Casualty! OTT's At Work Outside of the Operating Theatre

One of the real joys, for me was achieving Operating Theatre Technician Class 1 status. An even greater joy was working in the hospital Casualty Department. Achieving Class 1 status did not automatically invest us with the sudden power of healing the sick or damaged, or even the occasional malingerer. The in depth training which included anatomy and physiology, anaesthetic and emergency  routines,  combined with the nurse training gained before entering theatre, gave us a substantial level of ability that could be employed in such a place. I wouldn't want anyone running away with the idea that I, and my colleagues were suddenly let loose on an unsuspecting public without supervision and ongoing training and development.Image via Wikipedia

A further skill developed during Theatre Technician training was the correct application of plaster (of Paris) casts for arm and leg fractures or immobilisation required due to persistent Chondromalasia Patellae etc, Back Slabs, Minerva (head/neck immobilisation) Plaster Jacket (spine) as well as making Plaster Beds. As well as the application of casts etc, we were trained in the safe removal of the same. These skills were ideal, as we were able to treat patients in the Casualty Department and reduce waiting times as well as making appointments for them to attend Fracture Clinic or even return to Casualty for review.

The Casualty Department was managed, very efficiently and expertly, by a civilian Sister with many years of experience. Her name;Sister Mary Bonner. Any of my colleagues reading this who spent time at Tidworth Military Hospital, will know of her and her reputation. Her knowledge was legendary. Her ability to manage we Technicians and to ensure that we followed all the then current protocols, was beyond doubt. She ran a very tight ship, ensuring that the emergency areas were returned to a state of total orderliness following an emergency and that the department was always "able to be responsive."

There was, as well as a treatment room, doctors office and store area, an Operating Theatre. It was equipped to the same standards as the main theatre and very busy. Besides its' use as a busy Casualty Theatre, it was used for routine pre-booked minor ops surgery such as Local ties to varicose veins, excision of external hemorrhoids and enucleation of sebaceous cysts. While these cases may not exactly fill everyone with joy, they were the daily bread and butter of a busy General Hospital-and they still are.

As well as the above, Examination Under Anaesthetic (EUA) and Manipulation Under Anaesthetic (MUA) were also popular and frequently performed, by day and by night.

The Hospital was close to the A303, an exceptionally busy road. It was also positioned between Andover and Salisbury and took in its share of casualties from road accidents. It would be easy to spend time listing a whole range of injuries, suffice it to say though, Tidworth Military Hospital Casualty Department performed the same role as bigger hospitals, and just as efficiently. It wasn't just confined to coping with road accidents of course-there was more to it than that. Just like any other similar department it had it's fair share of drunks, overdoses, fractures and so on. It certainly pulled it's weight!!

All in all, the life of an Operating Theatre Technician was a busy one. My favourite times were spent working in Casualty. If I had been given a choice I would have reverted back to nursing and remained a member of casualty staff.

 I loved every minute of my experiences in Tidworth. This was not necessarily the case for some of my subsequent experiences.


                                                 

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More "Downstairs" than "Upstairs"

Image via WikipediaAfter my first couple of years or so in "Mans Service" as it was called back in the so-called swinging 60's, I could have been forgiven for being of the opinion that I had in fact joined a cleaning company rather than a  Fighting Machine that was capable of policing troubles the world over. In fairness, I had "travelled", perhaps not to all corners of the globe, but I had seen North Wales, Talacre Beach, Rhyl Seafront, Hollywell on a cold day and Colwyn Bay. Add to this the move to that well known epicentre of excitement-Tidworth.

The Tidworth move I do not regret for one moment. It was, for me, the start of a life long learning curve that stays with me even until today. The hunger for learning has not left me. Sadly, there was the small matter of what I was learning. Largely it was cleaning. This next chapter of Life In The Fast lane, sorry, "Once Upon A Time" will reveal secrets of even more cleaning!!

Cleaning consisted of High Cleaning, Low Cleaning, Cupboard Cleaning, Cardboard Box Cleaning, Needle Tray Cleaning, Scissor Tray Cleaning, Patient Trolley Cleaning, Surgeons Boots Cleaning and.........laundry. Well, someone had to wash and iron the cotton reusable facemasks and theatre caps, so why not get the trainee techs to do it. (I must be fair and say that the Theatre Sisters did their fair share of this last part of cleaning as well as with the needle and scissor trays)

The High (and low) cleaning was oh so much fun! After every list all theatre furniture, including anaesthetic machines, operating tables and suction apparatus etc., was removed to the foyer area, while buckets full of steaming hot soap and water was spread across all floor areas of the theatre, anaesthetic room, scrub up area, laying up room (instrument prep room) and sluice area. It was at this point that it became clear that whoever had designed the suite of rooms had done so with a sense of humour and cunning. Then the builders had been brought on board and persuaded to lay the floors so that they tilted away from the drains, by which route we were challenged to persuade the water to leave. Hands up whoever it was said "I bet the floors were set to drain the water in the opposite direction". Spot on, hole in one so to speak. Still, being almost as devious as the designers etc., we persuaded the water away and into the drains.

Added to the above daily ritual, there was the weekly "Blitzing" to look forward to. same emptying routines, but then out came "The Stirrup Pump". The aim became not only to clean the floor, but the walls as well. A good "stirrup pump aimer" could point the hose bit at the walls while person number two pumped feverishly, with such deliberate aim that the corner was cleaned efficiently without wetting the ceiling. As you might imagine, wetting the ceiling turned the rooms into something approaching a tropical rain forest with it taking hours to stop dripping. Not only were the walls and floors sprayed, but anything that moved was likely to be soaked, i.e, any person foolish enough to enter the room during this procedure was immediately soaked. Not too bad when the water was warm, but as it cooled after hitting you, it was bordering on the cold side to say the least. I always found myself on the pumping end of the procedure. Possibly my aim was found to be suspect.

Cupboard cleaning was an every weekend  experience. Tidworth Theatres were blessed with a number of cupboards I never saw equalled, let alone exceeded, throughout the whole of my 23 years and 231 days in Her Majestys Armed Forces, regardless of where I worked. The biggest, and possibly least favourite were the Surgical Instrument cupboards. In the days to which I refer, there were only ever a small number of pre-packed and sterilised instrument sets. There were just a General (basic) set of instruments that were used as a starter kit for cases where an incision was required and added to this was a Tracheostomy Set, Hysterectomy Set and Tonsil Set. All other instruments required for any and all other use, were "sterilised" in the Laying Up room using steam heated water. It was occasionally possible however to construct a set in advance of a pre-planned list or individual case.

In the cupboards were perhaps around 1000 or more instruments, ranging from tiny "Bulldog Clamps" used in fine vascular surgery, to large Aorta Clamps, Amputation Shields and Saws. I know it sounds a little odd, but all techs would have their favourite instrument, based upon it's design. Mine was the Myoma Screw-a beautifully designed and perfectly manufactured "screw" shaped instrument with a handle, used to.....perhaps I should leave it there!!
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Next time I'll be talking about work carried out by the Theatre Technicians outside of the Operating Theatre. Vesatility being the name of the game.

Once Upon A Time......"Time Waits For No Man"

In the world of learning, there is no time available in which to dawdle, drag your feet, or whatever phrase you choose. In a pressured environment there is always a pressure put upon trainors to ensure the new guys are up to speed as early as possible, while at the same time respecting that to rush headlong into the training programme may lead to things being missed. This could well lead to failure in an individual in a field or local emergency, such as a Major Incident being declared locally.

I will say one thing about every aspect of military, clinical and management training I undertook-willingly or otherwise, it was thorough, complete and always but always validated. What happened after that was down to the individual as to how they performed or responded in whatever situation they found theirselves. I have, in the 43 years since I qualified as an Operating Theatre Technician and the 46 years since I qualified as an Army Trained Nurse, found myself in situations, both emergency and non critical that I should have been capable of managing following the training I received. I have also found myself in emergency and non-critical types of situation,  that were not covered in my training. How did I cope? Simply by standing back for a moment-appraising the situation-assessing the job that has to be done-deciding how to deliver what is required and in what order. This has to be done in moments, not minutes and days in an emergency. My training in my roles as a nurse and in theatres taught me this. Not what I should do, but how to "manage" what I must do and quickly. Many of you reading this will know exactly what I mean. This will cover colleagues working as doctors, nurses, physio's, lab techs, pharmacy techs et al.

Returning to my training as an Operating Theatre Technician, which was supervised by senior Techs, Surgeons, Anaesthetists and Sisters, I certainly remember being put through my paces in all areas of the operating theatre. No stone was unturned in ensuring that I received the full works in terms of tips, short cuts, risk assessing and managing what to do first and subsequently, during an emergency situation and pre-empting what others would be doing in such circumstances. The skill in knowing what you and others would be doing was most useful when being called out after normal working hours for emergency surgery.

Tidworth was strategically placed between Andover, Hampshire, and Salisbury, Wiltshire. (I hope I am right geographically-never my strongest subject!) The main road between the two, and passing worryingly close to Tidworth Military Hospital was the A303. The hospital had a busy and well managed casualty department, that was "on take" for blue lights (or blues and two's as they are known now.) The A303 was infamous for the amount of accidents occuring. Many of them were due to the fact that "drinking and driving" was not as well publicised as now, and speed. To be honest, the local roads were just as good at supplying casualties as the A303 at times. Another contributing fact was that seat belts were not in place in my early years in Tidworth. Anyway-back to what I was saying about knowing what to do and what others would be doing. When called out to theatre to attend to casualties, information was sent to you from Reception, giving some details of the situation, this gave you the opportunity to "put your thinking head on" prior to arrival. This invarioubly gave you a good start on arrival. Often the surgeon would be scrubbed up and ready to go just as you finished assembling the "starter kit" of surgical instruments required for the early part of the surgical procedure. If your role on that occasion was to work with the anaesthatist, you had, again, a starter kit of drugs, intubation equipment and so on, so that the patient could reach the operating table swiftly.

All in all, My training was invaluable at the time and subsequently. Don't believe though that it was all blood and gore and excitement. Most of the time was spent carrying out what I found to be boring daily routines that included washing and ironing Theatre Caps and Masks!!!!! In the next part I'll talk about the less than glamorous side of the job.

Once Upon A Time ....................Part 10

Image via WikipediaFollowing on from Part 9.....Did the Theatre Sgt listen to my plea to get out of theatre? Did he help me to leave? Did he hell!!!!!

Basically it was along the lines of "you've made your bed, now lie on it." In other words-you are stuck, now get on with it. Once you signed up to become an Operating Theatre Technician, you found out that it was what was known as a Restricted Trade. There WAS no get out of jail free card, this was no monopoly game. So what was a poor boy to do? Correct! GET STUCK IN.

My apprenticeship in the Sluice Room was actually far more instructional than I at first thought it might be. It was an excellent place to start learning the identities of the myriad of instruments available to surgeons of different surgical persuasions. In Tidworth, back in the sixties, those "persuasions" or Specialties, were E.N.T (Otorhinolaryngology), General Surgery, Orthopaedics, Gynae, Dental and Trauma. If I have misssed any from the list, I apologise to any surgeon reading this-please don't be offended, it's nothing personal.

Before proceeding, I must pay my respects to some of the Surgeons who passed through the theatres while I was there. Those that stand out in my mind are,  Patrick "Paddy" Dignan, (please see the note at the end of this re: Paddy Dignan) Adrian Boyd, Major Owen-Smith and "Pop" Reid. Each was outstanding and a pathfinder in a way, within their specialties, without whom surgery and research in general, may not have benefitted.

I should not forget the Anaesthetists. I remember Col. Cardew, Anthony Booth and Jeremiah Leahy amongst others. They worked very hard, not just in their efforts to stabilise patients and have them ready for surgery at exactly the right moment, allowing surgery to continues non-stop until lists were finished, but to ensure that trainee Technicians benefitted during their formative days in theatre. Col Cardew and Anthony Booth were especially helpful with training.

Now I've mentioned the above, I really must mention the Theatre Sisters. I mentioned three of them in an earlier part of this Blog. The outstanding Sister, in my humble opinion, was Mary Challis. I found her to be strict in her approach to performance and behaviour as well as turn out in theatre. Most of all however, she made sure that training was delivered as required, but even more than that, she ensured that it was received by the individuals learning the trade, by questioning us trainees and ensuring we were on the ball. I sometimes despair that this ensuring that training has been received and validated does not always occur these days.

I'll move forward now, leaving the housework period behind us. Just before I do, I would admit that, just as in the nursing training, if you don't get that background work right, the treatment delivered to each patient might not succeed without infection. Cleanliness IS the key.

After three months the level of Operating Theatre Technician, Class 3 had been achieved. Looking back it doesn't seem to have been much of an achievement, but at that time-I felt good about myself, knowing that I had indeed stuck to the task despite my early misgivings.

 One of the advantages of having trained as an Army Nurse, was that a very good knowledge of anatomy and physiology had been gained during that former training. This helped dramatically when surgeons "talked" a trainee through a procedure. It certainly helped knowing the relationship of one internal organ to another when an appendicectomy or other abdominal procedure was being described. Part of the training for Part Two of the three level full qualification, included scrubbing up and just standing at the operating table. (This, apart from, at first anyway, making one feel like a spare appendage at the wedding of a lady of the night, was exceptionally helpful in getting used to scrubbing up and learning to respect the "sterile field") I spent many a time just standing behind the surgeon listening carefully to what was being talked about. Surprisingly enough, not all of what was being discussed was concerning the case in hand!!! Having signed the Official Secrets Act upon joining the Army, I knew not to discuss the details of the latest bit of "gossip" picked up at the table.
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Next time-more of life at the table, and the dangers of not paying attention!!!

Re: Patrick "Paddy" Dignan. He has written a book, "A Doctors Experiences Of Life." by Patrick Dignan.I would reccomend this to anyone who knew him, as well as to those who would like to know of his life as an Army surgeon. It is published by The Pentland Press Limited. ISBN 1 85821 136 0
I got my copy via Amazon, but can be obtained via other reputable booksellers.

Once Upon A Time........Part 9

I WANT OUT! is how I finished Part 8. I had just gone to start training in Theatre as an OTT. Time now for DAY 2.


I should just say, if anyone reading this is an OTT, I apologise for some of the details, with which you will all be familiar. There are however, a lot of readers trained in other areas of responsibility in the RAMC, for whom the details are included. ....................


My first day in Theatre had passed by in a blur. In truth I was very excited and could hardly wait for the next day to come along. So, bright eyed, bushey tailed and well-breakfasted I headed for work on day two. It being a Tuesday, it was General Surgery, all day.

I was assigned to one of the Corprals. His job for the day was to make sure the Theatre was in good order and ready for all cases that appeared on the Operating List, as well as to keep an eye on me and ensure that I listened to his every instruction, and to learn how to do things as quickly as possible. (I have to say that the only way to learn in those days was quickly-failure to grasp detail at the first time of telling,and, depending on the teaching technique employed by the trainor, could lead to extra sluice and floor scrubbing duties as well as extra on-call duties,as if there weren't enough anyway.) From memory, duties included making sure the scrub-up area was stocked with sufficient Operating Gown Packs, a complete range of surgical gloves from size 6 through to 8, with 6 being the smallest and 8 the biggest. (The range would be different from theatre to theatre depending on the staff membership.) I don't know if any other OTT reading this remembers this, but invarioubly it was the Gynaecologists who wore the largest size!!!. There was also the need to make sure the Post Op dressings tray was topped up and that all any extra Operating Table parts were ready, such as arm tables, hand tables and stirrups.

One of the more critical pieces of equipment to ensure being available was a stool upon which the surgeon would sit for some of the procedures on the list. These might typically include hand and foot surgery, gynae procedures, rectal surgery, or, sometimes just to sit on while waiting for the patient to emerge from the anaesthetic room, hopefully suitably stunned and ready for knife to penetrate skin without the patient jumping off the table!!!. During my first few weeks, I found that the second biggest sin that could be commited as the gopher for the day, was to have to be told to put the stool under the rapidly lowering undercarriage of the surgeon. He always "knew" it would be there so didn't even look round for it. It was always expected that the surgeons' every move was being anticipated by the hopefully fully alert gopher. The FIRST and BIGGEST sin was to whip the stool away before the surgeon was finished with it. Sometimes the surgeon would stand up and have a little rummage around whichever part of the lower end of the body he was servicing, and a quick witted but sadly mistaken gopher would whip the stool away-complete with smile on face, firmly believing he was being efficient. Sadly, on more than one occasion he would be wrong. Only once though, in my career in theatre, did I see a surgeon end up on the floor, letting fly with deletives that could not be deleted. I will not name the surgeon involved, but, I developed an instant respect for him and his knowledge of the English, and possibly several other languages, when it came to cussing.

Having ensured the Theatre was ship-shape, it was off to the sluice to check out such things as stocks of linen bags, rubbish bags, and copious quantities of detergents and soaps with which to clean the floors at the end of the operating list. At this point, my new found friend and tutor made it quite clear that I was to familiarise myself with all the practices of the sluice, as it was to be my new home until it was thought that I had mastered the art of cleaning all things, movable or immovable. Now, where had I heard that before? Oh yes!-when I started my Nurse training.

Before the day was out, I had made up my mind that I was not as happy with my new career as I had hoped. To be perfectly honest, I never did get to like the cleaning aspect of working in theatres, throughout the years between 1968 and 1986. Don't get me wrong, life wasn't all about cleaning, but it did play a massive part in the overall role of the OTT. With training, demonstration to the bosses of competence and subsequent seniority came progression within the organisation, and more opportunity to practice such other skills as teaching and management in the different aspects of managing day-to-day life in the Theatre and ensuring patient safety at all times.

At the end of Day 2 however, I knew nothing of the future and what it would hold for me. I was not going to waste my time cleaning again. I wanted OUT, and damn it, I was going to tell the theatre sergeant this, as soon as he got back from the bookies shop. I was sure he would understand!!

NEXT TIME........ did he understand? did he listen to me?

Once Upon A Time..........Part Eight

It's my own fault I suppose! I started  a series of reminiscenses about the five years I spent in Tidworth at the Military Hospital. I got to the point where I was, at last, starting a new career, this time as an Operating Theatre Technician, and then it all went quiet. I have received quite a number of messages, nay, enquiries, asking when I am going to get on with the series of articles. Oddly enough, most of them come from outside the UK and mainly from Eastern European readers. As a mark of respect to all of you, thanks for your messages and now-Part Eight.
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As with any change, whether it be a change of job, location, role or in the case of a military career, a promotion, life is immediately a challenge. The first few days can even be a maker or breaker period. My first few days in Theatre were close to being a breaker!

To be fair, I was welcomed warmly into the new "family." Each and every person from Stan Jones-Theatre Sgt., through to Jim Goreman, civilian Porter, made my first day one to remember. I had better add here that I remember the first day for all the RIGHT reasons. Stan was an easy going kind of guy, not a bad bone in his body I would suggest. He did have a tendency though to study racing form, rather than what cases were on the operating list! The rest of the team, or as many as I can now remember included: Ken Hudson, Barry Gaukroger, "Chimp" Roberts, Bud Holder, Phil Reeves, a guy called Gartside (first name escapes me,) Phil Olive, John Thomas, Ron Days and others. Not all were senior Techs, some were new but just a little less new than I was. Over the years many more techs came and went, I would need a new Blog to mention all names.

During my first day, I was introduced to the Theatre Sisters, of whom there were two. Please don't ask me who they were. I see faces in my minds eye, but names totally escape me. In all the years I was there, some names remain in my mind for varying reasons. I can think of Mary Challis, Phyllis Broad and Maggie Watson. Of these, I remember two with great fondness. They were good at their own jobs, and able to gain the respect of just about everyone they worked with.  The other? Well, lets just say that she made much out of nothing, appeared to dislike all technicians, trusted no-one other than herself, and rather annoyingly, insisted upon scribbling her initials on just about everything, whether it belonged to her or not and whether it was nailed down or not! Those of you reading this and who knew the above three ladies will know to whom I refer.

My first day consisted of "the tour" of the estate, which included a remote Central Sterile Supply Department building, (CSSD) on the other side of the Hospital "square." The theatre suite consisted of an entrance corridor, Foyer, Anaesthetic Room, Laying Up Room, one Operating Theatre, a Sluice room, a Store room and the Sisters office. The CSSD consisted of two conjoined "packing areas" within which were two dependable steam sterilisers and a store area and a tea room. I say the sterilisers were dependable, which they were, until Phil, the electrician/maintenance man came in to do his weekly maintenance, following which they played up for the rest of the day!!! Oh, why can't people just leave things alone I used to think.

 There were two more operating theatres besides the main one. The Casualty Department directly beneath main theatre, had a theatre that was used for minor operations and emergency surgery and for MUA's and EUA's. These were Manipulation Under Anaesthetic and Examination Under Anaesthetic. There was also a Maternity Theatre within the Maternity Unit, used for Caesarian Sections and various other pre and post natal procedures.

Before I knew what was what, my first day was over. The highlight of my day? It had to be the dressing up. The change from my Nursing "whites" to theatre "greens" was kind of exciting to a young lad, such as I was then. I felt rather strange in them at first, but that soon went. My only complaint would be that the trousers were supposed to have waist and fly buttons, but many didn't. This meant using a one inch cotton bandage to tie around the waist to keep them up. Safety pins were the order of the day to keep the fly area in good order and under control.

Day two took on a totally new complexion. As with my introduction to life on the wards as a trainee Nurse, cleaning was to play a major part in daily life in the Operating Theatre. Clearly I hadn't done my homework before forsaking my hard earned level of status at nursing level before jumping ship for this new career. If I had I would possibly not have opted for starting at the bottom all over again. Day two started in reasonable style. Tuesday was General Surgery all day. I was "given" to one of the senior techs for the day. He, quite clearly, was not over impressed with the gift bestowed upon him by Stan Jones. I won't mention his name out of fairness to him. After the first case, which I believe was an Inguinal Hernia repair, I was taken out of the theatre itself and into the sluice. No more surgery for me THAT day!!

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Next time-I WANT OUT!!!!!

A little early perhaps, but Happy Christmas To All

Not the usual Christmas carols or video, but something that brings a tear to my eye every time I hear it. I hope you enjoy it too. Happy Christmas and a very Special 2012 to all.

http://www.youtube.com/watch?v=4pWDp-cbKX4&feature=youtube_gdata_player