Thursday, 27 September 2007

Bear with me

I'm off to Croatia to do some stuff on behalf of the ambulance service. I'll be back next week, so I'll catch up with emails and comments then.

I've re-written the book. I wasn't happy to just reproduce the blog, so I haven''s a completely different format and a lot better, I think. There is a LOT of new and unpublished stuff in there now.

This has cost me time, of course, thus the few and far between postings. Sorry about that. It should all get back to normal after next week, so bear with me.


Wednesday, 26 September 2007

The first cut...

Twelve emergency calls and one running call; three assisted-only, one no trace and the rest went to hospital by ambulance.

A thirty year-old woman who ‘feels like she may have a fit’ was my first call of this long night shift. She was in a public place and it took me more than ten minutes to locate her because, even though I walked right past her, she failed to signal her whereabouts. By the time I did get to her, she was feeling better. The cycle responder had also arrived and he waited with me in case the lady decided she was unwell again.

She has a history of epilepsy and she suddenly felt dizzy.

‘My feet go strange when I know I’m going to have a fit’, she told me.

‘Ok’, I said, ‘just let me know if they start to feel strange and we’ll deal with it’.

Luckily for all concerned her feet decided not to misbehave and she was given ten minutes in the back of an ambulance to recover. By this time her boyfriend, with the two-tone hair (I think I mentioned a split personality) turned up and rescued her.

Straight after that I was winging my way to Soho for a 30 year-old female ‘choking on chewing gum’. These calls are almost always not as given. Choking to many people means they are having trouble swallowing, or they have a lump in their throat or they can’t get enough food in and it’s stuck in their mouths - that sort of thing. I’ve only ever been to a couple of genuine choking calls where I’ve had to intervene to save a life.

I stopped outside the alley leading to the address and as I got out of the car I bumped into one of our frequent flyers – our suspected hoax caller and general time waster.

‘I didn’t call you this time, boss’, he shouted.

I was reassured.

The flat was one of three in a tiny building in the middle of the alley and the minute I stepped inside I realised I was in a brothel. There were an awful lot of ‘beautiful and glamorous models’ being advertised. I was led up to the third floor just as one of the employees of the establishment brought in a customer. They went to the second floor.

In the front room there were a couple of women, one of whom was sitting on the sofa. They all looked tired and worn. Haggard is the word I’m fishing for. There was nothing beautiful or glamorous about any of them. Someone should point out the Trade’s Description Act or Advertising Standards or something.

‘I’m alright now. I don’t need to go to hospital’, said the sitting prostitute with a hoarse voice.

‘What happened?’ I asked.

‘I was chewing gum and it got stuck at the back of my throat. I’ve managed to cough it out, so I’m alright’.

‘I’ll have a look at your throat before I go then, if that’s okay with you’.

See? Gentleman to the end, that’s me.

I asked her to open her mouth and I had a look down her throat with my little torch (please, no crude puns or jokes at this juncture). It was red and painful looking, as I would expect but there was an additional medical problem that I didn’t mention because I thought it would be bad mannered of me and would probably result in my rapid and violent expulsion from the place. She had the worst case of thrush I had seen for years.

As I left I saw that a bedroom had been prepared for the next client. A grotty sheet and blanket with an incontinence pad laid out on it. My mind shuddered at the thought of it. Out I went, back into the Soho night.

A fall down concrete steps outside a church took me to the west. A 62 year-old man had tripped and toppled over on the top step as he left with his congregational friends. When I arrived a crew were on scene and they were working over him while a crowd of around thirty people mingled and jostled around them. He was lying conscious on the ground, with a head injury that was producing a lot of blood. The crew had quickly dealt with this and I assisted them with the immobilisation and lifting of the patient.

In the ambulance and on close examination, I could see that he also had a bad knee injury – it looked dislocated. I popped a needle in and asked him if he wanted pain relief. He refused at that point but my cannula left the option open if he changed his mind.

Then a 49 year-old diabetic with chest pain. When I checked his BM, it read 37.2 – that’s a wee bit high. His meter ‘wasn’t working’, according to the patient but when I checked it the machine was fine. I think he had been testing his blood glucose, saw the word ‘Hi’ on the screen and decide it was a fault of some kind. He went to hospital for his own good.

A serious RTC next, involving a 30 year-old motorcyclist and a car. I arrived to find the police just getting on scene, so I went straight to the first (and only) casualty I could see – the motorcyclist, who was lying on the road. I got the police to assist me while I kept him still because he was wriggling a bit and complaining loudly about pain.

I had been asked to report and I told my Control that I only needed one ambulance and that no further resources were required but when the crew arrived and I was telling them about my patient on the ground, a police officer walked another seemingly injured person from the car. I had completely missed that possibility because the cops had told me nothing about another person; I had assumed the driver was fine.

‘Is he alright?’ I shouted.

‘He’s got a bit of a sore neck’, the officer shouted back as he walked the man to the pavement.

‘Keep him still. Don’t move him at all until another crew gets here’, I told him.

I asked one of the crew with me to get on the radio and request another ambulance. The man on the ground had a chest injury and was having difficulty breathing properly, so he was our priority. A collar was made available for the other man; although he told the police that he didn’t need one.

The other crew arrived and took care of patient number two as I completed immobilising the motorcyclist with the first crew. His complaints about one side of his chest and the breathing problems he was experiencing became more urgent and we suspected he may have a pneumothorax, so he had to get to hospital fast.

While the crew were getting ready to take him to hospital, I asked the police officers how the accident had happened. They told me that an eye witness, himself a motorcyclist, said the injured biker had shot through the red lights at about 70mph, colliding with the side of the car, which then dragged him underneath at the back. The patient’s punctured lung could have been caused when he held his breath as he hit the car or the car itself had crushed his chest momentarily when he was dragged under. Either way, the mechanisms were significant.

I escorted the ambulance to hospital and as we made progress through the city, found the way blocked completely by one of those damned ‘road closed’ signs that have been popping up without warning as they dig up more and more roads to repair and replace water pipes. It wasn’t funny at the time and luckily we weren’t conveying a patient whose chest had just been decompressed because the delay could have killed him. Members of the public saw the dilemma and moved the cones away for us. The road had been prepared for digging but hadn’t yet been demolished, so we weaved our way through to the other side on an uneven, bumpy surface. The alternative was a long diversion.

The patient arrived in a stable condition and was taken straight into Resus.

A call for a 30 year-old female ‘drunk, dropped on head’ had me cruelly finishing the sentence ‘as a baby' as I made my way to the scene. She turned out to be a vomiting female who had fallen from her friend’s shoulders as they mucked about. She was fine but she was taken to hospital because she had initially been unconscious, according to her mates. More than likely fast asleep.

Another drunk, this one 21 years old, was said to be ‘fitting’ outside a pub. He was slumped in the corner, surrounded by the door staff who were obviously annoyed at his presence. He was drunk and looked younger than his age. No ambulances were available for me and I had waited with him for more than fifteen minutes before I decided to take him to hospital myself but he refused. He hadn’t fitted and wasn’t epileptic; he was just very drunk.

The door staff said they would get him a taxi to take him home and the young man agreed. I said I would stick around until they got him into a cab but as I sat in the car and watched them I saw that they were trying to get one of the local (and illegal) mini-cab drivers to take him. That wouldn’t be good. These guys would rip him off.

I got out of the car and stopped them, telling them that I would take him to hospital where it was safer for him. I reminded them and myself about my duty of care. The young man, despite his protestations about going to hospital, was vulnerable.

As I set off with him in the back, I was asked to help someone just around the corner who had a badly cut hand. Apparently he had been waiting for an ambulance for 30 minutes. I called it in and went round to have a look – my drunken friend was in the back moaning about his life.

I stopped outside a pub and a man was brought out with a large kitchen towel over his hand. He had fallen onto a glass, which had shattered and cut into his hand, across the fleshy part of the palm under the thumb. I unwrapped the crimson-soaked rag and a jet of blood shot passed me. He had a serious arterial bleed. He looked quite pale. I applied two dressings, one on the other because the first wasn’t stemming the flow. I put pressure on his radial artery for a minute and that seemed to help bring things under control. I was standing with him in the middle of a crowd of drinkers in Soho. There were no ambulances free to deal with this, so I called it in and told Control that I was going to take both patients to hospital. It would take me no more than three minutes to get there, as opposed to waiting another ten minutes or more for an ambulance.

I rushed him to hospital and my drunken friend continued to moan about his life. My bleeding patient’s wound was under control and his arm was elevated in a sling. He was stable and less ‘shocked’ looking than before. I got both of them to A &E in a few minutes. The bleeding man was taken into Resus and the drunken boy was taken to the waiting room, where he promptly fell asleep.

I had no break tonight and my next call was for a female ‘unconscious ? cause’. The location was a police station and I walked into the custody area expecting to be taken through to the cells but they knew nothing about the call. I called my Control and they said that it had come from someone who had seen the woman collapse outside the police station, so an officer came out with me to investigate. I certainly hadn’t seen anyone on the ground when I came in and nobody tried to attract my attention.

There was a small group of people milling about just up the road from the station and I suggested that they might have something to do with it. One of them was holding a girl who looked emotional. When we approached and asked them if they had called, the woman who was holding the girl said she had and that she was a nurse. This was a strange situation. She knew I was there but she ignored me completely, even though she had made the call for an ambulance in the first place. I went to check on the girl who had supposedly collapsed while the police officer spoke to the nurse, who was being very obnoxious.

‘Are you alright?’ I asked.

‘Yeah. I don’t need you’, she replied but she was a bit defensive, almost as if my presence offended her in some way. She wouldn’t make proper eye contact and I thought her behaviour was suspicious.

‘Did you collapse on the road?’ I asked.

‘No. That wasn’t me. That was someone else’.


‘My friend but she got a taxi home. She’s alright.’

She was lying to me and I knew it. She didn’t want to tell me or the police officer anything. The nurse (if indeed she was a nurse) was still being a pain in the rear and the others turned out to be innocent passers-by who had helped. One of the men in the group took me aside and told me that the girl had been punched and knocked down by her boyfriend. This had been witnessed by the nurse who then called an ambulance. The young girl didn’t want the police involved but that had happened coincidentally because the location had been given as inside the police station.

The story made me very angry. This stupid little girl was wasting everyone’s time and had no apology or excuse to offer. To her, we were simply working and getting paid and were nothing more than an interruption to her life. If she wanted to let her boyfriend punch her lights out, fine, but women like her give the abuse a free licence I think.

I left them to it and the police officer went back to work just as fed up as me.

Another police station call, this time inside, for a 24 year-old male with a head injury who was ‘in and out of consciousness’. He had a small cut to his head but the police didn’t want to take a chance because he wasn’t responding to them. I gave him oxygen and played along with him until he decided to end the game and wake up. The crew arrived and he woke up even more when they lifted him to his feet and made him walk out to the ambulance. The guy just wanted a more comfortable bed to sleep in for the night.

A young man with a minor cut to his chin approached my car as I stopped to do my paperwork at The Haymarket. He had been assaulted and was waiting for an ambulance but on a night like this, he had little hope of getting one soon. I examined his injury, assured him that it was very minor and cancelled the ambulance. He was happy to go home with his mate after that.

A huge Russian, found asleep (drunk) under the seats in a bus next. He was firmly wedged between two rows of seats. I have no idea how he got there. He must have slid off like melting ice cream and slithered underneath as he dozed. I shook his shoulder, pinched it, thumped his back and did everything in my book of tricks for awakening the dead but he refused to budge. He shouted at me, threw his fists at me and was generally unpleasant, so I asked the police to assist.

They dragged him off the bus and stood him against a wall. He continued to sleep – standing up. I cancelled the ambulance and waited until I knew I could go. I asked him if he needed an ambulance but he didn’t reply. I pointed to the street and said ‘go home’. He seemed to understand and toddled off but he got no further than a few steps before he stopped and went back to sleep. He was still standing up. With the help of the police, I sat him down on a step and left him to sleep it off.

My last call was to a vomiting female who was slumped in the seat of a bus. I woke her up and spoke to her. During the conversation I found out that she had learning difficulties. She was also drunk and miles away from home. She had taken the wring bus.

‘Do you have psychiatric problems?’ I asked

She lifted her hand up and waved it in a ‘so-so’ fashion.

‘Are you a diabetic?’

‘I think I might be.’ She said as she dribbled saliva from her mouth as if she had no control.

Her BM was normal, as were her other signs. The crew arrived and as we took her to the ambulance I tried to persuade her to use her own two feet, rather than us lifting her from the bus.

‘You’re a grown up. You can walk for yourself’ I suggested.

She gave me an odd look and said ‘I’m only 22’. Then she grinned and said ‘How did I get all the way down here?’

‘The wrong bus’ I said.

Then with an even cheekier smile, she said ‘Do you have a cigarette?’

Be safe.

Thursday, 20 September 2007

Bad manners

Six emergencies. One cancellation; the rest went by ambulance.

Sometimes I will go to a call and the family will behave strangely towards me, almost as if I am the enemy. I know that this is simply a different way of reacting to stress, especially when worried about a loved one but it can be unnerving and a little annoying when you are asking questions and getting nothing back.

My first call was to a '67 year-old male ?CVA'. He had a history of stroke in the past and now he stood in his kitchen looking confused and very flushed about the face, with his daughter and son-in-law . I asked him a few simple questions about how he felt and his answer was always the same.

‘I’m alright now.’ He’d say.

I checked his blood pressure and found it to be very high. I asked him what had happened and he wasn’t clear at all. I knew I was looking at a possible CVA but I wanted something a bit more conclusive from the history, so I asked the daughter.

She looked at me as if I was a gate-crasher at her birthday party. I almost felt there were issues between her and her father that were being left unsaid. It’s difficult to do the job properly with obstruction and that’s how it felt now. She wouldn’t give me a direct answer about anything, except to tell me that he was a drinker. She looked almost disgusted with him but at the same time worried. Maybe it was both and I was taking it too personally.

I continued my obs and questioning until the crew arrived. Evetually we were told that he had collapsed in the garden and called his daughter, telling her he was in trouble. He stood in his kitchen denying anything was wrong now, however.

Then I realised that she was so concerned and angry that I was just a necessary shadow in the world she currently inhabited. She didn’t like me or my colleagues being there because we reminded her of an issue she had obviously been avoiding for years. I was currently a see-through person and could only be answered if I asked loud enough. I was never to be spoken to voluntarily.

The man had a high BP, unequal pupils and was flushed. Regardless of what he said, he was going to hospital.

A 42 year-old woman with itchy skin and stinging urine walked out to meet the ambulance crew when we arrived at the same time on scene and I wasn’t required.

Then a vulnerable lady who had an epileptic fit and banged her head at home. She was nervous and tearful about me being there. She felt guilty because she didn’t call us, someone else did. It took me a while to convince her to go to hospital because she believed the staff at her usual hospital didn’t like her. I arranged to have her taken to an alternative hospital and she relented.

Luckily my next call wasn’t as serious as it could have been; my navigation system thought it would be funny to send me the longest way around to a 74 year-old male with DIB. By the time I reached the address, a crew was on scene and I wasn’t required.

A 29 year-old female who was ‘shivering and ? fitting’ needed an ambulance, so I sped to the address a few miles away and leaned on the buzzer. The call description had stated ‘when asked questions, caller said she didn’t know or care because she is drunk’. Now, I wondered if the patient was the caller or someone else had called and was describing themselves as drunk or the patient as drunk. Either way, it didn’t matter because after twenty minutes of leaning on the buzzer, chatting to the crew who had now arrived, banging on the entry door to the block of flats and requesting a ‘ring back’ to find out what was going on, the patient decided that an ambulance would be inconvenient.

‘An ambulance crew is standing outside the main door to your building, can you let them in please?’, Control had asked

‘Na, don’t need one now.’ Said the caller and promptly hung up.

I should have been furious but I was strangely calm – not like me at all.

Anyway, the shift ended with a call to a ‘diabetic, coughing’. I would have suggested no relationship between one and the other but who am I to argue?

I got on scene at the same time as the crew and went inside the building to the world’s smallest bedsit. As soon as we stepped over the threshold we were showered with a viral-filled mist from the man’s cough. He had to be asked three times to cover his mouth. Why in God’s name do people do this to us? If you have a cough, cover your mouth and don’t spread it to me – I don’t want it. Honestly, I don’t. It takes me ages to get over a cough. I still have the residue of a cough from the beginning of the year.

I could see that I wasn’t needed so I took off before I got any more of his unhealthy welcome. One day, I'll go home with a dose of bird flu. That's not even funny, really...

Be safe.

Tuesday, 18 September 2007

Dopey parents

Eleven calls. One assisted-only, one refused, two running calls, one conveyed, one false alarm and seven taken by ambulance, including the running calls.

Alcoholism and depression are best buddies. My first call of the night was to a 56 year-old female described as ‘unconscious thru drink’ on the system. The police were on scene when I arrived and the lady was conscious. She was slumped in a corner and she was very drunk. It took about five seconds for the tears to start flooding when I spoke to her. I’d like to think I have a more positive effect on drunken women than that but there you go.

She claimed that she had taken an overdose of co-codamol but after that she told me she had only taken six, downed with a bottle of vodka. Hardly an overdose but the bottle of vodka could kill her. Initially I thought she was a wandering soul, on the streets and helpless but the more I looked at her the more I realised that she wasn’t poor or needy.

Her husband turned up out of the blue as the ambulance arrived. He had come into town to meet her and they were supposed to be going out. She had dashed those plans by binging and munching on pills for reasons he couldn’t fathom. She did, of course, have a long history of depression and that doesn’t come cheap or easy in most people’s lives, so I felt very sorry for her.

Every now and then I come across a patient with an ‘eating disorder’. This call was for a 16 year-old female with abdominal pains and vomiting. I drove past the address twice. There was a queue of people outside and a couple of security guys but nobody knew I was coming, so they didn’t wave me down. I assumed that I was at the wrong place. There was no name plate on the building and no way of identifying it as a ‘ballroom’. As I drove around the square for the third time, the ambulance caught up with me. They had been going around in circles (squares) too.

Eventually I stopped and got out to ask. The security guy went inside the building and found someone who knew what was going on. People still call ambulances and then expect us to know, by some psychic means, exactly where they are, even when the address is vague and the building is completely anonymous.

Anyway, the mother of the patient came outside with a first aider who was on duty at the venue. They guided me to the young girl who was sitting at the bottom of the stairs, looking more upset than ill. I asked my usual questions to get the ball rolling and took her and her mother upstairs with the ambulance crew. The first aider gave no handover and simply melted into the background.

‘She has an eating disorder’, mum told me, ‘she has been feeling ill on and off and fainting but the doctors aren’t doing anything about it.’

She hadn’t fainted but she did look a little pale. She had obviously recovered from whatever had happened to her earlier and she was taken to hospital for a check over.

Stupid drunken women should go home as soon as they feel the urge to tightrope-walk in public places. The 25 year-old female I went to next had fallen from a table and banged her head on the floor. We were called because the pub manager had seen blood coming from her ear and was concerned, which is fair enough.

She was sitting on a chair when I got to her. The pub was crowded and very noisy. She was extremely drunk and wouldn’t even talk to me at first. Then she replied with the standard drunk person’s silly grin every time I asked a question. I think it means ‘yes’.

She had lost her balance during her trapeze act and cracked her head on the floor because she was far too drunk to stop herself from hitting it. I looked at her ear and found nothing more than a superficial cut to the inside. When the crew arrived she hurled abuse at them almost immediately and that was that. She was left alone and a friend was instructed to take her home by taxi. There were only two things wrong with her, she was drunk and she was obtuse.

For the second time in one night I was driving around in circles with an ambulance ahead of me doing the same. Some addresses, especially in those big estates, are extremely difficult to find. This call was for a 1 month-old baby boy who was having difficulty in breathing. Eventually, a kindly gentleman asked where I was trying to get to. I told him and he jumped in the back of my car to direct me. The ambulance missed it and I radioed instructions to them via Control.

I got to the address, thanked the man (who had to walk all the way back to where he had been before he met me) and made my way urgently to the flats. I say urgently because there was a panicking man at the foot of the stairs and he was in a hurry to get me up to the child, so I figured this call was genuine.

Sure enough I was confronted with a very floppy baby. His breathing was laboured and slow and he wasn’t responding properly at all. Floppy babies are almost always very ill. I took the child, told the parents to follow me and hoped that the ambulance had caught up and was waiting outside. It had and it was but the crew were on their way up in the lift as I descended the stairs with the family. Luckily they saw me from the balcony and started to return. The ambulance was unlocked and I bundled everyone inside and waited for the crew.

As soon as we were all assembled I gave a quick handover and the crew took it from there. All my basic obs were normal for this child, so I have no idea why he was in that condition.

An allergic reaction that resulted in no more than a mild urticarial rash next. The 28 year-old man had no history of allergies and couldn’t pinpoint what might have triggered this one. He had quite a wide-spread rash but there was no airway compromise and his breathing was fine. He went to hospital for a proper diagnosis.

I rolled around to Leicester Square after that and sat on stand-by, chatting to a couple of police officers I know. As I bantered, I noticed two young women crossing the road with red buckets. Each bucket was adorned with stickers proclaiming that they were collecting money for Cancer Research. I found it ironic therefore that both of them should be smoking fags as they walked on by, buckets swinging merrily in the air.

A posh hotel next. The place was crawling with private medics because there had been a major boxing tournament there all evening. Inside was a 55 year-old well off Russian man who reportedly had chest pain. He had collapsed at his table and the medics had been called to help. When I arrived I thought there were probably too many cooks...two paramedics, two technicians and an Emergency Care Practitioner...and now me. Soon enough the crew turned up and it was looking like a party (where green is the only colour allowed). I told them that the patient had refused to go to hospital and his obs had been checked and were normal. He had no chest pain and was patently drunk.

I stuck around while a 12-lead ECG was taken; I wanted to be sure before I left this guy to his vodka. It wasn’t normal – he had an irregular heartbeat and the ECG wasn’t completely stable, so I advised him in the strongest terms to go to hospital. He still refused. I had lots of witnesses and I got my magic form signed, there was nothing else I could do but leave. So I did.

A stabbing in the West End and I was first on scene. Well, I would have been if the traffic hadn’t been so bad. The police were ahead of me, lights and sirens going but it was useless; none of the cars and buses could move, it was gridlock. Behind me an ambulance was fighting its way through the mess. If this guy had serious wounds, he was waiting unnecessarily. London traffic can cost you your life.

When I got to him I found that he had two serious stab wounds – one to the abdomen which had split the muscle wall wide open and one to the arm which had gone all the way through to the bone. They were long slashes, rather than deep penetration wounds, so he would survive these. They were allegedly caused by a broken glass or bottle and were inflicted on him ‘for no reason’, according to the patient.

‘I was in the wrong place at the wrong time’, he said

We dressed his wounds and got him to hospital where they would clean and stitch him up. He would have significant battle scars for the rest of his life.

Liberal parents annoy me. Not because I am particularly politically flavoured but because my upbringing means I simply don’t understand them. Tolerance is one thing but complete abstinence of responsibility for your child is another.

My next call, in the early hours of the morning, took me to a very well-off part of town – out of my area in fact. Inside the large house was a 16 year-old boy who needed an ambulance because he ‘thought he may faint’. The call had been made by an adult in the house. The young lad was visiting and was surrounded by his teenage mates.

He told me he had long Q-T Syndrome (LQTS) and he was feeling faint. He was worried that he might pass out and his doctor (private of course) had advised him to dial 999 if he ever felt like this. This is fine because LQTS can, in some cases, deteriorate into a life-threatening arrhythmia, so I took him at face value and began my obs.

As I questioned him about what he had been doing prior to feeling faint, I discovered that he had been drinking alcohol and smoking cannabis. Well, well. I wonder why he felt faint after all that? I told him off for being irresponsible (I couldn’t help it, as a parent the nagging gene kicks in) and he just nodded and said acquiescent things that meant nothing at the end of the day.

Then his parents arrived and I thought there was going to be trouble. I wasn’t going to say anything about the drinking or smoking because I didn’t want to drop the boy in it, so I just told them why I was there and what I was going to do next. I got the shock of my life when daddy piped up.

‘Have you been drinking?’ he asked the boy with the same downward drawl you use with a two year-old who’s been naughty.

‘Yes’, the boy replied

‘And smoking?’ smiled the dad

‘uh-huh’ the boy said sheepishly (but not guiltily)

I was gob-smacked. Was this a Soap Opera? If I had been caught drinking or smoking (and I know a lot of us did it) I would have been dragged home and never let out again! Worse than that is the fact that these parents didn’t seem too concerned about the massively damaging effect this stuff could be having on their son’s already fragile heart. Either that or I was reading them wrong.

When I am worried about my family, I tend to look worried. I don’t patronise them with soothing tones and reassurances as I semi-lecture them in a completely unconvincing neutral tone about the errors of their ways. Daddy even mentioned the fact that their own doctor had instructed the boy not to take cocaine as it would be detrimental. He took this to mean he could take any other kind of illicit substance. What the hell kind of medicine is that? This is what took place in my car all the way to hospital. I had cancelled the ambulance because it wasn’t required; the young lad was fine, just drunk and stoned.

I dropped them off at hospital and left with a feeling of dismay.

During my break, as I sat inside the station, I was called and advised by Control that a large gang fight had broken out nearby and that I should stay put for the time being for my own safety. It’s usually so quiet up there at night, so I was a bit taken aback by this. Couldn’t the thugs stick to the West End?

I got called out soon after my break had ended and was cancelled as I approached the end of the road but a small group of people were running around in front of me and one of them approached the car and asked me to stop. I slowed down and cautiously weighed up what I had to deal with. There were five or six men around the car but they didn’t seem threatening. One of them looked hurt.

The man who had flagged me down told me that his friend had been hit over the head with a belt buckle when a ‘madman’ had suddenly gone berserk in a shop. He had lashed out with his belt at everyone in the queue.

I inspected the man’s head and he had a small cut to his scalp. He would live. The police and an ambulance had been called for me because I had radioed in the fact that I had been stopped by this gang.

As I spoke to the men, a guy appeared from the shadows with a belt rolled up in his hand. He headed straight towards us and I thought we were all going to be attacked by him but it turned out to be one of their mates. He had been hunting down the assailant and was ready to inflict an equal punishment on him. I advised him to put the belt away before the police saw it.

The man with the head injury was taken to hospital and the police began a search for the assailant. The little gang dispersed and I went back to the station.

Later on I went south for a 22 year-old female who was sleeping in the street. She was drunk and I considered her to be vulnerable, so I asked for an ambulance to take her to hospital. She was in no fit state to go home alone.

My last call was to a house fire in east London. The LFB were on scene and the fire was out when I arrived. Only one person had been inside at the time and she escaped with minor smoke inhalation but she refused to go to hospital. She looked fine and was recovering from her ordeal – she had lost a lot in the fire and her home was now open and exposed so I could understand why she would rather not be away from the house.

House fires leave a smell in your nose that doesn’t go away for hours. I went home with that smell.

Be safe.

Saturday, 15 September 2007

I'm so lazy

Yep. Haven't been able to post a damned thing, even though I have enough of it written down.

I have been re-structuring the book and I only have a few weeks left before it goes to press so it's got to be right. Lots of new stuff going in there...stuff I've never blogged, so it should appeal to regulars and new readers alike.

I'll be off next week so should be able to post every day for you.

My apologies to those of you that I have agreed to publish as guest writers. I will create a link to a separate place for that. If you want to write something as a guest, feel free but here are the rules:

1. NO profanity at all.

2. It must be well written and as grammatically correct as possible...please.

3. No personal, racist, sexist or other 'ist stuff if you don't mind.

4. Humour. If you have it.



Sunday, 9 September 2007

Dogs and drug addicts

Six emergencies; one conveyed and five taken by ambulance.

After a few false starts I was off to a train station first aid room for a 38 year-old pregnant woman who had collapsed on an incoming train. Ironically, I had been sent this call earlier (when she was on the train) and it had been cancelled – it was a low-priority Green call at that time. Now it was a category A, Red call. All moot, however – when I arrived on scene an ambulance crew were already attending and I wasn’t required.

My next call didn’t take much skill either - a 21 year-old fitting in the street with a warning on the log that there was ‘an altercation’ at the scene. I called in and asked what this meant exactly and requested police just in case. I thought I might be driving into a fight. It turned out to be nothing more than the patient’s friend shouting at him while he was fitting. He told me that his mate had taken longer than usual to recover and it worried him, so he had raised his voice as he became more concerned. I found them both walking along the street – the patient was still very groggy and needed to be propped up and encouraged all the time. He kept wandering off in the opposite direction to the one we needed him to travel in, so he had to be led into the ambulance like a sheep to a pen.

It was a good few hours before I received my next call and I had a nice long break at the station, which included hot food for a change.

An emergency call to a local park for a 30 year-old female who had overdosed. The parks around Bloomsbury are frequented by drug addicts and nothing much is done about it. The same parks are shared with tourists (who probably lose faith when they see the mess) and children, who play on the slides and swings, oblivious to the human tragedies and associated paraphernalia surrounding them.

I arrived just after the motorcycle solo and found him on his knees on the grass, supporting a thin woman’s breathing by ‘bagging’ her. A thin man (they are all thin; they don’t eat) was crouched over her and he was fussing (they all fuss when their habit goes horribly wrong).

The woman had overdosed on heroin, which is no surprise – it’s the drug of choice around these parts. The MC paramedic had his hands full just keeping the woman alive because her breathing was so depressed she would not last more than a few minutes without support, so I got on with drug administration. She needed Naloxone, or Narcan (narcotic antidote) to reverse the effects of the opiate she had taken.

I couldn’t find a vein – it’s usually difficult to do so with habitual IV drug users, so I gave her the first dose by intramuscular injection in the thigh. I knew it wouldn’t work as fast and may be completely ineffective but it was a start and would buy us time while I looked for a better IV site.

Meanwhile the overpowering smell of dog crap was getting to us. I thought I might be kneeling in it. She was certainly lying in the stuff and the thin man didn’t seem bothered but I found myself looking around identifying all the little clumps of poo from various visiting mongrels so that I could mentally ‘map’ my way around them should I have to move about. The smell remained in my nostrils throughout the entire episode with this woman.

The police turned up as we were treating her and the thin man was pulled away so that he couldn’t annoy us while we worked. He had been very irritating and at one point had shown us the syringe and needle that had been used for this potentially lethal injection. I asked him to give it to me so that I could dispose of it but he simply snapped the neck of the thing and the needle fell off into the grass. He didn’t care a jot that some poor unsuspecting kid (or dog) might stick himself/herself/itself with the promise of HepB or HIV. He didn’t give as toss quite frankly.

I found a suitable vein; it was less rigid than the others and had enough patent length to support the catheter from an 18g cannula, so I went for it. It went in without any problems and I got a drop of blood on my kit for my trouble. I would have to remember that and ensure I cleaned it up afterwards.

I gave the thin woman another 400mcg of Narcan, this time IV and the miracle of her recovery took place within minutes. Her breathing improved and she began to respond.

‘Hello, I gave you something to spoil your trip. You’ve wasted your money’, I said.

She started to talk to the MC paramedic and was making sense (kind of) by the time the ambulance crew arrived to take over. The police were neutral about her life being restored and there is a part of me that felt the same, I'm sorry to say. She will do this again and again at our expense until she kills herself. There were kids playing in the park only feet from where she had taken her hit with her skinny mate. She would have died on the grass, surrounded by dog mess in full plain view of the local children. It’s sickening.

I checked my boots and clothes for tell-tale brown or yellow (or green) goo and found nothing but my nostrils wouldn’t repent and I had to bear the smell for a few hours after the job. The smell of vomit would be heaven after this I thought.

As I was leaving the park a young boy came up to the car to ask what had happened. I told him a drug addict had pushed her luck and asked him what he thought of drugs. He told me he knew what went on but that he and his friends ignored it and just got on with playing football.

‘I’ll never do drugs’, he said, ‘all I want to do is play football.’

I hope he keeps his word or he will end up in the park with his skinniest friends.

Then this unusual RTC involving two vans and a motorcycle. One of the vans (the blue one) was being towed when it snapped loose at a bend and careered into a private ambulance waiting at the traffic lights. A motorcyclist was also waiting at the lights, on the inside. He became sandwiched at speed between the blue van and the ambulance. The force of the impact crushed his bike, throwing his top box up into the air, after which he followed.

When I arrived plenty of police were already on scene and one of our motorcycle solos was dealing with him. He had escaped with only minor injuries to his leg and was able to put weight on it. Another lucky escape I think. The ambulance driver was also unhurt.

Tall, thin people are prone to spontaneous pneumothorax as a result of simply stretching or coughing. Most of the time it is left alone to repair itself but everyone suffering one of these events should go to hospital in case it develops into something more dangerous.

My next call was to a 52 year-old ex-police officer who had coughed and suddenly felt a sharp pain in his chest whilst on his way up the escalators at a tube station. I found him standing, looking very uncomfortable and with shortness of breath, beside a newspaper stand on the main concourse of the station. After a quick exam and a few questions I asked him his height and he told me he was six feet two inches tall and, although he wasn’t particularly thin, his symptoms fitted the bill for SP. He also told me he was an asthmatic and had tried his inhaler with no effect after his breathing began to deteriorate.

I gave him oxygen and the ambulance crew wheeled him to the ambulance. He’ll be diagnosed and treated, depending on the severity of his condition.

Finally, a 71 year-old with a pacemaker and high blood pressure who fainted and fractured her wrist. She had an obvious deformity with bruising and swelling at the site. It was, of course, very important to establish why she had fainted in the first place, so her pacemaker and general health would need to be checked. She had no chest pain, no dizziness and all her vital signs were normal. She was fully conscious and quite aware of what was going on, so I took her to hospital myself. It took me three minutes to deliver her to the nurse at A&E.
Be safe.

Thursday, 6 September 2007

Hanging about

Ten emergencies, all of them required an ambulance.

I started my day with a minor leg injury, possibly a sprained knee, as the result of an RTC in which the patient, a 39 year-old male, was knocked off his moped by a white van driver. Quite a few moped riders are getting knocked about on the roads these days. I assisted the crew on scene and made my way back to finish cleaning the car. I’m the only FRU out of the station at the moment because of the number of people who are off on holiday, so I’m being fully utilised.

Just around the corner from the RTC an 81 year-old woman with chest pain diverted me from my mission to complete the cleaning chore. Her daughter is a doctor and had called an ambulance because her mum was suffering from unstable angina. When I got to the address, however, the old lady wasn’t complaining of any pain whatsoever. Without pain, there is no angina, stable or otherwise. She was feeling unwell and had vomited several times overnight and this morning but she was good on her feet and sharp enough to contradict most of what her daughter was trying to tell me.

Only after a long period of questioning and re-questioning did she admit to having an ‘aching’ left arm. She had suffered a heart attack in the past but was categorical about the difference between that pain and the arm numbness she felt now. Fine but she still had to go to hospital – her age, her medical history and that aching arm said so.

I felt for the daughter. The old lady had contradicted her and made her look stupid before the true story came out. Patients sometimes do that. I don’t know if they have a specific agenda but when it happens it’s embarrassing. I don’t think any one of us have escaped it.

‘This is Mrs Miller, she has left sided pain and has been vomiting’

‘No I haven’t’

‘But you told me you had been sick and that you had some pain’

‘No I didn’t’

And so it goes.

A weekend of boozing fun is all very well until you have to wake up on a Monday morning and face the responsibility of earning your week’s party funds. My next patient was a very weak, very tired and just recently fainted 20 year-old woman who had been travelling to work on the underground when she blacked out. Her body simply had enough and needed a rest. She had no medical history of significance and she was conscious now that I was kneeling beside her on the platform. She made me feel tired just looking at her. The crew took her to hospital where no doubt her state of health with be verified and she will get a couple of hours sleep.

If you call an ambulance please send someone to meet us, especially if you work in a large office building. I won’t have a clue where to go unless I am directed. A delay of even a few minutes could be significant if the patient is suffering from a time-critical condition.

My next patient had chest pain but I couldn’t find him. He was secreted somewhere on the second floor of an office building but nobody came to meet me and when I got onto the second floor, by sheer guesswork, nobody knew what was going on. A young girl had to go walkabout to find the patient. It cost him three minutes.

Eventually I was shown into a meeting room where the patient sat, colleagues in attendance. He had chest pain and had suffered a similar attack before but nothing was ever found to cause it. He didn’t look particularly in agony but he pointed to his chest and left arm when I asked where the pain was, so it was prudent to take him seriously. I gave him GTN and aspirin and the crew too him to hospital after an ECG which revealed nothing important. Before he left, he admitted that he was the ‘nervous type’.

Court buildings attract ambulances on a fairly regular basis. The defendant will ‘collapse’ as soon as the verdict has been read out or during the immigration hearing or when they have been called to appear. This doesn’t mean that there isn’t a genuine medical reason for calling an ambulance but I have never genuinely treated anyone from a court house.

A 35 year-old male had collapsed and was shivering outside a court room and I was called to support the ambulance crew who were on scene. Someone had said epileptic fit too hastily. The guy had mental health issues and was at an immigration hearing that was probably not going in his favour. He was jerking about on the floor (more of a shivering motion) and refusing to speak or open his eyes for the crew. Since this was taking place in public it was best to move him into the ambulance for a proper assessment.

In the ambulance he still refused to help us and I began to wonder if he was epileptic. He had no history of epilepsy, according to his cousin who was with him, but it can never be ruled out conclusively. Luckily before I started to take him seriously, he stopped shivering and opened his eyes. He even spoke to me. I think the fact that I had been taking to the crew about options had helped him ‘recover’ more speedily. Nobody likes a needle in their arm.

I was asked to check on a man who had attempted to hang himself and was now fitting. It was a couple of miles away and when I arrived the ambulance crew was on scene and dealing. The man had bought himself a brand new step ladder, taken it to the nearest standing post, pulled a sign over his chest proclaiming how unfair Britain was, gone up the steps, chucked over a ready-noosed rope, covered his head with a brown hood (execution style) and prepared to step off into oblivion.

Luckily for him, two police officers happened by and casually asked him if he was ok. It seems hilarious when you hear this story but in essence these two cops potentially saved this man's life because, as he replied he toppled over and began to hang in his very effective noose. The quick cops grabbed him and held his weight whilst he was brought back down to Earth.

Now he lay on the pavement, not talking to anyone and being treated for a suspected neck injury. It was a bizarre call and the whole incident took place at the side of a very busy main road - for maximum impact I'm sure. I have no doubt he intended to kill himself; everything was too well thought out...except the possibility that two police officers would stop for a chat mid-suicide - inconvenient to say the least.

The biggest irony of all is that the post he chose for his death was a speed camera. If his luck is very bad he will also get a fine and three points.

Hyperglycaemia causes internal dehydration because water is dragged out into the renal system along with glucose as the body seeks to remove it as it builds up in the blood. Slow rehydration is important and not usually carried out on scene but I was waiting for an ambulance with a 20 year-old female at an underground station who had developed a BM of 32 over a 24 hour period despite using her regular insulin and not eating. She had been vomiting and was extremely thirsty. Her blood pressure was normal but I gave her a hundred mils of fluid to be on the safe side while I waited for an ambulance to take her to hospital. I like to think ahead on these jobs.

After my break, which was given later in the day than usual, I headed up to W1 for a 35 year-old female who was fitting in the street. She was surrounded by people trying to help but all they could do was stand over her as she thrashed around, her waist and legs on the pavement, her upper body and head in the road. Only a helpful soul at the junction stopped vehicles from hitting her as he signalled them to slow down. None of them thought to move her out of immediate danger.

After I had dragged her from the road, with the help of a few volunteers, I tried to establish how far gone she was. She had stopped wriggling about and was (hopefully) recovering from her episode. Nobody knew her and her ‘phone kept ringing in her bag. I ignored it as I did my baseline obs but eventually relented and answered it when it rang for the third time in quick succession. Her husband was on the other end and he told me he had heard everything that was happening – the ‘phone must have been answered at some point when the woman put her hand in the bag and he had listened to my attempts at communicating with his wife.

He told me she was epileptic and had suffered a few fits this year. He told me how long they usually lasted and how long I would expect to have to wait for a full recovery – all valuable information. I told him where I thought she would be going and advised the crew that he wished to be called back when they got on scene. I had moved her to my car when she was steady on her feet. She had lost bladder control and was still in full public view, so it was a good idea to get her (and her loss of dignity) out of sight. She also had a large bump at the back of her head – the result of her rapid and unchecked descent to the ground.

One of the bystanders/helpers at the scene was wearing a stethoscope around his neck. He declared to the woman that he and his friends were doctors but I suspect they were medical students. Not many doctors are keen to keep their stethoscopes on their necks when they go out for lunch. None that I know anyway.

Recovering epileptics converse using language that starts with grunting, moves into gibberish, through nonsense and eventually lucidity. My patient was somewhere between gibberish and nonsense when the crew arrived to take her away. She was on the mend.

Another fit, this time non-epileptic, at a busy train station. The man had collapsed suddenly and burst his lip on the concrete floor. He had fitted and become unconscious for a short time afterwards. I arrived with the crew and we checked him out. His BM was low (3.3), so that was possibly the cause of his seizure. He wasn’t diabetic, however, so there had to be a mechanism for his hypoglycaemia – alcohol could be the culprit but he hadn’t been drinking (according to him and as far as we could tell). He was a respectable looking businessman but I have learned never to let that influence the possibilities.

He was recovering well by the time he was in the ambulance, although his memory still wasn’t functioning properly. He was given glucose gel and his BM began to improve. The oxygen also helped him recover. He went to hospital in the hope that the reason for his sudden crash could be determined.

I got back to my base station and was ready to pack up and go home when a Sector request had me heading south for a 72 year-old lady with breathing difficulties who had been waiting for an ambulance.

Her concerned family were with her and she was definitely short of breath, although there was no discernable wheeze or other added sound in her chest. She had been recovering from a recent bout of pneumonia and had been under investigation for a suspected DVT, so one or the other was causing this acute change.

There was no chest pain and, although her ankle had been swollen the previous night, it had gone down. Her legs weren’t hard or hot and there was no change in blood pressure either side of her body. It was reasonable to assume that her pneumonia hadn’t fully cleared or that there was a residual infection. Whatever the cause, oxygen sorted her out within minutes and she was talking in full sentences and looking a LOT more relieved when the crew arrived to take her to hospital.
I like straight-forward jobs at the end of a shift.

Be safe.

Wednesday, 5 September 2007

Fit for hospital

Eight 999 calls – one assisted-only, one hoax and the others were genuinely in need of an ambulance.

Young people shouldn’t have cardiac problems so it is usually non-cardiac when you receive a ‘chest pain’ call to a 19 year-old. I never met the patient because an ambulance was already on scene so I wasn’t required but I’m willing to bet they weren’t too concerned about his imminent demise.

A pattern emerged for the rest of the shift – foreign drunks. A 28 year-old Lithuanian alcoholic, known to me and many of my colleagues no doubt, lay in an alley claiming epilepsy (this is an age-old stunt to get into hospital) and soliciting the sympathy of anyone who cared enough to stop and listen to him. He insisted on going to hospital and part of me wanted to leave him where he was but I couldn’t prove he wasn’t epileptic, so he had to go. He knew that and he was quite smug about it. He found a cigarette on the ground, picked it up, lit it and waited with me until the ambulance arrived to taxi him to a warm bed and a free sandwich (free for him, not for me or you).

This call was followed by another alcoholic patient, this time from Poland, claiming epilepsy. I think they all get on the ‘phone to each other and plan what they are going to call ambulances for each evening; chest pain, diabetic problems, epilepsy…alcoholism.

The police were on scene with this guy because he and his friends were being moved away from the doorway of a posh house in a tidy and quiet area where they had all settled down for the evening with their cans of beer and bottles of cider. Fair enough if you live there and pay your taxes.

I waited for 30 minutes before an ambulance arrived to take the man away, during which time he entertained me and the police officers with the most awful acting we had ever seen. He feigned as many ‘seizures’ as he could squeeze in and for effect, tried to slam his head against the small wall of the building – probably because we weren’t taking him seriously. He was an insult to genuine epileptic patients and before you feel too sorry for him and think of me as cruel and unprofessional, the lady who lives in the house came out to thank me when he had finally been removed. She had been admitted to hospital several times with stress-related illnesses as a result of having to cope with these drunkards on her doorstep, none of whom could (or would) speak English. She had called the police so many times to have them moved on that she had suffered a nervous breakdown. How much sympathy would you have for these men after seeing her poor broken demeanour?

Then a 28 year-old who got himself kicked and punched around the head simply for looking at someone the wrong way. He is a homeless gentleman and had been mooching around for his next meal when another homeless guy and his mates asked him 'who the hell he was looking at'. He didn't need to reply one way or the other because he got a kicking anyway. The police called us but he refused medical aid and insisted that he just wanted to get his evening meal.

The LAS have partnered an outreach group who want us to report on individuals who wish to be taken off the streets and into some kind of accommodation. I asked this man if he wanted help and he agreed to give his details. I called the number we have all been given and made my report. Apparently they email you to give you feedback on what has happened, so it'll be interesting to see if this is worth the effort.

Another known alcoholic soon after that job. I have written several times about this man. He has changed his hair and grown a beard and I think he used the new look to try and fool me but I recognised him when I got close. He had wandered up to a group of young men at a table outside a bar, plonked himself down, asked them for a beer (which he got) and then complained of chest pain. He demanded they call an ambulance (which they did) and I arrived to tell them the bad news. They were NOT happy at being made to look like fools and I think they wanted to do something about it there and then.

This frequent flyer is usually quite aggressive and can be physically violent but tonight he decided to play it meek so I had no trouble with him as he was led to the waiting ambulance.

Our West End hoax caller struck again. His modus operandi is to dial 999 and ask for police, fire and ambulance. He gets connected to the fire service first and hangs up before they can get any information. This triggers a ‘please investigate’ call, although why I should be the one to do this I don’t know. Surely the police should be running after him?

I fly round to the callbox in Leicester Square, three minutes after the call was made and find no-one. Surprise, surprise. He was probably watching with great delight from the shadows somewhere. He’ll do it again next week. He seems to know when we are busiest. Maybe he’s a disgruntled insider.

A posh hotel in West London was the setting for my next call. A 48 year-old man was suffering chest pains in his hotel room. He had a cardiac history, including a previous heart attack and was grossly overweight. I asked him how much he had been drinking and he told me he had downed only four glasses of wine but there were about a dozen empty bottles outside his room, so I guessed he was probably stretching the truth, unless he wanted me to believe his wife/girlfriend (with him in the room) was a raving alcoholic who could drink twenty glasses of wine and remain as sober as a judge.

When the crew arrived and moved him to the ambulance I tried to get his details from the hotel manager but he had used a false name on checking in (he had given us an English name but the man was quite clearly Arabic). I had given him the benefit of the doubt because he could well be Mr. Smith but the hotel manager outed him when I requested his full name. It’s nice to know that some traditions are truly international.

My last call was also a chest pain and was also for a 48 year-old, this time a female. It was likely she was suffering from a chest infection though as she had a long history of this and was on antibiotics and steroids. Her episode tonight had woken her up and she wasn’t comfortable; her breathing was shallow and she was restless with it. When I listened to her lungs they sounded ‘dry’ and raspy. She was living in a small flat while renovation was being carried out and there was a bit of dust around and the overpowering smell and taste of fresh paint, so none of that would have helped her condition.

I waited with her for an ambulance and her chubby brown cat (I called it the fattest cat I’d seen but she refused to admit that and preferred ‘well fed’) nuzzled and purred around me and my bags. I was going to be covered in cat hair when I got home. I’m not a cat person, never have been but I have recently been won over by the introduction of a kitten to my household. He was the last of his litter and a friend of mine offered him up and I couldn’t refuse – his future wasn’t bright otherwise and I have always been a sucker for rescuing mongrels. He has turned out to be a wonderful animal and highly intelligent. He helps me to relax (all animals have that effect on me). His name is Scruffs. I should give him his own blog one day.

Be safe.

Monday, 3 September 2007

So little time

I haven't had much time to reply to everyone (including emails) and I apologise. I'll put a couple of things to bed now if you don't mind...

First of all the little debate about what the term BM meant had me smiling a few times. You are of course ALL correct but BM is a variable term - it means Bedside Measurement and applies to ALL tests conducted at the bedside (usually in hospital) and since the only applicable test we carry out in the field which could fit the bill is for blood glucose, then we use BM to describe it.

It also stands for the manufacturer of the chemical strips used in glucose tests BUT also for other blood tests; the company make a range of strips and tests so the term BM could not necessarily be applied to one.

It also stands for Bowel Movement (you can stop grinning now) of course but this is mainly used in hospital.

I hope this clarifies the BM debate :-)

Next, should know better...I won't identify a location unless I know it is safe to do so (nice try though).

Finally, thank you all for your comments about the last post; I'm sure my colleagues will be happy to know that you care about our worst days.

Sunday, 2 September 2007

Dead babies

One of the faces of Big Ben stopped at midnight. The others told the correct time (5.15).

Six emergency calls. One conveyed home, one gone before arrival and the others went to hospital; one of them didn’t stand a chance.

The shift started out routinely and slid down the rubbish chute in a short time. Ironically, I had been chatting to a colleague about newborn babies – he and his crew mate had just delivered one in the back of their ambulance. I told him that BBA’s were my worst nightmare. I have had several horrible jobs involving neonates. Of course, I have delivered and assisted the delivery of more healthy babies than not but when you get a bad baby job it numbs you for a long time. I shouldn’t have mentioned my fears because it tempted fate.

I started the shift with a call to a 21 year-old female who had fainted ‘due to shock after hearing bad news’. I went to this call with no feeling of crisis. I didn’t expect to see anyone is serious trouble.

She was collapsed on the floor of a small house in which she was one of the carers for a severely disabled person. She had been told some bad news about her brother, who had been injured in a car crash, and now she was wailing and thrashing on the floor of someone else’s house. I calmed her and explained to her that she was emotional and I couldn’t help her other than take her home. She relented and I had to taxi the woman all the way to her suister's place. This was, of course, very inconvenient for the family who needed her to be there.

I made my way back to the West End after dropping the emotional lady off. I sat through several cancelled calls until one came through that stuck. It was a ‘Born Before Arrival’ (BBA). I looked more closely at the call details and saw that the baby had apparently been born on a street. More seriously, the report stated that it was not breathing. I called in for clarification and was told that the call was still in progress. Then an update confirmed that a driver had stopped when he saw what was happening and that the baby had been confirmed to be in cardiac arrest. I knew then that this was going to be a horrible job.

I raced to the scene and arrived to find the police already there. An ambulance was just pulling up too. I ran out of the car with my red paediatric bag and the crew were heading back towards me with a police officer who was holding a little bloody bundle in a foil blanket. It was the baby. It wasn’t moving.

We piled into the back of the ambulance and I began ‘bagging’ the baby whilst my colleague compressed the chest. We had tried the ‘stimulation’ stuff but this little thing wasn’t even trying to respond. It was floppy, heavy and pale. We attempted to resuscitate for five minutes before deciding to get going and continue resus on the way; the quicker the better. The whole scene was confusing – nobody knew exactly what was going on or what had happened.

I left my car keys with a Station Officer who had arrived shortly after me and stayed in the ambulance to travel with the child. I intubated and had to struggle through fluid and meconium which had gathered in the upper airway. Suctioning cleared the problem only temporarily – it soon filled up again. This was looking bleak.

There was also a smell that seemed familiar. At first none of us mentioned it but it was the smell of putrefaction; rotting flesh.

Attempts to resuscitate the baby continued at hospital but they were fruitless and it was called after a while. Another ambulance had transported the mother to hospital. She had mental health issues and didn’t show a single emotion during this drama. The whole story is one of the most bizarre BBA’s I’ve ever heard.

The baby had simply fallen out of its mother while she was walking down the street. It had fallen head-first onto the ground. This was witnessed by a passing motorist who stopped and called an ambulance, thinking the baby had stopped breathing as a result of the head injury. The mother must have pulled the cord, ripping it from the placenta (we wondered who had cut the cord but it transpired that nobody had) before slumping down with the lifeless baby on the ground.

I think the smell told us that the baby had been dead for some time in the womb – that may or may not already have been known. We couldn’t identify the sex of the child either because it didn’t have any external sexual organs, probably due to a genetic condition.

It took me the rest of the shift to get through the numbness that settled over me. Every insignificant job after that wound me up.

After a long rest and a re-stock I was sent on a Red1 goose chase for a 20 year-old male who had collapsed in the street and was not responding. Drink or drugs I guessed as I made my way there.

It was drugs. He had left the scene before I arrived. The caller told me he is a local user and that he just wanted him moved from the front of the posh hotel where he works. Glad to be of service I’m sure.

Then an 83 year-old who had fainted and hit his head. He was in bed when I arrived but he was very pale and shivered all the time. Both his temperature and BM were high and he was very vague at times. He had very little strength and was unable to pull himself out of bed when the crew arrived to take him to hospital. He had no pain but he vomited several times and it was clear he wasn’t well.

A 54 year-old female who reported DIB and then walked out to the ambulance as if it was her taxi to the ball had me completing my paperwork for yet another ‘not required’ after which I made my way to Waterloo bridge and watched the London Eye turning as the engineers checked it over before the start of the tourist rush. This was my calm time and it helped me recover from the bad start of shift I’d had.

My shift ended with a RTC involving a moped and a car. The moped rider was in the middle of the road in a pool of oil. He had no significant injuries, apart from pain in his arm and leg on the side that took the impact of his fall and he was able to move to the side of the road, out of harm’s way. I had already been passed by buses and trucks with inches to spare, it was only a matter of time before one of them hit me and I joined my patient on the ground. Yellow jackets make no difference in rush hour.

The LFB, police and an ambulance arrived and I was free to complete my day and go home. It would take me the rest of the next day to get over the sight and smell of that little baby.

Be safe.

Saturday, 1 September 2007


Ten emergency calls – one deceased and left on scene, nine taken by ambulance.

A strange shift that ended as it began. My first call was to an overturned car in a Sainsbury’s car park. The driver’s foot had jammed on the accelerator as he reversed, causing the vehicle to travel backwards at speed. It clipped another car and was flipped over, rolling a few times before settling down on its roof. There were three people inside; the driver, his wife and his daughter.

When I got on scene, the LFB were pulling up in front of me. I saw that all three people involved were out of the car (they had pulled themselves free); two were sitting on the ground and one was lying flat. I ran a quick triage and established than nobody was seriously injured. They had all been very lucky, escaping with headaches and emotional shock. The car was one of those little compact things with barely enough room for two adults, never mind three. The fact that they had been tightly contained whilst the vehicle flipped and rolled must have been in their favour – if they had been thrown around, I doubt we would be dealing with minor injuries.

I requested another ambulance (one was on its way) and the police pulled into the car park. There was already a crowd gathered of course and a number of staff members from the store were on hand to help – none of them were first aiders as far as I was able to establish but there were plenty of foil blankets being used.

I left the scene when all of the patients had been taken to hospital. I followed one of the ambulances in and did my paperwork at the A&E entrance.

On my way out I greened up and received a call for a 41 year-old female who had DIB and was ‘slumped over a table’ at a nearby pub. I got there to find a woman who had no difficulty breathing at all. She had been drinking with her friend and suddenly become ill. She had vomited a few times and then slumped forward (she claimed her head was too heavy to lift) prompting her friend to call an ambulance.

She had no significant medical history and her vital signs checked out, so she may have been ill as a result of drinking too much or she had a separate problem. She was taken to hospital. She didn’t look the type to waste our time.

I was sent on an errand after that job. I was asked to convey a member of the HART team to his base station. During the trip I was diverted to a call – a 32 year-old pregnant woman was bleeding from a vein in her leg. I expected I’d see a ruptured varicose vein; a common problem in late pregnancy, especially when the baby is causing increased pressure on the Inferior Vena Cava.

I got on scene, paramedic passenger in tow, and another FRU arrived. The call had been doubled up for some reason. We exchanged call signs and the second FRU pilot left.

A few people had gathered at the base of the stairs to the block of flats and they waved frantically for us to come over. We made our way to the second floor and found a pregnant lady on the ground on the balcony. She was bleeding from the back of her leg but it was very dark up I could barely see the wound when I removed the dish cloth that had served as a makeshift dressing. It was only when my colleague pointed out that blood was shooting out of her leg and around my boots that I noticed the source. I quickly applied a sterile dressing and tied it tightly. The bleeding was under control.

Varicosed veins bleed profusely and people have died as a result of massive blood loss, so they need to be dealt with immediately. Lots of pressure and elevation will do the job in most cases.

After the ambulance crew had taken her to hospital and I completed my mission to deliver the HART paramedic, I swung around to get back to my own area but I was defeated by the south again and received another call, a few minutes away for a 77 year-old ‘deceased’.

The housing complex I arrived at was a nightmare and I couldn’t find the address. This would have been a tragedy for anyone who hoped to have their loved one resuscitated and the design of some of these places frustrates us all. Even the ambulance crew, who were from the area, didn’t have a clue about the exact location of the flat. I had to call Control and ask for someone at the address to come out and meet us.

Eventually, we were found by the son of the deceased. The ambulance sped off (to the other side of the estate) and I followed with the man in the back of my car. He explained that his mother had passed away about 20 minutes ago, so I knew there was little chance of us doing anything but recognising life extinct.

When we got to the flat she was lying on the sofa. She had been suffering heart problems recently and had gone suddenly and peacefully. The family were crying in the kitchen.

We did our usual checks (breathing, pulse, heart sounds, ECG, body temperature and rigor) and covered her back up. I then left the crew to complete their paperwork because I simply wasn’t needed.

I got back to my own area and was dragged right back out of it to attend a call a few miles away. A 44 year-old female was apparently fitting behind locked doors. The police were on their way to gain entry and when I arrived a crew were on scene. I wasn’t needed for this call because they were a paramedic crew. I stuck around to help though and they told me they had been trying all the buzzers on the front door to get someone to let them in with no luck. There was someone in the basement flat, so I crossed into the little garden in front of the window and looked inside. There was a man sitting watching TV, cans of beer around him. I tapped on the window and he looked up.

‘London Ambulance. Can you let us in please?’

He shook his head vigorously. I couldn’t believe it. I pointed at the badge on my stab vest.

‘We have a patient in urgent need of help. Can you please let us in?’

Again, he shook his head. He was definitely not interested in helping. I continued to call out to him, my voice growing louder and a little more annoyed each time I made the request for access but he ignored me and did something extremely childish and bizarre. He put his fingers into his ears and sat like that until I gave up. In fact, he was still sitting, staring at his TV with his fingers firmly plugged into his ears when the police arrived to help. I hope he missed his favourite programme.

Ironically, after all that fuss, the patient buzzed us in just before the police got out of their car. We all went up to the flat and she opened the door. She hadn’t been fitting at all. She claimed that her care line had called the ambulance, not her. She looked distressed that we were all there. I knew when I wasn’t wanted, so I left and made my way back north of the river.

A 19 year-old female fitting at a club in Soho next. I arrived to find the crew inside and dealing with her. She was conscious and lucid so we took her to the ambulance for a check-up. She wasn’t epileptic but had suffered several seizures without consulting her GP, so there was a strong possibility that she would fit again. She asked to go to the toilet because she gets desperate to urinate after these episodes, so the crew allowed her back into the club to relieve herself. Within a few minutes, her friend ran out and told us she had collapsed again.

We ran into the packed and very noisy venue to find her slumped on the toilet floor. She didn’t look like she was having a fit but her legs were shaking and she was hyperventilating. I began to wonder about this whole act to be honest. She was getting a truckload of attention from her friends and I think she needed it.

Back in the ambulance I put a cannula in her arm and advised her that I would have to give her diazepam if she had another fit. She wasn’t happy with that and started to cry. She was scared of the effect the drug might have on her, a natural enough response...especially if there is nothing really wrong with you.

I hate to be such a cynic but I think I have earned the right to be one at times, as do my colleagues. When she arrived at hospital she was completely calm and alert; no evidence of anything amiss at all. She remained like that throughout her stay as far as I am aware.

My second bleeding vein was attached to an 85 year-old woman whose relatives had frantically called an ambulance when they saw her foot bleeding badly. The old woman was not completely alert when I arrived and her pulse was extremely slow. Her foot had bled into her slipper, which was now soaked through and heavy with blood. She looked as if she was ready to pass out.

I dressed the wound, began my obs and the crew arrived to take her away. She fainted as we were about to move her into the chair. I think her family thought she was dying – they were pacing around and worrying themselves about her. She is obviously well loved.

She recovered as soon as she was given oxygen. In fact, she was quite talkative in the ambulance.

Then a 73 year-old female who had collapsed and vomited at home. Her husband and daughter were on scene when I arrived. She was lying in the hallway of the flat, a pool of vomit around her. She was very pale and sweaty and looked ill from a distance. I began my obs and ask my usual questions. The daughter told me she had an abdominal aortic aneurysm (AAA) and that concerned me. This is a dangerous and potentially lethal condition. If it ruptured she could bleed to death in seconds. Although she had complained of initial abdominal pain I didn’t know if her present condition was related to her AAA or not (her blood pressure was normal) but I wasn’t taking any chances.

When the crew arrived we got her onto the chair as quickly as possible. She vomited blood immediately. Luckily she remained fairly stable all the way to the ambulance, where she felt sick again. Her colour had not improved but there was nothing critical going on with her vital signs. It was still necessary to get her to hospital quickly, however.

She was taken into Resus when we arrived at hospital. She seemed stable when I left.

I am still trying to come to terms with people who call ambulances and answer yes to any appropriate question just to get a fast response. I was on my way to a 55 year-old man with ulcerated feet at a railway station. He also had ‘chest pain’ incidentally. Where is the connection? The crew arrived ahead of me and the EMT got out, shook his head and I knew I wasn’t needed. Just as well.

And almost as if I needed to round my shift off, my last job is an overturned car. This time one of the drivers went through a red light (allegedly) and T-boned a private taxi heading across the junction. It must have happened at a decent speed because the damage to both cars was extensive and the people carrier had been thrown onto the pedestrian railing.

Again, as with my first job, nobody was badly hurt. The young driver who had allegedly run the lights complained of mild neck pain but he was up and walking around when I arrived. He hadn’t been wearing his seatbelt and there was a bull’s-eye in his windscreen, so he would need a collar. The taxi driver was shouting down his mobile ‘phone, so I knew he didn’t need any help. LFB and police were on scene and two ambulances arrived, despite the fact that I had called in to request only one.

The neck injury was taken to hospital and the mobile 'phone man refused all help.

As I sat in the car completing my paperwork, the young man’s parents arrived, knocked on my window and asked if he was alright. I can imagine it is quite a shock to see the wreckage of your child’s car on the road and not find him there. I reassured them and directed them to the hospital where he had been taken. Relief spread across their faces and I felt happy to be delivering good news for a change.

Be safe.