4 ,'::

Checkup
I Work in groups.Describethe type of rapid response
shown inthe photos.

2 Which of these is more appropriate for urban or built-

up areas?Forrural areas?Givereasonsand examples.
, Whichtype of responseis commoninyourcountry?

4 Doesworking in suchareasof medicine appealto you?

ListeningI
Listeningfor detail
I O Listento a conversationbetweena doctor and a
patient. Write down as many details asyou can about
what you hear. Compareyour answerswith a partner.

2 Completea copy of the form on page 115.

3 Q tisten to the conversationagain and then compare

notes again.
4 Checkyour details with the rest of the class.
 E m e r g e n cmy e d i c i n e5

In thi s uni t
o rapi dtensechange
o adverbsof manner
o thi rd partyi ntervi ew i ng
O compari son
o conti nui ngprofessi onal devel opment

Vocabulary
Adverbs:describinghow things happened
I Adverbscan help to describehow things happened
and help to make a diagnosis.look at these statements
from Listening1 and underline the adverbs.

...urftH4tu114 Barbara, *ft, jutt

ry
Wetn*i. togrt hm ufrAl4t a/4d
shn*artun h,(rtiltl41 I*tt vtilpilt|/.

2 Underlinethe most appropriateadverbin these

sentences.
1 Thefainting? It just happenedabruptly / gradually /
slowly.Thenext thing I knew shewas lying
completely flat on the pavement.
2 The patient suddenlybecamepale and startedto
sweat,but notprofusely/ rapidly / enormously.
3 Afterthe attack,MrJonescameto rapidly / slowly/
Ieisurely,whichquestionswhether it was a seizure.
4 Embarrassingly/ Gradually/ Clearly,lsoiledmyself
and wet myself.It wasn't very pleasant.
5 Shewas lying flat, but bystanderswere trying to Patientcare
keep her upright, so she was twitchingslowly / t Decidewhether theseitems aretechnicalor non-
convulsively/ suddenly. technical.Then match them with correspondingwords
6 As he couldn't seegood / clearly/ visually,hegot
and phrasesin Vocabulary2.
quite frightened.
a post-ictal
7 Ina seizure,thereistypically/ rarely/ seldomno
b flt
prodrome,but this is not alwaysthe case.
c to be incontinent of stool
8 After collapsing,he didn't get better spontaneously/
d syncope
slowly/ gradually.Thepatient was a bit drowsy for
e a warning sign
quite a while afterwards.
f to be incontinent of water
9 He recoveredcompletely / partially / poorlyfrom the
g supine
accident.Now he'sperfectlyOK.
h to go into spasm,but not reallyjerking
10 Fainting and vomiting don't reliably/ partially /
clearlydiscriminate seizuresfrom faints. I to tell the difference(between)

3 Work in pairs.Decidewhether the statementsin 2 are Ideally,when speakingto a patient,you should use
likeiy to be saidby a patient or a medical professional. non-technicalwords.Sometimes,you can make the
mistake of using technicalwords.Work in pairs and
practisegiving lay terms or your own explanationsfor
the technicalwords above.

EXAMPLE

PATIENT: I'm sorry,butwhat'sa prodrome?

What doessupinemean?
DOCTOR: It'sa ...ltmeans...lt'swhere...
6 U n i t1

comeover(v)suddenlyfeel
9 9 9 ( n ) t h en u m b e d r ialledfor
e m e r g e n ccya l l si n t h e U K

Speaking 2 Placesentences7,2,8,9,and 15on the timeline.

Work in pairs. Study the information in the form you

completedf or Listening 1.Taketurns role-playinga
doctor askingquestionsto elicit the information from
the patient who fainted in the street.

Now

Completethe sentencesusing the verbsin bracketsin

the correctpast tense.
1 W e (walk) along the street when she
(pass)outsuddenly.
She (havenever)the pain before
till now, but she (experience)some
bleedingthe first time.
3 After he (admit),he
(become)suddenlyworse,but he'sstarted
o Languagespot respondingto treatment.
Rapidtensechange 4 H e (neversuffer) a fit before,but he

1 Understandingthe sequenceof eventsand hencethe (feel)unwell sincethis morning.

tensesis important for correctdiagnosis.What are the 5 H e (yawn) repeatedly,which he
tensesof the highlighted phrases? (not do) before,and then he just
lWe were shopping in Cambridge Streetin town, when (faint).
suddenly Barbara,my wife, 2justfainted. 3Wetried
6 After he (fall),he
to get her upright and ashestarted twitching quite
violently.sltwas quite scary.6Shecameroundvery (start)twitching violently when we
rapidly.But 7wedialled 999 and a paramedicappeared (try)to get him up.
almost instantly andthenthe ambulancealmost 7 When she (lie)on the ground,she
immediately afterwards. 8Shehad been complaining
(not shake)at all.Then shejust stood
of feeling a bit unwell, and shad almost fainted and
10shefelt a bit woozy.l1Shewas a bitdizzy and 12she up.
was yawning repeatedly andthen all of a sudden, 8 What actually (happen)whenshe
t3thereshewas,lying onthe ground.When I cometo (fall)?
think of it,lashepassedout oncebefore about a month
9He (bite)his tongue and he
ago.tsShehasn't been feeling well on and off over the
summer.l6Wethought it was the heat. (mess)himselfand he

a PresentPerfect(PresPerf) (feel)a bit groggy since.

b PastContinuous(PC)
c PastPerfect(PastPerf)
d PastPerfectContinuous(PastPerfCont)
e PresentPerfectContinuous(PresPerfCont)
f SimplePast(SP)
 E m e r g e n cmy e d i c i n e7

button battery(n)a smallroundflat

battery

4 Useeachof the tensesin bracketsonceonly asyou

expandthesenotes into sentences.
1 We eat in a restaurant.I suddenly feel woozy.I faint.
This never happen before.6n SnPC,presperJ)
2 Ahmed never be ill before but feel unwell yesterday.
He abruptly cried and then passout. (pastperf,S| Sp)
3 We travel by train to the city. He not eat sincethe
morning. He vomit and we come straight here. (SB
Past Perf,Sn PC)
4 Mary have fainting fits for the past few days.Shedo
a lot of running around when it happen secondtime.
Shenever have them before.And none of us have
them, either. (PC,PresPerf Cont,presperf, Sp,presperJ)
5 Sheget out bed when she come over all giddy,but
she have it before,so we think nothing of it. (SBSB
PastPerf,PC)
5 Work in pairs and describeyour day sofar, pointing out
. what youhave done sofartoday
. things you haven't done yet
. things you were doing while doing something else
. and things you had done beforeyou did something. Speaking
5 nole-playthesesituations. Work in groups.Decidewhat would be the main signs
and symptoms youwould expectin a case
1 StudentA,go to page114.StudentB,take a history
from Student A. Write notes as you listen and decide 1 where an otherwiseflt 3O-year-old
man presents
what the patient's complaint is. with pneumonia at A&E or
2 StudentB,go to page116.StudentA, take a history 2 where a mother presentsat A&E with a child who
from StudentB. has swallowed a button battery.
)) Goto Grammar referencep 118 You are going to role-play the history. Decidewhich two
of theseitems you want to focus on in the assessment
of the role-play.Givereasonsfor your choice.
. the sequenceof the tenses
. the grammatical accuracyof the tenses
r the accuracyof the descriptionelicitedbythe doctor
. the use of non-technicallanguage
. fluency

Work with a partner from another group.Eachchoose

one of the two scenariosin 1.Agree on the two items
you want to be assessed on. Takea history from your
patient. The patient should make a few notes about the
doctor'sperformance.When you have finished, give
feedbackto your partner about your own performance
and then invite comments from your partner.
Remembertobegin with positivecommentsand use
constructivecriticism.
8 U n i t1

t r a f f ic - b u s t i n g( a d j )a b l e
to get through road
congestion
f r e e u p ( v )r e l e a s e

It's my job
\Vhat do you think the work of a cycleparamedic 4 Is the bike the most efficient rapid responsemeans
involves?What do you think are the advantages or is this not mentioned?
of a cycleparamediccomparedto a conventional 5 Doesthe cycleparamedicresponsetime in the West
ambulance? End exceedor equalthe governmentbenchmark?

Work in pairs.Skim the text and the questionsin 3 4 Work in groups.Is the emergencysystemsimilar in
qulckly and decidewhat the text is about. your own country?Giveexamples.How do you thlnk
the systemdescribedbelow could operatein urban /
Answerthe questions.
rural areasin your country?
1 Do cycleparamedicsin London'sWest End
arrive at the sceneas rapidly as or more rapidly than
conventional ambulances?
Is the paramedic'sbike equippedwith only a basic
FirstAid Kit or more sophisticatedequipment?
In seriouscases,arethe conventionalambulance
and the cycleparamedicssent simultaneouslyor are
the latter sentfirst?

fohn Rhys
My nam eisJ ohnRh y sa, n d I' m o n e o f a te a m o f fo u r
cyclepar am edicof s t h e L o n d o nA m b u l a n c eSe rv i c e ' s
tra ffic - bus t ing bic y c l ea m b u l a n c e s e rv i c eW. e a tte n d
9 9 9 em er genccyallsi n th e C i tyo f L o n d o n- th e
f i n a n c i a l c e n t cr ea l l e dt h e S q u a r e
M i l e . T h eb i k ei t s e l f
i s the s am east hos eu s e db yth e s u c c e s s fu c yl c l eu n its
o p e r at ingin London 'We s s tEn dw , h i c h re g u l a rl yre a ch
p a tient sf as t ert han c o n v e n ti o n aalmb u l a n c e s .
Th eteam ' sbik esar efi tte d w i th b l u el i g h tsa n d s i re ns,
ca rr ya r angeof equi p m e n t, i n c l u d i n ga h e a rt-s ta rti ng
d e fi br illat or
ox, y genp, a i n -re l i e v i ngga s ,a n d e v e na
ma t er nit ypac kf or d e l i v e ri n gbabies.
Wh er et he pat ientis b e l i e v e to d b e i n a l i fe -
t h r e a t e n i ncgo n d i t i o nw, e a r es e n ta t t h e s a m et i m e touri stsw ho vi si tthe areaeachyear.U si ngthe bi ke
a sa r e g u l aar m b u l a n ccer e ws ot h a t w e c a ns t a r t gi vesus an opportuni tyto savepotenti al l vi y tal
i re at m entbef or et he y a rri v eW . h e reth e p a ti e n ti s seconds i n starti ngtreatment,especi al liyn the narrow
u n der s t ood t o be s u ffe ri n gfro m a mo rem i n o ri n j u ry streetsw hi chw e cannegoti atemorequi ckl yand
o r i l l n e s sw, e a r ei n i t i a l l ys e n to n o u r o w n a n dt h e n e a s i l yt h a n a m b u l a n c eFs o
. re x a m p l em, y c o l l e a g u e s
a r ea b l et o r e q u e sftu r t h e ra s s i s t a n c- fer e e i n gu p i n the W estE ndC ycl eR esponse U ni t regul arl yreach
a mbulanc es t o at t en do th e r,mo rep o te n ti a l l lyi fe - 1OOpercentof the mostseri ous,' C ategory A ' ,999cal l s
t h r e a t e n ign, 9 9 9c a l l se l s e w h e rien t h e C i t y . w i thi n ei ght mi nr-i tes.Thi response
s i s muchqui cker
Mo r et han 300, 000p e o p l ew o rk i n th e C i tyo f L o n d o n than the governmentstandardfor thi s categoryof
a n dt h e i rn u m b e r sa r es w e l l e db yt h e s e v e r aml i l l i o n cal lof 75percent.
 E mergency
medi cine9

G u i d e l i n epsu b l i s h e d
b yt h e A m e r i c a nH e a r tA s s o c i a t i o n
statethat for everyminuteof delayin gettingto a patient
in cardiacarrest,the chancesof successful resuscitation
decrease by 10 percent.

o Languagespot 4 Work in pairs. Compareyour life now as a student /

Comparativeand superlativeadjectives worker with the past.Usethese adjectives/ adverbs:
and adverbs hard / easy;stimulating / duII; relaxing / stressful;
complicated/ simple.Givereasonsand examples.
Look at lt's myjob. Canyou flnd examplesof
comparative and superlative adjectivesand adverbs? ) Goto Grammar referencep 118

EXAMPLE
...reachpatientsfgs'terthanconventionalambulances listening2
Completethe sentenceswith a word from the list. Descriptionof an emergencyincident
Add any necessarywordsto indicate comparativeor
superlativeand make any necessarychangesto the 1 Look at the picture
adjectiveor adverb. and describethe
equipment. What do
drowsy frequent lively long youthink is the beneflt
bad serious shallow vioient wet of such equipment on
cycleambulances?
1 This time Jessicatook to improve
than before. 2 Q ti stentoacase
2 Shedidn't twitch as study about an
asthe last time.
incident at Heathrow
3 It',s I have ever had.It was agony.
Airport.Write down as
4 Is this attack than the last time, or much detail asyou can.
not asbad? Comparenotes with a
5 He's than he was about ten minutes partner.

ago.He'scomingto gradually. 3 Q tisten again and write dornmthe verb only in each
6 Natalia appearsa bit missing step.
than the last
time we sawher. She'srunning around. 1 GaryEdwardshadbeenrelaxing.

7 How have you been coping with the weather? It's 2 He developeda severepain in his chest and arms.

much than last year. 3

8 Herbreathing is 4 His respirationceased.

than before.
9 Peopleseemto be coming in with this 5

than last year. 6

7 A cycleparamedicarrivedfaster than the ambulance.
Expandthe part of the sentencesin italics adding
a comparativeor superlativein eachcase.Insome 8 He continued resuscitation.
sentences,both more and lessmay be used. 9
1 He is much big the last time you brought him to seeus. 1 0 Paramedics,dispatchedin an ambulance,turned up
2 This is by far good hospitall have everbeen in. afewminutes later.
3 How doesthis compareto severepainyou'vehad? 11
4 It's easyto walk now itwas before the operation.
5 He was sweating p rofusely before. 4 Work in pairs and complete the rest of the missing
6 His heart is beating irregularlybefore.It'salmost details.
backto normal. In groups,discusswhetherthis type of rapid response
7 I'm pleased.Johnis stressedhe was last year. would work in your country. Givereasonsand
8 He needsexerciseto get the full movement back. examples.
1 O U n i t1

instigate(v)start

Reading Correctthese statementsabout the text by changing

or removing words.
Ansrverthesequestions.
1 All doctorskeepa written log of their CPD.
1 Do you try to keep up to date with current
2 The Collegeof EmergencyMedicineinstigatedthe
developmentsin medicine?How?
processof appraisal.
2 Is lt important to continue studying throughout
3 The GMCdocument GoodMedicalPractice(2OO7)
your medical career?Why?
contributed considerablyto the revisionof the
3 Lookat the title. What do you think Continuing
Collegeguidelineson CPD.
ProfessionalDevelopment involves?
4 CPDis a processthat replacesformal educationand
Find words in the text which havethe samemeaning trainlng.
asthesewords. 5 The responsibilityfor keepingup to date lies with
1 experienced,gonethrough the Coliegeof Medicine.
2 put together,drafted,compiled,composed
3 altered,changed,modifled
4 set up, introduced,started
5 lying behind, underpinning
6 pertinent,applicable
7 requirements,whatyou require

Guidelineson Continuing ProfessionalDevelopment

Thevastmajorityof Emergency
Medicine Thisrevisionof the Collegeguidelines
on for all
CPDis an obligatoryrequirement
(EM)doctorspractiseContinuing CPDis basedon: practising Medicinephysicians
Emergency
Professional (CPD);
Development however, . Aframeworkfor ContinuingProfessional and it is up to eachdoctor[you]to keepup
not all doctorskeepa record.CPDhas - TheAcademyof MedicaI
Development to date.
undergonea dramaticevolutionandwas RoyalColleges(February2002) TheGMCsetout in paragraph10of Good
initiallyformalized
by an agreementin . Guidelines
on CPDFacultyof Accidentand (September2001)
MedicalPracfice
- HenryGuly,past 'Youmustkeepyourknowledgeand skills
1993by the Conference
of MedicalRoyal EmergencyMedicine
Colleges Thefirstguidancefor
and Faculties. Directorof CPD(2003) up to datethroughoutyourworkinglife.ln
continuingmedicaleducation(CME)
for the . TheGMCguidelineson CPD(April2004) you shouldtakepart regularly
particular,
Collegeof Emergency
Medicinewasdrawn . TheGMCdocumentGoodMedicalPractice in educational whichmaintain
activities
up in November1995.Sincethentherehave (2001) andfurtherdevelopyourcompetence
and
beenmanychangesdueto the introduction performancel
of appraisal
and recommendations
by the PrinciplesunderlyingContinuing However,CPDmust be relevantto you
GMC(General
MedicalCouncil),
andthe ProfessionalDevelopment and meetyourneedsto allowmaintenance
guidelines
wereamendedin January1999 ContinuingProfessionalDevelopment of a highqualityof patientcare.Continuing
andJanuary2000.Themostrecentedition (CPD)isa continuinglearningprocess
that professional shouldbe
development
of the guidelines
waswrittenin September complements and
formalundergraduate learningallowingyou to
reflective,lifelong
2003. postgraduate
educationandtraining.CPD of emergency
developwithinthe specialty
Sinceappraisal
hasbeeninstitutedand you to maintainand improveyour
requires andshouldalsosupportyou in
medicine,
revalidation
is inevitable
despitethe delayin acrossall areasof yourpractice.
standards interests.
developingoutsideor subspecialty
the implementation,
the documentation
of and support
CPDshouldalsoencourage
proofof CPDhasbecomemorerelevant. specificchangesin your practiceandcareer ICPDGuidanceGMCApril2004]
development.
 E m e r g e n cmy e d i c i n e

Checklist
Assess your progressin this unit.
Tick(/) the statementswhich aretrue.
I canchangetensesrapidly
I can understand
adverbsof manner
I cando thi rd-partyi ntervi ew i ng
I canunderstand
compari son
Project I canunderstand
conti nui ngprofessi onal
I development
work in groups.Are jobs in A&E departments/ Emergency
departments popular in your country? Why / Why not?
2 what methods are common in your countryfor obtaining Keywords
jobs,e.g.recruitment by job advert,curriculum vitae (cv)
followed by an interview? Adverbs
abruptl y
3 what do you understandby a job specification/ job spec? embarrassi ngl y
spontaneousl y

Writing N ouns
apprai saI
Ajob application bystander
I Continui ng Professiona
I Development
Look at this extract from a job application form for a post in the
job specification
emergencydepartment of a large city hospital.
paramedi c
rapidresponse
sei zure
Jobapplication w arni ngsi gn
statewhyyouthinkyoushouldbeconsidered
for thispostgiving Adjectives
. suitability
for the post giddy
. relevant experience groggy
. t r aining woozy
. qualit ies , Verbs
di spatch
faint
write a descriptionof your suitability for the post or a post in soi l
your speciality.Rememberthe information must be individual to twitch
you and contain genuine details. wet

Speaking Usefulreference
In an interview,rememberthat what you say
needsto match Oxford Handbookof EmergencyMedicine
accuratelywhat you have written in your job
application.work 3rd edition,Wyatt et al,
in pairs'Giveyour descriptionfrom your job
appircationin lsBN978- 0-19_920607_O
writing 2 to a partner. Taketurns asklng !".i-,
otl,.r about the
detailsyou wrote. Checkthe descriptionfor
accuracy.
Make surethat what you are sayingdoesnot
sound asif you have
iearnt it by heart.Avoid repeating exacily what
you have written.
USEFUL EXPRESSIONS

WhenI wasin ...

After Ifinished ...
What makesme suitablefor the postis ...
The relevantexperienceI have is ...
I'vefollowed various training coursestike...
As regardsmy qualities,...
128Listening
scripts

Listening
scripts
Unit 1 D When she fell, how did she fall? it most probably made the difference
P Shejust crumpled to the ground between life and death.
Listening 1 slowly.Infact, it all happened so
Dave emphasized the importance of
D=Doctor,P=Patient abruptly and silently I didn't realize it quick intervention when someone
D Hi, Mr Stone,I'm Dr Tariq, one of the had happened.
suffers a cardiac arrest and took the
doctors inA&E. How are you? D So she didn't cry out or anything?
opportunity to remind members
P I'm OK,but I'm abitworried about my P No, there was no warning sign at all.
of the public that they can learn
D Just a few more questions.
wife. cardiopulmonary resuscitation - or CPR
D Yourwife's OK. P OK. - at free'Heartstart'classes given across
P That's good. D Has she ever had anything like this
the capital bythe London Ambulance
D Amir, one of the paramedics, says you before?
Service and supported by the British
were walking along the street when P V/hen I come to think of it, she passed
Heart Foundation. Effective CPRbuys
your wife collapsed. Can you tell me out once before about a month ago. time for a patient and doubles a petson's
a bit more about what you actually She hasn't beenfeeling well offand
chances of survival.
saw? on overthe summer. We thought it
P Mmm. Yes,sure.We were shopping was the heat.
in Cambridge Street in town, when D At the moment it looks like ... Unit2
suddenly Barbara, my wife, just listening 2 Listening t
fainted. Mmm, we tried to get her
Gary Edwards, a British Airways D=Doctor,P=Patient
upright and she startedtwitching
customer service arrivals agent, had 1
quite violently.It was quite scary.
been sitting with his work colleagues D You look as if you are in quite a lot of
D Yes,jt certainly can be, but it can
in a rest room at HeathrowAirport's pain.
happqr, when people faint like this.
Terminal One when he suffered severe P Yes,I think I've hurt my hip badly. It's
Did anything else happen?
pain in his chest and arms. Within giving me a lot of pain.
P No. Nothing at all. She came round
seconds,he lost consciousnessand D I think we need to get you some
very rapidly. But we dialled 999 and a
stopped breathing. His British Aintrays painkillers. So ...can you tell me a bit
paramedic appeared almost instantly
colleagues immediately dialled 999 for more?
and then the ambulance almost
an ambulance andbegan attempts to P Oh,I slipped on the kitchen floor. I
immediately afterwards. Do you think
resuscitate him. must have spilled some water and I
she had a seizure or something like
epilepsy? All he can remember is that he had was coming into the living room with
D We don't think so.But can I ask got up from the sofa and said to his a cup of tea and I just went down on
you a few more questions? Did she colleagues that his chest and arm hurt. my bottom and twisted my leg.
complain of anything before that? Afterthat, everything went blank. D Oh, dear. That sounds bad.
P Mmm. She had been complaining of Within secondsof the 999 call being P It was.I couldn't move. Fortunately,
feeling a bit unwell, and had almost made, cycle paramedic Dave Parks I had my mobile in my apron pocket
fainted and she felt a bit woozy? She reached Mr Edwards. Dave was able to and I phoned myneighbour who
.- yes, er...she was a blt dizzy and she continue resuscitation and re-start Mr had the key to come in. She called an
was yawning repeatedly andthen all Edwards's heart after three attempts ambulance.
of a sudden, there she was,lying on using the portable defibrillator that is D Falls like this happen so easily. You
the ground. carried on ambulance birycles. may just have pulled a joint out of
D Anything else?Was she ill or anything place rather than breaking anything.
Paramedics, dispatched in an ambulance
before she fell? 2
at the same time as the birycle
P No. Just tired. D \Alhat's brought you here today?
ambulance, arrived a few minutes later
D What about her eyesight? P My wrist is really hurting. I think I've
to continue treatment and took Mr
P Nothing, but she said her hearing broken it.
Edwards to hospital. This resuscitation
was a bit funny- she wasn't hearing D OK. How did it happen?
shows how well-suited bikes are to
clearly. P Well, I was coming out of a shop and
reaching patients quickly inside the
D Any vomiting? I was trlnng to avoid someone and I
airport. As they are based at the airport
P No. didn't notice the paving stone was
and were able to get to him so quickly,