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.