian for their hard work sourcing and delivering the parts.

The ambulance service have expressed their thanks and have said there will be “a proper thank you at the end of the incident” I have some details and I will keep you updated as to this.

As well as this our members have been helping the service cope with day to day running, a huge thanks to Barry for driving ambulance staff to work who were stranded at home and for getting staff home so they could be properly rested for the next day which I’m sure will be just as challenging! Barry has also been delivering vital meals on wheels to elderly residents, some of these this is their only contact with the outside world and their only food source.

Thanks to Steve for coming to our aid when the Ambulance broke down and for taking us into work tomorrow so we can continue to support the public.

Thank you to Roger who came to work for a whole 12 hours with me just in case we needed an extra EDSFAT driver. As it was we managed on a normal ambulance but the assistance with patient handling in some fairly dicey conditions was really appreciated by myself and Tony.

We have all promised to help other people as scouts and EDSFAT have really stepped up to the mark this week.

I would like to say how proud I am to be a member of this team. Not only have we become a slick, professional first aid and medical event cover team we can also step up and help the public when they need us. Thanks for everyone’s hard work, the ambulance service are still asking for support and myself and Ed will liaise between the service, the team and the district as and when they need extra support.

Well done EDSFAT pat on the back and I look forward to a true celebration when we can finally hold our social event!

Matt Jones

The tale of three patients

Somewhere in the welsh countryside we were covering an event with one of our Rapid Response Vehicles when we were alerted to an incident that was at the other end of the course from where we were situated.

As a result of the information we were given we turned on the lights and sierns and rapidly made our way to the scene of the accident. We arrived at the road and location we had been told the incident was at only to be told by the people we saw there that there was a second more serious incident further on. We jumped back into the RRV and continued on down the road for a few hundred more yards before we were flagged down to the more serious incident.

Hopping out of the RRV we were told that the casualty was unconscious but breathing, immediately my partner took over attending to the patient while I attempted to contact our control. After several fruitless attempts I advised my partner that I was going down the road to get control on the radio. Within seconds of me leaving the scene I was met on the road by an NHS RRV and pointed them to the incident that we needed them at.

I turned around and returned to the scene with the RRV Paramedic and my attendant gave him a hand over while we waited for an Ambulance to come to take the patient to hospital. Luckily this did not take too long and two arrived after a short period of time, it turned out that the RRV paramedic had already been dealing with another incident further up the road and had been advised of the incident we were at and called the first ambulance for that one and a second ambulance for our incident.

With the arrival of our Ambulance we worked jointly to get the patient quickly packaged up on a spinal board and onto the ambulance. Once this was done we rapidly repacked our RRV and returned to our standby point for the event.

This was our first time working closely with an NHS crew and there was no difficulty working together with everyone treating each other with respect and giving good handovers.

Ambulance Chaser

A couple of months back I was driving home from an event at around midnight when I was passed out by a Garda car on lights. I thought nothing more of it until I came across the RTA that they had been responding to. As there was no HSE Ambulance on scene yet I pulled over and asked the Guards if they wanted assistance. The Guards confirmed that they were still waiting for a HSE ambulance to be dispatched to them so were grateful for my assistance.

I approached the lady who was driving the car and was by now in the passenger seat and introduced myself to her. The first thing that I was aware of was a strong smell of alcohol in the vehicle and she admitted to having consumed a few drinks. She had no obvious injuries and confirmed several times that she was fine. Despite this I still advised her to get checked out in A&E and she then said that she did not want to go to hospital.

I have a policy of repeating this question several times before getting them to sign the paperwork and followd this policy. After the third refusal I advised the Guards to cancel the ambulance request and then proceeded to read the refusal part of the paperwork out to the lady. On the mention of the word refusal she turned around and said that she wasnt refusing to go to Hospital. I asked her again did she want to go to hospital and she replied no I dont. I then pointed out to her that by saying no she didnt want to go to hospital she was essentially refusing to go to hospital. I then asked her that If I had an ambulance here to take her to hospital would she get in the Ambulance and go to the hospital for a checkup, she replied no.

At this stage the Guards were getting annoyed and I turned around and asked them would they sign the form witnissing that she had refuse to go to hospital five times despite my advise to get checked out. They agreed to sign the form and I stepped back to allow them to carry out the procedures that they needed to complete.

While I was giving my details to one of the other guards for them to fill in their paperwork she was assisted out of the car and started to be guided towards the nearest garda car. She then saw me again this time and walked in my direction and started to demand to know my "role in all this". I advised her that I was there to ensure her safety and health and to advise her to go to hospital. She then demanded why I needed to know her information (ie name, address etc) and I advised her that I required the information for the Patient Report forms which detailed the examination and treatment that I gave her.

What happened next surprised us all and she started screaming at me that I was an Ambulance Chaser much to the amusement of the guards considering I had been driving an ambulance there which was behind us with lights flashing. At this stage she was politely but firmly escorted to the Garda Car and taken to the nearest Garda Station to be brethalysed and so on.

Ambulance chaser indeed...

I have a dream...

I have had a dream of becoming a Paramedic, or Emergency Medical Technician* as it was then known, for the last 10 years. At that time I got a lot of support from several quarters. However over time it eventually emerged that several of these people were privately saying that I had no chance of ever becoming an Emergency Medical Technician*. I resolved not to let some negative vibes hold me back and went to try to succeed in reaching my dream of becoming an Emergency Medical Technician*.

It should be noted that I have the greatest of respect for peoples opinions and would not get annoyed or angry at someone for saying to me that I cannot do something because of whatever reason. What does annoy me and make me angry is that people choose to tell blatant lies to my face instead of being upfront and honest with me. Lieing to me just makes me more determined to achieve my goals which is not what these individuals intended to happen in the first place.

The biggest obstacle I faced was taking part in an interview board for obtaining a place on the Emergency Medical Technician* training course. At one of interviews I took part in it became clear to me that there was a fear of me doing the course. This was made blatantly obvious in the form of the questions asked which indicated quite clearly to me that I would never pass an interview.

Questions such as "What is the economic cost of an Ambulance call?" were thrown at me which it later emerged had not been asked of any other participant on the interview panel. Needless to say I received a letter in the post confirming that I did not pass the interview.

Following this I resolved that I would some day become an Emergency Medical Technician*. This vow was made 10 years ago and since then I have attended many training courses in Ireland and the States with a view to qualifying as an Emergency Medical Technician*.

In 2005 I completed a 3 week Emergency Medical Technician - Basic course in the Fire Services Institute (https://www.fsi.uiuc.edu/) completing the course with a 100% pass rate and the State Registration exams with a pass rate of 98%.

However despite having completed this course I was still longing and aiming towards higher training I still wished to complete an Irish Emergency Medical Technician course that was by now known as a Paramedic course. Unfortunately by then the system had changed and private students were no longer allowed to take part in Paramedic Courses in Ireland and could only be trained through obtaining employment through the Health Services Executive or Dublin Fire Brigade.

For many reasons these were never an option for me and training privately was the only option. Where the training was done did not matter provided it met or preferably exceeded the requirements for obtaining recognition in Ireland as a Paramedic.

It did not happen until the tail end of 2009 when I became aware of an IHCD (Institute for Health Care Development) Ambulance Technician course that was being proposed to be run in the UK by a private ambulance company there. After much discussion and contact with the director of the course it was confirmed that the course would exceed the requirements for recognition in Ireland.

In addition to organising additional placements after the course was completed I discussed with a doctor friend my attendance in his hospital on placements in various departments to obtain more experience and knowledge. Thankfully he agreed that it would be possible to organise these and agreed to discuss the finer details at a later date.

At this stage you are probably asking yourself why I am running into so many obstacles in attempting to become a Emergency Medical Technician / Paramedic. What many of you who know me are aware of I am profoundly deaf and wear two hearing aids. What many people forget is that just because I am wearing hearing aids does not mean I am not able to do the same things that a normal hearing person can do. I will be the first to admit that there are things I cannot do and will never assume that I can do everything the same. However i feel that this does not give a small minority of people the right to shatter your dreams. In this case all they have succeeded in doing is making me even more determined than ever to become an Emergency Medical Technician / Paramedic.

It has taken me 10 years, and by the time I actually qualify will have taken me 12 years to become a Paramedic. It has been a long road with many obstacles deliberately placed in my path by narrow minded individuals, but also a lot of encouragement and support by individuals who felt that I could succeed.

Now that I am well on course to becoming a Paramedic there is a small piece of the back of my brain saying to me, "you have got this far, push yourself that little bit further and consider becoming an Advanced Paramedic". So you never know, I may just end up staying in the UK for another 3 years and obtaining the highest level of Pre-Hospital care currently available in Ireland.

*Emergency Medical Technician title is now replaced by the Paramedic title for a nominal length of 2 year course that includes placements and class work. Registrations in Ireland to this level are governed by the Pre-Hospital Emergency Care Council.

Need for a good partner...

The field of emergency Medical care is a field that it is extremely important that you have a partner that you can trust to treat any patients as well as if not better than you treat them. Over the years I have worked with people with various qualifications and my experiences with them have ranged from the wonderful to the absolute terrifying.

Nowhere is this more important than in the areas surrounding medication and the administration of medication. On one of my many trips abroad with organised groups we were being asked constantly for Antihistamine tablets for hayfever complaints from most of the group that travelled. After a few days I went to replenish my supply from the central supply we had brought with us to discover that this too was severly depleated.

It did not take me long to investigate the reason behind the rapid depletion, the other medic had replaced his supplies from the central store having used them to treat many of the same patients that I had been giving them to! It subsquently transpired that they had noticed that I would ask them had they had any already that day and they answered me honestly, however the other medic did not ask them had they had any already and also did not ensure they actually took the tablets!. This resulted in some people managing to take two or three or in one case four tablets a day having used other friends to get the tablets for them from the second medic.

A strong reinforcement of drugs policy was dished out to the second medic and from then on he was only allowed to give out medications under strict supervision. He was never subsquently asked to help out at those events again.

I'm stiff, I'm sore, I'm.....

On many organised trips away the most common complaint is of stiffness, soreness and general aches and pains. My experience of this is that it is 9 times out of 10 caused by dehydration. This is typified by the participation by novices on long distance cycles that I assist at every year who do not drink enough water because of the difficulty in drinking it while on the move.

On one particular event the participants were cycling in 26degree temperatures and peddelling frantically to keep up with the lead cyclist despite it not being a race but rather a sponsored cycle. On the first morning several participants retired into the luxurious air conditioned coach complaining of aches, pains and headaches. All of them were very quickly diagnoised as having not drank enough fluids so were dehydrated. They improved enough by lunchtime to go out and cycle some more but sure enough the same problem arose again in the afternoon. Again the same “treatment” was administered and they all felt well enough by the time the evening came.

At dinner that night everyone was told to increase their fluid intake while cycling (although some took that to increasing their alcoholic intake at and after dinner but thats a blog entry for another day to spare the blushes of certain people, you know who you are!!!)

Unfortunately the next morning it was obvious that enough fluids were still not being taken and drastic measures were called for. During the lunch break I adopted a jarhead style education namely insisting that everyone finish the water they had on them then refilling their bottle, finishing THAT before cycling and finishing another whole bottle WHILE cycling. The good news is that this method worked and everyone came to me that night saying that it had been so much easier to cycle that afternoon and that they were really glad they had listened to me.

Now if only I could get them to listen to me when I say to stop drinking three bottles of vodka each......

Embarassing Moments...

Early one fine morning, while I was working in the states, I arrived onto the station just as another crew was getting toned out for an emergency call involving a child who had taken a fall earlier in the morning and who now 3 hours later was apparantly using their arm inapproprately (We never did find out what was ment by this!). As they were due off shift in an hour and I wasnt actually due to start for another few hours I went along with them to give them another pair of hands just in case they were needed. Little did I know I was going to be providing the entertainment!

Due to the distances involved in responding to the location the local fire department arrived first and assessed the child before placing them onto a spinal board and having them ready to be transferred onto our stretcher and from there to hospital in our ambulance. As the backup technician on the crew I busied myself taking the vital signs and assessing the patient while the leading technician took the handover from the firefighters.

We loaded the stretcher into the ambulance and I continued to assess the patient in conjunction with the technician asking the mother for any medical history etc while i fed the information I was gathering back to her. The patient who had long hair (remember this bit it becomes important later....) would not respond to any of our questions which made it akward to try to figure out what was wrong with them. Despite this I continued my assessment and as a part of that I continuously explained to them what i was doing and that they were being a very good and brave girl for me.

About five minutes from the hospital i got a chance to ask my partner the childs name, she turned the paperwork so I could read it and in big block letters all I could make out was “Nathan”. I stopped short with what I was doing, picked up my pen and wrote on my gloves, “Is this a boy or a girl”. My partner put on her biggest grin possible and simply mouthed “BOY”. Cue much internal cursing and a rapid change from “Good Girl” to “Good Boy” and many strange looks from the mother!.

Needless to say I wasnt allowed to live that one down for a few days!

The day the bouncer was shot.

The night had started out as any normal night in the club coming in and getting introduced to whoever happened to be doing their first night in the club. Inside the club things went on as normal with the clients partying the night away until suddely a loud bang was heard. This was not a noise I had heard in the club before so it stood out, thinking that something had happened on the main dance floor I walked towards the main dance floor to see if I could figure out what was going on. I had barely taken two steps towards the dance floor when all the bouncers from outside came rushing into the club slamming the doors closed and holding them closed.

At first I did not have a clue as to what was going on but I quickly noticed that one of the door men was injured with blood seeping out of two wounds, one on his chin and one on the right hand side of his neck. I quickly grabbed him and brought him out towards the back of the club to assess and treat him. It was at this point that I was made aware that a gun was involved and the cause of the loud bang. I then realised that the wounds were the entry and exit wounds from the bullet.

Quickly, with assistance from one of the other bouncers we got him outside the back of the club where there would be no interfearance from anyone. In the middle of assessing the injuries an unidentified person started walking towards us from the side of the building. Not recognising this individual we stopped what we were doing to issue him with instructions to stop where he was and identify himself. Thankfully he identified himself as a plain clothes Garda (Irish Police) and showed his identification. He was then issued instructions to vet any other people coming into the area and to ensure that the area was safe for us to continue treating the injured bouncer.

It was only when further Gardai, including armed Gardai arrived on the scene that a Dublin Fire Brigade Ambulance and Fire Truck were allowed to come into the area to take over the treatment of the patient. After giving them a handover of what I had noticed and done I stepped back and let them take over. They subsquently rushed him into hospital but luckily he was only suffering from a flesh wound with no major injuries or ill effects from the shot.

With him safe in the care of Dublin Fire Brigade Paramedics I went back inside to see if there was any other injuries or problems. It was only then that I noticed that there was a dent on the inside of the door which was a wooden door approximately 3 inchs thick. It took me a few minutes to realise that the dent was in the area that I had been standing when the bang was heard explaining why I heard the bang and noone else inside had heard it.

It is hard to know but if the door had not been so thick, or the gunman closer to the door, I may not have been here today typing in this blog entry for you to read. It serves to remind us all that life is fragile and you never know which day will be your last day or when you will be seriously injured.

Golden Cockup Award....

A necessary evil of our job is refresher training and training to expand our knowledge and it is during one of these training courses that this little gem comes from. During a part of the course we were doing scenarios where there was more patients than practitioners to treat the patients. I was voluntold to be a patient and given a list of injuries namely I was an UNCONSCIOUS patient with a lower arm injury.

We went outside and positioned ourselves into the most akward places we could find so as to create merry havoc for our "rescurers". I was the first one they were to come across coming out the door but every single one of them (5 or 6 cant remember which) went flying past me towards the other patients. Needless to say i took the opportunity to doze off...

Ten minutes later the rescurers decided it was time to "rescue" me and woke me from my slumber crying out "are you ok, are you ok, whats wrong with you". In my half asleep state the immortal words came out "I've hurt my arm.... Oh wait forget I said that". This results in one very confused rescurer and the instructor calling out "Well done Shane!"

And that is how I became the proud owner of the Golden Cockup Award.

Bastardised equipment...

Many moons ago while travelling to Scotland with a group of friends on a well known ferry companys sailing we heard over the speakers a request for medical assistance on the ferry. True to form we made our presence known to the staff on the ferry and we were asked to have a look at a little girl who was acting quite strangely.

The mother said to us that her young daughter (about 4 or 5 years old from what I can remember) had not been herself for the previous day and was now seen to be biting her arm constantly thankfully without doing any actual physical harm.

Finding that her temperature was on the high side we removed excess clothing in an efford to cool her down. It was suggested that we give her some oxygem to see if it relieved some of her obvious distress.

Unfortunately it was discovered at this stage that instead of a standard oxygen delivery system of oxygen cylinder and oxygen mask with small tubing connected to the variable flow metre that delivers a maximum of 15 lpm the tube was jury rigged to the 300 lpm port! Not wanting to add being blown up the poor girls problems we decided not to use this strange system!

We eventually had her transferred to the local hospital when we arrived in port thanks to the assistance of a local NHS crew. We never did find out what was wrong with her so if anyone has any suggestions we would be grateful to hear them.