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.