Tuesday, 28 August 2007


Eleven emergency calls; two assist-only. All the others went to hospital by ambulance.

Yet another rainy shift – some of the downpours were just mean. I’m beginning to feel like I’m back home in Scotland!

Every now and then I get a call to assist a crew with a ‘heavy’ patient. This rarely means well-built. My first call of the morning was to a 74 year-old man who was lying on the floor after having suffered a stroke. The crew were already on scene and simply wanted an extra pair of hands to lift the patient into the ambulance.

When I arrived, the crew were attending to the man’s needs (oxygen, etc) and I helped them move him onto the chair. I had come up some steep stairs to his bedroom, where he had been found lying on the floor with a weakened left side. The man knew he had suffered a stroke so it was important to keep him calm and reassured whilst we carefully carried his large frame down those narrow steps and out to the ambulance.

An ECG showed he had Left Bundle Branch Block (LBBB) and possibly Atrial Fibrillation (AF) but determining that is difficult when the patient is shivering and you can’t get a clean reading but it is quite common and likely to have been the cause of his stroke. With this in mind he was taken quickly to hospital.

A 25 year-old who had collapsed and become unconscious in an underground station was my next patient. She was almost fully recovered when I got to her and it sounded, from the short history I was able to take prior to the crew arriving, like she had a touch of food poisoning. She had been ill before she set off for work. It may have been wise of her to stay in bed and call in sick.

After a short break, during which the rain fell relentlessly, I was sent to a 23 year-old man who had collapsed. He had vomited on the floor of his office and I remember looking at the carpet and thinking his little pool of sick was going to leave a nasty stain when it dried fully. His colleagues were concerned about him so I guess cleaning the mess up wasn’t their priority.

I examined him as he lay on the floor; his blood pressure was low – it fell even lower when he was moved to a less supine position. Postural hypotension can be a clue to numerous possible diseases and conditions but it is fairly common and can lead to no pertinent diagnosis whatsoever except that the person became ‘vasovagal’. Until recently I treated such attacks, especially in younger people, as no more than a simple faint and either left them where they had recovered or took them to hospital if their condition hadn’t improved or they had refused to go. However, recent research into sudden adult death suggests that it is prudent for pre-hospital professionals to thoroughly examine unexplained faints in young people, especially after stress or exercise. This means an ECG for every one of them.

Considering how many faints we attend every day, this may seem unnecessarily time-consuming but the thinking behind the research is that some of those young people who have died may have been saved if a heart defect had been detected earlier. In my opinion ten minutes on an ambulance having an ECG carried out is not a problem – a decision can still be made about conveying to hospital and the person concerned may still refuse to go but at least there will be a record of examination should things go wrong.

A simple trip and fall next; a 70 year-old tourist who missed the kerb and stumbled into the road. He had suffered no more than a few grazes but he had a pacemaker, so we checked it for functionality on the ECG. It was working just fine as far as we could see. The crew completed their checks and let him and his wife carry on their day.

I had numerous cancellations after my break then I was sent to the north for a 46 year-old male ‘passed out in street, now nauseous’. The rain was still hitting the ground hard as I stood banging on the front door of the address with the crew, who had arrived with me. The patient refused to answer (or couldn’t). I called Control and asked them to ring the patient back but the number rang unanswered. We were beginning to look like wet door-to-door salesmen for the NHS and continued to try until eventually it opened and the patient walked out, bothering not a jot that we had been stood there for ten minutes waiting for him.

He was an alcoholic and had been out drinking when he felt dizzy and collapsed. He made his way home and called an ambulance because he now felt sick. I left him with the crew and made my way back to familiar territory.

I didn’t get far though. My next call took me all the way into N7 for a fitting 20 year-old male. The ambulance arrived as I pulled up in front of the address and I went in with them to see if I could be of any help, especially as I had just driven all this way.

The man was standing in a classroom where he had been taking an exam. He is a known epileptic and had suddenly had a fit, causing his tutor to run for help. He was recovering now but he kept clearing his throat in a loud and exaggerated manner; it sounded like a seal crying. This may have been his usual post ictal behaviour but it was quite unusual and strange to watch. Every now and then he would punctuate the noise with a coughed up blob of phlegm. I left him to the crew and made my way, once again, back to my own area.

The radio had been going on about blue skies in the afternoon with 20 degree temperatures but this hadn’t transpired. It was grey and raining still. The wind had changed and made the weathermen look like idiots – the tourists had relied on these weather reports and as I watched the soaking, plastic-covered foreigners board their open-top buses I remembered how brave we tend to become on holiday. Appreciation for fine art suddenly increases too; the National Gallery hosts a swell of extra bodies when the torrents begin.

I was sitting on stand-by watching the wet world go by when I got a call to Piccadilly Circus. A 60 year-old male had severe DIB and had collapsed. On my way there, an update advised me that he had ‘? Asthma’. The call had come from the police and they were on scene when I arrived. I expected to see an elderly gentleman but I didn’t. I was greeted by a wailing gang of teenage German tourists, one of whom had suffered a panic attack and begun to hyperventilate. By the time I arrived his fingers had gone numb and he was worrying about the loss of feeling around his mouth. I explained that it was perfectly normal and that he should try to relax.

His English was weak and he was distracted by his friends – the young girls were crying and trying to hug him. They were all about 16 years old and there was no supervising adult on scene (although he had been called and was on his way). I was being manhandled by weeping youngsters who thought their world was ending.

I took the young man away from the hysterical little crowd and sat him in the car until he calmed down, a process that began almost as soon as he lost sight of his highly-strung friends. The police officers joined me in the car too because they were getting soaked through and hadn’t brought their jackets out.

The crew arrived and took the young man into the ambulance to fully recover and await the arrival of the adult in charge. He won’t be going to hospital. Meanwhile, the police asked me if they were needed any longer because they had a prisoner in the van across the road and really should be going now. I found that amusing and agreed they should get on with their arrest.

Scotland Yard next for a 25 year-old male who had been working below a large, heavy shutter door when it collapsed and almost crushed him. Luckily he dodged it but his hand got caught by a very nasty cog (see photo) which tore through it. The police, who are always nearby, attended and there was a large dressing on the wound when I arrived. I had a look at it, saw how deep it was and covered it over again. He had been very lucky – the door could have killed him. He got away with the hand injury and a good old fashioned fright.

We often get calls to doctor’s surgeries – sometimes the patient had been well treated and is ready to go to hospital with a full history and two sets of obs and sometimes we find a chest pain sitting out in reception. This time we found a 66 year-old who had fitted, sitting in the doctor’s office, unaware that we had been called and not quite sure that he needed to go to hospital at all. He was very pale and sweaty and at times he seemed non-responsive and distant (absent) when I spoke to him but I couldn’t say for sure if that was his normal behaviour or, as an alcoholic, he was the worse for wear but the doctor was insistent that he had fitted and was ‘not himself’, so I treated him accordingly.

The crew were with me and all I needed to do was assist but the patient disagreed with the diagnosis I think.

My quickest response of the day took me across the road and all of 30 seconds for a 50 year-old man who was ‘collapsing’ on a station concourse. He had been seen staggering around and collapsing every now and then. This was brought to the attention of rail staff and police who called an ambulance whilst they located him and sat him in a chair. I was met at the entrance to the station and told that the man was ‘probably drunk’, although I could smell very little alcohol on his breath when I examined him. He had lost bladder control and his BP was very high. His verbal responses were extremely slurred and nonsensical, so he was either stupidly drunk or he had possibly suffered a stroke. There was something about him that led me to believe the latter and when the crew arrived, my colleagues seemed to agree.

My last call of the shift was for a 70 year-old female who was dizzy and vomiting. She was in a hotel room and had already been seen by a doctor who gave her an anti-emetic to stop her being sick. She had called an ambulance because the drug hadn’t worked and every time she moved the room began to spin, making her vomit. Initially I thought she may be suffering from vertigo and asked her about possible recent ear infections and other relative disorders but she had no suggestive medical history.

The crew arrived and took her to the ambulance while I packed up and made my way back to base to go home. My bags had soaked and dried several times today and now there was a musty damp smell around them. I’ll need to air them out before I start work again tomorrow...don't want the customers complaining.
Be safe.


Anonymous said...


Does a person have to go into an ambulance to have an ECG? Can it not be carried out at the scene?

Xf said...

ECGs can be carried out on scene (my last posting mentioned that I think)

The machine (LP12) is quite bulky and heavy so we generally don't walk into houses with it.

Kirtai said...

A friend of mine used to have blackouts when young which turned out to be three(!) congenital, life threatening heart conditions.
These weren't found till much later in life when she nearly died and got an implanted defibrillator.
As a result, I'm quite glad to hear of the ecg change since this sort of thing should be caught earlier.