Monday, 30 April 2007

Movies, bomb scares and gumballs


Busier but still not as busy as usual. There were lots of things going on today. If you walked in a straight line from the Strand to Pall Mall, you would have had plenty to see. They were filming a movie, set in the 1930's I believe, on The Strand. There were actors and actresses dressed in dapper costumes, there were old buses and cars on the street and the famous Savoy Hotel was part of the scenery. In fact, the scenes were being shot in there. I bet they put the room prices up for this occasion.

Traffic was still flowing up and down the road but, every now and then, the police would stop it and 'action' would begin for a few minutes. Then the road would open again. Nobody seemed to mind the inconvenience and there were dozens of tourists out to watch the spectacle.

Meanwhile police started to arrive at the Waterloo Bridge end of the Strand. They sealed off the road and a cordon was put up. I got a call from Control informing me that there was a suspect vehicle on the bridge and that it was shut for the time being. Since I was only a few metres away, I found myself in the middle of the operation. Soon there were other vehicles arriving, including our own HART team.

After twenty minutes of probing and investigating from a safe distance, the white van on the bridge was deemed safe and everyone was stood down. The area cleared as quickly as it had clogged.Filming carried on as this little drama unfolded and a member of the support crew came over to me and asked if a set of ladders, which were standing in a bus lane, belonged to me. At first I didn't answer because I felt sure she would come to her senses but eventually I had to capitulate and give her the bad news about new ambulance equipment, a tall ladder and a short car.

On Trafalgar Square, the Sikh festival of Vaisakhi was being celebrated. Thousands of people were expected to turn up to take part or to watch the proceedings, which included music, speeches and free food all day! The food queue went on for about half a mile at one point I think.

I sat on stand-by in between calls and watched this colourful gathering of different people progress through the day - many were Indian Sikhs, many were not. Nobody cared. The atmosphere was upbeat and only marred when a small contingent of the Darfur demonstration march cut through the Square, chanting and banner-waving through the music, on their way to Whitehall. We had been briefed about this demonstration and were expecting hundreds of protestors to descend at some point in the morning. I only saw this small group of about a dozen until later on, when they were already opposite Downing Street en masse.

Then there was the famous Gumball Rally which was being held on Pall Mall, a few minutes’ walk from Trafalgar Square. I went over in the afternoon to check it out but was sent away by LAS officers who were there officially. I hadn't been told it was covered and I was curious to see it but I didn't see much and I had a flea to remove from my ear!

My first call of the day was to a male with chest pain. He had a previous history of three heart attacks and a triple bypass. He didn't look well when I arrived and his pulse was thready and irregular, so he was taken to hospital without delay.

An emergency call for a 'male, cannot walk, foot locked up' sent me to a block of flats but as I pulled up, the ambulance arrived. The only reason this was a ‘Category A’ call was the addition of a vital but probably nonsensical piece of information - 'difficulty in breathing'. Once again, the great deeds of the call takers are undone by the impurity of open questioning.

"What seems to be the problem?"

"My foot has seized up. I can't walk"

"Do you have any breathing problems?"

"Erm. Yes"

"Has your leg got gangrene and is it about to fall off?"

"Erm. Yes""Would you like a million pounds?"

Well, you know what I mean. It’s frustrating for all of us. The ambulance crew went inside to deal with that call, I was surplus to requirements.

Soon after, I was sent to the West End for a male who was coughing up blood and passing black stools - in the street apparently. This call also had me thinking about how fast the turnaround would be. On my way to this (it was a Red3 because it had included chest pain - obviously) I found my way blocked by a large 4x4, driven by a large man who could neither see or hear me - we simply must get the siren volume increased on all our vehicles. After a 20 - 30 second delay in which I sat directly behind him, in line of sight of his wing mirror, he noticed and moved to the left for me. As I rolled past I looked at him and he looked back at me. Then he dropped his mobile 'phone from his ear. Some people just don't get it and never will.

When I got on scene, I had to search, along with the ambulance crew who had arrived behind me, for this bleeding man. He wandered up to me after ten minutes and began to talk to me whilst standing in the middle of the road. Traffic was meandering around him until I persuaded him to move to a safer spot. The man was a known alcoholic and a regular caller. No sign of coughing or blood or tarry stools. I left him to the crew.

An emergency call to a male with acute epigastric pain led me out of area for a nice old gentleman who came out to meet me at the lift, even though he shouldn't have been on his feet. He was very unwell, pale, diaphoretic and had a very low BP when I checked. He was constantly trying to vomit but producing nothing. He needed to go to hospital as soon as possible and, as he retched over his toilet bowl in his tidy little flat, I began to plan my options for his collapse at any moment. Then the crew arrived and I had back-up. Luckily, he remained fairly stable (if that could be a fair description) when they moved him to the ambulance. Some jobs put you on alert automatically.

On the way back from this call, I was verbally accosted by an irate taxi driver who wanted me to push through a red light and into the busy traffic at a junction because he had been waiting too long to move. I told him I wasn't about to go through a red light for him or anyone else and he stormed off to his cab. When we did get through the junction, he drove through another red light at a busy pedestrian crossing. Nice.

An alcoholic who had been fitting sent me to Victoria where I found the man waiting for me. He was a little confused and a LOT drunk. The crew arrived soon after me and, with wry grins, took him to hospital to 'recover'. Incidentally, alcoholics do suffer seizures and they can be serious, so forgive me if I seem a little flippant about it today. I still look at it seriously when I know it is. This wasn't.

I stayed in that part of London to deal with a young man who was hyperventilating but thought he was having a heart attack - thus a Red3 for chest pain. He was concerned about a Uni assignment he had to hand in the next day. He hadn't yet started on it, so he was fretting about where he was going to come up with a thousand words. The word preparation sprang to my mind. He wanted me to call his mother. I wondered if she was the panicking type too. If she was, then I could imagine the conversation if I called her.

"Hello, Mrs X. I'm a paramedic with the London Ambulance Service. Don't be worried, I have your son with me and he is alright. He has just had a panic attack and wants to go to hospital".


"Hello, Mrs X. Are you there?"

Ahh, bless. He continued to worry all the way to hospital and I kept an eye on him in case he tried to jump out of the car or something. He'll be fine until the next crisis looms in his life.When I booked him in I found that the hospital software had been updated to include a whole new raft of questions for us, including 'wheel stop time'. Eh? They want to know exactly what time my wheels stopped when I arrived at the hospital. Crazy.

I got back to base and was dragged away from my hopes of getting home on time by a last minute call - back to Victoria. This was for an ill child. I didn't get to see this patient, although I had been to the address before and suspected it would be the same problem; unwell child, nothing more. A crew was already on scene, so I turned around and headed back to base, late.

Nice to have had a trip out though.

Be safe.

All quiet on the Central front

An altogether strange weekend. The sun was out, it was warm and there were plenty of people around - in fact, Central London was extremely busy and yet I probably had the quietest couple of shifts I have experienced for at least four years. My usual callsign (the 'amber' car) had been suspended, for reasons not explained to me and I was on a 'CS' callsign, which means I dealt only with Red and Amber calls - no green calls.

I was the only FRU on duty out of my station but I still wasn't as busy as expected, especially on a weekend. I will probably regret bringing this up at some point in the near future!

On Saturday I melted into the Trafalgar Square crowds at a food festival (I think it was at any rate) called 'Eat London'. I stood by the car and waited for a call. I only got TWO all day. One of these emergency calls was to a male who had fainted in a bookshop. He had gone down quite hard and hit his head on the edge of a shelf, splitting his scalp open. There is always plenty of initial bleeding when that part of the body gets opened up, so his head was matted with blood when I arrived but the bleeding had stopped.

The gentleman refused to go to hospital and continued to refuse throughout my treatment and obs. He had a significant cardiac history and I suspected his BP was quite low, not that my wrist monitor was any good at the moment (its going through a moody phase). He was very pale and diaphoretic, although he tried to put that down to the weather. I wasn't convinced and neither were my colleagues when they arrived. At first I thought there was no point in having the ambulance crew here - the patient was adamant that he wasn't going anywhere. I had given him three opportunities to change his mind and was prepared to get my paperwork and let him sign it so that he could continue his day out with his friend. The problem, however, was that I couldn't convince myself that it was the right thing to do considering his condition and past medical history. There was a possibility of cardiac origin for his present status, chest pain or no chest pain but in a situation like this, where a grown man is refusing, you can only hang around trying to persuade him for so long - you can't harrass people into going to hospital and my gentle coaxing wasn't working.

Between us, the crew and I persuaded him to go to the ambulance for further checks. His BP was indeed low, which explained his faint but he hadn't recovered fully and that was of concern to all of us. Still he refused to go. I took the details I required and left it to the crew. I sat in the car and completed my paperwork. The attending paramedic came up to the car five minutes later and told me that the patient had finally agreed to go to hospital.

I guess it was difficult for him to make the decision to go because of the circumstances in which he found himself - a public place, people all around and a lot of pride to tackle. Or the fact that my colleague was female. Who knows?

As a 'CS' unit I am on the same radio channel as the HEMS team so I can listen in to the chatter between the helicopter pilot, the medics on board and the Control desk that activates and directs them to their jobs. They seemed to be busy today, unlike some.

My last call was to a very posh apartment (too posh to call a flat) in Mayfair. The lady who lived there had been experiencing a fast heart beat for over five hours. She had a history of PSVT and had gone through these episodes many times but this was lasting longer than normal and had not resolved when she used her usual techniques. It was giving her and her husband cause for concern. It is common for chest pain to be present during these episodes and she reported this to me when I arrived.

I had almost completed my obs. when the crew turned up. I explained the lady's history and gave them her pulse rate reading - 196 bpm. The heart is a strong muscular organ and can work very hard for long periods of time but this patient's heart will eventually tire and things could get complicated. She needed to go to hospital now. The crew wasted no time and she was in the ambulance and on her way in a few minutes.

I wrapped up my day on stand-by then made my way back to base, where I almost copped a call at five minutes to going home time! It was cancelled before I started rolling on it - maybe Control had only just noticed me and I had been invisible on the radar prior to that.

Be safe.

Monday, 23 April 2007

In the River

A man jumped into the river tonight. I was asked to stand-by on the Embankment while the River Police, LFB and a helicopter searched for him but, after almost two hours of scanning the fast flowing water, he wasn't found. He is unlikely to have survived.

The activity on the river drew small crowds onto the bridges and Embankment area where I was stationed. Some of them clumped around with their children hoping to glimpse a body so that they could join in the excitement of it all. People are strange like that but its natural I suppose. A number of logs and floating debris became drowned men as sightings were made by onlookers. The witnesses to the watery jump (from a bridge apparently) introduced themselves to me and said that they had seen a body floating downstream - they were quite convinced. I called it in and the search vessels were pulled away to the area where they claimed to have seen him. Nothing was found.

The current tends to pull objects under the many boats that are moored off the banks. Its likely that he is still underneath one of them and will surface with the next tidal change.

A group of young women kept me occupied in banter when the search was called off and dusk fell. They kept me company for a time, which is just as well because Control forgot about me and I had to call them to ask if I was required on scene any longer! Still, thanks for the pleasant 30 minutes ladies.

Almost as soon as I greened up I was sent to a female DIB at a hotel. I passed the location because it was obscured by scaffolding and nobody came out to flag me down (I sometimes depend on windmills to get to the right place). By the time I located the establishment an ambulance was pulling up, so I left them to it.

I went on stand-by at my usual spot on the Square and a young woman walked by with her friend and said "thank you for all you do". She was, of course, referring to ALL of us in the service and I had to smile. It was a nice and utterly spontaneous thing for her to say and a pleasant surprise. It made a change from the usual nee naw sounds or requests for directions to places I have never heard of, some of which are probably not even in London.

Then an emergency call to a well known pub in Soho for a waste of time female who had faked epilepsy to get the staff to call us. Just before I left for this call I was asked to help a woman who had fallen down a few steps in a pub. I was about to radio in but this call came through and it was a higher priority, so I had to leave and instruct them to call another ambulance. When I arrived a few minutes later in Soho, the 'epileptic' was wandering around, quite drunk, with her boyfriend. Both looked like drug addicts and she certainly looked familiar to me. She told me she was okay and that she was sorry I had been called out. Then she weaved off into the sunset with her strange boyfriend. The member of staff from the pub was very sheepish and he too apologised. Can't blame him though.

I requested a return to the running call in Leicester Square and was told I could continue, so I made my way back.

The woman had fallen down a few steps at the entrance of the pub and she was extremely drunk and extremely tearful. She wouldn't behave herself for me, so getting information was difficult, although her small group of friends were very helpful...and apologetic. One of them became very tearful herself later on at the difficulty she was having controlling her volatile mate.

After ensuring that she had no injuries, I moved her to my car, with the help of another FRU colleague who had arrived soon after me. She wasn't easy to help - she wouldn't walk and kept falling down. In fact she did a lot of falling down. A lot.

In the car, she calmed down but it took a ton of effort and quite some time before she was ready to see the light and get a taxi home with her group. All her obs. were normal and she refused to go to hospital. It wouldn't have done her any good, they wouldn't have the patience for her to be honest. She did hit her head when she tumbled down the steps and I was careful to advise her friends to call an ambulance if her condition changed. The last time I saw her, she was being propped up on a corner while one of the group waved frantically for a taxi.

Then off to a gentleman with severe DIB as a result of an exacerbation of his asthma. He was in a bit of trouble but I have seen much worse, so I wasn't too concerned when I got to him. The crew arrived at the same time and we all went to check him out. He was sitting on his front step with his wife. He was a pleasant man and he needed help.

His wife made a point of telling us that he had been to hospital and had been treated as if he was wasting their time. She stressed that they both worked and paid their taxes. She was obviously frustrated about the treatment he received. I had to agree; pay your taxes, get your money's worth...without attitude if possible. I also understand the view of the hospital staff. They see a lot of nonsense and sooner or later it becomes routine to assume you are having your time wasted yet again. Nevertheless, its the sponging alcoholics and drug abusers who drain our NHS and that's the real problem.

We took care of him of course. We nebulised him with Salbutamol and Ipatropium but neither had any real effect, so he was taken straight to hospital by the crew. No time to waste really.

I got my break and enjoyed a bit of a rest until a call came in for a ? meningitis. I went with the ambulance to the address and the three of us piled into the lift and made our way to the flat. Inside, a young girl was lying in bed with a temperature of + 38 degrees. Apart from that, she had no other sign or symptom of meningitis. She was taken, with mum, to hospital where she will be monitored for a while, tested and checked then sent right back home to get better naturally.

A long period of nothing followed, so I had a nap at the station. These twelve hour nights, coupled with my 1 (sometimes 2) hour drive to and from work, tend to wear me out. The days don't seem to affect me so much.

My last call was to a male with chest pain. I found him lying in bed with abdominal pain and a recent history of vomiting. He had been prescribed Augmentin for an ear infection and had become ill soon after starting them.That was it.

Augmentin has a nasty habit of making you much sicker than you were before you took them. I had toothache once and was given this antibiotic. I was violently sick for days after starting them. Never again.

I asked about the chest pain and his daughter told me (he didn't speak much English) that he had described pain all over his body. That's a standard phrase when English is not the first language.

"Where's the pain?"

"All over my body...pain all over"

So that equates to chest pain? I don't get it.

Someone in EOC will have an explanation.

All his obs. were fine. He needed to see his GP but, as usual, the LAS were going to taxi him to hospital where a doctor will do nothing except give him another antibiotic. The sort of thing his own GP would do. Its all he needed. That and bed rest...and fluids.

The Marathon seemed to have emptied London because it was quiet for a Sunday night. I guess after having spent all day watching runners the last thing you want to do is stay out drinking til 3am. We should have a marathon every weekend.

Be safe.

Sunday, 22 April 2007


I enjoyed this shift. A lot of people I like working with were on duty with me and so I was bumping into them frequently over the course of 12 hours. Its nice to work with good company.

My first call was to a hyerventilating man who had been seen just an hour earlier by another crew. He had been treated but the panic attack had started again and his friend was concerned, so she dialled 999 for the second time. The man was a mute and could only sign to communicate, something that takes a bit of getting used to. Its also quite bizarre to treat hyperventilation with a one-way verbal communication. Most of the time the length of the patient's sentences is a guide to how well they are recovering. I took him and his friend to hospital in the car. By the time he arrived, and after ten minutes of oxygen, he was almost fully recovered again.

My next call was to a female in a restaurant who was having an allergic reaction to nuts. The call description added 'she has taken her Epipen but it hasn't worked'. Its bad enough getting a call to what may be life-threatening anaphylaxis without the additional complication that the life-saving drug isn't working. I sped to the scene and arrived within a few minutes. A man was standing outside the restaurant waiting for me. He told me that the woman was in the ladies toilet (I find that a lot of females in trouble head straight for the toilets; men don't seem to do that so often - or maybe that's just coincidence).

I grabbed my bags and headed in the right direction - I had been to this establishment a couple of times before, so I knew the layout. I was expecting to see a collapsed, barely breathing person on the floor when I went into the toilet, if the call description was anything to go by. The man who met me also said that this was the worst reaction she had ever had. I walked in and she was standing in a cubicle with her friend. Her face was a little puffy but not the mass of swollen tissue that I had expected. Her breathing was fine - a little fast but she was able to speak in full sentences and she exercised that right a LOT as she panicked and demanded pain relief. She had abdominal pain, which can occur in such reactions but I wasn't going to give her any drugs at this stage, she simply didn't need them. I told her this and she seemed to understand.

As for the Epipen. She didn't have one. Hadn't taken one. Had never heard of it before. So, I wondered where that elaboration in the call had come from. This was NOT a life-threatening emergency, this was a moderate allergic reaction, mainly involving the gastro-intestinal system.
I walked her to the car and sat her in the back seat while I continued my obs. All of her vitals were normal. She probably required anti-histamine therapy and that could be done at hospital.

When the ambulance arrived I explained the situation to the crew and they took over from there. This call generated a Red2 and resulted in myself, an ambulance and the motorcycle paramedic attending. Elsewhere on the sector I was hearing of other calls getting over-the-top responses. Someone, somewhere was being a little too cautious.

Then off to another spectacular MOP call. This was for a 'male collapsed, caller thinks he may be deceased'. Now, the supposedly dead person was lying in a street at a busy bus station, so my first reaction was 'Yeah, right', but as I said before, I can't afford to be cynical, so I sped to the scene with the same determination as I would muster for a cardiac arrest. An ambulance was just in front of me as I left Leicester Square and I figured it was also going to this call. Together we headed to the scene.

This can be problematic. Sometimes the ambulance you follow is NOT going to the same call. There can be embarrassing consequences if you turn up at the wrong address. I decided to overtake the ambulance and keep to my own heading. I don't like doing this, it seems rude but I am supposed to get there first, so I went for it. In the event, the ambulance was on the same call. In fact, they took a shorter route and arrived on scene a second in front of me. Damn!

We arrived, jumped out of our vehicles and saw this lump of humanity lying in a corner with people hovering nearby, waiting for their respective buses. Of course the guy was going to be drunk. Of course he was. We approached, prodded and shook and he made non-death type movements and sounds. Even the police, who arrived soon after saaid he was very lively for a corpse.

The person who had made this 999 call had left the scene apparently. A lot of them do that. They call us, make frantic suggestions about death and serious injury, then they hang up and clear off.

We got the man, who was seriously drunk (and smelly) into the ambulance. His BP was very low, so I sorted that out with fluids. Then there was a tap on the ambulance door. One of the crew opened it and a voice said "Is he alright?" This was the 999 caller, who had returned to the scene and was showing concern!

Back in the Square and it was very busy tonight. Heaving is the word that comes to mind but not in a vomiting allegory. Plenty of people coming and going and standing. A little gang of 12-year-olds strolling by at 1am. Their parents must be so proud.

A man singing along, out of tune, to the music generated by his aged discman and delivered by his huge, floppy headphones "la la la, hey hey, la la la..." etc. I had no notion of joining in except to grin at the brass of it.

A beggar who uses his dog as a prop for gaining sympathy from passers-by, especially women. His dog, a lovely Staffordshire Terrier, lies like a big baby in his lap with a dummy in his mouth. The girls love it. Hats off to the beggar with an imagination - he gets to eat every night. So does his 'baby' I hope. Whenever he sees me, he nods, waves, gets his dog to wave a paw and then they both howl. I take all that as a compliment.

A call to a female, fallen down stairs at one of those 'school' clubs where middle-aged men and women can dress up as schoolies again but with the addition of legal drinking til you are sick. School was never quite like that...except for the drinking til you are sick bit. On the way, I was flagged down to attend a couple of doormen who had been assaulted. I called it in and asked to be cancelled for the school club job - I couldn't find the place anyway to be honest and was driving around in circles like an idiot. I checked the two doormen out - scratches really - then asked EOC if they wanted me to continue on the original call, since I was in the vicinity and the ambulance that had been despatched was lost too. They said yes.

Eventually I found the club and was met by one of the EMTs from the ambulance. She was about to get the board out of the vehicle because they were going to 'collar and board' the patient who had fallen down the stairs drunk. I went in and had a look. The stairs were dangerous and obstructed, very narrow and steep. The lady was at the bottom of them but was conscious and moving quite easily. No neck pain, no neurological deficit, no other injury - just a pain in her head where she had bumped it on landing. She was also very drunk and apologetic. I liaised with the crew and we agreed that she could walk up these stairs. So, we helped her to her feet, walked her to the ambulance through a crowd of barely dressed adults in school uniforms and pigtails (and that was just the men). :-) Then off she went to hospital, head in hands, still apologising.

I went back to my station and had a cup of coffee and a rest. Then I went back on stand-by because I was bored but the West End, particularly around Piccadilly Circus, was absolutely heaving with people and vehicles. There were traffic jams. It was 3am!

My next call came in while I tried to fight my way through the mess on the roads. I was going to a collapsed male. I arrived to find a little group of people gathered around a man lying in the street between two parked cars. They hadn't touched him or tried to rouse him - they never do. At least they hadn't called it in as 'possibly deceased'. Thank goodness we don't live in the bad old days of Burke and Hare. Unconscious drunks would be carted off and cut up for medical experiments every day of the week.

I gripped the man's shoulder tight and shook him until he made sense of the world. He was drunk and had been sleeping. He was now drunk and awake. The ambulance arrived and he got a bed for the night.

Immediately after that job, another call, This time to a police station I have visited a number of times (not as a criminal obviously). They had a young man in custody who was not responding. I arrived to find the police doctor (known as the Forensic Medical Examiner - FME) in the cell with the patient. He had carried out all my initial obs. for me and gave me a handover. I tried to get a response from the man but he was out like a light. Probably alcohol, I thought. He was in for being drunk and incapable so it made sense. He had also allegedly taken ecstacy and probably something else. I gave him oxygen and then used narcan to extract a possible cause but he didn't come round. All his obs. were normal so he was probably just sleeping it off. The crew arrived and he was taken to the ambulance where he began to wake up a little. By the time he got to hospital, he was on a higher plane of consciousness.

I went back to the station and made some more coffee. Two other crews were there and it was beginning to look like the end of the shift would be non-eventful. Instead the 'phone rings, dragging crew number one out. Then it rings again immediately for crew two. Then my service mobile goes and I am out. This call was to a male, unconscious on a bus. Whenever I get a call like that I know I am going to be waking someone up and telling them to get off a bus.

I arrived at the bus in question, walked on, woke the man up (he was a bit aggressive at first) and asked him to leave the bus...'sir'. I followed him out and the ambulance (from my station) arrived and went away again.

As the clock ticked by and I made my way to my base station across the river I got a call for another person 'unconscious' on a bus. I had to double back to New Oxford Street, where I was required to walk onto the bus, wake the patient up (a woman this time) and ask her to leave the vehicle. I did and she did.

Oh and in both cases I asked if they needed to go to hospital, I always do but on calls like these you wonder if you are tempting fate.

On my last attempt to get home, I was called to a drug overdose just South of the river. The call description added 'caller was aggressive and abusive'. Great, I thought. I'm going to get punched out before I go home to bed. I asked Control to send the police.

When I got on scene a large man was waiting for me at the door of the address. I become very cautious at this hour of the day with people like this. After a night of alcohol and class A drugs, they can be very dangerous. I smiled, remained friendly and put on my best 'not judging you' voice when I walked in. The young lad who had taken too much cocaine and alcohol (and dope) was not looking well at all. He was tachycardic, diaphoretic and very agitated - the latter is mainly down to cocaine. I found it very difficult to work with him, some of my obs. were incomplete because he moved and fidgeted a lot.

Then the police arrived. I had forgotten about them. This changed the atmosphere dramatically. All had been calm and I was hoping to hear an ambulance siren soon but when the police entered the big guy's house, he wasn't happy. I explained that they were here for my protection after abuse had been reported by my Control but he just wanted them out. The police, bless 'em, ignored the man and stayed with me while I finished what I had to do. Tense.

In the end, the young man refused to go to hospital. I have to tell you I was relieved, even though he didn't look good and probably should go, I can't sympathise, I'm afraid. It's drug abuse and self-abuse and when he gets hospital care he will simply go back to his drugs when he is better. He will end up in hospital of course - hopefully not via LAS but in the back of his mate's car. This is how a lot of them arrive.

I finished my shift, signed out and headed home. I noticed a lot of ambulance control vehicles around and there were dozens of motorcycle police arriving in town. I was leaving London on the morning of one of its greatest annual spectacles, the marathon. The sun was up and it was getting warm. Time for bed.

Be safe.

Saturday, 21 April 2007

Night of the rubbish gloves

As usual, I hovered around the Euston area until the congestion charge time had elapsed (thus saving myself £8 in going to work costs) and made my way across the Euston Road at precisely 1801 hours and on to the drag South for Waterloo. Incidentally, we can claim back 50% of the congestion charge (they used to give us all of it) but you need to fill a sheet in every month and have it in by a certain time or you don't get a penny. I am very organised in this department, so I never get a penny.

On the way in I stopped to assist at a RTC in which a cyclist had run into the back of a car and been thrown over it, landing hard on his face - almost right in front of me. He had a cut to his chin that needed to be closed and he was shaken by the experience. I sidled over because I thought he may have needed help. As it was, he had an off-duty nurse attending to him.

"Can I help?", I asked

"No, we are fine here. I'm a nurse", she said without looking up at me once.

"I'm with London Ambulance, you sure I can't help?"

"Oh...didn't recognise you."

I cover my uniform up when I travel to and from work, so I guess I could see her point. I was 35 minutes from being on-duty so if I needed to do anything here I would call it in and get myself pre-shifted, so that I was effectively on-duty (and thus covered by LAS). Its all necessary I suppose. In any case, he had a cut chin and that was hardly a problem, even though the nurse seemed to be quite excited about the prospect that he might need a stitch. A colleague of mine turned up and I left him to it.

I wandered into work and went through my usual routine: VDI; drugs; paperwork; stabvest and jacket. Ready.

My first call was a Red1, to a suspended patient in a restaurant in the West End. That call got cancelled as I made my way there. Apparently, the patient was breathing and had a pulse. I wondered just how bad the food was.

Then, ironically, I went to a cyclist who had collided with a car and had, wait for it, gone over and hit the pavement hard, cutting his chin (and lip). He was also concussed - he kept repeating the same question "where did you come from?" over and over. Or maybe he was just curious about my accent - or trousers.

Another emergency call that got cancelled as I prepared to get my teeth into it was a Red1 for a man 'collapsed at the wheel of a car, ? breathing'. My first instinct was that this was nothing more than a drunk driver. Sometimes you can get things very wrong when you assume, so I put my cynicism aside, raced up towards the scene, along with one of the motorcycle paramedics and then shut it all down when the cancellation came through - that harsh ringing sound that says you aren't going to work on this call. The crew that cancelled it told me later on that he was nothing more than a drunk driver after all.

I spent a long time in Leicester Square tonight. I wasn't rushing around like normal for a Friday night, partly because EOC wanted to use the cars for emergencies only and partly because FRED kept sending calls and then cancelling them immediately. I got a whole string of calls that were cancelled as I prepared to run on them. In the end, I radio'd in to ask if I was required or not. It saved me the hassle of getting my gloves on and annoying other drivers by shutting down my lights and sirens (without apparent explanation) after I had forced them all to the side of the road and made Moses of the public highway.

And the gloves. Well, usually they are a bit of a pain to put on but tonight they seemed to fight with me every time. I struggled to get them over my hands without a finger or two sticking out at an air-filled angle. Sometimes I blow into them so that they are easier to put on but that can look bizarre to passers-by, so I don't always do that. They are powder-free things and they cause only one allergic reaction - frustration. I will get a fresh box tonight I think.

As I sat in the Square, I noticed three young lads, probably around 13 years of age, sauntering by, smoking a cigarette. At least I thought it was a cigarette until I caught a whiff of the smoke and then noticed how they were holding it and sharing it. Cheeky gits.

Then a gang of about 30 motorcyclists descended on the Square, driving, rather alarmingly, over the pedestrian area to park up at McDonald's for a healthy meal. They caused a lot of commotion - noise and excitement and the police didn't like it, so they were told to clear off. They did but only after making a fuss and almost getting themselves arrested. When they were gone, the only evidence left behind that they had ever been there was the pile of rubbish on the pavement. Nice touch.

A couple of young girls thought it would be fun to come up to the passenger side window of the car, lift their tops and expose their (covered) breasts to me. I didn't complain. That would be rude. Smile and wave, boy, smile and wave.

A run up to an underground station for a 'male fallen, with head injuries' led to me to the end of another fruitless call. A vehicle was already on scene and I was not required. I returned to my usual area of operation and a young woman ran up to the car, thumping on the window, asking for help. I asked her what was wrong and she said her friend wasn't well.

"Is she not well, or is she drunk?", I asked

"She's not well...and she's drunk", came the reply

I went over to where she sat, surrounded by her friends. I knelt down beside her and asked her what was wrong.

"I need hospital. If you are the ambulance I will talk to you", she slurred.

"I am the ambulance", I said, "what do you want me to do though?"

"I want to go to hospital. I'm ill."

If I didn't take her, she would have ambulances out to help her all night. When I asked her friend why they didn't just get a taxi home, her reply was the standard default. "There are no taxis". Not quite true, I thought, you still have the LAS at hand.

This girl couldn't (or wouldn't) walk so I said I would lift her to the car. Her friend looked me up and down and said "do you want a hand?". Cheek.

So I lifted her (yes, on my own) to the car, poured her in and allowed her friend to travel with her. I took them to hospital and the hospital staff were more than happy to receive them. I don't think I have ever seen such a look of disappointment on a nurse's face.

My last call of the night came in the early hours of the morning as I sat on stand-by. A man ran up to the car. He was covered in blood. He thumped on the window (they all do that) and then he opened the car door. Now that was a step too far and it worried me a little. I told him to stay outside the vehicle and asked him what was wrong. He explained that his friend had just been stabbed. I looked at the blood, looked again at him and decided he didn't have a knife. I hoped.

I called it in, requesting an ambulance and the police and asked Control to track me so that they knew where I was going with this man. I told him to get in the back of the car and to take me to his friend. I asked him twice if the attacker was still on scene - he said no, so I continued. I drove around the corner and his friend was standing in the street with a couple of PCSO's. His friend had no injuries, so it was quickly assumed that someone else had been stabbed, possibly the assailant.

I waited on scene until the ambulance arrived and explained what had happened. The police were now looking for someone with a stab wound, as well as a gang of youths in possession of a large knife, according to the man covered in blood. He told me he had felt the knife touch him when one of the gang had robbed him of his phone. His friend had hidden under a parked vehicle and the gang had spotted him. When the man ran, he assumed the gang had laid into and stabbed his mate. Scary.

I spent the last hour of my morning standing on Waterloo Bridge, looking at the water and the boats and the scenery. I do love London, its full of the strangest, nastiest, nicest people I have ever met.

Be safe.

Wednesday, 18 April 2007

Sick doctors

Nine emergencies, 1 green, 1 assist-only, 3 conveyed and 6 ambulances required.

Now I'm tired!

Before I completed my VDI (vehicle daily inspection) I was asked to attend a 'male, collapsed in street'. I suspected a drunk and arrived on scene to find...a drunk. There was a MOP (member of the public - no disrespect intended, it justs works well) waving frantically at me, mobile phone in hand. He pointed to the figure slumped in the corner of a doorway and I pointed to the can of extra strength lager that was sitting beside him. I may or may not have politely mentioned the fact that the gentleman was probably drunk and what, exactly, did he want me to do about this?But I can't remember. All I could think of was that I was still fifteen minutes away from officially being on duty and that I hadn't even had a chance to fuel up with a cup of coffee for the morning.

So I sat with this drunk (Polish) man who spoke very little English and whose vocabulary could only string the words "take me home please" together in a slurred, spit-filled shower. He kept grabbing at me and trying to hold on to my arm. That is a no-no. Don't even attempt that.

I had no choice but to request an ambulance. I don't like bringing in crews for this stuff but I couldn't take him in the car and he was certainly going to generate calls all day long if he wasn't removed from the street to a place of safety. He was quite big, so I wasn't going to grapple with him to control him. Instead, I lodged him against a corner to keep him upright.

The crew arrrived and I explained what we had. They removed him to hospital, after a little exchange in which the drunken Pole attempted to grab my colleague's arms. The empty lager can was left behind in the doorway. I was going to remove it and bin it but I forgot.

I heard the crew from that job reporting that they had been called to this guy again, outside the hospital. He had walked out and made a nuisance of himself in the street. This time, the police were requested and he was taken away to a better place.

I returned to the same area on my next call to attend a cyclist and a pedestrian who had been punching and kicking each other in a cycle/pedestrian-rage incident. It's the first one I have attended and I know there will be more. I'm sorry if you are a cyclist but drivers and pedestrians are absolutely fed up with the way a lot of them behave on the road. They buzz through red lights and pedestrian crossings like they are immune to the highway code. I have seen a number of near-misses involving cyclists who have hammered across red lights, almost hitting people who were, rightfully, crossing the road. It's high time they were made to put ID plates on their bikes so that they can be photographed breaking the law and brought to book. I believe they can get points on their driving licences if they are caught. Personally, since they are using the same roads drivers have to pay for, I think they should have a little tax disc on their bikes. Just my opinion.

This particular cyclist had annoyed a pedestrian by almost hitting him, so he lashed out. They had a very public punch-up and the cyclist (18 years old) ended up with a bruised cheek, whilst the pedestrian (in his 50's) got a black eye. Nice start to the day. Dignified.

Soon after this job (both got arrested) I was called to a female 'sitting on wall feeling dizzy'. I saw her, sitting on the wall as described, her head in her hands. She didn't even look up when I got out of the car and said good morning in my professional voice. Its one of my pet hates - people who call ambulances and then ignore you when you speak to them. I believe they think it will make them look genuinely ill if they don't look up or react when you speak. To me its just plain bad manners. Eventually, she looked up and answered my questions. She answered them slowly and in as quiet a voice as possible. This is another annoying addition to the 'I am very ill' act. It turns out she was on her way to work and felt dizzy and tired. I feel like that every morning. She fell asleep in the back of my car, only waking momentarily to ask me a question.

"Can you people call my work for me?", she said.

"No. My people can't. You have to do that yourself." I replied.

I was hurt. No, really.

An emergency call to a pregnant female whose waters have gone and who is now in labour but has collapsed twice. I race to the scene, requesting a midwife, considering the call description and another ambulance but when I arrive I find a woman, in her twenties, who is having a normal labour. Her pains are about 3 minutes apart and she is stable. Even the attendant from the crew who arrived shortly after me asked why this was an Amber call. She walked to the ambulance and went to hospital like anyone else in her condition. This was a maternitaxi and nothing more.

A Red1 for a ? suspended sent me into the posh side of London. The man was sitting up in the street when I arrived, so I called Control and advised them that it was not as given. The crew were a still few minutes away because they were delayed in traffic. The man had collapsed sudddenly and he certainly looked unwell. He was a doctor and, ironically, another doctor who was passing helped him. He also gave me an excellent handover before he left the scene. The patient's brother was also there.

The patient had a long history of heart problems and had undergone a CABG (pronounced Cabbage by all who use it) a few years ago. Now he was diaphoretic, confused, had an extremely low BP and had lost bowel and bladder control. I also noticed that his pulse was racing and felt very weak, even though my pulse oximeter recorded a heart rate of just over 100, it was likely to be much faster. He was also a diabetic and his BM was high. I watched him carefully and his level of consciousness slipped a few times. I called Control and asked for an ETA for the ambulance. I didn't think this man was going to remain conscious for much longer.

Thye crew arrived soon after and we transfered the patient to the ambulance. An ECG revealed his problem - he was in VT. This could convert to a life-threatening arrhythmia so it was now critical to get him to hospital quickly. His blood pressure was low because his heart was not pumping effectively and it needed cardioversion as soon as possible. IV access was gained, his feet were elevated to help his BP and he was blued in to the nearest hospital. I followed the ambulance in the car (well, I went in front to clear and stop the traffic - this ensures a smoother drive for the ambulance crew).

When we got him to hospital, we watched as he was put to sleep, intubated and then shocked to convert his VT to sinus rhythm. It worked perfectly and his heart behaved normally for about 5 minutes. Then it converted back to VT and he was in trouble again. I think it caught the hospital team out as they were just about to wake him. They shocked him again and his heart stabilized once more. I had to leave after that and get back on duty, so I don't know how many times they had to do that or even if he survived.

All through this, the man's brother sat outside the resus room, quietly awaiting news. He still didn't realise how serious things were.

Later on I was called to a man who had 'poured boiling water on his feet', the description had the word 'accidentally' stuck on the end of it. I had to smile at the thought of such a self-inflicted deliberate act. The ambulance was already on scene when I arrived. The man's injuries were minor so I was not required.

I went into the West End to attend a French man who had become ill overnight in his hotel room. He had chronic diarrhoea and didn't look well at all. Whilst in the toilet he had stumbled and fallen, bursting his nose open on the floor. The bleeding had stopped but it looked like it might be broken. His wife was with him and he insisted on going to the toilet just before I walked him out to the car. He insisted on going to the toilet with the door wide open and his wife standing in the doorway watching. I was also invited to watch, just in case something happened to him during the event. I declined the offer and waited at the front door. I still had to listen though.

I had just put a teaspoon full of coffee into my cup at the station when my 'phone rang. I was going to a female who was fitting. I arrived to find a woman and her friend sitting on the floor. Although the patient wasn't epileptic, her friend confirmed that she had just had a seizure. Since it was a witnessed event and her first, I advised her to go to hospital. She was a doctor and she knew what I was saying but I noticed that she was a little vague with details, although I assumed she was just confused about what had happened.

The crew arrived to take her away and she became more confused and stopped answering questions. I looked at her as we wheeled her out on the chair and she was staring into the corner. She was absent. I told my colleague and she was wheeled out with more urgency but a few seconds later she began to have another seizure. We got her into the ambulance, with some difficulty, and my colleague immediately sorted out her airway. I placed a cannula but she pulled it out, so there was no further attempt to give her diazepam - we took her straight to hospital. By the time she got there, she was post ictal again.

This lady had told me she had SLE and I completely forgot what that stood for. Only when the word Lupus was used did I remember - SLE; Systemic Lupus Erythematosus. I had only ever used the term 'Lupus' for this disease but there are different kinds, so SLE is more specific. It can cause inflammation of the brain that may lead to seizures.

I saw her again later on and she was fully recovered. She didn't remember pulling the cannula out of her arm though.

Then a RTC for a 'car vs ped - bleeding from ears'. This sounded serious and I was asked to report for HEMS on arrival. When I arrived, I could see HEMS wasn't required, so I reported back. The woman hadn't been hit by a car at all. She had attempted to get into a taxi but the taxi driver had locked the doors (she was drunk) and allegedly driven off. Unfortunately, she was still holding onto the door handle and got pulled onto the road, where she hit her head. The bleeding was coming from a wound just above her ear. She was taken to hospital by ambulance and I saw her wandering around the A&E department, barely dressed, later on.

My final call of the day was to a lovely 87-year-old lady who had fallen off the kerb and hit her head on the road. She also had a little knee pain. She was being cared for by two kind MOPs who had witnessed the fall. Interestingly, this old lady remembered and used my name 20 minutes after I had introduced myself to her. Its unusual because very few people bother to keep a mental record of your name when they are ill or injured. It is especially unusual when they are in their 80's. I found it heart-warming.

I took her to hospital in the car and she started singing to herself in the back seat. This lady has nobody else in the World, she has no relatives but what a happy soul she was.

Be safe.

Working the South

Two emergencies, 7 Green and 1 running call. Five assisted and five conveyed - not a single ambulance required today.

I enjoy working the 'amber car' during the day. The variety of work is greater and, despite what is popularly assumed, I use a lot more of my basic and advanced skills. Most of my suspended calls have been during early shifts. I also get to meet a lot more people (and they are generally sober) and I can enjoy the sights and sounds of this iconic city. It also feels safer working in the daylight!

My Control desk requested that I stay in South London for the day as we were short of vehicles to cover the area. I think they hate me.

First call and I'm off to a 'BR' station for a female with abdo pain. She is pale, cold, has a low BP and low temperature when I examine her but after a chat and a rest, she recovers enough to confirm that she would rather not go to hospital and, instead, carries on to work for the day. As usual, she gets three opportunities to decline and I get a signature. She really looks much better when I leave her with the station staff.

Another abdo pain - this time a male at a hostel. He has a recent history of duodenal ulcer and it is giving him a lot of pain. He could have gone to hospital himself but he calls 999 because that's what he always does when his ulcer plays up. I am trying not to lecture people today about calling ambulances. I am trying to remember that I get paid to do this and I actually enjoy it, regardless, so I take him to hospital in the car and have a pleasant conversation with him.

Oh...another abdo pain. Another male but this time the pain is reportedly lower down, in the groin area. He works on a bulding site and I have to travel miles to get to him. He has recently had a hernia and he thinks this is the same problem. He is in a lot of pain and will not move, so I offer him entonox, which he declines because he doesn't like gas, then I offer him morphine, which he accepts. Unfortunately, he doesn't like needles either and when I cannulate him he writhes as if in agony (a little over the top I thought). He has just given me a pain score of 10/10 - that's the worst pain, for his lower abdomen and yet he considers a little sting in the arm to be worse. I can never fathom that out. What it does confirm, however, is that he is quite possibly NOT in as much pain as he is reporting. For that reason I ask him again if he is sure about pain relief and he declines. I thought he might.

In the car I could smell the problem. He didn't have a hernia, he had a UTI.

Control sent me a job 4 miles away for a sore throat. This call had been waiting 4 hours for an ambulance. Each time Control contacted the caller to ask if they still required an ambulance, they insisted that they did. For some people it still isn't sinking in. We are very busy and there are lives at risk when people do this. I got cancelled down when I queried it but this person will probably wait all day until a vehicle is free.

My running call was to assist a member of staff at HQ who was unwell. This happens every now and then. The irony is that they must call for an ambulance to attend, just like anyone else, even though they are surrounded by ambulances and crews. Even more ironic is that being on top of an ambulance station doesn't guarantee a faster response. I had to travel from Central London to attend.

I met a nice elderly gentleman later on during a call to the same 'BR' station I visited earlier. He had stumbled over a high kerb and had fallen into a wall, hitting his head on it. He had a bruised cheek, which may or may not have been fractured, but was otherwise unhurt. He was, however, very tearful and he drew me closer to tell me that he had lost his wife of 50-odd years just six weeks earlier. I told him I was very sorry to hear that and I showed as much compassion as I could during his treatment and the short drive to hospital. I asked him if he wanted me to note his recent bereavement on the PRF so that hospital staff knew and he said yes. I think he needed to talk to someone at length. I cannot imagine what it feels like to lose someone so close after so long - it must be devastating.

A call to a faint in the afternoon, as the temperature started to climb and I found myself in an office managing the recovery of a young woman who had passed out. The office was stuffy and had no air conditioning, so I suggested fresh air and a change of scene. She agreed.

Then off to a posh hotel, where a member of staff was in agony with back pain. He was down in the bowels of the place, (they have a red phone box down there for staff to use), in the changing room. He had been washing his face and had twisted his body to talk to someone when he heard and felt his lower back go. He couldn't move and was stuck to the bench when I arrived. I gave him entonox and this helped loosen him up enough to walk to the car. He continued with the entonox until he couldn't feel his lips, never mind his back pain.

An emergency call around the corner from where I had parked up to complete my paperwork. A female had fallen in the road and had facial injuries. I arrived to find a familiar face (bloodied face) looking up at me. She was known at the hospital and was currently an in-patient on one of the wards. She had come out for a coffee and had tripped on the kerb, falling into the busy road. She was lucky not to be killed. Bystanders had helped her to her feet and mopped up the blood around her mouth - she had a burst lip and a loose tooth. I got her into the car and took her the few yards back from whence she came.

Another faint at work because of the heat. It's not even May and I am already dealing with heat-related problems. This Summer is going to be extremely busy I suspect.

My last call of the day was to a back pain. The lady was recovering from 'flu and was now stuck on the floor, unable to move without pain. She had called NHS Direct (don't get me started) and they had advised her to remain where she was and to call 999 for an ambulance. Why had they done that? What did they think could possibly be wrong with her? Back pain during 'flu is common. Back pain occurs after heavy and persistent coughing. If there is no neurological deficit associated with it, then all that is needed is pain relief, in the form of paracetamol or Ibuprofen and gentle exercise. Or, if you live in London, an emergency paramedic response.

When I arrived on scene I heard a GB for a boy who had jumped into the Thames after his dog. I was only half a mile away and could have been there in 2 minutes. Still, I had a back pain to deal with. I went up to the flat and the patient's friend let me in. The patient was on her side on the floor. I chatted with her, stood her up, sat her down, chatted some more and left her at home with her friend. Got a signature, gave her advice, went home tired.

Be safe.

Saturday, 14 April 2007

Unlucky for some

I tried to find a specific reason why Friday the 13th was considered unlucky but my research ended in a corner. Fear of that particular day/date combination goes way back in history, with many superstitious and religious events associated with it and as we are creatures of habit, we tend to follow those fears into the future. Working on Friday the 13th felt no different than any other day to me, I had just gone through the night of the 12th and into this new and supposedly unlucky date with no real problems.

My night started with a call to a train station for a male collapsed, (for some reason we still refer to all the stations as 'BR' - British Rail, even though that monolith has long since disappeared). On scene, the man was lying in the middle of the main concourse, surrounded by station staff and being attended to by his wife. He had been undergoing treatment for a brain tumour and the Radio and Chemo therapies had taken their toll. He had travelled a distance into London for a dinner party with friends and had collapsed when his leg had 'just given way'. Otherwise, he was fully recovered and refused to go to hospital. My policy on refusals is simple: I ask the patient at the beginning of my treatment/assistance and then I ask again later. Finally, I ask just before I get them to sign my PRF. Every patient I manage gets three opportunities to change their minds. This patient chose not to go and I don't blame him. He had a 'funny moment' and was better now. Considering his recent problems and the treatment he had received, his body had every right to throw a wobbly every now and then.

My next call was to a fire station, where several of London's finest were attending a man who had staggered in with chest pain. He was an American tourist who had a history of heart problems. His chest pain was real enough - none of this pretending malarky that goes on - and he was very diaphoretic; a give-away when it comes to a genuine cardiac event. The boys of the LFB had him on oxygen before I arrived and he was still very conscious and alert but the pain had not changed and there was no improvement in his condition. I carried out my obs. and was preparing to start treatment (an aspirin to begin with) when the crew arrived to take over. He was placed on a trolley bed and wheeled into the ambulance for further checks (an ECG) and treatment. No GTN was given because the patient had a problem with it, consequently he didn't carry it either.

FRED dragged me off to NW London for a pregnant female with DIB and a low BP. I arrived on a sprawling estate that I didn't know at all and had to drive slowly around it until I got to the address given. There was a man waving me in (a windmill) towards him, so I figured this was the location. The man was the patient's father - he was a doctor. He felt it necessary to call an ambulance because his daughter's blood pressure was too low but insisted there was no bleeding associated with it. Just as I was grabbing my bags from the car, the ambulance rolled up, so I waited for the crew to join me before heading up to the flat.

Upstairs, the girl was in bed, puffing and panting (but not genuine DIB), fully conscious and looking quite normal (no pallor, no sweating). The crew attended and I looked on. I asked the Doc to do another BP and he read it as low. It wasn't critically low (it is normal for a pregnant woman's BP to drop during the 2nd trimester), it was about 107/85 but I could see why he was concerned. It all came down to his ability to 'hear' a blood pressure accurately because he used a steth and sphyg. I wondered if he was panicking unduly. In the event, the patient walked to the ambulance without any difficulty. There was no abdominal pain and no other symptoms to be concerned about. I certainly wasn't needed.

I discovered that the fuel card for the vehicle was missing. There was no reason why it should be missing but it was. I was getting into my last quarter tank of fuel and it is considered (at the least) bad manners to hand over a vehicle with low fuel. It is a disciplinary offence to hand one over with almost no fuel. I had to ask for one of the other FRU medics to meet me at the station so that I could borrow his card. I called in my request to re-fuel and I made my way to the petrol station. I was within 10 metres of it when I got another call. It was a minute away and was for a '4 year-old female, fitting'. I raced to the scene and went up to the flat, walked through the door and heard a woman's voice. She was wailing and crying in another language and I felt a shudder run through me. I honestly thought I was walking into the place to find a dead child.

The mother was holding the little girl very tightly. Both mother and child were looking at me with fear. The child looked fine to me - scared but fine. I asked the mother if her child had been fitting and she said no. I was a little confused (and annoyed). The father was also in the room.

"Has your child had a fit?", I asked him.

"No but we feared she was about to", he said.

Apparently, she had been ill recently and had suffered a febrile convulsion earlier in the day. She had been taken to hospital by ambulance and had been discharged. The mother was very upset about it all and neither parent completely understood the condition. I explained to her that it was a common occurrence in children and rarely dangerous. I also explained that her child looked scared because of seeing me and the tension of the whole situation. She was terrified at the prospect of more needles and medical examinations. I agreed to take them to hospital myself - I cancelled the ambulance. I firmly believe that an ambulance, with two more bright yellow jackets arriving, increases the stress of a child. Unless it is an emergency, I will always try to resolve the situation myself. I also carry out fewer obs. (she had a high temperature) for the sake of the child.

I noticed that the little girl had ECG 'dots' on her arms and legs, so I peeled them off. This made her scream and wail. I had caused her no pain (and had promised I wouldn't) but still she made a fuss. This was a very fragile and frightened child.

I packed them all into the car and prepared to set off for the 3 minute journey to hospital. Just before we left, the mother started panicking again. Her daughter was closing her eyes and becoming sleepy.

"What's happening? Why is she closing her eyes like that?", she wailed.

"It's after midnight. Your daughter is tired. She wants to go to sleep", I answered.

Some people need to calm down when dealing with their children. No wonder the little girl looked continually frightened and agitated. Even the nurses couldn't make her smile when she arrived at the hospital. She kept flinching when anyone tried to touch her.

I had a long break after that. I filled the car up with fuel, gave the card back to my colleague and stood outside the station in the early hours contemplating the calm. Two cats were squaring up to each other across the road. They were both from the estate that towers over our station and so they were hard nuts, as we say in Glasgow. As they prepared to fight (I don't mind being the referee) a fox appeared from nowhere and ran between them, on his way back home from feasting in the local bins. The cats were startled by this and a little bemused (I reckon). The fight was off because they were just too confused to remember what the problem was and so they slunk off in opposite directions. Nature can be funny.

Later in the morning, around 4am, I was on stand-by in the Square. I chatted to a couple of my police mates and watched as they challenged a couple of young men acting suspiciously. The men ignored the challenge and kept walking away from the Officers. I watched as one of the cops walked behind the men, getting faster and faster until he was jogging, trying to keep up. It was hilarious. Those young men had no respect at all for the poor bloke panting along behind them. Eventually he collared one of them in a doorway. The other got away I think. Lucky for him.

Be safe.

Thursday, 12 April 2007


I wet my trousers today. I was washing the FRU and the brush/hose connection sprayed cold water all over me. I had to start my shift with a damp outlook and a sunny disposition. I tried to make it to my station so that I could dry off properly but, despite asking them nicely, my colleagues in EOC thought I might want to attend a chest pain in Chinatown first. So I arrived and penguin walked my way over to a patient with no chest pain and LOTS of alcohol in his system. Very funny.

By the time I got to my station I had already dried off naturally.

All the calls are RED because I am working on the CS(Charlie Sierra) callsign, as I always do at night. There are usually three of us running around Central and South London - all CS and all attending emergency calls only, though they don't always turn out to be emergencies.

I was off to a 5 month old male who had DIB and got cancelled before I had gathered any head of steam for the 4.5 mile trip (FRED is out there!). Then, on my way back from that jaunt, I saw a stupid drunk female stagger into the middle of the road, in front of a taxi which was just ahead of me, with a wooden pallet in her hands. She couldn't see where she was going and walked up the road waving the pallett ahead of herself. The taxi had to brake hard to avoid hitting her and I put on my lights so that she would clear off. It worked, she saw the blue flashing lights, obviously thought it was the police and took herself and her wooden friend to the pavement. She dumped her new acquaintance next to the 7/7 memorial plaque (nice touch) and scarpered - in as much as you can scarper when you are that drunk.

South of the River to meet a group of teenagers whose 20-odd year old mate was lying on the pavement, very drunk and suffering the effects of a dodgy ecstacy tablet. He bought it from a 'geezer in the street', allegedly. I was on my own and there had been no ambulance despatched yet. The guy was in and out of consciousness but didn't seem to be in trouble. When he was conscious, he was a pain in the neck and his cousin told me he could be violent, so I kept an arms length when he was shouting and vomiting. When he was unconscious, he was quite charming. A nicer bloke you couldn't hope to meet.

The police arrived and asked if I needed help. I told them I was okay and that the guy, and his mates, were no trouble. The police left me to it and I called Control for an update on the ambulance. I was in a busy street with these people and it wasn't the nicest part of town. Still no ambulance. Then Mr. E gets very annoying and becomes a lot more aggressive (verbally anyway), so I ask the FRU desk to send the police back. The guy kept getting up and falling straight back down again, mostly onto his head. He was big and heavy and there was no way I was getting under him to stop his dead weight, so he hit the pavement a couple of times. His cousin and his girlfriends dealt with him.

When the police got back and calmed the guy down (kinda), I asked again for an ETA on the ambulance but was told there were none to spare, so I made an executive decision. The guy was conscious enough to walk and, with the help of the police officers and his cousin, I had him bundled into the back of my car. It looked like a street kidnapping. I had the cousin and one police officer in the back with him and I drove on lights and with a police escort to the hospital. All too dramatic for one drunk idiot but needs must and I got there in 3 minutes. I had been on scene with an ever more aggressive and potentially violent man for over 30 minutes.

We got him into hospital, with additional help from one of my colleagues, and he went straight to a cubicle and slept. I think he may have cracked a rib when he hit the pavement on his third or fourth swan dive but I'm not sure.

Back at Leicester Square on stand-by and I get a call just around the corner to an assault. The man has had his nose punched and its bleeding a little, Nothing to be done really. He had allegedly been caught urinating in a restaurant doorway and the two members of staff who witnessed it took exception, as you would. They asked him to stop and he (allegedly) became abusive and violent, punching oone of them in the face and running off. I hope his little man was safely stowed away and that he had shaken it properly prior to that event.

Just before I went to that call, an American man staggered up to the car, leaned in the window (it was open) and said "Take me to my hotel". He obviously thought I was a taxi. Not only that but he must have thought I was the world's first psychic taxi service.

I went back over the bridge to treat a 2 year-old male suffering an acute severe asthma attack. He was breathing with some difficulty and had been like this for over two hours before the parents decided to call an ambulance. Children compensate extremely well and so they may look fine while they have such an attack but they will deteriorate rapidly and it will be too late. I have cared for a number of dying asthmatic children over the years. It is so easy to be lulled by them.

This child was still active and orientated but he was using his abdomen a lot more than normal to breathe. I gave him 2.5mg nebulised Salbutamol, followed by 0.25mg Ipatroprium. He responded after 10 minutes and his breathing became less of a struggle, although his very audible wheeze was still hanging around. I handed him over to the ambulance crew and he was virtually bouncing around enjoying himself with the female paramedic. Its good that the treatment worked so well but you really want your handover to reflect the need for such treatment and with him smiling and chatting now, It looked like I made the whole thing up!

I saw a BMW with the number plate 'Y IRAQ' rolling around the West End. I couldn't get a photo for you unfortunately because it is still illegal to use a camera whilst driving. I also saw a straw-haired and youngish man wandering around the Square telling the pigeons off at 4am. The pigeons looked concerned. They must have been because a whole gang of them gathered in a corner to talk about this guy. I know, I was there.

My last call came in at 6am and it was to a female with abdominal pain. I was behind the ambulance when we arrived on scene and went in to see if I was needed. The woman was in agony and it looked and sounded like a Liver-related problem. I couldn't give her morphine because her blood pressure was way too low, so she got fluids to sort that out. She couldn't use the entonox the crew offered because it was too painful to breathe in. The hospital was only 2 minutes away, so we took her there as quickly as possible.

Oh and the water sprinkling system in Leicester Square gardens is rubbish. It sprays water onto the paved area, making it slick and soaking passers-by. The potential for drowning an unsuspecting drunk lies therein but two young lads saw this as an opportunity to start their very own mini-Olympic event - landwater skating. Until they fell on their backsides.

Be safe.

Happy birthday TPD

It has been exactly a year since I put finger to keyboard to start writing this weblog. Since then, I have written more than a hundred postings and received hundreds of comments, good and bad, about my views. Most of the time it has been a pleasure writing because I love to write and haven't had the time or inclination to do so for years; this online diary gave me the opportunity to get started.

Some of the time I agonised over whether it had been worth the aggravation I received at work. I was as close as I could possibly be to quitting the diary this year and there were days when I simply did not want to go to work because this blog was creating a division between me and a few of my colleagues - men and women who never identified themselves to me and still haven't. I lost sleep and became quite depressed. It affected my home life and impacted on others in my life quite profoundly for a short time.

Now I don't care about the few who simply don't like this idea or the way it is written, thousands of readers have had their say and have been positive about it, including many colleagues.

When I started writing, I had no idea that there were other ambulance-related blogs out there; I barely understood the idea behind blogging but I had wanted to record my professional life for years and this is where the diary comes from. It was always my intention to write a book about the job and since I had been recording my experiences in a reflective diary anyway, it made logical sense to translate that into a blog.

So, on with YEAR 2 and hopefully, plenty of things to see, try, do and say. Thanks for sticking with me for the past year.

Friday, 6 April 2007

The long Good Friday

Three emergencies, 1 green, 1 no trace, 1 assisted, 1 conveyed and 1 ambulance required.

A quiet day on the prairie for the first part of the shift. Londoners leave their fair city for greener fields far away whilst the option of sunshine and travel beckons, as they do during Easter time. The tourists move in by the double-decker coach load and English is replaced by German, Spanish, French and Italian. I get to drive down roads I can see the end of and my colleagues have the rare pleasure of moving their ambulances in straight lines for more than a hundred yards at a time. Its great.

My first call was to an underground station where, a mere two hours before, a woman had called 999 and requested an ambulance because she simply couldn't cope. She had complained that nobody took her seriously or cared about her problems. Ironic then that I should show up long after she had gone to assist her with her troubles. This was a green call and it had been a very busy night by all accounts (start of the serious drinking season - also called Summer), so there would have been no crews, or cars, available when she actually made the call.

I logged a no trace on that call and made my way to the station. Amazingly, I made it there and got settled with a cuppa...or two. Nothing happened except telly. Crews went out but not me, so I went on stand-by out of boredom. I put my sunnies on and left the confines of the car to go walkabout. The main reason I did this was that my right arm was in danger of burning in the sun, whilst my left arm paled by comparison. You know how it is when you are sitting in a car in the sunshine. The opposite detail applies if you are the driver of a continental vehicle :-)

A couple of tourists asked directions, as they do, and then a man approached me and told me that someone had collapsed in a doorway and was 'foaming at the mouth'. I called it in as a running call and went to the bottom of the road where I found another frequent flyer sitting in a doorway...foaming at the mouth. Well, he was dribbling thick saliva in a long stream from his mouth. He looked dazed.

I knew this man to be epileptic, asthmatic and have several other medical problems. I guessed the problem today was his epilepsy. He has absences and they become more frequent when he has been walking distances. Today, as it was sunny, he decided to go on a jolly long walk. I sat with him, did my obs., chatted and waited for an ambulance to convey him to hospital.

Then I went back to my little patch on Trafalgar Square. I find quiet days allow for more tolerance of frequent flyers, like my absent friend. I can spend more time talking to them and thinking about their perspectives without the pressure of worrying about getting on to the next call. As I pondered this a woman approached and informed me that she was on her way to a 'client' who had fallen. She was from the local Social Services and was answering an alarm call made by one of those around-the-neck buttons that elderly and vulnerable people wear. They certainly save lives (the button alarms, not the elderly or vulnerable).

I wasn't sure why she was telling me where she was going but I think she was fishing for a lift. By the time I worked it out (I might have had sun stroke) she was already gone, with the comment "Don't worry about me, you stay there" still floating in the air. I caught the sarcasm only after I got over the sun stroke. I sensed I was going to see her again.

The call for this fallen alarm patient came in ten minutes later. In retrospect, I should really have gone with the woman and called it in. I buzzed round to the address (which was incomplete, so I couldn't find it at first and had to wait for further information) and met up with the lady from the Square again, just as I had thought I would. On the floor, in the hallway of the flat was a woman with a head injury. She had fallen and hit her head on the skirting, causing a scalp laceration. They bleed a lot and this lady was on aspirin, so she bled a little more than normal. The wound itself was small and the bleeding was under control when I arrived.

The lady refused to go to hospital from the start. She had been drinking and, judging from the many bottles of alcohol on the premises, liked to drink a lot. This didn't help me at all. I was concerned about her and tried to persuade her to go to hospital. I tried for over an hour, during which time I took two full sets of obs. and watched her improve steadily until she was able, with a little help, to be moved to her chair in the front room.

There is nothing I can do beyond insistent persuasion in these circumstances but if a patient has capacity and says no, then no it is. She signed the 'get out of jail free' section of my PRF and I left her to wait for her daughter. I had spoken to her daughter on the phone and explained the situation and my concerns, so she had agreed to visit and try to persuade her mother to do the sensible thing.

Out into the sunshine and another call to a local walk-in centre for an 'unwell woman with a non-blanching rash'. This could mean meningitis. We don't get many of these and I have only given Benzylpenicillin twice so far, so I made tracks and got there in a few minutes. Fortunately for the patient, her rashes appeared to be urticarial and blanched for me when I pressed them. She didn't have a temperature, she wasn't photophobic and there was no neck stiffness or vomiting associated with her illness. In fact, as we spoke, she began to point out new rashes around her face and body which I just couldn't see. Maybe my eyes are going. Sun stroke again.

I took her to hospital and by the time we arrived I was quite convinced that this lady belonged to the group of people who come out into the world for attention when all else fails.

That was it. My day ended. It seemed long but that's because I had a good few hours of nothingness. You can be absolutely sure of one thing though - I got out of Dodge before the party people put on their party feet.

Be safe.

Here we go

Nine emergencies, 2 green calls, 4 conveyed, 3 assisted, 1 refused, 1 no trace, 1 referred to a G.P. and 2 requiring an ambulance.

Sunny days in London at this time of year result in a combination of things: more people on the streets; more people getting more drunk; fewer ambulance staff because many are on leave and higher 999 call numbers because those who can't get out to enjoy the sunshine want some kind of attention...AND the number of buses on the roads seem to increase in direct proportion to the reduction of the number of ambulances available, so heavier traffic (mainly bendy buses - I don't like bendy buses) and slower response times.

Four miles South of the river for a female with sinusitis. The day was shaping up and it was only 7am. I gave advice, a friendly smile and a wave goodbye. Then on to a call, a mere 3.5 miles away (once I'm down there, I'm stuck) for a child with a sore penis. I arrived to find mum and child at home waiting for me. I carried out a cursory examination and decided, after a few questions, that he had either pushed something up there (boys do that during their penis exploration period) or he had a natural blockage of the Urethra. I took them both to hospital.

I got myself back up over the bridge and received a Red1 for a 'male collapsed, life status questionable'. This usually means one of two things:

1. The person is suspended.
2. The person is NOT suspended.

It's like science, isn't it? I drove to the call as if it was the former and discovered it was the latter. That's okay because I could now relax my bag-carrying arm and focus on the problem. The man had gone to work drunk and had collapsed suddenly. He had a history of hypertension, so I couldn't just dismiss this one. His blood pressure was a little high but the tests we use for stroke were negative. The ambulance crew arrived and I explained the problem - they agreed that alcohol seemed to be the prominent reason for his sudden collapse. His bosses were around and they seemed sympathetic but I also sensed embarrassment and possibly anger.

Five minutes on station for a cup of coffee and then I got a call to attend 'people being crushed' at the opening of a new Primark store in Oxford street. An Officer and motorcycle paramedic were already on scene but I was cancelled just before I got there. Apparently, only one person was slightly injured. I don't know what the fuss was all about frankly.

I didn't get back to the station to finish my cuppa though. I was asked to go on a 4.5 mile trip down South for a patient with cuts that were days old. I asked EOC if this was a necessary trip and they cancelled me - only to give me a 3.5 mile waste of time. They had no choice, neither did I but as soon as I saw the name of the patient, I knew who it was. I have written about this frequent flyer before and he calls us so often he has even had home visits from high ranking LAS Officers in a bid to persuade him to stop.

I got to his house in about 25 minutes (no blue lights) and he was sitting on the bottom step, as usual, waiting for me. I sat him in the car and chatted to him about calling us out for his minor problems - he had a mild eye infection this time. He agreed with everything I said but none of it was being absorbed. Just as I was about to take him to hospital (well, I couldn't leave him alone at home), his Community Matron appeared and asked if she could help. She explained that he had been having problems with his eye for days and that his doctor had already seen it and prescribed drops for it. She offered to guide me to the G.P surgery where she would take him to see his doctor. Apparently his G.P will see him anytime, at the drop of a hat. I found this incredible; I have to wait days to see my G.P!

As soon as I got back to my usual patch I received a call to attend a female with rib pain. She was at work and had bent down to pick something up when she felt something pop in her side and couldn't move after that without severe pain in her ribcage. She had fallen a few days ago, sustaining facial and rib injuries but her ribs had been cleared, without x-ray, by her doctor. Maybe now it was time to x-ray them. It took 5mg of morphine to move her to the car and another 3mg to keep her in it. No ambulances for me to call on, so this was a day for conveying as many as could safely be conveyed, simple as that.

I then rushed to a tube station for a female with abdo pain who had been waiting for an hour and a half. I was on a break and had just finished when this one came in. By the time she got an ambulance response she could have walked to the hospital and back twice. Three times if she was really fit and up for a mini-marathon. I can't believe people with minor problems (she was not in much pain) wait that long to be taxied to hospital. When I delivered her to the nurses, they gave her two paracetamol and a glass of water...oh, and a seat out front.

An emergency call to Sw1, where an elderly woman had collapsed and was now having DIB after walking up 7 flights of stairs in a theatre. After I had climbed them to get to her I was pretty breathless myself and I consider myself to be fit. There is no lift in this building and she had no choice but I could see that she was not recovering properly, her breathing had settled but she just didn't look too good. With the help of a member of staff, I slowly walked her back down the stairs and into the car, her friend in tow. She was fine during the trip to hospital but suddenly got worse when she was in the cubicle waiting to be seen. Her breathing deteriorated and she complained of pains in her legs (she was hyperventilating so the pains could have been pins and needles). I assisted the doctor in calming her down and he got on with her ECG and other tests. I got on with my very long day.

No sooner had I completed my paperwork than I got called to a train station to deal with a female having an epileptic fit. She had recovered and was a little post ictal when I arrived, so I did my obs. and asked her several times if she wanted to go to hospital (they rarely do). She refused and I let her and her family get on with their journey home, complete with a copy of my PRF and a little advice.

Then Mr. Colostomy struck. Control asked me to investigate an abandoned call that came from a phone box outside a pub I recognised. I knew the pub because this gentleman uses this location regularly. The call was an hour old now, so he was unlikely to be there but I went to check it out, I wouldn't dare presume in case I got it wrong. I was right though, he wasn't there and people had witnessed him around the phone box at the time of the call. I did an area search, mainly because I wanted to have a little chat with him but he was long gone - probably had his feet up in the waiting room of his favourite hospital. Today wasn't a good day for people like him, it really wasn't.

As I made my way back, looking for Mr. C. a van driver flagged me down and told me that someone had been knocked off his bike by a bus just around the corner. I called it in and got the incident sent to me as it was being phoned in via 999. I was on top of it in 2 minutes.

The bus had allegedly struck a man on his bicycle, knocking him off and dragging him a little way before stopping. The man was sitting up, chatting to witnesses who were now helping him. He had a nasty little cut on his forehead, which had bled profusely enough to worry people around him but otherwise he was completely unscathed; not shaken, not stirred. Lucky man.

The ambulance was on scene shortly after I covered his head wound and when the police got there, I left on yet another call. This one took me back up to the West End where a young man was 'fitting and coughing up blood'. There was already a car on scene when I got there, a young technician I know quite well, but Control had sent me too because of the nature of the call (paramedics are sent to every epileptic call now). I wasn't required though, he was recovering and despite my colleague's best advice, he refused to go to hospital. He should have gone because this was apparently his first fit.

Ten minutes later and another fit, this time in a crowded shop. The young girl was lying on the floor, dazed and confused. She started crying and didn't stop when she realised what was happening. Again, this was her first fit, if that's what it was. It sounded like a drop attack to me, she wasn't epileptic but was being investigated for a number of faints she had recently suffered. The poor thing wept inconsolably all the way into the ambulance and probably all the way to hospital. The crew were very gentle with her and I'm sure she knew she was in good hands.

My last call of the shift (13 calls today) was to a male who had collapsed and was unconscious in the street. I raced to the scene and saw nothing untoward. Well, there was a drunk sitting against a post. Could it be him? Yes, of course it was! The police turned up just as I was making my cautious approach to ask him if he had made the 999 call, so I let them do it instead.

The man denied making the call but his little mate, who swayed just as badly as he did, said that another alcoholic (from the same gang I guessed) had done it as a taunt while our main man was asleep. One of the officers gently pushed drunk #1 away from drunk #2, as they were getting a little close to one another and drunk #1 tried to pick a fight...with the cop! I couldn't believe it. Nobody, least of all the police officers, wanted the paperwork - we were all off at 7pm.

So drunk #1 relents and things calm down. Drunk #2 decides he doesn't like the way the police officers are talking to his mate (drunk #1) and now he wants a fight! I'm standing there thinking for Pete's sake lets all go home (but not to the same place obviously). My eyes are blurring now and for a completely different reason to drunks 1 and 2. I am dog tired.

Then peace breaks out, everyone smiles and the thing that was going to blow up never does. I get in the car, wave my police friends goodbye and set off back to base and home.

I have described the same day for all of my colleagues too incidentally.

Be safe.

Wednesday, 4 April 2007

Acting under warrant

Four emergencies, 4 Green calls, 4 conveyed, 1 assisted, 1 treated at work, 1 not required and absolutely NO ambulances required.

My first shout of the day was to a female having an epileptic fit. I got on scene to find the flat being searched under a warrant by the police. I thought there may be less of a medical emergency and more of a distraction going on here. On numerous occasions I have attended calls for fits, faints, asthma attacks and chest pains only to find the abode being ransacked by the authorities and the suspect claiming one, some or all of these conditions in order to get out of the situation - not unlike the shoplifters I have mentioned before. It's human nature, I guess. when you are desperate and need to buy time, a little chest pain goes a long way. The theory is that we are too dumb, or scared to say they are faking it...there's the whole liability thing if it goes wrong. Unfortunately, we see the situation for what it is and often these people get nowhere. We are not dumb and some of us will tell them they are faking.

This young girl had two witnessed events, described as blackouts. They could have been seizures but she was more alert than me when I walked into the flat. You generally need a little more than five minutes to recover from an epileptic fit. She could have been genuine, so I gave her the works, in terms of obs. and she checked out just fine. I explained to her that it sounded like she may just have passed out. She agreed. It was her boyfriend who was being arrested, after all, not her.

I offered her the opportunity of going to hospital and she declined, twice. That wasn't the game plan anyway, I was there as a distraction. In fact, when I first got on scene and entered the flat, the police had to guide me past another little distraction left in the hallway on a piece of newspaper - human excrement.

Then I was sent 3.5 miles over the River (you know how I feel about that) to attend a 'female with headache'. It was given a Green2 category, which is fine but its a long way to drive (no blue lights for this one) for someone who could have taken a cab. Sorry to be so harsh but I get headaches, on the odd occasion they have been blinding and made me physically sick but I certainly DO NOT call the ambulance service. I do what you do, I cope.

I arrived on scene but could not identify the house. Then a woman waved out of the window. No, she didn't wave, she summoned me to stop and wait. I felt like a mini-cab driver. So I stopped and began to get my bags out of the car. Before I got to the door, the woman hustled the patient, who was holding her hand against her forehead, out of the house. Usually I get a chance to introduce myself and do some obs. on scene. Not this time.

I carried out my obs. in the car and took some details and discovered that she had...a headache. A bad headache. She was young and she had no significant medical problems. Her obs. were perfectly normal and she had no rash, photophobia or stiff neck. She had not been in contact with anyone who was ill and she had not been intimate with birds or foul. She had not been abroad recently and she was taking no medicines or drugs. She simply had a headache. I took her to hospital. They won't find a tumour and they won't even bother trying. She will get better.

I tried to get back across the river and made it as far as SE1 when I got call to a 'bus driver, assaulted, punched in head'. I got on scene in 3 minutes and couldn't find the bus. Well, its not an obvious object in a road full of buses. I knew the police were coming, so as soon as I saw them I tagged along and they led me to the correct vehicle. I had to pull a u-turn to achieve this.

The bus driver was unhurt and didn't want to go to hospital. He was angry about being hit like that and I don't blame him. The man can't even do his job without risk to himself. He had been hit with an iron bar across the head in the past - just for saying "fares please". It's not right.

Ironically, the bus was parked up directly in front of the local police station, yet neither the driver nor his boss had thought of nipping in and speaking to an officer on the front desk. They had called the police instead. Then they had waited for about 6 minutes until they (and I) arrived! Just as well he wasn't badly hurt.

I went to a train station to help a man with learning difficulties get home. He was a little lost and confused after wandering away from his home and he had got his head trapped in the doors of a train, so the ambulance was called (British Transport Police worry about these things). He wasn't really hurt and I established that fairly quickly, but he needed the encouragement, so I told him he was fine and I had the BTP escort him to a bus bound for home. Last time I saw him he was standing at the bus stop with the two officers next to him, waiting for appropriate transportation.

Then a 2-for-1. I attended an elderly lady who had fallen and broken her wrist. I sat her in the car and drove to hospital, as is my routine, but on the way I came across a collapsed female with police in attendance. I felt I couldn't justify driving past, so I asked my patient if she was okay with me stopping and checking this other lady and she nodded her confirmation. I got out and approached the little gathering. The lady on the ground was conscious but had a few minor cuts. The police told me they had been waiting for an ambulance but it had been diverted to a more serious call. I checked the patient out, took a short history and still wasn't sure what was going on. She seemed very confused but not post ictal. She denied being epileptic anyway. She had just collapsed for no reason, according to witnesses. The police thought she might be a bit dodgy and they wanted to check her out but time was pressing and I had a patient in the car with a painful wrist. I thought about it and decided to bundle the new patient into the car too. I took them both to hospital (with a police escort) and got them both assessed at the same time. They were quite happy with that arrangement and the second patient didn't become a werewolf.

When I eventually got on stand-by in Trafalgar Square I heard a mother chastise her young son for chasing the pigeons around.

"Benjamin, get over here! You do NOT go running after birds", she shouted.

"Not 'til you are older anyway", I thought to myself wickedly.

A call to a diabetic going hypo had me summoning up all the skills and knowledge I needed for this particular emergency - chocolate and coke. He was not alert and he was sweating profusely. His own BM meter read 5.6 but I knew that could not be right. Mine said 2.3 - that was more likely. I got a member of staff in his office to gather the necessary materials for appropriate treatment and I fed and watered him for five minutes. I had one chocolate myself too, for moral support.

He recovered very quickly and finished his treatment off with a salad roll. By the time I left him his BM read 6.2 - much better. His meter would have been skewed because his fingers had not been cleaned prior to the first measurement so any sugar residue would have given a falsely high reading. No ambulance and no hospital needed. He's fine and I got a free chocolate.

My last job dragged me South again, this time for a ? fractured ankle that looked more like a sprain to me. The young man had been playing football and had fallen awkwardly, twisting his ankle inward. That'll do it. He heard it crunch and saw the joint go 'wobbly'. It was swollen and bruised. Sprained, possibly fractured.

I splinted it, hopped him to the car, drove him to hospital (very busy now) and chatted along the way, as I do - just tell me to shut up if I bore you. I arrived, unsplinted him, wheel-chaired him to A&E and left him to ponder his footballing future. Nice guy actually.

Be safe.