Friday, 24 August 2007

Waterworld

Twelve emergencies; two assist-only and ten went by ambulance.

It was raining when I started my first of three early shifts. It was still raining after my first coffee and had settled to grey drizzle by the time my first call came in. Predictably, as in most days of adverse weather, it was a RTC. This one involved a 34 year-old female who had fallen from her moped on a busy road in rush hour.
She had a suspected broken arm, probably the distal end of her Humerus (known as the funny bone), but she didn't seem amused at all. I put a sling on her after removing 3 coats and a jumper (it was wet but it wasn't that cold!). Of course, the removal of each layer caused her some pain and discomfort but short of cutting through them, which would have been a tad over the top, we both had to grin and bear it - mainly her.

Over on the east side I found myself on my knees in a puddle for a 55 year-old man who had collapsed and had a ‘? Fit’ after a spontaneous nosebleed. After a few minutes and a few pertinent questions, it became clear that he was an alcoholic and had probably fallen earlier (and damaged his nose) before collapsing with a bloody nose on the road, where bystanders had witnessed him having a seizure.

There was a wee bit of over-resourcing on this job; myself, two ambulances and a motorcycle solo – not to mention the police, who were already on scene. The patient was recovering and smelled of alcohol. He didn’t deny being an alcoholic but he was taken to hospital for further checks anyway.

Next, a 46 year-old male who had fainted at work. The ambulance was already on scene so I wasn’t required. This was followed by a call for a 37 year-old female who was suffering severe back pains at her workplace. Her pain was located mainly around the right lumbar area, directly above her kidney, so there was a good chance, judging by her description of the pain and the intensity of it that she had renal colic. I sympathised with her – it’s one of the worst pains to suffer, short of toothache. I hate toothache.

It was still raining when I saw her off to the ambulance.

I got a call to attend a doctor’s surgery for a 24 year-old female who had been suffering intermittent SOB over the past four days. The doctor had given the woman salbutamol and called us because there seemed to be no reason for this sudden problem.

I asked her about her medical history but there was nothing significant to report – meanwhile her kids are standing in the little treatment room with her, they didn’t seemed too concerned. Mum was breathing with long expiratory intervals, which tends to indicate the need to ‘dump’ excess carbon dioxide from the body. A CO2 monitor was put on in the ambulance and sure enough she was producing long, shallow plateaus. She had been hyperventilating, that’s all. Now whether this was due to stress, panic or the aspirin she had taken a few days earlier ( I gleaned this from her during our chat), just prior to the beginning of these attacks, I don’t know but I’m willing to bet nobody will get to the bottom of it all and she will recover fully in time.

When the police call for us, we give their calls a priority response, generally speaking, but we rely on their good judgment in deciding whether an emergency ambulance is required or not. My next call took me four miles south for a 70 year-old male with a ‘cut finger’. That was it. No other issues or complications. The call was categorized as a red3, a Category ‘A’ emergency. The FRU Control desk even called me to apologise for sending me on this journey, which involved a long and tricky drive in wet and extremely windy conditions through some heavy traffic.

When I got on scene there was already an ambulance crew dealing with the patient, a man who was nowhere near 70 years of age and who was nowhere near death’s door, with his bandaged finger in the air. The ambulance paramedic was already ‘chatting’ to the two PCSO’s who had called this in. He was discussing the very real problem of sapping our resources for a walk-in A&E job. I stood there doing nothing as the patient passed me on his way to the ambulance. He sucked his teeth and said ‘ambulance’ in a sing-song voice. Interesting.

Just for good measure another FRU showed up for this call.

On my way back I received a call for an 80 year-old man who had collapsed and stopped breathing briefly, before recovering. He was in fact 90 years old and was a retired cardiologist whose GP had recently doubled his dose of beta-blockers as a ‘prophylaxis’. I found this odd as increasing such a drug will increase the likelihood of faint due to a drop in blood pressure but maybe that’s the thing to do – increase the drug based on the possibility that a more problematic condition (such as hypertension) may get worse in the near future; one evil over another. Perhaps a doctor out there can enlighten me please.

The patient was an extremely pleasant man and was surrounded by retired colleagues – they were all at a get-together lunch in a sports ground. One of his friends was a surgeon for decades before bowing out.

When I examined him I found nothing amiss – in fact, he was in very good shape for a man of his age. He had no medical problems except for slight hypertension, which at 90 years is to be expected. He also had a specific heart problem called right bundle branch block (RBBB) but this wouldn’t impair his ability to live a normal life and he was well aware of that, being ‘in the trade’ so to speak.

He had fully recovered from his faint (the fact that he was seen to have stopped breathing was never convincingly argued) and I walked him down to the waiting ambulance, where a thorough check up was carried out, including an ECG which clearly showed his RBBB but nothing else of note. He refused to go to hospital and I have to say I wasn’t concerned about him, neither were his friends and the attending crew agreed.

Nice man. It was a pleasure to chat to him.

Next up, an RTC involving a young female. She walked into the path of a car on a busy road and put a bulls-eye in the windscreen with her head. There was a crew on scene when I arrived and so I assisted with the care of this patient. The motorcycle solo arrived to add a pair of hands and together we collared, blocked and scooped her – all good practice and all precautionary. She had no neurological deficit and complained of no significant pain but it’s not a good idea to presume too much and give the all-clear when the windscreen says different.

It was raining hard when I did that job.

Then, after a short break, I was sent miles away to an unfamiliar part of London for a 32 year-old diabetic who was confused. The call came from a doctor’s surgery but it wasn’t until I got to the address that I realised the patient wasn’t actually in the surgery. He was at home and the place I had arrived at wasn’t the most obvious surgery-type building, so it threw me. The ambulance arrived while I was circling the neighbourhood wondering where this surgery was!

I didn’t get to treat this patient; the crew went in instead. It was still raining.

On my way back I witnessed a bizarre arrest (not the cardiac kind) in Trafalgar Square. There was a police van Parked up and inside were about eight or nine fully suited up riot police with helmets on their heads and (strangely) balaclava-type covers over their faces so that only their eyes could be seen. They were all fairly big guys and looked quite menacing.

Three of them jumped out of the van and ran down the steps, returning a few seconds later with a handcuffed young man in their collective grips. He was about 5’10” and they towered over him at more than 6 feet to a man. I thought it was some kind of rehearsal or an anti-terrorism snatch squad. Then I went to a call at Baker Street tube station and saw a LOT of police around. Only then did I learn there was a football match on at Wembley; England v Germany. The police had been out all day arresting potential trouble-makers before they could set off for the game and stir things up (the trouble-makers, not the police). I think they cover their faces because some of them work undercover but I’m not sure. One of my police readers will tell me no doubt.

Oh and the call to Baker Street was for a 65 year-old tourist who was vomiting and had DIB. The crew arrived just in front of me so I wasn’t required.

My next RTC (and I knew there would be a few in this lousy weather) involved a car and a motorcycle. A 45 year-old male was sitting on the pavement after having been knocked off his motorbike by a car. He had a leg injury and the crew were, once again, on scene with me, so they dealt with it. It was too wet to stand around looking interested…it was still raining hard.

As I sat in the car (dry and warm) doing my paperwork, a young woman crossed the road ahead of me. She was talking on her mobile ‘phone and didn’t see that the lights were not in her favour. A taxi almost knocked her down – he had to slam on his brakes and skid to a halt, inches from her. She let out a quick scream, stepped back then carried on her conversation as if nothing had happened. I wonder what her friend on the other end of the ‘phone thought?

My last call of the shift was a replacement job. I was already running on an amber call for a minor problem (backache I think) when I was cancelled for a higher priority call – a Red2. It was for a 6 year-old boy who had been run down by a car. The vehicle had gone over his legs. This was serious.

It was still raining and visibility was poor so the journey was horrendous, especially in the heavy traffic.

When I got on scene the police were already there and all the traffic had slowed to a crawl leading up to the scene (rubber-neckers and traffic control) but I couldn’t see a body on the ground, which is what I expected. Instead I was directed to a stationary car. I could hear a young child’s screams coming from inside. There was nobody with him; he was sitting in the back seat, screaming in pain and virtually all alone. For some reason his parents were standing away from him on the pavement. There was no attempt from either of them to comfort him at all. The only person who was near him was the plain-clothes police officer who had been driving the car that hit him – the very car he was now sitting in!

I examined him but could find no obvious visible injury. HEMS had been activated for this and I was tempted to cancel them but as I chewed it over they flew overhead, so I thought they might as well join me. This young boy was in obvious pain but had no obvious injury. He kept referring to his upper leg and I tried to piece together what had happened. The first thing I asked out loud when I saw him was ‘who moved him?’

Apparently, the boy had run in front of the unmarked police car and it had swerved to avoid him. It clipped him and he tumbled under the rear of the vehicle. His leg was trapped by the rear wheel which went over it. The officer said he clearly heard the sound of it being crushed. I had to believe him.

Then, despite the officer’s protestations and attempts to stop him, the father picked the child up and started running around the road, shaking him as if he didn’t know what else to do. This couldn’t have made things any better for the child. The mother, who had been down the road and had seen it all happen, ran up to them and started clobbering the dad with an umbrella. I find this behaviour seriously flawed. Maybe one of my psychologist readers can explain these actions for me.

As a parent I would NOT have moved him and I would NOT allow anyone to take me away from him. I wouldn’t have concerned myself with who was to blame and dole out the punishment on the spot and I certainly wouldn’t have stood on the pavement listening to his screams of agony without an emotion. This, of course, is my own opinion and some of you might have different parenting methods or opinions on how people deal with their emotions but I am long enough in the tooth to spot the difference between concern and apparent indifference. I just couldn’t believe it.

The boy had either sustained a potentially life-threatening injury (a fractured femur) or his leg had somehow managed to survive the weight of a car – I don’t know. HEMS arrived and the doctor had a look at him. He was just as concerned as me but couldn’t identify an injury either.

With kids the risk of missing something significant because they seem stable is very high. They compensate extremely well with dangerous internal injuries before any signs appear and by that time it could be too late. Just getting him to hospital on blue lights and factoring in the mechanism is a life-saving move and that’s exactly what we did.

I still find myself amazed and shocked by the behaviour of certain groups of people (God knows, I daren’t specify any particular group in case I’m branded a racist) when it comes to the health and welfare of their children. There is either a cultural behaviour that I am unaware of and need to be told about or there are some very stupid parents out there. I go for the latter until I’m told otherwise.

It was still raining when I went home.

Be safe.

8 comments:

Anonymous said...

That poor boy who had been knocked down! I'm a mum and i would like to think i always act in a calm and collected way when my child injures herself,however i am also a paediatric nurse and nothing ceases to suprise me when it comes to parents behaviour...sometimes the children act more maturely than the adults!

Anonymous said...

Xf,

I ached inside when I read of that poor little boy screaming in agony with seemingly oblivious parents, and wished I could have been there to comfort him.... I'm glad you were there to help him! Did you find out how he got on?

Out of curiosity, how does a CO2 monitor work? Despite 3rd. crewing with my local ambulance station for a few shifts (which included a very thorough rundown of all the equipment), I haven't come across one before.

Thanks,

millymollymandy

Jeanie said...

I trained as a first aider with the Red Cross and was taught not to move a patient unless the situation they were in was dire, a burning building or danger of something falling on to them, I clearly recall attending someone on the A13 the policeman had put her into recovery and gone so I put my woollen hat under her head and waited for the amblance, I kept talking to her, she grunted and handed her over once the ambulance making absolutely sure they were aware that I was not the one who had placed her into the recovery and then left her lying in the road, I never knew how she fared but she was taken to Oldchurch Hospital Romford where the neurosurgical facilities were excellent.

Anonymous said...

That poor little boy, As a mum i like to think i stayed calm whilst dealing with there injurys, but will admit to sometimes panicking after..lol My worst nightmare was choking, but i would never leave a crying child, mine or someone else's
Will you be able to let us know how he got on and what injurys he
had if any?

John said...

Jeanie - back in the day that may have been the recommended treatment, but nowadays we actively encourage movement into the recovery position no matter what the potential injuries.

Chances of having a spinal injury which could be made worse by rolling carefully - almost 0. Chances of dying of obstructed airway if not turned - almost 100%.

A lot more people could be saved if the public embraced this message. I think we're gradually getting there!

Xf said...

millymollymandy

Sorry I'm late with this...been up to my eyes in it.

The monitor draws expired air from a tube fitted to either an oxygen mask or an ET tube. The expired gas is enalysed via a chemical filter and a CO2 reading is made on a digital graph.

Xf said...

John

To be honest I'd prefer it if first aiders left the patient alone after an accident, for various reasons. The recovery position is only important where there is a risk of airway aspiration and if you are constantly monitoring a patient...or even talking to them, don't move them unless it is vital to do so.

Xf said...

anonymous

I will do my best to get news of the boy's condition but we get no feedback about these jobs...