Fuel for the fire

Seven emergency calls, all requiring an ambulance.

A short, sharp kind of night shift – the City’s bodies are moving in familiar circles, preparing themselves for the drunken binge that we know as summer (and they call fun). Already there has been a tragic death as a result of alcohol-fuelled stupidity.

My first call was to a '42 year-old man with chest pain on roof'. I thought I was going cherry-picking again. The man was a construction worker who was up on the roof of a department store when he began to feel unwell. He had abdominal pains, not chest pains and they seemed to be more muscular than cardiac in origin but, with caution on our side, the attending crew and I checked him over thoroughly and he was taken to hospital where they would get to the bottom of it.

Then on to a 77 year-old man who had collapsed in the street. When I arrived there was a little crowd of people around him, including his wife who was quite anxious. He had been walking home with his spouse when he suddenly stumbled and fell, hitting his head on the way down on a wall. He had been drinking earlier on but not much, I was told. He had no obvious head injury but he did not look well at all and, as I proceeded with my obs, he stopped responding and closed his eyes. I couldn’t get him to open them.

He was still breathing but it was shallow and his pulse felt weak and thready. This man had either suffered a stroke or he had simply fallen and the bang to his head had complicated things. He was a little cyanosed but, at that age, it’s difficult to determine whether that is because of an acute event or age-old hypoxia. I presumed nothing and put him on oxygen while I waited for the ambulance to pull up.

When the paramedic from the ambulance approached for a hand-over I asked for the trolley bed – it felt rude not to start off with a “hello, this is...” statement but the man still wasn’t responding properly and he had to be taken off the street and into the vehicle as quickly as possible. When he was inside and an ECG started, he began to respond and was soon back to normal(ish); his skin colour was still bad and he was diaphoretic and limp.

His ECG was abnormal and he was taken to hospital on blue lights.

A baby with a high temperature was my next patient. He was lying on the floor, surrounded by his concerned family, only one of whom could speak English, so I was left to communicate my requests and reassurances in broken language, facial expressions and gestures – it makes for much harder work when treating someone. As it turned out, the baby had a history of high temperatures and was simply restless with it; his temperature was 38.1c but his grandmother had made him shiver with cold by flannelling him for too long with a cold, wet towel.

He went to hospital, where they will probably dole out more Calpol and Nurofen because without evidence of an underlying, treatable cause, there’s not much else they can do.

I was being bounced back and forth into the EC1 area of London all night for some reason (probably a shortage of ambulances and personnel). Most of my calls were in this region and my next job, a 70 year-old Chinese man who was suffering DIB, was no exception. I found him sitting on his bed in a small, cramped flat, shared by a few other Chinese residents. His young friend told me he had flown in from Hong Kong recently and was doing martial arts, as he always did every day, when he suddenly collapsed with breathing difficulties. He also described a sharp pain in his chest.

When I examined him, he was restless, was having great difficulty in breathing, with very low sats of 82% and was off-colour and sweaty. He had a history of high blood pressure but had no problems with it normally. The martial arts exercises were gentle, I was told – no more than Chi in nature.

The crew had arrived with me on this call but were a minute or so behind me while they gathered the stuff they needed from the ambulance. I had gone ahead to start the assessment. All the basic signs and symptoms were there for a PE and the additional information about the recent long-haul flight and his propensity for high blood pressure lent weight to that diagnosis. There was always the possibility of infection too, so I asked questions relating to recent illnesses and contact with birds and fowl. I discovered he had been treating himself for a recent chest infection, so that couldn’t be ruled out either.

During the shift, I saw this man in Resus and asked the doctor about him. He was being investigated for a PE and his condition was poor, although he is likely to recover after treatment. He went up to ITU later in the night.

I responded to a Red3 for a ‘female with pain in her lower body’ before I thought of questioning it. Normally I would radio in and asked what in the nature of the call made it such an emergency. This time I was on scene and chatting to the newly arrived crew before it dawned on me that it was a mistake. The crew had received this call as a Green, which means it is not an emergency and that makes sense. For some reason I got it as a Red, so the result was an over-resourced call and an unnecessary risk to me and other road users during my run to it on blue lights and sirens. Control apologised for the error, so I won’t harp on about it.

After a quick five minutes at the station I was heading out to a local club to deal with an 18 year-old female who had collapsed after possibly having her drink spiked. More likely, however, she was drunk.

When I arrived I was ushered into the back of the club, where she lay on a couch, out cold. Her friends were with her and they stood back and looked on as I tried to persuade the drunken girl to respond in some way. She had been out in the sun all day drinking and then come to the club with her mates to drink some more. Initially, she was completely unresponsive but after a few minutes and during my obs, she moved and reacted a little.

By the time the crew arrived and she was hauled into the chair like a big sleeping rag-doll, she was becoming a little more aware. In the ambulance she began to nod and shake her head in answer to questions, which is just as well because I had opened my bag and was about to put her up on fluids.

The police had been called because there had been a suspicion of drink spiking or drug use but the crew and I confirmed that she was simply too drunk to function, so they left knowing that they had much less paperwork to do for this one.

The girl later recovered in hospital. Her mother and aunt appeared and sat with her for a few hours the prepared to take her home later on. I spoke to them and her aunt turned to the girl and said, “don’t worry, think of it as life experience to learn from”.

Or you could just not drink so much.

My last call of the night was for a male with a head injury. He had allegedly been accosted by someone outside his flat when he was dropped off by taxi in the early hours. There was a good size pool of blood in the street, just where he would have been dropped off and little splashes led the way into his apartment complex. If he had been hit over the head, then it had happened immediately after he stepped out of the vehicle, which didn’t make sense unless the taxi driver did it (I imagined).

The crew were on scene with me and I stuck around to assist if need be. He appeared at the door of the elevator after his sister had shown us in. His mother was with him and together we all went back down to the ambulance.

His head was matted in blood and he had a long, fairly deep gash in the back of it. He had no memory of what had happened. He just remembered waking up with his head covered in blood. So whoever hit him had left him in the street – he could have died for all they cared.

His money and personal items had been stolen.

This wasn’t an alcohol-fuelled crime, as with the story I highlighted earlier but it was certainly assisted by alcohol, given that the young man had been out drinking and probably looked less aware and alert to his attacker(s), so therefore an easier mark. His loss of memory is probably a direct result of the blow to his head but it could also be an exacerbation of alcohol.

It’s unlikely the police will find who did this to him but he was lucky. If he hadn’t regained consciousness he would have been lying in the street, bleeding from his wound, for a long time before anyone found him.

Be safe.