Minefields

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

‘Yes’.

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

‘No’.

‘You just want some help, don’t you?’

‘Yes’.

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.