The Wizard of Oz

Nine emergency calls, one convey and one refusal. Seven required an ambulance.

Tonight was going to be the busiest night of the year for me so far. The jobs were interesting and varied and a few of them took a while to deal with, so the shift went very quickly.

It all started with a call for a 27 year-old having an allergic reaction at a local Hotel. She was part of a Hen group (you know I love those) and was about to go out with them for drinks and fun and trouble, no doubt. When I got to her room, she had a few friends around in various states of undress. I had to insist on covering my eyes ‘til they were all decent. Honest.

She was covered in red blotches. She looked as if she had been 60% in the sun and 40% in the shade. It was a shame the rash was so uneven – she might have got away with it. Unluckily for her, however, she had reacted to something she ate and the blotchy erythema indicated an allergy that could get worse, especially if it affected her upper airway. She told me that initially she had felt a ‘lump’ in her throat. For now, though, she was breathing normally and had no signs of distress. Except when I told her she had to go to hospital. Then I saw distress.

Her fellow Hens were gutted and said so…a few times. However, they bravely decided to go out and enjoy themselves in her honour. She was compliant and did what I asked; she knew it wasn't too serious and would clear up soon - that compensated for her missing the night out. Partly that and partly the fact that I told the her she would be in hospital for a few hours at most, would probably get a couple of pills and then she could join her mates.

Her half-naked friends gathered around her (I continued to cover my eyes of course) and clucked (sorry) about everything being ok and that she wouldn’t miss anything. I got the patient and an accompanying hen to the car and off we went to hospital. En-route I came across a RTC and had to stop. Two cars were involved and the drivers were still inside them. The vehicles were in the middle of the road and I called out to one of the drivers to get out of his vehicle and stand on the pavement. This is how the conversation went. You’ll like this.

“Sir, get out of your vehicle, it’s not safe to be inside it”

“I can’t”

Now, I thought he meant he couldn’t get out of his door, which was jammed into the other car. I didn’t have time to play games with him and I had a blotchy patient in the car.

“Sir, get out of your car”

“I can’t”

He looked angry.

“Why don’t you slide over and get out the other side?”

He looked even angrier.

“I can’t move. I’m disabled”

“Oh...sorry, I’ll come and help you”

The word dumbarse springs to mind. Add it to your dictionaries; I’ll be using it more often in future, probably in conjunction with "I'm a"

I called it in and asked the patient if she minded. She said she didn’t but also added that she felt much better and wanted to forget about the hospital trip. I persuaded her to hang tight while I dealt with the RTC.

I apologised again to the disabled driver and decided the best thing to do was to have the cars unlock themselves from the embrace they were in and then each driver could drive his vehicle over to the kerb. The police (now on scene) were happy to have that done and I knew an ambulance was nearby; I could hear the sirens not too far away.

Both drivers were unhurt, although the driver of the car who caused the collision decided he might have neck pain. Here we go, I thought.

Once the ambulance was on scene I continued my journey to hospital. I had to reassure the patient that she would be going to the ball all the way there. I got her into A&E, handed over as usual and the nurse told me she would probably be put on fluids and tested and probed for the duration of the night.

Oops. I need to avoid all hen groups until the dust dies down.

The next call was to another allergic reaction. This time it was a 19 year-old in a Halls of Residence. She had a nut allergy and had no Epipen with her because she had not reacted for years but now her luck had changed. She was in mild respiratory distress and hyperventilating to boot. Her friends were anxious about her and her condition had the potential of deteriorating. There was a crew on scene with me and the paramedic asked me to give her adrenaline. I obliged – prophylactically, it was good idea.

She started to settle down but she wasn’t out of the woods yet, so we carefully took her down to the ambulance for the short trip to hospital.

I haven’t seen many miracles recently, so the next job made up for it. It was to a male who had fallen from a 7th floor window - at least that’s how it was given. I was asked to report for a Delta Alpha (doctor). Control will ask us to do this if the job sounds serious enough to warrant sedation or on-the-spot open chest cardiac work.

I raced to the scene and found a solo motorcycle paramedic already there, attending to someone I couldn’t see on the ground. He had fallen from the window of a hotel room. The hotel is located less than two hundred meters from my station. There was a fence and hedge obscuring the scene, so I climbed up onto it and looked into the little crowd. I asked the paramedic if he needed a Delta Alpha. He didn’t answer but I saw the guy he was attending. He was lying on his back and he was talking, so that was a good sign. Maybe this wasn’t ‘as given’.

I went around to the place where all the action was and came out onto a narrow little patio area where guests can sit and drink. I went over to the crowd, found out who was needed and got rid of the rest. I also had the little gate at the end of the patio opened up so that the crew could get access when they arrived.

So, here’s the story. The guy, who is Australian, was very drunk. He walked into a guest’s room (who happens to be a fire fighter from the States), said something vague about not finding someone and continued walking the length of the room and through the third floor window, falling vertically 40 ft to the patio below. He landed on a metal table, which crushed instantly. Now he was lying on the ground, surrounded by worried looking staff and concerned paramedics, with nothing more than a scratched elbow!

There’s no doubt the table saved his life. It broke his fall and absorbed almost all of the energy. Luckily there was nobody actually dining at the table when he fell from heaven.

This young Australian was full of energy. I felt sure he had taken more than alcohol. He was buzzing. When I spoke to him, he shook my hand and our conversation turned into a Python sketch.

“Awrite mate. What’s the problem?” he said

“You fell a long way and you might have serious injuries”

“Na. I’m alright…look!” Now he was demonstrating his full range of movement.

“But you fell from the third floor window!”

“I’ve fallen before. I’ve had worse.”

“It’s a long way to fall, so you may have injuries you can’t feel yet.”

He looked at his elbow.

“Na…it’s just a scratch.”

Hilarious. I couldn’t help smiling all the time I was talking to him. He was boisterous to say the least and very alert. I thought he might have a head injury and it was being masked by the alcohol and possibly drugs. When told that his top would be cut so that we could examine him properly, he became quite angry and wasn’t having it. He told us he had just bought the top and there was no way he was allowing it to be cut. No way.

The Delta Alpha was stood down and we had more than enough resources on scene to deal with him – we had two ambulance crews, the solo MC paramedic and me. He was difficult to get on the ambulance and stretched his arms out deliberately to stop us getting him into the back of it. He laughed all the time, joking at our expense. He had a collar on but he ripped that off in the ambulance. No use arguing with him, I thought.

When he got into resus the first thing they did was cut off his top. He lay there looking very upset and suddenly very passive. I think it was sinking in at last.

After that, I was off to an out-of-area underground station for a fall with a head injury. It was a typical escalator-type injury; teeth marks in the head, a little bleeding (but not much) and a drunken patient. I helped him until the crew arrived. He was embarrassed and eventually refused to go to hospital.

Back to my patch for an acute severe asthma attack. The gentleman had been having regular but unpredictable asthma attacks recently and tonight he was having his fifth. This time it wouldn’t resolve after he had taken his inhaler. This is known as brittle asthma. I helped the crew with the obs. and I left them to it. He was being nebulised and already felt better but he needed to go to hospital and get his medication reviewed. There was one thing I felt may have contributed to these attacks, however. He told us that he had been given Ibuprofen by his doctor. This drug, along with aspirin, can actually trigger asthma.

No break yet and another trip to Leicester Square for a young female who was unconscious (drunk). I arrived to find a large girl lying on the ground with one of the local street urchins attending her. I should explain, the street urchin is a wheelchair-bound young lad who scoots about Central London helping people. He loves doing first aid and I have spoken to him on many occasions. On this occasion, he had taken all the basic obs and was very keen to stick around and help. I had to limit his involvement though; he was beginning to interfere with my job. I asked him to guard the car and guide the ambulance in. He duly obliged.

I waited 20 minutes for the ambulance. Things were getting stupidly busy now. When it arrived, I found that I was talking to a crew from well out of our area. They picked her up (with a struggle) and bundled her in to the ambulance. No other way of doing it really.

The next call was a ‘spiked drink’ job. Most of these are nonsense; the women are just drunk but can’t believe they are so out of their heads on ‘a few’ drinks. This time was different. This 31 year-old woman was not drunk – she was tripping. She had been at the bar of a club and had asked a man if the drink in front of her was his or not. It was the same drink she had ordered but there were two on the bar and she didn’t know which was hers. The man told her which one it was and soon after she drank it, she lost control.

Her husband was with her, as well as a number of wailing friends. The whole episode took place in the basement of the club. It was dark, noisy and stinking. The patient was lying on a couch and I tried to find out how she felt but she was confused and made no sense. At times she was lucid but more often than not she was ridiculously out of it. I suspected she had been given an amphetamine, probably methamphetamine. Ecstasy couldn’t explain all of her signs and symptoms.

Initially she was just nauseous but as time went on (I was with her for an hour before I got an ambulance, despite asking the club staff to make it clear I needed one urgently) she began to develop other, more sinister signs and symptoms. She began to have short seizures, lasting up to a minute, followed by periods of apnoea (no breathing), which required ‘bagging’ to remind her to breathe. This resulted in a gasp of breath (usually after squeezing the bag three times) and her return to the living. I had to carry out this procedure five or six times and her husband was becoming seriously concerned.

I had done all I could; oxygen, IV, fluids, all my obs. I had nothing else to offer except to keep her breathing when she stopped. No drug would be of any value in this situation. She needed to get to hospital as soon as possible. She just happened to be genuinely in need at the worst possible time.

When the crew arrived, I was relieved. We got her up to the ambulance with a struggle and we entered the outside world to the sound of sirens all around us. Someone had been stabbed in Leicester Square and there were police (some armed) running around and emergency vehicles blocking up the roads. It was 5am and we had a traffic jam.

I was half way through my paperwork for this job when Control rang me and asked if I could go on another. So off I went to yet another drunken, non-responsive female in the street. It was her 19th birthday and her friends were with her. During the time I spent with them, waiting for the ambulance, completing all my obs and chatting, they busied themselves by taking photographs of their young friend on the ground. That’ll teach her.

I got back to my base station and thought I might get off on time but I was given one more for the road. I thought it would be straight-forward. The call was for a male on a bus who was ‘not responding’. You know this is a drunken bloke who just needs to be woken up and thrown off the bus. So did I.

When I got there the bus driver attacked verbally me. He wasn’t happy to have been left with his “life at risk”, as he put it and so I was in his firing line the moment I stepped out of the car. It was too late in the day for this and I retaliated, which he didn’t expect. I think he thought, as a public servant, I was going to take his abuse and grovel apologetically. He thought wrong.

I told him to back off, leave the bus and let me do my job. He shut up and he left.

The man was slumped in the back between the seats. He was completely unresponsive, except when I induced pain – then he would clench his fists and open his eyes a little. He did this a few times and I felt uneasy about him, so I left him alone and got Control to call the police.

The bus driver came back and apologised and I learned that he had been trying to get the man out but he had just smiled at him. I told him that it was best to leave the man alone because he was probably violent. The bus driver was confused as to why I might think such a thing.

The police arrived (but not the promised relief ambulance) and they got him off the bus by physically dragging him out. I checked him further and asked the police officers to sit him up against a wall. The man suddenly launched a tirade of abuse at us, especially at the police. He used racist comments directly in the face of the black police officer (who was much bigger than him) and swore generally. He spat at us and refused to get up and move on.

I told the officers that there was no way he was going in an ambulance and they agreed. They tried to reason with him and I must say, I’m impressed with how calm and professional those two officers were, but he just wouldn’t play ball. They arrested him and cuffed him. He was so strong that I had to help restrain him while they got the cuffs on. Well, I had nothing better to do.

When I left I watched as the man kicked his leg back, catching one of the police officers in the shin a couple of times as they pinned him to the wall. He wasn’t going anywhere quietly.

Be safe.