A close call

There are some shifts that shake you out of your comfort zone and test your ability to remain calm and make the best decisions possible for the benefit of the patient. Tonight was one of those shifts.

I was just about to start my VDI when I got a call to a 6 year-old male, fitting. Control called me on my 'phone and apologised for the distance they were sending me but, at that moment I was the only paramedic available and near enough to deal. That's always an ominous statement.

I sped through rush hour traffic and got one scene, over four miles away, just outside the required Orcon time. In other words, I was late. I grabbed my bags and headed towards a door which was open and being guarded by a little girl. She had been sent to ensure I went to the correct address. She said nothing as I walked past her and into the flat.

Inside, a woman was kneeling on the floor, 'phone to her ear, looking down at a little boy who was on his side, writhing and shaking. He was clearly having difficulty breathing properly and his airway was very noisy. The woman handed me the 'phone as I put my bags down and assessed the situation. The call-taker from EOC was on the other end and, as I unpacked what I needed she confirmed my presence on scene and I asked her when I could expect an ambulance. I made it clear that I needed it quickly. She told me that one was on its way but I didn't get an ETA, nor did I remember to ask her not to have the call downgraded or over-ridden by a higher priority whilst the crew were en-route.

This call was originally given as a young male fitting but the updated information stated that he was no longer having a seizure and was simply 'hot'. As I rushed to get there, I instinctively thought that this would be another run-of-the-mill infection and temperature-related fit. In other words, non epileptic and likely to end with me assessing a conscious and lively (albeit hot) child. I knew the ambulance crew would be thinking the same way and I hoped that the tone of my voice held enough information for an experienced call-taker to recognise that I was dealing with something serious.

I immediately began my primary assessment; his airway was noisy, so I adjusted his head position manually and that improved things a little. His sats. were extremely low; 78% and so I put him on oxygen. His pulse was racing at 142 and he was hot to touch. He was in spasm, especially around the diaphragm and he was completely non-responsive. Given the initial call information and the history, which was related to me by his mum, there was a possibility of status epilepticus and I was not about to take the risk that it might be anything else at this stage, so I administered rectal Diazepam.

The boy's status did not change and his breathing was now causing me great concern. He was becoming flaccid, except for his Phrenic spasms and his sats. were only improving marginally to the mid 80's on oxygen. I knew I had to get him to hospital without delay. His mother told me that he had been like this for 20 minutes and that she had considered getting a taxi to hospital.

After what seemed a lifetime, the crew arrived and I wasted no time in getting him into the back of the ambulance. The two EMT's on the ambulance worked around me as I cannulated the little boy and considered another dose of Diazepam but something wasn't right with this. We set off on blue lights and I asked the attendant to put a nasal tube in. The child's breathing had now become much noisier and he was clenching his teeth - trismus. There was a problem with his brain.

His breathing began to deteriorate, despite his airway being improved by the nasal tube. He wasn't breathing adequately enough and so we 'bagged' him and prepared to resuscitate. All the time I was reaching over to the mother, who was travelling with her daughter, to comfort her and reassure her as best I could.

When we arrived at hospital, the boy's condition had deteriorated significantly. The attendant carried him him whilst the other EMT continually ventilated him. A colleague from my base station helped with the oxygen and that freed me up to begin the hand-over in resus. I stood and related the history and my findings, including drugs given and other treatment carried out, whilst the resus team and a paediatric registrar worked on the little boy. His mother and sister stood in isolation at the end of the room, distressed and overwhelmed.

Before I left, the team had intubated the boy and had him on a ventilator whilst they worked out what could be wrong with him. I spoke to his mother, gave her a little hug and reassured her daughter, who burst out crying from a state of staring silence. I sat with the crew who had been with me throughout this and had a cup of tea (I don't drink tea usually).

Then I got a lift back to my car, which had been left on scene. I said thanks and goodbye to the crew and off I went, back to base to reset my head and complete my VDI, not knowing whether we had saved the little boy or not.

A routine job in the West End after that. A doctor had fainted in a cafe and had a bump to her head. She was fine when I arrived and a little embarrassed I think but lucid enough to refuse the offer of hospital care. She had fallen down after feeling faint, probably as a result of lack of sleep - she was extremely tired and I sympathised with her. I sat with her for a few minutes and we chatted about clinical decisions. Then I gave her the honour of the golden signature and I left.

North London and my next call was to a 45 year-old with chest pains. He had no cardiac history and the pain was exacerbated when he breathed in. It sounded pleural to me; he had suffered a recent chest infection, so it wasn't a long shot. He was taken to hospital by ambulance just in case. I wouldn't risk leaving any chest pain at home.

A four mile trip on blue lights in the opposite direction and I found myself watching my colleagues attend to the needs of a woman who had fallen down the escalators in a tube station and sustained the all-too-familiar groove markings on her head. I wasn't really required, so I assisted the crew by carrying some equipment back up the escalators as they gingerly walked the lady to ground level and into the ambulance.

There were a lot of police officers in Whitehall tonight. At first I thought it was an anti-terror exercise but they were working in conjunction with Transport for London to arrest fare dodgers on the buses as they pulled up at the stands. A lot of money spent to save a few quid I think.

A few minutes rest and then I was on my way to a regular location - a police station. A prisoner was unconscious. It took me 10 seconds to establish that he was feigning unconsciousness and that his acting abilities were in dire need of improvement. Still, he persisted in playing the dead duck. His eyelashes flickered when they were touched, he moved when pain was induced...he even adjusted his head to a more comfortable position when I moved it into a slightly awkward angle! He wasn't funny though. When the crew arrived and the paramedic began to induce a little more pain, the prisoner became abusive and aggressive, lashing out and grabbing my colleague's leg. It took four police officers to hold him down and sort him out.

After that job I got a few routine drink-related calls. A young woman, lying in the rain, too drunk to understand she was alive. I waited with this lady, her friends and the police officer who had called it in until the crew arrived and we loaded her into the vehicle. She vomited a LOT on the way in and had completely dried up by the time she was in the back of the ambulance.

Then I was approached as I sat on stand-by. A young woman asked me to check her friend's condition. She was drunk and couldn't stand up. It sounded familiar. Sure enough when I went around the corner I found a teenager flopped on a ledge, vomiting and being assisted by her friends, some of whom were a little too loud and active for my comfort. I suggested they all calm down and let me do my job. Luckily for me, they obliged.

I called this one in and an ambulance plucked the young lady from obscurity to sobriety.

A little time to myself during which I saw nothing of interest, I'm afraid and then off to another sector for a female with abdo pain and a PV bleed. The ambulance arrived on scene at the same time as me, so I simply assisted them with the young woman. The crew looked very tired and the EMT attending told me that they had been thrown from one end of the town to the other, non-stop and with no break. That's not amusing when you're on nights.

My last job of the shift was for a male with chest pain. I thought the job was going to cost me sleep time, as it was creeping towards 7am but a crew were on scene and all I had to do was carry my bag back to the car with my false-alarm face on.

And now some good news. I posted this days after the shift and I got a call today from the mother of the little boy who was 'fitting'. He survived and is back home, awaiting future scans for a possible cranial bleed. The only reason I know this for sure is that I gave his mother my mobile number and asked her to let me know what happened. Otherwise, as with the other serious jobs I have written about, I would simply never find out.

Be safe.