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?"

"Bus"

"Where did you get the bus?"

"Regent Street"

Ahh.

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.