A rare case

Seven emergency calls. One non-convey and six requiring an ambulance.

A Red2 for someone with food poisoning, described as 'semi-conscious'. You mean her eyes were closed? There was already an ambulance on scene when I arrived so I wasn't required.

This was followed swiftly by a call to a 26 year-old male who had been knocked off his motorcycle by a taxi. He was sitting inside a building society when I got on scene - he was chatting to one of the staff and waiting for me. The incident had taken place some 30 minutes earlier and the taxi driver was nowhere to be seen. Meanwhile, the patient had hobbled inside at the behest of the nice lady who was now offering me (and the police officer who had just arrived) a cup of tea.

There was nothing really wrong with this man. He had fallen awkwardly on his ankle and now it was hurting him. The taxi driver had allegedly told him it was his own fault and carried on about his business. He hadn't even stopped to help the poor guy up off the road.

I did my usual baseline stuff and he declined to go to hospital. I got him to sign my magic form and then I left him to explain the incident to the police officer.

It was raining all day today and the roads were slippery. I left the vomit-smelling car at the station to air out and took my usual vehicle, complete with new battery, onto the slick surfaces of London Town. I was driving with extra caution.

After a bit of a pause, during which I searched for my stethoscope (it disappeared from the top of my bag), I got a call to a G.P. surgery for a 44 year-old male, DIB ?cause. The job was out of my area but I was familiar with the territory because I used to work in it a few years ago.

I went into the surgery and waited for the receptionist to acknowledge me and let me through the security door to the doctor's office. Inside, a large man was sitting on a chair with an oxygen mask on his face. The nurse was there with the doctor and they told me that he had come in complaining of having shortness of breath (SOB) and chest pain (now gone) over the previous weekend.

He looked fatigued and was certainly out of breath. I checked his oxygen saturation and it was low. I listened to his chest and I checked his ankles and hands for signs of swelling. The doctor was suspicious of heart failure and I had been thinking the same. He had some kind of cardiac problem and his pump wasn't behaving itself. He could collapse at any moment.

The crew arrived as I was gaining IV access and completing the rest of my checks. They wheeled him out to the ambulance and carried out a 12-lead ECG. This gave us a good look at what his heart was doing (or not doing). It looked like he had a block and other anomalies which went some way to explaining his present condition. I took a copy of the ECG back into the surgery for the doctor to have and left the crew to get on with delivering the man to hospital, where he really needed to be.

I continued my search for the elusive stethoscope after that. I thought I might have left it in a patient's house but I couldn't remember the last time I took it out and used it. I know it was recently but I just couldn't pin down the memory of the location. I had lost a stethoscope before when I left it in the back of an ambulance but this tends to happen, especially during difficult or messy jobs - things get left behind. It was my favourite steth and I had a cheap one in my pocket as a substitute - it didn't feel right.

I stood in the rear area of a large department store in Regent Street for 15 minutes. I stared at a lift door, waiting for it to open. I was bored and a bit annoyed at being left here. There was a patient somewhere in the building. He was vomiting, had DIB and did not want the rest of the staff to know, so he was hiding himself away until the ambulance arrived to take him quietly to hospital. He hid himself so well that the staff member charged with taking me to him couldn't remember where he was. So I stood by the lift while he went on a search for his missing boss.

Meanwhile, the crew had arrived and were sent up the escalators. They were steered a long way off and I couldn't contact them. This was beginning to look like a farce.

The 'guide' came back for me and apologised. The lift opened but nobody was in it. He looked upset and decided to take me to another part of the building where the patient was supposed to be (he was supposed to be in the lift). I walked all the way to the other side of the building, went up some stairs, around a corner or two and we still couldn't find the patient.

Eventually, 25 minutes in, I went back to the shop floor with my trusty guide and called Control to ask where the crew were and if they had seen the patient. After a short investigation on the other end of the line, I was told that the crew had left with a patient on board. If I had been holding a biscuit, it would have been snatched from my hand.

Near the end of my day and a very interesting job arrived on my MDT. A 16 year-old female was having a fit in a theatre. I got there as fast as I could and parked up beside the ambulance which was already on scene. I had to ask for directions because this theatre is a maze and, for a few minutes, I couldn't locate the crew or the patient. Finally I found them in the basement.

A young girl was thrashing around on the floor and the ambulance paramedic and a solo motorcycle responder were trying to control her. The paramedic told me that she had a specific condition but I hadn't heard of it before and wasn't sure what we were dealing with. It looked like epilepsy but the girl was fully aware of what was happening and had already refused to have rectal Diazepam administered, which is the normal first step in such cases. Getting a line in would be a challenge - every muscle in her body seemed to be fighting with her. She had already been given some of her own meds. by her teacher, who was with her, but it had no effect.

She had oxygen on and was put into a chair, albeit with some difficulty. There wasn't a choice - she had to be carried up a lot of steps to street level. She had been like this for almost 40 minutes when I arrived and so it was imperative that we got her out of there. The second crew member arrived to assist - he had been getting more equipment to the scene - and together we got her up the stairs and out of the building.

As soon as she was in the back of the ambulance, we got started in earnest. I put a line in and gave her Diazepam. The effect was almost instant; she calmed down and her breathing slowed. It slowed so much that I was concerned about her initially but she was fine and was able to talk to the crew. For some reason another crew had been sent and so there were two ambulances, a car and a motorcycle on scene - a total of 6 LAS staff. Somebody is being very cautious.

The girl had another seizure a few minutes after the Diazepam had been given. We had her on a glucose drip because her blood sugar levels had dropped (no wonder with all that exertion) but she still wasn't stable and this had been going on far too long now. She was rushed to hospital and I accompanied the ambulance - well, I drove in front and cleared the traffic, which is a lot easier to do in a car than in a large ambulance.

At the hospital she was given more Diazepam and settled down again. I found out that her condition is called Propriospinal Myoclonus. It's quite rare - so rare in fact that I could only find a few relevant links for it. In this patient's case, I understand the origin of the problem is childhood disease but I wondered if I had seen this before without knowing it.

I dealt with a young man having a mysterious seizure in a wine bar last year (you may remember). He too could communicate and seemed to be fully aware. His spasms also seemed to be jerky and muscular in nature (myoclonic). It had me thinking.

After that job I was asked to attend a young man who felt ill at work. All of his obs. were normal but he insisted he felt faint and dizzy. When the crew arrived he asked for a brain scan to be carried out. I think we explained to him that the ambulance was out of brain scanning machines at that time of day.

I volunteered myself for the last call of the shift. It was near to where I was located and very near to my station, so it would be a handy call to finish on. There was a drug addict lying in the street and the motorcycle responder was dealing with him. A passer-by had called an ambulance for him because he appeared to be having a seizure. I thought I might offer my assistance with this one. Fitting drug addicts can be a handful, so my colleague may find the extra mittens useful.

Control allowed me to go and help. It took me 20 seconds to get there.

My colleague was talking to the man, who was jerking on the pavement but managing to chat. It seems he bought some dodgy stuff from a 'bloke in the street' and was now paying the price. He wasn't in any real trouble - he was mainly obnoxious and difficult to deal with and I felt no sympathy for his situation to be honest. There are plenty of people out there who really need our help and who don't abuse drugs to excuse themselves from responsibility.

I waited until the ambulance arrived and then I went home.

I found my stethoscope. It was wrapped around a bush in my garden at home. It must have snagged and been pulled off the top of my bag as I went to work a few days ago. It got coiled around the bush and looked like a snake. I am currently drying it out and will have to strip it for spiders.

Be safe.