Tuesday, 30 October 2007

A mixed bag

Eight emergencies; one hoax, one refused, on treated on scene and the rest required an ambulance.

First call of the shift was for a drunken youth. He and his mates (one of whom had dialled 999) thought he needed an ambulance because he couldn’t or wouldn’t walk in a straight line. I arrived in Regent Street at the location given but saw no patient. A voice from behind me prompted me to turn around as I searched for this elusive 21 year-old and his friends.

‘Are you here for the drunk fellow?’ a man asked. He was coming out of the shop in which he worked.

‘Yes...and his friends I believe’, I replied.

‘Well, they left. They dragged him away with them.’

I could have looked shocked or concerned but I was neither. People who call us for their inebriated mates often leave the scene when they can’t be bothered waiting any longer. They hoist their fallen comrade up between them and haul him or her away. Sometimes we never see or hear from them again, which means that they did the sensible thing and took him/her home in a taxi. Home is where the heart is, after all. And the sick bucket.

On this occasion I was to see them again. I told Control that I thought this was a ‘Gone Before Arrival’ and they acknowledged that but just as I was about to leave after completing my paperwork, a young lad sprang down the road and waved his arms at me frantically.

‘He’s up there. We moved him’, he panted.

‘Why did you go away? Couldn’t you have at least called us back and let us know?’

I wasn’t happy with them. Calling an ambulance and then leaving the scene without informing us is more than bad manners; it smacks of indifference.

I drove up into Oxford Street and saw a police officer with three or four men, one of whom was lying on the ground at a bus stop. He had vomited a little and was groaning away to himself. His friends looked tired and fed up – the two qualities you commonly detect in sober mates who have just had to drag a wasted friend along the streets.

Initially I wanted to have a go at them all for wasting emergency services time but the little I did say fell on deaf ears. They weren’t interested. So I turned their mate onto his side and waited until the ambulance arrived to take him to hospital.

Chest pain can come and go. It can mean nothing and it can mean everything, that’s why it is better to get it checked out, regardless of your medical history or how well you may feel. I am, of course, talking about genuine chest pain – the kind that worries you.

My next call was for a 40 year-old man with chest pain. It had come on suddenly but disappeared by the time I arrived. He still looked very pale and sweaty though and, although he had no past history of cardiac problems, his ECG wasn’t quite right, so he was taken to hospital just in case.

The crew were arriving at the same time as me when I got to my next call – a 67 year-old female with back and abdominal pains, so I wasn’t required but I picked up a hoax call immediately after pressing the GREEN button on my screen. The caller didn’t identify himself and the line went dead on ring-back, so I was sent there in case it was a genuine emergency. I arrived to find an empty callbox and a few suspicious looking kids hanging around watching me. Half term can be fun for everyone.

A lovely 53 year-old lady with DIB and tingling in her arms and legs next. She was very pale and clammy but didn’t have any particular health problems to relate her present condition to. She had called initially with dizziness and palpitations and if she had been hyperventilating it may have been easier to diagnose but she wasn’t so she was taken to hospital.

My next call was given as a '44 year-old male, dizzy now unconscious'. He was conscious when I arrived – he may have fainted earlier but nobody mentioned him having blacked out at all. He was an alcoholic and had a long history of liver disease. His family were concerned because he had started to vomit blood and his abdomen was swollen. I felt over the right side and his liver was quite prominent – not a good sign because it indicates swelling of the organ – more than likely due to his chronic condition. This could be fatal for him and it was clear he should be in hospital.

Over to London Bridge and a call for a 60 year-old man who was found unconscious in the street. A few people were milling around, including an irritating alcoholic who insisted on ‘helping’ me out. The others were being very kind to the old man lying on the ground. I say old because he wasn’t 60 – he was 91. He was a Japanese man and didn’t speak any English. I asked a couple of passers-by to help me translate. The two girls I stopped just happened to be Japanese too, so they were very useful in finding out why the man had collapsed in the street.

I learned that he was a tourist and frequently visited London. He had been walking all day (he showed me his little step-counter and it read 36,000) and had collapsed (he reckoned) because of sheer exhaustion. He had cut his head when it hit the kerb but he hadn’t been unconscious. There were cuts to his mouth and nose too and he couldn’t explain them so I considered the possibility that he had fallen earlier. Maybe he fell a lot more than he remembered.

I told the crew what I knew when they arrived and the translation continued to see if he could be persuaded to go to hospital but he absolutely refused. His wishes were respected in the end and he was taken to his hotel instead. Hopefully he will have an uneventful stay. We were all amazed at how young he looked; he didn't look 91 - I wonder if that's a Japanese thing?

Finally, a 73 year-old diabetic man with a BM of 1.8 and a very worried family.

‘Usually he takes care of himself’, his wife said as I entered the house.

I gave him Glucogel and he responded rapidly, recovering to 4.4 within ten minutes. I left him with his loved ones; he had crackers, cheese and chocolate cake to work through, so, unless I wanted to be seen salivating over his food, I thought it best to beat a retreat. It was nearly time for me to go home and get my own dinner anyway.

Be safe.

Saturday, 27 October 2007

Whistle while you work

Eight emergencies; one assisted-only and seven required an ambulance.

Sometimes the radio is on in the car when I start my shift. More often than not it's been left on one of the commercial stations and eventually, after hearing a thousand ads and two songs, I switch it off.

Tonight, however, the radio was set to the ‘Classics’ station. Normally I wouldn’t bother with it, even though I do enjoy classical music but tonight I left the volume alone and the music seeped into the car’s environment like a warm friend. The music was playing even when I was running on my calls and I discovered that there’s a wonderfully relaxing quality to the mixture of sounds that I was being enveloped by as I rushed to my first call – I call it Vivaldi and sirens.

The call described this 24 year-old woman as ‘turning blue’ with DIB. Of course, when I got there nothing could be further from the truth – she had a kidney infection and her antibiotics weren’t working. She had a bit of a temperature and a low BP but her respiratory system wasn’t affected and so there was no DIB and she wasn't blue - she wasn't any particular colour.

A call that fit the bill for a 33 year-old female ‘drunk, dizzy and vomiting’. Why do we even bother? Surely the call-taker can see it’s not an emergency. This is an obviously drunk person. When I got on scene a crew were already dealing with her. I wasn’t required. She was taken to hospital, where she remained drunk and dizzy but probably showed no remorse or gratitude.

Thespians, I mean true honest-to-God actor types, are a quirky breed; they assimilate scripts into the fabric of their lives and eventually absorb the dialogue of numerous plays so that their everyday speech reeks of drama. I was called to a basement flat in an expensive part of town for a 70 year-old woman who was feeling weak and had been described by the caller, a friend and fellow artiste, as ‘drifting in and out of consciousness’.

I went to the wrong part of the house and stood at the wrong door, ringing on the wrong bell. A groups of people came from the basement area up onto the street. They were chatting, hugging each other, saying 'Ciao!' a lot and one of them mentioned success with ‘the script’. Not one of them, even though they had seen me, chose to point me in the right direction. I didn’t know that they knew where I was supposed to be but they knew an ambulance had been called and could clearly see that I wasn’t selling cleaning products door-to-door.

‘Oh, there’s an ambulance car’, one of them even remarked.

‘Oh, yes’, another said, ‘there’s the chappie at the door’.

I don’t like being called chappie, it’s the closest to ‘boy’ anyone will ever dare to venture when using it in the context of public servant.

‘Did you call an ambulance for this address?’ I asked them.

‘Oh, yes but she’s down there’, one of them pointed out. The young man who had bothered to enlighten me spoke like Oscar Wilde – well, in the fashion of. He had a flare about him and every move he made seemed to be choreographed. I stood on the wrong step and wondered what kind of emergency this was. None of them seemed concerned about the person I was supposed to be attending to downstairs – there was no sense of urgency.

I was directed to the basement flat and guided through a maze of posters, costumes and the paraphernalia of Theatreland. At the end of a hallway I was sent into a bedroom where a woman lay on the bed like a dying swan. She was fully conscious and displayed no sign of illness. Her obs were normal and all she could tell me was that she was ‘incredibly run down’. She did look tired but that was about the extent of it. I would argue that the times when she was ‘in and out of consciousness’ were nothing more than episodes of sleep!

She spoke in over-the-top detail about her every emotion and physical feeling during her bouts of illness. She had seen numerous doctors and her condition had been deteriorating like this for many weeks. She had her hand held over her forehead, palm up wards, like they do in the movies and she spoke in hushed tones...for added effect I guessed.

The crew arrived as I gathered my handover information and I left them to help the woman make a decision. Meanwhile, I looked around the room at the various costumes, wigs, photographs and props that she had gathered during her career. I have been to a few households where retired artistes reside – a lot of them live in the W1 area – and I am always amazed at how good they look in those photographs; head shots of former youth and glory. When I visit them, they are shells of their former selves and it can be a bit depressing because it comes to us all in the end.

She was taken to hospital for further investigation – despite my cynicism there are genuine illnesses that can cause fatigue, so for her own benefit off she went.

Then I was sent miles out of my area for a 25 year-old female who was 'vomiting blood' and had ‘? food poisoning’. When I arrived at the address an ambulance was joining me. We both pulled and it was a pleasant surprise to see him.

I pressed the buzzer to the flat and a young woman answered the door.

‘Ambulance’, we said, kind of in unison.

‘No, I didn’t ask for one’, the woman replied. She looked very confused.

We confirmed the address and she stood there for a few seconds considering what might have happened. Then she had an epiphany – maybe her flatmate had called us. As she dashed off to investigate this possibility we were left standing in the doorway looking at each other in bewilderment.

She returned and confirmed that her friend had made the call. She was in her bedroom but hadn’t told her that she was ill, so she knew nothing about an ambulance being called.

‘Sorry’, she said. Then we were taken to the patient.

I left this one to my friend. I stood with his crew mate and listened to the unfolding story. The girl had been sick but hadn’t vomited blood, at least not proper blood. She had retched so hard a couple of blood vessels had burst in her throat and that had produced a red tinge to the vomit. It’s quite common and not the least life-threatening.

She was taken to the ambulance for further checks and I used this as an excuse to catch up with things and do my paperwork. The patient was lively and chatty – she probably had a touch of food poisoning after all but she didn’t want to go to hospital – she thought she could dial 999 and get an ambulance crew to give her a second opinion. Another waste of time but I got to see my mate and have a ten minute chat before heading back to my own area for more of the same.

Falling down escalators is a ‘festive season’ thing. It happens all year round but it becomes much more common the nearer to Christmas we get, I find. When you fall down these steps you will probably make contact with the metal grooves with your head. This will leave a prominent, but not permanent, mark. It looks like three scratches. Sometimes they are deep enough to bleed.

A 60 year-old Irish man fell down the escalator steps at a busy tube station but he was having none of this ‘going to hospital’ fuss. He was drunk (escalator-fallers invariably are) and he may or may not have been knocked out during his descent. That is why the crew and I were trying to persuade him to go and get checked out. He hadn’t bled from his wounds – they weren’t deep enough but his drunken condition meant we couldn’t really assess him properly. We couldn’t be sure that he didn’t have an underlying injury. It took us more than 30 minutes to persuade him to go to hospital.

Fortress council estates are an obstruction to the emergency services – some of these places are quite impossible to access unless you have keys, know a code or have the navigating ability of a pigeon...or you live there. I was called to a 78 year-old man with chest pain. The call came during the early hours and I got on scene very quickly but was immediately slowed down by the inaccessible design of the estate he lived in. The numbering system was confusing and I tried four doors before finding the one that led to his floor. Then I had to work out which floor his flat number was on – they weren’t listed anywhere.

When I got to the correct floor, I found the flat numbering wasn’t logical. It wasn’t even consecutive. I wandered from one end of the dark concrete corridor to the other until, eventually, I found the man’s flat tucked in a corner. My two minute response time had been stretched to seven by the time I found him.

The patient had vomited a decent amount of ‘coffee ground’ blood, indicating that it had come from his stomach. He had chest pain and was very pale and sweaty. He told me he felt faint and when I checked his BP it was low. I carried out my obs and decided to cannulate him on scene, just in case he suspended on me before the crew arrived but as I completed this task, his door buzzer went – it was very loud and made both of us jump. His little jump pulled the cannula back out of the vein.

The crew took him straight to the ambulance. There was no time to spare with this man and I wondered just how close he was to going off as a result of where he lived.

Just before my shift ended I was sent to Regent Street for a 71 year-old male with chest pain. He was standing outside a shop waiting for me and even flagged me down as I pulled up. He looked more agitated than in pain but that was moot because the ambulance arrived seconds later and I didn’t get a chance to ask him anything more than his name. I handed him over to the crew and went back to my base station in preparation for my journey home.

Control had other ideas, however, and sent me to SW1 for a 78 year-old male with DIB. I sped over there and climbed the steep stairs to his flat. He met me at the door and told me he just felt unwell. He had no problems with his breathing and I decided to take him to the car – I may even take him to hospital myself, I thought.

He told me he couldn’t walk but when I pointed out that he had walked to the front door and was standing right in front of me, he said he would ‘give it a go’. I walked him down the stairs and out onto the street, where the ambulance crew were just pulling up. I handed him over and he was taken to the vehicle.

As I sat in the car (with my background music on) completing my paperwork a red-faced, panting woman tapped on my window. I wound it down and asked her if I could help.

‘I’m the key holder for the gentleman upstairs’, she explained, ‘do you want me to let you in?’

‘He’s already in the ambulance’, I told her.

‘How did you get to him?’

‘He let me in’.

‘But he can’t walk – he doesn’t ever leave the house and I always have to let ambulance people in’.

‘He walked down the stairs with me – there’s nothing wrong with his legs’, I told her.

I could see a mixture of anger and bitter disappointment on her face. It was early in the morning and she had been dragged out of bed for this call. She wasn’t a happy citizen and she stormed off to her car – probably to do a mile of paperwork and report in to her boss.

As for me, I was chilled. I had Mozart in my ears and I was going home. I felt sorry for her but I also thought she might need to be firmer with Mr. ‘I can’t walk so carry me’. She might also benefit from a bit of classical music in the background.

Be safe.

Thursday, 25 October 2007

Scruffs update

Ever since I introduced you to Scruffs the cat I have received a number of emails requesting more information about him. You are obviously cat-lovers.

I myself was never a cat lover. People who know me believe I hate them in fact but that isn't true - I just never had the time for them...I was always more of a dog person, having owned many since childhood. There's an element of control with a dog but I never knew until now how relaxing a cat could be. Scruffs de-stresses me I think, so here are some things you should know about him.

* He is allergic to fish

* He loathes milk but loves custard

* He also loves Special K - it drives him crazy

* He has climbed the tree in my garden several times, forcing me to clamber up after him when he gets stuck. He climbs ever high in an attempt to get down (he hasn't yet figured up and down) and I end up bruised and battered after rescuing him. He doesn't get out without supervision now.

* He purrs a LOT and very loudly

* He runs fast and jumps high

* He wakes me up, even after nights, by jumping on my chest and pawing my face - he likes to stick his sharp claws in my chin dimple - that hurts

* He 'buries' the imitation coal from the fireplace under a rug and sometimes goes in after it

* He has never, ever soiled the house - he only uses his cat box and will do so immediately after it has been cleaned - cheeky git!

* He won't go near strangers and is only used to me and mine.

* He is an avid tennis and snooker fan and will sit in front of the telly for hours watching those sports

* He is extremely affectionate

* He thinks he is invisible 'cos he crouches down in corners waiting to pounce at my feet when I pass. I usually see him a mile off but it's fun to wind him up

* I tell him off and he ignores me...most of the time

* He is nearly due for a visit to the vet for the snip. I won't be going with him. I can't bear the thought of it

* He has almost worked out how to use a door handle

* I think he jumped up onto the cooker and bumped the switch, leaving the gas on while the house was empty for a day

* He will only drink water from a glass. He has his own tumbler. He has never used a drinks bowl

* His expensive bed, with his name on it, lies redundant in the kitchen - he doesn't like it. Cost me forty quid!

* He crawls into any box or bag that's in his way

* He loves getting his photo taken

* Running water fascinates him and he will gladly climb into the sink. We keep all the toilet seats down

* He never leaves me when I'm working at the computer and will sit across the keyboard as I work

* He is mad


Tuesday, 23 October 2007


Eight emergency calls – one hoax, two conveyed, one false alarm, one assisted-only, one treated on scene and one (that’s right, just one) taken by ambulance.

Another busy shift started out with my favourite and yours...the notorious time-wasting hoax caller who demands all three services before hanging up. Tonight, however, he changed his M.O. slightly and enquired about the health of the call-takers each time (he called in three times but I was only activated once).

Of course, I didn’t get on scene in time to put an end to his fun and games but I’m beginning to wonder how much of a wimp service we are looking to the others. After all, the police never turn up and neither does the fire service – just us. Why is that I wonder? Don’t reply – I’m being rhetorical.

So I went back to work, proud to be a professional in the Cinderella Service – out there saving lives every day. This guy has to be stopped or ignored before he causes the death of someone who really does matter.

A dramatic hyperventilation in a restaurant next. A 33 year-old German man was having a panic attack and couldn’t control it. He was sitting on the steps leading to the toilets and there was a small gathering of young ladies waiting to go up before they wet themselves. They had the good manners to wait there while I carried out my basic obs. After a few seconds I felt sorry for them and allowed them through, even though they would be squeezing past my patient. Maybe human contact would calm him down.

I took the man and his friend to hospital in the car. On a busy night like this, there’s no point in tying up an ambulance crew.

Calls stating the patient’s condition is ‘unknown’ alert me to the possibility of death or deep drunken sleep. My next patient was described as ‘collapsed, unknown status’ at King’s Cross station. I found out his status when I arrived. He had been asleep but he decided to walk off before I got to him and the underground manager was ‘sorry to have wasted my time’. An ambulance was on scene when I arrived incidentally, but not for my call – they had a separate drunk to ‘treat’.

A crew were also on scene for my next adventure. I had been called to a 50 year-old male with DIB and I arrived at a hostel to find my colleagues dealing with him in the back of the ambulance. He was asthmatic and needed a few minutes on a nebuliser to settle him down but he refused to go to hospital. He was a die-hard Scouser and wanted nothing to do with wasting NHS time.

During his treatment I asked him how he got to where he was now. I often ask people who are on the street or in temporary accommodation how they came to be where they were in life – I think it’s important in order to temper any judgement that might skip through your mind before you know the facts.

He managed to keep us occupied for the next half hour with his life story, from mega-bucks to divorce to losing it all and ending up in alcoholism. I wondered just how easy it was to end up in the same mire - surely it can't be that simple? But so many do and it’s a little worrying.

I volunteered for the next call; or rather I was volunteered by someone else. A colleague and I were talking to a couple of police officers over a quick coffee at a hospital canteen when their radios blared.

‘LAS required urgently!’ was all I could hear but the chatter was frenetic – something was going on out there.

My colleague suggested I take the call because it sounded like the police were getting no ambulance support and they needed it. The colleague in question is also a paramedic and his ambulance had just been impounded by the police after a stabbing victim had been transported in it, so he joined me for the job, leaving his crew-mate to gaurd the vehicle. Control were made aware of this and were happy to let us go.

We got on scene, south of the river, a few minutes later and saw a huge crowd of young black men and women being controlled by dozens of police officers. The crowd had come out of the local club, where Nigeria’s Independence Day was being celebrated and somehow one of them, a teenage girl, got hit with a police baton (allegedly), knocking her unconscious. Now there was an angry crowd around her and we were expected to go in there to help. I found myself hoping the ambulance service weren’t going to be seen as an extension of the police.

My colleague jumped out and went to the patient and I followed a few seconds behind. The crowd were baying for blood and the police were looking a little bewildered – and outnumbered. The sounds being made by some of the people around us were not friendly and both my colleague and I wondered about the presence of weapons.

We decided to lift the woman up and take her to the relative safety of the car. Neither of us was comfortable kneeling down in the middle of that mob. Abuse and threats were being hurled at the police and it wasn’t long before other things followed – glass bottles and stones were launched into the officers from somewhere further down the road. This prompted the release of the police dogs and this, in turn, provoked a serious increase in the tension. The crowd, which had pretty much dispersed from immediately around the car, rushed towards us, screaming and shouting as those large Alsatians bore down on them. The dogs were leashed to their handlers but they were un-muzzled and clearly excited.

Out of the crowd I was delivered a young man with a head injury, caused by a broken bottle. I dressed his wound and put a tight bandage around it and told him to wait inside the car. The police dogs were feet away from us and snapped at him every now and again. He was clearly afraid of them.

I had requested an ambulance and an Officer to the scene urgently but now we needed more than that, so a request was made for another ambulance. The first vehicle turned up after five minutes or so. Things were still very heated and as the crew moved the patient to the ambulance another surge of screaming, shouting bodies came directly towards us. We were stuck in the open and all we could do was tuck ourselves in to the vehicles and wait for it to pass.

There were three or four armed police officers on scene now but I could see that they were uncomfortable with the situation – their weapons could be taken if they were over-run, so they left the immediate area and withdrew to a safer distance. This did nothing for our confidence.

The ambulance left and an Officer arrived to help us out. We were given ballistic vests and instructions for our safety. It was all getting a little too dramatic.

The second ambulance arrived and my head injury patient was taken away to hospital. Meanwhile, all hell was breaking loose down the road and there was a real danger of this situation spilling out of control. More police arrived and riot shields were used to keep the main body of trouble-makers away from the generally innocent crowd of people who had just come out for a good night and got caught up in this.

We stood there, in the middle of the road, for another 30 minutes or so until it all calmed down. It had taken a few more charges by the police and the slow release of people to continue their journeys home but at long last it was quiet again. At one point a tall black girl faced the police dog handler and requested to cross the road. The officer said yes but the dog had other ideas and launched at her. She just stood there looking down at it and the brightest smile I've ever seen broke across her face. If I had a camera at that moment it would have been the picture of an angel looking down on a beast. She didn't flinch.

We went back to the station after being stood down for a debrief – not that we needed one because we had done nothing of note and weren’t the targets of that particular disturbance - but it was a good excuse for a break.

When I got back to reality my next call was for a 20 year-old ‘collapsed in the street’. I looked at my watch and decided there could only be one reason for that and when I arrived on scene I found I was right – he was drunk. A crew were dealing with him, so I left them to it and went to another call in the same area. This time it was for a ‘21 year-old ? fitting’. He wasn’t fitting, he was drunk and his friends were confused. He refused an ambulance and went home with his mates. He didn’t have epilepsy, he didn’t have any significant medical problem but he did have a bad attitude.

I conveyed my final patient to hospital myself, rather than ask a crew to do it. He was 35 year-old and was complaining of chest pain. He had been smoking marijuana all night and now he had palpitations a dry mouth and felt ‘weird’. Funny that.

I checked his obs and asked him all the right questions to be sure he wasn’t having a heart attack. If he was, he would have waited a while for an ambulance anyway because they were all out picking up drunks and other marijuana smokers who felt the need to express their concern about the ill-effects of their habits.

He was edgy and when the police pulled up next to my car to ask if everything was alright, he became even wrigglier.

‘Did you tell them I smoked drugs?’ he asked.

‘Nope. I told them you were going to hospital. They don’t care about you – you aren’t important to them’.

I was, of course, trying to keep him calm otherwise he would have walked himself to hospital but it came across as unkind. However, I forgave myself because he was the one wasting his life and I was the one taking him to good people who would waste their lives on him.

Be safe.

Monday, 22 October 2007

Let the games begin

Ten emergency calls; two refused, one false alarm, one assisted-only and six went by ambulance.

It all started very quickly, minutes into my shift. I was called to an 11 year-old boy who had come off his bike and smashed his head off the concrete surface of a play area. It was getting dark – winter’s on its way – and I made my way up into a housing estate, in the middle of which was located a small community centre with a play area. I drove in under the direction of a scared looking woman and saw that a small boy was lying on the ground, surrounded by adults and other kids.

He had been playing on his bike, which had perfectly good brakes and decided to swap with a friend, whose bike had no brakes at all. I understood this need for danger from my own childhood. He sped down a concrete ramp but lost his balance. The front wheel must have twisted – he had no brakes remember, so he may have tried to use steering to slow himself down. He was catapulted over the handlebars and came crashing down (without a helmet) onto the ground, head-first.

He was conscious but upset and the adults around him were concerned, especially as they were in charge of the Community Centre and were responsible for the welfare of the kids. He had a head injury but I couldn’t see it properly; the light in the area was poor and twilight was giving way to the night, so I used my little pen-torch to see what damage had been caused. I shone it on his head but could only see blood trickling from his ears. I checked them but the blood wasn’t coming from inside, thankfully – it seemed to be coming from a wound further up – it had run down his head and into his ears before spilling back out again.

‘Do you have any pain?’ I asked the little boy.

‘My head hurts’, he sobbed.

‘Can you move your hands and feet?’

‘Yes’. He demonstrated this for me. I had also been told that he was sitting up before I arrived.

The boy was lying on his side and I could only examine a limited area of his body, including his head. I wanted to rule out any significant spinal injury before I moved him and I continued my basic obs and checks until I was confident. There was still no ambulance and I had been on scene for five minutes. I called Control.

‘Is there an ambulance on its way for this patient? He has a head injury and needs to go to hospital urgently’, I said.

‘There isn’t one running but you need one right?’ the voice replied.

I couldn’t quite believe it. This was an emergency call and I assumed I would be getting an ambulance for it. Nothing had been sent and I would have sat there waiting in vain. Its busy tonight and we are short-staffed but sooner or later and ambulance should have to be sent for a call like this.

The boy’s frantic parents arrived and gathered around him and I roped them in to help me. I knew that the delay meant I had to continue treatment as if I had a crew with me. I had to put his collar on and deal with the head injury – I couldn’t just sit there holding his head for him.

I now had the assistance of his family (his brother had shown up too) and the other adults on scene. With their help I turned the boy onto his back. I was now able to see the extent of his injury. He had a deep gash in the front of his head. It ran down to his skull, which was visible underneath the skin. There was a bit of bleeding going on but it had slowed down and was beginning to congeal.

I wrapped his head in a dressing and continued my obs. I had the collars brought to me and began to fit one around his neck but I stopped when I heard the sirens of an ambulance approaching. I would wait for the crew now.

When they pulled up and got out, we finished the process of immobilising the patient; collar on, blocks down and straps tightened. Now he was secure. It was all precautionary but the mechanisms for neck and head injuries were significant enough to justify what we were doing. The only thing that upset him more was the fact that I had to cut his brand new football shirt off. It was his favourite.

I went with the crew to hospital and we made sure he was seen in Resus. He was stable and quite chatty when he arrived. His parents seemed relieved that he had gotten away with his mishap.

I threaded my way back to the West End and got called to Trafalgar Square for a 35 year-old German man who had taken an overdose of paracetamol. He had swallowed a couple of packets and was now feeling weak and sick. At first I thought he had deliberately taken them. The police were with him and his homeless friends were rallying but when I heard his story I realised that this was an accidental overdose.

‘Why did you take so many of those pills? I asked. Everything I said was being translated by his friend, who was also German, so I didn’t get a reply from the patient. Instead, I was told what had happened second-hand.

‘He was climbing over a fence at a hotel and got caught on the barbed wire’. The translator told me.

‘And what has this to do with now? I fished.

‘He tore his testicle off on the wire and had to go to hospital. They gave him these pain killers but they are not working and he has taken all of them to try and ease the pain’.

To be honest, although I was listening to the reason for having taken so many pills, I was still stuck on the vision of him tearing his manhood apart on rusty barbed wire as he scrambled to get over the fence. He had probably been stealing from the hotel’s yard. I couldn’t see a single male within ear-shot who didn’t cringe.

The ambulance arrived and I relayed the story to the crew. They also needed a moment to digest the information before taking him to hospital.

I spent ten minutes on my paperwork and got my next call as soon as I pressed the green button on my screen. '30 year-old female, not alert – collapsed. Only had one drink' it read. It’s almost as if people are prepared with an excuse as soon as they dial 999 – or maybe that’s a good thing; maybe it means conscientious people who don’t want to call an ambulance have to make it plain that they had no choice and that alcohol has not been a factor. Maybe.

I got on scene to find a collapsed woman lying on the pavement with her friends around her. She had, in fact, been drinking since early that evening, so the ‘just one drink’ theory was out the window but she certainly wasn’t behaving as if she was drunk. We can often tell the difference. After checking her obs and asking her a few questions I felt she may have been given something in her drink. She was very drowsy but able to communicate.

‘Did you accept a drink from someone you don’t know tonight?’ I asked.

She nodded her head. Her friends had been adamant that she had couldn’t possibly have had a drink bought for her by a stranger but they hadn’t been with her all night – only the past few hours. She had been drinking for at least five hours.

‘Did the person who bought you the drink try to chat you up?’

She nodded again. Then she said ‘Yes’.

Although I am very suspicious of anyone claiming to have had their drink ‘spiked’, I am more aware of the possibility in circumstances like this, where no mention of drugs is made and the patient is patently sedated, rather than drunk. A lot of alcohol can produce a sedative effect but it also causes vomiting. Date rape drugs like Rohypnol are easy to introduce into drinks and are sometimes given whether or not the female in question is being targeted. I couldn’t rule it out but neither could I prove it, so she was taken to hospital as an ETOH (drunk).

A quick call to Victoria Coach Station where a man was ‘unconscious and not breathing’, according to the description. I got there fast and watched him walk away with his alcoholic mate, who saw me coming and decided to wake him up. Some people should stay away from the phone when they see something they think is life-threatening without checking it out properly. The only life at risk on this call was mine.

Another call for a collapsed female. A 21 year-old who had thrown up and fallen down on one of those Thames boat parties. Her friends jostled me and generally got in my way as they explained how she ‘must have been spiked because she never gets this bad after a few drinks’. In this case, she was clearly drunk and had never been exposed to Rohypnol for the entire adventure as she washed down one mixer with another. What the hell is a ‘few drinks’ these days anyway?

Two assaults for the price of one. A 25 year-old Spanish visitor allegedly got punched in the head by an over-zealous doorman at a club in the West End. He had a cut to his head and a bruise to his pride but I could also hear a genuine hatred developing for this country. When the ambulance treated him, he went on his way, refusing any further aid. Then another man, an Italian, came up to us and asked for help. He too had allegedly been hit by a doorman at the same club. Who trains these people?

The Italian man had been punched in the throat – not a safe thing to do – and was gasping for air when he came to see us. His two girlfriends were not impressed with the way things are done in the UK and told me so. I called the police for this one and the ambulance crew stuck around to help out. He wasn’t seriously injured but something had to be done about the thuggish behaviour that was going on there.

Just as we were settling down to coffee and paperwork I was asked to go and check on a drunken girl who was described as ‘falling all over the place’. I went to see her and she was, indeed, falling all over the place. Her drunken friend was no good because she was too small to hold her large friend up and they both ended up on the ground, skirts in the air, with a large howling crowd of men cheering them on. It should be possible to show this sort of thing on local television (CCTV footage) so that drunks can be named and shamed before they do more than just lose their dignity in front of a baying mob.

I helped them up and a police officer came to my aid. The large girl was more than I could handle and she kept getting in my face as she spat her abuse at me...and the cop. She was threatened with arrest and settled down. She staggered a few feet with her poor little friend supporting her and periodically chastising her until she reached a pizza counter. She bought and promptly dropped a perfectly good pizza, much to the amusement of the little group of fans that had gathered for the show.

I watched as they staggered off but then they both fell into an alley way and I waited to see if they came back out. They didn’t, so, concerned that I was, I went to see if they were alright. They were. The large girl was crouched down, knickers around her ankles, peeing in full public view. Her friend was trying to persuade her to wait. It was all too late. A parent or two (or more) somewhere have no idea of the level their daughters have stooped to for alcohol. Either that or they just don’t care.

Without a break, I was off to see a cyclist who had come off his bike. He had been drinking and decided it was still safe to cycle home. He lost his balance, fell hard and got himself a head injury and a broken collar bone for his trouble.

At around 2am I was asked to ‘investigate’ a man seen lying in the street ‘not moving’. This was obviously another one of those calls where someone had seen a person who may, or may not be in trouble but decided against actually approaching to find out. What has become of us as a society? Are we simply too scared to care anymore?

I slowed down in the street given but couldn’t see anyone. Then I looked into a dimly lit alley and saw a large figure on the ground. He was lying on his back and he wasn’t moving as far as I could tell.

I drove into the alley and parked up next to him. He was tall, wiry and had a thick head of dreadlocks. I watched him for a few seconds from the car, as I always do with this type of call and at this time of night. I looked around for anyone else but the place was deserted. I sounded the siren – that usually stirs the average drunk – but he didn’t move.

I got out and went over to him, aware of his size and cautious about the space he had to move in if he was going to turn ugly on me. I shook him hard a few times, pinched his shoulder, brushed his eyelashes with my finger but got no reaction. I looked at his breathing – it was very slow – slower than normal.

I checked his pupils – they were pin-point. I didn’t know how long an ambulance was going to take so I started my treatment for a possible narcotic overdose on the street. I put an airway in and he didn’t gag. I gave him oxygen and I got a line in. The crew arrived as I was withdrawing the needle from its sheath and I asked them to help me finish the job.

I gave the guy Narcan and waited for a result. It came almost instantly. He woke up, looked around and coughed out the airway. When he stood up the three of us looked like midgets under him. He was over six feet tall.

‘What the f**k?’ he shouted in an Australian accent.

‘Calm down, you’ve been unconscious. You’ve taken something, haven’t you?'

It was a struggle. He recognised who we were and refused to let us help, so we followed him around in little circles as we tried to explain that he couldn't just walk off yet.

Ok, if you want to go I’ll need to take this out of your arm’, I told him.

He looked down at the cannula in his vein and repeated his earlier idiom.

‘What the f**k?’

There seemed to be no language barrier.

He looked at the cannula closely and ripped it out of his vein. We got no warning. Blood flowed out of it and trickled down his arm. We were all in danger of getting some of it in our faces. It took a combined effort to persuade him to settle down so that we could dress the wound. He looked as if he was going to storm off with his leaking vein contaminating everything he touched.

He calmed down and the police arrived (I asked for them to be called when he initially kicked off).

‘Aw man, my stuff. Where’s my stuff? Aw man, it’s all gone. My money, my passport, all those beautiful photographs’, he moaned as the police officers tried to understand what had happened.

‘Did you take any drugs tonight?’ I asked him.

‘Aw man, my stuff’.

A hypodermic had been found next to him but nothing else. If he had a rucksack with him, as he claimed, it was long gone. It looked like he had been using heroin with someone he thought he could trust and had collapsed unconscious, giving his new found pal the opportunity to rob him of everything he owned. I felt sorry for him but I also thought he was incredibly naive.

He wouldn't admit taking heroin, or any other drug (who would with the police on scene?) and he insisted on making his way back to his hostel, which he couldn’t afford to pay for now. He was clearly confused about his situation – he couldn’t remember anything about the evening except being with his friend – and he kept wandering back towards us for the same instructions on how to get to his temporary home.

‘Go straight on until you get there’, he was told.

‘What? Straight that way?’

‘No, straight the other way’.

I was starting to get confused now and I decided to get on with my shift, rather than watch him suffer any longer.

The shift ended with a difficult spinal extrication from an underground station escalator. The 32 year-old had fallen from the top step, all the way to the three-quarter mark – about 70 metal steps, tumbling head over heels all the way, according to his friend. Both men were drunk and more than a little vociferous, so the job was difficult to begin with. The tumbling man had a head injury and the mechanisms were there for a spinal injury too, so he had to be immobilised. The trouble was the escalator was pitched at a hard angle, so sliding a scoop under him and tying him down was going to be a challenge.

When the crew arrived I asked them to bring what was needed. They had to work their way down one set of steps and up toward the patient on the set I was on, so there was a delay before we could get him moving. Meanwhile, he and his mate were trying their best to impress upon me what a waste of time all this was. Drunk people can be extremely irritating patients.

Eventually, with a bit of forward planning and a good deal of muscle power to stop him sliding down the scoop, we secured the patient and had the escalator running again. Then all we had to do was hold on. Of course, the higher the escalator went, the more gravity had a say in things and the heavier the patient became. By the time he was at the top, we were all tired. If just one of us had lost our grip, he would have slid all the way back down like a snow boarder on his back.

This was the first shift of the ‘busy season’ as far as I was concerned. More and more people will now go out and get drunk just because we are a step closer to Christmas – the season to be inebriated. Things will get a whole lot worse when December hits and the office parties begin in earnest. When I was a kid, I don’t remember needing alcohol to help me enjoy the festive season. Even as an adult, the thought of drinking to excess, just because I can, seems rather immature. I’m hoping I don’t run into anyone I know while my colleagues and I are scraping up the human results of the company Christmas meal budget.

Be safe.

Sunday, 21 October 2007

Book progress and other stuff

The book is progressing (all my fault) and you can keep track of what's going on by clicking on this link http://mondaybooks.blogspot.com/. I have also placed it on the side bar for future use.

I've removed the archives from my old AOL blog but will be adding them to this blog as soon as I have time. They haven't been deleted permanently as some thought, they have simply been taken out of public view for the time being.

I have yet to do the favours I promised people, I know but I have been snowed under as of late and will get around to doing what I said I would do eventually. Honest.

Professionally, I am staying on the FRU for another six months at least and am contemplating medicine next year...possibly.


Saturday, 20 October 2007


Eight calls – two cancelled on scene, one false alarm and the rest went to hospital.

Paramedics are continually hit with assessments and refresher courses in a bid to keep us ‘up to speed’ with the latest developments and thinking – we are also being kept on our toes in case we forget things that may be relevant to a future call...like the latest resuscitation guidelines. Unfortunately, the system is so haphazard and disjointed that not everyone on the road knows what the new rules are and this can lead to confusion.

I was being assessed on my FRU driving today, regardless of the fact that I have been doing it for over a year, in order to tick the boxes that need ticking. It’s a necessary evil I suppose but it meant I had to be shadowed for a few hours of my shift and, although it could have been made very uncomfortable for me, it wasn’t; the training officer was a no-nonsense sort who let me get on with it.

So my first call, before my assessment began, was to a RTC in the City. A motorcycle had hit a pedestrian and I raced over there to see what I could do. When I got on scene a private ambulance was just leaving – apparently they had stopped to help. They helped me by letting me know that one of ‘my lot’ had been and gone and that the person who had been hit didn’t want to go to hospital.

Then a police officer approached and told me pretty much the same thing, so I was cancelled on scene.

A call for a '15 year-old female, fainted' at an underground station turned out to be a 17 year-old female. She was with a gang of her friends and they were off to college for the day. There was a responsible adult with them but he was busily trying to contact the girl’s mum when I got there, so I didn’t see him for a few minutes into my assessment.

The girl had behavioural problems and was lying on the steps at the station where she had collapsed. Her friends were worried about her but could offer no information about her medical background, so I couldn’t establish whether she had fainted before in her life or not.

One of the most important new developments to have come from recent research into sudden cardiac death in young people (and I have mentioned this before) is that we should carry out an ECG check on every faint. Hospitals are now doing this routinely. The girl was recovering well, however and no previous incidents were known, so I was reluctant to ask the crew to put her through a 12-lead – I think most of us are with young females.

A 12-lead ECG involves exposing the central chest area, not necessarily to the extent of uncovering the breasts but placing the electrodes requires some delicate manoeuvring around them. It’s tricky enough in the elderly and in well-endowed women but with young girls it is a minefield. Obviously, the answer is to have a female do this and leave us blokes out of the loop but I don’t know how clinically viable it is to have someone else do the ECG then simply show you the print-out. Also, there are no guarantees that a female will be on the ambulance that arrives. If there is a paramedic on the vehicle I can simply pass the buck but if there isn’t, I am supposed to oversee the procedure. This is my understanding of things as they stand now. I may be wrong, I'm sure someone will point it out if I am.

I pondered this and the crew arrived to take my hand-over. They agreed that, as the girl was recovering well, she might want to continue her journey to college, or go home when her mother arrived. I didn’t argue because I agreed with it too.

The crew took her to the ambulance and waited for the mother to arrive. They carried out all the obs I had done to make sure she was okay and I sat in the car and did my paperwork but I had niggling doubts about this and went back to the ambulance to ask the attendant if he would do an ECG – especially if they were letting her go home. A 12-lead wouldn’t be necessary I thought, maybe enough information could be read on a print-out from three views – so that’s what we did.

The ECG was abnormal. Not drastically but there were things on it that didn’t look right for a healthy 17 year-old. Or maybe I was misreading it. Whatever it was, I no longer wanted to take the risk and asked the crew if they would take her to hospital. Mum had arrived and she was happy to let us do this. Then she told me that her daughter had been fainting regularly and would sometimes black out while walking. That was enough for me, so I was happier with my ‘over the top’ decision.

I haven’t heard how she got on and I still don’t know if I made the right call but I am happy that the safest thing to do was to send her for a second (and better) opinion, rather than assume all was fine. This won’t apply to every faint I know, but the new instructions are there to prevent just the one cardiac death that we miss because of complacency or, in my case, age and gender.

My FRU assessment began and it all went quiet. No calls. It was as if a jinx had been placed on me. I only had to run on two jobs and it would be over but no, the hairy hand of fate pushed the pause button and all of London forgot it was ill. In the end we had to call in and request jobs to be sent to us! Control had even tried to put me on a break twice, even though everyone there knew, or should have known, I was under scrutiny.

I was sent a '25 year-old male, vomiting a lot' and thought they must be messing with me now. I sped off as normal, not wanting to think too much about the fact that my every move was being checked. I hoped I hadn’t picked up any bad habits, like spitting out the window whilst driving...that sort of thing.

I got on scene and went to the patient, who was collapsed on the pavement. He had told police that he wanted to die and that he had taken 100 paracetamol, alcohol and crack cocaine. There were empty paracetamol boxes lying around and a lot of the tablets were still in their silver foil, scattered next to them. There were also a number of half-chewed, wet tablets that had been tried and spat out. He was clearly not serious.

‘Did you try to kill yourself?’ I asked


‘But you don’t really want to, do you?’


‘You just want some help, don’t you?’


He was teary eyed now so my hard-hitting psychological profiling had obviously struck a nerve. I had often thought about becoming a psychiatrist but I know that I am far too sarcastic for the role. Nevertheless, I knew the guy needed help and he seemed a nice bloke so that’s exactly what he was going to get.

The crew picked him up, dusted him off and sympathetically chatted to him as they walked him to the ambulance. He had stopped vomiting now (there was a lot of it on the pavement) and he seemed less depressed than before.

My next call was to a 42 year-old female who was fitting. The job was a few miles away, such was the need for Control to give me something to do and it took nearly ten minutes to get on scene. By the time we did, the crew had arrived and as I pulled up I was given the ‘cut throat’ gesture, which means, unless I have been leaving many dead people on scene, that the patient doesn't need any more help and the call is not as given.

Immediately after this I was given a chemical incident in Waterloo to deal with. I don’t normally get these but because I had an officer with me and it is within his remit, I was asked to go. I sped to the scene of the supposed chemical spill and found the area sealed off by police. They let me through the cordon and my assessor left the car to do what was required of him.

It was all a false alarm, of course, but I never found out what triggered it (us lower ranks are rarely given the details) but it served a purpose and I was now free to drop my assessor off and continue my day in the knowledge that I had ticked all the boxes.

I wasn’t required for my next call – the crew were on scene and dealing with a 45 year-old female who suffered from a disorder that made her unconscious without warning unless she received supplemental oxygen. She was conscious and explaining this to the crew when I popped my head round. The oxygen cylinder sat idly on the floor.

Then I was off to a 27 year-old man who was having a seizure in the street. He was recovering when I got to him but he looked incredibly pale. He was being investigated for similar fits in the past but nobody had labelled it epilepsy yet. He vomited and became ‘absent’ in the ambulance. His ECG had wide complexes, so there was something not quite right and not quite epileptic going on here. Off he went to see if someone could give him a proper diagnosis.

One of the thorniest issues I have to deal with is not removing my shoes when entering certain households and establishments. I always apologise for my footwear when I enter a Muslim household and most of the time it is accepted but my last call of the shift required more insistence that I would NOT be taking my boots off than usual.

A 22 year-old man was vomiting and had DIB at a university prayer room. I was about to enter when the students barred my way.

‘You’ll need to take your shoes off’.

‘No, I don’t need to’. I was trying not to be rude but I felt a little obstructed by this request.

‘You must remove your shoes’.

‘No, I mustn’t and I won’t’.

I explained to them that, for health and safety reasons, we are not to remove our protective footwear at any time but it is much more fundamental than that. Yes, I completely respect the necessity to keep a sanctified area clean and I feel the same way when I walk into someone’s home and they have a light coloured carpet or rug on the floor but surely the welfare of the person for whom an emergency ambulance has been called is paramount and supercedes all other concerns? Am I honestly expected to delay a possible resuscitation by removing my boots before entering certain areas? I will then have to mess about putting them back on as we remove the patient.

This, I know, is a very sensitive subject but I don’t understand why. I don’t know who decides it is sensitive. The young men barring my way were actually obstructing me, which is now illegal but they eventually relented and I got to the patient. He, after all this fuss, was just dizzy and sick.

Ironically, there were men at prayer when I entered, yet when I said I wanted to move the patient away so that they could pray in peace I was told that it ‘wasn’t a problem’ if I wanted to stay where I was. I find this kind of paradox confusing.

Apparently we are getting special covers to go over our boots. I’m eager to see just how practical this solution will be in a dire emergency. After all, when you dial 999, it is a dire emergency, right?

Be safe.

Wednesday, 17 October 2007


Six calls – one cancelled on scene, one conveyed, one assisted-only and three required an ambulance.

It started with a 24 year-old female who had fainted at an underground station. By the time I arrived, she had recovered a little but was still groggy enough to benefit from a little oxygen; the universal waker-upper. She had low blood pressure, which explained the faint and had soiled her trousers, which is unusual for such a simple event. I wondered if she had suffered a seizure. She was taken to hospital because, as always, when more than one problem can’t be ruled out, they must be ruled in until someone else on a higher pay-scale can make a decision.

After this I was off to see a 61 year-old man who had been suffering left arm and shoulder pain for the past three days. He spoke no English but his daughter was there to translate. This slows the whole process of communication down and it makes it harder to define the problem, especially where there are inconsistencies within the dialogue. I found it hard to determine what kind of pain he had and how badly it affected him. Our 1 – 10 pain scale is almost useless when there is a language or cultural barrier.

Her G.P. had called us and wanted me to take him to hospital but I don’t convey possible cardiac pain and an ambulance was requested. I discovered that the pain increased on exertion and when eating, so I had a little more to go on for the crew when they arrived. I hate standing there trying to explain a problem only to be told that it’s inaccurate because the whole translator procedure had fallen down. He probably had angina...or indigestion. Or both.

The rain fell down hard on our heads on the next call. I had arrived with the crew and we were being led into a grimy estate by the caller who identified himself as a mate of the patient. He had been standing on the street corner when I got on scene and I saw him waving at me – not windmilling – just waving. I get so many pranksters who do this when the blue lights are on that I ignore them until I find the correct address for the call, otherwise I end up stopping for some idiot without a cause...or brain. Unfortunately, he was the guy I needed to pay attention to but I shot right past him.

The patient had been locked inside the flat they shared while he popped out to make the 999 call. If he had needed to get out, he would have been in trouble.

Inside we found a 43 year-old man who had collapsed after taking heroin. His mate had described him as going grey in colour and then passing out just after the dose. Now he looked pale, shaky and confused as the three of us descended on him. He refused our help and confirmed that he was alright but the crew persuaded him to accompany them to the ambulance for a check-up before they left him in the care of his friend. I drove off into the rain.

Taking two tramadol for pain isn’t going to kill anyone but my next patient called an ambulance because she feared she was reacting badly to the pills. She was dizzy and generally unwell after eating them but I wasn’t required to help out because the crew had arrived just before me and she was walking out the door with them. All her obs were normal (I stuck around in the ambulance to nosey in).

Later in the day a call to a 5 year-old with difficulty in breathing was cancelled when I arrived on scene. Well, it should have been on scene; according to my MDT I was at the correct address...but I wasn’t. I called Control to have them sort it out but they told me not to bother as a crew had already been and gone.

My last call of the shift was for a 31 year-old woman who was suffering abdominal pains at work. Again, I shot past the address (the rain makes navigation hard work) but managed to slow down and stop in time to realise I was a good few doors away. I reversed to the location and a man stood on the kerb waiting for me – he had a wry smile on his face.

The woman was inside the building, sitting in the hall and I managed to get enough information about her condition to make a decision about cancelling the ambulance but the crew showed up as I dialled in to control. I explained that the lady, who was Italian, (just so you can see how cosmopolitan my job is), had Irritable Bowel Syndrome (IBS), thus her discomfort. The crew agreed to let me convey the patient and I took her to hospital in the car. This, incidentally, also ensured that I could get home on time.

Be safe.

Tuesday, 16 October 2007

You drink - we drive

Six emergency calls – One assisted-only, one conveyed and four taken by ambulance.

I had a short time to meet the demands of my VDI before getting my first call for a 65 year-old male, ‘collapsed outside pub’. Now that was coincidental – imagine collapsing outside a pub. I wonder what caused it?

I know, one of these days my sarcasm and cynicism is going to catch me out but rest assured, I do actually love my job and care for my patients, it’s just that after going to hundreds of ‘collapsed outside pub’ type calls and finding someone drunk on the pavement, it becomes easy to predict the clinical outcome for the people you are racing to ‘save’. Only very rarely does it transpire that the person collapsed is actually unconscious or in need of any medical aid.

I got on scene to find a crew dealing with the man. He was drunk. I wasn’t required. I left.

I finished off my vehicle and equipment checks and settled down for my shift by getting my first cup of coffee in as soon as possible. Then I was off to see a 57 year-old man about his chest pain.

His flat was full of people. He had a large family and was on his bed, rolling around in pain whilst they stood and watched. I stumbled in with my bags (I usually take a lot more in with me when its a chest pain call) and tried to avoid tripping over a relative (his, not mine).

I could tell by the way he was acting that he didn’t have chest pain at all. He was physically too active to be having a heart attack. I tried to settle him down so that I could get to the root of the problem.

‘Sir, try to relax and stop rolling around if you can’, I said in my best persuasive voice.

I had no doubt he was in some kind of pain, I just needed him to sit still while I determined what it was.

‘Too much pain’, he said, gasping and writhing.

‘Too much pain’ is a standard description given to us to describe the fact that the pain is indescribable. Non-English speakers use the term because they don't know the exact words or phrases required.

‘Where does it hurt?’ I asked him.

He pointed to his abdomen; particularly his stomach and I decided it was time to ask an elimination question.

‘Do you have chest pain at all?’

He shook his head. So one crisis was over and another, less severe crisis was ongoing.

I persuaded him to sit up and relax. He eventually settled down completely – especially when most of his family were asked to vacate the room. During my conversation with him I discovered that he had a long history of ulcer and that this pain was exactly the same as his other gastric experiences. He also had angina, so nothing could positively be ruled out but I was convinced that the source of his discomfort was his ulcer. So was the paramedic from the ambulance crew who arrived to take the man to hospital.

A call to an ‘unconscious’ 35 year-old male turned out to be yet another waste of time (and diesel) for a drunken man who had decided the pavement was a safe bet for sleeping on. A crew were on scene and they scraped him up for the free ride to hospital.

My work with the great drunken population was not yet done, however, and I was sent to a 20 year-old man who had collapsed on a tube station platform. He lay there refusing to get up, or respond to the kindest requests by tube staff to ‘move along’. Obviously, as with the buses, the only other course of action is to call out the cavalry.

So I arrived, went down a million escalator steps, dragged myself along the station wall (people never clear the way for us) and made it to the side of this tall, thin, pathetically drunk young man. I shook his shoulder hard a couple of times and shouted in my sternest voice.

‘Wake up. Time to go home!’

He swiped at me and just missed my head. I am now an expert at avoiding head shots.

I reinforced my efforts by pinching his shoulder muscle. He didn’t like that at all and suddenly he was WIDE AWAKE. I explained that he was sleeping on a tube station platform and that an ambulance had been called for him.

‘Do you need an ambulance?’ I asked.

‘No, I’m fine’, he replied.

It struck me that he was an intelligent looking young guy and he probably should have more sense than to behave like this in public. Everybody knows when they’ve had enough alcohol – it’s a question of deciding to stop drinking it when your brain suggests it. I know he’s young but that’s no excuse for defying a reasonable thought and it’s one thing to get completely skunked at home or at a private party – it’s another to go out into the public domain and become a nuisance to society. He could easily have rolled onto the track; it’s happened before.

As he began to take in the situation, his adamancy about not going to hospital intensified. The crew arrived and were in conversation with him when I left but as I did my paperwork up in the real world, they came out of the exit and smiled knowingly at me. They had no patient because they had packed him onto the next train home. A wise move methinks.

It had been an all-male patient shift so far and the trend continued with a call to an ‘unknown male, lying in street, covered in blood’. Of course, when I got there the only fact that fitted was that he was male. He was sitting in the street, drunk out of his skull and, by his own admission, high on dope. He was aggressive and argumentative and only settled down when the police came to help me out. Then he just became annoying.

The man was in his mid-twenties, was decently dressed and seemed intelligent but he was continuously and purposely provocative and the police decided to caution him. I still needed to take him to hospital and decided to take him in the car as long as one of the officers travelled with him. I later found out from one of the officers that the loud-mouthed, bad-mannered drunken dope-head worked for a bank. Now I know why it’s so easy to get into debt.

A call to an RTC ended my shift but it also left me with a dirty uniform. A 35 year-old man had been hit by a motorcycle on a busy road. The call had originally described a man who had fallen from his bike but when I got on scene I saw immediately that this was not this case. The man lying on the ground, surrounded by friends and helpful passers-by had a serious head injury. In fact, when I lifted the make-shift dressing (a hankie) that had been applied to the wound I could see that a large vein had been ripped open. The bleeding was relentless, so I forced more pressure down on it and stacked up a dressing pad or two for good measure but it was on a part of his head that was difficult to get a wrap-around on, especially as he was lying on his back and his neck was also a consideration.

I got one of the helpers to place his hand (I supplied him with gloves) on the wound while I managed the scene and kept the man’s head and neck still. I had to wait until the police and an ambulance crew arrived before I could take any further steps with this patient. He seemed to have no other injuries, just this isolated head injury but I needed a colleague to help me determine this for sure before he was moved.

The crew arrived within a few minutes and we got him immobilised and into the ambulance but not before my trousers and parts of my kit had been soaked in blood.

Throughout the entire process the man maintained an air of calm and understood what we needed to do and why. He, like most of the others, had been drinking tonight but he was older and wiser – an ex-serviceman from the old school – and he respected our role in the maintenance of his life. I wish all our drunk patients were so reasonable.

Be safe.

Monday, 15 October 2007

Things that slow us down

Six emergencies - one hoax and the others went by ambulance.

It was a busy night for retired professionals and there were dinners and functions going on all over the place, so when an 84 year-old man collapsed at the table during one of these soirĂ©es, the crew and I found it difficult to get to him. The location was packed with people and the patient was at the top of the building. We waited for the lift to take us to the 5th floor. You know how it is, you stand there and look at the stairs and consider whether it would be easier just to walk up. Then you think ‘What if the stairs are long and steep?’ and ‘What if the lift arrives just as I’m dying for oxygen on the third floor?’ – not that I am unfit, although I do need to get to the gym again regularly – but with all the bags we have to carry around, a handy lift is a huge incentive to avoid lugging them up a load of steps.

There was a long queue of elderly chaps, all smartly dressed in suits and shiny shoes, waiting for the one lift the building had to take them to their relevant floor. As I stood there I thought (and I can be forgiven for thinking like this, considering the company) about how easy it would be for one or two of them to have a heart attack as they mounted the stairs in frustration. Then again, these guys may well have had lots of practice, since this was their ‘club’ and they came here regularly, so they were probably fit enough to tackle them. Then I pondered the contrast to the men and women I see every day who are as old as these men and how different they are when stuck in a council flat with no prospects and a shabby state system looking after them.

The lift arrived and I snapped out of my day (night) dream. It had taken five minutes to finally get to its landing point and we were prepared to fight these old men to get in if necessary but it wasn’t necessary, of course. They stood aside and let us in. A few of them joined us. Then we wasted another three minutes as the lift visited every floor on the way up. It would have been quicker to walk up the stairs after all.

Luckily for all concerned, the patient was sitting in a chair in a side lounge when we got to him. He was conscious and alert, although a little off-colour. The crew began their chat and obs and I had little more to do than stand and watch. It was clear the gentleman wasn’t in serious trouble; he had probably fainted and, although it merited some investigation, considering his age, he looked as though he was recovering well. I asked the crew if they needed me and when I was told ‘no’ I made my way back to the lift – and waited – eventually, I relented and took the stairs.

As the rain began to fall I made my way to a small estate in the Holborn area for an 87 year-old lady who was ‘vomiting blood’, according to the call description. When I arrived I found the gate to the little community required a code. Obviously, I didn’t know the code, so I parked in front of it and pressed the buzzer but there was no reply. A young couple who lived on the estate approached me, told me the code and I let myself in. Now all I had to do was remember the number; the ambulance crew would need it. I have a rubbish memory at times, so I called my Control and told them the code – that way if the crew didn’t receive it, I wasn’t to blame.

I struggled to find the lady’s house – there was scaffolding up and none of the door numbers were visible. Detours were marked in such a haphazard way it was impossible to know what the number logic was unless you actually lived there. I despair at these places sometimes – someone will die as a result of the access and location difficulties we frequently encounter.

I found the flat after a few minutes of searching and was met by the patient at the door. She had been looking out for me. I walked her back into the flat, sat her down and asked her my usual questions (after an introduction of course). She had back pain and was vomiting blood. I couldn’t see evidence of the latter but if it was true then she may have a serious problem, although the sign and symptom may be unconnected. What was evident, however, was that she was in pain.

The crew arrived as I completed my obs and she was quickly taken to the ambulance. Unfortunately, the gate code had not been passed to them and the patient had to be wheeled all the way across the road in the rain to the waiting vehicle.

I got back to my station and managed a cup of coffee before my next call to an underground station for a 60 year-old female who was ‘in pain and unable to walk’. When I got on scene I was taken to the staff office and introduced to the lady. She was sitting on a chair where she had been deposited after being rescued by two British Transport Police (BTP) officers.

I learned that she had a history of hip problems, including a replacement and previous fracture. I also learned that she was sozzled. I don’t know how much she had been drinking but her speech was unintelligible at times and her eyes had that lazy, wandering look about them. I find the wandering eye thing is more distinct in women than men – I have no idea why.

She hadn’t fallen (or she couldn’t remember) and the pain had started suddenly. She had a low BP and looked a little pale. I think she had fallen over, drunk as she was and damaged her femur. She may even be bleeding internally, which would explain her blood pressure. I gave her entonox for the pain and when the crew arrived she was carefully moved to the ambulance. Alcohol and brittle bone disease is a dangerous combination.

During the night there were no less than four hoax calls, made by our usual suspect from phone boxes in and around his stamping ground. I was called out to the first and the others were cancelled but I made a point of finding the man I think is responsible. I saw him talking to some of his cronies on the street around the corner from where the last call had originated a few minutes before. He saw me and approached the car – he knows me well and we have not always seen eye to eye in the past. I’ll call him ‘M’ here.

‘Awrite boss’, he said as he slouched towards the vehicle.

‘Hello M’, I replied, ‘have you called us tonight at all?’

‘Not me boss, I haven’t been making calls. Ask my mate, he knows. I’ve been here for an hour.’

His spiky-haired, tattooed and pierced punk mate looked at me and nodded but M is shifty and he is a damned good liar. His behaviour was suspicious and he said more than he should have considering I hadn’t mentioned hoax calls yet. Why would he feel he needed an alibi? As far as I am concerned he is making good on his promise to ‘wind up’ the emergency services with every opportunity. He made that vow over a year ago when he attacked me in an alley way. The guy is going to cost someone their life if he continues to do this.

‘Last week someone’s mum almost died because of these hoax calls M’, I lied.

I was hoping that a threat would lead to the end of this game. These calls, all with the same request for all of the emergency services, have been going on for months and are received every week. As many as six calls are made in a single night, all from the same area.

‘Well, it weren’t me. I was here and my mate can vouch for it’.

Yeah, his mate looked like a stand-up guy.

Not once had I actually accused him of making the calls but he was very defensive. I can’t prove he does this but I hope that I am close enough to one of these calls and get to scene whilst it’s still in progress. We can identify the callbox from its number, so if I am a minute or less away from it, he won’t have time to get away before I see him.

An hour after I spoke to him another call was received.

I had an hour or so of quiet before I went to my next patient, a 75 year-old asthmatic female with DIB. She lived in one of those posh flats that are deceptively spacious on the inside – the Tardis effect I like to call it. She was in bed and her family were around her. The home nebuliser she had used didn’t help and she had a terrible sporadic cough, although she could still speak in full sentences, which is always a positive sign with asthmatics.

She had a recent history of chest infection and her G.P. had changed her antibiotics a few times because they weren’t working. Her current problem was certainly just an exacerbation of that infection – she was wheezy and her peak flow (PEFR) was lower than normal. There really wasn’t much I could do and when the crew arrived they felt just as redundant. Nebulising her again would relieve the problem slightly but the patient had already tried it four times that day without success.

I handed her over to the crew paramedic, who would make a decision about hospital or a G.P. referral, which was more likely. I went back to my station and waited for my next call. It would prove to be my last call of the shift.

‘Man on fire’ the call descriptor read. It was out of my area but I ran on it and arrived to find the Fire Brigade, two ambulances and the police on scene already. There were two women with smoke inhalation being treated by the one of the crews and one other patient, the burning man, was in the back of the other ambulance. I had nothing to do really except assist one of the crews and hook up with the officer on scene but I stuck around long enough to find out what had taken place.

A young Asian man had walked into his home with a bottle of flammable liquid. He threatened to kill the women (his family I believe) inside and threw the bottle into the lit fire. It ignited and he was engulfed in flames – he made it to the hallway but burned for a while as he tried to escape through the front door. His family were lucky to escape the fire but were overcome by smoke as they fled the house.

By the time we arrived, the man had received burns to more than 60% of his body. His chances of survival are less than 50%. He was conscious and in extreme pain in the back of the ambulance - he would need a whole lot of morphine to relieve it.

Before I left, a fire officer told us that when they entered the house they found a row of knives laid out on the floor, as if ready for use. I think the man intended one way or another, to kill himself and his family – nobody seemed to know why.

Monday, 8 October 2007

What's in your wallet?

Ten Emergencies; one assist-only, two ran away(!); one refused and one false alarm. The others went by ambulance.

I've been doing a lot of thinking about the financial consequences of certain calls. For example, alcohol-related calls - collapses, unconscious individuals, violence. Every time we go to one of these, the person who goes to hospital (whether a tax payer or not) is responsible for the costs associated with it. If that cost is, say, £300, it means his or her drinking session, which might have cost £30, has resulted in ten times the expense, payable by you and me. We might as well just go and put a quid each from our hard-earned cash into his or her stupid pocket.

If the person is a tax payer then he or she has made a contribution towards being stupid, although that doesn't excuse it but if he or she is not paying taxes, then we are paying for his/her drinks...and the fall out.

My first call was to a ‘?fit, ?drugs’ but when I got on scene, I learned that the ‘patient’ had scarpered. He ran away when he saw the ambulance coming but this isn’t a problem because, deep down I’m sure he pays his taxes and is entitled to run the emergency services around like that. Stop me when I become sarcastic.

Then a call to a 24 year-old cyclist who was cycling at speed across a junction (I wonder if the lights were red?) and got himself run over by a van, which was turning right at the time. He had a fractured wrist and a sorry looking face.

After that, I was off to rescue a 49 year-old man who called us to say he was vomiting blood. When I got there, he was standing on the pavement waving at me. There was no blood. He told me he had chest pain now and that he had a history of cardiac problems. He had ventolin and GTN with him, so I had to believe his story, although he seemed perfectly ok to me. He also claimed DIB but was able to talk in good long sentences without a problem. After a conversation with him about his circumstances he came clean and admitted he just needed a place to stay. He had been made homeless. I handed him over to a sympathetic crew and he was taken to hospital

The crew were already on scene for my next call; a 49 year-old female with chest pain. I wasn’t required, so I did my paperwork and ‘greened up’. As soon as I hit the button, I was off to wake up a sleeping drunk on a bus. I am now practised at this and so I went aboard, shook him ‘til he got the message, explained his options (get off, be genuinely ill or get arrested) and he responded by choosing option number one.

Another cyclist in trouble. This time the guy was hit by a car. Unfortunately, he decided to leave the scene when he heard the police coming. He’ll go home with his injuries and have another explanation for them no doubt.

Anaphylaxis is a very real and potentially life-threatening problem, yet time and time again I come across patients whose G.P. has either been reluctant or has simply refused to give them an Epinephrine device (i.e. Epipen) so that they can save themselves when the reaction occurs. I hope a G.P. out there can explain this to me because my next call was to a 4 year-old with a known nut allergy who developed a sudden anaphylactic reaction. I found him with a widespread rash and a wheeze when I listened to his breathing. Although he wasn’t yet critical, the swelling had gone far enough to cause his throat to come up a little.

I gave him nebulised Salbutamol and this brought some relief. Then he was packed off with mum to hospital.

Immediately after this call, I received another anaphylaxis job. This time it was a 46 year-old male, again the reaction was caused by eating food containing traces of nuts. I arrived to find him sitting on the floor of his office, surrounded by colleagues. He had puffy eyes, red and swollen hands and was complaining of nausea. He had eaten a trifle at lunch time and it’s possible it contained nuts. He too had been denied an Epipen when he was first diagnosed.

I nebulised him to clear his wheezy breathing and got him off to hospital – I took him myself; he was stable and recovering well after the Salbutamol and there were no ambulances available for him.

A pleasant (not) call to a hostel that I haven’t had to visit since my days working as a relief in another sector. I knew it as a place full of reprobates and I was being asked to go and assist a 60 year-old who had collapsed. The usual cause of collapse in this place is alcohol, so I wasn’t surprised when I was met at the door and told...

‘He got up and went back to his room. He’s absolutely covered in faeces but I don’t think he wants any help’.

One of the hostel workers had greeted me on my arrival with this information and I was glad to know that he didn’t want my help but I still had to check before I left, so I asked him if he would take me to the guy’s room and I would have a word.

We walked along the cramped, smelly corridor and knocked on the relevant room door.

‘Hello. The ambulance man is here. Do you want to speak to him?’ the hostel worker shouted through the wood.

A shuffling sound from behind the door and a moaning, winging comment that I could barely hear (or decipher) heralded his imminent appearance. He opened the door a little, stuck his filthy head through it and looked at us with a fag in one hand and a beer can in the other.

‘Do you need an ambulance?’ I asked.

‘Naw pal!’, he spat in broad Glaswegian.

Then he slammed the door in our faces. The sudden draft created by the force made me blink.

The ambulance crew arrived, despite the fact that I had cancelled them over the radio and I explained what had gone on. They cheerfully left the scene and I completed yet another form for someone who couldn’t care less for the NHS.

My next call took me to an area of London that I’m not familiar with. It’s certainly not a nice area because as soon as I turned into the little street I was confronted by one of those yellow police notices asking for witnesses to the murder of a young woman. The murder had taken place in one of the houses – hopefully not the one I was about to enter.

The house I went to was inhabited by an 83 year-old man who sat on his sofa, shaking and breathing with some difficulty. His wife, who seemed like a long-suffering woman, wasn’t happy that he had ignored her previous requests to call an ambulance. He had been coughing up blood for the past four days and now had a high BP. He had a cardiac history and had also suffered a stroke in the past.

‘Why didn’t you call an ambulance when you started coughing up blood?’ I asked. I could sense his wife rolling her eyes to the ceiling behind me.

‘I thought it would go away on its own son’, he said. I like going to older patients – I can get called ‘son’ every now and again.

I made sure he was taken to hospital by ambulance and I warned him about ignoring things like this in the future. I hope he gets better.

My final call of the shift brought me back to reality. That is, I was sent to another complete waste of time and tax-payers money. Someone called an ambulance for a collapsed person, ‘probably fitting’ but I arrived, as did the motorcycle responder and the ambulance, to find a drunken female who had been sleeping. She hadn’t called us remember – a Good Samaritan had.

‘I’m sorry you were called out’, she cried after us as we departed to go home.

Not as sorry as this country is for allowing such a shambles to continue.

Be safe.

Sunday, 7 October 2007

The future generation

Ten emergencies - three assist-only and seven required an ambulance.

The morning kicked off with a 28 year-old female with chest pain, which she had apparently endured for three days before deciding to call an ambulance. When I examined her it looked and sounded like a chest infection - she had pain on inspiration and a ‘tender’ chest - although there are other possibilities. There was no trauma involved and she had no cardiac history. Her DIB was real enough, so she went to hospital.

It’s mid-morning and I am starving because I haven’t eaten since starting my shift (I tend to get hungry in the first three hours of work), so I got a call to a hotel restaurant where the residents were tucking into their cooked breakfasts – it didn’t seem fair. Still, I maintained a professional distance between myself and the food.

I was there to deal with a 70 year-old retired doctor who had collapsed, fainted and vomited at her table. She was conscious when I arrived and looked very pale. I chatted to her, carried out my obs and discussed her medical history while all around there was the sound of sausages being chomped. The poor woman had vomited down the front of her blouse and was very embarrassed. She had low blood pressure when I checked it. She also had an irregular pulse and was diaphoretic. She had no cardiac history but she is a doctor and she knew, as well as I did, that something was amiss.

The crew arrived and take her to the ambulance and I waited for the results of her ECG. When I saw it I could see the problem immediately; the doc had a second degree heart block – a cardiac condition that can deteriorate and become life-threatening if not treated. She was taken to hospital after I discussed the ECG with her – she knew that she may need a pacemaker for the rest of her life now.

The next call required my ‘assisting’ skills as I helped a crew to lift a drunken 30 year-old man to his feet after he collapsed in a heap on the pavement. He smiled, adjusted the cap on his head and shuffled off into the horizon with a sheepish look on his face.

I was ten seconds away from my next call – a 26 year-old male having an epileptic fit in a park. He was initially very combative but his mates, who had witnessed him collapse, helped me to control him until the crew arrived. Oxygen helped him recover and by the time he was on his way to hospital his condition was a lot more stable.

An ‘unwell’ woman with DIB and a temperature of 40*c in north London next. She had a recent history of UTI and had received antibiotic treatment for it but it had not cleared, so now she was in a worse state than when she was first diagnosed. She lay in bed looking like she was on her last legs, which she would have been if her daughter hadn’t called us.

Another epileptic fit – this time in a small and extremely untidy flat. I pulled up outside the address and a young girl’s head appeared out of a second floor window.

‘Up here!’ She shouted.

I went up to the flat and walked in to find a bespectacled 20 year-old girl sitting on her bed, crying and shaking. The other girl – her sister, who was 14 years-old, told me that she had fitted on the floor just before I arrived and that she had epilepsy. Her fits were becoming more frequent and she now has one almost every day.

I looked around the room and as I looked into the hall from the doorway, two younger girls appeared – one was about twelve and the other eight. Then a young, possibly 11 year-old boy ran into the bedroom.

‘Where’s your mum or dad?’ I asked them.

‘Oh, mum’s gone to visit her friend’, one of the kids replied.

‘So, apart from your sister, who's in charge of you today?’

‘Nobody’, they chanted.

I called my Control and asked them to hurry the ambulance up and to arrange for the police to visit because I couldn’t leave a house full of minors alone when I left. I was also reluctant to become their unofficial babysitter.

I continued my obs on the fitting girl and she continued to wail and cry. She was quite immature and out of control – there was really no reason for her to be so upset.

I asked one of the other girls if they had been on their own before when their sister fitted. They had – apparently mum leaves them alone in the flat quite often. The young epileptic girl has two babies, and her sister told me she dropped one of them when having a fit in the past. Strangely, the babies aren’t in the house and the girl can’t remember where they are until her sister reminds her that they’re with a relative. Probably safer, I thought.

I found the whole situation bizarre and unsettling. These kids were not responsible enough to look after themselves. Even the 20 year-old had no grown up qualities and could arguably be said to have a distinct lack of responsibility.

One of the upstairs neighbours came down and offered to watch the children and that meant the police were no longer needed. The crew arrived and I explained the situation to them. They took the crying patient out to the ambulance and her 14 year-old sister screamed instructions out from the window.

‘Remember to wait until our mum gets back!’

They had contacted their mum who, reluctantly, agreed to come home and rescue her children (from Social Services if she’s not careful). As I was standing in the ambulance with the crew, mum appeared – a large, tattooed, skin-headed woman. She starting barking orders at her kids and didn’t look a bit concerned about our presence. We are, after all, merely servants of the underclass.

Before I left, another sister appeared on the scene. She looked about 21 or 22 years-old and seemed a lot more sensible. Where the hell was she when I needed her? I don’t know how many more off-spring existed in that family but I left the scene as soon as I could before any more of them decided to join in the fun.

A quick call to a 65 year-old male ‘choking’ in a restaurant in Convent Garden next. When I get there a crew are on scene and the patient is sitting talking to them. He had choked but cleared it himself – people often do.

After a short break, I get called to a shop for a 17 year –old male who is feeling faint. His girlfriend and their child are with him. Initially, it looks like he may have had a drop in blood pressure but I asked the crew to do an ECG and it didn’t look right at all. He was taken to hospital and the doctor there agreed that something else was going on. I think the patient was crying when I left - it was probably a shock to him.

A man with a cut thumb next. He was working at a hotel when he broke a glass, a piece of which sliced through his thumb – almost to the bone. He looked very pale and was shaking when I got to him. His wound was dressed and he was reminded of the fact that he would live – that seemed to help.

My last call was to a grotty block of flats where a 23 year-old diabetic had collapsed. When I got to the address I was led into the kitchen by a relative. He was sitting at the dining table with a couple of other relatives (his mum and a sister I think). He was recovering – his mum had given him a sweet drink – so I asked if I could check his blood sugar. He agreed but insisted on doing it himself. I wasn’t sure at first because I wanted to get an accurate result but he was insistent, so I gave him the lancet to jab himself with.

I prepared the test finger for him, however -I always clean the test finger with a non-alcohol wipe, to remove any trace of sugar that may skew the reading but when I started to do this he became obnoxious and pulled away.

‘Aw that’s bullshit man. You don’t need to do that’, he moaned, ‘my diabetic nurse says you never clean the finger before doing this – its bullshit!’

‘This is how I do it – this is how it’s done by the ambulance service’, I said but, to be honest, I had no more time for him. In his voice and on his face I recognised a stupid little upstart with more attitude than manners. I was trying to help him and he was sitting there giving me abuse. Rude that is, just rude.

I did what I had to do, including cleaning his finger before he lanced himself, then I left them to it. The only person who bothered to say thanks was the man who had shown me in – his uncle I think. I walked out of that place and thought about thecrew that would come here someday and probably save his life when he goes hypo. Not once will that guy ever thank them. He is the future of our country and that depresses me.

Be safe.