The National Gallery in Trafalgar Square. Eight emergency calls; one refused, one conveyed and six taken by ambulance.
It’s been a week in which I’ve had to make decisions and hope that I got it right...for the patient and for my career. All paramedics are registered and personally accountable for their actions. Any detrimental decisions which lead to harm or death can lead to prosecution at worst or being struck from the register – that would mean the end of a career for most of us.
Over the next few shifts I was called to medical emergencies that required the right decision to be made. The outcome for the patient depended on it. I can tell you that I questioned and doubted myself throughout this set of shifts. I depended on colleagues and peers to help me resolve my inner conflicts. There isn’t a paramedic out there who can say s/he hasn’t done the same from time to time.
All the Zafiras were off the road today, so I was assigned an Astra – they are small and crowded inside but they are fast. Unfortunately, as soon as I started it up the engine began clicking strangely. I took if off the road and commandeered a brand new Zafira - it was sitting in the garage, all shiny and bright and the Station Officer offered it.
Once I had swapped all the equipment over I got myself out on the road. For the rest of the shift I would be worrying about that ominous burning smell you get with new engines. Of course, as usual, the thing had no guts when it came to power from a standing start; 0 - 60 in a month.
My first call of the day was for a 44 year-old man who had collapsed with chest pain on the stairs at a bank. He was very big and reluctant to move from his position on the floor (lying down) to one where his pain may be relieved a little (sitting up). He barely communicated to me and moaned with discomfort every few seconds. When asked to identify where the pain was in his body, he pointed more to his upper abdomen than to his chest. The pain also radiated, according to the patient, across his abdomen to his right side. This didn’t seem cardiac-related to me but I gave him GTN and aspirin anyway.
When the crew arrived, we had to lift him on the chair down a flight of stairs to the street. He was extremely heavy and I don’t lift patients much now that I'm on the car – the exercise did me good but I was sweating horribly into my stab vest after it and that's not comfortable at all.
His ECG appeared to show a prolonged Q-T interval but nothing else. He had also just been given a prescription for antacid medicine because he had a history of stomach problems – this is probably what was troubling him now but considering his likely QT history, he went to hospital just in case.
A tall and extremely agitated man who had collapsed on the street after taking a drug was taken to the ambulance by the crew, who arrived on scene when I did. I wasn’t required for this one. At first it looked like he was going to be trouble and the police had him ‘surrounded’ as he lay on the pavement protesting. A little crowd of tourists had created a self-imposed cordon a few metres away – I knew they were tourists because Londoners wouldn’t have bothered and would have walked on by regardless.
Later, I was sitting on stand-by at Trafalgar Square when a man came running up to the car and asked me to help an elderly man who had collapsed inside the National Gallery. I called it in because, although the staff had called 999, I had yet to receive the CAD. I ran in with him and found the gentleman on the floor, his wife standing near him and the Gallery staff helping out.
It took all of 30 seconds and a failed FAST test to conclude that he had suffered a stroke. His left side was useless; no movement, no sensation. He was confused and weak. It was decision time. With acute CVA the right thing to do is to take the patient directly to the most appropriate care centre – in this case, the National, Queen’s Square. The crew had arrived by now and a few seconds were spent debating whether the National would take the patient; the hospital is so busy that there was always a chance of being turned away. If we got this wrong, there would be a delay in treatment.
I called Control for advice as the patient was taken to the ambulance and made confortable. I was then able to pass the information I had onto the crew paramedic. They were to go to the National and Control would pre-alert. I went with them in the car and the patient was taken straight to scan.
This was a simple decision to make and every crew knows where the best treatment centres are for various conditions – it wasn’t this one that gnawed at me.
After a short rest I was off to deal with a 63 year-old who had slipped and twisted his knee, causing a dislocation. He was lying on the pavement at a pedestrian crossing – people were continuing to cross regardless, of course, but a few good colleagues of his stood around to protect him from being knocked and tripped over. He was in quite a lot of pain but was also embarrassed to be where he was.
A Team Leader was already on scene when I arrived and the ambulance showed up a few seconds after I did, so he was quickly splinted and moved to a more private area for treatment. Traffic was building up behind the emergency vehicles, so it was important to get going as soon as possible. Some drivers have very limited patience, regardless of what we are dealing with.
A 15 year-old ballet dancer with an allergic reaction turned out to be an emotional young girl (possibly with a crush on her dance teacher). As soon as he was there she decided not to go to hospital, despite telling me and the crew that she would – she had eaten a chocolate biscuit, which may have contained nuts and had felt sick and dizzy afterwards. She had experienced a tingling sensation on her tongue and that’s what prompted the 999 call. She had no history of anaphylaxis and this seemed like a very local reaction to me but we were willing to get her checked out at hospital, just in case.
Her teacher's presence made her smile, when none of us could so she changed her mind. I got the in loco parentis signature I needed and she got the attention she needed. Hopefully she’ll stay off the chocolate biscuits.
When I got back to Central London, I was called to a 40 year-old man who was ‘fitting’. I got on scene within two minutes and was shown up to the third floor via some very narrow wooden steps to a lobby area. I could hear the first aider shouting the man’s name over and over again, so I knew I was dealing with an unconscious patient.
He was slouched in a chair, unresponsive and with a noisy airway. He was gasping sporadically and I could see that he was in serious trouble. It all looked terribly familiar to me. I had just started my primary survey when the crew arrived. Together, we made his airway safe and began to investigate possibilities for his current condition, which was not improving.
He had no history of epilepsy as far as his work colleagues were concerned, although they admitted they didn’t know him all that well. His pupils were pin-point, so Narcan was given just in case but I was convinced he was having a completely different kind of crisis and my colleagues suspected it too. In the past few months I had separately treated a child and a woman with a very similar clinical presentation; sudden collapse and apparent seizure, agonal breathing, and a high BM ( I have yet to find anything useful to explain this but I’m guessing that the condition influences glucose release – I wouldn’t mind an expert opinion). In each case, an intracranial bleed was the culprit. Now I was looking at the same thing and I was pretty damned sure of it.
By the time we began the slow and very precarious descent down the stairs with this heavy man, we were supporting his breathing with a Bag-Valve-Mask. He was deteriorating.
There was a problem, however. Do we transport him directly to the National, where his condition could be quickly diagnosed and treated, or do we take him to the nearest A&E where a resus team would be able to stabilise him? If we sent him further than he needed to go and we were wrong, then it could cost him his life – if we took him to the nearest hospital, he would at least get everything done before being transferred to the appropriate care centre. It wasn’t my call now but I could see both sides of the debate; it was a tricky one and the right decision had to be made for the sake of the patient.
He was taken to the nearest hospital. His condition was time-critical.
It was almost time for me to return to my base station. It was almost home time and I was drained. Unfortunately Control had other ideas and sent me in the opposite direction for 2 miles for an 85 year-old with DIB who had refused an ambulance earlier in the day, only to find an ambulance on scene when I arrived. I was not required. Arrrgh!!
On the way back I spotted a man dressed in canvas clothing and a cloth cap standing in the street playing a penny whistle. He was playing it well but the bottle of red wine at his feet must have put people off (or diminished their sympathy for him) because nobody contributed to his cap. He tried harder and gave a cheeky wink to the ladies passing by – they ignored him and he shook his head in defeat. He’ll pack up and go home as penniless as he had started.
I was almost there...almost at the threshold of going home when I received a call to a 60 year-old having ‘dizzy spells’. He wasn’t critical and had a history of this, so I took him to hospital myself. By the time I had booked him in and returned to base I was on overtime that I hadn’t elected to do.
Spare a thought for us as you clock off exactly on time every day. We can get called out at one minute to going home time and there’s not a lot we can do about it.
It’s been a week in which I’ve had to make decisions and hope that I got it right...for the patient and for my career. All paramedics are registered and personally accountable for their actions. Any detrimental decisions which lead to harm or death can lead to prosecution at worst or being struck from the register – that would mean the end of a career for most of us.
Over the next few shifts I was called to medical emergencies that required the right decision to be made. The outcome for the patient depended on it. I can tell you that I questioned and doubted myself throughout this set of shifts. I depended on colleagues and peers to help me resolve my inner conflicts. There isn’t a paramedic out there who can say s/he hasn’t done the same from time to time.
All the Zafiras were off the road today, so I was assigned an Astra – they are small and crowded inside but they are fast. Unfortunately, as soon as I started it up the engine began clicking strangely. I took if off the road and commandeered a brand new Zafira - it was sitting in the garage, all shiny and bright and the Station Officer offered it.
Once I had swapped all the equipment over I got myself out on the road. For the rest of the shift I would be worrying about that ominous burning smell you get with new engines. Of course, as usual, the thing had no guts when it came to power from a standing start; 0 - 60 in a month.
My first call of the day was for a 44 year-old man who had collapsed with chest pain on the stairs at a bank. He was very big and reluctant to move from his position on the floor (lying down) to one where his pain may be relieved a little (sitting up). He barely communicated to me and moaned with discomfort every few seconds. When asked to identify where the pain was in his body, he pointed more to his upper abdomen than to his chest. The pain also radiated, according to the patient, across his abdomen to his right side. This didn’t seem cardiac-related to me but I gave him GTN and aspirin anyway.
When the crew arrived, we had to lift him on the chair down a flight of stairs to the street. He was extremely heavy and I don’t lift patients much now that I'm on the car – the exercise did me good but I was sweating horribly into my stab vest after it and that's not comfortable at all.
His ECG appeared to show a prolonged Q-T interval but nothing else. He had also just been given a prescription for antacid medicine because he had a history of stomach problems – this is probably what was troubling him now but considering his likely QT history, he went to hospital just in case.
A tall and extremely agitated man who had collapsed on the street after taking a drug was taken to the ambulance by the crew, who arrived on scene when I did. I wasn’t required for this one. At first it looked like he was going to be trouble and the police had him ‘surrounded’ as he lay on the pavement protesting. A little crowd of tourists had created a self-imposed cordon a few metres away – I knew they were tourists because Londoners wouldn’t have bothered and would have walked on by regardless.
Later, I was sitting on stand-by at Trafalgar Square when a man came running up to the car and asked me to help an elderly man who had collapsed inside the National Gallery. I called it in because, although the staff had called 999, I had yet to receive the CAD. I ran in with him and found the gentleman on the floor, his wife standing near him and the Gallery staff helping out.
It took all of 30 seconds and a failed FAST test to conclude that he had suffered a stroke. His left side was useless; no movement, no sensation. He was confused and weak. It was decision time. With acute CVA the right thing to do is to take the patient directly to the most appropriate care centre – in this case, the National, Queen’s Square. The crew had arrived by now and a few seconds were spent debating whether the National would take the patient; the hospital is so busy that there was always a chance of being turned away. If we got this wrong, there would be a delay in treatment.
I called Control for advice as the patient was taken to the ambulance and made confortable. I was then able to pass the information I had onto the crew paramedic. They were to go to the National and Control would pre-alert. I went with them in the car and the patient was taken straight to scan.
This was a simple decision to make and every crew knows where the best treatment centres are for various conditions – it wasn’t this one that gnawed at me.
After a short rest I was off to deal with a 63 year-old who had slipped and twisted his knee, causing a dislocation. He was lying on the pavement at a pedestrian crossing – people were continuing to cross regardless, of course, but a few good colleagues of his stood around to protect him from being knocked and tripped over. He was in quite a lot of pain but was also embarrassed to be where he was.
A Team Leader was already on scene when I arrived and the ambulance showed up a few seconds after I did, so he was quickly splinted and moved to a more private area for treatment. Traffic was building up behind the emergency vehicles, so it was important to get going as soon as possible. Some drivers have very limited patience, regardless of what we are dealing with.
A 15 year-old ballet dancer with an allergic reaction turned out to be an emotional young girl (possibly with a crush on her dance teacher). As soon as he was there she decided not to go to hospital, despite telling me and the crew that she would – she had eaten a chocolate biscuit, which may have contained nuts and had felt sick and dizzy afterwards. She had experienced a tingling sensation on her tongue and that’s what prompted the 999 call. She had no history of anaphylaxis and this seemed like a very local reaction to me but we were willing to get her checked out at hospital, just in case.
Her teacher's presence made her smile, when none of us could so she changed her mind. I got the in loco parentis signature I needed and she got the attention she needed. Hopefully she’ll stay off the chocolate biscuits.
When I got back to Central London, I was called to a 40 year-old man who was ‘fitting’. I got on scene within two minutes and was shown up to the third floor via some very narrow wooden steps to a lobby area. I could hear the first aider shouting the man’s name over and over again, so I knew I was dealing with an unconscious patient.
He was slouched in a chair, unresponsive and with a noisy airway. He was gasping sporadically and I could see that he was in serious trouble. It all looked terribly familiar to me. I had just started my primary survey when the crew arrived. Together, we made his airway safe and began to investigate possibilities for his current condition, which was not improving.
He had no history of epilepsy as far as his work colleagues were concerned, although they admitted they didn’t know him all that well. His pupils were pin-point, so Narcan was given just in case but I was convinced he was having a completely different kind of crisis and my colleagues suspected it too. In the past few months I had separately treated a child and a woman with a very similar clinical presentation; sudden collapse and apparent seizure, agonal breathing, and a high BM ( I have yet to find anything useful to explain this but I’m guessing that the condition influences glucose release – I wouldn’t mind an expert opinion). In each case, an intracranial bleed was the culprit. Now I was looking at the same thing and I was pretty damned sure of it.
By the time we began the slow and very precarious descent down the stairs with this heavy man, we were supporting his breathing with a Bag-Valve-Mask. He was deteriorating.
There was a problem, however. Do we transport him directly to the National, where his condition could be quickly diagnosed and treated, or do we take him to the nearest A&E where a resus team would be able to stabilise him? If we sent him further than he needed to go and we were wrong, then it could cost him his life – if we took him to the nearest hospital, he would at least get everything done before being transferred to the appropriate care centre. It wasn’t my call now but I could see both sides of the debate; it was a tricky one and the right decision had to be made for the sake of the patient.
He was taken to the nearest hospital. His condition was time-critical.
It was almost time for me to return to my base station. It was almost home time and I was drained. Unfortunately Control had other ideas and sent me in the opposite direction for 2 miles for an 85 year-old with DIB who had refused an ambulance earlier in the day, only to find an ambulance on scene when I arrived. I was not required. Arrrgh!!
On the way back I spotted a man dressed in canvas clothing and a cloth cap standing in the street playing a penny whistle. He was playing it well but the bottle of red wine at his feet must have put people off (or diminished their sympathy for him) because nobody contributed to his cap. He tried harder and gave a cheeky wink to the ladies passing by – they ignored him and he shook his head in defeat. He’ll pack up and go home as penniless as he had started.
I was almost there...almost at the threshold of going home when I received a call to a 60 year-old having ‘dizzy spells’. He wasn’t critical and had a history of this, so I took him to hospital myself. By the time I had booked him in and returned to base I was on overtime that I hadn’t elected to do.
Spare a thought for us as you clock off exactly on time every day. We can get called out at one minute to going home time and there’s not a lot we can do about it.
Be safe.
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5 comments:
Those darn recent visitors things on peoples sidebars :)..I can never just lurk quietly and unassumingly. It looks like you've got a nice blog here. I know of a 41 year old with a heart attack. If it wasn't for the 12 leads read on the rig..he might have been dismissed.
When the body is under stress it releases hormones such as cortisol which act in a similar way to glucagon to raise blood glucose.
This is why diabetics often go into DKA following an illness - they feel sick, so they don't eat, so they don't take insulin, not realising that their blood sugar levels are rising all by themselves without any food.
Just a guess, but this could explain what's going on.
Another explanation could be that due to increased intracranial pressure, sugar was unable to move from the blood to brain tissue (the body's biggest user of sugars), and hence, being left unused, floated around in the blood.
chrysalis angel
Don't be shy. If you want to hide, use an anonymous if you like..otherwise, nice to have you aboard.
:-)
John
Two good possibilities there. Thanks. I'll need to look into this further though - there may be no connection or it could be a relevant indicator.
I haven't heard from any doctors out there about this one...
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