Saturday, 31 March 2007

Spitting drunk

Seven calls today; 3 greens and 4 emergencies. One assisted only, 5 conveyed and only 1 requiring an ambulance (and that was only because she was too drunk for the car).

A quiet morning, so I used the time to research some material for my book. I'll be writing a few this year, one for the blog and a first aid manual (I've published before with some success). I also watched telly 'cos that's important.

Today wasn't about stress, it was about routine and I love routine. The early shifts provide me with an opportunity to keep my basic first aid and patient care stuff up to scratch because that's what it's all about. If you can't put a good sling on as a paramedic it can be rather embarrassing.

My first call of the day was to a lady who had ? sprained her ankle after taking part in a ballet workshop. She wasn't a ballet dancer and was doing it as part of a group with children. She hadn't warmed up before starting and that's probably why her muscles, tendons and ligaments weren't quite prepared or tolerant enough for the exercise. I put this to her (m'lud) and she agreed. I also told her I would write this up and she was quite happy about that! So, hello!

Remember the postings about shoplifters who feign illness in order to get out of their predicament when they are caught? I got another one today. He had been caught allegedly stealing from a shop and I was called because as soon as the police turned up he collapsed and pretended (allegedly) to have a fit. No ambulance was despatched; even EOC sensed a time-waster. I arrived to find him making moaning noises and clutching at bits of his body. The police were bemused and the shop staff confused. He told me that he now had chest pain - usually a gauranteed 'get out of jail' card but not this time. All his obs. were normal and I chatted to him about the situation, explaining that he would have a police officer with him all the way to and through hospital and he would be charged after he had been checked out. This is true.

The police were experienced enough to know the game we were playing and the man recovered completely (no moaning or clutching) when he was told that he could just go home if he didn't waste anybody's time. I know that this sounds crass and possibly risky but I had no doubt whatsoever and neither did the police. He was faking. He declined my offer of hospital treatment on the basis that he could walk away and that's exactly what he did. He walked remarkably fast for a postictal chest pain patient.

I was the only car on and there were few ambulances to spare for trivial calls, so I did my best to convey calls when I knew it was safe and appropriate to do so.

I got a half hour of stand-by in the sun at my usual spot at Trafalgar Square. The opera singer was there again, this time with blue high heels on. I wouldn't have noticed but they were very blue. She enchanted the crowd (and me) with a couple of beautifully delivered arias. I wish all buskers were this sophisticated. Class on the street, that's what she is.

My serenity was shattered by an incoming call. This time I was off to see a lady who had dislocated her shoulder. I arrived to find her sprawled in the doorway of a theatre. She had fallen hard and put her shoulder out. This was her second dislocation, the first had required surgery to repair and now the same shoulder was poking out abnormally. I gave her entonox, which brought relief from the pain and I knew I had to move her. I decided to take her in the car because I was literally 2 minutes away from hospital. Also, calls were being GB'd, so I knew she would be lying there for a while if I didn't. I put a splint on her arm and this had the effect of slightly extending and rotating her arm (without pain I should add). The shoulder popped back in on its own. Instant relief.

We are not allowed to reduce disloctions, lots of things can go wrong if you don't do it properly but I knew that a little manipulation might prove useful and it did. I was going to have to move her anyway, so she had to be in a splint or sling first. A sling was out of the question because she was lying down and her arm was straight. She arrived at hospital happy and pain-free. She will get an x-ray to check all is well but it sounds like her shoulder will be the bane of her life.

I had my break late in the day and then I was sent to a station to sort out a drunk woman who had refused to move from a train she had arrived in from up North. The police were on scene and LAS had been called because she had medical problems - alcoholism was one of them. She had recently been discharged from hospital after treatment for a head injury, sustained when she was drunk and incapable, so that added to the need for her to go and be checked out. I asked for an ambulance for her. She was far too loud and boisterous for me to convey in the car. The crew were very understanding though.

On the way to the ambulance she said something and sprayed saliva as she spoke. I caught a drop of it on my lip. I know it wasn't raining because there were no clouds up there, so I worriedly wiped my mouth and averted my face (proximity is sometimes a bad thing). I spat a lot after that.

I love to treat independent elderly people, they prove that old age doesn't have to be debilitating and that, sometimes, life can be good to you and serve you up enough energy to go on for much longer - Duracell longevity I call it. I went to a supermarket to treat a 90-year-old who had fallen down stairs and twisted her ankle. She had also bumped her head and hurt her wrist in the process. These are standard injuries for this type of fall. She had no significant medical history, which is astonishing. At that age blood pressure, the heart, the kidneys...something must be failing and causing trouble. For a lot of people the process of disease begins in middle age, yet this lady had me write something on my PRF that usually only applies to much younger people 'normally fit and well'. She was a lovely person too and I enjoyed chatting to her as I drove her to hospital.

At the end of my day I started driving towards base and was given one last call. The description sounded familiar and I sensed this was a regular. He had already called three times before and nobody had found him on scene. He was claiming that he had a burst hernia and that his bowel was spilling out.

I arrived on scene and couldn't find him. I asked a couple of traffic wardens and they pointed him out (after I gave a description relayed by EOC) in a call box further down the street. I knew him instantly. He was a real frequent flyer and even the hospital staff don't listen to him anymore. His colostomy bag had spilled over and he was covered in faeces. He smelled abominably and it took me a couple of tries to get in the phone box so that I could talk to him. I have dealt with this guy (and written about him) at least three times before. He neglects himself, that's all. Then he calls for an ambulance and goes to hospital and cleans himself up - the nurses refuse to do it now.

I asked for an ambulance but realised, at this time of day, I was unlikely to get one soon. Other crews would know this guy and I thought about my options. I didn't really have any. I wrapped him in a blanket (which will be burned I hope) and put him in the car. I drove him to hospital with the windows open.

I can still smell him on my uniform.

Be safe.

Friday, 30 March 2007

New Stuff

I've been away doing other business-type things. Am back on duty soon.

I have added a new feature to the site, the blog community thingy (scroll down, you'll see it). Join if you can, then I can see the 'regular' readers amongst you. I haven't actually read all about how it works yet but I'm sure it's safe!

And can I remind you that the little voting feature is perfectly secure and private! I can't see inside your house with the Google map! It's an approximate location only. If you do or say something illegal then I can always track your IP address, right? :-)

I've also had one person (ambulance service) complain about how graphic I am. I didn't publish the comment because, as you know, they get messy and pointless after a while. I have considered what was said though and I am sure of 2 things:

1. I have cut RIGHT back on my graphic descriptions of bad jobs. The description I gave of recent horror jobs was very diluted, I can assure you.

2. I completely understand patient confidentiality and have studied it in some depth, so don't worry about that. This blog complies with all stated internal and legal policies on the definition of patient confidentiality. Next time you are chatting to your girlfriend or boyfriend about a job, you should consider the definition of patient confidentiality.

If you have a 'negative' comment to make, please feel free but DO NOT get personal or insulting, especially if you are hiding behind anonymous. If you know who I am I much prefer a level playing field. Come and talk to me.

Right. Back to work.

Be safe.

Monday, 26 March 2007

Recharging the batteries

Four emergency calls, no conveys.

A 12 hour shift can really drag on when there's not much to do. The general public (drunk and sober) have been leaving us alone for a while - making up for the busy Saturday night, no doubt. It was nice to have a break from the frantic pace of the weekend but its also problematic because you just never know when you will get a call, so you can't settle down with a good book (well I can't anyway) or indulge in other time-wasting pastimes. Years ago, and not that long ago in fact, stations had pool or snooker tables in the mess room. A quiet spell was predictable and a game or two could be played whilst on duty. The tables have gone from most stations - retired as props and storage tables. Ornaments of a lost calm.

So I sat and watched telly and chatted with colleagues.

I did do some work though...

I went to attend a 3-year-old who was fitting. When I arrived the crew were following behind. We all piled out and up to the flat where the child was lying on a sofa, surrounded by concerned children and adults. He had been febrile, that's all. It's common in young children and can lead to a convulsion if the body temperature goes above 101.3f. He was recovering and doing what recovering children do - crying. Its a good sign.

We reassured the mother and bundled everyone who was interested into the ambulance. I said my farewells and greened up. Then I was sent to a 'man vomiting in the street'. I wondered why.

I arrived on scene and was waved over by a man who had been standing at the bus stop where the vomiting man lay across a bench. He had deposited two large and very chunky mounds of sick onto the pavement, as you do, and was now resting quietly on the bench without a care in the world. I approached and asked him his name. I asked him what he was doing there and he gave me his home address. This is how it went and continued even when the crew, who I had tried to cancel, arrived.

"Are you drunk?"

"Yes", then he gives his home address.

"Why don't you get a bus or taxi home?"

" ", he gives his home address.

"You can't lie there all night, we will have to get the police to move you on".

"Take me to.." home address again.

"We are NOT a taxi service!"

"I know but can you take me to..." home address.

I didn't even understand where his home address was. I mistook it for somewhere in North London but then I discovered he was French and, although he spoke some English, he preferred French. Funny that.

My French is rusty but the crew's was non-existent, so I pitched in with a few well chosen and probably badly constructed phrases and I got his proper address. See, you can use what you learned in school. He lived south of the river in fact.

The crew kept him occupied and periodically told him off for spitting at their feet, unintentionally I'm sure but still very bad manners, whilst I busied myself looking for a taxi. I hoped I could get one to take him home (he had the money for his fare). I was beaten, not literally, by the police who turned up, at our earlier request, to deal with him. They remonstrated with him and took a mere 3 minutes to shoo him away to Oxford Circus where he would, hopefully, fall into a cab and get home. Vive la France!

Then I wandered down to the square and sat people-watching as usual. No sweets or Manilow remarks tonight; different crowd. However, I did notice a teenager walking from point to point with a little dog on a leash and a cup in his hand (the boy, not the dog - dogs don't have hands). He was begging from anyone and everyone (except me) but nobody noticed him. Now I know there is only so much compassion a person can give when busily getting home, or to the cinema or theatre but to walk through a young man who is obviously down on his luck, well that's no good for humanity, is it? Give him 10p or something. Look at him and say no but don't just walk on and ignore his presence. The poor sod made no headway at all as I watched him. It occurred to me that his dog will be walking to heel off the leash in a few years if things don't improve.

I went back to the station and had my break. I ate my little packed lunch and had some grapes. I love grapes. Then I was summoned to a dodgy estate for a man who had difficulty breathing. I went to the wrong gate of the relevant block of flats and the ambulance arrived before I could get in to see the patient. It didn't matter anyway because he was round the other side of the building, where the entrance was, waiting for us in the street. He didn't look particularly out of breath when he jumped in the back of the ambulance. I did say summoned, didn't I?

The only potentially serious call I got all night was for a diabetic man who was unconscious but even that turned out to be a turkey. I went into the house and he was sitting on the sofa with his eyes shut. He opened them when I spoke and he was quite conscious, I can tell you. Not only that but he didn't have any complaints about his diabetes, all he had was a niggling neck pain. Hmm.

The crew arrived and took him away. Don't worry, I checked his BM before I became presumptious. It was a little high but nothing to be concerned about, certainly not high enough to merit an emergency response. Still, we were having a quiet night so nobody complained.

After that I sat around watching telly and rested my eyes. I felt guilty about not doing anything but that passed and I decided I needed the battery re-charge, as did my colleagues.

I have been trying to get some news about the hit and run girl but haven't had any luck. She was taken to a hospital that I don't go to often and so I can't go over there to find out personally. I have asked my contacts to find out for me. This is an issue for us. We don't get told how our patients are doing, we get no updates or outcomes, unless the patient wants to thank us or there is an enquiry. Poor show I think.

Oh and I will remember those Kiev photos soon!

Be safe.

Sunday, 25 March 2007


Ten emergency calls; 2 running calls and 2 conveyed.

The weather doesn't even have to be much of a factor anymore. If it's Saturday night, people are gonna go out and get as drunk and as stupid as they possibly can. Young females will wear the shortest of skirts (if at all) and the guys will wear a shirt over jeans, even if its only 10 degrees. I was always taught 'never cast a cloot til May's oot', which roughly translated means don't start stripping off until the month of May has finished, then its Summer. Mind you, that applied more in Scotland where Summer tends to come when it suits - like August.

My first job dragged me down South of the river to a collapse ? cause. I arrived to find a bystander with a man of considerable girth who was lying in an alley on a large estate. I had to use my torch to see what he looked like - these places are never lit properly. He was asking to go to a specific hospital and when that happens I know that we are probably not dealing with a dire emergency. The crew arrived and we all hoisted him up and shuffled him into the ambulance. I didn't spend too long getting to know the ins and outs of his condition but I suspect he just wanted to be somewhere warmer and safer than here. So did I.

As I made my way back towards the river and Central London, I was given a job just around the corner in SE-nearlymadeit. It was to a stabbing - 'male stabbed in head by schitzophrenic person'. Lovely. I saw a police van screaming off in that general direction and I called Control to ask if there was a police presence on scene. They told me to wait at a safe stand-by point and they would get back to me (that has never happened) and I told them I had seen the police go that way so I would trundle along and catch up with them. I got caught out however.

I turned a corner at a junction and found myself on scene, with no police, just a bunch of people at a bus stop looking up at the top floor of a 'known' building. I stopped the car and I could hear voices shouting down at me. The bus stop crowd looked at me and then back up again. I got out of the car, after I had told Control where I was, and the voices became faces attached to heads that were leaning out of the top floor window. They were shouting and gesturing for me to go up. I called back to them and told them I would have to wait for the police and I asked if the man with the weapon was still up there. They said no.

I prepared my bags and the police, thankfully, began to arrive. First one car, then another, then a few more. The noise of sirens became a cacophony in seconds.

The police rushed in and up the stairs, with me in tow. At the top floor - no lift and a million stairs - there were four noisy people inside a tiny little bedsit. One of them had been stabbed a number of times. I inspected the stab wound on his head, which was actively bleeding and dressed it quickly. I then worked systematically down his neck and chest and discovered another wound, quite a deep one, in his chest and another, less deep, in his back. He also had a wound on his arm, which was deep. The crew arrived quickly and I didn't get any further with my checks. They got him out of there and into the ambulance.

The patient was quite aware that he had wounds but he didn't have a clue how many. He didn't know he had been stabbed in the chest and that was potentially the most serious wound for him. He went to hospital in a stable condition and I have no doubt he will need stitches and possibly some repair to any damage caused to his lung.

This call unnerved me for the rest of the night because I was aware of how easy it is to be stabbed. On a separate call I was with a suicidal and very depressed man with chest pain. He was a big man and I was alone with him in his flat, surrounded by strange artwork, self-written poems and weird declarations adorning the walls. He also had a lot of condoms lying around. All the time I was checking him and talking to him I was planning an escape route in case he suddenly decided to attack me. Even with the stab vest on, I felt vulnerable. I don't usually feel like that and so it must have been the stabbing job that triggered this unease. It wasn't a particularly horrible job - as you know, I've seen much worse - it was the vulnerability of it. How easily it could be done. In seconds you could have a potentially fatal stab wound.

The man in the flat was no threat to me, I realised that when I had spent twenty minutes with him but I still didn't feel safe in that place.

I got a call to a frequent flyer who always complains of chest pain. As soon as the location of the call was given, I knew it would be him. Sure enough, there he was, sitting on the pavement, mobile phone to his ear as he clutched his chest and parodied pain in the worst possible way. He has no heart condition - he just has a problem with attention and not getting enough. I spoke of this man in an earlier posting and I told you he wouldn't catch me out again. Neither me nor the police (who also recognised him) were fooled. A crew came to pick him up anyway - we can't refuse an ambulance in these circumstances, especially with 'chest pain'.

While I was on that call, I was handed a running call by the police. They had a man with them who had sprained his thumb after falling in the road, in front of a bus. The bus driver had got out and shouted at him to get out of the way, the man had not responded and so the driver really shouted at him and the man actually wet himself with fear. The police handed him over to me and told me he was a deaf mute. That explains his reluctance to get off the road on demand. The poor bloke was scared stiff and I was happy to run him up to hospital in the car while our regular timewaster got an ambulance and two professionals to tend to his needs.

Whilst on stand-by I was offered a chocolate by a girl dressed as a devil (or maybe it was the devil). The chocolate eclairs were taped to her top and I had to pick one off. Cost me 50p.

I was also told by two middle-aged women that I looked like Barry Manilow. My nose took offence at this immediately! Barry Manilow...I don't think so!

Then I was off to an address in North London I couldn't find and when the ambulance arrived, neither could they. Eventually we got it and I wasn't required anyway. Good use of the service I think. All this for a 'man with swollen face, ? cause'.

An assault near the square and I was waiting almost 30 minutes for an ambulance. When everyone starts fighting, we get stretched very thin. The young man had allegedly been set upon by an angry man whose girlfriend had, allegedly, been insulted. He kicked and punched the young man, who was now lying on the pavement, then jumped on his head a couple of times for good measure - allegedly. Nice to see that once a man is down he is pretty much left alone.

My last call of the night was to a very upset young girl, again lying on the pavement, drunk and emotional and not at all interested in me or my kind words. She was quite rude to me in fact. Nevertheless, alcohol being everyone's enemy, I took her and her in-laws to hospital for a rest.

The news has been covering the story of an LAS employee who was set upon and beaten up on a train as he went to work. The reason? He was wearing his uniform. The future is NOT bright.

Be safe.

Saturday, 24 March 2007

Drunk Chinamen

Most of the time my colleagues and I will be attending the needs of the drunk and disorderly on a regular basis when the weekend starts (Thursday night - or Monday night if it's Summer). We ask them if they have had a drink tonight, sir/madam, and convince them that they can, (a) walk away - no harm done, (b) come with us to hospital and waste everyone's time and money or (c) get arrested for doing neither A nor B. Those options have always been offered to the 'usual suspects'. Recently, however, I have noticed a growing number of our Chinese friends getting in on the act.

My first call of the night was to a 'man cutting his head with glass'. He was seen acting in this erratic manner by police, who subsequently approached and told him to stop it. Then they called an ambulance because he must be mad if he is doing this, right? When I arrived I inspected the damage caused by the self-glassing. He had scratches on the top of his cranium - nothing to write home (to Poland, incidentally) about and certainly nothing to treat. He did go to hospital though, he had issues. He was depressed and had nowhere to live. As you know, I have a lot of sympathy for those in need of shelter, especially on a cold night but I wondered why he wanted to be in this country at all if he couldn't survive. Surely he had family and friends at home?

On my way back to the station I saw a mob of skaters (the roller-blade type, it wasn't that cold) scooting down Charing Cross Road. It looked like they were either demonstrating their constitutional right to skate down the middle of a busy and dangerous road or they were mutually lost.

Then a call to an unconscious 16 year-old female. She was lying in the street with her personal belongings scattered around her. On closer inspection, her belongings consisted of far too many condoms for a young lady. She didn't look as young as sixteen but she was either an enthusiastic collector of condoms, very sexually active, or a working girl. She was drunk or stoned or both and needed to be scraped off the pavement by myself and the attending crew. When I had done what was required of me, I sat in the car doing my paperwork. I heard a crash and a raised voice and looked up to see a young Chinese man punching the air and pushing into the street crowds. He had just upset some rubbish bins and was aggressively laying into anything inanimate that obstructed his path. I watched him disappear into Chinatown.

What is it with parents who let their kids out late in dangerous parts of town? I saw a little gang of ten-year-olds wandering around Leicester Square well after midnight. No adult supervision. No safe guidance. Not enough clothes on and way too many creepy blokes wandering around in the same arena with them. I would be worried sick if my young daughter was out this late. Am I old fashioned or am I making sense?

As I sat on the Square wondering what the world was coming to and imagining the licensing system that we needed for parenting in the future, I received a call for an 'unconscious female'. The location was nearby so it took me a minute to get there. I arrived to find four Christian leaflet distributors gathered around an intoxicated lady who was crouching and crying in the doorway of a restuarant. She told me she didn't want me there as soon as I opened my mouth to say hello and so I called Control and cancelled the ambulance. I wasn't wasting any time with this if I didn't have to. The Christians told me that she had been here for a while and that she was not well. I suggested she was just panicking and drunk but the Christians were not convinced.

"She has a fever", the tall lady Christian said

"How do you know madam, do you have a thermometer?", I asked (politely of course)

"No but she must be ill"

"She is panicking and hyperventilating, that's all."

I wasn't going to have a stand-up debate in the street and besides, there were more Christians than Scotsmen on scene and I know when I'm beat! I persuaded them all that I was in control now and that there was nothing to see here. I thanked them, they thanked me and off they went to drum up more business for Jesus.

It turns out the woman had lost her friend and her wallet had gone missing in a club. She was a very fragile soul with other issues going on in her life, as she confessed later. She had been drinking and that never helps when you are already depressed, so she was crying and hyperventilating and all she needed was a quiet voice and a bit of reassurance. I had the restaurant open its now locked doors so that she could use the loo and she became much calmer after that. We sat and chatted and she decided to use her Oyster card to get the bus home. That, for me, was a successful call and it didn't cost the taxpayer much either.

I sat with my beloved paperwork and I noticed, out the corner of my eye, that a cyclist had stopped at the passenger side window to look in at me. I wound the window down and he nodded and smiled.

"London's too dangerous now", he said, "too many nutters - they're all mad".

As he cycled off at a 45 degree angle across the haymarket traffic, I had to agree.

I spent the shift with a plaster on my thumb because I sliced it open on something earlier and it wouldn't stop bleeding. Annoying little paper-cut. Plasters are rubbish these days, there's hardly enough adhesive on them to keep them stuck. Thankfully, I'm a 24-hour healer :-)

On my way back to base I drove across Waterloo bridge and saw another drunk Chinaman. He was hanging over the bridge, waving at the water and shouting (I assume) obscenities at the boats. I see a trend developing.

Be safe.

Wednesday, 21 March 2007

Acts of God

Four emergency calls, one green2, 2 conveyed and 3 ambulances required.

This is what fell on a young woman from about 12 feet as she went to work in Oxford Street.

It missed her head only because she put her hands up in time and stood away quickly enough to avoid serious injury. When I got there the solo motorbike paramedic was attending and she was already sitting up, talking to him. She was very shaken, as you can imagine, but nonetheless virtually unscathed. She went to hospital to be checked out. She had back pain (non-cervical) in the area where the sign had landed on her but otherwise she was ok. Lucky her.

Later I was called to a woman who had fallen down about 20 steps in an underground station. The call had come in describing 'serious bleeding' from a head injury but when I got there I could see that this wasn't the case. For a completely separate reason the London Fire Brigade (LFB) were also on scene and when I approached and saw their trucks parked outside, beacons flashing, I thought I might be entering a major incident. It just so happens that the lady slipped and fell down the stairs just as the evacuation alarm was sounding! No bombs went off and we weren't burned to death while I was there so I am assuming it was all a false alarm.

She had a cut above her eye and the eye was beginning to swell. I dressed the wound, did all my usual ABCD checks and waited for an ambulance. Communications this far down are non-existent for me, nothing has been done since 7/7 about our ability to send for help from underground (and in some places, overground). I had to rely on the underground staff and the attending Police Community Support Officer (CPSO) using radios to get a message to my Control. When I got a reply I was told that there were no ambulances available and no ETA given to expect one.

Initiative time. I had fully assessed her and had spent 20 minutes getting to know her life story. She had heard most of my worst jokes and now it was time to move. She was happy to get up, with support, and walk up to street level and I was happy to get her out of there. I asked the CPSO to call my Control and tell them to cancel any ambulance they might be sending now and that I was taking her myself.

We walked her all the way up to street level without incident and as we reached the top, we heard an ambulance siren. Control had sent one anyway. Communications gone awry. It turns out the crew were told to get a move on because it was a dire emergency. Not really. She had a dressing on her head and was smiling and joking with us all the way up the stairs. My jokes were the only dire things of note. That crew could and should have been sent to something more worth their while, never mind the risk they may have taken on blue lights through heavy traffic to get there. Still, I'm not here to moan - just making a point.

Then it was the turn of the mad, foreign and drunk people of London. I arrived on scene expecting an unconscious man who had been hit by a car; that was the call description anyway. My motorcyle colleague was there ahead of me and I assisted where I could. Truth is the patient was out of his head on something - alcohol and possibly something else. He had strolled across the road while traffic was moving, not being hit on his first crossing by sheer luck, only to walk head-first into a van that was travelling along the road when he crossed onto the next section. What an idiot. The van driver was really concerned about him. He felt guilty. Meanwhile, the drunk and barely injured Polish man jibbered about the mark on his face left by the van. He stopped making sense when the police arrived but was happy to talk a little about his experience when anyone in green was with him.

He went to hospital for a check-up but I think they probably found him disagreeable and chucked him out for being disorderly at some point.

Oh, as an aside, I am placing little polls on the blog every now and then. I would like you to participate in the one I have here now because it will give me an idea of the reader number. You can only vote once and, although the map shows where the votes come from, it doesn't actually identify your house - so don't worry!

My last notable call of the day was for a middle-aged lady who had slipped on cobbles, fallen and broken her wrist, probably in more than one place from what I saw. It was very badly out of line and I think both the radius and ulna were affected. She was in a LOT of pain. She got entonox and then morphine and plenty of TLC and some of my best crap jokes. She must have liked all that because she still had a sense of humour by the time I got her to hospital, where she tried to faint, thus ruining the whole plan.

Be safe.

Tuesday, 20 March 2007

Busking opera

Glasgow: a man walks into a baker's shop, points to an item on display and says "Is that a donut, or a meringue?" The baker looks at the item, looks at the man and replies "Naw, yer right. It's a meringue".

Three emergencies and one green2. Three conveyed and one assisted.

I attended a woman who had allegedly been assaulted in the course of a robbery at the donut shop where she works. It happened in the centre of town, in broad daylight and the thief made off with a paltry £5 after shoving the woman so that he could reach into the till. She had no injuries but was badly shaken up, as you can imagine. This was given on the MDT as 'shock' and therefore the reason to call an ambulance - also the reason for a blue light response. The word shock is commonly misused to describe an emotional state, rather than its proper description for a lack of perfusion to the body's tissues.

I took the woman to hospital so that she could recover from her ordeal. Only then did I discover that the person who allegedly stole the money had been in his 60's, confused and somewhat disturbed (he had accused the staff of various things out of the blue). He sounded mentally ill to me and that diminished the crime somewhat. I know, he could have been just as dangerous and its not nice to experience that sort of threatening behaviour but its a distance from a teenage thug climbing over the counter with malice.

The shift before this had been reasonably quiet; the weather being a factor - snow, sleet, sunshine, snow...more snow. Global warming, here it comes.

I attended a young lady who had fainted on the underground (on the train) and was now recovering in the station office. London Underground staff are very good, generally speaking, at dealing with first aid problems and will do all they can, including shutting down the platform, to help. I have had to resuscitate a number of people whilst trains were coming in and unloading passengers around me. Having the staff shut down a section makes the job easier.

Anyway, the young lady recovered perfectly well and I took her to hospital so that she could rest and be checked out before she travelled again - just in case.

Then off I went to deal with a 2 year old who had fallen, sustaining 'head injuries'. When I arrived on scene I was greeted by three single mums and their broods, all contained in a tiny little front room in a tiny little flat...on the top floor (where else?). The child in question stared up at me as I walked in and greeted them. He had a split lip. Even the nurse at the receiving hospital had a go at the mother for calling an ambulance for this. Personally, I wasn't bothered. If I can extend the courtesy to picking up drunks on a Friday night, I can smile and be pleasant for a mother who hasn't got a clue. Anyway, the sight of the blood and nagging doubts about the degree of the child's injury may have prompted her to call. Or maybe her friends made her do it. Or maybe she doesn't have a car and can't afford a taxi. Did I mention that the hospital was a five minute bus ride away?

For the the last few hours of my shift I did a service run and didn't carry out any patient care at all. Only in the last hour did I have to rush to someone's aid. A grazed pair of knees in South London. She had been running for a bus, both arms laden with the week's (day's?) shopping and she fell, landing heavily on her knees. The Community Police Service officers who were on scene insisted that an ambulance be called to assess the damage. Hmmm. I arrived, I assessed, I cancelled any other resource and I bundled her into a taxi and she went home with a smile on her face and a couple of scratches on her pins.

My time on the car has been extended again and I am hoping to stay on it but that will be up to the powers that be. With Summer just around the corner (if it doesn't keep snowing), I am looking forward to my short periods of down-time on stand-by. In one of the rare bursts of sunshine today I stood beside the car on Trafalgar Square and watched a slim, red high-heeled opera singer busking for money. She sang beautifully and was probably (I thought) between jobs at the moment. It was the most pleasant sound I had heard that day. I didn't give her any money though - I didn't have any.

Be safe.

Friday, 16 March 2007

A night on the town

Before the hit and run incident I had been working my way through a busy and fairly routine shift. It started with a call to a flat in which a young woman was fitting. She wasn't epileptic and she certainly didn't look like she was having an epileptic episode. Most of the spasm jerking her body was in her diaphragm and larynx - she was hyperventilating as a result and looked like she was having the world's worst panic attack.

I gave her Oxygen and a calm voice (I can do calm voices, really) but it didn't make much difference. I wasn't even going to consider drugs because this was an undiagnosed and still unknown problem so it was more Oxygen and more TLC until the ambulance crew arrived.

Pretty soon the woman was being bombarded with calming voices and seemed to be responding a little. She wasn't in any critical trouble but it must have been very tiring doing what she was doing on that kitchen floor. Her boyfriend was with her and told us they had been arguing earlier and that she had just fallen down like this soon after.

I checked her blood sugar and it was a little low, certainly lower than normal (I discussed low blood glucose sensitivity in an entry last year). We gave her a little ice cream, which was allowed to melt. It brought her BM up to normal but her condition barely changed so the crew carefully walked her to the ambulance where she checked more thoroughly. I had taken her temperature earlier too and it was a little high. I wondered if she had an infection, possibly a UTI, triggering a dystonic reaction. There was also the possibility of a psychiatric link.

As I sat in the car completing my paperwork, a plain clothes police officer flashed his warrant card at me and asked if everything was alright. He had heard the couple arguing earlier and now that we were on scene was concerned that it had escalated. I assured him that it hadn't and he moved along because there was nothing to see here.

FRED, our electronic despatch system, was going mad tonight. I heard at least five FRU's call in to complain about the distance they were expected to travel (up to 8 miles) for calls, knowing full well they would never make it in 8 minutes.

I drove through Parliament Square to a call and there was a big anti-war rally going on. Lots of police around. Somehow it didn't make me feel any safer.

Then a call to a DIB, which turned out to be a woman who felt she couldn't breathe, burped and then felt better. It had happened before to her. You and the rest of us, I thought. An ambulance and a car for that little emergency. Still, she pays her taxes I suppose. After that call I was asked to attend a chest pain but when I got there I went to the wrong flat (the arriving crew knew the patient and I watched them go to the other side of the building in a confident manner). Eventually I caught up and walked in to a fag-smoking frequent flyer who was explaining his predicament to the paramedic who knew him better than I did. I wasn't required so off I went.

I sat on standy-by in Leicester Square for a short while and met a newly homeless person. A young man who had just been turfed out by his landlord. He was walking the Square with a little suitcase and little else. He asked me for a blanket and I gave him one of the new BIG size foil blankets I have in the car. I give these out whenever I see someone homeless and cold. I'm sure my bosses won't complain. If they do, I'll pay for them myself.

I advised the homeless man to stick to well lit areas and try to establish a patch to sleep in where somebody else won't object. The risk of a beating is high if you encroach on someone else's sleeping territory. He thanked me and shuffled off, looking for shelter.

Some friends aren't worth having. I attended a petite young girl (I think she was a dancer), who had been abondoned unconscious in a pub toilet by her mates. She looked about 13 years old, although her ID said otherwise. She wouldn't respond at all and had clearly consumed enough alcohol to accomplish her mission, if her mission was to knock herself out. When the crew arrived we lifted her to her feet and walked/dragged her out to a place of safety - the ambulance, thence (I like that word :-)) to another place of safety - the hospital.

The MDT led me astray again tonight. I went to the location indicated only to find that it wasn't near the actual location. I called it in and was sent further up the road to be met by a waving woman (we call people who wave at us windmills, especially if they use both arms). She was very Irish and very loud. Even I couldn't work my way through the accent in front of the words she used. I asked her to repeat everything three times - nothing to do with my deafness!

Her husband had been coughing up blood and I quickly discovered why. He had been diagnosed with a chest infection two weeks earlier, had been given the appropriate antibiotics and had decided he didn't need them after all. His condition had deteriorated while the remedy stared at him from its home in its little box on the bedside table. He preferred to smoke than take tablets.

Just before my night became a nightmare, I watched as a drunken female harrassed my friend and his neighbour as they slept, or tried to sleep, in the cinema doorway. I walked up to her and she shooed herself away. Good girl. Then an old man walked past me with a bright pink bag from which a stuffed rabbit protruded, it's head mocking me and its floppy ears reminding me that I was getting tired. If I sat on stand-by long enough I think I would see too much weird stuff and would turn.

Be safe.

Calling it

One of the most difficult decisions we can make is whether or not to continue a resuscitation. It may not be in the best interests of the patient or their family to continue the almost barbaric activity we call CPR, especially when there is little evidence of a recovery. Calling a resus is an emotional bridge to cross for any paramedic.

I didn't sleep well at all today and I set off for my last night shift with a heavy heart after my previous job. This one affected me a lot I think and so I found it difficult to set my wheels in motion for any crisis that may arise tonight. Unfortunately, as is usually the case, God rolled me another loaded dice.

My second call of the shift was to an elderly woman 'believed to be dead'. I asked Control to clarify this. Was I going to carry out a ROLE (Recognition of Life Extinct), or was I facing a resuscitation? The latter applied. A crew were just about on scene and I was a couple of minutes behind them.

I went into the house and up to the bedroom where she lay in bed. She certainly looked as if she had passed on but she wasn't cold and the family confirmed that she had been seen alive within ten minutes of the 999 call being made. We had to begin resus and so we set about laying her on the floor and getting our respective jobs sorted out. I prepared my drugs and I&I kits but I also wrote down the start time for the CPR; I was preparing myself for a decision in the near future. Nobody else was coming and so it was up to me this time.

The crew I was working with were excellent. We went through the appropriate protocols and we spent 20 minutes attempting to save this woman but her airway was full of blood and that meant she had a serious underlying problem - the one that killed her probably. Apparently (and allegedly) her GP had been told by her family that she was having back pains and couldn't move. She was listless all the time and had no energy. So he telephoned the relatives back later on with a diagnosis (UTI) and a prescription to be collected at their convenience! How the hell does that work?

After 20 minutes and a serious attempt to save her (the crew worked til they sweated on those compressions), I stopped the drugs and called it. I gave a time and asked the crew if they agreed. They did. We could have taken this lady to hospital, resuscitating her all the way but it was agreed among us that dignity was important here and she should be left at home with her family. It was the right thing to do and I am glad that the guys I worked with suggested and supported this decision. It was also the hardest thing I have done for a long time. Now the husband and son had to be told. One of the EMT's broke the news and I spoke to the husband.

"We did all we could, I'm sorry". I don't know how that sounds from their perspective.

Both men had their quiet moments and we began clearing up our mess and preparing the lady for viewing by the relatives and the police, who would now have to be called. I removed the endotracheal tube that I had inserted and I took out the cannula from her arm. She was cleaned with a damp cloth and we replaced her body in the bed, with pillows under her head and a quilt over her. I closed her eyes and left the room to do the necessary paperwork.

I left the scene about an hour later. The crew stayed on to liaise with the police, who had arrived shortly before I went. I completed my PRF and drove off, Green Mobile.

The FRU desk sent me on a couple of routine errands. I collected a colleague and took her back to the station as her shift had ended (a minor injury) and I got some diesel for an ambulance that had run out (!) - shouldn't happen but sometimes does. I think they were trying to give me some time off from 'heavy' jobs. Last night and tonight were beginning to take their toll so the change in pace helped me a lot. Thanks guys.

I also attended a couple of routine jobs; a regular with leg and arm pain and a need for hospital company at 3am and a febrile baby boy who recovered completely by the time I arrived at his home. He didn't appreciate the thermometer in his ear one little bit. I decided that was pretty much the end of my obs. as far he was concerned! Now he was waving and smiling at me. You should be in bed asleep young man!

Earlier, an obnoxious and unco-operative polish man gave me and the attending crew a hard time by not speaking any English but fully understanding it when it suited him and generally being obstructive when we tried to help him. Language Line was used to establish as much information in a three-way conversation as possible but he simply lolled about feigning chest pain and groaning (in Polish). He was homeless and he needed a hospital bed for the night. Why didn't he just ask? Incidentally, his chest pain disappeared when he spoke Polish to the person on the phone from Language Line. It only ever re-appeared when we spoke to him. I can spot a kidder a mile off and he was only a few feet away. I wasn't really in the mood for him to be honest.

I promise I will catch up with all the other stuff I'm due to report but I can tell you that the young woman who was hit by the car is in Intensive Care. I believe she is still in a serious condition but she had surgery so that may be a good sign. I'll keep you posted.

Be safe.

Thursday, 15 March 2007

Hit and run

I spoke too soon. The end of the shift was looming and I was at the station when my phone went. I had a call on my MDT in the car. I wandered out and found the MDT shut down (low power does that). I re-booted the system, which takes forever, and called Control to let them know I wasn't yet rolling to the job because I had no details.

The system restarted as I moved off and it was a call to a RTC at a normally very busy road in Central London, although at this time of the day the rush hour would be getting off to a slow start. The call details also stated "vehicle vs ped. - ?inj"; nothing could be further from the truth.

I arrived at the top of the road in question and found it cordoned by the police. This meant that it was a serious incident, not the 'possibly drunk and has no injuries after bumping lightly into a parked vehicle' that I thought it was going to be. I continued down the road until I got to the scene. There was an ambulance in attendance but I couldn't see the crew or the casualty. Two buses were blocking my access to the area and the bus drivers, who were parked side by side across the entire road, were having a conversation and not paying any attention to my flashing blue lights or my cold stare. I sounded my siren and they looked. A police officer waved one of the buses out of my way and I proceeded around the wrong side of the road to the accident scene.

I parked up and glanced over my shoulder at the road behind me. One of my colleagues was attending to a casualty on the ground. Then I realised what I was seeing. A young woman, in her early twenties, lay in the middle of the road with a large pool of blood around her. She was stripped of her clothing, which was blood-soaked and my colleague was at her head, his crew mate rushing to the ambulance for equipment.

I got out and ran over to them. She was in serious trouble. She had a massive obvious head injury. She lay there and her legs and arms moved in a grotesque slow-motion mime for help. I have no idea whether she understood what was happening to her or not, all I know is that she squeezed my hand once when I spoke to her but didn't respond like that again afterwards.

Someone had hit her hard and had left the scene. A coward with a car as a weapon had wiped this young girl's future out in a split second and didn't have the guts to stay and help her. Nobody witnessed this apparently and she must have been lying in the middle of that road for God knows how long, with the entire left side of her face obliterated and her life bleeding onto the street, until somebody saw her and called for help.

All her personal belongings were strewn around her and we worked frantically on her to keep her alive. Another FRU arrived and the four of us gathered her up in the scoop and got her into the ambulance. I had called for a Delta Alpha (emergency doctor) to attend but it was going to take too long. If this had happened a few hours later, she would have had the benefit of the Helicopter team (HEMS) but she had us and we weren't waiting.

In the ambulance fluids were given and, as well as her more obvious injuries, a left side pneumothorax was identified. An attempt was made to de-compress but it was too difficult to deal with immediately, so it was decompressed successfully at hospital - we use a large bore needle, inserted into the chest to get the air out of the chest cavity - this allows the lung to re-inflate and is a potentially life-saving technique.

She was fighting for her life and continued to breathe, albeit agonally, until she got to hospital. There she was put to sleep and intubated (RSI) so that her breathing could be managed properly. This is what we needed done on scene but there was no time to wait. When I left she was still being worked on and I have no idea whether she will survive. If I was to be honest, I expected her to be dead on scene when I saw the extent of her head injury but miraculously she stayed alive and hung on until she could get the best possible chance of survival at hospital. I will find out what happens to this young woman for you and report back.

My FRU colleague gave me a lift back to the scene (my car was left there whilst I worked with the other paramedic in the ambulance) and I looked at the mess that was left behind. The entire street was cordoned off and no doubt there will be traffic chaos right about now as I'm writing this but I don't care. I am angry that I have, yet again, witnessed the lowest form of human cowardice.

If you are a young driver (especially if you are male), let me tell you something - you can't really drive. You think you can and you will convince yourself that you are the world's best driver but you need years behind the wheel - decades - and you need further training to become a good driver. I don't mean a good fast driver, I'm talking about seeing whilst driving. Ambulance professionals receive weeks of intense training to be able to drive the way we do and a lot of it involves forward thinking and really seeing what is going on as you approach at speed. Even then it is possible to make a stupid mistake. Possible but much less likely. Please don't drive away from the scene of any accident you may cause. Please face the music and help anyone you may have hurt. A world of pain is left behind for everyone involved when you hit and run.

If I find out the driver of the vehicle that destroyed this young woman's life was on a mobile phone I will string him up myself.

I had a lot of other things to say about other jobs tonight but it all seems pale and irrelevant at the moment. I'll catch up later. I'm going to sleep now.

Be safe.

Wednesday, 14 March 2007

Killing time

A very quiet night shift. I attended four calls in twelve hours. Two of them were stumbled upon, so officially I was only sent to two.

We have TV and we have DVD's and we have a big sofa, so we needn't get bored, but I do. I need to be active and I find these long shifts tedious if it's quiet out there. I'm not moaning about it per se, I'm sure I'll be writing about how manic it is and how I never seem to get a cup of coffee soon (probably the next posting) but a night shift can seem to last two nights when you are sitting around or patrolling the area looking for trouble.

My official calls were to a cut lip - the result of a collision between a cyclist and a pedestrian and an alcoholic who claimed to have downed nearly 40 paracetamol with his liquid diet for the day. I cancelled the ambulance on both calls and felt guilty in case the crews really wanted something to do and I had robbed them of the opportunity. They may have been much busier than me but it seemed like a slow night all round.

I stumbled upon a head injury in the West End when I was making my way back after one of those calls. Another crew were in attendance but there were two casualties, the result of a recent fight. I offered my assistance and it was accepted. I called it in and attended to the man with the head injury. He had been viciously slashed across the head and face with some kind of sharp object and had three fairly nasty looking wounds to be treated. Both casualties were taken to hospital in the same ambulance and my involvement ended there.

My second accidental job was to a cold, hungry vagrant who had wandered into a phone box and called an ambulance for chest pain. I was patrolling around and got an eyeful of bright light from a police officer's torch as he attempted to catch my attention. I nearly crashed the car.
The man was walking and talking and exhibited no sign of chest pain at all. He didn't refer to it unless it was mentioned.

"Do you have chest pain?"


Then later...

"Do you still have chest pain?"

"Eh? What chest pain?"

Otherwise, he was just lonely and hadn't eaten for three days. Luckily (for him) I had just bought a packet of cake slices (look away now if you are on a diet) and so I offered him one. He wolfed it down. I offered him another. Ditto. I stopped at that point because I really wanted to eat at least one of those cakes myself.

Oh yes, I did all the obs and found nothing untoward and yes, I know that people have heart attacks where there is no real evidence of chest pain or failing vital signs but I used common sense again. It's a tool I will use whenever I feel it is appropriate. He was hungry and he was cold and he was homeless. That's it.

I took him to hospital and the nurse rolled her eyes to heaven when she saw me come in with him. He was put to bed and he slept, which is all he wanted.

Upside - I got to go home on time.

Be safe.

Monday, 12 March 2007

Choices, choices...

Pancreatitis. Not a funny condition at all. Very, very painful. If you suffer with it, you have my sympathy.

I attended four pancreatitis-related calls during my last run of shifts and one of them was particularly severe. The gentleman was in extreme pain. The sort of pain you know at-a-glance is not being put on, faked or exaggerated in any way, shape or form. He was as white as a sheet and sweating for England. He couldn't move without screaming out in agony.

I gave him morphine and he needed 10mg before he settled down. It took three attempts for me to get a cannula in him though. The first attempt was a rubbish vein (which I could have assessed better before attempting it), the second came out when he jumped up in a spasm of pain but the third stayed where it was needed and gave me access to his bloodstream for analgesia. I also had a clinical decision to make. There was no ambulance available just yet and I had to make the best of his stability whilst the morphine had an effect. So, while he was able to walk I took him to the car and sped to hospital with him. It took me 7 minutes. I may have waited up to 20 minutes otherwise. This was a green2, so low down on the priority for a vehicle.

I'm not going to whine about the system, it's pointless. Instead, I'm going to exercise my professional ability to make clinical decisions about conveying patients. I'll call it in - I always do - but if it's a choice between a patient waiting in pain and one that gets to definitive care quickly, then I will do it, provided there is no obvious risk to the patient. That's my job, isn't it?

I was asked to go and assess an elderly leukaemia patient who wasn't feeling well. She had an appointment at the hospital for treatment but didn't make it as far as the bus stop. I went to her home, where she had been waiting with a worried neighbour for 40 minutes (green2), and carried out a thorough assessment (I really need to consider doing my ECP training. I might as well). She wasn't well at all. Very low BP, pale, sweaty. Shocky. I contacted Control and asked that the call be upgraded because we had all been sitting in her little hallway for almost an hour now and I had run out of things I could actually do to help her. Even conversation tends to become stinted when there is nothing left of relevance to say. I could hardly discuss the telly with her in the state she was in.

The crew arrived and removed her to hospital as quickly as I would have done myself. Obviously, there was no way I was moving this lady by car - even though I was tempted. She couldn't walk and just didn't look like she was going to survive an upright journey.

I have touched on this clinical decision making subject before, I know, but I truly believe that it is why we are trained to think in the first place. Surely we are skilled enough to see the obvious and deal with it appropriately? None of it is about being better or best. It's all about the patient.

You may have noticed that I am now using links where relevant. I hope you don't mind this and find it useful. It saves me rambling away from my main point in order to explain something in greater detail. It's also a good educational tool if you need it!

I went to Kiev a few weeks ago (I know, I didn't tell you) - I was incognito. I spent a few days there discovering the old Soviet fingerprint of structure and architecture (which is pretty amazing) from the bad old days of the Cold War. I also went to learn some Russian and educate myself. I didn't know that there was a Russian language and a Ukranian language. You see, I learned tons. Anyway, I saw the ambulance pictured and thought you might be interested in seeing it.

I might publish a few more of the photo's I took (they won't be relevant to any entry but they will be pretty to look at!). You don't mind, do you?

будьте безопасны

Saturday, 10 March 2007

The good, the bad and the obnoxious

My second of three early shifts proved very busy. I dealt with a man with rheumatoid arthritis at a busy train station early in the morning. He was at work and it struck him suddenly, inflaming his knees, making him collapse onto the floor. He couldn't get up and an ambulance was called. He was in a lot of pain and I felt very sorry for him. I gave him entonox, which eased the discomfort and helped space him out a little, then I persuaded him to hobble to the car.

By the time I got him to hospital he was in less pain. His main grievance was the way in which his condition was being passed on as 'mysterious' by one doctor to another. He was being given pain killers but nothing else - not even a more definitive diagnosis. He is only 29.

Then I was asked to go a long way out of my sector to attend an elderly woman (91) who had fallen the day before and was now complaining of shoulder pain. I got to her rather smart flat in a leafy part of London and had just threatened the door with my knuckle when she opened it, ready to leave. I persuaded her back inside so that I could carry out an exam and chat to her first and she duly obliged. Some people, especially the active elderly, just want to get on with it and don't want to fuss around. She was that type and it doesn't bother me in the least but I have a pace I need to work at and I have to control the patient and the environment to a degree in order to get things done.

So, I asked her what had happened and she explained that she had fallen and hit her shoulder. She had broken the same shoulder a few years previously and it was 'playing up' again. I asked her if she knew what had made her fall and she told me she couldn't even remember falling. This is worrying. It suggests she is falling, possibly as a result of a medical problem, more often than she is telling me. They have specialist nurses for this problem in the elderly.

I checked her shoulder and it did look swollen and out of place. I left her arm as it was - I firmly believe in leaving simple fractures alone. If the patient is comfortable holding it themselves then I won't move it. I checked for a pulse and all the other stuff I needed to do. Apart from the visual change in shape, her limb was fine. She probably had a fracture but it was up to the hospital to determine that.

I took her blood pressure and found it to be quite low for her age. If her BP is consistently low, this may explain her fall. Her pulse was also quite slow. Otherwise she was quite able to get into the car and travel with me to hospital. This was a Green2 job and, unless I asked for one, no ambulance would come for this lady. It wasn't necessary anyway.

During the journey to hospital, I spotted a man standing on the corner of a busy junction with a big green parrott on his shoulder. The creature was nibbling his ear like a lover! I drew my patient's attention to it and she was just as amused as I was. We had a nice long conversation and she turned out to be a very sharp and well-tuned old lady. She was a miss; had never married and had no intention to. I wonder if all spinsters live to a good old age?

She had letters that needed posting, so I did that for her at the hospital once I had booked her in. It was a pleasure.

From there I was directed South of the river to a block of flats for a 'diabetic male, unconscious, hypo'. These calls tend to be straightforward. The person is either not diabetic nor unconscious, is diabetic but not unconscious, is diabetic and is unconscious.

I arrived on scene and took the lift to the millionth floor to find that he was diabetic and he was unconscious. I got some response to mild pain so it wasn't too bad. He was breathing noisily and his father told me he had not been eating properly. I began my obs and discovered my BM meter wasn't working properly. It was fine earlier but now it didn't want to play. Typical.

Fortunately, a crew arrived as I struggled to get the damned meter to oblige. Unfortunately, they had not brought theirs up with them as they had seen my car and assumed I knew what I was doing. The patient's dad brought his own (the patient's) meter in but it didn't work either. Now that worried me.

Just as I was about to treat as hypo anyway, my colleague managed to get my meter to play ball. His BM was 2.2 - too low. We had him on Oxygen and I injected 1mg of Glucagon into his arm. This hormone facilitates the release of stored glucose from the Liver. It takes about 10 to 20 minutes to work and will only be effective if there is any Glucose in the Liver at all.

Ten minutes later and luckily for us, he began to respond. He swore a LOT during his recovery but he was never physically aggressive. It took a full 20 minutes for his condition to improve enough for him to be lucid. He sat up in bed, wolfed down a chocolate bar and started sucking on those plastic nicotine things that supposedly stop you smoking. He was back to normal. His BM was now in the high 5's.

There remained the problem of future management, however. My colleague knew him more than I did and he was a fairly regular caller (well, he wasn't but his dad was). He was frequently going hypo and we all thought there must be a problem somewhere. It turns out that his Insulin dose may be far too high and so the crew stayed behind to arrange a visit from a GP to solve the problem. Otherwise, one of these calls is going to be for a dead diabetic.

Then what do you know? I am deep in the South and don't have a clue when I get a call for 'woman lying on pavement. Wants to sleep'. Yeah, wants to sleep it off I thought. I scooted to scene, pressed 'on scene' and realised I wasn't - the mapping system had sent me around the back of the shops on that particular High Street, so I had to adjust my position by means of U-turn and a short drive around the block.

I saw her lying on her side with two Community Officers standing with her. Not near her, just in the vicinity of her. I soon found out why. I went over to her and she stared right at me.

"Hello, what are you doing lying there?", I asked politely

"F**K off!", she replied (politely)

The conversation beyond that is full of expletives and ridiculous comments about her being Jewish and therefore surrounded by people who hate her. There I was, standing in a predominantly Black area of London, trying to see that connection.

She had downed at least two bottles of Vodka and was happily pouring it down her throat as she lay there abusing me and anyone who passed by. She even had a pop at a woman and child who walked past. I decided not to bother with this and to get reinforcements. I asked Control to send the police.

She was insistent on being taken home and, you know what? I would have done if she had been less abusive and annoying or had bothered to give her address. Every time I asked her where she lived I got a stoney look and a nonsensical answer.

The police arrived and she gave them the same treatment. They were getting nowhere until one of the Officers decided to lure her to the police van by holding her plastic bag, containing the Vodka bottles, in front of her. She followed it like a hypnotized sheep. She still wouldn't help with her address and so they arrested her for being drunk and disorderly.

I dealt with two seriously cut fingers today. Partial amputation is a more apt description for them. The first was at a building site where a young man had lifted a manhole cover and it had slipped, slicing his finger all the way through to the bone. It was still hanging on but only just. It had been well dressed by the site first aider, so I left it as it was and only saw the damage sustained when I got the patient to hospital. The second call for a finger injury came almost immediately after. This time it was a young woman, working in a fast food restaurant. She had sliced her finger through with a baguette knife. She was in a lot of pain and very distressed. Quite a bit of bleeding had occurred with this injury and she was looking a little pale. Both patients should hold on to their digits (no pun) and should recover fully.

My last job of the shift was to a pretty dancer who had twisted her ankle. She had a decent sprain and could only hobble to the car with assistance. See? The job isn't bad all the time!

Be safe.

Deal or no deal?

A new law has come into force which makes it illegal to obstruct emergency workers whilst they go about their duties. This act includes ambulance personnel. Anyone obstructing us from carrying out our duties can be arrested and faces a fine of up to £5,000. The reality is that when Mr. Joe Drunk stands in the way of progress he will probably be cited and slapped on the wrist (with a £50 fine). Still, at least now the law recognizes our need to be protected from the minority who enjoy being obtuse.

I got a nice long run down to SE16 to investigate a call made by a child from a phone box at a bus station. When I got there I couldn't see anyone or anything out of place. People standing around waiting for the bus to go to work. Kids going to school or bunking off and using public transport to do so (some of you probably walked nine miles to school without a complaint when you were young - no wonder our kids are so unfit).

I carried out two circuits of the general area and still nobody was interested. I felt like a salesman for the LAS; "Anyone want an ambulance?", "Come and get your free ambulance...anyone?" Na.

Itwas a time waster. No surprise there. When I read child and phone box together in one comment I don't hold my breath for it. Still, I did what was required of me and vacated the area as soon as I completed my paperwork; "Apparent hoax".

Then I was sent in the opposite direction to a dislocation at an underground station. I arrived to find a young woman sitting on a bench with a first aider. She had stumbled on the escalator and fallen onto her hand, bending her middle finger back so far that it dislocated at the extremity. The last bone in her finger was bent upwards. She could point at you and still be pointing to the sky. I hope that clarifies it.

She was in moderate pain and I did nothing, at her request. She held her own arm and I took her to hospital. Straightforward.

A severe anaphylactic reaction kept me busy with a crew later on in the morning. The young lady had reacted badly to flower pollen at work and was in severe respiratory distress when I arrived. After some basic obs to establish what her condition was, I put her on nebulised salbutamol, which would help keep her airways open. Of course, what she needed ultimately was an antihistamine but our aim is to stabilise the life threatening problems and so her ABC stuff was a priority for me. The hospital could deal with the longer term treatment for this condition.

The woman had administered her own Epipen injection but that had given her no relief. I have long argued that the dose of Epinephrine in one of these auto-injectors is too low to be effective. Indeed, in the ambulance I gave her a further 0.5mg of the hormone and it had an immediate effect; her breathing improved and she became less panicky. The Epipen delivers 0.3mg, if that, in a single bolus. I wonder if any of you have a perspective on this?

She was taken to hospital and was stable when she arrived.

I got another one of those purple plus jobs I hate. Maybe the word is dislike in this case because I didn't have to search and discover this one, the police were already on scene and had called us to confirm life extinct (they are not allowed to do this). I arrived at the same time as a crew from another sector and went into a messy, dark flat. He was kneeling, bent forward with his face down on the seat of a chair in his bedroom. There was a fair amount of blood on the floor and around his mouth and nose. At first I thought we may be dealing with a suspicious death, especially since I found smeared blood on his back when I examined him, but the police officer had checked him and it was her glove marks on his back. The blood was still quite runny and I'm sure this man had been dead for hours - there was rigor and he was very cold, so I wondered why the blood hadn't yet congealed as it should. It turns out he was on Warfarin. I completed the form pronouncing life extinct, liaised with the crew and left the scene to the police. I was glad to be out of there to be honest, I was beginning to notice all the things around him that made up his life. I find that more disturbing than death itself.

Remember that I am on the 'Amber car' and so not all of my calls are to potential life-threatening emergencies. For example, a regular caller - the man with jelly knees - asked me to take him to hospital as he couldn't walk. The fact that he was in a public place and had been walking all morning to reach his destination seemed to be irrelevant, regardless of the number of times I mentioned it. So I persuaded him that it wasn't a good idea to call us every time his knees got tired of walking. I still took him to hospital, he wanted to go and it was a five minute trip in the car.

Another call took me to a primary school where a 4 year old had bumped his head and was now 'sluggish'. Only when I got there did the staff tell me that he was normally 'sluggish'. The crew arrived soon after I did and, after getting his name wrong and shouting it at him a few times to get a response, I left them to it. Trust me, most kids who bump their heads survive. School staff are paranoid about getting it wrong and being sued by the parents. Shame on the parents for making them feel like that.

I got my break and sat on station watching Deal or No Deal (well, it was afternoon telly and who can resist?). The guy playing was very popular and had been on the panel for ages. It was his time now and he got three very generous offers, including a big £30,000 tempter. He had a fairly weak board at that point but he was confident and positive and a thoroughly good chap. I liked him myself. He refused the offer and went downhill like an ice-hockey puck on a frozen waterfall. He ended up with £1,000. I thought, this is real life. If this was a movie, he would have won everything at the very last minute and been a hero but he gambled and lost and that is what actually happens. He reminded me of every patient I had seen who had died or gone to hospital very ill because they refused to give in and call for help.

The end of my shift provided me with my smile moment. I got called to a '60 year old male, collapsed in street, possibly drunk'. I headed out and he was nowhere to be seen. I called it in and Control informed me that he had got up and caught a bus! This was very familiar. I waited for my next call and it came through ten minutes later; '60 year old male, collapsed with head injury'. This one came from about a mile further up the road. I called Control and suggested this was the same man as before. They agreed.

I arrived on scene to find a cycle responder at the side of a drunken, abusive man who was slumped on the pavement. He had a head injury. In fact, he had two head injuries. I told the responder that I suspected I had been called to this guy earlier. He asked the drunk two simple questions for me.

"How did you get here?"


"Where did you get the bus?"

"Regent Street"


He had fallen in Regent Street, bumped his head, had a sleep, then got up and scrambled onto a bus (somehow). Then he had alighted or been thrown off further up the road and had fallen down and bumped his head again. If we hadn't arrived and taken him to hospital for his own safety, he would be falling down and bumping his head all over London right now.

Be safe.

Tuesday, 6 March 2007

A two-way street

I wish the weather would make its mind up! I'm changing in and out of my jacket every ten minutes.

The tourists are flocking back and its getting busier out there. Manic even. I love the buzz of this city when its like this though. A nice atmosphere for work I think, even if working on the car means sitting on your own for long periods. I can listen to everyone around me happily clucking and chattering away as they go about their business or pleasure.

During the day I deal with all grades of call; green (non-emergency), amber and red. Obviously, as you know, these gradings don't always reflect the true nature of the call. A green2 can be a major emergency when you get there and a red1 can be a minor injury. The way the call is received, perceived and passed on is down to various factors: the caller's nationality, mental capacity, need for urgency, relative lack of common sense; the call-taker's ability to understand what is being said, their knowledge of terminology and spelling (!); the despatcher's experience and knowledge and his/her ability to communicate caution or otherwise to the crew.

Of course, I don't work in the EOC (Emergency Operations Centre) and so I may have made the whole thing sound simplistic but its how I envisage things (and I did spend a day there during my initial training - always a good idea). I have a healthy respect for them all down there and I get on very well with a few of them in particular. One or two will even bother to call me and discuss a job that is being sent. It means I don't bitch about how unfair they are being to me. If it's a distance I'll usually get a warning from them in person and a reason to go - not that I could refuse.

A number of EOC personnel read this diary and I hope they get a perspective from the other side as it were.

Explaining the EOC helps to explain my day. I got a call to a large department store for a male who could not feel his hands. That's it. No other explanation. I got there to discover that the young man had actually burned both his palms on a hot tray. He had minor contact burns and it was really nothing to worry about but the security staff had made the call and the details had been given is a very vague way. I mean, its a long way out to describe a couple of burned mittens as 'can't feel hands' over the phone when asked by the call-taker "what is the problem?"
You see what I mean? The call was given as an amber (if memory serves) and so an ambulance would normally be called as well as myself. That's a few more resources than are required for a first aid job. I cancelled the ambulance as soon as I saw the young man's poorly paws. Sometimes I feel my eyes rolling when I get to a call like this but it's part of the routine.

All morning I seemed to be the designated taxi service for the lost and the weary. I was called to a fast-food place to attend two young girls who claimed to have had their drink spiked the previous night and now 'could not move'. When I arrived they were slumped across the tables in this place as if they had become rag-dolls (remember Kevin the teenager?). The manager was not amused. One of them (the designated spokeswoman) told me that they had been with 'some bloke' and he had probably spiked their drink because they were feeling rough. I suggested two things to her:

1. Maybe they should be careful about making allegations unless they had proof.

2. Maybe the alcohol was making them feel rough.

The look of shock on this teenager's face was hilarious. I smiled and she decided I didn't know what planet I was on. After all, they had only had a few drinks each, according to the spokeswoman. I understand this as the common phrase used in such cases where either the effects of alcohol induce an inability to remember the first 5 drinks and drunks conveniently only remember the last 2 or 3, or the size of the 'few' drinks had been seriously underestimated, even though they had probably paid a tenner for each! That's a clue.

I did have a problem, however. These two weren't going to go away and leave me alone and they weren't fit to travel anywhere either. They were vulnerable, both being 17 (ish). I called control and spoke to my mate there who can authorise some of the decisions that I make. I used the 'place of safety' term, cancelled the ambulance (waste of resources) and took both of them home by request. I could have taken them to the local hospital but, again, I don't like wasting nursing staff time either and they just happened to live near the hospital so it was an easy decision. I logged my journey there, my arrival and the safe return of the two drunks girls to their block of flats. I watched them go inside and I left. Oh and I got them to sign my paperwork for good measure!

I am not paranoid about taking these little risks but I'm sure my colleagues would not approve if I didn't cover myself, which I believe I did. My safest option was to leave them where they were but that's just not nice. As a father myself, I wouldn't be happy to know that my child(ren) could have been taken home to safety but instead were left in the street because a uniformed public servant decided it wasn't worth the risk. Mind you, it did cross my mind that I would never have left my child(ren) to expose themselves to such harm overnight in the first place.

My next job was to a man who had collapsed on a park bench. It was raining hard when I arrived and the man claimed to be diabetic. He was very pale and so I carried out a BM in the rain. Tricky. His BM was normal, as were all his other obs. He then told me that he was prone to drop attacks and that this had just been another one and could I please take him home because he didn't want to go to hospital. He sounded very well rehearsed at this to me. His face was familiar too.

I called it in, cancelled the ambulance (after asking him three further times if this was his wish) and took him home. The address was a little out of my area of operation and when I got there he literally sprang out the door and took off. I asked control to flag the name and address in case he decided to use his next drop attack for a ride home again. That way, the crew can decide other courses of action for treatment, or not.

I got two jobs for the price of one at an underground station later on. The first was to an autistic man who had gone out for the night and got drunk and fell down, as you do. He was a lovely guy with a good sense of humour but he didn't have a clue where he was. Remember the guy on the bus last year? The one who was out on his own just to get away from his environment? He was doing the same. Same MO, different guy. I handed him over to the crew when they arrived - he wasn't fit to travel and needed to be safe somewhere.

The second patient was also in the vicinity and had been waiting for me to attend to her. She was being treated by other first responders who had arrived and been directed to her whilst I dealt with the autistic man. I was asked to give her pain relief because she had severe abdominal pain (gall bladder related). I went to her as soon as I could and delivered morphine as requested. This eased her pain enough so that she could be moved to the car and I took her and her husband to the hospital myself. I was down there (in the underground station) for about half an hour on those two jobs. I was hot and sweaty when I came up for air. Not pleasant.

An (?)asthmatic old lady who 'didn't like to fuss' and never went to the doctors or hospitals when she felt unwell had no choice this time. Her breathing was getting desperate and her sats were very low and falling as time went on. Her anxious family made the call because she refused to do so. I nebulised her and the crew arrived immediately and took over. She was treated with immense respect and gently taken to the ambulance. I have mentioned a few patients like this in the past but they are few and far between. Obviously its not nice to know that people will not want to cause a fuss and may suffer as a result when we could have helped but its nice to know that they exist and are genuine calls. It creates perspective and thus stability for us.

My last call of the shift was to another painful gall bladder patient. Gall bladders and buses, I wonder? I took him myself because he was stable enough and the hospital was only two minutes away.

Then the EOC left me alone to get on with my paperwork and make my way back to base and then home. A two way street, that's how I see it.

Be safe.

Saturday, 3 March 2007

National abdo pain day

My first of the day was a young woman who was in a lot of pain and my suspicion was that she probably had appendicitis. Tender, painful right lower abdomen with nausea and a high temperature pointed in that general diagnostic vicinity. All my other questions (you know the ones about being pregnant and going to the loo properly) drew a blank and it was a reasonable assumption but her pain was the priority and so I dealt with that whilst she sat on the floor of her workplace. I gave her a little morphine and waited for it to take effect. She didn't seem to like it though because she said she felt 'strange' and began to glaze over. She was going to faint. Her BP had dropped too quickly and so I set about reversing the effects of the morphine by giving her Narcan and that did the trick, although her pain score only dropped one point as a result.

When the crew arrived I explained what I had done and there was a concensus on the appendicitis theory but confusion over her reaction to such a small amount of morphine. It was entirely possible that the morph had nothing to do with her 'reaction'. Maybe her appendix had perforated. She was in a stable condition when she went to hospital but her BP remained low.

My next call was to...wait for abdo pain. Another young female. This time she was screaming out in pain and the problem was on her left side. Another responder was on scene and had done all the obs and so it was down to me to administer pain relief, if she wanted it. Amazingly, she did.

I gave this dose of morphine very slowly and watched her every move. The pain went away and all she was left with was an uncomfortable feeling as if a 'bubble' was in her groin. I thought about this and asked her if she had been on any flights recently. She had. I also asked her if she had injured her legs recently. She had. The other questions had been asked and so there were only a few realistic possibilities left. Thrombosis was one of them.

Now I don't go around second-guessing diagnoses and I don't try to dramatise people's conditions but if I don't use my brain to make educated guesses based on evidence and/or possibilities then I have wasted my years of training. I also enjoy working out what might be wrong with a patient. Even if I get it wrong, I learn something from it. It's the way I like to work.

During the shift I attended another couple of abdo pains but they amounted to discomfort rather than pain. I dealt with a few faints today as well. Perhaps fainting and abdo pain deserve their own commemorative plaque in the hall of 'common problems for which an ambulance is called'. At least that plaque would have a genuine place, unlike its friend 'too drunk to get home' which rests shamefully next to it.

I saw a frequent flyer who had me race to his aid last year for chest pain he never had. I hadn't been on the car long and we were under a lot of pressure. That was my first introduction to him and he called at our busiest time (March is a nightmare month as we have to reach our Government targets and so we run out of ambulances on an almost daily basis). He did it again today and I only knew him when I saw him. I recognised the area I was in to be honest and that triggered the memory. This time he had back pain and DIB. He had to add the DIB to get a blue light response - them's the rules.

This gentleman is nice enough. He doesn't shout at me or abuse medical staff as far as I know. He just calls for the company and to be taken to hospital where he can say hello to all his friends (the staff know him and are all on chatting terms). Fair enough but I decided to take him by car as I didn't feel an ambulance should be wasted. It was a short journey of around 10 minutes and he talked every inch of the way. He swore and belched his way through a conversation that cycled around his hatred of 'stupid people' (including the control staff who didn't know where he lived apparently) and his need to cut down on salt in his diet.

"And what about that woman who killed her kid with salt?" He declared, referring to the recent news item.

I tried to explain to him that she had not killed her child and that he had a medical condition that led to his death. When I tried to explain the condition I was referring to he got confused and changed the subject.

"So, the father killed the boy then?"

I gave up just as I reached the hospital.

I took him to the nurse and she glanced at us once and sent us packing to triage and reception where I booked him in.

I went back a few hours later with another patient and he was still sitting on the same chair waiting to be seen, poor sod.

Thanks to all of you for wishing me well again. I had flu. Man flu probably. I'm over it and am busily passing it on by cough and sneeze to anyone who gets in my way.

Be safe.

Friday, 2 March 2007


Been ill. Getting better. Back soon.