Wednesday, 8 August 2007

Hot & bothered

Twelve emergency calls. Four assist-only, one false alarm, one refused and one hoax. The others went by ambulance.

I probably watched more people (men) urinate in the street tonight than on any single shift.

Did I mention how hot it was down in the underground system? My first call was to a 35 year-old female having an epileptic fit on the platform of one of these hell holes. She was so near the edge that there was a real risk of her, or me, falling onto the track.

She had suddenly collapsed and started fitting with brief pauses and seizures in repeating cycles; never a good thing. I had already established from her friend that she was epileptic and that she had been drinking so when the crew arrived I prepared to give her diazepam. Trains were still coming into the platform and people were running and shuffling all around us. Even with the help of the staff there was little we could do, short of closing down the entire platform. We dragged her further away from the edge because every time she fitted she moved perilously near to it. It was too dangerous to lift and move her just yet, so I tried to gain IV access for the drug I was going to administer but her vein was thin and useless. I tried again elsewhere but with no better luck, so I was left with the only option open - rectal administration. In such a public place it's not a choice I make initially but I had run out of immediate options and something had to be done about her condition. She had oxygen and her airway was clear but she would be impossible to move safely.

We got the staff and a few of her friends to create a 'sheet wall' around us while I administered the drug. She seemed to settle down after a few minutes and we prepared to move her but then she had another violent seizure, so another 5mg of diazepam was administered. She settled again and we decided it was time to go. She was put into a chair, strapped down as securely as possible and wheeled all the way up to ground level. She fitted twice more on the way up, the second time slipping dangerously out of the chair at the top of some steps. The stretcher was brought to her and we moved her swiftly onto it and into the ambulance. I left my car at the station and joined the attendant in the back of the ambulance with the patient.

During the trip to hospital, I attempted once more to gain IV access. She was fitting again. I still had no luck, even with the smallest needle. I had to administer more rectal diazepam. Despite this, she fitted twice more on the way to hospital.

When we arrived she had settled down. All her obs were settling and she went into Resus in a more stable condition...the diazepam had finally worked.

I thought I might be losing my touch - I had tried three times to get a cannula in and failed but when I went back into Resus twenty minutes later, she had two inserted - one in her neck and one in her ankle, that's how difficult her veins were.

I was sweating through my shirt after that job. I had to throw my stab vest off in the ambulance because I felt so uncomfortable - the thing doesn't allow your body to breathe and hot, sticky environments are the worst places for high-exertion jobs.

I went back to my base station to replenish my drugs and cool down a bit, then I was off to a police station to aid a woman who had fainted in the front office area. She had been waiting for news of her newly-arrested son and the stress had been too much for her. She had a few family members with her and they explained that the boy had never done anything wrong in his life and that this was the first time any member of the family had been in a police cell. I felt sorry for the patient and I stayed until she felt ‘normal’ again; she didn’t want to go to hospital.

Another ‘unconscious thru drink’ call sent me to Soho where a young man greeted me by vomiting in the direction of my boots as I approached him. His sober(ish) friends were apologetic and the man on the ground looked up and realised what was going on. He was embarrassed that an ambulance had been called – he had passed out momentarily but was fully recovered now, albeit too drunk to think straight. He could, however, walk fairly straight and with assistance from his gang of mates, he made his way home without the help of the NHS.

My next patient was also very drunk but he too realised that an ambulance was probably over the top. He was in a tube station (thankfully in the ticket hall) and his friends had called us because he had cut his thumb, seen the blood (a mere trickle) and promptly passed out. I have to tell you that I have more personal experience of men fainting than women – especially at the sight of blood. Even when I teach first aid, every now and then a male student will faint at the very mention of the stuff.

He went home with his buddies and all was well with my shift so far.

Then I got a call while driving around the West End for a 35 year-old male ‘fitting’. I couldn’t find him at first and the person who had made the call didn’t make themselves known, so I drove into the street and looked around for someone fitting. All I could see was a thin, drunken man sitting in a doorway eating a pizza. I had seen him earlier in the night and thought his behaviour was strange. He had one of those extreme twitches where he almost throws a punch. If anyone got close enough during one of those reactions, they were going to get accident of course.

So, there he was, sitting on the step, twitching away, minding his own business. That’s when I realised the ‘patient’ had to be him. I got out of the car, approached him and asked him if he had called us. He looked up, eventually, (the pizza was just too good) and shook his head. Then he mumbled incoherently. I nodded sagely, although I had no clue what he had said. It bought me time to retreat.

I called it in and as I was speaking on the radio a young girl approached the car with the ‘I have just dialled 999’ look on her face.

“Did you call an ambulance?” I asked

“Yes” she replied

“For someone who is fitting?”


“But he isn’t. He just twitches and he’s eating a pizza.”

I know but I couldn’t get in.”

She had seen the man sitting on the step twitching away and had called us because she was too scared to pass him on her way into the building where she lived. I know she may have been nervous about him but come on, he was eating a pizza. How many random assaults have taken place during the act of eating a pizza?

I walked her to the step and around the man sitting on it. He took the hint after that and moved along, deeply offended that anyone would think the worst of him. I watched him go, twitching and eating.

Just around the corner my next patient stood on the pavement, waiting for me to rescue him. He was a 20 year-old complaining of ‘cold sweats, sore tonsils and pain in the neck’. Hmm. Just for good measure and a guaranteed emergency response, the word ‘chest pain’ had been added. Everybody knows how to play the system these days.

He was a tall, healthy looking young man and he had a viral infection - I would put money on it. I had to stop myself from getting too wound up about his stupidity. Personally, I would be highly embarrassed if an ambulance came for me just because I had a cold...and before anyone goes on about tonsillitis, I know all about it and I know it can become complicated but I also know a healthy person with a mild infection when I see one. I knew that if I sent him on his way by bus he would end up dramatising the whole thing and complaining to his local MP, so I took him to hospital myself. I literally taxied him to the A&E door. I’ll keep you posted on his condition if you want...

A 50 year-old diabetic man whose confusion and lack of co-ordination was causing a good citizen enough concern to dial 999 turned out to be a drunken diabetic who couldn’t walk or find his way home because he was full of alcohol. His BM was normal. The crew had no choice but to take him to a place of safety. He would have generated calls all night otherwise.

Later on in the night I was sent to a collapsed male who was lying in the street. This usually means he is too drunk to move any further. It always amazes me the distance people achieve before suddenly becoming too drunk to move another inch. They must get drunker the further away from the pub they get. Or they get weaker the closer to home they get.

Anyway, there he was, lying on the pavement area in front of a shop. I approached, shook, pinched and eventually got him to open his eyes and look at me. He spat something in Russian and I continued my vocal onslaught until he began to move. Using words like ‘police’ and ‘arrest’ normally provoke a reaction with East European drunks – they fear the police but they generally have zero respect for the ambulance service – they know we have no real power to do anything. Not that there’s a lot the police can do either but it’s always good to have something in the armoury.

Unfortunately he was stubborn and wouldn’t budge. My ploy was failing.

A few likely looking guys were hanging around shouting at him and generally provoking him while I tried to make him get up and go home. This was making the situation less stable for me and there was no ambulance on scene yet. I asked the trouble makers to leave but they hovered around behind me, so I kept myself alert.

Eventually I got the man to stand up as the ambulance arrived but he ignored the crew and they accepted his ignorance as a refusal. I found myself back where I was at the beginning – he lay down, refusing to move and I waited in the car until police arrived to move him along. If I drove off and left him there I would be called back again and again.

The shop owner obviously had enough of this and he stormed out of the premises and immediately began to provoke the man on the ground. This developed very quickly into a stand-up scuffle. I got out of the car and tried to calm them down but I was in the middle of two fairly large men and my voice wasn’t being heard at all. They were shouting at each other and the drunken Russian was gripping the shop owner's arm so tightly it was causing him a lot of pain. That didn’t stop him from threatening him to his face, however. It was clear that someone was going to get hit soon. I asked Control for urgent police assistance because the other men were starting to get involved and I could see it all blowing up. Luckily a passing police unit stopped and the officers quickly dragged the protagonists off each other. The other men disappeared around the corner.

The drunken man was sent on his way and he staggered unevenly down the road and into the dimly lit narrows of Covent Garden. He will stop somewhere, lay down and if someone sees him, another ambulance will be called. On and on it goes.

I had always thought that sooner or later one of those pedicabs that work around Central London is going to be involved in an accident. This was my first call to one but it wasn’t the ‘driver’ who was to blame, it was his passenger, a 40 year-old New Zealander. She was so drunk that she decided to skip the cab in the middle of the road – she threw herself off the back and into the path of traffic, smashing her head on the ground and giving herself an injury that bled a decent amount, not to mention a massive headache in the morning. At first she was compliant and friendly but when the crew arrived she became abusive and stormed off the ambulance, despite her just-as-drunk friends insisting that she behave herself. There is no behaving with alcohol.

Then she tried to get back on the ambulance and the crew were more than a little bemused. She had a scalp injury but there was no way of knowing if she had a more significant problem because she was so drunk. Head injuries and drink do not mix well.

A passing patrol of armed cops sorted the antipodean group out and sent them on their way. She had refused and was frankly too much to handle. Zero tolerance.

The wee small hours is when we get our ‘drunk on a bus’ type calls and sure enough, at about 5am, I was activated with an ambulance to an ‘unconscious male, ?cause’. I boarded the bus with my colleagues and there he was, in the usual place at the back. He was slumped on the back seats and there was a large stain of dried vomit next to him, soaked right into the fabric where some poor commuter will sit in the morning. If only you knew what went on at night, poor commuter.

We got him to open his eyes but he refused to budge. The police arrived and they soon had him on the move but when he got outside he stood with his hands behind his back, preparing to be cuffed. It was an almost instinctive move; he had obviously done this so many times that it had become second nature. At the sight of the police, assume the position. Just how guilty can a person become?

He wasn’t arrested of course, this is the UK and technically he hadn’t done anything illegal, so he was taken to hospital to sleep it off instead. Liberal values cost us a fortune.

Near the end of my shift I got a wakeup call. I met a 36 year-old Iranian man who had been tortured in his home country, simply for objecting to the regime. He had been thrown from a fifth floor window, breaking his legs, pelvis and arms only to be sent to prison and tortured further after a seven month stay in hospital. I can’t imagine the feelings he must have endured as he lay on his hospital bed, knowing his fate.

Now he needed an ambulance for a headache. He calls us a lot apparently; the crew knew him from previous times. He is so depressed and scared that the smallest thing is now too much for him to cope with and he needs help and reassurance. I felt terribly sorry for him. Nothing brings you back to Earth quicker than the sight of a broken man.

Just as I made my way back at the end of my shift I was asked to ‘investigate’ an abandoned call. I arrived at a posh block of flats and the security staff told me that they thought they knew who was making the calls (I was the second ambulance in an hour) but couldn’t prove it. I helped them out by asking Control to confirm the source telephone number. An ambulance arrived behind me and I told them it was a false alarm and explained what the security man had said. The crew agreed to take the job and let me get home, which was very nice of them.

Now I was tired; I had dealt with a genuine emergency and worked my way through the usual run of drunken calls to find myself watching the inside of my eyelids close on another night shift. I’m on earlies next and the sun is coming back.

Be safe.

No comments: